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Fulltext Limitations of cytochrome oxidase I for the barcoding of Neritidae (Mollusca: Gastropoda) as revealed by Bayesian analysis

Chee SY

Genet. Mol. Res., 2015;14(2):5677-84.
PMID: 26125766 DOI: 10.4238/2015.May.25.20

The mitochondrial DNA (mtDNA) cytochrome oxidase I (COI) gene has been universally and successfully utilized as a barcoding gene, mainly because it can be amplified easily, applied across a wide range of taxa, and results can be obtained cheaply and quickly. However, in rare cases, the gene can fail to distinguish between species, particularly when exposed to highly sensitive methods of data analysis, such as the Bayesian method, or when taxa have undergone introgressive hybridization, over-splitting, or incomplete lineage sorting. Such cases require the use of alternative markers, and nuclear DNA markers are commonly used. In this study, a dendrogram produced by Bayesian analysis of an mtDNA COI dataset was compared with that of a nuclear DNA ATPS-α dataset, in order to evaluate the efficiency of COI in barcoding Malaysian nerites (Neritidae). In the COI dendrogram, most of the species were in individual clusters, except for two species: Nerita chamaeleon and N. histrio. These two species were placed in the same subcluster, whereas in the ATPS-α dendrogram they were in their own subclusters. Analysis of the ATPS-α gene also placed the two genera of nerites (Nerita and Neritina) in separate clusters, whereas COI gene analysis placed both genera in the same cluster. Therefore, in the case of the Neritidae, the ATPS-α gene is a better barcoding gene than the COI gene.
Fulltext Dietary management of hyperlipidaemia - a survey amongst Malaysian dietitians

Karupaiah T, Chee SS

Malays J Nutr, 1997;3(2):117-130.
MyJurnal

Coronary Heart Disease (CHD) is recognised as an important public health problem in Malaysia. Hyperlipidaemia is one of the main risk factors related to CHD. The mainstay of treatment is diet therapy which should be maintained even if drug treatment is indicated. Since dietitians are the primary providers of dietary treatment to hyperlipidaemic patients, this retrospective study attempts to report the dietary approaches and methodologies adopted by Malaysian dietitians in managing their patients. A postal questionnaire covering various aspects of dietary management of hyperlipidaemia were sent to 47 dietitians practicing in private and government hospitals. A response rate of 53 % was elicited. The survey found that there was a disparity amongst the respondents in the approach to the dietary management of hyperlipidaemia in Malaysia. This was largely due to the absence of a standardised dietary protocol for general lipid lowering in patients with hyperlipidaemia.
Study site: Private and public hospitals in Malaysia
Fulltext Resemblance in dietary habits and calcaneal ultrasound attenuation in malay mother-daughter pairs

Chee S, Lee S

Malays J Nutr, 2003 Sep;9(2):85-93.
PMID: 22691730 MyJurnal

The relationship between dietary habits and bone health status was evaluated in 61 pairs of premenopausal mothers and their biological daughters aged 10-19 years. Subjects were volunteers living in Kuala Lumpur. Bone status of the calcaneus was assessed using Quantitative Ultrasound (QUS) which measured the Broadband Ultrasound Attenuation (BUA; in units of dB/MHz) of the bone. Daily nutrient intake of all subjects was evaluated using a 3-day dietary record. Reproductive history, food intake habits, and physical activity level were assessed using questionnaires. Bone health status of mothers (mean BUA of 98.0 ± 15.8 dB/MHz) was significantly higher (p<0.001) compared to their daughters (mean BUA of 86.4 ± 17.0 dB/MHz). BUA (r=0.30, p<0.05), weight (r=0.30, p<0.05) and BMI (r=0.32, p<0.05) were significantly correlated within mother-daughter pairs. Lifestyle characteristics such as calcium intake and physical activity were not correlated. However, other dietary habits (energy intake, milk intake and frequency of skipping meals) in daughters were significantly correlated with their mothers. This study suggests that mothers play an important role in influencing the dietary habits of their daughters, which in turn may affect their bone health status.
Fulltext Anthropometry, dietary patterns and nutrient intakes of Malaysian estate workers

Chee S, Zawiah H, Ismail M, Ng K

Malays J Nutr, 1996 Sep;2(2):112-26.
PMID: 22692134 MyJurnal

Studies were carried out in two estates in Kedah and Johor to characterize the anthropometry and dietary patterns of 334 (169 females, 165 males) Malaysian estate workers. Subjects were Malay and Indian adults (aged 18 to 60 years) engaged in various work activities including rubber tappers, palm fruit harvesters, field supervisors and workers in the estate factories. Anthropometric results showed that the prevalence of overweight (26% in men, 25% in women) and obesity (5% in men, 11% in women) were higher compared to prevalence of underweight (11% in men, 9% in women) in these workers despite being engaged in moderate to heavy activities. The dietary intake pattern revealed that the main sources of calories in the diet were rice, cooking oil and sugar. Major sources of protein in the Malay diet were anchovies and fish whilst in the Indian diet protein was provided by salted fish, anchovies, eggs, fish, and pulses. The consumption of poultry, meat and dairy products were low for both ethnic groups. The dietary intakes of a subsampel of 108 normal weight subjects (56 females, 52 males) were recorded for 3 days. The results showed that the mean energy intake was 8.44 ± 2.12 MJ in males and 6.48 ± 1.29 MJ in females. The contribution of calories from protein, fat and carbohydrate were 13%, 22% and 60% in males and 12%, 23% and 65% in females, respectively. Alcohol intake was found to contribute five percent of energy in the diet of the Indian male subjects. Calcium, iron, vitamin A, thiamin, riboflavin and niacin intake were below 66% of the Malaysian RDA, particularly amongst the women. Income appeared to have a significant correlation with energy and iron intakes of the female workers as well as thiamin, niacin and riboflavin intakes of the male workers. There is a need for improving the quality of the dietary intakes of these workers as well as nutrition education on the prevention of obesity and its consequences.
Fulltext Predictive equations for the estimation of basal metabolic rate in Malaysian adults

Ismail M, Chee S, Roslee R, Zawiah H

Malays J Nutr, 1998 Dec;4(1):73-80.
PMID: 22692343

In the field of human energy expenditure, the measurement of basal metabolic rate (BMR) is an essential element to derive energy requirement estimates for any given population. Besides basic anthropometrics data, this paper reports the generation of predictive equation for basal metabolic rates of healthy Malaysian adult from prospective measurements on 307 male and 349 females aged 18-60 years, using the Douglas bag technique. These new equations based on body-weight reveal that the current FAO/WHO/UNU (1985) predictive equations overestimate BMR of adult Malaysian by an average of 13% in males and 9% in female subjects while differences of between 4-5% were observed when compared to Henry and Rees (1991) equations for tropical people. There is a good reason to believe that the capacity to slow down metabolism amidst the hot and humid climate experience throughout the year as a genuine phenomenon for Malaysians. Similarly, these findings suggest that at equal energy intake recommendation for similar body weight, the lower energy needs of Malaysian could put them at greater risk for developing obesity. These observed deviations must be taken into account in formulating energy requirements of the population.
Fulltext The Effect of Bi-Functionalized MMT on Morphology, Thermal Stability, Dynamic Mechanical, and Tensile Properties of Epoxy/Organoclay Nanocomposites

Sand Chee S, Jawaid M

Polymers (Basel), 2019 Dec 04;11(12).
PMID: 31817284 DOI: 10.3390/polym11122012

In this work, the optimum filler loading to prepare epoxy/organoclay nanocomposites by the in-situ polymerization method was studied. Bi-functionalized montmorillonite at different filler loading (0.5, 1.0, 2.0, 4.0 wt %) was dispersed in epoxy resin by using a high shear speed homogenizer. The effect on morphology, thermal, dynamic mechanical, and tensile properties of the epoxy/organoclay nanocomposites were studied in this work. Wide-angle X-ray scattering (WAXS) and field emission scanning electron microscope (FESEM) studies revealed that possible intercalated structures were obtained in epoxy/organoclay nanocomposites. Thermogravimetric analysis (TGA) shows that epoxy/organoclay nanocomposites exhibit higher thermal stability at the maximum and final decomposition temperature, as well as higher char content, compared to pristine epoxy. The dynamic mechanical analysis (DMA) indicate that storage modulus (E'), loss modulus (E″), cross-link density and glass transition temperature (Tg) of the nanocomposites were improved with organoclay loading up to 1 wt %. Beyond this loading limit, the deterioration of properties was observed. A similar trend was also observed on tensile strength and modulus. We concluded from this study that organoclay loading up to 1 wt % is suitable for further study to fabricate hybrid nanocomposites for various applications.
DNA barcoding reveals neritid diversity (Mollusca: Gastropoda) diversity in Malaysian waters

Chee SY, Mohd Nor SA

Mitochondrial DNA A DNA Mapp Seq Anal, 2016 05;27(3):2282-4.
PMID: 25471442 DOI: 10.3109/19401736.2014.987237

This is the first study to identify and determine the phylogenetics of neritids found in Malaysia. In total, twelve species from the family Neritidae were recorded. Ten species were from the genus Nerita and two species were from the genus Neritina. DNA barcodes were successfully assigned to each species. Although some of these species were previously reported in the region, three are only presently reported in this study. The dendrogram showed Nerita and Neritina strongly supported in their respective monophyletic clades. Phylogenetic positions of some species appeared unstable in the trees. This could be due to the differences in a small number of nucleotides, thus minimizing genetic variation between each specimen and species.
Fulltext Phylogenetic study and barcoding of the blood cockle, Tegillarca granosa, found on the west coast of peninsular Malaysia using the COI gene

Chee SY, Devakie MN, Siti Azizah MN

Genet. Mol. Res., 2011;10(2):1237-44.
PMID: 21732288 DOI: 10.4238/vol10-2gmr1104

Blood cockles are among the most economically important brackish water invertebrates found in Malaysia. However, our knowledge of blood cockle phylogeny and systematics is rudimentary, especially for the species Tegillarca granosa. It is unclear, for instance, whether the cockles occurring on the west coast of peninsular Malaysia constitute a single species, or multiple, phylogenetically distinct species. We performed the first DNA molecular phylogenetic analysis of T. granosa to distinguish it from other related species found in other parts of the world and to create a DNA database for the species. An approximately 585-nucleotide fragment of the mitochondrial DNA (cytochrome oxidase I, COI) was sequenced for 150 individual cockles, representing 10 populations: three from the north, four from the central part and three from the southern part of peninsular Malaysia. Phylogenetic analyses of the resulting dataset yielded tree topologies that not only showed the relationship between T. granosa and its closest relatives but its position in the evolutionary tree. Three mitochondrial clades were evident, each containing an individual genus. Using the mutation rate of the COI gene, the divergence time between T. granosa and its closest related species was estimated to be 460 thousand years ago. This study provides a phylogenetic framework for this ecologically prominent and commercially important cockle species.
Fulltext Utilization of molecular markers for the conservation of blood cockles, Anadara granosa (Arcidae)

Chee SY, Azizah MN, Devakie MN

Genet. Mol. Res., 2011;10(2):1245-61.
PMID: 21732289 DOI: 10.4238/vol10-2gmr1103

We examined genetic variation in blood cockles in an effort to obtain information useful for the sustainability, management, and the stability of this species as a major commodity in the fisheries sector. Ten populations of cockles were sampled from the north to the south of the west coast of peninsular Malaysia. The cockles were collected in collaboration with the Fisheries Research Institute, Penang. The population genetic analysis of the cockles were studied via RAPD-PCR and mtDNA sequencing. Three hundred individuals were analyzed with RAPD-PCR experiments. High gene diversity over all loci was observed (Shannon index = 0.549 ± 0.056 and Nei's gene diversity = 0.4852 ± 0.0430 among 35 loci). The second method, mtDNA sequencing, was employed to complement the information obtained from RAPD-PCR. The gene selected for mtDNA sequencing was cytochrome c oxidase I (COI). One hundred and fifty individuals were sequenced, yielding a partial gene of 585 bp. Statistical analysis showed homogeneity in general but did reveal some degree of variability between the populations in Johor and the rest of the populations. The Mantel test showed a positive but nonsignificant correlation between geographic and genetic distances (r = 0.2710, P = 0.622), as in the RAPD analysis. We propose that the homogeneity between distant populations is caused by two factors: 1) the translocation of the spats; 2) larvae are carried by current movement from the north of the peninsula to the south. The different genetic composition found in Johor could be due to pollution, mutagenic substances or physical factors such as the depth of the water column. This population genetic study is the first for this species in peninsular Malaysia. The data from this study have important implications for fishery management, conservation of blood cockles and translocation policies for aquaculture and stock enhancement programs.
Randomized controlled study of the effects of different durations of light exposure on weight gain by preterm infants in a neonatal intensive care unit

Boo NY, Chee SC, Rohana J

Acta Paediatr, 2002;91(6):674-9.
PMID: 12162601

A randomized controlled study was carried out on 96 preterm infants (< 37 wk) with birthweight less than 2000 g admitted to a neonatal intensive care unit. The aim was to compare the weight gain between preterm infants exposed to 12 h cyclical lighting (intensity of light: 78.4 +/- 24.7 lux, mean +/- SD) and those exposed to a continuously dim environment (5.9 +/- 1.9 lux). The exclusion criteria were infants with major congenital malformations or who needed continuous lighting for treatment procedure and care. From day 7 of life until discharge, 50 infants were randomized to receive 12 h cyclical lighting and 46 infants to a continuously dim environment. There was no significant difference in the mean birthweight (12 h lighting vs continuously dim: 1482 vs 1465 g, p = 0.8), mean gestational age (31.6 vs 31.4 wk, p = 0.6), median duration of hospital stay (28.5 vs 28.5 d, p = 0.8), mean age to regain birthweight (13.0 vs 12.9 d, p = 0.3), mean weight gained by day 14 (27.6 vs 36.2 g, p = 1.0), median weight gain per day (11.9 vs 12.2 g, p = 0.9) or median body weight on discharge (1800 vs 1800 g, p = 0.4) between the two groups of infants.
CONCLUSION: Exposing preterm infants to either 12 h cyglical lighting or continuously dim environment did not have any significant effect on their weight gain during the neonatal period.
Fulltext Prevalence of obesity and chronic energy deficiency (CED) in adult Malaysians

Ismail MN, Zawiah H, Chee S, Ng K

Malays J Nutr, 1995 Mar;1(1):1-9.
PMID: 22692009 MyJurnal

Anthropometry is the single most portable, easily applied, inexpensive and non-invasive method of assessing body composition. It reflects both health and nutrition and predicts performance, health and survival. The use of body mass index (BMI) as a measure of obesity has been widespread and has recently been promoted for assessment of chronic energy deficiency (CED) in adults. This report provides BMI values of 2636 adult males and 2111 adult females from the three main ethnic groups residing in urban areas and BMI of adult Malay and Dayak (380 males and 496 females) residing in rural areas in Peninsular Malaysia, Sabah and Sarawak. The percent prevalence of obesity and CED in males for the three ethnic groups were apparently quite similar. However, in the females, CED were higher in the Malays and Chinese while overweight problems were more serious in the Indians. Among the Malays, prevalence of CED for males and females were 7% and 11% in urban areas and 11% and 14% in rural areas, respectively. In the males, it is interesting to note that there is a two-fold difference between urban and rural, while a high prevalence of overweight women (20%) even in the rural areas should be viewed as a potential health problem of the future.
A note on the search for potential vectors of rural Wuchereria bancrofti and periodic Brugia malayi in Malaysia barat

Cheong WH, Omar AH, Chee SL

Med J Malaya, 1968 Mar;22(3):244.
PMID: 4234379
Maternal and neonatal effects of Acinetobacter colonisation in preterm premature rupture of membrane and term labour

Sood M, Mohd Zain Z, Abu NA, Chee SC, Mohd Nor NS

Med J Malaysia, 2019 02;74(1):40-44.
PMID: 30846661

INTRODUCTION: Some anecdotal reports suggest that maternal colonisation with Acinetobacter baumannii during pregnancy is associated with adverse maternal and neonatal effects, including preterm premature rupture of membrane (PPROM). The objective of this study was to compare the maternal and neonatal effects of A. baumannii colonisation in cases with PPROM and those with spontaneous onset of labour at term.
METHODS: The recruitment of participants' was carried out at Selayang Hospital, Selangor, Malaysia. Vaginal swabs were prospectively taken from 104 patients of PPROM and 111 with spontaneous onset of labour at term. Swabs were also taken from the axillae and ears of their babies. These swabs were cultured to isolate A. baumannii. Maternal and neonatal adverse outcomes were documented.
RESULTS: Sixteen mothers were A. baumannii positive, eight from each group respectively. None of the cases developed chorioamnionitis or sepsis. Those positive were four cases of PPROM and two babies of term labour. None of the babies developed sepsis.
CONCLUSIONS: This study does not support the suggestion that A. baumannii colonisation during pregnancy is associated with adverse maternal and neonatal outcomes.
Fulltext A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes

Tan MY, Magarey JM, Chee SS, Lee LF, Tan MH

Health Educ Res, 2011 Oct;26(5):896-907.
PMID: 21715653 DOI: 10.1093/her/cyr047

We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design. One hundred and sixty-four participants with poorly controlled diabetes from two settings were randomized using computer-generated list into control (n = 82) and intervention (n = 82) groups, of which 151 completed the study. Monthly interventions over 12 weeks addressed the self-care practices of diet, physical activity, medication adherence and self-monitoring of blood glucose (SMBG). These self-care practices were assessed at Weeks 0 and 12 using pre- and post-questionnaires in both groups together with glycated haemoglobin A1c (HbA1c) and diabetes knowledge. In the intention-to-treat analysis (n = 164), the intervention group improved their SMBG (P = <0.001), physical activity (P = 0.001), HbA1c (P = 0.03), diabetes knowledge (P = <0.001) and medication adherence. At Week 12, HbA1c difference adjusted for SMBG frequency, medication adherence and weight change remained significant (P = 0.03) compared with control group. For within group comparisons, diabetes knowledge (P = <0.001), HbA1c level (P = <0.001), SMBG (P = <0.001) and medication adherence (P = 0.008) improved from baseline in the intervention group. In the control group, only diabetes knowledge improved (P = <0.001). These findings can contribute to the development of self-management diabetes education in Malaysia.
The ideal measurement of the quality of life in post stroke patients: an urban study

Samsiah M, Das S, Chee SY, Rashidah R, Siti H, Ruth P, et al.

Clin Ter, 2011;162(3):209-15.
PMID: 21717044

There is paucity of literature on the measurement of the quality of life in post stroke patients in the developing countries. The main objective of this study was to determine the quality of life (QOL) of post stroke patients.
Fulltext Dietary calcium and bone mineral density in premenopausal women with systemic lupus erythematosus

Chong HC, Chee SS, Goh EM, Chow SK, Yeap SS

Clin Rheumatol, 2007 Feb;26(2):182-5.
PMID: 16565892 DOI: 10.1007/s10067-006-0258-6

The primary objective of this study was to determine the relationship between dietary calcium intake and bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus (SLE) on corticosteroids (CS). The secondary aim was to identify other risk factors for osteoporosis in these patients. A cross-sectional sample of patients attending the SLE Clinic at a teaching hospital was recruited. BMD was measured using dual-energy X-ray absorptiometry. Daily dietary calcium intake was assessed using a structured validated food frequency questionnaire, in which patients were asked to estimate their food intake based on their recent 2-month dietary habits. Sixty subjects were recruited with a mean age of 33.70+/-8.46 years. The median duration of CS use was 5.5 years (range 0.08-24). The median cumulative dose of steroids was 17.21 g (range 0.16-91.37). The median daily dietary calcium intake was 483 mg (range 78-2101). There was no significant correlation between calcium intake and BMD, even after correcting for CS use. There were also no correlations between BMD and the duration of SLE, cumulative CS use, duration of CS use, smoking, alcohol intake, and SLE disease activity index score. Twenty-eight (46.7%) patients had normal BMD, 28 (46.7%) had osteopenia, and four (6.6%) had osteoporosis. Duration of SLE significantly correlated with cumulative CS dosage. In conclusion, 6.7% of these Asian premenopausal SLE women had osteoporosis and only 46.7% had normal BMD. Daily dietary calcium intake did not correlate with BMD.
Study site: SLE clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Fulltext Obesity in Malaysia

Ismail MN, Chee SS, Nawawi H, Yusoff K, Lim TO, James WP

Obes Rev, 2002 Aug;3(3):203-8.
PMID: 12164473 DOI: 10.1046/j.1467-789x.2002.00074.x

This study was undertaken to assess the recent data on Malaysian adult body weights and associations of ethnic differences in overweight and obesity with comorbid risk factors, and to examine measures of energy intake, energy expenditure, basal metabolic rate (BMR) and physical activity changes in urban and rural populations of normal weight. Three studies were included (1) a summary of a national health morbidity survey conducted in 1996 on nearly 29 000 adults > or =20 years of age; (2) a study comparing energy intake, BMR and physical activity levels (PALs) in 409 ethnically diverse, healthy adults drawn from a population of 1165 rural and urban subjects 18-60 years of age; and (3) an examination of the prevalence of obesity and comorbid risk factors that predict coronary heart disease and type 2 diabetes in 609 rural Malaysians aged 30-65 years. Overweight and obesity were calculated using body mass index (BMI) measures and World Health Organization (WHO) criteria. Energy intake was assessed using 3-d food records, BMR and PALs were assessed with Douglas bags and activity diaries, while hypertension, hyperlipidaemia and glucose intolerance were specified using standard criteria. The National Health Morbidity Survey data revealed that in adults, 20.7% were overweight and 5.8% obese (0.3% of whom had BMI values of >40.0 kg m(-2)); the prevalence of obesity was clearly greater in women than in men. In women, obesity rates were higher in Indian and Malay women than in Chinese women, while in men the Chinese recorded the highest obesity prevalences followed by the Malay and Indians. Studies on normal healthy subjects indicated that the energy intake of Indians was significantly lower than that of other ethnic groups. In women, Malays recorded a significantly higher energy intake than the other groups. Urban male subjects consumed significantly more energy than their rural counterparts, but this was not the case in women. In both men and women, fat intakes (%) were significantly higher in Chinese and urban subjects. Men were moderately active with the exception of the Dayaks. Chinese women were considerably less active than Chinese men. Chinese and Dayak women were less active than Malay and Indian women. In both men and women, Indians recorded the highest PALs. Hence, current nutrition and health surveys reveal that Malaysians are already affected by western health problems. The escalation of obesity, once thought to be an urban phenomenon, has now spread to the rural population at an alarming rate. As Malaysia proceeds rapidly towards a developed economy status, the health of its population will probably continue to deteriorate. Therefore, a national strategy needs to be developed to tackle both dietary and activity contributors to the excess weight gain of the Malaysian population.
Study name: National Health and Morbidity Survey (NHMS-2006)
Fulltext Nutritional status, dietary intake patterns and nutrition knowledge of children aged 5-6 years attending kindergartens in the Klang Valley, Malaysia

Poh BK, Kathryn Tham BL, Wong SN, Winnie Chee SS, Tee ES

Malays J Nutr, 2012 Aug;18(2):231-42.
PMID: 24575669 MyJurnal

Early childhood is a period during which many factors influence the development of lifelong eating habits. This study aimed to assess the nutritional status of young children and to determine factors related to eating habits.
Haemoglobin Constant Spring (HbA2: c.427T>C) and Haemoglobin Adana (HbA2: c.179G>A) in jaundiced Malaysian term neonates with clinically significant hyperbilirubinemia

Shwe S, Boo NY, Ong HK, Chee SC, Maslina M, Ling MMM, et al.

Malays J Pathol, 2020 Aug;42(2):253-257.
PMID: 32860378

INTRODUCTION: Haemoglobin Constant Spring (Hb CoSp) and Haemoglobin Adana (Hb Adana), are two non-deletion type of α-thalassemia reported in Malaysia. Owing to their structural instability, they cause hemolysis and hyperbilirubinemia. This observational study was part of a large study investigating multiple factors associated with severe neonatal jaundice. In this part we aimed to determine the prevalence of Hb CoSp and Hb Adana and their association with clinically significant neonatal hyperbilirubinemia (SigNH, total serum bilirubin (TSB>290µmol/L)) among jaundiced Malaysian term neonates.
MATERIALS AND METHODS: The inclusion criteria were normal term-gestation neonates admitted consecutively for phototherapy. PCR-restriction fragment length polymorphism method was applied on DNA extracted from dry blood spot specimens of each neonate to detect for Hb CoSp and Hb Adana gene. Positive samples were verified by gene sequencing.
RESULTS: Of the 1121 neonates recruited (719 SigNH and 402 no-SigNH), heterozygous Hb CoSp gene was detected in only two (0.27%) neonates. Both were SigNH neonates (0.3% or 2/719). No neonate had Hb Adana variant.
CONCLUSION: Hb CoSp was not common but could be a risk factor associated with SigNH. No Hb Adana was detected.
Early-onset sepsis in Malaysian neonatal intensive care units

Boo NY, Ang EBK, Neoh SH, Ang EL, Chee SC

Malays J Pathol, 2022 Dec;44(3):443-459.
PMID: 36591712

OBJECTIVES: To determine the incidence, causative pathogens, morbidities, mortality, and risk factors associated with blood culture-positive early-onset sepsis (EOS, ≤72 hours of age) in symptomatic neonates admitted to the neonatal intensive care units (NICUs) of a middle-income country.
STUDY DESIGN: Retrospective cohort study using data submitted prospectively to the Malaysian National Neonatal Registry (MNNR).
SETTING: 44 Malaysian NICUs.
PARTICIPANTS: All neonates born in 2015- 2020.
RESULTS: EOS was reported in 991 neonates. The annual incidence of EOS increased from 0.46 to 0.49/1000 livebirths over the six years. The most common pathogen was Streptococcus agalactiae or Group B haemolytic streptococcus (GBS) (n=388, 39.2%), followed by Escherichia coli (E. coli) (n=80, 8.1%), Klebsiella spp (n=73, 7.4%), coagulase negative staphylococcus (CONS) (n=73, 7.4%), Pseudomonas spp (n=44, 4.4%) and methicillin-sensitive Staphylococcus aureus (n=34, 3.4%). The incidence of EOS due to GBS increased from 0.17 to 0.22/1000 livebirths. Morbidities and mortality were higher in those with EOS than without EOS. Multiple logistic regression analysis showed that Indian ethnic group, chorioamnionitis, gestation≥37weeks, female, spontaneous vaginal delivery, instrumental delivery, and surfactant therapy were significantly associated with increased risk of EOS due to GBS. Four factors were significantly associated with increased risk of non-GBS EOS (outborns, birthweight lt;1000 g, vaginal delivery, and surfactant therapy). Early continuous positive airway pressure was associated with significantly lower risk of EOS.
CONCLUSION: The incidence of EOS showed an increasing trend in Malaysian NICUs. GBS was the most common causative pathogen. Several modifiable risk factors associated with EOS have been identified.

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