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Fulltext Benign Lymphoepithelial Cyst: An Unusual Cause of Parotid Swelling in Two Immunocompetent Patients

Thong HK, Athar PPSH, Mustaffa WMW

Open Access Maced J Med Sci, 2019 Jul 15;7(13):2142-2145.
PMID: 31456841 DOI: 10.3889/oamjms.2019.577

BACKGROUND: Lymphoepithelial cysts, which are benign and slow-growing tumours, usually involve the head and neck regions. Benign lymphoepithelial cysts (BLECs) are the most common cause of parotid swelling in human immunodeficiency virus (HIV)-positive patients and are less common in immunocompetent patients.
CASE PRESENTATION: Here, we present two cases of immunocompetent patients with long-standing, progressively enlarging parotid swelling. Postoperative histopathological examination of these patients revealed features of BLEC.
CONCLUSION: Wide surgical excision is the gold standard for treatment and recurrences is rare. These cases are of particular interest because of the rarity of BLEC in HIV-negative patients and highlight an important differential diagnosis of parotid swelling.
Fulltext Painless Giant Submandibular Gland Sialolith: A Case Report

Thong HK, Othman IA, Ramli R, Sabir Husin Athar PP

Cureus, 2021 Nov;13(11):e19429.
PMID: 34926020 DOI: 10.7759/cureus.19429

Sialolithiasis is one of the most common diseases involving the salivary glands. It is a condition that occurs due to an obstruction in a salivary gland or its duct due to a calculus. The formation of a salivary stone is believed to be secondary to the deposition of mineral salts around a nidus, which is frequently associated with a recurrent bacterial infection. Patients with submandibular sialolithiasis usually present with acute swelling over the neck associated with pain, fever, and purulent intraoral discharge. The size of the calculus varies from <1 mm to a few centimeters. The frequency of sialolithiasis is relatively common. It is estimated to affect 12 in 1000 of the adult population. However, the occurrence of giant sialoliths, >15 mm in any diameter, is rare. Here, we describe our experience with a case of giant submandibular sialolithiasis measuring 25 mm presenting as a painless submandibular mass. The patient underwent submandibular gland excision followed by a full recovery.
Fulltext Temporal Bone Chondroblastoma: a Rare Entity

Yusof ANM, Thong HK, Kamalden TMIT

Med Arch, 2020 Aug;74(4):312-314.
PMID: 33041452 DOI: 10.5455/medarh.2020.74.312-314

INTRODUCTION: Chondroblastoma is an uncommon benign, locally destructive tumor that usually arises from epiphyses of the long bones. Temporal bone chondroblastoma is an extremely rare occurrence. Chondroblastoma arise from immature cartilage cells and it may display certain malignant features by invading surrounding structures and metastasizing to adjacent sites.
AIM: To present a case of extradural temporal bone chondroblastoma and discuss the clinical presentation, radiographic findings, histology and particularly the surgical management of the case.
CASE REPORT: We report a case of a 31-year-old man who presented with a painless left temporal swelling and left sided hearing loss for four months. Computed tomography (CT) scan revealed an aggressive mass involving the left preauricular region with temporal mastoid bone erosion. Magnetic resonance imaging (MRI) showed an extra-axial left temporal mastoid mass pushing the left temporal lobe superiorly. The patient underwent complete excision of the temporal bone tumor. The final histopathological diagnosis was in keeping with chondroblastoma.
CONCLUSION: Temporal bone chondroblastoma is rare but an aggressive condition. Complete tumor resection via an appropriate approach that enables adequate exposure will lead to a favorable outcome.
A review of smell and taste dysfunction in COVID-19 patients

Wong DKC, Gendeh HS, Thong HK, Lum SG, Gendeh BS, Saim A, et al.

Med J Malaysia, 2020 09;75(5):574-581.
PMID: 32918429

INTRODUCTION: Multiple anecdotal reports suggest that smell and taste loss were early subclinical symptoms of COVID-19 patients. The objective of this review was to identify the incidence of smell and taste dysfunction in COVID-19, determine the onset of their symptoms and the risk factors of anosmia, hyposmia, ageusia or dysgeusia for COVID-19 infection.
METHODS: We searched the PubMed and Google Scholar on 15th May 2020, with search terms including SARS-COV-2, coronavirus, COVID-19, hyposmia, anosmia, ageusia and dysgeusia. The articles included were cross sectional studies, observational studies and retrospective or prospective audits, letters to editor and short communications that included a study of a cohort of patients. Case reports, case-series and interventional studies were excluded.
DISCUSSION: A total of 16 studies were selected. Incidence of smell and taste dysfunction was higher in Europe (34 to 86%), North America (19 to 71%) and the Middle East (36 to 98%) when compared to the Asian cohorts (11 to 15%) in COVID-19 positive patients. Incidence of smell and taste dysfunction in COVID-19 negative patients was low in comparison (12 to 27%). Total incidence of smell and taste dysfunction from COVID-19 positive and negative patients from seven studies was 20% and 10% respectively. Symptoms may appear just before, concomitantly, or immediately after the onset of the usual symptoms. Occurs predominantly in females. When occurring immediately after the onset of the usual symptoms, the median time of onset was 3.3 to 4.4 days. Symptoms persist for a period of seven to 14 days. Patients with smell and taste dysfunction were reported to have a six to ten-fold odds of having COVID-19.
CONCLUSION: Smell and taste dysfunction has a high incidence in Europe, North America, and the Middle East. The incidence was lower in the Asia region. It is a strong risk factor for COVID-19. It may be the only symptom and should be added to the list of symptoms when screening for COVID- 19.
Fulltext Recurrent Submandibular Sialolithiasis in a Child

Thong HK, Mohamad Mahbob H, Sabir Husin Athar PP, Tengku Kamalden TMI

Cureus, 2020 Dec 19;12(12):e12163.
PMID: 33489575 DOI: 10.7759/cureus.12163

Sialolithiasis is a commonly encountered disease of the salivary glands, reported to represent up to 30% of all salivary gland diseases. However, the condition is rarely encountered in the pediatric population. The formation of a salivary stone is believed to be secondary to the deposition of calcium salts around a nidus. The formation of a nidus is commonly associated with desquamated epithelial or sloughing from a recent bacterial infection. Patients with submandibular sialolithiasis usually present with acute swelling over the neck associated with pain, fever, and purulent intraoral discharge. Neglected and poorly treated acute infection may progress to life-threatening abscess formation. Here we are describing our encounter with a 10-year-old boy with recurrent submandibular sialolithiasis. He was initially treated with conservative measures and antibiotics regimen. Failure of medical treatment and recurring symptoms led to submandibular gland excision followed by a full recovery.
Fulltext Metastatic carcinoma of the lung presenting as jugular venous thrombosis: a valuable clinical lesson

Thong HK, Sugumaran V, Mohamad Mahbob HB, Tengku Kamalden TMIB

J Med Life, 2021 8 12;14(3):419-423.
PMID: 34377211 DOI: 10.25122/jml-2020-0061

Thromboses of the upper extremity and neck are rare and not as commonly seen as lower extremity deep vein thrombosis (DVT). Internal jugular vein thrombosis (IJVT) is a serious condition with a potentially fatal outcome. Jugular vein thrombosis refers to the formation of intraluminal thrombi anywhere from the intracranial part of the jugular vein to the junction between the internal jugular vein (IJV) and subclavian vein. The relationship between malignancy and thromboembolic disorders has been well established, as Trousseau first described it in 1865. Tumor cells are known to promote hypercoagulability by expressing tissue factors that activate clotting cascades and procoagulants while promoting interactions between the tumor cells, platelets, and endothelial cells via different cytokines, tumor antigens, and their immune complexes. We are reporting our encounter with a patient who presented with extensive left internal jugular vein thrombosis as the first presenting sign of primary lung malignancy.
Fulltext Perception of telemedicine among medical practitioners in Malaysia during COVID-19

Thong HK, Wong DKC, Gendeh HS, Saim L, Athar PPBSH, Saim A

J Med Life, 2021;14(4):468-480.
PMID: 34621369 DOI: 10.25122/jml-2020-0119

The novel Coronavirus Disease 2019 (COVID-19) has brought unprecedented changes in the way conventional health care is delivered. This study examined if clinicians' perceptions regarding telemedicine and its barriers to implementation in Malaysia have changed during this pandemic. A cross-sectional survey was conducted among Malaysian medical doctors of various specialties in four urban healthcare facilities between June 2020 and July 2020. A total of 146 (41.7%) out of 350 responses were obtained. 62% of doctors reported a reduction greater than 50% in outpatient visits during the COVID-19 pandemic. The majority of doctors either found telemedicine useful in situations similar to COVID-19 (34.2%) or that it is essential to their daily practice (42.5%). However, only 22% reported using telemedicine for consultation during the COVID-19 pandemic. 74% of doctors felt that telemedicine would only benefit up to 30% of their patient population. Significantly more female doctors (80%) felt that telemedicine would benefit their patients compared to male doctors (45.8%) (P=0.03). Physicians (51.3%) were more inclined to adopt telemedicine in comparison to surgeons (32.4%) (P=0.03). The majority cited medico-legal issues and consent (80.6%), billing and charges (66.7%) and insurance reimbursement (62.5%), technical difficulties (62.5%) as their barrier to the adoption of telemedicine. Female doctors and physicians were more willing to adopt telemedicine when compared to male doctors and surgeons. Although the COVID-19 pandemic appeared to improve the perception, significant barriers should be resolved before many can incorporate it into their practice.