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Fulltext Balloon dilatation of laryngotracheal stenosis: Hospital Ampang experience

Loo, L.Y., Mawaddah, A., Shahrul, H., Khairullah, A.

International Medical Journal Malaysia, 2017;16(2):113-116.
MyJurnal

The upper airway is a crucial structure. It becomes a grave problem should it be narrowed. Several methods
of treatment were rendered for patients with laryngotracheal stenosis. We share our experience with the
combination total intravenous anaesthesia and apneic pause technique with or without steroid injection.
Four cases of laryngotracheal stenosis were observed in Hospital Ampang: two adult and two paediatric
cases. Age, gender, causative factor, stenosis segment length, grade or severity were observed before and
after dilatation, number of dilatation were observed and compared. The outcome measures are
decannulation and avoidance of tracheostomy. All cases had improvement of symptoms. Half or 50% of the
patient required repeated balloon dilatations. The paediatric cases successfully avoided tracheostomy while
the adult cases successfully decannulated with no complication from the procedure. Balloon dilatation by
total intravenous anaesthesia coupled with apneic method is a safe and effective method of treatment for
the narrowed airway.
Fulltext Prolong placement of tracheostomy tube causing unusual complication

Mohamad Norkahfi, R., Marina, M.B., Mawaddah, A., Abdullah Sani, M.

Medicine & Health, 2016;11(2):298-302.
MyJurnal

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.
Fulltext High intraocular pressure: a comparative study between Obstructive Sleep Apnea (OSA) and Non-OSA subjects

Marina, M.B., Mohd Tahir, J., Mawaddah, A., Asma, A., Mohd Razif, M.Y., Jemaima, C.H.

Medicine & Health, 2018;13(2):36-47.
MyJurnal

Obstructive Sleep Apnoea (OSA) affects 2-5% of the middle-aged population and is a potentially life-threatening condition. Previous studies on OSA and glaucoma have reported mixed findings. This was a cross-sectional comparative study with a study duration of one year to compare the incidence of high intraocular pressure among OSA subjects and non-OSA subjects. This study took place in a tertiary hospital where a total of 50 subjects with OSA and 50 non-OSA subjects were recruited. The average age was 37 years (19,65) in a multiethnic study population (76% (Malay), 18% (Chinese) and 6% (Indian)). All patients underwent a full night computer-assisted polysomnogram (SOMNOCheck Effort Weinmann, Hamburg, Germany), Epworth Sleepiness Scale (ESS), Mullers manouevre (MM) to assess the level of obstruction and tonometry. The incidence of high Intra Ocular Pressure (IOP) among OSA subject was 52% with a significant difference between non-OSA and OSA subjects. Correlation between ESS and IOP were significant (p
Fulltext The incidence of thyroid gland invasion in patients with carcinoma of the larynx who underwent total laryngectomy.

Mawaddah A, See-Sze S, Marina MB, Pua KC, Abdullah-Sani M

IIUM Medical Journal Malaysia, 2019;18(1):13-20.
MyJurnal

Total thyroidectomy or at least hemithyroidectomy is routinely performed alongside total laryngectomy in patients with advanced carcinoma of the larynx. Life-threatening hypocalcaemia and hypothyroidism are common sequelae especially with adjuvant radiation. The study aims to determine the incidence of microscopic thyroid gland invasion and challenge the idea of routine thyroidectomy in advanced carcinoma of the larynx. Materials and Methods:This study was a retrospective observational study. It was done in two tertiary centres in Malaysia between 2003 and 2013 for a total duration of 11 years. A total of 72 patients were included in this study. Data from medical records, operative notes, and histopathological reports were collected and analysed. Results: Three patients (4.2%) had the presence of microscopic thyroid gland invasion. There were no significant associations between microscopic thyroid gland invasion and tumour subsites, histological types of a tumour nor T staging (p>0.05) Conclusion: The incidence of microscopic thyroid gland invasion in advance carcinoma of the larynx is low, disavowing routine thyroidectomy. Limitations: Some factors such as cartilage invasion on CT imaging and central lymph node treatment were not considered due to limitations in case documentation.
Fulltext Case report: progression of pre-septal cellulitis to orbital subperiosteal abscess despite intravenous broad-spectrum antibiotics in a child

Noor Aniah A, Norshamsiah MD, Safinaz MK, Bastion, MLC, Mawaddah A

Journal of Surgical Academia, 2016;6(1):62-65.
MyJurnal

We report a case of a 7-year-old girl who initially presented with painless right eyelid swelling with full extra-ocular movement (EOM). She was treated with intravenous broad-spectrum antibiotics for preseptal cellulitis but her condition worsened. An urgent magnetic resonance imaging (MRI) of the brain and orbit showed orbital abscess, subperiosteal abscess in the medial orbital wall and evidence of sinusitis in the anterior ethmoidal air cells. She underwent Endoscopic Orbital Decompression (EOD) surgery on day 4 of presentation and her condition improved remarkably. We report a case of orbital abscess with subperiosteal abscess in the medial orbital wall. This case highlights the possibility of progression of orbital cellulitis despite administration of a broad-spectrum antibiotic.
Fulltext Gore-tex medialisation thyroplasty for unilateral vocal cord palsy: a tertiary centre 7 years experience

Dayangku, N.P.S., Marina, M.B., Mawaddah, A., Sharifa Ezat, W.P., Abdullah, S.

International Medical Journal Malaysia, 2016;15(2):13-17.
MyJurnal

Background: The resultant dysphonia and aspiration in unilateral vocal cord palsy can be overcome with
medialisation thyroplasty. With this background, we aim to determine the aetiology of the unilateral vocal
cord palsy and effectiveness of the phonosurgical procedure with Gore-Tex as a sole treatment. Methods:
Within a seven year period, 37 Gore-Tex medialisation thyroplasty were performed for unilateral vocal cord
palsy at our institution and medical records were retrospectively reviewed. Results: There were 18
males and 19 females with mean age of 48.7 years (range 19–81 years). The predominant aetiology was
thyroidectomy (43.2%) with benign thyroid disease predominates (n=13) over thyroid malignancy (n=3). Voice
outcome was evaluated subjectively using visual analogue scoring system, results indicating that Gore-Tex
medialisation thyroplasty was effective in addressing dysphonia in 62.5% (n=15) patients. However it alone
cannot address aspiration seen in those with high vagal nerve lesion. Airway compromise occurred in two
cases postoperatively (5.4%) presenting as acute stridor. Conclusion: In unilateral vocal cord palsy, Gore-Tex
medialisation thyroplasty can effectively improve the resultant dysphonia and often accompanying aspiration
which would otherwise be disabling for the patients.
Upper respiratory tract sampling in COVID-19

Mawaddah A, Gendeh HS, Lum SG, Marina MB

Malays J Pathol, 2020 Apr;42(1):23-35.
PMID: 32342928

INTRODUCTION: To review the present literature on upper respiratory tract sampling in COVID-19 and provide recommendations to improve healthcare practices and directions in future studies.
METHODS: Twelve relevant manuscripts were sourced from a total of 7288 search results obtained using PubMed, Medline and Google Scholar. The search keywords used were COVID-19, nasopharyngeal, oropharyngeal, swabs, SARS and CoV2. Original manuscripts were obtained and analysed by all authors. The review included manuscripts which have not undergone rigorous peer-review process in view of the magnitude of the topic discussed.
RESULTS: The viral load of SARS-CoV-2 RNA in the upper respiratory tract was significantly higher during the first week and peaked at 4-6 days after onset of symptoms, during which it can be potentially sampled. Nasopharyngeal swab has demonstrated higher viral load than oropharyngeal swab, where the difference in paired samples is best seen at 0-9 days after the onset of illness. Sensitivity of nasopharyngeal swab was higher than oropharyngeal swabs in COVID-19 patients. Patient self-collected throat washing has been shown to contain higher viral load than nasopharyngeal or oropharyngeal swab, with significantly higher sensitivity when compared with paired nasopharyngeal swab.
RECOMMENDATIONS: Routine nasopharyngeal swab of suspected COVID-19 infection should take anatomy of the nasal cavity into consideration to increase patient comfort and diagnostic yield. Routine oropharyngeal swab should be replaced by throat washing which has demonstrated better diagnostic accuracy, and it is safe towards others.
Fulltext Isolated blunt lingual artery injury secondary to a road traffic accident: diagnostic and therapeutic approach

Mawaddah A, Goh BS, Kew TY, Rozman Z

Malays J Med Sci, 2012 Apr;19(2):77-81.
PMID: 22973141 MyJurnal

Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.
Parapharyngeal Schwannoma Masquerading as Lymphangioma

Kai Jun T, Suhana AR, Avatar Singh MS, Kadar Shiraz Qamil MA, Mawaddah A

Iran J Med Sci, 2020 Jul;45(4):316-317.
PMID: 32801423 DOI: 10.30476/ijms.2020.81956.0
Fulltext A Ten-Year Kuala Lumpur Review on Laser Posterior Cordectomy for Bilateral Vocal Fold Immobility

Mawaddah A, Marina MB, Halimuddin S, Mohd Razif MY, Abdullah S

Malays J Med Sci, 2016 Jul;23(4):65-70.
PMID: 27660547 MyJurnal DOI: 10.21315/mjms2016.23.4.9

Bilateral vocal fold immobility (BVFI) is commonly caused by injury to the recurrent laryngeal nerve (RLN) and leads to stridor and dyspnea of varying onsets. A retrospective study was done at the Department of Otorhinolaryngology of Universiti Kebangsaan Malaysia Medical Centre on laser microsurgical posterior cordectomy for BVFI. The objectives were to identify the average duration of onset of stridor from the time of insult and to evaluate the outcome of laser posterior cordectomy as a surgical option. From 1997 to 2007, a total of 31 patients with BVFI were referred for surgery. Twelve patients had tracheostomy done prior to the procedure, whereas 19 patients were without tracheostomy. Ten patients were successfully decannulated, and only 4 patients had complications related to the procedure. The minimum onset of stridor was 7 months, maximum onset of stridor was 28 years, and the mean onset of stridor was 8.7 years. The commonest complication observed was posterior glottic adhesion following bilateral posterior cordectomy. Laser endolaryngeal posterior cordectomy is an excellent surgical option as it enables successful decannulation or avoidance of tracheostomy in patients with BVFI. The onset of stridor took years after the insult to the recurrent laryngeal nerves.
Fluorescent microscopy evaluation of diode laser effect on the penetration depth of turmeric (Curcuma longa) extract cream on skin tissues of Wistar rats

Astuti SD, Mawaddah A, Kusumawati I, Mahmud AF, Nasution AMT, Purwanto B, et al.

Lasers Med Sci, 2024 Feb 23;39(1):79.
PMID: 38393433 DOI: 10.1007/s10103-024-04020-3

The study investigates the effect of diode laser exposure on curcumin's skin penetration, using turmeric extraction as a light-sensitive chemical and various laser light sources. It uses an in vivo skin analysis method on Wistar strain mice. The lasers are utilized at wavelengths of 403 nm, 523 nm, 661 nm, and 979 nm. The energy densities of the lasers are 20.566 J/cm2, 20.572 J/cm2, 21.162 J/cm2, and 21.298 J/cm2, which are comparable to one another. The experimental animals were divided into three groups: base cream (BC), turmeric extract cream (TEC), and the combination laser (L), BC, and TEC treatment group. Combination light source (LS) with cream (C) was performed with 8 combinations namely 523 nm ((L1 + BC) and (L1 + TEC)), 661 nm ((L2 + BC) and (L2 + TEC)), 403 nm ((L3 + BC) and (L3 + TEC)), and 979 nm ((L4 + BC) and (L4 + TEC)). The study involved applying four laser types to cream-covered and turmeric extract-coated rat skin, with samples scored for analysis. The study found that both base cream and curcumin cream had consistent pH values of 7-8, within the skin's range, and curcumin extract cream had lower viscosity. The results of the statistical analysis of Kruskal-Wallis showed a significant value (p 0.05), while the treatment using BC and TEC showed a significant difference (p