1.Neonatal Clavicle Fracture: A Review of Fourteen Cases in East Coast Peninsular Malaysia
Awang MS ; Abdul Razak AH ; Che Ahmad A
The International Medical Journal Malaysia 2017;16(2):79-83
Introduction: The purpose of this study is to identify the incidence of clavicle fractures in newborn
associated with fetal, maternal and process of deliveries in Kuantan General Hospital from June 2012 until
January 2014. This study is to determine epidemiological data of clavicle fractures, maternal and baby risk
factors associated with clavicle fractures of newborn and its’ outcome. Methods: This is a prospective
study. 13 patients were identified to fulfill the inclusion criteria of the study. The data of
sociodemographic, associated fetal and maternal risk factors and the outcomes were recorded using
proforma. The statistical data analysis was done using SPSS 12.0. Results: Out of 20,257 live births at our
centre during the study period, 13 infants were diagnosed to have clavicle fractures, giving an incidence of
0.64 per 1000 live births. There were 5 (38.5%) left, 7 (53.8%) right and one (7.7%) bilateral fracture. All
fractures located at the mid shaft of the clavicle and none have associated brachial plexus injuries. All
infants were delivered through vaginal delivery (61.5%); five through assisted delivery (instrumental); 2
(15.4%) forcep and 3 (23.1%) vacuum. Two of the babies developed shoulder dystocia. The average birth
weight was 3371 grams (SD 0.269) and mean gestational age was 38.7 weeks (SD 1.16). Five of the mothers
(38.5%) were primigravida and eight (61.5%) were multigravida in which,7 (53.8%)were healthy without
other co-morbidty, 5 (38.5%) having gestational diabetis and one (7.7%) hypertension. The average maternal
weight was 62.0 kg and height 1.58 metres with average BMI of 24.16 (3.29SD). All eventually had a
complete recovery at 6 weeks with clinical and radiological evident of fracture union. Conclusions: In
conclusion, all patients with clavicle fractures were found following vaginal delivery. There were no
associations between neonatal clavicle fractures with maternal or baby risk factors. All fractures healed
without any complications.
2.Characteristics and Microbiological Profile of Patients with Diabetic Foot Infections in Kuantan, Pahang
Kow RY ; Low CL ; Ayeop MAS ; Che-Ahmad A ; Awang MS
Malaysian Orthopaedic Journal 2022;16(No.1):11-17
Introduction: The number of people suffering from diabetic
foot infection (DFI) has increased precipitously over the
years in Malaysia, owing to increased population,
urbanisation, the surge of number of people with obesity and
physical inactivity. As one of the most dreaded
complications of diabetes mellitus, DFI is associated with
high morbidity and mortality. We aim to study the
microbiological profile of patients with DFI at a university
hospital in Kuantan, Pahang.
Materials and methods: This retrospective study was
carried out at at Sultan Ahmad Shah Medical Centre @IIUM
(SASMEC @IIUM) from 1 January 2018 to 30 April 2019.
Patients’ demographic data, types of infection and surgical
intervention, and the microbiological profile were obtained
from the medical records.
Results: A total of 142 causative pathogens were cultured
from 130 tissue samples, with an average of 1.09 pathogens
per lesion. Majority of the pathogens were gram-negative
pathogens (52.8%). Staphylococcus sp. was the most
common pathogen isolated (22.5%). This was followed by
Streptococcus sp. (10.6%), Pseudomonas sp. (9.2%),
Morganella sp. (5.6%), Klebsiella sp. (4.9%), Enterobacter
sp. (4.9%), and others. Among the 142 pathogens, there were
9 multidrug-resistant strains observed. Most of the
antibiotics were effective against the gram-positive
pathogens except benzylpenicillin, tetracyclin, fusidic acid
and ciprofloxacin. Meanwhile, cefotaxime, amoxicillin and
ampicillin-sulbactam were also not suitable against gramnegative pathogens. Oxacillin and sulfamethoxazole/
trimethoprim can be used as empirical antibiotics against
gram-positive pathogens, while vancomycin should be
reserved for patients with septic shock or suspected multidrug resistant strain infection. Piperacillin/tazobactam and
ceftazidime can be used as empirical antibiotics against
gram-negative pathogens.
Conclusion: Early initiation of empirical antibiotic(s) is
paramount to stymie the infection from getting worse while
waiting for the identification of causative pathogens in the
management of DFI. This study provides a guide for treating
physicians to initiate the most appropriate empirical
antibiotic in DFI.
3.COVID-19 Pandemic: Two-year Experience and Response of a Teaching Hospital in Malaysia and the Effect on Postgraduate Orthopaedic Training
Kow RY ; Khalid KA ; Zakaria Z ; Awang MS
Malaysian Orthopaedic Journal 2022;16(No.2):1-14
As the number of COVID-19-related infections and deaths
increased exponentially in the during 2020, few countries
were equipped to manage and curb this novel coronavirus.
Initially there was no proven cure or vaccine to this novel
virus (SARS-Cov-2), leaving the authorities with no choice
but to impose quarantines at the short-term expense of their
economies. As we gain more knowledge on this novel virus,
the tried-and-tested method of selective testing of the
symptomatic patients, used successfully in almost all
infectious respiratory diseases, has been replaced with traceand-test method, as most of the infected patients remained
asymptomatic. In early 2021, the availability of vaccines
provided a shed of light out from this pandemic.
Nevertheless, we faced an enormous task in juggling
between vaccination of the population, managing patients
with COVID-19 infection as well as non-COVID-19
patients. Here, we share our experience and response in
managing this healthcare crisis across a two-year period
during the pandemic and we hope other centres can learn
from what we went through and help them derive a protocol
to navigate through a future pandemic.