Displaying publications 1 - 20 of 106 in total

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  1. Bakrin FS, Makmor-Bakry M, Che Hon WH, Faizal SM, Manan MM, Ming LC
    Pharmacy (Basel), 2020 Dec 08;8(4).
    PMID: 33302438 DOI: 10.3390/pharmacy8040235
    INTRODUCTION: Drug utilization of analgesics in a private healthcare setting is useful to examine their prescribing patterns, especially the newer injectable cyclooxygenase (COX)-2 inhibitors (coxibs).

    OBJECTIVES: To evaluate the utilization of coxibs and traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) indicated for postoperative orthopaedic pain control using defined daily dose (DDD) and ratio of use density to use rate (UD/UR).

    METHOD: A retrospective drug utilization review (DUR) of nonsteroidal anti-inflammatory drugs (NSAIDs) at an inpatient department of a private teaching hospital in Seremban, Malaysia was conducted. Patients' demographic characteristics, medications prescribed, clinical lab results, visual analogue scale (VAS) pain scores and length of hospital stay were documented. Orthopaedic surgeries, namely arthroscopy, reconstructive, and fracture fixation, were included. Stratified random sampling was used to select patients. Data were collected through patients' medical records. The DDD per 100 admissions and the indicator UD/UR were calculated with the World Health Organization's DDD as a benchmark. The inclusion criteria were patients undergoing orthopaedic surgery prescribed with coxibs (celecoxib capsules, etoricoxib tablets, parecoxib injections) and tNSAIDs (dexketoprofen injections, diclofenac sodium tablets). Data were analysed descriptively. This research was approved by the academic institution and the hospital research ethics committee.

    RESULT: A total of 195 records of patients who received NSAIDs were randomly selected among 1169 cases. In term of the types of orthopaedic surgery, the ratio of included records for arthroscopy:fracture fixation:reconstructive surgery was 55.4:35.9:8.7. Most of the inpatients had low rates of common comorbidities such as cardiovascular disease as supported by their baseline parameters. The majority were not prescribed with other concomitant prescriptions that could cause drug interaction (74.9%), or gastroprotective agents (77.4%). Overall, DDDs per 100 admissions for all NSAIDs were less than 100, except for parecoxib injections (389.23). The UD/UR for all NSAIDs were less than 100, except for etoricoxib tablets (105.75) and parecoxib injections (108.00).

    DISCUSSION: As per guidelines, the majority (96.9%) received other analgesics to ensure a multimodal approach was carried out to control pain. From the UD/UR results, the arthroscopy surgery was probably the most appropriate in terms of NSAID utilization.

    CONCLUSION: The prescribing pattern of NSAIDs except parecoxib was appropriate based on adverse effect and concurrent medication profile. The findings of this DUR provide insight for a low-risk patient population at a private specialized teaching hospital on the recommended use of NSAIDs for postoperative orthopaedic pain control.

    Matched MeSH terms: Orthopedics
  2. Dhanoa A, Yong TL, Yeap SJ, Lee IS, Singh VA
    PMID: 25324121 DOI: 10.1186/1472-6882-14-404
    Although studies have shown that a large proportion of cancer patients use CAM, no study on CAM use amongst orthopaedic oncology patients has been published. Therefore, this study aims to determine the prevalence, characteristics and factors associated with CAM use amongst orthopaedic oncology patients.
    Matched MeSH terms: Orthopedics
  3. Roy KD, Sharma GM, Qureshi F, Wadia F
    Malays Orthop J, 2020 Nov;14(3):137-142.
    PMID: 33403074 DOI: 10.5704/MOJ.2011.021
    Introduction: A small proportion of patients presenting to the Emergency department (ED) of any hospital tend to take discharge against medical advice (DAMA) due to several patient related or hospital/service related reasons. Amongst these, orthopaedic patients are a special group due to their inability to mobilise independently due to injuries and have treatment needs which involve higher costs. The aim of the current study was to ascertain and analyse the reasons for orthopaedic walkouts at a tertiary care new private hospital.

    Materials and Methods: This retrospective telephonic structured interview-based study was carried out on all orthopaedic patients taking DAMA during a one-year period from July 2016 to June 2017. They were telephonically interviewed with a structured questionnaire. Hospital and ED records were analysed for demographic as well as temporal characteristics.

    Results: A total of 68 orthopaedic patients walked out of casualty against medical advice out of a total 775 (8.77%) orthopaedic patients presenting during the period as against 6.4% overall rate of DAMA for all specialties. The main reasons for DAMA were financial unaffordability of treatment (36.7%), preference for another orthopaedic surgeon (22%) and on advice of the patient's General Practitioner (16.1%).

    Conclusion: Unaffordability of treatment is a significant cause for walkouts amongst orthopaedic patients. Private hospitals need to recognise and implement processes by which these patients can be treated at affordable costs and with coverage either by medical insurance or robust charity programs. Patient education and awareness are important to encourage them to have insurance coverage.

    Matched MeSH terms: Orthopedics
  4. Singh A, Panda K, Mishra J, Dash A
    Malays Orthop J, 2020 Nov;14(3):129-136.
    PMID: 33403073 DOI: 10.5704/MOJ.2011.020
    Introduction: The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT.

    Materials and Methods: The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT.

    Results: We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations.

    Conclusion: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

    Matched MeSH terms: Orthopedics
  5. May Honey Ohn
    MyJurnal
    This systematic review was aimed to evaluate the effectiveness of technology-enhanced learning (TEL) used in medical teaching for undergraduate medical students. The objectives are to (a) identify various teaching modalities which are used to enhance TEL; (b) evaluate whether TEL is more effective than traditional learning (TL) in cognitive and affective learning domain outcome. The empirical studies were searched in the following databases: Google Scholar, MEDLINE, ERIC, ProQuest, Cochrane Library and Scopus. All papers published from 2008 to 2018 were included. From eligible studies, the study design, study field, study population, intervention methods, type of assessment and learning achievement were abstracted and summarized the information. The search results were independently reviewed by two authors. From a pool of 1384 articles, 43 eligible articles were identified, enrolling 7292 undergraduate medical students examining comparative study between TEL and traditional learning. The results showed that there was a high degree of heterogeneity seen amongst the included studies in terms of TEL modalities used. The majority of intervention studies favoured online resources, while the rest used various offline multimedia electronic devices, virtual simulations and blended modes. Overall findings showed promising data that TEL is better than TL with regards to knowledge gain and skill acquisition, as well as providing higher student satisfaction. In all, the findings present blended learning in a positive and promising light in time, particularly where systematic reviews on technology-enhanced learning in the field of the undergraduate medical programme have produced mixed result.REVIEW ARTICLEA Systematic Literature Review on Technology-Enhanced Learning in Medical EducationMay Honey Ohn1*, Bareth Ravindran2, Chan Zhi Wei3, Khin Maung Ohn4, Ng Pey Luen5Borneo Journal of Medical Sciences 14 (1) January, 2020: 3 – 171 Emergency Department, Sandwell & West Birmingham NHS Trust, United Kingdom2 Surgical Department, Hospital Tuanku Ja’afar Seremban, Kuala Lumpur, Malaysia3 Orthopaedics Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia4 Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia5 Radiology Department, Hospital Queen Elizabeth II, Sabah, Malaysia* Corresponding author’s email: mayhoney.ohn@gmail.com Received: 14 July 2019 Accepted: 5 November 2019Borneo Journal of Medical SciencesBJMSKeywords: blended learning, technology-enhanced learning, medical education, hybrid learning, undergraduate medical students
    Matched MeSH terms: Orthopedics
  6. Balaji G, Bhukya S, Nema S, Rajeswari M, Vellaipandi V
    Malays Orthop J, 2021 Mar;15(1):85-92.
    PMID: 33880153 DOI: 10.5704/MOJ.2103.013
    Introduction: Unstable ankle injuries require anatomical reduction and stabilisation for optimal outcome. In spite of adequate care, a few patients have poor outcome. In this study, we assessed the risk factors that predict the clinical outcomes in surgically treated unstable ankle fractures.

    Material and methods: This prospective cohort study was conducted on 68 patients who underwent surgical management for an unstable ankle injury. Demographic details, fracture type and associated medical comorbidities were recorded. Pre-operative radiographic assessment was done for all patients. At the end of one year follow-up, clinical (American Orthopaedic foot and ankle society-AOFAS and Olerud-Molander ankle - OMAS) scores and radiological parameters were assessed and analysed.

    Results: Fracture dislocation (0.008), diabetes mellitus (0.017), level of alchohol consumption (0.008) and pre-operative talocrural angle (TCA) > 100° (0.03) were significant predictors of poor outcomes as per AOFAS. Fracture dislocation (0.029), diabetes mellitus (0.004), pre-operative TCA > 100° (0.009), female gender (0.001), age more than 60 years (0.002) and open injuries (0.034) had significantly poor outcome as per OMAS. Other parameters (smoking, hypertension, classification, syndesmotic injury, medial clear space and tibiofibular overlap) did not affect the outcome significantly.

    Conclusion: Our study showed that poor outcome predictors in unstable ankle fractures are age >60 years, female gender, diabetes mellitus, alcohol consumption, fracture dislocation, open fractures and pre-op TCA >100°.

    Matched MeSH terms: Orthopedics
  7. Gema A, Irianto KA, Setiawati R
    Malays Orthop J, 2021 Mar;15(1):63-71.
    PMID: 33880150 DOI: 10.5704/MOJ.2103.010
    Introduction: Early femoral stem subsidence has been a concern as a predictor of the beginning of implant loosening, especially on cementless hip arthroplasty implants. This study aimed to determine the factors that affect femoral stem subsidence and outcome following hemiarthroplasty in the geriatric population.

    Materials and Methods: This is a retrospective study of 179 patients who underwent cementless bipolar hemiarthroplasty during the 2011-2019 period at an orthopaedic and traumatology hospital. Data on the patient's demography, pre-operative American Society Anaesthesiologist (ASA) score, body mass index (BMI), canal flare index (CFI), Dorr classification, and stem alignment were obtained. The primary outcomes were post-operative femoral stem subsidence, post-operative pain, and functional outcome using Harris Hip Score (HHS). Statistical analysis was conducted to identify risk factors associated with the primary outcome.

    Results: The mean femoral stem subsidence was 2.16 ±3.4 mm. The mean post-operative Visual Analog Score (VAS) on follow-up was 1.38 ± 1. Mean HHS on follow-up was 85.28±10.3. American Society Anaesthesiologist score 3 (p = 0.011, OR = 2.77) and varus alignment (p=0.039, OR = 6.963) were related to worse stem subsidence. Otherwise, neutral alignment (p = 0.045 and OR = 0.405) gave protection against femoral stem subsidence. The female gender (p = 0.014, OR 2.53) was associated with postoperative pain onset. Neutral alignment had significant relationship with functional outcomes (p = 0.01; OR 0.33).

    Conclusion: A higher ASA score and varus stem alignment were related to a higher risk of femoral stem subsidence. Meanwhile, neutral stem alignment had a protective effect on the femoral stem subsidence and outcome.

    Matched MeSH terms: Orthopedics
  8. Faria G, Virani S, Tadros BJ, Dhinsa BS, Reddy G, Relwani J
    Malays Orthop J, 2021 Mar;15(1):100-104.
    PMID: 33880155 DOI: 10.5704/MOJ.2103.015
    Introduction: COVID-19 has had a significant impact on the entire health system. The trauma and orthopaedic service has been compelled to alter working practices to respond proactively and definitively to the crisis. The aim of this study is to summarise the impact of this outbreak on the trauma and orthopaedic workload and outline the response of the department.

    Materials and Methods: We retrospectively collected data comparing patient numbers pre-COVID-19, and prospectively during the early COVID-19 pandemic. We have collected the numbers and nature of outpatient orthopaedic attendances to fracture clinics and elective services, inpatient admissions and the number of fracture neck of femur operations performed.

    Results: The number of outpatient attendances for a musculoskeletal complaint to Accident and Emergency and the number of virtual fracture clinic reviews reduced by almost 50% during COVID-19. The number of face-to-face fracture clinic follow-ups decreased by around 67%, with a five-fold increase in telephone consultations. Inpatient admissions decreased by 33%, but the average number of fracture neck of femur operations performed has increased by 20% during COVID-19 compared to pre-COVID-19 levels.

    Conclusion: We have noted a decrease in some aspects of the trauma and orthopaedic outpatient workload, such as leisure and occupational-related injuries but an increase in others, such as fracture neck of femurs. Many injuries have significantly reduced in numbers and we consider that a model could be developed for treating these injuries away from the acute hospital site entirely, thereby allowing the acute team to focus more appropriate major trauma injuries.

    Matched MeSH terms: Orthopedics
  9. Pan, K.L., Zolqarnain A., Ong, G.B.
    Malays Orthop J, 2009;3(2):55-57.
    MyJurnal
    Osteosarcoma occurring in the humerus is often confined to the proximal part, in which case, reconstruction after excision is less daunting. When the tumour spreads down the medullary cavity distally, a total humeral replacement is often required. This is costly and beyond the means of the average patient in a developing country. An amputation is often the procedure of first resort. We report a 13-year-old boy with osteosarcoma originating from the left proximal humerus, with involvement of the marrow reaching down to the distal diaphyseal-metaphyseal junction, leaving only 6 cm of the distal humerus intact after wide resection. Reconstruction of the defect was done with a composite cement-autoclaved autograft fixed to the remaining humerus with a plate. At 40 months of follow-up, the patient is well with normal function of the elbow, wrist and hand. Salvaging the limb despite near total involvement of the humerus by high grade osteosarcoma is possible using material available in the average orthopaedic operating room.
    Matched MeSH terms: Orthopedics
  10. Joehaimey, J., M. Anwar Hau A., Kamil, M.K., Jaya Purany, S.P., Saadon, I., Chee Huan, P., et al.
    MyJurnal
    Introduction: The aim of this study is to determine the most common organisms isolated in diabetic foot infection and the most utilised antibiotic regimes as the first line of treatment.
    Methods: This is a retrospective record review of the National Orthopaedic Registry Malaysia among diabetes mellitus type 2 patients who had foot infections. All identified cases admitted to 18 government hospitals in Malaysia from the 1st January 2008 until the 31st December, 2009 were included in the study.
    Results: A total of 416 patients were included in the study. The most common organisms cultured were Proteus species (17.5%), Klebsiella species (17.1%) and Staphylococcus aureus (17.9%), while the most commonly used antibiotic was ampicillin/sulbactam (67.5%). None of the patients was appropriately treated with metronidazole, cefoperazone or fucidic acid. All patients were given appropriate antibiotics to treat Serratia infection.
    Conclusion: Significant number of patients with diabetic foot infections were not treated using appropriate antibiotics as the first line treatment.
    Matched MeSH terms: Orthopedics
  11. Shahid Hassan
    MyJurnal
    Context: Community-based medical education (CBME) has become widely accepted as an important innovation in undergraduate medical education. In curriculum featuring CBME, students are acquainted with the community early in their studies however; the impact of this training can be judged best to see them practice the required aspects of CBME. Malaysia is a multiracial country with a very strong community dependant life style. Main national health problems have called for a change in health profession education from traditional hospital based health care to community-based delivery system. Three major university's medical schools that either practice community oriented or community based medical education in undergraduate medical curriculum are evaluated. Universiti Sains Malaysia (USM) has a community based medical education (CBME) curriculum as Community and Family Case Study (CFCS) compared to a community oriented education curriculum (COE) adopted by Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM). However, UM at the time of undertaking this study back in 2005 was though practicing COE has also later opted CBME as CFCS.

    Objective: To determine whether medical graduates from USM with a community-based medical education in its curriculum for more than 25 years are inspired to have stronger commitment towards community health as shown in their on-job practice of medicine compared to other graduates from UM and UKM, who have adopted community-oriented medical education program.

    Method: A questionnaire-based pilot study with 12 items (variables) was designed to obtain supervisor's opinion on commitment of interns towards the health of community they serve. The questionnaire was administered to a randomized group of 85 specialists supervising the internship training program in five major disciplines including internal medicine, surgery, orthopaedic, gynaecology and obstetrics and paediatric medicine. The data received from 62 respondents from five major disciplines was analyzed utilizing SPSS version 12.0.1.

    Result: The responses received from 62 supervisors on an inventory in which 9 out of 12 variables were directly related to community commitments of interns. It was shown that the USM graduates who were taught through a CBME curriculum have performed better than the graduates from UM and UKM who followed a COE curriculum. P-value (< 0.001) was highly significant and consistent with higher mean score in those variables.

    Conclusion: The graduates taught through a CBME curriculum performed better in community commitments towards patients care compared to graduates from COE curriculum.
    Matched MeSH terms: Orthopedics
  12. Al-Husuny, A., Rampal, L., Manohar, A.
    MyJurnal
    Work-Related Hand Injuries (WRHIs) may result in disability and diminished productivity and cause economic impacts not only to the individual, worker’s families and industries, but to the local community as well.
    Objectives: To determine the prevalence of severe Work-Related Hand Injuries (WRHIs) and factors associated at a tertiary hospital.
    Methods: A pre-tested validated questionnaire was used to obtain data. All patients 18 years and above with WRHIs seen at a tertiary hospital between January 2010 and June 2010 were included in the study. Data was analysed using SPSS version 18.
    Results: Out of the 297 industrial accidents, 74 (24.9%) were WRHIs. Among those with WRHIs, (47.3%) of them had severe hand injuries. The overall mean age of the respondents was 30.36 (± 9.54 SD) years. Majority (82.5%) of the injuries occurred between Mondays to Friday. Majority (70.1%) of hand injuries were caused by machine and 48.6% of the hand injuries occurred when the hand was caught in the operating part of the machine. Majority (62.1%) of the respondents had fingers’ injuries and 32.4% had open fracture. Bivariate analysis showed that there was significant association between severity of WRHIs and locations of injury, mechanisms of injury, sources of injury and sectors of industry (p < 0.05). Logistic regression analysis showed that WRHIs was significantly associated with source of injury and sector of industry. Respondents with hand injury resulted while operating on mechanical machine was 26 times more likely to report severe WRHIs than those with other sources of their hand injury like (sharp tool, heavy door, and wet floor). Respondents working in metal-machinery industries were eight times more likely to report severe WRHIs than those who working in other sectors of industry like (wood-furniture, constriction, food preparing, service and automotive).
    Conclusions: WRHIs contributed to 24.9% of all industrial accidents seen at the emergency department and orthopaedic clinic and 47.3% of the respondents with WRHIs had severe hand injuries. Severity of WRHIs was significantly associated with sources of injury and sectors of industry.
    Study site: emergency room, orthopaedic ward, general surgery ward and the orthopaedic outpatient clinic of a tertiary hospital
    Matched MeSH terms: Orthopedics
  13. Duraisamy, G.
    MyJurnal
    Congenital Coagulation Disorders (CCD) are inherited and present from birth. Their diagnosis depends on clinical awareness and correct laboratory investigations. The central registry for CCD or Congenital Bleeding Disorders (CBD) is at the Blood Services Centre, Kuala Lumpur Hospital and was established in 1975. There are 871 CCD registered. The commonest CCD are 631 (72%) Haemophilia A, 102 (12%) Haemophilia B and 93 (10.7%) von Willebrand's Disease. The other deficiencies registered are rare, only 45 in total:— Factor 1 (4), FV (4), FVII (21), FX (4), FXII (6), and FXIII (6). Diagnosis is based on clinical suspicion, screening tests namely the Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) and confirmation of the diagnosis was by doing specific factor assays. Molecular studies were done on FVIII and FXIII. Treatment is by transfusing the deficient factor when there is bleeding and comprehensive care involving the specialities like the neurologist/ neurosurgeon /orthopaedic / physiotherapy/ dental besides the haematologist and paediatrician to manage the complicatioons seen. There are fewer problems now as patients are diagnosed earlier and managed better. There is now a good prognosis and a better quality of life.
    Matched MeSH terms: Orthopedics
  14. Komang-Agung IS, Sindrawati O, William PS
    Malays Orthop J, 2018 Jul;12(2):25-30.
    PMID: 30112125 DOI: 10.5704/MOJ.1807.005
    Introduction: The only treatment for grade IV knee osteoarthritis is total knee arthroplasty (TKA) irrespective of the age of the patient. Most of the grade IV OA patient are elderly and most likely to have some comorbidities. Age and comorbidities are the major reasons for patient's reluctance to undergo TKA. A clinical pathway with standard length of stay (LOS) could justify the patient's hesitation for TKA. The aim of this study was to determine the factors, including age and comorbidity, that affect the LOS of patients treated with TKA. Materials and Methods: This is a retrospective study of TKA patients in Surabaya Orthopedics and Traumatology Hospital from January 2011 to July 2017. Preoperative comorbidities were scored using Charlson Comorbidity Index (CCI) and physical status by ASA (American Society of Anesthesiologist), classification for age, sex, BMI, blood loss, operation time, method of anaesthesia and postoperative day of rehabilitation were recorded as factors potentially affecting LOS. The discharge criteria for the patients were ability to ambulate to the bathroom and clean operative wound with no complications. The data obtained were analysed statistically. Results: The average LOS was 5.58 days, ranging from three to eight days. There were no demographic factors that affected the patients' LOS. BMI, ASA, CCI, and blood loss did not significantly affect LOS. Operation time was between 90-140 minutes, and spinal anaesthesia showed significant longer LOS, but within the average. Conclusion: Age and comorbidity did not affect length of stay in TKA patients.
    Matched MeSH terms: Orthopedics
  15. Zulkifli MM, Kadir AA, Elias A, Bea KC, Sadagatullah AN
    Malays Orthop J, 2017 Jul;11(2):7-14.
    PMID: 29021872 MyJurnal DOI: 10.5704/MOJ.1707.003
    Introduction: This study aimed to cross-culturally adapt a Malay version of Knee Injury and Osteoarthritis Outcome Score (KOOS) and to evaluate its psychometric properties in patients with knee osteoarthritis (OA). Materials and Methods: The English version KOOS was translated into a Malay version using forward and backward translation process, followed by face validity and content validity. Two hundred and twenty-six knee OA patients attending the Outpatient and Orthopaedic Clinics, Universiti Sains Malaysia Hospital, completed the Malay version KOOS. Construct validity using confirmatory factor analysis and internal reliability assessment were performed. Results: The results showed that the original five-factor model with 42 items failed to achieve acceptable values of the goodness of fit indices, indicating poor model fit. A new five-factor model of 26 items demonstrated acceptable level of goodness of fit (comparative fit index= 0.929, incremental fit index= 0.930, Tucker Lewis fit index= 0.920, root mean square error of approximation= 0.073 and Chisquared/degree of freedom= 2.183) indices to signify a model fit. The Cronbach's alpha value for the new model ranged from 0.776 to 0.946. The composite reliability values of each construct ranged between 0.819 and 0.921, indicating satisfactory to high level of convergent validity. Conclusion: The five-factor model with 26 items in the Malay version of KOOS questionnaire demonstrated a good degree of goodness of fit and was found to be valid, reliable and simple as an assessment tool for symptoms, pain, activity of daily living, sports and recreational activity and quality of life for Malaysian adults suffering from knee osteoarthritis.

    Study site: Outpatient and orthopedic clinics, Hospital Universiti Sains Malaysia (HUSM)
    Matched MeSH terms: Orthopedics
  16. Chua, S.K., Singh, Devinder K.A., Rajaratnam, B.S., Mokhtar, Sabarul A., Sridharan, R., Gan, K.B., et al.
    MyJurnal
    Older adults are at risk of osteoporotic fractures. Osteoporotic vertebral fractures are associated with a reduced cross-sectional area and muscle strength of the back extensor muscles, increased intramuscular fat infiltration and thoracic and lumbar curvature alterations. This study proposed a protocol to examine in more detail the contributions of altered spinal morphological, physical performance and biochemical markers to the risk of developing osteoporotic vertebral fractures. In this cross-sectional study, we plan to recruit 100 adults aged 50 years and above from an orthopaedic clinic, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia. The fracture prediction tool (FRAX) will be used to categorise high and low risk groups. Back muscle strength will be quantified using a load cell system. Thoracolumbar curvatures will be examined using an electromagnetic tracking system and intramuscular fat infiltration in the lumbar muscles will be measured using Magnetic Resonance Imaging. The Short Physical Performance Battery and JAMA dynamometer will quantify physical performance and the European Quality of Life Questionnaire will be used to assess self-perceived quality of life. Biochemical markers of serum C terminal telopeptide and N terminal propeptide of type I procollagen will be assessed using an enzyme-linked immunosorbent assays kit. A spine-specific model using regression analysis will be developed to predict osteoporotic vertebral fractures using the measured parameters in the present study.
    Matched MeSH terms: Orthopedics
  17. Md Nizar ND, Hassan SK, Mohamad Zaini RH, Hassan MH, Wan Hassan WMN, Mazlan MZ
    Malays J Med Sci, 2020 Dec;27(6):68-78.
    PMID: 33447135 DOI: 10.21315/mjms2020.27.6.7
    Background: Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids.

    Methods: A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte (n = 47) or Gelaspan (n = 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded.

    Results: Both fluids could not prevent significant reductions in SBP (P = 0.011), DBP (P = 0.002) and MAP (P = 0.001). There was also significant reduction in HR over time (P < 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status.

    Conclusion: The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.

    Matched MeSH terms: Orthopedics
  18. Eu CW, Ajit Singh V, Yasin NF
    J Orthop Surg (Hong Kong), 2019 5 16;27(2):2309499019847232.
    PMID: 31084248 DOI: 10.1177/2309499019847232
    PURPOSE: This study aims to determine the prevalence of malnutrition among orthopaedic oncology patients with malignant tumour during preoperative period.

    METHODS: This is a prospective observational study involving patients from the orthopaedic oncology unit who were undergoing surgery. They were assessed with Patient Generated Subjective Global Assessment (PG-SGA), Malnutrition Screening Tool (MST) and 3-minute Nutritional Screening (3MinNS) questionnaires. Anthropometric data such as body mass index, mid upper arm circumference (MUAC) and blood parameters such as serum albumin, total lymphocyte count and haemoglobin were also investigated. Patients were then followed up for 3 months. Post-operative complications were divided into infectious and non-infectious groups. Length of stay and unplanned readmission were also documented.

    RESULTS: Prevalence of malnutrition ranged from 13.3% to 45.8% under different nutritional assessment methods. Patients who were determined as malnourished were significantly associated with both infectious and non-infectious post-operative complications ( p < 0.001). PG-SGA and 3MinNS values were also significant in univariate and multivariate analysis, respectively. Low serum albumin (<35 g/L) was associated with post-operative infectious complications, especially surgical site infection ( p < 0.001), prolonged hospital stay ( p = 0.009) and unplanned readmission ( p = 0.017). 3MinNS and Charlson Comorbidity Index were predictive of non-infectious complications, whereas serum albumin and the presence of metastasis were predictive of infectious complications.

    CONCLUSION: This pilot study of patients with soft tissue and bone sarcoma of upper and lower limbs showed that malnutrition is a significant independent factor related to infectious and non-infectious complications which leads to unplanned readmission and prolonged length of stay. Periodic screening using the PG-SGA or 3MinNS questionnaires, MUAC and evaluation of serum albumin levels is recommended during clinic session and pre-surgery assessment rounds to identify those predisposed to malnutrition and help in reducing incidence of post-operative complications.

    Matched MeSH terms: Orthopedics*; Orthopedic Procedures/adverse effects*
  19. Wazir NN, Kareem BA
    Singapore Med J, 2011 Jan;52(1):47-9.
    PMID: 21298241
    Cervical spondylotic myelopathy (CSM) represents a spectrum of pathologies with progressive compression of the spinal cord. The clinical signs and symptoms play a key role in diagnosis. The characteristic hand myelopathy signs are of significant clinical importance. The aim of this descriptive study was to report a relatively easy to elicit new hand myelopathy sign. The basis for this is finger and wrist flexor disinhibition, which is used for the spinal specificity of cord compression at or above the C5/6 level.
    Matched MeSH terms: Orthopedics/methods
  20. Yeap JS, Yeap JK, Ruslan NG
    Med J Malaysia, 1999 Dec;54(4):539.
    PMID: 11072481
    Matched MeSH terms: Orthopedics
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