Background Cystic fibrosis is a debilitating, autosomal recessive disease which results in chronic upper and lower airway infection and inflammation. In this study, four adult patients presenting with cystic fibrosis and chronic rhinosinusitis were recruited. Culture and molecular techniques were employed to evaluate changes in microbial profiles, host gene expression and antimicrobial resistance (AMR) in the upper respiratory tract over time. Methods Swab samples from the sinonasal cavity were collected at the time of surgery and at follow-up clinics at regular time intervals for up to 18 months. Nucleic acids were extracted, and DNA amplicon sequencing was applied to describe bacterial and fungal composition. In parallel, RNA was used to evaluate the expression of 17 AMR genes and two inflammatory markers (interleukins 6 and 8) using custom qPCR array cards. Molecular results were compared with routine sinus and sputum culture reports within each patient. Results Bacterial amplicon sequencing and swab culture reports from the sinonasal cavity were mostly congruent and relatively stable for each patient across time. The predominant species detected in patients P02 and P04 were Pseudomonas aeruginosa, Staphylococcus aureus in patient P03, and a mixture of Enterobacter and S. aureus in patient P01. Fungal profiles were variable and less subject specific than bacterial communities. Increased expressions of interleukins 6 and 8 were observed in all patients throughout the sampling period compared with other measured genes. The most prevalent AMR gene detected was ampC. However, the prevalence of AMR gene expression was low in all patient samples across varying time-points. Conclusions We observed a surprising degree of stability of sinonasal microbial composition, and inflammatory and AMR gene expression across all patients post sinus surgery.

BACKGROUND Harvesting of hamstring tendon is a very important step in anterior cruciate ligament (ACL) reconstruction. Many techniques of hamstring graft harvest have been reported. There are many disadvantages of using the traditional technique for hamstring tendon harvesting. Here we have used a new and easy technique to avoid the disadvantages and allow for easy and perfect hamstring tendon graft harvesting which is also reproducible as the medial structures of the tibia have a consistent anatomic pattern and offers protection to saphenous nerve and superficial medial collateral ligament. METHODS We carried out arthroscopic ACL reconstruction using hamstring tendons auto graft on 70 patients with knee ligament injuries with instability using a new technique for hamstring tendons harvesting. RESULTS Subjective assessment was done according to International Knee Documentation Committee rating system. This was defined as four grades as follows: Normal (A), Nearly Normal (B), Abnormal (C), and Severely Abnormal (D). Before ACL injury, 70 (100%) patients considered their knees to have been grade A. Twenty-four months after reconstruction, 68 patients rated their knees as normal or nearly normal. Two patients rated their knee as abnormal at 2 years of follow-up. These patients had severe osteoarthritic changes. CONCLUSIONS The technique of hydrodissection is a simple and fast technique to aid in identification, isolation and indirect separation of hamstring tendons with small incision used as grafts in knee surgeries at no extra cost to the patient.

Inverted papillomas form about 0.4 to 5% of nasal tumors. They usually present as unilateral firm, bulky, red and vascular masses. We present three cases which were initially diagnosed as a maxillary mucocele, pansinusitis and antrochoanal polyp based on clinical and radiological findings. It is important to keep the diagnosis of inverted papilloma in mind in unilateral diseases of the paranasal sinuses as a more radical approach is required.

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Chronic hypoxia induced by periods of hypo-oxygenation in obstructive sleep apnoea (OSA) can be associated with reduced foetal growth in pregnancy. Obesity, hormonal and physiological changes during pregnancy plus variations in the craniofacial anatomy could increase the incidence of snoring and possibly OSA. In spite of the high incidence of obesity noted in Malaysia, especially in females, there have been no studies so far conducted to study the prevalence of OSA during pregnancy in this population. Thus, we sought to determine the prevalence of snoring and those who are at high risk for OSA among pregnant women in Malaysia.