One-stage bilateral anterior bikini total hip replacement − experience of two cases

Bilateral hip arthrosis is commonly seen and two-staged bilateral Total Hip Arthroplasty (THA) is a preferred choice of treatment due to the fear of complications associated with one-stage bilateral procedures. However, many studies now indicate that the treatment option should be patient specific. We report two cases of one-stage bilateral anterior THA. First, a 54-year-old male operated over a year ago and second a 59-year-old female operated 6 weeks ago. Both presented with a long history of bilateral grade IV hip arthritis causing them severe pain, compromised gait and disturbed sleep. Post-surgery, they were mobilized within few hours after surgery as part of our enhanced recovery programme. There was a drastic increase in their Harris Hip Scores from 34.5 in case 1 and 19.2 in case 2 to 100 for both hips in both patients. They reported excellent recovery, regained normal gait pattern, returned quickly to their routine lifestyle and felt it was an economical option. We conclude that one-stage bilateral bikini anterior THA is a preferred surgical option for patients with bilateral hip arthritis that are medically fit

Accuracy of bone resection in total knee arthroplasty using CT assisted-3D printed patient specific cutting guides

Introduction: We conducted this study to determine if the pre-surgical patient specific instrumented planning based on Computed Tomography (CT) scans can accurately predict each of the femoral and tibial resections performed through 3D printed cutting guides. The technique helps in optimization of component positioning determined by accurate bone resection and hence overall alignment thereby reducing errors. Methods: Prophecy evolution medial pivot patient specific instrumented knee replacement systems were used for end stage arthrosis in all consecutive cases over a period of 20 months by a single surgeon. All resections (4 femoral and 2 tibial) were measured using a vernier callipers intraoperatively. These respective measurements were then compared with the preoperative CT predicted bone resection surgical plan to determine margins of errors that were categorized into 7 groups (0 mm to ≥2.6 mm). Results: A total of 3618 measurements (averaged to 1206) were performed in 201 knees (105 right and 96 left) in 188 patients (112 females and 76 males) with an average age of 67.72 years (44 to 90 years) and average BMI of 32.3 (25.1 to 42.3). 94% of all collected resection readings were below the error margin of ≤1.5 mm of which 90% showed resection error of ≤1 mm. Mean error of different resections were ≤0.60 mm (P ≤ 0.0001). In 24% of measurements there were no errors or deviations from the templated resection (0.0 mm). Conclusion: The 3D printed cutting blocks with slots for jigs accurately predict bone resections in patient specific instrumentation total knee arthroplasty which would directly affect component positioning

When do patients drive after minimally invasive anterior hip replacements? A single surgeon experience of 212 hip arthroplasties

Introduction: Patients desire to return to normal activities soon after hip arthroplasty, with driving often being an integral component. We aimed to determine when patients resumed driving following a minimally invasive anterior bikini hip replacement and when they returned to work. Methodology: All consecutive patients undergoing elective primary bikini hip replacements between January 2017 and April 2018 were included in the study. Patients who did not drive were excluded. A detailed questionnaire was sent to patients 3–6 weeks after surgery to record their driving status. Fifty patients were randomly selected to assess flexion at the hip, knee and ankle joints while seated in the driver's seat of their own vehicle. Results: Altogether 212 anterior bikini total hip replacements (L = 102, R = 108 and 1 bilateral one stage) were performed in 198 patients (F = 129 and M = 69) with a mean age of 69 years. A total of 76% patients returned to driving within the first 3 weeks after surgery, of which 25 (14%) resumed driving within the first post-operative week, 71 (39%) in the second week and 42 (23%) in the third week. Among them, 98.4% stated they were confident when they first started driving and 90.66% stated they were more comfortable driving after surgery than before. Employed patients returned to work within 1–79 days (mean = 24 days). Conclusion: Surgeons may allow patients to resume driving within 1 week after anterior hip replacement and return to work within 3 weeks if they are medically fit and deemed safe

Do Nonsteroidal Anti-Inflammatory Drugs Cause Endoprosthetic Loosening? Mid- to Long-Term Follow-Up of 100 Total Hip Arthroplasties after Local NSAID Infiltration

We evaluated the effect of local infiltration of NSAIDs on prosthetic fixation at mid- to long-term follow-up of total hip arthroplasties. Intra-articular local NSAID (ketorolac) was injected into hip joints and surrounding tissues intraoperatively and postoperatively as a part of multimodal pain management protocol. Clinical and radiographic evaluation was performed for any evidence of component loosening or failure and clinical outcomes in 100 total hip joint arthroplasties with a mean follow-up of 7.3 years (4.9 to 11 yrs). Radiographic analysis at the most recent follow-up showed no evidence of loosening, subsidence, or migration and no evidence of impending failure. Clinical outcomes showed improved Harris hip scores. Intra-articular NSAID used in the intraoperative/postoperative period in hip arthroplasty showed no evidence of prosthetic loosening at mid- to long-term follow-up

Health Information Engagement Factors in Malaysia: A Content Analysis of Facebook Use by the Ministry of Health in 2016 and 2017

Health organizations have widely adopted social media for health promotion, public health communication conveyance, and organizational promotion activities. However, little published data exists on the factors that facilitate health information diffusion in South East Asia, especially Malaysia compared with Western countries. This study aimed to investigate factors associated with good engagement rates among internet users on the Facebook (FB) page of Ministry of Health Malaysia. In this observational study, 2123 FB posts were randomly selected. Data dated from 1 November 2016 to 31 October 2017 was gathered from the Facebook Insight. The logistic regression model was applied to identify factors associated with good engagement rates. This study found that a FB post with a good engagement rate was significantly associated with a health education post (Adjusted Odd Ratio (AOR): 3.80, 95% Confidence Interval CI: 3.02⁻4.78, p < 0.001), a risk communication post (AOR: 1.77, 95% CI: 1.39⁻2.26, p < 0.001), a post in the afternoon (AOR: 1.76, 95% CI: 1.34⁻2.31, p < 0.001) or in the evening (AOR: 1.48, 95% CI: 1.20⁻1.82, p < 0.001), and a video format (AOR: 3.74, 95% CI: 1.44⁻9.71, p = 0.007). Therefore, we present the first comprehensive analysis of health information engagement among internet users in Malaysia. The growing trends of online health information-seeking behaviors and demand for the availability of validated health information require effective strategies by public health organizations to disseminate health information and achieve better audience engagement on social media

In Vitro and in Vivo Effects of Three Different Mitragyna speciosa Korth Leaf Extracts on Phase II Drug Metabolizing Enzymes—Glutathione Transferases (GSTs)

In the present study, we investigate the effects of three different Mitragyna speciosa extracts, namely methanolic, aqueous and total alkaloid extracts, on glutathione transferase-specific activity in male Sprague Dawley rat liver cytosol in vitro and in vivo. In the in vitro study, the effect of Mitragyna speciosa extracts (0.01 to 750 µg/mL) against the specific activity of glutathione transferases was examined in rat liver cytosolic fraction from untreated rats. Our data show concentration dependent inhibition of cytosolic GSTs when Mitragyna speciosa extract was added into the reaction mixture. At the highest concentration used, the methanolic extract showed the highest GSTs specific activity inhibition (61%), followed by aqueous (50%) and total alkaloid extract (43%), respectively. In in vivo study, three different dosages; 50, 100 and 200 mg/kg for methanolic and aqueous extracts and 5, 10 and 20 mg/kg for total alkaloid extract were given orally for 14 days. An increase in GST specific activity was generally observed. However, only Mitragyna speciosa aqueous extract with a dosage of 100 mg/kg showed significant results: 129% compared to control

Airborne particles in the city center of Kuala Lumpur: Origin, potential driving factors, and deposition flux in human respiratory airways

Equatorial warming conditions in urban areas can influence the particle number concentrations (PNCs), but studies assessing such factors are limited. The aim of this study was to evaluate the level of size-resolved PNCs, their potential deposition rate in the human respiratory system, and probable local and transboundary inputs of PNCs in Kuala Lumpur. Particle size distributions of a 0.34 to 9.02 μm optical-equivalent size range were monitored at a frequency of 60 s between December 2016 and January 2017 using an optical-based compact scanning mobility particle sizer (SMPS). Diurnal and correlation analysis showed that traffic emissions and meteorological confounding factors were potential driving factors for changes in the PNCs (Dp ≤1 μm) at the modeling site. Trajectory modeling showed that a PNC ˂100/cm3 was influenced mainly by Indo-China region air masses. On the other hand, a PNC >100/cm3 was influenced by air masses originating from the Indian Ocean and Indochina regions. Receptor models extracted five potential sources of PNCs: industrial emissions, transportation, aged traffic emissions, miscellaneous sources, and a source of secondary origin coupled with meteorological factors. A respiratory deposition model for male and female receptors predicted that the deposition flux of PM1 (particle mass ≤1 μm) into the alveolar (AL) region was higher (0.30 and 0.25 μg/h, respectively) than the upper airway (UA) (0.29 and 0.24 μg/h, respectively) and tracheobronchial (TB) regions (0.02 μg/h for each). However, the PM2.5 deposition flux was higher in the UA (2.02 and 1.68 μg/h, respectively) than in the TB (0.18 and 0.15 μg/h, respectively) and the AL regions (1.09 and 0.91 μg/h, respectively); a similar pattern was also observed for PM10

Spatial-temporal variations in surface ozone over Ushuaia and the Antarctic region: observations from in situ measurements, satellite data, and global models

The Antarctic continent is known to be an unpopulated region due to its extreme weather and climate conditions. However, the air quality over this continent can be affected by long-lived anthropogenic pollutants from the mainland. The Argentinian region of Ushuaia is often the main source area of accumulated hazardous gases over the Antarctic Peninsula. The main objective of this study is to report the first in situ observations yet known of surface ozone (O3) over Ushuaia, the Drake Passage, and Coastal Antarctic Peninsula (CAP) on board the RV Australis during the Malaysian Antarctic Scientific Expedition Cruise 2016 (MASEC’16). Hourly O3 data was measured continuously for 23 days using an EcoTech O3 analyzer. To understand more about the distribution of surface O3 over the Antarctic, we present the spatial and temporal of surface O3 of long-term data (2009–2015) obtained online from the World Meteorology Organization of World Data Centre for greenhouse gases (WMO WDCGG). Furthermore, surface O3 satellite data from the free online NOAA-Atmospheric Infrared Sounder (AIRS) database and online data assimilation from the European Centre for Medium-Range Weather Forecasts (ECMWF)-Monitoring Atmospheric Composition and Climate (MACC) were used. The data from both online products are compared to document the data sets and to give an indication of its quality towards in situ data. Finally, we used past carbon monoxide (CO) data as a proxy of surface O3 formation over Ushuaia and the Antarctic region. Our key findings were that the surface O3 mixing ratio during MASEC’16 increased from a minimum of 5 ppb to ~ 10–13 ppb approaching the Drake Passage and the Coastal Antarctic Peninsula (CAP) region. The anthropogenic and biogenic O3 precursors from Ushuaia and the marine region influenced the mixing ratio of surface O3 over the Drake Passage and CAP region. The past data from WDCGG showed that the annual O3 cycle has a maximum during the winter of 30 to 35 ppb between June and August and a minimum during the summer (January to February) of 10 to 20 ppb. The surface O3 mixing ratio during the summer was controlled by photochemical processes in the presence of sunlight, leading to the depletion process. During the winter, the photochemical production of surface O3 was more dominant. The NOAA-AIRS and ECMWF-MACC analysis agreed well with the MASEC’16 data but twice were higher during the expedition period. Finally, the CO past data showed the surface O3 mixing ratio was influenced by the CO mixing ratio over both the Ushuaia and Antarctic regions. Peak surface O3 and CO hourly mixing ratios reached up to ~ 38 ppb (O3) and ~ 500 ppb (CO) over Ushuaia. High CO over Ushuaia led to the depletion process of surface O3 over the region. Monthly CO mixing ratio over Antarctic (South Pole) were low, leading to the production of surface O3 over the Antarctic region