Introduction: There are various methods used to repair lacerated tendons. The minimum requirement for the best results and lowest rupture rate is the four-strand repair technique. The cruciate type of repair is among the most popular methods available but is very technical and requires expertise. An easier two-double-loop method for tendon healing is suggested in this study. This study assessed the biomechanical properties of two well-known tendon repair techniques—the modified Kessler and cruciate approaches—and two lesser-known double-loop techniques for tensile strength, stiffness, and failure mode. Materials and methods: Twenty-four adult chickens' Achilles tendons were randomly divided into three groups and sutured with a four-strand core suture using the fourstrand modified Kessler technique, the four-strand cruciate technique, and the two-double-loop approach. Twenty-four more adult chicken Achilles tendons were acquired, and they were randomly assigned to the same three groups along with an extra running epitendinous repair. A synthetic, nonabsorbable monofilament polypropylene suture was used for all repairs. Results: The four-strand modified Kessler, and the fourstrand cruciate procedures had the lowest mean ultimate tensile strength, whereas the two double-loop techniques had the strongest. The results were dramatically impacted by using an epitendinous suture during test analysis. Conclusion: The strongest and comparatively less technically complex technique used in this investigation was the two-double-loop, four-strand core suture method. The significance of the extra strength that the epitendinous suture gave was clear. Using this in a clinical setting is recommended for hand flexor tendon injuries.

Introduction: One session of high energy extracorporeal shockwave therapy (ESWT) was found to improve the healing of anterior cruciate ligament (ACL) after reconstruction in animal and human studies. This study investigated the effects of three and six sessions of low energy ESWT on graft incorporation and knee functions post ACL reconstruction in humans. Materials and methods: Thirty participants with ACL injuries were recruited and assigned equally into three groups with 10 participants per group (n=10). Participants in the control group received physiotherapy alone without low energy ESWT. Participants in the 3ESWT group underwent three sessions of low energy ESWT (one session per week) combined with physiotherapy, and participants in the 6ESWT group received six sessions of low energy ESWT (one session per week) combined with physiotherapy. However, five participants were lost to follow-up. Evaluations of graft incorporation of the tibial tunnel using magnetic resonance (MRI) and Lysholm score were carried out before ACL reconstruction and after six months post ACL reconstruction. Results: The number of grafts with partial incorporation in the tibia tunnel in 6ESWT was significantly higher compared with the number of grafts with non-incorporation at six months post-operatively, X2 (1, N=9) =5.44, p =0.02. However, there was no significant difference between frequencies of graft incorporation in tibia tunnel in the control and 3ESWT groups, X2 (1, N=7) =3.57, p =0.06 and X2 (1, N=9) =2.78, p =0.10, respectively at 6 months postoperatively. Lysholm scores were significantly higher at 6 months post ACL reconstruction compared to the baseline value for each group (p<0.002, respectively). However, there was no significant difference in the Lysholm score between each group (F = 2.798, p = 0.083). Conclusions: Six sessions of low energy ESWT improved graft incorporation in the tibial tunnel. Both three and six sessions of low energy of ESWT does not affect the knee function score at six months post ACL reconstruction.

Introduction: Anaemia is common during pregnancy and can lead to miscarriage, intrauterine growth retardation, premature labour and antepartum haemorrhage. Anaemia in pregnancy is defined as a haemoglobin (Hb) level of <11 g/dL. Methods: This retrospective review included 407 antenatal mothers diagnosed with anaemia at 36±1 weeks of gestation at all 10 health clinics in Alor Gajah between January and December 2018. Results: According to the district annual returns, 2,407 antenatal mothers (36 weeks of gestation) were registered in the health clinics in Alor Gajah in 2018. Among them, the prevalence of anaemia was 18.6% (n=448). However, there were only 407 cards found. Most participants were Malays (89.4%), aged 20–40 years (93.6%) and married (96.3%). Almost all anaemia cases (96.5%) were mild (Hb level of 9–10.9 g/dL). Approximately 34.4% of the mothers were already anaemic at booking; 77.6% belonged to the B40 income group; and 31.6% had poor pregnancy spacing of <2 years. Iron deficiency anaemia was the most common type of anaemia (51.0%), followed by dilutional anaemia (34.0%), which did not normalise at 36 weeks of gestation. Anaemia was associated with lower educational (P<0.05) and Hb levels at booking (P<0.001). Conclusion Having normal maternal Hb levels in early pregnancy especially at booking is crucial, as it may reduce the possibility of anaemia during pregnancy. Early screening and supplementation of at-risk pregnancies may be applied as a preventive strategy. Suitable methods of iron treatment and investigation need further exploration.

Ovitrap surveillance was carried out in fifteen localities encompassing foggingfree and dengue risk areas in West Malaysia to determine on the dispersal and prevalence of single and co-breeding of mosquito larvae particularly Aedes. Ovitraps were sited randomly indoors and outdoors within human settlements in all study areas. All the localities exhibited positive ovitraps with single breeding of Ae. albopictus that ranged between 64.29% and 100.00%. These findings indicated Ae. albopictus as the predominant container-breeding species in all study areas. The co-breeding of Ae. aegypti with Ae. albopictus larvae (34 ovitraps), Ae. albopictus with Culex quinquefasciatus larvae (32 ovitraps) as well as Cx. quinquefasciatus with Armigeres subalbatus larvae (1 ovitrap) were also detected in certain study localities. Interestingly, co-breeding of Ae. albopictus with Ar. subalbatus larvae as well as Ae. albopictus with Uranotaenia sp. larvae in Malaysia is reported for the first time in the present study. Better understanding of the co-breeding scenario involving different species of mosquito larvae is needed to ensure the efficacy of vector control actions to be conducted.

Spinal tuberculosis is not common in the paediatric age group. Initial clinical features are often vague and non specific until the disease progresses to later stages. We highlight the diagnostic difficulties and management challenges of a complicated extradural tuberculoma with neurological deficits in a very young girl.
Tuberculosis, Spinal

Myogenic tone is the response of the vascular smooth muscle to an increase in intraluminal pressure with vasoconstriction and with vasodilation when the pressure is decreased. Such myogenic tone contributes a level of physiological basal tone in response to neurohumoral stimuli. In spite of myogenic tone discovery by Sir William Bayliss 100 years ago, questions still remain regarding the underlying signaling mechanism of the myogenic response. Studies have shown that increased intraluminal pressure or wall tension leads to membrane depolarization, voltage-operated calcium channel (VOCC), stretch-activated cation (SAC) channels, extracelullar matrix (ECM) and actin cytoskeleton. Recently, evidence has shown a potential role for reactive oxygen species (ROS) as a key signalling mediator in the genesis of myogenic tone. The identification of the primary mechanosensors in the initiation of pressure-dependent myogenic tone is essential as these components could be potential therapeutical targets in the future.

Acral melanoma has been reported to have distinctive clinical presentation and ethnic distribution compared to other histological types of malignant melanoma. Acral melanoma also exhibits distinctive focused gene amplifi cations, including cyclin D1 overexpression. We reviewed archived histological material of malignant melanoma in the Sarawak General Hospital from year 2004 to 2010. 43 tumours, comprising 28 acral melanoma and 15 non-acral melanoma, had suffi cient material to be included in the study. The majority (36%) of acral melanoma tumours occurred in the heel. The tumours were analyzed for cyclin D1 expression by immunohistochemistry. 68% of acral melanoma were cyclin D1 positive compared to a positivity of 33% in non-acral tumours. This difference was statistically signifi cant (p <0.05). This fi nding may improve the histological diagnosis of acral melanoma and detection of positive resection margins.

A study was carried out to isolate Brucella melitensis using established bacteriological and PCR techniques in Brucella seropositive goats in farms in Selangor, Negeri Sembilan, Melaka and Pulau Pinang. Brucella melitensis was isolated from 7 of 134 reactors with the highest isolation from the vaginal swabs (57.14%) followed by the spleen (28.57%), uterine fluid (14.29%). No Brucella was isolated from the lymph nodes. PCR confirmed all the seven isolates as B. melitensis and isolates were phylogenetically related to other isolates from India, Iran, and Israel but most closely related to isolates from Singapore.

We report Mycobacterium fortuitum (M. fortuitum) catheter-related sepsis in a five-year-old boy with acute lymphoblastic leukaemia (ALL). This is the first reported case of M. fortuitum infection seen in our paediatric oncology patients. The patient was in haematological remission and receiving maintenance chemotherapy via an indwelling central venous catheter (Port-a-Cath). He was febrile, toxic-looking and was in respiratory distress. Clinically, he had a right pleural effusion and gross hepatomegaly. The patient was lymphopaenic and had deranged liver function test. Repeat paired blood cultures were positive for M. fortuitum. The catheter was promptly removed and he was treated aggressively with intravenous amikacin, cefoxitin, ciprofloxacin, trimethoprim-sulfamethoxazole and oral clarithromycin, with good clinical response. The patient remained well without further complications while on chemotherapy. M. fortuitum is an uncommon cause of catheter-related infection in patients with malignancies. Removal of an infected catheter is necessary for complete control of atypical mycobacterial infection in an immunosuppressed patient.
Acute Disease ; Antineoplastic Agents ; administration & dosage ; Catheters, Indwelling ; microbiology ; Child, Preschool ; Humans ; Immunocompromised Host ; Male ; Mycobacterium Infections, Nontuberculous ; complications ; microbiology ; Mycobacterium fortuitum ; isolation & purification ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; drug therapy ; Sepsis ; etiology ; microbiology

Hydroxyapatite (HA) has been earmarked as suitable for implantation within the human of its chemical makeup to human bone. In this paper, HA powders were synthesized via the precipitation method where phosphoric acid (H3PO4) was titrated into calcium hydroxide solution [Ca(OH)2]. Two parameters such as temperature and stirring rate were identified as factors that influenced the amount and purity of HA powder. Phase identification of the synthesized powder was done using X-Ray Diffraction (XRD). The results show that HA phase can be synthesized from this titration process of Ca(OH)2 and H3PO4 with yield amount of HA powder around 45 - 61 grams but with less than hundred percent purity. In order to study the effect of heat treatment to HA crystals structure, HA powder was calcined at 850 degrees C for 2 hours. It's found that the degree of crystallinity increases after calcination because of lattice expansion when the materials were heated at higher temperature
Sjogren's syndrome B antibody ; Powders ; Durapatite ; Precipitation ; hydroxyl group