MyMedR

Fulltext Using pulsed-field gel electrophoresis in the molecular investigation of an outbreak of Serratia marcescens infection in an intensive care unit

Alfizah H, Nordiah AJ, Rozaidi WS

Singapore Med J, 2004 May;45(5):214-8.

PMID: 15143356

Serratia marcescens is a well-known cause of nosocomial infections and outbreaks, particularly in immunocompromised patients with severe underlying disease. An outbreak due to S. marcescens infection was detected from 13 to 22 February 2001 at the intensive care unit (ICU) of our institution. We used pulsed-field gel electrophoresis (PFGE) typing to analyse the outbreak strains involved.

Matched MeSH terms: Intensive Care Units

Fulltext A ten-year retrospective study of tetanus at a general hospital in Malaysia

Lau LG, Kong KO, Chew PH

Singapore Med J, 2001 Aug;42(8):346-50.

PMID: 11764050

To study the demographic and clinical features as well as outcomes of tetanus patients at the Sarawak General Hospital, Kuching from 1990 to 1999.

Matched MeSH terms: Intensive Care Units

Fulltext Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units

Boo NY, Cheah IG

Singapore Med J, 2016 Mar;57(3):144-52.

PMID: 26996633 DOI: 10.11622/smedj.2016056

This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR).

Matched MeSH terms: Intensive Care Units, Neonatal*

Fulltext Impact of infection control training for interns on PICU-acquired bloodstream infections in a middle-income country

Ng YY, Abdel-Latif Mel-A, Gan CS, Siham A, Zainol H, Lum LC

Singapore Med J, 2015 Sep;56(9):506-12.

PMID: 26451053 DOI: 10.11622/smedj.2015135

The present study aimed to determine the impact of an extended infection control training programme, which was conducted for all interns posted to the Department of Paediatrics, on the incidence of paediatric intensive care unit (PICU)-acquired bloodstream infections (BSIs) in University Malaya Medical Centre, Malaysia.

Matched MeSH terms: Intensive Care Units, Pediatric*

Fulltext Usefulness of a semi-quantitative procalcitonin test kit for early diagnosis of neonatal sepsis

Boo NY, Nor Azlina AA, Rohana J

Singapore Med J, 2008 Mar;49(3):204-8.

PMID: 18363001

This study was designed to determine the sensitivity and specificity of a semi-quantitative procalcitonin (PCT) test kit for the diagnosis of neonatal sepsis.

Matched MeSH terms: Intensive Care Units, Neonatal

Fulltext Predictors of newborn admission after labour induction at term: Bishop score, pre-induction ultrasonography and clinical risk factors

Tan PC, Suguna S, Vallikkannu N, Hassan J

Singapore Med J, 2008 Mar;49(3):193-8.

PMID: 18362999

Following labour induction at term, 12 percent of neonates can expected to be admitted to the neonatal intensive care unit. We aimed to evaluate the Bishop score, pre-induction ultrasonography (US) assessment of amniotic fluid, foetal weight and cervical length, and pre-induction and intrapartum risk factors as predictors of neonatal admission.

Matched MeSH terms: Intensive Care Units, Neonatal

Fulltext Neonatal resuscitation programme in Malaysia: an eight-year experience

Boo NY

Singapore Med J, 2009 Feb;50(2):152-9.

PMID: 19296030

The neonatal resuscitation programme (NRP) published by the American Academy of Paediatrics and American Heart Association was launched in Malaysia in 1996. This study aimed to review the outcome of NRP in Malaysia during the first eight years.

Matched MeSH terms: Intensive Care Units, Neonatal

Fulltext A quality assurance study on the administration of medication by nurses in a neonatal intensive care unit

Raja Lope RJ, Boo NY, Rohana J, Cheah FC

Singapore Med J, 2009 Jan;50(1):68-72.

PMID: 19224087

This study aimed to determine the rates of non-adherence to standard steps of medication administration and medication administration errors committed by registered nurses in a neonatal intensive care unit before and after intervention.

Matched MeSH terms: Intensive Care Units, Neonatal*

Fulltext Early outcome of congenital diaphragmatic hernia in a Malaysian tertiary centre

Rohana J, Boo NY, Thambidorai CR

Singapore Med J, 2008 Feb;49(2):142-4.

PMID: 18301842

This prospective observational study was conducted to determine the outcome of newborns with congenital diaphragmatic hernia (CDH). They were managed with a protocol of gentle ventilation to avoid barotraumas, and inhaled nitric oxide (iNO) or intravenous magnesium sulphate for treatment of persistent pulmonary hypertension of newborns (PPHN).

Matched MeSH terms: Intensive Care Units, Neonatal

Fulltext A review of Orang Asli newborns admitted to a neonatal unit in a Malaysian general hospital

Kandasamy Y, Somasundram P

Singapore Med J, 2007 Oct;48(10):926-8.

PMID: 17909678

The Orang Asli are the indigenous population in peninsular Malaysia and are in fact a diverse sub-ethnic group with different languages. Our aim was to collect data on Orang Asli newborns, from western and central Pahang, that were admitted to a general hospital with paediatric specialist services.

Matched MeSH terms: Intensive Care Units, Neonatal/statistics & numerical data*

Fulltext Predictors of failed closure of patent ductus arteriosus with indomethacin

Boo NY, Mohd-Amin I, Bilkis AA, Yong-Junina F

Singapore Med J, 2006 Sep;47(9):763-8.

PMID: 16924357

Introduction: The aim of this study was to determine predictors of failed closure of patent ductus arteriosus (PDA) following a single course of indomethacin in symptomatic preterm infants.
Methods: This prospective observational study was carried out on 60 preterm infants weighing less than 1,750 g with symptomatic PDA confirmed by echocardiography. At a median age of 7.0 days (interquartile range 4.0), they were given indomethacin of 0.1 mg/kg/day intravenously daily for six days. Closure of PDA was reassessed by echocardiography upon completion of therapy.
Results: The PDA of 40 percent (n=24) of these infants remained patent. Forward logistic regression analysis showed that the only significant predictors of failed PDA closure in these infants were: PDA size (adjusted odds-ratio [OR] is 7.0; 95 percent confidence interval [CI] of OR is 2.0, 24.8; p-value is 0.002), birth weight (adjusted OR is 0.996; 95 percent CI of OR is 0.993, 1.000; p-value is 0.03) and platelet count (adjusted OR is 0.987; 95 percent CI is 0.975, 1.000; p-value is 0.045). Gestational age, maternal age and left atrium/aorta ratios were not significant predictors.
Conclusion: Larger PDA, lower birth weight and lower platelet count were significant predictors of high failure in indomethacin therapy given late at one week of life.

Matched MeSH terms: Intensive Care Units, Neonatal

Fulltext Impact of pre-dilution and flushing on continuous renal replacement therapy

Koh KH

Singapore Med J, 2006 Sep;47(9):785-95.

PMID: 16924361

Infusing the replacement solution before the filter (pre-dilution) and regular flushing have not been accounted for in conventional mathematical equations. Their effects on various continuous renal replacement therapy (CRRT) parameters, such as ultrafiltration fraction and urea clearance, have not been well studied. We incorporated these parameters into mathematical equations to help in understanding and prescribing CRRT.

Matched MeSH terms: Intensive Care Units

Fulltext An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in Singapore: a 20-month study of clinical characteristics and control

Tan KW, Tay L, Lim SH

Singapore Med J, 1994 Jun;35(3):277-82.

PMID: 7997904

Methicillin resistant Staphylococcus aureus (MRSA) is a major infection control problem in many countries. There have been many reports of outbreaks in neonatal nurseries including, in our part of the world, Australia, Hong Kong and Malaysia. A recent outbreak of MRSA in the neonatal intensive care unit in the Kandang Kerbau Hospital, Singapore, presented us with the opportunity to study the clinical characteristics of the outbreak and the effects of infection control measures. Neonates admitted to the neonatal intensive care unit were studied over a 20-month period. They were all screened for nasal colonisation on admission and weekly thereafter. Infections were documented. Over this period there were altogether 2,576 admissions of which 85 infants had nasal colonisation with MRSA (3.3%) and 28 developed infections (1%). Although the majority of infants colonised by MRSA suffered no ill effects, 3 had septicaemia and 2 had septicaemia with osteomyelitis. There were no deaths. Standard infection control measures with barrier nursing and the use of mupirocin nasal ointment were ineffective, and control was achieved only after strict cohorting together with the use of mupirocin was instituted. This was done without additional costs to the department and without additional nurses or doctors.

Matched MeSH terms: Intensive Care Units, Neonatal*

Fulltext The burden of hypoxic-ischaemic encephalopathy in Malaysian neonatal intensive care units

Boo NY, Cheah IG

Singapore Med J, 2016 Aug;57(8):456-63.

PMID: 27549510 DOI: 10.11622/smedj.2016137

INTRODUCTION: This study aimed to determine the incidence of hypoxic-ischaemic encephalopathy (HIE) and predictors of HIE mortality in Malaysian neonatal intensive care units (NICUs).

METHODS: This was a retrospective study of data from 37 NICUs in the Malaysian National Neonatal Registry in 2012. All newborns with gestational age ≥ 36 weeks, without major congenital malformations and fulfilling the criteria of HIE were included.

RESULTS: There were 285,454 live births in these hospitals. HIE was reported in 919 newborns and 768 of them were inborn, with a HIE incidence of 2.59 per 1,000 live births/hospital (95% confidence interval [CI] 2.03, 3.14). A total of 144 (15.7%) affected newborns died. Logistic regression analysis showed that the significant predictors of death were: chest compression at birth (adjusted odds ratio [OR] 2.27, 95% CI 1.27, 4.05; p = 0.003), being outborn (adjusted OR 2.65, 95% CI 1.36, 5.13; p = 0.004), meconium aspiration syndrome (MAS) (adjusted OR 2.16, 95% CI 1.05, 4.47; p = 0.038), persistent pulmonary hypertension of the newborn (PPHN) (adjusted OR 4.39, 95% CI 1.85, 10.43; p = 0.001), sepsis (adjusted OR 4.46, 95% CI 1.38, 14.40; p = 0.013), pneumothorax (adjusted OR 4.77, 95% CI 1.76, 12.95; p = 0.002) and severe HIE (adjusted OR 42.41, 95% CI 18.55, 96.96; p < 0.0001).

CONCLUSION: The incidence of HIE in Malaysian NICUs was similar to that reported in developed countries. Affected newborns with severe grade of HIE, chest compression at birth, MAS, PPHN, sepsis or pneumothorax, and those who were outborn were more likely to die before discharge.

Matched MeSH terms: Intensive Care Units, Neonatal*

Pharmacokinetic/Pharmacodynamics-Optimized Antimicrobial Therapy in Patients with Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia

Sulaiman H, Abdul-Aziz MH, Roberts JA

Semin Respir Crit Care Med, 2017 06;38(3):271-286.

PMID: 28578552 DOI: 10.1055/s-0037-1602716

Hospital-acquired pneumonia and ventilator-associated pneumonia continue to cause significant morbidity and mortality. With increasing rates of antimicrobial resistance, the importance of optimizing antibiotic treatment is key to maximize treatment outcomes. This is especially important in critically ill patients in intensive care units, in whom the infection is usually caused by less susceptible organisms. In addition, the marked physiological changes that can occur in these patients can cause serious changes in antibiotic pharmacokinetics which in turn alter the attainment of therapeutic drug exposures. This article reviews the various aspects of the pharmacokinetic changes that can occur in the critically ill patients, the barriers to achieving therapeutic drug exposures in pneumonia for systemically delivered antibiotics, the optimization for commonly used antibiotics in hospital- and ventilator-associated pneumonia, the agents that should be avoided in the treatment regimen, as well as the use of adjunctive therapy in the form of nebulized antibiotics.

Matched MeSH terms: Intensive Care Units

Fulltext Predicting need for intensive care unit admission in adult emphysematous pyelonephritis patients at emergency departments: comparison of five scoring systems

Yap XH, Ng CJ, Hsu KH, Chien CY, Goh ZNL, Li CH, et al.

Sci Rep, 2019 11 12;9(1):16618.

PMID: 31719593 DOI: 10.1038/s41598-019-52989-7

This study assesses the performance of National Early Warning Score (NEWS), Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting emphysematous pyelonephritis (EPN) patients' need for intensive care unit (ICU) admission. A retrospective analysis was conducted at four training and research hospitals' emergency departments (EDs) on all EPN adult patients from January 2007 to August 2017. Data extracted were used to calculate raw scores for five physiologic scoring systems. Mann-Whitney U tests and χ2 tests were done for numerical and categorical variables respectively to examine differences between characteristics of ICU and non-ICU patient populations. Predictability of ICU admission was evaluated with AUROC analysis. ICU patients had lower GCS scores, SpO2, platelet counts, and estimated glomerular filtration rate; and higher bands, blood urea nitrogen, creatinine, and incidences of septic shock and nephrectomy. NEWS performed best, with 73.85% accuracy at optimal cut-off of 3. In this multicentre ED EPN series, we recommend using NEWS in early identification of critical EPN patients and advance planning for ICU admission. This would reduce delays in ICU transfer and ultimately improve patient outcomes.

Matched MeSH terms: Intensive Care Units*

Fulltext Neonatal intensive care unit (NICU) exposures exert a sustained influence on the progression of gut microbiota and metabolome in the first year of life

Yap PSX, Chong CW, Ahmad Kamar A, Yap IKS, Choo YM, Lai NM, et al.

Sci Rep, 2021 01 14;11(1):1353.

PMID: 33446779 DOI: 10.1038/s41598-020-80278-1

Emerging evidence has shown a link between the perturbations and development of the gut microbiota in infants with their immediate and long-term health. To better understand the assembly of the gut microbiota in preterm infants, faecal samples were longitudinally collected from the preterm (n = 19) and term (n = 20) infants from birth until month 12. 16S rRNA gene sequencing (n = 141) and metabolomics profiling (n = 141) using nuclear magnetic resonance spectroscopy identified significant differences between groups in various time points. A panel of amino acid metabolites and central metabolism intermediates significantly correlated with the relative abundances of 8 species of bacteria were identified in the preterm group. In contrast, faecal metabolites of term infants had significantly higher levels of metabolites which are commonly found in milk such as fucose and β-hydroxybutyrate. We demonstrated that the early-life factors such as gestational age, birth weight and NICU exposures, exerted a sustained effect to the dynamics of gut microbial composition and metabolism of the neonates up to one year of age. Thus, our findings suggest that intervention at this early time could provide 'metabolic rescue' to preterm infants from aberrant initial gut microbial colonisation and succession.

Matched MeSH terms: Intensive Care Units, Neonatal*

Fulltext Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of the Intensive Care Unit - A Systematic Review & Meta-analysis

Tan TL, Tang YJ, Ching LJ, Abdullah N, Neoh HM

Sci Rep, 2018 Nov 12;8(1):16698.

PMID: 30420768 DOI: 10.1038/s41598-018-35144-6

The purpose of this meta-analysis was to compare the ability of the qSOFA in predicting short- (≤30 days or in-hospital mortality) and long-term (>30 days) mortality among patients outside the intensive care unit setting. Studies reporting on the qSOFA and mortality were searched using MEDLINE and SCOPUS. Studies were included if they involved patients presenting to the ED with suspected infection and usage of qSOFA score for mortality prognostication. Data on qSOFA scores and mortality rates were extracted from 36 studies. The overall pooled sensitivity and specificity for the qSOFA were 48% and 86% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Odd ratio, OR = 5.6; 95% CI = 4.6-6.8; Higgins's I2 = 94%), while long-term mortality studies were homogenous (OR = 4.7; 95% CI = 3.5-6.1; Higgins's I2 = 0%). There was no publication bias for short-term mortality analysis. The qSOFA score showed poor sensitivity but moderate specificity for both short and long-term mortality, with similar performance in predicting both short- and long- term mortality. Geographical region was shown to have nominal significant (p = 0.05) influence on qSOFA short-term mortality prediction.

Matched MeSH terms: Intensive Care Units/statistics & numerical data*

Fulltext Acute kidney injury in intensive care unit, hospital Universiti Sains Malaysia: A descriptive study

Hamid SA, Adnan WW, Naing NN, Adnan AS

Saudi J Kidney Dis Transpl, 2018 11 2;29(5):1109-1114.

PMID: 30381507 DOI: 10.4103/1319-2442.243961

Acute kidney injury (AKI) was frequently encountered complication among intensive care unit (ICU) patients and recognized as a major public health problem. The present study aimed to determine the basic features of AKI patients admitted to ICU. A retrospective cohort study was conducted among 106 AKI patients admitted to ICU, Hospital Universiti Sains Malaysia from January 1, 2007 until the end of December 2013. The AKI patients ranged from 18 to 80 years old with the mean (standard deviation) of 58.93 (15.76) years, 60.4% were male and 91.5% were Malay ethnicity. Hypertension and diabetes were in 38.1% and 28.8%, respectively. The median (interquartile range) length of ICU stay was 4.50 (9.00) days. Eighty-two patients (79.6%) were classified as the Acute Kidney Injury Network (AKIN)-I, 12 (11.7%) as AKIN-II, and nine (8.7%) as AKIN-III. Sepsis was the common etiology among AKI patients (74.3%). Twenty-four patients (22.9%) required dialysis and 90.5% were mechanically ventilated. In conclusion, AKI developed more in male patients, Malay ethnicity, presented with comorbid, caused by sepsis, admitted to ICU, required mechanical ventilation, and need for renal replacement therapy.

Matched MeSH terms: Intensive Care Units*

Fulltext Associated factors of dialysis-dependence among acute kidney injury patients in intensive care unit

Kamaruddin M, Hamid SA, Adnan AS, Naing NN, Wan Adnan WN

Saudi J Kidney Dis Transpl, 2019 11 8;30(5):1131-1136.

PMID: 31696852 DOI: 10.4103/1319-2442.270269

Acute kidney injury (AKI) is a common problem in hospitals and many end up requiring dialysis. The aim was to identify the associated factors of dialysis-dependent of AKI patients admitted to the intensive care units (ICUs). A retrospective cohort study was conducted where a list of 121 AKI patients admitted to ICU in Hospital Universiti Sains Malaysia was retrospectively reviewed. AKI patients aged below 18 years old, had kidney transplantation or chronic dialysis before ICU admission and had incomplete medical record were excluded from the study. Simple and multiple logistic regression analysis were used. The mean [standard deviation (SD)] age of patients was 56 (17.15) years. Majority of patients were males (63.2%) and Malay ethnic (54.1%). 49.3% of patients were in stage I, 48.3% in stage II and 76.2% in stage III. The mean (SD) duration of patients stayed in ICU was 7 days (6.92) for non-dialysis dependent and 12 days (8.37) for dialysis-dependent. The associated factors were male gender [adjusted odds ratio (OR): 3.68; 95% confidence interval [CI]: 1.53, 8.86; P = 0.004], AKI Stage III (adjusted OR: 4.51; 95% CI: 1.28, 15.91; P = 0.019), admitted in ICU (adjusted OR: 3.05; 95% CI: 1.28, 7.29; P = 0.012), and longer length of stay (adjusted OR: 1.10; 95% CI: 1.03, 1.18; P = 0.003). The factors influence of dialysis-requiring AKI were observed to be dependent on the male male gender, suffer from the advanced stage (Stage III), admitted to the ICU and had a longer length of stay in ICU. Therefore, it is important for physicians to identify patients who are at high risk of developing AKI and implement preventive strategies.

Matched MeSH terms: Intensive Care Units*

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