MyMedR

Fulltext Mahmood Merican Award for Masters in Orthopaedic Surgery Trainees in Malaysia

Sara Ahmad, T.

Malays Orthop J, 2011;5(3):35-37.

MyJurnal

The Mahmood Merican Award is an annual award for the best original scientific or clinical study submitted by young trainees in orthopaedic surgery in Malaysia, for presentation during the annual scientific meeting of the Malaysian Orthopaedic Association (MOA). This award was initiated in 1997 to encourage high standard of research and scientific presentations among young trainees.A cash prize of RM 1,000 was donated by Dato Dr Mahmood Merican. All Award finalists will represent MOA as ambassadors to regional orthopaedic association meetings, a duty that will be fully sponsored by MOA.

Fulltext Splinter Removal with the Aid of Ultrasonography:A Case Report

Lee, C.K., Sara Ahmad, T., Abdullah, B.J.J.

Malays Orthop J, 2008;2(2):47-49.

MyJurnal

Splinter or foreign body removal from the hand and foot is a common occurrence. Usually only the deep seated, broken or missed splinters are referred to the surgeon for removal. Unless the object is radio-opaque, plain radiograph will not give any useful information, hence removal can sometimes be very difficult and traumatic. We are reporting a case where a radiolucent splinter was removed with the aid of ultrasonography. This modality can help to localize a splinter at the pre and intra-operative period, minimizing amount of exploration and time of operation.

Fulltext Fibula Osteocutaneous Flap for Mandible Reconstruction after Ameloblastoma Resection: Amending Technique to Reduce Ischaemic Time

Chee, E.K., Sara Ahmad, T., Ng, E.S.

Malays Orthop J, 2007;1(1):39-41.

MyJurnal

A 27-year-old patient with ameloblastoma of the mandible
underwent anterior mandibulectomy and reconstruction with
left fibula osteocutaneous flap. The bone was shaped at the
lower limb before cutting the pedicle. Vascularised free fibula flap provides a good alternative to other bone grafts in mandible reconstruction as it is relatively easy to perform, carries a low complication rate, and mandibular shaping with intact pedicle cuts down on ischaemic as well as total operative time.

Fulltext Spinal cord stimulation for treatment of failed back surgery syndrome--two case reports

Vijayan R, Ahmad TS

Med J Malaysia, 1999 Dec;54(4):509-13.

PMID: 11072471

Severe, persistent back pain following back surgery is often referred to as Failed Back Surgery Syndrome (FBSS). Conservative measures such as physiotherapy, back strengthening exercises, transcutaneous electrical nerve stimulation and epidural steroids may be inadequate to alleviate pain. Spinal Cord Stimulators were implanted into two patients suffering from FBSS. Both patients responded successfully to spinal cord stimulation with reduction of pain and disability.

Prospects of banana waste utilization in wastewater treatment: A review

Ahmad T, Danish M

J Environ Manage, 2018 Jan 15;206:330-348.

PMID: 29100146 DOI: 10.1016/j.jenvman.2017.10.061

This review article explores utilization of banana waste (fruit peels, pseudo-stem, trunks, and leaves) as precursor materials to produce an adsorbent, and its application against environmental pollutants such as heavy metals, dyes, organic pollutants, pesticides, and various other gaseous pollutants. In recent past, quite a good number of research articles have been published on the utilization of low-cost adsorbents derived from biomass wastes. The literature survey on banana waste derived adsorbents shown that due to the abundance of banana waste worldwide, it also considered as low-cost adsorbents with promising future application against various environmental pollutants. Furthermore, raw banana biomass can be chemically modified to prepare efficient adsorbent as per requirement; chemical surface functional group modification may enhance the multiple uses of the adsorbent with industrial standard. It was evident from a literature survey that banana waste derived adsorbents have significant removal efficiency against various pollutants. Most of the published articles on banana waste derived adsorbents have been discussed critically, and the conclusion is drawn based on the results reported. Some results with poorly performed experiments were also discussed and pointed out their lacking in reporting. Based on literature survey, the future research prospect on banana wastes has a significant impact on upcoming research strategy.

Steroid injection versus NSAID injection for trigger finger: a comparative study of early outcomes

Shakeel H, Ahmad TS

J Hand Surg Am, 2012 Jul;37(7):1319-23.

PMID: 22721455 DOI: 10.1016/j.jhsa.2012.03.040

Stenosing tenosynovitis of the flexor tendon sheath of the digits of the hand results from a discrepancy between the diameter of the flexor tendon and its sheath at the A1 pulley. The treatment options for trigger digits include oral nonsteroidal anti-inflammatory drugs (NSAIDs) and local NSAID applications, splintage, steroid injection, and percutaneous and open release of the A1 pulley. Injectable NSAID is used intramuscularly and locally in other sites. The hypothesis is that an injectable NSAID is as effective as the traditionally used steroid injection in the treatment of trigger digit, based on Quinnell grading, and that the treatment works as well in patients with diabetes as in those without diabetes.

Fulltext Primary osteosarcoma of the sphenoid wing in a middle-aged woman with extensive intracranial extension: A case report

Ong WF, Musa AT, Ooi LW, Karim NKA

J Taibah Univ Med Sci, 2021 Dec;16(6):943-947.

PMID: 34899138 DOI: 10.1016/j.jtumed.2021.07.007

Primary osteosarcomas involving the base of the skull in middle-aged patients are rare. We describe the case of a 59-year-old Asian woman presenting with lethargy, epistaxis, left maxillary and mandibular pain, and headache. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large left greater sphenoid wing tumour with extensive local infiltration and intracranial extension. The tumour was diagnosed as osteosarcoma based on histological examination. In this report, we discuss the clinical presentations, radiological features, and imaging differential diagnoses of this case.

The Effect of Topical Agents on the Tensile Strength of Absorbable and Non-absorbable Suture Materials-An in Vitro Study

Alnaqi A, Burhamah W, Al-Sultan AT, Taqi E

World J Surg, 2023 Feb;47(2):448-454.

PMID: 36316513 DOI: 10.1007/s00268-022-06788-3

INTRODUCTION: Topical agents are sometimes applied to surgical wounds after closure; these may include antiseptics or antibiotics. Minimal research has been undertaken to investigate the effect of topical regimens on the tensile strength of suture materials.

AIM: To investigate the effect of four commonly used wound care regimens on the tensile strength of suture materials.

METHODS: The failure load of 9 different suture materials was tested using the Instron Electroplus E3000 tensile testing machine (Instron Corporation, Norwood, Massachusetts). Tensile strength was represented as the failure load, measured in Newtons (N), and defined as the maximal load that could be applied across the suture prior to failure. Each suture was tested dry and after immersion in one of 4 products for 7 days and tested on day 7. The immersion agents tested were: sodium chloride 0.9%, MicroSafe® (Sonoma Pharmaceuticals, Petaluma, CA), Aqueous Povidone-iodine 10% solution (Betadine-Mundipharma), and Fucidin ointment.

RESULTS: Sodium chloride 0.9%, MicroSafe®, Aqueous Povidone-iodine 10%, and Fucidin seem to increase the failure load of most absorbable and non-absorbable sutures. However, the failure load of Polyglactin 910 suture (Surgilactin, coated, violet-Ethicon) is reduced by long-term exposure to either sodium chloride 0.9% or MicroSafe®, while the failure load of the Polydioxanone suture (PDS Plus-Ethicon) is reduced by long-term exposure to MicroSafe® only.

CONCLUSION: In our experiment, the commonly used wound care products have been shown to alter the tensile strength of suture materials. Further human studies are required to ascertain the clinical validity and applicability of our findings.

Fulltext A modified Blatt dorsal capsulodesis in the treatment of dynamic scapholunate instability

Azura L, Ahmad TS, Kamarul T

Med J Malaysia, 2006 Dec;61 Suppl B:51-4.

PMID: 17600993

We report a case of scapholunate dissociation which was initially missed and presented late. A modification of Blatt dorsal capsulodesis performed using dorsal intercarpal ligament (DICL) and extra tunnel appears not only to add to dorsal stability but also address the volar problem as well. This modification may be a better alternative to the current technique of using a single flap.

Fulltext Automatic top loader washing machine related injury. A report of four cases with serious injury

Kwan MK, Saw A, Sara Ahmad T

Med J Malaysia, 2005 Mar;60(1):112-4.

PMID: 16250295 MyJurnal

We are reporting four cases of serious washing machine related injury that presented within a period of 5 months. All patients were young children with the mean age of 9 year-old and three had their dominant hand injured. The washing machines involved were the automatic top loader type and all injuries occurred during the spinning phase. Serious automatic washing machine injury is not uncommon in Malaysia. We feel that there is a need to improve the safety features especially during the spinning phase. The operating instructions and safety precautions on the washing machine should be displayed in different languages that can be understood well. Parents should also aware of the potential risks of this seemingly benign household appliance.

Fulltext Thumb Schwannoma : A Frequent Misdiagnosis

Mooi SS, Ahmad TS

Malays Orthop J, 2016 Mar;10(1):53-54.

PMID: 28435548 MyJurnal DOI: 10.5704/MOJ.1603.010

A 32 year-old Malay lady presented with a swelling over the dorsal surface of her right thumb for 6 months. The swelling was non-tender, smooth surfaced, mobile and nonfluctuating with no bony involvement. The provisional diagnosis was ganglion cyst. Excisional biopsy did not show features of ganglion cyst as it appeared to be wellencapsulated, multi-lobulated and yellowish in colour. Histopathological examination showed that it was a schwannoma. Schwannomas are relatively rare benign tumours which are frequently misdiagnosed. In this case, it was misdiagnosed both as a ganglion and a lipoma.

Simplifying four-strand flexor tendon repair using double-stranded suture: a comparative ex vivo study on tensile strength and bulking

Low TH, Ahmad TS, Ng ES

J Hand Surg Eur Vol, 2012 Feb;37(2):101-8.

PMID: 21636621 DOI: 10.1177/1753193411409840

We have compared a simple four-strand flexor tendon repair, the single cross-stitch locked repair using a double-stranded suture (dsSCL) against two other four-strand repairs: the Pennington modified Kessler with double-stranded suture (dsPMK); and the cruciate cross-stitch locked repair with single-stranded suture (Modified Sandow). Thirty fresh frozen cadaveric flexor digitorum profundus tendons were transected and repaired with one of the core repair techniques using identical suture material and reinforced with identical peripheral sutures. Bulking at the repair site and tendon-suture junctions was measured. The tendons were subjected to linear load-to-failure testing. Results showed no significant difference in ultimate tensile strength between the Modified Sandow (36.8 N) and dsSCL (32.6 N) whereas the dsPMK was significantly weaker (26.8 N). There were no significant differences in 2 mm gap force, stiffness or bulk between the three repairs. We concluded that the simpler dsSCL repair is comparable to the modified Sandow repair in tensile strength, stiffness and bulking.

A preliminary study of the effects of glucosamine sulphate and chondroitin sulphate on surgically treated and untreated focal cartilage damage

Kamarul T, Ab-Rahim S, Tumin M, Selvaratnam L, Ahmad TS

Eur Cell Mater, 2011 Mar 15;21:259-71; discussion 270-1.

PMID: 21409755

The effects of Glucosamine Sulphate (GS) and Chondroitin Sulphate (CS) on the healing of damaged and repaired articular cartilage were investigated. This study was conducted using 18 New Zealand white rabbits as experimental models. Focal cartilage defects, surgically created in the medial femoral condyle, were either treated by means of autologous chondrocyte implantation (ACI) or left untreated as controls. Rabbits were then divided into groups which received either GS+/-CS or no pharmacotherapy. Three rabbits from each group were sacrificed at 12 and 24 weeks post-surgery. Knees dissected from rabbits were then evaluated using gross quantification of repair tissue, glycosaminoglycan (GAG) assays, immunoassays and histological assessments. It was observed that, in contrast to untreated sites, surfaces of the ACI-repaired sites appeared smooth and continuous with the surrounding native cartilage. Histological examination demonstrated a typical hyaline cartilage structure; with proteoglycans, type II collagen and GAGs being highly expressed in repair areas. The improved regeneration of these repair sites was also noted to be significant over time (6 months vs. 3 months) and in GS and GS+CS groups compared to the untreated (without pharmacotherapy) group. Combination of ACI and pharmacotherapy (with glucosamine sulphate alone/ or with chondroitin sulphate) may prove beneficial for healing of damaged cartilage, particularly in relation to focal cartilage defects.

The role of wrist anthropometric measurement in idiopathic carpal tunnel syndrome

Lim PG, Tan S, Ahmad TS

J Hand Surg Eur Vol, 2008 Oct;33(5):645-7.

PMID: 18662961 DOI: 10.1177/1753193408093326

Anthropometric wrist measurement ratios were examined for an association with idiopathic carpal tunnel syndrome (CTS). Wrist measurements were recorded in 67 patients with CTS and in a matched control group of 67 healthy volunteers. The Wrist Ratio (WR) (wrist anterior to posterior dimension/wrist medial-lateral dimension) and the Wrist Palm Ratio (wrist anterior to posterior dimension/palm length) were calculated for each case. We found that a WR of > or =0.70 and a Wrist Palm Ratio of >0.342 were significantly associated with idiopathic CTS.

Fulltext Quantitative and qualitative evaluation of sural nerve graft donor site

Ng SS, Kwan MK, Ahmad TS

Med J Malaysia, 2006 Dec;61 Suppl B:13-7.

PMID: 17600987

This study is designed to evaluate twenty patients after sural nerve harvest using the single longitudinal incision method. The area of sensory loss to pin prick was assessed by the authors at different intervals. Donor site factors, scar cosmesis, functional status and complications were assessed using a questionnaire. The mean area of anaesthesia at one month was 65 cm2 and it had reduced by 77% to 15 cm2 at one and a half years. The mean area of reduced sensation was 49 cm2 at one month and it increased by 18% to 58 cm2 over the same period. Therefore, the total area of sensory deficit was reduced by 36% from 114 cm2 at one month to 73 cm2 at one and a half years. Subjective patient evaluation indicated moderate level of pain during immediate post surgical period, which reduced significantly at one month. A low level of neuroma symptoms was recorded throughout the study period. At a mean follow-up period of two years, there was no area of anaesthesia in 50% of the patients. Mean area of anaesthesia for all patients was 12 cm2 and mean area of reduced sensation was 55 cm2. Subjective patient evaluation indicated a low level of pain, neuroma symptoms and numbness over the sural nerve sensory distribution. Twenty five percent of the patients were not satisfied with the scar appearance. Function and daily activities were not affected significantly. No surgical complications were observed.

Fulltext A novel and improved method of predicting hand grip strength in the adult Malaysian population

Kamarul T, Ahmad TS, Loh WY

Med J Malaysia, 2006 Dec;61 Suppl B:37-44.

PMID: 17600991

Hand grip strength measurement is a recognized part of hand function assessment. The standard measurement using the Jamar dynamometer and comparing these results to the recommended normal values suggested by the manufacturers of the Jamar was questioned as these values were based on Western population. A study comparing a novel method of predicting grip strength using our software was conducted on 25 normal subjects using the LIDO kinetic workset (Group A and B ). These results were then compared against our predictive software (Group A) and the expected values supplied together with the Jamar Dynamometer (Group B). In another group, 22 normal subjects were tested using the Jamar (Group C and D) and then matched against the predicted values using their recommended chart (Group C). The last group (Group D) was tested using the Jamar but the values attained were compared to the results from our software. In group A, the predictability of our predictive method was 100% (both R & L) as compared to (R = 64%, L = 68%) in group B, (R = 27.3%, L = 59.1%) in group C and (R = 81.8%, L = 86.4%) in group D. The differences between the predictability of both methods were statistically significant. The data collected using both the Jamar and the LIDO kinetic workset correlated well to the data from our software but not to the values suggested by the manufacturers of Jamar. We conclude that our method of predicting hand grip values are superior to that suggested by the manufacturers of dynamometers. The standard reference for hand grip strength provided by the manufacturers is less accurate in predicting the grip strength of our local population.

Fulltext Reconstruction of the heel defect with in-step island flap. A report of four cases

Kwan MK, Marican AM, Ahmad TS

Med J Malaysia, 2005 Jul;60 Suppl C:104-7.

PMID: 16381293

Soft tissue loss of the heel is difficult to treat as it may cause significant morbidity particularly recurrent ulceration and subsequent chronic osteomyelitis. Reconstruction of such defect with local flap can provide good result. We report our experience in treating four patients with heel defect using the in-step island flap. The flap, which is based on the medial plantar neurovascular pedicle, provides a sensate durable tissue required for weight-bearing and normal gait.

Fulltext Marjolin's ulcer--a near forgotten entity

Tan BC, Horton TC, Sara Ahmad T

Med J Malaysia, 2006 Feb;61 Suppl A:91-3.

PMID: 17042239

We report a case of a 55-year-old man who presented with a 6-month history of a fungating ulcer on the right hand at the site of a previously healed ulcer that had been present for 40 years. Histopathological examination of four-quadrant biopsy specimens showed a moderately differentiated squamous cell carcinoma (SCC). A transradiocarpal amputation with stump closure using radial flap was performed as it was not possible to achieve a functionally and cosmetically acceptable hand after a wide excision with 2 cm tumour-free margin. It is our intention to highlight this rare condition as reminder to consider this entity as a differential diagnosis of chronic non-healing skin ulcer.

Hand grip strength in the adult Malaysian population

Kamarul T, Ahmad TS, Loh WY

J Orthop Surg (Hong Kong), 2006 Aug;14(2):172-7.

PMID: 16914783

To measure the hand grip strength of Malaysians aged 18 to 65 years.

The use of an aberrant flexor carpi ulnaris tendon with an ulnar artery island forearm flap for reconstruction of a dorsal defect of the hand

Jeyaratnam TS, Ahmad TS, Kassim NM

Hand Surg, 2001 Jul;6(1):99-102.

PMID: 11677671