Pusat Pengajian Sains Perubatan - Tesis

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    Genetic polymorphisms of xrcc1 on cervical cancer susceptibility risk
    (2022)
    Hamid, Mohd Ridzuan
    Background: Cervical cancer was ranked fourth as the most frequently diagnosed cancer worldwide and the fourth leading cause of cancer mortality among women. DNA repair mechanism plays a major role in protecting cells against DNA damage and carcinogenesis. It is well known that the DNA repair gene has become an important determinant of cancer risk. Genetic polymorphisms among the genes which are involved in DNA damage response may contribute to an augmented risk of cancer development including cervical cancer. X-ray repair cross-complimenting protein 1 (XRCC1) is a nuclear protein that is one of the key nonenzymatic scaffolding proteins involved in base excision repair (BER). Inter-individual genetic variations such as single nucleotide polymorphisms (SNPs) of XRCC1 Arg399Gln G>A (rs25487) and XRCC1 Arg194Trp C>T (rs1799782) may reduce the XRCC1 activity in repairing DNA damage and thus may increase the cancer risk predisposition. Knowledge and scientific evidence on the frequency of XRCC1 Arg399Gln G>A (rs25487) and XRCC1 Arg194Trp C>T (rs1799782) among cervical cancer patients is considerably limited. Therefore, this research was conducted to fill this knowledge gap by investigating the impact of XRCC1 polymorphisms on cervical cancer susceptibility risk. Methods: In this study, 133 cervical cancer patients and 133 healthy female control individuals were enrolled. The genotyping of XRCC1 Arg399Gln G>A (rs25487) and XRCC1 Arg194Trp C>T (rs1799782) was performed by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Next, the genotype patterns were categorized into homozygous wildtype, heterozygous and homozygous variant. The genotype and allele frequencies of both XRCC1 polymorphisms were calculated and compared between cervical cancer patients and healthy individual group using chi-square test. Next, logistic regression analysis deriving Odds Ratio (OR) with 95% CI was performed to elucidate the cervical cancer susceptibility risk. Results: We found a significant association of genetic polymorphism in XRCC1 Arg399Gln G>A (rs25487) with cervical cancer susceptibility risk. The heterozygous (GA) genotype of XRCC1 Arg399Gln G>A (rs25487) showed significantly higher risk for cervical cancer susceptibility with OR: 2.325, 95% CI: (1.380-3.918) and p-value of 0.002. However no significant association was observed for XRCC1 Arg194Trp C>T (rs1799782) with cervical cancer susceptibility risk. Conclusion Our study demonstrated an association between genetic polymorphisms in one of DNA repair pathway (BER) gene XRCC1 Arg399Gln G>A (rs25487) with susceptibility risk of cervical cancer patients. The positive association from this research study may be considered to be applied as a screening tool for early detection in cervical cancer patient in the future. However no significant association was observed for XRCC1 Arg194Trp C>T (rs1799782) with cervical cancer susceptibility risk. Although a prospective study with a larger patient population and involvement of multiple SNPs and genes necessary to validate this findings, our findings provides preliminary data locally and opportunity for future study
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    Husbands’ experience of living with survivors of breast cancer who had sexual dysfunction, in Kelantan, Malaysia
    (2022)
    Wahid, Mohd Najman Abd
    Background: Sexual dysfunction is prevalent among Malaysian women with breast cancer. Having sexual dysfunction on top of breast cancer cause consequences not only to the wives but also to their husbands. Understanding about our clients’ sexual and relationship issue may reduce negative consequences and provide better health outcome for both parties since husbands or partners act as the main supporter for our patients. Aim: To explore husbands’ view on sexuality and their experiences when dealing with the wives’ sexual dysfunction after diagnosed with breast cancer. Methods: This qualitative study was conducted within phenomenological framework among sexually active husbands of wife with sexual dysfunction after breast cancer in Kelantan. Husbands who did not have erectile dysfunction following sexual screening using International Index of Erectile Function (IIEF-5) with the score of >11 were purposely encouraged to participate in in-depth interviews between September 2019 and March 2021. The interviews were audio-recorded and transcribed verbatim. The transcriptions were then transferred to analytic computer software NVivo® for data management and analysis. The thematic analysis was done by placing meaning making theory in to the consideration. Results: Four themes were developed to understand the experience of the husbands: Narrow sexual understanding, emotional sequela, intimacy adaptation, channelling sexual needs Conclusion: This study highlights the experience of husband dealing with wife sexual dysfunction after breast cancer. Husbands embraced various respond and coping strategies that emphasised the religious belief and self-distraction pivoting sex to health concern and other activities.
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    The effectiveness of robotic rehabilitation therapy on activities of daily living among workers with acquired brain injury
    (2022)
    Kamdi, Mohd Khairul Anwar
    Background: Stroke is one of the leading causes of acquired disability in adults and the sixth leading cause of death worldwide. In Malaysia, there are 50,000 cases of stroke per year, and 40,000 of those cases occur in working-age people. Ageing populations have increased the global need for physical therapy services. Many use the Barthel index self-care evaluation to determine whether a stroke, neuromuscular, or cancer patient can meet their basic needs. This study aims to determine the effectiveness of robotic rehabilitation therapy compared to conventional rehabilitation therapy on Modified Barthel Index (MBI) score and the predictor effect among workers with stroke in East Coast Peninsular Malaysia. Objectives: The first objective of the study was to measure the changes of MBI scores among workers with acquired brain injury who underwent robotic rehabilitation therapy compared to conventional rehabilitation therapy, upon starting therapy (baseline), during therapy (week 2), and at the discharge of therapy (week 4). Secondly, to measure the effect of HADS on the changes of MBI during a 4-week follow-up on intervention in robotic rehabilitation therapy. Thirdly, we would like to determine the mediating effect of HADS between the mRS and MBI score among workers with stroke who underwent robotic rehabilitation therapy. Methodology: A prospective cohort study was implemented in Kelantan, which receives stroke patients throughout east coast Peninsular Malaysia. Each group of robotic and conventional rehabilitation therapy consisted of 50 samples. Robotic rehabilitation therapy comprises of three sessions every day for four weeks. Meanwhile, the conventional rehabilitation therapy group did gait training for two weeks, five days a week, with a weekend rest day. Data was collected at baseline (at admission), week two, and week four (at discharge) for both therapies. The patient's impairment was assessed using the Modified Barthel Index (MBI) by a certified therapist. Modified Rankin Scale (mRS) was the predictor to observe the effect of the rehabilitation outcome. Anxiety and depression that were assessed by Hospital Anxiety and Depression Scale (HADS) was considered the mediator that explained the underlying mechanism of the relationship between mRS and MBI. As for the first objective, Repeated Measures Analysis of Variance (RM-ANOVA) was performed to evaluate the outcome’s changes and compare the changes with both treatment groups. The overall effectiveness was analysed using Generalized Linear Mixed Model (GLMM) for both rehabilitation for second and third objectives. Results: We only managed to recruit 54 acquired brain injury patients to participate in this study. Thirty (55.6%) of these patients received robotic rehabilitation therapy. When we compared for all the characteristics, those who received conventional rehabilitation therapy were significantly older than those who received robotic rehabilitation therapy, while the MBI scores has a significant increased over 4 weeks duration for both therapies. The MBI scores also significantly increased when compared with the treatment group. As for HADS-A, there was a significant difference between the treatment group, in which those in the robotic rehabilitation group had higher HADS-A. When adjusted HADS to the treatment group, there is a decrease in HADS with HADS-Anxiety reduced to 0.22 units and HADS-Depression reduced to 0.28 units although it was not significant. After we add mRS in model 5, it showed that the MBI score improve overtime and those with Poor mRS had lower MBI by 11.15 units. HADS also did not influence the mRS when adjusted with the treatment group when the MBI scores still showed significant improvement with an average of 3.74 units at week 2 from baseline and 5.41 units at week 4 from baseline. Conclusion: Functional recovery occurs in acute stroke patients when the mean Barthel Index score increases from baseline (week 0) to week 2 and then to the time of discharge (week 4) in both therapies. It shows that the activities of daily living improved over time and the psychological status of the workers with acquired brain injury did not affect the level of disability after undergoing robotic rehabilitation therapy. There is no harm or disadvantage in introducing robotic rehab in post-stroke patients. However, evaluation in a larger clinical trial is required to evaluate the effectiveness of this useful adjunct therapy in the stroke population.
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    Knowledge attitude and practice (KAP) among nurses towards covid-19: A comparison in covid-gazetted hospital against non-covid-19 gazetted hospital
    (2022)
    Kamail, Mohd Hatif
    Background: Numerous studies have been conducted on knowledge, attitudes, and practices (KAP) related to the COVID-19 outbreak, but only a small proportion included nurses as a study population. Therefore, this study aims to investigate the KAP related to COVID-19 among nurses in a COVID-19 gazetted hospital and a non-COVID-19 gazetted hospital. Method: A cross-sectional survey was conducted between 1st October 2021 and 31st January 2022, among 300 nurses proportionally distributed between Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II (HRPZ II), with systematic selection within six key departments. A timed online questionnaire in English consisting of 4 main sections with 30 questions on sociodemographic, and KAP related to COVID-19 was distributed via WhatsApp and Telegram. Results: The study found that 91.3% had good knowledge, 97.7% had a positive attitude, and 88.3% had good practices related to COVID-19. However, there is no significant difference in knowledge, attitudes, and practices between nurses in the COVID-19 gazetted hospital (HRPZ II) and nurses in the non-COVID-19 gazetted hospital (HUSM). Conclusion: Despite the high percentage of good knowledge and attitudes, the practices related to COVID-19 still need to be improved. Therefore, the focus should not only be about theoretical knowledge but also on improving the training, and strictly enforcing a proper standard of procedure for COVID-19.
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    Effectiveness of deep brain stimulation (DBS) surgery and its clinical outcomes among parkinson disease patients in Hospital Universiti Sains Malaysia (HUSM)
    (2022)
    Wahab, Mohd Ghaddafi
    Title : Effectiveness of deep brain stimulation (DBS) surgery and its clinical outcomes among Parkinson Disease patients in Hospital Universiti Sains Malaysia (HUSM) Background: Deep brain stimulation (DBS) has proven itself as a viable treatment option for individuals with Parkinson Disease (PD) who exhibit bothersome motor fluctuations and dyskinesias that are resistant to standard pharmacological treatments. At present, only a limited amount of information on the efficacy and safety of DBS for the treatment of individuals with PD is available in Malaysia. As such, we sought to evaluate its efficacy and post-DBS complications at our hospital, Hospital Universiti Sains Malaysia (HUSM). Methodology: We used a retrospective cohort design and we gathered secondary data on Parkinson disease patients who had (DBS) surgery at our hospital from 2008 to 2021. We assessed the efficacy of DBS at six- and twelve-months post-surgery using the UPDSR III score and Activities of Daily Living (ADL). Our objectives were determined using the Wilcoxon rank sum and the McNemar Test. Results: This study included a total of 15 participants. At six months, either with or without the medication, DBS treatment resulted in a statistically significant decrease in the UPDRS III score. However, no substantial changes were seen over a 6- to 12-month follow-up period. Additionally, we discovered a statistically significant difference in the percentage of ADL performed without drug post DBS. Meanwhile, none of our patients had cerebral haemorrhage after DBS, although three acquired infection post-operatively. Conclusion: In Malaysia, DBS has been shown to be a safe and effective short-term therapy for persons with Parkinson's disease. Additional research is needed to demonstrate that early DBS decreases the need for and complexity of PD medicines while delivering long-term motor improvement compared to normal medical treatment.