Pusat Pengajian Sains Perubatan - Tesis

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Readiness and satisfaction of the online learning among medical students undergoing clinical rotation during covid-19 pandemic
(2023)
Musa, Mohd Jamaluddin
Online learning has become an important teaching method across academic programs during COVID-19 pandemic. We examined students’ level of readiness and satisfaction on online learning and their association with selected variables. A cross-sectional study was conducted among medical students who undergo clinical rotation during restricted movement order, when face-to-face teaching and learning is converted into online method. Participants were recruited conveniently by inviting students from targeted clinical years to fill up Online Learning Readiness Scale (OLRS) and E-Course Satisfaction Scale (ECSS) distributed via digital platform. One-hundred and eighty-three (N=183) students in clinical posting of year 3 (33.9%), 4 (32.2%), and 5 (33.9%) completed the survey voluntarily. Majority was female (n=142, 78%) with a mean age of 22.85. Overall, they reported high level of readiness and satisfaction on online learning. There was positive moderate to good correlation between readiness and satisfaction (r=0.61, p < 0.001). Readiness was significantly associated with age (β = 1.12, p = 0.037), type of clinical posting (β = -4.09, p = 0.003), online attendance (β = 0.45, p = 0.008), and learning duration (β = 3.44, p = 0.036). Only duration of learning showed significant linear relationship with satisfaction. Medical students reported high levels of readiness and satisfaction on online learning, despite heavily relying on this online learning mode to complete their clinical posting, during COVID-19 pandemic.
Predictive factors and renal outcomes in childhood systemic lupus erythematosus
(2023)
Zawavi, Mohd Haikal Abdullah
Objective: This study aims to define predictive factors of kidney involvement in a cohort of paediatric patients with SLE. Studies have sought to identify early clinical features, laboratory tests, and molecular mechanisms that are associated with unfavorable renal prognosis, to optimize the surveillance and interventions in these patients. Method: A retrospective cross-sectional study was conducted at Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia. A total of 101 patients were diagnosed with Systemic Lupus Erythematosus. aged below 18 years old were recruited for this study. Demographic data (age, gender, race, height, weight, body mass index, parent’s monthly income, family history of Systemic Lupus Erythematosus and blood pressure), age during diagnosis of Lupus Nephritis, duration between onset of SLE and Lupus Nephritis, clinical factors (hypertension, anemia), Laboratory factors (proteinuria, hypoalbuminemia, hematuria eGFR, serum creatinine level, dsDNA positivity, and Histological WHO Class renal biopsy) were obtained from the patient’s medical records. Descriptive and simple linear regression was used to investigate predictors for renal outcomes, and prognostic analyses were performed. Multivariate logistic regression analysis was performed to determine independent predictors of renal outcomes. Result: One hundred and one children and adolescents with SLE were recruited in the cohort. Majority of them were females (93.1% with mean age 12.4 years old). 65 of them have lupus nephritis with biopsy proven of class IV and above in 53 (81.5%) of them. Presence of hypertension, abnormal eGFR, and histological biopsy of diffuse proliferative glomerulonephritis were initially identified as significant variables, however, only the latter two factors were found to be significantly predicting complication of CKD (OR 11.8, 95 %CI 2.22-63.5), (OR 29.9, 95% CI 3.05-294), respectively. The Kaplan Meier mortality survival analysis among patients with CKD also demonstrated 5- and 10-years mortality were 64% and 43%, respectively. Conclusion: Lupus Nephritis has been demonstrated to be associated with poor clinical outcomes and high mortality. Histological findings of diffuse proliferative disease and abnormal eGFR of stage IV onwards had been shown to be significantly associated with CKD. Lupus Nephritis children with CKD had mortality rate of almost 50% within 5 years.
Analysis of image quality of pediatric chest radiography in the neonatal intensive care unit (nicu) of Hospital Universiti Sains Malaysia (HUSM)
(2023)
Awal, Mohd Firdaus Mohd
Abstract Background: Chest radiography is the commonest radiography examination performed in the radiology department. It is vital to ensure the excellent quality of the chest radiograph performed to aid in diagnosing the clinical condition and to reduce the incidence of the repeated chest radiograph. One of the methods to analyse the quality of the chest radiograph is using a visual grading analysis score (VGAS) scoring. Other factors that affect the quality of the radiograph are image collimation by using collimation score and body weight. This study aims to analyse the quality of the chest radiographic performed in our centre's neonatal intensive care unit (NICU) using a visual grading analysis score VGAS scoring. We also will study the correlation between VGAS score, collimation score, body weight and gender. Methods: This cross-sectional study was done at NICU Hospital University Sains Malaysia, Kubang Kerian, Kelantan. A portable chest radiograph performed in the neonatal intensive care unit NICU during the study duration was reviewed and scored according to the VGAS scoring criteria and collimation score. The correlation between VGAS score, collimation score, body weight and age were tested using the Pearson correlation test. Correlation between VGAS score between males and females were tested using One-way ANOVA. Results: The mean VGAS score and collimation score were 21.66 ± 1.54 and 2.57 ± 1.96 respectively. There is significant weak negative correlation between the collimation score and VGAS score (r = -0.182, p = 0.010). There is also a significant weak negative correlation between age and VGAS score (r = -0.303, p < 0.001). However, there was no significant correlation found between weight and VGAS score (r = 0.035, p = 0.630) and no significant difference in VGAS score between males and females (F(1,195) = 0.669, p = 0.414). Conclusion: VGAS scoring for our center shows the excellent quality of chest radiographs. There are statistically significant correlation between VGA score with the collimation score and patient’s age.
Incidence of rheumatic fever and rheumatic heart disease and its associated factors among paediatric patients in Malaysia
(2023)
Nik, Mohd Anas Che
Introduction: Acute rheumatic fever (ARF) cases are still a significant cause of morbidity and early death in poor and developing countries. In Malaysia, ARF remains the primary cause of acquired cardiac problems, particularly in the East Coast of Peninsular Malaysia and East Malaysia. This study aims to reveal the incidence of ARF and its risk factors to develop better strategies to combat ARF in Malaysia. Methodology: This cross-sectional study was conducted across 23 centres in Malaysia over a period of one year from July 2021 to June 2022. The study included all new cases of ARF or RHD with a ratio of one case to two control patients. Sociodemographic characteristics such as age, gender, race, parental education, house condition, and monthly income were recorded. Clinical profiles such as clinical presentation, echocardiography findings, complication, management and outcome of the disease were captured. Multivariate analyses were used to determine the associated sociodemographic risk factors. Result: The incidence of ARF was 34.1 per 100,000 paediatric admissions, with Kelantan and Sabah states recording most of the cases. The most common clinical presentation for ARF patients was carditis (85.7%) and migrating polyarthritis (31.4%), with majority had valve involvement and mitral regurgitation being the most common valvular abnormality. Multivariate analysis showed age, total monthly income and rural population are significant risk factors for ARF. Conclusion: This study showed that the incidence of the Acute Rheumatic Fever was still high in Malaysia. Factors such as age, low socioeconomic status and rural residential area showed strong correlation of getting the ARF.
Prevalence and risk of infection in patients with diabetes following primary total knee arthroplasty: a global systematic review and meta-analysis of 120,754 knees
(2022)
Ahmad, Mohd Aliff
INTRODUCTION Diabetes mellitus (DM) is a known risk factor for infection following total joint arthroplasty. This study looked at the prevalence and risk of infection in diabetic and non-diabetic patients who had primary total knee arthroplasty (TKA). METHODOLOGY PubMed, Scopus, Google Scholar, Web of Science, and Science Direct electronic databases were searched for studies published up to 21 April 2022. To compare the risk of infection between diabetic and non-diabetic subjects, a pooled prevalence, and a risk ratio (RR) with 95% confidence intervals (CIs) were used. This research has been registered with PROSPERO (CRD42021244391). RESULTS There were 119,244 participants from 18 studies, with a total of 120,754 knees (25,798 diabetic and 94,956 non-diabetic). We discovered that the risks of infection in diabetic patients were 1.84 times significantly higher than in non-diabetic patients. Infection was more common in diabetic patients (1.9%) than in non-diabetic patients (1.2%). In a subgroup analysis, the risks of developing deep surgical site infection (SSI) were 1.96 times higher in diabetic patients, but no significant difference when compared in superficial SSI. Prevalence of deep SSI was higher in diabetic (1.5%) than in non-diabetic (0.7%), but the prevalence of superficial SSI was lower in diabetic (1.4%) than in non-diabetic (2.1%). CONCLUSION Consistent with previous research, we found diabetes is a risk factor for infection following primary TKA. However, the risk is much lower than previously published data, indicating that other factors play a larger role in infection.

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