1.Isolation of the biofilm producing bacteria from osteomyelitis patients at Hospital Tengku Ampuan Afzan (HTAA), Kuantan
Khairul Ikhwan Yaakob ; Nazri Mohd Yusof ; Farahidah Mohamed ; Mohd Affendi Mohd Shafri
Malaysian Journal of Microbiology 2015;11(4):317-323
Aims: Accurate diagnosis and proper treatments of osteomyelitis are often difficult and ineffective due to several
reasons such as less sensitive sample collected and the formation of biofilm following prosthetic use. Thus, our goal of
this study is to identify suitable sample for laboratory diagnosis and also microbial species that cause osteomyelitic
infection and discriminate between biofilm and non-biofilm producing strains in patients at Hospital Tengku Ampuan
Afzan, Kuantan.
Methodology and results: Samples of bone, prosthetic material, tissue and swab were collected from patient with
suspected osteomyelitis at the hospital. Bacteria were isolated from sample using methods such as homogenization,
direct transfer, and sonication. Then, species identification was done by colony characterization, biochemical test and
the API identification system. Once species identified, tissue culture plate method was performed to discriminate the
biofilm-producing strain from the non-biofilm-producing strain. The total number of 57 samples were collected from 17
cases of suspected osteomyelitis with 34 samples were found positive bacterial growth. Prosthetic samples produced
highest positive growth with 81.3%, following by bone samples with 66.7% while swab and tissue samples with 46.2%
and 43.8% respectively. We found that 14 from total 16 pathogens identified were biofilm producing-strains.
Conclusion, significance, and impact of study: Prosthetic and bone samples produced higher bacterial growth, in
contrast to other type of samples. Sonication method improves bacterial detection. Biofilm producing-bacteria were also
the most common isolated strains from osteomyelitic infection. These have underscored the need to revise current
clinical and laboratory practice as proper identification biofilm bacteria may influences management an outcome.
Biofilms
;
Osteomyelitis
2.Acute vascular complications (flap necrosis and congestion) with one stage and two stage distally based sural flap for wound coverage around the ankle
Nazri Mohd Yusof ; Ahmad Fadzli Sulong ; Wan Azman Wan Sulaiman ; Mohammed Azril Mohammed Amin
The Medical Journal of Malaysia 2016;71(2):47-52
Introduction: The understanding of the skin’s vascular
anatomy has improved in the last decade. It has lead to
technique modification such as the staged procedure in
performing sural flaps and improvement in the flap survival
rate. The aim of this study was to evaluate the acute vascular
complications (flap necrosis or congestion) of 29 patients
who underwent distal base sural flap for coverage of wound
around the ankle.
Methods: Twenty-four males and five females with a mean
age of 37.1 years old underwent sural flap surgery to cover
wounds at around the ankle. There were 12 cases of open
fracture, five infected fractures, four spoke injuries, four
degloving injuries and four diabetic foot ulcers. Twentythree
cases were done as a single stage procedure while six
as a two-stage procedure. The flaps were tunnelled under
the skin in three cases.
Results: Twenty one flaps healed uneventfully, seven acute
vascular complications occur in a single stage group: five
developed partial necrosis, one had congestion with
epidermolysis, and one had complete flap necrosis.
Complications were treated by dressing or skin grafting and
only one required a repeat flap surgery.
Conclusions: Acute vascular complications may be
minimised when sural flap is done in stages for elderly,
diabetic, smokers and/or patients with large wound around
the ankle. Even if the flap appears necrotic, the underlying
structure may still be covered as the fasciosubcutaneous
layer of the flap may still survive.
3.Outcomes of infected grade IIIB open tibial fractures.
Nazri Mohd YUSOF ; Ahmad Sukari HALIM
Singapore medical journal 2012;53(9):591-594
INTRODUCTIONInfection following grade IIIB open tibial fracture is common. The primary aim of managing this condition is to achieve control of infection before the bone reconstruction procedure is performed. The outcomes for such patients have not been evaluated in the literature. This study was conducted to examine the outcome of a multi-stage procedure for the treatment of infected grade IIIB open tibial fractures.
METHODSBetween 2004 and 2008, we treated 11 patients with infected grade IIIB open tibial fractures in our unit. The management of infected grade IIIB open tibial fracture comprised three stages, which included serial debridement, wound closure by local flap surgery and bone reconstruction. The margin of resection and the type of bone reconstruction depended on the anatomical location of the disease, the extent of osteomyelitis and patient preference regarding treatment options. Bone reconstruction procedures included bone grafting, plating, interlocking nail, hybrid and monolateral external fixator, and Ilizarov bone transport.
RESULTSGram-negative organisms were isolated from all patients. Pseudomonas aeruginosa (P. aeruginosa) (44%) was the most common organism cultured. Infection was resolved in all patients. Nine fractures achieved union, with a mean union time of 15 months. Two patients with P. aeruginosa infection developed non-union of the fracture and refused additional surgery after three years of treatment.
CONCLUSIONThe multi-stage management approach is well-accepted and effective in controlling infection in infected grade IIIB open tibial fractures.
Adult ; Aged ; Aged, 80 and over ; Debridement ; methods ; Female ; Fracture Fixation ; methods ; Fractures, Open ; complications ; surgery ; Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique ; Malaysia ; Male ; Middle Aged ; Osteomyelitis ; etiology ; microbiology ; surgery ; therapy ; Prospective Studies ; Surgical Flaps ; Tibial Fractures ; complications ; surgery ; Treatment Outcome ; Wound Infection ; etiology ; microbiology ; surgery ; therapy
4.Quality of life of diabetes amputees following major and minor lower limb amputations
Nazri Mohd Yusof ; Aminudin Che Ahmad ; Ahmad Fadzli Sulong ; Mohd Jazlan Mohd Adnan ; Jamalludin Abdul Rahman ; Ramli Musa
The Medical Journal of Malaysia 2019;74(1):25-29
Minor amputation was performed as a salvage
procedure because most of the patients were not able to
ambulate and become dependent following major
amputation. Minor amputation is defined as amputation at
the level of ankle joint and below while major amputation is
defines by amputation above the ankle joint. The aim of this
study was to compare the quality of life among diabetes
patients following major and minor amputations.
5.Predictors of major lower limb amputation among type II diabetic patients admitted for diabetic foot problems.
Nazri Mohd YUSOF ; Jamalludin Ab RAHMAN ; Ahmad Hafiz ZULKIFLY ; Aminudin CHE-AHMAD ; Kamarul Ariffin KHALID ; Ahmad Fadzli SULONG ; Naveen VIJAYASINGHAM
Singapore medical journal 2015;56(11):626-631
INTRODUCTIONDiabetes mellitus (DM) is the most common cause of amputations in Malaysia. This study aimed to identify the predictive factors for major lower limb amputation among patients with type 2 DM (T2DM) who were admitted to a hospital, in order to reduce its likelihood.
METHODSThis cross-sectional study involved 218 patients with T2DM who were admitted to Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, for diabetic foot problems from June 2011 to July 2012. A form was developed to document the patients' profiles, comorbidities, complications, investigations, treatment and clinical outcomes. The predictors for major lower limb amputations were determined using univariate and stepwise logistic regression analysis.
RESULTSA total of 31 patients underwent major lower limb amputations (25 transtibial, 6 transfemoral). The following factors were found to be associated with the incidence of major lower limb amputations: T2DM duration ≥ 10 years, diabetic neuropathy, diabetic nephropathy, presentation with gangrene, diabetic foot conditions of Wagner grade 4 or 5, and necrotising fasciitis. Patients who underwent major amputations had significantly lower haemoglobin and albumin levels, and higher total white blood cell counts, erythrocyte sedimentation rates, and C-reactive protein, urea and creatinine levels. However, only T2DM duration ≥ 10 years, positive bacterial culture and albumin levels were significant on stepwise logistic regression analysis.
CONCLUSIONT2DM duration ≥ 10 years, positive bacterial culture and low albumin levels were found to be significant predictive factors for major lower limb amputation among patients with T2DM admitted for diabetic foot problems.
Adult ; Aged ; Aged, 80 and over ; Amputation ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Foot ; epidemiology ; etiology ; surgery ; Female ; Humans ; Incidence ; Lower Extremity ; surgery ; Malaysia ; epidemiology ; Male ; Middle Aged ; Prognosis ; Risk Factors
6.A Two Years Retrospective Study on Epidemiology Characteristics of Sexually Transmitted Infections From Malaysian Private Healthcare Perspective
Shafiq Aazmi ; Fadzilah Mohd Nor ; Tengku Shahrul Anuar ; Tengku Nur Syahirah Tengku Kamaruzaman ; Muhammad Nazri Aziz ; Nabila Ibrahim ; Mohd Fakharul Zaman Raja Yahya ; Azdayanti Muslim ; , Farida Zuraina Mohd Yusof
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):268-274
Introduction: Sexually transmitted Infections (STIs) are major public health concerns reaching an all-time high, globally. In Malaysia data on the prevalence of STIs remains scarce which limits the understanding of STI transmission
dynamics and the role of interventions in the control of STIs. The aim of this study is to determine the epidemiology
characteristics of STIs mainly from Malaysian private healthcare institutions. Method: A two years (2016 and 2017)
retrospective review was conducted on 160 multiplex RT-PCR STI reports from KPJ hospitals, Malaysia. Results:
There were 65 (40.6 %) patients positive STIs [male: 21/65 (32.3 %); female: 44/65 (67.7 %)]. The STIs was prevalent among young adults (56/65; 86.2 %) from the central region (46/65; 70.8 %). Females had 1.7 times greater risk
to develop STI (20 per 100) and two times higher chance to have multiple STIs (10 per 100) in comparison to male.
The single STIs was caused mainly by U. parvum (N=17). In males, U. urealyticum (N=3) and C. trachomatis (N=3)
were prevalent, while U. parvum (N=15) was prevalent in females. There were 19 dual infections of STIs which were
commonly caused by U. parvum and M. hominis (N=5). There were seven STIs cases caused by three pathogens
concurrently including U. urealyticum, U. parvum and C. trachomatis (N=2) and U. urealyticum, M. genitalium
and C. trachomatis (N=2). Females from urban communities have higher risk in comparison to males for developing
multiple STIs. Conclusion: This study provides an imperative platform for temporal trends of STIs in Malaysia which
reflects the health status of certain populations that warrant immediate public health interventions.