BackgroundPreeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes.MethodsA cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia).ResultsThe reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518–2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670–10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071–2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775–70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240–4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988–21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267–8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244–7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587–5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687–9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130–4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115–10.830).ConclusionsNulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.

Background: We reviewed studies on the prevalence of Chlamydia infection as a risk factor for developing cervical cancer in a meta-analysis studies published in that subject area. Methods: Cochrane Library and PubMed databases were systematically searched for articles (observational and randomized controlled trials) published from 2008-2018. A meta-analysis of studies was performed to analyse the association between chlamydia infection and cervical cancer. Results: Five articles were included in the final analysis (N=5271). All five articles were case-control studies, of which three studies sampled from population-based registries. All studies involved with sexually active women with minimum 15 years old. Three studies reported the association of C. trachomatis infection cervical cancers, two other studies reported C. trachomatis-HPV co-infection in association with cervical cancer. Result showed C. trachomatis has an overall prevalence of 31.9%, pooled OR 1.96, 95% CI 1.05 to 3.67, OR 2.13, 95% CI 1.78 to 2.54 among cervical cancer. There was a mild publication bias detected at 3.0 effect estimation. Heterogeneity detected from clinical and methodological diversities particularly from C. trachomatis-HPV co-infection subgroup analysis, including sampling bias, geographical strain diversity, and different outcome endpoint measured. Conclusion: C. trachomatis infection was significantly associated with the development of cervical cancer. Co-infection of C. trachomatis-HPV with cervical cancer is plausibly sound but temporality of C. trachomatis-HPV with the development of cervical cancer need to be proven in future prospective cohort studies.

Background: Preeclampsia is a significant cause of maternal and perinatal mortality worldwide. Oxidative stress plays a key role in its pathophysiology, hence antioxidants such as tocotrienol may be preventive against preeclampsia. In 2018, the ISSHP revised the definition of preeclampsia. In accordance with the new definition, we report a secondary data analysis from a clinical trial comparing palm oil vitamin E in the form of tocotrienol-rich fraction (TRF) against placebo, in preventing preeclampsia.Method: A randomized double-blind controlled trial was conducted in 2002–2005 to assess the benefits of TRF in preeclampsia prevention. A total of 299 primigravidae were recruited. The intervention group was supplemented with TRF 100 mg daily in super-olein capsules, whereas the placebo group was prescribed super-olein capsules without TRF, beginning from 12 to 16 gestational weeks until delivery. The primary outcome measure was incidence of preeclampsia.Results: The total incidence of pregnancy induced hypertension (PIH) was 5%, whereas the incidence of preeclampsia was 2.3%. The odds of developing PIH (adjusted OR 0.254; 95% CI: 0.07–0.93; p–value 0.038) and preeclampsia (adjusted OR 0.030; 95% CI: 0.001–0.65; p-value 0.025) were significantly lower in the TRF arm compared to the placebo arm.Conclusion: Antenatal supplementation with palm oil vitamin E in the form of TRF is associated with significant reductions in the incidence of preeclampsia and PIH in a single urban tertiary hospital. Palm oil vitamin E deserves further scrutiny as a potential public health preventive measure against preeclampsia and PIH.

Background Preeclampsia significantly contributes to maternal and perinatal morbidity and mortality. It is imperative to identify women at risk of developing preeclampsia in the effort to prevent adverse pregnancy outcomes through early intervention. Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) level changes are noticeable several weeks before the onset of preeclampsia and its related complications. This study evaluated the feasibility of the sFlt-1/PlGF biomarker ratio in predicting preeclampsia and adverse pregnancy outcomes using a single cut-off point of >38. Methods This is a prospective cohort study conducted at a single tertiary centre, in an urban setting in Kuala Lumpur, Malaysia, between December 2019 and April 2021. A total of 140 medium to high risk mothers with singleton pregnancies were recruited at ≥20 weeks’ gestation. sFlt-1/PlGF ratio was measured and the participant monitored according to a research algorithm until delivery. The primary outcome measure was incidence of preeclampsia and the secondary outcome measure was incidence of other adverse pregnancy outcomes. Results The overall incidence of preeclampsia was 20.7% (29/140). The mean sFlt-1/PlGF ratio was significantly higher in preeclampsia (73.58 ± 93.49) compared to no preeclampsia (13.41 ± 21.63) (p = 0.002). The risk of preeclampsia (adjusted OR 28.996; 95% CI 7.920–106.164; p<0.001) and low Apgar score (adjusted OR 17.387; 95% CI 3.069–98.517; p = 0.028) were significantly higher among women with sFlt-1/PlGF ratio >38 compared with sFLT-1/PlGF ratio ≤38. The area under the receiver-operator characteristic curve (AUC) for a combined approach (maternal clinical characteristics and biomarker) was 86.9% (p<0.001, 95% CI 78.7–95.0) compared with AUC biomarker alone, which was 74.8% (p<0.001, 95% CI 63.3–86.3) in predicting preeclampsia. The test sensitivity(SEN) was 58.6%, specificity (SPEC) 91%,positive predictive value (PPV) 63% and negative predictive value (NPV) 89.3% for prediction of preeclampsia. For predicting a low Apgar score at 5 minutes, the SEN was 84.6%, SPEC 87.4%, PPV 40.7%, and NPV 98.2%; low birth weight with SEN 52.6%,SPEC 86.0%, PPV 37.0%, NPV 92.0%; premature delivery with SEN 48.5%, SPEC 89.5%, PPV 59.3%, NPV 84.7% and NICU admission with SEN 50.0%, SPEC 85.8%, PPV 37.0% and NPV 91.2%. Conclusions It is feasible to use single cut-off point of >38 ratio of the biomarkers sFlt-1/PlGF in combination with other parameters (maternal clinical characteristics) in predicting preeclampsia and adverse pregnancy outcomes among medium to high risk mothers without restricting outcome measurement period to 1 and 4 weeks in a single urban tertiary centre in Kuala Lumpur, Malaysia.

Introduction: The community-based intervention was proven as one of the best approaches in combatting malaria. It is widely used to reduce malaria cases worldwide. A multisectoral approach must be made to ensure the success of the intervention. Therefore, this study is aimed is to determine the effectiveness of community-based intervention for malaria based on recent findings. Methods: A search strategy using Pub Med and Cochrane database platform investigating the effectiveness of malaria community-based intervention. There are selected terms and words predefined to obtain a comprehensive search strategy that included text fields within records and Medical Subject Headings (MeSH terms). Results: Eight articles were selected for this study. This review identified six communitybased interventions for malaria and four outcome measures. Most of the studies included a low risk of bias in each criterion except for random sequence and allocation of concealment. The meta-analysis found that the overall incidence difference of the included studies was significant (0.05 CI 0.02, 0.08), while the subgroup analysis of Permethrin LLIN the I2 was reduced to 75%. However, the overall usage percentage difference in health education and community mobilization to improve intervention usage was not significant (0.28 CI -0.02, 0.58). Conclusion: The community-based intervention approach is practical to fight malaria thus, to reduced mortality due to malaria. An integrated approach and engagement with multiagency will ensure outstanding achievement in fighting malaria.