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Echocardiographic Assessment of Left Atrial Systolic Function after Percutaneous Mitral Balloon Valvuloplasty Using Tissue Doppler Imaging

Hasan MN, Banarjee SK, Ahsan SA, Habib SM, Mahmood M

Mymensingh Med J, 2018 Oct;27(4):851-858.
PMID: 30487504

Mitral stenosis (MS) affects left atrial (LA) function as a result of hemodynamic and myocardial factors that causes significant symptoms and complications. Conventional echocardiographic methods have been practicing to see the improvement of left atrial function after successful percutaneous mitral balloon valvuloplasty (PMBV). Introduction of tissue doppler imaging allows direct and non-invasive measurement of myocardial velocities. The aim of the study was to evaluate LA functions after PMBV using colour tissue doppler imaging. This cross sectional study was performed in Cardiology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2014 to February 2015. Forty six (46) patients (28 females, mean age: 28.96±5.78 years) presenting with mitral valve stenosis who fulfilled the indications for PMBV were included in the study. Within 24 hours before PMBV, all the patients underwent colour tissue doppler study in addition to routine conventional echocardiographic examinations. Late diastolic velocities (A') measured at the septal and lateral annuli were recorded. All the measurements were repeated 24 hours after PMBV. The PMBV was done using the Inoue technique. After PMBV mitral valve areas (MVA) were significantly increased. Maximum and mean gradients, LA diameter, LA area, LA volume, systolic pulmonary arterial pressure and mean LA pressures were decreased while septal and lateral A' were significantly (p<0.001) increased. Lateral and septal A' velocities were correlated with MVA and inversely related to LA pressure measured invasively during PMBV. Tissue doppler velocities illustrated improvement of left atrial systolic function after PMBV in relation to decreased mean left atrial pressure and increased mitral valve area. Therefore, tissue doppler Imaging is a useful tool to detect improvement of left atrial systolic function after PMBV in patients with mitral stenosis.
A 35 Year Old Bangladeshi Lady with Hereditary Mucinous Ovarian Cancer, Complicated with Omental Metastasis

Islam MJ, Roshid B, Pervin S, Kabir S, Chigurupati S, Hasan MN

Mymensingh Med J, 2019 Apr;28(2):484-489.
PMID: 31086172

Approximately 80% ovarian tumors are benign, and these arise mostly in young adult females. Malignant tumors are more prevalent in ageing women, between the ages of 45-65 years. Mucinous ovarian cancer represents about 5% of epithelial ovarian cancers (EOC). We have reported a case of mucinous cystadenocarcinoma in 35-year-old lady with metastasis to momentum. Imaging (Radiograph & CT scan) studies showed a large right sided pelvic mass with probable origin in the right ovary. Cancer antigen-125 was elevated, while carcinoembrionic antigen and alpha-fetoprotein were normal. Mutational profiles shown distinct finding, as KRAS mutations positive nevertheless p53 and BRCA mutations are absent. She had undergone total abdominal hysterectomy with bilateral salphingo-oopherectomy along with pelvic dissection for removal of lymph nodes at the age of 35. She was given 3 cycles of chemotherapy with cisplatin and paclitaxel. To the best of our knowledge, this is the one of the little cases of ovarian mucinous cystadenocarcinoma being reported at a relatively young age and the first case being reported from Bangladesh.
Anesthetic considerations in scoliosis patient with dopa-responsive dystonia or Segawa's syndrome

Hasan MS, Leong KW, Chan CY, Kwan MK

J Orthop Surg (Hong Kong), 2017 01;25(1):2309499016684743.
PMID: 28166704 DOI: 10.1177/2309499016684743

Segawa's syndrome or dopa-responsive dystonia is a rare hereditary disorder characterized by progressive dystonia of childhood onset, diurnal fluctuation of symptoms and complete or near complete alleviation of symptoms with administration of low-dose oral levodopa. From our literature search in PubMed, we found only three related publications: two on anesthesia for cesarean section and one on anesthesia for electroconvulsive therapy. We report our experience in providing anesthesia for corrective scoliosis surgery in two biological sisters with Segawa's syndrome. A review of the literature is also included.
Fulltext Knockdown of Annexin A1 induces apoptosis, causing G2/M arrest and facilitating phagocytosis activity in human leukemia cell lines

Hasan M, Kumolosasi E, Jantan I, Jasamai M, Nazarudin N

Acta Pharm, 2022 Mar 01;72(1):109-122.
PMID: 36651527 DOI: 10.2478/acph-2022-0005

Annexin A1 (ANXA1) is an endogenous protein involved in the control of proliferation, cell cycle, phagocytosis, and apoptosis in several types of cancer. To investigate the effects of ANXA1 knockdown in leukemia cells, transfection with specific ANXA1 siRNA was performed. Cell cycle and apoptosis were analyzed using flow cytometry and a mechanism involving caspases and Bcl-2 was quantified using Western blotting. Phagocytosis activity was evaluated using hematoxylin & eosin staining. The ANXA1 expression was significantly downregulated after the knockdown and apoptosis was induced in tested cells. The expression of caspase-9 and -3 increased in U937 and Jurkat cells respectively. Bcl-2 expression was downregulated in K562 and Jurkat cells while upregulated in U937. The number of leukemic cells arrested at the G2/M phase and the phagocytosis index were significantly increased in transfected cells. This suggests that ANXA1 knockdown might be a potential approach in the therapeutic strategy for leukemia.
Molecular prevalence of Anaplasma marginale in ruminants and Rhipicephalus ticks in northern Pakistan

Ali S, Hasan M, Ahmad AS, Ashraf K, Khan JA, Rashid MI

Trop Biomed, 2023 Mar 01;40(1):7-13.
PMID: 37355998 DOI: 10.47665/tb.40.1.005

Anaplasma marginale is the most prevalent tick-borne haemoparasite of cattle and causes huge economic losses to the dairy industry worldwide. This study aimed to determine the occurrence of A. marginale infection in blood and tick samples collected from livestock animals in the districts located in Khyber Pakhtunkhwa (KPK), Pakistan. A total of 184 blood and 370 tick samples were included in this study. It has never been reported that sheep, goats, and cattle in Tank, Ghulam Khan, Birmil and Miran Shah areas were infected with A. marginale. All samples of blood and ticks were collected through random sampling from March 2021 to January 2022 from cattle, sheep and goats and screened through PCR for anaplasmosis by using primer pairs of Anaplasma spp. Three hundred and seventy ticks were collected from infested hosts (120/184, 64.21%). Among the four morphologically identified tick species, the highest occurrence was recorded for Rhipicephalus sanguineus (n=138, 37.29%), followed by Rhipicephalus microplus (n=131, 35.4%), Rhipicephalus annulatus (n=40, 10.81%), Hyalomma anatolicum (n=31, 8.37%), and Hyalomma marginatum (n=30, 8.1%). The occurrence of female tick was highest (n=160, 43.24%), followed by nymphs (n=140, 37.38%) and males ticks (n=70, 18.9%). Among these ticks, A. marginale was detected in female ticks of R. microplus, and R. sanguineus. Molecular identification of A. marginale was confirmed in 120 out of 184 blood samples and 6 out of 74 tick samples. Overall, occurrence of A. marginale in blood and tick samples was found to be 65.21% and 8.1% respectively. Species-wise occurrence in blood samples of goats were 71.11% followed by sheep 68.31% and cattle 50%. Specie-wise occurrence of A. marginale in tick samples of cattle were 12.5% followed by goats 6.89%. The obtained sequence showed similarity with A. marginale reported from Kenya and USA. We report the first PCR based detection of A. marginale infection in blood samples and in R. sanguineus ticks of goats simultaneously.
Utilization of bottom ash waste as a granular column to enhance the lateral load capacity of soft kaolin clay soil

Zaini MSI, Hasan M, Jusoh WNBW

Environ Sci Pollut Res Int, 2023 Feb 24.
PMID: 36826761 DOI: 10.1007/s11356-023-25966-x

Implementation of industrial wastes such as bottom ash in ground improvement can be cost-effective and environment-friendly. Ground improvement is an effective method of mitigation to improve problematic soils including soft kaolin clay soils as the problematic soils always expose to the severe settlements, low shear strength, immoderate plasticity, greater compressibility, dispersivity, bulging, erodibility, and susceptibility to climatic variables. Several studies conducted on the granular column using the bottom ash column. However, only a few studies have reported findings coherent with the statistical analysis. In this study, the lateral load capacity of bottom ash column-kaolin clay has been conducted. Coherently, the reinforced kaolin clay samples were tested via particle size distribution, Atterberg limit test, relative density, compaction test, permeability test, unconfined compression test, and unconsolidated undrained triaxial test with the single and group of encapsulated bottom ash columns with the geotextile encasement and a prediction model was developed. The effect of a number of columns, column diameter, column height, area replacement ratio, height penetration ratio, height-diameter column ratio, volume replacement ratio, and confining pressures on the shear strength of the single and group of encapsulated bottom ash columns have been investigated. The findings showed the effectiveness of using the bottom ash columns at various number of column, column diameter, column height, area replacement ratio, height penetration ratio, height-diameter column ratio, volume replacement ratio, and confining pressures can enhance the shear strength of the soil up to 77.00% at the optimal utilization of single encapsulated bottom ash column of 10-mm diameter and 80-mm height. Therefore, the study proved that the utilization of bottom ash waste as a granular column can significantly enhance the lateral load capacity of soft kaolin clay soil.
Fulltext Determinants of functional status among survivors of severe sepsis and septic shock: One-year follow-up

Al Khalaf MS, Al Ehnidi FH, Al-Dorzi HM, Tamim HM, Abd-Aziz N, Tangiisuran B, et al.

Ann Thorac Med, 2015 Apr-Jun;10(2):132-6.
PMID: 25829965 DOI: 10.4103/1817-1737.150731

RATIONALE: Sepsis is a leading cause of intensive care unit (ICU) admissions worldwide and a major cause of morbidity and mortality. Limited data exist regarding the outcomes and functional status among survivors of severe sepsis and septic shock.
OBJECTIVES: This study aimed to determine the functional status among survivors of severe sepsis and septic shock a year after hospital discharge.
METHODS: Adult patients admitted between April 2007 and March 2010 to the medical-surgical ICU of a tertiary hospital in Saudi Arabia, were included in this study. The ICU database was investigated for patients with a diagnosis of severe sepsis or septic shock. Survival status was determined based on hospital discharge. Patients who required re-admission, stayed in ICU for less than 24 hours, had incomplete data were all excluded. Survivors were interviewed through phone calls to determine their functional status one-year post-hospital discharge using Karnofsky performance status scale.
RESULTS: A total of 209 patients met the eligibility criteria. We found that 38 (18.1%) patients had severe disability before admission, whereas 109 (52.2%) patients were with severe disability or died one-year post-hospital discharge. Only one-third of the survivors had good functional status one-year post-discharge (no/mild disability). After adjustment of baseline variables, age [adjusted odds ratio (aOR) = 1.03, 95% confidence interval (CI) = 1.01-1.04] and pre-sepsis functional status of severe disability (aOR = 50.9, 95% CI = 6.82-379.3) were found to be independent predictors of functional status of severe disability one-year post-hospital discharge among survivors.
CONCLUSIONS: We found that only one-third of the survivors of severe sepsis and septic shock had good functional status one-year post-discharge (no/mild disability). Age and pre-sepsis severe disability were the factors that highly predicted the level of functional status one-year post-hospital discharge.
KEYWORDS: Disability; functional status; septic shock; severe sepsis
Physicochemical fabrication of chitosan and algae with crosslinking glyoxal for cationic dye removal: Insight into optimization, kinetics, isotherms, and adsorption mechanism

Agha HM, Abdulhameed AS, Jawad AH, Sidik NJ, Aazmi S, ALOthman ZA, et al.

Int J Biol Macromol, 2023 Dec 31;253(Pt 5):127112.
PMID: 37774818 DOI: 10.1016/j.ijbiomac.2023.127112

Herein, a highly efficient and sustainable adsorbent of cross-linked chitosan-glyoxal/algae biocomposite (CHT-GLX/ALG) adsorbent was developed through an innovative hydrothermal cross-linking method. The CHT-GLX/ALG biocomposite was characterized using several complementary analytical methods that include CHN-O, XRD, FTIR, SEM-EDX, and pHpzc. This new adsorbent, named CHT-GLX/ALG, was utilized for the adsorption of a cationic dye (methyl violet 2B; MV 2B), from synthetic wastewater. The optimization of the dye adsorption process involved key parameters is listed: CHT-GLX/ALG dosage (from 0.02 to 0.1 g/100 mL), pH (from 4 to 10), and contact time (from 20 to 180 min) that was conducted using the Box-Behnken design (BBD). The optimal adsorption conditions for the highest decolorization efficiency of MV 2B (97.02 %) were estimated using the statistical model of the Box-Behnken design. These conditions include a fixed adsorbent dosage of 0.099 g/100 mL, pH 9.9, and a 179.9 min contact time. The empirical data of MV 2B adsorption by CHT-GLX/ALG exhibited favorable agreement with the Freundlich isotherm model. The kinetic adsorption profile of MV 2B by CHT-GLX/ALG revealed a good fit with the pseudo-second-order model. The maximum adsorption capacity (qmax) for MV 2B by CHT-GLX/ALG was estimated at 110.8 mg/g. The adsorption of MV 2B onto the adsorbent can be attributed to several factors, including electrostatic interactions between the negatively charged surface of CHT-GLX/ALG and the MV 2B cation, as well as n-π and H-bonding. These interactions play a crucial role in facilitating the effective adsorption of MV 2B onto the biocomposite adsorbent. Generally, this study highlights the potential of CHT-GLX/ALG as an efficient and sustainable adsorbent for the effective removal of organic dyes.
Enhancing cationic dye removal via biocomposite formation between chitosan and food grade algae: Optimization of algae loading and adsorption parameters

Agha HM, Abdulhameed AS, Jawad AH, Aazmi S, Sidik NJ, De Luna Y, et al.

Int J Biol Macromol, 2024 Feb;258(Pt 1):128792.
PMID: 38110162 DOI: 10.1016/j.ijbiomac.2023.128792

Herein, a natural material including chitosan (CTS) and algae (food-grade algae, FGA) was exploited to attain a bio-adsorbent (CTS/FGA) for enhanced methyl violet 2B dye removal. A study of the FGA loading into CTS matrix showed that the best mixing ratio between CTS and FGA to be used for the MV 2B removal was 50 %:50 % (CTS/FGA; 50:50 w/w). The present study employed the Box-Behnken design (RSM-BBD) to investigate the impact of three processing factors, namely CTS/FGA-(50:50) dose (0.02-0.1 g/100 mL), pH of solution (4-10), and contact time (5-15 min) on the decolorization rate of MV 2B dye. The results obtained from the equilibrium and kinetic experiments indicate that the adsorption of MV 2B dye on CTS/FGA-(50:50) follows the Langmuir and pseudo-second-order models, respectively. The CTS/FGA exhibits an adsorption capacity of 179.8 mg/g. The characterization of CTS/FGA-(50:50) involves the proposed mechanism of MV 2B adsorption, which primarily encompasses various interactions such as electrostatic forces, n-π stacking, and H-bonding. The present study demonstrates that CTS/FGA-(50:50) synthesized material exhibits a distinctive structure and excellent adsorption properties, thereby providing a viable option for the elimination of toxic cationic dyes from polluted water.
Assessment of Intraoperative Blood Loss at Different Surgical Stages During Posterior Spinal Fusion Surgery in the Treatment of Adolescent Idiopathic Scoliosis

Chiu CK, Chan CY, Aziz I, Hasan MS, Kwan MK

Spine (Phila Pa 1976), 2016 May;41(9):E566-73.
PMID: 26630421 DOI: 10.1097/BRS.0000000000001304

STUDY DESIGN: Prospective clinical study.
OBJECTIVE: To analyze the amount of blood loss at different stages of Posterior Instrumented Spinal Fusion (PSF) surgery in adolescent idiopathic scoliosis (AIS) patients.
SUMMARY OF BACKGROUND DATA: Knowing the pattern of blood loss at different surgical stages may enable the surgical team to formulate a management strategy to reduce intraoperative blood loss.
METHODS: One hundred AIS patients who underwent PSF from January 2013 to December 2014 were recruited. The operation was divided into six stages; stage 1-exposure, stage 2-screw insertion, stage 3-release, stage 4-correction, stage 5-corticotomies and bone grafting, and stage 6-closure. The duration and blood loss at each stage was documented. The following values were calculated: total blood loss, blood loss per estimated blood volume, blood loss per minute, blood loss per vertebral level fused, and blood loss per minute per vertebral level fused.
RESULTS: There were 89 females and 11 males. The mean age was 17.0 ± 5.8 years old. Majority (50.0%) were Lenke 1 curve type. The mean preoperative major Cobb angle was 64.9 ± 15.0°. The mean number of levels fused was 9.5 ± 2.3 levels. The mean operating time was 188.5 ± 53.4 minutes with a mean total blood loss 951.0 ± 454.0 mLs. The highest mean blood loss occurred at stage 2 (301.0 ± 196.7 mL), followed by stage 4 (226.8 ± 171.2 mL) and stage 5 (161.5 ± 146.6 mL). The highest mean blood loss per minute was at stage 5 (17.1 ± 18.3 mL/min), followed by stage 3 (12.0 ± 10.8 mL/min). The highest mean blood loss per vertebral levels fused was at stage 2 (31.0 ± 17.7 mL/level), followed by stage 4 (23.9 ± 18.1 mL/level) and stage 5 (16.6 ± 13.3 mL/level).
CONCLUSION: All stages were significant contributors to the total blood loss except exposure (stage 1) and closure (stage 6). Blood loss per minute and blood loss per minute per level was highest during corticotomies (stage 5), followed by release (stage 3). However, the largest amount of total blood loss occurred during screw insertion (stage 2).
LEVEL OF EVIDENCE: 2.
Panoramic radiography in evaluating the relationship of mandibular canal and impacted third molars in comparison with cone-beam computed tomography

Ishak MH, Zhun OC, Shaari R, Rahman SA, Hasan MN, Alam MK

Mymensingh Med J, 2014 Oct;23(4):781-6.
PMID: 25481601

This study evaluated the validity of panoramic radiography and cone beam computed tomography (CBCT) in the assessment of mandibular canal and impacted third molar. In this descriptive-analytical study, 58 mandibular third molars from 42 patients who showed a close relationship between impacted third molar and canal on panoramic radiographs were selected. They were then classified into seven radiographic markers in panoramic radiographs (superimposition, darkening of the root, interruption of the white lines, root narrowing, canal diversion, canal narrowing, and also closed distance in OPG <1mm). The groups of markers were further assessed with CBCT to see presence or absence of contact. The three most common markers seen in panoramic images are superimposition, interruption of white line and root darkening. In CBCT, superimposition marker always presented higher frequency of contact with canal compared to non-contact group. There are 31% of teeth presented with interruption of white lines and there are 29.3% of teeth presented with superimposition. About 55.6% and 35.3% of the impacted mandibular third molars which indicated interruption of white lines and superimposition also indicated contact in the CBCT respectively. Presence or absence of radiological sign in panoramic radiography was not properly predict a close relationship with third molar and it is suggested that in case of tooth-canal overlapping, the patient should be referred for CBCT assessment.
Fulltext Apoptosis Induction by Polygonum minus is related to antioxidant capacity, alterations in expression of apoptotic-related genes, and S-phase cell cycle arrest in HepG2 cell line

Mohd Ghazali MA, Al-Naqeb G, Krishnan Selvarajan K, Hazizul Hasan M, Adam A

Biomed Res Int, 2014;2014:539607.
PMID: 24955361 DOI: 10.1155/2014/539607

Polygonum minus (Polygonaceae) is a medicinal herb distributed throughout eastern Asia. The present study investigated antiproliferative effect of P. minus and its possible mechanisms. Four extracts (petroleum ether, methanol, ethyl acetate, and water) were prepared by cold maceration. Extracts were subjected to phytochemical screening, antioxidant, and antiproliferative assays; the most bioactive was fractionated using vacuum liquid chromatography into seven fractions (F1-F7). Antioxidant activity was measured via total phenolic content (TPC), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and ferric reducing antioxidant power (FRAP) assays. Antiproliferative activity was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Most active fraction was tested for apoptosis induction and cell cycle arrest in HepG2 cells using flow cytometry and confocal microscopy. Apoptotic-related gene expression was studied by RT-PCR. Ethyl acetate extract was bioactive in initial assays. Its fraction, F7, exhibited highest antioxidant capacity (TPC; 113.16 ± 6.2 mg GAE/g extract, DPPH; EC50: 30.5 ± 3.2 μg/mL, FRAP; 1169 ± 20.3 μmol Fe (II)/mg extract) and selective antiproliferative effect (IC50: 25.75 ± 1.5 μg/mL). F7 induced apoptosis in concentration- and time-dependent manner and caused cell cycle arrest at S-phase. Upregulation of proapoptotic genes (Bax, p53, and caspase-3) and downregulation of antiapoptotic gene, Bcl-2, were observed. In conclusion, F7 was antiproliferative to HepG2 cells by inducing apoptosis, cell cycle arrest, and via antioxidative effects.
Nanoparticle sensor for label free detection of swine DNA in mixed biological samples

Ali ME, Hashim U, Mustafa S, Man YB, Yusop MH, Bari MF, et al.

Nanotechnology, 2011 May 13;22(19):195503.
PMID: 21430321 DOI: 10.1088/0957-4484/22/19/195503

We used 40 ± 5 nm gold nanoparticles (GNPs) as colorimetric sensor to visually detect swine-specific conserved sequence and nucleotide mismatch in PCR-amplified and non-amplified mitochondrial DNA mixtures to authenticate species. Colloidal GNPs changed color from pinkish-red to gray-purple in 2 mM PBS. Visually observed results were clearly reflected by the dramatic reduction of surface plasmon resonance peak at 530 nm and the appearance of new features in the 620-800 nm regions in their absorption spectra. The particles were stabilized against salt-induced aggregation upon the adsorption of single-stranded DNA. The PCR products, without any additional processing, were hybridized with a 17-base probe prior to exposure to GNPs. At a critical annealing temperature (55 °C) that differentiated matched and mismatched base pairing, the probe was hybridized to pig PCR product and dehybridized from the deer product. The dehybridized probe stuck to GNPs to prevent them from salt-induced aggregation and retained their characteristic red color. Hybridization of a 27-nucleotide probe to swine mitochondrial DNA identified them in pork-venison, pork-shad and venison-shad binary admixtures, eliminating the need of PCR amplification. Thus the assay was applied to authenticate species both in PCR-amplified and non-amplified heterogeneous biological samples. The results were determined visually and validated by absorption spectroscopy. The entire assay (hybridization plus visual detection) was performed in less than 10 min. The LOD (for genomic DNA) of the assay was 6 µg ml(-1) swine DNA in mixed meat samples. We believe the assay can be applied for species assignment in food analysis, mismatch detection in genetic screening and homology studies between closely related species.
Open gastrostomy under ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a case series

Hasan MS, Ling KU, Vijayan R, Mamat M, Chin KF

Eur J Anaesthesiol, 2011 Dec;28(12):888-9.
PMID: 21857518 DOI: 10.1097/EJA.0b013e32834ad9bd
Fulltext Antioxidant, antibacterial activity, and phytochemical characterization of Melaleuca cajuputi extract

Al-Abd NM, Mohamed Nor Z, Mansor M, Azhar F, Hasan MS, Kassim M

BMC Complement Altern Med, 2015;15:385.
PMID: 26497742 DOI: 10.1186/s12906-015-0914-y

The threat posed by drug-resistant pathogens has resulted in the increasing momentum in research and development for effective alternative medications. The antioxidant and antibacterial properties of phytochemical extracts makes them attractive alternative complementary medicines. Therefore, this study evaluated the phytochemical constituents of Melaleuca cajuputi flower and leaf (GF and GL, respectively) extracts and their antioxidant and antibacterial activities.
Fulltext Posterior parasagittal in-plane ultrasound-guided infraclavicular brachial plexus block-a case series

Beh ZY, Hasan MS, Lai HY, Kassim NM, Md Zin SR, Chin KF

BMC Anesthesiol, 2015;15:105.
PMID: 26194896 DOI: 10.1186/s12871-015-0090-0

The brachial plexus at the infraclavicular level runs deeper compared to its course proximally, giving rise to impaired needle visualisation due to the steep angle of needle insertion with the current ultrasound-guided approach. A new posterior parasagittal in-plane ultrasound-guided infraclavicular approach was introduced to improve needle visibility. However no further follow up study was done.
The anatomical locations of postoperative pain and their recovery trajectories following Posterior Spinal Fusion (PSF) surgery in Adolescent Idiopathic Scoliosis (AIS) patients

Chiu CK, Chong KI, Chan TS, Mohamad SM, Hasan MS, Chan CYW, et al.

Med J Malaysia, 2020 01;75(1):12-17.
PMID: 32008013

INTRODUCTION: This study looked into the different anatomical locations of pain and their trajectories within the first two weeks after Posterior Spinal Fusion (PSF) surgery for Adolescent Idiopathic Scoliosis (AIS).
METHODS: We prospectively recruited patients with Adolescent Idiopathic Scoliosis (AIS) scheduled for PSF surgery. The anatomical locations of pain were divided into four: (1) surgical wound pain; (2) shoulder pain; (3) neck pain; and (4) low back pain. The anatomical locations of pain were charted using the visual analogue pain score at intervals of 12, 24, 36, 48 hours; and from day-3 to -14. Patient-controlled analgesia (morphine), use of celecoxib capsules, acetaminophen tablets and oxycodone hydrochloride capsule consumption were recorded.
RESULTS: A total of 40 patients were recruited. Patients complained of surgical wound pain score of 6.2±2.1 after surgery. This subsequently reduced to 4.2±2.0 by day-4, and to 2.4±1.3 by day-7. Shoulder pain scores of symptomatic patients peaked to 4.2±2.7 at 24 hours and 36 hours which then reduced to 1.8±1.1 by day-8. Neck pain scores of symptomatic patients reduced from 4.2±1.9 at 12 hours to 1.8±1.1 by day-4. Low back pain scores of symptomatic patients reduced from 5.3±2.3 at 12 hours to 1.8±1.1 by day- 12.
CONCLUSIONS: Despite the presence of different anatomical locations of pain after surgery, surgical wound was the most significant pain and other anatomical locations of pain were generally mild. Surgical wound pain reduced to a tolerable level by day-4 when patients can then be comfortably discharged. This finding provides useful information for clinicians, patients and their caregivers.
Posterior spinal instrumented fusion for idiopathic scoliosis in patients with multisystemic neurodegenerative disorder: a report of two cases

Loh KW, Chan CY, Chiu CK, Bin Hasan MS, Kwan MK

J Orthop Surg (Hong Kong), 2016 08;24(2):273-7.
PMID: 27574278

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS) syndrome is a progressive multisystemic neurodegenerative disorder. MELAS syndrome impairs oxidative phosphorylation and predisposes patients to lactic acidosis, particularly under metabolic stress. We report 2 siblings with MELAS-associated idiopathic scoliosis who underwent posterior spinal instrumented fusion with measures taken to minimise anaesthetic and surgical stress, blood loss, and operating time.
Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Hasan MS, Choe NC, Chan CYW, Chiu CK, Kwan MK

J Orthop Surg (Hong Kong), 2017 May-Aug;25(2):2309499017718951.
PMID: 28675975 DOI: 10.1177/2309499017718951

BACKGROUND: Massive blood loss during posterior spinal fusion for adolescent idiopathic scoliosis remains a significant risk for patients. There is no consensus on the benefit of acute normovolemic hemodilution (ANH) or intraoperative cell salvage (ICS) in scoliosis surgery.

METHODS: Patients were randomized to one of two groups. Group A received ANH and ICS during operation, while group B received only ICS. Patients' age, sex, height, weight, body blood volume, number of fusion level, Cobb angle, number of screws, duration of surgery, and skin incision length were recorded. Hemoglobin and hematocrit levels were obtained preoperatively and postoperatively (0 h and 24 h).

RESULTS: There were 22 patients in each group. There was no significant difference in total blood loss. The perioperative decrease in hemoglobin levels between preoperation and postoperation 24 h (group A 2.79 ± 1.15 and group B 2.76 ± 1.00) showed no significant difference ( p = 0.93). Group A observed a larger decrease in hemoglobin levels at postoperative 0 h relative to preoperative level (2.57 ± 0.82 g/dl), followed by a smaller decrease within the next 24 h (0.22 ± 1.33 g/dl). Group B showed a continued drop in hemoglobin levels of similar magnitude at postoperation 0 h (1.60 ± 0.67 g/dl) and within the next 24 h (1.16 ± 0.78 g/dl). One patient from group B received 1 unit of allogenic blood transfusion ( p = 0.33).

CONCLUSIONS: The addition of ANH to ICS in posterior spinal fusion surgery for AIS resulted in a similar decrease in hemoglobin levels between preoperative values and at 24 h postoperatively.
Comparison between effect of desflurane/remifentanil and propofol/remifentanil anesthesia on somatosensory evoked potential monitoring during scoliosis surgery-A randomized controlled trial

Hasan MS, Tan JK, Chan CYW, Kwan MK, Karim FSA, Goh KJ

J Orthop Surg (Hong Kong), 2018 7 31;26(3):2309499018789529.
PMID: 30058437 DOI: 10.1177/2309499018789529

BACKGROUND: Drugs used in anesthesia can affect somatosensory evoked potential (SSEP) monitoring, which is used routinely for intraoperative monitoring of spinal cord integrity during spinal surgery.
OBJECTIVE: The objective of this study was to determine whether combined total intravenous anesthesia (TIVA) technique with propofol/remifentanil is associated with less SSEP suppression when compared to combined volatile agent desflurane/remifentanil anesthesia during corrective scoliosis surgery at a comparable depth of anesthesia.
DESIGN: It is a randomized controlled trial.
SETTING: The study was conducted at the Single tertiary University Hospital during October 2014 to June 2015.
PATIENTS: Patients who required SSEP and had no neurological deficits, and were of American Society of Anesthesiologist I and II physical status, were included. Patients who had sensory or motor deficits preoperatively and significant cardiovascular and respiratory disease were excluded. A total of 72 patients were screened, and 67 patients were randomized and allocated to two groups: 34 in desflurane/remifentanil group and 33 in TIVA group. Four patients from desflurane/remifentanil group and three from TIVA group were withdrawn due to decrease in SSEP amplitude to <0.3 µV after induction of anesthesia. Thirty patients from each group were analyzed.
INTERVENTIONS: Sixty-seven patients were randomized to receive TIVA or desflurane/remifentanil anesthesia.
MAIN OUTCOME MEASURES: The measurements taken were the amplitude and latency of SSEP monitoring at five different time points during surgery: before and after the induction of anesthesia, at skin incision, at pedicle screw insertion, and at rod insertion.
RESULTS: Both anesthesia techniques, TIVA and desflurane/remifentanil, resulted in decreased amplitude and increased latencies of both cervical and cortical peaks. The desflurane/remifentanil group had a significantly greater reduction in the amplitude ( p = 0.004) and an increase in latency ( p = 0.002) of P40 compared with the TIVA group. However, there were no differences in both amplitude ( p = 0.214) and latency ( p = 0.16) in cervical SSEP between the two groups.
CONCLUSIONS: Compared with TIVA technique, desflurane/remifentanil anesthesia caused more suppression in cortical SSEP, but not in cervical SSEP, at a comparable depth of anesthesia.

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