A health related quality of life assessment in treated head and neck cancer patients in east coast of Malaysia

INTRODUCTION Length of survival and tumour recurrence has long been used as the assessment of treatment outcome in Head and Neck cancer patients. However for the past 20 years with reduction in tumour recurrence and increasing survival rates, quality of life (QOL) of the survivors has becoming the measure of treatment outcome. Recent data from United State indicated that the number of patients with Head and Neck cancer is increasing over the years and the trend is probably similar in Malaysia. QOL is a broad concept which covers four essential components which are physical function, psychological state, social interaction and somatic sensation. There are many validated instruments available worldwide and the University of Washington quality of life (UWQOL) questionnaire is the most commonly used in United Kingdom as well as United States. As in other parts of the world, there has been an increasing demand for Malaysian researchers nowadays to assess the QOL in their Head and Neck cancer patients. OBJECTIVES The main objective in this study is to evaluate quality of life in the treated Head and Neck cancer patients. METHODOLOGY This is a cross-sectional study in a treated Head and Neck cancer patients conducted in Ear, Nose and Throat clinic (ENT) of Hospital Tengku Ampuan Afzan (HTAA) Kuantan in the state of Pahang and ENT clinic of Hospital Universiti Sains Malaysia (HUSM) Kubang Kerian in the state of Kelantan. Those Malay patients who fullfilled the inclusion and exclusion criteria were recruited into this study. Standard validation process were followed which include forward and backward translation of the originial version UWQOL. Patients were asked to answer the Malay version UWQOL. Data were analysed using statistical software SPSS version 12.0 for Windows. RESULTS Reliability was tested by inter-item correlation coefficient with Cronbach' s alpha value of 0.80. Test-retest reliability as reflected by intraclass correlation coefficient was 0.85. Patients with early stage tumour (stage I and II) tend to score higher than advance stage tumour (III and IV). Site of tumour and mode of treatment does not significantly affect the patients QOL. CONCLUSION This data suggest that Malay version of UWQOL is reliable and valid qestionnaire when applied to a sample of Head and Neck cancer patients in Malaysia. Tumour stage was the strongest determinant of quality of life in Head and Neck cancer patients

Pilomatrixoma: a diagnostic pitfall on fine-needle aspiration cytology of benign ‘neck metastases’

Pilomatrixoma is a benign tumour that originates from the matrix of the hair root. This rare tumour is usually managed by the dermatologists. The commonest location of this tumour is in the head and neck region; hence, it can be encountered by any doctors with interest in this area. When presented in the neck, this hard tumour may pose a diagnostic challenge. A case report of pilomatrixoma misdiagnosed as a metastatic neck disease from fine-needle aspiration cytology is presented. The mistake in the diagnosis has led to a more aggressive and high morbidity surgery than necessary. It is important that head and neck doctors be aware of this condition and includes it in the differential diagnosis of hard masses presenting in the neck

Thyroglossal duct carcinoma

We report a 56-year-old Malay woman with a tumour that involved the skin and caused hyoid bone erosion. There was no clinical or radiological evidence of regional lymph node involvement. A modified radical neck dissection with preservation of the accessory nerve and internal jugular vein was performed, followed by an "extended" Sistrunk operation. The surgical defect was reconstructed with a pectoralis major myocutaneous flap. Our literature review showed that this is the first reported thyroglossal duct carcinoma which involved the skin and required a pedicle flap reconstruction

Antimicrobial combination effects between curcuminoids and ampicillin against standard and clinical strains of staphylococcus aureus

Antimicrobials combination therapy has been used to treat infections for decades, with the goal of achieving synergistic effects, producing wider spectrums of coverage and minimizing any toxicity effects of conventional antimicrobial agents. Plant metabolites are among the suitable candidates to be used as antimicrobial and synergistic agents, which can help mankind to curb the evolution of drug-resistant strains of microbes. S. aureus infections are commonly treated with the penicillin group antibiotics such as ampicillin. However, S. aureus resistance to these antibiotics keeps on increasing and the therapy produce serious side effects, such as hypersensitivity or anaphylactoid reactions. Curcuminoids, which are responsible for the yellow colour of Curcuma longa L. or turmeric rhizomes possess bio-protective properties, which include promising antimicrobial activity with very low incidence of toxicity. For these reasons, our research effort turned to the antimicrobial combination study between ampicillin and curcuminoids in a view to enhance antimicrobial efficacy and developing safer drugs. In this study, the antimicrobial activity of curcuminoids mixture, which was fractionated from the dichloromethane extract of turmeric rhizomes was determined alone and in combination with ampicillin. The activity was tested against the standard strain of Staphylococcus aureus ATCC 25923 and the clinical isolate, which was obtained from patient diagnosed as having S. aureus infection at Hospital Tuanku Ampuan Afzan (HTAA), Kuantan. The minimum inhibitory concentration (MIC) for antimicrobial activity of the curcuminoids fraction and ampicillin, alone and in combination were evaluated by means of broth microdilution assay and chequerboard assay, respectively. The curcuminoid constituents of the fraction were analysed by TLC co-chromatography with authentic samples. TLC Agar Overlay Bioautographic assay was performed to screen the responsible curcuminoids for the antimicrobial activity of the fraction against both strains.The antimicrobial activity studies showed that the combination of ampicillin with curcuminoids fraction is likely to reduce the MIC of ampicillin compared with when tested alone against both strains of S. aureus. The results highlighted the occurrence of a pronounced synergism between 312.50 µg/ml of curcuminoids fraction and 1.56 µg/ml of ampicillin against the clinical strain with Fractional Inhibitory Concentration Index (FICI) of 0.25. These curcuminoids-drug combination augmented the antimicrobial activity of both ampicillin and curcuminoids fraction eight times compared with when tested alone. TLC profile of the curcuminoids fraction showed three yellow phenolic pigments, namely curcumin, demethoxycurcumin and bisdemethoxycurcumin, with the Rf values of 0.66, 0.46 and 0.31, respectively in dichloromethane(18):ethyl acetate(1) solvent system. TLC bioautographic assay has revealed these curcuminoids as the responsible compounds in the fraction that act synergistically with ampicillin. The finding suggests that curcumin, demethoxycurcumin and bisdemethoxycurcumin are promising synergistic agents for antimicrobial combination therapy with ampicillin. The synergistic combination is found useful in combating S. aureus resistance towards ampicillin and minimizing the undesired effects of the antibiotic

Tracheal agenesis as a rare cause of difficult intubation in a newborn with respiratory distress: a case report

<p>Abstract</p> <p>Introduction</p> <p>Tracheal agenesis is a very rare congenital airway anomaly. It may pose a great challenge to the first attending physician both in diagnosis and in establishing the airway during the first day of life.</p> <p>Case presentation</p> <p>We report a newborn Malay baby boy with trachea agenesis (type III by Floyd's classification) who presented with severe respiratory distress immediately after birth. Clinical diagnosis in this case was not straightforward, as it started with difficulty in intubation followed by an unsuccessful emergency tracheostomy in the neonatal intensive care unit. Urgent surgical neck exploration with endoscopic examination in the general operating theatre revealed the final diagnosis. The authors present a short description of the embryopathology and diagnostic criteria of the abnormality.</p> <p>Conclusion</p> <p>We hope this case presentation will be valuable in increasing the awareness of physicians about this rare cause of tracheal obstruction or difficult intubation.</p

Differential expression of miR-101 and miR-744 in nasopharyngeal carcinoma in Pahang state of Malaysia

Previous study found that microRNA-101 (miR-101) and microRNA-744 (miR-744) were deregulated in head and neck cancers and were implicated in nasopharyngeal carcinoma (NPC) carcinogenesis. Thus, this study aimed to determine the expression of miR-101 and miR-744 in NPC and analyse the utility of these microRNAs (miRNAs) as diagnostic biomarkers. Total RNA was extracted from 31 NPC and 7 non-NPC control formalin-fixed paraffin-embedded (FFPE) samples. Complementary DNA (cDNA) was synthesized from the total RNA and proceeded with quantitative real-time polymerase chain reaction. Differential expression of miR-101 and miR-744 were calculated from quantification cycle (Cq) data using 2-ΔΔCq calculation. The performance of these miRNAs were calculated using receiver operating characteristic (ROC) curve analysis. The differential expression for miR-101 and miR744 were -1.39 (p 0.05), respectively, where the deregulations were consistent with the previous report. The area under curve for miR-101, miR-744 and combination of miR-101 and miR744 were 0.654 (95 % CI: 0.465 - 0.844), 0.588 (95 % CI: 0.368 - 0.808) and 0.626 (95 % CI: 0.481 - 0.771), respectively. However, re-analysis using balanced sample size between NPC and non-NPC control group showed the value decreased to 0.653 (95 % CI: 0.347 - 0.959) for miR-101 but increased to 0.827 (95 % CI: 0.601 - 1.000) for miR-744 and 0.758 (95 % CI: 0.576 - 0.939) for the combination of miR-101 and miR-744, indicating the importance of having a balanced sample size. We have successfully determined the expression of miR-101 and miR-744 in NPC samples. We also demonstrated statistically the utility of these miRNAs as diagnostic biomarkers

Expression of microrna-101 in formalin-fixed paraffin- embedded samples of nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is among the five most common malignancies in Malaysia. Most NPC patients are diagnosed at late stages of the disease which complicates the clinical management of the patients. Identification of new reliable biomarker is crucial to improve early diagnosis of NPC and increase the survival rate of patients. Recent study found that microRNAs (miRNAs), particularly miR-101, were involved in the tumorigenesis of head and neck cancer where NPC samples were included in the study. This study was conducted to observe the expression of miR-101 in NPC tumour tissues and compare its consistency with previous study as a step towards finding the new biomarker for NPC. The biopsy samples were obtained from hospitals and verified histologically using hematoxylin and eosin method for tissue classification. Total RNA was extracted from NPC tissues and normal nasopharyngeal epithelium tissues. The expression of miR-101 in NPC was quantified using quantitative polymerase chain reaction (qPCR) method. The differential expression of miR-101 in NPC as compared to normal nasopharyngeal epithelium tissues was analysed using 2-ΔΔCT calculation. The significance of the differential expression was analysed using SPSS software. Five samples have been verified as NPC and three samples were normal nasopharyngeal epithelium. The differential expression calculation found that miR-101 was downregulated in NPC as compared to normal nasopharyngeal epithelium tissues, which consistent with previous study. However, the differential expression was not significant. Therefore, our finding provides a preliminary result towards embarkment of a larger and comprehensive study. © 2019 Malaysian Society for Biochemistry and Molecular Biology. All rights reserved

Quantile Normalization for High Throughput Circulating MicroRNA Expression Study using TaqMan® Low Density Array Panels: Supporting Evidence

In searching for new biomarkers, high throughput technique has been widely used by researchers, including for gene expression study. However, the reliability and accuracy of results from high throughput study critically depends on appropriate data management, including normalization methods. Data driven normalization has been introduced as a normalization method for high throughput gene expression study. Thus, this study was conducted to evaluate the performance of various data driven and reference genes normalization methods using a high throughput circulating microRNA expression dataset. A quantification cycle (Cq)  dataset generated from a high throughput circulating microRNA study was used to test the normalization methods using HTqPCR package in R software. The normalized Cq generated from different methods were compared descriptively using box plot analysis and coefficient of variance. The box plot analysis showed that quantile normalization produced more homogenous Cq distribution, lesser outliers and reduced coefficient of variance as compared to other normalization methods in screening and validation phases. The overview on quantile normalized Cq showed consistency in its level of expression before and after 2-∆∆Cq calculation indicating the reliability of quantile normalized Cq. Quantile normalization is suggested to be used in high throughput miRNA expression study due to its performance in homogenizing the data, reduce outliers and coefficient of variance

Cutaneous ALCL mimicking malignant epithelial tumor in the head and neck region

Objective: To highlight a rare case of cutaneous ALCL in the head and neck region. Method used: Case report. Result: The patient presented with large ulcerative lesion in the lateral neck region and at presentation has already had multiple lung metastasis. With its aggressive behavior and appearance, this lesion is mimicking malignant epithelial tumor of the lateral neck. Conclusion: This case has highlighted that cutaneous ALCL may occur in the head and neck region and behave aggressively. It may present in an unusual way, and this may cause delay in the diagnosis. Therefore, early diagnosis is essential so that treatment can be instituted early for a better prognosis

Socio-demographic factors and quality of life of head and neck cancer patients before and after treatment in the East Coast of Malaysia

Objective: This study aimed to determine the association of socio-demographic factors and quality of life (QOL) of HNC survivors before and after treatment in Malaysia. Methods: 40 HNC patients were recruited, and assessed for their with QOL with Life Cancer Survivor (QLQ-CS) Head & Neck 35 (QLQ-H&N35) questionnaire pre-treatment and six months post-treatment. One way analysis of variance (ANOVA) and paired t-test were done to analyse the data. Results: The result shows that the QOL of HNC patients were at medium level (total mean score M= 6.22) before treatment, and reduced (total mean score M= 4.84) at 6 months after treatment) . Only health history was seen significantly associated with QOL of HNC patients, both pre and post-treatment. Post treatment showed only marital status factor associated with QOL of HNC patients. The paired sample t-test result shows that the symptoms /problem pre- treatment (M = 255.10, SD = 20.405 )was lower than post treatment (M = 201.80, SD = 22.025)(t (49) = 9.337; p =0.001). Conclusions: The present research suggested that the patients’ QOL is reduced after treatment (medium level). This could be due to the advancement of the cancer and evidence when the health history and symptoms found significantly associated with the QOL. Thus, socio-demographic factors is very crucial factors that must be considered during patients’ assessment in improving patients’ care and optimum QOL pre and post treatment