Osteoma is the most common benign tumour of the nose and paranasal sinuses. However, involvement of the sphenoid sinus by osteoma is rare. Most of the time, patients with paranasal sinus osteoma are asymptomatic. However, symptoms may present, depending on the location and extension of the tumour. We report a case of a patient with sphenoethmoidal osteoma found incidentally on imaging, with evidence of impingement onto the optic nerve at the optic canal. However, the patient was asymptomatic. He was surgically treated using the endoscopic transnasal approach.
Osteoma ; Sphenoid Sinus

Helminthiasis is a common parasitic condition particularly among children in rural areas in developing countries where poor hygiene standard is practiced. The study aimed to determine the prevalence of helminthiasis among Indian preschoolers in urban areas in Penang and its associated factors. A total of 194 urban Indian preschoolers aged 4 to 6 years old were selected randomly from 11 kindergartens in the state of Penang for this cross sectional study. Data collection was carried out in 2 phases. First, microscopic stool examinations were done to examine the presence of helminths. Second, self administered questionnaires which inquired about human, environment and socioeconomic factors were completed by the parents/guardians. The overall prevalence of helminthiasis was 7.2% and the most frequently encountered infective agent was Ascaris lumbricoides (57.1%) and followed by the tapeworms (42.86%). The logistic regression indicated that habitual thumb sucking (AOR= 5.6. 95%CI: 1.73-18.39) and families owning domestic pets (AOR= 3.2; 95%CI: 1.03-10.14) were the significant contributing factors to helminthiasis among the Indian pre-schoolers in urban Penang. Although the prevalence of helminth infection among the urban Indian preschoolers is lower than rural area, it is still a public health concern. Children habitual thumb sucking and rearing domestic pets at home were the significant contributing factors in helminthiasis. Prevention strategy should focus on health education and promotion among adults and children, awareness on domestic animal hygiene and maintaining good environmental sanitation. Multi agency collaboration is clearly essential, especially between state health, education and veterinary departments in curbing this disease.

Thalassaemia is an inherited blood disorder and is a significant public health alarm in Malaysia with many not knowing they are carriers of this haemoglobin disorders. Materials and methods: This study conducted a one off collection of blood samples from 72 Malays students of International Islamic University Malaysia (IIUM) in Kuantan. Blood samples were subjected to conventional haemoglobin analyses that include full blood count and picture, HPLC, Haemoglobin electrophoresis and H-inclusion test. All samples were also genotyped for alpha thalassaemia–1 of Southeast Asia (a-Thal1SEA). Result: There were 17(23.6%) students who were diagnosed as thalassaemia carriers. Out of this, four (5.5 %) and six (8.3 %) students were presumptive β-thalassaemia trait and Haemoglobin-E trait as determined by the HPLC assay respectively. Nine (12.5%) students were genotyped a-Thal1SEA among whom two were also β-thalassaemia carriers. All thalassaemia cases had MCH of < 27pg. Nonetheless, two out of six Haemoglobin-E trait and three out of nine a-Thal1SEA carrier had MCV value of >80fL. Two out of four (50%) presumptive β -thalassaemia trait and one out of six (17%) students of presumptive Haemoglobin-E trait had family history of thalassaemia respectively. Conclusion: The high occurrence of the three common types of thalassaemia carrier (β, Hb-E and a-Thal1SEA thalassaemia) in our small group of subjects could be due to better participation of students who had family history of thalassaemia. The study reaffirmed the importance of molecular study for detection of alpha-thalassaemia and the use of MCH value of <27pg rather than MCV value of < 80fL for prediction of thalassaemia.

This study was conducted to obtain tympanometric normative data for Malay preschoolers and compare them between genders. Non-pathological factors such as age, gender and ethnicity may influence tympanometric normative data. Guidelines for middle ear screening by American Speech and Hearing Association (ASHA) are based on Caucasian children population and may not be applicable to Malay children population. The tympanometric parameters measured were peak compensated static acoustic admitan (peak Ytm), volume ear canal (Vea) and tympanometric width (TW). Onehundred and sixty-one Malay pre-schoolers (eighty boys and eighty-one girls) participated in this study. However only fourty-five boys and fourty-six girls (163 out of 182 ears) had fulfilled the study inclusion criteria which include normal otoscopic findings, pass hearing screening and presence of ipsilateral acoustic reflex at 1000 Hz. Two-way Mixed ANOVA to compare the mean tympanometric parameters of boys and girls showed no significant difference for the mean peak Ytm ( p > 0.05), mean Vea [( p > 0.05), mean TW (p > 0.05). Thus data from the two groups were combined. Overall, the mean peak Ytm was 0.55 ± 0.28 mmhos, mean Vea was 0.90 ± 0.40 cm3, and mean TW was 104.68 ± 32.08 daPa. The 90th percentile values for peak Ytm, Vea and TW were 0.27 to 1.18 mmhos, 0.45 to 1.65 cm3 and 59.60 to 149.80 daPa consecutively. This current study suggests that the data obtained are applicable to Malay preschoolers but gender-specific norms are not necessary. Application of each value of TW > 200 daPa and Vea > 1.0 cm3 by ASHA on Malay preschoolers will cause under referral rate and over-referral rate consecutively.

Electromagnetic navigational bronchoscopy (ENB), one of the methods of navigational bronchoscopy is an advanced diagnostic tool allowing tissue sampling at the lung peripheries which were previously accessible only by computed tomography (CT) guidance or video-assisted thoracoscopic surgery (VATS). We report a 53-year-old man who presented with a cough and dyspnea with constitutional symptoms for one month. CT thorax revealed multiple bilateral peripheral lung nodules and there were no endobronchial lesions on flexible bronchoscopy. ENB was performed using a loan machine from Veran navigational technology. Biopsy successfully revealed small cell carcinoma of the lung thus preventing him from undergoing a more invasive diagnostic procedure. This case highlights the utility of ENB in the evaluation of peripheral lung nodules that were inaccessible by conventional bronchoscopy. This is one of the first few successful applications of Veran ENB in Asia.

The most common extra-articular manifestation of rheumatoid arthritis (RA) is interstitial lung disease (ILD). RA related ILD (RA-ILD) is associated with significant morbidity and mortality. The main objective of this study was to determine the correlation between the rheumatoid factor (RF) serotypes and the severity of RA-ILD based on computed tomography (CT) findings. We recruited a total of 100 RA patients who were tested for IgA RF, IgG RF and IgM RF and had high resolution CT chest performed. Seventy-two patients had ILD changes on HRCT of the chest and were included in this study. We found that the the CT scores for ground glass showed significant positive correlation with disease duration and IgA RF levels whereas the fibrosis scores had significant relationship with multiple clinical covariates i.e age, disease duration, IgA RF levels, IgG RF levels and anti-CCP levels. On multivariate analysis, only IgA levels remained significantly (p<0.05, standardized beta coefficient = 0.604) associated with the ground glass scores. Regarding the fibrosis scores, IgA RF levels and age were independent predictors based on multivariate analysis after adjusting for confounders, with p scores of <0.05 and 0.02, respectively. In conclusion, the IgA RF was the only serotype which was independently associated with the severity of RA-ILD.

Infections caused by Strongyloides stercoralis (S. stercoralis) in human are generally asymptomatic, however in immunocompromised individual, hyperinfection may develop with dissemination of larvae to extra-intestinal organs. The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself, which may lead to low index of suspicion as a consequence. In this report, a case of a Malaysian male with underlying diabetes mellitus, hypertension, cerebrovascular ac-cident, bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented. However, he developed septicemic shock later, and S. stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli. Regardless of aggressive resuscitation, the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome. It was revealed that the current case has alarmed us via incidental finding of S. stercoralis larvae in the tracheal aspirate, indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.

Aims: The goal of the study is to isolate new bacteria species which are capable to utilizing 2,2-dichlropropionic acid (2- 2-DCP) as a sole carbon source from the wastewater sample that was taken from Tioman Island off the coast of Malaysia. Methodology and results: Genomic DNA from unknown bacterial strain (MR1) was extracted and PCR amplification was carried out using universal primers, Fd1 (5’-AGA GTT TGA TCC TGGCTC AG-3’) and rP1 (5’-ACG GTC ATA CCT TGT TAC GAC TT-3’) prior to sequencing. The BLASTn and phylogenetic analysis of the 16S rRNA of the MR1 gene found it shares a 95% homology to an aerobic bacillus Raoutella ornithilolytica. The bacteria which is usually found in an aquatic and hospital environment was found to possess a distinctive feature of being able to utilize 2,2-DCP as sole carbon source. The bacteria has cell doubling time of 23.11 h and maximum release of chloride ion at 0.257 mmol/L in 20 mM 2,2-DCP. Based on morphological and partial biochemical characteristics, the strain was found to be non-motile, Gram negative bacteria with red colonies that gave a positive catalase reaction. Conclusion, significance and impact of study: A better understanding of newly isolated microorganisms from the environment which can potentially be used as bioremediation tools in environmental management. This is the first reported case of Raoutella sp. that has the unique ability to degrade halogenated compound. Hence, the dehalogenation properties and capabilities of the bacteria deserve to be assessed further.

Aims: A 2,2-dichloropropionic acid (2,2-DCP) naturally degrading bacterial species, strain SN1 was successfully isolated from cow dung capable of utilizing the substance as the sole carbon source and energy. Methodology and results: Strain SN1 was preferred over other strains (SN2, SN3 and SN4) following observations on its rapid growth in 20 mM 2,2-DCP liquid minimal media. Since strain SN1 clearly exhibited tolerance towards 2,2-DCP, its growth in various concentrations (10 mM, 20 mM, 30 mM and 40 mM) of the substance was evaluated. The study found the bacteria grew particularly well in 20 mM 2,2-DCP with the highest chloride release of 39.5 µmole Cl- /mL while exhibiting a remarkably short doubling time of 3.85 h. In view of such notable characteristics, species identification via Biolog GEN III system and 16S rRNA analysis was performed and established strain SN1 as Bacillus cereus. Conclusion, significance and impact of study: Considering the rapid growth of B. cereus strain SN1 in such medium, its employment as a bioremediation agent to treat 2,2-DCP contaminated soils may prove beneficial. Moreover, this is the first reported case of a Bacillus sp. isolated from cow dung capable of utilizing 2,2-DCP. Therefore, further assessment into its ability to degrade other types of haloalkanoic acids merit special consideration.
Bacillus cereus

This study was designed to obtain and compare the nasalance scores produced by normal Malay children and those with repaired palatal cleft. Data from 103 noncleft children and 27 children with repaired clefts were included. All children were of Malay origin with the Malay language (Kelantan dialect) as their first language. Two short and simple test stimuli were constructed in the Malay language; one resembled the Nasal Sentences and the other resembled the Zoo Passage (oral passage) used in nasometer testing. Nasalance scores were obtained with the Nasometer II model 6400 by Kay Elemetrics. Calibration of the nasometer and collection of data followed the recommended protocol outlined in the manual. Nasalance scores for the Oral Passage was significantly higher (p < 0.001) for the children with repaired palatal clefts when compared to scores for children without clefts. However, no differences in nasalance scores were detected between both groups for the Nasal Passage. The normative nasalance scores for Malay children with Kelantan dialect was established, which can be used as an objective reference in the management of Malay patients with resonance disorders.