A 40-year-old woman, a grand multipara with uncertain gestation, presented with severe, prolonged... more A 40-year-old woman, a grand multipara with uncertain gestation, presented with severe, prolonged diarrhoea. She was previously diagnosed to have melanoma. Examination revealed gross ascites with hepatosplenomegaly and uterus corresponding to 29 weeks gestation. An emergency caesarean section confirmed widespread metastases to the ovaries, mesentery and placenta. A viable male foetus was delivered with features of intrauterine growth restriction. The baby survived, but the mother died a week later. This case highlights the importance of thoroughly assessing placentas and babies of patients with melanoma for metastases.
Risky sexual activities among youths are on the increase, the use of condom may provide some prot... more Risky sexual activities among youths are on the increase, the use of condom may provide some protection. This study assessed gender differences in awareness, perception and condom use among youths aged 18-24 years in Kuala Lumpur. A cross sectional survey using anonymous, self-administered questionnaire was conducted among 935 female and 653 male youths. Analysis shows no differences by place of birth or living arrangement but females had higher education and more males were employed. 3.3% males and 6.6% females were married but significantly more males (14.9%) compared to females (9.4%) reported sexual intercourse. During their first intercourse, only 26/121 (21.5%) sexually active males and 10/113 (8.8%) sexually active females reported condom use. For both, less than 1% had seen a health provider for any contraceptives, condom, or emergency contraceptive services in the last one year. Among the sexually active, condom was the most commonly reported contraceptive ever used (64.5% ...
1. During human pregnancy marked vasodilatation occurs in arterial and venous vascular beds. The ... more 1. During human pregnancy marked vasodilatation occurs in arterial and venous vascular beds. The mechanisms responsible for this change remain unclear. The contribution of increased nitric oxide activity to vasodilatation associated with pregnancy was determined by examining superficial hand vein responses to NG-monomethyl-L-arginine, an inhibitor of nitric oxide synthase, in post-partum women 24-48 h after delivery when vasodilatation remains at levels present during the third trimester. 2. Seventeen healthy women, 24-48 h post partum, and 13 healthy non-pregnant women were studied. Eight of the post-partum women underwent repeat studies 12-16 weeks after delivery. 3. NG-monomethyl-L-arginine (100 nmol/min) resulted in venoconstriction in non-constricted veins (baseline, 0%; 5 min, 26 +/- 9%; 10 min, 14 +/- 8%; 15 min, 8 +/- 7%; means +/- SEM) and noradrenaline-constricted veins (5 min, 30 +/- 7%; 10 min, 24 +/- 10%; 15 min, 14 +/- 11%). No constrictor response to NG-monomethyl-L-a...
The Southeast Asian journal of tropical medicine and public health, 2002
A total of 1,661 pregnant women aged between 13 and 45 years were screened for bacteriuria by uri... more A total of 1,661 pregnant women aged between 13 and 45 years were screened for bacteriuria by urine culture. Of the 1,661 culture results, 615 (37%) yielded no growth; 728 (43.8%) yielded no significant growth (presence of <10(5) organisms/ml urine of one or more types of bacteria); 286 (17.2%) yielded mixed growth (presence of >10(5) organisms/ml urine of more than one type of bacteria) and only 32 (1.9%) showed significant growth (presence of >10(5) organisms/ml urine of a single bacterium). Urine microscopy was also conducted. Two hundred and twenty-four (13.5%) specimens had >10 white blood cells/ml urine, of which 66 had >100 white blood cells; 13 were from the significant growth group. Three hundred and seventy-four (22.5%) specimens showed the presence of bacteria, 42 (2.5%) had red blood cells, 370 (22.3%) had epithelial cells, 58 (3.5%) had crystals, and 14 (0.8%) had yeasts. The most common bacterium isolated was Escherichia coli (12; 40%); the others includ...
The incidence of a coexistent normal fetus is quoted in literature as 1 in 22,000 to 100,000 preg... more The incidence of a coexistent normal fetus is quoted in literature as 1 in 22,000 to 100,000 pregnancies and may be associated with multiple complications including persistent trophoblastic neoplasia. A 35-year-old woman with a complete mole and a coexistent normal fetus presented with multiple complications but was successfully managed until 30 weeks' gestation and gave birth to a healthy, normal female fetus. After delivery the mother recovered completely with no evidence of persistent trophoblastic disease. Although termination of pregnancy is an option chosen by most patients, continuing the pregnancy while optimizing the maternal condition by appropriate management of complications can result in a successful outcome.
The Southeast Asian journal of tropical medicine and public health, 2006
This was a retrospective study of patients with dengue infection in pregnancy from year 2000 till... more This was a retrospective study of patients with dengue infection in pregnancy from year 2000 till 2004. Data were analyzed by looking at the presentation, complications of patient and fetus, and pregnancy outcomes. There was a total of 16 cases with an increasing trend (0.12% in 2003 vs 0.25% in 2004). The mean age of patients was 30.19+/-6.85 years. Fifty percent of patients were multiparae and in their third trimester. The average gestation was 24.44 weeks with 7.5 days being the average duration of ward admission. Tourniquet test was positive in 62.5% of patients. Dengue serology IgM was positive in 50% whereas dengue serology IgG were positive in 68.8% of patients. There were three cases of maternal death. One patient presented as missed abortion. Preterm deliveries happened in 50.0% of the women. There were 4 premature babies, one in-utero fetal death, and two fetuses which suffered acute fetal distress. Three babies required intensive care. One unrelated fetal anomaly resulted...
Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové, 2011
This prospective observational study was done to analyse the prevalence of gestational diabetes m... more This prospective observational study was done to analyse the prevalence of gestational diabetes mellitus (GDM) among primigravidae and its outcome. All healthy primigravidae with singleton pregnancies were offered universal glucose tolerance testing between 16 and 28 weeks gestation. GDM and non GDM groups were managed according to hospital protocol. The antenatal features and pregnancy outcomes were analysed. Out of 616 primigravidae, 113 (18.34%) were GDM with slightly older (27.9 +/- 4.2 versus 26.32 +/- 3.3, p < 0.001) age. The mean fasting and two hours postprandial blood glucose in both groups were 4.99 +/- 1.08 mmol/l, 8.86 +/- 1.41 mmol/l(GDM) and 4.36 +/- 0.43 mmol/l, 5.71 +/- 1.11 mmol/l (Non GDM), respectively. Maternal family history of diabetes mellitus, weight exceeding 80 Kg, polyhydramnios (2.65% versus 0.2%, p = 0.028) and neonatal hyperbilirubinaemia (9.73% versus 2.98%, p = 0.01) occurred significantly more frequent in the GDM group compared to normal. There wa...
Dysmenorrhoea is painful menstruation that occurs in 45-72% of all women. This was a prospective ... more Dysmenorrhoea is painful menstruation that occurs in 45-72% of all women. This was a prospective randomised study of the efficacy of etoricoxib (Arcoxia) compared with mefenamic acid (Ponstan) in treating primary dysmenorrhoea. All single, sexually inactive women with primary dysmenorrhoea were randomised into two groups (mefenamic acid and etoricoxib) of pain relief and underwent a cross-over study. The success of treatment as evidenced by pain relief, the side-effects and complications were observed and analysed. Some 80% (20 women) had significantly better pain relief with etoricoxib, compared with only 20 per cent in the mefenamic acid group (p = 0.007). Etoricoxib has significantly fewer side-effects compared with mefenamic acid (p = 0.005) with significantly reduced menstrual blood loss (p = 0.025). In conclusion, etoricoxib is a better treatment for primary dysmenorrhoea with better pain relief, less menstrual blood loss and fewer side-effects compared with mefenamic acid.
A 40-year-old woman, a grand multipara with uncertain gestation, presented with severe, prolonged... more A 40-year-old woman, a grand multipara with uncertain gestation, presented with severe, prolonged diarrhoea. She was previously diagnosed to have melanoma. Examination revealed gross ascites with hepatosplenomegaly and uterus corresponding to 29 weeks gestation. An emergency caesarean section confirmed widespread metastases to the ovaries, mesentery and placenta. A viable male foetus was delivered with features of intrauterine growth restriction. The baby survived, but the mother died a week later. This case highlights the importance of thoroughly assessing placentas and babies of patients with melanoma for metastases.
Risky sexual activities among youths are on the increase, the use of condom may provide some prot... more Risky sexual activities among youths are on the increase, the use of condom may provide some protection. This study assessed gender differences in awareness, perception and condom use among youths aged 18-24 years in Kuala Lumpur. A cross sectional survey using anonymous, self-administered questionnaire was conducted among 935 female and 653 male youths. Analysis shows no differences by place of birth or living arrangement but females had higher education and more males were employed. 3.3% males and 6.6% females were married but significantly more males (14.9%) compared to females (9.4%) reported sexual intercourse. During their first intercourse, only 26/121 (21.5%) sexually active males and 10/113 (8.8%) sexually active females reported condom use. For both, less than 1% had seen a health provider for any contraceptives, condom, or emergency contraceptive services in the last one year. Among the sexually active, condom was the most commonly reported contraceptive ever used (64.5% ...
1. During human pregnancy marked vasodilatation occurs in arterial and venous vascular beds. The ... more 1. During human pregnancy marked vasodilatation occurs in arterial and venous vascular beds. The mechanisms responsible for this change remain unclear. The contribution of increased nitric oxide activity to vasodilatation associated with pregnancy was determined by examining superficial hand vein responses to NG-monomethyl-L-arginine, an inhibitor of nitric oxide synthase, in post-partum women 24-48 h after delivery when vasodilatation remains at levels present during the third trimester. 2. Seventeen healthy women, 24-48 h post partum, and 13 healthy non-pregnant women were studied. Eight of the post-partum women underwent repeat studies 12-16 weeks after delivery. 3. NG-monomethyl-L-arginine (100 nmol/min) resulted in venoconstriction in non-constricted veins (baseline, 0%; 5 min, 26 +/- 9%; 10 min, 14 +/- 8%; 15 min, 8 +/- 7%; means +/- SEM) and noradrenaline-constricted veins (5 min, 30 +/- 7%; 10 min, 24 +/- 10%; 15 min, 14 +/- 11%). No constrictor response to NG-monomethyl-L-a...
The Southeast Asian journal of tropical medicine and public health, 2002
A total of 1,661 pregnant women aged between 13 and 45 years were screened for bacteriuria by uri... more A total of 1,661 pregnant women aged between 13 and 45 years were screened for bacteriuria by urine culture. Of the 1,661 culture results, 615 (37%) yielded no growth; 728 (43.8%) yielded no significant growth (presence of <10(5) organisms/ml urine of one or more types of bacteria); 286 (17.2%) yielded mixed growth (presence of >10(5) organisms/ml urine of more than one type of bacteria) and only 32 (1.9%) showed significant growth (presence of >10(5) organisms/ml urine of a single bacterium). Urine microscopy was also conducted. Two hundred and twenty-four (13.5%) specimens had >10 white blood cells/ml urine, of which 66 had >100 white blood cells; 13 were from the significant growth group. Three hundred and seventy-four (22.5%) specimens showed the presence of bacteria, 42 (2.5%) had red blood cells, 370 (22.3%) had epithelial cells, 58 (3.5%) had crystals, and 14 (0.8%) had yeasts. The most common bacterium isolated was Escherichia coli (12; 40%); the others includ...
The incidence of a coexistent normal fetus is quoted in literature as 1 in 22,000 to 100,000 preg... more The incidence of a coexistent normal fetus is quoted in literature as 1 in 22,000 to 100,000 pregnancies and may be associated with multiple complications including persistent trophoblastic neoplasia. A 35-year-old woman with a complete mole and a coexistent normal fetus presented with multiple complications but was successfully managed until 30 weeks' gestation and gave birth to a healthy, normal female fetus. After delivery the mother recovered completely with no evidence of persistent trophoblastic disease. Although termination of pregnancy is an option chosen by most patients, continuing the pregnancy while optimizing the maternal condition by appropriate management of complications can result in a successful outcome.
The Southeast Asian journal of tropical medicine and public health, 2006
This was a retrospective study of patients with dengue infection in pregnancy from year 2000 till... more This was a retrospective study of patients with dengue infection in pregnancy from year 2000 till 2004. Data were analyzed by looking at the presentation, complications of patient and fetus, and pregnancy outcomes. There was a total of 16 cases with an increasing trend (0.12% in 2003 vs 0.25% in 2004). The mean age of patients was 30.19+/-6.85 years. Fifty percent of patients were multiparae and in their third trimester. The average gestation was 24.44 weeks with 7.5 days being the average duration of ward admission. Tourniquet test was positive in 62.5% of patients. Dengue serology IgM was positive in 50% whereas dengue serology IgG were positive in 68.8% of patients. There were three cases of maternal death. One patient presented as missed abortion. Preterm deliveries happened in 50.0% of the women. There were 4 premature babies, one in-utero fetal death, and two fetuses which suffered acute fetal distress. Three babies required intensive care. One unrelated fetal anomaly resulted...
Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové, 2011
This prospective observational study was done to analyse the prevalence of gestational diabetes m... more This prospective observational study was done to analyse the prevalence of gestational diabetes mellitus (GDM) among primigravidae and its outcome. All healthy primigravidae with singleton pregnancies were offered universal glucose tolerance testing between 16 and 28 weeks gestation. GDM and non GDM groups were managed according to hospital protocol. The antenatal features and pregnancy outcomes were analysed. Out of 616 primigravidae, 113 (18.34%) were GDM with slightly older (27.9 +/- 4.2 versus 26.32 +/- 3.3, p < 0.001) age. The mean fasting and two hours postprandial blood glucose in both groups were 4.99 +/- 1.08 mmol/l, 8.86 +/- 1.41 mmol/l(GDM) and 4.36 +/- 0.43 mmol/l, 5.71 +/- 1.11 mmol/l (Non GDM), respectively. Maternal family history of diabetes mellitus, weight exceeding 80 Kg, polyhydramnios (2.65% versus 0.2%, p = 0.028) and neonatal hyperbilirubinaemia (9.73% versus 2.98%, p = 0.01) occurred significantly more frequent in the GDM group compared to normal. There wa...
Dysmenorrhoea is painful menstruation that occurs in 45-72% of all women. This was a prospective ... more Dysmenorrhoea is painful menstruation that occurs in 45-72% of all women. This was a prospective randomised study of the efficacy of etoricoxib (Arcoxia) compared with mefenamic acid (Ponstan) in treating primary dysmenorrhoea. All single, sexually inactive women with primary dysmenorrhoea were randomised into two groups (mefenamic acid and etoricoxib) of pain relief and underwent a cross-over study. The success of treatment as evidenced by pain relief, the side-effects and complications were observed and analysed. Some 80% (20 women) had significantly better pain relief with etoricoxib, compared with only 20 per cent in the mefenamic acid group (p = 0.007). Etoricoxib has significantly fewer side-effects compared with mefenamic acid (p = 0.005) with significantly reduced menstrual blood loss (p = 0.025). In conclusion, etoricoxib is a better treatment for primary dysmenorrhoea with better pain relief, less menstrual blood loss and fewer side-effects compared with mefenamic acid.
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