Stroke: prevention is better than cure. Early education is the way forward

Stroke is a global health problem which is associated with morbidity and mortality. In Malaysia, stroke is one of the top five leading causes of death [1,2]. According to the Third National Health and Morbidity Survey (NHMS) in 2006, the prevalence of stroke was estimated to be 0.3% and progressively increased in trend. The fourth NHMS in 2011 reported the incidence as 0.7%. The mean age of stroke patients is between 54.5 to 62.6 years with male preponderance [1,2]. Approximately 80% of stroke cases in Malaysia are ischemic in origin and the remaining as hemorrhagic. This is comparable with reported data from other countries [3,4]. There are many stroke-related risk factors. These can be divided into modifiable and non-modifiable factors such as age, sex and race. Hypertension is the major modifiable risk factor for stroke accounting for 53.2 – 62.6% followed by diabetes mellitus (27.4-55.2%) and hypercholesterolemia (4.8-37.3%). Other risk factors include smoking, ischemic heart disease and history of transient ischemic attack [1-8]. Stroke can cause high level of emotional and physical distress to both the patient and caregiver and carries a substantial burden to the government. For major stroke, the average hospital-stay is estimated around 9.8 days and 3.6 days for minor stroke. The estimated cost of admission for major stroke is MYR 9000 and MYR 3353 for minor stroke [1,9]. Prevention is always better than cure. Early education should be the best method for government to move forward. School children should be taught about healthy diet and lifestyle. These subjects should be included in the curriculum and continuously taught from primary school up to higher level. Malaysia is the most obese country in Asia. The 2015 NHMS reported that 5.6 million of adult age 18 and above was overweight and 3.3 million was obese. The abundance of food and to some extent changing to Western diet is responsible for high obesity rate in Malaysia. Poor lifestyle posed a serious threat to life and health. Smoking habit among school children and adolescents are alarming [10]. Twenty years ago, it is almost difficult to see young female adolescent to smoke in the street or café. Nowadays, it has become a trend and lifestyle. Lack of exercise is another major contributing factor to obesity. Sedentary lifestyle doubles the risk of coronary heart disease, diabetes and obesity [1,10]

Robotic neurosurgery: an active vision Guided robotic arm for endoscopic and Bone drilling maneuvers

Surgical robots have been appearing in the operating room over the past decade and neurosurgery was one of the pioneer in this area. The aims of this study were to create a program using V+ module and to design a suitable end effector capable of holding bone perforator and endoscope. In addition, the ability and accuracy of the robot perfonning bone drilling and endoscopic maneuvers were assessed. The study was divided into two parts which were bone drilling and endoscopic maneuvers. In bone drilling section, immediately after image processing, the coordinates of the target were detennined. The robotic arm (together with bone perforator) was simulated and driven to the target. The insertion force by the robot was placed at minimal as to allow the bone perforator to stop once it hit the plasticine. After a burr hole was made, the robot was instructed to move away from the target. A total of 30 burr holes were performed at 5 different positions (supine, sitting, right and left lateral, and prone). In endoscopic maneuver section, the robot was initiated to recognize the targeted burr hole. The robotic arm was simulated and driven to the targeted burr hole and placed the endoscope into the burr hole. On command, the robot was instructed to move forward (insertion) and outward. A total of ten burr holes were examined. In supine position, the accuracy was 1.0mm with the repeatability value ranged from 0.04mm to 0.17mm. Time taken to do burr holes was in the range of 13.1 to 14.3 seconds. In sitting position, the accuracy ranged from 0.1 mm to 1.0mm with the repeatability ranged from 0.1 Omm to 0.92 mm and time taken to perform burr holes ranged from 6.6 to 10.5 seconds. In left lateral position, the accuracy was 1.0mm with repeatability of 0.03 to 0.12 mm and in right lateral position, the accuracy ranged from 1.0mm to 2.0mm with repeatability of 0.10mm. Time taken to drill in left and right lateral was in the range of 14.0 to 15.4 seconds and 12.5 to 13.0 seconds respectively. In prone position, the accuracy ranged from 0.5mm to 1.0mm with repeatability of 0.08 to 0.31 nun and the time taken to drill was in the range of 9.0 seconds to 16.6 seconds. For endoscopic procedure, the accuracy ranged from 0.3mm to 1.0mm with repeatability of 0.31nun to 0.77mm and the endoscope was able to be inserted into all 10 burr holes. In summary, the present robotic arm has the ability to perform basic surgical procedures although there were some limitations. Further study is needed to refine the robotic system

Nerve conduction study of the upper limb and lower limb ii 250 subjects. a comparison between age, sex, height, and weight

Introduction: Nerve conduction study (NCS) is an important tool as part of investigating some neurological disorders. NCS can measure both motor and sensory velocities. There are specific personal factors that can influence the nerve velocity which include age ,sex , height and weight. Objectives: The aim of this study was to investigate the conduction velocities of nerves both in the upper limb and lower limb. The other aim of this study was to observe the influence of specific personal factors like age, sex, height and weight on nerve conduction velocities (NCVs). Material and Method: Two hundred fifty healthy subjects were recruited in this study. They were mainly hospital staffs. The subjects were excluded if they have any neuromuscular disorders or any diseases that can have direct or indirect effect on nerve function such as diabetes or carpal tunnel syndrome. The subjects were divided into different age, height and weight (expressed as body mass index or BMI) groups. The nerves that were tested include: median and ulnar nerves for the upper limb (both motor and sensory velocities) and common peroneal (motor velocity) and sural nerves (sensory velocity) for the lower limb. Surface electrodes were used. The temperature in the laboratory was kept constant above 27 ° C. The targeted nerve was suprarnaximally stimulated using square wave with a duration of 0.2ms and the action potential was picked up by the recording electrodes. The length of each nerve was estimated with a flexible measuring tape. Nerve velocities (rnls) were calculated and documented. Results: Of 250 subjects, 137 were male and 113 were female. The mean age, height and BMI were 34.46 ± 10.79 years, 159.47 ± 8.53 (em) and 23.99 ± 4.20 (kglm2 ). Reduction in NCVs in median, ulnar, common peroneal and sural nerves across different age. Slowing ofNCV was seen only in common peronei nerve across different height groups. There were reduction in NCVs of median, ulnar (motor component), common peroneal and sural nerves as BMI increased. Conclusion: In conclusion, our results showed that age has great influence on nerve velocities. We observed reduction in NCVs as the age increased in median and ulnar nerves (upper limb) and common peroneal plus sural nerves (lower limb) . However, mixed trend ofNCVs were seen across different height and body mass index group

The needs of traumatic brain injury survivors' caregivers and the implication required during the COVID-19 pandemic: Public health issues

Background: Traumatic brain injury (TBI) survivors require attention and dependence from their primary caregiver. This is because TBI is a defect that affects both the psychological and physical functions of the victim. Caregivers play an essential role in providing the adequate care victims need to adjust to the new problems they may experience due to their condition, as family members alone may not be able to provide for their needs. In particular, TBI caregivers may face specific challenges when assisting their patients in handling unexpected changes to their daily routines. Therefore, this quantitative study aims to explore the needs of caregivers, their coping mechanisms towards stressful and traumatic circumstances, and how they provide care to their loved ones during the COVID-19 pandemic.Design and Methods: It was conducted with ten caregivers of individuals suffering from traumatic brain injury, that were selected using a theoretical sampling method. Data were obtained using a semi-structured interview guide, which helped the caregivers provide their responses. Meanwhile, data analysis was performed using the NVIVO analysis software.Results: The results showed that there were, three significant themes namely, (a) Support needed, (b) the information need for care, and (c) developing self-resilience. The results also showed that caregivers really need support from the various parties, and the participants lack information on specific care techniques for the severe traumatic brain injury (TBI) survivors.Conclusion: In conclusion, caregivers require approval and seek more useful information to provide excellent care to their loved ones. Being aware of the caregiver's needs would enable them to offer improved customized care

Functional outcomes 6 months after severe traumatic brain injury following admission into intensive care unit: a cohort study in two tertiary hospitals

Severe traumatic brain injury (TBI) survivors show physical and functional improvements but continue to have cognitive and psychosocial problems throughout recovery. However, the functional outcome of severe TBI in Malaysia is unknown. The objective of this study is to measure the functional outcomes of severe TBI within 6 months post-injury. A cohort study was done on 33 severe TBI survivors. The Glasgow Outcome Scale–Extended (GOSE) was used in this study. The mean age of the participants was 31.79 years (range: 16-73 years). The logistic regression model was statistically significant, χ²(5, N = 33) = 29.09, p < .001. The length of stay (LOS) in incentive care unit (p = .049, odds ratio = 6.062) and duration on ventilator (p = .048, odds ratio = 0.083) were good predictors of the functional outcomes. Future research should focus on larger sample size of severe TBI in Malaysi

A disastrous complication of colonephrocutaneous fistula: brain abscess

A rare case of colonephrocutaneous fistula complicated with a brain abscess is a lifethreatening clinical condition. We report a case of a 35-year-old lady with a history of partial left nephrectomy complicated with left colonic injury who presented with persistent vomiting associated with headache and blurry vision for 5 days. Clinically, she was confused and restless with Glasgow Coma Scale (GCS) of 12/15, however her pupils were equal and reactive bilaterally. Other neurological examinations were unremarkable. Abdominal examination noted functioning ileostomy with a skin opening at left lumbar with pus discharge. Diagnosis of brain abscess was made after contrasted computed tomography (CT) scan of brain. Urgent open drainage surgery was done followed by long course of antibiotic. Contrasted CT abdomen and fistulogram revealed a left colo-psoas and left nephrocutaneous fistula, hence, she was subjected for surgery. Intraoperatively, there was a fistula tract connecting the descending colon, remaining of left kidney, and the skin. Thus, left hemicolectomy, completion of left nephrectomy, and fistulectomy was done. The long-standing infective foci can lead to septic emboli and causes formation of abscess at distant site. Its management is challenging involving both medical and surgical therapy

Symptomatic cerebral ependymal cyst: a case report

Cerebral ependymal cyst is a rare benign neuroepithelial cyst. We report a case of cerebral ependymal cyst in a 62-year-old lady who presented with status epilepticus. She gave history of progressive right occipital headache over a year. Magnetic Resonance Imaging of the brain showed a large occipital cyst. She underwent a right craniotomy, deroofing of the cyst and insertion of Ommaya catheter. The clinicopathological aspects of the cyst are discussed

Biomechanical analysis of patient-specific femur model of osteogenesis imperfecta with cortical and cancellous bone

Osteogenesis imperfecta (OI) is a fragile bone disease characterized by easy fractures. The femur consists of cortical and cancellous bone, each with different mechanical properties. Bone fractures often occur throughout patients’ lifetime. However, doctors still have no quantitative method to predict fractures. This project’s purpose is to investigate the mechanical behaviour of patient-specific OI femur from the finite element analysis. The fracture risk in daily activities (ADL) were examined. All the stress values were judged by the fracture criteria, assumed as 115 MPa. The exercises that exerted force more than 6 times of body weight could cause fractures. Cancellous bone was not affected in any case of ADL. The effects of force and stress on cancellous bone and its impact on fracture risk are negligible