Many forms of management of the Paradoxical Vocal Fold Movement (PVFM) disorder have been presented in past literature, but it is vital to recognize the complexity of the disorder and the necessity for proper diagnosis to allow for appropriate management. A review of the literature suggests that this disorder predominantly occurs in the young female, and presents with a history of associated medical conditions. A single case study of an unusual presentation of PVFM in a young eleven year old boy with PVFM is discussed in this paper. The PVFM was observed and diagnosed by the Otorhinolaryngologist at the University Malaya Medical Center (UMMC), Kuala Lumpur. Nasendoscopy revealed otherwise normal vocal fold movement in quiet breathing and during an episodic attack. The young boy was subsequently referred for speech therapy; management of the PVFM was solely with speech rehabilitation. The management of the disorder in this young boy is discussed up to the time of discharge from therapy.

BACKGROUND: We tested the hypothesis that dengue haemorrhagic fever (DHF) is associated with a T(H)1-skewed immune response as opposed to dengue fever (DF). METHODS: We estimated intracellular (in T-cells) and serum levels of designate T(H)1/T(H)2 cytokines [interferon-gamma (IFN-gamma), interleukin-4 (IL-4), and tumor necrosis factor-alpha] and macrophage inflammatory protein-1alpha (MIP-1alpha) at admission, 48 h, and day 5 in 20 adults with dengue (DF=10, DHF=10) and 10 dengue-naive healthy controls. RESULTS: At admission, intracellular IFN-gamma/IL-4 ratio in CD4+ T-cells and proportion of MIP-1alpha-positive CD8+ T-cells were significantly higher in patients with DHF [7.21 (5.36~10.81) vs. 3.04 (1.75~4.02); p=0.011 and 6.2% (3.2~8.2%) vs. 2.4% (2.0~3.6%); p=0.023]. The latter showed a significant positive correlation with IFN-gamma/IL-4 ratio in CD4+ T-cells (Spearman's rho=0.64; p=0.003), percentage-change in haematocrit (rho=0.47; p=0.048), and serum alanine aminotransferase level (rho=0.61; p=0.009). CONCLUSION: We conclude that DHF is associated with a T(H)1-skewed immune response. Further, MIP-1alpha in CD8+ T-cells is an important immunologic correlate of disease severity in dengue.
Adult ; Alanine Transaminase ; Chemokine CCL3 ; Cytokines ; Dengue ; Fever ; Humans ; Interferon-gamma ; Interleukin-4 ; Macrophages ; Necrosis ; T-Lymphocytes

Knowledge of normal anatomy and physiology of swallowing is fundamental in the identification of individuals with orat risk for swallowing disorders. Learning anatomy and physiology however, is not an easy task thus, computer-assistedlearning (CAL) approaches have been incorporated into the learning of the topics to enhance understanding. Althoughevidence exists on the benefits of using CAL in education, more studies are necessary in the field of swallowing. Whilecourseware for the learning of anatomy and physiology of swallowing exist, they are not comprehensive. Therefore, thisstudy aimed to develop a comprehensive CAL courseware for anatomy and physiology of swallowing. The current studyused a designed-based research following the ADDIE (analysis, design, development, implementation, and evaluation)model to create a multimedia courseware, incorporating the use of text, still images, animations, audio narrations,and presented on a simple graphical user interface. The courseware was evaluated by 27 undergraduate students interms of its usefulness, ease of use, and users’ satisfaction. Results indicate that the participants were satisfied with thecourseware and that they perceived the courseware as useful, easy to learn and easy to use. The study represents aninitiative to investigate the use of CAL in the subject and to establish the basis for further work which includes assessmenton the learning outcomes from the usage of the CAL courseware. It is hoped that the use of this courseware in teachingand learning of anatomy and physiology of swallowing can enhance students’ knowledge and understanding of the areaefficiently and effectively.