Eosinophilic inflammation in the airways is important in the pathogenesis of childhood asthma. Serum eosinophilic cationic protein (ECP), a marker of eosinophil activation was measured in 20 asthmatic children and 19 non-asthmatic controls. There was no difference in the socio-demography, passive smoke exposure, urinary cotinine levels and family history of asthma between the 2 groups. The median serum ECP in asthmatic children was 27.0 mcg/L (IQ1 8.8, IQ3 59.0); which was higher than in non-asthmatic controls [5.9 mcg/L (IQ1 3.0, IQ3 11.9), p=0.002]. An elevated serum ECP level can be helpful as supportive evidence in the diagnosis of bronchial asthma in Malaysia children.
The turnaround time (TAT) for oral biopsies received for histological examination by the Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya, for the years 1978, 1988 and 1998 was evaluated. For the three years studied, TATs for 61, 233 and 463 specimens were retrospectively analysed. Testing intervals, that is, from the dates the surgeons procured the specimens, the laboratories accessioned them and until the pathologists signed off the diagnoses, were used to calculate TAT. The performance level of the respective pathologists, the growth of tissue diagnostic services and the possible variables that influence TAT were also evaluated. As prompt diagnosis means prompt treatment, which in turn has a bearing on prognosis, the TAT pertinent to oral malignant tumors was emphasized. The mean TAT, its mode and median fell significantly in 1998 compared with the previous 2 years; it was lower for soft tissue than for hard tissue specimens, and lower for malignant, than for non-malignant specimens. The progression of tissue diagnostic services is up to a satisfactory level, as 88.89 % of biopsies could render diagnoses within a fair period of time in 1998.
Heat stroke, which is also known as "sun stroke," is a medical emergency, and fatalities can occur unless it is diagnosed early and treated efficiently. Heat stroke may manifest quite suddenly, giving little time to differentiate it from extreme physical exhaustion in collapsed subjects. It is also known to lead to serious disseminated intravascular coagulation. Sudden death in a young female is presented who collapsed after trekking in a hilly, jungle area in Malaysia on a warm, humid day. She had joined a weight reduction programme a few weeks earlier. She was found collapsed and in a semiconscious state in the jungle by her groupmates and was taken to hospital. On admission she was unconscious, hyperpyrexic, with rapid, thready pulse and a low blood pressure. Biochemical studies revealed metabolic acidosis, elevated liver and cardiac enzymes and impairment of renal function. Her coagulation profile was found to be impaired and she started bleeding through the mouth and nostrils. She also developed watery diarrhoea and initially a septicaemic condition, including acute enteritis was suspected. Despite active treatment, her condition deteriorated and she died eight hours after admission. Autopsy confirmed a generalised bleeding tendency, with pulmonary, oesophageal and gastrointestinal mucosal haemorrhages. Flame-shaped subendocardial shock haemorrhages were seen in the interventricular septum on the left side of the heart. The findings support a diagnosis of heat stroke. Various aspects related to heat stroke, the autopsy diagnosis and its prevention are discussed.
Interstitial lung disease (ILD) is very rare in children. In the majority of cases the aetiology is unknown. Very little is known about the clinical course of this condition in children. Prognosis may be influenced by sex, age of onset of symptoms, radiographic features, presence of right ventricular hypertrophy and histopathology. We report our experience in managing four children with interstitial lung disease. All these children presented in early infancy with cough, respiratory distress, cyanosis and failure to thrive. Three of these children had finger clubbing and right ventricular hypertrophy. All patients received oral steroids. Chloroquine was added in two patients who showed no response. A trial of oral cyclophosphamide was started in one patient who failed with both drugs. One child is oxygen independent while another is on home oxygen therapy. The other two patients eventually died.
A 62-year-old man presented with a 3-month history of chronic non-productive cough and unexplained fever. Further questioning revealed that he had headaches and myalgia. Bilateral thickened temporal arteries were noted on physical examination. The erythrocyte sedimentation rate was 96 mm in 1 h. A biopsy specimen of the left temporal artery showed inflammatory changes consistent with the diagnosis of giant cell arteritis. Commencement of prednisolone resulted in rapid and dramatic resolution of his symptoms. Physicians should be aware of respiratory symptoms in patients with giant cell arteritis in order to avoid delay in diagnosis and therapy of this condition.
This study aimed to validate the Beck Depression Inventory (BDI) in the Malaysian urological population. Reliability and internal consistency were evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Responsiveness was expressed as the effect size. Internal consistency was high (Cronbach's alpha value = 0.56 to 0.87). Test-retest correlation coefficient and intraclass correlation coefficient were significant (ICC = 0.56 to 0.87) and a high degree of sensitivity and specificity. The BDI is thus a reliable and a valid instrument to be used in Malaysia.
Neural leprosy is rare. This is a report of a 63-year-old Indian man who had long standing multiple peripheral neuropathy. The slit skin smear for acid-fast bacilli of Mycobacterium leprae was positive. The skin and nerve biopsies were normal. He was treated with rifampicin, dapsone and clofazimine.
BACKGROUND:
The prevalence of latex-specific IgE computed from the results of serologic assays is commonly thought to reflect, to a greater or lesser extent, the prevalence of latex allergy and its implied risk.
OBJECTIVE:
The study examines how imperfect test specificity of in vitro assays influences the precision of latex allergy prevalence that it estimates.
METHODS:
Various models encompassing a range of hypothetical test sensitivity and specificity values are investigated to gauge their influence on the estimate of latex allergy prevalence. The models examine these interactions in situations of high or low allergy prevalence.
RESULTS:
Serologic latex diagnostic assays with test specificity within the range of those of commercially available assays can greatly overestimate prevalence where the true prevalence is low (eg, of the order of one in 100 or one in 1,000). A formula to correct for errors in prevalence estimates arising from imperfect test sensitivity and specificity of an in vitro assay is presented.
CONCLUSION:
While serologic assays for latex IgE pose few hazards to the patient and are useful for confirming the diagnosis of latex allergy, the test results may vastly overestimate the true prevalence of latex allergy and its associated risks in situations where latex allergy is actually rare.
A 35-year-old Malay man underwent treatment for uveitis of the right eye in 1992 but developed marked visual impairment in the affected eye after he failed to attend follow-up. Two years later, he complained of difficulty swallowing and was found to have left sided X and XI cranial nerve palsies. Chest radiograph showed a cavitating lesion in the lower zone of the right lung field. Inflammation and perforation of the nasal septum was found on examination of his upper respiratory tract. Punch biopsies taken from that area showed chronic inflammatory change and necrotizing vasculities. The patient was diagnosed as having Wegener's granulomatosis and made a very good recovery with immunosuppressive therapy.
Matched MeSH terms: Granulomatosis with Polyangiitis/diagnosis
Venous thromboembolism (VTE) is thought to be a rare occurrence in Asian patients. The clinical features of VTE are elusive and the disease often unsuspected. Objective testing such as the duplex ultrasound scans and pulmonary imaging are necessary as clinical diagnosis alone is inaccurate. Fatality can occur in untreated patients not suspected of the disease as shown by our post-mortem studies. Indeed VTE is one of the leading causes of maternal mortality in Singapore. There is a rising trend in the incidence of VTE in Asia. Initial studies found an incidence of about 3 per 10,000 hospital admissions in Hong Kong and Malaysia in 1988 and 1990, respectively; rising to 8 and 15.8 per 10,000 hospital admissions in Singapore 1992 and 2000, respectively. The major risk factors for developing deep vein thrombosis (DVT) in our patients are immobilisation, surgery and malignancy. While Factor V Leiden mutation and mutation at position 20,210 in the prothrombin gene are found to be extremely rare in Chinese, the rest of the thrombophilia has not been formally studied. Studies in Singapore reported rates of 3% to 7% of DVT after general surgery, 9.7% after hip surgery and 14% after total knee replacement surgery. It is difficult to compare with studies from other centres because of differences in patient selection and diagnostic criteria. Studies in Singapore showed that the use of prophylactic low molecular weight heparin completely abolished the occurrence of DVT for patients undergoing total knee replacement and colorectal surgery without an increase in bleeding complications. In conclusion, VTE is not an uncommon problem here. Major acquired risk factors do not differ from the Caucasian populations. VTE is a preventable disease and a better understanding of its epidemiology, patient-risk factors and biological factors will allow better management of this condition.
Ruptured splenic artery aneurysm during pregnancy is a rare event with high maternal and fetal mortality rate. A case of ruptured splenic artery aneurysm in the post partum period is presented. The literature is reviewed on pathophysiology, clinical presentation and management of this rare and potentially fatal entity.
Congenital diaphragmatic hernia (CDH) is rare in adults. We report a 24 year old woman presenting with shortness of breath, chest pain and nausea after the birth of her first baby. Clinical examination, plain radiography and a CT scan revealed herniation of abdominal contents into her left chest. Via a midline laparotomy, the contents were reduced and the defect repaired, using a mesh. She remains symptom-free three years since her surgery and even after a second childbirth. A brief review of the literature reporting adult diaphragmatic hernia of congenital origin accompanies this case report. We conclude that symptomatic CDH in adults usually presents as an emergency with gastrointestinal and occasionally respiratory complications. Early diagnosis and repair is essential to avoid subsequent morbidity and mortality.
Otitis media with effusion (OME) is a very common condition seen in children, and is the commonest cause of hearing loss in an infant. It is also a fairly common condition encountered by the family practitioner, and often the family practitioner is the first doctor the parents bring the child to. Otitis media with effusion is a simple condition but, if left undiagnosed or untreated, can lead to preventable long-term consequences. Hence, a high index of suspicion is necessary, early and accurate diagnosis, prompt treatment, with close follow-up is of essence. The epidemiology, aetiological factors, clinical presentations, diagnosis, various medical and surgical options, cost-effectiveness of therapy and the impact of OME on the child's development are discussed.
Matched MeSH terms: Otitis Media with Effusion/diagnosis*
Melioidosis is a potentially deadly infection that can affect any organ system. Reports of melioidosis of the ENT/head and neck region are relatively uncommon. Four cases are presented: (i) parotid abscess evolving into necrotising fasciitis, (ii) acute sinusitis and parapharyngeal cellulitis resulting in upper airway obstruction, (iii) acute suppurative lymphadenitis (iv) and chronic suppurative otitis media causing meningoencephalitis. Three of the four cases are believed to be unique, as a literature review of melioidosis in ENT/head and neck is also presented. Some practical issues of management are also discussed. Not suspecting melioidosis does not change contemporary empirical broadspectrum antibiotic therapy. The value of suspicion or on confirmation of diagnosis lies in anticipating and planning for rapid change.
Typhoid fever (TF), a systemic prolonged febrile illness, continues to be a worldwide health problem especially in developing countries where there is poor sanitation and poor standards of personal hygiene. The worldwide incidence of TF is estimated to be approximately 16 million cases annually with 7 million cases occurring annually in SE Asia alone. More than 600,000 people die of the disease annually. The pathogenesis of TF is beginning to be understood. The clinical features and diagnosis of TF are well known. New diagnostic methods have yet to gain universal acceptance. Traditional treatment with the first-line antibiotics (i.e. chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole) though still being used in most developing countries are gradually being replaced with shorter courses of treatment with third generation cephalosporins or fluoroquinolones especially with the growing incidence of multi-drug resistant S typhi strains (MDR-ST). MDR-ST strains are particularly common in the Indian subcontinent; Pakistan and China. The presently available vaccines are far from satisfactory in terms of safety, efficacy and costs. Newer vaccines have been developed and are presently undergoing clinical trials in human volunteers.
Conflicting recommendations exist on the issue of scoliosis screening in the general population. Worldwide, opponents cite the relative inaccuracy of screening tests, cost-ineffectiveness and psychosocial effect of 'labelled' patients but advocates quote the successes in many centres and the advantages of timely intervention. We studied 205 patients with idiopathic scoliosis and found they presented at relatively later ages and with curves that showed rapid annual progression. We suggest that screening in Malaysia may identify patients early for treatment besides promoting health awareness.
Development and usage of Case Based Reasoning (CBR) driven medical diagnostic system requires a large volume of clinical cases that depict the problem-solving methodology of medical experts. Successful usage of CBR based systems in healthcare is constrained by the need for a continuous supply of current and correct clinical cases (in an electronic medium) from medical experts. To address this constraint we present a strategy to pro-actively transform generic Electronic Patient Records (EPR) to Operable CBR-oriented Cases (OCC) that are compliant to specialised CBR-based medical systems. EPR-OCC transformation methodology is based on XML parse-trees, Unified Medical Language Source (UMLS) meta-thesauri and medical knowledge ontologies. The featured work involves the implementation of a Java-based computer system for the automatic transformation of XML-based EPR-originating from heterogeneous EPR repositories accessible over the Internet/WWW-to specialised OCC that can then be seamlessly incorporated within Intelligent CBR-based Medical Diagnostic Systems.