Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants' input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% ± 7%, 16% ± 4% and 61% ± 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs' Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.
The relationship between anaemia and cognitive function was evaluated among 35 Chinese elderly (24 men and 11 women) aged 60 to 85 years (mean age 70.1 ± 6.7 years) from five old folks homes in Klang Valley. They were interviewed to obtain information on social and health status, habitual dietary intake and cognitive function. Hodkinson's Abbreviated Mental Test was used to measure the cognitive function. Haematological indices which included Full Blood Count (FBC), serum iron, serum ferritin, Total Iron Binding Capacity (TIBC), serum folate and serum cobalamine (vitamin B12) were measured using an automated analyzer. Anthropometric measurements and clinical signs of anaemia were also examined. The findings indicated that the prevalence of anaemia as assessed using haemoglobin alone was 22.9%, while iron deficiency anaemia based on low serum iron, microcytic and hypochromic criterion was detected among 5.7% of the sample. Subclinical folate and vitamin B12 deficiencies were diagnosed among 34.3% and 8.6% of the subjects. However, there was no occurrence of megaloblastic anaemia. There was a positive correlation between cognitive score with mid upper arm circumference (MUAC) (r=0.547, p
Heel Effect is the well known phenomena in x-ray production. It contributes the effect to image
formation and as well as scattered radiation. But there is paucity in the study related to heel effect.
This study is for mapping and profiling the dose on the surface of water phantom by using mobile
C-arm unit Toshiba SXT-1000A. Based on the result the dose profile is increasing up to at least
about 57% from anode to cathode bound of the irradiated area. This result and information can be
used as a guide to manipulate this phenomenon for better image quality and radiation safety for
this specific and dedicated fluoroscopy unit.
Epithelioid sarcoma is a very infrequent soft tissue sarcoma involving predominantly distal extremities of adolescent and young adult. We hereby report a case of epithelioid sarcoma in a 34-year-old young adult who presented with 1-year history of a painful left upper limb associated subsequently with warm left forearm swelling and a Volkman contracture. He was treated as an inflamed soft tissue condition of the left upper limb. A computed tomography study showed presence of multiple hypodense lesions mainly in the flexor compartment of the left arm as well at the subcutaneous tissue, which measured 1 to 1.7 cm in diameter. Histological examination of the left upper limb mass showed nodular proliferation of epithelioid tumour cells and some with rhabdoid features surrounding a central zone of necrosis and was diagnosed as epithelioid sarcoma. Concurrent presence of epithelioid sarcoma and Volkman ischaemic contracture are rarely seen in clinical practice. The present case highlights the importance of the histology which can be confused with other types of sarcoma or chronic granuloma and even missed at times thereby causing diagnostic problems.
Work related musculoskeletal disorders represent a serious public health problem as it is a leading cause for disability and absenteeism in workers. The main purpose of the present quasi-experimental study was to compare the muscle activity of the upper trapezius in subjects with neck pain and compare it to those of normal subjects.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
This multicenter, double-blind, randomized study compared the efficacy, pharmacokinetics (PKs)/pharmacodynamics (PDs), safety and immunogenicity profile of RTXM83 vs. reference rituximab (R-rituximab), both with CHOP, as first-line treatment of diffuse large B-cell lymphoma (DLBCL). A total of 272 patients <65 years of age, with good prognosis (136 per arm) were randomized (1:1) to receive six cycles of either RTXM83 or R-rituximab. The primary efficacy endpoint was achieved (overall response rate of 83.6% for RTXM83 and 82.9% for R-rituximab) with a difference 0.7% between arms (95%CI: [-8.77% to 10.17%]) fulfilling the predefined non-inferiority margin (-13%). Similar number of patients reported at least one adverse event (AE) (131 per arm) or one serious AE (47 with RTXM83 and 45 with R-rituximab). Anti-drug antibody development was comparable between the arms. PK/PD secondary endpoint results support similarity between the compounds. RTXM83 exhibits non-inferior efficacy and similar safety/immunogenicity to R-rituximab, being an accessible alternative for the treatment of patients with previously untreated DLBCL.
Introduction: Acne vulgaris is a chronic inflammatory dermatosis caused by Propionibacterium acnes. Clinicians are constantly attempting to discover the best antibiotic regimes in treating acne vulgaris. This study compares two regimens in terms of efficacy, tolerability, compliance and recurrence rate to make recommendation on which is the best regime. Methods: An open-labelled prospective randomized investigator-blinded interventional study was carried on moderate acne vulgaris patients. Patients were assigned to treatment arm at enrolment followed by fol- low-up and maintenance visits. Demographic data were collected at enrolment and questionnaire enquiring acne condition, general health and quality of life impairment were filled at every visit followed by blinded dermatologist assessment. Antibiotic tablets were provided based on assigned arm until follow-up 3. Results: 26 mild acne vulgaris patients aged 17 to 29 years were recruited. Physician assessment based on GAGS and photo assessment analysis showed an overall significant change (p0.05) were found between regimens. Similarly, patient self-perceived assessment and CADI assessment also showed overall significant changes (p
Introduction:Despite significant advancements in testing technologies and treatment, 80% of 80 million chronically hepatitis C virus (HCV) infected people remain undiagnosed. FIND in collaboration with Ministries of Health and local partners, initiated seven Unitaid funded Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) projects in four countries (Georgia, India, Malaysia and Myanmar) to demonstrate innovative models of HCV care to inform programme scale-up nationally and globally. Here, we describe preliminary findings for patient retention in the HCV cascade for each project. Methods: Target populations and settings include people who inject drugs (PWID) in harm reduction sites (Manipur, Georgia, Myanmar), high risk patients in primary health care facilities (Malaysia), general population in polyclinics and district hospitals (Delhi) and people living with HIV (PLHIV) in antiretroviral therapy (ART) clinics (Punjab). All projects employ rapid diagnostic tests for HCV screening. HCV seropositive patients received confirmatory testing either on site (Georgia, Myanmar) or via centralized laboratory (Malaysia, Georgia, Delhi) or testing hubs (Punjab, Manipur). Results: In Malaysia, 4,613 patients were screened - 23% (1,042) are HCV seropositive, 57% (594) received RNA confirmatory testing and 11% (54) confirmed RNA-positive initiated treatment. In Delhi, 17,101 patients were screened – 2% (355) are seropositive, 92% (326) received confirmatory testing and 70% (180) initiated treatment. In Punjab, 17,507 patients were screened – 19% (3,368) are seroposi-tive, 94% (3,165) received confirmatory testing and 31% (828) initiated treatment. In Manipur, 3,845 patients were screened - 56% (2,180) are seropositive, 73% (1,591) received confirmatory testing and 67% (823) initiated treat-ment. In Myanmar, 199 patients were screened – 96% (191) are seropositive, 100% received confirmatory testing and 86% (151) initiated treatment. In Georgia (Arm 1) - 100% (619) received confirmatory testing and 76% (389) initiated treatment. Conclusion: The fully decentralised HCV testing model demonstrated higher numbers of patients progressing to each step in the care cascade.
This article aimed to review the available anthropometry measurements used in the assessment of nutritional sta- tus among Cerebral Palsy (CP) children. Searched journals were from Medline, PubMed and Ovid published from 2015 to 2018. The search identified 443 articles, and eight studies met the criteria. Anthropometric measurements included weight, height, recumbent length, knee height, tibia length, Dual-energy X-ray absorptiometry (DXA), Bio- electrical impedance (BIA), Mid arm circumference (MUAC) subscapular skinfold (SFT), Triceps skinfold (TSF) and prediction equations. Body fat composition can be obtained by DXA, BIA, skinfold measurement, and also prediction equation. The predictive equation is the most reported method to determine nutritional status among CP. This review found that TSF and SFT are more accurate to determine body fat percentage when using together with the predictive equation. Besides, predictive equations using segmental length are reliable in estimating the height and can be used to evaluate the nutritional status using the specific CP growth chart.
Though cases of AIDS are visible in Nigeria and awareness of HIV is high, correct knowledge on HIV transmission and prevention has remained low with significant numbers of people living with HIV/AIDS having low attitudes towards life and the disease itself. This study determined the baseline knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS of adult HIV positive patient enrolled into care at all four comprehensive antiretroviral therapy (ART) sites in Yola, Nigeria. Baseline reports on the knowledge and attitudes of adult HIV positive patients were obtained from a three arm randomized single blind clinical trial involving 386 randomly selected adult HIV patients who were enrolled into ART care at all four comprehensive ART sites in Yola. An administered, validated structured questionnaire was used for data collection. Outcome measures were sound knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS. Data was analyzed using SPSS version 22. Test of significance was at α level 0.05. Overall 237 (61.4%) had sound knowledge on HIV transmission and prevention, while 346 (89.6%) of respondents had high attitudes towards HIV/AIDS. Though majority of respondents had sound knowledge on HIV transmission and prevention as well as high attitudes towards HIV/AIDS, interventions to improve knowledge and attitudes among this group of individuals would improve positive preventive strategies.
The computer is well known as one of the important tools in the office that gives a lot of benefits but silently leads to musculoskeletal pain. There are many different kinds of musculoskeletal complaints pain but the most common seen among computer users in developed countries is the complaint of arm, neck and shoulder (CANS). Despite this, definite factors that can be associated with the prevalence of CANS have not been established. This study was conducted to identify the prevalence and factors associated with work-related complaints of arm, neck and shoulder (CANS) among office workers in Selangor and Kuala Lumpur. A survey study design was conducted where 110 (n=110) office workers were recruited from around the Selangor and Kuala Lumpur area for 5 months periods. Participants were required to answer the Maastricht Upper Extremity Questionnaire (MUEQ) and the Level of Ergonomic Knowledge Questionnaire. The study showed the highest percentage of CANS reported was at neck region (53.6% of participants), followed by shoulders with 53.0%. The majority of participants have low level of computer ergonomic awareness where only 19.09% (n=21) from government sector and 10% (n=11) office workers from private sector reported knowledge of ergonomics. Majority of the participants did not have the know-how in implementing correct computer ergonomics. However there was a weak association (r=
The objectives of this study are to determine the prevalence of hand-arm vibration (HAVS) among the automobile
assembly workers and the associated risks. A cross sectional study was conducted to determine the prevalence of
HAVS and also ascertain the association between HAVS and reduction in VPT among workers using vibration hand held
tool in automobile industry. Aim of this study was to determine the prevalence Hand Arm Vibration Syndrome
(HAVS) among vibrating hand held tool exposed workers. A cross sectional study design using structured
questionnaire and invasive measurement of vibrotactile perception threshold (VPT) at the fingertips was conducted
in one of the automobile company in Klang Valley. All the respondents were hand arm vibration exposed workers. A
total 109 assembly line workers with at least one year job tenure participated in this study. The finding revealed
that 27.5% of workers reported HAVS through questionnaire. This study consisted of 109 respondents. All of them
were male. The mean age was 32.9 years. The mean daily vibration exposure for 8-hours was 1.41m/s2. There was
11% of the tools measured were above the Action Level recommended by European Union Directive 2002. The overall
prevalence of HAVS based on reported symptom through questionnaire was 27.5%. None of the respondent reported
any whiteness at their fingers due to exposure to vibration. However, 36.7% of the respondent reported tingling
sensation and 57.8 % reported the feeling of numbness in their hands. Only 10.1% claim that the pain was
persistence. Since this study was done among exposed workers without control group, the thresholds were measured
by comparing the observed VPT with the VPT of healthy population provided by ISO 13091-2. The result showed that
98.2% of the respondent in this study having positive threshold which indicate the percentage of respondent that
having deterioration in finger tactile perception. The positive threshold from comparison above showed that the
respondent of this study was affected with the vibration exposure. The value proven that the exposure has caused
the deterioration of tactile sensitivity in 98.2% of respondent in this study which showed by having positive threshold
compared to healthy population. The result also showed that there was a significant correlation between daily
vibration exposure A (8) and VPT at both frequency tested which was 31.5Hz (r = 0.417, p = 0.002) and 125Hz (r =
0.480, p = 0.001). Even though the mean daily vibration exposure for 8-hours was low and below the recommended
level, the workers still exposed to the effect of hand arm vibration.
Elbow injuries are common in children. Supracondylar fractures occurred in 16% of all pediatric fractures. Supracondylar fractures can be classified into 4 types according to the Gartland classification, depending on the degree of the fracture present in the lateral radiograph. This case highlights the case of a child with a Gartland Type I fracture. A misdiagnosis of this fracture will compromise the management of the injury with regards to immobilization and subsequent care. As this injury can be managed on an outpatient basis, primary care frontliners need to be aware of the condition.
Nursemaid’s elbow is a radial head subluxation caused by axial traction on the extended arm while
the forearm is pronated, allowing for slippage of the radial head. A 2-year-old boy presented with
pain, swelling and reduced range of movement of the right elbow for 4 days. The mother noted that
the child was moving the right upper limb less often and there was tenderness over the right elbow.
X-ray of the right elbow showed subluxation of the elbow joint with no obvious fracture. A trial of
conservative management was decided upon and the patient was placed on a right elbow backslab
with the right forearm in a supine position. On follow-up, there was no swelling, tenderness or
neurological deficit noted. A repeate x-ray revealed normal findings.
Introduction: Nutrition screening is recommended as a first step of nutrition care to allow early identification and intervention of malnourished patients. The present study determined the validities and reliabilities of two malnutrition screening tools namely, the Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) among adult patients at the Hospital Kuala Lumpur. Methods: The sensitivity, specificity and predictive value of MUST and MST were conducted against the Subjective Global Assessment (SGA), anthropometric parameters including body mass index (BMI), calf circumference (CC), mid-upper arm circumference (MUAC) and energy intake. Inter-rater reliability was evaluated using kappa value (κ) to determine the level of agreement between raters. Results: A total of 151 subjects with mean age of 45.2 ± 13.7 years participated in this study. Prevalence of malnutrition according to MUST, MST and SGA was 34.4%, 33.8% and 19.9%, respectively. As compared to SGA, MUST and MST had a sensitivity of 96.6% and 93.3% respectively, whereas the specificity was 80.9% for both tools. The sensitivity and specificity of MUST against the anthropometric parameters (BMI, CC and MUAC) were between 53.8% to 88.8% and 67.4% to 69.9%, respectively. The sensitivity values for MST were between 46.1% to 63.6% and specificity values were between 64.4% to 67.6%. The inter-rater reliability of MUST was higher (substantial, mean (κ) = 0.78) than for MST (moderate, mean (κ) = 0.52). Conclusions: In conclusion, MUST was found to have similar validity levels but higher reliability result than MST. Based on our result, MUST is recommended for use in identifying adult patients who are at high risk of malnutrition. It can be used as a malnutrition screening tool but there is a need to evaluate the cost effectiveness of its implementation.
Introduction: Malnutrition is a serious unresolved nutritional problem amongst dialysis patients associated with increased mortality and morbidity and prevalence differs according to dialysis modalities. This study compared proteinenergy malnutrition (PEM) prevalence in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: A total of 155 HD and 90 CAPD patients were enrolled. PEM prevalence was determined using body mass index (BMI), serum albumin, Dialysis Malnutrition Score (DMS) and dietary intake. Results: CAPD patients had significantly higher BMI (24.1 ± 4.8 kg/m2 vs. 22.7 ± 4.8 kg/m2; p=0.024) and mid-arm muscle area (32.1±12.4 cm2 vs. 29.5 ± 15.9 cm2; p=0.044) than HD patients. They also had significantly lower serum albumin (31 ± 5 g/L vs. 35 ± 6 g/L; p
Sprengel’s shoulder and myositis ossificans (MO) are rarely seen concomitantly. This report is about a rare case in a 4 year-old girl who presented with right shoulder deformity and pain associated with right proximal arm swelling.
Objective: To compare the fusion rate between autogenous tricortical iliac crest bone graft and hydroxyapatite block graft in anterior cervical discectomy and fusion (ACDF) surgery. Methodology: Retrospective review of cases that underwent ACDF surgery between 2005 and 2008. They were divided into two groups based on the graft material used. Assessment of fusion at 6 months post-surgery was carried out based on the static lateral cervical radiograph. Results: 32 cases were reviewed; 16 in each arm. There were 29 discectomies performed in the hydroxyapatite group as compared to 22 in the iliac crest group. 18 levels in the hydrxyapatite group showed radiological fusion while in the iliac crest group there were 21 levels fused. Seven patients had donor site pain. Conclusion: The fusion rate for autogenous tricortical iliac crest bone graft in anterior cervical discectomy and fusion surgery was 95%, a more superior fusion rate than that of hydroxyapatite block graft which was 62.1%.
Congenital partial aplasia of the atlas with a posterior arch remnant is rare. It may be found as an incidental radiological finding or patients can present with neurological signs and symptoms after head or neck trauma. A 36-year-old female presented with a 3-day history of right sided neck pain radiating down the right arm. Radiographs of the cervical spine showed a radiolucent area in the region of the posterior arch of the atlas. Computed tomography subsequently revealed partial absence of the posterior arch of the atlas with a defect at the anterior ring. Her clinical condition subsequently improved with rest, analgesia and physiotherapy. This case report illustrates a situation where congenital defect of the posterior arch of the atlas was revealed in a patient with neck pain. Awareness of the existence of this condition will help clinicians avoid misdiagnosis and excessive investigations.
Filariasis continues to be one of the endemic problems worldwide with 40% of the cases in India. We report a case of lymphatic filariasis in a 32-year old female who presented with a non-tender swelling over left upper arm. Blood sample showed no eosinophilia while the FNAC was diagnostic of W. bancrofti. Patient responded well with oral diethylcarbamazine. High index of suspicion of filariasis is indicated when dealing with a swelling of unknown cause especially in filariasis endemic areas.