Neonatal COVID-19 treatment: Are there new chances?

Coronavirus disease 2019 (COVID-19) is considered an infectious disease which is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neonatal COVID-19 had been occurred in many countries which would indicate the need of effective and safe treatment for these vulnerable group. In this study, we showed symptoms of corona virus in neonates, investigation of coronavirus in neonates and radiological features of neonatal COVID-19. In addition, we discussed management of neonates with COVI-19, antiviral treatment, monoclonal antibodies administration, immunomodulatory therapy, antibiotics, vitamins, and minerals in the treatment of neonatal COVID-19, and also telemedicine in neonatal COVID-19 and feeding the newborn of COVID-19 mother. We also discussed multisystem inflammatory syndrome in neonates (MIS-N), management of affected COVID-19 neonates and discussion of the complication of the neonatal COVID-19. We further discussed the methods of dealing with COVID-19 neonates and the research done on the neonatal COVID-19 treatment.

Findings from a Malaysian multicentre study on oropharyngeal squamous cell carcinoma

BACKGROUND

In addition to the conventional aetiologic agents of oropharyngeal squamous cell carcinoma (OPSCC) such as tobacco usage, alcohol consumption and betel quid usage, it has been established that a proportion of OPSCC are driven by persistent oncogenic human papillomavirus (HPV) infections. Currently, there is a lack of data on the burden of HPV- associated OPSCC in Asian countries including Malaysia.

METHODS

A cross-sectional multicentre study with tissue analysis of Malaysian patients diagnosed with primary OPSCC within a five-year period, from 2015 to 2019 between 01/01/2015 to 31/12/2019 was undertaken. Determination of HPV status was carried out using p16INK4a immunohistochemistry on tissue microarrays constructed from archived formalin-fixed paraffin-embedded tissue.

RESULTS

From the cases identified, 184 cases had sufficient tissue material for analysis. Overall, median age at diagnosis was 63.0 years (IQR = 15) and 76.1% of patients were males. In our cohort, 35.3% of patients were Indian, 34.2% were Chinese, 21.2% were Malay and 9.2% were from other ethnicities. The estimated prevalence of HPV-associated OPSCC in our cohort was 31.0% (CI 24.4-38.2%). The median age for the HPV-associated OPSCC sub-group of patients was not significantly lower than the median age of patients with HPV-independent OPSCC. More than half of HPV-associated OPSCC was seen in patients of Chinese ethnicity (54.4%). Patients with HPV-associated OPSCC had a much better overall survival than patients with HPV-independent OPSCC (Log rank test; p < 0.001). Patients with HPV-associated OPSCC with no habit-related risk factors such as smoking, were found to have much better overall survival when compared to all other sub-groups.

CONCLUSIONS

The findings from our study suggests that prevalence of HPV-associated OPSCC in Malaysia, though not as high as some developed countries, is however on an upward trend. HPV-associated OPSCC appears to be more frequently encountered in patients of Chinese ethnicity. Conventional risk-factors associated with OPSCC such as smoking, alcohol consumption and betel quid chewing should still be considered when estimating prognosis of patients with HPV-associated OPSCC.

Vitamin D status and clinical implications in the adult population of Malaysia: a position paper by the Malaysian Vitamin D Special Interest Group

PURPOSE

Vitamin D deficiency and insufficiency is common among populations globally, and in Asia and Malaysia. The purpose of this Position Paper is to propose recommendations for both clinicians and non-clinicians to promote vitamin D sufficiency in Malaysian adults. Formation of a national multisector, multidisciplinary alliance is also proposed to progress initiatives relating to safe sun exposure, adequate vitamin D intake through food fortification, and vitamin D supplementation for high-risk groups.

METHODS

Literature reviews were undertaken to inform summaries of the following: vitamin D status globally and in Asian and Malaysian populations, vitamin D status among individuals with common medical conditions, and current recommendations to achieve vitamin D sufficiency through sun exposure, food intake and supplementation. Recommendations were based on the findings of the literature reviews, recent European guidance on vitamin D supplementation, the 2018 road map for action on vitamin D in low- and middle-income countries, and research recommendations proposed by the Malaysian Ministry of Health in 2017.

RESULTS

Recommendations on assessment of vitamin D in the adult Malaysian population include using serum or plasma 25-hydroxyvitamin D concentration as a biomarker, widespread participation by Malaysian laboratories in the Vitamin D Standardization Program, adoption of the US Endocrine Society definitions of vitamin D deficiency and insufficiency, and development of a comprehensive nationwide vitamin D status study. Specific high-risk groups are identified for vitamin D assessment and recommendations relating to loading doses and ongoing management are also made.

CONCLUSION

This Position Paper provides individual clinicians and national stakeholder organisations with clear recommendations to achieve vitamin D sufficiency in the adult population of Malaysia.

Diagnostic and Operative Challenges in a Type I First Branchial Cleft Cyst: A Case Report

First branchial cleft cyst (FBCC) is a rare entity of congenital anomalies in the head and neck area. Dealing with FBCC is a clinical challenge as the condition is frequently forgotten in the differential diagnosis of lateral neck swelling. We report a rare case of unilateral type I FBCC in an 11-year-old boy who presented with a painless and slow-growing preauricular mass masquerading as a benign cystic lesion of the parotid. The lesion was completely removed via surgical excision. Histopathology report confirmed the findings of squamous epithelium‑lined cyst wall, which was a characteristic of a branchial cleft cyst. The combination of good clinical acumen, with the help of radiological correlation, along with a strong degree of suspicion for the condition, facilitates the diagnosis of this condition and hence proper management.

Posterior Auricular Myiasis: Rare Presentation of a Malignant Lesion

Squamous cell carcinoma (SCC) arises from the malignant proliferation of the keratinocytes of the epidermis that has invaded into the dermis or beyond. Posterior auricular SCC is categorized as high-risk SCC. Infestation of fly larvae or maggots in living tissue of humans and other vertebrate animals is known as myiasis. Rarity of the site of involvement with an underlying malignancy is the peculiarity of this case report. We present a case of elderly male with a posterior auricular mass with myiasis, which turns out to be SCC. Early detection and combined modality of aggressive treatment with surgery and radiation improves the overall patient survival rate.

Neuropsychiatric Symptoms in a p16-Positive Tongue Carcinoma Patient: An Unexpected Diagnosis

Differential diagnosis of neuropsychiatric symptoms in a patient with an underlying malignancy is exhaustive. 5-fluorouracil (5-FU) is one of the most widely used chemotherapy agents and it is often used as the first-line regimen in head and neck malignancies. We present a case of an elderly female with an underlying locally advanced p16-positive squamous cell carcinoma of the tongue who presented with manic symptoms for one week after cycle 2 of chemotherapy. Multidisciplinary management by otorhinolaryngologists with psychiatrist and oncologist led to the cessation of 5-FU, administration of antipsychotics, and replacement with a different chemotherapy agent, leading to complete resolution of manic symptoms. Possible mechanisms of the 5-FU-induced manic episode with its treatment are discussed in this report.

Keeping in Mind Its Synchronous Features, Is Sinonasal Inverted Papilloma Always Benign?

Sinonasal inverted papilloma (SNIP) is a rare benign tumor of paranasal sinuses. SNIP is known to be locally aggressive, with high rates of recurrence and a high potential for malignant transformation. We present a patient who presented with right-sided cheek pain and swelling for two weeks. The initial biopsy revealed SNIP. However, postoperative histopathology examination results revealed synchronous squamous cell carcinoma (SCC) with sinonasal inverted papilloma. Although the initial biopsy result showed a benign lesion, the aggressive features such as bony destruction and orbital involvement in computed tomography scan should raise a suspicion of a malignant lesion. Imaging features of SNIP from synchronous SCC are discussed.

Explaining Osteomyelitis and Prosthetic Joint Infections (PJI) in terms of Biofilm - A Review

Osteomyelitis is a chronic infection of bones. Eradication of bone infection is usually with antibiotics and debridement, but it is slow and the infection can recur even after many years. It is now established that osteomyelitis is due to biofilm and a better understanding of the process is required. We review the development of biofilm and apply it to osteomyelitis management. The planktonic microbes' response to adverse conditions is the formation of biofilm. Bacterial infections in planktonic forms cause infections that can be controlled with antibiotics and immunisation, however the same microbe when its phenotype becomes biofilm is more resilient. The understanding of how planktonic bacteria convert to biofilm is one of the aims set out for this article.

Early Experience of Reverse Total Shoulder Arthroplasty in a Public Hospital in Malaysia

Introduction:

Reverse total shoulder arthroplasty provides a surgical alternative to standard total shoulder arthroplasty for the treatment of cuff tear arthropathy, arthritis and fracture sequelae. This study aimed to assess the short-term outcomes following reverse total shoulder arthroplasty for patients in a large public hospital in Malaysia.

Materials and Methods:

We identified and performed five primary reverse total shoulder arthroplasties between 1 May 2019 and 1 June 2020. All patients were contactable and available for analysis. Assessment of functional outcomes was performed using the Constant-Murley score, the patient satisfaction score (PSS), and imaging studies. The mean follow-up from operation to the time of reporting was 9.6 months (range, 3 to 14 months)

Results:

The median age for our patients was 58 years (±11.91). The most common indication for surgery was post-traumatic arthritis, followed by rotator cuff arthropathy and osteoarthritis. The mean Constant score improved from 9.0 pre-operatively to 52.3 post-operatively at a mean of 9.6 months. The majority of the patients were satisfied with the surgery as the post-operative range of motion, especially anterior elevation and abduction, improved in four of our patients and there were no short-term complications, for example, of infection or revisions, reported at the last follow-up.

Conclusion:

This study has shown that reverse total shoulder arthroplasty can yield good short-term outcomes for the treatment of complex shoulder problems in addition to cuff tear arthropathy. It should be considered a treatment for rotator cuff tears, severe arthritis and ≥ 3 parts proximal humeral fractures.

Functional Outcomes Following Posterior Cruciate Ligament and Posterolateral Corner Reconstructions. A Three-year Experience in Seremban, Malaysia

Introduction:

This study was conducted to evaluate the demographics, causes and outcomes of patients who underwent Posterior Cruciate Ligament (PCL) reconstruction and/or Posterolateral Corner (PLC) reconstruction performed at our institution over the last three years. Sub-analysis was performed to assess the impact of delay from injury to surgery and how this affected outcomes.

Material and Methods:

From an initial number of 10 patients, seven were contactable and available for analysis. All patients underwent PCL and/or PLC reconstruction (modified Larson’s procedure) between 2017 and 2019. The mean age of our cohort was 31.4±9.6 years (range, 21 to 46). Assessment of functional outcomes pre- and post-operatively were done using the Lysholm knee scoring scale, the Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). The mean follow-up from operation at time of reporting was seven months (range, 2 to 12 months).

Results:

There were four combined PCL and PLCs, two isolated PLCs and one patient who underwent an isolated PCL reconstruction. There were significant improvements between pre-operative and post-operative in all functional outcome scores utilised following PCL reconstruction and/or modified Larson’s reconstruction. Lysholm knee scoring scale improved from pre-operative to post-operative at 41.14±12.32 to 74.86±13.52 (p=0.0001), KOOS from 49.71±11.19 to 71.43±13.84 (p=0.001), and VAS from 5.71±2.06 to 2.86±2.48 (p=0.001). Our sub-analysis showed that higher functional outcomes were present when surgery was done less than six months from the time of index injury. There were no complications (eg. Infections, revisions) in this cohort at the time of reporting.

Conclusion:

Reconstructive surgery for PCL and/or PLC injury is successful in increasing the functional outcomes of patients post-operatively. Delays from injury to surgery remains a problem in the public setting as patients may need to await appropriate imaging and approval of funding. Increased awareness for early surgical intervention may improve overall outcomes of PCL and/or PLC reconstruction in Malaysia.

Primary nasal septal acinic cell carcinoma

BACKGROUND. Acinic cell carcinoma (ACC) is a rare malignant salivary gland tumour. It is of a low-grade type. The commonest site involved is the parotid gland. ACC is not common in minor salivary glands; this tumour type mainly arises in the oral cavity.

CASE REPORT. We present an 84-year-old Malay man with spontaneous, self-limiting, left-sided epistaxis for 2 days. He also had progressive left-sided nasal blockage. There was no hyposmia, blurry vision or headache. He had underlying hypertension. The clinical examination showed he was normotensive. There was no external nasal deformity. The anterior rhinoscopy demonstrated a fungating irregular mass filling up the left nasal vestibule. There was no neck node. The computed tomography showed a tumour localized in the nasal cavity. The biopsy showed features of acinic cell carcinoma. We proceeded with left lateral rhinotomy and wide excision. Intraoperatively, we discovered that the tumour aroused from the nasal septum and part of the septum had to be sacrificed for margin clearance. Currently, he is on routine surveillance and tumour-free.

CONCLUSION. We highlighted the importance of recognizing nasal acinic cell carcinoma and the fact that early biopsy is important as surgery provides a good prognosis even in the extreme age group.

Preparation, characterization and biological evaluation of copper(II) and zinc(II) complexes with cephalexin

Copper(II) and zinc(II) complexes of cephalexin have been prepared and characterized by microanalysis and by thermogravimetric, magnetic and spectroscopic analysis. The complexes were found to be five-coordinate, monohydrate, and ML2 type. The electron paramagnetic resonance spectral lines revealed rhombic distortion from axial symmetry, with g(parallel) > g(perpendicular) > g(e), in the elongated-tetragonal copper(II) complex. The geometry of the zinc(II) complex seems to be square-pyramidal. On complexation with copper and zinc the antimicrobial activity of cephalexin improved significantly. The copper complex was found to be active against kaolin paw oedema whereas the parent drug was inactive. These results suggest that the metallic elements should be seriously considered during drug design, and that complexes already reported should be subjected to clinical evaluation. Their use could provide an easy way of improving the activity and reducing the toxicity of drug substances.