Browse publications by year: 2018

Fulltext The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study

Chuah FLH, Tan ST, Yeo J, Legido-Quigley H

Int J Equity Health, 2018 08 15;17(1):120.
PMID: 30111329 DOI: 10.1186/s12939-018-0833-x

BACKGROUND: In Malaysia, refugees and asylum-seekers are a vulnerable group that often face circumstances in which their health and wellbeing can be compromised. This qualitative study sought to examine the key health concerns and barriers to healthcare access among refugees and asylum-seekers in Malaysia through the lens of healthcare professionals, program staff and experts on refugee and migrant health.
METHODS: We conducted 20 semi-structured in-depth interviews with experts, healthcare professionals, program managers or executives from UN agencies, public healthcare facilities, civil society organizations, and academic institutions in Malaysia. Interviews were transcribed and analyzed both deductively and inductively using thematic analysis.
RESULTS: Participant narratives highlight that the health needs of refugees and asylum-seekers in Malaysia are complex. As reported, access to healthcare is underpinned by numerous social, cultural and economic determinants compounded by a legal environment that lacks inclusivity of refugees and asylum-seekers. Apart from the health risks associated with the migration process, limited access to comprehensive healthcare post-arrival remain a problem for refugees and asylum-seekers in Malaysia. Key barriers to healthcare access are linked to poor health literacy and the lack of awareness on one's right to healthcare; language and cultural differences; protection issues resulting from a lack of legal status; and an inability to afford healthcare due to inadequate livelihoods. Overall, poor access to healthcare is perceived to have detrimental consequences on the health status of refugees, asylum-seekers and its host population, and may incur greater costs to the health system in the long run.
CONCLUSION: Comprehensive efforts in practice and research that tackle the social, cultural and economic determinants of health, and more inclusive health policies are crucial in strengthening healthcare access among refugees and asylum-seekers in Malaysia. Practical recommendations include improving the health literacy of refugees and asylum-seekers for better navigation of the health system; bridging language and cultural gaps through translation support and inter-cultural orientation; implementing policies grounded in the right to healthcare for all regardless of legal status and in the interest of public health; and establishing a larger evidence base to drive policy development and implementation for refugee health within the Malaysian context.

MeSH terms: Health Services Accessibility/statistics & numerical data*; Health Services Needs and Demand/statistics & numerical data*; Humans; Interviews as Topic; Language; Malaysia; Refugees/statistics & numerical data*; Transients and Migrants/statistics & numerical data*; Qualitative Research
Vasorelaxant effect of sinensetin via the NO/sGC/cGMP pathway and potassium and calcium channels

Yam MF, Tan CS, Shibao R

Hypertens Res, 2018 Oct;41(10):787-797.
PMID: 30111856 DOI: 10.1038/s41440-018-0083-8

Orthosiphon stamineus Benth. (Lambiaceae) is an important traditional plant for the treatment of hypertension. Previous studies have demonstrated that the sinensetin content in O. stamineus is correlated with its vasorelaxant activity. However, there is still very little information regarding the vasorelaxant effect of sinensetin due to a lack of scientific studies. Therefore, the present study was designed to investigate the underlying mechanism of action of sinensetin in vasorelaxation using an in vitro precontraction aortic ring assay. The changes in the tension of the aortic ring preparations were recorded using a force-displacement transducer and the PowerLab system. The mechanisms of the vasorelaxant effect of sinensetin were determined in the presence of antagonists. Sinensetin caused relaxation of the aortic ring precontracted with PE in the presence and absence of the endothelium and with potassium chloride in endothelium-intact aortic rings. In the presence of Nω-nitro-L-arginine methyl ester (nitric oxide synthase inhibitor), methylene blue (cyclic guanosine monophosphate lowering agent), ODQ (selective soluble guanylate cyclase inhibitor), indomethacin (a nonselective cyclooxygenase inhibitor), tetraethylammonium (nonselective calcium activator K+ channel blocker), 4-aminopyridine (voltage-dependent K+ channel blocker), barium chloride (inwardly rectifying Kir channel blocker), glibenclamide (nonspecific ATP-sensitive K+ channel blocker), atropine (muscarinic receptor blocker), or propranolol (β-adrenergic receptor blocker), the relaxation stimulated by sinensetin was significantly reduced. Sinensetin was also active in reducing Ca2+ release from the sarcoplasmic reticulum (via IP3R) and in blocking calcium channels (VOCC). The present study demonstrates the vasorelaxant effect of sinensetin, which involves the NO/sGC/cGMP and indomethacin pathways, calcium and potassium channels, and muscarinic and beta-adrenergic receptors.

MeSH terms: Animals; Aorta/drug effects; Aorta/metabolism; Enzyme Inhibitors/pharmacology; Flavonoids/pharmacology*; Cyclic GMP/metabolism*; Male; Nitric Oxide/metabolism*; Vasodilator Agents/pharmacology*; Calcium Channels/metabolism*; Potassium Channels/metabolism*; Signal Transduction/drug effects*; Rats, Sprague-Dawley; Nitric Oxide Synthase/antagonists & inhibitors; NG-Nitroarginine Methyl Ester/pharmacology; Rats; Soluble Guanylyl Cyclase/metabolism*
Fulltext 10-Year Cardiovascular Disease Risk Estimation Based on Lipid Profile-Based and BMI-Based Framingham Risk Scores across Multiple Sociodemographic Characteristics: The Malaysian Cohort Project

Borhanuddin B, Mohd Nawi A, Shah SA, Abdullah N, Syed Zakaria SZ, Kamaruddin MA, et al.

ScientificWorldJournal, 2018;2018:2979206.
PMID: 30111990 DOI: 10.1155/2018/2979206

Cardiovascular disease (CVD) leads to high morbidity and mortality rate worldwide. Therefore, it is important to determine the risk of CVD across the sociodemographic factors to strategize preventive measures. The current study consisted of 53,122 adults between the ages of 35 and 65 years from The Malaysian Cohort project during recruitment phase from year 2006 to year 2012. Sociodemographic profile and physical activity level were assessed via self-reported questionnaire, whereas relevant CVD-related biomarkers and biophysical variables were measured to determine the Framingham Risk Score (FRS). The main outcome was the 10-year risk of CVD via FRS calculated based on lipid profile and body mass index (BMI) associated formulae. The BMI-based formula yielded a higher estimation of 10-year CVD risk than the lipid profile-based formula in the study for both males (median = 13.2% and 12.7%, respectively) and females (median = 4.3% and 4.2%, respectively). The subgroup with the highest risk for 10-year CVD events (based on both FRS formulae) was the Malay males who have lower education level and low physical activity level. Future strategies for the reduction of CVD risk should focus on screening via BMI-based FRS in this at-risk subpopulation to increase the cost-effectiveness of the prevention initiatives.
Study name: The Malaysian Cohort (TMC) project

MeSH terms: Adult; Aged; Cardiovascular Diseases/epidemiology*; Humans; Lipids/analysis*; Malaysia/epidemiology; Middle Aged; Risk Factors; Socioeconomic Factors*; Body Mass Index; Risk Assessment/methods
Fulltext Lumbar Spinal Stenosis: The Reliability, Sensitivity and Specificity of the Nerve Root Sedimentation Sign

Yusof MI, Azizan AF, Abdullah MS

Malays Orthop J, 2018 Jul;12(2):1-6.
PMID: 30112121 MyJurnal DOI: 10.5704/MOJ.1807.001

Introduction: This study is to evaluate the reliability, sensitivity and specificity of nerve root sedimentation sign (NRS) in our populations. The NRS is a radiological sign to diagnose lumbar spinal stenosis (LSS). It is claimed to be reliable with high sensitivity and specificity. Materials and Methods: A total of 82 MRI images from 43 patients in Group A (LSS) and 39 patients in Group B (non LSS) were analysed and compared for the presence of the NRS sign. Two assessors were used to evaluate intra and inter-assessor reliability of this sign based on 56 (33 patients, Group A and 23 patients, Group B). The findings were statistically analysed using SPSS software. Results: There was a significant association between spinal claudication and leg numbness with LSS (p<0.001 and Kappa=0.857, p<0.001). The inter-assessor reliability was also good (Kappa of 0.786, p<0.001). Conclusion: The NRS sign has high sensitivity and specificity for diagnosing LSS. The sign also has good intra and inter-assessor reliability.

MeSH terms: Humans; Hypesthesia; Magnetic Resonance Imaging; Radiography; Radiology; Sensitivity and Specificity; Software; Spinal Stenosis; Reproducibility of Results
Fulltext Closed Intramedullary Locking Nailing for Metacarpal Fractures: A Retrospective Study of Sixty-Six Fractures

Ghazala C, Choudhry N, Rajeev A

Malays Orthop J, 2018 Jul;12(2):7-14.
PMID: 30112122 DOI: 10.5704/MOJ.1807.002

Introduction: Metacarpal fractures are frequent injuries in the young male working population and the majority are treated non-operatively. There is a growing trend to surgically treat these fractures, with the aim of reducing the deformity and shortening the rehabilitation period. The aim of this retrospective case series is to report on our experience and clinical outcomes of using percutaneous flexible locking nails for the management of displaced metacarpal fractures. This study is a retrospective review of 66 fractures that were managed at our centre over a 7-year period. Materials and Methods: Records of 60 patients were retrospectively reviewed. Indications for surgery were a displaced metacarpal shaft or neck fracture with associated rotational deformity, or multiple metacarpal fractures. The fracture was reduced by closed manipulation, and a flexible pre-bent locked intramedullary nail (1.6mm diameter) was inserted through a percutaneous dorsal antegrade approach, facilitated by a specially designed pre-fabricated awl. The implant was removed at union. Patients were followed-up in clinic until the fracture had united. Results: The mean union time was seven weeks (range 2 to 22 weeks) and there were nine (14%) delayed unions (>3 months) and no non-unions. The nail had migrated in three cases (5%) and caused skin impingement in two cases (3%). There was one infected case (2%). Rotational clinical deformity was evident for two (3%) cases. Conclusion: The use of a minimally-invasive locked intramedullary nailing for unstable metacarpal fractures has a significantly low complication rate, with predictable union times and good functional outcomes.

MeSH terms: Fractures, Multiple; Fracture Fixation, Intramedullary; Humans; Male; Retrospective Studies; Internal Fixators; Metacarpal Bones; Fractures, Bone
Fulltext Are Gap and Cast Indices Predictors of Efficacy of Reduction in Fractures of Both Bones of the Leg? A Cohort Study

Shalabh K, Ajai S, Vineet K, Sabir A

Malays Orthop J, 2018 Jul;12(2):15-19.
PMID: 30112123 DOI: 10.5704/MOJ.1807.003

Introduction: Non-operative management has successfully been practised for long in diaphyseal fractures of both bones of the leg. This study attempts to establish an acceptability criteria for plaster cast in order to predict future loss of reduction and its adequacy. Materials and Methods: A total of forty subjects were included as per inclusion-exclusion criteria. Gap and cast indices were calculated in the immediate post reduction phase and at third week follow-up visit. Results: The mean values of gap and cast indices in the immediate post-reduction phase were 0.35±0.220 and 0.99±0.08 respectively and at the third week follow-up the mean value for both the parameters in those without loss of reduction were 1.11±0.50 and 1.03±0.09 respectively and in those with loss of reduction were 0.84±0.44 and 1.01±0.06 respectively. Conclusion: Gap and cast indices are not informative in assessing adequacy of reduction in diaphyseal fractures of both bones of the leg.

MeSH terms: Casts, Surgical; Follow-Up Studies; Diaphyses; Fractures, Bone
Fulltext Complex Proximal Humeral Fracture Fixation with PHILOS Plate using Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique: A Series of 30 Patients

Narayanan VL, Balasubramanian N

Malays Orthop J, 2018 Jul;12(2):20-24.
PMID: 30112124 DOI: 10.5704/MOJ.1807.004

Introduction: Proximal humerus fracture fixation using plate osteosynthesis depends on the quality of the bone, design of the fixation devices and intra-operative soft tissue dissection. This study evaluates the functional outcome of minimally invasive percutaneous plate osteosynthesis using locking compression plate in proximal humerus fracture treatment. Materials and Methods: The study was conducted on 30 patients with complex proximal humerus fractures treated by minimally invasive percutaneous plate osteosynthesis using locking compression plate (PHILOS). There were 21 males and 9 females. The average age of our study group was 58.8 years. All the patients were evaluated at six weeks, three months, four months, six months and 12 months following surgery. Results: All patients had fracture union at an average of 13.2 weeks. The mean DASH score at the follow-up was 8.69 (2.5 to 17.16), the average range of flexion was 143.83 degrees (100 to 170 degrees) and abduction was 121.49 degrees (90 to 160 degrees). We had superficial infection in three patients which resolved with a short course of antibiotics. There was excellent outcome in 26 patients, good and fair in two patients each. Conclusion: Proximal humerus fractures treated with minimally invasive percutaneous plate osteosynthesis using locking compression plate with minimal soft tissue dissection, provides good functional outcome and early return of shoulder function.

MeSH terms: Anti-Bacterial Agents; Bone Plates; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Humerus; Male; Shoulder; Shoulder Fractures
Fulltext Do Age and Co-morbidy, Among other Factors, affect Length of Hospital Stay following Total Knee Arthroplasty

Komang-Agung IS, Sindrawati O, William PS

Malays Orthop J, 2018 Jul;12(2):25-30.
PMID: 30112125 DOI: 10.5704/MOJ.1807.005

Introduction: The only treatment for grade IV knee osteoarthritis is total knee arthroplasty (TKA) irrespective of the age of the patient. Most of the grade IV OA patient are elderly and most likely to have some comorbidities. Age and comorbidities are the major reasons for patient's reluctance to undergo TKA. A clinical pathway with standard length of stay (LOS) could justify the patient's hesitation for TKA. The aim of this study was to determine the factors, including age and comorbidity, that affect the LOS of patients treated with TKA. Materials and Methods: This is a retrospective study of TKA patients in Surabaya Orthopedics and Traumatology Hospital from January 2011 to July 2017. Preoperative comorbidities were scored using Charlson Comorbidity Index (CCI) and physical status by ASA (American Society of Anesthesiologist), classification for age, sex, BMI, blood loss, operation time, method of anaesthesia and postoperative day of rehabilitation were recorded as factors potentially affecting LOS. The discharge criteria for the patients were ability to ambulate to the bathroom and clean operative wound with no complications. The data obtained were analysed statistically. Results: The average LOS was 5.58 days, ranging from three to eight days. There were no demographic factors that affected the patients' LOS. BMI, ASA, CCI, and blood loss did not significantly affect LOS. Operation time was between 90-140 minutes, and spinal anaesthesia showed significant longer LOS, but within the average. Conclusion: Age and comorbidity did not affect length of stay in TKA patients.
Fulltext Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment?

Kapil-Mani KC, Niroula A

Malays Orthop J, 2018 Jul;12(2):31-36.
PMID: 30112126 DOI: 10.5704/MOJ.1807.006

Introduction: The optimal surgical treatment for acromioclavicular joint (ACJ) injuries remains controversial. The modified Weaver-Dunn (WD) procedure is one of the frequently used techniques. Recently when it was compared with anatomical autogenous tendon graft reconstruction procedures, the results were inferior. However, these anatomical procedures are technically more demanding with small margin of error and they have tendency for postoperative pain because of extra donor site incision. Materials and Methods: Forty patients with type IV to VI ACJ dislocations were treated by modified WD procedure using non-absorbable synthetic suture passed through the base of coracoid process for augmentation of transferred coraco-acromial (CA) ligament. Functional outcome was assessed using the Oxford Shoulder Score, Nottingham Clavicular Score and Visual Analog Score (VAS) at the final follow-up after surgery. Results: The mean pre-operative Oxford Shoulder Score improved from 25.22±2.64 (range 20 to 30) to 44.75±1.99 (range 40 to 48) and mean pre-operative Nottingham Shoulder Score improved from 49.25±4.91 (range 39 to 58) to 87.27±4.39 (range 79 to 96) at last follow-up after surgery with p-value <0.001. Thirty-five (87.5%) patients had excellent outcomes, four (10%) patients had good outcomes and one (2.5%) patient had fair outcome. Thirty-eight (95%) patients had no pain while two (5%) had moderate pain based on VAS score. Conclusion: Modified Weaver-Dunn is a simple well established technique for grade IV to VI ACJ dislocation. We cannot consider this procedure as old and outdated on the argument that the long term functional outcomes are not suboptimal.

MeSH terms: Acromioclavicular Joint; Clavicle; Follow-Up Studies; Humans; Ligaments; Pain, Postoperative; Shoulder; Shoulder Dislocation; Sutures; Tendons; Orthopedic Procedures; Coracoid Process
Fulltext Microgrids: A Model for Basic Microsurgery Skills Training

Gunasagaran J, Rasid RJ, Mappiare S, Devarajooh C, Ahmad TS

Malays Orthop J, 2018 Jul;12(2):37-41.
PMID: 30112127 MyJurnal DOI: 10.5704/MOJ.1807.007

Introduction: Microsurgery is a subspecialised field which requires high technical skill. Laboratory training offers good opportunity for novice surgeons to learn and repetitively practise their skills prior to hands-on clinical practice. Commonly, the training programme consists of models in a stepwise increase in fidelity: from latex sheet to anaesthetised rat. We introduce microgrids model as a daily warm up procedure in a 5-day basic microsurgery course. The purpose of this study is to evaluate the correlation between microgrids colouring under magnification with microsuturing proficiency among novice surgeons. Materials and Methods: Participants were required to fill in microgrids under magnification everyday during their 5-day training as a starter test. The number of completely filled in microgrids in 20 seconds was recorded. A simulated cut on latex sheet was sutured and the time taken to apply five sutures was recorded. The sutures were evaluated with modified Global Rating Scale (GRS). Data was analysed with SPSS. Results: There was a statistically significant correlation between the number of microgrids coloured and the time taken to apply five sutures (p<0.01). An increase in number of microgrids coloured was significantly associated with the increase in quality of the suturing technique (p< 0.01). During the 5-day basic microsurgery skills training for novice surgeons, microsuturing skill improvement correlated with microgrid colouring. Conclusion: Microgrids colouring reflected microsuturing proficiency. It is an inexpensive, readily available, and simple model of 'warm up' for hand dexterity. The microgrids model can function as a starter test for initial training and a quick screening measure to assess microsurgical skill.

MeSH terms: Animals; Hand; Latex; Microsurgery; Suture Techniques; Sutures; Rats; Surgeons
Fulltext Proposal for a Radiological Classification System for Carpo-Metacarpal Joint Dislocations with or without Fractures

Pundkare GT, Deshpande SS

Malays Orthop J, 2018 Jul;12(2):42-46.
PMID: 30112128 DOI: 10.5704/MOJ.1807.008

Introduction: Though complex injuries like CarpoMetacarpal (CMC) Joint dislocations represent only 1% of all hand injuries, they have disabling impact on the functional status of patient. There are no reports in the literature classifying disabling complex injuries like CMC joint dislocations presumably because of low incidence. We propose a new classification through retrospective analysis of patients, along with literature search. Materials and Methods: A new classification system has been proposed and designed at our clinical unit and applied to eight patients with CMC joint dislocations. All patients were treated with open reduction with Kirschner wire fixation. At follow-up all these patients were analysed for radiographic assessments and functional scores. Results: The proposed classification identifies three types of dislocations and an additional complex category to supplement any basic type. The direction of dislocation describes the types as Type A: Dorsal, Type B: Volar and Type C: Divergent. Among the eight patients in our study, we had two of Type A, two Type B, three Type B.1, one Type C. 1. These patients had average follow-up of 18 months. The quick DASH score improved from 75.76 at 6 weeks to 1.9 at 18 months. We also did intra-observer and inter-observer reliability which scored 1. Conclusion: Our proposal is a reproducible, simple, comprehensive and practical classification, easily remembered and communicated among colleagues. It is clinically relevant as it helps us in planning surgical management and prognostic evaluation.

MeSH terms: Bone Wires; Follow-Up Studies; Hand Injuries; Humans; Prognosis; Retrospective Studies; Reproducibility of Results; Incidence; Carpometacarpal Joints; Open Fracture Reduction
Fulltext Bilateral Talus and Navicular Fractures accompanied with Unilateral Calcaneal Fracture: A Case Report

Bulut G, Colak I, Mik G, Kilic Z, Tasdemir Z

Malays Orthop J, 2018 Jul;12(2):47-51.
PMID: 30112129 DOI: 10.5704/MOJ.1807.009

An 18-year old male patient, with a history of paragliding accident, sustaining a coronal shear fracture of the body of the talus, an anterior process fracture of the calcaneus extending to the calcaneocuboid joint and a nondisplaced navicular body fracture at the right foot and a displaced fracture of the navicular body accompanied with posteromedial process fracture of the talus at the left side was referred to our emergency clinic. For the right foot, the coronal plane fracture of the talar body was anatomically reduced and fixed with screws. For the left foot, screw fixation was performed through the lateral aspect to fix the large posteromedial fragment. Small bone fragments were removed from the left navicular fracture, and the main fragments were also fixed with screw. The talo-navicular joint was stabilised with a Kirschner wire. At 36 months follow-up, bilateral foot and ankle functions were satisfactory, Maryland scores of the right and left foot were 85 (good) and 90 (excellent), respectively, and the patient regained his full activity level by the 5th month postoperatively. With reference to the number and types of fractures in this one patient, we present a standard protocol for treatment of isolated talus, navicular and calcaneal fractures presenting together in a single foot injury.

MeSH terms: Accidents; Adolescent; Ankle; Bone Screws; Bone Wires; Calcaneus; Follow-Up Studies; Foot; Humans; Male; Maryland; Talus; Ankle Injuries; Foot Injuries; Fractures, Bone
Fulltext Discal Cyst of the Lumbar Spine: Case Report of a Rare Clinical Entity

Sanjeevan R, Prabu S, Azizul A, Abdul-Halim Y

Malays Orthop J, 2018 Jul;12(2):56-58.
PMID: 30112131 MyJurnal DOI: 10.5704/MOJ.1807.011

Being a rare clinical entity, discal cyst presents indistinguishably from other causes of lower back pain and radiculopathy. It is an extremely rare pathology with unclear pathogenesis, indeterminate natural history with no consensus on the ideal management of the condition. We report a rare case of discal cyst in a patient who presented to our centre with localised low back pain and subsequently left sided radicular pain. With the aid of MRI and with clear surgical indication we proceeded with endoscopic removal of the cyst and intraoperatively confirmed its origin from the adjacent disc. The patient had immediate relief of his symptoms and no postoperative complications. We recommend that endoscopic surgery can be an effective alternative to conventional open surgery for discal cyst of the lumbar spine.

MeSH terms: Cysts; Endoscopy; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Radiculopathy; Low Back Pain
Fulltext Fracture and Posterior Dislocation of Meniscal Bearing Insert in Mobile Bearing Unicompartmental Knee Arthroplasty: A Case Report

Munjal A

Malays Orthop J, 2018 Jul;12(2):62-64.
PMID: 30112133 DOI: 10.5704/MOJ.1807.013

Dislocation of meniscal bearing insert is a rare but well-recognised complication in meniscal bearing unicompartmental knee arthroplasty (UKA). On the other hand, fracture of meniscal bearing insert of phase III Oxford UKA has only been reported once in the current literature. The authors report a case of fracture and posterior dislocation of one of the fragments of the meniscal bearing insert in a mobile bearing medial UKA. The fracture was only diagnosed during the revision surgery. The posteriorly dislodged fragment was subsequently retrieved through the same skin incision and a new polyethylene insert of the same size was implanted.

MeSH terms: Reoperation; Arthroplasty, Replacement, Knee; Polyethylene; Meniscus
Fulltext Neglected Anterior Dislocation of the Elbow Joint: Case Report of a Rare Injury

Nema SK, Behera G, Poduval M

Malays Orthop J, 2018 Jul;12(2):65-67.
PMID: 30112134 DOI: 10.5704/MOJ.1807.016

We present an unusual case of five months old neglected anterior dislocation of the right elbow joint in a 19-year old man. The patient had been initially treated by a traditional bone setter, but the elbow remained unreduced. He presented to us with pain, deformity and limited range of motion of his right elbow joint. Radiographs revealed an unreduced anterior dislocation of the right elbow joint. We describe the problems encountered during open reduction and rehabilitation and result one year after the operation with the patient having a stable elbow and a functional range of motion.

MeSH terms: Adult; Elbow; Elbow Joint; Humans; Male; Pain; Radiography; Range of Motion, Articular; Young Adult; Open Fracture Reduction
Fulltext A New Approach to Body Donation for Medical Education: The Silent Mentor Programme

Saw A

Malays Orthop J, 2018 Jul;12(2):68-72.
PMID: 30112135 MyJurnal DOI: 10.5704/MOJ.1807.015

Cadaveric dissection is an integral component of medical education. There had been concerns about negative impact on medical students exposed to deceased donors before their clinical years, but most studies reported overall positive outcome following this form of teaching. Due to reducing number of body donations in most parts of the world, many institutions are adopting alternative models especially for the teaching of gross anatomy. A new body donation programme that incorporate humanistic values in the procurement process was initiated by Tsu Chi University of Taiwan in 1996. Early observations following teaching with the so-called "silent mentors" noted less negative emotional impact on the students. With increasing number of body donation following the initiation of the silent mentor programme as reported in some regions, we will be able to continue the time-honoured cadaveric dissection for anatomy teaching, at the same time promoting humanistic values on junior doctors.

MeSH terms: Dissection; Education, Medical; Humanism; Medical Staff, Hospital; Mentors; Students, Medical
Fulltext Paediatric Femur Fractures: A Plea for Minimally Invasive Surgery to Prevent Osteomyelitis

Mansor N, Abdul-Rashid AH, Ibrahim S

Malays Orthop J, 2018 Jul;12(2):73-74.
PMID: 30112136 DOI: 10.5704/MOJ.1807.014
Fulltext Neuronal Cell Death and Mouse (Mus musculus) Behaviour Induced by Bee Venom

Oktiansyah R, Juliandi B, Widayati KA, Juniantito V

Trop Life Sci Res, 2018 Jul;29(2):1-11.
PMID: 30112137 DOI: 10.21315/tlsr2018.29.2.1

Neuronal cell death can occur in a tissue or organ, including the brain, which affects memory. The objectives of this study were to determine the dose of bee venom that causes neuronal death and analyse the alteration of mouse behaviour, focusing in particular on spatial memory. Fifteen male mice of Deutsche Denken Yoken (DDY) strain were divided into control and treatment groups. Bee venom was injected six times for two weeks intraperitoneally with 1.88 mg/kg, 3.76 mg/kg, 5.6 mg/kg, and 7.48 mg/kg doses of venom. Brain histology was studied using haematoxylin-eosin stained paraffin embedded 5 μm coronal sections. A Y maze test was used to assay behaviour. Parameters observed were the number of dead neurons and the percentage of mice with altered behaviour. ANOVA showed that the effects of bee venom were significantly different in the case of the neuronal death parameter but were not significantly different in the case of the mice behaviour parameter. Duncan's Multiple Range Test (DMRT) demonstrated that P4 (7.48 mg/kg) gave the highest effect of bee venom to promote neuronal death.

MeSH terms: Analysis of Variance; Animals; Bee Venoms; Brain; Eosine Yellowish-(YS); Hematoxylin; Male; Neurons; Paraffin Embedding; Cell Death; Maze Learning; Mice; Spatial Memory
Fulltext Phylogenetic Relatedness of Several Agarwood-Producing Taxa (Thymelaeaceae) from Indonesia

Lee SY, Turjaman M, Mohamed R

Trop Life Sci Res, 2018 Jul;29(2):13-28.
PMID: 30112138 MyJurnal DOI: 10.21315/tlsr2018.29.2.2

Indonesia is home to several tree taxa that are harvested for agarwood. This highly valuable oleoresin ironically was the cause for some species to become vulnerable due to gluttonous human activity. However, information on the genetic diversity of these endangered trees is limited. In this study, 28 specimens representing eight species from two genera, Aquilaria and Gyrinops, were collected from ex-situ and in-situ populations in Indonesia. Phylogenetic analysis conducted on DNA sequences of the nuclear ribosomal internal transcribed spacer (ITS) and the trnL-trnF intergenic spacer regions, revealed that Aquilaria and Gyrinops are paraphyletic when Aquilaria cumingiana is excluded. The phylogenetic analysis for ITS and trnL-trnF showed capability to categorise agarwood-producing species based on their regions: East Indonesia and West Indonesia, using Wallace's Line as the divider. In addition, we discuss challenges in species identification and taxonomy of agarwood-producing genera, and their conservation efforts in Indonesia.

MeSH terms: Cell Nucleus; DNA; Human Activities; Indonesia; Phylogeny; Plant Extracts; Genetic Variation; DNA, Intergenic; Thymelaeaceae
Fulltext Resistance Response of Chilli (Capsicum annuum L.) F1 to Fusarium oxysporum Involves Expression of the CaChi2 Gene

Ferniah RS, Kasiamdari RS, Priyatmojo A, Daryono BS

Trop Life Sci Res, 2018 Jul;29(2):29-37.
PMID: 30112139 DOI: 10.21315/tlsr2018.29.2.3

Cross-breeding is a method of producing progeny with better resistance to pathogens. Resistance to pathogens usually involves pathogenesis-related (PR) proteins. Class II chitinase is an example of a defensive PR protein in plants. The class II chitinase in chilli is coded by the CaChi2 gene. In this study, we crossed susceptible with resistant chilli cultivars, analysed the F1 resistance response against pathogenic F. oxysporum, and analysed the level of CaChi2 gene expression in the F1. Data were collected using disease severity index (DSI) determination and gene expression analysis by qRT-PCR (quantitative Reverse Transcriptase Polymerase Chain Reaction). Results showed that the DSI of F1 was not significantly different from the resistant ancestor. The relative CaChi2 expression level of F1 was higher than the susceptible ancestor but not significantly different from the resistant ancestor. We concluded that the F1 can be categorised as resistant to F. oxysporum, and the CaChi2 gene is involved in the molecular defense response.

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