Pusat Pengajian Sains Perubatan - Tesis
Browse
Browsing Pusat Pengajian Sains Perubatan - Tesis by Type "thesis"
Now showing 1 - 20 of 39
Results Per Page
Sort Options
- PublicationA 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 SongA 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.
- PublicationA 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 MdIntroduction: 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.
- PublicationA retrospective study on survival analysis and its prognostic factors of prostate cancer patients in Hospital Universiti Sains Malaysia(2020)Lutfi, Ahmad Firdaus AhmadBackground: 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.
- PublicationA study on dengue fever presentation and outcome in Hospital Universiti Sains Malaysia(2020)Ismail, Abdullah LutfiDengue fever is one of the most endemic infectious disease in Malaysia and the number of cases increases each year. Patients may present in various phases and forms of dengue, which can progress to severe dengue. The aims of this study were to determine the presentations of dengue infection and factors associated with severe complications. Methods: This retrospective study involved patients aged 12 years and above with positive dengue infection presented to emergency department in our tertiary, suburban hospital and admitted, from year 2016-2018. Patients sociodemographic patterns, presentation and complications of dengue were identified. Factors associated with severe dengue were determined. Results: A total of 327 cases were included, with 66 patients (20.2%) contracted severe dengue. Most common symptoms was loss of appetite (75.2%), followed by fever (65.7%) and vomiting (55.7%). Most common complication was dengue shock syndrome (18.3%) followed by respiratory distress (1.2%). Factors predictive of severe dengue include shortness of breath (AOR 5.82, 95% CI 1.37-24.69, p=0.017), diarrhoea (AOR 0.49, 95% CI 0.27-0.91, p=0.023), tachycardia (AOR 2.85,95% CI 1.59-5.10, p=0.001 and hepatomegaly (AOR 2.76, 95% CI 1.24-6.18, p=0.013). Conclusions: Identifying factors predictive of severe dengue may help physicians in prioritizing the patients care and anticipate deterioration and complications. Factors associated with severe dengue in this study were shortness of breath, diarrhea, tachycardia and hepatomegaly.
- PublicationAn assessment of optic nerve parameters in Malay normal tension glaucoma and Primary open angle glaucoma patients.(2012)Adlina Abdul RahimThe recent availability of retinal imaging device plays an important role to differentiate the appearance of optic nerve in normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) patients. There no published literature of these two group of glaucoma in patients of Malay ethnicity, or even those who are living in South East Asian areas. To compare optic nerve head parameters among Malay NTG and POAG patients using HR.T III analysis. A comparative cross sectional study was carried out from November 2010 till February 2012 in two hospitals with availability of glaucoma service. A total of 154 eyes of 154 Malay patients were included in this study; 32 NTG patients, 45 POAG patients and 77 control group. All participants underwent a thorough ocular examination including visual acuity, subjective refraction, anterior segment and fundus examinations, Humphrey visual field 24-2, intraocular pressure measurement, gonioscopy examination and fundus photography. An assessment of optic nerve head parameters was conducted using FIRT III by an identified masked investigator in each hospital. Comparison of these two glaucoma groups was further analyzed according to the appearance on cup disc ratio on clinical assessment and AGIS scoring system. Both glaucoma groups had notably larger discs, larger cupping, smaller retinal rims area and thinner nerve fiber layers when compared to the control group (p<0.05). NTG patients revealed larger disc and cup areas when compared to the POAG patients (the mean (SD) for disc area was 2.65 (0.41) mm2 NTG group, and 2.40 (0.36) mm2 in POAG group, p = 0.006; the mean cup area (SD) of NTG patients was 1.54 (0.43) mm2 and 1.32 (0.40) mm2 in POAG group, p = 0.027). This observation was also parallel when they were further analyzed according to the severity of glaucoma in both studied groups. The optic nerve head parameters are significantly different in Malay NTG and POAG patients when compared to healthy individuals. Disc and cup areas are significantly larger in Malay NTG compared to POAG patients, while the other parameters are comparable in both groups
- PublicationAnalysis of brain activation and effective connectivity during self-paced unilateral and bilateral finger tapping using functional magnetic resonance imaging in patients with temporal lobe epilepsy(2021)Yusoff, Bazli MdBackground: Temporal lobe is the most frequent site of origin of partial seizures. Patients with Temporal Lobe Epilepsy (TLE) represent approximately two thirds of the intractable seizure population. Objectives: This study aims to compare the area of activation in between Healthy subjects and Temporal Lobe Epilepsy (TLE) patients as a result of increase in blood oxygen level in different parts of the brain during self-paced unilateral and bilateral finger tapping. In addition, this study also aims to compare the effective connectivity in between region of interest in Healthy subjects and TLE patients during self-paced unilateral and bilateral finger tapping. Methodology: This study involves 12 healthy subjects and 12 TLE patients. All of them undergone functional magnetic resonance imaging (fMRI) where they performed self-paced unilateral and bilateral finger tapping. The images were then pre-processed and undergone first level analysis using Statistical Parametric Mapping (SPM). Second level analysis were then performed to compare the area of activation in Healthy subjects and TLE patients. For effective connectivity, two regions of interest chosen which representing visual and motor region. Three models tested in between each region of interest which are bidirectional, visual to motor and motor to visual. These tests were conducted in each brain hemispheres of both Healthy subjects and TLE patients. Results: In both Healthy subjects and TLE patients, first level analysis showed intense activation at the visual area. Second level analysis was performed comparing the two group of samples, using two samples t-test, FWE p < 0.05, Healthy subjects showed more areas of significant activation. For effective connectivity, two regions of interest were tested, visual area and motor area. Three models were tested, bidirectional, visual to motor, and motor to visual. In healthy subjects, visual to motor was the dominant model with average value of 0.03Hz bilaterally. In TLE subjects, on the right hemisphere, a contrary result was observed whereby motor to visual area was the dominant model. On the left hemisphere, the same model as healthy subjects was the dominant model, visual to motor, but with higher average value of 0.1Hz. Conclusion: This study found that there was less area of brain that has significant activation in TLE patients during motor activity. TLE brains also exhibit different effective connectivity whereby in the right hemisphere, motor area exerts more influence on the visual area and in the left hemisphere, visual area exerts significantly more influence on the motor area. These findings suggest that there is alteration of the motor networks in TLE patients.
- PublicationAssociation of genetic polymorphisms and their attributing factors with lipid profiles among outpatient statin users in Hospital USM(2022-07)Shamsudin, Amirul FaezStatins, or 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, are routinely used to lower lipid levels primarily low-density lipoprotein cholesterol (LDL-c). Treatment guidelines recommend LDL-c as the primary target of therapy in hyperlipidaemic patients. Inter-individual variation in LDL-c-lowering efficacy and side effects of statins are due to genetic polymorphisms and environmental factors. However, pharmacogenetics studies on the effects of the aforementioned factors on the lipid profiles of statin users in Malaysia are still lacking. We evaluated the association of patient’s genetic polymorphisms, demographic profiles, and clinical factors with lipid profiles among outpatient statin users from Hospital Universiti Sains Malaysia (HUSM). In a cross-sectional retrospective study, a total of 229 hyperlipidaemic statin users were recruited and the patients' genotypes for eight single nucleotide polymorphisms (SNPs) in seven candidate genes were determined using the polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) method and validated by sequencing analysis. Using a dominant genetic model, an independent t-test was used to compare total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), LDL-c and triglycerides (TG), and the results with significant differences were stratified according to gender. A multiple binary logistic regression model was conducted, with LDL-c < 2.6 mmol/L at the endpoint serving as the dependent variable while other explanatory factors as independent variables. Minor allele frequency (MAF) of the studied SNPs as follow; CETP rs708272 = 0.39, ABCG2 rs2231142 = 0.12, ABCC2 rs717620= 0.58, APOE E4 = 0.35, GATM rs9806699 = 0.63, COQ2 rs4693075= 0.96, and APOA5 rs662799= 0.45. Only CETP rs708272 and COQ2 rs4693075 were matched to the MAF of the reference population (i.e., East Asian populations) obtained from the ENSEMBLE database (P>0.05). Of all SNPs genotyped, two SNPs (CETP rs708272 and ABCG2 rs2231142) were associated with baseline lipid parameters. At the baseline before statin treatment, female minor allele carriers of CETP rs708272 were associated with higher LDL-c (4.02 ± 1.44 mmol/L vs 3.44 ± 0.84 mmol/L, P=0.007) and lower TG levels (1.52 ± 0.63 mmol/L vs 1.90 ± 0.98 mmol/L, P=0.044). ABCG2 rs2231142 was associated with higher HDL-c levels in both overall (1.38 ± 0.37 mmol/L vs 1.25 ± 0.26 mmol/L, P=0.035) and females group (1.49 ± 0.38 mmol/L vs 1.33 ± 0.27 mmol/L, P=0.047). After the initiation of statin treatment, two SNPs (ABCC2 rs717620 and APOA5 rs662799) were associated with anti-atherogenic effects. In particular, ABCC2 rs717620 was associated with significant reduction of TG levels in the overall (1.48 ± 0.75 mmol/L vs 2.17 ± 1.14 mmol/L, P=0.009) and males group (1.48 ± 0.85 mmol/L vs 2.40 ±0.91 mmol/L, P=0.006). Similarly in males, minor allele carriers of APOA5 rs662799 resulted in higher HDL-c (1.20 ± 0.25 mmol/L vs 1.07 ± 0.15 mmol/L, P=0.006) and lower TG levels (1.42 ± 0.81 mmol/L vs 1.69 ± 0.75 mmol/L, P=0.038). In the multiple binary logistic regression analysis, only pravastatin users independently predicted patient’s achieving LDL-target of <2.6 mmol/L (P=0.040, OR=0.110). In conclusion, CETP rs708272 and ABCG2 rs2231142 determined the baseline lipid differences in females, whereas ABCC2 rs717620 and APOA5 rs662799 determined the lipid differences after statin initiation in males group.
- PublicationBrain activation changes during positive and neutral emotion regulation task following brief mindfulness: an fMRI study(2022-05)Balakrishnan, Dhiviya GopalIntroduction: Mindfulness is used to bring awareness and focus to a present state of mind. It also enhances positive emotion where people with a mindfulness state have control of their emotion and reduces the regulation of negative emotion. Objective: This study focuses to identify the associated brain activation of positive and neutral emotion regulation task following brief mindfulness exercises. Methodology: This study focuses on the healthy and young adult population. A neurotechnology tool is used which is functional magnetic resonance imaging (fMRI) to identify the brain activation of positive and neutral emotions. The positive and neutral emotion regulation task which was measured during the pre and post task consisted of positive word and neutral word stimuli which are extracted from Affective Norms for English Words (ANEW). Mindfulness state is assessed using the Mindful Attention Awareness Scale (MAAS) and the affect of the positive emotion regulation task is assessed using the Positive Affect and Negative Affect Scale – Expanded (PANAS-X). Results: Six participants were included in this study. The mindfulness group for positive emotion showed activation in the inferior frontal operculum, tri – inferior frontal, superior frontal and calcarine, while the neutral emotion showed activation in Rolandic operculum, postcentral gyri, calcarine and precentral gyri. The response time for both groups was insignificant (p > 0.05) but displayed a large size effect over the post-task. The positive effect for both groups was insignificant (p > Introduction: Mindfulness is used to bring awareness and focus to a present state of mind. It also enhances positive emotion where people with a mindfulness state have control of their emotion and reduces the regulation of negative emotion. Objective: This study focuses to identify the associated brain activation of positive and neutral emotion regulation task following brief mindfulness exercises. Methodology: This study focuses on the healthy and young adult population. A neurotechnology tool is used which is functional magnetic resonance imaging (fMRI) to identify the brain activation of positive and neutral emotions. The positive and neutral emotion regulation task which was measured during the pre and post task consisted of positive word and neutral word stimuli which are extracted from Affective Norms for English Words (ANEW). Mindfulness state is assessed using the Mindful Attention Awareness Scale (MAAS) and the affect of the positive emotion regulation task is assessed using the Positive Affect and Negative Affect Scale – Expanded (PANAS-X). Results: Six participants were included in this study. The mindfulness group for positive emotion showed activation in the inferior frontal operculum, tri – inferior frontal, superior frontal and calcarine, while the neutral emotion showed activation in Rolandic operculum, postcentral gyri, calcarine and precentral gyri. The response time for both groups was insignificant (p > 0.05) but displayed a large size effect over the post-task. The positive effect for both groups was insignificant (p > 0.05) but the audiobook group, showed a medium size effect while the mindfulness group showed a large size effect in the positive affect of PANAS – X. Conclusion: Visual, motor, and language had higher activation which would be defined by the presence of the audiobook and mindfulness audio and word stimuli while the mindfulness audio group showed a slight regulation of positive emotion. The small sample size showed the reduced efficiency of the results, but the large effect size indicated that differences in response time and positive effects are worth to be conducted in future studies. The study is suggested to be expanded to all age groups. In this preliminary study, a brief mindfulness exercise with 15 minutes time frame was able to identify the emotional effect on an individual.
- PublicationChildhood atopic eczema: children’s Quality of life and family impact.(2012)Ahmad Abir Ab GhaniChildhood atopic eczema accounted 40% of the referral to pediatric dermatology clinic in Malaysia. One of the most important issues that should be discussed during outpatient hospital based clinic is health related quality of life (HRQOL). HRQOL was defined as a broad multidimensional concept that usually includes self-reported measures of physical and mental health. The current study was aimed to determine the quality of life of children with atopic eczema, impact of atopic eczema to the family and associated factors for children’s quality-of-life. A cross-sectional study conducted at Dermatology clinic, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia from January 2010 to January 2011. Children who were diagnosed as atopic eczema, aged between 5 and 18 years and fulfilled the inclusion and exclusion criteria were selected using systematic random sampling. Qualityof- life (Qol) was measured using CDLQI. Family Impact was measured using DFI. The Children’s Dermatology Life Quality Index (CDLQI) and Dermatology Family Impact (DFI) questionnaires were specifically designed to measure Qol of children with atopic eczema and the family impact of the similar disease. Data were analyzed according to distributions. Descriptive analyses were done for quality of life and family impact score and univariate and multivariate analyses were done to determine associated factors for Qol. Results: A total of 110 participants with 100% response rate entered this study. Majority of subjects suffered mild to moderate disease which comprised of 30.9% and 62.7%, respectively. Only 6.4% had severe atopic eczema. The median (IQR) for quality of life and family impact score was 8.0 (8.0) and 7.0 (9.0), respectively. Disease severity was the significant associated factor for quality of life in childhood atopic eczema. Regression analyses showed that 15% of the variance in quality of life score could be explained by disease severity score. In the present study, the overall children’s quality of life was not impaired because not all the items in the children’s quality of life were equally affected. Childhood atopic eczema also had no impact on family life as majority of parents perceived the disease was not severe. The only significant associated factor for children’s quality of life was disease severity. Measurement of HRQOL among childhood atopic eczema should be done along with objective disease severity assessment.
- PublicationComparison of ease of intubation in patients using C-MAC D-Blade between simulated cormack lehane 1 and 2 videolaryngoscopic view : a randomised controlled trial(2020)Semanat, Ahmad ShamilBackground: Difficult intubation could result in both morbidity and mortality. Current surging popularity with videolaryngoscope such as C-MAC D-Blade can reduce the risk of complications associated with difficult intubation. Despite showing good glottis view, the unique laryngoscope shape could pose a problem during tracheal intubation. Having a lesser appearance of the glottis may hypothetically ease the endotracheal tube delivery. This study compares the ease of intubation in patients using C-MAC D-Blade between simulated Cormack Lehane 1 and 2 videolaryngoscopic view among adult patient undergoing elective surgery. Methods: 94 adults with no features of difficult intubation undergoing elective surgical procedures in Hospital Universiti Sains Malaysia Kelantan were recruited and randomly assigned to two groups either A for Cormack Lehane 1 (n=46) or B for Cormack Lehane 2 (n=48) videolaryngoscopic view. The outcome measured include duration of intubations, number of intubation attempts, and easiness of intubations. Results: Duration of intubation was less (7.7 ± 1.93s) in Group B than in Group A (9.2 ± 2.49s) with a mean difference of 1.4s (95% CI=0.53, 2.35, p=0.002). There is no significant difference between the two groups in terms of the number of intubation attempts (p=0.322) and easiness of intubation (p=0.78). Conclusion: Cormack-Lehane 2 videolaryngoscopic view significantly reduce time to intubation compared to Cormack-Lehane 1 videolaryngoscopic view when using C-MAC D-Blade.
- PublicationComparison of the efficacy of intravenous oxycodone versus morphine on postoperative pain following orthopaedics surgery under general anaesthesia(2020)Sim, Chua BoonBackground Acute, severe postoperative pain is common following orthopaedics surgery and morphine is the commonest used intravenous opioid. The introduction of intravenous (IV) oxycodone has replaced morphine as the first choice of opioid used in postoperative pain management in some countries. The aim of this study is to assess the efficacy of IV oxycodone versus morphine on postoperative pain following orthopaedics surgery under general anaesthesia. Methods Fifty-eight American Society of Anesthesiologists (ASA) physical status I–II patients were randomly assigned to receive either 0.08 mg/kg IV oxycodone (Group O, n = 29) or 0.08 mg/kg morphine (Group M, n = 29) at the starting of skin closure. Postoperative pain was evaluated using a visual analogue scale (VAS) from at 0 min, hourly till 6th hour postoperatively. The time to first rescue analgesia, requirement of the first and second rescue analgesia and adverse effects were assessed. Results Postoperative pain score did not differ significantly in Group O and Group M from 0 min, hourly till 6th hour postoperatively (P > 0.950). There were no significant differences in the time to first rescue analgesia (P = 0.721), requirement of first (P = 0.594) and second rescue analgesia (P = 0.517) and adverse effects in both groups. Conclusion Intravenous oxycodone is equipotent to morphine in treating acute postoperative pain following orthopaedics surgery, and it is not associated with an increased risk of opioid related adverse events.
- PublicationEffect of electronic medical record utilization on Depression, anxiety and stress among doctors and Nurses in johor.(2012)Ahmad Fairuz MohamedHealthcare systems throughout the world and in Malaysia are transforming from industrial age healthcare system to information and communication age healthcare system. This transformation will support and strengthened by telemedicine. However, many doctors and nurses are facing with the challenges and obstacles of this implementation of electronic medical record. Thus, this study was designed to evaluate the effect of electronic medical record utilization on depression, anxiety and stress among doctors and nurses in Johor. A comparative cross-sectional study was conducted between January till April 2012 among doctors and nurses in Hospital Sultan Ismail, Johor Bharu (HSIJB) which using electronic medical record and Hospital Pakar Sultanah Fatimah, Muar (HPSF) using manual medical record. There were 130 respondents with response rate 91% for electronic medical record and 123 respondents with response rate 86% for manual medical record. Data was collected using self-administered questionnaire which consists of socio-demographic and occupational characteristics and validated Malay version of Depression, Anxiety, Stress Scales-21 items (DASS-21). The mean (SD) age of respondents electronic medical record and manual medical record group were 34.7 (9.42) and 29.7 (6.15). The mean (SD) duration of respondents using electronic medical record was 46.1 (35.83) months. The prevalence of depression, anxiety and stress among respondents using electronic medical record were 6.9%, 25.4% and 12.3%. There were no significance difference proportion of depression, anxiety and stress between respondents using electronic medical record and manual medical record. In multivariable analysis, the significant factors associated with depression among respondents using electronic medical record was age (OR 1.10, 95% CI 1.02,1.19). The significant factors associated with stress among respondents using EMR was marital status (OR 3.33, 95% CI 1.10,10.09) and borderline significant was computer skill course (OR 2.94, 95% CI 0.98,8.78). There was no significant factor associated with anxiety among respondents using electronic medical record. The prevalence of depression, anxiety and stress respondents using electronic medical record were within range of prevalence depression, anxiety and stress in Malaysia and worldwide. There were no different in mental health outcome among those doctors and nurses using electronic medical record compared to manual medical record. This reflects the successful of Telehealth projects in Malaysia by Ministry of Health and also may reflect the good coping mechanism. In this study, we were found that age was predicted factor for depression among respondents using electronic medical record. We also able to show that computer skill course and marital status were factors that associated with stress level among respondents using electronic medical record.
- PublicationEtomidate versus ketamine for procedural sedation in paediatric Patients in the emergency department(2012)Ahmad Abdulbasitz Ahmad FatanEtomidate versus ketamine for procedural sedation in paediatric patients in the Emergency Department. The objectives of the study was to compare the sedation time (Ti) between Etomidate versus Ketamine and the safety of both drugs in the procedural sedation and analgesia among paediatric patients in Emergency department. A single blinded, randomized control study was conducted in Emergency Department Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan, from 1s’ Jun 2010 untill 31st May 2011. 29 paediatric patients aged from 2 years old until 12 years old were recruited with the permission of their parents. They were randomized to two group, Etomidate group which received IV Fentanyl 1pg/kg plus IV Etomidate 0.2mg/kg and Ketamine group which received IV ketamine 1.5mg/kg. 13 patients randomized to Etomidate group and 16 patients to Ketamine group. Sedation time (Tj) was measured from the start of administrating the sedation drug until patients achieved adequate sedation which is characterized by Ramsay sedation score of 4. Vital sign was monitored and any adverse events documented until patients safely discharged/ admitted. From 29 subjects, only 23 subjects able to achieved adequate sedation level with the study drugs. All subjects who did not achieved adequate sedation level were from Etomidate group. From those 23 subjects, median Ti for Etomidate group was 5.0 minutes (IqR 9.0). In the Ketamine group, the median Ti was 1.5 minutes (IqR 4.0). There was no statistical difference in the Ti between the Etomidate group and Ketamine group (P value = 0.17). In this study, the adverse event that has been documented was retching and vomiting and the incidence between the two groups of study drug was similar and no significant difference. (P value = 0.53). There was no serious adverse effect documented during this study. This study proved that sedation time between Etomidate and Ketamine for the PSA were not significantly differ and Etomidate was less effective for PSA compared to the Ketamine in the paediatric age group. Nevertheless, both groups of sedative agents were relatively safe to be used without any serious adverse effect in the paediatric population in Malaysia.
- PublicationEvaluation of interleukin-6 and tumor necrosis factor-alpha in tears and serum and its associated factors in age related macular degeneration patients(2021)Rosli, Abdul HadiIntroduction: Age-Related Macular Degeneration (AMD) is a progressive neurodegenerative disease that affect the macula lutea. AMD is the leading cause of irreversible central vision loss in elderly population in developed countries. AMD is a multifactorial disease. The development of AMD involve continuous interaction between genetic factors, oxidative stress and environmental factors. Recent studies has been showing that inflammation plays a critical role in pathogenesis of AMD. Increased in Interleukin-6 (IL-6) and Tumor necrosis factor alpha (TNF-α) in the serum and intraocular fluid has been associated with AMD and its progression. Measurement of IL-6 and TNF-α in tears will provide a potential non-invasive biomarker for the progression and monitoring of AMD. Objectives: Our objective was to evaluate IL-6 and TNF-α in tears and serum between AMD patients and Control group as well as between Early AMD and Late AMD. Our objective also was to determine the association between IL-6 and TNF-α in tears with duration of AMD, serum level of IL-6 and TNF-α, smoking status and AMD status. Methods: A comparative cross-sectional study was conducted at a tertiary hospital in Malaysia, Hospital Universiti Sains Malaysia (USM) from June 2018 till May 2021. This study involved patients with Early AMD, Late AMD and Control group who attended Ophthalmology Clinic. Tears and serum samples were collected. The samples were analysed using commercial Human IL-6 and TNF-α ELISA kit to measure IL-6 and TNF-α levels in tears and serum. Statistical analysis was done using SPSS Inc Version 24. Results: A total of 142 patients (56 early AMD, 56 late AMD and 30 Control group) were recruited and analysed in this study. In the late AMD group, there was no late dry AMD and only include late neovascular AMD (nAMD). The adjusted mean for IL-6 in tears was significantly higher in AMD compared to Control group (21.91 (95%CI: 19.89, 23.93) vs 16.27 (95%CI: 12.32, 20.22), respectively, p= 0.014) after adjusted with covariates. The adjusted mean for IL-6 in serum also was significantly higher in AMD compared to Control group (12.01 (95%CI: 10.93, 13.08) vs 8.51 (95%CI: 6.41, 10.62), respectively, p= 0.004) after adjusted with covariates. The adjusted mean IL-6 in serum was significantly higher in Late nAMD compared to Early AMD (13.97 (95%CI: 12.43, 15.52) vs 10.03 (95%CI: 8.49, 11.58), respectively, p= 0.001) after adjusted with covariates. The adjusted mean TNF-α in serum was significantly higher in AMD compared to Control group (18.49 (95%CI: 17.11, 19.86) versus 13.96 (95%CI: 11.27, 16.65), respectively, p= 0.004) after adjusted with covariates. There was no significant association found between IL-6 and TNF-α level in tears with duration of AMD, serum level of IL-6 and TNF-α, smoking status and AMD status. Conclusion: Systemic IL-6 level was significantly higher in Late nAMD. There was no different in the level of IL-6 and TNF-α in tears between Early AMD and Late nAMD. There was also no significant factors associated with IL-6 and TNF-α in tears among AMD patients. A large cohort study is needed for further evaluation of tears inflammatory biomarkers level in AMD patients.
- PublicationEvaluation of optic nerve head functions and Topography after an episode of optic neuritis.(2011)Chua Chui YinOptic neuritis primarily affects the optic nerve. Most patients with typical optic neuritis have excellent recovery of visual acuity. However, certain degree of optic atrophy will almost always occur and the axonal loss could have consequences especially on other non acuity visual functions. Using the optic nerve head parameters, it is possible to evaluate the structural and functional damage of optic nerve after an episode of optic neuritis. To evaluate the optic nerve functions and optic nerve head parameters post single attack of optic neuritis, and to compare the functional and structural changes based on the persistence of relative afferent pupillary defect (RAPD). In addition, to correlate the optic nerve functions and optic nerve head parameters in eyes with post single attack optic neuritis. The study was conducted from July 2010 to June 2011. Fifty six subjects with history of single episode of optic neuritis and age-, sex- and race-matched controls underwent complete ocular examination and optic nerve function tests. In addition to RAPD examination, LogMAR acuity test, Humphrey visual field 30-2, Functional Acuity Contrast Test (F.A.C.T®) and Ishihara plates were employed for the assessment of optic nerve functions. The optic nerve head parameters were measured using Heidelberg Retinal Tomography III (HRT III). Pearson’s correlation was used to determine the correlation between the optic nerve functions and optic nerve head parameters. Mean duration between recruitment process and first episode of optic neuritis was 5.21 ± 2.94 years. Significant reduction in the optic nerve functions was seen in the optic neuritis group. Among the optic nerve head parameters, there was significant RNFL thinning (p 0.001), reduction of neuroretinal rim volume (p =0.006) and increase in the cup shape (p < 0.001), cupdisc area ratio (p = 0.009) and optic cup area (p = 0.030). The mean RNFL thickness demonstrated good correlation with the optic nerve functions, in particular contrast sensitivity at high spatial frequency (r = 0.7351, p < 0.001). There was also fair and inverse correlation between the cup shape and contrast sensitivity (r= -0.4463, p = 0.016). Subjects with persistent RAPD showed significant worse performance in visual acuity, colour vision and contrasts sensitivity score, compare to those without persistent RAPD. However, no significant difference was seen in the optic nerve head parameters between these two groups. After an episode of optic neuritis, there were significant reduction in optic nerve functions and changes to the optic nerve head parameters. The thinning of RNFL was especially significant. The good agreement between the optic nerve functions and optic nerve head parameters suggested that in addition to the optic nerve function tests, HRT III is useful for post optic neuritis evaluation.
- PublicationEvaluation of retinal nerve fibre layer and macular thickness pre-and post-chemotherapy with carboplatin and paclitaxel in patients with endometrial and ovarian cancer(2021)Background Carboplatin and paclitaxel are two standard chemotherapeutic agents known to cause neurotoxicity. In this study we aim to evaluate the toxicity by measuring the peripapillary retinal nerve fibre layer (RNFL) and macular thickness in patients with endometrial and ovarian cancers receiving them. Methods A one-year prospective cohort study involving 28 patients who were treated intravenously with carboplatin (200-400mg/m2) and paclitaxel (175mg/m2) three-weekly for 6 cycles was conducted. RNFL and macula thickness were measured using optical coherence tomography (OCT) before commencement of chemotherapy, after the third cycle, and one month after the sixth cycle. The main outcome measurements were the average RNFL thickness and central subfield thickness of macula. Results The mean age of the 28 participants was 54.68 years old (SD=9.03). Eleven had endometrial cancer while 17 had ovarian cancer. The mean of the average RNFL thickness during baseline pre-chemotherapy was 96.43μm (SD 11.39). One month after cessation of treatment the mean RNFL thickness increased to 101.57μm (SD 13.54). Statistical analysis showed a significant increment in the mean RNFL thickness (p=<0.001), from baseline to after three cycles, and baseline to one-month post six cycles of chemotherapy, except nasal quadrant. The increment in all the macular quadrants was statistically significant (p < 0.05) except central subfield thickness. Conclusion Systemic administration of carboplatin and paclitaxel affected both the peripapillary RNFL and macula thickness. This represents early evidence of subacute subclinical retinal toxicity. OCT can be used as a screening tool to assess peri-chemotherapeutic retinal alterations.
- PublicationEvaluation of sexual dysfunction and its associated factors in primary open angle glaucoma patients(2021)Chee, Chew ChiaINTRODUCTION Malaysia is expected to be an aging nation by 2030. Sexual dysfunction (SD) and primary open angle glaucoma (POAG) are diseases that generally affect older population. The prevalence of both diseases is increase with age. Moreover, human life expectancy increases over time. POAG is the most common form of glaucoma and is known as 'silent thief of sight'. SD affects quality of life on top with the treatment burden from POAG. Thus, consideration to confront the older adults is important to warrant an individual's future well-being. OBJECTIVE The aim of this study is to evaluate sexual dysfunction (SD) and its associated factors in primary open angle glaucoma patients. METHODOLOGY A cross sectional study was conducted from September 2019 to September 2020 involving three ophthalmology clinics in Malaysia: Hospital Raja Permaisuri Bainun (HRPB), Hospital Raja Perempuan Zainnab II (HRPZ II) dan Hospital Universiti Sains Malaysia. Only participants aged between 40-80 years old who attended clinic and able to provide two consecutive reliable and reproducible Humphrey visual fields (HVF) 24- 2 were recruited. Participants were interviewed on demographic data and latest health status. Severity of glaucoma was based on modified Advanced Glaucoma Intervention Study (AGIS) scoring system on HVF and categorized into mild, moderate and severe glaucoma. SD assessment was done using validated Bahasa Malaysia version of 'International Index of Sexual Function' (IIEF-5) for male POAG participants and 'Female Sexual Function Index' (FSFI-6) for female POAG participants. RESULT A total of 432 participants with pre-existing POAG were recruited (222 men and 210 women). Men and women were assessed and analyzed differently by using two different questionnaires. Prevalence for erectile dysfunction (ED) was 91% by using IIEF-5 questionnaire and prevalence rate of female sexual dysfunction (FSD) was 78.5% by using FSFI-6 questionnaire. Prevalence of ED and FSD increased with age. There was significant association between ED and severity of glaucoma (p<0.001) but not found in FSD. High educational level had 67% lower odds to experience FSD compared to lower educational level (OR=0.33, 95% CI=0.12, 0.88). For 1 year older in male POAG patients, there were 1.23 times odds to experience ED (OR=1.23, 95% CI=1.10, 1.38). CONCLUSION Prevalence of SD is high in patients with POAG in our study population. Malaysia is expected to be aging nation by 2030. Sexual health in older adults should not be overlooked as both diseases are affecting them. Sexual health is an integral part of overall health in older life and quality of life includes the pleasure of sexual activity.
- PublicationEvaluation of vascular endothelial growth factor level in tears and aqueous among patients with non-proliferative diabetic retinopathy(2022)Shahrudin, Azima AhmadIntroduction Diabetic retinopathy is a reversible cause of blindness with early detection and treatment. Vascular endothelial growth factor (VEGF) plays an essential role in the pathogenesis of blindness-related diseases, such as diabetic retinopathy (DR). VEGF is largely produced intraocularly such as in vitreous and aqueous. As tears sampling is less invasive, evaluating the VEGF level in tears may provide an association of the disease process with ocular surface fluid. Objectives This study aims to evaluate the VEGF level in tears and aqueous among diabetes mellitus (DM) patients with non-proliferative diabetic retinopathy (NPDR) and their correlation. Method A cross-sectional study was conducted in Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II from July 2019 until November 2021. Fifty-one diabetic patients with no diabetic retinopathy (DR), 45 patients with NPDR, and 54 non-DM patients were enrolled in this study. Type 2 DM patients and non-DM patients that were planned for cataract surgery and fulfilled the selection criteria were included in the study. Tears were collected using a Schirmer strip before the operation and aqueous were collected via cornea paracentesis during cataract surgery. The concentration of VEGF was determined using an ELISA kit test. Results The mean VEGF concentration in tears was 46.9 ± 18.7 pg/ml in DM patients with NPDR, 46.7 ± 23.3 pg/ml in patients with no DR, and 40.1 ± 20.6 pg/ml in non-DM. There was no significant difference in mean VEGF level in tears between the three groups before and after adjusting for covariates (p = 0.180 and p = 0.155 respectively). VEGF concentration in aqueous was 217.5 89.2 pg/ml in patients with NPDR, 174.3 75.1 pg/ml in DM patients with no DR group, and 140.7 41.9 pg/ml in the non-DM group. There was a significant difference in mean VEGF level in aqueous between the three groups before and after adjusting for age, duration of DM, level of HbA1c, hypertension, dyslipidemia, and status of smoking (p < 0.001 and p = 0.004, respectively). Post hoc analysis showed VEGF level in NPDR was significantly higher than in no DR (p = 0.012) and non-DM (p = 0.033). There was a significant weak correlation of VEGF levels between tears and aqueous among diabetic patients (r = 0.201, p = 0.049). Conclusions This study demonstrated that aqueous levels of VEGF were significantly higher in DM patients with NPDR than in no DR and non-DM. The level of tears VEGF has little or no relationship to the level of aqueous VEGF. These findings suggest that aqueous VEGF may reflect the DR status.
- PublicationExpression of sema4d and its receptor Plexin-b1 in invasive breast ductal Carcinoma in relation to Tumor angiogenesis and Tumor-associated macrophages.(2012)Ch’ng Ewe Seng,Cumulative experimental and clinical studies have shown involvement of Sema4D, a Class IV semaphorin, and its receptor, Plexin-Bl in tumor progression. Particularly, regulation of monocytic cells by Sema4D, and tumor angiogenesis via Sema4D/Plexin-B 1 receptor system are of great interest. This study characterized the expressions of Sema4D and Plexin-B 1 in human invasive breast ductal carcinoma and evaluated their relationships with other pertinent clinicopathological parameters in general, and with tumor-associated macrophages and tumor angiogenesis in particular. Expressions of Sema4D and Plexin-Bl in 94 patients diagnosed of invasive ductal carcinoma, NOS were explored immunohistochemically on paraffinembedded tissue sections. For each section, three best-stained hotspots and the wholeslide tumor area were evaluated using an intensity distribution score (IDS), a modified H-score system. In addition, tumor-associated macrophages highlighted by anti-CD68 antibody were evaluated with reference to their histological locations whether in the tumor nests or the tumor stroma. Microvessels were immunostained with anti-CD34 antibody and counted for microvessel density. Invasive ductal carcinomas variably expressed Sema4D and Plexin-Bl. Their expressions showed weak significant correlation when the whole-slide IDSs were evaluated (r=0.208, p=0.045). The average 3-hotspot IDS of Sema4D expression showed positive association with Her-2 expression (p=0.032), while the whole-slide IDS was associated with positive hormonal receptor status (p-0.022). High average 3- hotspot IDS of Plexin-Bl expression had higher numbers of lymph node metastasis (p=0.032). Limiting to estrogen receptor positive cases or Her-2 overexpressed cases, high Plexin-Bl expression by the whole-slide assessment was paradoxically associated with absence of lymph node metastasis (p=0.009 and p=0.039, respectively). In relation to tumor-associated macrophages, higher levels of Sema4D expression by the wholeslide assessment were observed in lower grades of tumor stromal macrophages (p=0.001), but no such relationship was observed for Plexin-Bl. Both Sema4D and Plexin-Bl expressions had no relationship with the tumor nest macrophage counts. With regard to tumor angiogenesis, Plexin-Bl expression assessed by 3-hotspot methodology demonstrated weak positive correlation with microvessel density (r=0.206, p=0.047). Sema4D expression was not correlated to microvessel density. Heterogeneity of Sema4D and Plexin-Bl expressions in human invasive breast ductal carcinoma was demonstrated. Their expressions were associated with a few traditional predictive and prognostic factors. Sema4D expressed in tumors appeared to have an inhibitory effect on the tumor stromal macrophages. In contrast to experimental studies, proangiogenic properties of Sema4D could not be validated. Focal expression of Plexin-Bl might be a weak marker for a more angiogenic tumor. However, Plexin-Bl expression was not associated with tumor-associated macrophages.
- PublicationHemostatic effect of nasal saline irrigation during endoscopic sinus surgery : a systematic review and meta-analysis(2020)Nagarajah, DarshiniIntroduction: Intraoperative hemostasis is crucial for adequate anatomical visualization during endoscopic sinus surgery (ESS) and has been identified as gold-standard treatment for medically refractory chronic rhinosinusitis (CRS). Effective surgery is termed upon adequate identification of anatomic structures, good surgical visualization and controlled bleeding throughout the surgery. Nasal saline irrigation is a novel technique to reduced intra-operative bleeding during endoscopic sinus surgery. Objective: The aim of this research is to assess the suitable and optimum temperature for nasal saline irrigation during endoscopic sinus surgery with regards to bleeding control and quality of surgery site during endoscopic sinus surgery(ESS). Methods: Three authors independently conducted an electronic search via (PubMed, SCOPUS, Google Scholar) and (Cochrane) from their origination to September 2018. The included studies compared nasal saline irrigation (hot saline /warm saline irrigation (HSI/WSI) versus room temperature/normal saline irrigation (RTSI/NSI) during ESS. The outcomes of interest were bleeding score(BS), mean arterial pressure(MAP), duration of the surgery(DS), blood loss (BL), and the surgeon satisfaction score (SS). Results: Based on three studies with a total of 212 patients providing the data, we found that WSI/ HSI produced a better outcome compared to the RTSI/NSI group in the surgical field quality (Mean Difference (MD)= -0.51, 95% CI [-0.84,-0.18], P<.003, I2=72%), 3 studies consisting 237 patients ;moderate certainty. There was no significant difference between the two comparison group in regard to mean arterial pressure ( Mean Difference(MD)= -0.60, 95% CI [-2.17, 0.97], P=0.45, I2=0% , 3 studies with 237 patients; moderate certainty. The surgeons’ satisfaction about the significant reduction in bleeding during the operation showed that there was significant decrease in bleeding in WSI/HSI compared to RTSI/NSI in two studies (Risk ratio = 0.18, 95% CI [ 0.09, 0.33] P<0.001, I2= 0% , 2 studies with 175 patients ; moderate certainty). The volume of blood loss was also significantly higher in groups under RTSI/NSI than HSI/WSI in all the studies reviewed (Mean Difference (MD)=56.4, 95% CI[-57.30, -55.51], P<0.001,I2=0%; moderate certainty). The duration of surgery showed significant increase in RTSI/NSI group than HSI/WSI group in all the studies (Mean Difference (MD)= -9.02, 95% CI [-11.76, -6,28], P<0.001, I2=0% , 3 studies with 237 patients ; moderate certainty). Conclusion: The evidence from this review suggests that WSI/HSI group are statistically better compared to RTSI/NSI group. Also, no beneficial or detrimental effect of surgeons’ satisfaction score could be determined based on existing evidence. However, since very small number of studies were recruited, further trials are needed to establish the results of this study.