Displaying publications 41 - 60 of 95 in total

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  1. Fulltext Pediatric osteomyelitis due to rare tropical multi-drug resistance (MDR) organisms: a treatment quandary
    Er CJ, Chun WK, Chiang LM, Nasir MNBM
    Rev Inst Med Trop Sao Paulo, 2021;63:e7.
    PMID: 33533810 DOI: 10.1590/S1678-9946202163007
    Osteomyelits due to concurrent multi-drug resistance organisms is difficult to treat for any surgeon and infectious disease physician. An eleven-year-old boy presenting with an open fracture of the left radius and ulna after a fall in a stagnant wet field. Despite prophylactic antibiotics and surgical intervention, the open wound was infected, and Chromobacterium violaceum as well as Klebsiella pneumoniae were isolated. He was treated with six weeks of parenteral cefepime and amikacin and was discharged upon clinical improvement. Unfortunately, chronic osteomyelitis set in with persistent sinus drainage. He then underwent a second procedure for debridement of the wound and Burkholderia pseudomallei was isolated. Parenteral antibiotic therapy was initiated progressing with a marked improvement. However, the long course of antibiotics had exhausted the patient and his family, leading to a premature interruption of the parenteral antibiotic. Despite the suboptimal antibiotic course, there were no signs of relapsed osteomyelitis during subsequent review. The timely surgical intervention with appropriate sampling for subsequent microorganism isolation guided the suitability of the treatment line.
    Matched MeSH terms: Debridement
  2. Diabetic Hand Infection: An Emerging Challenge
    Bahar Moni AS, Hoque M, Mollah RA, Ivy RS, Mujib I
    J Hand Surg Asian Pac Vol, 2019 Sep;24(3):317-322.
    PMID: 31438802 DOI: 10.1142/S2424835519500401
    Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.
    Matched MeSH terms: Debridement
  3. Fulltext An unusual case of chronic suppurative osteomyelitis of the mandible
    Kamran Ali, Ashfaq Akram, Muhammad Usman Akhtar
    Archives of Orofacial Sciences, 2012;7(1):1-5.
    MyJurnal
    Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.
    Matched MeSH terms: Debridement
  4. Fulltext The dilemma of diagnosing wound botulism in an infant: A rare case of paralysis with topical application of honey
    Mohd Tamrin MI
    Int J Infect Dis, 2020 Jun;95:157-159.
    PMID: 32220630 DOI: 10.1016/j.ijid.2020.03.044
    Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.
    Matched MeSH terms: Debridement
  5. Fulltext Scanning electron microscopic evaluation of the successful sterilization of Lucilia cuprina (Wiedemann) utilized in maggot debridement therapy (mdt)
    Yeong YS, Nazni WA, Santana RL, Mohd Noor I, Lee HL, Mohd Sofian A
    Trop Biomed, 2011 Aug;28(2):325-32.
    PMID: 22041752
    In Malaysia, maggot debridement therapy (MDT) utilizes maggots of Lucilia cuprina (Wiedemann) to debride necrotic tissue from wound surface, reduce bacterial infection and therefore, enhance wound healing process. To evaluate the sterility of the sterile maggots produced after sterilization process before delivering onto patient wounds. Sterility of sterile maggots is crucial in ensuring the safe usage of MDT and patient's health. Eggs of L. cuprina collected from a laboratory colony were divided into treated group (sterilized) and control group (non-sterilized). Treated group underwent sterilization while eggs from control group were allowed to hatch without sterilization. Sodium hypochlorite and formaldehyde were the main disinfectants used in this sterilization process. Scanning electron microscope (SEM) was used to examine and ascertain the sterility of sterile maggots. SEM results showed that all sterilized L. cuprina eggs and maggots achieved sterility and all were cleared from bacterial contamination. In contrast, all non-sterilized eggs and maggots were found to be colonized by microorganisms. Sterilization method employed to sterilize eggs and maggots used in Malaysia MDT was proven successful and MDT is safe to be used as wound management tools.
    Matched MeSH terms: Debridement/methods
  6. Fulltext Chronic Osteomyelitis Revisited: A Case Report
    Chuah SK, Bajuri MY, Mohd Nor F
    Cureus, 2019 Jun 28;11(6):e5023.
    PMID: 31501722 DOI: 10.7759/cureus.5023
    Chronic osteomyelitis treatment is always a challenge to orthopaedic surgeons which requires great dedication and perseverance. We report a successful limb salvage case of a 46-year-old man who suffered from a left tibia chronic osteomyelitis with soft tissue defect. The treatment approach was a thorough wound debridement of devitalized tissues and necrotized bone, commencement of culture-directed antibiotics, reconstruction with vascularized osteomyocutaneous fibula flap, and skeletal stabilization with internal fixation. As compared to below knee amputation, the result we obtained in this case is more promising with regard to mobility and function.
    Matched MeSH terms: Debridement
  7. Fulltext Evaluation of root debridement skill in periodontology module
    Erni Noor, Al-Bayaty, Fouad Hussain, Muhammad Qadri Bin Mohd Shukri, Mohamad Syahir Bin Zulkiflee
    Compendium of Oral Science, 2019;6(1):15-25.
    MyJurnal
    Objective: To evaluate the root debridement skill in periodontology pre-clinical module among dental students and to estimate the effectiveness of conducting periodontology pre-clinical module before entering clinical module. Materials and Method: : A total of 47 pre-clinical dental students (Year 2) were included in this study. Single rooted extracted teeth were collected, mounted on acrylic resin and set into the level of 1/3 of the root length. Each of them were instructed to prepare a mounted teeth and to perform root debridement procedure on the labial surface of the tooth only within 10 minutes using Gracey curette #5/6. The similar samples were distributed back to the same students (which were already in clinical year (year 4) to repeat the same procedure on the lingual surface of the same tooth. Root surface roughness was evaluated by using scanning electron microscope (SEM) and profilometer for both labial and lingual surfaces. Statistical analysis was done using Mann-Whitney U test and T-test. Significance level of p ≤ 0.05 was assumed for all analysis. Results: SEM photomicrographs of root surfaces with magnifications of 100x and 800x revealed that there were incomplete removal of the dental calculus in both surfaces and significant roughness root surfaces noted. Conclusion: : No significant differences noted between the students’ root debridement skill in the pre-clinical and also clinical year. Objectives of the current module were fulfilled but in order to meet the highest standard, current module need to be improved in the future.
    Matched MeSH terms: Debridement
  8. Fulltext Necrotizing fasciitis of the lower limb: an outcome study of surgical treatment
    Kwan MK, Saw A, Chee EK, Lee CS, Lim CH, Zulkifle NA, et al.
    Med J Malaysia, 2006 Feb;61 Suppl A:17-20.
    PMID: 17042223
    Necrotizing fasciitis is a limb- and life-threatening rapidly spreading infection affecting the deep fascia with secondary necrosis of the subcutaneous tissue. It requires immediate medical attention and emergency surgery to prevent morbidity and death. This study was undertaken to determine its co-morbidity and risk factors affecting the outcome of its surgical treatment. This is a retrospective review of 36 cases of necrotizing fasciitis of the lower limb treated in our center between 1998 and 2002. Only 19% of the cases were correctly diagnosed upon admission and 48.6% were initially diagnosed as 'cellulitis'. Diabetes mellitus was the most common co-morbid. Pseudomonas, Staphylococcus, Streptococcus and Enterobactericae were the common pathogens isolated. Ten patients (27.8%) had major amputation as part of radical debridement. The overall mortality rate was 36% with laboratory parameters: high serum urea and creatinine, and low haemoglobin levels were predictors for higher mortality. Poor white cell response which is common in diabetic patients and a delay in surgical debridement were. notable attributes to a higher mortality. Necrotizing fasciitis is a serious infection associated with significant morbidity and mortality. A poor white blood cell response, high serum urea and creatinine, and low haemoglobin level were the predictors for mortality. Early diagnosis and prompt treatment are of paramount importance in the treatment of this infection.
    Matched MeSH terms: Debridement
  9. Surgical Reconstruction of an Open Medial Malleolus Fracture Using a Novel Technique: A Case Report
    Kow RY, Yuen JC, Ahmad Alwi AA, Abas MF, Low CL
    JBJS Case Connect, 2019 6 25;9(2):e0163.
    PMID: 31233428 DOI: 10.2106/JBJS.CC.18.00163
    CASE: A 17-year-old male sustained an open fracture of the right medial malleolus (MM) with significant bone and soft tissue loss following a motor-vehicle accident. Following serial wound debridement, his ankle was effectively reconstructed with MM antiglide plate stabilization, iliac autogenous bone graft, and a free radial forearm soft tissue flap.

    CONCLUSIONS: Open MM fracture with bone and soft tissue loss is rare. It is feasible to treat this injury with a novel surgical reconstruction technique involving autogenous bicortical iliac bone graft and radial forearm free flap.

    Matched MeSH terms: Debridement/methods
  10. Fulltext Topical insulin for healing of diabetic epithelial defects?: A retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients
    Bastion ML, Ling KP
    Med J Malaysia, 2013 Jun;68(3):208-16.
    PMID: 23749008 MyJurnal
    PURPOSE: To investigate whether topical insulin improves healing rate of corneal epithelial erosions induced during vitreoretinal surgery in diabetics.
    METHODS: We retrospectively reviewed case notes and serial post-operative photographs of 15 eyes of 14 patients who had corneal epithelial debridement performed during various vitreoretinal surgeries to improve one surgeon's view over a 10 month period in 2010.
    RESULTS: Three groups were identified: DTI, comprising diabetics who received topical insulin 1 unit qds postoperatively (n=5); DCT comprising diabetics treated with conventional post-operative medications only (n=5) and NDCT comprising non diabetic patients on conventional post operative therapy (n=5). Only eyes in which the corneal epithelial defect had been serially photographed at time, t= 0, 12, 24, 36, 48, 60, 72 and 120 hours following commencement of topical medications were included. The size of the defect was calculated using local software. DTI eyes had a significantly smaller defect size at t= 24 (p=0.009), 36 (p=0.009), 48 (p=0.015) and 60 hours (p=0.005) compared to DCT eyes and had no statistical difference from NDCT eyes at all times in the Mann Whitney U analysis (p>0.05). In the diabetic operated bilaterally, the insulin treated eye re-epithelialised by 48 hours whereas fellow eye treated conventionally re-epithelialised in 72 hours.
    CONCLUSIONS: Topical insulin or insulin eye drops 1 unit qds may be applied to the corneal surface to normalize the rate of healing of epithelial defects in diabetic patients undergoing epithelial debridement to improve the surgeon's view.
    Matched MeSH terms: Debridement*
  11. Fulltext Necrotizing fasciitis
    Zubaidah AW, Lim VKE
    Med J Malaysia, 1996 Mar;51(1):134-6.
    PMID: 10967993
    A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.
    Matched MeSH terms: Debridement
  12. Fulltext Flaccid paralysis in an infant associated with a dirty wound and application of honey
    Joseph CJ, Khoo TB, Lee KY
    BMJ Case Rep, 2017 Jan 06;2017.
    PMID: 28062435 DOI: 10.1136/bcr-2016-218044
    An infant, who was born preterm at 36 weeks, presented with fever and ulcer at umbilical region which progressed to necrotising fasciitis of anterior abdominal wall. He was treated with intravenous penicillin, intravenous cloxacillin and local application of medicated honey. Subsequently, he required wound debridement. Postoperatively, he required prolonged invasive ventilation due to poor respiratory effort which was associated with hypotonia and areflexia. Nerve conduction study revealed absent responses. The diagnosis of infant botulism was made based on the clinical presentation, nerve conduction study and his clinical progress. Botulinum immunoglobulin was not available. He was treated with intravenous immunoglobulin and oral pyridostigmine. He was successfully extubated after 37 days, and currently the patient is doing well.
    Matched MeSH terms: Debridement/methods
  13. The effect of periodontal scaling and root polishing on serum IL-17E concentrations and the IL-17A:IL-17E ratio
    Nile CJ, Apatzidou DA, Awang RA, Riggio MP, Kinane DF, Lappin DF
    Clin Oral Investig, 2016 Dec;20(9):2529-2537.
    PMID: 26888221 DOI: 10.1007/s00784-016-1749-8
    OBJECTIVES: The serum IL-17A:IL-17E ratio has previously been demonstrated to be a clinical marker of periodontitis. The aim of this study was to determine the effects of non-surgical periodontal treatment on the serum IL-17A:IL-17E ratio.

    MATERIALS AND METHODS: Forty chronic periodontitis patients completed this study and received periodontal treatment comprising scaling and root planing plus ultrasonic debridement. Clinical data were recorded at baseline, 6 weeks (R1) after treatment completion (full-mouth or quadrant-scaling and root planing) and 25 weeks after baseline (R2). Serum samples were taken at each time point and cytokines concentrations determined by ELISA.

    RESULTS: Following treatment, statistically significant reductions were noted in clinical parameters. However, IL-17A and IL-17E concentrations were significantly greater than baseline values before- and after-adjusting for smoking. The IL-17A:IL-17E ratio was lower at R1 and R2. Serum IL-6 and TNF levels were significantly lower at R1 only. Also exclusively at R1, serum IL-17A and IL-17E correlated positively with clinical parameters, while the IL-17A:IL-17E ratio correlated negatively with probing pocket depth and clinical attachment.

    CONCLUSION: Increased serum IL-17E and a reduced IL-17A:IL-17E ratio may be indicative and/or a consequence of periodontal therapy. Therefore, the role of IL-17E in periodontal disease progression and the healing process is worthy of further investigation.

    CLINICAL RELEVANCE: IL-17E may be a valuable biomarker to monitor the healing process following periodontal treatment as increased IL-17E levels and a reduced IL-17A:IL-17E ratio could reflect clinical improvements post-therapy. Therefore, monitoring serum IL-17E might be useful to identify individuals who require additional periodontal treatment.

    Matched MeSH terms: Debridement
  14. Fulltext Conjunctiva Necrosis Following Subconjunctival Amphotericin B Injection in Fungal Keratitis
    Han Shu T, Hussein A, Kursiah MR
    Cureus, 2019 Sep 05;11(9):e5580.
    PMID: 31695999 DOI: 10.7759/cureus.5580
    A 30-year-old Bangladeshi gentleman presented with history of sand entering his left eye and was diagnosed as having fungal keratitis by private ophthalmologist. He was treated with three doses of conventional subconjunctival amphotericin B injections (1.5 mg of amphotericin B and 1.2 mg of deoxycholate) over the inferior bulbar conjunctiva and topical antibiotics. Subsequently, he developed conjunctival necrosis over the site of injections and there was no clinical improvement of the keratitis. He was then treated with intensive antifungal and antibiotics eye drops. Debridement of epithelial plug was done and he was given intracameral amphotericin B injection. There was gradual improvement observed then with conjunctival epithelialization. The conjunctival tissue was completely healed after three months along with the corneal ulcer. Subconjunctival injection of Amphotericin B (AMB) may be considered as an adjunct therapy in severe fungal keratitis to address the issue of compliance. Close monitoring is needed due to its known complication of scleritis, scleral thinning and conjunctival necrosis. Liposomal AMB which is known to cause less toxicity given via subconjunctival injection in human subjects needs to be further studied.
    Matched MeSH terms: Debridement
  15. Fulltext Close fracture complicated by acute haematogenous osteomyelitis
    Baskaran S, Nahulan T, Kumar AS
    Med J Malaysia, 2004 Dec;59 Suppl F:72-4.
    PMID: 15941170
    This is the first time we encountered a peculiar case of osteomyelitis complicating a closed fracture. The patient was a 38 year-old lady who presented just like any other patient with a closed fracture of the right femur. Intraoperatively we were surprised to find pus from the fracture site. This not only changed the surgical management but altered the subsequent outcome as well.
    Matched MeSH terms: Debridement/methods
  16. Fulltext Chronic osteomyelitis secondary to human bite: a case report
    Tan W, Wazir N, Chiu C, Ko M
    Malays Orthop J, 2012 Nov;6(3):40-1.
    PMID: 25279055 MyJurnal DOI: 10.5704/MOJ.1207.003
    We report a case of a human bite that was initially inadequately treated and progressed to chronic osteomyelitis, finally resulting in digital amputation. Human bites are seemingly innocuous, but if neglected, may lead to subsequent infection and morbidity. Persistence of symptoms should alert the practitioner to the possibility of infection extending to the soft tissue or bone. Bacteriological studies commonly yield mixed aerobic and anaerobic flora. Early debridement and antibiotic treatment may prevent development of severe soft tissue or bone infection.
    Matched MeSH terms: Debridement
  17. Fulltext Management of osteonecrosis of the hip complicated with fracture: a case report
    Chua Y, Wazir N, Chiu C, Kareem B
    Malays Orthop J, 2012 Jun;6(SupplA):43-5.
    PMID: 25279075 MyJurnal DOI: 10.5704/MOJ.1211.011
    A 47-year-old gentleman, with underlying seborrhoeic dermatitis that was treated with steroid therapy, and hepatitis B, presented with pain in his right hip. He was diagnosed with stage 2 osteonecrosis of the right hip (Ficat and Arlet classification). Core decompression and bone grafting was performed but recovery was complicated by a surgical site infection. Wound debridement, removal of bone graft and clearance of the bone tunnel were carried out. The patient was allowed to bear weight after surgery. Twelve days later, he developed right hip pain and radiographs showed fractured femur neck; the patient then underwent a two-stage total hip replacement (THR).
    Matched MeSH terms: Debridement
  18. Fulltext Tuberculous cold abscess of sternoclavicular joint: a case report
    Burud I, Ikram MA, Tata MD, Jaafar J
    Pan Afr Med J, 2020;36:16.
    PMID: 32774593 DOI: 10.11604/pamj.2020.36.16.20697
    Bone and joint tuberculosis is a serious medical problem; tuberculosis of sternoclavicular joint is rare. We present a case of a healthy 37-year old man with sternoclavicular joint tuberculosis. The subject presented with a three weeks history of left sternoclavicular joint painless swelling without fever or weight loss. He had no previous history of pulmonary tuberculosis. Laboratory testing revealed erythrocyte sedimentation rate of 70 mm/hour, C-reactive protein of 30 mg/liter and a normal leucocyte count. Biopsy of the lesion showed caseous necrosis and pus culture revealed Mycobacterium tuberculosis. He was treated with joint debridement and anti-tuberculous medications. Tuberculosis resolved completely but post-infection patients had residual joint arthritis. Tuberculosis may infect unusual joints such as the sternoclavicular joint.
    Matched MeSH terms: Debridement
  19. The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture
    Mohamed Haflah NH, Ng MH, Mohd Yunus MH, Naicker AS, Htwe O, Fahmi M, et al.
    Int J Low Extrem Wounds, 2017 Sep;16(3):212-216.
    PMID: 28862056 DOI: 10.1177/1534734617724974
    Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.
    Matched MeSH terms: Debridement/methods
  20. Fulltext Refractory Scedosporium apiospermum Keratitis Successfully Treated with Combination of Amphotericin B and Voriconazole
    Fadzillah MT, Ishak SR, Ibrahim M
    Case Rep Ophthalmol Med, 2013;2013:413953.
    PMID: 23509650 DOI: 10.1155/2013/413953
    Aim. To report a case of refractory fungal keratitis caused by Scedosporium apiospermum. Methods. Interventional case report. Results. A 47-year-old Malay housewife presented with left eye cornea ulcer as her first presentation of diabetes mellitus. There was no history of ocular trauma, contact lens used, or cornea foreign body. Scedosporium apiospermum was isolated from the cornea scrapping. Her cornea ulcer initially responded well to topical Amphotericin B within 3 days but subsequently worsened. Repeat cornea scrapping also yields Scedosporium apiospermum. This refractory keratitis was successfully treated with a combination of topical Amphotericin B and Voriconazole over 6 weeks. Conclusion. Scedosporium apiospermum keratitis is an opportunistic infection, which is difficult to treat despite tight control of diabetes mellitus and intensive antifungal treatment. The infection appeared to have very quick onset but needed long duration of treatment to completely heal. Surgical debridement always plays an important role as a therapeutic procedure as well as establishes the diagnosis through repeat scrapping.
    Matched MeSH terms: Debridement
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