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Fulltext Kinetic studies of the partially purified molybdenum-reducing enzyme from Bacillus pumilus strain Lbna

Abo-Shakeer, L.K.A., Rahman, M.F.A., Yakasai, H., Syed, M.A., Shukor M.Y., Bakar, N.A., et al.

Bioremediation Science and Technology Research, 2017;5(1):18-23.
MyJurnal

Bacterial based remediation of environmental toxicants is a promising innovative technology
for molybdenum pollution. To date, the enzyme responsible for molybdate reduction to Moblue
from bacteria show that the Michaelis-Menten constants varies by one order of magnitude.
It is important that the constants from newer enzyme sources be characterized so that a
comparison can be made. The aim of this study is to characterize kinetically the enzyme from a
previously isolated Mo-reducing bacterium; Bacillus pumilus strain Lbna. The maximum
activity of this enzyme occurred at pH 5.5 and in between 25 and 35 oC. The Km and Vmax of
NADH were 6.646 mM and 0.057 unit/mg enzyme, while the Km and Vmax of LPPM were 3.399
mM and 0.106 unit/mg enzyme. The results showed that the enzyme activity for Bacillus
pumilus strain Lbna were inhibited by all heavy metals used. Zinc, copper, silver, chromium,
cadmium and mercury all caused more than 50% inhibition to the Mo-reducing enzyme activity
with copper being the most potent with an almost complete inhibition of enzyme activity
observed.
Fulltext Edible mushrooms from malaysia; a literature review on their nutritional and medicinal properties

Samsudin, N.I.P., Abdullah, N.

International Food Research Journal, 2019;26(1):11-31.
MyJurnal

Mushrooms have been consumed by mankind for millennia. In Malaysia, there are many species of edible mushrooms which are either cultivated (Agaricus spp., Auricularia spp., Pleurotus spp.) or harvested in the wild (Ganoderma spp., Polyporus spp., Termitomyces spp.). With the advancement of technology, numerous discoveries have been made that elucidated the nutritional (high in fibres, proteins, vitamins; low in fats, cholesterols, sodium) and medicinal (anti-oxidative, anti-hypertensive, neuritogenesis) properties of edible mushrooms, all of which are highly beneficial for the maintenance of human health and well-being. This review thus compiles and documents the available literatures on edible mushrooms reported from Malaysia complete with scientific, English, and vernacular names for future references; provides a comprehensive and updated overview on the nutritional and medicinal properties edible mushrooms reported from Malaysia; and identifies the research gaps to promote further research and development on edible mushrooms reported from Malaysia. Overall, Malaysia is and remains a natural repository for wild and cultivated edible mushrooms. Deeper investigation on their nutritional and medicinal properties will certainly serve as an impetus for economic as well as scientific progress.
Fulltext Optimization of enzymatic hydrolysis of tilapia (Oreochromis niloticus) by- product using response surface methodology

Roslan, J., Mustapa Kamal, S.M., Md. Yunos, K.F., Abdullah, N.

International Food Research Journal, 2015;22(3):1117-1123.
MyJurnal

Fish protein hydrolysate was recovered from tilapia by-product (TB) through enzymatic hydrolysis using alcalase enzyme. Hydrolysis reaction of TB was monitored according to the degree of hydrolysis (DH) by employing O-phtaldialdehyde (OPA) method. Optimization process for obtaining high yield of TB protein hydrolysate was performed using response surface methodology (RSM) by optimizing a combination of four independent variables namely, pH (6.5-8.5), temperature (55-70oC), substrate concentration (10-17.5% w/v), and enzyme concentration (1.5-3.5% w/w) with (DH) as a response. The optimum enzymatic hydrolysis conditions were obtained at pH 7.5, temperature of 60oC, substrate concentration of 15% (w/v) and 2.5% (w/w) of enzyme concentration and yielded about 20.20% of DH after hydrolyzing for 120 min. RSM generated model predicted that 20.42% of DH could be achieved at these conditions and this model was valid based on the DH value obtained from the experimental study (20.31%) which was quite similar with the predicted value. High yield of DH obtained from the optimization process could produce fish protein hydrolysate with good nutritional and functional properties.
Protective Effect of Antioxidant Extracts from Grey Oyster Mushroom, Pleurotus pulmonarius (Agaricomycetes), Against Human Low-Density Lipoprotein Oxidation and Aortic Endothelial Cell Damage

Abidin MH, Abdullah N, Abidin NZ

Int J Med Mushrooms, 2016;18(2):109-21.
PMID: 27279533 DOI: 10.1615/IntJMedMushrooms.v18.i2.20

This study evaluated the in vitro antioxidant capacities of extracts from Pleurotus pulmonarius via Folin-Ciocalteu, 1,1-diphenyl-2-picrylhydrazyl free radical scavenging, metal chelating, cupric ion reducing antioxidant capacity, and lipid peroxidation inhibition assays. Extract compositions were determined by phenol-sulfuric acid; Coomassie Plus (Bradford) protein; Spectroquant zinc, copper, and manganese test assays; and liquid chromatography-tandem mass spectrometry (LC/MS/MS) and gas chromatography-mass spectrometry (GC/MS). Methanol-dichloromethane extract, water fraction, hot water, aqueous extract and hexane fraction exhibited the most potent extracts in the antioxidant activities. LC/MS/MS and GC/MS showed that the extracts contained ergothioneine, ergosterol, flavonoid, and phenolic compounds. The selected potent extracts were evaluated for their inhibitory effect against oxidation of human low-density lipoproteins and protective effects against hydrogen peroxide-induced cytotoxic injury in human aortic endothelial cells. The crude aqueous extract was deemed most potent for the prevention of human low-density lipoprotein oxidation and endothelial membrane damage. Ergothioneine might be the compound responsible for the activities, as supported by previous reports. Thus, P. pulmonarius may be a valuable antioxidant ingredient in functional foods or nutraceuticals.
Antiatherogenic Potential of Extracts from the Gray Oyster Medicinal Mushroom, Pleurotus pulmonarius (Agaricomycetes), In Vitro

Abidin MHZ, Abdullah N, Abidin NZ

Int J Med Mushrooms, 2018;20(3):283-290.
PMID: 29717672 DOI: 10.1615/IntJMedMushrooms.2018025821

This study evaluates the in vitro inhibition of angiotensin-converting enzyme (ACE) and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA) by Pleurotus pulmonarius extracts. The protective effect on the endothelial membrane against oxidative stress through the protection of nitric oxide bioavailability, as well as inhibition of endocan expression, was evaluated using human aortic endothelial cells (HAECs). Crude cold aqueous extract exhibited the most potent inhibitory activities against ACE and HMG-CoA reductase, with 61.79% and 44.30% inhibition, respectively. It also protected the bioavailability of NO released by HAECs, with 84.88% cell viability. The crude hot water extract was the most potent in inhibiting endocan expression, with 18.61% inhibition.
Fulltext Goals, beliefs, knowledge, and barriers for diabetes self-care in a multi-ethnic population in Malaysia: A qualitative study

Neblett RS, Chia YC, Abdullah N, Ablah E

Med J Malaysia, 2019 12;74(6):483-491.
PMID: 31929473

INTRODUCTION: Ethnic differences may influence diabetes selfcare practices and glycaemic control among people with type 2 diabetes mellitus. This qualitative study explored goals, beliefs about treatment effectiveness, knowledge, and barriers to and facilitators for diabetes self-care among the three main ethnic groups in Malaysia.

METHODS: Patient focus group discussions were conducted in three different ethnic groups: Malays, Chinese, and Indians. Participants were recruited from the primary-care clinic of a university medical centre located in an urban area. Focus group discussions were audio-recorded, transcribed, and analysed using a thematic approach.

RESULTS: A total of 31 patients participated in the study: Malays (n=12), Indians (n=10), and Chinese (n=9). There were three sessions for each ethnic group. Reported goals primarily related to quality of life and glycaemic control. Participants expressed the belief that the combination of diet, exercise, and medications is effective for controlling diabetes. Groups described their obtaining information external to a healthcare system and reported a need for more specific, practical counselling from health professionals on diet, exercise, and medications. Barriers to and facilitators for diabetes self-care practices were categorised into three major themes: having discipline, social habits, and "other" themes.

CONCLUSION: Emerging themes were similar across the ethnic groups and included quality-of-life goals, confidence in combination treatment, common use of complementary and alternative medicine, need for further counselling, and the challenge regarding self-discipline.
Estimation of stature by using lower limb dimensions in the Malaysian population

Nor FM, Abdullah N, Mustapa AM, Qi Wen L, Faisal NA, Ahmad Nazari DA

J Forensic Leg Med, 2013 Nov;20(8):947-52.
PMID: 24237796 DOI: 10.1016/j.jflm.2013.09.006

Estimation of stature is an important step in developing a biological profile for human identification. It may provide a valuable indicator for an unknown individual in a population. The aim of this study was to analyse the relationship between stature and lower limb dimensions in the Malaysian population. The sample comprised 100 corpses, which included 69 males and 31 females between the age range of 20-90 years old. The parameters measured were stature, thigh length, lower leg length, leg length, foot length, foot height and foot breadth. Results showed that the mean values in males were significantly higher than those in females (p
Evaluation of antioxidant potential of Artocarpus heterophyllus L. J33 variety fruit waste from different extraction methods and identification of phenolic constituents by LCMS

Daud MNH, Fatanah DN, Abdullah N, Ahmad R

Food Chem, 2017 Oct 01;232:621-632.
PMID: 28490120 DOI: 10.1016/j.foodchem.2017.04.018

Artocarpus heterophyllus J33 (AhJ33) fruit is a popular and valuable jackfruit variety in Malaysia. For export, the pulp has to be separated from the skin which is usually discarded. Hence, the conversion of the fruit waste to food products with economic value needs to be explored utilizing the waste to wealth concept. This paper reports the evaluation of antioxidant potential of AhJ33 fruit waste (rind and rachis) extracts from three different extraction methods (maceration, percolation and Soxhlet). The antioxidant potential was assessed by DPPH radical scavenging, FRAP and β-carotene bleaching assays. The total phenolic and total flavonoid contents were estimated by TPC and the TFC assays. For both rind and rachis, the maceration technique yielded extracts with the strongest antioxidant activities which correlated with the highest TPC and TFC values. TOF LCMS analyses identified two phenolic acids as the major constituents responsible for the antioxidant activity of the active extracts.
Bioassay-guided fractionation of Artocarpus heterophyllus L. J33 variety fruit waste extract and identification of its antioxidant constituents by TOF-LCMS

Daud MNH, Wibowo A, Abdullah N, Ahmad R

Food Chem, 2018 Nov 15;266:200-214.
PMID: 30381177 DOI: 10.1016/j.foodchem.2018.05.120

We have previously reported on the antioxidant potential of Artocarpus heterophyllus J33 (AhJ33) variety fruit waste from different extraction methods. In the study, the rind maceration extract (RDM) exhibited the highest phenolic and polyphenolic contents and strongest antioxidant potential measured by the DPPH assay (R2 = 0.99). In this paper, we now report on the bioassay-guided fractionation of the active ethyl acetate (EtOAC) fraction of RDM and its TOF-LCMS analysis. Seven sub-fractions resulting from the chromatographic separation of the EtOAC fraction showed radical scavenging activities between 80 and 94% inhibition. Subsequent LCMS analysis led to the identification of fifteen compounds comprising 5 phenolics and 10 non-phenolic compounds, 11 of which are reported for the first time from AhJ33 variety. Most of the identified compounds have been reported to possess antioxidant activity in many previous studies. This indicates that AhJ33 is a promising source of antioxidants for the development of food and nutraceutical products.
Fulltext Phorbol esters isolated from Jatropha meal induced apoptosis-mediated inhibition in proliferation of chang and Vero cell lines

Oskoueian E, Abdullah N, Ahmad S

Int J Mol Sci, 2012;13(11):13816-29.
PMID: 23203036 DOI: 10.3390/ijms131113816

The direct feeding of Jatropha meal containing phorbol esters (PEs) indicated mild to severe toxicity symptoms in various organs of different animals. However, limited information is available on cellular and molecular mechanism of toxicity caused by PEs present in Jatropha meal. Thus, the present study was conducted to determine the cytotoxic and mode of action of PEs isolated from Jatropha meal using human hepatocyte (Chang) and African green monkey kidney (Vero) cell lines. The results showed that isolated PEs inhibited cell proliferation in a dose-dependent manner in both cell lines with the CC(50) of 125.9 and 110.3 μg/mL, respectively. These values were compatible to that of phorbol 12-myristate 13-acetate (PMA) values as positive control i.e., 124.5 and 106.3 μg/mL respectively. Microscopic examination, flow cytometry and DNA fragmentation results confirmed cell death due to apoptosis upon treatment with PEs and PMA at CC(50) concentration for 24 h in both cell lines. The Western blot analysis revealed the overexpression of PKC-δ and activation of caspase-3 proteins which could be involved in the mechanism of action of PEs and PMA. Consequently, the PEs isolated form Jatropha meal caused toxicity and induced apoptosis-mediated proliferation inhibition toward Chang and Vero cell lines involving over-expression of PKC-δ and caspase-3 as their mode of actions.
Fulltext Phorbol esters from Jatropha meal triggered apoptosis, activated PKC-δ, caspase-3 proteins and down-regulated the proto-oncogenes in MCF-7 and HeLa cancer cell lines

Oskoueian E, Abdullah N, Ahmad S

Molecules, 2012 Sep 10;17(9):10816-30.
PMID: 22964499 DOI: 10.3390/molecules170910816

Jatropha meal produced from the kernel of Jatropha curcas Linn. grown in Malaysia contains phorbol esters (PEs). The potential benefits of PEs present in the meal as anticancer agent are still not well understood. Hence, this study was conducted to evaluate the cytotoxic effects and mode of actions of PEs isolated from Jatropha meal against breast (MCF-7) and cervical (HeLa) cancer cell lines. Isolated PEs inhibited cells proliferation in a dose-dependent manner of both MCF-7 and HeLa cell lines with the IC₅₀ of 128.6 ± 2.51 and 133.0 ± 1.96 µg PMA equivalents/mL respectively, while the values for the phorbol 12-myristate 13-acetate (PMA) as positive control were 114.7 ± 1.73 and 119.6 ± 3.73 µg/mL, respectively. Microscopic examination showed significant morphological changes that resemble apoptosis in both cell lines when treated with PEs and PMA at IC₅₀ concentration after 24 h. Flow cytometry analysis and DNA fragmentation results confirmed the apoptosis induction of PEs and PMA in both cell lines. The PEs isolated from Jatropha meal activated the PKC-δ and down-regulated the proto-oncogenes (c-Myc, c-Fos and c-Jun). These changes probably led to the activation of Caspase-3 protein and apoptosis cell death occurred in MCF-7 and HeLa cell lines upon 24 h treatment with PEs and PMA. Phorbol esters of Jatropha meal were found to be promising as an alternative to replace the chemotherapeutic drugs for cancer therapy.
Genetic relationships among five varieties of Curcuma alismatifolia (Zingiberaceae) based on ISSR markers

Taheri S, Abdullah TL, Abdullah NA, Ahmad Z

Genet. Mol. Res., 2012;11(3):3069-76.
PMID: 23007984

The genus Curcuma is a member of the ginger family (Zingiberaceae) that has recently become popular for use as flowering pot plants, both indoors and as patio and landscape plants. We used PCR-based molecular markers (ISSRs) to assess genetic variation and relationships between five varieties of curcuma (Curcuma alismatifolia) cultivated in Malaysia. Sixteen ISSR primers generated 139 amplified fragments, of which 77% had high polymorphism among these varieties. These markers were used to estimate genetic similarity among the varieties using Jaccard's similarity coefficient. The similarity matrix was used to construct a dendrogram, and a principal component plot was developed to examine genetic relationships among varieties. Similarity coefficient values ranged from 0.40 to 0.58 (with a mean of 0.5) among the five varieties. The mean value of number of observed alleles, number of effective alleles, mean Nei's gene diversity, and Shannon's information index were 8.69, 1.48, 0.29, and 0.43, respectively.
In vitro degradation of poly (D, L-lactide-co-glycolide) nanoparticles loaded with linamarin

Hussein AS, Abdullah N, Ahmadun FR

IET Nanobiotechnol, 2013 Jun;7(2):33-41.
PMID: 24046903

Linamarin-loaded poly (lactide-co-glycolide) (PLGA) nanoparticles (NPs) were prepared by the double emulsion solvent evaporation technique. The formulated PLGA (50:50) and PLGA (85:15) NPs were spherically shaped, having an average particle size < 190 nm, drug entrapment efficiency (50-52%) and zeta potentials ranging from -25 to -30 mV. Interestingly, all formulated PLGA NPs exhibited a controlled biphasic release profile. Polymer degradation was investigated in the current research to determine the major degradation products and then the polymer biocompatibility as well as safety. The PLGA NPs degradation behaviour was investigated by measuring water uptake, mass loss, change of pH of the degradation medium, morphological changes, and lactic and glycolic acid concentrations. Gravimetrical methods, pH meter, scanning electron microscope and high-performance liquid chromatography were employed, respectively. PLGA (50:50) NPs were found to degrade faster than PLGA (85:15) NPs. With regard to water uptake, mass loss and pH change, the degradation behaviour of PLGA (50:50) NPs was significantly (rho < 0.05) different from that of PLGA (85:15) NPs. A complete degradation of PLGA (50:50) NPs was achieved after 102 days, whereas, only about 60% of PLGA (85:15) NPs were degraded within the same period. Complete degradation and release of the degradation products naturally by the body ensures safety of the delivery carrier.
A reappraisal of thyroid surgery under local anaesthesia: back to the future?

Hisham AN, Aina EN

ANZ J Surg, 2002 Apr;72(4):287-9.
PMID: 11982518 DOI: 10.1046/j.1445-2197.2002.02372.x

BACKGROUND: Thyroid surgery is usually performed under general anaesthesia. However, for a selected group of patients, local anaesthesia may be preferable. The aim of this study was to review the authors' experiences with local anaesthesia with regard to the safety and outcome of this approach.
METHODS: A total of 65 consecutive patients who underwent primary thyroid surgery were accrued prospectively into this study from May to December 1999. A field block with 0.5% bupivacaine and adrenaline in 1:200 000 dilutions was given in all cases. In addition, light sedative and narcotics were given as necessary to achieve patient comfort and cooperation. The pain experienced during surgery was recorded using a visual analogue scoring system on a scale of 1-10.
RESULTS: Unilateral thyroid resection was performed in 58 patients, isthmectomy in four patients and bilateral thyroid resection in three patients, two of which were in their second trimester of pregnancy diagnosed with papillary thyroid cancer. There were 55 women and 10 men with an average age of 38.2 years (range: 18-67 years). No conversion to general anaesthetic was needed, and the mean operating time was 80 min. The postoperative recovery was quick with this technique and, of interest, 22 (33.9%) patients were discharged within 6 h following the surgery. Overall 62 (95.4%) patients were discharged in the first 24 h and three (4.6%) patients after 24 h. There were no significant postoperative complications encountered except for wound infection in two (3.1%) patients.
CONCLUSIONS: Thyroid surgery under local anaesthesia can be performed safely in a selected group of patients. It offers an effective alternative approach to general anaesthesia and is associated with low morbidity and high levels of patient satisfaction.
Fulltext Probabilistic Detection of Indoor Events Using a Wireless Sensor Network-Based Mechanism

Al-Zabin LR, Al-Wesabi OA, Al Hajri H, Abdullah N, Khudayer BH, Al Lawati H

Sensors (Basel), 2023 Aug 03;23(15).
PMID: 37571696 DOI: 10.3390/s23156918

Wireless sensor networks (WSNs) have been commonly utilized in event detection and environmental observation applications. The main aim of event detection is to define the presence or absence of an event. Various existing studies in the field of event detection depend on static or threshold values to reveal the occurrence of an event, which can result in imprecise sensor readings. Recently, many studies have utilized fuzzy logic to treat fluctuating sensor readings; as a result, they have decreased the number of false alarms created. However, there is some attention required when utilizing fuzzy logic. One aspect is that the efficiency and accuracy of the fuzzy membership function can be impacted by the utilization of heterogeneous sensors, which may increase the complexity of the fuzzy logic operation as the number of inputs rises. To address these issues, this paper proposes an approach named Probabilistic Collaborative Event Detection (PCED), which is a hybrid event detection technique that is based on a cluster WSN topology. The PCED approach utilizes a validated probabilistic technique for heterogeneous sensor nodes to transform sensing values into probability formulas and introduces a Cluster Head Decision Mechanism to make decisions based on the aggregated data from the sensors. The proposed approach employs fuzzy logic at the fusion center level to enhance the precision of event detection. The effectiveness of this method is thoroughly evaluated using MATLAB software, demonstrating an improvement in the probability of detection and a decrease in the probability of false alarms. PCED is compared to well-established event detection mechanisms such as the REFD mechanism. The results show that PCED reduces the occurrence of false alarms from 37 to 3 in certain scenarios, while improving detection accuracy by up to 19.4% over REDF and decreasing detection latency by up to 17.5%.
Fulltext Most prevalent unmet supportive care needs and quality of life of breast cancer patients in a tertiary hospital in Malaysia

Edib Z, Kumarasamy V, Binti Abdullah N, Rizal AM, Al-Dubai SA

Health Qual Life Outcomes, 2016;14:26.
PMID: 26898558 DOI: 10.1186/s12955-016-0428-4

Addressing breast cancer patients' unmet supportive care needs in the early stage of their survivorship have become a prime concern because of its significant association with poor quality of life (QOL), which in turn increases healthcare utilization and costs. There is no study about unmet supportive care needs of breast cancer patients in Malaysia. This study aims to assess the most prevalent unmet supportive care needs of Malaysian breast cancer patients and the association between QOL and patients' characteristics, and their unmet supportive care needs.
Fulltext Mammography screening uptake among hospital personnel in Kuala Lumpur tertiary hospital

Abdullah NN, Aziz NA, Rampal S, Al-Sadat N

Asian Pac J Cancer Prev, 2011;12(10):2643-7.
PMID: 22320967

BACKGROUND: Breast cancer is the most common cancer among women in Malaysia. Of the total cancer cases registered in the National Cancer Registry for 2006, 3,525 were female breast cancer cases. The overall age standardized rate was 39.3 per 100,000 population in 2006. An estimated 30%-40% were diagnosed in the late stages and this had resulted in poor survival rates. The purpose of the study was to determine the factors and barriers related to mammography screening uptake among hospital personnel.

METHODS: This mixed method explanatory study was carried out on a universal sampling of 707 female personnel aged 40 and above, from June 2007 until November 2007. The study was conducted at University Malaya Medical Centre, a tertiary hospital in Kuala Lumpur. Pre-tested self-administered questionnaires were mailed to eligible personnel.

RESULTS: The prevalence of mammography screening uptake was 80.3% (95%CI: 76.8%,83.5%) among 534 respondents. Personnel who had physician recommendation had significantly higher odds of mammography screening uptake compared to those who did not have recommendation, adjusted odds ratio of 21.25 (95%CI:12.71,36.56). Reported barriers can be grouped into several themes; negative perception of the procedure like embarrassment due to the presence of male technicians/radiographers; low confidence with radiologist/radiographers in detecting abnormality; lack of coping skills in dealing with expected results and pain during procedure.

CONCLUSIONS: The findings of this study highlighted that 20% of personnel did not undertake mammography screening although there is no cost incurred and the procedure is fully accessible to them. Opportunistic recommendation by physician and concerns on the procedure should be addressed.
Fulltext Efficacy of Harmonic Scalpel Versus Bipolar Diathermy in Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Nine Randomized Controlled Trials

Albazee E, Alenezi A, Alenezi M, Alabdulhadi R, Alhubail RJ, Ahmad Al Sadder K, et al.

Cureus, 2023 Feb;15(2):e34734.
PMID: 36755770 DOI: 10.7759/cureus.34734

Hemorrhoidectomy is one of the most common surgical interventions to remove the third and fourth degrees of prolapse hemorrhoid. We carried out this systematic review and meta-analysis of the randomized controlled trials (RCTs) to comprehensively evaluate the efficacy of harmonic scalpel (HS) versus bipolar diathermy (BD) methods in terms of decreasing intraoperative and postoperative morbidities among patients undergoing hemorrhoidectomy. Suitable citations were found utilizing digital medical sources, including the CENTRAL, Web of Science, PubMed, Scopus, and Google Scholar, from inception until December 2022. Only RCTs that matched the inclusion requirements were selected. We used the updated Cochrane risk of bias (ROB) tool (version 2) to assess the quality of the involved citations. The Review Manager (version 5.4 for Windows) was used to perform the pooled analysis. Data were pooled and reported as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in random-effects models. Overall, there was no significant difference between HS and BD in terms of decreasing intraoperative morbidities like operative time, intraoperative blood loss, mean duration of hospital stay, and mean duration of first bowel movement (P>0.05). Similarly, the rate of postoperative complications like pain, bleeding, urinary retention, anal stenosis, flatus incontinence, and wound edema; was similar in both groups with no significant difference (P>0.05). In conclusion, our pooled analysis revealed there was no substantial difference between HS and BD in terms of intraoperative and postoperative endpoints. Additional RCTs with larger sample sizes are needed to consolidate the power and quality of the presented evidence.
Unplanned PICU Readmission in a Middle-Income Country: Who Is at Risk and What Is the Outcome?

Mat Bah MN, Syed Mohamed SA, Abdullah N, Alias EY

Pediatr Crit Care Med, 2020 11;21(11):e959-e966.
PMID: 32590834 DOI: 10.1097/PCC.0000000000002406

OBJECTIVES: To study the rate of unplanned PICU readmission, determine the risk factors and its impact on mortality.
DESIGN: A single-center retrospective cross-sectional study.
SETTING: Tertiary referral PICU in Johor, Malaysia.
PATIENTS: All children admitted to the PICU over 8 years were included. Patients readmitted into PICU after the first PICU discharge during the hospitalization period were categorized into "early" (within 48 hr) and "late" (after 48 hr), and factors linked to the readmissions were identified. The mortality rate was determined and compared between no, early, and late readmission.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: There were 2,834 patients in the study with 70 early and 113 late readmissions. Therefore, the rate of early and late PICU readmission was 2.5% (95% CI, 1.9-3.0%) and 3.9% (95% CI, 3.2-4.7%), respectively. The median length of stay of the second PICU admission for early and late readmissions was 2.7 days (interquartile range, 1.1-7.0 d) and 3.2 days (interquartile range, 1.2-7.5 d), respectively. The majority of early and late readmissions had a similar diagnosis with their first PICU admission. Multivariable multinomial logistic regression revealed a Pediatric Index Mortality 2 score of greater than or equal to 15, chronic cardiovascular condition, and oxygen supplement upon discharge as independent risk factors for early PICU readmission. Meanwhile, an infant of less than 1 year old, having cardiovascular, other congenital and genetic chronic conditions and being discharged between 8 AM and 5 PM was an independent risk factor for late readmission. There was no significant difference in the mortality rate of early (12.9%), late (13.3%), and no readmission (10.7%).
CONCLUSIONS: Despite the lack of resources and expertise in lower- and middle-income countries, the rate and factors for PICU readmission are similar to those in high-income countries. However, PICU readmission has no statistically significant association with mortality.
Fulltext Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia

Mat Bah MN, Tan RYH, Razak H, Sapian MH, Abdullah N, Alias EY

J Perinatol, 2021 04;41(4):786-793.
PMID: 33589728 DOI: 10.1038/s41372-021-00962-6

OBJECTIVE: This study aims to determine the immediate outcome of persistent pulmonary hypertension of the newborn (PPHN) and risk factors for mortality in the era of inhaled nitric oxide (iNO).
STUDY DESIGN: This observational cross-sectional study includes 195 confirmed PPHN with a gestational age of ≥34 weeks without congenital heart disease. Multivariable logistic regression was used to identify risk factors for mortality.
RESULTS: The mortality rate was 16.4%, with the highest mortality with pulmonary hypoplasia. Of 195, 65% received iNO; 18% were iNO non-responders with the majority having pulmonary hypoplasia. Independent risk factors for mortality were the presence of reversal of flow at the descending aorta, pulmonary hypoplasia, APGAR scores ≤ 5 at 5 min, and idiopathic PPHN with an adjusted odds ratio of 15.9, 7.5, 6.7, and 6.4, respectively.
CONCLUSIONS: Despite the usage of iNO, mortality due to PPHN remains high and is related to etiology and cardiac function.

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