Pusat Pengajian Sains Kesihatan - Tesis

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Retrospective study on the management of liver trauma: a 7-year experience in a hepatobiliary center
(2021)
Yusoff, Muhammad Za’im Mohammad
Background: Liver trauma is one of the most common injury in abdominal trauma. For the last three decades, there was a paradigm shift from operative to non-operative management (NOM) in liver trauma, with stable haemodynamic, regardless to the grading of liver injury. There are factors that should be considered for anticipating failure of nonoperative management. Therefore, this study is performed to identify these factors, to ensure that early intervention is done in order to achieve less morbidity and mortality in non-operative management of liver trauma. Methods: This is a retrospective study of case record of patients diagnosed with liver injury in Hospital Sultanah Bahiyah, Alor Setar from 1st January 2012 to 31st December 2018. Subjects who met the inclusion criteria were recruited in this study. The outcome of non-operative management and factors leading to its failure were studied. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26. Results: A total of 158 patients were included in this study. They were 12 to 80 years old, with mean age of 25.6 years. The subject pool comprised of 125 males and 33 females. Majority of the liver traumas were due to motor vehicle accidents, 141 (89.2%), followed by fall, 6 (3.8%) and industrial injury 3 (1.9%). Grade III and grade IV liver injuries were the two most common grading with a total of 43 (27.2%) and 42 (26.6%) cases encountered respectively. Fifty-three patients underwent emergency laparotomy and 20 (37.2%) of them developed post-operative complications. Hundred and five patients were treated non-operatively. Majority of the patients in this group were young, mean age of 21.0 years old. Simple logistic regression revealed six predictive factors associated with failure of NOM, including haemoglobin at presentation (p 0.015), blood transfusion status (p 0.008), unit of blood transfused (p 0.014), liver injury grade (p0.001), length of stay (p 0.028) and intensive care unit admission (p 0.041). Multiple logistic regression shown that liver injury grade and length of stay had significant association with failure of NOM, with p value of 0.003 and 0.040 respectively. Conclusion: Non-operative management in liver trauma is a safe approach in haemodinamically stable patients. Factors related to its failure must be considered for better outcome in term of morbidity and mortality.
Predictive risk factor for difficult elective laparoscopic cholecystectomy in HUSM
(2021)
Azmi, Mohd Azem Fathi Mohammad
Laparoscopic cholecystectomy (LC) is a gold standard management for symptomatic cholelithiasis. However, LC might be difficult due to the various risk factors. Preoperative risk factors are very important for the surgeon and patient in anticipating of difficulty during surgery. The aim of this study to identify clinical, radiological, and perioperative risk factor with difficult elective laparoscopic cholecystectomy patient in HUSM. Methods: This is a retrospective record review of patients who underwent elective laparoscopic cholecystectomy from 2013 to 2018 in Hospital Universiti Sains Malaysia. The patient’s characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were retrospectively analyzed to evaluate predictors of difficult LC. Results: A total of 154 patients whom underwent elective laparoscopic cholecystectomy and fullfill the criteria were included in this study. The conversion rate to open surgey was 4.5%, the mean operative length was 91.71 minutes and the mean hospital stay post operative was one day. The prevalence of difficult elective laparoscopic cholecystectomy in HUSM was 55.2% (95% CI = 47.3, 63.0). Multivariate analysis showed that history of cholangitis , history of ERCP , thick gallbladder wall on ultrasound , dense adhesion and fibrosed Calot’s triangle intraoperatively had significant association with difficult laparoscopic cholecystectomy. Conclusion: From this study, it is concluded that patient’s history of cholangitis, history of ERCP, thick gallbladder wall on ultrasound, dense adhesion and fibrosed Calot’s triangle intraoperatively were found to be the predictive factors of difficult LC.
A review of cervical cancer in HUSM for 15 years period, from 1996 to 2010
(2014)
Narawi @ Nawi, Mohamad Maulizal
Objective: This study was designed to review the cervical cancer cases that presented to HUSM between 1996 to 2010. In specific, it involved determination of characteristic of cervical cancer cases in HUSM during this period. This study also compared the epidemiology trend of cervical cancer in HUSM in the second and third 5 years period of the study. Apart from that, it also determined and compared the associated factors between early versus advanced cervical cancer in relation to morbidity and mortality in HUSM during the period Methodology: This retrospective study was conducted in HUSM for a period between 1996 to 2010. It covered all the 221 recorded case of cervical cancer that been admitted and primarily treated in HUSM . All their medical records were review and related information were entered in a standard data collection form. Results: There were 221 cervical cancers cases involved in this study. The vast majority were Malay ethnic. Base on Malaysian and Kelantan population study, it can be concluded that Chinese ethnic group had slightly higher risk to developed cervical cancer. 72% of patients were from Kelantan and 25% from Terengganu. Most came from the capital city of Kelantan and Terengganu due to its high population. The mean age of the patients diagnosed to have cervical cancer in this study was 54 years old. The majority of the patients were in the 50th decade of their life (age 50-59 years old). Generally patients that presented in this study were healthy patients with no comorbid (84%). All of the patients were married. Vast majority (95.5%) were multiparity with average parity of 5. More than half patients were postmenopausal (55.7%). There were very high correlation between not doing any pap smear to cervical cancer as 90% of patient never did any pap smear before. However poor corelation between smoking (5%) and family history of malignancy(2.7%) to cervical cancer in this study. Obtaining sexual history were not an easy task in this population. It was considered as humilation and for some as dysrespect. Thus it was very highly likely that the number of patients or partners with multiple sexual partners will be far less then it really were. Meanwhile, mean age of sexual exposure was 20 years old. Most patients were referred to HUSM by terteiry centre for further treatment 54%. Most patients either presented with PMB (38.9%) or PCB (38.5%). Majority of patients presented during stage 2B (31.2%) and 3B (25.3%). As per other underdeveloped country, 67.4% of cases were in their late stage. Only 32.6% came when the diseases still early. 78% were SCC, 15.4% were adenocarcinoma. Base on limited CT scan report 84.6% were locally advance disease. Correspond to stage at presentation 61.5% were treated with Rtx/ CCRT. Only 60 patients undergo surgical intervention with 80% without any complication. Of that, 77% had no dyscrepancy between clinical and surgical staging. 120 patients were disease free. The average were 36 months. However up to 65% defaulted their follow up and never turn up thereafter. Most patients that had recurrent presented in >12 to 36month periods, so did the death. However 49 patients having progressive disease. Up to 13% of patient that died due to non cervical cancer causes The comparison between year 2001-2005 and 2006-2010 shows few promising data. There were slight increased patients from terengganu (20 vs 28%) and coincidental reduce in chinese patient from 13 to 6.6%. The risk factor were comparable to general population of the study. In term of stages, the prominant changes were double the case of 1b2 disease ( from 6 to 12%). This were likely influenced the increased surgery and adjuvant Rtx/CCRT in 2006-2010 periods. Early recurrent (within 6-12 months periods) were almost triple (from 4.6 to 13.9% ). The exact cause were unknown. The death were also different,where by in the earlier year had only 53% death within 36 months,while in later years the percentage of death at the same periods were 72%. Regarding the factor between early and late disease. It was noted that patients with early stage were majority in 40th decades, whereby the late stage group were majority in 50th decades. Patients from Terengganu had 3 times likely late stage compare those from Kelantan. So did patients that referred by terteiry centre (with Odd 2.5) Postmenopausal were more associates with late disease with odd more than 2.5 times. The late stage groups had higher defaulter percentage in the first year of diagnosis (41% compare to 22% in early stage). There were significantly more death at late stage arm. The majority death in late stage were within 6 months (46%), while in early stage were in >12 to 36months periods (29.6%). Conclusion: Despite the innability to come with survival rate secondary to logistic problem, the study had shown the character of cervical cancer in HUSM. The main prognosis were still the stage of the disease. It was also proven that positive changes were not achieved easily with time alone. Thus wide coverage of screening with right targetted population to detect precancerous lesion and early disease, follow by proper treatment is the key to successfull in overall outcome of cervical cancer.
Translation and adaptation of self evaluation of listening function and ease of listening form (self+) into Malay version
(2025-07)
Yusuf, Nur Hidayah
Hearing loss is a significant global health issue, affecting more than 430 million people worldwide, including a considerable number of children. Early detection and intervention were crucial to reducing the negative effects of hearing impairment on a child’s communication skills, social development, and academic performance. Subjective assessment tools, such as the Self Evaluation of Listening Function and Ease of Listening Form (SELF+), provide valuable insights into children’s listening experiences in everyday situations. However, a validated Malay version of the SELF+ questionnaire was previously unavailable, limiting its use among Malay-speaking populations.This study aimed to translate and culturally adapt the SELF+ into the Malay language for use with Malaysian children aged 7 to 12 years. A cross-sectional design was employed, following a standardized six-step process that included preparation, forward translation, back translation, expert committee review, field testing, and finalization. The validation process involved assessment of content validity by experts.The findings revealed that the Malay version of SELF+ demonstrated strong content validity, with content validity index (CVI) values exceeding the recommended threshold of 0.80. For each item, the Item-level Content Validity Index (I-CVI) for items Q2, Q3, Q4 ,Q6,Q7,Q8,Q9 and Q10 achieved perfect I-CVI scores of 1.00, indicating agreement on clarity and appropriateness. Items such as Q1, Q5, Q11, and Q12 each received I-CVI scores of 0.94, showing strong agreement with minor reservations. The Scale-level Content Validity Index Average (S-CVI/Ave) was 0.98, demonstrating overall excellent clarity across the questionnaire write this in malay version Feedback from children and experts confirmed that the questionnaire items were clear, appropriate, and culturally relevant. The final version was well understood by the target age group. The adapted tool also showed excellent coherence among items, indicating its stability and consistency in assessing listening-related experiences.In conclusion, the Malay version of SELF+ is a valid and reliable tool for evaluating listening function and ease of listening among Malay-speaking children. Its careful cultural and linguistic adaptation makes it a useful instrument for clinicians, educators, and researchers in improving auditory assessments and enhancing hearing healthcare services for children across Malaysia.
Validation of the arabic version of soho-5 and its use to assess oral impact on quality of life in 5-year-old children
(2025-10)
Alhammadi, Fatema Khalfan Mohamed Ibrahim
Poor oral health can significantly impair young children’s daily functioning, affecting eating, speaking, playing, and self-esteem. Consequently, measuring oral health-related quality of life (OHRQoL) in preschoolers is essential to understand and address these impacts. The study objectives were to (1) translate the original English version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Arabic, and validate the Arabic version (A-SOHO-5), and (2) assess the impact of dental conditions on the OHRQoL of Arabic-speaking preschoolers in the United Arab Emirates (UAE). The study was conducted in two stages. Stage I involved cross-cultural adaptation (CCA) and psychometric assessment of A-SOHO-5. The translation process adopted and modified the guideline of Beaton, and pre-testing was conducted among 32 child-parent pairs. A separate sample of 157 child-parent pairs was recruited from government preschools for the psychometric assessment. Children participated in structured Arabic interviews, while parents completed self-administered questionnaires. Clinical dental examinations were conducted following WHO criteria. Psychometric evaluation included internal consistency, test–retest reliability (n=30), and validity testing (discriminant, convergent, and construct). Stage II was cross-sectional study assessed the association between oral health conditions and OHRQoL using a cluster sample of 372 child-parent pairs from one government and five private schools in Sharjah and Ajman. Clinical examinations and structured interviews/questionnaires were conducted as in Stage I. Results demonstrated strong internal consistency for the parent version (Cronbach’s alpha = 0.89) and moderate for the child version (α = 0.68). Test–retest reliability was excellent (Cronbach’s alpha = 0.97 for child, 0.98 for parent; ICC range: 0.77–1.00). Discriminant validity was confirmed by significantly higher A-SOHO-5 mean scores in caries-experienced children (child 1.72; parent 2.38) than in caries-free peers (child 0.02; parent 0.39). Convergent validity was demonstrated by a strong correlation between A-SOHO-5 (parent version) and A-ECOHIS functional scores (r = 0.72, p < 0.001). Construct validity confirmed using A-SOHO-5 and global rating questions. A moderate correlation between child and parent A-SOHO-5 scores (r = 0.42, p < 0.001) supported the agreement. Children with dental caries had significantly poorer OHRQoL. Multivariable regression identified clinical status, parental education, and school type as significant predictors of impaired OHRQoL (p < 0.05). The findings confirm that the A-SOHO-5 is a valid and reliable instrument for assessing OHRQoL in Arabic-speaking preschoolers. This study highlights the substantial impact of oral conditions on children's well-being and emphasises the importance of targeted preventive strategies across diverse populations in the UAE

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