Pusat Pengajian Sains Perubatan - Tesis

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Retrospective review of clinicohistopathologic characteristics of basal cell carcinoma and squamous cell carcinoma in patients operated on at department of plastic surgery, Hospital Kuala Lumpur from 2004-2018
(2021)
San, Deborah Ding Ying
Introduction: Non-melanoma skin cancers (NMSC) are the most common skin cancer worldwide. Highest incidences have been reported among the Caucasian population. Asian countries display a lower prevalence of NMSC, however its onset in the region has been rising over time. Method: Histopathology reports of patients diagnosed with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were retrieved from the clinic of the Plastic and Reconstructive Surgery Department in Hospital Kuala Lumpur from 2004 to 2018 and analysed. Results: A total of 777 patients, with a total of 1,346 lesions were reported from 2004 to 2018. BCC comprised 71.5% (555), and SCC 28.5% (222) of patient cases. A rise in incidence of BCC and SCC cases was observed from 2004 to 2018. Chinese patients made up for the majority of cases for both NMSCs, at 46.8% (260) and 59.4% (132) for BCC and SCC respectively, followed by Malay patients at 43.7% (242) and 29.2% (65), Indian patients at 4% (23) and 9% (20), and patients of other ethnicities at 5%(29) and 2%(5). Average age of onset for both NMSCs was above 60 years. Mean size (diameter) of lesions examined was 16.98 mm for BCCs (Standard deviation; SD=19) and 30 mm for SCCs (SD=30). For BCC, the nodular variant was the commonest histopathological subtype, making up 81% (742) of all lesions. The majority of SCCs were well differentiated, comprising 46% (198) of all lesions. A total of 866 (64.3%) of all lesions excised achieved adequate margin clearance, that of 63% (577) of BCCs and 67.2% (289) of SCCs. For SCCs, larger lesions >2cm were linked to poorer rates of histological margin clearance (Adjusted 95% CI (0.98-0.99), p = 0.002). Conclusion: Surgical excision remains as the most effective choice of treatment for NMSCs, compared with other existing techniques
Neonatal outcomes of pregnancies complicated by maternal hyperthyroidism
(2021)
Mamat @ Abdullah, Adlina Awanis
Objective: We aim to study the proportion of infants born to maternal hyperthyroidism, their clinical, hormonal status, median time and factors affecting time for serum free T4 (fT4) and TSH normalization. Methodology: A cross-sectional study recruited 186 inborns admitted to Neonatal Intensive Care Unit (NICU), Hospital Universiti Sains Malaysia (Hospital USM) from January 2013 until December 2018. We analyzed newborn’s demographic and clinical characteristic, maternal treatment, maternal thyroid autoantibodies level and thyroid function. Finally, we analyzed the newborn’s thyroid function and thyroid autoantibodies. Abnormal thyroid function was categorised according to European Society of Paediatric Endocrinology (ESPE) for newborn. Kaplan Meier analysis were used to determine median time of fT4, TSH normalization and multiple logistic regression model were used to examine the associations between risk variables affecting fT4, TSH normalization in these newborns. Results: The proportion of newborns with maternal hyperthyroidism were 0.92% (186/ 20198). Only 170 newborns were included in the study. Out of 102 (60%) newborns with an abnormal TFT, 7 (4.1%) developed overt hyperthyroidism with 4 (2.4%) were complicated by thyroid storm. Only 54 out 170 mothers (31.7%) were checked for presence of thyroid autoantibodies. The overall median time for TFT normalization was 30 days (95% CI): (27.1, 32.8). Cox Proportional Hazard revealed normal TFT on day 3-5, crude HR: 95% CI: 4.918 (2.11, 11.44) and day 15: 3.496 (1.61, 7.58) were significant variables affecting time of normalization. Conclusion: The proportion of newborns with maternal hyperthyroidism were 0.92%. Most infants with maternal hyperthyroidism had a self-limiting course with median TFT normalization time of 30 days. Abnormal TFT at day 3-5, abnormal TFT at day 15, maternal received thyroid treatment and maternal presence of thyroid autoantibodies were significant predictors affecting fT4, TSH normalization for these newborns.
Modified contrast volume and saline chaser to reduce artifacts in computed tomography pulmonary angiography (CTPA)
(2022)
Pin, Chia Fui
Background: Computer tomography pulmonary angiography (CTPA) is the gold standard imaging for the diagnosis of pulmonary embolism (PE). Therefore, the quality of the images plays a big role in the diagnosis and patient’s management later. The image quality is mainly assessed by the pulmonary artery enhancement in the Hounsfield Unit (H.U.) and the impact of the streak artifacts from the high concentration of contrast in the adjacent vessels. In Hospital Universiti Sains Malaysia (HUSM), the major problem that we faced was poor enhancement of the pulmonary artery as most of the contrast remained in the subclavian vein, brachiocephalic vein, and superior vena cava (SVC). Many factors contributed to these problems, which were divided into 2 categories: scanning protocol and patient-related factors. The patient-related factor is a component that is difficult and almost impossible to adjust. Thus, the purpose of the study is to modify the CT protocol to improve the image quality and correlate with the body mass index (BMI) factor. Methods: A prospective study was conducted in HUSM, Kota Bharu, Kelantan, Malaysia on patients who were suspected to have PE and underwent CTPA using Toshiba Aquilion PRIME computer tomography (CT) scanner. All the patients who underwent CTPA from 1st June 2020 to 14th February 2021 used a standard protocol (contrast volume 40 ml and saline flush 60 ml). While those who underwent CTPA from 15th February 2021 to 31st October 2021, used a modified protocol (contrast volume 30ml and saline flush 70ml). It is a non-randomized, convenient sampling based on inclusion and exclusion criteria. All the scans were performed using the bolus tracking technique. Both protocols were compared for pulmonary trunk enhancement and degree of artifacts from the SVC and subclavian vein. The pulmonary trunk enhancement was also correlated with patient’s BMI. Results: A total of 254 patients with suspected PE underwent CTPA. Based on the inclusion and exclusion criteria, 199 patients were enrolled. Of these, 83 patients underwent CTPA with standard protocol and 116 patients underwent modified protocol. The age range of the subjects for standard protocol was 13 to 86 (mean age 50.5) years old, and the modified protocol was 13 to 95 (mean age 52.7) years old. The mean BMI for standard protocol was 26.0 (range 14.3 to 43.0) and for modified protocol was 24.8 (15.6 to 43.8). The mean H.U. of pulmonary trunk showed significant difference between the two protocols, which was higher in the modified protocol [Mean difference (95% CI) = -41.97 (-80.60, -3.34), p = 0.033]. However, the difference in mean H.U. of pulmonary trunk between the protocols showed no significant difference after adjusted to BMI and HR as covariates. Majority of subjects had artifact grade 3 for SVC (75.4%) and subclavian vein (62.8%). The modified protocol had a lower proportion of grade 3 artifacts for both SVC and subclavian vein (p<0.001). BMI and H.U. of pulmonary trunk revealed a significant correlation, overall (r=-0.4) and by each type of protocol (standard protocol r=- 0.3, modified protocol r=-0.4). Conclusion: The modified protocol showed better contrast enhancement in pulmonary trunk and lower artifacts than the standard protocol in this study. BMI was a cofounding factor and showed significant correlation with pulmonary trunk enhancement
The relationship between personality traits, coping styles and psychological distress among health care workers involved in the treatment and care of covid-19 patients in Kelantan Malaysia
(2022)
Subramanian, Barath Chidambar
Introduction: Health care workers (HCWs) face a risk of developing psychological distress during the COVID-19 pandemic. Our study examined socio-demographic characteristics, trait neuroticism, and coping styles and their association with psychological distress among HCWs in Kelantan facing the pandemic. Methodology: We conducted an online cross-sectional survey between 1st July 2020 till 28 February 2021 among HCWs in three designated COVID hospitals in Kelantan, Malaysia, namely Hospital Raja Perempuan Zainab II, Kota Bharu, Hospital Sultan Ismail Petra, Kuala Krai, and Hospital Tumpat. A non-probabilistic purposive sampling method was used. Online questionnaires consisting of sociodemographic data, Big Five Inventory (N) to assess trait neuroticism, Brief COPE scale to assess coping styles and General Health Questionnaire (GHQ-12) to assess psychological distress were distributed to all HCWs. Results: A total of 336 HCWs were included in the analysis. 22.9% HCWs experienced psychological distress. In multiple logistic regression analysis, only higher trait neuroticism remained significantly positively associated with psychological distress (Adjusted OR = 1.348, 95% CI = 1.243-1.461), while use of religious coping remained significantly negatively associated with psychological distress (Adjusted OR = 0.581, 95% CI = 0.386-0.876). Conclusion: In conclusion, trait neuroticism and use of religious coping are important predictors of psychological distress among HCWs facing the COVID-19 pandemic
A comparison of prevalence, clinical management and treatment outcome of ischemic stroke prior to and during covid-19 pandemic in Hospital Universiti Sains Malaysia
(2022)
Suliman, Ayman Sirelkhatim Ali
Introduction Ischemic stroke is a medical emergency. Risk of poor outcomes in stroke increases with delay in time to treatment. Covid-19 pandemic had a significant impact on stroke management resulting in more severe stroke. This study aims to determine the impact of Covid-19 pandemic on the total number of ischemic stroke patients admissions, stroke standards of care and outcome. Methodology This is a retrospective record review study. Data of patients with radiologically or clinically confirmed AIS in HUSM diagnosed from 1st March 2019 until 28th February 2021 were included. Results A total of 229 patients were included; 114 (49.8%) patients in the pre -covid-19, and 115 (50.2%) patients during covid-19. Initial NIHSS score was similar, 5.3 ± (4.18) in 2019 and 5.9 ± (4.42) in 2020. Onset to door time in minutes was 1875.2(2034.72) in pre- Covid-19 vs 1827.1(2163.95) in Covid-19 group (t. test 0.17 p-value 0.863). Time to see emergency doctor in minutes was 25.3 (30.21) in pre covid-19 vs 22.6(16.48) in Covid- 19 group (t. test .48 p-value 0.402). Door to CT brain time in minutes 83.8 (58.91) vs 92.4 (120.20) in pre-covid-19 and Covid-19 group subsequently (t. test -.69 p- value 0.493). For patients received thrombolytic therapy; 7(6.1%) pre covid-19 vs. 4 (3.5%) during covid-19 period (p-value>0.5). Other stroke metrics including physiotherapy,occupational therapy, speech therapy assessment and dietician, results were ;(77.2% vs 81.7% p-value >.05) (76.3% vs 81.7% p-value >.05) (50% vs 59.1% p- value>.05) (43.9% vs45.2% p-value>.05) for physiotherapy, occupational therapy, speech therapy and dietician subsequently. For treatment outcome, duration of hospital stay was [(6.4 ± 4.5 vs. 7.56.74) (t. test - 1.36, p-value0.175)] in pre Covid-19 and during covid-19 respectively. While MRS score at discharge was [(2.8(1.38) vs. 2.9(1.49) (t. test .33 p- value 0.742)] in pre -Covid-19 and during Covid-19 respectively. Conclusion Covid-19 had no significant impact on stroke management in HUSM. Comparison of stroke risk factors, subtypes and severity, door to needle time and onset to needle time for thrombolysis were statistically insignificant. Stroke management outcomes were similar for MRS score, duration of hospitalization, hospital acquired infection and 7 days mortality

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