Abstracts of Theses Approved for the M.Sc., M.Med. and Phd. Degrees at the School of Medical Sciences, University Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia.

Introduction The α2 agonist dexmedetomidine is a new sedative and analgesic agent which is licensed in the USA for post-operative intensive care sedation. We compared dexmedetomidine with the mixture of midazolam and morphine for post-operative patient who required mechanical ventilation in intensive care unit (ICU). Objective : To compare the effect of dexmedetomidine and midazolam-morphine mixture among post-operative patients in ICU; in term of the amount of analgesic (PCA morphine) requirement, sedation score, haemodynamic profiles and time of extubation. Methodology : Prospective, double-blinded randomized controlled trial study design involved post-operative patients admitted to the Intensive Care Unit (ICU) of Hospital Universiti Sains Malaysia (HUSM) conducted from June 2003 to June 2004. Thirty-four mechanically ventilated post-operative patients were randomly assigned to receive short-term (minimum 4 hours) sedation with either continuous intravenous infusion of dexmedetomidine (group Dex. n=17) or midazolam-morphine mixture (group MM, n=17). Both groups received similar intraoperative anaesthetic regime. Patient controlled analgesia (PCA Morphine) was given to patient as rescue analgesic. Analgesic (PCA morphine) used (mg/hour), Ramsay sedation scoring, extubation time (minute), systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate were Medical Sciences, Universiti Sains Malaysia had approved this study on 9th April 2003. Result : Mean extubation time of dexmedetomidine group was significantly lower than midazolam and morphine mixture group [mean (s.d.): 40.3 ± 16.5 minutes versus 57.9 ± 17.7 minutes. p=0.05]. Within the first 4 hours drug infusion, mean systolic blood pressure [mean (s.d.): 105 ±14 mmHg vs 127 ± 24 mmHg, (p=0.000)], mean diastolic blood pressure [mean (s.d.): 59 ± 8mmHg vs 66 ± 13 mmHg (p=0.000)], mean arterial pressure [mean (s.d.): 76 ± 9 mmHg vs 86 ± 15mmHg (p=0.000)] and mean heart rate [mean (s.d.): 88 ± 13 beats per minute vs 102 ± 24 beats per minute (p=0.000)] were significantly lower in dexmedetomidine group than those in midazolam and morphine mixture. There was significant difference of mean Ramsay sedation score between dexmedetomidine and midazolam morphine mixture (p=0.000). However, there was no significant difference of mean dose of morphine per hour between dexmedetomidine groups and midazolam morphine mixture [(mean (s.d.); 1.4 ± 0.7 mg/hour) versus mean (s.d.); 1.1 ± 0.8 mg/hour). p= 0.157 ]. Conclusion : Dexmedetomidine provides safe, effective sedation and analgesia for postoperative long surgical patient in intensive care unit. Haemodynamic variables of dexmedetomidine group was more stable than midazolam and morphine mixtures group. Thus dexmedetomidine provides better perioperative haemodynamic control or a long sugery. The use of dexmedetomidine also allowed for more rapid tracheal extubation. Dr. Saedah Ali : Supervisor Dr. Nik Abdullah Nik Mohamed : Co-Supervisor Introduction Therapeutic modalities are useful adjuncts in the rehabilitation of many patients commonly seen by orthopedic surgeons. Therapeutic heat, electrical stimulation, infrared light and magnetic field treatments have been used extensively in the management of low back pain. The majority of therapeutic modalities have been investigated and their efficacy has been emphasized in the literatures. On the other hand, application of cold is not popular even though its role in the management of low back pain has been recommended in some literatures. Objectives : The purpose of this study is to find out whether application of cold has beneficial effect in the management of acute low back pain. This research was conducted with an interest to identify cold therapy as a potential therapeutic modality in the rehabilitation program of low back pain particularly in acute cases. DESIGN: Prospective randomized control trial. SETTING: Hospital Universiti Sains Malaysia. PARTICIPANTS: 40 patients with acute presentation of low back pain. Methodology : The study was carried out from March 2004 to August 2004. A special clinic staffed by a trained medical officer was established for the purpose of this study and a group of adult patients was selected. The patients were managed in accordance with standard recommendations. For the intention of this study, the patients were further divided into 2 groups. Group A patients was subjected to cold therapy (study group) whereas Group B patients was not subjected to cold therapy or any form of therapeutic modalities (control group). Data on pain intensity score and functional disability index were taken and collected before the initation of treatment, on weekly basis, and at the end of the program (at 6 weeks). A comparative analysis was done ;tween these 2 groups. Results : A total of 40 participants who met the criteria were included in the study. They were subsequently divided equally into 2 groups 20 patients ‘ere in Group A and another 20 patients were in Group B. Results during the study period low a faster deceleration rate of pain level in Group A as compared to Group B. The pain level decreased significantly from week 2 in group A in comparison to Group B (P 0.05). Conclusions : Cold therapy is beneficial by means of reducing the pain intensity early during the rehabilitation of low back pain, particularly in those with acute presentation. On the contrary, cold therapy vas found out not to influence the functional disability index of these patients. Results indicate that application of cold was more effective by reducing the pain level more quickly than those who did not receive cold therapy or any form of therapeutic modalities. Cold therapy is not a placebo and may perhaps be considered as a potential therapeutic modality to reduce pain more rapidly while managing patients with acute low back pain. Dr. Abdul Halim Yusof : Supervisor Dr. Abdul Nawfar Sadagatullah : Co-Supervisor Introduction The HIV/AIDS epidemic has led to a rise in the incidence of TB particularly pulmonary TB and an epidemic of coinfection. The identification of risk factors, which may predict the occurrence of pulmonary TB, is needed. Hence, this study is done to identify factors associated with increased risk of contracting pulmonary TB in adult HIV patients. Methodology : A case control study was conducted at infectious diseases clinic, Hospital Kota Bharu from November 2003 to August 2004. Ninety seven patients were cases (HIV and pulmonary TB) and ninety seven patients were controls (HIV only). No probability sampling method was applied. All patients who fulfilled the inclusion and exclusion criteria and who gave consent were recruited into the study due to limited number of patients. Interviewer guided questionnaire was administered and medical record was Results : Cases were found to be more males, older and singles. The number of cases who smoked and consumed alcohol were higher than controls. High-risk behaviors such as intravenous drug users and having multiple sexual partners were found to be more in the cases compared to controls. The commonest mode of HIV infection in the cases was intravenous drug users (41.9%). Cases also had higher proportion of TB contact, past history of TB and other chronic diseases. They had lower hemoglobin, lymphocyte, CD4 and CDS but higher erythrocyte sedimentation rate (ESR) as compared to controls. In multiple logistic regression analysis, the significant risk factors detected were history of TB contact (OR=4.94, 95%CI=1.73, 14.07), past history ofTB (OR=4.59, 95%CI=1.06, 19.78) and history of chronic diseases (OR=4.41, 95%CI=1.28, 15.20). Being females (OR=0.06, 95%CI=0.02, 0.24) and married (OR=0.06, 95%CI=0.01, 0.25) or widowed (OR=0.14, 95%CI=0.02, 0.84) had protective effect towards the risk to contract pulmonary TB. Other significant factors were CD4 (OR=0.996, 95%CI=0.993, 0.999), total white blood cell (TWBC) (OR=0.76, 95%CI=0.62, 0.92) and ESR (OR=1.04, 95%CI=1.03, 1.06). Conclusions : The significant independent risk factors for pulmonary TB were male, single, had history of TB contact, had past history of TB, had chronic disease, low CD4, low TWBC and high ESR level. It showed that patients at high risk can be identified on the basis of demographic and clinical features. Assoc. Prof. Dr. Syed Hatim Noor : Supervisor Dr. Rosemi Saleh : Co-Supervisor Introduction Menopause is associated with numerous transient typical and atypical symptoms. It is believed that Asian women suffer more of the atypical symptoms and fewer, and with lesser severity, the typical psychological and vasomotor symptoms than the western women. Objectives : This study reports the incidence and nature of menopausal symptoms in Kelantanese women and the self-care actions taken by them. Methodology : A semi-structured, self-administered questionnaire was administered to 326 postmenopausal women (aged, 57.01 ± 6.58 (SD) years) residing in the state of Kelantan. The subjects comprised of naturally menopaused, healthy women. Women with uncontrolled diabetes and hypertension were not included. Descriptive statistical analysis was performed on the data using SPSS programme. Results : Mean age at menopause was 49.4 ±3.4 (SD) years while both the mode and median were 50 years. The mode for the number of symptoms complained by each woman was 8 (range 0 – 16). The incidences for atypical symptoms was; tiredness (79.1%), reduced concentration (77.5%), musculo-skeletal aches (70.6%) and backache (67.7%). Night sweats (53%), headaches (49.4%) and hot flushes (44.7%) were the typical vasomotor symptoms, whereas mood swings (51%), sleep problems (45.1%), loneliness (41.1%), anxiety (39.8%), and crying spells (33.4%) were the main psychological symptoms. Majority of the women reported reduced vaginal secretion (50.9%). The commonest coital frequency was approximately 2–4 times per month (49.7%). Overall, 42.3% reported a decrease in the frequency of sexual activity postmenopausally. Over two-thirds (69%) of the women reported either reduced (39%) or absent (29.6%) sexual desire or interest. A similar pattern was also reported for libido. Varying degree of dyspareunia was reported by 34% of the women. Some women (23.3%) had noticed that their spouses9 sexual interest in them had reduced compared to before menopause. A small percentage (7.1%) reported that their vagina was not able to accommodate completely an erect penis. A small percentage (2.1%) admitted to having sexual problems, which had an affect on their marital relationship and another group (9.5%) had spouses with sexual problems. A quarter of the women thought their sexuality could be improved while another quarter thought otherwise. More than half (52.6%) did not take any action to improve their sexuality. Those who did, took HRT, “Jamu”, Evening Primrose Oil, Royal jelly, did regular exercises and controlled their diet. The percentage of women taking self-care actions depended upon the symptom, and ranged from 47.7% for reduced concentration to 100% for crying spells and anxiety. Their self-care actions included taking traditional medicine, alternative medicine, prescribed medications, getting actively involved in community work, and having peer support. More than half (55%) did not seek any advice regarding their menopause. Those who did, mainly approached their friends. Some 13% of women were not aware of the menopause when it occurred. The sources of knowledge on menopause, according to the respondents, were friends, health professionals, and attending seminars. Conclusions : Most of the respondents viewed menopause as biological event and placed it within the context of their development milestones. Those who viewed menopause as a marker of old age accepted it as a time frame within the lifespan. In conclusion, it appears that the menopause symptoms experienced by women elsewhere, albeit, with differing frequencies. Majority of the women accepted menopause as the beginning of the aging process and resorted to numerous selfcare actions to help see them through this transition. Dr. Nor Aliza Abdul Ghaffar : (Supervisor) Assoc. Prof. Dr. N. Md. Zaki N. Mahmod : (Co-Supervisor)