Pusat Pengajian Sains Perubatan - Tesis

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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.
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.
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.
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.
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.
Depression among caregivers of children following traumatic brain injury in hospital universiti sains Malaysia.
(2012)
Mohd Zin, Faridah
Depression among caregivers of children following traumatic brain injury in Hospital Universiti Sains Malaysia : Although it is generally accepted that traumatic brain injury leads to significant degree of depression among the caregivers, little is known about such impact on the population of North East Coast of Peninsular Malaysia. Hospital Universiti Sains Malaysia, being the only referral centre for traumatic brain injury in this region, it provides a suitable place to investigate the degree of depression and the possible risk factors. To determine the prevalence of depression and the associated factors among caregivers following traumatic brain injury in Hospital Sains Malaysia. This is a cross sectional study involving 208 caregivers of children following traumatic brain injury. They were recruited during follow up at the Neurosurgical Outpatient, Hospital Universiti Sains Malaysia from April 2010 until March 2011. Duration since injury ranged from 1 week to 75 months. The caregivers were requested to answer a set of guided questionnaires on socio demographic and a self administered Beck Depression Inventory as the instrument to screen for depression. Those who had scored more than 10 were considered depressed. The medical records of the TBI patients were reviewed for the injury factors. The prevalence of depression was 38.5% (95%CI: 31.89, 45.11). Depression among caregivers was significantly associated with income per capita (p=0.035). Depression among caregivers was not associated with severity of injury, outcome of injury, duration since injury or mode of injury. Socio demographic factors of the caregivers and the TBI patients, were also not associated with depression following traumatic brain injury, both by simple and multiple logistic regression. Prevalence of depression among caregivers of children following traumatic brain injury in Hospital Sains Malaysia was very much higher than the general population. Household income per capita was found to have significant association with depression. Other associated factors tested were found to have no association with depression among caregivers. Thus, depression has to be expected and assessed accordingly among the caregivers especially those with low household income per capita.
Correlation of apoptotic related protiens and clinicopathological parameters in liposarcoma.
(2012)
Abd Alabbas, Haider K.
Information on prognostic factors is important to setup a proper therapeutic modalities for soft tissue sarcomas. Tumor growth depends on two distinctive pathways: cell proliferation and apoptosis. Liposarcoma is one of the most common soft tissue sarcomas (account about 20-30%), thus this study was designed to look into apoptotic activity of LPS as single entity. In relation to that, we also try to correlate the relationship between apoptotic activity and the clinic-pathological parameters. A cross sectional study was conducted from April 2009 To October 2011. 45 cases of different histologic subtypes of LPS were included in this study. Tissue sections that were retrieved from archived tissue blocks were stained with immunohistochemical stain for Bcl-2 and Bax proteins. Higher expression of Bax in the tumor cells (71.1%) was seen compared to the expression of Bcl-2 (48.9%). Significant correlation between the expression of Bcl-2 and tumor grade (p< 0.005) and histologic subtypes (p<0.001) were found. At the same time Bax expression is higher in LPS and significantly correlate with histological grade and the site of the tumors (p<0.048) and histologic grade (p<0.014). However, there were no correlation between apoptotic activity and tumor size, tumor depth and surgical margins. In conclusion, apoptotic activity plays an important role in tumor developments and progression. Immunohistochemical detection of the proteins used in this study might be useful as markers for predicting the prognosis in LPS.
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.
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.
'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.
Comparison of immediate release oral oxycodone hydrochloride(kappa 2 receptor agonist) with oral pantoprazole in the treatment of functional dyspepsia.
(2012)
Omar, Azaharim
Comparison of Immediate Release Oral Oxycodone Hydrochloride(Kappa 2 receptor agonist) with Oral Pantoprazole in the treatment of Functional Dyspepsia The treatment of patients with functional dyspepsia remains unsatisfactory. We assessed the efficacy and safety of Oxycodone Hydrochloride-Kappa 2 receptor agonist, in patients with functional dyspepsia. Patients with functional dyspepsia were randomly assigned to receive either Oral Oxycodone Hydrochloride 5mg pm basis and Oral Pantoprazole 40mg od. After eight weeks of treatment, three primary efficacy end points were analyzed: the change from baseline in the severity of symptoms of functional dyspepsia(as assessed by the Leeds Dyspepsia Questionnaire(LDQ)), patients' global assessment of efficacy using Global Assessment Score(GAS) (the proportion of patients poor and good improvement), and the severity of pain and bloatedness as rated by LDQ severity scale. The safety of Oxycodone Hydrochloride assessed by the presence of significant side effect. We randomly assigned 60 patients for this study. After eight weeks, overall patients in Oxycodone Hydrochloride group had marked improvement of symptoms, as compared with patients receiving Pantoprazole daily. Analysis of patients' global assessment of efficacy(GAS) also revealed that Oxycodone Hydrochloride group was significantly superior to Pantoprazole with excellent proportion of good(26 vs 1)(P value<0.001). The total LDQ symptom score improved significantly in Oxycodone Hydrochloride groups(13.00±3.29 vs 20.40±3.07)(P va!ue<0.001), with the greatest symptom-score improvement is less than 15(P<0.05). Epigastric pain and bloatedness improvement were greater in Oxycodone Hydrochloride than Pantoprazole; LDQ severity scale for epigastric pain(2.0±l vs 4.0±l) (P<0.001) and bloatedness(2.0±l vs 3.0±l) (P<0.001). The side effects of Oxycodone Hydrochloride was giddiness(13 vs 0)(P<0.001). However when comparing it amongst the Oxycodone Hydrochloride group, it was statistically insignificant(13 vs 17)(p=0.465). Oxycodone Hydrochloride significantly improves symptoms in patients with functional dyspepsia with tolerable side effects.
The expression of peroxisome proliferatoractivated Receptor-gamma (ppary) in Colorectal carcinoma in relation to Tumour-associated macrophages.
(2012)
Haidi Mohamad
The relationship between inflammation and cancer has even been established for many cancers such as colorectal cancer, prostate cancer and pancreatic cancer. However, the role of inflammation differs in different types of tumours. This study aims to assess the presence of tumour-associated macrophages and their role in colorectal cancers using a simple grading scale devised by Klintrup et aL, to determine the expression of PPARy in colorectal cancer and to determine if there is any association between the two parameters. A total of 90 resection cases of colorectal cancer was selected from the archives of the Pathology Department of Hospital University Sains Malaysia, Kubang Kerian, Kelantan from 2002 to 2011. Cases with sufficient tissue material to represent the central areas and the invasive margins were selected based on the H&E stained slides. Assessment of macrophages at central areas and the invasive margins of each case was performed. Immunohistochemical staining for macrophages using CD68 antibody for macrophage counting and PPARy were also carried out at the central areas and the invasive margins of each case. The Klintrup grading scale was positive for all cases. Comparison between macrophage counts and clinicopathological parameters revealed that the presence of lymphovascular permeation was inversely associated with the density of macrophage infiltration at the invasive margin (p=0.016, Pearson chi-square). Trends of association were seen for lymphovascular permeation and macrophage counts at the central areas. PPARy expression at the invasive margin was associated with lower TNM stages (p=0.039, Pearson chi-square) and absence of distant metastases (p-0.018, Pearson chi-square). The expression of PPARy and absence of metastases at the central areas was also significant (p=0.011, Fisher’s exact test). Inverse trends of association were seen for Dukes’ stage and PPARy expression both at the central areas and invasive margins (p=0.09 and 0.090, Fisher’s exact test) respectively. Also, at the invasive margins, expression of PPARy was associated with high macrophage counts (p=0.039, Fisher’s exact test). In conclusion, this study has elucidated that high tumour-associated macrophage infiltration and expression of PPARy especially at the invasive margins of colorectal cancers are markers of indolent tumour behavior and better prognosis; which is in line with the findings of previous research done.
Expression of c-erbb-2 in upper gastrointestinal tract carcinoma and its associations with metastasis.
(2012)
Yunus, Nor Hayati
The availability of drugs therapy targeting the EGFR signaling pathways forms a basis foundation for accurate diagnosis of cancer that will predict responses to treatment. Data of HER2 protein expression and gene amplification in upper gastro intestinal cancer is still conflicting but its expression is firmly established in adenocarcinoma of upper gastrointestinal tract. The expression or its gene amplification is related with poor prognosis of the disease. Experience from HER2 testing in breast cancer provides the importance of quality of HER2 interpretation that guides its application in the upper gastro intestinal cancer. Indeed, standardization of HER2 interpretation in upper gastro intestinal cancer is even important. ToGA trials have showed that immunohistochemistry should be the initial testing method and followed by FISH or CISH to retest. In this study, we determine and comparing the expression of HER2 in esophageal and gastric carcinoma and correlate its expression with the presence of lymph node metastasis and survival status. A cross-sectional study was conducted on 66 cases of upper gastrointestinal carcinoma in which 30 cases were of gastric carcinoma and 36 cases were of esophageal carcinoma. All of these cases were tissue biopsies from archived paraffin embedded tissue blocks from Hospital Universiti Sains Malaysia between Januaryl998 until August 2011. All specimens were stained with Hematoxylin and Eosin followed by immunohistochemical stain for HER2. Positive staining was demonstrated by the presence immunohistochemical stain for HER2. Positive staining was demonstrated by the presence basolateral or lateral membranous reactivity where as negative stain was tumor with faint or no membranous reactivity at all. We observed that 7 (10.6%) out of 66 cases of upper gastrointestinal carcinoma were positive for HER2. The frequency of HER2 positivity is more in esophageal carcinoma than gastric carcinoma. Four (6.1%) of the positive cases were esophageal adenocarcinoma and one positivity (1.5%) in esophageal squamous cell carcinoma. The other 2(3%) were contributed by intestinal type gastric carcinoma. Most of the cases with positive HER2 were moderately differentiated tumor (9.1%). Only one case (1.5%) of poorly differentiated tumor was found to express HER2. Only 3 positive HER2 cases (8.8%) have evidence of lymph nodes metastasis. Of the 7 positive cases, 6 of them were still alive with disease within 1 year after diagnosis. However, all the result showed no statistical significant associations with HER2 expression. Identification of HER2 protein expression in upper gastro intestinal cancer is rather important as in breast cancer to justify patients who might benefit from anti-HER2 therapy. This will aid in proper patients selection for optimum therapy of this cancers. Our findings suggest that there are variable expressions of HER2 interpretation in both esophageal and gastric carcinoma even though statistically our results were not significant. This emphasized that immunohistochemistry method is not a stand-alone test in order to evaluate HER2 protein expression in this heterogenous tumor.

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