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Background/Aims: Limb load asymmetry (LLA) is common in clinical conditions related to the lower limbs such as degenerative joint disease, soft tissue injuries, joint replacements, amputations and stroke. However, the measurement of LLA is limited in clinical practice as the equipment used is expensive and not readily available in most health care settings. The digital weighing scale is proposed as an inexpensive alternative method of measuring LLA and the objective of this study was to investigate the reliability and accuracy of a digital weighing scale relative to the Nintendo Wii in measuring limb load asymmetry during static standing. Methods: Twenty-four participants (12 participants with knee osteoarthritis (OA) and 12 healthy participants) were recruited through convenient sampling from a public university teaching hospital. The participants were required to perform a quiet standing task during the measurement of LLA. The measurements were taken over three trials during both eyes-open (EO) and eyes-closed (EC) resting conditions. LLA was measured in kilograms and computed with a symmetry index. Intra-class correlation coefficient (ICC) (3, 1) analysis, standard error of measurement and coefficient of variation were performed to assess reliability. The Bland-Altman plot was used to test the degree of agreement between digital weighing scales and the Nintendo Wii. Results: The digital weighing scale showed an excellent reliability of 0.983 and 0.988 in EC and EO conditions, respectively. The Bland-Altman plot showed good agreement between digital weighing scales and the Nintendo Wii in measuring LLA. Conclusions: The digital weighing scale is a reliable tool to measure LLA and has excellent potential to be used in clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: Heterotopic ossification is common in patients with traumatic brain injury, spinal cord injury and after arthroplasty, however, it is rarely seen in paraplegic patients with spinal infection especially spinal actinomycosis. Method: We report a case of spinal cord compression caused by Actinomyces israelii, complicated with heterotopic ossification (HO) in both hip joints in 42 year-old Malay gentle man. He presented with gradual onset of bilateral lower limb weakness associated with constitutional symptoms and difficulty in passing urine for 3 months. On physical examination, his neurological level was T12 AIS (American Spinal Injury Association Impairment Scale) B. Bony swelling was noted over antero-lateral aspect of the proximal thigh (Left). The limitation of range of motion in both hip joints was noted. Results: Laboratory tests indicated leukocytosis with raised ESR and C Reactive Protein. Alkaline phosphatase was 176 IU/ L. Radiograph of the pelvis (AP view) showed heterotopic ossification in both hip joints and it was graded as Class 4 on Brooker's classification. Magnetic Resonance Imaging (MRI) scan of the thorax showed paraspinal mass at thoracic (T2-9) region which extended intraspinally causing compression of the spinal cord. CT guided biopsy was done and HPE confirmed actinomyces infection. Therefore, decompression and spinal fixation was offered but patient refused and opted for conservative management. Conclusion: Although heterotopic ossification is rarely seen in patient with spinal cord compression due to thoracic spinal actinomycosis, physicians should bear in mind this rare incidence so as to get early diagnosis and give prompt and effective treatment. [ABSTRACT FROM AUTHOR]

Introduction: Psychiatric emergency is a clinical condition where prompt psychiatric attention with psychotherapeutic intervention is necessary to facilitate a recovery and prevent permanent harm. Modern Psychiatric Emergency Service is now applying highly complex and comprehensive set of interventions and treatment models in psychiatric centers. Many patients discharged from chronic hospital into the community had relapse of symptoms. The only access to the mental health care of these patients and the patients from under privileged class was through Emergency Departments or Psychiatric Emergency Service. The Emergency Department was over loaded with mental health cases and it is a national crisis in the United States now. Psychiatric emergency assessment is expected to detect acute presenting symptoms of mental illness, psychiatric symptoms of underlying medical conditions and dangerous behaviors to self or others. Accurate diagnosis is crucial for rapid implementation of appropriate initial treatment. Objective: The Objective of our study is to assess the agreement of diagnosis in Emergency Department and Final Discharge diagnoses from the Ward. The reliability of the diagnosis was investigated from the comparison of the diagnoses in Emergency and Final Discharge diagnoses. Methods: It is a retrospective record review study. Medical officers from Psychiatric Ward collected data in data collection form. All first admission cases of 2006 and 2007 were taken. Data analysis was done applying kappa and chi-square statistics excluding chance concordance and over diagnosis. Results: The result of our study did not compare favorably with that of previous studies. Conclusion: The excellent agreement originated from application of uniform criteria, structured interview, descriptive psychopathology, acquiring significant information for diagnoses. Reliable psychiatric diagnoses are possible in the skilled hands. [ABSTRACT FROM AUTHOR]

Introduction: There is tremendous development in scientific medicine; psychiatry is in need of such development for the diagnosis of functional and neurotic disorders. Certain pathological investigations are useful in assessing the medical cause of psychiatric presentations which constituted about 15 to 90%. Until a breakthrough in finding the cause of psychiatric illness, comprehensive data collection of patient's clinical picture and obtaining appropriate and detailed information are methods for getting reliable diagnoses. Objective: To highlight the role of investigations in Psychiatry until a break through in finding the aetiology of diagnosis. Method: Review the literature. Result: Psychosocial investigation is the only tool for assessing the diagnosis. It consists of history of the patient from a reliable source and getting information from family and friends. To diagnose disorders, doctor should acquire sufficient knowledge about disorders and must know their signs, symptoms, course and complications. Past and present history of the patient, family history, social history, medical history, mental state examination and physical examination are crucial to reach to the diagnoses and effective treatment. Furthermore, the biopsychosocial factors increasing the severity or reducing the severity is to be searched. Conclusion: At the present situations where there is no gold standard to diagnose psychiatric disorder as in other branch of medicine, we have to use a classification which is founded on symptomatology and not etiologically based. Therefore, in view of having diagnostic issues in psychiatry, physicians must be very thorough and systematic in approaching psychiatric cases so as to reach a proper diagnosis and immediate and effective treatment, which in turn will lead to improve the clinical outcome and quality of life of the patients. [ABSTRACT FROM AUTHOR]

Objective: To highlight the rare presentation of spinal cord compression due to actinomycosis. Materials and methods: We report a case of spinal cord compression caused by Actinomyces israelii in a 42 year-old Malay gentleman, who presented with gradual onset of bilateral lower limb weakness and difficulty in passing urine for 3 months. He had no history of trauma to the spine or other medical illness. However, he had history of chronic cough for more than 6 weeks and weight loss of about 15 kg within 3 months. On physical examination, his neurological level was T12 ASIA Impairment Scale B. Laboratory tests indicated leukocytosis and raised C Reactive Protein level. Results: Computed Tomography Scan of the thorax and abdomen showed paraspinal mass at thoracic (T2-9) region. CT guided biopsy was done and HPE results showed inflammation with actinomyces infection. Treatment with Intravenous (IV) Crystalline penicillin 4 mega unit q.i.d. was started and planned to continue for 4 weeks, followed by oral Penicillin 6-12 months. After 1 week of IV antibiotics, white cell count and C Reactive Protein level reduced to 50% of pre-treatment levels. Unfortunately, there was no improvement in neurology. Decompression and spinal fixation was offered but patient refused and opted for conservative management. Conclusion: This case report highlights the rare presentation of cord compression due to actinomycosis of thoracic spine, wherein the importance of biopsy obviously precedes clinical and radiological diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Situs Inversus is a congenital anomaly characterized by the transposition of the thoracic and abdominal viscera. When associated with dextrocardia, it is termed as Situs Inversus Totalis. The anomaly results from mechanical disturbance during the rotation of the gut during its development. The anomaly is rare and can pose a diagnostic dilemma if associated with chest pain. Objective: To highlight the diagnostic dilemma in a patient with Situs Inversus Totalis. Method: Clinical report and literature review. Result: We hereby report a case of situs inversus totalis in 50-year-old man who presented with the complaint of chest pain. Although situs inversus is a rare condition, the attending physician should pay proper attention to the patients who present with chest pain whether it is right or left sided. Conclusion: Many cases remain undetected due to the lack of symptoms. The present case illustrates the embryological and clinical aspect of a case of situs inversus totalis. [ABSTRACT FROM AUTHOR]

Paragangliomas are tumors that arise from the paraganglia cells of the autonomic nervous system, which are in turn derived from the neural crest. Approximately 80%-90% of these tumors arise in the glomus jugulare or carotid bodies. Faragangliomas arising within the spinal canal are rare, and when they occur are usually found in the intradural, extramedullary compartment and in the lumbosacral region. Large lumbar paragangliomas are very rare. We report a case of a 58-year-old woman who had a history of back pain and radiculopathy was found to have a primary lumbar paraganglioma presenting with spinal cord compression. In this case, a large vascularised paraganglioma measuring 13.0 cm x 15.0 cm was occupying L2-L4 vertebrae body extending to paravertebral space and spinal canal with distant metastasis to left 5th rib in CT scan. Total debulking procedure was impossible because of its high vascularity. Thus angiography and embolization was carried out instead. Seventy five percent reduction in vascular supply was noted after 2nd embolization procedure. We believe that paragangliomas should be included in the diagnosis of intraosseous spinal tumors. They are highly vascular and difficult to excise in total. Optimal treatment of the lesions can be difficult because of their hypervascular nature and high morbidity associated with complete surgical resection. Preoperative embolization, surgical resection if possible, and radiation therapy should be combined. [ABSTRACT FROM AUTHOR]

Limb loading measurements serve as an objective evaluation of asymmetrical weight bearing in the lower limb. Digital weighing scales (DWSs) could be used in clinical settings for measurement of static limb loading. However, ambiguity exists whether limb loading measurements of DWSs are comparable with a standard tool such as MatScan. A cross-sectional study composed of 33 nondisabled participants was conducted to investigate the reliability, agreement, and validity of DWSs with MatScan in static standing. Amounts of weight distribution and plantar pressure on the individual lower limb were measured using two DWSs (A, B) and MatScan during eyes open (EO) and eyes closed (EC) conditions. The results showed that intra- and interrater reliability (3, 1) were excellent (0.94–0.97) within and between DWS A and B. Bland-Altman plot revealed good agreement between DWS and MatScan in EO and EC conditions. The area under the receiver operating characteristic curve was significant and identified as 0.68 (p = 0.01). The measurements obtained with DWSs are valid and in agreement with MatScan measurements. Hence, DWSs could be used interchangeably with MatScan and could provide clinicians an objective measurement of limb loading suitable for clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: Pressure ulcers (PUs) are a leading health problem among spinal cord injury(SCI) patients. Therefore, this comprehensive study was aimed at determining the association between potential factors and the occurrence of PUs among SCI adults in community settings. Methods: A cross-sectional study was conducted among adults with SCI aged 18 years and above from five selected locations in Kuala Lumpur, Malaysia. The study was carried out through interviews based on validated questionnaires such as the Dietary History Questionnaire (DHQ), Spinal Nutrition Screening Tool (SNST), Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), Barthel Index for Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). Estimated weight and height were obtained using recumbent formula. The stages of their PUs were assessed based on National Pressure Ulcer Advisory Panel (NPUAP) grading system. Results: A total of 40 subjects participated in the study, 25% of whom were having PUs. Their nutritional inadequacies were identified, whereby 90%, 70% and 85.5% of them were receiving below their daily requirement of energy, carbohydrate and protein, respectively. The fat and sodium intakes of 55% of them were above the Malaysian Recommended Nutrient Intakes(RNI). It was successfully found that physical activity could decrease the risk of PUs(R2=0.654, OR=0.310, p<0.05). Conclusion: Overall, 25% of the subjects had PUs that were associated with physical inactivity. The majority of the subjects did not meet their nutrient requirements. Therefore, there is a need for increased physical activity and improved nutrient intake in order to reduce the risk of pressure ulcers among SCI adults in communities. [ABSTRACT FROM AUTHOR]

We evaluated bridging of 15 mm nerve gap in rat sciatic nerve injury model with muscle-stuffed vein seeded with olfactory ensheathing cells as a substitute for nerve autograft. Neurophysiological recovery, as assessed by electrophysiological analysis was faster in the constructed biological nerve conduit compared to that of autograft. [ABSTRACT FROM AUTHOR]

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDerm TM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

Limb loading measurements serve as an objective evaluation of asymmetrical weight bearing in the lower limb. Digital weighing scales (DWSs) could be used in clinical settings for measurement of static limb loading. However, ambiguity exists whether limb loading measurements of DWSs are comparable with a standard tool such as MatScan. A cross-sectional study composed of 33 nondisabled participants was conducted to investigate the reliability, agreement, and validity of DWSs with MatScan in static standing. Amounts of weight distribution and plantar pressure on the individual lower limb were measured using two DWSs (A, B) and MatScan during eyes open (EO) and eyes closed (EC) conditions. The results showed that intra- and interrater reliability (3, 1) were excellent (0.94-0.97) within and between DWS A and B. Bland-Altman plot revealed good agreement between DWS and MatScan in EO and EC conditions. The area under the receiver operating characteristic curve was significant and identified as 0.68 (p = 0.01). The measurements obtained with DWSs are valid and in agreement with MatScan measurements. Hence, DWSs could be used interchangeably with MatScan and could provide clinicians an objective measurement of limb loading suitable for clinical settings.

Objective: The aim of this study was to investigate the intra- and inter-rater reliability of ultrasonography (US) to measure anterior translation of the humeral head (ATHH) among healthy subjects and patients with sacroiliac joint dysfunction., Methods: The study included a total of 22 shoulder joints from 11 subjects. Six subjects were healthy and 5 had sacroiliac joint dysfunction. Anterior translation of the humeral head was measured twice using US by two different investigators. Intraclass correlation coefficient (ICC3,1), standard error of measurements (SEMs), coefficient of variations (CVs) and Bland-Altman plot were used as analytical tests to investigate intra- and inter-rater reliability, amount of error and agreeability of the measurements between investigators., Results: Intraclass correlation coefficient was 0.94, showing a high level of intra-rater reliability of the first investigator with SEMs (0.01 cm) and CV (5.1%) in measuring ATHH. Intra-rater reliability of the second investigator was 0.84 with SEMs (0.03 cms) and CV (9.6%), indicating a high level of reliability. Inter-rater reliability was high, with an ICC value of 0.92 with SEMs (0.02 cms) and CV (5.9%)., Conclusion: The use of US as a measurement of ATHH has good levels of intra- and inter-rater reliability in clinical practice.