Institut Perubatan & Pergigian Termaju - Tesis

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Browsing Institut Perubatan & Pergigian Termaju - Tesis by Subject "AMDI"

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    Anaemia And Red Blood Cell Transfusion Among Breast Cancer Patients At Tertiary Centres In Kelantan
    (2022-05)
    Ramli, Nur Akuna
    Pengenalan: Anemia semasa kemoterapi adalah salah satu beban bagi pesakit kanser. Namun, data yang sedia ada mengenai prevalensi anemia serta rawatan untuk anemia seperti transfusi darah sering berbeza. Kajian ini bertujuan untuk mengenal pasti prevalensi anemia dan praktis transfusi darah di kalangan pesakit kanser payudara serta menentukan faktor penyebab anemia akibat kemoterapi. Kaedah: Kajian kohort retrospektif ini dilakukan di Kelantan melibatkan 104 pesakit kanser payudara yang menjalani kemoterapi. Chi-square digunakan untuk perbandingan antara kumpulan yang mendapat anemia akibat kemoterapi atau tidak berdasarkan demografik pesakit, kriteria klinikal dan rawatan kanser payudara. Simple dan multiple logistic regression digunakan untuk menentukan hasil yang berkaitan. Keputusan: Sebelum menjalani rawatan kemoterapi, 40.4% pesakit mempunyai anemia. Terdapat 30.8% telah menerima transfusi darah merah semasa kemoterapi dengan purata hemoglobin sebelum transfusi darah ialah 7.9 g/dL. Anemia akibat kemoterapi direkodkan sebanyak 54.8%. Waiau bagaimanapun, tiada perbezaan signifikan dicatatkan berkenaan anemia akibat kemoterapi dari segi demografik pesakit, data klinikal dan rawatan kanser payudara. Kesimpulan: Peratusan anemia yang tinggi dicatatkan di kalangan pesakit kanser payudara yang meningkat selepas menjalani kemoterapi. Lebih kurang 1/3 daripada pesakit memerlukan transfusi darah merah. Penilaian awal mengenai pesakit yang berisiko untuk anemia dengan penggunaan erythropoietin dan iron boleh mengurangkan prevalensi anemia akibat kemoterapi. Mengoptimumkan rawatan untuk anemia adalah penting, seterusnya meminimumkan akibat buruk dan membantu pesakit.
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    Anti-inflammatory Effects Of Mesenchymal Stem Cells Derived Extracellular Vesicle In Rat Model Of Chronic Obstructive Pulmonary Disease
    (2022-01)
    Ridzuan Noridzzaida
    Chronic obstructive pulmonary disease (COPD) is a chronic lung disease characterized by progressive airflow obstruction associated with chronic inflammation. The current treatment strategies are focusing on improving the symptoms and quality of life but do not provide cure for the underlying caused. Recently mesenchymal stem cells (MSC)-derived extracellular vesicles (EV) is actively being investigated as a potential source of new cell-free based therapy for COPD due to it’s ability to ameliorate inflammation, however no research has been conducted to study the anti-inflammatory effects of MSC-EV in COPD model.Thus, this study aimed to assess the anti-inflammatory effects of human umbilical cord mesenchymal stem cell (hUC-MSC) derived EV in a rat model of COPD. Human UC-MSC-EV were isolated and characterized by using transmission electron microscope, western blot, and nanoparticle tracking analysis. Male sprague dawley rats (n=66) age 8-9 weeks were divided into 11 groups; Naïve, Cigarette Smoke (CS), Self-healing (SH), treatment groups (CS-hUC-MSC-EV, CS-hUC-MSC, CS-hUC-MSC-CM), vehicle groups (culture media alone (MD), and phosphate buffered saline (PBS)), and control (C) group (C-hUC-MSC-EV, C-hUC-MSC, and C-hUC-MSC-conditioned media (CM)). Five groups (CS, SH, CS-hUC-MSC, CS-hUC-MSC-EV, and CS-hUC-MSC-CM) were exposed to CS from 3 cigarettes for approximately 15 minutes per session, 2 times a day at 2 hours interval, 7 days a week, for 12 weeks. Meanwhile, Naïve, and control groups were left to breathe normal air. The treatments (hUC-MSC, hUC-MSC-EV, and hUC-MSC-CM) and PBS and MD were administered at week 13. Naïve and injury group were euthanized at week 13, while treatment groups, vehicle groups, and self-healing group were euthanized at week 15. Lungs from all groups were then subjected to histological analysis by using hematoxylin and eosin (H&E) staining, alcian blue-periodic acid Schiff (AB-PAS) staining, immunofluorescence staining, and microarray analysis. Increased lymphocytes count, inflammation in peribronchial and perivascular area, as well as parenchyma area, increased goblet cells count, increased emphysema, and increased p65 expression were observed in CS group as compared to Naïve group.Self-healing for two weeks did not reduce the inflammation in peribronchial and perivascular area, as well as parenchyma area. Self-healing for two weeks also did not reduce goblet cells count, emphysema, and p65 expression. In treatment groups, reduction of inflammation in peribronchial and perivascular area, as well as parenchyma area, reduced goblet cells count, and emphysema, reduced p65 expression were observed as compared to CS and SH groups. Meanwhile, the treatments did not induce inflammation or increased goblet cells count, and did not induced emphysema in rat exposed to normal air. Microarray analysis showed regulation of COPD related pathways and genes in CS, hUC-MSC-EV, hUC-MSC groups. hUC-MSC-EV, and hUC-MSC significantly regulating many genes expression including NFKB1, MAPK1, MAP2K1, JUN, PRKCZ, and P65. In conclusion, hUC-MSC-EV effectively ameliorating the CS induced inflammation and could potentially serve as a new cell-free based therapy for the treatment of COPD.
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    In Silico Selection And Validation Of Dna Aptamer Against Progesterone Receptor Dna Binding Domain
    (2022)
    Tholasi Nadhan, Navien
    Progesterone receptor plays an important role in the progression of breast cancer. Currently, antibody-based Immunohistochemistry is used in pathological assessment of PR levels for the detection of breast cancer. The shortcomings associated with antibodies pave the path to use aptamers as the alternatives. Aptamers are single-stranded DNA or RNA oligonucleotides generated by SELEX that are capable of binding to their cognate target molecules with high affinity and specificity based on their unique structural folding capacity.The tediousness and rigor associated with certain steps of the conventional SELEX intensify the efforts to select DNA aptamers using in silico-docking approach. That said, we report an in silico selection and validation of DNA aptamer to the progesterone receptor DNA binding domain (PR DBD) using ssDNA sequences derived from human progesterone response elements (PREs).Firstly, a library of sixty-four different nearnative ssDNA analogs of the corresponding PRE sequences was designed and subjected to secondary and tertiary structural determination. After that, docking between the ssDNA tertiary structures with the PR DBD was carried out using PatchDock. The sequence with the highest docking score was chosen as the aptamer candidate and further validated by in vitro direct ELASA.Among the candidates, we selected the ssDNA sequence (PRDBDapt17; 5′- AGAACAGCGTGTTCT -3′), which showed the highest docking scores of 11334 as a promising PR DBD binding aptamer. In addition, the PRDBDapt17 detected recombinant PR DBD in direct ELASA with a limit of detection of 3.91 nM. The dissociation constant was estimated at 366.6 nM. Therefore, PRDBDapt17 is a potential aptamer that can be used in the diagnosis of breast cancer.
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    Red Blood Cell Transfusion Among Neonatal Sepsis Patients At Hospital Usm
    (2022-05)
    Misran, Siti Marlina
    INTRODUCTION: The prevalence of neonatal sepsis varies in different countries. It is one of the most common reasons for admission to NICU, and it remains a significant cause of neonatal morbidity and mortality. Neonates represent a frequent group of recipients receiving red blood cell (RBC) transfusion. However, there is limited information about the impact of RBC transfusion among neonates with sepsis in Malaysia. The risk and potential adverse associations with RBC transfusions are poorly described in neonates. This study aimed to explore the clinical characteristics of neonatal sepsis, evaluate the outcomes related to RBC transfusion and assess the factors associated with mortality in neonatal sepsis. METHODS: This case-control retrospective study involved 220 neonates admitted with sepsis in NICU Hospital USM from 2014 until 2019. The association between patients' demographics, clinical characteristics and RBC transfusion with mortality was analysed by logistic regression. RESULTS: Only half (59.5%) of the neonates were delivered prematurely with a gestational age of fewer than 3 7 weeks. Low birth weight neonates were found to have a higher risk for RBC transfusion, with a mean birth weight of2.34 kg. Among 55 (25.0%) neonates who had proven blood culture positive, 43 (39.1 %) of them had RBC transfusion. There were two (1.8%) reported cases of acute transfusion reaction among neonatal sepsis with RBC transfusion. The mean length of stay in NICU for neonatal sepsis with RBC transfusion was prolonged, up to 15 days compared to neonatal sepsis without RBC transfusion, up to 8 days only. About 71 (32.2%) neonates died during hospitalization in the NICU, of which 55 (50.0%) of them were among neonatal sepsis in transfuse group. Mortality among neonatal sepsis was significantly associated with proven positive blood culture, neonatal birth weight and the total number of RBC transfusions, either with two or more than two RBC transfusions (p<0.05). CONCLUSION: Our study was able to prove that proven positive blood culture, neonatal birth weight and the total number of RBC transfusions were significantly associated with mortality among neonatal sepsis. This information can be utilised by clinicians to ensure that any blood transfusion decision is made judiciously in neonates. Regular clinical audit on blood transfusion and appropriate Patient Blood Management among neonates able to reduce neonatal sepsis morbidity and mortality
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    Study On Practice Of Massive Transfusion Protocol Activation In Hospital Universiti Sains Malaysia
    (2022-05)
    Wan Zulkipli, Nusaibah
    Introduction: Massive transfusion protocol (MTP) was designed to improve the outcome of patients at risk of mass ive haemorrhage. This study focused on the prevalence, indications, associated factors toward the indication of MTP cases and 24-hour mortality among who received MTP in Hospital USM. Methods: A retrospective cross-sectional study was performed on 110 patients for whom MTP was activated in Hospital USM. Data were extracted from the medical records and blood bank system (MyTransfus i). Simple and multiple logistic analysis was used for stati stical analysis, and a p-value of< 0.05 was considered significant. Results: A total of 273,087 patients were admitted to Hospital USM and 193 patients required MTP activation during the study period. The prevalence of MTP activation was only 0.07%. This study included 110 MTP cases which consisted of 62 (56.3%) trauma and 48 (43 .7%) non-trauma patients. The mean age of total patients were 40.0 years old, and maj ority were male (66.4%). The two most common MTP indications were motor vehicle accidents (n = 58) and gastrointestinal bleeding (n = 24). Female (adjusted OR= 20.08, 95% CI 5.76- 70.00, p <0.00 I) and presence of comorbidity (adjusted OR= 13.66, 95% CI 4.21 - 44.39, p<0.001) significantly associated with MTP indication. Meanwhile, no emergency procedure (adjusted OR= 12.77, 95% CI 4.22- 38.61, p <0.001) and noncompliance to MTP (adjusted OR = 4.30, 95% CI l.21 - 15.38, p = 0.024) were significantly associated with high mortality within 24-hour post MTP activation. Conclusion: The prevalence of MTP was low. Our result suggested that early emergency procedures to control the haemorrhage source should be done, and compliance towards MTP needs to be improved for better patient outcomes.