Self-reported symptom study of COVID-19 chemosensory dysfunction in Malaysia

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.

Retropharyngeal foreign body in a Down Syndrome girl

Pharyngeal foreign bodies are quite common. The diagnosis is usually clinical. The risk of complications including retropharyngeal abscess and mediastinitis are very low depending on the nature of foreign body and the duration taken for intervention. We share a challenging case of retropharyngeal abscess secondary to embedded foreign body in a Down syndrome patient, who presented with the sole presentation of torticollis. Surgical intervention with difficulties was performed with favourable outcome. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.641-645

Sudden sensorineural hearing loss: A missed opportunity for treatment

Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.

A rare case of bilateral congenital posterior mesotympanic cholesteatoma

Bilateral congenital mesotympanic cholesteatoma is a very rare disease. It can present differently from ordinary congenital cholesteatoma. We report a case of bilateral congenital cholesteatoma diagnosed at age of 22 years old. She presented with bilateral intermittent ear discharge since 10 years old that worsening two weeks prior to her presentation to our clinic and associated with bilateral reduced hearing. Clinically there was intact tympanic membrane with retraction of the mesotympanic area with present of mass medial to tympanic membrane. CT scan imaging showed there was soft tissue in the bilateral middle ear cavity with intact scutum and ossicles. Patient undergone canal wall down procedure and the diagnosis of congenital mesotympanic cholesteatoma was confirmed with present of cholesteatoma sac at the posterosuperior part, as opposed to anterosuperior quadrant, where the common site for congenital cholesteatoma.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.307-310

Laryngeal giant cell tumour presenting as a tongue base lesion causing severe dysphagia

Giant cell tumours are benign lesions that are uncommonly found in the larynx. Patients with these tumours may present with dysphagia, hoarseness and anterior neck swelling. Giant cell tumours are extremely rare and only a few cases have been reported. We present a case of an elderly woman who presented with severe dysphagia and a mass at the base of her tongue. The mass was found to be a laryngeal giant cell tumour and was successfully treated with chemotherapy.

Unilateral rhinolith in an adult man: a case report

Foreign bodies in the nose are rarely seen among adults. Rhinoliths are uncommon intranasal foreign bodies that have a very low incidence. They are often asymptomatic may be up to many years and subsequently present with nasal symptoms. We reported a case of an adult man with unilateral rhinolith, who complained of unilateral nasal blockage and foul-smelling nasal discharge. He was diagnosed with rhinolith endoscopically and successfully removed under general anaesthesia.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.448-451

Facial nerve paralysis due to intra aural tick infestation: a case report

Tick infestation in the ear canal may have variable clinical presentations. We present here a case of facial nerve paralysis in a 73 years old lady due to intra aural tick infestation. The patient presented with left otalgia, vertigo and left sided facial asymmetry. The case could be confused with cerebrovascular accident or transient ischemic attack.IMC J Med Sci 2017; 11(1): 29-31

Sensitization of AIDS related non-Hodgkin's B lymphoma cell lines to cytotoxic drugs toxins by interferon-gamma

AIDS-related lymphomas (ARL) progressively become resistant to conventional chemotherapy. We have developed three B cell lines from tumor biopsies of AIDS patients with non-Hodgkin's lymphoma (NHL). The ARL cell lines were shown to be resistant to a panel of cytotoxic cytokines, toxins and drugs such as tumor necrosis factor, diphteria toxin, ricin, adriamycin, cis-platinum and anti-Fas antibody. However, when these cell lines were pretreated with low concentrations of interferon-gamma (IFN-gamma), (50 U/ml or 150 U/ml) for 24 to 48 h, the tumor cells became sensitive to these cytotoxic agents. Pretreatment of ARL with IFN-gamma stimulated proliferation while IFN-gamma inhibited the growth of ovarian tumor cell lines. Further, following treatment with IFN-gamma, the secretion of TNF-alpha by ARL lines was significantly decreased and TNF-alpha surface receptor expression was downregulated. The expression of several surface antigens on ARL was upregulated by IFN-gamma. These findings demonstrate that treatment of ARL with IFN-gamma stimulated cell proliferation, modulated several surface antigens, inhibited TNF-alpha secretion and sensitized the tumor cells to cytotoxicity by various drugs/toxins. These findings may be clinically relevant in the treatment of drug-refractory ARL.

IgG antibodies to human herpesvirus-6 in children and adults and in primary Epstein-Barr virus infections and cytomegalovirus infections [corrected]

Antibody titers against human herpesvirus-6 (HHV-6) were determined in 80 healthy adults and 100 children and teenagers from Sweden to gain information on the role of the virus and its epidemiology. Based on a positive immunofluorescence titer of 1:10 and above, about 85% of the adults and children were seropositive with 60% seropositivity of children below age one year. Titers were generally higher in patients with simultaneous EBV or CMV infection, yet crossreactivity appeared essentially no problem. HHV-6 thus is ubiquitous like other herpesviruses. Primary infection seems to occur early in life, and reactivation or delayed primary infection may be associated with a variety of disorders.

Human herpesvirus-6 (HHV-6, HBLV) in sarcoidosis and lymphoproliferative disorders

Serologic studies were done to estimate the antibody prevalence against human herpesvirus 6 (HHV-6) in patients with malignant lymphomas, Sjögren's syndrome and sarcoidosis. Serologic studies showed IgG antibody titers against HHV-6 in up to 41% of patients with sarcoidosis, 50-70% with malignant lymphomas and in 36% with Sjögren's syndrome. In situ hybridization on lymph node biopsies was positive for HHV-6 genome in 1 out of 5 sarcoidosis lymph nodes.

Selective inhibition of IgE versus beta 2-microglobulin in human U-266 myeloma cell line treated with T-cell-derived factors

Concanavalin-A-activated T cells and their crude supernatants were assayed for suppressive activity on an IgE-producing U-266 cell line. Detectable and comparable degrees of suppression were obtained with the co-culture and the supernatant protocols. Separation of the effector population into T4+ and T8+ subsets showed the most effective cells in the T8+ fraction. Control experiments demonstrated that the IgE down-regulation was selective, since parallel measurement of beta 2-microglobulin synthesis showed no effect of T cells or T-cell-derived supernatants. In addition, several human T-cell lymphoma-leukaemia virus I-transformed T-cell lines were explored for their capacity to produce factor(s) able to suppress IgE synthesis in the U-266 cell line, and four out of 25 cell lines could be shown to do this in a constitutive manner. Kinetic studies suggested that the inhibition occurred at a transcriptional level. The results indicate that the T-cell-myeloma system is an interesting model to define better the regulation of IgE in the human.

Effect of type C viral expression and cellular karyotype on human B-lymphoblast tumorigenicity in nude mice

Cultured human hematopoietic cells from several normal and leukemic sources, including those cells initiated after exposure to primate type C retroviruses were tested for their capacity to induce tumors in young athymic BALB/c (nu/nu) mice after sc inoculation. An attempt was made to correlate these results with virus expression and chromosome patterns. Progressively growing tumor formation was observed in 5 of 18 normal diploid B-lymphoblast lines from normal peripheral blood and in one of three diploid B-lymphoblast lines from leukemic donors established after infection with primate type C viruses (gibbon ape leukemia virus or simian sarcoma virus). In contrast, none of eight spontaneously transformed B-lymphoblast lines with normal diploid karyotypes formed progressively growing tumors, although one formed a tumor that remained the same size (0.5 cm) for several months. Progressive tumor formation occurred in four of seven previously established cell lines of different cell types that had abnormal karyotypes. Of the normal diploid B-lymphoblast cultures exposed to type C viruses, 12 were tested for the presence of viral RNA and structural proteins (p12, p30, gp70), and this information was correlated with tumorigenicity. Four of the six cultures expressing viral RNA or proteins were tumorigenic, whereas only one of six cultures that did not express virus information was positive. The results of this study suggest that expression of type C viral RNA and proteins by human B-lymphoblasts increases their tumorigenicity in nude mice. It is also apparent that caution must be used in attempts to correlate cell tumorigenicity and chromosome abnormalities in nude mice.