Domestic violence management in Malaysia: A survey on the primary health care providers

<p>Abstract</p> <p>Aim</p> <p>To assess the knowledge, attitudes and practices of primary health care providers regarding the identification and management of domestic violence in a hospital based primary health care setting.</p> <p>Method</p> <p>A survey of all clinicians and nursing staff of the outpatient, casualty and antenatal clinics in University Malaya Medical Centre using a self-administered questionnaire.</p> <p>Results</p> <p>Hundred and eight out of 188 available staff participated. Sixty-two percent of the clinicians and 66.9% of the nursing staff perceived the prevalence of domestic violence within their patients to be very rare or rare. Majority of the clinicians (68.9%) reported asking their patients regarding domestic violence 'at times' but 26.2% had never asked at all. Time factor, concern about offending the patient and unsure of how to ask were reported as barriers in asking for domestic violence by 66%, 52.5% and 32.8% of the clinicians respectively. Clinicians have different practices and levels of confidence within the management of domestic violence. Victim-blaming attitude exists in 28% of the clinicians and 51.1% of the nursing staff. Less than a third of the participants reported knowing of any written protocol for domestic violence management. Only 20% of the clinicians and 6.8% of the nursing staff had ever attended any educational program related to domestic violence.</p> <p>Conclusion</p> <p>Lack of positive attitude and positive practices among the staff towards domestic violence identification and management might be related to inadequate knowledge and inappropriate personal values regarding domestic violence.</p

Effect of coitus at term on length of gestation, induction of labor, and mode of delivery.

OBJECTIVE: To determine coital incidence at term and to estimate its effect on labor onset and mode of delivery. METHODS: Healthy women with uncomplicated pregnancies and established gestational age were recruited to keep a diary of coital activity from 36 weeks of gestation until birth and to answer a short questionnaire. Two hundred women with complete coital diaries were available for analysis. Outcome measures include coitus, postdate pregnancy (defined as pregnancy beyond the estimated date of confinement), gestational length of at least 41 weeks, labor induction at 41 weeks of gestation, and mode of delivery. RESULTS: Reported sexual intercourse at term was influenced by a woman's perception of coital safety, her ethnicity, and her partner's age. After multivariable logistic regression analysis controlling for the women's ethnicity, education, occupation, perception of coital safety, and partner's age, coitus at term remained independently associated with reductions in postdate pregnancy (adjusted odds ratio [AOR] 0.28, 95% confidence interval [CI] 0.13-0.58, P = .001), gestational length of at least 41 weeks (AOR 0.10, 95% CI 0.04-0.28, P < .001), and requirement for labor induction at 41 weeks of gestation (AOR 0.08, 95% CI 0.03-0.26, P < .001). At 39 weeks of gestation, 5 (95% CI 3.3-10.3) couples needed to have intercourse to avoid one woman having to undergo labor induction at 41 weeks of gestation. Coitus at term had no significant effect on operative delivery (adjusted P = .15). CONCLUSION: Reported sexual intercourse at term was associated with earlier onset of labor and reduced requirement for labor induction at 41 weeks

Analysis of peripheral blood of ovarian cancer patients indicates higher sub-populations of natural killer and B cells compared to healthy volunteers

Ovarian cancer is a challenging disease to treat, and one of the potential treatments is by immunotherapy. NK cells have been shown to play a role in slowing tumour progression and cancer development. This study aims to investigate the numbers of NK cells and other lymphocyte sub-populations in ovarian cancer and their impact on ovarian cancer clinical outcome. This project aims to study the significance of different lymphocyte populations, particularly NK cells, involved in the peripheral blood of ovarian cancer patients. Venal blood was drawn from ovarian cancer patients before chemotherapy. PBMCs were isolated from 13 ovarian cancer patients and 11 age-matched healthy volunteers. Immunophenotyping was performed using a commercial kit to quantify the lymphocyte populations and RNA isolation performed to examine the expression of KIR genes using reverse transcription polymerase chain reaction. Immunophenotyping of PBMC was successfully performed on 13 ovarian cancer patients and 11 healthy controls. Significant increases in the mean of peripheral NK cells and B cells were found in ovarian cancer patients as compared to the healthy controls (P=0.0559). No other significant results were obtained for C D4 and CD8 lymphocytes. There was significant increase in numbers of NK cells and B cells in ovarian cancer patients as compared to the healthy volunteers. These results should be pursued with a larger sample size with the hopes of finding a significant difference between the two groups and to provide a keener insight into are promising preliminary results the immune defence against ovarian cancer

Expectant management of missed miscarriage

Early pregnancy losses occur in 10-20% of all pregnancies. Surgical evacuation has always been the mainstay of management of miscarriages. The main aim of this study was to understand the success rate of expectant management of miscarriage with regards to gestational sac size and period of gestation. The secondary outcome was to measure the satisfaction level and the rate of pregnancy after 6 month of expectant management. Patients diagnosed with missed miscarriages were requested to choose between expectant or surgical management. Those decided for expectant management on “wait and watch” approach were assessed weekly up to 5 completed weeks until complete miscarriage was achieved spontaneously. Surgical evacuation was performed if medically indicated or requested by the patients at any time or at the end of fifth week if complete miscarriage was not achieved. Out of 212 cases, 75 (35.4%) opted for expectant management. Complete miscarriage was achieved in 85.3% of subjects by the end of fifth weeks respectively. Mean of Gestational sac size and period of gestation was not found to influence the success rate of complete spontaneous miscarriage in the expectant management. No morbidity was recorded during the five weeks of the study period. Mean satisfaction score was 9.7±8.3. Pregnancy occurred in 47% of patients within 6 months follow up. The Receiver operation characteristic (ROC) curve analysis suggested the end of second week as the cut off for surgical intervention. This study revealed that expectant management of missed miscarriage is a reliable management of missed miscarriage within the first two weeks

Characteristics of human spermatozoa harvested in culture media with and without serum proteins

This study was aimed to determine the efficiency of synthetic protein-free media in spermatozoa washing, preparation and retention of the activity of washed spermatozoa over short periods in vitro. Normozoospermic semen samples (n = 71) were equally apportioned and washed using synthetic protein-free medium (PFM), minimum essential medium + HSA (MEM) or commercial protein-containing medium (CPC). Washed spermatozoa were cultured in vitro using PFM, MEM or CPC media and held for 24 hrs at 4°C, 15°C, 22°C or 37°C. Spermatozoa activity was evaluated at 0 hr, 4 to 7 hrs and 24 hrs post-wash. The effects of PFM on spermatozoa motility, vitality, membrane integrity and DNA fragmentation level were not significantly different from that of MEM and CPC media at 0 hr, 4 to 7 hrs and 24 hrs post-wash in vitro. Synthetic PFM, MEM and CPC retained spermatozoa activity highest when specimen were held at 22°C and it was significantly higher (p 0.05) were noted in spermatozoa DNA fragmentation (SDF) levels when specimen were held at 22°C or 37°C at 4 to 7 hrs and also after 24 hrs post-wash in vitro in all media. The use of synthetic PFM as an alternative to the commercial protein-containing media in human spermatozoa washing and preparation procedure for an efficient and safer (Assisted Reproduction Technology) ART outcome. Spermatozoa activity can be successfully retained at room temperature post-wash over short periods; spermatozoa may lose viability rapidly if held for long hours at 37°C in all media

Common variants at theCHEK2gene locus and risk of epithelial ovarian cancer

Genome-wide association studies have identified 20 genomic regions associated with risk of epithelial ovarian cancer (EOC), but many additional risk variants may exist. Here, we evaluated associations between common genetic variants [single nucleotide polymorphisms (SNPs) and indels] in DNA repair genes and EOC risk. We genotyped 2896 common variants at 143 gene loci in DNA samples from 15 397 patients with invasive EOC and controls. We found evidence of associations with EOC risk for variants at FANCA, EXO1, E2F4, E2F2, CREB5 and CHEK2 genes (P ≤ 0.001). The strongest risk association was for CHEK2 SNP rs17507066 with serous EOC (P = 4.74 x 10(-7)). Additional genotyping and imputation of genotypes from the 1000 genomes project identified a slightly more significant association for CHEK2 SNP rs6005807 (r (2) with rs17507066 = 0.84, odds ratio (OR) 1.17, 95% CI 1.11-1.24, P = 1.1×10(-7)). We identified 293 variants in the region with likelihood ratios of less than 1:100 for representing the causal variant. Functional annotation identified 25 candidate SNPs that alter transcription factor binding sites within regulatory elements active in EOC precursor tissues. In The Cancer Genome Atlas dataset, CHEK2 gene expression was significantly higher in primary EOCs compared to normal fallopian tube tissues (P = 3.72×10(-8)). We also identified an association between genotypes of the candidate causal SNP rs12166475 (r (2) = 0.99 with rs6005807) and CHEK2 expression (P = 2.70×10(-8)). These data suggest that common variants at 22q12.1 are associated with risk of serous EOC and CHEK2 as a plausible target susceptibility gene.Other Research Uni

Identification of six new susceptibility loci for invasive epithelial ovarian cancer.

Genome-wide association studies (GWAS) have identified 12 epithelial ovarian cancer (EOC) susceptibility alleles. The pattern of association at these loci is consistent in BRCA1 and BRCA2 mutation carriers who are at high risk of EOC. After imputation to 1000 Genomes Project data, we assessed associations of 11 million genetic variants with EOC risk from 15,437 cases unselected for family history and 30,845 controls and from 15,252 BRCA1 mutation carriers and 8,211 BRCA2 mutation carriers (3,096 with ovarian cancer), and we combined the results in a meta-analysis. This new study design yielded increased statistical power, leading to the discovery of six new EOC susceptibility loci. Variants at 1p36 (nearest gene, WNT4), 4q26 (SYNPO2), 9q34.2 (ABO) and 17q11.2 (ATAD5) were associated with EOC risk, and at 1p34.3 (RSPO1) and 6p22.1 (GPX6) variants were specifically associated with the serous EOC subtype, all with P < 5 × 10(-8). Incorporating these variants into risk assessment tools will improve clinical risk predictions for BRCA1 and BRCA2 mutation carriers.COGS project is funded through a European Commission's Seventh Framework Programme grant (agreement number 223175 ] HEALTH ]F2 ]2009 ]223175). The CIMBA data management and data analysis were supported by Cancer Research.UK grants 12292/A11174 and C1287/A10118. The Ovarian Cancer Association Consortium is supported by a grant from the Ovarian Cancer Research Fund thanks to donations by the family and friends of Kathryn Sladek Smith (PPD/RPCI.07). The scientific development and funding for this project were in part supported by the US National Cancer Institute GAME ]ON Post ]GWAS Initiative (U19 ]CA148112). This study made use of data generated by the Wellcome Trust Case Control consortium. Funding for the project was provided by the Wellcome Trust under award 076113. The results published here are in part based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancer Institute and National Human Genome Research Institute (dbGap accession number phs000178.v8.p7). The cBio portal is developed and maintained by the Computational Biology Center at Memorial Sloan ] Kettering Cancer Center. SH is supported by an NHMRC Program Grant to GCT. Details of the funding of individual investigators and studies are provided in the Supplementary Note. This study made use of data generated by the Wellcome Trust Case Control consortium, funding for which was provided by the Wellcome Trust under award 076113. The results published here are, in part, based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancerhttp://dx.doi.org/10.1038/ng.3185This is the Author Accepted Manuscript of 'Identification of six new susceptibility loci for invasive epithelial ovarian cancer' which was published in Nature Genetics 47, 164–171 (2015) © Nature Publishing Group - content may only be used for academic research

Cis-eQTL analysis and functional validation of candidate susceptibility genes for high-grade serous ovarian cancer

Genome-wide association studies have reported 11 regions conferring risk of high-grade serous epithelial ovarian cancer (HGSOC). Expression quantitative trait locus (eQTL) analyses can identify candidate susceptibility genes at risk loci. Here we evaluate cis-eQTL associations at 47 regions associated with HGSOC risk (P≤10−5). For three cis-eQTL associations (P<1.4 × 10−3, FDR<0.05) at 1p36 (CDC42), 1p34 (CDCA8) and 2q31 (HOXD9), we evaluate the functional role of each candidate by perturbing expression of each gene in HGSOC precursor cells. Overexpression of HOXD9 increases anchorage-independent growth, shortens population-doubling time and reduces contact inhibition. Chromosome conformation capture identifies an interaction between rs2857532 and the HOXD9 promoter, suggesting this SNP is a leading causal variant. Transcriptomic profiling after HOXD9 overexpression reveals enrichment of HGSOC risk variants within HOXD9 target genes (P=6 × 10−10 for risk variants (P<10−4) within 10 kb of a HOXD9 target gene in ovarian cells), suggesting a broader role for this network in genetic susceptibility to HGSOC

A case report of fatal outcome of cerebral venous sinus thrombosis with cerebral hemorrhage during early pregnancy secondary to antithrombin III deficiency

Objectives: Cerebral venous sinus thrombosis (CVST) with cerebral hemorrhage is relatively rare but may result in a catastrophic outcome. Antithrombin III deficiency is an inherited disease that contributes to an increase in the occurrence of thromboembolic events during pregnancy. Case Presentation: A nulliparous, 34-year-old Chinese woman at 9 weeks of pregnancy with underlying antithrombin III deficiency was under treatment with low dose molecular weight heparin. She presented with a frontal headache and projectile vomiting. A plain computed tomography (CT) scan and magnetic resonance angiography and venography (MRAV) of the brain showed features suggestive of CVST involving superior sagittal sinus with venous infarct and right frontal and left parietal intraparenchymal hemorrhage. During admission, she developed episodes of fainting and loss of consciousness. A repeated brain CT scan showed worsening intraparenchymal hemorrhages with midline shift, subfalcine herniation and cerebral edema. An emergency bilateral craniectomy was performed to relieve the intracranial pressure. Despite the surgery and supportive measures, the patient succumbed to death. Conclusion: Due to the highly hypercoagulable state of pregnancy with concomitant antithrombin III deficiency, preconception counselling including optimization of anticoagulant dosage is crucial. In addition, the administration of antithrombin III concentrate should be considered during pregnancy for women with antithrombin deficiency