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Anchor Hole Placement for Bankart Repairs and Its Interaction With Variable Size Hill-Sachs Defects-Minimizing Risk of Glenoid Rim Fractures

Dabirrahmani D, Bokor D, Tarento T, Ahmad S, Appleyard R

J Biomech Eng, 2019 Oct 01;141(10).
PMID: 31175841 DOI: 10.1115/1.4043969

As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability after Bankart lesions of the shoulder, increases, an emerging problem has been the incidence of glenoid rim fractures through suture drill holes. Very little is known regarding the effect of the Hill-Sachs lesion on the glenoid's susceptibility to fracture and how drill hole location can further affect this. This study used finite element modeling techniques to investigate the risk of fracture of the glenoid rim in relation to variable sized Hill-Sachs defects impacting on the anterior glenoid edge with suture anchor holes placed in varying positions. The distribution of Von Mises (VM) stresses and the factor of safety (FOS) for each of the configurations were calculated. The greatest peak in VM stresses was generated when the glenoid was loaded with a small Hill-Sachs lesion. The VM stresses were lessened and the FOS increased (reducing likelihood of failure) with increasing size of the Hill-Sachs lesion. Placement of the suture drill holes at 2 mm from the glenoid rim showed the highest risk of failure; and when combined with a medium sized Hill-Sachs lesion, which matched the central line of the drill holes, a potentially clinically significant configuration was presented. The results of this study are useful in assisting the surgeon in understanding the interaction between the Hill-Sachs lesion size and the placement of suture anchors with the purpose of minimizing the risk of subsequent rim fracture with new injury.
Prediction of work productivity outcomes by identifying critical risk factors among garment industry workers

Javed I, Md Dawal SZ, Nukman Y, Ahmad A

Int J Occup Saf Ergon, 2022 Dec;28(4):2238-2249.
PMID: 34556003 DOI: 10.1080/10803548.2021.1984673

Work productivity is one of the most important economic measures in the manufacturing industry. However, the physical, psychosocial and individual risk factors of an industrial work environment affect workers' physical or mental health, resulting in work productivity loss, absenteeism and presenteeism. Therefore, this study aims to identify the most critical risk factors and develop statistical models for predicting work productivity loss, absenteeism and presenteeism of garment industry workers. A sample of 224 sewing machine operators was taken for data collection through observation and self-reported studies. The results indicated that the average work productivity loss, absenteeism and presenteeism was 38.21, 2.35 and 37.23%, respectively. Finally, the statistical models of work productivity loss, absenteeism and presenteeism was developed using multiple linear regression with precision of 69.9, 53.7 and 84.0%, respectively. Hence, this study will help garment industries to improve their work productivity by taking initiatives based on the developed models.
Evaluation of oil palm fiber biochar and activated biochar for sulphur dioxide adsorption

Iberahim N, Sethupathi S, Bashir MJK, Kanthasamy R, Ahmad T

Sci Total Environ, 2022 Jan 20;805:150421.
PMID: 34818803 DOI: 10.1016/j.scitotenv.2021.150421

The emission of sulphur dioxide (SO2) gas from power plants and factories to the atmosphere has been an environmental challenge globally. Thus, there is a great interest to control the SO2 gas emission economically and effectively. This study aims to use and convert abundantly available oil palm fiber (OPF) biomass into an adsorbent to adsorb SO2 gas. The preparation of OPF biochar and activated biochar was optimised using the Response Surface Methodology (RSM) based on selected parameters (i.e., pyrolysis temperature, heating rate, holding time, activation temperature, activation time and CO2 flowrate). The best adsorbent was found to be the OPF activated biochar (OPFAB) compared to OPF biochar. OPFAB prepared at 753 °C for 73 min of activation time with 497 ml/min of CO2 flow yields the best adsorption capacity (33.09 mg/g) of SO2. Meanwhile, OPF pyrolysed at 450 °C of heating temperature, 12 °C/min of heating rate and 98 min of holding time yield adsorption capacity at 18.62 mg/g. Various characterisations were performed to investigate the properties and mechanism of the SO2 adsorption process. Thermal regeneration shows the possibilities for the spent adsorbent to be recycled. The findings imply OPFAB as a promising adsorbent for SO2 adsorption.
Fulltext Innovation Diffusion: The Influence of Social Media Affordances on Complexity Reduction for Decision Making

Md Nordin S, Ahmad Rizal AR, Zolkepli IA

Front Psychol, 2021;12:705245.
PMID: 34803798 DOI: 10.3389/fpsyg.2021.705245

Social media is a prominent communication platform. Its active usage permeates all generations and it is imperative that the platform be fully optimized for knowledge transfer and innovation diffusion. However, there are several considerations regarding platform usage, including media affordances. Social media affordances enable users to interact with the world around them through features of modality, agency, interactivity, and navigation. Previous studies have indicated that social media affordances significantly influence user behavior and usage. However, research exploring the effect of social media affordances on knowledge acquisition and the reduction of decision-making complexities is limited. Therefore, focusing on 179 paddy farmers in Malaysia, this study examined the effect of social media affordances on information quality, knowledge acquisition, and complexity reduction regarding innovation adoption decisions using a quantitative approach. This study's findings reveal that social media affordances have a significant effect on perceived information quality, knowledge acquisition, and complexity reduction.
Prevalence and treatment outcomes of skin infections among elderly population: a retrospective cross-sectional study

Akhtar A, Ahmad Hassali MA, Zainal H, Khan AH

J Dermatolog Treat, 2021 Nov;32(7):778-782.
PMID: 31916477 DOI: 10.1080/09546634.2020.1714539

BACKGROUND: Geriatric population is increasing day by day throughout the world and there is a critical need to provide them the best health services including dermatological care due to their weakened immune system. The main objective of this study is to determine the prevalence and factors affecting the treatment outcomes of skin infections among elderly population.
METHODS: A 5-year retrospective cross-sectional study was conducted at the Department of Dermatology, Hospital Pulau Pinang. Patients aged ≥65 years of age with confirmed diagnosis of skin infection were included in the study.
RESULTS: A total of 455 patients were included and the most prevalent skin infections were eczema (27.6%) followed by dermatitis (13.8%), xerosis (13.8%), and bullous pemphigoid (8.8%). Cloxacillin (18%), Tetracycline (7.9%), and Unasyn (Ampicillin and Sulbactam) (5.7%) are the common antibiotics prescribed to treat skin infections. Age, alcohol consumption, polypharmacy, and presence of other co-morbidities are the most important factors that affected the treatment outcomes of skin infections among geriatrics.
CONCLUSION: Eczema is the most prevalent skin infection among the elderly population. Age, consumption of alcohol, usage of more than five medicines simultaneously, and presence of co-morbidities are the main factors that are involved in better treatment outcomes of skin infections among study population.
Clinical outcome of Maggot Debridement Therapy followed by Negative Pressure Wound Therapy for chronic hand wound with Multi-Drug Resistant Organism infection: Two cases and review of the literature

Phang ZH, Khoo SS, Gunasagaran J, Tunku Ahmad TS

J Orthop Surg (Hong Kong), 2021 12 19;29(3):23094990211067302.
PMID: 34920683 DOI: 10.1177/23094990211067302

The advancement in science and research has led to development of medical maggots which feed exclusively on dead tissue. Medical maggots have three important functions namely debridement, disinfection, and stimulation of wound healing. The modern use of medical maggots now goes by the term "Maggot Debridement Therapy" (MDT) for use in wound management. MDT is still used infrequently due to the effectiveness of surgical debridement and antibiotics for treatment of wound infection. Lately, there was emergence of Multi-Drug Resistant Organism (MDRO) likely due to inappropriate antibiotics usage. Maggot secretions have been shown to be effective in inhibiting some MDRO, for example, Methicillin-resistant Staphylococcus aureus, thus making MDT an attractive option for wounds with MDRO. We report two patients with multiple medical comorbidities, diagnosed with serious MDRO Diabetic Hand Infections treated with three cycles of MDT followed by Negative Pressure Wound Therapy.
Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity

Lalonde D, Ayhan E, Ahmad AA, Koehler S

J Hand Surg Eur Vol, 2022 Jan;47(1):24-30.
PMID: 34256616 DOI: 10.1177/17531934211029543

Hand surgery is rapidly changing. The wide-awake approach, minimum dissection surgery and early protected movement have changed many things. This is an update of some of the important changes regarding early protected movement with K-wired finger fracture management, simplification of nerve decompression surgery, such as elbow median and ulnar nerve releases, and some new areas in performing surgery with wide-awake local anaesthesia without tourniquet.
Fulltext N-Arylation of Protected and Unprotected 5-Bromo-2-aminobenzimidazole as Organic Material: Non-Linear Optical (NLO) Properties and Structural Feature Determination through Computational Approach

Mumtaz M, Rasool N, Ahmad G, Kosar N, Rashid U

Molecules, 2021 Nov 17;26(22).
PMID: 34834012 DOI: 10.3390/molecules26226920

The interest in the NLO response of organic compounds is growing rapidly, due to the ease of synthesis, availability, and low loss. Here, in this study, Cu(II)-catalyzed selective N-arylation of 2-aminobenzimidazoles derivatives were achieved in the presence of different bases Et3N/TMEDA, solvents DCM/MeOH/H2O, and various aryl boronic acids under open atmospheric conditions. Two different copper-catalyzed pathways were selected for N-arylation in the presence of active nucleophilic sites, providing a unique tool for the preparation of NLO materials, C-NH (aryl) derivatives of 2-aminobenzimidazoles with protection and without protection of NH2 group. In addition to NMR analysis, all synthesized derivatives (1a-1f and 2a-2f) of 5-bromo-2-aminobenzimidazole (1) were computed for their non-linear optical (NLO) properties and reactivity descriptor parameters. Frontier molecular orbital (FMO) analysis was performed to get information about the electronic properties and reactivity of synthesized compounds.
Fulltext Coronavirus Disease 2019 Presenting as Conjunctivitis

Ying NY, Idris NS, Muhamad R, Ahmad I

Korean J Fam Med, 2021 Nov;42(6):487-490.
PMID: 32475104 DOI: 10.4082/kjfm.20.0090

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The world is currently challenged to handle this pandemic. The common symptoms of COVID-19 are fever, cough, fatigue, and shortness of breath. There are few reports on the association of SARS-CoV-2 with ocular abnormalities including conjunctivitis. We report a case of a 54-year-old woman who presented solely with conjunctivitis subsequently diagnosed with COVID-19. A lack of full history of her travel abroad was another issue leading to a delay in evaluating her COVID-19 status that increased the infection risk to her managing team. Thus, primary care practitioners should be suspicious of this atypical feature of COVID-19, thus enabling us to identify such patients at entry points. Maintaining safety measures while managing patients is also crucial.
Comprehensive exploration of natural degradation of poly(lactic acid) blends in various degradation media: A review

Rosli NA, Karamanlioglu M, Kargarzadeh H, Ahmad I

Int J Biol Macromol, 2021 Sep 30;187:732-741.
PMID: 34358596 DOI: 10.1016/j.ijbiomac.2021.07.196

Poly(lactic acid) (PLA), a bio-based polyester, has been extensively investigated in the recent past owing to its excellent mechanical properties. Several studies have been conducted on PLA blends, with a focus on improving the brittleness of PLA to ensure its suitability for various applications. However, the increasing use of PLA has increased the contamination of PLA-based products in the environment because PLA remains intact even after three years at sea or in soil. This review focuses on analyzing studies that have worked on improving the degradation properties of PLA blends and studies how other additives affect degradation by considering different degradation media. Factors affecting the degradation properties, such as surface morphology, water uptake, and crystallinity of PLA blends, are highlighted. In natural, biotic, and abiotic media, water uptake plays a crucial role in determining biodegradation rates. Immiscible blends of PLA with other polymer matrices cause phase separation, increasing the water absorption. The susceptibility of PLA to hydrolytic and enzymatic degradation is high in the amorphous region because it can be easily penetrated by water. It is essential to study the morphology, water absorption, and structural properties of PLA blends to predict the biodegradation properties of PLA in the blends.
Effects of Using Laryngeal High-Speed Videoendoscopy Images Visualizing Partial Views of The Glottis on Measurement Outcomes

Mohd Khairuddin KA, Ahmad K, Ibrahim HM, Yan Y

J Voice, 2022 Jan;36(1):106-112.
PMID: 32456835 DOI: 10.1016/j.jvoice.2020.04.027

Ideally, an analysis method for laryngeal high-speed videoendoscopy (LHSV) based on the glottal area waveforms (GAW) requires images of a complete view of the glottis to ensure findings that are representatives of the vibratory behaviors of the whole vocal folds. However, in practice, the preferred images may not be obtained at all times. Often, the only available images that a clinician has to work with consist of a partial view of the glottis. This study aims to examine the effects of using images of a partial view of the glottis (ie, posterior-middle, anterior-middle, or middle) on the LHSV-based measures (ie, fundamental frequency (F0GAW), frequency perturbation (jitterGAW), amplitude perturbation (shimmerGAW), open quotient (OQGAW), and Nyquist plot). The participants consisted of 9 young normophonic females. The procedures involved LHSV recording of the vibration of the vocal folds. The images of the complete view of the glottis were analyzed to obtain the LHSV-based measures. The same images were used to simulate the images of partial views of the glottis by changing the outline of the region of interest to include only either the posterior-middle, anterior-middle, or middle parts of the glottis. The LHSV-based measures from the images of the partial views were then compared to those with the complete view . The results showed that all LHSV-based measures from the images of the posterior-middle view were similar to those of the complete view. However, only the F0GAW, jitterGAW, and shimmerGAW from the images of the anterior-middle and middle views were similar to those of the complete view. Lower OQGAW and different Nyquist plots than those of the complete view were generated by the images of the anterior-middle and middle views. In conclusion, all LHSV-based measures from the images of the posterior-middle view of the glottis, and only the F0GAW, jitterGAW, and shimmerGAW from the images of the anterior-middle and middle views of the glottis reflect the vibratory behaviors of the whole vocal folds. The same conclusion could not be applied to the OQGAW and Nyquist plots of the images of the anterior-middle and middle views of the glottis. A possible effect of the presence or absence of a posterior glottal gap on the findings warrants further confirmation.
Fulltext Growth patterns and nutritional status of small for gestational age infants in Malaysia during the first year of life

Ahmad N, Sutan R, Tamil AM, Hajib N

Child Health Nurs Res, 2021 Oct;27(4):317-327.
PMID: 35004520 DOI: 10.4094/chnr.2021.27.4.317

Purpose: This study aimed to identify small for gestational age (SGA) infants' growth patterns, nutritional status, and associated factors.
Methods: This prospective cohort study was conducted at primary-care child health clinics in Greater Kuala Lumpur, Malaysia. The sample consisted of infants who fulfilled the criteria and were born in 2019. The anthropometric data of infants were assessed at birth and at 1, 3, 6, 9, and 12 months.
Results: A total of 328 infants were analysed. In total, 27.7%(n=91) of the subjects were SGA infants, and 237 of them were not. Significant differences in the median weight-for-age and length-for-age z-scores were observed between SGA and non-SGA infants at birth, 1 month, 6 months, and 12 months. There was a significant difference between the growth patterns of SGA and non-SGA infants. Birth weight and sex significantly predicted the nutritional status(stunting and underweight) of SGA infants during their first year of life.
Conclusion: SGA infants can catch up to achieve normal growth during their first year of life. Even though the nutritional status of SGA infants trends worse than non-SGA infants, adequate infant birth weight monitoring and an emphasis on nutritional advice are crucial for maintaining well-being.
A narrative review of brain-derived neurotrophic factor (BDNF) on cognitive performance in Alzheimer's disease

Ismail NA, Leong Abdullah MFI, Hami R, Ahmad Yusof H

Growth Factors, 2021 01 11;38(3-4):210-225.
PMID: 33427532 DOI: 10.1080/08977194.2020.1864347

Brain-derived neurotrophic factor (BDNF) is a neurotrophin that is highly expressed in the brain. It influences neuronal survival, growth and acts as a control centre for neurotransmitters. It also plays a crucial role in learning and memory. Current evidence indicates that BDNF may be a possible neurotrophic factor that controls cognitive functions under normal and neuropathological conditions. Recent findings indicate a reduction in cognitive performance in individuals with Alzheimer's disease (AD). This relationship between cognitive performance and AD is important for investigating both the time they overlap and the pathophysiological mechanism in each case. Therefore, this study reviewed the existing knowledge about BDNF and cognitive performance in the AD population. The findings support the idea that this tropic factor may be a potential biomarker for evaluating the changes in cognitive performance in AD.
Comparative analysis of IVF-ICSI outcomes between advanced and early stage of endometriosis stimulated with HMG

Arshad AH, Azrai Abu M, Ahmad MF, Abdul Karim AK

Med J Malaysia, 2022 Jan;77(1):1-5.
PMID: 35086987

INTRODUCTION: Endometriosis is a challenging disease to treat, and patients may eventually need in vitro fertilisation with Intracytoplasmic sperm injection (IVF/ICSI) to conceive after other modalities failed. There are inconsistent outcomes of IVF performance in patients with endometriosis especially with highly purified human menotropin gonadotrophin (hMG). This study was commenced to determine whether the use of hMG affects the IVF outcome in different stage of endometriosis.
MATERIALS AND METHODS: This is an observational study. Eighty-seven women who had endometriosis confirmed surgically and underwent IVF/ICSI treatment, stimulated with hMG alone were included. Based on the revised American Society for Reproductive Medicine (rASRM), the participants were classified as early endometriosis (I/II) (n=39) or advanced endometriosis (III/IV) (n=35). The main outcome measures used were clinical pregnancy rate.
RESULTS: Women with advanced endometriosis had a lower oocyte yield, less good quality day-3 embryos and lower clinical pregnancy rate compared with the mild endometriosis. However, higher fertilisation rate were recorded in advanced stage endometriosis compared to milder disease.
CONCLUSIONS: The rASRM classification of endometriosis is valuable in predicting IVF outcome as advanced endometriosis performs poorly compared to a milder disease. Highly purified hMG could be an alternative as an ovarian stimulation in endometriosis.
Phytochemical constituents from Cassia alata with inhibition against methicillin-resistant Staphylococcus aureus (MRSA)

Hazni H, Ahmad N, Hitotsuyanagi Y, Takeya K, Choo CY

Planta Med, 2008 Dec;74(15):1802-5.
PMID: 18991205 DOI: 10.1055/s-0028-1088340

The methanolic extract of the leaves of CASSIA ALATA was sequentially partitioned in increasing polarity to afford the hexane, chloroform, butanol and residual extract. Crude extracts were evaluated against MRSA using the agar well diffusion assay. The butanol and chloroform extracts both exhibited inhibition against MRSA with inhibition indexes of 1.03 +/- 0.16 and 0.78 +/- 0.07 at the concentration of 50 mg/mL. The butanol extracts were further purified using silica gel and reverse phase chromatography to afford kaempferol ( 1), kaempferol 3- O-beta-glucopyranoside ( 2), kaempferol 3- O-gentiobioside ( 3) and aloe emodin ( 4). The four constituents showed varying degrees of inhibition against MRSA. Both 1 and 4 exhibited MIC (50) values of 13.0 +/- 1.5 microg/mL and 12.0 +/- 1.5 microg/mL, respectively. The kaempferol glycosides 2 and 3 were less active with MIC (50) values of 83.0 +/- 0.9 microg/mL and 560.0 +/- 1.2 microg/mL, respectively. A free hydroxyl group at C-3 of the flavonol structure is a structural requirement for the inhibition of MRSA.
Fulltext Molecular subversion of Cdc42 signalling in cancer

Murphy NP, Binti Ahmad Mokhtar AM, Mott HR, Owen D

Biochem Soc Trans, 2021 06 30;49(3):1425-1442.
PMID: 34196668 DOI: 10.1042/BST20200557

Cdc42 is a member of the Rho family of small GTPases and a master regulator of the actin cytoskeleton, controlling cell motility, polarity and cell cycle progression. This small G protein and its regulators have been the subject of many years of fruitful investigation and the advent of functional genomics and proteomics has opened up new avenues of exploration including how it functions at specific locations in the cell. This has coincided with the introduction of new structural techniques with the ability to study small GTPases in the context of the membrane. The role of Cdc42 in cancer is well established but the molecular details of its action are still being uncovered. Here we review alterations found to Cdc42 itself and to key components of the signal transduction pathways it controls in cancer. Given the challenges encountered with targeting small G proteins directly therapeutically, it is arguably the regulators of Cdc42 and the effector signalling pathways downstream of the small G protein which will be the most tractable targets for therapeutic intervention. These will require interrogation in order to fully understand the global signalling contribution of Cdc42, unlock the potential for mapping new signalling axes and ultimately produce inhibitors of Cdc42 driven signalling.
Upper limb infections: A comparison between diabetic and non-diabetic patients

Lim SH, Tunku Ahmad TS, Devarajooh C, Gunasagaran J

J Orthop Surg (Hong Kong), 2022 2 2;30(1):23094990221075376.
PMID: 35103531 DOI: 10.1177/23094990221075376

BACKGROUND: Upper limb infections are common among patients with diabetes mellitus and their sequelae can be debilitating. They tend to present with severe infections but minimal symptoms probably due to neuropathy and vasculopathy among diabetics. The study aims to compare the demographic characteristics, clinical presentations and outcomes of upper limb infections between diabetic and non-diabetic patients.
METHODS: All patients with upper limb infections who were admitted in a tertiary hospital from June 2017 to December 2020 were included in this study. Demographic data, clinical presentations, investigations and outcomes were obtained retrospectively from electronic medical record. There were 117 patients with diabetes mellitus and 127 with no diabetes mellitus. Comparisons were made between these two groups, and statistical analysis was done with SPSS.
RESULTS: There were 244 patients included; 117 were diabetic and 127 were non-diabetic. Diabetic patients were more likely to present with emergent scenarios, especially necrotizing fasciitis and infective tenosynovitis (p < .05) with higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) readings (p < .05). Their microbiological cultures were less likely to be negative (p < .05). Diabetic patients also had poorer clinical outcomes with higher risk of amputation, re-operation and longer duration of hospital stay (p < .05).
CONCLUSION: Upper limb infections among diabetic patients should be treated aggressively. Early diagnosis and surgical intervention might decrease the morbidity and mortality in this group. Prevention of infections should be emphasized.
Fulltext Ultrasound-assisted encapsulation of Pandan (Pandanus amaryllifolius) extract

Omer N, Choo YM, Ahmad N, Mohd Yusof NS

Ultrason Sonochem, 2021 Nov;79:105793.
PMID: 34673338 DOI: 10.1016/j.ultsonch.2021.105793

Pandan (Pandanus amaryllifolius) is commonly used as a food ingredient in Southeast Asia due to its delicious flavor, appetizing aroma and bright green colour. Pandan plant is uniquely found only in certain parts of the world. Despite its increasing popularity worldwide, its export market is limited by practical issues. One of the main problems for exporting Pandan to global market is its stability during transport. Due to the volatility of its active constituent, the functional properties of Pandan are lost during storage and shipment. In this study, we explored the ability of ultrasound processing technology to encapsulate the aromatic Pandan extract using lysozyme or chitosan as a shell material. 20 kHz ultrasonicator was used to encapsulate the pandan extract at 150 W of applied power. Two parameters, the ultrasonic probe tip and the core-to-shell ratio were varied to control the properties of the encapsulates. The diameters of the probe tip used were 0.3 and 1.0 cm. The core-to-shell volume ratios used were 1:160 and 1:40. The size distribution and the stability of the synthesized microspheres were characterized to understand and explore the possible parameters variation impact. Both size and size distribution of the microspheres were found to be influenced by the parameters varied to certain extent. The results showed that the mean size of the microspheres was generally smallest when using 1 cm probe tip with lower core-to-shell volume ratio but largest when using the 3 mm tip with higher core-to-shell volume ratio. This indicates that the sonication parameters could be fine-tuned to achieve the encapsulation of Pandan extract for storage and export. The pandan-encapsulated microspheres were also found to be stable during storage at least for one month.
A Case of Twisted Ovarian Cyst in a Young Patient and Review of the Literature

Idris S, Daud S, Ahmad Sani N, Tee Mei Li S

Am J Case Rep, 2021 Nov 17;22:e933438.
PMID: 34785630 DOI: 10.12659/AJCR.933438

BACKGROUND Adnexal torsion is a gynecologic emergency that dictates immediate surgical intervention. Twisted ovarian cysts are rare in adolescents, but they can cause significant distress to patients. Idiopathic ovarian torsion is uncommon in adolescents and the incidence is reportedly higher in women aged 20 to 40 years. Most twisted cysts in adolescents are benign. In the past, oophorectomy was commonly performed for a torsed ovary, but currently there is a trend toward ovary preservation. The diagnosis of twisted ovarian cyst is based on pathognomonic symptoms and findings from a focused clinical examination and ultrasound. Because the differential diagnosis includes acute appendicitis and gastroenteritis, referral to a gynecologist may be delayed. CASE REPORT We present the case of a huge, twisted ovarian cyst in a 16-year-old girl who presented with an acute abdomen. The initial diagnosis was acute appendicitis, which delayed her referral to a gynecologist. An emergency laparotomy and left salpingo-oophorectomy were performed. The histopathology of the ovarian cyst was reported as serous cystadenoma. CONCLUSIONS The optimal management of a twisted ovarian cyst in adolescents is the subject of much debate. Here, we review the literature on ovarian torsion in children and adolescents. The patient in the case we present had a twisted ovarian cyst that was managed with salpingo-oophorectomy.
Fulltext Knowledge, Attitude, and Practice of Evidence-Based Medicine among Emergency Doctors in Kelantan, Malaysia

Ahmad Ghaus MG, Tuan Kamauzaman TH, Norhayati MN

Int J Environ Res Public Health, 2021 10 27;18(21).
PMID: 34769813 DOI: 10.3390/ijerph182111297

This study aimed to determine the prevalence of high levels of knowledge, positive attitude, and good practice on evidence-based medicine (EBM) and identify the associated factors for practice score on EBM among emergency medicine doctors in Kelantan, Malaysia. This cross-sectional study was conducted in government hospitals in Kelantan. The data were collected from 200 emergency physicians and medical officers in the emergency department using the Noor Evidence-Based Medicine Questionnaire. Simple and general linear regressions analyses using SPSS were performed. A total of 183 responded, making a response rate of 91.5%. Of them, 49.7% had a high level of knowledge, 39.9% had a positive attitude and 2.1% had good practice. Sex, race, the average number of patients seen per day, internet access in workplace, having online quick reference application, and attitude towards EBM were significantly associated with EBM practice scores. It is recommended that appropriate authorities provide emergency doctors with broader access to evidence resources. EBM skill training should be enhanced in the current medical school curriculums.

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