Papers by Mohd Ariff Sharifudin
Religion plays an imperial role in the ever-changing healthcare system of Malaysia. The Malaysian... more Religion plays an imperial role in the ever-changing healthcare system of Malaysia. The Malaysian, being a multi-racial society, has to adapt and accommodate various practices of religion from different cultural and religious backgrounds. It is this diversity that demands the understanding of the different ideologies of faith as a necessity to the healthcare giver such as doctors, nurses, and paramedics. This article aims to compare the principles and practices of the official religion of Malaysia, Islam, as compared to the mainstream religion of the Chinese, which is Buddhism. The discussions focus on the general beliefs and practices of these two religions, the approach towards health and disease and dealing with the issues of death and dying.
International Medical Journal Malaysia, 2019
Aneurysmal bone cyst (ABC) infrequently occurs within the upper cervical vertebrae. Various thera... more Aneurysmal bone cyst (ABC) infrequently occurs within the upper cervical vertebrae. Various therapeutic options have been reported in the literature. We would like to share our experience in managing a case of a 16-year-old girl diagnosed with ABC at the body of axis (C2) vertebra. Serious attention had to be given on the stability of the cervical spine following tumour resection, which can be affected by the mode of treatment chosen. Instability can have a detrimental effect on the cervical spine, in which case may necessitate further surgery. We performed a single-staged intra-lesional curettage via a transoral approach and temporary non-fusion posterior stabilization of C1 lateral mass screw and C2 pedicle screw. The implants were removed after six months once ossification of C2 has taken place to regain full motion of the neck. There was no evidence of recurrence or instability of the cervical spine three years following surgery.
Central Asian Journal of Global Health, 2019
Introduction: Public awareness of osteoporosis is low among women in the developing countries. He... more Introduction: Public awareness of osteoporosis is low among women in the developing countries. Health education was shown to be effective in improving knowledge and awareness on maintaining bone health. This study aims to identify the level of knowledge and attitudes among post-menopausal women in Malaysia on achieving bone health throughout the menopausal transition period. Methods: A total of 116 post-menopausal female patients of orthopedic menopause clinic were recruited using a purposive sampling approach. Data on osteoporosis awareness and knowledge were collected using validated structured questionnaires Osteoporosis Prevention and Awareness Tool and Osteoporosis Attitude Knowledge Test. The chi-square test was used to determine the association between post-menopausal women's socio-demographic characteristics and their knowledge and attitude towards maintaining bone health. Results: Participants' age ranged between 49 and 82 years (61.84, SD=7.87). The knowledge of osteoporosis varied significantly by age (p=0.014) and education (p=0.001) among the studied population. No significant diffrences were found for participants' attitude towards bone health. Conclusion: This study showed that the age and education levels have significantly different knowledge of bone health.
International Journal of Women’s Health and Reproduction Sciences, 2019
Objectives: The study has evaluated bone health status among post-menopausal women in a public ho... more Objectives: The study has evaluated bone health status among post-menopausal women in a public hospital of Malaysia.
Materials and Methods: A total of 116 post-menopausal women, who met the criteria, participated in this study. The purposive sampling method was used to achieve the criteria of participants.
Results: This cross-sectional study revealed that more than half of the respondents (52.6%, n = 61) had osteopenia; whereas, 47.4% (n=55) of the respondents had osteoporosis. There was a significant correlation between the age and menopausal years with the bone health status (i.e. P = 0.004 and P = 0.028, respectively) in postmenopausal women.
Conclusions: Menopausal women experienced deterioration of bone mineral density (BMD) with advancing age and menopausal years.
Introduction: Critical size defects (CSD) in the long bones of New Zealand White rabbits (Oryctol... more Introduction: Critical size defects (CSD) in the long bones of New Zealand White rabbits (Oryctolagus cuniculus) have been used for years as an experimental model for investigation of the effectiveness of a new bone substitute material. There are varieties of protocols available in the literature. This technical note attempts to present an alternative surgical technique of a CSD in the New Zealand white rabbit tibia. Methods: Thirty-nine New Zealand White rabbits were used in this study. A CSD of approximately 4.5 mm (width) X 9.0 mm (length) was surgically drilled at the proximal tibial metaphysis, approximately 1 cm from the knee joint. The surrounding of soft tissue was repositioned and sutured layer by layer with bioabsorbable surgical suture. Two x-rays of anteroposterior and lateral were taken before assessed under computed tomography scan at 6, 12 and 24 weeks. Results: This alternative method created CSD with less bleeding from the muscle observed. No mortality or other surgical complications observed within 6 weeks, 12 weeks and 24 weeks following surgery. Conclusion: A simple and safe method for performing CSD was demonstrated and recommended as an alternative approach for surgery on New Zealand White rabbits.
Introduction: Burst fracture results from compression failure of both the anterior and middle col... more Introduction: Burst fracture results from compression failure of both the anterior and middle columns under substantial axial loads. Conservative treatment was a method of treatment for fractures without neurological deficit. This cross sectional study was designed to evaluate the functional and radiological outcome of patient with thoracolumbar burst fracture treated conservatively. Methods: 40 cases were recruited from January 2013 till December 2015. They were followed-up with minimum period of 1 year and evaluated for the functional (Oswetry Disbility Index) and radiological outcomes (kyphotic angle deformity and anterior body compression). Results: 20 patients were treated with body cast made form plaster of Paris and remaining 20 patients with fiberglass cast. In plaster of Paris group, mean kyphotic angle deformity at last follow up was 16.60 ± 2.95 with a mean improvement 4.45 degree and anterior body compression at last follow up was 30.35% ± 10.2 with mean improvement of 9.30%. In fiberglass group, mean kyphotic angle deformity at last follow up was 15.55 ± 3.38 with a mean improvement 7.25 degree and anterior body compression at last follow up was 25.90% ± 7.81 with mean improvement of 3.45%. The functional outcome showed Oswetry Disability Index (ODI) score in plaster of Paris group was 23.70 (SD = 7.82) and in fiberglass group was 18.50 (SD = 5.94). Conclusions: Application of body cast using a fiberglass material give better radiological outcome hence less pain, more functional and higher patient's satisfaction as compared to plaster of Paris.
Objective: The study aims to identify the risk of obtaining a fracture among post-menopausal wome... more Objective: The study aims to identify the risk of obtaining a fracture among post-menopausal women with osteopenia and osteoporosis. Method: This work was a cross-sectional study involving a purposive sample of 87 post-meno-pausal women who attended the orthopedic and menopause clinics of Hospital Tengku Ampuan Afzan, Kuantan. The data were entered into the WHO fracture risk assessment tool (FRAX ®) to predict major fracture and risk for hip fracture in 10 years' time. Results: The mean age of the respondents was 61.6 years (SD = 7.9). Among the respondents, 50.6% had osteopenia and nearly half (48.3%) had osteoporosis. The mean number of menopausal years of the respondents was 11.9 (SD = 8.5), ranging between 1 and 44 years. The FRAX findings indicated 9.7% major osteoporotic fracture probability and 3.5% hip fracture probability, which were denoted as high risk. A Pearson correlation coefficient was computed to assess the relationship between menopausal years and the FRAX major osteoporotic fracture probability. A significant positive correlation was found between the two, but the correlation was weak (r = 0.581, n = 87, p < 0.001). Conclusions: The present findings indicate that menopausal years have a positive correlation with the risk of obtaining a fracture.
Objectives: Hydroxyapatite (HA) has osteoconductive properties and is widely used as a bone graft... more Objectives: Hydroxyapatite (HA) has osteoconductive properties and is widely used as a bone graft substitute. Platelet-rich plasma (PRP) is an autologous product with osteoinductive effects. Hypothetically, a combination of both would augment the bone formation effect of HA and widen its application in spinal fusion surgeries. This study aimed to compare new bone formation with HA granules alone and in combination with PRP versus an autologous bone graft during a lumbar intertransverse process spinal fusion. Methods: A total of 16 adult New Zealand white rabbits underwent single-level bilateral intertransverse process fusion at the L5–L6 vertebrae. One side of the spine received either HA granules alone or a combination of HA granules and PRP, while the contralateral side received an autologous bone graft. Four animals each from the HA group and the HA plus PRP group versus the autograft group were assessed either at six or 16 weeks by undecalcified histology and histomorphometry. The mean percentage of new bone areas over the corresponding fusion masses were compared between groups. Results: No significant difference in new bone formation was observed between the HA and HA plus PRP groups at six or 16 weeks. The autograft group had significantly more new bone formation at six and 16 weeks (P = 0.004 and <0.001, respectively). Conclusion: An autologous bone graft remains superior to HA granules, with or without PRP. HA granules demonstrated an excellent osteoconductive scaffold but had poor biodegradability. While PRP enhances the properties of HA granules, these biomaterials do not have a synergistic effect.
Objective: The study aims to identify risk of getting a fracture among post-menopausal women with... more Objective: The study aims to identify risk of getting a fracture among post-menopausal women with osteopenia and osteoporosis. Methods: Cross-sectional study involving a purposive sample of 87 post-menopausal women who attended orthopaedic and menopause clinic Hospital Tengku Ampuan Afzan, Kuantan was used in this study. The data were entered into WHO Fracture Risk Assessment Tool (FRAX ®) to predict a major fracture and risk for fracture hip in 10 years time. Results: The mean age of respondents was 61.6 years (SD=7.9). 50.6% of respondents were osteopenia and nearly half (48.3%) of the respondents was osteoporosis. The mean menopausal years of respondents was 11.9 (SD=8.5), ranging between 1 and 44 years. The FRAX findings indicated 9.7% major osteoporotic fracture probability and 3.5% hip fracture probability, which were designated as high risk. A Pearson correlation coefficient was computed to assess the relationship between menopausal years and FRAX major osteoporotic fracture probability. There was a significant positive correlation between the two, but the correlation was weak. (r=0.581, n=87, p <0.001). Conclusions: The present findings indicate that menopausal years has a positive correlation the risk of obtaining a fracture. Thus, this study empowers women to increase knowledge on osteoporosis prevention to promote healthy lifestyle behaviour and eliminate fracture risk among post-menopausal women. Implication for Practice: The assessment of fracture risk underpins all management strategies to tackle the growing problem of osteoporotic fractures thus, this study will expand the roles of nurses to promote and conduct healthy lifestyle behaviour program of bone health at community setting in the future.
Among the reported complications of scoliosis is restrictive lung disease. Resting metabolic rate... more Among the reported complications of scoliosis is restrictive lung disease. Resting metabolic rate is increased when the pulmonary function is impaired. Reduction in patients’ body mass index (BMI) may be an important INDICATOR of thoracic insufficiency syndrome. The objective of this retrospective study was to determine the correlation between spinal deformity, pulmonary function and BMI. All patients with adolescent idiopathic scoliosis (AIS) aged between 13 to 24 years, confirmed cases of AIS, and admitted at Hospital Raja Perempuan Zainab II for surgical interventions from year 2000 to 2013 were selected. Spinal deformity were determined by measuring the spinal curve angle using the Cobb angle on anterior-posterior radiographs. Pre-operative pulmonary function were evaluated using the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Pearson correlation was performed to analyse the correlation between spinal deformity and pulmonary function with BMI. Th...
Singapore Medical Journal, 2016
This retrospective review aimed to examine the relationship between preoperative pulmonary functi... more This retrospective review aimed to examine the relationship between preoperative pulmonary function and the Cobb angle, location of apical vertebrae and age in adolescent idiopathic scoliosis (AIS). To our knowledge, there have been no detailed analyses of preoperative pulmonary function in relation to these three factors in AIS. A total of 38 patients with thoracic or thoracolumbar scoliosis were included. Curvature of spinal deformity was measured using the Cobb method. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were used to evaluate preoperative pulmonary function. Statistical methods were used to analyse the relationship between preoperative pulmonary function and the factors that may contribute to poor pulmonary function. The mean age of the patients was 16.68 ± 6.04 years. An inverse relationship was found between the degree of the Cobb angle and FVC as well as FEV1; however, the relationships were not statistically significant (p = 0.057 and p = 0.072, respectively). There was also a trend towards a significant negative correlation between the thoracic curve and FVC (p = 0.014). Patients with larger thoracic curves had lower pulmonary function. A one-year increase in age significantly decreased FVC by 1.092 units (p = 0.044). No significant relationship between age and preoperative FEV1 was found. The median FVC was significantly higher in patients with affected apical vertebrae located at levels L1-L3 than at T6-T8 or T9-T12 (p = 0.006). Lung function impairment was seen in more severe spinal deformities, proximally-located curvature and older patients.
The glenohumeral joint has the most mobility of any in the body, and contact between the humeral ... more The glenohumeral joint has the most mobility of any in the body, and contact between the humeral head and glenoid labrum contributes to its stability. Patients with recurrent dislocations may have bone defects in one or both of these surfaces, due to the presence of a Bankart lesion or an engaging Hill-Sachs lesion. We present a case of an adult whose left shoulder required intervention following a 10-year history of chronic, recurrent glenohumeral dislocation. Our assessment revealed a large Bankart lesion combined with a large Hill-Sachs lesion. We performed an open surgery with bone augmentation of the glenoid osseous defect using a tricortical autogenous bone graft harvested from the iliac crest. Intra-operative assessment showed adequate stability without intervention for the humeral head defect. The technical aspect of the surgery is described together with the clinical outcomes of the patient. We briefly review therapeutic options for glenohumeral osseous defects described in the literature.
Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intert... more Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cutout with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cutout. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cutout in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cutout or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.
INTRODUCTION Physiotherapy is an important part of rehabilitation following arthroplasty, but the... more INTRODUCTION Physiotherapy is an important part of rehabilitation following arthroplasty, but the impact of preoperative physiotherapy on functional outcomes is still being studied. This randomised controlled trial evaluated the effect of preoperative physiotherapy on the short-term functional outcomes of primary total knee arthroplasty (TKA). METHODS 50 patients with primary knee osteoarthritis who underwent unilateral primary TKA were randomised into two groups: the physiotherapy group (n = 24), whose patients performed physical exercises for six weeks immediately prior to surgery, and the nonphysiotherapy group (n = 26). All patients went through a similar physiotherapy regime in the postoperative rehabilitation period. Functional outcome assessment using the algofunctional Knee Injury and Osteoarthritis Outcome Score (KOOS) scale and range of motion (ROM) evaluation was performed preoperatively, and postoperatively at six weeks and three months.
RESULTS Both groups showed a signi cant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not signi cant in the sports and recreational activities subscale for both groups (p > 0.05). Signi cant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No signi cant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus- treatment analysis (p = 0.928).
CONCLUSION Six-week preoperative physiotherapy showed no signi cant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.
Religion plays an imperial role in the ever-changing healthcare system of Malaysia. The Malaysian... more Religion plays an imperial role in the ever-changing healthcare system of Malaysia. The Malaysian, being a multi-racial society, has to adapt and accommodate various practices of religion from different cultural and religious backgrounds. It is this diversity that demands the understanding of the different ideologies of faith as a necessity to the healthcare giver such as doctors, nurses, and paramedics. This article aims to compare the principles and practices of the official religion of Malaysia, Islam, as compared to the mainstream religion of the Chinese, which is Buddhism. The discussions focus on the general beliefs and practices of these two religions, the approach towards health and disease and dealing with the issues of death and dying.
The secularisation of the modern fields of knowledge leads to the deprivation of religious and sp... more The secularisation of the modern fields of knowledge leads to the deprivation of religious and spiritual considerations, particularly in the current medical curriculum. In the past, the heavy medical curriculum has been blamed as a major contributing factor of production of ―disease- oriented‖ rather than ―patient-oriented‖ medical practitioners. Undergraduate students are very much unprepared to integrate the Islamic knowledge acquired during school-going years into the hectic life and specific conditions that they will encounter in the real clinical settings. There is a great need to reform the current education system to produce critical-minded medical practitioners, especially from the various aspects of the Islamic perspective. In IIUM, the teaching of medicine is augmented by series of relevant lectures and programs in line with the University‖s Islamization of Human Knowledge agenda. The Department of Orthopaedics, Traumatology and Rehabilitation of IIUM has taken a step ahead by introducing the Islamic Input in Orthopaedics (Triple IO) Module since 2002. Since its implementation, various obstacles have been faced and many improvements have been made. After more than a decade, we would like to share our experience in conducting the program and how to improve it further to cope with future challenges.
Rukhsoh (permit) is a concessionary law and is the technical opposite of azimah (decidedness) in ... more Rukhsoh (permit) is a concessionary law and is the technical opposite of azimah (decidedness) in Islamic jurisprudence. It is considered an important flexible rule that Muslim physicians need to understand in order to develop solutions for hardships and difficulties in performing practical acts of worship. However, discussions regarding this matter in both classical and current literatures of Islamic jurisprudence are generally limited and poorly structured. This review attempts to deliver a structured account on the principles and applications of rukhsoh in medical issues related to practical acts of worship. This review comprises two parts of discussion. The first section begins with a general discussion of rukhsoh i.e. concept of rukhsoh in Islamic jurisprudence followed with a discussion on the types of rukhsoh and their determining factors. The general principles in applying the concept of rukhsoh in ibaadah and daily life will also be outlined and discussed. The second part delves into specific discussions, which focus on selected common practical issues, which necessitates the application of rukhsoh. The discussions will revolve around the specific medical conditions, which jeopardise patients‖ ability to conduct their act of worship and how the rukhsoh would come into place.
The public has questioned many of the previously accepted medical treatments. One of the factors ... more The public has questioned many of the previously accepted medical treatments. One of the factors highlighted is the uprising of social demands influenced by religious-centered ideation. Even though medical practitioners are regarded as one of the noble professions in society, their professional opinions are started to be questioned. To complement this social phenomenon, we reviewed and construct models of doctor-patient relationships from the religious perspective, Islamic law in particular. Most discussions related to doctor-patient relationship focused on codes of conducts such as medical ethics, professionalism, and confidentiality. In this brief review, we would like to highlight more on the models of doctor-patient relationship and the Islamic rulings related to it. The rulings were reviewed from various aspects pertaining to the patient who seeks for treatments, the doctor who provides the medical services or treatment, involvement of a third party, and the form of agreement involving all related parties. The rulings were derived from the five basic rules pertaining to the actions and interactions of a person (al-ahkam al-taklifiyyah). Relationship models were classified based on the profitability of the service rendered, types of contract involved, as well as the related Islamic rulings. The obligation of becoming a medical practitioner varies depending on various factors. Similarly, the rulings on patients seeking for treatment for medical illnesses remain debatable among religious scholars. Models of doctor-patient relationship can be summarized into four models; Model A-Charitable Work, Model B-Profit-based, Model C-Civil Servant, and Model D-Private Employee. Providing medical services is indeed a noble obligation. However, it involves certain requirements and principles in relation to the religious rulings that may differ from what are commonly practiced.
Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk f... more Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.
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Papers by Mohd Ariff Sharifudin
Materials and Methods: A total of 116 post-menopausal women, who met the criteria, participated in this study. The purposive sampling method was used to achieve the criteria of participants.
Results: This cross-sectional study revealed that more than half of the respondents (52.6%, n = 61) had osteopenia; whereas, 47.4% (n=55) of the respondents had osteoporosis. There was a significant correlation between the age and menopausal years with the bone health status (i.e. P = 0.004 and P = 0.028, respectively) in postmenopausal women.
Conclusions: Menopausal women experienced deterioration of bone mineral density (BMD) with advancing age and menopausal years.
RESULTS Both groups showed a signi cant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not signi cant in the sports and recreational activities subscale for both groups (p > 0.05). Signi cant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No signi cant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus- treatment analysis (p = 0.928).
CONCLUSION Six-week preoperative physiotherapy showed no signi cant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.
Materials and Methods: A total of 116 post-menopausal women, who met the criteria, participated in this study. The purposive sampling method was used to achieve the criteria of participants.
Results: This cross-sectional study revealed that more than half of the respondents (52.6%, n = 61) had osteopenia; whereas, 47.4% (n=55) of the respondents had osteoporosis. There was a significant correlation between the age and menopausal years with the bone health status (i.e. P = 0.004 and P = 0.028, respectively) in postmenopausal women.
Conclusions: Menopausal women experienced deterioration of bone mineral density (BMD) with advancing age and menopausal years.
RESULTS Both groups showed a signi cant difference in all algofunctional KOOS subscales (p < 0.001). The mean score difference at six weeks and three months was not signi cant in the sports and recreational activities subscale for both groups (p > 0.05). Signi cant differences were observed in the time-versus-treatment analysis between groups for the symptoms (p = 0.003) and activities of daily living (p = 0.025) subscales. No signi cant difference in ROM was found when comparing preoperative measurements and those at three months following surgery, as well as in time-versus- treatment analysis (p = 0.928).
CONCLUSION Six-week preoperative physiotherapy showed no signi cant impact on short-term functional outcomes (KOOS subscales) and ROM of the knee following primary TKA.