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- PublicationRed Blood Cells Transfusion Practice In Paediatric Cardiac Surgery At The National Heart Institute (Ijn) Of Malaysia(2021-05)Introduction: Allogenic blood transfusion among paediatric cardiac surgery conducted under cardiopulmonary bypass (CPB) remains very frequent and is associated with potential adverse consequences, including postoperative morbidity. This study aims at identifying the predictive factors associated with perioperative red blood cells (RBC) transfusion and finding its association with postoperative outcomes, in order to promote patients' effective management and guide clinicians to decide on judicious blood transfusion. Methods: This cross-sectional retrospective study, conducted in IJN, involved 243 paediatric patients with cardiac surgery less than 18 years of age who had CPB surgery done in 2018. Results: Preoperatively, 4.5% of patients received RBC transfusion with significant predictor for transfusion; haemoglobin (Hb) with mean value of 8.3 to 9.8 g/dL. Intraoperatively, cumulative of 99.2% of patients received RBC transfusion with predictive factors for transfusion in high RBC transfusion subgroup; young age, low body weight, RACHS-1 scores of ≥ 3 and had longest CPB time compared to other groups. RBC transfusion status pre- and intraoperatively was found not to influence postoperative RBC transfusion status significantly. Our analysis showed that 25.9% of our studied population received low RBC transfusion during the postoperative period, while another 11.5% received high RBC transfusion. The CBP time and surgery duration were profoundly longer in the postoperative high RBC transfusion subgroup. Longest mechanical ventilation is significantly associated with preoperative low RBC transfusion subgroup and other covariates like lower body weight and longer CPB time. Longer duration of PICU stay was correlated with low preoperative and high postoperative RBC transfusion, lower body weight, RACSH-1 score >2 and longer CPB time duration. Conclusion: The predictive transfusion factors identified in relation to operative time were unique to each phase. This study also concluded that certain perioperative RBC transfusion status showed a significant association with selected postoperative outcomes, duration of mechanical ventilation and length of the PICU stay.
- PublicationThe Efficacy Of Radiocolloid In Sentinel Lymph Node Biopsy In Early-stage Breast Cancer(2021-11)Purpose: This study aims to evaluate the performance of radiocolloid, blue dye and combined method in sentinel lymph node biopsy in early breast carcinoma. Methods: One hundred seventy-two clinically node-negative, early-staged breast cancer patients who underwent SLNB with combined radiocolloid and blue dye were recruited. The numbers of hot node and blue node were analysed in all patients, all excised nodes and metastatic nodes patients, giving rise to the detection rate, metastatic rate and failure rate of combined method, radiocolloid and blue dye method. The association between the clinicopathological factors and the SLN detection was also analysed. Results: Out of 172 patients, the presence of a hot node and a blue node were 98.2% (169/172) and 95.9% (165/172) respectively. The overall SLN detection rate through combined method was 99.4% (171/172) and metastatic rate was 19.2% (33/172). Among the 33 metastatic-node patients, the combined method, radiocolloid and blue dye method failed to identify 1, 1 and 4 patients respectively. Therefore, the failure rate of the combined method, radiocolloid and blue dye method were 3.0% (1/33), 3.0% (1/33) and 12.1% (4/33), respectively. No significant finding was observed to associate clinicopathological factors and the SLN detection. Conclusion: This study showed the combined method of SLNB yielded the highest detection rate when compared to radiocolloid-alone and blue dye-alone method. More SLN was detected by radiocolloid method than blue dye method. Therefore, incorporating radiocolloid method in the blue dye method will improve SLN identification rate and reduce the failure rate of metastatic detection.
- PublicationDay And Night Time Packed Red Blood Cells Transfusion Practice Among Adult Patients In Non-emergency Wards At Hospital Universiti Sains Malaysia (Husm) Kelantan(2021-05)Background: Most of the transfusion services have a policy of strongly discouraging blood administration at night unless for emergency cases. However, blood transfusion at night is still a common practice in most hospitals even in the non-emergency wards. Thus, this study aimed to audit the practice of PRBC transfusion and its compliance towards national transfusion guideline. Methods: This is a cross-sectional study involving a retrospective data collection of 385 adult inpatients who received PRBC transfusion in Hospital Universiti Sains Malaysia (HUSM) from 1st January 2017 to 31st December 2018. The selected patients were grouped into day and night time transfusion. Night time blood transfusion is defined as those who received PRBC between 8.00 pm to 8.00 am. Data for demographics, clinical characteristics, and three time intervals of transfusion process were collected from blood transfusion request form, MyTransfusi online system, and patient case note. Factors associated with night time blood transfusion were analysed using multiple logistic regression. Results: Total PRBC transfusion was 13,090 units. The prevalence of night time PRBC transfusion was 19.3% (2,523 units). Generally, female (56.2%), Malay (93.8%), bloop group O (35.7%), and from the medical discipline (28.6%) were the highest group of patients transfused at night. There were only 44 (39.3%) patients who received night time transfusion classified into acute clinical need group of transfusion indication. Most of the night time PRBC were transfused after 30 minutes issued by the blood transfusion service which were 70 patients (62.5%). Besides, 29 patients (25.9%) for night time group of patients received transfusion beyond four hours limit. Cryoprecipitate was 2.7 times more likely to be transfused at night (adjusted OR= 2.70; 95% CI= 1.04,7.01; P= 0.041). Adverse transfusion reaction was 7.1 times higher risk to develop at night (adjusted OR= 7.07; 95% CI= 1.26,39.71; P=0.026). Conclusion: Even though the practice of the night time PRBC transfusion was low, there was an increased in adverse transfusion reactions during this time and thus potentially increased morbidity and mortality of patients.
- PublicationMaternal And Neonatal Characteristics In Fetal/neonatal Alloimmune Thrombocytopenia In National Blood Centre(2021-05)Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is an uncommon condition due to maternal alloimmunization of fetal platelet leading to thrombocytopenia in fetal and neonate. The aim of this study was to determine the incidence of FNAIT in Malaysia and the associated maternal and neonatal factors. Retrospective data analysis of matched, case control study (39 FNAIT cases and 39 randomly selected controls) from the year 2011 to 2019 at National Blood Centre, Malaysia. Maternal and neonatal characteristics were compared with controls. The incidence of FNAIT in Malaysia was 0.85 per 100 000 live births.Common anti-Human Platelet Antigen (-HPA) identified in this study were Anti-HPA-5b, Anti-HPA-3a and Anti-HPA-5a. Fifty-eight (58%) (p=0.012) of mothers were younger than 35 years old, of Malay ethnicity and multiparous. Malay mothers were 4.8 times more likely to develop FNAIT as compared to non-Malay. Neonatal onset of presentation, platelet count and blood group were not significantly different than in control group. The most significant factor associated with FNAIT was neonatal presentation. Symptomatic neonates were more likely to develop FNAIT. Incidence of FNAIT among Malaysians was lower than reported in the literature. Malay mothers and neonates presenting with symptoms are more likely to have FNAIT.
- PublicationParental Perception On Quality Of Life Of Their Children Following Dental Treatment Under General Anaesthesia(2021-09)General anaesthesia (GA) is extensively used to deliver safe and effective dental treatment for paediatric patients with physical, mental and medically compromising conditions who fail to respond to other behaviour modification techniques. This study's objective is to determine the importance and acceptance of general anaesthesia among parents whose child has undergone treatment under GA at Advanced Medical and Dental Institute, Universiti Sains Malaysia and the impact of treatment under GA has on their child’s Oral Health Quality of Life (OHQoL). Part 1 of this study, 113 records (October 2015 - February 2019) were retrived to find out the type of treatment performed and reasons for the treatment being provided under GA. Simultaneously, only 56 out of 113 parents from the record responded to answer parents' perception and satisfaction on dental treatment under GA using a questionnaire adapted from the Parents and Caregivers Perception Questionnaire (PCPQ) and Cleft Evaluation Profile (CEP). For part 2, it was pre and post-treatment study where 58 parents with children (March 2019 - December 2019) registered for their treatment under GA were requested to answer the same questionnaire as in Part 1. The results showed the main type of treatment performed was extractions of deciduous teeth (93.0%) and restoration using stainless steel crowns and Glass ionomer cement. The reasons for administering GA were total oral rehabilitation (72.5%) due to rampant caries, medical (18.7%) and behavioural problems (8.8%). The total mean(SD) score for P- CPQ was 57.44 (17.75), and for Facial Evaluation Profile was 17.44 (9.59). All the 56 parents (100%) were satisfied with the dental treatment under GA. For pre and post-treatment study, there is a significant difference between the mean score of P-CPQ pre-treatment and post-treatment for oral symptoms, functional limitation, emotional well-being, and social well-being with a P-value of 0.007, 0.006, 0.001 and 0.043, respectively. However, there is no significant difference in the facial evaluation profile with P=0.385. Oral rehabilitation was the reason of providing treatment under GA and SSC were used to protect posterior dentition, whereas GIC was the material of choice. Acceptance by parents on treatment under GA for children could be seen in this study with a positive effect on OHRQoL of their child. All the respondents reported satisfied with the dental treatment provided under GA. Generally, there was a significant improvement in the quality of life of the patient’s post-treatment. Further study with a larger number of subjects may give a more precise results
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- ItemFormulation And Evaluation Of Channa Striatus Extract And Fusidic Acid Aerosol For Treatment Of Wounds And Burn(Universiti Sains Malaysia, 2011)Aerosol is a new drug delivery system for wound dressing and wound treatment. Aerosol has several benefits when compared with other delivery systems such as plasters or bandages for wound dressing and cream or gel for wound treatment. When applied to the body aerosol reduces pain that may result from the mechanical rubbing of gel and creams onto the skin. Aerosol could cover any size of wound which could not be covered by films due to films have a fixed size. Channa striatus has been used since a long time ago traditionally to accelerate the wound healing. Channa striatus extract contained amino acids and fatty acids which important for healing process. Fusidic acid is an antimicrobial for topical application. Channa striatus extract and in combination with fusidic acid have been used as active ingredients in this study. Channa striatus extract contained about 3.61% protein. HPLC systems for amino acids analysis and GC systems for fatty acids analysis method used in this study met the requirements of validation. These HPLC systems are reliable and reproducible. Channa striatus extract contained amino acids that could promote the wound healing process. Channa striatus extract also contained omega-3 and omega-6 that are very important in wound healing process. Ratio between omega-3 and omega-6 fatty acids was 0.85. Omega-6 fatty acid is needed as inflammatory inducer in the early phase of wound healing process. HPMC is the best among polymers tested to produce concentrate for aerosols and films with the expected qualities. Glycerine has been used as plasticizer for formula E and PEG 400 for formula G. Tocopherol was used as antioxidant. Aerosol aluminium can was used as container. Based on safety and economic aspect, butane was chosen to be used as the propellant for Channa striatus and fusidic acid aerosols.
- PublicationA Theory Of Planned Behavior And Transformational Leadership: An Examination Of Corporate Philanthropy In Malaysia'S Smes(2014)According to SME Annual Report 2012 - 2013, Malaysia Small Medium Enterprises (SMEs) will become the nation's future engine of growth. In addition, the government had launched SME Master plan 2012 - 2020 which define the policy direction for SMEs companies toward achieving Malaysia's goal of becoming high income nation by 2020. Despite the important role play by SMEs companies, little attention has been given to understand these groups of company engagement in corporate philanthropy. The involvement by SMEs companies in corporate giving is critical in order to ensure Malaysia become a caring nation by 2020. This study intends to examine the determinants of SMEs corporate philanthropy decision. Ajzen's theory of planned behavior (TPB) and Bass's transformational leadership theory which have been validated in many academic fields will provide the theoretical foundation for a further understanding of SMEs companies' philanthropic behaviors. Moral obligation and government incentives were also included to provide a more complete study. The study was carried out using 82 questionnaires answered by SMEs companies' top management.
- PublicationThe expression of egfr and pegfr in nasopharyngeal carcinoma patients in HUSM(2021)Introduction: Epidermal growth factor receptor (EGFR) is commonly upregulated in several carcinomas, in which EGFR activation into phosphorylated EGFR (pEGFR) promotes tumour cell growth and inhibits apoptosis, enhances tumour invasion and metastasis, and induces chemoresistance and radio-resistance. Furthermore, EGFR family members have the property to translocate (shuttle) from cell membrane of cancer cells into nucleus through signalling pathways. Nonetheless, overexpression of EGFR in primary tumours has been associated with an aggressive clinical course in many cancers including nasopharyngeal carcinoma (NPC). Objectives: The present study has investigated the cellular localisation, extent, and intensity of EGFR and pEGFR expression on nasopharyngeal cancer cells including the possibility of cellular translocation (shuttle) from the cell membrane into nucleus of cancer cells and investigated their clinical significance. Methods: Thirty-four cases of nasopharyngeal carcinoma (NPC) were diagnosed and treated in Hospital Universiti Sains Malaysia from year 2005 to 2018. The cases were examined for EGFR and pEGFR immunohistochemistry expression to study the cellular localisation and possible cellular translocation of EGFR and pEGFR. The extent and intensity of EGFR and pEGFR expression were calculated using descriptive analysis. The association between clinicopathological parameters with EGFR and pEGFR expression were then analysed using Fisher’s exact test or Chi-square test. Results: All 34 (100%) cases were positive for EGFR and pEGFR as they showed clear membranous expression on the cancer cells of NPC with no significant association was noted with clinicopathological parameters. Only 23 (67.6%) cases, showed pEGFR membranous and nuclear localisation in cancer cells which indicated the cellular translocation. Moreover, 21 out of 23 (91.3%) cases that showed membranous and nuclear pEGFR expression were in advanced TNM staging (stage IV) (P value = 0.217). Conclusion: All cases were positive for EGFR and pEGFR as they showed clear membranous expression on NPC cells. All cases with EGFR expression were negative for cell membrane to nuclear translocation, whereas 23 (67.6%) cases of pEGFR expression showed cellular translocation (shuttle) from cell membrane into nucleus. 21 out of 23 (91.3%) cases that showed pEGFR nuclear translocation were diagnosed as NPC TNM stage IV, indicating that nuclear localisation of pEGFR in NPC cells carry poor prognosis
- ItemEffect of tannic acid-trimesoyl chloride on thin film composite membrane(2018-07-01)A thin film composite membrane was prepared by synthesized the reacting tannic acid aqueous solution and trimesoyl chloride in organic phase. Previous research shows that fouling and stability issue on the UF membrane particularly during filtration of protein. Therefore, interfacial polymerization (IP) technique was employed to investigate the effect of tannic acid and trimesoyl chloride on the performances of anti-fouling resistance, hydrophilicity and permeation properties of thin film composite membrane. The role of tannic acid and trimesoyl chloride (TATMC) with various concentrations on membrane properties such as chemical bonding properties, morphology, surface roughness, hydrophilicity,and performance in term of water permeability and protein rejection (Bovine serum albumin and Lysozyme) were investigated, respectively. The results revealed that the increasing on the concentration of monomer during interfacial polymerization process could reduce the surface roughness and reduce the defect on the surface of composite membrane due to the intense polymerization reaction. Furthermore, the formation of polyester selective skin layer was also found to influence the hydrophilicity, fouling property and membrane performances tests. The best overall performance result were achieved with composite membrane produced by 0.5 g/L tannic acid and 0.3 g/L trimesoyl chloride leading to a pure water flux of 114.16 Lm-2h-1 and, BSA and Lysozyme rejection of 98 % and 94%, respectively. The effect of tannic acid and trimesoyl chloride (TA-TMC) on hydrophilicity of membrane is studied as well. Further polymerization process with increasing the tannic acid concentration (TA) improved the hydrophilicity to 29.70 and improved the roughness of layer with a more uniform structure from 73.96 nm to 30.07 nm. Different concentration of monomers (tannic acid and TMC) used also affect the different rates of cross-linking occurred on the surface of membrane that contribute towards the formation peak of ester group and O-H stretch which more clearly observed as the concentration of tannic acid and trimesoyl chloride (TA-TMC) increased.
- PublicationWheel momentum dumping using magnetic torquer(2009-04-01)The wheel momentum unloading is an important process in the small satellite based on momentum bias. Usually the process is achieved by the magnetic torquers because it’s easily to designed and low cost saving. The main purpose of this thesis is to develop control algorithm for wheel momentum dumping using magnetic torquer. To develop the appropriate control algorithm the dynamic equation of the satellite is defined and need to be linearized. The control algorithm then carried out in the MATLAB and Simulink to observe the wheel momentum unloading performance. The result is compare with the performance of the wheel without the unloading process and it shows that the momentum unloading process give the better performance of the momentum wheel. For the demonstration purposes, the Tiung-Sat satellite has been chosen to simulate the wheel momentum unloading using magnetic torquer for the small momentum bias satellite. The performance of the momentum unloading process exhibits that the angular momentum wheel steady state error is achieved with accuracy value in range of 0 to 0.008 Nms. Thus, the magnetic torquer is a promising option for the small momentum bias satellite.