Ahmad Farouk Musa

By Ahmad Farouk Musa

Vitamin E was first discovered as a fertility factor in 1922 in the laboratory of Herbert McLean Evans, a scientist and anatomist. Following this discovery, it was extensively researched and found to possess a potent antioxidant property. It soon dawned that the family of vitamin E has eight members: four tocopherols, namely α-, β-, δ- and γ-tocopherol; and four tocotrienols in the form of α-, β-, δ- and γ-tocotrienols. This chapter discusses this rather unknown and underrated isomer of vitamin E with unsurpassed health benefits: tocotrienols. Until recently, tocotrienols rarely figured in vitamin E research in spite of their relative superiority to tocopherol coupled with their abundant presence in palm oil. In fact, since palm oil contains about 70% of all tocotrienol homologues, it would be no exaggeration to call it nature’s best kept secret, if not the most promising natural substance in influencing health and disease. While highlighting the wonders of tocotrienols as a safe and efficacious product, this chapter offers a panoramic view of recent research into tocotrienols that demonstrates their undeniable benefits in conferring protection against cancer as well as a whole litany of ailments including cardiovascular, metabolic, autoimmune, bone and neurological diseases. Admittedly, many of these researches were conducted in the laboratory, with some preclinical trials translated into clinical trials. Nonetheless, it is hoped that more randomised clinical trials will be carried out on a global scale in the near future. From the vessels in the heart to the neurons in the brain, tocotrienols have the extraordinary potential to be the future of vitamin E research.

Part of the book: Vitamin E in Health and Disease

By Ahmad Farouk Musa and Cheang Jia Min

Wound healing remains a major issue in surgery. None of the existing treatment modalities in caring for wounds can yet claim to be the holy grail of wound management. Channa striatus, locally known in Malaysia as Haruan, is a freshwater air-breathing carnivorous fish that is proven to influence the different phases of wound healing. As a medicinal fish, not only does Haruan have a high content of amino and fatty acids, which are essential in collagen fibre synthesis during wound recovery, it also abounds in arachidonic acid and polyunsaturated fatty acids that promote prostaglandin synthesis, a vital component of the healing process. Moreover, its antinociceptive effects could potentially reduce wound pain, an important factor in wound healing. Proteomic studies show that a quarter of the total protein detected in freeze- and spray-dried C. striatus extract are actin, myosin and tropomyosin – all molecules that play a role in the wound healing process. Proteomic profiling also reveals that Haruan possesses two types of collagen namely collagen type-I and type-II that confer tensile strength during the healing process. It is proven that collagen along with other components of the extracellular matrix form the granulation tissue which, when contracted, closes the wound and concomitantly aligns the collagen fibres in the extracellular matrix. Hence, it is inferred that Haruan promotes the maturation of granulation tissue, thereby expediting the wound healing process itself. Consequently, it could mediate a faster recovery from surgical wound coupled with a lower incidence of wound infection due to an improved and accelerated wound healing process. Additionally, Haruan has demonstrated its ability in promoting angiogenesis and cell proliferation in wound bed preparation for skin grafting. Furthermore, a Haruan aerosol concentrate can act as a wound dressing at the donor site thereby enhancing the healing process while simultaneously exhibiting some antinociceptive properties. Haruan’s exceptional ability in promoting wound healing together with its potential use in skin grafting would be instrumental in the field of surgery. In essence, the cumulated benefits from all the processes involved would translate into a significant reduction of hospitalisation cost; that would immensely benefit not only the patient, but also the government.

Part of the book: Skin Grafts for Successful Wound Closure

By Ahmad Farouk Musa

Coronary Artery Bypass Grafting (CABG) is the preferred revascularization modality among diabetic patients due to extensive coronary involvement and elevated risk of restenosis. Since drug-eluting stent significantly reduces restenosis, we expect it to narrow down the long-term benefit-gap between these two revascularization strategies. In our review, we compare the long-term outcomes of Percutaneous Coronary Intervention (PCI) to CABG in diabetic patients. While PCI can be a reasonable alternative to CABG at a low SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score, an intermediate-high SYNTAX score makes CABG necessary. In left main stem occlusion, PCI and CABG demonstrated similar long-term outcomes. However, in cases of bifurcation or unprotected left main stem disease, revascularization is best done via CABG. Indeed, CABG is the main revascularization therapy in multivessel involvement— it lowers the risk of all-cause mortality, myocardial infarction and repeat revascularization at the expense of increasessd stroke. Glycaemic control, use of antiplatelet agents and feelings of disability are all factors that can potentially affect long-term outcomes. We expect hybrid coronary revascularization (HCR) involving both robotic surgery and PCI to be the future trend in treating diabetic patients with multivessel disease, although its clinical use needs further studies.

Part of the book: Coronary Artery Bypass Grafting