Pusat Pengajian Sains Perubatan - Tesis
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- PublicationThe significance of capillary electrophoresis in the detection of haemoglobin constant spring and its relationship with high-performance liquid chromatography(2021)Rameli, NabilahIntroduction: Haemoglobin Constant Spring (Hb CS) is one of the most common non-deletional types of alpha (α) thalassaemia in Southeast Asia region. The nature of this abnormal globin gene is that it is unstable, labile and is present in minute amount in the peripheral blood. Thus, this may lead to underdiagnosis of the disease. This study was conducted to determine the proportion of Hb CS among the Kelantan population and to compare range of peak value in Zone 2 CE findings for 3 groups of Hb CS (heterozygous, homozygous, and compound heterozygous) and their haematological parameters. The study aimed to look at the findings of HPLC in relation to CE results in detecting Hb CS. Study design and methods: This was a cross-sectional study involving secondary data collection from 378 samples which showed peak value on Zone 2 of CE. The samples were taken from the National Thalassemia screening of Form 4 students from all districts in Kelantan. The haematological parameters of red cells were analysed using Sysmex XN 3000 automated blood cell analyser, Hb analysis was performed using automated CE system (CAPILLARYS2 Flex-Piercing System Sebia), HPLC Biorad variant II, DNA analysed using multiplex polymerase chain reaction (PCR) and multiplex Amplification refractory mutation system (ARMS) to detect both deletional and non-deletional α-thalassaemia. Results: 376 samples (99.5%) with presence of peak value on Zone 2 of CE were confirmed to have termination codon CS mutation. Heterozygous Hb CS is the most common type of Hb CS detected in 344 samples (91.5%), followed by compound heterozygous Hb CS which was 31 samples (8.2%) and only 1 sample (0.3%) of homozygous Hb CS. The mean ± SD of peak value in Zone 2 of heterozygous Hb CS and compound heterozygous Hb CS were 0.61 ± 0.13 and 0.77 ± 0.34 respectively. The only sample of homozygous Hb CS showed the value of 4.9% of peak value in Zone 2 of CE. The significant differences of haematological parameters between heterozygous and compound heterozygous Hb CS were observed in haemoglobin level, MCV, MCH and MCHC. This study showed there was a good linear correlation between peak in C-window on HPLC and peak value in Zone 2 of CE in detecting Hb CS, r=0.73. Conclusion: Thus, by combining the haematological parameters and complementary tests of both CE and HPLC, the diagnosis of Hb CS can be detected prior to confirmation by DNA molecular study that is far more expensive.
- PublicationLipiodol accumulation pattern as imaging biomarker of tumoral response after conventional transarterial chemoembolization and survival outcome in hepatocellular carcinoma patients(2021)Azizi, Mohd Yadie SyazwanBackground: TACE is the locoregional treatment of choice for unresectable hepatocellular carcinoma, and a successful procedure would improve the survival rate of the patient. Good antitumoral coverage in the targeted liver tumor is necessary to produce good tumoral necrosis and results in a good therapeutic effect. TACE by using a mixture of anticancer and iodized oil (Lipiodol) may provide an overview of the degree of accumulation and retention within the targeted tumor on subsequent CT-scans follow up, thus predicting the outcome of the treatment. This study aimed to determine the correlation between the pattern of accumulation pattern of lipiodol and the targeted tumoral response toward the treatment given and the overall survival rate of HCC patients. Methods: This retrospective record review was done from 2013 until 2020 in patients who received TACE with anticancer and Lipiodol in Hospital Universiti Sains Malaysia, who are fulfilling inclusion and exclusion criteria. Lipiodol accumulation pattern is observed approximately after six weeks post-TACE on the follow-up CT scans and later is classified into 4 accumulation patterns; pattern 4, complete accumulation; pattern 3, intense (>75% of tumor volume); pattern 2, moderate (<75% of tumor volume); and pattern 1 – low accumulation. Evaluation of the tumoral response was done according to the mRECIST criteria. Chi-Square or Fischer Exact test and multiple logistic regression test analysis was used to determine the association between the lipiodol accumulation pattern and the tumor response towards the treatment. A survival analysis test (Kaplan-Meier analysis) was used to determine the association between the accumulation pattern and the overall survivability of the patient who received TACE. Simple and Multiple Cox Proportional Hazard Regression tests were used to study other associated factors affecting overall survivability. Results: A total of data from 38 subjects were obtained in both BCLC stage B (n=33) and BCLC stage C (n=10) groups. In BCLC stage B, 18% (n=7) were in complete accumulation, 26% (n=10) in intense accumulation, 16% (n=6) in moderate accumulation and 13% (n=5) in low accumulation pattern. Fisher’s exact test for BCLC stage B subjects showed significant association between lipiodol accumulation pattern and tumor response with Fisher’s Exact value of 27.025 (p<0.001). Spearman-rho test reports a significant association of lipiodol accumulation pattern and tumor response with a magnitude of 0.84 in this group. In BCLC stage C no complete accumulation pattern was observed, 5% (n=2) were in intense accumulation, 11% (n=4) were in moderate accumulation and 11% (n=4) were in low accumulation pattern. The Fisher’s exact test for subjects in BCLC Stage C showed no significant association between lipiodol accumulation pattern and tumor response with Fisher’s Exact value 2.281 (p>0.05). Survival analysis shows higher proportion of cases survived at 1- year and 3-year in complete (85.7% at 1-year and 17.1% at 3-year) and intense (88.9% at 1- year and 38.1% at 3-year) lipiodol accumulation group in BCLC stage B group as compared to other accumulation patterns. The median survival time in BCLC stage B for each group were 26 months (complete), 30 months (intense), 9 months (moderate) and 16 months (low). In BCLC stage C group where only moderate and low accumulation pattern were observed above one year, with 1-year survival rate was 50% (moderate) and 25% (low) with none survive at three and five years. The median survival time for BCLC stage C group were six months (intense), four months (moderate), and eight months (low). Simple and Multiple cox regression analysis revealed that the number of liver nodules group and number of TACE procedures done were among significant prognostic factor of death in HCC. Patients that have 5-9 liver nodules had a 12.1 times higher risk of death as compared to the group of patients with 1-4 liver nodules (HR: 12.1, 95% CI: 1.17 – 124.57). Patients that received one TACE procedure are expected to have a decrease in risk of death by 0.57 (HR: 0.565, 95% CI: 0.393 – 0.812). Though additional regression analysis did not report a significant influence of lipiodol accumulation pattern on disease progression, correlation analysis reported a moderate positive correlation between lipiodol accumulation pattern and disease progression (rs(36) = 0.796, p < 0.001). Conclusion: Lipiodol deposition in liver tumors can be evaluated using quantitative baseline imaging characteristics and it shows significant correlation with tumor response toward the treatment and influence the survival outcome of the patients. Our study confirms the findings of previous studies and validates the unique properties and function of Lipiodol as a tumorspecific, drug-carrying, and imaging biomarker agent to treat HCC patients.
- PublicationClinical outcome of epilepsy surgery of the temporal lobe in pediatric group : A retrospective cohort study(2021)Mispan, Mohd Khairun MohdAim: This study was to identify seizure outcome following epilepsy surgery in pediatric group using Engel classification. We also identified histological and radiological findings of the study population. Finally we identified potential prognostic factor for seizure free outcome (Engel Class I). Methods: This study was a retrospective cohort study over a period of 8 years from 1st January 2012 until 1st July 2019. Engel Outcome Classification was used to identify seizure outcome at immediate, 3-6 months and one year post operation. Age, sex, age of seizure onset, age of operation, body weight, number of antiepileptic medications pre and post operation, duration of stay in ICU and ward, MRI and histopathological findings and complications were noted. Analytically, Fisher Exact test was used for categorical data. Wilcoxon Signed rank test was used for continuous but not normally distributed data. In this study, Univariate Logistics regression is used to understand whether Engel Classification I can be predicted from categorical variables and numerical variables. A set p-value of <0.05 was considered of statistical significant. Results: 29 pediatric patients met study criteria. The Mean time between seizure onset and surgery was 5.6 years. None invasive evaluation was used in all 29 patients during preoperative assessment. With the use of the Engel Outcome Classification, Engel 1 Outcome or Seizure Free was achieved in 28 patients (96.6%) at immediate follow up, 24 patients (82.8%) at 3-6 months follow up and 24 (82.8%) at 1-year follow up. Hippocampal Sclerosis was present in 13 patients (44.8%). Tumours were present in 16 patients (55.2%). The complication proportion was 14.4%. Only 2 (6.9%) patients underwent reoperations. There is significant changes in post operative Anti Epileptic Medications (AEDs) reduction in this study (P= 0.006). Possible risk factor of seizure was suggestive for less recurrence of seizure which may become as a predictor to achieve to Engel I classification in this study (P= 0.052). Conclusion: The surgery outcome of epilepsy surgery of the temporal lobe in pediatric group was remarkable in this study. Careful patients’ selection by multidisciplinary evaluations is mandatory. Seizure freedom was achieved successfully with acceptable complications rates.
- PublicationFactors associated with chronic wounds among surgical wounds in wound clinic from 2016 till 2019 in Hospital Universiti Sains Malaysia(2020)Ramalingam, TheebanrajaBackground: Wound management have been a cornerstone in medical field. Wound management have taken leaps and bounds over the years with the latest advancement and products to improvise the healing process. Patients with surgical wounds require wound dressing and long term follow up especially in cases of chronic wound. Patients with chronic wound will undergo wound dressing for long term. Wound care clinic HUSM was establish in 2016 and have actively providing wound care service for patients in HUSM as well as the surrounding neighbourhood. This study is to establish factors associated with chronic wounds among surgical wounds from 2016 till 2019 in HUSM. By identifying the associated risk factors, progression of surgical wound to the chronic wound could be reduced. Methods: A retrospective secondary data of total 147 patients who underwent wound dressing for surgical wounds in wound clinic at HUSM between Jun 2016 and December 2019 was carried out. Initially the data of patients were gained from patient’s wound clinic assessment records and entered in a data collection form. Simple random sampling using random number generator(using Microsoft Excel) of all surgical patients with acute surgical wound underwent dressing at wound clinic at HUSM from 2016 till 2019 was done to choose the patients. The demographic and medical history data was obtained from patients summary from the medical record. The primary outcome were to describe the prevalence of chronic surgical wound among acute surgical wound under wound clinic follow up . Outcome parameters were: healed wound and chronic wound after duration of 3 months. Demographic and medical history of patients (diabetes mellitus, hypertensionand coronary artery disease, smoking habits and type of wounds were analysed as the factors influencing the wound healing of the patients Results: A total of 147 patients were included into the study, and vast majority of them were Malay (96.6%). Eighty of them were less than 55 years old, and more than half were Male (52.4%). Sixty patients out of hundred forty seven patients were active smoker. More than half of them had diabetes mellitus (72.8%) and hypertension (60.5%), and only 23.1% had cardiovascular disease. There were 15 patients with clean and clean contaminated wound each. Five patient wound was found to be contaminated and 115 patients had dirty wound. The median initial wound size was 52cm3 (interquartile range: 18cm3, 193.5cm3). For patients with chronic wound, the median wound size after 3 months were 4.5cm3 (interquartile range: 2.3cm3, 8.5cm3). Significant associations were found in between wound healing time with smoking status (p=0.018), diabetes mellitus (p=0.004) and hypertension (p=0.029). There were more smokers found to have chronic wound (57.1%) compared to patients which wound healed in less than 3 months (35.7%). Besides, patients with diabetes were observed to contribute to higher proportion in chronic wounds (91.4%) compared to acute wound (67.0%). Significant association was found between hypertension and wound healing time where 77.1% of patients with hypertension were observed to have chronic wound compared to 55.4% in patients with normal blood pressure. Apart from that, significant difference was found in initial wound size between patients with wound healing time of less than 3 months vs more than 3 months (p<0.001). Patients with chronic wound were observed to have bigger initial wound compared to patients which wound healed in 3 months. Conclusions: This study showed significant influence of smoking habit, comorbid like diabetes and hypertension as factor that influence the wound healing process and causing more chronic wounds among patients. Significant associations found in between wound healing time with smoking status (p=0.018), diabetes mellitus (p=0.004), and hypertension (p=0.029). Apart from that, significant difference was found in initial wound size between patients with wound healing time of less than 3 months vs more than 3 months (p<0.001). A unit increase in wound size (cm3) will increase the odds for chronic wound by 1%
- PublicationThe study of effectiveness of high-fiber multigrain supplementation among rheumatoid arthritis patients in Hospital USM Kubang Kerian: A randomized open label clinical trial(2021)Supramaniam, ThamaraiBackground: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that attacks human joints, leading to joint destruction. Early treatment can help to delay joint destruction and maintain joint function. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) are the cornerstones of RA treatment. However, they are associated with various side effects. Evidence suggests that dietary factor plays an important role in RA management. Therefore, dietary therapy should be considered as part of the treatment regimen for RA patients. This study intended to explore the complementary effects of multi-grained powder supplementation on the clinical severity of the disease activity, inflammatory blood molecules and the changes in the nutritional status of RA patients , and to monitor general well being of participants compared to those who are receiving conventional drug therapies. Methods: This study was an open randomized supplementation trial conducted between March 2019 and June 2019 on RA patients who followed up at the Hospital Universiti Sains Malaysia (HUSM) Rheumatology clinic. A total of 51 patients were recruited in this study. Patient information such as age, comorbidities, drug history, body mass index (BMI), waist circumference, duration of RA, disease activity (disease activity score [DAS]), health assessment questionnaire disability index (HAQ-DI) score, morning stiffness rating scale, visual analogue scale (VAS) score, as well as biochemical parameters such as renal function test, liver function test, total cholesterol, erythrocyte sedimentation rate (ESR) and full blood count was obtained. The pre and post-DAS 28, VAS score, HAQ-DI score, morning stiffness rating scale and biochemical parameters were assessed. Results: The mean ages of the participants in the intervention and control groups were 54.68 (SD=8.28) and 51.88 (SD=14.09) respectively. The collected data showed that the majority of the participants in both the intervention and control groups were female, with 19 (37.2%) and 24 (47.1%) female participants respectively. There were no significant differences in the baseline characteristics between the two groups. For both the intervention and control groups, the analysis of the clinical characteristics showed that 29.4% of the participants had low disease activity (DAS between 2.6 to 3.2), 54.9% had moderate disease activity (DAS between 3.2 to 5.1) and 15.7% had high disease activity (DAS higher than 5.1). The results of the pre and post-tests of the intervention and control groups were compared to evaluate the efficacy of high-fiber multigrain supplementation in reducing inflammatory markers and clinical disease activity among the participating RA patients. For the intervention group, it was observed that the mean scores of the BMI (p<0.001), waist circumference (p=0.005), DAS 28 (p<0.001), HAQ-DI (p=0.034), morning stiffness scale (p=0.010) and VAS pain scale (p=0.003) in the pre-test were significantly different from those of the post-test However, there were no significant differences in the mean scores of the variables in both the pre and post-tests between the intervention and control groups, except for the HAQ-DI score (p=0.009), morning stiffness scale (p=0.035) and VAS pain scale (p=0.003) in the post-test. The mean score of the HAQ-DI of the intervention group in the post-test was lower by 0.32 (95% CI=-0.56, -0.08) than that of the control group. For the morning stiffness scale, the mean score of the control group was higher by 1.42 (95% CI=-2.75, -0.10) as compared to the intervention group.As for the VAS pain scale, the mean score of the intervention group was lower by 2.03 (95% CI=-3.34, -072) than the control group. As for the assessment of side effects of high-fiber multigrain supplement , it was observed that twenty participants developed satiety, six participants had flatulence, three participants developed nausea, three participants experienced headache, three participants suffered from heartburn and a small number of participants experienced intestinal rumbling and constipation. None of the participants from the control group developed diarrhea. As far as compliance assessment was concerned, all the participants in the intervention group achieved a target compliance percentage of 80%. Conclusion: In conclusion, the physical functioning and quality of life (QoL) of the participating RA patients in this study were significantly improved with the multigrain-enriched powder supplementation. Furthermore, the data of this study has clearly demonstrated the potential of multigrain-enriched powder supplementation as nutritional medicine to support current standard therapies for RA patients. Although the data might not be conclusive enough, dietary advice has its place in rheumatology as part of an integrated approach for RA patients