Association of Piriformis Thickness, Hip Muscle Strength, and Low Back Pain Patients with and without Piriformis Syndrome in Malaysia

Low back pain is a serious threat to human health and the illness jeopardizes the human workforce and pressurizes the health system in the community. Low back pain might be related to piriformis syndrome (PS), which is a disorder presented as muscular spasm and hypertrophy that is strongly associated with piriformis thickness. Nevertheless, the relationship between piriformis thickness and morphological and functional changes of the gluteal muscles in PS remains unclear. This study aimed to investigate the association between the thickness, strength, and activation of piriformis and gluteus muscles (maximus and medius) among low back pain (LBP) patients with and without PS. This is a case-control study conducted at HSNZ and UiTM from 2019-2020. A total number of 91 participants (LBP + PS (n = 36), LBP - PS (n = 24), and healthy (n = 31)) were recruited in this study. Negative radiography, specific symptoms, and a positive PS test were applied for PS diagnoses. The thickness, strength, and activation of piriformis and gluteus muscles were measured using ultrasonography (USG) and a surface electromyogram, respectively. Resultantly, the one-way ANOVA test demonstrated no significant difference in piriformis thickness between LBP + PS and LBP - PS (p > 0.01). Piriformis thickness was inversely correlated with gluteus maximus strength (r = -0.4, p < 0.05) and positively correlated with gluteus medius activation (r = 0.48, p < 0.01) in LBP + PS. Stepwise linear regression for LBP + PS revealed a significant association between piriformis thickness and gluteus maximus strength (R = -0.34, accounted for 11% of the variance) and gluteus medius activation in prone lying with the hip in an externally rotated, abducted, and extended (ERABEX) position (R = 0.43, accounted for 23% of the variance). With the adjustment of age and gender, piriformis thickness, gluteus maximus strength, and gluteus medius activation in prone lying with hip ERABEX demonstrated a significant association, but no independent effect of age and gender was detected within the range. Meanwhile, a significant association between piriformis thickness and gluteus maximus thickness was observed (R = 0.44, accounted for 19% of the variance) in the LBP - PS group. These findings may assist to elucidate the actions and functions of piriformis and gluteus muscle in LBP with and without PS.

Stature estimation of Malaysians using post-mortem computed tomography images of the spine

Background

Stature estimation is important in medical investigations to identify victims and is most accurate using anatomical methods utilizing the entire skeleton. However, in cases of mass fatalities, it has been calculated using regression analysis formulas of different body parts. Radiology especially post-mortem computed tomography (PMCT) is increasingly being used in victim identification as it is non- invasive and allows for multi planar reconstruction.

Methods

This study aims to generate stature estimation formulae using regression analysis of the vertebral column incorporating population that form the Malaysian ancestry i.e. Malay, Chinese and Indian using PMCT. This was a retrospective study involving 115 subjects who had a PMCT. Subjects consisted of Malaysian males and females (92 males and 23 females) aged 18–70 years. Cervical length (CL), thoracic length (TL), lumbar length and the whole spine length (WSL) incorporating cervical, thoracic and lumbar length were compared against cadaveric length.

Results

Whole spine length had the highest correlation coefficient of 0.570 and showed highest correlation with cadaveric length among female subjects compared to males. Whole spine length amongst the Malay was the highest followed by the Chinese and Indian ethnic groups (r = 0.671, 0.629, 0.402).

Conclusion

Our study concluded that the use of WSL from PMCT images can be used for body height estimation amongst Malaysians. This study has also successfully generated population-specific database for Malaysian experts to perform stature estimation using measurements of the vertebral column.

Eating behaviours of normal and overweight female undergraduate students in positive and negative emotions

Emotional well-being affects eating behaviour, whether making an individual eat less or more than they normally do. This paper aimed to compare eating behaviour between normal and overweight female undergraduate students in response to positive and negative emotions. This cross-sectional study was conducted among 166 female university students. Data collection involved the assessments of participants’ anthropometric measurements to obtain body mass index (BMI) and two self-administered questionnaires to measure of eating behaviour in positive and negative emotions; Emotional Appetite Questionnaire (EMAQ) and Eating Junk Food Questionnaire (EJFQ). Data from the two groups were compared to obtain differences in eating behaviour between normal and overweight female undergraduate students in response to positive and negative emotions. Both normal (Mean = 5.96±1.05) and overweight (Mean = 5.60±0.81) participants reported no changes in the levels of eating under positive emotions. The results also showed that both BMI categories “ate less” when they experienced negative emotions. For EJFQ, there was no significant difference in eating junk food between normal and overweight participants in response to positive emotions. However, the results revealed that the overweight group has more tendency to choose pizza (X 2 (1) = 6.879), p = 0.009) and cake (X 2 (1) = 7.458, p = 0.006) than the normal group under negative emotions. These results offer an insight that both BMI groups have almost similar eating-related concerns and thus intervention programs can be constructed on distressing eating-related thoughts and emotions among female undergraduate students

A CASE OF INFILTRATING LOBULAR CARCINOMA OF THE BREAST WITH GASTRIC METASTASIS 22 YEARS AFTER INITIAL SURGERY

Gastric metastasis from breast carcinoma is uncommon and rarely encountered in our daily practice. We report a case of late gastric metastasis from previous infiltrating lobular carcinoma of the breast. The patient had extended disease-free interval of 22 years prior to metastasis. Gastroscopy and fluoroscopy showed changes appearing like linitis plastica of the body of the stomach. Computed tomography of the thorax and abdomen demonstrated pulmonary metastasis and mediastinal lymphadenopathy. Biopsy of the mediastinal lymph node and stomach lesion confirmed metastatic adenocarcinoma from breast carcinoma based on immunohistochemistry staining. Immunohistochemistry staining of both specimens revealed strong positivity for cytokeratin 7 and negative for cytokeratin 20.

Paraspinal back muscles in asymptomatic volunteers: quantitative and qualitative analysis using computed tomography (CT) and magnetic resonance imaging (MRI)

Background

To evaluate paraspinal back muscles of asymptomatic subjects using qualitative and quantitative analysis on CT and MRI and correlate the results with demographic data.

Methods

Twenty-nine asymptomatic subjects were enrolled prospectively (age: mean 34.31, range 23–50; 14 men, 15 women) from August 2016 to April 2017. Qualitative analysis of muscles was done using Goutallier’s system on CT and MRI. Quantitative analysis entailed cross sectional area (CSA) on CT and MRI, Hounsfield unit (HU) on CT, fat fraction using two-point Dixon technique on MRI. Three readers independently analyzed the images; intra- and inter-observer agreements were measured. Linear regression and Spearman’s analyses were used for correlation with demographic data.

Results

CSA values were significantly higher in men (p < 0.001). Fat fraction was higher (22.53% vs. 14.35%) and HU lower (36.00 vs. 47.43) in women (p < 0.001). Intra- and inter-observer reliabilities of the two methods were greater than 0.8, except for CSA of L5/S1 on MRI; however, regarding quantitative analysis, decreasing HU and increasing fat fraction were correlated with increasing age, female gender and lower lumbar segment (p < 0.001).

Conclusion

MRI and CT can be reliably used for qualitative and quantitative analysis of paraspinal back muscles, regarding fat content. Fat fraction and HU showed highest reliabilities.

Assessment of fruit and vegetable consumption among female university students

The low intake of fruits and vegetables is a global issue. This research aimed to determine the association of fruit and vegetable intake with waist circumference and barriers of intake. A total of 279 female students from the International Islamic University Malaysia, Kuantan, were recruited through convenience sampling and provided with a set of questionnaires to identify their fruits and vegetable intake. The waist circumference of respondents was measured. The majority of students consumed only one serving of fruit and vegetable per day, which is less than the levels recommended by the Malaysian Dietary Guideline. Only 9.0% of students had a fruits intake of two servings/day, while 6.5% had a vegetable intake of three servings/day which meets the recommendation. There was no significant association of fruits and vegetable intake with waist circumference among female students. Non-availability and not delicious were identified as major barriers to fruit and vegetable consumption respectively. In conclusion, the fruit and vegetable intake among the majority of female university students is inadequate. Thus, there is a need to increase awareness and develop strategies to promote adequate fruit and vegetable intake among this specific target group.

Disseminated Melioidosis Presenting with Community-Acquired Pneumonia: A Presentation Not to be Missed – A Case Report

BACKGROUND: Melioidosis commonly presents with pneumonia and is associated with a high mortality rate. This case report discussed a case of confirmed disseminated melioidosis. The case focused on the chronological clinical progressions of melioidosis which initially masqueraded as community-acquired pneumonia (CAP) and subsequently developed into septicemia. This case report aims to create awareness among the primary care doctors working in a potentially endemic area for melioidosis to be vigilant of its non-specific presentation. CASE REPORT: We report a case of an 80-year-old man who was treated for CAP and presented with unresolved fever and subsequently sepsis. A contrast-enhanced computed tomography showed disseminated lesions of varying sizes in the lungs, liver, spleen, and blood cultures grew Burkholderia pseudomallei. A pigtail drainage catheter was inserted into the liver abscess. In addition, the patient received a 46-day course of intravenous ceftazidime and a 4-month maintenance regime of oral trimethoprim-sulfamethoxazole and oral doxycycline. CONCLUSION: Completion of antimicrobial treatment resulted in resolution of clinical signs and abscesses on imaging.

Effect of Magnesium Acetyltaurate and Taurine on Endothelin1-Induced Retinal Nitrosative Stress in Rats

PURPOSE

Retinal ganglion cell apoptosis in glaucoma is associated with elevated levels of endothelin-1 (ET1), a potent vasoconstrictor. ET1-induced retinal ischemia leads to altered expression of nitric oxide synthase (NOS) isoforms leading to increased formation of nitric oxide (NO) and retinal nitrosative stress. Since magnesium (Mg) is known to improve endothelial functions and reduce oxidative stress and taurine (TAU) possesses potent antioxidant properties, we investigated the protective effects of magnesium acetyltaurate (MgAT) against ET1-induced nitrosative stress and retinal damage in rats. We also compared the effects of MgAT with that of TAU alone.

METHODS

Sprague Dawley rats were intravitreally injected with ET1. MgAT and TAU were administered as pre-, co-, or posttreatment. Subsequently, the expression of NOS isoforms was detected in retina by immunohistochemistry, retinal nitrotyrosine level was estimated using ELISA, and retinal cell apoptosis was detected by TUNEL staining.

RESULTS

Intravitreal ET1 caused a significant increase in the expressions of nNOS and iNOS while eNOS expression was significantly reduced compared to vehicle treated group. Administration of both MgAT and TAU restored the altered levels of NOS isoform expression, reduced retinal nitrosative stress and retinal cell apoptosis. The effect of MgAT, however, was greater than that of TAU alone.

CONCLUSIONS

MgAT and TAU prevent ET1-induced retinal cell apoptosis by reducing retinal nitrosative stress in Sprague Dawley rats. Addition of TAU to Mg seems to enhance the efficacy of TAU compared to when given alone. Moreover, the pretreatment with MgAT/TAU showed higher efficacy compared to co- or posttreatment.

Taurine protects against retinal and optic nerve damage induced by endothelin-1 in rats via antioxidant effects

Endothelin-1 (ET-1), a potent vasoconstrictor, is involved in retinal vascular dysregulation and oxidative stress in glaucomatous eyes. Taurine (TAU), a naturally occurring free amino acid, is known for its neuroprotective and antioxidant properties. Hence, we evaluated its neuroprotective properties against ET-1 induced retinal and optic nerve damage. ET-1 was administered intravitreally to Sprague-Dawley rats and TAU was injected as pre-, co- or post-treatment. Animals were euthanized seven days post TAU injection. Retinae and optic nerve were examined for morphology, and were also processed for caspase-3 immunostaining. Retinal redox status was estimated by measuring retinal superoxide dismutase, catalase, glutathione, and malondialdehyde levels using enzyme-linked immuosorbent assay. Histopathological examination showed significantly improved retinal and optic nerve morphology in TAU-treated groups. Morphometric examination showed that TAU pre-treatment provided marked protection against ET-1 induced damage to retina and optic nerve. In accordance with the morphological observations, immunostaining for caspase showed a significantly lesser number of apoptotic retinal cells in the TAU pre-treatment group. The retinal oxidative stress was reduced in all TAU-treated groups, and particularly in the pre-treatment group. The findings suggest that treatment with TAU, particularly pre-treatment, prevents apoptosis of retinal cells induced by ET-1 and hence prevents the changes in the morphology of retina and optic nerve. The protective effect of TAU against ET-1 induced retinal and optic nerve damage is associated with reduced retinal oxidative stress.

Glaucoma severity affects diffusion tensor imaging (DTI) parameters of the optic nerve and optic radiation

OBJECTIVES

To evaluate whether MR diffusion tensor imaging (DTI) of the optic nerve and optic radiation in glaucoma patients provides parameters to discriminate between mild and severe glaucoma and to determine whether DTI derived indices correlate with retinal nerve fibre layer (RNFL) thickness.

METHODS

3-Tesla DTI was performed on 90 subjects (30 normal, 30 mild glaucoma and 30 severe glaucoma subjects) and the FA and MD of the optic nerve and optic radiation were measured. The categorisation into mild and severe glaucoma was done using the Hodapp-Parrish-Anderson (HPA) classification. RNFL thickness was also assessed on all subjects using OCT. Receiver operating characteristic (ROC) analysis and Spearman's correlation coefficient was carried out.

RESULTS

FA and MD values in the optic nerve and optic radiation decreased and increased respectively as the disease progressed. FA at the optic nerve had the highest sensitivity (87%) and specificity (80%). FA values displayed the strongest correlation with RNFL thickness in the optic nerve (r=0.684, p ≤ 0.001) while MD at the optic radiation showed the weakest correlation with RNFL thickness (r=-0.360, p ≤ 0.001).

CONCLUSIONS

The high sensitivity and specificity of DTI-derived FA values in the optic nerve and the strong correlation between DTI-FA and RNFL thickness suggest that these parameters could serve as indicators of disease severity.

Primary ovarian pregnancy: current diagnosis and management

We reviewed five cases of ovarian pregnancy that were diagnosed at the Kandang Kerbau Hospital Histopathology Laboratory over three years. The clinical presentation, diagnosis and management of these patients are discussed in detail. This condition usually occurs in parous fertile women as evidenced by three of the five patients studied. It is probably an accidental event with no predisposing features as compared to the tubal pregnancy patient. The diagnosis has been aided by the recent advances in human chorionic gonadotrophin determination and ultrasound. Ultrasound, especially transvaginal ultrasound scanning has proven to be an invaluable tool in the diagnosis of this condition. Fertility after conservative surgical procedures does not appear to be affected and ovarian wedge resection or ovarian cystectomy is the treatment of choice.

Primary unruptured ovarian pregnancy--a case report

A rare case of an unruptured ovarian ectopic pregnancy is reported. This patient had a dilatation and curettage for an incomplete abortion and no products of conception were revealed in the histology specimen. A repeat ultrasound scan detected an ectopic pregnancy. Laparotomy confirmed the diagnosis of an unruptured ovarian pregnancy. The problems with the diagnosis and the management of this case are discussed.

Delivery after a lower segment caesarean section

A retrospective study on the outcome of 130 consecutive patients with a previous lower segment Caesarean section who delivered in Kandang Kerbau Hospital, Singapore from January to June 1989 was performed. Seventy-six percent of these patients were selected for a trial of labour and 24% of the patients had a repeat (elective) Caesarean section. Vaginal delivery was achieved in 65% of patients chosen to undergo a trial of labour. A trial of labour was found to be relatively safe with only a 0.7% incidence of uterine dehiscence and a perinatal mortality of 10.1 per 1,000 births with no maternal mortality. Cephalopelvic disproportion in the previous pregnancy and cervical dilatation during the previous Caesarean section were not important prognostic factor for the subsequent pregnancy outcome. A previous vaginal delivery in patients who had a previous Caesarean section was a good prognostic factor for a subsequent successful vaginal delivery (p < 0.05) in the trial of labour. More vaginal deliveries (p < 0.05) were achieved when oxytocic infusion was used in selected cases during the trial of labour. Maternal morbidities were higher in patients who had a failed trial of labour (57%) and repeat elective Caesarean section (20%) than those who had a successful trial of labout (10%). Management of patients with a previous lower segment Caesarean section may present a dilemma, but if properly conducted, the outcome can be favourable.