Embryonal rhabdomyosarcoma of external ear canal is very rare, even in the pediatric population. We report an embryonal rhabdomyosarcoma of external acoustic canal, occurring in a 12-year-old Chinese girl who presented with left ear canal mass. Wide local excision of the mass was done under local anesthesia. Histopathological examination revealed the diagnosis. She then underwent 20 cycles of radiotherapy. CECT scan post treatment showed clearance of tumor cell. Now, patient is disease free for 5 years. We believe that early diagnosis followed by complete resection of the tumor with clear margin and radiotherapy improves the prognosis of the disease.
Studies on the impact of Ramadan diurnal intermittent fasting (RDIF) on the metabolic syndrome (MetS) components among healthy Muslims observing Ramadan month have yielded contradictory results. This comprehensive meta-analysis aimed to obtain a more stable estimate of the effect size of fasting during Ramadan on the MetS components, examine variability among studies, assess the generalisability of reported results and perform subgroup analyses for associated factors. We searched the CINAHL, Cochrane, EBSCOhost, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus and Web of Science databases for relevant studies published from 1950 to March 2019. The MetS components analysed were: waist circumference (WC), systolic blood pressure (SBP), fasting plasma/serum glucose (FG), TAG, and HDL-cholesterol. We identified eighty-five studies (4326 participants in total) that were conducted in twenty-three countries between 1982 and 2019. RDIF-induced effect sizes for the MetS components were: small reductions in WC (no. of studies K = 24, N 1557, Hedges' g = -0·312, 95 % CI -0·387, -0·236), SBP (K = 22, N 1172, Hedges' g = -0·239, 95 % CI -0·372, -0·106), FG (K = 51, N 2318, Hedges' g = -0·101, 95 % CI -0·260, 0·004) and TAG (K = 63, N 2862, Hedges' g = -0·088, 95 % CI -0·171, -0·004) and a small increase in HDL-cholesterol (K = 57, N 2771, Hedges' g = 0·150, 95 % CI 0·064, 0·236). We concluded that among healthy people, RDIF shows small improvement in the five MetS components: WC, SBP, TAG, FG and HDL.
This is a retrospective review of congenital cholesteatoma cases that were managed surgically. There were 5 cases. The age of presentation ranged from 5 to 18 year old. Three patients presented with complication of the disease. Three patients had intact tympanic membrane, two had perforation at the anterior superior quadrant. All patients had cholesteatoma medial to tympanic membrane. Four cases had extensive ossicular erosion with preoperative hearing worse than 40 dB. Four cases underwent canal wall down mastoid surgery and one underwent canal wall up surgery. One patient had recurrence which required revision surgery. In conclusion, congenital cholesteatoma presented late due to the silent nature of disease in its early stage. Extensive disease, ossicular destruction with risk of complication at presentation were marked in our study. Hence, more aggressive surgical intervention is recommended in the management of congenital cholesteatoma.
Burn injuries are one of the most devastating injuries in the world. A uniform burn wound is essential for burn research. The objective of this study was to describe a new model for inducing deep partial-thickness burns in rats. Burn wounds were performed on the dorsal part of Sprague-Dawley rats using a constructed heating device in our laboratory. Digital images of each animal were captured every day for macroscopic evaluation and for assessment of the wound contraction rate. Six animals were sacrificed on days 1, 3, 7, 11, 14, and 21 after onset of burn and their skin tissues were harvested for histological analysis. Uniform deep partial-thickness burns could be achieved in Sprague-Dawley rats under the condition of a contact temperature of 70°C, with the weight of heating devices of 300 g, and a duration of 10 s. Macroscopic evaluation recorded the general appearance of the deep partial-thickness burns. Evaluation of the wound contraction rate showed that the deep partial-thickness wound area was reduced by 90.39% of the original wound area by day 21 after burn. Microscopic evaluation by hematoxylin-eosin staining revealed the histological changes during the wound healing process. This is a standardized and reproducible model for inducing deep partial-thickness burns in Sprague-Dawley rats.
Acute mastoid abscess is common in daily practice. In children, it is usually caused by unsuccessful treatment or partially treated acute otitis media (AOM). Some authors had reported that chronic suppurative otitis media (CSOM) can be the source of infection but it is usually associated with the presence of cholesteatoma. A case of an acute mastoid abscess in a 7 year old girl is presented. She had a history of severe otalgia with left post auricular swelling for 3 days. Clinically she was febrile, the left otoscopy showed diffuse post auricular swelling and sagging of the posterior wall of the external canal. She underwent an emergency cortical mastoidectomy for the left mastoid abscess and had an uneventful recovery. In conclusion, this patient was partially treated with antibiotics which increased the risk for ‘masked mastoiditis’, and she later developed a mastoid abscess. Therefore we advocate that all AOM patients should be treated with antibiotics at least for a duration of one week.
Premenstrual syndrome (PMS) is a cyclical late luteal phase disorder of the menstrual cycle whereby the daily functioning of women is affected by emotional and physical symptoms substantially interfering with their quality of life. Little is known about PMS in the United Arab Emirates (UAE). This study aimed to determine the prevalence and severity of PMS among university students in Sharjah, UAE, and clarify its associations with dietary habits, lifestyle behaviors, and anthropometric factors. A cross-sectional study was conducted on female college students at the University of Sharjah, UAE. Data were collected using self-administered questionnaires and anthropometric assessments. Descriptive statistics and multiple logistic regression analyses were performed. Participants were 300 adult university students aged 18-24 years (mean age 20.07 ± 1.53 years). In total, 95% of participants reported at least one PMS symptom during their menstrual period. The prevalence of PMS was 35.3%, with mild symptoms being the most commonly reported. Multiple regression analysis showed that smoking was associated with increased risk of reporting psychological (OR 2.5, 95% CI 1.1-5.8; p < 0.05) and behavioral symptoms (OR 2.2, 95% CI 1.0-4.9; p < 0.05), while high calorie/fat/sugar/salt foods intake was associated with increased risk of reporting physical symptoms (OR 3.2, 95% CI 1.4-7.3; p < 0.05). However, fruit consumption (OR 0.34, 95% CI 0.125-0.92; p < 0.05) was associated with a decreased risk of reporting behavioral symptoms. A high prevalence of PMS was reported among university students, with smoking and high calorie/fat/sugar/salt food consumption identified as strong risk factors for PMS.
Large Vestibular Aqueduct Syndrome (LVAS) is the most common radiographic malformation in children with early onset of hearing loss. Usually its occurrence is non-familial, however intriguingly a portion of patients with LVAS is found to have evidence of genetic predisposition. We described cases of LVAS in two siblings of a Chinese family. The elder sister first presented with reduced hearing since childhood and her brother has a similar complaint upon further questioning. Their hearing test showed bilateral sensorineural hearing loss (SNHL) and computed tomography (CT) of temporal bone showed enlarged vestibular aqueduct in both patients. We described an approach to diagnosis of LVAS and highlight the importance of hearing assessment in genetic link hearing loss.
Ethylmalonic encephalopathy is a rare metabolic disease presenting in infancy with developmental delay, acrocyanosis, petechiae, chronic diarrhea and early death. The biochemical characteristics of this autosomal recessive disease are urinary organic acid abnormalities. Recently it has been found to be caused by mutations in the ETHE1 gene, located on Ch19q13. Only about 30 patients have been reported, and we describe two additional cases. The first patient showed a typical clinical picture and biochemical abnormalities, with additional atypical clinical features. Neuroimaging studies showed extensive changes. A new homozygous mutation in exon 3 of the ETHE1 gene was found. The second patient was not investigated genetically; however besides the typical clinical picture and biochemical profile he was found to have cytochrome C oxidase deficiency.
This study was aimed to see the difference between chondrocytes from normal cartilage compared to chondrocytes from microtic cartilage. Specific attentions were to characterize the growth of chondrocytes in terms of cell morphology, growth profile and RT-PCR analysis.
Chondrocytes were isolated from normal and microtic human auricular cartilage after ear surgery carried out at Universiti Kebangsaan Malaysia Medical Centre. Chondrocytes were cultured and expanded until passage 4. After reached confluence, cultured chondrocytes at each passage (P1, P2, P3 and P4) were harvested and assigned for growth profile analysis. There was no significant difference in cell viability between both normal and microtic samples (p = 0.84). Both samples showed no significant differences for growth profile parameters in terms of growth rate, population doubling time and total number of cell doubling, except in passage 1, where there is significant difference in cell growth rate (p = 0.004). This preliminary data has indicated that chondrocytes from microtic cartilage has the potential to be used in the reconstruction of human pinna in the future.
Introduction: The aim of this study was to determine the effects of pedometer-based intervention and the relationship between daily walking steps and nutritional status among overweight/obese university students in Kuala Terengganu. Materials and methods: The study was an 8-week intervention study that included 23 overweight/obese university students. After 7 days of baseline activity, anthropometric data such as weight, height and waist circumference and a one-day dietary record were taken. The participants were divided into a control and case group. The control group (n=15) was instructed to continue with their normal activities and habits throughout the 8 weeks. The case group (n=8) was instructed to walk based on the targeted number of steps. Data such as body weight, waist circumference and a one-day dietary record were taken after the intervention. Results: Both case and control group show significant differences in body mass index (BMI) with p=0.017 and p=0.047 respectively. However, there is a large and significant difference between walking steps and BMI before and after intervention for the case group. There were no differences in any other study parameters during the 8-week study. Conclusion: In conclusion, short-term intervention with a pedometer increased physical activity and positively affected the BMI of overweight/obese participants. The use of a pedometer was efficient in measuring daily physical activity (r= 0.756, p< 0.05).
Cat scratch disease (CSD) is a benign condition caused by the inoculation of Bartonella henselae. The imaging findings are non-specific, and it is difficult to diagnose the disease via imaging. However, imaging studies help exclude other differential diagnoses in diagnostic dilemmas. We encountered a case of a 17-year-old adolescent who presented with painful neck swelling. CT showed multiple bilateral cervical lymphadenopathies with triangular soft tissue mass at the anterior mediastinum likely to be thymic hyperplasia, which is unusual in CSD and was mistaken for a lymphoproliferative disorder. Tissue diagnosis with a thorough clinical history yielded the diagnosis of cat scratch disease, and follow-up imaging showed resolution of the cervical lymphadenopathy and thymic hyperplasia.
Obstructive Sleep Apnoea (OSA) affects 2-5% of the middle-aged population and is a potentially life-threatening condition. Previous studies on OSA and glaucoma have reported mixed findings. This was a cross-sectional comparative study with a study duration of one year to compare the incidence of high intraocular pressure among OSA subjects and non-OSA subjects. This study took place in a tertiary hospital where a total of 50 subjects with OSA and 50 non-OSA subjects were recruited. The average age was 37 years (19,65) in a multiethnic study population (76% (Malay), 18% (Chinese) and 6% (Indian)). All patients underwent a full night computer-assisted polysomnogram (SOMNOCheck Effort Weinmann, Hamburg, Germany), Epworth Sleepiness Scale (ESS), Mullers manouevre (MM) to assess the level of obstruction and tonometry. The incidence of high Intra Ocular Pressure (IOP) among OSA subject was 52% with a significant difference between non-OSA and OSA subjects. Correlation between ESS and IOP were significant (p
To demonstrate a simple, practical, cheap method of preventing potentially fatal aspiration of a dislodged voice prosthesis; this method was developed by a laryngectomised patient.
To review cases of congenital external auditory canal anomaly with cholesteatoma, documenting clinical presentation, cholesteatoma site and extent, complications, and surgery.
Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.
Temporal bone carcinoma may masquerade as an infective process causing late diagnosis. A delay in treatment as a result of missed diagnosis would carry a poor prognosis as the disease progresses to an advanced stage. We present a lady with history of chronic otorrhea, who developed left sided otalgia associated with hearing loss in her sixth decade. She underwent surgery which revealed left mastoiditis and cholesteatoma. After a year, she had a mass in her left ear and pus discharge which was initially treated as an infection. The biopsy of the mass was proven to be squamous cell carcinoma. High index of suspicion is necessary when encountering patients presenting with a mass in the ear canal with prior history of chronic otorrhea or cholesteatoma. Proper tissue biopsy is crucial. Early referral to tertiary centre is required for further management of the patient.
Tinnitus is a common disorder, it can be classified as pulsatile and non-pulsatile or objective and subjective. Pulsatile tinnitus is less common than non-pulsatile and can be due to vascular tumour such as glomus or vascular abnormality. We presented an interesting case of a 30 year-old Malay lady with a two-year history of pulsatile tinnitus which was worsening in three months duration. It was associated with intermittent headache. Clinical examination and tuning fork test were unremarkable. Apart from mild hearing loss at high frequency on the left ear, the pure tone audiogram (PTA) was otherwise normal. In view of the patient's young age with no risk factor for high frequency loss, a magnetic resonance imaging (MRI) was performed to look for any abnormality in the cerebellopontine angle. It revealed a single vessel looping around the left vestibulocochlear and facial nerves at the cisternal portion, likely a branch of the anteroinferior cerebellar artery (AICA). Literature review on the pathophysiology and treatment option in this condition is discussed.
Congenital cholesteatoma (CC) is rare clinical condition and It is known as a pearly white mass medial to an intact tympanic membrane. In this case report, we describe a 6-year-old boy who presented with a one year history of left ear discomfort, reduced hearing, followed by ear discharge two months prior to admission. Otoscopic examination revealed a large attic perforation. Radiological investigation showed extensive cholesteatoma in the mastoid, mesotympanum and epitympanum with destruction of the ossicles including the stapes footplate. He underwent radical mastoidectomy in view of extensive cholesteatoma with tympanoplasty type V. In this case report, the classification, treatment and theories related to CC are discussed.
This study was aimed at regenerating autologous elastic cartilage for future use in pediatric ear reconstruction surgery. Specific attentions were to characterize pediatric auricular chondrocyte growth in a combination culture medium and to assess the possibility of elastic cartilage regeneration using human fibrin.