ORCID Profile
0000-0002-3776-7454
Current Organisations
Malaysian Society of Intensive Care
,
Universiti Malaya
,
Academia Diplomatica de Chile Andres Bello
,
European Society of Intensive Care Medicine
,
Monash University Malaysia
,
University Malaya Medical Centre
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Publisher: S. Karger AG
Date: 2014
DOI: 10.1159/000363220
Abstract: b i Objectives: /i /b To measure plasma pro-apoptotic and pro-necrotic activity in severe acute kidney injury (AKI) patients within a randomized controlled trial of continuous veno-venous hemofiltration with high cut-off filters (CVVH-HCO) versus standard filters (CVVH-Std). b i Methods: /i /b We measured pro-apoptotic and pro-necrotic plasma activity by trypan blue exclusion cell viability assay, detection of DNA fragmentation, and by determination of caspase-3 activity and annexin V-based apoptosis and necrosis detection assay. b i Results: /i /b Compared to no apoptosis or necrosis after incubation with healthy plasma, 14-18% of cells showed apoptosis and 4-8% showed necrosis after incubation with plasma from AKI patients. When comparing different measures of pro-apoptotic or pro-necrotic activity, CVVH-HCO and CVVH-Std showed no differential effects on such activity, which remained high over the first 3 days of treatment. However, using annexin V-FITC, there was a significant drop in pro-apoptotic activity across the filter for the CVVH-HCO group (p = 0.043) but not for the CVVH-Std group (p = 0.327) and a significant difference between the two groups (CVVH-HCO vs. CVVH-Std p = 0.006). b i Conclusions: /i /b Patients with severe AKI have increased pro-apoptotic and pro-necrotic activity. Although on single-pass effect assessment, CVVH-HCO was superior to CVVH-Std in decreasing annexin V-FITC-assessed pro-apoptotic activity, there was no overall attenuation of such activity during the first 3 days of treatment.
Publisher: American Astronomical Society
Date: 05-02-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2018
DOI: 10.1097/CCM.0000000000003350
Abstract: In critically ill patients with acute kidney injury receiving vasopressors, high cytokine levels may sustain the shock state. High cutoff hemofiltration achieves greater cytokine removal in ex vivo and in animal models and may reduce the duration of shock but may also increase albumin losses. This was a single-center double-blind randomized controlled trial comparing continuous venovenous hemofiltration-high cutoff to continuous venovenous hemofiltration-standard. Tertiary care hospital in Australia. Vasopressor-dependent patients in acute kidney injury who were admitted to the ICU. Norepinephrine-free time were calculated in critically ill vasopressor-dependent patients in acute kidney injury, randomized to either continuous venovenous hemofiltration-high cutoff or continuous venovenous hemofiltration-standard. A total of 76 patients were randomized with the following characteristics (continuous venovenous hemofiltration-high cutoff vs continuous venovenous hemofiltration-standard) median age of 65 versus 70 year, percentage of males 47% versus 68%, and median Acute Physiology and Chronic Health Evaluation scores of 25 versus 23.5. The median hours of norepinephrine-free time at day 7 were 32 (0–110.8) for continuous venovenous hemofiltration-high cutoff and 56 hours (0–109.3 hr) ( p = 0.520) for continuous venovenous hemofiltration-standard. Inhospital mortality was 55.6% with continuous venovenous hemofiltration-high cutoff versus 34.2% with continuous venovenous hemofiltration-standard (adjusted odds ratio, 2.49 95% CI, 0.81–7.66 p = 0.191). There was no significant difference in time to cessation of norepinephrine ( p = 0.358), time to cessation of hemofiltration ( p = 0.563), and filter life ( p = 0.21). Serum albumin levels ( p = 0.192) were similar and the median dose of IV albumin given was 90 grams (20–212 g ) for continuous venovenous hemofiltration-high cutoff and 80 grams (15–132 g ) for continuous venovenous hemofiltration-standard ( p = 0.252). In critically ill patients with acute kidney injury, continuous venovenous hemofiltration-high cutoff did not reduce the duration of vasopressor support or mortality or change albumin levels compared with continuous venovenous hemofiltration-standard.
Publisher: EDP Sciences
Date: 04-2022
DOI: 10.1051/0004-6361/202142384
Abstract: Context. Submillimeter galaxies (SMGs) have been proposed as the progenitors of massive ellipticals in the local Universe. Mapping the neutral gas distribution and investigating the gas accretion toward the SMGs at high redshift can provide information on the way SMG environments can evolve into clusters at z = 0. Aims. In this work, we study the members of the protocluster around AzTEC-3, a submillimeter galaxy at z = 5.3. We use Ly α emission and its synergy with previous CO and [C II ]158 μm observations. Methods. We analyzed the data from the Multi Unit Spectroscopic Explorer (MUSE) instrument in an area of 1.4 × 1.4 arcmin 2 around AzTEC-3 and derived information on the Ly α line in emission. We compared the Ly α profile of various regions of the environment with the zELDA radiative transfer model, revealing the neutral gas distribution and kinematics. Results. We identified ten Ly α emitting sources, including two regions with extended emission: one embedding AzTEC-3 and LBG-3, which is a star-forming galaxy located 2″ (12 kpc) north of the SMG and another toward LBG-1, which is a star-forming galaxy located 15″ (90 kpc) to the southeast. The two regions extend for ∼27 × 38 kpc 2 (∼170 × 240 ckpc 2 ) and ∼20 × 20 kpc 2 (∼125 × 125 ckpc 2 ), respectively. The sources appear distributed in an elongated configuration of about 70″ (430 kpc) in extent. The number of sources confirms the overdensity around AzTEC-3. We study the MUSE spectra of the AzTEC-3+LBG-3 system and LBG-1 in detail. For the AzTEC-3+LBG-3 system, the Ly α emission appears redshifted and more spatially extended than the [C II ] line emission. Similarly, the Ly α line spectrum is broader in velocity than [C II ] for LBG-1. In the former spectrum, the Ly α emission is elongated to the north of LBG-3 and to the south of AzTEC-3, where a faint Ly α emitting galaxy is also located. The elongated structures could resemble tidal features due to the interaction of the two galaxies with AzTEC-3. Also, we find a bridge of gas, revealed by the Ly α emission between AzTEC-3 and LBG-3. The Ly α emission toward LBG-1 embeds its three components. The HI kinematics support the idea of a merger of the three components. Conclusions. Given the availability of CO and [C II ] observations from previous c aigns, and the Ly α information from our MUSE dataset, we find evidence of starburst-driven phenomena and interactions around AzTEC-3. The stellar mass of the galaxies of the overdensity and the Ly α luminosity of the HI nebula associated with AzTEC-3 imply a dark matter halo of ∼10 12 M ⊙ at z = 5.3. By comparing this with semi-analytical models, the dark matter halo mass indicates that the region could evolve into a cluster of 2 × 10 13 M ⊙ by z = 2 and into a Fornax-type cluster at z = 0 with a typical mass of 2 × 10 14 M ⊙ .
Publisher: Frontiers Media SA
Date: 09-01-2023
DOI: 10.3389/FMED.2022.1086288
Abstract: Coronavirus disease 2019 (COVID-19) emerged with a wide range of clinical presentations Malaysia was not spared from its impact. This study describes the clinical characteristics of COVID-19 patients admitted to intensive care unit, their clinical course, management, and hospital outcomes. COVIDICU-MY is a retrospective analysis of COVID-19 patients from 19 intensive care units (ICU) across Malaysia from 1 March 2020 to 31 May 2020. We collected epidemiological history, demographics, clinical comorbidities, laboratory investigations, respiratory and hemodynamic values, management, length of stay and survival status. We compared these variables between survival and non-survival groups. A total of 170 critically ill patients were included, with 77% above 50 years of age [median age 60, IQR (51–66)] and 75.3% male. Hypertension, diabetes mellitus, hyperlipidemia, chronic cardiac disease, and chronic kidney disease were most common among patients. A high Simplified Acute Physiology Score (SAPS) II score [median 45, IQR (34–49)] and Sequential Organ Failure Assessment (SOFA) score [median 8, IQR (6–11)] were associated with mortality. Patients were profoundly hypoxic with a median lowest PaO 2 /FiO 2 ratio of 150 (IQR 99–220) at admission. 91 patients (53.5%) required intubation on their first day of admission, out of which 38 died (73.1% of the hospital non-survivors). Our s le had more patients with moderate Acute Respiratory Distress Syndrome (ARDS), 58 patients (43.9%), compared to severe ARDS, 33 patients (25%) with both ARDS classification groups contributing to 25 patients (54.4%) and 11 patients (23.9%) of the non-survival group, respectively. Cumulative fluid balance over 24 h was higher in the non-survival group with significant differences on Day 3 (1,953 vs. 622 ml, p & 0.05) and Day 7 of ICU (3,485 vs. 830 ml, p & 0.05). Patients with high serum creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and low lymphocyte count throughout the stay also had a higher risk of mortality. The hospital mortality rate was 30.6% in our s le. We report high mortality amongst critically ill patients in intensive care units in Malaysia, at 30.6%, during the March to May 2020 period. High admission SAPS II and SOFA, and severe hypoxemia and high cumulative fluid balance were associated with mortality. Higher creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and lymphopenia were observed in the non-survival group.
Publisher: Public Library of Science (PLoS)
Date: 20-09-2022
DOI: 10.1371/JOURNAL.PONE.0273071
Abstract: Dengue infection is the most prevalent mosquito-borne viral infection globally. Concurrently, there has also been an upsurge of non-communicable comorbidities. We aimed to investigate the association between these comorbidities and the development of severe dengue. We performed a retrospective, case-control study involving 117 cases with severe dengue and 351 controls with non-severe dengue matched according to gender, age (+/- 5 years old), and admission date (+/- 2 weeks). We analyzed the data using conditional odds ratio (cOR) and adjusted conditional odds ratio (AcOR) using univariate and multivariable conditional logistic regression respectively. Six main comorbidities namely obesity, diabetes mellitus, hypertension, hyperlipidemia, chronic pulmonary disease, and ischemic heart disease were observed among cases and controls. Multivariable conditional logistic regression model found only hypertension to be independently associated with the development of severe dengue (ACOR 2.46 95% CI:1.09–5.53). Among symptoms at presentation, lethargy, vomiting, bleeding manifestations, and abdominal pain were associated with increased odds of severe dengue, although the associations were not statistically significant. Headache (ACOR: 0:32 95% CI: 0.21–0.51) and skin rash (ACOR: 0.42 95% CI: 0.22–0.81) were associated with significantly lower odds of severe dengue. Severe dengue patients were also found to have significantly higher white cell count, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase on admission, while platelet and albumin were significantly lower compared to non-severe dengue patients. Our study found a significant association between hypertension and the development of severe dengue in adult patients. For clinical practice, this finding suggests that dengue patients with underlying hypertension warrant closer clinical monitoring for deterioration. The association between significant derangement in various laboratory parameters and severe dengue as shown in this study is in keeping with previous reports. While further substantiation by larger prospective studies will be desirable, this association may serve to inform the dengue triaging process.
Publisher: SAGE Publications
Date: 09-2016
DOI: 10.5301/IJAO.5000527
Abstract: To study the effects of continuous veno-venous hemofiltration (CVVH) with high cut-off filters (CVVH-HCO) on plasma cytokine levels, sieving coefficient and clearance compared to CVVH using standard filters (CVVH-Std) in a nested cohort within a double-blind randomized controlled trial in severe acute kidney injury (AKI) patients. We measured plasma and post-filter levels of IL-6, TNF-alpha, IL-8, IL-1 beta, RANTES, IL-10, IFN-gamma and IFN-alpha in both study groups. We also measured cytokine levels in the ultrafiltrate and calculated sieving coefficients and clearances. By 72 hours of treatment, IL-6 had decreased during both treatments (p = 0.009 and 0.005 respectively). In contrast, IL-10 had decreased with CVVH-Std (p = 0.03) but not CVVH-HCO (p = 0.135). None of the other cytokines showed changes over time. There were also no significant between group differences in plasma levels for each cytokine over the 72-hour treatment period. For all cytokines combined, however, the median sieving coefficient was higher for CVVH-HCO (0.31 vs. 0.16 p = 0.042) as was the mass removal rate by ultrafiltration (p = 0.027). While overall combined cytokine levels had fallen to 62.2% of baseline at 72 hours for CVVH-HCO (p .0001) and to 75.9% of baseline with CVVH-Std (p = 0.008) there were no between group differences. CVVH-HCO achieved greater combined sieving coefficient and mass removal rate by ultrafiltration for a group of key cytokines than CVVH-Std. However, this effect did not differentially lower their plasma level over the first 72 hours. Our study does not support the use of CVVH-HCO to lower cytokines in critically ill patients with AKI.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Informa UK Limited
Date: 19-07-2013
Publisher: SAGE Publications
Date: 28-02-2013
DOI: 10.5301/IJAO.5000128
Abstract: Extracorporeal cytokine removal may be desirable. We sought to assess extracorporeal blood purification (EBP) techniques for cytokine removal in experimental animal studies. We conducted a targeted, systematic search and identified 17 articles. We analyzed cytokine clearance, sieving coefficient (SC), ultrafiltrate (UF) concentration, and percentage removal. As this review concerns technical appraisal of EBP techniques, we made no attempts to appraise the methodology of the studies included. Results are in descriptive terms only. Applying predicted clearance for 80 kg human, high volume hemofiltration (HVHF) techniques and plasmafiltration (PF) showed the highest rates of cytokine removal. High cutoff (HCO)/HF and PF techniques showed modest ability to clear cytokines using low to medium flows. Standard hemofiltration had little efficacy. At higher flows, HCO/HF achieved clearances between 30 and 70 ml/min for IL-6 and IL-10. There was essentially no removal of tumor necrosis factor (TNF)-alpha outside of PF. Experimental animal studies indicate that HVHF (especially with HCO filters) and plasmafiltration have the potential to achieve appreciable IL-6 and IL-10 clearances. However, only PF can remove TNF-alpha reliably.
Publisher: Wiley
Date: 14-03-2017
Publisher: Elsevier BV
Date: 09-2022
Publisher: Unpublished
Date: 2017
Publisher: Monash University
Date: 2019
Publisher: Elsevier BV
Date: 12-2013
Publisher: American Astronomical Society
Date: 02-2016
Publisher: American Astronomical Society
Date: 14-03-2013
Publisher: S. Karger AG
Date: 2012
DOI: 10.1159/000333845
Abstract: i Background and Aims: /i Attempts at achieving cytokine homeostasis include blood purification to deliver cytokine removal. Assessment of ex vivo studies for optimal operating conditions is a vital step. i Methods: /i We conducted a systematic search for ex vivo studies on cytokine removal using known modalities of extracorporeal circulation. We selected 29 articles and analyzed data according to clearance, sieving coefficient, ultrafiltrate concentration and percentage removal. i Results: /i We identified four main techniques for cytokine removal: standard techniques, high cut-off (HCO) techniques, adsorption techniques and combined plasma filtration adsorption. HCO hemofiltration (HCO/HF) showed greatest consistency in cytokine removal among all approaches. Mean albumin clearance with HCO filters was 3.74 ml/min. i Conclusion: /i Ex vivo data support the view that HCO/HF is the most consistently effective approach in terms of sieving and clearance. Further investigation of HCO/HF in randomized controlled trials in animal models and humans seems desirable.
Location: Australia
No related grants have been discovered for Rafidah Atan.