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  1. Yusof NM, Halim AS
    Singapore Med J, 2012 Sep;53(9):591-4.
    PMID: 23023900
    Infection 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.
  2. Ahmadipourroudposht M, Fallahiarezoudar E, Yusof NM, Idris A
    Mater Sci Eng C Mater Biol Appl, 2015 May;50:234-41.
    PMID: 25746266 DOI: 10.1016/j.msec.2015.02.008
    Magnetic nanofibers are composed of good dispersion of magnetic nanoparticles along an organic material. Magnetic nanofibers are potentially useful for composite reinforcement, bio-medical and tissue engineering. Nanofibers with the thinner diameter have to result in higher rigidity and tensile strength due to better alignments of lamellae along the fiber axis. In this study, the performance of electrospinning process was explained using response surface methodology (RSM) during fabrication of magnetic nanofibers using polyvinyl alcohol (PVA) as a shelter for (γ-Fe2O3) nanoparticles where the parameters investigated were flow rate, applied voltage, distance between needle and collector and collector rotating speed. The response variable was diameter distribution. The two parameters flow rate and applied voltage in primary evaluation were distinguished as significant factors. Central composite design was applied to optimize the variable of diameter distribution. Quadratic estimated model developed for diameter distribution indicated the optimum conditions to be flow rate of 0.25 ml/h at voltage of 45 kV while the distance and rotating speed are at 8 cm and 1500 rps respectively. The obtained model was verified successfully by the confirmation experiments.
  3. Fallahiarezoudar E, Ahmadipourroudposht M, Idris A, Yusof NM
    Mater Sci Eng C Mater Biol Appl, 2017 Jul 01;76:616-627.
    PMID: 28482571 DOI: 10.1016/j.msec.2017.03.120
    Tissue engineering (TE) is an advanced principle to develop a neotissue that can resemble the original tissue characteristics with the capacity to grow, to repair and to remodel in vivo. This research proposed the optimization and development of nanofiber based scaffold using the new mixture of maghemite (γ-Fe2O3) filled poly-l-lactic acid (PLLA)/thermoplastic polyurethane (TPU) for tissue engineering heart valve (TEHV). The chemical, structural, biological and mechanical properties of nanofiber based scaffold were characterized in terms of morphology, porosity, biocompatibility and mechanical behaviour. Two-level Taguchi experimental design (L8) was performed to optimize the electrospun mats in terms of elastic modulus using uniaxial tensile test where the studied parameters were flow rate, voltage, percentage of maghemite nanoparticles in the content, solution concentration and collector rotating speed. Each run was extended with an outer array to consider the noise factors. The signal-to-noise ratio analysis indicated the contribution percent as follow; Solution concentration>voltage>maghemite %>rotating speed>flow rate. The optimum elastic modulus founded to be 28.13±0.37MPa in such a way that the tensile strain was 31.72% which provided desirability for TEHV. An empirical model was extracted and verified using confirmation test. Furthermore, an ultrafine quality of electrospun nanofibers with 80.32% porosity was fabricated. The MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and cell attachment using human aortic smooth muscle cells exhibited desirable migration and proliferation over the electrospun mats. The interaction between blood content and the electrospun mats indicated a mutual adaption in terms of clotting time and hemolysis percent. Overall, the fabricated scaffold has the potential to provide the required properties of aortic heart valve.
  4. Yusof NM, Fadzli AS, Azman WS, Azril MA
    Med J Malaysia, 2016 04;71(2):47-52.
    PMID: 27326940 MyJurnal
    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.
  5. Alauddin MS, Yusof NM, Adnan AS, Said Z
    Eur J Dent, 2022 Oct;16(4):901-910.
    PMID: 35189641 DOI: 10.1055/s-0041-1742121
    OBJECTIVE:  Concentrated growth factor (CGF) is particularly gaining acceptance and popularity in regenerative dentistry. Nonetheless, there are no available studies showing its effect against microorganisms of oral cavity particularly in chronic oral disease-induced biofilms. This in vitro research was conducted to determine the antimicrobial effects of CGF against Staphylococcus aureus sp. (S. aureus) and Streptococcus mutans sp. (S. mutans).

    MATERIALS AND METHODS:  Blood samples were obtained from a healthy volunteer. CGF was then prepared using specialized centrifugation equipment (Medifuge, Silfradent, Santa Sofia FC, Italy) and protocol. Antimicrobial activity of the CGF was observed and recorded on standard strains of S. aureus and S. mutans using a well diffusion method to determine the inhibition zone, broth microdilution to determine minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), and crystal violet assay for biofilm assessment, with chlorhexidine (CHX) 0.12% used as a positive control. Statistical analysis was then performed using one-way analysis of variance followed by Tukey Test post hoc analysis.

    RESULTS:  It was observed that there was a presence of clear zones of inhibition around the CGF after 24 hours of incubation. The mean diameter of the inhibition zone was 1.26 ± 0.12 nm and 1.20 ± 0.06 nm for S. aureus and S. mutans, respectively, with significance difference (p 

  6. Yusof NM, Oh CW, Oh JK, Kim JW, Min WK, Park IH, et al.
    Injury, 2009 Dec;40(12):1286-91.
    PMID: 19539282 DOI: 10.1016/j.injury.2009.02.020
    Although non-operative treatment is a mainstay of tibial fracture management in children, certain fractures require a surgical approach. However, choices concerning optimal methods and implants are difficult. The purpose of this study was to determine the effectiveness of percutaneous plating of tibial fractures in children.
  7. Ngadiman NH, Idris A, Irfan M, Kurniawan D, Yusof NM, Nasiri R
    J Mech Behav Biomed Mater, 2015 Sep;49:90-104.
    PMID: 26002419 DOI: 10.1016/j.jmbbm.2015.04.029
    Maghemite (γ-Fe2O3) nanoparticle with its unique magnetic properties is recently known to enhance the cell growth rate. In this study, γ-Fe2O3 is mixed into polyvinyl alcohol (PVA) matrix and then electrospun to form nanofibers. Design of experiments was used to determine the optimum parameter settings for the electrospinning process so as to produce elctrospun mats with the preferred characteristics such as good morphology, Young's modulus and porosity. The input factors of the electrospinnning process were nanoparticles content (1-5%), voltage (25-35 kV), and flow rate (1-3 ml/h) while the responses considered were Young's modulus and porosity. Empirical models for both responses as a function of the input factors were developed and the optimum input factors setting were determined, and found to be at 5% nanoparticle content, 35 kV voltage, and 1 ml/h volume flow rate. The characteristics and performance of the optimum PVA/γ-Fe2O3 nanofiber mats were compared with those of neat PVA nanofiber mats in terms of morphology, thermal properties, and hydrophilicity. The PVA/γ-Fe2O3 nanofiber mats exhibited higher fiber diameter and surface roughness yet similar thermal properties and hydrophilicity compared to neat PVA PVA/γ-Fe2O3 nanofiber mats. Biocompatibility test by exposing the nanofiber mats with human blood cells was performed. In terms of clotting time, the PVA/γ-Fe2O3 nanofibers exhibited similar behavior with neat PVA. The PVA/γ-Fe2O3 nanofibers also showed higher cells proliferation rate when MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay was done using human skin fibroblast cells. Thus, the PVA/γ-Fe2O3 electrospun nanofibers can be a promising biomaterial for tissue engineering scaffolds.
  8. Ngadiman NH, Yusof NM, Idris A, Misran E, Kurniawan D
    Mater Sci Eng C Mater Biol Appl, 2017 Jan 01;70(Pt 1):520-534.
    PMID: 27770924 DOI: 10.1016/j.msec.2016.09.002
    The use of electrospinning process in fabricating tissue engineering scaffolds has received great attention in recent years due to its simplicity. The nanofibers produced via electrospinning possessed morphological characteristics similar to extracellular matrix of most tissue components. Porosity plays a vital role in developing tissue engineering scaffolds because it influences the biocompatibility performance of the scaffolds. In this study, maghemite (γ-Fe2O3) was mixed with polyvinyl alcohol (PVA) and subsequently electrospun to produce nanofibers. Five factors; nanoparticles content, voltage, flow rate, spinning distance, and rotating speed were varied to produce the electrospun nanofibrous mats with high porosity value. Empirical model was developed using response surface methodology to analyze the effect of these factors to the porosity. The results revealed that the optimum porosity (90.85%) was obtained using 5% w/v nanoparticle content, 35kV of voltage, 1.1ml/h volume flow rate of solution, 8cm spinning distance and 2455rpm of rotating speed. The empirical model was verified successfully by performing confirmation experiments. The properties of optimum PVA/γ-Fe2O3 nanofiber mats such as fiber diameter, mechanical properties, and contact angle were investigated. In addition, cytocompatibility test, in vitro degradation rate, and MTT assay were also performed. Results revealed that high porosity biodegradable γ-Fe2O3/polyvinyl alcohol nanofiber mats have low mechanical properties but good degradation rates and cytocompatibility properties. Thus, they are suitable for low load bearing biomedical application or soft tissue engineering scaffold.
  9. Qaid E, Zakaria R, Sulaiman SF, Yusof NM, Shafin N, Othman Z, et al.
    Hum Exp Toxicol, 2017 Dec;36(12):1315-1325.
    PMID: 28111974 DOI: 10.1177/0960327116689714
    Impairment of memory is one of the most frequently reported symptoms during sudden hypoxia exposure in human. Cortical atrophy has been linked to the impaired memory function and is suggested to occur with chronic high-altitude exposure. However, the precise molecular mechanism(s) of hypoxia-induced memory impairment remains an enigma. In this work, we review hypoxia-induced learning and memory deficit in human and rat studies. Based on data from rat studies using different protocols of continuous hypoxia, we try to elicit potential mechanisms of hypobaric hypoxia-induced memory deficit.
  10. Ahmad MK, Abdollah NA, Shafie NH, Yusof NM, Razak SRA
    Cancer Biol Med, 2018 Feb;15(1):14-28.
    PMID: 29545965 DOI: 10.20892/j.issn.2095-3941.2017.0107
    Mitogen-activated protein kinases (MAPKs) are the main regulators of cellular proliferation, growth, and survival in physiological or pathological conditions. Aberrant MAPK signaling plays a pivotal role in carcinogenesis, which leads to development and progression of human cancer. Dual-specificity phosphatase 6 (DUSP6), a member of the MAPK phosphatase family, interacts with specifically targeted extracellular signal-regulated kinase 1/2 via negative feedback regulation in the MAPK pathway of mammalian cells. This phosphatase functions in a dual manner, pro-oncogenic or tumor-suppressive, depending on the type of cancer. To date, the tumor-suppressive role of DUSP6 has been demonstrated in pancreatic cancer, non-small cell lung cancer, esophageal squamous cell and nasopharyngeal carcinoma, and ovarian cancer. Its pro-oncogenic role has been observed in human glioblastoma, thyroid carcinoma, breast cancer, and acute myeloid carcinoma. Both roles of DUSP6 have been documented in malignant melanoma depending on the histological subtype of the cancer. Loss- or gain-of-function effects of DUSP6 in these cancers highlights the significance of this phosphatase in carcinogenesis. Development of methods that use the DUSP6 gene as a therapeutic target for cancer treatment or as a prognostic factor for diagnosis and evaluation of cancer treatment outcome has great potential. This review focuses on molecular characteristics of the DUSP6 gene and its role in cancers in the purview of development, progression, and cancer treatment outcome.
  11. Fallahiarezoudar E, Ahmadipourroudposht M, Yusof NM, Idris A, Ngadiman NHA
    Polymers (Basel), 2017 Nov 06;9(11).
    PMID: 30965883 DOI: 10.3390/polym9110584
    Valvular dysfunction as the prominent reason of heart failure may causes morbidity and mortality around the world. The inability of human body to regenerate the defected heart valves necessitates the development of the artificial prosthesis to be replaced. Besides, the lack of capacity to grow, repair or remodel of an artificial valves and biological difficulty such as infection or inflammation make the development of tissue engineering heart valve (TEHV) concept. This research presented the use of compound of poly-l-lactic acid (PLLA), thermoplastic polyurethane (TPU) and maghemite nanoparticle (γ-Fe₂O₃) as the potential biomaterials to develop three-dimensional (3D) aortic heart valve scaffold. Electrospinning was used for fabricating the 3D scaffold. The steepest ascent followed by the response surface methodology was used to optimize the electrospinning parameters involved in terms of elastic modulus. The structural and porosity properties of fabricated scaffold were characterized using FE-SEM and liquid displacement technique, respectively. The 3D scaffold was then seeded with aortic smooth muscle cells (AOSMCs) and biological behavior in terms of cell attachment and proliferation during 34 days of incubation was characterized using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and confocal laser microscopy. Furthermore, the mechanical properties in terms of elastic modulus and stiffness were investigated after cell seeding through macro-indentation test. The analysis indicated the formation of ultrafine quality of nanofibers with diameter distribution of 178 ± 45 nm and 90.72% porosity. In terms of cell proliferation, the results exhibited desirable proliferation (109.32 ± 3.22% compared to the control) of cells over the 3D scaffold in 34 days of incubation. The elastic modulus and stiffness index after cell seeding were founded to be 22.78 ± 2.12 MPa and 1490.9 ± 12 Nmm², respectively. Overall, the fabricated 3D scaffold exhibits desirable structural, biological and mechanical properties and has the potential to be used in vivo.
  12. Idris A, Hassan N, Mohd Ismail NS, Misran E, Yusof NM, Ngomsik AF, et al.
    Water Res, 2010 Mar;44(6):1683-8.
    PMID: 19963234 DOI: 10.1016/j.watres.2009.11.026
    Magnetically separable photocatalyst beads containing nano-sized iron oxide in alginate polymer were prepared. This magnetic photocatalyst beads are used in slurry-type reactors. The magnetism of the catalyst arises from the nanostructured particles gamma-Fe(2)O(3), by which the catalyst can be easily recovered by the application of an external magnetic field. These synthesized beads are sunlight-driven photocatalyst. In the system without magnetic photocatalyst beads, no chromium reduction was observed under sunlight irradiation due to the stability of the chromium (VI). Upon the addition of magnetic photocatalyst beads, the photo-reduction of Cr(VI) was completed in just after only 50min under sunlight irradiation due to the photocatalytic activity of the beads. However when placed away from sunlight, the reduction rate of the chromium is just about 10%. These observations were explained in terms of absorption occurrence of chromium (VI) onto the catalyst surface which took place in this reaction. In addition, photo-reduction rate of chromium (VI) was more significant at lower pH. The results suggest that the use of magnetic separable photocatalyst beads is a feasible strategy for eliminating Cr(VI).
  13. Yusof NM, Rahman JA, Zulkifly AH, Che-Ahmad A, Khalid KA, Sulong AF, et al.
    Singapore Med J, 2015 Nov;56(11):626-31.
    PMID: 26668408 DOI: 10.11622/smedj.2015172
    Introduction: Diabetes 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.
    Methods: This 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.
    Results: A 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.
    Conclusion: T2DM 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.
    Keywords: amputation; diabetes mellitus; diabetic foot; lower limb; type II.
  14. Zayzan KR, Yusof NM, Sulong AF, Zakaria Z, Ab Rahman J
    Singapore Med J, 2020 Dec 02.
    PMID: 33264560 DOI: 10.11622/smedj.2020164
    INTRODUCTION: The clinical outcomes and factors associated with treatment failure of post-traumatic osteomyelitis have been investigated by many studies. However, limb functionality and quality of life following treatment for this condition have not been thoroughly studied.

    METHODS: This was a cross-sectional study that included 47 patients with post-traumatic osteomyelitis of the lower limb. Functional outcome was assessed using the Lower Extremity Functional Score (LEFS), and quality of life was assessed using the validated Malay version of Short Form-36 version 2.

    RESULTS: Mean follow-up time was 4.6 (range 2.3-9.5) years. Median age was 44 years. Osteomyelitis was located in the tibia for 26 patients and in the femur for 21 patients. Osteomyelitis was consequent to internal infection in 38 patients and due to infected open fractures in nine patients. 42 (89.4%) patients had fracture union and control of infection. Bone defect was found to be a significant contributing factor for treatment failure (p = 0.008). The median LEFS for the success group was 65 when compared to 49 for the failure group. Although the success group showed better scores with regard to quality of life, the difference between the two groups was not statistically significant.

    CONCLUSION: The success rate for post-traumatic osteomyelitis of the lower limb was high. The presence of a bone defect was associated with treatment failure. Successfully treated patients had significantly better functional outcomes than failed ones.

  15. Yusof NM, Khalid KA, Zulkifly AH, Zakaria Z, Amin MA, Awang MS, et al.
    Malays J Med Sci, 2013 Oct;20(5):47-53.
    PMID: 24643115 MyJurnal
    Although open tibial fractures are common in Malaysia, the outcomes for these patients have not been evaluated in the literature. This retrospective study was conducted to examine the factors associated with infection and non-union in open tibial fractures managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009.
  16. Azib FN, Lee CH, Mohd Yusof NM, Yusuf N, Mohd Fuad NF, Saharuddin NS, et al.
    MyJurnal
    1st UMS INTERNATIONAL NURSING CONFERENCE IN CONJUNCTION WITH 11TH INTERNATIONAL NURSING STUDENTS’ FORUM
    A view into the future of nursing: Nursing Transformation towards IR-4.0, Held at the Faculty of Medicine and Health Sciences,, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia, On 6-8th March 2020
    Introduction: Delayed wound healing and a hefty cost of treatment poses a burden to those undergoing treatment for Diabetic wound care. An alternative wound product to speed up wound healing may address this problem. Honey has been recognized around the world for its efficacy as treating wounds, eczema, and inflammation while cinnamon has a variety of biological functions including anti-diabetic, anti-microbial, and anti-inflammatory. As both cinnamon and honey possess different properties in wound healing, it is hypothesized that combining both products can accelerate wound healing. This study is to compare the efficacy of pure honey, pure cinnamon and honey-cinnamon commixture in diabetic wound healing.
    Methods: Three volunteers were selected from Kitamura clinic, Pontianak, Indonesia participated in this study. Each of them was given a different wound product which were pure honey (subject 1), pure cinnamon extract (subject 2), and honey-cinnamon commixture (subject 3). The wound bed percentage, size, and characteristics were recorded and compared. Results: Usage of pure cinnamon was discontinued during the second visit due to its drying effect. Subjects 1 and 3 both presented with an increase in granulation and reduction in sloughing of cells and biofilm. However, subject 3 showed faster wound contraction and reduction in maceration as compared to subject 1.
    Conclusion: Pure cinnamon extract should not be used as a standalone wound product due to its drying properties. However, topical co-administration of honey and Cinnamon cassia extract has a synergistic interaction effect, improves wound healing in diabetic individuals and is recommended as a new topical herbal drug production for treating of the diabetic wound. Further studies on the therapeutic concentration of honey-cinnamon commixture should be conducted.
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