Pusat Pengajian Sains Perubatan - Tesis

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    The proportion of pulmonary embolism in covid-19 pneumonia diagnosed by computed tomography pulmonary angiography with its associated imaging features and marker in Hospital Sultanah Bahiyah (HSB)
    (2023)
    Eng, Tan Yew
    Background: COVID-19 pneumonia is a viral infection that primarily affects the respiratory system and can lead to severe respiratory distress. Recent studies have suggested an increased risk of pulmonary embolism (PE) in COVID-19 pneumonia which could lead to morbidity and mortality. However, the proportion, imaging features, and biomarkers such as D-dimer level of PE in COVID-19 pneumonia are yet to be established in Malaysia. The purpose of this study is to determine the proportion of PE, clinical staging of COVID-19 pneumonia, D-dimer levels, associated imaging features and the mortality rate among COVID-19 pneumonia. Methods: A cross-sectional study that using retrospective data conducted in Hospital Sultanah Bahiyah (HSB), Alor Setar, Kedah, Malaysia, on 949 patients with COVID-19 pneumonia suspected with PE underwent CTPA. All the CTPA images were reviewed and reported for the presence of PE and associated imaging features by radiologists in the Radiology Department at HSB. The demography, clinical staging of COVID-19 pneumonia, D-dimer levels and mortality status were collected. The association between PE in COVID-19 pneumonia and mortality status were tested using Pearson’s Chi-Square Test. The independent T-test was used to estimate the mean difference age and D-dimer levels between PE and without PE in COVID-19 pneumonia. Result: A total of 216 (22.8%) were diagnosed with PE by CTPA and commonly found in segmental and subsegmental pulmonary arteries. The most common associated imaging feature was ground-glass opacities. COVID-19 pneumonia with PE showed elevated D-dimer levels, with a mean of 6.74 (SD 7.34) vs. 3.93 (SD 5.51) without PE (p = <0.001). Out of the 216 death in COVID-19 pneumonia with PE, the clinical staging in stage 4 were 121 (56.0%) and followed by stage 5 which demonstrated 90 (41.7%). The mortality rate (32.4%) among the PE in COVID-19 pneumonia was statistically significant association with PE (p < 0.001). Conclusion: Our study demonstrated that one-fifth of COVID-19 pneumonia were diagnosed with PE by CTPA and highlights the importance of evaluating clinical biomarkers to identify those at risk for this complication. The identification of imaging features and biomarkers associated with PE in COVID-19 pneumonia could improve the diagnosis and treatment of this potentially life-threatening condition and thus prevent mortality.
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    Relationship between site of facial nerve injury and percentage of denervation in electroneuronography: A retrospective study
    (2022)
    Rajoo, Tamil Selvi
    Objective Traumatic facial nerve injury is very devastating functionally and aesthetically for a patient. It is crucial for an Otorhinolaryngology surgeon to be vigilant in diagnosing facial nerve injury and intervene at a right time . Hence, we aimed to study the clinical outcome of patients with temporal bone fracture (TBF) and traumatic facial nerve injury. In addition, the association between site of facial nerve injury and percentage of denervation in electroneuronography(ENOG) was studied. Methodology This a retrospective study (observational) which done in tertiary university hospital between 1st January 2010 to 31st January 2020. A total 82 patients who had TBF and traumatic facial nerve injury who fulfilled inclusion and exclusion criteria have been recruited. The inclusion criteria are all the patients who involved with trauma with complete documentation of facial nerve function with House Brackmann (HB) grading, Electroneuronography (ENOG) result and post trauma High Resolution Computer Tomography (HRCT) of Temporal bone. The data on demography of patients, clinical findings, Pure Tone Audiometry, HB grading, ENOG and HRCT Temporal result were collected and analysed. Results The mean age of patients involved in trauma were 27.5 years old. Motor Vehicle Accidents (MVA) constituted 92.7% of the cause for trauma. Most of the motorcyclists who involved were without helmet (83.3%). Delayed facial paralysis was found in 87.8% cases. Half of the patients with facial nerve injury had severity of HB grade IV (50%). The conductive hearing loss was commonly seen among our patients. The prevalence of patients with longitudinal TBF were the highest (60.5%). Based on the new classification of TBF, majority of our cases were otic capsule sparing (84.4%). Based on the old classification, we found the tympanic segment of facial nerve (28%) commonly injured followed by the first genu (24.4%). There was no significant difference between the percentage of denervation (ENOG) and the sites of facial canal fracture (p value<0.075). Conclusion There is no association between sites of facial nerve injury and ENOG result. The selection of patients for surgery should not solely rely on HRCT but also clinical grading (time of onset) and serial ENOG monitoring
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    The correlation of airway obstruction and emphysema on high resolution computed tomography (HRCT) thorax with spirometry in severe chronic obstructive pulmonary disease (COPD)
    (2022)
    Othman, Syahida Sh
    Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease which involves both pulmonary and extrapulmonary components. The pulmonary component is due to airflow limitation, due to parenchymal destruction (emphysema), and airway changes that is partially reversible and usually progressive. Although spirometry is the gold standard to diagnose and assess COPD, but it is unable to provide a comprehensive assessment of the complexity of the disease. On the other hand, high-resolution computed tomography (HRCT) is able to determine the structure involved either airway or parenchymal and extent of lung damage. Thus, this study was conducted to evaluate HRCT thorax parameters in severe COPD patients and correlate with spirometric parameters. Methods: A retrospective cross-sectional study was conducted in Hospital Universiti Sains Malaysia (USM), Kota Bharu, Kelantan, Malaysia with 34 patients who were diagnosed with severe COPD and underwent spirometry and HRCT thorax. The HRCT images were evaluated for airway changes and emphysema at upper, middle and lower lung fields. Pearson Correlation Coefficient was used to determine correlation between FEV1% predicted with airway parameters and emphysema scores. Results: Majority of patients involved in this study comprise of smokers 91.2% (31 patients) and dyspnoea 73.5% (25 patients). Spirometry results showed the mean of FEV1% predicted was 42.2 with standard deviation of 6.84. There was no correlation between airway parameters and emphysema score grading with the FEV1%. In our study, the worse affected area was the upper lobe and majority suffer from Centriacinar emphysema. Conclusion: Our study showed no correlation between airway parameters with FEV1% predicted or emphysema score grading. The other parenchymal changes such as fibrosis and bullae were also present in certain patients which was the likely cause of severe GOLD stage other than emphysema or airway obstruction. Thus, it is imperative that we should consider a combination of spirometry and HRCT Thorax, to diagnose as well as assess the extent of lung damage and provide timely and effective treatment for these patients.
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    Subjective wellbeing and its associated factors among community in a university during the covid-19 pandemic in Malaysia
    (2022)
    Dinsuhaimi, Syaheedatul Iman
    Introduction: COVID-19 pandemic has impacted people negatively psychosocially. The university community (staff and students) are among those who are vulnerable to psychological distress during the movement control order (MCO) due to disruption of routine. Wellbeing can be influenced by negative emotions in stressful events. This study aimed to examine the psychological status and subjective wellbeing of the university staff and students during the COVID-19 pandemic as well as factors associated with it. Methods: A cross-sectional online study, was conducted during the COVID-19 pandemic from March until April 2020, involving 1148 staff and students of Universiti Sains Malaysia via voluntary response sampling. Questionnaires consisted of sociodemographic proforma and questions relating to COVID-19 and MCO. Depression, Anxiety and Stress 21 (DASS-21) and Personal Wellbeing Index (PWI) were used to assess the psychological status and subjective wellbeing respectively. Descriptive analysis was used to describe the demographic characteristics. Multiple regression analysis was carried out to find the association between subjective wellbeing score with the sociodemographic data and DASS-21 scores. Result: Of the 1148 respondents, 27.4% reported to have moderate to very severe anxiety, compared to 18.4% and 11.5% for depression and stress of the same severity respectively. The mean (SD) subjective wellbeing score among the university community was 7.67 (1.38). Among the 8 domains of wellbeing, satisfaction with personal health was the highest (7.98). A relatively low level of satisfaction was found in the aspects of community relations, life achievement and future security with scores of 7.50, 7.49 and 7.44 respectively. Older age (b = 0.016, 95% CI 0.008 to 0.025) and being married (b = 0.189, 95% CI 0.018 to 0.359) were found to contribute to higher subjective wellbeing scores. Subjective wellbeing scores were lower among university staff (b = 0.206, 95% CI 0.390 to 0.022) than among students. Additionally, experiencing difficulties due to MCO (b = -0.363, 95% CI -0.496 to -0.231), as well as higher scores of depression (b = -0.046, 95% CI -0.062 to -0.030) and stress (b = -0.022, 95% CI -0.037 to -0.007) were found to significantly reduce subjective wellbeing scores. Conclusion: Difficulties due to MCO, depression and stress are negatively affecting towards the wellbeing of the university community, especially staff, during the pandemic. Psychosocial support should be emphasized to reduce the negative impact on the wellbeing of the university community that can affect the productivity of a university.
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    A10-year review on the outcome of primary repair of obstetric anal sphincter injury in Hospital Universiti Sains Malaysia
    (2022)
    Haiyee, Syafnaz Abdul
    Background Obstetric anal sphincter injuries (OASIS) are a major factor in the development of anal incontinence and can have a devastating effect on the physical and emotional well-being of affected women. It is a grave complication as it can affect the quality of life as well as it can give an impact on subsequent pregnancies. Sound operative repair is essential, yet between 14 and 61% patients with obstetric anal sphincter injuries report incontinence symptoms. Objective To determine the proportion of anal incontinence following primary repair and to identify the risk factor associated with anal incontinence after six months post-primary repair in Hospital USM from 1st December 2010 until 31st November 2020. Methodology: This was a retrospective observational study involving all women who underwent primary repair following obstetrics anal sphincter injury in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. A total of 271 cases of OASIS were encountered and at six months its repair outcome was analyzed. Patients were assessed regarding the anal incontinence symptoms and the risk factors contributing to OASIS were also analyzed. The degree of perineal injury and other related information were retrieved from the case notes. Data were analysed using univariate analysis to look for the association between risk factors and the outcome of primary repair. Results In this research, there were 271 cases of OASIS during the 10 years study period. Only 5 cases ( 1.8%) of anal incontinence cases were encountered. There was a significant association between grading of OASIS and the occurrence of anal incontinence on descriptive statistics. 80 women sustained a Grade 3a tear (29.6% ), 127 women had a Grade 3b tear ( 47% ), 32 women had a Grade 3c ( 11.9% ) and 31 women had a fourth-degree tear (11.5%) However, this association was not significant on multiple logistic regression. There was no association noted between other variables and anal incontinence Conclusion : Anal incontinence complicates 1.8% (5 cases) of OASIS during the 10 year study period. There was no significant association between anal incontinence and risk factors.