Life Threatening Stridor Due to Primary Laryngeal Tuberculosis

Tuberculosis is a potentially serious infectious disease. In otorhinolaryngology practice, lymph node infection is the most common site of predilection followed by the larynx. Laryngeal tuberculosis (LTB) typically presents with dysphagia, odynophagia and hoarseness. We reported a case of primary LTB presenting with acute upper airway obstruction and respiratory distress mimicking acute supraglottitis which requires emergency tracheostomy. Therefore, in acute upper airway obstruction, the appropriate initial investigation should be done to rule out TB to make sure early treatment can be given and it may prevent complications of disease to the patient. .

Persistent Pseudomonas Infection Mastoiditis—Local Antibiotic Treatment Is Superior than Systemic

Mastoiditis is a common complication of acute otitis media. It is common in younger age compared to adulthood. Mastoiditis occurs when an otitis media infection spread directly to involve the bone of mastoid air cell causing osteitis. Cholesteatoma can contribute to the development of mastoiditis. This typically leads to breakdown of some of the fine bony trabeculae of mastoid cells producing a coalescent mastoiditis with an emphyema in mastoid antrum. Cholesteatoma can contribute to the development of mastoiditis. The common treatment for mastoiditis is intravenous antibiotic. Our cases show that local antibiotic treatment is superior compared to systemic antibiotic in treating multi-drug resistant chronic. Pseudomonas mastoiditis compared to intravenous antibiotic. However, if it presents together with cholesteatoma the main treatment is still early mastoidectomy.

Infiltrative cardiac lymphoma with tricuspid valve involvement in a young man

Cardiac metastases are among the topics with limited systematic reviews.Theoretically,the heart can be infiltrated by any malignancy with the ability to spread to distant structures.Thus far,no specific tumors are known to have a predilection for the heart,but some do metastasize more often than others,for example,melanoma and primary mediastinal tumors.We report a case of cardiac metastasis from a diffuse large B cell lymphoma in a young man.The peculiarity of this case is that besides the involvement of right ventricle and atrium,the tricuspid valve was also infiltrated.Valvular metastasis is rarely reported in the medical literature.

Fenofibrate for the prevention of progression of non-proliferative diabetic retinopathy:review,consensus recommendations and guidance for clinical practice

The prevalence of diabetic retinopathy(DR),and associated morbidity is high in the Asia-Pacific region.Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR,especially in patients with cardiovascular risk,and pre-existing mild-to-moderate DR.Fenofibrate has also been found to reduce maculopathy,and the need for laser treatment in these patients.Considering these benefits of fenofibrate,a group of experts from the fields of endocrinology and ophthalmology convened in May 2017,to discuss on the the mechanism of action,and clinical efficacy of fenofibrate in DR.The findings from key clinical studies on fenofibrate in DR were reviewed by the experts,and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR.The statements were rated based on the GRADE criteria.An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes(T2D),and the place of fenofibrate was defined in the algorithm.The expert recommendations,and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.

Anemia among Antenatal Mother in Urban Malaysia

An understanding of factors influencing haemoglobin (Hb) level among antenatal mothers can help healthcare providers assess, take appropriate action and manage anaemia in this risk group more effectively. A cross-sectional study was conducted in urban areas in Malaysia to determine the Hb levels of antenatal mothers and their association with various socio-economic characteristics. Data for this study were collected from pregnant women during their first antenatal check-up at three selected polyclinics in Malaysia. Anaemia in pregnancy was determined by the Hb level recorded during the first and the last antenatal visits. Determination of Hb was either by a photo calorimetric method or by the Sahliís method. A structured self-administered questionnaire was used to identify the factors influencing Hb level among the antenatal mothers. This study found that 73 out of 217 mothers (33%) were anaemic in that their Hb levels were below 11.00 g/dl. The findings also suggested that Hb levels among the antenatal mothers were influenced by various factors such as education level, occupation, and family income. Anaemia was generally more common among antenatal mothers who had a lower level of education and who were from a background of lower family income.

Predicting severe dengue using quantified warning signs.A retrospective cohort study

Objective:To develop and evaluate predictive models by quantifying warning signs prior to the development of severe dengue.Methods:A retrospective cohort study was conducted in which the total number of warning signs each day was compared between dengue with warning signs and severe dengue.Multivariate logistic regression with forward likelihood ratio method was employed to achieve the best fit models for the prediction of severe dengue.The models were also being explored by adding diarrhoea and removing lethargy.Receiver operating characteristics were then used in these best fit models to identify suitable cut-off probability values derived from the equation of the models.Results:Median age of patients was 26 years old(interquartile range was 15 years)and 65.3%(1110)were males.Age with total number of warning signs at day one of illness(model T1)and age with total number of warning signs at day two of illness(model T2)were identified as the best fit models.The best probability cut-offs for model T1 was 0.0506 with 10.1%positive predictive value,96.4%negative predictive value,99.4%sensitivity,1.8%specificity;for model T2 was 0.0503 with 10.2%positive predictive value,96.4%negative predictive value,99.4%sensitivity,1.8%specificity.Conclusions:The models developed in this study might not reduce the burden effectively.Clinicians may use the models but the models must be re-validated in their clinical settings as the effect size might vary.Furthermore,the risk and benefit in selecting the cut-off values should be evaluated before implementing such models.

Comparison of vomiting and diarrhoea frequency among dengue-infected patients

Objective:To compare the differences of vomiting and diarrhoea frequency between dengue with warning signs and severe dengue,and to describe the sites of mucosal bleeding among dengue-infected patients.Methods:This was a retrospective cohort study which included patients with laboratory-confirmed dengue infection along with clinical diagnosis of dengue.Exclusion criteria were patients with haematological disorders or any other malignancy.The vomiting and diarrhoea frequency on each day(Day 1 to Day 5)between dengue with warning signs and severe dengue were compared by using Mann-Whitney U test.The different sites of mucosal bleeding were stratified according to the diagnoses and displayed by bar charts.Results:Out of 1700 patients,1003(59.0%)had vomiting and 587(34.5%)had diarrhoea.Both vomiting and diarrhoea frequency were not statistically different between dengue with warning signs and severe dengue from Day 1 to Day 5.Gum bleeding,hematemesis and menorrhagia were the only sites of mucosal bleeding seen in severe dengue for the first three days of illness.Hematemesis was seen only in severe dengue during the first day of illness but not in dengue with warning signs.Conclusions:The frequency of vomiting and diarrhoea could not differentiate severe dengue from dengue with warning signs.Nevertheless,it is important to have high index of suspicion for dengue when patients are presented with diarrhoea.The different sites of mucosal bleeding could possibly predict severe dengue,especially hematemesis on the first three days of illness.