*Anopheles ; *DDT ; *Dieldrin ; *Malaysia

This retrospective radiographic analysis of 57 patients (62 knees) examined two possible factors involved in pin tract fractures of the femur due to navigated total knee arthroplasty (TKA): the angle of the tracker pin with respect to the lateral femoral cortex, and the distance between the tracker pin and the lateral joint line. Our findings demonstrate a relationship between postoperative pin tract induced stress fractures (3 patients), with pin tract angles exceeding 15. Pin placement at a site more th
Orthopaedic

Health Occupations

Cerebrovascular diseases are one of the leading causes of death in Singapore and worldwide. Post-stroke neuropsychiatric disorders such as depression and anxiety disorders are common and there have been primary care articles highlighting the need for general practitioners to actively monitor patients for neuropsychiatric sequelae such as post-stroke depression. There is however a scarcity of primary care articles on post-stroke delusional disorder. Though post-stroke delusional disorders are uncommon, primary care physicians should be equipped to not only be able to manage common diseases well but also uncommon presentations of common diseases, as they can cause significant morbidity and mortality. We present a pilot case report on a middle-aged Chinese gentleman with a rare occurrence of post-stroke delusional disorder that presented and was managed in the community setting in Singapore.

Femoral vein tunnelled catheter is susceptible to various complication, Advocating early arteriovenous fistula creation in chronic renal impairment patients should be emphasised.

Transposed brachio-basilic fistula could be created for successful use for dialysis especially in patients who has exhausted other option of native fistulas.

The cost of maintaining autogenous arteriovenous fistula is less expensive than artificial access because of lower surgical morbidity, mortality, incidence of infection and good patency rate. However when autogenous AVF was occluded by thrombosis, the salvaging procedure for re-vascularisation did not show satisfactory results. The National Kidney Foundation Dialysis Outcomes Quality Initiatives suggests that choosing the method of salvage procedure depends on the ability of each institute. Here we present a 38year old man came with failure of left brachio-cephalic fistula thrombosis due to cannulation site infection and thrombosis. Proximal neo vein to vein anastomosis was performed. 3weeks post intervention, wound was well-healed and patient was able to continue hemodialysis without venous hypertension in the forearm.

Dendritic cells (DCs) are professional antigen presenting cells of the immune system. They can be generated in vitro from peripheral blood monocytes supplemented with GM-CSF, IL-4 and TNF alpha. During induction, DCs will increase in size and acquire multiple cytoplasmic projections when compared to their precursor cells such as monocytes or haematopoietic stem cells which are usually round or spherical. Morphology of DCs can be visualized by conventional light microscopy after staining or phase-contrast inverted microscopy or confocal laser scanning microscopy. In this report, we described the morphological appearances of DCs captured using the above-mentioned techniques. We found that confocal laser scanning microscopy yielded DCs images with greater details but the operating cost for such a technique is high. On the other hand, the images obtained through light microscopy after appropriate staining or phase contrast microscopy were acceptable for identification purpose. Besides, these equipments are readily available in most laboratories and the cost of operation is affordable. Nevertheless, morphological identification is just one of the methods to characterise DCs. Other methods such as phenotypic expression markers and mixed leukocyte reactions are additional tools used in the characterisation of DCs.
Dendritic Cells/*cytology ; Microscopy, Confocal ; Microscopy, Phase-Contrast

Gamma-irradiation of blood components is regarded a safe procedure used for prevention of transfusionassociated graft-versus-host disease. However, reports showed that irradiation can cause erythrocyte haemolysis and damage to the RBC membrane. In Universiti Kebangsaan Malaysia Medical Centre (UKMMC), a number of suspected transfusion reactions (TR) featured unusual isolated episodes of red-coloured-urine or haemoglobinuria among paediatric patients without clinical features of acute haemolytic TR. Haemolysis of irradiated red cells was suspected as a cause. This study was conducted to evaluate haemolytic changes of RBC components following irradiation. A prospective, pre- and post- irradiation comparative study was conducted on 36 paired RBC-components in the blood-bank, UKMMC in the year 2013. Samples were tested for plasma-Hb, percent-haemolysis, plasma-potassium (K+) and lactate dehydrogenase (LDH) level. Post-irradiation mean plasma-Hb and percent-haemolysis were significantly higher than pre-irradiation values at 0.09±0.06g/dl VS 0.10±0.06g/dl and 0.19±0.13% VS 0.22±0.13% respectively, while plasma-K+ and LDH values did not show significant difference. However, the mean percent-haemolysis level was still within recommended acceptable levels for clinical use, supporting that irradiated RBC units were safe and of acceptable quality for transfusion. There was no conclusive reason for isolated haemoglobinuria following transfusion of irradiated red-cell products. Further research is suggested to investigate the other possible causes.