MyMedR

Fulltext Uterine artery bleeding and haemoperitoneum during the second trimester in pregnancy

Achanna KS, Goh CS

Med J Malaysia, 2003 Mar;58(1):128-30.

A case of spontaneous rupture of uterine artery in the second trimester of pregnancy is described. Haemorrhage from rupture of uterine artery during pregnancy was discovered at laparotomy. This was an unusual but serious complication of pregnancy. This condition is extremely rare and one must consider it in cases of incomprehensible abdominal pain with or without haemodynamic collapse. A review of the literature revealed only four similar cases so far. This pregnancy continued till 37 weeks pregnancy and had a spontaneous vaginal delivery. Immediate institution of effective resuscitative measures and early surgical intervention were essential to both foetal and maternal survival.

Matched MeSH terms: Uterine Hemorrhage/diagnosis*

Fulltext Pentaplex PCR assay for detection of hemorrhagic bacteria from stool samples

Al-Talib H, Latif B, Mohd-Zain Z

J Clin Microbiol, 2014 Sep;52(9):3244-9.

PMID: 24958797 DOI: 10.1128/JCM.00891-14

Diarrheal diseases cause illness and death among children younger than 10 years in developing countries. Conventional testing for the detection of hemorrhagic bacteria takes 2 to 5 days to yield complete information on the organism and its antibiotic sensitivity pattern. Hence, in the present study, we developed a molecular-based diagnostic assay that identifies common hemorrhagic bacteria in stool samples. A set of specific primers were designed for the detection of Salmonella spp., Shigella spp., enterohemorrhagic Escherichia coli (EHEC), and Campylobacter spp., suitable for use in a one-tube PCR assay. The assay in the present study simultaneously detected five genes, namely, ompC for the Salmonella genus, virA for the Shigella genus, eaeA for EHEC, 16S rRNA for the Campylobacter genus, and hemA for an internal control. Specific primer pairs were successfully designed and simultaneously amplified the targeted genes. Validation with 20 Gram-negative and 17 Gram-positive strains yielded 100% specificity. The limit of detection of the multiplex PCR assay was 1 × 10(3) CFU at the bacterial cell level and 100 pg at the genomic DNA level. Further evaluation of the multiplex PCR with 223 bacterium-spiked stool specimens revealed 100% sensitivity and specificity. We conclude that the developed multiplex PCR assay was rapid, giving results within 4 h, which is essential for the identification of hemorrhagic bacteria, and it might be useful as an additional diagnostic tool whenever time is important in the diagnosis of hemorrhagic bacteria that cause diarrhea. In addition, the presence of an internal control in the multiplex PCR assay is important for excluding false-negative cases.

Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis*

Fulltext Gastric duplication cyst with a red flag presentation: a case report

Alagoo D, Sellappan H, Jayasilan J, Azizan N, Hayati F

Pan Afr Med J, 2021;39:141.

PMID: 34527157 DOI: 10.11604/pamj.2021.39.141.29895

Gastric duplication cyst (GDC) is a rare congenital malformation of the gastrointestinal (GI) tract. Despite being benign in the entity, its complications vary from an asymptomatic abdominal mass to fulminant or massive GI bleeding. A 28-year-old lady presented with unexplained GI haemorrhage, in which the upper endoscopy showed a classic feature of GI stromal tumour. The preoperative diagnosis was also confirmed by the computed tomography. She subsequently underwent surgical resection and the final histopathology was consistent with a benign entity of GDC.

Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis

Fulltext Massive lower gastrointestinal bleeding secondary to colonic mucormycosis

Anand J, Ghazala K, Chong VH

Med J Malaysia, 2011 Aug;66(3):266-7.

PMID: 22111457

Lower gastrointestinal bleeding is usually due to haemorrhoids, diverticular disease, or colorectal cancer. Infective causes of gastrointestinal bleeding are rare. A 70-year-old lady was admitted with septic shock secondary to community acquired pneumonia. She later developed massive lower gastrointestinal bleeding secondary to colonic mucormycosis. Her condition deteriorated rapidly and she died of septicemia. Mucormycosis of the colon is extremely rare and is still associated with a high mortality.

Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis

Factors associated with abrupt discontinuation of dabigatran therapy in patients with atrial fibrillation in Malaysia

Beshir SA, Chee KH, Lo YL

Int J Clin Pharm, 2016 Oct;38(5):1182-90.

PMID: 27450507 DOI: 10.1007/s11096-016-0350-1

Background Oral anticoagulant therapy is indicated for the prevention of stroke or other thromboembolic events. Premature discontinuation of oral anticoagulants may increase the risk of thromboembolism resulting in adverse sequelae. There are sparse data on the prevalence and the predictors of dabigatran discontinuation in Malaysian patients with atrial fibrillation. Objectives Determine the reasons and identify associated factors for abrupt discontinuation of dabigatran, assess the switching pattern and the occurrence of thromboembolic events after dabigatran discontinuation. Setting A university-affiliated tertiary hospital in Kuala Lumpur, Malaysia. Methods The clinical and demographic data of a cohort who were initiated with dabigatran between 2010 and 2012 at the University of Malaya Medical Centre were reviewed until the date of death or on 31st December 2013. Those patients who discontinued dabigatran were further followed up until 31st December 2015 to determine the occurrence of any thromboembolic event. Main outcome measure Permanent discontinuation of dabigatran for more than 8 weeks. Results 26 (14 %) of a cohort of 192 patients discontinued dabigatran therapy during a median follow-up period of 20 (range 3-45) months. About one-half of the discontinuation occurred within the first 6 months of dabigatran use. The three most cited reasons for discontinuation are bleeding events (19 %), high out-of-pocket drug payment (19 %) and cardioversion (19 %). Heart failure [adjusted odds ratio 3.699 (95 % confidence interval 1.393-9.574)] or chronic kidney disease [adjusted odds ratio 5.211 (95 % confidence interval 1.068-23.475)] were found to be independent risk factors for abrupt dabigatran discontinuation. Patients who discontinued dabigatran received warfarin (38 %), antiplatelet agents (16 %) or no alternative antithrombotic therapy (46 %). Five of the 26 patients who discontinued dabigatran developed an ischaemic stroke within 3-34 months after discontinuation. Conclusion Abrupt dabigatran discontinuation without an alternative oral anticoagulant increases the risk of thromboembolic events. As adverse drug events and renal impairment contribute substantially to the premature discontinuation of dabigatran, it is important to identify and monitor patients at risk to reduce dabigatran discontinuation rate especially during the first six months of dabigatran therapy.

Matched MeSH terms: Hemorrhage/diagnosis

Periventricular haemorrhage in very low birth weight Malaysian neonates

Boo NY, Ong LC, Lye MS, Wong KP, Mastura M

J Trop Pediatr, 1993 Aug;39(4):224-9.

PMID: 8411316

A prospective study was carried out to determine the incidence, clinical presentation, early outcome, and risk factors associated with periventricular haemorrhage (PVH) in 88 (84 per cent) of the 105 consecutive very low birth weight (VLBW) (< 1500 g) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur. Based on the cranial ultrasound findings, PVH was detected in 86 of the 88 neonates (98 per cent, 95 per cent confidence intervals: 95 to 101). Seventeen (20 per cent) of them had grade I, 52 (61 per cent) had grade II, 7 (8 per cent) had grade III and 10 (12 per cent) had grade IV PVH. PVH was detected in all the affected neonates by the fifth day of life. Sixty-four neonates (74 per cent) were symptomatic when PVH was first detected. Shock (P < 0.01), pallor (P = 0.028), low haematocrit of less than 40 per cent (P < 0.01), convulsion (P < 0.001), and bulging of anterior fontanelle (P = 0.019) were significantly more common in the neonates with severe PVH (grades III or IV). Death occurred in 43/86 (50 per cent, 95 per cent confidence interval: 39-61 per cent) of the neonates with PVH before their first discharge from the hospital. Ventriculomegaly developed in 29/43 (67 per cent, 95 per cent confidence intervals: 54.4-81.4) of the survivors with PVH. Our study suggests that PVH is a common problem in the Malaysian VLBW neonates. To reduce the incidence and severity of this condition, prevention of preterm delivery and improvement in the basic facilities for neonatal care would help.

Matched MeSH terms: Hemorrhage/diagnosis*

Spontaneous orbital haematoma in a scurvy child: A forgotten diagnosis

Cheah SC, Tang IP, Matthew TJH, Ooi MH, Husain S

Int J Pediatr Otorhinolaryngol, 2020 Oct;137:110224.

PMID: 32896344 DOI: 10.1016/j.ijporl.2020.110224

Spontaneous unilateral orbital haematoma in children is not common and very rarely caused by scurvy. Scurvy is a clinical syndrome with a spectrum of clinical manifestations due to severe prolonged vitamin C deficiency leading to impairment of collagen synthesis over skin, bone, teeth and blood vessels. This paper presents a unique case of a 7- year-old girl with learning difficulty who presented with spontaneous right proptosis due to scurvy. Imaging studies suggestive of intra- orbital extraconal haemorrhage. The child was treated with a higher than recommended dose of vitamin C initially in emergency situation. She responded well and discharged without complication. Spontaneous orbital haematoma due to scurvy is very rare with less than 10 cases published in literature. The present case should raise the awareness regarding this forgotten disease and importance of balance nutrition amongst children.

Matched MeSH terms: Eye Hemorrhage/diagnosis

Cullen and Grey Turner signs in abdominal pain

Chuah YY, Lee YY

Med J Aust, 2021 03;214(4):164.

PMID: 33458825 DOI: 10.5694/mja2.50924

Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis*

Neonatal post-hemorrhagic hydrocephalus resulting in foraminal septae-radiological technique and surgical implications

Fadzli F, Ramli NM, Rahmat K, Ganesan D

Childs Nerv Syst, 2013 Jan;29(1):159-62.

PMID: 22996826 DOI: 10.1007/s00381-012-1923-5

Intraventricular haemorrhage is the most common cause of hydrocephalus in a pre-term baby and may require surgical intervention depending on severity.

Matched MeSH terms: Cerebral Hemorrhage/diagnosis

Fulltext Statistical analysis plan for the 'Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage' (TICH-2) trial

Flaherty K, Bath PM, Dineen R, Law Z, Scutt P, Pocock S, et al.

Trials, 2017 Dec 20;18(1):607.

PMID: 29262841 DOI: 10.1186/s13063-017-2341-5

RATIONALE: Aside from blood pressure lowering, treatment options for intracerebral haemorrhage remain limited and a proportion of patients will undergo early haematoma expansion with resultant significant morbidity and mortality. Tranexamic acid (TXA), an anti-fibrinolytic drug, has been shown to significantly reduce mortality in patients, who are bleeding following trauma, when given rapidly. TICH-2 is testing whether TXA is effective at improving outcome in spontaneous intracerebral haemorrhage (SICH).

METHODS AND DESIGN: TICH-2 is a pragmatic, phase III, prospective, double-blind, randomised placebo-controlled trial. Two thousand adult (aged ≥ 18 years) patients with an acute SICH, within 8 h of stroke onset, will be randomised to receive TXA or the placebo control. The primary outcome is ordinal shift of modified Rankin Scale score at day 90. Analyses will be performed using intention-to-treat.

RESULTS: This paper and its attached appendices describe the statistical analysis plan (SAP) for the trial and were developed and published prior to database lock and unblinding to treatment allocation. The SAP includes details of analyses to be undertaken and unpopulated tables which will be reported in the primary and key secondary publications. The database will be locked in early 2018, ready for publication of the results later in the same year.

DISCUSSION: The SAP details the analyses that will be done to avoid bias arising from prior knowledge of the study findings. The trial will determine whether TXA can improve outcome after SICH, which currently has no definitive therapy.

TRIAL REGISTRATION: ISRCTN registry, ID: ISRCTN93732214 . Registered on 17 January 2013.

Matched MeSH terms: Cerebral Hemorrhage/diagnosis

Valsalva haemorrhagic retinopathy after push-ups

Hassan M, Tajunisah I

Lancet, 2011 Feb 5;377(9764):504.

PMID: 21255827 DOI: 10.1016/S0140-6736(10)60677-0

Matched MeSH terms: Retinal Hemorrhage/diagnosis

Hemorrhagic Descemet Membrane Detachment Following Syphilitic Interstitial Keratitis

Höllhumer R, Zairani Mz A, Watson S

Cornea, 2016 Sep;35(9):1255-6.

PMID: 27227396 DOI: 10.1097/ICO.0000000000000889

PURPOSE: Syphilitic interstitial keratitis is a stromal inflammatory disease with characteristic secondary vascularization. This case illustrates a late complication of hemorrhagic Descemet membrane detachment.

METHODS: Case report.

RESULTS: The patient presented with painless sudden visual loss and progressive shallowing of the anterior chamber caused by hemorrhagic Descemet membrane detachment. She had corneal neovascularization and a positive syphilis serology. Owing to the risk of pupil block glaucoma, the patient had surgical drainage of the blood via an ab externo approach.

CONCLUSIONS: This case illustrates a previously unreported complication of syphilitic interstitial keratitis. The patient recovered good visual acuity and had residual pigment deposits in the pre-Descemet interface.

Matched MeSH terms: Eye Hemorrhage/diagnosis

A rare cause of spontaneous bleeding per oral in an elderly

Ibrahim FM, Mohamad I

Ann Acad Med Singap, 2010 Oct;39(10):817-8.

PMID: 21063648

Matched MeSH terms: Oral Hemorrhage/diagnosis

An unusual differential diagnosis of myringitis bullosa haemorrhagica

Indudharan R, Dharap AS, Htun YN

Trop Geogr Med, 1995;47(5):227-8.

PMID: 8553451

Matched MeSH terms: Hemorrhage/diagnosis

Fulltext Endoscopy in upper gastrointestinal haemorrhage

Jalleh RP, Goh KL, Wong NW

Med J Malaysia, 1988 Sep;43(3):213-7.

PMID: 3266521

Matched MeSH terms: Gastrointestinal Hemorrhage/diagnosis; Peptic Ulcer Hemorrhage/diagnosis

Bone in the eye

Jumaat BH, Dahalan A, Mohamad M

Am J Ophthalmol, 2003 Feb;135(2):254-6.

PMID: 12566045

PURPOSE: To report a case of choroidal osteoma presenting with massive subretinal hemorrhage not associated with choroidal neovascularisation (CNV).

DESIGN: Case report.

METHODS: An 18-year-old man presented with sudden loss of vision in the right eye following competitive swimming. He was found to have a massive subretinal hemorrhage involving the macula.

RESULTS: Following resolution of the hemorrhage, the patient was found to have an underlying choroidal osteoma. There was no evidence of choroidal neovascularisation clinically and angiographically. He regained his normal vision.

CONCLUSIONS: Choroidal osteoma presenting with massive subretinal hemorrhage not associated with underlying choroidal neovascularization need not result in poor visual outcome.

Matched MeSH terms: Retinal Hemorrhage/diagnosis

Fulltext I jejunal patch repair of a duodenal perforation

Kalyani A, Teoh CM, Sukumar N

Med J Malaysia, 2005 Jun;60(2):237-8.

PMID: 16114169

A patient with duodenal ulcer who developed iatrogenic perforation post endoscopy is presente. We present t is case that was treated successfully treated by jejunal serosal patch.

Matched MeSH terms: Peptic Ulcer Hemorrhage/diagnosis

A validation study of the Siriraj Stroke Score

Kan CH, Lee SK, Low CS, Velusamy SS, Cheong I

Int J Clin Pract, 2000 Dec;54(10):645-6.

PMID: 11221275

A cross-sectional study was conducted on 160 Malaysian patients to validate the usefulness of the Siriraj Stroke Score (SSS) for differentiating intracerebral haemorrhage and infarction following acute strokes. Our results indicate that the score lacks sensitivity and specificity. It should thus not be used in epidemiological studies to determine stroke types in a community. More importantly, in the absence of information from neuroimaging of the brain, it cannot be used safely by physicians to assess the need or otherwise of thrombolytic and/or anticoagulant therapy after an acute stroke.

Matched MeSH terms: Cerebral Hemorrhage/diagnosis*

The role of a high augmentation index in spontaneous intracerebral hemorrhage to prognosticate mortality

Keong LH, Ghani AR, Awang MS, Sayuthi S, Idris B, Abdullah JM

Acta Neurochir. Suppl., 2011;111:375-9.

PMID: 21725785 DOI: 10.1007/978-3-7091-0693-8_63

The aim of the study was to determine the prognostic value of a high augmentation index, which was a surrogate marker of arterial stiffness in patients with spontaneous intracerebral hemorrhage. The outcome was divided into two groups in which the following data were collected in a computer running SphygmoCor CvMS software version 8.2. Logistic regression analysis was carried out among significant variables to identify an independent predictor of 6-month outcome and mortality. Sixty patients were recruited into the study. Admission Glasgow Coma Scale score (OR, 0.7; 95% CI, 0.450-0.971; P=0.035), total white cell count (OR, 1.2; 95% CI, 1.028-1.453; P=0.023) and hematoma volume (OR, 1.1; 95% CI, 1.024-1.204; P=0.011) were found to be statistically significant for identifying poor 6-month outcome in multivariate analysis. Factors independently associated with mortality were a high augmentation index (OR, 8.6; 95% CI, 1.794-40.940; P=0.007) and midline shift (OR, 7.5; 95% CI, 1.809-31.004; P=0.005). Admission Glasgow Coma Scale score, total white cell count and hematoma volume were significant predictors for poor 6-month outcome, and a high augmentation index and midline shift were predictors for 6-month mortality in this study.

Matched MeSH terms: Cerebral Hemorrhage/diagnosis*

Pulmonary manifestation as initial presentation for systemic lupus erythematosus

Khor CG, Kan SL, Tan BE

Int J Rheum Dis, 2018 Jun;21(6):1322-1325.

PMID: 24495523 DOI: 10.1111/1756-185X.12302

We report a 29-year-old Malay man who had pulmonary manifestations as an initial presentation for systemic lupus erythematosus. He had prolonged hospitalization and was treated with intensive care therapy with immunosuppressants.

Matched MeSH terms: Hemorrhage/diagnosis

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