Antenatal (AN) care is vital for all pregnant women and for reduction of maternal mortality and morbidity. AN care knowledge and specific AN care practices are some of the crucial components of what determines effective AN care. In developing nations, the health of pregnant women can be even more sensitive to these factors. Objectives of this study was to assess the antenatal (AN) care practice and pregnancy outcome of ever-married women aged 18 to 49 years old having at least one pregnancy experience ,residing in kampongs of Sikuati area, Kudat between March to December 2015. Cross–sectional descriptive study, non-probability convenient sampling method was used and 150 eligible participants were interviewed through face to face by trained interviewers using a semi-structured questionnaire and their knowledge of AN care, their AN care practices and outcomes and complications of their pregnancies were recorded. 99% of all the women received AN care, and 64% of the women received essential AN care practice (AN visit of minimum 4 times). The study revealed that overall knowledge amongst the women with good knowledge was 48% and low knowledge was 52%. Despite this, it was found that low knowledge of AN care was associated with essential AN care practice. Additionally, AN care practices, assessed through timing of first AN care visit and frequency of visits, was not significantly associated with pregnancy complications. Despite these results, outcomes were good and all complications were properly and successfully addressed. This may reflect the effectiveness of current programs in place promoting importance of AN care and delivery practices. Maintenance of current programs with targeted interventions to address low knowledge level and the low level of compliance with essential AN care completed are recommended..
The Emergency Department (ED) provides treatment for acutely ill patients in need of urgent medical attention. Despite the availability of the primary care unit ‘Klinik Kesihatan’, where non urgent patients should be treated, Malaysia’s public hospitals still need to deal with overcrowding of non-urgent patients in ED. The main aim of the study was to assess the willingness of non-urgent patients to be redirected to Klinik Kesihatan. This was a cross-sectional study conducted at Hospital Tuaran Emergency Department, Sabah. Non-urgent patients were interviewed using a questionnaire, to find out the purpose of their visit to Emergency Department. A total of 318 non-urgent patients out of 457 patients were interviewed during the study duration. 41 respondents (12.9%) were willing to be redirected towards a Klinik Kesihatan. No associated factors were found when compared with the unwilling to be redirected group. Among 277 respondents who rejected redirection to Klinik Kesihatan, 70.4% agreed to pay a surcharge to be treated in the Emergency Department and there was no association found with the employment status (p= 0.391). Most patients were not willing to accept redirection to a Klinik Kesihatan and would prefer to visit the Emergency Department despite knowing that their condition or illness is one that does not require emergency treatment. Social media, advertisements and pamphlets must be made available to educate patients on the proper use of the Emergency Department.
Prenatal exposure to chronic stress during critical periods of foetal development produces depression, attention and learning deficits, hormonal imbalances and affects the brain. The effect of prenatal restraint-stress on the postnatal developmental milestones, anthropometric measurements, and the body, brain and adrenal gland weights of the pups were examined and compared with the unrestrained control and the restrained group under the pyramid at postnatal day 10 and 21. Pregnant rats were restrained (9h/day) from gestation day 7 until parturition. Results showed significant delay in the milestones by one day in the restraint control (RC) compared to the unrestrained normal control (NC), while pups of the restrained pyramid (RP) group did not show the delay. Significant decreases in the anthropometric measurements, body and brain weights in RC group were observed at both postnatal days, while the RP group results matched with the NC group. Significant increase in the adrenal weights was found in the RC group compared to NC group and not the RP group. Results suggest prenatal restraint-stress definitely hampers the developmental milestones, anthropometric measurements, and body and brain weights of the young offspring. Results suggest, pyramid environment counteracts and protects the deleterious effects of chronic prenatal stress.
Diabetic amyotrophy also known as Bruns-Garland syndrome is diabetic neuropathy subtype affecting the lumbosacral nerve roots and peripheral nerves. There is an ongoing debate on the pathophysiology behind this condition whether is it ischaemic, metabolic (hyperglycaemia) or inflammatory. A 36-year-old man with uncontrolled diabetes mellitus complained of unprovoked weight lost and right proximal thigh discomfort with weakness for one week duration. In neurological examination, his right hip flexion was at medical research council (MRC) grade 3, right hip extension MRC grade 4, his knee and ankle flexion and extension are normal (MRC grade 5). The muscle tones and reflexes were normal. Sensation and proprioception were intact bilaterally. Nerve conduction study (NCS) showed markedly reduced amplitude of the compound muscle action potentials and sensory nerve action potentials, while conduction velocities show only mild slowing. He was started on a course of oral prednisolone 10 mg daily and improved gradually. At three months follow-up, his right lower limb power has recovered fully and he can walk without any assistance. Diabetic amyotrophy was confirmed by suggestive clinical features supported by electrophysiological findings of the affected nerves. This condition is due to metabolic derangement and vasculopathy or immune mediated nerve injury. So, the healthcare providers should be aware about this rare complication of diabetes.
Electrocardiogram (ECG) is a record of electrical activity of the heart. PQRST waves represent
the electrical activities of atria and ventricles. A complete three-dimensional electrical activity is
possible to be recorded using a 12-lead ECG. The normal and different routinely-met clinical ECG
are elaborated and discussed. This routine, normal and abnormal ECG, like arrhythmias and heart
block records as well as their clinical notes shall be educational information for the medical students.
Evidence-based data confirm the relationship between an increased availability of effective contraception and reduction in induced abortion rate. In Malaysia, the contraception prevalence rate in 1966 was 8.8 per cent to 52 per cent in 1984, but has levelled off since then. In recent years there has been increasing report of babies ‘abandonment’ in Malaysia. The aim of this study is to determine the knowledge, attitudes and practices related to contraception among women and doctors in Kota Kinabalu the capital of Sabah, Malaysia. Descriptive and analytical community-based cross-sectional study was used. A total of 240 women and 60 doctors were selected from either private or public clinics. The instrument used was face-to-face interview for the women and self-administered questionnaires for doctors. Analysis was done using SPSS version 21. The doctors (80%) felt that contraception is extremely important, and routinely discuss (63%) with their patients. Oral contraceptive pill (97%) is the most common type of contraceptive available in their clinics. About 68% of doctors surprisingly cited that abstinence plays a major part in their contraceptive advice. The average correct answer by doctors on knowledge is 62%. The women surveyed (98.8%) have heard of contraception. The main reason for using is for spacing of pregnancy and many stopped or did not use because of fear of side effects. Women attending the public clinic appear to know more about female and male sterilization and intrauterine contraceptive device compared to those attending private clinic. Further research is needed to reinforce this study.
Study site: Klinik Kesihatan (maternal and child health clinics), private general practitioner clinics. Kota Kinabalu, Sabah, Malaysia
Ludwig’s angina is a grave, fatal cellulitis usually occurs in adults. If it is diagnosed early along with
immediate treatment planning can save a life. In this case, it is a widespread dental infection which
extends to the neck and chest, therefore elevation of floor of mouth which causes respiratory
obstruction. Airway protection techniques along with proper parenteral antibiotics and meticulous
surgical drainage are the mainstay of treatment in a case of advanced staged Ludwig’s angina.
Ebola virus disease (EVD) is an emerging and remerging zoonosis associated with high fatality rate, mainly caused by the Zaire Ebola virus (ZEBOV) and Sudan Ebola virus (SEBOV) strains. Approximately 20 epidemics of EVD have been documented mainly in Central African countries since 1976. Currently, there are no therapeutics agents and vaccines yet approved for EVD. However, several promising therapeutics and vaccines candidates are actively undergoing various phase of clinical development. This study aims to study the EVD dynamics and evaluate the potential impacts of vaccines and other preventive measures on EVD transmission control and significance of medical intervention on outcome of the disease. An initial branch chain model of EVD dynamics was built based on data obtained from previous study. Different epidemiological scenarios for EVD with impacts of intervention were simulated using Berkeley-Madonna Version 8.3.18 software. Every reduction in the exposure rate of EBV infection by 10% produces two- to five-fold improvement in protection against EVD. Transmission control is optimum when the rate of exposure to EBV infection is reduced below 1%. Optimal control of EVD transmission can be achieved through strategic implementation of successful vaccination programme, and other preventive measures as well as rapid delivery of supportive medical care.
Many studies on postural photogrammetry had reported various intra-class correlation coefficients (ICC) across postural variable measurements, however no conclusive solution was given. This reliability and cross-sectional study was done in June 2016 at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah. A total of 24 male adult subjects with mean age 28.5 years (± 4.8 years), body mass 24.97 kg (± 3.85 kg) and height 166.6 cm (± 6 cm) were evaluated for standing postural photogrammetry. Four sets of manually digitized posture image files (by 4 raters) were measured and statistically analyzed for interrater agreement as well as the influence of image resolution and camera height from the floor on various postural variable measurements. The ICC between 4 raters for all postural variables was excellent (the lowest ICC was 0.940 for Q Angle of the Right Knee measurements). Two-Way ANOVA showed that postural variable measurements were not affected by either image resolution or camera height from the floor. Scrupulous attempts done on standing postural photogrammetry amplified the potential for standing postural evaluation in clinical settings.
The main objective of this study was to obtain information regarding the effects of educational and socio-economic status of the patients on the prescribing pattern of non-steroidal antiinflammatory drugs (NSAIDs) by the qualified medical personnel in the outpatient departments (OPDs) of two selected polyclinics in Kota Kinabalu, Sabah, Malaysia. A total of 200 selected patients (100 from each polyclinic) attending the OPDs were interviewed using a questionnaire. Again data were collected, photocopied and later analyzed. Educated and higher income group of patients mostly attended in a Private Polyclinic (PPC) whereas less educated and lower income group of patients generally attended UMS Polyclinic (UPC). This was reported as a probable reason for the wide variations in the prescribing pattern with respect to pharmacological subclasses of NSAIDs in the OPDs of two polyclinics. The present results strongly support that probable reason. The number of patients taking NSAIDs before coming to hospital was more in PPC compared to UPC. They were influenced by pharmacists, friends and doctor’s advice given previously. In conclusion, it may be mentioned that overall prescribing pattern of NSAIDs among two polyclinics is rational.
The Diamond Dialogue has previously been used as a research tool, as a way of evaluating the effectiveness of development of interventions in changing quality of life in a variety of contexts. This paper aims to describe the development of the Diamond Dialogue as a community intervention tool to reduce alcohol-related harm. This was part of an action research study. Focus groups, using the Diamond Dialogue, were conducted during workshops to reduce alcohol-related harm in two different villages. The Diamond Dialogue was initially used as a tool to better understand how drinking was affecting their quality of life. The Diamond Dialogue was intentionally used as part of the intervention in one village, with the discussion on alcohol and quality of life leading into discussion on community level change to reduce alcohol-related harm. The discussion notes were analysed for themes related to quality of life and alcohol use. Alcohol was seen by community members to have both positive and negative effects on the community. Using the Diamond Dialogue as an intervention lead to greater levels of engagement, created a collective motivation to change and led to community level action planning. Exploring community ambivalence towards alcohol, acceptance of both the positive and negative effects and validation of the community’s views provided a platform for engagement. This then lead to “change talk” about adopting low-risk drinking and ownership of possible solutions for alcohol related problems.
The needs of family members of patients have often been neglected. Many investigations have presented that meeting the needs of families and helping them cope with the period of hospitalization will improve the well-being of relatives of patients admitted to the Intensive Care Unit (ICU). The aim of this study was to identify the needs of family members of patients admitted to the ICU at Queen Elizabeth Hospital, Kota Kinabalu, Sabah. This cross-sectional study recruited 60 family members, and a validated Critical Care Family Needs Inventory in Bahasa Malaysia was used to verify the needs of these families. The outcomes disclosed that family members ranked “assurance” as their utmost need. “support” was ranked the least important. The differences in mean values of gender, education level, history of admission and types of relationships among the family members were trivial. The results of this research will help us prepare guidelines to educate ICU healthcare providers, as well as information pamphlets for the relatives of admitted patients.
Intrauterine infection has emerged to be the main and frequent cause of premature delivery and foetal demise. Microorganisms gain entry into the amniotic cavity via ascending route, haematogenous dissemination, retrograde seeding from peritoneal cavity and accidental introduction during invasive procedures. This is a case of foetal loss in utero from a twin pregnancy due to intrauterine sepsis diagnosed through placenta examination. Both maternal and foetal evidences of inflammatory response were demonstrated in the placenta on histology. Microscopically, there were acute chorioamnionitis and villitis as well as abundant gram positive cocci in the foetal blood within placental villous capillaries. The presence of intravascular bacterial organism provides evidence for a conclusive diagnosis of intrauterine sepsis, particularly where the placenta or foetal blood microbiological cultures results are not available or equivocal. More attention should therefore be given when sampling, as pathological evidences of underlying foetal compromise or death could be provided by well-represented placental tissue samples.
Dandy-Walker syndrome is a rare congenital malformation of the brain that involves the cerebellum and the fourth ventricle. It is characterised by a classical triad of hydrocephalus, cystic dilatation of the fourth ventricle and complete or partial agenesis of the vermis. Majority of cases are diagnosed during neonatal or early infantile period. In this case report, a seven-year-old boy complained of recurrent headaches for the past one year. Physical examination was unremarkable. Examination of the fundus on the same day revealed bilateral papilloedema. His subsequent computed tomography scan of the brain done at a major district hospital demonstrated features in keeping with Dandy-Walker malformation. Our case highlighted the importance of embarking on a detailed and thorough approach when dealing with a child with chronic headache, especially in rural settings where advanced medical equipment is not readily available.
Xylazine is an alpha-2agonist often used as a sedative, analgesic and muscle relaxant agent
in animals. Xylazine was not accepted by Food and Drug Administration (FDA) for human use
due to hazardous side effect such as hypotension, bradycardia, respiratory depression and coma.
This is a rare case report of a 64-year-old farmer who accidentally injected himself with Xylazine
which was supposed to be given to a fractious cow. He developed altered conscious level, hypotension, bradycardia and respiratory failure requiring mechanical ventilation. Fortunately, he
recovered and was discharged home after three days. This occurred due to improper handling of
Xylazine without standard operating procedures. Xylazine is regulated for animal use only. Therefore, effects of Xylazine toxicity in human must be emphasized for awareness on proper handling as well as for right management of its poisoning incident in future.
Obscure gastrointestinal bleeding is a surgical enigma of disastrous proportions. Patient’s haemodynamic status often dictates the path of management ranging from endoscopy, embolization and/or surgery. Minority of the cases has failed to identify the exact source of bleeding during endoscopic and imaging techniques. Emergency surgery is warranted in hypovolaemic shock which has failed to respond to fluid and blood resuscitation. We present a 72-year-old male with an obscure upper gastrointestinal bleeding due to ruptured cystic artery pseudoaneurysm and illustrate the rarity of the presentation with successful management.
Purple urine bag syndrome (PUBS) is a rare presentation of urinary tract infections (UTIs). It is commonly seen in constipated patients. There is a deep purple discoloration of contents of urine bag due to presence of indigo and indirubin pigments which are metabolites of tryptophan. We would like to describe an interesting case of purple urine bag syndrome of 88-year-old woman who presented with catheter-related urinary tract infection. She had low-grade fever and suprapubic discomfort for three days duration. She had increased white cell count and C-reactive peptide (CRP). Urinalysis showed protein 2+, nitrite and leucocyte esterase positive. Urine culture grew Escherichia coli and Klebsiella pneumoniae. She was treated with oral cefuroxime and recovered. This case report may be the first case of PUBS reported in this region.
Reconstruction of hand injury is the challenge for the surgeon especially in rural settings. This case report is about a 10-year-old boy, who sustained large degloving wound of dorsum of right hand with extensor tendon injury following a road traffic accident. We performed a staged abdominal flap with tensor fascia lata graft for tendon reconstruction as microsurgery facilities was not available. Post-operatively he was subjected to physiotherapy and he has a functional right hand. This case report aimed to highlight abdominal flap as reconstructive option as compared to skin grafting which is reproducible with limited resources. Besides that, overall exposure to all surgical options is of paramount importance in the training of trainees to equip them with skills to serve in rural setting.
Medication errors (MEs) are preventable mistakes that occur when there is a failure in the treatment process of any disease that can cause potential harm to patients. Having an effect on patients, health outcomes and costs incurred, it does burden our economically-developing country. Database systems have been created worldwide for the reporting of MEs, but varying countries practise different classifications of MEs hence it poses a challenge to categorize them. This makes it next to impossible to fully curb this continual problem. There are a number of classifications of MEs, based on mistakes and errors based on skills, based on the mistakes itself, based on symptoms and based on the stages of drug delivery system. This review summarizes the pre-existing classifications of MEs.
Rowing exercise is one of the cardiorespiratory exercises that induce higher aerobic capacity. Cardiorespiratory parameters, cardiac output (CO), stroke volume (SV), and heart rate (HR) are indicators to measure one’s cardiorespiratory fitness. The aim was to study the effects of 12-week rowing training on resting cardiac output (RCO), resting stroke volume (RSV), and resting heart rate (RHR) of stroke survivors. Ten stroke survivors (6 males; 4 females), mean age of 43.6 ± 16.15 years, were subjected to a 12-week rowing training (Concept II Rowing Ergometer, Model C, USA). An individualised programme was prescribed based on %HRR for each of stroke individual. Rowing training was conducted twice per week (12 HIIT; 12 MR). Paired t-test and repeated measures ANOVA (RPM ANOVA) were used for statistical analyses using IBM® SPSS® Statistics 20 software. RPM ANOVA analysis showed no significant effect on RCO [F (5, 45) = 1.066, p = 0.392, RSV [F (2.188, 19.693) = 0.677, p = 0.532)], and RHR [F (5, 45) = 0.856, p = 0.518]. Paired t-test showed no significant difference between pre- and posttest despite the improved values of Mean ± Standard Deviation (RCO: 8129.50 ± 3916.31 to 8494.18 ± 6248.86 mL/min; RSV: 99.27 ± 33.98 to 121.84 ± 66.24 mL; RHR: 78.02 ± 17.39 to 77.17 ± 11.98 bpm) for all respective parameters. Twelve weeks rowing training did not improve resting cardiorespiratory parameters of stroke survivors statistically. Future studies are suggested to include gender difference and medication effect variables.