Pusat Pengajian Sains Perubatan - Tesis

Browse

Now showing 1 - 5 of 2768

A 3-year review of group-b streptococcus colonization in pregnancy and its perinatal outcome in Hospital Selayang
(2022)
Jayakumar, Yogan
INTRODUCTION AND OBJECTIVE: There is an increase in the prevalence of GBS infection in pregnancy, which causes significant morbidity and mortality to both mother and baby. This retrospective study will evaluate the impact and outcome of pregnancy associated with GBS in Selayang Hospital from year 2017 till 2019. STUDY METHOD: This retrospective study was performed at Hospital Selayang over a three-year period between 1st January 2017 and 31st December 2019. Patients with GBS colonization were identified from their case note and laboratory investigation result. Those patients who had their high vaginal swab culture growing GBS bacteria were considered as patient with GBS colonization. Patient’s demographic, obstetric and neonatal data were documented in Performa (Appendix 1). Data analysis was carried out with SPSS version 26.0. RESULTS: A total of 31762 patients delivered at Hospital Selayang. From this a total of 344 patients were noted to have GBS colonization, making its prevalence of 1.09%. Out of 344 deliveries, 114 of babies were admitted to NICU for various reason. Majority (56.3%) of them were admitted in view of presumed sepsis as the infants showed early sign of infection. From our study noted, that Chinese mothers has a significant association and 1.92 likelihood of baby admitted to NICU compared to other ethnicity (Adj 95% CI (1.11, 3.30), p =0.02) when antibiotic variable was controlled. Meanwhile patients who were given antibiotics has 0.62 reduce likelihood of baby admitted to NICU compared to patients who did not receive intrapartum antibiotic prophylaxis (p = 0.004). CONCLUSION: The prevalence (1.09%) shown much lower than other literature review, as the sample size not as universal screening in general population of pregnant patients. Only those patients who came with excessive vaginal discharge, PROM, PPROM and preterm labour were screened. There is significant association between Chinese ethnicity and NICU admission. It shown that babies born to Chinese mothers with GBS infection more prone to get admitted to NICU compare to other race and foreigners.
Shoulder mobility and strength assessment using biodex 3tm system following conservative treatment of middle clavicle fracture
(2022)
Sheng, Yap Yan
Introduction Clavicle fractures are common injuries. Loss of shoulder mobility and strength are common problems reported after conservative treatment of clavicle fracture, which cause significant deterioration of occupational and sports performance. This study investigates the alterations in shoulder mobility and strength following conservative treatment of middle clavicle fractures. Methodology A cross-sectional study was conducted in Health Campus USM to compare shoulder mobility and strength between subjects who underwent conservative treatment of middle clavicle fracture for at least 12 months, and the healthy subjects. 25 subjects with unilateral middle clavicle fractures were recruited by simple random sampling. 25 healthy subjects with age, gender, and limb dominance matched with the subjects in the Clavicle Fracture Group were recruited. Limb dominance was determined by Laterality Quotient generated from Edinburgh Handedness Inventory (EHI). Weight and height were measured to calculate lean body mass (LBM) using Boer's Formula. A digital goniometer was used to measure the active range of motion (ROM) for six shoulder motions (external rotation, internal rotation, forward flexion, extension, abduction, and adduction). The isokinetic peak torque of shoulder motions was measured using Biodex 3™ System Dynamometer in two different test velocities (60 and 180/s). Normalized peak torque (NPT) was calculated by dividing measured peak torque values with LBM. Chi-Square Test was used to analyze the descriptive demographic characteristics of the study subjects. Independent T-test and Mann-Whitney U Test were used to analyze the active ROM and NPT difference between the Clavicle Fracture Group and the No Fracture Group. Statistical analysis was performed using SPSS Software Version 26 (SPSS Inc, Chicago, IL). Results Subjects in the Clavicle Fracture Group have significantly lower active ROM in almost all planes of shoulder motions (except shoulder extension), as compared to the No Fracture Group. The Clavicle Fracture Group showed significantly lower NPT at both test velocities for shoulder external rotation. NPT at 180/s for shoulder extension is significantly lower in the Clavicle Fracture Group, but the NPT at 60/s showed no significant difference between the groups. For shoulder abduction and adduction, NPT at 60/s is significantly lower in the Clavicle Fracture Group, despite no significant difference between the groups at 180/s. Conclusions Conservative treatment of middle clavicle fracture may not address the residual deficits in glenohumeral joint mobility and strength. Surgical treatment should be considered to improve functional outcome. Future studies should investigate rehabilitation regimes that improve joint mobility and muscle group-specific strengthening tailored for patients with middle clavicle fractures.
Comparison of prophylaxis phenylephrine infusion and rescue bolus administration for maintaining blood pressure during spinal anaesthesia for caesarean delivery in obese women
(2022)
Cui, Wong Pit
Background: Obesity and Caesarean section (CS) have been identified as independent risk factors for maternal morbidity and mortality. Regional anaesthesia should ideally be used for all Caesarean delivery unless contraindicated. However, maternal hypotension, a recognized complication of post-spinal anaesthesia, found more severe among obese mothers. Phenylephrine (PE) is a preferred choice of vasopressor in this setting as it results in better neonatal outcomes. This study investigates the effect of prophylactic PE infusion on the haemodynamics of obese parturients undergoing elective CS under spinal anesthesia. (SA) Methods: This was stratified balanced randomization, double blinded, parallel group study conducted in Hospital Universiti Sains Malaysia. A total of 74 parturients scheduled for elective CS under SA were randomized into two arms, Group A (n=37) received prophylactic PE infusion starting at 50 μg/min and adjusted according to the given algorithm or Group B (n=37) who received 100 μg phenylephrine bolus to treat post-spinal hypotension. The primary outcome measured included systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean artery pressure (MAP). The secondary outcomes were the total requirement of PE and neonatal Apgar scores. Results: Six patients were excluded from the analysis due to missing data. The result showed that SBP, DBP, and MAP were statistically significantly higher in the prophylactic infusion group compared with the therapeutic bolus group (p<0.05). The mean difference of SBP, DBP, and MAP between the two groups were significant. The mean requirement of PE was higher in the infusion group compared with the bolus group. Both groups have no difference in terms of neonatal Apgar score. Conclusion: Prophylactic PE infusion provides more excellent haemodynamic stability control than therapeutic PE boluses among obese parturients with BMI between 30 -40 kg/m2 undergoing CS under SA.
Prevalence and outcome of infected tumour endoprosthesis in Hospital Universiti Sains Malaysia
(2022)
Keat, Wong Joon
INTRODUCTION AND OBJECTIVE Endoprosthesis implantation is a viable option in the surgical management of malignant bone tumours; its modularity for joint and osseous defect reconstruction provides early good functional outcomes. However, with such significant operative intervention, it carries tremendous risk, and infection is one of the most dreaded complications. This study aims to determine the prevalence and outcome following treatment of infected endoprosthesis. METHODOLOGY This is a retrospective study in which all oncology patients that had undergone limb salvage surgery in the orthopaedic oncology unit, Hospital Universiti Sains Malaysia, from 2008-2018. A total of 69 patients were identified, and the prevalence and outcomes of patients complicated with endoprosthesis infection were determined. The diagnosis of infection is based on CDC criteria 2018. Patients' demographic data were collected, and statistical analysis was done using repeated measure analysis of variance (ANOVA) to determine the relationship between risk factors for infection. RESULTS A total of four out of 69 patients (5.8%) were found to be infected in this study. The four patients underwent staged surgery during the treatment period. There was no significant relationship between demographic or comorbidity and infection risk factors evaluated on multivariate analysis. However, the duration of surgery was found to be independently associated with an increased risk of infection (p=0.02). Of the three patients who underwent debridement and stages surgery and became infection free, only one required amputation due to unresolved infection. CONCLUSION The prevalence of infected endoprosthesis was considerably low, and the surgery duration was identified as a risk factor for infection.
Point of care procalcitonin for early detection of bacterial coinfection in patients with severe dengue in the intensive care unit: A prospective cohort study
(2022)
Azmi, Wan Nur Aida Wan
Background: Early detection of bacterial coinfection in severe dengue remains challenging. Point-of care (POC) Procalcitonin (PCT) may fulfil this role, but its performance has not been investigated. We therefore aimed to evaluate the performance of POC PCT for early detection of bacterial coinfection in patients with severe dengue admitted to the intensive care units (ICU). Methodology: In this dual-centre prospective cohort study, we analysed PCT level in severe dengue patients with and without bacterial coinfection upon their ICU admission. The diagnostic performance of PCT for the coinfection was determined through analysis of the receiver operating characteristics curve. Results: Fifty severe dengue patients were enrolled over a 1-year period. Fourteen (28.0%) of these patients had bacterial coinfection on ICU admission. PCT was significantly higher in patients with the coinfection than those without (36.2 [SD = 41.8] versus 3.6 [SD = 5.6] ng/mL, P = 0.012). The AUC of 0.768, ideal cut-off of >4.6 ng/mL, sensitivity of 64.3% and specificity of 83.3% revealed that PCT was a good marker for detecting bacterial coinfection in our severe dengue cohort. Conclusion: POC PCT provides early detection of bacterial coinfection with a good performance in severe dengue although further studies are warranted to validate these findings.

Browse

Recent Submissions