Pusat Pengajian Sains Kesihatan - Tesis

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Relationship Between Iron Deficiency Anaemia With Cognitive Function And Academic Performance Of The Primary School Children In Bachok, Kelantan
(2012-07)
Hasmiza Halib
The main objective of the study was to investigate the relationship between IDA with cognitive function of the school children. A cross-sectional study was conducted on 249 Malay primary school children (122 males and 127 females) aged 7-9 years old by systematic sampling method in rural area of Bachok, Kelantan.
A review of cervical cancer in HUSM for 15 years period, from 1996 to 2010
(2014)
Narawi @ Nawi, Mohamad Maulizal
Objective: This study was designed to review the cervical cancer cases that presented to HUSM between 1996 to 2010. In specific, it involved determination of characteristic of cervical cancer cases in HUSM during this period. This study also compared the epidemiology trend of cervical cancer in HUSM in the second and third 5 years period of the study. Apart from that, it also determined and compared the associated factors between early versus advanced cervical cancer in relation to morbidity and mortality in HUSM during the period Methodology: This retrospective study was conducted in HUSM for a period between 1996 to 2010. It covered all the 221 recorded case of cervical cancer that been admitted and primarily treated in HUSM . All their medical records were review and related information were entered in a standard data collection form. Results: There were 221 cervical cancers cases involved in this study. The vast majority were Malay ethnic. Base on Malaysian and Kelantan population study, it can be concluded that Chinese ethnic group had slightly higher risk to developed cervical cancer. 72% of patients were from Kelantan and 25% from Terengganu. Most came from the capital city of Kelantan and Terengganu due to its high population. The mean age of the patients diagnosed to have cervical cancer in this study was 54 years old. The majority of the patients were in the 50th decade of their life (age 50-59 years old). Generally patients that presented in this study were healthy patients with no comorbid (84%). All of the patients were married. Vast majority (95.5%) were multiparity with average parity of 5. More than half patients were postmenopausal (55.7%). There were very high correlation between not doing any pap smear to cervical cancer as 90% of patient never did any pap smear before. However poor corelation between smoking (5%) and family history of malignancy(2.7%) to cervical cancer in this study. Obtaining sexual history were not an easy task in this population. It was considered as humilation and for some as dysrespect. Thus it was very highly likely that the number of patients or partners with multiple sexual partners will be far less then it really were. Meanwhile, mean age of sexual exposure was 20 years old. Most patients were referred to HUSM by terteiry centre for further treatment 54%. Most patients either presented with PMB (38.9%) or PCB (38.5%). Majority of patients presented during stage 2B (31.2%) and 3B (25.3%). As per other underdeveloped country, 67.4% of cases were in their late stage. Only 32.6% came when the diseases still early. 78% were SCC, 15.4% were adenocarcinoma. Base on limited CT scan report 84.6% were locally advance disease. Correspond to stage at presentation 61.5% were treated with Rtx/ CCRT. Only 60 patients undergo surgical intervention with 80% without any complication. Of that, 77% had no dyscrepancy between clinical and surgical staging. 120 patients were disease free. The average were 36 months. However up to 65% defaulted their follow up and never turn up thereafter. Most patients that had recurrent presented in >12 to 36month periods, so did the death. However 49 patients having progressive disease. Up to 13% of patient that died due to non cervical cancer causes The comparison between year 2001-2005 and 2006-2010 shows few promising data. There were slight increased patients from terengganu (20 vs 28%) and coincidental reduce in chinese patient from 13 to 6.6%. The risk factor were comparable to general population of the study. In term of stages, the prominant changes were double the case of 1b2 disease ( from 6 to 12%). This were likely influenced the increased surgery and adjuvant Rtx/CCRT in 2006-2010 periods. Early recurrent (within 6-12 months periods) were almost triple (from 4.6 to 13.9% ). The exact cause were unknown. The death were also different,where by in the earlier year had only 53% death within 36 months,while in later years the percentage of death at the same periods were 72%. Regarding the factor between early and late disease. It was noted that patients with early stage were majority in 40th decades, whereby the late stage group were majority in 50th decades. Patients from Terengganu had 3 times likely late stage compare those from Kelantan. So did patients that referred by terteiry centre (with Odd 2.5) Postmenopausal were more associates with late disease with odd more than 2.5 times. The late stage groups had higher defaulter percentage in the first year of diagnosis (41% compare to 22% in early stage). There were significantly more death at late stage arm. The majority death in late stage were within 6 months (46%), while in early stage were in >12 to 36months periods (29.6%). Conclusion: Despite the innability to come with survival rate secondary to logistic problem, the study had shown the character of cervical cancer in HUSM. The main prognosis were still the stage of the disease. It was also proven that positive changes were not achieved easily with time alone. Thus wide coverage of screening with right targetted population to detect precancerous lesion and early disease, follow by proper treatment is the key to successfull in overall outcome of cervical cancer.
Investigation of quercus infectoria (qi) methanolic extract cytotoxicity effect on glioma and neural stem cell.
(2016)
Nasarudin, Mohamad Amirul Imran Mohd
Glioblastoma multiforme (GBM) is the most malignant subtype of brain cancer. Current standard treatment are limited in effectiveness and impose additional side effect. Quercus infectoria (QI) was reported to be anti-carcinogenic and exhibit inherent antioxidant activity. This study evaluated the effect of QI extract on GBM cell line (DBTRG-05MG) and neural stem cell line (H9-hNSC). Soxhlet extraction was performed using 70% and 100% methanol solvent. Antioxidant activity was measured using DPPH free radicals scavenging assay. Cells were cultured and optimal extract concentration was determined via MTT assay. The genomic and proteomic analysis of the Ql-treated cells were performed using real-time PCR and Western Blot respectively. We observed that 100% methanolic QI extract (100%-Met) produced significantly higher yield (78.46%) compared to 70% methanolic QI extract (70%- Met) (43.7%). Despite not significant, 100%-Met showed higher antioxidant activity compared to 70%-Met (94.62% vs 91.33%). 100%-Met (1C5o:70.76 pg/ml) and 70%-Met (ICso:71.55 pg/ml) were found to show anti-DBTRG-05MG proliferation. Following treatment, DBTRG-05MG showed reduced cancer cell marker (PKM2) gene expression. CASP3 gene, a key player in apoptotic pathway was expressed significantly higher in 100%- Met-treated DBTRG-05MG compared to non-treated group. However, CASP3 expression in 100%-Met-treated H9-hNSC was not significantly different to the non-treated control, indicating QI extract did not possess apoptotic effect on H9-hNSC. Similarly, Western Blot analysis produced clear band at 35 kDA which represent caspase-3 protein for treated DBTRG-05MG, but absent in treated H9-hNSC and non-treated control. In conclusion, QI extract is a potential anti-cancer drug with negative cytotoxicity response towards non cancerous cell such as NSCs. Further study is warranted to elucidate the precise effect of reduction ofCD133 expression on H9-hNSC activity and cell integrity.
The effects of cessation of supplementary isokinetic and isotonic training on strengh and biomechanical variables in state-level weightlifters
(2016-06)
Mohamed, Iqbal Wan
INTRODUCTION: To date, no studies have been carried out to compare the effects of cessation of supplementary Isokinetic Training (IT) and Isotonic Training (TON) in strength and biomechanical variables among elite weightlifters. Regarding biomechanical variables of the rotator cuff muscles, most studies were conducted on sedentary population and racket-sports instead of advanced level of weightlifting athletes. OBJECTIVES: This study aimed to compare the cessations effects 1 month after they completed the 24 sessions of isokinetic and isotonic supplementary training among state-level weightlifters on biomechanical variables of rotator cuff muscles. METHODS: Nineteen participants were gender- and weight- matched and randomly assigned into isotonic training group (TON) and isokinetic training (IT) group. Both groups went through 24 sessions of training programmed three times per week for 8 weeks in three distinct lifting positions. The intensity of training was increased progressively in terms of number of lifting repetitions per set and number of sets lifted. After 1 month of the cessation of supplementary training programmed, the athlete when through a follow-up testing. The 2D-kinematic analysis of barbell velocity was evaluated during the second pull and turnover phases of I-RM power clean and power snatch tests. In IT group, the participant was allowed to be seated on the the guidelines instructions. The position of the chair and dynamometer will be set at the particular angle depends on the xvi chair to perform the training programed based on the participant’s comfortability. The participants were asked to perform two sets of 12 repetitions and the angular velocity was set at 120°.s '. Meanwhile in TON group, they using the dumbbell and perform the exercise with maximum effort (as fast as they can). RESULTS: This study revealed that there was no interaction between time (e.g., post- and postl month-tests) and training programmed (e.g., IT versus TON) was found I month after they completed their 24 sessions of supplementary training on biomechanical variables among state-level weightlifters. There was a trend that indicated positive changes in biomechanical variables of IT group compared to TON group in terms of peak torque/body weight, time to peak torque and average power of the external rotation of the shoulder joint. However, the TON training was better compared to IT training after the cessation effects in 1RM (repetition maximum) power snatch and power clean, and also in kinematic analysis during 1RM test. CONCLUSION: The isokinetic training program has a potential to be proposed as an additional mode of training among the experienced weightlifters to improve their performance.
Assessing the level of lead, cadmium and arsenic among farmers in KADA agricultural area, Kelantan
(2016-06)
Kasri, Hazmira Mohd
Heavy metals, particularly cadmium, lead, and arsenic, constitute a significant potential threat to human health. This study was conducted to determine the concentration of lead, cadmium and arsenic in nail samples from farmers at Kemubu Agricultural Development Authority (KADA), Kelantan, Malaysia. Control group of this study was selected from participants working in different environment which are USM Health Campus’s staffs. A total of 35 farmers and 35 USM Health Campus’s staffs participated in this study. The fingernails samples were extracted by using acid digestion and then analysed by Atomic Absorption spectrometry (AAS). Checklist was given to participants to get demographic, health status, and their agricultural activities data. In this study, the concentration of heavy metals was within the normal range and varies according to demographic factors. The result showed that the concentration of all heavy metals were significant different in exposed group as compared to control group (p < 0.05). There were also significant correlations between age with concentration of lead, arsenic (r = 0.317 and r = 0.326, resp., p < 0.01) respectively and cadmium (r = 0.257, p < 0.05). Findings suggested that agricultural activities could contribute to the accumulation of heavy metals in farmers. Hence, the control of human exposure to these metals was important in order to prevent adverse health effects. In conclusion, lead, cadmium and arsenic concentration among farmers were lower compared to the allowable limit and they should conduct good agricultural practice to maintain in normal range.
Recovery study of dangerous drugs in soft drinks using liquid-liquid extraction followed by gas chromatography-flame ionisation detector (GC-FID)
(2016-06)
Khai, Lee
Raves and night clubs are always associated with the recreational drugs, which are also referred as 'club drugs'. Dissolving illegal drugs, such as ketamine and 3,4-methylenedioxymethamphetamine (MDMA), into liquid forms to be disguised as bottled soft drinks is one of the current drug concealment methods. Hence, a recovery study to develop suitable method for detection and quantification of the amount of specific drugs contained in the soft drinks is proposed. The objective of this study is to study the recovery efficiency of liquid-liquid extraction (LLE) method used to extract drugs from the soft drinks. LLE with chloroform allowed the extraction of ketamine and MDMA from the sample soft drinks. Gas Chromatography-Mass Spectrometry (GC-MS) analysis was used to confirm the presence of desired drugs in the extracts, followed by Gas Chromatography-Flame Ionisation Detector (GC-FID) analysis to quantify the amount of desired drugs extracted from the soft drinks. In GC-MS analysis, it was found that the quality of mass spectral match for MOMA (78%- 87%) was lower compared to ketamine (98%) and internal standard (91 %). In recovery study of repeated extraction on same sample, it was found that the amount of drugs recovered were consistent for blackcurrant juice (RSD = 6.77%) and ice lemon tea (RSD = 5.38%), but inconsistent for green tea (RSD = 15.52%) and orange juice (RSD = 29.43%). In recovery study using spiked samples, the average recovery percentage of ketamine from blackcurrant juice was 87.27 ± 5.72 %. The regression curve for recovery ofketamine was found to be sufficiently linear (R2 = 0.997), which indicated that the method was accurate. In brief, the analytical procedures of LLE, coupled with GC-MS and GC-FID in recovery study were found reliable for the extraction, detection and quantitation of ketamine and MDMA in the drug-laced soft drinks.
Morphological classification of male face images of three major ethnic groups for retrieval during identification
(2016-06)
Ghouse, Hazzreen Effendy Md
Human faces have their individual uniqueness. The morphology of the face is influenced by the genetic and epigenetic factors. The factors that contribute to individuality are exerted on every faces. The present human population originated from three distinct stock races, Mongoloid, Caucasoid and Negroid. The subsequent breakdown of the geographic barriers and mixing up of the gene pools due to factors such as marriage between stock races has been the cause for the diversity among features of the present population in general, and specifically in the facial structure. Epigenetic influences such as extreme climate, and differences in atmospheric pressure, has caused physical alteration in the human physical traits. Three major ethnic groups, Malay, Chinese and Indian that have originated in different geographical regions but are now living in Malaysia as Malaysian national are studied in this research for identifying facial features that manifest significant relationship to ethnic affiliation. The data collected from photogrammetric measurement of the scaled face images that were recorded in a controlled manner from each of the 105 volunteering individuals were analysed using one-way ANOVA. These ethnic groups were found to exhibits significant differences in twenty out of the total twenty-four anthropometric measurements taken.
Study on vitamin D status and determination of optimum vitamin D level based on bone turnover markers in Kota Bharu, Kelantan.
(2017)
Muda, Noor Bayani Che
Background: There is no optilnmn level or threshold that has been clearly established to define whether there is adequate store of vitamin D in the body for general bone health. Therefore, our study is to determine the optimum level of vitamin D for maintenance of healthy skeleton based on bone remodelling process. Methods: This was a cross sectional study involving healthy adult population in Kota Bharu, Malaysia, aged 18-50 years. We measured serwn 25(0H)D, serum parathyroid hormone (PTH), serum C-terminal telopeptide of type 1 collagen ( CTX) and Procollagen 1 Intact N-Terminal (P1NP) in 120 healthy adult from 6 sub districts that had been selected by multi stage sampling ( 64 males, 56 females). Results: The mean of vitamin Din this study was 23.50 (±8.74) nmol/L and there was significant difference of vitamin D betvveen gender (26.81±8.3 nmol/L and 19.72±7.68 nmol/L males and females respectively), p value < 0.001. More than 50% of female subjects had vitamin D less than 20 nmol/L, while only 20.3% of male subjects had vitamin D below 20 nmol/L. Based on LOESS plot, the bone turnover markers showed plateau result at vitamin D level of 3 5 nmoi!L for CTX and 20 nmoi/L for p 1 NP. Then, at vitamin D level of 20 nmol/L there is a step decrease of PTH level. Conclusion: The mean of vitamin D among general healthy population in Kota Bharu was 23.50nmoi/L. Based on inspection of LOESS plot for CTX, PlNP and PTH versusvitamin D level, we concluded that vitamin D level between 20 nmol/L to 35 nmol/L is considered sufficient to maintain healthy skeleton.
A study on geriatric patients attending emergency department Hospital Universiti Sains Malaysia.
(2017)
Sjahid, Afifah Sjamun
This study aimed to determine the proportion of geriatric patients attending Emergency Department in Hospital Universiti Sains Malaysia (USM) within January 2015 to March 2015, the mean duration of hospital stay and the outcome of the illness in geriatric patients admitted to Hospital USM. This study also aimed to identify the associated factors of mortality in geriatrics patients admitted to Hospital USM. This study was a retrospective cohort study from January 2015 till March 2015 at Emergency Department Hospital USM. All patients aged 60 years and above attended Emergency Department of Hospital USM from January 2015 until March 2015 were included. Systematic random sampling was used. A total of 209 patients had been included in this study. Descriptive statistics were expressed as cross-tables for categorical variables and as mean ± standard deviation for numerical variables. Independent categorical variables were compared using Chi-Square test or Fisher’s exact test. Paired group comparisons were performed using Independent t-test or Mann Whitney test for numerical variables. Total patients included in this study were 209 patients. The mean (standard deviation, SD) age was 68.4 (6.95) years old, with age range from 60 till 106 years old. Fifty-eight percent were male and 95.7% were Malay. Seventy-eight percent were triaged as an emergency; with 19.6% were red zone cases, while 51.2% were yellow zone cases. Three most common presenting symptoms were respiratory symptoms (24.9%), cardiovascular symptoms (19.65%) and gastrointestinal symptoms (12.9%). Out of209 patients studied, 95 patients (45.5%) were admitted. Mean duration of hospital stay was 8 days (mean 7.57, SD 12.97). Out of 95 patients admitted, only 15 patients (15.8%) died in the ward. Factors associated with mortality in hospitalized geriatric patients were gender (p = 0.009), patient’s method of arrival (p = 0.001), conscious level on arrival (p < 0.001), patient’s condition when transferring to the ward; either ventilated (p = 0.014) and on inotropic agent (p < 0.001) or not, patient’s first pulse rate taken at triage (p < 0.001) and first blood investigations taken in emergency department; white blood cell (p = 0.007), hemoglobin (p = 0.019), serum lactate (p < 0.001) and serum urea (p = 0.036). Majority of the geriatric patients triaged as emergency cases indicated that they mostly came with ill-conditioned that need to be attended immediately. By knowing the common presenting symptoms and associated factors of mortality in admitted geriatric patients will alert medical personnel in the emergency department to treat this group of patients more thoroughly and judiciously.
Assessment of nutritional status, nutrient intake, physical activity and quality of life among overweight & obese female government staffs in Kota Bharu, Kelantan.
(2017)
Ayoub, Aqila
Assessment of nutritional status, nutrient intake, physical activity and quality of life were carried out among 160 overweight and obese women government staffs in Kota Bharu, Kelantan. Data was collected using a questionnaire which included socio-demographic characteristics, the International Physical Activity Questionnaire (IPAQ), 24-hour dietary recall and Impact Weight Quality of Life (IWQOL) questionnaire. Body mass index, waist circumference, weight and height were measured using standardized methods. Almost half of the respondents (36.9 %) were within age of 30-39 years. Majority of the respondents were Malay (99.4%) and followed by Chinese (0.6%). Mean weight, height and BMI of the respondents were 72.3 ± 9.12 kg, 1.55 ± 0.06 cm, and 30.0 ± 3.33 kg/m2 respectively. Based on WHO classification, 60.0% of respondent were overweight and 40% of respondents are obese respectively. The waist circumference of respondents for normal and obese individuals are 1.9% and 98.1% respectively. The mean total physical activity score was high in obese group (17171.63 ± 13353.24) than overweight group (14238.23 ± 9963.04). Furthermore, the mean total calorie intake of respondents for overweight (1631.13 ± 458.18 kcal) was higher than obese (1513.03 ± 475.68 kcal). Significant linear relationship was found between protein intake in sexual life of quality of life (b=0.13, 95% CI= 0.001, 0.258, p < 0.048), age in public distress of quality of life (b= -0.386, 95% CI= -0.006, -0.106, p < 0.007) and individual income in public distress of quality of life (b= -0.002, 95% CI= -0.003, 0.000, p < 0.024). This indicate that age, individual income and protein intake can be used a predictor for quality of life. However, there is no association was identified between physical activity and BMI with quality of life.
Effects of using breathing appplication and eeg muse device to enhance state level bowlers’ performance
(2018-07)
Raza, Muhammad Qasim
Given the key role of coping strategies in sports, this study sought to determine whether the use of breathing app and EEG-muse neurofeedback training would cause a reduction in arousal level and to enhance the scoring performance of the Malaysian state level tenpin bowlers. Besides, Heart Rate Variability indices were also measured to predict performance outcomes. Eleven State-level bowlers volunteered to took part in the study. The participants were exposed to three research conditions namely control, breathing intervention and muse intervention. The study was conducted over three weeks, with a research condition each week at random order. Prior to the intervention, the participants were required to answer the CSAI- 2R questionnaire; then the intervention was applied after which the players performed three sets of tenpin bowling simulated competition. The CSAI-2R questionnaire was again completed by the participants after post-performance. The HRV indices namely (SDNN and RMSSD) were also measured during the resting state of the bowlers (prior to the performance) and immediately following muse intervention. The results revealed that there was no significant difference in the arousal level of the bowlers following the intervention (p > 0.05). The bowling performance improved following the interventions as the results were significant (p = 0.032), which showed that Muse intervention has the highest bowling performance scores (359.09 ± 20.48), followed by breathing apps intervention (354.64 ± 21.68), and then control condition (344.27 ± 21.15). The results for HRV indices were only significant for RMSSD (p = 0.004). The bowling performance of the bowlers increased following intervention while the interventions did not have any effect over the sub-scales of CSAI-2R. The HRV indices also did not appear to be significant in predicting bowlers’ performance although the RMSSD results changed but were higher instead of being lower. The findings of the study suggest thatthere is a positive effect of EEG-muse NFB and breathing app use in enhancing bowlers’performance.
A 4-week internal training load monitoring and fatigue responses of malaysian under-18 rugby players during competitive season
(2018-08)
Azis, Muhamad Fakhrul Hakim
Monitoring internal training loads using session ratings of perceived exertion (RPE) has been used extensively to manage fatigue and to optimise sports performance in athletes but none was reported in Malaysian athletes. Accurate monitoring of internal training loads could assist coaches in the adjustment of training, mode, intensity and duration during the competitive season. This study was to quantify the internal training loads (training load, monotony and strain) and fatigue and to identify the correlation of internal loads on fatigue responses of Malaysian under-18 rugby players for 4-weeks during competitive season. Thirty eight male participants of the study, aged from 16-18 years old, were recruited among the students from the Kolej Vokasional Pengkalan Chepa (N=38). The research variables of this study were collected in four weeks prior to their competition. After 90 minutes of every training session, they were asked to rate their training session using the RPE scale. Then, the Multidimensional Fatigue Symptom Inventory (MFSI)-Short form were administered once per week at the end of their training session for 4 weeks. The participants were trained five days per week as per coach’s training programme, hence the total number of days of data collection were 20 days. The types of training consisted of cardiovascular, strength, power and tactical. All data was entered into Microsoft Excel 2013. Statistical analyses was performed using IBM SPSS version 24.0. All data are presented as mean �} standard deviation (SD) in descriptive statistics. The statistical analysis used in this study was repeated measure ANOVA. The statistical significance was set 0.05. Pearson correlation at p was used to analyse the relationship between internal training load variables and MFSI. Results showed that the training load in week 4 (2594.00 �} 2.30) was significantly higher compared to week 1 (2388.55 �} 343.87), week 2 (2284.34 �} 411.41) and week 3 (2218.42 �} 521.63). Monotony in week 4 was higher (1.70 �} 3.13) compared to week 3 (1.43 �} 0.44). The mean of monotony in week 2 was higher (1.60 �} 0.35) than week 1 (1.49 �} 0.09). Strain increased in week 2 was higher (3728.44 �} 1228.51) compared to week 1 (3605.57 �} 653.51). In week 3, the mean strain decreased (3354.59 �} 1810.58) and increased in week 4 (4145.66 �} 306.38). In training load, monotony, strain and the total score of fatigue (TSF) correlation, the result showed that training load increased with moderate correlations to TSF (r=0.342; r=0.402; r=0.469). In monotony (r=354; r=0.371; i=0.421) and strain (r=0.343; r=0.383; r=0.446), there were also moderate correlation to TSF. The results obtained in this study will help the coaches and trainers to develop an effective training programme in order to maximise their athlete’s performance, reduce fatigue and subsequently prevent injuries.
Predictive risk factor for difficult elective laparoscopic cholecystectomy in HUSM
(2021)
Azmi, Mohd Azem Fathi Mohammad
Laparoscopic cholecystectomy (LC) is a gold standard management for symptomatic cholelithiasis. However, LC might be difficult due to the various risk factors. Preoperative risk factors are very important for the surgeon and patient in anticipating of difficulty during surgery. The aim of this study to identify clinical, radiological, and perioperative risk factor with difficult elective laparoscopic cholecystectomy patient in HUSM. Methods: This is a retrospective record review of patients who underwent elective laparoscopic cholecystectomy from 2013 to 2018 in Hospital Universiti Sains Malaysia. The patient’s characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were retrospectively analyzed to evaluate predictors of difficult LC. Results: A total of 154 patients whom underwent elective laparoscopic cholecystectomy and fullfill the criteria were included in this study. The conversion rate to open surgey was 4.5%, the mean operative length was 91.71 minutes and the mean hospital stay post operative was one day. The prevalence of difficult elective laparoscopic cholecystectomy in HUSM was 55.2% (95% CI = 47.3, 63.0). Multivariate analysis showed that history of cholangitis , history of ERCP , thick gallbladder wall on ultrasound , dense adhesion and fibrosed Calot’s triangle intraoperatively had significant association with difficult laparoscopic cholecystectomy. Conclusion: From this study, it is concluded that patient’s history of cholangitis, history of ERCP, thick gallbladder wall on ultrasound, dense adhesion and fibrosed Calot’s triangle intraoperatively were found to be the predictive factors of difficult LC.
Retrospective study on the management of liver trauma: a 7-year experience in a hepatobiliary center
(2021)
Yusoff, Muhammad Za’im Mohammad
Background: Liver trauma is one of the most common injury in abdominal trauma. For the last three decades, there was a paradigm shift from operative to non-operative management (NOM) in liver trauma, with stable haemodynamic, regardless to the grading of liver injury. There are factors that should be considered for anticipating failure of nonoperative management. Therefore, this study is performed to identify these factors, to ensure that early intervention is done in order to achieve less morbidity and mortality in non-operative management of liver trauma. Methods: This is a retrospective study of case record of patients diagnosed with liver injury in Hospital Sultanah Bahiyah, Alor Setar from 1st January 2012 to 31st December 2018. Subjects who met the inclusion criteria were recruited in this study. The outcome of non-operative management and factors leading to its failure were studied. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26. Results: A total of 158 patients were included in this study. They were 12 to 80 years old, with mean age of 25.6 years. The subject pool comprised of 125 males and 33 females. Majority of the liver traumas were due to motor vehicle accidents, 141 (89.2%), followed by fall, 6 (3.8%) and industrial injury 3 (1.9%). Grade III and grade IV liver injuries were the two most common grading with a total of 43 (27.2%) and 42 (26.6%) cases encountered respectively. Fifty-three patients underwent emergency laparotomy and 20 (37.2%) of them developed post-operative complications. Hundred and five patients were treated non-operatively. Majority of the patients in this group were young, mean age of 21.0 years old. Simple logistic regression revealed six predictive factors associated with failure of NOM, including haemoglobin at presentation (p 0.015), blood transfusion status (p 0.008), unit of blood transfused (p 0.014), liver injury grade (p0.001), length of stay (p 0.028) and intensive care unit admission (p 0.041). Multiple logistic regression shown that liver injury grade and length of stay had significant association with failure of NOM, with p value of 0.003 and 0.040 respectively. Conclusion: Non-operative management in liver trauma is a safe approach in haemodinamically stable patients. Factors related to its failure must be considered for better outcome in term of morbidity and mortality.
Development and optimization of rapid resolution liquid chromatography (RRLC) method following solid-phase extraction for determination of anthocyanin in rat plasma
(2021-08)
Sauji, Nadiratul Asyikin
The growing interest of anthocyanins in roselle has brought upon the importance of the compound’s analysis to investigate its pharmacological properties. Sensitive and specific analytical methods are required to accurately analyse the anthocyanin present in the sample. In this study, rapid resolution liquid chromatography (RRLC) was used to analyse cyanidin-3-O-glucoside chloride, one of the anthocyanins found in roselle. Spectrophotometric analysis and optimization of chromatographic conditions were performed to develop a suitable and precise RRLC method for the determination of the selected anthocyanin. Both liquid-liquid extraction (LLE) and solid-phase extraction (SPE) method were performed to evaluate the best extraction method of anthocyanin in the rat plasma sample. The optimised chromatographic method demonstrated that the mobile phase composition of 0.1% trifluoroacetic acid aqueous solution and acetonitrile in the ratio of 81:19, respectively with a flow rate of 0.5 mL/min, at 30°C column temperature and detection wavelength of 525 nm were suitable for RRLC analysis of cyanidin-3-O-glucoside chloride. SPE was chosen as the final extraction method in the study as it produced better peaks in the chromatogram compared to LLE. In conclusion, the developed RRLC method in this study can be used to determine anthocyanins in the future pharmacokinetic study of roselle.
Designing a multi-epitope vaccine based on MSP1, AMA1, and CSP proteins of plasmodium falciparum 3D7 with TLR4 as adjuvant using immunoinformatic approach
(2021-08)
Mim, Maria Akter
A significant portion of severe malaria cases and deaths are reported all over the world mainly due to Plasmodium falciparum, the deadliest species among all Plasmodium spp. Established and implemented malaria controlling measures becoming less effective as P. falciparum gradually increasing its resistance to most of the primary line anti-malarial drugs. Until so far, the foremost effective vaccine RTS, S/AS01 which was succeeded to reach the phase III trial stage showed less effectiveness in young infants. Therefore, the development of a more effective malaria vaccine that can protect all individuals is urgently required. In this study, an immuno-informatics approach is used to design an effective and long-lasting antibody-inducing multi-epitope vaccine against the erythrocyte stage of P. falciparum targeting merozoite surface protein 1 (MSP1), apical membrane antigen 1 (AMA1) and circumsporozoite antigen (CSP). MSP1 and AMA1 can be synthesized in the mature stage of Plasmodium parasites and involved in the invasion and disruption of red blood cells (RBC) of erythrocyte stage. CSP is one of the most highly expressed proteins on the surface of sporozoites and plays role in hepatocyte invasion as well as further infection toward erythrocytes. After numerous analyses, highly antigenic, non-allergic non-homolog and non-toxic 9 linear B-lymphocyte (LBL), 11 helper T-lymphocyte (HTL) and cytotoxic T-lymphocyte (CTL) epitopes were selected for the final vaccine construct. All the selected HTL epitopes were IL4, IL10, and IFNγ inducer. Two adjuvant motives, Hp91 and RS09 were adjoined via a suitable linker to stimulate the immune response of helper T cell and cytotoxic T cell, respectively. The physicochemical and immunological analysis found that the constructed vaccine was antigenic (antigenicity 0.7725), basic in nature (pI-9.16), soluble (0.905932), hydrophilic (GRAVY-0.842) and non-allergen. Secondary structural features and tertiary structure were predicted using several bioinformatics-based online software. The modeled vaccine was then refined and validated to evaluate the basic nature of proteins. A good binding affinity between TLR-4 (Chain A of 3FXI) and our multi-epitope vaccine was determined by molecular docking. In summary, findings of the immunoinformatic-based analysis had shown acceptable results however further in vivo and in vitro assessments are required to perform on constructed vaccine to confirm its efficacy and safety.
Evaluation of the male reproductive toxicity of the anthocyanin-rich standardized extract of hibiscus sabdariffa L.loaded niosomes in sprague dawley rats
(2021-08)
Ghazali, Mohamad Luqman Hanafi
Hibiscus sabdariffa has long been widely utilised for medicinal purposes. Aqueous extract of H. sabdariffa encapsulated in niosome (AEHS-Nio) was formulated to improve the effectiveness of this plant extract. It was administered to forty male Sprague Dawley rats at four different dosages 0 (control), 250, 500, and 1000 mg/kg/day by oral gavage for 63 days to evaluate the potential effects of AESHNio on the male reproductive system. A substantial number of parameters were evaluated throughout the treatment period that was comprised of three phases; premating, mating, and post-mating. Results obtained demonstrated that the effects of AEHS-Nio on the male rat reproductive system were slightly significant for certain doses. No mortality and any signs of physical toxicity were observed. The mating performance was also not affected. However, due to the established anti-obesity effects of H. sabdariffa extract, the bodyweight of rats were considerably changed. As a consequence, the reproductive organ weights were found to be statistically different. Furthermore, AEHS-Nio increased the testosterone levels and sperm counts of the 250 and 1000 mg/kg dose groups, while the 500 mg/kg dose group showed considerably low levels for both parameters. The 500 mg/kg dose group was detected to exhibit inconsistent data for certain parameters when compared to other groups, which might be caused by confounding factors instead of AEHS-Nio. Therefore, the current data suggest that AEHS-Nio did not toxic to the reproductive system of male rats. Nevertheless, AEHS-Nio should be consumed with caution as long as the dose administered does not exceed 250 mg/kg of bodyweight a day.The human risk on male reproductive parameters associated with its use should also be reasonably estimated.
Comparative analysis of amoebic seropositivity among Kelantan cattle farm dwellers using CSA- and rCL-IgG-ELISA
(2021-08)
Almazaraa, Khadeeja Ameen Khudhair
Kelantan cattle farm dwellers are one of the high-risk groups for invasive amoebiasis, as the farming activities involve the use of untreated water source such as underground and well water. Screening for invasive amoebiasis by crude soluble antigen (CSA) and recombinant c-terminal lectin (rCL) antigen provide different interpretation on the disease exposure. Assay based on the former antigen has higher affinity towards variety of anti-amoebic antibodies, while the latter is specific for invasive amoebiasis. The present study aimed to study the amoebic seropositivity among Kelantan cattle farm dwellers using customised CSA- and rCL-IgG-ELISA. The two different antigens were produced and used for the screening of the serum samples based on previously optimised parameters. Thirty blood donor serum samples were used for the determination of cut-off values for the two customised assays. RIDASCREEN® Entamoeba histolytica IgG was used as the reference test. From the analysis, the reference test detected 31 (34.83%) positive cases, while CSA- and rCL-IgG ELISA detected 41 (46.07%) and 17 (19.10%) cases, respectively. The two customised assays showed moderate agreement with the commercial test, nonetheless, CSA-ELISA showed higher agreement with the findings of commercial test, as compared to rCLELISA. From ROC curve analysis, the area under the curve of CSA-IgG-ELISA was higher than that of rCL-IgG-ELISA, as well. In conclusion, CSA- and rCL-IgG-ELISA showed different seropositivity; findings by the rCL-IgG-ELISA are lower and could be more specific for invasive amoebiasis.
Elucidation of the vasorelaxation mechanisms induced by syzygium polyanthum leaves aqueous extract
(2021-08)
Hairul, Nuriana Munirah
Previous studies have demonstrated that aqueous extract of Syzygium polyanthum leaves (AESP) has vasorelaxation activity. However, there is still very little information on its mechanism of action on direct vasorelaxation activity. Therefore, the present study was designed to determine endothelium-dependant relaxation of the AESP and investigated the mechanism of vasorelaxation. The in vitro method was utilised, mounting the aortic ring into myograph, precontracted with phenylephrine (1 μM) and studied based on the agonist-antagonist inhibition protocols. The endothelium-dependant was studied on endothelium intact and denuded thoracic arterial ring isolated from Wistar-Kyoto (WKY) rats. The vasorelaxation mechanisms of AESP were evaluated on the endothelial-intact aortic rings. This study shown that the AESP relaxation was endothelium-dependant. The vasorelaxant effect of AESP was attenuated by L-NAME (endothelial nitric oxide synthase/eNOS inhibitor, 100 μM) and ODQ (soluble guanylate cyclase/sGC inhibitor, 10 μM). However, methylene blue (cyclic guanosine monophosphate/cGMP lowering agent, 10 μM) and indomethacin (non-selective COX inhibitor, 10 μM) did not produce significant inhibition on the AESP relaxation. Taken together, the findings indicated that vasorelaxation of AESP was endothelium-dependent, through NO/eNOS and sGC pathways.
In vivo activities of ethanolic extract from endiandra kingiana (lauraceae) as potential anti-diabetic agents
(2021-09)
Noriman, Ahmad Zakwan
Diabetes mellitus is one of the most prevalent diseases in the worldwide population. The impairment in insulin secretion, insulin action or both has led to the hyperglycaemic condition. In 2019, 4.2 million deaths were reported due to diabetes mellitus. Uncontrolled hyperglycaemia condition leads to secondary complications such as retinopathy, nephropathy, cardiomyopathy, and limb amputation. Thus, one of the plants found in Malaysia, known as Endiandra kingiana (Pokok Medang) was evaluated. It has in vitro α-glucosidase inhibitory effect but lacking evidence in in vivo antidiabetic properties. Thus, there is merit to evaluate the antidiabetic effects of oral crude bark E. kingiana ethanolic extract (EKEE) on Type 2 diabetic rats (T2DR). The study was divided into acute phase (24 hours) and subacute phase (28 days). T2DR was induced by a combination of high-fat diet (HFD) and low-dose streptozotocin (STZ) (30 mg/kg). A dose of EKEE at 250 mg/kg was found to be most effective in lowering fasting blood glucose (FBS) in the acute study. The effect was further evaluated over 28 days in a sub-acute study. Thirty male Sprague-Dawley (SD) rats were divided into 4 groups. Group 1 – normal, Group 2 – untreated-diabetic rats, Group 3 – diabetic rats on EKEE (250 mg/kg) and Group 4 – diabetic rats on metformin (300 mg/kg). FBS, body weight, BMI and SBP were monitored biweekly. At the end of the study, renal function test, liver function test, lipid profiles, glucagon, and oxidative stress markers were evaluated. EKEE did not significantly reduce FBS. EKEE also did not prevent the reduction of body weight and BMI. Glucagon remains normal with EKEE. As for oxidative stress markers, EKEE significantly decreased MDA, and increased total antioxidative capacity, but not significant. These results suggested further study are needed to evaluate E. kingiana as an antidiabetic agent.

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