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Fulltext Case report: fatal Plasmodium knowlesi malaria following an atypical clinical presentation and delayed diagnosis

Rajahram GS, Barber BE, Yeo TW, Tan WW, William T

Med J Malaysia, 2013;68(1):71-2.
PMID: 23466773 MyJurnal
Matched MeSH terms: Delayed Diagnosis*
Fulltext Clinical-Epidemiological Pattern of Primary Immunodeficiencies in Malaysia 1987-2006: A 20 year experience in Four Malaysian Hospitals

Noh LM, Nasuruddin BA, Abdul Latiff AH, Noah RM, Kamarul Azahar MR, Norzila MZ, et al.

Med J Malaysia, 2013;68(1):13-7.
PMID: 23466760

To determine the clinical and epidemiological characteristics of patients seen with primary immunodeficiencies referred at four Malaysian Hospitals between 1987 to 2007.

Matched MeSH terms: Delayed Diagnosis*
Primary Breast Angiosarcoma: Utilisation of Pre-surgical Magnetic Resonance Imaging (MRI) for Accurate Tumour Characterization and Planning - A Case Report and Literature Review

Mumin NA, Rahmat K, Hamid MTR, Ng WL, Chan WY, Cheah XY, et al.

Curr Med Imaging, 2021;17(4):552-558.
PMID: 33030134 DOI: 10.2174/1573405616666201007161119

BACKGROUND: Primary breast angiosarcoma is a rare malignancy with non-specific clinical and radiological findings.
CASE REPORT: A 30-year-old lady presented with left breast pain and lumpiness for over one year. She has had several breast ultrasounds (US) and was treated for acute mastitis and abscess. Subsequently, in view of the rapid growth of the lump and worsening pain, she was re-investigated with US, elastography, digital breast tomosynthesis (DBT) and MRI. MRI raised the suspicion of angiosarcoma. The diagnosis was confirmed after biopsy and she underwent mastectomy.
DISCUSSION: Literature review on imaging findings of breast angiosarcoma, especially on MRI, is discussed. MRI features showed heterogeneous low signal intensity on T1 and high signal intensity on T2. Dynamic contrast enhancement (DCE) features included either early enhancement with or without washout in the delayed phase, and some reported central areas of non-enhancement.
CONCLUSION: This case report emphasises on the importance of MRI in clinching the diagnosis of breast angiosarcoma, and hence, should be offered sooner to prevent diagnostic delay.

Matched MeSH terms: Delayed Diagnosis
Fulltext Delayed presentation of HIV among older individuals: a growing problem

Justice AC, Goetz MB, Stewart CN, Hogan BC, Humes E, Luz PM, et al.

Lancet HIV, 2022 Apr;9(4):e269-e280.
PMID: 35218732 DOI: 10.1016/S2352-3018(22)00003-0

Late presentation for care is a major impediment to the prevention and effective treatment of HIV infection. Older individuals are at increased risk of late presentation, represent a growing proportion of people with late presentation, and might require interventions tailored to their age group. We provide a summary of the literature published globally between 2016-21 (reporting data from 1984-2018) and quantify the association of age with delayed presentation. Using the most common definitions of late presentation and older age from these earlier studies, we update this work with data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, focusing on data from 2000-19, encompassing four continents. Finally, we consider how late presentation among older individuals might be more effectively addressed as electronic medical records become widely adopted.

Matched MeSH terms: Delayed Diagnosis
Fulltext Diagnosis delay of breast cancer and its associated factors in Malaysian women

Norsa'adah B, Rampal KG, Rahmah MA, Naing NN, Biswal BM

BMC Cancer, 2011;11:141.
PMID: 21496310 DOI: 10.1186/1471-2407-11-141

Breast cancer is the leading cause of cancer mortality among women in Malaysia. Delayed diagnosis is preventable and has major effects on patients' prognosis and survival. The objectives of our study were to identify the magnitude of delayed diagnosis and its associated factors in women with breast cancer in Malaysia.

Matched MeSH terms: Delayed Diagnosis*
Recognizing pitfalls in breast cancer follow-up: a necessity--reply

Taib NA

World J Surg, 2015 Feb;39(2):548-9.
PMID: 25446473 DOI: 10.1007/s00268-014-2872-9
Matched MeSH terms: Delayed Diagnosis/psychology*
An international multicenter survey reveals health care providers' knowledge gap in childhood central nervous system tumors

Rajagopal R, Moreira DC, Faughnan L, Wang H, Naqvi S, Krull L, et al.

Eur J Pediatr, 2023 Feb;182(2):557-565.
PMID: 36383283 DOI: 10.1007/s00431-022-04712-4

Childhood central nervous system (CNS) tumors have longer delays in diagnosis than do other pediatric malignancies because health care providers (HCPs) lack awareness about clinical presentation of these tumors. To evaluate the knowledge gap among HCPs, we conducted a global cross-sectional survey. The survey consisted of a set of CNS tumor knowledge questions focused on symptoms, signs, and imaging indications. The survey was disseminated to HCPs via email (November 2018-March 2020). Participants had to complete a pre-test survey, attend an education seminar on CNS tumors, and complete a post-test survey. The knowledge gap was evaluated using pre-test and post-test scores. We received 889 pre-test and 392 post-test responses. Most respondents were from Asia (73.1% of pre-test responses; 87.5% of post-test responses). The median pre-test score was 40.0% (range: 13.1-92.9%). A high percentage of correct answers were given in post-test responses (median score: 77.1%, range: 14.9-98.2%). In the pre-test, 18.7% of participants accurately responded that Cushing's triad was a less common symptom, and 15.0% recognized that children aged > 10 years are at risk of late diagnosis. Surprisingly, 21.9% falsely reported that patients with malignancy experienced the longest pre-diagnostic symptom interval, and 54.5% of respondents wrongly selected medulloblastoma as the most common CNS tumor. Overall, pediatricians demonstrated a greater knowledge gap on both surveys than did other specialties. Conclusion: Pre- and post-test surveys revealed significant knowledge gaps in childhood CNS tumors among HCPs. Thus, raising professional awareness on clinical presentations of CNS tumors through educational strategies is important to address this knowledge deficit. What is Known: • Diagnostic delay in childhood central nervous system (CNS) tumors continues to be a significant problem that negatively impacts the quality of life and treatment sequelae. • Lack of medical education on CNS tumors is a contributing factor to this problem. What is New: • Most health care providers do not realize that low-grade tumors are the most common neoplasm in children. • Health care providers fail to recognize that teenagers and adolescents are a vulnerable age group for diagnostic delays, with the longest pre-diagnostic symptom interval.

Matched MeSH terms: Delayed Diagnosis*
Fulltext Lessons of the month: A forgotten classic: Delayed diagnosis of mitral stenosis presenting initially as Ortner's syndrome

Shariff RER, Abidin HAZ, Kasim SS

Clin Med (Lond), 2020 11;20(6):e267-e268.
PMID: 33199335 DOI: 10.7861/clinmed.2020-0750

We present a rare case of delayed diagnosis of mitral stenosis, initially presenting with hoarseness in her voice due to left recurrent laryngeal nerve (LRLN) compression. A 60-year-old woman presented to the otorhinolaryngology department following complaints of progressive hoarseness in voice over a 6-month period. There was dysphonia but no additional evidence of a cranial nerve IX or X palsy on examination, with subsequent flexible nasopharyngolaryngoscopy demonstrating left vocal cord palsy. She was referred for a cardiology consult following findings of atrial fibrillation on electrocardiography. Transthoracic echocardiography revealed an enlarged left atrium with evidence of severe mitral stenosis. A diagnosis of Ortner's syndrome was made and the patient underwent mitral valve replacement. Common causes of Ortner's syndrome include mitral stenosis with left atrium compression of the LRLN, but it can occur due to other causes including pulmonary hypertension or aortic aneurysm compression, among others. There are few data at present to conclude that regression of left atrial enlargement and pulmonary arterial hypertension with symptoms are associated with Ortner's syndrome. Therefore, it remains pertinent for clinicians to be aware of clinical features linked to mitral stenosis including its more uncommon presentations, such as in our case, as earlier intervention may improve prognosis.

Matched MeSH terms: Delayed Diagnosis
Fulltext Tuberculosis of the Left Wrist Joint and Spine

Sivasamy P, Bajuri MY, Ghani AW

Cureus, 2019 Nov 19;11(11):e6203.
PMID: 31890405 DOI: 10.7759/cureus.6203

The incidence of wrist tuberculosis is rare. Clinical features and radiographs are not conclusive in the beginning, happen to delay the achievement of the diagnosis, and thus result in poor treatment. We present a case report of wrist tuberculosis that had delayed diagnosis. Hence, the initiation of antituberculous treatment was delayed, as the initial investigations were not conclusive of tuberculous infection. The patient was treated surgically multiple times before tuberculosis was diagnosed. Antituberculous chemotherapy was started for the patient for one year until she became afebrile and infective markers returned to normal. However, the patient developed left wrist stiffness due to arthrofibrosis and bony destruction of the wrist joint.

Matched MeSH terms: Delayed Diagnosis
Fulltext Internalized stigma among urban tuberculosis patients in Selangor: the prediction

Qudsiah Suliman, Salmiah Md. Said, Lim Poh Ying, Nor Afiah Mohd. Zukefli, Tan Kit-Aun, Alif Ramli, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):60-60.
MyJurnal

Introduction: Evidently, stigma has potentially prompted the negative outcome in Tuberculosis (TB) control through delayed diagnosis and poor adherence to treatment. Amidst accelerating treatment interruption in Selangor, little attention is paid to the quantitative assessment of stigma, thus warrant further characterisation of TB stigma in ur-ban districts, Selangor. This study aimed to determine the predictors of internalised stigma among newly diagnosed PTB smear positive in urban districts, Selangor. Methods: A multi-centric longitudinal study recruited 345 newly diagnosed PTB smear positive patients who started TB treatment from November 2018 until June 2019. Baseline assessments utilised pre-tested self-administered questionnaire and standardised data collection form. Using IBM SPSS version 25.0, multiple linear regression was computed to determine the predictors. Results: The response rate was 84.7% with most of respondents were married and attained educational level up to secondary school. Other than low mean score of social support [mean (SD)=33.39(5.86)], the prominent findings were lacking knowledge of anti-TB side effect and wrongly perceived damaging effect of anti-TB drug to internal organ. The mean internalised stigma score was 24.88 (SD=4.70), which predicted by age, educational level (no formal education), employment status (retiree), alternative medicine practice, baseline symptoms score, perceived barrier, and social support, with entire group of variables significantly predicted TB stigma (F [9, 331] =21.476, p

Matched MeSH terms: Delayed Diagnosis
Skin eruption induced by dieting - an underdiagnosed skin disease in Malaysia

Goh SW, Adawiyah J, Md Nor N, Yap F, Ch'ng P, Chang CC

Malays Fam Physician, 2019;14(1):42-46.
PMID: 31289632

Prurigo pigmentosa is an inflammatory dermatosis characterized by a pruritic, symmetrically distributed erythematous papular or papulo-vesicular eruption on the trunk arranged in a reticulated pattern that resolves with hyperpigmentation. It is typically non-responsive to topical or systemic steroid therapy. The exact etiology is unknown, but it is more commonly described in the Far East countries. Dietary change is one of the predisposing factors. We report on nine young adult patients with prurigo pigmentosa, among whom five were on ketogenic diets prior to the onset of the eruptions. All cases resolved with oral doxycycline with no recurrence. We hope to improve the awareness of this uncommon skin condition among general practitioners and physicians so that disfiguring hyperpigmentation due to delayed diagnosis and treatment can be avoided.

Matched MeSH terms: Delayed Diagnosis
Fulltext Clinical management of chronic mercury intoxication secondary to skin lightening products: A proposed algorithm

Ramli FF

Bosn J Basic Med Sci, 2021 Jun 01;21(3):261-269.
PMID: 32415819 DOI: 10.17305/bjbms.2020.4759

Mercury is a toxic substance that is commonly used in skin lightening products. Various effects on humans have been observed, which affect both users and non-users. Many studies reported delayed diagnosis and treatment, even after weeks of hospitalization. The possible reasons are non-specific clinical manifestation and lack of awareness and knowledge regarding chronic mercury intoxication secondary to skin lightening products. A thorough history of mercury exposure is crucial. Physical assessment and relevant supporting tests are indicated to establish a diagnosis. Blood and urine mercury levels are an essential examination for diagnosis and monitoring of the progress and response to treatment. The primary treatment is the discontinuation of the skin lightening products. Chelation therapy is not mandatory and is usually indicated for symptomatic patients. The prognosis depends on the duration of the product use, concentration of mercury in the skin product, and the severity of clinical presentation.

Matched MeSH terms: Delayed Diagnosis
Natural history and clinical features of ALS in Malaysia

Abdul Aziz NA, Toh TH, Goh KJ, Loh EC, Capelle DP, Abdul Latif L, et al.

Amyotroph Lateral Scler Frontotemporal Degener, 2021 02;22(1-2):108-116.
PMID: 33084408 DOI: 10.1080/21678421.2020.1832121

OBJECTIVE: Studies from multiethnic populations are rarely reported but do indicate differences in phenotypic presentation and survival in amyotrophic lateral sclerosis (ALS). In this study, we aimed to investigate the natural history of a cohort of ALS patients from a multiethnic population. Methods: Data from ALS patients presenting to our multidisciplinary ALS clinic were prospectively collected from January 2015 to June 2020 as part of an ongoing hospital-based patient registry. Kaplan-Meier and Cox regression model were performed to identify potential prognostic factors. Results: A total of 144 ALS patients were recruited. We estimated the crude ALS incidence as 0.53 per 100,000 for 2019 but rises to 2 per 100,000 in patients aged 60-74 years. The majority of patients were of Chinese ethnicity (59.7%), followed by Malay (24.3%), Indian (11.1%), and others (4.9%). Malaysian Indians had a significantly steeper ALSFRS-R slope at diagnosis (p = 0.040). We found a worse prognosis in patients with bulbar-onset (HR = 1.915, p = 0.019), older age (HR = 1.052, p = 0.000), and who were fast-progressors (HR = 1.274, p = 0.000). In contrast, a higher body mass index (HR = 0.921, p = 0.007) and a longer time to diagnosis (HR = 0.967, p = 0.006), noninvasive ventilation (HR = 0.820, p = 0.000) and percutaneous endoscopic gastrostomy insertion (HR = 0.823, p = 0.000) were associated with better survival. On multivariate analysis, diagnostic delay and slow disease progression were associated with better survival. Conclusions: In our cohort, diagnostic delay and a slow disease progression were significantly associated with better survival in ALS. We also found ethnic variation with Chinese preponderance and more rapid disease progression in patients of Indian descent.

Matched MeSH terms: Delayed Diagnosis
Delayed diagnosis of Kawasaki disease in Malaysia: Who is at risk and what is the outcome

Mat Bah MN, Alias EY, Sapian MH, Abdullah N

Pediatr Int, 2022 Jan;64(1):e15162.
PMID: 35789141 DOI: 10.1111/ped.15162

BACKGROUND: Data on the delayed diagnosis of (KD) is limited. This study aimed to determine the prevalence and trend of delayed diagnosis over time and identify the associated risk factors in Malaysia.
METHODS: This retrospective, observational, population-based study involved all children with KD registered in Johor Kawasaki Clinical Registry over 10 years (January 2010 and December 2019). The prevalence of delayed diagnosis and its trend over time was calculated. Multivariable binary logistic regression was used to identify the independent risk factors for delayed diagnosis.
RESULTS: There were 556 cases of KD, with 28% having incomplete criteria, 11% atypical presentation, while 10% developed a coronary aneurysm. The overall prevalence of delayed diagnosis was 9.9% (95% confidence interval (CI): 7.6-12.7%). There was a statistically significant decrease in delayed diagnosis over time (P = 0.008), with the latest rate of 4.6%. The majority of delayed diagnoses were due to failure to diagnose the disease during the initial consultation. Independent risk factors for delayed diagnosis were children older than 1 year, diagnosis before 2015, atypical presentation, and incomplete KD, with adjusted odds ratios (ORs) of 2.7, 2.3, 4.3, and 3.6, respectively. Compared to early diagnosis of KD, delayed diagnosis was significantly associated with coronary aneurysms (27.3% vs. 8.2%, P < 0.001, OR 4.2, [95% CI: 2.1-8.3]).
CONCLUSIONS: One-tenth of cases of KD were diagnosed late, but it has improved over time. Children > 1 year, presenting with atypical presentation, and incomplete criteria are associated with late diagnosis.

Matched MeSH terms: Delayed Diagnosis
Fulltext A commentary on delayed presentation of breast cancer in Singapore

Chang G, Chan CW, Hartman M

Asian Pac J Cancer Prev, 2011;12(6):1635-9.
PMID: 22126512

Breast cancer is the most common cancer in Singaporean women and the rate of increase in incidence is one of the highest in the world. In view of the significant contribution of delayed presentation to the disease burden in South East Asia, we reviewed the incidence of late presentation of breast cancer and the contributing factors in Singapore. Disease presentation was analysed using studies based on the Singapore Cancer Registry 2004-2008 and with data from women with breast cancer at the National University Hospital (NUH) in Singapore 1990-2007. Available literature from Singapore on factors contributing to delayed presentation was reviewed and presented here. The overall age-standardized 5-year relative survival for Singaporean women was 70% with only half diagnosed with localized cancer. Of all women diagnosed at NUH close to 20% presented at Stages III and IV. Given the magnitude of the problem of women presenting with more advanced stages of breast cancer, the National University of Singapore has joined a collaborative team with the University of Leeds (UK), the University of Malaya, and University of UAE to set up the UK-SEA-ME Psychosocial-Cultural Cancer Research Network to better understand late presentation.

Matched MeSH terms: Delayed Diagnosis*
Fulltext Recognising symptoms of breast cancer as a reason for delayed presentation in Asian women--the psycho-socio-cultural model for breast symptom appraisal: opportunities for intervention

Taib NA, Yip CH, Low WY

Asian Pac J Cancer Prev, 2011;12(6):1601-8.
PMID: 22126506

INTRODUCTION: Advanced presentation of breast cancer and the problem of late diagnosis is well documented. Patient delay beyond three months has been shown to reduce survival. This paper aims to explore the experience of Malaysian women presenting with advanced breast cancer with regards to their interpretation of breast symptoms.

METHOD: Purposive sampling of 19 breast cancer patients presenting with delayed treatment and/ or advanced cancer diagnosed within two years at the University Malaya Medical Centre, Kuala Lumpur were carried out. In-depth interviews were conducted using a self-devised interview guide. The interview guide covered the journey of the patient from discovering of symptoms to their present state. The audiotaped interviews were transcribed verbatim. NVivo 8 qualitative software was utilised for data management. Grounded theory with thematic analysis was utilised.

RESULTS: Nine women delayed seeking diagnosis although recognizing the symptom, five did not recognize symptom, three delayed treatment and two did not delay health attention. Themes that emerged with regards to triggering help seeking behavior were: a) poor symptom knowledge and recognition; b) importance of knowledge of the disease and its' outcomes; c) role of coping mechanisms and affect; and lastly d) role of significant others in appraising a breast symptom.

CONCLUSION: Symptom recognition remains an important public health issue in Malaysia. Educating women, their significant others and primary health and primary care providers in detecting early staged breast cancer are needed. Supporting and sanctioning women with breast symptoms are important. The psycho-social-cultural model of symptom appraisal may serve as an important addition to the fight against cancer in countries that do not have the resources for population based screening mammogram programmes.

Matched MeSH terms: Delayed Diagnosis*
Fulltext Congenital cholesteatoma: delayed diagnosis and its consequences

Goh BS, Faizah AR, Salina H, Asma A, Saim L

Med J Malaysia, 2010 Sep;65(3):196-8.
PMID: 21939167

This is a retrospective review of congenital cholesteatoma cases that were managed surgically. There were 5 cases. The age of presentation ranged from 5 to 18 year old. Three patients presented with complication of the disease. Three patients had intact tympanic membrane, two had perforation at the anterior superior quadrant. All patients had cholesteatoma medial to tympanic membrane. Four cases had extensive ossicular erosion with preoperative hearing worse than 40 dB. Four cases underwent canal wall down mastoid surgery and one underwent canal wall up surgery. One patient had recurrence which required revision surgery. In conclusion, congenital cholesteatoma presented late due to the silent nature of disease in its early stage. Extensive disease, ossicular destruction with risk of complication at presentation were marked in our study. Hence, more aggressive surgical intervention is recommended in the management of congenital cholesteatoma.

Matched MeSH terms: Delayed Diagnosis/adverse effects*
Fulltext Head and neck cancer: possible causes for delay in diagnosis and treatment

Lee SC, Tang IP, Avatar SP, Ahmad N, Selva KS, Tay KK, et al.

Med J Malaysia, 2011 Jun;66(2):101-4.
PMID: 22106686 MyJurnal

To explore the possible causes for delay in diagnosis and treatment of head and neck cancer at Sarawak General Hospital (SGH).

Matched MeSH terms: Delayed Diagnosis*
Fulltext Treatment delay in rectal cancer

Law CW, Roslani AC, Ng LL

Med J Malaysia, 2009 Jun;64(2):163-5.
PMID: 20058579 MyJurnal

Early diagnosis of rectal cancer is important for prompt treatment and better outcome. Little data exists for comparison or to set standards. The primary objective of this study is to identify factors resulting in delays in treatment of rectal cancer, the correlation between the disease stage and diagnosis waiting time, treatment waiting time and duration of symptoms. A five year retrospective audit was undertaken in University of Malaya Medical Centre (UMMC). There were 137 patients recruited and the median time to diagnosis was nine days after the first UMMC Surgical Unit consultation with a mean of 18.7 days. Some 11% had to wait more than four weeks for diagnosis. The median time from confirmation of diagnosis to surgery was 11 days with a mean of 18.6 days. Sixty-two percent of patients were operated upon within two weeks of diagnosis and more than 88% by four weeks. However, 10% of them had delayed surgery done four weeks after diagnosis. Long colonoscopy waiting time was the main cause for delay in diagnosis while delay in staging CTs were the main reason for treatment delays.

Matched MeSH terms: Delayed Diagnosis*
Association of Knowledge and Cultural Perceptions of Malaysian Women with Delay in Diagnosis and Treatment of Breast Cancer: a Systematic Review

Khan TM, Leong JP, Ming LC, Khan AH

Asian Pac J Cancer Prev, 2015;16(13):5349-57.
PMID: 26225677

BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved.
OBJECTIVES: This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease.
MATERIALS AND METHODS: A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer.
RESULTS: A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge.
CONCLUSIONS: This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.

Matched MeSH terms: Delayed Diagnosis*

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