Hospital Sultanah Nur Zahirah Research Articles

Does the Difference in Axial Length Affect the Refractive Outcome?

The purpose of this study is to compare axial length (AL) and the refractive outcome after phacoemulsification surgery from 2014 to 2019 at Hospital Sultanah Nur Zahirah, Terengganu, Malaysia. This was a retrospective record review of all cataract patients who met the inclusion criteria and underwent uneventful superior wound phacoemulsification with nontoric intraocular lens (IOL) by a single surgeon from 2014 to 2019. Using optical biometry or immersion technique, the preoperative AL determined solely via the Sanders, Retzlaff and Kraff 2 (SRK2) formula was selected. The postoperative spherical equivalent (SE) at 6 weeks-12 weeks was retrieved. Using Statistical Package for the Social Sciences version 24.0, the mean differences between targeted and actual postoperative SE were analysed based on the AL. In this study, 490 eyes of 472 patients aged 25 years old-88 years old (mean age 65.72 years old [SD 8.83]) were involved. There were 162 eyes (33%) in Group A (< 23 mm), 189 eyes (39%) in Group B (23.01 mm-24.0 mm) and 139 eyes (28%) in Group C (> 24.0 mm). The mean AL was 23.63 mm (SD 1.19). The mean differences between the targeted and actual postoperative SE were: -0.09 D (SD 0.60) in Group A, -0.07 D (SD 0.53) in Group B and -0.16 D (SD 0.52) in Group C. No significant difference was found between these groups (P = 0.327). There was no significant difference in the refractive outcome using the SRK2 formula in different ALs after phacoemulsification surgery. Hence, there is no reason to modify or adjust the targeted SE based on AL.

The Outcome Of Sigmoid Volvulus Cases: A Single Centre Experiences Over 8 Years

Introduction&#x0D; Sigmoid volvulus is one of the causes of large bowel obstruction. Its management can be challenging because of its prevalence in high-risk individuals. This study was designed to review the management and outcome of all patients admitted with sigmoid volvulus.&#x0D; Methods&#x0D; A retrospective review of all patients admitted at Hospital Sultanah Nur Zahirah, Terengganu, for Sigmoid Volvulus from January 2015 to December 2022 was performed. The data was extracted from Hospital Information System (HIS) and analysed using SPSS 27.&#x0D; Results&#x0D; Twenty-four patients were admitted, a total of 41 admissions for sigmoid volvulus during the study periods. The majority of the patients (n=16, 66.7%) were male and (n=8,33.3%) were female. Seven (29.2%) patients underwent emergency surgery on the presentation, and three (12.5%) patients died on admission due to septic shock. The remaining 14 (58.3%) were managed by endoscopic decompression. 13 (92.9%) patients had successful decompression procedures, and one patient (7.1%) failed, which required emergency surgery. About seven patients (53.8%) were readmitted for recurrence of sigmoid volvulus after successful decompression on initial admission, in which subsequently all of them required emergency surgery. The remaining six (46.2%) did not experience any recurrence episodes, and three (50%) of them underwent subsequent elective surgery. In our series, three patients died on initial presentation due to perforation and septic shock without any intervention, two patients died after emergency surgery due to septic shock and multi-organ failure, and one patient died due to covid 19 pneumonia. There was no mortality after elective surgery.&#x0D; Conclusion&#x0D; Sigmoid volvulus is a surgical emergency in which the majority (58.3%) can be successfully decompressed non-operatively. Emergency surgery in these patients is associated with 13.3% mortality in our series. Elective definitive surgery is suggested in view of the high recurrence rate (&gt;50%) and considerable risk of emergency surgery.

A Descriptive Analysis of Computed Tomography Urography (CTU) Cases in Patients With Hematuria in Comparison with Ultrasound Kub(US) And Cystoureteroscopy (CU)

The aim of our study was to correlate and evaluate the accuracy of Computed Tomography Urography (CTU) results with other imaging modalities in patients who presented with haematuria in 2020. Retrospectively comparison of CTU findings with ultrasound KUB(US) and cytoureteroscopy (CU) also have been made.  This is a retrospective study in which all CTU cases in a total of 186 patients with hematuria in 2020 were included in this study. The data was retrieved from the PACS system at Department of Radiology in Hospital Sultanah Nur Zahirah Kuala Terengganu. Frequency of the clinical manifestation were calculated among the patients and compared between US, CU and CTU findings. A total of 186 patients with hematuria involved in this study. Demographic data on clinical information have exhibited microscopic hematuria, calculi, hydronephrosis and renal calculi yielded higher percentage with 81.7%, 82.8%, 72.0% and 63.4%, respectively. The correlation between hematuria and US together with CTU findings was not significant with p value of 0.259. The data also revealed 133 patients (71.5%) had similar US and CTU findings. Meanwhile, 76.0% patients who underwent CU also yielded consistent findings with CTU. This study demonstrated no significant correlation between CTU - US findings in the detection of causes of hematuria. However, there was a good correlation of US and CU with CTU in a detection causes of hematuria with almost equal accuracy and sensitivity.

Whole Genome Sequencing of a Clinical Methicillin-Resistant Staphylococcus aureus from Terengganu Led to the Discovery of a Novel 58.4 kb Conjugative Plasmid

Methicillin-resistant Staphylococcus aureus (MRSA) has been listed by the World Health Organization as a priority antibiotic-resistant nosocomial pathogen in urgent need of new antimicrobials [1]. Plasmids are a key factor in the pathology and epidemiology of MRSA isolates and play important roles in their evolution. In our on-going efforts to better understand the genetic background and molecular epidemiology of MRSA isolates from Terengganu, Malaysia, whole genome sequencing using Illumina HiSeq platform (HiSeq-PE150) was performed on a 31 selection of clinical isolates obtained from the main tertiary hospital, Hospital Sultanah Nur Zahirah (HSNZ). One of these isolates, designated S. aureus SauR23, was isolated from pus in 2016 and was resistant to seven classes of antimicrobials and thus categorized as multidrug resistant (MDR). Analysis of the genome sequence of SauR23 showed it belonged to the ST22 clone with a SCCmec class IV(2B) and harbored the blaZ, mecA, norA, lmrS, mepR and ermC resistance genes, which corresponded to its MDR phenotype. Besides the norA-encoded efflux pump, fluoroquinolone resistance in SauR23 could also be due to the S84L point mutation in its gyrA-encoded DNA gyrase. SauR23 was found to carry three plasmids, designated pSauR23-1 (58,422 bp), pSauR23-2 (3,011 bp), and pSauR23-3 (2,473 bp). The smallest plasmid, pSauR23-3 was a RepL-family plasmid that encoded the ermC gene and was likely responsible for the inducible macrolide-lincosamide-streptogrammin B (iMLSB) phenotype exhibited by the host strain. Plasmid pSauR23-2 was a Rep_1 family small cryptic plasmid. On the other hand, pSauR23-1 is a novel, potentially conjugative plasmid that contains a replicase of the RepA_N domain (repUS20) that shared low sequence identity (34%) to the RepA_N replicase of pWBG749, a known staphylococcal conjugative plasmid. The putative conjugative region of pSauR23-1 differed from the conjugative transfer system of pWBG749 as well as other known conjugative systems in the database. Nevertheless, genes which contained conserved motifs for the MobL relaxase, the TraG/TraD-like conjugative transfer protein, and a type VI secretion system ATPase were detected within this region of the plasmid.

Lens-Induced Glaucoma: An Audit of Cataract Cases in Hospital Sultanah Nur Zahirah, Kuala Terengganu (HSNZKT).

Introduction: Cataract is the main cause of preventable blindness worldwide and as such, it is important to identify these patients early before complications develop. Cataracts may progress to become intumescent (phacomorphic) or hypermature (phacolytic). This can lead to lens-induced glaucoma, which may subsequently cause permanent optic nerve damage.Objective: To report on lens-induced glaucoma (LIG) of cataract cases treated in Hospital Sultanah Nur Zahirah, Kuala Terengganu (HSNZKT), Malaysia.Method: National Eye Database (Malaysia) data from 2011 till 2017 were collected and analysed.Results: A total of 81 (1.08%) cases of lens-induced glaucoma were calculated from 7468 cataract cases treated during the seven years of the study period. The number of cases showed an increasing trend with 0.78% in 2011 to 1.26% in 2017. Most of the patients were in the age group of 70-79 years (44.30%), followed by 60-69 years (34.18%), 50-59 years (11.39%), 80-89 years (7.59%), 40-49 years, and 90-99 years (1.27%). Most of the cases are female (57%). The majority of them (79.75%) underwent cataract operation for the first eye.Conclusion: Overall, this study was able to highlight the significant association between the incidence of LIG and increasing age as well as surgery series (either first or second eye). Therefore, more outreach programs should be conducted in the future to enable younger elderly patients from all areas to receive treatment. More online education and talk series can be organized to increase the community’s awareness and acceptance of cataract operations.

The Thromboembolism and Bleeding Event in Patients Receiving Warfarin, Dabigatran, or Rivaroxaban in Nonvalvular Atrial Fibrillation

Increasing in trend of Dabigatran and Rivaroxaban usage every year in Hospital Sultanah Nur Zahirah (HSNZ) has raised concerns regarding their effectiveness and safety compared to Warfarin. Therefore, we investigated the prevalence of thromboembolism (stroke or systemic embolism) and bleeding events in patients receiving Warfarin, Dabigatran or Rivaroxaban in our setting. This retrospective cohort study involved patients with nonvalvular atrial fibrillation who were started on Warfarin, Dabigatran or Rivaroxaban from January 1, 2014 to December 31, 2018. To fulfil inclusion criteria, patients must be on treatment for at least one year and for Warfarin group, at least 65% of Time in Therapeutic Range (TTR) should be achieved. Data were collected from Warfarin registration book, drug usage record card and Hospital Information System. 142 patients (Warfarin, n=98; Dabigatran, n=30; Rivaroxaban, n=14) with mean age of 68±8.7 years old were included in the study. Majority of them were male, Malay and non-smoker with 57.0%, 97.2% and 95.8% respectively. Upon study enrolment, all patients were at moderate risk of stroke (median CHA2DS2-VASc score=3) and low risk of bleeding (median HAS-BLED score=2). One Ischemic stroke was identified in each group of Rivaroxaban 15 mg and Dabigatran 150 mg. Four bleeding events occurred in all groups except for Dabigatran group that were hematuria, gum bleeding and upper gastrointestinal bleeding. Thromboembolism and bleeding events still occur in all groups. However, the prevalence is small in our setting with the percentage of 1.4% and 2.8% respectively. The events mostly attributed by the predisposed risk factors.

Myocardial infarction with no obstructive coronary artery (MINOCA): Prevalence and 1 year outcome at Hospital Sultanah Nur Zahirah

Myocardial infarction in the absence of obstructive coronary artery (MINOCA) disease is a new entity that differs from Acute MI which has an obstructive lesion that requires immediate revascularization. In 2018, 130 patients diagnosed with Acute Myocardial Infarction underwent angiography in our center and 6 patients were found to fulfill the criteria of MINOCA.

Reduced hepcidin expression enhances iron overload in patients with HbE/β-thalassemia: Α comparative cross-sectional study.

Iron homeostasis is regulated by hepcidin (HEPC) that controls the dietary iron absorption and iron recycling. HEPC deficiency contributes to iron overload in β-thalassemia patients. The present study aimed to investigate the correlation between HEPC concentration and serum iron status among hemoglobin E (HbE)/β-thalassemia patients and their parents (HbE trait and β-thalassemia trait) compared with healthy controls. This study is a comparative cross-sectional study in which iron profile and HEPC level were examined in 65 HbE/β-thalassemia patients (pretransfusion) and 65 parents at the Hospital Sultanah Nur Zahirah and in 130 students as healthy controls from Univesiti Sultan Zainal Abidin, Terengganu, Malaysia. Furthermore, six samples from each group (HbE/β-thalassemia patients, parents and healthy controls) were randomly selected for gene expression analysis of HEPC and ferroportin1 (FPN1) using reverse transcription quantitative PCR. The results demonstrated that serum HEPC level were significantly decreased in HbE/β-thalassemia patients and their parents (P<0.001) compared with healthy controls. In addition, the gene expression analysis showed a dramatically downregulated HEPC in HbE/β-thalassemia patients and their parents (P=0.001) compared with healthy controls. However, there was a marked upregulation of FPN1 in HbE/β-thalassemia patients and their parents (P=0.001) compared with healthy controls. Iron profiling results revealed a significantly increased serum ferritin in HbE/β-thalassemia patients and their parents compared with healthy controls (P<0.001). In summary, the present study demonstrated that HEPC expression level and serum level were significantly decreased in HbE/β-thalassemia patients and their parents, which was combined with a marked increased FPN1 expression level and serum ferritin level compared with healthy volunteers. These findings supported the hypothesis that downregulated HEPC could lose its function as a negative regulator of FPN1, resulting in iron overload in HbE/β-thalassemia patients. Subsequently, assessing HEPC and FPN1 gene expression may be a useful tool to determine the risk of iron toxicity in patients with HbE/β-thalassemia and their parents, and could therefore be considered as a therapeutic target in the management of iron burden in these patients.

Depression in Acute Coronary Syndrome Patients: A Cross-sectional Study in Malaysia

Background and purpose: Linked with high mortality rate, depression is common among acute coronary syndrome (ACS) patients. The current study sought to identify the factors associated with depression among ACS patients in Malaysia.&#x0D; Materials and Methods: A cross-sectional study was conducted on 400 ACS patients in two Malaysian hospitals: Hospital Universiti Sains Malaysia (USM), Kelantan and Hospital Sultanah Nur Zahirah (HSNZ), Terengganu. ACS patients were included if they were above 18 years of age, able to read and/or write in Bahasa Melayu language and had informed consent. Patients were excluded if they were intubated, had an altered mental status, mental retardation and had psychological problems prior to ACS. Depression in this study was defined as having dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest or involvement, anhedonia, and inertia among ACS patients. A questionnaire was distributed to all 400 ACS patients. Simple and multiple logistic regressions were used for data analysis.&#x0D; Results: The mean (standard deviation) age of ACS patients was 60.4 (11.3) years at Hospital USM and 61.2 (10.4) years at HSNZ. Nearly all of the depressive-ACS patients were Malay (79.4%), 85.9% were male, and 79.7% were married. Approximately 87.7% of depressive-ACS patients had ischemic heart disease, 87.1% had stroke, 83.4% had hyperlipidaemia, 81.8% had diabetes mellitus, and 80.7% had hypertension. The factors associated with depression were female gender (adjusted odd ratio (OR): 2.48, 95% confidence interval (CI): 1.50, 4.10, p&lt;0.001) and ischemic heart disease (adjusted OR: 2.44, 95% CI: 1.41, 4.25, p=0.002).&#x0D; Conclusion: The results showed that female gender and ischemic heart disease were the most significant associated factors of depression among ACS patients.

Determination of calorie and protein intake among acute and sub-acute traumatic brain injury patients

PurposeMalnutrition is a common problem among hospitalized patients, especially among traumatic brain injury (TBI) patients. It is developed from hypermetabolism and the condition may worsen under the circumstance of underfeeding or incompatible dietary management. However, the data of nutrient intake especially calorie and protein among TBI patients were scarce. Hence, this study aimed to determine the calorie and protein intake among acute and sub-acute TBI patients receiving medical nutrition therapy in hospital Sultanah Nur Zahirah, Terengganu. MethodsThis observational study involved 50 patients recruited from the neurosurgical ward. Method of 24 h dietary recall was utilized and combined with self-administered food diaries for 2–8 days. Food consumptions including calorie intake and protein intake were analyzed using Nutritionist PRO™ (Woodinville, USA) and manual calculation based on the Malaysian food composition database (2015). ResultsPatients consisted of 56% males and 44% females with the median age of 28.0 (IQR = 22.8-36.5) years, of which 92% were diagnosed as mild TBI and the remaining (8%) as moderate TBI. The Glasgow coma scale (GCS) was adopted to classify TBI severity with the score 13–15 being mild and 9–12 being moderate. The median length of hospital stay was 2 (IQR = 2.0–3.3) days. Calorie and protein intake improved significantly from day 1 to discharge day. However, the intake during discharge day was still considered as suboptimal, i.e. 75% of calorie requirement, whilst the median protein intake was only 61.3% relative to protein requirement. Moreover, the average percentages of calorie and protein intakes throughout hospitalization were remarkably lower, i.e. 52.2% and 41.0%, respectively. ConclusionAlthough the calorie and protein intakes had increased from baseline, hospitalized TBI patients were still at a risk to develop malnutrition as the average intakes were considerably low as compared to their requirements. Optimum nutrient intakes especially calorie and protein are crucial to ensure optimum recovery process as well as to minimize risks of infection and complications.

Perioperative Hyperglycemia as a Risk Factor for Early Surgical-Site Infection in Stable Trauma Patients in Orthopedic Unit

Introduction: Perioperative hyperglycemia resulted from known diabetes mellitus, occult diabetes or stressed-induced hyperglycemia. It is associated with increasing risk of surgical-site infection (SSI). This research is to evaluate relationship between perioperative hyperglycemia and early SSI in stable trauma patients with orthopaedic injuries.  Materials and method: We conducted an observational cohort study in Hospital Sultanah Nur Zahirah, Kuala Terengganu over 15 months. We included patients 18 years and older with operative orthopaedic injuries and excluded those with steroid use, multisystem injuries, critically ill or unstable and patients with perioperative infection. Demographics, medical comorbidities, body mass index, type of fracture, HbA1c level in diabetic patients and length of hospital stay were recorded. Fingerprick glucose values were obtained twice daily. Hyperglycemic index (HGI), an area under the glucose curve above the normal range divided by the length of stay, were calculated. Perioperative hyperglycemia was defined by HGI greater than 1.76. SSI was defined by gross purulence or positive intraoperative culture at reoperation within 30 days. The categorical data were analysed using chi square test while continuous data were analysed using T-test.  Results: Total of 90 patients, 15-diabetic and 75 non-diabetic. 10 diabetic and 1 non-diabetic patients were hyperglycemic (p=0.001). Perioperative hyperglycemia was associated with mean age 54.3 year old, having 1 or more co-morbidity or mean admission glucose 13.1 mmol/L (p=0.001). There were 12 early SSI giving infection rate 13.3%. Early SSI was associated with HGI 1.76 and more (p=0.001), patients             with 1 or more co-morbidity (p=0.006), mean admission glucose of 9.63 mmol/L (p=0.001). Conclusion: Our study showed perioperative hyperglycemia in stable trauma patients with orthopaedic injuries were associated with SSI. More patients are needed to find association of other variables and more studies are required in determining the acceptable glucose level and optimal treatment of perioperative hyperglycemia in stable trauma patients.

The Use of Active Melioidosis Detect TM in Early Diagnosis of Melioidosis in Hospital Tengku Ampuan Afzan and Hospital Sultanah Nur Zahirah

Introduction: Melioidosis is endemic in Malaysia and an important cause of sepsis. Current gold standard for diagnosis is by culture method,but its long procedure will delay the treatment leading to hospital-related mortality.Thus,a good rapid test is needed to reduce its mortality burden. Recently, Active Melioidosis Detect (AMD) have been shown to be useful. Objectives: (1)To measure the sensitivity and specificity of AMD. (2)To study the sensitivity and specificity of early morning urine AMD compared to spot urine AMD. Materials and method: A prospective crosssectional study of clinically suspected melioidosis patients in HTAA and HSNZ from April until December 2018. Blood and urine samples were tested with AMD. Test results were analysed for sensitivity, specificity,positive predictive value and negative predictive value. Results: A total of 89 patients were included in this study.The mean age is 52 years old, and 56.3% were male gender.64% of patients have diabetes mellitus.11 patients have positive blood culture for Bukholderia pseudomallei, 4 of them were tested positive for AMD.3 of them presented with septic shock (3.4%), however none died.The sensitivity of the AMD was 36.4% ([95% CI 12.4 to 68.4]) and the specificity was 66.7% ( [95% CI 46.0 to 82.8]) in all samples, with positive predictive value of 30.7% and negative predictive value of 72%.Blood samples have lower sensitivity of 9.1% ([95% CI 4.8 to 42.9]) with high specificity of 100% ([95% CI 84.5 to 100]). Urine spot samples have higher sensitivity compared to serum and morning urine, with 36.4% ([95%CI 12.4 to 68.4]) and specificity of 88.9% ([95% CI 69.7 to 97.1]). Conclusion: From this pilot study, this test requires further evaluation before incorporating as point of care assay.

Effect of calorie on cognitive function among traumatic brain injury (tbi) patients: a pilot study

Cognitive recovery is a major concern to traumatic brain injury (TBI) patients and their caregivers as patients need to resume normal life after hospital discharge. A recent discovery showed that low calorie was beneficial for cognitive function with lower mortality rate and produced better clinical outcomes in critically-ill and medical intensive care unit patients. However, the effect of low calorie on cognitive function among TBI patients has not been determined yet. Hence this study was conducted to provide preliminary evidence of the relation between calorie and cognitive function and to determine calorie adequacy for optimal cognitive recovery among them. This pilot study involved ten patients recruited from Hospital Sultanah Nur Zahirah, Kuala Terengganu. The patients underwent a series of nutritional assessments including 24-hours diet recall combined with food diary; neuropsychology test [Montreal Cognitive Assessment (MoCA)], and eye-open-eye-close paradigm of electroencephalography (EEG) for two to six days. Socio-demography, nutritional and neuropsychology data were analyzed using SPSS version 22 with the percentage of calorie intake (%CI) was set as the independent variable; whilst duration to finish trail-making subtest (FT), and the total score (TS) of MoCA were the dependent variables. EEG data were analyzed using Fast-Fourier Transform (FFT) and power ratio (PR) which is the ratio of slow to fast frequency brain band was calculated. Then the comparison of %CI, FT, TS, and PR were done between day-1 and discharge-day (early or follow-up visit in EEG). Six male and four female patients with mild TBI, median age 24.0 years (IQR = 9.5) were included in the study. Scatter dot plot between %CI to FT and TS showed that the graph increased at the beginning before it became a plateau at 70%. The %CI had significant negative correlation with FT (r = -0.717; p = 0.000) but positive correlation with TS (r = 0.789; p = 0.000). Results revealed that cognitive function was improved at low %CI, approximately below CI of 70%. Improvement in neuropsychology test results was strengthened by the significant differences of median EEG power ratio between follow-up and first visit (p = 0.000). In this pilot study, it appears that cognitive function showed improvement with low calorie intake among TBI patients.

Suggestive evidence of protective haplotype within TGF-B1 gene region in breast density utilizing fine mapping analysis

Introduction and aimIncreased mammographic density is a strong and independent attribute factor for breast carcinoma. The density is associated with epithelial cell proliferation and stromal fibrosis development that is regulated by Transforming Growth Factor-Beta 1 (TGF-β1). This study was aimed to fine map the TGF-β1 gene cluster in predicting the role of predisposing haplotypes in breast density development using tagging SNPs. Materials and methodsGenotyping was conducted for three tagging TGF-β1 SNPs assigned as rs1800469, rs1800470 and rs4803455 in a total of 50 consented female participants as case group which involved BI-RADS 3 and 4, while the control group (n = 50) consisted of BI-RADS 1 and 2 who underwent a mammography check-up at The Department of Radiology, Hospital Sultanah Nur Zahirah of Kuala Terengganu. A series of bioinformatics analysis including individual SNP-based association analysis, haplotype-based association analysis and fine mapping analysis was conducted spanning the gene region of 20 kb utilizing Chinese Hans Beijing (CHB) and Japanese (JPT) representing the Asian dataset from the HapMap database. ResultsThe study demonstrated two tagging SNPs of TGF-β1 yielded a significant association (rs1800469, p-value = .034; rs1800470, p-value = .004). However, rs4803455 did not show a significant association with p value of 0.053. We further revealed the susceptible haplotype that was assigned as haplotype GGA with significant P value 0.003 indicated by odd ratio of 3.349 (1.482–7.568). A potential protective haplotype was observed in haplotype AGC with odd ratio 0.585 (0.316–1.080) even though with less significant (p = .085). The fine map revealed four targeted SNPs in which consist of rs12461895, rs10416269, rs7408955 and rs1549934 from Block 2 and five potential SNPs from Block 4 assigned as rs4803457, rs2317130, rs1166933, rs1982072, rs11670143 as another potential genetic variant that might contribute to breast density. DiscussionThis fine map study suggests the potential protective haplotype and genetic variants of TGF-β1 in predisposing to breast density development which is worth to be genotyped and further investigated.

Prevalence and antimicrobial susceptibilities of Acinetobacter baumannii and non-baumannii Acinetobacters from Terengganu, Malaysia and their carriage of carbapenemase genes.

A total of 153 non-repeat Acinetobacter spp. clinical isolates obtained in 2015 from Hospital Sultanah Nur Zahirah (HSNZ) in Terengganu, Malaysia, were characterized. Identification of the isolates at species level was performed by ribosomal DNA restriction analysis (ARDRA) followed by sequencing of the rpoB gene. The majority of the isolates (n=128; 83.7 %) were A. baumannii while the rest were identified as A. nosocomialis (n=16), A. calcoaceticus (n=5), A. soli (n=2), A. berezeniae (n=1) and A. variabilis (n=1). Multidrug resistance (MDR) was most prevalent in A. baumannnii (66.4 %) whereas only one non-baumannii isolate (A. nosocomialis) was MDR. The blaOXA-23 gene was the predominant acquired carbapenemase gene (56.2 %) and was significantly associated (P<0.001) with carbapenem resistance. However, no significant association was found for carbapenem resistance and isolates that contained the ISAba1-blaOXA-51 configuration.

Recurent Ectopic Pregnancy Score As Predictor To Fertility Outcome Following Tubal Ectopic Pregnancy

Introduction: Ectopic pregnancy may occur in fallopian tube, ovary or abdominal cavity. This study focused on tubal pregnancy outcome. The return of fertility after operative removal of tubal ectopic pregnancy was examined in 237 women who were admitted to Hospital Sultanah Nur Zahirah (HSNZ) for ectopic pregnancy between 2012 and 2016. The follow-up period averaged six months to four years. Materials and Methods: This was a case control, retrospective non-comparative study. Data collected from HSNZ Human Resources Management Information System (HRMIS). Patient who has no pregnancy or delivery record after six months of ectopic event were contacted via phone. Multivariate analysis was done to identify score for patients who were at risk of recurrence, and who require fertility help. Results: One hundred forty eight women (64%) aged 20-35 years old able to conceive spontaneously after ectopic pregnancy, with the mean-time of 8 months if one tube is patent. Ninety three percents of those who conceived had intrauterine pregnancy, 5% had recurrent ectopic pregnancy. Conclusion: From a multivariate analysis, a scoring system, Recurrent Ectopic Pregnancy (REP) score was made to choose most suitable patient for laparoscopic intervention, preserve fertility or facilitate fertility. Significant REP score of 4/5 suggest laparoscopic salpingectomy with contralateral sterilization to prevent recurrence of ectopic. Patient with REP score 2-3 may have spontaneous conception and REP score less than 1/5 will require further fertility treatment.

&amp;lt;i&amp;gt;vicK&amp;lt;/i&amp;gt; Gene as Potential Identification Marker for &amp;lt;i&amp;gt;Staphylococcus aureus&amp;lt;/i&amp;gt;

Staphylococcus aureus is an important human pathogen frequently detected in hospital community and has emerged as an important health concern in human medicine. Identification of S. aureus from clinical specimens by phenotypic methods may produce variable characteristics leading to ambiguity. Hence, a rapid and reliable method for identification of S. aureus is required which could expedite appropriate antibiotic therapy. This study aimed to evaluate the specificity of polymerase chain reaction (PCR) targeting a signal transduction gene, vicK, among S. aureus isolates of Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia. A total of 118 bacterial isolates were screened, which consisted of one hundred S. aureus isolates, ten Staphylococcus spp. and eight non-Staphylococci. Results indicated that PCR targeting vicK was able to identify 98% of S. aureus isolates with high sensitivity and specificity, while the remaining isolates of Staphylococcus spp. and non-Staphylococci did not yield any amplification of the gene. vicK thus, is highly specific within interspecies and intraspecies, which is potential to be used as a molecular identification marker for S. aureus.

107 A SINGLE CENTRE INCIDENCE, RISK FACTORS AND SHORT TERM OUTCOMES OF ACUTE KIDNEY INJURY IN ADULTS AT HOSPITAL SULTANAH NUR ZAHIRAH

Category: Epidemiology and Outcomes from AKI Presenter: Dr NURUL AIN YUSOF Keywords: Acute Kidney Injury, Incidence, Risk Factors, Outcomes The epidemiology of Acute Kidney Injury (AKI) in developing country is under reported. The rate of AKI has increased with high mortality. Age, evidence of chronic kidney disease, sepsis, multiple comorbidities (Diabetes Mellitus, Hypertension, Ischeamic Heart Disease) and multi organ dysfunction at the initial presentation were among risk factors for AKI. To determine single centre incidence, risk factors and analysis of association for short term outcomes and risk factors of AKI . This is a retrospective cross sectional cohort analysis of patient diagnosed with AKI admitted to medical and non-medical ward at Hospital Sultanah Nur Zahirah from 1st June 2015 to 31th December 2015. All subjects with abnormal serum creatinine were screened via computerized Hospital Information System(HIS) and recruited in the study based on the inclusion criterias. The demographic criterias, risk factors, management and short term outcomes of AKI were recorded and analyzed using Pearson's Chi square and the association between the outcome and the risk factors were analyzed with multiple logistic regression. A total of 210 patients admitted with AKI in a given study period. The cumulative incidence of AKI in our cohort is 11%. Of these, 30%( 63) were males and 70%( 147) were females and 56% of them (119) were more than 60 years of age. Identified risk factors for AKI are age, cardio renal syndromes, sepsis, drugs related and post-operative period with sepsis and post-operation had significant p value of 0.002 and 0.019. Short term outcomes include renal recovery in 28.5%, 3.8% had surgical intervention, 12.8% required dialysis support and 54.8% patients died (of which 20 requires renal replacement therapy). Main cause of death is septiceamia shock (56%). Sepsis has significant association with outcome i.e mortality and abnormal renal function with p value of 0.001(95% CI: 1.6-4.9) and 0.03 (95%CI: 0.25 -0.93). Renal recovery is significantly associated with gender, cardio-renal syndromes and sepsis with p value of 0.03 (95%CI: 0.21-0.94), 0.01(95% CI: 0.03-0.62) and 0.008 (95% CI: 0.22- 0.80) respectively. AKI cause significant morbidity and mortality for at risks population. This database perhaps would initiate more studies in the area as early recognition would certainly improve AKI outcomes.

Functional Outcome 6 Months after Severe Traumatic Brain Injury Following Admission to Intensive Care Unit: A Follow-Up Study in Two Neuro-Center Hospitals

Introduction: Traumatic brain injury (TBI) is a major medical and socioeconomic problem. Patients with severe TBI shows physical and functional improvement but remain with cognitive and psycho-social problem throughout recovery. Despite all the issues, the impact of TBI on long-term survivors in Malaysia is unknown. The aim of this study is to measure the functional level of ICU survivors with severe TBI within 6 months post injury. Materials and method: A cohort study was employed for this study. 33 participants from Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang and Hospital Sultanah Nur Zahirah (HSNZ) Kuala Terengganu with severe TBI were included in this study. The functional assessment of Glasgow Outcome Scale Extended (GOSE) was measured in all samples within in a 6 month period. Results: The participants mean age was 31.79 with ranged from 16 to 73 years old. The result of this study showed that within 3 months after discharged from the hospital, all the participants still had poor recovery n=33 (100.0%). Meanwhile, at 6 months after discharge from the hospital, n= 16 (48.5%) participants were scored good recovery. In this case, the SOFA and SAPS II score contributed significantly to the prediction (SOFA score p=0.045, SAPS II score p= 0.028) of functional outcome. Conclusion: The functional outcome of severe TBI improved in six months post injury. The SOFA score and SAPS II score become significant predictors for functional outcome in this study. However, there were some limitations to this study, which are small sample size and short follow-up duration. This study emphasized the importance of SOFA and SAPS II score in predicting functional outcome; thus early care plan should be done if severe TBI have higher SOFA or SAPS II score.

Outcome of Anterior Cruciate Ligament Reconstruction: A Comparison between Biotransfix Screw and All-Inside Technique

Introduction: Anterior cruciate ligament (ACL) reconstruction has evolved during past decade. All inside technique is introduced aiming for less invasive procedure, bone stock preservation, preservation of tendon at its donor site, better graft positioning and fixation technique. This study is conducted to compare the outcomes of this new technique to the previous biotransfix screw. Materials and method: A cross sectional study was conducted in patients with ACL injury treated with ACL reconstruction surgery in Hospital Sultanah Nur Zahirah, Kuala Terengganu and Hospital Kemaman, Terengganu. Functional outcome with International Knee Documentation Committee (IKDC) score, SF-36 quality of life score and time taken to return to normal activities were evaluated at 18 to 24 months post-operative. Results: Forty patient were recruited, 20 in each group. Of this, 37 were male with age of 25±6.48 years old. 25 were office worker and the rest were field worker. 37.5% were smoker. Patients in biotransfix screw technique operated at 21.3±12.6 months after the injury while those in all inside technique at 17.7±11.9 months(p-value 0.35). BMI was 24.58±4.59. The SF-36 score were similar in both groups with p-value 0.59. Both groups have same IKDC score of 82.99±12.55. Time taken to return to normal activity level was 46.3±19.7 weeks which was similar in both groups(p-value 0.943). Re rupture rate were 10% in biotransfix screw technique and 5% in all inside technique. None of them has any form of infection. There were no correlation between quality of life SF-36 score with age, tobacco use, BMI, duration of injury until operation and occupation of the patient in both techniques. Conclusion: The functional outcome, quality of life and time return to normal activity were similar between patients who had biotransfix screw and all inside technique. There were also no correlations between factors studied with quality of life in both groups.