Publications by authors named "Saedah Ali"

14 Publications

  • Page 1 of 1

Right-sided patent ductus arteriosus with bovine aortic arch, tetralogy of Fallot, dextrocardia and situs inversus.

J Surg Case Rep 2021 Jul 23;2021(7):rjab307. Epub 2021 Jul 23.

Department of Anesthesia, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia.

A neonate with cyanosis at birth was found to have a rare type of tetralogy of Fallot. Echocardiography showed dextrocardia, left aortic arch with constricting and tortuous patent ductus arteriosus (PDA). Computed tomography angiography thorax revealed visceroatrial situs inversus, mirror image dextrocardia, tetralogy anatomy and tortuous right PDA arising from bovine brachiocephalic artery. In view of severe cyanosis, emergency division of PDA and modified right Blalock-Taussig shunt through median sternotomy were performed under cardiopulmonary bypass. Post-operatively, the sternum was left open and he developed pulmonary overcirculation requiring prolonged ICU stay. He was discharged well at Day 26 post surgery. This case highlights a rare association tetralogy of Fallot, dextrocardia and situs inversus, with concomitant unilateral right PDA and bovine aortic arch.
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http://dx.doi.org/10.1093/jscr/rjab307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302079PMC
July 2021

Comparison of Esmolol and Dexmedetomidine Infusion in Attenuating Haemodynamic and Blood Glucose Response to Laryngoscopy and Intubation: A Single Blinded Study.

Malays J Med Sci 2021 Jun 30;28(3):46-55. Epub 2021 Jun 30.

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Background: This study aims to compare the effect of infusions of two agents, dexmedetomidine and esmolol, with the control group in attenuating the haemodynamic stress response and neuroendocrine modulation surrogated by capillary blood glucose (BG) during the procedures.

Methods: Sixty patients aged 18-70 years old who underwent elective surgeries involving endotracheal intubation were randomised into three groups of equal size: i) control; ii) dexmedetomidine and iii) esmolol. Heart rate (HR) was measured at baseline (T0), after drug administration (T1), after induction of anaesthesia (T2), immediately after intubation (T3), and 3 min, 5 min and 10 min after intubation (T4, T5 and T6). BG was measured pre-operatively and 30 min post-intubation.

Results: Two-way repeated-measures analysis of variance showed significant time [within-group changes, (3.2, 182.5) = 30.39, < 0.001], treatment [between-group differences regardless of time, (2, 57) = 50.24, < 0.001] and interaction [between-group differences based on time, (6.4, 182.5) = 37.65, < 0.001] effects on HR. A significantly higher HR was observed in the control group compared to the dexmedetomidine and esmolol groups from T2 to T6. BG exhibited a significant time effect [(1, 57) = 41.97, < 0.001] with no significant treatment and interaction effects. All three groups showed a significant increase in BG from baseline.

Conclusion: Both dexmedetomidine and esmolol are equally effective in attenuating haemodynamic responses to laryngoscopy and intubation. However, both do not significantly modulate neuroendocrine stress.
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http://dx.doi.org/10.21315/mjms2021.28.3.4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260065PMC
June 2021

Efficacy and safety of the point-of-care procalcitonin test for determining the antibiotic treatment duration in patients with ventilator-associated pneumonia in the intensive care unit: a randomised controlled trial.

Anaesthesiol Intensive Ther 2021 ;53(3):207-214

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.

Introduction: This study was conducted to assess the efficacy of point-of-care (POC) procalcitonin (PCT) serial measurement in determining the antibiotic treatment duration in patients with ventilator-associated pneumonia (VAP).

Material And Methods: One hundred patients were randomly recruited and then further randomly divided into two groups of 50 patients each. The first group used the POC PCT test along with the standard sepsis parameter monitoring, while the second group had the standard monitoring only (C-reactive protein [CRP] level, total white count, temperature and tracheal aspirate culture). Serial PCT test results and CRP levels were monitored on days 1, 3, 7 and 9. The patients were followed up for 28-day mortality.

Results: Eighty-five patients completed the trial, of whom 43 were in the PCT group and 42 were in the control group. The PCT group had a significantly lower mean (SD) antibiotic treatment duration (10.28 [2.68] days) than the control group (11.52 [3.06]). The mean (SD) difference was -1.25 (95% confidence interval [CI], -2.48 to 0.01; t-statistic [df] = -1.997 [83]; P = 0.049). The PCT group also had a higher number of antibiotic-free days alive during the 28 days after VAP onset than the control group (mean [SD], 10.79 [7.61] vs. 8.72 [6.41]). The Sequential Organ Failure Assessment score was the sole factor for the decrease in duration after VAP onset (regression coefficient β [95% CI], -0.70 [-1.19 to -0.20]; P = 0.006).

Conclusions: The POC procalcitonin test can reduce the antibiotic treatment duration in patients with VAP.
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http://dx.doi.org/10.5114/ait.2021.104300DOI Listing
January 2021

Postoperative Maladaptive Behavior, Preoperative Anxiety and Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review.

Glob Pediatr Health 2021 7;8:2333794X211007975. Epub 2021 Apr 7.

Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Kelantan, Malaysia.

Over the years, the number of pediatric patients undergoing surgeries are increasing steadily. The types of surgery vary between elective to emergency with involvement of multidisciplinary teams. The development of day care surgery unit is expanding where the patients will only come to the hospital on the day of surgery and discharge home after such as satisfactory parameters achieved, minimal to no pain, minimal to no bleeding from surgical site and able to tolerate fluids. Hospitalization and surgery could contribute to significant psychological disturbance to the children. These issues are not being addressed as children have difficulty in conveying their problems and fear. They do however express it through negative behavioral changes.
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http://dx.doi.org/10.1177/2333794X211007975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040608PMC
April 2021

Challenges Faced During the Ventilation of a Child With Bronchobiliary Fistula: A Case Report.

A A Pract 2020 Jul;14(9):e01281

From the Department of Anaesthesiology & Intensive Care, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Hepatoblastoma is the most frequently occurring malignant tumor of the liver in children (ages ≤5 years). The formation of bronchobiliary fistula is a rare complication. We present a case report that describes the associated anesthetic challenges that we encountered for the treatment of this pathology.
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http://dx.doi.org/10.1213/XAA.0000000000001281DOI Listing
July 2020

Humanitarian Mission in Pediatric Cardiothoracic Surgery: A Recipient's Perspective.

Front Pediatr 2019 7;7:230. Epub 2019 Jun 7.

East Midlands Congenital Heart Center, Glenfield Hospital, Leicester, United Kingdom.

Pediatric cardiac surgical mission programs are deemed as common practice, especially in developing nations funded by international non-governmental organizations (NGOs). This article presents and discusses the results and strategies implemented by this partnership, aiming at achieving the autonomy of the local center by this collaboration. A retrospective review was conducted on patients with congenital heart disease who underwent surgical intervention from the beginning of the NGO collaboration (September 2015) until November 2018 in an existing cardiac center. In between those visits, any congenital heart disease patient with Risk Adjustment Congenital Heart Surgery (RACHS)-1 Category 1-3 would be discussed in a local multi-disciplinary meeting with regards to the feasibility of the surgery being performed by the local members. A total of 60 operations were performed during the trips. Throughout the visit, 46% (28) of the operations were performed by the local surgeon, with or without assistance from the visiting surgeon. Between September 2015 and November 2018, 27 cases were also performed by the local team independently. For the 27 cases performed by the local team independently, the median age of the patient was 42 days (ranging from 14 days to 20 years old), with median body weight of 3.2 kg (ranging from 2.8 to 64 kg). Humanitarian pediatric cardiac surgical missions are safe to be done for the population in need. In order to achieve autonomy, continuous efforts by both teams are crucial, as the cooperation by the two parties ensures that the objectives are achieved.
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http://dx.doi.org/10.3389/fped.2019.00230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6568032PMC
June 2019

Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis.

Respir Med Case Rep 2017 28;22:292-294. Epub 2017 Oct 28.

Department of Anaesthesiology & Intensive Care, School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition.
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http://dx.doi.org/10.1016/j.rmcr.2017.10.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676088PMC
October 2017

Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis.

IDCases 2017 27;9:91-94. Epub 2017 Jun 27.

Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.
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http://dx.doi.org/10.1016/j.idcr.2017.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506869PMC
June 2017

Predictors of polymyxin B treatment failure in Gram-negative healthcare-associated infections among critically ill patients.

J Microbiol Immunol Infect 2018 Dec 29;51(6):763-769. Epub 2017 Jun 29.

Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Infection Control and Hospital Epidemiology Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Electronic address:

Background: With increasing prevalence and spread of multidrug resistant Gram-negative infections, parenteral polymyxins resurged in clinical practice. The primary aim of the study was to determine the predictors of treatment failure and in-hospital mortality among critically ill patients treated with polymyxin B.

Methods: Demographic data, underlying diseases, procedures and details on polymyxin B therapy were retrospectively analyzed in a cohort of 84 patients who received intravenous polymyxin B in an intensive care unit from 2010 to 2014.

Results: Polymyxin B was used to treat bacteremia (46.4% of cases) and pneumonia (53.6%). Majority of the pathogens isolated were Acinetobacter spp. (96.4%). The mortality rate was 48.8%, of which 82.9% was attributed to polymyxin B treatment failure. The independent predictors of treatment failure were low doses of polymyxin B (p = 0.002), shorter duration of therapy (p = 0.009), not combining with cefoperazone/sulbactam (p = 0.030), female gender (p = 0.004), administered for treatment of bacteremia (p = 0.023) and renal impairment (p = 0.021). Low polymyxin B doses (p = 0.007), not combining with cefoperazone/sulbactam (p = 0.024), female gender (p = 0.048) and renal impairment (p = 0.022) were also significant predictors for in-hospital mortality.

Conclusions: To the best of our knowledge, this is the first report on the association of inadequate dose of polymyxin B (<15,000 units/kg/day) with poor outcome in critically ill patients. Besides that, further clinical studies are warranted to evaluate the use of cefoperazone/sulbactam as second antibiotic in the combination therapy.
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http://dx.doi.org/10.1016/j.jmii.2017.03.007DOI Listing
December 2018

Non-invasive ventilation in a pregnancy with severe pneumonia.

Respir Med Case Rep 2017 8;21:161-163. Epub 2017 May 8.

Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Introduction: Non-invasive ventilation (NIV) is not proven to be effective in treating respiratory failure in severe pneumonia. However, some clinicians nevertheless attempt NIV to indirectly deliver adequate oxygenation and avoid unnecessary endotracheal intubation.

Case Presentation: In this article, we report the case of a 24-year-old woman at 32 weeks' gestation who presented with hypoxemic respiratory failure requiring mechanical ventilation. She was successfully managed by NIV.

Discussion: However, NIV must be managed by providers who are trained in mechanical ventilation. This is of the utmost importance in avoiding any delay should the patient's condition worsen and require endotracheal intubation. Moreover, in pregnant women, the severity of illness may progress quickly due to the immunosuppression inherent in these patients.

Conclusion: Special attention should be given to the choices of invasive ventilation and NIV to manage community acquired pneumonia patients in third trimester.
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http://dx.doi.org/10.1016/j.rmcr.2017.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435593PMC
May 2017

Significance of a clean-tip catheter closed suctioning system in a high-setting ventilated, super morbidly obese patient with profuse respiratory secretions.

Respir Med Case Rep 2017 19;21:129-131. Epub 2017 Apr 19.

Department of Anesthesiology and Intensive Care, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Introduction: Closed suctioning is commonly used in the context of high-setting mechanical ventilation (MV), given its ability to prevent lung volume loss that otherwise accompanies open suctioning. However, closed suctioning systems (CSS) are not equivalent regarding components and capabilities, and thus this technique may be differentially effective to adequately clear patient secretions from an endotracheal tube (ETT), which is of paramount importance when the tube size makes the ETT particularly vulnerable to block by patient secretions.

Case Presentation: A 25-year-old super morbidly obese female (body mass index = 55 kg/meter) presented with worsening shortness of breath. For MV, pairing of a 6 mm (mm) diameter ETT to accommodate the patient's vocal cord edema, with a CSS not designed to maintain a clean catheter tip, precipitated ETT blockage and respiratory acidosis. Replacement of these devices with a 6.5 mm ETT and a CSS designed to keep the catheter tip clean resolved the complications. After use of the different ETT and CSS for approximately one week, the patient was discharged to home.

Discussion: The clean-tip catheter CSS enabled a more patent airway than its counterpart device that did not have this feature. Use of a clean-tip catheter CSS was an important care development for this patient, because this individual's super morbidly obese condition minimized tolerance for MV complications that would exacerbate her pre-existing tenuous respiratory health status.

Conclusion: Special attention should be given to the choices of ETT size and CSS to manage super morbidly obese patients who have a history of difficult airway access.
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http://dx.doi.org/10.1016/j.rmcr.2017.04.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408147PMC
April 2017

Sequestrated caudal catheter in a child: An anesthetic nightmare and surgical dilemma.

Saudi J Anaesth 2017 Jan-Mar;11(1):86-88

Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.

The usage of epidural infusion for intraoperative and postoperative pain relief is widely used in certain pediatric anesthetic practice because of the effectiveness and advantages. However, there is drawback for these techniques due to its potential complications such as inadvertent intrathecal placement, local anesthetic toxicity, catheter migration, infection, and breakage of epidural catheter. Though occur infrequently, epidural catheters have been known to snap during insertion or removal. The retained catheter tip may lead to multiple complications, including nerve injury, infection, and even catheter migration. Although there are literatures recommend options for management of removal of retained catheter, there are limited reports of these occurrences, especially among children. We report a case of sequestrated sheared epidural catheter segment in a child, aiming to share this experience for the future management of patients under similar condition.
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http://dx.doi.org/10.4103/1658-354X.197333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292860PMC
February 2017

Normothermia for pediatric and congenital heart surgery: an expanded horizon.

Front Pediatr 2015 28;3:23. Epub 2015 Apr 28.

Pediatric and Congenital Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Kelantan , Malaysia ; Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia , Kubang Kerian, Kelantan , Malaysia.

Cardiopulmonary bypass (CPB) in pediatric cardiac surgery is generally performed with hypothermia, flow reduction and hemodilution. From October 2013 to December 2014, 55 patients, median age 6 years (range 2 months to 52 years), median weight 18.5 kg (range 3.2-57 kg), underwent surgery with normothermic high flow CPB in a new unit. There were no early or late deaths. Fifty patients (90.9%) were extubated within 3 h, 3 (5.5%) within 24 h, and 2 (3.6%) within 48 h. Twenty-four patients (43.6%) did not require inotropic support, 31 (56.4%) received dopamine or dobutamine: 21 ≤5 mcg/kg/min, 8 5-10 mcg/kg/min, and 2 >10 mcg/kg/min. Two patients (6.5%) required noradrenaline 0.05-0.1 mcg/kg/min. On arrival to ICU and after 3 and 6 h and 8:00 a.m. the next morning, mean lactate levels were 1.9 ± 09, 2.0 ± 1.2, 1.6 ± 0.8, and 1.4 ± 0.7 mmol/L (0.6-5.2 mmol/L), respectively. From arrival to ICU to 8:00 a.m. the next morning mean urine output was 3.8 ± 1.5 mL/kg/h (0.7-7.6 mL/kg/h), and mean chest drainage was 0.6 ± 0.5 mL/kg/h (0.1-2.3 mL/kg/h). Mean ICU and hospital stay were 2.7 ± 1.4 days (2-8 days) and 7.2 ± 2.2 days (4-15 days), respectively. In conclusion, normothermic high flow CPB allows pediatric and congenital heart surgery with favorable outcomes even in a new unit. The immediate post-operative period is characterized by low requirement for inotropic and respiratory support, low lactate production, adequate urine output, minimal drainage from the chest drains, short ICU, and hospital stay.
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http://dx.doi.org/10.3389/fped.2015.00023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411990PMC
May 2015

Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study.

Intensive Care Med 2013 May 24;39(5):910-8. Epub 2013 Jan 24.

Department of Intensive Care, University New South Wales Clinical School, The Prince of Wales Hospital, Randwick, NSW, Australia.

Purpose: To ascertain the relationship among early (first 48 h) deep sedation, time to extubation, delirium and long-term mortality.

Methods: We conducted a multicentre prospective longitudinal cohort study in 11 Malaysian hospitals including medical/surgical patients (n = 259) who were sedated and ventilated ≥24 h. Patients were followed from ICU admission up to 28 days in ICU with 4-hourly sedation and daily delirium assessments and 180-day mortality. Deep sedation was defined as Richmond Agitation Sedation Score (RASS) ≤-3.

Results: The cohort had a mean (SD) age of 53.1 (15.9) years and APACHE II score of 21.3 (8.2) with hospital and 180-day mortality of 82 (31.7%) and 110/237 (46.4%). Patients were followed for 2,657 ICU days and underwent 13,836 RASS assessments. Midazolam prescription was predominant compared to propofol, given to 241 (93%) versus 72 (28%) patients (P < 0.0001) for 966 (39.6%) versus 183 (7.5%) study days respectively. Deep sedation occurred in (182/257) 71% patients at first assessment and in 159 (61%) patients and 1,658 (59%) of all RASS assessments at 48 h. Multivariable Cox proportional hazard regression analysis adjusting for a priori assigned covariates including sedative agents, diagnosis, age, APACHE II score, operative, elective, vasopressors and dialysis showed that early deep sedation was independently associated with longer time to extubation [hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.89-0.97, P = 0.003], hospital death (HR 1.11, 95% CI 1.05-1.18, P < 0.001) and 180-day mortality (HR 1.09, 95% CI 1.04-1.15, P = 0.002), but not time to delirium (HR 0.98, P = 0.23). Delirium occurred in 114 (44%) of patients.

Conclusion: Irrespective of sedative choice, early deep sedation was independently associated with delayed extubation and higher mortality, and thus was a potentially modifiable risk in interventional trials.
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http://dx.doi.org/10.1007/s00134-013-2830-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625407PMC
May 2013
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