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Fulltext Collimator and shielding design for boron neutron capture therapy (BNCT) facility at triga mark II reactor

Mohd Rafi Mohd Solleh, Abd. Aziz Tajuddin, Eid Mahmoud Eid Abdel Munem, Abdul Aziz Mohamed, Mohamad Hairie Rabir, Julia Abd. Karim, et al.

Journal of Nuclear and Related Technologies, 2011;2011(2):41-48.
MyJurnal

The geometry of reactor core, thermal column, collimator and shielding system for BNCT application of TRIGA MARK II REACTOR were simulated with MCNP5 code. Neutron particle lethargy and dose were calculated with MCNPX code. Neutron flux in a sample located at the end of collimator after normalized to measured value (Eid Mahmoud Eid Abdel Munem, 2007) at 1 MW power was 1.06E8 n/cm2/s. According to IAEA (2001) flux of 1.00E9 n/cm2/s requires three hours of treatment. Few modifications were needed to get higher flux.

Matched MeSH terms: Lethargy
Fulltext Comparison of clinical and laboratory characteristics between severe and non-severe dengue in paediatrics

Idrus NL, Md Jamal S, Abu Bakar A, Embong H, Ahmad NS

PLoS Negl Trop Dis, 2023 Dec;17(12):e0011839.
PMID: 38113250 DOI: 10.1371/journal.pntd.0011839

BACKGROUND: The timely identification of severe dengue in peadiatric patients is of utmost importance, as any delay in diagnosis could lead to an irreversible state of shock potentially leading to fatal consequences. The primary aim of our study was to characterize dengue severity in paediatric patients based on initial symptoms, signs, and laboratory investigation of their presentation in the emergency department.
METHODOLOGY: We conducted a retrospective data retrieval from the medical records of 254 paediatric patients who had been diagnosed with confirmed cases of dengue fever. The clinical characteristics were compared between severe and non-severe dengue. Multiple logistic regression analysis was utilised to elucidate the variables that exhibited associations with severe dengue.
RESULTS: A total of 254 paediatric patients were included, among whom 15.4% (n = 39) were diagnosed with severe dengue. Multiple logistic regression analysis identified lethargy, systolic blood pressure (SBP) below 90 mmHg, capillary refilled time (CRT) longer than 2 seconds, ascites, and hepatomegaly were independently associated with severe dengue.
CONCLUSION: In paediatric patients, severe dengue is associated with specific clinical indicators, including lethargy, low systolic blood pressure, prolonged capillary refill time (CRT), and the presence of ascites and hepatomegaly. Identifying these clinical features early is crucial for primary care physicians, as it enables accurate diagnosis and timely intervention to manage severe dengue effectively.

Matched MeSH terms: Lethargy
Fulltext Life-threatening parapharyngeal and retropharyngeal abscess in an infant

Balasubramanian A, Shah JR, Gazali N, Rajan P

BMJ Case Rep, 2017 Oct 09;2017.
PMID: 28993356 DOI: 10.1136/bcr-2017-221269

Severe extensive deep neck abscess in an infant is uncommon. We share the case of a previously well 4-month old infant who was referred for a 4-day history of fever, lethargy and left lateral neck swelling. Contrast-enhanced CT scan revealed a large 5.3×8 cm collection involving the left parapharyngeal and retropharyngeal space, causing significant airway narrowing. 40 mL of frank pus was drained via intraoral incision and drainage with the aid of endoscope, and undesirable complications from an external approach were averted. The infant was extubated 48 hours postsurgery and was discharged home well after completion of 1 week of intravenous antibiotics. The child was discharged well from our follow-up at 1 month review. We discuss the pathophysiology of deep neck space abscesses, its incidence in the paediatric population and the various management options.

Matched MeSH terms: Lethargy/microbiology; Lethargy/therapy*
Fulltext Prevalence of post-vaccine side effects among COVID-19 immunized community of Southern Pakistan

Qureshi A, Syed Sulaiman SA, Rehman W, Mehmood A, Idrees S, Kumar N

PLoS One, 2023;18(5):e0285736.
PMID: 37220099 DOI: 10.1371/journal.pone.0285736

BACKGROUND: The response to the vaccine may vary among individuals. Hence, it is important to know how often individuals experience side effects after immunization against COVID-19.
OBJECTIVE: This study aimed to assess the incidence of side effects following COVID-19 vaccination across different vaccine recipients in Southern Pakistan and identify the potential factors associated with these side effects in the population.
METHODS: The survey was conducted across Pakistan through Google-forms Links from August to October 2021. The questionnaire included demographic information and COVID-19 vaccine information. Chi-square (x2) was performed for comparative analysis to check the significance level with P <0.05. The final analysis included 507 participants who had received COVID-19 vaccines.
RESULTS: Of the total 507 COVID-19 vaccines recipients, 24.9% received CoronaVac, 36.5% received BBIBP-CorV, 14.2% received BNT162b2, 13.8% received AZD1222, and 10.7% received mRNA-1273. The most prominent side effects after the first dose were fever, weakness, lethargy, and pain at the site of injection. Moreover, the most commonly reported side effects after the second dose were pain at the injection site, headache, body ache, lethargy, fever, chills, flu-like symptoms, and diarrhea.
CONCLUSION: Our results suggested that the side effects due to COVID-19 vaccination can vary between the first and second doses and type of COVID-19 vaccine. Our findings suggest continuing monitoring of vaccine safety and the importance of individualized risk-benefit assessment for COVID-19 immunization.

Matched MeSH terms: Lethargy
Fulltext Hereditary spherocytosis in a malay patient with chronic haemolysis

Sheikh MK, Yusoff NM, Kaur G, Khan FA

Malays J Med Sci, 2007 Jul;14(2):54-7.
PMID: 22993492 MyJurnal

This case report describes a 35-year-old lady who presented with generalized weakness and lethargy of two weeks duration and jaundice of more than 20 years duration. Her initial workup was suggestive of haemolysis and blood film showed a leucoerythoblastic picture with moderate microspherocytes. She was finally diagnosed as a case of hereditary spherocytosis after ruling out other possible causes of chronic haemolysis and supported by an abnormal osmotic fragility test, although family members refused for screening. Hereditory spherocytosis is uncommon in Malay population and presentation with jaundice of 20 years duration with leucoerythroblastic picture on blood film were interesting features in this case. Patient is being followed closely for need of splenectomy in near future as per severity of haemolysis and currently being managed with folic acid supplement.

Matched MeSH terms: Lethargy
Fulltext False positive blood culture from automated microbial detection system in severe malaria – a case report

Syarifah Mohd Rahim, Siti Norbaya Masri, Rosni Ibrahim

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):342-344.
MyJurnal

Automated microbial detection system (AMDs) are design to detect early growth of bacterial and fungal. We herein report a rare case of false positive blood culture by AMDs in Plasmodium falciparum infection. A 41-year-old pre- viously healthy lady, with recent history of travelling to Lagos, Nigeria had presented to the casualty with history of fever and lethargy for three days. There was no malaria prophylaxis taken prior to the travelling history. Peripheral blood smear confirmed the presence of young trophozoite of Plasmodium falciparum with parasitemia of 7%. Con- current blood culture sent was positive, however all subcultures were negative for any growth. She was treated with intravenous artesunate however succumbed to death on the day of admission due to severe falciparum infection complicated with multiorgan failure and shock. The aim of this report is to highlight, the circumstances that can trigger the false positive AMDs detection and the possible underlying mechanism.

Matched MeSH terms: Lethargy
Fulltext First case report on the occurrence of Trypanosoma evansi in a Siam B Mare in Kelantan, Malaysia

Mohd Rajdi NZI, Mohamad MA, Tan LP, Choong SS, Reduan MFH, Hamdan RH, et al.

Vet Med Sci, 2021 Mar;7(2):303-309.
PMID: 33161648 DOI: 10.1002/vms3.379

This is the first case report for the positive Trypanosoma evansi incident in Kelantan, Malaysia confirmed through protozoa detection in a Siam B mare. The horse was presented with complaints of lethargy and inappetence and it collapsed on the day of visit. Normal saline and dextrose solution were administered intravenously, while multivitamins and nerve supplements were given intramuscularly to stabilise the horse before further treatment. Haematological findings showed normocytic hypochromic anaemia and are suggestive of regenerative anaemia. Thin blood smear and examination revealed the presence of Trypanosoma sp., and it was confirmed as T. evansi through molecular identification. The horse was found dead 2 days after and post-mortem was conducted. Histopathology revealed that the horse had developed a neurological form of the disease, besides the detection of the protozoa in heart, spleen and kidney tissue. This first positive Surra case in Kelantan, Malaysia, that is bordering Thailand confirms the increasing concern of transboundary infections. In conclusion, Surra is a potential emerging disease and should be considered as differential diagnosis in horses with pale mucous membrane. This condition is particularly imperative in horses found in these regions as Surra is endemic.

Matched MeSH terms: Lethargy
Fulltext A Case Report of Steroid Withdrawal Syndrome

Wahab F, Rahman RA, Yaacob LH, Noor NM, Draman N

Korean J Fam Med, 2020 Sep;41(5):359-362.
PMID: 32961047 DOI: 10.4082/kjfm.18.0181

We report a case of steroid withdrawal syndrome in a 74-year-old woman who was suspected of having an occult exogenous Cushing's syndrome secondary to prolonged traditional complementary medicine use. She presented with non-specific symptoms of lethargy, malaise, and poor oral intake with weight loss for 1 month, and investigations showed suboptimal 9 AM cortisol level. She has responded well to steroid replacement.

Matched MeSH terms: Lethargy
Fulltext Risk factors for diabetic nephropathy among non insulin dependent patients who attended city hall’s staff clinic in Kuala Lumpur

Ahmad U, Mohd Nor MI, Ali O

Malaysian Journal of Public Health Medicine, 2001;1(1):16-21.
MyJurnal

Diabetes mellitus and its main complication, nephropathy, ajjbcts the economic wellbeing and quality of Iife of the sufferers and the population. A matched case control study was conducted in September 1998 to investigate the factors involved with nephropathy such as diabetic control, smoking, hypertension, familv history of diabetes and diabetic duration. Respondents were classyied based on the presence of microalbuminuria or macroalbuminuria, Seventy-two pairs of case and control were studied Duration of diabetes Q2 = 0.005), presence of lethargy and weakness prior to diabetes diagnosis @7 = 0.019), duration of smoking @7 = 0.014), duration of hypertension @2: 0.000), systolic hypertension Qu= 0e 025), uncontrolled diabetes with poor HbA1c level (v= 0.02Q and lack of diabetes knowledge Q2 = 0.037) were jbctors which related signyicantlv to nephropathy by univariate anahrsis. In multivariate anahrsis, systolic hypertension (p = 0.0015), lack of diabetes knowledge (17 = 0.0197), presence of lethargy symptom Q7 = 0.0027), prolonged diabetic duration @ = 0.0301) and higher body mass indices (p = 0. 0213) were predictors to diabetic nephropathy.

Matched MeSH terms: Lethargy
Late diagnosis of congenital hypothyroidism : the case for newborn screening

Tan, Kah Kee, Kaur, Pyar

Malaysian Journal of Child Health, 1994;6(1):36-39.
MyJurnal

26 cases of congenital hypothyroidism were diagnosed at the Penang General Hospital from 1979 to 1993. Therewere 19 femalesand7males, thefemaletomaleratiowas2 .7 : 1. All three main ethnic groups were almost equally afflicted (10 Chinese,8Malays,8 Indians). The mean age at diagnosis was 15.8 months (range 21 days — 9 years) and only 11 (42.3%) patients were diagnosed within thefirst three months of life. 19 (73.7%) patients were diagnosed within thefirstyear and 7 (26.3%) after the firstyear. The correct referral diagnosis was made in less than half (n = 11) of the patients, with a mean of 2.3 doctors being consulted prior to the diagnosis. The five most common clinical features were coarse facies (n = 22), dry skin (n = 22), macroglossia (n = 21), lethargy (n = 20) and constipation (n = 19). The develop-ment quotient was appropriate for chronologi-cal age in less than one third (n = 8) of patients while the school performance was at least average in only less than one third (n = 5) of school-goers (n = 16). The mean (SD) T4 at diagnosis was 23.7 (12.2) nmollL while the mean (SD) TSH at diagnosis was 72.7 (37.0) mUIL. In the light of these clinical findings, screening for congenital hypothyroidism with a view to early diagnosis and prompt treatment are strongly recommended.

Matched MeSH terms: Lethargy
Fulltext Coughing Shih Tzu dog due to myxomatous mitral valve disease stage C2

Khor, K.H., Jessie-Bay, J.X.

Jurnal Veterinar Malaysia, 2018;30(1):15-19.
MyJurnal

Myxomatous Mitral Valve Disease is a degenerative condition of the mitral valves leaflets. A 10-year-old
male castrated Shih Tzu was presented with primary complaint of coughing. Clinical examination revealed normal
heart rate, respiratory rate and rectal temperature. Systolic murmur Grade IV/VI was heard at the left heart apex.
Thoracic radiographic findings were cardiomegaly with the vertebral heart score of 11.0 and had evidence of
cardiogenic pulmonary edema. Echocardiographic examination revealed thickening mitral valves with evidence of
moderate regurgitation observed. Based on the findings obtained, the dog was diagnosed with Myxomatous Mitral
Valve disease stage C2. Dog was treated with benazepril (0.5mg/kg), pimobendan (0.2mg/kg) with a combination of
furosemide (2mg/kg). Frusemide was gradually removed from the treatment regime as coughing improved over time.
The dog was no longer lethargy and even gained weight.

Matched MeSH terms: Lethargy
Single-centre study of therapeutic drug monitoring of posaconazole in lung transplant recipients: factors affecting trough plasma concentrations

Jeong W, Snell GI, Levvey BJ, Westall GP, Morrissey CO, Wolfe R, et al.

J Antimicrob Chemother, 2018 Mar 01;73(3):748-756.
PMID: 29211913 DOI: 10.1093/jac/dkx440

Objectives: This study describes therapeutic drug monitoring (TDM) of posaconazole suspension and modified release (MR) tablets in lung transplant (LTx) recipients and evaluates factors that may affect posaconazole trough plasma concentration (Cmin).
Methods: A single-centre, retrospective study evaluating posaconazole Cmin in LTx recipients receiving posaconazole suspension or MR tablets between January 2014 and December 2016.
Results: Forty-seven LTx patients received posaconazole suspension, and 78 received the MR tablet formulation; a total of 421 and 617 Cmin measurements were made, respectively. Posaconazole was concurrently administered with proton pump inhibitor in ≥ 90% of patients. The median (IQR) of initial posaconazole Cmin following 300 mg daily of posaconazole tablet was significantly higher than that of 800 mg daily of posaconazole suspension [1.65 (0.97-2.13) mg/L versus 0.81 (0.48-1.15) mg/L, P

Matched MeSH terms: Lethargy
Fulltext Salmonella Thyroid Abscess Treated by Serial Aspiration: Case Report and Literature Review

Vengathajalam S, Retinasekharan S, Mat Lazim N, Abdullah B

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):823-826.
PMID: 31742073 DOI: 10.1007/s12070-019-01654-6

Thyroid abscesses are the most rare conditions of the thyroid gland but it could be potentially life threatening. Most patients are immunocompromised or has an underlying chronic thyroid disorder. We report a case of a 58 year-old lady with underlying uncontrolled diabetes mellitus and a long standing uninvestigated goiter who presented with lethargy, a new anterior neck swelling with dysphagia and change of voice. Ultrasound and computed tomography were performed and showed collection with multiple air pockets in the right thyroid lobule extending to the anterior mediastinum. She was started on intravenous antibiotics and underwent serial bedside aspiration. Her symptoms improved and complete resolution was achieved after serial aspirations and antibiotics.

Matched MeSH terms: Lethargy
Fulltext 'Houdini's Pituitary:' A Case Report of Regression of Pituitary Mass to Empty Sella in a 58-Year-Old Man with Autoimmune Hypophysitis

Ooi CP, Kamarruddin NA, Mustafa N, Kew TY

J ASEAN Fed Endocr Soc, 2018;33(1):69-73.
PMID: 33442114 DOI: 10.15605/jafes.033.01.12

A 58-year-old male presented with persistent severe headache, lethargy, decline libido and no neurological deficits. Besides quadruple anterior pituitary hormonal deficiencies, magnetic resonance imaging (MRI) demonstrated an enlarged ring-enhanced non-homogenous pituitary. Following hormonal replacement, these symptoms improved but empty sella evolved. The challenges of diagnosis and management were discussed. Awareness of the unclear etiology and uncertain clinical course of autoimmune hypophysitis in a man in this age group is essential for prompt and appropriate management.

Matched MeSH terms: Lethargy
Fulltext Autoimmune Thyroiditis as Initial Presentation of Systemic Lupus Erythematosus Complicated by Massive Ascites: A Case Report

Abdullah NRA, Akbar RZA

J ASEAN Fed Endocr Soc, 2017;32(1):50-53.
PMID: 33442085 DOI: 10.15605/jafes.032.01.09

Autoimmune thyroiditis in the course of other autoimmune diseases such as systemic lupus erythematosus (SLE) is common because these disorders are attributed to the production of autoantibodies against various autoantigens. Beyond this association, autoimmune thyroiditis can occur before, during or after the development of SLE. In this report, we describe a female who presented with facial puffiness, lethargy and progressive abdominal distension. She was diagnosed with autoimmune thyroiditis followed by the diagnosis of SLE complicated by a massive ascites, a rare form of lupus peritonitis, which is sterile ascites that results from severe serositis. Her presentation was complex and posed a diagnostic challenge and dilemma to the physicians involved in her care.

Matched MeSH terms: Lethargy
Fulltext Urogenital melioidosis: a review of clinical presentations, characteristic and outcomes

Chong Vh VH, Sharif F, Bickle I

Med J Malaysia, 2014 Dec;69(6):257-60.
PMID: 25934955 MyJurnal

INTRODUCTION: Melioidosis is endemic to the tropical regions, in particular Thailand and Northern Australia. Any organ can be affected by melioidosis. Involvement of the urogenital system is common in Northern Australia, but is less common in other regions. This study assesses the characteristics of melioidosis affecting the urogenital system treated in a tertiary referral centre in Brunei Darussalam.

MATERIAL AND METHODS: All patients treated for melioidosis of the urogenital system were identified and retrospectively reviewed.

RESULTS: There were 9 patients with 11 episodes of urogenital infections treated over 13 years. The median age at diagnosis was 38 years old (range 29 - 63) with men predominantly affected. The major risk factor was underlying diabetes mellitus (n=9), including three patients diagnosed at the time of diagnosis of melioidosis. The median glycosylated haemoglobin (HbA1c) was 12.8% (range 6.4 to 16.6%). One patient's risk factor was only moderate alcohol consumption. Common symptoms included; fever, lethargy, rigor and anorexia. Dysuria was reported by two patients. The median duration of symptoms before presentation was 7 days (range 2 to 21 days) and the median number of sites involved were 3 (range of 2 to 6). Urogenital involvement included prostate (n=6), kidney (n=8), seminal vesicles (n=1) and testis (n=1). Radiological imaging showed that large prostate abscesses (>4.5cm) were common, and in some patients, the kidney abscess had the 'honeycomb' previously described as typical for melioidosis liver abscess. All patients were successfully treated for melioidosis and at a median follow up of 34 months (range 1 - 97), there was one death from complications of diabetes mellitus.

CONCLUSION: Urogenital melioidosis only accounted for a small proportion of all melioidosis involvement, with prostate and kidney most commonly affected. Concomitant involvement of other sites were common. The major risk factor was poorly controlled diabetes mellitus.

Matched MeSH terms: Lethargy
Fulltext Intractable normal anion gap metabolic acidosis in a patient with diabetic ketoacidosis

Huan, Nai Chien, Wan Awatif Wan Mohd Zohdi

Borneo Journal of Medical Sciences, 2020;14(2):37-40.
MyJurnal

High anion gap metabolic acidosis (HAGMA) is a hallmark of Diabetic Ketoacidosis (DKA). Occasionally, a Normal Anion Gap Metabolic Acidosis (NAGMA) can be seen, especially during the treatment phase. In this case report, a 55-year-old lady with diabetes mellitus who presented with a 2-day history of fever, lethargy and multiple episodes of vomiting and diarrhoea. Initial laboratory investigations revealed: capillary blood glucose as 27 mmol/L, urine ketone as 3+, blood ketone as 3.5 mmol/L, serum bicarbonate as 14 mmol/L, and serum chloride as 95 mmol/L. She was treated with intravenous normal saline fluid resuscitation and constant rate insulin infusion which was fortunately accompanied by stabilization of blood glucose and normalization of blood ketone to 0.2 mmol/L. However, despite normalization of her anion gap (25 to 14), she remained unwell with acidotic breathing due to refractory hyperchloraemic NAGMA with bicarbonate at 11 mol/L and chloride of 112 mmol/L. It was then decided to administer 100 mL of 8.4% Sodium Bicarbonate solution. The next day, she was no longer tachypneic as her bicarbonate and carbon dioxide improved to 21 mmol/L and 32 mmHg respectively. The presence of NAGMA in DKA should prompt clinicians to conduct a thorough search for possible underlying causes, such as gastrointestinal fluid loss, sepsis and chloride load from aggressive fluid resuscitation with normal saline. Sodium bicarbonate should only be considered in intractable cases to correct a NAGMA and not routinely used in the treatment of DKA.

Matched MeSH terms: Lethargy
Fulltext Case Series of Pancytopenia Secondary to Pernicious Anaemia

Low, Qin Jian, Hong, Eric Qiu Weng, Cheo Seng Wee

Borneo Journal of Medical Sciences, 2019;13(2):55-59.
MyJurnal

Pernicious anaemia is an autoimmune disorder where vitamin B12 deficiency is caused by autoantibodies that interfere with vitamin B12 absorption by targeting intrinsic factor or parietal cells or both. It is commonly associated with anaemia, rarely pancytopenia. Here we reported two cases of pancytopenia due to undiagnosed pernicious anaemia. First case was a 26-year-old man presented with lethargy and reduced effort tolerance, associated with postural giddiness and palpitation. Clinically, he was pale with no other findings. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was treated with daily subcutaneous injection of vitamin B12 cyanocobalamin 1 mg for one week followed by weekly injection for a month and subsequently with lifelong monthly subcutaneous injection. After receiving 2 weeks of B12 replacement, his full blood count had normalized and his symptoms resolved. Second case was a 65-year-old man presented with yellowish discolouration of the eyes with lethargy. On examination, he was pale with jaundice. On blood investigations, the patient was diagnosed pancytopenia secondary to pernicious anaemia. He was started with intramuscular injection of 1000 mcg vitamin B12 replacement daily for one week followed by monthly for 6 months. After one week of B12 replacement, his full blood count had normalized. He was started on lifelong 3 monthly injections of vitamin B12 replacement and he remained symptom free. Patients with pernicious anaemia often present with general signs and symptoms which occur insidiously. It is important that early diagnosis is made to avoid harmful complications such as neuropsychiatric disorders.

Matched MeSH terms: Lethargy
Fulltext Primary plasma cell leukaemia in a 39-year-old man

Kasinathan G

BMJ Case Rep, 2020 Jul 23;13(7).
PMID: 32709663 DOI: 10.1136/bcr-2020-235543

Plasma cell leukaemia (PCL) is an aggressive haematological malignancy which is classified into primary (pPCL) and secondary PCL. A 39-year-old Indian man presented to the Department of Hematology with a 2-week history of fever and lethargy. Clinically, he was pale and febrile. Haemogram revealed bicytopenia with leucocytosis. The peripheral blood film portrayed rouleax formation with 45% of circulating plasma cells. Serum protein electrophoresis and immunofixation revealed IgG lambda paraproteinaemia of 48 g/L. Bone marrow aspirate, flow cytometry and trephine were consistent with IgG lambda pPCL. He was treated with six cycles of bortezomib, thalidomide and dexamethasone combination chemotherapy followed by high-dose melphalan conditioning and autologous stem cell transplant. Currently, he is in complete remission for the past 18 months and is on oral lenalidomide maintenance therapy. Prognosis is often dismal in pPCL with the median overall survival below 1 year if treatment is delayed.

Matched MeSH terms: Lethargy
Fulltext Thrombosis at unusual sites in reproductive age group - a case series

Mohd.Tohit ER, Khalid B, Seman Z, Md Noor S

Malaysian Journal of Medicine and Health Sciences, 2016;12(1):63-66.
MyJurnal

Thrombosis is one of the causes of morbidity and mortality in women of reproductive age group. Thrombosis at unusual sites may pose diagnostic and management dilemma for health care personnel. Teamwork and good communication provide the best modalities for maximum benefits to patients. Here with, we presented a case series of thrombosis at unusual sites seen and managed in our clinic.
A 35 year-old Malay lady presented with left hemiparesis while she was on oestrogen based combined contraception pills (C-OCP). Imaging studies showed extensive venous thrombosis with bilateral acute cortical infarct. Thrombophilia screening of antiphospholipid syndrome were negative. She was put on anticoagulant and stopped 2 years after the incident.
A 40 year-old Malay lady presented with abdominal discomfort, lethargy and massive splenomegaly. Bone marrow and trephine examination revealed primary myelofibrosis with positive JAK2617F. Imaging study showed chronic portal vein thrombosis with portal vein hypertension, complicated by gastro-oesophageal varices. She was put on hydroxyurea and later started on ruxolitinib with banding done over her gastro-oesophageal varices.
A 26 year-old Malay lady presented with serositis, mouth ulcer and anaemia symptoms. Laboratory studies were positive for systemic lupus erythematosus and negative for antiphospholipid study. Imaging study showed long segment thrombosis of right internal jugular vein with surrounding subcutaneous oedema. She is currently stable on anticoagulants and steroid. Teamwork and holistic approach is practiced in the investigation and management to provide maximum benefits for patients.

Matched MeSH terms: Lethargy

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