Pusat Pengajian Sains Perubatan - Tesis

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Ultrasound assessment of diaphragm as a predictor tool of successful extubation in mechanically ventilated patients
(2021)
Suang, Kuang Ting
Background Weaning failure is defined as failure to pass a spontaneous breathing trial or the need for re-intubation within 48 hours following extubation. An estimated 20% of all mechanically ventilated patients will encounter a failed extubation scenario. The pathophysiology of weaning failure is multifactorial but a recent factor of interest described in current literature is that of diaphragm dysfunction. The purpose of this study is to determine the role of ultrasound assessment of diaphragm as a predictor tool of successful extubation in mechanically ventilated patients Methods This study was carried out in Hospital Queen Elizabeth, Sabah and Hospital Universiti Sains Malaysia, Kelantan. Seventy-five mechanically ventilated patients who were planned for extubation and met the inclusion criteria were enrolled into the study. Written consent was obtained from the next of kin. Bedside diaphragmatic ultrasound was carried out prior to extubation to assess diaphragm excursion and diaphragm thickness fraction. The diaphragm ultrasound was performed by the clinician who had no role in the management of the patients. Extubation was based on intensivist’s or anaesthetist’s decision who were blinded of the ultrasound results. The patients were followed up for 48 hours post extubation. Results There was a statistically significant difference in both the mean diaphragm excursion and the mean diaphragm thickness fraction between the successful extubation group and the failed extubation group. When the diaphragm thickness fraction increased by 1 %, the chance of successful extubation increased by 1.29 times. Conclusion Ultrasound assessment of diaphragm thickening fraction can be used as a predictor tool of successful extubation in mechanically ventilated patients.
Quality of life after scoliosis surgery: The Hospital Sultanah Bahiyah experience
(2021)
A/L Karthikesan, Kishanraj
Introduction Idiopathic scoliosis is a is a complex three-dimensional deformity of the spinal column. Adolescent idiopathic scoliosis (AIS) is the most common type affecting healthy young individuals. Psychological well-being of these young group of patients has been area of concern when managing these patients. Aim of this study is to assess quality of life in patient undergoing corrective surgery for AIS using the SRS-30 questionaire. Methodology A cross sectional study of all patients that underwent deformity correction surgery for AIS from January 2016 till December 2019 in Hospital Sultanah Bahiyah was done. Patient had to be followed up for at least 6 months. Only patient with idiopathic adolescent scoliosis were included. Radiographic measurements of the cobb angle preoperative and postoperatively were obtained from medical records of the patient. Patients were then contacted and given the SRS-30 questionnaire to be filled up. Results 24 patients were recruited in this study based on the inclusion and exclusion criteria . The median preoperative Cobb angle was 63.0 (19.90), while post operatively it was 18.0 (11.25) with a percentage of correction of 68.0 (17.5). The average total SRS score is 4.20(0.38). Using the Spearman’s Rho correlation analysis there was a significance and moderately positive correlation between the satisfaction with management domain scores and the percentage of Cobb’s Angle correction. However, the total scores despite having a positive correlation, were not statisitcally significant. Conclusion In this study, the average total SRS score was 4.2(0.38) indicating a favourable outcome in terms of quality of life in patient undergoing scoliosis surgery in Hospital Sultanah Bahiyah.
Foot care knowledge and practice Among type 2 diabetes mellitus patients In Hospital Universiti Sains Malaysia
(2021)
Chuan, Khaw Yam
Introduction: Diabetic foot ulcer (DFU) is a chronic disease which causes significant mortality and morbidity to diabetic patients worldwide, especially complication like lower limb amputation. This study aims to determine the level of foot care knowledge and practice among type 2 diabetes mellitus (T2DM) patients and to determine relationship of foot care knowledge or practice with DFU. Materials and Methods: A cross sectional study was conducted in Hospital Universiti Sains Malaysia with subjects recruited from May 2019 to Jun 2020. They were recruited using convenient sampling method. Foot care knowledge and practice were obtained using a validated self-administered questionnaire. All patients were assessed for body mass index, monofilament testing for neuropathy and ankle brachial index for arterial insufficiency by single trained medical personnel. Results: Among 134 T2DM patients, 56 (42.8%) patients had DFU. The mean (SD) age of the study participants was 58.3 (9.9) years. A total of 113 (84.3%) T2DM patients had good foot care knowledge, and 85 (63.4%) T2DM patients had good practice. Majority of the T2DM patients with DFU had good foot care knowledge (87.5%), but poor practice (62.5%); while T2DM patients without DFU had good knowledge (82.1%) and good practise (82.1%). The Multiple Logistic Regression model showed that the foot care practice was an independent factor associated with DFU when age, peripheral diabetic neuropathy and BMI were adjusted, with estimated adjusted odds ratio 0.242 (95% CI: 0.077, 0.761). The foot care knowledge was not significantly associated with an increased risk of DFU when other confounders were adjusted (AOR: 1.347, 95% CI: 0.296, 6.741). Conclusion: Poor foot care practice was significantly associated with DFU. Apart from having foot care knowledge, adherence to education regarding foot hygiene, nail care and proper footwear is strongly recommended to prevent DFU and lower limb amputation. We suggest that the foot care practice adherence be evaluated and reinforced during every visit of T2DM patients to the health care facilities.
Evaluation of health-related quality of life in children with vernal keratoconjunctivitis using quality of life in children with vernal keratoconjunctivitis questionnaire
(2021)
Khusus, Khairil Ridzwan Kamalul
INTRODUCTION Vernal keratoconjunctivitis (VKC) is a recurrence, and chronic bilateral ocular allergic conjunctivitis mainly affected male prepuberty children. The signs and symptoms of VKC given a negative impact on well-being, lifestyle and limitation on psychosocial activities. There has been a lack of data on health-related quality of life (HRQoL) in children with VKC from Southeast Asia. OBJECTIVE To evaluate the mean total and subscales score of the QUICK questionnaire between the severity of VKC and in children with VKC and healthy groups. METHODOLOGY This study is a comparative cross-sectional study conducted in Hospital Selayang, Universiti Sains Malaysia between February 2019 and May 2020 involving children aged 8-15 years. The VKC participant's recruitment depends on the diagnosis of VKC, which was made based on the patient's clinical history, previous diagnosis, and objective examination. While in the control group, the participants were recruited from children with no existing ocular problems. RESULTS Two hundred forty children were recruited, including 120 children with VKC and 120 normal healthy children as control. There were statistically significant differences in all aspects of clinical data in the comparison between children with VKC and normal children (p<0.001) and within the children with VKC group (p<0.001). There was a statistical difference in mean total scores and all of the subscales between children with VKC and the control group (p<0.001) and between the children with mild, moderate and severe VKC(p<0.05). CONCLUSION The QUICK questionnaire is a good tool to assess the HRQoL among children with VKC. VKC disease negatively impacts HRQoL in children with VKC compared to normal children and in comparison within the severity of the VKC group. Understanding the psychosocial limitation and sign and symptoms of VKC that affected most HRQoL leads the physician to a holistic approach to managing the VKC patient.
Determination of group B streptococcus (gbs) serotypes, its virulenece genes and patient’s clinical presentation among non-pregnant adults in Kelantan
(2021)
Sulung @ Ab Hadi, Faridah
Background: GBS infection among non-pregnant adults is emerging nowadays. The severity of the disease caused by GBS depends on the serotype and presence of virulence genes in the particular strains. This study aimed to determine the distribution of GBS serotypes and virulence genes and to know the association of GBS serotype with the clinical disease. Methods: A cross-sectional study involving retrospective record review was done involving a total of 75 GBS isolates collected from October 2018 till October 2019 in two major hospitals in Kelantan (East coast of peninsula Malaysia). Those isolates were from various clinical samples of non-pregnant adults > 18 years old (excluding vaginal swab). Identification of all isolates serotype (serotype Ia, Ib, II until IX) and their virulence genes (scpB, lmb, bca, bac, rib, cylE, and hylE) were done using conventional PCR. The antibiotic susceptibility testing was traced from The BIOMIC V3, Microbiology System. Clinical information of patient was assessed from medical records and were analysed and presented as tables and figures. Background: GBS infection among non-pregnant adults is emerging nowadays. The severity of the disease caused by GBS depends on the serotype and presence of virulence genes in the particular strains. This study aimed to determine the distribution of GBS serotypes and virulence genes and to know the association of GBS serotype with the clinical disease. Methods: A cross-sectional study involving retrospective record review was done involving a total of 75 GBS isolates collected from October 2018 till October 2019 in two major hospitals in Kelantan (East coast of peninsula Malaysia). Those isolates were from various clinical samples of non-pregnant adults > 18 years old (excluding vaginal swab). Identification of all isolates serotype (serotype Ia, Ib, II until IX) and their virulence genes (scpB, lmb, bca, bac, rib, cylE, and hylE) were done using conventional PCR. The antibiotic susceptibility testing was traced from The BIOMIC V3, Microbiology System. Clinical information of patient was assessed from medical records and were analysed and presented as tables and figures.

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