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Background: The delay in diagnosis of oral squamous cell carcinoma (OSCC) is a factor in rendering the poor prognosis, and recent research has explored the use of serum tumour markers such Beta 2 Microglobulin (B2M), to aid early diagnosis. However, despite a high incidence of OSCC in Southeast Asia, no studies on the clinical use of B2M in the region were found. Objectives: To determine if serum B2M level can serve as an initial diagnostic tool to indicate if a biopsy is warranted, and if so, to propose a local B2M serum reference value to identify OSSC patients. Methodology: Twenty-one patients were seen at Hospital Universiti Sains Malaysia (HUSM) for a one-year period, between June 2016 and June 2017, and equal number of healthy controls participated in the study. Apart from patient history, venous blood of approximately 5ml volume was collected from each subject at the pre-treatment stage and analysed by an Abbot ARCHITECT c8000 analyser using the immunoturbidimetry method. The results were analysed using ROC analysis and the Mann Whitney test. Results: Serum B2M levels showed a statistically significant increase (p<0.001) in patients compared to controls. The test was shown to have 90.5% sensitivity and 90.5% specificity. It was found to be a sensitive and specific serum tumour marker at a cut off value of 1.57mg/l to differentiate cases from controls. Conclusion: B2M is a sensitive and specific tumour marker to differentiate OSCC cases from controls. It is cost effective and minimally invasive, making it a potentially useful adjunct diagnostic tool in a high-risk patient pool. Bangladesh Journal of Medical Science Vol.18(4) 2019 p.729-735

Background: The tracheostomy procedure is commonly required to wean patients off the severe traumatic brain injury (TBI). This study aimed to determine the practice, outcome and complications of two techniques: i) surgical tracheostomy (ST) versus percutaneous tracheostomy (PT) and ii) two different times of procedure: early tracheostomy (ET) versus late tracheostomy (LT). Methods: This was a retrospective, cross-sectional study conducted from 1 January 2013 until 31 December 2017, involving 268 severe TBI patients who required tracheostomy during neurosurgical intensive care unit (Neuro-ICU) management. The data were obtained from their medical records. Results: When based on techniques, PT displayed a significantly shorter day of tracheostomy plan (7.0 [2.5] versus 8.3 [2.6] days; P < 0.001); day of execution (7.2 [2.6] versus 8.6 [2.9] days; P < 0.001); duration of mechanical ventilation (9.8 [3.4] versus 11.3 [3.1] days; P < 0.001) and duration of ICU stay (12.3 [3.7] versus 13.8 [3.5] days; P < 0.003) than ST. If based on timing, ET showed a significantly shorter duration of mechanical ventilation (8.8 [2.1] versus 12.9 [2.9] days; P < 0.001), length of ICU stay (11.4 [2.4] versus 15.2 [3.5] days; P < 0.001) and length of hospital stay (17.1 [3.2] versus 20.0 [4.0] days; P < 0.001) than LT. Conclusion: PT showed a shorter mechanical ventilation and ICU stay duration than ST. In comparison, ET showed shorter mechanical ventilation, ICU stay and hospital stay duration than LT.

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A 20-year old Malay female presented with swelling at the angle of the mandible on the left side of 7 months duration. It was associated with neck discomfort, dysphagia and few episodes of aspiration. Examination showed a diffuse fixed swelling at the angle of mandible on the left side. It was non-tender and lymph node was not palpable. Multiple left cranial nerve palsies were elicited involving glossopharyngeal, vagus, accessory and hypoglossal nerves. Intraorally the left tonsil was medialized. A CT scan showed a left parapharyngeal tumour encasing the left carotid artery and left internal jugular vein (Figure 1). It measured 2.6 cm × 4.6 cm × 4.5 cm. The cerebral angiogram showed tumour blush which was not suggestive of a glomus tumour. The feeding vessel was from ascending pharyngeal branch of the external carotid artery. A CT guided trucut biopsy revealed a meningothelial meningioma. She underwent subtotal tumour resection (Figure 2).