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TENS for surgical stabilisation of acetabular fracture in the skeletally immature: A novel technique

Razak KAA, Ghani KHA, Musa AA

Injury, 2021 Jan;52(1):90-94.
PMID: 33168201 DOI: 10.1016/j.injury.2020.11.004

BACKGROUND: Acetabular fractures in childhood are rare and the literature is scarce to describe a standard protocol in surgical management of these injuries. As the patient is still growing, it warrants a detailed assessment with a sound surgical plan if operative intervention is deemed necessary to prevent late complications. Throughout literature, most fixation rely on using pins, screws, plates or combination of the three which require large surgical exposure and risk of secondary physeal injury, hence we come up with a method of using the Titanium Elastic Nail System (TENS) to overcome this issue. We describe a novel technique in managing acetabular fractures in this group of patients using the TENS.
METHOD: An 8 year old girl with a diagnosis of right anterior column posterior hemitransverse acetabular fracture was fixed with 3 TENS for supra-acetabular, anterior column and posterior column fragments. Surgery was performed in a minimally invasive manner. No drilling was performed during the surgery and implant insertion is done manually.
RESULTS: Advantages of this procedure include minimally invasive surgery with smaller wounds, minimal intraoperative bleeding and theoretically reduces the risk of premature fusion of the triradiate cartilage. Patient is allowed early rehabilitation with this method.
CONCLUSION: This novel method provides an alternative to traditional usage of wires, pins, plates and screws as is described in most literature. However, it requires the surgeon to appreciate that the safe corridors for the implant are much narrower than adults. We recommend this technique for fractures that are deemed suitable for intramedullary fixation and further research in the future will be needed.
MRI findings suggestive of Alzheimer's disease in patients with primary open angle glaucoma - a single sequence analysis using rapid 3D T1 spoiled gradient echo

Hanafiah M, Johari B, Ab Mumin N, Musa AA, Hanafiah H

Br J Radiol, 2022 May 01;95(1133):20210857.
PMID: 35007174 DOI: 10.1259/bjr.20210857

OBJECTIVE: Primary open-angle glaucoma (POAG) is a degenerative optic neuropathy disease which has somewhat similar pathophysiology to Alzheimer's disease (AD). This study aims to determine the presence of medial temporal atrophy and parietal lobe atrophy in patients with POAG compared to normal controls using medial temporal atrophy (MTA) scoring and posterior cortical atrophy (PCA) scoring system on T1 magnetization-prepared rapid gradient-echo.
METHODS: 50 POAG patients and 50 normal subjects were recruited and an MRI brain with T1-magnetization-prepared rapid gradient-echo was performed. Medial temporal lobe and parietal lobe atrophy were by MTA and PCA/Koedam scoring. The score of the PCA and MTA were compared between the POAG group and the controls.
RESULTS: There was a significant statistical difference between PCA score in POAG and the healthy control group (p-value = 0.026). There is no statistical difference between MTA score in POAG compared to the healthy control group (p-value = 0.58).
CONCLUSION: This study suggests a correlation between POAG and PCA score. Potential application of this scoring method in clinical diagnosis and monitoring of POAG patients.
ADVANCES IN KNOWLEDGE: The scoring method used in AD may also be applied in the diagnosis and monitoring of POAGMRI brain, specifically rapid volumetric T1 spoiled gradient echo sequence, may be applied in POAG assessment.
Fulltext Ocular Jarisch-Herxheimer Reaction in the Treatment of Ocular Syphilis: A Case Report and Review of the Literature

Abd Manan N, Musa AA, Lott PW, Zahari M, Tajunisah I

Cureus, 2023 Jan;15(1):e33696.
PMID: 36788917 DOI: 10.7759/cureus.33696

Jarisch-Herxheimer reaction (JHR) is a transient clinical phenomenon in patients with syphilis who receive antibiotic treatment. A 31-year-old man with an underlying HIV infection presented with worsening vision in the right eye two days after being treated with oral doxycycline for presumed left-eye neuroretinitis. Prior history revealed two episodes of penile discharge and ulcers that were not investigated. Examination showed bilateral optic disc swelling with right eye placoid chorioretinitis around the macula. Optical coherence tomography (OCT) demonstrated right macular edema and left macular thinning. Blood investigations confirmed syphilis infection. Subsequently, the patient was scheduled for a contrasted brain CT with oral steroid coverage due to underlying allergies. His vision incidentally improved soon after the short course of steroids. Repeated OCT demonstrated marked improvement of right macular edema, which we believe was secondary to JHR initiated by the earlier doxycycline treatment. Following oral steroid addition, improvement in vision and ocular findings were seen. At six-month post-treatment, there was right macular atrophy as a sequela of the macular edema. Ophthalmologists should be aware of ocular-related JHR complications, particularly in potentiating macular atrophy following macular edema upon initiating antibiotic treatment in syphilitic disease.
Undiagnosed Uterine Didelphys, Concomitant Right Renal Agenesis, and Left Nephrolithiasis in a Primigravida With Breech Pregnancy: A Case Report

Che Musa AA, Husin MH, Aziz ME, A Hamid MA, Zon EM

Cureus, 2024 Jul;16(7):e65573.
PMID: 39192893 DOI: 10.7759/cureus.65573

Mullerian duct anomalies are congenital abnormalities involving the female genital systems. A double uterus or uterine didelphys is one of the uterine duplication anomalies that result from impaired fusion with regard to the Mullerian ducts. The uterine didelphys can be diagnosed earlier in symptomatic patients. However, the diagnosis can be delayed or the patients may remain undiagnosed throughout their lifetime if asymptomatic. Pregnant women with uterine didelphys are at a greater risk for spontaneous miscarriage, malposition, premature labor, and cervical incompetence. Uterine didelphys are also associated with renal anomalies such as renal agenesis or duplex kidneys. We present a case of a 24-year-old primigravida who had a spontaneous pregnancy and underwent a lower segment cesarean section (LSCS) after a failed external cephalic version for the breech fetal position. The uterine didelphys was diagnosed postnatally. Her condition was associated with right renal agenesis and concomitant left renal calculus.
Mapping the Research Landscape of Intra-Articular Knee Injections: A Bibliometric Analysis Using the Scopus Database

Musa AA, Low CL, Nizam Siron K, Mohamad Nazarallah MH, Kow RY, Abu Bakar IB, et al.

Cureus, 2024 Jul;16(7):e65647.
PMID: 39205742 DOI: 10.7759/cureus.65647

Intraarticular injection of osteoarthritis knee is one of the treatment options for pain management and delays the need for knee surgery. Various materials have been promoted for the procedure, ranging from corticosteroid to viscosupplement to the more recent autologous biological materials. Despite the increasing attention and interest in regard to the material selection, efficacy, safety, and effect of this intervention, a comprehensive bibliometric analysis using the Scopus database has yet to be conducted. In this bibliometric analysis, we reviewed the Scopus database from 2003 to 2023 to investigate the literature on intraarticular injection for the treatment of knee osteoarthritis. A total of 1,318 articles that satisfied the selection criteria were included in this review. The trend of intervention shows changes since 2006, with corticosteroid injection and hyaluronic acid as the main topics of publication before 2006. However, starting in 2010, there has been a noticeable shift towards biological agents, such as plasma-rich proteins, and autologous materials, including marrow aspiration and stromal vascular fraction. This shift reflects the increasing interest in regenerative medicine and the potential of these newer therapies to provide improved outcomes. The overwhelming majority of the articles were authored by researchers and clinicians from across European countries, the United States of America (USA), and Australia. Similarly, most of the articles with the highest number of citations were authored by researchers and clinicians from these regions. This comprehensive bibliometric analysis using Scopus in the domain of intraarticular injection has the potential to act as a roadmap for researchers, clinicians, and policymakers, facilitating informed decision-making, promoting collaborative initiatives, and guiding the development of future studies to further advance the options of knee intraarticular injection, specifically in the management of knee osteoarthritis.