Introduction: Studies have found that breastfeeding problems are associated with negative breastfeeding outcomes. Unfortunately, assessing breastfeeding problems can be quite difficult. The objective of the paper is to share the process of tool development for the assessment of breastfeeding problem in an Indonesian setting. Methods: The development of the tool was a two-stage process, consisting of understanding the range and pattern of breastfeeding problems (through literature review, discussions with lactation experts, and in-depth interviews with nursing mothers) and the production of the tool (through discussions with graphic designers and communication practitioners, pre-testing the tools, and finalising a workable, viable tool). The process led the authors to use flash cards for assessing the breastfeeding problems. Each card consisted of information about age, a code number, an image and a description of the breastfeeding problem. Each set of the flash cards represented an age period of 0-1, 1-3, and 3-6 months. The final flash cards were used in a cross-sectional study of 205 mothers of infants aged 6-12 months in Maros District, South Sulawesi. Results: The flash cards captured patterns of breastfeeding problems experienced by mothers within the first month, such as sore nipple, no milk production, fatigue, breast engorgement, and sleepy baby, or those problems that persisted throughout the six-month period such as infants' refusal to breastfeed and mothers feeling fatigued. The decreasing or increasing magnitude of a problem over time was also reflected in the flash cards. Conclusion: Identification of the dynamic patterns and magnitude of breastfeeding problems was successfully captured with the use of flash cards.
Plasma cell myeloma is known to cause expansion of a single clone of munoglobulin (Ig) which results in the secretion of a unique homogeneous monoclonal protein (M component). However, there are cases which reported that it can also cause production of two different clones of these monoclonal proteins. Although it is relatively very rare as the prevalence is only 2% of all plasma cell myeloma cases, the clinical features are said to be similar to monoclonal gammopathy. It is suggested that these biclonal gammopathy results from either one monoclonal cell clone in monoclonal gammopathy or two different monoclonal cell clones. Whichever the mechanism of the disease be, the response to treatment seems to be similar as compared to the monoclonal cases although some reports shows chemoresistant. Here, we report a rare case of plasma cell myeloma with IgG (lambda) and IgA (lambda) type of biclonal gammopathy, the clinical presentation, the haematological and biochemical markers as well as the response to the treatment.
Keywords: biclonal gammopathy, M protein, plasma cell myeloma