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Role of clinical scoring system and imaging in acute appendicitis in adults: a review of literature

Nicqeshen N, Dilashini S, Kirthana S

Med J Malaysia, 2020 05;75(3):316-321.
PMID: 32467556

INTRODUCTION: Ultrasound is widely available, easy-to-use and less expensive than most other imaging methods. It is widely used as a non-invasive method to diagnose acute appendicitis; however, its efficiency still remains questionable, especially when compared to costlier and invasive methods such as computed tomography.
METHODS: An exploratory review of past literatures on the usage of ultrasound technique in the diagnosis of acute appendicitis in adult patients, and the role of other imaging techniques were undertaken for the study.
RESULTS: The gold standard for the diagnosis of acute appendicitis still remains a histopathological confirmation after appendectomy. The study further shows imaging has high diagnostic accuracy in the diagnosis of acute appendicitis with low rate of negative appendectomy (<10%). Multiple reasons are identified, including the introduction of computed tomography imaging especially in those patients where ultrasound was unequivocal, more education on imaging which leads to better operator skill or improved performances of machines.
CONCLUSION: Imaging undoubtedly plays an important role in the diagnosis of acute appendicitis with ultrasound remaining the first-line method in patients referred with clinically suspected acute appendicitis. Nevertheless, those with borderline ultrasound findings or unable to visualize appendix on ultrasound with highly suspicious sign and symptoms were offered other imaging modalities such as CT scan.
RECOMMENDATION: It is recommended that the managing team balance the risk of radiation exposure, risk of delay in urgent operation and risk of perforation prior to a decision.

Matched MeSH terms: Acute Disease*
Fulltext Dieulafoy's lesion: an unexpected and rare cause of upper gastrointestinal bleeding

Rajanthran SK, Singh HC, Than DJ, Hayati F

BMJ Case Rep, 2020 Dec 23;13(12).
PMID: 33361139 DOI: 10.1136/bcr-2020-240905
Matched MeSH terms: Acute Disease/therapy
Fulltext Imported case of acute respiratory tract infection associated with a member of species nelson bay orthoreovirus

Yamanaka A, Iwakiri A, Yoshikawa T, Sakai K, Singh H, Himeji D, et al.

PLoS One, 2014;9(3):e92777.
PMID: 24667794 DOI: 10.1371/journal.pone.0092777

A Japanese man suffered from acute respiratory tract infection after returning to Japan from Bali, Indonesia in 2007. Miyazaki-Bali/2007, a strain of the species of Nelson Bay orthoreovirus, was isolated from the patient's throat swab using Vero cells, in which syncytium formation was observed. This is the sixth report describing a patient with respiratory tract infection caused by an orthoreovirus classified to the species of Nelson Bay orthoreovirus. Given the possibility that all of the patients were infected in Malaysia and Indonesia, prospective surveillance on orthoreovirus infections should be carried out in Southeast Asia. Furthermore, contact surveillance study suggests that the risk of human-to-human infection of the species of Nelson Bay orthoreovirus would seem to be low.

Matched MeSH terms: Acute Disease
Fulltext Severe thrombocytopenia due to hypersplenism treated with partial splenic embolisation

Hanafiah M, Shahizon AM, Low SF, Shahrina MH

BMJ Case Rep, 2013 Jul 05;2013.
PMID: 23833091 DOI: 10.1136/bcr-2013-010163

A 35-year-old woman with background of liver cirrhosis and portal hypertension secondary to chronic hepatitis C presented with complication of hypersplenism and thrombocytopenia. She developed severe menorrhagia requiring multiple blood transfusions. In addition, her interferon therapy was withheld owing to the underlying thrombocytopenia. Partial splenic embolisation was performed, which improved her platelet counts. Subsequently, the menorrhagia was resolved and her interferon therapy was restarted.

Matched MeSH terms: Acute Disease
Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia

Awang R, Al-Sohaim SI, Zyoud SH, Khan HR, Hashim S

Intern Emerg Med, 2011 Oct;6(5):441-8.
PMID: 21750875 DOI: 10.1007/s11739-011-0662-z

Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.

Matched MeSH terms: Acute Disease
The quality of life among coronary heart disease patients at a teaching hospital

Ho SE, Ting CK, Das S, Loo CY, Rohayu AB, Khor SY, et al.

Clin Ter, 2011;162(3):217-22.
PMID: 21717045

Quality of life after acute coronary heart disease amongst patients is important outcome factor in deliberations of patient's care. The main aim of the study was to examine the quality of life amongst acute CHD patients.

Matched MeSH terms: Acute Disease
Fulltext Acute stroke patients with high BMI are less likely to have severe disability at initial presentation

Choo WS, Foo S, Tan E, Thayaparan FS, Chung YY, Raman S, et al.

Med J Malaysia, 2009 Mar;64(1):34-6.
PMID: 19852318 MyJurnal

This is a prospective study to determine the severity of disability and prognosis of acute stroke patients related to their Body Mass index (BMI). A total of 79 consecutive CT-scan-proven acute stroke patients who were admitted to Hospital Tuanku Ja'afar, Seremban between November 2006 and April 2007 were recruited (male:female 49:30; mean age 62.7 years; ischemic stroke 70, intracerebral bleed 9). The patients were divided according to BMI less than 25 (Group A) and equal or greater than 25 (Group B). Severity of disability was measured between 24-48 hours by modified Rankin's score. Patients were followed up after one month. Thirty-seven patients had severe disability (Rankin Score 5). Twenty-nine patients had adverse outcomes including 11 deaths and 18 rehospitalizations or prolonged hospital/nursing home stay. 34.3% of Group B had severe disability compared to 56.8% of Group A (chi2 P = 0.046). Conversely 42.9% of Group B had adverse events at one month compared to 31.8% of Group A (chi2 P = 0.312). There were no statistical differences between high- and low-BMI groups for gender ratio, smoking, hypertension, diabetes, prior cardiovascular disease, mean age, mean lipid profile and blood pressure. When comparing patients with Rankin Score 1-4 versus 5, age and BMI were statistically significant between the two groups. By multivariate analysis only age is independent predictor for severe disability (P < 0.05). The results of this pilot study should be confirmed in larger prospective multicentre trial.

Matched MeSH terms: Acute Disease
Fulltext Typhoid fever presenting as acute cerebellar ataxia and severe thrombocytopenia

Cheong BM

Med J Malaysia, 2008 Mar;63(1):77-8.
PMID: 18935745 MyJurnal

Typhoid fever being a systemic infection can present in a multitude of ways, involving various systems. Here we describe a case of typhoid fever presenting with acute cerebellar ataxia and marked thrombocytopenia. This atypical presentation is not common in typhoid fever and can lead to misdiagnosis as well as a delay in the initiation of appropriate therapy. Prompt clinical improvement and the return of platelet counts to normal were noted after the patient was started on IV Ceftriaxone.

Matched MeSH terms: Acute Disease
Fulltext Co-infection of dengue virus and chikungunya virus in two patients with acute febrile illness

Nayar SK, Noridah O, Paranthaman V, Ranjit K, Norizah I, Chem YK, et al.

Med J Malaysia, 2007 Oct;62(4):335-6.
PMID: 18551940 MyJurnal

During an outbreak of chikungunya in a dengue hyperendemic area within the Kinta district of Perak, two patients with acute febrile illness were laboratory confirmed to have co-infection of both dengue and chikungunya viruses in their blood. The concomitant presence of two types of viruses transmitted by the same vector in a susceptible population contributed to the resultant event. A good understanding of virus vector ecology in association with population dynamics and wider application of improved laboratory techniques by using different cell-lines suited for optimal replication of each type of virus and the correct utilization of powerful molecular techniques will enhance accurate diagnosis of these infectious diseases.

Matched MeSH terms: Acute Disease
Fulltext Identification and characterization of a new orthoreovirus from patients with acute respiratory infections

Chua KB, Voon K, Crameri G, Tan HS, Rosli J, McEachern JA, et al.

PLoS One, 2008;3(11):e3803.
PMID: 19030226 DOI: 10.1371/journal.pone.0003803

First discovered in the early 1950s, reoviruses (respiratory enteric orphan viruses) were not associated with any known disease, and hence named orphan viruses. Recently, our group reported the isolation of the Melaka virus from a patient with acute respiratory disease and provided data suggesting that this new orthoreovirus is capable of human-to-human transmission and is probably of bat origin. Here we report yet another Melaka-like reovirus (named Kampar virus) isolated from the throat swab of a 54 year old male patient in Kampar, Perak, Malaysia who was suffering from high fever, acute respiratory disease and vomiting at the time of virus isolation. Serological studies indicated that Kampar virus was transmitted from the index case to at least one other individual and caused respiratory disease in the contact case. Sequence analysis of the four small class genome segments indicated that Kampar and Melaka viruses are closely related. This was confirmed by virus neutralization assay, showing an effective two-way cross neutralization, i.e., the serum against one virus was able to neutralize the other. Although the exact origin of Kampar virus is unknown, epidemiological tracing revealed that the house of the index case is surrounded by fruit trees frequently visited by fruit bats. There is a high probability that Kampar virus originated from bats and was transmitted to humans via bat droppings or contaminated fruits. The discovery of Kampar virus highlights the increasing trend of emergence of bat zoonotic viruses and the need to expand our understanding of bats as a source of many unknown viruses.

Matched MeSH terms: Acute Disease
Fulltext Low dose unilateral spinal anaesthesia for lower limb amputation in critically ill patients

Chuah KH, Thong CL, Krshnan H, Chan L

Med J Malaysia, 2007 Mar;62(1):81-2.
PMID: 17682582 MyJurnal

Patients with poorly controlled diabetes mellitus have an increased risk of lower limb infection and gangrene. In Malaysia, they frequently present late and are often in septic shock with multi-organ dysfunction. We report on two patients who presented for lower limb amputation in a desperate attempt to control sepsis and save their lives. Both patients were classified as ASA 5. Both patients had successfully undergone surgery under low dose unilateral spinal anaesthesia. The anaesthetic management of these critically ill patients in view of limited resources is discussed.

Matched MeSH terms: Acute Disease
Vessel density ratio: A novel approach to identify "culprit" coronary lesion by spiral computed tomography

Chin BS, Ong TK, Seyfarth TM, Liew CK, Chan WL, Rapaee A, et al.

J Comput Assist Tomogr, 2006 7 18;30(4):564-8.
PMID: 16845284

BACKGROUND AND OBJECTIVE: We hypothesized that a "culprit" lesion in acute coronary syndrome (ACS) should have low overall vessel lumen and plaque density on multidetector computed tomography-assisted coronary angiography (MDCTA) because of lower calcification and the presence of occlusive thrombus. However, thrombi and calcification both can themselves blur the demarcation between vessel wall and lumen. If we calculated a "vessel density ratio" (VDR) obtained by measuring the mean density of contrast-enhancement within a region of interest (ROI), which includes the vessel wall, lumen, plaque, and thrombus, and comparing that with the aortic root mean density acting as a reference point, this ratio may be more convenient, standardized, and reproducible to test the feasibility of VDR in identifying "culprit" lesions in ACS.
METHODS: Sixty-four patients-21 exertional angina; 17 unstable angina/non-ST elevation myocardial infarction (NSTEMI); 26 ST elevation myocardial infarction (STEMI)-provided 188 diseased segments on conventional angiography. All underwent MDCTA within a week of angiography. ROI was mapped out from maximum intensity projections of diseased segments in planar view.
RESULTS: One hundred seventy-four segments were evaluated. Patients who presented with ACS (STEMI and unstable angina/non-ST elevation myocardial infarction) had lower mean VDR compared to patients with exertional angina (0.58 vs. 0.66 vs. 0.81; P < 0.001). Culprit lesions in ACS patients also had the lowest mean VDR when compared to nonculprit lesions and lesions in patients without ACS (0.51 vs. 0.68 vs. 0.81; P < 0.001).
CONCLUSIONS: VDR is a new, convenient, and standardized approach in identifying "culprit" lesions by MDCTA.

Matched MeSH terms: Acute Disease
Fulltext Clinical predictors of a positive troponin T test in patients presenting with probable acute coronary syndromes

Omar AR, Ping C, Tan HC, Lim YT

Med J Malaysia, 2005 Mar;60(1):50-3.
PMID: 16250280

Acute coronary syndrome (ACS) patients with positive troponin T (TnT) test are at higher risk for death and myocardial reinfarction. They would significantly benefit from early aggressive pharmacologic and invasive therapy. However, TnT test is not widely available. This retrospective study of 173 patients with ACS showed: that prolonged or repetitive episodes of angina at rest in the previous 24 hours (p = 0.01) and evidence of myocardial ischaemia on ECG (p < 0.001) were associated with positive TnT tests (> or = 0.1 ng/mL). The two variables in combination showed 100% positive predictive value, facilitating early identification and streamlining of therapy.

Matched MeSH terms: Acute Disease
Intravenous Lipid Emulsion as an Antidote for the Treatment of Acute Poisoning: A Bibliometric Analysis of Human and Animal Studies

Zyoud SH, Waring WS, Al-Jabi SW, Sweileh WM, Rahhal B, Awang R

Basic Clin Pharmacol Toxicol, 2016 Nov;119(5):512-519.
PMID: 27098056 DOI: 10.1111/bcpt.12609

In recent years, there has been increasing interest in the role of intravenous lipid formulations as potential antidotes in patients with severe cardiotoxicity caused by drug toxicity. The aim of this study was to conduct a comprehensive bibliometric analysis of all human and animal studies featuring lipid emulsion as an antidote for the treatment of acute poisoning. The Scopus database search was performed on 5 February 2016 to analyse the research output related to intravenous lipid emulsion as an antidote for the treatment of acute poisoning. Research indicators used for analysis included total number of articles, date (year) of publication, total citations, value of the h-index, document types, countries of publication, journal names, collaboration patterns and institutions. A total of 594 articles were retrieved from Scopus database for the period of 1955-2015. The percentage share of global intravenous lipid emulsion research output showed that research output was 85.86% in 2006-2015 with yearly average growth in this field of 51 articles per year. The USA, United Kingdom (UK), France, Canada, New Zealand, Germany, Australia, China, Turkey and Japan accounted for 449 (75.6%) of all the publications. The total number of citations for all documents was 9,333, with an average of 15.7 citations per document. The h-index of the retrieved documents for lipid emulsion research as antidote for the treatment of acute poisoning was 49. The USA and the UK achieved the highest h-indices, 34 and 14, respectively. New Zealand produced the greatest number of documents with international collaboration (51.9%) followed by Australia (50%) and Canada (41.4%) out of the total number of publications for each country. In summary, we found an increase in the number of publications in the field of lipid emulsion after 2006. The results of this study demonstrate that the majority of publications in the field of lipid emulsion were published by high-income countries. Researchers from institutions in the USA led scientific production on lipid emulsion research. There is an obvious need to promote a deeper engagement through international collaborative research projects and funding mechanisms.

Matched MeSH terms: Acute Disease
A four-point clinical criteria distinguishes immune thrombocytopenia from acute lymphoblastic leukaemia

Lum SH, How SJ, Ariffin H, Krishnan S

Med J Malaysia, 2016 02;71(1):28-9.
PMID: 27130741

Immune thrombocytopenia is the most common diagnosis of isolated thrombocytopenia. The dilemma encountered by paediatricians is missing diagnosis of acute leukaemia in children with isolated thrombocytopenia. We demonstrated childhood ITP could be diagnosed using a four point clinical criteria without missing a diagnosis of acute leukaemia. Hence, bone marrow examination is not necessary in children with typical features compatible with ITP prior to steroid therapy. This can encourage paediatricians to choose steroid therapy, which is cheaper and non-blood product, as first line platelet elevating therapy in children with significant haemorrhage.

Matched MeSH terms: Acute Disease
Fulltext Appendicular mass complicating acute appendicitis in a patient with dengue fever

Low YN, Cheong BM

Med J Malaysia, 2016 04;71(2):83-4.
PMID: 27326951 MyJurnal

Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis.

Matched MeSH terms: Acute Disease
Fulltext Clinical profile of acute flaccid paralysis

Rasul CH, Das PL, Alam S, Ahmed S, Ahmed M

Med J Malaysia, 2002 Mar;57(1):61-5.
PMID: 14569719

This study was done to determine the clinical course, cause and outcome of Acute Flaccid Paralysis (AFP) in children. All AFP cases (< 15 years) in the children's ward of Khulna Medical College Hospital (Bangladesh) were recorded, investigated and followed up to sixty days as a part of passive surveillance. Main outcome variables were vulnerable age group, vaccine status, predominant limb involvement, clinical variants, virus isolation and residual paralysis. Thirty-four children with AFP were admitted in hospital in the last three years with the highest number (14) in 1998. The majority of children belonged to the age group 5-9 years with a male female ratio of 1.3:1. Nearly one third of the cases were either partially vaccinated or not vaccinated at all. The lower limbs bore the brunt of paralysis excepting a few (14.7%). Clinically, Guillain Barre Syndrome was the commonest (47.1%) followed by encephalomyelitis. No poliovirus was isolated from these cases. Residual paralysis was observed in four out of ten cases who returned for follow up. AFP will continue to occur even after eradication of poliomyelitis and Guillain Barre Syndrome is the most important clinical entity for this.

Matched MeSH terms: Acute Disease
Fulltext Deaths following acute diarrhoeal diseases among hospitalised infants in Kuala Lumpur

Lee WS, Ooi TL

Med J Malaysia, 1999 Sep;54(3):303-9.
PMID: 11045055

The risk factors and modes of death following acute diarrhoeal illness in children admitted to University Hospital, Kuala Lumpur between 1982 and 1997 were studied retrospectively. Among 4,689 cases of acute gastroenteritis admitted, ten deaths were noted. The case mortality rate was 2.1/1000 admissions. All deaths were infants below one year, with eight females and two males. Acute renal failure and acute pulmonary oedema were common preceding events. Female sex, infants less than twelve months, the presence of hyper or hyponatraemia and moderate to severe dehydration on admission were risk factors for deaths.

Matched MeSH terms: Acute Disease
Fulltext Pancreatic tuberculosis presenting with recurrent acute pancreatitis

Redha S, Suresh RL, Subramaniam J, Merican I

Med J Malaysia, 2001 Mar;56(1):95-7.
PMID: 11503305

Tuberculosis, in its extrapulmonary form, though emerging as a common clinical problem, rarely affects the pancreas. Its indolent course, vague symptomatology along with its non-specific laboratory and radiographic findings call for greater vigilance. We report a case of pancreatic tuberculosis, previously managed as recurrent alcohol related pancreatitis which showed symptomatic improvement following commencement of antituberculosis drugs. The diagnosis of pancreatic tuberculosis in this case was based on the abdominal CT scan findings, response to anti-tubeculous chemotherapy and overall laboratory and radiological work-up.

Matched MeSH terms: Acute Disease
Acute respiratory infection in Malaysian children

Lye MS, Deavi U, Lai KP, Kaur H, Nair RC, Choo KE

J Trop Pediatr, 1994 Dec;40(6):334-40.
PMID: 7853437

A cross-sectional community-based survey was conducted to determine the prevalence of acute respiratory infection (ARI) in children below 7 years of age and to obtain baseline information for an intervention programme. A total of 6190 households comprising 38,632 persons with 12,273 children (32 per cent) below 7 years of age were surveyed. Information on socio-demographic variables, environmental sanitation, occurrence of ARI and diarrhoea, treatment seeking behaviour during episodes of those illnesses and immunizations among children were obtained. Thirty per cent of children had experienced ARI in the 2-week period prior to the interview, and 94 per cent had mild ARI, 1 per cent had moderate and 5 per cent had severe ARI. There was lack of concurrence between mother's perception of severity and that of the investigators' (Kappa coefficient = 0.083 (95 per cent CI = 0.017-0.149). Twenty-four and 39 per cent of severe and moderate ARI, respectively, were reported by mothers to be mild. There is cause for concern as these children may not receive timely and appropriate treatment. The findings from this study contribute to identification of target populations and priority areas for health education of the population. The survey has provided useful baseline data for the implementation of an intervention programme for the control of ARI in children.

Matched MeSH terms: Acute Disease

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