Research in forensic anthropology is recent in Malaysia due to limited access to documented skeletal collections. However, advanced imaging techniques provide virtual bone samples for use in morphometric studies to establish populationspecific standards by virtual anthropology. This study examined sexual dimorphism in the subpubic angle using a threedimensional computed tomography model of the pelvis, in a contemporary Malaysian population. The sample comprised multidetector computed tomography (MDCT) scans of 50 male and 50 female adults. Segmentation of the MDCT scans was performed using 3D Slicer, and four landmarks were acquired using Stratovan Checkpoint for the subpubic angle measurement. The technical error of measurement (TEM), relative TEM, and coefficient of reliability (R) exhibited high reliability in measurements. Results showed that the subpubic angle in males was 68.6°±7.6° and in females 87.4°±6.5°. The subpubic angle in females was significantly larger than in males (P<0.001). Inverse correlation was found between the subpubic angle and age, in both males (r=-0.449, P<0.01) and females (r=-0.385, P<0.01). The overall accuracy of sex estimation using the subpubic angle was 94% (P<0.001). The subpubic angle, with a demarcating point of 78.6°, showed a sensitivity and specificity of 94% in the classification of female individuals. In conclusion, sex estimation using the subpu bic angle is highly accurate, with a high degree of expected sensitivity and specificity in the Malaysian population.
Background
Current management of poorly draining complex effusions favours less invasive image-guided placement of smaller tubes and adjunctive intrapleural fibrinolysis therapy (IPFT). In MIST-2 trial, intrapleural 10 mg alteplase (t-PA) with 5 mg of pulmozyme (DNase) twice daily for 72 h were used. We aimed to assess the effectiveness and safety of a modified regimen 16 mg t-PA with 5 mg of DNase administered over 24 h in the management of complex pleural infection.
Methods
This was a single centre, prospective study involving patients with poorly drained pleural infection. Primary outcome was the change of pleural opacity on chest radiograph at day 7 compared to baseline. Secondary outcomes include volume of fluid drained, inflammatory markers improvement, surgical referral, length of hospitalisation, and adverse events.
Results
Thirty patients were recruited. Majority, 27 (90%) patients were successfully treated. Improvement of pleural opacity on chest radiograph was observed from 36.9% [Interquartile range (IQR 21.8–54.9%)] to 18.1% (IQR 8.8–32.7%) of hemithorax (P < 0.05). T-PA/DNase increased fluid drainage from median of 45 mls (IQR 0–100) 24 h prior to intrapleural treatment to 1442 mls (IQR 905–2360) after 72 h; (P < 0.05) and reduction of C-reactive protein (P < 0.05). Pain requiring escalation of analgesia affected 20% patients and 9.9% experienced major adverse events. None required surgical intervention.
Conclusion
This study suggests that a modified regimen 16 mg t-PA with 5 mg DNase can be safe and effective for patients with poorly drained complex pleural infection.
Trial registration The study was registered retrospectively on 07/06/2021 with ClinicalTrials number NCT04915586 (https://clinicaltrials.gov/ct2/show/NCT04915586).
Objective: Sex estimation is one of the crucial steps for human identification, which is evident in cases of commingled, eroded, and/or missing remains. When pelvis or skull are unavailable, scapula has been used as an alternative bone for determining sex. Besides, the scapula was shown to be population-specific in several studies. Limited dry bone collections in Malaysia have led to various recommendations of virtual anthropology studies of bone in human identification. The aims of this study were to investigate the sexual dimorphism of the scapula using three-dimensional (3D) computed tomography (CT) imaging and to generate population-specific equations for sex determination in the Malaysian population.Methods: A total of 66 CT thorax images of 33 males and 33 females were taken. Morphological breadth (MB) and morphological length (ML) on bilateral scapulae were measured on 3D CT reconstructed images. Independent t-test and discriminant function analysis (DFA) were performed for analysis.Results: Results revealed that both parameters showed sexual dimorphism of scapula but displayed no difference between the right and left scapulae. DFA showed that MB and ML had high accuracy for sex estimation. The equations were highly accurate when both parameters were used in combination, followed by MB only and ML only, in that sequence.Conclusion: In brief, scapula measurements may be useful for forensic assessment of sex in the Malaysian population.
In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.
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