Browse publications (publication year unrecorded)

  1. Madhwani KP, Nag PK
    PMID: 29540968 DOI: 10.4103/ijoem.IJOEM_151_17
    Background: Use of laptops and hand-held devices increase the risk of musculoskeletal disorders (MSDs). More time spent on this activity adopting faulty postures, higher the risk of developing such injuries. This study addresses training on office ergonomics with emphasis on sustainable behavior change among employees to work in safe postures, as this is a top priority in the corporate environment, today.

    Aim: To explore training intervention methods that ensure wider coverage of awareness on office ergonomics, thereby promoting safer working and suggesting sustainable programs for behavior change and job enrichment.

    Materials and Methods: A cross-sectional study was conducted (2012 - 2017), encompassing corporate office employees of multinational corporations selected from India, Dubai (U.A.E), Nairobi (East Africa), Durban (South Africa), South East Asian countries (Philippines, Vietnam, Indonesia, Singapore, Malaysia, Thailand and Sri Lanka).Participant employees (n= 3503) were divided into two groups to study the effect of interventions'; i.e., (a) deep training: 40 minute lecture by the investigator with a power point presentation (n= 1765) using a mock workstation and (b) quick training: live demonstrations of 10 minutes (n= 1738) using a live workstation.

    Results: While deep training enhanced awareness in 95.51% and quick training in 96.59% globally, the latterwas much appreciated and educated maximum employees. From statistical analysis, quick training was found superior in providing comprehensive training and influencing behavior modification in India, but all over the world it was found highly superior in knowledge enlargement, skills enrichment in addition to providing comprehensive training (P< 0.05). In countries, located to West of India, it significantly influenced behavior modification.

    Conclusion: As because few employees attend deep training lectures, the quick 10-minute program is highly promising as it is practical, replicable, yields increased awareness with wider employee coverage in a much shorter time, instilling a feeling of caring and confidence amongst them towards a robust office ergonomics program. This could lead to propose as a best practice for corporate offices globally.

  2. Yoshida N, Naito Y, Murakami T, Ogiso K, Hirose R, Inada Y, et al.
    Case Rep Gastroenterol, ;12(1):27-31.
    PMID: 29515342 DOI: 10.1159/000486128
    Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis is sometimes difficult with only white light observation. Irregular findings by narrow-band imaging (NBI) are useful for differentiating malignant lesions from benign lesions, and cases with this finding are not expected for CSP. We present a diminutive T1 cancer resected by CSP as a reflection case. A 68-year-old man underwent colonoscopy for surveillance after polypectomy. A reddish polyp 4 mm in size was detected at the rectum. White light observation showed no depression, but a slight, heterogeneous color change. NBI magnification showed irregular vessel and surface patterns. The polyp was diagnosed as intramucosal cancer. Even though cancerous lesions are regularly resected by endoscopic mucosal resection (EMR), this polyp was resected by CSP in daycare surgery because the patient requested not to be treated by EMR but by CSP, which needed an admission to our institution. The surgeon thought the polyp could be completely resected by CSP. It was thoroughly resected, and a histological examination showed submucosal cancer with a positive vertical margin. Additional surgical resection was not accepted by the patient, since he had received total gastrectomy for gastric cancer and a right hemicolectomy for colonic cancer in the past 7 years. He underwent follow-up colonoscopy 2 months after the CSP. Although there were no recurrent endoscopic findings, endoscopic submucosal dissection was performed to the scar area. The histological examination showed no residual tumor. In conclusion, CSP should only be adopted for benign cases, as cancerous lesions have a possibility for invading the submucosa, like in our case.
  3. Sam JE, Gee TS, Wahab NA
    Asian J Neurosurg, ;13(1):56-58.
    PMID: 29492121 DOI: 10.4103/1793-5482.185056
    Dengue fever has been a major cause of morbidity and mortality in subtropical and tropical countries. We report a rare case of severe dengue with spontaneous intracranial hemorrhage. A search of literature through PubMed revealed that the largest series analyzed so far only included five cases. A 47-year-old man presented with 7 days history of fever, headache, myalgia, and vomiting with hematemesis. On the day of presentation, he had reduced consciousness and an episode of generalized tonic-clonic seizure. His Glasgow Coma Scale was E1V1M3 with anisocoria. Postresuscitation computed tomography of the brain revealed a right subdural and left thalamic hemorrhage. His blood investigations revealed thrombocytopenia, dengue virus type 1 nonstructural protein antigen test was positive, dengue IgM negative, and dengue IgG positive. A right decompressive craniectomy was done. Unfortunately, the patient died soon after. Spontaneous intracranial hemorrhage in patients with dengue fever is an uncommon entity but usually carry a grave prognosis. To date, there has been no clear management guideline for such cases, as both operative and nonoperative approaches have their own inherent risks.
  4. Zamiah SAKS, Draman CR, Seman MR, Safhan AF, Rozalina R, Nik Ruzni NI
    PMID: 29456216 DOI: 10.4103/1319-2442.225185
    Cardiovascular (CV) event is the most common cause of death in dialysis patients. Both traditional and nontraditional CV risk factors related to malnutrition, inflammation, and anemia are commonly found in this population. This study was conducted to evaluate the burden factors of CV risk factors and its management in our regularly dialyzed patients. It was a single-center, cross-sectional analysis of prevalent intermittent hemodialysis (IHD) and continuous ambulatory peritoneal dialysis (CAPD) patients followed up in our hospital. Both the traditional and non-traditional CV risk factors were recorded and compared between the two groups. Eighty-eight patients were recruited. Forty-five were treated with CAPD and 43 patients were treated with IHD. The mean age was 49.5 ± 15.17 years old and 54.5% were females. Eighty percent were Malay followed by Chinese (14.7%) and Indian (5.7%). Thirty-eight percent were hypertensive and 17% were diabetic. The mean age of CAPD patients was 48.9 ± 16.9 compared to 50 ± 13.5 years old for IHD patients (P > 0.05). The body mass index (BMI) of CAPD patients was 23.9 kg/m2versus 21.7 kg/m2of the IHD (P = 0.04). The systolic and diastolic blood pressure of CAPD patients were 158 and 89 mm Hg in comparison to 141 and 72 mm Hg in IHD patients (P <0.001) and their total and low-density lipoprotein cholesterol level were 5.93 mmol/L and 3.84 mmol/L versus 4.79 mmol/L and 2.52 mmol/L, respectively (P≤0.001). The CAPD patients were hyperglycemic more than IHD patients, although it was not statistically significant. All the nontraditional CV risk factors except serum albumin were comparable between the two groups. Serum albumin in CAPD patients was 35.5 g/L compared to 40.8 g/L in the IHD patients (P <0.001). In our prevalent dialysis-dependent patients, both traditional and non-traditional CV risk factors are common. Due to the prolonged and continuous glucose exposure from the peritoneal dialysis fluid, the CAPD patients had highly atherogenic serum, higher BMI, and intensified inflammation which pre-disposed them to higher CV events.
  5. Fuah KW, Lim CTS, Pang DCL, Wong JS
    PMID: 29456232 DOI: 10.4103/1319-2442.225177
    Tranexamic acid (TXA) is an antifibrinolytic agent commonly used to achieve hemostasis. However, there have been a few case reports suggesting that high-dose intravenous TXA has epileptogenic property. In patients with renal impairment, even administering the usual recommended dose of TXA can induce seizure episodes. We present here a patient on hemodialysis who developed seizures after receiving two doses of TXA over 5 h period.
  6. Hosadurga R, Shanti T, Hegde S, Kashyap RS, Arunkumar SM
    J Indian Soc Periodontol, ;21(4):315-325.
    PMID: 29456307 DOI: 10.4103/jisp.jisp_139_17
    Background: In developing nations like India awareness and education about dental implants as a treatment modality is still scanty.

    Aim: The study was conducted to determine the awareness, knowledge, and attitude of patients toward dental implants as a treatment modality among the general population and to assess the influence of personality characteristics on accepting dental implants as a treatment modality in general and as well as treatment group.

    Materials and Methods: A structured questionnaire-based survey was conducted on 500 randomly selected participants attending the outpatient department. The study was conducted in 2 parts. In the first part of the study, level of awareness, knowledge, and attitude was assessed. In the second part of the study, interactive educational sessions using audiovisual aids were conducted following which a retest was conducted. The participants who agreed to undergo implant treatment were followed up to assess their change in attitude towards dental implants posttreatment. Thus pain, anxiety, functional, and esthetic benefits were measured using visual analog scale. They were further followed up for 1 year to reassess awareness, knowledge, and attitude towards dental implants.

    Results: A total of 450 individuals completed the questionnaires. Only 106 individuals agreed to participate in the educational sessions and 83 individuals took the retest. Out of these, only 39 individuals chose implants as a treatment option. A significant improvement in the level of information, subjective and objective need for information, was noted after 1 year.

    Conclusion: In this study, a severe deficit in level of information, subjective and objective need for information towards, dental implants as a treatment modality was noted. In the treatment group, a significant improvement in perception of dental implant as a treatment modality suggests that professionally imparted knowledge can bring about a change in the attitude.

  7. Hammad MA, Tangiisuran B, Kharshid AM, Abdul-Aziz N, Hassan Y, Aziz NA, et al.
    J Pharm Bioallied Sci, ;9(4):221-228.
    PMID: 29456372 DOI: 10.4103/jpbs.JPBS_26_17
    Context: The literature of drug-drug interaction (DDI)-related uncontrolled causality, and preventability of DDI-induced UCG (HbA1c >7%) in outpatients glycemia (UCG) among outpatients with Type 2 diabetes mellitus is still limited.

    Aims: The aim of this study is to identify the prevalence, mechanism, severity, with Type 2 diabetes.

    Settings and Design: A cross-sectional study was conducted in Penang General Hospital.

    Methods: A computerized system for DDI checking was used to assess the severity and mechanism of DDIs. Drug interaction probability scale was used to evaluate the likelihood of DDIs. Preventability of DDIs has been determined by the instrument of Hallas. The UCG prevalence related to DDIs was further assessed.

    Statistical Analysis Used: SPSS 21.00 was used in this study.

    Results: From 425 outpatients with HbA1c% test, their mean age was 58.7 ± 12.8 years. Only 225 (52.9%) cases had controlled glycemia while 200 (47.1%) cases with UCG. They had multiple comorbidities, with a mean number of 3.8 ± 2.2/patient and often prescribed with multiple medications, with a mean number of 6.33 ± 4.67/patient. It has been detected that 86 DDIs causing UCG in 46 patients (23%) with range of (1 - 4) DDIs per patient. Drugs with DDI-induced UCG were as follows: diuretics (79%), salbutamol (9.2%), cortisones (5.8%), and others (6%). The majority of these DDIs were categorized as possible (77.9%) and preventable (37%).

    Conclusion: Nearly one-quarter of UCG was induced by DDIs; most of these DDIs are possible, and more than one-third are preventable. It was concluded that thiazide diuretics have the highest prevalence of DDI-related UCG.

  8. Ramatillah DL, Syed Sulaiman SA, Khan AH, Meng OL
    J Pharm Bioallied Sci, ;9(4):229-238.
    PMID: 29456373 DOI: 10.4103/jpbs.JPBS_191_17
    Background: Quality of life is one of the parameters to check the improvement of hemodialysis treatment among hemodialysed patients. Those patients will be dealing with this treatment in long term if this treatment is the only way for them to replace their kidney function and this thing will affect their quality of life.

    Objective: To evaluate the quality of life patients on hemodialysis using kidney disease quality of life-short term 24 (KDQoL-SF24) Malaysian Version.

    Materials and Methods: Cohort observational study was conducted in this study. The study included 78 hemodialysed patients in HD center Penang, Malaysia.

    Results: There were 9 components which had the lower of the mean and standard deviation (SD) than the standard form; work status (15.01 ± 35.57), cognitive function (75.66 ± 13.75), quality of life social interaction (76.32 ± 16.11), sleep (55.86 ± 15.30), social support (59.61 ± 22.08), patient satisfaction (43.24 ± 15.32), physical functioning (50.06 ± 42.81), general health (29.62 ± 25.56), and role emotional (54.27 ± 49.92). In this HD center, the group of patient's age who had the lower mean ± SD from the KDQoL-SF Manual Standard were the first and the sixth groups of patient's age (≤20 and 61-70).

    Conclusion: The study conducted in HD center, Penang, Malaysia showed that the scoring of work status, cognitive function, quality of social interaction, sleep, social support, patient satisfaction, physical functioning, general health, and role emotional were low than standard form.

  9. Ariffin NM, Islahudin F, Makmor-Bakry M, Kumolosasi E, Hamid MHA
    J Pharm Bioallied Sci, ;9(4):239-245.
    PMID: 29456374 DOI: 10.4103/jpbs.JPBS_48_17
    Introduction: Primaquine is vital for the management of liver-stagePlasmodium vivaxandPlasmodium ovalemalaria. However, primaquine effectiveness is dependent on various factors and differs between populations. Therefore, this study was conducted to identify factors that affect the length of stay and relapse during primaquine combination treatment in malaria-infected patients in the local setting.

    Materials and Methods: A retrospective study on the use of primaquine combination amongP. vivaxandP. ovaleinfected patients in Selangor, Malaysia within a 5-year period from 2011 to 2015 was obtained from the National Malaria Case Registry, Malaysia. Data collected were patient characteristics (age, gender, nationality, glucose-6-phosphate dehydrogenase, pregnancy); disease characteristics (survival, past malaria infection, parasite type, presence of gametocyte, parasite count, week onset, severity, transmission type); and treatment characteristics (type of antimalarial, treatment completion). Outcome measures were length of stay and relapse during a 1-year follow-up.

    Results: A total of 635 patients were included in the study. Based on a multivariate logistic regression analysis, the significant predictors for length of stay were gender (P= 0.009) and indigenous transmission (P< 0.001). Male patients had a shorter length of stay than females by 0.868 days (P= 0.009), and indigenous transmission took 1.82 days more compared to nonindigenous transmission (P< 0.001). Predictors for relapse were indigenous transmission of malaria (P= 0.019), which was 15.83 times more likely to relapse than nonindigenous transmission (P< 0.01).

    Conclusions: This study reveals that the effectiveness of primaquine was clinically associated with gender and indigenous transmission. To that end, vigilant monitoring of primaquine use is required to reduce relapse and future transmission.

  10. Shakeel S, Nesar S, Rahim N, Iffat W, Ahmed HF, Rizvi M, et al.
    J Pharm Bioallied Sci, ;9(4):266-271.
    PMID: 29456378 DOI: 10.4103/jpbs.JPBS_327_16
    Aims: Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors' opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients.

    Setting and Design: The current research is a cross-sectional study conducted from January 2015 to July 2015. The study population comprised physicians rendering their services in different hospitals of Karachi, Pakistan, selected by the nonprobability convenience sampling technique. In this study, 500 questionnaires were distributed through email or direct correspondence.

    Methods and Materials: Physicians' perception toward the impact of electronic and print media on the health status of patients was assessed with a 20-item questionnaire. Different demographic characteristics, such as age, gender, institution, position, and experience of respondents, were recorded. Quantitative data were analyzed with the use of Statistical Package for Social Sciences, version 20.0 (SPSS, Chicago, IL). The association of the demographic characteristics of the responses of physicians was determined by one-way ANOVA using 0.05 level of significance.

    Results: In this study, 254 physicians provided consent to show their responses for research purposes. A response rate of 50.8% was obtained. Nearly one-third of the respondents negated that patients get health benefit using electronic and print media. The majority did not consider electronic and print media as lifestyle-modifying factors. Physicians thought that patients particularly do not rely on mass media for acquiring health information and consider healthcare professionals as unswerving information resource.

    Conclusions: Mass media can be productive resources to augment awareness among patients, although physicians seem unconvinced about the extended usage of print/electronic media.

  11. Siddiqui MJ, Kamarudin MFB, Mohammed Al-Shami AK, Mat So'ad SZ, Jamshed SQ
    J Pharm Bioallied Sci, ;9(4):279-281.
    PMID: 29456380 DOI: 10.4103/jpbs.JPBS_24_17
    Hypertension is a pathological condition in which the blood pressure is higher than under normal physiological conditions, i.e., 140/90 mmHg or higher. Blood pressure is measured as the force exerted by the blood pumped by the heart against the walls of arteries (aorta) and distributed throughout the body. Use of complementary and alternative medicine as a cure for hypertension is a common phenomenon because of the high risk of cardiovascular complications and kidney diseases caused by conventional Western medicine. It is reported that high blood pressure causes ~49% of myocardial infarction and 62% of strokes. Effective treatment of hypertension is restricted by adverse effects and cost of the medication. Moxibustion is the application of heat by burning a small bundle of tightly bound moxa, to targeted acupoint, and sometimes it is used along with acupuncture. Encouraging results have been reported on randomized trials indicating the efficacy of moxibustion. But more controlled clinical trials are required to further establish the potential efficacy of moxibustion approach in hypertension.
  12. Hasamnis AA, Arya A
    J Pharm Bioallied Sci, ;9(4):282-283.
    PMID: 29456381 DOI: 10.4103/jpbs.JPBS_96_17
    Cardiac arrhythmias are a major cause of morbidity and mortality across the world. Learning the science behind the use of antiarrhythmic drugs is essential for all medical graduates. However, many antiarrhythmic drugs are available, and most of them have complex pharmacodynamic and pharmacokinetic profiles. We tried to improvise our teaching by conducting interactive, worksheet-based, small-group discussion on antiarrhythmic drugs with preclinical students of School of Medicine, Taylor's University, Malaysia. This survey was conducted to analyze the outcomes of worksheet-based, small-group discussion.
  13. Zakaria A, Jais MR, Ishak R
    J Nat Sci Biol Med, ;9(1):23-26.
    PMID: 29456388 DOI: 10.4103/jnsbm.JNSBM_131_17
    Background: This study investigates the analgesic properties of the aqueous extracts ofNigella sativa and Eucheuma cottoniiin mice. The analgesic properties of both extracts were evaluated in an experimental model of acetic acid-induced writhing test.

    Materials and Methods: The mice were divided into four different groups and received the test extracts and the standard drug (aspirin) for 14 days via force-feeding. On day 15, the mice were injected with 5% acetic acid, and the number of abdominal constriction and elongation of hind limb (writhes) were counted for 20 min.

    Results: The numbers of writhes were counted starting after 5 min of the acetic acid injection. TheN. sativaextracts significantly reduced the number of writhes as compared to the control group. Both of the extracts revealed a comparable result as referred to the aspirin effects in the mice.

    Conclusions: These findings indicate thatN. sativaandE. cottoniimay possess protective active constituent that is effective in reducing the sensation of pain in mice.

  14. Rath A, Fernandes BA, Sidhu P, Ramamurthy P
    J Indian Soc Periodontol, ;21(3):245-248.
    PMID: 29440795 DOI: 10.4103/jisp.jisp_221_17
    New and innovative surgical techniques are necessary to help the clinician ensure the best results and satisfy patient's expectations. One such periodontal problem that has been challenging to the dental practitioners and impacts the oral health quality of life of patients has been gingival recession. When present anteriorly where esthetics is a major concern, patient centric parameters too become paramount. Root coverage esthetic score (RES) evaluation helps to keep the patient outcomes in mind. This case reports the successful treatment of a wide anterior mucogingival defect using epithelial embossed connective tissue graft which was evaluated for the first time using RES.
  15. Donald PM, Renjith G, Arora A
    J Indian Soc Periodontol, ;21(3):249-251.
    PMID: 29440796 DOI: 10.4103/jisp.jisp_109_17
    Smokeless tobacco is used orally or nasally without burning tobacco. This is equally harmful as smokers due to the tobacco content and can cause oral cancer as well as systemic effects such as nicotinic dependence. Many other oral conditions have also been reported in association with smokeless tobacco. This paper presents features of tobacco pouch keratosis and aims to highlight the oral effects of smokeless tobacco, management, and guidelines for dentists in educating and counselling tobacco users.
  16. Ali SS, Dubikaitis A, al Qattan AR
    Med Princ Pract, ;11(1):35-7.
    PMID: 12116693
    OBJECTIVES: To prospectively assess the magnitude of changes in the arterial-to-end tidal carbon dioxide gradient [P(a-ET)CO2] as well as in the ratio of physiological dead space to tidal volume (Vdphys/Vt) during controlled hypotensive anaesthesia, and to evaluate whether or not ventilatory requirements remain unaltered during this procedure.

    SUBJECTS AND METHODS: Twelve adult patients with American Society of Anesthesiologists' physical status I and II undergoing middle ear surgery were selected. A standard anaesthetic procedure was followed for all cases, using thiopental sodium, succinylcholine, fentanyl, atracurium and 60% N2O in 40% oxygen supplemented with isoflurane. Mean arterial blood pressure (MAP) was reduced to 60 +/- 5 mm Hg in all patients using a sodium nitroprusside infusion. The end tidal (ET) CO2, PaCO2, MAP, peak airway pressure, plateau pressure and expiratory minute volume were recorded during a period of normal arterial blood pressure (time 1) and during hypotension (time 2).

    RESULTS: A significant decrease in PaCO2 (7%) and ETCO2 (17%) from time 1 to time 2 (p < 0.01) was noted, as was a significant increase in P(a-ET)CO2 (48%) and in the Vdphys/Vt ratio (41.17%) (p < 0.01) during the same period.

    CONCLUSION: The decrease in ETCO2 does not reflect the changes in PaCO2. The larger decrease in ETCO2 is mainly due to the increase in the Vdphys/Vt ratio. During anaesthesia, once normocapnia is achieved with normal arterial blood pressure, there is hardly any need to change the ventilation after initiation of controlled hypotension.

    MeSH terms: Adult; Blood Pressure/physiology; Carbon Dioxide/analysis*; Carbon Dioxide/blood; Ear, Middle/surgery; Female; Humans; Hypotension, Controlled*; Male; Middle Aged; Prospective Studies; Respiration; Respiration, Artificial; Respiratory Function Tests
  17. Singh VA, Sarrafan S, Veriah RS
    Indian J Orthop, ;52(1):15-21.
    PMID: 29416165 DOI: 10.4103/ortho.IJOrtho_101_17
    Background: The femur is the most common long bone affected by metastatic bone disease, with 25% involving the proximal third of the femur. Long stem cemented hip replacement (LHR) is an important option for cases of impending fracture. Pulmonary embolism is a critical complication that can occur. This study evaluates the effectiveness of distal femoral canal decompression in reducing the risk of cardiopulmonary events.

    Materials and Methods: Thirty two patients with metastatic bone disease of the proximal femur undergoing LHR were recruited and randomized. Conventional technique was used in 16 cases and distal decompression of the medullary canal was carried out for the other 16 patients. The decompression was carried out through a trocar inserted into the distal medullary canal, connected to a vacuum suction. Quantity of emboli was detected through A4 chambers transesophageal echocardiography; the blood pressure and oxygen saturation readings were also recorded.

    Results: The decompression group experienced significantly lower Grade 2 and Grade 3 embolic events compared to the conventional group (11 vs. 26), and the duration of the embolic phenomena was shorter. Insertion of the stem and relocating the hip gave the highest amount embolic events. There was a significant drop in systolic blood pressure (SBP) in 12 out of 16 patients (75.0%) in the conventional group and 5 out of 16 patients in the decompression group (31.3%). This is statically significant (P = 0.0124). The average drop in SBP for the conventional group is 45.8 mmHg and the decompression group was 32.9 mmHg. Oxygen saturation remained at above 96% in the decompression group. However, in the conventional group, 25% of the patients had their oxygen saturation drop to below 96% during the insertion of stem and relocation of hip joint.

    Conclusion: Distal femoral canal decompression is an effective method in reducing the risk of cardiopulmonary embolic events associated with LHR.

  18. Ghani SA, Wan Ismail WF, Md Salleh MS, Yahaya S, Syahrul Fitri ZM
    Indian J Orthop, ;52(1):31-34.
    PMID: 29416167 DOI: 10.4103/ortho.IJOrtho_153_17
    Background: Giant cell tumor (GCT) of bone is a benign locally aggressive primary bone tumor which is risky for local recurrences and pulmonary metastasis. Till date, there are still many uncertainties in predicting the aggressiveness of GCT. We aim to investigate whether receptor activator nuclear kappa-B ligand (RANKL) expression may determine the prognosis of the lesion.

    Materials and Methods: We examined RANKL expression in 39 patients (21 males, 18 females) by immunohistochemistry. Four patients (10%) were presented with tumor recurrence, eight patients (20%) were complicated with lung metastasis, and two patients (5%) were presented with both recurrence and lung metastasis. Positive RANKL expression was assessed according to a scoring system evaluating the percentage of the immunostained epithelial area and the staining intensity. The cumulative score was calculated to determine the final score value. Data were analyzed using PASW version 18.0 and independent t-test between nonrecurrence/recurrence groups, and nonlung metastasis/lung metastasis groups. Significance was set at P < 0.05.

    Results: Thirty-two patients (82%) scored 3 in RANKL-staining percentage from whole stromal cell population (>75%), 6 patients scored 2, and 1 patient scored 1. Nine patients (23%) scored 3 in RANKL-staining intensity (most intense), 19 patients (48%) scored 2, and 11 patients (29%) scored 1. Twenty six patients (67%) had strong RANKL expression (total score of 5-6), 12 patients (31%) showed moderate score (3-4) whereas only 1 patient (2%) showed weak RANKL expression. Together, the mean value of RANKL-staining percentage was 2.79, intensity 1.95 and the total score 4.77. The mean RANKL-staining percentage between recurrence and nonrecurrence groups was statistically significant (P = 0.009). There was no significant difference in the mean staining intensity and total score between nonrecurrence and recurrence groups, and staining percentage staining intensity and a total cumulative score of RANKL expression between lung metastasis and nonlung metastasis groups.

    Conclusion: RANKL expression is generally high in Stage III GCT and is a reliable prognostic marker in predicting the risk of local recurrence however not in lung metastasis.

  19. Singh VA, Heng CW, Yasin NF
    Indian J Orthop, ;52(1):65-72.
    PMID: 29416172 DOI: 10.4103/ortho.IJOrtho_188_17
    Background: Limb salvage surgery with endoprosthesis for bone tumor around the knee is reported to have good functional and oncological outcomes. However, the functional assessment using musculoskeletal tumor society (MSTS) and Toronto extremity scoring system remains subjective. We performed gait analysis as an objective assessment of their functional outcome.

    Materials and Methods: Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee. The temporal parameters assessed during gait analysis were walking velocity, stride length, duration of stance, and goniometry of the knee. These parameters were compared with the functional outcome score of the MSTS.

    Results: The mean free-paced walking velocity was 0.91 m/s (normal is 1.33 m/s), which was 68% lower than normal gait. The stride length and stance phase were shorter for the affected limb compared to normal (P < 0.05). However, the gait was symmetrical with no difference in stride length (P = 0.148), velocity (P = 0.918), knee flexion (P = 0.465), and knee extension (P = 0.321) between the affected and unaffected limbs. Sixteen patients demonstrated stiff knee gait, two had a flexed knee gait, and only two patients had normal gait during the stance phase. The mean MSTS score was 21. There was significant correlation between overall MSTS scores (P = 0.023), function (P = 0.039), and walking scores (P = 0.007).

    Conclusion: Limb salvage surgery with endoprosthesis reconstruction around the knee gives good functional outcome, both objectively and subjectively, as evidenced by the symmetrical gait pattern and significant correlation with MSTS score. Despite decreased walking velocity, stride length, and stance phase of the operated limb, the patient still has a symmetrical gait.

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