Introduction: Examination of placenta provides an insight into the aetiology of stillbirth. Obstetricians and general pathologists have tendency to underestimate the significance of placental examination. We report a case of a perinatal death, where the placenta was retrieved from the burial site and was in fact the cause of death in the stillborn. Case Report: A 26-year-old lady, G2P1 at 28 weeks gestation, was investigated for persistent sudden left upper limb pain and numbness associated with bluish discoloration of the fingers. Further investigations revealed a left ulnar artery stenosis and she was suspected to have microvascular/connective tissue disease. During her admission, a fetal assessment performed showed absence of fetal heart activity. Her first child was born 2 years ago at 35 weeks with low birth weight of 1.28 kg. She subsequently underwent induction of labour and delivered a macerated stillborn. After a small focal sampling of the placenta in the labour room for histopathological examination, it was handed over to the parents for burial purposes. A consent for autopsy was obtained afterwards. Upon request by the pathologists and with the consent of the parents, the placenta disc was immediately retrieved from the burial site within 24 hours. On thorough examination of the placenta, there was a significant area of infarction within the placental disc. Microscopically, there was decidual spiral arterioles vasculopathy. Both the macroscopic and microscopic changes were not seen in the initial tissue sampling. These underlying uteroplacental insufficiency were supportive evidences to the hypoxic mode of death identified at autopsy. Learning Points: Placental examination remains necessary as part of investigations in any stillbirth. In instances where a consent for autopsy cannot be obtained, the placenta may provide the answer to the cause of the perinatal death.

Maintenance of bone marrow mesenchymal stem cells (BMMSC) numbers is crucial for tissue repair and regeneration since adult stem cells are often limited in number, expansion capacity and lifespan. It is believed that certain types of foods are beneficial in the preservation and stimulation of stem cells throughout life. Black seeds and stingless bee honey are among the widely investigated functional food with general health promoting benefit. We aim to explore the proliferative, anti-apoptosis and anti-senescence effect of Nigella sativa and Trigona honey on BMMSC. Cell proliferation was evaluated using MTT assay. We performed flow cytometric analysis to verify stem cell surface markers while quantitative PCR was done to measure the relative expression of target genes. Results showed favourable concentration dependent enhancement of cell proliferation by 1 to 10 ug/mL Nigella sativa and 0.097% to 0.195% Trigona honey. Observation on BMMSC’s morphology and surface markers expression revealed no alteration on BMMSC stemness properties. In addition, gene expression analysis supported that there was a significant (P<0.05) increase in proliferation related gene, β-Catenin, and lower expression of apoptotic- and senescence-related gene, BAX and p21, respectively. These preliminary findings suggest a promising effect of Nigella sativa and Trigona honey on stem cell proliferation.

Objectives: Preeclampsia can manifest from mild proteinuria in pregnancy with high blood pressure to eclampsia, which is characterized by concomitant fetal growth limitation or placental insufficiency and a greater degree of multi-organ involvement. There are several developing biochemical tools that can be used to detect and predict it early in pregnancy, yet many are expensive. Thus, this study aimed to determine the prevalence of preeclampsia over 5 year period (2016–2020) in Hospital Ampang, Selangor Malaysia. To review the maternal and fetal outcome in our center. Methods: Retrospective data of all pregnant women with preeclampsia delivered in Hospital Ampang over 5 years duration (2016 till 2020) were reviewed. Patients with a confirmed diagnosis of preeclampsia and valid documentation were recruited and descriptively analyzed. Results: The prevalence of preeclampsia was 0.34% (N=156) with a total of 45 677 deliveries. Malay ethnicity was the majority (70.9%), with mean reproductive age of 30.3 (SD 5.9) and mean parity of 1.8 (SD 1.5). 40.5% neonatal admission to intensive care unit at birth with mean weight upon birth was 2.21 kg (SD 0.77). Two-third of the babies were low birth weight (LBW) (50.3%; less 2.5 kg) and very low birth weight (VLBW) (21.9%, less1.5 kg) contributed by prematurity and growth-restricted fetus. Conclusions: The Preeclampsia prevalence seems not to change over the last decade worldwide. Despite early risk stratification and low-dose aspirin commenced and emphasized. Perhaps the use of placental biochemical parameters and considering weight-adjusted aspirin dosage may reflect a different maternal and fetal outcome.

Team-based learning (TBL) is relatively new in medical education and has yet to be implemented in Malaysia. The main purpose of TBL is to change the classroom experience from acquiring to applying knowledge in a team. The aim of this study is to identify the student’s perception of TBL and the impact on the student’s learning in Universiti Sains Islam Malaysia (USIM). The TBL pedagogy was imparted into the teaching of Haematology module among the 3rd year medical students of USIM. Part of the face-to-face teaching sessions (25%) was changed to online learning packages while the tutorial and practical sessions were transformed into readiness assurance tests (RATs) and application exercises. The TBL implementation and the students’ performance were observed closely and at the end of the module, a feedback form was distributed to the students (n = 79). Data was analysed using SPSS version 19.0. We found that TBL encouraged students to work more seriously and effectively in teams (93.59%). They are comfortable working in teams and satisfied with the team members’ participation (98.72%). They agreed that TBL enhanced their understanding, evidenced by improvement in the tutorial marks (98.72%). TBL also improves their communication skill and self-confidence (84.42%). In general, they preferred the TBL compared to the traditional method (89.61%). Many are not comfortable with online learning and would appreciate more face-toface lecture sessions (52.56%). However, they commented that adequate facilities are required for an effective TBL (94.87%). In conclusion, students’ perception and outcome assessment showed promising results and should be considered for implementation. Keywords: Medical education, TBL, Pedagogy, Outcome, Assessment