Cervical spondylotic radiculopathy: Early result from a conservative therapy

Introduction: Patients who had cervical spondylotic radiculopathy without major motor deficit and no evidence of cord compression will have good outcome with non-operative measures. The aim of this study was to determine the severity of degenerative changes on plain radiograph among the patients with cervical spondylotic radiculopathy, their rated outcomes following conservative treatment and to evaluate correlations between pain score with: 1) neck disability index, 2) severity of degenerative changes of the cervical spine and 3) different level of root compression. Methods: This is an observational cohort study recruiting all patients with a clinical diagnosis of cervical spondylotic radiculopathy treated conservatively between December 2016 and January 2018. One-way ANOVA, paired sample test, and Pearson’s correlation test were used for correlation analyses. The total of 29 patients was used to achieve the power of 80% at 0.05 significance level, in detecting a difference of five score from a mean of 28.6 with an estimated standard deviation of 9.2, using a two-sided one-sample t-test. Results: Neck disability index (NDI) and pain score showed significant correlation after conservative treatment (p<0.001). However, this was not observed between pain score and radiographic severity grade, or between pain score and different level of nerve root compression. Conclusion: Patients with cervical spondylotic radiculopathy treated conservatively showed favorable clinical outcomes. Keywords: Cervical spine; Conservative treatment; Degenerative spine; Radiculopath

Clinical factors affecting minor amputation in diabetic foot diseases at Tengku Ampuan Afzan Hospital, Kuantan

Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King’s classification respectively. The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King’s classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot

Unexpected case of ankle tuberculosis in a young professionals leading to delay in diagnosis

We report a case of a 38 year-old engineer presented with left ankle pain for 2 years and initially treated as gouty arthritis because of high serum uric acid. A year later his left ankle become swollen and plain radiograph showed soft tissue swelling around the ankle with normal articular surface and bone. An MRI investigation reported as gouty arthritis of ankle with tophi. While on treatment for gouty arthritis, he developed pus discharge from the swelling. The ankle pain also worsen and he was unable to weight bear on the affected leg. An incision and drainage shown pus from the ankle joint which grew pseudomonas aeruginosa. He was treated with intravenous followed by oral ciprofloxacin 250 mg bd. However his condition does not improved and a month after antibiotic treatment a repeated radiograph shows narrowing of joint space with irregular cortical destruction, osteopenic bone . suggestive of worsening of his septic arthritis. During this period he deny of having any fever, cough or night sweats. However he did notice some loss of weight and loss of appetite. He has worked in Africa and Russia before in petroleum industry. After 4 months of antibiotic and no sign of improvement, a biopsy and repeat culture was taken from the ankle which reveal tuberculous arthritis and positive for AFB culture. A plain chest radiograph revealed miliary tuberculosis picture. He was started on a anti TB treatment and the wound healed after a few weeks. After 4 months of treatment he was able to walk without support with reduce ankle range of motion. This case illustrate that the diagnosis was delay because tuberculosis was not suspected in a young professionals with ankle pain and elevated serum uric acid level. Further delay in diagnosis because MRI report also suggestive of gouty tophi and the pus culture and sensitivity grew pseudomonas aeruginosa

Osteopaste - a pre-clinical in vivo histological evaluation: future application

Auto graft plays a vital role in promoting fusion in spinal surgery. Bone substitutes such as calcium sulphate, calcium phosphate or hydroxyapatite (HA) have osteoconductive properties, which enhance the fusion process. Osteopaste is a Malaysian-made bone substitute derived from a combination of tetracalcium phosphate (TTCP) and tri-calcium phosphate that has been designed in order to conduct a pre-clinical in vivo histological evaluation. The process was compared with the other available commercial bone substitute products. We discuss the histological results and future application of our local bone substitute product in fusion /spinal surgery

Chronic tibial osteomyelitis in children. A case review at Hospital Tengku Ampuan Afzan, Kuantan

Osteomyelitis in children has various clinical manifestations causing diagnostic and therapeutic difficulties. Inappropriate treatment of acute osteomyelitis may lead to chronic, serious and complicated condition. Chronic osteomyelitis continues to be a major cause of morbidity and disability in children living in developing countries. We present three cases of tibial osteomyelitis that have different presentations and sequalae. Our intention is to alert our colleagues, particularly primary physicians, regarding the variety of presentation and the important of early diagnosis and treatment to reduce the risk of morbidity following osteomyelitis

Early functional and radiological outcomes between plaster cast and fiberlass cast in stable thoracolumbar burst fracture

Introduction: Burst fracture results from compression failure of both the anterior and middle columns under substantial axial loads. Conservative treatment was a method of treatment for fractures without neurological deficit. This cross sectional study was designed to evaluate the functional and radiological outcome of patient with thoracolumbar burst fracture treated conservatively. Methods: 40 cases were recruited from January 2013 till December 2015. They were followed-up with minimum period of 1 year and evaluated for the functional (Oswetry Disbility Index) and radiological outcomes (kyphotic angle deformity and anterior body compression). Results: 20 patients were treated with body cast made form plaster of Paris and remaining 20 patients with fiberglass cast. In plaster of Paris group, mean kyphotic angle deformity at last follow up was 16.60 ± 2.95 with a mean improvement 4.45 degree and anterior body compression at last follow up was 30.35% ± 10.2 with mean improvement of 9.30%. In fiberglass group, mean kyphotic angle deformity at last follow up was 15.55 ± 3.38 with a mean improvement 7.25 degree and anterior body compression at last follow up was 25.90% ± 7.81 with mean improvement of 3.45%. The functional outcome showed Oswetry Disability Index (ODI) score in plaster of Paris group was 23.70 (SD = 7.82) and in fiberglass group was 18.50 (SD = 5.94). Conclusions: Application of body cast using a fiberglass material give better radiological outcome hence less pain, more functional and higher patient’s satisfaction as compared to plaster of Paris

Optimizing U-Net Architecture with Feed-Forward Neural Networks for Precise Cobb Angle Prediction in Scoliosis Diagnosis

In the burgeoning field of Artificial Intelligence (AI) and its notable subsets, such as Deep Learning (DL), there is evidence of its transformative impact in assisting clinicians, particularly in diagnosing scoliosis. AI is unrivaled for its speed and precision in analyzing medical images, including X-rays and computed tomography (CT) scans. However, the path does not lack obstacles. Biases, unanticipated outcomes, and false positive and negative predictions present significant challenges. Our research employed three complex experimental sets, each focusing on adapting the U-Net architecture. Through a nuanced combination of feed-forward neural network (FFNN) configurations and hyperparameters, we endeavored to determine the most effective nonlinear regression model configuration for predicting the Cobb angle. This was done with the dual purpose of reducing AI training time without sacrificing predictive accuracy. Utilizing the capabilities of the PyTorch framework, we meticulously crafted and refined the deep learning models for each of the three experiments, focusing on an FFFN dropout rate of p=0.45. The Root Mean Square Error (RMSE), the number of epochs, and the number of nodes spanning three hidden layers in each FFFN were utilized as crucial performance metrics while a base learning rate of 0.001 was maintained. Notably, during the optimization phase, one of the experiments incorporated a learning rate scheduler to protect against potential pitfalls such as local minima and saddle points. A judiciously incorporated Early Stopping technique, triggered between the patience range of 5-10 epochs, ensured model stability as the Mean Squared Error (MSE) plateau loss approached approximately 1. Consequently, the model converged between 50 and 82 epochs. We hypothesize that our proposed architecture holds promise for future refinements, conditioned on assiduous experimentation with an array of medical deep learning paradigms

Production of autologous platelet-rich plasma from an animal model

There has been recent interest regarding the role of autologous platelet-rich plasma (PRP) on soft and hard tissue healing. Inactivated platelets contain various growth hormones that involve in tissue healing such as platelet-derived growth hormone (PDGF), vascular ndothelial growth hormone (VEGF), transforming growth factor-ß (TGF-ß), epidermal growth factor (EGF) and insulin-like growth factor (IGF). Upon activation, platelets release these hormones from its α-granule. PRP concentration of three to five-fold the baseline level or the count above 1,000,000/ml was shown the ability to promote tissue healing. Even though the protocol for the production of PRP from a large amount of blood has been established in human, the method could not be adopted in animal studies, which require small amount of blood. Lack of method’s standardization in PRP preparation has also contributed to the difficulty of getting sufficient PRP for experimental studies. Here, we presented a double-centrifugation technique for the production of autologous PRP from rabbit’s blood