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Fulltext Diagnostic challenge in silent metastatic invasive breast carcinoma: dysphagia as the only symptom

Alfian Sulai DD, Krishnasamy T, Nik Mahmood NRK

BMJ Case Rep, 2021 Jul 21;14(7).
PMID: 34290001 DOI: 10.1136/bcr-2020-239997

Metastatic cancer to the oesophagus is rare. Most cases are diagnosed at autopsy or surgery. The breast is the most common organ bearing a primary tumour. Metastatic oesophageal tumours are nearly always located in the submucosal layer with normal benign-looking mucosa, rendering tissue diagnosis difficult. In the absence of breast-related symptoms, the diagnosis of oesophageal metastasis from breast primary would be very challenging. We report a case of a 50 year-old woman, who was referred to our centre for a second opinion after she was offered an esophagectomy for a suspected oesophageal carcinoma. She presented solely with dysphagia and weight loss. Multiple investigations were performed to investigate her dysphagia which eventually led to the diagnosis of metastatic breast cancer with oesophageal involvement. She underwent excision of right breast invasive lobular carcinoma with axillary dissection. She completed her adjuvant chemoradiotherapy and currently on daily dose of tamoxifen, whereby her dysphagia has dramatically improved.

Matched MeSH terms: Middle Aged
Mindful breathing for suffering

Tung YZ, Tan SB

BMJ Support Palliat Care, 2023 Jun;13(2):241-242.
PMID: 32581002 DOI: 10.1136/bmjspcare-2020-002373

We present a case of a 64-year-old woman with stage 1 breast cancer. She underwent a modified radical mastectomy, followed by chemotherapy. She reported physical and psychosocial suffering due to her disease and treatment. Four weekly sessions of guided 30-min mindful breathing were delivered by the palliative care team to ease her suffering. The patient reported feelings of calmness, peace and relaxation after each session, with decrease in suffering, negative emotions and physical discomfort. This is the first report on the use of guided 30-min mindful breathing in palliating suffering of a patient with cancer.

Matched MeSH terms: Middle Aged
Fulltext Constructing causal pathways for premature cardiovascular disease mortality using directed acyclic graphs with integrating evidence synthesis and expert knowledge

Hasani WSR, Musa KI, Chen XW, Cheng KY

Sci Rep, 2024 Nov 21;14(1):28849.
PMID: 39572630 DOI: 10.1038/s41598-024-80091-0

Cardiovascular disease (CVD) is a major global cause of premature mortality. While multiple studies propose CVD mortality prediction models based on regression frameworks, incorporating causal understanding through causal inference approaches can enhance accuracy. This paper demonstrates a methodology combining evidence synthesis and expert knowledge to construct a causal model for premature CVD mortality using Directed Acyclic Graphs (DAGs). The process involves three phases: (1) initial DAG development based on the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAGs) framework, (2) validation and consensus-building with 12 experts using the Fuzzy Delphi method (FDM), and (3) application to data analysis using population-based survey data linked with death records. Expert input refined the initial DAG model, achieving consensus on 45 causal paths. The revised model guided selection of confounding variables for adjustment. For example, to estimate the total effect of diabetes on premature CVD mortality, the suggested adjustment set included age, dietary pattern, genetic/family history, sex hormones, and physical activity. Testing different DAG models showed agreement between expert ratings and data accuracy from regression models. This systematic approach contributes to DAG methodology, offering a transparent process for constructing causal pathways for premature CVD mortality.

Matched MeSH terms: Middle Aged
Older people's experiences of participation in mindfulness-based intervention programmes: A qualitative systematic review

Hmwe NTT, Chan CM, Shayamalie TGN

Int J Ment Health Nurs, 2024 Oct;33(5):1272-1288.
PMID: 38717012 DOI: 10.1111/inm.13350

This systematic review aimed to synthesise the qualitative evidence of mindfulness-based interventions and focused on the perceptions and experience of older people. A literature search was conducted using electronic databases including CINAHL, EMBASE, EMCare, and MEDLINE. The inclusion criteria for the review were an original study that includes qualitative data on experience and perceptions of mindfulness interventions, a study population involving older people aged 60 years and above, and articles published in English. Eleven articles are included in this review. Four major descriptive themes were generated from the data synthesis: benefits on physical health, improved psychosocial well-being, development of new perspectives, and motivators and challenges of mindfulness practice. Mindfulness practice provided health benefits for pain management, promoting sleep quality, psychosocial well-being, and development of positive strategies such as a new way of coping in negative situations, acceptance, and a sense of freedom. Health benefits and positive reinforcement were reported as motivators, whereas time commitment and an easily distracted mind were barriers to continued mindfulness practice. In addition to the descriptive themes, two analytical themes were derived: inner peace and well-being through mindfulness and development of acceptance-based coping. The positive outcomes indicated in this review suggest that mindfulness-based interventions could be an effective therapeutic tool for the well-being of older people.

Matched MeSH terms: Middle Aged
A Case of Neglected, Recurrent Adenoid Cystic Carcinoma of Parotid Gland

Low A, Kadir AJ, Wong KT, Choo MM

Ophthalmic Plast Reconstr Surg, 2021 4 3;37(5):e193.
PMID: 33795606 DOI: 10.1097/IOP.0000000000001947
Matched MeSH terms: Middle Aged
Relations between clinical characteristics and cognitive deficits among adult patients diagnosed with major depressive disorder

Subhas N, Ang JK, Tan KA, Ahmad SNA

Int J Psychiatry Clin Pract, 2023 Sep;27(3):219-231.
PMID: 36448673 DOI: 10.1080/13651501.2022.2149415

OBJECTIVE: The present study examined the relations between clinical characteristics and cognitive deficits in adult patients with major depressive disorder (MDD) from a local outpatient psychiatric clinic in Malaysia.
METHODS: The present sample included 110 participants aged 20-60 years old. Participants were invited to provide their information on sociodemographic variables (age, gender, and educational level) and clinical characteristics (age at onset of depression and duration of illness) and to complete a series of cognitive performance measures including the Trail Making Tests A (psychomotor speed) and B (executive function), the Digit Symbol Substitution Test (attention), and the Auditory Verbal Learning Test (immediate free recall, acquisition phase, and delayed recall). The Mini International Neuropsychiatric Interview Version 6.0 was used to confirm the diagnosis of MDD and the Montgomery-Åsberg Depression Rating Scale was used to assess illness severity.
RESULTS: At the bivariate level, relations of age and educational level to all cognitive deficit domains were significant. At the multivariate level, only educational level and illness severity consistently and significantly predicted all cognitive deficits domains.
CONCLUSIONS: Therapeutic modalities should be individualised whilst considering the impacts of cognitive deficits in an attempt to prevent further deterioration in psychosocial functioning of MDD patients.KEY POINTSCognitive deficits are an elemental component of Major Depressive Disorder (MDD) persisting during a current major depressive episode or during remission, altering individuals' ability to process information and changes the way they perceive and interact with the environment.Cognitive deficits in MDD are evident among the upper-middle income groups in South-Eastern Asian countries warranting more local research as such deficits could lead to functional decline and work performance such as absenteeism and presenteeism.Therapeutic modalities should be individualised by taking the impacts of cognitive deficits into consideration to promote psychosocial functioning of MDD patients.

Matched MeSH terms: Middle Aged
A Case Report of Guillain-Barré Syndrome In Association with SARS-CoV-2 Vaccination in Malaysia

Sii HL, Ng SH, Wong VF, Law WC

Acta Neurol Taiwan, 2023 Dec 30;32(4):207-211.
PMID: 37723913

PURPOSE: Guillain-Barré Syndrome (GBS) associated with SARS-CoV-2 vaccine administration is very rare. Early recognition of GBS at early stage could prevent extensive nerve damage with potential respiratory and autonomic failure.
CASE REPORT: We report a case of paraparetic spectrum of GBS in a 53-year-old lady who presented with rapidly progressive acute flaccid paralysis involving both lower extremities with areflexia eight days after the first dose of Sinovac vaccine for SARS-CoV-2 in Malaysia. Cerebrospinal fluid (CSF) albuminocytological dissociation was seen and nerve conduction study (NCS) revealed sensory neuropathy. The diagnosis of GBS was made based on the Brighton criteria. Patient responded well to intravenous immunoglobulin (IVIG).
CONCLUSION: Though there is currently no convincing evidence of any causation between GBS and SARS- CoV-2 vaccination, clinicians should remain vigilant and consider GBS in the differential diagnosis for patient who presents with weakness with reduced or absent deep tendon reflex after vaccination against SARS-CoV-2.

Matched MeSH terms: Middle Aged
Fulltext Recurrent Temporal Infections: The Link to Systemic Lupus Erythematosus

Shuhardi SA, Mohamed Said MS, Kew TY, Ramli R

Am J Case Rep, 2023 Dec 29;24:e942163.
PMID: 38155491 DOI: 10.12659/AJCR.942163

BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse manifestations. The involvement of the musculoskeletal system is very common, and infection is one of the manifestations, which can involve any part of the body. We report a case of a middle-aged woman with recurrent episodes of infection of her left temple. CASE REPORT A 51-year old woman was referred to our clinic following failures to eradicate infection on her left temple for 9 months. Examination revealed facial asymmetry, with diffuse non-tender swelling involving her left temple area, which extended to her cheek. Computed tomography and magnetic resonance imaging (MRI) showed a periosteal reaction of the zygomatic bone. Left temporalis muscle thickening and residual osteomyelitis of the zygomatic bone were also shown by MRI. In view of the unresolved infection with incision and drainage and antibiotics, further blood investigations led to the discovery of SLE. The antinuclear antibody and anti-double-stranded DNA were positive. In addition, low nephelometry markers, C3 (26.7 mg/dL) and C4 (8.24 mg/dL), were observed. This patient was treated with 200 mg of oral hydrochloroquine once daily and 5 mg of oral prednisolone once daily. After 6 months of treatment, the infection subsided, and the structures involved showed remarkable healing. The patient is still taking the same dose and frequency of both drugs at the present time. CONCLUSIONS Temporalis pyomyositis and osteomyelitis of the zygomatic bone could be manifestation of SLE disease; however, the involvement of infection cannot be ruled out.

Matched MeSH terms: Middle Aged
Fulltext Establishing associated risk factors, including fungal and parasitic infections among Malaysians living with schizophrenia

Franklin F, Rajamanikam A, Phang WK, Raju CS, Gill JS, Francis B, et al.

Sci Rep, 2024 Jan 03;14(1):385.
PMID: 38172146 DOI: 10.1038/s41598-023-50299-7

The aetiology of schizophrenia is multifactorial, and the identification of its risk factors are scarce and highly variable. A cross-sectional study was conducted to investigate the risk factors associated with schizophrenia among Malaysian sub-population. A total of 120 individuals diagnosed with schizophrenia (SZ) and 180 non-schizophrenic (NS) individuals participated in a questionnaire-based survey. Data of complete questionnaire responses obtained from 91 SZ and 120 NS participants were used in statistical analyses. Stool samples were obtained from the participants and screened for gut parasites and fungi using conventional polymerase chain reaction (PCR). The median age were 46 years (interquartile range (IQR) 37 to 60 years) and 35 years (IQR 24 to 47.75 years) for SZ and NS respectively. Multivariable binary logistic regression showed that the factors associated with increased risk of SZ were age, sex, unemployment, presence of other chronic ailment, smoking, and high dairy consumption per week. These factors, except sex, were positively associated with the severity of SZ. Breastfed at infancy as well as vitamin and supplement consumption showed a protective effect against SZ. After data clean-up, fungal or parasitic infections were found in 98% (39/42). of SZ participants and 6.1% (3/49) of NS participants. Our findings identified non-modifiable risk factors (age and sex) and modifiable lifestyle-related risk factors (unemployment, presence of other chronic ailment, smoking, and high dairy consumption per week) associated with SZ and implicate the need for medical attention in preventing fungal and parasitic infections in SZ.

Matched MeSH terms: Middle Aged
Fulltext Ruptured Liver Abscess Post Severe COVID-19 Infection: A Case Report

Isa MFM, Ghazi FN, Merican SRHI, Zulkifli AZ, Singh P

Prague Med Rep, 2024;125(3):273-278.
PMID: 39171554 DOI: 10.14712/23362936.2024.25

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) caused imminent acute infection of respiratory tract known as Coronavirus disease 2019 (COVID-19). Complications of hepatobiliary system especially liver often found in post-acute COVID-19 patients. However, there are only few studies specifically discussing about liver abscess in patients who had history of contracted COVID-19. We present a case of a 54-years-old gentleman with no previous medical illness and no history of vaccination, who was presented with ruptured liver abscess post COVID-19 infection Category 4 (symptomatic with lung infection and the need of oxygen supplementation). Percutaneous drainage was performed to drain the abscess and collections.

Matched MeSH terms: Middle Aged
Sequential SAFE Score and Transient Elastography for Detecting Significant Fibrosis in Asian Patients with MASLD

Kaewdech A, Sripongpun P, Treeprasertsuk S, Charatcharoenwitthaya P, Chan WK, GO ASIA Study Group, et al.

Clin Gastroenterol Hepatol, 2024 Dec;22(12):2535-2537.
PMID: 38880124 DOI: 10.1016/j.cgh.2024.06.003

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD),1 represents a global public health issue. Fibrosis stage is the most important risk for long-term undesirable outcomes.2,3 From recent meta-analyses, all-cause and liver-related mortalities significantly increased from fibrosis stage 2 (significant fibrosis; F≥2) onward.4,5 In primary care setting, those with F≥2 should be referred to hepatologists; therefore, noninvasive tests to stratify risk of patients with MASLD are crucial. Steatosis-associated fibrosis estimator (SAFE) was recently developed to predict F≥2.6 SAFE has been externally validated and outperformed fibrosis-4 (FIB-4) and NAFLD fibrosis score (NFS).7,8 Recently, international guidelines proposed sequential diagnostic steps, initially using FIB-4 and then transient elastography (TE) in non-low-risk patients.9,10 However, the guidelines focused on identifying advanced fibrosis (F≥3), which might be too late. This study aimed to compare the performance among SAFE, FIB-4, and NFS, and evaluate SAFE-TE sequential approach. We hypothesized that by initially using SAFE, the proportion of patients misclassified as low risk despite already having F≥2 could be diminished.

Matched MeSH terms: Middle Aged
Fulltext Parkinson's disease screening using a fusion of gait point cloud and silhouette features

Connie T, Aderinola TB, Ong JY, Ong TS, Goh MKO, Erfianto B, et al.

PLoS One, 2025;20(1):e0315453.
PMID: 39752461 DOI: 10.1371/journal.pone.0315453

Parkinson's Disease (PD) is a neurodegenerative disorder that is often accompanied by slowness of movement (bradykinesia) or gradual reduction in the frequency and amplitude of repetitive movement (hypokinesia). There is currently no cure for PD, but early detection and treatment can slow down its progression and lead to better treatment outcomes. Vision-based approaches have been proposed for the early detection of PD using gait. Gait can be captured using appearance-based or model-based approaches. Although appearance-based gait contains comprehensive features, it is easily affected by factors such as dressing. On the other hand, model-based gait is robust against changes in dressing and external contours, but it is often too sparse to contain sufficient information. Therefore, we propose a fusion of appearance-based and model-based gait features for PD prediction. First, we extracted keypoint coordinates from gait captured in videos and modeled these keypoints as a point cloud. The silhouette images are also segmented from the videos to obtain an overall appearance representation of the subject. We then perform a binary classification of gait as normal or Parkinsonian using a novel fusion of the gait point cloud and silhouette features, obtaining AUC up to 0.87 and F1-Scores up to 0.82 (precision: 0.85, recall: 0.80).

Matched MeSH terms: Middle Aged
Fulltext Intervention accelerator to prevent and respond to abuse of older people: insights from key promising interventions

Campo-Tena L, Farzana A, Burnes D, Chan TA, Choo WY, Couture M, et al.

Lancet Healthy Longev, 2024 Dec;5(12):100647.
PMID: 39681125 DOI: 10.1016/j.lanhl.2024.100647

Globally, abuse of older people (AOP) affects one in six individuals aged 60 years and older every year. Despite the widespread prevalence of AOP, evidence-based interventions for preventing and responding to this issue are insufficient. To address this gap, WHO proposed an initiative to accelerate the development of effective interventions for AOP across all country income levels. In the first phase, the initiative identified 89 promising interventions across a total of 101 evaluations or descriptions, which led to the creation of a public database. Most interventions targeted physical, psychological, and financial abuse and neglect, were implemented in the USA, and focused on victims or potential victims. These interventions were primarily delivered by social workers and nurses, usually in health-care facilities and community centres. Face-to-face delivery was common. Additionally, 28 (28%) of the 101 evaluations used randomised controlled trial designs. The results of this Review can be used to identify interventions that are ready for a rigorous outcome evaluation.

Matched MeSH terms: Middle Aged
Fulltext Metallic foreign body penetrating the carotid sheath: a case report

Vamanshankar H, Nair AB, Rajan N

Malays J Med Sci, 2011 Jan;18(1):72-5.
PMID: 22135577

Foreign bodies are a common problem seen in otolaryngological practice. Of the reported foreign bodies, metallic foreign bodies are a rare entity. One of the least common complications of foreign body ingestion is penetration and migration. We describe a case of a migrating metallic foreign body in a 50-year-old woman with a history of accidental ingestion causing odynophagia. In the present case, the foreign body migrated extraluminally into the carotid sheath. Our review of literature revealed that few such cases have been reported.

Matched MeSH terms: Middle Aged
Age-related features of the pattern of oral fluid patients with non-alcoholic fatty liver disease

Emelyanova N, Emelyanov D

Folia Med (Plovdiv), 2024 Dec 31;66(6):834-841.
PMID: 39774354 DOI: 10.3897/folmed.66.e137447

In recent years, non-invasive screening methods for diagnosing various human conditions, including those corresponding to biological age, have attracted great interest, one of the sources for non-invasive research of which is oral fluid.

Matched MeSH terms: Middle Aged
Right Iliac Fossa Pain

Abu Hassan H, Suppiah S

Ann Acad Med Singap, 2016 Dec;45(12):567-568.
PMID: 28062887
Matched MeSH terms: Middle Aged
Fulltext CD8+ T-Cell Signatures as Prognostic and Immunotherapy Response Predictors in Non-Small Cell Lung Cancer

Zhao T, Dhillon SK

Folia Biol (Praha), 2024;70(4):196-208.
PMID: 39692574 DOI: 10.14712/fb2024070040196

Non-small cell lung carcinoma (NSCLC) represents the majority of lung cancer cases, comprising approximately 85 % of the total. The five-year survival rate for NSCLC patients remains discouragingly low. Recently, immunotherapy has emerged as a promising approach. Nevertheless, only a minority of patients experience considerable benefits from these treatments. This highlights the critical need for effective biomarkers that can predict both patient prognosis and response to immunotherapy. CD8+ T cells play a crucial role in cancer immunotherapy. Their presence within tumours is generally indicative of a favourable prognosis and increased efficacy of immunotherapy. This study was undertaken to identify and authenticate a novel biomarker signature based on CD8+ T-cell marker genes, to prognosticate therapeutic responses in individuals afflicted with NSCLC. This in-depth study was based on a total of 1,200 samples, which included four NSCLC specimens analysed through single-cell RNA sequencing (scRNA-seq), 1,000 NSCLC samples obtained from The Cancer Genome Atlas (TCGA) and 196 NSCLC specimens collected from the GSE37745 cohort. In patients with NSCLC, those presenting a favourable risk profile demonstrated notable elevations in specific immune cells while concurrently exhibiting reductions in other types. CD8+ T cells, with their established role in inducing apoptosis in cancer cells, have emerged as crucial predictors and modulators of treatment strategies for NSCLC patients. The combination of single-cell and bulk RNA sequencing has produced a biomarker signature, emphasizing the CD8+ T cells' crucial role in NSCLC prognosis and treatment.

Matched MeSH terms: Middle Aged
Fulltext More marginalization, less career development? Linking marginalization profiles to decent work among rural teachers

Wang J, Chang B

Acta Psychol (Amst), 2025 Feb;252:104668.
PMID: 39674078 DOI: 10.1016/j.actpsy.2024.104668

Using Latent Profile Analysis, this study explored the connections between different marginalization profiles and perceptions of decent work among rural primary school teachers in China. Analyzing data from 443 teachers across seven rural primary schools in Fujian Province, we discerned three unique marginalization profiles: Robust Adapters (n = 182, 41 %), Challenge Facers (n = 210, 47 %), and Conditioned Survivors (n = 51, 12 %). These profiles were examined for their links to decent work dimensions. Findings indicated that the Robust Adapters significantly outperformed both the Challenge Facers and Conditioned Survivors across all five dimensions of decent work. In contrast, there were no significant differences between the performances of the Challenge Facers and Conditioned Survivors in these dimensions, which indicated that more marginalization was not inevitably linked to less decent work. The study concluded by discussing the implications of these findings and the directions of future research.

Matched MeSH terms: Middle Aged
Fulltext Total thyroidectomy: the procedure of choice for toxic goitre

Hussain M, Hisham AN

Asian J Surg, 2008 Apr;31(2):59-62.
PMID: 18490216 DOI: 10.1016/S1015-9584(08)60059-7

Over the years, subtotal thyroidectomy has been the mainstay of treatment for toxic goitre; however, total thyroidectomy is increasingly being considered as the procedure of choice. This study aimed to review our experience with total thyroidectomy in toxic goitre and evaluate the outcome of this procedure.

Matched MeSH terms: Middle Aged
Uncommon radiological findings: a case report

Tandjung YR, Hong CP, Nambiar P, Ibrahim N

Int Dent J, 2007 Jun;57(3):173-6.
PMID: 17695738

A 50-year-old friendly and attractive Chinese lady was examined by the Primary Care Unit, Faculty of Dentistry, University of Malaya. Her requests for treatment included implants and crowns. Two periapical radiographs of teeth 16 and 48 were taken to aid diagnosis. Interestingly, pin-like radio-opaque objects were found over the crown of the impacted tooth 15 and also tooth 17. These objects were initially interpreted as silver points or radiographic artifacts but further investigation employing panoramic radiography revealed the distribution of more radio-opaque objects in the orofacial region. Based on a review of the literature and the opinion of experienced radiology and oral surgery lecturers, these foreign radio-opaque objects were diagnosed as susuks or charm needles.

Matched MeSH terms: Middle Aged

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