Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tis... more Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tissue engineering of peripheral nerves. Human MSCs were subjected to a series of treatment with a reducing agent, retinoic acid and a combination of trophic factors. This treated MSCs differentiated into Schwann cells were characterized in vitro via flow cytometry analysis and immunocytochemically. In contrast to untreated MSCs, differentiated MSCs expressed Schwann cell markers in vitro, as we confirmed by flow cytometry analysis and immunocytochemically. These results suggest that human MSCs can be induced to be a substitute for Schwann cells that may be applied for nerve regeneration since it is difficult to grow Schwann cells in vitro.
Purpose Synthetic ligaments have been widely used in the knees for anterior cruciate ligament rec... more Purpose Synthetic ligaments have been widely used in the knees for anterior cruciate ligament reconstruction and in the shoulder rotator cuff repair, but they have been rarely used in the hand. The only reported usage is in the Artelon space for carpometacarpal joint osteoarthritis. We describe our experience using the synthetic ligament or scaffold known as Orthotape (its predecessor was known as the Leeds-Keio ligament) in the hand and fingers. Methods We retrospectively reviewed all patients in whom polyester synthetic ligament (Orthotape) was used to reconstruct absent tendons involving both flexor and extensor compartments between 2011 and 2016. The reconstruction procedures were performed as elective surgeries. The tendons were absent due to either trauma or infection. We collected data on demographics, the injury mechanism, prior surgeries, the zone of tendon loss, the presence of skin flaps, and the number of strips of ligament inserted. Results We inserted 18 strips of Orthotape in the hands of 9 patients. The follow-up period was 3–7 years, and the mean duration of Orthotape in the hand was 44.1 (range, 1–91) months. Four strips extruded, resulting in a 22.2% extrusion rate. Of the 9 patients, 5 retained the Orthotape within their hand for time periods ranging from 60 months (5 years) to 91 months (7.5 years). The extruded strips were in the superficial areas of the hand. Seven patients had traumatic injuries with varying severity and 2 had infections. Conclusions The high extrusion rate of Orthotape discourages its use in the superficial areas of the hand, including flexor and extensor surfaces of the fingers and hand. We recommend its usage in regions with a thick skin cover such as underneath a flap or in deep areas such as the palm. Nevertheless, it remains as a possible option in cases of complex reconstruction with a limited availability of donor tendons. Type of study/level of evidence Therapeutic IV.
Kaposi hemangioendothelioma (KHE) is a rare vascular neoplasm that presents usually within the fi... more Kaposi hemangioendothelioma (KHE) is a rare vascular neoplasm that presents usually within the first year of life. Because of its rarity and complexity, there is often a delay in diagnosis. KHE could be associated with a life-threatening consumptive coagulopathy named the Kasabach–Merritt phenomenon (KMP). Here, we present the case of a 2-month-old girl who presented with progressive redness and swelling of her right upper limb over 6 weeks. Multiple health practitioners misdiagnosed her condition as an insect bite, cellulitis, and necrotizing fasciitis and gave treatment accordingly, which proved futile. A full blood count revealed bicytopenia of anemia and thrombocytopenia, a normal coagulation cascade, low fibrinogen, and raised D-Dimer levels. The imaging was suggestive of a high-flow vascular tumor likely to be a KHE. Subsequently, she was started on single-agent oral sirolimus with a dose increment to achieve satisfactory therapeutic levels and was treated for 1 year. She succ...
Objectives/Interrogation: Cox's Bazar is a border town in Bangladesh currently supporting app... more Objectives/Interrogation: Cox's Bazar is a border town in Bangladesh currently supporting approximately 1 million Rohingya refugees from Myanmar. The Malaysian government has sent the Malaysian army field hospital as part of a government to government initiative supporting the influx. The [for full text, please go to the a.m. URL]
Introduction: Wide-awake local anesthesia and no tourniquet (WALANT) has come a long way. It has ... more Introduction: Wide-awake local anesthesia and no tourniquet (WALANT) has come a long way. It has been reported to be successful in the surgery of distal radius and ulna fractures. We report a case of olecranon fracture plating under WALANT. Methods: Surgery was performed with the patient fully conscious where tumescent anesthesia was injected into the surgical site without application of tourniquet 30 minutes before the first incision. Posterior approach to the elbow was used, and the fracture was fixed with anatomical locking plates. Results: The surgery was successfully completed without pain. The numerical pain rating score was 0 throughout the surgery. Conclusions: The use of WALANT for surgical fixation can be expanded beyond the hand and wrist. This is a safe and simple option for patients at high risk of general anesthesia, producing similar surgical outcomes without intraoperative and postoperative complications.
We investigated the efficacy of a muscle-stuffed vein seeded with neural-transdifferentiated huma... more We investigated the efficacy of a muscle-stuffed vein seeded with neural-transdifferentiated human mesenchymal stem cells as an alternative nerve conduit to repair a 15-mm sciatic nerve defect in athymic rats.Other rats received either muscle-stuffed vein conduit alone, commercial polyglycolic acid conduit (Neurotube®), reverse autograft or were left untreated. Motor and sensory functions as well as nerve conductivity were evaluated for 12 weeks, after which the grafts were harvested for histological analyses. All rats in the treatment groups demonstrated a progressive increase in the mean Sciatic Functional Index (motor function) and nerve conduction amplitude (electrophysiological function); and showed positive withdrawal reflex (sensory function) by the 10th week of post-implantation. Autotomy, which is associated with neuropathic pain, was severe in rats treated with conduit without cells; there was mild or no autotomy in the rats of other groups. Histologically, harvested grafts from all except the untreated groups exhibited axonal regeneration with the presence of mature myelinated axons. In conclusion, treatment with muscle-stuffed vein conduit is comparable to that of other treatment groups in supporting functional recovery following sciatic nerve injury; and the addition of cells in the conduit alleviates neuropathic pain.
A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome.... more A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.
In peripheral nerve injury, autologous nerve graft is the usual option for bridging larger nerve ... more In peripheral nerve injury, autologous nerve graft is the usual option for bridging larger nerve gap which will result in loss of sensory. The present study investigated the performance of human MSV conduit seeded with human neural-differentiated stem cells in promoting nerve regeneration at a different time points. We used histological and immunohistochemical analysis (S100B) to determine the maturation of nerve regeneration at different time points i.e. at 2 weeks, 9 weeks and 3 months post-implantation (n=1). At 2 weeks, the structure of the vein of MSV was patent, accelular and can be clearly distinguished from the stuffed muscles. At 3 months, the veinous tissue was highly infiltrated with cells and the stuffed muscle fibers no longer visible, and no clear distinction between the border of the vein and the stuffed muscles can be made. Instead, structure resembling nerve fibers appeared. No infiltration of inflammatory cells was observed at the three sites at each time points. I...
Autologous nerve grafting is the usual option for bridging large nerve gap 1 which will result in... more Autologous nerve grafting is the usual option for bridging large nerve gap 1 which will result in loss of sensory function at the donor site. Hence, commercial conduits have been explored. However, in terms of functional recovery, the currently available commercial nerve conduits are still slacking compared with autologous nerve grafting 2 . In our previous study, human muscle-stuffed vein incorporated with human neural-differentiated stem cells had shown a good biocompatibility and have a potential as a stable scaffold for nerve tissue engineering 3 . We have now embarked upon replicating this by directly implanted at 15 mm sciatic nerve defect in a immunocompromised rat model. Here we report the histological findings of the post-implanted human nerve conduits from our nude rat model at a different time points.
Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tis... more Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tissue engineering of peripheral nerves. Human MSCs were subjected to a series of treatment with a reducing agent, retinoic acid and a combination of trophic factors. This treated MSCs differentiated into Schwann cells were characterized in vitro via flow cytometry analysis and immunocytochemically. In contrast to untreated MSCs, differentiated MSCs expressed Schwann cell markers in vitro, as we confirmed by flow cytometry analysis and immunocytochemically. These results suggest that human MSCs can be induced to be a substitute for Schwann cells that may be applied for nerve regeneration since it is difficult to grow Schwann cells in vitro.
Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tis... more Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tissue engineering of peripheral nerves. Human MSCs were subjected to a series of treatment with a reducing agent, retinoic acid and a combination of trophic factors. This treated MSCs differentiated into Schwann cells were characterized in vitro via flow cytometry analysis and immunocytochemically. In contrast to untreated MSCs, differentiated MSCs expressed Schwann cell markers in vitro, as we confirmed by flow cytometry analysis and immunocytochemically. These results suggest that human MSCs can be induced to be a substitute for Schwann cells that may be applied for nerve regeneration since it is difficult to grow Schwann cells in vitro.
Purpose Synthetic ligaments have been widely used in the knees for anterior cruciate ligament rec... more Purpose Synthetic ligaments have been widely used in the knees for anterior cruciate ligament reconstruction and in the shoulder rotator cuff repair, but they have been rarely used in the hand. The only reported usage is in the Artelon space for carpometacarpal joint osteoarthritis. We describe our experience using the synthetic ligament or scaffold known as Orthotape (its predecessor was known as the Leeds-Keio ligament) in the hand and fingers. Methods We retrospectively reviewed all patients in whom polyester synthetic ligament (Orthotape) was used to reconstruct absent tendons involving both flexor and extensor compartments between 2011 and 2016. The reconstruction procedures were performed as elective surgeries. The tendons were absent due to either trauma or infection. We collected data on demographics, the injury mechanism, prior surgeries, the zone of tendon loss, the presence of skin flaps, and the number of strips of ligament inserted. Results We inserted 18 strips of Orthotape in the hands of 9 patients. The follow-up period was 3–7 years, and the mean duration of Orthotape in the hand was 44.1 (range, 1–91) months. Four strips extruded, resulting in a 22.2% extrusion rate. Of the 9 patients, 5 retained the Orthotape within their hand for time periods ranging from 60 months (5 years) to 91 months (7.5 years). The extruded strips were in the superficial areas of the hand. Seven patients had traumatic injuries with varying severity and 2 had infections. Conclusions The high extrusion rate of Orthotape discourages its use in the superficial areas of the hand, including flexor and extensor surfaces of the fingers and hand. We recommend its usage in regions with a thick skin cover such as underneath a flap or in deep areas such as the palm. Nevertheless, it remains as a possible option in cases of complex reconstruction with a limited availability of donor tendons. Type of study/level of evidence Therapeutic IV.
Kaposi hemangioendothelioma (KHE) is a rare vascular neoplasm that presents usually within the fi... more Kaposi hemangioendothelioma (KHE) is a rare vascular neoplasm that presents usually within the first year of life. Because of its rarity and complexity, there is often a delay in diagnosis. KHE could be associated with a life-threatening consumptive coagulopathy named the Kasabach–Merritt phenomenon (KMP). Here, we present the case of a 2-month-old girl who presented with progressive redness and swelling of her right upper limb over 6 weeks. Multiple health practitioners misdiagnosed her condition as an insect bite, cellulitis, and necrotizing fasciitis and gave treatment accordingly, which proved futile. A full blood count revealed bicytopenia of anemia and thrombocytopenia, a normal coagulation cascade, low fibrinogen, and raised D-Dimer levels. The imaging was suggestive of a high-flow vascular tumor likely to be a KHE. Subsequently, she was started on single-agent oral sirolimus with a dose increment to achieve satisfactory therapeutic levels and was treated for 1 year. She succ...
Objectives/Interrogation: Cox's Bazar is a border town in Bangladesh currently supporting app... more Objectives/Interrogation: Cox's Bazar is a border town in Bangladesh currently supporting approximately 1 million Rohingya refugees from Myanmar. The Malaysian government has sent the Malaysian army field hospital as part of a government to government initiative supporting the influx. The [for full text, please go to the a.m. URL]
Introduction: Wide-awake local anesthesia and no tourniquet (WALANT) has come a long way. It has ... more Introduction: Wide-awake local anesthesia and no tourniquet (WALANT) has come a long way. It has been reported to be successful in the surgery of distal radius and ulna fractures. We report a case of olecranon fracture plating under WALANT. Methods: Surgery was performed with the patient fully conscious where tumescent anesthesia was injected into the surgical site without application of tourniquet 30 minutes before the first incision. Posterior approach to the elbow was used, and the fracture was fixed with anatomical locking plates. Results: The surgery was successfully completed without pain. The numerical pain rating score was 0 throughout the surgery. Conclusions: The use of WALANT for surgical fixation can be expanded beyond the hand and wrist. This is a safe and simple option for patients at high risk of general anesthesia, producing similar surgical outcomes without intraoperative and postoperative complications.
We investigated the efficacy of a muscle-stuffed vein seeded with neural-transdifferentiated huma... more We investigated the efficacy of a muscle-stuffed vein seeded with neural-transdifferentiated human mesenchymal stem cells as an alternative nerve conduit to repair a 15-mm sciatic nerve defect in athymic rats.Other rats received either muscle-stuffed vein conduit alone, commercial polyglycolic acid conduit (Neurotube®), reverse autograft or were left untreated. Motor and sensory functions as well as nerve conductivity were evaluated for 12 weeks, after which the grafts were harvested for histological analyses. All rats in the treatment groups demonstrated a progressive increase in the mean Sciatic Functional Index (motor function) and nerve conduction amplitude (electrophysiological function); and showed positive withdrawal reflex (sensory function) by the 10th week of post-implantation. Autotomy, which is associated with neuropathic pain, was severe in rats treated with conduit without cells; there was mild or no autotomy in the rats of other groups. Histologically, harvested grafts from all except the untreated groups exhibited axonal regeneration with the presence of mature myelinated axons. In conclusion, treatment with muscle-stuffed vein conduit is comparable to that of other treatment groups in supporting functional recovery following sciatic nerve injury; and the addition of cells in the conduit alleviates neuropathic pain.
A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome.... more A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.
In peripheral nerve injury, autologous nerve graft is the usual option for bridging larger nerve ... more In peripheral nerve injury, autologous nerve graft is the usual option for bridging larger nerve gap which will result in loss of sensory. The present study investigated the performance of human MSV conduit seeded with human neural-differentiated stem cells in promoting nerve regeneration at a different time points. We used histological and immunohistochemical analysis (S100B) to determine the maturation of nerve regeneration at different time points i.e. at 2 weeks, 9 weeks and 3 months post-implantation (n=1). At 2 weeks, the structure of the vein of MSV was patent, accelular and can be clearly distinguished from the stuffed muscles. At 3 months, the veinous tissue was highly infiltrated with cells and the stuffed muscle fibers no longer visible, and no clear distinction between the border of the vein and the stuffed muscles can be made. Instead, structure resembling nerve fibers appeared. No infiltration of inflammatory cells was observed at the three sites at each time points. I...
Autologous nerve grafting is the usual option for bridging large nerve gap 1 which will result in... more Autologous nerve grafting is the usual option for bridging large nerve gap 1 which will result in loss of sensory function at the donor site. Hence, commercial conduits have been explored. However, in terms of functional recovery, the currently available commercial nerve conduits are still slacking compared with autologous nerve grafting 2 . In our previous study, human muscle-stuffed vein incorporated with human neural-differentiated stem cells had shown a good biocompatibility and have a potential as a stable scaffold for nerve tissue engineering 3 . We have now embarked upon replicating this by directly implanted at 15 mm sciatic nerve defect in a immunocompromised rat model. Here we report the histological findings of the post-implanted human nerve conduits from our nude rat model at a different time points.
Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tis... more Bone marrow derived Mesenchymal stem cells (MSCs) were evaluated as an alternative source for tissue engineering of peripheral nerves. Human MSCs were subjected to a series of treatment with a reducing agent, retinoic acid and a combination of trophic factors. This treated MSCs differentiated into Schwann cells were characterized in vitro via flow cytometry analysis and immunocytochemically. In contrast to untreated MSCs, differentiated MSCs expressed Schwann cell markers in vitro, as we confirmed by flow cytometry analysis and immunocytochemically. These results suggest that human MSCs can be induced to be a substitute for Schwann cells that may be applied for nerve regeneration since it is difficult to grow Schwann cells in vitro.
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Papers by Shalimar Abdullah