Maternal allo-antibody production is stimulated when fetal red blood cells are positive for an an... more Maternal allo-antibody production is stimulated when fetal red blood cells are positive for an antigen absent on the mother's red cells. The maternal IgG antibodies produced will pass through the placenta and attack fetal red cells carrying the corresponding antigen. Allo-immune hemolytic disease of the fetus and newborn caused by anti-E rarely occurs. We report two cases of anti-E hemolytic diseases in neonates. One of the neonates had severe hemolysis presenting with severe anemia, thrombocytopenia, and conjugated hyperbilirubinemia, while the other had moderate anemia and unconjugated hyperbilrubinemia. Although both the neonates were treated by phototherapy and intravenous immunoglobulin, one of them received double volume exchange transfusion. There appeared to be an increase in the occurrence of hemolytic disease of the fetus and newborn caused by Rh antibodies other than anti-D. In this case report, both patients presented with anemia and hyperbilirubinemia but were successfully treated, with a favorable outcome.
Archives of disease in childhood. Fetal and neonatal edition, Jan 26, 2016
To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achie... more To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants. Parallel-group randomised controlled trial with a 1:1 allocation ratio. Two regional tertiary neonatal intensive care units. 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited. Infants were enrolled to either 2-hourly or 3-hourly interval feeding after randomisation. Blinding was not possible due to the nature of the intervention. The primary outcome was time to achieve full enteral feeding (≥100 mL/kg/day). Secondary outcomes include time to regain birth weight, episode of feeding intolerance, peak serum bilirubin levels, duration of phototherapy, episode of necrotising enterocolitis, nosocomial sepsis and gastro-oesophageal reflux. 72 infants were available for primary outcome analysis in each group as three were excluded due to death-three...
Benzene is classified as carcinogenic compound which is emitted mainly from cars. In this study, ... more Benzene is classified as carcinogenic compound which is emitted mainly from cars. In this study, benzene was measured at various sites in Nibong Tebal (urban, suburban, town, and rural) of different traffic volume, and traffic counts were performed simultaneously. Monitoring was carried out during the morning and afternoon traffic peaks. The aim of this study is to monitor benzene concentration at several development sites with different traffic flow. The monitoring was done by using indoor air quality meter. The results obtained from monitoring show that the mean concentrations of benzene ranged from 54.7 ppb in the suburban area to 115.1 ppb in the town area. Multiple linear regression analysis correlated the benzene concentrations with traffic volume, temperature, humidity, and time of monitoring as predictors. The results show that R 2 of the model was 0.97 in Taman Cowin site, and it was 0.47 in Taman Nibong Tebal Jaya site. Negative correlation was found between benzene concentration and temperature while there was positive correlation with humidity being found through the study. Pearson's correlation indicates that gasoline vehicular exhaust could be the major source of benzene. The UK Air Quality Standards stipulated that the annual mean of ambient benzene should not exceed 5 ppb or 16.25 μg/m 3 . The results show that the current concentrations of benzene exceeded the permissible limits set by the UK standards.
An ensemble of classifiers is proposed in this study where we combined the k-nearest neighbor cla... more An ensemble of classifiers is proposed in this study where we combined the k-nearest neighbor classifier with LAD Tree through stacking. Two different data sets which are macroeconomic and the International Risk Country Risk are used for application. Both of the data are taken for 27 countries from the first quarter of 1984 until the fourth quarter of 2011. Before we applied those two data sets on the ensemble of classifiers, we have done the multicollinearity test to see if the predictor variables are highly correlated. By using the variance inflation factor, the results showed that some predictor variables are highly correlated in the macroeconomic data set. To solve the multicollinearity problem, we used principal component analysis that is available in SPSS as it can reduce a set of factors. The remaining variables are used in the analysis of the proposed method to observe the prediction accuracy. It is proven that different type of data does affect the prediction accuracy, but then it is different for every country.
The Malaysian journal of medical sciences : MJMS, 2010
Delays in transporting blood samples may cause inaccurate results. Samples may be exposed to ligh... more Delays in transporting blood samples may cause inaccurate results. Samples may be exposed to light or heat during delays, resulting in the degradation of analytes, for example, bilirubin. This study was done to determine the effect of delays in the transportation of blood samples on serum bilirubin test results. Samples taken from neonates admitted to a tertiary hospital with jaundice were included in the study. The samples were collected through venipuncture in 3 labelled containers. The first container was sent immediately to the laboratory, while the second and third containers were sent after being kept in the ward for 1 and 3 hours, respectively. Bilirubin values were measured colourimetrically at a wavelength of 578 nm using a Roche Hitachi 912 Chemistry Analyser upon arrival in the laboratory. A total of 36 serum samples were studied. The mean of the indirect bilirubin measurements for 0-, 1-, and 3-hour samples were 174 (SD 68.65), 186.97 (SD 60.47), and 184.56 (SD 66.93), r...
Even though in the corporate world psychological science has been widely used, the formal use of ... more Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU).
Gilbert syndrome is caused by defects in the uridine diphosphate glucuronosyltransferase 1A1 (UGT... more Gilbert syndrome is caused by defects in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene. These mutations differ among different populations and many of them have been found to be genetic risk factors for the development of neonatal jaundice. The objective was to determine the frequencies of the following mutations in the UGT1A1 gene: A(TA)7TAA (the most common cause of Gilbert syndrome in Caucasians), G71R (more common in the Japanese and Taiwanese population), and G493R (described in a homozygous Malay woman with Crigler-Najjar syndrome type 2) in a group of Malaysian babies with hyperbilirubinemia and a group of normal controls. The GeneScan fragment analysis was used to detect the A(TA)7TAA variant. Mutation screening of both G71R and G493R was performed using denaturing high performance liquid chromatography. Fourteen out of fifty-five neonates with hyperbilirubinemia (25%) carried the A(TA)7TAA mutation (10 heterozygous, 4 homozygous). Seven out of fifty controls (14%) carried this mutation (6 heterozygous, 1 homozygous). The allelic frequencies for hyperbilirubinemia and control patients were 16 and 8%, respectively (p=0.20). Heterozygosity for the G71R mutation was almost equal among both groups (5.5% for hyperbilirubinemia patients and 6.0% for controls; p=0.61). One subject (1.8%) in the hyperbilirubinemia group and none of the controls were heterozygous for the G493R mutation (p=0.476). The A(TA)7TAA seems more common than the G71R and G493R mutations in the Malaysian population.
The use of reflecting curtains with single phototherapy has not yet been directly compared with d... more The use of reflecting curtains with single phototherapy has not yet been directly compared with double phototherapy (DP). The objective of this study is to compare the efficacy of single phototherapy with reflecting curtains (SPRC) and DP in treating neonatal jaundice. This randomised controlled trial involved 160 term newborns with severe neonatal jaundice in the first 2 weeks of life. The subjects were randomised in two groups: the intervention group receiving SPRC (n = 80) and a control group receiving DP (n = 80). Because of post-hoc exclusions, 78 subjects resulted in each group, respectively. The primary outcome was mean decrease in total serum bilirubin (TSB) levels after 4 h of phototherapy. The secondary outcomes were mean decrease in TSB levels after 10 h of phototherapy and duration of phototherapy. The mean decrease in TSB after 4 h of phototherapy in the intervention group was similar for the intervention and the control groups (23.46 ± 27.03 vs. 22.43 ± 27.38 μmol/L; P = 0.81). Also, after 10 h, it was similar in both groups (56.06 ± 31.36 vs. 58.17 ± 31.71 μmol/L, respectively; P = 0.67). Cox proportional hazards regression analysis indicated that there was no statistically significant difference in duration of phototherapy in both intervention (SPRC) and control (DP) (x2 change 0.393, P = 0.531; hazard ratio 1.060; 95% confidence interval 0.883-1.273). There were no significant adverse events noted. This study suggested that single phototherapy with reflecting curtain is as effective as DP in the treatment of neonatal hyperbilirubinaemia requiring intensive phototherapy.
Intrahospital variations in antimicrobial profiles may be related to many factors. This study com... more Intrahospital variations in antimicrobial profiles may be related to many factors. This study compared causative agents of nosocomial bloodstream infections between a neonatal intensive care unit (NICU) that adopted a ward-tailored antibiotic policy and adult intensive care units (ICUs). Data on organisms from blood cultures obtained from the respective wards between 2005 and 2009 were analyzed. Compared with the adult ICUs, the NICU had a higher frequency of Enterobacteriacae and lower frequencies of typical hospital-acquired pathogens (eg, Klebsiella pneumoniae, 17.4% vs 10.0% [P < .001]; Acinetobacter baumannii, 3.9% vs 11.6% [P < .001]). Antibiotic resistance of gram-negative organisms was also significantly lower in the NICU, including resistance to imipenem (5.7% vs 32.1%; P < .001), amikacin (8.8% vs 30.3%), and ceftriaxone (36.1% vs 74.6%; P < .001). This could possibly be due to the ward-tailored antibiotic policy adopted by the NICU but not by the other ICUs.
Malaysian Journal of Paediatrics and Child Health, Jan 24, 2011
Objectives: To determine the bacteriology of nosocomial infection within the neonatal intensive c... more Objectives: To determine the bacteriology of nosocomial infection within the neonatal intensive care unit (NICU) of Hospital Universiti Sains Malaysia (HUSM) and compare it to other intensive care and high dependency units (ICU/HD) in HUSM.
Maternal allo-antibody production is stimulated when fetal red blood cells are positive for an an... more Maternal allo-antibody production is stimulated when fetal red blood cells are positive for an antigen absent on the mother&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s red cells. The maternal IgG antibodies produced will pass through the placenta and attack fetal red cells carrying the corresponding antigen. Allo-immune hemolytic disease of the fetus and newborn caused by anti-E rarely occurs. We report two cases of anti-E hemolytic diseases in neonates. One of the neonates had severe hemolysis presenting with severe anemia, thrombocytopenia, and conjugated hyperbilirubinemia, while the other had moderate anemia and unconjugated hyperbilrubinemia. Although both the neonates were treated by phototherapy and intravenous immunoglobulin, one of them received double volume exchange transfusion. There appeared to be an increase in the occurrence of hemolytic disease of the fetus and newborn caused by Rh antibodies other than anti-D. In this case report, both patients presented with anemia and hyperbilirubinemia but were successfully treated, with a favorable outcome.
Archives of disease in childhood. Fetal and neonatal edition, Jan 26, 2016
To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achie... more To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants. Parallel-group randomised controlled trial with a 1:1 allocation ratio. Two regional tertiary neonatal intensive care units. 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited. Infants were enrolled to either 2-hourly or 3-hourly interval feeding after randomisation. Blinding was not possible due to the nature of the intervention. The primary outcome was time to achieve full enteral feeding (≥100 mL/kg/day). Secondary outcomes include time to regain birth weight, episode of feeding intolerance, peak serum bilirubin levels, duration of phototherapy, episode of necrotising enterocolitis, nosocomial sepsis and gastro-oesophageal reflux. 72 infants were available for primary outcome analysis in each group as three were excluded due to death-three...
Benzene is classified as carcinogenic compound which is emitted mainly from cars. In this study, ... more Benzene is classified as carcinogenic compound which is emitted mainly from cars. In this study, benzene was measured at various sites in Nibong Tebal (urban, suburban, town, and rural) of different traffic volume, and traffic counts were performed simultaneously. Monitoring was carried out during the morning and afternoon traffic peaks. The aim of this study is to monitor benzene concentration at several development sites with different traffic flow. The monitoring was done by using indoor air quality meter. The results obtained from monitoring show that the mean concentrations of benzene ranged from 54.7 ppb in the suburban area to 115.1 ppb in the town area. Multiple linear regression analysis correlated the benzene concentrations with traffic volume, temperature, humidity, and time of monitoring as predictors. The results show that R 2 of the model was 0.97 in Taman Cowin site, and it was 0.47 in Taman Nibong Tebal Jaya site. Negative correlation was found between benzene concentration and temperature while there was positive correlation with humidity being found through the study. Pearson's correlation indicates that gasoline vehicular exhaust could be the major source of benzene. The UK Air Quality Standards stipulated that the annual mean of ambient benzene should not exceed 5 ppb or 16.25 μg/m 3 . The results show that the current concentrations of benzene exceeded the permissible limits set by the UK standards.
An ensemble of classifiers is proposed in this study where we combined the k-nearest neighbor cla... more An ensemble of classifiers is proposed in this study where we combined the k-nearest neighbor classifier with LAD Tree through stacking. Two different data sets which are macroeconomic and the International Risk Country Risk are used for application. Both of the data are taken for 27 countries from the first quarter of 1984 until the fourth quarter of 2011. Before we applied those two data sets on the ensemble of classifiers, we have done the multicollinearity test to see if the predictor variables are highly correlated. By using the variance inflation factor, the results showed that some predictor variables are highly correlated in the macroeconomic data set. To solve the multicollinearity problem, we used principal component analysis that is available in SPSS as it can reduce a set of factors. The remaining variables are used in the analysis of the proposed method to observe the prediction accuracy. It is proven that different type of data does affect the prediction accuracy, but then it is different for every country.
The Malaysian journal of medical sciences : MJMS, 2010
Delays in transporting blood samples may cause inaccurate results. Samples may be exposed to ligh... more Delays in transporting blood samples may cause inaccurate results. Samples may be exposed to light or heat during delays, resulting in the degradation of analytes, for example, bilirubin. This study was done to determine the effect of delays in the transportation of blood samples on serum bilirubin test results. Samples taken from neonates admitted to a tertiary hospital with jaundice were included in the study. The samples were collected through venipuncture in 3 labelled containers. The first container was sent immediately to the laboratory, while the second and third containers were sent after being kept in the ward for 1 and 3 hours, respectively. Bilirubin values were measured colourimetrically at a wavelength of 578 nm using a Roche Hitachi 912 Chemistry Analyser upon arrival in the laboratory. A total of 36 serum samples were studied. The mean of the indirect bilirubin measurements for 0-, 1-, and 3-hour samples were 174 (SD 68.65), 186.97 (SD 60.47), and 184.56 (SD 66.93), r...
Even though in the corporate world psychological science has been widely used, the formal use of ... more Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU).
Gilbert syndrome is caused by defects in the uridine diphosphate glucuronosyltransferase 1A1 (UGT... more Gilbert syndrome is caused by defects in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene. These mutations differ among different populations and many of them have been found to be genetic risk factors for the development of neonatal jaundice. The objective was to determine the frequencies of the following mutations in the UGT1A1 gene: A(TA)7TAA (the most common cause of Gilbert syndrome in Caucasians), G71R (more common in the Japanese and Taiwanese population), and G493R (described in a homozygous Malay woman with Crigler-Najjar syndrome type 2) in a group of Malaysian babies with hyperbilirubinemia and a group of normal controls. The GeneScan fragment analysis was used to detect the A(TA)7TAA variant. Mutation screening of both G71R and G493R was performed using denaturing high performance liquid chromatography. Fourteen out of fifty-five neonates with hyperbilirubinemia (25%) carried the A(TA)7TAA mutation (10 heterozygous, 4 homozygous). Seven out of fifty controls (14%) carried this mutation (6 heterozygous, 1 homozygous). The allelic frequencies for hyperbilirubinemia and control patients were 16 and 8%, respectively (p=0.20). Heterozygosity for the G71R mutation was almost equal among both groups (5.5% for hyperbilirubinemia patients and 6.0% for controls; p=0.61). One subject (1.8%) in the hyperbilirubinemia group and none of the controls were heterozygous for the G493R mutation (p=0.476). The A(TA)7TAA seems more common than the G71R and G493R mutations in the Malaysian population.
The use of reflecting curtains with single phototherapy has not yet been directly compared with d... more The use of reflecting curtains with single phototherapy has not yet been directly compared with double phototherapy (DP). The objective of this study is to compare the efficacy of single phototherapy with reflecting curtains (SPRC) and DP in treating neonatal jaundice. This randomised controlled trial involved 160 term newborns with severe neonatal jaundice in the first 2 weeks of life. The subjects were randomised in two groups: the intervention group receiving SPRC (n = 80) and a control group receiving DP (n = 80). Because of post-hoc exclusions, 78 subjects resulted in each group, respectively. The primary outcome was mean decrease in total serum bilirubin (TSB) levels after 4 h of phototherapy. The secondary outcomes were mean decrease in TSB levels after 10 h of phototherapy and duration of phototherapy. The mean decrease in TSB after 4 h of phototherapy in the intervention group was similar for the intervention and the control groups (23.46 ± 27.03 vs. 22.43 ± 27.38 μmol/L; P = 0.81). Also, after 10 h, it was similar in both groups (56.06 ± 31.36 vs. 58.17 ± 31.71 μmol/L, respectively; P = 0.67). Cox proportional hazards regression analysis indicated that there was no statistically significant difference in duration of phototherapy in both intervention (SPRC) and control (DP) (x2 change 0.393, P = 0.531; hazard ratio 1.060; 95% confidence interval 0.883-1.273). There were no significant adverse events noted. This study suggested that single phototherapy with reflecting curtain is as effective as DP in the treatment of neonatal hyperbilirubinaemia requiring intensive phototherapy.
Intrahospital variations in antimicrobial profiles may be related to many factors. This study com... more Intrahospital variations in antimicrobial profiles may be related to many factors. This study compared causative agents of nosocomial bloodstream infections between a neonatal intensive care unit (NICU) that adopted a ward-tailored antibiotic policy and adult intensive care units (ICUs). Data on organisms from blood cultures obtained from the respective wards between 2005 and 2009 were analyzed. Compared with the adult ICUs, the NICU had a higher frequency of Enterobacteriacae and lower frequencies of typical hospital-acquired pathogens (eg, Klebsiella pneumoniae, 17.4% vs 10.0% [P < .001]; Acinetobacter baumannii, 3.9% vs 11.6% [P < .001]). Antibiotic resistance of gram-negative organisms was also significantly lower in the NICU, including resistance to imipenem (5.7% vs 32.1%; P < .001), amikacin (8.8% vs 30.3%), and ceftriaxone (36.1% vs 74.6%; P < .001). This could possibly be due to the ward-tailored antibiotic policy adopted by the NICU but not by the other ICUs.
Malaysian Journal of Paediatrics and Child Health, Jan 24, 2011
Objectives: To determine the bacteriology of nosocomial infection within the neonatal intensive c... more Objectives: To determine the bacteriology of nosocomial infection within the neonatal intensive care unit (NICU) of Hospital Universiti Sains Malaysia (HUSM) and compare it to other intensive care and high dependency units (ICU/HD) in HUSM.
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