We present a young adult female with symptoms of acute tonsillitis and tender cervical lymphadenopathy. Despite a full course of oral antibiotics, she had persistent left lower cervical lymphadenopathy measuring 2.0 x 1.5 cm at 2 weeks post-treatment. Rigid and flexible scope examinations did not reveal any abnormalities in the nasopharynx, oropharynx or hypopharynx. Tuberculosis tests were negative and blood index results were normal. Fine needle aspiration cytology revealed a non-specific granulomatous inflammatory process. Excisional lymph node biopsy was performed, and the patient was diagnosed as having Kikuchi’s Disease (KD). We would like to highlight the diagnostic challenges in detecting this condition and the importance of differentiating KD from tuberculosis and malignant lymphoma, the latter of which requires aggressive treatment.

BACKGROUND: Allergic rhinitis and rhinosinusitis, common and debilitating conditions, should be managed in accordance with guideline recommendations. Guideline adherence shows regional differences. As of now, there is little data from Asia and none from Malaysia on the current treatment practices and unmet needs in the management of these conditions. OBJECTIVE: The objective of this study was to assess the current practice in the management of allergic rhinitis and rhinosinusitis by conducting a survey among ear, nose and throat (ENT) specialists, pharmacists, and general practitioners (GPs) in Malaysia. METHODS: We conducted a survey study among ENT specialists, pharmacists, and GPs in Malaysia, who answered a multiple choice questionnaire focused on the current practice in the management of allergic rhinitis and rhinosinusitis in their respective field. More than 200 ENT specialists, 100 pharmacists, and 200 GPs participated in the survey. RESULTS: Antihistamines were the most preferred choice for the treatment of mild allergic rhinitis by ENT specialists (45%), pharmacists (78%), and GPs (51%), with the most preferable duration of <2 weeks. In moderate-to-severe allergic rhinitis, a combination of antihistamines and intranasal steroids was the most preferred treatment of choice in 90% of ENT specialists, 72% of pharmacists, and 69% of GPs. Efficacy of antihistamines was the main criteria of choice in 58%, 53%, and 38% of ENT specialists, pharmacists, and GPs, respectively. Notably, complaints of drowsiness associated with nonsedative antihistamines were the major unmet need identified in the survey. For chronic rhinosinusitis, a combination of antihistamines and intranasal steroids was the most preferred treatment. The majority of the respondents preferred a treatment duration of >3 months with antihistamines. Satisfaction with the recommendations in the current Allergic Rhinitis and its Impact on Asthma (ARIA) guideline was high; 66%, 58%, and 89% of the ENT specialists, pharmacists, GPs, respectively, reported that the current ARIA guidelines are sufficient for their clinical/pharmacy practice. CONCLUSION: The current practices in the management of allergic rhinitis in Malaysia are largely in line with the ARIA guidelines. The majority of physicians and pharmacists are satisfied with the recommendations in the ARIA guidelines.
Asia ; Asthma ; Ear ; General Practitioners ; Guideline Adherence ; Histamine Antagonists ; Humans ; Malaysia ; Nose ; Pharmacists ; Pharynx ; Professional Practice ; Rhinitis, Allergic ; Sleep Stages ; Specialization ; Steroids ; Surveys and Questionnaires

We report a case of young male referred for evaluation of recent onset recurrent syncope. Inhospital electrocardiogram revealed an episode of ventricular flutter which reverted spontaneously to sinus rhythm. Transthoracic echocardiogram showed hyperechoic mass in the left ventricle. For further tissue characterization a cardiac magnetic resonance imaging was done which revealed a left ventricular mass with predominant fat content. The tumor was surgically resected. Histopathological examination confirmed the diagnosis of cardiac fibrolipoma. The patient recovered and is currently asymptomatic.
Arrhythmias, Cardiac* ; Diagnosis ; Electrocardiography ; Heart Neoplasms ; Heart Ventricles* ; Humans ; Magnetic Resonance Imaging ; Male ; Syncope ; Ventricular Flutter

Literature has consistently reported that horticultural wastes including leaves, skin, stones and seeds contain substantial amounts of bioactive compounds. Therefore, this study aims to evaluate antioxidant activity, Total Phenolic Content (TPC) and colour parameters in avocado, banana, and papaya leaves. Antioxidant activity of the leaves was determined using Trolox Equivalent Antioxidant Capacity (TEAC) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assays, TPC was evaluated using Folin-Ciocalteu assay whereas the colour parameters were analysed with a colour picker software. Data analysis was carried out using SPSS version 25.0 of triplicate determinations. Mean differences among the fruit leaves extracts were determined using One-way ANOVA, while the correlations between the studied components were by the Pearson’s Correlation Coefficient test. The TEAC values were in the range of 332.30 ± 18.04 µg Trolox/g D.W. (avocado leaves) to 12217.71 ± 18.04 µg Trolox/g D.W. (banana leaves) while the DPPH radical scavenging activity was from 10.07 ± 3.89% (banana leaves) to 86.70 ± 0.26 % (avocado leaves). Besides, TPC was from 871.33 ± 38.35 µg GAE/g D.W. (papaya leaves) to 1199.08 ± 6.00 µg GAE/g D.W. (avocado leaves). The hue values were from 19º in avocado leaves extract to 37º in banana leaves extract. Results from Pearson’s Correlation Coefficient test revealed that there were no significant correlations between the studied assays. Avocado leaves had the highest DPPH radical scavenging activity and TPC among the three extracts. Findings derived from the present study could be exploited in nutraceuticals formulation.