Red blood cell alloimmunization is a common complication among the transfusion recipients. In Malaysia, multiple ethnicity causes genetic heterogeneity among the population which in turn can cause a wide variation of antibody. The objective of this study was to analyse the red cell alloantibody detected during the pre-transfusion testing. This was a cross-sectional study done in the blood bank of Universiti Kebangsaan Malaysia Medical Centre during the period of January-December 2010. The data was retrieved from the hospital laboratory information system. A total of 24,263 patients' blood samples were subjected for pre-transfusion testing. Antibody screening was done using an indirect antiglobulin test method. The positive samples were further identified for antibody specificity. Antibody screening tests were positive in 184 patients out of 24,263 samples with the incidence of 0.76 %. Autoantibodies and alloantibodies were detected in 39/184 (21.2 %) and 140/184 (76.1 %) of the patients respectively. In five patients (2.7 %) the antibody specificity remained undetermined. Total 161 alloantibodies were identified. The suspected Anti-Mia alloantibody was observed most frequently (49/161, 30.4 %) followed by anti-E (30/161, 18.6 %) and anti-D (22/161, 13.7 %). Anti-E and anti-c were the most common combination of multiple alloantibodies. In view of the high incidence of suspected Anti-Mia antibodies, more efforts are needed to look into the techniques for confirmation of the Anti-Mia antibodies. Besides that, we suggested that all multiply transfused patients should be phenotyped for the Rh system and to supply Rh phenotype specific blood in order to limit alloimmunization.

Predicting readability of a reading text for second language learners is important for teachers, educators, and other concerned parties to make sure the text matches targeted readers’ proficiency. Suitable reading materials would promote language development among readers, especially children. In Malaysia nowadays, English story books for children which are published locally can be easily found in libraries or bookstores. However, the readability of these reading materials has remained uncovered. Hence, this study aimed to investigate the readability of Malaysian English children story books on five aspects (narrativity, syntactic simplicity, word concreteness, referential cohesion and deep cohesion) as provided by the computational tool, Coh-Metrix Common Core Text Ease Readability Assessor (T.E.R.A). Ten local English children story books were selected as samples. It was found that the majority of the samples have high narrativity, syntactic simplicity, and word concreteness but average referential cohesion and deep cohesion. The result revealed that there is lack of attention given to the aspect of cohesion in children story books. This study recommends that children book writers consider the readability of ESL children story books to help children’s language development.  Keywords: readability, assessment of reading materials, Coh-Metrix, picture books, childrenCite as: Ismail, A., & Yusof, N. (2016). Readability of ESL picture books in Malaysia. Journal of Nusantara Studies, 1(1), 60-70.

Background Immune thrombocytopenia (ITP) is well characterized in Western, European and other Asia-Pacific countries. Nevertheless, the clinical epidemiology, treatment pattern and disease outcome of ITP in Malaysia are still limited and not well known. Objective This study aimed to describe the clinical epidemiology, treatment outcome and mortality of ITP patients in haematology tertiary multicentre in Malaysia. Methods Clinical and laboratory data of newly diagnosed adults with ITP by a platelet count <100 × 10 9 /L from January 2010 to December 2020 were identified and analyzed. Results Out of 500 incident ITP, 71.8% were females with a striking age preponderance of both genders among those aged 18–29 years. The median age was 36 years. The median platelet count was 17.5 × 10 9 /L, 23.0% had a secondary ITP, 34.6% had a Charlson’s score ≥1, 53.0% had bleeding symptoms including 2.2% intracranial bleedings (ICB). Helicobacter pylori screening was performed in <5% of cases. Persistency and chronicity rates were 13.6% and 41.8%, respectively. Most (80.6%) were treated at diagnosis onset and 31.2% needed second-line treatment. Throughout the course of ITP, 11.0% of patients died; 3.0% and 8.0% with bleeding and non-bleeding related ITP. Conclusion This study confirms the epidemiology of ITP is comparable with worldwide studies. Our incidence is high in the female, Malay ethnicity, primary ITP and events of cutaneous bleeding at ITP onset with 18–29 years predominance age group for both genders. The frequency of persistent and chronic ITP is inconsistent with published literature. Corticosteroids and immunotherapies are the most prescribed first-line and second-line pharmacological treatments. Thrombopoietin receptor agonist medications (TPO-RAs) usage is restricted and splenectomy is uncommon. Our mortality rate is similar but ITP related bleeding death is fourth-fold lower than previous studies. Mortality risks of our ITP patients include age ≥60 years, male, severe bleeding at presentation, CCI≥1 and secondary ITP.

<em><span>KOH wet etching is widely used in realizing MEMS diaphragm due to its low cost, safe and easy handling. However, wet etching process parameters need to be studied thoroughly in order to realize the desired shape and size of MEMS devices. This paper presents the numerical study and optimization of KOH etching process parameters using the response surface method (RSM). Face central composite design (FCC) of RSM was employed as the experimental design to analyze the result and generate a mathematical prediction model. From the analysis, the temperature was identified as the most significant process parameter that affects the etching rate, thus affecting the thickness and size of the diaphragm. The results of RSM prediction for optimization were applied in this study. Particularly, 45% of KOH concentration, temperature of 80°C, 1735 µm2 of mask size, and 7.2 hours of etching time were implemented to obtain a square MEMS diaphragm with thickness of 120 µm and size of 1200 µm2. The results of RSM based optimization method for KOH wet etching offers a quick and effective method for realizing a desired MEMS device.</span></em>

IntroductionHemolytic disease of the fetus and newborn is most commonly caused by anti-D alloantibody. It is usually seen in Rhesus D (RhD)-negative mothers that have been previously sensitized. We report here a case of hemolytic disease of the fetus and newborn in a newborn baby caused by anti-D and anti-S alloantibodies, born to a mother who was RhD negative, but with no previous serological evidence of RhD alloimmunization.Case presentationA one-day-old Chinese baby boy was born to a mother who was group A RhD negative. The baby was jaundiced with hyperbilirubinemia, but with no evidence of infection. His blood group was group A RhD positive, his direct Coombs' test result was positive and red cell elution studies demonstrated the presence of anti-D and anti-S alloantibodies. Investigations performed on the maternal blood during the 22 weeks of gestation showed the presence of anti-S antibodies only. Repeat investigations performed post-natally showed the presence of similar antibodies as in the newborn and an anti-D titer of 1:32 (0.25 IU/mL), which was significant. A diagnosis of hemolytic disease of the fetus and newborn secondary to anti-D and anti-S was made. The baby was treated with phototherapy and close monitoring. He was discharged well after five days of phototherapy.ConclusionsThis case illustrates the possibility of an anamnestic response of allo-anti-D from previous sensitization in a RhD-negative mother, or the development of anti-D in mid-trimester. Thus, it highlights the importance of thorough antenatal ABO, RhD blood grouping and antibody screening, and if necessary, antibody identification and regular monitoring of antibody screening and antibody levels for prevention or early detection of hemolytic disease of the fetus and newborn, especially in cases of mothers with clinically significant red cell alloantibody.