Dysphagia lusoria caused by an aberrant right subclavian artery

Dysphagia of vascular origin is termed dysphagia lusoria and it is relatively uncommon. Amongst the vascular causes, aberrant right subclavian artery is the most common. This case illustrates the usefulness of imaging in the investigation of dysphagic patient for an accurate diagnosis and appropriate management of the condition

Dysphagia caused by an aberrant right subclavian artery

An aberrant right subclavian artery is the commonest aortic arch anomaly. Majority of them were asymptom- atic. An aberrant subclavian artery is a rare cause of dysphagia in adults. This condition is also known as dys- phagia lusoria. We report a case of dysphagia in a 49-year-old woman from an aberrant right subclavian artery. Diagnosis of her condition was made with barium swallow and MDCT (multidetector computed tomography) scan. She was managed conservatively

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

Ingestion of honey improves the symptoms of allergic rhinitis: Evidence from a randomized placebo-controlled trial in the East Coast of Peninsular Malaysia

BACKGROUND AND OBJECTIVES: The role of honey in the treatment of allergic rhinitis (AR) is controversial. We studied the complementary effect of ingestion of a high dose of honey, in addition to standard medications, on AR. DESIGN AND SETTINGS: Prospective randomized placebo-controlled study. Subjects were recruited from an otolaryngology clinic in 2 tertiary referral centers in the East coast of Peninsular Malaysia. The study period ranged from April 2010-April 2011. METHODS: Forty AR patients were divided equally into a case group and a control group. All the subjects received a daily dose of 10 mg of loratadine for 4 weeks. The case group ingested 1 g/kg body weight of honey daily in separate doses for the 4-week period. The control group ingested the same dose of honey-flavored corn syrup as placebo. AR symptoms were scored at the start, week 4, and week 8 of the study. RESULTS: There were no significant differences between the mean total symptom score of the case and the control groups at the start of the study. At week 4, both groups showed progressive improvement in the symptoms; at week 8, only the case group showed a continuous improvement in the symptom score. Only the group that ingested honey showed a significant improvement in individual AR symptoms. The improvement persisted for a month after the cessation of the treatment. CONCLUSION: Honey ingestion at a high dose improves the overall and individual symptoms of AR, and it could serve as a complementary therapy for AR

Penetrating large retro-orbital foreign body -fishing sinker: removal via endoscopic transnasal approach

Objective: To report a rare penetrating large orbital foreign body case in a young man with normal vision and ocular movement, and discuss issues regarding best route of its removal. Design: Case report. Materials and Methods: A young man had an accident while fishing and ended up with a sinker penetrated into his right orbit. He has no loss of vision and normal ocular movement. X-ray and CT scan showed a 4 cm bullet shaped sinker in the inferior aspect of the medial wall of the right orbit. Results: The removal was successfully done via endoscopic opening of the posterior ethmoid air cells and creating an opening at the anterior wall of the sphenoid sinus to facilitate the removal transnasally. There was no short term and long term complications resulting from the surgery. Conclusion: Transnasal endoscopic approach should be considered for removal of any medially positioned orbital foreign bodies. This case highlights the importance of a multidisciplinary approach in the management of orbital foreign body and in deciding the best route of foreign body removal to limit potential complications

Diagnosis and management decision in delayed posterior mediastinal abscess secondary to thoracic esophageal perforation following accidental fish bone ingestion

Accidental swallowing of fish bone, which arrested in either the cervical or thoracic esophagus, is fairly common. However, the incidence of esophageal perforation due this fish bone is low. Delayed posterior mediastinal abscess as a result of the esophageal perforation is a rare manifestation and may leads to fatal outcome. Two cases of delayed formation of posterior mediastinal abscess following thoracic esophageal perforation due to accidental fish bone ingestion are described in this presentation. In both cases the sole clinical feature is interscapular back pain. In one of the cases the patient died because of the presentation was misdiagnosed hence delayed intervention. The clinical presentations, radiological findings and surgical management are discussed. Neck exploration and esophagoscopy as the surgical treatment for this problem are illustrated. Key words: esophageal perforation, posterior mediastinal absces

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