Background: Surgical robots have been appearing in operating rooms over the past decade, and neurosurgery has been one of the pioneers in this area. In neurosurgery, the clinical use of robots has been limited to stereotactic procedures and endoscopic manoeuvres, although the brain is a unique organ and well-suited for robotic application. The aim of this study was to assess the ability of our vision-guided robotic system to perform basic neurosurgical procedures. Methods: The study was divided into two parts: bone drilling and endoscopic manoeuvres. The robotic system was instructed to recognise targets on artificial skull models placed in different positions (supine, lateral, sitting, and prone) and to make burr holes. A total of 10 selected burr holes were used to assess the capability of the robot to insert an endoscope. Results: The accuracy ranged 0.1–1.0 mm with repeatability ranged 0.03–0.92 mm. Conclusion: Generally, the present robotic system is able to perform the surgical tasks. However, further study is needed to refine the robotic system, including the safety mechanisms.

Monostotic fibrous dysplasia of the vertebra is a rare entity. A case of a 53-year-old lady who presented with an 8 months history of pain in the thoracic spine region with paraparesis is discussed. She had a history of papillary thyroid carcinoma and had undergone total thyroidectomy one year prior to her current problem. Magnetic resonance imaging revealed isolated osteolytic lesion over the posterior element of the T12 vertebra with narrowing of the spinal canal causing compression of the cord. The diagnosis of fibrous dysplasia was made histologically. Fibrous dysplasia rarely occurs in axial bones compared with peripheral bones. This case illustrates that osteolytic lesion of the vertebrae should be evaluated with detailed radiological and histopathological examination before an empirical diagnosis of spinal metastasis is made in an adult with a background history of primary malignancy well-known to spread to the bone.
Fibrous Dysplasia, Monostotic

Background: Chronic pain is a common medical issue. Beside chronic devastating pain, patients also suffer dysfunction more generally, including in the physical, emotional, social, recreational, vocational, financial, and legal spheres. Integrated multidisciplinary and multimodal chronic pain management programmes offer clear evidence for relief of suffering and return to functional lifestyles. Materials and Methods: This retrospective review was performed in order to evaluate one-year outcomes among all newly referred patients of the multimodal chronic pain service at Hospital Universiti Sains Malaysia (HUSM). All patients received multimodal pain therapy, including pharmacological, physical, and psychological therapy, exercise, and pain intervention. The variables evaluated were based on a patient’s global pain assessments, which were made using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), modified by patient self-report, and were taken within days to months of commencing our multimodal pain regime. Results: A total of 169 patients were enrolled in this study. Out of this number, 102 (60.4%) were seen at the pain clinic, and 67 (39.6%) were referred while they were inpatients. About one-third of the patients had chronic pain due to cancer. Our data showed that 128 (75.7%) of our chronic pain patients were successfully managed when ≥50% of pain relief (as measured by their VAS score) was achieved at any point during the course of the study period. In addition, 104 patients (61.5%) showed improvement in their modified ODI by 50% or more. Conclusion: A multimodal chronic pain service plays a significant role in managing chronic pain patients in a major hospital, as it is capable of delivering comprehensive and attainable care to manage refractory and intractable chronic pain.

Dichloromethane and methanolic extracts of each plant were tested for their antiplasmodial activity on chloroquineresistant strain of Plasmodium falciparum (FCB strain), based on lactate dehydrogenase activity. Cytotoxicity was assessed with the MTT test on MRC-5 human diploid embryonic lung cells. Most extracts of ten selected plants used in Malay traditional medicine in Malaysia had activity in vitro. This supports continued investigations of traditional medicine in the search for new antimalarial agent. The compounds responsible for the observed antiplasmodial effects are under investigation.

The anticoagulant effect of leech saliva was traditionally employed in the treatment of diabetes mellitus complications such as peripheral vascular complications. This study was carried out to examine the effect of leech saliva extract (LSE) on blood glucose levels in alloxan-induced diabetic rats. First, LSE was collected from leeches which were fed on a phagostimulatory solution. Second, total protein concentration was estimated using the Bradford assay. Third, diabetic rats were injected subcutaneously (sc) with LSE at doses of 500 and 1 000 μg·kg(-1) body weight (bw). Other diabetic rats were injected sc with insulin at doses of 10 and 20 U·kg(-1) bw. Another group was injected simultaneously with LSE (250 μg·kg(-1) bw) and insulin (10 U·kg(-1) bw). Fasting blood glucose (FBG) concentrations were monitored during a study period of eight hours at regular intervals. Findings showed that both doses of LSE resulted in a significant and gradual decrease in FBG starting from 10%-18% downfall after two hours of injection reaching the maximal reduction activity of 58% after eight hours. Remarkably, LSE was sufficient to bring the rats to a near norm-glycemic state. The high dose of insulin induced a severe hypoglycemic condition after 2-4 h of injection. The lower dose was able to decline FBG for 2-6 h in rats which became diabetic again after 8 h. On the other hand, the concurrent injection of low doses of LSE and insulin produced a hypoglycemic effect with all rats showing normal FBG levels. Taken together, these findings indicated that the subcutaneous injection of LSE of the medicinal Malaysian leech was able to provide better glycemic control compared with insulin. Moreover, the synergism between LSE and insulin suggests that LSE could be utilized as an adjuvant medication in order to reduce insulin dosage or to achieve better control of blood glucose.
Animals ; Biological Factors ; administration & dosage ; Blood Glucose ; metabolism ; Diabetes Mellitus, Experimental ; drug therapy ; metabolism ; Humans ; Hypoglycemic Agents ; administration & dosage ; Leeches ; chemistry ; Male ; Rats ; Rats, Sprague-Dawley ; Saliva ; chemistry

INTRODUCTION: Uncontrolled asthma may cause an increase in healthcare utilisation, hospital admission and productivity loss. With the increasing burden of asthma in Malaysia, strategies aimed at reducing cost of care should be explored. OBJECTIVE: This study aims to determine if a clinical pathway (CPW) for inpatient paediatric asthma would reduce average length of stay (ALOS), improve asthma management and decrease cost. METHODS: A quasi-experimental, pre-post study was used to evaluate the CPW effectiveness. Paediatric inpatients aged 5-18 years old, admitted for acute asthma exacerbation from September 2015 to April 2016 were prospectively recruited. Data from patients admitted from January-July 2015 were used as control. CPW training was carried out in August 2015 using standardised modules. Direct admission cost from the provider's prospective was calculated. Outcomes compared were differences in ALOS, discharge medication, readmission within 28 days of discharge and cost. RESULTS: ALOS is 26 hours lower in the CPW group for severe exacerbations and underlying uncontrolled asthma (19.2 hours) which is clinically significant as patients have shorter hospital stay. More newly-diagnosed intermittent asthmatics were discharged with relievers in the CPW group (p-value 0.006). None of the patients in the CPW group had readmissions (p-value 0.16). Mean treatment cost for patients in the intervention group is higher at RM843.39 (SD ±48.99, versus RM779.21 SD±44.33). CONCLUSION: This study found that management using a CPW may benefit asthmatic patients with uncontrolled asthma admitted with severe exacerbation. Further studies will be needed to explore CPW's impact on asthma management starting from the emergency department.