Surgical Correction of Ischiopagus Tripus Conjoined Twins with Fused Pelvis: Enhancing Quality of Life through Orthopedic Intervention.

BACKGROUND The rarity of ischiopagus tripus conjoined twins complicates the surgical separation, owing to the lack of cases and high complexity. We aim to report our experience in performing orthopedic correction for ischiopagus tripus twins. CASE REPORT A pair of 3-year-old conjoined boys presented with a fused body at the pelvis region and only 1 umbilicus. There were 2 legs separated by shared genitalia and an anus at the midline, and 1 fused leg, which could be felt and moved by both of the patients. The twins also shared internal organs of the bladder, intestine, and rectum, as visualized through angiography computerized tomography scan. After several team discussions with the institutional review board, the hospital ethics committee, and both parents, it was agreed to perform disarticulation of the fused third limb, followed by correction of the trunk alignment by pelvic closed wedge osteotomy and internal fixation. We successfully reconstructed the pelvis using locking plates and additional 3.5-mm cortical screws and 1.2-mm stainless steel wire. CONCLUSIONS This report describes the presentation and surgical management of a case of ischiopagus tripus conjoined twins. It highlights the challenges involved in surgery and the importance of investigating these infants for other congenital abnormalities. Although surgical approaches for different sets of twins should be individually tailored, interventions aimed to provide optimal outcomes should consider ethical issues and parental/patient expectations. Even in situations in which the twins are inseparable, there is still room for surgical correction to be performed.

Utilizing Low-cost Vacuum-assisted Closure as Adjuvant Therapy in Soft Tissue Reconstruction for a Mangled Upper Extremity.

Soft tissue reconstruction using flaps in managing mangled injuries is occasionally insufficient due to large defects and low flap viability. Conversely, delaying the closure of the defect can elevate the risk of infection. Adjuvant therapy becomes essential in the management of mangled injuries. We aim to present the use of low-cost vacuum-assisted closure (VAC) as an adjuvant therapy for mangled injuries. We reported the case of a 20-year-old man who sustained a mangled injury to his left forearm in a traffic accident 4 hours before admission. The mangled extremity severity score was 9; however, the patient declined amputation. Although the initial reconstruction was done, the flap could only cover vital structures. VAC was utilized to address the uncovered portion of the defect, to promote optimal granulation and prevent infection. The reconstruction proceeded with a skin graft and wrist arthrodesis. At 1-year follow-up, viable tissue was obtained but contracture occurred at the metacarpophalangeal and proximal interphalangeal joints. We intend to perform functional reconstruction at a later stage. Although the benefits of VAC in wound management are well established, reports regarding its advantages in mangled injury management remain relatively scarce. The high cost of VAC is a limiting factor, particularly in developing countries. This prompts the need for an affordable VAC innovation with comparable efficiency to the commercial model. Reverse Aqua Pump VAC, our innovative low-cost VAC, shows satisfactory outcomes in managing patients with mangled injuries with mangled extremity severity score indicating amputation.

Synthesis and Characterization of SiO2-Based Graphene Nanoballs Using Copper-Vapor-Assisted APCVD for Thermoelectric Application.

This study describes a method by which to synthesize SiO2-based graphene nanoballs (SGB) using atmospheric pressure chemical vapor deposition (APCVD) with copper vapor assistance. This method should solve the contamination, damage, and high costs associated with silica-based indirect graphene synthesis. The SGB was synthesized using APCVD, which was optimized using the Taguchi method. Multiple synthesis factors were optimized and investigated to find the ideal synthesis condition to grow SGB for thermoelectric (TE) applications. Raman spectra and FESEM-EDX reveal that the graphene formed on the silicon nanoparticles (SNP) is free from copper. The prepared SGB has excellent electrical conductivity (75.0 S/cm), which shows better results than the previous report. Furthermore, the SGB nanofillers in bismuth telluride (Bi2Te3) nanocomposites as TE materials exhibit a significant increment in Seebeck coefficients (S) compared to the pure Bi2Te3 sample from 109 to 170 µV/K at 400 K, as well as electrical resistivity decrement. This approach would offer a simple strategy to improve the TE performance of commercially available TE materials, which is critical for large-scale industrial applications.

Neglected bilateral triphalangeal of the thumb delta type in adult case: A case report.

INTRODUCTION: In rare case, thumb has extra phalanges known as triphalangeal of the thumb (TPT). Patients with TPT can have difficulty doing work/activities that require high precision. Therefore, surgical intervention is essential. This report provides an approach for a patient with TPT. PRESENTATION OF CASE: A patient with TPT who underwent removal of extra phalanges and arthrodesis of interphalangeal (IP) joints is presented. The left thumb deviated 25o to ulnar while the contralateral part deviated 15o to radial. X-ray revealed both thumbs had extra delta-shaped middle phalanges. Complete excision of extra phalanges and simple arthrodesis of IP joints with two K-wires in 10° to 15° flexion was performed. Healing process ended without any complications and the patient had an improvement. DISCUSSION: Productive-age patients with TPT can have difficulty doing work and activities that require high precision, especially in the non-opposable type of the right hand. Furthermore, the female patient is highly emphasizing the cosmetics of her hand to increase her self-confidence. Therefore, surgical intervention is essential for this patient. We performed complete excision of extra phalanges and simple arthrodesis of IP joints with two K-wires in 10° to 20° flexion. The first K-wire is introduced intramedullary as a primary fixator for longitudinal alignment, and the second wire is inserted obliquely as an anti-rotation wire. Functional outcome was assessed after 6 months post-removal of the wire which gave a satisfying result. CONCLUSION: TPT is a rare anomaly which surgical intervention can improve the appearance and the precision of the hand.

The impact of vitamin D on clinical parameters and bone turnover biomarkers in ligature-induced periodontitis: An experimental study in rats.

Objectives and Background: Vitamin D has been associated with an increased risk of tooth loss and the severity of periodontal diseases. This study aimed to evaluate the effect of vitamin D on the clinical, radiographic, and serum level changes of bone turnover biomarkers in ligature-induced periodontitis. Methods: A total of 28 rats were included in this study and divided into test groups: Vitamin D supplement (VS), Vitamin D deficient (VD), and control (CG). Ligature-induced periodontal tissue destruction was performed and kept for 21 days. Clinical attachment and radiographic changes were recorded, and serum samples were tested for Osteoprotegerin (OPG), Dickkopf-1 (DKK1), Sclerostin (SOST), and Fibroblast growth factor 23 (FGF23) on the initial and final day of the study. Results: Groups that were made VD exhibited a more significant amount of clinical attachment loss (1.05 ± 0.50 mm) compared to the CG (0.83 ± 0.14 mm) and VS group (0.60 ± 0.13 mm), showing significant differences (p < 0.05). The radiographic alveolar bone loss amount was greater in the VD group compared to the other groups. For serum level assessment, the VD groups also exhibited a statistically significant reduction in the levels of OPG. They showed higher concentrations of DKK1, SOST, and FGF23 than other groups, with significant differences (p < 0.05). Conclusion: The results revealed that Vitamin D may play a role in the progression of periodontal disease. It was found to affect both clinical parameters and bone turnover biomarkers, suggesting its potential impact on the disease process.

Biceps Transfer to FDP-FPL Tendon Augmented with Fascia Lata to Restore Hand Function in Neglected Fracture Treated by Traditional Bone-setters.

Neglected bone fractures owing to the traditional bone-setter practices could lead to devastating complications. We aimed to describe the procedure and outcome of fascia lata augmentation for a forearm massive soft tissue loss case. Here, we report a case of a 14-year-old boy who presented to our hospital with a history of neglected right forearm fracture 4 years prior. He had been treated by a traditional bone-setter instead of seeking professional medical help, which resulted in wide-spread infection requiring debridement and, eventually, massive soft tissue loss, wrist radial deviation deformity due to epiphyseal growth arrest, and loss of all right-hand function. Intervention performed was biceps transfer to flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendon augmented with fascia lata with anterior capsulectomy, bilobed flap, and transfixing wire of wrist joint, followed by ulnar centralization with wrist arthrodesis. The patient reported satisfaction postreconstruction, owing to the enhancement of hand function and appearance. He also showed significant improvement in activities of daily living and penmanship, and was even able to continue his old hobby as a traditional puppeteer. Autologous fascia lata tendon transfer connecting biceps to FDP and FPL tendon alongside ulnar centralization with wrist arthrodesis is a novel technique that has promising results to improve hand function and appearance.

Modified femoral neck rotational osteotomy with supercapsular approach as hip preservation surgery technique for osteonecrosis of femoral head in young patient: A case report.

INTRODUCTION: Osteonecrosis of Femoral Head (ONFH) is a debilitating condition with multiple contributory etiological factors that can lead to significant hip pain and disability. All attempts should be taken to save the joint and postpone or avoid the necessity for a total hip arthroplasty (THA), particularly in young and active individuals. CASE PRESENTATION: A 21-year-old female with 5-year history of Systematic Lupus Erythematosus (SLE) and long-term use of corticosteroids presented with left hip pain and limping that worsening over the past two months. She had a Leg Length Discrepancy (LLD) of 1 cm. After radiological examination, she was diagnosed with left ONFH FICAT II-III ARCO stage 3. The measured Kerboul angle was 1800, indicating a medium necrotic area. We performed joint preservation surgery through Femoral Neck Rotational Osteotomy (FNRO) using Hip Supercapsular Approach. On a 3-month evaluation, the patient's pain improved significantly, and radiographic evaluation showed good healing of the osteotomy site. DISCUSSION: FNRO is a joint preservation surgery technique that aims to improve vascularization by moving the area of necrosis away from the weight-bearing region. The Hip Supercapsular Approach was chosen due to numerous advantages, such as short incisions, preservation of blood supply to the femoral head, and clear visualization of both necrotic lesion and healthy bone and cartilage. CONCLUSION: Modified FNRO with Hip Supercapsular approach may be a promising surgical procedure for young patients with ONFH. It yields favorable results in terms of pain alleviation, improvement in joint functionality, and radiological outcomes while maintaining a minimally invasive setting.

Impacts of COVID-19 pandemic on pediatric fractures: a 4-year evaluation of epidemiology and delayed treatment from prepandemic to pandemic period at a tertiary referral hospital.

Background: Definitive fracture surgery should be performed as soon as the patient's condition allows. However, there may be some delays in the treatment during a pandemic. Objective: This study aimed to investigate and compare the epidemiology and delays in pediatric fracture management during the pandemic and prepandemic periods in terms of how many cases were delayed, how long were the delays, and the causes for the delays of fracture treatment. Methods: This comparative-retrospective study was conducted in a tertiary referral hospital in Yogyakarta, Indonesia. The authors included all patients who presented to the hospital from 1 December 2019 to 30 November 2021 (pandemic group period) and from 1 December 2017 to 30 November 2019 (prepandemic group period). The collected data included: patients' age and sex, fractured bone, fracture type, concurrent fracture, hospital stay duration, treatment, need for multidisciplinary treatment, interval from arrival to treatment, and reasons for delayed surgical treatment. The data were obtained from the patients' medical records. Results: Results showed a decrease in the pediatric fracture cases during the 2 years pandemic period compared to the prepandemic period (75 vs. 135 cases). There was no significant difference in the evaluated parameters of demographic, fractured bone and type, hospital stay duration, treatment, other department involvement, and delayed surgical treatment for the fracture. The most common reason for the definitive surgical management delay was the need for medical condition improvements (n=63, 79.7%) and it was significantly associated with the need for multidisciplinary treatment approach (22.83 in isolated orthopedic cases vs. 87.5% in multidisciplinary cases; P=0.000). Conclusion: There was a decrease in the pediatric fracture cases during the 2-year pandemic period compared to the prepandemic period. The delay in definitive surgical management was mainly due to the need for the medical condition improvements and it was associated with the need for a multidisciplinary treatment approach.

A devastating complication from neonate knee septic arthritis due to conservative treatment: A case report.

INTRODUCTION: Septic arthritis in the neonate is a devastating condition that affects children and causes irreversible limb dysfunction or deformity. Neonatal septic arthritis is harmful and will end with skeletal abnormalities. PRESENTATION OF CASE: Neonate born with ileal atresia and underwent surgical treatment. Postoperatively, the patient experienced sepsis and was accompanied by septic arthritis. The patient was given triple IV antibiotic treatment without surgical debridement. Ten months later the deformity became prominent with physeal destruction of the affected area at distal femur. At age six the patient came to the orthopaedic outpatient clinic and there was a 3 cm limb-length discrepancy of both legs. DISCUSSION: Early diagnosis of septic arthritis is critical for successful treatment, since neonates with delayed proper diagnosis have been shown to have poor long-term prognosis. In our case the patient was only managed by IV antibiotics administration and continued with oral antibiotics. The reason for this decision due to general condition was improved after medication although clinically he still has a small amount of knee swelling. CONCLUSION: Neonatal septic arthritis is dangerous and may have a devastating long term complication. Surgical management should be considered as treatment of choice if there is a lack or no progression from clinical and laboratory examination after antibiotic adiminstration. Growth arrest on the distal femur will result in leg length disparity and angular deformity.

Tourniquet-Related Nerve Injury Following Reconstructive Surgery for Wassel Type IV Preaxial Polydactyly of 13-Year-Old Boy: A Case Report.

BACKGROUND Congenital thumb duplication comes under the Wassel type IV classification is the hypoplastic variety, with the extra digit growing from the dominant thumb's soft tissue alone. Excising the hypoplastic finger while reconstructing for the retained one has been the most adopted approach. Tourniquets are commonly utilized tools in orthopedic surgeries to reduce the amount of blood, thus enhancing the visibility. Unfortunately, tourniquet-related nerve injury (TNRI) is gaining more attention as a serious complication of tourniquet use in surgery. CASE REPORT A 13-year-old Asian boy with preaxial polydactyly Wassel type IV of the right hand underwent reconstruction surgery. A pneumatic tourniquet was applied at 200 mmHg on the right mid-upper arm and maintained for 90 min. After the surgery, the patient had total weakness with numbness, tingling, and burning sensation from his right upper arm to his fingertips. The neurological examination and nerve conduction studies (NCS) results were consistent with axonotmesis lesions. Pharmacological and physical rehabilitation therapy had successfully restored full motoric and sensory function after 6 months. CONCLUSIONS Nerve injury should be acknowledged as a possible complication from routinely-utilized tourniquets in orthopedic surgeries. Our cases may expand the need for further studies to establish a guideline for tourniquet use and TRNI management.

Control of morphology and crystallinity of CNTs in flame synthesis with one-dimensional reaction zone.

The growth of carbon nanotubes (CNTs) in a flame requires conditions that are difficult to achieve in a highly heterogeneous environment. Therefore, the analysis of the properties of the reaction zone within the flame is critical for the optimal growth of CNTs. In the present study, a comprehensive comparison between the CNT synthesis using a methane diffusion flame and a premixed flame is conducted regarding the morphology and crystallinity of the as-grown nanotubes. The premixed burner configuration created a flame that is stabilized through axisymmetric stagnation flow through sintered metal with one-dimensional geometry, different from a conventional co-flow flame. The significant difference in temperature distribution between the two flames causes a difference in the characteristics of the growth products. In the diffusion flame, the growth is limited to specific regions at certain height-above-burner (HAB) values with a temperature range of 750 to 950 °C at varying radial locations. The identified growth regions at different HAB values showed similar temperature distributions that yield CNTs of similar characteristics. Interestingly, the growth of CNTs in the premixed flame is dictated by only the HAB because the temperature distribution is relatively uniform along the radial directions but significantly different in the vertical direction. 17.3% variation in temperature in the axial direction successfully led to 44% and 66% variation in CNT diameter and crystallinity, respectively. The morphology control capability demonstrated in the present study is important for CNT functionalization for energy storage, nanosensor, and nanocomposite applications, where diameter and crystallinity are influential properties that govern the overall performance of the components.

Orthopedic Surgical Management of Complicated Congenital Popliteal Pterygium Syndrome: A Case Report.

Introduction: Popliteal pterygium syndrome (PPS) is a rare autosomal-dominant condition that causes fixed flexion deformity of the knee. The popliteal webbing and shortening of the surrounding soft tissue could limit the functionality of the affected limb unless it is surgically corrected. We reported a case of PPS in a pediatric patient encountered in our hospital. Case: A 10-month-old boy came with a congenital abnormally flexed left knee with bilateral undescended testis and syndactyly of the left foot. The left popliteal pterygium extending from the buttock to the calcaneus was observed, with an associated fixed flexion contracture of the knee and equine position of the ankle. Normal vascular anatomy was seen in the angiographic CT scan; therefore, multiple Z-plasty and fibrotic band excision were performed. The sciatic trunk was exposed on the popliteal level, and the fascicular segment was excised from the distal stump and sutured to the proximal stump under the microscope to extend the sciatic nerve for approximately 7 cm. No postoperative complications were reported. Multiple tendons and soft tissue reconstruction were performed when the patient was 2-year-old to correct the adductus and equine deformity of the left foot. Discussion: Surgical correction for popliteal pterygium demands staged techniques to deal with the shortened structure. In our case, multiple Z-plasty were performed, and the fibrotic band was excised until its base with meticulous consideration of the underlying neurovascular bundle. Fascicular shifting technique for sciatic nerve lengthening can be considered in unilateral popliteal pterygium with difficulty extending the knee due to shortened sciatic nerve. The unfavorable outcome of nerve conduction disturbance resulting from the procedure may be multifactorial. Still, the existing foot deformity, including a certain degree of pes equinovarus could be treated by multiple soft tissue reconstructions and adequate rehabilitation to achieve the desired outcome. Conclusion: Multiple soft tissue procedures resulted in acceptable functional outcomes. However, the nerve grafting procedure is still a challenging task. Further study is required to explore the technique in optimizing the nerve grafting procedure for popliteal pterygium.

Management of pediatric Madelung's deformity of the forearm due to physeal growth arrest of the distal ulna: a case report.

The authors presented a treatment option for Madelung's deformity due to physeal growth arrest of the distal ulna after Kirschner wire (K-wire) fixation for pediatric forearm fractures. Case presentation: A boy, 16 years old, suffered from a close fracture of the middle third of the left radius and ulna and was treated with open reduction and internal fixation (ORIF) pinning with intramedullary K-wires. Eight months after surgery, the implant was removed. There was no complaint for more than 10 years. Nevertheless, the patient complained of a bowing hand and was diagnosed with Madelung's deformity of the left forearm due to physeal growth arrest 12 years ago. The authors treated this patient with the release of fibrous tissue of the distal ulna, Darrach's procedure, and extensor carpi ulnaris (ECU) tenodesis, along with a close wedge osteotomy of the distal radius and an ORIF of the distal radius. Four months after surgery, the clinical and radiological results were satisfactory. Clinical discussion: Pinning across a physis has the potential to cause full or partial development to stop. Madelung's deformity is usually treated conservatively or surgically, depending on the severity of the symptoms. Darrach's procedure, ECU tenodesis, close wedge osteotomy, and ORIF of the distal radius are available options to treat Madelung's deformity. Conclusion: The use of transphyseal K-wires may result in physeal growth interruption. The developed Madelung's deformity can be satisfactorily managed by Darrach's procedure, ECU tenodesis, in combination with a close wedge osteotomy and ORIF of the distal radius.

Longstanding Volkmann ischemic contracture of the forearm following traditional bonesetter practice successfully treated with combined flexor origin slide and tendon transfer: A case report.

INTRODUCTION AND IMPORTANCE: The Volkman ischemic contracture (VIC) of the forearm is a sequel of the compartment syndrome of the forearm. There were no studies reported the outcome of surgical treatment for VIC, particularly the muscle origin slide procedure, in treating the VIC that had been developed more than 20 years. CASE PRESENTATION: We reported a 34 years old right-hand dominant painter with fingers flexion contracture, decreased hand mobility and sensation on her right hand. She had history of closed right forearm fracture when she was 10 years old that was treated by a traditional bonesetter. A week afterward, she experienced clinical presentation of compartment syndrome. Not long thereafter, the pain subsided but she started to have stiffness and discomfort in her forearm and hand condition. Twenty-four years later, she wants to get treatment for her hand. We diagnosed her with VIC, moderate degree based on Tsuge Classification. We then performed flexor origin slide procedure and tendon transfer. In 1.5 year of follow-up, a satisfactory functional outcome was noted. CLINICAL DISCUSSION: Flexor origin slide was the preferred treatment if the flexors still retain adequate strength. During the surgery, severe degeneration of FPL and FDP was found. Therefore, we performed tendon transfer to increase the grip strength. CONCLUSION: VIC is not uncommon following fracture treated in the traditional bonesetter. For moderate VIC, the flexor origin slide procedure and tendon transfer could still give benefit, even in the case of treatment delay of more than 20 years from onset.

Genetic Role in Recurrence of Idiopathic CTEV: A Systematic Review.

Background: Congenital Talipes Equinovarus (CTEV) is a multitude of deformities involving equinus, varus, adductus, and cavus deformities. Clubfoot affects 1 in every 1000 infants born worldwide, with various incidences according to geographical areas. It has been previously hypothesized that the possible genetic role in Idiopathic CTEV (ICTEV) might have a treatment-resistant phenotype. However, the genetic involvement in recurrent ICTEV cases is yet to be determined. Aim: To systematically review existing literature regarding the discovery of genetic involvement in recurrent ICTEV to date to further understand the etiology of relapse. Methods: A comprehensive search was performed on medical databases, and the review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed on several medical databases: PubMed (MEDLINE), Scopus, the Cochrane Library, and European PMC on May 10, 2022. We included studies reporting patients with recurring idiopathic CTEV or CTEV of unknown cause after treatment, reporting whole-genetic sequencing, whole-exome sequencing, Polymerase Chain Reaction, or Western blot analysis as methods of genetic analysis (intervention) and providing results of idiopathic CTEV genetic involvement. Non-English studies, literature reviews, and irrelevant articles were excluded. Quality and risk of bias assessments were performed using Newcastle-Ottawa Quality Assessment Scale for non-randomized studies where appropriate. The authors discussed data extracted with the primary outcome of gene(s) frequency being reported of their involvement in recurrent ICTEV cases. Results: Three pieces of literature were included in this review. Two studies analyzed the genetic involvement in CTEV occurrence, while one analyzed the protein types found. Discussion: With included studies of less than five, we could not perform other forms of analysis apart from qualitatively. Conclusion: The rarity of literature exploring the genetic etiology of recurrent ICTEV cases has been reflected in this systematic review, giving opportunities for future research.

Issues and Challenges in the Primary Prevention of Type 2 Diabetes Mellitus: A Systematic Review.

BACKGROUND: Primary prevention of type 2 diabetes mellitus (T2DM) is possible in at-risk populations, and prevention programmes have been shown to be effective in real-world scenarios. Despite this evidence, diabetes prevalence has tripled in recent decades and is expected to reach 700 million patients by 2045, making it one of the leading causes of death globally. This review is aimed at identifying the issues and challenges in the primary prevention of T2DM. METHODS: Scopus, Web of Science, PubMed and Ovid MEDLINE were systematically searched for published articles. Articles were screened based of inclusion and exclusion criteria. The inclusion criteria were: (1) published in 2010-2020, (2) full original article, (3) written in English, (4) qualitative, mixed-methods article, observational or interventional study. The exclusion criteria were: (1) animal study, (2) in vivo/in vitro study, (3) type 1 diabetes or gestational DM and (4) conference abstract, book chapter, report, and systematic review. Eligible articles were assessed using Mixed Methods Appraisal Tool (MMAT) by three assessors. RESULTS: A total of 11 articles were selected for qualitative synthesis from the initial 620 articles. The issues and challenges seen in T2DM primary prevention followed three themes: healthcare program (sub-themes: lack of resources, community partnership, participation, health literacy), health provider (sub-themes: lack of implementation, health care staff, collaboration, availability), individual (sub-themes: awareness, communication, misbehaviour, family conflict). CONCLUSION: Factors relating to healthcare programmes, health providers, and individual issues are the main challenges in T2DM primary prevention. By establishing sustainable preventative initiatives that address these issues and challenges in the primary prevention of T2DM, a reduction in T2DM prevalence could be achievable.

Diseases among Orang Asli community in Malaysia: a systematic review.

Orang Asli, the indigenous people of Peninsular Malaysia, is a minority population and placed behind in terms of socioeconomy, education and health. The Malaysian government has supported Orang Asli since the second Malaysia Plan in the 1970s, resulting in changes in their living standard, access to health, education and occupation. Hence, this review aims to assess the recent prevalence of diseases among Orang Asli in Peninsular Malaysia. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) review protocol guided this systematic review. The research question was formulated based on Population, Interest, Comparison and Outcome (PICO). The selected databases include Web of Science, Scopus, Ovid and EBSCOhost. The process of identification, screening and inclusion identified 33 articles. The mixed methods appraisal tool (MMAT) was then used to rank the quality of the articles. Selangor is the most frequent state involved in this review (12 studies), followed by Perak (10 studies), Pahang (10 studies) and Kedah (one study). We categorised into four categories of diseases, namely neglected tropical disease (n = 20), non-communicable disease (n = 6), nutritional status (n = 5), and hepatic disease (n = 2). The prevalence of diseases among Orang Asli is higher than in the general population, especially for soil-transmitted helminth (STH) and malnutrition. There is increasing research on non-communicable diseases due to an increasing trend in the socioeconomic status and lifestyle of the Orang Asli. Government agencies and private organisations must work together to empower Orang Asli with a healthy lifestyle, improve their socioeconomic status, and enhance food security, all of which will improve Orang Asli's health and reduce the prevalence of diseases.

An Update on Vitamin D Deficiency Status in Malaysia.

Vitamin D is essential for maintaining serum calcium levels, ensuring sufficient bone mineralization, immunomodulatory properties, and a protective effect on the cardiovascular system, renal disease, cancer, as well as in pregnancy. Vitamin D deficiency is prevalent worldwide, and it is not related to a country's development index. However, the data on vitamin D deficiencies are primarily taken from out-of-date, small-scale studies on target age groups or specific diseases, rather than from large-scale, population-based surveys. In Malaysia, for the past 16 years, studies were conducted involving adult men and women, pregnant women, postmenopausal women, adolescent, and children especially with specific diseases such as spina bifida, epilepsy, chronic liver disease, and atopic dermatitis. Only a few large surveys were conducted involving children and adolescents. Across the specific target population studied, vitamin D deficiency and insufficiency were seen particularly among females, Indians, and those of Malay ethnicity. This is related to widely known causes of vitamin D deficiency such as skin type (melanin) and sun avoidant lifestyles that include covering clothes, largely practiced by Malay Muslims in Malaysia. Other related causes or the high-risk groups are breastfed infants, the elderly, the obese, those on medications, and those characterized by fat malabsorption and geophysical factors. Vitamin D deficiency can be managed with pharmacological or non-pharmacological approaches, depending on the severity. The objective is to raise serum vitamin D to a normal level, hence, relieving the symptoms and reducing the adverse health outcomes. Despite no clear guidelines in treating vitamin D deficiency in Malaysia, this condition can be prevented with taking adequate vitamin D in food resources, sun exposure, or supplementation. Special attention should be given to high-risk groups including infants, obese patients, and the elderly.

Pediatric neglected distal femoral fracture with growth arrest.

INTRODUCTION AND IMPORTANCE: Distal femoral growth plate fracture is one of the most common growth plate fractures in the pediatric age, and associated with growth disturbance risk. Consequences that may arise are hindered growth, irreversible decrease in range of motion, instability, angular deformity and neurovascular issues. Fractures of the lateral condyle show a higher risk of developing sequelae compared to the medial side. CASE PRESENTATION: Corrective osteotomy of the distal femur was performed in patient with history of femoral fracture which undergone an ORIF procedure for the shaft at the previous hospital, while the lateral condyle fracture was treated conservatively. We did close wedge osteotomy medially and transferred the bone fragment to the lateral side as an open wedge to lengthen the lateral cortex. The leg-length discrepancy was reduced from 5 to 2 cm even though subsequent deformities may possibly occur. CLINICAL DISCUSSION: The management approach for fracture of distal femoral physis can be done conservatively or surgically. Unfavorable outcomes from the conservative approach gave more reasons to opt for a surgical approach. The growth plate location should be considered when deciding which level of osteotomy is best and the fixation points in younger patients. When physeal bars are formed due to the fracture stress on the growth plate, the treatment is based on the patient's age and the bar's size. CONCLUSION: Fractures of the distal femur involving a growth plate in children should not be considered a trivial case, and a comprehensive treatment plan should be coordinated.

On Bayesian approach to composite Pareto models.

In data modelling using the composite Pareto distribution, any observations above a particular threshold value are assumed to follow Pareto type distribution, whereas the rest of the observations are assumed to follow a different distribution. This paper proposes on the use of Bayesian approach to the composite Pareto models involving specification of the prior distribution on the proportion of data coming from the Pareto distribution, instead of assuming the prior distribution on the threshold, as often done in the literature. Based on a simulation study, it is found that the parameter estimates determined when using uniform prior on the proportion is less biased as compared to the point estimates determined when using uniform prior on the threshold. Applications on income data and finance are included for illustrative examples.