Browse publications by year: 2017

  1. Chuah LO, Yap KP, Shamila-Syuhada AK, Thong KL, Ahmad R, Liong MT, et al.
    Int J Syst Evol Microbiol, 2017 Dec;67(12):4979-4985.
    PMID: 29034853 DOI: 10.1099/ijsem.0.002386
    Three strains of Gram-staining-positive, coccus-shaped, lactic acid bacteria, designated as HibF3T, HibF2 and HibF5 were isolated from fresh flowers of hibiscus, and a fourth, DF1T, was isolated from fresh flowers of durian tree, in Penang, Malaysia. Taxonomic characterisation was performed by polyphasic analysis. Sequence similarities of the 16S rRNA gene and the housekeeping rpoA and pheS genes of these strains with their closely-related lactococcal and streptococcal relatives were 92-94, 78 and 81 %, respectively. The results of phylogenetic analysis indicated that strains DF1T, HibF2, HibF5 and HibF3T were clustered together but were clearly separated from species of the genera Streptococcus and Lactococcus, indicating that they represent members of a novel genus of the family Streptococcaceae. Calculation of average nucleotide identity (ANI) values between the genomes of DF1T and HibF3T yielded values of 92.50-92.93 %. ANI values below the cut-off value and distinctive chemotaxonomic characteristics supported the hypothesis that these strains represented two novel species. Major cellular fatty acids in DF1T, HibF2 and HibF5 were C18 : 1ω7c and C16 : 0, while C12 : 0 and C14 : 0 were also dominant, in addition to C18 : 1ω7c and C16 : 0, in HibF3T. A novel genus is proposed with the name Floricoccus gen. nov. which consists of two species, Floricoccus tropicus sp. nov as the type species, and Floricoccus penangensis sp. nov. The respective type strains are DF1T (=LMG 29833T=JCM 31733T) and HibF3T (=LMG 29831T=DSM 31735T).
    MeSH terms: DNA, Bacterial/genetics; Fatty Acids/chemistry; Genes, Bacterial; Malaysia; Nucleic Acid Hybridization; Phylogeny*; RNA, Ribosomal, 16S/genetics; Streptococcaceae/classification*; Streptococcaceae/genetics; Streptococcaceae/isolation & purification; Bacterial Typing Techniques; Sequence Analysis, DNA; Hibiscus/microbiology*; Bombacaceae/microbiology*; Flowers/microbiology*
  2. Junaid QO, Khaw LT, Mahmud R, Ong KC, Lau YL, Borade PU, et al.
    Parasite, 2017;24:38.
    PMID: 29034874 DOI: 10.1051/parasite/2017040
    BACKGROUND: As the quest to eradicate malaria continues, there remains a need to gain further understanding of the disease, particularly with regard to pathogenesis. This is facilitated, apart from in vitro and clinical studies, mainly via in vivo mouse model studies. However, there are few studies that have used gerbils (Meriones unguiculatus) as animal models. Thus, this study is aimed at characterizing the effects of Plasmodium berghei ANKA (PbA) infection in gerbils, as well as the underlying pathogenesis.

    METHODS: Gerbils, 5-7 weeks old were infected by PbA via intraperitoneal injection of 1 × 106 (0.2 mL) infected red blood cells. Parasitemia, weight gain/loss, hemoglobin concentration, red blood cell count and body temperature changes in both control and infected groups were monitored over a duration of 13 days. RNA was extracted from the brain, spleen and whole blood to assess the immune response to PbA infection. Organs including the brain, spleen, heart, liver, kidneys and lungs were removed aseptically for histopathology.

    RESULTS: Gerbils were susceptible to PbA infection, showing significant decreases in the hemoglobin concentration, RBC counts, body weights and body temperature, over the course of the infection. There were no neurological signs observed. Both pro-inflammatory (IFNγ and TNF) and anti-inflammatory (IL-10) cytokines were significantly elevated. Splenomegaly and hepatomegaly were also observed. PbA parasitized RBCs were observed in the organs, using routine light microscopy and in situ hybridization.

    CONCLUSION: Gerbils may serve as a good model for severe malaria to further understand its pathogenesis.

    MeSH terms: Animals; Body Temperature; Body Weight; Brain/immunology; Brain/pathology; Disease Models, Animal*; Erythrocyte Count; Gerbillinae/parasitology*; Hemoglobins/analysis; Liver/pathology; Malaria/etiology*; Malaria/mortality; Malaria/parasitology; Plasmodium berghei/physiology*; RNA/genetics; RNA/isolation & purification; Spleen/metabolism; Spleen/pathology; Survival Rate; Cytokines/analysis; Cytokines/genetics; In Situ Hybridization; DNA, Complementary/genetics; Parasitemia/etiology; Parasitemia/mortality; Parasitemia/parasitology; Real-Time Polymerase Chain Reaction
  3. Brown D, Feeney M, Ahmadi M, Lonoce C, Sajari R, Di Cola A, et al.
    J Exp Bot, 2017 Nov 02;68(18):5045-5055.
    PMID: 29036360 DOI: 10.1093/jxb/erx331
    Natural rubber (polyisoprene) from the rubber tree Hevea brasiliensis is synthesized by specialized cells called laticifers. It is not clear how rubber particles arise, although one hypothesis is that they derive from the endoplasmic reticulum (ER) membrane. Here we cloned the genes encoding four key proteins found in association with rubber particles and studied their intracellular localization by transient expression in Nicotiana benthamiana leaves. We show that, while the cis-prenyltransferase (CPT), responsible for the synthesis of long polyisoprene chains, is a soluble, cytosolic protein, other rubber particle proteins such as rubber elongation factor (REF), small rubber particle protein (SRPP) and Hevea rubber transferase 1-REF bridging protein (HRBP) are associated with the endoplasmic reticulum (ER). We also show that SRPP can recruit CPT to the ER and that interaction of CPT with HRBP leads to both proteins relocating to the plasma membrane. We discuss these results in the context of the biogenesis of rubber particles.
    MeSH terms: Amino Acid Sequence; Cytosol/enzymology; Endoplasmic Reticulum/metabolism; Models, Biological; Plant Proteins/genetics; Plant Proteins/metabolism*; Rubber/metabolism*; Tobacco/cytology; Tobacco/genetics; Tobacco/metabolism; Transferases/genetics; Transferases/metabolism*; Sequence Alignment; Genes, Reporter; Plant Leaves/cytology; Plant Leaves/enzymology; Plant Leaves/genetics; Hevea/cytology; Hevea/enzymology*; Hevea/genetics; Antigens, Plant/genetics; Antigens, Plant/metabolism*
  4. Wei LK, Au A, Teh LK, Lye HS
    Adv Exp Med Biol, 2017;956:561-581.
    PMID: 27957710 DOI: 10.1007/5584_2016_75
    Hypertension is a silent killer worldwide, caused by both genetic and environmental factors. Until now, genetic and genomic association studies of hypertension are reporting different degree of association on hypertension. Hence, it is essential to gather all the available information on the reported genetic loci and to determine if any biomarker(s) is/are significantly associated with hypertension. Current review concluded the potential biomarkers for hypertension, with regards to electrolyte and fluid transports, as well as sodium/potassium ions homeostasis, which are supported by the results of case-controls and meta-analyses.
    MeSH terms: Animals; Blood Pressure/genetics*; Genetic Markers; Humans; Hypertension/genetics*; Hypertension/physiopathology; Phenotype; Polymorphism, Genetic*; Risk Factors; Genetic Predisposition to Disease; Genome-Wide Association Study
  5. P S L, Miskan MM, Y Z C, Zaki RA
    BMC Anesthesiol, 2017 Oct 11;17(1):137.
    PMID: 29020936 DOI: 10.1186/s12871-017-0430-3
    BACKGROUND: Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study.

    METHODS: A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group).

    RESULTS: We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p 

    MeSH terms: Adult; Cough/diagnosis*; Cough/etiology; Cough/prevention & control*; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Male; Middle Aged; Postoperative Complications/diagnosis*; Postoperative Complications/etiology; Postoperative Complications/prevention & control*; Severity of Illness Index*; Neuromuscular Blockade/adverse effects; Neuromuscular Blockade/methods; gamma-Cyclodextrins/administration & dosage*; gamma-Cyclodextrins/adverse effects
  6. Jacob PJ, Masarudin MJ, Hussein MZ, Rahim RA
    Microb Cell Fact, 2017 Oct 11;16(1):175.
    PMID: 29020992 DOI: 10.1186/s12934-017-0789-3
    BACKGROUND: Iron based ferromagnetic nanoparticles (IONP) have found a wide range of application in microelectronics, chemotherapeutic cell targeting, and as contrast enhancers in MRI. As such, the design of well-defined monodisperse IONPs is crucial to ensure effectiveness in these applications. Although these nanostructures are currently manufactured using chemical and physical processes, these methods are not environmentally conducive and weigh heavily on energy and outlays. Certain microorganisms have the innate ability to reduce metallic ions in aqueous solution and generate nano-sized IONP's with narrow size distribution. Harnessing this potential is a way forward in constructing microbial nanofactories, capable of churning out high yields of well-defined IONP's with physico-chemical characteristics on par with the synthetically produced ones.

    RESULTS: In this work, we report the molecular characterization of an actinomycetes, isolated from tropical freshwater wetlands sediments, that demonstrated rapid aerobic extracellular reduction of ferric ions to generate iron based nanoparticles. Characterization of these nanoparticles was carried out using Field Emission Scanning Electron Microscope with energy dispersive X-ray spectroscopy (FESEM-EDX), Field Emission Transmission Electron Microscope (FETEM), Ultraviolet-Visible (UV-Vis) Spectrophotometer, dynamic light scattering (DLS) and Fourier transform infrared spectroscopy (FTIR). This process was carried out at room temperature and humidity and under aerobic conditions and could be developed as an environmental friendly, cost effective bioprocess for the production of IONP's.

    CONCLUSION: While it is undeniable that iron reducing microorganisms confer a largely untapped resource as potent nanofactories, these bioprocesses are largely anaerobic and hampered by the low reaction rates, highly stringent microbial cultural conditions and polydispersed nanostructures. In this work, the novel isolate demonstrated rapid, aerobic reduction of ferric ions in its extracellular matrix, resulting in IONPs of relatively narrow size distribution which are easily extracted and purified without the need for convoluted procedures. It is therefore hoped that this isolate could be potentially developed as an effective nanofactory in the future.

    MeSH terms: Dynamic Light Scattering; Fresh Water/microbiology; Iron/chemistry*; Silver; Spectrometry, X-Ray Emission; Spectrophotometry, Ultraviolet; X-Ray Diffraction; Spectroscopy, Fourier Transform Infrared; Nanotechnology/methods*; Actinobacteria/metabolism; Metal Nanoparticles/chemistry*; Wetlands*; Magnets/chemistry*
  7. Huei TJ, Mohd Yussof SJ, Lip HTC, Salina I
    Ann Burns Fire Disasters, 2017 Jun 30;30(2):150-153.
    PMID: 29021730
    Electrical injuries make up a relatively small portion of burn injuries. Safety measures in place on domestic electricity supply have reduced the occurrence of high voltage electrical injuries. We present the case of a young man who sustained a high voltage electrical injury on all four limbs. Early fasciotomy was performed on both his hands and forearms. Despite early compartment release, the left upper limb deteriorated and required amputation. In this article we discuss the indications, outcomes and complications of early fasciotomy.
  8. Sorokowski P, Randall AK, Groyecka A, Frackowiak T, Cantarero K, Hilpert P, et al.
    Front Psychol, 2017;8:1728.
    PMID: 29021774 DOI: 10.3389/fpsyg.2017.01728
    [This corrects the article on p. 1199 in vol. 8, PMID: 28785230.].
    MeSH terms: Humans
  9. Mohd S, Yusof N, Ramalingam S, Ng WM, Mansor A
    Malays Orthop J, 2017 Jul;11(2):1-6.
    PMID: 29021871 MyJurnal DOI: 10.5704/MOJ.1707.004
    Despite increasing use of bone graft in Malaysia, there was still lack of data to quantify knowledge level on bone banking among orthopaedic community who are involved in transplantation related work. Therefore, a survey on awareness in tissue banking specifically bone banking, usage and choice of bone grafts was conducted. From 80 respondents, 82.5% were aware about tissue banking however only 12.5% knew of the existence of tissue banks in Malaysia. Femoral head was the bone allograft most often used as a substitute to autograft. Only 34.8% respondents preferred irradiated bone grafts whilst 46.9% preferred nonirradiated, indicating the need to educate the importance of radiation for sterilising tissues. Exhibition was the most preferred medium for awareness programme to disseminate information about bone banking in the orthopaedic community. The professional awareness is necessary to increase the knowledge on the use of bone graft, hence to increase bone transplantation for musculoskeletal surgeries in the country.
    MeSH terms: Femur Head; Humans; Malaysia; Orthopedics; Surveys and Questionnaires; Sterilization, Reproductive; Tissue Banks; Bone Transplantation; Bone Banks; Allografts; Autografts
  10. Zulkifli MM, Kadir AA, Elias A, Bea KC, Sadagatullah AN
    Malays Orthop J, 2017 Jul;11(2):7-14.
    PMID: 29021872 MyJurnal DOI: 10.5704/MOJ.1707.003
    Introduction: This study aimed to cross-culturally adapt a Malay version of Knee Injury and Osteoarthritis Outcome Score (KOOS) and to evaluate its psychometric properties in patients with knee osteoarthritis (OA). Materials and Methods: The English version KOOS was translated into a Malay version using forward and backward translation process, followed by face validity and content validity. Two hundred and twenty-six knee OA patients attending the Outpatient and Orthopaedic Clinics, Universiti Sains Malaysia Hospital, completed the Malay version KOOS. Construct validity using confirmatory factor analysis and internal reliability assessment were performed. Results: The results showed that the original five-factor model with 42 items failed to achieve acceptable values of the goodness of fit indices, indicating poor model fit. A new five-factor model of 26 items demonstrated acceptable level of goodness of fit (comparative fit index= 0.929, incremental fit index= 0.930, Tucker Lewis fit index= 0.920, root mean square error of approximation= 0.073 and Chisquared/degree of freedom= 2.183) indices to signify a model fit. The Cronbach's alpha value for the new model ranged from 0.776 to 0.946. The composite reliability values of each construct ranged between 0.819 and 0.921, indicating satisfactory to high level of convergent validity. Conclusion: The five-factor model with 26 items in the Malay version of KOOS questionnaire demonstrated a good degree of goodness of fit and was found to be valid, reliable and simple as an assessment tool for symptoms, pain, activity of daily living, sports and recreational activity and quality of life for Malaysian adults suffering from knee osteoarthritis.

    Study site: Outpatient and orthopedic clinics, Hospital Universiti Sains Malaysia (HUSM)
    MeSH terms: Adult; Ambulatory Care Facilities; Factor Analysis, Statistical; Hospitals, University; Humans; Knee; Knee Injuries; Malaysia; Orthopedics; Outpatient Clinics, Hospital; Outpatients; Pain; Psychometrics; Quality of Life; Surveys and Questionnaires; Sports; Translating; Reproducibility of Results; Osteoarthritis, Knee
  11. Imma II, Nizlan NM, Ezamin AR, Yusoff S, Shukur MH
    Malays Orthop J, 2017 Jul;11(2):30-35.
    PMID: 29021876 MyJurnal DOI: 10.5704/MOJ.1707.012
    Introduction: The aims of this study are to define the coracoid process anatomy in a Malaysian population, carried out on patients in Hospital Serdang with specific emphasis on the dimension of the base of coracoid process which is important in coraco-acromial (CC) ligament reconstruction, to define the average amount of bone available for use in coracoid transfer, and to compare the size of coracoid process based on gender and race, and with findings in previous studies. Materials and Methods: Fifteen pairs of computed tomography (CT) based 3-dimensional models of shoulders of patients aged between 20 to 60 years old were examined. The mean dimensions of coracoid were measured and compared with regards to gender and race. The data were also compared to previously published studies. Results: The mean length of the coracoid process was 37.94 ± 4.30 mm. Male subjects were found to have larger-sized coracoids in all dimensions as compared to female subjects. The mean tip of coracoid dimension overall was 19.99 + 1.93mm length × 10.03 + 1.48mm height × 11.63 + 2.12mm width. The mean base of coracoid dimension was 18.96 + 3.71mm length × 13.84 + 1.76mm width. No significant differences were observed with regards to racial denomination. The overall coracoid size measurements were found to be smaller compared to previous studies done on the Western population. Conclusion: This study may suggest that Malaysians have smaller coracoid dimension compared to Caucasians. The findings further suggest that the incidence of coracoid fracture and implants pull out in Malaysian subjects may be higher.
    MeSH terms: Acromion; Adult; Female; Humans; Ligaments; Male; Middle Aged; Shoulder; Tomography; Tomography, X-Ray Computed; Incidence; Reconstructive Surgical Procedures; Fractures, Bone; Young Adult; Coracoid Process
  12. Syed A, Alvin T, Fazrina A, Abdul R
    Malays Orthop J, 2017 Jul;11(2):36-39.
    PMID: 29021877 MyJurnal DOI: 10.5704/MOJ.1707.005
    Introduction: Necrotising fasciitis (NF) is a rapidly progressive infection of the subcutaneous tissue and fascia which spreads rapidly. The scoring system of Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) developed by Wong et al has been proposed as a tool for distinguishing NF and other soft tissue infections (STI) in Singapore. We set out to establish whether the LRINEC score is applicable in our Malaysian setting. Materials and Methods: A cross sectional study of all patients admitted to our hospital diagnosed with NF or To Rule Out NF (TRO NF) between January 1st 2016 to 30th June 2016. The sensitivity, specificity, positive and negative predictive values were then calculated for LRINEC score of ≥ 6 and ≥ 8. Results: Fourty-four patients were identified with the diagnosis of NF or TRO NF in the study. Twenty-seven patients (61.4%) were deemed post-operatively as having NF and 17 patients (38.6%) not having NF. A sensitivity of 59.3% and specificity of 47.1% when a LRINEC score of ≥ 6 was taken with positive predictive value (PPV) of 64.0% and the negative predictive value (NPV) of 42.1%. When score ≥ 8 was taken, the sensitivity was 48.1% and specificity of 58.8% with PPV of 65% and NPV of 41.7%. Conclusion: The low sensitivity and low PPV achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections.
    MeSH terms: Cross-Sectional Studies; Fascia; Humans; Risk Factors; Sensitivity and Specificity; Singapore; Soft Tissue Infections; Fasciitis, Necrotizing; Subcutaneous Tissue; Subcutaneous Fat
  13. Solayar GN, Chinappa J, Harris IA, Chen DB, Macdessi SJ
    Malays Orthop J, 2017 Jul;11(2):45-52.
    PMID: 29021879 MyJurnal DOI: 10.5704/MOJ.1707.006
    Introduction: Optimal coronal and sagittal component positioning is important in achieving a successful outcome following total knee arthroplasty (TKA). Modalities to determine post-operative alignment include plain radiography and computer tomography (CT) imaging. This study aims to determine the accuracy and reliability of plain radiographs in measuring coronal and sagittal alignment following TKA. Materials and Methods: A prospective, consecutive study of 58 patients undergoing TKA was performed comparing alignment data from plain radiographs and CT imaging. Hip-knee-angle (HKA), sagittal femoral angle (SFA) and sagittal tibial angle (STA) measurements were taken by two observers from plain radiographs and compared with CT alignment. Intra- and inter-observer correlation was calculated for each measurement. Results: Intra-observer correlation was excellent for HKA (r>0.89) with a mean difference of <1.9°. The least intra-observer correlation was for SFA (mean r=0.58) with a mean difference of 8°. Inter-observer correlation was better for HKA (r>0.95) and STA (r>0.8) compared to SFA (r=0.5). When comparing modalities (radiographs vs CT), HKA estimations for both observers showed the least maximum and mean differences while SFA observations were the least accurate. Conclusion: Radiographic estimation of HKA showed excellent intra- and inter-observer correlation and corresponds well with CT imaging. However, radiographic estimation of sagittal plane alignment was less reliably measured and correlated less with CT imaging. Plain radiography was found to be inferior to CT for estimation of biplanar prosthetic alignment following TKA.
    MeSH terms: Femur; Humans; Knee; Knee Joint; Prospective Studies; Radiography; Tibia; Tomography; Tomography, X-Ray Computed; Reproducibility of Results; Arthroplasty, Replacement, Knee
  14. Or SY, Khaw YC, Hwang PX, Ong TK
    Malays Orthop J, 2017 Jul;11(2):60-63.
    PMID: 29021881 MyJurnal DOI: 10.5704/MOJ.1707.007
    Chronic sagittal band injury with tendon dislocation of the extensor digitorum communis in the hand often requires operative stabilization. Various surgical techniques have been reported to repair and reconstruct the sagittal band. Nonetheless, most of the techniques are technically demanding and require donor graft. In this case report, we report a novel surgical technique to centralize and stabilize the tendon by reattaching the radial sagittal band with anchor sutures. The advantages of this new technique are simple, no donor morbidity and stable repair to restore the normal biomechanics of the tendon. The patient was able to return to work in three months and no recurrent dislocation was noted at review two years after surgery.
    MeSH terms: Humans; Sutures; Tendons; Suture Anchors; Return to Work
  15. Saadon I, Amit B, Zolquarnian A, Muhamad F
    Malays Orthop J, 2017 Jul;11(2):64-67.
    PMID: 29021882 MyJurnal DOI: 10.5704/MOJ.1707.010
    Musculoskeletal tumours of the lower limbs especially malignant tumours are not common. The fibula is the site of primary bone tumours as reported in 2.4% of lower limb tumours with the proximal third being more frequently involved than the distal segment. Osteosarcoma is the most common primary malignant bone tumour of nonhaematopoietic origin, with distal fibular involvement in 0.47% of patients. The advances in imaging techniques and neo-adjuvant chemotherapy have now made it possible to accurately define the extent of tumour and plan limb salvage with tumour resection. The purpose of this case report is to highlight the successful outcome of limb salvage procedure with a five year follow up in an 11-year old boy with distal fibular osteosarcoma. Limb salvage surgery with distal fibulectomy and retention of the foot are a good alternative to radical amputation.
    MeSH terms: Amputation; Bone Neoplasms; Child; Fibula; Follow-Up Studies; Humans; Male; Osteosarcoma; Neoadjuvant Therapy; Limb Salvage; Lower Extremity
  16. Kow RY, Low CL, Ruben JK, Zaharul-Azri MZ, Ng MS
    Malays Orthop J, 2017 Jul;11(2):72-74.
    PMID: 29021884 MyJurnal DOI: 10.5704/MOJ.1707.008
    Chlorhexidine is a common antiseptic and disinfectant used in the medical field. Allergy to chlorhexidine has been reported in the literature but life-threatening anaphylactic shock is rare. We present a case of severe anaphylactic shock due to chlorhexidine occurring during surgery. Literatures suggest that profound anaphylactic shock to chlorhexidine is commonly preceded by milder, non-specific reactions. These mild symptoms are often dismissed by both the patient and physicians alike. Direct questioning of these symptoms is necessary as a part of the pre-operative assessment and the patient should be referred for further immunology testing if indicated.
    MeSH terms: Anaphylaxis; Anti-Infective Agents, Local; Chlorhexidine; Disinfectants; Drug Hypersensitivity; Humans; Sterilization
  17. Abilash K, Mohd Q, Ahmad Z, Towil B
    Malays Orthop J, 2017 Jul;11(2):75-77.
    PMID: 29021885 MyJurnal DOI: 10.5704/MOJ.1707.013
    Ankylosing spinal disorders (ASD) tend to result in fractures and/or dislocations after minor trauma because of the altered biomechanical properties. The relative risk of traumatic vertebral fractures in patients with ankylosing spondylitis has been estimated as three times higher than in the general population. These spine traumas, which are located at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock in a middle aged man with undiagnosed ankylosing spondylitis.
    MeSH terms: Adult; Humans; Malaysia; Male; Massage; Middle Aged; Spondylitis, Ankylosing; Spinal Fractures; Fractures, Bone; Fracture Dislocation
  18. William C, Simmrat S, Suhaeb AM
    Malays Orthop J, 2017 Jul;11(2):78-81.
    PMID: 29021886 MyJurnal DOI: 10.5704/MOJ.1707.015
    Infection of the hip after implant fixation is an uncommon yet devastating complication that results in poor long-term outcome. The gold standard treatment for chronic infection after hip arthroplasty is a two-stage protocol: eradication of infection, follow by re-implantation arthroplasty. The use of interim antibiotic-laden cement spacer has become a popular procedure to maintain hip joint function and provide antibiotic elution simultaneously before re-implantation. However, antibiotic cement spacer is mechanically weak and breaks if overloaded. Therefore, we designed a cement mould with metallic endoskeleton with the aim of creating a stronger, inexpensive, antibiotic-impregnated spacer resembling a unipolar arthroplasty. We report two cases of severe hip joint infection after implant fixation (bipolar hemiarthroplasty, screw fixation neck of femur). Both patients had undergone first stage surgery of debridement and articulating antibiotic cement insertion using our design. Although the second stage surgery was planned for these patients, both patients delayed the operation in view of good functional status after a year walking with the antibiotic cement spacer. These cases showed that the mechanical property of the new antibiotic cement spacer was promising but further mechanical studies upon this new endoskeleton design are required.
    MeSH terms: Anti-Bacterial Agents; Bone Cements; Bone Screws; Debridement; Femur; Hip Joint; Humans; Walking; Hemiarthroplasty
  19. Logheswaren S, Sulaiman AR, Munajat I
    Malays Orthop J, 2017 Jul;11(2):82-84.
    PMID: 29021887 MyJurnal DOI: 10.5704/MOJ.1707.014
    The ideal size of intramedullary device to fix corrective osteotomy of proximal femur in abnormal bone in children and small patients may not be easily available. We report the successful use of Rush rod in combination with multiple Kirschner wires to fix the corrective osteotomy of coxa vara and shepherd crook deformity in two patients with osteogenesis imperfecta and fibrous dysplasia. The union was achieved on time, neck shaft angle and rotation were maintained.
    MeSH terms: Bone Wires; Child; Femur; Fracture Fixation, Internal; Humans; Osteogenesis Imperfecta; Osteotomy; Rotation; Coxa Vara
  20. Hanifah J, Joehaimey J, Yusof MI
    Malays Orthop J, 2017 Jul;11(2):85-88.
    PMID: 29021888 MyJurnal DOI: 10.5704/MOJ.1707.018
    Spinal epidural abscess is a severe, generally pyogenic, infection of the epidural space of spinal cord or cauda equina. The swelling caused by the abscess leads to compression or vascular disruption of neurological structures that requires urgent surgical decompression to avoid significant permanent disability. We share a rare case of Klebsiella pneumoniae spinal epidural abscess secondary to haematogenous spread of previous lung infection that presented late at our centre with cauda equina syndrome that showed good short-term outcome in delayed decompression. A 50-year old female presented with one-week history of persistent low back pain with progressively worsening bilateral lower limb weakness for seven days and urinary retention associated with saddle anesthesia of 2-day duration. Magnetic resonance imaging with contrast of the lumbo-sacral region showed an intramuscular collection of abscess at left gluteus maximus and left multifidus muscle with a L3-L5 posteriorly placed extradural lesion enhancing peripherally on contrast, suggestive of epidural abscess that compressed the cauda equina. The pus was drained using the posterior lumbar approach. Tissue and pus culture revealed Klebsiella pneumoniae, suggestive of bacterial infection. The patient made immediate improvement of muscle power over bilateral lower limbs postoperative followed by ability to control micturition and defecation the 4th post-operative day. A good short-term outcome in delayed decompression of cauda equine syndrome is extremely rare. Aggressive surgical decompression combined with antibiotic therapy led to good short-term outcome in this patient despite delayed decompression of more than 48 hours.
    MeSH terms: Anesthesia; Animals; Anti-Bacterial Agents; Bacterial Infections; Cauda Equina; Decompression; Defecation; Drainage; Epidural Space; Female; Horses; Humans; Klebsiella pneumoniae; Magnetic Resonance Imaging; Middle Aged; Polyradiculopathy; Sacrococcygeal Region; Urination; Urinary Retention; Low Back Pain; Decompression, Surgical; Epidural Abscess; Lower Extremity; Paraspinal Muscles
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