MyMedR

Myocardial infarction false alarm: initial electrocardiogram and cardiac enzymes

Gupta ED, Sakthiswary R

Asian Cardiovasc Thorac Ann, 2014 May;22(4):397-401.

PMID: 24771726 DOI: 10.1177/0218492313484917

The objectives of this study were to determine the incidence of a myocardial infarction "false alarm" and evaluate the efficacy of the initial electrocardiogram and cardiac enzymes in diagnosing myocardial infarction in Malaysia.

Matched MeSH terms: Diagnosis, Differential

A rare cause of left ventricular outflow tract mass in infancy: Cardiac papillary fibroelastoma

Haranal M, Febrianti Z, Latiff HA, Rahman SA, Sivalingam S

Asian Cardiovasc Thorac Ann, 2021 Oct;29(8):816-818.

PMID: 33641433 DOI: 10.1177/0218492321998500

Primary cardiac tumors are one of the rare causes of intracardiac masses in pediatric population. Cardiac papillary fibroelastomas are benign cardiac tumors with predilection for valvular endocardium, and the presentation is dictated by the cardiac structure involved and the tumor characteristics. We report an infant with cardiac papillary fibroelastoma manifesting as an asymptomatic left ventricular outflow tract mass. This case is being presented to emphasize the rare occurrence of cardiac papillary fibroelastoma in pediatric population and to be cognizant of this entity when considering differential diagnosis of intracardiac masses in this subgroup.

Matched MeSH terms: Diagnosis, Differential

Prospective diagnostic study on the use of narrow-band imaging on suspicious lesions during colonoscopy examination

Yaacob H, Ikhwan SM, Hashim MN, Syed Abd Aziz SH, Wan Zain WZ, Tuan Sharif SE, et al.

Asian J Endosc Surg, 2018 Nov;11(4):318-324.

PMID: 29424061 DOI: 10.1111/ases.12463

INTRODUCTION: Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow-band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non-neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non-neoplastic colorectal lesions.

METHODS: This study enrolled 100 patients in a single-center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano's classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly.

RESULTS: The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver-operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non-disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P

Matched MeSH terms: Diagnosis, Differential

Fulltext Current Updates on Idiopathic Normal Pressure Hydrocephalus

Liew BS, Takagi K, Kato Y, Duvuru S, Thanapal S, Mangaleswaran B

Asian J Neurosurg, 2019 9 10;14(3):648-656.

PMID: 31497081 DOI: 10.4103/ajns.AJNS_14_19

Idiopathic normal pressure hydrocephalus (iNPH) is one of the neurodegenerative diseases which can be treated surgically with favorable outcome. The gait disturbance, cognitive, and urinary symptoms are known as the clinical triad of iNPH. In this review, we have addressed the comorbidities, differential diagnoses, clinical presentations, and pathology of iNPH. We have also summarized the imaging studies and clinical procedures used for the diagnosis of iNPH. The treatment modality, outcomes, and prognosis were also discussed.

Matched MeSH terms: Diagnosis, Differential

Delusional infestation successfully controlled with typical antipsychotic depot injection: An illustrative case report

Jamaluddin R

Asian J Psychiatr, 2018 Jan;31:69-70.

PMID: 29438922 DOI: 10.1016/j.ajp.2018.02.002

Matched MeSH terms: Diagnosis, Differential

A proposed hierarchical fuzzy inference system for the diagnosis of arthritic diseases

Lim CK, Yew KM, Ng KH, Abdullah BJ

Australas Phys Eng Sci Med, 2002 Sep;25(3):144-50.

PMID: 12416592 DOI: 10.1007/BF03178776

Development of computer-based medical inference systems is always confronted with some difficulties. In this paper, difficulties of designing an inference system for the diagnosis of arthritic diseases are described, including variations of disease manifestations under various situations and conditions. Furthermore, the need for a huge knowledge base would result in low efficiency of the inference system. We proposed a hierarchical model of the fuzzy inference system as a possible solution. With such a model, the diagnostic process is divided into two levels. The first level of the diagnosis reduces the scope of diagnosis to be processed by the second level. This will reduce the amount of input and mapping for the whole diagnostic process. Fuzzy relational theory is the core of this system and it is used in both levels to improve the accuracy.

Matched MeSH terms: Diagnosis, Differential

Prognosis of patients who present with an episode of myelopathy of unknown origin in Malaysia: a retrospective study of 52 patients

Tan CT

Aust N Z J Med, 1989 Aug;19(4):297-302.

PMID: 2783084

Fifty-four per cent of 52 patients presenting to the University of Malaya Medical Centre with a myelopathy for which appropriate investigations uncovered no definite etiology, subsequently developed clinically definite or probable multiple sclerosis. In the subgroup of patients with a presentation indicative of acute/subacute transverse myelopathy, 14 or 52% also went on to develop clinically definite or probable multiple sclerosis, a far higher proportion than previously recorded in the literature. This finding is probably a further manifestation of racial difference in the behaviour of multiple sclerosis. For the group as a whole, the only factor which appeared to be associated with an increased risk of developing multiple sclerosis was female sex; 67% of 33 female patients went on to develop multiple sclerosis after a mean follow-up period of 5.5 years. Other factors such as age of onset, racial composition, level of spinal cord involvement, presence of fever and CSF finding were found not to be important.

Matched MeSH terms: Diagnosis, Differential

Dens evaginatus on a wisdom tooth: a diagnostic dilemma. Case report

Ngeow WC, Chai WL

Aust Dent J, 1998 Oct;43(5):328-30.

PMID: 9848984

Pericoronitis is the most common odontogenic problem associated with the wisdom tooth in young men and women. Patients may present with problems associated with infection, swelling and pain. However, other associated pathology such as caries, periodontal disease and referred pain from the temporomandibular joint must be investigated when treating pain from the wisdom tooth. The authors wish to present a case in which the pain from a wisdom tooth was due to a fractured dens evaginatus. The importance of this dental anomaly should not be overlooked.

Matched MeSH terms: Diagnosis, Differential

Fulltext Extensive lip ulcers: a case report. Erythema multiforme

Chean KY

Aust Fam Physician, 2014 Jul;43(7):443-4.

PMID: 25006604

Matched MeSH terms: Diagnosis, Differential

Fulltext Oral hyperpigmented lesions--a case study

Kwa SK, Gupta ED

Aust Fam Physician, 2013 Jul;42(7):490-1.

PMID: 23826603

An overweight woman, aged 58 years, presented for follow up of hypertension, diabetes and dyslipidaemia. She was noted to have hyperpigmented brown macules on the inner surface of the lower lip and buccal mucosa (Figure 1). She stated that she had first noticed these lesions when aged in her 40s. Her mother died at age 58 years from gastric cancer with extensive metastases, and her brother died at age 45 years from colon cancer with spread to the liver and lungs.

Matched MeSH terms: Diagnosis, Differential

Fulltext The eyes have it - A diagnostic challenge

Loh KY, Kew ST

Aust Fam Physician, 2010 Sep;39(9):647-8.

PMID: 20877768

Matched MeSH terms: Diagnosis, Differential

Fulltext A tile factory worker presenting with breathlessness and dry cough

Khajotia R, Gupta ED

Aust Fam Physician, 2009 Oct;38(10):803-4.

PMID: 19893821

Jenny, a nonsmoker, 54 years of age, presents with 3 years of dry cough, progressive breathlessness and reducing exercise tolerance. Two years ago she was diagnosed with asthma and treated with inhaled bronchodilators (which have been marginally effective). Jenny has worked in a tile factory for 22 years; 15 years in the grinding department, transferring to the chipping department 7 years ago. On examination she is tachypnoeic with a prolonged expiratory phase. There are bilateral rhonchi and a few fine crepitations at the left infrascapular region. Jenny's full blood count and electrocardiogram are normal. Arterial blood gas show mild hypoxia with respiratory alkalosis. Spirometry demonstrates mixed moderate obstructive and restrictive impairment. The diffusion capacity for carbon monoxide is reduced. Mantoux is negative and erythrocyte sedimentation rate is 10 mm/hour. A chest X-ray is taken.

Matched MeSH terms: Diagnosis, Differential

Fulltext A man with contracted fingers

Loh KY, Kew ST

Aust Fam Physician, 2008 Mar;37(3):150.

PMID: 18345365

An Indian man from Malaysia presented with contracture of his hands. He is 55 years of age and has a history of chronic alcohol consumption. Examination revealed bilateral thickened structure at the palms.

Matched MeSH terms: Diagnosis, Differential

A fever from the tropics

Gherardin T

Aust Fam Physician, 2000 Mar;29(3):259.

PMID: 10785992

Shirley is a 42 year old woman who has rung you 5 days after returning from a 3 week resort holiday in Malaysia and Thailand. You saw her before her trip and administered a hepatitis A vaccine and advised her that she did not require anti malarial drugs as she was only going to large cities and beach resorts. She says she has had a high fever, headache and body aches for several days and that she feels exhausted, but is well enough to come to the surgery. When you see her later that morning, she looks fairly well, although she is moving rather gingerly. She says she has been resting, is drinking lots of fluids, has some anorexia, but no other significant symptoms. Examination reveals a temperature of 38 degrees C and she has a fine morbilliform rash on her body, limbs and neck. There are no other abnormal findings.

Matched MeSH terms: Diagnosis, Differential

Unilateral diffuse lung opacification in an asymptomatic woman

Khajotia RR, Raman S

Aust Fam Physician, 2017 Nov;46(11):845-846.

PMID: 29101921

Matched MeSH terms: Diagnosis, Differential

Fulltext A comparative study of the SVM and K-nn machine learning algorithms for the diagnosis of respiratory pathologies using pulmonary acoustic signals

Palaniappan R, Sundaraj K, Sundaraj S

BMC Bioinformatics, 2014;15:223.

PMID: 24970564 DOI: 10.1186/1471-2105-15-223

Pulmonary acoustic parameters extracted from recorded respiratory sounds provide valuable information for the detection of respiratory pathologies. The automated analysis of pulmonary acoustic signals can serve as a differential diagnosis tool for medical professionals, a learning tool for medical students, and a self-management tool for patients. In this context, we intend to evaluate and compare the performance of the support vector machine (SVM) and K-nearest neighbour (K-nn) classifiers in diagnosis respiratory pathologies using respiratory sounds from R.A.L.E database.

Matched MeSH terms: Diagnosis, Differential

Fulltext Non-traumatic splenic rupture - a rare first presentation of diffuse large B-cell lymphoma and a review of the literature

Kaniappan K, Lim CTS, Chin PW

BMC Cancer, 2018 Aug 02;18(1):779.

PMID: 30068299 DOI: 10.1186/s12885-018-4702-1

BACKGROUND: Cases of non-traumatic splenic rupture are rare and entails a potentially grave medical outcome. Hence, it is important to consider the differential diagnosis of a non-traumatic splenic rupture in patients with acute or insidious abdominal pain. The incidence of rupture in Diffuse B-cell non-Hodgkin Lymphoma is highly infrequent (Paulvannan and Pye, Int J Clin Pract 57:245-6, 2003; Gedik et el., World J Gastroenterol 14:6711-6716, 2008), despite reports of various non-traumatic splenic rupture in the literature (Orloff and Peksin, Int Abstr Surg 106:1-11, 1958; Paulvannan and Pye, Int J Clin Pract 57:245-6, 2003). In this article, we attempt to highlight the features of a rare cause of splenic rupture that might serve as a future reference point for the detection of similar cases during routine clinical practice.

CASE PRESENTATION: A 40-year-old man presented with 1 week history of left hypochondriac pain associated with abdominal distention. There was no history of preceding trauma or fever. Clinical examination revealed signs of tachycardia, pallor and splenomegaly. He had no evidence of peripheral stigmata of chronic liver disease. In addition, haematological investigation showed anemia with leucocytosis and raised levels of lactate dehydrogenase enzyme. However, peripheral blood film revealed no evidence of any blast or atypical cells. In view of these findings, imaging via ultrasound and computed tomography of the abdomen was performed. The results of these imaging tests showed splenic collections that was suggestive of splenic rupture and hematoma. Patient underwent emergency splenectomy and the histopathological report confirmed the diagnosis as DLBCL.

CONCLUSIONS: The occurrence of true spontaneous splenic rupture is uncommon. In a recent systematic review of 613 cases of splenic rupture, only 84 cases were secondary to hematological malignancy. Acute leukemia and non-Hodgkin lymphoma were the most frequent causes of splenic rupture, followed by chronic and acute myelogeneous leukemias. At present, only a few cases of diffuse large B-cell lymphoma (DLBCL) have been reported. The morbidity and mortality rate is greatly increased when there is a delay in the diagnosis and intervention of splenic rupture cases. Hence, there should be an increased awareness amongst both physicians and surgeons that a non-traumatic splenic rupture could be the first clinical presentation of a DLBCL.

Matched MeSH terms: Diagnosis, Differential

Fulltext Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries

Jaenisch T, Tam DT, Kieu NT, Van Ngoc T, Nam NT, Van Kinh N, et al.

BMC Infect Dis, 2016 Mar 11;16:120.

PMID: 26968374 DOI: 10.1186/s12879-016-1440-3

The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year. Although most dengue infections are asymptomatic, patients can present with a wide spectrum of clinical symptoms ranging from mild febrile illness through to severe manifestations of bleeding, organ impairment, and hypovolaemic shock due to a systemic vascular leak syndrome. Clinical diagnosis of dengue and identification of which patients are likely to develop severe disease remain challenging. This study aims to improve diagnosis and clinical management through approaches designed a) to differentiate between dengue and other common febrile illness within 72 h of fever onset, and b) among patients with dengue to identify markers that are predictive of the likelihood of evolving to a more severe disease course.

Matched MeSH terms: Diagnosis, Differential

Fulltext Investing in the use of a checklist during differential diagnoses consideration: what's the trade-off?

Chew KS, van Merrienboer JJG, Durning SJ

BMC Med Educ, 2017 Nov 29;17(1):234.

PMID: 29187172 DOI: 10.1186/s12909-017-1078-x

BACKGROUND: A key challenge clinicians face when considering differential diagnoses is whether the patient data have been adequately collected. Insufficient data may inadvertently lead to premature closure of the diagnostic process. This study aimed to test the hypothesis that the application of a mnemonic checklist helps to stimulate more patient data collection, thus leading to better diagnostic consideration.

METHODS: A total of 88 final year medical students were assigned to either an educational intervention group or a control group in a non-equivalent group post-test only design. Participants in the intervention group received a tutorial on the use of a mnemonic checklist aimed to minimize cognitive errors in clinical decision-making. Two weeks later, the participants in both groups were given a script concordance test consisting of 10 cases, with 3 items per case, to assess their clinical decisions when additional data are given in the case scenarios.

RESULTS: The Mann-Whitney U-test performed on the total scores from both groups showed no statistical significance (U = 792, z = -1.408, p = 0.159). When comparisons were made for the first half and the second half of the SCT, it was found that participants in the intervention group performed significantly better than participants in the control group in the first half of the test, with median scores of 9.15 (IQR 8.00-10.28) vs. 8.18 (IQR 7.16-9.24) respectively, U = 642.5, z = -2.661, p = 0.008. No significant difference was found in the second half of the test, with the median score of 9.58 (IQR 8.90-10.56) vs. 9.81 (IQR 8.83-11.12) for the intervention group and control group respectively (U = 897.5, z = -0.524, p = 0.60).

CONCLUSION: Checklist use in differential diagnoses consideration did show some benefit. However, this benefit seems to have been traded off by the time and effort in using it. More research is needed to determine whether this benefit could be translated into clinical practice after repetitive use.

Matched MeSH terms: Diagnosis, Differential

Antibodies against prM protein distinguish between previous infection with dengue and Japanese encephalitis viruses

Cardosa MJ, Wang SM, Sum MS, Tio PH

BMC Microbiol, 2002 May 5;2:9.

PMID: 12019028

In Southeast Asia, dengue viruses often co-circulate with other flaviviruses such as Japanese encephalitis virus, and due to the presence of shared antigenic epitopes it is often difficult to use serological methods to distinguish between previous infections by these flaviviruses.

Matched MeSH terms: Diagnosis, Differential

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