How to perform solah with upper limb injuries

Solah is one of the Five Pillars of Islam. The task of performing solah is of utmost importance for all Muslims. The order of performing solah was bestowed directly to Prophet Muhammad S.A.W during Israk Mikraj. This highlights the greatest priority of performing solah even in injurious conditions. In patients with upper limb injuries and limited function, solah is compulsory and must be performed with any remaining physical functions. A group of undergraduate medical students researched and discussed the correct method of performing ablution and solah in injured patients with a facilitator from Kulliyyah of Islamic Revealed Knowledge, IIUM. The issues discussed were the options available in performing ablution prior to solah which either was with water, tayammum (dust), or both. The method of performing solah in upper limb injuries was highlighted. We conclude that the tayammum is the most practical and feasible ablutions method for patients with upper limb injuries prior to perform solah

Comparison of ex-vivo x-ray changes in different groups of injectable biomaterials (JectOS, MIIG®X3, Osteopaste) in critical size defect of rabbit tibia bone

Introduction: Critical size defect (CSD) is defined as a defect that will not heal without intervention within the lifetime. The gold standard treatment for CSD is bone graft, although with some limitations. Substitute biomaterials were introduced to overcome the limitations. JectOS and MIIG® X3 are commercially available biomaterials in the market. Osteopaste is a local product produced by SIRIM. The objective of this study is to compare the radiological changes between Osteopaste, JectOS and MIIG® X3 in CSD in rabbit tibia bone. Methods: New Zealand White rabbits were divided into four groups: control group (Sham operation, n=3); Osteopaste treatment (n=12); JectOS treatment (n=12) and MIIG® X3 treatment (n=12). CSD was created at the right proximal tibia bone of the rabbits in each of the groups and the defects were filled with the biomaterial as assigned. Four animals from each group were sacrificed at 6 weeks, 12 weeks and 24 weeks respectively. The bones were harvested and x-ray imaging performed using SkyScan 1176 at 90kV, 281µA, resolution 4000x2672 with Aluminium 1.0mm. Results: The radiographic density at the CSD area was more prominent in the JectOS group throughout the 24 weeks. Meanwhile, in the MIIG® X3, full resorption occurred at 24 weeks. The Osteopaste group exhibited radiographic density in between that of JectOS and MIIG® X3. Conclusions: Different types of biomaterial exhibit different radiological changes over the period of bone healing. KEYWORDS: critical size defect, osteopaste, bone biomateria

Bilateral olecranon fracture in adult. A case report.

We report a case of a 14 - year - old Malay male who fell at school and sustained bilateral olecranon fractures. He had undergone an open redu ction and tension band wiring to stabilize the fracture. Three months after the surgery, the movement of both his elbows was satisfactor

An in vivo implantation study in New Zealand white rabbits for granular hydroxyapatite

We developed hydroxyapatite (HA) granules made from local raw materials (GranuMaS™), which have been fabricated using a novel method (Patent (Pending) No. PI 2004 0748). GranuMaS™ have been fully characterized using X-ray diffraction, scanning electron microscopy, energy dispersive x-ray, Fourier transform infra-red spectroscopy and inductively coupled plasma methods. It has also been shown to comply with the ASTM F1185 - 88 (1993) specification standards. Biocompatibility studies have been performed on the product, which include neutral red cytotoxicity assay using cultured fibroblast and CRL-1427 osteoblast cells; MTT (Tetrazolium Salt) assay; cytotoxicity studies for apoptosis using Acridine Orange / Propidium Iodide (AO/PI) dual staining of V79 cells in DMEM; and COMET assay genotoxicity studies using L-929 (normal mouse epithelial) cells. An in vivo implantation study involving New Zealand White rabbits were carried out in the course of this study

An In Vivo Implantation Study in New Zealand White Rabbits for Granular Hydroxyapatite

Introduction: We developed hydroxyapatite (HA) granules made from local raw materials (GranuMaS™), which have been fabricated using a novel method (Patent (Pending) No. PI 2004 0748). GranuMaS™ have been fully characterized using X-ray diffraction, scanning electron microscopy, energy dispersive x-ray, Fourier transform infra-red spectroscopy and inductively coupled plasma methods. It has also been shown to comply with the ASTM F1185 - 88 (1993) specification standards. Biocompatibility studies have been performed on the product, which include neutral red cytotoxicity assay using cultured fibroblast and CRL-1427 osteoblast cells; MTT (Tetrazolium Salt) assay; cytotoxicity studies for apoptosis using Acridine Orange / Propidium Iodide (AO/PI) dual staining of V79 cells in DMEM; and COMET assay genotoxicity studies using L-929 (normal mouse epithelial) cells. An in vivo implantation study involving New Zealand White rabbits were carried out in the course of this study. Materials and Methods: HA granules of between 250 to 500 μm in diameter were implanted into a 9mm by 4.5mm defect made in the proximal metaphyseal region of the rabbits’ left tibia. The tibia was harvested at 2, 3, 4, 6 and 12 weeks. The retrieved specimens were processed to produce undecalcified tissue sections using a hard tissue band cutting and microgrinding system (EXAKT Apparatebau, Germany). Prepared slides were analyzed under the light microscope using compound polarized light, Toulidine Blue, Masson Goldner’s Trichrome and von Kossa stains. Results and Discussion: New bone formation is seen even at 2 weeks post-implantation, which further consolidates at 3, 4 and 6 weeks. At 12 weeks the new bone between the granules are well-formed and the cortical defects made have closed off with well-formed lamellar bone seen between the granules. There is direct apposition of the new bone to the granules. The new bone seen with bridging of the medullary cavity and no major voids or defects found. No evidence of any fibrous or inflammatory tissue was seen. Conclusions: GranuMaS™ is osteoconductive and biocompatible when implanted in rabbits. It could be used as an alternative bone graft substitute, as there is profound new bone formation in-between and around the granules

Evaluation of blood loss during internal (limb-salvage) hemipelvectomy for pelvic tumours : what have we learned so far?

Introduction: Pelvic tumour resections are complex and associated with extensive bleeding. Despite various blood management options in orthopaedic surgery, their used are limited particularly for pelvic tumour resections. Identifying predictive factors for a large amount of blood loss during surgery is essential. Objective: To evaluate the volume of blood loss in limb salvage pelvic resections and identify the risk factors for large amount of perioperative blood loss. Methodology: We retrospectively reviewed 25 patients underwent pelvic tumour resections performed between 2000 and 2010 in a single institution. Tumours originating from the sacrum were excluded. Total blood volume loss consisted of estimated intra-operative blood loss and the drainage volume on the first day after surgery. Loss of more than 3000ml of blood was classified as large amount of blood loss. Statistical analysis performed using Fisher’s exact test. Results: Six (24.0%) patients had total blood loss greater than 3000ml. Resections of primary bone sarcomas (osteosarcoma and chondrosarcoma) have the highest mean blood loss volume (6556.67ml and 1768.57ml, respectively). Most important factor associated with large amount of blood loss is the involvement of the acetabulum. Neo-adjuvant therapies and pre-operative embolization were not shown to be associated with extensive blood loss.. Conclusion: Resections of pelvic tumours involving the acetabular region are likely to have a large amount of blood loss perioperatively and should be anticipated. Radiation therapy prior to surgery was believed to increase the risk of bleeding intra-operatively, was not observed in this study

Practical Islamic input in Orthopaedics Undergraduate Medical Curricula

The International Islamic University of Malaysia (IIUM) was founded in 1983 upon a renewed awareness of the perennial values of the teachings in the Al-Quran and Sunnah and is dedicated to the reorientation of the ummah and mankind towards this end. The first Mission Statement of IIUM stated that it would ‘…undertake the special and greatly needed task of reforming the contemporary Muslim mentality and integrating Islamic Revealed Knowledge and the Human Sciences in a positive manner’. When it was first founded, IIUM had faculties only in the Human and Social Sciences. In 1995, the Kulliyyah of Medicine (Kulliyyah al-Tabb) was established and the fist batch of 69 medical undergraduates started their medical education in 1997. Previously, fresh medical graduates have been accused of being very uncaring towards their patients when they start working in the hospitals. In a country with a large Muslim population like Malaysia there are certain aspects of medical practice that may make both the patient and the medical practitioner uncomfortable, such as how to perform solah while the patients are incapacitated. As the doctor is responsible for patients while they are hospitalised, there is a responsibility under syariah law for the doctor to ensure that the patients do not forgo their obligations as Muslims. The fact that the patient is under the doctor’s care does not absolve the doctor of this responsibility and, in fact, further strengthens the need for something to be done. The heavy medical curriculum has been blamed in the past as a major factor that medical students become more ‘disease-orientated’ rather than ‘patient-orientated’. In a non-English speaking country like Malaysia, the burden on the medical students to perform is much bigger due to the language barrier as most teaching medium available are in English. Thus, the medical students’ time will be further taken up by their efforts to study and do well in their exams at the end of their posting or semester. They spend more time in trying to read and memorise as much as possible rather than understanding the problem. In the Western world this phenomena is a well known fact, leading to the advent of ‘Problem Based Learning’ (PBL) in trying to overcome this shortcomings in the medical student. Furthermore, the secularisation of all fields of knowledge has lead towards the medical curriculum largely devoid of any religious or spiritual considerations. Although undergraduate students have had formal teaching about the basics of the Islamic fiqh and tawhid during their school-going years, they are very much unprepared to apply the knowledge that they acquired towards the pathological conditions that they will see in the clinical setting. Therefore, there is a great need to re-educate the medical undergraduates on how to be more critical of the information that they acquire in medical school and how to better apply the knowledge gained, especially from the various aspects of the Islamic perspective. In the Kulliyyah of Medicine in IIUM the teaching of medicine in a holistic manner is being achieved by having a series of relevant Islamic Revealed Knowledge lectures for the students every week throughout their five year course. To our knowledge IIUM is the first university in the world to incorporate Islamic Input courses into the medical curriculum. The Department of Orthopaedics, Traumatology & Rehabilitation has gone further by introducing a practical session on the relevant aspects of the Islamic Input in Orthopaedics (Triple IO) practice since 2002

Implementation of project based learning for civil engineering students at Universiti Teknologi Malaysia

Implementation of Project Based Learning (PtBL) in Universiti Teknologi Malaysia (UTM) as part of Outcome Based Education (OBE) framework have faced various challenges (i.e revamp on the undergraduate co-curricullum, required high commitments from academicians & faculty and facilities to cater PtBL activities). This paper discusses the effectiveness of PtBL teaching method in an effort to develop the students’ soft skills in tandem with the technical or professional competencies; and problems, challenges and potential improvement in the course. The Survey Camp course which is offered at year one of a four years civil engineering degree programme in the Faculty of Civil Engineering (FKA), UTM was chosen for this study. It is a ten days fieldwork in which the students will carry out an engineering survey project from field to finish in groups of five to six students supervised by the academic staff. Assessment of the technical aspects was based on the students ability to meet the minimum engineering surveying’s standard whereas the assesment of soft skills was conducted during various sessions of the survey projects. Survey questionaires were given at the beginning and the end of the course as part of evaluation of the course effectiveness. The research has found that the technical aspects were achievable though with lesser degree for the engineering design. However, on the soft skills, students demonstrated an overall improvement of competency but it was difficult to determine the levels for the average students while the best and poor performers were easily observed

Contriving local orthopaedic oncology database: IIUM experience using filemaker pro

Objectives: To evaluate the efficacy of creating and maintaining Orthopaedic oncology database using Filemaker Pro in the absence of centralised data collection system. Materials and Method: We created our database using FileMaker Pro Advanced in 2014 with the ability to capture multitude of information such as patient profile, history, clinical diagnosis and photos, investigations including photo-captured version of plain radiograph, CT, MRI and bone scan, biopsy results, list of surgery done and the surgical photos, records of chemotherapy and radiotherapy and current follow-ups. It has built-in capability to calculate Mirel's score, Tomita's score, MSTS score, etc. The database was powered by a Mac laptop while iPhone and iPad version of FileMaker Go were used to record patients' data which has the capability to snap photos or insert images right within the app. Results: Within a year, we successfully captured 70 patients' data, many with photos and follow-up. We also circumvented the problems of missing or untraceable records during follow-up as patients' information were easily accessible through the electronic database. Our aim of getting a snapshot of our work was successful as we had our local statistics regarding our patients and cases. Furthermore, we could present our data to our peers effortlessly through the contrived database. Conclusion: Database creation and maintenance with FileMaker Pro is fairly straightforward which could be done with minimal computing background. This system can be adapted by other similar institutions to improve their patient database management