MyMedR

Fulltext Endoscopic cauterization of the sphenopalatine artery in persistent epistaxis

Harvinder S, Rosalind S, Gurdeep S

Med J Malaysia, 2008 Dec;63(5):377-8.

PMID: 19803294 MyJurnal

The management of epistaxis remains to be a challenging problem for most ENT surgeon especially posterior epistaxis. Most cases are managed by placement of posterior nasal packs or balloons and failure leads to more invasive techniques, involving ligation of the internal maxillary artery. The above management is associated with significant patient complication and morbidity. Endoscopic ligation or cauterization of the sphenopalatine artery has emerged as a viable and minimally invasive alternative. We have performed endoscopic cauterization of nine sphenopalatine arteries in eight patients with no further episodes of epistaxis and complications, with an average follow-up of 25 months. The mean age of the patients was 52.75 years. Fifty percent of the patients had a history of hypertension.

Fulltext Prevalence of onodi cells in Hospital Raja Permaisuri Bainun, Ipoh, Malaysia

Tan KL, Harvinder S

Med J Malaysia, 2010 Jun;65(2):101-2.

PMID: 23756790 MyJurnal

Onodi cell is a posterior ethmoid air cell that pneumatizes into the sphenoid sinus, It is an important entity for clinicians when performing endoscopic sinus surgery (EES) because it encroaches into the optic nerve and internal carotid artery. CT-scans are the road map for ESS to prevent damage to structures mentioned above. Its prevalence in Malaysia is unknown.

Fulltext An arrow in the maxillary sinus

Harvinder S, Jenny L, Gurdeep S

Med J Malaysia, 2008 Oct;63(4):333-4.

PMID: 19385497

We experienced the case of a patient who had a foreign body in the maxillary sinus. The foreign body was an arrow accidentally triggered by the patient while fishing. The foreign body was removed via the Caldwell-Luc approach.

Fulltext Endoscopic resection of primary nasoseptal chondrosarcoma

Jenny L, Harvinder S, Gurdeep S

Med J Malaysia, 2008 Oct;63(4):335-6.

PMID: 19385498 MyJurnal

Chondrosarcoma of the nasal septum is an extremely rare malignant tumor. It accounts for only 10% to 20% of primary bone tumors, with approximately 10% found in the head and neck. A case is presented here to illustrate its presentation, evaluation and surgical treatment.

Fulltext Management of sinonasal inverted papillomas: endoscopic medial maxillectomy

Harvinder S, Rosalind S, Mallina S, Gurdeep S

Med J Malaysia, 2008 Mar;63(1):58-60.

PMID: 18935736

Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after excision. They usually present as unilateral firm, bulky, red and vascular masses. The objective of this case series is to discuss the surgical treatment options for IPs and to review the literature with a special emphasis on our experience with endoscopic medial maxillectomy. A retrospective review of the data of patients with IP treated by endoscopic medial maxillectomy was performed. This report describes the surgical experience with five patients with IP arising from various sites on the lateral nasal wall. Data points collected included age, sex, location(s) and histopathological diagnosis (benign IP vs IP with dysplasia or carcinoma). The surgical treatment strategy, need for adjunct approaches, complications, recurrence rates and length of follow-up were determined. The average age was 51.2 years (range, 35-62 years), with four males and one female. All cases were managed with endoscopic medial maxillectomy as the primary surgical modality. Adjunctive approaches included endoscopic dacryocystorhinostomy (EDCR) in two patients who presented with epiphora post-operatively. Intra-operative frozen section was performed in all cases to ensure complete tumor removal. No intra-operative complications were encountered. No recurrences were noted in these patients, with a mean follow-up period of 23 months.

Fulltext Sinonasal malignant melanocytic melanoma: a rare case report

Pathma L, Philip R, Harvinder S, Manjit S

Med J Malaysia, 2008 Jun;63(2):152-3.

PMID: 18942306 MyJurnal

Malignant melanocytic melanoma is a rare sinonasal malignancy. We present a case report of an elderly lady who presented with epistaxis and intranasal polyps. Computed tomography revealed soft tissue mass in the oropharynx, nasopharynx, left ethmoid and entire maxillary sinus. The mass was removed via endoscopic medial maxillectomy. Histopathology examination revealed sinonasal melanocytic malignant melanoma. At present 17 months postoperatively she is symptom free with no recurrence and under regular follow up.

Fulltext Endoscopic management of sinonasal inverted papilloma

Bathma S, Harvinder S, Philip R, Rosalind S, Gurdeep S

Med J Malaysia, 2011 Mar;66(1):15-8.

PMID: 23765136 MyJurnal

Inverted papillomas (IPs) are benign sinonasal epithelial tumors that are locally aggressive and has a preponderance to recur if incompletely excised. This is a retrospective report describing 13 patients who underwent endoscopic excison from March 2004 to December 2010. Data was summarized into age, sex, location of tumor, surgical outcome and disease free status. Majority of the patients were males with the remaining 3 females, with a mean age of 50.9 years (range 24-76 years). Two patients needed an additional procedure of endoscopic dacrocystorhinostomy (EDCR) for epiphora. Out of the 13 patients surveyed, three patients underwent revision surgery for recurrences, of which one was a referred from another instituition. All patients are currently disease free. The mean follow-up period is 40 months.

Fulltext Powered endoscopic dacryocystorhinostomy with mucosal flaps without stenting

Harvinder S, Rosalind S, Philip R, Mallina S, Gurdeep S

Med J Malaysia, 2008 Aug;63(3):237-8.

PMID: 19248697 MyJurnal

Dacrycystorhinostomy (DCR) is a procedure performed to drain the lacrimal sac in cases of nasolacrimal duct obstruction or in chronic dacryocystitis. It can be performed externally or endoscopically. This is a prospective, nonrandomized study involving twenty-two consecutive patients (16 Females and 6 Males; mean age 45.54 y; range 18-74 y) who presented to the DCR clinic with epiphora secondary to nasolacrimal duct obstruction and recurrent infection. All patients underwent primary powered endoscopic DCR. A total of 24 procedures were performed using a standardized surgical technique. Post-operatively, symptom evaluation and endoscopic assessment of the newly created lacrimal ostium were done. Twenty-two of the 24 DCR's were patent after a mean follow-up of 21.5 months, yielding a success rate of 91.66%. Patency was assessed by symptomatic evaluation and endoscopic visualization at each post-operative visit. Two patients had complications, one orbital fat exposure and the other secondary haemmorhage. The two failures were due to synechiae formation. Therefore, powered endoscopic DCR with mucosal flaps without stenting has a success rate comparable to that achieved with stents and external DCR.

Fulltext Endoscopic assisted transseptal transphenoidal hypophysectomy

Mallina S, Harvinder S, Rosalind S, Philip R, Gurdeep S, Anil S

Med J Malaysia, 2006 Aug;61(3):320-2.

PMID: 17240583 MyJurnal

Eight patients with pituitary tumors were operated via the transseptal transsphenoidal approach from April to November 2004 at Hospital Ipoh. Seven patients presented with visual disturbances while three also had endocrine abnormalities. The post-operative follow-up period was between six months to a year. There was no mortality in this series. There were no complications related to the approach i.e. nasal or septal related. All patients with visual impairment showed improvement. Only one patient had hormonal irregularities. The endoscopic assisted transseptal approach to the sphenoid sinus for pituitary surgery was found to be easy and without sinonasal or labial complications often found with the sublabial approach.

Fulltext Intranasal Use of Quicklot in a Patient with Uncontrollable Epistaxis

Gurdeep S, Harvinder S, Philip R, Amanjit K

Med J Malaysia, 2006 Mar;61(1):112-3.

PMID: 16708748

A 60-year-old man who presented with nasopharyngitis developed uncontrollable epistaxis following a punch biopsy of the nasopharynx. QuickClot was successfully used to arrest the haemorrhage under general anaesthesia after the usual methods employed to secure haemostasis failed. The haemostatic plug was successfully removed a week later after control of the infection. This case represents the first reported intranasal use of QuickClot. We describe our experience and a literature review on this haemostatic agent.

Anatomical variations of the sphenoid sinus and its adjacent structures: a review of existing literature

Anusha B, Baharudin A, Philip R, Harvinder S, Shaffie BM

Surg Radiol Anat, 2014 Jul;36(5):419-27.

PMID: 24146215 DOI: 10.1007/s00276-013-1214-1

The sphenoid sinus, one of the posterior groups of sinuses, has long been regarded as a 'neglected sinus' due to the anatomical location, poor understanding and poor accessibility, till the advent of endoscopes and modern imaging techniques. Increasing knowledge and greater understanding of this sinus has permitted an evolution in surgical practices and boundaries. Various literatures of the past report a great variety of rates of pneumatization, rates of optic nerve protrusion and dehiscence, as well as internal carotid artery (ICA) protrusion and dehiscence. One similarity noted among these studies is that the rates vary according to the ethnicity of the patients. Recommendations have also been made along the way with regard to modified surgical techniques. This review aims to describe the pneumatization of sphenoid sinus and the topographical relation of the optic nerve and ICA in different populations.

Fulltext A case series of nasopharyngeal carcinoma among Indians, a low risk population, in Perak state, Malaysia

Anusha B, Philip R, Norain K, Harvinder S, Gurdeep SM

Med J Malaysia, 2012 Dec;67(6):641-3.

PMID: 23770968 MyJurnal

Nasopharyngeal carcinoma (NPC) is rare among people of Indian ethnicity. A short retrospective case review of clinical records of Indian patients diagnosed with nasopharyngeal carcinoma in a period of 5 years was conducted. Their slides were further subjected to EBV encoded RNA (EBER) - In- situ Hybridization (ISH). The histologic subtype was nonkeratinizing carcinoma in all 4 patients. All were Epstein Barr Virus (EBV) positive. We believe that the crucial factor responsible for nasopharyngeal carcinoma is genetics; either a genetic susceptibility among high risk groups or genetic resistance/immunity in low risk groups. Further genetic studies are required to look for somatic or inherited chromosomal mutations among the various risk populations.

Fulltext Nodular fasciitis: a diagnostic dilemma

Mallina S, Rosalind S, Philip R, Harvinder S, Gurdeep S, Sabaria MN

Med J Malaysia, 2007 Dec;62(5):420-1.

PMID: 18705482 MyJurnal

A 65 year old man presented with a right upper cervical mass. A diagnosis of pleomorphic adenoma was reported on fine needle aspiration cytology (FNAC). CT scan however reported an intramuscular sternocleidomastoid swelling. The tumor was excised and a diagnosis of nodular fasciitis was made. It is important to be aware of this diagnosis and that FNAC reports may mimic that of a pleomorphic adenoma.

Impact of Harvesting on a Bioeconomic Predator-Prey Fishery Model Subject to Environmental Toxicant

Ang TK, Safuan HM, Sidhu HS, Jovanoski Z, Towers IN

Bull Math Biol, 2019 07;81(7):2748-2767.

PMID: 31201660 DOI: 10.1007/s11538-019-00627-8

The present paper studies a predator-prey fishery model which incorporates the independent harvesting strategies and nonlinear impact of an anthropogenic toxicant. Both fish populations are harvested with different harvesting efforts, and the cases for the presence and non-presence of harvesting effort are discussed. The prey fish population is assumed to be infected by the toxicant directly which causes indirect infection to predator fish population through the feeding process. Each equilibrium of the proposed system is examined by analyzing the respective local stability properties. Dynamical behavior and bifurcations are studied with the assistance of threshold conditions influencing the persistence and extinction of both predator and prey. Bionomic equilibrium solutions for three possible cases are investigated with certain restrictions. Optimal harvesting policy is explored by utilizing the Pontryagin's Maximum Principle to optimize the profit while maintaining the sustainability of the marine ecosystem. Bifurcation analysis showed that the harvesting parameters are the key elements causing fishery extinction. Numerical simulations of bionomic and optimal equilibrium solutions showed that the presence of toxicant has a detrimental effect on the fish populations.

Fulltext Underlay myringoplasty: comparison of human amniotic membrane to temporalis fascia graft

Harvinder S, Hassan S, Sidek DS, Hamzah M, Samsudin AR, Philip R

Med J Malaysia, 2005 Dec;60(5):585-9.

PMID: 16515109

Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympanic membrane perforations in 50 patients with chronic otitis media. Human amniotic membrane was used in 20 patients while temporalis fascia was used in the remaining 30. Anatomical closure of the perforation and reduction of the air-bone gap was measured. The graft uptake showed a 65% success rate for the amniotic membrane and 56.7% for the temporalis fascia at 3 months post-operatively. Significant closure of air-bone gap was observed in the human amniotic group. These results indicate comparable outcomes between human amniotic membrane and the temporalis fascia graft.

Anatomical variants of surgically important landmarks in the sphenoid sinus: a radiologic study in Southeast Asian patients

Anusha B, Baharudin A, Philip R, Harvinder S, Shaffie BM, Ramiza RR

Surg Radiol Anat, 2015 Dec;37(10):1183-90.

PMID: 25990686 DOI: 10.1007/s00276-015-1494-8

Failure of a surgeon to understand the local variations of the anatomical landmarks of the sphenoid sinus is a potential risk factor to cause damage to the optic nerve (ON) or internal carotid artery (ICA) that lies on the walls of the sphenoid sinus. The aim of this study was to identify the anatomical variants of the sphenoid sinus and its related surrounding structures among the Southeast Asian (SEA) population, based on computed tomography (CT) scans.

Oligogenic inheritance in severe adult obesity

Almansoori S, Alsters SI, Yiorkas AM, Nor Hashim NA, Walters RG, Chahal HS, et al.

Int J Obes (Lond), 2024 Jan 31.

PMID: 38297031 DOI: 10.1038/s41366-024-01476-9

BACKGROUND/OBJECTIVE: The genetic architecture of extreme non-syndromic obesity in adults remains to be elucidated. A range of genes are known to cause monogenic obesity, but even when pathogenic mutations are present, there may be variable penetrance.

METHODS: Whole-exome sequencing (WES) was carried out on a 15-year-old male proband of Pakistani ancestry who had severe obesity. This was followed by family segregation analysis, using Sanger sequencing. We also undertook re-analysis of WES data from 91 unrelated adults with severe obesity (86% white European ancestry) from the Personalised Medicine for Morbid Obesity (PMMO) cohort, recruited from the UK National Health Service.

RESULTS: We identified an oligogenic mode of inheritance of obesity in the proband's family-this provided the impetus to reanalyze existing sequence data in a separate dataset. Analysis of PMMO participant data revealed two further patients who carried more than one rare, predicted-deleterious mutation in a known monogenic obesity gene. In all three cases, the genes involved had known autosomal dominant inheritance, with incomplete penetrance.

CONCLUSION: Oligogenic inheritance may explain some of the variable penetrance in Mendelian forms of obesity. We caution clinicians and researchers to avoid confining sequence analysis to individual genes and, in particular, not to stop looking when the first potentially-causative mutation is found.

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