Parental control on handphone access and usage among Malaysian children

INTRODUCTION

Parental control for a child's handphone access is important to ensure online safety. This study was to determine parental control on handphone access and the usage amongst Malaysian children.

MATERIALS AND METHODS

A cross-sectional survey was conducted electronically between April 2017 and March 2018 among parents with children above 2 years of age, who owned a handphone. The 10-item questionnaire included questions about rules applied to the use of handphones, education on cybersafety, the characteristics and activities of their youngest children who had full-time access to a handphone, and parental perceptions of their children's usage of handphones. A total of 215 parents were included.

RESULTS

From this, 92% controlled their children's handphones use by setting rules. The commonest rules were limiting the time of handphone usage (77%) and being aware of whom the child was communicating with (77%). The majority (94%) educated their children on cybersafety, and the commonest discussed topic was not to communicate with strangers (93%). The children's average age of first handphone ownership was 10.6 (SD: 3.6) years, and the use of the handphone averaged 17.4 (SD: 18.5) hours a week. Despite the rules and education provided, only a quarter of parents were confident of their children's capability to manage their own safety when using handphones (27%).

CONCLUSION

In summary, Malaysian parents did control their children's handphone usage.

Marine Autotroph-Herbivore Synergies: Unravelling the Roles of Macroalgae in Marine Ecosystem Dynamics

Simple Summary

Invasive species are a leading hazard to marine ecosystems worldwide, coupled with climate change. Tackling the emerging biodiversity threat to maintain the ecological balance of the largest biome in the world has now become a pivotal part of the Sustainable Development Goals (SDGs). Marine herbivores are generally regarded as biological agents that restrict invasive species, and their efficiency depends on their dietary habits, especially the autotrophs they eat. Many researchers have found contradicting findings on the effects of nutritional attributes and novelty of autotrophs on herbivore eating behaviour. In light of the scattered literature on the mechanistic basis of autotroph-herbivore interactions, we provide a comprehensive review to fill knowledge gaps about synergies based on macroalgae, an important group of photosynthetic organisms in the marine biome that interact strongly with generalist herbivores. We also analyse macroalgal defence measures against herbivores, underlining unique features and potential roles in maintaining marine ecosystems. The nutritional qualities, shape, and novelty of autotrophs can alter herbivore feeding behaviour. Future research should explore aspects that can alter marine autotroph-herbivore interactions to resolve inconsistent results of specific features and the uniqueness of the organisms involved.

Abstract

Species invasion is a leading threat to marine ecosystems worldwide, being deemed as one of the ultimate jeopardies for biodiversity along with climate change. Tackling the emerging biodiversity threat to maintain the ecological balance of the largest biome in the world has now become a pivotal part of the Sustainable Development Goals (SDGs). Marine herbivores are often considered as biological agents that control the spread of invasive species, and their effectiveness depends largely on factors that influence their feeding preferences, including the specific attributes of their food–the autotrophs. While the marine autotroph-herbivore interactions have been substantially discussed globally, many studies have reported contradictory findings on the effects of nutritional attributes and novelty of autotrophs on herbivore feeding behaviour. In view of the scattered literature on the mechanistic basis of autotroph-herbivore interactions, we generate a comprehensive review to furnish insights into critical knowledge gaps about the synergies based largely on the characteristics of macroalgae; an important group of photosynthetic organisms in the marine biome that interact strongly with generalist herbivores. We also discuss the key defence strategies of these macroalgae against the herbivores, highlighting their unique attributes and plausible roles in keeping the marine ecosystems intact. Overall, the feeding behaviour of herbivores can be affected by the nutritional attributes, morphology, and novelty of the autotrophs. We recommend that future research should carefully consider different factors that can potentially affect the dynamics of the marine autotroph-herbivore interactions to resolve the inconsistent results of specific attributes and novelty of the organisms involved.

Rescue supraglottic airway devices at caesarean delivery: What are the options to consider?

Tracheal intubation is considered the gold standard means of securing the airway in obstetric general anaesthesia because of the increased risk of aspiration. Obstetric failed intubation is relatively rare. Difficult airway guidelines recommend the use of a supraglottic airway device to maintain the airway and to allow rescue ventilation. Failed intubation is associated with a further increased risk of aspiration, therefore there is an argument for performing supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI). The technique of SAGFBI has a high success rate in the non-obstetric population, it protects the airway and it minimises task fixation on repeated attempts at laryngoscopic tracheal intubation. However, after failed intubation via laryngoscopy, there is a lack of specific recommendations or indications for SAGFBI in current obstetric difficult airway guidelines in relation to achieving tracheal intubation. Our narrative review explores the issues pertaining to airway management in these cases: the use of supraglottic airway devices and the techniques of, and technical issues related to, SAGFBI. We also discuss the factors involved in the decision-making process as to whether to proceed with surgery with the airway maintained only with a supraglottic airway device, or to proceed only after SAGFBI.

P6586Brugada syndrome risk stratification - Evaluation of clinical and ECG risk markers in a multicenter international primary prevention cohort

Background

Risk stratification for sudden cardiac death (SCD) in Brugada syndrome (BrS) is a significant challenge.

Purpose

To evaluate the importance of clinical and ECG factors in the likelihood of developing significant ventricular arrhythmias (VAs)/SCD in BrS patients.

Methods

VA occurrence during follow-up were assessed and the role of 16 proposed clinical or ECG risk markers evaluated in a multicenter international study of BrS patients and no history of cardiac arrest. Markers with predictive power were identified and incorporated into a risk score model.

Results

Across 15 international centers, 1084 patients were included. During a follow-up of 5.3 years (IQR 2.7–9.0 years)- 110 patients had VA occurrence (10.1%) with an annual event rate of 1.7% (95% CI 1.4–2.0). Of the 16 proposed risk factors, diagnosis by family screening of sudden cardiac death (HR 4.65; p<0.001), probable arrhythmia related syncope (HR 3.88, p<0.001), type 1 spontaneous ECG (HR 3.56; p<0.001), Early Repolarisation (HR 3.15; p<0.001) and type 1 Brugada pattern in peripheral leads (HR 2.42; p<0.001) were associated with a higher VA occurrence risk during follow-up. These 5 variables were incorporated into a risk score model whereby each variable was allocated a point score based on the variable's predictive strength. The total points obtained from the model for a patient could then be translated into the predicted VA occurrence risk during follow-up (Figure 1). The model showed a sensitivity of 63.5% (95% CI 50.0–76.9) and specificity of 84.2% (95% CI 81.1–87.1) in predicting VA occurrence at 5-years follow-up. The model showed a greater discriminative power compared to an existing model (AUC 0.83 vs. 0.71; p<0.001).

Figure 1

Conclusions

This multicenter study with longest reported follow-up to date identified 5 risk markers for VA occurrence. Utilizing these markers in a risk score model can aid BrS risk stratification to enable individualized risk prediction and ICD prescription.

Major liver surgery in a Jehovah’s Witness patient: challenges for safe surgery

Jehovah’s Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah’s Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on the material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.

Strong independent association between obesity and essential hypertension

Obesity and hypertension (HTN) are major risk factors for cardiovascular disease. Association between obesity and HTN has not been studied in a large populations following adjustment for comorbidities. The goal of this study was to evaluate any association between obesity and HTN after adjusting for baseline characteristics. We used ICD-9 codes for obesity and HTN from the Nationwide Inpatient Sample (NIS) databases. Two randomly selected years, 1992 and 2002, were chosen from the databases as two independent samples. We used uni- and multivariable analysis to study any correlation between obesity and HTN. The 1992 database contained a total of 6,195,744 patients. HTN was present in 37.2 % of patients with obesity versus 12% of the control group (OR: 4.36, CI 4.30-4.42, P < 0.001). The 2002 database contained a total of 7,153,982 patients. HTN was present in 50.7% of patients with obesity versus 25.6% of the control group (OR: 2.98, CI 2.96-3.00, P < 0.001). Using multivariable analysis adjusting for gender, hyperlipidaemia, age, smoking, type 2 diabetes and chronic renal failure, obesity remained correlated with HTN in both years (1992: OR 2.69, CI 2.67-2.72, P < 0.001; 2002: OR 2.98, CI 2.96-3.00, P < 0.001). The presence of obesity was found to be strongly and independently associated with HTN. The cause of this correlation is not known warranting further investigation.

Performance of case definitions for influenza surveillance

Influenza-like illness (ILI) case definitions, such as those from the European Centre for Disease Control and Prevention, World Health Organization (WHO) and United States Centers for Disease Control and Prevention, are commonly used for influenza surveillance. We assessed how various case definitions performed during the initial wave of influenza A(H1N1) pdm09 infections in Singapore on a cohort of 727 patients with two to three blood samples and whose symptoms were reviewed fortnightly from June to October 2009. Using seroconversion (≥ 4-fold rise) to A/California/7/2009 (H1N1), we identified 36 presumptive influenza A(H1N1)pdm09 episodes and 664 episodes unrelated to influenza A(H1N1)pdm09. Cough, fever and headache occurred more commonly in presumptive influenza A(H1N1)pdm09. Although the sensitivity was low (36%), the recently revised WHO ILI case definition gave a higher positive predictive value (42%) and positive likelihood ratio (13.3) than the other case definitions. Results including only episodes with primary care consultations were similar. Individuals who worked or had episodes with fever, cough or sore throat were more likely to consult a physician, while episodes with Saturday onset were less likely, with some consultations skipped or postponed. Our analysis supports the use of the revised WHO ILI case definition, which includes only cough in the presence of fever defined as body temperature ≥ 38 °C for influenza surveillance.

FGF receptor genes and breast cancer susceptibility: results from the Breast Cancer Association Consortium

BACKGROUND

Breast cancer is one of the most common malignancies in women. Genome-wide association studies have identified FGFR2 as a breast cancer susceptibility gene. Common variation in other fibroblast growth factor (FGF) receptors might also modify risk. We tested this hypothesis by studying genotyped single-nucleotide polymorphisms (SNPs) and imputed SNPs in FGFR1, FGFR3, FGFR4 and FGFRL1 in the Breast Cancer Association Consortium.

METHODS

Data were combined from 49 studies, including 53 835 cases and 50 156 controls, of which 89 050 (46 450 cases and 42 600 controls) were of European ancestry, 12 893 (6269 cases and 6624 controls) of Asian and 2048 (1116 cases and 932 controls) of African ancestry. Associations with risk of breast cancer, overall and by disease sub-type, were assessed using unconditional logistic regression.

RESULTS

Little evidence of association with breast cancer risk was observed for SNPs in the FGF receptor genes. The strongest evidence in European women was for rs743682 in FGFR3; the estimated per-allele odds ratio was 1.05 (95% confidence interval=1.02-1.09, P=0.0020), which is substantially lower than that observed for SNPs in FGFR2.

CONCLUSION

Our results suggest that common variants in the other FGF receptors are not associated with risk of breast cancer to the degree observed for FGFR2.

Cutaneous lesions as a presenting sign of metastases in male breast cancer: a rare clinical entity

Male breast cancer accounts for only 1% of cancers in men and 1% of breast cancers. Cutaneous metastases occur less than 10% of all patients with visceral malignancies and are considered a rare and late event in progression of metastatic disease. A 45-year-old man presented with a lump in the left breast which was confirmed to be infiltrating ductal carcinoma. He underwent a left mastectomy and axillary clearance followed by chemotherapy and radiotherapy to the left chest wall. However, he was non-compliant to adjuvant tamoxifen due to hot flushes. One year later, he presented with biopsy proven cutaneous metastases. Initially he had complete excision of the lesions, however, two months later more skin lesions appeared predominantly over the chest wall and back. Hormonal therapy failed to control the metastases as such he was treated with systemic chemotherapy. He is currently on third line chemotherapy.

Cyclosporin variably and inconsistently reduces infarct size in experimental models of reperfused myocardial infarction: a systematic review and meta-analysis

Cyclosporin is an immunosuppressant that has recently been proposed as a treatment to prevent reperfusion injury in acute myocardial infarction (MI). We aimed to determine the overall efficacy of cyclosporin in experimental studies of acute reperfused MI. We conducted a systematic review and stratified meta-analysis of published studies describing the efficacy of cyclosporin in experimental models of acute reperfused MI. We included all in vivo publications of cyclosporin where infarct size was measured. A literature search identified 29 potential studies of which 20 fulfilled the eligibility criteria. In these studies (involving four species of animals), cyclosporin reduced myocardial infarct size by a standardized mean (95% confidence interval) difference of -1.60 (-2.17, -1.03) compared with controls. Cyclosporin failed to demonstrate a convincing benefit in studies involving pigs. Despite this observation, the overall efficacy of cyclosporin did not differ across species (P= 0.358). The dose of cyclosporin given did not affect final infarct size (P= 0.203). Funnel plots of these data suggested heterogeneity among the studies. Cyclosporin had variable effects on infarct size compared with placebo. Cyclosporin had no effect on myocardial infarct size in swine, raising a question over the potential cardioprotective effects of cyclosporin in man.

Ministry of health clinical practice guidelines: screening of cardiovascular disease and risk factors

The Ministry of Health (MOH) publishes clinical practice guidelines on Screening of Cardiovascular Disease and Risk Factors to provide doctors and patients in Singapore with evidence-based guidance on the screening of cardiovascular disease and risk factors. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Screening of Cardiovascular Disease and Risk Factors, for the information of readers of the Singapore Medical Journal. Page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=25776). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Health Promotion Board-Ministry of Health clinical practice guidelines: functional screening for older adults in the community

The Health Promotion Board (HPB) and the Ministry of Health (MOH) publish clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the HPB-MOH clinical practice guidelines on Functional Screening for Older Adults in the Community, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website (http://www.hpb.gov.sg/uploadedFiles/HPB_Online/Publications/CPGFunctionalscreening.pdf). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Influenza A/H1N1 (2009) infection in pregnancy--an Asian perspective

OBJECTIVE

To describe the characteristics of an obstetric population with influenza A/H1N1 (2009) infection, with a focus on the need for hospitalisation and complications.

DESIGN

Cohort study.

SETTING

Tertiary referral centre.

POPULATION

Two hundred and eleven pregnant women with influenza A/H1N1 (2009) infection diagnosed by nasopharyngeal swab polymerase chain reaction (PCR).

METHODS

Obstetric patients presenting to our centre were recruited and followed up. Data collected included demographic and clinical information.

MAIN OUTCOME MEASURES

H1N1 and pregnancy complications, and hospitalisation needs.

RESULTS

The median age of the cohort was 29.0 years (range 16-42 years), the median gestation at referral was 23.0 weeks (range 4-38 weeks), the median time interval between illness onset and presentation was 2.0 days (range 1-7 days), and the median time interval between illness onset and commencement of oseltamivir was 2.0 days (range 1-11 days). Hospital admission was significantly associated with the presence of co-morbidity (OR 4.14, 95% CI 1.82-9.37, P = 0.0001), breathlessness (OR 5.2, 95% CI 2.19-12.41, P = 0.0003) and sore throat (OR 0.35, 95% CI 0.16-0.73, P = 0.005). There were two cases of pneumonia complicating H1N1 infection, but no mortality. Nine cases developed pregnancy complications. All women recovered.

CONCLUSIONS

The need for hospitalisation was significantly associated with breathlessness and co-morbidity. There was minimal morbidity and no mortality observed. We attribute this to early presentation, diagnosis and treatment.

Antenatal use of a novel vaginal birth training device by term primiparous women in Singapore

INTRODUCTION

To study the use, safety and effectiveness of a novel antenatal vaginal birth training device (EPI-NO) in primiparous women.

METHODS

Antenatal use of the EPI-NO vaginal birth trainer was prospectively studied in 31 primiparous booked patients who were delivered by obstetricians from July to December 2002 at the KK Women's and Children's Hospital. This was studied in relation to episiotomy rate, perineal trauma and analgesic requirements during the postpartum period. A patient questionnaire form was used to assess their perception of pain and how well they coped with its use. For comparison, perineal trauma was also studied retrospectively in 60 consecutive obstetrician-booked primiparous term patients who had normal vaginal delivery (NVD) and who did not use EPI-NO during the same study period.

RESULTS

The mean length of usage was for 2.1 weeks (standard deviation [sd] 1.2 weeks). The mean frequency of use was 5.3 episodes per week (sd 2.1, range 1 to 7). There was no laceration and vaginal infection arising from its usage. There was a case of minimal bleeding post-usage. There were 20 (64.5 percent) NVDs, four (12.9 percent) forceps deliveries, five vacuum deliveries (16.1 percent) and two (6.5 percent) Caesarean sections. Of the 29 vaginal delivery cases, 19 (65.5 percent) had episiotomy, eight (27.6 percent) had lacerations, and two (6.9 percent) did not sustain laceration. The reasons for episiotomy in the 19 cases were nine cases of pending tearing of vagina/perineum, nine cases of instrumental vaginal deliveries, and one to shorten second stage. There was no third degree tear. 21 (67.7 percent) out of 30 required a painkiller. The majority of patients (17; 54.8 percent) appeared to be comfortable with the use of EPI-NO. All coped well with vaginal examination after using EPI-NO perineal training. Comparing among term primiparous NVD cases with (n value equals 20) and without (n value equals 60) EPI-NO, the perineal trauma rate (90.0 percent vs 96.6 percent, p value equals 0.24) was slightly but not significantly lower in the EPI-NO group. The episiotomy rate was significantly lower (50.0 percent vs 93.3 percent, p value is less than 0.0001) and the extent of perineal trauma in the patient appeared to be less severe in cases using EPI-NO.

CONCLUSION

EPI-NO appeared to be safe and acceptable to the majority of users. Although birth training with EPI-NO significantly decreases the rate of episiotomies in term primiparous patients, and the degree of perineal tissue injury appeared to be less in the EPI-NO group especially among those with lacerations, the overall perineal trauma rate was slightly but not significantly lower, in view of the higher spontaneous laceration rate in the EPI-NO group.

A case of human enteric myiasis due to larvae of Hermetia illucens (Family: Stratiomyiadae): first report in Malaysia

A case of true enteric myiasis in a 7-year-old girl is reported. Two larvae were obtained from the vomitus of the patient. After processing and identification, the larvae were found to be those of Hermetia illucens (Soldier Fly). This is the first case of true enteric myiasis due to these larvae in Malaysia.