Intratympanic methylprednisolone injection in idiopathic sudden sensorineural hearing loss after failure of systemic corticosteroid therapy

Idiopathic sudden sensorineural hearing loss (ISSNHL) is considered to be an otological emergency. The intratympanic (IT) steroid injection technique is introduced to decrease the side effects of systemic steroids and assumed to deliver a higher concentration of corticosteroids into the affected cochlea. The objective of the current study was to evaluate the hearing outcomes of high dose IT methylprednisolone among ISSNHL patients after failure of systemic corticosteroid therapy (SCT). Hearing outcomes of SCT were evaluated over a 15 months period. Upon failure of SCT, the treatment was continued with higher dose IT steroid (methylprednisolone 62.5 mg/mL). Pre-treatment and post-treatment audiometric evaluations were analysed using pure tone audiogram (PTA). There were 36 patients diagnosed with ISSNHL included in the study. After two weeks of SCT, eighteen (56.3%) patients had hearing improvement of more than 10 dB. Another fourteen (43.7%) patients had no hearing improvement (less than 10 dB). Following that, twelve patients were recruited for weekly IT methylprednisolone for three weeks. During the one month follow up after completion of IT therapy, six patients (50%) showed more than 10 dB improvement in the PTA with a mean of 19.37 dB (p<0.05). Out of the six, two patients had more than 20 dB hearing improvement. Almost all patients in this study had an improvement in their symptoms of tinnitus and vertigo. High dose IT methylprednisolone after failure of SCT resulted in significant improvement in the patients’ hearing outcome during one month follow up. The IT therapy not only improved the patients’ hearing but in addition reduced the symptoms of tinnitus and vertigo

Transforming growth factor beta 3 induced human adipose-derived stem cells for auricular chondrogenesis

The limitation of self-repair and proliferation capacity of chondrocytes in cartilage reconstruction lead to alternative search of cell source that can improve the auricular regeneration. Human adipose-derived stem cells (HADSC) are an alternative cell source that have unique characteristics to self-renew and differentiate into various tissues making it suitable for cell therapy and tissue engineering. This study aimed to examine the chondrogenic differentiation potential of (HADSC) in monolayer culture by the presence of different transforming growth factor beta’s, TFG-β1, -β2 and -β3. HADSC at passage 3 (1.5 × 105 cell/mL) were cultured in chondrogenic medium containing 5 ng/mL of different transforming growth factor beta’s, TFG-β1, -β2 and -β3 for 7, 14 and 21 days. Data analysis was evaluated based on the growth rate of cells, cells morphological changed, production of collagen type II and glycosaminoglycan sulphate (sGAG). The quantitative RT-PCR was carried out to determine the chondrogenic, fibrogenic and hypertrophic gene expression levels. Differentiation of HADSC into chondrocytes using TFG-β indicates the occurrence of the chondrogenesis process. The best chondrogenic differentiation was observed in HADSC induced by TFG-β3 through the chondrocytes-like cells morphology with cells aggregation and high production of proteoglycan matrices compared to other TGF-βs groups. Additionally, the expression of chondrocytes-specific genes such as Type II collagen, Aggrecan core protein, Elastin and Sox 9 was high. In conclusion, this study has showed that TGF-β3 is the potential growth factor in producing chondrogenic cells for auricular cartilage tissue engineering

Perceptions of patient safety competency among graduating pharmacy, nursing, physiotherapy and medical imaging students: A cross-sectional study in Malaysia

Aim: The study aimed to investigate the perceptions of patient safety competency (PSC) among a sample of graduating healthcare professionals in a developing country. Methods: A cross-sectional survey on self-reported confidence in PSC was conducted among 469 graduands of pharmacy, nursing, physiotherapy and medical imaging at a private healthcare educational institution in Malaysia. Students’ confidence in six core domains of competency in the validated Health Professional Education in Patient Safety Survey (H-PEPSS) questionnaire was evaluated in the classroom and clinical settings. Results: Nursing students were the most confident in PSC followed by pharmacy, physiotherapy and medical imaging students (p <0.05) in both settings. The pharmacists’ scores in both settings were equal in all the domains except for the learning on the ‘Recognise and respond to reduce harm’ domain (p = 0.01). Conclusion: Based on H-PEPSS, the pharmacy students attained equal high levels of confidence in patient safety competency from both classroom and clinical settings

Detection of Human Papillomavirus, p53 and c-erbB-2 Protein Expression in Juvenile Laryngeal Papillomatosis: A Report of 2 Cases

The association of human papillomavirus (HPV) with juvenile laryngeal papillomatosis has been well documented. We report two cases of juvenile laryngeal papillomatosis and correlated these cases with presence of HPV, p53 and c-erbB-2 proteins. The first case was a one-year-old male patient and the second a six-year-old female patient. Formalin-fixed paraffin-embedded biopsy specimens were tested for the presence of HPV genome by the technique of in situ hybridisation using wide spectrum and type specific biotinylated probes while the immunohistochemical expression of p53 (D07, 1:50) and c-erbB-2 (DAKO A0485, 1:300) proteins were evaluated with commercially available antibodies. Histologically the tumours in both cases showed papillary configuration of squamous papilloma. The first case detected HPV type 6, HPV type 11 and p53 protein expression while the second case showed only HPV type 6. Both cases of HPV showed positive signals confined to the nuclei in the superficial squamous epithelium. The first case showed p53 positivity seen from the basal region up to one third of the epithelium of laryngeal papillomas and the subsequent recent repeat biopsy showed the positivity of p53 had extended throughout the upper layers of the epithelium. Expression of c-erbB-2 protein was not detected in both cases. These findings were similar as in other studies where follow-up of the cases was recommended since they tend to recu

Cochlear implantation in congenital cochlear abnormalities

Many children have benefited from cochlear implant device including those with congenital malformation of the inner ear. The results reported in children with malformed cochlea are very encouraging. We describe 2 cases of Mondini’s malformation with severe sensorineural hearing loss. Cochlear implantation was performed and both of them underwent post-implantation speech rehabilitation. Post-implantation both of them were noted to respond to external sound. But the second case developed facial twitching a few months after the device was switched on. It is important to evaluate the severity of the inner ear deformity and the other associated anomalies in pre-implantation radiological assessment in order to identify the problem that may complicate the surgery and subsequent patient management

Mastoid Abscess in Acute and Chronic Otitis Media

Background: Mastoid abscess remains a recognised complication of otitis media despite the advent of antibiotics. The objectives of this study were to describe the risk factors in patients with mastoid abscess following acute and chronic otitis media and discuss the management of this infection. Methods: A retrospective analysis was done on all patients who underwent mastoidectomy for mastoid abscess from January 2002 to December 2007. Data on the patients’ presentation, associated complications, management, and follow-up were analysed. Results: A total of 12 patients were enrolled in this study population. Group A consisted of patients with mastoid abscess preceded by acute otitis media, while Group B consisted of patients with mastoid abscess and chronic otitis media. In Group A (n = 7), 4 patients had a pre-morbid immunocompromised condition, but they did not have cholesteatoma. None of the patients in Group B (n = 5) had any pre-morbid illnesses. Out of 12 patients, 7 patients had associated extracranial complications, and 1 patient had intracranial complications. Most patients recovered well after mastoidectomy. Recurrence was noted in 1 patient who had acute lymphoblastic leukaemia. Conclusion: Mastoid abscess is still a recognised complication of acute otitis media, especially in patients who are immunocompromised. Immunocompetent patients may also develop mastoid abscess following chronic otitis media associated with cholesteatoma. Thus, early treatment of otitis media and close vigilant follow-up are advocated to ensure prompt detection of mastoid abscess complications

Management of Iatrogenic Facial Nerve Palsy and Labyrinthine Fistula in Mastoid Surgery

A 6-year review of complications of mastoid surgery between June 1995 and June 2001 revealed five cases with serious iatrogenic complications from mastoid surgery, of which four were facial nerve palsy and two were labyrinthine fistula. One of these patients had concomitant facial nerve palsy and labyrinthine fistula. There were two cases of complete facial nerve palsy (House Brackmann grade VI) and two cases of incomplete palsy (House Brackmann grades IV and V). The second genu was the site of injury in three of the four cases. Of the four cases with facial nerve palsy, two patients had full recovery (House Brackmann grade I), one recovered only to House Brackmann grade III, and one was lost to follow-up. Both patients with labyrinthine fistula had postoperative vertigo and profound sensorineural hearing loss. The site of iatrogenic fenestration was the lateral semicircular canal in both cases

Public and private sectors collective response to combat COVID-19 in Malaysia.

Over the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed "private contractors" who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment