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Fulltext Wound contraction effects and antibacterial properties of Tualang honey on full-thickness burn wounds in rats in comparison to hydrofibre

Khoo YT, Halim AS, Singh KK, Mohamad NA

BMC Complement Altern Med, 2010;10:48.
PMID: 20815896 DOI: 10.1186/1472-6882-10-48

Full-thickness burn wounds require excision and skin grafting. Multiple surgical procedures are inevitable in managing moderate to severe full-thickness burns. Wound bed preparations prior to surgery are necessary in order to prevent wound infection and promote wound healing. Honey can be used to treat burn wounds. However, not all the honey is the same. This study aims to evaluate the wound contraction and antibacterial properties of locally-produced Tualang honey on managing full-thickness burn wounds in vivo.
Fulltext Wound bed preparation from a clinical perspective

Halim AS, Khoo TL, Saad AZ

Indian J Plast Surg, 2012 May;45(2):193-202.
PMID: 23162216 DOI: 10.4103/0970-0358.101277

Wound bed preparation has been performed for over two decades, and the concept is well accepted. The 'TIME' acronym, consisting of tissue debridement, infection or inflammation, moisture balance and edge effect, has assisted clinicians systematically in wound assessment and management. While the focus has usually been concentrated around the wound, the evolving concept of wound bed preparation promotes the treatment of the patient as a whole. This article discusses wound bed preparation and its clinical management components along with the principles of advanced wound care management at the present time. Management of tissue necrosis can be tailored according to the wound and local expertise. It ranges from simple to modern techniques like wet to dry dressing, enzymatic, biological and surgical debridement. Restoration of the bacterial balance is also an important element in managing chronic wounds that are critically colonized. Achieving a balance moist wound will hasten healing and correct biochemical imbalance by removing the excessive enzymes and growth factors. This can be achieved will multitude of dressing materials. The negative pressure wound therapy being one of the great breakthroughs. The progress and understanding on scientific basis of the wound bed preparation over the last two decades are discussed further in this article in the clinical perspectives.
Fulltext Wound bed preparation for chronic diabetic foot ulcers

Mat Saad AZ, Khoo TL, Halim AS

ISRN Endocrinol, 2013;2013:608313.
PMID: 23476800 DOI: 10.1155/2013/608313

The escalating incidence of diabetic mellitus has given rise to the increasing problems of chronic diabetic ulcers that confront the practice of medicine. Peripheral vascular disease, neuropathy, and infection contribute to the multifactorial pathogenesis of diabetic ulcers. Approaches to the management of diabetic ulcers should start with an assessment and optimization of the patient's general conditions, followed by considerations of the local and regional factors. This paper aims to address the management strategies for wound bed preparation in chronic diabetic foot ulcers and also emphasizes the importance of preventive measures and future directions. The "TIME" framework in wound bed preparation encompasses tissue management, inflammation and infection control, moisture balance, and epithelial (edge) advancement. Tissue management aims to remove the necrotic tissue burden via various methods of debridement. Infection and inflammation control restores bacterial balance with the reduction of bacterial biofilms. Achieving a moist wound healing environment without excessive wound moisture or dryness will result in moisture balance. Epithelial advancement is promoted via removing the physical and biochemical barriers for migration of epithelium from wound edges. These systematic and holistic approaches will potentiate the healing abilities of the chronic diabetic ulcers, including those that are recalcitrant.
Fulltext Vital roles of stem cells and biomaterials in skin tissue engineering

Mohd Hilmi AB, Halim AS

World J Stem Cells, 2015 Mar 26;7(2):428-36.
PMID: 25815126 DOI: 10.4252/wjsc.v7.i2.428

Tissue engineering essentially refers to technology for growing new human tissue and is distinct from regenerative medicine. Currently, pieces of skin are already being fabricated for clinical use and many other tissue types may be fabricated in the future. Tissue engineering was first defined in 1987 by the United States National Science Foundation which critically discussed the future targets of bioengineering research and its consequences. The principles of tissue engineering are to initiate cell cultures in vitro, grow them on scaffolds in situ and transplant the composite into a recipient in vivo. From the beginning, scaffolds have been necessary in tissue engineering applications. Regardless, the latest technology has redirected established approaches by omitting scaffolds. Currently, scientists from diverse research institutes are engineering skin without scaffolds. Due to their advantageous properties, stem cells have robustly transformed the tissue engineering field as part of an engineered bilayered skin substitute that will later be discussed in detail. Additionally, utilizing biomaterials or skin replacement products in skin tissue engineering as strategy to successfully direct cell proliferation and differentiation as well as to optimize the safety of handling during grafting is beneficial. This approach has also led to the cells' application in developing the novel skin substitute that will be briefly explained in this review.
Fulltext Versatility of the latissimus dorsi flap in upper limb salvage tumour surgery

Dorai AA, Halim AS, Zulmi W

Med J Malaysia, 2004 Dec;59 Suppl F:42-6.
PMID: 15941160

Reconstructive surgeons often encounter complex soft tissue and skeletal defects following oncological surgery. Soft tissue defects after wide resection in upper extremities posses a difficult challenge to find adequate tissue for reconstructing these defects. Paucity of local tissues dictates the requirement of loco-regional or distant flaps for these complex soft tissue defects which often exposes tendons, bones, nerves and joints. The latissimus dorsi muscle is a near ideal flap for the reconstruction because of the long neurovascular pedicle, ease of mobilization and its expendability. It can be rotated, with or without overlying skin, to cover soft tissue defects of the shoulder arm and elbow. Due to the large size of the muscle, it can be used to resurface the soft tissue defects and cover all major structures. Eleven consecutive cases were reviewed in which latissimus dorsi myocutaneous flap was used to reconstruct soft tissue defects of the upper limb following radical tumor resection. Flap survival was 100% with nominal donor site morbidity.
Use of dermal regeneration template (INTEGRA) in reconstructive burn surgery

Sasidaran R, Dorai AA, Sulaiman WA, Halim AS

Med J Malaysia, 2008 Jul;63 Suppl A:29.
PMID: 19024967

We present our two year experience with a dermal regeneration template (INTEGRA) in burn reconstructive surgery for contracture release as well as a reconstructive tool for management of soft tissue loss.
Fulltext Two novel genes TOX3 and COL21A1 in large extended Malay families with nonsyndromic cleft lip and/or palate

Mohamad Shah NS, Sulong S, Wan Sulaiman WA, Halim AS

Mol Genet Genomic Med, 2019 May;7(5):e635.
PMID: 30924295 DOI: 10.1002/mgg3.635

BACKGROUND: Nonsyndromic cleft lip and/or palate is one of the most common human birth defects worldwide that affects the lip and/or palate. The incidence of clefts varies among populations through ethnic, race, or geographical differences. The focus on Malay nonsyndromic cleft lip and/or palate (NSCL/P) is because of a scarce report on genetic study in relation to this deformity in Malaysia. We are interested to discuss about the genes that are susceptible to cause orofacial cleft formation in the family.
METHODS: Genome-wide linkage analysis was carried out on eight large extended families of NSCL/P with the total of 91 individuals among Malay population using microarray platform. Based on linkage analyses findings, copy number variation (CNV) of LPHN2, SATB2, PVRL3, COL21A1, and TOX3 were identified in four large extended families that showed linkage evidence using quantitative polymerase chain reaction (qPCR) as for a validation purpose. Copy number calculated (CNC) for each genes were determined with Applied Biosystems CopyCallerTM Software v2.0. Normal CNC of the target sequence expected was set at two.
RESULTS: Genome-wide linkage analysis had discovered several genes including TOX3 and COL21A1 in four different loci 4p15.2-p16.1, 6p11.2-p12.3, 14q13-q21, and 16q12.1. There was significant decreased, p
Tualang honey has higher phenolic content and greater radical scavenging activity compared with other honey sources

Kishore RK, Halim AS, Syazana MS, Sirajudeen KN

Nutr Res, 2011 Apr;31(4):322-5.
PMID: 21530807 DOI: 10.1016/j.nutres.2011.03.001

Many chronic diseases are associated with increased oxidative stress caused by an imbalance between free-radical production and the antioxidant level. Antioxidants, which are abundant in natural honey, are free-radical scavengers that either reduce the formation of or neutralize free radicals. The composition and source of honey greatly dictates its biochemical properties. We performed a comparative analysis of the total phenolic content and antioxidant potential of common commercially available honeys along with Malaysian tualang honey. In vitro biochemical analysis of the phenolic content by the Folin-Ciocalteau method revealed a significantly elevated phenolic content (83.96 ± 4.53 mg gallic acid equivalents per 100 g) in tualang honey. In addition, the antioxidant capacity (53.06 ± 0.41 mg ascorbic acid equivalents per gram) of tualang honey was greater, as assessed by the phosphomolybdenum method, 2,2-diphenyl-1-picryl-hydrazyl assay, and ferric reducing/antioxidant power assay. Peroxynitrite and superoxide radical scavenging activity was determined by spectrophotometric analysis in different honey types. Our data suggest that the elevated free-radical scavenging and antioxidant activity observed in tualang honey is due to the increased level of phenolic compounds. In addition to its antibacterial, anticarcinogenic, and anti-inflammatory properties, our study highlights the favorable antioxidant properties of tualang honey, which may be important to human nutrition and health.
Fulltext Translation, Cross-Cultural Adaptation, and Validation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) into the Malay Language

Zun AB, Ibrahim MI, Mokhtar AM, Halim AS, Wan Mansor WNA

Int J Environ Res Public Health, 2019 06 10;16(11).
PMID: 31185665 DOI: 10.3390/ijerph16112054

BACKGROUND: Patient feedback is an important tool in assessing health system quality. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed in 2006 as a standardized instrument to assess patient perceptions in the United States of America. This study aimed to translate and validate the HCAHPS questionnaire into the Malay language in order to assess patient perceptions of health services in Malaysia.
METHODS: The original HCAPHS in English was translated into Malay based on the established guideline. The content validation involved an expert panel of 10 members, including patients. The face validation pilot testing of the HCAHPS-Malay version was conducted among 10 discharged patients. The exploratory factor analysis (EFA) used principal axis factor, and varimax rotation was established based on a cross-sectional study conducted among 200 discharged patients from Hospital Universiti Sains Malaysia (Hospital USM).
RESULTS: The overall content validity index was 0.87, and the universal face validity index was 0.82. From the EFA, the factor loading value ranged from 0.652 to 0.961 within nine domains. The internal consistency reliability with Cronbach's alpha was 0.844.
CONCLUSION: The HCAHPS-Malay is a reliable and valid tool to determine patients' perception of healthcare services among inpatients in Hospital USM based on the content and face validation result together with a good construct validity and excellent absolute reliability. Further testing on HCAHPS-Malay version in other settings in Malaysia needs to be done for cross-validation.
Fulltext The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction

Mat Saad AZ, Khoo TL, Dorai AA, Halim AS

Indian J Plast Surg, 2009;42(1):94-9.
PMID: 19881027 DOI: 10.4103/0970-0358.53017

Skin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.
The use of glycerol-preserved skin allograft in conjunction with reconstructive and flap surgery: seven years of experience

Saad AZ, Halim AS, Khoo TL

J Reconstr Microsurg, 2011 Feb;27(2):103-8.
PMID: 20976667 DOI: 10.1055/s-0030-1268208

Major reconstructive surgery may be extensive and prolonged, and it may cause edema and compromise the flap pedicle if closed under tension. Glycerol-preserved skin allograft (GPA) can provide a means for tension-free closure and temporary cover of the wound. Seven years of analysis on GPA used in conjunction with major reconstruction was undertaken to highlight its indications, results, and outcomes. Forty-seven patients were included, aged between 9 and 73 years. Majority of patients had reconstruction following tumor resection and trauma. The main indication for use of GPA was temporary, loose cover of the wound in 44% of cases; flap pedicle protection in 31% of cases; donor site wound cover in 10%; flap monitoring in one case; and management of flap-related complications in 6% of cases. Free flap reconstruction was performed in 72% of cases. In conclusion, GPA is a useful adjunct in reconstructive surgery. It can be used temporarily to allow tension-free wound closure, as well as to protect the flap pedicle until edema subsides and the pedicle becomes stable. This latter approach allows secondary wound closure and good esthetic outcome.
Fulltext The pudendal thigh fasciocutaneous flap for vaginal atresia reconstruction

Azman WS, Halim AS, Samad IA

Med J Malaysia, 2005 Oct;60(4):505-7.
PMID: 16570718

Vaginal defects can either be congenital or acquired due to tumor or trauma. The reconstructions are aimed in producing a good physical and functional result with the least donor site morbidity. The pudendal thigh flap is a sensate fasciocutaneous flap based on the terminal branch of the superficial perineal artery, the continuation of the internal pudendal artery. Although various flaps have been described for vaginal reconstruction, the pudendal thigh flap offers a very attractive alternative.
Fulltext The outcomes of salvage surgery for vascular injury in the extremities: a special consideration for delayed revascularization

Jagdish K, Paiman M, Nawfar A, Yusof M, Zulmi W, Azman W, et al.

Malays Orthop J, 2014 Mar;8(1):14-20.
PMID: 25279079 MyJurnal DOI: 10.5704/MOJ.1403.012

A seven years retrospective study was performed in 45 consecutive vascular injuries in the extremities to investigate the pattern of injuries, managements and outcomes. Motor-vehicle accidents were the leading cause of injuries (80%), followed by industrial injuries (11.1%) and iatrogenic injuries (4.4%). Popliteal and brachial artery injuries were commonly involved (20%). Fifteen (33.3%) patients had fractures, dislocation or fracture dislocation around the knee joint and 6 (13.3%) patients had soft tissue injuries without fracture. Traumatic arterial transection accounted for 34 (75.6%) cases, followed by laceration in 7 (15.6%) and 9 (6.7%) contusions. Associated nerve injuries were seen in 8 (17.8 %) patients using intra-operative findings as the gold standard, both conventional angiogram (CA) and computerized tomography angiogram (CTA) had 100% specificity and 100% sensitivity in determining the site of arterial injuries. The mean ischemic time was 25.31 hours (4 - 278 hours). Thirty-three (73.3 %) patients were treated more than 6 hours after injury and 6 patients underwent revascularization after 24 hours; all had good collateral circulation without distal pulses or evidence of ischemic neurological deficit. The mean ischemic time in 39 patients who underwent revascularization within 24 hours was 13.2 hours. Delayed amputation was performed in 5 patients (11.1%). Of the 6 patients who underwent delayed revascularization, one patient had early amputation, one -had delayed amputation following infection and multiple flap procedures while the rest of the patients' limbs survived. Joint stiffness was noted in 10 patients (22.2%) involving the knee joint, elbow and shoulder in two patients each. Infection was also noted in 5 patients (11.1%) with two of them were due to infected implants. Other complications encountered included nonunion (2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1 patient, 2.2%) and leaking anastomosis in one patient (2.2%). Volkmann's ischemic contracture occurred in 3 (6.7%) patients. There was no complication noted in 8 (17.8%) patients Three patients (6.7%) died of whom two were not due to vascular causes. We conclude that early detection and revascularization of traumatic vascular injuries is important but delayed revascularization also produced acceptable results.
The hyoid bone in malay infants with cleft lip and palate

Rajion ZA, Townsend GC, Netherway DJ, Anderson PJ, Hughes T, Shuaib IL, et al.

Cleft Palate Craniofac J, 2006 Sep;43(5):532-8.
PMID: 16986987

To compare morphological and positional variations of the hyoid bone in unoperated infants with cleft lip and palate (CL/P) with those in noncleft infants.
The effect of vitamin E on basic fibroblast growth factor level in human fibroblast cell culture

Rashid SA, Halim AS, Muhammad NA

Med J Malaysia, 2008 Jul;63 Suppl A:69-70.
PMID: 19024988

Basic fibroblast growth factor (bFGF) is angiogenic and effective in down-regulating excess collagen production. The aim of this study is to evaluate the effectiveness of vitamin E (Tocotrienol Rich Fraction) in altering the level of bFGF, a cytokine involved in the scar formation process. In this model, normal human fibroblasts were treated with various concentrations of vitamin E at different time frames. The levels of bFGF were determined by Enzyme-Linked Immunosorbant Assay (ELISA). This study demonstrated that Tocotrienol Rich Fraction (TRF) stimulated bFGF production by fibroblast and postulate that vitamin E may decrease aberrant scar formation.
The application of glycerol-preserved skin allograft in the treatment of burn injuries: an analysis based on indications

Khoo TL, Halim AS, Saad AZ, Dorai AA

Burns, 2010 Sep;36(6):897-904.
PMID: 20299154 DOI: 10.1016/j.burns.2009.03.007

Glycerol-preserved skin allograft (GPA) plays a crucial role in the management of burns. Its indications include wound-bed preparation, definitive dressing and sandwich grafting technique.
Fulltext The antibacterial properties of Malaysian tualang honey against wound and enteric microorganisms in comparison to manuka honey

Tan HT, Rahman RA, Gan SH, Halim AS, Hassan SA, Sulaiman SA, et al.

BMC Complement Altern Med, 2009;9:34.
PMID: 19754926 DOI: 10.1186/1472-6882-9-34

Antibiotic resistance of bacteria is on the rise, thus the discovery of alternative therapeutic agents is urgently needed. Honey possesses therapeutic potential, including wound healing properties and antimicrobial activity. Although the antimicrobial activity of honey has been effectively established against an extensive spectrum of microorganisms, it differs depending on the type of honey. To date, no extensive studies of the antibacterial properties of tualang (Koompassia excelsa) honey on wound and enteric microorganisms have been conducted. The objectives of this study were to conduct such studies and to compare the antibacterial activity of tualang honey with that of manuka honey.
The Practice of First Aid for Burn Injuries Among the Population of East Coast of Peninsular Malaysia for 2012-2016

Seow SN, Halim AS, Wan Sulaiman WA, Mat Saad AZ, Mat Johar SFN

J Burn Care Res, 2020 Jul 03;41(4):905-907.
PMID: 32166315 DOI: 10.1093/jbcr/iraa025

Burns are a devastating public health problem that result in 10 million disability-adjusted life-years lost in low- and middle-income countries. Adequate first aid for burn injuries reduces morbidity and mortality. The rate of proper first aid practices in other countries is 12% to 22%.1,2 A 5-year retrospective audit was performed on the database of the Burn Unit in Hospital Universiti Sains Malaysia for 2012-2016; this involved 485 patients from the east coast of Malaysia. The mean age of the patients is 17.3 years old. The audit on first aid practices for burn injury showed poor practice. Out of 485 burned patients, 261 patients (53.8%) claimed that they practiced first aid. However, only 24 out of 485 patients (5%) practiced the correct first aid technique where they run their burn wound under cool water for more than 20 minutes. Two hundred and twenty-two patients had not received any first aid. Two patients did not respond to the question on the first aid usage after burn injury. The mean age of patients who practiced first aid was 15.6 years old. Out of the 261 patients who practiced first aid, 167 (64%) run their wound under tap water for different durations. Others practiced traditional remedies such as the application of "Minyak Gamat" (6.5%), soy sauce (5.5%), other ointments (3.6%), milk (1.8%), and eggs (0.7%), as well as honey, butter, and cooking oil (0.4% each). First aid practices for burn injuries in the population of east coast Malaysia are still inadequate. The knowledge and awareness of school children and the general Malaysian population must be enhanced.
The Effects of Passive Cigarette Smoke Exposure on the Survival of the Reverse Sural Fasciocutaneous Flap

Sadagatullah AN, Halim AS, Bathusha MS, Ramachandran AK

J Hand Microsurg, 2017 Dec;9(3):120-125.
PMID: 29302135 DOI: 10.1055/s-0037-1605354

Background The possibility of a person who had undergone surgery to be exposed to the ill effects of cigarette smoke is high, more so if the person lives with a smoker. With increasing popularity of reverse sural fasciocutaneous flaps, a surgeon may have to manage a person who lives with a smoker or is exposed to cigarette smoke. A clear understanding of the effects of exposure to cigarette smoke on reverse sural fasciocutaneous flaps is necessary. This study was performed to establish a clearer understanding of the effects of smoking on reverse sural fasciocutaneous flaps and evidence for preoperative patient counseling about smoking and smoke exposure. Objective The study investigated effects of exposure to cigarette smoke on the survival of the reverse sural fasciocutaneous flap. Methods This was an experimental observational study conducted at the Laboratory for Animal Research Unit in the Health Campus of Universiti Sains Malaysia. Twelve adult White New Zealand rabbits ( Oryctolagus cuniculus ) were divided into two groups of six. All 12 rabbits had a 2.5- × 2.5-cm reverse sural fasciocutaneous flap raised on both its hind limbs. The group exposed to cigarette smoke underwent 4 weeks of smoke exposure for 2 hours daily prior to surgery. This was then continued until analysis of the results. The control group had no intervention. All flaps were analyzed on the seventh postoperative day, after tracing on transparent plastic sheets with the necrotic area marked followed by 2D planimetry done on a grid paper. The flaps were assessed on the total flap area and survival area percentage. It was recorded as mean ± SD. The presence or absence of infection and hematoma was also noted. Results Twelve flaps were analyzed in each group. Total mean flap area and survival area percentage of the control group were 120.33 ± 31.03 mm 2 and 80.12 ± 15.75%, respectively, whereas in the cigarette smoke-exposed group, it was 121.83 ± 17.93 mm 2 and 62.04 ± 34.01%, respectively. The control group had two infections and one hematoma, and the smoking-exposed group had six infections and nine hematomas. The comparison between the groups was made in terms of total flap area, survival percentage, presence of infection, and hematoma for which the p values were 0.886, 0.115, 0.083, and 0.003, respectively. The differences between right and left hind limbs were also analyzed ( p = 0.414). Conclusion There was no statistical difference in the results from the right and left hind limbs. There was no statistical difference in the survival of reverse sural fasciocutaneous flap between the control and smoking-exposed groups.
Synergistic effects of chitosan scaffold and TGFβ1 on the proliferation and osteogenic differentiation of dental pulp stem cells derived from human exfoliated deciduous teeth

Farea M, Husein A, Halim AS, Abdullah NA, Mokhtar KI, Lim CK, et al.

Arch Oral Biol, 2014 Dec;59(12):1400-11.
PMID: 25222336 DOI: 10.1016/j.archoralbio.2014.08.015

Multipotent stem cells derived from human exfoliated deciduous teeth (SHED) represent a promising cell source for tissue regeneration. In the present study we decided to test the inductive effect of chitosan and transforming growth factor-β1 (TGFβ1) as a scaffold/factor combination on SHED proliferation and osteogenic differentiation.

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