Browse publications by year: 2019

Fulltext Incidence and Prevention of Invasive Meningococcal Disease in Global Mass Gathering Events

Muttalif AR, Presa JV, Haridy H, Gamil A, Serra LC, Cané A

Infect Dis Ther, 2019 Dec;8(4):569-579.
PMID: 31471813 DOI: 10.1007/s40121-019-00262-9

INTRODUCTION: Mass gathering events involve close contact among large numbers of people in a specific location at the same time, an environment conducive to transmission of respiratory tract illnesses including invasive meningococcal disease (IMD). This report describes IMD incidence at mass gatherings over the past 10 years and discusses strategies to prevent IMD at such events.
METHODS: A PubMed search was conducted in December 2018 using a search string intended to identify articles describing IMD at mass gatherings, including religious pilgrimages, sports events, jamborees, and refugee camps. The search was limited to articles in English published from 2008 to 2018. Articles were included if they described IMD incidence at a mass gathering event.
RESULTS: A total of 127 articles were retrieved, of which 7 reported on IMD incidence at mass gatherings in the past 10 years. Specifically, in Saudi Arabia between 2002 and 2011, IMD occurred in 16 Hajj pilgrims and 1 Umrah pilgrim; serotypes involved were not reported. At a youth sports festival in Spain in 2008, 1 case of serogroup B IMD was reported among 1500 attendees. At the 2015 World Scout Jamboree in Japan, an outbreak of serogroup W IMD was identified in five scouts and one parent. At a refugee camp in Turkey, one case of serogroup B IMD was reported in a Syrian girl; four cases of serogroup X IMD occurred in an Italian refugee camp among refugees from Africa and Bangladesh. In 2017, a funeral in Liberia resulted in 13 identified cases of serogroup C IMD. Requiring meningococcal vaccination for mass gathering attendees and vaccinating refugees might have prevented these IMD cases.
CONCLUSIONS: Mass gathering events increase IMD risk among attendees and their close contacts. Vaccines preventing IMD caused by serogroups ACWY and B are available and should be recommended for mass gathering attendees.
FUNDING: Pfizer.
Recent advances in thermal properties of hybrid cellulosic fiber reinforced polymer composites

Krishnasamy S, Thiagamani SMK, Muthu Kumar C, Nagarajan R, R M S, Siengchin S, et al.

Int J Biol Macromol, 2019 Dec 01;141:1-13.
PMID: 31472211 DOI: 10.1016/j.ijbiomac.2019.08.231

Bio-composites are easy to manufacture and environmentally friendly, could reduce the overall cost and provide lightweight due to the low density of the natural fibers. In a bid to compete with the synthetic fiber reinforced composites, a single natural fiber composite may not be a good choice to obtain optimal properties. Hence, hybrid composites are produced by adding two or more natural fibers together to obtain improved properties, such as mechanical, physical, thermal, water absorption, acoustic and dynamic, among others. Regarding thermal stability, the composites showed a significant change by varying the individual fiber compositions, fiber surface treatments, addition of fillers and coupling agents. The glass transition temperature and melting point obtained from the thermomechanical analysis and differential scanning calorimetry are not the same values for several hybrid composites, since the volume variation was not always parallel with the enthalpy change. However, the difference between the temperature calculated from the thermomechanical analysis and differential scanning calorimetry was lower. Significantly, this critical reviewed study has a potential of guiding all composite designers, manufacturers and users on right selection of composite materials for thermal applications, such as engine components (covers), heat shields and brake ducts, among others.

MeSH terms: Cellulose/chemistry*; Glass/chemistry*; Materials Testing*; Stress, Mechanical*; Tensile Strength*
RELATIONSHIP BETWEEN CARBOHYDRATE METABOLISM VALUES AND CALPROTECTIN LEVELS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH REGARD TO CONCOMITANT TYPE 2 DIABETES MELLITUS

Zhuravlova M, Ryndina N, Kravchun P

Georgian Med News, 2019 Jan.
PMID: 30829588

According to literature, the presence of concomitant diabetes mellitus type 2 (DM) is associated with a high frequency of complications in patients with acute myocardial infarction (MI) due to the development of repeated episodes of myocardial ischemia, left ventricular dysfunction, life threatening rhythm disorders, and thromboembolic events Aim: to analyze the state of immuno-inflammation based on the study of calprotectin, as well as to assess the presence and nature of links with carbohydrate metabolism parameters based on the study of blood glucose, insulin and insulin resistance. Patients with AMI in combination with DM 2 were found to have a significant increase in the level of calprotectin by 25.9% (p<0.001) compared to patients with AMI without DM 2. Assessment of carbohydrate metabolism rates revealed changes in the form of statistically significant increase in the concentration of fasting glucose in patients with AMI in combination with DM 2 by 41.8% (p<0.001) when compared to patients with isolated AMI. As for serum insulin, the level of this parameter when combined with the course of AMI and DM 2 significantly exceeded those in patients with AMI without DM 2. The level of HOMA index in patients with AMI with concomitant DM 2 when compared to patients with isolated AMI was also higher (differences are statistically significant, p<0.01). The study showed a correlation between serum calprotectin and insulinemia (R=0.57; p<0.05), HOMA index (R=0.52; p<0.05), fasting glycemia (R=0.59; p<0.05) and troponin I level (R=0,64; p<0,05). The obtained results indicate that the growth of immune inflammatory activity due to the proinflammatory parameter of calprotectin is accompanied by an increase in changes in carbohydrate homeostasis in the form of an increase in the degree of insulin resistance in patients with AMI and DM 2, and severity of cardiac ischemia.

MeSH terms: Blood Glucose; Humans; Leukocyte L1 Antigen Complex/blood; Carbohydrate Metabolism*
METOPROLOL SUCCINATE: GENETIC ASPECTS OF INDIVIDUAL SENSITIVITY AND EFFICACY IN PATIENTS WITH OBESITY AND CHRONIC HEART FAILURE

Gasanov I, Rudyk Y

Georgian Med News, 2019 Jan.
PMID: 30829590

Aim - optimization of the treatment of obesity and chronic heart failure (CHF) patients by identifying key factors for the progression of cardiac decompensation and the principles of using metoprolol succinate, taking into account pharmacogenetic aspects in the complex treatment of this comorbidity. 127 patients with CHF 2nd-3rd stages, 1st-4th functional class by New York Heart Association at the age of 32-87 (61 [57; 65]) years were examined, including 93 men and 34 women. A comparative analysis of certain clinical criteria using the sequential analysis of Wald A.A. The results were statistically plausible with p<0.05. Conducting factor analysis allowed to separate groups of indicators and estimate the specific weight of individual factors in the pathogenesis of combined pathology - obesity and heart failure. The first two factors determine 76.8% of the variability of the indicators, given the indicators that load them, they were given descriptive titles "clinical-hemodynamic factor", "clinical and anthropometric factor". The proposed prognostic protocol provides new possibilities for predicting the efficacy of metoprolol succinate in patients with obesity and chronic heart failure. The developed discriminatory models allow to objectify the criteria for determining the doses of metoprolol succinate in patients with obesity and chronic heart failure - the maximum initial, maximal endpoint, and also to evaluate the expediency of a subsequent stepwise increase in dose. Perspective of further studies - development and clinical approbation of the protocol of the use of metoprolol succinate in patients with CHF in the context of obesity, taking into account the results of the conducted factor analysis and developed prognostic means.

MeSH terms: Chronic Disease; Female; Hemodynamics; Humans; Male; Pharmacogenomic Testing*
Fulltext Artificial Neural Network Approach for Modelling of Mercury Ions Removal from Water Using Functionalized CNTs with Deep Eutectic Solvent

Fiyadh SS, AlOmar MK, Binti Jaafar WZ, AlSaadi MA, Fayaed SS, Binti Koting S, et al.

Int J Mol Sci, 2019 Aug 28;20(17).
PMID: 31466219 DOI: 10.3390/ijms20174206

Multi-walled carbon nanotubes (CNTs) functionalized with a deep eutectic solvent (DES) were utilized to remove mercury ions from water. An artificial neural network (ANN) technique was used for modelling the functionalized CNTs adsorption capacity. The amount of adsorbent dosage, contact time, mercury ions concentration and pH were varied, and the effect of parameters on the functionalized CNT adsorption capacity is observed. The (NARX) network, (FFNN) network and layer recurrent (LR) neural network were used. The model performance was compared using different indicators, including the root mean square error (RMSE), relative root mean square error (RRMSE), mean absolute percentage error (MAPE), mean square error (MSE), correlation coefficient (R2) and relative error (RE). Three kinetic models were applied to the experimental and predicted data; the pseudo second-order model was the best at describing the data. The maximum RE, R2 and MSE were 9.79%, 0.9701 and 1.15 × 10-3, respectively, for the NARX model; 15.02%, 0.9304 and 2.2 × 10-3 for the LR model; and 16.4%, 0.9313 and 2.27 × 10-3 for the FFNN model. The NARX model accurately predicted the adsorption capacity with better performance than the FFNN and LR models.

MeSH terms: Adsorption; Mercury/chemistry*; Solvents/chemistry; Neural Networks (Computer)*; Water Purification/methods*; Nanotubes, Carbon/chemistry*
Fulltext Targeting of CD133+ Cancer Stem Cells by Mesenchymal Stem Cell Expressing TRAIL Reveals a Prospective Role of Apoptotic Gene Regulation in Non-Small Cell Lung Cancer

Fakiruddin KS, Lim MN, Nordin N, Rosli R, Zakaria Z, Abdullah S

Cancers (Basel), 2019 08 28;11(9).
PMID: 31466290 DOI: 10.3390/cancers11091261

Mesenchymal stem cells (MSCs) are emerging as vehicles for anti-tumor cytotherapy; however, investigation on its efficacy to target a specific cancer stem cell (CSC) population in non-small cell lung cancer (NSCLC) is lacking. Using assays to evaluate cell proliferation, apoptosis, and gene expression, we investigated the efficacy of MSCs expressing tumour necrosis factor (TNF)-related apoptosis inducing ligand (MSC-TRAIL) to target and destroy CD133+ (prominin-1 positive) NSCLC-derived CSCs. Characterization of TRAIL death receptor 5 (DR5) revealed that it was highly expressed in the CD133+ CSCs of both H460 and H2170 cell lines. The human MSC-TRAIL generated in the study maintained its multipotent characteristics, and caused significant tumor cell inhibition in NSCLC-derived CSCs in a co-culture. The MSC-TRAIL induced an increase in annexin V expression, an indicator of apoptosis in H460 and H2170 derived CD133+ CSCs. Through investigation of mitochondria membrane potential, we found that MSC-TRAIL was capable of inducing intrinsic apoptosis to the CSCs. Using pathway-specific gene expression profiling, we uncovered candidate genes such as NFKB1, BAG3, MCL1, GADD45A, and HRK in CD133+ CSCs, which, if targeted, might increase the sensitivity of NSCLC to MSC-TRAIL-mediated inhibition. As such, our findings add credibility to the utilization of MSC-TRAIL for the treatment of NSCLC through targeting of CD133+ CSCs.

MeSH terms: Carcinoma, Non-Small-Cell Lung; Cell Line; Humans; Lung Neoplasms; Membrane Potentials; Mitochondria; Neoplastic Stem Cells; Apoptosis; Annexin A5; Coculture Techniques; Gene Expression Profiling; Cell Proliferation; Receptors, TNF-Related Apoptosis-Inducing Ligand; TNF-Related Apoptosis-Inducing Ligand; Mesenchymal Stromal Cells; Myeloid Cell Leukemia Sequence 1 Protein; AC133 Antigen
Fulltext Contemporary Strategies and Current Trends in Designing Antiviral Drugs against Dengue Fever via Targeting Host-Based Approaches

Ahammad F, Tengku Abd Rashid TR, Mohamed M, Tanbin S, Ahmad Fuad FA

Microorganisms, 2019 Aug 28;7(9).
PMID: 31466307 DOI: 10.3390/microorganisms7090296

Dengue virus (DENV) is an arboviral human pathogen transmitted through mosquito bite that infects an estimated ~400 million humans (~5% of the global population) annually. To date, no specific therapeutics have been developed that can prevent or treat infections resulting from this pathogen. DENV utilizes numerous host molecules and factors for transcribing the single-stranded ~11 kb positive-sense RNA genome. For example, the glycosylation machinery of the host is required for viral particles to assemble in the endoplasmic reticulum. Since a variety of host factors seem to be utilized by the pathogens, targeting these factors may result in DENV inhibitors, and will play an important role in attenuating the rapid emergence of other flaviviruses. Many experimental studies have yielded findings indicating that host factors facilitate infection, indicating that the focus should be given to targeting the processes contributing to pathogenesis along with many other immune responses. Here, we provide an extensive literature review in order to elucidate the progress made in the development of host-based approaches for DENV viral infections, focusing on host cellular mechanisms and factors responsible for viral replication, aiming to aid the potential development of host-dependent antiviral therapeutics.
Haemolytic anaemia precipitated by dengue fever

Abdullah NH, Mohammad N, Ramli M, Wan Ghazali WS

BMJ Case Rep, 2019 Aug 28;12(8).
PMID: 31466966 DOI: 10.1136/bcr-2018-226760

We reported a case of a woman with no past medical illness who presented with a few days' history of fever, myalgia, arthralgia, hypochromic microcytic anaemia and thrombocytopaenia and who was nonstructural protein 1 antigen (NS1Ag)-positive. Haemolytic anaemia including full blood picture work-up revealed high reticulocyte count and haemolysis with positive direct Coombs test. She was started on prednisolone and was discharged well.

MeSH terms: Adult; Anemia, Hemolytic/etiology*; Coombs Test/methods; Dengue/blood; Dengue/complications*; Dengue/drug therapy*; Dengue/immunology; Diagnosis, Differential; Female; Fever/diagnosis; Hemolysis; Humans; Prednisolone/administration & dosage; Prednisolone/therapeutic use; Thrombocytopenia/diagnosis; Thrombocytopenia/etiology; Treatment Outcome; Reticulocyte Count
Multiple asymptomatic vascular air embolisms following contrast-enhanced CT scan

Zulkifle AM, Faisal M

BMJ Case Rep, 2019 Aug 28;12(8).
PMID: 31466969 DOI: 10.1136/bcr-2018-229169

Vascular air embolism (VAE) is a known complication of contrast-enhanced CT (CECT) scan occurring in venous or arterial circulation with a wide spectrum of presentations. We report a case of a 44-year-old woman with endometrial adenocarcinoma stage IVB complicated with liver abscess and pulmonary embolism who developed VAE following a routine CECT scan after the sixth cycle of chemotherapy. This was an incidental finding and the patient remained asymptomatic throughout. As such, she was treated conservatively and gradually recovered. This case report serves as a reminder that VAE should be considered in patients presenting with unexplained symptoms following this procedure.

MeSH terms: Adult; Contrast Media/administration & dosage; Embolism, Air/etiology*; Female; Humans; Neoplasm Staging; Tomography, X-Ray Computed/adverse effects*; Endometrial Neoplasms/complications; Endometrial Neoplasms/drug therapy*; Endometrial Neoplasms/pathology; Incidental Findings; Conservative Treatment
Fulltext Two truncating variants in FANCC and breast cancer risk

Dörk T, Peterlongo P, Mannermaa A, Bolla MK, Wang Q, Dennis J, et al.

Sci Rep, 2019 08 29;9(1):12524.
PMID: 31467304 DOI: 10.1038/s41598-019-48804-y

Fanconi anemia (FA) is a genetically heterogeneous disorder with 22 disease-causing genes reported to date. In some FA genes, monoallelic mutations have been found to be associated with breast cancer risk, while the risk associations of others remain unknown. The gene for FA type C, FANCC, has been proposed as a breast cancer susceptibility gene based on epidemiological and sequencing studies. We used the Oncoarray project to genotype two truncating FANCC variants (p.R185X and p.R548X) in 64,760 breast cancer cases and 49,793 controls of European descent. FANCC mutations were observed in 25 cases (14 with p.R185X, 11 with p.R548X) and 26 controls (18 with p.R185X, 8 with p.R548X). There was no evidence of an association with the risk of breast cancer, neither overall (odds ratio 0.77, 95%CI 0.44-1.33, p = 0.4) nor by histology, hormone receptor status, age or family history. We conclude that the breast cancer risk association of these two FANCC variants, if any, is much smaller than for BRCA1, BRCA2 or PALB2 mutations. If this applies to all truncating variants in FANCC it would suggest there are differences between FA genes in their roles on breast cancer risk and demonstrates the merit of large consortia for clarifying risk associations of rare variants.

MeSH terms: Breast Neoplasms/genetics*; Breast Neoplasms/metabolism; Fanconi Anemia/genetics; Female; Humans; Genetic Variation; Case-Control Studies; Sequence Deletion*; BRCA1 Protein/genetics; Genetic Predisposition to Disease; BRCA2 Protein/genetics; Fanconi Anemia Complementation Group C Protein/genetics*; Fanconi Anemia Complementation Group C Protein/metabolism
Fulltext Microfluidics Chip for Directional Solvent Extraction Desalination of Seawater

Abdulbari HA, Basheer EAM

Sci Rep, 2019 08 29;9(1):12576.
PMID: 31467344 DOI: 10.1038/s41598-019-49071-7

Directional solvent extraction is one of the promising membrane-less seawater desalination method. This technique was not extensively investigated due the poor mixing and separation performances of its bench-scale system. It is believed that, overcoming these drawbacks is possible now with the rapid development of microfluidics technology that enabled high-precession micro mixing and separation. This work presents microfluidics chip for extracting and separating salt from seawater. The chip was designed with two sections for extraction and separation. In both sections, the liquids were separated using capillary channels perpendicular to the main stream. The main channels were designed to be 400 µm in width and 100 µm in height. Two streams inlets were introduced through a Y-junction containing octanoic acid as the organic phase and saltwater as the aqueous phase. The desalination performance was investigated at four different temperatures and five different solvent flow rates. Water product salinity was recorded to be as low as 0.056% (w/w) at 60 °C and 40 mL/h. A maximum water yield of 5.2% was achieved at 65 °C and 40 mL/h with a very low solvent residual (70 ppm). The chip mass transfer efficiency was recorded to be as high as 68% under similar conditions. The fabricated microfluidic desalination system showed a significant improvement in terms of water yield and separation efficiency over the conventional macroscale. The high performance of this microsystem resulted from its ability to achieve a high mixing efficiency and separate phases selectively and that will provide a good platform in the near future to develop small desalination kits for personal use.

MeSH terms: Saline Waters; Caprylates; Seawater; Sodium Chloride; Solvents; Temperature; Water; Microfluidics; Salinity; Bays
Fracture Non-Union: A Review of Clinical Challenges and Future Research Needs

Stewart SK

Malays Orthop J, 2019 Jul;13(2):1-10.
PMID: 31467644 DOI: 10.5704/MOJ.1907.001

Non-union of bone following fracture is an orthopaedic condition with a high morbidity and clinical burden. Despite its estimated global prevalence of nine million annually, the limit of bone regeneration therapy still results in patients living with pain, a reduced quality of life and associated psychological, social and financial repercussions. This review provides an overview of the current epidemiological and aetiological data, and highlights where the clinical challenges in treating non-union lie. Current treatment strategies are discussed as well as promising future research foci. Development in biotechnologies to treat non-union provides exciting scope for more effective treatment for this debilitating condition.

MeSH terms: Biotechnology; Bone Regeneration; Humans; Morbidity; Orthopedics; Pain; Quality of Life; Prevalence; Treatment Outcome; Fractures, Bone
Fulltext The Effects of Total Knee Arthroplasty on Sleep Quality

Koken M, Guclu B

Malays Orthop J, 2019 Jul;13(2):11-14.
PMID: 31467645 DOI: 10.5704/MOJ.1907.002

Introduction: Symptomatic osteoarthritis is one of the most common indications for total knee arthroplasty (TKA) operations. Pain in every stage of the disease causes sleep disturbances in patients. The primary objective of this study was to evaluate the effect of TKA on the quality of sleep in patients with symptomatic osteoarthritis. Materials and Methods: This retrospective, descriptive study was performed on 80 patients diagnosed with symptomatic osteoarthritis who underwent TKA. The patients responded to the Pittsburgh Sleep Quality Index (PSQI), which is widely used to evaluate sleep quality. Additionally, the effects of demographic and clinical variables such as age, gender, body mass index, smoking and alcohol consumption were also evaluated before and after surgery. Results: There was no correlation between demographic variables and PSQI scores pre- and postoperatively. There was a decrease in sleep quality on the sixth postoperative week compared to the preoperative period however this difference was not statistically significant. On the other hand, there was a statistically significant difference between preoperative and postoperative sixth month PSQI scores. Mean values of overall sleep quality and daily function were significantly higher in the postoperative sixth compared to the preoperative period (p<0.001) Conclusion: Treatment of symptomatic OA with TKA will improve sleep quality in the long term.
Study site: Hospital, Turkey

MeSH terms: Alcohol Drinking; Demography; Humans; Osteoarthritis; Pain; Postoperative Period; Retrospective Studies; Sleep; Smoking; Body Mass Index; Arthroplasty, Replacement, Knee; Preoperative Period
Fulltext Orthopaedic Resident Burnout: A Literature Review on Vulnerability, Risk Factors, Consequences and Management Strategies

Wong KP, Kaliya-Perumal AK, Oh J

Malays Orthop J, 2019 Jul;13(2):15-19.
PMID: 31467646 DOI: 10.5704/MOJ.1907.003

Introduction: Orthopaedic surgery is physically demanding. Surgeons may have to work long unpredictable hours especially during residency training. This arduous task comes with the risk of burnout leading to negative repercussions to the surgeon and the patient. In view of strategising peer support, we intend to review the literature and analyse whether orthopaedic resident burnout is a global issue. We also intend to derive common strategies to tackle burnout at individual and organisational levels. Materials and Methods: A literature search was carried out in the databases including PubMed, Scopus, SciELO, and Google Scholar to shortlist studies dealing with orthopaedic residency and related burnout. Those studies that used the Maslach Burnout Inventory (MBI) for quantifying burnout were collectively interpreted. Other studies were reviewed to analyse the vulnerability, risk factors, consequences and management strategies related to burnout. Results: Among a total of 72 titles shortlisted, eight studies independently reported burnout among orthopaedic surgery residents/trainees and used MBI as a tool for assessing burnout. Based on the three subscales of MBI, 37.2% had high degree of emotional exhaustion (EE), 48% had high degree of depersonalisation (DP) and 33.1% perceived low personal accomplishment. This signifies the high prevalence of burnout among orthopaedic residents/trainees. Conclusion: Burnout among orthopaedic surgery residents seems to be a universal problem. Risk factors could be multifactorial, influenced by clinical competency and work-home environment. This can be tackled at the individual level by being aware of burnout syndrome, involving in adequate physical activity and spending quality social time; and at the organisational level by duty hour limitation, professional appreciation and mentorship programme.
Structured Total Knee Replacement Rehabilitation Programme and Quality of Life following Two Different Surgical Approaches - A Randomised Controlled Trial

Antony-Leo AP, Arun-Maiya G, Mohan-Kumar M, Vijayaraghavan PV

Malays Orthop J, 2019 Jul;13(2):20-27.
PMID: 31467647 DOI: 10.5704/MOJ.1907.004

Introduction: The key important factor influencing the outcomes following rehabilitation is the surgical approach involved in Total Knee Replacement (TKR). Most studies have analysed the functional outcome in comparing the approaches on surgical perspective rather on post-operative therapeutic interventions. The current study was to analyse the effects of structured TKR rehabilitation programme on the quality of life and joint specific outcomes between two different surgical approaches. Materials and Methods: In this double-blind randomised controlled trial, participants were randomly allocated to one of two groups: Group 1- those who underwent medial parapatellar approach and Group 2- those who underwent mid-vastus approach. Both groups received three-phase structured rehabilitation protocol for 12 weeks. The outcome measures of SF-36, knee mobility, isometric knee musculature strength and six-minute walk distance were measured at baseline, on discharge and at review after three months. Results: The quality of life and joint specific outcome scores were better in mid-vastus approach than the popular medial parapatellar approach. The outcomes of knee flexion mobility (p=0.04), knee extension mobility (p=0.03), isometric muscle strength of quadriceps (p=0.001), isometric muscle strength of hamstrings (p=0.03), six-minute walk distance (p=0.001) and Physical Cumulative Scores (PCS) (p=0.03) were found to exhibit significant improvements at three months follow up. Conclusion: The mid-vastus approach was found to exhibit better improvements following structured rehabilitation care, in physical summary scores of quality of life and joint specific outcomes than medial parapatellar approach.

MeSH terms: Double-Blind Method; Follow-Up Studies; Knee Joint; Quality of Life; Outcome Assessment (Health Care); Arthroplasty, Replacement, Knee; Quadriceps Muscle; Muscle Strength; Hamstring Muscles
Periprosthetic Fractures after Total Knee Arthroplasty: the Influence of Pre-Operative Mechanical Factors versus Intraoperative Factors

Zainul-Abidin S, Lim B, Bin-Abd-Razak HR, Gatot C, Allen JC, Koh J, et al.

Malays Orthop J, 2019 Jul;13(2):28-34.
PMID: 31467648 DOI: 10.5704/MOJ.1907.005

Introduction: Periprosthetic fractures are a devastating complication following total knee arthroplasty. Little is known about the effect of mechanical factors on the incidence of periprosthetic fractures. The aim of this study was to examine the correlation between pre-operative mechanical factors, like side of surgery, coronal alignment and pre-operative range of motion and intra-operative factors, and the incidence of a periprosthetic fracture, following primary total knee arthroplasty (TKA). Materials and Methods: Forty-two patients with periprosthetic fractures (PPF) after primary TKA were identified from our hospital arthroplasty registry. These patients were matched two-to-one for gender and age at primary knee arthroplasty to 84 patients without PPF. The incidence of periprosthetic fracture with regards to laterality, coronal alignment and pre-operative range of motion was analysed. Intra-operative factors like implant type, patellar resurfacing and notching were also analysed using logistic regression. Results: Coronal alignment, pre-operative range of motion and patella resurfacing were not significant predictors of periprosthetic fractures. Anterior femoral notching was found to be significantly higher in the fracture group with an odds ratio of 17. Left sided surgery was also significantly higher in the periprosthetic fracture group. Conclusion: Periprosthetic fractures are 17 times more likely to occur in a knee with anterior femoral notching. Preoperative factors like coronal alignment and poor preoperative range of motion do not seem to increase the risk of periprosthetic fractures after TKA.

MeSH terms: Femur; Humans; Knee Joint; Patella; Registries; Incidence; Logistic Models; Odds Ratio; Range of Motion, Articular; Arthroplasty, Replacement, Knee; Periprosthetic Fractures
Osteochondritis Dissecans of the Lateral Femoral Trochlea Healing after Isolated Medial Patellofemoral Ligament Reconstruction: A Case Report

Barbosa NC, Carvalho L, Fernandes LR, Castro D, Lino T

Malays Orthop J, 2019 Jul;13(2):35-37.
PMID: 31467649 DOI: 10.5704/MOJ.1907.006

We report on a 12 years old female patient who had been diagnosed with patellofemoral instability - recurrent dislocation and anterior knee pain. Radiologic evaluation further revealed osteochondritis dissecans (OCD) of the lateral femoral trochlea. She underwent surgical procedure with isolated medial patellofemoral ligament reconstruction, no surgical procedure was done to the OCD lesion. Postoperatively, there was clinical improvement of patellofemoral instability, with radiological evidence of healing of the OCD lesion. Isolated realignment procedures such as medial patellofemoral ligament reconstruction may be associated with spontaneous healing of osteochondritis dissecans of the lateral femoral trochlea.

MeSH terms: Child; Female; Femur; Humans; Knee Joint; Ligaments, Articular; Osteochondritis Dissecans; Pain; Radiography
Integration and Vascular Ingrowth of a Collagen Meniscal Implant: A Case Report

Duarte-Silva M, Guerra-Pinto F, Camelo-Barbosa N, Beja-da-Costa P

Malays Orthop J, 2019 Jul;13(2):38-41.
PMID: 31467650 DOI: 10.5704/MOJ.1907.007

Meniscectomy is the most common surgery in orthopaedics. The absence of meniscal tissue might be related to irreversible damage to the articular cartilage. Meniscal replacement is a tissue-engineering technique for post-meniscectomy syndrome. Its success depends on the implant integration which was vastly proven in animal model studies. Histological evidence is hard to obtain in humans due to ethical issues. We report a clinical case in which a collagen scaffold meniscal implant was harvested six months after implantation due to mechanical failure. Histological analysis was performed revealing vascularisation not only of the peripheral attachment of the implant but also on the anterior horn. These morphologic findings demonstrate that this implant allows the colonisation by precursor cells and vessels, leading to the formation of a fully functional tissue. This present report is one of the few independent reports of scaffold biological integration in the literature.

MeSH terms: Animals; Cartilage, Articular; Collagen; Humans; Orthopedics; Orthopedic Procedures; Models, Animal; Tissue Engineering; Meniscus
Remodelling of Humeral Fracture in a Child with Osteopetrosis Tarda following Conservative Management - A 7-year Follow-up: A Case Report

Erkus S, Turgut A, Kose O, Kalenderer O

Malays Orthop J, 2019 Jul;13(2):42-44.
PMID: 31467651 DOI: 10.5704/MOJ.1907.008

Osteopetrosis (OP) is a rare hereditary sclerosing bone dysplasia characterised by generalised hard and brittle bone secondary to defective osteoclastic function. Osteopetrotic bone is brittle, thus these subjects are prone to frequent fractures, particularly of the long bones. Due to defective osteoclastic function, remodeling is also defective in OP. This report is a case of humeral fracture in a 9 years old girl who was followed seven years. The fracture had remodeled totally similar to healthy bone at the final follow-up. Conservative treatment should be kept in mind in the management of fractures in children with OP, and fractures within acceptable angulations and/or translations should be treated conservatively without hesitation.

MeSH terms: Bone and Bones; Bone Diseases, Developmental; Child; Female; Follow-Up Studies; Humans; Humeral Fractures; Osteoclasts; Osteopetrosis; Conservative Treatment
Graft and Button Modification of Technique of Coracoclavicular Joint Reconstruction in Treatment of Chronic Type V Acromioclavicular Joint Dislocation: A Case Report

Leong YC, Muhammad-Suhairi J

Malays Orthop J, 2019 Jul;13(2):45-48.
PMID: 31467652 DOI: 10.5704/MOJ.1907.009

Treatment of chronic Rockwood's type V Acromioclavicular (AC) joint dislocation remains controversial. We describe a surgical technique to reduce and maintain AC joint using a combination of gracilis autograft with GraftMax™ button (Conmed Inc, Utica, NY). Graft was prepared using running whip stitch technique with No. 5 Hi-Fi high strength suture (ConMed Linvatec, Largo, FL). Our technique reduces intraoperative clavicular and coracoid tunnel fracture and restores anatomical coracoclavicular ligament. At sixth week and third month postoperatively, the patient demonstrated good clinical and radiographic outcome.

MeSH terms: Acromioclavicular Joint; Clavicle; Humans; Ligaments, Articular; Running; Sutures; Autografts

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