Pusat Pengajian Sains Perubatan - Tesis

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10 years review of successful external cephalic version (ECV) at Hospital Raja Perempuan Zainab II (HRPZII)
(2022)
Makhtar, Nurul Ain Sah
Objectives: To determine the proportion of patients with successful ECV in breech pregnancy from 36-40 weeks of gestation, the predictors for successful ECV and to create a predictor tool to assist in term of counseling of patients before ECV. Study design: This single center retrospective based on clinical records reviewed 479 medical records with singleton pregnancies and breech presentations that experienced ECV attempt at Hospital Raja Perempuan Zainab II from January 2010 to December 2019 between 36 to 40 weeks of gestation. Variables with a possible effect on ECV success were collected. These variables include gestation, parity, body mass index (BMI), types of breech, fetal parameters, engagement of buttock, well flexed fetal head, and amniotic fluid index (AFI). Variables’ association with ECV success was assessed using a multivariate logistic regression and predictor tool was created. Results: Overall, 479 clinical records of women underwent ECV being reviewed and success rate of the ECV was 54.7%. Flexed breech (p= 0.007), multiparity (p= 0.000), unengaged of fetal buttock (p=0.000), smaller head circumference (p= 0.017) and higher amniotic fluid index (AFI) (p=0.002) were the independent factors of the version success, while other variables had no statistically significant effect on the success rate. Preoperative predictive score had been created which consist of parity, types of breech, body mass index (BMI), amniotic fluid index (AFI) and engagement of buttock with the minimum score of 8 and maximum score of 13. The favourable predictor score is 9 and above. Conclusion: The overall successful rate for ECV performed in HRPZ II is analogous to other studies and ECV should be offered as an option for the mother. Recognized fetal and maternal factors can help to estimate the chances of success and prediction tool enables accurate prediction of successful ECV and in which when the score is more than 8, it is high chance that the ECV will be successful.
A 5 year review of pre-eclampsia in Hospital Universiti Sains Malaysia
(2022)
Hanafi, Nor Fatimah Zakiah
Objective: To determine the rate of early onset pre-eclampsia (onset of pre-eclampsia before 34 weeks) and late onset pre-eclampsia (onset of pre-eclampsia after 34 weeks) in patients who delivered in Hospital Universiti Sains Malaysia, the risk factors, the maternal and fetal outcomes for both groups and the associated factor for poor maternal and neonatal outcomes of both groups. Methodology: This retrospective observational study involved all patients with singleton deliveries in Hospital Universiti Sains Malaysia, with the diagnosis of pre-eclampsia from January 2016 until December 2020. The demographic data, co-morbid, clinical presentation, clinical assessment, laboratory results, mode of delivery, and outcome were retrieved from the case notes and recorded and analyzed. Categorical data were analyzed by n (percent) and numerical data were analyzed by mean (SD) and median (IQR). Simple logistic regression testing was used to test for factors associated with poor maternal and fetal outcomes in pre-eclampsia. Any significant variables with a p-value <0.25 were included in multiple logistic regression for further analysis, and variables with p-value <0.05 were considered significant. Results: 108 (30.8%) of 351 cases had early onset pre-eclampsia, 243 (69.2%) had late onset pre-eclampsia. The prevalence rate of pre-eclampsia in our centre was 1.4%. Advanced maternal age occurs in 43.5% of the early onset pre-eclampsia group vs 24.3% in the late onset group. 58.3% of women in the early onset group had a history of pre-eclampsia in a previous pregnancy, and they were likely to be obese (59.3% vs 46.1%). Chronic hypertension significantly increased the risk for early onset pre-eclampsia. Nulliparous women were more likely to develop late onset pre-eclampsia although not statistically significant. Women with early onset pre-eclampsia had a higher percentage of the poor maternal outcome (33% vs 21%). In addition, their babies had significantly increased rates of morbidity and mortality. Among women with early onset pre-eclampsia that had a maternal complication, they were more likely to have a history of pre-eclampsia and obese, although not statistically significant. Furthermore, among women with late onset pre-eclampsia that had a maternal complication, they were likely to be nulliparous or had a shorter interpregnancy interval of less than 2 years, although not statistically significant. Among women with early onset pre-eclampsia that had poor perinatal outcomes, there was a higher percentage of advanced maternal age and nulliparous women, and among women with late onset pre-eclampsia that had poor perinatal outcomes, there was a higher percentage of patients with Diabetes Mellitus and obese. However, these differences failed to reach statistical significance. Conclusion: The prevalence of pre-eclampsia in the general population was 1.4% which was comparable to other Asian countries. Some risk factors were common to both early and late onset pre-eclampsia, however, several risk factors had quantitatively different associations with the 2 subtypes of pre-eclampsia. Pre-eclampsia causes significant maternal complications, especially early onset pre-eclampsia. Outcomes of babies of women with early onset pre-eclampsia are significantly worse than for those who presented later. Overall, women presenting with pre-eclampsia after 34 weeks have generally good maternal and fetal outcome.
A comparison of intraoperative ultrasound and post-operative MRI in paediatric intra axial tumours
(2022-11)
Fuad, Nadiah Ahmad
Background Malignant tumours of the Central Nervous System (CNS) is the second most common paediatric malignancy, following haematological malignancy. CNS tumours depend significantly on the extent of tumour resection. In the past decade, intraoperative ultrasound (IOUS) has evolved into a widespread neuroimaging tool that offers real-time surgical guidance, and is a widely accessible imaging modality with minimal identified risk or additional operative time, and also lower economic investment. Recent studies found a strong correlation between IOUS and post operative MRI findings when evaluating extent of tumour resection in adult population suggesting that IOUS might have significant clinical implications, however not many studies involved the paediatrics population. The objective of our study was to compare correlation and reliability of the ultrasound as compared to MRI for tumour resection in paediatric population. We also evaluated IOUS as a real-time navigation tool during surgical resection of intra axial tumours in paediatric patients. Methods This was a prospective observational study done in a Hospital Tunku Azizah, Kuala Lumpur. Patients aged less than 12 years old, admitted between 1st December 2019 to 30th November 2021 with preoperative MRI diagnosis of intra-axial brain tumour were recruited in this study. IOUS was performed intraoperatively, and post-operative MRI performed within 24-72 hours post-op. IOUS utility assessment scoring was performed intraoperatively. Results We analysed a total of 25 paediatric patients that met the inclusion criteria. Concordance analysis between IOUS evaluation and MRI showed good agreement (kappa = 0.527). A multivariate logistic regression analysis was performed to look for any significant factors of discordance, and none of the variables were found significant for discordance. Hosmer and Lemeshow goodness of fit test was performed, and showed that our model is a good fit, with a good prediction value of 0.497. Conclusion The use of IOUS allowed reliable intra operative imaging modality to achieve more successful gross total resection of brain tumours in paediatrics.
A randomized control trial: insertion of peripherally inserted central catheter (picc) in neonates; mathematical formula versus direct measurement
(2023-02)
Jusili, Syamila Huda
Introduction Peripherally inserted central catheters (PICC) is commonly used in preterm infants. However, many studies have shown a high need for adjustment of their position after insertion. The aim of this study was to test a new method to estimate the ideal catheter depth for cubital PICC insertion in preterm infants. Methods A multi-center randomized, controlled trial was conducted, comparing direct measurement from insertion site to sternal notch (control group) versus a formula based on the length of the infant (intervention group) to estimate the ideal depth of cubital PICC in preterm infants with a birth of less than 1.5kg. The primary outcome was the rate of correctly placed PICCs. Catheter related complications were also monitored. Results There was no difference in baseline characteristics between the intervention group and the control group except for a significant lower birth weight in the intervention group. There was no significant difference in correct placement between the intervention and the control groups (6 out of 25 or 24% vs 10 out of 27 or 37% respectively, p=0.309). There was also no significant difference in complication rates between the two groups. Discussion and conclusion This study did not show benefits of using an alternative formula for estimation of catheter depth for cubital PICC insertion in preterm infants. As in previous studies the rate of correct initial placement was low and there is definitely a need for studies to identify better ways to estimate the depth of PICC insertion for preterm infants.
A study of antibiotic agents prescribed, guideline compliance and associated factor of antibiotic failure among the hospitalised paediatric and adult general medical patients in Hospital Universiti Sains Malaysia
(2023)
Ramli, Nurshahira
Background: Antibiotic is the commonest drugs used in hospitals. Inappropriate use of antibiotics has been shown to contribute to the occurrence of multidrug-resistant organisms (MROs). Understanding antibiotic prescription patterns is essential for combatting limited access and excessive use of antibiotics and controlling resistance. Thus, we evaluated antibiotic agents prescribed and the associated factor of antibiotic failure among hospitalized adult and pediatric patients in Hospital USM. Methodology: This was a retrospective study of antibiotic patterns among the adult general and pediatric general medical wards. A total of 227 patients were identified after had fulfilled the inclusion and exclusion criteria. This study used descriptive and inferential analysis to find out the objectives. The descriptive analysis includes the frequencies, percentage, mean and standard deviation, carried out to determine the patient’s demographic, patient’s clinical diagnosis, and patients comorbid. The inferential statistics involving simple logistic and multiple logistic regression are conducted to identify the factors associated with antibiotics failure. Results: Respiratory tract infections were found to be the highest infection sites and treated with antibiotics among all age groups with a total of 163 patients. Among these, 57.7% (94 patients) have been prescribed with penicillin with β-lactamase inhibitor group, followed by 28.8% (47 patients) with macrolide and a balance of 13.5% with other groups. Amoxicillin and clavulanic acid were reported to be the commonest among the penicillin with β-lactamase inhibitor group prescribed which was 65.2%. A total of 160 (70.5%) patients' prescription was noted as a single prescription while only 67 (29.5%) were of 2 antibiotics combination prescription. Most of them were given parenterally(75.3%). As of notes, more than half of prescriptions 60.8% (138) were deemed compliance to the guidelines. The rate of antibiotic failure was 12.8% (29) which was quite similar to a few other studies. 3 factors that been identified as the significant associated factor of antibiotic failure in this study were female sex (OR, 3.459; 95% CI, 1.075,11.130), the presence of acute kidney injury (OR, 3.084; 95% CI, 1.021, 9.311) and resistant organisms (OR, 2.961; 95% CI, 3.813,97.916). Conclusion: Most of the antibiotics prescribed in this study were penicillin with β-lactamase inhibitors. Despite this, there was only 12.8% (29) antibiotic failure and only 3 significant associated factors of failure were reported. Further larger scale and longer study needed to look for more antibiotic prescriptions not limited to the medical ward but including all disciplines such as surgical, orthopaedic, obstetrics, and gynaecology to conclude more realistic rate of antibiotic failure and associated factors.
Aesthetically ideal breast preference among plastic surgeons and general population
(2020)
Hamzan, Muhammad Izzuddin
Introduction: Describing and accurately evaluating the ideal female breast is essential for surgical planning and to establish the goals of surgery as well as to assess surgical outcomes. There are, nevertheless, no measurable aesthetic standards for the female breast. Henceforth, setting objectively measurable ends is a critically vital element of breast surgical procedures in plastic surgery, moreover, that previous study showed that there were different opinions among plastic surgeons and their patients. In this study, we are determining the preference of an ideal breast by using 4 key parameters of which are areola size, upper pole contour, upper pole to lower pole ratio and breast size from plastic surgeons, and general population point of view in Malaysia. Methodology: A cross-sectional study using a web-based interactive questionnaire was conducted among plastic surgeons and the general population group. This questionnaire consists of created images of female breasts with 4 key parameters to assess subjects' preference towards the appearance of an aesthetically ideal female breast. Results: There were 45 plastic surgeons and 135 men and women participated in the study. There is no significant difference in the preference when comparing both the plastic surgeons and the general population group. This study showed that generally, both plastic surgeon and general population group more prefer an aesthetically ideal breast that are; areola size of 3 cm (50.4%), slightly convex upper pole contour (40.7%), 45:55 ratio of the upper pole to lower pole (36.7%), and breast size of a D cup (49.25%). Conclusion: The appearance of an aesthetically ideal female breast should have areola with 3 cm diameter, a slightly convex in upper pole contour, have a proportion of upper pole to lower pole of 45:55, and with a breast size of a D cup. Any deviation from these parameters is prone to an unattractive appearance.
Anti-diabetic and anti-lethargic effects of stichopus horrens extract in type 2 diabetes-induced sprague dawley male rats
(2025-01)
Vixuan, Eng
Diabetes mellitus is a chronic metabolic disorder, that is attributed to either insufficient insulin production by the pancreas or impaired response of body cells to insulin. Present medication like metformin has brought significant therapeutic effects in treating this disease but the side effects prompt the researchers to explore other alternative treatments especially natural products. This study aimed to investigate the potential of different sea cucumber samples of Stichopus horrens, differentiated by extraction methods, in reducing fasting blood glucose level, minimising fatigue condition, and restoring structure and function in organs of diabetic type 2-induced rats. Two extraction methods were utilised in this study, which are hydrolysis and high-pressure processing (HPP). The first extract of sea cucumber was subjected to hydrolysis only, while the second extract was exposed to HPP only. The last extract of sea cucumber was subjected to both hydrolysis and HPP. In the in-vitro assay, human umbilical vein endothelial cells (HUVECs) were exposed to three Stichopus horrens body wall samples, and a positive control, metformin with concentrations ranging from 6.25 to 4000 µg/mL in MTT assay to obtain starting dosage of treatments for animal study. The in-vivo study involved Sprague Dawley (SD) rats, which included the induction of high fat diet for five weeks, 110 mg/kg of nicotinamide injection, followed by 55 mg/kg of streptozotocin (STZ) into creating Type 2 diabetes mellitus (T2DM) rat model. Rats were randomly grouped into six groups; normal control (n=3), diabetic control (n=3), metformin-treated group (n=3), sea cucumber extract (hydrolysis only) (n=3), sea cucumber extract (HPP only) (n=3), and sea cucumber extract (HPP and hydrolysis) (n=4). The findings displayed a decreasing trend in cell viability with increasing sea cucumber concentration with ICS0 values of 3.771 ± 0.152 µg/mL in sea cucumber extract (hydrolysis only), 3.783 ± 0.063 µg/mL in sea cucumber extract (HPP only), and 4.006 ± 0.054 µg/mL in sea cucumber extract (HPP and hydrolysis) while metformin depicted an increasing trend of cell viability with ECS0 value of 4.931 ± 4.044 µg/mL. As a result, the starting dosage for animal study pertaining to different treatments is 150 mg/kg each. The findings depicted decreasing trend of blood glucose level after four weeks of treatments with 150 mg/kg sea cucumber samples and increased exercise tolerance in sea cucumber extract (HPP and hydrolysis) group with 150 mg/kg. Apart from that, sea cucumbers exhibited mild restoration in histological changes of liver, kidney, and pancreas. The short treatment duration of sea cucumber on diabetic rats might prove that sea cucumber is a promising candidate for the development of novel product in the future.
Anticancer effects of apis cerana and heterotrigona itama honeys on temozolomide-resistant glioblastoma cells
(2025-01)
Hui, You Ying
Glioblastoma is characterized by high aggressiveness and poor prognosis with median survival rate of less than 15 months. Due to the complexity of surgery to remove whole tumour and rapid development of chemoresistance towards temozolomide (TMZ), apitherapy using honey emerges as potential alternative treatment for glioblastoma due to its rich phenolic compounds with high antioxidant properties. However, the difference between Apis cerana honey and Heterotrigona itama honey for anti-glioblastoma effects has not been extensively studied. In this study, the phytochemical composition of A. cerana and H. itama honey were compared using phytochemical screening test and fourier transform infrared spectroscopy (FTIR) analysis. Their antioxidant capabilities were also compared using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay. Then, the half-maximal inhibitory concentration (IC50) values of both honeys on TMZ-resistant glioblastoma cell line (DBTRG-05MG cells) were determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, while the analysis of cancer invasiveness and recurrence were determined through scratch assay and clonogenic assay respectively. After that, gene expressions between both honey-treated DBTRG-05MG cells were compared using quantitative reverse transcription polymerase chain reaction (qRT-PCR) to elucidate their effects towards apoptosis (MDM2 gene), metastasis (WNT5A gene) and chemoresistance (YTHDF2 gene). The analysis revealed that A. cerana honey contained higher levels of alkaloid and saponin as compared to H. itama honey, which contributed to its higher antioxidant activity as evidenced via the DPPH assay. This data was also supported by its lower IC50 value (130.5 ± 33.1 mg/mL) than H. itama honey (185.8 ± 27.6 mg/mL) in 72-hour treatment on DBTRG-05MG cells. In contrast, H. itama honey contained higher levels of flavonoid than A. cerana honey. Both honeys shared similar functional groups as indicated in FTIR analysis. A. cerana honey exerted strong inhibitory effect towards invasiveness and migration of DBTRG-05MG cells with its lowest closure percentage up to 72 hours while H. itama honey exerted strong prophylactic effect towards recurrence of DBTRG-05MG cells with its lowest colony number formed. However, there was no significant difference in MDM2, WNT5A and YTHDF2 expressions between honey-treated DBTRG-05MG cells. These findings suggest that A. cerana honey could be more effective in killing TMZ-resistant glioblastoma cells while H. itama honey could be more effective in preventing glioblastoma recurrence. The anticancer effect of each phytochemical in both honeys should be further investigated in future for better elucidation towards apoptotic, metastasis and chemoresistance mechanisms
Antiviral activities of tualang honey against chikungunya virus-infected human fibroblast-like synoviocytes (HFLS)
(2025-11)
Mohamad, Nur Aliah
Chikungunya is a mosquito-borne viral disease caused by chikungunya virus (CHIKV), primarily transmitted to humans by Aedes aegypti and Aedes albopictus mosquitoes. The illness is characterised by fever, polyarthralgia, myalgia, rash and headache. In chronic chikungunya, arthralgia can persist for months or even years. Although a vaccine called IXCHIQ exists, it is not widely used and current treatment options focus on symptom relief. This study aimed to investigate the in vitro antiviral activity of Tualang honey against CHIKV infection in human fibroblast-like synoviocytes (HFLS) cells. The potential anti-CHIKV activity of different concentrations of Tualang honey at various incubation periods was evaluated through pre-treatment and post-treatment assays. Additionally, the modes of action were further investigated using virucidal, anti-adsorption, and anti-entry assays. The maximum non-toxic dose (MNTD) of honey in HFLS cells was found to be 50 mg/mL although for subsequent antiviral assays ≤ 20 mg/mL concentrations were used. The viral inhibitory effect was evaluated using plaque assays to measure viral titres and quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR) to quantify RNA copy numbers. Tualang honey exhibited minimal to excellent prophylactic activity during the pre-treatment assay, reducing viral titres by 29.21% to 94.87% and RNA copy numbers by 12.90% to 69.80%. Significant inhibition (p < 0.05) of CHIKV viral titres was observed following pre-treatment with 10 and 15 mg/mL for 6 and 12 hours before infection, respectively. Interestingly, the anti-CHIKV effects of Tualang honey in HFLS cells were more prominent during pre-treatment compared to post-treatment. Post-treatment with Tualang honey resulted in minimal to strong inhibition, reducing CHIKV viral titres by 6.67% to 72.46% and RNA copy numbers by 10.87% to 29.21%. The greatest inhibition was observed following post-treatment with 15 mg/mL concentration at 4 hour post infection (hpi), although these effects were not statistically significant. Notably, Tualang honey exhibited a virucidal effect, with up to an 80.50% reduction in CHIKV viral titres. Significant virucidal activity (p < 0.05) was observed when 15 and 20 mg/mL of honey were incubated with 2 X 10³ pfu of CHIKV. Furthermore, Tualang honey demonstrated both anti-adsorption and anti-entry effects, with the latter being more pronounced, reducing viral titres by up to 90.45% compared to 66.89% for anti-adsorption. In conclusion, this study demonstrates that Tualang honey possesses anti-CHIKV activities and exerts its effects through broad modes of action. Further research is required to confirm its clinical applicability and fully elucidate its mechanisms of action
Assesment of monocyte phagocytosis in the presence of synovial-fluid-derived exosomes from osteoarthritis patients
(2025-01)
Ruhani, Muhammad Akid
Osteoarthritis (OA) is a degenerative joint disease characterised by cartilage degradation, inflammation, and joint dysfunction, and monocytes play an important role in its pathogenesis via phagocytosis and inflammatory regulation. This study investigated the effect of synovial fluid-derived exosomes from OA patients on monocyte phagocytic activity. Synovial fluid (SF) was harvested from OA patients undergoing total knee arthroplasty, and exosomes were isolated by ultracentrifugation. Monocytes from healthy donor were cultured for 24 and 48 hours at different exosome concentrations (1:10, 1:20, and 1:40). Then, pHrodo™ Green E. coli conjugates were used to measure monocyte phagocytosis, which was quantified by flow cytometry. The findings demonstrated a significant increase in monocyte phagocytic activity upon exosome treatment, indicating a modulatory effect. These findings provide insight into the interaction between exosomes and monocyte in OA pathogenesis, underlining the possibility of exosome-based treatments to manage this degenerative illness
Assessment of consumers visual attention towards packaging attributes on stingless bee’s honey box designs using eye-tracking – A study of neuromarketing perspective
(2022)
Mawi, Nur Nasihken
Neuromarketing skills and techniques were widely used in many fields that were not only for academic purposes, but their benefit has been spreading to a lot of others, especially in the marketing world. Neuromarketing is a new discipline of marketing that examines the subconscious reactions of customers to marketing products, brands, goods, and materials. There was a lot of methods that were used by the marketer to advertise their product to attract the attention of consumer as they vary not only in their opinions of brands but also in their interactions with them, which marketers must manage. This is where neuromarketing step into the area by advancing its strategies to improve marketing skills and achieving more target in business instead of using the old traditional way of marketing that was costly and less profit given to the business. The food industry was one of the industries that used this technique to investigate in-depth how to attract customer attention and at the same time influence them to buy the product. One of the elements that were used was the design of the packaging. In this study, we gathered and evaluated the visual attention towards different attributes on stingless bee honey box packaging using the eye-tracking technique by examined the pattern of visual fixation on the attributes of the packaging that was designed solely for this experiment. The attributes are composed of the brand logo, halal logo, font style, price tag, and quality remark stamp. Every attribute consists of 3 variation that are position, size, type of font styles, placement of price tag, and word quality remark. The pattern in visual attention towards all attributes is determined whether they are related to the perceived attractiveness of the product and willingness to buy the product. The result shows that the attribute of brand logo has shown a statistically significant difference in the fixation duration. Here, the visual fixation on the left side of the brand logo is higher score and caught attention rather than the center or right position variation. Result also revealed that there was no correlation between the relation of visual fixation and attractiveness as well as visual fixation and willingness to buy according to the variation of the attributes on the box. Furthermore, even though the left position brand logo score significant value, one positive correlation between visual fixation and the attractiveness for centre position of brand logo were observed. Overall, this research provides a new insight of pattern visualization of different attributes towards subject’s choice on stingless honey box packaging and this implies that gaze fixation on the attributes of the packaging can influence consumers to be attracted and motivate them to buy the product.
Assessment of the impact of computed tomography (CT) slice thickness on image noise and noise power spectrum (NPS)
(2025-07)
Nadzim, Akma Fatiny Mohammad
Slice thickness in computed tomography (CT) plays a critical role in image quality and diagnostic accuracy. This study aims to assess the impact of CT slice thickness on image noise and the Noise Power Spectrum (NPS) using the IndoQCT software. CT images were acquired using a water phantom at various slice thicknesses, and the resulting data were analyzed using the image analysis module in IndoQCT. Image noise was evaluated by calculating the standard deviation within a uniform region of interest, while the NPS was computed to examine the frequency distribution of the noise. The findings indicate that varying slice thickness significantly affects the level of image noise and its frequency characteristics. Thinner slices tend to produce images with higher noise but better spatial resolution, whereas thicker slices reduce noise at the expense of image detail. In this project, a water phantom was scanned using varying slice thicknesses ranging from 0.6 mm to 10 mm. The resulting images were analysed using IndoQCT software to quantify image noise and evaluate the NPS across the different slice thicknesses. Image noise was measured in terms of standard deviation within a uniform region of interest, while the NPS was used to characterise the spatial frequency distribution of the noise. These results are essential for determining the optimal slice thickness for quality control and clinical scanning purpose.
Association between mobility performance and severity of primary glaucoma
(2022)
Rasidin, Abd Hadi Mohd
Glaucoma is the leading cause of irreversible blindness worldwide with primary open angle glaucoma (POAG) as the predominant subtype followed by primary angle closure glaucoma (PACG). Patients with advancing glaucoma suffer from increasing difficulty with daily living activities requiring peripheral vision which affects a broad array of activities that includes navigation and mobility at home. While there are effective medical interventions to minimize the progression of peripheral visual field loss in glaucoma, there is no cure the acquired field loss is irreversible. These limitations could be potentially be overcome by objective simulation of functional visual ability OBJECTIVE To compare mobility performance between patients with glaucoma and control and to associate with severity of glaucoma METHODOLOGY A cross sectional study was conducted involving patients with primary glaucoma and age-matched controls between June 2020 and June 2022 at Hospital Universiti Sains Malaysia (HUSM). Baseline visual assessment including visual acuity, contrast sensitivity, colour vision and Esterman binocular visual field were conducted. Patients with primary glaucoma were divided into severity of glaucoma based on the modified Hodapp-Anderson-Parish criteria on the visual field of their better eye. A mobility course arranged in a maze of 12-meters long and seeded with obstacles that represent furniture at home was created. The course was divided into four zones with fixed illumination and surveillance camera to observe the activities. Mobility performance was assessed by the time required to complete the course (in seconds) and number of mobility incidents which include bumps, stumbles, and orientation problem. RESULTS A total of 318 subjects (159 primary glaucoma and 159 controls) were recruited in this study. The mean time required by patients with primary glaucoma (53 mild, 54 moderate, and 52 severe) to complete the mobility course was 31.5 + 13.5 sec compared to 17.0 + 2.2 sec by the age-matched control (p<0.001). Those with severe glaucoma took longer time (46.8 + 15.2 sec) compared to mild (25.1 + 1.3 sec) and moderate (23.0 + 2.2 sec) (p<0.001). Patients with glaucoma have significant more mobility incidences (p<0.001). Mean mobility incidents were 4.9±3.2 and all were documented in patients with severe visual field of the better eye. Esterman visual field test showed strong negative correlation with mobility performance (r=-0.932) and contrast sensitivity showed moderate correlation (r=-0.520). The best distance between the furniture is 1.5 meter, while the distance of 0.5 meter reported 48 + 30.2 mobility incidence among patients with glaucoma. CONCLUSION Patients with glaucoma walk slower than the age-matched controls of which those with severe glaucoma walk the slowest. Mobility incidents were reported among those with severe glaucoma. Proper arrangement of furniture, good illumination and contrast sensitivity in their home environment may improve their navigation especially among those with severe disease
Brain activation changes during negative emotion regulation task following brief mindfulness exercise. an fmri study
(2022-05)
Vijayakumar, Kavishashree
Introduction: Mindfulness enhances mental health by promoting adaptive emotional control responses. Mindfulness is linked to emotion control since it needs a nonreactive awareness and acceptance of current circumstances. Objective: This study aims to measure the changes in negative emotion regulation task and the associated brain activation following a brief audio mindfulness exercise and a brief audiobook exercise. Methods: Six participants (2 male and 4 female) between the ages of 19 and 34 (mean = 24, SD = 2.19) participated in this study. The neurotechnology used is functional magnetic resonance imaging (fMRI). Brief mindfulness intervention for 15 minutes was carried out after the pre-emotion regulation task where participants responded to emotionally valent negative and neutral words, A post emotion regulation task was carried out to evaluate the effectiveness of the brief mindfulness intervention. The negative and neutral word stimuli used in this study were extracted from Affective Norms for English Words (ANEW). We used self-reporting questionnaires such as PANAS-X and MAAS Malay version to measure emotion and mindfulness. Results: Repeated measure ANOVA was carried out for between-group differences (treatment effect), between-group differences based on time (time-treatment interaction effect) and within-group changes (time effect) for PANAS-X scores and reaction time of the negative and neutral visual stimuli. Independent sample t-test was carried out to analyze the activated brain regions in the conjunction analysis. The p-value used in these statistical tests was uncorrected < 0.05 for all three objectives. The commonly activated regions between both the mindfulness and audiobook groups are the left precentral gyrus, left postcentral gyrus, left cuneus, and left middle occipital gyrus for negative stimuli. As revealed from the study’s findings, mindfulness exercise enhances emotion regulation by showing less negative emotion trait as seen from PANAS-X score. Participants showed more positive emotion in the post-PANAS-X scoring. However, the results of the PANAS-X score and Reaction Time did not yield statistically significant results but a medium and large effect size prominently were identified for both the mindfulness and audiobook group. Conclusion: As revealed from the study’s findings, mindfulness exercise enhances emotion regulation by showing less negative emotion trait as seen from PANAS-X and Reaction Time results. Participants showed more positive emotion in the post PANAS-X scoring compared to the pretesting and participants also responded at a faster rate compared to the pretesting reaction time score. Audiobook and mindfulness groups showed common regions that are responsible for voluntary motor movements, proprioception, generation and regulation of emotions, visual information, and mindfulness. Although the mindfulness intervention was given for only 15 minutes, brain activation were able to be identified
Cardioprotective effects of bunga kantan (etlingera elatior) in hypercholesterolaemic myocardial infarction sprague dawley rats
(2025-01)
Selvapaandian, Sharran
Cardiovascular diseases (CVDs), especially myocardial infarction (MI), remain a global health challenge with high mortality rates. Despite advancements in surgical and pharmacological interventions, the prevalence of MI continues to rise, often linked to risk factors such as hypercholesterolaemia. Alternative therapies utilising natural compounds with cardioprotective properties offer a promising alternative for addressing these limitations. This study investigates the potential of Etlingera elatior aqueous extract (EEAE) as a preventive treatment against hypercholesterolaemia-induced MI. The research employed a high-cholesterol diet (HCD) to induce hypercholesterolaemia in male Sprague-Dawley rats, followed by isoprenaline administration to induce MI. Rats treated with EEAE at 1000 mg/kg were evaluated over 12 weeks. Parameters, including blood pressure and cholesterol levels, were taken. Histopathological analyses were conducted to observe structural improvements in the myocardium. Results demonstrated that EEAE had no significant effect in lowering cholesterol levels and blood pressure but showed capability in preserving cardiac integrity. EEAE-treated groups exhibited enhanced histological recovery compared to untreated controls. These findings suggest that EEAE holds potential as a natural therapeutic agent for preventing MI in hypercholesterolemic conditions. Further research is needed to explore its mechanisms and applicability in clinical settings
Changes of retinal nerve fiber layer thickness, macular thickness and choroidal thickness in migraine patients on topiramate
(2022)
Suparmaniam, Sruban
Introduction: Migraine is a common primary headache disorder and is ranked as the world's second leading cause of years lived with disability. It is a neurovascular disorder believed to cause altered and permanent structural abnormalities to the optic nerve, retina, and choroid. Topiramate (TPM) is a sulfa-derivative monosaccharide that is effective as a preventive therapy for migraine. TPM may impair retinal function when administered for long periods. Retinal nerve fiber layer (RNFL) thickness measurement can be used as an index to assess ganglion cell and retinal nerve fiber damages while alteration of macular thickness (MT) and choroidal thickness (CT) values due to decreased blood flow in migraine with the usage of TPM can affect the visual functions. Objectives: The aim of this study is to assess changes in RNFL thickness, MT, and CT in migraine patients on topiramate (TPM). Methods: This cross-sectional study involves migraine patients with and without TPM attending the Neurology Clinic and Ophthalmology Clinic at Hospital USM and Hospital Raja Perempuan Zainab II (HRPZ II) Kota Bharu, Kelantan. The RNFL thickness, MT, CT was measured using Cirrus HD-OCT 5000 and statistical analysis was done using SPSS Inc Version 26. Results: A total of 84 migraine patients (42 patients with TPM and 42 patients without TPM) were recruited into the study and were analysed. With respect to all mean values of RNFL thickness and MT in all quadrants, there were no statistically significant differences in migraine patients with TPM and control. For subfoveal CT, there was a significant increase with adjustment of age and gender (adjusted mean 272.26μm; 95% CI = 263.73, 280.80 vs 288.14μm; 95% CI = 279.60, 296.68; p = 0.011). Conclusion: This study showed no significant differences between RNFL thickness and MT in migraine patients with and without TPM. Compared to control, there was a significant increase in central subfoveal CT in migraine patients with TPM. The CT measurement during the use of TPM in migraine patients can be considered as a potential non-invasive follow-up method in asymptomatic patients.
Characteristic of abo antibodies among group o blood donors in Hospital Universiti Sains Malaysia Kelantan
(2022)
Saidin, Nur Ilyia Syazwani
Background and Objectives: Hemolytic transfusion reaction due to anti-A and anti-B antibodies in group O blood products is rare but potentially fatal. This study aims to identify the prevalence of high ABO antibodies titer and the immunoglobulin classes either IgM only or with IgG combination. We also intended to estimate the prevalence of high IgG titers and hemolysin antibodies in group O blood donors and to determine the association of the above parameters with gender and age. Methods: Plasma from group O blood donors was tested for ABO antibody titration using the conventional tube technique at room temperature, and titer obtained higher than 64 were considered high. The plasma was then treated with 0.01 M dithiothreitol (DTT) to determine the presence of IgG antibodies and their titer. IgG titers more than 64 were considered high. Test for hemolysis was done using tube method by mixing the plasma with 3% of fresh A and B cells suspension and incubated at 37 degrees temperature. The hemolysis was observed macroscopically. Statistical analysis was done using Chi-Square Test/Fisher Exact test, and P-values less than 0.05 were considered statistically significant. Results: From 311 donors, 238 (76%) showed high anti-A and/or anti-B antibody titer. The highest antibody titer obtained was 256. High anti-A and anti-B titer were found more in younger age group (<40). We found anti-B titer shows association with gender (P <0.001), in which female donors (78%) demonstrated a high anti-B titer. From 311 donors, 209 also showed the presence of IgG types of ABO antibodies. Of these, 124 (60%) donors have high anti-A and/or anti-B IgG titer (≥64). Our population showed a low prevalence of hemolysins which was 3.5%. No association was seen between hemolysins and antibody titers. Conclusion: Our study showed high prevalence of blood donors with high ABO antibodies titer and IgG titers, but low prevalence of hemolysins. Hence, the risk of intravascular hemolysis may not be significant. However, we still suggest antibody titration in younger female donors less than 40 years to prevent transfusion of high titer O blood product into the non-O recipient and to ensure safe blood products are given to the patient.
Characterization of acoustic parameters of resonant /m/ and /n/ sounds for the development of objective indicators of resonant voice therapy
(2025-10)
Razak, Siti Sufiah Abdul
Resonant voice therapy (RVT) is an evidence-based intervention for voice disorders, often initiated with nasal sounds such as /m/ and /n/. Resonant voice (RV) is usually verified through auditory and tactile feedback under a speech-language therapist’s (SLT) guidance, but these perceptual methods are limited outside clinical settings. The present study aimed to identify objective acoustic parameters that could indicate RV and support tangible feedback tools for self-guided practice. Ninety participants (45 females, 45 males) contributed data for /m/, and 83 (41 females, 42 males) for /n/. After RV training, each provided three 6-second recordings of RV and typical voice (TV). The middle 3 seconds were analyzed in Praat to extract fundamental frequency (F0), formants (F1–F4), F0 standard deviation (F0SD), perturbation measures, cepstral peak prominence (CPPFull, CPPVoice), harmonic-to-noise ratio (HNR), and mean intensity. Significant differences (p < 0.05, medium effect size) were found in APQ3 and DDA for females, as well as in mean intensity for males. Mean intensity consistently distinguished RV from TV, with significantly higher values in RV. Compared to the /n/ sound, the /m/ sound presented with lower value perturbation measures and F0SD and higher value for CPP and HNR, though not significant. Formant analyses revealed significant F2 and F3 differences in males, while female results were less consistent. These findings demonstrate the potential of acoustic parameters to differentiate RV from TV. Consistent patterns across multiple measures, some statistically supported, highlight their promise as objective indicators and their utility in developing tangible feedback tools to enhance RVT practice
Clinical assesment of laryngomalacia and the role of laryngeal ultrasound
(2022)
Hasny, Nurul Syuhadah
Introduction: Stridor in infants is a common referral to the Department of Otorhinolaryngology (ORL) and are mostly due to laryngomalacia followed by vocal cord paralysis and subglottic stenosis. Besides stridor, they can also present with certain signs such as apnoea, cyanosis, failure to thrive, episodes of respiratory distress, obstructive sleep apnoea and feeding disturbances which also determines the severity. Flexible nasopharyngolaryngoscopy (FNPLS) is the gold standard diagnostic tool to determine the cause of stridor including laryngomalacia. Laryngeal ultrasound (LUS) is a non-invasive, painless, and well tolerated imaging option but is not routinely used to assess stridorous patients in Malaysia. Objectives: To evaluate proportion, severity, and types of laryngomalacia among stridorous infants in Hospital Universiti Sains Malaysia (HUSM) and the diagnostic role of laryngeal ultrasound (LUS) in laryngomalacia. Methods: We conducted a cross-sectional study from 2021-2022 on infants aged 12 months and below who were referred for stridor to HUSM. They were assessed clinically upon referral and via FNPLS. The following variables were collected; gestational age, birth weight, age at presentation, current weight, comorbidities, presenting signs and symptoms as well as FNPLS findings. Within one week after FNPLS, patients were seen by the radiologist for LUS, who was kept unaware of the previous findings. The severity of laryngomalacia were classified according to the presenting symptoms and physical examination. Endoscopic findings were recorded, reviewed and scored, while types of laryngomalacia were determined by Olney Classification. Results: A total of 47 patients met the criteria for the study. Congenital heart disease, syndromic child and gastroesophageal reflux (GERD) were the commonest comorbidity among them. The proportion of laryngomalacia among infants with stridor was 93.6% with the precision of 0.1 with 95% confidence. Seven of patients with laryngomalacia also had other concomitant findings such as vocal cord immobility (6) and granuloma (1). Three patients who had no laryngomalacia features were diagnosed with the following : vallecula cyst (1), left vocal cord paralysis (1) and normal findings (1). There is a significant association between Type 1 (p=0.005) and Type 3 (p=0.032) with severity (moderate-severe) of laryngomalacia. Those with combined types also show association with severity (p=0.022) where 75% infants with combined Type (1+2, 2+3, 1+2+3) had moderate-severe laryngomalacia. There was a statistically significant difference in laryngoscopic score between the different severity of laryngomalacia (p=0.012) with a median score of 1.00 for mild, 2.00 for moderate and 3.00 for severe. LUS as adjunct tool in laryngomalacia had the sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 66.7%, 97.7%, and 100% respectively. Conclusion: Laryngomalacia is consistently the most common cause of congenital stridor. FNPLS revealed that combined Type (1+2) and Type 3 laryngomalacia were associated with moderate-severe laryngomalacia. A higher laryngoscopic score suggest a more severe laryngomalacia. LUS can safely be used to screen for laryngomalacia in stridorous infants when FNPLS is not feasible.
Clinical characteristics and its association with driver gene mutations (JAK2 V617F, CALR, AND MPL) in myeloproliferative neoplasms
(2022)
Zulkeflee, Razan Hayati
Background: Mutations of JAK2V617F, CALR, and MPL genes confirm the diagnosis of myeloproliferative neoplasms (MPNs). This study aims to determine the genetic profile of JAK2V617F, CALR exon 9 Type 1 (52 bp deletion) and Type 2 (5 bp insertion), and MPL W515 L/K genes among Malaysian patients and correlate these mutations with clinical and hematologic parameters in MPNs. Methods: Mutations of JAK2V617F, CALR, and MPL were analyzed in 159 Malaysian MPNs patients using allele-specific polymerase chain reaction, including 76 polycythemia vera (PV), 41 essential thrombocythemia (ET), and 42 primary myelofibrosis (PMF), and the demographics including clinical and laboratory data of the patients were retrieved. Results: The result showed that 73.6% JAK2V617F, 5.66% CALR, and 27.7% were triple-negative mutations. No MPL W515L/K mutation was detected. In ET and PMF, the predominance type was the CALR Type 1 mutation. Serum LDH showed higher in mutated CALR PMF compared to PV and ET. PV has a higher risk of evolving to post PV myelofibrosis compared to ET. A thrombotic event at initial diagnosis of 40.9% was high compared to global incidence. Only one PMF patient had a CALR mutation that transformed to acute myeloid leukemia. Conclusion: JAK2V617F and CALR mutations play an important role in diagnostics. Hence, every patient suspected of having a myeloproliferative neoplasm should be screened for these mutations.

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