Pusat Pengajian Sains Perubatan - Tesis

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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.
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 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 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 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 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 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 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.
A novel moldless sintering porous titanium for dental post system: development, characterization and evaluation of mechanical properties
(2022-08)
Al-Hajj, Mohammed Nasser Ahmed
Different types of intraradicular posts are available to restore the endodontically-treated teeth. However, debonding of the post is still the main drawback till date. In this study, we developed a porous titanium dental post with porosity to increase the flexibility of the post, and with porous surface to improve the micro-interlocking with the luting cement. In the first part, pure titanium powder was mixed with wax binder (as space holder) in three different percentages (85%, 90%, and 95% wt. titanium powder). The samples were exposed to heating temperature through two phases. In the first phase (air heating), the samples were heated in an open-air environment for 2 hours (at 380◦C) to remove the wax binder. In the second phase, the samples were sintered in a tube furnace with argon environment for 10 hours (at 1100◦C) to complete the process. The samples were then characterized and tested to select the best mixture for further investigation. The field-emission scanning electron microscopy (FESEM) showed good roughness of the surface and thorough porosity of the structure, with better melting of the titanium particles in the 85% group. The energy dispersive X- ray spectrometry (EDX) analysis showed higher percentages of titanium within the material. The density values were close to the theoretical ones, and the porosity revealed good distribution with less than half of the volume (40%). The compressive and flexural strength tests revealed higher values of 85% group than other groups. The 85% group was then selected to fabricate the porous titanium post (PTP). In the second part, 96 extracted human teeth were collected to investigate the push-out bond strength of the porous post. Two different luting cements (RelyX U200TM 3M ESPE and ParaCore® Coltene Whaledent) were used and the roots were sectioned at the coronal and middle levels (3.00 ± 0.2 mm thickness). The push-out bond strength of the PTP was compared to other dental posts (Coltene Whaledent) namely commercially-pure titanium post (CTP) (ParaPost® XP), stainless steel post (SSP) (ParaPost® XP), and fiber glass post (FGP) (ParaPost® Fiber Lux). The push-out bond strength values of PTP were comparable to that of the other posts, with no significant differences (P> 0.05) in RelyX U200 group at both sections of the root. The adhesion of PTP was better than the other posts, with no prevalence of post-cement failure in PTP. FESEM images on the post-cement-dentin interface showed better adhesion of PTP to both types of cements, with no visible separating line between post and cement. The findings of this study provide a possibility to use the porous titanium post as alternative option for dental post systems.
A pilot study of serum anti-müllerian hormone in polycystic ovary syndrome and its relationship with insulin resistance, lipid profile and adiponectin
(2018)
Jun, Thien Jun
Objectives: This study was done to estimate the level of serum anti-Müllerian hormone (AMH) in patients with polycystic ovary syndrome (PCOS) and to correlate serum AMH level with insulin resistance, lipid profile and adiponectin levels. Study design: This cross sectional study was conducted at Hospital Universiti Sains Malaysia (HUSM), Health Campus, Kubang Kerian, Kelantan, Malaysia. Total of thirty (30) women (aged 18-40 years old) diagnosed with PCOS were recruited from patients attending gynaecology clinic between July 2016 and April 2017. Fasting venous blood sample were collected from all subjects. Serum AMH, insulin, adiponectin, triglycerides, high-density lipoprotein cholesterol (HDL-C), and plasma glucose levels were measured. Insulin resistance was calculated based on homeostasis model of assessment-insulin resistance (HOMA-IR). The serum AMH level was estimated by using descriptive analysis and the correlation of serum AMH level with the metabolic parameters were analysed by using either Pearson correlation or Spearman correlation. Results: The median of serum AMH levels in women with PCOS was 6.8 ng/mL (IQR: 7.38 ng/mL). There was a significant negative correlation between serum AMH and HOMA-IR or triglycerides levels (r = -0.49, p = 0.006 and r = -0.55, p = 0.002, respectively). A significant positive correlation was observed between serum AMH and serum HDL-C or serum adiponectin levels (r = 0.56, p = 0.001 and r = 0.44, p = 0.014, respectively) in all study subjects. Conclusion: The serum AMH level in patients with PCOS is associated with HOMA-IR, triglycerides, HDL-C and adiponectin levels. Therefore, this pilot study suggested that AMH may be used as a potential cardiometabolic risk marker in women with PCOS.
A pilot study on Pedsql™ modul impak keluarga among caregivers of children with transfusion dependant thalassaemia in Hospital USM, Malaysia.
(2013)
Tan, Suria Emilia Suhana Othman
Thalassaemia is one of the commonest genetic blood disorders worldwide (Cao et al., v v Approximately 240 million people are heterozygous for [3-thalassaemia and estimated 200.000 affected homozygous are born each year(Cao et al., 2007). In Malaysia, it was estimated that around 150 to 350 babies were born with thalassaemia each year (Ismail et al., 2006). A child with beta thalassemia usually is well at birth, but they will develop progressive anemia due to partial or total absence in hemoglobin, which will lead to early death without blood transfusion. In those who survive, the condition imposes serious implications on their health and quality of life as well as their families. Parents of children with transfusion dependant thalassaemia need to accompany their child for monthly blood transfusion in which they usually spend the whole day in the hospital. The children need to come in the morning for blood investigations to check for hemoglobin level and blood cross match and then, they need to wait for the blood products to be available. Usually, this process takes about two to three hours but it may be prolonged if there is a problem with the children's blood. For example, if the children develop autoantibodies towards the red blood cell, the blood bank needs to do further test to find the most suitable blood for the child. It may take another one or two days depending on the availability of blood and severity of the autoantibodies. Thus, the parents need to bring the child home first and then bring back the child to the hospital once the blood is ready. For the uncomplicated situation, the children need to wait for two to three hours for blood cross matching and then only the blood transfusion can be started. The duration for each transfusion usually takes about 4 hours. The children also need frequent iron chelation therapy in order to reduce the impact of transfusion-related toxicity due to iron overload. This iron chelation therapy is available in subcutaneous and oral form. Unfortunately, this therapy also has its own adverse effects and limitations that contribute to noncompliance to the drugs. Patient who does not comply to iron chelation therapy often develop various complications such as cardiomyopathy, endocrinopathy, infection, coagulopathy, liver toxicity and others that might compromising the child and family quality of life further. Currently, only successful hematopoietic stem cell transplant (HSCT) can offer a permanent cure but it is limited by HLA-matched sibling donor and procedure related complication (Cheuk et al., 2008). Thus, parents of these children are exposed to protracted physical and emotional suffering because of their children’s devastating health problem leading to disruption of their normal psychosocial life. Previous literature has mainly focused on assessing health-related quality of life in children with beta thalassaemia but less is known about their parents and families (Ismail et al., 2006; Dahlui et al., 2009; Clarke et al., 2010). Findings of studies conducted elsewhere might not be the reflection of true Malaysian due to difference in their ethnicity, religion and socioeconomic background of the family. Therefore, this study was conducted to look at the impact of having a child with beta thalassaemia on the parents’ health-related quality of life (HRQOL) and family functioning in Kelantan.
A prospective diagnostic study on the use of narrow band imaging on suspiscious lesions during colonoscopic examination in Hospital Universiti Sains Malaysia.
(2013)
Yaacob, Huzairi
Colonoscopy is the gold standard to detect colorectal neoplasm. There have been multiple attempts to improve diagnostic accuracy partly by image improvement and one of them is narrow band imaging. Based on published reports that NBI have the good diagnostic accuracy, the usage of NBI in differentiating neoplastic and non-neoplastic colorectal lesions was carried out in our hospital (HUSM) for the first time. OBJECTIVE: To explore the diagnostic validity of NBI colonoscopy as well as associated factors related to the neoplastic and non-neoplastic colorectallesions. METHOD: One hundred patients who came mainly for screening colonoscopy with variable lower gastrointestinal symptoms that have suspicious colorectal lesions were included in this study. Only one ofthe most suspicious lesions in each patient (n=IOO) was analyzed using NBI colonoscopy based on Sano' s classification. These lesions were then either biopsied or resected for histopathological analysis. Endoscopic images were captured electronically and allocated for single reader evaluation. Sensitivity, specificity and diagnostic accuracy of the NBI colonoscopy was assess by comparing it to histopathology results. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly. RESULTS: ROC analysis showed that the sensitivity and specificity of the NBI were 88.2% and 71.9% respectively. The analysis also showed that the area under ROC was 0.801, indicating good level of discriminative ability of NBI to differentiate between disease and non-disease. Bowel preparation failed to reach significant association with NBI outcomes; therefore this study suggests that suboptimal bowel preparation is adequate to obtain good outputs of NBIcolonoscopy. There were significant association between LOW and site of lesions to the HPE outcomes even after controlling other variables (p
A prospective study on the effects of Different methadone dosages on qtc Interval in opiate dependent individuals Receiving methadone maintenance therapy (mmt).
(2012-05)
Azlie Hassan
A PROSPECTIVE STUDY ON THE EFFECTS OF DIFFERENT METHADONE DOSAGES ON QTc INTERVAL AMONG OPIATE DEPENDENT INDIVIDUALS RECEIVING METHADONE MAINTENANCE THERAPY (MMT). Methadone is an effective treatment for opioid dependence and chronic pain. However, recent evidence suggests it also prolongs the QTc interval, resulting in torsade de pointes (TdP), a prerequisite to fatal cardiac arrhythmia, ventricular fibrillation (VF). Although higher doses of methadone are clearly more efficacious in reducing illicit opioid abuse, arrhythmia risk appears to increase in parallel creating an efficacy-safety paradox. This study investigates the effects of different methadone dosages on the QTc interval in opioid dependent individuals undergoing MMT over an eight week period. To compare the QTc interval duration between low and high dose methadone groups. To determine the correlation between QTc interval and different methadone doses. To determine the proportion of prolonged QTc interval amongst methadone treated patients at different methadone dosages. To determine the association of prolonged QTc interval between low and high dose methadone groups. A prospective cohort study for a six months duration was done from June until December 2010 on eligible subjects undergoing Methadone Maintenance Therapy (MMT) in HUSM. The QTc intervals were measured at the beginning of the study (week 0) and measured again during follow up at week 4 and week 8 of study period. Serum potassium, calcium and magnesium along with serum methadone levels were also measured at each visit. The association between prolonged QTc interval and different methadone dose groups as well as other parameters was analyzed using SPSS version 18.0. There were 46 patients enrolled into the study during the study period. No patient had a QTc interval of more than 500 ms during the study period. There were no statistically significant correlation between QTc interval and both clinical dose and plasma methadone level (r = 0.22,/? = 0.148 and r = 0.08,/? = 0.617 respectively). There was a marginally significant association between prolonged QTc interval and methadone dose group at week 0 [p = 0.044, OR 4.29 (0.98,18.72. In week 4, there was a significant association between prolonged QTc interval and methadone dose [p - 0.013, OR 5.18 (1.34,20.06)]. However, the QTc interval prolongation was not associated with different methadone dose in week 8 [p = 0.139, OR 2.44 (0.74,8.01)]. Further analysis with RM ANOVA revealed a significant increase of QTc interval over time (p = 0.005). We concluded that opiate dependent individuals who received MMT showed a progressive QTc interval prolongation over the course of methadone treatment. Subjects who were receiving methadone dose of greater than 80 mg per day are more likely to develop prolonged QTc interval compared to subjects receiving less than 80 mg of methadone daily. However, the effects of the different methadone dosages on QTc interval were not consistent throughout the study period, suggesting the complex and fluctuating nature of methadone induced QTc interval prolongation even when the dose remained constant.
A qualitative study on active ageing and development of active ageing questionnaire among the elderly in Malaysia
(2018-04)
Esa, Wafaak
Background: Active ageing is a conceptual understanding of ageing well and may affect on the quality of life. Therefore accurate measurement of active ageing is important in health of the elderly. Objective: To explore the perception, determinants, and to develop and validate an instrument measuring level of active ageing among the elderly in Malaysia. Method: Phase 1: A qualitative study using phenomenology tradition was carried out in all five regions of Malaysia. A purposive sampling was applied among the members of Persatuan Pesara Kerajaan and Kelab Warga Emas. Data was collected through nine focus group discussions and 19 in-depth interviews. Thematic analysis was carried out. Phase 2: Result from phase 1 informed development of the scale, Active Ageing Questionnaire. Three domains with 82 items were developed and went through content and face validation. Construct, criterion validation and reliability test were carried out on 302 elderly. Convenient sampling was applied among members of same organisations. World Health Organization Quality of Life Assessment Brief Version in Malay language was also used for criterion validation. Content validation index, face validation index, exploratory factor analysis, Pearson Correlation and Cronbach’s Alpha analysis were carried out. Results: The participants were mixture of multiracial, gender and between 60 to 80 years old. Three emergent themes of active ageing were independence, participation and positive emotion effect. In Malaysia, active ageing is a process of doing activity independently, as a continuity and optimisation of life through participation which bring benefit to the self, family and community, and resulting in a positive emotional effect to life. These informed the Active Ageing Questionnaire development which showed an excellent content and face validation index. Three factors, independent, participation and satisfaction, were extracted with 20 items each. There were significant positive strong correlations between Active Ageing Questionnaire score and World Health Organization Quality of Life Assessment Brief Version score. The Cronbach’s Alpha value was 0.96 for overall value; for independence, participation and satisfaction domain these were 0.95, 0.93 and 0.92 respectively. Conclusion: The conceptual active ageing understanding among Malaysia’s elderly is multidimensional and has similarities to the model by World Health Organization. There is a complex interaction between body and environment. The Active Ageing Questionnaire showed a good validity and reliability for measuring active ageing level among elderly in Malaysia. This will allow measurement of active ageing to inform policy development.
A randomized controlled trial on the use of Budesonide/formoterol (symbicortr) as an alternative Reliever medication for mild to moderate asthmatic attack in Adult patients in emergency department, hospital universiti Sains malaysia.
(2012-05)
Hamizah Kamarudin
A RANDOMIZED CONTROLLED TRIAL ON THE USE OF BUDESONIDE/FORMOTEROL (SYMBICORT®) AS AN ALTERNATIVE RELIEVER MEDICATION FOR MILD TO MODERATE ASTHMATIC ATTACK IN ADULT PATIENTS IN EMERGENCY DEPARTMENT, HOSPITAL UNFVERSITI SAINS MALAYSIA. Nebulized Salbutamol has been commonly used as the conventional reliever in the treatment of patients with acute exacerbations of asthma regardless of whether in outpatient clinic settings or in the emergency departments. On the other hand, Symbicort turbuhaler is a combination of Formoterol (long acting 02- agonist) and Budesonide (steroid). Salbutamol and Formoterol are 02-agonist that acts as bronchodilators, but Salbutamol is a short acting 02-agonist, whereas Formoterol is a long acting 02-agonist. Budesonide is a steroid that plays a role as an anti-inflammatory agent that usually occur in acute asthma attack. This research is done to evaluate the effectiveness of Symbicort turbuhaler which is a combined long acting 02-agonist and steroid as an alternative reliever in mild to moderate acute axacerbation of bronchial asthma and to look at patient’s acceptance regarding the use of Symbicort turbuhaler and the feasibility in starting Symbicort maintanance and reliever therapy (SMART) in emergency department. To evaluate the effectiveness of Symbicort therapy as an alternative reliever in treating mild to moderate acute exacerbation of bronchial asthma. To evaluate control of asthma based on Asthma Control Test (ACT) among adult asthmatic patients that presented to emergency department HUSM. To evaluate the effectiveness of Symbicort turbuhaler as an alternative treatment for mild to moderate asthma exacerbation by using respiratory rate, oxygen saturation and peak expiratory flow rate (PEFR) as objective assessment tools for the severity of asthmatic attack and patient’s response to treatment. To evaluate the effectiveness of symbicort turbuhaler as an alternative treatment for mild to moderate asthma exacerbation by using Visual Analog Score (VAS) and 5-point Likert Scale of breathlessness as subjective assessment tools for the severity of asthmatic attack and patient’s response to treatment. To understand patient’s acceptance regarding the use of Symbicort turbuhaler as an acute asthma reliever and maintainance therapy (SMART). To evaluate the fraction exhaled nitric oxide (FENO) level in asthmatic patient and its association with asthma control. A randomized controlled trial was done from March until August 2011 between nebulizer Salbutamol and Symbicort turbuhaler in adult patients with mild to moderate acute exacerbation of bronchial asthma who presented to Emergency Department HUSM. Patients who fulfilled the criteria and agreed to participate in this study were randomly assigned either nebulizer Salbutamol or Symbicort turbuhaler as the treatment. Objective and clinical parameters such as respiratory rate (RR), oxygen saturation (SPO2), peak expiratory flow rate (PEFR) and fraction of exhale nitric oxide (FENO) were recorded before and after treatment. Parameters were analyzed using SPSS version 18.0. A total of 32 patients fulfilled the inclusion criteria and consented to participate in this study. After randomization, 17 patients were chosen to receive nebulized salbutamol and another 15 patients received symbicort turbuhaler. There were significant improvements in respiratory rate (RR), oxygen saturation (SPO2) and PEFR in patients received symbicort turbuhler (p=0.001, p=0.027 and p=<0.001 respectively). This result is as significant as patients received nebulized salbutamol. When comparing the means difference between this two groups using ‘Independence ttest’, it showed that there were no significant difference in terms of changes in respiratory rate, SPO2 and PEFR (p=0.687,p=0.350 and p=0.507 respectively). In terms of subjective parameters using ‘Visual Analog Score’ and ‘5-point Likert Scale’ of breathlessness, it also showed that there were no significant difference in patients who received symbicort turbuhaler or nebulized salbutamol (p=0.765 and p=0.688 respectively). Regarding asthma control based on Asthma Control Test (ACT) score, by using Me Nemar test, there were no significant difference in asthma control in patients started on SMART therapy or with MDI salbutamol plus MDI budesonide (p=0.754). We also found that SMART therapy were well accepted by most of the patients based on questionnaires answered. From this randomized controlled trial study, it showed that symbicort turbuhaler can be used as an alternative treatment for patients with mild to moderate exacerbation of asthma as there were no significant difference improvements in objective parameters and in subjective parameters compared to nebulized salbutamol.
A retrospective review of ranson score versus apache-ii score in predicting outcomes of acute pancreatitis in Hospital Universiti Sains Malaysia.
(2013)
Mokhter, Wan Muhamad Mokhzani Wan Muhamad
Acute pancreatitis is a common and potentially lethal inflammatory process with a highly variable clinical course. Persistent organ failure develops in 10-20% of patients, with mortality reaching 30% in this subgroup. It is therefore important to identify patients with acute pancreatitis who are at risk for developing persistent organ failure early in the course of the disease. Ranson score and APACHE-II system are two of the many scoring systems utilized for predicting acute pancreatitis with adverse outcomes. The present study is aimed at assessing both scoring system for its sensitivity, specificity, PPV, NPV and comparing them using the relevant statistical tools to assess and determine which system is better at predicting outcomes of patients with acute pancreatitis presenting to Hospital Universiti Sains Malaysia between 2007 to 2011. Case notes of 156 patients with acute pancreatitis were reviewed retrospectively, Ranson score and APACHE-II score are assigned according to the relevant parameters and outcome is documented for each case. Ranson score is categorically assigned as mild (score less than 3) or severe (score equal to or more than 3) and APACHE-II score as mild (score less than 10) or severe (score equal to or more thanlO). Outcome is also categorically assigned as good (patient discharged from hospital) or poor (patient requires ICU admission, intervention either surgical or radiological and death). Chi-squared test was used to determine association of each test with outcomes and kappa-test was applied to determine strength of relationship for each test with outcomes of acute pancreatitis. Both Ranson score equal to or more than 3 and APACHE-II score equal to or more than 10 are associated with poor outcome of acute pancreatitis in the study cohort (p<0.01). The sensitivity and specificity for Ranson score or equal to or more than 3 is 94.1% and 68.3% respectively (PPV 26.7%. NPV 99.0%). The sensitivity and specificity for APACHE-II score equal to or more than 10 is 70.6% and 90.6% respectively (PPV 48.0%, NPV 96.2%). The kappa value for Ranson score is 0.30 (fair relationship) and kappa value for APACHE-II score is 0.51 (moderate relationship).
A retrospective study (2009-2018) on the outcome of uncomplicated twin pregnancies in Hospital Sultan Ismail Johor Bahru : the association between gestational age at delivery and the neonatal outcomes
(2020)
Nor, Nurliza Md
Introduction: The incidence of twin pregnancy is increasing worldwide1, and so does in Malaysia. It is associated with a higher risk of morbidity and mortality throughout pregnancy to both mother and fetus. This study aims to determine the maternal and fetal characteristic of twin pregnancies in Hospital Sultan Ismail Johor Bahru (HSIJB) and to observe the association between the gestational age at delivery and the delivery outcomes in uncomplicated twin pregnancies. Methodology: This is a retrospective observational study of women with uncomplicated monochorionic and dichorionic twin pregnancies delivered at 36 completed weeks or beyond from January 2009 until December 2018 in HSIJB. The data is divided into 36 weeks group, 37 weeks group, and ≥38 weeks group. The maternal demographic and pregnancy characteristics were observed. The primary outcome was neonatal composite morbidity, which was defined as having one or more of the following: neonatal intensive care unit's admission, low Apgar score, the requirement of mechanical ventilator support, respiratory distress syndrome, and stillbirth or perinatal/ neonatal mortality. The optimal gestational age for delivery according to chorionicity is determine based on the neonatal composite morbidity. Results: A total of 949 sets of twins delivered at HSIJB over ten years, from which 360 women with uncomplicated twin pregnancies and 720 neonatal outcomes were eligible for the study (144 DCDA and 216 MCDA). In DCDA twins, the composite morbidity was least in the 37 weeks group, followed by the ≥ 38 weeks group and then 36 weeks group. On the contrary, more composite morbidity wasseen in the MCDA twinning group at 36 weeks group, followed by the 37 weeks group and later in ≥ 38 weeks group. However, the association between the gestational age at delivery with composite morbidity in MCDA twin were insignificant. Conclusion: Our data suggest that the optimal gestational age for delivery in uncomplicated DCDA twins was at 37 weeks and MCDA twins at ≥38 weeks.
A retrospective study on survival analysis and its prognostic factors of prostate cancer patients in Hospital Universiti Sains Malaysia
(2020)
Lutfi, Ahmad Firdaus Ahmad
Background: Prostate cancer is a leading cause of male morbidity and mortality globally and in Malaysia. This study assessed the five-year survival and prognostic factors among prostate cancer patients in Hospital USM, Kelantan. Methodology: We reviewed 150 medical records of patients diagnosed with prostate cancer, from 2009 to 2014. Survival time was analyzed in relation of patient demographics, Gleason score, ASA classification, ECOG scores, PSA level, family history, cancer staging, cancerrelated hematological parameters, and treatment method. Kaplan-Meier survival curves and Cox proportional hazards models are used for the analysis. Results: The prostate cancer five-year survival rate was 84.5%. Overall Kaplan-Meier survival curve showed good median survival times. Univariate regression analysis revealed significant prognostic factors including age (HR=1.06, 95% CI:1.00, 1.11, p=0.034), ASA 3 classification (HR=3.72, 95% CI:1.38, 10.00, p=0.009), ECOG score 2 (HR=17.98, 95% CI:3.98, 81.1, p<0.001), ECOG 3 (HR=33.94, 95% CI:7.41, 150.0, p<0.001), anemia (HR=9.07, 95% CI:3.33, 24.6, p<0.001), High LDH (HR=5.37, 95% CI:1.80, 15.90, p=0.003), High ALP (HR=8.94, 95% CI:3.31, 24.1, p<0.001), Nodular staging (HR=5.87, 95% CI:1.74, 19.85, p=0.004), Metastasis (HR=3.48, 95% CI:1.28, 9.44, p=0.014), Androgen Deprivation Therapy (HR= 0.29, 95% CI:0.08, 0.99, p=0.05) and Chemotherapy (HR=4.57, 95% CI:1.79, 11.6, p=0.001). Conclusion: The five-year survival rate of HUSM patients treated for prostate cancer was 84.5%. The survival rate reduces significantly due to prognostic factors like age, ASA classification, ECOG score, some hematological parameters, cancer staging and chemotherapy. However, patients received the ADT have a better survival rate, which suggests the main role of prompt initiation of the therapy in improving patient survival.

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