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Abstract Introduction Tracheal agenesis is a very rare congenital airway anomaly. It may pose a great challenge to the first attending physician both in diagnosis and in establishing the airway during the first day of life. Case presentation We report a newborn Malay baby boy with trachea agenesis (type III by Floyd's classification) who presented with severe respiratory distress immediately after birth. Clinical diagnosis in this case was not straightforward, as it started with difficulty in intubation followed by an unsuccessful emergency tracheostomy in the neonatal intensive care unit. Urgent surgical neck exploration with endoscopic examination in the general operating theatre revealed the final diagnosis. The authors present a short description of the embryopathology and diagnostic criteria of the abnormality. Conclusion We hope this case presentation will be valuable in increasing the awareness of physicians about this rare cause of tracheal obstruction or difficult intubation.

Background: Circulating microRNAs (miRNAs) are a group of noncoding RNAs with promising potential as minimal invasive biomarkers for noncommunicable diseases. However, challenges exist in the preparation of these miRNAs from peripheral blood samples for quantification purposes. The low quality of miRNA extracts presents an obstacle. Acknowledging the superior performance of quantitative real-time polymerase chain reaction (qPCR) as gold standard for gene expression analysis, we conducted this study to observe the capabilities of qPCR using the Taqman® protocol in amplifying circulating miRNAs from miRNA extracts with low purity and yield. Methods: miRNAs were extracted from thirty-six plasma samples that were obtained from public subjects. Four selected miRNAs were quantified using the Taqman® protocol in an integrated fluidic circuit chip that was optimized from a previous study. The amplification graph and Cq values were obtained to observe any abnormal amplification signs and expression levels, respectively. Results: The qualitative observation of the amplification of the four miRNAs showed no sign of abnormality, thereby indicating the successful amplification of the miRNAs without enzymatic inhibition. Furthermore, the miRNAs were quantified in high expression levels. Conclusion: The circulating miRNA extracts with low purity and yield were practical for the study of circulating miRNA expression based on the Taqman® protocol as the method of detection. [ABSTRACT FROM AUTHOR]

Previous study found that microRNA-101 (miR-101) and microRNA-744 (miR-744) were deregulated in head and neck cancers and were implicated in nasopharyngeal carcinoma (NPC) carcinogenesis. Thus, this study aimed to determine the expression of miR-101 and miR-744 in NPC and analyse the utility of these microRNAs (miRNAs) as diagnostic biomarkers. Total RNA was extracted from 31 NPC and 7 non-NPC control formalin-fixed paraffin-embedded (FFPE) samples. Complementary DNA (cDNA) was synthesized from the total RNA and proceeded with quantitative real-time polymerase chain reaction. Differential expression of miR-101 and miR-744 were calculated from quantification cycle (Cq) data using 2-ΔΔCq calculation. The performance of these miRNAs were calculated using receiver operating characteristic (ROC) curve analysis. The differential expression for miR-101 and miR- 744 were -1.39 (p < 0.05) and 2.48 (p > 0.05), respectively, where the deregulations were consistent with the previous report. The area under curve for miR-101, miR-744 and combination of miR-101 and miR- 744 were 0.654 (95% CI: 0.465 - 0.844), 0.588 (95% CI: 0.368 - 0.808) and 0.626 (95% CI: 0.481 - 0.771), respectively. However, re-analysis using balanced sample size between NPC and non-NPC control group showed the value decreased to 0.653 (95% CI: 0.347 - 0.959) for miR-101 but increased to 0.827 (95% CI: 0.601 - 1.000) for miR-744 and 0.758 (95% CI: 0.576 - 0.939) for the combination of miR-101 and miR-744, indicating the importance of having a balanced sample size. We have successfully determined the expression of miR-101 and miR-744 in NPC samples. We also demonstrated statistically the utility of these miRNAs as diagnostic biomarkers. [ABSTRACT FROM AUTHOR]

Primary thyroid lymphoma is a relatively uncommon pathology of the thyroid gland that mainly occurs in elderly females. We describe a rare case of B-cell thyroid lymphoma in a young healthy male. It is an important diagnosis to be considered in patients presenting with a rapidly enlarging neck mass as its management is different from other differentiated thyroid carcinoma which require total thyroidectomy plus adjuvant radioactive iodine ablation. Our report emphasizes the need for clinical awareness leading to early detection, followed by early multidisciplinary management. [ABSTRACT FROM AUTHOR]

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is relatively a rare tumour of head and neck region. Without histopathological confirmation, it appears and behaved as like malignant epithelial tumor of the head and neck region as will be illustrated in the present case. Cutaneous involvement of the tumor with distant metastasis has made the prognosis unfavorable. This isolated case of head and neck PC-ALCL was highlighted as it has a tendency to behave aggressively and early diagnosis and treatment is crucial to avoid poor survival outcome. [ABSTRACT FROM AUTHOR]

Importance: In patients with obstructive sleep apnea (OSA), operative risks depend on the severity of the underlying OSA and the invasiveness of the surgical procedure., Objective: To investigate the nature of the associations between the severity of OSA and the number and anatomical sites of upper airway operations with operative complications., Design, Setting, and Participants: This retrospective study included adult patients diagnosed with OSA (apnea-hypopnea index [AHI], >5) who underwent upper airway surgery at a single tertiary referral hospital between October 1, 2008, and October 1, 2015., Interventions: All patients underwent single or combination surgery on the nose, palatopharyngeal (tonsils, adenoids, and soft palate), and tongue base as a treatment of OSA., Main Outcomes and Measures: Pulmonary, surgical, and cardiovascular complications within the first 30 postoperative days were analyzed according to OSA severity and types of upper airway surgery. Logistic regression was used to assess the multivariable association of OSA, age, sex, body mass index, medical comorbidities, and types of upper airway surgery with short-term operative complications., Results: The study included 95 patients (87 males [91.6%]; 83 were Malay [87.4%]; mean [SD] age, 37.7 [1.6] years) with complete data and follow-up who underwent upper airway surgery to treat OSA. Patients with more severe OSA had greater body mass index (Cohen d, 0.27; 95% CI, -0.28 to 0.82), longer surgical time (Cohen d, 1.57; 95% CI, 0.95-2.15), and older age (Cohen d, 3.06; 95% CI, 2.29-3.77). At least 1 operative complication occurred in 48 of 95 patients (51%). In a multivariable model, the overall complication rate was increased with age and body mass index. Complication rates were not associated with AHI severity, type of procedure performed, and whether the surgery was single or combination surgery. Lowest oxygen desaturation (odds ratio, 1.03; 95% CI, 0.96-1.45; P = .04) and longest apnea duration (odds ratio, 1.03; 95% CI, 0.99-1.08; P = .02) were polysomnographic variables that predict the short-term operative complications., Conclusions and Relevance: In patients with OSA undergoing upper airway surgery, the severity of OSA as assessed by AHI, and the sites and numbers of concurrent operations performed were not associated with the rate of short-term operative complications.

Background: Surgical management of head and neck cancer is undoubtedly challenging, and we would like to see the outcome of managing such cases at one of the tertiary referral center in the East Coast of Malaysia., Methods: A 6-year retrospective analysis of surgically treated head and neck cancer cases in Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang was conducted., Results: The total number of patients reviewed was 55 and mean age of the patients was 59 years (SD 12). The larynx was the most common surgically treated site (29.1%), followed by the oral cavity (16.4%) and the paranasal sinuses (14.5%). Majority of the patients presented with stage III (32.8%) and stage IV (41.8%) cancer. Post-operative local complications (23.6%) and wound breakdown was identified as the most common cause (20%). Low hemoglobin level prior to surgery was associated with anemia after surgery (P = 0.007) and prolonged hospital stay (P = 0.030). Tumor recurrence was observed in 21.8% of the cases. Advanced stage tumor had more percentage of positive margin than early stage tumor i.e., 23% in early stage versus 58% in advanced stage (P = 0.050)., Conclusion: Surgical management of head and neck cancer in this center has an acceptable outcome.