Noppachart Limpaphayom

The entire genome sequence of hepatitis E virus genotype 3 isolated from a patient with neuralgic amyotrophy

Abstract We report the case of a Thai male patient with neuralgic amyotrophy, presenting with acute and severe pain in the upper extremities, followed by patchy muscle weakness, associated with hepatitis E virus (HEV) infection. The entire HEV genome was sequenced and subjected to phylogenetic analysis and found to be genotype 3. Data on the most common HEV genotypes circulating in Thailand are scarce. The origin of infection and the mode of HEV transmission in this patient remained inconclusive; however, this study provides essential baseline data as a reference for further genetic analysis of HEV.

Idiopathic clubfoot: ten year follow-up after a soft tissue release procedure

PurposeOur objective is to report longitudinal outcomes of selective surgical soft tissue release for idiopathic clubfoot (ICF).MethodsThirty-six ICF patients who had surgery at the average age of 11 (range nine to 17) months and 12 age-matched normal feet were evaluated yearly until subjects had the average age of 11 (range seven to 19) years using eight radiographic parameters. The Ponseti and Dimeglio scores were rated. Serial ankle and subtalar motions and talocalcaneal (TC) index changes over time were analyzed using mixed effects random-intercept longitudinal models.ResultsAt the last follow-up, ankle and subtalar motions were more restricted in the ICF but no significant changes in motion were observed over follow-up, except for small but significant decreases in the TC index in both ICF and control feet. The average measurement in ICF group versus control revealed significantly lower angles in the five assessed parameters. The mean Ponseti score was 88 (range 40–97) and ICF showed an improvement of the Dimeglio score. A positive correlation between the Ponseti score and the subtalar motion was noted, whereas talar flattening had a negative influence on the ankle motion.ConclusionsSoft tissue release surgery limited to only pathologies encountered during the procedure maintains motions of ankle and subtalar joints in ICF.

Anterior greater trochanteric muscle pedicle bone grafting: a viable graft option adjunct to hip osteotomy or fracture surgery

Introduction The objectives were to evaluate a technique, outcome and complications following anterior greater trochanteric with gluteus medius muscle pedicle bone graft (AMG) procedure in the treatment of adolescent and active adult hip disorders. Methods 20 patients (20 hips) with a mean age of 22.7 ± 15.6 (range 10.0-63.5) years who had undergone AMG and been followed up more than 12 months postoperative were retrospectively enrolled in our study. The AMG procedure was performed in conjunction with subcapital osteotomy for slipped capital femoral epiphysis in 12 and open reduction for fracture/dislocation in 8 hips. At the most recent evaluation, patient functional status was rated by the Harris Hip Score (HHS) and radiographic changes were graded according to Tönnis criteria. Complications were defined as Tönnis grade >2 or hip requiring further surgery. Univariate analysis was used to explore factors associated with complications. Spearmans rank correlation coefficient was calculated between HHS and Tönnis grading. Results At mean follow-up of 4.4 ± 2.6 (range 1.1-9.5) years, mean HHS was 87.4. Tönnis grading was rated as 0 in 10 hips, 1 in 5 hips, 2 in 2 hips, and 3 in 3 hips. Avascular necrosis of the femoral head as a complication developed in 3 hips (15%). Clinical parameters including age at surgery, duration of follow-up and diagnosis were not significantly associated with postoperative complications. A negative correlation between HHS and Tönnis grade was shown by Spearmans rank correlation (rs = −0.49, p = 0.03). Conclusions The AMG can be safely recommended as an adjunct bone graft procedure when performing anterior open reduction of adolescent and active adult hip disorders.

Effects of Cemented Hip Stem Pre‐heating on Stem Push‐out Strength

To determine the effect on ultimate push‐out load and cement–stem surface shear strength of thermally manipulating the cobalt‐chromium‐molybdenum (CoCrMo) alloy stems of bone cement–stem constructs.

Serum Leptin as a Nutritional Biomarker in Children with Cerebral Palsy

Adequate nutrition is crucial for children with cerebral palsy (CCP). However, conventional nutritional assessments may be inadequate for defining undernourished CCP. Leptin, an adipocyte hormone controlling energy expenditure, could be a useful marker. Objectives of this cross-sectional analytic study were to explore correlations between serum leptin level and nutritional status, anthropometric measurements, and biochemical parameters in 86 CCP (aged 9 ± 2 years). Subscapular (SST) and triceps (TST) skinfold thicknesses, weight, and calculated height were obtained. Body mass index and weight-for-height (WH) Z-scores were calculated. Complete blood count and serum levels of leptin and albumin were collected. CCP were classified as undernourished if their WHZ was < -2 according to the World Health Organization criteria. Correlations between anthropometric measurements, biochemical data, and serum leptin levels were evaluated. From 86 CCP, 11 (12%) children were undernourished, and SST, hemoglobin, and hematocrit were significantly lower. Serum leptin levels of nourished and undernourished CCP were 5.4 ± 6.2 and 2.9 ± 1.6 ng/mL (p < 0.001), while the reported value from normal children was 4.9 ng/mL. Serum leptin levels demonstrated a significant correlation with SST and TST (r = 0.83 and 0.72; p < 0.001). Serum leptin was the only marker significantly correlated with WHZ (r = 0.45, p < 0.001) while adjusting for covariates. A serum leptin level of 2.2 ng/mL was the optimal cutoff point for defining adequate nutritional status (WHZ ≥ -2). The measurement of serum leptin should be included in a care scheme of CCP especially during surgical evaluation.

Infantile osteoarticular tuberculosis misdiagnosed as Bacillus Calmette-Guerin related osteomyelitis

Tuberculosis, a re-emerging public health problem, is uncommon in infancy. Two healthy completely immunized infants presenting with manifestations compatible with osteoarticular infection required surgical debridement. The cultures of the specimens were positive for M. tuberculosis (MTB) complex comprised multiple subspecies. One case was misdiagnosed as a Bacillus Calmette-Guerin (BCG) related osteomyelitis by a polymerase chain reaction (PCR) based on detection of genes at the region of difference 1. Genome extraction and PCR using the rimM gene and sequences analysis against MTB and BCG control samples confirmed that both specimens were infected by M. tuberculosis. The lesions were successfully healed within one year. Surgical debridement of suspected lesions is warranted in infants as a definitive treatment and to obtain tissues for further evaluation. Microbiological cultures only confirm nonspecific MTB complex infection. PCR kits may yield a false positive result. Identification of the pathogen by DNA extraction and sequence analysis should be recommended.