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Background: The death of a fetus is emotionally traumatic for the parents. It is also distressing for the treating obstetrician. Besides being emotionally challenging, fetal demise raises a lot of questions and increases an obstetrician’s medicolegal risk. The aim of this study was to identify various maternal conditions and socio-demographic factors associated with fetal death and to find the preventable causes of fetal death.Methods: A retrospective observational study was undertaken at Lalla Ded Hospital, Srinagar, Kashmir - a tertiary care centre. The cases of singleton intrauterine fetal deaths (IUFD) with either ultrasound reports proving IUFD or diagnosed on clinical examination by absence of fetal heart sound with gestational age >28 weeks were included. Exclusion criteria includes molar pregnancy and multiple pregnancy.Results: Still birth rate in our study was 19.6 per 1000. Most of the patients with stillbirth belonged to age group of 21-30 years accounting for 67.1% of all cases. Unbooked cases comprised of 58.9%. Most of the study patients i.e. 74.7% belonged to lower middle class. In our study 39% of stillbirth cases were in the range of 28-32 gestational weeks followed by 33.6% cases in 33-37 gestational weeks. Maternal hypertensive disorders had a strong association with IUFD 33.6% (pre-eclampsia 27.4%, eclampsia 6.2%). This was followed by placental abruption comprising 11.7%. Gestational diabetes and severe anaemia accounted for 6.2% and 3.4% respectively. Gross congenital anomalies and fetal infections contributed 2.7% and 2% respectively.Conclusions: Routine antenatal checkups with identification of high risk pregnancies, better access to emergency obstetric care especially during labor, emphasis on institutional deliveries community birth attendant training should help in reducing stillbirth rates in developing countries. Optimal evaluation for future pregnancy is necessary. Counseling and support group should be involved.
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@#algorithm for mobile application and perform a pilot study todetermine its validity and reliability as a tool for vision testin the community.Methods: A simple visual acuity test algorithm in the form ofa single letter E display was designed as the optotype fordevelopment of a mobile application. The standardisedoptotype is presented at random to test visual acuity forcorresponding level of 3/60, 6/60, 6/18, and 6/12. The finalresult is auto-generated based on the classification of theWHO for visual impairment and blindness. The Snellen chartwas used as the gold standard to determine its validity whilefive different users were involved to determine its inter-raterreliability. A pilot study was performed between April tillNovember 2019, in the Universiti Sultan Zainal AbidinMedical Centre (UMC) at Kuala Nerus and MoorisOptometrist Centre at Marang, Terengganu. A total of 279participants aged four years old and above were involved inthis study. Results: The highest sensitivity was found at the vision levelcut-off point of 6/12 with the percentage of 92.7% and 86.8%for the right and left eye, respectively. The specificity wasmore than 89% for all vision levels in both eyes. TheKrippendorff’s alpha value for the inter-rater reliability was0.87 and 0.83.Conclusion: The relatively high level of validity andreliability obtained indicate the feasibility of using thedesigned optotype to develop a valid and reliable mobile appfor vision test. The app can be used to screen vision by non-medical persons, at anytime and anywhere to help improvepublic awareness and capability to correctly determine theirvisual status.
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Background: To determine frequency of different structural uterine anomalies in patients with recurrent pregnancy loss.Methods: This observational study was conducted over a period of one and half year at a tertiary care Hospital, included 40 women with recurrent pregnancy loss who underwent combined laparoscopy and hysteroscopy.Results: Twenty-eight patients (70%) had 3 episodes of miscarriage, eight patients (20%) had experienced 4 abortions and three patients (7.5%) had five abortions. Only one patient (2.5%) had six abortions. 32.5% patients had normal hysteroscopy while as 65% patients had no abnormal finding on laparoscopy. Hysteroscopy was abnormal in 67.5% patients with uterine septum (25%) being the most common finding followed by submucous myoma(20%), polyp (12.5%), cervical incompetence (7.5%) and intra uterine adhesions (2.5%). Laparoscopy was abnormal in 35% patients with endometriosis(17.5%) being the most common finding followed by intra pelvic adhesions (15%) and bicornuate uterus (2.5%).Conclusions: Women with recurrent pregnancy loss have increased association with structural uterine anomalies than general population. Both congenital and acquired uterine anomalies are associated with recurrent abortions.
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Objective: Cataract is the leading cause of blindness inMalaysia. There is an alarming backlog of cataractextraction surgery as the majority believes they did notrequire surgery. This study aimed to explore the barriersat the primary care level to cataract surgery from theperspective of patients with severe cataract blindness.Methods: Eleven participants were involved in thisqualitative research which utilised the interpretativephenomenological analysis approach more renowned inhealth psychology research. All interviews conducted attheir home. The interviews were recorded, typedverbatim, and the transcripts were analysed using NVivosoftware version 8.0.Results: The main barriers identified at the primary carelevel were 1) nondisclosure of their visual problemsoriginated from their belated needs for better sight,delayed awareness of their visual status and socialstigma and 2) patient-provider-related issues namelymiscommunication and delayed referral. The first maintheme explains their belief for not requiring surgery. Thishas led to their delayed awareness and impededdisclosure of their visual problems to family members orprimary care providers. The second main theme reflectsthe provider-patient-related issues which retardedcataract detection and referral process required for earliercataract extraction surgery.Conclusion: Thus, the appropriate approach targeting thesespecific barriers at primary care level will be able to detect,motivate and assist patients for early uptake of cataractextraction surgery to improve their vision and prevent severeblindness.
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Background: Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen, capable of causing a wide spectrum of infections. Treatment is difficult because it is resistant to many antimicrobial agents, thus reducing the treatment options. The aims of this study were to describe the antimicrobial susceptibility patterns and synergistic effect of selected antimicrobial combinations against S. maltophilia isolates. Methods: This was a descriptive cross-sectional study undertaken in the Hospital Universiti Sains Malaysia from April 2011 to March 2012. S. maltophilia isolated from various clinical specimens were included in the study. Antimicrobial susceptibility testing was done using the epsilometer test (E-test) and interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. In the synergy test, the isolates were tested against six different antimicrobial combinations. Results: In total, 84 S. maltophilia isolates were collected and analysed. According to the E-test, the antimicrobial susceptibility of trimethoprim-sulfamethoxazole (TMP-SMX), tigecycline, and ciprofloxacin was 100%, 91.1%, and 88.9% respectively. The antimicrobial combination of TMP-SMX and ceftazidime showed the highest synergistic effect. Conclusion: TMP-SMX remains the antimicrobial of choice to treat S. maltophilia infection. TMP-SMX and ceftazidime was the most effective combination in vitro.
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Background: Depression is one of the common post-menopausal symptoms. In addition to estrogen deficiency, social instability stress may contribute as an additional underlying factor in the development of depressive behaviour in females. Therefore, this study was aimed at examining the influence of social instability stress on depressive behaviour in ovariectomized rats. Methods: The rats were divided into four groups (n = 5 per group); (i) sham-operated control without stress, (ii) sham-operated control with stress, (iii) ovariectomized without stress, and (iv) ovariectomized with stress. These rats were subjected to social instability stress procedures for 15 days prior to an enforced swimming test. Struggling, immobility, and swimming times were recorded promptly. Results: The results were analysed using the one-way analysis of variance (ANOVA) and a P value of < 0.05 was considered as significant. The mean durations of struggling, immobility, and swimming behaviour were significantly distinct among the four groups. Ovariectomized rats exhibited a substantial decrease in struggling and swimming behaviour, and an increase in immobility behaviour in comparison with the sham-operated controls (P < 0.05). Ovariectomized rats with stress displayed a supplementary decrease in struggling and swimming behaviour as well as an advanced increase in immobility behaviour, compared to sham-operated controls with or without stress (P < 0.05). Conclusion: In summary, these findings suggest that ovariectomized rats encountered an augmented amount of depressive behaviour following social instability stress.
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This study describes the prevalence of Clostridium difficile toxin (CDT) in loose stool samples from inpatients aged more than two years of a tertiary hospital. A total of 175 samples that had been examined were from stool samples that were sent to the Medical Microbiology & Parasitology Laboratory for various clinical indications. The toxin was detected by a commercial immunochromatograhic test, and the patients’ demography, clinical features, treatment and outcomes were analyzed from their medical records. Clostridium difficile toxin was positive in 24 (13.7%) of the stool samples. Male and female were 11 (45.8 %) and 13 (54.2 %) respectively, with the majority of them aged more than 50 years. Most were from medical wards (n=21, 87.5%), with the rest from surgical wards (n=2, 8.3%) and intensive care units (n=1, 3.4%). All the CDT positive patients had history of prior antibiotic usage within 6 weeks before the detection of the toxin. The mean duration of antibiotics usage was 17.75 (±13.75) days, while the mean duration of diarrhea was 5.21((± 5.85) days. Eighteen patients had underlying medical illnesses that were diabetes mellitus, chronic renal disease, hypertension, ischaemic heart disease, cerebrovascular disease and malignancy; with seven of them being CDT positive while on chemotherapy. Stool occult blood test was positive in 15 patients whereas presence of pus cells in the CD positive stool samples were detected in 21 patients. The duration of hospitalization among the patients was 27.96 (± 23.22) days.
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The anatomical and patterns of recurrence were studied in 92 patients with first recurrence of breast cancer. Most patients recurred in a single site and 50% of the recurrences were diagnosed within the first 2 years from initial diagnosis. Generally, the status of primary demographic, clinical and pathoanatomical characteristics as well as primary treatment were not predictive as to the development of recurrences. Bone scanning is an effective method to exclude metastatic bone disease. A positive scan, however, requires radiologic confirmation [specificity: 64%]. The diagnostic value of clinical examinations and biochemical tests for liver metastases is satisfactory. Chest X-ray revealed intrathoracic recurrence in 25% [23 patients]. The location of unilateral pleural effusions was significantly related to same site as the primary tumor [P < 0.01]. Local and regional recurrences constituted the most common sites of soft recurrence [37% and 30%]