Study of Deep Vein Thrombosis Screening by using Ultrasound Doppler in Patients with Pelvic and Acetabulum Fractures Requiring Operative Intervention.

Introduction: Pelvic and acetabulum fractures are commonly caused by high impact injuries, increasing the risk of patients developing thromboembolic diseases such as deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, this study was performed to determine the incidence of lower extremity DVT in patients with pelvic and acetabulum fractures and the importance of preoperative screening with Doppler ultrasound prior to surgical intervention. Materials and methods: This retrospective study involved 78 patients with pelvic and acetabulum fractures requiring surgical intervention from January 2015 until December 2019. Patients who underwent surgical interventions were screened pre-operatively with Doppler ultrasound to detect lower limb DVT and later compared with the incidence of lower limb DVT post-operatively. Descriptive statistical analysis was performed using IBM SPSS Statistics Version 24. Results: The participants of this study consisted of 30.8% females and 69.2% males. Pre-operative screening with Doppler ultrasound showed that three patients (3.8%) were diagnosed with lower limb DVT, whereas one of them (1.3%) was symptomatic and diagnosed with PE. Postoperatively, one patient developed DVT, and one patient developed PE. Both patients were negative for DVT preoperatively. Conclusion: The incidence of DVT in patients with pelvic and acetabulum fractures requiring operative intervention was significant despite the initiation of mechanical and pharmacological thromboprophylaxis upon admission. Despite the low incidence of DVT in our study, it has a high impact on patients' morbidity and mortality; thus, preoperative screening is important for early detection and the subsequent reduction of the risk of developing PE. The compulsory use of Doppler ultrasound of bilateral lower limbs as a part of pre-operative screening is highly recommended because it is cost-effective, efficient and readily available in most tertiary hospitals nationwide.

The Incidence of Fracture-Related Infection in Open Tibia Fracture with Different Time Interval of Initial Debridement.

Introduction: The primary aim of open fracture management is to prevent fracture-related infection by early antibiotic administration, debridement and wound coverage. However, the timing of the initial debridement is still controversial, and 6 to 24 hours is commonly advocated. Studies have yet to provide substantial evidence regarding the best time for surgical debridement. Thus, this study was conducted to compare the incidence of fracture-related infection at different time intervals of initial debridement of the open tibia fracture. Materials and methods: A total of 91 patients with grade I, II and IIIa open tibia fractures were recruited from 2016 to 2018, and their data were obtained from the consensus book and medical records. Participants were divided into four groups based on the time of initial debridement: (1) less than 6 hours, (2) 6 to less than 12 hours, (3) 12 to less than 24 hours, and (4) 24 hours and more. Fracture-related infection was determined by using Metsemakers confirmative criteria. Association between time and infection were determine by Binary Logistic Regression analysis by remerged the group into three; (1) less than 12 hours, (2) 12 to less than 24 hours and (3) 24 hours and more. The collected information was analysed using SPSS version 24 and Microsoft Excel 2010. Results: The mean age of the participants was 31.9 years old, with male predominant (n=80, 87.0%). Most participants had delayed initial debridement of more than 24 hours and predominantly Gustilo-Anderson type IIIa (n=47). A total of 8 fractures complicated with infection (8.7%), majority in grade IIIa and debridement performed within 12 to less than 24 hours. Binary logistic regression showed increased odds of infection with a delayed wound debridement both in clinical presentation and positive culture, but the association was not statistically significant. The commonest organism isolated was Pseudomonas aeruginosa. Conclusion: Comparing to different time interval, initial wound debridement of more than 24 hours did not have strong association with increasing infection rate. However, even though statistically not significant, the odds of infection was increase with increasing time of initial wound debridement of an open tibia fracture, thus it should be performed early.

Infantile esotropia in Malaysian children: The impact of surgery on health-related quality of life assessment in patients and their parents.

INTRODUCTION: Limited information is available on healthrelated quality of life (HRQoL) in children with strabismus in South East Asia. We aimed to evaluate the HRQoL and associated factors pre- and post-strabismus surgery in Malaysian children with infantile esotropia and their parents/guardians. METHODS: A prospective study was conducted on children with infantile esotropia aged 8-17 years old and their parents/guardians who attended two tertiary hospitals with a paediatric ophthalmology service from 2017 to 2018. The patients and parents answered the Intermittent Exotropia Questionnaire (IXTQ), translated into Malay, at the time of enrolment and three months after the surgery. RESULTS: Thirty-four children and one (each) of their parents/guardians were enrolled. Thirteen (38.2%) children had esotropia with angles of deviation of more than 50 prism dioptres. A total of 33 (97.1%) children achieved successful alignment correction three months after surgery. Surgery significantly improved the total mean scores of the children, which were 62.87 (17.05) preoperatively and 87.13 (13.26) postoperatively (p<0.001). There was statistically improvement in the total mean scores in the parent/guardian group, which was 37.07 (22.01) preoperatively and 75.39 (22.09) postoperatively (p<0.001). The parents/guardians functional, psychosocial and surgery subscales also had a significant increment in the score postoperatively (p<0.001). Older children and children with poorer visual acuity on presentation had a lower score preoperatively, while girls scored better postoperatively (p<0.05). Mothers scored significantly lower preoperatively and postoperatively (p<0.05). CONCLUSION: Surgery significantly improved the HRQoL score in Malaysian children with infantile esotropia and their parents/guardians. The score was significantly higher in female children after the surgery. Mothers exhibited poor scores before and after surgery.

Study on ABO and RhD blood grouping: Comparison between conventional tile method and a new solid phase method (InTec Blood Grouping Test Kit).

INTRODUCTION: 'InTec Blood Grouping Test kit' using solid-phase technology is a new method which may be used at outdoor blood donation site or at bed side as an alternative to the conventional tile method in view of its stability at room temperature and fulfilled the criteria as point of care test. This study aimed to compare the efficiency of this solid phase method (InTec Blood Grouping Test Kit) with the conventional tile method in determining the ABO and RhD blood group of healthy donors. METHODS: A total of 760 voluntary donors who attended the Blood Bank, Penang Hospital or offsite blood donation campaigns from April to May 2014 were recruited. The ABO and RhD blood groups were determined by the conventional tile method and the solid phase method, in which the tube method was used as the gold standard. RESULTS: For ABO blood grouping, the tile method has shown 100% concordance results with the gold standard tube method, whereas the solid-phase method only showed concordance result for 754/760 samples (99.2%). Therefore, for ABO grouping, tile method has 100% sensitivity and specificity while the solid phase method has slightly lower sensitivity of 97.7% but both with good specificity of 100%. For RhD grouping, both the tile and solid phase methods have grouped one RhD positive specimen as negative each, thus giving the sensitivity and specificity of 99.9% and 100% for both methods respectively. CONCLUSION: The 'InTec Blood Grouping Test Kit' is suitable for offsite usage because of its simplicity and user friendliness. However, further improvement in adding the internal quality control may increase the test sensitivity and validity of the test results.

A rare case of methicillin resistant Staphylococcus aureus (MRSA) cerebral abscess secondary to conjunctivitis.

This case report discusses the rare association of cerebral abscess related to conjunctivitis in an otherwise healthy child. A 6 year old boy presented with conjunctivitis was treated with topical antibiotics and resolved after a week. Conjunctival swab cultures grew MRSA. A month later he developed status epileptics and CT scans revealed a large cerebral abscess. He was treated with intravenous antibiotics which covered for MRSA, along with an incision and drainage for the cerebral abscess. Pus cultures grew MRSA. The patient recovered well with no disturbance in visual acuity or visual field. On post-operative follow ups, he had no other neurological deficit apart from a slight limp.

A review of biocompatible metal injection moulding process parameters for biomedical applications.

Biocompatible metals have been revolutionizing the biomedical field, predominantly in human implant applications, where these metals widely used as a substitute to or as function restoration of degenerated tissues or organs. Powder metallurgy techniques, in specific the metal injection moulding (MIM) process, have been employed for the fabrication of controlled porous structures used for dental and orthopaedic surgical implants. The porous metal implant allows bony tissue ingrowth on the implant surface, thereby enhancing fixation and recovery. This paper elaborates a systematic classification of various biocompatible metals from the aspect of MIM process as used in medical industries. In this study, three biocompatible metals are reviewed-stainless steels, cobalt alloys, and titanium alloys. The applications of MIM technology in biomedicine focusing primarily on the MIM process setting parameters discussed thoroughly. This paper should be of value to investigators who are interested in state of the art of metal powder metallurgy, particularly the MIM technology for biocompatible metal implant design and development.

Corrosion and surface modification on biocompatible metals: A review.

Corrosion prevention in biomaterials has become crucial particularly to overcome inflammation and allergic reactions caused by the biomaterials' implants towards the human body. When these metal implants contacted with fluidic environments such as bloodstream and tissue of the body, most of them became mutually highly antagonistic and subsequently promotes corrosion. Biocompatible implants are typically made up of metallic, ceramic, composite and polymers. The present paper specifically focuses on biocompatible metals which favorably used as implants such as 316L stainless steel, cobalt-chromium-molybdenum, pure titanium and titanium-based alloys. This article also takes a close look at the effect of corrosion towards the implant and human body and the mechanism to improve it. Due to this corrosion delinquent, several surface modification techniques have been used to improve the corrosion behavior of biocompatible metals such as deposition of the coating, development of passivation oxide layer and ion beam surface modification. Apart from that, surface texturing methods such as plasma spraying, chemical etching, blasting, electropolishing, and laser treatment which used to improve corrosion behavior are also discussed in detail. Introduction of surface modifications to biocompatible metals is considered as a "best solution" so far to enhanced corrosion resistance performance; besides achieving superior biocompatibility and promoting osseointegration of biocompatible metals and alloys.

A review of hydroxyapatite-based coating techniques: Sol-gel and electrochemical depositions on biocompatible metals.

New promising techniques for depositing biocompatible hydroxyapatite-based coatings on biocompatible metal substrates for biomedical applications have continuously been exploited for more than two decades. Currently, various experimental deposition processes have been employed. In this review, the two most frequently used deposition processes will be discussed: a sol-gel dip coating and an electrochemical deposition. This study deliberates the surface morphologies and chemical composition, mechanical performance and biological responses of sol-gel dip coating as well as the electrochemical deposition for two different sample conditions, with and without coating. The review shows that sol-gel dip coatings and electrochemical deposition were able to obtain the uniform and homogeneous coating thickness and high adherent biocompatible coatings even in complex shapes. It has been accepted that both coating techniques improve bone strength and initial osseointegration rate. The main advantages and limitations of those techniques of hydroxyapatite-based coatings are presented. Furthermore, the most significant challenges and critical issues are also highlighted.

Investigation of a PAX6 gene mutation in a Malaysian family with congenital aniridia.

Mutations in the PAX6 gene that cause aniridia have been identified in various ethnicities but not in the Malaysian population. Therefore, the objective of this study was to investigate the PAX6 mutation in a Malaysian family with congenital aniridia. In this study, a complete ophthalmic examination was performed on a Dusun ethnic family with aniridia. Genomic DNA was extracted from the peripheral blood of the subjects and screened for the PAX6 gene mutation using polymerase chain reaction amplification high-resolution melting curve analysis (PCR-HRM) followed by confirmation via direct DNA sequencing. A heterozygous G deletion (c.857delG) in exon 7 causing a frame shift in PAX6 was identified in all affected family members. Genotype-phenotype correlation analysis revealed congenital cataract and all affected family members showed a similar spectrum of aniridia with no phenotypic variability but with differences in severity that were age-dependent. In summary, by using a PCR-HRM approach, this study is the first to report a PAX6 mutation in a Malaysian family. This mutation is the cause of the aniridia spectra observed in this family and of congenital cataract.

Cobalt(II) selective membrane electrode based on palladium(II) dichloro acetylthiophene fenchone azine.

A new cobalt(II) ion selective electrode based on palladium(II) dichloro acetylthiophene fenchone azine(I) has been developed. The best membrane composition is found to be 10:60:10:21.1 (I)/PVC/NaTPB/DOP (w/w). The electrode exhibits a Nerstian response in the range of 1.0 × 10(-1)-1.0 × 10(-6)M with a detection limit and slope of 8.0 × 10(-7)M and 29.6 ± 0.2 mV per decade respectively. The response time is within the range of 20-25s and can be used for a period of up to 4 months. The electrode developed reveals good selectivity for cobalt(II) and could be used in pH range of 3-7. The electrode has been successfully used in the determination of cobalt(II) in water samples.

Effect of surfactants on the cementation of cadmium.

The cementation of cadmium ions (Cd(2+)) from aqueous solution onto zinc was studied in two batch reactors, a batch stirred reactor lined with a cylindrical zinc sheet and another that used a rotating zinc cylinder. The rate of cadmium removal was studied as a function of speed of rotation, initial cadmium concentration, and the addition of certain surfactants and their mixtures. Rotational speed and initial cadmium concentration affect the rate of cadmium cementation. It was found that sodium dodecyl sulfate (SDS) improves the rate of cadmium cementation, while Triton X-100 and cetyltrimethylammonium bromide (CTAB) inhibit it. Thermodynamic parameters were calculated and discussed. Visual observations showed that cadmium deposits on the zinc sheet are in the form of a powder, while cadmium deposits on the zinc cylinder, in the presence of SDS, give porous grains which increases the roughness of the surface, leading to an increase in the cementation rate. The lowest deposit porosity was observed in the presence of CTAB, which corresponds to the highest decrease obtained in the rate of cadmium cementation. The cementation process was successfully applied to recover Cd(2+) spiked into an industrial wastewater sample.

Congenital lobar emphysema: a review of 10 cases.

We reviewed the clinical features and management of 10 patients with congenital lobar emphysema (CLE) treated in our institution over a period of seven years, from September 1988 to September 1995. The age of onset of symptoms ranged from few days from birth to six months. Correct diagnosis was made in only 4 patients before referral, even though diagnosis could have been arrived at from the chest radiograph in all of them. Lobectomy was done in seven patients, while one patient had vascular ring resected. Of the three patients managed conservatively, in one lobectomy was performed at the end of 5 months conservative course as her clinical condition deteriorated during an intercurrent chest infection. Of the remaining two, one has mild episodic reactive air way disease and the other patient is asymptomatic.

Coronary artery bypass graft (CABG) surgery: current University Hospital (K.L.) experience.

A personal series of 163 patients who underwent coronary artery bypass surgery (CABG) in the University Hospital, Kuala Lumpur between March 1988 and December 1990 were reviewed retrospectively to determine factors affecting hospital morbidity and mortality. One hundred and thirty eight were elective cases while 25 patients underwent emergency CABG surgery. Of these, 15 patients had recent myocardial infarction, with unstable haemodynamics or post infarct angina; six had failed angioplasty procedures and four patients immediately following coronary angiogram. The elective hospital mortality rate was 2.2% (three cases) and there were two deaths in the emergency group. Pre-operatively 20 patients (13%) had very poor left ventricular function of less than 30% ejection fraction. Significant improvement in ejection fraction was observed following surgery. The follow-up periods were between three months to three years. Ninety eight percent of patients showed improvement in their functional status (NYHA classification) in relation to angina and exercise performance.

Fractured tracheostomy tube in the tracheobronchial tree.

A fractured tracheostomy tube is a rare complication; cases have been reported in the past, usually associated with prolonged usage in patients with chronic airway obstruction. We present here a fracture occurring in a new tube, and also describe a method for retrieving the tube from the tracheobronchial tree.

Surgical management of patent ductus arteriosus. A review of 413 cases.

Ligation under controlled hypotension is a simple, quick and effective surgical management of patent ductus arteriosus. In this study 413 cases are reviewed: clinical presentations, cardiac catheterization and operative findings are studied in relation to the surgical procedures. Ligation of the ductus was the treatment of choice in 357 cases irrespective of the age and size of the ductus with only four instances of recanalization which needed religation. Other procedures included division and suture, patch aortoplasty, transaortic patch and transpulmonary closure under profound hypothermia and arrest. There were two deaths and only five major types of morbidities described.