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Carcinosarcoma of the Mediastinum: A Rare Cause of Vocal Cord Palsy and Progressive Dysphagia

Kanesan N, Mohamad I, Mohamad Umbaik NA, Zawawi N

Medeni Med J, 2020;35(2):166-169.
PMID: 32733767 DOI: 10.5222/MMJ.2020.82956

Carcinosarcoma is a rare type of malignant tumour that possess both the elements of carcinoma and sarcoma. They may occur in various locations such as the uterus, breast, thyroid, lung and gastrointestinal system. However, very few primary mediastinal carcinosarcomas have been reported. We are presenting a case of a 75-year-old male who presented with progressive dysphagia and hoarseness for 3 weeks. Contrast-enhanced computed tomography of the neck showed features of enlarged mediastinal necrotic nodes and the biopsy of this mass showed morphology and immunohistochemical profile that are consistent with carcinosarcoma. However, the patient succumbed to his illness soon after diagnosis.
Fulltext Extracardiac Rhabdomyoma Mimicking Plunging Ranula

Hakim I, Yunus MRM

Medeni Med J, 2020;35(3):271-275.
PMID: 33110681 DOI: 10.5222/MMJ.2020.88120

Histopathologically adult extracardiac rhabdomyoma is a benign tumour of mature striated muscle. It is a slow- growing tumour with predilection to occur in head and neck region. They appear mainly as a solitary lesion, and about 15% of them can be multicentric. A 56-year-old man presented to us with the floor of mouth swelling persisted for one year and the right neck swelling for three years mimicking a plunging ranula. Radiological imaging revealed enhancing mass at the floor of mouth and submandibular region. The mass represented a nonvascular benign tumour. Subsequently, the patient underwent excision of the mass via transcervical and transoral method. Histopathological examination revealed adult type of extracardiac rhabdomyoma. Adult type of extracardiac rhabdomyoma should be considered in the differential diagnosis for the head and neck masses. A complete excision will reduce the risk of recurrence.
Nasal Plasmablastic Lymphoma in an HIV-Negative Immunocompetent Patient

Shakri NM, Husain S, Zahedi FD, Tan GC

Medeni Med J, 2020;35(1):71-74.
PMID: 32733753 DOI: 10.5222/MMJ.2020.45389

Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B-cell lymphoma predominantly in oral cavities of human immunodeficiency virus (HIV)-positive male patients or immunosuppressive hosts. Limited number of reports on HIV-negative PBL in immunocompetent patients are available in the literature. We reported an unusual case of sinonasal PBL which occurred in an HIV-negative and immunocompetent female patient. She underwent endoscopic removal of the tumor and completed 6 cycles of chemotherapy (hyperfractionated-CVAD). Any finding in favour of tumour recurrence was not observed in positron-emission tomography scan (PET-scan) performed 18 months after the treatment.
The Prevalence of Hearing Loss Among Babies in the Neonatal Intensive Care Unit in a Tertiary Hospital in Malaysia

Abdullah A, Dahari KASA, Tamil AM, Rohana J, Razif MYM, Shareena I

Medeni Med J, 2020;35(2):116-120.
PMID: 32733760 DOI: 10.5222/MMJ.2020.68466

Objective: To study the prevalence of hearing loss (HL) and to identify the possible risk factors causing HL.
Methods: This retrospective study was conducted from January 2014-December 2016 at a tertiary hospital in Malaysia. All neonates admitted to the neonatal intensive care unit (NICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were screened with a two-step protocol using an automated auditory brain response (AABR) and/or Otoacoustic Emission and auditory brain response (ABR). Descriptive analysis was used for the prevalence of HL, degree of HL and number of risk factors per infant.
Results: A total of 2713 babies underwent hearing screening in NICU was enrolled in this study. Two thousand six hundred eight (96%) babies passed the screening test and 214 (4%) babies required further diagnostic test. Only 105 (49%) babies completed diagnostic tests. Out of 105 babies, 40 (38.1%) babies had HL. Mild HL was the commonest HL with 22 (55%), moderate HL was in seven babies (17.5%), severe HL in two babies (5%), and profound HL in nine babies (22.5%). The presence of craniofacial anomalies was the only significant independent risk factor for HL with p<0.05 with an odds ratio of 0.105 CI 95% [0.028-0.389]. Of Babies with the presence of three or more risk factors, 100% of them had HL.There was an increased risk of hearing loss in those with craniofacial anomalies up to 11 times higher compared to those without such anomalies.
Conclusion: The prevalence of HL among the NICU babies was 1.5% and mild HL was the commonest degree of HL (55%).
Fulltext Malay Version of Nijmegen Cochlear Implant Questionnaire and Quality of Life of Patients with Post-lingual Deafness

Paul M, Abdullah A, Hashim ND, Ismail NFM, Shah SA

Medeni Med J, 2023 Jun 20;38(2):128-139.
PMID: 37338914 DOI: 10.4274/MMJ.galenos.2023.60980

OBJECTIVE: The Nijmegen Cochlear Implant questionnaire (NCIQ) was used to gauge the quality of life (QOL) improvement among cochlear implant (CI) users who suffered from post-lingual deafness. This study aimed to determine the consistency and reliability of the Malay version of the Nijmegen Cochlear Implant questionnaire (NCIQ-M) and to report the QOL of patients using NCIQ-M.
METHODS: This study has two phases: Phase I involves the translation of the NCIQ from English to Malay, followed by internal consistency and test-retest reliability assessment of the final version of NCIQ-M. Phase II involves QOL assessment of post-lingual deafness using NCIQ-M.
RESULTS: Twenty CI users and 20 non-CI users answered the NCIQ-M. Test-retest reliability analysis of the NCIQ-M was performed using an intraclass correlation coefficient, achieving scores of more than 0.85. Internal consistency was analysed with Cronbach α of more than 0.70 in all subdomains. Scores between the two groups of subjects were analyzed using an independent sample t-test. Good internal consistency, intraclass correlation, and test-retest reliability were obtained. Scores in all six subdomains of the NCIQ-M are significantly higher in the CI user group than in the non-CI user group.
CONCLUSIONS: The NCIQ-M is a consistent and reliable subjective questionnaire to determine the QOL of CI users concerning physical, psychological, and social functioning.
Fulltext Ceruminous Adenoma: A Rare Mass that Impair Hearing

Mohd Ramli SS, Abdullah A, Md Pauzi SH, Ramli M

Medeni Med J, 2021;36(3):270-275.
PMID: 34915686 DOI: 10.5222/MMJ.2021.36974

Ceruminous adenoma is described as a glandular neoplasm of ceruminous glands. It is seen for less than one percent of all external ear tumours. Ceruminous adenoma cases were reported to have recurrence and residual tumour, however there was no malignant transformation known in ceruminous adenoma up to this date. Here, we report a young adult woman with two years history of progressive reduced hearing and tinnitus of the right ear. She was proven to have right moderate conductive hearing loss with pure tone audiometry. There was a cystic mass with serous content arising from the posterior wall of the right ear canal. We proceeded with wide local excision of the mass via trans-canal approach. Ceruminous adenoma was confirmed with histopathology and immunohistochemistry of CK7 staining. The hearing impairment was resolved completely post excision and there was no recurrence of the tumour on one year follow-up. We concluded wide local excision with appropriate margin of the mass is adequate to prevent recurrence in ceruminous adenoma cases.
Primary Eustachian Tube Tuberculosis

Hamzah MH, Mohamad I, Mutalib NSA

Medeni Med J, 2021;36(2):172-175.
PMID: 34234985 DOI: 10.5222/MMJ.2021.52460

Nasopharyngeal tuberculosis is a rare occurrence, and primarily involves the proximal part of the Eustachian tube. Mechanical obstruction of the Eustachian tube will affect the pressure discrepancy between the middle ear and the external atmosphere, leading to aural fullness, unilateral hearing disturbance, and otitis media. These conditions can be overlooked or mistakenly diagnosed as ear pathology. We report a case of unilateral hearing loss and tinnitus in a 31-year-old healthy woman that was later confirmed to be tuberculosis of the Eustachian tube. In cases with indicators suggesting a high index of suspicion, a thorough examination of the head and neck regions is especially very important. Once it has been diagnosed, Eustachian tuberculosis can be successfully treated with anti-tuberculosis medications.
Fulltext Knowledge, attitude and practice on diabetic wound care management among healthcare professionals and impact from a short course training in Sabah, Borneo

Bondi ME, Rahim SSSA, Avoi R, Hayati F, Ahmedy F, Omar A, et al.

Medeni Med J, 2020;35(3):188-194.
PMID: 33110670 DOI: 10.5222/MMJ.2020.02929

Objective: Healthcare professionals with an advanced level of knowledge and skills on diabetic wound care management are needed to effectively manage complex wounds. This study aimed to determine the effects of an educational intervention to enhance the management of wound care among healthcare professionals.

Method: This study was part of a quasi-experimental pre-post research design where 82 healthcare professionals were recruited and assigned to intervention and control groups. The participants in the intervention group attended two days of educational intervention training on diabetic wound care management, while there was no intervention in the control group. A questionnaire on knowledge, attitude, and practice was applied before and one-month post-intervention to both groups.

Results: Pre-test resulted in a low level of knowledge 72.1% and 74.4%, negative level of attitude 67.4% and 66.7%, and a moderate level of practice 79.1% and 76.9% in both intervention and control groups respectively. Post-test resulted in increasing levels of knowledge (76.7%), positive attitude (100%), and practice (76.7%) in the intervention group. At the same time, there was no significant change in the control group. Repeated Measure ANOVA for within-subject and between-subject effects resulted in a statistically significant p-value of 0.001 for knowledge, attitude, and practice after the educational intervention.

Conclusion: Health professionals have only a moderate level of knowledge on diabetic wound care management. It is important to improve this level by specific trainings and by using a good training module.
Fulltext Molecular Detection of Alpha Thalassemia: A Review of Prevalent Techniques

Vijian D, Wan Ab Rahman WS, Ponnuraj KT, Zulkafli Z, Mohd Noor NH

Medeni Med J, 2021;36(3):257-269.
PMID: 34915685 DOI: 10.5222/MMJ.2021.14603

Alpha thalassemia (α-thalassemia) is an autosomal recessive disorder due to the reduction or absence of α globin chain production. Laboratory diagnosis of α-thalassemia requires molecular analysis for the confirmatory diagnosis. A screening test, comprising complete blood count, blood smear and hemoglobin quantification by high performance liquid chromatography and capillary electrophoresis, may not possibly detect all the thalassemia diseases. This review focused on the molecular techniques used to detect α-thalassemia, and the advantages and disadvantages of each technique were highlighted. Multiplex gap-polymerase chain reaction, single-tube multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification, and loop-mediated isothermal amplification were used to detect common deletion of α-thalassemia. Furthermore, the reverse dot blot analysis and a single tube multiplex polymerase chain reaction could detect non-deletion mutation of the α-globin gene. Sanger sequencing is widely used to detect non-deletion mutations of α-thalassemia. Recently, next-generation sequencing was introduced in the diagnosis of both deletion and point mutations of α-thalassemia. Despite the advantages and disadvantages of different techniques, the routine method employed in the laboratory should be based on the facility, expertise, available equipment, and economic conditions.
Fulltext Knowledge, Attitude, and Stigma on Tuberculosis and the Associated Factors for Attitude Among Tuberculosis Contacts in Malaysia

Loh SY, Zakaria R, Mohamad N

Medeni Med J, 2023 Mar 28;38(1):45-53.
PMID: 36974481 DOI: 10.4274/MMJ.galenos.2023.14478

OBJECTIVE: Tuberculosis (TB) is an old disease and it has infected millions of people worldwide. Since it is a highly infectious disease, many people became TB contact due to prolonged exposure to a person with TB infection. This group of people is at a higher risk of getting latent and active TB infection, hence a vulnerable group for active TB screening. This study explored the factors that determined the attitude score, the level of knowledge, attitude, and stigma (KAS) regarding TB disease among TB contact.
METHODS: This cross-sectional study used a validated KAS questionnaire, performed among 338 TB contacts from 5 health clinics in Kedah, Malaysia. The respondents were selected via convenience sampling. Simple and multiple linear regressions were used to analyze the data.
RESULTS: The mean KAS scores of participants are 73.5% [standard deviation (SD)=17.06], 83.0% (SD=10.33), and 67.0% (SD=16.72), respectively. Higher income (p=0.001), better knowledge score (p<0.001), and higher stigma score (p=0.003) are the significant associated factors for the attitude score.
CONCLUSIONS: This study revealed that most of the TB contacts have good knowledge and constructive attitude toward TB prevention and screening, but their level of stigma on TB is high. The implementation of TB education and intervention programs among TB contacts are required especially among low-income groups.
Fulltext A Rare Intraorbital Mass: An Isolated Mucocele

Che Mat CMH, Mustapha F, Noor RM, Ramli R, Mohamad I

Medeni Med J, 2020;35(4):344-348.
PMID: 33717628 DOI: 10.5222/MMJ.2020.01057

Mucocele is a mucous filled benign cystic lesion. It develops due to obstruction of any natural os-tium of the paranasal sinus. Even though being benign, it has capability to erode and cause thinning the adjacent bony structures. Isolated intraorbital mucocele without paranasal sinus disease is a rare condition. We present a 39-year-old female patient with right medial canthal swelling without any nasal symptoms, and normal nasoendoscopic finding. Imaging revealed the lesion as a right ethmoidal mucocele with normal paranasal sinuses. However intraoperatively, it was an isolated intraorbital lesion, lateral to lamina papyracea with thick-yellowish mucin discharge.
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.
Aspiration Avoiding Tracheostomy in Neonatal Cystic Oral Lesion

Nasir MSNM, Ishak MN, Abd Wahid FH, Asif JA, Mohamad I

Medeni Med J, 2019;34(4):400-403.
PMID: 32821468 DOI: 10.5222/MMJ.2019.44977

Oral cyst is uncommon in the neonatal period. Depending on the size and site of occurrence, its symptoms may vary. If not diagnosed and managed expeditiously, these oral cysts may cause significant and potentially fatal morbidity and mortality. We report a successfully managed case of oral cyst in neonate that presented with huge tongue at birth and complaints of impending airway obstruction. She was referred for tracheostomy as intubation was impossible. We attempted needle aspiration and the airway successfully relieved without the need for tracheostomy.
Ex Utero Intrapartum Treatment (Exit) of Gigantic Intrapartum Lymphangioma and Its Management Dilemma - A Case Report

Lo RH, Mohd NKN, Abdullah K, Aziz A, Mohamad I

Medeni Med J, 2020;35(2):161-165.
PMID: 32733766 DOI: 10.5222/MMJ.2020.06992

With the advancement of radiological investigation, intrapartum detection of fetal abnormalities is now precisely performed. Lymphangiomas are now diagnosed even before patient is born. The swelling may be gigantic and potentially life-threatening during the delivery. Nowadays, it is still a great challenge to doctors as how to deliver the baby together with the big neck mass. We present a case of huge intrapartum neck lymphangioma, for which we performed ex-utero intrapartum treatment (EXIT) procedure, followed by excision of the lesion later. The challenges on managing both mother and infant will be discussed.
Kimura Disease with Parotid Swelling and Cervical Lymphadenopathy: A Case Report and Literature Review

Eh Dam VSK, Mohamad S, Mohamad I

Medeni Med J, 2020;35(2):170-174.
PMID: 32733768 DOI: 10.5222/MMJ.2020.84594

Kimura disease (KD) is a rare chronic benign inflammatory disorder of unknown etiology that is prevalent in Asian males. The head and neck region, especially the parotid glands and cervical lymph nodes, are most commonly affected. Diagnosis is based on clinicopathological features, while radiology findings are nonspecific. Although various treatment strategies have been proposed, there is a high recurrence rate. Combination therapy has been found to produce better results than monotherapy. We present a case of KD with huge parotid and cervical lymph node involvement that was treated with a combination of surgery and corticosteroids administered perioperatively.
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 Concurrent Double Primary Tumours: Papillary Thyroid Carcinoma and Cervical Epithelioid Angiosarcoma

Lum SG, Mahmud N, Isa N, Mat Baki M

Medeni Med J, 2020;35(4):349-355.
PMID: 33717629 DOI: 10.5222/MMJ.2020.83479

Angiosarcoma is one of the rarest types of malignant vascular tumours that involved the head and neck region. It predominantly affects the scalp and superficial soft tissues. Angiosarcoma arising from the deep cervical soft tissue is extremely rare. There is a limited literature on neck angiosarcoma that occurred simultaneously with papillary thyroid carcinoma. We report a rare case of concurrent papillary thyroid carcinoma and cervical epithelioid angiosarcoma, and postoperative rapid progression of residual angiosarcoma that mimicked a neck haematoma. The diagnostic challenge and possible etiologies have been discussed here.
Fulltext Respiratory Symptoms Among Domestic Waste Collectors

Salvaraji L, Jeffree MS, Avoi R, Akhir HM, Rahim SSSA, Lukman KA

Medeni Med J, 2020;35(4):304-309.
PMID: 33717622 DOI: 10.5222/MMJ.2020.82246

Objective: Increasing amount of waste concurrently increases the risk of exposure to hazardous materials among waste collectors. Vigorous exertion in the field intensifies the abundance of contaminated inspirable droplets. If left undetected and untreated, it may provoke significant pernicious health effects and redundant burdens to employees and employers. The purpose of this study is to determine the prevalence of respiratory symptoms and their associated factors among domestic waste collectors.
Method: A cross-sectional study was conducted in Kota Kinabalu, Sabah between January and April 2020. Data were collected using a validated questionnaire which encompasses details about sociodemographic, health status, environment, and employment characteristics.
Results: A total of 290 waste collectors with a mean age of 40 (±9) years old were participated in the study. Most of them were from Kadazan-Dusun-Murut ethnic origin with educational background till secondary school. The average monthly income of the workers was USD 298.45 (±171.9) per month, and they had been in service for 11 (±9.04) years. Respiratory symptoms were seen in 21% of the workers. The identified significant risk factors were determined as underlying chronic diseases (OR=2.34; 95% CI=1.054, 5.219) and contact with pets (OR=1.87; 95% CI=1.004, 3.288).
Conclusion: Respiratory symptoms are prevalent amidst domestic waste collectors and related to their health and field activities.
Fulltext Posterior Ethmoid Nodular Fasciitis

Baki AM, Ramli R, Noor RM, Mohamad I, Jais M

Medeni Med J, 2020;35(3):276-280.
PMID: 33110682 DOI: 10.5222/MMJ.2020.90093

Nodular fasciitis (NF) is an uncommon and benign tumour-like fibroblastic proliferation that is difficult to distinguish from sarcoma both clinically and histologically. In addition, it is a type of lesion characterised by having a potential for spontaneous regression. NF is frequently misdiagnosed due to its rapid growth, rich cellularity, and mitotic figure. Although NF is only rarely diagnosed in children, the head and neck represent the most common locations for NF among this population. The cause of NF remains unknown, however trauma is believed to be an important triggering factor. We describe an unusual case of NF in the posterior ethmoid sinus in a six-year-old boy with no history of trauma. The NF was incidentally noted on a computed tomography scan after the patient complained of a squint. The diagnosis of NF was also supported by histopathology and specific immunohistological staining. A surgical biopsy was performed, and no recurrence was observed after one year.
Significance of Nasal Septum Angulation and Its Association with Rhinosinusitis Symptom Scores

Lazim NM, Abdullah AM, Abdullah B, Ismail ZIM

Medeni Med J, 2019;34(4):333-339.
PMID: 32821458 DOI: 10.5222/MMJ.2019.25986

Objective: The aim of the study was to determine the association of angulation of nasal septum with the severity of rhinosinusitis as measured by symptom score and Visual Analog Score (VAS).
Method: The study was performed as a cross sectional study conducted at two different centres in Malaysia. Ninety-eight patients who were diagnosed with rhinosinusitis and fulfilled the selection criteria were assessed as for the symptom score and VAS and the measurement of angulation of nasal septum was performed through a coronal view of CT paranasal sinuses in bone window setting at osteomeatal complex level.
Results: The result obtained from one-way ANOVA test revealed a significant association between category of severity of septal angulation and the symptom score of rhinosinusitis (p=0.025). In addition, the result obtained from one-way ANOVA test also revealed a significant association between category of severity of septal angulation and the VAS of rhinosinusitis (p<0.05).
Conclusion: Severity of nasal septum angulation may be significantly associated with severity of rhinosinusitis based on symptom score and VAS. These findings could be used in tailored management of patient with rhinosinusitis especially during functional endoscopic sinus surgery.

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