Pusat Pengajian Sains Perubatan - Tesis

Browse

Now showing 1 - 20 of 436

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.
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.
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.
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.
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.
Anorectal Malformations (ARM) : The Hospital Universiti Sains Malaysia (HUSM) experience from 1999 to 2006
(2007-11)
Malapan, Kirubakaran
Anorectal Malformations (ARM) are a complex group of malformations diagnosed at the time of birth because of absence or an ectopic location of anus. The usual rep01ted incidence is between l per 1500 and 1 per 5000 live births and they are more often seen in boys than in girls. The incidence of associated organ anomalies with ARM is variously reported from 20% -70% some being minor anomalies but others being life threatening. Further management depends on the sex of the patient, type of malformation either high or low and the associated anomalies. All operative procedures for the correction of ARM aim at providing portal for the discharge of feces from the perineum and establishing a working relationship between the bowel and sphincter. The aim of the study is to review the patients presenting with anorectal malf01mations (ARM) to Hospital Universiti Sains Malaysia (HUSM) and describe the demographics and outcome in relation to the type of ARM. The study was a retrospective case review which was canied out in the Paediatric Surgery Unit, Depa1iment of Surgery, Hospital Universiti Sains Malaysia (HUSM) between January 1999 and January 2006. The case notes and operative notes were screened for epidemiological data and data relevant to the study. Patients diagnosed with ARM but did not undergo surgery, and patients whose case notes could not be traced or incomplete were excluded from the study. All the data entry and analysis were carried out using the social science and statistical packaged (SPSS) version 12 licensed to USM. A p value of less than 0.05 was considered statistically significant. Ninety eight patients were included into the study after fulfilling the inclusion criteria. The male to female ratio was 2 to 1 and 97% of the patients were Malays. The birth weight of the patients in this study ranged from l.3kg to 4.5kg. Forty two point eight percent of the patients presented to HUSM within the first day of life. The most common presenting symptoms were abnonnal passage of meconium (39.7%), abdominal distension ( 15.3%) and constipation (5.1 %). The investigative procedures done to detect associated anomalies were ultrasound abdomen (94.8%), babygram (87.7%) and echocardiogram (75.5%). Associated anomalies were detected in 56.6% of the patients. The most number of associated anomalies detected in patients with ARM was cardiovascular anomalies (25.5%) followed by urological anomalies (22.4%) and chromosomal anomalies (17.3%). Fifty two patients (53%) underwent surgical repair for low ARM which were mini PSARP (69.2%) followed by anoplasty (25%) and anal shift (5.8%). Forty six patients (46.9%) underwent surgery for high ARM of which only 2% underwent single stage PSARP repair. Forty four patients (73.3%) who had colostomy formed were later diagnosed with high type of ARM. The remaining 16 patients who had colostomy formed were diagnosed with low ARM (26.7%). Post operative complications were similar to those reported in earlier studies. In this study, there were 46 patients (46.9%) with high type of ARM and 52 patients (53 .1 %) with low type of ARM. Only 44 patients were able to be contacted and interviewed to assess their functional outcomes. Anal stricture was a significant complication in patients who were not compliant with the anal dilatation protocol (p = 0.007). Patients with low ARM were noted to have more adequate weight gain as compared to high ARM patients (p=0.002). The incidence of constipation was higher among patients with low ARM and this was highly significant (p= 0.000). However, the incidence of soiling and incontinence was higher among patients with high ARM (p=O.OOO). Seven patients achieved full continence at follow up and they were all males (p=0.048). Only 7 patients in our study achieved "good" outcome following surgery, 54 patients achieved "fair" outcome and 16 patients had "poor" outcome. The mortality rate after definitive surgery in this study was 4%. The demographic finding in the study is quite similar to those published in the literature from other parts of the world. The clinical diagnosis of type of ARM was accurate in 76.8% of the patients and it was more difficult in making a diagnosis of high ARM clinically, compared to low ARM. The high incidence of associated anomalies in our study makes careful clinical examination and evaluation during the neonatal and early infantile period mandatory in all cases of ARM. Anal dilatations are a vital part of the postoperative management to avoid stricture at the anoplasty site. The low number of patients with good outcome in our study suggests that more attempts must be made to keep these patients on follow up, with the development of a proper bowel management program and an integrated team approach to achieve better outcomes.
Evaluation of optic nerve head functions and Topography after an episode of optic neuritis.
(2011)
Chua Chui Yin
Optic neuritis primarily affects the optic nerve. Most patients with typical optic neuritis have excellent recovery of visual acuity. However, certain degree of optic atrophy will almost always occur and the axonal loss could have consequences especially on other non acuity visual functions. Using the optic nerve head parameters, it is possible to evaluate the structural and functional damage of optic nerve after an episode of optic neuritis. To evaluate the optic nerve functions and optic nerve head parameters post single attack of optic neuritis, and to compare the functional and structural changes based on the persistence of relative afferent pupillary defect (RAPD). In addition, to correlate the optic nerve functions and optic nerve head parameters in eyes with post single attack optic neuritis. The study was conducted from July 2010 to June 2011. Fifty six subjects with history of single episode of optic neuritis and age-, sex- and race-matched controls underwent complete ocular examination and optic nerve function tests. In addition to RAPD examination, LogMAR acuity test, Humphrey visual field 30-2, Functional Acuity Contrast Test (F.A.C.T®) and Ishihara plates were employed for the assessment of optic nerve functions. The optic nerve head parameters were measured using Heidelberg Retinal Tomography III (HRT III). Pearson’s correlation was used to determine the correlation between the optic nerve functions and optic nerve head parameters. Mean duration between recruitment process and first episode of optic neuritis was 5.21 ± 2.94 years. Significant reduction in the optic nerve functions was seen in the optic neuritis group. Among the optic nerve head parameters, there was significant RNFL thinning (p 0.001), reduction of neuroretinal rim volume (p =0.006) and increase in the cup shape (p < 0.001), cupdisc area ratio (p = 0.009) and optic cup area (p = 0.030). The mean RNFL thickness demonstrated good correlation with the optic nerve functions, in particular contrast sensitivity at high spatial frequency (r = 0.7351, p < 0.001). There was also fair and inverse correlation between the cup shape and contrast sensitivity (r= -0.4463, p = 0.016). Subjects with persistent RAPD showed significant worse performance in visual acuity, colour vision and contrasts sensitivity score, compare to those without persistent RAPD. However, no significant difference was seen in the optic nerve head parameters between these two groups. After an episode of optic neuritis, there were significant reduction in optic nerve functions and changes to the optic nerve head parameters. The thinning of RNFL was especially significant. The good agreement between the optic nerve functions and optic nerve head parameters suggested that in addition to the optic nerve function tests, HRT III is useful for post optic neuritis evaluation.
A study on the variation of peripapillary retinal nerve fiber layer thickness in myopic patients using optical coherence tomography.
(2011)
Gan, Eng Hui
Myopia is a common ocular abnormality worldwide. Individuals with myopia have increased risk of glaucoma compared to non-myopic individuals, but the clinical diagnosis of glaucoma in patients with myopia is often difficult. An important approach in detecting early structural change in glaucoma is based on assessment of the retinal nerve fiber layer (RNFL). Thus, evaluation of the RNFL is very valuable for early detection of glaucoma especially in myopes. However, it remains uncertain whether RNFL thickness would vary with the refractive status of the eye. To compare the peripapillary RNFL thickness between control subjects with emmetropia and myopia subjects with low, moderate and high myopia as well as the relation of RNFL thickness with age, spherical equivalent, axial length of the eye respectively. Four hundreds and three eyes from 403 subjects were recruited according to the selection criteria. The eyes were divided into 4 groups according to their spherical equivalent: control (+0.5D > spherical equivalent > -0.5D), low myopia (-0.5D > spherical equivalent > -3.0D), moderate myopia (-3.0D > spherical equivalent > -6.0D), high myopia (spherical equivalent < -6.0D). All subjects underwent full ocular examination with A-scan and imaging with optical coherence tomography (OCT). The peripapillary RNFL thickness profiles were compared between the groups with ANCOVA. The relation between RNFL thickness and age, spherical equivalent and axial length of the eye were evaluated respectively with coefficient of correlation. Multivariate analysis adjusted for sex, age groups, laterality and axial length of the eyes showed significant thinning of the 360° (p=0.017) and the inferior quadrant (p=0.017) RNFL in high myopic eyes when compared to emmetropic eyes. No significant difference in the RNFL thickness when comparing other refractive error groups. Significant fair correlations were evident between RNFL thickness and spherical equivalent (i=0.330, p<0.001) and axial length (r=-0.286, p<0.05) of the eye respectively. The correlation between age and RNFL thickness was poor but statistically significant (r=-0.156, p<0.05). High myopic eyes had thinner 360° and inferior RNFL thickness compared to emmetropic eyes but not universal in all quadrant around the optic disc. No statistical significant difference of RNFL thickness between other refractive error groups. There was a fair linear relationship between RNFL thickness and spherical equivalent as well as axial length of the eye but, the relationship between RNFL thickness and age was poor in our study model.
The l0th Iranian congress on audiology
(2011-04)
Zainun, Zuraida
-
Outcome of severe head injury in school age patients at emergency department of hospital universiti sians malaysia.
(2011-05)
Ismael, Haidi Abdulsalam
Emergency department Hospital Universiti Sains Malaysia is a referral center for neurosurgical cases for vast area in Kelantan. Head injury patients are referred for neurosurgical intervention and management. Head injury severity, initial vital signs and metabolic response of the patient will affect the overall outcome. The aim of this study is to determine the survival probability of school aged patient with severe head injury treated in Emergency department of HUSM, to determine the mean length of stay (days) of school aged patient with severe head injury treated in Emergency department of HUSM, to determine the prognostic factors that influence the risk of death among school aged patient with severe head injury treated in Emergency department of HUSM and to determine the associated factors that affect the length of hospital stay among school aged patient with severe head injury treated in Emergency department of HUSM. A retrospective chohort study done for a sample of 91 (severe head injury) school aged patients data were collected from the records of HUSM during the period 2007 to 2OO9.These patients were then followed for 30 days following admission to identify their outcome. The mean age was 15.More than 50% of the cases came with initial GCS 6 and above and 67 patients (73.6%) were alive at the end of 30-days.From this study we found that survival probability for severely head injured school aged children was 73.6%. The mean length of stay (days) in hospital was 17 days. Age, CT Finding and GCS of patient at admission were identified as factors related to mortality outcome and to total length of stay in hospital.
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.
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.
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.
Evaluation of captopril and nefediplne in Treatment of hypertension secondary to Post streptococcal acute Glomerulonephritis - A randomized control trial.
(2012)
Aznor Fadly Azim
Post-streptococcal Acute Glomerulonephritis (PSAGN) is still common in Malaysia. Hypertension is one of its main complications which can lead to severe morbidity in children. Conventional method in treating hypertension in these patients was to use nifedipine to reduce the blood pressure. Recent study in the pathophysiology of the disease had shown apart from water and sodium retention, inappropriate production of angiotensin II could also contributes to the development of hypertension. Captopril, an angiotensin converting enzyme inhibitor can help to reduce the production of angiotensin II which can cause blood pressure reduction. To compare the effectiveness of captopril versus nifedipine in controlling blood pressure in children with PSAGN with hypertension. This was a double blinded randomized controlled trial, registered with ANZCTR (Trial No: ACTRN12611000778987) All children admitted to Wad 6 Selatan HUSM diagnosed clinically with PSAGN with hypertension during a one year study period are eligible for the study. Subjects were randomized either to receive nifedipine (control) or captopril (intervention). Outcomes measured are blood pressure changed in the first 4 hours and blood pressure changes until Day 3 of starting the medication, duration of days to achieve blood pressure control, total duration of admission and the need to use additional medication. Blood urea and serum creatinine levels are compared from before starting treatment and at Day 3 after starting treatment. Out of 40 patients who were recruited and randomized, only 19 from the nifedipine treatment group and 13 from the captopril treatment group completed the study. Both treatment groups had no difference in their baseline data. Nifedipine produces a more significant reduction in SBP and DBP compared to captopril in the first 4 hours of starting treatment (SBP p= 0.001, DBP — 0.016). There was no difference in reduction of SBP and DBP after 8 hours of treatment between the groups (SBP p=0.630, DBP p=0.497). There were no significant differences in the duration of blood pressure normalization (nifedipine: 2.7 days, captopril 2.9 days, p= 0.803) and duration of admission (nifedipine: 6.9 days, captopril: 5.4 days; p=0.183) and the need for additional medication to control the blood pressure (p=0.32) between the groups. Changes of blood urea and serum creatinine levels were not significant before and after treatment (Blood urea changes, /?= 0.564; serum creatinine changes, p- 0.236). Nifedipine produces more significant blood pressure reduction in SBP and DBP in the first 4 hours of starting treatment.
Role of nasal irrigation by using alkaline nasal solution in allergic rhinitis treatment as an adjunct therapy.
(2012)
Periasamy, Chenthilnathan
Nasal irrigation is an important component in the management of upper respiratory tract diseases. Alkaline nasal solution plays vital role as an adjunctive therapy in the treatment of allergic rhinitis. Unfortunately, there still exits lack of evidence and practice regarding usage of alkaline solution as nasal irrigation in allergic rhinitis treatment. The aim of this study was to determine the effectiveness and role of nasal irrigation by using alkaline solution with any changes in nasal or non-nasal symptoms in the treatment of allergic rhinitis as an adjunct therapy. Besides, this study also analyzed for any side effects of alkaline nasal solution following its usage for the treatment of allergic rhinitis. This was a prospective, randomized control trial in which a total of 64 patients recruited fromHUSM and divided into Test group (n=32) and Control group (n=32). These patients confirmed suffering from allergic rhinitis with the presence of positive skin prick test. Then these patients of both groups, their symptoms will be assessed with a standardized and validated symptom score questionnaire pre and post study. Their symptoms were evaluated based on nasal and non - nasal symptoms. The test group had been given alkaline nasal solution as nasal irrigation for the period of 6 weeks along with regular nasal spray and antihistamine. Furthermore, the control group was given only the nasal spray and antihistamine for 6 week duration. During this study period, assessments of any adverse effect by usage of alkaline nasal solution as nasal irrigation in the Test group subjects were also analyzed. This study shows most of the sample subjects were middle age (21-40 years) and active earning group in which their daily routine and quality of life are strongly related to their allergic rhinitis symptom control. Most of the subjects were grouped into moderate/severe persistent allergic rhinitis. Furthermore majority of subjects in this study were allergic to house dust mite. This study shows statistically significant nasal symptom improvement in nasal discharge, nasal itchiness and sneezing among the Test group. There were no side effects noted in the usage of alkaline nasal solution during the study. Therefore alkaline nasal solution as nasal irrigation in the treatment of allergic rhinitis is beneficial. Nasal irrigation is a simple mode of treatment that relieves the symptoms with no documented adverse effects. Alkaline nasal solution as nasal irrigation has better effect on patient’s nasal symptoms and improves quality of life. Nasal irrigation techniques are simple and easily taught in primary health care. Moreover alkaline nasal solution is an important component in the management of allergic rhinitis as an adjunct therapy.
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.
'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.
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.
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.

Browse

Browsing Pusat Pengajian Sains Perubatan - Tesis by Issue Date

Results Per Page

Sort Options