Severe Haemolytic Disease of Foetus and Newborn due to Anti-c Alloimmunisation in a Multiparous Malay Woman: A case study

Severe haemolytic disease of foetus and newborn (HDFN) is commonly caused by anti-D, anti-c and anti-K alloimmunisation. However, anti-c associated HDFN are infrequent because the majority of infants are relatively often c-negative. This case report describes a severe HDFN due to anti-c alloimmunisation in a multiparous Rhesus D positive mother. The baby was delivered prematurely at 32 weeks of gestation and unable to survive due to hydrops foetalis. Failure to detect anti-c alloimmunisation at the early antenatal period and unknown previous RBC alloimmunisation status were the main reasons for poorly suspicion of HDFN, which lead to improper foetal management and end up with foetal loss. Thus, routine antenatal RBC antibody screening during the early antenatal period is recommended for every pregnant woman with a history of HDFN or at risk for alloimmunisation for early detection and management of HDFN to prevent severe related morbidity or mortality.

The Effect of Family Psychoeducation on Tuberculosis Treatment Adherence of Children in Indonesia

Tuberculosis (TB) is an infectious disease leading cause of death in the world but treatment adherence the most underrated and understudied factor affecting the outcome of TB therapy. The aim of this study was to determine the effect of family psychoeducation on TB treatment adherence of children. The study used a randomized controlled trial (RCT). The sample was 40 pairs of primary caregivers and children who received TB treatment and experienced no side effects of anti-TB drugs in Wonosari Hospital Indonesia in 2019. The treatment group was given psychoeducation by trained health personnel psychoeducators, while the control group was given education by health workers. Psychoeducation was carried out individually, 3 meetings in the first week of the study. Adherence was measured at the sixth month which was the end of treatment period, using a questionnaire. Data were analyzed by using multiple logistic regression. The results showed that family psychoeducation had a significant effect on TB treatment adherence in children after controlling for mother’s knowledge (P-value 0.05 ≤ 0.05). Family psychoeducation is a preventive factor for non-adherence to TB treatment. It is important that psychoeducation is provided to all TB patients to reduce psychological problems that can lead to treatment non-adherence.

Knowledge, Attitude and Practices on Maternal Hypertensive Disorder Among Mothers in Kuantan, Pahang, Malaysia

Maternal hypertensive disorder (MHD) complicates 10% of pregnancy worldwide. In Malaysia, the percentage of maternal deaths due to MHD increased from 2012 to 2017 and did not show any decline yet. Hence, this study was aimed to develop and validate the questionnaires, to measure the level of knowledge, attitude and practices (KAP) on MHD, to evaluate the associated factors and any correlation between KAP on MHD. A cross-sectional study was conducted in Kuantan, Pahang between January 2020 and March 2020. A convenience sampling was used, and self-administered questionnaires were distributed to 100 respondents that fulfil the criteria. The questionnaire was developed through literature review and validated by five medical experts. Then, the pilot study validation was resulted in 0.894 of Cronbach’s Alpha test, which achieved the reliability between the questions. Most of the respondents had a moderate knowledge (n=63; 63.0%), moderate attitude (n=66; 66.0%) and high practices (n=61; 61.0%) on MHD. There was no significant association between socio-demographic factors and KAP of the respondents. A significant correlation is identified between knowledge and attitude (r=0.613, p<0.001) and knowledge and practice (r =0.326, p=0.001) but no significant association between attitude and practice (r=0.183, p=0.068). In conclusion, this study has revealed that majority of the respondents possess moderate knowledge and attitude, and excellent practice on MHD. Hence, future studies that related to KAP on maternal mortality and morbidity across setting should be done so that the early prevention steps can be taken to accommodate the possible problems that may arise in the future.

Effects of Game-Based Task-Oriented Circuit Training on Physical Functions of Stroke Survivors: A Pilot Study in A State Hospital in Kelantan, Malaysia

Despite being increasingly popular and commonly used in rehabilitation, both game-based exercise training and task-oriented circuit training have never been combined to provide a new training experience for stroke survivors undergoing rehabilitation. Past studies have assessed the effectiveness of these exercise approaches separately and reported positive outcomes. Combining the two training programs may create a more enriched environment and yield favorable outcomes. The aim of this study was to determine the effects of game-based task-oriented circuit training on the physical functions of stroke survivors. This research was a pretest-posttest experimental pilot trial involving 30 participants at post-acute and chronic stage post-stroke (mean age and standard deviation = 58.9 ± 6.6 years; mean Montreal Cognitive Assessment scoring = 23.4 ± 7.1) conducted at a state hospital in Kelantan, Malaysia between August 2019 to February 2020. All participants received game-based task-oriented circuit training using a “Checkercise Board” for 45 minutes, twice per week for 8 weeks. The outcome of the training was measured with regard to lower limb strength, functional stability and aerobic capacity, with the use of the 30-second chair rise test, Dynamic Gait Index (DGI) and 6-minute walk test, respectively. Analysis was done by the ‘intention-to-treat’ approach, using paired samples t-test to determine the differences between pre and post-training outcomes scores. All data was analyzed using the Statistics Package for the Social Sciences (SPSS), version 23.0. The significance level was set at p < 0.05 and Cohen’s (d) was used to determine the effect size. Post-training, participants’ mean 30-second chair rise test, DGI and 6-minute walk test scores increased by 9%, 7% and 23% respectively compared to pre-treatment (p < 0.05), with medium effect size of 0.5 to 0.6. Game-based task-oriented circuit training effectively improves lower limb strength, functional stability and aerobic capacity of stroke survivors, and may be used as a therapy option for this population. A future study is needed to confirm these study finding.

Association Between Body Fat Percentage and Level of Physical Activity Among Adolescents in Kuala Nerus, Terengganu

Lack of physical activity among adolescents is one of the factors which lead to the accumulation of body fat and increase prevalence of obesity among Malaysian population. Therefore, this study was aimed to determine the association between body fat percentage and physical activity level among adolescents in Kuala Nerus, Terengganu. This cross-sectional study involved 300 participants consists of 44.7% male and 55.3% female aged between 10 to 16 years old. Anthropometric measurements included body weight, height and waist circumference. Body fat percentage (%BF) was assessed using bioelectrical impedance analysis (BIA). Physical activity was assessed by physical activity questionnaire (PAQ-C) and pedometers in a subsample (n = 50). The result shows that the mean body fat percentage and BMI of the participants were 23.02±9.41% and 20.03±4.77 kg/m2, respectively. Mean PAQ-C score and pedometer steps count for both genders were 1.9±0.42 and 6079±1878, respectively. Male has higher PA level compared to female in their daily life based on PAQ-C score and pedometer steps count. PAQ-C score and pedometer step counts were negatively associated with %BF however there is no significant association between screen time and %BF. As a conclusion, the problems of obesity can be solved by providing strategies to promote active living among adolescents in Malaysia not only focus on increasing physical activity but also emphasise reduction in sedentary behaviours.

A Retrospective Study of Lacunar Stroke Cases in University Malaya Medical Centre (UMMC) According to Age and Gender

Worldwide, stroke was ranked as the second commonest cause of death and the third most common cause of disability-adjusted life-years. Lacunar stroke is one type of stroke. The aim of this study is to determine the dependability of gender differences in lacunar stroke epidemiology on patient age as the influence of gender on stroke risk and outcome changes across the lifespan. Thus, this study was to identify age, and gender differences among lacunar stroke patients at University Malaya Medical Centre (UMMC). This study was conducted retrospectively from January 2016 to December 2019 in UMMC. Patients were selected based on inclusion and exclusion criteria. The inclusion criteria include a clinical diagnosis of lacunar stroke, age categories of middle age (40 – 59 years old) and older age (60 years and above), as well as undergo CT examination. The exclusion criterion is other than lacunar stroke patients. Patient’s data on gender and age were retrieved from the database PACS of UMMC. The analyzation includes cross tabulation of categorical data and independent t-test. Among 94 cases, higher cases of lacunar stroke are found to occur in men (58.51%). Furthermore, both middle age (13.83%) and older age (44.68%) among male patient shows higher percentage of lacunar incidence compared to female patients. Moreover, old age patients (76.60%) for each gender shows higher percentage of lacunar incidence compared to middle-aged patients (23.30%). Meanwhile the independent t-test result demonstrated that the mean age of female patients (67.79) diagnosed with lacunar stroke is not statistically different from the mean age of male patients (68.47). The study indicated that lacunar stroke is most likely to occur in men either at age 40 or 60 and above. Higher cases were recorded in older category which is at age 60 and above for both genders.

Knowledge, Attitude and Practice on Maternal Sepsis Among Mothers in Kuantan, Pahang, Malaysia

Maternal sepsis is one of the main contributors to maternal mortality worldwide. Malaysia has the least number of cases associated with maternal sepsis in 2015. However, the number of cases has increase by eight cases in 2017 as stated by the Family Health Development Division Ministry of Health Malaysia. Hence, this study aimed to investigate the knowledge, attitude and practice on maternal sepsis and its associated factors among mothers in Kuantan,Pahang. A cross sectional study design with convenience sampling were applied to 100 respondents among mothers based on specific criteria. From the findings, the majority of the mothers in Kuantan has good level of knowledge (52%), whereas the level of attitude was moderate (85%). In addition, the finding shows that the level of practice among mothers in Kuantan was excellent (76%). Maternal knowledge significantly associated with the age of the mother with p = 0.007. There was a significant correlation between knowledge and attitude (r = 0.433, p = less than 0.001) and knowledge with practice (r = 0.236, p = 0.018). While attitude and practice (r = 0.194, p = 0.053) showed no significant correlation. This study shows that the mothers in Kuantan, Pahang had good level of knowledge, moderate attitude towards maternal sepsis and excellent practice in preventing maternal sepsis. Continues education on maternal sepsis and other risk factors of maternal mortality should be done especially to young mothers in order to control and reduce the the rates of maternal mortality. Furthermore, this can be a benchmark initiative to achieve the targets in reducing maternal mortality rate in Malaysia as outlined under sustainable development goals 3 (SDG3).

Cytotoxicity Effect and Morphological Changes of Chrysanthemum Morifolium Methanolic Extract against Chronic Myeloid Leukaemia K-562 Cell Line

Chrysanthemum morifolium, also known as “Bunga kekwa” in Malaysia, has various benefits and widely used in Chinese herbal medicines. The plant extract was reported to have significant biological activities, such as anti-inflammation, anti-tumour, anti-oxidant, and anti-cancer. Nonetheless, its anti-cancer potential on chronic myeloid leukaemia has remained elusive. The main goal of this study is to evaluate the cytotoxic effect of C.morifolium buds and flowers in methanolic extracts on chronic myeloid leukaemia malignancy K-562 cell lines. The bud and flower of C.morifolium were macerated for 72 hours in 100% methanol then were concentrated under reduced pressure using a rotary evaporator and oven-dried to obtain crude extracts. K-562 cells were treated with six different concentrations 400, 200, 100, 50, 25, and 12.5 µg/ml and incubated for 24, 48 and 72 hours. The in vitro cytotoxic activity was measured using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT) test and was quantified using a microplate reader at 570 nm. Acridine orange and propidium iodide (AO/PI) staining were used to assess morphological alterations. MTT assays results showed moderate toxicity of both extracts. The lowest maximal half inhibitory concentration (IC50) value were observed at 72 hours of incubation; 182 ± 4.04 ug/ml for BM and 161 ± 7.88 ug/ml for flower extract (FM). However, there was a significantly different IC50 value (p<0.05) between the incubation periods of both treatments where the IC50 value at 24 hours was 301.33 ± 8.51 ug/ml 301 µg/ml in BM, 216 ± 10.79 ug/ml 216 µg/ml in FM and at 48 hours was 227 ± 12.25 ug/ml 227 µg/ml in bud extract (BM), 174 ± 11.92 ug/ml 174 µg/ml in FM. The morphological changes evidence was shown in AO/PI staining by the appearance of a mixed population of cells; early apoptosis, late apoptosis and necrotic cells. These findings suggested that methanolic C.morifolium extracts showed moderate cytotoxic effect on chronic myeloid leukaemia K-562 cells. Further study needed to identify the mode and mechanism of cell death in K-562 cells treated with the C.morifolium extracts.

A case study: Multiple Lacunar Infarct using Magnetic Resonance Imaging

Background: An ischemic stroke takes place when a blood vessel supplying the brain is blocked and blood circulation to a part of the brain is damaged. A lacunar stroke occurs due to one of the arteries that provide blood to the brain's deep structures is blocked. Case Study: A 55-year-old male patient have right cerebrovascular accident (CVA) with left hemiparesis on 16th of August 2019. Normal result was seen by brain Computed Tomography (CT) scanning. Magnetic Resonance Imaging (MRI) brain was done resulted in hyperintense lesion in right pons and foci and Magnetic Resonance Angiography (MRA) was done and resulted in severe basilar artery stenosis.

An Investigation of Exposure to the Eyes and Thyroid of Personnel Near to Patient in Abdominal Radiography: A Phantom Study

Abdominal radiography is beneficial in a variety of clinical situations. Prior to the introduction of multiplanar imaging, it was considered as the main examination for gastrointestinal pathology. However, the radiation dose received is considered high since it is equivalent to the dose of at least 75 chest radiographs. Personnel including staff or relatives may be required to assist patients in many conditions, increasing unnecessary radiation and the likelihood of radiation-induced cancer. The purpose of this study was to determine the radiation dose received by personnel when eyes and thyroid are exposed during abdominal radiography. The Rando and body phantoms were used to represent personnel and patients in this experimental approach. The dose was measured as entrance surface dose (ESD) by using TLD-100, which was positioned at the Rando phantom's eyes and thyroid. The study included a total of twenty exposures, five times at each of four distinct sites. The mean doses (eyes/thyroid in mGy) were (0.083/0.081), (0.090/0.087), (0.093/0.092), and (0.092/0.089), respectively, at locations 1, 2, 3, and 4. The results indicated that there was no correlation between organ and location affecting ESD measurement (p=0.960). There was no significant difference in dose between the two organs (p=0.355), with the mean difference in the eyes being 0.002 more than in the thyroid. The proximity of the eyes to the tube source contributed for the increased dose observed at the eyes. Though ESD was substantial for location pairings 1 vs. 3 (p=0.001) and 1 vs. 4 (p=0.015) owing to the anode-cathode phenomena. In conclusion, personnel should avoid the tube source and cathode region, since they give a greater dose of radiation, particularly when the personnel are closest to the patient and does not have eyes or thyroid protection.