ORAL PRESENTATIONS - Bioline International

ABSTRACT, 9TH NCMS, 22 - 23 MAY 2004, UNIVERSITI SAINS MALAYSIA, HEALTH CAMPUS, KUBANG KERIAN, KELANTAN

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ABSTRACTS

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A PILOT STUDY OF RISK FACTORS IN CLEFT LIP/PALATE PATIENTS

AuthorsA. R. Ismail, N.M. Ismail, L. Naing

InstitutionSchool of Dental Sciences, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionThe risks of non-syndromic cleft lip with or without cleftpalate and isolated cleft palate (CLP) are influenced byvariations at several loci of the gene and these lociinteract with environmental factors to determine diseaserisk.

ObjectiveThe aim of the study is to establish the relationshipbetween environmental risk factors and incidence of cleftlip and palate.

MethodologyThis is a case controlled study of non-syndromic CLPpatients attending combined clinic in Kota Bharu andpatients attending outpatient clinic in HUSM. Informationwas obtained using questionnaires. The information inthe questionnaire includes paternal & maternal smokinghabit, amount of tobacco used, genetic consideration.Environmental factors such as area of residence, birthdates, maternal problems, use of complementarymedicine and diseases during pregnancy are explored.Details of socio-economic status are also obtained. 201CLP patients and 212 controls were interviewed.Univariate and multiple logistic regression analysis wereused to analyze the data.

ResultsIt was found that demographically there were variationsto risks of non-syndromic CLP. People from Tanah Merahand Tumpat had a 8.74-fold increased risk compared topeople from Kota Bharu. There was an associationbetween passive smokers and CLP (OR) = 2.45 (95%CI: 1.52, 3.94). Maternal and paternal history of cleft,occupation of father and position of child in the familyincreased the risk of CLP (p=0.009).

ConclusionThe study suggested that there were some geographicalvariations in the risk of CLP. Maternal exposure tocigarette smoke (passive smokers) showed increasedrisk of CLP. The seventh child and above had increasedrisk of CLP.

ORAL (A2 - 5)

IN VITRO STUDIES OF PROPERTIES OF ER: YAGLASER-TREATED HUMAN DENTINE

AuthorsAdam bin Husein

InstitutionRestorative Department, School of Dental Sciences, UniversitiSains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

AimsEr: YAG laser irradiation (_ = 2.94µm) has been provento be effective in ablating human enamel and dentine.The aims of this study were firstly to examine the surfacemorphology of human dentine resulting from Er: YAGlaser ablation, compared with that produced byconventional methods of cavity preparation. Secondly,it was to test the Shear Bond Strength (SBS) ofcomposite resin (CR) to those dentine surfaces

Materials and MethodsBuccal enamel of fifty extracted human molar teeth wasremoved using a high-speed diamond wheel bur underwater spray so as to leave a planed surface of exposeddentine. Five of each specimen were subjected to: (i)surface treatment using Er: YAG ablation (250 mJ, 10Hz, VSP), (ii) Er: YAG ablation plus acid etching (37%Phosphoric acid, 10 seconds), (iii) surface treatmentusing conventional methods (fine grit diamond bur) and(iv) conventional plus acid etching. Four groups of fiveteeth were examined under an SEM (Philip XL30). Threegroups of ten teeth underwent SBS testing to comparethe bond strength of CR to the three categories of treateddentine surfaces, using a universal testing machinefollowing ISO standard TR 11405.

ResultsResults indicate that the Er: YAG laser irradiationproduces micro-irregularities on dentine surfaces withopen tubules and no smear layer present. The micro-irregularities were completely removed following acidetching procedure. The SBS tests reveal that the Er:YAG laser irradiation with or without acid etching didproduce slightly higher bond strength values than theconventional group but was not statistically significant(student t-test). The SBS values for Er: YAG laser, Er:YAG laser plus etching and conventional are 7.7 ± 4.4MPa, 8.7 ± 3.4 MPa and 7.4 ± 5.3 MPa respectively.

ConclusionThe results of this study indicate that Er: YAG laser canbe successfully used as an alternative to theconventional method in preparing dentine for CRrestoration.

ORAL (A2 - 6)

PROSTHODONTICS AND ITS SCOPE IN MAXILLOFACIAL REHABILITATION

Author

Jacob John

InstitutionKlinik Pergigian Hospital Pasir Mas, Kelantan – Dental division,Ministry of Health, Malaysia


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Man’s need for replacement of missing or lost bodyparts probably existed as long as man himself. Althoughsocial cultures have characteristically changed and theaccepted modalities for rehabilitation have variedthroughout the centuries, there has apparently alwaysbeen a social awareness that the deformed body is notcompletely accepted. A considerable number of people,each year, acquire varying facial defects due tomalignant disease, trauma or congenital deformity.Although modern plastic surgery techniques, in particularmicrosurgery, can help to restore some lost tissue, incases of radical surgery they cannot replace the lostpart in a way which creates an acceptable illusion ofnormal appearance. In addition, the age and generalmedical condition of the patient may also contraindicatemajor reconstructive surgery. In these cases a majordefect persists following surgery. These patients,therefore, can be offered prosthetic rehabilitation as analternative to help fill this void. The specialty ofProsthodontics has grown from mere replacement ofmissing teeth, to include treatment of patients with headand neck malignancy, post tumor therapy surgicalreconstruction and congenital and developmentaldefects.

ORAL (A2 - 7)

KNOWLEDGE, ATTITUDE AND PRACTICE OF PITAND FISSURE SEALANTS BY DENTALPRACTITIONERS IN KOTA BHARU, KELANTAN

AuthorsMani SA, Ahmad B

InstitutionSchool of Dental Science, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.

BackgroundIt is clearly recognized that pit and fissure sealant is aneffective, safe and cost-effective method of preventingpit and fissure caries. Improvement in dental materialshave increased retention rates and shown long lasting,caries preventive effect. This study was done toinvestigate the use of fissure sealant among dentalpractitioners and probable factors associated with itsusage.

MethodForty questionnaires were handed out to dentists in 3sectors; private practice, Ministry of health and HospitalUSM. Questionnaires were designed to evaluateknowledge of type of sealant used, attitude towardsplacement of sealants and preference of type of sealantused.

ResultsAn eighty percent response rate was obtained, of which56.3% practice the use of pit and fissure sealants intheir clinical practice. All dentists consider age of thepatient prior to placing pit and fissure sealants and only

33.3% consider the caries risk of the patient. Delton FSwas the most commonly used band of sealant (40%).Descriptive statistics was used for this study.

ConclusionDental practitioners in the city have a positive attitudetowards practice of pit and fissure sealants. However,private practitioners have been slow to adopt sealantuse in their practice.

ORAL (A2 - 8)

THE DEFINITIVE DIAGNOSIS OF ORAL HAIRYLEUKOPLAKIA IN HIV-SEROPOSITIVE AND AIDSPATIENTS.

AuthorsMohamed Mabruk1, Stephen Flint2, Mary Toner2 and Greg Atkins3

InstitutionAdvanced Medical and Dental Institute, University Sains MalaysiaPenang, Malaysia 1; Dublin Dental Hospital 2, MicrobiologyDepartment, University of Dublin3

IntroductionOral hairy leukoplakia (OHL) is a white or grayish orallesion. OHL lesion, usually located on the ventral surfaceand/or lateral border of the tongue. The histopathologicalfeatures of OHL are not pathognomonic to establish adefinitive diagnosis. The definitive diagnosis of OHLrequires the demonstration of Epstein Barr virus in theOHL lesion.

ObjectiveTo investigate the possibility of using Polymerase Chainreaction(PCR) technology in reaching a definitivediagnosis of OHL in tongue scraping obtained from HIV-seropositive patients and to compare our finding to theconventional in situ hybridisation on OHL biopsiesobtained from the same patients. Furthermore, we haveinvestigated the possibility of using a rapid microwavein situ-hybridisation technology in order to accelerateand simplify the definitive diagnosis of OHL.

MethodologyPolymerase chain reaction approach was carried outand compared to the conventional in situ hybridisationmethod. Furthermore, we have modified a microwavein situ hybridisation technique and designed a novel insitu hybridisation chamber to accelerate the technicalprocedures for reaching a definitive diagnosis of OHL.

ResultsEBV DNA was not only detected in all OHL lesionalscrapings but also in 36.3% of normal control. However,by using a conventional in situ hybridisation approach,EBV DNA was detected only in OHL biopsies and nonin the normal healthy controls biopsies. Furthermore,using microwave in situ hybridisation and our newlydesigned chamber, we have shortened the hybridisationstep for EBV detection in OHL biopsies, from over-nightincubation to 14 minutes.


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ConclusionPCR is highly sensitive and of low specificity and shouldnot replace in situ hybridisation for reaching a definitivediagnosis of OHL. In addition we have established arapid microwave in situ hybridisation approach forreaching a definit ive diagnosis of OHL in HIV-seropositive and AIDS patients.

ORAL (A2 - 9)

THE MAXILLARY ARCH FORM OF SELECTEDETHNIC GROUPS IN MALAYSIA AND ITSRELATIONSHIP TO CEPHALOMETRICLANDMARKS

AuthorsKhin Myo Thu1, Than Winn2, J.A.P. Jayasinghe1, Nizam Abdullah2,and G.L.Chandima3

Institution1Department of Anatomy, 2Department of Community Medicine,School of Medical Sciences, 3School of Dental Sciences,Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian,Kelantan, Malaysia.

IntroductionA correct knowledge of tooth size, dental archdimensions and head form of a population are importantfor several dental treatment procedures. Heritabledifferences present in these parameters among themare also useful for the practice of Aesthetic Dentistryand effective orthodontic treatment.

ObjectivesTo estimate maxillary arch measurements, the validityof the Pont’s & Korkhaus’ indices, the relationshipbetween maxillary arch form with head form, the cephalicindex (CI) and also to compare these measurementsamong ethnic Malays and Chinese.

MethodologyA cross-sectional study was conducted on 87 Malay and89 Chinese students. Head measurement was takenusing anthropometric instrument and dental archmeasurements made on the casts. Data analysis wasdone using STATA 7.0.

ResultThe Cephalic Indices (CI), for Malay (86.4) and theChinese (85.9) were not significantly different. But themeans of anterior arch width (AAW), posterior-arch-width(PAW) and arch-length were significantly differentbetween two groups. AAW and PAW were significantlydifferent from their corresponding Indices for Malays butnot for Chinese. Correlation Coefficient betweenbizygomatic width and anterior-arch-width in Malay was0.18 (p >.05) and in Chinese 0.20 (p < 0.01).

ConclusionThe Pont’s and Korkhaus’ Indices could not be appliedto the study Malays but moderately to the Chinese. C.I.of our study subjects were found to be brachycephalic

without any gender difference.

ORAL (B2 - 1)

INTERLEUKIN-6 AS A POTENTIAL EMBRYOTOXICFACTOR IN ENDOMETRIOSIS: LOCAL ORSYSTEMIC EXPRESSION?

AuthorsLiza Noordin1, Gregory JS Tan2 and Mohd Shukri Othman3

Institutions1Departments of Physiology and 3Obstetrics & Gynaecology,Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian,Kelantan, Malaysia. 2 School of Biomedical Sciences, TheUniversity of Notre Dame Australia P.O.Box 1225, Fremantle WA6959 Australia.

Objectives1. To determine interleukin (IL)-6 as a possible

embryotoxic factor in endometriosis.2. To determine the effect of IL-6 on in vitro development

of early mouse embryos.

IntroductionThe aetiology of endometriosis associated infertilityremains an enigma. In recent years, peritoneal fluid andserum are two biological fluid, which have been studiedextensively as possible mediators of infertility in thisdisease through its toxic effect on early embryo growth.We have shown previously that in women withendometriosis, the peritoneal fluid was embryotoxic1.

Various embryotoxic factors have been determined inthese fluid, including interleukins.

Methodology1. The levels of IL-6 in the peritoneal fluid and serum

from infertile women with and without endometriosiswere measured using the ELISA method.

2. Two-cell mouse embryos were cultured in 1mlmodified Whitten’s medium in the presence orabsence of IL-6 at different concentrations (1.6pg/ml and 100pg/ml). The embryos were cultured andobserved for 3 consecutive days.

ResultsThe levels of IL-6 were significantly higher in theperitoneal fluid with endometriosis as compared towithout endometriosis (p<0.05, Mann Whitney U-test),and correlated with the severity of endometriosis(p<0.05, Kruskal-Wallis test). However, no significantdifferences were noted in the levels of serum IL-6. Thedevelopment of 2-cell mouse embryos to blastocysts wassuppressed by IL-6, especially at higher concentration(100pg/ml) (p<0.001, Fisher’s exact test), as comparedto the control (absence of IL-6).

ConclusionThe increased levels of IL-6 in the peritoneal fluid ofendometriosis together with the embryotoxic effects,suggests IL-6 as a possible mediator of embryotoxicityin endometriosis. The levels of peritoneal fluid IL-6 do


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not correlate with the serum levels suggesting thatchanges in the interleukin concentration resulting fromendometriosis occur locally.

ORAL (B2 - 2)

ASSESSMENT OF LABOUR PAIN BY MIDWIVESIN LABOUR SUITE HOSPITAL UNIVERSITY OFSAINS MALAYSIA, KELANTAN.

AuthorsIntan Idiana H1, Nik Hazlina NH2, Rogayah Abd. R2, TengkuNorbainee TH3, Kamarul Imran M3.

Institution1School of Health Sciences, 2Department of Obstetrics andGynecology, School of Medical Sciences, 3Department ofCommunity Medicine, Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionAccurate assessment of labour pain will guide theappropriate management and increase the quality ofcare. Because pain is subjective, labour pain is oftenunder or overestimated by midwives.

ObjectiveThe aim of the study is to compare the assessment oflabour pain among midwives and mother and to identifyfactors affecting the assessment by the midwives.

MethodologyThe study population consisted of 60 mothers and 30midwives. All mothers were asked to rate their pain level using graphic visual analogue scale (VAS). At the sametime the mothers using the same scale exhibited theirattending midwives estimated the degree of pain, as wasexhibited by the mothers using the same scale.

ResultA good correlation (0.618) was found betweenassessment of midwives and mothers. But there wasno statistically significant different in experience, age,number of children, pain management course andmethod of assessment among midwives (p>0.05).

ConclusionMidwives in this study were able to assess labour painaccurately as reported by the mothers and factors suchas age, experience, number of children, painmanagement course and method of assessment doesnot have any influence on the midwives assessment.

ORAL (B2 - 3)

SCREENING FOR ASYMPTOMATICBACTERIURIA (ABU) IN PREGNANCY AMONGANTENATAL ATTENDEES IN HUSM

Authors1Nik Hazlina N. Hussain, 1Nizar Bidin, 1Che Anuar Che Yaakob,2

Md. Radzi Johari, 2Maimunah Ahmad, 3Norsaadah Bachok, 3NorlenMohamed.

Institution1Department of Obstetrics & Gynaecology, 2Dept. of Microbiology,3Community Medicine Dept., School of Medical Sciences,Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian,Kelantan, Malaysia.

Introduction :Asymptomatic bacteriuria in pregnancy is not withoutrisk to mother and fetus. Screening and treatment ofthis condition had been shown to improve the sequelaeof the disease. Screening for ABU is not a routinepractice in Malaysia.

ObjectivesTo determine the prevalence and outcomes ofasymptomatic bacteriuria in pregnancy in HUSMantenatal clinic population.

MethodologyA cross sectional study was conducted from 1st July 2002to 1st January 2003 in HUSM antenatal clinic. MSUFEME clean catch urine for culture and sensitivity andmicroscopy was obtained from 447 women attendingHUSM antenatal clinic with no symptoms to indicateinvestigation for urinary tract infection. 72 were excludedas they have mixed growth in MSU C&S and 6 forincomplete outcome data. 369 women had either nogrowth (group A) or significant growth (group B). Thefinal outcome of the pregnancy was looked into. Alsorecorded were period of gestation at delivery, birth weightand complications that arose during the course ofpregnancy.

ResultsThe prevalence of ABU was 4.3% (16/375). The meanperiod of gestation at delivery was 38.6 ± 1.6 for GroupA and 38.7 ± 1.3 for Group B. The mean birth weightwas 3.1 ± 0.4 for Group A and 3.2 ± 0.5 for group B andthe difference was not significant statistically. Thematernal outcomes revealed no statistically significantdifference in UTI complications, prelabour rupture ofmembranes, preterm labour/ delivery or perinatalmortality and sepsis.

ConclusionThe prevalence of ABU was comparable with that foundin other studies. However we were unable todemonstrate the strong association with preterm delivery,low birth weight and symptomatic UTI.

ORAL (B2 - 4)

KNOWLEDGE ON CERVICAL CARCINOMA ANDPAP SMEAR AMONG WOMEN ATTENDINGGYNAECOLOGY CLINIC HUSM

AuthorsK. S. Law1, L. K. Soon1, Nik Hazlina NH2, and 3Tg. Norbanee Tg.H

Institution1 School of Health Sciences, USM, 2Department of Obstetrics andGynecology and 3Department of Community Medicine, School


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of Medical Sciences, Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionCervical carcinoma is the second most common cancerin Malaysian women.

ObjectiveThe study is performed to explore knowledge aboutcervical carcinoma and Pap smear tests among womenattending the gynaecology clinic in HUSM

MethodologyA cross sectional study was conducted from October2003 till December 2003. Random sampling method wasused. Patients were told regarding the study and a selfanswered questionnaire was filled up by the respondent.

ResultThe study found that the majority of the respondentswere aware of cervical carcinoma (90.3%) and had heardabout Pap smear (86.1%). Only 33.3% of therespondents had a high score knowledge (21-30) oncancer of the cervix and 25.7% of respondents trulyappreciate the importance of Pap smear. 68.9% ofrespondents did not acknowledge the duration of whichpap smear should be carried out on a regular basis.Further analysis revealed that majority of the informationof pap smear was obtained from reading materials(48.6%). Only 6.3% of respondents obtained theknowledge of Pap smear from their husband. There is asignificant correlation between the knowledge of Papsmear with occupation (p= 0.005), education level(p=0.001), those who had undergone Pap smear(p<0.000) and those who had heard of cancer of thecervix (p= 0.016) and Pap smear (p<0.000).

ConclusionThis study showed that the knowledge on cancer cervixand Pap smear is insufficient in the study group.

ORAL (B2 - 5)

PATTERN OF PRESCIRIBING DRUGS IN FIRSTTRIMESTER OF PREGNANCY IN A TEACHINGHOSPITAL OF DHAKA

AuthorZ. A. Begum

ObjectiveTo find-out the pattern of prescribing drugs in earlypregnancy

MethodsA descriptive study was carried out on 77 early pregnantwomen by their interview in a structured questionnairein the gynae out-patient department (GOPD), DhakaMedical College Hospital (DMCH), Dhaka, Bangladesh.Data were analyzed by using the INRUD prescribingindicators. The following parameters were studied – the

average number of drugs per encounter, the percentageof antibiotics prescribed per encounter and thepercentage of teratogenic drugs per encounter.

ResultsThe maximum number of drugs prescribed per encounterwas 4. Poly pharmacy was practiced in 3.89 percent ofprescriptions. Among all the prescriptions, the maximum73 prescriptions had vitamin and minimum 1 prescriptionhad analgesic. The rest 53 prescriptions had iron, 20prescriptions had calcium, 18 prescriptions had folic acid,8 prescriptions had stemetil, 7 prescriptions had antibioticand 2 prescriptions had teratogenic drugs. Statisticalanalysis shows that 9% early pregnant women tookantibiotics and 2.5% early pregnant women tookteratogenic drugs.

ConclusionsAntibiotics and Teratogenic drugs are not indicated in1st trimester of pregnancy though these were used inteaching hospital. So it was highly errational. The mosturgent need is the improvement of the rationalprescribing in early pregnancy.

ORAL (B2 - 6)

THE VANISHING TWINS PHENOMENON

AuthorsHakim G. Bilal, Awang Nila, N H Nik Hussein, Adibah, Rosilawati

InstitutionDepartment of Obstetric and Gynaecology, Hospital UniversitiSains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

The case of a 30 year old Malay lady Gravida 3 para2 at 6 weeks + 5 days of gestation is described. Shepresented with a three day history of minimal per vaginalbleeding but with no abdominal pain or having passedproducts of gestation. Examination showed an eightweek size uterus with the cervix long and closed and noadnexal abnormality.

The diagnosis first appeared to be a threatenedmiscarriage then a missed abortion and then an ectopicpregnancy. It was not a straightforward case!

US showed three gestation sacs, but only one hada viable fetal echo.

At just beyond six weeks of gestation, with the BhCGlevels plateauing for one week, ectopic pregnancy hadalso to be considered as a diagnosis.

Finally this case emerged as a case of “vanishing”twins.The pregnancy continued as a singleton pregnancy

There are many reports on the phenomenon whereone gestation sac disappears from what has been a twinpregnancy. In this case however two gestation sacs havedisappeared from a presumed triplet pregnancy – a lessusual “vanishing twins” phenomenon.

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MANAGEMENT OF COLORECTAL CARCINOMAAT HUSM DEPT OF RADIOTHERAPY ANDONCOLOGY

AuthorsDr Murali Bhavaraju*, Dr B M Biswal, Dr Nik Min Ahmad

InstitutionDept of Radiotherapy and Oncology, Universiti Sains Malaysia,Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionColorectal carcinoma (CRC) is the commonest cancerof the western world, but the incidence of CRC is low inAsian countries. Surgery is the definitive treatment andthe staging of CRC is surgico-pathological staging. Therole of adjuvant treatment in the form of radiotherapyand chemotherapy is well documented in themanagement of CRC.

ObjectiveTo analyze the pattern of presentation, stage of disease,and the protocol of management of CRC at HUSM. Thepattern of failure at the locoregional and distant siteswere analyzed.

MethodologyThis is a retrospective study reviewing the case files ofpatients of CRC attending the Oncology OPD at HUSMduring the year’s 2001- 2003.The role of adjuvantradiotherapy and chemotherapy with 5Fu-based regimeswill be discussed.

ResultsA total of 77 patients were analyzed in the present study,Dukes staging system is used for the staging. Fiftypercent of patients presented in the 6 th & 7th decade oflife. Patient’s age ranged from 19 years to 82 years.Rectum and recto-sigmoid region is the most commonlyaffected site in the large gut. More then 65% patients ofCRC presented in advanced stages. Thirty five percentof patients received radiotherapy and 53% receivedchemotherapy FUFA regime. Disease free status isnoted in 46% of patients and liver is the most commonsite for metastasis. The follow up ranged from 1 monthto 30 months.

Conclusion CRC is one of the commonest cancers seen in theOncology OPD, HUSM. Most of the patients present inthe advanced stage of the disease. They needMultimodality treatment for their cancer management.

ORAL (B2 - 8)

A STUDY ON THE PSYCHOSOCIAL IMPACT ANDTHE USE OF ALTERNATIVE MEDICINEPRACTISES(HOMEOPATHY AND TRADITIONAL)ON THE INFERTILE FEMALE IN HUSM.

AuthorsNorliza M1, Shaiful I1, Nik Hazlina NH2 and Hasanah CI 3

Institution1 Department of Family Medicine, 2Department of Obstetrics andGynecology, 3Department of Psychiatry, School of MedicalSciences, Universiti Sains Malaysia, Health Campus, 16150,Kubang Kerian, Kelantan, Malaysia.

IntroductionInfertility is one of the health problems that may be facedby the married couple. However not many study iscarried out in Malaysia to look on the psychosocial impactof infertility on the infertile couples.

ObjectiveTo determine the use of alternative medicine (traditionaland homeopathy) and its psychosocial impact oncouples in which the female is infertile.

MethodologyA cross sectional study was conducted for one yearduration to all infertile females and their partners whowere attending the Obstetric and Gynaecology Clinic,Hosiptal Universiti Sains Malaysia (HUSM). It wasconducted on 182 respondents using a self answeredquestionnaire.

ResultAt least two third of the respondents, had used alternativemedicine for their infertility problem with half of thempracticing a traditional medicine, 14.8% practicinghomeopathy and 1.6% practicing both. Eighty threepercent respondents had a psychosocial impact becauseof their infertility. Statistical analysis showed that therewas a significant association between the psychosocialimpact with the education level and use of alternativemedicine. There was no significant association betweenpsychosocial impact with age, ethnic, occupation, typeof infertility, duration of marriage and duration of infertility.

ConclusionMost of infertile female had a psychosocial impact andthis was significantly associated with education level anduse of alternative medicine. Recognition of theserelations may help in the counseling of infertile couples.The management of infertility should not only includephysical treatment but also understanding, sympathyand support.

ORAL (B2 - 9)

IMMUNE CELL CHANGES IN PRIMARY BREASTCANCER PATIENTS UNDERGOINGCHEMOTHERAPY WITH FEC REGIMENS

AuthorsN. Wijayahadi1, M.R. Haron2, J. Stanslas3, Z. Yusuf1

Institution1Dept. of Microbiology & Immunology, Faculty of Medicine,Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia., 2Dept.


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of Radiotherapy and Oncology, Hospital Kuala Lumpur, KualaLumpur, Malaysia, 3Dept. of Biomedical Sciences, Faculty ofMedicine and Health Sciences, Universiti Putra Malaysia,Serdang, Malaysia.

IntroductionBreast cancer is the most common malignancy in womenof which treatment modalities include variouscombinations of surgery, radiotherapy, chemotherapy,and hormonal therapy. Selection of therapy andprognosis is influenced by the integrity of the immunesystems, especially the profile of subsets of the immunecells. This study examines the effect of combinationchemotherapy 5-fluorouracil, epirubicin/doxorubicin andcyclophosphamide (FEC) regimens on the subsets ofthe immune cells of patients with primary breast tumours,before and after starting systemic chemotherapy. Ouraim is to determine the ability of FEC in changing profilesof immune cells of breast cancer patients.

MethodsBlood from 31 primary breast cancer patients undergoingchemotherapy with FEC was taken before chemotherapyand after every cycle (3 weeks) for 6 cycles. Blood takenfrom 31 normal healthy donors served as normal control.Subsets of lymphocytes T-helper cells (CD3+CD4+), T-cytotoxic cells (CD3+CD8+), B-cells (CD19+CD20+) andNK cells (CD16+/CD56+CD3-) were analyzed by flowcytometry (FacsCalibur, BD) using monoclonalantibodies (Multitest, BD).

ResultsThere was no significant difference in the immune cellsprofile between the control and pretreatment groups.FEC regimens led to increase counts of monocytes(p<0.01) and percentages of T-cytotoxic cells (p<0.01)and NK cells (p<0.01), but decrease counts of PMNs(p<0.01), percentages of T-helper cells (p<0.01) and B-cells (p<0.01). T-helper/T-cytotoxic ratio was declined(p<0.01), T-cells/B-cells ratio and NK-cells/B-cells ratiowere also decreased due to drastic reduction in thenumber of B-cells.

ConclusionThis study indicates that FEC chemotherapy regimenssuppress the immune system in general. However, theyappear to still conserving cell-mediated immunityresponse needed for fighting against cancer cells.

ORAL (C2 - 1)

ANALYSIS OF EXON 21 OF THE MDR1 GENE INTHE ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)AND CHRONIC MYELOID LEUKEMIA (CML)PATIENTS USING DENATURING HIGHPERFORMANCE LIQUID CHROMATOGRAPHY(DHPLC)

AuthorsBadrul Hisham Y1., Rosline H.2, Wan Maziah W.M.3, Abdul AzizB.1, Nor Sa’adah B.4 Narazah M.Y.1

Institution1Human Genome Center, 2Department of Haematology,3Department of Paediatrics 4 Biostatistics & ResearchMethodology Unit, School of Medical Sciences, Health Campus,Universiti Sains Malaysia, 16150 Kubang Kerian, KelantanMalaysia

IntroductionGenetic polymorphisms of the MDR1 gene have beenreported where they affect the expression and functionof the P-gp efflux pump. DHPLC has been recentlydescribed as a feasible method for screening DNAsamples for SNPs and mutations. The principle of thismachine is that fully an automated system used for thedetection of heteroduplexes in PCR products by ion-pair reverse phase HPLC under partially denaturingconditions.

ObjectiveThe objective of this study was to detect SNPs andmutations in exon 21 of MDR1 gene in patients withacute lymphoblastic leukemia (ALL) and chronic myeloidleukemia (CML) from Hospital Universiti Sains Malaysia(HUSM).

MethodologyWhole blood samples were collected from 14 patientsdiagnosed as ALL and 6 patients diagnosed as CMLbased on the FAB classification from HUSM. GenomicDNA was extracted using QIAamp blood minikit(QIAGEN). Exon 21 was amplified using primers asdescribed previously and the amplified products wereelectrophoresed on 1.7% agarose gel. Prior to dHPLCanalysis, the amplicons for each exon were preparedby performing the reannealing method using thethermocycler and dHPLC was performed in varioustemperatures to obtain the optimum temperature. Theprofiles of dHPLC analysis of these samples werecompared with wild type samples as normal controls.

ResultsBased on portion elution profiles, 6 (42.86%) ALL and 4(66.67%) CML samples showed mutation peaks whilethe rest showed the normal peaks when compared withthe wild type.

ConclusionThus SNPs and mutations in MDR1 gene has beensuccessfully screened using the dHPLC technique inleukemia patients in HUSM where this information isuseful for patients’ stratification of treatment. Furtheranalysis to confirm the mutations using automatedsequencing is ongoing.

ORAL (C2 - 2)

SEROLOGICAL STUDY OF TOXOPLASMOSISUSING ENZYME-LINKED IMMUNOSORBENTASSAY


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AuthorsAl-Jashamy K., Zeehaida M.and Nik Zairi

InstitutionDepartment of Medical Microbiology and Parasitoogy, School ofMedical Science, Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

BackgroundToxoplasma gondii is an opportunist protozoan parasitethat may induce a disseminated and lethal disease inimmunosuppressed patients. Toxoplasma serologic testsare used most commonly for diagnosis, but may beinsensitive in patients lacking normal responses. Aretrospective study was conducted to review thetoxoplasma cases seen in HUSM / laboratory ofparasitology.

MethodsDuring the period from January 2001 to March 2004, allthe cases were recorded. Blood samples were examinedby enzyme-linked immunosorbent assay using IgG andIgM.

ResultsA total of 206 blood samples were collected from thepatients who were suspected to have toxoplasmosis.The rate of positive tests for toxoplasmosis was 2.5%(1 out of 40 cases) in 2001, 6.9% (4 out of 58 cases) in2002 and 16.0% (8 out of 49 cases) in 2003. It was49.0% (29 out of 59 cases) in the period of 1st Januaryto 31 st of March 2004. The overall positivity fortoxoplamosis was 20.0%. No significant differences byage or sex were observed.

ConclusionThe studied individuals had a high prevalence ofToxoplasma gondii infection

ORAL (C2 - 3)

ANALYSIS OF G_A 211 (G71R) MUTATION OF THEUGT1A1 GENE IN NEONATALHYPERBILIRUBINEMIA IN MALAYS.

AuthorsSurini Y. 1, Van Rostenberghe H. 2, Norlelawati A.T.1, Abdul Aziz I.1, Noraida R.2, Isa M.N. 1, Nishio H.3 , Matsuo M.4, Narazah M. Y.1

Institution1 Human Genome Center , 2 Department of Pediatrics , School ofMedical Sciences, Universiti Sains Malaysia, Health Campus,16150, Kelantan, Malaysia. Division of Public Health, 3 Departmentof Environmental Health and Safety, Faculty of Medical Sciences, 4 Department of Pediatrics, Kobe University Graduate Schoolof Medicine, Kobe, Japan.

IntroductionA missense mutation of G-to-A at nucleotide 211 in exon1 of UGT1A1 gene results in amino acid change fromglycine to arginine at codon 71 (G71R). This is one ofthe genetic risk factors in neonatal hyperbilirubinemiaamong Japanese neonates. This finding led us to

evaluate the presence of G71R mutation inhyperbilirubinemia in Malay neonates.

Subjects and methodsA total of 55 Malay neonates (36 males and 19 females)with hyperbilirubinemia and 50 Malay neonates withouthyperbilirubinemia (controls) were studied. The studysubjects were term babies, normal birth weight and withtotal serum bilirubin level more than 250 µmol/L withinfirst 7 days of life. Blood was collected from afterinformed consent taken from the parents and DNAextracted by standard methods. Screening for the G_A211 mutation was performed using DHPLC. PCR primersfor PCR amplification and for DHPLC conditions wereas described before. For heteroduplex formation, crudePCR products were denatured at 950C for 5 min followedby cooling to 250C for 1h. DHPLC was performed usinga fully automated system (Varian Helix System). Thechromatograms of subjects were compared with thoseof heterozygous controls and normal controls.

ResultsOut of 55 neonates, 3 neonates (5.5%) were noted tohave the G71R mutation. In the normal controls therewere 3 positive (6.0%) samples. Thus there was nosignificant association (p < 0.05) of G71R in neonateswith hyperbilirubinemia and without hyperbilirubinemia.

ConclusionThe results suggested that the high incidence of neonatalhyperbilirubinemia among Malays cannot be explainedby a high frequency of G71R mutation.

ORAL (C2 - 4 )

CYTOTOXIC EFFECTS OF THE METHANOLICEXTRACTS FROM 20 SPECIES OF ARACEAEAGAINST HUMAN HEPATOCELLULARCARICOMA CANCER (HEPG2) CELL LINE.

AuthorsVenugopal Balakrishnan, Tengku Sifzizul Tengku Muhammad andShaida Fariza Sulaiman

InstitutionSchool of Biological Science, Universiti Sains Malaysia, 11800Minden, Penang, Malaysia.

The 80% (v/v) methanolic extracts from 20 speciesof Araceae were screened for their anticancer activitiesagainst Human Hepatocellular Carcinoma (HepG2) celll ine and the cell survival was determined usingMethylene Blue Assay. All the plant extracts exhibiteddose-dependent inhibition on the growth of HepG2 cellline. The most significant inhibition was produced byAlocasia macrorrhiza extract with EC 50 (effectiveconcentration that can kill 50% of cancer cells) of15.11mg/ml. In addition, three other extract that havebeen identified as potential anti-cancer agents areAmydrium media (EC50= 17.116 mg/ml), Ariseama waryi(EC50= 19.626 mg/ml) and Scindapsus aureus (EC 50=


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18.083 mg/ml. Alocasia macrorrihiza was furtherfractioned using three different solvents i.e. hexane,chloroform and 80% (v/v) methanol. Only the hexaneand chloroform fractions exhibited significant cytotoxiceffect on HepG2 cells with EC50 value of 11.018 mg/mland 4.217 mg/ml, respectively. The chloroform extractwas subsequently fractioned and from the 17 fractionsobtained, fraction F8 was considered the most potentfraction with EC50 value of 3.695 mg/ml against HepG2cells. DeadEnd Colometric Apoptosis Detection Systemand DNA Fragmentation ELISA indicated that thechloroform extract and fraction F8 triggered the HepG2cell death via apoptosis mechanism.

ORAL (C2 - 5)

SMN1 AND NAIP GENE DELETION IN MALAYSIANSMA PATIENTSAuthorsWatihayati MS1, Zilfalil BA2, Naing L4, Sutomo R5, Nishio H5,Narazah MY1, Tang TH3, Matsuo M6, Zabidi-Hussin AMH2

Institution1Human Genome Centre 2Department of Pediatrics 3Departmentof Microbiology and Parasitology, School of Medical Sciences4Biostatistician, School of Dental Sciences, Universiti SainsMalaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia. 5Department of Public Health and 6Department ofPediatrics, Kobe University Graduate School of Medicine, Japan.

IntroductionSpinal Muscular Atrophy (SMA) is one of the mostcommon autosomal recessive inheritance diseases.According to the previous reports, 90-95% of SMApatients show homozygous deletion of exons 7 and 8,while the rest of the patients have other mutations inthe SMN1 gene. The NAIP gene, which exists near theSMN1 gene, is reportedly correlated with the severity ofSMA. In Malaysia, SMA has been diagnosed based onthe clinical features, muscle biopsy findings, EMG andnerve conduction studies, but not based on molecularanalysis. Here we did a molecular analysis of MalaysianSMA patients, and compared the results with the datareported previously.

ObjectivesTo determine the incidence of SMN1 gene deletion inMalaysian SMA patients and to clarify the relationshipbetween the NAIP gene deletion and severity of thedisease.

Material and methodsA total of 13 patients (Type I = 4 patients, Type II = 6patients, Type III = 3 patients) who fulfilled the diagnosticcriteria for SMA were enrolled into this study. GenomicDNA was extracted from 2.5ml of blood. The SMN geneswere analyzed by the methods of van der Steege et al,and the NAIP gene were analyzed by the methods ofRoy et al.

ResultsHomozygous deletion of SMN1 was found in 77% of

our patients. Seventy-five % of Type I, 83% of Type IIand 66% of Type III patients show homozygous deletionof this gene while the NAIP gene deletion was seen in50% of both Types I and II and 33% in Type III.

DiscussionFrom these findings, the SMN1 gene deletion incidenceis much lower in our population than that in otherpopulations. In addition, the NAIP gene was not relatedto the severity of the disease. However, it is too early tocome to a conclusion with a limited number of thepatients. Larger scale studies are necessary todetermine the exact incidence of SMN1 gene deletionin Malaysian SMA patients and to clarify the role of theNAIP gene.

ORAL (C2 - 6)

IDENTIFICATION OF URIDINE DIPHOSPHATEGLUCURONOSYL TRANSFERASE 1A1 (UGT1A1)GENE MUTATION IN BABIES WITH EARLY ONSETOF NEONATAL JAUNDICE (NNJ)AuthorsNorlelawati A.T1, H. Von Rostenberghe2 ,Sutomo R3, Selamah G,Matsuo M. 4 Nishio H.3 and Narazah M.Y5

InstitutionsHaematology Department1, Paediatrics Department2 and HumanGenome Centre5, School of Medical Sciences, Universiti SainsMalaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia. Division of Molecular Medicine5 and Department ofOccupational Health2, Kobe University Graduate School ofMedicine.

IntroductionNNJ, a potential cause of kernicterus is common inMalaysia. However, no obvious aetiology is identified inmost of the cases. Recently, mutations in the bilirubinUGT1A1 gene attributed to NNJ and hyperbilirubinemiasyndromes have been reported in many populations

Objective and MethodsMolecular techniques were applied for investigating ofthe UGT1A1 mutation in three babies [B1, B2, and B3]who had early onset of jaundice. Identifiable causes ofpathological jaundice have been excluded earlier. Aninherited phenomenon of this mutation wasdemonstrated by doing family study and molecularanalysis.

ResultsNucleotides sequenced identified two different novelmutations in two Malay babies [B1, B2]. One mutationwas transversion G Æ C at nucleotide 1477 in exon 5(G493R) in B1. Another mutation was transition AÆ Gat nucleotide 964 in exon 2 (I322V) in B2. A specificmutation i.e. transition GÆA at nucleotide 211 in exon 1(G71R) was identified in B3, a Chinese.

ConclusionThese results suggest that mutations in UGT1A1 genemay play a role in the pathogenesis of early onset ofNNJ.


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ORAL (C2 - 7)

PREVALENCE OF INTESTINAL PARASITESAMONG SUSPECTED CASES IN HOSPITALUNIVERSITI SAINS MALAYSIA

AuthorsAl-Jashamy K. and Zeehaida M.

InstitutionDepartment of Medical Microbiology and Parasitoogy, School ofScience, Universiti Sains Malaysia, Health Campus, 16150,Kubang Kerian, Kelantan, Malaysia.

BackgroundA retrospective study was conducted to review theintestinal parasites cases seen in HUSM / laboratory ofparasitology.

MethodsDuring the period from January 2001 to December 2003,all the cases were recorded. The stool samples weremicroscopically examined for intestinal parasites usingthe formalin-ether concentration technique.

ResultsA total of 4588 stool samples were collected from thepatients who were suspected to have a parasiticinfection. Overall infection rate was 11% (530 out of 4588samples), with Ascaris lumbricoides (3.8% or 174 cases)and Trichuris trichiura (3.8% or 173 cases) as thecommonest parasites. The positivity of Blastocystishominis was 1% (50), Entamoebia histolytica 1% (46),Giardia lamblia 0.8% (38), Hook worm 0.7% (33),Stronyloides and Entrobius vermicularis were 0.2% and0.01% respectively. Overall positivity rate in 2001 was13% which was higher than in 2002 (11%) and 2003(11%). Conclusions: The overall positivity rate indicatedthat the parasitic infection rate was less in 2002 and2003 than 2001 using the same technique.

ORAL (C2 - 8)

HLA CLASS II ANTIGENS IN MALAYS WITHSYSTEMIC LUPUS ERYTHEMATOSUS IN HUSM

AuthorsNurul Khaiza Y1, Nadeem A1, Kamaliah MD2.

Institution1Department of Immunology, 2Department of Medical, School ofMedical Sciences, Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

BackgroundSystemic lupus erythematosus ( SLE ) is a disease ofabnormal immune regulation, characterized by theproduction of autoantibodies. Autoantibody productiondepends on the interaction of helper T lymphocytes withHLA Class II molecules on antigen presenting cells;therefore, the class II genes have a role in susceptibilitythrough alteration of T cell recognition.

ObjectiveThis study was designed to evaluate the frequency ofHLA-DR and –DQ alleles in ethnic Malays with SLE inorder to determine the role of these genes in diseasesusceptibility.

MethodologyHLA typing of fifty-five SLE patients from Malay ethnicwho fulfilled the American Rheumatism Association (ARA ) were analysed, and compared with the controlgroup consisting of 55 healthy unrelated subject withcomparable age, sex and ethnic. HLA typing of class IIantigen were carried out using MicroSSP Class II generic( DRB/ DQB ) from One Lambda Inc.

ResultsWe found a strong significant association of HLA-DR15and HLA-DR17 with SLE compared to healthy controlgroup ( p corr = 0.002 , adjusted OR = 5.513 ; p corr =0.04, adjusted OR = 7.87 , respectively ). There was aweak decrease of HLA-DR4 which was not significantafter corrections for multiple comparisons made.

ConclusionOur data suggests the role of the HLA Class II genes inconferring SLE susceptibility and in clinical expression.

ORAL (C2 - 9)

AN OUTBREAK OF PANTOEA SPP. IN ANEONATAL INTENSIVE CARE UNIT (NICU)SECONDARY TO CONTAMINATED TOTALPARENTERAL NUTRITION (TPN).

AuthorsHabsah H*, Zeehaida M*, Rosliza AR*, Van Rostenberghe H**,Noraida R**, Wan Pauzi WI**, Fatimah I**, Nik Sharimah NY**Maimunah H***

Institution* Department of Medical Microbiology and Parasitology, **Department of Pediatric, PPSP, Infection control and HospitalEpidemiology Unit HUSM, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.

BackgroundNeonates are particularly susceptible to infectionbecause their immune system is not fully developed. Inaddition, they often require invasive diagnostic andtherapeutic procedures that are associated with anincreased risk of infection. An important source ofinfection is contaminated parenteral nutrition. Pantoeaspp. rarely cause infection in immunocompetent hostsand has never been reported to cause mortality or severemorbidity. The objective of the study is to investigate anoutbreak caused by Pantoea spp. in a neonatal intensivecare unit.

MethodologyA descriptive study of an outbreak of sepsis in NICU,HUSM. Pantoea spp. infection was detected in eightpatients during three-days period from 24 th to 27 th


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January 2004 following the administration of TPN. Sevenof eight patients died due to the infection. An extensiveenvironmental sampling and culture were done includingin-use TPN and other unused TPN in NICU andpharmacy during the outbreak period.

ResultsPantoea spp. was isolated from blood cultures ofinfected patients, the unused TPN from pharmacy andalso from the unused TPN from NICU. All the strains ofPantoea spp. had the same antibiotic susceptibilitypattern and biochemical reaction.

Discussion and ConclusionThe source of the outbreak was the TPN and thecontamination occurred during the preparation of TPNin pharmacy. A thorough investigation has been carriedout and where possible corrective measures have beentaken to avoid similar outbreaks in the future.

ORAL (A3 - 1)

RISK FACTORS IN ADULT POISONING, A CASE-CONTROL STUDY AT PENANG GENERALHOSPITAL- MALAYSIA

AuthorsAhmed I Fathelrahman1, AF Ab Rahman2 and Z M Zain3

Institution1,2School of Pharmaceutical Sciences, Universiti Sains Malaysia,Minden 11800 USM Pulau Pinang Malaysia 3General HospitalPulau Pinang Malaysia

IntroductionIdentification of risk factors related to acute poisoning isessential in any prevention or educational program. Toour knowledge worldwide, moat of the previous case-control studies on poisoning have been dealing withchildhood poisoning.

ObjectivesTo determine possible risk factors associated with adult’sadmissions at Penang General Hospital (GHP) due toacute drug or chemical poisoning.

MethodologyThe present study was a case- control study, conductedover 18 weeks. 100 acutely poisoned adult patients,consecutively admitted to GHP during the period from15 September 2003 to the third of February 2004 wereconsidered as cases. 200 Patients admitted to the samemedical wards for other illnesses during the same period,matched for age and gender with the poisoned caseswere selected as controls. McNemar test was used forunivariate analysis and logistic regression analysis formultivariate ones. The odds ratio (OR) and its 95%confidence interval (95%CI) were calculated for eachpredictor variable.

ResultsIndian race, private employment, self-employment and

living in a rental house were significant risk factorsassociated with adult’s admissions at GHP for poisoning.Other significant risk factors included study, family,marital and boy/ girl friend problems.

ConclusionsThis study has identified risk factors can be used as aguide for targeting poison control programs.

ORAL (A3 - 2)

MENINJAU KEHADIRAN MIKROORGANISMAPADA ALATAN GALIPOT DAN CECAIR YANGDIGUNA SAMA UNTUK PROSEDUR SEDUTANTIUB ENDOTRAKEA DAN TIUB TRAKEOSTOMI.

AuthorsAnisah binti Mat Desa, Farid bin Che Ghazali,

InstitutionPusat Pengajian Sains Kesihatan, Universiti Sains Malaysia,Kampus Kesihatan, 16150, Kubang Kerian, Kelantan, Malaysia.

PengenalanStrategi yang mantap dalam menghalang terjadinyakolonisasi bakteria pada secincin trakea dan paru-parubukan hanya kos-efektif malah adalah kunci kepenurunan kadar mortaliti pesakit dan jumlah harimereka di wad. Terdapat beberapa laporan dansemakan penyelidikan tentang usaha untukmendapatkan data saintifik yang konkrit tentang faktorpenyebab dan yang berhubungkait dengan terjadinya‘hospital infection’ dan peradangan paru-paru khususnyayang berhubungkait dengan prosedur ‘endo-trachealintubations’. Prosedur sedutan merupakan proseduryang perlu dalam jagarawatan klien yang berada dalamunit kritikal ICU. Prosedur ini dilakukan untukmemastikan salur udara yang sentiasa paten danberfungsi. Dipercayai peralatan yang digunakan untukmelakukan prosedur ini boleh menjadi alat transmisipatogen nasokomial.

Tujuan kajianKajian ‘pilot’ ini dilakukan bertujuan untuk meninjaukemungkinan wujud mikroorganisma pada peralatan dancecair yang digunakan dalam prosedur sedutan bagiklien yang memerlukan bagi memastikan satu protokoljagarawatan yang asepsis dan memenuhi piawaiandigunapakai di HUSM.

MetodologiSampel swab diambil langsung dari galipot dan cecairyang telah digunakan untuk prosedur sedutan bagisubjek yang telah dikenal pasti pada waktu-waktu yangberbeza (jam pertama, ketiga dan kelima). Seterusnyapengkulturan mikroorganisma dilakukan ke atas sampelyang diambil dan dibiarkan selama 24-jam sebelumbacaan dibuat. Data yang dikumpul dianalisamenggunakan SPSS versi ke 10 untuk analisa variabelfrekuensi berhubungkait dengan demografi,penggunaan antibiotik, dan jenis mikroorganisma yangdapat di kultur.


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KeputusanHasil daripada sampel swab didapati 30-sampelmenunjukkan pertumbuhan ‘gram negative bacilli’ dan‘mixed growth of GNB’. Manakala terdapat pertumbuhanmikroorganisma yang terdiri dari basilus gram negatif,spesis klebsiella dan spesis enterobacter daripengkulturan sampel yang diambil dari peralatan dancecair yang telah digunakan dalam prosedur sedutan diwad 2 Delima dan ICU HUSM. Mikroorganisma inimungkin hadir dalam persekitaran ataupun dari kawasanendotrakea atau trakeostomi subjek.

RumusanPenggunaan alatan secara berulangkali boleh

menyebabkan kontaminasi terjadi dan ianya merupakanfaktor penyokong utama tersebarnya infeksi. Keputusanpenyelidikan ini menyarankan agar tidak dipaktikkanpemakaian alatan secara berulangkali apatah lagi dengancecair yang sama dalam tempuh masa yang agak lama.Jagarawatan dengan protokol peralatan dan cecair yangdibiarkan yang dikesan dalam penyelidikan ini yangberhubungkait dengan prosedur sedutan boleh menjadi alathubungkait transmisi patogen nosokomial. Diharapkanakan terjadi anjakan paradigma dalam teknik jagarawatanberhubungkait dengan prosedur sedutan.

ORAL (A3 - 3)

JAGARAWATAN ORAL KLIEN KANSER DIHOSPITAL UNIVERSITI SAINS MALAYSIA

AuthorsAzlina Binti Daud, Farid Bin Che Ghazali,

InstitutionPusat Pengajian Sains Kesihatan, Universiti Sains Malaysia,Kampus Kesihatan, 16150 Kubang Kerian, Kelantan, Malaysia.

PengenalanJagarawatan oral merupakan satu prosedur yang palingasas dalam perawatan klien dan ianya merupakan satukeperluan asas dalam memenuhi aktiviti hidup harianklien dan menjamin kesejahteraan klien.Memandangkan klien yang mengidap kanser padaumumnya menerima rawatan kemoterapi atauradioterapi mempunyai tahap pertahanan badan yangrendah maka jagarawatan oral amatlah penting untukdilakukan sebelum dan selepas klien menjalani rawatantersebut. Semakan bacaan menunjukkan tahap kavitioral klien kanser yang menerima rawatan kemoterapiatau radioterapi mempunyai risiko yang cukup tinggiuntuk mendapat keadaan klinikal yang dikenali sebagaimukositis dan xerostomia. Keadaan ini memerlukan satustandard penilaian pada kaviti oral dengan itujagarawatan yang saintifik, sistematik dan holistik dapatdiberikan kepada klien.

Objektif kajianKajian ini adalah untuk mengenalpasti permasalahanpada tisu kaviti oral yang dihadapi oleh klien kanser yangmenjalani rawatan kemoterapi dan radioterapi

berdasarkan carta penilaian oral yang diadaptasikan dariShareen et al., 2003 dan mengenalpasti mikroorganismayang wujud pada kaviti oral klien kanser tersebut dalamhubungkaitnya dengan keberkesanan praktisjagarawatan oral di wad onkologi Hospital UniversitiSains Malaysia.

MetodologiKajian berasaskan pemeriksaan dengan carta penilaianoral dilakukan terhadap 30 orang klien kanser yangdipilih secara “convenience sampling”, yang menerimarawatan hanya kemoterapi atau hanya radioterapi ataukedua-duanya sekali di wad onkologi (3S) HUSM.Penilaian dibuat pada hari pertama, ketiga dan kelimaklien berada di wad tersebut. Selepas setiap penilaian,swab kultur diambil dari bahagian kiri dan kanan bukalretromolar ke dalam media pengangkut Stuart untukpemeriksaan kultur.

KeputusanKeputusan penyelidikan ini menunjukkan 46.7% klienmengalami bibir kering, ulserasi dan pendarahan.Keadaan mukosa bibir yang kering juga mengalamiulserasi dan mudah terjadi pendarahan spontan yangdikenali secara klinikal sebagai mukositis. Manakala90.0% klien menunjukkan mengalami mulut kering,96.7% mengalami membran mukosa kering dan 70.0%mengalami keadaan saliva yang kering serta 30.0%mengalami kepekatan saliva. Jumlah peratus frekuensimikroorganisma gram negatif bertambah kepada 63.3%pada hari kelima manakala mikroorganisma gram positif16.7%, dan kandida 10.0%.

RumusanHasil penyelidikan menyokong penekanan, penyerapandan aplikasi carta penilaian oral khususnya di wadonkologi HUSM bagi jagarawatan yang berkesan.Penilaian status kaviti oral sebelum memulakan rawatandapat memastikan keberkesanan rawatan danjagarawatan yang saintifik, sistematik dan bersifat holistikkepada klien.

ORAL (A3 - 4)

THE DETERMINATION OF LOCAL MALAYFEMALE BONE MINERAL DENSITY ANDITS’CORRELATION WITH GEOMETRICPROPERTIES IN THE EVALUATION OF SKELETALSTATUS

AuthorsLee Cheng Wai, Hj.Abdul Kareem, Hj.Ibrahim Lutfi Shuaib, MohdEzane Aziz, Shaiful Bahari, Nik Haslina Nik Hussain.

InstitutionHospital Universiti Sains Malaysia, Health Campus, 16150,Kubang Kerian, Kelantan, Malaysia.

IntroductionOsteoporosis is a systemic skeletal diseasecharacterized by low bone mass, fragility and a


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consequent increase in fracture risk. Currently therecommended method to measure bone mineral density(BMD) is Dual Energy X-Ray Absorstometry (DEXA).However to be more precise in the diagnosis ofosteoporosis and fracture risk prediction, other riskfactors and biomechanics of the bone should be takeninto consideration.

Aims1) To obtain bone mineral density reference data for

local Malay female population.2) To determine the correlation of geometric properties

and BMD.

Material and MethodsA total of 137 volunteers who have given a writteninformed consent and undergone DEXA of the spine,dual femur and total body. A non-dominant handradiograph was also taken for geometric properties (GP)measurement.

ResultsA graph of BMD (DEXA) versus age group was obtainedfrom the mean and standard deviation of the peak agevalue. The local BMD corresponding to -2.0 standarddeviation from the peak adult value for vertebral andtotal body BMD were 12.2% and 3.2% respectively lowerwhereas for the dual femur it was 1.2% higher comparedto the Caucasian reference data (U.S/Europe). Therewere fair to good correlation between weight and BMD(r = 0.344 – 0.642). Generally fair to good correlationwas seen between vertebral, dual femur and total bodyBMD with cortical area (CA), cortical thickness (CT) andmetacarpal index (MCI), particularly of the secondmetacarpal. Multi linear correlation models accountingfor CA2 and CT2 in addition to weight have improvedthe predictive power of a model for weight alone.

ConclusionEstablishment of database for each race in Malaysia isimportant for proper skeletal status evaluation, in viewof significant differences in the local Malay BMD valuecompared to other population reference data. Geometricproperties can be used as a lower cost tool to predictBMD and may improve the accuracy of diagnosis ofosteoporosis and prediction of fracture risk.

ORAL (A3 - 5)

PILOT STUDY: PREVALENCE OF NEGATIVEPLAIN CT AND POSITIVE PERFUSION CT SCANIN CASES OF ACUTE STROKE.

AuthorsK. Man, M.M Abdul Kareem, A.Prasad, J. Abdullah

InstitutionDepartment of Radiology, Department of Neurosciences, Schoolof Medical Sciences, Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

Introduction and objectivesCT perfusion study is a new method to diagnoseinfarction in cases of normal plain CT scan. It alsoidentifies the area of ischemia and size of infarction. Theaim of this study is to determine the number of cerebralinfarction cases in Hospital USM where there is normalplain CT scan and abnormal Perfusion CT.

Material and MethodsForty two consecutive plain and perfusion CTexaminations of brain in patients 12 years and aboveperform from August 2002 to August 2003 wereevaluated qualitatively. Plain CT scan was performed inpatients presented with acute stroke symptoms followedby Perfusion CT.

ResultsTwelve out of 42 cases were found to have normal plainCT scan. Nine out of these 12 patients were positive forinfarction in Perfusion CT scan. Two out of 12 casesturned out to be transient ischemic attack and one case,CT perfusion was normal even though patient showedsigns and symptoms of acute stroke. The prevalence ofnegative plain CT scan and positive perfusion CT foracute stroke in Hospital USM from August 2002 to August2003 was 21.3%.

ConclusionCT perfusion is a useful imaging tool for determiningischemia and infarction in cases where the plain CT scanis normal. The results obtained from CT perfusionscanning are used to determine mode of treatmentsuitable for acute stroke patients.

ORAL (A3 - 6)

THE PROGNOSTIC VALUE OF INITIAL ANDFOLLOW-UP COMPUTERIZED TOMOGRAPHY(CT) OF BRAIN IN ADULT PATIENTS WITHMODERATE AND SEVERE HEAD INJURYFOLLOWING MOTOR VEHICLE ACCIDENT

AuthorsAzman Kiflie, Nurul Azman Alias, Jafri Malin Abdullah, Dr. Salmah@ Win Mar, Abdul Kareem

InstitutionDepartment of Radiology, Department of Neurosciences, Schoolof Medical Sciences, Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

OverviewHead injury is still the most common problem throughoutthe world. In Malaysia, the most common cause of headinjury is due to motor vehicle accident. The impact ofthe head injury is so great because the youngergeneration is the highest populations involved. Theoutcome may ranges from good recovery and disabilityto death. In view of the important of the outcome, theauthor felt that it is important to assess the clinical aswell as the CT scan of brain of those patients in order to


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predict the outcome. Currently, it is believed that thepermanent outcome of the patient can be predicted froma follow-up CT scan of brain as early as six weeks.

Objective and MethodsThe aim of this study is to predict the outcome of theadult patients with moderate and severe head injury inmotor vehicle accident by using clinical parameters (age,Glasgow Coma Scale), initial CT scan of brain parameter(intracranial haemorrhage, volume and site of intracranialhaemorrhage, midline shift and hydrocephalus) andfollow-up CT scan of brain parameter (residualintracranial bleed, post-traumatic hydrocephalus, midlineshift and gliosis). The patient is assessed clinically onadmission for GCS. Those categorised into moderateand severe head injury with initial and follow-up CT scanof brain 6 weeks later will be selected for the study. Theparameters were analyzed statistically using univariteanalysis, chi square test and logistic regression. The pvalue of < 0.05 is taken as significant level.

ResultsA total of 31 patients were selected, 67.7% are maleand 32.3% are female. The GCS of the patients werestatistically significant as outcome predictors. Othersignificant predictors analyzed from the study are midlineshift and volume of subdural haemorrhage in the initialCT scan and post-traumatic hydrocephalus and gliosisin the follow-up CT scan.

ConclusionThe study showed that the above-mentioned parametersare significant predictors of outcome. The author alsohave suggested a new outcome predictors by using theparameters from follow-up CT scan i.e. presence ofgliosis, site of gliosis and post-traumatic hydrocephalus.

ORAL (A3 - 7)

CIGARETTE SMOKING AS A RISK FACTOR FORSTROKE DEATH IN JAPAN: NIPPON DATA 80

AuthorsUeshima H1, Choudhury SR2, Okayama A3, Hayakawa T4, Kita Y1,Kadowaki T1, Okamura T1 and NIPPON DATA80 Research Group

Institution1Department of Health Science, Shiga University of MedicalScience, Otsu, Japan. 2Department of Community Medicine,School of Medical Sciences, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionSome previous Japanese cohort studies failed to showan association between smoking and stroke risk. Sincesuch an association has been noted in other populations,this issue should be re-examined in a recentrepresentative Japanese cohort with a higher totalcholesterol level.

ObjectivesTo investigate the association between cigarettes

smoking and stroke death in a representative Japanesepopulation.

MethodsA total of 9,638 men and women aged 30 years andolder without a history of cardiovascular disease (CVD)at baseline in 1980 were followed for 14 years. Follow-up rate was 91.4%. Causes of death were ascertainedfrom National Vital Statistics. Cox proportional hazardratios were calculated adjusting for age, systolic bloodpressure, and other conventional risk factors.

ResultsWe observed 203 stroke deaths (107 cerebralinfarctions, 45 cerebral hemorrhages, and 51 others),191 heart disease deaths, and 413 CVD deaths. Theaverage serum total cholesterol level was ~4.91mmol/L. The hazard ratios for men who smoked 1-20cigarettes/day on all strokes, cerebral infarction, andcerebral hemorrhage were 1.60 (95% confidence interval(CI), 0.91-2.79), 2.97 (CI. 1.27-6.98), and 0.42 (CI. 0.16-1.09), respectively, and for those who smoked ≥21cigarettes/day, they were 2.17 (CI. 1.09-4.30), 3.26(CI.1.11-9.56), and 0.68 (CI. 0.20-2.33), respectively. Forwomen who smoked ≥21 cigarettes/day, the hazard ratiofor all strokes was 3.91 (CI 1.18-12.90). For CVD, allheart disease, and ischemic heart disease, the hazardrisks of smoking were significant (1.49 to 4.25) for menbut not significant for women.

Conclusions :Smoking in a cohort with moderate serum totalcholesterol level was a potent risk factor for stroke,especially cerebral infarction, for both men and women,and CVD and ischemic heart disease for men.

ORAL (A3 - 8)

DIAGNOSTIC VALUE OF ECG CHANGES,ARRHYTHMIA AND CHEST PAIN DURINGDOBUTAMINE STRESS MYOCARDIALPERFUSION IMAGING

AuthorsTuhin H1, Zurkurnai Y2, Sapawi M2, Tee MH2.

Institution1Department of Nuclear Medicine, Radiotherapy and Oncology,2Department of Medicine, School of Medical Sciences, UniversitiSains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

BackgroundThe presence of myocardial perfusion abnormalitiesassessed by dobutamine stress myocardial perfusionimaging (MPI) accurately diagnoses patients withcoronary artery disease, and are powerful predictors ofcardiac events. Thus, results of this imaging modalityhelp in selecting the appropriate management strategies.During dobutamine stress test, ECG changes,arrhythmia and chest pain occur frequently. However,data regarding diagnostic value of these parameters to


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predict myocardial perfusion abnormalities are scarce.Thus, the aim of this study was to determine thediagnostic value of ECG changes, arrhythmia and chestpain to predict myocardial perfusion abnormalities onSPECT.

MethodWe performed dobutamine-atropine stress 99Tcm-tetrofosmin/MIBI myocardial perfusion SPECT in 26patients referred to the department of nuclear medicinefor MPI. SPECT imaging was performed 30 min post-injection using one-day stress-rest protocol.

ResultsMyocardial perfusion abnormalities (reversible or fixeddefects) were detected in 11(42.3%) out of 26 patients.The sensitivity and specificity of ECG changes (STdepression, ST elevation or T wave normalization) topredict myocardial perfusion defects were 45.5% and86.7% respectively. The sensitivity and specificity ofcardiac arrhythmia (significant supraventricular orventricular arrhythmia) were 45.5% and 86.7%,and ofchest pain were 18.2% and 80% respectively.

ConclusionECG changes, cardiac arrhythmia and chest pain duringdobutamine stress test showed high specificity. However,the low sensitivity of these parameters warrantsperforming dobutamine stress test in conjunction with amore sensitive imaging modality such as MPI.

ORAL (A3 - 9)

VOLUME OF HIPPOCAMPAL COMPLEX INMAJOR DEPRESSION PATIENTS BEFORE ANDAFTER TREATMENT WITH SELECTIVESEROTONIN REUPTAKE INHIBITOR (SSRI)DRUGS

AuthorsMagendiran A/L Shummugam; Hj. Mohd Shafie Abdullah; MohdNajib Alwi; Win Mar @ Salmah Jalaluddin

InstitutionDepartment of Radiology, Hospital Universiti Sains Malaysia,Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

PurposeTo assess change in volume of the hippocampal complexin major depression patients following treatment withSSRI drugs. This is correlated with progress of thepatients’ illness. To date no other institution has donethis study on humans. Similar studies on rats showedhippocampal volume increase of about 70 %.

MethodNewly diagnosed untreated major depression patientsfulfilling the study criteria are selected. First MRI of thebrain done for the hippocampal complex structure.Patients start consuming the SSRI drugs after the MRI.After six months, the MRI study is repeated followingsimilar protocols. The hippocampal complex volume

calculated from the MRI study. The volume change iscorrelated with patients’ clinical progress as assessedby the treating psychiatrist.

ResultsSeven patients came for the initial MRI while only fourcame for the second MRI. About 13 – 25 % increase involume of hippocampal complex was found followingtreatment. It correlated with the patients’ progress ofillness.

ConclusionThe result shows that there is increase in hippocampalcomplex volume following treatment which correlateswith the patients’ clinical improvement. In future, thisfinding can aid in assessing clinical response in majordepression patients treated with SSRI drugs.

ORAL (A3 - 10)

INSULIN SENSITIVITY STATUS OF NON-OBESENORMOGLYCEMIC MALAY SUBJECTS :RELATIONSHIP BETWEEN INSULIN SENSITIVITYAND LIPID STATUS.

AuthorsA. Kholdun Al-Mahmood, A.A. Ismail, Faridah A. Rashid, WB WanMohammed, Sohel R. Choudhury, Nor Azwany Yaakob

InstitutionSchool of Medical Sciences, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionHyperlipidaemia and insulin resistance has a complexrelationship. Most of the previous studies were lookingat insulin resistance in hyperlipidaemic subjects whowere also obese. So influence of obesity andhyperlipidaemia acted simultaneously in the genesis ofinsulin resistance.

ObjectiveThe present study was designed to determine insulinsensitivity and secretory status of non-obesenormoglycemic subjects, and to find out the relationshipbetween hyperlipidemia and insulin sensitivity in a non-obese population.

MethodologyA cross sectional study on 74 non-obese (BMI<25, waistcircumference male<102cm, female <88cm.) and non-diabetic subjects age between 30-60 years was carriedout. The subjects underwent OGTT, LFT and RFT toexclude type 2 diabetes, IGT, IFG, renal and liverdiseases. Fasting plasma glucose, fasting insulin andlipid profile were done. Insulin sensitivity and secretorystatus was calculated using homeostasis modelassessment (HOMA) software (HOMA%S, HOMA%Band HOMA-IR). The subjects were devided into twogroup according to their lipid status and their insulinsensitivity was compared by MannWhitney test.


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ResultsThe hyperlipidemic subjects showed substantially lowerinsulin sensitivity and higher insulin resistance incomparison to normolipidemic subjects. The median ofHOMA%S of hyperlipidemic and normolipidemicsubjects were 50(83) and 232(227) (p<.0001) for maleand 71(86) and 241(221)(p<.0001) for femalerespectively. Insulin secretory status of hyperlipidemicsubjects indicate that the B cells of these subjects haveto secrete more insulin to overcome lowered insulinsensitivity, the median of HOMA%B were 179(144) and98(32) for male and 179(102) and 87(34) for female.

Conclusion

1. Insulin sensitivity of otherwise healthy non-obesehyperlipidemic subjects is lower than normolipidemicsubjects.

2. The B cells of hyperlipidemic subjects have to workmore to compensate lowered insulin sensitivity.

3. Hyperlipidemia can be considered as a risk factorfor development of insulin resistance syndrome infuture and should be treated.

ORAL (A3 - 11)

THREE-DIMENSIONAL ULTRASOUND

AuthorsSaffuwan bin Haji Mohamed Johar1; Wan Ahmad Kamil WanAbdullah2

Institution1Pusat Pengajian Sains, Kolej Universiti Teknologi Tun HusseinOnn 86400 Parit Raja, Batu Pahat, Johor. 2Jabatan Radiologi,Hospital Universiti Sains Malaysia, Universiti Sains Malaysia,Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

BackgroundThis project report was done to investigate feasibilityand potential application of three-dimensional (3-D)ultrasonography in Hospital Universiti Sains Malaysia(HUSM), Kubang Kerian, Kelantan. First attempt wastested on tissue-equivalent ultrasound phantom toreview several 3-D ultrasound enhancements which wasnot offered by two-dimensional (2-D) ultrasonography.They are 3-D orthogonal slices, arbitrary slicing as wellas high resolution reconstruction, volume renderingimages and image manipulation interactively.

Method3-D images were generated by a Siemens SonolineElegra Ultrasound Imaging System located at theRadiology Department, HUSM. Transducers used arethe linear array transducer (VF13-5) which operates atfrequency of 9.0 MHz and sector array transducer(3.5C40H) at frequency of 3.5 MHz. Images wereacquired with free-hand technique by linear and rockedmethods.

ResultsUsing this imaging system, 2-D and 3-D phantom

structures from various perspectives and orientationswere reviewed simultaneously in a four-quadrant display.New 2-D section from anyplane slices may be obtainedfrom the single 3-D volume for visualization.

ConclusionThe results suggest that 3-D ultrasonography developedby the respective ultrasound imaging system has thepotential to complement 2-D ultrasonography.

ORAL (A3 - 12)

EVALUATION OF TOSHIBA GAMMA CAMERAGCA-901A/HG PERFORMANCE BY USINGUNCONVENTIONAL MATERIAL FILTERS WITHTC-99M IN PLANAR IMAGING

AuthorsSayed Inayatullah Shah, Ahmad Zakaria*, Ismaliza and SitiNazipah

InstitutionSchool of Health Sciences, Universiti Sains Malaysia, HealthCampus, 16150 Kubang Kerian, Kota Bharu, Kelantan.*Department of Nuclear Medicine, Oncology and Radiotherapy,School of Medical Sciences, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionData for diagnostically reliable images can only beobtained with gamma camera when the performanceparameters, such as, uniformity, sensitivity and spatialresolution are tested and are within the limits ofacceptability. These parameters are affected by thescattered radiation emanating from the object/organ tobe scanned.

ObjectivesTo investigate the effects of unconventional materialfilters (Cu 0.125 mm, Al 0.2 and 0.3 mm thick sheet) onthe performance parameters via attenuating somefraction of scattered radiation prior to detection.

MethodsFlood field phantom, petri dish and line source by usingTc-99m radionuclide is scanned for uniformity, sensitivityand spatial resolution measurements, respectively.Either LEGP or LEHR collimators are applied. Data arecollected within a symmetrical standard energy window(126 – 154 keV centered at 140 keV) without and withunconventional material filters by mounting on the outersurface of collimator.

ResultsResults obtained without material filters are comparedwith those obtained with unconventional material filters.Integral uniformity is improved when material filter isapplied with the LEHR collimator. The sensitivity isdecreased, as expected, with both collimators whenmaterial filters are mounted. Improvement in FWHMvalues for 0 – 4 cm source-collimator distance withunconventional filters is noted with both the collimators.


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ConclusionUnconventional material filters may be applied forscanning objects/organs and may provide improvedquality images.

ORAL (A3 - 13)

MICRONUTRIENTS CORRELATED TO CANCER

AuthorsC.S.Kavitha Menon1 and B.V. Muralikrishna2

InstitutionSchool of Health Sciences, University Sains Malaysia, KubangKerian, Universiti Sains Malaysia, Health Campus, 16150, KubangKerian, Kelantan, Malaysia.

Diet and cancer appear to be closely related. Severalepidemiological, experimental and metabolic studiessuggest important role for nutrients in the diet, whichmodulate the process of carcinogenesis and immunefunctions. Recent studies emphasize the etiological roleof vitamins and minerals in epidemiology of cancer at anumber of sites. Micronutrient deficiencies (vitamins andminerals) are commonly encountered and significantlyinfluence carcinogenic processes. Considerable interestin the role of vitamins A, C, E and B in the genesis andprevention of cancer. Most of the vitamins seem to beacting either through the inhibition or formation ofcarcinogen, or by protecting against free radicals. Amongminerals and trace metals iron, zinc and seleniumdeficiency seem to increase the risk of cancer.

Commonly consumed foods, particularly vegetablesand fruits, are sources of numerous micronutrients.Several of these, including ß-carotene (a vitamin Aprecursor), vitamin E, vitamin C, selenium (which allhave antioxidant potential), calcium, vitamin D (in fish,eggs and fortified dairy products) and folate, have beenthe focus of extensive experimental and epidemiologicalresearch to determine their influence on cancer risk.Based on in vitro data, and while recognising theirprooxidant potential under certain conditions, some havepostulated that anti-oxidant micronutrients may protectagainst oxidative damage to biomolecules, such aslipids, lipoproteins and DNA, thus influencing the riskfor cancer development. Selenium is a component ofnumerous selenoproteins (e.g. glutathione peroxidase,thioredoxin reductase) that function as enzymes in redoxreactions that may affect cancer risk. Anti-oxidantmicronutrients may also influence carcinogenesisthrough other mechanisms. For example, vitamin Einhibits cell proliferation and carotenoids, including ß-carotene, may affect cell transformation anddifferentiation, enhance cell-to-cell communication, andenhance immune responses. Experimental evidencegenerally suggests that calcium and vitamin D mayreduce risk for colorectal cancer by decreasing cellularproliferation.

ConclusionEven though the role of few micronutrients either in the

genesis or prevention of cancer have identified, the roleof individual micronutrients in different types of cancersstill remains controversial.

ORAL (B3 - 1)

TRANS-SEPTAL TRANS-SPHENOIDALCOMBINED APPROACH FORHYPOPHYSECTOMY

AuthorsShahid Hassan*, Jafri Malim Abdullah**, Imran Azmi*, ZamzuriIdris**

InstitutionDept. of ORL-HNS*,Dept. of Neurosciences**,Universiti SainsMalaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

IntroductionThe pituitary gland is inaccessible to the surgeon directlyhowever there are indications for normal as well asneoplastic pituitary gland excision. The pituitary glandis also required to be removed for certain medicalreasons. History of pituitary gland excision shows that anumber of approaches were in practice in the past. Thisinvolved, trans-cervical and trans-sphenoidalprocedures. We experienced the trans-septal, trans-sphenoidal procedure as combined approach withneurosurgeon in hospital USM.

ObjectiveTo highlight the practicallity and efficacy of trans-septaltrans-sphenoidal appraoch in pituitary gland lesion andhow to perform it in a feasible manner

MethodIndications of pituitary gland excision, history of variousapproaches and the video demonstration of trans-septaltrans-sphenoidal as combined ORL-neurosurgicalapproach and its outcome is analysed.

ConclusionTreatment of pituitary gland should involve anendocrinologist, oncologist and a surgeon trained intrans-sphenoidal approach. CT-scan can localisemicrotumors preoperatively.This is an effective methodof surgical treatment too and care being taken is liableto minimum complications.

ORAL (B3 - 2)

CENTRAL CORNEAL THICKNESS ANDMORPHOLOGY IN MYOPIC MALAYUNDERGRADUATES OF HEALTH CAMPUS,UNIVERSITI SAINS MALAYSIAAuthorsMohd Aziz H, Liza Sharmini AT, Mohtar I

InstitutionDepartment of Ophthalmology, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.


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ObjectiveTo evaluate the central corneal thickness andmorphology in myopic Malay undergraduates of HealthCampus, USM.

MethodsA cross sectional study was conducted in 65 myopicand 65 emmetropic subjects, with age ranges from 20to 25 years old. Spherical equivalent and corneacurvature was determined with Humphrey autorefractor/keratometer 599 (Humphrey System, USA). Centralcorneal thickness and morphology (endothelial density,coefficient variation and hexagonality) was determinedwith Topcon SP2000P specular microscope (TopconCorp, Japan).

ResultsMyopes have thinner central cornea (p=0.003), lowerendothelial density (p =0.017) and steeper corneacurvature (p=0.017) compared to emmetropes. Therewas no difference seen in endothelial hexagonality andcoefficient variation. We observed a significant inversecorrelation between degree of myopia (measured inspherical equivalent) and central corneal thickness (r =-0.282, p =0.023).

ConclusionsMyopes have significantly thinner central cornea, lowerendothelial density and steeper cornea curvature. Higherdegree of myopia is associated with thinner centralcornea. All these factors need to be considered inmanaging myopia, especially in refractive surgery

ORAL (B3 - 3)

LASER TONSILLOTOMY: AN ALTERNATIVE TOCONVENTIONAL TONSILLECTOMY IN CHILDREN

AuthorsDr A. Baharudin, Dr H. Shahid, Dr S.Rosdan, and Dr G.Asha

InstitutionDept ORL-HNS, School of Medical Sciences, Universiti SainsMalaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

Introduction :Tonsillectomy in children is done on a regular basis inENT. The indications are chronic recurrent sore throatand URTI, odynophagia, sleep apnea and access todeeper structures.

ObjectiveThe natural history of tonsilllar hypertrophy is regressionwhen a child is 6 years old or older. In children withobstructive symptoms we study the use of laser as analternative procedure to reduce the bulk of the tonsilsmass. Naturally, the remnants of the tonsils will regressas the child grows older.

Method

Children with obstructive symptoms of tonsillarhypertrophy underwent laser tonsillotomy. The tonsilswere dissected using laser from anterior pillar to posteriorpillar. The tonsils bed were left untouched. Intraoperativeand postoperative conditions were noted.

ResultIntraoperatively, blood loss was negligible.Postoperatively, all of the patients were able to swallowwith minimal discomfort and discharged the followingday after observation.

ConclusionLaser tonsillotomy is an alternative procedure in childrenhaving obstructive tonsillar hypertrophy.

ORAL (B3 - 4)

DETECTION OF HERPES SIMPLEX INFECTION INVIRAL CONJUNCTIVITIS USING POLYMERASECHAIN REACTION – A PILOT STUDY

AuthorsAlwi AA, Hussein E, Gopalakrishnan V, Ravichandran M

InstitutionDepartment of Ophthalmology, Department of Microbology &Parasitology, School of Medical Sciences, Universiti SainsMalaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

ObjectiveTo detect the viral conjunctivitis in HUSM caused byherpes simplex virus (HSV) using polymerase chainreaction (PCR) method.

MethodA cross-sectional hospital-based study was conducted.A total number of 70 patients with viral conjunctivitis wereseen in the ophthalmology clinic, HUSM during one yearperiod. Presenting clinical features were identified andconjunctival scrapping using sterile swab was taken fromsuperior and inferior fornices of affected eye for PCRanalysis. The PCR was performed using a commerciallyavailable primer. The presence of this amplified targetsequence was determined by agarose gel. A positiveresult reflected the prevalence of viral conjunctivitiscaused by HSV. Descriptive analysis was performedusing SPSS system.

ResultThe prevalence of HSV infection among viralconjunctivitis patients seen in HUSM, using PCR methodwas 17% (95% CI=8.1,26.0). Majority of these patientspresented with moderate follicular conjunctivitis withfrequent early corneal involvement. A large portion ofpatients presented with unilateral involvement.

ConclusionThis study showed the prevalence of viral conjunctivitiscaused by HSV infection, in HUSM was higher than otherstudies.


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ORAL (B3 - 5)

INTRAVENTRICULAR CAVERNOUSHAEMANGIOMA

AuthorsRofiah Ali, Win Mar, Latifah Mohd Basheer, SS Mutum*,J.PGeorge** J. Abdullah**

InstitutionDepartment of Radiology, *Department of Pathology andDepartment of Neurosciences, Hospital Universiti Sains Malaysia,Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

A rare case of a cavernous haemangioma in the thirdventricle is reported. This patient, a seven-year old boypresented with fever, vomiting and not active for a week.Examination revealed neck stiffness, left lateral rectusmuscle palsy and blurred right optic disc. Urgent CT-scan revealed minimally enhancing mass in the thirdventricle. Magnetic resonance imaging was done twodays later, and showed a heterogenous, multilobulated,minimally enhancing tumour in the third ventricle. Thetumour was almost totally excised. Histology of thetumour revealed a cavernous haemangioma.Intraventricular location for a cavernous haemangiomais rare with less than 50 cases reported in literature.The clinical and radiological features are discussed andrelevant literature is briefly reviewed.

ORAL (B3 - 6)

COMPARISON OF CONJUNCTIVAL IMPRESSIONCYTOLOGY BETWEEN GLAUCOMA PATIENTSTREATED WITH TOPICAL TIMOLOL MALEATE0.5% AND TOPICAL LATANOPROST 0.005%.

AuthorsDr Tan Soo Hoi, Dr Wan Hazabbah Wan Hitam, Dr Hasnan Jaafar

InstitutionDepartment of Oftalmology & Pathology, School of MedicalSciences, Universiti Sains Malaysia, Health Campus, 16150,Kubang Kerian, Kelantan, Malaysia.

ObjectiveTo compare the conjunctival surface morphology thatdevelops with the use of topical timolol maleate 0.5%and topical latanoprost 0.005%.

MethodNewly diagnosed glaucoma patients are randomlydivided into 2 groups by closed envelope method:

Group 1 : treated with topical timolol maleate 0.5%Group 2 : treated with topical latanoprost 0.005%

First conjunctival impression cytology was takenbefore the treatment was started. Second conjunctivalimpression cytology was taken after 3 months oftreatment. The conjunctival impression cytology of theboth groups was compared.

Results1. In both the timolol group and latanoprost group, there

was no change of the conjunctiva epithelial cellmorphology after three months of anti-glaucomadrugs treatment.

2. Within three months of therapy, both these drugscause significant reduction of goblet cells and mucousgranules.

3. There was no significant difference in the density ofgoblet cells and mucous granules in both groups ofpatients after 3 months of treatment.

ConclusionBoth topical timolol maleate 0.5% and topical latanoprost0.005% cause significant reduction of conjunctival gobletcells and mucous granules however there was nosignificant difference of conjunctiva surface morphologybetween the two groups after treatment.

ORAL (B3 - 7)

EXPERIENCE OF INVERTED PAPILLOMAS INKELANTAN

AuthorsShamim Ahmed Khan*, Shahid Hassan*, Mohammad Hamza*, DinSohaimi*Ramiza*, Zulkifli S**.

Institution*Department of ORL-HNS, School of Medical Sciences, UniversitiSains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia. ** Department of ENT, Hospital Kota Bharu, Kelantan,Malaysia.

ObjectiveThe study looked into the demographic presentation,morbidity due to local invasion, surgical management,outcome and recurrence of inverted papillomas inKelantan.

IntroductionInverted papillomas are slow growing, most commonlybenign neoplasms of the sinunasal tract. However theirthree characteristic features, a tendency to recur, adestructive capability for the surrounding structures andan association with malignancy make them distinct fromother benign neoplasm of this region.

Methodology19 operated patients for inverted papilloma were followedthrough hospital records. Besides demographic data themorbidity of the disease at the time of presentation wasnoted. The types and extent of surgical procedures werecritically evaluated for their morbidity and control of signsand symptoms.

ResultsA total of 14 cases were managed through classicalmedial maxillectomies through lateral rhinotomyapproach, in another 4 cases endoscopic medialmaxillectomies while in one case intranasal excision was


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done. Late presentation, refusal for surgery andinfrequent follow up of the patients, has been establishedhallmark of Kelantan. This has ultimately influenced theselection of operative procedure performed.

ConclusionEn block removal of medial wall of maxilla along withpartial removal of ethmoids through a lateral rhinotomyapproach is a comfortable and satisfactory procedurein the management of inverted papilloma.

ORAL (B3 - 8)

CENTRAL CORNEAL THICKNESS ANDINTRAOCULAR PRESSURE AMONG MALAYUNDERGRADUATES OF HEALTH CAMPUS,UNIVERSITI SAINS MALAYSIA.

AuthorsMohd Aziz H, Liza Sharmini AT, Mohtar I

InstitutionDepartment of Ophthalmology, School of Medical Sciences,Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian,Kelantan, Malaysia.

ObjectiveTo study the correlation between central cornealthickness and intraocular pressure among Malayundergraduates of Health Campus, USM.

MethodologyA cross sectional study was conducted in 130 subjects.Central corneal thickness was measured with non-contact Topcon SP2000P specular microscope (TopconCorp, Japan). Intraocular pressure was measured byGoldman applanation tonometer. Each parameter wasrepeated for three times by the primary investigator toget an average reading. All measurements wereperformed between 3 and 5 pm.

ResultsThere is a strong positive correlation between intraocularpressure and central corneal thickness (r=0.467, p<0.01). Linear regression analysis showed a b1 value of0.0408 (p< 0.01).

ConclusionCentral corneal thickness may influence measurementof intraocular pressure made by an applanationtonometer. In this study, we observed that there is anestimated 4 mmHg increased in intraocular pressure forevery 100 micron increase in central cornel thickness.The thickness of the central cornea should be consideredwhen intraocular pressure is measured using anapplanation tonometer.

ORAL (B3 - 9)

A STUDY OF THE HIGH RISK FACTORS FORDEAFNESS AND PROBLEMS OFREHABILITATION AMONG THE DEAF CHILDREN

IN KELANTAN

AuthorsChe Ismail CL, Mohd Nasir CMY, DinSuhaimi Sidek, Mohd NormaniZ, Azlinda AG, Mohd Jaffri AR, Shahid Hassan

InstitutionDepartment of Otorhinolaryngology-Head & Neck Surgery, Schoolof Medical Sciences,Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionDeafness present at birth or arising early in life, is oneof the most serious long-life handicaps from which ahuman being can suffer. Prevention, early identificationand early rehabilitation can prevent the ‘social andcommunication’ isolation. Severe deafness is presentin every 1 person of 750 population. About 50% of casesof deafness are of unknown aetiology.

Objectives1. To identify the aetiologic/high risk factors among

hearing impaired (sensorineural deafness) children2. To determine the possible preventable aetiologic

causes and its preventive aspects3. To define the problems resulting to non-compliance

and failure of rehabilitation

MethodologyTraining of health clinic personnels in Kelantan (110nurses) and centrally in KL (30 nurses) was done toidentify children early (using distraction test of hearing).Hospital and clinic staffs were made aware of high riskfactors and referrals and appointments were fascilitatedin order to accommodate for the new cases. HearingScreening was also done in the Special Care Nursery,and later extended to other newborns in the maternityward. A community based screening for ear and hearingdisorders was also done in the district of Tumpat among2,004 people. The number of new cases has significantlyincreased during the study period for e.g. from 271 inyear 2000 to 512 cases in 2001. From Jan 2000- Dis2001, there were 783 new referral to the clinic and outof that, 75 were diagnosed to have sensorineural hearingloss

ResultsIn 36.7% of patients (27/75) they were diagnosed earlierand 63.7% were diagnosed late (more than 3 years old).The average age af diagnosis is 4.6 years. The mostconsulted high risk factor is family history (21.3%),prenatal infection (TORCHES) (6.6%), another 6.6% hadexposure to ototoxic drug and 6.6% with ventilation morethan 10 days. In 40% no known aetiological in risk factorsare found.

DiscussionMany of the possible etiological risk factors arepreventable e.g. exposure to ototoxic drug, prenatalinfection, hiperbilirubinaemia and meningitis, and stepsshould be taken approximately. The average age afdiagnosis is 4.6 years, which is very late where the


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recommendable age is at 3 months. A delay in obtaininghearing aids includes poor motivation and ignorance ofparents and delay of welfare financial help. With earlyrehabilitation it is proven that the deaf children is able tospeak and enter a normal school with guidance.

ORAL (B3 - 10)

ANTIFUNGAL EFFECTS OF ‘GAMAT’ EXTRACTS(STICHOPUS CHLORONATUS) IN ASPERGILLUS-KERATITIS IN RABBITS

AuthorsBakiah Shaharuddin, Abd Razak Koyakutty, Syed Mohsin SyedSahil, Afifi Abu Bakar


IntroductionSea cucumber or better known as ‘gamat’ by the localMalaysian people possesses high nutritional value andis widely used as a traditional medicine. Fungal cornealulcers although considered rare in occurrence, usuallyresults in devastating complications and blindness. Thetreatment of fungal ulcers is still not satisfactory due tolimited availability of antifungal drugs owing to theirrestricted market value. Due to this, the treatment isvery costly and often very toxic to the eyes and alsosystemically

ObjectivesTo determine the inhibitory effect of ‘gamat’ and theminimum inhibitory concentration (MIC) of ‘gamat’extracts against Aspergillus fumigatus.and to assess theantifungal effects of ‘gamat’ in Aspergillus-inducedkeratitis in rabbits.

MethodsMethanolic extract of Stichopus chloronatus was usedto prepare eye ointment based on its inhibitory effectsand MIC value. Aspergillus-keratitis was induced in botheyes of 7 New Zealand White rabbits’ cornea and treatedrandomly with ‘gamat’ extracts and placebo. Daily clinicalexamination of ocular infection was recorded.

ResultsThe largest inhibition zone (average =18.2 mm) wasobserved when ‘gamat’ extract was dissolved inchloroform compared to other solvents. The MIC valueof 1.562 mg/ml was recorded in serial dilution of theextracts using disc diffusion method on Aspergillusfumigatus. Six rabbits were enrolled in the clinical controltrial. Inoculation of fungus was successful in all sixrabbits. Daily clinical examination showed variabledegree of infectivity and response. Colony count at theend of five days of treatment with ‘gamat’ and placeboshowed no significant difference in means between thetwo groups (p > 0.05). Limitations of this study and

suggestions were discussed.

ConclusionMethanolic extract of ‘gamat’ gave a good inhibitiontowards fungal growth in the in vitro study. This warrantsa future exploration of the antifungal effects of ‘gamat’in clinical control trial with more refined instruments andmethods.

ORAL (B3 - 11)

COMPARISON OF AIR-DRIED AMNIOTICMEMBRANE GRAFT WITH BARE SCLERATECHNIQUE FOR PRIMARY PTERYGIUMEXCISION

AuthorsAfizah Isnin, Elias Hussein, Abdul Rani Shamsuddin

InstitutionDepartment of Oftalmology & National Bank Tissue, School ofMedical Sciences, Universiti Sains Malaysia, Health Campus,16150, Kubang Kerian, Kelantan, Malaysia.

ObjectiveTo compare recurrence rate between air-dried amnioticmembrane graft and bare sclera technique for primarypterygium excision.

MethodPrimary pterygium patients were randomized into 2groups by closed enveloped method:Group A: pterygium excision with air-dried amnioticmembrane graft

Group B: pterygium excision with bare sclera technique.Post-operative pterygium recurrence were comparedwithin 7 months follow-up.

Result1) In amniotic membrane group, the pterygium

recurrence rate was 19.2%. The recurrence rate inbare sclera was significantly higher, 60.7% (p=0.02).However fibrous tissue (grade 3 appearance) wasseen more in amniotic membrane group at 7 monthsof follow-up (31.1%) compare to bare sclera group(13.3%)

2) The significant difference for recurrence betweenthese 2 groups can be seen as early as 5 months offollow-up. 3) There was no significant differencebetween recurrence and age or sex

ConclusionsThe relatively low recurrence rate for post pterygiumexcision allows one to use air-dried amniotic membranegraft as an alternative for pterygium surgery. Howeverlonger follow-up might revealed higher recurrence ratein this technique as well?

ORAL (B3 - 12)


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LONG TERM VISUAL OUTCOME IN DIABETICRETINOPATHY AFTER LASERPHOTOCOAGULATION THERAPY

AuthorsRajesh K Khanna, Puneet Agarwal

InstitutionDepartment of Oftalmology, School of Medical Sciences,Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian,Kelantan, Malaysia.

IntroductionDiabetic retinopathy is one of the commonest causes ofvisual loss in adults of working age in Malaysia. Sightthreatening conditions such as maculopathy andproliferative diabetic retinopathy are more amenable tolaser treatment if diagnosed at an early stage. Although,unawareness and the lack of skilled personnel remainthe major problems in early detection and treatment.

ObjectiveTo analyse the long-term visual outcome in patients withdiabetic retinopathy after laser photocoagulation.

MethodologyThe records of diabetic retinopathy patients wereanalysed for demographic data, type and duration ofdiabetes, diabetic control, associated risk factors,indication for laser therapy, pre- and post-laser best-corrected visual acuity and causes for visual impairment.

ResultsAfter analysing the hospital records of 48 patients whounderwent laser photocoagulation therapy formaculopathy and proliferative diabetic retinopathy, aslight female preponderance (52%) was observed withmajority of Malays (91.7%) and type-2 diabetes (88%).Nearly half of them presented with retinopathy at thetime of presentation with 2 or more risk factors andbelonged to the age group between 45-60 years. Fair togood control of diabetes (<10.0% HBA1c or RBS <11.0m mol/l) was seen in only 11 patients (23%).

The major risk factors were found to be duration ofdiabetes for more than 10 years (66.7%), hypertension(62.5%), nephropathy (29%), peripheral neuropathy(25%), and hyperlipidemia (25%). Macular oedema(62.5%) was the most important cause of visualimpairment followed by vitreous haemorrhage (27%) andtractional retinal detachment (8%).

Long-term visual acuity (post-laser) with minimumof one-year follow-up improved in 7 patients (14.5%),remained stable in 19 patients (39.5%) and worsenedin 19 patients (39.5%). Various factors attributing toworsening of vision were found to be uncontrolleddiabetes, presence of multiple risk factors, severeexudative maculopathy, vitreous haemorrhage andtractional retinal detachment.

Inspite of laser therapy, legal blindness (<3/60) wasseen in 7 patients bilaterally (14.5%) and 14 patientsunilaterally (29%) whereas visual impairment (6/60 – 6/

18) in 6 patients bilaterally (12.5%) and 27 patientsunilaterally (56%).

ConclusionSight threatening conditions of diabetic retinopathy iftreated early by laser therapy, can delay or halt theprogression of retinopathy with stabilisation of vision.Although, control of diabetes remains the most importantfactor in preventing visual impairment along with othercomplications.

ORAL (B3 - 13)

A STUDY OF REHABILITATION OUTCOMEAMONG CHILDREN WITH HEARING LOSS IN THEHUSM ORL-AUDIOLOGY CLINIC

Authors*Farohah Mat Zain, **Din Suhaimi Sidek, *Nor Azlinawani Hussin,*Rohaida Ismail, *Abdul Wahab Muhammad, *Al-Hafiz Ibrahim,**Wan Zaharah Abd. Wahid, **Norazizah Kadil, **Rozazipah Ahmad

Institution**Department of Otorhinolaryngology-Head and Neck, School ofMedical Sciences, USM, *Student’s Department, School of MedicalSciences, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

IntroductionHearing loss is the most common defect in the neonatalperiod occurring about 1-6 per 1,000 population. Earlydetection and rehabilitation is of utmost importance asthe development of speech and language is biologicallytime-locked. After the age of 2 years the chance of gettinga normal speech and language even using the besthearing devices is slim.

Objective1. To document the effect of hearing loss to

communication ability among children2. To determine factors affecting early rehabilitation3. The role of parents and the level of knowledge

towards rehabilitation.

MethodologyChildren with hearing impairment attending theAudiology and Speech clinic of ORL were divided intoearly (less than 2 years old) and late (more than 2 yearsold) rehabilitation. Twenty children were selected, 10from each group. Home visits were performed andparents were interviewed, questionnaires used and videodocumentation for speech were taken. The healthpersonnel involved were also interviewed i.e theaudiologists, speech pathologists and ENTs.

ResultsChildren with early detection and rehabilitation do farbetter in terms of speech and language as compared tothe those detected late. However, severity of hearingloss, motivation, implementation of auditory and speechstimulation at home are important success factors.


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DiscussionWe hope with the implementation of universal hearingscreening in HUSM children will be detected andhabilitated early. These children, though hearingimpaired, benefit from their hearing aids or cochlearimplant to be able to speak and hopefully enter into themainstream education.

ORAL (C3 - 1)

MALAYSIA TOWARDS ELECTRONIC MEDICALRECORD

AuthorsHaslina Mohd, Sharifah Mastura Syed Mohamad


Electronic Medical Record (EMR) is the corecomponent in Telehealth and Total Hospital InformationSystem (THIS). This paper will provide further insight toEMR by providing some overview of EMR, discuss thebenefits of EMR, provide some guidelines to implementEMR and finally discuss some area for future research.EMR is defined as a computer-based information systemthat integrates patients-specific information from diversesources and tracks that information over time to facilitateclinical management and information retrieval, analysisand reporting. The implementation of EMR shouldbenefits various stakeholders including government andhealth care providers, administrators, clinicians, policymakers and researchers. Overall, the implementationof EMR can improve the quality of care, reduce cost inmanaging care environment and improve providerefficiency. The transition from paper-based proceduresto EMR requires proper planning. Urgent actions are toprovide legal and social framework for acceptance,introduction and implementation plan of EMR. A goodtransition to an EMR depends on commitment, researchand implementation. Since EMR in Malaysia is quite newand not very well established, many areas need furtherresearch. Users and organizational acceptance is oneof the social factors that need serious consideration inorder to ensure successful EMR implementation.Therefore, before MOH extends EMR implementationto other hospitals in Malaysia, study must be conductedto get feedbacks from the stakeholders that are currentlyinvolve with EMR. Outcome from this study can be usedas a guideline to enhance EMR features, may influencethe EMR usage, increase usefulness and easy of useof EMR. With regard to EMR design and development,important issue that needs immediate action is thestandardized identifier. Several areas that need thestandardization are message format standard, medicalterminologies, business case for patient medical recordinformation standard, relationship to the national healthinformation infrastructure, data quality, accountability andintegrity, diverse laws and regulations, and privacy,confidentiality and security. Therefore, another area that

needs immediate action is the research anddevelopment of at least, national standard for EMR.Without standard, differences in EMR systems,underlying architecture and the way that the systemsare configured and used in individual institutions limitthe quantity and quality of data that can be conveyed. Itis timely that MOH makes these standards as part ofthe National Health Information Infrastructure to helphealthcare providers to adopt more comprehensive,accessible clinical systems for more effective datasharing and public health protection.

Keywords: Telehealth, Total Hospital Information System,Electronic Medical Record

ORAL (C3 - 2)

PROBLEM-BASED LEARNING AS PERCEIVED BYDENTAL STUDENTS OF SCHOOL OF DENTALSCIENCES, UNIVERSITY SAINS MALAYSIA.

AuthorsArunodaya Barman1, Rogayah Jaafar1, Noorliza Mastura Ismail3

Institution1Department of Medical Education, School of Medical Sciences2Lecturer, School of Dental Sciences, Universiti Sains Malaysia,Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

BackgroundSince the implementation of problem-based learning inMcMaster University in 1969 it spreaded throughoutdifferent parts of the world with variations of itsimplementation (Albanese & Mitchell, 1993). In spite ofits growth and advantages, there is continuing debateabout its effectiveness over the conventional teachingand learning methods. In the School of Dental Sciences(SDS), Universiti Sains Malaysia (USM), the Doctor ofDental Sciences (DDS) program follows a 5-yearintegrated curriculum. Basically the curriculum isproblem-based and community oriented. This study isto explore the perception of DDS students about PBLsession.

MethodThis cross sectional descriptive study is carried out onall the 110 students of the SDS who completed theirsecond year of the course which included participationin PBL sessions. Pre-tested questionnaires weredistributed to the students for their responses.

ResultsNinety five students responded to the questionnairegiving a response rate of 86%. Dental students foundPBL session interesting and wanted to maintain PBLfrom the beginning of year 2 up to the end of year 3. Allstudents participated in discussion during PBL sessionsbut the level of participation varied. Some of them workedhard to prepare themselves for discussion while otherswere relatively passive. It helped them with in-depthunderstanding of certain topics and linking their basicscience knowledge to clinical classes. They felt that


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guidance from subject specialists and well-preparedfacilitators of the sessions were beneficial. The studentsbelieved that repetition of triggers from year to yeardiscouraged their active search for learning issues. Theyalso reported that there was not enough learningmaterials made available for their self-study.

ConclusionsReviewing and renewing the PBL triggers, providingguidelines for searching for resource materials andbriefing the students and facilitators about the philosophyand principles of PBL may make the PBL sessions morebeneficial.

ORAL (C3 - 3)

THE EFFECTIVENESS OF THE ROLE OF PBLTUTORS: USM STUDENTS’ PERCEPTIONS

AuthorsA.T.M. Emdadul Haque; Rogayah Ja’afar; Ahmad Fuad AbdulRahim

InstitutionDepartment of Medical Education, School of Medical Sciences,Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian,Kelantan, Malaysia.

BackgroundIn problem-based learning strategy, the roles of PBLtutors are crucial that involves the facilitation of an activelearning process and fostering the skills of critical thinkingand habits of continued learning rather than to conveyknowledge, but requires special skills and training. It isanticipated that the ideal PBL tutor will be a groupfacilitator rather than a subject matter expert. Students’evaluation of tutors is also found to be effective for facultydevelopment. This study was carried out at USMKK toinvestigate students’ perceptions regarding theeffectiveness of the role of PBL tutors.

MethodsBased on all aspects of tutors role and area of expertise,a questionnaire was developed. The items were scoredon a 5-point Likert-type scale and ratings were distributedas strongly agree (1) to strongly disagree (5). Thestudents from all the PBL groups in phase-II of 2003-2004 sessions were included in this study.

ResultsThe students’ perception on tutors’ role significantlychanged towards positivity in some areas across theyear of their training. Among different races, Malaystudents rated best that significantly differed with others.There was also significant difference in ratings betweengenders. It was seen that non-clinical tutors were ratedbetter, but it didn’t differ significantly between tutor types.

ConclusionStudents’ feedback is an important exercise forimprovement of tutor skills, so tutor evaluation can beadopted as a part of PBL tutorial process. This study is

in fact an illumination of perceptions in pertinent issuesregarding the tutors’ roles and indicates the importanceof taking specific strategies for both tutors and studentswith different backgrounds.

ORAL (C3 - 4)

SERVICE IN THE RURAL HEALTH CENTRE:DOCTORS’ VIEW - BANGLADESHPERSPECTIVES

AuthorsHafiza Arzuman, Khaleda Islam, Tabasssum F. Khan

InstitutionDepartment of Medical Education, School of Medical Sciences,Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian,Kelantan, Malaysia.

ObjectiveTo explore the opinion of the doctors about the reasonsand factors for not being interested to serve the ruralhealth complex

IntroductionThe health care system of Bangladesh is developedaround primary, secondary and tertiary level. At theprimary level the health care services are provided byUpazilla health complex (UHC) and union sub-centers(USC). There is considerable evidence that, basic healthcare does insufficiently reach the majority of thepopulation of the country. Different studies showed thatthe service of UHC is underutilized. There is alwayscriticism from different corners of the country and innewspapers that the doctors are not interested to servethe rural health centres. The study was intended to findout the actual facts and reasons that are responsible forpoor motivation and a lack of interest among the doctorsto serve the community.

MethodologyA cross sectional qualitative study was carried out amongmedical doctors. A pre-tested self-administeredquestionnaire was distributed to 400 randomly selecteddoctors working in secondary and tertiary level hospitalsin Bangladesh

ResultsOut of the 400 questionnaires 357 were returned; theresponse rate was 87.5%. Among the respondents 81%had working experience at UHC/USC level from 1 to 8years. Though the majority of them had work experienceat UHC/USC level but they did not like to stay and servethe rural health centers. The main identified factors werea) lack or irregular supply of proper medicine at thecentres, b) lack of proper accommodation, c) lack ofproper school facilities for the children, d) minimumrecreation facilities and e) minimum scope forprofessional development. Non co-operation from seniorcolleagues (48%), interference by local administration(81%) and political leaders (84%) in UHC/USC activities


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were also identified by the respondents as majorprohibiting factors. 75% of the respondents also felt thatour undergraduate medical curriculum could not motivatestudents to serve the rural health centres. Therespondents mentioned that a) specific time duration forrural health service, b) special facilities for higher studies,c) special facilities for promotion and d) provision ofincentives in different form might improve the situation.

ConclusionRecommendations for improvement of the present statuswere offered according to the result of the study.Selection of study place had been identified as a majorlimitation. Some of the identified issue needs to beconsidered for further in-depth study.

ORAL (C3 - 5)

VALIDATION OF QUESTIONNAIRE FORKNOWLEDGE, ATTITUDES, AND PRACTICERELATED TO RESPIRATORY HEALTH HAZARDSAND RISKS AT WORKPLACES

AuthorsLin Naing1, Razlan Musa2, Rusli Nordin1, Zulkifli Ahmad2, AbdulKareem3, Azwan Aziz2

Institution1School of Dental Sciences, 2 Department of Community Medicine,3 Department of Radiology, School of Medical Sciences, UniversitiSains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

IntroductionWorkplaces especially dusty places have considerablerespiratory health hazards. To minimize the risk, practiceof workers has played an important role. Therefore, it isimportant to assess workers regarding their Knowledge(K), Attitudes (A), and Practice (P) related to respiratoryhazards in dusty workplaces.

PurposeTo develop and validate the questionnaire for K, A, andP related to respiratory health hazards.

MethodsA workshop was conducted (participants: threeoccupational health specialists and five trainees) todevelop the first version of questionnaire. Based on theitem-analysis on a pilot study (42 sawmill workers), thesecond version was developed. After conducting a largerstudy (277 saw mill and rice mill workers), the finalversion was developed according to the item-analysis.

ResultsThe first version of the questionnaire consisted 79, 82and 29 items for K, A, and P respectively. Only 62, 49and 28 items for K, A, and P respectively remained inthe second version. Only 25, 15 and 12 items for K, A,and P respectively remained in the final version. Thefinal version achieved the internal consistency reliabilityof 0.78, 0.70, and 0.81 for the domains of K; 0.71 and

0.82 for the domains of A; and 0.70 for the P. Factoranalysis also revealed that selected items wereappropriate in their corresponding domains.

ConclusionThe final version was considered short and accurate interms of content validity, construct validity and internalconsistency reliability.

ORAL (C3 - 6)

NEUROBEHAVIOURAL EFFECTS OF PESTICIDEEXPOSURE IN TOBACCO FARMERS

AuthorsRusli Nordin, Mazalisah Matsah, Lin Naing, Nur Intan BaizuraMohd Salleh

InstitutionSchool of Dental Sciences, Universiti Sains Malaysia, HealthCampus, 16150, Kubang Kerian, Kelantan, Malaysia.

IntroductionIt is well documented that pesticide poisoning producesneurobehavioural manifestation. However, only a fewstudies have been done among tobacco farmers locally,although they have been exposed to pesticides atworkplace.

ObjectiveThis cross-sectional study compared theneurolobehavioural outcome between 3 study groups(tobacco farmers using pyrethroid, tobacco farmers usingother pesticides, and office workers as controls).

MethodsThree study samples were recruited from Bachok district,Kelantan. They were asked for possible neurologicalsymptoms by using a questionnaire. They underwent 7tests of WHO Neurobehavioural Core Test Battery(NCTB). The test scores were compared among studygroups.

ResultsOne of the profiles of mood (POM) state, fatigue scorewas significantly higher in non-pyrethroid userscompared to controls and pyrethroid users. Digit symboltest revealed that both pesticide groups had significantlyless correct numbers of symbols than controls. SantaAna manual dexterity test on preferred hand shown thatthe non-pyrethroid users performed the test significantlyless correctly compared to the other 2 study groups.Others NCTB test scores were not significantly differentamong 3 study groups.

ConclusionNeurobehaviour effect is observed among local pesticideusers. Non-pyrethroid pesticide users have more effectcompared to pyethroid users. The appropriateintervention should be done to prevent further chronicpoisoning among local pesticide users.


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ORAL (C3 - 7)

PATIENTS’ SATISFACTION TOWARD MEDICALWARD SERVICES IN HUSM AND HKB

AuthorsMohd-Zamri-Ali1, Than-Winn2, Lin-Naing3

Institution1Ministry of Health, 2 Department of Community Medicine, Schoolof Medical Sciences, 3School of Dental Sciences, Universiti SainsMalaysia, Health Campus, 16150, Kubang Kerian, Kelantan,Malaysia.

IntroductionIt is crucial to assess patient’s satisfaction in order toimprove the quality of services and to maintain patientload so that students and researchers will have sufficientnumber and variety of patients to sustain medicalexpertise.

ObjectivesTo assess factors associated with patient satisfactiontoward medial ward services in two hospitals.

MethodCross-sectional design with prospective recruitment

of subjects of systematic random sample of inpatientsadmitted to HUSM and HKB. Interviewer-assistedvalidated questionnaires were administered to 188inpatients from each hospital.

ResultsSatisfaction was assessed on seven domains. Fouritems under nurse-services domain were higher forHKB.. Out of 13 items under doctor-services domain,11 scored higher for HKB. Four items under other staff-services domain were more favoured for HKB. Six outof nine items under clean-and-comfort domain werehigher for HUSM with significant p-values on furniture,ventilation and space items. Under miscellaneousdomain, item on car-parking was highly scored forHUSM. Regarding financial issues, all 3 items were morein favour for HKB. Multivariate analysis for each domainusing demographic and other variables related to currentadmission, adjusted satisfaction scores for HKB weresignificantly higher than those for HUSM for all domainsexcept clean-and-comfort.

ConclusionThe patients admitted to HKB scored more favourablythan those admitted to HUSM. Being hospital-basedsurvey, it is not appropriate to compare two hospitalshead to head. It is recommended that each hospitaladministration should assess areas for improvement togain higher satisfaction and better utilization of theirservices.

ORAL (C3 - 8)

STUDENT’S PERCEPTION OF PROBLEM-BASEDLEARNING: CARDIOVASCULAR BLOCKEVALUATION STUDY

AuthorsAbdus Salam1, Rogayah Jaafar1 and Abdul Rahman Noor2

Institution1Department of Medical Education and 2Department ofPharmacology, School of Medical Sciences, Universiti SainsMalaysia, Health Campus, 16150 Kubang Kerian, Kelantan,Malaysia

ObjectivesTo investigate the student’s perception of PBL sessionsand of tutoring skills

IntroductionMedical education is moving to a more problem-orientedbasis than was the case formally. The School of MedicalSciences, Universit Sains Malaysia is the pioneer inimplementing PBL curriculum in the region since itsinception in 1980. Main objectives of PBL is to helpstudents to develop their abilities to analyze and to solveproblem and thereby to develop self-learning skills andto be able to learn on their own for the rest of their lives.It is one of the best methods of interactive learning wherea tutor facilitates a small self-directed group start with abrain storming session. It is crucially important to monitorhow well do the teaching personnel and how do thestudents embrace the idea that groups collectively andeach of them individually is responsible for learningprocess. This paper is aimed at to investigate theeffectiveness of PBL sessions in order to developeducation.

MethodologyIt was a cross sectional descriptive study carried outamong the phase two undergraduate medical / dentalstudents of academic session 2003-2004 of the Schoolof Medical Sciences, Universiti Sains Malaysia duringtheir four weeks of cardiovascular block rotation from20/09/03-16/10/03. Sample size was 116. Data wascollected through an anonymous evaluation formsubmitted to the respondents at the closing day of thecardiovascular block. The results was then compiled andanalyzed.

ResultMajority of the respondents was of the opinion that theywere actively involved in discussion sessions and thegroups shared knowledge. Regarding tutor skills amajority of the students thought that tutors kept thegroups in focus, demonstrated well the ground rules,assisted them to distinguish main from minor issues,facilitated functioning of the groups, showed interest inthe subject matter. The students were satisfied overallwith tutors roles in the four PBL weeks of cardiovascularblock. However, there were a few negative commentssuch as tutors should play a role to lead brainstormingand lead students, tutor should not just be sitting, PBL


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is boring as the tutor is boring, tutor is not friendly anddidn’t stimulate and guide properly, tutor is not attentive,not experienced and not well facilitating, don’t use “X”tutor as guide.

ConclusionThe key to successful learning in PBL lies in theinteractiveness of its sessions, which again dependsupon how the tutor handles the group. Tutor skills ofclear communication and awareness of learning needsof the students are of great importance. To benefit formPBL students needs careful induction by tutor. The tutorneeds to introduce progressive changes in the processof PBL in order to avoid boredom on the part of thestudents. In processing a small group, the tutor has toconsider the task and maintenance of the group. Thetask must be clearly defined and all members in the smallgroup must understand each member’s role. Themaintenance of the group involves establishing a“climate” for discussion that is open, non-threatened,trustful and supportive.

ORAL (C3 - 9)

ARE SURGICAL SUB-SPECIALTIES STILLPERCEIVED AS A MAN’S PROFESSION?SHARING A MALAYSIAN EXPERIENCEAuthorsMd. Anwarul Azim Majumder,1 Ahmad Fuad Ab. Rahim1, RogayahJaafar1, Lin Naing 2 , Muhammad Najib Mohamad Alwi3, WanHazabbah Wan Hitam4, Mazlan Abdullah5.

Institution1Medical Education Department, 3Psychiatry Department,4Ophthalmology Department, 5Community Medicine Department,School of Medical Sciences; 2School of Dental Sciences,Universiti Sains Malaysia (USM), Kelantan, Malaysia.

BackgroundIn recent years, the number of female students and thefemale to male ratio has been increasing steadily inmedical schools. An under representation of womenoccurs in some clinical specialties, e.g. surgery. Thecombination of domestic responsibilities and professionalcareer demands is mainly responsible for suchmaldistribution. This study aimed to investigate thecareer choices of the female medical graduates of USM.

MethodsA cross-sectional study on career choices among 95female medical graduates of USM in 2003, wasconducted using “Graduate Evaluation Questionnaire”.

ResultsThe findings of the study showed that a majority of thefemale graduates selected surgery and its subspecialtiesthan any other specialties. This is a new trend firstobserved in Malaysia, and perhaps in the rest of theAsian countries.

ConclusionEffective strategies should continue to be developed to

eliminate obstacles and create conducive workingenvironment for the female surgeons, so that they wouldbe able to combine productive careers with rewardingfamily lives.

ORAL (C3 - 10)MEDICAL EDUCATION IN BANGLADESH: ISSUESAND APPROACHES

AuthorsMd. Ruhul Amin1, Md. Anwarul Azim Majumder2, MohammedNazrul Islam3, SM Idris Ali4

Institution1Department of Physiology & 4Department of OrthopaedicSurgery, Dhaka Medical College, Bangladesh; 2Department ofMedical Education & 3Department of Anatomy, School of MedicalSciences, Universiti Sains Malaysia, Health Campus, 16150Kubang Kerian, Kelantan, Malaysia

BackgroundIn recent years, educational institutions around the worldhave been increasingly confronted with the challengeof making their curricula relevant to the needs of thetime. Medical education in Bangladesh has alsoexperienced many changes and challenges. Thegovernment has taken initiatives to bring reform inmedical education through various government-lededucational projects and programmes. As a result, an“educational environment for change” has beenestablished in the arena of medical education.

MethodsFor this study, relevant publications and documents wereconsulted and analyzed.

ResultsThe changes and challenges which medical educationin Bangladesh has experienced include growingrealization among stakeholders to review the educationalprogrammes, availability of a large “critical mass” oftrained teachers in medical education, resources,procedures and guidelines developed by formereducational projects, and commitment to improve themedical education in the current government health careprogrammes.

ConclusionQuality health care of a country depends on theavailability of the well-trained and competent healthpersonnel. Medical education plays an important role toproduce such health personnel using need-based “input-process-output” curriculum strategies. Stakeholdersshould take the note of the various shortcomings of themedical education and draw need-based strategies toimprove quality of medical education.

ORAL (C3 - 11)

STUDENTS’ PERCEPTIONS OF ‘TECHNOLOGY-BASED’ LECTURE HANDOUTS


116

AuthorsMohammed Nazrul Islam1, Md. Anwarul Azim Majumder2, RogayahJa’afar2, Sayeeda Rahman3

Institution1Department of Anatomy; 2Department of Medical Education;3Department of Pharmacology; School of Medical Sciences,Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian,Kelantan, Malaysia

BackgroundLecture handouts are widely used instructional tools.Handouts supplement rather than substitute students’regular reading. It is now a common practice to supplyPowerPoint handouts and publish lecture handouts onthe web for students’ access.

MethodsA questionnaire survey was conducted among the firstyear medical students (n=142) of School of MedicalSciences (SMS), Universiti Sains Malaysia (USM) inorder to determine their perceptions and expectationswith regards to lecture handouts provided to them.

ResultsA majority of the students reported that they read thelecture handouts as a reference and found them usefulas a guide for future learning. However, more than half(68%) of the students have shown their dissatisfactionwith overall presentation format of the handouts whichis mainly technology-related i.e. PowerPoint andphotocopying.

DiscussionThis study indicated that students’ expectations andexperiences were positive towards the use of handouts.They used handouts as a means of supplementing ratherthan substituting their learning. Much care is neededwhen educators supply computer-based handouts, asthis study shows some limitations when students usethem. Medical schools should consider publishing web-based handouts with online and other facilities to makeit interesting and effective.

ORAL (C3 - 12)

NEUROBEHAVIOURAL PERFORMANCES IN CARSPRAY PAINTERS AND MECHANICS EXPOSEDTO ENVIRONMENTAL LEAD IN KOTA BHARU,KELANTAN

Authors*Mohd Nazhari M.N., Rusli N. dan Abu Hassan Shaari A.K.

Institution*Department of Community Medicine, USM dan Ministry of Health

IntroductionLead exposure poses a major public health hazard andis recognized as the most prevalent and preventablehealth issue in many industrialized countries. Lead-based paint poisoning, a well recognized entity amongyoung children in poor, urban neighbourhoods, is not

confined exclusively to such areas. Worldwide, about830,000 people died every year through illness linkedto exhaust fumes and industrial smog that engulfed manycities of the Third World. Most accurate estimates ofhealth risks due to lead can be obtained from reliablehistory of blood lead measurements. Level of lead in airwill consequently lead to contamination of soil, waterand food and subsequently increase exposure to futuregeneration. Previous study have shown that chronicexposure to inorganic lead among spray painters,mechanics and battery workers causedneurobehavioural effect in the workers.

ObjectiveTo investigate the neurobehavioural performances of carspray painters and mechanics exposed to environmentallead in the workplace.

MethodologyThis is a cross-sectional comparative study of 44 carspray painters exposed to lead chromate in car paintand 44 car mechanics working in car spray painting andservice premises in Kota Bharu, Kelantan. Assessmentof exposure and outcome were based on symptoms ofpossible neurotoxic obtained via WHO standardquestionnaire form; signs of neurotoxic obtained viaWHO standard examination form; blood lead levelschecked as exposure consistent for biologicalmonitoring; neurobehavioural performance tested usingWHO NCTB; and environmental lead level.

ResultsSymptoms of lethargy, sleepiness, sudden wakefulness,forgetfulness, stress, confusion, irritability, headache,vertigo, palpitation, excessive sweating and numbnessnoted more when there was high level of blood leadand recognized among car spray painters and carmechanics. Mean blood lead level among car spraypainters was 10.19 µg/dl and significantly higher ascompared to car mechanics was 7.39 µg/dl (p=0.01).Mean environmental lead level inside the car spray andpainting chambers was 8.07 µg/m_ and slightly lowerthan environmental lead level around services andrepairing areas which was 8.58 µg/m_.

Neurobehavioural symptoms, neurobehaviouralperformances and environmental lead levels were notsignificantly different between car spray painters andmechanics. Also noted mean blood lead levels of carspray painters and car mechanics were higher ascompared to other group of occupation in Malaysia.Although environmental lead levels around car servicingand maintaining areas were slightly higher than insidecar spraying chamber, it actually not showing the trueexposure and what actually needed was the personalair sampling.

ConclusionCar spray painters had significantly higher in blood leadlevel as compared to car mechanics. However,neurobehavioural symptoms, neurobehavioural


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performances and environmental lead levels were notsignificant between car spray painters and mechanics.

ORAL (C3 - 13)

ADOLESCENTS’ SELF-REPORT ON THEQUALITY OF FRIENDSHIPS AND THERELATIONSHIP WITH SELF-ESTEEM.

AuthorsMohd Jamil Yaacob, Naliza Zulkifli, Mark Newman1, Nick Goddard2

InstitutionSchool of Medical Sciences, Universiti Sains Malaysia, HealthCampus, 16150 Kubang Kerian, Kelantan, Malaysia; 1St. Bunstan’sCollege, London; 2Lewisham South East, London.

ObjectiveA cross-cultural study was conducted in United Kingdom(UK) and Malaysia to look at the patterns of friendshipand self-esteem among adolescents aged 13-16 withrespect to age, gender, race and length of friendship.

MethodologyAll Year 10 (St Dunstan’s College students in UK) andForm 2 (King George V Secondary School in Malaysia)were included. A total of 198 pupils from both schoolswere recruited but only 168 were chosen for finalstatistical analyses using SPSS and EQS computerprogramme. The 46-item Friendship Qualities Scale and11-item Rosenberg Self-esteem scale were translatedinto the Malay language and were subjected to validityand reliability studies using confirmatory and exploratoryfactor analyses. Cross-cultural comparison was madeusing non-parametric tests based on compatibility scalesbetween the two cultures.

ResultFriendship varied between St Dunstan’s and KingGeorge V but not self-esteem. Girls had higher friendshipqualities but lower self-esteem in St Dunstan’s but onthe other hand, boys had higher friendship qualities butlower self-esteem in King George V. Race differed withself-esteem in St Dunstan’s but it differed with friendshipin King George V. Length of friendship did not differ withfriendship and self-esteem in both places.

ConclusionContemporary discovery in cross-cultural psychology

indicates that there are different paths of developmentin the West as compared to the East. In UK, the path isone of individual maturation that result in higher self-esteem scores as compared to friendship qualities. InMalaysia, the path is one of symbiotic group maturation,as shown in higher friendship qualities scores ascompared to self-esteem.

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