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  1. Yildirim O, Talo M, Ay B, Baloglu UB, Aydin G, Acharya UR
    Comput Biol Med, 2019 10;113:103387.
    PMID: 31421276 DOI: 10.1016/j.compbiomed.2019.103387
    In this study, a deep-transfer learning approach is proposed for the automated diagnosis of diabetes mellitus (DM), using heart rate (HR) signals obtained from electrocardiogram (ECG) data. Recent progress in deep learning has contributed significantly to improvement in the quality of healthcare. In order for deep learning models to perform well, large datasets are required for training. However, a difficulty in the biomedical field is the lack of clinical data with expert annotation. A recent, commonly implemented technique to train deep learning models using small datasets is to transfer the weighting, developed from a large dataset, to the current model. This deep learning transfer strategy is generally employed for two-dimensional signals. Herein, the weighting of models pre-trained using two-dimensional large image data was applied to one-dimensional HR signals. The one-dimensional HR signals were then converted into frequency spectrum images, which were utilized for application to well-known pre-trained models, specifically: AlexNet, VggNet, ResNet, and DenseNet. The DenseNet pre-trained model yielded the highest classification average accuracy of 97.62%, and sensitivity of 100%, to detect DM subjects via HR signal recordings. In the future, we intend to further test this developed model by utilizing additional data along with cloud-based storage to diagnose DM via heart signal analysis.
    Matched MeSH terms: Diagnosis, Computer-Assisted*
  2. Chowdhury MEH, Khandakar A, Alzoubi K, Mansoor S, M Tahir A, Reaz MBI, et al.
    Sensors (Basel), 2019 Jun 20;19(12).
    PMID: 31226869 DOI: 10.3390/s19122781
    One of the major causes of death all over the world is heart disease or cardiac dysfunction. These diseases could be identified easily with the variations in the sound produced due to the heart activity. These sophisticated auscultations need important clinical experience and concentrated listening skills. Therefore, there is an unmet need for a portable system for the early detection of cardiac illnesses. This paper proposes a prototype model of a smart digital-stethoscope system to monitor patient's heart sounds and diagnose any abnormality in a real-time manner. This system consists of two subsystems that communicate wirelessly using Bluetooth low energy technology: A portable digital stethoscope subsystem, and a computer-based decision-making subsystem. The portable subsystem captures the heart sounds of the patient, filters and digitizes, and sends the captured heart sounds to a personal computer wirelessly to visualize the heart sounds and for further processing to make a decision if the heart sounds are normal or abnormal. Twenty-seven t-domain, f-domain, and Mel frequency cepstral coefficients (MFCC) features were used to train a public database to identify the best-performing algorithm for classifying abnormal and normal heart sound (HS). The hyper parameter optimization, along with and without a feature reduction method, was tested to improve accuracy. The cost-adjusted optimized ensemble algorithm can produce 97% and 88% accuracy of classifying abnormal and normal HS, respectively.
    Matched MeSH terms: Heart Diseases/diagnosis*
  3. Rosen HN, Hamnvik OR, Jaisamrarn U, Malabanan AO, Safer JD, Tangpricha V, et al.
    J Clin Densitom, 2019 07 10;22(4):544-553.
    PMID: 31327665 DOI: 10.1016/j.jocd.2019.07.004
    The indications for initial and follow-up bone mineral density (BMD) in transgender and gender nonconforming (TGNC) individuals are poorly defined, and the choice of which gender database to use to calculate Z-scores is unclear. Herein, the findings of the Task Force are presented after a detailed review of the literature. As long as a TGNC individual is on standard gender-affirming hormone treatment, BMD should remain stable to increasing, so there is no indication to monitor for bone loss or osteoporosis strictly on the basis of TGNC status. TGNC individuals who experience substantial periods of hypogonadism (>1 yr) might experience bone loss or failure of bone accrual during that time, and should be considered for baseline measurement of BMD. To the extent that this hypogonadism continues over time, follow-up measurements can be appropriate. TGNC individuals who have adequate levels of endogenous or exogenous sex steroids can, of course, suffer from other illnesses that can cause osteoporosis and bone loss, such as hyperparathyroidism and steroid use; they should have measurement of BMD as would be done in the cisgender population. There are no data that TGNC individuals have a fracture risk different from that of cisgender individuals, nor any data to suggest that BMD predicts their fracture risk less well than in the cisgender population. The Z-score in transgender individuals should be calculated using the reference data (mean and standard deviation) of the gender conforming with the individual's gender identity. In gender nonconforming individuals, the reference data for the sex recorded at birth should be used. If the referring provider or the individual requests, a set of "male" and "female" Z-scores can be provided, calculating the Z-score against male and female reference data, respectively.
    Matched MeSH terms: Osteoporosis/diagnosis*
  4. Majeed Alneamy JS, A Hameed Alnaish Z, Mohd Hashim SZ, Hamed Alnaish RA
    Comput Biol Med, 2019 09;112:103348.
    PMID: 31356992 DOI: 10.1016/j.compbiomed.2019.103348
    Accurate medical disease diagnosis is considered to be an important classification problem. The main goal of the classification process is to determine the class to which a certain pattern belongs. In this article, a new classification technique based on a combination of The Teaching Learning-Based Optimization (TLBO) algorithm and Fuzzy Wavelet Neural Network (FWNN) with Functional Link Neural Network (FLNN) is proposed. In addition, the TLBO algorithm is utilized for training the new hybrid Functional Fuzzy Wavelet Neural Network (FFWNN) and optimizing the learning parameters, which are weights, dilation and translation. To evaluate the performance of the proposed method, five standard medical datasets were used: Breast Cancer, Heart Disease, Hepatitis, Pima-Indian diabetes and Appendicitis. The efficiency of the proposed method is evaluated using 5-fold cross-validation and 10-fold cross-validation in terms of mean square error (MSE), classification accuracy, running time, sensitivity, specificity and kappa. The experimental results show that the efficiency of the proposed method for the medical classification problems is 98.309%, 91.1%, 91.39%, 88.67% and 93.51% for the Breast Cancer, Heart Disease, Hepatitis, Pima-Indian diabetes and Appendicitis datasets, respectively, in terms of accuracy after 30 runs for each dataset with low computational complexity. In addition, it has been observed that the proposed method has efficient performance compared with the performance of other methods found in the related previous studies.
    Matched MeSH terms: Diagnosis, Computer-Assisted*
  5. Nahdiya S, Syukri C
    Med J Malaysia, 2018 12;73(6):441-442.
    PMID: 30647228
    Bipolar mood disorder is an established psychiatric disorder affecting 1% of the population and it is a highly disabling disease. As of today, its aetiology is still a confounding question. This case is interesting as the patient presented with a full-blown mania after suffering from electrical injury. The persistent syndrome in this case could point to a unique diagnostic entity and offer possible explanation of the pathophysiology of manic depressive as well as a consideration for caution when prescribing electroconvulsive therapy (ECT).
    Matched MeSH terms: Bipolar Disorder/diagnosis
  6. Mugilan SR, Joseph JP
    Med J Malaysia, 2018 12;73(6):433-435.
    PMID: 30647225
    The diagnosis of Creutzfeldt-Jakob disease (CJD) can be challenging as findings are non-specific and there is low awareness of the disease. We present a case of an 83-yearold man with a two months history of rapidly progressive dementia. After a series of extensive diagnostic examinations, he was diagnosed with probable sporadic CJD with key findings of rapidly progressive dementia, myoclonus, pyramidal signs, abnormal hyperintensity signals on diffusion-weighted magnetic resonance imaging (DW-MRI) and typical electroencephalograph (EEG). His symptoms progressively worsened and he died four months after the onset of symptoms.
    Matched MeSH terms: Creutzfeldt-Jakob Syndrome/diagnosis
  7. Chidambaram VA, Anita CSY, Robert C, Garry C
    Med J Malaysia, 2018 12;73(6):415-417.
    PMID: 30647218
    IgG4-related disease is a newly described systemic autoimmune and allergic disease, characterized histologically by a fibroinflammatory response with IgG4 plasma cells. It was initially described as affecting the pancreas, but commonly involves the head and neck region as well. While a biopsy is essential for definitive diagnosis, cross sectional imaging may be the initial modality which may suggest this entity. We describe a case of pathologically proven IgG4 related disease which highlights some key radiologic features seen in this entity. Our case highlights some key radiological features of IgG4- related disease in the head and neck, with involvement of the lacrimal glands, pituitary gland and cranial nerves on CT.
    Matched MeSH terms: Orbital Diseases/diagnosis*
  8. Kazemi M, Bala Krishnan M, Aik Howe T
    Iran J Allergy Asthma Immunol, 2013 Sep;12(3):236-46.
    PMID: 23893807
    In this paper, the method of differentiating asthmatic and non-asthmatic patients using the frequency analysis of capnogram signals is presented. Previously, manual study on capnogram signal has been conducted by several researchers. All past researches showed significant correlation between capnogram signals and asthmatic patients. However all of them are just manual study conducted through the conventional time domain method. In this study, the power spectral density (PSD) of capnogram signals is estimated by using Fast Fourier Transform (FFT) and Autoregressive (AR) modelling. The results show the non-asthmatic capnograms have one component in their PSD estimation, in contrast to asthmatic capnograms that have two components. Furthermore, there is a significant difference between the magnitude of the first component for both asthmatic and non-asthmatic capnograms. The effectiveness and performance of manipulating the characteristics of the first frequency component, mainly its magnitude and bandwidth, to differentiate between asthmatic and non-asthmatic conditions by means of receiver operating characteristic (ROC) curve analysis and radial basis function (RBF) neural network were shown. The output of this network is an integer prognostic index from 1 to 10 (depends on the severity of asthma) with an average good detection rate of 95.65% and an error rate of 4.34%. This developed algorithm is aspired to provide a fast and low-cost diagnostic system to help healthcare professional involved in respiratory care as it would be possible to monitor severity of asthma automatically and instantaneously.
    Matched MeSH terms: Asthma/diagnosis
  9. Singh VA, Ramalingam S, Haseeb A, Yasin NFB
    J Orthop Surg (Hong Kong), 2020 7 23;28(2):2309499020941659.
    PMID: 32696708 DOI: 10.1177/2309499020941659
    INTRODUCTION: Limb length discrepancy (LLD) of lower extremities is underdiagnosed due to compensatory mechanisms during locomotion. The natural course of compensation leads to biomechanical alteration in human musculoskeletal system leading to adverse effects. General consensus accepts LLD more than 2 cm as significant to cause biomechanical alteration. No studies were conducted correlating height and lower extremities true length (TL) to signify LLD. Examining significant LLD in relation to height and TL using dynamic gait analysis with primary focus on kinematics and secondary focus on kinetics would provide an objective evaluation method.

    METHODOLOGY: Forty participants with no evidence of LLD were recruited. Height and TL were measured. Reflective markers were attached at specific points in lower extremity and subjects walked in gait lab at a self-selected normal walking pace with artificial LLDs of 0, 1, 2, 3, and 4 cm simulated using shoe raise. Accommodation period of 30 min was given. Infrared cameras were used to capture the motion. Primary kinematic (knee flexion and pelvic obliquity (PO)) and secondary kinetic (ground reaction force (GRF)) were measured at right heel strike and left heel strike. Functional adaptation was analyzed and the postulated predictor indices (PIs) were used as a screening tool using height, LLD, and TL to notify significance.

    RESULTS: There was a significant knee flexion component seen in height category of less than 170 cm. There was significant difference between LLD 3 cm and 4 cm. No significant changes were seen in PO and GRF. PIs of LLD/height and LLD/TL were analyzed using receiver operating characteristic curve. LLD/height as a PI with value of 1.75 was determined with specificity of 80% and sensitivity of 76%.

    CONCLUSION: A height of less than 170 cm has significant changes in relation to LLD. PI using LLD/height appears to be a promising tool to identify patients at risk.

    Matched MeSH terms: Leg Length Inequality/diagnosis*
  10. Cunningham IG, Yong NK
    Br J Surg, 1974 Jun;61(6):482-3.
    PMID: 4835202
    Matched MeSH terms: Thrombophlebitis/diagnosis
  11. Abhishek A, Curran DJ, Bilwani F, Jones AC, Towler MR, Doherty M
    Rheumatology (Oxford), 2016 Feb;55(2):379-80.
    PMID: 26342227 DOI: 10.1093/rheumatology/kev339
    Study done in England
    Matched MeSH terms: Arthritis, Gouty/diagnosis
  12. Ting HC, Adam BA
    Australas J Dermatol, 1984 Aug;25(2):83-8.
    PMID: 6529404
    Matched MeSH terms: Erythema Multiforme/diagnosis
  13. Nair HKR, Chong SS, Othman AM
    J Wound Care, 2020 Apr 01;29(Sup4):S44-S48.
    PMID: 32279612 DOI: 10.12968/jowc.2020.29.Sup4.S44
    OBJECTIVE: To validate the accuracy and reliability of Harikrishna Periwound Skin Classification (HPSC) for wound assessment.

    METHOD: Post-basic students (staff nurses and medical assistants) were given real life pictures showing the wound and periwound area. The students were asked to classify all pictures according to the HPSC at zero months (before attachment) and after two months of attachment. The images were the same but the answers were never given or discussed after the first test.

    RESULTS: A total of 30 post-basic students participated in the study, assessing wound 30 images. The results showed that there was an increase of 25.42% in accuracy of wound assessment using the HSPC after two months of clinical attachment compared to pre-attachment. The reliability of the HPSC in wound assessment 79.87%.

    CONCLUSION: Health professionals have to be able to assess and classify wounds accurately to be able to manage them accordingly. Assessment and classifications of the periwound skin are important and need to be validated and integrated as a part of a full wound assessment. With experience and adequate training, health professionals are able to comprehensively assess wounds using the validated tool, to enable effective wound management and treatment, accelerating wound healing and improving the quality of life for patients.

    Matched MeSH terms: Surgical Wound Infection/diagnosis*
  14. Balakrishnan P, Katakam PK, Hegde AP
    BMJ Case Rep, 2019 Mar 25;12(3).
    PMID: 30914414 DOI: 10.1136/bcr-2018-228687
    Headache is a common presenting complaint in the paediatric population, with often migraine being a clinical diagnosis. Hemiplegic migraine is characterised by aura, sudden onset weakness of one side of the body which usually recovers without any residual neurological deficit. We report a child with a history of seizure disorder, well controlled and off medication for 3 years, who presented with a headache, aura and transient hemiplegia. Similar history in the patient's mother suggests the diagnosis of familial hemiplegic migraine. We would like to emphasise the importance of detailed history as an important aid in the diagnosis of neurological disorders in children.
    Matched MeSH terms: Migraine with Aura/diagnosis*
  15. Tamin NSI, Razalli KA, Sallahuddin SN, Chan HK, Hassan MRA
    Cancer Epidemiol, 2020 12;69:101829.
    PMID: 32998070 DOI: 10.1016/j.canep.2020.101829
    INTRODUCTION: The immunochemical fecal occult blood test (iFOBT) has been widely used for opportunistic colorectal cancer (CRC) screening in average-risk individuals seeking care from public health clinics in Malaysia. This study provides a 5-year outcome evaluation of such a practice.

    METHODS: The findings for a few outcome indicators, ranging from the iFOBT uptake to the CRC and polyp detection rates, were generated from the data contributed by 583 public health clinics between 2014 and 2018. The trends in their changes were also evaluated.

    RESULTS: The iFOBT uptake constantly increased over the years (p < 0.001), totaling 2.29 % (n = 127,957) as at 2018. Nearly 10 % (n = 11,872) of the individuals screened had a positive test result. Of those who underwent colonoscopy (n = 6,491), 4.04 % (n = 262) and 13.93 % (n = 904) were found to have CRC and polyps, respectively.

    CONCLUSION: An uptrend in the CRC screening uptake was witnessed following the introduction of the iFOBT in public health clinics.

    Matched MeSH terms: Colorectal Neoplasms/diagnosis*
  16. Lee WC, Russell B, Lau YL, Fong MY, Chu C, Sriprawat K, et al.
    PLoS One, 2013;8(4):e60303.
    PMID: 23565221 DOI: 10.1371/journal.pone.0060303
    The quantity of circulating reticulocytes is an important indicator of erythropoietic activity in response to a wide range of haematological pathologies. While most modern laboratories use flow cytometry to quantify reticulocytes, most field laboratories still rely on 'subvital' staining. The specialist 'subvital' stains, New Methylene Blue (NMB) and Brilliant Crésyl Blue are often difficult to procure, toxic, and show inconsistencies between batches. Here we demonstrate the utility of Giemsa's stain (commonly used microbiology and parasitology) in a 'subvital' manner to provide an accurate method to visualize and count reticulocytes in blood samples from normal and malaria-infected individuals.
    Matched MeSH terms: Malaria/diagnosis
  17. Manchaiah V, Granberg S, Grover V, Saunders GH, Ann Hall D
    Int J Audiol, 2019 09;58(9):565-575.
    PMID: 31017493 DOI: 10.1080/14992027.2019.1602738
    Objective: This study evaluates the content validity (i.e. domains assessed) and readability levels of patient-reported questionnaire instruments using internationally recognised procedures and tools. Design: A review of the literature to identify candidate instruments and a synthesis of information including mapping extracted items onto the World Health Organisation's - International Classification of Functioning, Disability, and Health (WHO-ICF) and estimating readability. Study sample: 14 patient-reported questionnaire instruments. Results: In general, item content focussed on body function and on activity limitations and participation restrictions, with less emphasis on environmental and personal factors and with different emphases across instruments. Many items did not clearly map onto any of the WHO-ICF categories (i.e. not coded items ranged from 3.7 to 39.1% across the 14 questionnaires). All 14 instruments exceeded the sixth-grade reading level when calculated according to the FORCAST formula which is appropriate for assessing a non-narrative text. Conclusions: Clinical assessment of hearing disability is only as comprehensive as the items covered by the chosen measurement instrument. Our findings confirmed the diversity of domains covered by hearing disability instruments and gaps in assessment. Some concern is raised about whether the item content is appropriate for those respondents with poor literacy.
    Matched MeSH terms: Hearing Loss/diagnosis*
  18. George-Kodiseri E, Faridah K
    Family Physician, 1991;3(1):25-27.
    Haemoglobin Bart's hydrops fetalis syndrome is totally lethal. Globin chain electrophoresis on mylar backed cellulose acetate strips, by a method modified from Ueda and Schneider has been established to demonstrate total absence of alpha chains in this syndrome. This simple test can identify fetuses, stillbirths and newborns with homozygous αo-thalassaemia. In this region where DNA studies are limited, and prenatal diagnosis is unavailable, this test which describes the phenotypic expression of Hb Bart's syndrome will improve genetic counselling of women at risk of homozygous αo-thalassaemia.
    Matched MeSH terms: Diagnosis; Prenatal Diagnosis
  19. Wang J, Sung V, Carew P, Burt RA, Liu M, Wang Y, et al.
    Acad Pediatr, 2019 07;19(5):504-514.
    PMID: 30872125 DOI: 10.1016/j.acap.2019.01.010
    BACKGROUND: Better epidemiologic information on childhood hearing loss would inform research priorities and efforts to prevent its progression.

    OBJECTIVES: To estimate prevalence and secular trends in children's hearing loss.

    DATA SOURCES: We searched MEDLINE and Embase from January 1996 to August 2017.

    STUDY ELIGIBILITY CRITERIA: We included epidemiologic studies in English reporting hearing loss prevalence.

    STUDY APPRAISAL AND SYNTHESIS METHODS: The modified Leboeuf-Yde and Lauritsen tool was used to assess methodological quality. Meta-analyses combined study-specific estimates using random-effects models.

    PARTICIPANTS: Children 0 to 18 years of age.

    RESULTS: Among 88 eligible studies, 43.2% included audiometric measurement of speech frequencies. In meta-analyses, pooled prevalence estimates of slight or worse bilateral speech frequency losses >15 decibels hearing level (dB HL) were 13.1% (95% confidence interval [CI], 10.0-17.0). Using progressively more stringent cutpoints, pooled prevalence estimates were 8.1% (95% CI, 1.3-19.8) with >20 dB HL, 2.2% (95% CI, 1.4-3.0) with >25 dB HL, 1.8% (95% CI, 0.4-4.1) with >30 dB HL, and 0.9% (95% CI, 0.1-2.6) with >40 dB HL. Also, 8.9% (95% CI, 6.4-12.3) had likely sensorineural losses >15 dB HL in 1 or both ears, and 1.2% (95% CI, 0.5-2.1) had self-reported hearing loss. From 1990 to 2010, the prevalence of losses >15 dB HL in 1 or both ears rose substantially (all P for trend

    Matched MeSH terms: Hearing Loss/diagnosis
  20. Ang KP, Nordin RB, Lee SCY, Lee CY, Lu HT
    Med J Malaysia, 2019 02;74(1):51-56.
    PMID: 30846663
    INTRODUCTION: We aim to study the diagnostic value of electrocardiogram (ECG) in cardiac tamponade.

    METHODS: This study was a single centre, retrospective casecontrol study. We recruited 42 patients diagnosed with cardiac tamponade of various aetiologies confirmed by transthoracic echocardiography and 100 controls between January 2011 and December 2015. The ECG criteria of cardiac tamponade we adopted was as follows: 1) Low QRS voltage in a) the limb leads alone, b) in the precordial leads alone or, c) in all leads, 2) PR segment depression, 3) Electrical alternans, and 4) Sinus tachycardia.

    RESULTS: Malignancy was the most common causes of cardiac tamponade, the two groups were of similar proportion of gender and ethnicity. We calculated the sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of each ECG criteria. Among the ECG abnormalities, we noted the SN of 'low voltage in all chest leads' (69%), 'low voltage in all limb leads' (67%) and 'sinus tachycardia' (69%) were higher as compared to 'PR depression' (12%) and 'electrical alternan' (5%). On the other hand, 'low voltage in all chest leads' (98%), 'low voltage in all leads' (99%), 'PR depression' (100%) and 'electrical alternans' (100%) has highest SP.

    CONCLUSION: Our study reaffirmed the findings of previous studies that electrocardiography cannot be used as a screening tool for diagnosing cardiac tamponade due to its low sensitivity. However, with clinical correlation, electrocardiography is a valuable adjuvant test to 'rule in' cardiac tamponade because of its high specificity.

    Matched MeSH terms: Cardiac Tamponade/diagnosis*
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