Background: Opioid dependence (OD) is a chronic, relapsing condition representing a significant societal burden in Asia. Opioid maintenance treatment (OMT) in combination with psychosocial treatment is considered to be the most effective strategy to treat opioid dependence. In Malaysia, about 52,000 patients reported receiving OMT in December 2012. Objective: The International Survey Informing Greater Insights in Opioid Dependence Treatment (INSIGHT) project aimed to assess aspects of OMT access and quality of care by surveying patients and users with opioid dependence, and healthcare professionals treating opioid-dependent patients. Materials and Methods: Using a structured questionnaire, 50 patients who were currently receiving OMT (or had received OMT in the past 3 months) and 77 physicians were surveyed in Malaysia regarding the provision and quality of OMT. Results: Patients were predominately male and in their thirties. Nearly all patients (98%) reported currently receiving methadone liquid; almost half (48%) reported ever having received psychosocial counselling and only 14% had ever received buprenorphine−naloxone in the past. Most physicians reported they were treating their patients with OMT (77% on methadone and 15% on buprenorphine−naloxone), and 3% used psychosocial counselling alone. Although methadone maintenance doses were close to levels recommended by WHO guidelines, induction doses of methadone, and both induction and maintenance doses of buprenorphine were well below these levels in Malaysia. Conclusions: The findings suggest that OMT implementation in Malaysia can be improved by providing patients with more education on treatment options, better access to available treatments, including abuse-deterrent formulations, and psychosocial support.

Evoked Potentials, Motor ; Humans ; Spine ; surgery

BACKGROUND:Depending on different pH values, nanohydroxyapatite materials have different purities, whether root canal sealers formed by which exert effects on antimicrobial resistance, root canal closure and apical histocompatibility has no reports.
OBJECTIVE:To compare the antimicrobial and sealant properties of nanohydroxyapatite materials with different pH, nanohydroxyapatite-composite and traditional root canal sealants.
METHODS:We detected the antimicrobial action of nanohydroxyapatite with pH 8, 9, 10, Vitapex and AH-Plus root canal sealants with and without addition of ornidazole against three microbial strains namely Enterococcus faecalis, Candida albicans and Staphylococcus aureus using agar diffusion method. And we also analyzed the endodontic microleakage of six root canal sealants by determining the apical reservoir glucose concentration using Glucose Oxidase Method.
RESULTS AND CONCLUSION:Pure nanohydroxyapatite with different pH did not show antimicrobial properties. Addition of ornidazole to nanohydroxyapatite showed greater inhibitory action against Enterococcus faecalis, lesser in Staphylococcus aureus, fol owed by Candida albicans. Vitapex root canal sealer had inhibitory effects only against Staphylococcus aureus. AH-Plus, itself, had antimicrobial activity against al the three strains, but the antimicrobial activity decreased after addition of ornidazole. Nanohydroxyapatite, as a root canal sealant, was superior to zinc oxide eugenol and Vitapex, but inferior to AH-Plus. Addition of ornidazole to nanohydroxyapatite for a short period showed no impact on sealant properties of the material.

·AIM: To investigate the effect of hydralazine on choroidal blood flow in rabbits and laser-induced choroidal neovascularization (CNV) in rats and the effect of hydralazine on tube formation of human umbilical vein endothelial cells (HUVEC).used with raised intraocular pressure (IOP) of the left eye to 40mmHg.Hydralazine (10g/L) eye drops were instilled and ocular blood flow was measured with colored microspheres technique. Male Brown Norway rats were treated with Nd: YAG laser to break Bruch's membrane. Hydralazine (5, 10, 20g/L) eye drops or saline alone was instilled three times a day for 4 weeks after laser treatment. Fluorescein angiography (FA) and choroidal flat mount were used to measure the area of CNV. Tube formation of HUVEC was studied at different concen-trations of hydralazine.hydralazine eye drops enhanced the choroidal blood flow significantly at 30 and 60 minutes after drug instillation. After 4 week of drug treatment, 5, 10 and 20g/L hydralazine eye drops all reduced the CNV formation dramatically measured by fluorescein angiography and choroidal flat mount. When HUVEC was cultured on matrix gel for 48 hours, hydralazine at 3-30mg/L preven-ted the tube formation.vivo and HUVEC tube formation in vitro, and enhanced rabbits' choroidal blood flow after ischemia. It is hoped that hydralazine could be used to treat age-related ma-cular degeneration in the future.

Fracture of hip prostheses is a rare occurrence. A case of bilateral hip prostheses fracture is described here. The need to follow-up and remain vigilant post hip replacement is highlighted.
Hip Fractures

Upper case Bee ; Therapeutic procedure ; Hepatitis, Chronic

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 5-month-old child was admitted to the paediatric intensive care unit with status epilepticus and cardio-respiratory arrest. Due to difficulty with obtaining intravenous access, an intraosseous infusion was started in the left proximal tibia. This was discontinued after two days. On examination there was swelling of the left leg with minimal redness. The site of infusion did not show any abnormality. A radiograph of the left leg performed on the ninth day did not reveal any abnormalities. A repeat radiograph performed on the twentieth day is shown above (Panel). What is the diagnosis? Answer: refer to page 237