COVID-19 Pandemic: Two-year Experience and Response of a Teaching Hospital in Malaysia and the Effect on Postgraduate Orthopaedic Training.

As the number of COVID-19-related infections and deaths increased exponentially in the during 2020, few countries were equipped to manage and curb this novel coronavirus. Initially there was no proven cure or vaccine to this novel virus (SARS-Cov-2), leaving the authorities with no choice but to impose quarantines at the short-term expense of their economies. As we gain more knowledge on this novel virus, the tried-and-tested method of selective testing of the symptomatic patients, used successfully in almost all infectious respiratory diseases, has been replaced with trace-and-test method, as most of the infected patients remained asymptomatic. In early 2021, the availability of vaccines provided a shed of light out from this pandemic. Nevertheless, we faced an enormous task in juggling between vaccination of the population, managing patients with COVID-19 infection as well as non-COVID-19 patients. Here, we share our experience and response in managing this healthcare crisis across a two-year period during the pandemic and we hope other centres can learn from what we went through and help them derive a protocol to navigate through a future pandemic.

Recombinant sclerostin antagonizes effects of ex vivo mechanical loading in trabecular bone and increases osteocyte lacunar size.

Sclerostin has emerged as an important regulator of bone mass. We have shown that sclerostin can act by targeting late osteoblasts/osteocytes to inhibit bone mineralization and to upregulate osteocyte expression of catabolic factors, resulting in osteocytic osteolysis. Here we sought to examine the effect of exogenous sclerostin on osteocytes in trabecular bone mechanically loaded ex vivo. Bovine trabecular bone cores, with bone marrow removed, were inserted into individual chambers and subjected to daily episodes of dynamic loading. Cores were perfused with either osteogenic media alone or media containing human recombinant sclerostin (rhSCL) (50 ng/ml). Loaded control bone increased in apparent stiffness over time compared with unloaded bone, and this was abrogated in the presence of rhSCL. Loaded bone showed an increase in calcein uptake as a surrogate of mineral accretion, compared with unloaded bone, in which this was substantially inhibited by rhSCL treatment. Sclerostin treatment induced a significant increase in the ionized calcium concentration in the perfusate and the release of ß-CTX at several time points, an increased mean osteocyte lacunar size, indicative of osteocytic osteolysis, and the expression of catabolism-related genes. Human primary osteocyte-like cultures treated with rhSCL also released ß-CTX from their matrix. These results suggest that osteocytes contribute directly to bone mineral accretion, and to the mechanical properties of bone. Moreover, it appears that sclerostin, acting on osteocytes, can negate this effect by modulating the dimensions of the lacunocanalicular porosity and the composition of the periosteocyte matrix.

Impact of seroconversion and antichlamydial treatment on the rate of pre-eclampsia among Egyptian primigravidae.

OBJECTIVE: To evaluate the effect of antichlamydial treatment and Chlamydia pneumoniae seroconversion on the incidence of pre-eclampsia among Egyptian primigravidae. METHODS: The present prospective study included 600 healthy normotensive primigravidae who attended an outpatient clinic at 10-16weeks of pregnancy. A single venous blood sample was collected to test for C. pneumonia-specific immunoglobulin G (IgG) antibodies using an enzyme-linked immunosorbent assay. Seropositive women were randomly allocated to receive or not receive antichlamydial treatment before 20weeks of pregnancy. Seronegative participants had another test at delivery for the presence of C. pneumonia-specific IgG to determine seroconversion. All participants were followed up for up to 8weeks postpartum and observed for the development of pre-eclampsia. RESULTS: The rate of pre-eclampsia among seropositive participants differed significantly depending on whether the women received treatment or not (6.5% and 19.1%, respectively; P=0.014). No statistically significant difference in the rate of pre-eclampsia was detected between seronegative participants who underwent seroconversion and those who did not. CONCLUSION: The present results indirectly support the hypothesis that infectious agents (in particular C. pneumoniae) have a role in the development of pre-eclampsia. The findings also indicate that antichlamydial treatment might help to reduce the incidence of pre-eclampsia.

Successful commercialisation of locally fabricated bioceramics for clinical applications.

This paper chronicled the development of a locally produced bone graft substitute based on calcium phosphate bioceramics called "GranuMaS--from concepts to clinics, and finally to its successful commercialization all within 5-year duration. It was a Prioritized Research (PR) collaborative project of 5 institutions namely SIRIM, ANM, USM, UKM and IIUM, funded by MOSTI to the amount of approximately RM2.5 millions under RM8. This paper also highlighted the requirements needed in terms of technical expertise/manpower, facilities and infrastructure, and government/institutional supports, as well as the challenge faced in developing and commercializing such product.

Cycle spokes and chain related injuries in children--emerging injuries in Malaysia.

A descriptive prospective study of 16 children with injuries inflicted by bicycle spokes and chain was undertaken to identify the demographic profiles of such injuries. Aspects of preventive measures are proposed.

Sterilisation effect study on granular hydroxyapatite (HA).

Hydroxyapatite is a calcium phosphate bioceramic that has been shown by many authors to be biocompatible with bioactive properties. It is widely accepted as the best synthetic material available for surgical use as a bone graft substitute. HA granules produced by AMREC-SIRIM from local materials underwent 5 types of sterilisation techniques with different ageing periods. Samples were tested for chemical and phase composition and microbial contamination before and after being sterilised. From the microbiological tests done, none of the unsterilised positive control yielded a positive culture. Results from X-Ray diffraction studies found that all the sterilisation techniques did not chemically degrade or structurally change the HA granules significantly.

Histological evaluation of the early bone response to hydroxyapatite (HA) implanted in rabbit tibia.

This study is to qualitatively evaluate a locally produced hydroxyapatite (HA), made by AMREC-SIRIM in an experimental animal bone defect using New Zealand White (NZW) rabbits. HA cylindrical blocks measuring 2.5 mm (D) x 1.0 mm (H) were implanted in the rabbits' left tibia. The tibias were harvested within one to three weeks post-implantation. The implantion site was cut into thin undecalcified sections of about 30 microm to 60 microm and stained with Toluidine Blue and Goldner's Masson Trichrome. Microscopic examinations using standard light microscopy of these slides were performed.