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

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

Fluctuations in Serum magnesium and Systemic Arterial Blood Pressures during the Menstrual Cycle in young reproductive women

Introduction: The menstrual cycle involves a sequence of structural, functional, and hormonal changes in the reproductive system. This is linked and controlled by cyclical fluctuations in the levels of FSH, LH, estrogen, and progesterone. Because of these cyclical fluctuations, there might also be associated cyclical changes of magnesium and systemic arterial blood pressures during the menstrual cycle. Purpose: To assess the changes in serum magnesium level and systemic arterial blood pressures during the menstrual cycle in young reproductive women. Methodology: the sample population is 40 apparently healthy young reproductive-aged 18- 25years female students from the University of Medicine, Magway participated in this study. Systemic arterial blood pressures were measured by indirect method. The serum magnesium level was measured by spectrophotometry. These measurements were done in the early follicular phase (EF), the peri-ovulatory phase (PO), and the midluteal phase (ML) of the menstrual cycle. The serum magnesium levels were significantly (p <0.001) lower, and the systolic blood pressures were significantly higher (p <0.05) in the PO than the EF and the ML. In the EF, there was a significant negative correlation between serum magnesium level and diastolic blood pressure (r= - 0.374, p <0.05) and mean arterial pressure (r = -0.354, p < 0.05) but no significant correlation with systolic blood pressure. In the PO, there was no significant correlation between serum magnesium level and systemic arterial blood pressures. In the ML, there was significant negative correlation between serum magnesium level and systolic blood pressure (r = -0.651, p <0.001), diastolic blood pressure (r = -0.607, p <0.001), and mean arterial pressure (r = -0.661, p <0.001). Conclusion: The study concludes that serum magnesium level has a negative effect on blood pressure changes and the blood pressure-lowering effect of magnesium. These changes are related to the fluctuation of estrogen levels during the menstrual cycle. KEYWORDS: Serum magnesium, systemic arterial blood pressures, menstrual cycle reproductive syste

Bioactive compounds screening, antimicrobial activities of leave extract from two palatable plants: Piper betle and Murraya koenigii (Curry leaves)

Introduction: Piper betle Linn is one of the most commonly used compounding plants for ethno-medical purposes, with its extract generally used in modern products to enrich their functional efficacy. The extraction methods always lead to differences in the antimicrobial efficacy of methanol extracts of bioactive compounds. Purpose: The study was conducted to screen for bioactive compounds and determine their antimicrobial efficacy in a methanol extract of Piper betle and Murraya koenigi leaves from five different regions. Methodology: The phytochemical screening done according to the procedure that is implied in from Patil, et.al, with minor modifications by the researchers of the current study. Antimicrobial activity was determined; efficacy was measured by disc diffusion analysis. Results: Phytochemical screening revealed the presence of saponin, tannin, terpenoids, alkaloids and flavonoids in the extracts. The methanolic extract of betel leaves from all the selected regions except from Bau exhibited antimicrobial activities. Among them, extract from Kuching and Simunjan have no effect on E. coli. The methanolic extract of curry leaves from Kuching, Balai ringai and Bau have antimicrobial activities against Staph aureus and those from Balai ringai is also active against E.coli. Conclusion: Although there were previous reports of phytochemical screening and antimicrobial activities from the extract of these plants, there were still lack of research conducted on the specimens especially from our local community (Sarawak). The outcome of this study will help us to identify the bioactive compounds of the local samples and give us some pictures of their activities on how to ensure these plants can be brought forward based on the origin of the sample. KEYWORDS: Bioactive Compounds Screening, Antimicrobial Activities of Leave Extract, Palatable Plants, Piper betle and Murraya koenigii

Risk factors for cesarean delivery in primigravida during spontaneous labor

Objective: To identify the risk factors for cesarean delivery among primigravida at Hospital Serdang. Methodology: This was a case control study which involved total 260 of 130 primigravida patients that underwent cesarean section (cases) and 130 primigravida patients that underwent vaginal delivery (control) at obstetrics and gynaecology department of Hospital Serdang, Malaysia from January until June 2013. A standardized proforma was used to collect the data of each primigravida patient presenting in spontaneous labour at term with singleton pregnancy with either caesarean or vaginal delivery. Results: Majority of the cases were Malaysian (86.9%) and mostly were from Malay ethnic group (75.4%). In multivariate logistic regression analysis, presence of hypertension status (odds ratio [OR] 5.7, 95% CI; 1.56-20.84) and gestational age less than 40 weeks (OR 2.60, 95% CI 1.34-5.02), fetal weight more than 3000gm (OR 1.8, 95% CI 1.1-2.95), were associated with higher odds of cesarean delivery. Conclusion: Primigravida with presence of hypertension, having gestational age less than 40 weeks and heavier fetus were associated with higher odds of cesarean delivery

Integrating a Mobile-Learning Platform for Enhancing Clinical Teaching: The Learners’ Perspective

The role of mobile technology has become an integral part of daily activity among today’s society, including medical schools and hospitals. This study aimed to establish a mobile-learning platform for providing high-quality clinical teaching in undergraduate medical education. It was a mixed-methods design of quantitative survey and qualitative focus-group discussions to analyse the learners' view for acceptance of technology-integrated learning in clinical teaching at Universiti Sultan Zainal Abidin. Forty-two undergraduate medical students from years 3 and 5 participated in this study. The vast majority found that a mobile-learning platform was a helpful medium for the integration of leaning resources and collaboration with other health-care professionals in a clinical setting (p<0.001). They generally agreed that there is an improvement in clinical competence, confidence in clinical reasoning and focusing on the discussion by providing constructive feedback (p<0.001). The qualitative focused group discussion’s findings indicated that most of the participants expressed their satisfaction with improving their intellectual skills and their anticipation of achieving strategic learning via integrated bedside teaching with mobile-group discussions. Overall, the participants accepted that a mobile-learning platform integrated bedside teaching is a constructive, productive approach for enhancing and facilitating their learning in a clinical setting. This study offered a unique insight into learners’ perceptions of benefits and the limitation of technology-enhanced learning in undergraduate medical training. The essential attributes of mobile technology are crucial for technology integration in high-quality clinical teaching