IIUM Medical Journal Malaysia (IMJM)
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The Role of Soft Tissue Coverage in Limb Salvaging and Reconstructive Surgery of Foot and Ankle
Get PDFSince humans evolutionally adapt to a bipedal gait, the foot is important to allow humans to stand up, walk, run, and to jump. Without the soft tissues and bones at the foot and ankle, our lower limbs could not support the weight of the body. Crush injury of the foot and ankle is a consequence of high energy trauma leading to combined bone and soft tissue loss or destruction. The treatment of crush injury of the foot and ankle remains a challenge as it is associated with high morbidity. We report two cases of traumatic injury of foot and ankle to highlight the paramount importance of soft tissue coverage in limb salvaging and reconstructive surgery of foot and ankle
A Rare Case of Primary Extranodal Laryngeal Non Hodgkin Lymphoma
Get PDFLymphoma is generally a nodal disease and arises from lymphoid tissues or organs. Extranodal lymphoma accounts for almost a third of malignant lymphomas. Squamous cell carcinoma accounts for 90 % of laryngeal carcinoma, while extranodal Non Hodgkin Lymphoma (NHL) attributes only less than 1% of laryngeal neoplasms. Less than 100 of such cases been reported in literature since 1952. As to our best knowledge, no such case was ever reported in our country. We report a case of a 58-year-old gentleman who presented the typical history of laryngeal malignancy however the pathology turned out to be as NHLof Diffuse Large B-cell subtype
Epidemiology and Outcomes of Candidaemia among Adult Patients Admitted at Hospital Universiti Sains Malaysia (HUSM): A 5-Year Review
Get PDFIntroduction: Candida organisms are opportunistic fungal pathogens that have become a major cause of nosocomial infections worldwide. We investigated the clinical characteristics and outcomes of hospitalized patients with candidaemia caused by Candida albicans and non-albicans Candida spp at HUSM. Materials and Methods: We retrospectively evaluated all hospitalized patients with candidaemia from January 2010 till December 2014 based on inpatient hospital records and laboratory data. Results: A total of 134 patients with candidaemia were enrolled. Candida albicans and non-albicans Candida spp were responsible for 20% (27/134) and 80% (107/134) of candidaemia cases, respectively. Hospitalized patients with diabetes mellitus, surgical conditions, or concomitant septicaemia and those who received instrumentations such as CVC or CBD, and those admitted under medical settings were prone to develop candidaemia caused by either C. albicans or non-albicans Candida spp. All isolates were susceptible to Fluconazole except for C. krusei isolates. All-cause mortality within 30 days post diagnosis of candidaemia was 59%. Factors associated with mortality were solid tumor (p =0.014), surgical illness (p=0.128), central venous catheterization (p= 0.096) and leucocytosis (p=0.116). Only solid tumor was an independent contributory factor for mortality among patients with C. albicans candidaemia in the multivariate analyses (OR 5.09, 95% CI 1.38,18.74, p=0.014). Conclusions: The patients’ clinical characteristics were fairly comparable between Candida albicans and non-albicans candidaemia. The changing epidemiology of candidaemia at this centre was in fact alarming. The outcome associated with candidaemia was poor
Model of A Critical Size Defect in the New Zealand White Rabbit’s Tibia
Get PDFIntroduction: Critical size defects (CSD) in the long bones of New Zealand White rabbits (Oryctolagus cuniculus) have been used for years as an experimental model for investigation of the effectiveness of a new bone substitute material. There are varieties of protocols available in the literature. This technical note attempts to present an alternative surgical technique of a CSD in the New Zealand white rabbit tibia. Methods: Thirty-nine New Zealand White rabbits were used in this study. A CSD of approximately 4.5 mm (width) X 9.0 mm (length) was surgically drilled at the proximal tibial metaphysis, approximately 1 cm from the knee joint. The surrounding of soft tissue was repositioned and sutured layer by layer with bioabsorbable surgical suture. Two x-rays of anteroposterior and lateral were taken before assessed under computed tomography scan at 6, 12 and 24 weeks. Results: This alternative method created CSD with less bleeding from the muscle observed. No mortality or other surgical complications observed within 6 weeks, 12 weeks and 24 weeks following surgery. Conclusion: A simple and safe method for performing CSD was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits
Outcome of Pregnancy in Chromosomally Normal Foetus with Increased Nuchal Translucency
Get PDFObjective: The aim of this study is to evaluate the outcome of pregnancy in prenatal and postnatal period of pregnancy complicated with thick nuchal translucency but normal karyotype. Methods: This is a retrospective study of 119 singleton pregnancies with increased NT (NT > 2.5mm) but a normal karyotype over a 3 year period. The records of ultrasound at 18-20 and 25-26 weeks’, antenatal and postnatal details were reviewed. The developmental and health outcomes of the surviving children were obtained through telephone conversation with the family. Adverse outcome such as miscarriages, termination of pregnancy, intrauterine death, structural anomalies and neurodevelopment delay were analysed. Results: Out of 119 foetuses with increased NT but normal karyotype, 11.8% of pregnancies ended with miscarriages, termination of pregnancy and intrauterine death. 89.9% foetuses were structurally normal. 12.9% presented with structural anomalies in the second-trimester ultrasound scan. 81.8% showed major malformations, out of which 44% consisted of heart defects. 1% of foetuses were syndromic and 1.9% had developmental delay. 96.8% of foetuses with NT equal to or greater than the 95th percentile (3.4mm) and 80% with NT equal to or greater than the 99 percentile (5.5mm) had a normal outcome. 50% of foetuses with thickened nuchal fold had a poor outcome. Postnatal follow-up was established for all infants and toddlers, and abnormalities were observed in 5.6% of them. Chances of having a live and healthy infant decreases with increased NT, corresponding to 80% for NT equal to or greater than 5.5mm. Conclusion: We have provided data that may help in the counselling of parents and increasing their confidence on a favourable pregnancy outcome. In cases with increased nuchal translucency but normal karyotype, the chances of normal pregnancy success rate is 89.9%. Parents can be reassured that thickened nuchal translucency with a normal karyotype and normal targeted ultrasound between 20-22 weeks gestation, the risk of adverse perinatal outcome and postnatal developmental delay is not increased in comparison with that of the general population. This seems to be the case for all degrees of increased nuchal translucency
Comparison of Functional Outcome Between Computer Navigated Total Knee Replacement with Conventional Method
Get PDFIntroduction: Total knee replacement (TKR) is considered one of most successful treatment in treating knee arthritis. It aims at restoring neutral mechanical axis, balanced ligaments and normal Q angle. Surgeons have been using manual jig to achieved perfect implant placement. Since 2002 computer assisted surgery (CAS) is gaining popularity in TKR surgery to improved accuracy of implant placement. In a large meta-analysis by Bauwen’s et al, computer assisted surgery reduced number of patients with post-operative malalignment >3 degree. In another study by Kim et al found there was no no difference in alignment between computer assisted and conventional method TKR in bilateral TKR with one using conventional and the other computer assisted. In our study we compared the functional outcome between these two methods. Materials and Methods: This was a cross-sectional study conducted in Penang General Hospital comparing the functional outcome using SF-36 questionnaire and Hospital for Special Surgery (HSS) knee scoring. It involved 35 knees in each arm. All patients were operated by single surgeon using same type of implant and navigation system. Patients with post-operative complications were excluded. Results: We found that there was no significant difference (p<0.05) in both SF-36 and HSS knee score using U Mann Whitney test. Conclusion: There was no difference in functional outcome between conventional TKR and CAS
Knowledge, Attitude and Practice of Doctors Regarding Perioperative Tobacco Smoking Intervention in Surgical Based Discipline in IIUM Medical Centre
Get PDFIntroduction: Surgery provides an exceptional chance for smoking cessation and apparently surgeons can play an important role in tobacco control. Tobacco intervention in surgical patients benefited them both in the short-term and longterm health outcome. Unfortunately, little is known about the knowledge, attitudes and practices of Malaysian surgeon regarding peri-operative tobacco smoking interventions which triggers this study. Materials and Methods: A survey of written questionnaires was conducted on medical doctors in the surgical based discipline at the International Islamic University Malaysia Medical Centre. Results: The survey response rate was 100%, and 6.7% of respondents themselves were current smoker, 23.3% were former smoker. A high proportion of respondents had accurate perceptions of peri-operative and long-term health risks of smoking. However, most of them also knew how to counsel about smoking or help patients get the help they needed to quit. Majority (93.3%) of them frequently or almost always asked about smoking status; 56.7% advised about the health risk of tobacco use; 80.0% advised patients to stop smoking peri-operatively and 60.0% advised patients to quit smoking permanently. Compared with non-smokers, smokers were significantly less likely to advice about the health risks of smoking and quitting. Not only that, most of the respondents were willing to learn about peri-operative interventions and spend an extra 5 min to help patients quit smoking. Conclusions: Majority of the respondents poised adequate knowledge of health risks of smoking, strong perception of responsibilities, and willingness to participate in tobacco control, IIUM Medical Centre doctors actually play a significant role in tobacco control in which could improve peri-operative outcomes and promote long-term health
Neuroprotective Effect of Oral Administration of Trigonella Foenum-Graecum on Chronic Cerebral Hypoperfusion in Rat Model
Get PDFIntroduction: Decreased cerebral blood supply to the brain can generate a condition of chronic cerebral hypoperfusion, which is one of the pathophysiological mechanisms of neuronal degeneration and cognitive impairment in Alzheimer’s disease. This study aimed to evaluate the potential neuroprotective effects of Trigonella foenum graecum seeds on chronic cerebral hypoperfusion in a rat model. Materials and Methods: Chronic cerebral hypoperfusion was induced by permanent bilateral ligation of the common carotid arteries (a two-vessel occlusion, 2VO) in male Sprague–Dawley rats. The experimental groups were divided into three groups (11 rats/group): i) sham (control) group; ii) 2VO group without any treatment; and iii) 2VO group that was administered orally with the Trigonella foenum graecum extract (100 mg/kg/day) by oral gavage from 3 days before the date of 2VO surgery and continued daily until the end of the 8th postoperative week. Spatial memory performance was assessed by the Morris water maze test. Malondialdehyde and C-reactive protein (CRP) concentration, superoxide dismutase and glutathione activities were measured in serum after 8 weeks from 2VO injury. Results: Chronic cerebral hypoperfusion rats resulted in spatial memory impairments. This behavioral dysfunction was accompanied by decreasing superoxide dismutase and glutathione activities, and increasing malondialdehyde and CRP levels in serum. Oral administration of Trigonella foenum graecum extract significantly improved the memory impairment, enhanced antioxidant enzyme activities, and decreased the malondialdehyde and CRP levels to near normal levels. Conclusion: The potential activity offered by Trigonella foenum graecum extract showed the neuroprotective effect that may be beneficial in cerebrovascular type dementia
Outcomes Of Proximal Femur Metastases After Surgical Fixation: A Two Centres Study
Get PDFIntroduction: Surgery to skeletal metastases of proximal femur is important to reduce morbidity and improve quality of life. However, choice of surgery still remain debatable. This study evaluated functional outcome and survival rate in patients after skeletal reconstructive surgery. Material and Methods: Thirty patients for skeletal metastasis over the proximal femur fracture were performed in two centres. The choice of implant, complications, survival rate (using Kaplan Meier) and functional outcome (MSTS score) were evaluated. Results: Endoprosthesis was the most common procedure performed (17 patients), followed by osteosyntheses (13 patients). Total hip replacement (9 patients) and hemiarthroplasty (8 patients) was almost of the same proportion used as endoprosthesis implant. Plating osteosynthesis by using Dynamic Hip Screw was the most common surgical procedure (6 patients) performed followed by Interlocking Nail (4 patients) and Proximal Femoral Nail (3 patients). There were total of ten complications, of which four were due to systemic issues and six due to implant related problems. Survival rate at one year after surgery was 83.3% and at 3 years was 61.9%. The mean MSTS score six months post-operative was 71%. Conclusion: Patients with skeletal metastasis had a prolonged survival rate and should undergo skeletal reconstruction to reduce morbidity and improve quality of life. The surgical construct should be stable and outlast the patient to avoid further surgery
Point-of-care Procalcitonin Guidance to Reduce Antibiotic Use in Critically Ill Patients: A Randomized Controlled Trial
Get PDFIntroduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected critically ill patients. Materials and Methods: Eighty adult patients admitted to or acquired sepsis in the intensive care unit (ICU) were enrolled in this randomized controlled trial. Patients were allocated to either POC PCT-guided intervention arm (n=40) or the control arm, in which antibiotic therapy followed local guidelines (n=40). In the PCT-guided arm, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT concentration decreased by >80% of its peak value, or when it reaches a value of <0·5 g/L. Results: The mean duration of antibiotic use for PCT arm was 6.4 (SD 2.3) days compared to 9 (SD 4.3) days in the control arm (p=0.004). In the first 30 days after being assigned to a group, the proportion of patients who received a repeated course of systemic antibiotics was 33% in the PCT arm vs 38.1% in the control arm (p=0.757). Mean length of stay in the ICU was 8.4 (SD 5.3) days in the PCT arm vs 10.4 (SD 12.3) days in the control arm (p=0.404). Mortality at 30 days was 22.5% in the PCT-arm vs 25% in the control arm (p<0.0001). Conclusion: POC PCT guidance stimulates reduction of duration of antibiotic use in ICU, accompanied by a significant decrease in mortality