Introduction: Glomus tumour is a rare benign neoplasm of the normal neuroarterial structure called glomus body. They present with obscure symptoms making diagnosis difficult and delayed. Though classical symptoms and signs such as pain, temperature sensitivity, and point tenderness are described, imaging such as magnetic resonance imaging is increasingly being used for diagnosis. The aim of this study was to review the current understanding of glomus tumours of the hand in the context of the cases treated in Brunei Darussalam emphasising the importance of detailed clinical examination over imaging modalities. Materials and Methods: We present a series of seven patients diagnosed as glomus tumour and operated in our hospital from Sept 1997 to Sept 2009. Data was collected from the clinical and operative records regarding preoperative history and workup, intraoperative details, postoperative follow up and histopathology. Results: There were three male and four female patients with a median age of 37 years. All patients had severe fingertip pain on touch with positive Love's test. One patient had hypersensitivity to cold. Presumptive diagnosis of glomus tumour was made in six patients and foreign body granuloma in one patient based on detailed history and clinical examination alone. Histopathology confirmed glomus tumour in all the patients. All are asymptomatic after surgery. One patient had increased mitotic activity on histopathological examination and is on close follow up. Conclusion: High suspicion, detailed history and careful physical examination can significantly decrease the pre-operative morbidity of the patient with glomus tumour. An imaging study may not always be required for diagnosis.
Glomus Tumor ; Hypersensitivity ; Diagnosis ; Diagnostic Imaging

A literature search of related articles was carried out in electronic data sources. Initially, 276 randomised controlled trials related to the title were collected, after which 44 were selected using the keywords. Overlapping articles, articles with a study duration of less than six months, and studies involving young participants were removed from the list. The remaining 20 articles were checked for entitlement using the PEDro scale. A total of nine eligible articles with 1486 participants were analysed. Seven trials used dual-energy x-ray absorptiometry (DXA) to measure bone mineral density (BMD). The six trials published from 2005 to 2013 found a significant increase in BMD. In the remaining one trial, there was no significant increase in BMD. One study published in 2013 reported a significant increase in BMD measured with peripheral qualitative computed tomography, whereas another trial published in 2014 stated that there was a reduction in calcaneal bone density measured by peripheral qualitative ultrasound. From these findings it can be concluded that the whole body vibration machine is a good adjunctive therapy for the prevention and management of osteoporosis in postmenopausal women. However, further investigations are necessary before the same can be recommended for elderly men.

Platelet-rich plasma (PRP) has gathered widespread acceptance among orthopaedic surgeons because of its multimodal effects on tissue healing. Varying results have been reported when PRP injections are combined with hip arthroscopic surgery. To evaluate the influence of PRP on clinical outcomes following hip arthroscopy. We hypothesized that patients treated with PRP would have improved postoperative outcome scores. A search of the National Institute for Health and Care Excellence (NICE) healthcare database advanced search (HDAS) via Athens (PubMed, MEDLINE, CINAHL, EMBASE, and AMED databases) was conducted from their years of inception to May 2018 with the keywords: “Hip Arthroscopy” and “Platelet-Rich Plasma”. A quality assessment was performed based on the Cochrane risk of bias tool. Three studies were included for analysis; two of which had low risk of bias. The studies included 363 hips, of which 141 were randomised for PRP treatment. The mean age of all patients was 35 years and the follow-up ranged from 18.5 to 36 months. Authors used different PRP systems and preparations. Modified Harris hip score was reported in all three studies with two studies favouring the use of PRP. The use of PRP following hip arthroscopy did not lead to significantly improved postoperative pain or functional outcomes when compared to control groups in the studies included in this review.

OBJECTIVE: Osteoporosis is a rapidly rising cause of concern for elderly patients. Various classes of drugs are available in the market. Bisphosphonates are considered as a first-line therapy for the prevention and treatment. Denosumab is an antiresorptive agent which is a RANK ligand inhibitor. There is a scarcity of comparison between these two classes of drugs. The aim of this study is to compare efficacy of Bisphosphonates and Denosumab in various parameters. MATERIALS AND METHODS: Literature search was done for randomized controlled trials (RCTs) comparing bisphosphonates with denosumab. RCTs with a treatment period of at least one year with a baseline bone mineral density (BMD) and bone turnover markers (BTM) and follow up values at one year were included in the study. All included studies were also analysed for complications. The study has also been registered in PROSPERO International prospective register of systematic reviews. RESULTS: A total of five RCTs were identified providing data on 3751 participants. In all five studies, the BMD changes at both hip and spine were statistically significant in favour of denosumab. Result was similar in three studies that studied BMD changes at the wrist. Denosumab also produced significant reduction in BTM as early as one month, but at one year there was no difference compared to the bisphosphonates. There was no statistically significant differences in the complication rates. CONCLUSION: Though both bisphosphonates and denosumab were effective with similar side effects, the latter was statistically superior in increasing the BMD and reducing the BTM.
Aged ; Bone Density ; Bone Remodeling ; Denosumab* ; Diphosphonates* ; Female ; Follow-Up Studies ; Hip ; Humans ; Osteoporosis ; Osteoporosis, Postmenopausal* ; Prospective Studies ; RANK Ligand ; Spine ; Wrist