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 3-year review of group-b streptococcus colonization in pregnancy and its perinatal outcome in Hospital Selayang
(2022)
Jayakumar, Yogan
INTRODUCTION AND OBJECTIVE: There is an increase in the prevalence of GBS infection in pregnancy, which causes significant morbidity and mortality to both mother and baby. This retrospective study will evaluate the impact and outcome of pregnancy associated with GBS in Selayang Hospital from year 2017 till 2019. STUDY METHOD: This retrospective study was performed at Hospital Selayang over a three-year period between 1st January 2017 and 31st December 2019. Patients with GBS colonization were identified from their case note and laboratory investigation result. Those patients who had their high vaginal swab culture growing GBS bacteria were considered as patient with GBS colonization. Patient’s demographic, obstetric and neonatal data were documented in Performa (Appendix 1). Data analysis was carried out with SPSS version 26.0. RESULTS: A total of 31762 patients delivered at Hospital Selayang. From this a total of 344 patients were noted to have GBS colonization, making its prevalence of 1.09%. Out of 344 deliveries, 114 of babies were admitted to NICU for various reason. Majority (56.3%) of them were admitted in view of presumed sepsis as the infants showed early sign of infection. From our study noted, that Chinese mothers has a significant association and 1.92 likelihood of baby admitted to NICU compared to other ethnicity (Adj 95% CI (1.11, 3.30), p =0.02) when antibiotic variable was controlled. Meanwhile patients who were given antibiotics has 0.62 reduce likelihood of baby admitted to NICU compared to patients who did not receive intrapartum antibiotic prophylaxis (p = 0.004). CONCLUSION: The prevalence (1.09%) shown much lower than other literature review, as the sample size not as universal screening in general population of pregnant patients. Only those patients who came with excessive vaginal discharge, PROM, PPROM and preterm labour were screened. There is significant association between Chinese ethnicity and NICU admission. It shown that babies born to Chinese mothers with GBS infection more prone to get admitted to NICU compare to other race and foreigners.
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 CURB65 and PSI scores in predicting outcomes for hospitalized bronchiectasis patient with community acquired pneumonia (CAP) in Hospital Sultanah Nurzahirah (HSNZ)
(2021)
Isa, Intan Aaroni Md
Background: Community Acquired Pneumonia is a common illness occur in the community however if not treated accordingly may cause morbidity and mortality. Bronchiectasis is a chronic lung disease in whom if developed pneumonia has a higher risk of mortality compared to those in general population. Hence the need for prompt recognition of bronchiectasis patients with CAP who are at increased risk for ICU admission and mortality. 2 commonly used scoring systems to assess severity of pneumonia are CURB65 and Pneumonia Severity Index (PSI). As bronchiectasis population is expected to increase in number and with higher mortality, it is important to detect CAP severity prediction directly upon admission in order to better assist in patient management. Therefore this study is made to compare these 2 scoring system, which one is better in predicting outcomes of hospitalized bronchiectasis patients with CAP. Methodology: This is a retrospective cohort study which was conducted in Hospital Sultanah Nur Zahirah (HSNZ) from May to August 2021 involving data from Jan 2010 till May 2021. 367 patients have been identified fulfilling inclusion and exclusion criteria after screening. CURB65 and PSI scores were calculated for each patients based on parameters taken upon admission. Demographic data were also recorded. Patients’ outcome which are the 30 days mortality and ICU admission were also identified. Data were analysed where the specificity, sensitivity, positive predictive value and negative predictive values were calculated for each score’s outcome. Comparison using ROC curve was made afterwards by heeding on the Area Under the Curve (AUC). Conclusion: In this study, PSI shown to be more sensitive to predict 30 days mortality and ICU admission for bronchiectasis patients who admitted for CAP compared to CURB65. However for specificity CURB65 is better. AUC of ROC curve did not show difference for both scores indicating that both are non-inferior to each other in terms of performance.
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 randomised controlled trcomparing the efficacy of intracuff alkalinised lignocaine plus intravenous dexamethasone and intravenous dexamethasone in preventing post-operative sore throat
(2021)
Han, Chia Lip
Background: Post-operative sore throat (POST) is a common complication of endotracheal intubation. This study aimed to evaluate the efficacy of intracuff alkalinised lignocaine plus intravenous dexamethasone (LD) and intravenous dexamethasone (D) alone in reducing POST. Methods: This was a single-blinded, parallel, randomized controlled, single-centre trial in patients who underwent surgery under general anaesthesia that required endotracheal intubation in supine position. Patients were randomized into Group D who received intravenous dexamethasone 8mg only (n=36), and Group LD who received intracuff alkalinised lignocaine 2% plus intravenous dexamethasone 8mg (n=36) using simple randomization method with sealed-enveloped. POST and post-operative hoarseness (PH) were assessed at 1-hour post-operation and 24-hour post-operation by blinded assessor by interviewing the patients and scoring visual analogue score (VAS). Results: Total 72 patients were randomized and analysed. The overall incidence of POST was 38.9% versus 44.4% in group D and LD respectively (p=0.633), which was same with the incidence of POST at 1-hour after surgery. At 24-hour after surgery, the incidence was 11.1% versus 8.3% (p=1.000). At 1-hour post-operatively, the VAS for group D and LD were 19.0mm (Interquartile range (IQR): 14.0) and 21.5mm (IQR: 25.0)(p=0.803). At 24-hour post-operatively, there was no significant difference of VAS between two groups. There was no significant difference in the overall incidence of PH between group D and LD (61.1% versus 63.9%, p=0.808). There were no adverse events reported. Conclusion: Combination of intravenous dexamethasone and intracuff alkalinised lignocaine did not significantly reduce in incidence of POST and PH compared to intravenous dexamethasone alone. It also didn’t affect the pain score significantly in both groups.
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
Anxiety and depression with its associated factors in primary open angle glaucoma patients
(2021)
Kwok, Iu Kwang
INTRODUCTION Anxiety and depression are associated with chronic medical illness. Primary open angle glaucoma (POAG) is a chronic disease and requires lifelong treatment. Psychological aspect is often overlooked during the course of glaucoma management. The awareness and knowledge of anxiety and depression in glaucoma in our local setting is still inadequate. Screening of anxiety and depression at different severity stage of POAG is essential to detect the psychological disorder at its early stage and help to better manage glaucoma treatment. OBJECTIVE The aim of this study is to compare the anxiety and depression score between different types of glaucoma severity (mild, moderate, severe) and to identify the associated factors of the anxiety and depression using HADS in primary open angle glaucoma patients METHODS A cross-sectional study was conducted involving 191 patients diagnosed with POAG with no chronic ocular disease except cataract. They were grouped into mild, moderate and severe group based on the better eye using modified AGIS scoring system with two reliable and reproducible SITA standard 24-2 Humphrey visual field results. Depression and anxiety scoring were evaluated using Hospital Anxiety Depression Scale (HADS) which consist of two subscales, Anxiety (HADS-A) and Depression (HADS-D) with scoring ranges from 0-21. The scoring for each subscale were compared among three POAG severity groups and its associated factors. RESULTS HADS-A and HADS-D score was significantly lower in mild severity (3.48±2.77; 3.57±3.29) group compare to moderate (5.21±2.51, p<0.001; 4.99±2.57, p=0.031) and severe (6.54±0.85, p=0.009, 7.01±4.29, p<0.026) group respectively. A younger age group (b= -0.14, p<0.001), duration of glaucoma (b= 0.43, p<0.001), number of antiglaucoma (b= 1.95, p=0.003) and bilateral blindness (b= 1.53, p=0.005) were associated with higher HADS-A score. Significant independent predictor of higher HADS-D score were seen younger subjects (b= -0.13, p< 0.001), duration of glaucoma (b=0.44, p<0.001), financial responsibility (b= 1.07, p< 0.029) and history of glaucoma surgery (b= 2.31, p< 0.05). CONCLUSION Severity of POAG is an independent predictor of HADS score. Glaucoma severity associated with higher level of anxiety and depression. Younger age, longer duration of glaucoma, higher number of anti-glaucoma and bilateral blindness were associated factors for anxiety whereas younger age, longer duration of glaucoma and history of glaucoma surgery were associated factors for depression.
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 healthiness and the quality of meals using meal quality index at the primary school canteens of Kelantan
(2025)
Zulkifli, Asna Salihah
Healthy eating among primary school children is a crucial factor influencing their health, physical development, and academic performance. However, the quality of food provided in school canteens often raises concerns as it does not always comply with healthy dietary guidelines. This study was conducted to assess the healthiness and nutritional quality of meals served in primary school canteens in Kelantan using the Meal Quality Index (MQI). The main objectives were to evaluate the nutritional quality of canteen menus and to compare MQI scores between schools located in urban and rural areas. This quantitative study employed random sampling involving several primary schools across Kelantan. Canteen menus were collected and analyzed using the MQI, which evaluates key components such as fruits, vegetables, protein, whole grains, fat, added sugar, and sodium. The findings revealed that the overall MQI scores were at a moderate level, with notable deficiencies in fruits and vegetables. Urban schools recorded higher MQI scores compared to rural schools, although not all components showed significant differences. In conclusion, this study highlights the need for nutritional interventions in primary school canteens, particularly in increasing the provision of fruits, vegetables, and whole grain options. The results are expected to serve as a reference for schools, canteen operators, and policymakers in improving the dietary quality of meals provided to schoolchildren in Kelantan.
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.
Assessment of vestibulotoxicity of henna leaf (lawsomnia inermis) in a rat animal model
(2021)
Kailani, Abdul Azim Al-Abrar Ahmad
Introduction: Otomycosis is a stressful and complicated condition for patients and otologists since it always needs long-term care and follow-up, but the rate of recurrence remains large. Management is targeted towards intensive aural toileting with the administration of topical antifungals. Classical antifungal agents, including azoles and polyenes, have shown increased resistance. This has contributed to studies into medicinal plants as an alternative therapy for fungal infections. Objective: This research aims to examine the potential vestibulotoxic effects of the henna leaf (Lawsomnia inermis), an ancient folk medicine, on the inner ear of a rat animal model. Methods: Twenty-four healthy, adult male Wistar Kyoto rats were categorized into three groups; group A (8 animals), group B (8 animals), and group C (8 animals). Baseline vestibular parameters were tested before endoscopic-guided transtympanic instillation of aqueous and ethanol henna extract into the right middle ear of rats in Group A and B, respectively. At the same time, normal saline was instilled in the right middle ear of rats in Group C. Vestibular parameter testing were conducted on rat's post instillation of transtympanic henna at intervals of 4 hours, 24 hours, 48 hours, 72 hours, one week, two weeks and three weeks. Results: All vestibular parameters documented were not affected after the instillation of henna extract into the middle ear. Conclusion: Henna extract is a safe and potential alternative in treating otomycosis even with tympanic membrane perforation as it does not have any vestibulotoxic adverse effects.
Association between aqueous humour level of glutathione peroxidase and reductase among primary glaucoma patients
(2021)
Satar, Huwaina Abdul
Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. Oxidative stress is believed to have a significant role in pathogenesis of glaucoma by trabecular meshwork degeneration leading to aqueous outflow resistance. Subsequently, this condition might lead to IOP elevation, retinal ganglion cell loss and glaucomatous optic neuropathy. Detection of oxidative stress level in ocular tissues may show a role of oxidative stress in pathogenesis of glaucoma that would affect the disease prognosis. Objective: To evaluate the oxidative stress level of glutathione peroxidase and reductase in aqueous humour between primary glaucoma and age-matched controls. Methodology: A cross sectional study was conducted between June 2018 to February 2021 involving patients with confirmed diagnosis of primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) who attended eye clinic in two tertiary hospitals in Malaysia; Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab 11, Kota Bharu, Kelantan. Age-matched non glaucoma patients were recruited as controls. Complete evaluations, detail medical, ocular and drug history such as antioxidant supplement were obtained. Ocular examinations were conducted including intraocular pressure and Humphrey visual field analysis. Aqueous samples collected during cataract surgery, trabeculectomy or triple procedure. Laboratory analysis was performed to test on glutathione peroxidase (GPX) and reductase (GR) levels in aqueous using commercially available immunological kits (ELISA). Statistical analysis was done using Statistical Package for the Social Science (SPSS Inc Version 26.0). Independent t-test was used to compare the level of GPX and GR in aqueous between glaucoma and controls. Result: A total of 70 primary glaucoma patients and 70 controls were recruited. Control subjects were older than glaucoma patients. Predominantly, Malay samples were the highest in both groups. The mean values of glutathione peroxidase (GPX) and reductase (GR) in both groups were slightly higher in control group. There was no significant difference in GPX level (p=0.154) and GR level (p=0.756) between glaucoma and controls using multivariate analysis after adjusting confounding factors. There is significant association between the female patients in primary glaucoma and higher level of glutathione reductase. Conclusion Lower aqueous level of GPX and GR may play a role in pathogenesis of primary glaucoma. Improvement of the levels GPX and GR might help to reduce the risk of primary glaucoma. In the future, perhaps comparing with older adults without ocular disease will provide a better understanding of the role of these antioxidant enzymes.
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

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