Serdang Hospital is a government-funded multi-specialty hospital located in Sepang District, Selangor, Malaysia. This hospital is located near Putrajaya, the Malaysian federal government administrative centre. The location of the hospital borders the South Klang Valley Expressway (SKVE) to the east and the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM) and the upcoming UPM own teaching hospital to the west. It is clearly seen from the North–South Expressway at the Kajang Interchange..
This case report discusses a 16-year-old male patient with a history of recurrent allergic rhinitis and sinusitis, who initially presented with left eyelid swelling, proptosis, and progressive facial edema extending from the left medial canthus to the nasal bridge. He was treated for nearly a year under the working diagnosis of chronic left dacryocystitis with multiple courses of topical, oral, and intravenous antibiotics. However, the patient developed worsening proptosis, progressive left-sided vision loss, and left submandibular lymphadenopathy, which ultimately guided the diagnostic focus toward ocular adnexal lymphoma (OAL) involving the left orbit. Despite multiple imaging studies and histopathological assessments, it took nearly a year to identify the exact pathology. This case report details the diagnostic journey, treatment strategies, and interventions employed to preserve the patient's vision, ultimately enabling him to resume normal activities. We emphasize that in cases of chronic, unresponsive dacryocystitis, ocular adnexal lymphoma should be considered in the differential diagnosis. Early surgical intervention plays a critical role in optimizing visual outcomes and should be pursued to avoid further morbidity associated with delayed diagnosis.
Background: Tuberculous pleural effusion (TBE) and malignant pleural effusion (MPE) are the most common causes of exudative pleural effusion in tuberculosis-endemic regions. This study evaluates transthoracic ultrasound (TUS) features of TBE vs. MPE and incorporates clinical and pleural fluid (Pf) parameters into a machine learning-based random forest (RF) model for differentiation. Methods: This prospective observational study was conducted over 6 months across six tertiary hospitals in Malaysia, involving patients undergoing diagnostic medical thoracoscopy (MT). Diagnostic confidence for TBE and MPE was determined based on final thoracoscopic diagnosis. Logistic regression and RF models were applied to predefined clinical, imaging, and laboratory variables. Results: Among 187 recruited patients, 132 (70 TBE and 62 MPE) subjects with at least moderate diagnostic confidence were analyzed. On TUS, TBE was more likely to be non-hyperechoic, complex, and loculated, with the presence of fibrin and less pleural thickening, while MPE showed hyperechoic effusion and hemidiaphragm nodules. Independent predictors for TBE included younger age [adjusted odds ratio (aOR) =0.94], presence of fibrin (aOR =2.86), lower Pf lactate dehydrogenase (LDH) (aOR =0.996), and higher Pf adenosine deaminase (ADA) (aOR =1.10). Without Pf ADA, these parameters, along with the absence of hemidiaphragm nodules (aOR =0.33), remained significant for TBE prediction. The RF model outperformed logistic regression (92.6% vs. 87.9% accuracy), even without Pf ADA. Conclusions: TUS parameters can aid in differentiating TBE from MPE. The RF model demonstrated superior diagnostic performance, offering a potential point-of-care tool, even in the absence of Pf ADA.
A man in his late 60s presented with rapidly progressive dyspnoea and inspiratory stridor requiring emergency intubation. Bronchoscopy demonstrated critical bilateral main bronchial compression, and biopsy confirmed small cell lung cancer (SCLC) with bulky mediastinal disease. Deliberately dose-reduced carboplatin and etoposide were initiated. Despite prophylactic hydration and allopurinol, he developed fulminant tumour lysis syndrome (TLS) approximately 72 hours after chemotherapy initiation, meeting Cairo-Bishop criteria and died despite rasburicase and maximal supportive care.TLS is rare in solid tumours, and in SCLC, it is typically reported following spontaneous lysis or full-dose chemotherapy. This case demonstrates that even dose-reduced chemotherapy, when used emergently in bulky, chemosensitive disease, can precipitate catastrophic TLS. It highlights critical airway compromise in SCLC as a high-risk phenotype and highlights the need for heightened vigilance and anticipatory management when balancing urgent airway stabilisation against systemic therapy.
BackgroundIschemic heart disease (IHD) is becoming increasingly prevalent, with a rising trend significantly impacting the quality of life (QoL) of young Malaysians. ObjectiveThis study aimed to investigate the direct and indirect relationships between eHealth literacy (eHealth) and patient adherence (PA), as well as their mediating effects on the associations of health consciousness (HC) and perceived severity to chronic disease (PS) with QoL among young patients with IHD. MethodsA cross-sectional study was conducted at 2 hospitals, recruiting eligible patients through consecutive sampling at outpatient cardiology clinics. Data were collected via a validated self-administered questionnaire encompassing sociodemographic and socioeconomic status, medical history, and PS, HC, eHealth, PA, and QoL data. Structural equation modeling analysis was used to evaluate the relationships. The ethics approval was obtained from the Ethical Committee of Universiti Kebangsaan Malaysia Medical Centre (FF-2021-117). ResultsA total of 136 young patients with IHD participated in the study. Structural equation modeling analysis revealed that eHealth had the strongest positive effect on QoL (β=0.287, P=.002), followed by PA (β=0.245, P=.02), and HC (β=0.218, P=.02). Two significant mediation models were identified, aligning with the Transactional Model of eHealth Literacy theory. The first model demonstrated parallel mediation, where eHealth (β=0.125, P=.008) and PA (β=0.083, P=.046) significantly mediated the relationship between HC and QoL. The second model indicated serial mediation through eHealth and PA between HC and QoL (β=0.042, P=.049). The parallel mediation model exhibited medium predictive power and was deemed the best-fit model. ConclusionsThe parallel model pathway showed significant direct and indirect associations between eHealth, PA, HC, and QoL, with eHealth demonstrating the strongest association. Higher eHealth and PA were associated with QoL among young patients with IHD; interventions to support eHealth warrant further investigation in longitudinal or interventional studies.
