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- PublicationRadiomics features of magnetic resonance imaging for prediction of survival in osteosarcoma patients(2021)Introduction: Osteosarcoma is a primary bone tumour associated with a poor prognosis, and prediction of overall survival of osteosarcoma can help in personalizing the patient's management. Recently many studies have shown that the tumour texture, the heterogeneity of tumors, and the intensity may have the potential to predict the prognosis or the survival of patients with osteosarcoma. The aim of this study was to investigate the prognostic value of Magnetic resonance imaging (MRI) texture, shape and intensity parameters in patients with osteosarcoma to develop a radiomics nomogram by combining clinical factors and the radiomics features. The radiomics features were extracted from the pre-treatment magnetic resonance images of T1WI, T2WI and T1 post contrast. Upon many features were extracted, the most significant features were selected then the Kaplan-Meier survival analysis was performed. Methodology: This retrospective study was conducted in Hospital Universiti Sains Malaysia (HUSM), Kelantan, from January 2000 until December 2010 on 60 patients were diagnosed within that period. MRI images of T1WI, T2WI and T1 post Gad sequences of patients who fulfilled the inclusion criteria were retrieved from the PACS system. Tumour segmentation and features extraction using MATLAB software. The Univariate analysis was done for features selection. A final model was built by integrating the significant radiomic features with the significant clinical data. Data were split into training and test data set in 70:30 ratio, randomly selected. Results: Total of sixty subjects (n=60) with a mean age of 17.39 years old were included in this retrospective study. Overall survival probability among the subjects was 45.7%. Cox proportional hazard regression for the patient clinical data and the extracted radiomics features showed no statistically significant of most of the radiomics fractures with (P > 0.05) as well as most of the radiomics features except 3 radiomic features extracted from T2WI. Multiple logistic regressions were done with increasing the P value to < 0.25, as results of that features and clinical data with P value < 0.25 were included in the final model. The sensitivity, specificity and accuracy of the model were 70%, 77.8% and 73.7. The positive and negative predictive values were 77.8% and 70% respectively. Conclusions: The study showed the radiomic features were statistically significant compared to the clinical data which can play a major role in prediction of the patient's survival. However due to the limited data of one centre the results of the study were not significantly high. Multicentric study with large data should be performed to obtain significant results and be useful in the future clinical patient management.
- PublicationEmergency department patients comprehension difficulty of their diagnosis and care upon discharge and description of factors contributing to their knowledge deficit(2021)Introduction : Emergency Department (ED) patients must be aware of their diagnosis, treatment options, and implications of their diagnosis and its outcome in order to engage effectively in treatment options. Objectives: To identify the proportion of discharged ED patients who have comprehension difficulty of their diagnosis and treatment received and to describe the factors contributing to patient comprehension difficulty. Methodology : A cross-sectional survey of 332 discharged green zone patients of ED Hospital Universiti Sains Malaysia chosen by simple random sampling was conducted from May to December 2020. A newly developed questionnaire adapted from previously established study at Chicago was content and face validated and translated. Pilot study involving 50 patients was done. Cronbach alpha value of 0.9 was obtained. Patients rated their subjective understanding on degree of agreement of 3 domains: diagnosis, ED care (tests and treatment) and factors contributing to comprehension deficit. Descriptive statistics was used to summarise sociodemographic characteristics, proportion of perceived comprehension difficulty of diagnosis and ED care. Statistical significance for association between variables were calculated using Pearson Chi-square test. Results: More than 80% patients had good comprehension of their diagnosis and ED care. All the factors described except long waiting time were statistically significant for patient comprehension. Noisy environment and lack of privacy was statistically significant as contributing to poor comprehension of ED care. Conclusion: There is great improvement on patient comprehension of their diagnosis and treatment over the years. A conducive environment in addition to effective communication is vital further improvement of patient understanding of diagnosis and treatment received.
- PublicationKelulut honey as an alternate source of carbo-loading in abdominal surgery involving the digestive system a randomized blinded comparative study(2021)Background and objective: The benefits of carbohydrate loading prior to elective surgery is well researched and documented, and guides surgeons based on texts published by the group for Enhanced Recovery after Surgery (ERAS). Commonly, maltodextrin extracts are utilised for this purpose, which can be quite expensive. Honey, a naturally occurring substance that is well tolerated amongst the Asian population is known to have antibacterial, anti-inflammatory as well as wound healing properties. If Kelulut Honey, the locally available variant is shown to have a significant effect in carbohydrate loading, it can be used as a cheaper alternative in our setting. This study aims to determine the effect of Kelulut Honey on insulin resistance and residual gastric volume as well as compare several post-operative outcomes when used as carbohydrate loading preoperatively in patient undergoing abdominal surgery involving the gastrointestinal tract in Hospital Universiti Sains Malaysia (HUSM). Study design and method: This is a prospective single centre randomised double blinded comparative study conducted at HUSM. A total of 64 patients undergoing elective intra-abdominal surgery involving the digestive system, above the age of 18 will be recruited into the study. Patients with a background history of Diabetes, Fasting Glucose level > 7mmol/L, poor pre-morbid condition (American Society of Anaesthesiology (ASA) >3), on concurrent steroid treatment, recent infection in the past 3 months, preoperative unintentional weight loss >10% of usual body weight within 6 months, minors and those with allergies to maltodextrin and honey will be excluded from the study. Objective data analysis is conducted using the independent sample t-test. Secondary objective data assessment will be done using Chi2 test. Result: A total of 64 patients were recruited, however 1 patient was excluded as they were unable to complete the consumption of the carbohydrate loading solution from the Carborie® group. Measurement of residual gastric volume analysis showed no significant difference between both groups. Man-Whitney test was performed to analyse the comparison of blood glucose level which also showed no significant difference throughout measurement time. The average blood glucose on induction was 5.3-5.6 mmol/L and the post-operative blood glucose analysis showed blood glucose below 10 mmol/L where insulin administration was suggested. Most of the participants could pass flatus before 12 hours post operatively, and more than half were able to ambulate within 12 hours. More than half were started on clear fluid within 6 hours from surgery. Comparison between the groups indicates no significant difference in terms of complications, length of stay, pain control and return to function. The intention to treat analysis reveals that there is no significant difference in primary and secondary outcome of both groups. Conclusion: Kelulut honey is safe to be used as an alternative to conventional carbohydrate loading in patients undergoing abdominal surgery involving the digestive system and its effects on insulin resistance, residual gastric volume and post-operative outcomes are similar with the commercially available carbohydrate loading product.
- PublicationThe effects of evening primrose oil on menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials(2021)Introduction : Evening primrose oil has been a treatment option for reducing menopausal symptoms but evidence for its use is inadequate. Objective : To determine the effectiveness of evening primrose oil in treating menopausal symptoms among peri and postmenopausal women. Methodology : The study design is a systematic review with meta-analyses of randomized controlled clinical trials. We searched CENTRAL, Medline, Embase and trial registries for relevant randomized clinical trials. The methodology and reporting were carried out grounded on references from the Cochrane collaboration and the preferred reporting items for systematic reviews and meta-analyses statement. Review manager version 5.3.5 was used to perform all the statistical analyses. Results : Five randomized clinical trials, recruiting a total of 402 peri and postmenopausal women were identified. There was no difference between evening primrose oil and control for the frequency of daily vasomotor symptoms (MD 0.01 episodes; 95% CI -0.54 to 0.57; P=0.960; two trials; I2 = 38%), frequency of daytime hot flash episodes (MD -0.51 episodes; 95% CI -2.05 to 1.03; P=0.510; two trials, I2 = 87%), frequency of night sweat episodes per day (MD 0.33 episodes; 95% CI -0.48 to 1.13; P=0.430; two trials, I2=74%) and severity of vasomotor symptoms (SMD -0.45; 95% CI -1.56 to 0.66; P=0.420, four trials; I2 = 95%). EPO may reduce the severity of overall menopausal symptoms (SMD -1.18; 95% CI-2.18 to -0.18, P=0.02, two trials, I2 = 91%). There was no significant difference for the occurrence of nausea (RR 5.94; 95% CI 0.74 to 48.00; P=0.090; I2 = 0%). There were insufficient data to pool results for musculoskeletal symptoms, mood, sexuality, sleeping disorders and quality of life. Conclusion : Evening primrose oil may reduce the severity of overall menopausal symptoms but is not effective to reduce the frequency and severity of vasomotor symptoms. The evidence quality ranged from very low to moderate. Further research is needed to enhance related evidence.
- PublicationComparison of the efficacy and safety of magnesium sulphate added ropivacaine 0.375% solution and ropivacaine 0.375% alone for pectoralis and serratus anterior nerve block in unilateral breast surgery(2021)Title: Comparison of the efficacy and safety of ropivacaine 0.375% with magnesium sulphate added and ropivacaine 0.375% alone in pectoralis and serratus anterior (PEC II) nerve block in unilateral breast surgery: A randomised controlled trial Introduction: PECS II nerve block is a multimodal analgesia approach for opioid sparing analgesia. Previous study had shown that addition of magnesium sulphate improved analgesic effect, reduced in opiod consumption with minimal side effect. This is the first study to evaluate its efficacy and safety of magnesium sulphate added into ropivacaine 0.375% as an adjuvant in PEC II block. Objective: To assess the efficacy analgesia and safety of magnesium sulphate added into ropivacaine 0.375% in PEC II nerve block in unilateral breast surgery. Methods: This was a double blinded randomised controlled trial. A total of 50 ASA class 1 and 2 patients who underwent a unilateral breast surgery with or without axillary clearance were randomised into 2 groups, intervention (M) group (n=25) who received ropivacaine 0.375% added with magnesium sulphate (5mmol) and control (R) group (n=25) who received ropivacaine 0.375% alone for PEC II nerve block. PEC II nerve block was performed under ultrasound guidance in sterile technique. Post-operative VAS pain score at 0, 4, 8, 12, and 24 hours were assessed. Intra and post-operative opioid rescue requirement usage were evaluated and documented. Post-operative side effect of magnesium sulphate such as nausea, vomiting, hypotension, cardiac arrhytmias and muscle weakness were assessed. Results: There was no statistical significants in demographic profile between groups. There was statistical significance difference in post-operative VAS mean pain score at rest from time 8hours and movement from time 4hours onwards (0.20 and 0.68, P-value of < 0.01). There was a significant difference in frequency of intra-operative opioid rescue requirement. (68% versus 7%, P-value < 0.05). There was no significant side effects or complications from the used of magnesium sulphate in this study. Conclusion: Pectoralis and serratus anterior (PEC II) nerve block with ropivacaine 0.375% and magnesium sulphate significantly reduced post-operative pain score and intra-operative opioid consumption without any significant side effects.
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- ItemDoes Shareholder Concentration Matter In Small And Medium Enterprises (SMES)? Empirical Evidence From SMES In Manufacturing Sector In Northern Corridor Economic Region (NCER).(Universiti Sains Malaysia, 2009-06)Given the important role of SMEs as a growth factor in local economy, ensuring a strong and competitive development for this industry segment has become a key concern in making the Northern Corridor Economic Region (NCER) a success. This study investigates the effects of shareholder concentration, together with financial inputs and outputs on the relative operating efficiency in utilization of financial resource (financial efficiency) for SMEs in manufacturing sector in NCER for the financial year 2007. The financial efficiency is derived from Data Envelopment Analysis (DEA). DEA shows that only 27 SMEs scored 100% efficiency, and they are mostly from Penang and Perak. This study delivers three important findings: first, shareholder concentration does affect the financial efficiency for SMEs involved in manufacturing sector in NCER; second, lower financial inputs and higher financial outputs produce higher financial efficiency SMEs involved in manufacturing sector in NCER; third, the distribution of financial efficiency is not balance across the three states in NCER. The last point is consistent with the Korean case reported in Yang (2006).
- PublicationPredicting occurrence of rainfall using discriminant analysis(2009-04-01)Malaysia has a tropical climate that is consistently hot with high frequent rainfall. Water is one of the most vital natural resources for all life on Earth. So, it is important to quantify it accurately. Rainfall rate is affected by some unpredicted weather conditions such as humidity, air pressure, temperature and wind speed which are liable to change. The relationship between the rainfall rate (dependent variable) to the humidity, temperature, air pressure, and wind speed (independent variables) is analyzed by the method of discriminant analysis using the SPSS 15.0 software. A total of 340 cases for year 2008 were used to develop a model to discriminate among the 2 levels of rainfall rate which is rain or no rain. The aim of this project is to develop a set of discriminating functions to predict the category of the rainfall rate. The usefulness of a discriminant model is based upon its accuracy rate, or ability to predict the categories of the dependent variable. As a conclusion, the discriminant analysis in this study successfully estimates the categories of the rainfall rate. The accuracy is high that is 84.7%. So, the results show that the discriminant analysis can be considered as an effective tool in forecasting the type of rainfall condition.
- PublicationIpo Information Disclosure And Price Stabilisation Action From The Perspective Of Information Asymmetry In Hong Kong Listed Companies(2024-08)The topics of IPO have attracted attentions from scholars for a long time. Among these research topics, price stabilisation, which is an aftermarket action taken by underwriters, is relatively less concentrated by prior studies. Factors which cause the stabilisation done by underwriters are not clear, owing to the barrier resulted from the non-mandatory disclosure of such actions in many countries. Meanwhile, as a compulsory document for IPO issuers, the prospectus contains sufficient information for investors to make decision for IPO investment. Recent studies have focused on the information disclosed in IPO prospectus, such as the text content and textual tone, and its corresponding influence on market performance. Yet, studies which have investigated the relationship between the information disclosure of IPO prospectus and price stabilisation are scarce. This thesis probes into the potential factors of price stabilisation from the theoretical perspective of information asymmetry by examining how the information disclosed in the IPO prospectus can impact the aftermarket stabilising actions using a sample data from 2004 to 2021 in Hong Kong stock market. Specifically, the effects of the information disclosure related to cornerstone investors, Chinese state ownership, as well as the narrative uncertainty contained in the prospectus, are investigated using ordinary least square regression model. This thesis finds that the information related to cornerstone investors is positively correlated with price stabilising actions in the aftermarket.
- PublicationQuantitative mri fibre tractography in leukoaraiosis: Analysis of lesional and non-lesional cerebral white matter(2022)Background: Leukoaraiosis was first described as area of hypodensity on CT imaging and on conventional MRI, it is an appear hyperintense on both T2-weighted and fluid attenuation recovery inversion (FLAIR). Both may represent a variety of different pathologies, only some of which are associated with tissue destruction and neuronal disfunction. Diffusion tensor imaging (DTI) MR imaging was based on movement of water molecules in biology tissue. DT imaging was widely used to study microstructural in brain, musculoskeletal and spinal cord. Any change in tissue will affect the water molecules movement that provide microscopy information regarding the tissue which allow detection of abnormalities in early stage. The distinctive features of DT imaging are fiber tractography which give quantitative and qualitative assesment of the nerve fiber in the brain. This study compares the ADC, FA and Fiber density Index value between leukoaraiosis and normal control subjects using 3T MRI system. Methodology: A retrospective study was conducted in Hospital USM, Kota Bharu for 36month duration. This study involves age-matched 34 healthy subjects and 34 Leukoaraiosis patients. All of them had undergone magnetic resonance imaging (MRI) where images were then post-processed and underwent first level analysis to meet the optimum sequence and DTI parameter. Second level analysis were then performed using tractography software by manually drawed region of interest (ROI) at leukoaraiosis area and to compare the parametric value with normal appearing white matter subjects at the same region. For effective result, age-matched comparison with same area of brain regions were chosen for both control subjects and leukoaraiosis patients. FA, ADC, fiber volume and voxel were generate automatically by the software. Statistical analysis was using paired T-test to compare value of both group. Results: The mean of FA value in control and leukoaraiosis group were 0.393 (±0.039) and 0.333 (±0.058) respectively. The mean of ADC value in control and leukoaraiosis group were 0.782 (±0.036) and 0.823 (±0.068) respectively. The mean of FDI value in control and leukoaraiosis group were 1.341 (±0.310) and 1.062 (±0.240) respectively. The different was statistically significant in FA, ADC and FDI value between two group. Conclusion: This study found that there is a statistically difference mean value of FA, ADC and FDI between leukoaraiosis and normal appearing white matter control subject. The ability of MRI‐based fiber tractography to delineate the white matter fibre pathways of the brain non‐invasively has raised possibilities for clinical applications and offers potential used for early detection of white matter integrity, evaluation of white matter severity and progression in the future.
- ItemPembinaan Dan Kesan Modul Terapi Seni Dalam Pengurusan Kemarahan Remaja(Universiti Sains Malaysia, 2021-04)Kajian ini bertujuan untuk membina Modul Terapi Seni Dalam Pengurusan Kemarahan Remaja (TASMAR) dan mengkaji kesan modul tersebut. Kajian ini juga untuk mengenal pasti kesahan dan kebolehpercayaan modul. Nilai kesahan modul adalah 82.28 peratus manakala nilai alpha cronbach’s bagi kebolehpercayaan modul adalah .96. Sampel dikenal pasti melalui kaedah persampelan bertujuan. Sampel terdiri daripada remaja yang mendapat skor tahap kemarahan 76-100 dalam ujian State-Trait Anger Expression Inventory-2 Child and Adolescent (STAXI-2 C/A). Bagi melihat kesan modul, rekabentuk kajian kuasi eksprimen digunakan dengan gabungan kaedah kuatitatif dan kuanlitatif. Keputusan kuatitatif mendapati terdapat perbezaan yang signifikan kesan modul terhadap kemarahan remaja, nilai t=2.83, df=71, p=0.00 (p<.05). Kesan modul terhadap pengurusan kemarahan remaja berdasarkan jantina menunjukkan perbezaan yang signifikan, nilai t=5.86, df=70, p=.000 (p<.05). Seterusnya, terdapat perbezaan yang signifikan kesan modul terhadap pengurusan kemarahan remaja berdasarkan masa, nilai t6.54, df=71, p=.000 (P>.05). Secara kuantitatif, modul berkesan dalam pengurusan kemarahan terhadap remaja lelaki dan perempuan. Modul juga berkesan secara kualitatif dengan hasil dapatan temu bual yang membentuk tema-tema yang menunjukkan kesan positif modul terhadap remaja iaitu memberi pengetahuan baru, meluahkan kemarahan, menyembuhkan emosi, merubah diri dan memberi motivasi. Impikasi kajian ini, remaja dapat diberikan kemahiran mengatasi kemarahan. Hal ini dapat mengurangkan kesan negatif kemarahan seperti salah laku, jenayah serta masalah kesihatan mental dan fizikal. Kajian ini juga memberi sumbangan ilmu dalam penghasilan modul intervensi kaunseling menggunakan pendekatan terapi seni.