Browse publications by year: 2021

  1. Kuek CY, Gurmukh Singh SKA, Tay PS
    Asian Bioeth Rev, 2021 Jun;13(2):167-178.
    PMID: 33968213 DOI: 10.1007/s41649-021-00166-2
    The conception of saviour siblings using preimplantation genetic diagnosis coupled with human leukocyte antigen (HLA) typing or HLA typing alone is controversial and receives a wide divergence of legal responses among countries around the world. The resulting child conceived through this procedure is dubbed a 'saviour sibling' as the child can potentially act as a compatible donor for an elder ailing sibling who needs a haematopoietic stem cell transplantation. At present, the acceptability of this procedure in Malaysia is ambiguous as there is no specific statute governing assisted reproductive technology, and the guideline issued by the Malaysian Medical Council does not expressly address this issue. The ethical arguments relating to the conception of saviour siblings in the current literature are mainly thought to reflect a liberal viewpoint which is predominantly Western in nature. This paper seeks to explore the perception of selected key stakeholders on the acceptability of and ethical concerns related to this procedure in the Malaysian context. The findings indicate that stakeholders generally support the conception of saviour siblings and some of their concerns echo the Western viewpoint. Interestingly, many were highly anxious about its economic implication, which is rarely discussed in the current literature on saviour siblings.
  2. Nasir ZM, Subha ST
    Int Arch Otorhinolaryngol, 2021 Apr;25(2):e193-e199.
    PMID: 33968219 DOI: 10.1055/s-0040-1709739
    Introduction  Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective  To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods  We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results  Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion  Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.
    MeSH terms: Airway Obstruction; Bronchi; Bronchoscopy; Child; Child, Preschool; Foreign Bodies; Humans; Length of Stay; Malaysia; Arachis; Respiratory Sounds; Retrospective Studies; Trachea; Bronchoscopes; Delayed Diagnosis; Time-to-Treatment
  3. Chilakamarry CR, Mahmood S, Saffe SNBM, Arifin MAB, Gupta A, Sikkandar MY, et al.
    3 Biotech, 2021 May;11(5):220.
    PMID: 33968565 DOI: 10.1007/s13205-021-02734-7
    Over recent years, keratin has gained great popularity due to its exceptional biocompatible and biodegradable nature. It has shown promising results in various industries like poultry, textile, agriculture, cosmetics, and pharmaceutical. Keratin is a multipurpose biopolymer that has been used in the production of fibrous composites, and with necessary modifications, it can be developed into gels, films, nanoparticles, and microparticles. Its stability against enzymatic degradation and unique biocompatibility has found their way into biomedical applications and regenerative medicine. This review discusses the structure of keratin, its classification and its properties. It also covers various methods by which keratin is extracted like chemical hydrolysis, enzymatic and microbial treatment, dissolution in ionic liquids, microwave irradiation, steam explosion technique, and thermal hydrolysis or superheated process. Special emphasis is placed on its utilisation in the form of hydrogels, films, fibres, sponges, and scaffolds in various biotechnological and industrial sectors. The present review can be noteworthy for the researchers working on natural protein and related usage.
    MeSH terms: Agriculture; Animals; Biopolymers; Biotechnology; Cosmetics; Cytoskeleton; Hydrolysis; Keratins; Microwaves; Poultry; Solubility; Steam; Textiles; Hydrogels; Regenerative Medicine; Ionic Liquids; Nanoparticles
  4. Hassan N, Ahmad T, Ashaari A, Awang SR, Mamat SS, Wan Mohamad WM, et al.
    Results Phys, 2021 Jun;25:104267.
    PMID: 33968605 DOI: 10.1016/j.rinp.2021.104267
    Complex systems require rigorous analysis using effective method, in order to handle and interpret their information. Spectrum produced from Fourier transform infrared (FTIR) instrument is an example of a complex system, due to their overlapped bands and interactions within the spectrum. Thus, chemometrics techniques are required to further analyze the data, in particular, chemometrics fuzzy autocatalytic set (c-FACS). The c-FACS is initially used to analyze the FTIR spectra of gelatins. However, in this study, the c-FACS is generalized and implemented for analysis of Coronavirus disease 2019 (Covid-19), particularly, the pandemic outbreak in Malaysia. The daily Covid-19 cases in states in Malaysia are modeled and analyzed using c-FACS, to observe the trend and severity of the disease in Malaysia. As a result, the classification of severity of zones in Malaysia are identified. The obtained results offer descriptive insight for strategizing purposes in combating the Covid-19 outbreak in Malaysia.
    MeSH terms: Disease Outbreaks; Fourier Analysis; Gelatin; Health Services; Humans; Malaysia; Research Design; Spectroscopy, Fourier Transform Infrared; Coronavirus; Coronavirus Infections; Pandemics
  5. Lau SCD, Loh CK, Alias H
    Front Pediatr, 2021;9:660627.
    PMID: 33968859 DOI: 10.3389/fped.2021.660627
    Asparaginase-induced hypertriglyceridemia can have a spectrum of clinical presentations, from being asymptomatic to having life-threatening thrombosis or hyperviscosity syndrome. At present, there is no recommendation on routine lipid monitoring during asparaginase-containing treatment phase, nor a standardized guideline on its management. Two cases are presented here to illustrate the effects of concurrent infection on asparaginase-induced hypertriglyceridemia in patients with high-risk ALL and the use of SMOFlipid infusion as a treatment option in an acute situation.
    MeSH terms: Asparaginase; Hematologic Diseases; Humans; Hyperlipidemias; Lipids; Thrombosis; Hypertriglyceridemia
  6. Farzin A, Ibrahim R, Madon Z, Basri H, Farzin S, Motalebizadeh A
    Front Public Health, 2021;9:594953.
    PMID: 33968872 DOI: 10.3389/fpubh.2021.594953
    Prospective Memory (PM) is a cognitive function affected by aging. PM is the memory of future intentions and is significantly involved in everyday life, especially among older adults. Nevertheless, there are a few studies focused on PM training among healthy older adults and these studies did not report the optimal duration of training regarding improving PM performance among older adults. The present study aimed to determine the effective duration for training PM performance among healthy older adults. The current study was a randomized, controlled, single-blind, within-participants crossover trial including a training program with a duration of 12 h. The sample of 25 older adults aged 55 to 74 years recruited from the active members of the University of the Third Age (U3A), Kuala Lumpur/Selangor, their family members, and friends. The study design ensured some participants would receive the training after baseline while others would wait for 6 weeks after the baseline before receiving the training. All participants were evaluated five times: at baseline, 6, 12, 16, and at 24 weeks post-baseline. Moreover, the training program ensured all participants were assessed after each training session. The minimum number of hours to achieve training effects for this multi-component training program was eight. Results supported the efficacy of the training program in improving PM performance among healthy older adults. Also, the optimal duration for the multicomponent training program on PM performance among healthy older adults was obtained. This trial is registered at isrctn.com (#ISRCTN57600070).
    MeSH terms: Aged; Aging; Cognition; Humans; Learning; Middle Aged; Single-Blind Method; Memory, Episodic*
  7. Raja Adnan RNE, Mat Din H, Ashari A, Minhat HS
    Front Public Health, 2021;9:610184.
    PMID: 33968874 DOI: 10.3389/fpubh.2021.610184
    Deterioration in muscle mass and muscle strength is common among the frail older persons, cause functional dependence and decrease in the quality of life. Therefore, the identification of cost-effective interventions to prevent or ameliorate frailty is crucially needed. The aim of this study is to determine the effectiveness of a Community-based Muscle Strengthening Exercise (COME) program to increase muscle strength among pre-frail older persons. This study was a quasi-experimental study. A total of 32 older persons aged 60 years and older with pre-frail symptoms were recruited from the community center. The COME was developed based on the Growing Stronger program and the Otago Home Exercise Program. COME was designed to strengthen all of the major muscle groups in the upper and lower extremities. The exercise program was conducted for 12 weeks and divided into 3 parts; (1) to strengthen the body slowly and gently, using only body weight, (2) to introduce dumbbells and ankle weights to increase strength and (3) to add various new ways to boost strength even more. Functional tests were measured before and after the intervention. The results revealed non-significant p-value for pre- and post-intervention comparison for all study outcomes. Observing the values of mean difference, the study intervention was shown to have slightly improved the time up and go (Mean difference = -0.25), and sit-to-stand duration (Mean difference = -0.41) as well as the handgrip strength (Mean difference = 0.68) among the participants. On the assessment of Cohen ES, all three improvements exhibited small effect sizes. Sit-to-stand duration was shown to have most benefited from the intervention with highest ES among the outcome variables (ES = 0.20). COME intervention program among pre-frail older persons showed favorable trend toward improvement of upper and lower extremities muscle strength. This study should be further tested in randomized control trial to confirm its effectiveness.
    MeSH terms: Aged; Aged, 80 and over; Exercise Therapy; Humans; Malaysia; Middle Aged; Muscles; Pilot Projects; Quality of Life*; Frail Elderly*; Hand Strength; Muscle Strength
  8. Nishi SE, Rahman NA, Basri R, Alam MK, Noor NFM, Zainal SA, et al.
    Biomed Res Int, 2021;2021:6642254.
    PMID: 33969121 DOI: 10.1155/2021/6642254
    Objective: This pre-post study is aimed at determining the effects of masticatory muscle activity (masseter and temporalis) measured via sEMG between conventional, self-ligating, and ceramic bracket after six months of orthodontic treatment.

    Methods: A total of eighteen (18) malocclusion patients were identified. Malocclusion patients were subdivided into 3 groups based on the bracket selection (conventional, self-ligating, and ceramic bracket) with 6 patients for each group. sEMG of muscles were done using a two-channel electromyography device, where pregelled and self-adhesive electrodes (bilateral) were applied. Chewing and clenching of masseter and temporalis muscle activity were recorded for 20 s pre and 6 months of orthodontic treatment using sEMG (frequency 60 Hz). The data were analysed by using repeated measures ANOVA in IBM SPSS Statistics Version 24.0.

    Results: Chewing and clenching for masseter muscle showed no significant difference (P > 0.05) in sEMG activity of three types of the brackets. However, for temporalis muscle, there was a significant difference found in sEMG activity during chewing (P < 0.05) and clenching (P < 0.05) between these three brackets.

    Conclusion: The activity of temporalis muscle showed significant changes in chewing and clenching, where the conventional group demonstrated better muscle activity pre and at six months of fixed appliances.

    MeSH terms: Electrodes; Electromyography*; Female; Humans; Male; Masseter Muscle/physiology*; Mastication/physiology; Temporal Muscle/physiology*; Orthodontic Brackets*
  9. Ahmed N, Halim MSB, Ghani ZA, Khan ZA, Abbasi MS, Jamayet NB, et al.
    Biomed Res Int, 2021;2021:6674400.
    PMID: 33969123 DOI: 10.1155/2021/6674400
    The objective of this paper was to evaluate the existence of golden percentage in natural maxillary anterior teeth with the aid of 3D digital dental models and 2D photographs. And to propose regional values of golden percentage for restoration of maxillary anterior teeth. For this purpose, one hundred and ninety dentate subjects with sound maxillary anterior teeth were selected. Standardized frontal images were captured with DSLR, and the apparent width of maxillary anterior teeth was measured utilizing a software on a personal laptop computer. Once the dimensions were recorded, the calculations were made according to the golden percentage theory (GPT). The data were analyzed by independent and paired T-test. The level of significance was set at p < 0.05. The golden percentage values were not found in this study. The values obtained were 16%, 15%, 20%, 20%, 15%, and 16% moving from the right canine to the left canine teeth. There was no significant gender difference in the golden percentage values. Thus, golden percentage should not be used solely for the correction of anterior teeth or for determining dental attractiveness. Emphasis should be given to a range of dental proportion on regional basis.
    MeSH terms: Dental Models*; Female; Humans; Male; Photography*; Imaging, Three-Dimensional*; Young Adult
  10. Chan HH, Leong YQ, Voon SM, Pan ML, Leong CO, Lim CL, et al.
    Rep Biochem Mol Biol, 2021 Jan;9(4):417-425.
    PMID: 33969135 DOI: 10.52547/rbmb.9.4.417
    Background: Alzheimer's disease (AD) is a neurodegenerative disorder that causes cognitive dysfunction. Previous studies have suggested that amyloid plaques, mainly comprising of amyloid-beta peptides, play a pivotal role in AD pathophysiology. This study focuses on the evaluation of the effects of amyloid precursor protein (APP) overexpression on NF-κB, Rho-GTPase and Bcl-2 mediated pro-apoptotic pathways in neuronal cells.

    Methods: A lentiviral transduction system was used to generate SH-SY5Y cells overexpressing APP. Immunoblotting was conducted to determine expression levels of NF-κB, Rho-GTPase, and Bcl-2 family proteins in the APP overexpressed cells.

    Results: In the NF-κB signaling pathway, APP-overexpressing SH-SY5Y cells showed that there was a reduction of p-NF-κB (p< 0.05) and IKKα. Subsequently, there was upregulation of protein expression of NF-Κb, IKKβ and IκBα. On the other hand, protein expression of RhoC (p< 0.05) and Rac1/2/3 was upregulated as compared to the control group. Meanwhile, a decrease in RhoA, Cdc42 (p< 0.05) and p-Rac1/cdc42 protein levels was observed in the APP-overexpressed group. Lastly, in the pro-apoptotic pathway, the expression of Bcl-2, Bid, Bok and Puma (p< 0.05) was up regulated in the APP-overexpressed group. Downregulation of Bad and Bim expression was observed in the APP-overexpressed as compared to the control group, and Bax expression remained unchanged in the APP-overexpressed group.

    Conclusion: APP overexpression regulated signaling in the NF-κB, Rho-GTPase and Bcl-2 family pathways in neuronal cells, suggesting that these are involved in promoting neuronal survival and modulating synaptic plasticity in AD. However, further studies are essential to elucidate the APP-mediated mechanism of action.

    MeSH terms: Alzheimer Disease; Animals; Neuronal Plasticity; Immunoblotting; Signal Transduction; Down-Regulation; Up-Regulation; Amyloid beta-Peptides; NF-kappa B; Amyloid beta-Protein Precursor; cdc42 GTP-Binding Protein; Control Groups; Puma; bcl-2-Associated X Protein; I-kappa B Kinase; Plaque, Amyloid; NF-KappaB Inhibitor alpha
  11. Wong CK, Jaafar MJ
    Turk J Emerg Med, 2021 02 12;21(2):86-89.
    PMID: 33969246 DOI: 10.4103/2452-2473.309138
    BRASH syndrome is a syndrome characterized by bradycardia, renal failure, usage of atrioventricular (AV) nodal blocker, shock, and hyperkalemia (BRASH). It is more common among patients with multiple comorbidities such as cardiac disease, kidney dysfunction, and hypertension requiring AV nodal blockers. Cardiac conduction abnormalities are frequently caused by severe hyperkalemia. However, it may also occur in mild-to-moderate hyperkalemia with concomitant use of AV nodal blockers due to the synergistic effects between these two factors in the presence of renal insufficiency. It is essential for the physician to identify BRASH syndrome as the treatment may differ from standard advanced cardiovascular life support (ACLS) protocol. We report the two cases of patient who presented with BRASH syndrome who failed to respond to standard ACLS protocol.
    MeSH terms: Bradycardia; Cardiovascular System; Heart Diseases; Humans; Hyperkalemia; Hypertension; Kidney; Physicians; Reference Standards; Renal Insufficiency; Atrioventricular Block
  12. Foong HF, Haron SA, Koris R, Hamid TA, Ibrahim R
    Psychogeriatrics, 2021 Jul;21(4):586-595.
    PMID: 33969594 DOI: 10.1111/psyg.12709
    BACKGROUND: Low financial well-being is a common predicament among older adults living in poverty. The existing literature suggests a correlation between financial well-being and mental health in old age. Therefore, this study aimed to identify the relationships among financial well-being, life satisfaction, and cognitive function among low-income older adults and to examine the moderating effect of sex on these relationships.

    METHODS: This study involved 2004 nationally representative community-dwelling older Malaysians from the bottom 40% household income group. Financial well-being was assessed by the four-item financial satisfaction scale, while life satisfaction was measured by the Satisfaction with Life Scale. Cognitive function was measured by using the Malay version of the Mini-Mental State Examination. Hierarchical multiple regression was used as the prime method for statistical analysis.

    RESULTS: Financial well-being was positively associated with life satisfaction and cognitive function. Sex moderated the relationship between financial well-being and life satisfaction but not between financial well-being and cognitive function.

    CONCLUSIONS: Financial well-being and life satisfaction were strongly correlated among older women, although no gender difference was found for the relationship between financial well-being and cognitive function. It appears financial well-being strongly predicts mental health. As such, poverty eradication initiatives targeting low-income older adults should be implemented to sustain life satisfaction and cognitive function.

    MeSH terms: Aged; Cognition; Female; Humans; Mental Health; Personal Satisfaction*; Poverty; Independent Living*
  13. Krishnasamy K, Tan MP, Zakaria MI
    Int J Clin Pract, 2021 Aug;75(8):e14333.
    PMID: 33969596 DOI: 10.1111/ijcp.14333
    BACKGROUND: Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. The healthcare providers perception and their role are utmost important in delivering quality care and patient safety. This study aimed to determine the interdisciplinary differences in patient safety culture in a tertiary university hospital.

    METHOD: A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement scores of 60% was considered satisfactory. Comparisons were made between doctors, nurses, allied health professionals, nursing assistants and support staff.

    RESULTS: Of 6562 respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range = 31.1 to 84.7%), with job satisfaction (72.3% ± 21.9%) and stress recognition (58.3 ± 25.6%) representing the highest and lowest mean domain scores, respectively. Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety climate, job satisfaction and working conditions compared to nurses.

    CONCLUSIONS: The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.

  14. Lim YW, Lott PW, Mohamad NF, Begam Iqbal T
    Int J STD AIDS, 2021 09;32(10):968-973.
    PMID: 33969754 DOI: 10.1177/09564624211011917
    BACKGROUND: Penicillin is the conventional treatment for all stages of syphilis, including ocular and neurosyphilis, according to the recommendations by the Centre for Disease Control and Prevention Sexually Transmitted Disease. This case series highlighted three cases of ocular syphilis which showed prompt treatment response as early as 24 h after the adjunctive intravitreal ceftazidime injection.

    METHODS: Case Series.

    RESULTS: In case 1, there was significant improvement in the vision and vitritis after 24 h of a single intravitreal ceftazidime injection. In case 2, the patient achieved his best vision after a total of three intravitreal injections in his left eye and one in his right eye. In case 3, there was a further resolution of perivascular sheathing and retinal haemorrhages seen 1 week after a single intravitreal ceftazidime injection.

    CONCLUSION: The efficacy of intravitreal ceftazidime injection as a local adjunctive therapy in ocular syphilis treatment is noteworthy. It can be considered in cases which show suboptimal or slower treatment response despite early commencement of systemic penicillin to prevent devastating ocular sequelae.

    MeSH terms: Ceftazidime/therapeutic use; Humans; Syphilis Serodiagnosis
  15. Ullah S, Mohd Nor NH, Daud H, Zainuddin N, Gandapur MSJ, Ali I, et al.
    Geospat Health, 2021 May 05;16(1).
    PMID: 33969966 DOI: 10.4081/gh.2021.961
    Coronavirus disease 2019 (COVID-19) is the current worldwide pandemic as declared by the World Health Organization (WHO) in March 2020. Being part of the ongoing global pandemic, Malaysia has recorded a total of 8639 COVID-19 cases and 121 deaths as of 30th June 2020. This study aims to detect spatial clusters of COVID-19 in Malaysia using the Spatial Scan Statistic (SaTScan™) to guide control authorities on prioritizing locations for targeted interventions. The spatial analyses were conducted on a monthly basis at the state-level from March to September 2020. The results show that the most likely cluster of COVID-19 occurred in West Malaysia repeatedly from March to June, covering three counties (two federal territories and one neighbouring state) and moved to East Malaysia in July covering two other counties. The most likely cluster shows a tendency of having moved from the western part to the eastern part of the country. These results provide information that can be used for the evidence- based interventions to control the spread of COVID-19 in Malaysia. A Correction has been published: https://doi.org/10.4081/gh.2023.1233
    MeSH terms: Humans; Malaysia/epidemiology; Cluster Analysis; Spatial Analysis
  16. Cuttiford L, Pimsler ML, Heo CC, Zheng L, Karunaratne I, Trissini G, et al.
    J Med Entomol, 2021 07 16;58(4):1654-1662.
    PMID: 33970239 DOI: 10.1093/jme/tjab081
    A basic tenet of forensic entomology is development data of an insect can be used to predict the time of colonization (TOC) by insect specimens collected from remains, and this prediction is related to the time of death and/or time of placement (TOP). However, few datasets have been evaluated to determine their accuracy or precision. The black soldier fly, Hermetia illucens (L.) (Diptera: Stratiomyidae) is recognized as an insect of forensic importance. This study examined the accuracy and precision of several development datasets for the black soldier fly by estimating the TOP of five sets of human and three sets of swine remains in San Marcos and College Station, TX, respectively. Data generated from this study indicate only one of these datasets consistently (time-to-prepupae 52%; time-to-eclosion 75%) produced TOP estimations that occurred within a day of the actual TOP of the remains. It is unknown if the precolonization interval (PreCI) of this species is long, but it has been observed that the species can colonize within 6 d after death. This assumption remains untested by validation studies. Accounting for this PreCI improved accuracy for the time-to-prepupae group, but reduced accuracy in the time-to-eclosion group. The findings presented here highlight a need for detailed, forensic-based development data for the black soldier fly that can reliably and accurately be used in casework. Finally, this study outlines the need for a basic understanding of the timing of resource utilization (i.e., duration of the PreCI) for forensically relevant taxa so that reasonable corrections may be made to TOC as related to minimum postmortem interval (mPMI) estimates.
    MeSH terms: Data Accuracy; Animals; Diptera/growth & development*; Humans; Swine; Datasets as Topic
  17. A Hamid MS, Sazlina SG
    PLoS One, 2021;16(5):e0251111.
    PMID: 33970936 DOI: 10.1371/journal.pone.0251111
    Shoulder rotator cuff tendinopathy is a common debilitating condition that affects a person daily function and the quality of life. Despite its frequent occurrence, the best treatment is still inconclusive. This review assessed the clinical effect of platelet-rich plasma injection for rotator cuff tendinopathy. A systematic literature search was conducted using CINAHL, Medline, SCOPUS, SPORTSDiscus and Web of Science databases to retrieve articles published in peer-reviewed journals until December 2020. Randomised controlled trials (RCTs), which compared clinical effects of PRP injection to the usual care among adults diagnosed with rotator cuff conditions were reviewed. The main outcomes of interest were changes in shoulder pain symptoms and shoulder functions. All variables were analysed using random effects meta-analyses. Eight RCTs were reviewed in this study. The risk of bias for randomization was low for 6 RCTs, one study had unclear risk and the other was a high risk. Studies vary on the PRP techniques including preparation and injections. Moreover, the control intervention also differs. Four studies compared PRP with normal saline injection while in the remaining 4 RCTs the control intervention were rehabilitation program and dry needling. Meta-analysis of selected studies showed that PRP injection was safe and effective intervention for long-term pain control and shoulder function in patients with RC disorders.
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