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Fulltext A New Technique for Solving Tightrope Cutout during Acromioclavicular Joint Fixation: A Case Report

Ng BW, Abdullah AF, Nadarajah S

Malays Orthop J, 2017 Mar;11(1):57-59.
PMID: 28435576 MyJurnal DOI: 10.5704/MOJ.1703.003

Acromioclavicular joint (ACJ) dissociation is one of the common injuries affecting adults. The stability of ACJ largely depends on the integrity of acromioclavicular ligament, coracoclavicular ligament, capsule, trapezius muscle and deltoid muscle. The injury has been classified by Rockwood into six types and treatment options can be guided by the classification. TightRope fixation is one of the many surgical procedures available to address acromioclavicular joint separation. It consists of tensioning of a no. 5 Fibrewire suture secured at both ends to low-profile metallic buttons. Despite various advantages of using this technique, complications such as suture cut-out, clavicle fracture and suture failure have been documented. The author presents a case of a type III acromioclavicular joint dissociation treated with TightRope which suture cutout was noted intra-operatively. Decision to amend the fixation using a cut one-third tubular plate as an additional anchor for the metallic button on the clavicle was made. Patient's progress was evaluated using the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) and significant improvement was noted six months post operatively. We propose this technique as a solution to the encountered problem.
Necrotising fasciitis caused by aeromonas sobria: Not just a simple catfish sting

Ng BW, Ong KC, Ahmad-Azraf A, Abdul-Muttalib AW

Med J Malaysia, 2019 12;74(6):543-544.
PMID: 31929484

Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.
Fulltext Biochemically normal adrenal pheochromocytoma following extensive central necrosis in a child with von Hippel-Lindau (VHL) gene mutation

Ng BW, Wong JS, Toh TH

BMJ Case Rep, 2021 Dec 22;14(12).
PMID: 34937752 DOI: 10.1136/bcr-2021-245154

Pheochromocytomas are rare in children. The diagnosis is usually established from a raised urinary or plasma catecholamine or their metabolites. We present a girl aged 11 years who manifested with a hypertensive crisis secondary to an adrenal tumour but with unexpectedly normal urinary metanephrine and catecholamine results. She improved spontaneously following the crisis and underwent surgery later. The histopathological study confirmed a pheochromocytoma with large central necrosis. Her genetic screening reported a pathogenic von Hippel-Lindau gene mutation. Surveillance scan postsurgery detected no other tumours. Following the catecholamine crisis, an acute infarct occurred, resulting in extensive tumour necrosis and subsequent rapid remission of symptoms and paradoxically normal biochemical markers. Although not unheard of in adults, we believe this is the first reported case of an extensive spontaneous necrosis resulting in a biochemically normal pheochromocytoma in a child.
The role of particle-to-cell interactions in dictating nanoparticle aided magnetophoretic separation of microalgal cells

Toh PY, Ng BW, Ahmad AL, Chieh DC, Lim J

Nanoscale, 2014 Nov 7;6(21):12838-48.
PMID: 25227473 DOI: 10.1039/c4nr03121k

Successful application of a magnetophoretic separation technique for harvesting biological cells often relies on the need to tag the cells with magnetic nanoparticles. This study investigates the underlying principle behind the attachment of iron oxide nanoparticles (IONPs) onto microalgal cells, Chlorella sp. and Nannochloropsis sp., in both freshwater and seawater, by taking into account the contributions of various colloidal forces involved. The complex interplay between van der Waals (vdW), electrostatic (ES) and Lewis acid-base interactions (AB) in dictating IONP attachment was studied under the framework of extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) analysis. Our results showed that ES interaction plays an important role in determining the net interaction between the Chlorella sp. cells and IONPs in freshwater, while the AB and vdW interactions play a more dominant role in dictating the net particle-to-cell interaction in high ionic strength media (≥100 mM NaCl), such as seawater. XDLVO predicted effective attachment between cells and surface functionalized IONPs (SF-IONPs) with an estimated secondary minimum of -3.12 kT in freshwater. This prediction is in accordance with the experimental observation in which 98.89% of cells can be magnetophoretically separated from freshwater with SF-IONPs. We have observed successful magnetophoretic separation of microalgal cells from freshwater and/or seawater for all the cases as long as XDLVO analysis predicts particle attachment. For both the conditions, no pH adjustment is required for particle-to-cell attachment.
Fulltext Knowledge and attitude of nurses towards diabetic foot care in a secondary health care centre in Malaysia

Ng BW, Azhar AA, Azman MH, Sukri MS, Arvinder-Singh HS, Abdul Wahid AM

Med J Malaysia, 2020 07;75(4):391-395.
PMID: 32724000

INTRODUCTION: Nurses play a vital role in the care and prevention of ulcers in patients with diabetic foot. Patient education, prevention of ulcers and rehabilitation are some of the vital aspects that nurses provide on a daily basis. Thus, good knowledge and attitude of nurses towards diabetic foot ulcers and its care will ensure better patient care.

OBJECTIVES: The aim is to study the level of knowledge and attitude of nurses towards diabetic foot ulcers and its care in Hospital Segamat, Malaysia.

METHODS: A validated questionnaire was used between February 2019 to May 2019 covering area such as demography, predisposing factors of ulcer formation, characteristics of ulcers, complications of ulcers, and attitude towards diabetic foot care.

RESULTS: A total of 101 nurses took part and 57% of the participants scored poorly in the knowledge section of the questionnaire. In all 72% had scored poorly when asked regarding complications of diabetic foot ulcers; 49.5% of the nurses had positive attitude towards diabetic foot care; and 79.3% thought that care for diabetic foot ulcer is timeconsuming. Majority of them think that their colleagues are the main source of information. All demographic variables were deemed to be confounders with the knowledge and attitude of nurses towards diabetic foot ulcers and its care.

CONCLUSIONS: Nurses in this centre had poor knowledge towards diabetic foot ulcers and its care. None of the variable studied were correlated with the level know knowledge. Good or poor knowledge of nurses does not correspond equally to good or poor attitude towards diabetic foot ulcers care. More frequent formal training of diabetic foot care would be needed to ensure better knowledge.
Biomass and eicosapentaenoic acid production from Amphora sp. under different environmental and nutritional conditions

Cheah YT, Ng BW, Tan TL, Chia ZS, Chan DJC

Biotechnol Appl Biochem, 2023 Apr;70(2):568-580.
PMID: 35767864 DOI: 10.1002/bab.2379

Eicosapentaenoic acid (EPA) could be extracted from diatoms such as Amphora sp. present abundantly in the ecosystems. In view of the key environmental and nutritional factors governing the diatoms growth rate, culture conditions were optimized for the biomass yield, total lipid content, EPA yield, and fatty acid composition under two main cultivation regimes: photoautotrophic and heterotrophic. The fastest growth rate about 0.20 ± 0.02 g/L and the highest EPA yield about 9.19 ± 3.56 mg EPA/g biomass were obtained by adding 10 g/L glucose and sucrose, respectively. Under photoautotrophic culture conditions, Amphora sp. rendered higher EPA yield at 100 rpm and 16:8 light/dark cycle. Total fatty acids produced predominantly comprised of an approximate 40-70% of saturated fatty acids, followed by 10-27% of monounsaturated fatty acids and then 8-25% of polyunsaturated fatty acids. These findings were able to pave a way for huge-scale microalgal biomass production in commercial EPA production.
Surgical Management of Cervical Ossification of Posterior Longitudinal Ligament: The Treatment Algorithm and Outcome

Ng BW, Tan JA, Sabri S, Baharuddin A, Muhamad Ariffin MH

Cureus, 2023 Mar;15(3):e36517.
PMID: 37090402 DOI: 10.7759/cureus.36517

Introduction Managing patients who present with symptoms of cervical myelopathy secondary to cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. Various factors such as the number of levels involved with OPLL, types of OPLL, canal occupying ratio, K-line characteristics, and C2-C7 lordosis angle were found to guide decision-making and surgical approaches in managing this condition. However, no clear treatment algorithm has been published. This study aims to investigate the outcome of the management of cervical OPLL using a treatment algorithm used in a tertiary university hospital. Methods This is a retrospective cross-sectional study. Patients with cervical myelopathy secondary to cervical OPLL who were treated surgically in our center from 2014 to 2020 were included in this study. Demographic data and preoperative parameters that determined the treatment given according to our treatment algorithm were analyzed. Result A total of 24 patients fit the inclusion and exclusion criteria of the study. The mean recovery rate for all groups is 61.8[Formula: see text]21.9% and the mean postoperative neck disability index (NDI) is 17.83[Formula: see text]16.67%. There was a statistically significant difference between preoperative and postoperative Japanese Orthopaedic Association (JOA) scores for both anterior and posterior surgery subgroups. Conclusion We believe that the treatment algorithm used in our center could benefit other surgeons as a guide in managing patients who suffer from cervical myelopathy secondary to cervical OPLL. Further study including newer techniques would increase the surgeon's arsenal in providing the best outcome in managing this condition.
Office Three-Dimensional Printed Osteotomy Guide for Corrective Osteotomy in Fibrous Dysplasia

Zamri MF, Ng BW, Jamil K, Abd Rashid AH, Abd Rasid AF

Cureus, 2023 Mar;15(3):e36384.
PMID: 37090315 DOI: 10.7759/cureus.36384

Fibrous dysplasia is a benign condition but can lead to severe long-bone deformities. Three-dimensional (3D) printing technology is a rapidly developing field that has now been popularized to aid surgeons in preoperative planning. We report a case of hip deformity in a 21-year-old woman who suffered from fibrous dysplasia and underwent a corrective osteotomy. We utilized open-source 3D computing software for preoperative planning before producing an osteotomy guide to aid in the operation.
Fulltext Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome

Ariffin MH, Mohd-Mahdi SN, Baharudin A, M Tamil A, Abdul-Rhani S, Ibrahim K, et al.

Malays Orthop J, 2023 Jul;17(2):35-42.
PMID: 37583520 DOI: 10.5704/MOJ.2307.006

INTRODUCTION: To investigate the use of a tubular retractor to provide access to the craniovertebral junction (CVJ) sparing the soft palate with the aim of reducing complications associated with traditional transoral approach but yet allowing adequate decompression of the CVJ.
MATERIALS AND METHODS: Twelve consecutive patients with severe myelopathy (JOA-score less than 11) from ventral CVJ compression were operated between 2014-2020 using a tubular retractor assisted transoral decompression.
RESULTS: All patients improved neurologically statistically (p=0.02). There were no posterior pharynx wound infections or rhinolalia. There was one case with incomplete removal of the lateral wall of odontoid and one incidental durotomy.
CONCLUSIONS: A Tubular retractor provides adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushed away the uvula, soft palate and pillars of the tonsils as it docked on the posterior pharyngeal wall, the traditional complications associated with traditional transoral procedures is completely avoided.
Fulltext Unilateral external fixator and its biomechanical effects in treating different types of femoral fracture: A finite element study with experimental validated model

Abd Aziz AU, Ammarullah MI, Ng BW, Gan HS, Abdul Kadir MR, Ramlee MH

Heliyon, 2024 Feb 29;10(4):e26660.
PMID: 38404809 DOI: 10.1016/j.heliyon.2024.e26660

Previous works had successfully demonstrated the clinical effectiveness of unilateral external fixator in treating various types of fracture, ranging from the simple type, such as oblique and transverse fractures, to complex fractures. However, literature that investigated its biomechanical analyses to further justify its efficacy is limited. Therefore, this paper aimed to analyse the stability of unilateral external fixator for treating different types of fracture, including the simple oblique, AO32C3 comminuted, and 20 mm gap transverse fracture. These fractures were reconstructed at the distal diaphysis of the femoral bone and computationally analysed through the finite element method under the stance phase condition. Findings showed a decrease in the fixation stiffness in large gap fracture (645.2 Nmm-1 for oblique and comminuted, while 23.4 Nmm-1 for the gap fracture), which resulted in higher displacement, IFM and stress distribution at the pin bone interface. These unfavourable conditions could consequently increase the risk of delayed union, pin loosening and infection, as well as implant failure. Nevertheless, the stress observed on the fracture surfaces was relatively low and in controlled amount, indicating that bone unity is still allowable in all models. Briefly, the unilateral fixation may provide desirable results in smaller fracture gap, but its usage in larger gap fracture might be alarming. These findings could serve as a guide and insight for surgeons and researchers, especially on the biomechanical stability of fixation in different fracture types and how will it affect bone unity.
Isolated unilateral hypoglossal nerve palsy from suppurative retropharyngeal lymphadenitis in an infant

Ng BW, Lee JS, Lau FS, Chieng CH

BMJ Case Rep, 2024 Jun 05;17(6).
PMID: 38839397 DOI: 10.1136/bcr-2024-260266

Retropharyngeal infections (RPIs) are uncommon in young infants and are difficult to diagnose due to their non-classical presentation. RPI can occasionally be complicated with multiple cranial nerve palsies but rarely in isolation. Isolated hypoglossal nerve palsy (HNP) due to RPI has been described in the literature but mostly in older children and adults. Assessment for hypoglossal nerve function is challenging in a young infant because the conventional signs of hypoglossal nerve dysfunction are difficult to elicit in this age group. Early recognition and treatment of RPI are associated with good HNP recovery. We present a case of a young infant with tongue deviation and difficulty with feeding attributed to an isolated HNP caused by suppurative retropharyngeal lymphadenitis. The infant underwent incision and drainage with complete recovery of the tongue function after 8 weeks.
Rapid magnetophoretic separation of microalgae

Lim JK, Chieh DC, Jalak SA, Toh PY, Yasin NH, Ng BW, et al.

Small, 2012 Jun 11;8(11):1683-92.
PMID: 22438107 DOI: 10.1002/smll.201102400

Magnetic collection of the microalgae Chlorella sp. from culture media facilitated by low-gradient magnetophoretic separation is achieved in real time. A removal efficiency as high as 99% is accomplished by binding of iron oxide nanoparticles (NPs) to microalgal cells in the presence of the cationic polyelectrolyte poly(diallyldimethylammonium chloride) (PDDA) as a binder and subsequently subjecting the mixture to a NdFeB permanent magnet with surface magnetic field ≈6000 G and magnetic field gradient <80 T m(-1) . Surface functionalization of magnetic NPs with PDDA before exposure to Chlorella sp. is proven to be more effective in promoting higher magnetophoretic removal efficiency than the conventional procedure, in which premixing of microalgal cells with binder is carried out before the addition of NPs. Rodlike NPs are a superior candidate for enhancing the magnetophoretic separation compared to spherical NPs due to their stable magnetic moment that originates from shape anisotropy and the tendency to form large NP aggregates. Cell chaining is observed for nanorod-tagged Chlorella sp. which eventually fosters the formation of elongated cell clusters.
Diabetic foot infection and surgical treatment in a secondary health care centre in Malaysia

Ng BW, Muhammad Firdaus A, Mohd Syafiqq Al Hakim HR, Nur Sa'idah MS, Loi KW, Ong KC, et al.

Med J Malaysia, 2020 01;75(1):29-32.
PMID: 32008016

INTRODUCTION: Diabetic foot infection is often associated with high morbidity, disability and poor quality of life. This study focuses on the demography, the number of repetitive surgery and length of stay in hospital of patients with diabetic foot infection.
METHOD: This is a retrospective observational study. Patients who were admitted to the Orthopaedic ward of Hospital Segamat (HS), Johor, Malaysia from January 2016 to December 2018 and required surgical intervention were included in the study. Data was collected from the computer system of HS and medical notes of patients.
RESULTS: 35.6% of the total orthopaedic emergency surgeries performed were for patients with diabetic foot infection, 25% of the surgical procedures performed were major amputations of lower limb and 40% of the patients with diabetic foot infection required more than one surgical operation.
DISCUSSION: The demographics of the patients is consistent with the demographics of Malaysia where majority of them are Malays followed by Chinese, Indians and others. Despite being only 10% of total admission to the department, this group of patients contributed to 35.6% of the total emergency surgeries performed. The amputation rate in the centre is comparable to the other local studies. The average length of stay in hospital was found to be shorter compared to overseas due to different rehabilitation protocols.

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