Hospital USM Research Articles

Identification of Potential Biomarkers and Metabolic Changes in the Serum of Breast Lump Patients Among Kelantanese Based on 1H NMR Metabolomics

This case-control study, conducted at the Hospital USM BestARi unit, aimed to identify the serum metabolic fingerprint among individuals with breast lumps and healthy controls, and to discover potential biomarkers. Serum samples from healthy controls, benign breast lump patients, and malignant breast lump patients were analyzed using proton nuclear magnetic resonance spectroscopy (1H NMR). A multivariate data analysis approach was employed, with the OPLS-DA and clustered heat map techniques effectively differentiating between the three groups. The study revealed significant metabolite variations across the groups and proposed D-glucose, glycerol, and glycine as potential biomarkers for breast cancer diagnosis. Metabolic pathways such as alanine, aspartate, glutamate metabolism, and glycine, serine, and threonine metabolism were implicated. The metabolomics approach coupled with multivariate analysis successfully identified key metabolites leading to group separation and suggested altered metabolic pathways. However, further research and integration with other ‘omics’ technologies are necessary for clinical translation.

Associated Factors of Red Blood Cell Alloimmunization among Solid Cancer Patients in Teaching Hospital in Malaysia

Background: Alloimmunization is a known complication following repeated red blood cell transfusions. However, the associated factors of RBC alloimmunization are different among blood recipient groups. This study aimed to determine the associated factors of red blood cell alloimmunization among solid cancer patients in Hospital USM. Material and Methods: This cross-sectional study involved 322 adult solid cancer patients screened for red cell alloantibodies in our centre from October 2016 until February 2019. The clinical and transfusion data were obtained from the patient’s medical record and laboratory information system (My Transfusi). The multiple logistic regression was used for analysis of potential associated factors of red blood cells alloimmunization, and p-value of less than 0.050 was considered statistically significant. Results: The patient’s mean age was 52.0 years old, with the majority were Malays (91.0%) and females (61.2%). The most common cancers were breast (32.3%) followed by gastrointestinal (16.8%) and head and neck (14.3%). The presence of metastases (adjusted OR=13.53, p=0.017), numbers of packed red cell transfusions (adjusted OR=1.12, p= 0.015), and blood group A (adjusted OR=7.45, p=0.003) were the associated factors of alloimmunization. Conclusions: Solid cancer patients with metastases, received a higher number of packed red cell transfusions, and blood group A were at higher risk for alloimmunization. Strategies to provide phenotype RBC should focus on this type of patient to prevent red blood cells alloimmunization in solid cancer patients. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 379-384

An Analysis of the Unused Blood Components Return at the Teaching Hospital in North Eastern Malaysia

Introduction: All blood components should be returned to the blood bank immediately if a decision of not to transfuse is made for reissuance or proper disposal. Improper handling of returned blood components lead to blood components wastage and may jeopardized the next recepients safety.
 Aim and objectives: The aim of this study is to determine the frequency and reasons of unused blood components return and its quality indicator for the useful information of blood inventory plan in our centre.
 Methods: This was a cross sectional study done from August 2020 to February 2021 at Transfusion Medicine Unit, Hospital USM. Each of blood components return was examined for the type and number of units, return reasons and the quality indicator (duration of stay outside the blood bank, temperature and physical appearance changes).
 Results: The totals of 620 (3.1%) units of blood components were returned from 20120 units supplied and 80.8% units of them did not fit for reissuance resulted in 2.5% wastage from the total blood products. The highest rate of returned blood component was packed red cell (4.6%). The reasons of return mostly were inappropriate where majority due to ‘standby’ purpose (47.4%) followed by patient death (15.6%), adequate hemoglobin level (7.6%) and a few other unacceptable reasons.
 Conclusion: Although the number of returned blood component is small but it can affect the blood supply. The proper system for assurance of returned acceptable blood components for reissuance must be applied and continuously monitored for transfusion safety and minimize wastage of this precious resource.

An Audit on Transfusion error in 16 years of blood transfusion practice at a Teaching Hospital in North Eastern Malaysia

Clinical demand for blood transfusion is endless, and patients are exposed to the risk of transfusion error at any point along the transfusion chain which lead to incorrect blood component transfused (IBCT) if the standard transfusion practices have not complied. This study aimed to determine the prevalence, sources, and causes of error among IBCT in Hospital USM. This retrospective study involved all packed red cell (PC) transfusion and reported IBCT in Transfusion Medicine Units, Hospital USM from January 2005 to December 2020. The recipient and transfusion data of IBCT were collected from the medical record and laboratory information system (MyTransfusi). A total of 193 697 PC transfusions were documented, and 14 IBCT were reported within 16 years of transfusion services. The incidence of IBCT was 1 in 13 836 of PC transfusion. Most of the IBCT contributed by ward error (64.3%). The major cause of error was patient miss identification (85.7%) either in patient sampling, blood component issuing and administration. Most ABO incompatibility IBCT (3 out of 5) end up with severe morbidity or mortality related to an acute haemolytic transfusion reaction. Most of the errors occurred in the wards. Patient misidentification is a major cause of IBCT, and it is preventable. Thus, preventive measures should emphasize on positive patient identification at every step of transfusion chain.

Work-Related Stress and Turnover Intention during Covid-19 among Nurses in Hospital Universiti Sains Malaysia

The outbreak of COVID-19 had significantly impacted the healthcare system, placing it under tremendous strain. Nurses were shown to have suffered the impact of the pandemic, suggested traumatization and estimated a mass turnover intention among nurses globally due to the pandemic [1]. The objective of this cross-sectional study is to assess the prevalence of work-related stress and turnover intention among nurses in the Hospital Universiti Sains Malaysia (Hospital USM). This hospital is a teaching hospital with 830 beds that offers various specialties recognized as Hybrid COVID Hospital in managing patients.
 
 This study utilized multi-stage sampling. The population was stratified into three strata which were, Medical-Surgical wards, Specialty wards (Pediatric, Obstetrics and Gynecology), and Critical Care wards. Next, the wards were selected through a simple random method. The nurses from the selected wards who follow inclusion criteria; nurses with grade U29 or U32 (KUP) with at least one year of working experience [2] were invited to join the study. A total of 365 nurses participated in this study by answering a self-administered questionnaire through Google Forms sent to them. The questionnaire included three parts; Part A sociodemographic data, Part B Nurse Stress Index (NSI) with scoring ranging from 30-150 and Part C Turnover Intention Scale (TIS-6) with a scoring of 9-18[3]. The NSI is categorized into four categories: 30-60= no pressure, 61-90= very little pressure, 91-120= moderate pressure and 121-150=extreme pressure[3]. As for TIS-6, a score <18 indicates a desire to stay whereas ≥18 indicates a desire to leave [3].
 
 The collected data were analyzed using SPSS version 26.0. Sociodemographic characteristics, the prevalence of work-related stress and turnover intention were analyzed descriptively. Pearson correlation test was used to analyze the correlation between work-related stress and turnover intention. Nearly half of the nurses experienced little (40.8%) to moderate (42.5%) level of work-related stress however 73.3% of the nurses reported that they did not have the intention to leave (Table 1 and Table 2). The mean score of work-related stress and turnover intention showed that the nurses were in a moderate level of stress (90.78), with low turnover intention (16.42). Next, the findings showed a significant and positive correlation between work-related stress and turnover intention (r= 0.559, p< 0.001) (Table 3).
 This study found that work-related stress was significant among nurses although the data were collected towards the end of the pandemic approaching endemic phase. This could be explained by the uncertainty of the disease which was among the factors that could contribute to stress among frontliners [4]. Although the stress level is significant, the nurses in this study have low intention to leave. This could be possibly due to the job security working in government sector as this study was done in a semi-government hospital where the nurses receives benefits and securities such as salary remuneration and pension scheme[5]. Findings of the study shows a positive correlation between work-related stress and turnover intention. It is known that prolonged stress causes negative impact towards the physical and mental health of nurses, subsequently being the contributing factor towards turnover intention[6].
 
 Nevertheless, this study implies that healthcare personnel should be alert regarding the issues and consequences related to work-related stress and turnover intention. Appropriate strategies or recommendations should be done to improve nurses’ satisfaction and addressing issues related that surround the nursing practice environment to improve the quality of work life among nurses and thus, improve the quality of care delivered and patient safety, thus retaining highly skilled nurses.

COVID-19 Vaccine Acceptance Among Pregnant Women in Hospital Universiti Sains Malaysia

Many reports recently showed the worried outcomes such as neonatal pneumonia, preterm birth, postpartum infections to the mother, and COVID-19 vertical transmission to the foetus happened in pregnancy [1,5-6]. COVID-19 vaccination is an effective and safe approach to controlling the pandemic and decreasing associated morbidity and mortality [2]. Pregnant women are more likely develop more severe symptoms of COVID-19 than their non-pregnant peers [3]. Also, there is still less study conducted in Malaysia to assess COVID-19 vaccine acceptance among pregnant women.
 
 This cross-sectional study aimed to determine the COVID-19 vaccine acceptance rate among pregnant women in Hospital USM. Initially, 367 respondents estimated using Raosoft Software but only 254 were recruited using simple random sampling method. The link of the questionnaire was given through a WhatsApp platform. The questionnaire used were adapted from Goncu Ayhan [4] consists of three parts: sociodemographic data, acceptance rates of COVID-19 vaccine and the reasons for refusing the COVID-19 vaccine. The questionnaire was translated to Bahasa Malaysia, checked by the Language Unit USM, and validated by the experts, three nursing lecturers. The Cronbach Alpha result from the pilot test was 0.744. The data were analysed using IBM SPSS system version 26.0 and the significant level (α value) was set at 5% for all statistical analyses. All null hypotheses will be rejected if (p<0.05). The Descriptive Analysis test and the Pearson Chi-Square test were used to analyse the data. Both Human Research Ethics Committee USM and Obstetrics & Gynaecology Department in Hospital USM have approved this study. No conflict of interest in the study.
 
 A total of 254 pregnant women, most of them being 198 were aged 20 to 35, 246 were Malays, 180 respondents with college/university education, and 110 housewives. The 68 prevalence of participants' household incomes ranged from RM1000 to RM1999 and RM4000-RM4999, and their gravida and parity are primarily at 2-3 times, with the majority occurring between 20 and 30 weeks of gestation (Table 1). This study included only 58 pregnant women who had comorbidities during their pregnancy. The results revealed pregnant women in Hospital USM had moderate acceptance of COVID-19 (M=70.00, SD=14.629) with a minimal percentage of 55% and a maximal percentage of 82%. It was revealed that 174 (68.5%) showed moderate acceptance while 42 (16.5%) showed high acceptance. Meanwhile, only 38 (15%) indicate low acceptance of the COVID-19 vaccine.
 
 The main reasons for them to refuse the vaccine were lack of data on the safety of the COVID-19 vaccination in pregnant women, they believed that if they are sick, both mother and baby will not encounter any negative effects, and some of the family members were hesitant to be vaccinated. This study also examined the correlation between the COVID-19 vaccine acceptance rate and sociodemographic factors using Pearson's Chi- Square test. There was a significant correlation between age, educational level, career, household income, gravida, and parity with the COVID-19 vaccine acceptance rates (p<0.05). Yet, there was no significant correlation between ethnicity, gestational age, or comorbidities with the acceptance rate of the COVID-19 vaccine.
 
 In conclusion, the acceptance rate of the COVID-19 vaccine among pregnant women needs to be increased to reduce the risk of worse complications if contracting the COVID-19 disease. Health education regarding the importance of the COVID-19 vaccine can be delivered during every antenatal visit. Since this study was conducted in hospital settings which include clinics, the pregnant women shall be familiar with the updated regulations of the health systems. This benefits the nurses to increase their efforts for pregnant women to accept those two doses followed by taking the booster willingly. If this succeeds, the risk of them contracting the coronavirus disease and getting complications from it will be eliminated.

A Five-Year Retrospective Study on Fractured Orbital Walls: A Spearman Correlation Analysis

Objective: The purpose of this study is to find propotion of fractured orbital walls in the maxillofacial trauma cases and its associated maxillofacial fracture treated in the Oral Maxillofacial Clinic Oral Maxillofacial ward and operation theatre of Hospital USM in Kelantan, Malaysia. Materials and methods: From July 2013 to June 2018, records of patients who sustained maxillofacial fractures and presented them to the Accident and Emergency Department, Oral Maxillofacial Clinic, Hospital USM were reviewed, recorded, and analyzed. There are 294 patients whose data has been collected because they met the inclusion criteria. Each patient with a complete medical record was reviewed. Data were collected under the variables: Zygomatic Complex, Zygomatic Arch, Nasal, Maxillary Sinus, Le Fort I, Le Fort II, Le Fort III, Orbital Wall, Alveolar Process, Symphysis of Mandible, Condyle of Mandible, Ramus of Mandible, Maxillary Bone and Mandibular Bone of maxillofacial fracture. The fractured orbital walls in these cases was reviewed. At the first stage, all the selected variables will be screened for their important clinical point of view. The SPSS software version 26.0 was used to determine all possible factors contributing to orbital wall fracture. Results: This was a retrospective cross-sectional analysis of the medical records of 294 patients with maxillofacial fracture treated in the Oral Maxillofacial Clinic and Oral Maxillofacial ward, Hospital USM. There were 228 (77.3%) men and 66 (22.4%) women included in this study. The most common age range is 11-20 years (39.8%), 21-30 years (26.2%). Maxillary Bone Fracture (0.371; p <0.05), Maxillary Sinus Fracture (0.180; p <0.05), Zygomatic Arch Fracture (0.127; p <0.05) were found to be the most affected site, which had a positive correlation with an orbital fracture of the maxillofacial trauma cases. A path analysis based on the Spearman correlation was developed by taking into account significant correlations at the level of 0.05. Conclusion: Using the matrix spearman correlation, multiple response analysis (MRA), path analysis, we discovered a clear connection between orbital wall fracture and several other factors. This discovery will aid in the understanding of the most common fracture and the causes of orbital wall fracture in maxillofacial trauma. The Zygomatic Arch Fracture, Maxillary Sinus Fracture, and Maxillary Bone Fracture were found to have a significant relationship with the orbital wall when the significance level was set at 0.05. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 744-750

Infant Tracheostomy: A 10-year experience in A Tertiary Centre

We aim to report our experience of infant tracheostomies in a period of 10 years and discuss the indications, complications, outcome, and follow-up. This case series will contribute to the data of shifting trends in paediatric tracheostomy indications and outcomes. This study aims to review the indications, complications, and outcomes for paediatric tracheostomy at Hospital USM. A retrospective evaluation of the last ten years of experience at Hospital USM for all infants under the age of one who undergoes tracheostomy from January 2011 to January 2021 was undertaken. During the research period, twelve tracheostomies were performed. Complete data were available for all patients. There were 8 (67%) males and 4 (33%) females. The patient's age at the time of tracheostomy ranged from one day to nine months, with the mean age of tracheostomy insertion being 95 days. The most frequent indication was prolonged ventilation (50%), followed by upper airway obstruction caused by a craniofacial anomaly (33%), subglottic stenosis (8%), and laryngomalacia (8%). Sixteen per cent of patients were successfully decannulated. In newborns, tracheostomy is a life-saving procedure with high morbidity and mortality. The role of tracheostomy in airway management has evolved, both in terms of indication and outcome. This series complemented the current trends in indications of infant tracheostomy.

The Prevalence of Cytomegalovirus (CMV) Infection among Infants and Correlation between CMV PCR with Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia

Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of congenital hearing loss and neurodevelopmental disability. This study aimed to describe the prevalence and clinical manifestations of infants age 12 months and below with CMV infection in Hospital Universiti Sains Malaysia (Hospital USM) and to determine the correlation between CMV PCR with clinical outcomes. A total of 648 hospitalized infants with clinically suspected cases of cytomegalovirus infection admitted to Hospital USM from January 2018 to December 2018 were tested for anti-CMV IgM and IgG by electrochemiluminescence immunoassay method. The results suggestive of CMV infection were requested for the second serum sample at 2-4 weeks’ interval together with plasma samples for CMV DNA viral load quantification by real-time PCR and maternal sample for serological analysis. Correlation of CMV viral load with clinical outcomes was analyzed using the point- biserial correlation. The results showed that the prevalence of acute CMV infection was 6.48 % (42/648) and cCMV infection was 0.3% (n=2/648). The findings were as follows: acute CMV infection (n = 42), passive immunity (n = 113) and inconclusive (n =41).) CMV hepatitis (p-value= 0.018), rash (p-value= 0.043), presumed sepsis (p-value=0.044) and abnormal hearing (p-value 0.031) were significantly associated with CMV status. Significant moderate correlation between CMV viral load and abnormal hearing assessment was observed. As a conclusion, CMV hepatitis, presumed sepsis, rash, and abnormal hearing were associated with the infant's CMV status. A significant correlation was found between CMV viral load and abnormal hearing.

Geospatial Analyses of Thyroid Cancer Incidence in Kelantan, Malaysia

Geographical Information System (GIS) has been widely used in evaluating health data. GIS-based disease mapping can act as a tool for an effective form of communication in public health and planning disease surveillance strategies. Yet, there is limited data on spatial distribution of cancer in Malaysia. In the present study, GIS was employed to map the thyroid cancer incidences, analyse the spatial distribution of the cases and assess their geographical accessibility to public hospitals. Registries of patients diagnosed with thyroid carcinoma from the year of 2013 to 2020 were retrieved and information regarding the year of diagnosis, age, gender, residential addresses and histological subtypes were obtained. The coordinates of residential addresses and public hospitals were obtained using Global Positioning System (GPS) and the radius of public hospitals were set within and beyond 10 km. Then, all data were inserted into ArcGIS 10.2 software and spatial analysis was performed. A total of 90 cases with thyroid carcinomas were recorded and mapped. The spatial distribution of thyroid cancer cases in Kelantan represented a clustered pattern (NNR: 0.549377, p-value <0.001) with most cases concentrated at northern part of Kelantan. Buffer analysis revealed that most of the cases (60%, 54 cases) were located within 10 km radius from public hospitals and the remaining 36 cases (40%) were situated beyond 10 km radius from public hospitals. In conclusion, thyroid cancer cases in Hospital USM were clustered with most cases concentrated at the northern part of the state. Majority of the cases have a good geographical access to public hospitals. These study findings provide useful information for health practitioners in planning public health intervention by targeting locations with poor geographical access to health facilities in order to improve overall health population in Kelantan.

Melioidosis in Northeastern State of Malaysia: Spatial Analysis of Cases and Sequence Types

Melioidosis is caused by Burkholderia pseudomallei which can be found in water and soil, as well as in animals. This study was carried out to study the spatial distributions of the cases and their sequence types (ST) from the isolates. The cases were taken from the Hospital USM admission records from the years 2014 to 2019. There were 70 cases which from these cases 33 bacterial isolates were included in this study. Multi-locus Sequence Typing (MLST) was performed to the isolates. As the results, six novel STs were discovered. The cases were found to be clustered and concentrated in the northern part of the state. This study had revealed 15 different STs however, the predominant variant, ST371 (n=6) were found to be distributed in a dispersed manner. Meanwhile, the novel STs were found distributed sporadically in few districts of the state.

A complex scalp resurfacing utilizing Integra® as temporary dressing in aplasia cutis congenita

BACKGROUND: Aplasia cutis congenita is a rare newborn malformation characterized by focal absence of skin. It possesses difficulty in reconstruction surgery for neurosurgeons and plastic surgeons. We report a challenging case of aplasia cutis congenita who received treatment in our center.
 CLINICAL CASE: A 2-year-old boy, presented to Plastic and Reconstructive Surgery, Hospital USM, with bilateral vertex defect with encephalocele who received a series of surgical interventions since 1 month old. Unfortunately, he returned after 2 years with a chronic nonhealing scalp wound associated with dura defect and cerebral spinal fluid leakage. The wound was debrided and the swab culture result showed no organism growth. Part of the wound bed with dura defect was repaired using a small piece of transplanted fascia lata and Integra was applied.
 DISCUSSION: There is scarcity in the medical literature on the reconstructive technique of aplasia cutis congenita. In the case we described here, we successfully managed the wound with multiple application of dermal substitute (Integra) dressing with negative pressure wound therapy and split-thickness skin graft.
 CONCLUSIONS: Management of aplasia cutis congenita with skull defect remains a controversy. Its management varies depends on its pattern and underlying condition. We successfully develop a new simple method in treating scalp accutilizing Integra.

The Significance of Knowledge, Instructions, Habits and Denture Hygiene Practice in Relation to the Maintenance of Denture Hygiene at Hospital USM’s Dental Clinic

Good denture hygiene is crucial for the prevention of various periodontal diseases, dental caries and dental stomatitis, which can give rise to a negative impact on the general health of denture users. A comparison exercise was conducted, to determine the effectiveness of information on denture care, provided by different groups of dental personnel. A self-administered and structured questionnaire was distributed to patients who attended Hospital USM’s dental clinics, from 2014 to 2019 based on the attendance register of the clinic. The denture hygiene status of 100 participants was assessed during the interview session. The results derived through the questionnaire revealed that 100% of the respondents, who received both verbal and written instructions, practiced good dental hygiene. It was observed that the most effective instructions received by the respondents were delivered by the dental specialists. Respondents, who clean their dentures with denture cleaning tablets, soap, or denture cleaning paste, were observed to possess better denture hygiene than those who do not. Also, respondents who visit their dentists once every six months for routine dental examinations boasted a higher percentage of good denture hygiene (81.8%). A positive association was perceived, between knowledge and the status of denture hygiene.

Oral Mucosal Lesions in Kelantanese subpopulation: A One-Year Data Review

Purpose – Mucosal lesions of the oral cavity are common findings at dental clinic worldwide. Regardless of the severity and diagnosis, oral mucosal lesions (OMLs) affect an individual’s general health, as the oral cavity serves as the main route for nutrients intake that is crucial for human survival. Data on the prevalence and distribution of OMLs is imperative to aid in the diagnosis and management of OMLs. The aim of the present study was to determine the distribution of OMLs amongst patients attending dental clinic, Hospital Universiti Sains Malaysia (Hospital USM).
 Design and methodology - A cross-sectional study using secondary data was conducted. Dental records of patients receiving oral examination and treatment in dental clinic from January to December 2014 were obtained. Data were analysed using Chi-square test. Throughout 2014, 43 records of patients presented with OMLs were obtained.
 Findings - The most common lesion was ulcerative lesions (37.3%), followed by oral lichen planus (27.4%). Patients with exophytic lesions contributed 15.7%, while candida-related lesion and keratotic lesion contributed 11.8% and 7.8% respectively. Except for keratotic lesion, which was significantly associated with smoking, none other OMLs were associated with any of the risk habits (smoking, betel quid chewing or alcohol consumption).
 Originality/Value - Data from this study serve as a basis for OMLs epidemiology studies on larger scale that will further aid in the detection, diagnosis and better management of the oral lesions. Findings from this study further emphasize the importance of quit-smoking program to reduce the risk of developing oral keratotic lesion, among other diseases that have been associated with smoking habit.

KNOWLEDGE AND PRACTICES OF OSTEOPOROSIS PREVENTIVE MEASURES AMONG WOMEN IN A TERTIARY TEACHING HOSPITAL

Introduction: Osteoporotic fracture is a major public health problem in the pre and peri-menopausal period, associated with substantial morbidity, socio-economic burden and mortality. Poor knowledge and practice related to osteoporosis have been noted worldwide. In Malaysia, few studies have measured the knowledge and practice of osteoporosis among women. Objectives: This study aimed to determine the knowledge and practices of osteoporosis preventive measures among women in Hospital USM. Methods: A cross-sectional study using a validated, self-administered questionnaire about knowledge and practices of osteoporosis measures was employed with 185 hospitalized women in Hospital USM. A simple random sampling was used for the recruitment of participants. The data were analyzed using Chi-Square tests. Results: The Majority of the participants, 67%, belong to 45 – 55 age group with a mean age of 50.35 years. The findings indicate 40.5% had a good level of knowledge towards osteoporosis, while 53.5% had a poor practice level. Conclusion: Knowledge of osteoporosis and practices is still at a fair level, affecting osteoporosis prevention practices. Time was spend watching television. Therefore, public health strategies should be developed in Malaysia to increase women's knowledge of osteoporosis prevention and change lifestyle habits.

Randomized Clinical Trial Between Fluoxetine and Dapoxetine for Premature Ejaculation and Its Effect on Marital Relationship

INTRODUCTION: Premature ejaculation(PE) decreases sexual pleasure and quality of life, and both Fluoxetine and Dapoxetine were used in PE therapy. Dapoxetine is the first SSRI with a short half-life and fewer side effects, primarily designed for PE therapy. The aim is to evaluate and compare the effects of Fluoxetine and Dapoxetine on PE symptoms and marital satisfaction. MATERIALS AND METHODS: 44 participants aged between 18 and 64 with a PEDT score of ≥9 from Hospital USM's Primary-Care-Clinic, Kelantan Malaysia were selected and randomized into two groups: Fluoxetine(FG) and Dapoxetine Group(DG), and administered for 8 weeks with either regular Fluoxetine(20mg) or Dapoxetine (30mg) on-demand at least once a week. Premature Ejaculation Diagnostics Tool(PEDT) score was used to assess PE symptoms and Dyadic Satisfaction-Dyadic Adjustment Scale (DS-DAS) used to evaluate marital satisfaction at baseline and the 8th week. RESULT: 22 and 21 participants in FG and DG completed the study. For both groups, PEDT scores decreased substantially [from 11.41 to 5.45(P< 0.001) among FG, from 13.43 to 3.10(P<0.001) among DG]. After adjustment of the baseline PEDT score, PEDT scores in DG(6.03 vs 2.49, P><0.001) were lower at the 8th week. All groups showed significantly improved DS-DAS scores [from 34.50 to 40.68(P><0.001) in FG, from 36.57 to 44.33(P><0.001) in DG]. No marked difference in DS-DAS was scored after adjustment of the baseline DS-DAS score(41.13 vs 43.86, P=0.055) at the end of the assessment. CONCLUSION: Treatment of PE with either Fluoxetine or Dapoxetine decreases PE symptoms and increases marital satisfaction. ><0.001) among DG]. After adjustment of the baseline PEDT score, PEDT scores in DG (6.03 vs 2.49, P< 0.001) were lower at the 8th week. All groups showed significantly improved DS-DAS scores [from 34.50 to 40.68(P< 0.001) in FG, from 36.57 to 44.33(P< 0.001) in DG]. No marked difference in DS-DAS was scored after adjustment of the baseline DS-DAS score (41.13 vs 43.86, P=0.055) at the end of the assessment. CONCLUSION: Treatment of PE with either Fluoxetine or Dapoxetine decreases PE symptoms and increases marital satisfaction.

Patient Satisfaction Towards Dentist-Patient Interaction Among Patients Attending Outpatient Dental Clinic Hospital Universiti Sains Malaysia

Objective: To determine the satisfaction with the dentist-patient interaction and factors associated with patient satisfaction among patients attending the outpatient dental clinic Hospital Universiti Sains Malaysia (HUSM). Material and Methods: This cross-sectional study involved 229 patients who attended outpatient dental clinic Hospital USM that located in the East Coast region of Malaysia. A self-administered Skala Kepuasan Interaksi Perubatan – 11 (SKIP-11) questionnaire was used to assess the satisfaction towards dentist-patient interaction. Systematic random sampling was applied in this study. The data were analyzed using simple logistic regression analysis to determine the factors associated with patient satisfaction with dentist-patient interaction. Results: The mean age of patients was 32.6 ± 13.9 years, 71.6% of them study up to tertiary level, 31.5% came to for dental check up and 23.6% of them had tooth decay. More than half (64.6%) of the patients were satisfactory with dentist-patient interaction. The satisfaction percentage in the distress relief domain was 60.7%, 56.8% in the rapport domain, and 53.7% in the interaction outcome domain. Satisfaction with dentist-patient interaction was significantly associated with the dentists’ characteristics such as age (OR = 0.583, 95%CI 0.44-0.76, p=0.001), gender (OR = 0.386, 95% CI 0.22-0.69, p=0.001) and years of service (OR = 0.294, 95% CI 0.15-0.57, p=0.001) . Conclusion: The result showed that slightly more than half of the patients who attended the outpatient dental clinic HUSM were satisfied with the dentist-patient interaction, which was found to be influenced by the characteristics of the dentists. Efforts to improve patient-dentist interaction are recommended to ensure delivery of good quality oral health care.

The prevalence of Cytomegalovirus (CMV) infection among infants in Hospital Universiti Sains Malaysia

Background: The seroprevalence of Cytomegalovirus (CMV) infection in Malaysia ranges from 71.6 to 92%. The data on seroprevalence of CMV in Malaysia was scarce, particularly among infants in view of the limitation of the diagnostic methods available. Therefore, the aim of this study is to determine the prevalence of symptomatic CMV infection and its clinical demographics among infants in Hospital USM. Methods and materials: This is a hospital-based prospective cohort study conducted from 1st January until 31st December 2018. Infants serum for CMV IgM and IgG detection and plasma for CMV PCR (viral load monitoring) were collected for detection of CMV infection Maternal serum sample was also requested for serological study. Second serum sample was later requested from the symptomatic infants in between 2 and 4 weeks’ time. Acute infection among infants was defined as evidence of seroconversion of paired sera or positive CMV DNA from blood, urine or saliva. Those infants that were not fulfilling the criteria were regarded as possible passive immunity from the mother or inconclusive if no second sample sent. Results: The prevalence of acute symptomatic CMV infection among infants in Hospital USM was 20.9% (n = 41/196). There was a significant difference in the median age (in days) (p = < 0.01) between acute and non-acute (passive immunity and inconclusive) CMV infection. There were significant association (p < 0.05) for CMV hepatitis, presumed sepsis, rash and sensorineural hearing loss (SNHL) between acute or non-acute CMV infection in infants. Infants with CMV hepatitis were at 8.27 higher odds of being in acute CMV group. Infants without presumed sepsis were at 0.43 higher odds of correctly classified into acute or non-acute CMV infection). Infants presented with rash were at 4.97 higher odds of getting acute CMV infection. Infants with acute CMV infection were at 0.385 higher odds of getting SNHL. Conclusion: The prevalence of CMV infection among infants in Hospital USM was moderately low. CMV hepatitis, presumed sepsis, the presence of rash and SNHL was associated with acute CMV infection in infants.

MSC virtual e-abstract (CPP-03)

&#x0D; Activation of stroke protocol and thrombolysis in non ct hospital.&#x0D; Outcome of stroke thrombolysis in lacunar stroke at HSNZ.&#x0D; The use of international classification of functioning, disability and health (icf) to identify.&#x0D; Cerebral venous sinus thrombosis: Clinical features and rehabilitation outcome.&#x0D; Unlocking the locked-in syndrome (lis)’: International classification of functioning, disability and health (icf) as a clinical tool in formulating rehabilitation plans and overcoming challenges in lis patients.&#x0D; Vestibular migraine : A case report.&#x0D; Burden of stroke in Hospital USM, Kota Bharu, Malaysia.&#x0D;

MSC virtual e-abstract (NPP)

&#x0D; Endothelin-1 induced focal ischemia in adult zebrafish: A model with novel entity of stroke research.&#x0D; Poly (lactide-co-glycolide) nanoparticle encapsulating brain-derived neurotrophic factor promotes neuroprotection in an acute ischemic stroke model in the rat.&#x0D; Tele-consultation for augmentative and alternative communication in individuals with locked-in syndrome.&#x0D; Teleneurorehabilitation during covid-19 pandemic in Malaysia.&#x0D; Evaluation of oral health status and salivary parameters among stroke patients in Hospital USM, Kelantan.&#x0D; The neuroprotective effect of (s)-3,5-dhpg preconditioning via down regulatory antagonist modulator (dream) in acute ischemic stroke rats.&#x0D; The effects of hypothermia and p4 on glt-1 and p62 of primary cortical astrocytes following exposure to glutamate toxicity.&#x0D; Assessment of awareness and action towards signs and symptoms of stroke among lay public in Kuantan, Malaysia: A cross-sectional a study.&#x0D;