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Fulltext Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children

Mohan A, Manan K, Tan LS, Tan YC, Chin ST, Ahmad R, et al.

Int J Infect Dis, 2020 Sep;98:59-66.
PMID: 32535300 DOI: 10.1016/j.ijid.2020.06.025

OBJECTIVES: Melioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children.
METHODS: We conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018.
RESULTS: Fifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy.
CONCLUSIONS: A large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.

Matched MeSH terms: Liver Abscess/diagnosis; Melioidosis/diagnosis*; Splenic Diseases/diagnosis*
Primary Breast Angiosarcoma: Utilisation of Pre-surgical Magnetic Resonance Imaging (MRI) for Accurate Tumour Characterization and Planning - A Case Report and Literature Review

Mumin NA, Rahmat K, Hamid MTR, Ng WL, Chan WY, Cheah XY, et al.

Curr Med Imaging, 2021;17(4):552-558.
PMID: 33030134 DOI: 10.2174/1573405616666201007161119

BACKGROUND: Primary breast angiosarcoma is a rare malignancy with non-specific clinical and radiological findings.
CASE REPORT: A 30-year-old lady presented with left breast pain and lumpiness for over one year. She has had several breast ultrasounds (US) and was treated for acute mastitis and abscess. Subsequently, in view of the rapid growth of the lump and worsening pain, she was re-investigated with US, elastography, digital breast tomosynthesis (DBT) and MRI. MRI raised the suspicion of angiosarcoma. The diagnosis was confirmed after biopsy and she underwent mastectomy.
DISCUSSION: Literature review on imaging findings of breast angiosarcoma, especially on MRI, is discussed. MRI features showed heterogeneous low signal intensity on T1 and high signal intensity on T2. Dynamic contrast enhancement (DCE) features included either early enhancement with or without washout in the delayed phase, and some reported central areas of non-enhancement.
CONCLUSION: This case report emphasises on the importance of MRI in clinching the diagnosis of breast angiosarcoma, and hence, should be offered sooner to prevent diagnostic delay.

Matched MeSH terms: Delayed Diagnosis
Laboratory findings and clinical characteristics of Pneumocystis pneumonia and tuberculosis infection among HIV-infected patients with pulmonary infiltrates in Jakarta, Indonesia

Rozaliyani A, Wiyono WH, Nawas MA, Sijam R, Adawiyah R, Tugiran M, et al.

Trop Biomed, 2020 Dec 01;37(4):1117-1123.
PMID: 33612763 DOI: 10.47665/tb.37.4.1117

Pneumocystis pneumonia (PCP) and pulmonary tuberculosis infection (PTB) are important opportunistic infections in HIV-infected patients. The diagnosis remains challenging since Pneumocystis jirovecii cannot be cultured, and expectorated-sputum is frequently difficult to obtain. The monoclonal-antibody detection for P. jirovecii from induced sputum is promising in diagnosing PCP. This study determined the percentage of PCP in HIV-infected patients with pulmonary infiltrates at three government hospitals in Jakarta. The concurrent infection of PTB was carefully documented as well. This cross-sectional study was carried out by documenting the clinical symptoms, laboratory findings, chest X-ray, while clinical outcomes were evaluated during hospitalization. The sputum induction was conducted for P. jirovecii with monoclonal antibody detection at the laboratory of Parasitology Department, Faculty of Medicine Universitas Indonesia, as well as Ziehl-Nielsen staining for PTB. The results indicated that of 55 HIV-infected patients with pulmonary infiltrates, the positive monoclonal antibody for P. jirovecii was detected in eight patients (14.6%). Weight loss, fever, shortness of breath, and crackles were found in all PCP patients; while dry cough in five patients. Moreover, PTB cases with positive acid-fast bacilli (AFB) was detected in five patients (9.1%), the PTB cases with negative AFB was 43.6% (24 out of 55 patients), and the rest 26 patients (47.3%) were not proven to have PTB. The concurrent infections of PCP and PTB were documented in three out of five positive AFB patients. The clinical outcome of eight PCP patients showed improvement in five patients, but the other three patients died. Laboratory findings play an important role in the diagnosis of PCP and PTB, along with clinical characteristics and radiological features. Low CD4+ cell count was considered a possible risk factor for PCP and poor clinical outcomes.

Matched MeSH terms: Pneumonia, Pneumocystis/diagnosis*; Tuberculosis, Pulmonary/diagnosis*; AIDS-Related Opportunistic Infections/diagnosis*
Early-Stage Multifocal Candida chorioretinitis in an Immunocompromised Woman

Chen KJ, Chou HD, Teh WM

Ophthalmol Retina, 2019 10;3(10):887.
PMID: 31585711 DOI: 10.1016/j.oret.2019.05.023
Matched MeSH terms: Candidiasis/diagnosis*; Chorioretinitis/diagnosis*; Eye Infections, Fungal/diagnosis*
Biochemical evaluation of an infant with hypoglycemia resulting from a novel de novo mutation of the GLUD1 gene and hyperinsulinism-hyperammonemia syndrome

Balasubramaniam S, Kapoor R, Yeow JH, Lim PG, Flanagan S, Ellard S, et al.

J Pediatr Endocrinol Metab, 2011;24(7-8):573-7.
PMID: 21932603

Hyperinsulinism-hyperammonemia syndrome (HI/HA) (OMIM 606762), the second most common form of congenital hyperinsulinism (CHI) is associated with activating missense mutations in the GLUD1 gene, which encodes the mitochondrial matrix enzyme, glutamate dehydrogenase (GDH). Patients present with recurrent symptomatic postprandial hypoglycemia following protein-rich meals (leucine-sensitive hypoglycemia) as well as fasting hypoglycemia accompanied by asymptomatic elevations of plasma ammonia. In contrast to other forms of CHI, the phenotype is reported to be milder thus escaping recognition for the first few months of life. Early diagnosis and appropriate management are essential to avoid the neurodevelopmental consequences including epilepsy and learning disabilities which are prevalent in this disorder. We report an infant presenting with afebrile seizures secondary to hyperinsulinemic hypoglycemia resulting from a novel de novo mutation of the GLUD1 gene.

Matched MeSH terms: Hyperinsulinism/diagnosis*; Hypoglycemia/diagnosis; Delayed Diagnosis
Paroxysmal, exercise-induced, diurnally fluctuating dystonia: Expanding the phenotype of SPG8

Mulroy E, Magrinelli F, Mohd Fauzi NA, Kutty SK, Latorre A, Bhatia KP

Parkinsonism Relat Disord, 2021 04;85:26-28.
PMID: 33662919 DOI: 10.1016/j.parkreldis.2021.02.011
Matched MeSH terms: Dystonia/diagnosis; Paraplegia/diagnosis; Spastic Paraplegia, Hereditary/diagnosis
Fulltext Trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome: an update

Khan M, Nishi SE, Hassan SN, Islam MA, Gan SH

Pain Res Manag, 2017;2017:7438326.
PMID: 28827979 DOI: 10.1155/2017/7438326

Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.

Matched MeSH terms: Fibromyalgia/diagnosis; Trigeminal Neuralgia/diagnosis; Glossopharyngeal Nerve Diseases/diagnosis
Multimodality cardiac imaging of submitral left ventricular aneurysm with concurrent descending aorta mycotic aneurysm

Abdullah H, Jiyen K, Othman N

BMJ Case Rep, 2017 Sep 27;2017.
PMID: 28954754 DOI: 10.1136/bcr-2017-221466

We present a case of a 20-year-old Malay man with underlying tuberculous (TB) lymphadenitis who presented with shortness of breath and found to have submitral left ventricular aneurysm (SLVA). SLVA is well recognised but rare. Incidence of SLVA in Malay has never been documented. This is the first reported case of SLVA in Malays with concomitant thoracic aorta mycotic aneurysm. TB has been reported to be associated with SLVA. Treatment is either surgical or conservative. Imaging is required for diagnosis and preoperative assessment. Multimodality imaging include echocardiography (ECHO), cardiac CTangiography and the robust multiparametric cardiac MR (CMR). ECHO is the first line imaging and useful for initial detection of the aneurysm. CMR including the late gadolinium enhancement allows excellent visualisation of the LV aneurysm, tissue characterisation, cardiac function and detection of associated pathology as shown in this case.

Matched MeSH terms: Diagnosis, Differential; Heart Aneurysm/diagnosis*; Aortic Aneurysm, Thoracic/diagnosis*
Fulltext Reliability and construct validity of the Early Dementia Questionnaire (EDQ)

Arabi Z, Syed Abdul Rahman SA, Hazmi H, Hamdin N

BMC Geriatr, 2016 11 30;16(1):202.
PMID: 27903242 DOI: 10.1186/s12877-016-0384-1

BACKGROUND: Early Dementia Questionnaire (EDQ) was developed as a screening tool to detect patients with early dementia in primary care. It was developed based on 20 symptoms of dementia. From a preliminary study, EDQ had been shown to be a promising alternative for screening of early dementia. This study was done to further test on EDQ's reliability and validity.

METHODS: Using a systematic random sampling, 200 elderly patients attending primary health care centers in Kuching, Sarawak had consented to participate in the study and were administered the EDQ. Geriatric Depression Scale (GDS) was used to exclude patients with depression. Those who scored >21 MMSE, were retested using the EDQ. Reliability was determined by Cronbach's alpha for internal consistency and construct validity was assessed using confirmatory factor analysis (principle component with varimax rotation). Test retest Intraclass Correlation Coeeficient (ICC) was used to determine the reliability of the scale.

RESULTS: The result showed that the sensitivity and specificity for EDQ was 71.2% and 59.5%. The overall Cronbach's alpha coefficient was good which was 0.874. Confirmatory factor analysis on 4 factors indicated that the Cronbach's alpha for each domain were acceptable with memory (0.741), concentration (0.764), emotional and physical symptoms (0.754) and lastly sleep and environment (0.720). The Intraclass Correlation Coefficient between the first EDQ score and the retest EDQ score among those with MMSE of >21 showed a very strong overall agreement, ICC = 0.764, N = 160, P <0.001.

CONCLUSIONS: The results of the validation study showed that Early Dementia Questionnaire (EDQ) is a valid and reliable tool to be used as a screening tool to detect early dementia in primary care.

Matched MeSH terms: Dementia/diagnosis*; Early Diagnosis*
Acute calcific tendinitis of gluteus maximus tendon due to tumoral calcium pyrophosphate dihydrate deposition disease

Lim CH, Lin CT, Chen YH

Int J Rheum Dis, 2017 Dec;20(12):2249-2252.
PMID: 28036155 DOI: 10.1111/1756-185X.12969
Matched MeSH terms: Calcinosis/diagnosis; Chondrocalcinosis/diagnosis; Tendinopathy/diagnosis
Application of stacked convolutional and long short-term memory network for accurate identification of CAD ECG signals

Tan JH, Hagiwara Y, Pang W, Lim I, Oh SL, Adam M, et al.

Comput Biol Med, 2018 03 01;94:19-26.
PMID: 29358103 DOI: 10.1016/j.compbiomed.2017.12.023

Coronary artery disease (CAD) is the most common cause of heart disease globally. This is because there is no symptom exhibited in its initial phase until the disease progresses to an advanced stage. The electrocardiogram (ECG) is a widely accessible diagnostic tool to diagnose CAD that captures abnormal activity of the heart. However, it lacks diagnostic sensitivity. One reason is that, it is very challenging to visually interpret the ECG signal due to its very low amplitude. Hence, identification of abnormal ECG morphology by clinicians may be prone to error. Thus, it is essential to develop a software which can provide an automated and objective interpretation of the ECG signal. This paper proposes the implementation of long short-term memory (LSTM) network with convolutional neural network (CNN) to automatically diagnose CAD ECG signals accurately. Our proposed deep learning model is able to detect CAD ECG signals with a diagnostic accuracy of 99.85% with blindfold strategy. The developed prototype model is ready to be tested with an appropriate huge database before the clinical usage.

Matched MeSH terms: Coronary Artery Disease/diagnosis*; Diagnosis, Computer-Assisted/methods*
Fulltext Lipoleiomyoma of the uterus

Karikalan B, Pasupathi T

Indian J Pathol Microbiol, 2017 Jan-Mar;60(1):128-129.
PMID: 28195112 DOI: 10.4103/0377-4929.200052
Matched MeSH terms: Leiomyoma/diagnosis*; Lipoma/diagnosis*; Uterine Neoplasms/diagnosis
Fulltext At the heart of the problem: congestive cardiac failure as a cause of ascites: A narrative review

Goh ZNL, Teo RYL, Chung BK, Wong AC, Seak CJ

Medicine (Baltimore), 2022 Aug 05;101(31):e29951.
PMID: 35945724 DOI: 10.1097/MD.0000000000029951

Heart failure leading to cardiac ascites is an extremely rare and underrecognized entity in clinical practice. Recognizing cardiac ascites can be difficult, especially since patients presenting with ascites may have more than 1 etiology. Various biomarkers are available to aid in the diagnosis of cardiac ascites, though with differing sensitivities and specificities. Such biomarkers include serum albumin, ascitic albumin and protein, as well as serum N-terminal pro-brain natriuretic peptide (NT-proBNP). While serum NT-proBNP is a powerful biomarker in distinguishing the etiology of ascites and monitoring treatment progression, its cost can be prohibitive in low-resource settings. Clinicians practicing under these circumstances may opt to rely on other parameters to manage their patients. We go on further to report a series of 3 patients with cardiac ascites to illustrate how these biomarkers may be employed in the management of this patient population. Clinicians should always keep in mind the differential diagnosis of cardiac failure as a cause of ascites. The resolution of cardiac ascites may serve as a surrogate clinical marker for response to antifailure therapy in lieu of NT-proBNP at resource-scarce centers.

Matched MeSH terms: Diagnosis, Differential
Ovarian tissue characterization in ultrasound: a review

Acharya UR, Molinari F, Sree SV, Swapna G, Saba L, Guerriero S, et al.

Technol Cancer Res Treat, 2015 Jun;14(3):251-61.
PMID: 25230716 DOI: 10.1177/1533034614547445

Ovarian cancer is the most common cause of death among gynecological malignancies. We discuss different types of clinical and nonclinical features that are used to study and analyze the differences between benign and malignant ovarian tumors. Computer-aided diagnostic (CAD) systems of high accuracy are being developed as an initial test for ovarian tumor classification instead of biopsy, which is the current gold standard diagnostic test. We also discuss different aspects of developing a reliable CAD system for the automated classification of ovarian cancer into benign and malignant types. A brief description of the commonly used classifiers in ultrasound-based CAD systems is also given.

Matched MeSH terms: Diagnosis, Computer-Assisted/methods; Ovarian Neoplasms/diagnosis*
Fulltext Congenital tongue base lipoblastoma causing neonatal airway compromise

Wan MH, Tengku Nun Ahmad TE, Naicker MS, Abu Bakar MZ

BMJ Case Rep, 2021 Jan 18;14(1).
PMID: 33462056 DOI: 10.1136/bcr-2020-239554

Lipoblastomas are benign tumours of immature fat cells presenting in infancy. A lipoblastoma within the airway lumen causing airway compromise is an extremely rare occurrence. We present a 6 hours of life girl who had airway compromise due to a lobulated mass at the base of the tongue. The mass was excised after emergency endotracheal intubation.

Matched MeSH terms: Airway Obstruction/diagnosis; Tongue Neoplasms/diagnosis*; Lipoblastoma/diagnosis*
Fulltext Nevus lipomatosus superficialis

Yap FB

Singapore Med J, 2009 May;50(5):e161-2.
PMID: 19495497

Nevus lipomatosus superficialis is a rare benign skin malformation characterised by ectopic adipocytes in the upper dermis. It is classified into two types: a classical Hoffman-Zurhelle type and the solitary type. A case of the classical type with multiple soft, non-tender, pedunculated, cerebriform, skin-coloured papules and nodules over the right lower back is presented in a 21-year-old Malay woman. She had a rare occurrence of ulceration and necrosis of the lesions.

Matched MeSH terms: Lipomatosis/diagnosis*; Nevus, Pigmented/diagnosis; Skin Neoplasms/diagnosis
Fulltext Germinoma of the basal ganglia and thalamus--CT and MRI findings

Wong LW, Jayakumar CR

Singapore Med J, 1997 Oct;38(10):444-6.
PMID: 9529959

A case of germinoma originating in the basal ganglia and thalamus is presented. This tumour most commonly originates during childhood and adolescence, at pineal and suprasellar regions. In the early stages, the diagnosis of germinoma in the basal ganglion and thalamus is difficult because of its rarity and non-specific findings. The computed tomography (CT) and magnetic resonance imaging (MRI) findings though non-diagnostic, are discussed here. A few differential diagnoses had been discussed with radiological abnormality. Open biopsy done in this case proved to be two-cell pattern germinoma. Early detection of the tumour is desirable, since this tumour is highly sensitive to radio and chemotherapy and is potentially curable. Our patient was treated with combined chemotherapy and the response was well and no residual tumour or recurrence was seen on the repeated imaging modality, however his neurological deficits remained unchanged.

Matched MeSH terms: Brain Neoplasms/diagnosis*; Diagnosis, Differential; Germinoma/diagnosis*
Fulltext Hepatic mesenchymal hamartoma: a case report and radiological findings

Lai FM, Jayakumar CR, Saw L, Kumar G

Singapore Med J, 1996 Apr;37(2):226-8.
PMID: 8942272

Primary tumours of the liver are uncommon in childhood. Of these, more than two-thirds are malignant. As such, benign hepatic tumours are often not considered in the differential diagnosis of a hepatic mass in childhood. We report a case of hepatic mesenchymal hamartoma, a rare benign tumour, in a 10-month-old infant. This tumour is characterised by an admixture of ductal structures within a copious loose connective tissue stroma. Only approximately 160 cases had been reported in the literature. Awareness of the ultrasound (U/S) and computed tomography (CT) features, although not diagnostic, is helpful in distinguishing it from the more common malignant tumours. A correct preoperative diagnosis is important as surgical excision is often curative.

Matched MeSH terms: Diagnosis, Differential; Hamartoma/diagnosis*; Liver Diseases/diagnosis*
Fulltext Epidermal inclusion cyst of the breast: a rare benign entity

Lam SY, Kasthoori JJ, Mun KS, Rahmat K

Singapore Med J, 2010 Dec;51(12):e191-4.
PMID: 21221490

Epidermal inclusion cyst (EIC) arising from the breast is an uncommon benign condition. We report two cases of enlarging EIC of the breast in two women in their forties. The diagnosis of this condition may not be straightforward with imaging alone if an EIC presents as an enlarging lump in the breast and mimics a benign breast lesion, most commonly a fibroadenoma or malignant lesion with benign imaging features. Excision is usually recommended for a definite histopathological diagnosis and for the prevention of potential risks of malignant transformation. Asymptomatic stable lesions do not require treatment; biopsy is unnecessary, and follow-up imaging suffices if typical sonographic and clinical findings are found.

Matched MeSH terms: Breast Diseases/diagnosis*; Diagnosis, Differential; Epidermal Cyst/diagnosis*
Fulltext Dermatological features of an imported case of chikungunya in an infant

Lee CY, Ng LC, Koh TH

Singapore Med J, 2008 Nov;49(11):959-60.
PMID: 19037568
Matched MeSH terms: Exanthema/diagnosis; Fever/diagnosis*; Alphavirus Infections/diagnosis*

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