Prematurity is the leading cause of infant mortality and one of the main reasons for newborn infants to be admitted to the Neonatal Intensive Care Unit (NICU). Advancements in medicine has made the NICU a maze of sophisticated modern technology and expensive to run. These advances in technology have also resulted in an added layer of complexity to many ethical dilemmas that are encountered in the NICU. In 1977, Beauchamp and Childress introduced the principles of biomedical ethics. These four principles of (1)respect for autonomy, (2)nonmaleficence, (3)beneficence and (4)justice, form a suitable starting point for the analysis of the moral challenges of medical innovation. This article explores how the four ethical principles relate to decision-making in the NICU, and how they can be applied to the treatment of sick newborn infants in clinical practice. It also highlights the reasons why healthcare personnel need to equip themselves with good communication skills and up to date knowledge of ethical considerations in the NICU in order to make quality decisions about care for their patients. This article also suggests that a Clinical Ethics Committee can play a vital role in ensuring that the best decisions are achieved for these patients.
Mature cystic teratoma is the commonest ovarian germ cell tumour which accounts for 70% of all benign ovarian neoplasms in the reproductive age groups. Being a pluripotent germ cell tumour, mature cystic teratoma has at least two out of three mature embryonic germ cell components: ectoderm, mesoderm and endoderm. The presence of multiple cystic spaces within the tumour wall, also known as pneumatosis cystoides-like appearance is rarely described but a characteristic feature in cystic teratoma of the ovary. Currently, there is little information concerning the mechanism of its formation. Herein, we described an unusual case of ovarian mature cystic teratoma in a 31-year-old pregnant female with multiple sieve-like areas resembling pneumatosis cystoides of the intestine. Macroscopic and histological examination of the ovary revealed features diagnostic of mature cystic teratoma. Intriguingly, multiple cystic spaces of variable sizes were found within the cyst wall histologically. They were lined partially or completely by foamy histiocytes and foreign body type multinucleated giant cells, exhibiting strong CD68 immunoreactivity. Vascular endothelial markers (CD31 and CD34) and epithelial marker (cytokeratin AE1/AE3) were negative. A diagnosis of mature cystic teratoma with pneumatosis cystoides-like feature was rendered. The patient was discharged well with no signs and symptoms of early labour. The etiopathogenesis of this intriguing histological feature is briefly discussed in this article.
Local anaesthesia systemic toxicity (LAST) is an uncommon and a potentially life-threatening event that develops after peripheral nerve block. The cause may be multifactorial and may include the choice of drug, technique of block and individual patient risk factors. We report a case of a 55-year-old female who developed slurring of speech and quadriplegia after receiving a mixture of lignocaine and hydrocortisone through an intra-articular injection to the right shoulder. Neurological examination revealed hypotonia and absence of power (0/5) in all limbs. These toxic events may have resulted from an accidental intra-arterial or dural cuff injection of local anaesthesia or absorption from surrounding tissues. This case report demonstrated that an intra-articular injection in the shoulder may cause LAST and may be under-recognized as it can mimic stroke.
There is a strong need to reduce costs of hospital and advocating health economics in countries like the United States of America. The rising cost of healthcare globally especially in the United States of America has interestingly outraged the temper of many citizens about the Obamacare and Trumpcare. The issue about high cost in healthcare is the failure for people globally to recognize that healthcare facility is a 24-hour round-the-clock service. It therefore involves doubling of the utility bills, tripling the manpower due to shifts and rest, wear-and-tear of basic electrical devices is short-lived, breakdown period of huge machine is consistently due to overloaded usages in the government hospitals and poor knowledge of the maintenance programme. Low birth weights (LBW) is a public health concern because it has a well-known predisposition to increased risk for perinatal infections, respiratory distress and ultimately mortality. There is also a higher risk of poor health outcomes throughout the life course of the LBW newborns that includes Type 2 diabetes, high blood pressure, neurodevelopmental disabilities and cardiovascular diseases. The World Health Organization and United Nations Child’s Fund estimate the prevalence of low birth weights in the world ranges from 3% to 32%. Albania in the year 2000 recorded prevalence of low birth weight of 3% whereas Yemen recorded a low birth weight of 32% in 1997. In 2015, the US national vital statistics pointed out that 83.9% of preterm birth (PTB) are LBW. This indicates that prevention of PTB will lead to a decrease in the incidence of LBW.
Introduction: All pharmaceutical products in Malaysia must be registered with the Drug Control Authority (DCA) whereas cosmetics must be notified with the National Pharmaceutical Regulatory Agency (NPRA). Availability of unregistered products and unnotified cosmetics in the market are longstanding issues affecting public safety and health. It is vital that all government healthcare personnel (GHP) as the front liners are equipped with the knowledge to properly advise the public on this issue.
Objective: This study aims to determine the level of knowledge towards registered products and notified cosmetics among various groups of GHP under the Ministry of Health facilities in Labuan.
Methods: This was a cross-sectional study performed from August to November 2017 using a validated 12 question questionnaire. Respondents were divided into 4 groups (doctors/dentist, pharmacist, nurse, allied healthcare professional) and results between the groups were analysed using Chi-square analysis. Respondent’s knowledge was given score and those who scored 9 marks and above were considered to have good knowledge. Those who scored 8 marks and below were considered to have poor knowledge.
Results: Only 40.2% Pharmacists have the highest score of good knowledge on registered products and notified cosmetics at 81.8% (n=18). The level of good knowledge among allied health professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and 20% of doctors (n=6). However in total, only 40.2% (n=88) of the study population had good knowledge.
Conclusion: The level of knowledge towards registered products and notified cosmetics among doctors, pharmacist, nurses and allied health professional in Labuan is poor as only 40.2% have good knowledge. This study shows a significant association between the levels of knowledge among GHP varies between groups of profession. Pharmacist group has the highest score in knowledge in this study and thus should be another reference for the general public and patients when it comes to health-related matters. Further re-education should be conducted to improve the knowledge of GHPs in Labuan with regards to this subject.
Essential medicines have become indispensable to maintain and to improve our lives and health. Latest literature again reiterated that inappropriate use of medicine is a global phenomenon in both developed and developing countries still prevail. Poor adherence is associated with negative clinical outcome of the disease. It is important to note that about 50% of treatment failures are due to poor medication adherence and this results in substantial morbidity and mortality. Patient’s belief and perception have been reported to influence medication adherence. Low rate of adherence was found strongly associated with patient’s belief across the studies with chronic diseases with hypertension, coronary heart disease, diabetes, asthma and renal disease. Exploring the health beliefs of patients is vital to improve adherence and thereby blood pressure among the patients with hypertension. Lack of knowledge about usage of medication and various misleading perceptions of hypertension management have resulted inappropriate use of medication especially medication adherence among community-dwelling patients with hypertension. Literatures classified non-adherence into primary and secondary. Primary non-adherence refers to medication is purposefully never filled or taken; Secondary non-adherence is defined as medication is not taken properly or continued as prescribed and further classified into intentionally and unintentionally. Patient education aims to train patient in the skill and self-management of their chronic disease by adapting to the treatment or lifestyle changes. Despite improving in patients’ skill and self-care by providing information about the treatment, patient education could enhance their empowerment and medication adherence. Patient education is a basic right of the patients and healthcare members have responsible to provide such information. However, the authenticity of the available information is yet to be verified. Therefore, healthcare professional could play a vital role here to educate their patients about the appropriate information.
As urban centres pursue localisation of the Sustainable Development Goals (SDGs), rapidly growing cities in low-and middle-income countries (LMICs), many of which are located in the Asia-Pacific region, are experiencing competing demands for limited resources. The protection and enhancement of Urban Green Spaces (UGS) is a practical, low- cost opportunity to produce multiple benefits across the SDGs, ranging from improving the health and wellbeing of city dwellers and reducing inequalities to protecting local flora and fauna and attracting economic investments for future generations. In developing a city-wide strategy for UGS that aligns with the New Urban Agenda, it is important to consider the coordination of efforts from multiple sectors through participatory decision-making mechanisms that engage the civil society and address the needs of the most vulnerable population groups regarding mobility (such as children, elderly, women and people with disabilities) to ensure no one is left behind.
Mast cells (MCs) play a crucial role in the pathogenesis of allergic diseases due to their hypersensitive reaction to non-harmful substances that elicit an allergic response. As such, by interrupting certain signalling proteins within the signalling pathway of a MC, an allergic response may be avoided or inhibited. Compounds that attenuate the release of mediators from MCs are known as MC stabilizers. These drugs are clinically used to prevent MC effector responses towards common allergens. Although commonly prescribed clinical MC stabilizers such as disodium cromoglycate and ketotifen fumarate were used in the preventative treatment of various allergic diseases, there still remains a need of advancement towards the discovery of new MC stabilizing drugs that are able to target specific signalling molecules in order to provide better treatment option against these diseases. Among these newly discovered potential MC stabilizers, much efforts have been given to the inhibition of vital upstream signalling molecules such as spleen tyrosine kinase as well as surface receptors such as the high-affinity IgE receptor (FcεRI) and stem cell factor receptor (KIT). A recent study also reported that linker for activation of T cells (LAT) may also be an excellent molecular target for inhibiting MC degranulation. Although in most cases the exact mode of action of these molecules is yet to be elucidated, all these compounds have shown MC inhibition. Therefore, they might have potential therapeutic use in the treatment of allergies and allergy related diseases where MCs are majorly involved. Thus, this mini review will focus on summarising the potential signalling molecules or receptors that have been targeted to inhibit MC degranulation, particularly those located in the upstream signalling pathway.
This was a cross-sectional study which attempts to assess the effectiveness of the 18-hour lactation management course organised by Klang District Health Office for its health staff. The course was conducted for three days from 19 to 21 September, 2006 with a total of 18 hours, comprising 15 hours of lectures and three hours of supervised clinical experience. There were a total of 46 participants for the course. The pre- and post-test scores of the participants from the course were used for analysis. This study showed that the mean pre-test versus mean post-test scores were 12.63 and 19.87. The difference in the mean score was statistically significant (p < 0.001, 95%CI -8.285, -6.193). The difference was significant for the staff nurse, community nurse and assistant nurse but not for doctors. In conclusion, the 18-hour duration lactation management course was effective at improving the knowledge and skills on breastfeeding management for the health staff.