1.An Extensive Cervical Vagal Nerve Schwannoma: A Case Report
Chiun Kian Chai ; Ing Ping Tang ; Narayanan Prepageran ; Pailor Jayalakshmi
The Medical Journal of Malaysia 2012;67(3):342-344
Vagal nerve schwannoma is extremely rare. The majority of
cases present with a slow growing neck swelling without
neurological deficit. Magnetic resonance imaging is the gold standard investigation to establish a pre-operative diagnosis.
We report a case of a 32-year-old man with an extensive
right vagal nerve schwannoma involving the right jugular
foramen and parapharyngeal space. The tumour was
resected via a transcervical approach. Complete excision of
the tumour is the key to prevent recurrence.
2.Spontaneous temporosphenoidal meningoencephalo cele as a rare cause of non-traumatic cerebrospinal fluid rhinorrhoea
Bushra Johari ; Hazman Mohd Nor ; Gnana Kumar ; Prepageran Narayanan
Neurology Asia 2015;20(2):203-206
Cranial encephaloceles are rare conditions, which are more commonly seen in the anterior rather than in
the middle cranial fossa. Temporal lobe encephalocele can present with a variety of clinical symptoms,
amongst which include occult or symptomatic cerebrospinal fluid (CSF) fistula. We present a case of
a patient with a short history of rhinorrhea who was found to have a CSF pool in the sphenoid sinus
and right anteromedial temporosphenoidal encephalocele, which mimics sphenoid mucocoele, a much
more common entity. This case highlights the imaging findings of temporosphenoidal encephalocoele
and the diagnostic clues in differentiating this rare condition from the commoner mimics.
Cerebrospinal Fluid
3.Antibiotic Sensitivity and Spectrum of Bacterial Isolates in Otorhinolaryngological Infection: A Retrospective Study
Kian Joo Sia ; Ing Ping Tang ; MS ORL HNS ; Narayanan Prepageran
The Medical Journal of Malaysia 2013;68(1):6-9
Objectives: To identify the common bacteria of
otorhinolaryngological (ORL) infection in three general
hospitals in the state of Sarawak, East Malaysia and to
determine the antibiotic sensitivity of the common bacteria
to update local antibiotic policy.
Methods: All specimens with positive monoclonal culture,
received from inpatient and outpatient Otorhinolaryngology
Department in the year 2009 and 2010 were included in the
study. Patients’ demographics, nature of specimens,
bacterial isolates and antibiotic sensitivity were analysed by using the Statistical Package for the Social Sciences (SPSS).
Results: A total 244 positive monoclonal cultures were
identified. Staphylococcus species and Gram negative
bacilli were the commonest bacteria of ORL infections.
Common ORL bacteria remain sensitive to our front line
antibiotics. There are a number of multi-drug resistant
isolates of MRSA, ESBL Klebsiella pneumoniae and
Acinetobacter baumanii in the hospital-acquired infections.
Conclusion: Although resistance to antimicrobial agents is
growing worldwide, first line antibiotics still show significant therapeutic advantage in our local setting. The low resistance of bacterial isolates in our community reflects judicious use of antibiotics in our routine clinical practices.
4.The status quo and unmet needs in the management of allergic rhinitis and chronic rhinosinusitis: a Malaysian perspective
Narayanan PREPAGERAN ; De Yun WANG ; Gopalan NAIR ; Marcus MAURER
Asia Pacific Allergy 2014;4(3):142-148
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
5.Economic Burden of the Inadequate Management of Allergic Rhinitis and Urticaria in Asian Countries Based on the GA²LEN Model.
Kanokvalai KULTHANAN ; Supinda CHUSAKUL ; Marysia Tiongco RECTO ; Ma Teresita GABRIEL ; Derrick Chen-Wee AW ; Narayanan PREPAGERAN ; Alson WONG ; Jern Lin LEONG ; Henry FOONG ; Vo Thanh QUANG ; Torsten ZUBERBIER
Allergy, Asthma & Immunology Research 2018;10(4):370-378
PURPOSE: Across Hong Kong, Malaysia, the Philippines, Singapore, Thailand and Vietnam, (referred to as Asia) approximately 30–53 million individuals of the 151 million employed suffer from allergic rhinitis (AR) and urticaria. It is estimated that approximately 90% of patients with these allergic conditions are insufficiently treated, impacting the socioeconomic burden in terms of absence from work and decreased productivity. This study aims to estimate the socioeconomic burden of allergies in Asia and the cost savings that their adequate management can provide. Due to the limited availability of regional data, this study focused AR and urticaria in selected countries. METHODS: Published literature, information from statistical bureaus, clinician surveys and extrapolation of selected data from the European Union were used to determine the socioeconomic costs of AR and urticaria. RESULTS: Many patients in Asia suffer from perennial allergies and experience symptoms of AR and urticaria for up to 298 days per year. An estimate of the indirect costs of patients insufficiently treated for AR and urticaria amounts to USD 105.4 billion a year, which equates to USD 1,137–2,195 per patient due to absenteeism and presenteeism. Adherence to guideline-approved treatment can lead to estimated savings of up to USD 104 billion. CONCLUSIONS: The current study suggests that within Asia, the socioeconomic impact of AR and urticaria is similar to that seen in the European Union in spite of the lower wages in Asia. This is due to the mainly perennial allergens prevailing in Asia, whereas the sensitization patterns observed in the European Union are dominated by seasonal exposure to pollen. These results underline the need for governmental initiatives to increase public awareness on the prevention and treatment of these and other allergic diseases as well as greater research funding and large-scale studies to reduce their growing socioeconomic burden in coming years.
Absenteeism
;
Allergens
;
Asia
;
Asian Continental Ancestry Group*
;
Cost Savings
;
Efficiency
;
European Union
;
Financial Management
;
Hong Kong
;
Humans
;
Hypersensitivity
;
Income
;
Malaysia
;
Philippines
;
Pollen
;
Presenteeism
;
Rhinitis, Allergic*
;
Salaries and Fringe Benefits
;
Seasons
;
Singapore
;
Thailand
;
Urticaria*
;
Vietnam
6.Transcanal endoscopic excision of glomus tympanicum: A case report
Carren Teh Sui Lin ; Fadzilah Ismail ; Azrina Ahmad ; Prepageran Narayanan
The Medical Journal of Malaysia 2020;75(2):189-190
Glomus tympanicum is a highly vascular tumour
traditionally treated surgically via a post-auricular approach.
We present here the first published case in Malaysia where
total excision was achieved transcanal endoscopically. The
procedure was safe, quick and effective due to the better
visualisation of the surgical field with the endoscope.
Haemostasis was achieved with a modified suction catheter
that performed as a functioning suction diathermy.