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  1. Nanchappan NS, Chopra S, Samuel A, Therumurtei L, Ganapathy SS
    Malays Orthop J, 2021 Jul;15(2):136-142.
    PMID: 34429834 DOI: 10.5704/MOJ.2107.020
    Introduction: Mortality following traumatic femoral neck fractures in the elderly (age >60 years) is influenced by many factors. Addressing some of them may reduce the mortality rate thus improving patient survival and quality of life.

    Materials and methods: This study was a retrospective research using data collected from Hospital Sultanah Bahiyah, Kedah between the years 2008-2018. We measured outcomes such as age, gender, hospital stay, default rate, ambulation post-surgery, American Society of Anaesthesiologists score (ASA) and surgical timing in correlation with mortality rate and 10-year survival of elderly patients treated with Total Hip Arthroplasty for femoral neck fractures in this centre.

    Results: A total of 291 traumatic femoral neck fractures aged above 60 years post total hip arthroplasty performed were included. There was higher number of female (n =233) compared to male (n=53) Estimated 10 years survival from Kaplan Meier was 42.88% (95% CI: 33.15, 52.54). One year mortality rate in our study was found to be 18.9%. The average time to event was 7.1 years (95% CI:33.15, 52.24) with a mean age group of 75.

    Discussion: Total hip arthroplasty patients not ambulating after surgery had a 4.2 times higher hazard ratio compared to ambulators. Those with pre-existing systemic disease (ASA III and IV) were found to have the highest hazard ratio, almost five times that of healthy patients, after adjusting for confounding factors. Delay of more than seven days to surgery was found to be a significant factor in 10-year survival with a hazard ratio of 3.8, compared to surgery performed earlier.

    Conclusion: Delay of more than 7 days to surgery in 10 years survival was significant with high hazard ratio. It is a predictor factor for survival in 10 years. A larger sample size with a prospective design is required to confirm our findings regarding "unacceptable surgical timing" for femoral neck fractures in patients above 60 years of age.

  2. Ganapathy S, Vedam V, Rajeev V, Nair SV
    Trauma Case Rep, 2020 Jun;27:100306.
    PMID: 32420442 DOI: 10.1016/j.tcr.2020.100306
    Complicated crown root fractures are mostly difficult to treat and have a poor prognosis. To restore the biological space, intentional replantation may be chosen when other immediate treatment options are not viable. Intentional replantation with tooth rotation consists of extraction, 180° rotation and replantation, thereby maintaining the biological width. This article presents management of a maxillary central incisor with complicated crown root fracture with open apex. The tooth was rotated and splinted for one week. The apex was closed with mineral trioxide aggregate (MTA) followed by obturation and post placement. The incompletely obturated adjacent tooth was non-surgically managed by retreatment. Finally, glass fibre post followed by crown with indirect composite built up was made. Patient was followed up every three months for the next two years without any complications.
  3. Wong WK, Chan WK, Ganapathy S, Lim SK
    Nephrology (Carlton), 2023 Aug;28(8):425-433.
    PMID: 37269220 DOI: 10.1111/nep.14186
    AIM: This study aims to determine if metabolic-dysfunction-associated fatty liver disease (MAFLD) or advanced liver fibrosis is associated with erythropoietin stimulating agent (ESA) hypo-responsiveness in hemodialysis patients.

    METHODS: In a cross-sectional study of 379 hemodialysis patients, FibroTouch transient elastography was performed on all patients. Erythropoeitin resistance index (ERI) was used to measure the responsiveness to ESA. Patients in the highest tertile of ERI were considered as having ESA hypo-responsiveness.

    RESULTS: The percentage of patients with ESA hypo-responsiveness who had MAFLD was lower than patients without ESA hypo-responsiveness. FIB-4 index was significantly higher in ESA hypo-responsive patients. In multivariate analysis, female gender (aOR = 3.4, 95% CI = 1.9-6.2, p < 0.001), dialysis duration ≥50 months (aOR = 1.8, 95% CI = 1.1-2.9, p < 0.05), elevated waist circumference (aOR = 0.4, 95% CI = 0.2-0.8, p = 0.005), low platelet (aOR = 2.6, 95% CI 1.3-5.1, p < 0.01), elevated total cholesterol (aOR = 0.5, 95% CI 0.3-0.9, p < 0.05) and low serum iron (aOR = 3.8, 95% CI = 2.3-6.5, p < 0.001) were found to be independent factors associated with ESA hypo-responsiveness. Neither MAFLD nor advanced liver fibrosis was independently associated with ESA hypo-responsiveness. However, every 1 kPA increase in LSM increased the chance of ESA-hyporesponsiveness by 13% (aOR = 1.1, 95% CI =  1.0-1.2, p = 0.002) when UAP and LSM were used instead of presence of MAFLD and advanced liver fibrosis, respectively.

    CONCLUSION: MAFLD and advanced liver fibrosis were not independently associated with ESA hypo-responsiveness. Nevertheless, higher FIB-4 score in ESA hypo-responsive group and significant association between LSM and ESA hypo-responsiveness suggest that liver fibrosis may be a potential clinical marker of ESA hypo-responsiveness.

  4. Philip ST, Abdulla AM, Ganapathy S, Vedam V, Rajeev V
    J Pharm Bioallied Sci, 2019 May;11(Suppl 2):S463-S467.
    PMID: 31198388 DOI: 10.4103/JPBS.JPBS_78_19
    BACKGROUND: Changing lifestyle pattern and food habits has a deteriorating effect on dental tissues. Dental erosion is a pathological wear of hard tissues of teeth with increased consumption of acidic and carbonated drinks. Susceptibility to erosion in primary dentition is more compared to permanent dentition due to softer and disordered crystal structure of enamel.

    OBJECTIVES: The main aim of the study was to determine and compare the erosive potential of different fruit juices in frozen/unfrozen forms on primary teeth by studying the calcium dissolution.

    MATERIALS AND METHODS: pH of four different juices (pure) - apple, orange, citrus limetta (musumbi) and grapes were determined using a digital pH meter. The titratable acidity of these in frozen and unfrozen forms were determined by adding 0.2 ml of 1M NaOH to these to raise to pH=5.5(critical pH) and pH =7(neutral pH). Forty eight caries free deciduous anterior teeth specimens were prepared to study the calcium dissolution by atomic absorption spectrophotometer. The results were analysed for statistical significance using One-way Repeated Measures ANOVA and pair wise multiple comparison with Bonferroni correction.

    RESULTS: Total titratable acidity and calcium dissolution were found to be significantly more in the initial thawed fruit juices.

    CONCLUSION: Frozen fruit juices had more buffering capacity and erosive potential than unfrozen forms. The study concluded that sucking on frozen fruit juices is more damaging to teeth than unfrozen forms because more of erosion is expected to occur in a frozen state.

  5. Vedam VKV, Boaz K, Natarajan S, Ganapathy S
    J Clin Lab Anal, 2017 May;31(3).
    PMID: 27637993 DOI: 10.1002/jcla.22048
    BACKGROUND: The aim of this study was to evaluate salivary amylase in patients with primary oral cancer undergoing radiotherapy as the main modality of treatment.

    MATERIALS/METHODS: The study was conducted on ten histologically proven cases of oral cancer undergoing radiotherapy. Stimulated whole saliva was collected at three stages of radiotherapy-0, 3, and 6 weeks. Salivary amylase was estimated using Henry-Chiamori method and comparison was made with appropriate age- and gender-matched controls.

    RESULTS: Salivary amylase levels showed significant decrease in healthy subjects when compared to oral cancer patients (P < 0.001). The latter group also showed changing trend with initial decrease from 0 to 3 weeks followed by increase from 3 to 6 weeks following radiotherapy (P < 0.0528).

    CONCLUSIONS: The trend in changes in the levels of salivary amylase could be used as a surrogate marker of salivary gland function in patients with oral cancer undergoing radiotherapy as primary treatment.

  6. Arora S, Gill GS, Abdulla AM, Saluja P, Baba SM, Khateeb SU, et al.
    J Pharm Bioallied Sci, 2020 Aug;12(Suppl 1):S635-S639.
    PMID: 33149534 DOI: 10.4103/jpbs.JPBS_82_20
    It is very rare (2%-6% cases) for a mandibular canine to have two root canals and the incidence of finding two roots with two root canals in a mandibular canine that too bilaterally is almost negligible. This case report discusses the presence and multidisciplinary management of such rarest configuration in both mandibular canines of a female patient. This case shows the importance of recognition of anatomical variations in successful accomplishment of root canal treatment.
  7. Sainudeen S, Nair VS, Zarbah M, Abdulla AM, Najeeb CM, Ganapathy S
    J Pharm Bioallied Sci, 2020 Aug;12(Suppl 1):S423-S429.
    PMID: 33149499 DOI: 10.4103/jpbs.JPBS_127_20
    Aim: The purpose of this study was to evaluate the antimicrobial efficacy of Tylophora indica, Curcumin longa, and Phyllanthus amarus on Enterococcus faecalis biofilms formed on the tooth substrate. Sodium hypochlorite was used as a positive control. DMSO (dimethyl sulfoxide), the vehicle for the herbal extracts, was used as the negative control.

    Materials and Methods: Extracted human teeth were biomechanically prepared, vertically sectioned, placed in the tissue culture wells exposing the root canal surface to E. faecalis to form a biofilm. At the end of the third week, all groups were treated for 15 min with the test solutions and the control. The results were analyzed both quantitatively and qualitatively.

    Results: Statistical analysis was performed by using one-way analysis of variance and compared by the Mann-Whitney test using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. The qualitative assay with the 3-week biofilm on the canal portion showed complete inhibition of bacterial growth for NaOCl, whereas samples treated with herbal solutions showed significant reduction of bacterial growth compared to control group, which showed 139.9 × 109 CFU/mL among the experimental herbal solutions groups. P. amarus has shown maximum bacterial count followed by C. longa and T. indica.

    Conclusion: NaOCl 5% showed maximum antibacterial activity against 3-week biofilm on tooth substrate. T. indica, P. amarus, and C. longa showed statistically significant antibacterial activity against 3-week biofilm. The use of herbal alternatives might prove to be advantageous considering the several undesirable characteristics of NaOCl.

  8. Padmakumar V, Premkala Raveendran K, Abdulla AM, Ganapathy S, Sainudeen S, Nasim VS, et al.
    J Pharm Bioallied Sci, 2019 May;11(Suppl 2):S397-S401.
    PMID: 31198376 DOI: 10.4103/JPBS.JPBS_44_19
    Background: Mercury is a naturally occurring metal that exists in three forms: elemental (metallic), inorganic, and organic mercury. Amalgam, which is an alloy of inorganic mercury, is used as a restorative material in dentistry. Organic mercury gets ingested in the body mainly by the consumption of seafood. Mercury is also stated to cause various adverse health effects such as gastrointestinal disturbances, dermatitis, muscle weakness, and neurological disorders. In recent years, the use of amalgam has become a controversy stating the various adverse effects of mercury. Hence, the study was conducted to determine and compare the variation in levels of organic and inorganic mercury in fish-eating children before and after placement of amalgam restoration.

    Materials and Methods: Seventy-five subjects, 42 males (56%) and 35 females (44%) of age group ranging 7-13 years, living in South Canara district of Karnataka, India, were selected as a part of the study. Hair and urine samples were collected for estimation of organic and inorganic levels of mercury, respectively. Informed consent was collected from all the participating subjects.

    Results: On comparison between organic and inorganic mercury levels during the study period, the concentration of organic mercury in hair samples was greater irrespective of amalgam restorations present (1.172 and 0.085, respectively; P < 0.001).

    Conclusion: Thus inorganic levels of mercury do not seem to pose a threat as much as the organic levels observed in hair, which remain fairly constant for a longer period of time. Hence in a coastal region where this study was undertaken and fish being a staple food, the risk could probably be attributed to more of an organic toxicity than an inorganic one. Thus amalgam is relatively safe to be practiced and the controversy against it should be reevaluated.

  9. Letchumanan M, Anour AA, Ganapathy SS, Harry S, Nik Lah NSH, Arsad N, et al.
    Med J Malaysia, 2021 03;76(2):131-137.
    PMID: 33742618
    OBJECTIVES: To recognize the radiographic patterns of coronavirus disease 2019 (COVID-19) in Malaysia.

    MATERIALS AND METHODS: Chest radiographs of patients confirmed with COVID-19 in Hospital Tawau, Sabah, Malaysia were retrospectively analyzed by two radiologists. The radiographic pattern, distribution among subgroups and evolution of the disease over time were determined.

    RESULTS: Among the 82 patients studied, 65 (79.3%) were males. Mean age of our cohorts was 37 ± 15 years. Baseline chest radiographs were abnormal in 37 patients (45.1%). Over half (52.9%) of the symptomatic patients had abnormal baseline radiograph. Among the children, patients with comorbidities, and patients 60 years of age and above, the abnormal radiographs were 14.3%, 71.4% and 69.3% respectively. Ground glass opacities were the commonest abnormal radiographic feature (35.4%), were peripherally located (35.4%) with predilection for the lower zones (29.3%). Most radiographic abnormalities were multifocal (20.7%) and frequently located in the left lung (19.5%). Radiographic recovery was observed in 15 of 18 patients (83%). Computed tomography (CT) scan demonstrated greater extent of the disease than observed in radiographs of the same patient.

    CONCLUSIONS: COVID-19 pneumonia presented with a specific radiographic pattern in our cohort of patients, comprising of ground glass opacities in peripheral and basilar distribution, affecting a single lung field and was observed in both symptomatic and asymptomatic patients. Chest radiograph is a useful adjunct screening tool, and in combination with clinical and epidemiological assessment may facilitate in early diagnosis of COVID-19 pneumonia.

  10. Wong XZ, Gan CC, Mohamed R, Yahya R, Ganapathy S, Tan SS, et al.
    BMC Nephrol, 2020 11 13;21(1):480.
    PMID: 33187498 DOI: 10.1186/s12882-020-02154-4
    BACKGROUND: Hepatitis C virus (HCV) infects more than 71 million people worldwide and chronic HCV infection increases the risk of liver cirrhosis and failure. Haemodialysis (HD) is one of the renal replacement therapies with risk of HCV transmission. Anti-HCV antibodies are the serological screening test for HCV infection that does not detect active phase of infection. Majority HCV infected HD patients in Malaysia do not have further HCV RNA performed due to high cost and thus HCV treatment is less frequently offered. HCV Core Antigen (HCV Ag) can potentially be used to diagnose active HCV infection in HD population in comparison to HCV RNA, at lower cost.

    METHODS: We conducted a cross-sectional study to assess the correlation between HCV Ag and HCV RNA and to identify the prevalence of active HCV infection among HCV seropositive HD patients from dialysis centres across West Malaysia from July 2019 to May 2020. Pre-dialysis blood was taken and tested for both HCV Ag and HCV RNA tests. HCV Ag was tested with Abbott ARCHITECT HCV Ag test.

    RESULTS: We recruited 112 seropositive HD patients from 17 centres with mean age of 54.04 ± 11.62 years, HD vintage of 14.1 ± 9.7 years, and male constitute 59.8% (67) of the study population. HCV Ag correlates well with HCV RNA (Spearman test coefficient 0.833, p  3000 IU/mL, HCV Ag had a higher sensitivity of 95.1% and greater correlation (Spearman test coefficient 0.897, p 

  11. Rajeev V, Arunachalam R, Nayar S, Arunima PR, Ganapathy S, Vedam V
    Eur J Dent, 2017 4 25;11(1):58-63.
    PMID: 28435367 DOI: 10.4103/ejd.ejd_113_16
    OBJECTIVE: This in vitro study was designed to assess shear bond strength (SBS) of ormocer flowable (OF) resin as a luting agent, ormocer as an indirect veneer material with portrayal of modes of failures using scanning electron microscope (SEM).

    MATERIALS AND METHODS: Sixty maxillary central incisors were divided into Group I, II, and III with 20 samples each based on luting cement used. They were OF, self-adhesive (SA) cement, and total etch (TE) cement. These groups were subdivided into "a" and "b" of ten each based on the type of veneering materials used. Veneer discs were fabricated using Ormocer restorative (O) and pressable ceramic (C). Specimens were thermocycled and loaded under universal testing machine for SBS. The statistical analysis was done using one-way ANOVA post hoc Tukey honest significant difference method.

    RESULTS: A significant difference was observed between the Groups I and II (P < 0.05). The highest mean bond strength when using ormocer veneer was obtained with the Group Ia (19.11 ± 1.92 Mpa) and lowest by Group IIa (8.1 ± 1.04 Mpa), whereas the highest mean bond strength while using ceramic veneer was of similar range for Group Ib (18.04 ± 4.08 Mpa) and Group IIIb (18.07 ± 1.40 Mpa). SEM analysis revealed OF and TE presented mixed type of failure when compared with SA where failure mode was totally adhesive.

    CONCLUSION: OF was found equally efficient like TE. Bond strength of ormocer as a veneer was not inferior to ceramic making it one of the promising additions in the field of dentistry.

  12. Elenjikal MJ, Latheef AA, Kader MAM, Ganapathy S, Mohamed AB, Sainudeen SS, et al.
    J Pharm Bioallied Sci, 2019 May;11(Suppl 2):S450-S456.
    PMID: 31198386 DOI: 10.4103/JPBS.JPBS_75_19
    Background: Root resorption is the loss of dental hard tissues as a result of clastic activities. It might be broadly classified into external or internal resorption by the location of the resorption in relation to the root surface. the various techniques used these days for filling internal resorption include warm condensation, vertical condensation, core techniques, thermoplasticized gutta-percha, warm vertical compaction, and cold lateral condensation.

    Objectives: The aims and objectives of this study were to compare the quality of root fillings in artificially created internal resorption cavities filled with warm vertical compaction, lateral condensation, Obtura II along with System B, E and Q plus along with System B, and Thermafil, and to calculate the percentage of gutta-percha, sealer, and voids using an ImageJ software.

    Results: Results between the warm vertical compaction (group I), lateral condensation (group II), Obtura II with System B (group III), E and Q plus with System B (group IV), and Thermafil (group V), group III showed the highest percentage of gutta-percha plus sealer and gutta-percha, and least number of voids, which was statistically significant (P < 0.000).

    Conclusion: It can be concluded that Obtura II along with System B was found to be the most suitable obturation technique for the management of teeth exhibiting internal resorption. Thermafil was found to give the poorest obturation quality when used to fill the teeth with internal resorption. Similarly, lateral condensation technique was observed to show maximum sealer and hence was not ideal for the management of internal resorptive cavities.

  13. Wong XZ, Amirah A, Gan CC, Fatiha S, Maznah D, Yahya R, et al.
    Nephrology (Carlton), 2021 May;26(5):463-470.
    PMID: 33580732 DOI: 10.1111/nep.13862
    AIMS: In Malaysia, majority anti-HCV positive haemodialysis patients do not undergo hepatitis C confirmation due to the high cost of HCV RNA. HCV Core Antigen might be a cost-effective diagnostic test to identify HD patients who have active HCV infection eligible for Direct Acting Anti-viral therapy.

    METHODS: A cross-sectional study was conducted to assess the correlation between HCV Ag and HCV RNA and the cost implications of different diagnostic algorithms to diagnose active HCV infection using Anti-HCV, HCV Ag, and HCV RNA. Pre-dialysis blood was tested for both HCV Ag and HCV RNA. HCV Ag was tested with Abbott ARCHITECT HCV Ag test.

    RESULTS: Two-hundred twenty-seven haemodialysis patients were recruited from 20 centres with mean age of 57.68 ± 12.48 years, and male constitutes 56.8% (129) of the study population. HCV Ag correlated well with HCV RNA (Spearman test coefficient 0.943, p 

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