A study on heavy metals accumulation and human health risk assessment in the consumption of two tropical freshwater eel species (A. bengalensis bengalensis) from the Sungai Perak at Kuala Kangsar, Perak and (A. bicolor bicolor) from the Air Hitam irrigation canal, Kampung Kuala Sanglang, Kedah was carried out. Specimens were examined and analyzed for Pb and Cd concentrations using ICP-MS while the total Hg concentration was measured using a direct mercury analyzer (MA-3000). The range for the total concentrations (µg/g wet wt.) in A. bicolor bicolor were 0.01-0.4 (Cd), 0.03-0.77 (Pb) and 0.36-0.94 (Hg) while for A. bengalensis bengalensis, they were 0.76-1.23 (Cd), 0.01-0.10 (Pb) and 0.27-1.5 (Hg). A. bengalensis bengalensis (Sungai Perak) showed a significant strong relationship between Hg/Pb (r = .771, P < 0.05) and A. bicolor bicolor (Air Hitam irrigation canal) with Cd/Pb (r = -.895, P < 0.05) in muscle tissues and the results indicated Hg and Pb were introduced from point and non-point sources, therefore it is of concern. Interspatial comparison with the findings of previous local and international studies showed both species of freshwater eels accumulated Hg to high levels, exceeding the safe limits stipulated in the Malaysian Food Act of 1984, Food Regulations (1985) and USEPA (1997). However, the Target Hazard Quotient (THQ) and Hazard Index (HI) indicated that both freshwater eel spp. from the studied sites are safe to consume as there is no risk posed from consumption based on the health risk assessment results as Pb, Cd and Hg concentrations were under the permissible limits of nutrient intake.

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.
Tracheostomy

This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.

Bilateral vocal fold immobility (BVFI) is commonly caused by injury to the recurrent laryngeal nerve (RLN) and leads to stridor and dyspnea of varying onsets. A retrospective study was done at the Department of Otorhinolaryngology of Universiti Kebangsaan Malaysia Medical Centre on laser microsurgical posterior cordectomy for BVFI. The objectives were to identify the average duration of onset of stridor from the time of insult and to evaluate the outcome of laser posterior cordectomy as a surgical option. From 1997 to 2007, a total of 31 patients with BVFI were referred for surgery. Twelve patients had tracheostomy done prior to the procedure, whereas 19 patients were without tracheostomy. Ten patients were successfully decannulated, and only 4 patients had complications related to the procedure. The minimum onset of stridor was 7 months, maximum onset of stridor was 28 years, and the mean onset of stridor was 8.7 years. The commonest complication observed was posterior glottic adhesion following bilateral posterior cordectomy. Laser endolaryngeal posterior cordectomy is an excellent surgical option as it enables successful decannulation or avoidance of tracheostomy in patients with BVFI. The onset of stridor took years after the insult to the recurrent laryngeal nerves.

We describe a case of non-tuberculous mycobacterial infection of the larynx in a previously well, immunocompetent young woman. Laryngeal mycobacterial infection is rare and currently accounts for less than 1% of all cases. A diagnostic dilemma often occurs because it may mimic laryngeal carcinoma, chronic laryngitis, or laryngeal candidiasis. This case highlights the importance of considering non-tuberculous mycobacterial infection in the differential diagnosis of laryngeal lesions.
Candidiasis ; Diagnosis, Differential ; Female ; Humans ; Hypopharynx* ; Laryngitis ; Larynx ; Nontuberculous Mycobacteria ; Pharynx ; Ulcer*

INTRODUCTIONIn laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period.

MATERIALS AND METHODSA retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted.

RESULTSEighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain.

CONCLUSIONSTEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.

Academic Medical Centers ; statistics & numerical data ; Adult ; Aged ; Constriction, Pathologic ; epidemiology ; etiology ; Equipment Failure Analysis ; Female ; Humans ; Incidence ; Laryngectomy ; rehabilitation ; Larynx, Artificial ; adverse effects ; Malaysia ; epidemiology ; Male ; Middle Aged ; Punctures ; adverse effects ; Retrospective Studies ; Speech, Alaryngeal ; Trachea ; surgery

Aims: Pickled fruits are a popular condiment not only in Malaysia but throughout the world. Lactic acid bacteria (LAB) are known to be able to produce several antibacterial compounds during the pickling process. Pickled Eleiodoxa conferta or kelubi is among the commonly consumed pickled fruits in Malaysia and may be a promising source of LAB. This study was carried out to isolate and identify LAB from local pickled E. conferta and to determine their antibacterial activity against foodborne pathogens. Methodology and results: The isolation of LAB was conducted using standard methods and the isolated colonies were preliminarily identified based on their morphology on De Man, Rogosa and Sharpe (MRS) agar, Gram-positive staining characteristics and their catalase-negative reactions and subsequently chosen for identification with polymerase chain reaction (PCR) amplification of the 16S rRNA gene and sequencing. A total of four LAB isolates were successfully isolated and identified: Lactobacillus brevis (LABK1 and LABK2), L. plantarum (LABK3) and Leuconostoc mesenteroides (LABK4). The antibacterial activity of the identified LAB was determined against 10 commonly known foodborne bacterial pathogens using LAB cell cultures by agar spot test method. The antibacterial activity was also evaluated using the cell free supernatant (CFS) of the LAB through agar well diffusion method. All four LAB cultures were able to demonstrate antibacterial activity and inhibited five Gram-positive and five Gram-negative bacterial pathogens. Conclusion, significance and impact of study This study demonstrated that the isolated LAB from E. conferta has antibacterial effects against several foodborne pathogens. These LAB strains may have potential as a natural food preservative.

Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

OBJECTIVE: To report two cases of cardiovocal syndrome (or Ortner's syndrome) due to cardiovascular disease.

METHODS:
Design: Case report
Setting: Tertiary University Hospital
Subjects: Two

RESULTS: Two patients with Cardiovocal syndrome, one due to an aortic saccular aneurysm and the other due to severe mitral stenosis underwent surgery to correct the underlying cardiovascular disease. Post-operatively, the hoarseness resolved completely in the patient with mitral stenosis but persisted in the patient with aortic saccular aneurysm.

CONCLUSION: Cardiovascular disease should be considered as a differential diagnosis in a patient with hoarseness. A high index of suspicion is needed to make an early diagnosis which can lead to surgical correction of the potentially life-threatening, underlying cardiovascular disease.

Human ; Female ; Middle Aged ; Adult ; HOARSENESS ; Cardiovascular Diseases ; Mitral Valve Stenosis ; Diagnosis, Differential