Artificial Intelligence: Impact and Challenges to Authors, Journals and Medical Publishing

@#Artificial intelligence (AI)-assisted technologies are here to stay and cannot be ignored. These tools are able to generate highly-realistic human-like text and perform a wide range of useful language tasks with a wide range of applications. They have the potential to expedite innovation in health care and can aid in promoting equity and diversity in research by overcoming language barriers. When using these AI tools, authors must take responsibility for the output and originality of their work, as publishers expect all content to be generated by human authors unless there is a declaration to the contrary. Authors must disclose how AI tools have been used, and ensure appropriate attribution of all the text, images, and audio-visual material. The responsible use of AI language models and transparent reporting of how these tools were used in the creation of information and publication are vital to promote and protect the credibility and integrity of medical research, and trust in medical knowledge. Educating postgraduate and undergraduate students, researchers and authors on the applications and best usage of AI-assisted technologies, together with the importance of critical thinking, integrity and strict adherence to ethical principles, are key steps that need to be undertaken.

Pre-operative Halo-Pelvic Traction for Neurofibromatosis Patients with Severe Proximal Thoracic Spinal Deformity: Indications and Early Treatment Outcome

@#Introduction: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity. Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2). Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening. Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.

COVID-19 in Singapore and Malaysia: Rising to the Challenges of Orthopaedic Practice in an Evolving Pandemic

@#With the increasing number of COVID-19 cases and related deaths worldwide, we decided to share the development of this condition in Singapore and Malaysia. First few cases were diagnosed in the two countries at the end of January 2020, and the numbers have surged to thousands by end of March 2020. We will focus on strategies adopted by the government and also the Orthopaedic community of the two countries up till the beginning of April 2020. We hope that by sharing of relevant information and knowledge on how we are managing the COVID-19 condition, we can help other communities, and health care workers to more effectively overcome this pandemic.

The Perils of Predatory Journals and Conferences

@#Predatory journals and conferences have little or no peer review. Their raison d'être is for making money through the article processing charges and the conference registration fees. Without a critical evaluation, predatory journals publishing flawed results and conclusions would cloud the existing scientific literature. Predatory conferences are the offshoots of predatory publishing. The conferences are not organised by learned societies, but by profit-making event organisers. There is a need for awareness among researchers and clinicians regarding predatory publishing. The scourge of predatory publishing and conferencing should be more often highlighted during scientific meetings and publication courses.

Screening of three phenol-degrading bacteria for copper bioremoval of copper

Aim: Potential microbial isolates for bioremoval of copper were collected from phenolic and heavy metal-contaminated soils and screened in copper-containing medium for determining the maximum tolerance level for copper. Methodology: Bioremoval of copper was assessed using sodium diethyl dithiocarbamate assay. Physical and cultural conditions influencing copper bioremoval such as initial concentration, biomass dosage (inoculum volume), temperature and pH were optimised via one-factor-at-a-time. Results: The highest maximum tolerance level was displayed by Serratia sp. AQ5-03 at 600 mg l-1, while for Alcaligenes sp. AQ5-02 and Pseudomonas sp. AQ5-04 it was 500 mg l-1. The highest bioremoval for Alcaligenes sp. AQ5-02, Serratia sp. AQ5-03 and Pseudomonas sp. AQ5-04 was achieved at 20, 50 and 75 mg l-1, respectively. The optimum biomass dosage (inoculum volume) for both Serratia sp. AQ5-03 and Pseudomonas sp. AQ5-04 were 15%, whereas it was 10% for Alcaligenes sp. AQ5-02. The results also revealed that maximum bioremoval was achieved at pH 6 at an optimum temperature of 20°C for both Alcaligenes sp. AQ5-02 and Pseudomonas sp. AQ5-04, while Serratia sp. AQ5-03 showed optimum removal at pH 7 and at 30°C temperature. The maximum bioremoval efficiency for Alcaligenes sp. AQ5-02, Serratia sp. AQ5-03 and Pseudomonas sp were found to be 62, 57 and 70%, respectively. Interpretation: The results indicate that Alcaligenes sp. AQ5-02, Serratia sp. AQ5-03, Pseudomonas sp. AQ5-04 can be utilised as bioremoval agent since it possessed the highest bioremoval efficiency for copper remediation.

Histopathological and cholinesterase changes in the gills of Clarias gariepinus as a result of cadmium exposure

Aim: The cholinesterase (ChE) based inhibition and histopathological studies from fish were investigated and represented in this study to develop as one of the great potential biomarkers for heavy metals monitoring. Methodology: In this study, the histopathological study of gills were observed a under microscope. The capability of ChE extracted from the gills of Clarias gariepinus was assessed for declining Cd. ChE was purified through affinity chromatography and continued with the optimisation and inhibition study (IC50) of cholinesterase. Results: Histopathological study of gills was carried out and several changes such as aneurysm, necrosis and lamella fusion were noted. Purification fold obtained from purified enzyme was 1.15 with 30% a yield specific activity 20.726. The optimum temperature for purified AChE was 35°C along with acetylthiocholine iodide (ATC) as a preferable substrate that had the highest Vmax value of 0.5452 U mg-1 and the lowest Km value of 0.0311 mM. The optimum pH was observed to be 10 of Tris-HCl as a medium. Meanwhile, the IC50 of cadmium was 6.808 mg l-1 with R2 value of 0.9532. Interpretation: The result of the study can be used as a tool for further developing a biomarker for the detection of heavy metals in aquatic ecosystems. In addition, the baseline data provided can also be used for designing a kit, which would give rapid and accurate result.

A New Approach to Body Donation for Medical Education: The Silent Mentor Programme

@#Cadaveric dissection is an integral component of medical education. There had been concerns about negative impact on medical students exposed to deceased donors before their clinical years, but most studies reported overall positive outcome following this form of teaching. Due to reducing number of body donations in most parts of the world, many institutions are adopting alternative models especially for the teaching of gross anatomy. A new body donation programme that incorporate humanistic values in the procurement process was initiated by Tsu Chi University of Taiwan in 1996. Early observations following teaching with the socalled “silent mentors” noted less negative emotional impact on the students. With increasing number of body donation following the initiation of the silent mentor programme as reported in some regions, we will be able to continue the time-honoured cadaveric dissection for anatomy teaching, at the same time promoting humanistic values on junior doctors.

Ulnar Osteotomy with 2-Pin Unilateral Gradual Distraction for Treatment of Chronic Monteggia Fracture: A Case Report

Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.

Physical and Clinical Evaluation of Hip Spica Cast applied with Three-slab Technique using Fibreglass Material

Introduction: Hip spica casting is an important component of treatment for developmental dysplasia of the hip (DDH) and popular treatment method for femur fractures in children. Breakage at the hip region is a relatively common problem of this cast. We have developed a three-slab technique of hip spica application using fibreglass as the cast material. The purpose of this review was to evaluate the physical durability of the spica cast and skin complications with its use. Methodology: A retrospective review of children with various conditions requiring hip spica immobilisation which was applied using our method. Study duration was from 1st of January 2014 until 31st December 2015. Our main outcomes were cast breakage and skin complications. For children with hip instability, the first cast would be changed after one month, and the second cast about two months later. Results: Twenty-one children were included, with an average age of 2.2 years. The most common indication for spica immobilisation was developmental dysplasia of the hip. One child had skin irritation after spica application. No spica breakage was noted. Conclusion: This study showed that the three-slab method of hip spica cast application using fibreglass material was durable and safe with low risk of skin complications.

Prevalence of Underweight and Effect of Nutritional Status on Academic Performance of Primary School Children in Chapainawabganj District, Bangladesh

The high prevalence of underweight among children is a serious health concern in Bangladesh. Nutritional status influences students' academic performance directly or indirectly. This study aimed to determine factors that affect the academic performance of students in primary schools. Methods: Data were collected from several schools and madrasahs in Chapainawabganj district, Bangladesh using multistage stratified sampling with proportional allocation technique. Results: The prevalence of underweight children was 32.3%, with 43.0% of them being girls and 21.4% boys. Multiple logistic regression analysis demonstrated that normal weight children were more likely (p3.50) than underweight children. Children with gestational age of 39 to 41 weeks were more likely to obtain good results than those whose gestational age was 37 and 38 weeks. Children who were breastfed for 3.50) compared to their counterparts. Children whose parents had a higher income or higher education had a significantly better chance of obtaining good results compared to their counterparts. Conclusion: These results suggest that childhood nutritional status, parents' education and economic level are significant common factors which affect children's academic performance. Consequently, under-nutrition and poverty can be considered as the major problems for good academic performance of Bangladeshi children and requires attention

Treatment of Developmental Dysplasia of the Hip: Short and Mid term Outcome

Objective: To review the presentation and outcome of developmental dysplasia of the hip (DDH) cases in the last 6 years. Methodology: We retrospectively reviewed the presentation as well as short and mid term outcome of 17 children (18 hips) with DDH seen and treated from 2004 to 2010. Treatment was either splinting with Pavlik harness, closed or open reduction depending on age at presentation and the individual needs of each patient. Results: The average age at presentation was 31.1 months, and the male t

Kimura’s Disease Mimicking Hodgkin’s Lymphoma: An Unusual Cause of Parotid Swelling

Kimura’s disease (KD) is a rare, benign chronic inflammatory disease of unknown aetiology, typically presents in the Orientals as subcutaneous masses in the head and neck region that could be easily misdiagnosed as a malignant tumour, leading to unnecessary radical surgery or intensive cytotoxic therapy. It has been mainly reported in the Chinese and Japanese literature. It is difficult to diagnose before tissue biopsy and fine needle aspiration cytology (FNAC) has limited value. Hence, unless the pathologists are aware of this entity, it might be mistaken as a malignant lesion. We encountered a case of KD in a Malay patient presenting as a parotid mass that was initially diagnosed as Hodgkin’s lymphoma (HL). This disorder should be suspected in young male Asian patients presenting with a painless unilateral mass in the head and neck region with associated hypereosinophilia.

Bone Overgrowth after Fracture of the Femoral Shaft inChildren

Forty children treated non operatively for fractures of the femoral shaft were reviewed with regard to differences in limb length after treatment. Follow up duration ranged from two to seven years. The average femoral overgrowth was 0.85cm (range 0 2.5cm) and was influenced by age at the time of fracture. We were not able to find any association between the quantity of overgrowth and race, gender, level or configuration of the fracture.