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  1. Cross-linked enzyme aggregates of polyethylene terephthalate hydrolyse (PETase) from Ideonella sakaiensis for the improvement of plastic degradation
    Lee YL, Jaafar NR, Ling JG, Huyop F, Abu Bakar FD, Rahman RA, et al.
    Int J Biol Macromol, 2024 Apr;263(Pt 1):130284.
    PMID: 38382786 DOI: 10.1016/j.ijbiomac.2024.130284
    Polyethylene terephthalate (PET) is one of the most produced plastics globally and its accumulation in the environment causes harm to the ecosystem. Polyethylene terephthalate hydrolyse (PETase) is an enzyme that can degrade PET into its monomers. However, free PETase lacks operational stabilities and is not reusable. In this study, development of cross-linked enzyme aggregate (CLEA) of PETase using amylopectin (Amy) as cross-linker was introduced to solve the limitations of free PETase. PETase-Amy-CLEA exhibited activity recovery of 81.9 % at its best immobilization condition. Furthermore, PETase-Amy-CLEA exhibited 1.37-, 2.75-, 2.28- and 1.36-fold higher half-lives than free PETase at 50 °C, 45 °C, 40 °C and 35 °C respectively. Moreover, PETase-Amy-CLEA showed broader pH stability from pH 5 to 10 and could be reused up to 5 cycles. PETase-Amy-CLEA retained >70 % of initial activity after 40 days of storage at 4 °C. In addition, lower Km of PETase-Amy-CLEA indicated better substrate affinity than free enzyme. PETase-Amy-CLEA corroded PET better and products yielded was 66.7 % higher than free PETase after 32 h of treatment. Hence, the enhanced operational stabilities, storage stability, reusability and plastic degradation ability are believed to make PETase-Amy-CLEA a promising biocatalyst in plastic degradation.
  2. Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia
    Rahman RA, Mohammed Nawi A, Ishak S, Balaraman K, Abu MA, Abd Azman SH, et al.
    J Perinat Med, 2024 Mar 22.
    PMID: 38511669 DOI: 10.1515/jpm-2023-0449
    OBJECTIVES: To investigate factors associated with outcome of second twin during labour.

    METHODS: The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation.

    RESULTS: Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5 % (n=223) and 45.5 % (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20 % (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30 min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30 min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15-29 min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth.

    CONCLUSIONS: The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia.

  3. Construction 4.0 technology evaluation using fuzzy TOPSIS: comparison between sustainability and resiliency, well-being, productivity, safety, and integrity
    Shafei H, Rahman RA, Lee YS
    Environ Sci Pollut Res Int, 2024 Feb;31(10):14858-14893.
    PMID: 38285259 DOI: 10.1007/s11356-024-31862-9
    This study aims to compare the impact of Construction 4.0 technologies on different organizational core values, focusing on sustainability and resiliency, well-being, productivity, safety, and integrity. To achieve that aim, the study objectives are the following: (i) identify the critical Construction 4.0 technologies between core values; (ii) appraise overlapping critical Construction 4.0 technologies between core values; (iii) examine the ranking performance of Construction 4.0 technologies between core values; and (iv) analyze the interrelationships between Construction 4.0 technologies and core values. First, twelve Construction 4.0 technologies were identified from a national strategic plan. Then, the fuzzy technique for order of preference by similarity to ideal solution (TOPSIS) that incorporates subjective and objective weights was used to evaluate the impact of the Construction 4.0 technologies on the five core values. Finally, the collected data was analyzed using the following techniques: fuzzy TOPSIS, normalization, overlap analysis, agreement analysis, sensitivity analysis, ranking comparison, and Spearman correlation. The study findings reveal four critical Construction 4.0 technologies that enhance all five core values: building information modeling (BIM), Internet of Things (IoT), big data and predictive analytics, and autonomous construction. Also, there is a high agreement on the Construction 4.0 technologies that enhance well-being and productivity. Lastly, artificial intelligence (AI) has the highest number of very strong relationships among the core values. The originality of this paper lies in its comprehensive comparison of the impact of Construction 4.0 technologies on multiple organizational core values. The study findings provide valuable insights in making strategic decisions in adopting Construction 4.0 technologies.
  4. Bradycardia, headache, and vomiting in a child after a fall
    Tsyeng NK, Omar M, Rahman RA, Rahman SA
    BMJ, 2024 Jan 18;384:e077643.
    PMID: 38237943 DOI: 10.1136/bmj-2023-077643
  5. Developing a WELL building model for office environments
    Tan CYM, Rahman RA, Lee YS
    Environ Sci Pollut Res Int, 2024 Jan 18.
    PMID: 38236568 DOI: 10.1007/s11356-024-31923-z
    Many reported cases of occupants in modern office buildings suffer from severe health risks, negative impacts on well-being, and productivity loss. Existing building standards often prioritize energy performance and green environments over human sustainability. Moreover, office buildings have a distinct group of occupants that require extra attention. Hence, the study aims to develop a WELL building model specifically for office buildings to support occupants' well-being, health, and productivity (i.e., WELL). To achieve that objective, this study developed a list of physical indoor building features through a systematic literature review and semi-structured interviews. Then, the features were inserted into a survey and sent to office building occupants and built environment professionals. The collected data was analyzed using the analytic hierarchy process (AHP) and confirmatory factor analysis (CFA). The findings suggest twelve new features applicable for supporting WELL in office buildings: workspace privacy, sufficient space, office layout, cleanliness, efficiency in building services, individual control, building automation system, Information Technology (IT) infrastructure, Wireless Fidelity (WiFi) risk, security system, safety at parking lots, and safe design. Also, three new concepts for supporting WELL in office buildings were established: office space, building services and maintenance, and smart systems. The new concepts and features lay a foundation for designing office buildings that comprehensively target occupants' WELL. Finally, this study is unique as it accentuates the development of a WELL building model specifically for office buildings.
  6. Innovative biocatalyst synthesis of pectinolytic enzymes by cross-linking strategy: Potentially immobilised pectinases for the production of pectic-oligosaccharides from pectin
    Abd Rahman NH, Rahman RA, Rahmat Z, Jaafar NR, Puspaningsih NNT, Illias RM
    Int J Biol Macromol, 2024 Jan;256(Pt 1):128260.
    PMID: 38000618 DOI: 10.1016/j.ijbiomac.2023.128260
    Pectinases are outstanding multienzymes, which have the potential to produce new emerging pectic-oligosaccharides (POS) via enzymatic hydrolysis of pectin. However, free pectinase is unable to undergo repeated reaction for the production of POS. This study proposed a sustainable biocatalyst of pectinases known as cross-linked pectinase aggregates (CLPA). Pectinase from Aspergillus aculeatus was successfully precipitated using 2 mg/mL pectinase and 60 % acetone for 20 min at 20 °C, which remained 36.3 % of its initial activity. The prepared CLPA showed the highest activity recovery (85.0 %), under the optimised conditions (0.3 % (v/v) starch and glutaraldehyde mixture (St/Ga), 1.5: 1 of St/Ga, 25 °C, 1.5 h). Furthermore, pectin-degrading enzymes from various sources were used to produce different CLPA. The alteration of pectinase secondary structure gave high stability in acidic condition (pH 4), thermostability, deactivation energy and half-life, and improved storage stability at 4 °C for 30 days. Similarly to their free counterpart, the CLPA exhibited comparable enzymatic reaction kinetics and could be reused eight times with approximately 20 % of its initial activity. The developed CLPA does not only efficaciously produced POS from pectin as their free form, but also exhibited better operational stability and reusability, making it more suitable for POS production.
  7. Fulltext A measles IgM rapid diagnostic test to address challenges with national measles surveillance and response in Malaysia
    Senin A, Noordin NM, Sani JAM, Mahat D, Donadel M, Scobie HM, et al.
    PLoS One, 2024;19(3):e0298730.
    PMID: 38483868 DOI: 10.1371/journal.pone.0298730
    INTRODUCTION: A lateral flow rapid diagnostic test (RDT) enables detection of measles specific immunoglobulin M (IgM) antibody in serum, capillary blood, and oral fluid with accuracy consistent with enzyme immunoassay (EIA). The objectives of the study were: 1) to assess measles RDT inter-reader agreement between two clinic staff; 2) to assess the sensitivity and specificity of the measles RDT relative to standard surveillance testing in a low transmission setting; 3) to evaluate the knowledge, attitudes, and practices of staff in clinics using the RDT; and 4) to assess the impact of RDT testing on the measles public health response in Malaysia.

    MATERIALS AND METHODS: The clinic-based prospective evaluation included all suspected measles cases captured by routine measles surveillance at 34 purposely selected clinics in 15 health districts in Malaysia between September 2019 and June 2020, following day-long regional trainings on RDT use. Following informed consent, four specimens were collected from each suspected case, including those routinely collected for standard surveillance [serum for EIA and throat swabs for quantitative reverse transcriptase polymerase chain reaction (RT-qPCR)] together with capillary blood and oral fluid tested with RDTs during the study. RDT impact was evaluated by comparing the rapidity of measles public health response between the pre-RDT implementation (December 2018 to August 2019) and RDT implementation periods (September 2019 to June 2020). To assess knowledge, attitudes, and practices of RDT use, staff involved in the public health management of measles at the selected sites were surveyed.

    RESULTS: Among the 436 suspect cases, agreement of direct visual readings of measles RDT devices between two health clinic staff was 99% for capillary blood (k = 0.94) and 97% for oral fluid (k = 0.90) specimens. Of the total, 45 (10%) were positive by measles IgM EIA (n = 44, including five also positive by RT-qPCR) or RT-qPCR only (n = 1), and 38 were positive by RDT (using either capillary blood or oral fluid). Using measles IgM EIA or RT-qPCR as reference, RDT sensitivity using capillary blood was 43% (95% CI: 30%-58%) and specificity was 98% (95% CI: 96%-99%); using oral fluid, sensitivity (26%, 95% CI: 15%-40%) and specificity (97%, 95% CI: 94%-98%) were lower. Nine months after training, RDT knowledge was high among staff involved with the public health management of measles (average quiz score of 80%) and was highest among those who received formal training (88%), followed by those trained during supervisory visits (83%). During the RDT implementation period, the number of days from case confirmation until initiation of public response decreased by about 5 days.

    CONCLUSION: The measles IgM RDT shows >95% inter-reader agreement, high retention of RDT knowledge, and a more rapid public health response. However, despite ≥95% RDT specificity using capillary blood or oral fluid, RDT sensitivity was <45%. Higher-powered studies using highly specific IgM assays and systematic RT-qPCR for case confirmation are needed to establish the role of RDT in measles elimination settings.

  8. Comparisons of automated machine learning (AutoML) in predicting whistleblowing of academic dishonesty with demographic and theory of planned behavior
    Rahman RA, Masrom S, Mohamad M, Sari EN, Saragih F, Rahman ASA
    MethodsX, 2023 Dec;11:102364.
    PMID: 37744883 DOI: 10.1016/j.mex.2023.102364
    Machine learning has been very promising in solving real problems, but the implementation involved difficulties mainly for the inexpert data scientists. Therefore, this paper presents an automated machine learning (AutoML) to simplify and accelerate the modeling tasks. Focused on Python and RapidMiner rapid modeling tools, Tree-based Pipeline Optimization Tool (TPOT) and AutoModel were used. This paper presents a comprehensive comparison between these tools with regard to the prediction accuracy and Area Under Curve (AUC) in classifying real cases of whistleblowing academic dishonesty among undergraduate students of two universities in Indonesia. Additionally, the correlations weight from demographic and Theory of Planned Behavior (TOB) attributes in the different machine learning models are also discussed. All the machine learning algorithms from TPOT and AutoModel are considerable powerful to generate good accuracy level (between 70-93% of AUC) in classifying both cases of whistleblowing and non-whistleblowing on the hold-out samples from the testing process. Generally, based on the validation results of the prediction models, demographic attributes presented more importance than the TBP attributes. The findings of this study will be a great interest of many research scholars to conduct a more in-depth analysis on AutoML for many domains mainly in education and academic misconduct fields.•AutoML is the first of its kind to be empirically compared between TPOT and AutoModel in an application to predict academic dishonesty whistleblowing.•Besides accuracy performances of the AutoML, the proportion of the variance of each attribute from demographic and Theory of Planned Behavior (TPB) is also presented in the prediction models of academic dishonesty whistleblowing.•AutoML is a convenient and reproducible rapid modeling method of machine learning to be used in many kinds of prediction problem.
  9. Robust cross-linked cyclodextrin glucanotransferase from Bacillus lehensis G1 aggregates using an improved cross-linker and a new co-aggregant for the production of cyclodextrins
    Jailani N, Jaafar NR, Rahman RA, Illias RM
    Enzyme Microb Technol, 2023 Sep;169:110283.
    PMID: 37433237 DOI: 10.1016/j.enzmictec.2023.110283
    One of the potentials of carrier-free cross-linked enzyme aggregates (CLEA) immobilization is the ability to be separated and reuse. Yet, it might be impeded by the poor mechanical stability resulting low recyclability. CLEA of CGTase from Bacillus lehensis G1 (CGTase G1-CLEA) using chitosan (CS) as a cross-linker demonstrated high activity recovery however, displayed poor reusability. Therefore, the relationship between mechanical strength and reusability is studied by enhancing the CS mechanical properties and applying a new co-aggregation approach. Herein, CS was chemically cross-linked with glutaraldehyde (GA) and GA was introduced as a co-aggregant (coGA). CGTase G1-CLEA developed using an improved synthesized chitosan-glutaraldehyde (CSGA) cross-linker and a new coGA technique showed to increase its mechanical stability which retained 63.4% and 52.2%, respectively compared to using CS that remained 33.1% of their initial activity after stirred at 500 rpm. The addition of GA impacted the morphology and interaction consequently stabilizing the CLEAs durability in production of cyclodextrins. As a result, the reusability of CGTase G1-CLEA with CSGA and coGA increased by 56.6% and 42.8%, respectively compared to previous CLEA after 5 cycles for 2 h of reaction. This verifies that the mechanical strength of immobilized enzyme influences the improvement of its operational stability.
  10. Combined cross-linked enzyme aggregates of cyclodextrin glucanotransferase and maltogenic amylase from Bacillus lehensis G1 for maltooligosaccharides synthesis
    Yip YS, Manas NHA, Jaafar NR, Rahman RA, Puspaningsih NNT, Illias RM
    Int J Biol Macromol, 2023 Jul 01;242(Pt 1):124675.
    PMID: 37127056 DOI: 10.1016/j.ijbiomac.2023.124675
    Maltooligosaccharides (MOS) are functional oligosaccharides that can be synthesized through enzymatic cascade reaction between cyclodextrin glucanotransferase (CGTase) and maltogenic amylase (Mag1) from Bacillus lehensis G1. To address the problems of low operational stability and non-reusability of free enzymes, both enzymes were co-immobilized as combined cross-linked enzyme aggregates (Combi-CLEAs-CM) with incorporation of bovine serum albumin (BSA) and Tween 80 (Combi-CLEAs-CM-add). Combi-CLEAs-CM and Combi-CLEAs-CM-add showed activity recoveries of 54.12 % and 69.44 %, respectively after optimization. Combi-CLEAs-CM-add showed higher thermal stability at higher temperatures (40 °C) with longer half-life (46.20 min) as compared to those of free enzymes (36.67 min) and Combi-CLEAs-CM (41.51 min). Both combi-CLEAs also exhibited higher pH stability over pH 5 to pH 9, and displayed excellent reusability with >50 % of initial activity retained after four cycles. The reduction in Km value of about 22.80 % and 1.76-fold increase in starch hydrolysis in comparison to Combi-CLEAs-CM attested the improvement of enzyme-substrate interaction by Tween 80 and pores formation by BSA in Combi-CLEAs-CM-add. The improved product specificity of Combi-CLEAs-CM-add also produced the highest yield of MOS (492 mg/g) after 3 h. Therefore, Combi-CLEAs-CM-add with ease of preparation, excellent reusability and high operational stability is believed to be highly efficacious biocatalyst for MOS production.
  11. Fulltext Activin A and pathologies of pregnancy: a review
    Barber CV, Yo JH, Rahman RA, Wallace EM, Palmer KR, Marshall SA
    Placenta, 2023 May;136:35-41.
    PMID: 37028223 DOI: 10.1016/j.placenta.2023.03.008
    Activin A is a two-subunit protein belonging to the transforming growth factor β superfamily. First discovered almost three decades ago, it has since been implicated in diverse physiological roles, ranging from wound repair to reproduction. After 30 years of research, altered activin A levels are now understood to be associated with the development of various diseases, making activin A a potential therapeutic target. In pregnancy, the placenta and fetal membranes are major producers of activin A, with significantly enhanced serum concentrations now recognised as a contributor to numerous gestational disorders. Evidence now suggests that circulating levels of activin A may be clinically relevant in the early detection of pregnancy complications, including miscarriage and preeclampsia. This review aims to summarise our current understanding of activin A as a potential diagnostic marker in common pregnancy pathologies.
  12. Fulltext Cervical dilatation at diagnosis of active phase of labour determines the mode of delivery and peripartum outcomes: a retrospective study in a single tertiary centre in Malaysia
    Rosli AA, Nawi AM, Atan IK, Kalok AM, Ahmad S, Ismail NAM, et al.
    BMC Pregnancy Childbirth, 2023 Apr 01;23(1):221.
    PMID: 37005571 DOI: 10.1186/s12884-023-05523-7
    BACKGROUND: There is an increasing trend of Caesarean section rate in Malaysia. Limited evidence demonstrated the benefits of changing the demarcation of the active phase of labour.

    METHODS: This was a retrospective study of 3980 singletons, term pregnancy, spontaneous labouring women between 2015 and 2019 comparing outcomes between those with cervical dilation of 4 versus 6 cm at diagnosis of the active phase of labour.

    RESULTS: A total of 3403 (85.5%) women had cervical dilatation of 4 cm, and 577 (14.5%) at 6 cm upon diagnosis of the active phase of labour. Women in 4 cm group were significantly heavier at delivery (p = 0.015) but significantly more multiparous women were in 6 cm group (p 

  13. Effects of MDR1 and OPRM1 genetic polymorphisms on the pharmacodynamics of propofol-remifentanil TIVA in pediatrics
    Liew Y, Capule FR, Rahman RA, Nor NM, Teo R, Makmor-Bakry M
    Pharmacogenomics, 2023 Apr;24(5):247-259.
    PMID: 36999508 DOI: 10.2217/pgs-2023-0006
    Aims: To investigate the roles of MDR1 (1236C>T, 2677G>T/A, and 3435C>T) and OPRM1 (118A>G) gene polymorphisms on the anesthetic and adverse effects of propofol-remifentanil total intravenous anesthesia in pediatric surgery. Materials & methods: The genotypes were identified through Sanger sequencing. The clinical data including hemodynamics on anesthesia, postanesthesia pain and sedation score and the occurrence of adverse effects were recorded and compared against the genetic data. Results: A total of 72 pediatric patients undergoing surgery were recruited. A weak to no association was found between the genetic polymorphisms of MDR1 and OPRM1 and the anesthetic and adverse effects of propofol-remifentanil. Conclusion: Genetic polymorphisms in OPRM1, but not in MDR1, gene polymorphism, demonstrated plausible association with the effects of propofol-remifentanil.
  14. Analysis of the spatial characteristics and influencing factors of agricultural eco-efficiency: evidence from Anhui Province, China, during the period 2011-2018
    Wu Y, Rahman RA, Yu Q
    Environ Monit Assess, 2022 Feb 08;194(3):154.
    PMID: 35132444 DOI: 10.1007/s10661-022-09817-9
    Sustainable agriculture is important for preserving environmental health and simultaneously gaining economic profits while maintaining social and economic equity. One way to evaluate sustainable agriculture is by studying agricultural eco-efficiency (AEE). Hence, this study constructed a data-driven method to evaluate and optimize AEE with the aim of providing a basis for improving the sustainable development of regional agriculture. Sixteen cities in Anhui Province, China, were considered in the study, and the variables used were agricultural resource inputs, environmental pollution, and agricultural economic development. Agricultural non-point source pollution (NPSP) emissions were considered the undesired output to build an AEE evaluation index system. Furthermore, a data envelopment analysis (DEA) model was established to analyse AEE from the static and dynamic perspectives. The spatial development and the temporal and spatial characteristics of AEE were also analysed. In addition, we applied a random effect (RE) panel Tobit model to quantitatively analyse the influencing factors of AEE from the input perspective and then proposed reasonable suggestions for improving the sustainable development of regional agriculture. Our findings show that the overall agricultural development in the 16 cities in Anhui Province has been continuously improving, even though there is an agglomeration of spatial development in some regions. In conclusion, this study provides suggestions and references for policy makers and agricultural practitioners regarding how to improve regional AEE and promote the sustainable development of the regional agricultural economy.
  15. When paediatric facial nerve paralysis is not a Bell's palsy: A case of cerebellopontine angle tumour
    Ismail MT, Rahman RA, Idris NS
    J Taibah Univ Med Sci, 2022 Feb;17(1):141-145.
    PMID: 35140576 DOI: 10.1016/j.jtumed.2021.08.008
    Facial nerve paralysis in children is a rare clinical condition that can lead to serious complications. Due to their rare occurrence, tumours, especially in the cerebellopontine angle, may be overlooked. We report a case of cerebellopontine angle tumour in an 8-year-old boy who presented with a right-sided lower motor neuron type of facial nerve palsy. Further examination showed a mild bilateral nystagmus. However, misled by the initial diagnosis of Bell's palsy, there was a delay in performing diagnostic magnetic resonance imaging of the brain, which showed a large mass in the cerebellopontine. Subsequently, six weeks after his initial presentation, the boy succumbed to the disease. This case illustrates that careful clinical examination, even in a seemingly simple case, is imperative to avoid diagnostic errors.
  16. Fulltext Acute Kidney Injury following Rhabdomyolysis in Critically Ill Patients
    Saverymuthu A, Teo R, Zain JM, Cheah SK, Yusof AM, Rahman RA
    J Crit Care Med (Targu Mures), 2021 Oct;7(4):267-271.
    PMID: 34934816 DOI: 10.2478/jccm-2021-0025
    Introduction: Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury.

    Aim: To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients.

    Methods: All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury.

    Results: Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001].

    Conclusions: One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.

  17. Fulltext The Short-Term Effect of Active Skeletonized Sutural Distractor Appliance on Temporomandibular Joint Morphology of Class III Malocclusion Subjects
    Huqh MZU, Hassan R, Rahman RA, Yusof A, Narmada IB, Ahmad WMAW
    Eur J Dent, 2021 Jul;15(3):523-532.
    PMID: 33622009 DOI: 10.1055/s-0040-1722483
    OBJECTIVES:  The purpose of this study was to evaluate the short-term effect of active skeletonized sutural distractor (ASSD) appliance on temporomandibular joint morphology of class III malocclusion subjects.

    MATERIALS AND METHODS:  This was a prospective interventional study. Cone-beam computerized tomography (CBCT) images of 22 patients were taken before and after treatment by using Planmeca Promax 3D CBCT machine version 2.9.2 (Planmeca OY Helsinki, Finland). The condylar width, height, length, roof of glenoid fossa thickness, and all joint spaces were measured. The condylar position was determined based on Pullinger and Hollander formula. The condylar shape was determined as per Kinzinger et al. The condylar volume was calculated by using Mimics software (Materialize, Belgium).

    STATISTICAL ANALYSIS:  Data analysis was performed by using SPSS software version 24. Wilcoxon paired signed-rank test was used to compare the difference in temporomandibular joint morphology and condylar volume between pre- and post-treatment measurements. Chi-square test was used to compare the condylar position and shape.

    RESULTS:  The superior (p = 0.000 on the right side, p = 0.005 on the left side) and posterior joint spaces (p = 0.000 on both sides) were decreased after the treatment, respectively. The condyles were rotated upward and backward, thereby increasing the anterior joint spaces (p = 0.000 on both sides) after the treatment. The condylar volume increases after treatment, but no significant differences were observed (p = 0.903 on the right side, p = 0.062 on the left side).

    CONCLUSION:  The significant changes were observed in joint spaces. The condyles were more anteriorly placed before treatment. Condylar position and shape alter in response to ASSD treatment. The condylar volume did not show any significant change.

  18. Fulltext Use of the Arabin pessary in women at high risk for preterm birth: long-term experience at a single tertiary center in Malaysia
    Rahman RA, Atan IK, Ali A, Kalok AM, Ismail NAM, Mahdy ZA, et al.
    BMC Pregnancy Childbirth, 2021 May 10;21(1):368.
    PMID: 33971828 DOI: 10.1186/s12884-021-03838-x
    BACKGROUND: Spontaneous preterm birth is a global issue that contributed to perinatal morbidities and mortalities worldwide. The study aimed to describe the experience at UKM Medical Center in managing women at high risk for spontaneous preterm birth using the Arabin pessary.

    METHODS: This is a retrospective observational study involving 58 pregnancies from 1st January 2013 to 31st December 2019. Inclusion criteria were previous mid-trimester miscarriage and/or preterm birth, previous cervical surgery or short cervical length on routine sonogram. The demographic data, characteristics of each pregnancy and details of outcomes and management were described.

    RESULTS: The majority of women were Malay with mean age and body mass index of 32.9 ± 4.2 years and 27.1 ± 6.3 kg/m2 respectively. The most frequent indications for Arabin pessary insertion were previous mid-trimester miscarriage (46.4%) and early preterm birth (17.2%). A total of 73.4% of these women had the pessary inserted electively at a mean cervical length of 31.6 ± 9.1 mm at median gestation of 15.0 weeks. They were managed as outpatient (56.9%), inpatient (24.1%) or mixed (19.0%) with combination of progestogen (81.0%) and 53.4% received antenatal corticosteroids. Spontaneous preterm birth at or more than 34 weeks gestation occurred in 74.1% with birthweight at or more than 2000 g (82.4%). Despite cervical funneling in 12 women (20.7%), 66.7% delivered at or later than 34 weeks gestation and 2 (16.7%) resulted in miscarriage.

    CONCLUSIONS: Insertion of the Arabin pessary is beneficial to prevent spontaneous preterm birth in pregnant women who are at high risk. In particular, early insertion and close monitoring allows the best possible outcomes.

    TRIAL REGISTRATION: This study was retrospectively registered with ClinicalTrials.gov ( NCT04638023 ) on 20/11/2020.

  19. Fulltext Warpage Optimisation Using Recycled Polycar-bonates (PC) on Front Panel Housing
    Tamizi NAMA, Rahim SZA, Abdellah AE, Abdullah MMAB, Nabiałek M, Wysłocki JJ, et al.
    Materials (Basel), 2021 Mar 15;14(6).
    PMID: 33804036 DOI: 10.3390/ma14061416
    Many studies have been done using recycled waste materials to minimise environmental problems. It is a great opportunity to explore mechanical recycling and the use of recycled and virgin blend as a material to produce new products with minimum defects. In this study, appropriate processing parameters were considered to mould the front panel housing part using R0% (virgin), R30% (30% virgin: 70% recycled), R40% (40% virgin: 60% recycled) and R50% (50% virgin: 50% recycled) of Polycarbonate (PC). The manufacturing ability and quality during preliminary stage can be predicted through simulation analysis using Autodesk Moldflow Insight 2012 software. The recommended processing parameters and values of warpage in x and y directions can also be obtained using this software. No value of warpage was obtained from simulation studies for x direction on the front panel housing. Therefore, this study only focused on reducing the warpage in the y direction. Response Surface Methodology (RSM) and Genetic Algorithm (GA) optimisation methods were used to find the optimal processing parameters. As the results, the optimal ratio of recycled PC material was found to be R30%, followed by R40% and R50% materials using RSM and GA methods as compared to the average value of warpage on the moulded part using R0%. The most influential processing parameter that contributed to warpage defect was packing pressure for all materials used in this study.
  20. Fulltext The Role of Zinc Chloride in Enhancing Mechanical, Thermal and Electrical Performance of Ethylene Vinyl Acetate/Carbonized Wood Fiber Conductive Composite
    Mohd Pisal MH, Osman AF, Jin TS, Rahman RA, Alrashdi AA, Masa A
    Polymers (Basel), 2021 Feb 17;13(4).
    PMID: 33671304 DOI: 10.3390/polym13040600
    Carbonized natural filler can offer the production of low cost composites with an eco-friendliness value. The evolving field of electronics encourages the exploration of more functions and potential for carbonized natural filler, such as by modifying its surface chemistry. In this work, we have performed surface modification on carbonized wood fiber (CWF) prior to it being used as filler in the ethylene vinyl acetate (EVA) composite system. Zinc chloride (ZnCl2) with various contents (2 to 8 wt%) was used to surface modify the CWF and the effects of ZnCl2 composition on the surface morphology and chemistry of the CWF filler were investigated. Furthermore, the absorptive, mechanical, thermal, and electrical properties of the EVA composites containing CWF-ZnCl2 were also analyzed. SEM images indicated changes in the morphology of the CWF while FTIR analysis proved the presence of ZnCl2 functional groups in the CWF. EVA composites incorporating the CWF-ZnCl2 showed superior mechanical, thermal and electrical properties compared to the ones containing the CWF. The optimum content of ZnCl2 was found to be 6 wt%. Surface modification raised the electrical conductivity of the EVA/CWF composite through the development of conductive deposits in the porous structure of the CWF as a channel for ionic and electronic transfer between the CWF and EVA matrix.
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