Prevalence of metabolic syndrome among postmenopausal women and its associated factors at gynaecology clinic HUSM

The metabolic syndrome has been defined as a constellation of lipid and non-lipid risk factors that increase subjects’ risk to develop cardiovascular disease (CVD). The prevalence of the metabolic syndrome increases with age and after the onset of menopause, and may explain in part the apparent acceleration of cardiovascular disease in postmenopausal women determine the prevalence of metabolic syndrome among postmenopausal women and its associated factors at Gynaecology clinic HUSM. A cross-sectional study of all postmenopausal women that was conducted in Hospital Universiti Sains Malaysia. It involved all 411 patients who were postmenopausal and their age more than 45 years old, attending the Gynaecology clinic HUSM. Sociodemographic data, waist circumference, weight, height and blood pressure were recorded and a fasting blood sample obtained for serum glucose and results. Metabolic syndrome was defined in accordance with criteria of International Diabetic Federation (IDF). xvi lipid profile determinations. Woman were counseled and managed according to the The mean age of participants Results: was 57.2 + 6.9 years. The prevalence of metabolic syndrome, according to IDF criteria, was 36.7%. Using the same criteria, 100%, 78.8%, 67.5%, 58.3% and 53% of women presented with abdominal obesity hypertension, low high density lipoprotein (HDL) cholesterol, hypertriglyceridemia and diabetes, respectively. In this study we found that 92.2%, 71%, 42%, 19.4%, and 4.6% of all the participants had at least one, two, three, four, or five components, respectively. The risk of MS detection (univariate analysis) increased with presence of obstetric history of HPT (odds ratio (OR) 2.64, 95% (CI) 1.25-5.62), family history of HPT (odds ratio (OR) 1.71 , 95% (CI) 1.13-2.59) and obesity (odds ratio (OR) 2.59, 95% (CI) 1.08-6.23 ), and the usage of contraception (odds ratio (OR) 1.56, 95% (CI) 1.02-2.42). However, only family history of Hypertension (HPT) which accounts 45.4% is the most important associated risk factor to develop metabolic syndrome (MS) by using multiple logistic regression analysis. There is a high prevalence of the metabolic syndrome in postmenopausal Kelantan women seeking gynaecologic health care. The determinant factors of metabolic syndrome related to previous obstetric HPT history, family history of HPT and obesity, and contraception consumption. Therefore more effort should be encouraged toward the implementation of lipid screening and educational programs focused on high-risk populations to prevent cardiovascular morbidity and mortalit

Massive haemorrhage secondary to placenta percreta in the first trimester: a case report

Placenta percreta detected in the first trimester is a very rare condition. It is a known obstetric condition leading to serious maternal morbidity and mortality. High index of clinical suspicion and anticipation of placenta percreta is highly essential in early pregnancy as it is difficult to diagnose. The authors report on a patient who presented with heavy pervaginal bleeding in week 9 of pregnancy. Pelvic examination showed a 12-week sized uterus. Ultrasonography revealed a non-viable fetus. The subsequent emergency curettage performed was complicated by massive haemorrhage which required an abdominal hysterectomy performed as a life-saving procedure

THE NEEDS OF MANAGEMENT MODEL FOR PROFESSIONAL COMPETENCE TRAINING OF BASIC SCHOOL TEACHERS

Abstract This study aims to: (1) To determine the needs form of professional competence training management model required in working groups of teachers (KKG); group5, region3in the district ofGowa (2) To obtain initial design model of professional competence training management of teachers working group (KKG) group5, region3in the district of Gowa. This study uses the design R & D, research and development by Borg and Gall (1983) and by Sukmadinata is modified into 3 steps of research and development, the research stage developed, namely: (1) the preliminary study stage as needs and contens analysis, (2) the development stage as the design, development, and evaluation, (3) the stage of testing the effectiveness of the product as a semi-sumative evaluation. Results of the study: (1) Based on the questionnaire the training needs it is known that the condition of the training needs of professional competence in elementary school teacher of high category with a mean score of 3.42. (2) The need for professional competence training management model that is expected of teachers in elementary schools need to start from: (1) planning (needs analysis, designing); (2) the implementation of the (developing and implementing); and (3) evaluation. Keywords—model, management training, professional competence, the teachers working group

Fertility preservation opportunities for cancer patients in Malaysia

Fertility preservation is significant for oncology patients to maintain their ability to start a family when they are ready. Onco-fertility, as a discipline, exists at the intersection of oncology and reproductive medicine that safeguards and expands the fertility options for cancer survivors, by facilitating early intervention and suitable treatment with favourable outcomes. Successful fertility preservation requires a comprehensive networking among the gynaecologists, oncologists, pathologists, imaging and other specialists, involved in diagnosing and treating cancer in the reproductive age group. There are several ways in which fertility can be preserved, like role of gonadotrophin releasing hormone analogues, in vitro maturation, and cryopreservation

Short term neonatal outcomes of singleton term breech delivery: two year experiences in a Malaysian tertiary hospital

Background: There are few neonatal complications of breech delivery including the low Apgar score, birth trauma, admission to neonatal unit and perinatal mortality. Objective: To review the short term complications and their associating factors among singleton term breech infants in relation to mode of delivery. Methodology: This is a cross-sectional study that involves 294 term singleton pregnant women with breech presentation in Hospital Serdang, Malaysia from January 1, 2014 to December 31, 2015. Data abstracted from the delivery record book and the hospital database computerised system were used to compare the short term outcomes of singleton term breech infants born via vaginal breech delivery and pre-labour or in-labour caesarean section. Results: Out of 294 cases, 25% (n=73) displayed a successful vaginal delivery, whereas the remaining 75% (n=221) have undergone caesarean delivery. It was more common in multiparous women (64.3%) and frank-typed of breech (59.9%) is more prevalence compared to others. Nulliparity was found significantly predominant in caesarean section delivery (OR 2.38, 95% CI 1.114-5.084, p= 0.005), while the complete-typed of breech was significantly lesser in caesarean section group (OR 0.47, 95% CI 0.246-0.915, p= 0.026). However, there was no significant difference discovered in adverse neonatal outcome regarding the mode of delivery. Conclusion: Pre or in- labour caesarean section and vaginal delivery in terms of singleton breech presentation contains a similar risk of adverse neonatal outcome. According to this study, the main risk factors affecting the mode of delivery are parity and type of breech presentation

Metastatic Adenocarcinoma of right supraclavicular lymph nodes from primary ovarian cancer: a rare presentation

Background: Lymph-node metastases to the right supraclavicular lymph nodes (RSCLNs) in ovarian malignancies are very rare occurrences. The majority of RSCLN metastases normally originate from primary neck, lung, and esophagus malignancies. A literature review revealed that only 2 cases of ovarian metastases to the RSCLNs have been reported. Case: A 28-year-old, single nulliparous woman presented to a local tertiary hospital with a 2-month history of progressive abdominal distension. This was associated with a loss of appetite and a marked weight loss. She had no significant medical illnesses or family history of malignancies. Examination revealed a nontender palpable lymph node in the right supraclavicular region, measuring 4 × 3 cm. No other lymph nodes were palpable at the left supraclavicular or cervical areas. There was also gross ascites. Other examination results were unremarkable. A computed tomography (CT) scan showed an RSCLN mass and complex solid-cystic masses arising from the pelvis. Fine-needle aspiration (FNA) biopsy of the RSCLN was performed, revealing a metastatic adenocarcinoma with features compatible with serous adenocarcinoma of the ovary. Results: This patient was treated successfully with neoadjuvant chemotherapy that was followed by a total abdominal hysterectomy, and bilateral salpingo-oophorectomy, omentectomy, and appendectomy. She was alive with no recurrences at a 1-year regular follow-up. Conclusions: The rarity of RSCLN metastases in ovarian cancer might incline clinicians to neglect the presence of RSCLN enlargement during examinations. Thus, clinicians should examine both left and right SCLNs thoroughly in women suspected of having gynecologic malignancies

Malignant melanoma of the uterus: a rare cause of postmenopausal bleeding

Background: Malignant melanoma of the uterus is a very rare disease entity bearing potentially serious consequences with an unpredictable and poor prognosis. Case: A 64-year-old woman who had a longstanding, slow-growing blackish mass of the right big toe for more than a decade, presented with postmenopausal bleeding. Histopathologic examination confirmed the diagnosis of a likely secondary malignant melanoma of the uterus. Results: She was treated successfully without any complications via total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLHBSO). Even though malignant melanoma of the uterus has a poor prognosis, the patient was alive and disease-free at a 1-year regular follow-up. Conclusions: A malignant melanoma of the uterus is very rare and has a poor prognosis. However, laparoscopic excision of the uterus and adjacent organs in selected patients could be a superior option, especially in terms of rapid recovery and minimal tumor spillage. A combined multidisciplinary approach is highly recommended for dealing with malignant melanoma–related diseases for optimal care and a better clinical outcome

Prevalence and correlates of polycystic ovarian syndrome among women attending infertility clinic

Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder which affects 5% to10% of women worldwide. The disease is caused by insulin resistant that results in hyperinsulinaemia, and further stimulates the excessive production of androgen and luteinizing hormone. Hyperandrogenism which is referred to the excessive production of androgen leads to the clinical conditions like acne, obesity, alopecia and irregular menstruation. Previous studies have shown the risk factors of PCOS include age, ethnicity, obesity, smoking, alcohol consumption and menstrual problem. A cross sectional study was conducted at infertility clinic in Hospital Serdang. Simple random sampling was adopted to recruit 138 women who attended the infertile clinic. Data including sociodemographic data, lifestyle factors, medical disorders, gynaecology disorders, family medical history, menstrual problem, diagnostic criteria of PCOS, metabolic parameters, and causes of infertility, were retrieved from medical record. Chi square test and SPSS version 21 was used for data analysis. Among 138 participants, 37.7% are diagnosed with PCOS and 62.3% are not diagnosed with PCOS. Among PCOS patients, 92.3% are found to age less than 35 years old, 90.4% Malay, 75% with menstrual problem and 80.8% obese. Age, menstrual problem, and obesity were significantly associated with PCOS diagnosis. Measures like medical education and healthy lifestyle should be implemented to prevent the complications of PCOS

Acupressure only as pain relief for patient with multiple drug allergies undergoing oocyte retrieval

In vitro fertilization (IVF) is associated with significant stress, which can affect the general wellbeing of the couple as well as the outcome of treatment. Oocyte retrieval (OR) is the fundamental step in the IVF/intracytoplasmic sperm injection (ICSI) cycle. Transvaginal ultrasound-guided OR (TVOR) is the most common method used in assisted reproductive technology (ART). However, even though TVOR is a short and minimally invasive procedure, it is stressful and undoubtedly painful. Such pain is due to the passage of a double-bore needle through the vaginal wall and ovarian capsule followed by mechanical stimulation within the ovary during the procedure

Knowledge, attitude and perception of contraception among medical students in Universiti Putra Malaysia

The incidence of unintended pregnancy and unsafe abortion are significantly high due to the lack of knowledge and negative attitude towards contraception and it can be prevented by effective and appropriate contraceptive knowledge and usage. Considering the future role of medical students as family planning educator as well as counsellors, it is not only important to determine their knowledge, attitude and perception towards contraception but also should be updated for improvement on the quality of future healthcare professionals on contraceptive knowledge which may lead to the reduction in the number of unintended pregnancy with improving maternal morbidity and mortality. This was a cross sectional study using self-reported questionnaires survey that consists of four sections as socio-demographic characteristics information, knowledge towards contraception, attitude towards contraception, and perception of education and training in sexual and reproductive health among medical student. Questions were, distributed among medical students in Faculty of Medicine and Health Sciences and analyzed. The response rate was 100%. and most of the respondents in this study were Malay (64·4%), female (68·3%), single (98·6%) and live in urban area (69·1%). Most of their parents had tertiary education level (father educational level, 63·3%; mother educational level, 50·0%). 56·1% of the respondents had poor level of knowledge and 59.2% of them had negative attitude towards contraception. Regarding the perception on contraception, most of the respondents thought that they did not have sufficient clinical practice (50·4%) though adequate training (57·6%) in counselling the patients for family planning service during their clinical posting. There was a significant association between gender, place of birth, ethnicity, marital status, father educational status and level of knowledge. There were a higher percentage of respondents who had poor knowledge and negative attitude towards contraception. Assessing the knowledge and attitude of medical students on contraception and their relationship with socio-demographic characteristics and socio-economic factors plays a leading role in public health projects which are aimed to combat maternal mortality through reducing unintended pregnancies. To change the attitude towards contraception and further increase the level of knowledge of contraception among medical students, collaborated health education and similar studies among health workers are highly recommended