Pusat Pengajian Sains Perubatan - Tesis
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- PublicationAgreement between handheld ultrasound and automated breast volume scanner in detecting characteristic of complex breast cysts in Hospital Universiti Sains Malaysia(2023)Pei, Foo ChiaoBackground: Breast cysts are generally categorized as simple, complicated and complex breast cyst. Complex cystic breast lesions are classified as BI-RADS 4 as there are 23 to 31 % of chance being malignant. Breast ultrasonography is the first-line examination in detection and characterization of breast lesions. In view of few limitations of handheld ultrasound (HHUS), automated breast volume scanner (ABVS) was introduced to overcome the limitation. The purpose of this study is to focus on agreement between HHUS and ABVS in detecting characteristic of complex breast cysts which are thick septa, thick wall and solid component as there is no similar study are done before. Methods: A cross-sectional study was conducted in Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan from 3rd October 2021 to 2nd October 2023. Data was collected retrospectively and prospectively. Retrospectively, the data was taken from pool of patients with complex breast cysts who underwent ABVS and HHUS in Radiology Department HUSM from Picture Archiving and Communication System (PACS). Prospectively, complementary ABVS was performed in patients who had complex breast cyst after performed HHUS by radiology medical officers with at least 2 years of experience in radiology service after obtaining patient consent. Agreement between HHUS and ABVS was estimated using Kappa statistic (unweighted Kappa). Kappa statistics is a measurement of the agreement between two raters. The estimated Kappa was presented as the Kappa value, accompanied by its 95% confidence interval. Kappa value < 0 as indicating poor agreement and 0.01–0.20 as slight, 0.21–0.40 as fair, 0.41– 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement Results: The overall mean (SD) age for the patient was 45.9 (9.4) years old. Total 40 patients with 61 breast lesions were included in this study. The average size of the lesion was 0.6cm in anterior-posterior diameter and 1.1cm in width. There was substantial agreement between HHUS and ABVS in detecting thick septa and solid component which showed kappa agreement of 0.701 (95% CI: 0.525, 0.877) and 0.758 (95% CI :0.589,0.927) respectively. There was almost perfect agreement between HHUS and ABVS in detecting thick wall which showed kappa agreement of 0.880 (95% CI: 0.649, 1.0). Conclusion: Since there is good agreement between HHUS and ABVS in detecting features of complex breast cysts, complimentary HHUS can be exempted in further characterization of the complex breast cyst. Thus, it may help in reducing scanning time. However, larger cohort with more numbers of complex breast cysts is needed to yield favourable results.
- PublicationPrevalence and genotype distribution of hdv virus among chronic hepatitis b carriers in Hospital Universiti Sains Malaysia(2023)Hadi, FathinBackground HDV is one of the viral Hepatitis variants caused by the Hepatitis Delta virus. The HDV virus is unique in that it requires Hepatitis B for its propagation. HDV infection can present as co-infection (both Hepatitis B and D co-occur) or superinfection (subsequent infection with HDV after being infected with Hepatitis B). The combination of both Hepatitis B and D can lead to a severe form of chronic viral hepatitis as it can cause rapid liver cell injury and death, and may lead to the formation of hepatocellular carcinoma. HDV virus genotypes are known to be geographically distributed globally, with HDV 1 as the most frequently found genotype in high-income countries such as America and among European countries. In contrast, HDV 3, more commonly seen in South America, is more aggressive and may cause fulminant hepatitis. HDV 2 is commonly found in Asia. Due to the successful global Hepatitis B virus vaccination program, the number of HDV infections is declining worldwide. HDV infection can be prevented by Hepatitis B immunisation, but treatment success rates are low. Methodology This study was a non-interventional, cross-sectional cohort study. Participants who fulfilled the inclusion criteria and exclusion criteria were recruited from Hospital Universiti Sains Malaysia from 1st February 2020 till 27th January 2023. Selected clinical parameters were obtained with one-off blood taking for further analysis. HBV DNA extracted from serum was used for genotyping for HBV by using established specific primers in a two-tail PCR. Direct sequencing methods were used for the HBV genotypes detection, representing the eight HBV genotypes A to G, was performed using the MEGA 5 software. HDV-RNA detection uses RT PCR protocol using a specialised HDV nested primer to detect and amplify HDV. The PCR product will further be used for HDV genotyping according to the RFLP profile. Eight prototype HDV-genotype sequences were retrieved from the NCBI Gene bank for alignment and HDV genotyping. Results A total of 226 HBV positive subjects were recruited in the study. 26 subjects were HDV-positive from the HDV ELISA test. A total of 2 HDV genotypes were identified, which were genotype 1 with 9 subjects (34.6%) and genotype 2 with 4 subjects (15.4%). A total 13 subjects (50%) were unable to determine the HDV genotypes. From these 26 subjects, five subtypes of Hepatitis B were found 9 (34.6%) subtype B1, 5 (19.2%) subtype B2, 7 (26.9%) subtype B3, 4 (15.4%) subtype B4 and 1 (3.8%) subtype B5. From this study, no clinical association was found between the presence of liver cirrhosis with specific HDV genotypes with a p-value of 0.127 (p-value >0.05). In addition, this study found no association between AST and ALT levels with specific HDV genotypes with a p value of 0.821 (p-value >0.05). From our research, we could not demonstrate any significant association between HDV genotypes and specific selected clinical parameters. Conclusion From 226 total subjects, 26 subjects were positive HDV ELISA test. A total of 5 Hepatitis B subtypes were found with the most prevalent genotype of Hepatitis B; Hepatitis B Subtype B1 with 9 (34.6%) subjects, Hepatitis B Subtype B2 with 5 (19.2%) subjects, Hepatitis B Subtype B3 with 7 (26.9%) subjects, Hepatitis B Subtype B4 with 4 (15.4%) subjects, and Hepatitis B Subtype B5 with 1 (3.8%) subject. The data showed that genotype 1 is the most prevalent HDV genotype, with 9 subjects (34.6%), followed by genotype 2 with 4 (15.4%). We could not identify the HDV genotype sequences for 13 subjects (50%) due to several factors while handling the specimens like the small concentration of the synthesized cDNA from the RNA extraction, the volatility of RNA, and the unstable nature of RNA, the later usually cause loss of RNA integrity causes cDNA to denature early and in some cases produce non readable amplicons during its amplification using nested PCR. There was no significant association found between the HDV genotypes with the clinical manifestation.
- PublicationValidity and reliability of the Malay questionnaire for olfactory disorders(2023)Gima, Erica AnakBackground: Olfactory disorder is an umbrella term for a diverse group of smell problems. Numerous tests and questionnaires have been formulated to identify and test the severity of smell impairment, which is not readily available or not translated for the Malaysian population. We aimed to translate the Questionnaire for Olfactory Disorders (QOD), validate and test the reliability of the Malay questionnaire for olfactory disorders (mQOD). Methods: This was a cross sectional study conducted in two tertiary centres. A forward and back translation was done for the QOD. The translated questionnaire was distributed to subjects with self-reported smell disorders on day one and day seven. Internal consistency was analysed with Cronbach’s alpha and test retest reliability tested with intraclass correlation coefficient. Confirmatory factor analysis was done to test construct validity. Result: A total of 375 participants were recruited, 52 participants dropped out and 323 completed the questionnaire a second time. Cronbach’s alpha coefficient was 0.537 for P, 0.892 for LQ, 0.637 for S and 0.865 for VAS. The intraclass correlation coefficient (ICC) for domain scores were >0.9, while the ICC for all items were good to excellent. A three-factor model for mQOD showed acceptable fit with indices CMIN/DF=3.332, TLI=0.923, CFI=0.939, RMSEA=0.079 and SRMR=0.0574. Conclusion: The mQOD is a valid and reliable tool for assessing olfactory disorder in patients.
- PublicationVisual motor integration, visual perception and motor coordination in children with horizontal strabismus(2023)Meng, Edwin Pheng ChinIntroduction Strabismus refers to misalignment of the eyes, in which the eyes are pointing in different directions. This condition has many health and social implications which may disrupt normal development in a child. Visual motor integration, the ability of a person to perceive visual input and coordinate a motor response, is an essential skill to learn and master in a normal developing child. Exploring the visual motor integration of children with strabismus may allow healthcare providers to provide crucial services to these children. Objective This cross-sectional study aims to evaluate visual motor integration of children 6 to 17 years old with and without horizontal strabismus. Methodology A total of 90 children were recruited in this study (control vs test group). The ability of a child to integrate their visual and motor abilities was recorded using The Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI) with the supplemental Developmental Tests of Visual Perception and Motor Coordination. The scores between both groups were analysed using independent t-test and one way analysis of covariance. Results There were significant differences in the mean Berry-VMI score between children with horizontal strabismus and children without strabismus (p<0.001). Similarly, the visual perception score and motor coordination score in children with strabismus was significantly lower than in children without strabismus (p<0.001). These differences persisted even after adjustment for age, gender, favorite sport activities, number of siblings and the presence of stereopsis. Conclusion The mean score of children with horizontal strabismus is significant lower in Beery-VMI, Visual Perception and Motor Coordination when compared with children with normal eye alignment, even after adjustment for potential confounding factors. These finding give us an insight that children with strabismus may require extra attention and services to improve their visual motor integration compared to normal children.
- PublicationEvaluation of the outcome of sclerotherapy, complications and predictors of treatment success for venous malformations in hospital Kuala Lumpur(2023)Yeh, Ding ChuIntroduction: Percutaneous sclerotherapy is often considered as the first-line intervention for patient with cutaneous venous malformations. Objective: To determine the outcome of percutaneous sclerotherapy for cutaneous venous malformation (VM) and predictors of positive response to treatment. Method: A total of 149 patients with venous malformation were treated in Hospital Kuala Lumpur during the 10 years span of 2010 to 2020. 88 patients were successfully recruited for the study, all of them were given the same questionnaire to answer regarding treatment outcome and patient satisfaction. Patient files and imaging data were retrieved to obtain demographic data and information regarding the VM treatment. Logistic regression was used to determine significant predictors to patient satisfaction. Result: Most common site of VMs is the head and neck region (76.1%). Majority of the patients presented with swelling (97.7%, n=86) as symptoms. Sclerotherapy is most efficient in managing swelling and aesthetic complaints, but not pain. In all, 65 (73.9%) patients satisfied with the sclerotherapy. Out of 207 total sessions, only one patient had major complication (Grade 3 CIRSE), most common complications are post-procedure swelling (78.4%). No positive predictors were identified. Conclusion: Percutaneous sclerotherapy using Sodium Tetradecyl Sulfate (STS) as the sclerosant is an effective treatment for venous malformation with minimum major complications. Nevertheless, it resulted in a high recurrence rate.