Genetic structure and haplotype diversity of Tachypleus gigas population along the west coast of peninsular Malaysia-inferred through mtDNA AT rich region sequence analysis.

A detailed investigation was carried out to determine the genetic structure and haplotype diversity of Malaysian horseshoe crab (Tachypleus gigas [Muller, 1785]) distributed along the west coast of Peninsular Malaysia. Mitochondrial DNA (AT rich region = 369 bp) analysis showed that T. gigas had 13 haplotypes along the Malaysian west coast of which 4 were unique to Selangor samples while 3 were unique to Johor sample and 1 each were unique to other two stations respectively. Highest haplotype diversity (h) was observed among the Selangor samples (0.873±0.071) followed by Langkawi, Johor and Kedah samples with 0.833±0.222, 0.752±0.066 and 0.733±0.155 values, respectively. Over all haplotype diversity of T. gigas in west coast of Malaysia was observed to be 0.797±0.129. Pair wise haplotype frequency (FST) value were statistically significant (p<0.05) for all the groups except for Langkawi/Kedah samples indicating higher gene flow (Lower haplotype diversity) among these two populations. Average nucleotide diversity (π) was higher in Selangor samples (0.0083±0.001) followed by Johor (0.0063±0.0011) and it was almost similar in Langkawi (0.0045±0.0012) and Kedah (0.0040±0.0008) samples which indicated higher polymorphic sites in Selangor and Johor samples while it was lower in Langkawi and Kedah samples. In addition phylogenetic analysis clearly clustered T. gigas samples from T. tridentatus samples indicating good phylogenetic signals in mtDNA AT rich region. Overall, findings from this study have important implications for proper management and conservation of this living fossil along the west coast of Peninsular Malaysia

Maternal outcome of prenatally diagnosed lethal fetal anomalies: a year review

Objectives: To determine maternal morbidities in relation to prenatal diagnosis of lethal fetal anomalies and termination of pregnancy (TOP). Materials: Twenty five patients with prenatal diagnosis of lethal fetal anomalies in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia. Methods: This was a retrospective review in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia in the year of 2011. All patients diagnosed prenatally to carry lethal fetal anomalies was reviewed. Data regarding maternal morbidities and outcome was collected from patients’ case note in the hospital record office. Analysis was done by using SPSS version 17.0. Results: Twenty five pregnant patients were diagnosed with lethal fetal anomalies via ultrasound with or without genetic study. The patients’ mean age was 29.9±6.3 years old. The mean gestational age at diagnosis of lethal fetal anomalies and at TOP or delivery were 26.5±7.4 and 28.7±7.8 weeks respectively. The lethal fetal anomalies included fetuses with multiple structural abnormalities (40%), anencephaly or severe encephalocele (32%), non-immune hydrops fetalis (16%) and syndromic fetuses (12%) i.e. Pentalogy of Cantrell and Edward’s syndrome. Seven (28%) patients had early counseling and TOP at the gestation of <22 weeks. Beyond 22 weeks gestation, 8 (32%) patients had TOP and 10 (40%) patients had spontaneous delivery. Twenty (80%) patients delivered or aborted vaginally, 3 (12%) patients with assisted breech delivery, and 2 (8%) patients with abdominal delivery. The abdominal deliveries were for transverse lie in labour and emergency hysterotomy for failed induction complicated by hysterectomy due to intraoperative finding of ruptured uterus. Overall, the associated adverse events included abnormal lie during delivery (16%), symptomatic polyhydramnios requiring amnioreduction (16%), post-partum haemorrhage (12%), retained placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital stay was 6.6±3.7 days. Conclusions: Prenatal diagnosis and TOP at an early gestation may reduce maternal morbidities and improve the outcom

The impact of intrapartum pethidine on the neonatal outcome: a perspective review

Objective: To study the effect of intrapartum pethidine administration on the fetal heart rate pattern and neonatal outcome. Method: This is a prospective observational study done on forty low risk uncomplicated pregnancy at term in the first stage of labour. The study was done in the labour suite in Hospital Tengku Ampuan Afzan Kuantan, Malaysia. Intramuscular Pethidine 1mg/kg was given as intrapartum analgesia to all consented patient with normal baseline fetal heart rate and clear liquor. Intrapartum fetal heart rate pattern and neonatal outcome were reviewed and analysed by SSPS 17.0. Results: Total of 40 patients recruited in this study with mean age of 27.9 ± 6.03 years and mean gestational age of 39.0 ± 0.81 weeks. The mean duration from pethidine administration to delivery is 285.5 ± 178.9 minutes (4 hours and 45 minutes). Out of 40 patients, 2 (5%) cases had suspicious CTG 1 hour post pethidine administration, first one with absence of acceleration and the second with early deceleration which lasted for 45 minutes and one hour respectively. All neonates delivered with good Apgar Score, 8 at 1 minute and 9 at 5 minute. A total of 9 (22.5%) cases were admitted to the Neonatal Intensive Care Unit (NICU). Seven (17.5%) cases were admitted for observation because of delivery less than 4 hours after pethidine administration, following the neonatal protocol at our centre. Two (5%) cases were admitted for G6PD. Neither required ventilation nor antidotes. All of them were discharged to mother after 24 hours apart from those admitted because of G6PD. Conclusion: Intrapartum pethidine is still an analgesic option which is simple, cheap and easily available without major effect to the fetal heart rate pattern and the neonatal outcome

Maternal outcome of prenatally diagnosed lethal fetal anomalies: a year review

This was a retrospective review in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia In the year of 2011. All patients diagnosed prenatally to carry lethal fetal anomalies was Reviewed. The outcome of the pregnancy including type of labour, mode of induction and delivery, and associated morbidities during antenatal, intrapartum, and postpartum period was analyse

Effect of intrapartum pethidine on the neonatal outcome: is it duration related?

Objectives: To study the effect of pethidine on the intrapartum fetal heart rate (FHR) pattern and to assess the neonatal outcome with regards to the interval between pethidine administration to delivery of the fetus. Materials: 73 healthy women intrapartum from labour suite hospital Tengku Ampuan Afzan, Kuantan, Malaysia Methods: This is a prospective observational study done on 73 healthy consented women with singleton pregnancy at term . All fetus were normal, vertex presentation with reactive FHR tracing before pethidine administration. FHR recording were performed for 40 minutes prior to and one hour post pethidine. Cervical dilatation of all patients ≤ 4 cm at time of pethidine administration. Intramuscular pethidine 1mg/kg was given as an intrapartum analgesia. The study sample was divided into two groups, first group delivered within 4 hours and second group delivered more than 4 hours after the pethidine administration. The data were analysed by SSPS 17.0. Results: the mean age of the recruited patients is 28.15 ± 6.15 years and mean gestational age of 39.14 ± 1.094 weeks. The mean duration from pethidine administration to delivery is 296.48 ± 173.65 minutes (4 hours and 56 minutes). Four (5.5%) cases had suspicious CTG 1 hour post pethidine, 1 with absence of acceleration for 45 minutes and 3 cases with early deceleration lasted for 60 to 90 minutes. Out of 73 patients, 38 babies delivered within 4 hours and 35 delivered after 4 hours of pethidine. All neonates delivered with good Apgar Score (AS), 8 at 1 minute and 9 at 5 minute except 1 with AS of 5 at 1 min and 7 at 5 min which delivered more than 4 hours after pethidine. Sixteen (21.9%) cases were admitted to the Neonatal Intensive Care Unit (NICU). Eleven (68.75%) cases were admitted due to neonatal sedation from the delivery group less than 4 hours after pethidine. Five (31.25%) cases from the delivery group more than 4 hours, 4 cases with a diagnosis of transient tachypnea of newborn and 1 secondary to meconium aspiration syndrome (MAS). All discharge to mother after 24 hours, non required ventilation apart from the one with MAS which required ventilation for one day and longer admission. Despite of the higher number of those require admission in the less than 4 hours group, it was not statistically significant with P value of 7.44. Conclusions: Pethidine can be used as an intrapartum analgesia which is safe, easily available without major effect on fetal heart rate pattern and neonatal outcome even if given in advance stage of labour

Background knowledge, attitude and practice of contraception among Pahang women

Objectives: 1. To study the knowledge awareness regarding contraception among women from Pahang.. 2. To identify the most popular method of contraception in use. 3. To find out the common reasons for the less frequent use of contraception. 4. To asses factors impacting knowledge in the use of contraception. METHOD This cross sectional study included 200 women from Pahang state from the first of September to 31st of December 2012. Any women with history of sexual exposure and consented were included to this study. Questioner was given in malay language to each female who asked to answer it on the spot and without assistant unless for the indication of reading for those who cannot read and write(just three illiterate women required the assistant). RESULT Out of 200 participants who were included in this study, the majority 87%(174) were in the reproductive age between 20- 40 year old, 11.5%(23) age more than 40 and 1.5%(2) less than 20. Ninety five percent are married(190) and 5% (10) are unmarried. A 53% (106) have tertiary education, 41.5(83) participants with secondary level. Four percent(8) and 1.5%(three) responder were from primary and no education background respectively. Majority of the responder were Malay 185(92.5%), Indian 2.5%(five),Chinese 1.5 %(3) and 3.5% (7) others. There is positive correlation between the educational status and the knowledge of contraception, being higher among ladies with tertiary education about 54.2% and lowest 1.1% in among women without education background. The practice of contraception followed the same pattern. Almost 50%(97/200) of respondents were aware of modern contraception,only the minority (4/200) only aware of tradisional contraception and the other 50%(99/200) were know both type of contraception. Among the respondents 76%( 152/200) were believed that contraception were effective. and 12.5%(25/200) were not effective and a nonnegligible proportion 11.5%(23/200) were not sure. A large number of women 70%(140/200) stated that no contraception side effects, 15.5%(31/200) talking about that and 14.5%( 29/200) were unsure. Educational level had broadly positive impact on the mentioned attitude. The method known to the greatest degree were contaceptives pills 27.7%(46),condom 15%(25) and combinations method. Among all the women 22.5%(38) choosed other method of contraception. A total of hundred respondents were not using any contraception method in this study, 52%(52) due to inconvenience side effects 12%(12) related to medical problems and 36%(36) because of other reasons. Among 190 married women, 88.9% of them had a discussion with husband regarding contraception and 87.1%(148) had gained support from husband. Out of these 70.5%(134) agreed to practise contraception in future. CONCLUSION Educational level had significant impact on the knowledge ,attitude and practice of contraception among Pahang Women with majority of them gained husband support

Translation and validation of Bahasa Malaysia version of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Quality of Life Questionnaires (IIQ-7), a cross sectional study

Background: Urinary incontinence (UI) demonstrates major prevalence in women of different population groups. Reduced quality of life (QOL) is observed due to incontinence problems. Urogenital Distress Inventory (UDI-6) and Incontinence Impact Quality of Life (IIQ-7) are useful disease-specific questionnaires evaluating the impact of urinary incontinence on the QOL of women which is accepted internationally. Objective: This study aims to translate and validate UDI-6 and IIQ-7 in Malay language. Methods: A cross sectional study, which recruited 100 participants from two urogynecology clinics. Both questionnaires were initially translated from English to Bahasa Malaysia followed by back translation and final correction done by the professional translators. The participants were requested to maintain a urinary record of the upcoming week for three days that assisted in quantifying the severity of symptoms. None of the subjects were assigned any treatment during the study period. Validity and reliability of the translated questionnaires were determined by checking the internal consistency and also by doing test-retest. Results: The internal consistency levels of the UDI-6 and IIQ-7 Bahasa Malaysia questionnaires were 0.73 and 0.90 respectively with good test-retest (0.86 and 0.95). Incontinence episodes were strongly associated with obstructive, irritative, and stress symptoms. The factor of day time voiding had strong correlation with obstructive and irritative symptoms. Conclusion: UDI-6 and IIQ-7 did not measure similar outcomes; however, both questionnaires have their strengths in clinical settings. Analysis has also revealed that the Malaysian versions of both questionnaires had appropriate test-retest validity and reliability. Thus, it can be said that both of the questionnaires had great importance for screening patients with urinary incontinence in Malaysia

The outcome of transpelvic magnetic stimulation (TPMS) in treating women with urinary incontinence and overactive bladder : a prospective observational study

Pelvic floor muscle therapy (PFMT) is the simplest said to be and the most effective treatment for lower urinary tract dysfunction (LUTs) if it is done properly in a motivated women. Transpelvic Magnetic Stimulation (TPMS) is useful in women who are not able to effectively contract their pelvic floor muscle. Pulsed Magnetic Technology (Extracorporeal Magnetic Innervations (ExMI) ) has been developed for stimulation of pelvic floor muscle and approved by the US Food and Drug Association (FDA) in 1998. It generates pulsed magnetic fields which induces an electrical depolarization of the nerves within the pelvic floor thus causing the pelvic floor muscle to contract. The advantage of magnetic fields is it penetrates all tissue without significant alteratio

Cerebroplacental Ratio (CPR) as predictor of perinatal outcome in induction of labour

Doppler velocimetry studies of the placenta and the fetal circulation provide important information regarding the fetal well-being. When apply in appropriate conditions it may provide an opportunity to improve the perinatal outcome. Objective : To assess the usefulness of cerebro-placental ratio (CPR) Doppler in predicting perinatal outcomes among women who were scheduled for induction of labor. Methodology: There were 203 antenatal women recruited for CPR Doppler studies at 37 week and above gestations. CPR less than 1 was taken as predictor of adverse perinatal outcomes. The adverse perinatal outcomes were evaluated by intrapartum cardiotocograph (CTG), mode of delivery, meconeium-stained liquor, arterial cord blood pH, Apgar score at 5 minutes and admission to neonatal intensive care unit (NICU). Result: Low CPR was significantly associated with abnormal intrapartum CTG (p<0.001), caesarean or operative deliveries for fetal compromised (p<0.001) and low arterial cord blood pH (p<0.001). Conclusion : CPR was a valuable investigation in predicting the perinatal outcomes prior to induction of labor

Material outcome of early versus late termination of pregnancy among pregnant mothers with prenatal diagnosis of lethal fetal anomalies: a retrospective review

Objective: To compare the maternal morbidities between early (< 22 weeks gestation) and late (≥ 22 weeks gestation) termination of pregnancy (TOP) among pregnant mothers with prenatal diagnosis of lethal fetal anomalies. Methods: This was a retrospective study reviewing all patients diagnosed prenatally to carry lethal fetal anomalies in Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia during the year of 2011. Data was traced from patients’ medical record in hospital record office. These patients were divided into 2 groups, i.e. early and late TOP groups. The maternal morbidities and outcome of these 2 groups of patients were compared. Data was analyzed by using SPSS version 17.0. Results: There were 25 patients diagnosed (via ultrasound with or without genetic study) to have lethal fetal anomalies, included fetuses with multiple structural abnormalities (40.0%), anencephaly or severe encephalocele (32.0%), non-immune hydrops fetalis (16.0%) and syndromic fetuses (12.0%) i.e. Pentalogy of Cantrell and Edward’s syndrome. Seven (28.0%) and 18 (72.0%) patients had early and late TOP respectively. All patients with early TOP aborted vaginally. Among those with late TOP, 5 (27.8%) patients had complicated delivery, included 3 (16.7%) with assisted breech delivery and 2 (11.1%) with abdominal delivery. The abdominal deliveries were for transverse lie in labour and emergency hysterotomy for failed induction complicated by hysterectomy for ruptured uterus noted intraoperatively. Patients with late TOP were more prevalent to morbidities compared to early TOP arm, i.e. frequent hospital admissions (33.3% vs 14.3%), abnormal lie in labour (22.2% vs 0.0%), symptomatic polyhydramnios requiring amnioreduction (22.2% vs 0.0%), post-partum haemorrhage (16.7% vs 0.0%), blood transfusion (11.1% vs 0.0%) and uterine rupture (5.6% vs 0.0%). Mean duration of hospital stay was slightly longer in the late TOP group (6.9±4.1 days) than the early TOP group (5.7±2.8 days). One patient with late TOP developed impending eclampsia requiring IV MgSO4 infusion. However, there was higher prevalence of retained placenta in the group of early TOP (28.6%) compared to the group of late TOP (5.6%). One patient with early TOP developed endometritis following manual removal of retained placenta. Conclusion: Patients with late TOP seem to have more morbidities compared to patients with early TOP though the sample size is too small to yield statistically significant result. It may suggest that early prenatal diagnosis and TOP are essential to minimize the maternal morbidities and improve the outcome. More data need to be recruited to prove this conclusion