Pusat Pengajian Sains Perubatan - Tesis

Browse

Now showing 1 - 5 of 2384

Development, validation and evaluation of the usm insulin adherence module (USM-IAM) among patients with uncontrolled type 2 diabetes mellitus
(2024-11)
Zainudin, Aida Maziha
Many patients with type 2 diabetes mellitus do not achieve the desired glycemic control despite insulin treatment, likely due to an improper understanding of insulin function, its intensification process, and patients’ negative perceptions. We developed a USM-insulin adherence module (USM-IAM) to educate patients. This study involved a combination of qualitative and quantitative research. The first phase, namely, an exploration of patients’ knowledge and problems related to insulin therapy, utilised focus group discussion to collect information from patients. Phase 2: Development and validation of the USM-insulin adherence module. In this phase, a literature search was carried out, and the researcher identified a list of factors interfering with insulin adherence. The factors were combined with the findings from focus group discussions to produce an insulin adherence module. Content validation (CVI) by experts and face validation by patients (FVI) was subsequently performed. The third phase was the evaluation of the effectiveness of the USM-IAM. This RCT assessed the effect of USM-IAM-based counselling on adherence score, HbA1c and FBS compared to standard counselling. Patients were allocated to groups based on computer randomisation. Four diabetes educators counselled patients during endocrine clinic sessions. Patients received counselling on V1 and V2. Blood investigations and adherence scores were obtained at V1, V2 and V3. Three themes emerged from the focus group discussions. The newly developed module consists of five units and 20 items. The CVI and FVI of the module were good. In phase three, 180 patients were recruited. Ninety patients were randomised to each group. The baseline sociodemographic and clinical characteristics were homogenous among groups. Over the course of the study, significant improvements were noted in IAQDM scores, FBS, and HbA1c levels from baseline to both the third and sixth months for all participants, irrespective of their group allocation. Within group analysis showed a statistically significant improvement in the adherence scores and HbA1c from baseline to the third and sixth months for both groups. However, FBS changes within the control group were not significant. Between the third and sixth months, no significant changes were noted in any outcomes for either group. While differences between the groups were not statistically significant, the intervention group demonstrated greater improvement across all outcomes. In conclusion, patients had poor knowledge of diabetes and insulin. The USM-IAM has good CVI and FVI. Both groups had increased adherence scores and reduced FBS and HbA1c levels, with greater changes observed in the intervention group.
Profiling and characterization of antigenic surface-associated proteins for the identification and differentiation of acinetobacter baumannii from non-baumannii acinetobacter
(2023-07)
Bagudo, Ahmad Ibrahim
Acinetobacter nosocomial infections is a universal public health care problem. The time taken to diagnose Acinetobacter nosocomial infections and the rate associated mortality is a major drawback in patient management. Members of the ACB complex differ in their biology and antibiotic susceptibility pattern, which significantly impede the proper and prompt treantment of the patient. Hence, there is a need for a rapid and reliable identification test that not only rapidly identify Acinetobacter but can differentiate A. baumannii from A. nosocomialis and A. pittii. Surface-associated proteins (SAPs) proved to be reliable for such task in other bacteria such as Salmonella. Acinetobacter contain in their outer membrane lipopolysaccharides (LPS), which represent useful diagnostic markers. Characterized LPS of Acinetobacter have been shown to be of the smooth (S)-form. Therefore, a possible O-serotyping scheme represents a powerful tool in clinical laboratories to identify Acinetobacter species. The aim of this study was to profile the SAPs of A. baumannii, A. nosocomialis and A. pittii and to determine the antigenicity of the SAPs by Western blot towards identification of potential candidate for the development of rapid diagnostic test using serum from patients infected with A. baumannii, A. nosocomialis and A. pittii as well sera positive with other non-Acinetobacter infections. The SAPs of A. baumannii, A. nosocomialis and A. pittii was profiled using SDS-PAGE, antigenicity of the profiled SAPs was determined by Western Blot techniques. Exclusive SAPs to each of the three species, as well as those SAPs common to the three species (ACB complex) were characterized by LC-MS/MS technique. Result of SDS-PAGE profiles in this study demonstrated that 46.4% of the SAP bands were common to A. baumannii, A. nosocomialis, and A. pittii. The SDS-PAGE SAPs profiling further unveiled the presence of SAP bands (40.9, 36.0, and 34.4 kDa), which are unique to A. baumannii, 55.1 kDa and 33.0 kDa unique to A. nosocomialis, and 43.0 kDa and 35.0 kDa unique to A. pittii. Western blot analysis of the profiled SAPs showed variation in host immune response in all the sera tested. In A. baumannii AB1001, the antigenicity study revealed that 86.4% of the SAPs from SDS-PAGE profiles were antigenic. IgG and IgM detected a higher percentage of 84.2% each, followed by IgA 57.9%. In A. nosocomialis AN1001, 70% of the SAPs profiles from SDS-PAGE were antigenic, of which IgM detected all 100%, IgG ranked the second 92.9%, and then IgA 57.1%. Likewise, in A. pittii AP1001, 90% of the SAPs profiles from SDS-PAGE were antigenic. Among them, IgG detected a higher number (88.8%), IgA (77.8%), and IgM (61.1%). Furthermore, the A. baumannii, A. nosocomialis and A. pittii exclusive SAPs (40.9 and 34.4 kDa; 33.0 and 55.1 kDa and A. pittii 43.0 kDa and 35.0 kDa respectively) were recognised by the IgG, IgM, and IgA. The LC-MS/MS identification of the selected SAPs confirmed that the 34.4, 40.9, 48.7 and 23.0 kDa from A. baumannii were identified as OmpA, Omp38, an elongation factor protein and ribosome-recycling factor protein respectively. Whereas the SAPs of 33.0, 48.7, 55.1, and 23.0 kDa from A. nosocomialis were identified as 30S ribosomal protein, ATP synthetase subunit beta protein, chaperonin protein and 50S ribosomal L4. While the 35.0 kDa and 43.0 kDa from A. pittii were identified as Omp38 and Acinetobacter elongation factor respectively. The identification of antigenic SAPs exclusive to each member of the ACB complex and antigenic SAPs common to all members of the ACB complex could pave way in the development of rapid diagnostic test for the early diagnosis of Acinetobacter infection and differentiation of A. baumannii from A. nosocomialis and A. pittii infection. However, further studies on the species exclusive SAPs need to be carried out in vivo to evaluate the diagnostic performance of these proteins. Therefore, the biomarkers identified in this study can be further developed in the form of rapid test such as dipstick test, enzyme immunoassay or molecular assay, which can be very helpful in diagnosing patients with Acinetobacter infection.
Formulation and evaluation of nanoemulgel (in situ) nigella sativaloaded carbon dots for potential periodontal treatment: an in vitro study
(2025-08)
Bhavikatti, Shaeesta Khaleelahmed
Periodontal disease is an inflammatory condition of the gingiva and/or periodontium resulting in destruction of attachment apparatus and subsequently tooth loss. This study aimed to formulate and evaluate the biological properties of a novel nanoemulgel in-situ (NEG-IS) drug delivery system incorporating Nigella sativa essential oil (NSEO) and carbon dots (CDs). Essential oil was extracted from Nigella sativa (N. sativa) seeds by hydro-distillation method. CDs were green synthesized from ginger by hydrothermal method. To obtain optimum concentration of NSEO and CDs for nanoemulgel formulation, optimization was performed using three different NSEO:CDs ratios; 9:1, 1:1, 1:9 and assessed for antioxidant and antiinflammatory properties. NEG-IS gelling system was formulated by optimization using a three level (low, medium and high) with two factors (poloxamer and carbopol) full factorial design, that included a statistical design with nine runs. The phytochemical constituents’ analysis for NSEO was performed using Gas Chromatography Tandem Mass Spectrophotometry (GC-MS/MS) followed by the analytical characterization using UV-Vis Spectrophotometry, FT-IR Spectroscopy and Zeta Potential (ZP) measurement. CDs characterization included particle size evaluation, fluorescence profiling, HR-TEM, SEM-EDX, AFM, XRD, UV-Vis Spectrophotometry, FT-IR Spectroscopy and ZP measurement. Physico-chemical characterization of NEG-IS was done to assess its pH, viscosity, gelation time, gelation temperature, spreadability, syringeability and in-vitro gelling capacity. Other characterizations included globule size distribution, in-vitro drug release kinetics, UV-Vis spectroscopy FTIR and ZP measurement. Further stability studies for NEGIS were performed for a period of 1.5 months. Antioxidant, anti-inflammatory and antimicrobial properties against selected oral, fungal and periodontal pathogens were assessed for NSEO, CDs and NEG-IS. Cytotoxicity of NSEO, CDs and NEG-IS was assessed over human gingival fibroblast (HGF) cell lines. Presence of 17 bioactive compounds in NSEO was confirmed by GC-MS/MS. CDs exhibited mean particle size of 2.9 nm and other characterization results confirm presence of CDs. NEG-IS exhibited adequate physico-chemical characteristics and sustained release of the drug for up to 12 hours, which followed the Korsmeyer-Peppas (K-P) model kinetics that aligns with Fickian tendencies. NEG-IS was stable at elevated temperature and room temperature with no significant changes in gel appearance. NSEO, CDs and NEG-IS exhibited significant biological properties and had less cytotoxicity effects over HGF cell lines. The developed NEG-IS formulation showed biological properties in-vitro with the potential to be utilized as therapeutic formulation in future clinical studies
Factors associated with hand, foot and mouth disease (HFMD) outbreak cases in Kelantan 2018
(2020-06)
Ismail, Nur Akmal
Background: Hand, foot and mouth disease (HFMD) remains a significant public health concern worldwide, especially in the Western Pacific Region. In Malaysia, the Ministry of Health (MOH) had adopted the HFMD surveillance system, guideline, prevention and control program for managing the HFMD cases and outbreak occurrence at any level. However, there are still high cases of HFMD and outbreak occurrence reported despite these control program had been made. Therefore, it is vital to recognise the factor associated with the HFMD outbreak cases to overcome this problem. Objective: This research aims to describe characteristics of HFMD cases, the proportion of HFMD outbreak cases and to study the associated factors of HFMD outbreak cases in Kelantan state in 2018. Methodology: This study consists of two parts. Part I adopted the descriptive cross-sectional study while in Part II, the comparative cross-sectional study design was used. The data of HFMD patients in Kelantan in 2018 were using the secondary data obtained from Communicable Disease Control (CDC), Unit Kelantan State Health Department. Results: More than half of HFMD cases in Kelantan in 2018 were aged 5 years and above (53.1%) and male group (55.8%). Majority of them were Malays (96.4%), resided in rural areas (78.6%) and had been treated as outpatients (95.4%). Many of them attended kindergarten (38.3%) followed by others such as home care and different working places (27.1%), school (18.2%) and nursery (16.4%). Notified HFMD cases also more concentrated during warm weather season between May and August (40.9%). Among 1026 HFMD patients, 70 patients were HFMD outbreak cases, equivalent to 6.8%. The significant association found between HFMD outbreak cases among children aged less than 5 years old were those who attended the kindergarten (Adj. OR 0.330; 95% CI: 0.114, 0.957, p-value=0.041) and were taken care at home (Adj. OR 0.008; 95% CI: 0.001, 0.067, p-value<0.001) compared to those who attended the nursery and the disease occurred during the warm season (Adj. OR 0.154; 95% CI: 0.043, 0.557, p-value=0.004) compared to the rainy season. Conclusion: This study reported that the significant factors associated with HFMD outbreak cases in Kelantan among the children below than 5 years were the children who attended the kindergarten, home-care children and disease occurred during the warm season. Therefore, we recommend the collaboration of multi agencies to continuously monitor and improvise the current particular program related to HFMD in nurseries, kindergartens and schools to improve knowledge, attitude and practice among institution managers, teachers and staff towards HFMD. Other than that, we also suggest to develop targetted interventions including early detection of disease, improve the environmental hygiene, effective gatekeeping and good practice in preparation of food in daycare centres to reduce the incidence and burden of the outbreaks.
Structural equation modelling of holistic health variables, healthy diet, physical activity, and quality of life: comparison between Malaysian and Nigerian undergraduate students
(2025-09)
Abdulrahman, Abdulwali Sabo
Holistic health is increasingly recognized as a comprehensive approach that considers the whole person and the interplay of multiple life dimensions. Well-being arises from the interaction between individual potentials (IP), demands of life (DL), social determinants (SDH), and environmental determinants (EDH). Healthy diet (HD) and physical activity (PA) further contribute to overall quality of life. This study therefore aims to evaluate how SDH, EDH, IP, DL, HD, and PA interact within a holistic health model to influence quality of life. The study applied a mixed-methods approach, conducted in three phases, to develop and validate a holistic health model. In Phase I, four new instruments were developed to measure key determinants of holistic health: the Social Determinants of Health Questionnaire (SDHQ), Environmental Determinants of Health Questionnaire (EDHQ), Demands of Life Questionnaire (DLQ), and Individual Potentials Questionnaire (IPQ). These tools were developed through extensive literature review, in-depth interviews, and expert evaluations to ensure content and face validity. Phase II covers a validation study using a cross-sectional survey of 1,460 undergraduate students (730 each from Nigeria and Malaysia). This phase employed exploratory and confirmatory factor analyses (EFA and CFA), alongside assessments of reliability and validity, including composite reliability (CR), average variance extracted (AVE), Cronbach’s alpha, and test-retest reliability. Phase III investigated the structural relationships between SDH, EDH, DL, IP, HD, PA, and quality of life, using independent samples of 1,140 students (570 from each country), as well as the measurement and structural invariance to confirm the cross-cultural applicability of the instruments. Additionally, multigroup SEM was conducted to compare structural relationships across Nigerian and Malaysian samples. In Phase I, four holistic health questionnaires were developed: SDHQ (20 items, 2 factors), EDHQ (18 items, 2 factors), DLQ (18 items, 3 factors), and IPQ (14 items, 2 factors), all showing acceptable content and face validity (indices = 0.83–1.00). In Phase II, demonstrated adequate validity and reliability across all instruments, with adequate fit indices (CFI = 0.928–0.967; TLI = 0.910–0.957; SRMR = 0.039–0.080; RMSEA = 0.041–0.068) and high reliability (Cronbach’s α = 0.815–0.947; CR = 0.760–0.950; ICC = 0.765–0.987). In Phase III, structural equation modeling supported 8 of 10 hypothesized pathways in both Malaysian and Nigerian samples, with good model fit (CFI = 0.972-0.989, TLI = 0.954-0.982, SRMR = 0.021-0.026, RMSEA = 0.039-0.060, RMSEA p-value = 0.110-0.879). The instruments demonstrated measurement and structural invariance across both groups (ΔCFI and ΔTLI < 0.01, ΔRMSEA < 0.015), and multigroup SEM confirmed six similar path relationships (CFI = 0.982, TLI = 0.969, SRMR = 0.020, RMSEA = 0.052, RMSEA p-value = 0.360). The study confirmed that the SDHQ, EDHQ, DLQ, and IPQ are valid, reliable, and invariant across Nigerian and Malaysian students, making them suitable for assessing holistic health factors. It also introduced one of the first quantitative models relating these variables to HD, PA, and quality of life, offering a foundation for future interdisciplinary research on the interrelationship of social, environmental, and individual determinants of health.

Browse

Recent Submissions