A comparative study of Tualang honey spray versus film spray (OPSITE®) as post-long bone fracture fixation wound dressing

Introduction: Honey-based dressings have a potential benefit in treating wounds in implant-related surgery due to its anti-microbial activities and healing potentials. The aim of the study is to compare Tualang honey spray with film spray (Opsite®) as an alternative dressing material following long bone fracture fixations. This is a preliminary study in Malaysia that involves human subjects. Methodology: This is a randomized, controlled trial involving patients with closed diaphyseal fracture of tibia or femur treated with open reduction and internal fixation (plates or intramedullary devices) at a single tertiary centre. Forty patients were randomly divided into three groups according to the dressing material used; film spray (Opsite®) dressing (n=16), Tualang honey spray (n=13), and control group (n=11). Each group used a same wound protocol except for the control group in which involve application of non-adhesive film (Mepore) only. Dressing materials were applied immediately after surgery and on day three post-surgery. Wound assessment was done on day 14 and day 42 post-surgery. Outcomes evaluated include wound complications, and the effects on skin commensals. On day 42, infection rate (wound dehiscence) and scar formation were also evaluated. Results: There was a case of superficial surgical site infection from the Opsite® spray group. Acinobacter species was isolated from one of the patients under the control group. There was no statistically significant association between dressing methods used and wound healing. All wounds healed without any infection at the end of the study. Tualang honey spray have a significant influence in reducing the risk of hypertrophic scar formation and has similar wound outcomes as compared to Opsite® spray. Conclusion: Tualang honey spray is comparable to the widely used Opsite* spray as a safe alternative for dressing material. Contradict to some previous studies; it promotes good wound healing with a low risk of hypertrophic scar formation

Effects of monochromatic infrared energy therapy on diabetic feet with peripheral sensory neuropathy: a randomised controlled trial

ABSTRACT Introduction: Peripheral diabetic neuropathy, which is a cause of increasing morbidity and mortality following foot ulcers and amputations

A randomized, doubled-blind study comparing multiple doses of Channa striatus supplementation for knee osteoarthritis

Knee osteoarthritis (OA) is the leading cause of chronic disability at older age. Channa striatus (CS) is a freshwater fish that is traditionally valued for its medicinal properties in promoting wound healing and reducing post-operative pain. This study evaluate the efficacy of different doses of oral Channa striatus extract on primary knee osteoarthritis patients. A randomized, double-blind, placebo-controlled 3-arm trial was conducted comparing oral CS extract 1000 mg/day or 500 mg/day and placebo among knee OA patients for a 6-month intervention period. The main outcome measures were Western Ontario and McMaster University Osteoarthritis Index (WOMAC), analgesic scores and serum cartilage oligomeric matric protein (COMP). Laboratory-based blood tests were used as safety measures. A total of 120 patients were randomized, and 112 patients were included in the intention-to-treat analysis. Significant reductions in WOMAC stiffness and function scores were achieved at month 6 in CS 1000 mg/day and CS 500 mg/day compared to placebo groups (p < 0.05). No significant differences were found between the groups in terms of analgesic scores, serum COMP and biochemical parameters. No serious adverse events were reported in the study. In conclusion, both doses of CS showed similar efficacy and were more effective than the placebo in treating the symptoms of knee OA

The controversial role of ct angiogram in paediatric supracondylar humeral fracture with pulseless, perfused limb

Introduction: Almost 20% of displaced supracondylar humerus fractures in children are complicated by vascular compromise. At present, there is no clear consensus on the management of a persistent pulseless but well-perfused hand after a satisfactory closed reduction of the fracture. The role of angiography in such cases has been a source of controversy and debate. Case Report: An 18-month–old girl was referred to us with a closed, displaced, supracondylar fracture in her left humerus after a fall. She had an impalpable radial pulse but her hand looked pink with a capillary refilling time of less than 2 seconds. She underwent an emergency closed reduction and percutaneous pinning. Post-reduction, her hand remained persistently pulseless but well-perfused. A multi-disciplinary decision was made more than 24 hours after the initial surgery. The medical team decided to proceed with a computerized tomographic (CT) angiogram followed by surgical exploration and release of her left brachial artery, which was completely occluded by compression of the surrounding soft tissues. The procedure proceeded smoothly and the patient showed remarkable immediate and long term outcomes. There was no further complications observed as a result of the delay in surgical treatment. Discussion/ Conclusion:We believe that the decision to manage such cases should be made on based on appropriacy in each case. A CT angiogram is helpful in objectively determining the level of occlusion and the possible risk of proximal migration of thrombus which may eventually affect the available collaterals. A well-perfused limb may allow adequate time for a proper decision to be made for surgical intervention

The effect of monochromatic infrared energy therapy on diabetic feet with peripheral sensory Neuropathy - a randomized controlled trial

INTRODUCTION: Peripheral diabetic neuropathy has been a burden to the health and economy with increasing number of the morbidity and mortality following foot ulcer and amputation . Being an irreversible disease, foot care and glycemic control is the mainstay of treatment. Various adjunct treatments to improve neuropathy had been introduced to the market. Among them was Monochromatic Infrared Energy Therapy (MIRE) which was claims to produce promising results. This study focused on the effect of MIRE on the diabetic foot peripheral neuropathy. The main difference compared to other studies done before was the use of a neurometer for neuropathy assessment which is more quantitative and sensitive . OBJECTIVE: To assess the effect of MIRE on diabetic feet associated with peripheral neuropathy METHODOLOGY: A randomized controlled single blinded study was conducted at Hospital Sains Malaysia from February to October 2008. A total of 30 lower limbs from 24 patients were enrolled into the study. The neuropathy was screened by Michigan Neuropathy Scoring Investigation (MNSI) followed by the assessment of the Current Perception Threshold using a neurometer at 2000Hz, 250Hz and 5Hz frequencies. The limbs were randomized to receive either daily MIRE or placebo treatment for a total of 12 treatments. The foot was reassessed again with neurometer within a week of completion of the treatment and at 6 weeks following treatment RESULTS: The data obtained was analyzed with non parametric test to compare between the pre-treatment and post treatment groups. The inter relationship of each result between these 2 groups was confirmed by Chi-Square test. We found that there was no significant difference (p>0.05) between the neuropathic foot of diabetic patient in both MIRE and placebo groups . CONCLUSION: There was no improvement of neuropathy in the diabetic foot patient following MIRE treatment

Honey dressing as a means of granulation tissue promoter for wounds in patients with diabetic foot ulcers

Honey has been used as dressing material for various types of wound.The orthopaedic department of the school of Medical sciences , Un1versiti Sains Malaysia have experience using honey on recalcitrant wound at the foot of diabetic patients. An anecdotal observation is the promotion of healing has been hastened in these types of wound.Worldwide, similar finding have been noted with various types of wound treated with honey dressing. The New Zealand 'Manuka' Honey has been extensively studied and is claimed to have superior chemical desloughing properties and also as a .good agent for promotion of granulationThe 'Manuka' honey from New Zealand is at present being promoted and being sold as a medical product for wound dressing with substantial research to back the manufacturers' claims At present the local Tualang Honey has been discovered to be consistent in its content and has a potential to be promoted as 'medical grade' honey. This study was part of a group of studies done by the honey research cluster/ group. It was a head to head randomized single blinded clinical trial comparing the granulation tissue promoting effects of Tualang Honey as compared to the gold standard widely acclaimed Manuka honey. The general objective was to prove that the malaysian Tualang honey was comparable to Manuka honey to treat recalcitrant wounds (the example wound chosen was a diabetic foot ulcer). The study aim is so that at one time the Malaysian honey can be marketed as medical grade honey

Honey dressing as a means of granulation tissue promoter for wounds in patients with diabetic foot ulcers.

Honey has been used as dressing material for various types of wound.The orthopaedic department of the school of Medical sciences , Un1versiti Sains Malaysia have experience using honey on recalcitrant wound at the foot of diabetic patients. An anecdotal observation is the promotion of healing has been hastened in these types of wound.Worldwide, similar finding have been noted with various types of wound treated with honey dressing. The New Zealand 'Manuka' Honey has been extensively studied and is claimed to have superior chemical desloughing properties and also as a .good agent for promotion of granulationThe 'Manuka' honey from New Zealand is at present being promoted and being sold as a medical product for wound dressing with substantial research to back the manufacturers' claims At present the local Tualang Honey has been discovered to be consistent in its content and has a potential to be promoted as 'medical grade' honey. This study was part of a group of studies done by the honey research cluster/ group. It was a head to head randomized single blinded clinical trial comparing the granulation tissue promoting effects of Tualang Honey as compared to the gold standard widely acclaimed Manuka honey. The general objective was to prove that the malaysian Tualang honey was comparable to Manuka honey to treat recalcitrant wounds (the example wound chosen was a diabetic foot ulcer). The study aim is so that at one time the Malaysian honey can be marketed as medical grade honey

Tualang honey spray versus film spray (Opsite®) as post-long bone fracture fixation wound dressing: a comparative study

Background of Study: Honey-based dressings have a potential benefit in treating wounds in implant-related surgery due to its anti-microbial activities and healing potentials. The study aims to compare Tualang honey spray with film spray (Opsite®) as an alternative dressing material following long bone fracture fixations. This is a preliminary study in Malaysia on human subjects. Materials and Methods: This is a randomized, controlled trial involving trauma patients with closed fracture diaphysis of tibia or femur internally stabilized with either plates or intramedullary devices. Forty patients were randomly divided into three groups according to the dressing material used; film spray (Opsite®) dressing (n=16), Tualang honey spray (n=13), and control group (n=11). Each group used a same wound protocol except for the control group in which involve application of non-adhesive film (Mepore) only. Dressing materials were applied immediately following surgery and on day three post-surgery after wound inspection. Assessment of wound performed on day 14 and day 42 post-surgery. Outcomes measured include wound complications, and the effects on skin commensals. On day 42, infection rate and scar formation were also evaluated. Results: A patient from the Opsite® spray group had surgical site infection. Acinobacter was isolated from one of the patients under the control group. There was no statistically significant association between wound healing and dressing methods used. All wounds healed without any evidence of infection at the end of the study. Tualang honey spray have a significant influence in reducing the risk of hypertrophic scar formation. Wound outcomes were also similar compared to Opsite® spray. Conclusion: Tualang honey spray is a safe alternative for wound dressing material comparable to the widely used Opsite* spray. It promotes good wound healing with a low risk of hypertrophic scar formation

Tualang honey spray versus film spray (Opsite*) as post-long bone fracture fixation wound dressing: a comparative study

Introduction: Tualang honey spray is a new dressing agent with potential wound healing quality and outcome compared to other products. The aim of the study is to compare the advantages of Tualang honey versus spray film (Opsite*) as dressing materials following long bone fracture fixations. This is a preliminary study in Malaysia that involve human as subjects. Methodology: This is a prospective randomized controlled trial involving patients with closed fracture mid-shaft of tibia or femur treated with open reduction and internal fixation (plates or intramedullary devices) at a single tertiary centre. Forty patients fulfilling the criteria of the study were involved. It was a three-arm study that consist of film spray (Opsite*) dressing (n=16), Tualang honey spray (n=13), and control group (n = 11). Each group had a same wound protocol except for the control group that involve only application of non-adhesive film (Mepore). Dressing materials were applied on wounds of the other two groups accordingly, immediately after surgery and on day three following surgery. Wound assessment were done on day 14 and day 42 following surgery. Outcomes evaluated include wound complications and the effects on skin commensals. On the final evaluation on day 42, infection rate and scar formation were also evaluated. Results: A case of superficial surgical site infection was observed from the Opsite* spray group. Acinobacter species was isolated from one of the patients under the control group. There was no association between dressing methods used and wound healing. All wounds healed without any infection at the end of the study. Tualang honey spray was shown to have significant influence in reducing the risk of hypertrophic scar formation and has similar wound outcome as compared to Opsite* spray. Some of the results obtained were comparable to other previous studies on type of dressing and surgical wound healing. Conclusion: Tualang honey spray is a safe alternative for dressing material and was shown comparable to Opsite* spray. Contradict to some of the data available in the literature; its usage is able to promote a good wound healing with a low risk of hypertrophic scar formation

The controversial role of ct angiogram in paediatric supracondylar humeral fracture with pulseless, perfused limb.

Introduction: Almost 20% of displaced supracondylar humerus fractures in children are complicated by vascular compromise. At present, there is no clear consensus on the management of a persistent pulseless but well-perfused hand after a satisfactory closed reduction of the fracture. The role of angiography in such cases has been a source of controversy and debate. Case Report: An 18-month–old girl was referred to us with a closed, displaced, supracondylar fracture in her left humerus after a fall. She had an impalpable radial pulse but her hand looked pink with a capillary refilling time of less than 2 seconds. She underwent an emergency closed reduction and percutaneous pinning. Post-reduction, her hand remained persistently pulseless but well-perfused. A multi-disciplinary decision was made more than 24 hours after the initial surgery. The medical team decided to proceed with a computerized tomographic (CT) angiogram followed by surgical exploration and release of her left brachial artery, which was completely occluded by compression of the surrounding soft tissues. The procedure proceeded smoothly and the patient showed remarkable immediate and long term outcomes. There was no further complications observed as a result of the delay in surgical treatment. Discussion/ Conclusion:We believe that the decision to manage such cases should be made on based on appropriacy in each case. A CT angiogram is helpful in objectively determining the level of occlusion and the possible risk of proximal migration of thrombus which may eventually affect the available collaterals. A well-perfused limb may allow adequate time for a proper decision to be made for surgical intervention