Bilateral accessory middle turbinate presenting as double middle turbinate: A unique case report.

Many anatomical variations of the middle turbinate (MT), including pneumatized, paradoxically curved, bifurcate, trifurcate, secondary, and accessory, have been described. The most common is pneumatized MT (concha bullosa), but other less common variations may also impact the outcome of clinical management. Anatomical variations of the MT, particularly with a concomitant deviated nasal septum, tend to obstruct the middle meatus leading to disruption of the normal sinus drainage and worsening the symptoms of rhinosinusitis. By recognizing the unique anatomical variant by endoscopy or imaging will help us to improve the management. We report an endoscopic presentation of a rare accessory MT.

Conventional versus molecular detection of Chlamydia trachomatis and Neisseria gonorrhoeae among males in a sexually transmitted infections clinic.

BACKGROUND: Chlamydia trachomatis and Neisseria gonorrhoeae are important bacterial pathogens of sexually transmitted infections (STIs) worldwide. This study sought to compare the analytical sensitivity and specificity of conventional methods against a rapid molecular method in detecting STIs caused by these bacteria. METHODS: Ninety five first-time male attendees of the Genito-urinary Medicine Clinic in Hospital Kuala Lumpur were included in this cross-sectional study. The detection of C. trachomatis was achieved through direct fluorescence antibody (DFA) staining of urethral swabs and real-time polymerase chain reaction testing (Xpert® CT/NG assay) on urine specimens. N. gonorrhoeae was detected through Gram staining and culture of urethral swabs and Xpert® CT/ NG assay on urine specimens. RESULTS: From the Xpert® CT/NG results, 11 (11.6%) attendees had chlamydia, 23 (24.2%) had gonorrhoea and 8 (8.4%) had both STIs. The sensitivity and specificity of DFA in detecting chlamydia compared to Xpert® CT/NG were 5.3% (95% CI: 0-28) and 94.7% (95% CI: 86-98), respectively. For gonorrhoea, the sensitivity and specificity of Gram staining were 90.3% (95% CI: 73-98) and 95.3% (86-99), respectively, whereas the sensitivity and specificity of culture compared to Xpert® CT/NG were 32.2% (95% CI: 17-51) and 100% (95% CI: 93-100), respectively. CONCLUSION: Although Gram-stained urethral swab smears are sensitive enough to be retained as a screening tool for gonorrhoea, culture as well as DFA lack sensitivity and are poorly suited to screen for gonorrhoea and chlamydia, respectively. However, owing to their high specificity, conventional detection methods are still suitable as confirmatory tests for gonorrhoea and chlamydia.

Diagnosis of upper aerodigestive tract tumours using autofluorescence endoscopy in south east asian patients.

Diagnosis of upper aerodigestive tract tumours using autofluorescence endoscopy in south east asian patients. OBJECTIVES: Autofluorescence is a highly sensitive, and specific, complementary diagnostic tool for the photodiagnosis of head and neck squamous cell carcinomas. Together with ease of use, these properties suggest that autofluorescence, used alongside white light endoscopy, could be a promising tool for the screening of high-risk populations. The aim of this study was to evaluate its effectiveness in detecting tumours involving the upper aerodigestive tract, in comparison with histopathologic examination. METHODOLOGY: A cross-sectional prospective study was carried out from June 2011 till March 2012. Forty-five patients with clinical evidence of suspicious lesions involving the upper aerodigestive tract were enrolled and examined using conventional white light, and autofluorescence endoscopy. A biopsy of each lesion was subsequently submitted for histopathologic examination. RESULTS: Using histology as our gold standard, we compared the sensitivity, specificity, and predictive values of autofluorescence endoscopy in detecting upper aerodigestive tract tumours. In comparison to histopathologic examination, the sensitivity of autofluorescence endoscopy was 95%, with a specificity of 74% (P value<0.001). The positive and negative predictive values were 78%, and 94% respectively. These data confirm a statistically significant correlation between autofluorescence and histopathologic diagnoses. CONCLUSIONS: Autofluorescence endoscopy was effective in detecting upper aerodigestive tract tumours, with excellent discrimination between benign and malignant phenotypes; this methodology is an ideal adjunct to white light endoscopy.

Congenital epulis: A rare benign tumour.

Congenital epulis is a rare benign pedunculated tumour of the oral cavity arising from the alveolar ridges. It is usually detected in newborns and can be successfully resected surgically. We report a case of a newborn baby who had a 5x3x3cm pedunculated lobar mass arising from the upper alveolar ridge.

Utility of DNA barcoding for rapid and accurate assessment of bat diversity in Malaysia in the absence of formally described species.

Bats are important flagship species for biodiversity research; however, diversity in Southeast Asia is considerably underestimated in the current checklists and field guides. Incorporation of DNA barcoding into surveys has revealed numerous species-level taxa overlooked by conventional methods. Inclusion of these taxa in inventories provides a more informative record of diversity, but is problematic as these species lack formal description. We investigated how frequently documented, but undescribed, bat taxa are encountered in Peninsular Malaysia. We discuss whether a barcode library provides a means of recognizing and recording these taxa across biodiversity inventories. Tissue was sampled from bats trapped at Pasir Raja, Dungun Terengganu, Peninsular Malaysia. The DNA was extracted and the COI barcode region amplified and sequenced. We identified 9 species-level taxa within our samples, based on analysis of the DNA barcodes. Six specimens matched to four previously documented taxa considered candidate species but currently lacking formal taxonomic status. This study confirms the high diversity of bats within Peninsular Malaysia (9 species in 13 samples) and demonstrates how DNA barcoding allows for inventory and documentation of known taxa lacking formal taxonomic status.

The effects of water parameters on monthly seagrass percentage cover in Lawas, East Malaysia.

Seagrass is a valuable marine ecosystem engineer. However, seagrass population is declining worldwide. The lack of seagrass research in Malaysia raises questions about the status of seagrasses in the country. The seagrasses in Lawas, which is part of the coral-mangrove-seagrass complex, have never been studied in detail. In this study, we examine whether monthly changes of seagrass population in Lawas occurred. Data on estimates of seagrass percentage cover and water physicochemical parameters (pH, turbidity, salinity, temperature, and dissolved oxygen) were measured at 84 sampling stations established within the study area from June 2009 to May 2010. Meteorological data such as total rainfall, air temperature, and Southern Oscillation Index were also investigated. Our results showed that (i) the monthly changes of seagrass percentage cover are significant, (ii) the changes correlated significantly with turbidity measurements, and (iii) weather changes affected the seagrass populations. Our study indicates seagrass percentage increased during the El-Nino period. These results suggest that natural disturbances such as weather changes affect seagrass populations. Evaluation of land usage and measurements of other water physicochemical parameters (such as heavy metal, pesticides, and nutrients) should be considered to assess the health of seagrass ecosystem at the study area.

Treatment Challenges in a Pregnant Patient With Severe Burn Injury and Wound Care Using Amniotic Membrane: A Case Report.

We report a case of severe burn injury in a 42-year-old pregnant patient referred to our hospital's burn unit after experiencing a scald burn injury that burned her neck, chest, trunk, abdomen and limbs. The patient had burn wounds distributed on her neck, all four extremities, the chest and abdomen, with a total burn area of 46.5%. The burn wounds were treated with surgical debridement and then covered with silver sulfadiazine and damp gauze. The patient's wounds were treated every three days. The patient delivered a healthy baby full-term through a spontaneous, vaginal delivery. After delivery, the amniotic membrane from the patient was used as an amniotic membrane graft and was planted on the patient's chest, right arm and right thigh. The amniotic membrane in this patient helped to accelerate the preparation of the wound bed for skin grafting. Split-thickness skin grafts were then used on the wounds and the patient was discharged from the hospital one week later. Patients that present with burn injuries during pregnancy require intense monitoring and careful management from a multidisciplinary team. A collaborative effort needs to be made in order to plan the best outcome for the mother and fetus. Precise and early resuscitation is the first step to treating such cases. The administration of fluids should be titered based on the patient's hemodynamic condition and urine output. Wound management can also be optimized using the amniotic membrane as a temporary dressing before skin grafting.

Nous rapportons le cas d'une femme de 42 ans, enceinte, hospitalisée dans le service après un ébouillantement touchant le cou, le thorax, l'abdomen et les membres, représentant 46,5% SCT. Les pansements étaient réalisés tous les 3 jours avec de la sulfadiazine argentique recouverte de gaze humide. La patiente a accouché naturellement, à terme. Sa membrane amniotique a été utilisée pour recouvrir le thorax et les membres droits en attente de greffes, la patiente étant sortie 1 semaine après leur réalisation. Les patientes se brûlant durant leur grossesse doivent bénéficier d'un suivi multidisciplinaire attentif s'intéressant à la maman et au fœtus. Le remplissage initial doit être adapté à l'hémodynamique et à la diurèse. Le traitement local peut être optimisé, avant greffe, par l'utilisation de la membrane amniotique.

Osteo-odonto-keratoprosthesis for end-stage cornea blindness.

We report the first case of Osteo-odonto-keratoprosthesis (OOKP) who successfully underwent surgery in Malaysia following a grade 4 (severe) chemical injury in both eyes in 2006. The patient's left eye was eviscerated and his right eye underwent penetrating keratoplasty. However, the corneal graft failed and became opaque. His right eye could only perceive light. The OOKP was offered to him hoping to recover some functional vision. He underwent a 2-stage surgery to implant the OOKP into his right eye. However, 2 months post-operation, he developed vitreous haemorrhage. A successful pars plana vitrectomy (PPV) was performed via the limited view through the lens. He attained a final visual acuity of 6/60 (N36). He was able to mobilize more independently, feed, dress himself and read large print.

The accuracy of dry surgical field sublabial biopsy in the diagnosis of sicca syndrome.

BACKGROUND: Sublabial gland biopsy is the 'gold standard' in establishing the diagnosis of primary Sjögren's syndrome. Bleeding and nerve damage are complications. Our centre has adopted the use of the chalazion clamp to provide a dry surgical field to address these challenges. This study aimed to assess the accuracy of minor salivary gland harvest rate using this technique. METHOD: A retrospective review of all minor salivary gland biopsies was carried out in a single tertiary referral centre over a five-year period. RESULTS: Forty-one biopsy patients were identified, with a mean age of 56.1 years. There was 100 per cent accuracy in harvest rate in our series. Twelve patients (29 per cent) were positive for primary Sjögren's syndrome. No patients had a complication immediately or at one month follow up. CONCLUSION: Dry surgical field sublabial gland biopsy is a safe and highly effective technique in the diagnosis of primary Sjögren's syndrome. Initial results indicate it may provide a higher harvest rate with fewer complications than traditional non-ischaemic techniques.

Passively mode locked thulium and thulium/holmium doped fiber lasers using MXene Nb2C coated microfiber.

As a result of the emergence of two-dimensional (2D) materials for various opto-electronics applications, a new class of materials named MXenes have been attracting interests due to their outstanding nonlinear properties. In this work, an MXene niobium carbide (Nb2C) was proposed and demonstrated as a saturable absorber to induce mode-locking in thulium- and thulium/holmium-doped fiber lasers. The Nb2C solution was first prepared using the liquid exfoliation technique, and then deposited onto a microfiber for integration into the laser cavity. Stable mode-locking operation was observed in both laser cavities, where the center wavelengths of the laser were recorded at 1944 nm for the TDFL and 1950 nm for the THDFL. The generated pulses in the TDFL and THDFL had repetition rates of 9.35 and 11.76 MHz respectively, while their corresponding pulse widths were 1.67 and 1.34 ps. Both of the lasers were highly stable, having SNR values of more than 52 dB and showed no major fluctuations when tested for their long-term stabilities. The results demonstrate an excellent performance of the Nb2C as a saturable absorber, offering opportunities to further explore MXenes for future photonics devices.

2 µm passively mode-locked thulium-doped fiber lasers with Ta2AlC-deposited tapered and side-polished fibers.

In this work, mode-locked thulium-doped fiber lasers operating in the 2 µm wavelength region were demonstrated using tantalum aluminum carbide (Ta2AlC)-based saturable absorbers (SAs) utilizing the evanescent wave interaction. The Ta2AlC MAX Phase was prepared by dissolving the Ta2AlC powder in isopropyl alcohol and then deposited onto three different evanescent field-based devices, which were the tapered fiber, side-polished fiber, and arc-shaped fiber. Flame-brushing and wheel-polishing techniques were used to fabricate the tapered and arc-shaped fibers, respectively, while the side-polished fiber was purchased commercially. All three SA devices generated stable mode-locked pulses at center wavelengths of 1937, 1931, and 1929 nm for the tapered, side-polished, and arc-shaped fibers. The frequency of the mode-locked pulses was 10.73 MHz for the tapered fiber, 9.58 MHz for the side-polished fiber, and 10.16 MHz for the arc-shaped fiber. The measured pulse widths were 1.678, 1.734, and 1.817 ps for each of the three SA devices. The long-term stability of the mode-locked lasers was tested for each configuration over a 2-h duration. The lasers also showed little to no fluctuations in the center wavelengths and the peak optical intensities, demonstrating a reliable, ultrafast laser system.

Autogenous free fat graft combined with platelet-rich fibrin heals a refractory mandibular osteoradionecrosis.

Osteoradionecrosis (ORN) is a well-recognized, debilitating complication of radiotherapy for patients with head and neck cancer. There is no universally accepted treatment for ORN of the jawbones. We report on a case of refractory mandibular ORN treated by sequestrectomy of mandible and autogenous transplantation of fat graft combined with platelet-rich fibrin (PRF). Improved perfusion was observed using the laser Doppler flowmetry. This case highlights the use of autogenous free fat graft and PRF as an adjunct therapy to sequestrectomy in the management of ORN.

Dry surgical field minor salivary gland harvest using a chalazion clamp for sicca syndrome.

BACKGROUND: Sjögren's syndrome is a rheumatological condition. Diagnosing Sjögren's syndrome can be challenging given the overlapping nature of clinical presentations. Currently, minor salivary gland biopsy is considered the definitive test for diagnosing Sjögren's syndrome. Various surgical techniques have been described, targeting biopsy of minor salivary glands from the lower lip. Identification of minor salivary glands is often difficult because of bleeding. One common complication of minor salivary gland biopsy is lip paraesthesia from iatrogenic sensory nerve injury. OBJECTIVES: To describe a minor salivary gland biopsy technique in a bloodless operative field using a chalazion ophthalmic clamp under local anaesthesia, and to report our clinical outcomes. METHODS: A prospective study was performed on patients who underwent minor salivary gland biopsy using a chalazion ophthalmic clamp between July 2017 and April 2018. RESULTS: The study included 23 patients. The histopathological reports positively identified minor salivary glands for all patients. In nine cases, the histological findings were positive for Sjögren's syndrome. No lip paraesthesia complications were reported post-operatively. CONCLUSION: This technique facilitates a superior yield, ensures adequate sampling of appropriate glands for histopathological analysis, and minimises the complications associated with traditional techniques.

Chemical and antibacterial data of synthesized thioureido derivatives.

This paper provided comprehensive data on spectroscopic and antibacterial activities of thioureido compounds which are relevant with research article entitled "Synthesis, Spectroscopic Studies and Antibacterial Activity of New Lauroyl Thiourea Amino Acid Derivatives" [1]. Based on the reported study, four new thioureido derivatives, namely 3-(3-dodecanoyl-thioureido)propionic acid (R1), 2-(3-dodecanoyl-thioureido)-3-methyl butyric acid (R2), (3-dodecanoyl-thioureido)acetic acid (R3) and 2-(3-dodecanoyl-thioureido)-3-phenyl propionic acid (R4) were characterized by elemental analysis, Fourier Transform Infrared (FTIR), 1H Nuclear Magnetic Resonance (1H NMR) and 13C Nuclear Magnetic Resonance (13C NMR), and Ultraviolet Visible spectroscopy (UV-Vis). The preliminary results from antibacterial assay which were tested against Gram-positive bacteria such as Bacillus subtilis, Staphylococcus epidermidis, Staphylococcus aureus and Gram-negative bacteria such as Escherichia coli, Salmonella typhimurium are also described.

Maxillofacial trauma with emphasis on soft-tissue injuries in Malaysia.

Soft-tissue injuries with or without facial bone involvement are the most common presentation following maxillofacial trauma. The objective of this study was to look at the distribution, pattern and type of soft-tissue injury in relation to aetiology. Records of patients over a period of 5 years (1998-2002), who sustained maxillofacial injuries and were treated at Kajang Hospital, a secondary referral hospital, were reviewed. Out of 313 patients with maxillofacial injuries, 295 patients sustained soft-tissue injuries. Males (79%) between 21 and 30 years old (34%) were the majority of patients. Road-traffic accident was the main cause of soft-tissue injuries (75%) with motorcycle accident being the most frequent (40%). The upper lips (23%) and the lower lips (18%) were the most common extraoral site involved, while the labial mucosa and sulcular areas, both accounting for 21%, were the most common intraoral sites. Stringent road-traffic regulations should be practiced in developing countries, as morbidity arising from road-traffic accidents poses a national economic and social problem.

Molecular Detection of Coxiella burnetii from Farm Animals and Ticks in Malaysia.

Coxiella burnetii, the causative agent of Q fever, is an intracellular bacterium of medical and veterinary importance. The reservoirs of C. burnetii are extensive which include mammals and arthropods, particularly ticks. As the organism is difficult to culture, this study was aimed to detect C. burnetii DNA in animal (mainly blood and vaginal samples of cattle, goats and sheep) and tick samples obtained from farm animals, wild rodents and vegetation. Two polymerase chain reaction (PCR) assays targeting IS1111 transposon-like gene (TransPCR) and com1 gene (OMP-PCR) were used for C. burnetii detection. Sequence determination of the amplified fragments and a real-time PCR assay were used to confirm PCR findings. C. burnetii DNA was detected from 9.1% of cattle blood and 4.2% vaginal samples, respectively. A small percentage (5.8%) of ticks (including Amblyomma, Dermacentor, Rhipicephalus and Haemaphysalis spp.) haboring C. burnetii were identified in this study. This study provides molecular evidence on the presence of C. burnetii in cattle and ticks. The possible zoonotic transmission of C. burnetii is yet to be investigated.

Enigmatic phylogeny of skuas (Aves:Stercorariidae)

Multiple sources of evidence show that the skuas (Aves:Stercorariidae) are a monophyletic group, closely related to gulls (Laridae. On morphological and behavioural evidence the Stercorariidae are divided into two widely divergent genera, Catharacta and Stercorarius, consistent with observed levels of nuclear and mitochondrial gene divergence. Catharacta skuas are large-bodied and with one exception breed in the Southern Hemisphere. Stercorarius skuas otherwise known as jaegers) are smaller bodied and breed exclusively in the Northern Hemisphere. Evidence from both mitochondrial and nuclear genomes and from ectoparasitic lice (Insecta:Phthiraptera) shows that the Pomarine skua, S. pomarinus, which has been recognized as being somewhat intermediate in certain morphological and behavioural characteristics, is much more closely related to species in the genus Catharacta, especially to the Northern Hemisphere-breeding Great skua, C. skua, than it is to the other two Stercorarius skuas, the Arctic skua, S. parasiticus and the Longtailed skua, S. longicaudus. Three possible explanations that might account for this discordant aspect of skua phylogeny are explored. These involve (i) the segregation of ancestral polymorphism, (ii) convergent evolution of morphology and behaviour or (iii) inter-generic hybridization. The available evidence from both nuclear and mitochondrial genomes does not exclude any of these hypotheses. Thus, resolution of this enigma of skua phylogeny awaits further work.

Trans-cervical, trans-tracheal approach to proximal tracheo-oesophageal fistula: a novel technique.

Esophageal atresia and tracheo-esophageal fistula (TEF) occur in 1/2400-4500 births. Whilst the diagnosis of esophageal atresia is readily made shortly after birth, patients with an isolated H type TEF can present with varying degrees of symptomatology which can pose a diagnostic challenge. A combination of contrast esophagogram and endoscopic evaluastion is the most commonly employed localization strategy. Despite accurate pre-operative localization, intra-operative identification of the TEF can prove substantially more challenging. The authors of this report describe a novel approach in the management of a proximal TEF, which allows direct visualization and cannulation via a trans-cervical, trans-tracheal approach.