Gender differences in osteoporotic hip fractures in Sarawak General Hospital.

INTRODUCTION: Osteoporosis and osteoporotic fracture pose a major public health problem in our ageing population, and particularly concerning is the increased morbidity and mortality associated with osteoporotic hip fractures. While overall diagnosis and treatment for osteoporosis have improved, osteoporosis in men remains underdiagnosed and undertreated. We aim to describe the difference in clinical characteristics between elderly men and women with osteoporotic hip fractures in Sarawak General Hospital. MATERIALS AND METHODS: All patients diagnosed with osteoporotic hip fracture admitted to Sarawak General Hospital from June 2019 to March 2021 were recruited, and demographic data and clinical features were obtained. RESULTS: There were 140 patients with osteoporotic hip fracture, and 40 were men (28.6%). The mean age for males was 74.1 ± 9.5 years, while the mean age for females was 77.4 ± 9.1 years (p=0.06). The types of fracture consisted of neck of femur=78, intertrochanteric=61 and subtrochanteric=1. More men were active smokers (15% vs 1%, p<0.001). There were 20 men with secondary osteoporosis (50%), while 13 women (13%) had secondary osteoporosis (p<0.001). The causes of secondary osteoporosis among the men were hypogonadism, COPD, glucocorticoid-induced osteoporosis, renal disease, androgen deprivation therapy, thyroid disorder, prostate cancer and previous gastrectomy. There were two deaths among the men and four deaths among the women during the inpatient and 3 months follow-up period. There was no statistical significance between the mortality rates between male patients (5%) and female patients (4%) (p=0.55). CONCLUSION: There were more females with osteoporotic hip fractures, and there were significantly more males with secondary osteoporotic hip fractures.

Temporal migration of gonadotrophin-releasing hormone-1 neurones is modified in GAD67 knockout mice.

Gonadotrophin-releasing hormone (GnRH-1) neurones reside in the forebrain and regulate gonadal function via the hypothalamic-pituitary-gonadal axis. Disruption of this axis results in reproductive dysfunction. During embryonic development, GnRH-1 neurones migrate from the nasal pit through the nasal/forebrain junction (NFJ) into the developing brain. Prenatally gamma-aminobutyric acid (GABA) is excitatory and has been shown to play a role in nervous system development. Both in vivo and in vitro experiments suggest that GABA inhibits migration of GnRH-1 neurones. The present study examines the migration of GnRH-1 neurones in GAD67 knockout (KO) mice to further elucidate the role of GABA on GnRH-1 neuronal development. Three stages were examined, embryonic day (E)12.5, E14.5 and E17.5. GnRH-1 cell number and location were analysed by immunocytochemistry and in situ hybridisation histochemistry. The total number of GnRH-1 immunopositive cells was similar between wild-type (WT) and KO mice. However, significant differences were found in the overall distribution of GnRH-1 immunopositive cells in GAD67 KO compared to WT mice at all stages. Subsequent analysis by area revealed differences occurred at the NFJ with an increase in GnRH-1 cells in GAD67 KO at E14.5 and a decrease in GnRH-1 cells in GAD67 KO at E17.5. Comparable counts for cells expressing GnRH-1 transcript and protein were obtained. These data indicate that attenuated levels of GABA accelerate GnRH-1 cell migration in nasal areas as well as movement of GnRH-1 cells into the central nervous system at the NFJ.

Skin lifting in aesthetic cervicofacial rhytidectomy: personal experience in more than 1500 patients.

BACKGROUND: Skin lifting alone in face-lifting surgery is limited to minor lifts in younger patients. The extent of skin undermining depends on the operative plan. AIMS: An optimal aim is to minimize the amount of undermining to achieve a pleasing, natural rejuvenated result. RESULTS: By respecting the extensive network of the dermal vascular plexus and by good surgical technique, ischaemia of the elevated skin may be minimized. CONCLUSION: Moderate to maximal lifting, however, has proven to be anatomically sound in over 1500 cases operated on over the last 20 years using classical face-lift techniques to correct the pathoanatomy of the ageing face.

Iron metabolism in mammalian cells.

Most living things require iron to exist. Iron has many functions within cells but is rarely found unbound because of its propensity to catalyze the formation of toxic free radicals. Thus the regulation of iron requirements by cells and the acquisition and uptake of iron into tissues in multicellular organisms is tightly regulated. In humans, understanding iron transport and utility has recently been advanced by a "great conjunction" of molecular genetics in simple organisms, identifying genes involved in genetic diseases of metal metabolism and by the application of traditional cell physiology approaches. We are now able to approach a rudimentary understanding of the "iron cycle" within mammals. In the future, this information will be applied toward modulating the outcome of therapies designed to overcome diseases involving metals.

Effect of nitrogen dioxide and other combustion products on asthmatic subjects in a home-like environment.

Nitrogen dioxide (NO2) is one of a number of nitrogen compounds that are by-products of combustion and occur in domestic environments following the use of gas or other fuels for heating and cooking. In this study, we examined the effect of two levels of NO2 on symptoms, lung function and airway hyperresponsiveness (AHR) in asthmatic adults and children. In addition, in the same subjects, we examined the effects of the same levels of NO2 mixed with combustion by-products from a gas space heater. The subjects were nine adults, aged 19-65 yrs, and 11 children, aged 7-15 yrs, with diagnosed asthma which was severe enough to require daily medication. All subjects had demonstrable AHR to histamine. Exposures were for 1 h on five separate occasions, 1 week apart, to: 1) ambient air, drawn from outside the building; 2) 0.3 parts per million (ppm) NO2 in ambient air; 3) 0.6 ppm NO2 in ambient air; 4) ambient air+combustion by-products+NO2 to give a total of 0.3 ppm; and 5) ambient air+combustion by-products+NO2 to give a total of 0.6 ppm. Effects were measured as changes in lung function and symptoms during and 1 h after exposure, in AHR 1 h and 1 week after exposure, and in lung function and symptoms during the week following exposure. Exposure to NO2 either in ambient air or mixed with combustion by-products from a gas heater, had no significant effect on symptoms or lung function in adults or in children. There was a small, but statistically significant, increase in AHR after exposure to 0.6 ppm NO2 in ambient air. However, there was no effect of 0.6 ppm NO2 on AHR when the combustion by-products were included in the test atmosphere nor of 0.3 ppm NO2 under either exposure condition. We conclude that a 1 h exposure to 0.3 or 0.6 ppm NO2 has no clinically important effect on the airways of asthmatic adults or children, but that 0.6 ppm may cause a slight increase in airway hyperresponsiveness.

Production and characterization of monoclonal antibodies specific for the murine T cell receptor zeta chain.

The T cell receptor (TCR) comprises an antigen-specific alpha beta heterodimer non-covalently associated with the CD3 gamma delta epsilon and TCR zeta subunits. Both the CD3 and TCR zeta subunits are proposed to be responsible for the intracellular signal-transduction events. We report here the production of eight monoclonal antibodies (mAbs) that bind in an ELISA assay to a 113 amino acid synthetic peptide corresponding to the cytoplasmic domain of TCR zeta. Western blot analysis of anti-CD8 precipitates of lysates of transfectants expressing chimeric CD8/zeta constructs encoding increasing COOH-terminal truncations of TCR zeta indicates that four of these mAbs recognized the region of TCR zeta chain comprising the last 29 COOH-terminal residues. Thus, this region of TCR theta may encode an immunodominant epitope. Furthermore, one of these mAbs, G3, is capable of precipitating both non-phosphorylated and tyrosine phosphorylated TCR zeta. The G3 mAb should be useful for elucidating the structural and signalling characteristics of the TCR zeta chain.

Effects of a sclerosant, ethanolamine, on the venous drainage system of the dog penis.

To explore the possibility of using venous sclerosant therapy to overcome venogenic impotence we studied the effects of ethanolamine on the veins draining the dog penis. Following injection of the sclerosant into the deep dorsal vein radiological and histological evidence of occlusion was obtained but by one month recanalization of thrombi had occurred and collateral venous channels had formed. These findings cast doubt on the effectiveness of this sclerosant as a means of treating impotence.

Fracture of the penis--review with case report.

Fracture of the penis is a rare injury. Controversy exists regarding conservative versus operative management. A case of penile fracture managed conservatively is reported with a brief review of the literature.

The problem of the negative inmates in the Culion Sanitarium

This article, adopted from an official memorandum not designed for publication, deals with the problems of the "negatives" at the Culion Sanitarium, i.e., those inmates whose disease has so thoroughly cleared up that they are entitled to release or discharge. There are 440 such individuals, constituing about 25 per cent of the inmate population. They are of two categories, namely, adults (268) brought from elsewhere as patients, and children (172) born at Culion who have shown manifestations of the disease but are now clean. Among the adults, 216 (81 per cent) are unwilling or unprepared to leave. The reasos most frequently given are difficulties arising from mutilations due to the disease (171 adults have them in some degree), or the desire not to leave spouses or other relatives not ready for discharge. An important factor, discussed from more than one point of view, is the normality of life in the Culion Reservation and the many opportunities of self-help. Incidentally, less than one quarter of the adult negatives had taken any treatment during the past six months. Even among the patients still bacteriologically positive, less than one-half are taking treatment, in some cases because of difficulties with sulfone, but more often because they do not wish to become negative and therefore liable to be discharged. Many, but by no means all, have been at Culion so long that they have lost contact with the outside world. The negative-children group, almost all without interested relatives outside and 15 of them are already married to other inmates, is an especially intersting one from several points of view. They have had no outside contacts and therefore are highly "institution-minded". With a single exception, they have had no antileprosy treatment; their lesions disappeared spontaneously, not one of them showing any deformity resulting from the disease. Such cases have rarely shown any tendency to relapse. The conditions of life of patients at Culion are discussed. Recommendations are offered which, although intended only for local application, have features of wider interest.