POPULATION: Women with singleton, term pregnancies in active labour and immediate postnatal period, at low risk of complications.
SETTING: Healthcare facilities in low- and middle-income countries.
SEARCH STRATEGY: A systematic search and review were conducted on the current guidelines from WHO, NICE, ACOG and RCOG. Additional search was done on PubMed and The Cochrane Database of Systematic Reviews up to May 2020.
CASE SCENARIOS: Four common intrapartum urinary abnormalities were selected: proteinuria, ketonuria, glycosuria and oliguria. Using reagent strip testing, glycosuria was defined as ≥2+ on one occasion or of ≥1+ on two or more occasions. Proteinuria was defined as ≥2+ and presence of ketone indicated ketonuria. Oliguria was defined as hourly urine output ≤30 ml. Thorough initial assessment using history, physical examination and basic investigations helped differentiate most of the underlying causes, which include diabetes mellitus, dehydration, sepsis, pre-eclampsia, shock, anaemia, obstructed labour, underlying cardiac or renal problems. A clinical algorithm was developed for each urinary abnormality to facilitate intrapartum management and referral of complicated cases for specialised care.
CONCLUSIONS: Four simple, user-friendly and evidence-based clinical algorithms were developed to enhance intrapartum care of commonly encountered maternal urine abnormalities. These algorithms may be used to support healthcare professionals in clinical decision-making when handling normal and potentially complicated labour, especially in low resource countries.
TWEETABLE ABSTRACT: Evidence-based clinical algorithms developed to guide intrapartum management of commonly encountered urinary abnormalities.
MATERIALS AND METHODS: This is a retrospective cohort study of 17 monochorionic diamniotic (MCDA) twin pregnancies with severe TTTS treated by FLA over 15 months in a single centre by a single operator after performing simulations.
RESULT: The overall survival rate at day 28 after birth for at least one twin was 76% while the dual-twin survival was 64%. The survival rates at day 28 after birth for at least one twin for stages II, III and IV were 90% vs 40% vs 100% (p=0.054) while dual survival rates were 80% vs 0% vs 100% (p=0.05), respectively. The rate of miscarriage was higher with anterior placentation compared to posterior placentation (33% vs 18%, p=0.660). There was one case of recurrent TTTS and no twin anaemia-polycythaemia sequence post-FLA. The fetal medicine unit in Ipoh is the national centre in Malaysia which covers the whole country, including the western coast of the Borneo Island (Sabah, Sarawak and Labuan) accessible only by air travel. All three cases from Borneo Island had resolved TTTS after FLA and dual neonatal survival at day 28 after birth.
CONCLUSION: This data from an emerging new fetoscopic laser centre in Malaysia indicates results consistent with the published international learning curve and within the limits of good clinical governance.
MATERIALS AND METHODS: We retrospectively identified patients presenting with adhesive capsulitis within four weeks of administration of COVID-19 vaccine to the affected arm at our tertiary institution from March 2021 to December 2022.
RESULT: Based on the above criteria, we identified seven cases of adhesive capsulitis, comprising one male and six female patients, with average age of 60 years. We present initial symptoms, signs and the duration from when the vaccine was administered. We have highlighted our treatment strategies as well as the clinical and functional outcomes reported by these patients after treatment. We have reported improvement in both Visual Analogue Scale (VAS) and range of motion (ROM) in all our patients after non-surgical management which included physiotherapy and, in some cases, hydrodilatation.
CONCLUSION: SIRVA related adhesive capsulitis is rare and under-reported with limited information in current literature. This study highlights that adhesive capsulitis is a potential complication arising from improper COVID-19 vaccine administration and reinforces traditional wisdom of administering vaccinations on the non-dominant arm. Conservative treatment strategies appear to be effective, particularly hydrodilatation combined with physiotherapy, and patients are expected to have a good return of function.
METHODS: This study included all deaths that occurred in Malaysia in 2018. The YLL was derived by adding the number of deaths from 113 specific diseases and multiplying it by the remaining life expectancy for that age and sex group. Data on life expectancy and mortality were collected from the Department of Statistics Malaysia.
RESULTS: In 2018, there were 3.5 million YLL in Malaysia. Group II (NCDs) caused 72.2% of total YLL. Ischaemic heart disease was the leading cause of premature mortality among Malaysians (17.7%), followed by lower respiratory infections (9.7%), road traffic injuries (8.7%), cerebrovascular disease (stroke) (8.0%), and diabetes mellitus (3.9%).
CONCLUSIONS: NCDs are a significant health concern in Malaysia and are the primary contributor to the overall burden of disease. These results are important in guiding the national health systems on how to design and implement effective interventions for NCDs, as well as how to prioritise and allocate healthcare resources. Key strategies to consider include implementing health promotion campaigns, adopting integrated care models, and implementing policy and regulatory measures. These approaches aim to enhance health outcomes and the managements of NCDs in Malaysia.
OBJECTIVES: This study examined the relationship between suicide attempts and bullying among school adolescents in Malaysia.
METHODS: Data from the Malaysia NHMS 2017, a nationwide study that adopted a two-stage cluster sampling design, were analysed. The survey used a self-administered questionnaire in bilingual language adapted from GSHS developed by WHO. Participants were secondary school students aged 13 -17 in all states. Descriptive and multiple logistic regression analyses were performed using IBM SPSS version 28.
RESULTS: A total of 27,497 school adolescents participated in the study. Results showed that 6.9% of school adolescents had attempted suicide. There was 16.2% of adolescents being bullied. Multiple logistic regression revealed that students who were bullied were more likely to have suicide attempts (aOR 4.827, 95% CI: 4.143, 5.624) P
METHODS: The 307 open-label extension (OLE) study (NCT03531255) is a non-randomized, multicenter extension study of long-term safety and efficacy of pegcetacoplan in adult patients with PNH who completed a pegcetacoplan parent study. All patients received pegcetacoplan. Outcomes at the 48-week data cutoff (week 48 of 307-OLE or August 27, 2021, whichever was earlier) are reported. Hemoglobin concentrations, Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scores, and transfusion avoidance were measured. Hemoglobin > 12 g/dL and sex-specific hemoglobin normalization (i.e., male, ≥ 13.6 g/dL; female, ≥ 12 g/dL) were assessed as percentage of patients with data available and no transfusions 60 days before data cutoff. Treatment-emergent adverse events, including hemolysis, were reported.
RESULTS: Data from 137 patients with at least one pegcetacoplan dose at data cutoff were analyzed. Mean (standard deviation [SD]) hemoglobin increased from 8.9 (1.22) g/dL at parent study baseline to 11.6 (2.17) g/dL at 307-OLE entry and 11.6 (1.94) g/dL at data cutoff. At parent study baseline, mean (SD) FACIT-Fatigue score of 34.1 (11.08) was below the general population norm of 43.6; scores improved to 42.8 (8.79) at 307-OLE entry and 42.4 (9.84) at data cutoff. In evaluable patients, hemoglobin > 12 g/dL occurred in 40.2% (43 of 107) and sex-specific hemoglobin normalization occurred in 31.8% (34 of 107) at data cutoff. Transfusion was not required for 114 of 137 patients (83.2%). Hemolysis was reported in 23 patients (16.8%). No thrombotic events or meningococcal infections occurred.
CONCLUSION: Pegcetacoplan sustained long-term improvements in hemoglobin concentrations, fatigue reduction, and transfusion burden. Long-term safety findings corroborate the favorable profile established for pegcetacoplan.
TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03531255.