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Fulltext Anatomical variations of the lumbrical muscles causing carpal tunnel syndrome

Benny, E., Parminder, G.S., Nur Azuatul, A.K., Tan, J.A., Ahmad Suparno, B., JamarI, S., et al.

Medicine & Health, 2019;14(1):197-202.
MyJurnal

Many anatomical variations exist in and around the carpal tunnel. However, symptomatic anomalies causing carpal tunnel syndrome is rare. Additionally, carpal tunnel surgery is considered a simple operation commonly done by junior surgeons who are usually unaware of variations resulting in unfavorable surgical outcomes. We highlight a case of lumbrical muscle variation causing carpal tunnel syndrome. A 73-year-old male presented with numbness and pain of both hands associated with abnormal fullness over both wrists and distal forearms. Initially the right hand was numb and subsequently a year later, the left hand became numb. Physical examination was positive for Durkan, Phalen and Tinel signs at the carpal tunnel. Magnetic Resonance Imaging (MRI) showed abnormal muscle tissues in the carpal tunnel. During the carpal tunnel release and exploratory surgery, we noted an abnormally proximal origin of the lumbrical muscles in the forearm rather than the typical palmar origin. He also had lumbrical muscle hypertrophy in the left side. These two factors resulted in overcrowding within the carpal tunnel. Post-operatively the patient recovered well with pain relief and gradual improvement of his numbness. Variations in the anatomy of the lumbrical muscles is not uncommon and may result in carpal tunnel syndrome. Hence, carpal tunnel release surgeries may not be as straight forward as expected and surgeons should be aware of this possibility.
Fulltext Adhesions as an uncommon complication of k-wiring in paediatric phalangeal fractures

Nanchappan S., Parminder G.S., Nur Azuatul, A.K., Tan, J.A., Ahmad Suparno, B., Jamari, S., et al.

Medicine & Health, 2019;14(1):203-208.
MyJurnal

Paediatric hand fractures are common and prompt management is mandatory to achieve a good functional outcome. However many fail to realize that treating a fracture does not only involve bones but the soft tissues, as well. K-wiring itself can be difficult with multiple attempts inadvertently injuring the flexor or extensor tendons and resulting in adhesions. We highlight this possible complication of K-wiring which we believe is under reported due to the perception that K-wiring is a simple procedure. We present a case of a 9-year-old child, who sustained a closed displaced fracture of the base of the proximal phalanx (Salter Harris type 2) of the left index finger. He underwent percutaneous K-wiring but was complicated with severe adhesions of the flexor digitorum profundus (FDP) and flexor digitorum superficialis tendons (FDS). He was unable to flex the proximal and distal interphalangeal joints of the affected finger. We subsequently performed tendon adhesiolysis twice together with A2 pulley reconstruction, to restore movement of the finger. K-wiring of the fingers are not just simple bony procedures but also involve soft tissue components which can be prone to adhesions.
Fulltext Effect of acquisition parameters on the feasibility of computed tomography-based thermometry: an experimental assessment of radiofrequency ablation on phantom study

Daryl Tan, Yin How Wong, Kok-Sing Lim, Chai Hong Yeong

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):17-17.
MyJurnal

Introduction: This paper is aimed to evaluate the feasibility of computed tomography (CT) based thermometry for radiofrequency ablation (RFA) through the investigation on the effects of principal CT acquisition parameters to the CT number. Methods: The effects of CT acquisition parameters (tube voltage, tube current, gantry rotation time, and CT reconstructed slice thickness), as well as metal artefacts on CT number were evaluated by using liver tissue equivalent polyacrylamide (PAA) phantom. The correlation between CT number and tissue temperature from 37 0C to 80 0C was studied with the use of PAA phantom with optimum CT acquisition parameters. Results: The CT numbers show insignificant changes under variation of tube voltages, tube currents, gantry rotation time, and CT reconstructed slice thickness respectively. The CT number difference obtained for each series of the variations are less than 2 HU, which indicates the changes in the CT acquisition parameters has insignificant effects on the CT number shift. On the other hand, the CT reconstructed image is able to improve the metal artefact caused by RF electrode through the increases of CT reconstruction condition. In this paper. A linear regression analysis on the CT number and temperature suggested the CT number is inverse linearly proportional to temperature, with a CT thermal sensitivity of –0.521 ± 0.061 HU/0C (R2 = 0.998). Conclusion: In summary, the results show that assessment of CT thermometry is feasible with the use of current CT technology as it produces high reproducibility and stable CT measurement, which is proved to be independent for CT acquisition parameters.
Fulltext Development of peptides inhibitor against human papillomavirus E7 protein

Tan Wan Chein, Nurshamimi Nor Rashid, Heh Choon Han, Lim See Khai, Shatrah Othman

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):28-28.
MyJurnal

Introduction: Human papillomavirus (HPV) is a small, non-enveloped double-stranded circular DNA virus. The high risk types of HPV are claimed to be responsible for over 99% of cervical cancers while the most common oncogenic genotypes 16 and 18, implicated in approximately 70% of all cervical cancers. HPV has six early genes (E1, E2, E4, E5, E6 and E7) that code for regulatory proteins involved in viral DNA replication, transcription control and cellular transformation. The E7 protein is responsible for the escape from cell cycle arrest in HPV infected cells by binding to the retinoblastoma protein (pRB) through its LXCXE binding motif. This inhibits the tumour suppressor protein from regulating the cell cycle progression from G1 to S phase. In this study, the pocket domain of pRB which is targeted by LXCXE is used as a target to design peptide inhibitors using in silico methods. Methods: Biovia Discovery Studio Visualizer and UCSF Chimera softwares were used in designing the peptides. Results: Two crystal structures: 1GUX and 4YOZ were superimposed and studied. The similar amino acid sequences which bind to LXCXE were cut to form the potential peptide inhibitors. Based on this, peptide 1 was selected for further in vitro analysis. The cytotoxicity of the peptide 1 was analysed on three cell lines: CaSki (HPV16+ cervical cancer cell), C33a (cervical cancer cell), and HaCaT (normal keratinocyte). As a result, the IC50 of one of the designed peptide inhibitor – peptide 1, on CaSki cell line was 180 μM. The inhibitory effect of the peptide 1 was also analysed validated using Western Blot using antibodies from the B-Myb and pRB family. The changes in cell cycle before and after treatment of the peptide inhibitor will be further monitored using a cell analyser. Conclusion: Peptide 1 had shown potential as an inhibitor of the HPV E7 protein based on the in silico analysis, but further functional studies are needed to validate its potential.
Fulltext The immunomodulatory effects of Tualang and Kelulut honey on microglial cell activities

Ooi, Yin Yin, Soyza, R. M., Low, Z. X., Tan, K. L.

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):35-35.
MyJurnal

Introduction: Neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) have become increasingly prevalent in recent years. Microglia, the resident myeloid cells of the Central Nervous System (CNS) are primarily responsible for the production of inflammatory mediators that accumulate and become toxic during a chronic inflammatory response. The accumulation of inflammatory mediators over time inadvertently contributes to the functional impairment of surrounding neurons. Hence, suppressing microglial cell activation can be a solution to control the progress of neurodegenerative disorders. Symptomatic treatments are available, but no curative treatment is currently available, and some are linked to several side effects associated with their use. Honey is a natural product derived from the nectar harvested and modified by honeybees. Its therapeutic effects are widely documented, have been tested and verified extensively in literature. Honey is recognized in modern medicine for its varied pharmacological activities. While the medicinal properties of honeys such as Manuka honey are well established, further investigation is required to elucidate the medicinal properties of locally sourced honeys, namely Tualang (TH) and Kelulut (KH) honeys. In this study, we investigated the immunomodulatory effects of local TH and KH honey on microglial cell activities. Methods: BV2 cells, an immortalized microglial cell line was used in this in vitro study to assess the cell survival when treated with the TH and KH honey. Expression of CD40, CD11b and CD86 were measured using flowcytometry. Results: BV2 cells incubated with TH at concentrations of 0.1% and 0.5%, and KH at concentrations of 0.1% and 0.25% for 24 and 48 hours showed cell survivability above 75%. Both TH and KH decreased ROS production significantly on LPS-induced BV2 cells, but increased ROS production on unstimulated BV2 cells. Additionally, the expression levels of CD40, CD11b and CD86 were also reduced on honey- treated LPS-induced BV2 cells. Conclusion: These results have demonstrated that both TH and KH are capable of suppressing microglial activation. Therefore, we propose the idea of utilizing these honeys as a complementary treatment to suppress the progression of neurodegenerative diseases.
Fulltext Purification and characterization of charantin from Momordica charantia Linn.

Oh, J. H., Lim, P. K., Hamzah, S., Tan, C. P., Chan, Sook Wah

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):43-43.
MyJurnal

Introduction: Diabetes mellitus (DM) is one of the top diseases that lead public health concern in Malaysia. It was believed to rise in number up to 4.5 million on cases by year 2020 based on the current figure. Momordica charantia Linn (MC), a climber belonging to family Cucurbitaceae, is well known in treating diabetic-related conditions. In earlier studies related to the hypoglycemic properties of MC mainly utilized the crude extract, which contain a mixture of bioactives (charantins, insulin-like peptides and alkaloids). Till now, there is no conclusive result on the major bioactives that play role in the hypoglycemic effect of MC and research regarding the charantin purification was not well established. Hence, the objectives of this study were to purify the charantin from MC and to characterize the purified charantin before further subjected to in vivo hypoglycemic study. Methods: The crude was first extracted from MC using ethanol as solvent via Soxhlet extraction following by a series of purification steps via washing, centrifugation, and C-18 cartridges. Results: The HPLC analysis showed that the charantin of purified extract after passing out from the cartridge exuded at 12.50 min with a concentration of 500 ppm, which is relatively 20 times higher than the crude extract (25 ppm). The structural properties of purified charantin were studied using FTIR and it showed strong peaks of carboxylic acids (2884 nm), alcohols (1023 nm) and diethyl ether (1114 nm) as compared
with the standard. The compound was reconfirmed in LC-MS analysis. The result displayed mass spectrum in positive mode indicates the presence of similar compound in the purified extract and standard charantin, as presented by ion m/z = 300. Conclusion: The charantin was successfully purified from MC and can act as a potent plant-based hypoglycemic agent for diabetes.
Fulltext The effect of dietary glycemic index and glycemic load on overweight individuals and type 2 diabetes patients: an overview of the literature

Chekima, K., Wong, B. T. Z., Ooi, Y. B. H., Ismail M. N., Tan, C. H.

Malaysian Journal of Medicine and Health Sciences, 2019;15(102):45-45.
MyJurnal

Introduction: Type 2 diabetes is increasing at an alarming rate worldwide. One of the leading factors to this condition is obesity. Low glycemic index (GI) and glycemic load (GL) diets have been proposed as lifestyle changes to address obesity, however, there is a lack of consensus on the optimal approach for weight loss, glycemic control and improving insulin sensitivity. In addition, the outcome of these diets are equivocal, with some studies suggesting beneficial outcomes and others suggesting otherwise. Furthermore, discrepant study designs have led to divergent conclusions. In order to provide a comprehensive overview of the low GI and low GL diets, a systematic review of literature on relevant observational studies and randomised control trials was performed on these databases:- The Cochrane Library, Medline, PubMed, Embase, Cinahl and Web of Science. Methods: The review was conducted based on the methodological standards for the conduct and reporting of Cochrane intervention reviews, Version 1.07, November 2018. Population, Intervention, Comparison and Outcomes (PICO) tool was used as the organising framework to define key elements of the review question. Results: Pertinent outcome variables include body weight, insulin resistance, HbA1c, fasting serum glucose, BMI, waist-to-hip ratio, triglyceride, HDL and LDL cholesterol. Our current understanding of these diets has been complicated by the reports that were based on different study designs and study populations. This review defines the issues, gaps in the research, study design, and evidence that is needed to inform practice, policy making and future research. There is also a dearth of information on the effect of low GI and GL diets on the Asian populations, specifically on improving insulin resistance. High carbohydrate diets are a mainstay of Asian societies. Conclusion: As cases of obesity and type 2 diabetes surge, there is an urgent need for research on low GI and GL dietary modifications among the Asian populations.
Fulltext A case report of severe Ascariasis infection in systemic lupus erythematosus patient

Tan J. Y. S., R. Surendran, Mohd Noh Malehah, Shaila Kabir, Chong Y. Y. Eleen

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):53-53.
MyJurnal

Introduction: Ascariasis is a parasitic infection, which commonly affects immunocompromised patients. Most pa-tients remained asymptomatic during the early larval migration stage and respond well with conventional anti-hel-minthic drugs. Previous literature had reported symptomatic Ascaris infection mimicking bacterial pneumonia and the typical eosinophilia found in Loeffler syndrome was absent in patients on corticosteroids. Thus, a high index of suspicion for ascariasis is needed for immunosuppressed patients presented with infection. We present here a case of severe ascariasis infection in a systemic lupus erythematosus patient. Case description: A 16-year-old boy presented with fever, generalized maculopapular rash associated with neutropenia and thrombocytopenia. He was treated initially as Dengue Fever initially. However his symptoms did not resolve at even day 14 of admission. On further assessment, we were convinced he has SLE based upon presence of malar rash, oral ulcers, urinary protein-uria, persistent leucopenia, thrombocytopenia with low complements and ANA positive. He was promptly started on IV hydrocortisone. He showed a good progress in the first few days. On day 5 of admission, he coughed out a round worm which later identified as Ascarisis lumbricoides. He was started on Albendazole. Unfortunately he developed hemoptysis and respiratory compromisation where he required intubation. Post intubation he went into cardiac arrest, which required CPR. Following that event, his condition further deteriorated with multi organ failure. He succumbed to his illness three days later. Conclusion: Immunocompromised patients are prone to opportunistic infections including parasitic infections. we present here a case of ascariasis in an SLE patient who unfortunately succumbed to the illness. Due to the variable clinical symptoms that mimic other infections, screening for parasitic infections needs to be considered especially if the patients do not respond to antibiotics and routine treatments.
Fulltext Post spinal meningitis with subdural collection:an uncommon complication after spinal anaesthesia for caesarean section

Seng, Wee Cheo, Qin, Jian Low, Yee, Ann Tan, Yuen, Kang Chia

Neuroscience Research Notes, 2018;1(2):1-5.
MyJurnal

Abstract: Meningitis after spinal anaesthesia is a rare yet devastating complication of spinal anaesthesia. The exact incidence is unknown. Our patient developed signs and symptoms of meningitis 48 hours after spinal anaesthesia and required intensive care unit admission. Her cerebrospinal fluid was sterile. Computed tomography of brain showed left subdural collection. She recovered well after 6 weeks of intravenous antibiotics. No neurological sequela noted from subsequent follow-upexaminations. Our case provides an important insight of meningitis with subdural collection after spinal anaesthesia for emergency caesarean section.
Fulltext Malaysian society of neurosciences (MSN) –Asian and Oceanian myology centre (AOMC) annual scientific meeting 2018

Lim, Kheng-Seang, Goh, Khean-Jin, Tan, Ai-Huey, Low, Soon-Chai, Mustapha Muzaimi

Neuroscience Research Notes, 2018;1(2):6-11.
MyJurnal

The conjoint 17thAsian and Oceanian Myology Centre (AOMC) and 28thMalaysian Society of Neurosciences (MSN) Annual Scientific Meeting, held in Hotel Istana, Kuala Lumpur, Malaysia from 27 to 29 July 2018, was a great success to gather all neurosciences professionals locally and in the Asian-Oceanian region to share the latest updates in Neurology and specifically Myology. This congress attracted 516 local participants and 167 international delegates from 14 countries
Fulltext Factors affecting adherence to antiepileptic drugs therapy in Malaysia

Tan, XC, M Makmor-Bakry, Lau, CL, Tajarudin, FW, Raymond, AA

Neurology Asia, 2015;20(3):235-241.
MyJurnal

Poor adherence to antiepileptic drug (AED) therapy can lead to various undesirable complications. Identifying the contributing factors of poor adherence is beneficial in assisting health care professionals to provide optimal interventions to control the seizures. This study aimed to identify the prevalence and factors affecting the adherence level to AED therapy in a multiracial population with epilepsy. This cross-sectional study was conducted at the neurology clinic of a tertiary care setting. Researcher-assisted questionnaire was utilised. Adherence level was assessed using validated Modified Morisky Adherence Scale-8. A total of 145 patients with epilepsy were included in this study. The prevalence of poor adherence to AED therapy was 64.1%. Poor adherence level was significantly associated with younger age (χ2 = 7.609, p = 0.022), medication adverse effects (χ2 = 5.075, p = 0.020), shorter duration of epilepsy (r = 0.180, p = 0.030) and uncertainty about the necessity for AEDs (χ2 = 11.803, p = 0.001).
Conclusion, prevalence of poor adherence to antiepileptic drugs was high and factors associated with poor adherence to AEDs were identified for a multiracial population with epilepsy.
Study site: Neurology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext Evaluation of patient safety culture among Malaysian retail pharmacists: results of a self-reported survey

Sivanandy P, Maharajan MK, Rajiah K, Wei TT, Loon TW, Yee LC

Patient Prefer Adherence, 2016;10:1317-25.
PMID: 27524887 DOI: 10.2147/PPA.S111537

BACKGROUND: Patient safety is a major public health issue, and the knowledge, skills, and experience of health professionals are very much essential for improving patient safety. Patient safety and medication error are very much associated. Pharmacists play a significant role in patient safety. The function of pharmacists in the medication use process is very different from medical and nursing colleagues. Medication dispensing accuracy is a vital element to ensure the safety and quality of medication use.
OBJECTIVE: To evaluate the attitude and perception of the pharmacist toward patient safety in retail pharmacies setup in Malaysia.
METHODS: A Pharmacy Survey on Patient Safety Culture questionnaire was used to assess patient safety culture, developed by the Agency for Healthcare Research and Quality, and the convenience sampling method was adopted.
RESULTS: The overall positive response rate ranged from 31.20% to 87.43%, and the average positive response rate was found to be 67%. Among all the eleven domains pertaining to patient safety culture, the scores of "staff training and skills" were less. Communication openness, and patient counseling are common, but not practiced regularly in the Malaysian retail pharmacy setup compared with those in USA. The overall perception of patient safety of an acceptable level in the current retail pharmacy setup.
CONCLUSION: The study revealed that staff training, skills, communication in patient counseling, and communication across shifts and about mistakes are less in current retail pharmacy setup. The overall perception of patient safety should be improved by educating the pharmacists about the significance and essential of patient safety.
Fulltext Optimization of vanillin production using isoeugenol as substrate by Aspergillus niger I-1472

Tan, M. C., Liew, S. L., Wan Aida, W. M., Osman, H., Maskat, M. Y.

International Food Research Journal, 2015;22(4):1651-1656.
MyJurnal

Response Surface Methodology (RSM) was used in the study to optimize the production of vanillin from isoeugenol through fermentation by Aspergillus niger I-1472. Three factors were studied which include amount of isoeugenol, resin (Amberlite XAD-4) and Span 80. During fermentation, isoeugenol as substrate were vortexed with Span 80 and added into the culture on Day 4. Resin (Amberlite XAD-4) was added into the medium the following day. The predicted optimum medium combination consisted of 3.61 g/L of isoeugenol, 5.8% (g/ mL) of Amberlite XAD-4 resin and 0.37% of Span 80 with an expected vanillin production of 0.137 g/L. Verification test showed that the model produced similar predicted and experimental values.
Fulltext Extraction and characterization of pepsin-solubilized collagen from the body wall of crown-of-thorns Starfish (Acanthaster planci)

Tan, C. C., Karim, A. A., Latiff, A. A., Gan, C. Y., Ghazali, F. C.

International Food Research Journal, 2013;20(6):3013-3020.
MyJurnal

Pepsin-solubilized collagen (PSC) was extracted from the body wall of crown-of-thorns starfish (COTS) (Acanthaster planci) using pepsin digestion in 0.5 M acetic acid. The electrophoretic pattern of PSC showed that it consisted of two α chains (α1 and α2 chains). In addition, the peptide mapping showed that there were some differences in peptide patterns among PSC, calf skin collagen and salmon skin collagen. This suggested that the primary structure of the PSC was different from calf skin collagen and salmon skin collagen. Furthermore, Fourier transform infrared spectroscopy (FTIR) investigation showed the existence of triple helical structure in PSC, suggesting that the triple helical structure was well preserved during the extraction of collagen from COTS. The denaturation temperature of PSC was 33.0°C, which was comparable with mammalian collagen. In addition, the amino acid composition analysis showed that the imino acid content of PSC was similar to mammalian collagen but it was higher than other marine collagen. This suggested that the imino acid content might contributed the denaturation temperature of collagen. The results in this study suggest that PSC from the underutilized COTS has potential to be exploited in various commercial applications.
Fulltext Spontaneous remission without progression to limbic encephalitis in a patient with LGi1 seropositive faciobrachial dystonic seizure

Sherrini Bazir Ahmad, Suhailah Abdullah, Chong, Tin Tan, Lim, Kheng Seang, Goh, Khean Jin

Neurology Asia, 2016;21(2):191-193.
MyJurnal

Faciobrachial dystonic seizures are pathognomonic of leucine-rich glioma inactivated-1 (LGi1) antibody, non-paraneoplastic limbic encephalitis. Faciobrachial dystonic seizures usually precede limbic encephalitis by about a month. It is unknown whether, if untreated, faciobrachial dystonic seizures inevitably progress to limbic encephalitis. We present an LGi1 seropositive patient with a year’s history of faciobrachial dystonic seizures, who achieved remission spontaneously without immunotherapy or antiepileptic drug treatment, and did not develop evidence of limbic encephalitis over a three-year follow-up.
Attitudes towards induced abortion in Peninsular Malaysia--a Guttman scale analysis

Takeshita YJ, Tan Boon Ann, Arshat H

Malays J Reprod Health, 1986 Dec;4(2):73-90.
PMID: 12314887
Predictors of contraceptive use among women in Kuala Lumpur and Petaling Jaya

Salleh NM, Tan Boon Ann, Arshat H

Malays J Reprod Health, 1986 Dec;4(2):57-64.
PMID: 12314885
Fulltext The assessment of accuracy and reproducibility of cephalometric analyses using Computer-Assisted Simulation System for Orthognathic Surgery (CASSOS) software

Tan, Shiuan Lee, Mohd Fadhli Khamis, Albajalan, Osama Bahaa, Norehan Mokhtar

Archives of Orofacial Sciences, 2012;7(2):75-84.
MyJurnal

Cephalometric analyses using computer software have more advantages than manual analyses. However, the software should be evaluated for the accuracy and reproducibility before it can be used. The aims of the present study were: 1) to compare the differences in accuracy and precision between utilizing scanned images and soft copy images with the software 2) to assess the reproducibility of software and manual cephalometric analyses. Fifteen cephalograms were selected randomly from the Record Unit, Hospital Universiti Sains Malaysia. All films had 10 fiducial points marked and were scanned at 75 dots per inch (dpi) and 300 dpi. Manual and digital measurements were compared to obtain magnification factors. Seven digital x-ray images of a caliper were taken. The mean differences were measured between the fixed caliper measurement and digital measurements. Subsequently, 37 cephalograms were traced manually and digitally with Computer-Assisted Simulation System for Orthognathic Surgery (CASSOS) software to assess its accuracy and reproducibility after applying the obtained magnification factor. Steiner analysis was utilized and T tests were used to evaluate the mean difference. P
Fulltext A biomechanical comparison between Taylor’s spatial frame and ilizarov external fixator

Tan, B. B., Shanmugam, R., Chua, Y. P., Hossain, G., Saw, A.

Malays Orthop J, 2014;8(2):35-39.
MyJurnal

Taylor’s spatial frame (TSF) and Ilizarov external fixators (IEF) are two circular external fixator commonly used to address complex deformity and fractures. There is currently no data available comparing the biomechanical properties of these two external fixators. This study looks into the mechanical characteristics of each system. TSF rings with 6 oblique struts, 4 tube connectors, 4 threaded rods, and 6 threaded rods were compared to a standard IEF rings with 4 threaded rods. Compression and torsional loading was performed to the frame as well as construct with Polyvinylchloride tubes. TSF rings with 4 tube connectors had the highest stiffness (3288 N/mm) while TSF rings with 6 struts was the least stiff. The situation was reversed for torsion where TSF rings with 6 oblique struts had the highest torsional stiffness (82.01 Nm/Degree) and frame Ilizarov rings with 4 threaded rods the least. Standard TSF construct of two ring with 6 oblique struts have better torsional stiffness and lower axial stiffness compared to the standard IEF.
Fulltext Asian men’s health: gender disparity and life expectancy

Ho, Christopher C.K., Teo, C.H., Ng, C.J., Zulkifli, M.Z., Tan, M.H.

Journal of Surgical Academia, 2014;4(2):5-8.
MyJurnal

The aim of this review was to analyze the gender disparities found as well as the life expectancies in Asia. An analysis of the data on gender disparities as well as life expectancies of the different Asian countries was done based on the World Health Organization (WHO) Global Health Observatory Data Repository as well as the regional government databases. Middle Eastern countries have the highest male to female population ratio. The results show that in terms of population pyramid, Asia is moving towards a more geriatric population. Qatar has the highest life expectancy for men and is the only country in Asia where men live longer than women (difference of 2 years). In general, women in Asia live longer than men. High income countries like Hong Kong, Japan and Singapore have higher life expectancies as compared to those on the lower income nations. The life expectancy of Asian men still lags women. Men’s health care needs to be addressed urgently. The disparity in income-status reflecting the lifespan of men is an impetus for us to narrow the gap of health in Asian countries.

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