Displaying publications 161 - 180 of 808 in total

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  1. Fulltext Renal-limited AL amyloidosis - a diagnostic and management dilemma
    Fuah KW, Lim CTS
    BMC Nephrol, 2018 11 06;19(1):307.
    PMID: 30400895 DOI: 10.1186/s12882-018-1118-8
    BACKGROUND: Amyloidosis is a disorder caused by extracellular tissue deposition of insoluble fibrils which may result in a wide spectrum of symptoms depending upon their types, sites and amount of deposition. Amyloidosis can be divided into either systemic or localized disease.

    CASE PRESENTATION: We present a case of a middle-aged gentleman who presented with persistent nephrotic syndrome with worsening renal function. Repeated renal biopsies showed the presence of renal-limited AL amyloidosis. Systemic amyloidosis workup was unremarkable apart from a slightly raised band of IgG lambda level with no associated immunoparesis. The nephrotic syndrome and renal histology did not improve over a 3-year period despite being given two courses of chemotherapies.

    CONCLUSION: We hope that early recognition of this unusual localised presentation of renal- limited AL Amyloidosis and its poor response to conventional treatment can alert the nephrologist to the potential existence of this rare condition.

    Matched MeSH terms: Diagnosis, Differential
  2. Relapsed non-Hodgkin's lymphoma with high CA-125 mimicking ovarian tumour
    Leong CF, Cheong SK, Ng P, Amran AR
    Hosp Med, 2003 Nov;64(11):686-7.
    PMID: 14671884
    Matched MeSH terms: Diagnosis, Differential
  3. Relapsed lymphoma mimicking venous ulcer: A case report
    Kamal WSA, Affandi AM, Bhullar A, Kamal WSZ
    Med J Malaysia, 2018 08;73(4):253-254.
    PMID: 30121690 MyJurnal
    Lymphoma presenting with ulceration is not typical. We report a case of relapsed DLBCL in a 73-year-old man presenting with a chronic non-healing leg ulcer. He has underlying varicose veins with recurrent venous ulcers. This patient was diagnosed to have DLBCL six years earlier when he presented with recurrent epistaxis originating from a left nasal cavity nodule. Complete resolution was achieved after eight cycles of R-CHOP and intrathecal methotrexate. For this current problem, this patient was treated with rituximab combined with chemotherapy which resulted in healing of the ulcer.
    Matched MeSH terms: Diagnosis, Differential
  4. Relapse of B-cell acute lymphoblastic leukaemia presenting as right aural polyp with facial and mandibular nerves palsy
    Shiun Chuen C, Md Daud MK, Che Jalil NA, Hazmi H
    Med J Malaysia, 2017 10;72(5):318-320.
    PMID: 29197892 MyJurnal
    A patient presenting with an ear polyp is a common finding in otorhinolaryngology practice. The common causes include chronic otitis media and cholesteatoma. We report an adult female patient with a history of acute leukaemia presenting with chronic otitis media symptoms and right ear polyp. She was subsequently diagnosed as relapse of B-cell acute lymphoblastic leukaemia based on histopathological examination. The presentation may be similar to an inflammatory pathology of the middle ear, making it misleading.
    Matched MeSH terms: Diagnosis, Differential
  5. Reexamination of risk criteria in dengue patients using the self-organizing map
    Faisal T, Taib MN, Ibrahim F
    Med Biol Eng Comput, 2010 Mar;48(3):293-301.
    PMID: 20016950 DOI: 10.1007/s11517-009-0561-x
    Even though the World Health Organization criteria's for classifying the dengue infection have been used for long time, recent studies declare that several difficulties have been faced by the clinicians to apply these criteria. Accordingly, many studies have proposed modified criteria to identify the risk in dengue patients based on statistical analysis techniques. None of these studies utilized the powerfulness of the self-organized map (SOM) in visualizing, understanding, and exploring the complexity in multivariable data. Therefore, this study utilized the clustering of the SOM technique to identify the risk criteria in 195 dengue patients. The new risk criteria were defined as: platelet count less than or equal 40,000 cells per mm(3), hematocrit concentration great than or equal 25% and aspartate aminotransferase (AST) rose by fivefold the normal upper limit for AST/alanine aminotransfansferase (ALT) rose by fivefold the normal upper limit for ALT. The clusters analysis indicated that any dengue patient fulfills any two of the risk criteria is consider as high risk dengue patient.
    Matched MeSH terms: Diagnosis, Differential
  6. Fulltext Recurrent vomiting in a woman due to miscarriage: think out of the box
    Khalid S, Aris MS
    BMJ Case Rep, 2016 Mar 30;2016.
    PMID: 27030452 DOI: 10.1136/bcr-2015-213165
    A 25-year-old gravida 2 para 1 with 12-week amenorrhoea presented a second time for recurrent vomiting in pregnancy. She was diagnosed to have a missed miscarriage following absent fetal heart seen in an early scan. She opted for conservative management. However, on the third presentation, her vomiting continued. Repeated transvaginal ultrasound scan showed a fetus with a crown rump length of 19 mm, which is equivalent to 8 weeks and 4 days, with absence of fetal heart pulsation. Thyroid function tests and β human chorionic gonadotropin were then requested. Results showed that the patient's serum β human chorionic gonadotropin level was markedly raised to 147,000. A molar pregnancy was suspected. Her thyroid function tests came back normal. Suction curettage was performed and histopathology confirmed a partial molar pregnancy. On follow-up, the β human chorionic gonadotropin level was normal by 7 weeks after the curettage.
    Matched MeSH terms: Diagnosis, Differential
  7. Fulltext Recurrent lung cavities and endobronchial nodules in an adolescent male
    Fauzi MA, Fadilah SA, Bahariah K
    Med J Malaysia, 2007 Mar;62(1):66-7.
    PMID: 17682575 MyJurnal
    Multiple lung cavitations and endobronchial nodules are rare presentations of newly diagnosed and recurrent Hodgkin's disease. The clinical and radiological features can be confused with pulmonary tuberculosis, which can be difficult to exclude in endemic areas. However, the presence of endobronchial nodules point, towards Hodgkin's disease. Differential diagnosis is aided by the fact that these lesions usually respond promptly to specific therapy. We present a case of an adolescent male who had constitutional and pulmonary symptoms associated with pulmonary cavities and endobronchial nodules subsequently confirmed to be Hodgkin's disease.
    Matched MeSH terms: Diagnosis, Differential
  8. Recognition of pernicious syndromes in malaria infections
    Sidhu PS, Ng SC
    Ann Acad Med Singap, 1991 May;20(3):324-7.
    PMID: 1929172
    The case records of 64 patients with malaria over a five year period admitted to the University Hospital, Kuala Lumpur were examined. There were 32 cases of P. falciparum, 26 cases of P. vivax and two cases of mixed infections. Four cases of P. malariae were recorded. The clinical findings, biochemical and haematological parameters were examined for any indication of a pernicious syndrome. A high index of suspicion of a malarial infection may be based on the findings of anaemia, thrombocytopaenia, hyponatraemia, renal failure and abnormal liver function tests in the face of a negative blood film. These pernicious syndromes occur more often in malignant tertian malaria (anaemia 50%, hyponatraemia 39.1%) but a high percentage of the other malarial species show these abnormalities (P. vivax anaemia 57.7%, hyponatraemia 19.2%). When these abnormalities are present but blood films for malaria parasites are negative, repeat blood films are warranted until a parasitological diagnosis is achieved and correct treatment may be started.
    Matched MeSH terms: Diagnosis, Differential
  9. Fulltext Rare left-sided presentation of internal jugular vein ectasia in an adult
    Cheah SC, Wong HT, Lau CY
    Ann Saudi Med, 2018 10 5;38(5):381-382.
    PMID: 30284994 DOI: 10.5144/0256.4947.2018.381
    Matched MeSH terms: Diagnosis, Differential
  10. Rare case of huge retroperitoneal liposarcoma presenting as a gynaecological problem
    Kuppuvelumani P, Rachagan SP, Syed N, Kumar G, Cheah PL
    Eur J Obstet Gynecol Reprod Biol, 1993 Mar;48(3):220-2.
    PMID: 8335141
    A large retroperitoneal liposarcoma presented clinically as an ovarian tumour in an infertile woman. The importance of computed tomography in the differential diagnosis and the appropriate management of retroperitoneal liposarcoma is presented with a review of the relevant literature.
    Matched MeSH terms: Diagnosis, Differential
  11. Fulltext Quantitation of T lymphocyte subsets helps to distinguish dengue hemorrhagic fever from classic dengue fever during the acute febrile stage
    Fadilah SA, Sahrir S, Raymond AA, Cheong SK, Aziz JA, Sivagengei K
    Southeast Asian J. Trop. Med. Public Health, 1999 Dec;30(4):710-7.
    PMID: 10928365
    Activation of immunoregulatory T lymphocyte subsets has been observed in dengue viral infection, being more evident in dengue hemorrhagic fever (DHF) than in classical dengue fever (DF). There are, however, as yet no well-defined host markers to determine which patients with dengue viral infection will develop severe complications during the acute febrile stage of the disease. A study was performed to compare the cellular immune status in DHF, DF and non-dengue viral infections (NDF) in order to determine the value of these parameters in distinguishing DHF from classic DF and other viral infections during the acute febrile stage of the disease. This study involved 109 febrile patients admitted because of suspected DHF. Fifty patients were serologically confirmed cases of dengue infection, of which 25 had grade 1 or 2 DHF. There was a reduction in total T (CD3), CD4 and CD8 cells in DHF and demonstrated that a low level of CD3, CD4, CD8 and CD5 cells discriminated DHF from DF patients during the febrile stage of the illness. In contrast, B (CD19) cells and natural killer (NK) cells did not appear to be discriminatory in this study. Receiver operating characteristic (ROC) curve analysis showed that a combination of CD3 cell of < or = 45% and CD5 cell of < or = 55% was the best marker to identify DHF patients (sensitivity = 84% and specificity = 52% for CD3 cell of < or = 45%; sensitivity = 92% and specificity = 71% for CD5 cell of < or = 55%). CD4 cell of < or = 25% and CD8 cell < or = 30% were equally good in discriminating DHF from DF patients. On the other hand, the ROC curves indicated no clear difference between the immunoregulatory cell counts in DF from NDF Lymphopenia, atypical lymphocytosis and thrombocytopenia were significantly more evident in dengue compared to non-dengue infection but did not appear to be discriminatory among DHF and DF patients. The reduction in CD3, CD4, CD8, CD5 cells correlated with the degree of thrombocytopenia in DHF (p < 0.05) which suggests that these cells probably participate in a common pathogenetic mechanism.
    Matched MeSH terms: Diagnosis, Differential
  12. Pyopneumothorax secondary to Streptococcus milleri infection
    Che Rahim MJ, Mohammad N, Wan Ghazali WS
    BMJ Case Rep, 2016 Nov 23;2016.
    PMID: 27881590 DOI: 10.1136/bcr-2016-217537
    We report a case of a 46-year-old Malay woman with underlying hypothyroidism post thyroidectomy who presented with worsening breathlessness, orthopnoea, productive cough and left-sided pleuritic chest pain of 3 days duration. Chest X-ray on admission showed left-sided massive hydropneumothorax. Pleural tapping revealed empyema. A chest tube was inserted immediately. The culture of pleural fluid grew Streptococcus constellatus The patient was treated with antibiotics for a total of 6 weeks and underwent open thoracotomy and decortication during admission. Subsequently, her lung condition improved and there was no evidence of recurrence during follow-up.
    Matched MeSH terms: Diagnosis, Differential
  13. Fulltext Pulmonary tuberculosis--a review of clinical features and diagnosis in 232 cases
    Ismail Y
    Med J Malaysia, 2004 Mar;59(1):56-64.
    PMID: 15535337
    The diagnosis of pulmonary tuberculosis is often delayed due to atypical clinical features and difficulty in obtaining positive bacteriology. We reviewed 232 cases of pulmonary tuberculosis diagnosed in Kedah Medical Centre, Alor Setar from January 1998 to December 2002. All age groups were affected with a male predominance (Male:Female ratio = 60:40). Risk factors include underlying diabetes mellitus (17.7%), positive family history (16.8%) and previous tuberculosis (5.2%). Nearly half (45.3%) of patients had symptoms for more than one year. Only 22% of patients had typical symptoms of tuberculosis (prolonged recurrent fever, cough, anorexia and weight loss), whilst others presented with haemoptysis, chronic cough, COPD, bronchiectasis, general ill-health, pyrexia of unknown origin or pleural effusion without other systemic symptoms. Fifteen percent of the patients presented with extrapulmonary diagnosis. Ninety percent of the patients had previous medical consultations but 40% had no chest radiograph or sputum examination done. The chest radiographs showed 'typical' changes of tuberculosis in 62% while in the other 38% the radiological features were 'not typical'. Sputum direct smear was positive for acid-fast bacilli in only 22.8% of patients and 11.2% were diagnosed base on positive sputum culture. Sputum may be negative even in patients with typical clinical presentations and chest radiograph changes. Bronchial washing improved the diagnosis rate being positive in 49.1% of cases (24.1% by direct smear and the other 25.0% by culture). In 16.8% of cases, the diagnosis was based on a good response to empirical anti-tuberculosis therapy in patients with clinical and radiological features characteristic of tuberculosis. In conclusions, the clinical and radiological manifestations of pulmonary tuberculosis may be atypical. Sputum is often negative and bronchoscopy with washings for Mycobacterium culture gives a higher yield for diagnosis. In highly probable cases, empirical therapy with antituberculosis drugs should be considered because it is safe and beneficial.
    Matched MeSH terms: Diagnosis, Differential
  14. Pulmonary tuberculosis presenting as community-acquired pneumonia
    Liam CK, Pang YK, Poosparajah S
    Respirology, 2006 Nov;11(6):786-92.
    PMID: 17052309
    The aims of this study were to investigate the frequency of Mycobacterium tuberculosis as a cause of community-acquired pneumonia (CAP) requiring hospitalization in Malaysia, and to define the clinical features of pulmonary tuberculosis (PTB) that distinguish it from non-TB CAP.
    Matched MeSH terms: Diagnosis, Differential
  15. Fulltext Pulmonary siderosis in an arc welder
    Lim KH, Liam CK, Wong CMM
    Med J Malaysia, 2000 Jun;55(2):265-7.
    PMID: 19839158
    An asymptomatic subject with radiographic changes due to welders' siderosis is described. This condition has not been well recognized and described in our community. Siderosis of the lung is generally considered to be a benign condition not associated with respiratory symptoms. However, recent reports have associated welding with various disorders of pulmonary function as well as lung cancer. There is a need for future epidemiological studies to better define the risk of long term welding.
    Matched MeSH terms: Diagnosis, Differential
  16. Fulltext Pulmonary arteriovenous malformation: a rare cause of cyanosis in a child
    Sharifah AI, Jasvinder K, Rus AA
    Singapore Med J, 2009 Apr;50(4):e127-9.
    PMID: 19421665
    Pulmonary arteriovenous malformations are rare vascular anomalies. We report a 12-year-old girl who presented with exertional dyspnoea, cyanosis and clubbing since the age of five years, and multiple pulmonary arteriovenous malformations. Computed tomography pulmonary angiogram showed a large pulmonary arteriovenous malformation at the lower lobe of the right lung. Pulmonary angiogram showed a large right lung arteriovenous malformation and two small left lung arteriovenous malformations. The multiple arteriovenous malformations were occluded with Gianturco coils. She is now asymptomatic and on regular follow-up.
    Matched MeSH terms: Diagnosis, Differential
  17. Pulmonary actinomycosis masquerading as lung cancer: A case report
    Boo YL, How KN, Pereira DS, Chin PW, Foong KK, Lim SY
    Med J Malaysia, 2017 08;72(4):246-247.
    PMID: 28889138 MyJurnal
    Pulmonary actinomycosis is a rare yet important and challenging diagnosis to make. It is commonly confused with other lung diseases, such as tuberculosis and bronchogenic carcinoma, leading to delay diagnosis or misdiagnosis. A 49-year-old man presented with a chronic cough, hemoptysis, and pleuritic chest pain. His initial imaging studies including computed tomography (CT) was suggestive of bronchogenic carcinoma. A subsequent CTguided biopsy was consistent with pulmonary actinomycosis and excluded the possibility of bronchogenic carcinoma. He was treated with antibiotic therapy and achieved remission with complete radiological resolution upon follow-up.
    Matched MeSH terms: Diagnosis, Differential
  18. Pulmonary actinomycosis masquerading as aspergilloma
    Rosdina Z, Nurul Yaqeen ME, Hanafiah M, Nor Salmah B
    Med J Malaysia, 2017 04;72(2):147-149.
    PMID: 28473686 MyJurnal
    We report a case of a 34-year-old man who was initially treated as community acquired pneumonia following a three-month-history of productive cough, loss of weight and loss of appetite. However, three months after discharged from the hospital, he presented again with worsening respiratory symptoms and radiological evidence of a lung cavitation with intracavitary lesion resembling an aspergilloma associated with surrounding consolidation. Unfortunately, he remained symptomatic despite on antifungal therapy. The repeat computed-tomography demonstrated persistent cavitating lesion with development of necrotising pneumonia. He underwent lobectomy and the histopathological analysis of the resected specimen however revealed the diagnosis of actinomycosis.
    Matched MeSH terms: Diagnosis, Differential
  19. Fulltext Psychosis post corona radiata and lentiform nucleus infarction
    Abdullah KH, Saini SM, Sharip S, Rahman AH
    BMJ Case Rep, 2015 Apr 02;2015.
    PMID: 25837653 DOI: 10.1136/bcr-2014-208954
    Complications of stroke can include neuropsychiatric symptoms. However, post-stroke psychosis is rare. We report a case where an acute presentation of psychosis, depression and fluctuating cognitive impairment in a middle-aged man turned out to be related to a silent brain infarction. The patient had a background of poorly controlled type 2 diabetes mellitus with glycated haemoglobin level of 9.0-11.0%, hypertension and ischaemic heart disease. His CT brain results showed multifocal infarct with hypodensities at bilateral lentiform nucleus and bilateral corona radiata. His strong genetic predisposition of psychosis and a history of brief psychotic disorder with complete remission 3 years prior to the current presentation might possibly contribute to his post-stroke atypical neuropsychiatric presentation, and posed diagnostic challenges. He showed marked improvement with risperidone 6 mg nocte, chlorpromazine 50 mg nocte and fluvoxamine of 200 mg nocte. The need of comprehensive treatments to modify his stroke risk factors was addressed.
    Matched MeSH terms: Diagnosis, Differential
  20. Fulltext Psychiatric Education: Thinking Skills for Trainee Psychiatrists
    Maniam, T.
    Malaysian Journal of Psychiatry, 2010;19(2):1-5.
    MyJurnal
    The discipline of psychiatry requires the use of thinking skills to perform a number of tasks. The assessment of a patient’s history, his mental state especially the evaluation of thought disorders, the formulation of a diagnosis and differential diagnosis, the formulation of a management plan for what are often complex human problems and the wise application of therapeutic techniques, all require complex thinking skills. The process of communication with patients and their relatives is often fraught with pitfalls that requires a thoughtful approach that makes use of consciously shared information as well as non-verbal information. Evaluating scientific papers is another area that requires critical thinking. At times the lack of critical thinking is painfully apparent. It appears that schools, and sadly universities too, are merely training people and not educating them. Occasionally, of course, one is pleasantly surprised to come across a student with a very sharp and critical mind.
    Matched MeSH terms: Diagnosis, Differential
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