Tracheocutaneous fistula (TCF) is a known complication of tracheostomy. It can cause problems such as saliva leak, predispose to infection from external skin into respiratory tract and cosmetically not acceptable. Treatment of the underlying infection is paramount important. Persistence of tract after sufficient duration of observation period should be surgically treated. Cases reported in the literature are mainly regarding paediatric TCF and the procedures are usually done under general anesthesia. We describe a case of surgical treatment of an adult TCF which was done under local anaesthesia.

A laryngocoele is an abnormal dilatation of the laryngeal saccule. It is a rare cause of stridor in the newborn or in early infancy. Most laryngocoeles are asymptomatic but symptoms of hoarseness, feeding difficulty, lump in the neck and upper airway obstruction may occur. We report a case of external laryngocoele causing partial airway obstruction in early infancy. Spontaneous resolution occurred following conservative medical management thus avoiding surgical intervention.
Infant ; Complications ; Respiratory Distress Syndrome, Newborn

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

Purpose: This fMRI study is about modelling the effective connectivity between Heschl’s gyrus (HG) and the superior temporal gyrus (STG) in human primary auditory cortices. Materials & methods: Ten healthy male participants were required to listen to white noise stimuli during functional magnetic resonance imaging (fMRI) scans. Statistical parametric mapping (SPM) was used to generate individual and group brain activation maps. For input region determination, two intrinsic connectivity models comprising bilateral HG and STG were constructed using dynamic causal modelling (DCM). The models were estimated and inferred using DCM while Bayesian Model Selection (BMS) for group studies was used for model comparison and selection. Based on the winning model, six linear and six non-linear causal models were derived and were again estimated, inferred, and compared to obtain a model that best represents the effective connectivity between HG and the STG, balancing accuracy and complexity. Results: Group results indicated significant asymmetrical activation (puncorr < 0.001) in bilateral HG and STG. Model comparison results showed strong evidence of STG as the input centre. The winning model is preferred by 6 out of 10 participants. The results were supported by BMS results for group studies with the expected posterior probability,r = 0.7830 and exceedance probability, φ = 0.9823. One-sample t-tests performed on connection values obtained from the winning model indicated that the valid connections for the winning model are the unidirectional parallel connections from STG to bilateral HG (p < 0.05). Subsequent model comparison between linear and non-linear models using BMS prefers non-linear connection (r = 0.9160, φ = 1.000) from which the connectivity between STG and the ipsi- and contralateral HG is gated by the activity in STG itself. Conclusion: We are able to demonstrate that the effective connectivity between HG and STG while listening to white noise for the respective participants can be explained by a non-linear dynamic causal model with the activity in STG influencing the STG-HG connectivity non-linearly.

In this study, functional magnetic resonance imaging (fMRI) is used to investigate func-tional specialisation in human auditory cortices during listening. A silent fMRI paradigm was used to reduce the scanner sound artefacts on functional images. The subject was instructed to pay attention to the white noise stimulus binaurally given at an inten-sity level of 70 dB higher than the hearing level for normal people. Functional speciali-sation was studied using the Matlab-based Statistical Parametric Mapping (SPM5) software by means of fixed effects (FFX), random effects (RFX) and conjunction analyses. Individual analyses on all subjects indicated asymmetrical bilateral activation of the left and right hemispheres in Brodmann areas (BA) 22, 41 and 42, involving the primary and secondary auditory cortices. The percentage of signal change is larger in the BA22, 41 and 42 on the right as compared to the ones on the left (p>0.05). The average number of activated voxels in all the respective Brodmann areas are higher in the right hemisphere than in the left (p>0.05). FFX results showed that the point of maximum intensity was in the right BA41 whereby 599±1 activated voxels were ob-served in the right temporal lobe as compared to 485±1 in the left temporal lobe. The RFX results were consistent with that of FFX. The analysis of conjunction which fol-lowed, showed that the right BA41 and left BA22 as the common activated areas in all subjects. The results confirmed the specialisation of the right auditory cortices in pro-cessing non verbal stimuli.

No abstract available.

The aim of this work was to study radiation and the effects of temperature on conductivity properties of polyvinyl alcohol (PVA)-based potassium hydroxide (KOH) and propylene carbonate (PC), where the ionic conduction preferentially occurs in the amorphous phase by free radicals ions through gamma-irradiation. Alkaline composite polymer electrolyte (ACPE) consisting of PVA, KOH and PC of different concentration ratios were prepared by solvent-casting technique. The ACPE were irradiated with different doses from 5 kGy up to 200 kGy. The conductivity properties of the electrolyte films were measured at different frequencies in the range 20 Hz to 1 MHz using LCR meter. The results showed that the conductivity properties were dependent on the radiation dose, temperature and the concentration of the polymer blends.
Radiation ; asparaginase/prednisone/vincristine ; Personal Computers ; Temperature ; Concentration

Pharmacology teaching during preclinical years is important for medical students to make rational choices in choosing suitable treatment for patients in future. Therefore, the present study determined the adequacy and effectiveness of pharmacology teaching in the undergraduate medical program at the Universiti Kebangsaan Malaysia Medical Center (UKMMC). Suggestions for improvement of the curriculum were also identified. An online questionnaire on the perceptions of pharmacology teaching methodology was distributed to a total of 459 medical students in 4th and 5th year at UKMMC. The questionnaire covered demographics, perceptions about pharmacology teaching, the ideal teaching learning methodology for learning pharmacology, pharmacology topics which are useful for future clinical practice, the pharmacology topic which was most interesting and recommendations for improvement. The response rate was 46.4% and majority of the participants were females (65.7%). Most of the students agreed that interactive learning was more helpful than didactic lectures (88.0%). Seventy percent of the students reported that pharmacology lectures in the preclinical years were helpful during the clinical years. Percentage of students who agreed that pharmacology teaching in their preclinical was adequate for their clinical practice was 47.0%. There was no association between demographic variables (gender, race, year of study and medical family background) and interest in pharmacology (p>0.05). In conclusion, the pharmacology teaching during preclinical years was perceived to be effective and useful for students’ clinical practice. More pharmacology teaching sessions in clinical years was suggested which may improve adequacy of pharmacology teaching.

Carcinoma, Ductal ; pathology ; surgery ; Female ; Head and Neck Neoplasms ; pathology ; surgery ; Humans ; Middle Aged ; Neck Dissection ; Salivary Ducts ; pathology ; surgery

Driving activity has become more important as this medium being practical, it is also cheaper and faster in connecting human from one to another place. However, in some occurrence, it can cause accidents as they become fatigued while driving. Driver fatigue is one of the top contributors to the road accidents and can be dangerous as other road safety issues such as drink driving. Worst is, there are no laws regulating driver fatigue. Therefore, the main purpose of this study is to develop the regression model of apsychophysical factor for drivers’ fatigue which can predict the relationship between the process input parameters and output responses. The study was participated by ten subjects. The heart rate was taken and recorded using heart rate monitor. Design Expert 8.0.6 software was used for the regression analysis. The modeling validation runs werewithin the 90% prediction intervals of the developed model and the residual errors were less than 10%. The R 2 value is 0.9400 whichmeans that the linear regression line passed exactly through all points. The significant parameters that influenced the heart rate were also identified.The parameters are time exposure, type of road, and gender.
Psychophysical ; fatigue ; regression modeling ; heart rate