Displaying publications 1 - 20 of 37 in total

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  1. Yunus RM
    J Elder Abuse Negl, 2021 04 27;33(2):145-150.
    PMID: 33906576 DOI: 10.1080/08946566.2021.1919271
    This commentary highlights the issue of under-reporting of elder abuse and neglect (EAN) in the Malaysian context. It attempts to elucidate the findings of the 2018 National Health and Morbidity Survey (NHMS) related to the trend of reporting among EAN victims, and offer some recommendations.
  2. Yunus RM, Hairi NN
    Asia Pac J Public Health, 2020 01;32(1):57.
    PMID: 32019319 DOI: 10.1177/1010539520903541
  3. Memon MA, Yunus RM
    Surg Laparosc Endosc Percutan Tech, 2020 Jul 17;31(1):85-95.
    PMID: 32694405 DOI: 10.1097/SLE.0000000000000842
    BACKGROUND: To explore the perioperative outcomes, safety, and effectiveness of minimally invasive esophagectomy (MIE) versus open esophagectomy (OE).

    MATERIALS AND METHODS: Randomized controlled comparing MIE versus OE were searched from PubMed and other electronic databases between January 1991 and March 2019. Thirteen outcome variables were analyzed. Random effects model was used to calculate the effect size. The meta-analysis was prepared in accordance with PRISMA guidelines.

    RESULTS: Four randomized controlled trials totaling 569 patients were analyzed. For MIE, there was a significantly reduction of 67% in the odds of pulmonary complications. For operating time, MIE was nonsignificantly 29 minutes longer. MIE was associated with nonsignificantly less blood loss of 443.98 mL. There was nonsignificant 60% reduction in the odds of total complications and 51% reduction in the odds of medical complications favoring MIE group. For delayed gastric emptying, there was a nonsignificant reduction of 75% in the odds ratio favoring the MIE group. For postoperative anastomotic leak, there was a nonsignificant increase of 48% in the odds ratio for MIE group. For gastric necrosis, chylothorax, reintervention and 30-day mortality, no difference was observed for both groups. There was a nonsignificant reduction in the length of hospital stay of 7.98 days and intensive care unit stay of 2.7 days favoring MIE.

    CONCLUSIONS: MIE seems to be superior to OE for only pulmonary complications. All the other perioperative variables were comparable however, the trend is favoring the MIE. Therefore, the routine use of MIE presently may only be justifiable in high volume esophagogastric units.

  4. Yunus RM, Hairi NN, Choo WY
    Trauma Violence Abuse, 2019 04;20(2):197-213.
    PMID: 29333999 DOI: 10.1177/1524838017692798
    This article presents the results of a systematic review of the consequences of elder abuse and neglect (EAN). A systematic search was conducted in seven electronic databases and three sources of gray literature up to January 8, 2016, supplemented by scanning of citation lists in relevant articles and contact with field experts. All observational studies investigating elder abuse as a risk factor for adverse health outcomes, mortality, and health-care utilization were included. Of 517 articles initially captured, 19 articles met our inclusion criteria and were analyzed. Two reviewers independently performed abstract screening, full-texts appraisal, and quality assessment using the Newcastle-Ottawa Scale. Across 19 studies, methodological heterogeneity was a prominent feature; seven definitions of EAN and nine measurement tools for abuse were employed. Summary of results reveals a wide range of EAN outcomes, from premature mortality to increased health-care consumption and various forms of physical and psychological symptoms. Higher risks of mortality emerged as the most credible outcome, while the majority of morbidity outcomes originated from cross-sectional studies. Our findings suggest that there is an underrepresentation of older adults from non-Western populations and developing countries, and there is a need for more population-based prospective studies in middle- and low-income regions. Evidence gathered from this review is crucial in upgrading current practices, formulating policies, and shaping the future direction of research.
  5. Osland E, Yunus RM, Khan S, Memon B, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2016 Jun;26(3):193-201.
    PMID: 27258909 DOI: 10.1097/SLE.0000000000000279
    Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG), have been proposed as cost-effective strategies to manage obesity-related chronic disease. The objectives of this meta-analysis and systematic review were to analyze the "late postoperative complication rate (>30 days)" for these 2 procedures.
  6. Memon MA, Memon B, Yunus RM, Khan S
    Surg Laparosc Endosc Percutan Tech, 2016 Apr;26(2):102-16.
    PMID: 26841319 DOI: 10.1097/SLE.0000000000000243
    The aim of this study was to conduct a meta-analysis and systematic review of randomized controlled trials (RCTs) comparing 2 methods of colonic insufflation for elective colonoscopy, that is, carbon dioxide (CO2) or air, and to evaluate their efficiency, safety, and side effects.
  7. Osland E, Yunus RM, Khan S, Memon B, Memon MA
    Surg Endosc, 2017 04;31(4):1952-1963.
    PMID: 27623997 DOI: 10.1007/s00464-016-5202-5
    BACKGROUND: The prevalence of type 2 diabetes is growing in both developed and developing countries and is strongly linked with the prevalence of obesity. Bariatric surgical procedures such as laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are increasingly being utilized to manage related comorbid chronic conditions, including type 2 diabetes.

    METHODS: A systematic review of randomized controlled trials (RCTs) was undertaken using the PRISMA guidelines to investigate the postoperative impact on diabetes resolution following LVSG versus LRYGB.

    RESULTS: Seven RCTs involving a total of 732 patients (LVSG n = 365, LRYGB n = 367) met inclusion criteria. Significant diabetes resolution or improvement was reported with both procedures across all time points. Similarly, measures of glycemic control (HbA1C and fasting blood glucose levels) improved with both procedures, with earlier improvements noted in LRYGB that stabilized and did not differ from LVSG at 12 months postoperatively. Early improvements in measures of insulin resistance in both procedures were also noted in the studies that investigated this.

    CONCLUSIONS: This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative type 2 diabetes in obese patients during the reported 3- to 5-year follow-up periods. However, further studies are required before longer-term outcomes can be elucidated. Areas identified that need to be addressed for future studies on this topic include longer follow-up periods, standardized definitions and time point for reporting, and financial analysis of outcomes obtained between surgical procedures to better inform procedure selection.

  8. Awaiz A, Yunus RM, Khan S, Memon B, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2017 Jun;27(3):123-131.
    PMID: 28472017 DOI: 10.1097/SLE.0000000000000402
    AIMS AND OBJECTIVES: Laparoscopic Heller myotomy (LHM) is the preferred surgical method for treating achalasia. However, peroral endoscopic myotomy (POEM) is providing good short-term results. The objective of this systematic review and meta-analysis was to compare the safety and efficacy of LHM and POEM.

    MATERIALS AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, and current contents for English-language articles comparing LHM and POEM between 2007 and 2016 was performed. Variables analyzed included prior endoscopic treatment, prior medical treatment, prior Heller myotomy, operative time, overall complications rate, postoperative gastroesophageal reflux disease (GERD), length of hospital stay, postoperative pain score, and long-term GERD.

    RESULTS: Seven trials consisting of 483 (LHM=250, POEM=233) patients were analyzed. Preoperative variables, for example, prior endoscopic treatment [odds ratio (OR), 1.32; 95% confidence interval (CI), 0.23-4.61; P=0.96], prior medical treatment [weighted mean difference (WMD), 1.22; 95% CI, 0.52-2.88; P=0.65], and prior Heller myotomy (WMD, 0.47; 95% CI, 0.13-1.67; P=0.25) were comparable. Operative time was 26.28 minutes, nonsignificantly longer for LHM (WMD, 26.28; 95% CI, -11.20 to 63.70; P=0.17). There was a comparable overall complication rate (OR, 1.25; 95% CI, 0.56-2.77; P=0.59), postoperative GERD rate (OR, 1.27; 95% CI, 0.70-2.30; P=0.44), length of hospital stay (WMD, 0.30; 95% CI, -0.24 to 0.85; P=0.28), postoperative pain score (WMD, -0.26; 95% CI, -1.58 to 1.06; P=0.70), and long-term GERD (WMD, 1.06; 95% CI, 0.27-4.1; P=0.08) for both procedures. There was a significantly higher short-term clinical treatment failure rate for LHM (OR, 9.82; 95% CI, 2.06-46.80; P<0.01).

    CONCLUSIONS: POEM compares favorably to LHM for achalasia treatment in short-term perioperative outcomes. However, there was a significantly higher clinical treatment failure rate for LHM on short-term postoperative follow-up. Presently long-term postoperative follow-up data for POEM beyond 1 year are unavailable and eagerly awaited.
  9. Osland E, Yunus RM, Khan S, Memon B, Memon MA
    Obes Surg, 2017 May;27(5):1208-1221.
    PMID: 27896647 DOI: 10.1007/s11695-016-2469-5
    PURPOSE: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this systematic review was to study the peer review literature regarding postoperative nondiabetic comorbid disease resolution or improvement reported from randomized controlled trials (RCTs) comparing LVSG and LRYGB procedures.

    MATERIAL AND METHODS: RCTs comparing postoperative comorbid disease resolution such as hypertension, dyslipidemia, obstructive sleep apnea, joint and musculoskeletal conditions, gastroesophageal reflux disease, and menstrual irregularities following LVSG and LRYGB were included for analysis. The studies were selected from PubMed, Medline, EMBASE, Science Citation Index, Current Contents, and the Cochrane database and reported on at least one comorbidity resolution or improvement. The present work was undertaken according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA). The Jadad method for assessment of methodological quality was applied to the included studies.

    RESULTS: Six RCTs performed between 2005 and 2015 involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on the resolution or improvement of comorbid disease following LVSG and LRYGB procedures. Both bariatric procedures provide effective and almost comparable results in improving or resolving these comorbidities.

    CONCLUSIONS: This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative nondiabetic comorbid diseases in obese patients. While results are not conclusive at this time, LRYGB may provide superior results compared to LVSG in mediating the remission and/or improvement in some conditions such as dyslipidemia and arthritis.

  10. Memon MA, Yunus RM, Memon B, Awaiz A, Khan S
    Surg Laparosc Endosc Percutan Tech, 2018 Dec;28(6):337-348.
    PMID: 30358650 DOI: 10.1097/SLE.0000000000000589
    AIMS AND OBJECTIVES: The aim was to conduct a systematic review and meta-analysis of the randomized evidence to determine the relative merits of perioperative outcomes of laparoscopic-assisted (LARR) versus open rectal resection (ORR) for proven rectal cancer.

    MATERIALS AND METHODS: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified English-language randomized clinical trials comparing LARR and ORR. The meta-analysis was prepared in accordance with the PRISMA statement. Thirteen outcome variables were analyzed. Random effects meta-analyses were performed due to heterogeneity.

    RESULTS: A total of 14 randomized clinical trials that included 3843 rectal resections (LARR 2096, ORR 1747) were analyzed. The summary point estimates favored LARR for the intraoperative blood loss, commencement of oral intake, first bowel movement, and length of hospital stay. There was significantly longer duration of operating time of 38.29 minutes for the LARR group. Other outcome variables such as total complications, postoperative pain, postoperative ileus, abdominal abscesses, postoperative anastomotic leak, reintervention and postoperative mortality rates were found to have comparable outcomes for both cohorts.

    CONCLUSIONS: LARR was associated with significantly reduced blood loss, quicker resumption of oral intake, earlier return of gastrointestinal function, and shorter length of hospital stay at the expense of significantly longer operating time. Postoperative morbidity and mortality and analgesia requirement for both these groups were comparable. LARR seems to be a safe and effective alternative to ORR; however, it needs to be performed in established colorectal units with experienced laparoscopic surgeons.

  11. Osland E, Yunus RM, Khan S, Memon B, Memon MA
    PMID: 28145963 DOI: 10.1097/SLE.0000000000000374
    PURPOSE: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage morbid obesity. The aim of this meta-analysis was to compare the postoperative weight loss outcomes reported in randomized control trials (RCTs) for LVSG versus LRYGB procedures.

    MATERIAL AND METHODS: RCTs comparing the weight loss outcomes following LVSG and LRYGB in adult population between January 2000 and November 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The review was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA).

    RESULTS: Nine unique RCTs described over 10 publications involving a total of 865 patients (LVSG, n=437; LRYGB, n=428) were analyzed. Postoperative follow-up ranged from 3 months to 5 years. Twelve-month excess weight loss (EWL) for LVSG ranged from 69.7% to 83%, and for LRYGB, ranged from 60.5% to 86.4%. A number of studies reported slow weight gain between the second and third years of postoperative follow-up ranging from 1.4% to 4.2%EWL. This trend was seen to continue to 5 years postoperatively (8% to 10%EWL) for both procedures.

    CONCLUSIONS: In conclusion, LRYGB and LVSG are comparable with regards to the weight loss outcomes in the short term, with LRYGB achieving slightly greater weight loss. Slow weight recidivism is observed after the first postoperative year following both procedures. Long-term reporting of outcomes obtained from well-designed studies using intention-to-treat analyses are identified as a major gap in the literature at present.

  12. Memon MA, Memon B, Yunus RM, Khan S
    Ann Surg, 2016 Feb;263(2):258-66.
    PMID: 26445468 DOI: 10.1097/SLA.0000000000001267
    The aim was to conduct a meta-analysis of randomized controlled trials (RCTs) comparing 2 methods of hiatal closure for large hiatal hernia and to evaluate their strengths and flaws.
  13. Hassan MA, Yunus RM, Khan S, Memon MA
    World J Surg, 2021 10;45(10):3080-3091.
    PMID: 34279690 DOI: 10.1007/s00268-021-06238-6
    BACKGROUND: With many different operative techniques in use to reduce the incidence of incisional hernias (IH) following a midline laparotomy, there is no consensus among the clinicians on the efficacy and safety of any particular repair technique. This meta-analysis compares the prophylactic onlay mesh repair (POMR) and primary suture repair (PSR) for the incidence of IH.

    METHODS: A meta-analysis and systematic review of MEDLINE, PubMed Central (via PubMed), Embase (via Ovid), SCOPUS, ScienceDirect, Google Scholar, SCI and Cochrane Library databases were undertaken. Seven randomized controlled trials assessing the outcomes of PSR and POMR were analyzed in accordance with the PRISMA statement. The risk of bias was assessed using the Rob2 tool.

    RESULTS: According to the pooled analysis, POMR significantly reduced the incidence of IH compared to the PSR (OR 5.82 [95% CI 2.69, 12.58] P 

  14. Memon MA, Awaiz A, Yunus RM, Memon B, Khan S
    Am J Surg, 2018 11;216(5):1004-1015.
    PMID: 29958656 DOI: 10.1016/j.amjsurg.2018.06.012
    BACKGROUND: We conducted a meta-analysis of the randomized evidence to determine the relative merits of histopathological outcomes of laparoscopic assisted (LARR) versus open rectal resection (ORR) for rectal cancer.

    DATA SOURCES: A search of PubMed and other electronic databases comparing LARR and ORR between Jan 2000 and June 2016 was performed. Histopathological variables analyzed included; location of rectal tumors; complete and incomplete TME; positive and negative circumferential resection margins (+/-CRM); positive distal resected margins (+DRM); distance of tumor from DRM; number of lymph nodes harvested; resected specimen length; tumor size and perforated rectum.

    RESULTS: Fourteen RCTs totaling 3843 patients (LARR = 2096, ORR = 1747) were analyzed. Comparable effects were noted for all these histopathological variables except for the variable perforated rectum which favored ORR.

    CONCLUSIONS: LARR compares favorably to ORR for rectal cancer treatment. However, there is significantly higher risk of rectal perforation during LARR compared to ORR.

  15. Osland EJ, Yunus RM, Khan S, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2020 Dec;30(6):542-553.
    PMID: 32658120 DOI: 10.1097/SLE.0000000000000834
    BACKGROUND: Laparoscopic vertical sleeve gastrectomy (LVSG) has overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most frequently performed bariatric surgical procedure. To date little has been reported on the long-term outcomes of the LVSG procedure comparative to the traditionally favoured LRYGB. We undertook a systematic review and meta-analysis to review the 5-year outcomes of comparing LVSG and LRYGB. We undertook a systematic review and meta-analysis to compare 5-year weight loss outcomes of randomized controlled trials comparing LVSG to LRYGB.

    MATERIALS AND METHODS: Searches of electronic databases (PubMed, Embase, CINAHL, Cochrane) were undertaken for randomized controlled trials describing weight loss outcomes in adults at 5 years postoperatively. Where sufficient data was available to undertake meta-analysis, the Hartung-Knapp-Sidik-Jonkman estimation method for random effects model was utilized. The review was registered with PROSPERO and reported following in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

    RESULTS: Five studies met the inclusion criteria totaling 1028 patients (LVSG=520, LRYGB=508). Moderate but comparable levels of bias were observed within studies. Statistically significant body mass index loss ranged from -11.37 kg/m (range: -6.3 to -15.7 kg/m) in the LVSG group and -12.6 kg/m (range: -9.5 to -15.4 kg/m) for LRYGB at 5 years (P<0.001). Systematic review suggested that LRYGB produced a greater weight loss expressed as percent excess weight and percent excess body mass index loss than LVSG: this was not corroborated in the meta-analysis.

    CONCLUSIONS: Five year weight loss outcomes suggest both LRYGB and LVSG are effective in achieving significant weight loss at 5 years postoperatively, however, differences in reporting parameters limit the ability to reliably compare the outcomes using statistical methods. Furthermore, results may be impacted by large dropout rates and per protocol analysis of the 2 largest included studies. Further long-term studies are required to contradict or validate the results of this meta-analysis.

  16. Wazid SW, Yunus RM, Mohd Hairi NN, Choo WY
    J Elder Abuse Negl, 2021 10 20;33(5):368-384.
    PMID: 34670476 DOI: 10.1080/08946566.2021.1990815
    Among the challenges in systematic inquiry into elder abuse and neglect (EAN) is the lack of standardized tool of measurement. Existing literature demonstrates diverse tools being used, with the Conflict Tactics Scale (CTS) and its versions being the most common. The Malaysian Elder Mistreatment Project (MAESTRO) utilized the Modified CTS developed and used by the National Study of Elder Abuse and Neglect in Ireland (NSEA-I). This article aimed to validate this Malay version of the modified CTS for use in the Malaysian context and by Malay-speaking populations across Southeast Asia while highlighting the various practical and methodological challenges encountered along the process. Data were collected from 1927 older respondents who lived in Kuala Pilah district. Preliminary data screening led to the dropping of 10 items due to 0 variance. Further four items were deleted during CFA due to low loading. The indicators of neglect factor were made into a composite factor due to high collinearity. The final scale had acceptable reliability and validity. This tool is likely to assist in assessing and detecting EAN more quickly and conveniently. It will also assist future researches of EAN in taking into account the issues that arise in the measurement of EAN.
  17. Mohamed I, Othman F, Ibrahim AI, Alaa-Eldin ME, Yunus RM
    Environ Monit Assess, 2015 Jan;187(1):4182.
    PMID: 25433545 DOI: 10.1007/s10661-014-4182-y
    This case study uses several univariate and multivariate statistical techniques to evaluate and interpret a water quality data set obtained from the Klang River basin located within the state of Selangor and the Federal Territory of Kuala Lumpur, Malaysia. The river drains an area of 1,288 km(2), from the steep mountain rainforests of the main Central Range along Peninsular Malaysia to the river mouth in Port Klang, into the Straits of Malacca. Water quality was monitored at 20 stations, nine of which are situated along the main river and 11 along six tributaries. Data was collected from 1997 to 2007 for seven parameters used to evaluate the status of the water quality, namely dissolved oxygen, biochemical oxygen demand, chemical oxygen demand, suspended solids, ammoniacal nitrogen, pH, and temperature. The data were first investigated using descriptive statistical tools, followed by two practical multivariate analyses that reduced the data dimensions for better interpretation. The analyses employed were factor analysis and principal component analysis, which explain 60 and 81.6% of the total variation in the data, respectively. We found that the resulting latent variables from the factor analysis are interpretable and beneficial for describing the water quality in the Klang River. This study presents the usefulness of several statistical methods in evaluating and interpreting water quality data for the purpose of monitoring the effectiveness of water resource management. The results should provide more straightforward data interpretation as well as valuable insight for managers to conceive optimum action plans for controlling pollution in river water.
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