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Cognitive Function Among Obstructive Sleep Apnea Patients in North East Malaysia

Yusop CYC, Mohamad I, Mohammad WMZW, Abdullah B

J Natl Med Assoc, 2017 04 03;109(3):215-220.
PMID: 28987252 DOI: 10.1016/j.jnma.2017.03.004

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

Yusoff MSB, Hadie SNH, Mohamad I, Draman N, Muhd Al-Aarifin I, Wan Abdul Rahman WF, et al.

Malays J Med Sci, 2020 May;27(3):137-142.
PMID: 32684814 MyJurnal DOI: 10.21315/mjms2020.27.3.14

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.
Fulltext A thyroid mass that moves with tongue protrusion: An ectopic thyroid gland

Yaroko AA, Mohamad I, Abdul Karim AH, Wan Abdul Rahman WF

Malays Fam Physician, 2014;9(2):61-3.
PMID: 25883768 MyJurnal

Thyroglossal duct cyst (TDC) is a developmental anomaly that usually appears in early childhood. The common presentation is midline swelling of the neck, which moves with both tongue protrusion and deglutition. Diagnosis is usually clinical and radiological. Fine needle aspiration cytology (FNAC) can be used as a tool for the exclusion of malignancy in adult patients. In some cases thyroid scan is done to rule out the presence or absence of the normal thyroid gland. A complete work-up is mandatory before cyst removal given that it contains only thyroid tissue. We report the case of a 32-year-old woman with only thyroid tissue in thyroglossal duct cyst.
Fulltext Rhinolith: An important cause of foul-smelling nasal discharge

Yaroko A, Mohamad I, Hashim H

Malays Fam Physician, 2014;9(1):30-2.
PMID: 25606296 MyJurnal

Rhinoliths result from neglected nasal foreign bodies that gradually increase in size. They are usually discovered incidentally during routine ENT examination or due to the associated symptoms such as nasal obstruction or persistent foul-smelling unilateral nasal discharge. A case of a 14-year-old girl was reported with a year history of the symptom. The foul-smelling nasal discharge noted by her mother was not the main concern to them. She was referred by her primary care physician as she complained of impacted ear wax. However, rhinolith was incidentally found upon routine clinical examination in the ENT clinic and was removed uneventfully.
Fulltext Poorly differentiated thyroid carcinoma: A hospital-based clinicopathological study and review of literature

Win TT, Othman NH, Mohamad I

Indian J Pathol Microbiol, 2017 Apr-Jun;60(2):167-171.
PMID: 28631629 DOI: 10.4103/IJPM.IJPM_457_16

INTRODUCTION: Poorly differentiated thyroid carcinoma (PDTC) is a rare aggressive malignancy of thyroid follicular cells and has unique features in morphology and behavior. This study was aimed to describe the experience of a tertiary medical center with PDTC within a 10-year period.

MATERIALS AND METHODS: This is a descriptive retrospective study of eight cases of PDTC among 418 various thyroid carcinomas. All cases of PDTC were retrieved along with the clinicopathological information.

RESULTS: Only eight cases (1.9%) of PDTC were diagnosed among 418 thyroid carcinomas. Mean age was 48.12 with 3:5 (male:female) and tumor size ranged 3-12 cm. PDTC were diagnosed coexisting with one or more other pathologies; nodular hyperplasia (four cases), papillary carcinoma (one case), follicular carcinoma (three cases), and Hashimoto thyroiditis (two cases); with ≥60% PDTC component. Six cases associated with high-grade features died within 3 years after diagnosis.

DISCUSSION: Mean age in this study was younger including a 20-year-old girl. Younger age was associated with better prognosis. Most of the cases had underlying benign thyroid lesions and differentiated thyroid carcinoma. Most of the PDTC had poor prognosis associated with PDTC component ≥60%, tumor necrosis, high mitotic count, lymph node involvement, vascular invasion and distant metastasis; and these cases died within 3 years after diagnosis.

CONCLUSION: Although treatment of PDTC remains surgery followed by radioiodine therapy, correct histopathological diagnosis is important for clinicians and oncologists to predict the prognosis. All thyroid carcinoma should be sampled thoroughly not to miss small foci of PDTC component.
Fulltext The Insights of Head and Neck Non-Hodgkin Lymphoma

Wan Abdul Rahman WF, Mohamad I

Medeni Med J, 2020;35(2):179-180.
PMID: 32733770 DOI: 10.5222/MMJ.2020.23682
Fulltext A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy

Vong, K.S., Mohamad, I., Salim, R.

Malaysian Family Physician, 2018;13(1):34-36.
MyJurnal

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter.
Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia.
Usually, the patient will point at the level of FB on the neck to indicate the location.
Methods: Clinical report.
Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy.
Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.
Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may
cause total dysphagia as the passage of food is completely blocked.
Fulltext A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy

Vong KS, Mohamad I, Salim R

Malays Fam Physician, 2018;13(1):34-36.
PMID: 29796208

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter. Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia. Usually, the patient will point at the level of FB on the neck to indicate the location.

Methods: Clinical report.

Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy. Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.

Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may cause total dysphagia as the passage of food is completely blocked.
Bilateral Vocal Cord Immobility After Chemoradiotherapy For Nasopharyngeal Carcinoma

Vengathajalam S, Maruthamuthu T, Nik Hassan NFH, Mohamad I

Gulf J Oncolog, 2020 May;1(33):80-83.
PMID: 32476655

Post chemoradiation vocal cord immobility is a rare complication and this maybe life threatening when patients present with severe aspiration and recurrent pneumonia or even worse if they have an upper airway obstruction. We report a case of nasopharyngeal carcinoma patient whom after receiving curative concurrent chemoradiotherapy, presented with episodes of shortness of breath and aspiration pneumonia finally diagnosed with bilateral vocal cord immobility. She had no evidence of tumour recurrence.
Effect of constraint-induced music therapy in idiopathic sudden sensorineural hearing loss: A systematic review and meta-analysis

Vasiwala RA, Elhariri SY, Teng CL, Mohamad I

Noise Health, 2022;24(113):75-81.
PMID: 35900392 DOI: 10.4103/nah.nah_33_21

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.
Nasal NK/T-cell Lymphoma Presenting as Acute Inflammation of Nasal Vestibule

Vasiwala R, Mohamad I, Venkateswaran SP, Hamzah SZ

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1986-1989.
PMID: 31763280 DOI: 10.1007/s12070-018-1402-8

Extra nodal nasal NK/T cell lymphoma is relatively a rare type of non-Hodgkin lymphoma. Variable clinical presentation with rapidly progressive necrosis of the cartilaginous and bony wall of the nose and upper respiratory passages leads to delayed diagnosis and treatment. A 43-years-old patient presented with right nasal pain and furuncle-like swelling. The swelling progressed rapidly to cellulitis to the face up to the right eye. Within 2 months, it had advanced to necrosis of the lateral vestibular cartilage, medial maxillary wall, turbinate and nasal septal cartilage. Biopsy reported as non-Hodgkin diffuse T cell (angiocentric T cell) lymphoma.
Fulltext Challenges and Adaptation in Otorhinolaryngology Practice During Pandemic Lockdown: Experience from a Malaysian COVID-19 Hospital

Sultan Abdul Kader MI, Razak SS, Ramanna VR, Esa NK, Ahmad AR, Mohamad I

Malays J Med Sci, 2021 Jun;28(3):143-150.
PMID: 34285652 DOI: 10.21315/mjms2021.28.3.13

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

Subramaniam S, Johan S, Hayati F, Ng CY, Azizan N, Chuah JA, et al.

BMC Surg, 2020 Jun 11;20(1):130.
PMID: 32527309 DOI: 10.1186/s12893-020-00787-8

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.
Fulltext Acute Retropharyngeal Calcific Tendonitis as a Rare Cause of Odynophagia and Neck Pain

Singh PKM, Noor MIM, Jaafar R, Ahmad A, Mohamad I

Medeni Med J, 2021;36(1):75-79.
PMID: 33828894 DOI: 10.5222/MMJ.2021.37539

Retropharyngeal calcific tendonitis (RCT) is an aseptic inflammatory process of the superior oblique tendons of the longus colli muscle caused by the deposition of calcium hydroxyapatite crystals. We reported a 23-year-old woman who presented with a sudden onset of neck pain with odynophagia after waking up from sleep. Physical examination showed paracervical point tenderness with limited neck movement in all directions. Prior to surgery, further imaging was requested to aid in diagnosis, which in turn revealed RCT. It is important to be aware that RCT presentation may mimic other severe conditions such as retropharyngeal space abscess or meningitis.
Orbital Morphometry: A Computed Tomography Analysis

Singh J, Rahman RA, Rajion ZA, Abdullah J, Mohamad I

J Craniofac Surg, 2017 Jan;28(1):e64-e70.
PMID: 27922969 DOI: 10.1097/SCS.0000000000003218

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.
Acute labyrinthitis secondary to aural tick infestation

Shibghatullah AH, Abdullah MK, Pein CJ, Mohamad I

Southeast Asian J. Trop. Med. Public Health, 2012 Jul;43(4):857-9.
PMID: 23077807

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.
Fulltext A measles IgM rapid diagnostic test to address challenges with national measles surveillance and response in Malaysia

Senin A, Noordin NM, Sani JAM, Mahat D, Donadel M, Scobie HM, et al.

PLoS One, 2024;19(3):e0298730.
PMID: 38483868 DOI: 10.1371/journal.pone.0298730

INTRODUCTION: A lateral flow rapid diagnostic test (RDT) enables detection of measles specific immunoglobulin M (IgM) antibody in serum, capillary blood, and oral fluid with accuracy consistent with enzyme immunoassay (EIA). The objectives of the study were: 1) to assess measles RDT inter-reader agreement between two clinic staff; 2) to assess the sensitivity and specificity of the measles RDT relative to standard surveillance testing in a low transmission setting; 3) to evaluate the knowledge, attitudes, and practices of staff in clinics using the RDT; and 4) to assess the impact of RDT testing on the measles public health response in Malaysia.
MATERIALS AND METHODS: The clinic-based prospective evaluation included all suspected measles cases captured by routine measles surveillance at 34 purposely selected clinics in 15 health districts in Malaysia between September 2019 and June 2020, following day-long regional trainings on RDT use. Following informed consent, four specimens were collected from each suspected case, including those routinely collected for standard surveillance [serum for EIA and throat swabs for quantitative reverse transcriptase polymerase chain reaction (RT-qPCR)] together with capillary blood and oral fluid tested with RDTs during the study. RDT impact was evaluated by comparing the rapidity of measles public health response between the pre-RDT implementation (December 2018 to August 2019) and RDT implementation periods (September 2019 to June 2020). To assess knowledge, attitudes, and practices of RDT use, staff involved in the public health management of measles at the selected sites were surveyed.
RESULTS: Among the 436 suspect cases, agreement of direct visual readings of measles RDT devices between two health clinic staff was 99% for capillary blood (k = 0.94) and 97% for oral fluid (k = 0.90) specimens. Of the total, 45 (10%) were positive by measles IgM EIA (n = 44, including five also positive by RT-qPCR) or RT-qPCR only (n = 1), and 38 were positive by RDT (using either capillary blood or oral fluid). Using measles IgM EIA or RT-qPCR as reference, RDT sensitivity using capillary blood was 43% (95% CI: 30%-58%) and specificity was 98% (95% CI: 96%-99%); using oral fluid, sensitivity (26%, 95% CI: 15%-40%) and specificity (97%, 95% CI: 94%-98%) were lower. Nine months after training, RDT knowledge was high among staff involved with the public health management of measles (average quiz score of 80%) and was highest among those who received formal training (88%), followed by those trained during supervisory visits (83%). During the RDT implementation period, the number of days from case confirmation until initiation of public response decreased by about 5 days.
CONCLUSION: The measles IgM RDT shows >95% inter-reader agreement, high retention of RDT knowledge, and a more rapid public health response. However, despite ≥95% RDT specificity using capillary blood or oral fluid, RDT sensitivity was <45%. Higher-powered studies using highly specific IgM assays and systematic RT-qPCR for case confirmation are needed to establish the role of RDT in measles elimination settings.
Fulltext Purulent Discharge on the Pharyngeal Wall

Sefein M, Mohamad I, Hayati F, Ng CY

Oman Med J, 2021 Jan;36(1):e228.
PMID: 33628463 DOI: 10.5001/omj.2021.24
Laryngeal giant cell tumour presenting as a tongue base lesion causing severe dysphagia

Saud MRM, Salahuddin Z, Hassan A, Yunus MRM, Mohamad I, Zulkifli MM

J Taibah Univ Med Sci, 2018 Apr;13(2):201-204.
PMID: 31435324 DOI: 10.1016/j.jtumed.2017.10.002

Giant cell tumours are benign lesions that are uncommonly found in the larynx. Patients with these tumours may present with dysphagia, hoarseness and anterior neck swelling. Giant cell tumours are extremely rare and only a few cases have been reported. We present a case of an elderly woman who presented with severe dysphagia and a mass at the base of her tongue. The mass was found to be a laryngeal giant cell tumour and was successfully treated with chemotherapy.
Fulltext A Rare Differential Diagnosis of a Solitary Anterior Neck Mass

Saniasiaya J, Mohamad I

Oman Med J, 2016 Sep;31(5):384-6.
PMID: 27602195 DOI: 10.5001/omj.2016.76

Patients with anterior neck masses commonly present to otorhinolaryngology clinics, but there are limited differential diagnoses for such lesions. Common ones include thyroid nodule and thyroglossal duct cyst. In an elderly patient, a differentiated thyroid carcinoma should be suspected especially if it moves with swallowing. We encountered a typical presentation of a solitary thyroid nodule-like mass with the exception of pulsation in a 65-year-old female. Further investigation, using neck ultrasonography, revealed that it was a variant of right common carotid artery arising from the left common carotid artery. Knowledge of such variants is of great importance as ignorance of such a variation may lead to inadvertent surgical complications during procedures.

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