Hospital Universiti Kebangsaan Malaysia Research Articles

Retrospective Review of Management of Diabetic Retinopathy in Pregnant Diabetics at Hospital Universiti Kebangsaan Malaysia

Diabetic retinopathy (DR) may progress when diabetic women pregnant. It is clear that DR cases are increasing around the world and the danger is alarming. This is a retrospective case with 168 pregnant patients which were traced from the registry held by Endocrine Antenatal Clinic, Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre from 2016 to 2019. Of the 138 pregnancies in pre-existing diabetics, 97 records (70.3%) were found to have only one follow-up with incomplete ophthalmology records or defaulters. Only 41 pregnancy records (29.7%) completed with at least two ophthalmology reviews during the pregnancy. Progression of DR was noted in seven of these pregnancies, giving a rate of 17.0%. One eye of one patient progressed from mild non-proliferative DR to sight-threatening proliferative DR (PDR). When comparing the group of progressors with non-progressors, there was no statistically significant difference for risk factors (age, gender, ethnicity, type of diabetes, duration of diabetes, HbA1c level, hypertension, presence of maculopathy, risk factors for diabetes and fetal ultrasound findings). The rate of repeated follow-up for retinopathy during pregnancy in diabetics is about 30%. This study suggested that no risk factors were identified for DR progression.

Ultrasound cycloplasty: a case series examining the efficacy on a local Malaysian cohort of patients

Introduction: Ultrasound cycloplasty (UCP) is commercially available in Europe. It has been shown to have less side effects than its trans-scleral diode laser cyclophotocoagulation counterpart in reducing intraocular pressure (IOP) in refractory glaucoma patients.
 Case presentation: This retrospective case series followed seven patients treated with UCP for refractory glaucoma at the Ophthalmology Clinic, Hospital Universiti Kebangsaan Malaysia. Patients were aged 52–80 years, with baseline IOP 14–27 mmHg. All patients received sequential activation of the transducers lasting 8 seconds. Postoperatively, patients were followed-up at 1 week, 1 month, and 3 months. No complications or changes in best-corrected visual acuity were recorded postoperatively. One patient underwent a trabeculectomy 3 months post-procedure, whilst the others continued regular medication. At 1-month postoperative, there was IOP reduction of 6–10 mmHg in six patients. At the 3-month follow-up, IOP returned to the preoperative levels. Conservative power and duration of the shots were used to ensure patients safety.
 Conclusion: Most studies on UCP safety and efficacy have been conducted on Caucasian populations. A longer duration of UCP may be necessary in the Asian population. Further studies are required to determine the efficacy of UCP in the Asian population.

Health insurance status and its determinants among patients with type 2 diabetes mellitus in a tertiary teaching hospital in Malaysia.

IntroductionEven in a country with a tax-based healthcare financing system, health insurance can play an important role, especially in the management of chronic diseases with high disease and economic burden such as Type 2 Diabetes Mellitus (T2DM). The insurance coverage among T2DM patients in Malaysia is currently unclear. The aim of this study was to determine the insurance status of T2DM patients in public and private healthcare facilities in Malaysia, and the association between this status and patients’ sociodemographic and economic factors.MethodsA cross-sectional study among T2DM patients seeking inpatient or outpatient treatment at a public tertiary hospital (Hospital Canselor Tuanku Muhriz) and a private tertiary hospital (Universiti Kebangsaan Malaysia Specialist Centre) in Kuala Lumpur between August 2019 and March 2020. Patients were identified via convenience sampling using a self-administered questionnaire. Data collection focused on identifying insurance status as the dependent factor while the independent factors were the patients’ sociodemographic characteristics and economic factors.ResultsOf 400 T2DM patients, 313 responded (response rate, 78.3%) and 76.0% were uninsured. About 69.6% of the respondents had low monthly incomes of <RM5000. Two-thirds of participants (59.1%) spent RM100–500 for outpatient visits whilst 58.5% spent <RM100 on medicines per month (RM1 = USD0.244). Patients who visited a private facility had five times more likely to have insurance than patients who visited a public facility. Participants aged 18–49 years with higher education levels were 4.8 times more likely to be insured than participants aged ≥50 years with low education levels (2 times).ConclusionsThe majority of T2DM patients were uninsured. The main factors determining health insurance status were public facilities, age of ≥ 50 years, low education level, unemployment, and monthly expenditure on medicines.

Integrated Evolving Spiking Neural Network and Feature Extraction Methods for Scoliosis Classification

Adolescent Idiopathic Scoliosis (AIS) is a deformity of the spine that affects teenagers. The current method for detecting AIS is based on radiographic images which may increase the risk of cancer growth due to radiation. Photogrammetry is another alternative used to identify AIS by distinguishing the curves of the spine from the surface of a human’s back. Currently, detecting the curve of the spine is manually performed, making it a time-consuming task. To overcome this issue, it is crucial to develop a better model that automatically detects the curve of the spine and classify the types of AIS. This research proposes a new integration of ESNN and Feature Extraction (FE) methods and explores the architecture of ESNN for the AIS classification model. This research identifies the optimal Feature Extraction (FE) methods to reduce computational complexity. The ability of ESNN to provide a fast result with a simplicity and performance capability makes this model suitable to be implemented in a clinical setting where a quick result is crucial. A comparison between the conventional classifier (Support Vector Machine (SVM), Multi-layer Perceptron (MLP) and Random Forest (RF)) with the proposed AIS model also be performed on a dataset collected by an orthopedic expert from Hospital Universiti Kebangsaan Malaysia (HUKM). This dataset consists of various photogrammetry images of the human back with different types of Malaysian AIS patients to solve the scoliosis problem. The process begins by pre-processing the images which includes resizing and converting the captured pictures to gray-scale images. This is then followed by feature extraction, normalization, and classification. The experimental results indicate that the integration of LBP and ESNN achieves higher accuracy compared to the performance of multiple baseline state-of-the-art Machine Learning for AIS classification. This demonstrates the capability of ESNN in classifying the types of AIS based on photogrammetry images.

Knowledge and attitude on childhood hearing loss among mothers and mothers-to-be in urban and rural areas in Malaysia

ObjectivesMaternal knowledge and attitude towards childhood hearing loss play an important role in determining the success of early diagnosis and intervention of hearing loss programs in children. This study aimed to 1) assess the knowledge and attitude of childhood hearing loss among mothers, 2) compare knowledge and attitude of childhood hearing loss in urban and rural mothers, 3) investigate the relationship between knowledge and attitude on childhood hearing loss, and 4) identify socio-demographic factors that influence mothers’ knowledge and attitude on childhood hearing loss. MethodA cross-sectional survey was conducted on 362 mothers and mothers-to-be (mean age: 31.9 ± 4.9 years, range: 20–48 years old) recruited from Hospital Universiti Kebangsaan Malaysia in Cheras, Kuala Lumpur and two health clinics in Lenggeng, Negeri Sembilan and Beranang, Selangor representing the urban and rural areas respectively. All participants were interviewed in person using a newly developed and reliable questionnaire that tested their knowledge and attitude on childhood hearing loss. ResultsGenerally, the majority of mothers had a moderate level of knowledge and positive attitude towards childhood hearing loss. Urban mothers had a significantly higher knowledge than those of the rural area (p < 0.05). However, no significant differences were observed in attitude toward childhood hearing loss between urban and rural mothers. In addition, there was no significant relationship found between knowledge and attitude on childhood hearing loss among mothers. Age, race, occupation and education level contributed to the knowledge score significantly (p < 0.05), whereas, only race was significantly associated with attitude. ConclusionIn spite of positive attitude towards childhood hearing loss, the majority of mothers and mothers-to-be demonstrated poor knowledge on this aspect. Therefore, this study highlights the urgent need to develop and implement appropriate health education campaigns to improve mothers’ knowledge of childhood hearing loss.

Pre-drilling and self-drilling pins screw-bone fixation stress interaction analysis induced by uniaxial compression loading

A newly designed Uniaxial external fixator which functions as a universal fixator in the application of all types of bone fractures is recently introduced by both Hospital Universiti Kebangsaan Malaysia (HUKM) and Universiti Malaysia Perlis (UniMAP). The Investigation is focused on identifying and measuring the performance in terms of strength or weakness of the fixator that is needed before the application to the human body. Hence, this research was conducted to determine the performance of Uniaxial external fixator which was based on geometry using different screw drilling techniques applied during an angled uniaxial compression load. A three-dimensional fixator-bone was constructed using different screw inserting techniques which was then converted into ANSYS v14.5 for the purposes of conducting a finite element analysis (FEA). Axial compressive loading with various degrees from 60 to 6300 N were applied to bone models to stimulate patient’s daily activities while 10 to 100 N were applied to fixator models for the purposes of reviewing environmental loading to fixator-bone models. Findings revealed that maximum magnitude which caused deformation for predrilling and self-drilling models were located at the highest pin-bone interaction. Conversely, the maximum magnitude of the von Mises strain and stress was located at the lowest pin-bone interaction by omitting the existence of fixator for both Case 1 and 2. There was no obvious difference in the comparison of both models in terms of deformation. However, predrilling models have higher strain and stress than self-drilling models. In sum, findings indicated that self-drilling models have better performance compared to the predrilling models.

A Serious Game for Healthcare Industry: Information Security Awareness Training Program for Hospital Universiti Kebangsaan Malaysia

This paper aims to develop an information security awareness training program for the healthcare industry to ensure the appropriate protection of electronic health systems. Serious games are primarily designed for training purposes rather than pure entertainment. Serious games are proven as an effective training approach for awareness programs. Serious games benefit learning as the games are fun to play and motivate learners to participate and interact with learning activities. Developing a serious game requires the revision of adequate guidelines that identify all characteristics to be incorporated in such games. Thus, this paper reviews serious game models that have been constructed as game development guidelines. To this end, a serious game is developed and implemented at a selected healthcare organization.

A Pilot Study of Enhance Recovery after Surgery (ERAS) for Liver Resection

Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for liver resection was initiated. Objective: The aim of this study was to achieve discharge by postoperative day 3 for minor resection and day 5 for major resection. Design and Setting: This is a prospective study conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015. Material and Methods: All patients undergoing open liver resection were included in the study. They were then managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s demographics data, intra operative parameters, postoperative complications and adherence to postoperative recovery protocol were recorded. Results: Seventeen patients (7 major and 10 minor resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%) in the major group were discharged on time. 9 patients had postoperative complications with no mortality recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in 15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients - 35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14 patients). Conclusion: From these overall achievement, most of our targets have been met and this shows that our ERAS protocol is safe to be applied to patient undergoing hepatectomy. Limitations: Some patients had achieved their target but not discharged for unknown reason.

Coping Strategies among Parents of Children with Acute Lymphoblastic Leukemia

Background: Having a child with acute lymphoblastic leukemia represents challenges to the family which may impact their quality of life. In such circumstances, parents use various coping strategies to face this stressful situation, and understanding the relation of coping strategies on quality of life among parents of children with acute lymphoblastic leukemia may provide professionals with ideas about how to support them which in turn may improve their quality of life. Aim: The aim of the present study was to assess the correlation between coping strategies and the health related quality of life of parents whose children are suffering from acute lymphoblastic leukemia. Study design: A cross-sectional design using guided self-administered questionnaire by a single researcher was used. Methods: A universal sample consisted of 299 parents of children with acute lymphoblastic leukemia (ALL) was recruited from Hospital Universiti Kebangsaan Malaysia and Kuala Lumpur Institute Pediatrics. The response rate was 98%. The data collection tools were WHOQOL BREF which is the World Health Organization Quality of Life shorter version and Brief COPE questionnaires. Results: The results revealed that half of the parents perceived their health related quality of life as good. The highest scores for parents were reported on the social relationship domain meanwhile the lowest were reported on the environmental health domain. In regard to the coping strategies, it was found that religion was most frequently used while humor was the least to be used. Moreover, there was a significant positive relationship between quality of life of the parents and problem-focused coping style and a significant negative relationship with emotion-focused coping style. Conclusion: On the basis of the finding of present study, an appropriate intervention could be design to include program that promote the use of problem-focused copings such as active coping and planning and discourage the use of emotion-focused copings such as self-blaming to enhance parents’ health related quality of life.

Nerve injuries in supracondylar fractures of the humerus in children

A retrospective study of nerve injuries with displaced supracondylar fractures of the humerus in children younger than 12 years of age, treated in Hospital Universiti Kebangsaan Malaysia. Our objectives were to determine the incidence of primary and iatrogenic nerve injuries in supracondylar humerus fractures Gartland types II and III and to determine the outcome of nerve recovery. A total of 272 patients with displaced supracondylar humerus fractures who required admission to Hospital Universiti Kebangsaan Malaysia from January 2000 to December 2007 were reviewed. There were 182 boys (67%) and 90 girls (33%). The mean age was 6.0 years, ranging from 1 to 12 years. Of 272 supracondylar fractures, 79 were type II and 193 were type III. Fifty-one (19%) patients had closed reduction, 160 (59%) had closed reduction and percutaneous crossed Kirschner (K) wires, and 61 (22%) had open reduction and crossed K-wires. Associated nerve injuries involving the median, radial, and ulnar nerves were observed in 48 (18%) patients. Nerve injuries were observed in nine (3%) patients upon admission. Thirty-nine (14%) patients developed nerve injuries following treatment. Of these 39 patients, 34 had ulnar, three had radial, and two had median nerve injuries. Nerve exploration was performed in five patients (in four patients following debridement of open fracture and in one because of unacceptable postoperative radiographs, and they subsequently underwent open reduction and exploration). Except for these five patients, the K-wires were not removed earlier nor were the nerves surgically explored in others. The nerve injuries resolved clinically on an average time of 3.5 months (range from 3 weeks to 8 months). Our study found complete resolution of all patients with nerve injuries confirmed by clinical assessment. On the basis of our study, we believe that there is no indication to remove the K-wires immediately or to explore the nerve surgically following a mini-open technique, which reduces the risk of penetrating a nerve during pinning.

P53 codon 72 polymorphisms and random amplified polymorphic DNA analysis of non-melanoma skin cancer through archival formalin-fixed paraffin-embedded tissue

Non-melanoma skin cancer (NMSC) is classified among the ten most frequent cancers in Malaysia. A common polymorphism at codon 72 of the p53 tumor suppressor gene and its influence on cancer risk has been studied for different types of cancer with mixed and inconsistent results with limited published data on the Malaysian population so far. In the present study, the frequency of p53 codon 72 polymorphism in 60 patients with NMSC was investigated from archival formalin-fixed paraffin-embedded (FFPE) tissue obtained from Hospital Universiti Kebangsaan Malaysia (HUKM). Additionally, random amplified polymorhic DNA -polymorphic chain reaction (RAPD-PCR) was employed for preliminary biomarker development. NMSC FFPE samples (70%) possess Arg/Arg, 20% with Pro/Pro and 10% with Arg/Pro. In total, there was no significant difference in the p53 codon 72 genotypes between histological types of NMSC, gender, race, tumor location and age group. However, there was an apparent age-associated increase in the Arg/Arg genotype but did not reach statistical significance (P=0.235). NMSC types and demographic characteristics did not influence genotype distribution. On the other hand, BCC and SCC distributions are influenced by age group, race and tumor location.

A Single Blinded Randomized Controlled Study of the Effect of Conventional Oral Hypoglycemic Agents Versus Intensive Short-Term Insulin Therapy on Pure Tone Audiometry in Type II Diabetes Mellitus

Neuropathy is frequently a late complication of diabetes mellitus. Auditory neuropathy and microangiopathy of inner ear are the possible causes of hearing loss in diabetics. To study the correlation between glycaemic control and hearing threshold in patients with type 2 diabetes mellitus and to determine the differences of hearing threshold between groups treated with different modality. This single blind randomized controlled study was performed at the Department of Medicine and Department of Otorhinolaryngology, Hospital Universiti Kebangsaan Malaysia (UKM) between 1st May 2003 and 31st September 2004. This study was approved by Research Ethics Committee (code number FF-137). Subjects were randomized into two groups. Group 1 were patients treated with conventional oral hypoglycemic agents. The patients in group 2 were those treated with insulin injection. The subjects were seen 4weekly for 3months. Audiometric test were performed in all subjects at each visit. Blood were taken for fasting blood glucose, Hb1Ac, and fructosamine at every visit to determine the glycaemic controls of the subject. They were 11 patients (22 ears) treated with oral hypoglycemic agents and 17 patients treated (34 ears) with subcutaneous insulin. There is no significant difference between mean pure tone threshold before and after treatment at all frequencies in both groups. There is also no significance different in fasting glucose level and fructosamine. However, there is significant difference HbA1c levels between the two groups after treatment (P<0.05). This study has shown that glycaemic control does not have significant impact on hearing. The hearing threshold is neither affected by insulin treatment nor by the glycaemic control.

Evaluation of gram-chromotrope kinyoun staining technique: its effectiveness in detecting microsporidial spores in fecal specimens

This study was conducted to evaluate the modification of the usual Gram-chromotrope staining technique developed in-house known as Gram-chromotrope Kinyoun (GCK) in comparison with the Weber Modified Trichrome (WMT) staining technique; as the reference technique. Two hundred and ninety fecal specimens received by the Microbiology Diagnostic Laboratory of Hospital Universiti Kebangsaan Malaysia were examined for the presence of microsporidial spores. The sensitivity and specificity of GCK compared to the reference technique were 98% and 98.3%, respectively. The positive and negative predictive values were 92.5% and 99.6%, respectively. The agreement between the reference technique and the GCK staining technique was statistically significant by Kappa statistics ( K = 0.941, P < 0.001). It is concluded that the GCK staining technique has high sensitivity and specificity in the detection of microsporidial spores in fecal specimens. Hence, it is recommended to be used in the diagnosis of intestinal microsporidiosis.

Latent Toxoplasmosis in Patients With Different Malignancy: A Hospital Based Study

BackgroundSeroprevalence of toxoplasmosis in different populations may vary according to different environments, social customs and habits. This study was designed to measure the seroprevalence of toxoplasmosis among patients with different malignancies and to ascertain the association between common risk factors and disease transmission.MethodsThis Cross-sectional study was from January to April of 2009. Four Oncology wards in Hospital Universiti Kebangsaan Malaysia (HUKM) were selected as the site for undertaking the present study. The survey involved 129 patients with different malignancies. Information was gathered by using study subject information sheet and a standardized structured questionnaire. Toxoplasma was screened by a standerd ELISA commercial kit in accordance with the manufacturers instructions and performed at the Department of Microbiology, HUKM Kuala Lumpur. A result of > 51 IU/ml of anti-Toxoplasma (IgG) antibody was regarded as positive, indicating latent or pre-existing Toxoplasma infection. A result of > 51 IU/ml of anti-Toxoplasma (IgM) antibody was regarded as positive, indicating recently acquired Toxoplasma infection.ResultsTotal number of seropositive patients was 54 (67.6%), the mean age was 51 years (range15 - 88 years). Toxoplasma IgG positivity was highest among Malaysian (32%). Male to female ratio was almost equal. There was a statistically significant difference in seropositivity between patients living in rural areas compared to those living in urban areas, positive history of consumption of undercooked meat and/or blood transfusion (p < 0.05).ConclusionsThese findings give some support to Toxoplasma screening program and health education, including promotion of a healthy lifestyle exclusively in seronegative patients in order to prevent seroconversion and the incidence of clinically evident opportunistic infection.KeywordsToxoplasma gondii; Risk factors; Immunocompromised; seroconversion; Seroprevalence

A preliminary study on the prevalence of intestinal microsporidiosis in patients with and without gastrointestinal symptoms in Malaysia

An observational study was carried out to establish the existence of intestinal microsporidiosis among patients with and without gastrointestinal symptoms in Hospital Universiti Kebangsaan Malaysia, Malaysia. A total of 893 faecal specimens from hospitalized patients were examined for microsporidia using a modification of the usual Gram-chromotrope stain technique. One hundred and sixteen (13.0%) patients were positive for microsporidia: 84 (72.4%), 27 (23.3%) and 5 (4.3%) were low, moderate and high excreters of microsporidia spores, respectively. Of the 91 patients with available medical records, microsporidiosis was commonly observed in children aged 0-6 years (26.4%) and adults aged >or=31 years (57.2%). About one-third of this infection was observed in immunocompetent individuals. Among the immunosuppressive group, microsporidia were observed to be more prevalent in patients with haematological malignancy or a combination of malignancy and diabetes mellitus. About 74% of the patients who had microsporidia in their faeces had gastrointestinal symptoms, which could be related to infections or induced by immunosuppressive therapy. The role of microsporidia in causing gastrointestinal symptoms in this population is as yet unclear.

Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant public health issues in Asian countries, as they are worldwide. Mortality attributable to HAP and especially VAP can be very high. The present review aims to determine whether the incidence and prevalence of HAP and VAP are higher in Asian countries than in Western countries, whether the organisms causing these nosocomial infections differ etiologically, and whether they are more difficult to treat (ie, demonstrate greater resistance). The implementation of available guidelines can be best achieved through an understanding of local epidemiology, etiology, and resistance patterns, which can facilitate optimal treatment choices. The current review presents data on epidemiology, etiology, and diagnosis of HAP and VAP drawn from an expert panel of clinicians representing 10 Asian countries.

Relation of Distortion Product Otoacoustic Emission With Tinnitus

To investigate cochlear outer hair cell function based on distortion product otoacoustic emission (DPOAE) in patients with tinnitus. This is a case control study. The subjects are patients who attended the Otorhinolaryngology Clinic in Hospital Universiti Kebangsaan Malaysia over a period of 19 months from April 2005 until October 2006. All patients underwent a full ENT assessment and had tympanometry, pure tone audiometry, and DPOAE tests. The UKM Research and Ethics Committee reviewed and approved the study proposal prior to commencement of this study. The study population included 49 patients. They consisted of 16 patients (32 ears) with tinnitus and reduced hearing, 13 patients (26 ears) with tinnitus and normal hearing, 7 patients (13 ears) without tinnitus with reduced hearing, and 13 patients (26 ears) without tinnitus with normal hearing. Statistical analysis showed significant differences (P = .00) of mean DPOAE levels between the four groups of patients. Our results suggest that reduced outer hair cell activity, as detected by reduced DPOAE levels, may manifest as tinnitus even before there is a shift on hearing threshold. We also postulate that further reduction of cochlear outer hair cell activity, as shown by further reduced DPOAE levels, may actually terminate the source of tinnitus.

Laparoscopic salpingectomy in tubal pregnancy: Prospective randomized trial using endoloop versus electrocautery

Ectopic pregnancy is conventionally managed by laparoscopic salpingectomy. Electrocautery has been used widely to secure hemostasis during salpingectomy. However, this method is associated with a risk of thermal injury to the visceral organs. Endoloop, a pre-tied suture used in laparoscopic surgery may be an alternative treatment tool and its potential use in the management of ectopic pregnancy is explored here. Our study aims to compare the effectiveness of the endoloop technique to electrocautery during laparoscopic salpingectomy for tubal pregnancy. A prospective randomized controlled study was conducted over 24 months at the Hospital Universiti Kebangsaan Malaysia. One hundred and two patients with tubal pregnancy were randomized into two treatment groups: those treated with endoloop and those treated with electrocautery during laparoscopic salpingectomy. The use of an endoloop was associated with a shorter operating time (48.85 min +/- 21.019 vs 61.14 min +/- 22.603, 95% CI -20.864 to -3.724), lower visual analog scores for postoperative pain at day 1 (2.02 +/- 0.960 vs 2.74 +/- 0.828, 95% CI -1.074 to -0.368) and day 7 (0.85 +/- 0.802 vs 1.44 +/- 0.837, 95% CI -0.916 to -0.272), and lesser total analgesia required by patients at day 7 after the operation (7.65 +/- 6.119 vs 15.32 +/- 8.326, 95% CI -10.529 to -4.804). There was no significant difference in the ability to secure hemostasis when both techniques were compared. Duration of hospitalization (2.37 days +/- 0.817 vs 2.34 days +/- 0.519, 95% CI -0.245 to -0.296) and interval from operation to discharge were similar. The endoloop appeared to be as effective as electrocautery and is a safe alternative to electrocautery for laparoscopic salpingectomy in tubal pregnancy.

The SAFE (SGRQ score, air-flow limitation and exercise tolerance) Index: a new composite score for the stratification of severity in chronic obstructive pulmonary disease

Background: This study was proposed to develop a composite of outcome measures using forced expiratory volume percentage of predicted, exercise capacity and quality of life scores for assessment of chronic...

P26 Incidence of squamous cell carcinoma of the tongue in Hospital Universiti Kebangsaan Malaysia from 1999-2006

P26 Incidence of squamous cell carcinoma of the tongue in Hospital Universiti Kebangsaan Malaysia from 1999-2006