Teratomatous tumours of the head are rather uncommon. We report a 3-month-old child who presented with acute signs of raised intracranial pressure, needing craniectomy and subtotal tumour removal. The patient was diagnosed as intracranial immature teratoma grade 3, from the pathological study and elevated alpha-fetoprotein (AFP). Managing brain teratoma posed a challenge to the managing team due to the location of the tumour, the unavailability of standardized chemotherapy protocol and the dilemma of commencing adjuvant chemotherapy in a very young infant. The tumour was partially removed due to its critical location. And chemotherapy was delayed until the patient achieved 7 months of age. After four rounds of chemotherapy, the patient remained in remission for more than three years follow up.

Perioperative Patient Blood Management is part of the patient blood management (PBM) program specifically focused on surgical patients. Even though this concept had been introduced in 2010 by World Blood Organization (WHO), earlier studies in Europe had shown poor knowledge and practice among clinicians in this area. In Malaysia, PBM approach is still not comprehensive, and there was no published data to relate this problem with clinicians’ lack of knowledge and practice. Therefore, our main objective was to study the knowledge and practice of PBM among clinicians mainly involved in the perioperative field at Hospital Universiti Sains Malaysia (Hospital USM), Kelantan. A cross-sectional study was done from 1st December 2019 to 31st October 2020 using a structured and validated questionnaire containing 41 items. Logistic regression was used to evaluate the association between socio-demographic variables with knowledge level. A total of 252 participants were involved in this study. About 61.5% of the clinicians had a poor knowledge level. Poor knowledge level among clinicians was significantly associated with clinicians' age, primary field, previous knowledge about PBM, and PBM course attendance (p<0.05). The practice was at a moderate level. Overall, there were significant knowledge gaps and inadequate practice of PBM in perioperative patients among clinicians in Hospital USM. These results might guide the local clinical division to formulate more constructive and effective training strategies to strengthen the clinicians’ knowledge and practice of PBM in perioperative patients.
Knowledge

Introduction: Caring for children who have chronic kidney disease (CKD) is challenging. The goal of this study was to find out the prevalence of burnout and what factors contribute to it. We also want to know the correlation between caretaker’s strain and burnout. Methods: This was a cross-sectional study that involved caretakers of children with CKD. They were recruited from a university hospital in Kelantan, Malaysia. Self-administered questionnaire in Malay language comprised of Demographic Information Form, Copenhagen Burnout Inventory (CBI-M) and Caregiver Strain Index (CSI-M) was used. Results: Eighty-eight caretakers were involved in this study. The mean age of caretakers was 42 years old, majority were female (72.4%), Malay (99.0%) and Muslim (99.0%). The mean age of children with CKD was 11 years old, most of them were on medication (69.3%) and mean duration of illness was 4.6 years. The prevalence of burnout in all domains (personal, work-related, client-related) among the caretakers was 5.7%. Eight caretakers had personal burnout (9.1%) while five (5.7%) had client-related and work-related burnout respectively. Multiple linear regression showed positive association of duration since the initial diagnosis and total ward admission within six months with total burnout score. Pearson correlation revealed a positive and fair correlation between strain and burnout. Conclusion: Prevalence of burnout among caretakers was generally low, but personal burnout outnumbered other domains. Children with CKD with longer duration of illness and more frequent ward admission are the important factors leading to burnout among caretakers. A high number of caretakers having significant strain indicated that there were possibilities of developing burnout later on.