Pusat Pengajian Sains Perubatan - Tesis

Browse

Now showing 1 - 20 of 387

A study on the capability of frequency doubling perimetry in the detection of visual field abnormalities in primary open angle glaucoma patients.
(2007)
Abd jalil, Nor fadzillah
Frequency Doubling Perimetry (FDP) has become a more widely used technique for both screening for glaucoma patients and follow up of glaucomatous field loss. It is thought to be sensitive to glaucomatous visual field loss because it tests a sparse population of retinal ganglion cells (M cell) which comprise approximately I 0% of entire retinal ganglion cells. Therefore it is superior in the detection of early visual field loss in glaucoma patients than other present conventional methods. To detennine the capability of FDP in the detection of visual field abnonnalities in the primary open angle glaucoma (POAG) patients. Prospective, comparative, cross sectional study. A total number of I 50 POAG patients underwent both FDP in screening and threshold mode 30-2 and Humphrey Visual Field (HVF) 30-2 tests in Eye clinic Hospital Universiti Sains Malaysia (HUSM). All patients had a comprehensive ophthalmology assessment including visual acuity, intraocular pressure, cup-disc-ratio measurement and anterior chamber angle assessment. Data analysis including sensitivity, specificity, area under the receiver operating characteristic (ROC) curve and kappa agreement between FOP and HVF was performed using SPSS system version I 2.0. Data from I I 7 POAG patients were analyzed following inclusion, exclusion criteria and reliability of the visual field testing. For FDP in screening mode, when "at least 1 missed point" was used as the definition for abnormal FDP, the sensitivity was high between 92.2% to 96.2% and specificity was between I 4.3% to 19.3%. When "2 or more missed points", was used as definition for abnormal visual field, the sensitivity was 89.5% to 95.0% and specificity between 29.0% to 35.7% was achieved. For FOP in threshold mode and HVF with various definitions for abnormal visual field, the sensitivity was between 83.5% to I 00% and specificity between 0.0% to 50.0%. Kappa value for FOP and HVF was between 0.074 to 0.341 which showed poor to slight agreement. Conclusion: In this study, FOP showed high sensitivity but low specificity in the detection of visual field abnormalities among POAG patients. The new classification for severity of glaucoma with Glaucoma Scoring System 2 (GSS2) and Frequency Doubling Technology Scoring System 2 (FDT SS2) was able to provide immediate and reliable classification for both severity and characteristic of VF defect. Kappa value of poor to slight agreement was obtained between FOP and HVF.
Comparison of thinprep™ monolayer cytology versus conventional pap smear and the correlation with human papilloma virus detection using hybrid capture® 2 system
(2007)
Shah @ Ma'asah, Mohd. Shariman Md.
Pap smear is a useful screening tool for cancer of the cervix. Screening has resulted in the tremendous fall in cervical cancer incidence worldwide. However, the conventional pap smear has many limitations due to significant false negative and false positive rate, and unsuitability due to thick smears. Liquid-based cytology, such as ThinPrep™ technique is an alternative to conventional pap smear. This method provides monolayer cells which make cytological examination easier. HPV is the cause of cervical cancer. Identification of the virus is helpful in cervical cancer screening. Hybrid Capture® 2 systems is one of the examples of HPV testing that is useful to detect high-risk HPV in a large number of samples. We embarked on pap smear split-sampling study to determine if monolayer cytology would give better results than conventional cytology. Six hundred eighty eight women who gave consent were recruited. We collected the exfoliative cervical samples from all the subjects. Each sample was smeared as for the conventional pap smears as done routinely and then rinsed into a liquid buffer (PreservCyt) for monolayer cytology and HPV testing. The cytological examination was performed in blinded fashion. The performance of conventional and ThinPrep TM monolayer cytology pap smears was compared. Smears were classified based on The 2001 Bethesda classification. All cases which had epithelial abnormalities were further tested for HPV by Hybrid Capture® 2 technique. We found that adequacy of sampling was 94.3% in conventional pap smear and 89.4% in TbinPrep™ monolayer cytology. The commonest organism identified was Candida spp (4.1% in conventional smears, 3.9% by ThinPrepTM) and the agreement study is fair (k=0.27). Diagnosis of ASCUS, LSIL, HSIL and squamous cell carcinoma, were low in both techniques. The glandular cells abnormalities were also low in numbers. The agreement studies for LSIL showed k=0.40. The agreement studies for ASCUS, HSIL, squamous cell carcinoma, AGC (NOS) and adenocarcinoma (NOS) were not done as the number was too few. The HPV testing of cases with abnormal cytology showed low positivity (38.5%). The overall performance of ThinPrep™ is no better than conventional pap smears. The usage of the ThinPrep™ pap smear does not improve in detecting certain infective organisms nor abnormal epithelial cells. The low positivity of Hybrid Capture® 2 technique is questionable. Confirmation with other techniques like PCR is essential. In conclusion, split sampling gives adequate smears for cytological assessment. It can be carried out in laboratories working to change from one technique to another.
Cardiopulmonary assessment in transfusion dependent thalassemia patients at hospital Universiti Sains Malaysia
(2007)
Mohd Zain, Mohd Rizal
The thalassemias, a disease that result from mutations of genes encoding the synthesis of a.- and p-globin chains of haemoglobin are responsible for anaemia of variable severity. The P-Thalassemia is widespread throughout the Mediterranean region, Africa, the Middle East, the Indian subcontinent, Burma and Southeast Asia including southern China, the Malay Peninsula and Indonesia. Morbidity due to cardiovascular, endocrinological, and hepatic disease is considerable in P-thalassemia syndromes. Heart failure remains the major cause of death (60%), greatly exceeding deaths from the other causes such as infection (13%) and liver disease (6%). Abnormal pulmonary function tests were described in thalassemic patients who need regular blood transfusion. However this is not well described and has mixed results from the previous studies. These abnormalities could be due to anaemia, iron deposition in the lungs, or other factors. I. To describe the abnormalities in: 1.1 Cardiac function (i.e. left ventricular systolic and diastolic functions) 1.2 Respiratory function (i.e. flow rates and lung volumes) in transfusion dependent thalassemia (TOT) patients attending paediatric day care centre. 2. To determine the correlation between the abnormalities of the cardiac and the respiratory functions with serum ferritin. This is a cross sectional study, conducted at the Day Care Centre Unit, Department of Paediatrics, Hospital Universiti Sains Malaysia (HUSM) from January 2006 till December 2006. It involved all the transfusion dependent thalassemia (TOT) patients who were attending the paediatric day care centre at HUSM. A total of 41 subjects were included in this study, aged 11.4 ± 4.4 years, with the diagnosis of thalassaemia (including both alfa and beta thalassaemia). Doppler echocardiographic indexes of systolic and diastolic ventricular function were assessed. Pulmonary function test was performed using Micro loop Spirometer SPIDA and it only involved 29 subjects. This study revealed that cardiac assessment showed that when compared to the mean of normal values, there was no significant difference of LV systolic function but LV diastolic function showed significant differences and compatible with restrictive heart disease. Lung functions test showed that the majority of the patients, 26 (89. 7%) of them predominantly had restrictive lung pattern, one patient had obstructive lung pattern and only 2 of them were normal. There were no correlation of serum ferritin level with LV systolic function and diastolic function only showed weak correlation. However lung function test had no correlation at all with serum ferritin level. LV systolic perfonnance is well preserved in TOT patients despite high serum ferritin level. However diastolic dysfunction affected earlier than systolic dysfunction. Majority of TOT patients had predominantly restrictive lung pattern. Severe iron overload and deposition in the myocardium may leads to the restrictive abnormalities of left ventricular filling. However relationship between altered lung function tests and iron deposition in the lung remains unclear.
Proseal laryngeal mask airway versus endotracheal tube for delivering positive pressure ventilation during lap aroscopic surgery.
(2007-05)
Othman, Marini
The purpose of our study is to assess whether the new Proseal Laryngeal Mask airway (PLMA) can be a suitable alternative to the standard use of Endotracheal Tube (ETT) as an airway adjunct to deliver positive pressure ventilation during laparoscopic surgeries. We compared haemodynamic changes (by measuring heart rates, systolic blood pressures, diastolic blood pressures and mean arterial pressures at different time intervals) throughout the surgery, the quality of airway maintenance by measuring Sp02 and ETC02 and recorded intra operative as well as post operative complications related to use of both airway devices. We performed a prospective single blinded study on 64 patients undergoing laparoscopic surgical procedures. These patients were randomized using block randomization and divided into two groups; PLMA and ETT group. Both groups have 32 patients. After standardized induction of anaesthesia, PLMA or ETT was inserted and the patient was connected to ventilator that delivered positive pressure ventilation at set tidal volume and rate. Anaesthesia was maintained with Nitrous oxide, Oxygen and Isoflurane. Both airway devices were removed at the end of surgery with the patients fully awake. The haemodynamic changes were recorded at different time intervals, together with Sp02 and ETC02 changes. The incidences of intra operative complications (coughing, regurgitation, bronchospasm, desaturation and gas leaking) were recorded if present. The presence of blood upon airway device removal that indicates airway trauma was also recorded. Then we recorded post operative complications if present (persistent cough, vomiting and sore throat). We found that there were no statistical differences in HR changes measured at different time intervals between PLMA and ETT. However there were statistically significant decrease in systolic blood pressures and mean arterial pressures for PLMA group at 1 minute, 5 minute, 10 minute and 15 minute post intubation. For diastolic blood pressures, the lower values in PLMA group were only significant at 10 and 15 minutes post intubations. Comparing Sp02 and ETC02 monitoring, generally there were no significant statistical differences for both groups studied. Our findings on intra operative complications were that both groups have no statistical difference in the incidence of coughing, regurgitation, desaturation, bronchospasm and gas leaking. For presence of blood upon airway devices removal, we found no statistical difference between PLMA and ETT groups. The incidence of post operative persistent coughing and vomiting were also found to be statistically insignificant for both groups, however incidence of post operative sore throat was significantly higher in ETT group compared to PLMA with p value ofO.OOl. Therefore we concluded that for laparoscopic surgery with positive pressure ventilation, PLMA is a suitable alternative to standard ETI use and may offer advantages in terms of haemodynamic changes, with lower incidences or no statistically significant peri operative complications related to its use.
A study on the use of clinical practice guidelines (CPG) on management of type 2 diabetes mellitus in Kelantan.
(2007-05)
A. Rahman, Nor Azlina
The prevalence of diabetes is increasing in Malaysia. Majority of the patients were reported to have poor glycaemic control. CPG were developed to improve the practice of health care providers for better health outcomes in patients. The objective of this study was to determine the use of diabetic CPG among diabetes care team (DCT), to evaluate the effectiveness of intensive training on the CPG given to DCT in Kelantan on their knowledge, attitude and practice (KAP) and patients' KAP and diabetic control, and to determine the factors associated with HbAtc levels in type 2 diabetic patients with poor control in Kelantan. This study was conducted in all health centres (HC) in Kelantan from August 2005 till March 2006. Cross-sectional study design was used to determine the characteristics of DCT and their use of diabetic CPG, and the characteristics of type 2 diabetic patients with poor control and the factors associated with their HbAtc levels. To determine the effect of intensive course on diabetic CPG given to DCT on their KAP and their patients' KAP and diabetic control, randomised controlled trial was used where the participants were randomized into intervention and control group by cluster according to the districts in Kelantan. The participants were all DCT members and diabetic patients with poor control. Post-intervention data were collected four months after the intervention was completed. A total of 176 DCT members participated in this study. Most of the participants knew about the existence of diabetic CPG (79. 5%) or have ever read it (71. 6% ). In term of the use of CPG, only 40.4% to 83.1% of them claimed always practice according to the diabetes care measured. The mean total knowledge scores were 23.6 marks (SD = 3.41) from the total score of 30 or 78. 7%, and the median total attitude and practice scores were 29 (IQR = 8) from the total score of 35 and 27 marks (IQR = 4) from the total score of30 or 82.9% and 90%, respectively. A total of 208 diabetic patients with poor control participated in this study. Their mean total practice scores were 21.9 (SD = 2.49) from the total score of 32 or 68.4%, and the median of total knowledge and attitude scores were 42 (IQR = 8) from the total score of 48 and 14 (IQR = 2) from the total score of IS or 87.5% and 93.3%, respectively. Patients who were married, had no formal education and receiving their diabetic care in HC without Family Medicine Specialist (FMS) were significantly associated with poorer HbAtc levels. Fasting blood glucose (FBG) levels were significantly increased with increasing levels ofHbAtc· A total of 88 DCT participants in intervention and 55 in control group completed this study. In the intervention group, significant improvement was observed in knowledge scores as compared to control group. A total of 86 patient participants in each group completed this study. Their practice scores were significantly reduced more in intervention compared to control group. However the changes observed here were minimal. No significant changes were observed in all the other outcome variables measured in DCT or patient participants. Majority of the DCT members in Kelantan knew about the existence of diabetic CPG. However, their use of the CPG was not very satisfactory. The KAP ofDCT and patients were quite good but that did not translate into good diabetic control of the patients. Factors associated with HbAtc levels in the diabetic patients with poor control FBG, educational level, marital status and receiving care in HC with FMS. After intervention, significant improvement was only seen in the knowledge score ofDCT, albeit minimal. One day intensive course may not be enough to change DCT' s KAP and regularly structured continuing medical education (CME) might be needed to reinforce their KAP. Four months duration may not be enough for the DCT to properly manage their diabetic patients for observable changes in the patients' KAP and diabetic control measures.
Cross sectional study comparing the conventional method and modified misgav ladach method for caesarean section in hospital Kuala Terengganu
(2007-05)
Hassan, Mohamad Haslan
Caesarean section is a common obstetrical operation. About fifteen percent of all deliveries in Hospital Kuala Terengganu were by abdominal route. A century ago, Pfannensteil described a low transverse abdominal incision as an alternative to midline incision. Joel-Cohen introduced a new method of opening the abdomen, which was further modified by Dr. Michael Stark. The new technique was called Misgav Ladach technique. The large controlled studies have demonstrated many advantages of this method. However few steps of this technique had brought controversial issues until present time. This has lead to some modifications of the original method. A few studies with a different modification shown a promising result without arises much debate. This study was to compare the effect of modified Misgav Ladach with conventional method on the operating time, blood loss, duration to deliver the baby and complications such as post partum haemorrhage and extended tear in performing caesarean section. One group was operated by modified Misgav Ladach method and the other group by the conventional method. The operations were performed by two different surgeons. Operating time, duration for delivery the baby, amount of blood loss and complications occur in each method. Operating time was not significantly different between two methods with an average of 27.3 minutes in the modified Misgav Ladach method and 32.8 minutes in the conventional method (p=0.055). The amount of blood loss also was not significantly different with 360ml and 416ml (p=0.065) for modified Misgav Ladach and conventional method respectively. The duration for delivery the baby was not significantly different with modified Misgav Ladach took 2. 7 minutes and conventional method took 3.1 minutes (p=0.07). The numbers of case with extended tear were same in both methods (five cases). There was one case of PPH (0.3%) in conventional method and none in modified Misgav Ladach method (p=0.605). The episode of fever on second day of operation also was not significantly different with 4 cases (2.6%) and 3 cases (2.0%) in modified Misgav Ladach method and conventional method respectively. The modified Misgav Ladach method do not offer any advantages over the conventional method. There were no significant different in operative timing, amount of blood loss, duration for delivery the baby and complications either intra or post operatively.
Anorectal Malformations (ARM) : The Hospital Universiti Sains Malaysia (HUSM) experience from 1999 to 2006
(2007-11)
Malapan, Kirubakaran
Anorectal Malformations (ARM) are a complex group of malformations diagnosed at the time of birth because of absence or an ectopic location of anus. The usual rep01ted incidence is between l per 1500 and 1 per 5000 live births and they are more often seen in boys than in girls. The incidence of associated organ anomalies with ARM is variously reported from 20% -70% some being minor anomalies but others being life threatening. Further management depends on the sex of the patient, type of malformation either high or low and the associated anomalies. All operative procedures for the correction of ARM aim at providing portal for the discharge of feces from the perineum and establishing a working relationship between the bowel and sphincter. The aim of the study is to review the patients presenting with anorectal malf01mations (ARM) to Hospital Universiti Sains Malaysia (HUSM) and describe the demographics and outcome in relation to the type of ARM. The study was a retrospective case review which was canied out in the Paediatric Surgery Unit, Depa1iment of Surgery, Hospital Universiti Sains Malaysia (HUSM) between January 1999 and January 2006. The case notes and operative notes were screened for epidemiological data and data relevant to the study. Patients diagnosed with ARM but did not undergo surgery, and patients whose case notes could not be traced or incomplete were excluded from the study. All the data entry and analysis were carried out using the social science and statistical packaged (SPSS) version 12 licensed to USM. A p value of less than 0.05 was considered statistically significant. Ninety eight patients were included into the study after fulfilling the inclusion criteria. The male to female ratio was 2 to 1 and 97% of the patients were Malays. The birth weight of the patients in this study ranged from l.3kg to 4.5kg. Forty two point eight percent of the patients presented to HUSM within the first day of life. The most common presenting symptoms were abnonnal passage of meconium (39.7%), abdominal distension ( 15.3%) and constipation (5.1 %). The investigative procedures done to detect associated anomalies were ultrasound abdomen (94.8%), babygram (87.7%) and echocardiogram (75.5%). Associated anomalies were detected in 56.6% of the patients. The most number of associated anomalies detected in patients with ARM was cardiovascular anomalies (25.5%) followed by urological anomalies (22.4%) and chromosomal anomalies (17.3%). Fifty two patients (53%) underwent surgical repair for low ARM which were mini PSARP (69.2%) followed by anoplasty (25%) and anal shift (5.8%). Forty six patients (46.9%) underwent surgery for high ARM of which only 2% underwent single stage PSARP repair. Forty four patients (73.3%) who had colostomy formed were later diagnosed with high type of ARM. The remaining 16 patients who had colostomy formed were diagnosed with low ARM (26.7%). Post operative complications were similar to those reported in earlier studies. In this study, there were 46 patients (46.9%) with high type of ARM and 52 patients (53 .1 %) with low type of ARM. Only 44 patients were able to be contacted and interviewed to assess their functional outcomes. Anal stricture was a significant complication in patients who were not compliant with the anal dilatation protocol (p = 0.007). Patients with low ARM were noted to have more adequate weight gain as compared to high ARM patients (p=0.002). The incidence of constipation was higher among patients with low ARM and this was highly significant (p= 0.000). However, the incidence of soiling and incontinence was higher among patients with high ARM (p=O.OOO). Seven patients achieved full continence at follow up and they were all males (p=0.048). Only 7 patients in our study achieved "good" outcome following surgery, 54 patients achieved "fair" outcome and 16 patients had "poor" outcome. The mortality rate after definitive surgery in this study was 4%. The demographic finding in the study is quite similar to those published in the literature from other parts of the world. The clinical diagnosis of type of ARM was accurate in 76.8% of the patients and it was more difficult in making a diagnosis of high ARM clinically, compared to low ARM. The high incidence of associated anomalies in our study makes careful clinical examination and evaluation during the neonatal and early infantile period mandatory in all cases of ARM. Anal dilatations are a vital part of the postoperative management to avoid stricture at the anoplasty site. The low number of patients with good outcome in our study suggests that more attempts must be made to keep these patients on follow up, with the development of a proper bowel management program and an integrated team approach to achieve better outcomes.
Evaluation of optic nerve head functions and Topography after an episode of optic neuritis.
(2011)
Chua Chui Yin
Optic neuritis primarily affects the optic nerve. Most patients with typical optic neuritis have excellent recovery of visual acuity. However, certain degree of optic atrophy will almost always occur and the axonal loss could have consequences especially on other non acuity visual functions. Using the optic nerve head parameters, it is possible to evaluate the structural and functional damage of optic nerve after an episode of optic neuritis. To evaluate the optic nerve functions and optic nerve head parameters post single attack of optic neuritis, and to compare the functional and structural changes based on the persistence of relative afferent pupillary defect (RAPD). In addition, to correlate the optic nerve functions and optic nerve head parameters in eyes with post single attack optic neuritis. The study was conducted from July 2010 to June 2011. Fifty six subjects with history of single episode of optic neuritis and age-, sex- and race-matched controls underwent complete ocular examination and optic nerve function tests. In addition to RAPD examination, LogMAR acuity test, Humphrey visual field 30-2, Functional Acuity Contrast Test (F.A.C.T®) and Ishihara plates were employed for the assessment of optic nerve functions. The optic nerve head parameters were measured using Heidelberg Retinal Tomography III (HRT III). Pearson’s correlation was used to determine the correlation between the optic nerve functions and optic nerve head parameters. Mean duration between recruitment process and first episode of optic neuritis was 5.21 ± 2.94 years. Significant reduction in the optic nerve functions was seen in the optic neuritis group. Among the optic nerve head parameters, there was significant RNFL thinning (p 0.001), reduction of neuroretinal rim volume (p =0.006) and increase in the cup shape (p < 0.001), cupdisc area ratio (p = 0.009) and optic cup area (p = 0.030). The mean RNFL thickness demonstrated good correlation with the optic nerve functions, in particular contrast sensitivity at high spatial frequency (r = 0.7351, p < 0.001). There was also fair and inverse correlation between the cup shape and contrast sensitivity (r= -0.4463, p = 0.016). Subjects with persistent RAPD showed significant worse performance in visual acuity, colour vision and contrasts sensitivity score, compare to those without persistent RAPD. However, no significant difference was seen in the optic nerve head parameters between these two groups. After an episode of optic neuritis, there were significant reduction in optic nerve functions and changes to the optic nerve head parameters. The thinning of RNFL was especially significant. The good agreement between the optic nerve functions and optic nerve head parameters suggested that in addition to the optic nerve function tests, HRT III is useful for post optic neuritis evaluation.
A study on the variation of peripapillary retinal nerve fiber layer thickness in myopic patients using optical coherence tomography.
(2011)
Gan, Eng Hui
Myopia is a common ocular abnormality worldwide. Individuals with myopia have increased risk of glaucoma compared to non-myopic individuals, but the clinical diagnosis of glaucoma in patients with myopia is often difficult. An important approach in detecting early structural change in glaucoma is based on assessment of the retinal nerve fiber layer (RNFL). Thus, evaluation of the RNFL is very valuable for early detection of glaucoma especially in myopes. However, it remains uncertain whether RNFL thickness would vary with the refractive status of the eye. To compare the peripapillary RNFL thickness between control subjects with emmetropia and myopia subjects with low, moderate and high myopia as well as the relation of RNFL thickness with age, spherical equivalent, axial length of the eye respectively. Four hundreds and three eyes from 403 subjects were recruited according to the selection criteria. The eyes were divided into 4 groups according to their spherical equivalent: control (+0.5D > spherical equivalent > -0.5D), low myopia (-0.5D > spherical equivalent > -3.0D), moderate myopia (-3.0D > spherical equivalent > -6.0D), high myopia (spherical equivalent < -6.0D). All subjects underwent full ocular examination with A-scan and imaging with optical coherence tomography (OCT). The peripapillary RNFL thickness profiles were compared between the groups with ANCOVA. The relation between RNFL thickness and age, spherical equivalent and axial length of the eye were evaluated respectively with coefficient of correlation. Multivariate analysis adjusted for sex, age groups, laterality and axial length of the eyes showed significant thinning of the 360° (p=0.017) and the inferior quadrant (p=0.017) RNFL in high myopic eyes when compared to emmetropic eyes. No significant difference in the RNFL thickness when comparing other refractive error groups. Significant fair correlations were evident between RNFL thickness and spherical equivalent (i=0.330, p<0.001) and axial length (r=-0.286, p<0.05) of the eye respectively. The correlation between age and RNFL thickness was poor but statistically significant (r=-0.156, p<0.05). High myopic eyes had thinner 360° and inferior RNFL thickness compared to emmetropic eyes but not universal in all quadrant around the optic disc. No statistical significant difference of RNFL thickness between other refractive error groups. There was a fair linear relationship between RNFL thickness and spherical equivalent as well as axial length of the eye but, the relationship between RNFL thickness and age was poor in our study model.
The l0th Iranian congress on audiology
(2011-04)
Zainun, Zuraida
-
Outcome of severe head injury in school age patients at emergency department of hospital universiti sians malaysia.
(2011-05)
Ismael, Haidi Abdulsalam
Emergency department Hospital Universiti Sains Malaysia is a referral center for neurosurgical cases for vast area in Kelantan. Head injury patients are referred for neurosurgical intervention and management. Head injury severity, initial vital signs and metabolic response of the patient will affect the overall outcome. The aim of this study is to determine the survival probability of school aged patient with severe head injury treated in Emergency department of HUSM, to determine the mean length of stay (days) of school aged patient with severe head injury treated in Emergency department of HUSM, to determine the prognostic factors that influence the risk of death among school aged patient with severe head injury treated in Emergency department of HUSM and to determine the associated factors that affect the length of hospital stay among school aged patient with severe head injury treated in Emergency department of HUSM. A retrospective chohort study done for a sample of 91 (severe head injury) school aged patients data were collected from the records of HUSM during the period 2007 to 2OO9.These patients were then followed for 30 days following admission to identify their outcome. The mean age was 15.More than 50% of the cases came with initial GCS 6 and above and 67 patients (73.6%) were alive at the end of 30-days.From this study we found that survival probability for severely head injured school aged children was 73.6%. The mean length of stay (days) in hospital was 17 days. Age, CT Finding and GCS of patient at admission were identified as factors related to mortality outcome and to total length of stay in hospital.
A study of quality of life in children with cancer in hospital universiti sains malaysia, kelantan, Malaysia.
(2012)
Goh, Chin Buan
Holistic approach not only involve optimizing anti-cancer treatment but also improving Health Related Quality of Life. PedsQL™ Cancer Module is a widely used validated and developmentally appropriate questionnaire designed to measure pediatric cancer specific HRQOL for children age 2 to 18 years. This is the first report validating and assessing children and also first proxy report in HRQOL of children treated for cancer using cancerspecific and developmentally-appropriate questionnaire for children in Malaysia. The participants were children and their caretakers with various types of cancers who received treatment in Hospital Universiti Sains Malaysia (HUSM). The PedsQL consists of 2 sets of questionnaires, which are pediatric quality of life self-report for children ages 5-12 years and parent-proxy report of child QOL questionnaire. PedsQL™ Cancer Module was culturally and linguistically validated into Malay version as recommended by MAPI Research Institute. Lingusitic validation included forward and backward translation, face and content validation and reliability test. Reliability was determined by internal consistency using Cronbach alpha and test-retest reliability using Intra-class Coefficient Efficiency. The validated Malay version PedsQL™ 3.0 Cancer Module (Malay) was administered to 107 children with cancer (for aged 5 to 18 years) and 137 parental proxies (for aged 2 to 18 years) in HUSM, Kelantan, Malaysia. Paired t-test was used to determine the mean difference between child and parental proxy HRQOL scores (except for age group 2 to 4). Multifactorial ANOVA was used to compare the mean scores of HRQOL between groups (on treatment versus completed treatment). Cronbach’s alpha coefficients ranged from 0.77 to 0.93 for children and 0.80 to 0.93 for parental proxy reports. The Intra-class correlation coefficient was between 0.88 to 0.92 for children reports and 0.86 to 0.91 for parental proxy reports. The parental-proxy HRQOL reports scored significantly lower compared to children across all age groups [68.9 (19.20) vs 73.4 (18.8)]. The mean cut-off point for domain at risk of impaired HRQOL (less than 70) was ‘Procedural Anxiety’ across all age groups (between 39 to 65.9). After adjusted for gender and diagnoses, there was also significantly lower HRQOL score between ‘ontreatment’ and ‘completed treatment’ group across most of the age groups (except parental proxy reports for 2-4 and 8-12). PedsQL 3.0 Cancer module (Malay version) was linguistically validated and comparable to original and other translated questionnaire. Administration of the questionnaire to children with cancer and their proxy revealed that parental proxy reports tend to underestimate the HRQOL of children. “Procedural Anxiety” was identified as the main HRQOL affected subscale in our children. Children on treatment generally had impaired HRQOL independent of gender and diagnoses.
Predictors of good functional outcome in post stroke patient attending hospital raja perempuan zainab ii after 6 months.
(2012)
Ahmad, Afiza Hanun
Stroke is the second leading cause of death and adult disability globally. It is anticipated that by 2020, stroke will have moved from the 6th to 4th leading cause of lost disability adjusted life years. To determine the predictors of good functional outcome in post stroke patients attending Hospital Raja Perempuan Zainab II (HRPZ II) after 6 months post stroke. The study included all stroke patients who were admitted to HRPZ II from December 2009 to December 2010. Patients were interviewed to assess their socio-demographic data and medical history. Then, clinical examinations were done to assess the stroke severity using Scandinavian Stroke Scale (SSS) and functional status based on Modified Barthel Index (MBI). The clinical data and investigations results upon admission were gathered from the medical records. Patients were reassessed at six months post stroke on the Traditional Complementary Medicine usage, rehabilitation service, carer and also functional status (using MBI). The response rate was 92%. They were 52 men and 41 women with mean age of 63.7 (10.3) years. Sixty-one point three percent had hypertension and 30.1% had diabetic. On admission 34.4% had good functional status and at six months later, 84.9% had good functional status. SSS score (p<0.05) and age (p<0.05) significantly predict good functional outcome. The prevalence of good functional outcome after 6 months post stroke was higher compared to other studies. Higher SSS score and younger age at occurrence of stroke significantly predict good functional outcome.
Risk perception and factors associated With preferences for safe drinking water Outpatients at husm Kota bharu, kelantan.
(2012)
Azlina Azlan
RISK PERSEPTION ON SAFE DRINKING WATER AND FACTORS ASSOCIATED WITH SAFE DRINKING WATER PREFERENCES AMONG HUSM OUTPATIENT CLINIC ATTENDEES IN KOTA BHARU KELANTAN. Safe drinking water source is the main topic discussed nowadays. Worldwide, food and water borne diseases resulted from consuming unsafe drinking water source. The aim of this study is to assess preference for safe drinking water, risk perception on safe drinking water and factors associated with preference for safe drinking water among Hospital University Sains Malaysia (HUSM) outpatient clinic attendees in Kota Bharu, Kelantan. A cross-sectional study was conducted on 115 outpatient clinic attendees at HUSM from 1st February to 30th April 2011. Convenient sampling was applied and face to face interview was conducted among consented respondents. The questionnaire used consistad of sociodemographic data, preference for drinking water, perception on drinking water quality and safe drinking water, preventive measures taken and general knowledge on water and health. The proportion of preference for safe drinking water among HUSM outpatient clinic attendees is low at 30.4% (95% CI: 0.22, 0.39) compared to preference of unsafe drinking water source which is 69.6% (95% CI: 0.61, 0.78). The health risk perception toward safe drinking water is almost equal between those who have high perceived health risks and those with low perceived health which are 46.1% (95% CI: 0.37, 0.55) and 53.9% (95% CI: 0.45, 0.63) consecutively. The significant associated factors for preference of safe drinking water are current used of drinking water source and monthly household income status. Person who currently uses municipal water supply as their drinking water source has 14.32 times odds to prefer safe than person who uses drinking water other sources of drinking water (95% CI: 4.08,50.30, p <0.001). Person with low monthly household income status has 4.38 times odds to prefer unsafe drinking water than person who is below poverty line (95 % CI: 1.18, 16.19, p = 0.027). Furthermore, person with middle household income status has 9.28 times odds for preference of unsafe drinking water source than person who is below poverty line (95 % CI: 2.12, 40.59, p - 0.003). The proportion of preference of safe drinking water among HUSM outpatient clinic attendees is low. Health risk perceptions toward safe drinking water are worrisome. Effective public awareness campaigns and interventions to improve health risk perception, to build stronger confidence toward municipal water sources will enable public to make good decision on safe drinking water. Therefore, these will help to reduce incidence of health risk related to water borne diseases.
Childhood atopic eczema: children’s Quality of life and family impact.
(2012)
Ahmad Abir Ab Ghani
Childhood atopic eczema accounted 40% of the referral to pediatric dermatology clinic in Malaysia. One of the most important issues that should be discussed during outpatient hospital based clinic is health related quality of life (HRQOL). HRQOL was defined as a broad multidimensional concept that usually includes self-reported measures of physical and mental health. The current study was aimed to determine the quality of life of children with atopic eczema, impact of atopic eczema to the family and associated factors for children’s quality-of-life. A cross-sectional study conducted at Dermatology clinic, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia from January 2010 to January 2011. Children who were diagnosed as atopic eczema, aged between 5 and 18 years and fulfilled the inclusion and exclusion criteria were selected using systematic random sampling. Qualityof- life (Qol) was measured using CDLQI. Family Impact was measured using DFI. The Children’s Dermatology Life Quality Index (CDLQI) and Dermatology Family Impact (DFI) questionnaires were specifically designed to measure Qol of children with atopic eczema and the family impact of the similar disease. Data were analyzed according to distributions. Descriptive analyses were done for quality of life and family impact score and univariate and multivariate analyses were done to determine associated factors for Qol. Results: A total of 110 participants with 100% response rate entered this study. Majority of subjects suffered mild to moderate disease which comprised of 30.9% and 62.7%, respectively. Only 6.4% had severe atopic eczema. The median (IQR) for quality of life and family impact score was 8.0 (8.0) and 7.0 (9.0), respectively. Disease severity was the significant associated factor for quality of life in childhood atopic eczema. Regression analyses showed that 15% of the variance in quality of life score could be explained by disease severity score. In the present study, the overall children’s quality of life was not impaired because not all the items in the children’s quality of life were equally affected. Childhood atopic eczema also had no impact on family life as majority of parents perceived the disease was not severe. The only significant associated factor for children’s quality of life was disease severity. Measurement of HRQOL among childhood atopic eczema should be done along with objective disease severity assessment.
Role of nasal irrigation by using alkaline nasal solution in allergic rhinitis treatment as an adjunct therapy.
(2012)
Periasamy, Chenthilnathan
Nasal irrigation is an important component in the management of upper respiratory tract diseases. Alkaline nasal solution plays vital role as an adjunctive therapy in the treatment of allergic rhinitis. Unfortunately, there still exits lack of evidence and practice regarding usage of alkaline solution as nasal irrigation in allergic rhinitis treatment. The aim of this study was to determine the effectiveness and role of nasal irrigation by using alkaline solution with any changes in nasal or non-nasal symptoms in the treatment of allergic rhinitis as an adjunct therapy. Besides, this study also analyzed for any side effects of alkaline nasal solution following its usage for the treatment of allergic rhinitis. This was a prospective, randomized control trial in which a total of 64 patients recruited fromHUSM and divided into Test group (n=32) and Control group (n=32). These patients confirmed suffering from allergic rhinitis with the presence of positive skin prick test. Then these patients of both groups, their symptoms will be assessed with a standardized and validated symptom score questionnaire pre and post study. Their symptoms were evaluated based on nasal and non - nasal symptoms. The test group had been given alkaline nasal solution as nasal irrigation for the period of 6 weeks along with regular nasal spray and antihistamine. Furthermore, the control group was given only the nasal spray and antihistamine for 6 week duration. During this study period, assessments of any adverse effect by usage of alkaline nasal solution as nasal irrigation in the Test group subjects were also analyzed. This study shows most of the sample subjects were middle age (21-40 years) and active earning group in which their daily routine and quality of life are strongly related to their allergic rhinitis symptom control. Most of the subjects were grouped into moderate/severe persistent allergic rhinitis. Furthermore majority of subjects in this study were allergic to house dust mite. This study shows statistically significant nasal symptom improvement in nasal discharge, nasal itchiness and sneezing among the Test group. There were no side effects noted in the usage of alkaline nasal solution during the study. Therefore alkaline nasal solution as nasal irrigation in the treatment of allergic rhinitis is beneficial. Nasal irrigation is a simple mode of treatment that relieves the symptoms with no documented adverse effects. Alkaline nasal solution as nasal irrigation has better effect on patient’s nasal symptoms and improves quality of life. Nasal irrigation techniques are simple and easily taught in primary health care. Moreover alkaline nasal solution is an important component in the management of allergic rhinitis as an adjunct therapy.
Effects of virgin coconut oil as adjunct therapy in the treatment of allergic rhinitis.
(2012)
Zainuddin, Nazli
Allergic rhinitis is a disease of type I immediate hypersensitivity reaction, which is characterized by one or more of the following symptoms: sneezing, rhinorrhea, nasal congestion and itchiness. Management of allergic rhinitis includes patient education and counselling, medications and allergen-specific immunotherapy. In this study, we were determining-the effects of virgin coconut oil as adjunct therapy in the treatment of allergic rhinitis. To compare magnitude of allergic rhinitis symptoms (nasal and non nasal symptoms) in allergic rhinitis improvement after virgin coconut oil ingestion and to determine the side effects of virgin coconut oil following its consumption.An open label prospective randomised controlled clinical trial was carried out in Otorhinolaryngology clinic HUSM. Fifty-two patients with history suggestive of allergic rhinitis were recruited in this study. They were divided into control and test group. The patient's particular and history takings were recorded and compiled. Patients then undergone skin prick test. The allergens included in this study were Derrnatophagoides pteronyssinus (house dust mite), Dermatophagoides farina (house dust mite), Blomia tropicalis (house dust mite), Felis domesticus (cat) and shrimp. Symptoms score were recorded at before and after completed 28 days of study. The control group was given oral antihistamine while the test group was given oral antihistamine and 10 ml ofvirgin coconut oil three times per day. The highest prevalence of positive skin prick test among subjects in control group was Dermatophagoides pteronyssinus ( 100%) and the lowest prevalence was Dermatophagoides faririae (11.5% ). The highest prevalence of positive skin prick test among subjects in test group was Dermatophagoides pteronyssinus (96.2%) and the lowest prevalence was Felis domesticus (42.3%). There were no statistically significance differences in the mean nasal and non-nasal symptom score between test and control group, except for the mean nasal sneezing score which showed that the difference in nasal sneezing score is much better in . control than test group. More than half of the subjects in test group (65.4%) experienced side effects from consumption of virgin coconut oil. Approximately 50% complained of gastrointestinal tract side effects. Virgin coconut oil had no significance effects as adjunct therapy in allergic rhinitis and has more side effects. We concluded that virgin coconut oil is not suitable as an adjunct therapy in allergic rhinitis.
Developing the risk predictor of chronic suppurative otitis media in association with hypersensitivity state.
(2012)
Shahrjerdi, Behzad
Chronic suppurative otitis media (CSOM) is a main cause of acquired hearing impairment especially in developing countries. In view of worldwide burden of CSOM, recognizing the risk factors that contribute to the pathogenesis of CSOM is indispensable. There are some evidences regarding the relationship between hypersensitivity states and middle ear effusion; however the association between allergy and CSOM has not been well documented. To evaluate the association between allergy and chronic suppurative otitis media (CSOM). A comparative cross sectional study was carried out on 2 groups of subjects. 62 patients who were under regular otorhinolaryngology clinic (HUSM) follow up for CSOM were in the case group. The subjects in the control group were selected from USM staffs with no ear pathology. Meticulous history was taken and otoscopic examination and pure tone audiometry (PTA) were conducted. Subsequently, skin prick test was performed for all subjects to establish the presence of allergy. A total of 124 cases which included 62 patients with CSOM and 62 controls participated in this study. The age has been ranging from 15 to 70 years involving 33.1% of males and 66.9% of females. The commonest positive reaction to the allergens was noticed as Blomia Tropicalis and Dermatophagoides in both CSOM and control groups which are considered as house dust mite. The prevalence of allergy in CSOM and control groups was detected as 59.7% and 30.6% respectively. The analysis of the data showed a significant association between allergy and CSOM (p=0.001). The range of conductive hearing loss (CHL) in CSOM cases was from 5 to 50 dB. The Mean (SD) of CHL in allergic and non-allergic CSOM subjects was reported as 28.5(11.2) and 25.4(12.8) respectively. However, no significant relation between severity of hearing loss and presence of allergy in CSOM patients was noted (p=0.327). It seems that the hypersensitivity states have a role in the pathogenesis of CSOM. However, we suggest for the further inclusive studies in different populations to establish this association.
The evaluation of cognitive performance in obstructive sleep apnoea patient by using validated malay version of mini mental state examination.
(2012)
Yusop, Che Yusfarina Che
Obstructive Sleep Apnoea Syndrome (OSAS) is a condition where breathing stops temporarily or gets very shallow during sleep. It is most often caused by a complete or partial blockage in the throat. Untreated, it can result in neuropsychiatric and cardiovascular sequelae. Neuropsychiatric effects may include depression and cognitive dysfunction that can disrupt professional, family, and social life. Patients with OSA may develop deficits in the cognitive domains of attention, concentration, executive function, verbal and visuospatial memory, constructional abilities, and psychomotor functioning. The validated Malay Version of MMSE is one of the instrument to assess the cognitive function. The purpose of this study is to evaluate the cognitive performance in OSA patient. To compare cognitive performance between moderate and severe OSA patient and to analyze relationship of oxygen saturation (saO2) with cognitive performance. Cross sectional study on patients age 18 to 60 years old attending sleep clinic who underwent sleep study (polysomnography) in Hospital University Sains Malaysia from August 2011 to May 2012. The consented participants who fulfilled the criterias were interviewed using a questionnaire regarding demographic data, date of polysomnography and their polysomnography result. After that, the cognitive performance was evaluated using Validated Malay Version of Mini Mental State Examination which measured five areas of cognitive function which is orientation, registration, attention and calculation, word recall and language abilities , and visuospatial. A total of 38 OSA patients participated in this study with equal distribution in each groups. In our study showed that there was a statistically significant difference between the moderate OSA group and severe OSA group on cognitive performance (p=0.04). We also found that there was no significant linear correlation between oxygen saturation and cognitive performance (p=0.27). Cognitive performance of severe OSAS patients was mildly impaired in comparison to moderate OSAS. There was no association between oxygen saturation with cognitive performances in moderate and severe OSA patients. This may be due to limitations in performing MMSE test as it is unable to identify in very minimal or extremely severe cognitive dysfunction. More sophisticated test battery are required to detect small changes in cognitive performance.
'Nasi kandar': a study of eating habits and it's relations to a safe diet.
(2012)
Rahman, Abdul Rais Abdul
‘Nasi kandar’ was originated way back during the 18lh Century when Indian Muslim from Southern India migrated to Penang during the British Colonial period. It has evolve over the years is enjoyed by Malaysian from all walks of life regardless of age, gender, profession, race or religion thus becoming a multi-ethnic food. This outlet; factors that influence people to eat ‘nasi kandar’ and their eating habits; screen the microorganisms load in selected pairing dishes. A total of 122 Indian- Muslim stalls and restaurants in the Klang Valley and Penang were visited in order to compare food selection availability and locality. A total of 316 randomly selected patrons were picked up to answer a set of questionnaire concerning the reason for eating at the chosen food outlet and their typical choice of pairing dishes. Data from the questionnaires and observation list were analyzed with descriptive statistics using PASW 18.0 software. Thirty three random food samples were purchased and taken for lab testing to measure the existence of microorganisms specifically Staphylococcus aureus, Escherichia coli and coliforms. Rapid method using Petrifilm™ plates from 3M were used to count the bacteria loading instead of the conventional MPN method. More than half of the total respondent (58.9%) would consume ‘nasi kandar’ at least once a week while 41.1% consume more than once a week. Lunch time is the most popular time to eat ‘nasi kandar’. Chicken base dishes were the most diversed and widely available mainly for its cheaper price and have a more universal appeal to different race and religion thus making it the more popular choices among ‘nasi kandar’ partons. ‘Ayam go reng’ and ‘ikan go reng’ recorded S.aureus count of 4.4x102cfu/g and 1.3xl02 cfu/g respectively. Egg based samples showed a much higher count of E.coli, coliforms and S.aureus compared to meat based dishes, showing bacteria count ranging from 4.4xl02 cfu/g to 1.8xl04 cfu/g. Gravy base dishes in this study recorded of E.coli, Coliforms and S.aureus count ranging from below 1.5x10 cfu/g to 6.5x102 cfu/g. ‘Bendi’ recorded the highest E.coli (1.6xl03 cfu/g) and S.aureus (1.2xl03 cfu/g) counts. ‘Acar timun’ recorded the highest count for coliform bacteria (5.5x104 cfu/g). Bacteria are prone to thrive in vegetable and egg base items compare to gravies and fried items.

Browse

Browsing Pusat Pengajian Sains Perubatan - Tesis by Issue Date

Results Per Page

Sort Options