Browse publications by year: 2024

  1. Bouregba H, Hachemi M, Samatar AM, Mekhilef S, Stojcevski A, Seyedmahmoudian M, et al.
    Heliyon, 2024 Dec 15;10(23):e40650.
    PMID: 39691197 DOI: 10.1016/j.heliyon.2024.e40650
    This study evaluates the energy efficiency of an urban dairy farm in Tlemcen, Algeria, by assessing the feasibility of a grid-connected photovoltaic (PV)/wind hybrid energy system. Using HOMER and MATLAB software, the study explores the potential for replacing the farm's existing energy systems with a hybrid system integrated into a low-voltage electrical grid. The HOMER software determined the configuration that resulted in the lowest net present cost, energy cost in kWh, greenhouse gas emission mitigation, and renewable fraction (RF). The selected specifications of the renewable energy (RE) system components, power rates, and costs are based on the local market. The results indicate a net current cost of $106,117.90 and a levelized cost of energy of $0.0959/kWh, with a reduction in CO2 emissions by 594 kg/day. The system delivers 98 % RF with 4 kWh/m2/day medium solar radiation and 4 m/s wind speeds, and the ideal investment recovery takes 33 months. On the other hand, generation includes 933 kWh/year in grid buys and 42,488 kWh/year in sold-backs. The PV array generates 5457 kWh annually, the wind turbine produces 40,761 kWh/year, and an additional 939 kWh/year is purchased from the grid. Additionally, hybrid power systems in dairy farms reduce energy consumption by 90 % and increase milk production by 40 %, promoting sustainable agriculture. The findings highlight the importance of adopting RE systems in agricultural operations to achieve both economic and environmental sustainability.
  2. Fata Nahas ARM, Omar N, Osman AMY, Taufek NHM
    J Pharm Bioallied Sci, 2024;16(3):108-113.
    PMID: 39691543 DOI: 10.4103/jpbs.jpbs_802_24
    INTRODUCTION: The future of our healthcare services highly depends on the current generation of health science students since they are the ones who will work in the healthcare setting. Ensuring their mental well-being is an utmost priority so that they can offer top-tier quality care and services to people in need. This study aimed to explore the prevalence of mental well-being and mental help-seeking attitude among undergraduate sciences students and the impact of socioeconomic status toward both variables.

    MATERIALS AND METHODS: A cross-sectional study was conducted among students (N = 364) from six sciences schools at International Islamic University Malaysia via an online survey, which contained three main parts; socioeconomic status, mental well-being assessment using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and assessment of mental help-seeking attitude using the General Mental Help-Seeking Attitude Scale (MHSAS). Data were analysed using SPSS, version 29.0.

    RESULTS: Only 7.1% of the students have positive mental well-being, while 44.8% scored positive mental help-seeking attitude. There were no significant differences (P > 0.05) in students' mental well-being and any of SES components. There was a significant association between students' year of study and mental help-seeking attitude (P = 0.029), in addition, WEMWBS and MHSAS scores showed a positive correlation (P < 0.01).

    CONCLUSION: Future studies are essential to find out the contributing factors, prevention, and intervention that can be done to help the student in need.

  3. Ashruf R, Parasuraman S, Ismail NE, Thamby SA
    J Pharm Bioallied Sci, 2024;16(3):87-92.
    PMID: 39691544 DOI: 10.4103/jpbs.jpbs_291_24
    Cancer is a highly prevalent noncommunicable disease with low levels of awareness among the general public, as reported in numerous studies worldwide. Given the daunting nature of cancer, poor knowledge and awareness levels of this disease with regard to its warning signs, risk factors, and the importance of cancer screening among the public may lead to unfavorable health-related outcomes, such as delayed diagnosis and treatment initiation. However, there is potential to tackle this issue with properly designed health educational interventions. Quasi-experimental studies can be implemented to raise awareness in this subject matter via a myriad of traditional and digitalized educational intervention methods. Relevant studies identified across electronic databases were categorized based on the various educational interventions employed in promoting cancer knowledge and awareness. The effectiveness of these interventional approaches was assessed based on the pre-test and post-test scores, which captured the changes in knowledge and awareness levels before and after the educational intervention. Varying outcomes were observed across the diverse methods in individuals of different age groups. Nevertheless, evidence-based cancer educational interventions often yield multifaceted positive outcomes. The aim of this article is to review the various approaches of educational interventions utilized to positively alter the knowledge and awareness on cancer among the general public.
  4. Ismaeil R, Mat-Nor MB, Kamarudin NB, Abubakar U, Fata Nahas AR, Nik Mohamed MH
    J Pharm Bioallied Sci, 2024;16(3):114-120.
    PMID: 39691545 DOI: 10.4103/jpbs.jpbs_512_24
    BACKGROUND: The effectiveness of reducing healthcare-associated infections (HCAIs) depends on increasing healthcare providers' awareness, skills, and adherence to standard practices. Mhealth applications provide an innovative approach to enhancing access to information and resources while reducing time and expenses.

    OBJECTIVE: The study aimed to develop and evaluate a mhealth application for healthcare providers that offers quick access to updated recommendations, evidence-based guidelines, and protocols for managing patients with HCAIs.

    METHOD: The study included the development of the app, followed by a pilot test of its usability among physicians and nursing staff by using the Mobile Application Usability Questionnaire (MAUQ).

    RESULTS: The mhealth application, named HCAI Shield, was developed with four main menus. The menu includes HCAI's care bundle: hand hygiene, personal protective equipment, and standard precautions. The information has been gathered following standards established by both national and international organizations. Twenty-one participants took part in the evaluation, and the mean score for the application's usability was 5.28 ± 0.38. The areas of "ease of use," "interface and satisfaction" received high mean scores.

    CONCULSION: The HCAI Shield app provides convenient access to evidence-based guidelines and standards for HCAI management. Further evaluation is recommended.

  5. Savio SD, Artha K, Wiguna I
    Malays Orthop J, 2024 Nov;18(3):66-70.
    PMID: 39691565 DOI: 10.5704/MOJ.2411.009
    In young patients, the use of total elbow arthroplasty (TEA) is rarely preferred due to its high rate of mechanical failure. Poor compliance and psychological problems encountered may lead to increased difficulty in management. A 38-year-old male complained stiffness and pain on his left elbow. History of trauma was present 10 months ago, when he fell down from a tree of 6m high. Immediate closed reduction and immobilisation with backslab was performed, but he was lost to follow-up due to Schizophrenia. In physical examination, we found varus and recurvatum deformity with inability to flex the elbow beyond 30° and perform pronation. Plain radiograph and CT scan confirmed the terrible triad of elbow with callus formation. Total elbow arthroplasty with soft tissue release was then performed, resulting in satisfactory range of motion at one year follow-up. The management of neglected terrible triad of the elbow is challenging not only due to the bony problems, but also contracted muscles and fibrotic joint. TEA previously has been described in cases of inflammatory arthritis and degenerative arthritis, less in post-traumatic conditions especially in young patients. Though there is still scarcity in literatures discussing the burden of psychiatric problems in arthroplasty patients, but the existing literatures proved the correlation between psychiatric comorbidity with higher rate of post-operative adverse events. Total elbow arthroplasty can be considered as a surgical treatment for a young patient with neglected fracture dislocation of elbow with satisfactory result; however close post-operative monitoring and routine physiotherapy exercise should always be performed.
  6. Mishra JK, Sahu SA, Sindhuja A, Kar BK, Saha A
    Malays Orthop J, 2024 Nov;18(3):71-74.
    PMID: 39691566 DOI: 10.5704/MOJ.2411.010
    Free fibula flap has been a workhorse for head, neck, and extremity long bone defects. We discuss the reconstruction challenge in an unusual hand injury case involving the loss of multiple metacarpals and soft tissue with surprising preservation of finger vascularity. The reconstructive goals were addressed with a microvascular osteocutaneous fibula flap transfer with multiple osteotomies to create spitting images of metacarpals and soft tissue defects restored with the skin paddle. The outcome, in terms of functional gain, was sufficient for managing day-to-day activities. We share our experience in reconstructing this unique presentation of a complex hand injury.
  7. Khan AQ, Raza Q, Abbas MB, Chowdhry M, Khan MJ
    Malays Orthop J, 2024 Nov;18(3):42-50.
    PMID: 39691567 DOI: 10.5704/MOJ.2411.006
    INTRODUCTION: Recurrence after Giant Cell Tumour (GCT) treatment depends on the type of treatment used. Poly-Methyl-Meth-Acrylate (PMMA) after extended curettage provides structural support and allows for early identification of recurrence but carries a risk of thermal damage to the surrounding healthy tissue. The aim of this study was to compare long-term functional outcomes and complications in patients with GCT around the knee treated with extended curettage and bone grafting or cementation.

    MATERIAL AND METHODS: All patients with biopsy-proven GCT, involving either the distal femur or proximal tibia, and treated with either curettage with bone grafting (CBG), curettage with bone cementation (CBC), or curettage combined with grafting and cementation (the Sandwich technique) were included. They were further classified according to Campanacci grading. Patients were followed for a minimum of two years, and all complications were recorded.

    RESULTS: The three groups showed a statistically significant difference in terms of persistent pain after surgery (p=0.03), development of long-term arthritis (p=0.01), as well as overall complications (p=0.005). There was no significant difference in terms of the overall recurrence rate between each group (p>0.05). For Campanacci Grade II lesions, there was a statistically significant difference in terms of local recurrence (p=0.01), with lower recurrence rates observed after cementation procedures.

    CONCLUSION: The study indicates that the Sandwich technique was associated with a lower rate of complications compared to CBG or CBC. Patients in the CBG group reported persistent pain, while those in the CBC group exhibited early arthritic changes within five years of the index surgery. Although there was no overall difference in recurrence rates, cementation procedures had a significantly lower rate of recurrence in Campanacci Grade II lesions.

  8. Idulhaq M, Mudigdo A, Utomo P, Wasita B, Trapsilantya ME
    Malays Orthop J, 2024 Nov;18(3):27-31.
    PMID: 39691569 DOI: 10.5704/MOJ.2411.004
    INTRODUCTION: This study compares the quality of hydroxyapatite in Anadara granosa waste and laying chicken eggshell waste to commercial synthetic hydroxyapatite.

    MATERIAL AND METHODS: This experimental research included 27 samples of hydroxyapatite derived from clam shell waste (CSW-HAP), hydroxyapatite derived from eggshell waste (ESW-HAP), and commercial synthetic hydroxyapatite, with nine samples of each. The calcination method was used to process clam shell waste and eggshell waste into hydroxyapatite, which was then compared with synthetic hydroxyapatite from Bongros® for calcium and phosphate content. Scanning electron microscopy was used to compare their morphological structures.

    RESULT: The mean calcium levels in the CW-HAP, EW-HAP, and control groups were 41.3±2.9%, 41.5±2.3%, and 39.6±5.0%, respectively. According to One Way ANOVA, there was no significant difference between the CW-HAP or EW-HAP groups and the control group (p=0.49). The mean phosphate levels in the CW-HAP, EW-HAP, and control groups were 8.1±1.2%, 8.1±1.3%, and 9.4±2.0%, respectively. The results were also not significant (p=0.146).

    CONCLUSION: Clam shell waste and eggshells can be an alternative source of hydroxyapatite substitution, as demonstrated by the structural and porous formation of hydroxyapatite obtained from these sources (CW-HAP and EW-HAP) when compared to commercial synthetic hydroxyapatite.

  9. Wang CS, Atan Z
    Malays Orthop J, 2024 Nov;18(3):32-41.
    PMID: 39691570 DOI: 10.5704/MOJ.2411.005
    INTRODUCTION: Surgical treatment for indicated spinal metastases cases is an option to improve patients' outcomes. Local data in analysing the potential of patients' improvement after surgical treatment are limited. We intend to review the clinical outcomes of surgeries performed for cancer patients who were diagnosed with spinal metastases. We aim to identify factors associated with improved spinal pain, neurological deficit and patient survival.

    MATERIAL AND METHODS: The medical records of 51 patients who were diagnosed with thoracolumbar spinal metastatic tumour and underwent palliative single-stage posterior approach spinal surgery between June 2015 and June 2022 were recruited retrospectively. Patient demographic data, pre-operative and post-operative pain scores, neurological assessment and survival duration were collected from the medical records. Radiological findings were studied using respective imaging and reports.

    RESULTS: The mean age was 57.5 years, and the median survival was nine months after the surgical treatment. The post-operative pain improvements were statistically significant at two weeks (VAS improved from 5 to 2), and three months follow-up VAS was one (p<0.001 and p=0.009, respectively). At initial presentation, patients with a single-level spinal involvement had higher VAS compared to multiple spinal metastases (p=0.018). A total of 18 (35.3%) patients had improved one or more ASIA grades, of which eight (15.7%) of them had gain of ambulatory function (p<0.001). Twenty-seven (52.9%) patients were ambulatory post-operative. The slow growth type of primary carcinoma, post-operative ambulatory ability, and the absence of perioperative morbidity were factors associated with favourable survival duration (p=0.006, p<0.001 and p<0.001, respectively). Synchronous visceral metastases adversely affected the survival duration (p=0.008).

    CONCLUSION: Single-stage posterior decompression and stabilisation improved the clinical outcomes of spinal pain and neurological deficit in metastatic spinal tumours. Type of primary tumour, visceral metastasis, perioperative morbidity, and post-operative ambulatory status significantly impact post-operative survival duration.

  10. Muhammad-Zaidulkhair MR, Tan RS, Kamarul IK
    Malays Orthop J, 2024 Nov;18(3):84-87.
    PMID: 39691571 DOI: 10.5704/MOJ.2411.013
    Fractures of the distal radius are the most common type of forearm fractures seen in children. The most serious outcome of physeal injuries is growth arrest, which can result in deformity and even significant differences in limb length. Therefore, we'd like to share our experience with treating a patient whose left radius stopped growing after she had a physeal injury in an accident. Case presentation: we encountered a 10-year-old girl, who was involved in a road traffic accident. She sustained closed fracture distal end left radius (Salter Harris 2). She sought medical assistance late, so osteoclasis, open reduction, and a k-wire on her left radius to fix the fracture, however it was complicated with growth arrest of left radius after the bone united. It was observed that her left radius was around 4cm shorter than her right. She had an osteotomy performed on her left radius and a LRS implanted. After six months post-surgery, there was no visible shortening of her left upper limb, and the radius had grown by around 4cm. There was no neurovascular impairment after left radius lengthening. After a year had passed after her operation, the patient said she had no complaints about her left upper limb. Despite the prevalence of the ilizarov method, the monorail external fixator, also known as LRS, is an option for bone lengthening of the radius. The LRS was utilised in our situation, and the results demonstrated its usefulness.
  11. Rajani AM, Mittal A, Kulkarni VU, Rajani KA, Rajani KA
    Malays Orthop J, 2024 Nov;18(3):7-15.
    PMID: 39691572 DOI: 10.5704/MOJ.2411.002
    INTRODUCTION: Hypovitaminosis D plays an important role in post-operative bone pain and muscle strength in arthroplasty surgeries. Its role in unicompartmental knee arthroplasty (UKA) has not been elucidated yet. The objective of this study was to determine the impact of hypovitaminosis D and its correction on post-operative bone pain after UKA.

    MATERIALS AND METHODS: A prospective cohort study involving 240 patients undergoing mobile-bearing medial UKA was conducted. Group A (na=80) received postoperative correction of Vitamin D3 Deficiency (VDD), Group B (nb=80) received pre-operative correction of VDD, while Group C (nc=80) had normal Vitamin D3 levels to begin with (≥30ng/ml). Correction was done by three doses of intramuscular injection of 600,000 IU Arachitol® (Vitamin D3) given at an interval of one week each. All groups were matched for demography and outcome measures. The level of bone pain by checking for tibial shin tenderness quantified by the visual analog scale (VAS) and evaluated pre-operatively, and at 2, 4, 6 and 12 weeks post-operatively.

    RESULTS: Group B and C showed similar post-operative trends and remained significantly superior to Group A till the 6th-week follow-up. The biostatistical difference between Group A and the other two groups started decreasing after the completion of post-operative correction regime as noticed on the 6th-week follow-up. By 12 weeks post-operatively, all three groups had similar levels of bone pain.

    CONCLUSION: Vitamin D3 serves as an important preoperative investigation in patients undergoing UKA as it is a modifiable risk factor affecting post-operative bone pain. Its correction pre-operatively gives excellent post-operative pain control.

  12. Krishnan A, Dave BR, Degulmadi D, Mayi S, Rai R, Bang P, et al.
    Malays Orthop J, 2024 Nov;18(3):16-26.
    PMID: 39691573 DOI: 10.5704/MOJ.2411.003
    INTRODUCTION: Conservative and surgical approach timeline in post-operative spondylodiscitis (POS) following lumbar disc herniation (LDH) surgery is ill defined, and patients have a protracted recovery phase with social, psychological, and financial implications.

    MATERIAL AND METHODS: Retrospective analysis of patients operated by transforaminal lumbar interbody fusion (TLIF) in POS was done. Confirmed clinico-radiological diagnosed POS cases, not responding within three to four weeks were included. Normalisation of CRP and radiological stable reconstruction was assessed for objective clearance of POS and bony union.

    RESULTS: Ninety-five patients were included in the study with minimum follow-up period of two years. The mean age was 51.63±13.63 years. There were organisms cultured in 55 patients (57.89%). The ODI improvement of the patients was noted to improve from 88.71±5.3 to 20.80±9.7 (8 weeks) and was incremental at 2 years follow-up (10.12±6.41) and maintained further at final follow-up at 9±4.3. Bony union achieved in all with stable reconstruction. The resumption of activities of daily living (ADL) was quick (15.90±8.20 days) and job (3.67±1.31 months) was achieved in all the patients. In poor outcomes, two patients didn't respond, and one patient died due to uncontrolled infection.

    CONCLUSION: Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.

  13. Din MH, Aziz AM, Sahran Y, Mohamed-Saat MA, Abdul-Ghani NS, Faisham WI, et al.
    Malays Orthop J, 2024 Nov;18(3):51-58.
    PMID: 39691574 DOI: 10.5704/MOJ.2411.007
    INTRODUCTION: Sacroiliac joint disruption, resulting from high energy trauma can cause significant morbidity if no proper treatment given. Many techniques can be used to stabilise pelvic ring injuries. We studied the functional and radiological outcome following open reduction and anterior fixation of the sacroiliac joint and agreement between both outcomes.

    MATERIAL AND METHODS: This retrospective study involved 15 patients with unstable pelvic injuries requiring surgical intervention from January 2015 to December 2020 who undergone anterior stabilisation of the sacroiliac joint. Radiological outcome assessments were done postoperatively by using Lindahl criteria. The complete functional outcome was assessed at least six months postoperatively when patients were able to weight bear by using Majeed system. Descriptive statistical analysis was performed using IBM SPSS Statistics Version 27.

    RESULTS: The participants consist of 73.3% male and 26.7% female patients. A total of 66.7% of patients had a Tile type B pelvic ring injury, and the remaining 33.3% had a Tile type C pelvic ring injury. Based on the Majeed system, 73.3% of patients had excellent functional outcomes, and based on Lindahl criteria; there were 60% of patients who had excellent radiological outcome. However, there was no significant agreement between functional and radiological outcomes.

    CONCLUSION: Definitive fixation of the sacroiliac joint by anterior plate stabilisation provided an excellent functional and radiological outcome mainly due to good anatomical reduction and mechanical stability. However, further study may be needed to evaluate the correlation between functional and radiological outcomes and compare the various method of fixation with a larger sample size.

  14. Nazirul-Mubin K, Nazri MY, Ahmad-Fadzli S
    Malays Orthop J, 2024 Nov;18(3):75-79.
    PMID: 39691575 DOI: 10.5704/MOJ.2411.011
    Non-union refers to a disruption in the process of fracture repair, which can be identified through sequential clinical and radiographic assessments. The distinction between septic and aseptic non-union is essential because the treatment strategies are fundamentally different. Non-unions are most often treated surgically as it helps to provide both mechanical stability and good biological environment to promote bone healing. However, there is also the option of managing it conservatively by proper immobilisation using functional brace which is an alternative for surgical procedures and widely reported in tibia non-union cases. To date, there has been no reported case of femur non-union successfully treated with a functional brace. This case report details the success of treatment using a functional brace in a mentally disabled gentleman who sustained a femur non-union following a fracture related infection.
  15. Furuhata R, Tanji A, Nakamura S, Urabe T
    Malays Orthop J, 2024 Nov;18(3):59-65.
    PMID: 39691577 DOI: 10.5704/MOJ.2411.008
    INTRODUCTION: Antegrade intramedullary nail fixation for humeral shaft fractures yields satisfactory union rates. However, one of the related concerns is damage to the rotator cuff during nail insertion, which may affect long-term outcomes. The effect of a rotator cuff lesion on mid- and long-term shoulder outcomes remains unknown. This study aimed to investigate the incidence of rotator cuff tears 5 years or more after intramedullary nailing for humeral shaft fractures and to determine the impact of post-operative rotator cuff tears on mid-term outcomes.

    MATERIAL AND METHODS: We retrospectively identified 27 patients who underwent antegrade intramedullary nail fixation for traumatic humeral shaft fractures and received follow-up for at least 5 years post-operatively. The patients were divided into two groups: those without tears and those with partial or complete tears, diagnosed using ultrasonography. We compared the functional and radiological shoulder outcomes between the two groups.

    RESULTS: Of the 27 patients, 10 had partial or complete supraspinatus tears with a mean follow-up of 7.5 years postoperatively. The incidence of acromial spurs was significantly higher in patients with partial or complete tears than in those without tears (P<0.001). There were no significant differences in the age and sex-adjusted Constant score, or the American Shoulder and Elbow Surgeon score between the two groups.

    CONCLUSION: Our results revealed that 37% of patients developed partial or complete supraspinatus tendon tears in the mid-term. Post-operative rotator cuff tears were significantly associated with the formation of acromial spurs; however, they had no significant effect on mid-term shoulder functional outcomes.

  16. Faris MK, Izzuddin MS, Norazrin MA, Thiru MK
    Malays Orthop J, 2024 Nov;18(3):80-83.
    PMID: 39691578 DOI: 10.5704/MOJ.2411.012
    A 54-year-old gentleman with underlying hypertension and congestive cardiac disease was diagnosed with left lower limb necrotizing fasciitis following commencement of oral dabigatran. Small bruises on the limb progressed to full-blown sepsis. The calculated perioperative risk for surgery was unfavourable. Immediate diagnosis combined with targeted medical treatment managed to produce a medical wonder.
  17. Khan J, Ali R, Fahad S, Mariam F, Baloch N
    Malays Orthop J, 2024 Nov;18(3):2-6.
    PMID: 39691579 DOI: 10.5704/MOJ.2411.001
    INTRODUCTION: Multiple reviews of the applicability, cost-effectiveness, and safety of daycare reconstruction of anterior cruciate ligament have been published in French, American, and British setups, but have not been described in our population.

    MATERIALS AND METHODS: In this study, 25 patients who underwent Anterior Cruciate Ligament Reconstruction (ACLR) as a daycare surgery in our setup were assessed retrospectively. Post-operatively patients were reviewed for pain, complications, conversion from daycare to inpatients, readmission within two weeks post ACLR and cost-effectiveness.

    RESULTS: None of the patients required readmission within two weeks post-operatively, two patients were admitted on request from Surgical Day Care (SDC) to inpatient postoperatively, two patients developed urinary retention. Daycare ACLR was also cost-effective, as shown by cost analysis a reduction of cost by 26.9 %.

    CONCLUSION: Daycare ACLR is safe, feasible, and cost-effective treatment modality for young patients and can provide a substantial cost saving.

  18. Sibrecht G, Wong MY, Shrestha R, Bruschettini M
    Cochrane Database Syst Rev, 2024 Dec 18;12(12):CD007968.
    PMID: 39692246 DOI: 10.1002/14651858.CD007968.pub3
    BACKGROUND: Peripartum asphyxia affects three to five per 1000 live births, with moderate or severe hypoxic ischemic encephalopathy (HIE) occurring in 0.5 to 1 per 1000 live births, and is associated with high mortality and morbidity. Therapeutic hypothermia is an effective treatment, but alternative therapies such as acupuncture are also used.

    OBJECTIVES: To determine the benefits and harms of acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure) on mortality and morbidity in neonates with HIE, compared with 1) no treatment, 2) placebo or sham treatment, 3) any pharmacologic treatment, or 4) different types of acupuncture.

    SEARCH METHODS: We searched CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the WHO ICTRP in March 2023. We conducted a search of the grey literature to identify reports of trials conducted by or referenced in research by CORDIS EU, National Institute for Health and Care Excellence (NICE), and NHSGGC Paediatrics for Health Professionals. We also checked the reference lists of relevant articles to identify additional studies.

    SELECTION CRITERIA: We included randomized controlled trials (RCTs) or quasi-RCTs and cluster-randomized trials. We included studies where participants were term infants (37 weeks or greater) and late preterm infants (34 + 0 to 36 + 6 weeks' gestation) 10 days of age or less, with evidence of peripartum asphyxia. We included studies on acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure). We included studies where acupuncture was compared with: 1) no treatment; 2) placebo or sham treatment; 3) any pharmacologic treatment; or 4) different types of acupuncture.

    DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were all-cause mortality at the latest follow-up, major neurodevelopmental disability in children aged 18 to 24 months and aged 3 to 5 years, adverse events until hospital discharge, and length of hospital stay.

    MAIN RESULTS: We included four studies (enrolling 464 infants) that compared acupuncture with no treatment. The studies ranged in size from 60 to 200 infants. Three studies were conducted in China and one in Russia. None of the four studies reported on any of the prespecified outcomes of our review. We did not identify any ongoing studies.

    AUTHORS' CONCLUSIONS: There is limited availability of studies addressing this specific population. The included studies did not assess mortality, long-term neurodevelopmental outcomes, or adverse effects of acupuncture. We are unable to draw any conclusions about the benefits and harms of acupuncture for HIE in neonates. In light of the current limitations, clinicians are urged to approach the use of acupuncture in neonates with HIE cautiously, as there is no evidence to support its routine application. The available trials assessed surrogate outcomes that have a relatively small impact on newborns, and failed to report important outcomes such as mortality and long-term neurodevelopmental outcomes. Other available trials were performed on older infants who had experienced neonatal HIE. Given the lack of available evidence, well-designed randomized controlled trials with relevant outcomes such as mortality and neurodevelopmental outcomes are essential to evaluate the efficacy and safety of acupuncture for HIE in neonates.

    MeSH terms: Asphyxia Neonatorum/complications; Asphyxia Neonatorum/mortality; Asphyxia Neonatorum/therapy; Humans; Infant, Newborn; Bias (Epidemiology); Randomized Controlled Trials as Topic*
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