​In Malaysia although mortality rate among women of reproductive ages has reduced over the years, the reduction has been stagnant for the past ten years. In order to achieve the 5th Millennium Development Goal, several measures need to be taken including a proper implementation of pre-pregnancy services in this country. This study explores the awareness, intention and usage of pre-pregnancy care (PPC) services and its determinant among women of reproductive ages in Kedah, Malaysia. This is a qualitative study, which consisted of a focus group discussion (FGD) among women in the ages of 18 to 45 years old from all ethnic groups who attended four government clinics in the state of Kedah. The mothers were chosen through purposive sampling from twelve districts that were selected through a multistage random sampling. A semi-structured questionnaire was utilized during the FGD. The results from the FGD were recorded verbatim and thematic analysis was finalized once saturation of information from respondents was achieved. These are two themes was identified, namely personal reasons and reasons of service and there are several subthemes under two main themes. Under the Personal reason themes, the subthemes including awareness and intention to used the services, knowledge, perception, social support and history of medical illness. While under pre-pregnancy care services themes, the subthemes including the promotion of the services, the communication relationship with the health staff, the waiting time and also the accessibility of the service. As a conclusion, there is still part of society who was unaware of pre-pregnancy services and its importance in reducing maternal mortality rate as well as producing good pregnancy outcome. Information and knowledge on pre-pregnancy care services should be disseminated among community members through various means including roadshows and pre wedding workshops.​

This case illustrates the medical complication of a child that arose as a consequence of parents with intellectual disabilities in a primary care setting. A 9-month-old girl presented with multiple admissions because of recurrent pneumonia and was later diagnosed with failure to thrive based on child neglect resulting from the parents’ disabilities. This exemplifies a failure to thrive case with a complex and undiagnosed psychosocial background that required interdepartmental involvement to mitigate the health problem.

This case illustrates the medical complication of a child that arose as a consequence of parents with intellectual disabilities in a primary care setting. A 9-month-old girl presented with multiple admissions because of recurrent pneumonia and was later diagnosed with failure to thrive based on child neglect resulting from the parents’ disabilities. This exemplifies a failure to thrive case with a complex and undiagnosed psychosocial background that required interdepartmental involvement to mitigate the health problem.

in Eastern Borneo and the Sulu archipelago) presentedfollowing a fall, with penetrating injury through the axillacaused by a stilt pole, exiting at the supero-anterior aspectof the left shoulder. Due to the lack of comprehension ofmodern medical treatment and poor language skills, theparents refused to consent for detailed radioimagingstudies, nor surgical removal and exploration in theoperating theatre. The removal of retained stilt pole wasdone in casualty area in Hospital Tawau, followed by localexploration under sedation and local analgesia. Despite thehorrific injury, there was no limb-threatening neurovascularinjury sustained. Management of such injury in the nomadicBajau Laut population provides valuable insight and aboutthe challenges and decisions of management.

In systemic lupus erythematosus (SLE), haematological abnormalities are frequent, although they are an uncommon cause of acquired von Willebrand syndrome (AVWS). AVWS is a rare condition that can cause a bleeding disorder. We presented a case of AVWS in the early diagnosis of SLE. One month before admission, the patient had a history of recurrent epistaxis. He presented to the hospital with symptomatic anaemia and was noted to have severe anaemia with iron deficiency. During hospitalisation, recurrent epistaxis recurred and was found to have prolonged activated partial thromboplastin time (aPTT), presence of lupus anticoagulant (LA), and lower von Willebrand factor (VWF), and factor 8 (VIII) levels. Simultaneously, he was diagnosed with SLE based on Systemic Lupus International Collaborating Clinics (SLICC) criteria. He underwent blood transfusions and was treated with immunosuppressive drugs such as steroids, mycophenolate mofetil, and an anti-fibrinolytic agent; he subsequently stopped bleeding and showed clinical improvement.