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B. Gendeh

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● Retired after 37 years of government services as Professor and Senior Consultant ENT Surgeon ● Have been examiner for Undergraduate Medical Students ● He spent his Fulbright experience at the Hospital University of Pennsylvania(HUP), Philadelphia, University of Pittsburgh Medical Center and St Joseph’s Hospital, Chicago, USA sub-specializing in Rhinology(Endoscopic Sinus and Skull Base Surgery and Aesthetic Nasal Surgery). Have been examiner Conjoint Board Postgraduate ENT ● Have been President of four International ENT Conferences in Malaysia ●Past President of the Malaysian Society of Otorhinolaryngology-Head

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Papers by B. Gendeh

Diabetes Insipidus and Syndrome of Inappropriate Secretion of Antidiuretic Hormone in Children with Midline Suprasellar Brain Tumors

Journal of Pediatric Oncology Nursing, 1991

Diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) ... more

Minimally Invasive Surgical Approaches to the Sphenoid Sinus, Sella, Parasellar and Clival Region: Current and Future Perspectives

A review of smell and taste dysfunction in COVID-19 patients

The Medical journal of Malaysia, 2020

Multiple anecdotal reports suggest that smell and taste loss were early subclinical symptoms of C... more Multiple anecdotal reports suggest that smell and taste loss were early subclinical symptoms of COVID-19 patients. The objective of this review was to identify the incidence of smell and taste dysfunction in COVID-19, determine the onset of their symptoms and the risk factors of anosmia, hyposmia, ageusia or dysgeusia for COVID-19 infection. We searched the PubMed and Google Scholar on 15th May 2020, with search terms including SARS-COV-2, coronavirus, COVID-19, hyposmia, anosmia, ageusia and dysgeusia. The articles included were cross sectional studies, observational studies and retrospective or prospective audits, letters to editor and short communications that included a study of a cohort of patients. Case reports, case-series and interventional studies were excluded. A total of 16 studies were selected. Incidence of smell and taste dysfunction was higher in Europe (34 to 86%), North America (19 to 71%) and the Middle East (36 to 98%) when compared to the Asian cohorts (11 to 15%...

Observation of Spontaneous Cerebrospinal Fluid Rhinorrhoea to Body Mass Index: A Preliminary Report

The purpose of this retrospective study is to determine whether there is a correlation among over... more The purpose of this retrospective study is to determine whether there is a correlation among overweight, gender and the risk of development of spontaneous cerebrospinal fluid (CSF) rhinorrhoea. The clinical data of eight patients diagnosed with spontaneous cerebrospinal fluid rhinorrhoea who had been treated at our tertiary referral centre between 1998 and 2007 were assessed. Demographically, seven patients were female and one male with ages ranging from 14 to 53 years with a mean age of 43.6 years. This observation revealed that all patients were overweight with a mean body mass index (BMI) of 32.5 kg/m 2. This study suggests that there is a trend of increasing BMI to the risk of developing a spontaneous CSF rhinorrhoea.

Progressive Septal and Palatal Perforation Secondary to Intranascd Cocaine Abuse

Cocaine (benzylmethylecyonine) is used in its pure form for "snorting" and the more volatile "fre... more Cocaine (benzylmethylecyonine) is used in its pure form for "snorting" and the more volatile "free-base" form is used for smoking. Cocaine, a derivative of the leaves of Erythroxylon coca was long used by the Indian natives in Peru. However, it was not until 1855 that cocaine was isolated from the coca leaves. An estimated 30 million Americans have used cocaine and 6 million are compulsive users with a frequency of snorting amounting to once a month. Approximately, one in five American high school students have used cocaine before graduation. At one time, the cost of cocaine served as a barrier to its widespread use. However, with increasing availability and decreased cost, its use has escalated in

Endoscopic Repair of Spontaneous Cerebro-Spinal Fluid Rhinorrhoea: A Report of 3 Cases

Open Septorhinoplasty: Operative Technique and Grafts

In this case series, the senior author details his series of patients who had undergone open sept... more In this case series, the senior author details his series of patients who had undergone open septorhinoplasty for functional and/or aesthetic purposes in the Otorhinolaryngology Department at the Hospital Universiti Kebangsaan Malaysia (HUKM), Kuala Lumpur between January 2003 and September 2005. There were 23 patients, consisting of 15 men and 8 women from different Malaysian ethnic groups. Discussion on open septorhinoplasty with regards to operative technique, grafts and implants is presented from an otorhinolaryngologist's point of view.

Challenges in the treatment of sinonasal undifferentiated carcinoma: a ray of hope

The Medical journal of Malaysia, 2005

We studied nine cases of SNUCs presented to the Department of Otorhinolaryngology, Hospital Unive... more We studied nine cases of SNUCs presented to the Department of Otorhinolaryngology, Hospital University Kebangsaan Malaysia from 1999 to 2003. There were 8 males and 1 female with ages ranging from 24 to 78 years (mean 46.5y). The racial distribution consisted of 5 Chinese (55.5%), 3 Malays (33.3%) and 1 Indian (11.1%). Three patients were Kadish B (33.3%) and six were Kadish C (66.6%) by classification. In our series 2 years survival was 26.3% and median survival time was 14.2 months.

Graft selection in rinoplasty: indications and limitations

The Medical journal of Malaysia, 2008

The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Ma... more The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Malay noses. Reduction rhinoplasty is more common in the Caucasian Indian noses whereas augmentation rhinoplasty is more common in the Oriental Chinese or Malay noses. Graft selection remains the greatest challenge for surgeons performing rhinoplasty. However, the preferred choice as far as possible for nasal reconstruction would be autografts as compared to allografts due to their lower rate of infection, extrusion and they do not induce an immune response. We have evaluated 40 patients and compared our experience with the grafts available over a period of 46 months.

Atopic sensitization of children with rhinitis in Malaysia

The Medical journal of Malaysia, 2004

Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to ... more Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to exposure to allergens and assessed by skin prick test (SPT) responses to common allergens, which may contribute to the development of the clinical disorders (phenotype). Although it is generally agreed that atopy is an important risk factor for allergic diseases such as asthma, rhinitis, and eczema, the extent to which atopy accounts for these diseases is controversial. One hundred forty one children (up to 12 years) were skin prick tested to evaluate 16 foods common to the Malaysian diet and 4 common aeroallergens. Eighty-five percent of patients had positive SPT reactivity. The most commonly implicated aeroallergen and food allergen was house dust mite (HDM) and Prawn. Seventy percent had positive SPT reactivity results to HDM and 24.8% to prawns. Fifty five percent were positive to more than one allergen and 17.7% positive to single aeroallergen. The prevalence of atopy in children wi...

Nasal NK/T cell Lymphoma Mimicking an Iatrogenic Lateral Nasal Wall Infection: A Diagnostic Dilemma CASE REPORT

Extra nodal NK/T cell lymphoma, 'nasal type' is a rare clinicopathological entity. The pr... more Extra nodal NK/T cell lymphoma, 'nasal type' is a rare clinicopathological entity. The prevalence of nasal lymphoma is estimated at 0.17-1.5% for all non-Hodgkin's lymphomas (NHL), of which 45% originate from the NK/T cell. It is more commonly encountered in Asian countries. The main clinical features are nasal congestion and epistaxis due to local aggressive destruction. It has a distinct immunophenotypic profile of CD2 + , CD56 + and CD3-. The tumor often shows polymorphic lymphoreticular infiltrates and necrosis. We present a case of a 50-year-old male who presented with lateral nasal wall infection following endoscopic sinonasal surgery and later proven to be extranodal NK/T cell 'nasal type' lymphoma with immunophenotypic features.

Graft Selection in Rinoplasty: Indications and Limitations

The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Ma... more The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Malay noses. Reduction rhinoplasty is more common in the Caucasian Indian noses whereas augmentation rhinoplasty is more common in the Oriental Chinese or Malay noses. Graft selection remains the greatest challenge for surgeons performing rhinoplasty. However, the preferred choice as far as possible for nasal reconstruction would be autografts as compared to allografts due to their lower rate of infection, extrusion and they do not induce an immune response. We have evaluated 40 patients and compared our experience with the grafts available over a period of 46 months.

Hashimoto's thyroiditis: a rare cause for rhinosinusitis

The Medical journal of Malaysia, 2004

Rhinosinusitis is a common disorder with various etiological factors. In our clinical practice al... more Rhinosinusitis is a common disorder with various etiological factors. In our clinical practice allergy seems to be a predominant cause followed by other less common causes like infection, drugs and aspirin hypersensitivity. We present a case of chronic rhinosinusitis secondary to hypothyroidism. Although hormonal causes like hypothyroidism have been proven to cause nasal congestion and rhinosinusitis, this is the first reported case of chronic rhinosinusitis in Hashimoto's thyroiditis in our center. This is a diagnosis of exclusion for chronic rhinosinusitis not responding to optimal medical therapy.

The Role of Endoscopic Endonasal Approach to Pituitary Tumours: HUKM Experience

IgE-mediated hypersensitivity reaction to lignocaine - a case report

Tropical biomedicine, 2005

We report a 7 year old girl who developed ipsilateral left facial swelling immediately after lign... more We report a 7 year old girl who developed ipsilateral left facial swelling immediately after lignocaine injection. Skin prick test showed positive reaction to pure 2% lignocaine hydrochloride and to lignocaine oral dental gel. Specific Immunoglobulin E (Ig E) to lignocaine was detected. Lignocaine is a commonly used anaesthetic agent mainly as local anaesthesia. However type I hypersensitivity to lignocaine is rare and there have been very few cases reported in the literature.

Acquired nasal posterior choanal atresia: postradiotherapy

The Medical journal of Malaysia, 2006

Reported cases of acquired posterior choanal atresia are very few in the English literature. A ca... more

Progressive septal and palatal perforation secondary to intranasal cocaine abuse

The Medical journal of Malaysia, 1998

Septal perforation from intranasal cocaine abuse is well recognised. We present a case of progres... more Septal perforation from intranasal cocaine abuse is well recognised. We present a case of progressive septal as well as palatal perforation. Progression from septal perforation to palatal perforation occurred after cessation of intranasal cocaine abuse. This patient had a weakly positive cytoplasmic antineutrophilic cytoplasmic antibody (C-ANCA) but no histologic evidence of Wegener's Granulomatosis. The differential diagnosis for septal and palatal perforation is reviewed. This case represents the fifth reported case of palatal perforation secondary to cocaine abuse in the literature, and the second associated with positive C-ANCA.

Evaluation with acoustic rhinometry of patients undergoing sinonasal surgery

The Medical journal of Malaysia, 2003

The purpose of this study is to evaluate the use of Acoustic Rhinometry in assessing surgical out... more The purpose of this study is to evaluate the use of Acoustic Rhinometry in assessing surgical outcomes in sinonasal surgery. This prospective study was carried out from January till December 2001. A group of 44 patients who presented with nasal obstruction due to various rhinologic abnormality were examined with acoustic rhinometry pre and post-operatively. They were examined with acoustic rhinometry pre and post decongestion with cocaine and adrenaline. A highly significant correlation existed between minimal cross sectional area (MCA) and the subjective feeling of nasal problem, pre and post surgery. Thus MCA is a valuable parameter to express objectively the nasal patency. The mucovascular component of the nasal cavity plays a major role in the nasal patency as determined in the pre and post-decongestion acoustic rhinometry measurement. Acoustic rhinometry is a good tool to evaluate the nasal patency in cases where sinonasal surgery is considered in correcting the abnormality as ...

Observation of spontaneous cerebrospinal fluid rhinorrhoea to body mass index: a preliminary report

The purpose of this retrospective study is to determine whether there is a correlation among over... more The purpose of this retrospective study is to determine whether there is a correlation among overweight, gender and the risk of development of spontaneous cerebrospinal fluid (CSF) rhinorrhoea. The clinical data of eight patients diagnosed with spontaneous cerebrospinal fluid rhinorrhoea who had been treated at our tertiary referral centre between 1998 and 2007 were assessed. Demographically, seven patients were female and one male with ages ranging from 14 to 53 years with a mean age of 43.6 years. This observation revealed that all patients were overweight with a mean body mass index (BMI) of 32.5 kg/m2. This study suggests that there is a trend of increasing BMI to the risk of developing a spontaneous CSF rhinorrhoea.

Caring for the dying in a developing country, how prepared are we?

End of life care is framework to allow for a peaceful, comfortable and dignified death while cons... more End of life care is framework to allow for a peaceful, comfortable and dignified death while considering the patients' personal and religious values, bioethics and knowledge of the disease process. A well planned end of life pathway should allow for the flexibility to shift from an active (or aggressive) treatment approach to one of comfort and care when initial interventions have failed. The need for this pathway is most apparent in the intensive care setting. Implementation of a pathway will face various challenges due to religious and cultural beliefs, education of healthcare providers to carry out difficult discussions and larger socioeconomic implications. Clear medico-legal framework will be required to support this pathway. In conclusion, an end of life pathway tailored to our local needs is the way forward in allowing for dignified death of terminally ill patients; this will require the active participation of medical societies, religious leaders, healthcare providers, p...

Diabetes Insipidus and Syndrome of Inappropriate Secretion of Antidiuretic Hormone in Children with Midline Suprasellar Brain Tumors

Journal of Pediatric Oncology Nursing, 1991

Diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) ... more

Minimally Invasive Surgical Approaches to the Sphenoid Sinus, Sella, Parasellar and Clival Region: Current and Future Perspectives

A review of smell and taste dysfunction in COVID-19 patients

The Medical journal of Malaysia, 2020

Multiple anecdotal reports suggest that smell and taste loss were early subclinical symptoms of C... more Multiple anecdotal reports suggest that smell and taste loss were early subclinical symptoms of COVID-19 patients. The objective of this review was to identify the incidence of smell and taste dysfunction in COVID-19, determine the onset of their symptoms and the risk factors of anosmia, hyposmia, ageusia or dysgeusia for COVID-19 infection. We searched the PubMed and Google Scholar on 15th May 2020, with search terms including SARS-COV-2, coronavirus, COVID-19, hyposmia, anosmia, ageusia and dysgeusia. The articles included were cross sectional studies, observational studies and retrospective or prospective audits, letters to editor and short communications that included a study of a cohort of patients. Case reports, case-series and interventional studies were excluded. A total of 16 studies were selected. Incidence of smell and taste dysfunction was higher in Europe (34 to 86%), North America (19 to 71%) and the Middle East (36 to 98%) when compared to the Asian cohorts (11 to 15%...

Observation of Spontaneous Cerebrospinal Fluid Rhinorrhoea to Body Mass Index: A Preliminary Report

The purpose of this retrospective study is to determine whether there is a correlation among over... more The purpose of this retrospective study is to determine whether there is a correlation among overweight, gender and the risk of development of spontaneous cerebrospinal fluid (CSF) rhinorrhoea. The clinical data of eight patients diagnosed with spontaneous cerebrospinal fluid rhinorrhoea who had been treated at our tertiary referral centre between 1998 and 2007 were assessed. Demographically, seven patients were female and one male with ages ranging from 14 to 53 years with a mean age of 43.6 years. This observation revealed that all patients were overweight with a mean body mass index (BMI) of 32.5 kg/m 2. This study suggests that there is a trend of increasing BMI to the risk of developing a spontaneous CSF rhinorrhoea.

Progressive Septal and Palatal Perforation Secondary to Intranascd Cocaine Abuse

Cocaine (benzylmethylecyonine) is used in its pure form for "snorting" and the more volatile "fre... more Cocaine (benzylmethylecyonine) is used in its pure form for "snorting" and the more volatile "free-base" form is used for smoking. Cocaine, a derivative of the leaves of Erythroxylon coca was long used by the Indian natives in Peru. However, it was not until 1855 that cocaine was isolated from the coca leaves. An estimated 30 million Americans have used cocaine and 6 million are compulsive users with a frequency of snorting amounting to once a month. Approximately, one in five American high school students have used cocaine before graduation. At one time, the cost of cocaine served as a barrier to its widespread use. However, with increasing availability and decreased cost, its use has escalated in

Endoscopic Repair of Spontaneous Cerebro-Spinal Fluid Rhinorrhoea: A Report of 3 Cases

Open Septorhinoplasty: Operative Technique and Grafts

In this case series, the senior author details his series of patients who had undergone open sept... more In this case series, the senior author details his series of patients who had undergone open septorhinoplasty for functional and/or aesthetic purposes in the Otorhinolaryngology Department at the Hospital Universiti Kebangsaan Malaysia (HUKM), Kuala Lumpur between January 2003 and September 2005. There were 23 patients, consisting of 15 men and 8 women from different Malaysian ethnic groups. Discussion on open septorhinoplasty with regards to operative technique, grafts and implants is presented from an otorhinolaryngologist's point of view.

Challenges in the treatment of sinonasal undifferentiated carcinoma: a ray of hope

The Medical journal of Malaysia, 2005

We studied nine cases of SNUCs presented to the Department of Otorhinolaryngology, Hospital Unive... more We studied nine cases of SNUCs presented to the Department of Otorhinolaryngology, Hospital University Kebangsaan Malaysia from 1999 to 2003. There were 8 males and 1 female with ages ranging from 24 to 78 years (mean 46.5y). The racial distribution consisted of 5 Chinese (55.5%), 3 Malays (33.3%) and 1 Indian (11.1%). Three patients were Kadish B (33.3%) and six were Kadish C (66.6%) by classification. In our series 2 years survival was 26.3% and median survival time was 14.2 months.

Graft selection in rinoplasty: indications and limitations

The Medical journal of Malaysia, 2008

The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Ma... more The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Malay noses. Reduction rhinoplasty is more common in the Caucasian Indian noses whereas augmentation rhinoplasty is more common in the Oriental Chinese or Malay noses. Graft selection remains the greatest challenge for surgeons performing rhinoplasty. However, the preferred choice as far as possible for nasal reconstruction would be autografts as compared to allografts due to their lower rate of infection, extrusion and they do not induce an immune response. We have evaluated 40 patients and compared our experience with the grafts available over a period of 46 months.

Atopic sensitization of children with rhinitis in Malaysia

The Medical journal of Malaysia, 2004

Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to ... more Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to exposure to allergens and assessed by skin prick test (SPT) responses to common allergens, which may contribute to the development of the clinical disorders (phenotype). Although it is generally agreed that atopy is an important risk factor for allergic diseases such as asthma, rhinitis, and eczema, the extent to which atopy accounts for these diseases is controversial. One hundred forty one children (up to 12 years) were skin prick tested to evaluate 16 foods common to the Malaysian diet and 4 common aeroallergens. Eighty-five percent of patients had positive SPT reactivity. The most commonly implicated aeroallergen and food allergen was house dust mite (HDM) and Prawn. Seventy percent had positive SPT reactivity results to HDM and 24.8% to prawns. Fifty five percent were positive to more than one allergen and 17.7% positive to single aeroallergen. The prevalence of atopy in children wi...

Nasal NK/T cell Lymphoma Mimicking an Iatrogenic Lateral Nasal Wall Infection: A Diagnostic Dilemma CASE REPORT

Extra nodal NK/T cell lymphoma, 'nasal type' is a rare clinicopathological entity. The pr... more Extra nodal NK/T cell lymphoma, 'nasal type' is a rare clinicopathological entity. The prevalence of nasal lymphoma is estimated at 0.17-1.5% for all non-Hodgkin's lymphomas (NHL), of which 45% originate from the NK/T cell. It is more commonly encountered in Asian countries. The main clinical features are nasal congestion and epistaxis due to local aggressive destruction. It has a distinct immunophenotypic profile of CD2 + , CD56 + and CD3-. The tumor often shows polymorphic lymphoreticular infiltrates and necrosis. We present a case of a 50-year-old male who presented with lateral nasal wall infection following endoscopic sinonasal surgery and later proven to be extranodal NK/T cell 'nasal type' lymphoma with immunophenotypic features.

Graft Selection in Rinoplasty: Indications and Limitations

The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Ma... more The nasal profile and skin thickness in the Caucasian Indian vary from the Oriental Chinese or Malay noses. Reduction rhinoplasty is more common in the Caucasian Indian noses whereas augmentation rhinoplasty is more common in the Oriental Chinese or Malay noses. Graft selection remains the greatest challenge for surgeons performing rhinoplasty. However, the preferred choice as far as possible for nasal reconstruction would be autografts as compared to allografts due to their lower rate of infection, extrusion and they do not induce an immune response. We have evaluated 40 patients and compared our experience with the grafts available over a period of 46 months.

Hashimoto's thyroiditis: a rare cause for rhinosinusitis

The Medical journal of Malaysia, 2004

Rhinosinusitis is a common disorder with various etiological factors. In our clinical practice al... more Rhinosinusitis is a common disorder with various etiological factors. In our clinical practice allergy seems to be a predominant cause followed by other less common causes like infection, drugs and aspirin hypersensitivity. We present a case of chronic rhinosinusitis secondary to hypothyroidism. Although hormonal causes like hypothyroidism have been proven to cause nasal congestion and rhinosinusitis, this is the first reported case of chronic rhinosinusitis in Hashimoto's thyroiditis in our center. This is a diagnosis of exclusion for chronic rhinosinusitis not responding to optimal medical therapy.

The Role of Endoscopic Endonasal Approach to Pituitary Tumours: HUKM Experience

IgE-mediated hypersensitivity reaction to lignocaine - a case report

Tropical biomedicine, 2005

We report a 7 year old girl who developed ipsilateral left facial swelling immediately after lign... more We report a 7 year old girl who developed ipsilateral left facial swelling immediately after lignocaine injection. Skin prick test showed positive reaction to pure 2% lignocaine hydrochloride and to lignocaine oral dental gel. Specific Immunoglobulin E (Ig E) to lignocaine was detected. Lignocaine is a commonly used anaesthetic agent mainly as local anaesthesia. However type I hypersensitivity to lignocaine is rare and there have been very few cases reported in the literature.

Acquired nasal posterior choanal atresia: postradiotherapy

The Medical journal of Malaysia, 2006

Reported cases of acquired posterior choanal atresia are very few in the English literature. A ca... more

Progressive septal and palatal perforation secondary to intranasal cocaine abuse

The Medical journal of Malaysia, 1998

Septal perforation from intranasal cocaine abuse is well recognised. We present a case of progres... more Septal perforation from intranasal cocaine abuse is well recognised. We present a case of progressive septal as well as palatal perforation. Progression from septal perforation to palatal perforation occurred after cessation of intranasal cocaine abuse. This patient had a weakly positive cytoplasmic antineutrophilic cytoplasmic antibody (C-ANCA) but no histologic evidence of Wegener's Granulomatosis. The differential diagnosis for septal and palatal perforation is reviewed. This case represents the fifth reported case of palatal perforation secondary to cocaine abuse in the literature, and the second associated with positive C-ANCA.

Evaluation with acoustic rhinometry of patients undergoing sinonasal surgery

The Medical journal of Malaysia, 2003

The purpose of this study is to evaluate the use of Acoustic Rhinometry in assessing surgical out... more The purpose of this study is to evaluate the use of Acoustic Rhinometry in assessing surgical outcomes in sinonasal surgery. This prospective study was carried out from January till December 2001. A group of 44 patients who presented with nasal obstruction due to various rhinologic abnormality were examined with acoustic rhinometry pre and post-operatively. They were examined with acoustic rhinometry pre and post decongestion with cocaine and adrenaline. A highly significant correlation existed between minimal cross sectional area (MCA) and the subjective feeling of nasal problem, pre and post surgery. Thus MCA is a valuable parameter to express objectively the nasal patency. The mucovascular component of the nasal cavity plays a major role in the nasal patency as determined in the pre and post-decongestion acoustic rhinometry measurement. Acoustic rhinometry is a good tool to evaluate the nasal patency in cases where sinonasal surgery is considered in correcting the abnormality as ...

Observation of spontaneous cerebrospinal fluid rhinorrhoea to body mass index: a preliminary report

The purpose of this retrospective study is to determine whether there is a correlation among over... more The purpose of this retrospective study is to determine whether there is a correlation among overweight, gender and the risk of development of spontaneous cerebrospinal fluid (CSF) rhinorrhoea. The clinical data of eight patients diagnosed with spontaneous cerebrospinal fluid rhinorrhoea who had been treated at our tertiary referral centre between 1998 and 2007 were assessed. Demographically, seven patients were female and one male with ages ranging from 14 to 53 years with a mean age of 43.6 years. This observation revealed that all patients were overweight with a mean body mass index (BMI) of 32.5 kg/m2. This study suggests that there is a trend of increasing BMI to the risk of developing a spontaneous CSF rhinorrhoea.

Caring for the dying in a developing country, how prepared are we?

End of life care is framework to allow for a peaceful, comfortable and dignified death while cons... more End of life care is framework to allow for a peaceful, comfortable and dignified death while considering the patients' personal and religious values, bioethics and knowledge of the disease process. A well planned end of life pathway should allow for the flexibility to shift from an active (or aggressive) treatment approach to one of comfort and care when initial interventions have failed. The need for this pathway is most apparent in the intensive care setting. Implementation of a pathway will face various challenges due to religious and cultural beliefs, education of healthcare providers to carry out difficult discussions and larger socioeconomic implications. Clear medico-legal framework will be required to support this pathway. In conclusion, an end of life pathway tailored to our local needs is the way forward in allowing for dignified death of terminally ill patients; this will require the active participation of medical societies, religious leaders, healthcare providers, p...