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 : Pap smear is a useful screening tool for cancer of the cervix. Screening has resulted in the tremendous fall in cervical cancer incidence worldwide. However, the conventional pap smear has many limitations due to significant false negative and false positive rate, and unsuitability due to thick smears. Liquid-based cytology, such as ThinPrep™ technique is an alternative to conventional pap smear. This method provides monolayer cells which make cytological examination easier. HPV is the cause of cervical cancer. Identification of the virus is helpful in cervical cancer screening. Hybrid Captures 2 systems is one of the examples of HPV testing that is useful to detect high-risk HPV in a large number of samples. Objectives : We embarked on pap smear split-sampling study to determine if monolayer cytology would give better results than conventional cytology. Patients & Methods : Six hundred eighty eight women who gave consent were recruited We collected the exfoliative cervical samples from all the subjects. Each sample was smeared as for the conventional pap smears as done routinely and then rinsed into a liquid buffer (PreservCyt) for monolayer cytology and HPV testing The cytological examination was performed in blinded fashion. The performance of convetional and ThinPrep™ monolayer cytology pap smears was compared. Smears were based on The 2001 Bethesda classification All cases which had epithelial abnormalities were further tested for HPV by Hybnd Captures® 2 technique. Results : We found that adequancy of sampling was 943% in conventional pap smear and 894% in ThinPrep™ cytology. The commonest organism identified was Candida spp (4.1% in conventional smears,3.9% by ThinPrep ThinPrep™ and the agreement study is fair (k=0.27). Diagnosis of ASCUS, LSIL, HSIL and squamous cell carcinoma, were low in both techniques. The glandular cells abnormalities were also low in numbers. The agreement studies for LSIL showed k=0.40. The agreement studies for ASCUS, HSIL, squamous cell carcinoma, AGC (NOS) and adenocarcinoma (NOS) were not done as the number was too few. The HPV testing of cases with abnormal cytology showed low positivity (38.5%). Conclusions : The overall performance of ThinPrep™ is no better than conventional pap smears. The usage of the ThinPrep™ pap smear does not improve in detecting certain infective organisms nor abnormal epithelial cells. The low positivity of Hybrid Captures® 2 technique is questionable. Confirmation with other techniques like PCR is essential. Split sampling gives adequate smears for cytological assessment. It can be camed out in laboratories working to change from one technique to another. Prof. Dr. Nor Hayati Othman : Supervisor Introduction : Pain is the dominant symptom of labour and is multifactorial in origin. The appropriate pain relief may influence the general course and success of labour. Opioids are the cornerstone of pain management. Despite their extensive use, little is known about their effectiveness and whether certain opioids produce fewer side effects. Pethidine is one of the most commonly used opioids for labour pain relief. However, there are many unintended effects that have been found with its prescription during labour. Nalbuphine, a synthetic agonist-antagonist opioid analgesic agent is a potentially good alternative in view of the similar efficacy and better side effects profile. Objectives : To study and compare the efficacy of 2 different types of intramuscular opiods as labour analgesia and the adverse effects to both mothers and babies Patients & Methods : Labouring pnmigravida m Labour room, Hospital Alor Star from December 2004 to March 2005 who required analgesia were randomised to intramuscular Meperidine 75mg or mtramuscular Nalbuphme 20mg Main outcome measures changes in seventy of labour pam after administration of opiods, the adverse effects expenenced by the mothers, the acceptability of treatment by mothers, the mode of delivery, the Apgar score of baby and the need of opiod antidote for resuscitation of the baby. Results : A total of 480 patients were randomised, 240 received intramuscular Meperidine and 240 intramuscular Nalbuphine. Efficacy of the opiods was similar but patients who received Meperidine reported statistically significant (p <0.05) adverse effects. There were no difference in the mode of delivery and 5 minute apgar score between the two groups but more babies in the Meperidine group needed resuscitation with opioid antidote at birth (43.3% versus 22.8%) Conclusion : Intramuscular Nalbuphine seems to be the better choice of labour analgesia in our study group. Prof. Dr. Mohd. Shukri Othman : Supervisor Prof. Madya Dr. Nik Mohamed Zaki Nik Abdullah : Co-Supervisor Introduction : The principle of tissue engineering research is based on the seeding of cells onto porous biodegradable polymer scaffolds, which are used to support, reinforce and in some cases organize the regenerating tissue. Chitosan, the N-deacetylated derivative of chitin, is biocompatible and biodegradable, enabling it to be used effectively as a biomaterial scaffold. Objectives : The main purpose of this study is to study the induction of neovascularization and tissue response that occur in chitosan films that are placed with an arteriovenous bundle in an isolated PTFE chamber. The second objective was to determine the degrees of increase of neovascularization with time. Methodology : Twelve rabbits were used and they were divided into three groups (Group A, Group B and Group C). Arteriovenous bundles were created and placed inside a PTFE chamber. On the right side, the PTFE chamber was filled with chitosan film (test group); while on the left side the PTFE chamber was empty (control group). The PTFE chambers on both sides were then placed in separate submuscular pockets created in the anterior abdominal wall on each side. At the second week, rabbits from group A would be sacrificed and the contents of the chambers harvested. Tissue response and neovascularization of the tissue inside the PTFE chambers would be assessed by histopathological examination. Similar procedure was to be repeated at the fourth and sixth weeks for Group B and Group C respectively. Results : Showed the presence of chitosan provoked significant inflammatory reaction in the tissues adjacent to it with areas of tissue necrosis. No granulation tissue, new tissue formation and neovascularization were observed in the vicinity of the chitosan. The level of inflammation at second week was more intense that those at the forth and sixth weeks. There was no difference in term of scarcity of neovascularization among the test groups at second, forth and sixth weeks. In the control group, neovascularization and new tissue formation were observed. Discussion : Based on these observations, the results indicate that chitosan in the form we used in this experimental study did not support neovascularization from the arteriovenous bundle in the PTFE chambers. Chitosan may bring about desirable effects like promotion of wound healing or causes tissue destruction, depending on its physicochemical properties. Conclusions : The effects of chitosan of various physicochemical properties on animal tissue need to be studied in more details. Further studies are warranted to elucidate detailed information of the various properties of chitosan. Prof. Ahmad Sukari Halim : Supervisor Prof. Dato’ Dr. Ahmad Ridzwan Arshad : Co-Supervisor Introduction : Management of asthma in Emergency Department remains a challenge to all Emergency Physician and Allied Health Personnel. Various modality of treatment has surfaced since the last decade and lately, anaesthetic medications have found a place in treatment of mild to moderate asthma patients. Anaesthetic medications have long been found to have direct effect on airway smooth muscle and it causes relaxation of the bronchial smooth muscles. The anaesthetic medication in question is Lignocaine. Lignocaine is an local anaesthetic and anti-arrythmic medication that is easily available. It has a rapid onset of action and short duration of action. Lately it has been found to have property to attenuate reflex bronchoconstriction and also anti-inflammatory. Objectives : The objective of this study is to compare the result of relief of bronchoconstrjctjons in patients with acute asthma when they are given either combined nebulized lignocaine & salbutamol or salbutamol only This study also would like to document the side effects of combined nebuhzed lignocaine and salbutamol Patients & Methods : A prospective study was conducted on 50 patients who had come to the emergency department and required treatment for acute exacerbation of mild to moderate asthma. Patients who fulfilled the criterias for inclusion were randomized to receive either plain salbutamol or combined salbutamol with lignocaine nebulized treatment. Measurements of peak expiratory flow rate and other clinical datas such as blood pressure, pulse rate, respiratory rate and oxygen saturation level will be taken in intervals. Results : The results from 50 patients requiring treatment for acute exacerbation of asthma showed that there were no significant difference between those randomized to receive plain salbutamol treatment and those receiving combined salbutamol and lignocaine nebulizers. At 15 minutes of treatment, the mean percentage of increased PEFR value of 20.92 ±28.23 (Single) and 18.01 ± 22.09 (Combined). The p value seen was 0.687 at 15 s interval of treatment Even at 30 minutes of treatment shows the mean. value of increased PEFR at 33 91 ± 34 79 (Single) and 36 02 ± 4115 (Combined) with p value of 0 846. Out of 25 patients who were given combined salbutamol and lignocaine treatment, 16 patients experienced numbness of the oral cavity patients experienced both bitterness taste and numbmess of the oral cavity. Discussion & Conclusion : Combined sulbutamol and lignocaine did not have a better relief of bronschoconstriction as compared to salbutamol nebulization in mild to moderate asthma. The expected side effects of lignocaine were encountered and there were no new ones. Assoc. Prof. Dr. Wan Aasin Wan Adnan : Supervisor Dr. Nik Hisamuddin Nik Abd. Rahman : Co-Supervisor