Pusat Pengajian Sains Perubatan - Tesis

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Neuroprotective effects of tualang honey supplementation on the prefrontal cortex following chronic stress exposure in rat models
(2022)
Nawi, Faizah Md
Background: Stress has been a focus of attention among researchers as it is closely related to human psychological and physiological well-being. Chronic stress exposure causes sustained activation of the HPA axis resulting in an accumulation of cortisol hormones and free radicals, affecting many organs including the brain, leading to the development of many stress-related disorders. Tualang Honey is a Malaysian wild polyfloral honey with higher phenolic and flavonoid contents and has stronger antioxidant and anti-inflammatory activities compared to other local honey. Tualang Honey has been shown to protect the brain against stress-induced oxidative damage dominantly in neurons. However, the studies that focus on the supporting glial cells are still scarce. Objective: The objective of this study is to investigate the neuroprotective effects of Tualang Honey supplementations on astrocytes and microglial cells in the medial prefrontal cortex of rat models following exposure to chronic stress. Methodology: Twenty-four male Sprague Dawley rats were divided into four groups: (i) control, (ii) stress-exposed, (iii) Tualang Honey treated group (1.0 g/kg body weight twice daily), and (iv) stress-exposed treated with Tualang Honey (1.0 g/kg body weight twice daily). The stress-exposed group and stress-exposed treated with the Tualang Honey group underwent two types of physical stress tests consisting of 5 hours of restraint stress test (RST) and 15 minutes of forced swimming test (FST) daily for 21 days. Euthanasia was performed on day 22. The brain was collected, processed, and stained using the immunohistochemistry (IHC) technique. The number of glial cells (astrocytes and microglial cells), the number of primary processes of glial cells, and the maximum branch length of glial cells were counted and measured using Fiji J image and IC Measure software. Data were analysed, using SPSS software version 26. Results: Present study found that the number of GFAP positive astrocytes and their maximum branch length processes were reduced in the stress group compared to the control group, while the number of Iba-1 positive microglial cells and their maximum branch length processes increased in the stress group compared to the control group. Besides, the number of GFAP positive astrocytes in the stress + Tualang Honey treated group increased compared to the stress group whereas the number of Iba-1 positive microglial significantly reduced compared to stress group. Also, the number of primary processes in both glial cells showed no significant differences in all study groups. Conclusion: This study demonstrated that Tualang Honey supplementations has influenced the number of astrocytes and microglial cells in the medial prefrontal cortex possibly via its antioxidant and anti-inflammatory properties. However, Tualang Honey supplementation had no significant effect on the number of primary processes and the maximum branch length in both astrocytes and microglial cells processes after chronic stress exposure
Outcome of labour of untested caesarean scar and factors affecting its outcome in Sabah Women and Child Health Hospital
(2020)
Luong, Charlie Wong Choong
Objective: Caesarean section rate is on a rising trend worldwide resulting in increased pregnancies with previous caesarean scar. Proper patient selection for trial of labour after caesarean section is important as this improve success rate as well as reduce morbidity associated with labour. It is known that the single important predictor value is history of successful VBAC. Therefore. this study aims to evaluate the success rate of VBAC as well as to explore the factors affecting its success rate after excluding patient with history of successful VBAC. Methods: A retrospective cohort study was conducted at Hospital Wanita dan Kanak Kanak Sabah (HWKKS) involving reviews of patients’ record with one previous lower segment caesarean section which is untested and going for trial of labour in the hospital. The information obtained includes sociodemographic distribution, maternal non-modifiable and modifiable factors, antenatal and intrapartum factors and outcome of the delivery. The data were analysed using SPSS by multiple logistic regression. Results: The success rate of untested VBAC was 66.8%. The significant factors affecting the success rate of VBAC include inter-delivery intervals more than 60 months (adjusted OR 2.128, 95% CI 1.343 – 3.373), maternal obesity (adjusted OR 1.457 1.303 – 1.629), absence of previous vaginal birth (adjusted OR 3.436, 95%CI 2.307 – 5.118), increasing estimated fetal weight (adjusted OR 2.723, 95%CI 1.385 – 5.354), induction of labour (adjusted OR 3.645, 95% CI 2.541 – 5.227) and previous caesarean section for the indication of malpresentation, placenta previa, poor progress of labour, prolonged second stage of labour and cord prolapse. Following an unsuccessful VBAC, the risk of PPH is statistically insignificant. The OASIS risk increases with the need for instrumental delivery. The risk of uterine scar dehiscence increases with short inter-delivery interval. Their neonatal risk of neonatal asphyxia and meconium aspiration syndrome is considerably low. Conclusions: Proper patient selection can reduce morbidity associated with trial of labour after caesarean section as well as avoid unnecessary morbidity associated with repeated caesarean section. Obstetrician should assist the patient in making a sound decision on her delivery plan
Discogenic backpain; Outcome of intradiscal steroid injection
(2020)
Ali, Asrizuzairudin Muhammad
Introduction : Discogenic lower backpain and lumbar radicular pain is a common presentation with great disability and a negative impact of quality of life of the patient and subsequently toward working limitation. This minimally invasive intradiscal steroid injection provide an alternative to patient whom failed conservative treatment. We conducted a study to determine the outcome of intradiscal steroid injection in discogenic back pain patient based on the pain score(Visual Analog Score) and the disability score (Oswestry Disability Index).Finally we want to determine the correlation of discography grading (Adam grading with improvement /changes in pain and disability score Methodology :This was a retrospective cohort study involving 70 patients with chronic discogenic back pain evaluate from 1st December 2015 till 31st September 2018 .the clinical data evaluate using Visual Analog Score and Oswestry Disability Index(ODI).Statistical analysis was performed using SPSS VER. 24 to run paired t test to compare the VAS and ODI pre injection and at 6 months post injection .All p value less than 0.05 were considered as statistically significant. Result : Most patient (mean age of 56.4+9.2 years)significantly had reduction of pain score from pre injection VAS score of 66.3+16.1 to 32.2+17.4 6 months post injection. ODI show reduction of67.9+14.5% (severe disability) to 33.1 +13.6% ,6 months post injection were categorized as moderate disability. B ased on Spearman’s correlation analysis change of pain score VAS and change of disability score ODI weak and not significantly correlated with Adam’ classification. Conclusion: The intradiscal steroid injection is potential adjunt treatment in patient with chronic discogenic backpain who failed conservative management.Our study shows that result suggested that intradiscal steroid injection can improved the short term clinical outcome in patient with discogenic backpain
A randomized controlled trial comparing two doses of caffeine for apnoea in prematurity
(2021)
Kori, Anis Munirah Mohd
Caffeine is the most used methyl xanthine for the prevention of apnoea in prematurity, but its ideal dose was uncertain. This study compared two doses of caffeine for prevention of apnoea in prematurity. A clinical trial was conducted on 78 preterm infants ≤32 weeks in NICU at tertiary center hospital. They were randomly allocated to receive the intervention (loading 40 mg/kg/day and maintenance of 20 mg/kg/day) or the control (loading 20 mg/kg/day and maintenance of 10 mg/kg/day) dose of caffeine. The primary outcome of the study was the frequency and total days of apnoea per duration of treatment for both groups. The frequency of apnoea range from zero to fourteen in the intervention and zero to twelve in control group. There was no statistically significant different between the groups with p value 0.839. The number of days of apnoea was also similar between both groups with p value 0.928. There was also no significant difference of adverse events between both regimens. This study did not support the use of higher dose caffeine as a prevention for apnoea in prematurity
Comparison of PreHospital index with MGAP score to determine outcome in trauma patients presented to emergency department Hospital Tengku Ampuan Rahimah Klang, Selangor
(2020)
Mustamam, Adila Hana Mohd
Background Trauma is one of the leading causes of death worldwide including Malaysia. Death due to trauma is best explained by the Trimodal Death Model, death occurring immediately after trauma, intermediate death several hours after trauma and delayed death. The importance and significance of prehospital score system is to reduce the death rate in the intermediate group which can be prevented if given treatment in a timely manner. Methods This was a cross sectional observational study, using retrospective data from May 2019 till April 2020. A total of 502 patients were recruited, PHI and MGAP scores were calculated based on prehospital clerking done by responder at the scene or en route to the hospital. Convenient sampling was used with the researcher recruiting upon patient arrival in ED and follow up patient until they are discharged or until maximum 30 days post trauma for prolonged hospitalization cases. Results All 502 patient’s data were analysed. Pearson chi square was used to measure the finding of both scores. Both PHI and MGAP score were significant with a p value of <0.01 in determining patient’s general outcome (mortality, morbidity, prolonged hospital stay, major surgery prediction). However, PHI has higher sensitivity and specificity 72.97% and 95.91%, whilst MGAP score is 24.32% and 2.64%. Kappa was used to compare the association between the scores with the standard score to predict individual outcome of mortality, morbidity, prolonged hospital stay and prediction of major surgery. Both scores failed to predict prolonged hospitalization. For major surgery prediction also both scores failed to show significant result and Kappa score was less than 0, MGAP (-0.012) and PHI (0.060). In the prediction of morbidity and mortality PHI score showed slight agreement with ISS score, morbidity (0.299) and mortality (0.431), whilst MGAP showed no agreement for morbidity (-0.051) and mortality (-0.060). Conclusion We conclude that, between both scoring system, PHI has a better specificity and sensitivity in determining the outcome of trauma patients. However, both scores have low to no agreement with ISS score in predicting prolonged hospitalization, major surgery prediction, morbidity, and mortality. PHI can be used as screening tool to facilitate and tighten the management of trauma patients from the scene till arrival of patient to the hospital

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