From the MJM Editors’ Desk: Common errors authors make in submission to the Medical Journal of Malaysia

@#Proper understanding the ‘Instructions to authors’ for a particular journal is the key towards successful submission of a manuscript which will lead to it being published. Common errors that are frequently made by authors in their submission to the Malaysia Journal of Malaysia (MJM) that lead to rejection of their submission or requiring major revisions or minor revisions are listed and discussed in this article. Outright rejection prior to even a peer review process may be made for an article due to: it is poorly written or when there is suspicion on the authenticity of the submission, which contains elements that are suspected to be plagiarised, it is a duplicate submission or not in the format required by the MJM. The editor in charge of the issue makes a recommendation to the Editor in Chief for the final decision.

Visual electrophy siological tests in obstructive sleep apnoea / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) between obstructive sleep apnoea (OSA) patients and controls.METHODS: This was a prospective cross-sectional study involving 40 OSA patients and 31 control subjects in Hospital Universiti Sains Malaysia.Patients with a confirmed diagnosis of OSA who had no ocular pathology were randomly selected to participate in the study.The apnoea-hypopnoea index (AHI) was obtained from their records and used for stratification of OSA severity.Electrophysiological tests (PVEP and PERG) were performed on each patient by a trained technician in the electrophysiology laboratory of the Department of Ophthalmology, USM.The results obtained were recorded as median values.Data analysis was done using IBM Statistics Version 21.0.RESULTS: Among OSA patients, we observed a significant reduction of the PERG amplitude P50 (P<0.001) and the PVEP amplitude P100 (P<0.001) compared to the control group.OSA patients also had a significant increase in PVEP time to peak P100 (P=0.003) and time to peak N75 (P=0.004).However, no significant differences were detected in PERG time to peak between OSA patients and controls.There were likewise no significant differences in PVEP or PERG between OSA patients with different disease severity.CONCLUSION: OSA patients have significant abnormalities in PVEP amplitude and time to peak, as well as PERG amplitude.This may reflect subclinical optic nerve dysfunction in OSA.Further research is needed to determine the association between the severity of OSA and the degree of optic nerve dysfunction.

Noise-induced hearing loss among quarry workers in a north-eastern state of Malaysia: a study on knowledge, attitude and practice

Noise is known to be one of the environmental and occupational hazards listed in the Factory and Machinery Act 1967. Quarries with loud deafening sounds from trucks and machineries pose the risk of noise-induced hearing loss to workers. This study was designed to assess the knowledge, attitude and practice towards noise-induced hearing loss and to determine the prevalence of noise-induced hearing loss and its associated factors among quarry workers in a north-eastern state of Malaysia. A cross-sectional study was conducted at six quarries in a north-eastern state of Malaysia, with 97 consented respondents who answered a validated version of a questionnaire and underwent pure tone audiogram. The respondents were male, aged between 18 to 50 years, working in the quarry area for at least 6-months duration with no family history of ear diseases. The mean percentage scores of knowledge, attitude and practice were 44 [11], 70 [10] and 28 [16] percent, respectively. The prevalence of noise-induced hearing loss was found to be 57 [95% CI: 47, 67] with 46 [84%] having mild and moderate noise-induced hearing loss, and 34 [62%] involved both ears. Multiple logistic regressions showed that age and practice score were the associated factors with odd ratios of 1.1 [95% CI: 1.1, 1.2; p<0.001] and 0.9 [95% CI: 0.8, 1.0; p=0.008], respectively. The knowledge, attitude and practice scores of the respondents were poor and the high prevalence of noise-induced hearing loss was contributed by factors such as poor practice and old age.

Utilization of harmonic scalpel for hemiglossectomy in carcinoma of the tongue

Hemiglossectomy using monopolar diathermy is the conventional surgical treatment of choice for carcinoma of the tongue. Unnecessary and troublesome bleeding is quite often associated with the modality, although a careful identification and ligation of lingual artery can render the surgery less bloodless. Currently harmonic scalpel which is one of the modern modalities is being employed in surgical excision of tongue carcinoma. The mechanism of harmonic scalpel involved the combination of coagulation and cutting effect making glossectomy fast, simple and bloodless. We report a case of 62 years old patient who had right hemiglossectomy using harmonic scalpel for carcinoma of the tongue. The mechanism and advantages of harmonic scalpel modality over conventional modalities are discussed.

Radiographic evaluation of enlarged adenoids in children with chronic adenoiditis

To evaluate the use of soft tissue neck x-ray in the assessment of enlarged adenoids in children with chronic adenoiditis. Tertiary referral centre of Malaysia. Prospective study. We performed a soft tissue neck x-ray [lateral view] for adenoids in children with chronic adenoiditis admitted for adenoidectomy under general anaesthesia. Only those children whose parents /guardian agreed for imaging were included. The enlarged adenoids were graded from 1+ to 4+ where 1+ is the normal adenoids with normal nasopharyngeal airway and 4+ is massive enlargement of adenoids with totally occluded nasopharyngeal airway. RESULTS: Fifty children were accrued from June 1999 to September 2001. The ages of the children were from 3-12 years old. All of them had adenoidectomy successfully without any complications. The soft tissue neck x-ray showed 8% of the patients have 1+, 38% have 2+, 42% have 3+ and 12% have 4+ adenoids enlargement. Lateral soft tissue neck x-ray is a good method to demonstrate adenoids enlargement in children with chronic adenoiditis and convenient for the busy otorhinolaryngologists. It may help to determine that the symptoms are due to adenoids enlargement and exclude other causes

Sudden airway obstruction secondary to bilateral vocal cords polyps

Vocal polyps are benign laryngeal lesions which arise from the Reinke's space. Hoarseness is the most common presentation but airway compromised might occur in the presence of big polyps. We hereby report a case of big bilateral vocal polyps in which a tracheostomy under local anesthesia was required prior to endomicrolaryngeal surgery

Outcome of neck dissections in a rural tertiary University Hospital in Malaysia

To determine the outcome of neck dissection among our head and neck cancer patients in the setting of a rural Universitiy Sains Malaysia Hospital. Neck dissection procedures were reviewed from 2004 to 2008. The medical folders of each patient were traced and the data collected includes diagnosis, type of operative procedure and outcome on follow-up. A total of fourteen patients had undergone neck dissection as a combined procedure with the'primary tumor surgical removal. There were five radical neck and one modified type two radical neck dissections. The rest were eight selective neck dissections [three anterior and five supraomohyoid]. Twelve patients underwent unilateral neck dissections and two patients underwent bilateral neck dissections. The average duration of hospital stay was seventeen days, the longest stay was two months and the shortest stay was four days. One patient died secondary to complication of the primary tumor and one had to undergo exploration due to chylous leak post operation. Neck dissection is a surgical procedure to control neck lymph nodes metastasis from primary carcinoma of the head and neck. The extent of the cervical nodes involvement determines the type of neck dissections and their outcomes

Challenges in the Management of Nasopharyngeal Carcinoma: A Review

Nasopharyngeal carcinoma (NPC) is a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx, an area that shows varying degrees of differentiation. Although relatively rare worldwide, NPC has substantial incidence and mortality in populations in Southeast Asia and in people with Southern Chinese ancestry. In Malaysia, NPC is a leading cancer type. In the clinic, NPC presents on a very wide spectrum. Therefore, a high degree of suspicion on the part of the clinician and an increased awareness by the patient is essential for the recognition of an early lesion. Early detection of the cancer is important as it affects the patient’s prognosis and the mode of treatment. Managing patients with NPC is very challenging as patients usually present late when the cancer is already in an advanced stage. Here, we review the challenges in the management of NPC.

Outcome of laser-assisted uvulopalatoplasty (LAUP) in the management of snoring in Hospital Universiti Sains Malaysia (USM)

To determine the outcome of laser-assisted uvulopalatoplasty for the management of patients with snoring in Universiti Sains Malaysia Hospital (HUSM). A retrospective review of patients who underwent LAUP with or without tonsillectomy or adenoidectomy under general anaesthesia between December 2003 to December 2006. Data was obtained from admission and follow-up records in the otorhinolaryngology clinic of USM Hospital (HUSM). A total of nineteen patients underwent procedure for the treatment of snoring. Majority of these patients presented with symptoms of loud snoring and daytime somnolence. The main operations performed were LAUP with or without tonsillectomy or adenoidectomy. The justification for LAUP were overhanging and excessive uvula or soft palate, whereas for adenotonsillectomy were the hypertrophied adenoids and tonsils. On follow-up, most of the patients claimed improvement of snoring within the first 2 months post-operation. However, majority of them defaulted follow-up after that. One patient (AHI preoperatively was mild) was reviewed up to 8 months with no snoring. One patient (AHI was severe preoperatively and normal post operatively) remained in our follow-up was satisfied with the operation. Two patients continued to experience snoring post LAUP despite trial of non-surgical methods. The outcome of LAUP in our patients showed variable results. This showed that patient selection is very important to achieve good result in LAUP. Long-term follow-up is also essential to document the success for LAUP.

Clinical and audiological profiles in children with chronic otitis media with effusion requiring surgical intervention

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.

Arteriovenous malformation of the mandible: A rare but life-threatening disease

AVM in the mandible is rare. It may present with recurrent episodes of unexplained gingival haemorrhage, bony swelling, tooth mobility or facial asymmetry. We reported our experience in managing a case of a 15 year old Malay girl who presented with a life threatening bleeding from her mandible.

Appraisal of clinical profile and management of juvenile nasopharyngeal angiofibroma in Malaysia

Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally invasive tumour. Patients are usually in their adolescent age and present with epistaxis and nasal blockage. Diagnosis is based on clinical evaluation and the C.T. scan findings. Pre-operative superselective embolisation (SSE) and surgical excision is the treatment of choice. The outpatient clinic of ORL-HNS hospital of University Science Malaysia received 25 referrals, all male, majority between 9-13 years of age and few adolescents. Clinically the patients were consistent with symptoms of recurrent epistaxis and nasal blockage. They reported from October 1998 to October 2001 from within the state of Kelantan and the nearby states of Pahang, Kedah and Terenganu. Diagnosis was mostly made on typical radiological findings and the tumours were classified accordingly into four stages. SSE and surgical excision was carried out in all cases. Regular follow-up helped us to identify early recurrences which were treated with salvage surgery or radiotherapy in one case with extensive intracranial extension. A retrospective review of presenting features, diagnostic difficulties, surgical approaches and its outcome is presented. Maxillary swing procedure performed in three cases as a new surgical option in the management of JNA is also discussed.