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Fulltext Vancomycin-loaded bone cement bullet for treatment of chronic septic arthritis post ACL reconstruction surgery

Soon Teck Seo, Seow Hui Teo, Mohamed Zubair Mohamed Al-Fayyadh, Mohamed Razif Mohamed Ali, Wuey Min Ng

Malaysian Journal of Medicine and Health Sciences, 2019;15(3):158-160.
MyJurnal

The consequence of post-operative infection can be devastating despite its rare incidence. Common organisms caus- ing post-operative infection are normal flora of the skin: Staphylococcus aureus and Staphylococcus epidermidis. Early diagnosis followed by arthroscopic debridement and antibiotic therapy with graft retention remains the main aim of treatment. However, there are certain cases where the infection persists despite early intervention. Vancomy- cin-loaded bone cement bullet inserted into bone tunnel can provide a high local concentration of vancomycin with bactericidal effect and low systemic complications to treat deep-seated infection.
Fulltext Dilemma in chronic extrusion of medial meniscus with unicompartmental osteoarthritis in middle aged: a case report

Qi Qi Choo, Seow Hui Teo, Mohamed Zubair Mohamed Al-Fayyadh, Mohamed Razif Mohamed Ali, Wuey Min Ng

Malaysian Journal of Medicine and Health Sciences, 2019;15(3):155-157.
MyJurnal

Medial meniscus root tear (MMRT) is uncommon and is often associated with osteoarthritis during presentation. Whether it is a cause or effect, it is still debatable at this point of time. However, when a combination of injuries occurs in a middle age group patient, a careful examination before offering a treatment is advised. We herein report a case of a middle-aged gentleman suffering from both arthritis and MMRT.
A retrospective study on annual evaluation of radiation processing for frozen bone allografts complying to quality system requirements

Ramalingam S, Mohd S, Samsuddin SM, Min NG, Yusof N, Mansor A

Cell Tissue Bank, 2015 Dec;16(4):545-52.
PMID: 25687771 DOI: 10.1007/s10561-015-9501-1

Bone allografts have been used widely to fill up essential void in orthopaedic surgeries. The benefit of using allografts to replace and reconstruct musculoskeletal injuries, fractures or disease has obtained overwhelming acceptance from orthopaedic surgeons worldwide. However, bacterial infection and disease transmission through bone allograft transplantation have always been a significant issue. Sterilization by radiation is an effective method to eliminate unwanted microorganisms thus assist in preventing life threatening allograft associated infections. Femoral heads procured from living donors and long bones (femur and tibia) procured from cadaveric donors were sterilized at 25 kGy in compliance with international standard ISO 11137. According to quality requirements, all records of bone banking were evaluated annually. This retrospective study was carried out on annual evaluation of radiation records from 1998 until 2012. The minimum doses absorbed by the bones were ranging from 25.3 to 38.2 kGy while the absorbed maximum doses were from 25.4 to 42.3 kGy. All the bones supplied by our UMMC Bone Bank were sterile at the required minimum dose of 25 kGy. Our analysis on dose variation showed that the dose uniformity ratios in 37 irradiated boxes of 31 radiation batches were in the range of 1.003-1.251, which indicated the doses were well distributed.
Assessing bone banking activities at University of Malaya medical centre

Mohd S, Samsuddin SM, Ramalingam S, Min NW, Yusof N, Zaman TK, et al.

Cell Tissue Bank, 2015 Dec;16(4):523-30.
PMID: 25656787 DOI: 10.1007/s10561-015-9499-4

The main advantage of establishing in-house bone banks is its ability to readily provide allograft bones for local surgeries. Bone procurement activities of our university bone bank during the 10 years of operation were reviewed. Socio-demographic data of donors, types of bone procured, cases of rejected bones and types of allograft bones transplanted are presented. From 179 potential donors, 73 % were accepted with 213 procured bones. Femoral head was the common bone transplanted (45 %), as it was also the most common procured (82 %). Bones were rejected mainly due to non-technical reasons (83 %) rather than positive results of microbiological (13 %) and serological (4 %) tests. Comprehensive data could not be obtained for further analysis due to difficulties in retrieving information. Therefore, quality assurance system was improved to establish more systematic documentations, as the basis of good banking practice with process control hence allowing traceability.
Performance of cooling materials and their composites in maintaining freezing temperature during irradiation and transportation of bone allografts

Ramalingam S, Samsuddin SM, Yusof N, Mohd S, Hanafi NN, Min NW, et al.

J Orthop Surg (Hong Kong), 2018 4 27;26(2):2309499018770906.
PMID: 29695196 DOI: 10.1177/2309499018770906

PURPOSE: Bone allografts supplied by University Malaya Medical Centre Bone Bank are sterilized by gamma radiation at 25 kGy in dry ice (DI) to minimize radiation effects. Use of cheaper and easily available cooling materials, gel ice (GI) and ice pack (IP), was explored. Composites of DI and GI were also studied for the use in routine transportations and radiation process.
METHODS: (a) Five dummy bones were packed with DI, GI, or IP in a polystyrene box. The bone temperatures were monitored while the boxes were placed at room temperature over 96 h. Durations for each cooling material maintaining freezing temperatures below -40°C, -20°C, and 0°C were obtained from the bone temperature over time profiles. (b) Composites of DI (20, 15, 10, 5, and 0 kg) and GI were used to pack five dummy bones in a polystyrene box. The durations maintaining varying levels of freezing temperature were compared.
RESULTS: DI (20 kg) maintained temperature below -40°C for 76.4 h as compared to 6.3 h in GI (20 bags) and 4.0 h in IP (15 packs). Composites of 15DI (15 kg DI and 9 GI bags) and 10DI (10 kg DI and 17 GI bags) maintained the temperature below -40°C for 61 and 35.5 h, respectively.
CONCLUSION: Composites of DI and GI can be used to maintain bones in deep frozen state during irradiation, thus avoiding radiation effects on biomechanical properties. Sterile frozen bone allograft with preserved functional properties is required in clinical applications.
Verifying measurements of residual calcium content in demineralised cortical bone

Ariffin AF, Yusof N, Mohd S, Rahman SA, Ramalingam S, Mansor A, et al.

Cell Tissue Bank, 2019 Dec;20(4):527-534.
PMID: 31456097 DOI: 10.1007/s10561-019-09785-4

Calcium contents of demineralised human cortical bone determined by titrimetric assay and atomic absorption spectrophotometry technique were verified by comparing to neutron activation analysis which has high recovery of more than 90%. Conversion factors determined from the comparison is necessary to correct the calcium content for each technique. Femurs from cadaveric donors were cut into cortical rings and demineralised in 0.5 M hydrochloric acid for varying immersion times. Initial calcium content in the cortical bone measured by titration was 4.57%, only 21% of the measurement by neutron activation analysis; while measured by atomic absorption spectrophotometer was 13.4%, only 61% of neutron activation analysis. By comparing more readings with the measurements by neutron activation analysis with 93% recovery, a conversion factor of 4.83 was verified and applied for the readings by titration and 1.45 for atomic absorption spectrophotometer in calculating the correct calcium contents. The residual calcium content started to reduce after the cortical bone was demineralised in hydrochloric acid for 8 h and reduced to 13% after 24 h. Using the linear relationship, the residual calcium content could be reduced to less than 8% after immersion in hydrochloric acid for 40 h. Atomic absorption spectrophotometry technique is the method of choice for calcium content determination as it is more reliable compared to titrimetric assay.
Evaluating the risk of popliteal artery injury in the all-inside meniscus repair based on the location of posterior meniscal lesions

Al-Fayyadh MZM, Tan HCY, Hui TS, Ali MRBM, Min NW

J Orthop Surg (Hong Kong), 2019 2 21;27(1):2309499019828552.
PMID: 30782072 DOI: 10.1177/2309499019828552

The 'all-inside' meniscus repair is extremely useful technique in addressing tears at the far posterior horn of meniscus. However, this procedure may place the popliteal neurovascular bundle at risk of injury. The purpose of this study was to evaluate the risk of popliteal artery injury by the trajectory of anchor delivery instruments inserted through standard knee arthroscopic portals for the repair of the far posterior horn of meniscus tears. Standard arthroscopic portals were marked on five human cadaveric knees which were subsequently disarticulated. Axial photographs were taken after marking the 5 10, and 15 mm points from the meniscal root on the posterior horns of the menisci. The unsafe zones for meniscus repair at each of these points were identified on the photographs of knees by first drawing two lines from the edges of the popliteal artery and crossing at the respective points at the posterior horns. The points at which these lines meet a circular protractor applied to the center of each meniscus in the knee photograph were recorded as a range. The range signifies the unsafe zone for each respective point on the posterior horn of meniscus. The anterolateral arthroscopic portal fell within the unsafe zone of the 5 mm point on the posterior horn of lateral meniscus in three of the five knees and within the unsafe zone of the 10 mm point on the posterior horn of lateral meniscus in another two knees. A cautious approach should be practiced during the repair of tears located at these two points. None of the other points' unsafe zones (lateral 15 mm, medial 5 mm, 10 mm and 15 mm points) coincided with the ipsilateral portal sites. Level of evidence 5 (Human cadaveric study).
Effects of processing and gamma radiation on mechanical properties and organic composition of frozen, freeze-dried and demineralised human cortical bone allograft

Mansor A, Ariffin AF, Yusof N, Mohd S, Ramalingam S, Md Saad AP, et al.

Cell Tissue Bank, 2023 Mar;24(1):25-35.
PMID: 35610332 DOI: 10.1007/s10561-022-10013-9

Bone processing and radiation were reported to influence mechanical properties of cortical bones due in part to structural changes and denaturation of collagen composition. This comparative study was to determine effects of bone processing on mechanical properties and organic composition, and to what extent the radiation damaging after each processing. Human femur cortical bones were processed by freezing, freeze-drying and demineralisation and then gamma irradiated at 5, 15, 20, 25 and 50 kGy. In the compression test, freeze drying significantly decreased the Young's Modulus by 15%, while demineralisation reduced further by 90% (P
Epidemiology of human leptospirosis in Malaysia, 2004-2012

Benacer D, Thong KL, Min NC, Bin Verasahib K, Galloway RL, Hartskeerl RA, et al.

Acta Trop, 2016 May;157:162-8.
PMID: 26844370 DOI: 10.1016/j.actatropica.2016.01.031

Leptospirosis is an emerging disease, especially in countries with a tropical climate such as Malaysia. A dramatic increase in the number of cases has been reported over the last decade; however, information on the epidemiological trends of this disease is lacking. The objective of this study is to provide an epidemiological description of human leptospirosis cases over a 9-year period (2004-2012) and disease relationship with meteorological, geographical, and demographical information. A retrospective study was undertaken to describe the patterns of human leptospirosis cases and their association with intrinsic (sex, age, and ethnicity) and extrinsic (location, rainfall, and temperature) factors. Data was grouped according to age, sex, ethnicity, seasonality and geographical distribution, and analyzed using statistical tools to understand the influence of all the different factors on disease incidence. A total of 12,325 cases of leptospirosis were reported between 2004 and 2012 with an upward trend in disease incidence, with the highest in 2012. Three hundred thirty-eight deaths were reported with an overall case fatality rate of 2.74%, with higher incidence in males (9696; 78.7%) compared with female patients (2629; 21.3%), and overall male to female ratio of 3.69:1. Patients aged cohorts between 30-39 years old (16.22 per 100,000 population) had the highest disease incidence while the lowest incidence occurred between <1 to 9 years old (3.44 per 100,000 population). The average incidence was highest amongst Malays (10.97 per 100,000 population), followed by Indians (7.95 per 100,000 population). Stratification according to geographical distribution showed that the state of Malacca had the highest average disease incidence (11.12 per 100,000 population) followed by Pahang (10.08 per 100,000 population). The states of Terengganu, Kelantan, and Perak recorded similar rates of incidence (≈8.00 per 100,000 population), while Johor with the least number of reported cases (1.80 per 100,000 population). Positive relationships were recorded between the number of reported cases with the number of raining days per month and monthly average temperature (p-value<0.05). However, no significant association was noted between rainfall volume and number of reported Leptospirosis cases. This collaborative efforts between medical, academic and governmental institutions has enabled the construction of this comprehensive database that is essential to understand the disease trends in Malaysia and add insights into the prevention and control of this disease.
Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohumeral osteoarthritis via radiological study

Miswan MF, Saman MS, Hui TS, Al-Fayyadh MZ, Ali MR, Min NW

J Orthop Surg (Hong Kong), 2017 01;25(1):2309499017690317.
PMID: 28215115 DOI: 10.1177/2309499017690317

INTRODUCTION: We conducted a study to elucidate the correlation between the anatomy of the shoulder joint with the development of rotator cuff tear (RCT) and glenohumeral osteoarthritis (GHOA) by using acromioglenoid angle (AGA).
MATERIALS AND METHODS: The AGA is a new measured angle formed between the line from midglenoid to lateral end of the acromion with the line parallel to the glenoid surface. The AGA was measured in a group of 85 shoulders with RCT, 49 with GHOA and 103 non-RCT/GHOA control shoulders. The AGA was compared with other radiological parameters, such as, the critical shoulder angle (CSA), the acromion index (AI) and the acromiohumeral interval (AHI). Correlational and regression analysis were performed using SPSS 20.
RESULTS: The mean AGA was 50.9° (45.2-56.5°) in the control group, 53.3° (47.6-59.1°) in RCT group and 45.5° (37.7-53.2°) in OA group. Among patients with AGA > 51.5°, 61% were in the RCT group and among patients with AGA < 44.5°, 56% were in OA group. Pearson correlation analysis had shown significant correlation between AGA and CSA ( r = 0.925, p < 0.001). It was also significant of AHI in RCT group with mean 6.6 mm (4.7-8.5 mm) and significant AI in OA group with mean 0.68 (0.57-0.78) with p value < 0.001 respectively.
CONCLUSION: The AGA method of measurement is an excellent predictive parameter for diagnosing RCT and GHOA.