Browse publications by year: 2023

  1. Yaccob NS, Yunus MM, John DS
    Front Psychol, 2023;14:1007970.
    PMID: 37063540 DOI: 10.3389/fpsyg.2023.1007970
    Education evolves and progresses globally in a technology-driven world, highlighting the integration of VUCA elements of volatility, uncertainty, complexity, and ambiguity in lessons. Learners are molded to equip themselves with the world and real-life knowledge in their readiness to adapt to the VUCA world. Global education consists of preparing learners for the VUCA world. This study aimed to investigate the current English as a Second Language (ESL) teaching practices and the ESL teachers' incorporation of VUCA elements in ESL lessons. This study was conducted quantitatively using a survey questionnaire. This study was administered to 30 ESL teachers from different secondary schools in a district in Malacca. The results from the questionnaire revealed that the ESL participants had positive perceptions toward the adaptation of VUCA in the current ESL lessons. Most of the ESL teachers agreed that they adapted VUCA elements into the activities during lessons, although some showed uncertainty about their knowledge and understanding of VUCA. From the high agreement levels in the findings, it can be concluded that the ESL teachers agreed that VUCA elements through problem-based, digital-based, collaborative, and challenging activities in English lessons are beneficial to assist students' meaningful and autonomous learning. Based on these findings, implications were made for enhancing ESL teachers' knowledge, understanding, and skills in adapting VUCA in lessons in response to global education demand.
  2. Hartini N, Arbi DKA, Ahmed Tharbe IH, Sumari M
    Psychol Res Behav Manag, 2023;16:1141-1147.
    PMID: 37063615 DOI: 10.2147/PRBM.S400783
    INTRODUCTION: The use of written communication through short messages in social media on smartphone platforms has recently become a habit in social relations and communication. Language politeness and emotional intelligence are required by individuals, groups, communities, or institutions in conveying the contents of the messages, ensuring them to be perceived appropriately by their targets.

    METHODS: Survey research was carried out on 173 respondents with Malay culture background in Indonesia and Malaysia using the Self-Rated Malaysian Emotional Intelligence Scale developed by with a reliability value of 0.922 for Malaysian respondents and 0.803 for Indonesian respondents as well as using a politeness scale developed based on Lakoff's linguistic politeness theory.

    RESULTS: The findings of the study demonstrated that culture may affect language politeness (F (3.169) = 5.759 and M2 = F (4.168) = 4.300, P<0.05). However, language politeness did not correlate to emotional intelligence, age, gender, and educational background. Consequently, the use of communication in short messages should consider the cultural background of both the sender and receiver. Cultural similarities may facilitate the understanding of the message's content and diminish the occurrence of communication issues or conflicts.

  3. Chan CM, Mahlaoui N, Sánchez Ramón S, Pergent M, Solis L, Prevot J, et al.
    Front Immunol, 2023;14:1151335.
    PMID: 37063889 DOI: 10.3389/fimmu.2023.1151335
    OBJECTIVE: To analyze the implementation of the Principles of Care (PoC) in primary immunodeficiencies (PID) in Southeast Asia (SEA) countries - six years after its call of action.

    METHODOLOGY: Using the newly developed PID Life Index software, the index of implementation of principles of care in the management of PIDs patients involving the six participating SEA countries (Cambodia, Indonesia, Malaysia, Vietnam, Thailand, and Philippines) were extracted. For each of the six separate principles, the index from the six countries will be compared and presented based on the calculated index.

    RESULTS: Comparative analysis of the six principles of care of PID in the SEA countries showed low diagnostic rate with minimal availability of diagnostic tests options. Generally, almost all SEA countries provide curative treatments, vaccines, and anti-infectious therapies although the reimbursement scheme varied in relieving patients' financial burden. We also highlighted the active involvement of patient organizations in SEA, with main areas of work focused on advocacy and increasing awareness among public and healthcare professionals.

    DISCUSSION AND CONCLUSION: It is applaudable that the SEA continent is gradually strengthening its work in management of PID, especially in Thailand and Vietnam. However, more emphasis must be placed among stakeholders in SEA countries towards successful implementation of the PoC for a holistic management of PID patients.

    MeSH terms: Asia, Southeastern/epidemiology; Humans; Indonesia; Malaysia; Philippines; Thailand
  4. Rahman NNA, Sharif FM, Kamarudin NHA, Ali MSM, Aris SNAM, Jonet MA, et al.
    3 Biotech, 2023 May;13(5):128.
    PMID: 37064003 DOI: 10.1007/s13205-023-03534-x
    GDSL esterase is designated as a member of Family II of lipolytic enzymes known to catalyse the synthesis and hydrolysis of ester bonds. The enzyme possesses a highly conserved motif Ser-Gly-Asn-His in the four conserved blocks I, II, III and V respectively. The enzyme characteristics, such as region-, chemo-, and enantioselectivity, help in resolving the racemic mixture of single-isomer chiral drugs. Recently, crystal structure of GDSL esterase from Photobacterium J15 has been reported (PDB ID: 5XTU) but not in complex with substrate. Therefore, GDSL in complex with substrate could provide insights into the binding mode of substrate towards inactive form of GDSL esterase (S12A) and identify the hot spot residues for the designing of a better binding pocket. Insight into molecular mechanisms is limited due to the lack of crystal structure of GDSL esterase-substrate complex. In this paper, the crystallization of mutant GDSL esterase (S12A) (PDB ID: 8HWO) and its complex with butyric acid (PDB ID: 8HWP) are reported. The optimized structure would be vital in determining hot spot residue for GDSL esterase. This preliminary study provides an understanding of the interactions between enzymes and hydrolysed p-nitro-phenyl butyrate. The information could guide in the rational design of GDSL esterase in overcoming the medical limitations associated with racemic mixture.
  5. Amir Yusri MA, Sekar M, Wong LS, Gan SH, Ravi S, Subramaniyan V, et al.
    Drug Des Devel Ther, 2023;17:1079-1096.
    PMID: 37064431 DOI: 10.2147/DDDT.S389977
    Celastrol is a naturally occurring chemical isolated from Tripterygium wilfordii Hook. f., root extracts widely known for their neuroprotective properties. In this review, we focus on the efficacy of celastrol in mitigating memory impairment (MI) in both in vivo and in vitro models. Scopus, PubMed and Web of Science databases were utilised to locate pertinent literatures that explore the effects of celastrol in the brain, including its pharmacokinetics, bioavailability, behavioral effects and some of the putative mechanisms of action on memory in many MI models. To date, preclinical studies strongly suggest that celastrol is highly effective in enhancing the cognitive performance of MI animal models, particularly in the memory domain, including spatial, recognition, retention and reference memories, via reduction in oxidative stress and attenuation of neuro-inflammation, among others. This review also emphasised the challenges and potential associated enhancement of medication delivery for MI treatment. Additionally, the potential structural alterations and derivatives of celastrol in enhancing its physicochemical and drug-likeness qualities are examined. The current review demonstrated that celastrol can improve cognitive performance and mitigate MI in several preclinical investigations, highlighting its potential as a natural lead molecule for the design and development of a novel neuroprotective medication.
    MeSH terms: Animals; Drug Design; Oxidative Stress; Pentacyclic Triterpenes/pharmacology
  6. Nabihah Nasir N, Sekar M, Ravi S, Wong LS, Sisinthy SP, Gan SH, et al.
    Drug Des Devel Ther, 2023;17:1065-1078.
    PMID: 37064433 DOI: 10.2147/DDDT.S388490
    Streptonigrin is an aminoquinone alkaloid isolated from Streptomyces flocculus and is gaining attention as a drug molecule owing to its potential antitumor and antibiotic effects. It was previously used as an anticancer drug but has been discontinued because of its toxic effects. However, according to the most recent studies, the toxicity of streptonigrin and its structurally modified derivatives has been reduced while maintaining their potential pharmacological action at lower concentrations. To date, many investigations have been conducted on this molecule and its derivatives to determine the most effective molecule with low toxicity to enable new drug discovery. Therefore, the main objective of this study is to provide a comprehensive review and to discuss the prospects for streptonigrin and its derived compounds, which may boost the molecule as a highly interesting target molecule for new drug design, development and therapy. To complete this review, relevant literature was collected from several scientific databases, including Google Scholar, PubMed, Scopus and ScienceDirect. Following a complete screening, the obtained information is summarized in the present review to provide a good reference and accelerate the development and utilization of streptonigrin and its derivatives as pharmaceuticals.
    MeSH terms: Streptonigrin*; Drug Design
  7. Suhel A, Abdul Rahim N, Abdul Rahman MR, Bin Ahmad KA, Khan U, Teoh YH, et al.
    Heliyon, 2023 Apr;9(4):e14782.
    PMID: 37064486 DOI: 10.1016/j.heliyon.2023.e14782
    Neat waste plastic oil (WPO) application as a fuel in engines reduces BTE and increases deleterious emissions of CO, UHC, NOx, and smoke due to the presence of insufficient oxygen and unbreakable hydrocarbon chains in WPO. Present investigation was performed to evaluate the impact of ZnO nanoparticles on the performance and emission characteristics of a diesel engine operated with the waste plastic oil (WPO20) blend. The objective of doping ZnO nanoparticles with WPO20 was to enhance the oxidation reaction and heat transfer rate between fuel droplets during combustion, which aids in completing the combustion. The sol-gel technique was adopted to successfully synthesize the ZnO nanoparticles using zinc acetate (Zn(CH3CO2)2.2H2O) and sodium hydroxide (NaOH) precursors. The structure and morphology of resulted particles were studied by XRD and FESEM tests. Both results indicate the stable formation of ZnO, and exhibit the crystallinity nature, spherical surface, and size consistency. The synthesized ZnO nanoparticles were infused in WPO20 blend in the amounts of 50, 100, and 150 ppm with the aid of the ultrasonication technique. Engine test was conducted with diesel fuel, WPO20 blend, and nano-infused fuels at a constant speed of 1500 rpm under various loads. The disparities in performance and emission characteristics were examined and compared with pure diesel fuel. The findings demonstrated that adding nanoparticles to WPO20 significantly lowers the smoke, CO, UHC, and NOx emissions and simultaneously improves the BTE and decreases the BSFC of the diesel engine. Optimum results were obtained for 100 ppm concentration of ZnO nanoparticles. Reduction of smoke by 11.86%, CO by 5.7%, UHC by 28%, and NOx by 14.93%, along with the enhancement of BTE by 2.47%, were noticed at maximum load with 100 ppm particles. Based on the test results, it is concluded that ZnO nanoparticles can be used as a suitable additive in WPO blends to improve the overall engine characteristics. Further scope of the present work is to study the effect of organic nanoparticles with WPO on engine behaviour, the detailed combustion of nanoparticles infused WPO, and the nanoparticles doped WPO on engine wear and corrosion.
  8. Togami E, Chiew M, Lowbridge C, Biaukula V, Bell L, Yajima A, et al.
    PMID: 37064541 DOI: 10.5365/wpsar.2023.14.1.973
    The global burden of dengue, an emerging and re-emerging mosquito-borne disease, increased during the 20-year period ending in 2019, with approximately 70% of cases estimated to have been in Asia. This report describes the epidemiology of dengue in the World Health Organization's Western Pacific Region during 2013-2019 using regional surveillance data reported from indicator-based surveillance systems from countries and areas in the Region, supplemented by publicly available dengue outbreak situation reports. The total reported annual number of dengue cases in the Region increased from 430 023 in 2013 to 1 050 285 in 2019, surpassing 1 million cases for the first time in 2019. The reported case-fatality ratio ranged from 0.19% (724/376 972 in 2014 and 2030/1 050 285 in 2019) to 0.30% (1380/458 843 in 2016). The introduction or reintroduction of serotypes to specific areas caused several outbreaks and rare occurrences of local transmission in places where dengue was not previously reported. This report reinforces the increased importance of dengue surveillance systems in monitoring dengue across the Region.
    MeSH terms: Animals; Asia/epidemiology; Dengue/epidemiology; Disease Outbreaks*; Humans; Global Health*; World Health Organization; Serogroup
  9. Fahmi MZ, Aung YY, Ahmad MA, Kristanti AN, Sakti SCW, Arjasa OP, et al.
    Nanotheranostics, 2023;7(3):281-298.
    PMID: 37064612 DOI: 10.7150/ntno.80030
    The fluorescent imaging and drug delivery utilizing carbon dots nanomaterials (CDs) have attracted tremendously due to their unique optical ability and outstanding biocompatibility. Herein, we reported a new design of chalcone-loaded carbon dots (Chalcone-APBA-CDs) to serve chalcone transport onto cancer cells and enhance the CDs bioimaging and antitumor activity. The boronic acid was directly introduced to carbon dots (CDs) via pyrolysis process to drive CDs specifically to the cancer cell, and chalcone was mediated on CDs by ultrasonication to perform facile release of the drug delivery model. The successfully synthesized Chalcone-APBA-CDs were proved by their chemical structure, fluorescent activities, in vitro and in vivo analyses, and drug release systems using different pH. In addition, flow cytometry and confocal fluorescent imaging proved CDs' cellular uptake and imaging performance. In vitro analyses further proved that the Chalcone-APBA-CDs exhibited a higher toxicity value than bare CDs and efficiently inhibited the proliferation of the HeLa cells depending on their dose-response. Finally, the performance of Chalcone-APBA-CDs on cancer healing capability was examined in vivo with fibrosarcoma cancer-bearing mice, which showed a remarkable ability to reduce the tumor volume compared with saline (control). This result strongly suggested that the Chalcone-APBA-CDs appear promising simultaneously as cancer cell imaging and drug delivery.
    MeSH terms: Animals; Carbon/pharmacology; Carbon/chemistry; HeLa Cells; Humans; Drug Delivery Systems/methods; Chalcones*; Nanostructures*; Mice
  10. Ong SL, Bajuri MY, Mazli N
    Malays Orthop J, 2023 Mar;17(1):27-33.
    PMID: 37064618 DOI: 10.5704/MOJ.2303.004
    INTRODUCTION: Charcot arthropathy is a condition which is progressive, non-infectious, destructive and debilitating that commonly affect foot and ankle. This systematic review is to evaluate the occurrence of common outcomes associated with each intervention of Charcot neuroarthropathy in midfoot.

    MATERIALS AND METHODS: A systematic review on literatures that were published from Jan 2010 to Jan 2020 were collected, reviewed and selected regarding the surgical treatment procedures of Charcot neuroarthropathy in midfoot.

    RESULTS: The initial search yielded 231 reports and after exclusion, nine out of the total studies were included in the outcome analysis for review. These were studies that included data concerning surgical reconstruction of Charcot arthropathy in the midfoot.

    CONCLUSION: It is suggested that soft tissue preparation and usage of combination of implants thus reduce the risk of infection as well as increase rigidity of construct, respectively. These factors will aid to improve outcome of midfoot Charcot arthropathy reconstruction.

  11. Deslivia MF, Savio SD, Wiratnaya I, Astawa P, Sandiwidayat KS, Bimantara NG
    Malays Orthop J, 2023 Mar;17(1):98-110.
    PMID: 37064619 DOI: 10.5704/MOJ.2303.012
    INTRODUCTION: Anti-osteoclastic mechanism of Bisphosphonate (BP) is crucial to treat Giant Cell Tumour of the Bone (GCTB), however no established guidelines of its use have been published. This systematic review and meta-analysis is the first to summarise recent clinical studies on the subject.

    MATERIALS AND METHODS: A systematic search was performed based on PRISMA guidelines for clinical trials of BP administration in GCTB. Baseline data including BP regimen, dose and timing was summarised. The primary outcomes assessed were recurrence rate, metastases, survival rate, functional outcome, clinical outcome, radiological outcome, and adverse effect.

    RESULTS: We identified 8 articles from 2008-2020. Most studies administer 4mg of Zoledronic acid post-operatively, with five studies mentioning pre-operative administration and six studies describing post-operative administration. There was a total of 181 GCTB cases analysed in this study. The BP group presented lower recurrence rate than control group (three studies; Odds Ratio [OR] 0.15; 95% Confidence Interval [CI], 0.05 - 0.43; p<0.05; heterogeneity, I2=0%). As for survival rate, BP group is comparable to control group (two studies; OR 1.67; 95% CI, 0.06 - 48.46; p=0.77; heterogeneity, I2=65%).

    CONCLUSION: Bisphosphonate therapy offers satisfactory recurrence rate, functional outcome, clinical outcome, radiological outcome, survival rate and metastases rate in patients with GCTB, with minimal adverse effects. Pre- and post-operative administration of bisphosphonates in combination might be the most beneficial in minimalising the recurrence rate.

  12. Abdul-Karim S, Abdul-Hamid MS, Ho CA, Ling J
    Malays Orthop J, 2023 Mar;17(1):160-171.
    PMID: 37064621 DOI: 10.5704/MOJ.2303.019
    INTRODUCTION: The purpose of this study is to determine the validity, reliability, and responsiveness of the Malay Shoulder Pain and Disability Index (M-SPADI) in Malay speakers suffering from shoulder pain.

    MATERIALS AND METHODS: The M-SPADI, the Numerical Rating Scale (NRS), and measurements of shoulder active range of motion (AROM) were completed by 140 patients with shoulder pain (68 with rotator cuff pathology and 72 with other shoulder pathology). Thirty-four patients were retested for test-retest reliability with M-SPADI after an average of 9.2 days. M-SPADI was performed on twenty-one individuals three months after completing treatment for rotator cuff disorders to assess response.

    RESULTS: The results of exploratory factor analysis revealed a bidimensional structure for M-SPADI. M-SPADI disability score was significantly greater in patients with rotator cuff pathologies (median = 31.87, IQR 82.50) than in patients with other shoulder pathologies (median = 20.00, IQR 23.84). In multi-group factor analysis, measurement invariance revealed no significant difference between the two groups (p>0.05). There was a significant positive correlation between M-SPADI and NRS (Pain = 0.86, Disability = 0.75, Total = 0.82, p=0.005), and a significant negative correlation between M-SPADI and shoulder AROM (Pain = -0.34 to -0.67, Disability =-0.44 to -0.73, Total =0.43 to -0.72, p=0.005). M-SPADI had a high degree of internal consistency (Cronbach's 0.92 for pain and 0.95 for disability). Test-retest reliability was moderate to excellent (ICC Pain = 0.84, ICC Disability = 0.78, ICC Total = 0.81, p=0.001), and the smallest detectable change ranges (Pain = 8.74, Disability = 3.21, Total = 3.83) were less than the minimal detectable change ranges (Pain = 21.57, Disability = 6.82, Total = 8.79). The area under the receiver operating characteristic curve (AUC) for M-SPADI was greater than 0.90 (Pain = 0.99, Disability = 0.94, Total = 0.96).

    CONCLUSION: The M-SPADI has established construct validity, internal consistency, test-retest reliability, and responsiveness. The M-SPADI is a reliable and valid instrument for evaluating shoulder pain among Malay-speaking individuals. In addition, the M-SPADI disability subscale may be useful for monitoring functional score changes in patients with rotator cuff pathology.

  13. Novriansyah R, Sundoko W, Wibowo A, Putra FS
    Malays Orthop J, 2023 Mar;17(1):18-26.
    PMID: 37064622 DOI: 10.5704/MOJ.2303.003
    INTRODUCTION: ACL rupture is the most common type of knee injury. The All-inside ACL reconstruction procedure features some distinguished components including closed-socket tunnels with less bone expulsion, double suspensory fixation, and smaller incisions. We aimed to compare the outcomes between the All-inside Single-bundle and the Double-bundle ACL reconstruction techniques.

    MATERIALS AND METHODS: This study was a retrospective study which analysed the patient-reported and the clinical outcomes on patients who underwent ACL reconstruction between January and December 2020 at Dr Kariadi General Hospital Semarang, Indonesia. We compared the patient-reported and the clinical outcomes at 6- and 12-month follow-ups between the All-inside Single-bundle and the Double-bundle groups. The patient-reported outcomes were determined using the IKDC and Tegner-Lysholm scores while the clinical outcomes included the measurement of Thigh Circumference, Single Hop test, Anterior Drawer test, Lachman test, Range of motion, and the patient's level of return to sport.

    RESULTS: A total of 24 subjects were divided into two groups, namely the All-inside Single-bundle and the Double-bundle groups, consisting of 12 subjects in each group. Most of the subjects were male in both groups, including 9 (75%) subjects in the All-inside Single-bundle group, and 11 (91.67%) subjects in the Double-bundle group. The mean age of the subjects were 25.75±7.57 years old in the All-inside Single-bundle group, and 24.5±6.87 years old in the Double-bundle group. In terms of the side of the knee that suffered the most injuries in both groups were the right knees. The result of the patient-reported outcomes using IKDC and Tegner-Lysholm scores showed no statistically significant differences in both groups at 6- and 12-month follow-ups (p=0.864; p=0.293 and p=0.589; p=0.233, respectively). The results of clinical assessments at 6- and 12-month follow-ups also showed no statistically significant differences in both groups.

    CONCLUSION: Our study showed no significant differences in the patient-reported and the clinical outcomes between the All-inside Single-bundle and the Double-bundle ACL reconstruction techniques at 6- and 12-month follow-ups.

  14. Touloupakis G, Messori M, Gilli A, Theodorakis E, Ghirardelli S, Antonini G
    Malays Orthop J, 2023 Mar;17(1):172-179.
    PMID: 37064623 DOI: 10.5704/MOJ.2303.020
    INTRODUCTION: In this retrospective case-series study we discuss the clinical and radiographic outcomes obtained following the "tibia-first concept" in the treatment of distal tibia fractures, both in patients with fibular comminution and in cases with a simple fibula fracture.

    MATERIALS AND METHODS: We analysed a consecutive series of 64 patients who presented at our emergency department with a distal articular tibial and fibular fracture from January 2015 to September 2020. A total of 22 patients met the inclusion and exclusion criteria and were included in the study. Clinical and radiographic examination were performed at each follow-up. To quantify pain and functional disability, the Foot and Ankle Outcome Score (FAOS) and the American Orthopaedic Foot and Ankle Society's ankle-hindfoot scale (AOFAS) were applied.

    RESULTS: The overall mean age was 52.8 years, and the mean follow-up was 13.18 months. Multiple scales data from the FAOS were as follows: pain score 80.70; symptoms score 81.69; activities of daily living score 87.22; quality of life 76.05. The mean AOFAS ankle-hindfoot score was 74.36.

    CONCLUSIONS: Even though the principles of Rüedi and Allgöwer are still valid, in specific circumstances, the tibia-first concept could be considered as a valid option for the treatment of these demanding fractures. If a good reduction is obtained intra-operatively by ligamentotaxis, we recommend fixing the tibia first, avoiding surgical stress on tissues derived from a previous fibular fixation.

  15. Shamsuri NS, Yeap CY, Low K, Kaur-Dhaliwal T, Hashim H, Wan-Sim AY, et al.
    Malays Orthop J, 2023 Mar;17(1):149-159.
    PMID: 37064624 DOI: 10.5704/MOJ.2303.018
    INTRODUCTION: Hip fractures are a major health concern resulting in significant morbidity worldwide. They are the leading cause of fall-related injuries amongst the elderly with high risk of death, and numbers are expected to rise with the growing elderly population. Expedited surgical repair has been proven to improve patient outcomes, however there are often multiple barriers to early surgery especially in the elderly. The use of antiplatelets and anticoagulation is a significant contributory factor to surgical delay.

    MATERIALS AND METHODS: We conducted a retrospective, single centre study on hip fracture patients admitted to an acute care orthogeriatric unit over a 12-month period, aimed at determining the impact of pre-operative use of antiplatelets and anticoagulants on time to surgery (TTS) and its impact on one-year mortality rates.

    RESULTS: Amongst 404 eligible patients, 102 were on antiplatelets, 23 on anticoagulants and 279 were neither on antiplatelets or anticoagulants. Our study showed that patients taking clopidogrel (p<0.001) and DOACs (p=0.001) were more likely to have delayed surgery compared to those who were not on these agents. In addition, all patients on warfarin experienced surgical delay. Warfarin group also had highest mortality rates compared to other group and 10 times more likely to die within a year (p=0.001).

    CONCLUSION: The results from this study are consistent with existing literature, suggesting that the use of clopidogrel and anticoagulants have a negative impact on TTS in hip fracture patients. Strategies should be developed for patients on these medications to enhance their TTS.

  16. Isono M, Koga H, Nakagawa Y, Nakamura T, Sekiya I, Katagiri H
    Malays Orthop J, 2023 Mar;17(1):61-69.
    PMID: 37064625 DOI: 10.5704/MOJ.2303.008
    INTRODUCTION: Isolated meniscal repair has been suggested as one of the contributing factors in unhealed meniscal repair. The purpose of this study was to compare the healing rate between isolated meniscal repair and meniscal repair with concomitant anterior cruciate ligament reconstruction (ACLR) using a standardised assessment method after propensity score matching.

    MATERIALS AND METHODS: Accuracy of the Crues' grading system for meniscal healing was validated using second-look arthroscopy as the reference standard in 17 patients. Propensity score matching (one-to-one) was performed between 26 patients who underwent isolated meniscal repair and 98 patients who underwent meniscal repair with concomitant ACLR. Patients were matched for sex, age, side and zone of the meniscal repair, and number of sutures. Healing rates at one year which were evaluated with magnetic resonance imaging (MRI) were compared between the two groups.

    RESULTS: The sensitivity and specificity of the Crues' grading system on multiple plane MRI for meniscal healing were 100% and 83.3%, respectively. Both the isolated meniscal repair group and the meniscal repair with concomitant ACLR group included 21 patients after propensity score matching. Baseline characteristics did not differ significantly between the two groups. The healing rate was significantly lower in the isolated meniscal repairs group (14.3%) than in the meniscal repair concomitant with ACLR group (47.6%, P=0.04).

    CONCLUSION: The healing rate for isolated meniscal repair using a standardised MRI assessment method was inferior to that of meniscal repair with concomitant ACLR after propensity score matching.

  17. Gan G, Toon DH, Teo W, Wee T
    Malays Orthop J, 2023 Mar;17(1):111-116.
    PMID: 37064626 DOI: 10.5704/MOJ.2303.013
    INTRODUCTION: A posterior horn medial meniscus (PHMM) tear subjects the knee to pathological stresses, especially in the setting of a deficient anterior cruciate ligament (ACL). These PHMM tears have to be surgically addressed, however they remain a diagnostic challenge. Hence, this study aims to evaluate the wave sign as an arthroscopic diagnostic aid for the PHMM tear which may be occult.

    MATERIALS AND METHODS: This is a retrospective study of 61 consecutive patients (62 ACL-deficient knees) who underwent arthroscopic primary ACL reconstruction between September 2017 and August 2018. We defined PHMM tears as tears located in the posterior one-third of the medial meniscus. Root tears and ramp lesions were included in our analysis. The arthroscopic findings were recorded after a comprehensive arthroscopic survey.

    RESULTS: In the sample of ACL-deficient knees, 44 (71.0%) had a concomitant medial meniscus tear. The most common location for the tear was in the posterior horn (81.8%). There were seven occult PHMM tears, not described by the radiologist or identified by the operating surgeon on the pre-operative magnetic resonance imaging. The wave sign was identified in 10 (16.1%) knees, all confirming the presence of the PHMM tear. A positive correlation was found between the presence of the wave sign and the PHMM tear.

    CONCLUSIONS: The wave sign has a statistically significant but weak positive correlation with the presence of the PHMM. We view the wave sign as a valuable arthroscopic cue to rule-in the presence of the PHMM tear in the ACL-deficient knee.

  18. Liew SK, Lee JA, Tamam F, Ismail II, Mohamed-Saaid F, Chye PC
    Malays Orthop J, 2023 Mar;17(1):70-78.
    PMID: 37064627 DOI: 10.5704/MOJ.2303.009
    INTRODUCTION: The awareness of under-representation of female surgeons in orthopaedics has been increasing in this decade. We aim to investigate the reasons why female surgeons chose orthopaedic, the barriers that possibly hinder female surgeons into orthopaedics and analyse the obstacles that they encountered in their career in Malaysian context.

    MATERIALS AND METHODS: A total of 101 registered female orthopaedic surgeons registered with the Malaysian Medical Council, during the period 1980 to 2020, were contacted for a cross-sectional survey, consisting of thirty-four questions on their experience in the orthopaedic career. Eighty-two responses were received (81.2%). Questions in this survey consisted of four sections: (1) demographic details, (2) current clinical practice environment, (3) orthopaedics training experience, and (4) career experience.

    RESULTS: A total of 49% of respondents had subspeciality training, highest in paediatric orthopaedic (30%). Enjoyment of manual tasks (64.6%) and professional satisfaction (64.6%) were the top reasons for choosing orthopaedic as a career. Primary barriers to orthopaedic were physical strength required (56.0%) and public gender bias (52.4%). Twenty-eight percent reported gender discrimination in career opportunities while 60% reported similar in daily work. Thirty-three percent reported verbal and 11% physical sexual harassment in their career. Forty-four percent of respondents reported benefits as female orthopaedic surgeon in their work.

    CONCLUSION: The reasons for Malaysian female orthopaedic surgeons to choose orthopaedic as their career and the barriers perceived to hinder other females from choosing orthopaedics were similar to reports worldwide with no exception to gender discrimination and sexual harassment. The support given by male colleagues to married female surgeons marked a unique phenomenon in Malaysian culture.

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