Placenta Accreta Spectrum in Normal Situated Placenta and Unscarred Uterus.

Placenta accreta, one of the morbidly adherent placenta components and currently known as placenta accreta spectrum (PAS), is a condition characterized by abnormal adherence of the placenta to the uterine wall. This can lead to significant blood loss and may lead to high morbidity and mortality rates for the mother. It is a failure of placenta separation during the third stage of labor, which is thought to be high prevalence in those with previous cesarean delivery, especially with the presence of placenta previa. However, PAS is possible in cases of a normally-situated placenta without previous cesarean delivery. We reported an interesting case of a 41-year-old woman, gravida 8 para 7, admitted to the labor room for augmentation of labor, who needed emergency lower segment cesarean section. The incidental finding of PAS was made intraoperatively and was complicated with a hysterectomy. PAS in a normally situated placenta (upper segment) in a virgin abdomen that has been discovered during emergency lower segment cesarean section could cause a nightmare to the obstetrician as it leads to massive postpartum hemorrhage, ureteric injury, and high maternal morbidity and mortality.

The Incidence and Variation of Corona Mortis in Multiracial Asian: An Insight from 82 Cadavers.

Introduction: Corona Mortis (CMOR) is a term used to describe an anatomical vascular variant of retropubic anastomosis located posterior to superior pubic ramus. We aim to provide sufficient data on the incidence, morphology and mean location of 'crown of death' in Asian population. Other objectives include to assess the relationship between CMOR incidence with gender, race and age. Materials and methods: This is a cross-sectional cadaveric study involving 164 randomly selected fresh multiracial Asian hemipelves (82 cadavers). Hemipelves were dissected to expose and evaluate the vascular elements posterior to superior pubic rami. Data were analysed using Chi-Square, t-test and with the help of IBM SPSS Statistics v26 software. Results: CMOR was found in 117 hemipelves (71.3%). No new morphological subtype was found. The mean distance of CMOR to symphysis pubis was 54.72mm (SD 9.35). Based on the results, it is evident that precaution needed to be taken at least within 55mm from symphysis pubis during any surgical intervention. The lack of statistically significant correlation between CMOR occurrence and gender, race and age suggest that the incidence of CMOR could be sporadic in manner. Conclusion: We conclude that CMOR is not just aberrant vessel as the incidence is high and this finding is comparable to other studies. The mean location of CMOR obtained in this study will guide surgeons from various disciplines in Asia to manage traumatic vascular injury and to perform a safe surgical procedure involving the pelvis area.

Parametric study of coagulant recovery from water treatment sludge towards water circular economy.

This study aims to recover the used coagulants from two water treatment plants via acidification technique. The water treatment sludge (WTS) was acidified with sulfuric acid (H2SO-4) at variable normalities (0.5, 1, 1.5, 2.0 and 2.5 N). The surface morphology and functionalities of both recovered coagulants were analysed using scanning electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR). The performance of recovered coagulants was tested for turbidity removal in surface water treatment at different coagulant dosages and pH. It was found that the optimum normality of H2SO4 for recovered alum was 1.5 N, where 66% turbidity removal was recorded. The recovered PAC treated with 1.0 N H2SO4 indicated high turbidity removal percentage, which was 50.5%. The turbidity removal increased with increasing coagulant dosage. More than 80% turbidity removal was achieved with 40 mg/L dosage of recovered alum and recovered PAC. Maximum removal (85%) was observed with 50 mg/L dosage of recovered alum. For commercial coagulant, the turbidity removal was higher, with a difference of up to 6% in favor of recovered alum. The potential reuse of coagulants can be explored in order to reduce the operating costs and promotes the reduction of WTS disposal.

Macular haemorrhage in adult acute leukaemia patients at presentation and the risk of subsequent intracranial haemorrhage.

Retinal changes are common in adult acute leukaemia patients at presentation, but whether they correlate with the risk of subsequent intracranial haemorrhage is unknown. A 4-year study has been carried out in 82 newly-diagnosed acute leukaemia patients, aged 12-77 years, who were studied prospectively for the presence of intra-retinal haemorrhages (IRH), white-centred haemorrhages (WCH), cotton-wool spots (CWS) and macular haemorrhages (MH). Groups with and without these features were compared for their risk of intra-cranial haemorrhage (ICH) within the first 30 d following diagnosis. There was no association between the incidence of ICH and the presence of IRH, WCH or CWS. However, 6/13 of those with MH developed ICH, compared to 6/69 of those without MH (relative risk 5.0, CI 95% [2.03-12.33], P=0.003). The only other identifiable risk factor for ICH was the M3 subtype of AML, but if the four cases of M3-AML were discounted from analysis, MH remained a highly significant risk factor for ICH. Patients with MH should be monitored intensively for the development of ICH, and receive priority in the allocation of platelets where these are in short supply.

Variability in determination of body weight used for dosing busulphan and cyclophosphamide in adult patients: results of an international survey.

Fifty-two BMT institutions were sent a questionnaire asking for details of dosing for busulphan, cyclophosphamide (bu-cy), cyclosporin and methotrexate (CSA-MTX). The following data were requested: (a) the method used to determine the body weight for dosage calculations (b) the actual dose per weight and (c) the schedule of administration. Thirty-six (69%) institutions responded and 33 were evaluable. There was substantial variation in the method used to determine weight for bu-cy. No single method was used in more than 30% of units, although most units made some allowance for discrepancies between actual and ideal body weight. There was more uniformity in the method of weight determination for CSA-MTX, with the majority of units using actual body weight. Conversely, there was much more variation in the dose per weight formulae and schedules used for CSA-MTX than for bu-cy. These substantial differences highlight the importance of specifying these criteria when the toxicity and efficacy of chemotherapy regimens is reported and the need for further studies to determine the optimal weight formulae for dosage calculations.

Smoking habits and attitudes among secondary school teachers.

A questionnaire survey to study the smoking habits and attitudes toward smoking among secondary school teachers in Kelantan, Malaysia was conducted between July and September 1992. Questionnaires were sent to 5,112 teachers through their respective headmasters. Sixty-three percent (3,208 teachers; 61% males, 39% females) responded satisfactorily. Overall, 625 teachers (20%) were current smokers, 141 (4%) were occasional smokers, 317 (10%) were ex-smokers and 2,123 (67%) had never smoked. Only six (0.8%) of the 766 regular and occasional smokers were females. The rates of smoking among parents and siblings of smokers were higher than parents and siblings of non-smokers. Seventy-four percent of the smoking teachers admitted to smoking in the school premises. The teachers' attitudes about the health effects of smoking were statistically different between smokers and non-smokers. However, both smoking and non-smoking teachers had similar views regarding methods to control the smoking habit which included banning cigarette sales, putting a halt to the tobacco industry and banning cigarette advertisements.

Congenital posterior mediastinal teratoma--a case report.

Almost all mediastinal teratomas are found in the anterior mediastinum. We describe a case of a 41-day-old baby girl who had teratoma in the posterior mediastinum. She presented at the age of 6 days with the problem of progressive jaundice and was found to have septicaemia. During septic screening, chest X-ray revealed a mass in the right mediastinum. Ultrasound and CT-scan of the chest showed a multiloculated mass at the right posterior mediastinum. Fine needle aspiration biopsy of the mass confirmed a teratoma.

Spontaneous pneumothorax: a review of 29 admissions into Hospital Universiti Sains Malaysia 1984-90.

Twenty-nine patients (16 males, 13 females) with spontaneous pneumothorax admitted into Hospital Universiti Sains Malaysia, Kubang Kerian, from September 1984 to September 1990 were reviewed. Their ages ranged from newborn to 75 years. The commonest chief presenting symptom was dyspnoea (69%), followed by chest pain (35%). Four patients had chronic obstructive airway disease, 7 had pneumonia, 2 had pulmonary tuberculosis, one patient had emphysema while 4 patients had multiple underlying lung disorders. The left and right lungs were involved with equal frequency. Bilateral pneumothorax occurred in one patient. Most patients had a single episode of pneumothorax but recurrent pneumothoraces occurred in 3 patients (10%). Six patients were observed conservatively, 20 patients required chest tube insertion alone and 3 patients also required pleurodesis. Death occurred in 8 patients (28%) mainly due to coexisting infection and respiratory failure.