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Fulltext Role of Uterine Artery Embolization in Pseudoaneurysm of Uterine Artery: A Rare Cause of Secondary Postpartum Hemorrhage

Subramaniam S, Nadarajan C, Aziz ME

Cureus, 2018 Feb 23;10(2):e2220.
PMID: 29692958 DOI: 10.7759/cureus.2220

Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage, although it carries a high mortality rate. The etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. We present a post-cesarean female who developed delayed hemorrhage and was diagnosed with left uterine artery pseudoaneurysm. Selective transcatheter arterial embolization was performed and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and efficient method of treatment of postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Thus, it should be considered as a treatment option before opting for surgery in favorable cases.
Fulltext Performance of Osteoporosis Self-assessment Tool for Asian (OSTA) for primary osteoporosis in post-menopausal Malay women

Muslim D, Mohd E, Sallehudin A, Tengku Muzaffar T, Ezane A

Malays Orthop J, 2012 Mar;6(1):35-9.
PMID: 25279040 MyJurnal DOI: 10.5704/MOJ.1203.011

The Osteoporosis Self-Assessment Tool for Asians (OSTA) score has been developed to identify women at risk of osteoporosis. It can be used as a screening tool for patients at risk who would benefit from bone mineral density measurement and treatment. It was developed based on data from eight countries including Malaysia. However, most subjects were of Chinese (59%). This study evaluated the performance of OSTA among 152 post-menopausal Malay women. OSTA score calculation and DEXA scan were performed. Our results showed that the OSTA score is a good predictor of patients at risk of osteoporosis based on BMD measurements at the proximal femur. Instrument sensitivity was 87.5%, specificity was 95.8%, positive predictive value (PPV) was 0.538, negative predictive value (NPV) was 0.993, and the area under the receiver operating characteristic curve (ROC) was 0.895. We conclude that use of the OSTA score in postmenopausal Malay women is effective and has adequate sensitivity and specificity.
Fulltext Displaced Physeal and Metaphyseal Fractures of Distal Radius in Children. Can Wire Fixation Achieve Better Outcome at Skeletal Maturity than Cast Alone?

Syurahbil AH, Munajat I, Mohd EF, Hadizie D, Salim AA

Malays Orthop J, 2020 Jul;14(2):28-38.
PMID: 32983375 DOI: 10.5704/MOJ.2007.008

Introduction: Redisplacement following fracture reduction is a known sequela during the casting period in children treated for distal radius fracture. Kirschner wire pinning can be alternatively used to maintain the reduction during fracture healing. This study was conducted to compare the outcomes at skeletal maturity of distal radius fractures in children treated with a cast alone or together with a Kirschner wire transfixation.
Material and Methods: This was a retrospective study involving 57 children with metaphyseal and physeal fractures of the distal radius. There were 30 patients with metaphyseal fractures, 19 were casted, and 11 were wire transfixed. There were 27 patients with physeal fractures, 19 were treated with a cast alone, and the remaining eight underwent pinning with Kirschner wires. All were evaluated clinically, and radiologically, and their overall outcome assessed according to the scoring system, at or after skeletal maturity, at the mean follow-up of 6.5 years (3.0 to 9.0 years).
Results: In the metaphysis group, patients treated with wire fixation had a restriction in wrist palmar flexion (p=0.04) compared with patients treated with a cast. There was no radiological difference between cast and wire fixation in the metaphysis group. In the physis group, restriction of motion was found in both dorsiflexion (p=0.04) and palmar flexion (p=0.01) in patients treated with wire fixation. There was a statistically significant difference in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation in physis group with a more increased radial inclination in wire fixation and a more dorsal tilt in patients treated with a cast. All patients were pain-free except one (5.3%) in the physis group who had only mild pain. Overall outcomes at skeletal maturity were excellent and good in all patients. Grip strength showed no statistical difference in all groups. Complications of wire fixation included radial physeal arrests, pin site infection and numbness.
Conclusion: Cast and wire fixation showed excellent and good outcomes at skeletal maturity in children with previous distal radius fracture involving both metaphysis and physis. We would recommend that children who are still having at least two years of growth remaining be treated with a cast alone following a reduction unless there is a persistent unacceptable reduction warranting a wire fixation. The site of the fracture and the type of treatment have no influence on the grip strength at skeletal maturity.
Submuscular Plate Stabilisation After Lengthening: Standard and Modified Techniques

Munajat I, Sulaiman AR, Mohd EF, Zawawi M

Malays Orthop J, 2020 Mar;14(1):49-54.
PMID: 32296482 DOI: 10.5704/MOJ.2003.008

Introduction: Submuscular plating after lengthening shortened the period of external fixation in distraction osteogenesis of the femur. In the femur, where monolateral or ring fixators had been used for the distraction, plates, could be inserted laterally, anteriorly or medially. Specific technical modification of the plate insertion, however, would be necessary to accommodate the femoral varus angular correction created at the end of the distraction, in the pelvic support osteotomy lengthening.
Material and Methods: We reviewed a series of eight cases with standard and modified techniques of plating after lengthening. The amount of lengthening, the period of distraction, the external fixator index and the associated complications were assessed.
Results: The mean lengthening was 5cm, with a range of 3cm to 9cm. The external fixation index, the period of external fixators in days in relation to the length of distraction in cm, was between 18 days/cm to 58 days/cm. One patient with quadriceps contracture, underwent quadriceplasty to improve knee flexion. Three patients with transient knee stiffness had resolution with aggressive physiotherapy. One patient with transient hypoesthesia recovered spontaneously. None of the patients developed joint subluxation, deep infection, re-fracture or implant failures.
Conclusion: Standard and modified techniques of plating after lengthening were safe and required only a short period of external fixation. The modified technique offered an easier way of plate insertion in a deformed bone.
Fulltext Characterization of a Group B Streptococcus infection based on the demographics, serotypes, antimicrobial susceptibility and genotypes of selected isolates from sterile and non-sterile isolation sites in three major hospitals in Malaysia

Suhaimi MES, Desa MNM, Eskandarian N, Pillay SG, Ismail Z, Neela VK, et al.

J Infect Public Health, 2017 Jan-Feb;10(1):14-21.
PMID: 27095302 DOI: 10.1016/j.jiph.2016.01.009

BACKGROUND/PURPOSE: The purpose of this study is to characterize GBS isolates that were collected from three major hospitals in a densely populated area of Klang Valley for their demographics, serotypes, antibiotic susceptibility patterns and genetic background.

METHODS: Sixty GBS isolates from sterile and non-sterile samples in three major hospitals in the Klang Valley area of Malaysia were collected by convenience sampling from 2012 until March 2014. These isolates were studied for their antimicrobial susceptibilities, serotypes and genotypes. Patients' demographic data and clinical information were collected from lab request forms.

RESULTS: Diabetes mellitus was the only underlying condition (7 patients, 23.3%); the remaining samples were from patients who were immunocompromised due to medications. Fifty-nine (98%) isolates were sensitive to penicillin, while 78.3% and 88.3% of the isolates were sensitive to erythromycin and clindamycin, respectively. Serotype Ia was the most common serotype (n=27, 45%), followed by serotype III (n=10, 16.7%), V (n=9, 15%), VI (n=8, 13.3%), VIII (n=2, 3.3%) and VII (n=1, 1.7%). Random Amplified Polymorphic DNA (RAPD) typing showed a diverse genetic pedigree for all isolates, including four major groups that clustered according to geographical location.

CONCLUSION: This preliminary study determines the prevalence of limited common serotypes and antimicrobial resistance in distinct GBS isolates. Nonetheless, the RAPD clustering pattern suggests a close genetic lineage of the GBS isolates based on their isolation sites and location of hospitals.
Efficacy of an inactivated recombinant vaccine encoding a fimbrial protein of Pasteurella multocida B:2 against hemorrhagic septicemia in goats

Mohd Yasin IS, Mohd Yusoff S, Mohd ZS, Abd Wahid Mohd E

Trop Anim Health Prod, 2011 Jan;43(1):179-87.
PMID: 20697957 DOI: 10.1007/s11250-010-9672-5

This study was carried out to determine the antibody responses and protective capacity of an inactivated recombinant vaccine expressing the fimbrial protein of Pasteurella multocida B:2 following intranasal vaccination against hemorrhagic septicemia in goats. Goats were vaccinated intranasal with 10(6) CFU/mL of the recombinant vaccine (vaccinated group) and 10(6) CFU/mL of pET32/LIC vector without fimbrial protein (control group). All three groups were kept separated before all goats in the three groups were challenged with 10(9) CFU/mL of live pathogenic P. multocida B:2. During the course of study, both serum and lung lavage fluid were collected to evaluate the antibody levels via enzyme-linked immunosorbent assay. It was found that goats immunized with the inactivated recombinant vaccine developed a strong and significantly (p
Fulltext Reconstruction of Secondary Type Congenital Hallux Varus with Modification of the Farmer Technique for Cover of Skin Defect: Report of Three Cases

Sulaiman AR, Munajat I, M-Yusuf H, Nik-Jaffar N, Zarullail NH, Mohd EF, et al.

Malays Orthop J, 2019 Nov;13(3):72-76.
PMID: 31890115 DOI: 10.5704/MOJ.1911.013

The reconstruction of hallux varus deformity involves the release of contracted medial structure and realignment of the phalange, leaving a significant skin defect which requires cover. Farmer described proximal based rotational skin flap from the first web space to cover the defect. This technique may compromise the circulation to the flap and risk to the lateral digital vessels. We modified his technique to address these issues. We report a successful reconstruction using the Farmer's technique on one patient and a modified technique on three patients. We used the excess skin from the extra digit to cover the medial defect. We found this modified technique of skin cover safe without risk of injuring the neurovascular bundle. There was no recurrence of deformity at last foolow-up. All patients were able to wear normal shoes.