Effects of Eurycoma longifolia on fracture healing of androgen-deficient osteoporosis model: a micro computed tomograph analysis

Micro computed tomography (micro-CT) imaging is a useful tool to monitor fracture healing in osteoporosis model. It creates a 3-D image of the fracture callus which can be analysed to assess bone parameters quantitatively. In this study, micro-CT was used to assess the fracture healing of orchidectomised rats, an androgen-deficient osteoporosis model. The effects of Eurycoma longifolia, a medicinal plant with pro-androgenic effects, on fracture healing were assessed. The rats were grouped into orchidectomised-control (ORX), sham-operated (SHAM), orchidectomised and injected with testosterone intramuscularly once weekly (TEN) and orchidectomised and daily oral gavage of Eurycoma longifolia (EL). Treatment duration was six weeks following bone fracture. Fracture was induced in the right tibia of all the rats. A total of 100 axial slices above and below fracture line were scanned with a micro-CT. The micro-CT analysis was able to detect significant difference in the fracture healing rate of ORX and TEN groups. The bridging cortices and fraction of mineralized tissue of the bridging cortices of the callous of ORX group was significantly lower than TEN group. No significant micro-CT changes were seen in the fracture healing of the EL group. The effect of EL on fracture healing was not demonstrable in orchidectomised rat model

Kekuatan otot dan kualiti hidup dalam kalangan dewasa Malaysia berisiko keretakan osteoporotic rendah dan sederhana hingga tinggi

Penurunan kekuatan otot dan kualiti hidup memberi impak tinggi ke atas dewasa yang berisiko keretakan osteoporotic. Walaubagaimanapun, kekuatan otot dan kualiti hidup dalam kalangan dewasa Malaysia yang berisiko keretakan osteoporotic tidak diketahui. Tujuan kajian kami adalah untuk mengkaji kekuatan otot dan kualiti hidup serta perkaitannya dalam kalangan dewasa berisiko keretakan osteoporotic rendah dan sederhana hingga tinggi. Kajian keratan-rentas ini melibatkan 27 lelaki dan 78 wanita (purata usia 69.3 ± 85 tahun) dari klinik Ortopedik, Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia. Kebarangkalian 10 tahun untuk keretakan osteoporotic dikira berdasarkan penilaian risiko keretakan osteoporotic (FRAX) dengan ketumpatan mineral tulang femoral (femoral neck). Peserta kajian telah dikategorikan sebagai rendah dan sederhana hingga tinggi risiko keretakan osteoporotic berdasarkan keputusan FRAX titik potong 10%. Kekuatan otot extensor belakang dan kekuatan genggaman tangan dominan telah diukur dengan menggunakan masing-masing sistem sel beban (load cell system) dan dynamometer tangan (hand dynamometer). Borang soal selidik kualiti hidup Eropah (EQ5Dvas) telah digunakan untuk mengukur kualiti hidup. Regresi linear berganda dilakukan dengan kualiti hidup sebagai pembolehubah bergantung dan kekuatan otot extensor belakang dan kekuatan genggaman tangan sebagai pembolehubah bebas. Anggaran sebanyak 40% orang dewasa telah dikategorikan ke dalam kumpulan sederhana hingga tinggi risiko keretakan osteoporotic. Purata nilai di antara kumpulan rendah dan sederhana hingga tinggi risiko keretakan osteoporotic bagi mutu kualiti hidup adalah masing-masing 80.5 ± 13.2 dan 76.9 ± 16.9 (p = 0.77); kekuatan genggaman tangan adalah 25.7 ± 17.3 dan 20.6 ± 5.5 kg (p < 0.001) dan otot extensor tulang belakang adalah 25.0 ± 7.0 dan 18.9 ± 9.5 Newton (p < 0.01). Kekuatan otot genggaman tangan telah muncul sebagai penentu kualiti hidup dan menyumbang sebanyak 5.8% daripada jumlah varians. Peningkatan kekuatan otot boleh menyebabkan kualiti hidup yang lebih baik dalam kalangan dewasa berisiko keretakan osteoporotic

Development of a model for assessment and predicting outcome in surgery for degenerative disorder of the lumbosacral spine

"A dissertation submitted in partial fulfilment for the degree of Doctor of Philosophy (PhD)""2012"Includes bibliographical references.1. Thesis introduction -- 2. Health-related quality of life: a comparison of outcomes after lumbar fusion for degenerative spondylolisthesis with large joint replacement surgery and population norms -- 3. Health-related quality of life following revision surgery for 'Failed Back Surgery Syndrome' - a comparison with results following primary spinal fusion and large joint arthroplasty -- 4. Independence of clinical outcome measurement instruments in spinal surgical practice -- 5. Preoperative health-related quality of life scores as predictor of clinical outcomes after degenerative lumbar surgery -- 6. Lumbo-pelvic lordosis and the pelvic radius technique in the assessment of spinal sagittal balance: strengths and caveats -- 7. Compensatory mechanisms and the effect of age on sagittal balance in degenerative and isthmic spondylolisthesis: an analysis utilizing the pelvic radius technique -- 8. Thesis discussion and conclusion -- Appendices.Degenerative lumbosacral disorders involve the gradual loss of normal structure and function of the spine over time. The growth of the ageing population has led to an increase in the number of spinal surgery for degenerative lumbosacral disorder recommended when conservative treatment fails. Yet the clinical benefit of this surgery remains controversial when a significant number of patients fail to achieve the expected beneficial outcome.The overall aim of any surgical intervention in degenerative lumbosacral disorders should be to eliminate the primary pathology of the disease (e.g. loss of sagittal balance) to achieve an outcome that restores or improves patients' health-related quality of life (HRQL). In order to assess health-related quality of life, a plethora of outcome measures are employed in the speciality of spinal surgery. The ability to measure outcome of surgery and to predict which patients will have a good outcome from surgery is important for patients and the healthcare systems as a whole.The concept of maintaining or restoring spinal sagittal balance is essential in managing degenerative lumbosacral spine disorders. The focus of spinal fusion and deformity correction techniques are obtaining fusion of the diseased spinal column in the optimal balanced alignment in order to improve the long-term outcome of surgery. The spinal sagittal balance is characterized by both pelvic and spinal parameters. No single measurement can accommodate the entire spectrum of spinal curvatures. All methods available for assessing the spine in the sagittal plane have their strengths and caveats.The purpose of my PhD research is to establish that spinal surgery is a worthwhile surgical procedure in improving the health-related quality of life outcome for degenerative lumbosacral disorders by using the comparison model utilizing the generic HRQL outcome measure instrument (i.e. SF-12) to benchmark with established surgical procedures (i.e. total joint replacement surgery for osteoarthritis of the knees and hips). I also intend to develop a model for a simple and practical pre-operative assessment method utilizing the SF-12 scores as predictors of favourable outcome for patients with degenerative lumbosacral disorder undergoing spinal surgery. Another model would investigate the correlation of a simple VAS score with the lengthy and sophisticated outcome measures instruments used to monitor outcome of patients postoperatively. The final part of the thesis is to analyze the concept of sagittal balance as the biological factor in terms of its value and compensatory mechanism that affect the outcome of spinal surgery.Mode of access: World wide web1 online resource (xv, 202 leaves) illustration

Reliability of Self-Administered Questionnaire on Dietary Supplement Consumption in Malaysian Adolescents

The repeatability of most questionnaires utilized in previous studies related to the consumption of dietary supplements (DS) among youth has not been well documented. Thus, a simple and easy-to-administer questionnaire to capture the habitual use of DS in the past one year known as the dietary supplement questionnaire (DiSQ) was developed and supported with external reliability evaluation. Analyses were done based on a convenience sample of 46 secondary school students. To elicit information regarding the intake of DS, the questionnaire was partitioned into two domains. The first domain was used to identify vitamin/mineral (VM) supplements, while the second domain was utilized to identify non-vitamin/non-mineral (NVNM) supplements. Cohen&rsquo;s kappa coefficient (k) was used to evaluate the test&ndash;retest reliability of the questionnaire. Questionnaire administration to the respondents was done twice whereby a retest was given two weeks after the first test. Between test and retest, the reliability of individual items ranged from moderate to almost perfect for the VM (k = 0.53&ndash;1.00) and NVNM (k = 0.63&ndash;1.00) domains. None of the items had &ldquo;fair&rdquo; or &rdquo;poor&rdquo; agreement. Various correlation coefficients can be obtained for the DiSQ but are generally reliable over time for assessing information on the consumption of supplements among the adolescent population

The effects of alpha-tocopherol supplementation on fracture healing in a postmenopausal osteoporotic rat model

OBJECTIVE: Osteoporosis increases the risk of bone fractures and may impair fracture healing. The aim of this study was to investigate whether alpha-tocopherol can improve the late-phase fracture healing of osteoporotic bones in ovariectomized rats. METHOD: In total, 24 female Sprague-Dawley rats were divided into three groups. The first group was sham-operated, and the other two groups were ovariectomized. After two months, the right femora of the rats were fractured under anesthesia and internally repaired with K-wires. The sham-operated and ovariectomized control rat groups were administered olive oil (a vehicle), whereas 60 mg/kg of alpha-tocopherol was administered via oral gavage to the alpha-tocopherol group for six days per week over the course of 8 weeks. The rats were sacrificed, and the femora were dissected out. Computed tomography scans and X-rays were performed to assess fracture healing and callus staging, followed by the assessment of callus strengths through the biomechanical testing of the bones. RESULTS: Significantly higher callus volume and callus staging were observed in the ovariectomized control group compared with the sham-operated and alpha-tocopherol groups. The ovariectomized control group also had significantly lower fracture healing scores than the sham-operated group. There were no differences between the alpha-tocopherol and sham-operated groups with respect to the above parameters. The healed femora of the ovariectomized control group demonstrated significantly lower load and strain parameters than the healed femora of the sham-operated group. Alpha-tocopherol supplementation was not able to restore these biomechanical properties. CONCLUSION: Alpha-tocopherol supplementation appeared to promote bone fracture healing in osteoporotic rats but failed to restore the strength of the fractured bone

Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study

Fracture is a type of musculoskeletal injury that contributes to an inability to perform daily activities. The objective of this study was to evaluate activities of daily living (ADL) of older adult patients with lower body fracture and to determine factors influencing ADL. Patient’s ADL was assessed at pre-fracture, ward admission and post-discharge phases using the Katz ADL questionnaire. There were 129 subjects at pre-fracture and ward phases and 89 subjects at discharge phase. There were four independent variables; age, gender, type of fracture and ability to walk before fracture. Logistic regression models showed that ‘age’ and ‘ability to walk before fracture’ were the determinant factors of dependent for ‘bathing’, ‘dressing’ and ‘toileting’. The ‘ability to walk before fracture’ was the determinant factor of dependent for ‘transferring’. ‘Age’ and ‘gender’ were the determinant factors of dependent for ‘continence’, while ‘age’ was the determinant factor of dependent for ‘feeding’. The ADL score changes were significant across the phases with a reduction in ADL score in the ward admission phase and partial increment during the post-discharge phase. There were improvements in the health outcomes of subjects aged more than 50 years old after 3 months of being discharged from the hospital. In conclusion, age, being female, having a hip fracture and using a walking aid before fracture were the determinants identified in this study

Modifiable factors associated with bone health in Malaysian adolescents utilising calcaneus quantitative ultrasound.

Maximizing bone mineral accrual to attain an optimal peak bone mass (PBM), particularly during adolescence, appears to be an effective protective strategy in the prevention of osteoporosis. This study aimed to evaluate the influence of physical activity (PA), fat mass (FM), lean mass (LM), body mass index (BMI), calcium, or combination of vitamin D supplement intake, smoking and alcohol drinking status on bone health assessed by calcaneus quantitative ultrasound (QUS) in a healthy adolescent population. The participants comprised of 920 male and female secondary school adolescents aged 15-17 years old. Quantitative ultrasound measurements of the left heel were performed using Lunar Achilles EX II, which included results of broadband ultrasound attenuation (BUA), speed of sound (SOS), and a calculated stiffness index (SI). Multivariable linear regression analyses revealed that-PA was positively associated with all three QUS indices in both genders; BMI was positively associated with SI and SOS in females; LM was positively associated with BUA in both genders; and FM was negatively associated with SI in females. These variables accounted for 32.1%, 21.2% and 29.4% of females' SOS, BUA and SI variances (p<0.001), respectively and 23.6%, 15.4% and 17.2% of males' SOS, BUA and SI variances (p<0.001), respectively. Promoting health benefits from physical activity could influence bone status and consequently improve PBM, which is a potent protective determinant against osteoporosis in adulthood

Risk Factors of Osteoporosis and Post-Discharged Supplements and Drugs Intake in Patients with Lower Body Fractures

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