Peripartum hysterectomy clinical characteristics and outcomes- a hospital based retrospective audit study

INTRODUCTION

The study aims to evaluate and report on the clinical characteristics, incidence, risk factors and associated complications of emergency and planned peripartum hysterectomy in a single training and research tertiary health care centre in Malaysia.

MATERIALS AND METHODS

We conducted a 6-year retrospective cross-sectional study from the 1st January 2016 until 31st December 2021. Clinical, demographic characteristics, perioperative parameters, operative indications, blood loss, maternal/neonatal outcomes and complications were analysed. Patients were subdivided, analysed and studied in two subgroups- emergency hysterectomy (EH) and planned hysterectomy (PH).

RESULTS

There were 65 cases of peripartum hysterectomy out of total 100,567 deliveries, with a prevalence rate of 0.06%. Overall, the majority of patients were multiparous (96.9%), having previous caesarean scar (73.8%) or diagnosed with placenta praevia (75.4%). More than half of the total patients (61.5%) have both previous caesarean scar and concomitant placenta praevia. EH was carried out in 39(60%) patients while 26(40%) patients underwent PH. The only indication for surgery in the PH group (100%) was abnormal placentation while the most common indication for surgery in the EH group (53.8%) was postpartum haemorrhage related to abnormal placentation. Patients who underwent EH were more likely to have massive blood loss (p=0.001), require ICU admissions (p=0.001), have DIVC cycles transfused (mean [SD] regime: 1.35 [0.95] vs 0.54 [0.99]; p=0.002), have lower postoperative haemoglobin level (mean [standard deviation, SD] haemoglobin: 9.23g/l [SD1.8] vs. 10.8 g/l [SD1.86]; p=0.001) and have higher difference between pre/post operative haemoglobin level (mean [SD] haemoglobin difference: 1.78g/l [SD6.34] vs 0.32g/l [SD1.7]; p=0.008) compared to patients with PH. Red blood cell transfusion, operating time, length of stay, weight of babies and Apgar score between two groups showed no significant differences. A significant reduction of blood loss between the first and the second half duration of the study (mean [SD] blood loss: 6978 ml [SD 4999.45] vs. 4100ml [SD2569.48]; p=0.004) was also observed. In the emergency group, 'non-placental cause' EH required significantly more red blood cell transfusion than 'placental cause' (p<0.05) while in the PH group, no significant difference was observed between the occlusive internal iliac artery 'balloon' and 'no balloon' subgroup in terms of operating time, total blood loss or blood transfusion. Overall complications showed more cases of post operative fever and relaparotomy in the EH group (18.4% vs. 7.6%) while urinary tract injuries including injuries to bladder and ureter occurred only in the PH group (9.4% vs. 0%).

CONCLUSION

The majority of peripartum hysterectomy cases are due to placenta accreta spectrum disorders. Planned peripartum hysterectomies have a lower morbidity rate compared to emergency hysterectomies. Therefore, early identification of placenta accreta spectrum disorders and timely planning for elective procedures are crucial to minimise the need for emergency surgery.

Validity and reliability of a questionnaire on knowledge, attitude, practice and perception (KAP2) towards food poisoning and its prevention during dining out among consumers in Terengganu

Having adequate knowledge, attitude, practice, and realistic perception (KAP2) of food poisoning prevention will minimize the risk of food poisoning while dining out. However, there is no validated KAP2 questionnaire on the prevention of food poisoning during dining out, notably among consumers. Throughout the current research, a validated KAP2 questionnaire on food poisoning and prevention during dining was developed. A crosssectional pilot survey was conducted among 30 selected consumers in Kuala Nerus, Terengganu. Convenience sampling was applied to the recruitment of consumers based on inclusion and exclusion criteria. The KAP2 questionnaire comprised the knowledge section (42 questions), attitude (15 questions), practice (13 questions) and the perception (15 questions). Knowledge questions were analysed using difficulty and discrimination index, while attitude, practice, and perception were analysed by construct validity and reliability analysis. The difficulty index with less than 0.3 is considered as difficult, between 0.30-0.70 as an acceptable value, and more than 0.70 as easy. The discrimination index below than 0.2 is considered poor, between 0.2-0.24 as good, more than 0.35 as excellent items. The construct validity was conducted by referring to the value of Cronbach's alpha, inter-item correlation (˃ 0.30), item-total correlation (˃ 0.30), and Cronbach's alpha if item deleted. The results were found from 42 knowledge items, 29 easy items, ten acceptable items and three difficult questions. The discrimination index revealed that 25 items were poor, 11 items were excellent, three items had a good discrimination index and three items needed to be revised. Based on construct validity, five attitude’s items, three practice’s items and ten perception’s items were removed due to inter-item correlation and item-total correlation value < 0.30. The reliability analysis of the attitude portion was 0.848 which is a good reliability, 0.780 practice, and 0.611 perceptions to be found an acceptable value of reliability. Overall, the developed KAP2 questionnaire is a valid and reliable questionnaire that can serve as an evaluation tool for measuring knowledge, attitudes, practice and perception in the prevention of food poisoning during dining out among consumers.

Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia

OBJECTIVE

The high prevalence of leptospirosis in humans is of great public health concern, particularly in tropical and subtropical regions. This study aimed to determine the seroprevalence of leptospiral antibodies and distribution of serovars, and to assess the usefulness of enzyme-linked immunosorbent assay (ELISA) as a screening method for leptospiral antibodies in a high-risk healthy community.

METHODS

Cross-sectional study of 231 market workers and food handlers in wet markets and food premises from two localities in central Malaysia. Respondents' background information was obtained using a questionnaire. Serum samples were tested for leptospiral antibodies using ELISA and microscopic agglutination test (MAT).

RESULTS

Seroprevalence of leptospirosis among healthy workers was 46.3%. Detection of seropositivity was higher by MAT (46%) than ELISA (15%). We observed high seropositivity among local workers (49%), food handlers (49.5%), females (60.8%) and those aged 34 years and older (46.3%). Local strain LEP175 was the predominant serovar, followed by WHO strain Patoc.

CONCLUSION

Overall seroprevalence among healthy food handlers and market workers was high in this study. The workplace places susceptible individuals at risk of leptospirosis.

Influenza vaccination among Malaysian healthcare workers: a survey of coverage and attitudes

BACKGROUND

Healthcare workers (HCWs) are at increased risk of getting influenza than the general population, therefore putting patients at risk of nosocomial infection. Influenza vaccination coverage among HCWs is low despite the availability of a safe and effective vaccine. However, the reasons for such a poor uptake are not well reported in Malaysia. This study aimed at assessing the rate of influenza vaccination uptake, knowledge and attitude of healthcare workers regarding influenza, and employers' policy on influenza vaccination.

METHODS

A cross-sectional questionnaire survey was conducted in three hospitals in the Klang Valley. Mann-Whitney test was used to assess possible differences in knowledge and attitude towards flu vaccination and the χ² was used for categorical variables. Analyses were performed with SPSS 22.0.

RESULTS

A total of 690 questionnaires were distributed; 527 were returned (giving a response rate of 76.4%. The vaccine uptake was 51.4% with the majority (83.5%) of those believing they were vaccinated to protect themselves. Higher proportion of vaccinated HCWs (p <0.05) agreeing to the fact that influenza is a serious threat to their health, however, 10% were not sure of its safety. Eighty-three (15.7%) claimed their employers did not have a vaccination policy, while 43.3% were not sure if their employers have vaccination policy.

CONCLUSION

This study has demonstrated more than half of the healthcare workers were vaccinated, with a significant proportion of the healthcare workers believed they were vaccinated to protect themselves, while most of those that were not vaccinated claimed they are worried about the safety of the vaccine. Most employers did not have a flu vaccination policy in place. Hence, the need for government to enforce such policy and make annual flu vaccination free and compulsory for all healthcare workers.

Hyaluronatelyase production by Streptococcus pneumoniae isolated from patients and carriers

Hyaluronatelyase produced by various microorganisms are capable of degrading hyaluronic acid in connective tissues and initiating the spread of infection by opening an access for the pathogen into host tissues. The present study attempts to determine the distribution of hyaluronatelyase-producing Streptococcus pneumoniae among invasive, non invasive and carriage isolates, and correlate it with the clinical sources, year of isolation, colonial morphology and their serotypes. A total of 100 isolates from various clinical samples were selected and screened for hyaluronatelyase production and presence of the encoding SpnHyl gene. All isolates possessed SpnHyl gene. Ninety-six isolates including 34 carriage isolates were positive for production of hyaluronatelyase. Four hyaluronatelyase-negative isolates were from blood (2 isolates) and sputum (2 isolates). No significant association was detected among hyaluronatelyase production and bacterial characteristics except for colonial morphology (p = 0.040). High percentages of hyaluronatelyase production in these isolates suggest their possible role as human pathogens.

Parental refusal to diphtheria vaccine: a fatal outcome

We present a case of a four-year-old boy who succumbed to diphtheria following incomplete course of immunisation, which included diphtheria vaccine. This case report focuses on the issues of parental refusal to vaccines and the development of "halal" vaccines for the prevention of infectious diseases.

Hymenolepis nana in a renal transplant recipient: to treat or not to treat?

A case of hymenolepiasis in a renal transplant recipient. Issues discussed include the benefit of anti-parasitic agents as well as the preventive measures.

Prevalence of Penicillium specific Ig E level and allergy symptoms among office workers in a selected company in Bangi, Malaysia

Indoor fungal reservoirs, particularly airborne Penicillium species, were identified throughout the ventilation system of the building and dissemination of fungi from those reservoirs was found to be occurring all the time. The objectives of this study were to determine the association between air concentration of indoor mould (Penicillium) and allergy symptoms among office workers. The study design used in this research was a cross-sectional study. Risk factors were identified through the questionnaire survey. Office workers were selected based on the proximity of their workstations to the microbiological air sampler used for the mould sampling. Results from the current study suggests that individual susceptibility of exposed subjects might be influenced by several factors associated with mould exposure; for example, inhaled mycotoxins or volatile organic compounds, which may, in some complex way, affect the immune response. This study provides the much needed preliminary baseline data for developing guidelines with validated findings that will be of use for policy decisions in Malaysia regarding indoor air quality. Results from this study are recommended for use in planning and implementing control measures in order to reduce the exposure to indoor mould and promote healthy working environment among the workers.

Disease and risk factor perception among patients with coronary artery disease in Kuala Terengganu

One hundred consecutive patients with coronary heart disease attending the Physician Clinic, Kuala Terengganu General Hospital self-completed a questionnaire on their awareness of the coronary risk factors and their perception of their disease. Seventy-one subjects were males. Twenty-seven subjects had never had formal education and only 6 had completed tertiary education. Whilst 52% considered themselves as having less than 25% knowledge about their disease, many were aware of hypercholesterolaemia, emotional stress, inadequate exercise and smoking as risk factors for coronary heart disease. Diabetes and family history were less known as coronary risk factors. Despite their awareness of the risk factors, though, the subjects failed to control these. For example, smoking was prevalent and their awareness of the harmful effects of smoking did not seem to deter them from this habit. Further, formal education did not seem to influence positive health behaviour. In terms of disease perception, the subjects tended to believe that their illness could be cured. Eighty subjects expected a cure from their doctors. Sixty-three subjects wanted more explanation of their illness from their doctors. These findings suggest that efforts should be made to translate patients' awareness of their illness to appropriate health behaviour, and perhaps doctors could achieve this by spending more time explaining to the patients, and educating them.

Descriptive terms used by Malay patients for exertional angina pectoris

Description of the chest pain of angina pectoris by patients is commonly used in the diagnosis, evaluation and monitoring of ischaemic heart disease. Whilst certain descriptive terms have been identified as describing angina and not other causes of chest pain, these terms have not been systematically evaluated among local Malaysian patients. Reliance on a translation of the description used by Western patients may not be totally correct in the local context. Seventy-one Malay patients with documented ischaemic heart disease were asked, by questionnaire and by interview, to identify the descriptive terms they used for their angina pectoris. Common terms used by these patients were sempit (constrictive) [56.3%], mencuck (pricking) [54.9%], berat (heavy) [53.5%], panas (burning) [50.7%], menekan (pressing) [46.4%], and pedih (smarting) [43.7%]. Other less common descriptions used were tajam (sharp), mencengkam (strangulating), hempap (compressive), ngilu, hiris (knife-like), lengoh (aching). Two-thirds of the patients used more than three terms to describe their angina pectoris. Direct translation of the description of angina may not only be inaccurate but could also be misleading. It is suggested that the actual words used by the patients in Bahasa Malaysia be recorded in the patient's notes rather than a translation of these. More studies are required to determine whether the terms used by the patients in this study are related to local dialect (in this case Terengganu) or are actually common in Malaysia. Further, similar studies among Chinese and Indian patients are also required.