The association of human papillomavirus (HPV) with juvenile laryngeal papillomatosis has been well documented. We report two cases of juvenile laryngeal papillomatosis and correlated these cases with presence of HPV, p53 and c-erbB-2 proteins. The first case was a one-year-old male patient and the second a six-year-old female patient. Formalin-fixed paraffin-embedded biopsy specimens were tested for the presence of HPV genome by the technique of in situ hybridisation using wide spectrum and type specific biotinylated probes while the immunohistochemical expression of p53 (D07, 1:50) and c-erbB-2 (DAKO A0485, 1:300) proteins were evaluated with commercially available antibodies. Histologically the tumours in both cases showed papillary configuration of squamous papilloma. The first case detected HPV type 6, HPV type 11 and p53 protein expression while the second case showed only HPV type 6. Both cases of HPV showed positive signals confined to the nuclei in the superficial squamous epithelium. The first case showed p53 positivity seen from the basal region up to one third of the epithelium of laryngeal papillomas and the subsequent recent repeat biopsy showed the positivity of p53 had extended throughout the upper layers of the epithelium. Expression of c-erbB-2 protein was not detected in both cases. These findings were similar as in other studies where follow-up of the cases was recommended since they tend to recur.
The reciprocal translocation t(9;22)(q34;q11) which gives rise to the Philadelphia (Ph1) chromosome and BCR/ABL fusion gene, plays a pivotal role in the diagnosis and pathogenesis of chronic myeloid leukemia (CML). In this study, we evaluated the role of fluorescence in situ hybridisation (FISH) in detecting the BCR/ABL rearrangement in CML patients. The sensitivity, specificity and detection rate of BCR/ABL gene using FISH, PCR and conventional cytogenetics (karyotyping) methods were also compared. 18 bone marrow samples of patients with clinically diagnosed CML and suspected of CML were collected. The sensitivity, specificity and positive predictive values of FISH were altogether 100% while the sensitivity, specificity and positive predictive values for conventional cytogenetics (karyotyping) were 85%, 100% and 100% respectively. Convetional cytogenetics (karyotyping) detected an additional chromosomal aberration in addition to the Ph1 chromosome. In conclusion, FISH is a highly sensitive method in detecting the BCR/ABL gene. Conventional cytogenetics (karyotyping) remains an important investigation in the work up of suspected CML patients since there is a possibility of detecting chromosomal aberrations in addition to the Ph1 translocation. Therefore, conventional cytogenetics (karyotyping) and FISH are complementary techniques and their results should be interpreted together with clinical information.
Idiopathic sudden sensorineural hearing loss (ISSNHL) is considered to be an otological emergency. The intratympanic
(IT) steroid injection technique is introduced to decrease the side effects of systemic steroids and assumed to deliver
a higher concentration of corticosteroids into the affected cochlea. The objective of the current study was to evaluate
the hearing outcomes of high dose IT methylprednisolone among ISSNHL patients after failure of systemic corticosteroid
therapy (SCT). Hearing outcomes of SCT were evaluated over a 15 months period. Upon failure of SCT, the treatment was
continued with higher dose IT steroid (methylprednisolone 62.5 mg/mL). Pre-treatment and post-treatment audiometric
evaluations were analysed using pure tone audiogram (PTA). There were 36 patients diagnosed with ISSNHL included
in the study. After two weeks of SCT, eighteen (56.3%) patients had hearing improvement of more than 10 dB. Another
fourteen (43.7%) patients had no hearing improvement (less than 10 dB). Following that, twelve patients were recruited
for weekly IT methylprednisolone for three weeks. During the one month follow up after completion of IT therapy, six
patients (50%) showed more than 10 dB improvement in the PTA with a mean of 19.37 dB (p<0.05). Out of the six, two
patients had more than 20 dB hearing improvement. Almost all patients in this study had an improvement in their symptoms
of tinnitus and vertigo. High dose IT methylprednisolone after failure of SCT resulted in significant improvement in the
patients’ hearing outcome during one month follow up. The IT therapy not only improved the patients’ hearing but in
addition reduced the symptoms of tinnitus and vertigo.
The limitation of self-repair and proliferation capacity of chondrocytes in cartilage reconstruction lead to alternative
search of cell source that can improve the auricular regeneration. Human adipose-derived stem cells (HADSC) are an
alternative cell source that have unique characteristics to self-renew and differentiate into various tissues making it
suitable for cell therapy and tissue engineering. This study aimed to examine the chondrogenic differentiation potential of
(HADSC) in monolayer culture by the presence of different transforming growth factor beta’s, TFG-β1, -β2 and -β3. HADSC
at passage 3 (1.5 × 105 cell/mL) were cultured in chondrogenic medium containing 5 ng/mL of different transforming
growth factor beta’s, TFG-β1, -β2 and -β3 for 7, 14 and 21 days. Data analysis was evaluated based on the growth
rate of cells, cells morphological changed, production of collagen type II and glycosaminoglycan sulphate (sGAG). The
quantitative RT-PCR was carried out to determine the chondrogenic, fibrogenic and hypertrophic gene expression levels.
Differentiation of HADSC into chondrocytes using TFG-β indicates the occurrence of the chondrogenesis process. The best
chondrogenic differentiation was observed in HADSC induced by TFG-β3 through the chondrocytes-like cells morphology
with cells aggregation and high production of proteoglycan matrices compared to other TGF-βs groups. Additionally,
the expression of chondrocytes-specific genes such as Type II collagen, Aggrecan core protein, Elastin and Sox 9 was
high. In conclusion, this study has showed that TGF-β3 is the potential growth factor in producing chondrogenic cells
for auricular cartilage tissue engineering.
Over the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed "private contractors" who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.