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.
3-year survival rate and prognostic factors of acute lymphoblastic leukaemia among paediatric patients on ukall protocol in Hospital Universiti Sains Malaysia
(2022)
Ishak, Hasdalina
Background: Paediatric patients with acute lymphoblastic leukaemia have shown better overall survival and event-free survival over the recent decades. This outcome is due to the advancement of diagnostic modalities, individualised patient treatment and improved supportive care. This study was done to determine common clinical presentations, the known prognostic factors associated with disease outcomes and the overall survival in paediatric ALL patients treated with UKALL protocol. Methods: This was a retrospective cohort study involving data interpretation from medical records of children diagnosed with ALL and received treatment with UKALL protocol in Hospital Universiti Sains Malaysia from 1st January 2008 until 31st December 2018. Kaplan-Meier analysis with log-rank test was performed to determine the 3-year survival probability. Multivariate analysis with simple and multiple Cox regression was performed to determine the significant prognostic factors of poor disease outcome. Results: A total of 97 patients were included in the study. The commonest clinical presentations were fever (83.5%), pallor (82.5%) and lethargy (52.6%). Clinical examinations also revealed that most patients had hepatomegaly (92.8%), splenomegaly (83.5%) and lymphadenopathy (82.5%). The 3-year OS is 72.2%. In this study, the Kaplan -Meier analysis showed that the weight percentile (p=0.002) and CSF involvement (p=0.023) were significant factors in leukaemia patients' survival. Multivariate analysis showed that the weight percentile of the 10th – 95th percentile significantly predicted the poor survival outcome (p=0.002). Conclusion: Most paediatric ALL patients usually present with common clinical presentations of acute leukaemia. Our overall survival is considered fair and comparable to other developing countries
3D-CT craniofacial morphometry among Malay down syndrome and normal subjects in Hospital Universiti Sains Malaysia
(2018-05)
Al-Shammari, Haider Ali Hasan
This is the first three-dimensional computed tomography (3D-CT) study, as far as the author is aware, of the craniofacial morphology of Malay Down Syndrome (DS) subjects. This information is intended to increase understanding of the DS quantitative phenotypic features in order to improve the strategies required with the management of these patients. To study the size of the craniofacial structure which include linear and angular measurements in Malay DS subjects and to compare them with normal subjects. Additionally, sexual dimorphism and age differences of both the DS and normal subjects were also investigated. This is a cross sectional 3D-CT study on 240 Malays (Normal = 180, DS = 60) aged between 0 to 35 years old. The initial 2D formats were then reconstructed into 3D utilising Mimics V17.0 software. Linear and angular dimensions of craniofacial structures were measured for each subject using consistent landmark definitions. Comparisons were made between DS and normal subjects, between the males and females and among selected age groups. The selected ages are children (0 to 6 years), pre-adolescents (7 to 12 years), adolescents (13 to 20 years) and adults (21 to 35 years). High reliability of the examiner in carrying out the measurements was detected with ICC values in the range of 0.8 to 1. Generally, each craniofacial region showed unique growth pattern as observed from infancy to adulthood. Most of craniofacial measurements in DS subjects showed smaller values than normal from infancy to adulthood. Sexual This is the first three-dimensional computed tomography (3D-CT) study, as far as the author is aware, of the craniofacial morphology of Malay Down Syndrome (DS) subjects. This information is intended to increase understanding of the DS quantitative phenotypic features in order to improve the strategies required with the management of these patients. To study the size of the craniofacial structure which include linear and angular measurements in Malay DS subjects and to compare them with normal subjects. Additionally, sexual dimorphism and age differences of both the DS and normal subjects were also investigated. This is a cross sectional 3D-CT study on 240 Malays (Normal = 180, DS = 60) aged between 0 to 35 years old. The initial 2D formats were then reconstructed into 3D utilising Mimics V17.0 software. Linear and angular dimensions of craniofacial structures were measured for each subject using consistent landmark definitions. Comparisons were made between DS and normal subjects, between the males and females and among selected age groups. The selected ages are children (0 to 6 years), pre-adolescents (7 to 12 years), adolescents (13 to 20 years) and adults (21 to 35 years). High reliability of the examiner in carrying out the measurements was detected with ICC values in the range of 0.8 to 1. Generally, each craniofacial region showed unique growth pattern as observed from infancy to adulthood. Most of craniofacial measurements in DS subjects showed smaller values than normal from infancy to adulthood. Sexual dimorphism was observed for linear and angular variables in both DS and normal subjects. The number of variables that showed sexual dimorphism increased from infancy to adulthood. Differences in size between males and females were not obvious during infancy as only a few variables showed significant differences. During preadolescent and adolescent stages, only some of the variables showed significant size differences between the sexes. Sexual dimorphism in the craniofacial region was most evident during adulthood with more variables displaying significant differences between the sexes. The majority of the craniofacial variables increased in size significantly from birth to 35 years of age in both DS and normal subjects. This study provides comprehensive description of the craniofacial dimensions of Malay DS subjects. This study has generated craniofacial reference data for DS and some additional normal data. These reference data is hoped to facilitate management of Malay DS subjects. Moreover, these information could also help maxillofacial, orthognathic, plastic and reconstructive surgeons, orthodontists, medico-legal experts and forensic scientists to perform objective and quantitative management, decide treatment strategies and assessment of treatment outcome. In addition, the size of craniofacial structures showed sexual dimorphism at most age categories. Gender consideration should be taken into account in clinical assessment and procedures which may affect the craniofacial complex. Furthermore, quantification based on 3D data provides new insights into craniofacial growth changes and morphology compared with conventional 2D approaches.
6 years review of teenage pregnancy and it’s maternal and fetal outcome in HUSM
(2022)
Muhammad, Nadhilah Izni
OBJECTIVE: To determine the incidence of the teenage pregnancy, it sociodemographic issues and to determine the obstetric risks and complications of teenage pregnancy in HUSM from the year 2015 till 2020. STUDY METHOD: This retrospective cohort study involved all the teenage pregnancy patient that delivered in Hospital Universiti Sains Malaysia. The data for sociodemographic, obstetric risks and complications were collected from the patient notes. Data were analyzed using univariate analyses and Chi square test or Fisher exact test will be used for categorical independent variable and independent t-test or Mann Whitney U test will be used for numerical independent variable depending on normality of data to look for the obstetric and neonatal outcome and as well as sociodemographic. RESULTS: A total of 405 teenage pregnancy patient participated in this study. They are divided into 2 groups, young teenage pregnancy (n=71) and older teenage pregnancy (n=334). Young teenage pregnancy group are the group that equal or less than 16 years old, while older teenage group are older than 16 years old lesser than 20 years old. The prevalence of teenage pregnancy in HUSM is 1.01% and the mean incidence are 10 births out of 1000 women. The teenage pregnancy found to have low in education level where 88.9% had only attended secondary school and 8.9% did not have any education level compare to only 1.2% had attending college or university. The incidence of eclampsia in younger teenage group found to be higher (4.1%) compare to older teenage group (0.3%). However this is not significantly different between this two group. Post-partum hemorrhage found to be higher in younger teenage group (5.6%) compare to older teenage group(2.7%). Uncomplicated intrapartum outcome are more higher in older teenage pregnancy group(93.7%) compare to young teenage pregnancy group(91.5%). Complicated delivery such as retained placenta, meconium stained liquor, shoulder dystocia and obstetric anal sphincter injuries are found to be low in both teenage group. There is however no significant different in the incidence of Pre-eclampsia, PROM, anemia and adverse birth outcome. 89.7% of the teenager pregnancy are from Malay ethnicity(87.9%) and incidence of premarital conception(17.8%) and single mother(11.9%) are higher. CONCLUSION The younger teenage group have higher rate of successful at spontaneous delivery compare to older teenage group. Both groups have uncomplicated intrapartum outcome. There are no significant different in antenatal complications, mode of deliveries and birth outcome in both teenage pregnancy groups.
A 11-year review of emergency obstetric hysterectomy (eoh) in Hospital Universiti Sains Malaysia Kubang Kerian, Kelantan January 2007 – December 2017
(2020)
Hashim, Noor Adibah Hanum Che
Introduction: Emergency obstetric hysterectomy (EOH) is one of the life saving procedure performed in cases of intractable hemorrhage due to uterine atony, rupture uterus and placental disorders and it is usually reserved for the situations where conservative measures fail to control the hemorrhage. It is sometimes associated with both maternal and perinatal morbidity and mortality. Objective: To evaluate the prevalence, indications, maternal and perinatal outcome associated with emergency obstetric hysterectomy in a tertiary care hospital. Methodology: A retrospective study conducted in the Department of Obstetric & Gynaecology in Hospital Universiti Sains Malaysia (HUSM) for 11 years from January 2007 until December 2017 involving a total of 43 women who underwent emergency obstetric hysterectomy. The records of all cases of emergency obstetric hysterectomy were analyzed included patient profile, obstetric history, details of present labour, indications for obstetric hysterectomy and the fetomaternal morbidity and mortality associated with emergency obstetric hysterectomy. Results: Among 79,777 deliveries, there were 43 cases of emergency obstetric hysterectomy, giving the prevalence of emergency obstetric hysterectomy was 0.29 per 1000 deliveries. Maternal demographic characteristics showed that mean age was 36 years old in caesarean hysterectomy group while mean age for postpartum hysterectomy group was 33 years old. The most common parity group encountered in emergency obstetric hysterectomy was para two to para five. Whether or not women underwent prior uterine surgery was investigated and 30 women (69.77%) had history of previous caesarean section. Of the 30 women with an obstetric history of caesarean delivery, 15 (50%) had more than two caesarean deliveries. Placenta accreta was the most common indication for emergency obstetric hysterectomy (30 women, 69.8%) followed by uterine atony (10 women, 23.3%), uterine rupture (2 women, 4.7%) and extended tear (1 woman, 2.3%). Futhermore, about 93.33% (28 out of 30 patients) with adherent placenta had history of caesarean section prior. No maternal mortality reported in this study. The most significant maternal complications postoperatively include coagulopathy (12 out of 43 women), where 27.91% required massive transfusion protocol, followed with re-laparotomy (4 women, 9.3%), and febrile illness (3 women, 6.98%). Most of the babies were born with good Apgar score. The perinatal complication include perinatal death, 2 out of 43 babies, 4.65% were fresh stillbirth were both cases were referred to our center for abruptio placenta. Conclusions: Caesarean section, especially repeat caesarean sections in women with placenta previa and uterine atony, significantly increased the risks of emergency obstetric hysterectomy. Emergency obstetric hysterectomy is safe with reduce complications compared to before with advancement of obstetric care and good clinical practice. Early decision to perform emergency obstetric hysterectomy is essential before the patient’s condition deteriorates
A 11-year review of emergency obstetric hysterectomy (EOH) In Hospital Universiti Sains Malaysia Kubang Kerian, Kelantan January 2007 – December 2017
(2020)
Hashim, Noor Adibah Hanum Che
Introduction: Emergency obstetric hysterectomy (EOH) is one of the life saving procedure performed in cases of intractable hemorrhage due to uterine atony, rupture uterus and placental disorders and it is usually reserved for the situations where conservative measures fail to control the hemorrhage. It is sometimes associated with both maternal and perinatal morbidity and mortality. Objective: To evaluate the prevalence, indications, maternal and perinatal outcome associated with emergency obstetric hysterectomy in a tertiary care hospital. Methodology: A retrospective study conducted in the Department of Obstetric & Gynaecology in Hospital Universiti Sains Malaysia (HUSM) for 11 years from January 2007 until December 2017 involving a total of 43 women who underwent emergency obstetric hysterectomy. The records of all cases of emergency obstetric hysterectomy were analyzed included patient profile, obstetric history, details of present labour indications for obstetric hysterectomy and the fetomaternal morbidity and mortality associated with emergency obstetric hysterectomy. Results: Among 79,777 deliveries, there were 43 cases of emergency obstetric hysterectomy, giving the prevalence of emergency obstetric hysterectomy was 0.29 per 1000 deliveries. Maternal demographic characteristics showed that mean age was 36 years old in caesarean hysterectomy group while mean age for postpartum hysterectomy group was 33 years old. The most common parity group encountered in emergency obstetric hysterectomy was para two to para five. Whether or not women underwent prior uterine surgery was investigated and 30 women (69.77%) had history of previous caesarean section. Of the 30 women with an obstetric history of caesarean delivery, 15 (50%) had more than two caesarean deliveries. Placenta accreta was the most common indication for emergency obstetric hysterectomy (30 women, 69.8%) followed by uterine atony (10 women, 23.3%), uterine rupture (2 women, 4.7%) and extended tear (1 woman, 2.3%). Futhermore, about 93.33% (28 out of 30 patients) with adherent placenta had history of caesarean section prior. No maternal mortality reported in this study. The most significant maternal complications postoperatively include coagulopathy (12 out of 43 women), where 27.91% required massive transfusion protocol, followed with re-laparotomy (4 women, 9.3%), and febrile illness (3 women, 6.98%). Most of the babies were born with good Apgar score. The perinatal complication include perinatal death, 2 out of 43 babies, 4.65% were fresh stillbirth were both cases were referred to our center for abruptio placenta. Conclusions: Caesarean section, especially repeat caesarean sections in women with placenta previa and uterine atony, significantly increased the risks of emergency were both cases were referred to our center for abruptio placenta. Conclusions: Caesarean section, especially repeat caesarean sections in women with placenta previa and uterine atony, significantly increased the risks of emergency
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 5-year review of recurrent pelvic organ prolapse following pelvic reconstructive surgeries in Hospital Sultanah Nur Zahirah.
(2020)
Recurrent pelvic organ prolapse after primary pelvic reconstructive surgery is common with recurrence rate 29-34%. The study was carried out to determine the local prevalence of recurrent pelvic organ prolapse (POP) and to determine the associated factors for its recurrence following primary pelvic reconstructive surgery (PRS). It was a retrospective observational study which was carried out at Hospital Sultanah Nur Zahirah, Kuala Terengganu involving all patient who underwent PRS between 1st January 2011 and 31st December 2015. Case notes were review and patients who had recurrent POP more or equal to grade 2 Baden-Walker System within two years of the operation were included. A total of 125 patients were involved. The prevalence of recurrent POP following primary PRS in studied population was 24.8%. The association between each related variable towards recurrent POP was examined. However, no variables were found to be significant at the end. The prevalence of recurrent pelvic organ prolapse in HSNZ was 24.8% within two years interval between primary operation and recurrence. There were no significant risk factors identified to be associated with the recurrence in the studied population. However, the age was the nearest factor that influence recurrence of POP.
A cadaveric study of anatomical variation of sphenoparietal sinus & superficial sylvian draining veins in Sabah population
(2022)
Nagalingam, Harvinth
Background : The term "sphenoparietal sinus" was coined by Gilbert Breschet in an atlas of the venous system in the early nineteenth century (Breschet, 1829). Since then, many literatures have gained interest in knowing the sinus and the drainage. Drainage of superficial sylvian veins was consistent in many literatures however controversies exist. One of the key steps in the transsylvian and subtemporal approach is identifying this sinus and bridging veins from superficial sylvian vein (SSV) to create a wide surgical corridor. Hence, this study was aimed to delineate the microsurgical anatomy and variation of the sinus and sylvian draining veins. Methods : 30 fresh cadavers were examined in Forensic Department Queen Elizabeth Hospital between October 2020 to October 2021, were anatomically analysed and studied through a data collection sheet. All data were analysed using Statistical Package for the Social Science (SPSS) version 22.0. Results : The studied cadavers were 76% Male (n=23) and 23.3% female (n=7). The median age of cadavers is 52.5 years old with interquartile range of 14. All of Cadavers (100%, n=30) has Sphenoparietal sinus on both side and all draining to ipsilateral cavernous sinus. Number of superficial sylvian veins drainage (SSVD) varies from 0 veins up to 4 veins on both hemisphere. About 40% cadavers (n=12) has 3 SSV Vein draining on left hemisphere and 36.7% (n=11) has 2 and 3 draining veins on right side of hemisphere respectively. Only 3.3% of cadavers (n=1) has no draining veins on either side. Using McNemar test, there is no statistically significant difference of complexity between right and left hemisphere (p=0.332). It was noting to found that male group has more complex veins compare to female in the left hemisphere when compared with Fisher exact test (p=0.024). Based On cadaveric data, we have formulated new classification on SSV SPS drainage based on number of draining (bridging) veins. Type A (4 draining veins) Type B(3 draining veins) Type C ( 2 Draining veins) Type D ( 1 draining Vein) Type E (0 Draining veins) Conclusion: We have consolidated our hypothesis on the presence of SPS and variance in numbers of draining veins to SPS these new classifications is aimed at to provide new microsurgical nomenclature for future use in neuroanatomy and neurosurgery
A clinical test for a newly developed direct brain cooling system for the injured brain and pattern of cortical brainwaves in cooling, non-cooling and dead brain
(2020)
Yee, Ang Song
A direct brain cooling system was newly innovated purposedly to ensure direct delivery of therapeutic hypothermia at a selected constant temperature to the injured brain. The practicality, effectiveness and safety of this system were tested clinically in our initial series of fourteen patients with severe head injuries. The patients were randomized into two groups – direct brain cooling at 32°C and the control group. The patients underwent standard decompressive craniectomy. Post operatively, all of them received intracranial pressure, focal brain oxygenation, brain temperature and direct cortical brainwave monitoring. The direct brain cooling group did better in the Extended Glasgow Outcome Scale at the time of discharge and at six months after trauma. This could be due to a trend in the monitored parameters; reduction in intracranial pressure, increment in cerebral perfusion pressure, optimal brainredox regulation, near-normal brain temperature and lessening of epileptic-like brainwave activities are likely reasons for better outcomes in the cooling group. Finally, this manuscript depicts interesting cortical brainwaves during a transition time of being alive to dead. The demonstrated cortical brainwaves are thought as obeying the principles in quantum physics.
A combination of methodology building for multi-layer feed-forward neural network (MLFF) and linear modeling: an application in biometry modeling
(2024-01)
Jusoff, Muhammad Khairan Shazuan
Biostatistics, also known as biometry, is a field of statistics that focuses on the application of statistical methods to the field of biomedicine and health sciences. Biostatistics can assist researchers and healthcare professionals in identifying risk factors, evaluating intervention effectiveness and many more. However, biostatistics has not been entirely embraced by medical professionals due to several reasons. One of the main reasons is that the medical field is challenging, and maintaining a high level of accuracy is critical. In addition, many previous studies focused on individual modeling technique that has limited ability to capture the dynamic and complexities in the medical field. This study aims to develop a biometry model that combines several statistical techniques, namely bootstrap, Multi-Layer Feed-Forward Neural Network (MLFF) and Multiple Linear Regression (MLR). This study will propose two distinct models: (i) Hybrid MLFF-MLR model with case resampling and (ii) Hybrid MLFF-MLR model without case resampling. The two models will be compared using the Mean Square Error of Neural Network (MSE.net) and the Mean Square Error of the Linear Model (MSE.lm). The model with lower MSE.net and MSE.lm values will be deemed superior. The analysis results from both models show that the hybrid MLFF-MLR model with case resampling yields a more accurate output. This research contributes to the body of knowledge by exploring the potential of biometry modeling and can be a reference for future researchers in the same field.
A comparative cross-sectional study on comparison of hyperkalemia measurement between blood gas analyzer in emergency department and main laboratory biochemistry analyzer in Hospital Universiti Sains Malaysia
(2020)
Ismail, Mohd Helmie
Background: Potassium level is measured for patient with high risk of hyperkalemia in an emergency department (ED) using both blood gas analyser (BGA) and biochemistry analyser (BCA). The purpose of study to evaluate the correlation and agreement of hyperkalemia measurement between these two analysers. Methods and Materials: This is a prospective cross-sectional study was conducted at Hospital Universiti Sains Malaysia (HUSM) from Jun 2018 until May 2019. The blood samples were taken by single pricked from venous blood and were sent separately using 1-ml heparinized syringe and analysed immediately in the emergency department (ED) using BGA (Radiometer, ABL800 FLEX, Denmark) and another sample was sent to the main laboratory of HUSM and analysed by BCA (Architect, C8000, USA). Only patients who had potassium level ³ 5.0 mmol/L on blood gas results were included. The correlation and agreement were evaluated using Passing and Bablok regression, Linear Regression and Bland-Altman test. Result: A total of 173 sample pairs were included. The mean of potassium level based on BGA and BCA were 5.77 mmol/L (SD±0.74) and 6.05 mmol/L (SD±0.91) respectively. There was moderate correlation between two measurements (P<0.001, r: 0.36). The agreement between two measurements showed within acceptable mean difference which was 0.27 mmol/L with 95% limit of agreement was –1.21 mmol/L to 1.73 mmol/L. Conclusion: There is moderate correlation and acceptable agreement in hyperkalemia measurement between BGA to BCA. However, the BGA results tend to be lowered compared to BCA results. Therefore, the clinicians should use the BGA result with caution in certain clinical situation where time-is-of-the-essence to initiate treatment for hyperkalemia.
A comparative study between the standard AO method and fibula length measurement in estimating maximum femoral nail length
(2022)
Sandhu, Manharpreet Singh
Introduction Diaphyseal femur fractures are a common presentation in orthopaedics and are routinely managed with intramedullary fixation. Appropriate nail length and size is required to be measured preoperatively. Maximum nail length can be estimated by measuring either clinically or radiographically the contralateral femur or by using forearm referencing. However, these methods are inadequate when patients present with bilateral femoral bone fractures with concurrent forearm fractures. The aim of this study is to identify another reliable clinical method in estimating the maximum femoral nail length. Materials and methods A total of 140 patients who attended the Orthopaedic clinics and wards at Hospital Universiti Sains Malaysia (HUSM) that met the inclusion and exclusion criteria were chosen using a convenience sampling method and participated in this cross-sectional study. Their estimated maximum femoral nail length (EFNL) and fibula length were measured using a tailor measuring tape on the ipsilateral limb. The EFNL was measured according to the standard AO method while the fibula was measured from the tip of the fibula head to the tip pf the lateral malleolus. These data were collected and analyzed using SPSS version 26. Descriptive statistics was used to summarize the socio-demographic characteristics of the subjects. Numerical data were presented as mean (SD) or median (IQR) based on their normality distribution, while categorical data were presented as frequency (percentage). Results Of the 140 patients measured, the overall mean EFNL was 37.98cm (± 2.72cm) while the fibula length was 37.72cm (± 2.61cm). The Pearson’s Correlation analysis showed that the fibula length was highly correlated with the EFNL, and this correlation was not influenced by age, BMI or gender. Interclass correlation analysis (ICC) showed high degree of inter-observer reliability in the both the femur (ICC 0.938 with a 95% confidence interval) and fibula (ICC 0.972 with a 95% confidence interval) measurements. A formula for estimating maximum femoral nail length was derived from the correlation graph. Estimated maximum femoral nail length = 1 + (0.98 × fibula length) Conclusion The fibula length is shown to correlate well with the clinical measurement of EFNL in this study and can be used as a reliable alternative clinical method to estimate the maximum femoral nail length
A Comparative study of haemodynamic effects between two different doses of oxytocin in lower segment caesarian section under spinal anaesthesia.
(2012)
Zainudin, Asmah
A comparative study of haemodynamic effects between two different doses of oxytocin in lower segment caesarean section under spinal anaesthesia. There is always a discussion within the obstetric anaesthesia community about the correct dose of oxytocin and its method of administration. Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas an inadequate dose can result in increased uterine bleeding. We compared the effects of two doses of oxytocin in a randomised doubleblind trial. Seventy patients undergoing elective lower segment caesarean section received an intravenous bolus of either 10 unit or 2 unit of oxytocin after cord clamping. followed by oxytocin infusion 10 unit per hour. All patients received spinal anaesthesia. phenylephrine was used if the blood pressure fell more than 15% from the baseline. We compared changes in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, uterine tone, blood loss, additional usage of uterotonic drugs and emetic symptoms. There was a larger decrease in MAP in patients who received 10 unit, MD — 12.54 mmHg (15.1%), p value <0.0001 than in those who received 2 unit, MD= - 5.46 mmHg (7.1 %), p value = 0.023 There was a greater increase in mean heart rate in patients who received 10 unit , MD - +9.20 bpm (10.2%), p value <0.0001 than in those who received 2 unit , MD= -+8.23 bpm (9.5%), p value = 0.004. Maximum increase in HR was at 2 minutes (+15.57 bpm, 17.28%).The frequency of antiemetic use was higher after 10 unit (27.6%) than 2 unit (2.9%), (/?=0.042). There was no difference in blood loss, uterine tone, or request for additional uterotonic drugs in both groups. In elective lower segment caesarean under spinal anaesthesia with low risk for post-partum haemorrhage, a 2 unit bolus of oxytocin results in less haemodynamic changes than 10 unit, with less nausea and no difference in uterine tone, estimated blood loss and the need for additional uterotonics drugs.
A comparative study of haemodynamic effects between two different doses of oxytocin in lower segment caesarian section under spinal anaesthesia.
(2012-05)
Zainudin, Asmah
A comparative study of haemodynamic effects between two different doses of oxytocin in lower segment caesarean section under spinal anaesthesia. There is always a discussion within the obstetric anaesthesia community about the correct dose of oxytocin and its method of administration. Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas an inadequate dose can result in increased uterine bleeding. We compared the effects of two doses of oxytocin in a randomised doubleblind trial. Seventy patients undergoing elective lower segment caesarean section received an intravenous bolus of either 10 unit or 2 unit of oxytocin after cord clamping. followed by oxytocin infusion 10 unit per hour. All patients received spinal anaesthesia. phenylephrine was used if the blood pressure fell more than 15% from the baseline. We compared changes in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, uterine tone, blood loss, additional usage of uterotonic drugs and emetic symptoms. There was a larger decrease in MAP in patients who received 10 unit, MD — 12.54 mmHg (15.1%), p value <0.0001 than in those who received 2 unit, MD= - 5.46 mmHg (7.1 %), p value = 0.023 There was a greater increase in mean heart rate in patients who received 10 unit , MD - +9.20 bpm (10.2%), p value <0.0001 than in those who received 2 unit , MD= -+8.23 bpm (9.5%), p value = 0.004. Maximum increase in HR was at 2 minutes (+15.57 bpm, 17.28%).The frequency of antiemetic use was higher after 10 unit (27.6%) than 2 unit (2.9%), (/?=0.042). There was no difference in blood loss, uterine tone, or request for additional uterotonic drugs in both groups. In elective lower segment caesarean under spinal anaesthesia with low risk for post-partum haemorrhage, a 2 unit bolus of oxytocin results in less haemodynamic changes than 10 unit, with less nausea and no difference in uterine tone, estimated blood loss and the need for additional uterotonics drugs.
A comparison between goat milk and cow milk supplementation on nutritional status among paediatrics with cerebral palsy in Kelantan
(2024-04)
Shamsudin, Juliana
Goat milk (GM) can be used as an alternative if cerebral palsy (CP) children are unable to tolerate cow milk. The purpose of this study was to compare the anthropometric, biochemical, clinical, and dietary intake of powdered GM versus CM among CP children in Kelantan, Malaysia. The study consists of two phases: Phase 1 focuses on determining and analysing the proximate and fatty acids profile of GM and CM, while Phase 2 involves the intervention study. In Phase 1, a grand total of 20 GM samples were analysed, along with 1 GM sample (reference) and 1 CM sample. The study’s criteria for references on GM and CM involved the use of powdered full cream milk as a primary ingredient or the most popular brand among consumers. Meanwhile, during Phase 2 of the study (quasi-experimental design, single blind), a total of 87 children with CP were randomly assigned to either goat milk (GM, n=43) or cow milk (CM, n=44). The research achieved an 82.1% response rate. The study included children between the ages of 4 and 12, but excluded those with severe cases of CP who needed special nutritional requirements such as inborn error metabolism, tube feedings, and cow milk protein allergy (CMPA). In the intervention group, the mean age was 9.05 ± 2.30 years, while in the control group, it was 8.27 ± 2.55 years. The gender distribution was as follows: in the GM group, 53.5% were male and 46.5% were female, while in the CM group, 70.5% were male and 29.5% were female. Milk powder in the form of a sachet (21-23 grams, twice a day) was provided from the start of the study until the end of the 4 months (3 meetings; baseline, 2-months, and 4-months). Anthropometric data (weight, height, BMI, MUAC, triceps and subscapular skinfold measurements, body fat percentage), biochemical data (hemoglobin and hematocrit), clinical data (systolic and diastolic blood pressure and heart rate), and dietary intake were gathered from baseline to 4-months. The Phase 1 study found that only nine GM samples out of 20 contained pure GM (based on the ingredient label), and sample G17 was chosen as goat milk for Phase 2 because it contained the highest medium-chain fatty acid (MCFA) content of 2803.9 mg (12.97%) compared to CM, 765 mg (7.19%), and the other goat milk samples. Phase 2 results show that GM showed greater improvements. There were significant differences in triceps skinfold measurement (0.33 mm vs -0.20 mm, p=0.024) and vitamin B1 (p=0.043), while other parameters did not show significant differences between GM and CM after the intervention (p>0.05). Furthermore, there was a reduction in calcium (p=0.040) and vitamin B12 (p=0.022) levels between GM and CM. In conclusion, laboratory analysis shows that GM has a higher MCFA content than CM. Meanwhile, for the intervention study, GM can be used as a tolerable supplement for CP children based solely on significant differences in triceps skinfold measurement and vitamin B1 levels. Moreover, calcium and vitamin B12 intake decreased in the daily diet of GM in comparison to CM. Further research is needed to confirm and explore this matter over a longer duration, with the necessity of conducting blood tests to assess the decrease in calcium and vitamins from the daily diet.
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 comparison of prevalence, clinical management and treatment outcome of ischemic stroke prior to and during covid-19 pandemic in Hospital Universiti Sains Malaysia
(2022)
Suliman, Ayman Sirelkhatim Ali
Introduction Ischemic stroke is a medical emergency. Risk of poor outcomes in stroke increases with delay in time to treatment. Covid-19 pandemic had a significant impact on stroke management resulting in more severe stroke. This study aims to determine the impact of Covid-19 pandemic on the total number of ischemic stroke patients admissions, stroke standards of care and outcome. Methodology This is a retrospective record review study. Data of patients with radiologically or clinically confirmed AIS in HUSM diagnosed from 1st March 2019 until 28th February 2021 were included. Results A total of 229 patients were included; 114 (49.8%) patients in the pre -covid-19, and 115 (50.2%) patients during covid-19. Initial NIHSS score was similar, 5.3 ± (4.18) in 2019 and 5.9 ± (4.42) in 2020. Onset to door time in minutes was 1875.2(2034.72) in pre- Covid-19 vs 1827.1(2163.95) in Covid-19 group (t. test 0.17 p-value 0.863). Time to see emergency doctor in minutes was 25.3 (30.21) in pre covid-19 vs 22.6(16.48) in Covid- 19 group (t. test .48 p-value 0.402). Door to CT brain time in minutes 83.8 (58.91) vs 92.4 (120.20) in pre-covid-19 and Covid-19 group subsequently (t. test -.69 p- value 0.493). For patients received thrombolytic therapy; 7(6.1%) pre covid-19 vs. 4 (3.5%) during covid-19 period (p-value>0.5). Other stroke metrics including physiotherapy,occupational therapy, speech therapy assessment and dietician, results were ;(77.2% vs 81.7% p-value >.05) (76.3% vs 81.7% p-value >.05) (50% vs 59.1% p- value>.05) (43.9% vs45.2% p-value>.05) for physiotherapy, occupational therapy, speech therapy and dietician subsequently. For treatment outcome, duration of hospital stay was [(6.4 ± 4.5 vs. 7.56.74) (t. test - 1.36, p-value0.175)] in pre Covid-19 and during covid-19 respectively. While MRS score at discharge was [(2.8(1.38) vs. 2.9(1.49) (t. test .33 p- value 0.742)] in pre -Covid-19 and during Covid-19 respectively. Conclusion Covid-19 had no significant impact on stroke management in HUSM. Comparison of stroke risk factors, subtypes and severity, door to needle time and onset to needle time for thrombolysis were statistically insignificant. Stroke management outcomes were similar for MRS score, duration of hospitalization, hospital acquired infection and 7 days mortality
A cross sectional study of ambulance response time using Ambulance Vehicle Locator and Global Integrating System (AVL-GIS), and the factors contributing to delayed ambulance response time at Hospital Universiti Sains Malaysia.
(2020)
Asri, Zulaili
This study aims to determine ambulance response time in Kubang Kerian district, Kelantan, Malaysia using Ambulance Vehicle Locator and Global Integrating System (AVL-GIS) device and the factors associated with delayed response time. This was a 6-months prospective, cross-sectional study conducted at Emergency and Trauma Department, Hospital Universiti Sains Malaysia (HUSM) in Kubang Kerian, Kelantan, Malaysia. The possible factors identified to have caused delayed ambulance response time from previous literatures were included in this study. All prehospital cases from September 2017 until February 2018 attended to by AVL-GIS installed ambulances were included in this study. Data were obtained from the standardized prehospital Proforma forms and extracted from AVL-GIS using a GPS software. Simple and multiple logistic regression tests were used to determine the factors associated to delayed response time. The mean ambulance response time was 12 minutes. A total of 505 cases were included in this study in which 75% was recognized as delayed cases and 25% cases as non-delayed. Internal factors associated with delayed response time were found to be call duration (OR:1.67; 95% CI: 1.37, 2.05) and caller type in which calls from the public had higher odd of delayed response time as compared to calls received from Medical Emergency Call Centre (OR=0.38, 95% CI: 0.24, 0.59) and other emergency sectors (OR=0.16, 95% CI: 0.07, 0.34). For external factors, team allocation time (OR=1.57, 95% CI:1.32, 1.85), travelling time (OR=3.7, 95% CI: 2.82,4.85) and traffic condition (OR 0.47, 95% CI: 0.25, 0.90) were significantly associated with delayed ambulance response time. Conclusion This study concluded that type of caller, call duration, team allocation time, travelling time and traffic condition were found to be significant in affecting ambulance response time. Evaluation of each component contributing to delayed ambulance response time is needed for intervention to improve prehospital care in the future.
A cross-sectional study to assess pattern in wrinkle formation in different age groups in female population in Kelantan
(2018)
IV, Zosimo Ken L. Jimeno
Background Facial wrinkles encompasses superficial and mimetic wrinkles, and facial lines; formation of which are combined effect of intrinsic and extrinsic factors. Quantitative study of facial wrinkles using photographic methods enables researchers to measure the amount of wrinkles on specific area, and in this case the face. The aim of this study is to determine the means of facial wrinkles in female population of different age groups in Kelantan. Methods A total of 168 women aged 20 to 48 years old, were recruited in this study based on convenience sampling. Subjects were divided equally into 3 age groups (later adolescence, early adulthood and middle adulthood). Digital photography of subject’s frontal view of face at zero degree was taken using device developed by OptoBioMed (Korea). Measurement of wrinkles at glabella, forehead and frontal face were calculated using provided software. Results Wrinkle formation was more marked at all assessed regions in the older age group (p<0.01). Glabella showed an area more affected than forehead. In each age cohort, the formation of wrinkles in glabella and forehead showed positive correlation (p<0.05, Pearson Correlation Test). Conclusion The results of this present study showed progressive increase of facial wrinkles, more significantly in the older age group. The formation of facial wrinkles was expected to progress simultaneously as shown by their positive correlation.

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