Detection of dynorphin 1-17 biotransformation fragments in human nasal polyps by UPLC-QTOF-MS.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammation of the sinonasal mucosa. CRSwNP treatments are associated with inconsistent efficacy and recurrence of symptoms. Dynorphin 1-17 (DYN 1-17) and its fragments have been shown to modulate the immune response in various inflammatory conditions. This study aimed to investigate the effect of different pH and degrees of inflammation on DYN 1-17 metabolism in human CRSwNP tissues. DYN 1-17 was incubated with grade 3 and grade 4 inflamed tissues of CRSwNP patients at pH 5.5 and pH 7.4 over a range of incubation periods. The resulting fragments were identified using an ultra-performance liquid chromatography (UPLC) system coupled to quadrupole-time of flight (QTOF) mass spectrometry based on their accurate mass. The rate of DYN 1-17 fragmentation was slower at pH 5.5 in comparison to pH 7.4. The extent and rate of metabolism of DYN 1-17 were much lower in grade 3 inflamed tissue (31-32 fragments) than in grade 4 (34-41 fragments). N-Terminal fragments (DYN 1-15, 1-11, 1-10, and 1-6) were metabolized slower at pH 5.5 as compared to pH 7.4. DYN 1-12, 1-8, 2-10, 4-10, 5-10, and 8-14 were only observed under the inflammatory pH while DYN 5-17 and 6-17 were only identified upon incubation with grade 4 CRSwNP tissues. DYN 1-17 metabolism was significantly affected by the pH level and the severity of the inflammation of CRSwNP tissues, indicating the potential roles of DYN 1-17 and its fragments in modulating the inflammatory response and their avenue as therapeutics in future studies.

Traumatic Neck Injury: An Accidental Impalement by a Needlefish.

Encounters between marine animals and humans can result in critical injury and fatal complications. We highlight a 20-y-old male who sustained a penetrating injury to the neck as a result of impalement by needlefish (Tylosurus sp) while snorkeling. He sustained a penetrating injury in the posterior triangle of the neck. On presentation, he was stabilized and received empirical antibiotics, analgesia, and antitetanus toxoid injection before being transferred to a tertiary center. On presentation to the tertiary hospital, the patient was hemodynamically stable with no clinical evidence of injury to surrounding neck structures, and this was confirmed using computed tomography. The patient underwent local wound exploration and retrieval of the needlefish beak under general anesthesia. The wound was left open to heal by secondary intention. The patient was discharged with oral antibiotics and went on to make a complete recovery.

Challenges and Adaptation in Otorhinolaryngology Practice During Pandemic Lockdown: Experience from a Malaysian COVID-19 Hospital.

COVID-19 has taken the world by storm: since the first few cases appeared in Wuhan, China in December 2019 and by June 2020 there were more than 10 million cases of COVID-19 cases worldwide. Malaysia had its first case in January 2020 and acted promptly by implementing several drastic measures to contain the disease. Subsequently, the Ministry of Health Malaysia has implemented guidelines and recommendations on the management of COVID-19. The Department of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) provides services for patients with ear, nose, throat, head and neck diseases and provides audiology, speech and language therapy, as well as undergraduate and postgraduate training. As the department's staff is heavily involved in examinations and interventions of upper aerodigestive tract problems, the challenges are distinctly different from other specialties. This article discusses how COVID-19 affected ORL-HNS services and what measures were taken in Hospital Melaka, Malaysia.

Giant submandibular sialolipoma masquerading as huge goitre: a case report.

BACKGROUND: Sialolipoma is a rare tumour which may arise from both major and minor salivary glands and has recently been described as a variant of salivary gland lipomatous lesions. CASE PRESENTATION: We report a 54-year-old male who presented with a 7-year history of large right anterior neck swelling. He was clinically euthyroid and had no compressive or infiltrative symptoms. He sought medical attention due to the discomfort exerted by the weight of the mass and was keen for excision. The swelling appeared like a goitre but physical examination proved otherwise. Imaging was suggestive of a benign tumour arising from the right parapharyngeal fossa. The mass was surgically excised and was noted to be adherent to part of the submandibular gland. Histopathological examination revealed a new variant of benign adipocytic tumour of salivary gland or sialolipoma arising from the submandibular gland. Besides being the largest sialolipoma to be reported, there are also no reports of giant submandibular sialolipomas masquerading as a huge goitre in appearance. CONCLUSION: Submandibular sialolipomas can present in really large sizes and appear as a giant goitre. It is important to differentiate between benign lipomas from liposarcomas and tailor the management accordingly. Surgical enucleation is the preferred choice of treatment for these benign tumours with low recurrence rates.

Sustainable Medical Teaching and Learning During the COVID-19 Pandemic: Surviving the New Normal.

During the first phase of the Movement Control Order, many medical lecturers had difficulty adapting to the online teaching and learning methods that were made compulsory by the institutional directives. Some of these lecturers are clinicians who need to juggle between clinical work and teaching, and consider a two-week adaptation during this period to be not enough. Furthermore, converting traditional face-to-face learning to online formats for undergraduate and postgraduate clinical programmes would reduce the learning outcomes, especially those related to clinical applications and the acquisition of new skills. This editorial discusses the impact that movement restrictions have had on medical teaching and learning, the alternatives and challenges and the way forward.

A Critical Appraisal of COVID-19 in Malaysia and Beyond.

When the first report of COVID-19 appeared in December 2019 from Wuhan, China, the world unknowingly perceived this as another flu-like illness. Many were surprised at the extreme steps that China had subsequently taken to seal Wuhan from the rest of the world. However, by February 2020, the SARS-CoV-2 virus, which causes COVID-19, had spread so quickly across the globe that the World Health Organization officially declared COVID-19 a pandemic. COVID-19 is not the first pandemic the world has seen, so what makes it so unique in Malaysia, is discussed to avoid a future coronacoma.

Effects of immunonutrition on biomarkers in traumatic brain injury patients in Malaysia: a prospective randomized controlled trial.

BACKGROUND: Head injury is one of the top three diagnosis leading to intensive care unit (ICU) admission in Malaysia. There has been growing interest in using immunonutrition as a mode of modulating the inflammatory response to injury or infection with the aim of improving clinical outcome. The aim of the present study was to evaluate the effect of an immunonutrition on biomarkers (IL-6, glutathione, CRP, total protein and albumin) in traumatic brain injury patients. METHODS: Thirty six patients with head injury admitted to neurosurgical ICU in University Malaya Medical Centre were recruited for this study, over a 6-month period from July 2014 to January 2015. Patients were randomized to receive either an immunonutrition (Group A) or a standard (Group B) enteral feed. Levels of biomarkers were measured at day 1, 5 and 7 of enteral feeding. RESULTS: Patients in Group A showed significant reduction of IL-6 at day 5 (p < 0.001) with concurrent rise in glutathione levels (p = 0.049). Patients in Group A also demonstrated a significant increase of total protein level at the end of the study (day 7). CONCLUSION: These findings indicate the potential of immunonutrition reducing cytokines and increasing antioxidant indices in patients with TBI. However, further studies incorporating patient outcomes are needed to determine its overall clinical benefits. TRIAL REGISTRATION: National Medical Research Register (NMRR) ID: 14-1430-23,171. ClinicalTrials.gov identifier: NCT03166449 .

Cognitive Function Among Obstructive Sleep Apnea Patients in North East Malaysia.

INTRODUCTION: Obstructive sleep apnea patients may develop deficits in the cognitive domains of attention, concentration, executive function, verbal and visuospatial memory, constructional abilities, and psychomotor functioning. As cognitive performance will improve with the treatment, early screening for cognitive dysfunction should be done to prevent further deterioration. OBJECTIVE: We aim to evaluate the cognitive function of obstructive sleep apnea patients by using the 'Mini Mental State Examination'. METHODOLOGY: This was a cross sectional study to evaluate the cognitive function of moderate and severe obstructive sleep apnea patients with age ranged from 18 to 60 old who attended our sleep clinic. These patients were confirmed to have moderate and severe obstructive sleep apnea by Type 1 polysomnography (attended full overnight study). The age, gender and ethnicity were noted and other relevant data such as weight, height, body mass index and apnea and hypopnoea index were recorded accordingly. The cognitive function was evaluated using validated Malay version of Mini Mental State Examination which measured 5 areas of cognitive functions comprising orientation, registration, attention and calculation, word recall and language abilities, and visuospatial. RESULTS: A total of 38 patients participated in this study. All 19 patients of moderate group and 14 patients of severe group had normal cognitive function while only 5 patients in severe group had mild cognitive function impairment. There was a statistically significant difference between the moderate group and severe group on cognitive performance (p value = 0.042). CONCLUSIONS: Severe obstructive sleep apnea patients may have impaired cognitive function. Mini Mental State Examination is useful in the screening of cognitive function of obstructive sleep apnea patients but in normal score, more sophisticated test batteries are required as it is unable to identify in 'very minimal' or 'extremely severe' cognitive dysfunction.

Orbital Morphometry: A Computed Tomography Analysis.

INTRODUCTION: The human orbit is a complex anatomic region, which plays predominant role in the evaluation of craniofacial complex. A thorough understanding of the relationship of the distance from orbital rim to the important vital structures of the orbital apex is required for the surgeon to perform safe and effective surgery. OBJECTIVES: To evaluate and compare the depth and distances from various points of the orbital rim to the fissures and foramina of the orbital apex between genders in the local population. METHODOLOGY: Linear measurements were conducted on 60 orbits from 30 patients who had undergone head computed tomography scan. These measurements were done utilizing the multiplanar reconstruction modes on computed tomography images with minimum slice thickness of 1 mm. RESULTS: Males have statistically significant larger orbits than females with higher mean measurements in all parameters, except for the distance from posterior ethmoidal foramen to the optic canal which was the same. However, there were no significant differences in all parameters between the right and left orbits. CONCLUSION: This study provides the absolute limit of safe internal orbital dissection in respect to the local population. Despite males having larger orbits than females, it is clinically negligible.

'Not your average breast lump!'-Primary tuberculosis mimicking chronic abscess: A rare case report.

Primary breast tuberculosis is a rare disease under extrapulmonary tuberculosis category. It tends to affect females of reproductive age rather than postmenopausal women or prepubescent girls. This rare form of disease poses a challenge in diagnosing as imaging can mimic the appearance of both benign and malignant breast lesions. We describe a case of primary breast tuberculosis in a young female who presented with a persistent left breast lump. and was diagnosed with chronic left breast abscess. Histopathological examination of the lesion was consistent with granulomatous mastitis, secondary to mycobacterium tuberculosis infection. The patient was treated with a 6-month course of anti-tuberculosis drug with complete resolution of the symptoms and the left breast lesion on serial ultrasound imaging.

Emergence of mRNA vaccines in the management of cancer.

INTRODUCTION: mRNA vaccines have been developed as a promising cancer management. It is noted that specification of the antigen sequence of the target antigen is necessary for the design and manufacture of an mRNA vaccine. AREAS COVERED: The steps involved in preparing the mRNA-based cancer vaccines are isolation of the mRNA cancer from the target protein using the nucleic acid RNA-based vaccine, sequence construction to prepare the DNA template, in vitro transcription for protein translation from DNA into mRNA strand, 5' cap addition and poly(A) tailing to stabilize and protect the mRNA from degradation and purification process to remove contaminants produced during preparation. EXPERT OPINION: Lipid nanoparticles, lipid/protamine/mRNA nanoparticles, and cell-penetrating peptides have been used to formulate mRNA vaccine and to ensure vaccine stability and delivery to the target site. Delivery of the vaccine to the target site will trigger adaptive and innate immune responses. Two predominant factors of the development of mRNA-based cancer vaccines are intrinsic influence and external influence. In addition, research relating to the dosage, route of administration, and cancer antigen types have been observed to positively impact the development of mRNA vaccine.

Acute labyrinthitis secondary to aural tick infestation.

Aural tick usually menisfests as intolerable otalgia. The severity of pain makes the patient to seek early treatment. Other uncommon symptoms include inner ear dyfunctions such as vertigo and tinnitus. The diagnosis is established by clinical examinaion either by otoscopic evidence of the tick itself, or its fecal remnant. We report a case of patient with acute labyrinthitis features with concurent otoscopic findings of tick fecal material.

Effect of constraint-induced music therapy in idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis.

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is commonly encountered in audiologic and otolaryngologic practice. Constraint-induced music/sound therapy (CIMT) is characterized by the plugging of the normal ear (constraint) and the simultaneous, stimulation of the affected ear with music, which is based on a well-established neurorehabilitation approach. Corticosteroid therapy (CST) is the current mainstay of treatment. The prognosis for hearing recovery depends on many factors including the severity of hearing loss, age, and presence of vertigo. Objective: To analyze the effectiveness of CIMT with CST in ISSNHL. Methods: We performed a systematic search, using specific keywords relevant to our study, in PubMed, Cochrane Central Register of Controlled Trials, and additional sources of published trials till December 2020. We then screened all search results obtained according to our inclusion/exclusion criteria and performed a quality assessment on all studies using the Newcastle-Ottawa scale and using MedCalc, a meta-analysis was performed on suitable studies. Results: The recovery rates of three included nonrandomized studies were assessed at 1 to 3 months. A total of 229 (CST: 131, CST + CIMT: 98) patients were pooled for meta-analysis. The meta-analysis using the random-effect model found the relative risk of recovery rate within 3 months to be 1.213 (95% confidence interval 0.709-2.074), a result that is not statistically significant. Conclusion: Although our analysis results do not demonstrate the noticeable effect of CIMT in ISSNHL, it can support be a gainful adjunct to CST for better hearing results than CST alone. Therefore, it needs further prospective randomized controlled multicenter trials with a large sample.

Progressive Worsening of Snoring as a Rare Presentation of HPV-Positive Oropharyngeal Squamous Cell Carcinoma.

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) especially human papillomavirus (HPV) associated type is increasing in trend despite reducing in other head and neck squamous cell carcinoma. Muffled voice, dysphagia, neck mass and pain over the throat are among the common presentations; however, health care professional should be aware of unusual presentation to avoid delay in management. We present a case of HPV-positive OPSCC with a rare presentation; progressive worsening of snoring for 6 months duration. Patient sougth medical attention at the some of private clinics for the past 2 months, however, was told to have a normal tonsillar enlargement. Subsequently, patient was referred to our center with impression of obstructive sleep apnea. We highlight the important of early referral to appropriate center and otorhinolaryngology for assessment in cases presented with worsening snoring.

Intracapsular Enucleation of Intraparotid Facial Nerve Schwannoma with Intratemporal Extension.

Intraparotid facial nerve schwannoma is a rare condition, which is difficult to preoperatively diagnose without a definite biopsy, yet the diagnosis is important for surgical planning and avoiding accidental injury to the facial nerve. Considering the benign indolent nature of the schwannomas, the management should be prioritized on the long-term tumor control with special attention to the facial nerve function and facial cosmesis. Microscope-assisted intracapsular enucleation is an excellent treatment option for such lesions. Our patient showed House-Brackmann grade II facial function after the surgery. This technique is safe and offers a favorable outcome of facial nerve function.