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Fulltext The metaphyseal sleeve: an unexplored option in the treatment of complex primary knee osteoarthritis

Wong WK, Chua HS

Knee Surg Relat Res, 2020 Apr 16;32(1):20.
PMID: 32660589 DOI: 10.1186/s43019-020-00032-9

BACKGROUND: In an ever-aging society that as a whole has become more affluent, significant emphasis has been accorded to an improved quality of life. Knee osteoarthritis is ever-increasingly treated with total knee arthroplasty. The benefits and satisfaction experienced by those who have undergone total knee replacements (TKR) are well documented in the literature. The issue arises when osteoarthritis of the affected knee is more complex than simple osteoarthritis, i.e. the patient has complex primary osteoarthritis. This collective term encompasses conditions such as massive bone loss, ligamentous laxity, coronal defects and those with contractures. There are various classifications to describe massive bone loss but we utilized the Anderson Orthopaedic Research Institute (AORI) classification. Numerous treatment options are available and we report the use of metaphyseal sleeves as a highly successful treatment option.
METHODS: We retrospectively reviewed all the patients at our centre who underwent primary TKR using the metaphyseal sleeves. Patients were assessed on symptoms and functional status, and radiographs were also taken to assess for osseointegration. Only patients who completed 2 years of follow up were included in our study.
RESULTS: The updated (2011) Knee Society Score (KSS) was used in conjunction with radiological assessments at each follow up. Mean KSS scores improved from 53.83 preoperatively to 193.39 postoperatively. All patients demonstrated increasing osseointegration throughout follow up.
CONCLUSION: The metaphyseal sleeve is an excellent treatment option for complex primary osteoarthritic knees with good results objectively, functionally and radiologically and would be a great choice for all orthopaedic surgeons to include in their armamentarium.
Fulltext Open total talus dislocation: a case report

Tan E, Chua H, Ooi C, Zulkiflee O

Malays Orthop J, 2012 Nov;6(3):60-2.
PMID: 25279062 MyJurnal DOI: 10.5704/MOJ.1207.009

Total talus dislocation is a rare injury and is commonly accompanied by associated fractures. Common worrisome sequelae are infection, avascular necrosis and post-traumatic arthritis. We report here on a patient who sustained an open total talus dislocation with an ipsilateral medial malleolus fracture. Following early debridement, reduction and a combination of internal and external fixations, early recovery was good with no evidence of avascular necrosis.
Fulltext Pilomatrixoma of left shoulder in an elderly female: a case report

Tan L, Ooi C, Chua H, Zulkiflee O

Malays Orthop J, 2013 Jul;7(2):48-50.
PMID: 25722828 MyJurnal DOI: 10.5704/MOJ.1307.005

We report a huge pilomatrixoma of the left shoulder in an elderly female, raising fear of malignancy. Magnetic Resonance Imaging delineated the swelling and wide surgical excision was performed. Post operative recovery was uneventful. Long term follow up is necessary in view of the possibility of recurrence and malignant transformation.
KEY WORDS: Pilomatrixoma, Pilomatricoma, Calcifying Epithelioma of Malherbe, Shoulder, Upper Limb, Elderly, Female.
Fulltext Francisella philomiragia bacteremia in an immunocompromised patient: a rare case report

Chua HS, Soh YH, Loong SK, AbuBakar S

Ann Clin Microbiol Antimicrob, 2021 Oct 03;20(1):72.
PMID: 34602092 DOI: 10.1186/s12941-021-00475-2

BACKGROUND: Francisella philomiragia is a very rare opportunistic pathogen of humans which causes protean diseases such as pneumonia and other systemic infections. Subsequent failure of prompt treatment may result in poor prognosis with mortality among infected patients.
CASE PRESENTATION: The present report describes a case of F. philomiragia bacteraemia first reported in Malaysia and Asian in a 60-year-old patient with underlying end-stage renal disease (ESRF) and diabetes mellitus. He presented with Acute Pulmonary Oedema with Non-ST-Elevation Myocardial Infarction (NSTEMI) in our hospital. He was intubated in view of persistent type I respiratory failure and persistent desaturation despite post haemodialysis. Blood investigation indicated the presence of ongoing infection and inflammation. The aerobic blood culture growth of F. philomiragia was identified using the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (Score value: 2.16) and confirmed by 16S Ribosomal DNA (16S rDNA) sequencing. He was discharged well on day 26 of admission, after completing one week of piperacillin/tazobactam and two weeks of doxycycline.
CONCLUSION: Clinical suspicion should be raised if patients with known risk factors are presenting with pneumonia or pulmonary nodules especially as these are the most common manifestations of F. philomiragia infection. Early diagnosis via accurate laboratory identification of the organism through MALDI-TOF mass spectrometry and molecular technique such as 16S rDNA sequencing are vital for prompt treatment that results in better outcomes for the afflicted patients.
Integrated miniature fluorescent probe to leverage the sensing potential of ZnO quantum dots for the detection of copper (II) ions

Ng SM, Wong DS, Phung JH, Chin SF, Chua HS

Talanta, 2013 Nov 15;116:514-9.
PMID: 24148438 DOI: 10.1016/j.talanta.2013.07.031

Quantum dots are fluorescent semiconductor nanoparticles that can be utilised for sensing applications. This paper evaluates the ability to leverage their analytical potential using an integrated fluorescent sensing probe that is portable, cost effective and simple to handle. ZnO quantum dots were prepared using the simple sol-gel hydrolysis method at ambient conditions and found to be significantly and specifically quenched by copper (II) ions. This ZnO quantum dots system has been incorporated into an in-house developed miniature fluorescent probe for the detection of copper (II) ions in aqueous medium. The probe was developed using a low power handheld black light as excitation source and three photo-detectors as sensor. The sensing chamber placed between the light source and detectors was made of 4-sided clear quartz windows. The chamber was housed within a dark compartment to avoid stray light interference. The probe was operated using a microcontroller (Arduino Uno Revision 3) that has been programmed with the analytical response and the working algorithm of the electronics. The probe was sourced with a 12 V rechargeable battery pack and the analytical readouts were given directly using a LCD display panel. Analytical optimisations of the ZnO quantum dots system and the probe have been performed and further described. The probe was found to have a linear response range up to 0.45 mM (R(2)=0.9930) towards copper (II) ion with a limit of detection of 7.68×10(-7) M. The probe has high repeatable and reliable performance.
Fulltext Credit card fraud detection using a hierarchical behavior-knowledge space model

Nandi AK, Randhawa KK, Chua HS, Seera M, Lim CP

PLoS One, 2022;17(1):e0260579.
PMID: 35051184 DOI: 10.1371/journal.pone.0260579

With the advancement in machine learning, researchers continue to devise and implement effective intelligent methods for fraud detection in the financial sector. Indeed, credit card fraud leads to billions of dollars in losses for merchants every year. In this paper, a multi-classifier framework is designed to address the challenges of credit card fraud detections. An ensemble model with multiple machine learning classification algorithms is designed, in which the Behavior-Knowledge Space (BKS) is leveraged to combine the predictions from multiple classifiers. To ascertain the effectiveness of the developed ensemble model, publicly available data sets as well as real financial records are employed for performance evaluations. Through statistical tests, the results positively indicate the effectiveness of the developed model as compared with the commonly used majority voting method for combination of predictions from multiple classifiers in tackling noisy data classification as well as credit card fraud detection problems.
Novel Vibrio vulnificus sequence type 540 infection in a hepatitis patient

Chua HS, Soh YH, Ibrahim S, Abdullah NH, Che Mat Seri NAA, AbuBakar S, et al.

Trop Biomed, 2024 Jun 01;41(2):220-223.
PMID: 39154277 DOI: 10.47665/tb.41.2.014

Vibrio vulnificus infection is associated with high morbidity and mortality in high-risk patients. Poor prognoses could lead to >50% mortality rate. The present report describes a case of V. vulnificus bacteremia in a cirrhotic patient with underlying hepatitis C. He presented with generalised abdominal pain associated with distention and could not ambulate for one week. He also complained of fever for six days and pruritus for 10 days. Tea-coloured urine was noted in continuous bag drainage. The abdomen was distended but soft, with mild tenderness palpated over the left lumbar and iliac region. Blood investigation indicated ongoing infection and inflammation. The aerobic blood culture was identified using the matrix-assisted laser desorption/ionisation-time of flight mass spectrometry and confirmed via 16S rDNA sequencing as V. vulnificus. Multilocus sequence typing of the isolated V. vulnificus revealed a novel sequence type, ST540. The patient responded well to the intravenous cefoperazone and was then discharged with a four day-course of oral ciprofloxacin, 500 mg twice daily after completing the intravenous cefoperazone for 10 days. Clinical history and physical examination are important for early antibiotic therapy initiation and appropriate surgical intervention. Furthermore, bacterial strain typing is also essential for epidemiological surveillance and potentially anticipating the pathogen's virulence traits, which are vital in controlling and preventing the spread of infection.
Effect of magnetic field on nano-magnetite composite exhibits in ion-adsorption

Lo FF, Kow KW, Kung F, Ahamed F, Kiew PL, Yeap SP, et al.

Sci Total Environ, 2021 Aug 01;780:146337.
PMID: 33770606 DOI: 10.1016/j.scitotenv.2021.146337

Nano-magnetites are widely researched for its potential as an excellent adsorbent in many applications. However, the efficiency of the nano-magnetites are hindered by their tendency to agglomerate. In this work, we dispersed and embedded the nano-magnetites in a porous silica gel matrix to form a nanocomposite to reduce the extent of agglomeration and to enhance the adsorption performance. Our experimental results showed that the removal efficiency of Cu2+ ion has improved by 46% (22.4 ± 2.2%) on the nano-magnetite-silica-gel (NMSG) nanocomposite as compared to pure nano-magnetites (15.3 ± 0.6%). The adsorption capacity is further enhanced by 39% (from 11.2 ± 1.1 to 15.6 ± 1.6 mg/g) by subjecting the NMSG to a magnetic field prior to adsorption. We infer that the magnetic field aligned the magnetic domains within the nano-magnetites, resulting in an increased Lorentz force during adsorption. Similar alignment of magnetic domains is near to impossible in pure nano-magnetites due to severe agglomeration. We further found that the adsorption capacity of the NMSG can be manipulated with an external magnetic field by varying the strength and the configurations of the field. Equipped with proper process design, our finding has great potentials in processes that involve ion-adsorptions, for example, NMSG can: (i) replace/reduce chemical dosing in controlling adsorption kinetics, (ii) replace/reduce complex chemicals required in ion-chromatography columns, and (iii) reduce wastage of nano-adsorbents by immobilizing it in a porous matrix.