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Fulltext Western ontario and mcmaster universities (womac) osteoarthritis index as an assessment tool to indicate total knee arthroplasty in patients with primary knee osteoarthritis.

Ab Rahman S, Shokri AA, Narhari P, Sharifudin, MA

IIUM Medical Journal Malaysia, 2020;19(3):47-53.
MyJurnal

The WOMAC questionnaire is used extensively in the assessment of knee osteoarthritis but not as an indicator of total knee arthroplasty (TKA). We aimed to assess if the WOMAC score can be used as an assessment tool to indicate TKA in primary knee osteoarthritis. Materials and Methods:Patients with primary knee osteoarthritis Kellgren and Lawrence grades 3 or 4 were assessed separately by either one of two arthroplasty surgeons for indications to undergo TKA and evaluated using the WOMAC score. Patients who had received any form of intra-articular knee injection within six months before assessment were excluded. Patients were divided into two groups; indicated for TKA, and for non-surgical treatment. The mean WOMAC score of patients from both groups was compared using Independent t-test. The accuracy at different cut-off points in the score indicated for TKA was determined using the receiver operating characteristic (ROC) curve plotted on sensitivity and 1-specificity graph. Results:The study included 74 patients with a mean age of 62.5 years (SD=8.26). There was a significant difference in the total WOMAC score (p
Fulltext Clinical Factors affecting Minor Amputation in Diabetic Foot Disease at Tengku Ampuan Afzan Hospital, Kuantan

Zakaria Z, Afifi M, Sharifudin MA

Malays J Med Sci, 2015 Mar-Apr;22(2):41-7.
PMID: 26023294 MyJurnal

Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease.
Fracture risk prediction in post-menopausal women with osteopenia and osteoporosis: preliminary findings

Nik Mohd Hatta NNK, Lokman M, Said N M, Daud A, Ibrahim M, Sharifudin MA, et al.

Enferm Clin, 2018 Feb;28 Suppl 1:232-235.
PMID: 29650194 DOI: 10.1016/S1130-8621(18)30074-3

OBJECTIVE: The study aims to identify the risk of obtaining a fracture among post-menopausal women with osteopenia and osteoporosis.

METHOD: This work was a cross-sectional study involving a purposive sample of 87 post-menopausal women who attended the orthopedic and menopause clinics of Hospital Tengku Ampuan Afzan, Kuantan. The data were entered into the WHO fracture risk assessment tool (FRAX®) to predict major fracture and risk for hip fracture in 10 years' time.

RESULTS: The mean age of the respondents was 61.6 years (SD=7.9). Among the respondents, 50.6% had osteopenia and nearly half (48.3%) had osteoporosis. The mean number of menopausal years of the respondents was 11.9 (SD=8.5), ranging between 1 and 44 years. The FRAX findings indicated 9.7% major osteoporotic fracture probability and 3.5% hip fracture probability, which were denoted as high risk. A Pearson correlation coefficient was computed to assess the relationship between menopausal years and the FRAX major osteoporotic fracture probability. A significant positive correlation was found between the two, but the correlation was weak (r=0.581, n=87, p < 0.001).

CONCLUSIONS: The present findings indicate that menopausal years have a positive correlation with the risk of obtaining a fracture.

Study site: orthopedic and menopause clinics of Hospital Tengku Ampuan Afzan, Kuantan.
Fulltext Correlation Study Between Clinical Special Tests for Myelopathy and Static MRI Parameters in Patients of Malaysian Population Treated for Cervical Dysfunction

Zakaria Mohamad Z, Sharifudin MA, Din H, Abd Aziz A, Karupiah RK

Cureus, 2021 Oct;13(10):e18826.
PMID: 34804683 DOI: 10.7759/cureus.18826

INTRODUCTION: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Magnetic resonance imaging (MRI) remains the imaging modality of choice, but its findings are not completely specific for clinically significant CSM. This cross-sectional study aims to determine the pathoanatomy of CSM in patients and analyze the correlations between clinical key symptoms, myelopathic signs, and MRI findings.
METHODS: Patients with CSM aged 30 to 80 years old with no previous cervical spine disease or injuries were recruited. Clinical parameters include myelopathic hand signs and other clinical-specific tests. The MRI findings were analyzed for level of compression, underlying degenerative pathology, and parameters for cord compression.
RESULTS: Thirty patients were recruited. The most common myelopathic signs observed were positive Hoffmann's sign and the presence of reverse brachioradialis reflex. All patients had either degenerative or prolapse disc changes on MRI. There was a positive correlation between the clinical key features with MRI parameters for canal and cord diameter. The transverse cord diameter, cord compression ratio, and approximate cord area were the only independent variables related to almost all the positive clinical specific tests. All three have a moderate to strong correlation with the clinical findings.
CONCLUSION: The MRI parameters such as canal and cord size of the cervical spine are an objective reﬂection of compression on the spinal cord. Correlations observed indicate cord compression that plays a major role in the pathophysiology of CSM. These measurements are sensitive indicators of canal stenosis and play a signiﬁcant role in predicting the severity and outcome of CSM.
Fulltext Preoperative physiotherapy and short-term functional outcomes of primary total knee arthroplasty

Mat Eil Ismail MS, Sharifudin MA, Shokri AA, Ab Rahman S

Singapore Med J, 2016 Mar;57(3):138-43.
PMID: 26996450 DOI: 10.11622/smedj.2016055

INTRODUCTION: Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA).
METHODS: 50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months.
RESULTS: Both groups showed a significant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not significant in the sports and recreational activities subscale for both groups (p > 0.05). Significant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No significant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus-treatment analysis (p = 0.928).
CONCLUSION: Six-week preoperative physiotherapy showed no significant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.
KEYWORDS: algofunctional Knee Injury and Osteoarthritis Outcome Score; functional outcome; prehabilitation; preoperative physiotherapy; total knee arthroplasty
A Rare Case of Monostotic Spinal Fibrous Dysplasia Mimicking Solitary Metastatic Lesion of Thyroid Carcinoma

Sharifudin MA, Zakaria Z, Awang MS, Mohamed Amin MA, Abd Aziz A

Malays J Med Sci, 2016 Jan;23(1):82-6.
PMID: 27540330 MyJurnal

Monostotic fibrous dysplasia of the vertebra is a rare entity. A case of a 53-year-old lady who presented with an 8 months history of pain in the thoracic spine region with paraparesis is discussed. She had a history of papillary thyroid carcinoma and had undergone total thyroidectomy one year prior to her current problem. Magnetic resonance imaging revealed isolated osteolytic lesion over the posterior element of the T12 vertebra with narrowing of the spinal canal causing compression of the cord. The diagnosis of fibrous dysplasia was made histologically. Fibrous dysplasia rarely occurs in axial bones compared with peripheral bones. This case illustrates that osteolytic lesion of the vertebrae should be evaluated with detailed radiological and histopathological examination before an empirical diagnosis of spinal metastasis is made in an adult with a background history of primary malignancy well-known to spread to the bone.
Knowledge and Attitudes of Maintaining Bone Health among Post-Menopausal Women in Malaysia

Mohd Hatta NNKN, Nurumal MS, Isa MLM, Daud A, Ibrahim M, Sharifudin MA, et al.

Cent Asian J Glob Health, 2019;8(1):348.
PMID: 32002313 DOI: 10.5195/cajgh.2019.348

Introduction: Public awareness of osteoporosis is low among women in the developing countries. Health education was shown to be effective in improving knowledge and awareness on maintaining bone health. This study aims to identify the level of knowledge and attitudes among post-menopausal women in Malaysia on achieving bone health throughout the menopausal transition period.
Methods: A total of 116 post-menopausal female patients of orthopedic menopause clinic were recruited using a purposive sampling approach. Data on osteoporosis awareness and knowledge were collected using validated structured questionnaires Osteoporosis Prevention and Awareness Tool and Osteoporosis Attitude Knowledge Test. The chi-square test was used to determine the association between post-menopausal women's socio-demographic characteristics and their knowledge and attitude towards maintaining bone health.
Results: Participants' age ranged between 49 and 82 years (61.84, SD=7.87). The knowledge of osteoporosis varied significantly by age (p=0.014) and education (p=0.001) among the studied population. No significant diffrences were found for participants' attitude towards bone health.
Conclusion: This study showed that the age and education levels have significantly different knowledge of bone health.
Fulltext Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients

Johari J, Sharifudin MA, Ab Rahman A, Omar AS, Abdullah AT, Nor S, et al.

Singapore Med J, 2016 Jan;57(1):33-8.
PMID: 26831315 DOI: 10.11622/smedj.2016009

This retrospective review aimed to examine the relationship between preoperative pulmonary function and the Cobb angle, location of apical vertebrae and age in adolescent idiopathic scoliosis (AIS). To our knowledge, there have been no detailed analyses of preoperative pulmonary function in relation to these three factors in AIS.
A Prospective Multicenter Randomized Controlled Trial to Evaluate the Efficacy of Chitosan Hydrogel Paste in Comparison to Commercial Hydroactive Gel as a Wound Bed Preparation

Nasir NAM, Saad AZM, Bachok NS, Rashid AHA, Ujang Z, Noorsal K, et al.

Indian J Plast Surg, 2023 Feb;56(1):44-52.
PMID: 36998939 DOI: 10.1055/s-0042-1759503

Background This clinical trial aimed to evaluate the clinical efficacy of chitosan derivative hydrogel paste (CDHP) as a wound bed preparation for wounds with cavities. Methods This study enrolled 287 patients, with 143 patients randomized into the CDHP group (treatment) and 144 patients randomized into the commercial hydroactive gel (CHG) group (control). The granulation tissue, necrotic tissue, patient comfort, clinical signs, symptoms, and patient convenience during the application and removal of the dressing were assessed. Results The study was completed by 111 and 105 patients from the treatment and control groups, respectively. Both groups showed an increasing mean percentage of wound granulation over time when the initial wound size and comorbidity were adjusted (F(10,198) = 4.61; p
A Bone Health Optimization Framework for Malaysia: a position paper by the Malaysian Bone Health Optimization Network (MyBONe)

Lee JK, Leong JF, Thong FY, Sharifudin MA, Abbas AA, Kamudin NAF, et al.

Arch Osteoporos, 2024 Sep 21;19(1):88.
PMID: 39304537 DOI: 10.1007/s11657-024-01448-6

This position paper aims to establish and standardise Bone Health Optimization (BHO) strategies for older patients undergoing elective orthopaedic surgeries in Malaysia. It emphasises pre-, intra-, and post-operative assessments and tailored management. Adopting the "5IQ" approach, it proposes clinical standards and a registry to improve surgical outcomes and patient care.
PURPOSE: Osteoporosis and osteopenia are highly prevalent among older patients scheduled for elective arthroplasties and spinal surgeries. This position paper aims to establish, promote, and standardise effective Bone Health Optimization (BHO) strategies for such patients within orthopaedic practices in Malaysia. It emphasises the need for bone health assessments to be undertaken at the pre-operative, intra-operative, and post-operative stages, with tailored management strategies to meet individual patient needs.
METHODOLOGY: A comprehensive literature review was conducted, focusing on articles published from 2019 to 2024. Twelve broad themes were defined including definitions and importance of BHO, epidemiological data, assessment techniques, risk stratification, management strategies, and outcome metrics.
RESULTS: Elective surgeries on patients with poor bone health are associated with adverse outcomes, such as periprosthetic fractures, aseptic loosening of implants, and complications after spinal surgeries. This position paper advocates for routine bone health assessments and monitoring during the pre-operative, intra-operative, and post-operative phases. It provides summaries of imaging modalities, risk assessment tools, and techniques for each phase. By adapting the successful "5IQ" approach from secondary fracture prevention, we propose 5IQ-based Clinical Standards for BHO, including 18 Key Performance Indicators. A Malaysian BHO Registry is proposed to benchmark care in real-time and support a national quality improvement programme. Practical resources, such as a BHO algorithm and key practice points, are included.
CONCLUSION: This position paper proposes a paradigm shift in the management of bone health for patients undergoing elective orthopaedic surgery in Malaysia, aiming to improve surgical outcomes and patient care through standardised BHO strategies.