Pusat Pengajian Sains Perubatan - Tesis

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The mechanism of peri-implantation sexual intercourse and oxidative stress on placenta histopathological changes
(0025-12)
Ibrahim, Abubakar
The peri-implantation phase is a pivotal period in pregnancy establishment, characterized by intricate synchronization between maternal and embryonic factors that facilitate optimal implantation and placental development. Disruptions during this critical phase can lead to adverse maternal and fetal outcomes, including preeclampsia, fetal growth restriction (FGR), and placenta previa. Although peri-implantation sexual intercourse (PISI) is traditionally believed to support conception, its potential impact on placental health and pregnancy outcomes remains underexplored. This study investigated the effects of peri-implantation sexual abstinence on placental histomorphology, oxidative stress markers, placental positioning, and maternal-fetal outcomes. A randomized controlled trial was conducted, involving 33 participants divided into abstinence (n=9) and non-abstinence (n=24) groups. Placental samples were analyzed for histopathological changes, including inflammation, fibrin deposits, and chorion/amnion integrity, using H&E staining and CD31 immunohistochemistry to assess angiogenesis. Oxidative stress markers, malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and total antioxidant capacity (T-AOC), were quantified via ELISA. Placental positions were assessed through ultrasonography, and maternal-fetal outcomes, including preeclampsia, placenta previa, FGR, preterm birth, Apgar scores, NICU admissions, and neonatal anomalies, were documented. Statistical analyses were performed using GraphPad Prism version 8.4.3. The results demonstrated significant histomorphological improvements in the abstinence group, including lower inflammation rates (33.3% vs. 70.8%, p=0.167), absence of MPFD (0% vs. 33.3%, p=0.0731), and intact chorion and amnion integrity (100% vs. 25%, p<0.0001). CD31 staining revealed significantly higher vascular density in the abstinence group (15.3 ± 3.1 vs. 8.9 ± 2.7 vessels/HPF, p=0.0136), indicating enhanced angiogenesis. Additionally, oxidative stress markers reflected reduced oxidative stress in the abstinence group, with lower MDA levels (6.54 ± 2.37 vs. 16.65 ± 4.98 μmol/L, p=0.0006) and higher antioxidant activity (SOD: 52.16 ± 15.29 vs. 24.40 ± 6.30 U/mg protein, p=0.0038; CAT: 106.7 ± 23.24 vs. 57.33 ± 11.63 U/mg protein, p=0.0026; T-AOC: 137.5 ± 60.93 vs. 60.93 ± 22.35 μmol/L, p=0.0034). Placental positioning analysis revealed no cases of low-lying placenta in the abstinence group compared to 20.8% in the non-abstinence group, though this difference was not statistically significant (p=0.137). Maternal outcomes included one case of preterm delivery in each group, with NICU admission reported in the abstinence group, while FGR was observed in one case in the non-abstinence group. No cases of preeclampsia or placenta previa were reported. Fetal outcomes showed no significant differences in Apgar scores or neonatal anomalies between groups. Peri-implantation sexual abstinence was associated with significant improvements in placental health, including reduced oxidative stress, enhanced angiogenesis, and a reduced risk of abnormal placental positioning. These findings highlight the potential protective role of abstinence during the peri-implantation period in optimizing pregnancy outcomes. Further studies with larger cohorts are recommended to validate these results and explore their integration into preconception care strategies.
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
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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.
Immunoexpressions of e-cadherin and P-catenin and association with tumour Grading in primary ovarian carcinoma in Hospital univers1ti sains malaysia, Kelantan.
(2012)
Aniza Hassan
Immunoexpressions of E-cadherin and P-catenin and correlation with tumour grading in primary ovarian carcinoma in Hospital Universiti Sains Malaysia, Kelantan. E-cadherin and 0-catenin, cell adhesion molecules(CAM's) are shown to be involved in tumour progression. This study aims to analyze immunoexpression of E-cadherin and fi-catenin in surface epithelial ovarian carcinoma and evaluate its association with histological subtype, tumour grade and other important clinicopathological parameters. Tissue sections were obtained from archival blocks from HUSM for the duration of 13 years from 1998 to 2010. Expressions of both markers were analyzed immunohistochemically in 88 patients on paraffinized tissues. The tumor was evaluated and scored in hot spots according to intensity and proportion of cells stained. Expression was categorized as either positive or negative using median as cutoff positivity for statistical analysis. E-cadherin and P-catenin were variably expressed by tumour cells. The distribution of both markers was skewed (E-cadherin - mean 49.17, standard deviation 33.342, median 50.00; P-catenin -mean 34.23, standard deviation 34.032, median 20.00). In 64.7% of high grade ovarian carcinoma, both E-cadherin and P-catenin expression were lost (p=0.026). The grade of serous carcinoma was significantly associated with negative expression of both E-cadherin and P-catenin, in which 90.0% of the high grade cases lost expression of both markers(p=0.004). In early FIGO stage(FIGO I and II), 27.8% of cases had lost expression of both markers, whereas 72.2% of the patients maintained expression of one of the markers(p=0.037). This association was not seen in advanced FIGO stage. No significant association between E-cadherin and P-catenin expressions and age, race, peritoneal deposits and capsular breach(p>0.05) were observed. Ovarian carcinomas with loss of expression of both E-cadherin and P-catenin might behave more aggressive clinically as they tend to have higher grade and stage.
The effects of xylitol chewing gum on oral environment among malaysian infantry personnel involved in military operation.
(2012)
Ramli, Hafsah Othman
Oral health is an important aspect of combat readiness in the armed forces. However, certain conditions during military operation can hinder oral hygiene practice and expose military personnel to oral health problem. Many studies have consistently showed positive potential of xylitol chewing gums as a preventive strategy in maintaining oral health. To study the effects of xylitol chewing gum on oral environment (salivary parameters: hydration status of the labial mucosa, salivary resting pH, stimulated flow rate, buffering capacity; plaque pH and oral hygiene status) among Malaysian infantry personnel involved in military operation in the jungle near Malaysia-Thailand border. A community intervention study was conducted on 309 Malaysian infantry personnel who were assigned into a control group (n=147) and an intervention group (n=162). The intervention group consumed xylitol chewing gum for 5 minutes, three times a day for the period of the military operation (2 months). The daily dose was 6.0grams. The respondents underwent saliva testing, followed by oral examination and plaque test. Saliva parameters and plaque pH were assessed using Saliva-Check BUFFER and Plaque - Check +pH (GC Corporation, Japan) respectively, while oral hygiene status was measured using Simplified Oral Hygiene Index (OHI-S). The baseline data recorded a few days before undergoing military operation were compared with the data recorded after 2 months. Independent t, Chi square, Fisher’s Exact and McNemar tests were applied during univariable analysis. Repeated measures ANOVA was utilised to analyse the differences and changes in means between, within and within between groups while repeated measures analysis of covariance (RM ANCOVA) was used during multivariable analysis to control for confounders. There was a significant change of hydration status with time of intervention among respondents in both groups (p<0.05). Higher proportion of respondents with better hydration status was found in the intervention group after intervention period. There were significant increases in mean buffering capacity and mean plaque pH and a significant decrease in mean OHI-S among respondents in the intervention group after the intervention period (p<0.001). There were significant drop in mean resting pH (p=0.008), mean buffering capacity (p=0.012) and mean plaque pH (p<0.001) and a significant increase in mean OHI-S (p<0.001) among respondents in the control group. No significant change was found in mean resting pH in the intervention group and in mean stimulated flow rate in both groups after intervention period. In terms of between groups, respondents in intervention groups had significantly higher mean buffering capacity, 8.50 (95% CI: 8.01, 8.98) and mean plaque pH, 6.20 (95% CI: 6.14, 6.25) compared to control group, 7.12 (95% CI: 6.65, 7.58); 5.95 (95% CI: 5.91, 6.00) (p<0.001). In terms of group effect with regard to time, there were significant differences in mean buffering capacity, mean plaque pH and mean OHI-S between intervention and control groups after intervention period. CONCLUSION: Chewing xylitol gum can protect the oral health of infantry personnel during military operation in the jungle by improving their hydration status, buffering capacity, plaque pH and OHI-S.
Magnesium and phosphate level during admission in Sepsis patients in relation with mortality and Morbidity in intensive care unit Hospital universiti sains malaysia.
(2012)
Azman abd. Hamid
Magnesium And Phosphate Level During Admission In Sepsis Patients In Relation With Mortality And Morbidity In Intensive Care Unit Hospital Universiti Sains Malaysia. Magnesium and phosphate are electrolytes that important for body homeostasis and maintains normal body function. Hypomagnesaemia and hypophosphataemia are frequent phenomenon in hospitalized patient and have a higher prevalence in intensive care. The focus of this study was to determine the prevalence in these both electrolytes in sepsis patient during ICU admission and its relation to mortality and morbidity. The main aim of this study is to determine the level of magnesium and phosphate during ICU admission in sepsis patient admitted to Intensive Care Unit and its relation with mortality and morbidity. This study was a retrospective study with chart review from 108 sepsis adult patients admitted to Intensive Care Unit HUSM from January 2010 to July 2011. The baseline characteristics and ICU outcomes of all patients were retrospectively collected by reviewing their medical record. Patients characteristic including age, sex, APACHE II score, primary reason for ICU, magnesium and phosphate level during admission, ICU stay and last day in ICU were recorded. Total day required for mechanical ventilation, length of ICU stay, ICU mortality and recovery were recorded. There were 52.3% (34/65) ICU mortality from group hypomagnesaemia, 32.3 %( 21/65) normal magnesium and 15.4% (10/65) hypermagnesaemia (p<0.05). There was statistically significant that 53.8 % (21/39) from patients who were discharge home (recovery) have normal magnesium level compare to 35.9% (14/39) hypomagnesaemia. Hypomagnesaemia group required longer ventilatory support with mean 8.06±7.94 days than normal magnesium level group 5.79±6.089 days. The length of ICU stay was longer in hypomagnesaemia group that is 8.88±7.86 days compare with normal magnesium group 7.00±6.863 days (p>0.05). We found that 43.6 % (17/39) from patients who were discharge home (recovery) have normal phosphate level compare to 33.3% (13/39) hypophosphataemia (p>0.05). We also found for hypophosphataemia group required same duration of ventilator support with mean 7.44±6.66 days with normal phosphate level group 7.47±8.70days. The length of ICU stay is similar in hypophosphataemia group that was 8.96±6.41 days and normal phosphate group 8.49±8.64 days. The study was able to determine that the hypomagnesaemia during admission are associated with higher mortality rate and cause more morbidity in term of prolonged ventilatory support and increase length of ICU stay. However hypophosphataemia did not increase mortality and morbidity.
Effect of electronic medical record utilization on Depression, anxiety and stress among doctors and Nurses in johor.
(2012)
Ahmad Fairuz Mohamed
Healthcare systems throughout the world and in Malaysia are transforming from industrial age healthcare system to information and communication age healthcare system. This transformation will support and strengthened by telemedicine. However, many doctors and nurses are facing with the challenges and obstacles of this implementation of electronic medical record. Thus, this study was designed to evaluate the effect of electronic medical record utilization on depression, anxiety and stress among doctors and nurses in Johor. A comparative cross-sectional study was conducted between January till April 2012 among doctors and nurses in Hospital Sultan Ismail, Johor Bharu (HSIJB) which using electronic medical record and Hospital Pakar Sultanah Fatimah, Muar (HPSF) using manual medical record. There were 130 respondents with response rate 91% for electronic medical record and 123 respondents with response rate 86% for manual medical record. Data was collected using self-administered questionnaire which consists of socio-demographic and occupational characteristics and validated Malay version of Depression, Anxiety, Stress Scales-21 items (DASS-21). The mean (SD) age of respondents electronic medical record and manual medical record group were 34.7 (9.42) and 29.7 (6.15). The mean (SD) duration of respondents using electronic medical record was 46.1 (35.83) months. The prevalence of depression, anxiety and stress among respondents using electronic medical record were 6.9%, 25.4% and 12.3%. There were no significance difference proportion of depression, anxiety and stress between respondents using electronic medical record and manual medical record. In multivariable analysis, the significant factors associated with depression among respondents using electronic medical record was age (OR 1.10, 95% CI 1.02,1.19). The significant factors associated with stress among respondents using EMR was marital status (OR 3.33, 95% CI 1.10,10.09) and borderline significant was computer skill course (OR 2.94, 95% CI 0.98,8.78). There was no significant factor associated with anxiety among respondents using electronic medical record. The prevalence of depression, anxiety and stress respondents using electronic medical record were within range of prevalence depression, anxiety and stress in Malaysia and worldwide. There were no different in mental health outcome among those doctors and nurses using electronic medical record compared to manual medical record. This reflects the successful of Telehealth projects in Malaysia by Ministry of Health and also may reflect the good coping mechanism. In this study, we were found that age was predicted factor for depression among respondents using electronic medical record. We also able to show that computer skill course and marital status were factors that associated with stress level among respondents using electronic medical record.
'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.
The relationship between mast cell density and microvessel density with grading of breast carcinoma.
(2012)
Ismail, Darlina
The relationship between mast cell density and microvessel density with grading of breast carcinoma : There is increasing evidence that indicates the essential role of tumour microenvironment in relation to tumour initiation and progression. The need to further explore this role is crucial as it can provide important prognostic and predictive information on tumour as well as offering potential targets for therapeutic attack. In this study, we aimed to analyze the relationship between mast cell density and microvessel density with grading of breast carcinoma and the correlation between these two variables. In addition, we also analyzed the relationship between MCD and MVD with other clinicopathological parameters. 95 cases of breast carcinoma, diagnosed within 2009 to 2011 in Hospital Raja Permaisuri Bainun, Ipoh, were reviewed. We observed significant association between mast cell density with breast carcinoma grade (p=0.04), with higher count seen in low grade tumour. However, there was no significant association seen with microvessel density with grading of breast carcinoma (p=0.25). Both mast cell density and microvessel density did not show any statistically significant association. Among the clinicopathological parameters, it was observed that high mast cell density was seen in cases negative for lymph node invasion (p=0.01), whereas high microvessel density was noted in cases positive for vascular invasion (p=0.03). Other clinicopathological parameters did not show statistically significant association. As a conclusion, higher mast cell density was seen in low grade tumour and in cases without lymph nodes metastasis, as observed in other studies. However, the finding for microvessel density did not concur with other similar studies.
Etomidate versus ketamine for procedural sedation in paediatric Patients in the emergency department
(2012)
Ahmad Abdulbasitz Ahmad Fatan
Etomidate versus ketamine for procedural sedation in paediatric patients in the Emergency Department. The objectives of the study was to compare the sedation time (Ti) between Etomidate versus Ketamine and the safety of both drugs in the procedural sedation and analgesia among paediatric patients in Emergency department. A single blinded, randomized control study was conducted in Emergency Department Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan, from 1s’ Jun 2010 untill 31st May 2011. 29 paediatric patients aged from 2 years old until 12 years old were recruited with the permission of their parents. They were randomized to two group, Etomidate group which received IV Fentanyl 1pg/kg plus IV Etomidate 0.2mg/kg and Ketamine group which received IV ketamine 1.5mg/kg. 13 patients randomized to Etomidate group and 16 patients to Ketamine group. Sedation time (Tj) was measured from the start of administrating the sedation drug until patients achieved adequate sedation which is characterized by Ramsay sedation score of 4. Vital sign was monitored and any adverse events documented until patients safely discharged/ admitted. From 29 subjects, only 23 subjects able to achieved adequate sedation level with the study drugs. All subjects who did not achieved adequate sedation level were from Etomidate group. From those 23 subjects, median Ti for Etomidate group was 5.0 minutes (IqR 9.0). In the Ketamine group, the median Ti was 1.5 minutes (IqR 4.0). There was no statistical difference in the Ti between the Etomidate group and Ketamine group (P value = 0.17). In this study, the adverse event that has been documented was retching and vomiting and the incidence between the two groups of study drug was similar and no significant difference. (P value = 0.53). There was no serious adverse effect documented during this study. This study proved that sedation time between Etomidate and Ketamine for the PSA were not significantly differ and Etomidate was less effective for PSA compared to the Ketamine in the paediatric age group. Nevertheless, both groups of sedative agents were relatively safe to be used without any serious adverse effect in the paediatric population in Malaysia.
A Comparative study of haemodynamic effects between two different doses of oxytocin in lower segment caesarian section under spinal anaesthesia.
(2012)
Zainudin, Asmah
A comparative study of haemodynamic effects between two different doses of oxytocin in lower segment caesarean section under spinal anaesthesia. There is always a discussion within the obstetric anaesthesia community about the correct dose of oxytocin and its method of administration. Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas an inadequate dose can result in increased uterine bleeding. We compared the effects of two doses of oxytocin in a randomised doubleblind trial. Seventy patients undergoing elective lower segment caesarean section received an intravenous bolus of either 10 unit or 2 unit of oxytocin after cord clamping. followed by oxytocin infusion 10 unit per hour. All patients received spinal anaesthesia. phenylephrine was used if the blood pressure fell more than 15% from the baseline. We compared changes in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, uterine tone, blood loss, additional usage of uterotonic drugs and emetic symptoms. There was a larger decrease in MAP in patients who received 10 unit, MD — 12.54 mmHg (15.1%), p value <0.0001 than in those who received 2 unit, MD= - 5.46 mmHg (7.1 %), p value = 0.023 There was a greater increase in mean heart rate in patients who received 10 unit , MD - +9.20 bpm (10.2%), p value <0.0001 than in those who received 2 unit , MD= -+8.23 bpm (9.5%), p value = 0.004. Maximum increase in HR was at 2 minutes (+15.57 bpm, 17.28%).The frequency of antiemetic use was higher after 10 unit (27.6%) than 2 unit (2.9%), (/?=0.042). There was no difference in blood loss, uterine tone, or request for additional uterotonic drugs in both groups. In elective lower segment caesarean under spinal anaesthesia with low risk for post-partum haemorrhage, a 2 unit bolus of oxytocin results in less haemodynamic changes than 10 unit, with less nausea and no difference in uterine tone, estimated blood loss and the need for additional uterotonics drugs.

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