Displaying all 19 publications

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  1. Nair HKR
    J Wound Care, 2018 05 02;27(5):296-306.
    PMID: 29738296 DOI: 10.12968/jowc.2018.27.5.296
    OBJECTIVE: The primary aim is to assess the efficacy of microcurrent, a form of electrical stimulation, as an adjunct therapy in accelerating healing in chronic wounds by reducing wound size and pain level. The secondary aim is to assess the qualitative changes in these parameters: inflammatory symptoms, vasodilation, sleep quality, gait and frequency of bowel movement.

    METHOD: Eligible patients with chronic wounds were enrolled between March and June 2016, from the Wound Care Unit, Hospital Kuala Lumpur in this consecutive case series. Standard wound care was performed with microcurrent as an adjunct therapy. Each patient was treated with an anti-inflammatory frequency, followed by a vasodilation frequency, while having their wounds cleansed during each dressing change. Patients were loaned a home-microcurrent device to treat themselves three times daily using a tissue repair frequency for four weeks.

    RESULTS: A total of 100 patients with chronic wounds, such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers, were recruited. During the four-week treatment period, all patients had a reduction in wound size, with 16 having complete wound closure. All 89 of the 100 patients who complained of pain, associated with their wound, experienced reduced pain scores, with 11 being pain-free at the end of the four-week period. There was significant reduction (p<0.001) in both mean pain score and mean wound area during the treatment period, as well as improvements in other parameters, such as reduction in inflammatory symptoms (leg swelling, foot stiffness), increased vasodilation (skin discolouration, leg heaviness, early morning erection, sensation), improvement in sleep quality, gait, and frequency of bowel movement. No adverse events were reported.

    CONCLUSION: The results of this study show there was significant reduction in wound area and pain score during the treatment period. The ease of use of microcurrent devices would advocate its use in accelerating wound healing.

  2. Nair HKR
    J Wound Care, 2018 Sep 01;27(Sup9a):S32-S36.
    PMID: 30207850 DOI: 10.12968/jowc.2018.27.Sup9a.S32
    OBJECTIVE: To study the effectiveness of nano-colloidal silver and chitosan bioactive wound dressings in the treatment of diabetic foot ulcers (DFU).

    METHOD: Patients with DFUs were selected randomly. Wound size, appearance and presence of infection were recorded at each dressing change.

    RESULTS: We assessed five patients in this case series. The use of both nano-colloidal silver and chitosan biopolymer dressings aided wound healing. The patients did not require surgical debridement or amputation. All five cases in this study had a slow healing rate at presentation.

    CONCLUSION: Applications of nano-colloidal silver in conjunction with chitosan bioactive as primary dressings in managing DFUs cases are safe and help increase wound healing rates, thus, leading to significant cost savings in the hospital setting.

  3. Nair HKR
    J Wound Care, 2018 Sep 01;27(Sup9a):S12-S19.
    PMID: 30207849 DOI: 10.12968/jowc.2018.27.Sup9a.S12
    OBJECTIVE: The primary aim was to determine the productivity increase using digital imagery for better documentation and analysis. A case series was done in a specialised care centre with patients managed with advanced dressings and using state-of-the-art smartphone technology for documentation to save costs and time.

    METHOD: Wounds were cleansed and debrided before using the application to photograph, document, measure and analyse the wounds. The smartphone app was oriented parallel to the plane of the wound, where possible, to obtain accurate measurements. A longitudinal study report was generated for each wound and showed the progress of the wound healing until the wound was closed.

    RESULTS: A sample size of 60 patients consisting of wounds from different locations, and a total of 203 measurements and analyses were conducted over a period of seven months. The wound monitoring app proved to be effective for wound monitoring and required less than two hours' training. A report summary of wounds recorded could also be generated automatically through the dashboard. All 60 patients' cases were automatically recorded, measured and presented into reports for use in clinical analysis. There was a significant time savings (27 hours per day for a specialised care centre with 10 nurses) increase over manual wound documentation and measuring methods.

    CONCLUSION: The app provided a non-contact, easy to use, reliable and accurate smart wound management solution for clinicians and physicians to track wound healing in patients. The app could also be used by patients and caregivers for home monitoring of their wounds.

  4. Nair HKR
    J Wound Care, 2018 Sep 01;27(Sup9a):S37-S40.
    PMID: 30207848 DOI: 10.12968/jowc.2018.27.Sup9a.S37
    BACKGROUND: Cases of venous leg ulcers (VLU) are expected to rise due to the rapidly ageing population in Malaysia. Central to the management of these wounds is compression therapy together with an appropriate wound dressing. Pain and discomfort during dressing changes are common in these patients. Polyurethane foam dressings with SMARTPORE technology (micropore dressing; Mundipharma) facilitate vertical absorption of exudate to reduce risks of wound and periwound area maceration. They support easy dressing removal with less pain and trauma to the wound bed. Thus, the micropore dressing was chosen as a viable treatment option in these cases.

    CASES: Case 1, a 74-year-old diabetic female was treated for bilateral VLUs with micropore dressing for several months, which she noted to be painless and convenient. Case 2, a 49-year-old housewife with a solitary VLU was treated with micropore dressing, leading to good treatment results and high satisfaction.

    CONCLUSION: VLUs managed by the micropore dressing resulted in reduced pain and ease of use during dressing changes, as well as noticeable reduction in wound and periwound area maceration. The use of this type of dressing in these cases shows encouraging results and provides a desirable management option. More robust clinical studies are necessary to establish this.

  5. Nair HKR
    Int J Low Extrem Wounds, 2018 Mar;17(1):54-61.
    PMID: 29564953 DOI: 10.1177/1534734618762225
    The management of chronic nonhealing ulcers pose a great challenge because they are associated with morbidity and increased costs. This report presents the observations of standard management along with application of modified collagen with glycerin (MCG) in the periwound area for management of nonhealing wounds. This observational report included 50 patients (33 male, 17 female) aged 24 to 94 years having nonhealing wounds. All wounds were treated using standard treatment protocols (TIME concept), whereas the periwound severity was assessed using the Harikrishna Periwound Skin Classification (HPSC). All patients received once-daily application of MCG lotion directly in the periwound areas and compression bandaging until there was complete wound healing. Patient compliance was ensured by regular follow-up and counseling. All diabetic patients were counseled to ensure glycemic control during the entire follow-up period. The criteria used for wound healing were based on clinical observation, and proper epithelialization of the wound was the end point. The median age of the wounds was 12.0 weeks (95% CI = 8.00 - 58.08). Majority of the non-healing wounds were diabetic foot ulcers with age of wound between 4 weeks to 15 years. The median time to complete wound healing was 12.71 (95% CI = 10.00-16.67) weeks. Standard treatment protocol of TIME principle with periwound area assessment based on HPSC 2015 and treatment accordingly with topical application of MCG along with additional measures has shown complete healing of nonhealing wounds. However, further large-scale comparative studies are needed to substantiate these effects on a larger population.
  6. Nair HKR, Chong SS, Othman AM
    J Wound Care, 2020 Apr 01;29(Sup4):S44-S48.
    PMID: 32279612 DOI: 10.12968/jowc.2020.29.Sup4.S44
    OBJECTIVE: To validate the accuracy and reliability of Harikrishna Periwound Skin Classification (HPSC) for wound assessment.

    METHOD: Post-basic students (staff nurses and medical assistants) were given real life pictures showing the wound and periwound area. The students were asked to classify all pictures according to the HPSC at zero months (before attachment) and after two months of attachment. The images were the same but the answers were never given or discussed after the first test.

    RESULTS: A total of 30 post-basic students participated in the study, assessing wound 30 images. The results showed that there was an increase of 25.42% in accuracy of wound assessment using the HSPC after two months of clinical attachment compared to pre-attachment. The reliability of the HPSC in wound assessment 79.87%.

    CONCLUSION: Health professionals have to be able to assess and classify wounds accurately to be able to manage them accordingly. Assessment and classifications of the periwound skin are important and need to be validated and integrated as a part of a full wound assessment. With experience and adequate training, health professionals are able to comprehensively assess wounds using the validated tool, to enable effective wound management and treatment, accelerating wound healing and improving the quality of life for patients.

  7. Tariq G, Alvarez HP, Nair HKR, Cordero GL
    J Wound Care, 2018 Oct 01;27(Sup10):S39-S41.
    PMID: 30307814 DOI: 10.12968/jowc.2018.27.Sup10.S39
  8. Kee KK, Nair HKR, Yuen NP
    J Wound Care, 2019 Jan 01;28(Sup1):S4-S13.
    PMID: 30724120 DOI: 10.12968/jowc.2019.28.Sup1.S4
    OBJECTIVE:: Objectives. To determine the prevalence and risk factors for diabetic foot infection (DFI), and to identify factors associated with delayed wound healing of diabetic foot ulcer (DFU).

    METHOD:: The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic.

    RESULTS:: Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1±10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5±33.2cm2. Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose ≥7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size ≥10cm2 (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure ≥140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose ≥7mmol/l (p<0.001), high blood pressure ≥140/90mmHg (p<0.001), large DFU size ≥2cm2 (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05).

    CONCLUSION:: Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence.

  9. Nair HKR, Chong SSY, Selvaraj DDJ
    Int J Low Extrem Wounds, 2023 Jun;22(2):278-282.
    PMID: 33973828 DOI: 10.1177/15347346211004186
    "Light amplification by stimulated emission of radiation" or more commonly known as Laser has become very popular in the field of dermatology and aesthetic medicine over the past decades. For the treatment of wound healing, a combination of different wavelengths for laser therapy has been introduced which includes 660, 800, and 970 nm. The aim of this study was to note wound healing utilizing photobiomodulation as an adjunct therapy by measuring the wound size in terms of length and width (area measurement). Study participants were selected randomly from a pool of patients who were attending for their routine follow-up visits in the Wound Care Unit in Hospital Kuala Lumpur. Eleven patients with chronic wounds of different etiologies, ie, diabetic foot ulcer and nonhealing ulcer, were recruited for this study . Wound assessment was done prior to cleansing using distilled water and followed by debridement if necessary. Subsequently, the laser technician and patients used protective goggles before applying a super intense continuous flow of laser with 3 wavelengths, ie, 660, 800, and 970 nm with 30 kJ of energy with the handpiece over a 3 min period whereby it is focused on the wound milieu and then rotated around the periwound area. There were 9 diabetic foot ulcers and 2 nonhealing ulcers treated with photobiomodulation as an adjunct therapy. All wounds were managed with the standard of care. Three wounds ie, 3 diabetic foot ulcers and 1 nonhealing ulcer were closed completely. Meanwhile, the other 7 ulcers are at 68.2% to 99% in terms of wound area reduction and new granulomatous tissue was present indicating high healing potential. Therefore, the photobiomodulation was effective as an adjunct in the management of diabetic foot and nonhealing ulcers in this case series. A larger sample size would be able to show the significance of this finding.
  10. Nair HKR, Wasi Ahmad N, Teh CH, Lee HL, Chong SSY
    Int J Low Extrem Wounds, 2021 Sep;20(3):208-216.
    PMID: 32524879 DOI: 10.1177/1534734620932397
    Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of live, disinfected fly larvae or maggots into the nonhealing wound of a human or animal to debride the necrotic wound, reduce bacterial contamination of the wound as well as enhance the formation of healthy granulation tissue and stimulate healing in nonhealing wounds. In addition, van der Plas et al reported that the use of the medicinal larvae as natural remover of necrotic and infected tissue had prevented amputation in 11 selected patients. In Malaysia, Aaron et al had demonstrated prevention of amputation in 25 patients.
  11. Kurz P, Danner G, Lembelembe JP, Nair HKR, Martin R
    Int Wound J, 2023 Aug;20(6):2053-2061.
    PMID: 36601702 DOI: 10.1111/iwj.14071
    Evidence shows that Electrical Stimulation Therapy (EST) accelerates healing and reduces pain, but EST has yet to become widely used. One reason is the historical use of complex, clinic-based EST devices. This evaluation assessed the early response of different hard-to-heal wounds to a simple, wearable, single-use, automated microcurrent EST device (Accel-Heal, Accel-Heal Technologies Limited - Hever, UK). Forty wounds (39 patients: 18 female - 21 male), mean age 68.9 ± 14.0 years comprised of: seven post-surgical, three trauma, 12 diabetic foot (DFU), 10 venous (VLU), four pressure injuries (PI), four mixed venous or arterial ulcers (VLU/arterial) received automated microcurrent EST for 12 days. Early clinical responses were scored on a 0-5 scale (5-excellent-0-no response). Pain was assessed at 48 h, seven days, and 14 days on a 0-10 visual analogue scale (VAS). Overall, 78% of wounds showed a marked positive clinical response (scores of 5 and 4). Sixty eight percent of wounds were painful with a mean VAS score of 5.5. Almost every patient (96%) with pain experienced reduction within 48 h. All patients with painful wounds experienced pain reduction after seven days: 2.50 VAS (45% reduction) and further pain reduction after 14 days: 1.83 VAS (33%).
  12. Carter MJ, Frykberg RG, Oropallo A, Sen CK, Armstrong DG, Nair HKR, et al.
    Adv Wound Care (New Rochelle), 2023 Apr;12(4):177-186.
    PMID: 35593010 DOI: 10.1089/wound.2022.0041
    Objective: To conduct a systematic review and meta-analysis of recently published randomized controlled trials (RCTs) that employed the use of topical oxygen therapy (TOT) as an adjunct therapy in the treatment of Wagner 1 and 2 diabetic foot ulcers. Approach: Following a literature search of eligible studies from 2010 onward, four RCTs were included. Studies were analyzed for patient and wound characteristics, outcomes, risk of bias, and quality of the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. A random-effects meta-analysis for complete wound healing was carried out due to statistical heterogeneity of included studies. Results: Risk of bias judgment (RoB2 analysis) resulted in one low-risk trial and three trials with some risk. One study was determined to be the origin of the statistical heterogeneity. Pooled results showed statistical significance with a risk ratio (RR) of 1.59 (95% confidence interval [CI]: 1.07-2.37; p = 0.021). Sensitivity analysis, based on imputed values for missing outcomes, demonstrated that both the RR and 95% CIs changed little. The GRADE ratings for each domain were as follows: (a) risk of bias: moderate (3); (b) imprecision: moderate (2), high (1); (c) inconsistency: low (2), high (1); (d) indirectness: moderate (2), high (1); and (e) publication bias: moderate (1), high (2). Overall, the evidence was moderate. Innovation: Our study shows that TOT is a viable diabetic foot ulcer therapy. Conclusions: These data support the use of TOT for the treatment of chronic Wagner 1 or 2 diabetic foot ulcers in the absence of infection and ischemia.
  13. Ousey K, Chadwick P, Jawien A, Tariq G, Nair HKR, Lázaro-Martínez JL, et al.
    J Wound Care, 2018 05 01;27(Sup5):S1-S52.
    PMID: 29738280 DOI: 10.12968/jowc.2018.27.Sup5.S1
  14. Nair HKR, Ahmad NW, Lee HL, Ahmad N, Othamn S, Mokhtar NSHM, et al.
    Int J Low Extrem Wounds, 2022 Dec;21(4):425-431.
    PMID: 32815407 DOI: 10.1177/1534734620948299
    Leeches are hermaphrodite, bloodsucking parasitic worms usually found in places with fresh water. Leech therapy existed 3000 years, and it is being used at a different scope. Several species of leeches have been used in medicine, and the most common species used is Hirudo medicinalis. Leeches suck the excess blood, reduce the swelling in the tissues, and promote healing by allowing fresh oxygenated blood to reach the area until normal circulation can be restored. Pain relief from leech therapy is rapid, effective, and long-lasting in many conditions. The aim of this study was to evaluate the efficacy and duration of healing utilizing sterile medicinal leeches, Hirudinaria manillensis, in the management of pain and wound healing. Leech was taken out from its sterile tube by using a pair of non-tooth sterile plastic forceps and gloved hands. Each leech was left in place for as long as it was feeding. Leeches were removed only after they became detached from the patient. The specimen jars containing the used leeches were sealed in either a biohazard bag or in a small yellow clinical waste bin liner securely fastened with a cable tie. The leech was killed by using 70% alcohol prior to disposal into a yellow hazard bin, which undergoes incineration. All 3 patients had improvements in their condition, especially in terms of reduction in the pain and improvement in their sense of balance. All the wounds healed well. Therefore, leech therapy is effective in reducing pain and increasing perfusion to allow the wounds to heal quickly. However, a more robust trial is needed to show significance as the sample size is small.
  15. Nair HKR, Lew X, Liew KY, Kamis SA, Nik Kub NMH, Zakaria AM, et al.
    Int J Low Extrem Wounds, 2023 Dec;22(4):759-766.
    PMID: 34806457 DOI: 10.1177/15347346211058273
    Background: Venous leg ulcers severely affect patients' quality of life due to its high morbidity and recurrent nature. Currently, compression therapy is the first-line treatment for venous leg ulcers. Aim: This study sought to evaluate the efficacy of the Mobiderm® technology developed by Thuasne in a prospective case series of venous leg ulcers. Methods: Nine patients (N  =  9) with venous leg ulcers were enrolled into this case series. Mobiderm® bandage was applied on to the affected limbs of the patients in the multi-component bandages system. The bandages were changed as frequent as the patients had their wound dressing for their standard treatment in a 12-week duration. Wound size and calf circumference were measured at week 0 and week 12. Paired sample t-test was used to compare the mean values of wound size and calf circumference pre- and post-treatment. Results: Reductions in wound size and calf circumference were observed in all nine patients (100%). Five patients were evaluable at week 12. The wound sizes significantly reduced by 27.2% to 53.2% (p  =  0.02), and the calf circumferences significantly reduced by 3.2% to 26.0% (p  =  0.02) after 12 weeks (N  =  5). Safety was unremarkable, with no occurrence of treatment-emergent-related adverse event. Conclusion: Mobiderm® bandage was reported to be effective in promoting wound healing and reducing swelling, suggesting it to be integrated in the compression therapy for the management of venous leg ulcers.
  16. Nair HKR, Norlizah P, Mariam MN, Alsagoff SAL, Ming Long K, Anantha KR, et al.
    PMID: 35345926 DOI: 10.1177/15347346221090096
    Healthcare resource utilization for Diabetic foot ulcers (DFUs) in Malaysia needs to be clarified. This modified Delphi panel study aimed to describe the clinical pathways for diabetic foot ulcer in Malaysia and to define the healthcare resources used and their costs. A systematic review of the literature was carried out on the management of diabetic foot ulcer in Malaysia. A modified Delphi panel involving 7 local experts was organized to validate the statements, in order to arrive at a consensus on the resources used for the treatment of DFU patients in Malaysia and their costs. A Markov model was then used to estimate the financial burden of DFU patients in Malaysia.The total cost per patient per annum was MYR 5981 in public and MYR 8581 in private setting. In the public setting, outpatient visits costs represent 50% of the overall cost, followed by medical devices which represent 38% of total costs. In the private setting, as in the public, outpatient visits and devices contribute the most to overall costs with 51% and 21%, respectively. However, hospital inpatient costs are higher in private setting and represent 14% of the total costs versus 5% in public setting.These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing DFUs in Malaysia and the need for innovative therapies to reduce the burden for patients but also for the society.
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