Factors Influencing Excessive Gestational Weight Gain Among Pregnant Women in Urban Malaysia Introduction Excessive gestational weight gain (GWG) is a growing public health concern due to its association with higher risk of adverse maternal and perinatal outcomes. Recognising the key factors of underlying GWG incidence is thus crucial for developing targeted interventions. This study aims to determine the prevalence of excessive GWG and its associated factors among pregnant women in an urban district of Klang Valley, Malaysia. Methods A retrospective cross-sectional study was conducted (betweenNovember 2017 and October 2018) among 472 pregnant women who gave birth between January 2015 and December 2016. Data on sociodemographic characteristics, medical illnesses, and pre-pregnancy body mass index (BMI) were retrieved from the birth registry and maternal health records. The classification of GWG is based on the Institute of Medicine's recommendation Results The classification of GWG is based on the Institute of Medicine's recommendation. A total of 113 (23.9%) pregnant women had excessive GWG. Multiple logistic regression showed the odds of getting excessive GWG were higher among those with lower education levels (Adj. OR = 1.85; 95% CI = 1.084, 3.147), being employed (Adj. OR = 2.30; 95% CI = 1.342, 3.928), nulliparous (Adj. OR = 2.46; 95% CI = 1.450, 4.164), and having pre-pregnancy BMI of ≥25kg/m2(Adj. OR = 6.47; 95% CI = 3.909, 10.721). Conclusions Lifestyle interventions, such as weight reduction programs and health education, should focus on women with high pre-pregnancy BMI, nulliparous women, working women and women with low education levels. Pre-pregnancy clinics and workplaces can serve as platforms to promote healthy dietary choices and encourage regular physical exercise.

Pregnant adolescents have been shown to have a higher incidence of health and non-health-related complications that affect both mothers and infants. These include increased risk of pregnancy-related diseases such as anemia and pre-eclampsia, preterm and low-birth-weight babies, as well as other social consequences such as educational and financial difficulties. This mini review evaluates selected articles which explain the attitudes, knowledge, behavior and other risk factors associated with pregnancy among adolescents in developing countries. It also revealed that inadequate knowledge among adolescents about reproductive and sexual health, other social, cultural and peer influences, parenting values, and poor financial and educational status were factors that contribute to adolescent pregnancy. Likewise, a lack of support from parents, educators and healthcare workers had negative impacts on healthy sexual behavior among adolescents, which may ultimately lead to adolescent pregnancy. We conclude that the factors discussed in this review need to be evaluated and taken into consideration by policymakers and healthcare workers when formulating strategies to prevent pregnancies among adolescents.

Background: The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. Methods: A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). Results: Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. Conclusion Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.

Background: The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. Methods: A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). Results: Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. Conclusion Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.

Hyalinising trebecular adenoma (HTA) of the thyroid is rare and controversies remain regarding the diagnosis and management. It is an uncommon benign thyroid tumour that can present as a solitary thyroid nodule, a prominent nodule in a multinodular goitre, or as an incidental finding in a thyroidectomy specimen. Some considered HTA a unique entity, while others have proved it to be a variant of papillary carcinoma or have considered it a nonspecific pattern that may be seen with a variety of thyroid lesions. We report the case of a 31-year-old Chinese lady who presented with four years history of right sided goitre that was gradually increasing in size. Fine needle aspiration cytology showed appearances of follicular adenoma. Intra-operative frozen section histology of the excised right thyroid lobe was reported as trabecular adenoma which was confirmed with histopathological examination.

A 25-year-old Malay lady who was six month pregnant presented with a three day history of fever, malaise, odynophagia, dysphagia, trismus and change in voice. On clinical examination, she was dehydrated, mouth breathing and had foetid breath. She also had ‘hot potato-sounding’ speech. Examination of her oral cavity revealed oedematous and erythematous soft palate with inferior and medial displacement of the tonsils (Panel). There were also bilateral, solitary and tender jugulodigastric nodes. What is the diagnosis? Answer: refer to page 156

(Refer to page 134) Answer: Peritonsillar abscess/ Quinsy Peritonsillar abscess or quinsy is a collection of pus in the potential space between the fibrous capsule of the palatine tonsil and superior constrictor muscle of the pharynx, usually at its superior pole. Over 50% of the patients will have a previous history of tonsillitis. In our case, the patient had unilateral peritonsillar abscess a year earlier which required incision and drainage. Although beta-haemolytic Streptococcus is frequently isolated, mixed aerobic and anaerobic pathogens are also seen. 1

A 38-year-old female with background history of renal calculi and asthma was referred to the ENT department with more than a year history of chronic dry, irritative cough, regurgitation and globus sensation. On examination, the posterior pharyngeal wall was granular and the gag reflex was increased. Indirect laryngoscopy showed congested arytenoids and post-cricoid swelling consistent with laryngopharyngeal reflux (LPR). She was started on omeprazole (20 mg daily) and was advised on lifestyle modification. Despite these measures, her symptoms persisted. She was then referred for upper gastrointestinal endoscopy and abnormalities were noted in the proximal oesophagus (Panel). Q: What is the diagnosis? Answer: refer to page 112

(Refer to page 98) Answer: Heterotopic gastric mucosal patch of the proximal oesophagus or cervical inlet patch. The image showed two distinctive salmon coloured patches located in the proximal oesophagus. Biopsy from the lesion located at 5 o’clock was reported as follow: ‘The presence of glandular epithelium containing antral and gastric body type glands. The lamina propria is infiltrated by a moderate number of lymphocytes. Immunological staining was strongly positive for surface epithelium with CK20, whilst CK7 was weakly positive for surface epithelium and deep glands.