Displaying publications 1 - 20 of 124 in total

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  1. Chai KS, Omar FH, Mat Saad AZ, Wan Sulaiman WA, Halim AS
    Arch Plast Surg, 2019 Sep;46(5):426-432.
    PMID: 31550747 DOI: 10.5999/aps.2018.01487
    BACKGROUND: The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma.

    METHODS: This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved.

    RESULTS: Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years.

    CONCLUSIONS: Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.

  2. Mohd Hilmi AB, Hassan A, Halim AS
    Adv Wound Care (New Rochelle), 2015 May 1;4(5):312-320.
    PMID: 26005597
    Objective: An engineered skin substitute is produced to accelerate wound healing by increasing the mechanical strength of the skin wound via high production of collagen bundles. During the remodeling stage of wound healing, collagen deposition is the most important event. The collagen deposition process may be altered by nutritional deficiency, diabetes mellitus, microbial infection, or radiation exposure, leading to impaired healing. This study describes the fabrication of an engineered bilayer skin substitute and evaluates its effectiveness for the production of collagen bundles in an impaired healing model. Approach: Rats were exposed to 10 Gy of radiation. Two months postirradiation, the wounds were excised and treated with one of three skin replacement products: bilayer engineered skin substitutes, chitosan skin templates, or duoderm(©). The collagen deposition was analyzed by hematoxylin and eosin staining. Results: On day 21 postwound, the irradiated wounds displayed increased collagen bundle deposition after treatment using bilayer engineered skin substitutes (3.4±0.25) and chitosan skin templates (3.2±0.58) compared with duoderm (2.0±0.63). Innovation: We provide the first report on the fabrication of bilayer engineered skin substitutes using high density human dermal fibroblasts cocultured with HFSCs on chitosan skin templates. Conclusion: The high density of fibroblasts significantly increases the penetration of cells into chitosan skin templates, contributing to the fabrication of bilayer engineered skin substitute.
  3. Nasir NAM, Saad AZM, Bachok NS, Rashid AHA, Ujang Z, Noorsal K, et al.
    Indian J Plast Surg, 2023 Feb;56(1):44-52.
    PMID: 36998939 DOI: 10.1055/s-0042-1759503
    Background  This clinical trial aimed to evaluate the clinical efficacy of chitosan derivative hydrogel paste (CDHP) as a wound bed preparation for wounds with cavities. Methods  This study enrolled 287 patients, with 143 patients randomized into the CDHP group (treatment) and 144 patients randomized into the commercial hydroactive gel (CHG) group (control). The granulation tissue, necrotic tissue, patient comfort, clinical signs, symptoms, and patient convenience during the application and removal of the dressing were assessed. Results  The study was completed by 111 and 105 patients from the treatment and control groups, respectively. Both groups showed an increasing mean percentage of wound granulation over time when the initial wound size and comorbidity were adjusted (F(10,198) = 4.61; p  
  4. Poh Yuen Wen A, Halim AS, Mat Saad AZ, Mohd Nor F, Wan Sulaiman WA
    Complement Ther Med, 2018 Dec;41:261-266.
    PMID: 30477850 DOI: 10.1016/j.ctim.2018.10.006
    BACKGROUND: Gamat (sea-cucumber) is a natural occurring fauna which is popularly used as traditional medication in Southeast Asian countries. There have been many animal studies done on its' biochemical properties and its' effects in vivo. The effect of gamat on human cutaneous wounds was studied using a split-skin graft donor site wound.

    METHODS: This was a comparative case-control study done on patients in Hospital Universiti Sains Malaysia (Hospital USM), requiring split-thickness skin grafting, whereby, the skin graft donor site was divided to almost equal halves, and applied with both gamat-based gel on one side, with Duoderm® hydrogel on the other side. The epithelialization of the wounds was observed and compared on days 10, 14 and 21. Pain score, and pruritus score were also observed. Repeated measure analysis of variance (ANOVA) test and Paired t-test was used to test statistical significance accordingly.

    RESULTS: No significant differences were seen in rates of epithelialization of wounds on days 10, 14 and 21 (p > 0.01). No significant difference was also seen in the pain score and pruritus score (p > 0.01).

    CONCLUSIONS: A gamat-based gel is comparable to conventional hydrogels in treatment of split-skin graft donor site. No adverse effects were observed in either group.

  5. Khoo TL, Halim AS, Zakaria Z, Mat Saad AZ, Wu LY, Lau HY
    J Plast Reconstr Aesthet Surg, 2011 Jun;64(6):e137-45.
    PMID: 20869928 DOI: 10.1016/j.bjps.2010.08.029
    Despite widespread beliefs regarding the use of topical tocotrienol in the prevention of hypertrophic scars, there is very little evidence from well controlled and randomised clinical trials to justify its benefits for surgical scars.
  6. Rajion ZA, Townsend GC, Netherway DJ, Anderson PJ, Yusof A, Hughes T, et al.
    Cleft Palate Craniofac J, 2006 Sep;43(5):513-8.
    PMID: 16986980
    To investigate anatomical variations and abnormalities of cervical spine morphology in unoperated infants with cleft lip and palate.
  7. Airuddin SS, Halim AS, Wan Sulaiman WA, Kadir R, Nasir NAM
    Biomedicines, 2021 Nov 05;9(11).
    PMID: 34829853 DOI: 10.3390/biomedicines9111624
    Stem cells have been widely used for treating disease due to the various benefits they offer in the curing process. Several treatments using stem cells have undergone clinical trials, such as cell-based therapies for heart disease, sickle cell disease, thalassemia, etc. Adipose-derived stem cells are some of the many mesenchymal stem cells that exist in our body that can be harvested from the abdomen, thighs, etc. Adipose tissue is easy to harvest, and its stem cells can be obtained in higher volumes compared to stem cells harvested from bone marrow, for which a more invasive technique is required with a smaller volume obtained. Many scientists have expressed interest in investigating the role of adipose-derived stem cells in treating disease since their use was first described. This is due to these stem cells' ability to differentiate into multiple lineages and secrete a variety of growth factors and proteins. Previous studies have found that the hormones, cytokines, and growth factors contained in adipose tissue play major roles in the metabolic regulation of adipose tissue, as well as in energy balance and whole-body homeostasis through their endocrine, autocrine, and paracrine functions. These are thought to be important contributors to the process of tissue repair and regeneration. However, it remains unclear how effective and safe ADSCs are in treating diseases. The research that has been carried out to date is in order to investigate the impact of ADSCs in disease treatment, as described in this review, to highlight its "trick or treat" effect in medical treatment.
  8. Faisham WI, Zulmi W, Halim AS, Biswal BM, Mutum SS, Ezane AM
    Singapore Med J, 2006 Aug;47(8):679-83.
    PMID: 16865207
    The surgical treatment of Stage III or aggressive giant cell tumour of the bone, whether to perform intralesional or en-bloc resection, remains controversial. The aim of this study is to identify the effectiveness of en-bloc resection for local control and final oncological outcome of the disease.
  9. Ishak A, Mat Saad AZ, Azman WS, Halim AS
    Med J Malaysia, 2018 06;73(3):172-174.
    PMID: 29962502 MyJurnal
    Partial scalp alopecia is a common problem that can lead to severe social and psychological problems. Tissue expansion, although an old concept, provides a surgical alternative to manage areas of alopecia. We describe a case of alopecia secondary to repaired occipital encephalocele that was successfully treated using tissue expansion technique.
  10. Shahid H, Baharudin A, Halim AS, Biswal BM, Jihan WS
    Med J Malaysia, 2007 Jun;62(2):171-2.
    PMID: 18705458 MyJurnal
    Osteosarcoma is a rare tumour in the sinonasal region. Early diagnosis is essential for adequate management and better prognosis and this requires a meticulous histopathological examination. Reported is a case of osteosarcoma misdiagnosed as chondrosarcoma and treated by surgery followed by radiotherapy. However, appropriate diagnosis and pre-operative chemotherapy would have been significant in the prognosis. The pitfall of accurate diagnosis and the subsequent treatment is discussed in order to find the ways to maximize five years survival which is not more than 25% in this type of lesions.
  11. Hamzan MI, Hamid AR, Halim AS, Mat Saad AZ
    Hemodial Int, 2020 04;24(2):E33-E36.
    PMID: 32141217 DOI: 10.1111/hdi.12832
    A young lady with an arteriovenous (AV) fistula on hemodialysis was referred for surgical management following a failed endovascular approach to relieve central venous occlusion. She had an obstructed left brachiocephalic vein with a history of numerous central vein catheter placements. Alternative routes for new arteriovenous fistula creation had been exhausted due to previous contralateral upper limb fistula rupture and ligation. To the best of our knowledge, no similar cases of airway obstruction in central venous occlusion occurring in hemodialysis patients with AV fistula have been reported. The importance of identifying the possible emergency red flags in hemodialysis patients with central venous occlusion is important to prevent unwanted consequences.
  12. Nurul Syazana MS, Gan SH, Halim AS, Shah NS, Gan SH, Sukari HA
    PMID: 24146441
    The constituents of honey's volatile compounds depend on the nectar source and differ depending on the place of origin. To date, the volatile constituents of Tualang honey have never been investigated. The objective of this study was to analyze the volatile compounds in local Malaysian Tualang honey. A continuous extraction of Tualang honey using five organic solvents was carried out starting from non-polar to polar solvents and the extracted samples were analysed using gas chromatography-mass spectrometry (GC-MS). Overall, 35 volatile compounds were detected. Hydrocarbons constitute 58.5% of the composition of Tualang honey. Other classes of chemical compounds detected included acids, aldehydes, alcohols, ketones, terpenes, furans and a miscellaneous group. Methanol yielded the highest number of extracted compounds such as acids and 5-(Hydroxymethyl) furfural (HMF). This is the first study to describe the volatile compounds in Tualang honey. The use of a simple one tube, stepwise, non-thermal liquid-liquid extraction of honey is a advantageous as it prevents sample loss. Further research to test the clinical benefits of these volatile compounds is recommended.
  13. Halim AS, Wan Z
    Clin Anat, 2004 May;17(4):358-9.
    PMID: 15108344
    The combined latissimus dorsi and serratus anterior flap has been employed for large defect reconstruction and has been shown to be reliable. These flaps are based on the subscapular-thoracodorsal vascular pedicle that usually supplies both muscles. In the case reported, serratus anterior possessed an anomalous arterial supply totally independent of the subscapular pedicle. The latissimus dorsi and serratus anterior muscles were used as a combined flap to reconstruct a massive thigh defect. The combined flap required two arterial anastomoses.
  14. Nasir NA, Halim AS, Singh KK, Dorai AA, Haneef MN
    PMID: 20576085 DOI: 10.1186/1472-6882-10-31
    The use of honey as a natural product of Apis spp. for burn treatment has been widely applied for centuries. Tualang honey has been reported to have antibacterial properties against various microorganisms, including those from burn-related diagnoses, and is cheaper and easier to be absorbed by Aquacel dressing. The aim of this study is to evaluate the potential antibacterial properties of tualang honey dressing and to determine its effectiveness as a partial thickness burn wound dressing.
  15. Nurul Syazana MS, Halim AS, Gan SH, Shamsuddin S
    PMID: 21943200 DOI: 10.1186/1472-6882-11-82
    Keloid is a type of scar which extends beyond the boundaries of the original wound. It can spread to the surrounding skin by invasion. The use of Tualang honey is a possible approach for keloid treatment. The objective of this study was to determine the antiproliferative effect of methanolic extraction of Tualang honey to primary human keloid fibroblasts and to identify the volatile compounds in methanol extraction of Tualang honey.
  16. Emami A, Halim AS, Salahshourifar I, Yussof SJ, Khoo TL, Kannan TP
    Arch. Dermatol. Res., 2012 Sep;304(7):541-7.
    PMID: 22805880 DOI: 10.1007/s00403-012-1262-0
    Keloid is a complex condition with environmental and genetic risk-contributing factors. Two candidate genes, TGFβ1 and SMAD4, located in the same signaling pathway are highly expressed in the keloid fibroblast cells. In a case-control design, TGFβ1 haplotypes showed association with the risk of keloid in the present study. The CC haplotype, composed of both c.29C>T and -509T>C variants, was observed more frequently among cases (Corrected p = 0.037, OR = 2.07, 95 % CI = 0.87-4.93), showing a 4.5-fold increased risk for keloid. The AG genotype of the SMAD4 c.5131A>G variant showed a trend of significance (p = 0.0573, OR = 1.75, 95 % CI = 0.99-3.13). Taken together, either of these variants is most probably causative at the expression level or is in linkage disequilibrium with other causative variants in a complex pattern together with the environmental factors that contribute to the condition. To the best of our knowledge, there is only one documented report on a relationship between TGFβ1 and keloid with no association within the Caucasian population, while there have not been any reports for SMAD4. Therefore, the present study is likely the first research showing a significant association between TGFβ1 variants and keloids in the Malay population.
  17. Halim AS, Khoo TL, Mohd Yussof SJ
    Indian J Plast Surg, 2010 Sep;43(Suppl):S23-8.
    PMID: 21321652 DOI: 10.4103/0970-0358.70712
    The current trend of burn wound care has shifted to more holistic approach of improvement in the long-term form and function of the healed burn wounds and quality of life. This has demanded the emergence of various skin substitutes in the management of acute burn injury as well as post burn reconstructions. Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various aetiologies. At present, there is no ideal substitute in the market. Skin substitutes can be divided into two main classes, namely, biological and synthetic substitutes. The biological skin substitutes have a more intact extracellular matrix structure, while the synthetic skin substitutes can be synthesised on demand and can be modulated for specific purposes. Each class has its advantages and disadvantages. The biological skin substitutes may allow the construction of a more natural new dermis and allow excellent re-epithelialisation characteristics due to the presence of a basement membrane. Synthetic skin substitutes demonstrate the advantages of increase control over scaffold composition. The ultimate goal is to achieve an ideal skin substitute that provides an effective and scar-free wound healing.
  18. Sulaiman AR, Simbak N, Wan Ismail WF, Wan Z, Halim AS
    J Orthop Surg (Hong Kong), 2011 Aug;19(2):250-3.
    PMID: 21857057
    We report 2 patients with congenital pseudoarthrosis of the tibia who underwent intramedullary Rush rod transfixation through the ankle joint following refracture and nonunion of vascularised fibular grafting 6 and 8 months earlier. After 9 and 5 years, both Rush rods were broken at the level of the ankle joints, while the reconstructed area was solidly united. The growth of the distal tibia increased the distance of the tips of the broken rod and hence the ankle joint motion. The broken tips may damage the articular cartilage and result in valgus deformity of the ankle and limb length discrepancy.
  19. Ishak A, Yahya MM, Halim AS
    Clin Breast Cancer, 2018 10;18(5):e1011-e1021.
    PMID: 29784600 DOI: 10.1016/j.clbc.2018.04.012
    BACKGROUND: Breast reconstruction after mastectomy is important in breast cancer care.

    MATERIALS AND METHODS: A cross-sectional study was designed to assess surgeons' and patients' perceptions toward breast reconstruction. Questionnaires were distributed to general and breast surgeons in East Coast Malaysian hospitals and Hospital Kuala Lumpur and to postmastectomy patients with and without breast reconstruction at the Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. The response rates were 82.5% for the surgeons (n = 33), 95.4% for the patients with reconstruction (n = 63), and 95.5% for the patients without reconstruction (n = 278).

    RESULTS: The median surgeon age and experience was 42 and 6 years, respectively. Each surgeon saw an average of 20 new breast cancer cases annually. Most surgeons (86.7%) discussed reconstruction options with their patients but had only referred an average of 4 patients for reconstruction during a 3-year period. Surgeons' concerns regarding the qualitative outcome increased the likelihood of a breast reconstruction discussion (β = 4.833; P = .044). The women who underwent breast reconstruction were younger (mean age, 42 vs. 50 years), were more often working (69.4% vs. 42.2%), and more often had previous awareness of the option (90.3% vs. 44.3%). The most common reasons for undergoing breast reconstruction were "to feel more balanced" (92.1%) and "surgeon's strong recommendation" (92.1%). Previous knowledge of breast reconstruction increased the likelihood of reconstruction (odds ratio, 5.805; P = .026). Although 70% of surgeons thought that patients would not be interested in reconstruction, only 37.9% of patients with previous awareness reported having no interest.

    CONCLUSION: The low reconstruction rate (20.6%) can be attributed to the low referral rate. Patients' likelihood to undergo reconstruction with their surgeon's recommendation and with previous awareness were reflective of the surgeons' strong influence on their patients. Thus, clarification of surgeons' hypothetical criticisms could conceivably increase the reconstructive surgery rate.

  20. Lee YY, Medford AR, Halim AS
    J R Coll Physicians Edinb, 2015;45(2):104-7.
    PMID: 26181523 DOI: 10.4997/JRCPE.2015.203
    Increasing numbers of doctors are experiencing burnout now more than ever before and the worrying part is that what we see is just the tip of the iceberg. Burnout, a state of mental exhaustion caused by the doctor's professional life, is characterised by emotional exhaustion, depersonalisation and a reduced sense of accomplishment or success. Burnout has been largely ignored or under-recognised previously. This paper provides a perspective on burnout among doctors, including an overview of symptoms, the scale of the problem, the implications and causes of burnout and, finally, a strategic framework to provide a basis for managing it. Most importantly, professional bodies are urged to start taking steps to help troubled doctors. Medical Colleges should provide essential assistance, support and guidance as well as ensuring fair management and promotion policies.
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