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Fulltext A Rare Occurrence of Opportunistic Infection by Streptococcus mitis Due to Antibiotic-Induced Neutropenia in Prosthetic Joint Infection

Tan EK, Ahmad Hanif KA, Jebasingam Issace SJ, Che-Hamzah F

Cureus, 2023 Feb;15(2):e35583.
PMID: 37007355 DOI: 10.7759/cureus.35583

Prosthetic joint infection (PJI) is a devastating complication in arthroplasty surgery. Although the prevalence is less than 2%, its functional and financial implications are significant. Part of its treatment involves the usage of prolonged and high-dose systemic antibiotics. Ironically, this predisposes the patient to unwanted adverse effects caused by the drugs. We report a case of cefazolin-induced neutropenia that led to Streptococcus mitis (S. mitis) bacteraemia in a patient with Staphylococcus aureus PJI. There have been no previous reports on cefazolin-induced neutropenic bacteraemia complicating the treatment of PJI. This case report aims to create awareness among the attending physicians on the possibility of cefazolin-induced neutropenia, which led to bacteraemia from an opportunistic microorganism. The reversal was as simple as cessation of the antibiotic itself. However, if not recognized, it could be fatal.
Fulltext Deploying a Novel Approach to Prepare Silver Nanoparticle Bellamya bengalensis Extract Conjugate Coating on Orthopedic Implant Biomaterial Discs to Prevent Potential Biofilm Formation

Qamer S, Che-Hamzah F, Misni N, Joseph NMS, Al-Haj NA, Amin-Nordin S

Antibiotics (Basel), 2023 Sep 03;12(9).
PMID: 37760700 DOI: 10.3390/antibiotics12091403

This study is based on the premise of investigating antibacterial activity through a novel conjugate of silver nanoparticles (AgNPs) and antimicrobial peptides (AMPs) in line with a green synthesis approach by developing antimicrobial-coated implants to prevent bacterial resistance. The AMPs were obtained from Bellamya Bengalensis (BB), a freshwater snail, to prepare the nanocomposite conjugate, e.g., AgNPs@BB extract, by making use of UV-Visible spectroscopy. The antimicrobial assessment of AgNPs@BB extract conjugate was performed using the Resazurin Microtiter Assay Method (REMA), followed by the use of three biocompatible implant materials (titanium alloys, Ti 6AL-4V stainless steel 316L, and polyethylene). Finally, the coating was analyzed under confocal microscopy. The results revealed a significant reduction of biofilm formation on the surfaces of implants coated with conjugate (AgNPs@BB extract) in comparison to uncoated implants. For the MTT assay, no significant changes were recorded for the cells grown on the AgNPs/AMP++ sample in high concentrations. Staphylococcus epidermidis, however, showed more prominent growth on all implants in comparison to Staphylococcus aureus. It is evident from the results that Staphylococcus epidermidis is more susceptible to AgNPs@BB extract, while the minimum inhibitory concentration (MIC) value of AgNPs@BB extract conjugates and biosynthesized AgNPs was also on the higher side. This study indicates that AgNPs@BB extract carries antibacterial activity, and concludes that an excessive concentration of AgNPs@BB extract may affect the improved biocompatibility. This study recommends using robust, retentive, and antimicrobial coatings of AgNPs@BB extract for implantable biocompatible materials in accordance with the novel strategy of biomaterial applications.
Fulltext Navigating Complexity: A Case Report of Concurrent Central Cord Syndrome and Stroke in an Elderly Gentleman

Kee HT, Harun MHB, Mohamed Ramlee FA, Lim TS, Che-Hamzah F

Cureus, 2024 Jan;16(1):e51789.
PMID: 38322071 DOI: 10.7759/cureus.51789

Central cord syndrome (CCS) predominantly manifests in elderly individuals with pre-existing cervical spondylosis resulting from hyperextension mechanisms. However, it is not exclusive to the older population and can occur in younger individuals following traumatic cervical spine injuries or, less frequently, due to nontraumatic causes. The impact of this syndrome is more pronounced in the upper extremities, where motor function experiences greater impairment compared to sensory function. CCS presents itself along a spectrum of severity. At one end, individuals may exhibit weakness confined to the hands and forearms while preserving sensory function. At the other extreme, complete quadriparesis may occur, albeit with sacral sparing being the sole indication of an incomplete spinal cord injury. This spectrum underscores the varied and nuanced clinical presentations within CCS. Moreover, concurrent acute stroke presentations can mimic CCS symptoms, further complicating the diagnostic process. The challenge lies in differentiating these two distinct conditions, particularly in an elderly population with overlapping risk factors. This diagnostic challenge adds a layer of complexity to clinical decision-making and underscores the importance of comprehensive evaluations in patients presenting with neurological symptoms. This case report presents a 73-year-old gentleman with a history of a recent stroke and motor vehicle accidents, highlighting the diagnostic challenges and multidisciplinary management required for concurrent CCS and stroke mimicry. This report is unique, as there are no existing case report publications detailing concurrent CCS and stroke. It emphasizes the necessity for a comprehensive diagnostic approach and coordinated care in managing such intricate cases.
A Reshaping Recovery: The Reverse Shoulder Arthroplasty Triumphs in Salvaging Chronic Four-Part Proximal Humerus Fractures

Kee HT, Yeak RDK, Ahmad Hanif KA, Seri Masran SM, Che-Hamzah F

Cureus, 2023 Dec;15(12):e50363.
PMID: 38213375 DOI: 10.7759/cureus.50363

The aging population is witnessing a steady increase in the incidence of displaced proximal humerus fractures, particularly among elderly patients. Such fractures pose a significant challenge to orthopedic surgeons, given the complex interplay of factors involved, including fracture displacement, comminution, compromised bone quality, and the presence of concurrent medical comorbidities. While open reduction internal fixation (ORIF) remains a viable treatment option for these fractures, it is a technically demanding procedure associated with a high incidence of complications. Recently, reverse total shoulder arthroplasty (RTSA) with tuberosity repair has gained popularity as a successful approach for addressing such fractures. The present case report details a unique and complex case of a chronic four-part proximal humerus fracture, complicated by avascular necrosis of the humeral head, fracture non-union, and hardware penetration. The patient was successfully treated through a reverse shoulder arthroplasty procedure, highlighting the effectiveness of this surgical approach in such challenging scenarios. The advantages of RTSA in this context include the potential to address avascular necrosis, non-union, and hardware complications, as seen in our patient. Additionally, the procedure can restore functional independence and improve the overall quality of life in these challenging cases.
Fulltext A Triad of Shoulder Injuries Following Cardioversion: A Case Report

Tan EK, Ahmad Hanif KA, Seri Masran SM, Che-Hamzah F

Cureus, 2024 Jan;16(1):e52704.
PMID: 38384611 DOI: 10.7759/cureus.52704

Transthoracic defibrillation and cardioversion are commonly used techniques to resuscitate a patient during acute cardiac arrhythmic events. There are numerous complications associated with these procedures. We report a previously unreported complication where a patient suffered from a supraspinatus tear after cardioversion for ventricular tachycardia. There are numerous complications associated with these procedures. We report a previously unreported complication where a middle-aged Chinese patient with no previous trauma history suffered from a supraspinatus tear after cardioversion for ventricular tachycardia.
Fulltext Systematic Review on Biosynthesis of Silver Nanoparticles and Antibacterial Activities: Application and Theoretical Perspectives

Qamer S, Romli MH, Che-Hamzah F, Misni N, Joseph NMS, Al-Haj NA, et al.

Molecules, 2021 Aug 20;26(16).
PMID: 34443644 DOI: 10.3390/molecules26165057

The biosynthesis of silver nanoparticles and the antibacterial activities has provided enormous data on populations, geographical areas, and experiments with bio silver nanoparticles' antibacterial operation. Several peer-reviewed publications have discussed various aspects of this subject field over the last generation. However, there is an absence of a detailed and structured framework that can represent the research domain on this topic. This paper attempts to evaluate current articles mainly on the biosynthesis of nanoparticles or antibacterial activities utilizing the scientific methodology of big data analytics. A comprehensive study was done using multiple databases-Medline, Scopus, and Web of Sciences through PRISMA (i.e., Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The keywords used included 'biosynthesis silver nano particles' OR 'silver nanoparticles' OR 'biosynthesis' AND 'antibacterial behavior' OR 'anti-microbial opposition' AND 'systematic analysis,' by using MeSH (Medical Subject Headings) terms, Boolean operator's parenthesis, or truncations as required. Since their effectiveness is dependent on particle size or initial concentration, it necessitates more research. Understanding the field of silver nanoparticle biosynthesis and antibacterial activity in Gulf areas and most Asian countries also necessitates its use of human-generated data. Furthermore, the need for this work has been highlighted by the lack of predictive modeling in this field and a need to combine specific domain expertise. Studies eligible for such a review were determined by certain inclusion and exclusion criteria. This study contributes to the existence of theoretical and analytical studies in this domain. After testing as per inclusion criteria, seven in vitro studies were selected out of 28 studies. Findings reveal that silver nanoparticles have different degrees of antimicrobial activity based on numerous factors. Limitations of the study include studies with low to moderate risks of bias and antimicrobial effects of silver nanoparticles. The study also reveals the possible use of silver nanoparticles as antibacterial irrigants using various methods, including a qualitative evaluation of knowledge and a comprehensive collection and interpretation of scientific studies.
Prevalence and severity of Bertolottis syndrome in Malaysia: A common under diagnosis

Noorman MF, Sofian AA, Kandar MK, Ab Halim AH, Harun MH, Mohamed Ramlee FA, et al.

Malays Fam Physician, 2022 Nov 30;17(3):121-127.
PMID: 36606180 DOI: 10.51866/oa.64

INTRODUCTION: Bertolotti's syndrome (BS) is defined as the presence of low back pain (LBP), radiculopathy or both with a dysplastic transverse process (TP) of the fifth lumbar vertebra that is articulated or fused with the sacral base or iliac crest. This study aimed to investigate the prevalence and severity of BS to promote awareness of this disease.
METHOD: A retrospective review of anteroposterior lumbosacral plain radiographs was conducted between 1 January and 31 December 2017. Patients were recruited via systematic randomised sampling and were then interviewed and examined. The severity of BS was measured objectively using the numerical pain rating scale (NPRS) and Oswestry disability questionnaire (ODQ). Data were analysed using IBM SPSS for Windows version 22.
RESULTS: The prevalence of BS was 9.6% (16/166). Age significantly affected the severity of BS. The older and younger groups had a mean ODQ score of 42.86% and 24.08%, respectively (P=0.006). There was no significant relationship found between the prevalence of BS and age (P=0.126). Only one patient was diagnosed with BS during medical consultation. The mean NPRS score was 5.5. The majority of the BS cases were of moderate severity (43.8%), followed by those of minimal severity (31.2%) and severe disability (25%).
CONCLUSION: Early diagnosis of BS and orthopaedic referral are crucial to halt its progression. BS should be considered in patients presenting with LBP during assessments of lumbosacral radiographs.