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Fulltext Calf Compartment Syndrome associated with the Use of an Intra-osseous Line in an Adult Patient: A Case Report

Malhotra R, Chua WL, O'Neill G

Malays Orthop J, 2016 Nov;10(3):49-51.
PMID: 28553450 DOI: 10.5704/MOJ.1611.014

We present a case of a lower limb compartment syndrome associated with the use of an intra-osseous line inserted into the proximal tibia in an adult patient. An unconscious 59-year old male with multiple injuries presented to our Emergency Department after a road traffic accident. Bilateral proximal tibial intra osseous-lines were inserted due to poor venous access. After resuscitation his left leg was noted to be tense and swollen with absent pulses. Acute compartment syndrome was diagnosed both clinically and with compartment pressure measurement. Two incision fasciotomy on his left lower leg was performed. Intra osseous-lines in the proximal tibia are increasingly used in adult patients in the pre-hospital setting by paramedics and emergency physicians. Their use, along with the possible complications of these devices, such as the development of compartment syndrome or osteomyelitis leading to amputation, is well reported in the paediatric literature. To the best of our knowledge, there have not been any previous reports of complications in the adult patient. We present a case of lower leg compartment syndrome developing from the use of an intra-osseous line in the proximal tibia in an adult patient. With the increasing use of intra-osseous lines in adult patients, clinicians should be aware of the possibility of developing compartment syndrome which may lead to disability or amputation in severe cases.
Negative social reaction to strabismus in school children ages 8-12 years

Lukman H, Kiat JE, Ganesan A, Chua WL, Khor KL, Choong YF

J AAPOS, 2011 Jun;15(3):238-40.
PMID: 21683635 DOI: 10.1016/j.jaapos.2011.01.158

To investigate children's willingness to sit next to a child with noticeable exotropia as a measure of social alienation.
Strabismus-related prejudice in 5-6-year-old children

Lukman H, Kiat JE, Ganesan A, Chua WL, Khor KL, Choong YF

Br J Ophthalmol, 2010 Oct;94(10):1348-51.
PMID: 20601661 DOI: 10.1136/bjo.2009.173526

There is a general consensus that individuals with conspicuous strabismus are perceived more negatively with respect to physical appearance, personality and capability. Such social biases can potentially lead to social alienation and negative psychosocial development, particularly when experienced at a young age. This study aims to explore young children's perception of peers with noticeable exotropia.
Adherence to Iron Chelation Therapy Among Children with Beta Thalassemia Major: A Multicenter Cross-Sectional Study

Keowmani T, Teo SC, Yap KC, Chua WL, Mohd Tahir NF, Chua PW, et al.

Hemoglobin, 2023 Nov;47(6):237-244.
PMID: 38111324 DOI: 10.1080/03630269.2023.2295291

BACKGROUND: Adherence to iron chelation therapy (ICT) remains an issue among thalassemia patients. This study aimed to determine the prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia and the factors associated with it.
METHODS: This was a cross-sectional study conducted between November 2019 and November 2021 at seven tertiary hospitals in Malaysia. Participants registered with Malaysian Thalassemia Registry were recruited by convenience sampling. Adherence was measured via pill count and self-reported adherence. Knowledge about thalassemia and ICT was measured using a questionnaire from Modul Thalassemia by Ministry of Health of Malaysia. A decision tree was used to identify predictors of non-adherence.
RESULTS: A total of 135 patients were recruited. The prevalence of non-adherence to ICT in those who took subcutaneous ± oral medications was 47.5% (95% CI: 31.5%, 63.9%) and the prevalence of non-adherence to ICT in those who took oral medications only was 21.1% (95% CI: 13.4%, 30.6%). The median knowledge score was 67.5% (IQR 15%). A decision tree has identified two factors associated with non-adherence. They were ICT's route of administration and knowledge score. Out of 100 patients who were on oral medications only, 79 were expected to adhere. Out of 100 patients who were on subcutaneous ± oral medications and scored less than 56.25% in knowledge questionnaire, 86 were expected to non-adhere. Based on the logistic regression, the odds of non-adherence in patients who took oral medications only was 71% lower than the odds of non-adherence in patients who took subcutaneous ± oral medications (OR = 0.29; 95% CI = 0.13, 0.65; p = .002).
CONCLUSION: The prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia was 20/95 (21.1%) in those who took oral medications only and the prevalence of non-adherence was 19/40 (47.5%) in those who took subcutaneous ± oral medications. The factors associated with non-adherence were ICT's route of administration and knowledge score.