MyMedR

Harm reduction in Asia: a successful response to hidden epidemics. The Asian Harm Reduction Network

Crofts N, Costigan G, Narayanan P, Gray J, Dorabjee J, Langkham B, et al.

AIDS, 1998;12 Suppl B:S109-15.

Base of tongue tuberculosis: a case report

Hussaini J, Mutusamy S, Omar R, Rajagopalan R, Narayanan P

Acta Med Iran, 2012;50(2):151-2.

We report a rare case of base of tongue tuberculosis following pulmonary tuberculosis. Patient presented to us with chief complaints of sore throat and pain on swallowing for period of 3 months. On examination with 70 degree telescope, we observed an ulcer on right side of base of tongue. The edges of the ulcer appeared to be undermined with whitish slough at the centre of the ulcer. Examination of neck showed a multiple small palpable middle deep cervical lymph nodes on right side of neck. Biopsy of the ulcer was taken, which showed granulomatous inflammation, suggestive of tuberculosis. Laboratory investigations revealed a raise in erythrocyte sedimentation rate, sputum for acid fast bacilli was strongly positive. Chest X ray was performed for patient showed multiple areas of consolidation. Patient was referred to chest clinic for further management of tuberculosis and was started on anti-tuberculous drugs. In conclusion tuberculosis of oral cavity is rare, but should be considered among one of the differential diagnosis of the oral lesions and biopsy is necessary to confirm the diagnosis.

Nasal allergies in the Asian-Pacific population: results from the Allergies in Asia-Pacific Survey

Katelaris CH, Lai CK, Rhee CS, Lee SH, Yun WD, Lim-Varona L, et al.

Am J Rhinol Allergy, 2011 Sep-Oct;25 Suppl 1:S3-15.

PMID: 22185687 DOI: 10.2500/ajra.2011.25.3674

The Allergies in Asia-Pacific Survey describes the symptoms, impact, and treatment of allergic rhinitis (AR) across Australia, China, Hong Kong, Malaysia, Singapore, Taiwan, Vietnam, and the Philippines. The Allergies in Asia-Pacific Survey was undertaken to further clarify the prevalence of physician-diagnosed nasal allergies (NAs), impact on quality-of-life (QOL), existing treatment paradigms and gaps, and NA medications currently used in treatment.

Fulltext Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis

Manuel AM, Kalimuthu S, Pathmanathan SS, Narayanan P, Zainal Abidin Z, Azmi K, et al.

Asian J Surg, 2017 Apr;40(2):158-162.

PMID: 24210537 DOI: 10.1016/j.asjsur.2013.09.011

Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.

Efficacy of relocation of submandibular duct in cerebral palsy patients with drooling

Puraviappan P, Dass DB, Narayanan P

Asian J Surg, 2007 Jul;30(3):209-15.

PMID: 17638641

The efficacy of relocating the submandibular duct to treat drooling in children with cerebral palsy was studied.

Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma

Hussein J, Tan TS, Chong AW, Narayanan P, Omar R

Auris Nasus Larynx, 2013 Jun;40(3):323-6.

PMID: 22652485 DOI: 10.1016/j.anl.2012.05.004

Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron® followed by the application of mitomycin-C and stenting has been shown to be an effective option.
Study site: ENT clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Neck stiffness in a post-irradiated nasopharyngeal carcinoma adult: An unusual diagnosis

Lorna Ting KN, Liew YT, Abu Bakar Z, Narayanan P

Auris Nasus Larynx, 2019 Jun;46(3):469-473.

PMID: 30049634 DOI: 10.1016/j.anl.2018.07.002

Nasopharyngeal carcinoma is a neoplasm commonly found in population of South East Asia. The mainstay of treatment is high dose irradiation. Complications from radiotherapy are not uncommon especially to those nearby structures such as vertebrae and spinal cord. A 57 year-old gentleman with nasopharyngeal carcinoma (NPC) who was treated with chemo-radiation (total of 35 fractions,70Gy) presented to us 6 months post therapy with bilateral nasal discharge and progressive neck stiffness. Nasoendoscopy showed inflamed nasophayngeal mucosa and Computed Tomography (CT) brain and cervical spine showed retropharyngeal and anterior epidural collection with extension into atlantoaxial bone and spinal cord compression. Histopathological specimen revealed features of chronic inflammations with multiple actinomycetes colonies. Our patient suffered severe neck stiffness and loss of sensations on both upper limbs. He was treated conservatively with Halo vest and intravenous antibiotics for 8 weeks and recovered fully. Irradiation in NPC is known to cause devastating complications to cervical spine such as osteoradionecrosis, osteomyelitis. It also renders tissues hypoxic and risk of getting rare infection like actinomycosis. This report can represent a great diagnostic and therapeutic challenge with differentials of tumor recurrence, osteoradionecrosis or osteomyelitis. Patients must be regularly followed up to look for possible cervical complications as a result from irradiation, to prevent devastating outcome or prognosis.

Failed magnetic resonance imaging examinations due to claustrophobia

Sarji SA, Abdullah BJ, Kumar G, Tan AH, Narayanan P

Australas Radiol, 1998 Nov;42(4):293-5.

PMID: 9833363

A recognized cause of incomplete or cancelled MRI examinations is anxiety and claustrophobic symptoms in patients undergoing MR scanning. This appears to be a problem in many MRI centres in Western Europe and North America, where it is said to be costly in terms of loss of valuable scan time, and has led to researchers suggesting several anxiety-reducing approaches for MRI. To determine the incidence of failed MRI examination among our patients and if there are any associations with a patient's sex, age and education level, we studied claustrophobia that led to premature termination of the MRI examination in the University Malaya Medical Centre (UMMC) in 3324 patients over 28 months. The incidence of failed MRI examinations due to claustrophobia in the UMMC was found to be only 0.54%. There are associations between claustrophobia in MRI with the patients' sex, age and level of education. The majority of those affected were male patients and young patients in the 25-45-years age group. The patients' education level appears to be the strongest association with failed MRI examinations due to claustrophobia, where the majority of the affected were highly educated individuals. Claustrophobia in MRI is more of a problem among the educated individuals or patients from a higher socio-economic group, which may explain the higher incidence in Western European and North American patients.

Fulltext Hyphae in external auditory canal

Saniasiaya J, Narayanan P

BMJ Case Rep, 2021 Jul 26;14(7).

PMID: 34312145 DOI: 10.1136/bcr-2021-245388

Fulltext Valsalva manoeuvre to detect isolated hyoid bone fracture

Mohd Hamdan MH, Saniasiaya J, Narayanan P

BMJ Case Rep, 2021 Jul 13;14(7).

PMID: 34257127 DOI: 10.1136/bcr-2021-243756

The hyoid bone fracture has traditionally been attributed to strangulation and hanging. Although rare, ensuing its vague presentation, hyoid bone fracture is oftentimes overlooked and missed, leading to delayed complications. Herein, we are reporting an overlooked hyoid bone fracture in a man who attempted suicide by strangulating himself, whereby Valsalva manoeuvre performed during bedside flexible nasopharyngolaryngoscopy revealed the fractured segment. As the patient was stable and asymptomatic, he was successfully managed conservatively. We would like to highlight the awareness of the Valsalva manoeuvre, which could elicit hyoid bone fracture as missing or overlooking the fracture may lead to devastating complications which may ensue, such as respiratory distress.

Fulltext Lower motor neuron facial palsy in a postnatal mother with COVID-19

Kumar V, Narayanan P, Shetty S, Mohammed AP

BMJ Case Rep, 2021 Mar 01;14(3).

PMID: 33649026 DOI: 10.1136/bcr-2020-240267

COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.

Fulltext Cochlear Implant and Its Related Science

Hwang CF, Chen Y, Lin HC, Narayanan P, Oh SH, Truy E

Biomed Res Int, 2015;2015:683967.

PMID: 26240825 DOI: 10.1155/2015/683967

Fulltext MicroRNAs in adult high-grade gliomas: Mechanisms of chemotherapeutic resistance and their clinical relevance

Jegathesan Y, Stephen PP, Sati ISEE, Narayanan P, Monif M, Kamarudin MNA

Biomed Pharmacother, 2024 Mar;172:116277.

PMID: 38377734 DOI: 10.1016/j.biopha.2024.116277

Notorious for its high mortality rate, the current standard treatment for high-grade gliomas remains a challenge. This is largely due to the complex heterogeneity of the tumour coupled with dysregulated molecular mechanisms leading to the development of drug resistance. In recent years, microRNAs (miRNAs) have been considered to provide important information about the pathogenesis and prognostication of gliomas. miRNAs have been shown to play a specific role in promoting oncogenesis and regulating resistance to anti-glioma therapeutic agents through diverse cellular mechanisms. These include regulation of apoptosis, alterations in drug efflux pathways, enhanced activation of oncogenic signalling pathways, Epithelial-Mesenchymal Transition-like process (EMT-like) and a few others. With this knowledge, upregulation or inhibition of selected miRNAs can be used to directly affect drug resistance in glioma cells. Moreover, the clinical use of miRNAs in glioma management is becoming increasingly valuable. This comprehensive review delves into the role of miRNAs in drug resistance in high-grade gliomas and underscores their clinical significance. Our analysis has identified a distinct cluster of oncogenic miRNAs (miR-9, miR-21, miR-26a, miR-125b, and miR-221/222) and tumour suppressive miRNAs (miR-29, miR-23, miR-34a-5p, miR 181b-5p, miR-16-5p, and miR-20a) that consistently emerge as key players in regulating drug resistance across various studies. These miRNAs have demonstrated significant clinical relevance in the context of resistance to anti-glioma therapies. Additionally, the clinical significance of miRNA analysis is emphasised, including their potential to serve as clinical biomarkers for diagnosing, staging, evaluating prognosis, and assessing treatment response in gliomas.

Fulltext Dancing pharynx

Liew YT, Junior ACG, Bakri A, Narayanan P

Ci Ji Yi Xue Za Zhi, 2020 04 01;32(3):303-304.

PMID: 32955511 DOI: 10.4103/tcmj.tcmj_245_19

Outcome of canalith repositioning manoeuvre in benign paroxysmal positional vertigo in children and adolescents: A systematic review

Saniasiaya J, Kulasegarah J, Narayanan P

Clin Otolaryngol, 2023 May;48(3):371-380.

PMID: 36640123 DOI: 10.1111/coa.14038

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a debilitating condition that has been significantly described in adults. Recent data points out that BPPV occurs in children as well. Canalith repositioning manoeuvre (CRM) has shown promising results amongst adult patients with BPPV.

OBJECTIVE: We reviewed the literature to determine the outcome of CRM in children and adolescents with BPPV.

METHODS: A literature search was conducted over 1 month (March 2022). The primary outcome was defined as the resolution of positional nystagmus and symptoms, and secondary outcomes were determined by the presence of recurrence and the number of attempts of CRM.

RESULTS: Ten articles were selected based on our objective and selection criteria. A total of 242 patients were included, with a mean of 10.9 years. BPPV was diagnosed based on history and positional nystagmus in all patients (100%). CRM was performed in 97.9% of patients, whereby 80.5% recovered following a single attempt of CRM. Recurrence of symptoms was identified in 10% of patients with no reported major complications.

CONCLUSION: CRM has demonstrated promising results in children and adolescents. The quality of evidence is limited until a better-quality study involving randomised controlled studies with a larger sample size is completed.

Endoscopic transnasal removal of an intraconal foreign body using an image-guided surgical system

Teh D, Mohamad NF, Lim E, Zulkiflee AB, Narayanan P, Kamalden TA

Comput Assist Surg (Abingdon), 2016 Dec;21(1):25-28.

PMID: 27973957

Foreign bodies lodged in the intraconal space of the orbit pose a surgical challenge due to its deep location behind the globe. Image-guided endoscopic transnasal surgery facilitates the localization of the metallic foreign bodies and enables its safe removal with minimal surrounding tissue damage and optic nerve injury.

Fulltext Middle Ear Neuroendocrine Tumor Mimicking As Chronic Otitis Media

Sukumaran Y, Pol Ong Y, Siow Ping L, Ong CA, Narayanan P

Cureus, 2023 Jul;15(7):e42296.

PMID: 37609079 DOI: 10.7759/cureus.42296

Neuroendocrine neoplasms (NEN) of the head and neck are a rare and diverse group of tumors. Here, we report a case of a 40-year-old man presenting with symptoms resembling chronic left otitis media, including left ear otorrhea, otalgia, and reduced hearing. Otoscopic examination revealed a whitish mass located behind the tympanic membrane. The patient underwent examination under anesthesia and left cortical mastoidectomy, and a histopathological examination of the middle ear biopsy indicated the presence of an epithelial tumor with neuroendocrine differentiation, suggestive of middle ear adenoma. A staging CT scan performed three months after the mastoidectomy showed a hypodensity in the middle ear cavity, with no significant bony erosion, which could potentially indicate a residual or recurrent tumor. Consequently, a radical mastoidectomy was performed. The histopathological examination confirmed the presence of middle ear adenoma with neuroendocrine differentiation.

Fulltext New-Onset Dysphonia: A Silent Manifestation of COVID-19

Saniasiaya J, Kulasegarah J, Narayanan P

Ear Nose Throat J, 2023 Apr;102(4):NP201-NP202.

PMID: 33645290 DOI: 10.1177/0145561321995008

Ripple effect of the auditory canal

Saniasiaya J, Narayanan P

Eur Ann Otorhinolaryngol Head Neck Dis, 2021 Aug 18.

PMID: 34419419 DOI: 10.1016/j.anorl.2021.05.022

Rock in nose

Saniasiaya J, Narayanan P

Eur Ann Otorhinolaryngol Head Neck Dis, 2022 Jan;139(1):43-44.

PMID: 34426163 DOI: 10.1016/j.anorl.2021.06.014

Displaying publications 1 - 20 of 52 in total