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- PublicationMicrovascular Endothelial Function In Obesity; And The Effect Of Pharmacological Intervention With Orlistat And Sibutramine On Microvascular Endothelial Function And Selected Cardiovascular Risk Markers(2012)Obesity increases the risk of a variety of medical problems and cardiovascular diseases. Endothelial dysfunctionis one of the earliest vascular changes that occur in the pathogenesis.. Of cardiovascular diseases. This phd work is composed of three studies. The first study aimed to optimize a technique used to assess microvascular endothelial function, using laser doppler fluximetry (ldf) and the process of iontophoresis. Ldf measures skin perfusion, while iontophoresis is a non-invasive method of introducing charged substances across skin by means of a small electric current to evaluate both endotheliumdependent and endothelium independent vasodilatation. Firstly, the effect of sodium chloride used as a vehicle to dilute the iontophoresis drugs acetylcholine (ach) and sodium nitroprusside (snp) on non-specific vasodilatation was assessed. Secondly, to determine the number of electrical pulses needed to reach the maximum response during iontophoresis of ach and snp using low current strength. Thirdly, the reproducibility of different parameters during iontophoresis of ach and snp) were also determined. The initial iontophoresis protocol used consisted of 7 electrical pulses of2 minutes each separated by l minute current free interval.
- PublicationLaparoscopic cholecystectomy; intraoperative cholangiography versus no intraoperative cholangiography. a multi center randomized control trial(2019)Introduction: Intraoperative cholangiography (IOC) is not something new in the world of laparoscopic cholecystectomy (LC). However it is still not a favorite method to be applied as a routine procedure in LC. Objectives: To determine the feasibility and safety of performing IOC during LC, to detect the incidence of undiagnosed pre-operative bile duct stone and to identify whether IOC can prevent bile duct injury. Method: Multi-center, double blinded randomize controlled trial done from 2016-2018. Total of 308 patients recruited and divided into 2 arms; with IOC and without IOC. Exclusion criteria includes in situ biliary stent placement, history of multiple laparotomies, performed. Out of 308 patients, 154 patients were assigned to IOC group and 154 patients were assigned to no IOC group. Results: There was a statistically significant difference of mean operation time between the group with IOC and no IOC (mean operation time for IOC group was 66.0 minutes (SD Ā±28.20) compared to no IOC group 55.6 minutes (SDĀ±23.15), t statistics (df) = 306 (6.78), p-value <0.001). The successful rates for IOC was 98.1%. From 12 cases with presence of filling defects detected during IOC, 4 cases were confirmed CBD stones. Two were confirmed after conversion to CBDE and the other 2 cases were confirmed during ERCP performed. There was only 1 case of bile duct injury noted during IOC. No patients developed allergic reaction to contrast media and the post-operative complications were similar in both groups. Conclusion: IOC is a useful tool to delineate anatomy of bile duct during surgery. It also can easily been done by any surgeon with lots of practices and a proper guidance. Its use may be beneficial in selected cases.
- PublicationKnowledge and practice of preconception care among women in kampung orang asli Ulu Kampar Gopeng Perak(2025-08)Preconception care is an important preventive approach to improve maternal and child health. However, the awareness and practice of preconception care remain limited among the Orang Asli community in Malaysia. This study aims to determine the level of knowledge and practice of preconception care among women in Kampung Orang Asli Ulu Kampar, Gopeng, Perak, and to examine the association between them. A cross-sectional study was conducted involving 119 Orang Asli women aged 18 years and above. Data were collected using a validated self-administered questionnaire and analysed using SPSS Version 28.0, employing descriptive and inferential statistics. The result revealed that 63% of respondents had good knowledge of preconception care, while 79.8% demonstrated good preconception care practices. However, there was no significant association between knowledge and practice (p=0.139). In conclusion, the majority of women practised good preconception care, knowledge gaps remain, particularly in areas such as nutrition and birth spacing. Strengthening health education, improving culturally sensitive outreach services, and conducting further qualitative research are recommended to enhance preconception care in Orang Asli communities.
- PublicationKnowledge, attitude and practice towards 5 moments for hand hygiene among undergraduate nursing students at Univerisiti Sains Malaysia(2025-08)Hand hygiene is essential in healthcare to prevent infections, yet compliance among nursing students remains a challenge. This cross-sectional study assessed knowledge, attitude, and practice towards Five Moments for Hand Hygiene among undergraduate nursing students at Universiti Sains Malaysia. A total of 141 participants were recruited via convenience sampling, and data were collected using a self-administered validated questionnaire. Results showed that 95.7% of students had good hand hygiene practice, while most had moderate knowledge (72.3%) and attitude (58.9%). Weak, non-significant positive correlations were found between knowledge, attitude, and practice (knowledge-attitude: r = 0.137, p = 0.105; knowledge-practice: r = 0.129, p = 0.127; attitude-practice: r = 0.134, p = 0.111). Furthermore, no significant differences in practice were observed based on gender (ĻĀ² = 1.681, p = 0.219), education level (ĻĀ² = 0.187, p = 1.000), and year of study (ĻĀ² = 2.741, p = 0.506). These findings emphasize the need for ongoing education, regular hand hygiene campaigns, accessible placement of hand rubs and sinks, continuous supervision and practical training to maintain and enhance hand hygiene compliance.
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- PublicationThe association between toxoplasma gondii infection and psychiatric disorders among psychiatric patients in hospital Universiti Sains Malaysia(2023-12)Toxoplasma infection, caused by the protozoon Toxoplasma gondii, is one of the most common parasitic zoonoses globally. This facultative heteroxenic, polyxenic organism has been identified as playing a role in the etiology of various psychiatric disorders. The present comparative cross-sectional study purposed to investigate the association between Toxoplasma infection and psychiatric disorders in patients at Hospital Universiti Sains Malaysia, Kelantan. Fifty-four psychiatric disorder patients from each category (schizophrenia, bipolar disorder, and depressive disorder) and 54 healthy individuals were analyzed by an enzyme-linked immunosorbent assay (ELISA) that detects anti-T. gondii immunoglobulin G (IgG). Subsequently, all IgG- positive plasma samples were analyzed for Toxoplasma-specific IgM. IgG avidity ELISA was tested for the positive samples of T. gondii IgM. The presence of the Toxoplasma B1 gene and ITS-1 region was determined in all extracted deoxyribonucleic acids (DNAs) from the whole blood using the polymerase chain reaction (PCR). The sociodemographic, clinical manifestations, and behavioural factors of the psychiatric patients and healthy individuals were assessed using a data collection form. Out of 54 patients with depressive disorder, 24/54 (44.4%) were IgG+/IgM-, and four (16.7%) were IgG+/IgM+. A high avidity index that described a past infection for more than 20 weeks was reported in half of the sample (50.0%) and the other half (50.0%) showed a contradicting result that indicated a possible recent infection within 20 weeks. Moreover, 30/54 (55.6%) patients with bipolar disorder were IgG+/IgM-, five (16.7%) were IgG+/IgM+, and four of them had high avidity index and one showed a low avidity index. Meanwhile, 29/54 (53.7%) patients with schizophrenia were IgG+/IgM-, 2 (6.9%) were IgG+/IgM+, one of them had a high avidity index, and one low avidity index. Out of 54 healthy individuals, 37.0% (20/54) were seropositive for T. gondii antibodies. In this study, no positive results were found for the presence of the Toxoplasma B1 gene and ITS-1 region. A Chi-Square and multiple logistic regression proved age (p=0.031), marital status (p=0.007), and employment (p=0.012) were significantly associated with Toxoplasma seropositivity rate in patients with psychiatric disorders. Close contact with cats/pets (p=0.033) and contact with soil (p=0.012) also were significantly associated with Toxoplasma seropositivity rate in the patients. In conclusion, the findings revealed varying seropositivity rates, indicating that individuals with psychiatric disorders such as schizophrenia, bipolar disorder, and depressive disorder may have experienced both past and potentially recent infections with T. gondii. However, additional research is needed to elucidate the causal relationships and underlying mechanisms. This is essential for the development of targeted interventions and preventive strategies, with the potential to enhance overall mental health outcomes for those affected.
- ItemAdhesion of streptococcus mutans on tooth coloured restorative materials(Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia, 2016)Currently, the application of nanotechnology has become broadly developed in aesthetic dentistry due to its nanofiller particles size which offered numerous excellent advantages such as capable in reducing the bacterial adhesion of cariogenic oral bacteria mostly of early oral colonizers of S. mutans. This initial adhesion of S. mutans on the surface of materials contributed to the biofilm formation, surface deterioration of materials and may cause dental caries. In order to restore a carious tooth, the use of composite resin and resin-modified glass ionomer cement (RMGIC) in the restoration field has been increased due to the demand for aesthetic value. Different filler sized materials such as nanofilled, microfilled and microhybrid were used to compare and evaluate the adhesion of S. mutans on these materials at several incubation times. Four materials were used in this study which were RMGICs; KetacTM N100 (nanofilled) and Fuji IITM LC (microfilled) and composites resins; FiltekTM Z350 (nanofilled) and FiltekTM Z250 (microhybrid). A microscopy study was performed which include atomic force microscopy (AFM) for evaluation of surface roughness of the incubation materials, confocal laser scanning microscopy (CLSM) for evaluation of biofilm thickness and scanning electron microscopy (SEM) for distribution observation of S. mutans on materials. Fluoride release measurement was carried out for RMGIC materials to analyse the fluoride release of the materials. In addition, bacteria growth was done to assess the growth activity of S. mutans on the tested materials. Gene expression was also performed to determine the gene expression levels of gtfB and gbpB genes. Data obtained were statistically analyzed with either Independent T-test or One-way ANOVA at significance level of p<0.05. From the result, Fuji II LC gave a significantly higher of fluoride release compared to Ketac in both storage media (pā¤0.001). Both nanofilled materials gave a lower value of surface roughness while no significant difference of biofilm thickness between nanofilled and microfilled materials was shown except on day 7. RMGIC groups gave a lower S. mutans growth compared to composite resin group at all the incubation times. Nanofilled RMGIC gave significantly lower of expression levels of gtfB and gbpB gene compared to other materials p<0.05. From the results, surface roughness and fluoride release by RMGIC materials were recognized as a significant factor that affected the adhesion and accumulation of S. mutans on materials. In general, both nanofilled materials has the capability in reducing the bacterial adhesion of S. mutans compared to micron sized materials since most results in this study proved that nanofilled gave lower surface roughness, less biofilm thickness and low level of gene expression. Comparison between both nanofilled groups, Ketac showed an excellent improvement in reducing S. mutans adhesion compared to Z350 due to its fluoride release ability. These finding suggested a nanofilled RMGIC as the ideal material in reducing the accumulation of S. mutans, which could inhibit the adhesion of S. mutans on the surface materials.
- ItemContributions of TGFJ31 and SMAD4 genes to the etiology of keloid scars in the Malay population(Pusat Pengajian Sains Kesihatan, Universiti Sains Malaysia, 2012)Background: Keloid scars are complex dermal condition with genetic and environmental contributing factors. TGF(3 and SMAD candidate genes, which are located in the same signaling pathway, are highly expressed in the keloid fibroblast cells. To date, only few documented reports showing relationship between TGF(31 and keloid in Caucasian population but none on SMAD4. Purpose: The contributions of TGF(31 and SMAD4 in the keloid formation of Malay population were studies. Subjects and Methodology: The DNAs were extracted from the blood samples of 1 00 Malay patients with keloids with another 100 healthy individuals without keloids as controls. The DNAs were analyzed via Polymerase Chain Reaction and single-nucleotide polymorphism genotyping. Results: TGF(31 halotypes showed a strong association with the risk of keloid formation. The CC halotypes of TGF(31, composed of both c.29C>T and -509T>C variants, showed higher frequency among keloid patients compared with the controls (11% versus 2.7%, corrected p=0.037), showing 4.5-fold increased risk for keloid formation. The c.5131A>G variant of SMAD4 revealed a statistically significant trend (p=0.0573). Taken together, either of these variants is the most probable causative factor at the expression level or is in linkage disequilibrium with other causative variants in a complex pattern with the environmental factors, contributing to keloid formation. Conclusion: This is the first study documenting strong positive association between TGF(31 and SMAD4 variants and keloid formation in the Malay population.
- ItemPutative inhibitory actions of selected medical plants against exonic splicing enhancers(Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia, 2020-10)A previous study had demonstrated the successful use of isodiospyrin as an inhibitor of splicing factor and the use of a small-molecule compound as exon skipping inducer. Inhibition of serine and arginine-rich (SR) protein using isodiospyrin and their homolog results in exon skipping and indirectly restore the reading frame and protein product. Creating a novel minigene model can be used for studying the complexity of the splicing mechanism, potentially translatable into the identification of therapeutic targets in various related other conditions, such as Duchenne Muscular Dystrophy where the Dystrophin gene is affected. The objective of this study was to determine the inhibitory actions of isodiospyrin and isodiospyrin homolog of selected medicinal plant extracts for inducing skipping in the designed minigene against exonic splicing enhancers. Exonic splicing enhancers of dystrophin minigene was identified using ESEfinder 3.0 software. There are two subtypes of minigene which are genuine minigene and artificial minigene. Genuine minigene includes Gen-Ex45, Gen-Ex 51 and Gen-Ex53 while artificial minigenes with specific exonic splicing enhancers (ESE) are Art-SF2/ASF, Art-Sc35, Art-SRp40, Art-SRp55 and Art-NO ESE. All minigenes were constructed before being subjected to the cloning process and targeted minigenes were validated using sequencing before to transfection into the HEK-293 cell line for splicing assay. The assay was again validated using 2 methods which are luciferase assay by the fluorescent signal and another method by the presence of targeted size band after reverse transcriptase-polymerase chain reaction (RT-PCR) and were then confirmed by sequencing analysis. Six extracts from 5 plants similar to isodiospyrin homolog were screened using NADI software. Direct sequencing further validated the absence of exon after compounds exposure to all minigene, results showed no skipping in all genuine minigene, different with artificial minigene which showed all skippings based on the RT-PCR results. After luciferase analyses, their skipping values were still far from mock minigene (standard skipping) which showed a higher threshold indicating that no skipping occurred and that luciferase assay was more sensitive than RT-PCR. Based on the result obtained, it was proven that fewer ESE sequences in the exon are unable to retain exon. Also, there was a higher potential of skipping to occur if there are few ESE in the sequence, the presence of a silencer motif as well as when that sequence consists of positive splicing potential value. Five of the compounds were shown significantly to induce skipping after exposure to the Art-SRp55 and one of each Art-SC35 and Art-SRp40, while no compounds showed significant skipping after exposure to the Art-SF2/ASF. However, it was shown that the skipping level was not as much as that which occurred in the mock minigene that acted as a skipping standard. Interestingly, isodiospryin showed to have a high tendency to become ESE skipper when exposed to the Art- SRp40 minigene, because it showed a significant skipping value (p= 0.049) although with the presence of silencer motif 1 and higher SP value. In a conclusion, isodiopsyrin and its homologs might have shown the capacity to induce skipping, although in an ESE-specific manner, even with or without the presence of silencer motif and hnRNP A1. This approach may provide a view to further study ESE on the disease-related conditions.
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