Hospital Universiti Sains Malaysia Research Articles

Visual outcome and factors influencing surgical outcome of horizontal strabismus surgery in a teaching hospital in Malaysia: A 5-year experience.

PURPOSE:The available data on strabismus surgery in South East Asian countries are scarce. This study aimed to identify visual outcome and factors influencing surgical outcome of horizontal strabismus surgery in a Southeast Asian cohort.MATERIALS AND METHODS:A retrospective review of patients who underwent horizontal strabismus surgery between 2013 and 2017 in Hospital Universiti Sains Malaysia was conducted. Surgery was considered successful if the post-operative deviation was within 10 prism diopters at 6 months' postoperative period. Factors influencing the outcome of surgery at 6 months were identified. Chi-square and Fisher's exact tests were used in data analysis.RESULTS:Ninety-eight patients were included. Both genders were equally affected. Exotropia (58.2%) was the most common type. About 65.3% of patients had alternating strabismus, while 51% had an angle of deviation of more than 45 prism diopters. Amblyopia was documented in 14.3% of patients. Those operated on below 10 years of age comprised 64.3%. Ninety-four patients completed follow-ups at 6 months after the surgery. The success rate was 81.6%. Approximately 92% of the patients had best-corrected visual acuities of 6/12 and better at 6 months' postoperative period. There was no significant association between age of onset, gender, presence of amblyopia, type of deviation, amount of deviation, and postoperative best-corrected visual acuity with surgical outcome at 6 months' postoperative period (P > 0.05).CONCLUSION:The success rate was good. Postoperative best-corrected visual acuity was promising. Age of onset, gender, presence of amblyopia, type of deviation, amount of deviation, and postoperative best-corrected visual acuity did not influence the outcome of horizontal strabismus surgery in our review.

From Midi to Malay-Muslim-Friendly: Hospital Universiti Sains Malaysia’s Journey in Malaysianising Its Nursing Uniform

From Midi to Malay-Muslim-Friendly: Hospital Universiti Sains Malaysia’s Journey in Malaysianising Its Nursing Uniform

Serum Anti-Müllerian Hormone in Polycystic Ovary Syndrome and its Relationship with Insulin Resistance, Lipid Profile and Adiponectin.

Objectives:This study was done to estimate serum anti-Müllerian hormone (AMH) level in polycystic ovary syndrome (PCOS) patients and to correlate serum AMH level with insulin resistance, lipid profile, and adiponectin levels.Materials and Methods:A cross-sectional study was conducted at Hospital Universiti Sains Malaysia (Hospital USM), Health Campus, Kubang Kerian, Kelantan, Malaysia. Thirty newly diagnosed patients with PCOS attending gynecology clinic between July 2016 and April 2017 were recruited. Fasting venous blood samples were collected from the subjects. Serum AMH, insulin, adiponectin, triglycerides, high-density lipoprotein cholesterol (HDL-C), and plasma glucose levels were measured, and insulin resistance was calculated based on homeostasis model of assessment-insulin resistance (HOMA-IR). The serum AMH level was estimated, and the correlation of serum AMH level with the metabolic parameters was analyzed.Results:The median of serum AMH levels in women with PCOS was 6.8 ng/mL (interquartile range: 7.38 ng/mL). There was a significant negative correlation between serum AMH and HOMA-IR or triglyceride levels (r = −0.49, P = 0.006 and r = −0.55, P = 0.002, respectively). A significant positive correlation was observed between serum AMH and serum HDL-C or serum adiponectin levels (r = 0.56, P = 0.001 and r = 0.44, P = 0.014, respectively) in all study subjects.Conclusion:The serum AMH level is associated with HOMA-IR, triglycerides, HDL-C, and adiponectin levels, and hence it may be used as a potential cardiometabolic risk marker in women with PCOS.

The Effects of Insulin Infusion Protocol on the Glycemic Level of the Intensive Care Patients

Insulin infusion protocol is the standard protocol that has been practiced in Malaysia’s intensive care unit (ICU) for controlling the hyperglycemia. Multiple sliding scale method of the insulin infusion protocol may drive conflict in selecting an appropriate scale to be applied to the patient. The objective of this paper is to analyse the blood glucose outcome of eight sliding scales insulin infusion protocol adopted in the Universiti Sains Malaysia Hospital (HUSM). A retrospective data of 78 ICU patients of HUSM were fitted using a validated glucose-insulin system to identify insulin sensitivity profiles of the patients. Then, these SI profiles were simulated on various scale protocols. The results obtained from this study showed that among eight scales, Scale 4 had the highest percentage of BG within the HUSM’s target of 6.0–10.0 mmol/L. Scale 1 had the highest percentage of BG for the BG measurement more than 10.0 mmol/L while Scale 8 had the highest percentage of BG measurement of less than 6.0 mmol/L. However, none of the scale shown better performance than the current clinical practice. Furthermore, all of the eight scales had a more substantial number of BG measurement compared to the clinical. This study shows that Scale 2 and Scale 3 result in a similar outcome. Similarly, Scale 5 is almost the same as Scale 6. Thus, at least two sets of scale can be combined to reduce the number of scales. The reduction of scales consequently avoid confusion and helps the clinician in selecting the appropriate scale to be applied to the patients. From this study, it can be concluded that the HUSM protocol is a combination of scales. The scales may be shifted from one to another scale depending on patient condition and clinician judgement. A proper guideline for the scale shifting seems necessary to allow optimum glycemic management in the ICU.

Work-related musculoskeletal symptoms and coping strategies among dental auxiliaries at hospital universiti Sains Malaysia.

Dental personnel are vulnerable to work-related musculoskeletal symptoms (WMSS) due to the nature of their profession. To determine WMSS experienced by dental auxiliaries and their coping strategies toward these symptoms. A cross-sectional study was conducted on 82 dental auxiliaries at a university dental hospital in Malaysia. Nordic musculoskeletal questionnaire and the Brief COPE questionnaire were used to measure the musculoskeletal symptoms and coping strategies of the respondents, respectively. Data were analyzed using IBM SPSS version 22.0. Dental auxiliaries consisted of dental staff nurses (30.5%), dental surgery assistants (40.2%), dental technologists (18.3%), and healthcare assistants (11.0%). Their mean [standard deviation (SD)] age was 33.4 (7.60) years. Most of the respondents had been troubled with ache, pain, and discomfort at the neck, 54.9% (95% confidence interval 44.0%, 66.0%]. In addition, they were troubled mainly with distress at the low back (34.1%) and the ankle or feet (34.1%) which had prevented the respondents from doing their regular job over the past 12 months. The most common areas that had troubled the respondents over the past 7 days were the neck (36.6%), low back (36.6%), and ankle or feet (36.6%). The coping strategy most commonly practiced by the respondents was religion with a mean (SD) score of 3.70 (2.15), followed by active coping [3.13 (0.68)] and acceptance [3.13 (0.69)]. The prevalence of WMSS was high in the dental auxiliaries particularly in the neck region. The most common coping strategy used was religion. Awareness programs on the prevention of WMSS among the dental auxiliaries should be increased.

Perceived Oral Health Status and Its Association with Oral Health-Related Quality of Life of Patients with Rheumatoid Arthritis - A Pilot Study

Rheumatoid arthritis (RA) is an autoimmune disease that affects not only the joints, but also other organ systems including the oral cavity. Studies have demonstrated an association between RA and oral disease, in particular periodontal disease. This cross-sectional study aimed to determine self-reported oral health problems among RA patients and its association with oral health-related quality of life. A total of 67 RA patients attending the Rheumatology Clinic, Hospital Universiti Sains Malaysia participated in this study. Self-administered questionnaires including the Malay version of Short Oral Health Impact Profile [S-OHIP(M)] questionnaire were used to obtain the variables of interests. Most patients perceived their oral health status as good or very good (70.2%) although some reported having at least one oral health problem (40.3%). Commonly reported oral health problems were cavitated tooth (16.4%), swollen gums (16.4%), bad breath (14.9%), and bleeding gums (13.4%). Some patients have lost all upper teeth (32.8%) and all lower teeth (28.4%). The median S-OHIP(M) score was 3.00 (IQR 7.00). With regard to prevalence of impact, item discomfort due to food getting stuck has the highest prevalence of 13.4%, followed by avoided eating certain foods (7.5%). No significant association was found between median S-OHIP(M) score and self-reported oral health problem among RA patients, but a significant association was found between median S-OHIP(M) score and perceived oral health status (P=0.013). In conclusion, oral health problems were common in RA patients, and the association between patients’ oral health perceptions and severity of impact from oral problems was apparent.

The relationship between obesity and other medical comorbidities

IntroductionPrevalence of obesity is increasing at an alarming rate, fast becoming a global menace, and been associated with long-term comorbidity disease and the obese are more fold likely to develop these chronic diseases. MethodologyA prospective cross sectional study that employed a self-administered questionnaire of 17 medical comorbidity lists from Charlson Comorbidity Index CCI. The aim was to show the relationship between obesity and other medical comorbidities among 86 patients visiting Hospital Universiti Sains Malaysia HUSM. Patient self-reported outcome was used to obtain history of chronic diseases. Descriptive and one-way ANOVA test was used to show demographic data and the relationship between obesity and other medical comorbidities respectively. ResultsThe association detected by the study between the mean difference of BMI among the comorbidity groups was not significant, F(3, 82) = 0.82, P–value = 0.489, however, the mean BMI of patients in the “Severe-category” 34.8(S.D = 4.66) was higher than in the None-category mean: 32.10(SD = 12.38), implying that the patients in the “Severe-categories” are more obese and have more severe comorbid conditions. ConclusionThe trend showed a relationship between obesity and medical comorbidities in which patients with higher BMI are associated with more comorbid condition. However, a more drastic approach and further researches are needed to ensure adequate weight loss therapy to checkmate chronic illnesses.

Factors Associated With Medication Errors at a Teaching Hospital in Malaysia

Background: Medication errors (MEs) continue to pose a significant problem to health care systems across the world, not only causing harm and death in patients but also consuming approximately $42 billion annually in health care expenditure. The emergency department (ED) is considered a high-risk area of having MEs to occur. Little is known about the associated factors of ME in the ED of hospitals in Malaysia. Objective: The objective of this study was to determine the factors associated with ME in an ED of a teaching hospital. Methods: A cross-sectional study was conducted on patients who visited the ED of Hospital Universiti Sains Malaysia over 9 weeks during normal working hours (ie, 8:00 am-5:00 pm). A total of 547 patients who satisfied the inclusion criteria were enrolled for the study. Patient demographic information, clinical characteristics, and medication orders and procedures were observed and recorded. The required number of patient data (n = 311) were selected randomly for analysis. Multiple logistic regression method was employed to determine factors associated with ME. Results: Of the 311 patient data, 95 (30.5%) patients had at least 1 ME. The factors found to be associated with ME were number of medications (adjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.51-2.41), triage (adjusted OR, 0.11; 95% CI, 0.04-0.27), gender (adjusted OR, 0.50; 95% CI, 0.26-0.93), and time of patient visit (adjusted OR, 0.34; 95% CI, 0.52-0.75). Conclusion: Medication error was not uncommon in our ED setting. Patients with a higher number of medications prescribed during visit to the ED were found to be particularly at risk. Identification of such factors may guide intervention measures to prevent MEs in this setting.

Correlation among the fractured facial bones in a teaching hospital in Malaysia: A retrospective study of recent 5-years

ObjectiveThe study aims were to establish the correlation between the fractured facial bones in patients treated at the Hospital Universiti Sains Malaysia (USM), Kelantan, Malaysia. Materials and methodsThis study reviewed the medical records of the patients with maxillofacial fractures treated in Oral and Maxillofacial Surgery (OMFS) unit, Hospital USM during 5years period from January 2012 to December 2016, who had no associated head injury. The complete medical record of each patient was reviewed, and data were collected under the variables which were age, gender, etiology of maxillofacial fractures, types of maxillofacial fractures, and treatment modalities practiced for the correction of fractures. SPSS software version 23.0 was used to assess the correlation among the fractured facial bones. ResultsThis was a retrospective cross-sectional analysis of the medical records of 209 patients with maxillofacial fractures treated in the OMFS unit, Hospital USM. 167 patients were male and 42 patients were female. The ratio was seen as nearly 4:1. The age of the patients ranged from 5 to 74 years. Concomitant Zygomatic complex was found the most affected site which had a strong positive correlation with Orbital fracture. Besides, Mandibular fracture was mostly correlated with the fracture in the Symphysis area and the Condylar neck. All the correlations were statistically significant at the P < 0.05 levels. ConclusionThere was a strong correlation between the fractured facial bones within the same jaw compartment but the weak correlation between the opposing jaws.

ASSOCIATION OF TUMOR ANGIOGENIC CELLS (CD133+/ VEGFA+) AND CIRCULATING CANCER STEM CELLS (CD133+/VEGFR2-) IN ASTROCYTIC GLIOMA PATIENTS

Background: Astrocytic gliomas are the most common primary brain tumors that developed from glial origin. The angiogenic cell population from brain tumor enhances the recruitment of circulating cancer stem cells homing towards tumor site.Objectives: This study aimed to investigate the tumor angiogenic cell population that stained with CD133+ and VEGFA+ markers and its association with circulating cancer stem cell (CD133+/VEGFR2-) population in the peripheral blood mononuclear cells (PBMCs) of astrocytic glioma patients.Methods: A total of 22 astrocytic glioma patients from Hospital Universiti Sains Malaysia who consented to the study were included. Tumors (n=22) were sliced and stained with CD133+ and VEGFA+ angiogenic markers and counter stained with DAPI. The circulating cancer stem cells (CD133+/VEGFR2-) in PBMCs (n=22) were quantified using FACS based on the expression of CD133 and VEGFR2 markers. The paired t-test and Pearson correlation were used for the data analysis.Results: The percentage of angiogenic cell population was significantly higher in brain tumor compared to adjacent normal brain tissue (1.25 ± 0.96% vs. 0.74 ± 0.68%; paired t-test=2.855; df=21, p = 0.009). Positive correlation was found between the angiogenic cells of brain tumor tissue and adjacent normal brain tissue (Pearson correlation, r = 0.53, p = 0.011). Significant positive correlation was found between angiogenic cells in glioma tumor and cancer stem cells in peripheral circulating systems of astrocytic glioma patients (Pearson correlation, r = 0.42, p = 0.049).Conclusion: Angiogenic cells in the brain tumor resident promote the recruitment of circulating cancer stem cells homing to the tumor site and induce the proliferation and growth of the tumor in astrocytic glioma patients.

An Automated Intelligent Identification and Counting System Procedure for Tuberculosis

Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis or TB Bacilli. Currently, the classification of TB bacilli is carried out by microbiologist by using Ziehl-Nielsen (ZN) stained smear sputum slide under a light microscopy. However, the manual evaluation is time-consuming and lead to slow decision. Furthermore, the sensitivity is less due to incline of human error which lead to inaccurate conclusion. Therefore, this study proposes an intelligence identification and counting system to detect the presence of TB bacilli in the ZN-stained smear sputum image. This system is designed to identify the presence of TB bacilli and count the number of TB bacilli by applying digital image processing and artificial intelligence techniques. In image acquisition, there are 70 samples images of ZN-stained smear sputum image were collected from Hospital Universiti Sains Malaysia (HUSM) Kubang Kerian, Kota Bharu, Kelantan, Malaysia. The image processing technique consists of contrast enhancement, segmentation, and feature extraction. The contrast of original image was enhanced by the combination of global enhancement, local enhancement and Contrast Limited Adaptive Histogram Equalization (CLAHE). Then, the enhanced image was segmented using color thresholding and the features were extracted consists of on 18 colour features, 15 shape features and 5 texture features. Afterward, the features underwent feature selection to select the relevant features by using Neighborhood Component Analysis (NCA) and ReliefF Analysis. The study showed that there are relevant features were chosen by ReliefF at feature weight more than 0.004 including (8 colour features, 11 shape feature and 3 texture features) for improving the performance and accuracy of Multilayer Perceptron (MLP) trained by Scaled Conjugate Gradient (SCG). For classification process, MLP, k-Nearest Neighborhood (k-NN) and Support Vector Machine (SVM) are used with 6 folds cross-validation. It was found that MLP has the highest of accuracy, sensitivity and specificity with 93.8%, 93.4% and 94.1% respectively.

A Comparison of Supervised Learning Techniques for Predicting the Mortality of Patients with Altered State of Consciousness

The study attempts to identify a potentially reliable supervised learning technique for predicting the outcomes of mortality in an altered state of consciousness (ASC) patients. ASC is a state distinguished from ordinary waking consciousness, which is a common phenomenon in the Emergency Department (ED). Thirty (30) distinctive attributes or features are commonly used to recognize ASC. The study accordingly applied these features to model the prediction of mortality in ASC patients. Supervised learning techniques are found to be suitable for such classification problems. Consequently, the study compared five supervised learning techniques that are commonly applied to evaluate the risk of mortality using health-related datasets, namely Decision Tree, Neural Network, Random Forest, Naí¯ve Bayes, and Logistic Regression. The labeled dataset comprised patient records captured by the Universiti Sains Malaysia hospital’s Emergency Medicine department from June to November 2008. The cleaned dataset was divided into two parts. The larger part was used for training and the smaller part, for evaluation. Since the ratio between training and testing samples varies between individual supervised learning techniques, we studied the performance of the modeled techniques by also varying the proportion of the training data to the dataset. We applied four percentage splits; 66%, 75%, 80%, and 90% to allow for 3-, 4-, 5- and 10-fold cross-validation experiments to evaluate the accuracy of the analyzed techniques. The variation helped to lessen the chance of over fitting, and averaged the effects of various conditions on accuracy. The experiments were conducted in the WEKA environment. The results indicated that Random Forest is the most reliable technique to model for predicting the mortality in ASC patients with acceptable accuracy, sensitivity, and specificity of 70.9%, 76.3%, and 65.5%, respectively. The results are further confirmed by SROC analysis. The findings of the study serve as a fundamental step towards a comprehensive study in the future.

Biometry of brain and corpus callosum from MID sagittal MRI images in patients with history of epilepsy

The previous studies demonstrated that the epilepsy patients showed higher mid-callosal width, smaller corpus-callosal area and volumetric reduction of corpus-callosum, but this study focused on any changes in the callosal-to-brain ratio of subjects with epilepsy when compared to control. The sample population are patients that had their mid sagittal MRI image of their brain taken during their visit to Hospital Universiti Sains Malaysia (HUSM). Using the medical history available from the database, sample for patients with history of epilepsy (n=68) were selected. For the control group (n=68), they are age and gender matched, nominated from those who have radiologically normal MRI images in the database but without the history of epilepsy. Three individual ratters were measured the anterior-posterior (AP) length of the brain and the corpus-callosum followed by a callosal-to-brain (CB) ratio from their mid sagittal MRI images. Each group consists of 30 males and 38 females with a mean age of 25.6±15.3 years. One ratter did not show significant differences in the AP brain length, the AP callosal length and the CB ratio between epilepsy and non-epilepsy group. But other two ratters verified that the AP length of the corpus-callosum and CB ratio are significantly decreased in the epilepsy group compare to non-epilepsy group. Consistency analysis using two-way mixed model, the average measures of Intraclass Correlation Coefficients (ICC) for inter rater reliability was 89.5% (p=0.000). The results suggest that the callosal-brain ratio may be a potential additive biomarker for epilepsy prediction which is essential to elucidate further.

Body Mass Index and predisposition of patients to knee osteoarthritis

IntroductionObesity is increasingly a prevalent comorbid with potentially substantial adverse effects on pre and postoperative outcomes on osteoarthritis patients. The ablative effect on the joint especially on the weight sustaining joints is the major consequence of osteoarthritis that causes pain and the obese are most susceptible. MethodologyA retrospective cohort study, using a non-probability convenience sampling method. A self-administered twelve item questionnaire on the perception of knee osteoarthritis was used to determine the relationship of obesity with the development of knee osteoarthritis among patients visiting the surgery outpatient clinic of Hospital Universiti Sains Malaysia HUSM. Obesity was described as BMI ≥30 mg/kg2. Descriptive statistics were employed to describe the demographic data in frequency, mean, percentage, and standard deviation while independent T-Test was used to determine the association of obesity on the development of knee osteoarthritis. ResultsFrom the questionnaire analysis, the result revealed that there is a significant mean difference (P-value = 0.001) of BMI among the osteoarthritis group. The mean BMI of patients in the osteoarthritis group 40.97 (SD 3.59) was higher than the mean BMI of patients in the group without osteoarthritis 31.29 (S.D 0.71). Furthermore, it was observed that the mean of the group with osteoarthritis was very high indicating that the population group is highly obese when compared to the groups without osteoarthritis, thus implying that the presence of osteoarthritis can be associated with increasing weight. ConclusionObesity is associated with the development of knee osteoarthritis, however, whether it starts or worsens osteoarthritis progression remains an inconsistent resolution, following these, more prudent research would be required to solve this quest.

The Utility of Beta 2 Microglobulin (B2M) as an Initial Diagnostic Tool for Oral Squamous Cell Carcinoma (OSCC): Evidence from a Malaysian Scenario

Background: The delay in diagnosis of oral squamous cell carcinoma (OSCC) is a factor in rendering the poor prognosis, and recent research has explored the use of serum tumour markers such Beta 2 Microglobulin (B2M), to aid early diagnosis. However, despite a high incidence of OSCC in Southeast Asia, no studies on the clinical use of B2M in the region were found.&#x0D; Objectives: To determine if serum B2M level can serve as an initial diagnostic tool to indicate if a biopsy is warranted, and if so, to propose a local B2M serum reference value to identify OSSC patients.&#x0D; Methodology: Twenty-one patients were seen at Hospital Universiti Sains Malaysia (HUSM) for a one-year period, between June 2016 and June 2017, and equal number of healthy controls participated in the study. Apart from patient history, venous blood of approximately 5ml volume was collected from each subject at the pre-treatment stage and analysed by an Abbot ARCHITECT c8000 analyser using the immunoturbidimetry method. The results were analysed using ROC analysis and the Mann Whitney test.&#x0D; Results: Serum B2M levels showed a statistically significant increase (p&lt;0.001) in patients compared to controls. The test was shown to have 90.5% sensitivity and 90.5% specificity. It was found to be a sensitive and specific serum tumour marker at a cut off value of 1.57mg/l to differentiate cases from controls.&#x0D; Conclusion: B2M is a sensitive and specific tumour marker to differentiate OSCC cases from controls. It is cost effective and minimally invasive, making it a potentially useful adjunct diagnostic tool in a high-risk patient pool.&#x0D; Bangladesh Journal of Medical Science Vol.18(4) 2019 p.729-735

Procalcitonin as an Early Laboratory Marker of Sepsis in Neonates: Variation in Diagnostic Performance and Discrimination Value.

BackgroundAs an early recognition of neonatal sepsis is important for triggering the initiation of treatment, this study was thus designed to assess the diagnostic performance and discrimination value of procalcitonin (PCT) in neonatal sepsis cases.MethodsThis cross-sectional study, which was carried out at the Paediatric Intensive Care Unit of Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia, had involved 60 neonates admitted for suspected sepsis. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and the area under receiver operating characteristics curve (AUC) for PCT were determined at initial presentation (0 h) as well as 12 h and 24 h after presentation in comparison to blood culture as the gold standard.ResultsThe study consisted of 27 (45.0%) male and 33 (55.0%) female neonates with a mean (SD) age of 76.8 (48.25) h. At cut-off PCT value of > 2 ng/mL, the sensitivity, specificity, PPV and NPV were 66.7%, 66.7%, 33.3% and 88.9% at 0 h. The respective parameters were 83.3%. 56.3%, 32.3% and 93.1% at 12 h and 83.3%, 52.1%, 30.3% and 92.6% at 24 h. AUC was 71.6%, 76.6% and 71.7% at 0 h, 12 h and 24 h.ConclusionsDiagnostic performance and discrimination values of PCT for diagnosis of neonatal sepsis varied with time of obtaining the blood samples. The PCT result at 12 h demonstrates the most optimal diagnostic performance and discrimination values.

Cumulative organ dose and effective dose in adult population underwent repeated or multiple head CT examination

The computed tomography (CT) scan is one of the most frequently used tool in diagnostic imaging. Thus, it has resulted in growing frequencies of multiple and repeated exposures of CT imaging that resulted in high cumulative doses to patients. In consequence, concern also raised among professionals and public on the potential radiation-related health effects received from repeated CT exposures. This study was aimed to evaluate the cumulative organ dose received from multiple exposures in adult patients underwent CT head examination. The retrospective dose survey was performed at Advanced Medical and Dental Institute (AMDI), Penang and Hospital Universiti Sains Malaysia (HUSM), Kelantan. A total of 203 adult patients received multiple CT exposures (3 times or more) were selected. Most of the patients that received multiple CT scans were referred from the Emergency and Neurosciences Departments of HUSM. The cumulative organ doses and effective dose from multiple CT exposures were estimated using CT ImPACT software. From the survey, most of the patients received 3 times of repeated head CT examinations with the highest frequency of repeated CT was 14 times. The highest equivalent dose was observed at eye lens with the value of 8.02 mSv for 14 CT exposures followed by bone marrow with dose values of 7.06 mSv. Based on the recommendation by International Commission on Radiological Protection (ICRP), the highest mean dose of 8.02 mSv received by the eye lens was considered at low risk which is 0.1–8.0% below the ICRP recommended value of 20 mSv. Besides, the absorbed dose to eye lens was also considered at low risk of developing radiation-induced cataract. However, the increasing numbers of repeated CT exposures contributed to the dose increment (p-value = 0.01). Moreover, the absorbed dose of the lens received after 4 exposures exceeded the range of 2 Gy of cataract risk with the M = 244.81, p = 0.01. Besides, the highest cumulative effective dose by simple calculation (32.1 mSv) and ImPACT calculation (43.8 mSv) were also differed significantly with p‒value of 0.01. The organ dose and effective dose associated with repeated CT exposures should be carefully observed and repeated examinations on the same patients should be justified to ensure the dose received by patient is as low as reasonably practicable.

A Statistical Application on Determining the Prognostic Factors of Oral Squamous Cell Carcinomas (Oscc) In Malaysia

Oral cancer is an important global health concern, representing the sixth most frequent malignant tumor. The oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm of the oral cavity with up to 50% of mortality rate (highest prevalence being identified in Asia). In 2012, it has been reported that 14.1 million new cancer cases and 8.2 million cancer deaths. Numbers of studies have been performed to investigate the factors that have direct and indirect or both associated with the OSCC, including their survival time. In this paper, the potential clinicopathological prognostic factors will be determined in patients who attended Hospital Universiti Sains Malaysia from 2005 to 2015. For such prediction, the use of hazard regression is used previously, but here an attempt is made to propose a covariate-dependent prognostic model to identify the factors and the predictor importance according to the statistical significant point of view. The proposed model is very useful for the prediction and for the inferences of the patient’s management time with the high-risk clinicopathological factors.

Translation, Cross-Cultural Adaptation, and Validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) into the Malay Language.

Background: Patient feedback is an important tool in assessing health system quality. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed in 2006 as a standardized instrument to assess patient perceptions in the United States of America. This study aimed to translate and validate the HCAHPS questionnaire into the Malay language in order to assess patient perceptions of health services in Malaysia. Methods: The original HCAPHS in English was translated into Malay based on the established guideline. The content validation involved an expert panel of 10 members, including patients. The face validation pilot testing of the HCAHPS-Malay version was conducted among 10 discharged patients. The exploratory factor analysis (EFA) used principal axis factor, and varimax rotation was established based on a cross-sectional study conducted among 200 discharged patients from Hospital Universiti Sains Malaysia (Hospital USM). Results: The overall content validity index was 0.87, and the universal face validity index was 0.82. From the EFA, the factor loading value ranged from 0.652 to 0.961 within nine domains. The internal consistency reliability with Cronbach’s alpha was 0.844. Conclusion: The HCAHPS-Malay is a reliable and valid tool to determine patients’ perception of healthcare services among inpatients in Hospital USM based on the content and face validation result together with a good construct validity and excellent absolute reliability. Further testing on HCAHPS-Malay version in other settings in Malaysia needs to be done for cross-validation.

Evaluation of Optic Nerve Head Parameters, Retinal Nerve Fiber Layer Thickness, and Ocular Perfusion Pressure in Migraine Patients.

BackgroundNeurovascular changes occur during the migraine is believed to cause alteration in cerebral and retinal circulation that possible result in damage to the brain and even retina or optic nerve. Retinal nerve fiber layer (RNFL) thickness measurement can be used as an index to assess ganglion cell and retinal nerve fiber damages. The aim of this study was to evaluate the optic nerve head (ONH) parameters, RNFL thickness, and ocular perfusion pressure (OPP) in migraine patients.MethodsThis was a cross-sectional study, conducted in Hospital Universiti Sains Malaysia, Kelantan from July 2016 to November 2018, involving patients with a confirmed diagnosis of migraine and controls. Ninety-four eyes of 47 migraine patients and 94 eyes of 47 healthy subjects were included in this study. Blood pressure and intraocular pressure were measured and OPP was calculated. ONH parameters and RNFL thickness were measured using optical coherence tomography (OCT) after pupillary dilatation. Statistical analysis was done using Statistical Package for the Social Science (SPSS Inc Version 24).ResultsWith respect to all means values of ONH parameters, there was no statistically significant difference between migraine patients and controls. For RNFL, there were significant reductions in average and superior RNFL thickness on both eyes with adjustment of age and gender (P-value: right eye (RE) average = 0.027; RE superior = 0.034; left eye (LE) average = 0.037; LE superior = 0.031). In view of OPP, there was no significant difference between migraine patients and controls (P-value = 0.172). Weak correlations were found between the ONH parameters and RNFL thickness with OPP, respectively, in migraine patients.ConclusionThis study showed no difference in ONH parameters between migraine patients and healthy subjects. There was significant thinning in average and superior RNFL for migraine patients. No difference found in OPP between both groups. ONH parameters and RNFL thickness had a weak correlation with OPP in migraine patients.