Preliminary results of curettage and cementation in the treatment of fibrous dysplasia of the proximal radius

Introduction: Fibrous dysplasia (FD)is a benign pathological condition usually observed in the first three decades of life. A single bone may be involved either wholly or partially, or multiple bones may be affected, we aimed to use curettage and cementation as a control method of FDfibrous dysplasia of the proximal radius. Methods: We describe our finding with the treatment of FDfibrous dysplasia of the proximal radius in five patients(four females and, one male), the mean age of 28.6 years (22 to –39 years). The lesions were in the metaphysis extending to the diaphysis. Persistent pain and pain after pathological fracture were the indications for surgical intervention. We used an extensile approach to expose the lesion then extended curettage using a high-speed burr and filling the cavity with bone cement. Functional outcome and radiological findings were monitored on follow-up visits. Results: The mean follow-up period was 3.2 years (ranged from 2 years to 5 years).There was were no recurrences and no patient sustained a fracture at the end of the filling cement. At the time of the last follow-up, all patients have excellent score(mean 27 points) according to the musculoskeletal tumor society scoring system. Conclusion: Extended curettage and cementation provide a safe and reliable alternative for control of FDfibrous dysplasia of the proximal radius with little morbidity with little risk of recurrence and low incidence of complications

Development of health education module for the school-based health education intervention to improve the knowledge, attitude and practices on Pediculosis capitis

Background: Pediculosis capitis is a common infestation among the school-aged group. Necessary intervention must be taken to prevent and manage the problem. A full study using cluster randomized control trial is proposed to assess the effectiveness of a health education module on the knowledge, attitude and practices on Pediculosis capitis among government primary school students. If the intervention is effective, it can be generalized to the whole primary schools across the country. Therefore, this paper will discuss on the development of a school-based health education intervention to improve the knowledge, attitude and practices on Pediculosis capitis among the government primary school students. Materials and Methods: Literature review was done to examine the prevalence of Pediculosis capitis and its determinants. Based on the findings, a health education intervention module based on KAP Model was developed for the implementation at a school level. Contribution by the panel of experts was attained for the development of the module. Validation of the module was carried out to ensure it is suitable to be implemented and will be effective in preventing and managing Pediculosis capitis. Expected Result: The health education intervention is effective to improve the knowledge, attitude and practices on Pediculosis capitis of the respondents as compared to baseline. Conclusion:Preventing Pediculosis capitis and controlling its risk factors by a well-developed health education module will help to obtain the desired outcome which is the reduction of Pediculosis capitis and improvement of knowledge, attitude and practice on Pediculosis capitis among the respondents

Distribution and prevalence of microorganisms causing diabetic foot infection in Hospital Serdang and Hospital Ampang for the year 2010 to 2014

Background: In developing countries like Malaysia, the prevalence of diabetes mellitus is increasing at an alarming rate. Various complications develop in patients diagnosed with diabetes. Diabetic foot is one such complication that is a threat to morbidity and mortality rate owing to its risk of amputation. Understanding the microbiology of diabetic foot infection becomes an essential part of management as it can help to channel the exact treatment rather than empirical treatment. Aim: To determine the distribution and prevalence of microorganism causing diabetic foot infection in Hospital Serdang and Hospital Ampang for the year 2010 till 2014. Methodology: This was a cross-sectional study using retrospective data from January 2010 to December 2014 of 885 patients with diabetic foot infection in Hospital Serdang and Hospital Ampang, tertiary hospitals in Klang Valley. Data were analyzed using IBM SPSS Statistics version 22.0 for Windows. Results: A total of 1356 pathogens were isolated from 885 patients, with a rate of 1.53 isolates per culture (IPC). The prevalence of gram-negative bacteria was predominant in DFI accounting for 71.27% whereas gram-positive was only 28.73%. Among the gram-negative isolates, the most common pathogen was Pseudomonas aeroginosa accounting for 24.49% followed by Proteus mirabilis (14.34%) and Klebsiella spp. (11.12%). Gram-positive isolates consist of Staphylococcus aureus with a percentage of 66.77% and Streptococcus spp. 33.23%. The Methicillin-Resistant Staphylococcus aureus (MRSA) accounts for 26.24% of the isolates. There were more monomicrobial cultures than polymicrobial culture (465 vs. 420). The most common antibiotic prescribed is ampicillin/sulbactam (55.57%) followed by cloxacillin (13.29%) and penicillin (10.77%). Conclusion: The prevalence of gram-negative bacteria in DFI is higher than gram-positive bacteria. The most common gram-negative bacteria is Pseudomonas aeroginosa followed by Proteus mirabilis and Klebsiella spp. whereas the most common gram-positive bacteria is Staphylococcus aureus. The rate of monomicrobial infection is slightly higher than polymicrobial infection. Ampicillin/sulbactam is the most commonly prescribed antibiotic for a patient with DFI

Quantitative assessment of wound healing using high-frequency ultrasound image analysis

Purpose: We aimed to develop a method for quantitative assessment of wound healing in ulcerated diabetic feet. Methods: High‐frequency ultrasound (HFU) images of 30 wounds were acquired in a controlled environment on post‐debridement days 7, 14, 21, and 28. Meaningful features portraying changes in structure and intensity of echoes during healing were extracted from the images, their relevance and discriminatory power being verified by analysis of variance. Relative analysis of tissue healing was conducted by developing a features‐based healing function, optimised using the pattern‐search method. Its performance was investigated through leave‐one‐out cross‐validation technique and reconfirmed using principal component analysis. Results: The constructed healing function could depict tissue changes during healing with 87.8% accuracy. The first principal component derived from the extracted features demonstrated similar pattern to the constructed healing function, accounting for 86.3% of the data variance. Conclusion: The developed wound analysis technique could be a viable tool in quantitative assessment of diabetic foot ulcers during healing

Colonization of Methicillin-Resistant Staphylococcus aureus (MRSA) among medical students in tertiary institution in Central Malaysia

Methicillin-resistant Staphylococcus aureus or MRSA infection is virulent and presents with a broad spectrum of severity. Limited regional reports that specifically outlined the potential risk of medical students being part of the dissemination of MRSA in healthcare settings were noted. This study aims to assess the prevalence and contributory factors of colonization of MRSA on neckties, headscarves, and ID badges among medical students in a local medical university in Malaysia. A cross-sectional study was conducted involving 256 medical students. A validated questionnaire was used to collect the data, and sample swabs were collected between July and August 2013 by swabbing neckties, headscarves, or identification badges. The swabs were then streaked onto mannitol salt agar (MSA) and incubated at 37 °C overnight. Out of 433 samples taken, 40 swabs (9.24%) were positive for Staphylococcus aureus. Out of the 40 swabs, five (12.5%) isolates were MRSA (one culture was isolated from the headscarf of a preclinical student, one culture was isolated from the necktie of clinical students, while the remaining three were isolated from identification badges of clinical students. There was no significant association between age, gender, ethnicity, and phase of medical students with the colonization of MRSA (p > 0.05). There was a significant association between knowledge score on hand hygiene practice and phase of medical students. MRSA colonies were present on neckties, headscarves, and identification badges of medical students of all phases. The findings from this study suggest the need for improvement of hand hygiene knowledge and discontinuity of mandatory use of physical ID badges and neckties among medical students

Hypoxic-mediated oxidative stress condition and hydroxyapatite-inducing osteogenic differentiation of human mesenchymal stem cells: a mathematical modelling study

Avascular necrosis (AVN) of the bones remains a major clinical challenge. Fractures in the talus, the scaphoid, and the neck of the femur are especially challenging to heal due to the low blood vessel network and the lack of collateral blood supply. These fractures are associated with high rates of nonunion and increased infections that require repeated operations. Conventional treatments by autografting or allografting bone replacement and synthetic bone implants have limitations, including the invasiveness of operative procedures, tissue supply insufficiency, and the risk of host rejection. The advancement in tissue engineering has revealed the potential of stem cells as restorative agents for bone injuries. The administration of mesenchymal stem cells (MSCs) into the talus, the scaphoid, and the neck of the femur could produce enhanced osteogenesis via the manipulation of MSC culture conditions. In this study, we used hydroxyapatite as the nanomaterial, and hypoxic milieu to enhance MSC differentiation capacity into the osteogenic lineage, allowing for more rapid and efficient bone cell replacement treatment. Our results demonstrate 1% oxygen and 12.5 μg/mL of hydroxyapatite (HAP) as the optimal conditions to incorporate the osteogenic medium for the osteogenic induction of MSCs. We also established a proof of concept that the addition of HAP and hypoxic conditions could augment the osteoinductive capacity of MSCs. We also developed an accurate mathematical model to support future bone cell replacement therapy

A peculiar case of Morel-Lavelle lesion of upper limb

Morel-Lavallee lesions (MLL) are post-traumatic, closed internal degloving injuries that can result in severe complications if not diagnosed early. It is conventionally seen in cases of the high energy injuries of the pelvis and lower limb. The accumulation of extravasated blood, secondary to fracture and soft tissue damage may cause internal degloving injury, skin necrosis, soft tissue damage and acute osteomyelitis. We report here the clinical and radiological features in a 32-year-old male referred from the emergency department of a tertiary hospital who had sustained high energy motor vehicle accident. On examination, there was a fluctuant, mobile, non-tender subcutaneous mass over the distal arm with suspicion of internal degloving injury. Plain radiographs showed no fractures. Ultrasound showed a fluid collection with the presence of septations and echogenic debris within the collection. Extravasation was noted between subcutaneous tissue layer and fascia at the posterolateral aspect of the arm. Wound debridement under general anaesthesia was carried out. Intraoperative findings reported a significant amount of thick serous fluid with necrotic debris. Unhealthy skin and fat layers were debrided. Underlying muscles were found to be healthy. The results of the intraoperative fluid culture and sensitivity showed no growth. Negative pressure vacuum dressing was carried out. After five cycles of vacuum dressing, the wound showed signs of healing with an improved range of motion of the elbow. Orthopaedic surgeons need to be vigilant of the possibility of MLL in the upper limb as a differential diagnosis in the management of high energy trauma

Recurrent infestation with pediculosis capitis among aged 10-11 students in Hulu Langat, Selangor

Background: Recurrent Pediculosis capitis may lead to various physical, economical and psychological consequences. The aim of the study was to determine the level of recurrent Pediculosis capitis, identify the factors associated with the recurrence and its predictors. Materials and Methods: The study used cross-sectional study design. Ten schools were included in the study. A total of 4,390 students from standard four and five were screened for Pediculosis capitis. Only 308 students diagnosed with Pediculosis capitis were included and treated. After 6-weeks, the recurrent infestation level was determined. Result: The total level of recurrent infestation was 8.30%. Contact with person with lice infestation was associated with recurrent Pediculosis capitis (χ2 = 3.557, df =1, P = 0.050). Hair type (χ2 = 4.388, df =1, P = 0.036) and hair length (χ2 = 4.225, df =1, P = 0.040) showed significant association with recurrent Pediculosis capitis. Those with previous contact with an infested person had odds of 3.263 to have recurrent infestation at 6-weeks as compared to those without previous infestation (AOR=3.262, 95% CI = 1.138 – 9.356, P=0.028). The respondents with curly hair had the odds of 2.89 times higher than those with straight hair to have recurrent infestation at 6-weeks (AOR = 2.895, 95% CI = 1.155 -7.257, P = 0.023). Conclusion: The total level of recurrent infestation was 8.30%. It is associated with contact with person with Pediculosis capitis, hair type and hair length. Recurrent Pediculosis capitis is still a public health problem and necessary intervention must be taken to prevent or reduce its occurrence

Complementary medicine a costly risk in management of chronic knee osteoarthritis? A case report

Knee osteoarthritis is the commonest cause of knee pain in the elderly. It is characterized by unresolved pain, limitation of motion and reduced quality of life. Total knee arthroplasty (TKA) is a safe and effective method in treating chronic knee osteoarthritis. We report a rare case of a seventy-seven-year-old Chinese female with multiple comorbidities and bilateral degenerative osteoarthritis who had sought services of traditional and complementary medicine (TCM) for pain relief. The patient experienced unresolved pain and superficial skin scars following the unregulated procedure. This paper aims to outline the importance of awareness among surgeons regarding the unregulated practice of TCM that may exacerbate chronic osteoarthritis, joint synovitis, influence the surgical approach for future procedures with the presence of scars and prosthetic joint infection risk