MyMedR

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 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 Image-guided system endoscopic drainage of orbital abscess caused by methicillin-resistant Staphylococcus aureus in an infant

Chai-Lee T, Nadarajah S, Abdullah B, Mohamad I, Maruthamuthu T, Nadarajan C, et al.

Int J Surg Case Rep, 2017;33:119-123.

PMID: 28314224 DOI: 10.1016/j.ijscr.2017.02.051

INTRODUCTION: The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery.

PRESENTATION OF CASE: A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage.

DISCUSSION: Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique.

CONCLUSION: Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit.

Sudden Bilateral Sensorineural Hearing Loss Secondary to Cerebral Venous Thrombosis

Ishak MN, Nik-Abdul-Ghani NM, Mohamad I

Iran J Otorhinolaryngol, 2018 Mar;30(97):113-116.

PMID: 29594079

Introduction: Sudden sensorineural hearing loss (SSNHL) is an important otological emergency. Up to 90% of the cases are idiopathic. Cerebral venous thrombosis (CVT) is an extremely rare identifiable cause as it only represents 0.5% of all strokes.

Case Report: In this paper, an unusual case of bilateral SSNHL secondary to bilateral CVT with rapid and complete recovery is reported. The patient presented with sudden bilateral hearing loss associated with some neurological symptoms. Initial computed tomography (CT) venography revealed a CVT of bilateral transverse sinuses. The patient was started on an anticoagulant and imaging was repeated after five days, revealing the absence of the thrombosis. Serial pure tone audiometry (PTA) showed complete recovery of bilateral hearing within 10 days.

Conclusion: Early detection and intervention may fasten hearing recovery and improve the quality of life. The immediate restoration of venous blood flow and intracranial pressure may lead to the complete recovery of bilateral hearing loss.

Primary Squamous Cell Carcinoma of the Thyroid Gland

Ibrahim MI, Jusoh YR, Adam NN, Mohamad I

Iran J Otorhinolaryngol, 2018 Jan;30(96):65-68.

PMID: 29387667

Introduction: Primary squamous cell carcinoma (SCC) of the thyroid gland is one of the rarest types of all reported thyroid malignancies worldwide. It is very aggressive in nature and carries a poor prognosis. The surgical resection with adjuvant radiotherapy and chemotherapy is the most recommended treatment despite its poor reported outcome.

Case Report: A 74-year-old woman presented with a rapidly progressive neck swelling, with hoarseness and compressive symptoms. Physical examination revealed a multilobulated firm thyroid mass with unilateral vocal cord palsy. Histopathological findings confirmed the diagnosis of SCC while radiological investigations and panendoscopy findings ruled out the possibility of other primary tumors. A surgical intervention was performed; however, the patient eventually succumbed to death prior to undergoing an oncological treatment.

Conclusion: With no standard consensus to guide the management plan, SCC of the thyroid gland presents a great challenge for the managing team to come up with the best treatment option, due to its unfavorable rate of survival.

Fulltext Submandibular Gland Basal Cell Adenoma

Salleh MN, Ahmad Kailani AAA, Nik Min NFA, Mohamad I, Hussain FA, Mat Zin AA

Iran J Otorhinolaryngol, 2022 Mar;34(121):131-134.

PMID: 35655769 DOI: 10.22038/IJORL.2021.58329.3007

INTRODUCTION: Basal cell adenoma (BCA) is a rare benign epithelial tumour of the salivary gland majorly involving the parotid gland, and rarely the submandibular gland.

CASE REPORT: We describe a rare case of BCA of the submandibular gland diagnosed preoperatively using fine needle aspiration cytology in a 60-year-old woman presenting with painless submandibular swelling. The surgery went uneventfully, and the histopathological examination confirmed the diagnosis.

CONCLUSIONS: BCA can be accurately diagnosed only through histological observations due to its resemblance to various benign and malignant salivary and non-salivary gland tumours, which are difficult to biopsy.

A pilot study on the efficacy of nasal rinsing during ablution in reducing acute respiratory tract infection (ARI) among male Hajj pilgrims

Ramli RR, Mohamad I, Ab Wahab MS, Naing NN, Wan Din WS

J Taibah Univ Med Sci, 2018 Aug;13(4):364-369.

PMID: 31435348 DOI: 10.1016/j.jtumed.2018.04.004

Objective: This study aimed to assess the effectiveness of nasal rinsing during ablution in reducing acute respiratory tract infection among male Hajj pilgrims.

Methods: A quasi-experimental trial study was conducted to compare the effectiveness of nasal rinsing between two groups. The intervention group was instructed to perform nasal rinsing during ablution, while the control group was not asked to do nasal rinsing. Both groups were provided progress diaries to record the symptoms of respiratory tract infection, including cough, rhinorrhoea, nasal blockage, fever, and sore throat, as well as thick phlegm, shortness of breath, epistaxis, and changes in sense of smell. The groups were also instructed to record any visits to clinics for their symptoms throughout their stay in Makkah for the Hajj ritual.

Results: The study showed that nasal rinsing significantly reduced the symptoms of cough, rhinorrhoea, and nasal blockage. The intervention group had an increased number of visits to healthcare facilities for treatment, when compared to those of the control group. There were no significant differences in the groups regarding the symptoms of fever and sore throat.

Conclusion: Nasal rinsing can be included as part of intervention methods that include vaccination and the use of a face mask. Nasal rinsing can be easily practiced by the pilgrims, since it is a Sunnah act in ablution, which is an integral element of Muslims' daily life.

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.

Single-nucleotide polymorphisms and mRNA expression of CYP1B1 influence treatment response in triple negative breast cancer patients undergoing chemotherapy

Abdul Aziz AA, Md Salleh MS, Mohamad I, Krishna Bhavaraju VM, Mazuwin Yahya M, Zakaria AD, et al.

J Genet, 2018 Dec;97(5):1185-1194.

PMID: 30555068

Triple negative breast cancer (TNBC) is typically associated with poor and interindividual variability in treatment response. Cytochrome P450 family 1 subfamily B1 (CYP1B1) is a metabolizing enzyme, involved in the biotransformation of xenobiotics and anticancer drugs. We hypothesized that, single-nucleotide polymorphisms (SNPs), CYP1B1 142 C>G, 4326 C>G and 4360 A>G, and CYP1B1 mRNA expression might be potential biomarkers for prediction of treatment response in TNBC patients. CYP1B1 SNPs genotyping (76 TNBC patients) was performed using allele-specific polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism methods and mRNA expression of CYP1B1 (41 formalin-fixed paraffin embeddedblocks) was quantified using quantitative reverse transcription PCR. Homozygous variant genotype (GG) and variant allele (G) of CYP1B1 4326C>G polymorphism showed significantly higher risk for development of resistance to chemotherapy with adjusted odds ratio (OR): 6.802 and 3.010, respectively. Whereas, CYP1B1 142 CG heterozygous genotype showed significant association with goodtreatment response with adjusted OR: 0.199. CYP1B1 142C-4326G haplotype was associated with higher risk for chemoresistance with OR: 2.579. Expression analysis revealed that the relative expression of CYP1B1 was downregulated (0.592) in cancerous tissue compared with normal adjacent tissues. When analysed for association with chemotherapy response, CYP1B1 expression was found to be significantly upregulated (3.256) in cancerous tissues of patients who did not respond as opposed to those of patients who showed response to chemotherapy. Our findings suggest that SNPs together with mRNA expression of CYP1B1 may be useful biomarkers to predict chemotherapy response in TNBC patients.

Commentary

Mohamad I

J Neurosci Rural Pract, 2013 Aug;4(Suppl 1):S97-8.

PMID: 24174812

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 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 Metallic hair pin aspiration into the left tertiary bronchus

Noh, K.B., Salim, R., Abdullah, M.S., Mohamad, I.

Malaysian Family Physician, 2018;13(2):36-38.

MyJurnal

Foreign body aspiration is commonly described in infants and children. However, recently, a new
high-risk group was identified among young women, especially those from the Muslim population
who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the
lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the
scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a
case of scarf pin inhalation and the challenges encountered in managing this patient during the
successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular
case was technically challenging for us as the sharp tip of the needle was pointing upward and
piercing the bronchial mucosa.

Fulltext Coughing on palpation: a rare complication of vagal schwannoma

Samarakkody, Z.M., Sayuti, K.A., Mat Zin, A.A., Wan Abdul Wahab, W.N.N., Mohamad, I.

Malaysian Family Physician, 2018;13(3):40-43.

MyJurnal

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and
presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia,
dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication
of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused
any surgical intervention, conservative management was used.

Fulltext Kimura disease: a differential diagnosis in a nephrotic child

Aziz, A., Mohamad, I., Zawawi, N.

Malaysian Family Physician, 2018;13(2):32-35.

MyJurnal

Kimura disease presents as benign lesion and is commonly present among the Asian population. It
is a disease with a favourable prognosis and a peak age of onset in the third decade. It is a chronic
inflammatory disorder of unknown etiology that involves the lymph nodes and subcutaneous
tissues of the head and neck region. We report a case of a 15-year-old boy with multiple Kimura
lymphadenopathies involving the left posterior auricular region as well as the anterior and posterior
triangles of the neck.

Fulltext Massive subcutaneous emphysema after a blunt neck injury

Mohamad, I., Md Shukri, N., Fauzi, M.H., Abdul Karim, A.H., Nik Hassan, N.F.H.

Malaysian Journal of Emergency Medicine, 2017;2(1):16-20.

MyJurnal

Subcutaneous emphysema can occur after a breach to the air-containing space. The classical condition will be ruptured alveolus in chronic lung disease. A disruption of the upper airway such as trauma to the laryngotracheal framework may lead to similar presentation. The amount of air leak varies depending on site and size of the breach. We report a case of blunt neck trauma after a fall from bicycle, which ended with massive subcutaneous emphysema, pneumothorax and pneumomediastinum requiring intubation.

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 Otitis externa complicated with chloramphenicol ear drops-induced perichondritis

Mohamad I, Johan K, Hashim H, Nik Othman N

Malays Fam Physician, 2014;9(1):28-9.

PMID: 25606295 MyJurnal

Otitis externa is a common condition of the ear. It is manifested as narrowing of the lumen owing to the edematous swelling of the ear canal lining. Perichondritis may occur independently or as a complication of the otitis externa. We report a case of perichondritis after using a topical ear drop. Changing the medication provides immediate resolution of the condition.

Fulltext Hoarseness as the sole symptom of an impending thoracic aneurysm rupture?

Jaafar R, Mohamad I

Malays Fam Physician, 2014;9(1):25-7.

PMID: 25606294 MyJurnal

Unilateral vocal cord palsy secondary to thoracic aortic aneurysm is a rare occurrence. Direct compression of the enlarging thoracic aneurysm on the left recurrent laryngeal nerve causes neuronal injury of the nerve, which is manifested as hoarseness. We present a rare case of unilateral vocal cord palsy in a 60-year-old healthy gentleman caused by a large thoracic aortic aneurysm. This rare presentation, with a serious underlying pathology might be misdiagnosed or delayed. Therefore, it is important for us to have high index of suspicion in cases with a rare presentation such as this.

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.

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