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Fulltext "Discovery to treatment" window in patients with smear-positive pulmonary tuberculosis

Loh LC, Codati A, Jamil M, Noor ZM, Vijayasingham P

Med J Malaysia, 2005 Aug;60(3):314-9.
PMID: 16379186

Delay in commencing treatment in patients diagnosed with smear-positive pulmonary tuberculosis (PTB) may promote the spread of PTB in the community. Socio-demographic and clinical data from 169 patients (119 retrospectively and 50 prospectively collected) treated for smear-positive PTB in our hospital Chest Clinic from June 2002 to February 2003 were analysed. One hundred and fifty eight (93.5%) patients were started on treatment in less than 7 days from the time when the report first became available while 11 (6.5%) patients had their treatment started > or = 7 days. The median 'discovery to treatment' window was 1 day (range, 0 to 24 days). Of the factors studied, longevity of symptoms, absence of fever or night sweats and having sought traditional medicine were associated with delay in treatment commencement. The urgency and importance of anti-TB treatment should be emphasized especially to patients who are inclined towards treatment with traditional medicine.
Keywords: Smear positive, pulmonary tuberculosis, treatment delay, traditional medicine, Malaysia, Seremban, Negeri Sembilan

Matched MeSH terms: Early Diagnosis
Fulltext A Hybrid Lightweight System for Early Attack Detection in the IoMT Fog

Hameed SS, Selamat A, Abdul Latiff L, Razak SA, Krejcar O, Fujita H, et al.

Sensors (Basel), 2021 Dec 11;21(24).
PMID: 34960384 DOI: 10.3390/s21248289

Cyber-attack detection via on-gadget embedded models and cloud systems are widely used for the Internet of Medical Things (IoMT). The former has a limited computation ability, whereas the latter has a long detection time. Fog-based attack detection is alternatively used to overcome these problems. However, the current fog-based systems cannot handle the ever-increasing IoMT's big data. Moreover, they are not lightweight and are designed for network attack detection only. In this work, a hybrid (for host and network) lightweight system is proposed for early attack detection in the IoMT fog. In an adaptive online setting, six different incremental classifiers were implemented, namely a novel Weighted Hoeffding Tree Ensemble (WHTE), Incremental K-Nearest Neighbors (IKNN), Incremental Naïve Bayes (INB), Hoeffding Tree Majority Class (HTMC), Hoeffding Tree Naïve Bayes (HTNB), and Hoeffding Tree Naïve Bayes Adaptive (HTNBA). The system was benchmarked with seven heterogeneous sensors and a NetFlow data infected with nine types of recent attack. The results showed that the proposed system worked well on the lightweight fog devices with ~100% accuracy, a low detection time, and a low memory usage of less than 6 MiB. The single-criteria comparative analysis showed that the WHTE ensemble was more accurate and was less sensitive to the concept drift.

Matched MeSH terms: Early Diagnosis
Fulltext A case report of gastric volvulus, a rare cause of acute abdomen

Qader AQ, Abdul Hamid H

Radiol Case Rep, 2021 Jul;16(7):1907-1911.
PMID: 34093935 DOI: 10.1016/j.radcr.2021.04.059

Gastric volvulus is an uncommon disorder with an unknown incidence, unless it stays in the back of the diagnostician's mind, diagnosis of gastric volvulus, which can have significant morbidity and mortality associated with it, can be easily missed and can present either in the acute or chronic setting with variable symptoms. When it occurs in the acute scenario, patients present with severe epigastric pain and retching without vomiting. Together with inability to pass nasogastric tube, they constitute Borchardt's triad. The presence of a hiatal hernia with persistent vomiting despite initial antiemetic treatment should trigger one to think of gastric volvulus, despite the patient appearing very stable. We report a case which presented in our hospital with abdominal pain and vomiting. As Oesophagogastroduodenoscopy shows hiatal hernia and peptic ulcer. Primary gastric volvulus occurs in the absence of any defect in the diaphragm or adjacent organ pathology and may be caused by weakening of gastric supports. As conclusion; Gastric volvulus is a surgical case, requiring early diagnosis and aggressive management, as a delay results into complications like gangrene and perforation which substantially increase the morbidity and mortality in these patients, and contrast enhanced computed tomography (CECT) is the best modality for diagnosis of gastric volvulus.

Matched MeSH terms: Early Diagnosis
Fulltext A case series of hereditary congenital cataract

Nurul Faaiqah Jainuddin, Azlindarita Aisyah Mohd Abdullah, Visvaraja Subrayan, Norlina Ramli, Nurliza Khaliddin

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):336-338.
MyJurnal

Congenital cataract is a major cause of preventable blindness in children. It can be either hereditary or non-hereditary. In this case series, we present three cases of congenital cataract with a strong family history. The grandparents
and parents of these patients had cataract diagnosed in late childhood whilst the patients in this case series were
diagnosed with congenital cataract earlier. There was no history of consanguineous marriage in any of the families.
These cases show that, in the presence of a strong family history, a child will present with congenital cataract earlier
in their life. Hence, babies from such families should be screened at birth and at regular intervals within the first
year of life to enable early diagnosis and subsequent surgical intervention to reduce the incidence and burden of
amblyopia.

Matched MeSH terms: Early Diagnosis
Fulltext A challenging case report of acute sinus of Valsalva aneurysm rupture in cardiogenic shock and multi-organ failure with an emphasis on rapid recognition and 'never giving up' in face of futility

Jin QW, Jeswant Dillon J, Tjen Jhung L, Isman Rusani B

Eur Heart J Case Rep, 2020 Dec;4(6):1-5.
PMID: 33442636 DOI: 10.1093/ehjcr/ytaa441

Background : Sinus of Valsalva aneurysm (SoVA) is a rare anomaly and can be divided into acquired and congenital forms, the latter being commonly associated with ventricular septal defects (VSDs). Rupture is a catastrophic complication with high mortality without urgent surgical intervention. We would like to highlight the use of echocardiography in an emergency setting for diagnosis and surgical intervention in a critically ill patient.
Case summary : We report a 27-year-old female with history of conservatively managed VSD known since childhood. She presented with acute decompensated cardiac failure requiring intubation and inotropic support. Bedside echocardiography performed in the emergency department suggested a ruptured SoVA at the right coronary cusp with underlying supracristal VSD. Despite the patient being critically ill with multi-organ failure, surgery was performed as it was the patient's best chance for survival. Intraoperative findings tallied with the early echocardiographic results. She recovered gradually and was eventually discharged despite a stormy post-operative period.
Discussion : This case report highlights the importance of prompt recognition of SoVA rupture by using bedside echocardiography. Surgical intervention needs to be early despite ongoing sepsis in view of acute mechanical failure. This case was unique as it illustrates a successful management of an acutely ill patient with multi-organ failure through early diagnosis, intensive perioperative stabilization, and surgical intervention.

Matched MeSH terms: Early Diagnosis
A clinical update and global economic burden of rheumatoid arthritis

Fazal SA, Khan M, Nishi SE, Alam F, Zarin N, Bari MT, et al.

Endocr Metab Immune Disord Drug Targets, 2018 Feb 13;18(2):98-109.
PMID: 29141572 DOI: 10.2174/1871530317666171114122417

BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA) is a predominant inflammatory autoimmune disorder. The incidence and prevalence of RA is increasing with considerable morbidity and mortality worldwide. The pathophysiology of RA has become clearer due to many significant research outputs during the last two decades. Many inflammatory cytokines involved in RA pathophysiology and the presence of autoantibodies are being used as potential biomarkers via the use of effective diagnostic techniques for the early diagnosis of RA. Currently, several disease-modifying anti-rheumatic drugs are being prescribed targeting RA pathophysiology, which have shown significant contributions in improving the disease outcomes.

DISCUSSION: Even though innovations in treatment strategies and monitoring are helping the patients to achieve early and sustained clinical and radiographic remission, the high cost of drugs and limited health care budgets are restricting the easy access of RA treatment. Both direct and indirect high cost of treatment are creating economic burden for the patients and affecting their quality of life.

CONCLUSION: The aim of this review is to describe the updated concept of RA pathophysiology and highlight current diagnostic tools used for the early detection as well as prognosis - targeting several biomarkers of RA. Additionally, we explored the updated treatment options with side effects besides discussing the global economic burden.

Matched MeSH terms: Early Diagnosis
Fulltext A fatal case of rhinocerebral mucormycosis

Nurul Suhaili Kamarudin, Rosni Ibrahim, Nur Hanani Ahmad, Siti Norbaya Masri

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):329-331.
MyJurnal

Rhinocerebral mucormycosis is a potentially fatal and progressive angioinvasive fungal infection. It is classically described in patients with uncontrolled diabetes mellitus and hematological malignancies. This report describes a case of progressive rhinocerebral mucormycosis in a patient with poorly controlled diabetes who was on prolonged prednisolone therapy for autoimmune kidney disease. The patient, who was a female, presented to hospital with headache, orbital pain and nasal bridge swelling. Black eschar on nasal mucosae was present on admission. Later, she was started on intravenous fluconazole for the diagnosis of fungal sinusitis. Subsequently, she developed intra- cerebral haemorrhage complicated with transtentorial herniation. Diagnosis of rhinocerebral mucormycosis was later observed by a laboratory finding and the treatment was changed to intravenous amphotericin B. However, the patient succumbed to her illness on the 6th day of hospitalisation. This report discusses the risk factors associated with rhinocerebral mucormycosis as well as the underlying pathogenesis. This report will also highlight the importance of early diagnosis and appropriate treatment for mucormycosis to improve prognosis in patients.

Matched MeSH terms: Early Diagnosis
A sinister rash in a lady with breast malignancy

Tan WF, Voo SYM

Med J Malaysia, 2021 03;76(2):275-277.
PMID: 33742647

Cutaneous metastasis may be the first presentation of an undiagnosed malignancy or a relapse of a previously treated malignancy. We describe a case of a 64-year-old lady with cutaneous metastases from breast carcinoma, who presented with two uncommon rash morphology-carcinoma erysipeloides (CE) and annular erythema. Histopathological examination showed infiltration of neoplastic cells in the dermal lymphatics and staging CT showed distant metastases. She is currently on palliative chemotherapy. A high index of suspicion and early referral to a dermatologist is crucial for early diagnosis for a patient who presents with an inflammatory skin lesion that is refractory to treatment, particularly if the patient has a previous history of malignancy.

Matched MeSH terms: Early Diagnosis
Fulltext Acquired Hemophilia in a Patient Presenting with Swollen Left Limb

Kiam GWP

Korean J Fam Med, 2019 Mar;40(2):129-132.
PMID: 30001614 DOI: 10.4082/kjfm.17.0126

Acquired hemophilia is a rare, potentially life-threatening disease that usually remains under-recognized especially in a primary setting; thus, diagnosing this disease is very challenging. Given its prevalence in elderly patients, awareness and diagnosis of this condition in the aging population (particularly those with unexplained bleeding or prolonged activated partial thromboplastin time) should be improved and better managed by the clinicians. Early diagnosis and prompt treatment are usually effective in preventing the adverse outcomes of this disease. In this report, we discuss a case of an elderly patient with acquired hemophilia who initially presented with swelling of his lower left limb. The diagnosis of acquired hemophilia was made a month after the appearance of symptoms. Early diagnosis with proper treatment could have been provided to this patient, if the initial assessment had been thoroughly conducted.

Matched MeSH terms: Early Diagnosis
Fulltext Acute Acalculous Cholecystitis after Laparoscopic Appendicectomy that Responded to Conservative Management

Hui CK

Malays J Med Sci, 2011 Jan;18(1):76-8.
PMID: 22135578

Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with a poor prognosis and a high mortality rate. Thus, early diagnosis and prompt surgical intervention has been recommended to improve the outcome of AAC. Herein, I present a case report of AAC complicating laparoscopic appendicectomy. Unlike previous studies that have reported the need for urgent intervention in patients with AAC, in this study, our patient responded to conservative management. Therefore, the management of AAC after laparoscopic appendicectomy should be individualised.

Matched MeSH terms: Early Diagnosis
Fulltext Aggressive scalp and sternal lesion: A presentation of rare case of metastatic eccrine carcinoma

Rownose CS, Mohamad Saupi MS, Sharif SZ, Lah NASN

Ann Med Surg (Lond), 2021 May;65:102322.
PMID: 33996055 DOI: 10.1016/j.amsu.2021.102322

Introduction: Ductal Eccrine carcinoma (DEC) is a rare primary cutaneous tumor that exhibits both squamous and adnexal ductal differentiation. Due to its rarity in clinical practice we present as case of DEC and a literature review on the latest management of this rare disease.
Case presentation: We report a case 41 years old female presented with lesion on the scalp and sternal mass, increasing in size with itchiness and erythematous for 6 months duration. Further CECT scan of brain and neck shows features of malignant left frontal scalp lesion with poor plane with overlying skin and underlying skull bone and CECT of thorax shows a large, irregular heterogeneously enhancing mass with necrotic center noted at right hilar within superior segment of right lower lobe, encasing right middle and lower lobe bronchi. Wedge biopsy of scalp lesion showed an intradermal lesion extensively infiltrating by malignant gland accompanied by desmoplasia and the tumor cells are seen extending into the surgical margins suggestive of ductal eccrine carcinoma.Clinical Discussion:This case highlights the importance and challenges in achieving early diagnosis coupled with the scarcity of information on these leads to difficulty in managing this patient.
Conclusion: In managing Ductal Eccrine Carcinoma tumor, standard method of treatment for has not been established. However, wide surgical excision is the treatment of choice for localized lesions. Regarding prognosis, there is conflicting data published which we describe in this article.

Matched MeSH terms: Early Diagnosis
Fulltext An 8-Year-Old Child with Delayed Diagnosis of Netherton Syndrome

Leung AKC, Barankin B, Leong KF

Case Rep Pediatr, 2018;2018:9434916.
PMID: 29527381 DOI: 10.1155/2018/9434916

We report an 8-year-old boy with Netherton syndrome who was misdiagnosed and treated as severe atopic dermatitis. The diagnosis of Netherton syndrome was not made until the child was 8 years of age. We discuss the pitfalls in the diagnosis and alert physicians to the proper and early diagnosis of this syndrome. The child was treated with a low dose (0.25 mg/kg) of oral acitretin and a topical moisturizer with marked improvement of his skin and pruritus in 2 months. At 6-month follow-up, the skin was almost clear of erythema and scaling, and the hair was longer and stronger. The dose of acitretin was reduced to 0.12 mg/kg for another 6 months and then discontinued.

Matched MeSH terms: Early Diagnosis
Fulltext An Early Reading Assessment Battery for Multilingual Learners in Malaysia

Lee JAC, Lee S, Yusoff NFM, Ong PH, Nordin ZS, Winskel H

Front Psychol, 2020;11:1700.
PMID: 32754104 DOI: 10.3389/fpsyg.2020.01700

The aim of the study was to develop a new comprehensive reading assessment battery for multi-ethnic and multilingual learners in Malaysia. Using this assessment battery, we examined the reliability, validity, and dimensionality of the factors associated with reading difficulties/disabilities in the Malay language, a highly transparent alphabetic orthography. In order to further evaluate the reading assessment battery, we compared results from the assessment battery with those obtained from the Malaysian national screening instrument. In the study, 866 Grade 1 children from multi-ethnic and multilingual backgrounds from 11 government primary schools participated. The reading assessment battery comprised 13 assessments, namely, reading comprehension, spelling, listening comprehension, letter name knowledge, letter name fluency, rapid automatized naming, word reading accuracy, word reading efficiency, oral reading fluency, expressive vocabulary, receptive vocabulary, elision, and phonological memory. High reliability and validity were found for the assessments. An exploratory factor analysis yielded three main constructs: phonological-decoding, sublexical-fluency, and vocabulary-memory. Phonological-decoding was found to be the most reliable construct that distinguished between at-risk and non-at-risk children. Identifying these underlying factors will be useful for detecting children at-risk for developing reading difficulties in the Malay language. In addition, these results highlight the importance of including a range of reading and reading-related measures for the early diagnosis of reading difficulties in this highly transparent orthography.

Matched MeSH terms: Early Diagnosis
An insight into the role of Artificial Intelligence in the early diagnosis of Alzheimer's disease

Verma RK, Pandey M, Chawla P, Choudhury H, Mayuren J, Bhattamisra SK, et al.

CNS Neurol Disord Drug Targets, 2021 May 11.
PMID: 33982657 DOI: 10.2174/1871527320666210512014505

BACKGROUND: The complication of Alzheimer's disease (AD) has made the development of its therapeutic a challenging task. Even after decades of research, we have achieved no more than a few years of symptomatic relief. The inability to diagnose the disease early is the foremost hurdle behind its treatment. Several studies have aimed to identify potential biomarkers that can be detected in body fluids (CSF, blood, urine, etc) or assessed by neuroimaging (i.e., PET and MRI). However, the clinical implementation of these biomarkers is incomplete as they cannot be validated.
METHOD: To overcome the limitation, the use of artificial intelligence along with technical tools has been extensively investigated for AD diagnosis. For developing a promising artificial intelligence strategy that can diagnose AD early, it is critical to supervise neuropsychological outcomes and imaging-based readouts with a proper clinical review.
CONCLUSION: Profound knowledge, a large data pool, and detailed investigations are required for the successful implementation of this tool. This review will enlighten various aspects of early diagnosis of AD using artificial intelligence.

Matched MeSH terms: Early Diagnosis
Fulltext An unusual case of concurrent dengue and malaria infection

Hong, Eric Qiu Weng, Cheo, Seng Wee, Low, Qin Jian

Borneo Journal of Medical Sciences, 2021;15(1):57-60.
MyJurnal

Dengue and malaria infections are common mosquito-borne infectious diseases in tropical and subtropical regions. The clinical manifestations of dengue and malaria often mimic each other, causing the predicament of early diagnosis without laboratory investigations. Concurrent dengue and malaria infection are often rare scenarios when both diseases occur in a particular patient at the same time. A high index of suspicion is therefore required to establish an early diagnosis to ensure complete success in its management. This case report is about concurrent dengue and malaria infection in a 54-year-old Pakistani man who presented with high-grade fever for three days before admission. On examination, he was febrile (38.8°C) with no other findings. His blood investigations were positive for NS1 antigen and IgM but negative for IgG. His peripheral blood film revealed the presence of Plasmodium vivax. He was treated for dengue fever with supportive management and started with oral Riamet (artemether and lumefantrine) along with oral primaquine 30 mg daily for two weeks’ duration. Following treatment, the patient demonstrated progressive clinical improvement and was subsequently discharged back to the community clinic for the continuation of care.

Matched MeSH terms: Early Diagnosis
An unusual cause of acute abdomen and acute renal failure: Djenkolism

Sumitro K, Yong CS, Tan LT, Choo S, Lim CY, Shariman H, et al.

Malays Fam Physician, 2020;15(2):50-52.
PMID: 32843946

The djenkol bean (Archidendron pauciflorum) is a native delicacy in Southeast Asia, though consumption can sometimes lead to djenkolism. Clinical features of djenkolism include acute abdominal pain, hematuria, urinary retention, and acute kidney injury (AKI). The pain can be severe, which often leads to a misdiagnosis of acute abdomen. In this paper, we report the case of an Indonesian migrant with djenkolism. Due to the short history and severity of the abdominal pain, medical professionals suspected acute abdomen and proceeded with a negative exploratory laparotomy. However, djenkolism was suspected once relatives informed the professionals that the patient had consumed djenkol beans hours earlier. The patient recovered through aggressive hydration and urine alkalinization with bicarbonate infusion. We highlight the importance of being aware of this rare cause of AKI, especially in Southeast Asia, in order to provide early diagnoses and prompt treatments.

Matched MeSH terms: Early Diagnosis
Fulltext An unusual first presentation of hypopharyngeal carcinoma as thyroid abscess: Case report of a diagnostic challenge

Tan HY, Sanudin SH, Lum SG, Wong EHC

Int J Surg Case Rep, 2021 Apr;81:105723.
PMID: 33713999 DOI: 10.1016/j.ijscr.2021.105723

BACKGROUND: Hypopharyngeal carcinoma can involve thyroid gland due to their close proximity. However, an initial presentation as a thyroid abscess is rare in this malignancy. To our knowledge, this is the second reported case in the English literature.
CASE PRESENTATION: We described a 45-year-old female who presented with dysphagia, hoarseness and anterior neck swelling. The initial CT scan revealed a right thyroid abscess which was incised and drained with no malignancy found in the biopsy of the thyroid tissue. Patient presented one month later with worsening dysphagia, weight loss and a fungating anterior neck mass. Further investigation revealed a locally advanced hypopharyngeal squamous cell carcinoma extending to the right thyroid, upper oesophagus, prevertebral muscles and bilateral cervical lymph nodes (T4bN2cM0). Unfortunately, the patient passed away prior to initiation of treatment.
CONCLUSION: Clinicians should have raised index of suspicion of a possible underlying hypopharyngeal carcinoma in patients presenting with thyroid abscess and proceed to further investigations in order to ensure early diagnosis and treatment of the malignancy.

Matched MeSH terms: Early Diagnosis
Asphyxia screening kit

Zabidi A, Khuan LY, Mansor W

Annu Int Conf IEEE Eng Med Biol Soc, 2012;2012:1298-301.
PMID: 23366136 DOI: 10.1109/EMBC.2012.6346175

Infant asphyxia is a condition due to insufficient oxygen intake suffered by newborn babies. A 4 to 9 million occurrences of infant asphyxia are reported each year by WHO. Early diagnosis of asphyxia is important to avoid complications such as damage to the brain, organ and tissue that could lead to fatality. This is possible with the automation of screening of infant asphyxia. Here, a non-invasive Asphyxia Screening Kit is developed. It is a Graphical User Interface that automatically detects asphyxia in infants from early birth to 6 months from their cries and displays the outcome of analysis. It is built with Matlab GUI underlied with signal processing algorithms, capable of achieving a classification accuracy of 96.03%. Successful implementation of ASK will assist to screen infant asphyxia for reference to clinicians for early diagnosis. In addition, ASK also provides an interface to enter patient information and images to be integrated with existing Hospital Information Management System.

Matched MeSH terms: Early Diagnosis
Fulltext Avascular Necrosis of the Hip in Primary Care

Baharum NN, Ariffin F, Hanafiah M, Sulaiman SH

Korean J Fam Med, 2021 Jan;42(1):84-87.
PMID: 32447880 DOI: 10.4082/kjfm.19.0021

Avascular necrosis, or osteonecrosis of the femoral head, is a debilitating condition which leads to the destruction of the hip joint due to an interruption in the blood supply to the bony region and is most commonly due to trauma. The case discussed here has been highlighted as it presented as non-traumatic osteonecrosis of the femoral head with an absence of risk factors in a healthy adult male. A 37-year-old male presented with a 4-month history of recurrent left hip pain, which worsened with initiation of movement and weightbearing on the affected side. The patient was overweight but normotensive with a full range of movement of the hips bilaterally. There were no abnormalities detected on initial X-ray images of the left hip. However, due to the persistent pain and sclerotic changes in a subsequent X-ray, a magnetic resonance image of the bilateral hips was obtained, leading to the diagnosis of osteonecrosis of the bilateral femoral heads. Due to the lack of improvement with physiotherapy and analgesia, the patient was subjected to conservative surgery of the symptomatic left hip with concurring evidence of avascular necrosis based on intraoperative anatomical biopsy. This case emphasizes the importance of identifying underlying issues during history taking and physical examination in adults without risk factors. The early diagnosis of osteonecrosis assists in preventing joint collapse and can delay the requirement of joint replacements. High levels of suspicion are necessary to instigate investigation in persistent cases without the presence of risk factors.

Matched MeSH terms: Early Diagnosis
Fulltext Bilateral subtentorial empyema complicated with nosocomial acinectobacter ventriculitis: a case report

Sim SK, Ch'ng CH, Tan YC, Kandasamy R, Abdullah JM

Med J Malaysia, 2014 Apr;69(2):86-8.
PMID: 25241818 MyJurnal

Subtentorial subdural empyema is a rare and life threatening intracranial suppuration. It is usually an intracranial complication of otogenic infections. Early diagnosis and surgical drainage are the most important factors determining prognosis. The high mortality reported in the literature reflects the severity of subtentorial subdural empyema if proper management is delayed. Intracranial infections usually require between 4 to 6 weeks of intravenous antibiotics therapy. However, the prolonged duration of hospitalization as well as requirement for neurosurgically inserted indwelling devices may predispose these patients to new nosocomial infections.

Matched MeSH terms: Early Diagnosis

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