Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.

Background: Pregnancy is considered as state of emotional well-being. However, pregnancy increases the vulnerability to emotional and psychological conditions such as depression, anxiety, stress and psychoses which have implications to the mother and adverse perinatal outcomes. The objective of this study was to estimate the prevalence and identify the obstetrical and socioeconomic risk factors associated with common mental disorders in the antepartum period by screening and clinical diagnostic interview. Methods: This was a cross sectional study of pregnant women receiving antenatal care in two antenatal health clinics at Malaysia. Pregnant women were screened twice (16-22 weeks and 34-36 weeks) for common mental disorders by administering depression anxiety and stress scale (DASS-21). A detailed structured questionnaire was used to obtain information on socio-demographic and obstetric characteristics of subjects. Women who screened positive for common mental disorders (DASS 21 scores: depression > 10, anxiety >8, stress >15) were clinically assessed by trained clinician using mini international neuropsychiatric interview (MINI). Results: Among 288 women screened, the overall prevalence of antenatal depression, anxiety and stress was 23.6% (n=68) in the second trimester and 24.7% (n=71) in third trimester. The commonest mental health problems are anxiety, 18.8% depression 6.9% and stress 4.2%. Diagnostic clinical interview with MINI diagnosed 34% with adjustment disorder, 23% with anxiety spectrum conditions (panic and GAD) and 8.5% major depressive illness. There was no significant difference in developing common mental disorders between second and third trimester (p>0.05). The socio-demographic factors associated with mental health disorders were low socioeconomic status (p<0.02), lack of family support (p<0.028), partner violence (p<0.002) and obstetrics factors include unplanned pregnancy (p<0.01). Conclusions: Anxiety, depression and stress are associated with identifiable socioeconomic and obstetric risk factors.

Background: Item analysis is a quality assurance of examining the performance of the individual test items that measures the validity and reliability of exams. This study was performed to evaluate the quality of the test items with respect to their performance on difficulty index (DFI), Discriminatory index (DI) and assessment of functional and non-functional distractors (FD and NFD).Methods: This study was performed on the summative examination undertaken by 113 students. The analyses include 120 one best answers (OBAs) and 360 distractors.Results: Out of the 360 distractors, 85 distractors were chosen by less than 5% with the distractor efficiency of 23.6%. About 47 (13%) items had no NFDs while 51 (14%), 30 (8.3%), and 4 (1.1%) items contained 1, 2, and 3 NFDs respectively. Majority of the items showed excellent difficulty index (50.4%, n=42) and fair discrimination (37%, n=33). The questions with excellent difficulty index and discriminatory index showed statistical significance with 1NFD and 2 NFD (p=0.03).Conclusions: The post evaluation of item performance in any exam in one of the quality assurance method of identifying the best performing item for quality question bank. The distractor efficiency gives information on the overall quality of item.

Introduction: Needle stick and sharp injuries (NSSIs) are hazardous and are frequently reported injuries among health care workers (HCW). These injuries expose them to infectious disease pathogens such as Hepatitis B, Hepatitis C and HIV that can be lethal. The physicians, nurses, medical students and other healthcare workers are highly susceptible to needle stick injuries. Standard precautions are available for all the workers and students' safety purposes. Every incident is compulsory to be reported but some are under-reported. This represents a missed opportunity for initiating post exposrure prophylaxis, early detection of seroconversion and implementation of prevention strategies.Objectives: Obstetrics and Gynaecology Department is one of the department estimated as high risk of sharp injuries. The objective of the study is to identify the prevalence of needle stick and sharps injuries (NSSIs) and the rate of under-reporting to occupational health services. It also aims to explore the reasons for under-reporting and the knowledge, awareness and perception of risk of needle stick injuries in Obstetrics and Gynaecology Department of two teaching hospitals in Malaysia.

Background E-learning is the use of Information and Communication Technology (ICT) to provide online education and learning. E- Learning has now been integrated into the traditional teaching as the concept of ‘blended learning’ that combines digital learning with the existing traditional teaching methods to address the various challenges in the field of medical education. Structured e-learning activities were started in Melaka Manipal Medical College in 2009 via e-learning platform (MOODLE-Modular Object-Oriented Dynamic Learning Environment).Objectives The objective of the present study is to investigate the faculty opinions toward the existing e-learning activities, and to analyse the extent of adopting and integration of e-learning into their traditional teaching methods.Methods A cross sectional study was conducted among faculties of Medicine and Dentistry using pre-tested questionnaires. The data was analyzed by using the statistical package for social science, SPSS, version 16.0.Results The result of our survey indicates that majority of our faculty (65.4%) held positive opinion towards e-learning. Among the few, who demonstrated reservations, it is attributed to their average level of skills and aptitude in the use of computers that was statistically significant (p<0.05).Conclusion Our study brings to light the need for formal training as perquisite to support e-learning that enables smooth transition of the faculty from their traditional teaching methods into blended approach. Our results are anticipated to strengthen the existing e-learning activities of our college and other universities and convincingly adopt e-learning as a viable teaching and learning strategy.Kathmandu University Medical Journal Vol.13(1) 2015; 12-18