Synchronous Primary Parosteal Osteosarcoma and Primary Mediastinal Germ Cell Tumour with Atypical Mycobacterial Infection – A Rare Phenomenon: A Case Report

@#Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

Combination of polymyxin B and Aquilaria malaccensis extract enhanced the killing and inhibited the growth of Acinetobacter baumannii and Klebsiella pneumoniae

Aims@#Polymyxins are an important last-line treatment for infections caused by multidrug-resistant Gram-negative bacteria. Nonetheless, the emergence of polymyxin-resistance and the limiting of polymyxin monotherapy urgently demands its optimisation. Aquilaria malaccensis (Agarwood) has been widely used as traditional medicine. Many parts of the plant including leaves exhibit a considerable in vitro antibacterial activity against microbial pathogens. Exploiting A. malaccensis in combination with polymyxins provides a novel strategy in fighting antimicrobial resistance. The objective of this study was to evaluate the combination effects of A. malaccensis extract with polymyxins against Acinetobacter baumannii and Klebsiella pneumoniae.@*Methodology and results@#In vitro time-kill studies and GC-MS analysis were performed to evaluate the bacterial killing of polymyxin B and extract combination and analyse chemical compounds of the extract, respectively. The combination of polymyxin B (1 mg/L) and A. malaccensis extract (32 mg/mL and 64 mg/mL) treatments exhibited enhanced bacterial killing compared to polymyxin B alone at 4 h and 24 h. Combination treatments also inhibited the bacterial growth of both A. baumannii and K. pneumoniae observed throughout the 24 h. More than sixty compounds including phytol, 9,12-octadecadienal, fatty acid, alkanes and terpenoids were putatively identified as the compounds that likely contributed to the antibacterial activity.@*Conclusion, significance and impact of study@#This study was the first to report the potential application of A. malaccensis extract in combination with polymyxin B in treatment against A. baumannii and K. pneumoniae and can be further investigated and optimized for the treatment of bacterial infectious diseases.

Levels of Non-Essential (Cd, Pb and Hg) Elements in Muscle Tissues of A. bicolor bicolor, McClelland 1844 from Kedah and A. bengalensis bengalensis, Gray 1831 from Perak and Human Consumption Risks / Jurnal Sains Kesihatan Malaysia

@#A study on heavy metals accumulation and human health risk assessment in the consumption of two tropical freshwater eel species (A. bengalensis bengalensis) from the Sungai Perak at Kuala Kangsar, Perak and (A. bicolor bicolor) from the Air Hitam irrigation canal, Kampung Kuala Sanglang, Kedah was carried out. Specimens were examined and analyzed for Pb and Cd concentrations using ICP-MS while the total Hg concentration was measured using a direct mercury analyzer (MA-3000). The range for the total concentrations (µg/g wet wt.) in A. bicolor bicolor were 0.01-0.4 (Cd), 0.03-0.77 (Pb) and 0.36-0.94 (Hg) while for A. bengalensis bengalensis, they were 0.76-1.23 (Cd), 0.01-0.10 (Pb) and 0.27-1.5 (Hg). A. bengalensis bengalensis (Sungai Perak) showed a significant strong relationship between Hg/Pb (r = .771, P < 0.05) and A. bicolor bicolor (Air Hitam irrigation canal) with Cd/Pb (r = -.895, P < 0.05) in muscle tissues and the results indicated Hg and Pb were introduced from point and non-point sources, therefore it is of concern. Interspatial comparison with the findings of previous local and international studies showed both species of freshwater eels accumulated Hg to high levels, exceeding the safe limits stipulated in the Malaysian Food Act of 1984, Food Regulations (1985) and USEPA (1997). However, the Target Hazard Quotient (THQ) and Hazard Index (HI) indicated that both freshwater eel spp. from the studied sites are safe to consume as there is no risk posed from consumption based on the health risk assessment results as Pb, Cd and Hg concentrations were under the permissible limits of nutrient intake.

Antibacterial potential of lactic acid bacteria isolated from local pickled Eleiodoxa conferta (kelubi) against selected foodborne pathogens

Aims@#Pickled fruits are a popular condiment not only in Malaysia but throughout the world. Lactic acid bacteria (LAB) are known to be able to produce several antibacterial compounds during the pickling process. Pickled Eleiodoxa conferta or kelubi is among the commonly consumed pickled fruits in Malaysia and may be a promising source of LAB. This study was carried out to isolate and identify LAB from local pickled E. conferta and to determine their antibacterial activity against foodborne pathogens. @*Methodology and results@#The isolation of LAB was conducted using standard methods and the isolated colonies were preliminarily identified based on their morphology on De Man, Rogosa and Sharpe (MRS) agar, Gram-positive staining characteristics and their catalase-negative reactions and subsequently chosen for identification with polymerase chain reaction (PCR) amplification of the 16S rRNA gene and sequencing. A total of four LAB isolates were successfully isolated and identified: Lactobacillus brevis (LABK1 and LABK2), L. plantarum (LABK3) and Leuconostoc mesenteroides (LABK4). The antibacterial activity of the identified LAB was determined against 10 commonly known foodborne bacterial pathogens using LAB cell cultures by agar spot test method. The antibacterial activity was also evaluated using the cell free supernatant (CFS) of the LAB through agar well diffusion method. All four LAB cultures were able to demonstrate antibacterial activity and inhibited five Gram-positive and five Gram-negative bacterial pathogens. @*Conclusion, significance and impact of study@#This study demonstrated that the isolated LAB from E. conferta has antibacterial effects against several foodborne pathogens. These LAB strains may have potential as a natural food preservative.

Chronic Large Non Healing Ulcer: Non-Tuberculous Mycobacterial Infection of the Laryngopharynx / 가정의학회지

We describe a case of non-tuberculous mycobacterial infection of the larynx in a previously well, immunocompetent young woman. Laryngeal mycobacterial infection is rare and currently accounts for less than 1% of all cases. A diagnostic dilemma often occurs because it may mimic laryngeal carcinoma, chronic laryngitis, or laryngeal candidiasis. This case highlights the importance of considering non-tuberculous mycobacterial infection in the differential diagnosis of laryngeal lesions.

Prolong Placement of Tracheostomy Tube Causing Unusual Complication

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications.

Partial Cricotracheal Resection (PCTR), a RewardingOutcome for Paediatric Subglottic Stenosis : An Early Experience

This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.

Hoarseness due to cardiovascular disease: Two cases of cardiovocal syndrome

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To report two cases of cardiovocal syndrome (or Ortner's syndrome) due to cardiovascular disease.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Case report<br /><strong>Setting</strong>: Tertiary University Hospital<br /><strong>Subjects</strong>: Two</p> <p style="text-align: justify;"><strong>RESULTS</strong>: Two patients with Cardiovocal syndrome, one due to an aortic saccular aneurysm and the other due to severe mitral stenosis underwent surgery to correct the underlying cardiovascular disease. Post-operatively, the hoarseness resolved completely in the patient with mitral stenosis but persisted in the patient with aortic saccular aneurysm.</p> <p style="text-align: justify;"><strong>CONCLUSION</strong>: Cardiovascular disease should be considered as a differential diagnosis in a patient with hoarseness. A high index of suspicion is needed to make an early diagnosis which can lead to surgical correction of the potentially life-threatening, underlying cardiovascular disease.</p>

Adenoid cystic carcinoma of the subglottic

Adenoid cystic carcinoma [ACC] is one of the most common malignancies of the minor salivary glands in the head and neck. We report a case of adenoid cystic carcinoma of the subglottic region presenting with hoarseness and decrease effort tolerance. Smooth, solid and lobulated mass arising from the anterior part of the subglottic region was seen on direct laryngoscopy. Computed tomography [CT] scan and histopathological examination were confirmatory. Laser excision followed by radiation resulted in apparently normal subglottic mucosa