The Perioperative Lung Transplant Virome: Torque Teno Viruses Are Elevated in Donor Lungs and Show Divergent Dynamics in Primary Graft Dysfunction.

Primary graft dysfunction (PGD) is a principal cause of early morbidity and mortality after lung transplantation, but its pathogenic mechanisms are not fully clarified. To date, studies using standard clinical assays have not linked microbial factors to PGD. We previously used comprehensive metagenomic methods to characterize viruses in lung allografts >1 mo after transplant and found that levels of Anellovirus, mainly torque teno viruses (TTVs), were significantly higher than in nontransplanted healthy controls. We used quantitative polymerase chain reaction to analyze TTV and shotgun metagenomics to characterize full viral communities in acellular bronchoalveolar lavage from donor organs and postreperfusion allografts in PGD and non-PGD lung transplant recipient pairs. Unexpectedly, TTV DNA levels were elevated 100-fold in donor lungs compared with healthy adults (p = 0.0026). Although absolute TTV levels did not differ by PGD status, PGD cases showed a smaller increase in TTV levels from before to after transplant than did control recipients (p = 0.041). Metagenomic sequencing revealed mainly TTV and bacteriophages of respiratory tract bacteria, but no viral taxa distinguished PGD cases from controls. These findings suggest that conditions associated with brain death promote TTV replication and that greater immune activation or tissue injury associated with PGD may restrict TTV abundance in the lung.

Combined Spline and B-spline for an improved automatic skin lesion segmentation in dermoscopic images using optimal color channel.

In a computerized image analysis environment, the irregularity of a lesion border has been used to differentiate between malignant melanoma and other pigmented skin lesions. The accuracy of the automated lesion border detection is a significant step towards accurate classification at a later stage. In this paper, we propose the use of a combined Spline and B-spline in order to enhance the quality of dermoscopic images before segmentation. In this paper, morphological operations and median filter were used first to remove noise from the original image during pre-processing. Then we proceeded to adjust image RGB values to the optimal color channel (green channel). The combined Spline and B-spline method was subsequently adopted to enhance the image before segmentation. The lesion segmentation was completed based on threshold value empirically obtained using the optimal color channel. Finally, morphological operations were utilized to merge the smaller regions with the main lesion region. Improvement on the average segmentation accuracy was observed in the experimental results conducted on 70 dermoscopic images. The average accuracy of segmentation achieved in this paper was 97.21 % (where, the average sensitivity and specificity were 94 % and 98.05 % respectively).

Bibliometric Analysis of Malaysian Orthopaedic Journal using Scopus Database.

Introduction: The Malaysian Orthopaedic Journal (MOJ) (ISSN 1985-2533 / 2232-111X) is the official publication of the Malaysian Orthopaedic Association (MOA) and the ASEAN Orthopaedic Association (AOA). In May 2007, MOA published the first standalone issue of MOJ with the aim of disseminating new knowledge and providing updates in orthopaedics, trauma and musculoskeletal research. Since then, MOJ has grown significantly, achieving indexing in numerous databases and attaining a 2nd Quartile (Q2) rank in the Scopus database in 2022. This bibliometric analysis aims to explore the trends and distribution of articles published in MOJ. Materials and Methods: Bibliometric data for MOJ was extracted from the SCOPUS database, covering the years from its indexing to 2022. Information such as authors, country, document type, author's keywords, citations, and other parameters were extracted using the bibliometrix package in the R Studio software. The data were then presented in tables and illustrative graphs using the same software. Results: A total of 305 articles were retrieved from the Scopus database during the study period. Two-thirds of the articles were original articles and review articles. The highest number of citations received by an article is 56, and top ten articles in MOJ were authored by researchers from seven different countries, highlighting the journal's diversity. Despite receiving submissions from various countries, there is minimal collaboration between authors of different countries. Keywords such as "covid-19" and "pandemic" dominate the authors' keyword section due to the once-in-a-life-time COVID-19 which during the study period, resulting in numerous publications related to this issue. Conclusion: This bibliometric analysis reviews all the articles indexed in the Scopus database and provides insight into the contributors' information and the trends in orthopaedic research. By identifying the lack of collaboration between countries, it is hoped that this analysis can inspire more orthopaedic surgeons and researchers to collaborate and produce high-quality publications.

Femoral Neck Non-Union - A Biomechanical Solution with Valgus Sliding Subtrochanteric Osteotomy: A Case Report.

Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.

Long-term wear failure analysis of uhmwpe acetabular cup in total hip replacement.

A revision of a metal-on-ultra high molecular weight (UHMWPE) bearing couple for total hip replacement was performed due to aseptic loosening after 23 years in-vivo. It is a major long-term failure identified from wear generation. This study includes performing failure analysis of retrieved polyethylene acetabular cup from Zimmer Trilogy® Acetabular system. The UHMWPE acetabular cup was retrieved from a 61 years old male patient with ability to walk but limited leg movement when he presented to hospital in early 2016 with complaint left thigh pain. It was 23 years after his primary total hip replacement procedure. Surface roughness and morphology condition were measured using 3D laser microscope and Scanning Electron Microscope (SEM) to evaluate and characterize the wear features on polyethylene acetabular cup surface. ATR-Fourier Transform Infra-Red (ATR-FTIR), differential scanning calorimetry (DSC) and gel permeation chromatography (GPC) were used to characterize the chemical composition of carbon-oxygen bonding, crystallinity percentage and molecular weight of the polymer liner that might changes the mechanical properties of polyethylene. Nano indentation is to measure hardness and elasticity modulus where the ratio of hardness to elastic modulus value can be reflected as the degradation of mechanical properties. A prominent difference of thickness between two regions resulted from acentric loading concentration was observed and wear rate were measured. The linear wear rate for thin side and thick side were 0.33 mm/year and 0.05 mm/year respectively. Molecular weight reduction of 57.5% and relatively low ratio of hardness to elastic modulus (3.59â€¯× 10-3) were the indicator of major mechanical properties degradation happened on UHMWPE acetabular cup. This major degradation was contributed by oxidation and polishing wear feature accompanied with delamination, craters, ripple and cracks were the indication of extensive usage of UHMWPE from the suggested life span of acetabular cup application.

Apollo total knee replacements in University Malaya Medical Centre: a short-term outcome.

Total knee arthroplasty is the most preferred option for treatment of severe osteoarthritis of the knee. We report the short-term outcome of 48 total knee replacements in 31 patients utilizing the Apollo Total Knee System after an average follow-up of 48 months (range 15 to 70 months). Records of all patients who underwent TKA using Apollo Total Knee System were retrospectively reviewed. Functional outcome was evaluated using visual analogue scale for pain rating and the Oxford 12-item questionnaire. Postoperative radiographs of the replaced knees were assessed by using the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Degenerative osteoarthritis was the commonest indication for TKA. The average patient's age was 63.7 years (range, 30-77 years). The mean visual analogue scale for pre- and post-operative pain was eight and zero respectively. The mean Oxford 12-item questionnaire score pre- and post-operatively was 44.8 and 16.5 respectively. Patient satisfaction was notable in 98% of the cases with an average improvement in arc of flexion of 111 degrees. There were four failures; deep infection (one) and aseptic loosening (three) giving rise to a 94% implant survivor. The short-term results of this series is comparable with or better than a number of outcome studies of the Apollo Knee System or other implants of similar design.

Revision total hip arthroplasty using impaction bone grafting technique.

A variety of reconstructive options exist for revision of both femoral and acetabular components in total hip replacement surgery. The use of impaction bone grafting with morsellised allograft has shown promising results in revision total hip arthroplasty. It works as a biologic reconstitution of bone stock defects and provides a solid construct with stable fixation. We present a case of bilateral revision total hip arthroplasty with poor bone stock where reconstructive surgery was done by using impaction bone grafting, mesh and C-stem implants.

The regulation of plasma relaxin levels during human pregnancy.

The factors that determine the circulating levels of relaxin during pregnancy have been investigated by comparing the plasma levels of relaxin throughout pregnancy in women who became pregnant spontaneously (singleton, n = 240) or following superovulation (singleton and multifetal pregnancies (two to ten conceptuses), n = 83). Some of the women with multifetal pregnancies underwent selective fetal reduction to twin pregnancies. Relaxin levels were higher at 7-34 weeks of gestation in singleton pregnancies achieved following superovulation when compared with levels in spontaneously conceived singleton pregnancies (p < 0.05-0.001). In samples obtained between 10 and 12 weeks of gestation (before fetal reduction for the multifetal pregnancies), plasma relaxin levels correlated with fetal number (r = 0.526, P = 0.0001). Reduction in fetal number to a twin pregnancy did not alter relaxin levels. These data suggest that the circulating levels of relaxin throughout pregnancy are determined during the cycle of conception by gonadotrophin stimulation, and within the first 10 weeks of pregnancy by the luteotrophic stimulus from the conceptus. Furthermore, once corpus luteum synthesis of relaxin is established, then reduction in the luteotrophic stimulus does not appear to affect it.

Determinants of the utilization of maternal and child health services in Jordan.

The utilization of antenatal, delivery and postnatal services by a random sample of married women in Jordan during their most recent pregnancy resulting in a live birth is analysed. Marked variations are shown in the use of these services and of preventive infant care for women living in urban and rural areas. Women with increasing levels of formal education and those living near services were significantly more likely to use services. If effective coverage of these services is to be achieved then it is suggested that greater emphasis should be placed upon outreach and realistic social marketing.

PIP: A survey of 1765 married women in Jordan with a recent live birth revealed wide variations in the utilization of antenatal, delivery, and postnatal services. The respondents were representative of the total population of Jordan, with 46% living in the 3 main cities, 20% in the other urban localities, and 34% in smaller settlements. 50% of respondents received no antenatal care; this rate was highest (69%) among rural women and lowest (38%) among those from the urban centers. 48% delivered in a hospital, with a range from 38% among rural women to 60% in urban centers. 43% of those living in towns compared with only 35% of those in rural areas made use of postnatal services. 72% of respondents in rural areas versus 7% of those in the 3 main cities and 10% of women in other urban areas lived further than 5 km from a maternal-child health clinic. 53% indicated they had not received any health education dealing with pregnancy and delivery. The use of antenatal services was significantly associated with the following individual and health service access variables: level of female education, duration of marriage, increasing female age, parity 4-6, and low distance to health facility. Time and cost involved in travelling to services were significantly associated with nonuse. These findings suggest a need for more effective maternal-child health program coverage and outreach.

Long-term prognosis of 69 patients with dermatomyositis or polymyositis.

OBJECTIVES: To assess the long-term prognosis of dermatomyositis and pol myositis. METHODS: 69 patients with dermatomyositis or polymyositis were selected according to the diagnostic criteria of Bohan and Peter and were followed up for a minimum of 6.3 years (for surviving patients) (mean 11.6 years). Clinical and biological features, and pulmonary and muscle parameters were considered as prognostic factors for death. Functional disability was assessed using a 4-stage grading system. RESULTS: 30 deaths (43.5%) occurred mainly due to cardiovascular (8), pulmonary (8), carcinomatous (5) and iatrogenic complications (5). Survival rates were 82.6% at 1 year, 73.9% at 2.66, 7% at 5 and 55.4% at 9. Significant prognostic factors for death (Cox model with time-dependent covariates) were old age (p < 0.0001), dysphonia (p < 0.001), pulmonary interstitial fibrosis (p < 0.02), absence of dysphagia (p < 0.02) and asthenia-anorexia (p < 0.05). Dermatomyositis and polymyositis subgroups had slightly different significant prognostic factors for death: old age, cancer, pulmonary interstitial fibrosis and asthenia-anorexia for dermatomyositis; old age, failure to improve muscle strength in response to treatment after one month, and the absence of myalgia as presenting symptom for polymyositis. At the end of the follow-up, 33/39 surviving patients (84.6%) had no or insignificant muscular disability, whereas 3 children were bedridden due to generalized calcinosis. CONCLUSIONS: High mortality occurred in the first year, and the survival rate decreased continually up to 9 years. The main prognostic factor for death is old age, but dermatomyositis and polymyositis must be considered separately. General features (pulmonary fibrosis, cancer, asthenia-anorexia) are involved in dermatomyositis, whereas muscular symptoms are the most significant in polymyositis. The long-term functional prognosis was fairly good, except for generalized calcinosis, which tended to occur in childhood dermatomyositis.

Seventeen new 14- and 15-crown-formazans: their synthesis and evaluation in spectrophotometric determination of lithium.

A number of new crown-formazans with 14 and 15 membered rings have been synthesized, characterized and investigated as selective spectrophotometric chelating agents for lithium. The effect of sodium ion concentration on the background lithium signal was studied. A comparative study for the sensitivity of these new crown-formazans in spectrophotometric determinations was studied and compared with those reported previously. The three new 14- and 15-crown-formazans 4a-c containing the pyridyl N-oxide at the formazyl carbon showed the highest selectivity to lithium determination in the presence of sodium ion.

Evaluation of some new 14- and 15-crown-formazans as carriers in cesium ion selective electrodes.

A number of new crown-formazans with 14 and 15 membered rings have been investigated as selective neutral carriers in cesium ion selective electrodes. Two plasticizers (NPOE and NPBnE) were studied. The new 14-crown-formazan 4a containing the 4-pyridyl N-oxide at the formazyl carbon exhibited the highest selectivity in cesium ion selective electrodes, especially towards the two low selectivity monovalent ions K(+) and NH4(+). Also, membranes containing the plasticizer NPBnE showed better cesium selectivity relative to most ions than those containing NPOE. Membranes containing 4a and variable compositions of plasticizers, potassium tetrakis-(p-chlorophenyl)borate (KTpClPB), and trioctylphosphine oxide (TOPO) were studied in order to prepare an electrode with the optimum cesium selectivity. The highest selectivity for cesium was achieved with the two electrodes designated d and e with membranes containing the ionophore 4a, NPBnE and KTpClPB with and without TOPO. Selectivities are reported relative to sodium, potassium, barium, calcium, ammonium, lithium, cobalt, and magnesium.

Superovulation, IGFBP-1 and birth weight.

In this study, the effect of superovulation on the circulating levels of insulin-like growth factor binding protein-1 (IGFBP-1) has been investigated. IGFBP-1 levels were measured in singleton pregnancies achieved either naturally (n = 203) or following superovulation, in-vitro fertilisation and embryo transfer (IVF-ET) with either pituitary desensitisation with buserelin and superovulation with human menopausal gonadotrophin (b/hMG) followed by IVF-ET (n = 15) or with clomiphene citrate and hMG (CC/hMG) followed by IVF-ET (n = 15, 1st trimester only). The circulating levels of IGFBP-1 were similar in all three groups during the first trimester, and in both normal and b/hMG pregnancies in the second, but were significantly higher during the third trimester in b/hMG pregnancies than in normal pregnancies (P = 0.0002). The birth weights were significantly lower in the b/hMG group (P = 0.04), but not in the CC/hMG group compared with natural conceptions. Gestational age at delivery was similar in control and b/hMG pregnancies, but significantly reduced in CC/hMG pregnancies (P = 0.04). These data suggest that pregnancies achieved following superovulation with b/hMG are associated with elevated levels of IGFBP-1 during the third trimester of pregnancy and reduced birth weight.

New sites of Bulinus truncatus and indigenous cases of urinary schistosomiasis in Jordan.

Thirty-two autochthonous cases of Schistosoma haematobium are reported from Ghore As-Safi, Karak Lowlands, Jordan. All infected persons were males (9-46 years-old). New unusual breeding sites for Bulinus truncatus are discovered. The past and current distribution of the snail intermediate host is given.

Early results of metal on metal articulation total hip arthroplasty in young patients.

We report our early experience of 20 cases of metal on metal articulation total hip arthroplasty in 19 young patients. Avascular necrosis of the femoral head (63%) was the commonest diagnosis for patients undergoing this procedure, followed by osteoarthritis (21%). In general, most of the patients were young and physically active with an average age of 43.1 years (range, 25 to 58 years). The average follow-up period was 18 months (range, 7 to 46 months). The mean total Harris Hip Score preoperatively and at final follow-up was 31 points and 89 points respectively. The mean total Pain Score improved from an average of 11.5 to 41.1 points at final follow-up. Sixteen (84%) of the patients had a good to excellent hip score. There was one dislocation, which stabilized after reduction and conservative management. One case of early infection underwent a two-staged revision.

Surveying disabilities in Mafraq District in Jordan in view of approaching community based rehabilitation.

Disabilities in Mafraq District in Jordan were identified using active case detection. The identified disabilities were characterized by type, sex and age of the disabled as well as other variables pertaining to the reproductive history of their mothers and certain socioeconomic variables pertaining to their families. The results indicated an unmet need regarding services addressing the disabled and that they belong to poor families with high prevalence of illiteracy. The results also showed that the prevalence of consanguineous marriages as well as pregnancy at the two extremes of women's reproductive life is associated with congenital disability. The results were availed to the responsible authorities to facilitate embarking on Community Based Rehabilitation (CBR) in the district.

Maternal mortality in Mafraq District in Jordan.

The present study followed a multidimensional approach to determine maternal mortality ratio in Mafraq district in Jordan. It included active case (maternal deaths) surveillance combined with Civil Registry and hospital records review. Mafraq, by virtue of its geographic and demographic characteristics, is supposed to have a very high toll of maternal deaths and hence, generalizations reflecting the maximum expected maternal mortality ratio in Jordan could be made. The ratio, and as an average for the five years 1987-1991 covered in retrospect by the study was 42 deaths per 100,000 live births, very close to the estimated one. Establishing a baseline maternal mortality ratio and outlining risks pertaining to maternal survival as done in this study is an important prerequisite for interventions to reduce these risks and monitor progress towards reduction of maternal mortality ratio by half by the year 2000 which is a global goal to which Jordan is committed. The multidimensional approach followed by this study is shown to be superior to single source approaches in determining maternal mortality ratio in instances where populations are small and death registration is weak. The study suggests that maternal deaths (preferably as circumstances around the death and not as ICD coded, to avoid under reporting) should be reported in the same manner as notifiable diseases until improvements in death registration are completed and registries are accurate and valid.

Knee laxity of Malaysian adults: gender differentials, and association with age and anthropometric measures.

BACKGROUND: Knee laxity measurements have been shown to be associated with some medical conditions such as chronic joint pain and collagen tissue diseases. The aim of this study was to determine the effects of demographic factors and anthropometric measures on knee laxity. MATERIALS AND METHODS: Data were collected from 521 visitors, staffs and students from the University Malaya Medical Centre and University of Malaya between December 2009 and May 2010. Knee laxity was measured using a KT-1000 arthrometer. Multiple regression analysis was used to find the association of knee laxity with age and anthropometric measures. RESULTS: Using ANOVA, knee laxity did not show significant differences among ethnic groups for both genders. The average knee laxity in men was 3.47 mm (right) and 3.49 mm (left); while in women were 3.90 mm (right) and 3.67 mm (left). Knee laxity in women was significantly higher (right knee p<0.01 and left knee p<0.05) than men. Right knee laxity of men was negatively associated with height (p<0.05) and BMI (p<0.05); also a negative association was observed between left knee laxity and BMI (p<0.05). Overweight and obese men had less knee laxity than normal weight and underweight individuals. Elderly men and women (age 55 and above) had lower knee laxity (p<0.01) than young adults (ages 21-39). CONCLUSION: These results suggest that age and body size are important factors in predicting knee laxity.

Prognostic role of serum interleukin-18 in Egyptian patients with hepatitis c virus-related hepatocellular carcinoma treated by radiofrequency ablation.

Aim: The aim of this study is to identify the prognostic value of serum interleukin (IL)-18 level in hepatitis C virus (HCV) -related hepatocellular carcinoma (HCC) patients. Materials and Methods: This study was conducted in Tropical Medicine department and HCC unit in Ain Shams University Hospitals. It included 35 patients with HCV associated HCC fit for radio frequency ablation and 20 healthy control subjects. Serum IL-18 level was measured for all participants at the beginning of the study. Patients were followed-up for 1 year then serum IL-18 re-measured at the end of the follow-up period. Results: Pre-intervention serum IL-18 level was significantly higher in patients than healthy control subjects and was associated with bad clinical, laboratory or radiological prognosis. Post follow-up mean value of IL-18 level was significantly lower than pre-intervention level. Conclusion: Higher pre-intervention serum IL-18 level in HCV -related HCC patients level was associated with bad prognosis either clinically, laboratory or radiologically.