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Objective: To determine the effect of clinical governance in PHCs on maternal and perinatal health in Banten Province, Indonesia. Methods: This was an observational analytic study with cross sectional method performed on the PHCs on Banten Province, Indonesia. All PHCs in Banten Province having maternal and perinatal health services were included in the study. Clinical governance and services were measured using a self-made questionnaire filled by the representative of the PHC. Characteristics analyzed in this study were age, education level, completed training, and occupation. Clinical governance aspects analyzed in this study were leadership, culture, competence, governance, and readiness. The services analyzed in this study were antenatal, pathology, and emergency service. Results: There were 117 PHC representatives who were recruited to the study. The PHC which were categorized as “outstanding” for leadership, culture, competence, governance, and readiness were 23.1%, 41%, 98%, 81.2%, and 83.8%, respectively. The PHC which were categorized as having “good” antenatal, pathology, and emergency services were 92.3%, 51.3%, and 90.6%, respectively. The PHCs with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care. Conclusions: Primary health cares with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care. Therefore, improving clinical governance is essential to improve maternal and perinatal health services quality in Banten Province, Indonesia Keywords: clinical governance, health service, maternal health, quality assurance. Abstrak Tujuan: Untuk mengetahui pengaruh tata kelola klinik di Puskesmas terhadap kesehatan ibu dan perinatal di Provinsi Banten, Indonesia. Metode: Penelitian observasional analitik dengan metode potong lintang yang dilakukan di Puskesmas di Provinsi Banten, Indonesia. Semua Puskesmas di Provinsi Banten yang memiliki layanan kesehatan ibu dan perinatal diikutsertakan dalam penelitian ini. Tata kelola dan layanan klinis diukur menggunakan kuesioner buatan sendiri yang diisi oleh perwakilan Puskesmas. Karakteristik yang dianalisis dalam penelitian ini adalah usia, tingkat pendidikan, pelatihan yang diselesaikan, dan pekerjaan. Aspek tata kelola klinis yang dianalisis dalam penelitian ini adalah kepemimpinan, budaya, kompetensi, tata kelola, dan kesiapan. Pelayanan yang dianalisis dalam penelitian ini adalah pelayanan antenatal, patologi, dan gawat darurat. Hasil: Terdapat 117 perwakilan Puskesmas yang direkrut untuk penelitian. Puskesmas yang dikategorikan “sangat baik” untuk kepemimpinan, budaya, kompetensi, tata kelola, dan kesiapan masing-masing adalah 23,1%, 41%, 98%, 81,2%, dan 83,8%. Puskesmas yang memiliki pelayanan antenatal, patologi, dan gawat darurat yang tergolong “baik” berturut-turut adalah 92,3%, 51,3%, dan 90,6%. Puskesmas dengan aspek tata kelola klinis yang lebih baik memberikan layanan antenatal, patologi, dan darurat yang lebih baik untuk perawatan ibu dan perinatal. Kesimpulan: Pelayanan kesehatan primer dengan aspek tata kelola klinis yang lebih baik menghasilkan pelayanan antenatal, patologi, dan kegawatdaruratan yang lebih baik untuk pelayanan ibu dan perinatal. Oleh karena itu, peningkatan tata kelola klinis sangat penting untuk meningkatkan kualitas pelayanan kesehatan maternal dan perinatal di Provinsi Banten, Indonesia Kata kunci: kesehatan ibu, pelayanan kesehatan, penjaminan mutu, tata kelola klinik.

The objective of this study was to investigate the appropriate temperature for processing storage of chicken meatballs made of minced chicken meat with the sous vide method. The chicken meatballs were prepared and separated into four experimental groups according to the application of heat treatment (10 and 20 minutes) and storage time (+2 and +10°C). Sensory, microbiological (total aerobic mesophilic bacteria, total psychrotrophs, lactic acidbacteria, Enterobacteriaceae, Clostridiumperfringens, Listeria spp.), chemical (pH, thiobarbituric acid), color (L*, a*, b* values), and texture profile analyses were performed on meatball samples. Cl. perfringens and Listeria spp. were not detected in meatball samples during the storage period. Samples cooked at 10 minute and stored at +2°C the highest count of total aerobic mesophilic bacteria (p

While recent work developing GaAsBi for opto-electronic applications has shown promise, it has also indicated that the large valence band offset of GaAsBi/GaAs may cause undesirable hole-trapping in GaAsBi quantum wells. In this work, hole-trapping is demonstrated to be the cause of the reduced depletion width of GaAsBi/GaAs multi-quantum well solar cell devices under illumination. Modelling of the quantum confinement energies in these devices shows how the carrier escape times vary as functions of temperature, providing a tool for the design for future GaAsBi based photovoltaic devices. [ABSTRACT FROM AUTHOR]

The optical and structural properties of GaAsBi bulk and quantum well (QW) samples grown under various conditions were studied by photoluminescence (PL), high resolution x-ray diffraction (HR-XRD) and transmission electron microscopy (TEM). At 10 K, the 90 nm bulk sample shows two PL peaks at 1.18 and 1.3 eV. The temperature and power dependent PL data suggest that both PL peaks originate from the GaAsBi layer which consists of two regions with different Bi concentrations. The TEM images verify that the Bi concentration decreases monotonically across the layer, showing a high Bi concentration (∼0.053) close to the bottom interface which then reduces to ∼0.02 for thicknesses >25 nm. Besides, the high Bi content region cannot be detected by HR-XRD due to a broad and weak diffraction intensity. For multiple QW samples, a similar Bi profile was also observed in which the first well has a significantly higher Bi content compared to the other wells. The energy separation between the PL peaks is 0.12 eV and is consistent with the energy difference observed for the bulk sample. However, two PL peaks were not observed in the other GaAsBi bulk sample which was grown under different conditions, showing the importance of growth optimizations. [ABSTRACT FROM AUTHOR]

Introduction: Supracondylar fractures in children often result in malunion and subsequent cubitus varus or valgus deformity. While often considered cosmetic, these deformities can lead to pain, functional impairment, and other complications. Corrective osteotomy is a common treatment option, with step-cut osteotomy being a preferred method due to its effectiveness and relative simplicity. This study aims to evaluate the outcomes of step-cut osteotomy in correcting post-traumatic cubitus deformities., Materials and Methods: A prospective cohort study was conducted on patients presenting with post-traumatic cubitus varus or valgus deformity. Pre-operative evaluation included clinical and radiological assessment of the deformity. Step-cut osteotomy was performed, followed by rigid fixation with a recon plate. Post-operative outcomes were assessed in terms of deformity correction, range of motion (ROM), and complications., Results: The study included 10 patients (8 male, 2 female) with a mean age of 9.6 years. The mean pre-operative carrying angle was 25.25° varus, corrected to 3.37° valgus postoperatively. Significant improvement in ROM and humerus-elbow-wrist angle was observed. While the lateral prominence index decreased, it was not statistically significant. Excellent or good results were achieved in 80% of patients. One patient experienced transient radial nerve palsy., Discussion: Step-cut osteotomy effectively corrected cubitus deformities with minimal complications. While it primarily addresses coronal plane deformity, satisfactory outcomes were achieved without correction of rotational deformity. Rigid fixation with a recon plate provided stability and allowed for early mobilization. The study's limitations include a small sample size and the inability to conduct adequate follow-up due to the COVID-19 pandemic., Conclusion: Step-cut osteotomy is a reliable and effective treatment option for post-traumatic cubitus varus and valgus deformities in children. It demonstrates good to excellent outcomes in terms of deformity correction, ROM, and functional improvement, with a low complication rate. Further studies with larger sample sizes and longer follow-up periods are warranted to strengthen these findings., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Objective: This study evaluates the outcomes of modified transvaginal mesh (TVM) Surelift in managing advanced pelvic organ prolapse (POP) over a 3-year follow-up period, focusing on surgical success, functional improvement, and sonographic findings., Methods: A retrospective review was conducted on 99 women who underwent Surelift System surgery for advanced POP Stage III and IV between July 2018 to January 2020. Objective evaluation included Pelvic Organ Prolapse Quantification (POP-Q), multichannel urodynamic (UDS), and introital 2D ultrasonographic measurement. Subjective evaluation uses validated questionnaires of Incontinence Impact Questionnaire-7(IIQ-7), Urogenital Distress Inventory-6(UDI-6), Pelvic Organ Prolapse Distress Inventory 6(POPDI-6), Colorectal Anal Distress Inventory-8(CRADI-8) and Pelvic organ prolapse/ Urinary Incontinence Sexual Questionnaire (PISQ-12). Outcomes were examined at 3 months, yearly and at 3 years postoperative. Secondary outcome included de novo or persistent urodynamic stress incontinence (USI) and surgical complications., Results: Eighty-five women were included in the final analysis. At 3 years postoperative, the objective cure rate was 94.1 % and subjective cure rate of 91.8 %. Ultrasonography revealed initial mesh elongation and thickening at first year, resolving by the third year, while the distance between the bladder neck and mesh remained stable. Significant improvement in POP-Q components (Aa,Ba,C,Ap,Bp and TVL of p < 0.001), UDS (p < 0.001) and all validated Quality of Life (QoL) questionnaires (p < 0.001) were seen. De Novo USI and persistent USI occurred in 31.5 %. Complications included vaginal mesh exposure requiring excision in 4.7 % of patients, and one intraoperative bladder injury corrected promptly., Conclusion: The Surelift System TVM demonstrates safety and efficacy in treating advanced anterior-apical POP, achieving high cure rates, secured mesh placement, and minimal complications at 3 years post-operative., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Spinal tuberculosis (TB) is a significant health problem. While chemotherapy is the primary treatment, surgery is necessary in some cases. This study investigates the posterior approach for treating thoracolumbar spinal TB with neurological involvement., Materials and Methods: This prospective observational study included 75 patients with thoracolumbar TB and neurological deficits. All underwent posterior decompression and stabilization using pedicle screw fixation. Pre and post-operative neurological status, pain scores, and kyphotic angle were assessed., Discussion: The posterior approach demonstrated advantages over the traditional anterior approach. It facilitated decompression, improved neurological function, and corrected spinal deformity. Posterior fixation allowed early mobilization, reducing complications from prolonged bed rest. These findings align with previous research supporting the posterior approach for spinal TB., Conclusion: The posterior approach with decompression and pedicle screw fixation is a safe and effective surgical method for thoracolumbar spinal TB with neurological involvement. It offers good clinical outcomes, minimizes complications, and facilitates faster patient recovery., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Supraspinatus tendinopathy is a common reason for shoulder pain, with or without an associated cuff tear. Various modalities of treatment have been described in literature such as physiotherapy, analgesics, corticosteroid injection, surgical repair (open or arthroscopic), and platelet-rich plasma (PRP) injection. Recently, there has been an increasing trend of PRP injection for rotator cuff arthropathy. Hence, we conducted a study to assess the effectiveness of PRP injection under ultrasound (USG) guidance in patients with supraspinatus tear., Materials and Methods: Twenty-eight patients were divided into two groups: Group A (physiotherapy, n = 15) and Group B (PRP injection with USG guidance, n = 13). Pain (Visual Analog Score [VAS]) and function (Oxford Shoulder Score [OSS]) were evaluated at baseline, 1 week, 4 weeks, and 12 weeks., Results: 28 patients were divided into two groups, i.e., Group A (15 pt) - physiotherapy and Group B (13 pt) - PRP injection. On the basis of the VAS, PRP group has better score at 1 and 4 weeks as the results were statistically significant while insignificant at 12 weeks. On the basis of OSS, PRP group has better score at 1 and 4 weeks as the results were statistically significant while insignificant at 12 weeks similar to VAS score., Discussion: The findings on pain relief (VAS) generally agree that both methods offer short-term improvement, with PRP potentially having a slight edge. However, the long-term effects (beyond 3 months) are less clear. Similarly, physiotherapy shows promise in improving function (Oxford score) in the short term, while some PRP studies suggest sustained benefits, possibly dependent on the specific PRP formulation. Overall, the discussion highlights the need for further investigation into the long-term efficacy of PRP compared to physiotherapy for managing rotator cuff tears., Conclusion: Improvement in function and relief in pain were better in PRP group when compared to conservative group but we found that PRP has no superior result as compared to conservative therapy in the management of rotator cuff tear., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

The presence of large bismuth (Bi) atoms has been shown to increase the spin-orbit splitting energy in bulk GaAsBi, reducing the hole ionization coefficient (β) and thereby reducing the excess noise seen in avalanche photodiodes. In this study, we show that even very thin layers of GaAsBi introduced as quantum wells (QWs) in a GaAs matrix exhibit a significant reduction of β while leaving the electron ionization coefficient, α, largely unchanged. The optical and avalanche multiplication properties of a series of GaAsBi/GaAs multiple quantum well (MQW) p-i-n structures with nominally 5 nm thick, 4.4% Bi GaAsBi QWs, varying from 5 to 63 periods and corresponding barrier widths of 101 to 4 nm were investigated. From photoluminescence, ω-2θ X-ray diffraction, and cross section transmission electron microscopy measurements, the material was found to be of high quality despite the strain introduced by the Bi in all except the samples with 54 and 63 QW periods. Photomultiplication measurements undertaken with different wavelengths showed that α in these MQW structures did not change appreciably with the number of QWs; however, β decreased significantly, especially at lower values, the noise factor, F , is reduced by 58% to 3.5 at a multiplication of 10, compared to a similar thickness bulk GaAs structure without any Bi. This result suggests that Bi-containing QWs could be introduced into the avalanching regions of APDs as a way of reducing their excess noise., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Objective: To evaluate the impact of extensive vaginal pelvic reconstruction surgery (PRS) on advanced pelvic organ prolapse (POP) patients with bladder outlet obstruction (BOO)., Methods: We conducted a single-center, retrospective analysis of women who received extensive vaginal pelvic reconstruction surgery for advanced POP (POP-Q ≥3) with BOO from January 2006 to January 2016. Data regarding preoperative evaluation, surgical procedure, and postoperative management were abstracted from medical records. Patients were considered to have BOO when detrusor pressure at maximum flow (D max ) was ≥20 cm H 2 O and peak flow rate (Q max ) was ≤15 mL/s. Patients with postoperative value of D max lower than 20 cm H 2 O or Q max higher than 15 mL/s were regarded as objectively cured., Results: A total of 1894 patients with POP stages III or IV were assessed. The incidence of BOO was 22.8% (431/1894) within this patient population of advanced POP. One year after the vaginal PRS, the objective cure rate of BOO was 98.1%. Urodynamic parameters showed a significant increase in Q max (P < 0.001), while D max (P < 0.001) and postvoid residual urine (PVR) (P < 0.001) were significantly decreased. Previous POP surgery, native tissue repair (NTR), PVR ≥200 mL, and maximal cystometric capacity (MCC) ≥500 mL increase the likelihood of persistent BOO in patients., Conclusion: Vaginal PRS demonstrated effectiveness in treating BOO in patients with advanced POP. Irrespective of the types of transvaginal mesh (TVM), using TVM achieved better outcome than did NTR. Previous POP surgery, preoperative PVR ≥200 mL, and MCC ≥500 mL were the risk factors predicting the failure of PRS in improving BOO., (© 2024 International Federation of Gynecology and Obstetrics.)

Objective: To evaluate the surgical outcomes and predictors of failure of Single Incision Mini Sling (Ophira) in women with urodynamic stress incontinence., Materials and Methods: Records of 115 women underwent anti-incontinence procedure using Ophira Mini Sling from June 2019 to September 2020 reviewed. Subjective evaluation was assessed using validated IIQ-7, UDI-6, POPDI-6 and PISQ-12 questionnaires. Multichannel urodynamics, 1-h pad test and 72-h voiding diary was performed as objective evaluation. Primary outcome was the objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was to identify risk factors associated with failure for Ophira., Results: Total of 108 women were evaluated. The objective cure rate was 91.7% with subjective cure rate of 86.1%. Comparison of clinical outcome shows significant improvement of USI post-operatively (p < 0.001) and reflected in 1-h pad test (p < 0.001). Improvement in all subjective evaluation parameters is seen except for POPDI-6. Failure of Ophira correlate significantly in women age >66 years, presence of asthma, pre-operative Intrinsic Sphincter Deficiency (ISD), and Maximum Urethral Closure Pressure (MUCP) value < 40 cmH20., Conclusion: Ophira Single Incision Mini Sling is safe and effective treatment option for USI, showing high objective and subjective cure rates with low incidence of complications. Non-modifiable risks of age ≥66 years, asthma status, pre-operative intrinsic sphincteric deficiency and low maximal urethral closure pressure were the factors of failure for Ophira., Competing Interests: Declaration of competing interest The authors declare they have no competing interest., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Low Maximal Urethral Closure Pressure (MUCP) is linked to unfavourable outcome of anti-incontinence surgery, however the cut-off value varied within studies. This study aimed to predict the cut-off value of MUCP that contributes to poor outcome of Mid-Urethral Sling (MUS) surgery in Urinary Stress Incontinence (USI) patients., Materials and Methods: Records of 729 women underwent MUS procedure from January 2004 to April 2017 reviewed. Patients were divided into four MUCP groups, which were <20 cmH2O (≥20 and < 40) cmH2O (≥40 and ≤ 60) cmH2O and >60 cmH2O. Objective evaluation comprising 72-h voiding diary, multichannel urodynamic study (UDS) and post-operative bladder neck angle measurement. Subjective evaluation through validated urinary symptoms questionnaires. Primary outcome was objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was identifying risk factors of cure failure for MUS in low MUCP groups. To identify the risk factors of cure failure, MUCP groups were narrowed down into <40 cmH2O or ≥40 cmH2O., Results: Total of 688 women evaluated. Overall objective cure rate was 88.2% with subjective cure rate of 85.9%. Objective and subjective cure rates were lower in groups with low MUCP <40 cmH2O. Failure of MUS correlate significantly in patients with low MUCP <40 cmH20, bladder neck angle <30° and Functional urethral length (FUL) < 2 cm., Conclusion: Women with MUCP <40cmH2O, bladder neck angle <30° and FUL < 2 cm are more likely to have unfavorable outcome following MUS surgery. We proposed the cut-off low MUCP <40cmH2O as predictor for fail MUS surgery in SUI patients., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Background: The incidence of adhesive capsulitis varies from 2-5% in the general population to 20% in people with diabetes. One of the most effective treatment methods is hydrodilatation, which can be done under US-guidance or Fluoroscopic guidance. However, the clinical effectiveness of US-guided injections in comparison to fluoroscopy-guided injections is still debatable. The possibility of severe side effects, the expense, and the time required to carry out this minimally invasive procedure highlight how crucial it is for patients to have a precise intra-articular injection. This study aims to compare the effectiveness of Ultrasound-guided vs. Fluoroscopic guided hydrodilatation for patients with adhesive capsulitis., Methods: Sixty-four patients were randomly selected for hydrodilatation using any one of the techniques. The patients were evaluated for clinical improvements using the visual analog scale (VAS), oxford shoulder score (OSS), and range of motion (ROM)., Results: The US-guided group experienced more pain reduction than the fluoroscopy group within the first four weeks (P < 0.001). The increase in ROM was much more significant in the US-guided group for the first 8 weeks. Improvement in Abduction and External rotation was much more significant (P < 0.001) in the first 4 weeks after hydrodilatation in the US-guided group. The improvement in ROM was maintained on long-term follow-up (mean 24 months), with 45 out of 64 (70.3%) reporting a normal or near normal ROM. On assessing the Oxford shoulder score improvements, the US-guided group's score significantly increased after the first week (P = 0.003), but the fluoroscopy-guided group's score increased after the second week. On comparison between the two groups, the amount of score improvement was more significant in the US-guided group than in the fluoroscopy-guided group in the first 4 weeks (P < 0.001)., Conclusion: US-guided technique for intra-articular injection for patients with adhesive capsulitis provided a quicker pain reduction and a larger improvement in range of motion and overall shoulder functions., Competing Interests: None., (IJBT Copyright © 2024.)

Introduction: Spontaneous osteonecrosis of bones is a relatively well-studied entity, which has been linked to both COVID-19 as well as the "wonder drug" used to treat it: steroids. The disease is said to occur within 2 months of COVID-19 infection and the clinical picture is usually of a painful joint with a history of COVID-19 which may be associated with management using steroids. The report highlights the importance of clinical discretion while administering steroids as well as the increasing number of such cases of osteonecrosis of bones post the COVID-19 pandemic., Case Report: In this case report, we present the case of a young female who presented to us with complaints of spontaneous onset pain in her left knee, which the patient could trace back to when she got infected with the COVID-19 virus. Radiological investigations confirmed the clinical suspicion of osteonecrosis of knee joints secondary to steroid use for the management of COVID-19. The patient was managed conservatively with satisfactory results on follow-up., Conclusion: Painful knee joints are a common complaint in outpatient orthopedic clinics, but the presence of idiopathic knee pain, especially in young patients, with a prior history of COVID-19 should raise the suspicion of spontaneous osteonecrosis of the knee. The results of the condition are excellent using conservative management., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Intramedullary nail placement is a preferred method for femoral shaft fractures due to biomechanical advantages. Despite its simplicity and efficacy, complications, such as pseudoarthrosis and nail fracture, pose challenges. Removing the distal fragment presents a vexing issue, often requiring specialized instruments. Current retrograde techniques may not be universally accessible, potentially leading to non-union site opening and tissue damage. While intramedullary nailing benefits fracture treatment, addressing its removal complications is crucial for further advancements. In this case, universal zig and K-nail reamers are used to extract the broken nail., Case Report: A 42-year-old male suffered an injury to his left thigh in a bike collision. Radiological examination revealed an oblique fracture in the proximal 1/3rd and distal 2/3rd junction of the left femur shaft. Closed reduction and internal fixation were initially performed, but delayed union occurred. Nine months post-surgery, a broken femoral nail and non-united fracture were observed. The patient underwent successful removal and replacement of the broken nail with a wider intramedullary nail. The procedure involved using a universal zig for removal of the proximal fragment and K-nail reamers to remove the distal fragment of the broken nail, and inserting a wider proximal femoral nail. The patient was discharged in satisfactory condition with tolerable weight-bearing., Conclusion: Broken femoral nail presents a unique challenge to the operating surgeon. It requires diligent planning with appropriate instruments and techniques. There have been many techniques devised to tackle this problem and the use of K-nail reamers as described in this case is another innovative method in this regard., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

The current practice of restoring the anatomical structure in the treatment of pelvic floor dysfunction includes implantation of synthetic sling, which carries potential complications. This study aimed to develop biological substitutes to improve tissue function using scaffolds as a support to the host cells, through formation of new tissue. Human amniotic fluid stem cells (hAFSCs) were seeded on synthetic mesh-scaffold of AlloDerm Regenerative Tissue Matrix (RTM), Poly-DL-lactico-glycolic acid (PLGA) mesh (VICRYL) and Polydioxanone (PDS) meshes. In vitro study evaluates the metabolic activity of hAFSCs seeded mesh-scaffolds. In vivo study involving Sprague-Dawley rats was performed by assigning into 7 groups of sham control with fascia operation, AlloDerm implant, PDS implant, PLGA implant, AlloDerm harvest with hAFSC (AlloDerm-SC), PDS harvest with hAFSC(PDS-SC) and PLGS harvest with hAFSC (PGLA-SC). In vitro study reveals cell viability and proliferation of hAFSC on mesh scaffolds varies between meshes, with AlloDerm growing the fastest. The biomechanical properties of tissue-mesh-complex tension strength declined over time, showing highest tension strength on week-1, deteriorated similar to control group on week-12. All hAFSC-seeded mesh provides higher tension strength, compared to without. This study shed the potential of synthetic mesh as a scaffold for hAFSC for the surgical treatment of pelvic floor dysfunction., (© 2024. The Author(s).)

Introduction: Central hip dislocations are rare orthopedic injuries, and their concomitant occurrence with ipsilateral knee dislocations is an even rarer phenomenon. We present a unique case of central hip dislocation along with ipsilateral knee dislocation and additional fractures involving the lateral condyle of the left tibia and patella. This complex injury pattern resulted from a severe road traffic accident, necessitating operative management to address the multiple musculoskeletal injuries. Ultimately, femoral head avascular necrosis (AVN) developed, leading to the need for total hip replacement (THR)., Case Report: A 28-year-old male was involved in a high-impact road traffic accident, leading to central hip dislocation, ipsilateral knee dislocation, and fractures of the lateral condyle of the left tibia and patella. The patient was promptly assessed, and operative intervention was initiated. Closed reduction and internal fixation with K-wires were performed for the fractures of the lateral condyle of the left tibia and patella. For the central hip dislocation, open reduction was achieved using a 9-hole RECON plate. Following the procedures, a long leg slab was applied for 6 weeks to facilitate optimal healing.Postoperatively, at the 6-week mark, K-wires were removed, and the patient commenced physiotherapy with partial weight-bearing permitted. However, during the rehabilitation phase, the patient reported instability in his left knee. Magnetic resonance imaging revealed an avulsion fracture of the posterior cruciate ligament (PCL) from its tibial attachment site and a complete anterior cruciate ligament (ACL) tear. It was observed that the femoral head had developed AVN. This complication necessitated further intervention, leading to the performance of a THR., Discussion: This case underscores the challenges and complexities associated with managing central hip dislocation and ipsilateral knee dislocation with multiple fractures. The post-operative instability of the knee, diagnosed as an avulsion fracture of the PCL and complete ACL tear, necessitated additional intervention. The patient subsequently underwent PCL reconstruction using a semitendinosus graft, highlighting the importance of a comprehensive approach to address the diverse musculoskeletal injuries resulting from high-impact trauma., Conclusion: The successful management of central hip dislocation and ipsilateral knee dislocation with associated fractures requires a multidisciplinary approach, incorporating timely surgical intervention, rigorous rehabilitation, and vigilant post-operative monitoring to address potential complications. This case emphasizes the need for ongoing clinical assessment and imaging studies to identify and manage secondary injuries that may manifest during the recovery phase. In addition, it highlights the development of femoral head AVN, ultimately leading to the necessity for THR., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction and Hypothesis: Calistar-S is a single-incision synthetic mesh kit that addresses apical and anterior compartment prolapse. The aims of this study were to evaluate the short-term objective and subjective outcomes at the 1-year follow-up. The secondary objectives were to evaluate quality of life and lower urinary tract symptoms (LUTS) outcomes, as well as surgical complications., Methods: Records of 108 patients with symptomatic advanced pelvic organ prolapse (stages III and IV) who underwent prolapse surgery using the Calistar-S system from June 2018 to August 2022 were reviewed. The primary outcome was the objective cure of anterior and apical prolapse < stage 1, and the subjective cure was the negative response to questions 2 and 3 of the Pelvic Organ Prolapse Distress Inventory-6. Secondary outcomes measured quality of life, the presence of lower urinary tract symptoms, and complications., Results: A total of 101 patients were evaluated. The overall objective cure rate is 97% and the subjective cure rate is 92.1%. Good outcomes were seen in all three compartments. Secondary outcomes show significant improvement in all validated questionnaires. Persistence and de novo urinary incontinence were 15.2% and 18.2% post-operatively. There is one case of bladder injury and one case of vaginal mesh exposure., Conclusions: The Calistar-S System is a safe and efficient method for treating advanced-stage POP. We observed good anatomical results and subjective relief with a minimal complication rate. LUTS have also been positively affected, showing a high success rate. Additional studies are needed to establish the long-term efficacy of this system., (© 2024. The International Urogynecological Association.)

Background and Purpose: We present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms., Methods: This is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively., Results: Objective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %., Conclusion: The UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Study Objective: To determine the outcome of voiding function 1 year after pelvic reconstructive surgery (PRS) in women with bladder outlet obstruction (BOO)., Design: Retrospective cohort study., Setting: Tertiary referral hospital., Patients: A total of 1894 women underwent PRS for advanced pelvic organ prolapse (POP) stages 3 to 4 with urodynamic findings of BOO., Interventions: PRS., Measurements: The primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic testing at 1 year postoperatively. The secondary outcomes were to identify the different risk factors for persistence voiding dysfunction (VD) 1 year after PRS., Main Results: A total of 431 women with Pelvic Organ Prolapse Quantification stages 3 and 4, urodynamic study of maximum urinary flow rate ≤15 mL/s, and detrusor pressure at maximum flow ≥20 cm H 2 O were included. Resumption of normal voiding function was found in 91% (n = 392 of 431), whereas 9% (n = 39 of 431) remained to have VD 1 year postoperatively. Those with persistent VD, 20.5% (n = 8 of 39) remained having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression revealed factors associated with postoperative VD were pre-operative maximal cystometric capacity ≥500 mL and postvoid residual volume ≥200 mL., Conclusion: VD may persist in women with BOO after PRS, particularly in those with preoperative maximal cystometric capacity of >500 mL and postvoid residual volume >200 mL., (Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)

Purpose: Wider breast cancer (BC) treatment options, short consultation time with physicians, lack of knowledge, and poor coping skills at the time of diagnosis may affect patients' decisions causing treatment delays and non-adherence. To address this gap, a breast care nurse video orientation program was started. Our aim was to evaluate the video on patients' knowledge, satisfaction, and treatment adherence., Methods: The video was developed using the BC delay explanatory model. A self-administered pre- and post-survey on 241 newly diagnosed BC patients in University Malaya Medical Center was performed. The Wilcoxon matched paired signed rank test was used to evaluate patients' pre and post perceived knowledge using a Likert scale 0 to 4 (0 = "no knowledge," 4 = "a great degree of knowledge"). Treatment adherence among participants were measured after 1-year follow-up., Results: Eighty percent of the patients reported that the video met or exceeded their expectations. In total 80.5% reported that the video was very effective and effective in improving their perspective on BC treatments. There was improvement in perceived knowledge for treatment options (mean scores; M = 0.93 versus M = 2.97) (p < 0.001) and also for perceived knowledge on types of operation, information on chemotherapy, radiotherapy, hormone therapy, healthy diet, physical activity after treatments, and care of the arm after operation(p < 0.001). In total 89.4%, 79.3%, and 85.9% adhered to surgical, chemotherapy, and radiotherapy recommended treatment, respectively., Conclusion: The video improved patients' perceived knowledge and satisfaction. The program improved access not only to new BC patients but also the public and found sustainable using the YouTube platform.

This study aimed to establish the local diagnostic reference levels (LDRLs) of computed tomography pulmonary angiography (CTPA) examinations based on body size with regard to noise magnitude as a quality indicator. The records of 127 patients (55 males and 72 females) who had undergone CTPAs using a 128-slice CT scanner were retrieved. The dose information, scanning acquisition parameters, and patient demographics were recorded in standardized forms. The body size of patients was categorized into three groups based on their anteroposterior body length: P1 (14-19 cm), P2 (19-24 cm), and P3 (24-31 cm), and the radiation dose exposure was statistically compared. The image noise was determined quantitatively by measuring the standard deviation of the region of interest (ROI) at five different arteries-the ascending and descending aorta, pulmonary trunk, and the left and right main pulmonary arteries. We observed that the LDRL values were significantly different between body sizes ( p < 0.05), and the median values of the CT dose index volume (CTDI vol ) for P1, P2, and P3 were 6.13, 8.3, and 21.40 mGy, respectively. It was noted that the noise reference values were 23.78, 24.26, and 23.97 HU for P1, P2, and P3, respectively, which were not significantly different from each other ( p > 0.05). The CTDI vol of 9 mGy and dose length product (DLP) of 329 mGy∙cm in this study were lower than those reported by other studies conducted elsewhere. This study successfully established the LDRLs of a local healthcare institution with the inclusion of the noise magnitude, which is comparable with other established references.

Background: Girls born with congenital adrenal hyperplasia have virilized external genitalia. There is considerable debate regarding both the outcomes of feminizing genitoplasty and timing of the surgery in this population. Objective: To investigate outcomes of females 46,XX individuals with CAH in Malaysia, the surgical outcomes of feminizing genitoplasty (FG) and their attitudes toward surgery. Study Design: This is a cross-sectional study involving the two main tertiary centers in Malaysia. All 46,XX patients with CAH and raised female, who had undergone FG were identified and invited to participate. Data on socio-demographic, medical profiles, and attitudes toward surgery were collected. A standardized evaluation of the external genitalia was undertaken including the anatomic and cosmetic evaluation by independent gynecologists. Results: Of 61 individuals identified, 59 participated-consisting of children ( n = 12), adolescents ( n = 29) and adults ( n = 18). All but one had classical CAH (98.3%) and had undergone FG ( n = 55, 93.2%) with surgery mostly undertaken by pediatric surgeons trained in DSD work ( n = 44, 74.6%). Complications overall were low (20.3%), with repeat surgery rate of 9.1%. External genital examination was performed in 38 participants. Overall 36.8% had absent clitoral glands and 39.5% had a persistent urogenital sinus and in 10.5%, no vaginal orifices were seen. Poor cosmetic outcomes were present in 42.1% with 55.3% recommended for further assessment under general anesthetic. Almost half participants did not venture an opinion on FG, those who did varied from having a positive attitude toward it (18 participants) to 3 opining that it should not be done, or avoided or delayed. From the participants, 35.5% preferred FG to be done early in life compared to 44.0% of the parents. Conclusions: The reoperation rates of the feminizing genitoplasty surgeries were low however due to the anatomic and cosmetic outcomes, reassessment of the external genitalia of these CAH patients may be required once they consider becoming sexually active as they may require further treatment. Many factors such as cultural sensitivities and access to medical treatment and late diagnoses have an impact on attitudes toward FG.

Purpose: Mammographic density is a measurable and modifiable biomarker that is strongly and independently associated with breast cancer risk. Paradoxically, although Asian women have lower risk of breast cancer, studies of minority Asian women in predominantly Caucasian populations have found that Asian women have higher percent density. In this cross-sectional study, we compared the distribution of mammographic density for a matched cohort of Asian women from Malaysia and Caucasian women from Sweden, and determined if variations in mammographic density could be attributed to population differences in breast cancer risk factors., Methods: Volumetric mammographic density was compared for 1501 Malaysian and 4501 Swedish healthy women, matched on age and body mass index. We used multivariable log-linear regression to determine the risk factors associated with mammographic density and mediation analysis to identify factors that account for differences in mammographic density between the two cohorts., Results: Compared to Caucasian women, percent density was 2.0% higher among Asian women (p < 0.001), and dense volume was 5.7 cm 3 higher among pre-menopausal Asian women (p < 0.001). Dense volume was 3.0 cm 3 lower among post-menopausal Asian women (p = 0.009) compared to post-menopausal Caucasian women, and this difference was attributed to population differences in height, weight, and parity (p < 0.001)., Conclusions: Our analysis suggests that among post-menopausal women, population differences in mammographic density and risk to breast cancer may be accounted for by height, weight, and parity. Given that pre-menopausal Asian and Caucasian women have similar population risk to breast cancer but different dense volume, development of more appropriate biomarkers of risk in pre-menopausal women is required.

Heavily glycosylated mucin glycopeptides such as CA 27.29 and CA 15-3 are currently being used as biomarkers for detection and monitoring of breast cancer. However, they are not well detected at the early stages of the cancer. In the present study, perchloric acid (PCA) was used to enhance detection of mucin-type O-glycosylated proteins in the serum in an attempt to identify new biomarkers for early stage breast cancer. Sensitivity and specificity of an earlier developed sandwich enzyme-linked lectin assay were significantly improved with the use of serum PCA isolates. When a pilot case-control study was performed using the serum PCA isolates of normal participants (n = 105) and patients with stage 0 (n = 31) and stage I (n = 48) breast cancer, higher levels of total O-glycosylated proteins in sera of both groups of early stage breast cancer patients compared to the normal control women were demonstrated. Further analysis by gel-based proteomics detected significant inverse altered abundance of proteoglycan 4 and plasma protease C1 inhibitor in both the early stages of breast cancer patients compared to the controls. Our data suggests that the ratio of serum proteoglycan 4 to protease C1 inhibitor may be used for screening of early breast cancer although this requires further validation in clinically representative populations.

Background: Depression and anxiety are common psychiatric morbidity among breast cancer patient. There is a lack of study examining the correlation between depression, anxiety and quality of life (QoL) with perceived social support (PSS) among breast cancer patients. This study aims to study the level of depression, anxiety, QoL and PSS among Malaysian breast cancer women over a period of 12 months and their associations at baseline, 6 and 12 months., Methods: It is a 12 months prospective cohort study. Two hundred and twenty one female patients were included in the study. They were assessed at the time of diagnosis, 6 months and 12 month using Hospital Anxiety and Depression Scale (HADS), Quality-of-Life Questionnaire (QLQ-C30), Version 3.0 of the EORTC Study Group and Multidimensional Scale of Perceived Social Support (MSPSS). The information of age, ethnicity, types of treatment, and staging of cancer were collected., Results: The HADS anxiety and depression subscales scores of the subjects were relatively low. The level of anxiety reduced significantly at 6 and 12 months (Baseline - 6 months, p = 0.002; Baseline - 12 months, p < 0.001). There were no changes in the level of depression over the study period. The global status of QoL and MSPSS scores were relatively high. Correlation between the global status of QoL and MSPSS for the study subjects was positive (Spearman's rho = 0.31-0.36). Global status of QoL and MSPSS scores were negatively correlated with anxiety and depression., Conclusion: Malaysian breast cancer women had relatively better QoL with lower level of anxiety and depression. Perceived social support was an important factor for better QoL and low level of psychological distress. It reflects the importance of attention on activities that enhance and maintain the social support system for breast cancer patients.

Objectives: The c.2268dup mutation in the thyroid peroxidase (TPO) gene is the most common TPO alteration reported in Taiwanese patients with thyroid dyshormonogenesis. The ancestors of these patients are believed to originate from the southern province of China. Our previous study showed that this mutation leads to reduced abundance of the TPO protein and loss of TPO enzyme activity in a Malaysian-Chinese family with goitrous hypothyroidism. The aim of our study was to provide further data on the incidence of the c.2268dup mutation in a cohort of Malaysian-Chinese and its possible phenotypic effects., Setting: Cohort study., Participants: Twelve biologically unrelated Malaysian-Chinese patients with congenital hypothyroidism were recruited in this study. All patients showed high thyrotropin and low free thyroxine levels at the time of diagnosis with proven presence of a thyroid gland., Primary Outcome Measure: Screening of the c.2268dup mutation in the TPO gene in all patients was carried out using a PCR-direct DNA sequencing method., Secondary Outcome Measure: Further screening for mutations in other exonic regions of the TPO gene was carried out if the patient was a carrier of the c.2268dup mutation., Results: The c.2268dup mutation was detected in 4 of the 12 patients. Apart from the c.2268dup and a previously documented mutation (c.2647C>T), two novel TPO alterations, c.670&#95;672del and c.1186C>T, were also detected in our patients. In silico analyses predicted that the novel alterations affect the structure/function of the TPO protein., Conclusions: The c.2268dup mutation was detected in approximately one-third of the Malaysian-Chinese patients with thyroid dyshormonogenesis. The detection of the novel c.670&#95;672del and c.1186C>T alterations expand the mutation spectrum of TPO associated with thyroid dyshormonogenesis., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

We report a novel NR0B1 mutation in a patient affected with X-linked adrenal hypoplasia congenita (X-AHC). The proband first presented with a generalized convulsion at 11 years, 4 months. His clinical and biochemical presentations were consistent with adrenal insufficiency. His basal 17-hydroxyprogesterone (17-OHP) level was not high, and the poor response in 17-OHP on ACTH stimulation test excluded congenital adrenal hyperplasia. At 14 years of age, he did not show any signs of puberty, with low levels of LH, FSH, and testosterone and unresponsiveness to lutenizing hormone releasing hormone stimulation test. Direct DNA sequencing revealed that the proband is hemizygous for a novel NR0B1 mutation (c.1177&#95;1180delGGCC, p.Gly393Cysfs*4). The mother is the conductor of the mutation, which is likely pathogenic as the C-terminus truncated protein lacks the activation function-2 (AF2-TA) transactivation domain, which is highly conserved among members of the nuclear receptor superfamily.

The c.2268dup mutation in thyroid peroxidase (TPO) gene was reported to be a founder mutation in Taiwanese patients with dyshormonogenetic congenital hypothyroidism (CH). The functional impact of the mutation is not well documented. In this study, homozygous c.2268dup mutation was detected in two Malaysian-Chinese sisters with goitrous CH. Normal and alternatively spliced TPO mRNA transcripts were present in thyroid tissues of the two sisters. The abnormal transcript contained 34 nucleotides originating from intron 12. The c.2268dup is predicted to generate a premature termination codon (PTC) at position 757 (p.Glu757X). Instead of restoring the normal reading frame, the alternatively spliced transcript has led to another stop codon at position 740 (p.Asp739ValfsX740). The two PTCs are located at 116 and 201 nucleotides upstream of the exons 13/14 junction fulfilling the requirement for a nonsense-mediated mRNA decay (NMD). Quantitative RT-PCR revealed an abundance of unidentified transcripts believed to be associated with the NMD. TPO enzyme activity was not detected in both patients, even though a faint TPO band of about 80 kD was present. In conclusion, the c.2268dup mutation leads to the formation of normal and alternatively spliced TPO mRNA transcripts with a consequential loss of TPO enzymatic activity in Malaysian-Chinese patients with goitrous CH.

Background: Defects in the thyroid peroxidase (TPO) gene have been associated with goitrous congenital hypothyroidism (CH)., Case Report: In this study, we report 3 siblings possessing a homozygous mutation, c.1159G>A, but exhibiting different clinical phenotypes in a Malaysian-Malay family. The index patient was diagnosed with CH during a routine neonatal screening but the other 2 siblings appeared to be asymptomatic until the ages of 19 and 12.5, respectively, when they started to develop goiter., Results and Conclusion: The mutation was predicted to interrupt the correct splicing of pre-mRNA and also lead to structural alterations in the functional sites of the mutant TPO. The current results suggest the association of goiter development with a homozygous c.1159G>A mutation, but the CH in the index patient could be triggered by other genetic and epigenetic factors distinct from the c.1159G>A mutation., (© 2014 S. Karger AG, Basel.)

Background: Obesity and metabolic syndrome is prevalent among Malaysian adolescents and has been associated with certain behavioural factors such as duration of sleep, screen time and physical activity. The aim of the study is to report the prevalence of overweight/obesity, metabolic syndrome and its risk factors among adolescents., Methods: A multi-staged cluster sampling method was used to select participants from urban and rural schools in Selangor, Perak and Wilayah Persekutuan Kuala Lumpur. Participants underwent anthropometric measurement and physical examination including blood pressure measurement. Blood samples were taken for fasting glucose and lipids and participants answered a self-administered questionnaire. Overweight and obesity was defined using the extrapolated adult body mass index (BMI) cut-offs of >25 kg/m2 and >30 kg/m2, according to the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined based on International Diabetes Federation (IDF) 2007 criteria., Results: Data were collected from 1361 participants. After excluding incomplete data and missing values for the variables, we analysed a sample of 1014 participants. Prevalence of overweight and obesity in this population was 25.4% (N = 258). The prevalence of metabolic syndrome was 2.6% in the population and 10% among the overweight and obese adolescents. Participants who slept between 7 and 9 hours a day has a lower risk of developing metabolic syndrome OR 0.38(0.15-0.94)., Conclusion: Our results provide the prevalence of metabolic syndrome in Malaysian adolescents. Adequate sleep between 7 and 9 hours per day reduces the risk of developing metabolic syndrome.