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Background: Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study described the operative techniques using percutaneous basal closing wedge osteotomy of the first metatarsal in correction of moderate to severe hallux valgus (HV) and its short-term clinical outcomes. We postulated that satisfactory correction of hallux valgus (HV) angle, intermetatarsal (IM) angle, and patients' clinical outcomes could be achieved with this technique. Methods: We conducted a retrospective review of 25 feet in 23 patients who underwent a percutaneous basal closing wedge osteotomy of the first metatarsal (MT1) combined with a mini-open modified McBride procedure and mini-open resection of medial eminence. Follow-up averaged 21.5 months. Radiographic outcomes included pre- and postoperative HV angle, IM angle, absolute and relative shortening of MT1, and time to union. American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between pre- and postoperatively. Results: The average HV angle improved from 39.4 (range, 29-58.3) degrees preoperatively to 14.7 (range, 0.1-23.2) degrees postoperatively (P < .05). IM angle improved from 14.9 (range, 6.7-22.4) degrees to 6.6 (range, 0.9-14.8) degrees (P < .05). The average absolute shortening was 3.8 (range, 0.27-12.91) mm and the relative shortening was 0.8 (range, 0.05-1.91) mm. There was no delayed union or malunion at the osteotomy site. The average AOFAS score improved from 39 (range, 12-50) to 81 (range, 70-93) (P < .05). Conclusions: Satisfactory hallux valgus deformity correction and patients' outcomes were achieved with this technique. Our results are similar to results reported in other studies using open techniques. There was no malunion or delayed union of the osteotomy. [ABSTRACT FROM AUTHOR]

Abstract: Clandestine heroin laboratories have been a feature of the Malaysian illicit drug scene since soon after the abuse of heroin emerged in 1972. The first few clandestine heroin laboratories which synthesised heroin via the acetylation of imported morphine were uncovered in 1973 and 1977. By the mid‐1980s, this type of laboratory was replaced by heroin‐cutting laboratories whereby imported high‐grade heroin was cut to street heroin. This was to meet the rising demand for the drug owing to the rapid escalation of the number of drug users. Over the years, the most significant change in the composition of the street heroin is the decrease in its purity from 30%–50% to 3%–5%. Caffeine has remained the major adulterant and chloroquine is detected in virtually all recent seizures. [ABSTRACT FROM AUTHOR]

Recently, the abuse of ketum, an indigenous psychoactive plant, has received a lot of attention in Malaysia. To help national law enforcement agencies control its abuse, the laboratory of the Forensic Division has developed a procedure for its positive identification. Botanical identification may not be practical or conclusive, owing to the wide range of ketum materials available on the market, including dry macerated leaves, powdered leaves and drinks. In order to confirm that a substance is, in fact, ketum or that a preparation is derived from ketum, gas chromatography-mass spectrometry is used to definitively identify the presence of the psychoactive principle mitragynine. [ABSTRACT FROM AUTHOR]

Posteromedial ankle dislocation without malleolar fracture is a rare injury. Six patients who suffered from this injury were reviewed. The deltoid ligament was not at risk in this particular type of dislocation. Those patients without chondral lesion have a good long-term prognosis if prompt reduction is performed. Associated chondral lesion is a significant contributing factor to late development of ankle osteoarthrosis., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

In cases of hallux valgus deformity with primary medial collateral ligamentous insufficiency, there will be an abnormal hallux valgus angle with relatively normal intermetatarsal angle and sesamoid positions. Metatarsal osteotomies may not be effective to correct the deformity. Plication of the attenuated medial capsule may not be strong enough to provide long lasting correction of the hallux valgus deformity. We describe a minimally invasive technique of reconstruction of the medial collateral ligament by means of extensor hallucis brevis tendon graft. This can provide a stronger medial constraint to prevent recurrence of hallux valgus deformity., (Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: To study the feasibility of applying Krackow locking stitches in the endoscopic-assisted repair of acute Achilles tendon rupture and the possible complications encountered., Type of Study: Anatomic study., Methods: Twelve Achilles tendons in six cadavers were cut at 6cm from its insertion and endoscopic-assisted repair of Achilles tendon was performed. These legs were then cut open in midline to study (i) the locking stitches formed and (ii) the relation of the sural nerve to the locking stitches., Result: With endoscopic-assisted technique, Krackow-type locking stitches can be formed in eight legs. In four legs, the stitches fell into the ruptured gap and lie deep to the tendon. The tendon rupture end was grasped by the suture rather than forming a Krackow-type locking stitch when the suture was tightened. There was no sural nerve laceration noted. However, in two legs, the sural nerves were found trapped in the sutures at around the proximal portal., Conclusions: Krackow locking stitches can be formed by the minimally invasive technique. However, there are risks of stitches falling into the ruptured gap and lie deep to the tendon and risk of sural nerve entrapment at the proximal medial portal. The original technique is not suitable for clinical application. Modification of the technique by grasping the tendon end with Allis tissue forceps before passing the suture may prevent the suture from falling into the ruptured tendon gap.

Background: The interpretation of the results of randomized controlled trials (RCTs) has traditionally emphasized statistical significance rather than clinical importance. Our aim was to assess the quality of reporting of factors related to clinical importance in a sample of published RCTs., Methods: A random sample of 27 (of a total of 266) RCTs published in 5 major medical journals over a 1-year period were reviewed by 4 independent reviewers for factors considered important in the interpretation of the clinical importance of study results: identification of a clearly defined primary outcome, reporting of the expected difference between groups used in the calculation of sample size (the delta value) and whether it was based on the minimal clinically important difference of the intervention, the statistical significance of the results, presentation of pertinent confidence intervals, and the authors' interpretation of the clinical importance of the results., Results: Twenty-two of 27 (81%) articles explicitly reported a single primary outcome. Of the 20 articles that included a sample size calculation, 18 (90%) reported a delta value. Two of the 18 (11%) articles explicitly stated that the delta value was chosen to reflect the minimal clinically important difference of the intervention. For the primary outcomes, confidence intervals surrounding the point estimates of the efficacy of the interventions were reported in 11 of 27 (41%) studies. The study results were interpreted from the perspective of clinical importance in 20 of 27 (74%) of the articles. Of these 20 reports, 5 (25%) provided justification for their clinical interpretation of the results., Interpretation: Authors of RCTs published in major general medical and internal medicine journals do not consistently provide their own interpretation of the clinical importance of their results, and they often do not provide sufficient information to allow readers to make their own interpretation.

Recent developments in stress research have called for attention to how social structures influence the stress and coping processes. This paper examines the experience of work stress among professionals in Singapore and argues that workers' experiences in the workplace are influenced not only by individual personality and job nature, but also by structural forces shaping the profession, the social organization of work institutions and the development of the economy. Data were collected from a survey of professionals in Singapore conducted in 1989-1990. The sample consisted of 2570 men and women from six different professions and para-professions, namely general practitioners, lawyers, engineers, teachers, nurses and life insurance personnel. Results showed that performance pressure and work-family conflicts were perceived to be the most stressful aspects of work. These two stressors also significantly contributed to the experience of overall work stress. Further, stress arising from work-family conflicts, performance pressure and poor job prospects was negatively associated with the level of work satisfaction. These findings were discussed in the contexts of increasing professionalization and de-professionalization and the growing emphases on productivity and efficiency in a quickly developing economy.

Objective: To investigate the work stress of nursing and its relationship with the psychological well-being of the nurses., Design: A survey research method was adopted in which a questionnaire was designed for data collection., Setting: The study was conducted in the hospital setting., Subjects: Nurses (N = 1,043) of different grades participated in this study on an anonymous and voluntary basis., Measures: A work stress measure (ie, the Nursing Stress Inventory) and GHQ-12 were incorporated in a questionnaire which also contained items on subject's background information., Results: The eight areas of work stress identified were found to be negatively related to psychological well-being of the nurses, with stronger effects on anxiety and depression than sense of adequacy., Conclusion: Certain work stressors were more detrimental than those others. They may also exert differential effects on the affective and cognitive stress reactions.

"It is the intent of this paper to examine the interrelationships between early socialisation into core Chinese cultural values, international migration and Chinese immigrant entrepreneurship.... It is through a developmental socialisation process by which [cultural] values are articulated in family and kin network dynamics that social organisations begin to develop and define what is popularly understood as the 'Chinese way of doing business'. We argue that among the overseas Chinese, this way of doing business must be viewed historically and developmentally, as it is intimately intertwined with transmigration experiences and their consequences in shaping values necessary for the emergence and development of entrepreneurship." (SUMMARY IN FRE AND SPA), (excerpt)