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- PublicationChronic anterior pituitary dysfunction following traumatic head injury: Prospective study in Hospital Sultanah Aminah Johor Bahru(2020)Background and Objective Traumatic brain injury(TBI) is associated with increase morbidity, mortality and long term disability. Hypopituitarism following TBI is not rare and most patient had undiagnosed and untreated hypopituitarism. Association of post TBI hypopituitarism causing neurobehavioural and quality of life impairment. There are wide range of post-traumatic hypopituitarism (PTHP) has been reported ranging 10-58%. The aim of the study is to determine the incidence of the chronic anterior pituitary Deficiency in patients with traumatic brain injury. Subsequently determine the risk factor and the outcome of the patient with chronic anterior pituitary dysfunction. Methods This is the single centre prospective cross-sectional study where 105 traumatic head injury patients under Neurosurgical Department Hospital Sultanah Aminah, Johor Bahru follow up who fulfilled the inclusion criteria. The inclusion criteria were patient with traumatic head injury, age from 18 to 65-year-old and had history of trauma 3 month prior to enrolment. The exclusion criteria were traumatic brain injury patient in chronic vegetative state with low life expectancy, patient who diagnosed or taking hormonal replacement therapy prior to the trauma, pregnant woman and female patient with normal menses LH and FSH will not be taken. The primary investigator will do an interview with the patient and the patient will be asked question to complete questioner form (36 question). Subsequently, blood sampling will be done. Other demographic data will be required from the admission documents. Results A total 33 patients (31%) were noted to have anterior pituitary dysfunction. The mean age was 36.97 ± 12.96 years old with a median of 35 years old. Out of 33 patients, 27 (32.5%) were male and 6 patients were female (27.3%). Chronic anterior pituitary dysfunction also was seen in more patients with a severe traumatic head injury around 47.1%, a total of 23 patients sustained a severe head injury as compared to a moderate head injury (8 patients, 38.1%) and 2 sustained mild head injury (5.6%). The mean duration after the onset of trauma was 10.3 months ± 1.79 and the median was 11 months. Chronic anterior pituitary commonly found in the patient enrolled in the study at 11 and 12 months post-trauma. All patient with pituitary dysfunction had positive CT brain findings. Out of 33 patients, 22 had SAH at the basal cistern and 27 patients had a base of skull fracture. 52.1% of the patient underwent surgical intervention and 8 patients didn’t undergo any surgical intervention. Out of all 33 patients with chronic anterior pituitary dysfunction, 84.8% involved 1 axis and another 5 (15.2%) patients had 2 axes involved. Binary logistic regression analysis studies the relationship between each of the variables and showed that severity of the head injury (p < 0.001), prolonged duration of hospital stay (p=0.014), radiological findings of a base of skull fracture(p <0.001), and presence of SAH at basal cistern (p<0.001) was significantly associated with chronic anterior pituitary dysfunction There was a significant difference seen in SF36 marks, where the patient with anterior pituitary dysfunction has the lower SF-36 marks 56.3± 10.3.Conclusion The prevalence of hypopituitarism was estimated at 31%. Indicators of increased TBI severity, prolonged hospitalization and positive finding of radiological assessment ( presence of SAH and base of skull fracture). Post traumatic chronic anterior pituitary dysfunction also related with poor quality of life as showed by low SF36 marks.
- PublicationAssociation between types of mammographic breast density and histological subtypes of invasive breast carcinoma(2021)Background: Mammographic density is an established risk factor for breast cancer. It reflects the relative component of fat, epithelial tissue, and connective tissues that has a specific appearance due to different tissue attenuation on the mammogram. Women with dense breast have more epithelial and connective tissue and less fat tissue, and are at higher risk to get breast cancer. Histological subclassification of breast cancer can be divided into invasive carcinoma of no special type (NST) and special types (ST) which include lobular, tubular, cribiform, metaplastic, apocrine, mucinous, papillary, and many others. From various works of literature, the majority of ST breast carcinoma carries a better prognosis than NST. Thus, appropriate classification can allow accurate estimation of a patient’s prognostication and facilitate the identification of optimal treatment strategies. The purpose of this study is to evaluate the association between mammographic breast density and histological subtypes of invasive breast carcinoma. Methods: A cross-sectional study was conducted in Hospital Universiti Sains Malaysia (USM), Kota Bharu, Kelantan, Malaysia on 125 patients who had been diagnosed with breast carcinoma and had undergone mammogram prior to surgery. Breast density was determined using the Breast Imaging Reporting and Data System (BI-RADS) and Tabar classification. It was divided into dense (BI-RADS C and D, Tabar type I, IV, and V) and non-dense (BI-RADS A and B, Tabar II, and III) categories. Histological subtypes of breast carcinoma are categorized into invasive carcinoma of no-special type and special type breast carcinoma. The association between mammographic breast density and histological subtypes of breast carcinoma had been carried out using Pearson chi square test. Cohen’s kappa analysis was done to determine the agreement between BI-RADS and Tabar classification. Results: There is no significant association between mammographic breast density using BI-RADS and Tabar classification with histological subtype (p=0.833 and p=0.336 respectively). However, Cohen’s kappa analysis shows good agreement between BI-RADS and Tabar classification, with a Cohen’s kappa coefficient of 0.8 (p < 0.001) Conclusion: Our study shows no significant association between mammographic breast density and histological subtypes of invasive breast carcinoma. However, with limited literature, further research might be plausible to show the association between breast density and histopathological subtypes of breast carcinoma
- PublicationA study on acute chemical poisoning among patients in emergency department Hospital Tengku Ampuan Rahimah Klang and its complications(2020)Introduction Acute poisoning is one of the most common reasons of patient visits to the emergency department (ED). The sociodemographic and presentations vary from one region to another. This study purpose is to determine the sociodemographics, presentations and factors associated with complications in patients with acute chemical poisoning. Methodology This retrospective study involved all patients presented with acute chemical poisoning to the emergency department of a government hospital in Malaysia from January 2016 until December 2018. A total of 260 patients were included and their sociodemographic, clinical presentation, complications and outcomes were recorded. Multiple logistic regression analysis was used to determine factors associated with complications. Result From 260 patients, 168 (64.6%) patients had intentional poisoning while 92 (35.4%) patients accidentally exposed to different chemical substances. Majority were single (n=158,60.8%), male (n=152,58.5%), and Indian (n=149,57.3%). The most common agent involved was pesticide. Complication rate was 14.2% with mortality rate of 4.6%. Common complications included respiratory insufficiency (n=30,11.5%), altered consciousness (n=14, 5.4%) and renal failure (n=17, 6.5%). Factors significantly associated with complications were age (AOR 1.05, 95% CI 1.02 to 1.09, p=0.005), other race (AOR 30.35, 95% CI 2.77 to 332.94, p=0.005), Chinese (AOR 12.27, 95% CI 1.03 to 146.63, p=0.048), tachycardia (AOR 39.7, 95% CI 11.31 to 139.27, p=0.004), time of exposure from 0800-1600 (AOR 22.15, 95% CI 1.95 to 252.04, p=0.013) and latency time from presentation of 2 to 12 hours (AOR 3.43, 95% CI 1.28 to 9.21, p=0.015) Conclusion Acute chemical poisoning is common among single, male patients with intentional circumstance. Apart from that, other factors associated with complications were age, tachycardia, Chinese ethnicity and other races, time of exposure and latency time from presentation to ED
- PublicationMass hysteria among secondary school students in Kelantan: A phenomenological approach(2021)Despite rising incidences of hysteria especially among school students in Malaysia this phenomenon still puzzled and bring challenges to many parties. Due to scarcity of information and limited research in this occurrence this study will shed some light in exploring and interpreting this phenomenon and cultural factors that conceptualizes the hysteria expressions that are distinctive in our study setting. Qualitative interpretative phenomenological approach with face to face interviews were conducted among 20 Malay adolescence using the semi-structured in-depth interview guide. The participants were selected using purposive sampling. The mean age of participants were 14.3 years and all of them are Malay Muslim. 50% of participants were either youngest or eldest siblings and majority of the participants came from low socioeconomic household. The experience and interpretation of hysteria emerged as ‘Culture Stereotyping’, ‘Idiom of Distress’ and ‘Social Reinforcement Factors’. As the hysteria phenomenon is an intermeshed of deep-rooted cultural influence with the mental health issues, the management would need cultural competence and sensitivity apart from further psychological and emotional evaluation by the health professional
- PublicationClinical profiles and outcomes of renal scarring in children underwent dimercaptosuccinic acid renal scan in a tertiary Hospital(2021)Title Clinical Profiles and Outcomes of Renal scarring in Children Underwent Dimercaptosuccinic acid (DMSA) Renal scan in a Tertiary Hospital. Background: DMSA renal scan is universally applied to detect renal scarring. It is a known cause for hypertension and proteinuria and may progressed into chronic kidney disease (CKD). We reviewed the proportion of renal scarring and looking at their risk factors and its outcomes in all children that were referred for DMSA renal scan at tertiary centre hospital. Methodology: All records of children less than 18 years old that were referred for DMSA renal scan over ten years period were reviewed. Among children whose renal cortical defects were confirmed by DMSA scan, data of their risk factors and its outcome were collected manually. Results: Out of 92 children referred for DMSA renal scan, forty-eight of them were shown to have renal scarring of which more than 50% of them had underlying vesico-ureteric reflux (VUR). More than half had recurrent urinary tract infections (UTIs) of non-Escherichia coli organisms. The most common complication was CKD, of which majority were stage 3 with median duration of one year after detection of renal scarring. Six children (12.5%) developed hypertension with median age of 10.5 years and median duration of one year after diagnosis of renal scarring was demonstrated. Conclusion: DMSA renal scan is recommended to be performed in children with VUR to detect scarring as its long term complications such as hypertension and CKD have been demonstrated to occur as early as one year after diagnosis. Hence, early diagnosis and treatment of the underlying problem is crucial
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- ItemMR volumetric study of cerebellum related to age ang sex(Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia, 2015)Introduction: The advancement of MRI techniques has open up many neuroanatomical studies of normal brain growth and atrophy. Numerous neurological and neuropsychiatric disorders, which can cause changes in cerebellum volumes have been identified particularly epilepsy, schizophrenia, Alzheimer’s dementia, depression and autism among others. Investigations of aging effects on the cerebellum are important, not only to understand normal aging process, but also for comparative study of the pathophysiology of degenerative brain disorders. Sex differences in gross cerebellar neuroanatomy have been observed in several studies. Currently there is no normative data of MR cerebellum volumetry available for Malaysian population. Objectives: The general objective for this study is to determine the age and sex difference of the volume of cerebellum in healthy volunteers. Methods and materials: This was a cross sectional study involving 164 subjects who underwent MRI. The age of the subjects ranged from 7 to 77 years old. MRI was performed using Signa Horison LX 1.0 Tesla scanner by General Electric. MRI images were obtained in T1 sagittal sections with 5milimeter thickness with 2-millimeter gap. Cerebellum volumes were measured using manually traced slice volumetry method. The mean (SD) of total cerebellum volume was calculated and analyzed using IBM SPSS version 20. Anatomical boundaries for cerebellum volumetry done with manual tracing. Normalization of cerebellum volume with intracranial volume was done by using co-variance methods introduced by Jack et al. (1989). Manual tracing using alternate slice method was utilized in obtaining intracranial volume as described by Eritaia et al. (2000). Image display and manual tracing of the cerebellum and intracranial areas were performed using Osirix software ver.3.7.1 (Pixmeo Sarl). Data was compiled and analyzed using PASW Statistic ver.18 (SPSS Inc.). Results: The overall mean normalized cerebellar volume is 181.1 ± 24.8 cm3. When analyzed separately among gender, normalized cerebellar volume was significantly higher in male (p value= 0.035; 95% +- CI). There is a statistically significant negative correlation between age and total cerebellum volume (r is - 0.492). Cerebellar volume becomes smaller at older age with moderate to good correlation. Conclusion: The study provided a reference data of cerebellar volumes in original and normalized formats for normal Kelantan population for a valuable reference in many physiological and pathological conditions for local population. The mean normalized cerebellar volume was statistically significant in genders with larger volumes in male subjects. They also had larger intracranial volumes than female. There is significant relationship between normalized cerebellum volume with age.
- PublicationDesign, Development And The Effects Of Emotionally Sound Web-Based Instruction On Performance, Satisfaction, Engagement And Retention(2018-11)This study was designed to investigate the effectiveness of the emotionally sound web-based instruction on performance, satisfaction, engagement and retention in learning English grammar among students with different levels of emotional intelligence. The sample consisted of 183 Form Two students from a secondary school in the Northern region of the Peninsular Malaysia. The data were collected with the Trait Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), End-User Computing Satisfaction (EUSC), Post-Test 1, Retention Questionnaire (Post-Test 2) and E-Learning Engagement Instrument (ELEI). The research design for this study is Quasi-experimental with pre-test and post-test design.
- PublicationComparison of the three forensic DNA Sampling and extraction techniques on various mock crime scene samples for reliable and rapid DNA analysis.(2022-09)The capability to generate reliable DNA profiles rapidly via short tandem repeat (STR) analysis to identify the suspect could greatly assist in crime investigations. This study evaluated the performance of a compilation of sample collection and extraction techniques consisting of the Maxwell RSC 48 FSC DNA IQ Casework Kit, Casework Direct System, and the COPAN MicroFLOQ® Direct Swab. A total of 48 reactions consisting of 16 mock casework samples for each technique ranging from bloodstain, saliva stained and touch DNA samples that were commonly encountered in crime scene were used in this study. The samples extracted using the Maxwell RSC 48 FSC DNA IQ Casework Kit were quantified using the NanoDrop™ 2000 Spectrophotometer. Subsequently, the collected samples for the three techniques were amplified using the GlobalFiler™ Express PCR Amplification Kit. The amplified products were then loaded for capillary electrophoresis via the ABI 3500xL Genetic Analyzer before analyzed using the GeneMapper ID-X v1.4 software. Results demonstrated that the three techniques generated relatively high percentage of autosomal STR allele call in total (100%, 100% and 96% respectively). Particularly, the COPAN MicroFLOQ™ with 96% was possible to analyze wide range of DNA samples where seven out of 16 samples were typed successfully. Meanwhile, the same number of sample types (n=6) with 100% autosomal STR allele call percentage and full consistent profiles were generated via the extraction using the two extraction kits. Notably, the average peak height across the samples using the former extraction kit was the highest which attributed to the automated extraction and purification employed that corresponded to the high DNA concentration yielded. This were followed by Casework Direct System and COPAN MicroFLOQ . In terms of turnaround time and cost associated, the MicroFLOQ® Direct Swab outperformed the other two techniques followed by the Casework Direct System extraction which took one hour for complete extraction. Meanwhile, the Maxwell FSC DNA IQ Casework Kit which took a longer time and higher cost for the entire extraction (1 hour 30 minutes and average RM 76.15 per reaction respectively). Not to mention, the use of the kit coupled with the automated Maxwell RSC 48 instrument ( RM 450, 000 per instrument) were on the more expensive end as compared to the other two techniques. Overall, the three different techniques had their respective merits and pitfalls but the COPAN MicroFLOQ® Direct Swab had an edge over the other two methods in terms of time, cost-effectiveness and ease to use. It also offered numerous advantages due to its direct PCR amplification properties, relatively high detection ability and quality DNA profiles produced. This resulted in the COPAN MicroFLOQ® Direct Swab capable to generate DNA profiles reliably in a short time thus potentially become a novel preferable collection technique employed by law enforcement officers.
- PublicationFem analysis of solar water heater(2002-03-01)The direct use of solar energy has never before been accepted on a worldwide basis. The costs of constructing devices or systems to use the sun’s energy have always been greater than the costs of using the alternate energy sources available. In the immediate future, however, the price of energy will rise even more rapidly than in the recent past. Alternate sources of energy are dwindling, and their costs are increasing at rates of 10% or more every year. We must explore putting the sun’s energy to practical use in supplying a percentage of our ever-increasing energy needs. The “first” most appropriate large-scale application of solar energy use concerns the heating of water for domestic use. The sun is everyone’s life. Without its energy, the past, present, and the future of human beings would not be. The sun has provided us with stored chemical energy in the form of fossil fuels which is now rapidly being depleted, and this depletion is thus responsible for escalated social and economics costs. To curtail these adversities, the direct application of the sun’s radiant energy to alternative conversion processes such as photovoltaic, photochemical, thermionic, thermoelectric, and heat must be continuously developed and utilized. An economic “first” application for existing solar energy alternatives involves using solar collectors to convert the sun’s radiant energy into heat energy for domestic water heating.
- ItemSynthesis Of Ethyl Oleate Catalyzed By Immobilized Lipase Process Optimization(Universiti Sains Malaysia, 2022-06-01)Esterification synthesis by chemical synthesis, using strong acid as the catalyst causes drawbacks to the environment, formation of undesirable side products and the presence of high acidic conditions. Hence, esterification using lipase as biocatalysts is considered a promising alternative to produce ester through enzymatic esterification, because this method is more eco-friendly, as it proceeds at mild reaction conditions, thus reducing energy consumption and adverse environmental effects. In this study, ethyl oleate, a commercially valuable oleate ester, was synthesised by direct esterification reaction catalysed by immobilized lipase from Candida rugosa in batch system using n-hexane as organic solvent. The free C. rugosa lipase was successfully immobilised on functionalized multiwalled carbon nanotubes support. The influence of optimizing parameters including reaction time, enzyme loading, temperature, acid:ethanol molar ratio were studied using one-factor-at-a time (OFAT) method. Optimal conversion yield for ethyl oleate of 87% was obtained at 40 minutes incubation time with 30 U/ml of enzyme loading at 40℃ with a substrate molar ratio of 1:3 (oleic acid to ethanol). The comparison between bisubstrate kinetic models of enzyme catalysed esterification by correlating experimental findings from reported research study was also investigated using non-linear regression analysis. A model of Ping Pong Bi Bi with inhibition by both substrates was found to exhibit the best fit with the experimental value of where the model parameters were obtained as Vmax=11.93 mmol mg−1min−1 , Km,A=3.02×10−3 mmol L−1,Km,B=3.04×10−3 mmol L−1,Ki,A=6.94mmol L−1, Ki,B=1.14mmol L−1 which shows good agreement to the reported findings.