Various Approaches in Managing Fish Bone Migration: Our Experience in Tertiary Hospital in Sarawak.

Ingested fish bone is a common otorhinolaryngology emergency in Malaysia. Fish bone is commonly impacted in the oropharynx for young patients and oesophagus for elderly patients. Rarely, a fish bone migrated extraluminal and require surgical exploration. We report a five cases of fish bone which involved extraluminal migration, and needed repeat CT scans and various types of surgical exploration.

Life-Saving Multidisciplinary Management of Self-Inflicted Tracheal Transection: A Case Report.

Self-inflicted cut-throat injuries, often associated with severe psychiatric disorders and exacerbated by socioeconomic factors, present significant medical complexities. Here, we present the case of a 45-year-old male with major depressive disorder who attempted suicide with a sword, resulting in complete tracheal transection. Upon admission, he presented with severe respiratory distress and hemorrhage, necessitating immediate fluid resuscitation and immediate airway securing with pediatric fiberoptic bronchoscopy, which successfully stabilized his airway. The surgical intervention included end-to-end tracheal anastomosis and T-tube placement without immediate complications. Postoperatively, the patient required intensive care with ventilator support and psychiatric intervention. Successful management of severe self-inflicted neck injuries relies on prompt airway control, precise surgical techniques, and comprehensive postoperative care to mitigate complications such as sepsis and tracheal stenosis.

The Role of Cyclin d1 in Radiotherapy Resistance of Advance Stage Nasopharyngeal Carcinoma: A Systematic Review.

OBJECTIVE: One of the biggest therapy challenges for nasopharyngeal cancer (NPC) is still radioresistance.  The radioresistance in NPC is thought to be caused by cyclin D1 overexpression.  The purpose of this study was to determine how cyclin D1 contributes to radiation resistance in NPC. METHODS: Adhering to the PRISMA guidelines, we systematically reviewed studies on cyclin D1-associated radioresistance in NPC from 2012 until 2023.  From our search, 15 studies were included. RESULTS: Cyclin D1's role in radiotherapy resistance is elucidated through several mechanisms, notably SHP-1 and B-catenin. Overexpression of SHP-1 led to an increase in cyclin D1, a higher proportion of cells in the S-phase, and radioresistance.  Conversely, inhibiting ß-catenin and cyclin D1 expression enhances radiation sensitivity. CONCLUSION: In conclusion, Cyclin D1 has a strong correlation with radiation resistance; downregulation of the protein increases radiosensitivity, while overexpression of the protein promotes radioresistance.

Unraveling the path to osteoarthritis management: targeting chondrocyte apoptosis for therapeutic intervention.

Osteoarthritis (OA) is a chronic disease affecting joints and further causing disabilities. This disease affects around 240 million people worldwide. It is a multifactorial disease, and its etiology is difficult to determine. Although numerous therapeutic strategies are available, the therapies are aimed at reducing pain and improving patients' quality of life. Hence, there is an urgent need to develop disease-modifying drugs (DMOAD) that can reverse or halt OA progression. Apoptosis is a cell removal process that is important in maintaining homeostatic mechanisms in the development and sustaining cell population. The apoptosis of chondrocytes is believed to play an important role in OA progression due to poor chondrocytes self-repair abilities to maintain the extracellular matrix (ECM). Hence, targeting chondrocyte apoptosis can be one of the potential therapeutic strategies in OA management. There are various mediators and targets available to inhibit apoptosis such as autophagy, endoplasmic reticulum (ER) stress, oxidative stress, and inflammation. As such, this review highlights the importance and potential targets that can be aimed to reduce chondrocyte apoptosis.

Single high-dose intravenous injection of Wharton's jelly-derived mesenchymal stem cell exerts protective effects in a rat model of metabolic syndrome.

BACKGROUND: Metabolic syndrome (MetS) is a significant epidemiological problem worldwide. It is a pre-morbid, chronic and low-grade inflammatory disorder that precedes many chronic diseases. Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) could be used to treat MetS because they express high regenerative capacity, strong immunomodulatory properties and allogeneic biocompatibility. This study aims to investigate WJ-MSCs as a therapy against MetS in a rat model. METHODS: Twenty-four animals were fed with high-fat high-fructose (HFHF) diet ad libitum. After 16 weeks, the animals were randomised into treatment groups (n = 8/group) and received a single intravenous administration of vehicle, that is, 3 × 106 cells/kg or 10 × 106 cells/kg of WJ-MSCs. A healthy animal group (n = 6) fed with a normal diet received the same vehicle as the control (CTRL). All animals were periodically assessed (every 4 weeks) for physical measurements, serum biochemistry, glucose tolerance test, cardiovascular function test and whole-body composition. Post-euthanasia, organs were weighed and processed for histopathology. Serum was collected for C-reactive protein and inflammatory cytokine assay. RESULTS: The results between HFHF-treated groups and healthy or HFHF-CTRL did not achieve statistical significance (α = 0.05). The effects of WJ-MSCs were masked by the manifestation of different disease subclusters and continuous supplementation of HFHF diet. Based on secondary analysis, WJ-MSCs had major implications in improving cardiopulmonary morbidities. The lungs, liver and heart show significantly better histopathology in the WJ-MSC-treated groups than in the untreated CTRL group. The cells produced a dose-dependent effect (high dose lasted until week 8) in preventing further metabolic decay in MetS animals. CONCLUSIONS: The establishment of safety and therapeutic proof-of-concept encourages further studies by improving the current therapeutic model.

Overcoming Airway Hurdles: A Case Report of Anesthetic Challenges in Meningomyelocele Complications.

This case report delves into the anesthesia management in a 23-year-old male with complications of meningomyelocele, a catastrophic congenital neural tube defect. The patient, paraplegic since birth with severe scoliosis, presented with a femoral fracture, prompting the need for careful consideration of anesthesia strategies. The challenges included counseling the family on the risks and benefits of surgery under general anesthesia, selecting an appropriate anesthetic plan for an anticipated difficult airway, and addressing ventilation strategies for restrictive lung disease. To tackle the anticipated difficult airway, an awake pediatric fiberoptic bronchoscopy was performed in the recovery room, facilitating a conscious sedation approach. In the operating room, monitored anesthesia care with dexmedetomidine infusion was employed, complemented by careful positioning and padding in the lateral position. The awake fiberoptic checkscopy proved crucial in avoiding unnecessary general anesthesia. A patient-centered approach contributed to the successful execution of a complex anesthesia plan, ensuring optimal care for this unique patient population.

Pleomorphic Adenoma in a Posterior Cervical Soft Tissue Mass: A Diagnostic Conundrum.

Diagnosing a soft tissue tumor in the head and neck region can be challenging due to its complex anatomy and diverse histological spectrum. This case report highlights the case of a woman who presented with a painless neck lump in the posterior triangle of the neck. Various pathological and imaging studies were suggestive of pleomorphic adenoma, which arises from the left prevertebral space. The patient underwent complete surgical excision via the transcervical approach. Pleomorphic adenoma in the posterior triangle of the neck is extremely rare and causes a diagnostic dilemma in managing soft tissue tumors of the neck.

Medicinal Plants in the Treatment of Respiratory Diseases and their Future Aspects.

The utilization of medicinal plants in the treatment of respiratory diseases has a rich history dating back centuries. This study delves into the diverse range of plant species known for their therapeutic properties, with a specific focus on their applications in respiratory health. Medicinal plants have played a crucial role as a source of ingredients for medications and the synthesis of drugs. Globally, over 35,000 plant species are employed for medicinal purposes, particularly in emerging countries where traditional medicine, predominantly plant-based pharmaceuticals, serves as a primary healthcare resource. This review highlights the significance of medicinal plants, such as aloe, ginger, turmeric, tulsi, and neem, in treating a wide array of common respiratory ailments. These plants contain bioactive compounds, including tannins, alkaloids, sugars, terpenoids, steroids, and flavonoids, which have diverse therapeutic applications. Some medicinal plants, notably Echinacea purpurea and Zingiber officinale, exhibit potential for adjuvant symptomatic therapy in respiratory conditions, such as chronic obstructive pulmonary disease (COPD), bronchitis, asthma, the common cold, cough, and whooping cough. The leaves of medicinal plants like Acacia torta, Ocimum sanctum, Mentha haplocalyx, Lactuca virosa, Convolvulus pluricaulis, and Acalypha indica are commonly used to address pneumonia, bronchitis, asthma, colds, and cough. This review aims to shed light on specific medicinal plants with therapeutic value, providing valuable insights for researchers in the field of herbal medicine. These plants hold the potential to serve as novel therapeutic agents in the treatment of respiratory diseases.

Blue Parotid Unveiled: A Rare Case of Traumatic Hemorrhagic Parotid Lymphangioma in an Eight-Year-Old Boy.

Parotid lymphangioma is a benign lymphatic malformation commonly observed in infancy or early childhood. It often grows insidiously and presents as a painless, soft fluctuant mass. We report a case of an eight-year-old boy who was diagnosed from another center with right parotid lymphangioma of one-year duration. He presented with right painful preauricular swelling and trismus for nine days after a recent history of blunt trauma to the preauricular caused an acute expansion of the swelling and subsequently, the patient developed ipsilateral facial nerve palsy. Examination showed right preauricular swelling measuring about 6 x 6 cm that extended posteriorly until the mastoid region, superiorly until the zygoma, and inferiorly until the angle of the mandible, pushing the ear lobule anteromedially. There was bluish discoloration of the overlying skin. The swelling was warm and tender on palpation. Multiple shotty lymph nodes were palpable at the posterior triangle. Aspiration of the swelling revealed blood content, but it reaccumulated after a few hours. A magnetic resonance imaging (MRI) of the neck showed a lesion confined within the parotid gland. There was a presence of air-fluid level with dependent layers of hyperintense on the T1-weighted image (T1WI) and T2-weighted image (T2WI) with clumps of isointensity on T1WI, which are hypointense on T2WI, which is suggestive of acute-late subacute blood product. A diagnosis of lymphatic malformation complicated with hemorrhage was made. Hence, the patient underwent surgery for the evacuation of blood clot and right superficial parotidectomy. Histopathological examination of the intraoperative tissue biopsy revealed evidence of venolymphatic malformation of the parotid gland. Postoperatively, he was discharged home after three days. The facial nerve function recovered from House and Brackmann grade II to grade I three weeks after the surgery.

Virtual screening, molecular docking, molecular dynamics, and MM-GBSA approaches identify prospective fructose-1,6-bisphosphatase inhibitors from pineapple for diabetes management.

Diabetes affects millions globally and poses treatment challenges. Targeting the enzyme fructose-1,6-bisphosphatase (FBPase) in gluconeogenesis and exploring plant-based therapies offer potential solutions for improving diabetes management while supporting sustainability and medicinal advancements. Utilizing pineapple (Ananas comosus L. Merr.) waste as a source of drug precursors could be valuable for health and environmental care due to its medicinal benefits and abundant yearly biomass production. Therefore, this study conducted a virtual screening to identify potential natural compounds from pineapple that could inhibit FBPase activity. A total of 112 compounds were screened for drug-likeness and ADMET properties, and molecular docking simulations were performed on 20 selected compounds using blind docking. The lead compound, butane-2,3-diyl diacetate, was subjected to 100 ns MD simulations, revealing a binding energy of -5.4 kcal/mol comparable to metformin (-5.6 kcal/mol). The MD simulation also confirmed stable complexes with crucial hydrogen bonds. Glu20, Ala24, Thr27, Gly28, Glu29, Leu30, Val160, Met177, Asp178, and Cys179 were identified as key amino acids that stabilized the human liver FBPase-butane-2,3-diyl diacetate complex, while Tyr215 and Asp218 played a crucial role in the human liver FBPase-Metformin complex. Our study indicates that the lead compound has high intestinal solubility. Therefore, it would show rapid bloodstream distribution and effective action on the target protein, making butane-2,3-diyl diacetate a potential antidiabetic drug candidate. However, further investigations in vitro, preclinical, and clinical trials are required to thoroughly assess its efficacy and safety.Communicated by Ramaswamy H. Sarma.

An Unusual Case of Post-Operative Functional Stridor After Emergence From General Anesthesia.

Post-anesthesia stridor due to laryngospasm, laryngeal edema, or any other organic cause is a life-threatening condition requiring immediate intervention. The very rare functional stridor or psychogenic stridor following emergence from general anesthesia may sometimes mimic stridor due to an organic cause, but it is neither fatal nor require immediate airway management. However, if the condition is not diagnosed timely, it may lead to unnecessary manipulation of the airway, such as endotracheal intubation or tracheostomy. We report herein a case of functional stridor in a 48-year-old woman who underwent abdominal-perineal resection for carcinoma rectum. The case was timely diagnosed by the attending anesthetist, and the patient recovered spontaneously, thus avoiding any unindicated airway handling and its associated complications.

Electrodialysis membrane desalination with diagonal membrane spacers: a review.

Electrodialysis desalination uses ion exchange membranes, membrane spacers, and conductors to remove salt from water. Membrane spacers, made of polymeric strands, reduce concentration polarization. These spacers have properties such as porosity and filament shape that affect their performance. One important property is the spacer-bulk attack angle. This study systematically reviews the characteristics of a 45° attack angle of spacers and its effects on concentration polarization and fluid dynamics. Membrane spacers in a channel create distinct flow fields and concentration profiles. When set at a 45° attack angle, spacers provide greater turbulence and mass-heat transfer than traditional spacers. This is because both the transverse and longitudinal filaments become diagonal in relation to the bulk flow direction. A lower attack angle (<45°) results in a lower pressure drop coupled with a decline in wakes and stream disruption because when the filaments are more parallel to the primary fluid direction, the poorer their affect. This research concludes that membrane spacers with a 45° spacer-bulk attack angle function optimally compared to other angles.

Primary Lymphoepithelial Carcinoma of the Submandibular Gland in A Young Patient: A Case Report.

Lymphoepithelial carcinoma (LEC) is a rare entity of malignancy. It has been associated with Epstein-Barr virus (EBV), and in regions where it is endemic, such as Southeast Asia, EBV is typically associated with nasopharyngeal carcinoma. The incidence of such malignancies in the young population is unusual. Here we report a 17-year-old with a 5-year history of a painless right submandibular mass presenting with a sudden increase in size for one month before surgery. Neck examination revealed a firm right submandibular gland measuring five by five cm, with an irregular surface, non-tender with normal overlying skin. We performed a fine needle aspiration cytology (FNAC), and he underwent computed tomography (CT) scan of the neck. He underwent a right submandibulectomy. Lymph nodes from levels I and II were also removed. The final histopathology was reported as LEC. Following this tissue diagnosis, another follow-up surgery, a modified radical neck dissection, was carried out for locoregional clearance. Postoperatively, he completed chemoradiotherapy treatment and is now on regular follow-up.

Influence of particle size in supercritical carbon dioxide extraction of roselle (Hibiscus sabdariffa) on bioactive compound recovery, extraction rate, diffusivity, and solubility.

The purpose of this work was to establish the best particle size for recovering high yields of total phenolic compounds (TPC), total anthocyanin compounds(TAC) and total flavonoid compounds (TFC) from roselle (Hibiscus sabdariffa) by applying supercritical carbon dioxide (ScCO2). The extraction rate, diffusivity and solubility of yield in ScCO2 were also studied and calculated utilizing models. Pressure (10 and 30 MPa), temperature (40 and 60 °C), and particle size (250 µm < dp < 355 µm, 355 µm < dp < 425 µm and 425 µm < dp < 500 µm) were employed as variables in this experiment. The greatest recovery was 11.96% yield, 7.16 mg/100 g TAC, 42.93 mg/100 g TPC and 239.36 mg/100 g TFC under the conditions of 30 MPA, 40 °C and 250 µm < dp < 355 µm, respectively. The extraction rate of supercritical carbon dioxide in roselle extraction ranged from 5.19 E-03 to 1.35 E-03 mg/s fitted using the Esquivel model. The diffusivity coefficient of ScCO2 ranged from 2.17E-12 to 3.72E-11 mg/s2, as fitted by a single sphere model. The greatest solubility of global yield, TAC, TPC and TFC in ScCO2 was 1.50 g/L, 0.3 mg/L, 1.69 mg/L and 9.97 mg/L, respectively, with a particle size of 250 µm < dp < 355 µm. The smaller particle size of roselle provides the maximum bioactive compound recovery and solubility. Furthermore, the diffusivity and extraction of ScCO2 are increased by decreasing the particle size. Therefore, a smaller particle size is appropriate for roselle extraction by ScCO2 based on the experimental and modelling data.

Ion exchange membrane electrodialysis for water and wastewater processing: application of ladder-type membrane spacers to impact solution concentration and flow dynamics.

Concentration polarization, which creates a thin boundary layer along the membranes in electrochemical reactors and electrodialysis-related processes, is one of the main issues. Membrane spacers provide swirling motion in the stream and distribute fluid toward the membrane, which effectively breaks the polarization layer and maximizes flux steadily. Membrane spacers and the spacer-bulk attack angle are reviewed systematically in the current study. The study then in-depth reviews a ladder-type configuration composed of longitudinal (0° attack angle) and transverse (90° attack angle) filaments, and its effects on solution flow direction and hydrodynamics. The review discovered that, at the tradeoff of high-pressure losses, a laddered spacer can provide mass transfer and mixing activity along the channel while preserving comparable patterns of concentration near the membrane wall. Pressure losses are driven by a change in the direction of velocity vectors. Dead spots in the spacer design that are created by the large contribution of the spacer manifolds can be reduced using the high-pressure drop. Laddered spacers also permit long, tortuous flow paths, which help to create turbulent flow and prevent concentration polarization. The absence of spacers produces limited mixing and broad polarization effects. A major portion of streamlines changes direction at ladder spacer strands positioned transverse to the main flow by moving in a zigzag manner up and down the filaments of the spacer. Flow at 90° is perpendicular to the transverse wires in [Formula: see text]-coordinate, no change in [Formula: see text]-coordinate.

Electrodialysis membrane desalination for water and wastewater processing: irregular attack angles of membrane spacers.

Electrodialysis desalination is constructed with a number of anion exchange membranes (AEM), cation exchange membranes (CEM), anode, cathode, adjacent silicon gasket integrated membrane spacers, and inlet/outlet holes per cell. At the boundary among an ionic solution and an ion exchange membrane, concentration polarization develops. Spacers placed in between channel's walls function as stream baffles to increase turbulence, improve heat and mass transfer, diminish the laminar boundary layer, and lessen fouling problems. The current study offers a systematic review of membrane spacers, spacer-bulk attack angles, and irregular attack angles. Spacer-bulk attack angle is accountable for variations in the pattern and direction of stream which impact heat-mass transfer and concentration polarization. Irregular attack angles (e.g., 0°, 15°, 30°, 37°, 45°, 55°, 60°, 62°, 70°, 74°, 80°, 90°, 110°, 120°) in the present study were found to provide unique stream patterns due to the spacer's filaments being less or more transverse in respect to the primary solution direction, which may significantly alter heat transfer, mass transport, pressure drop, and overall flow dynamics. Spacer applies shear stress resulting by continuous stream tangent to the membrane exterior, which lessens polarization. In the end, 45° is concluded as the preferred attack angle that offers balanced rates of heat transfer, mass transport, and pressure drop throughout the feed channel while greatly lowering the rate of concentration polarization.

Valorization of Peanut Skin as Agricultural Waste Using Various Extraction Methods: A Review.

Peanuts (Arachis hypogea) can be made into various products, from oil to butter to roasted snack peanuts and candies, all from the kernels. However, the skin is usually thrown away, used as cheap animal feed, or as one of the ingredients in plant fertilizer due to its little value on the market. For the past ten years, studies have been conducted to determine the full extent of the skin's bioactive substance repertoire and its powerful antioxidant potential. Alternatively, researchers reported that peanut skin could be used and be profitable in a less-intensive extraction technique. Therefore, this review explores the conventional and green extraction of peanut oil, peanut production, peanut physicochemical characteristics, antioxidant activity, and the prospects of valorization of peanut skin. The significance of the valorization of peanut skin is that it contains high antioxidant capacity, catechin, epicatechin resveratrol, and procyanidins, which are also advantageous. It could be exploited in sustainable extraction, notably in the pharmaceutical industries.

Recent Advances in Synthesis of Graphite from Agricultural Bio-Waste Material: A Review.

Graphitic carbon is a valuable material that can be utilized in many fields, such as electronics, energy storage and wastewater filtration. Due to the high demand for commercial graphite, an alternative raw material with lower costs that is environmentally friendly has been explored. Amongst these, an agricultural bio-waste material has become an option due to its highly bioactive properties, such as bioavailability, antioxidant, antimicrobial, in vitro and anti-inflammatory properties. In addition, biomass wastes usually have high organic carbon content, which has been discovered by many researchers as an alternative carbon material to produce graphite. However, there are several challenges associated with the graphite production process from biomass waste materials, such as impurities, the processing conditions and production costs. Agricultural bio-waste materials typically contain many volatiles and impurities, which can interfere with the synthesis process and reduce the quality of the graphitic carbon produced. Moreover, the processing conditions required for the synthesis of graphitic carbon from agricultural biomass waste materials are quite challenging to optimize. The temperature, pressure, catalyst used and other parameters must be carefully controlled to ensure that the desired product is obtained. Nevertheless, the use of agricultural biomass waste materials as a raw material for graphitic carbon synthesis can reduce the production costs. Improving the overall cost-effectiveness of this approach depends on many factors, including the availability and cost of the feedstock, the processing costs and the market demand for the final product. Therefore, in this review, the importance of biomass waste utilization is discussed. Various methods of synthesizing graphitic carbon are also reviewed. The discussion ranges from the conversion of biomass waste into carbon-rich feedstocks with different recent advances to the method of synthesis of graphitic carbon. The importance of utilizing agricultural biomass waste and the types of potential biomass waste carbon precursors and their pre-treatment methods are also reviewed. Finally, the gaps found in the previous research are proposed as a future research suggestion. Overall, the synthesis of graphite from agricultural bio-waste materials is a promising area of research, but more work is needed to address the challenges associated with this process and to demonstrate its viability at scale.

Clinical Improvement in Depression and Cognitive Deficit Following Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is a long-standing treatment choice for disorders such as depression when pharmacological treatments have failed. However, a major drawback of ECT is its cognitive side effects. While numerous studies have investigated the therapeutic effects of ECT and its mechanism, much less research has been conducted regarding the mechanism behind the cognitive side effects of ECT. As both clinical remission and cognitive deficits occur after ECT, it is possible that both may share a common mechanism. This review highlights studies related to ECT as well as those investigating the mechanism of its outcomes. The process underlying these effects may lie within BDNF and NMDA signaling. Edema in the astrocytes may also be responsible for the adverse cognitive effects and is mediated by metabotropic glutamate receptor 5 and the protein Homer1a.