Pusat Pengajian Sains Perubatan - Tesis
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- PublicationTime to readmission and its prognostic factors among hospitalised heart failure patients in Kelantan(2024-08)Yusoff, Mohd YusranHeart failure (HF) is a common comorbidity among adult population and is associated with poor outcomes. One challenging aspect of it is the issue of recurrent admissions leading to significant healthcare burden. The aim of this study is to explore the proportion of readmission, median time and prognostic factors for time to readmission among hospitalised HF patients in Kelantan. This retrospective cohort study involved patients admitted primarily for HF in Hospital Raja Perempuan Zainab II from October 2021 until December 2022. Inclusion criteria include adult Malaysian citizen, age 18 years old and above with formal echo finding within one year of index hospitalisation. Those with in-patient mortality, transferred to another facility upon discharge or discharge at own risk and those with active malignancy were excluded. The cohort were followed up until December 2023 to identify the event of readmission which is defined as admission due to acute illness. Patients who had no readmission, loss to follow up or passed away were censored. Sociodemographic characteristics, clinical data during index hospitalisation including laboratory result and medication upon discharge were collected. Data was collected from electronic medical record based on standardised online data proforma and analysis was done using RStudio and StataMP. Prognostic factors for time to readmission were identified using multiple Cox regression analysis. A total of 276 patients were included for analysis. Mean age was 60.64 years old. Most of them were Malays (95.3%) with higher proportion of male (53.6%). Common comorbidities include Hypertension (81.5%), ischaemic heart disease (62%), type II diabetes mellitus (57.2%) and chronic kidney disease (50.4%). Proportion of readmission at 6 Month and 1 year post discharge was 51.8% (95% CI: 45.8, 57.8) and 63.4% (95% CI: 57.4, 69.0) respectively. The cohort had median time to readmission of 118 days (95% CI: 90,149). Prognostic factors for time to readmission were atrial fibrillation (adjusted HR: 2.06, 95% CI: 1.42, 2.99, P<0.001), chronic kidney disease (adjusted HR: 1.53, 95% CI: 1.14, 2.04, P=0.004), albumin level (adjusted HR: 0.96, 95% CI: 0.94, 0.99, P=0.005), aspartate aminotransferase level (adjusted HR: 1.003, 95% CI: 1.001, 1.006, P=0.022) and ejection fraction ≤40% (adjusted HR: 1.37, 95% CI: 1.03, 1.84, P=0.033). In conclusion, HF patients in Kelantan were relatively younger and had a higher rate of readmission compared to global figures at 6-month. Clinicians need to optimise patients prior to discharge with particular attention to the identified prognostic factors.
- PublicationBreast cancer awareness and factors associated with breast screening uptake among women in Kelantan(2024-06)Wajiah, Mohd Khairul Hanan MohdBackground: Breast cancer remains a significant public health challenge, both globally and in Malaysia. Late presentation of breast cancer often results in lower survival rates and higher mortality due to the advanced stage of the disease at diagnosis. Early detection through screening methods is crucial for improving survival rates. Despite this, the breast screening uptake in Kelantan remains low. Objective: To investigate breast cancer awareness, perceived barriers to healthcare-seeking, breast screening uptake and factors associated with breast screening uptake among women in Kelantan. Methods: A cross-sectional study was conducted using convenience sampling to select 242 women in Kelantan between November 2023 and June 2024. The Breast Cancer Awareness Measure Malaysia (BCAM-M) questionnaire, which consists of 60 items across six domains: sociodemographic, awareness of breast cancer signs and symptoms, awareness of risk factors, barriers to healthcare-seeking, breast self-examination practices, and breast screening uptake, was used for data collection. This study defined breast screening uptake as having ever undergone a clinical breast examination (CBE). Descriptive statistics and logistic regression analyses were performed to identify the factors associated with breast screening uptake. Results: Of 242 participants, 59.5% (95% CI 53.28, 65.73) were aware of breast cancer signs and symptoms, 17.4% (95% CI 12.55, 22.16) were aware of age-related risks, and 22.7% (95% CI 17.41, 28.04) were aware of breast cancer risk factors. Perceived barriers to healthcare-seeking were reported by 10.3% of participants, and 80.2% resided within five kilometres of a healthcare facility. Additionally, 40.5% (95% CI 46.0, 51.0) practised BSE regularly, 60.3% (95% CI 54.12, 66.54) had undergone a CBE, and 25.9% (95% CI 17.79, 34.01) of women aged 40 years and above had undergone a mammogram. Factors significantly associated with breast screening uptake were being married (AOR 4.78; 95% CI 2.20, 10.40), being divorced (AOR 4.99; 95% CI 1.35, 18.50), healthcare-seeking within two months (AOR 3.68; 95% CI 1.98, 6.85), ever heard of CBE (AOR 7.41; 95% CI: 2.55, 21.54), and residing within five kilometres of a healthcare facility (AOR 2.39; 95% CI 1.17, 4.89). Conclusion: The findings help health sectors design tailored interventions for specific identified groups to increase breast cancer awareness and screening uptake. Implementing these targeted strategies could enhance early detection, higher survival rates, and reduce breast cancer mortality.
- PublicationProportion and factors associated with unfavorable outcomes among pulmonary tuberculosis patients in Kelantan: 10 years perspective(2024-06)Johari, Mohd Khairi SafwanBackground: Tuberculosis (TB) is a major global health concern and a leading cause of death worldwide. Despite significant efforts to control TB, unfavorable treatment outcomes remain a challenge. Objective: To determine the proportion of unfavorable outcomes and identify factors associated among PTB patients in Kelantan from 2013 to 2022. Methodology: A retrospective cohort study design was employed, utilizing secondary data from the National Tuberculosis Registry (NTBR) in Kelantan. The study included 1,260 PTB patients selected through simple random sampling. Data on sociodemographic characteristics, comorbidities, and clinical features were analysed using descriptive statistics, and univariable, and multivariable logistic regression analyses. Results: The proportion of unfavorable outcomes among PTB patients was 20.8%. Key factors associated with unfavorable outcomes included positive HIV status (Adjusted OR 5.69, 95% CI: 3.78-8.57, p<0.001), multidrug-resistant TB (MDR-TB) status (Adjusted OR 5.69, 95% CI: 2.40-13.52, p<0.001), and DOTs supervision by family members (Adjusted OR 5.02, 95% CI: 1.73-14.59, p=0.003). Conclusion: The findings highlight significant challenges in managing PTB, particularly among HIV-positive and MDR-TB patients and underscore the importance of professional supervision in DOTs. These insights are crucial for developing targeted interventions to improve PTB treatment outcomes in Kelantan.
- PublicationProportion of the processed food and ultra-processed food (upf) consumption and its associated factors among adults attending general clinics in Hospital Universiti Sains Malaysia(2024-06)Husain, Mohd Hilmi MatNutritional-related diseases have emerged as a major public health concern, contributing to premature mortality and significantly impacting the increasing prevalence of obesity, noncommunicable diseases, and cardiovascular disease. Processed food and ultraprocessed food are usually formulated industrially. Ultra-processed food is characterised by its energy- density, reduced nutritious ingredients, and hyperpalatable taste, and it has strong links with adverse health outcomes. This study aimed to determine the proportion of the processed food and ultra-processed food consumption among adults attending general clinics at Hospital USM and its associated factors. This is a cross-sectional study that collected primary data from adults who went to general clinics at Hospital USM using a sociodemographic and Malay-validated food frequency questionnaire based on NOVA classification. We assessed the ultra-processed food diversity score by summing the different ultra-processed foods consumed within a week, which facilitated the classification of low and high consumption. Multiple logistic regression was used to predict factors associated with an increased level of ultra-processed food consumption among adults attending general clinics at Hospital USM. The majority of the respondents were female (64.6%), Malay (90.8%), single (62.2%), and belonged to the B40 household income group (68.1%). The most common ultra-processed foods consumed were packaged bread, yellow noodles, cocoa drinks, and flavoured milk drinks. The proportion of respondents who had a high ultra-processed food diversity score was 54%, indicating more than half had consumed ultra-processed food seven times per week. Screen time (AOR 2.148, 95% CI: 1.181–3.906, p-value = 0.012), having received financial aid (AOR 2.436, 95% CI: 1.267–4.684, p-value = 0.008), and being unemployed (AOR 2.436, 95% CI: 1.267–4.684, p-value = 0.023) were significantly associated with high consumption of ultra-processed among adults aged 18–39 years old attending general clinics Hospital USM. In conclusion, most adults attending general clinics in Hospital USM consume ultra-processed food regularly. The factors identified in this study may suggest areas of action for policymakers to explore ways to limit ultra-processed food consumption to achieve better health outcomes.
- PublicationDetermination of gene copy number status in tert and terc among chronic myeloid leukaemia patients resist ant and responsive to imatinib mesylate treatment(2014)Asrari, Zaidatul Shakila MohamadThe frontline treatment of chronic phase (CP) chronic myeloid leukaemia (CML) patients is the use of Imatinib Mesylate (IM). A remarkable CP CML (1/3) patients failed to achieve any degree of good response towards IM treatment. Cancer cells express a higher telomerase activity compared to normal cells in various type of cancers; thus amplification of telomerase core components TERT and TERC gene, is a mechanism responsible for up regulation of telomerase activity. We postulate amplification of telomerase genes might be one of the oncogenesis mechanisms in CP CML development and involved in resistance to IM. The aim of this study was to detennine the gene copy number status of TERT and TERC among CML patients who were either resistant or responsive to IM. A total of 63 CML-IM resistant, 63 CML-IM responsive, 30 nonnal controls and 2 cell lines were enrolled in this study. The DNAs were extracted from peripheral blood and cell pellets. TERT and TERC genes copy number amplification were analysed by qPCR assay by conventional (standard curve) and commercialized assay (Taqman® copy number). FISH analysis was done to validate the presence of TERT and TERC genes amplification. We also evaluated the association between patients' age, gender, treatment status and copy number of TERTITERC genes. There was an increase in TERTand TERC mean N values (standard curve method) in both groups of CML (CML-IM resistant 0.75 and 0.82; CML-IM responsive 0.77 and 0.93) compared to nonnal controls (0.62 and 0.60). Mean N of TERT and TERC values between the two groups of CML patients were significantly different from normal controls. There was however no significant difference of mean N TERT and TERC values between CML-IM resistant patients and CML-IM responsive patients. Only one patient (CML-IM responsive) had TERT gene amplification whereas 5 patients had TERC gene amplification (2 CML-IM resistant and 3 CML-IM responsive). Comparing to standard curve method, Taqman® copy number assay detected 6 CML-IM resistant and 11 CML-IM responsive had amplified TERT gene, whilst 5 CML-IM resistant and 4 CML-IM responsive had amplified TERC gene. Almost 80% of TERT and TERC genes amplification status in CML samples analysed by standard curve method have similar outcomes with FISH. There was no clear association between TERTITERC genes amplification and patients' age, gender and their treatment status. Our results showed a low level of TERTITERC genes amplification and lack of statistical significant difference between TERT/TERC amplification in CML-IM resistant and CML-IM responsive patients may not strongly to show that TERTITERC genes amplification were one of the molecular resistance towards IM. We postulate that increment of telomerase activity via amplification of telomerase genes might not have a huge impact on CML patients particularly in drug resistance.