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Lee SH, Yeoh ZX, Sachlin IS, Gazali N, Soelar SA, Foo CY, Low LL, Syed Alwi SB, Tengku Kamalden TMI, Shanmuganathan J, Zaid M, Wong CY, Chua HH, Yusuf S, Muhamad D, Devesahayam PR, Ker HB, Salahuddin Z, Mustafa M, Sawali H, Lee HG, Din S, Misnan NA, Mohamad A, Ismail MN, Periasamy C, Chow TS, Krishnan EK, Leong CL, Lim LPF, Zaidan NZ, Ibrahim MZ, Abd Wahab S, Mohd Hashim SS. Self-reported symptom study of COVID-19 chemosensory dysfunction in Malaysia. Sci Rep 2022; 12:2111. [PMID: 35136124 PMCID: PMC8826975 DOI: 10.1038/s41598-022-06029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Alterations in the three chemosensory modalities-smell, taste, and chemesthesis-have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June and 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains.Study Registration: NMRR-20-934-54803 and NCT04390165.
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Affiliation(s)
- Shen-Han Lee
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, KM 6 Jalan Langgar, Alor Setar, 05450, Kedah, Malaysia.
| | - Zhi Xiang Yeoh
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, KM 6 Jalan Langgar, Alor Setar, 05450, Kedah, Malaysia
| | - Ida Sadja'ah Sachlin
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, KM 6 Jalan Langgar, Alor Setar, 05450, Kedah, Malaysia
| | - Norzi Gazali
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, KM 6 Jalan Langgar, Alor Setar, 05450, Kedah, Malaysia
| | | | - Chee Yoong Foo
- Real World Insights, IQVIA Asia Pacific, Petaling Jaya, Malaysia
| | - Lee Lee Low
- Department of Medicine, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | | | | | | | - Masliza Zaid
- Department of Medicine, Hospital Sultanah Aminah, Johor, Malaysia
| | - Chun Yiing Wong
- Department of Otorhinolaryngology, Hospital Umum Sarawak, Sarawak, Malaysia
| | - Hock Hin Chua
- Department of Medicine, Hospital Umum Sarawak, Sarawak, Malaysia
| | - Suhaimi Yusuf
- Department of Otorhinolaryngology, Hospital Tengku Ampuan Afzan, Pahang, Malaysia
| | - Dzawani Muhamad
- Department of Medicine, Hospital Tengku Ampuan Afzan, Pahang, Malaysia
| | | | - Hong Bee Ker
- Department of Medicine, Hospital Raja Permaisuri Bainun, Perak, Malaysia
| | - Zulkiflee Salahuddin
- Department of Otorhinolaryngology, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
| | - Mahiran Mustafa
- Department of Medicine, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
| | - Halimuddin Sawali
- Department of Otorhinolaryngology, Hospital Queen Elizabeth, Sabah, Malaysia
| | - Heng Gee Lee
- Department of Medicine, Hospital Queen Elizabeth, Sabah, Malaysia
| | - Sobani Din
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Selangor, Malaysia
| | | | - Amran Mohamad
- Department of Otorhinolaryngology, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | - Mohd Noor Ismail
- Department of Medicine, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia
| | | | - Ting Soo Chow
- Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
| | | | - Chee Loon Leong
- Department of Medicine, Hospital Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | | | | | - Mohd Zambri Ibrahim
- Department of Otorhinolaryngology, Hospital Tuanku Fauziah, Perlis, Malaysia
| | | | - Siti Sabzah Mohd Hashim
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, KM 6 Jalan Langgar, Alor Setar, 05450, Kedah, Malaysia
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Mann GS, Rajan P, Sawali H. Otorhinolaryngology services at a district hospital in Sabah, Malaysia during the COVID-19 Pandemic. Med J Malaysia 2021; 76:39-41. [PMID: 34558557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
No abstract provided.
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Affiliation(s)
- G S Mann
- Hospital Tawau, Department of ORL, 91007, Tawau, Malaysia.
| | - P Rajan
- Hospital Raja Permaisuri Bainun, Department of ORL and Clinical Research Centre, Ipoh, Malaysia
| | - H Sawali
- Hospital Queen Elizabeth, Department of ORL, Kota Kinabalu, Malaysia
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Tan LP, Tan GW, Sivanesan VM, Goh SL, Ng XJ, Lim CS, Kim WR, Mohidin TBBM, Mohd Dali NS, Ong SH, Wong CY, Sawali H, Yap YY, Hassan F, Pua KC, Koay CE, Ng CC, Khoo ASB. Systematic comparison of plasma EBV DNA, anti-EBV antibodies and miRNA levels for early detection and prognosis of nasopharyngeal carcinoma. Int J Cancer 2019; 146:2336-2347. [PMID: 31469434 PMCID: PMC7065012 DOI: 10.1002/ijc.32656] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/17/2019] [Accepted: 08/15/2019] [Indexed: 12/31/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is originated from the epithelial cells of nasopharynx, Epstein–Barr virus (EBV)‐associated and has the highest incidence and mortality rates in Southeast Asia. Late presentation is a common issue and early detection could be the key to reduce the disease burden. Sensitivity of plasma EBV DNA, an established NPC biomarker, for Stage I NPC is controversial. Most newly reported NPC biomarkers have neither been externally validated nor compared to the established ones. This causes difficulty in planning for cost‐effective early detection strategies. Our study systematically evaluated six established and four new biomarkers in NPC cases, population controls and hospital controls. We showed that BamHI‐W 76 bp remains the most sensitive plasma biomarker, with 96.7% (29/30), 96.7% (58/60) and 97.4% (226/232) sensitivity to detect Stage I, early stage and all NPC, respectively. Its specificity was 94.2% (113/120) against population controls and 90.4% (113/125) against hospital controls. Diagnostic accuracy of BamHI‐W 121 bp and ebv‐miR‐BART7‐3p were validated. Hsa‐miR‐29a‐3p and hsa‐miR‐103a‐3p were not, possibly due to lower number of advanced stage NPC cases included in this subset. Decision tree modeling suggested that combination of BamHI‐W 76 bp and VCA IgA or EA IgG may increase the specificity or sensitivity to detect NPC. EBNA1 99 bp could identify NPC patients with poor prognosis in early and advanced stage NPC. Our findings provided evidence for improvement in NPC screening strategies, covering considerations of opportunistic screening, combining biomarkers to increase sensitivity or specificity and testing biomarkers from single sampled specimen to avoid logistic problems of resampling. What's new? Plasma Epstein–Barr virus (EBV) DNA is an established nasopharyngeal carcinoma (NPC) biomarker, but not all cases are associated with EBV and its sensitivity for stage I NPC remains controversial. Meanwhile, most newly‐reported NPC biomarkers have neither been externally validated nor compared to established biomarkers. This study systematically evaluates six established and four new biomarkers in NPC cases, population controls, and hospital controls. The findings provide evidence to policymakers for improvement in NPC screening and monitoring strategies, covering considerations of opportunistic screening, combining biomarkers to increase sensitivity/specificity, and testing multiple biomarkers on single specimens to avoid the logistic problems of resampling.
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Affiliation(s)
- Lu Ping Tan
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Selangor, Malaysia
| | - Geok Wee Tan
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.,Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vijaya Mohan Sivanesan
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Siang Ling Goh
- Faculty of Science, University of Malaya, Institute of Biological Sciences, Kuala Lumpur, Malaysia
| | - Xun Jin Ng
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Chun Shen Lim
- Faculty of Science, University of Malaya, Institute of Biological Sciences, Kuala Lumpur, Malaysia.,Department of Biochemistry, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Wee Ric Kim
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Nor Soleha Mohd Dali
- Haematology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Siew Hoon Ong
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Chun Ying Wong
- Department of Otorhinolaryngology, Sarawak General Hospital, Ministry of Health Malaysia, Jalan Hospital, Kuching, Sarawak, Malaysia
| | - Halimuddin Sawali
- Department of Otorhinolaryngology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Yoke Yeow Yap
- Department of Otorhinolaryngology, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.,Department of Surgery, Clinical Campus Faculty of Medicine and Health Sciences, University Putra Malaysia at Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Faridah Hassan
- Department of Otorhinolaryngology, Selayang Hospital, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia
| | - Kin Choo Pua
- Department of Otorhinolaryngology, Pulau Pinang Hospital, Ministry of Health Malaysia, Georgetown, Pulau Pinang, Malaysia
| | - Cheng Eng Koay
- Gleneagles Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.,Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Ching Ching Ng
- Faculty of Science, University of Malaya, Institute of Biological Sciences, Kuala Lumpur, Malaysia
| | - Alan Soo-Beng Khoo
- Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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Lim CC, Misron K, Loong SP, Liew YT, Sawali H. Primary Adenotonsillar Tuberculosis in an Immunocompetent Child -A Case Report. Iran J Otorhinolaryngol 2019; 31:319-322. [PMID: 31598501 PMCID: PMC6764808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Primary tuberculosis (TB) of the oropharynx and nasopharynx is an extremely rare form of extra-pulmonary TB in children. Primary tuberculosis occurs more likely secondary to pulmonary TB and is more common in immunocompromised patients. CASE REPORT We reported the case of a young male presented with the symptoms of non-specific chronic adenotonsillitis, mild obstructive sleep apnoea, and cervical lymphadenopathy. Subsequently, he underwent adenotonsillectomy and excision of the cervical lymph node with the tissue specimens came back strongly positive for TB. Then, he started using antituberculous medication and recovered well. CONCLUSION The authors would like to highlight this rare clinical entity in which accurate diagnosis is essential for complete treatment.
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Affiliation(s)
- Chee-Chean Lim
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia,Corresponding Author: Department of Otorhinolaryngology - Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia, 55, Jalan 3/132, Gasing Indah, 59200 Kuala Lumpur.E-mail:
| | - Khairunnisak Misron
- Department of Otorhinolaryngology - Head and Neck Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
| | - Siow-Ping Loong
- Department of Otorhinolaryngology - Head and Neck Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
| | - Yew-Toong Liew
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Halimuddin Sawali
- Department of Otorhinolaryngology - Head and Neck Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
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Lim CC, Sawali H, Ong CA, Nordin A, Liew YT. A Recalcitrant Huge Pyogenic Granuloma in a Young Child Mimicking as Lingual Hemangioma. Medeni Med J 2019. [DOI: 10.5222/mmj.2019.90236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Anastasius EJ, Sawali H. Stridor in a Newborn with Double Aortic Arch-A Case Report. Iran J Otorhinolaryngol 2019; 31:61-63. [PMID: 30783601 PMCID: PMC6368982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Double aortic arch (DAA) is a congenital anomaly of the aortic arch. It is the most common type of complete vascular ring. When it occurs, the connected segment of the aortic arch and its branches encircle the trachea and esophagus, leading to symptoms related to these two structures. CASE REPORT We present a case of a newborn baby who developed biphasic stridor immediately after a normal vaginal delivery. Endoscopic assessment of the trachea revealed a pulsatile narrowing at the level of the thoracic trachea, suggestive of an external compression. A contrast-enhanced computed tomography scan of the thorax with three-dimensional reconstruction confirmed the diagnosis of DAA with compression of the trachea and esophagus. CONCLUSION Clinicians should strongly consider the possibility of a congenital vascular ring compression should an infant with a normal upper airway present with stridor. A precise diagnosis can be made by radiological examination.
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Affiliation(s)
- Elsie-Jane Anastasius
- Department of Otorhinolaryngology, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia. ,Corresponding Author. Department of Otorhinolaryngology,University of Malaya, Jalan Universiti,50603 Kuala Lumpur, Wilayah Persekutuan Malaysia. E-Mail :
| | - Halimuddin Sawali
- Department of Otorhinolaryngology, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia.
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Sawali H, Yunus MRM, Ai OC, Athar PPSH. Cutaneous Metastases from Nasopharyngeal Carcinoma: A Rare Manifestation. Philipp J Otolaryngol Head Neck Surg 2010. [DOI: 10.32412/pjohns.v25i2.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: In this article, we report on two unusual cases of advanced nasopharyngeal carcinoma (NPC) with distant cutaneous metastases.
Methods:
Design: Case Report
Setting: Tertiary Referral Center
Patients: Two
Results: Two patients with advanced NPC developed multiple nodular skin metastases, one after completing radiotherapy and another during concurrent chemo-radiotherapy. Biopsies of these skin lesions confirmed metastatic NPC and both patients succumbed to the disease.
Conclusion: Nasopharyngeal carcinoma with skin metastases carries a very poor
prognosis. Early detection, diagnosis and treatment are still the best management strategy
for nasopharyngeal carcinoma.
Keywords: Nasopharynx, nasopharyngeal carcinoma, skin metastases, cutaneous
metastases
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Sawali H, Sabir Husin Athar PP, Ami M, Shamsudin NH, Nair G. Acute Tonsillitis With Concurrent Kikuchi's Disease as a Cause of Persistent Lymphadenopathy. Malays J Med Sci 2009; 16:73-76. [PMID: 22135516 PMCID: PMC3216133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 08/30/2009] [Indexed: 05/31/2023] Open
Abstract
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.
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Affiliation(s)
- Halimuddin Sawali
- Department of Otorhinolaryngology - Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | | | - Mazita Ami
- Department of Otorhinolaryngology - Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaakob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Nor Hasni Shamsudin
- Department of Pathology, Tuanku Jaafar Hospital, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia
| | - Gopalan Nair
- Ear, Nose, Throat-Head and Neck Consultant Clinic, Lam Wah Ee Hospital, 141 Jalan Tan Sri Teh Ewe Lim, 11600 Penang, Malaysia
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