Background: Lymphangiomas are congenital malformations of the lymphatic system with characteristic dilated endothelium-lined spaces. It is vulnerability to infection or chemical irritants cause spontaneous reduction in size and in some cases complete resolution. Intralesional injection of OK-432 or Picibanil (lyophilized incubation mixture of Group A Streptococcus pyogenes of human origin) is slowly gaining recognition as its safety and efficacy standards have shown to avoid complications resulting from surgical interventions. The objective of this study was to evaluate the clinical outcomes of cystic hygroma patients who received OK-432 injections. Methods: In between 2011 and 2013, six patients with cystic hygroma received intralesional injection of OK-432. All the patients were assessed clinically and radiologically either via ultrasound, computer tomography (CT) or magnetic resonant imaging (MRI) prior to and after receiving the injections. Patients’ response towards treatment was classified as total shrinkage, marked shrinkage (greater than 50% reduction in size), slight shrinkage (less than 50% reduction in size) or non-responsive to treatment. Results: Mean duration of follow-up was 12 months. Total shrinkage was achieved in one patient, marked shrinkage in three patients and one patient experienced mild shrinkage. Only one out of the six patients showed no response to treatment. None of the patients in this study experienced serious complications or adverse effects post intralesional injection of OK-432. Conclusions: Intralesional OK-432 injection is an effective and safe alternative in treating cystic hygroma.

Introduction: Malaysia has not legalized CPR teaching in the national curriculum, leaving it to school principals to implement the teaching of CPR who may have limited knowledge. This study aims to investigate Malaysian secondary school principals’ level of readiness, defined as knowledge, attitude, willingness to teach CPR, and barriers to implementation. Methods: Malaysian secondary school principals were invited to complete a survey that consisted of five parts: (1) demographics, (2) CPR knowledge, (3) attitude towards CPR, (4) willingness to teach CPR, and (5) barriers to implementing CPR teaching. Results: A total of 54 secondary school principals responded to the survey. Three (5.6%) principals passed the CPR test. More than 80% agreed CPR course is important for students, mandatory to be taken before graduation and best taught by certified teachers. Principals are willing to qualify themselves and teachers with CPR certification and to provide funding to support and hire an outsider to teach CPR courses. Funding, teachers’ readiness for skills and knowledge proficiency, and curriculum burden are perceived as potential barriers to successful CPR teaching. One-way MANOVA analysis showed that gender (p = .257), age (p = .108), qualifications (p = .321), teaching experience (p = .194), and administrative experience (p = .193) did not have a significant effect on the combined dependent variables. Conclusion: Malaysian secondary school principals are aware of the importance of CPR and were willing to acquire the knowledge, skills, funds, equipment, and support in ensuring its implementation in the national curriculum.