Introduction: There is no large population size study on school screening for scoliosis in Malaysia. This study is aimed to determine the prevalence rate and positive predictive value (PPV) of screening programme for adolescent idiopathic scoliosis. Materials and Methods: A total of 8966 voluntary school students aged 13-15 years old were recruited for scoliosis screening. Screening was done by measuring the angle of trunk rotation (ATR) on forward bending test (FBT) using a scoliometer. ATR of 5 degrees or more was considered positive. Positively screened students had standard radiographs done for measurement of the Cobb angle. Cobb angle of >10° was used to diagnose scoliosis. The percentage of radiological assessment referral, prevalence rate and PPV of scoliosis were then calculated. Results: Percentage of radiological assessment referral (ATR >5°) was 4.2% (182/4381) for male and 5.0% (228/4585) for female. Only 38.0% of those with ATR >5° presented for further radiological assessment. The adjusted prevalence rate was 2.55% for Cobb angle >10°, 0.59% for >20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle >10°, 12.8% for >20° and 2.6% for > 40°. Conclusions: This is the largest study of school scoliosis screening in Malaysia. The prevalence rate of scoliosis was 2.55%. The positive predictive value was 55.8%, which is adequate to suggest that the school scoliosis screening programme did play a role in early detection of scoliosis. However, a cost effectiveness analysis will be needed to firmly determine its efficacy.

No abstract available.
Animals ; Epidermal Growth Factor* ; Gene Expression* ; Gonadotropin-Releasing Hormone* ; Pituitary Adenylate Cyclase-Activating Polypeptide* ; Rats*

Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.
Intervertebral Disc Displacement ; Polyradiculopathy

A 50-year-old man with bladder cancer had spinal anesthesia for transurethral resection of bladder. After he had spinal block at the T8 level, he developed a persistent penile erection, making it impossible to introduce the 24 French cystoscope. To treat a persistent penile erection, intravenous glycopyrrolate was incrementally given for a total of 0.4 mg. A persistent penile erection was markedly subsided 5 minutes after last 0.2 mg glycopyrrolate was given. Then corpus cavernosum blood was aspirated. The cystoscope was easily introduced, and transurethral resection of bladder proceeded without further complication.
Anesthesia, Spinal* ; Cystoscopes ; Glycopyrrolate ; Humans ; Male ; Middle Aged ; Penile Erection* ; Urinary Bladder ; Urinary Bladder Neoplasms

BACKGROUND: Relationships among portable scanning mobility particle sizer (P-SMPS), condensation particle counter (CPC), and surface area monitor (SAM), which are different metric measurement devices, were investigated, and two widely used research grade (RG)-SMPSs were compared to harmonize the measurement protocols. METHODS: Pearson correlation analysis was performed to compare the relation between P-SMPS, CPC, and SAM and two common RG-SMPS. RESULTS: For laboratory and engineered nanoparticle (ENP) workplaces, correlation among devices showed good relationships. Correlation among devices was fair in unintended nanoparticle (UNP)-emitting workplaces. This is partly explained by the fact that shape of particles was not spherical, although calibration of sampling instruments was performed using spherical particles and the concentration was very high at the UNP workplaces to allow them to aggregate more easily. Chain-like particles were found by scanning electron microscope in UNP workplaces. The CPC or SAM could be used as an alternative instrument instead of SMPS at the ENP-handling workplaces. At the UNP workplaces, where concentration is high, real-time instruments should be used with caution. There are significant differences between the two SMPSs tested. TSI SMPS showed about 20% higher concentration than the Grimm SMPS in all workplaces. CONCLUSIONS: For nanoparticle measurement, CPC and SAM might be useful to find source of emission at laboratory and ENP workplaces instead of P-SMPS in the first stage. An SMPS is required to measure with high accuracy. Caution is necessary when comparing data from different nanoparticle measurement devices and RG-SMPSs.
Calibration ; Nanoparticles*

BACKGROUND: It is stated frequently that patients with spinal block may be drowsy, although they may not have received any sedative drugs. Intrathecal clonidine increase the duration of sensory and motor blockades, and also has a sedative effect. Thus we conducted this study to investigate the effects of spinal anesthesia and intrathecal clonidine on propofol hypnotic requirements. METHODS: Forty-five adult patients scheduled to undergo local or spinal anesthesia were enrolled in this study. Group 1 included patients on local anesthesia, group 2 were patients on spinal anesthesia with 0.5% hyperbaric bupivacaine, and group 3 were patients on spinal anesthesia with 0.5% hyperbaric bupivacaine and 75microgram clonidine. The target controlled infusion (TCI) of propofol was started at a target concentration of 1microgram/ml. We checked the lowest BIS during 5 min observation after the effect site concentration (Ce) had been reached (1microgram/ml). The TCI of propofol was then restarted at a target concentration of 1.5microgram/ml and we checked the lowest BIS during 5 min observation after the Ce had been reached (1.5microgram/ml). We also checked the Ce when the BIS reached 80 and 70. RESULTS: The minimum BIS's at 1 microgram/ml Ceiiwere 86.9 +/- 11.3 (Group 1), 80.5 +/- 8.5 (Group 2) and 66.9 +/- 15.5 (Group 3), and the minimum BIS's at 1.5microgram/ml Ce were 76.0 +/- 13.4, 62.9 +/- 12.4, 48.5 +/- 13.7, respectively. The Ce's of propofol at BIS 80 were checked initially at 1.4 +/- 0.5microgram/ml (Group 1), 1.1 +/- 0.3microgram/ml (Group 2) and 0.8 +/- 0.3microgram/ml (Group 3). The Ce's of propofol at BIS 70 were 1.8 +/- 0.6microgram/ml, 1.4 +/- 0.3microgram/ml and 1.0 +/- 0.3microgram/ml, respectively. The Ce's of Group 2 and Group 3 at BIS 80 and BIS 70 were statistically lower than those of Group 1 (P < 0.05), and the Ce's of Group 3 at BIS 80 and BIS 70 were statistically lower than those of Group 2 (P < 0.05). CONCLUSIONS: Spinal anesthesia and intrathecal clonidine reduce the requirement of propofol for conscious sedation. The Ce of propofol for conscious sedation is 1.4-1.8microgram/ml for local anesthesia, 1.1-1.4microgram/ml for spinal anesthesia with 0.5% hyperbaric bupivacaine, and 0.6-1.0microgram/ml for spinal anesthesia with 0.5% hyperbaric bupivacaine and 75microgram clonidine.
Adult ; Anesthesia, Local ; Anesthesia, Spinal* ; Bupivacaine ; Clonidine* ; Conscious Sedation* ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Propofol*

The laryngeal mask airway (LMA) has several advantages over endotracheal intubation for the airway management in tracheal stenosis patients. Endotracheal tubes are narrower than the natural trachea and can induce reflex airway constriction resulting in more resistance to ventilation. Furthermore, an endotracheal tube can injure the trachea, and cause airway edema, and further tracheal constriction. In contrast, the increase in airway resistance that occurs when using the laryngeal mask is relatively low, because the diameter of the laryngeal mask airway is larger than that of the endotracheal tube and the laryngeal mask airway is not intubated. However, patients with a mechanically obstructed trachea, those with tracheomalacia or an external compression of the trachea, cannot be managed with a laryngeal mask airway, because it cannot prevent tracheal collapse. Thus it is important that the causes of tracheal obstruction are differentiated. This report suggests that the laryngeal mask airway can be used as a route for mechanical ventilation and as a conduit for tracheal evaluation and endotracheal intubation using fiberoptic bronchoscope during tracheal reconstruction surgery in patients with tracheal stenosis.
Airway Management ; Airway Resistance ; Bronchoscopes ; Constriction ; Edema ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Reflex ; Respiration, Artificial ; Trachea ; Tracheal Stenosis ; Tracheomalacia ; Ventilation

INTRODUCTION: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore. METHODS: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission. RESULTS: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5). CONCLUSION The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.
Abortion, Spontaneous/epidemiology* ; Adult ; COVID-19/transmission* ; COVID-19 Nucleic Acid Testing ; COVID-19 Serological Testing ; Cohort Studies ; Disease Transmission, Infectious/statistics & numerical data* ; Female ; Fetal Blood/immunology* ; Humans ; Infectious Disease Transmission, Vertical/statistics & numerical data* ; Live Birth/epidemiology* ; Maternal Age ; Milk, Human/virology* ; Obesity, Maternal/epidemiology* ; Placenta/pathology* ; Pregnancy ; Pregnancy Complications, Infectious/physiopathology* ; Pregnancy Outcome/epidemiology* ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Prospective Studies ; RNA, Viral/analysis* ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index ; Singapore/epidemiology* ; Umbilical Cord/pathology* ; Young Adult