BackgroundUndifferentiated nasopharyngeal carcinoma (NPC) is strongly related to Epstein-Barr virus (EBV) infection, allowing aberrant antibodies against EBV and viral DNA load as screening tools in high risk populations. Methylation analysis in the promoter of tumor suppressor genes (TSGs) may serve as a complementary marker for identifying early cases. This study determined methylation status of multiple TSGs and evaluated whether it may improve early detection.MethodsNasopharyngeal brushings were taken from 53 NPC patients, 22 high risk subjects and 25 healthy EBV carriers. Corresponding NPC paraffin tissue was included. DNA was bisulfite-modified preceding analysis by methylation-specific PCR (MSP). Ten TSGs were studied.ResultsNPC paraffin and brushing DNA revealed an 81.8% concordance so that MSP analysis was done using either one of both specimens. NPC samples showed methylation for individual TSGs (DAPK1 79.2%, CDH13 77.4%, DLC1 76.9%, RASSF1A 75.5%, CADM1 69.8%, p16 66.0%, WIF1 61.2%, CHFR 58.5%, RIZ1 56.6% and RASSF2A 29.2%). High risk individuals, having elevated EBV IgA and viral load, showed high frequency of methylation of CDH13, DAPK1, DLC1 and CADM1, but low frequency of methylation of p16 and WIF1 and undetectable methylation of RASSF1A, CHFR, RIZ1 and RASSF2A. Healthy subjects showed similar patterns as high risk individuals. A combination of RASSF1A and p16 gave good discrimination between NPC and non-NPC, but best results were combined analysis of five methylation markers (RASSF1A, p16, WIF1, CHFR and RIZ1) with detection rate of 98%.ConclusionMultiple marker MSP is proposed as a complementary test for NPC risk assessment in combination with EBV-based markers.

Epstein-Barr (EBV) infection and presence of a nasopharyngeal cancer (NPC) case in the family increases the risk of developing NPC. Aberrant anti-EBV immunoglobulin A (IgA) antibodies (EBV-IgA) may be present in the sera of non-cancer individuals and predict NPC. Limited studies report the presence of EBV-IgA antibodies within non-cancer individuals in Indonesia where the disease is prevalent. This study aimed at exploring whether EBV-IgA was found more frequently among first degree relatives of NPC patients and individuals presenting with chronic symptoms in the head and neck area compared to healthy controls. A total of 967 non-cancer subjects were recruited, including 509 family members of NPC cases, 196 individuals having chronic complaints in the head and neck region, and 262 healthy donors of the local blood bank. Sera were analyzed using a standardized peptide-based EBV-IgA ELISA. Overall, 61.6% of all individuals had anti-EBV IgA reactivity equal to or below cut off value (CoV). Seroreactivity above CoV was significantly higher in females (38.7%) compared to males (28.7%) (p = 0.001). Older individuals had more seroreactivity above CoV (42.5%) than the younger ones (26.4%) (p< 0.001). Seroprevalence was significantly higher in family members of NPC patients (41.7%), compared to 32.7% of individuals with chronic head and neck problems (p = 0.028) and 16.4% healthy blood donors (p< 0.001). As conclusion, this study showed a significant higher seroprevalence in healthy family members of NPC cases and subjects presenting with chronic symptoms in the head and neck area compared to healthy individuals from the general community. This finding indicates that both groups have elevated risk of developing NPC and may serve as targets for a regional NPC screening program.

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Allergic rhinitis (AR) is disease by incidence, high prevalence, and expects to rise to load against the economy and lowering the quality of life of patients. AR involved many factors. It is an impact of highly significant on the quality of life and affects the economy. The patients' life quality was done to assess the effects and result of surgery. Sino nasal outcome test-20 (snot-20) was one of the instruments specific measurement of AR patient's live quality. Total of 10 patients who surgery action, obtained improving the quality of life based on snot-20 observed 28 days after done the act of surgery. Rate the SNOT-20 before surgically obtained 37.3 with DS±7.87 and 28 days after done surgically obtained mean snot-20 was 6 with DS ± 2.49. The SNOT-20 pre and post action were different of significant (p =0.024).

Background: Choanal atresia is an uncommon anomaly that causes upper airway obstruction in newborns, with a frequency of 1 in 5000 to 7000 births. The definitive treatment is surgery. Purpose: To inform the diagnosis and management of a bilateral choanal atresia. Case report: A 2-months-old girl with a diagnosis of bilateral choanal atresia. The patient underwent transnasal endoscopic repair of choanal atresia under general anesthesia. Clinical question: Could transnasal endoscopic repair of choanal atresia followed by stenting, provide better result than other approaches? Review method: Literature search using keywords ’choanal atresia’ AND ’bilateral’ AND ’membranous’ AND ’endoscopic’ AND ’surgery’ AND ’stent’ was conducted through PubMed, Science Direct, and The Cochrane Library. Result: The search obtained 34 articles concerning choanal atresia. Selection based on inclusion and exclusion criteria, found 15 articles were relevant with the topic. Conclusion: A baby girl came with bilateral choanal atresia. The diagnosis was established by nasoendoscopy, supported by CT imaging. She underwent transnasal endoscopic repair of the stenotic choanae under general anesthesia.Keywords: bilateral choanal atresia, transnasal endoscopic surgery, congenital nasal airway anomalyABSTRAKLatar belakang: Atresia koana merupakan kelainan pada neonatus yang jarang terjadi, yang dapat menyebabkan obstruksi jalan napas atas. Frekuensi kasus sebanyak 1 dari 5000 sampai 7000 kelahiran. Tatalaksana definitif pada kasus atresia koana adalah tindakan operatif. Tujuan: Memberikan informasi mengenai diagnosis dan tatalaksana atresia koana bilateral. Laporan kasus: Bayi berusia 2 bulan dengan diagnosis atresia koana bilateral. Tatalaksana pada kasus ini adalah operasi membuka koana dengan pendekatan endoskopi transnasal. Pertanyaan klinis: Apakah tatalaksana operasi perbaikan atresia koana dengan pendekatan transnasal endoskopi yang diikuti dengan pemasangan stent lebih baik dibandingkan dengan pendekatan lain? Telaah literatur: Dilakukan penelusuran menggunakan kata kunci ’choanal atresia’ DAN ’bilateral’ DAN ’membranous’ DAN ’endoscopic’ DAN ’surgery’ DAN ’stent’ pada beberapa sumber data seperti PubMed, Science Direct, dan The Cochrane Library. Hasil: Didapatkan 34 artikel yang membahas atresia koana. Melalui kriteria inklusi dan eksklusi diperoleh 15 artikel yang relevan dengan topik. Kesimpulan: Telah dilaporkan pasien dengan diagnosis atresia koana bilateral. Diagnosis ditegakkan melalui endoskopi transnasal dan CT scan. Dilakukan perbaikan koana menggunakan pendekatan endoskopi transnasal, dengan anestesi umum.Kata kunci: atresia koana bilateral, endoskopi transnasal, kelainan kongenital hidung

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Background: Nasal douching or irrigation has been recommended for adjunctive therapy of sinonasal diseases including allergic rhinitis (AR) for many years. Previous study reported large-volume high-pressure device as an effective standard application, but the solutions was remains controversy. This study systematically review the clinical efficacy of nasal irrigation with various solutions for adults with AR from medical literature.Methods: This research systematically asses clinical trial about nasal irrigation with various solutions for adults with AR from medical literature. The sources were PubMed, ProQuest, Scopus, Cochrane Register of Controlled Trials databases, and gray literature from google scholar and RAMA repository limited to English and Bahasa Indonesia language articles, published from January 2017 to July 2022. Only randomized controlled trials involving the human subjects studies will be included. The inclusion criteria research must be related to nasal irrigation for AR, and should be full texted available. Literature management, screening, data extraction will use Rayyan.ai tools. The quality assessment of qualified paper and risk of bias will be assessing independent conducted by 2 reviewer with risk of bias 2. We will use Review Manager (RevMan) [Computer program] Version 5.4. The Cochrane Collaboration, 2020 tools to produce the systematic review and meta-analysis.Results: After completion of the study process, the data analysis and review will be reported. The results will be publicized through a peer-review journal publication. Conclusion:The results of the systematic review will summarize the efficacy of various nasal irrigation for adults with AR, so it can be used as clinician recommendation.