Displaying publications 41 - 58 of 58 in total

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  1. Chua YP, Tan WJ, Yahya TS, Saw A
    Singapore Med J, 2013 Nov;54(11):630-3.
    PMID: 24276099
    INTRODUCTION: Foot pain is a common problem, especially in women, and studies have shown that it is related to footwear. This study was conducted to establish the prevalence of nontraumatic foot pain and its contributing factors in young working Malaysian women in an urban setting.

    METHODS: The survey was conducted on a group of working women (age range 21-40 years) selected using convenience sampling. Data on foot problems was collected through an investigator-directed questionnaire and during clinical inspection of the foot.

    RESULTS: A total of 400 women, with a mean age of 29.4 years, were recruited. Half (n = 200) of the women had experienced recurrent nontraumatic foot pain in the past one year. Subjective assessments of foot pain using the Numeric Intensity Scale gave an average score of 4.89 ± 1.78 (range 2-10), with most episodes occurring at the heel. There was no statistically significant association between foot pain and age, ethnicity or body mass index. However, there was a higher incidence of foot pain in women wearing high-heeled footwear than those wearing non-high-heeled footwear (p = 0.027, odds ratio 1.591).

    CONCLUSION: Nontraumatic foot pain is common among young working women in our society. More than half (68.4%) of the women with foot pain in our study attributed the pain to footwear. Wearing high-heeled shoes to work was a significant contributing factor. Increased public awareness on the importance of proper footwear may help to reduce the prevalence of nontraumatic foot pain in working women.
  2. Wong LP, Alias H, Tan SL, Saw A
    Anat Sci Int, 2023 Sep;98(4):558-565.
    PMID: 37072599 DOI: 10.1007/s12565-023-00723-9
    The new coronavirus disease 2019 (COVID-19) has had a substantial impact on the Silent Mentor Programme (SMP), a programme in which members of the public may pledge their bodies to be used for medical training and research after their death. This study aimed to explore the conduct of body donations and simulation surgery training during the COVID-19 pandemic from the viewpoints of the committee members of the SMP and the next-of-kin of body donor pledgers. This study utilised a qualitative exploration method to seek an in-depth understanding of this phenomenon. In-depth individual interviews were carried out. Thematic analysis was used to identify patterns of themes. The COVID-19 polymerase chain reaction (RT-PCR) test is compulsory before accepting a body donation, and this resulted in the turning down of several donations. Being a donor is the final wish of pledgers and this turning down led to a negative emotional remorseful feeling in the next-of-kin of pledgers. From the perspective of students, it is feared that the conduct of the programme, particularly the home visit session being held online, has impeded teaching of humanistic values, compassion, and empathy, which is the prime philosophy of the programme. Previous to the pandemic, the programme ceremonies were well-attended, denoting the utmost respect and recognition of the mentors; however, travel restrictions due to the pandemic limiting in-person attendance resulted in ceremonies becoming less impactful. Continuous postponements of cadaveric dissection training also resulted in students missing training opportunities, hence potentially impairing their professional practice and humanistic values in the medical profession. Counselling interventions should be directed at easing the negative psychological impact on the next-of-kin of pledgers. As the COVID-19 pandemic may pose a significant impediment to achieving the educational outcomes of cadaveric dissection training, efforts to make up for these gaps are essential.
  3. Tan WJ, Kwan MK, Deepak AS, Saw A, Peng BC, Jalalullah W
    Med J Malaysia, 2006 Dec;61 Suppl B:18-22.
    PMID: 17600988
    Fracture of the femur is most commonly treated with interlocking nailing. We conducted this study to describe and analyze the size of femoral interlocking nails used in our local population. This is a retrospective study on reamed intramedullary interlocking nailing procedures performed between 1st July 1998 and 30th June 2003. Demographic data, the diameter and length of femoral nails used were obtained from patient's medical record. A total of 267 procedures were included. The most common diameter used was 10 mm (56.9%), followed by 11 mm (27.0%) and 12 mm (13.1%). Only 2.6% of the nails were less than 10 mm in diameter. The most common nail length was 38 cm (31.1%), followed by 36 cm (24.9%) and 40 cm (19.5%). The longest nail used was 46 cm while the shortest 32 cm. The most commonly used femoral nails were of 10 mm diameter with the length ranging from 36 to 40 cm, which is smaller than those reported in the English literature. Nails with diameter smaller than 10 mm were required in 2.6% of patients.
  4. Saw A, Phang ZH, Alrasheed MK, Gunalan R, Albaker MZ, Shanmugam R
    J Orthop Surg (Hong Kong), 2019 9 19;27(3):2309499019873987.
    PMID: 31530084 DOI: 10.1177/2309499019873987
    PURPOSE: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy.

    METHODS: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA).

    RESULTS: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection.

    CONCLUSIONS: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.

  5. Islam MA, Mamun A, Hossain MM, Bharati P, Saw A, Lestrel PE, et al.
    PLoS One, 2019;14(4):e0215733.
    PMID: 31022237 DOI: 10.1371/journal.pone.0215733
    BACKGROUND: Early initiation of breastfeeding (EIBF) is associated with better health of the mothers and reduced risk of neonatal mortality. The objective of this study was to determine the prevalence of EIBF and associated factors among Bangladeshi mothers.

    METHODS: The data was extracted from the Bangladesh Demographic and Health Survey (BDHS)-2014. A total of 4,092 married non-pregnant Bangladeshi mothers who had at least one child aged 2 years or younger were included in this study. A two-level logistic regression model was used to remove the clustering effect for finding the impact of socio-economic and demographic factors on EIBF.

    RESULTS: The prevalence of EIBF among Bangladeshi mothers was 51.4% (urban: 47.1% and rural: 53.4%). A two -level logistic regression model showed that mothers living in the Sylhet division (p<0.01) and rural environment (p<0.05) were more likely to practice EIBF. Mothers who were obese or overweight (p<0.01), had secondary (p<0.05) or higher education (p<0.01) were less likely to provide early breastfeeding to their newborn babies compared to their counterparts. Those who delivered by caesarian-section (p<0.01) were less likely to perform EIBF while those who attended an antenatal care clinic more than 3 times (p<0.05) were more likely to do so.

    CONCLUSIONS: About half of the Bangladeshi mothers did not start breast-feeding within one hour after birth. This study identified several geographical and socio-demographic factors that were associated with EIBF, and hope that this information will help the government to focus their resources to promote early breastfeeding.

  6. Kamruzzaman M, Mamun ASMA, Bakar SMA, Saw A, Kamarul T, Islam MN, et al.
    J Biosoc Sci, 2017 Jul;49(4):498-508.
    PMID: 27866490 DOI: 10.1017/S0021932016000572
    The aim of this study was to investigate the socioeconomic and demographic factors influencing the body mass index (BMI) of non-pregnant married Bangladeshi women of reproductive age. Secondary (Hierarchy) data from the 2011 Bangladesh Demographic and Health Survey, collected using two-stage stratified cluster sampling, were used. Two-level linear regression analysis was performed to remove the cluster effect of the variables. The mean BMI of married non-pregnant Bangladeshi women was 21.60±3.86 kg/m2, and the prevalence of underweight, overweight and obesity was 22.8%, 14.9% and 3.2%, respectively. After removing the cluster effect, age and age at first marriage were found to be positively (p<0.01) related with BMI. Number of children was negatively related with women's BMI. Lower BMI was especially found among women from rural areas and poor families, with an uneducated husband, with no television at home and who were currently breast-feeding. Age, total children ever born, age at first marriage, type of residence, education level, level of husband's education, wealth index, having a television at home and practising breast-feeding were found to be important predictors for the BMI of married Bangladeshi non-pregnant women of reproductive age. This information could be used to identify sections of the Bangladeshi population that require special attention, and to develop more effective strategies to resolve the problem of malnutrition.
  7. Chung WH, Mihara Y, Toyat SS, Chiu CK, Hasan MS, Saw A, et al.
    Malays Orthop J, 2021 Nov;15(3):99-107.
    PMID: 34966502 DOI: 10.5704/MOJ.2111.015
    Introduction: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity.

    Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2).

    Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening.

    Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.

  8. Mahumud RA, Hossain MG, Sarker AR, Islam MN, Hossain MR, Saw A, et al.
    PMID: 29386920 DOI: 10.2147/OAJC.S76070
    Introduction: Contraceptive discontinuation is a worldwide incident that may be connected with low incentive to avoid pregnancy. Contraceptive discontinuation highly contributes to unplanned pregnancy and unwanted births.

    Objectives: The objective of this study was to observe the prevalence of discontinuation and switching of contraceptive methods among Bangladeshi married women. In addition, the sociodemographic factors associated with contraceptive discontinuation and switching were assessed.

    Methods: Secondary cross-sectional data was used in this study. A total of 16,273 married Bangladeshi women of reproductive age (15-49 years) were considered in the present study, from the Bangladesh Demographic and Health Survey, 2011. Logistic regression models were used to determine the relationships between key sociodemographic factors and user status.

    Results: The prevalence of discontinuation and switching of contraceptive method among women were 38.4% and 15.4%, respectively. The logistic regression model demonstrated that women in early reproductive years (25-29 years and 30-34 years) significantly more often (odds ratio [OR] =0.84 and 0.71, respectively) discontinued use of contraceptives. Significantly higher rates of discontinuation were pronounced among women who used the pill (OR =0.72) and injectable contraception users (OR =0.60), had small family size (OR =0.49), lived in a rural community (OR =1.65), and who were less educated (OR =1.55).

    Conclusion: Contraceptive discontinuation may reflect an association among less education, currently married, and smaller family size. Awareness of contraceptive methods can decrease the burden of unplanned pregnancies and thus progresses the family planning program.
  9. Wong LP, Tan SL, Alias H, Sia TE, Saw A
    Omega (Westport), 2023 Mar;86(4):1176-1189.
    PMID: 33818157 DOI: 10.1177/00302228211000952
    The COVID-19 pandemic has put a hold on the Silent Mentor Programme (SMP); this pause has not only caused unprecedented challenges for the delivery of medical education but has forced changes in the programme ceremony sessions. We aimed to describe the psychological impact and experiences of family members of silent mentors during the COVID-19 pandemic using qualitative interviews. Many expressed feelings of remorse and unrest about the unprecedented delay of the SMP. The delay increased negative emotions particularly among some elderly family members; however, there was no prominent negative effect on their functional health and well-being. Several participants relayed the belief that the soul cannot rest until the body receives a proper burial while some worried about the deterioration of the physical condition of the mentors. In conclusion, findings provide insights into the importance of not overlooking the mental health implications of delaying the SMP in future outbreaks or crises.
  10. Saw A, Sallehuddin AY, Chuah UC, Ismail MS, Yoga R, Hossain MG
    Singapore Med J, 2010 Sep;51(9):702-8.
    PMID: 20938610
    The pattern of fracture, including the anatomical location and age distribution, may differ among urban and rural populations due to various factors such as the inhabitants' occupation and living environment.
  11. Wong LP, Tan SL, Alias H, Sia TE, Saw A
    Omega (Westport), 2023 Nov;88(1):157-170.
    PMID: 34490819 DOI: 10.1177/00302228211043613
    This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p 
  12. Lau CF, Malek S, Gunalan R, Saw A, Milow P, Song C
    Health Informatics J, 2023;29(4):14604582231218530.
    PMID: 38019888 DOI: 10.1177/14604582231218530
    The paediatric orthopaedic expert system analyses and predicts the healing time of limb fractures in children using machine learning. As far we know, no published research on the paediatric orthopaedic expert system that predicts paediatric fracture healing time using machine learning has been published. The University Malaya Medical Centre (UMMC) offers paediatric orthopaedic data, comprises children under the age of 12 radiographs limb fractures with ages recorded from the date and time of initial trauma. SVR algorithms are used to predict and discover variables associated with fracture healing time. This study developed an expert system capable of predicting healing time, which can assist general practitioners and healthcare practitioners during treatment and follow-up. The system is available online at https://kidsfractureexpert.com/.
  13. Wong LP, Alias H, Tan SL, Sia TE, Saw A
    Omega (Westport), 2022 Oct 10.
    PMID: 36217612 DOI: 10.1177/00302228221132902
    Background: This study assesses the level of death anxiety among the family members of the Silent Mentor Programme (SMP) and determines whether their participation in various ceremonies during the training session impacted their death anxiety. Methods: The revised Collett-Lester Fear of Death Scale (CL-FODS) was administered to the study participants before the opening ceremony and after the sending-off ceremony of the programme. Results: All the four subscales that measure fear of one's own death, fear of the process of one's own dying, fear of the death of others and fear of the process of others dying in the CL-FODS showed significant reduction after the sending-off ceremony compared with before the opening ceremony. Younger family members reported significantly higher mean total death anxiety scores compared to the older members. Conclusion: The SMP not only nurtures doctors with humanity but also helps the family members to cope with grief and loss.
  14. Phang ZH, Albaker M, Gunalan R, Lee AYX, Saw A
    Singapore Med J, 2021 Nov 08.
    PMID: 34749494 DOI: 10.11622/smedj.2021189
    INTRODUCTION: The aim of this study was to determine whether any change in degree of medial tibia plateau depression after extra-articular mechanical realignment surgery was observed in children with Blount's disease who presented late for treatment in their adolescent and young adulthood.

    METHODS: We retrospectively reviewed the radiographic parameters of 22 patients (32 lower limbs) with Blount's disease who underwent gradual correction of deformity surgery using ring external fixator without surgical elevation of the depressed medial tibial plateau at a mean age of 15 (10-37) years. Preoperative and postoperative angles of depressed medial tibia plateau (ADMTP) of the same patient were compared for any significant change. Normally distributed data were analysed using Student's t-test when comparing two groups or one-way ANOVA when comparing more than two groups. Skewed data were analysed using Mann-Whitney test.

    RESULTS: After extra-articular mechanical alignment surgery, statistically significant improvements in medial tibial plateau depression were seen in the Infantile (p = 0.03) and Juvenile (p = 0.04) Blount's subgroups. Change of ADMTP was greater in patients who were operated on at age < 17 years, before skeletal maturity (p = 0.001). The improvement was likely due to ossification of unossified cartilage at the posteromedial proximal tibia and remodelling potential of proximal tibia physis after mechanical realignment.

    CONCLUSION: Improvement of medial tibia plateau depression is possible after mechanical realignment without surgical hemiplateau elevation in cases of Infantile and Juvenile Blount's disease that present late for treatment, especially when the operation is performed before age 17 years old.

  15. Kwan MK, Saw A, Chee EK, Lee CS, Lim CH, Zulkifle NA, et al.
    Med J Malaysia, 2006 Feb;61 Suppl A:17-20.
    PMID: 17042223
    Necrotizing fasciitis is a limb- and life-threatening rapidly spreading infection affecting the deep fascia with secondary necrosis of the subcutaneous tissue. It requires immediate medical attention and emergency surgery to prevent morbidity and death. This study was undertaken to determine its co-morbidity and risk factors affecting the outcome of its surgical treatment. This is a retrospective review of 36 cases of necrotizing fasciitis of the lower limb treated in our center between 1998 and 2002. Only 19% of the cases were correctly diagnosed upon admission and 48.6% were initially diagnosed as 'cellulitis'. Diabetes mellitus was the most common co-morbid. Pseudomonas, Staphylococcus, Streptococcus and Enterobactericae were the common pathogens isolated. Ten patients (27.8%) had major amputation as part of radical debridement. The overall mortality rate was 36% with laboratory parameters: high serum urea and creatinine, and low haemoglobin levels were predictors for higher mortality. Poor white cell response which is common in diabetic patients and a delay in surgical debridement were. notable attributes to a higher mortality. Necrotizing fasciitis is a serious infection associated with significant morbidity and mortality. A poor white blood cell response, high serum urea and creatinine, and low haemoglobin level were the predictors for mortality. Early diagnosis and prompt treatment are of paramount importance in the treatment of this infection.
  16. Yusuf A, Mamun ASMA, Kamruzzaman M, Saw A, Abo El-Fetoh NM, Lestrel PE, et al.
    BMC Pediatr, 2019 Jul 26;19(1):258.
    PMID: 31349810 DOI: 10.1186/s12887-019-1607-3
    Following publication of the original article [1], the authors reported that name that appeared in published online version is incorrect.
  17. Ong EKS, Wong TS, Chung WH, Chiu CK, Saw A, Hasan MS, et al.
    J Orthop Surg (Hong Kong), 2019 10 17;27(3):2309499019879213.
    PMID: 31615339 DOI: 10.1177/2309499019879213
    Aberrant left brachiocephalic vein is a rare condition. Its occurrence in patients requiring anterior cervicothoracic approach for severe kyphoscoliosis has not been described. A 16-year-old male with neurofibromatosis and severe upper thoracic kyphoscoliosis presented to us with curve progression. Halo gravity traction was attempted but failed to achieve significant correction. Subsequently, he underwent halo-pelvic traction and later Posterior Spinal Fusion (PSF) from C2 to T10. Second-stage anterior cervicothoracic approach with anterior fibula strut grafting was planned; however, preoperative computed tomography angiography revealed an aberrant left brachiocephalic vein with an anomalous retrotracheal and retroesophageal course, directly anterior to the T5/T6 vertebrae (planned anchor site for fibula strut graft) before draining into superior vena cava. Therefore, surgery was abandoned due to the risks associated with this anomaly. Aberrant left brachiocephalic vein is rare, the presence of which could be a contraindication for anterior cervicothoracic approach. Assessment of the anterior neurovascular structures is crucial in preoperative planning.
  18. Yusuf A, Mamun ASMA, Kamruzzaman M, Saw A, Abo El-Fetoh NM, Lestrel PE, et al.
    BMC Pediatr, 2019 06 29;19(1):213.
    PMID: 31255172 DOI: 10.1186/s12887-019-1581-9
    BACKGROUND: Anemia is not only a major public health problem among children in developing countries, it is also an important predictor for their future growth and development. The objective of this study was to identify possible factors associated with anemia among pre-school children in Bangladesh after removing a cluster effect of the population, and to determine the prevalence of this condition.

    METHODS: Data for this study was extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS-2011). In this survey, data was collected using a two-stage stratified cluster sampling approach. The chi-square test and a two-level logistic regression model were used for further analysis.

    RESULTS: Data from 2231 children aged 6-59 months were included for analysis. The prevalence of child anemia was noted to be 52.10%. Among these anemic children, 48.40% where from urban environment and 53.90% were from rural areas. The prevalence of mild, moderate and severe anemia among children was 57.10, 41.40 and 1.50% respectively. The two-level logistic regression model revealed that the following factors were associated with childhood anemia: children of anemic mothers (p 

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