We report a 21-year old female patient who presented with an 18-month history of a swelling in the distal phalanx of her right little finger. Although the history, clinical features and MRI were suggestive of a benign tumour or a tuberculous lesion, the histo-pathological examination of the swelling was reported as a conventional osteosarcoma. Osteosarcoma of the hand is very rare. This article highlights the possibility of a seemingly benign lesion seen in a routine clinic could well turn out to be malignant, and the need to maintain a high index of suspicion
Osteosarcoma

Radiofrequency ablation is one of the more established forms of local treatment in patients with unresectable tumours, including colorectal hepatic metastases. Complications associated with this method of intervention include thermal and mechanical injuries, including vascular insults resulting in haemorrhage or pseudoaneurysm formation. This is the first case demonstrating the detection of post-ablation acute pseudoaneurysm formation identified on the table using contrast-enhanced ultrasound (CEUS) and the subsequent successful management.

Adolescent ; Adult ; Anticoagulants ; therapeutic use ; Aortic Valve Stenosis ; congenital ; surgery ; Dengue ; complications ; Heart Valve Prosthesis ; Humans ; Male ; Thrombocytopenia ; etiology ; Warfarin ; therapeutic use

No abstract available.

BACKGROUND: Cardiac troponins I (cTnI) and T (cTnT) have received international endorsement as the standard biomarkers for detection of myocardial injury, for risk stratification in patients suspected of acute coronary syndrome, and for the diagnosis of myocardial infarction. An evidence-based clinical database is growing rapidly for high-sensitivity (hs) troponin assays. Thus, clarifications of the analytical principles for the immunoassays used in clinical practice are important. CONTENT: The purpose of this mini-review is (a) to provide a background for the biochemistry of cTnT and cTnI and (b) to address the following analytical questions for both hs cTnI and cTnT assays: (i) How does an assay become designated hs? (ii) How does one realistically define healthy (normal) reference populations for determining the 99th percentile? (iii) What is the usual biological variation of these analytes? (iv) What assay imprecision characteristics are acceptable? (v) Will standardization of cardiac troponin assays be attainable? SUMMARY: This review raises important points regarding cTnI and cTnT assays and their reference limits and specifically addresses hs assays used to measure low concentrations (nanograms per liter or picograms per milliliter). Recommendations are made to help clarify the nomenclature. The review also identifies further challenges for the evolving science of cardiac troponin measurement. It is hoped that with the introduction of these concepts, both laboratorians and clinicians can develop a more unified view of how these assays are used worldwide in clinical practice.
Acute Coronary Syndrome ; Biochemistry ; Biomarkers ; Diagnosis ; Hope ; Humans ; Immunoassay ; Myocardial Infarction ; Troponin*

Recent epidemics and pandemics have highlighted a number of ethical concerns about the response to the increasing threat of emerging infectious diseases. Some of these ethical concerns are very fundamental. They include why a pandemic was declared, how much clinical information can be collected for public health without threatening patient confidentiality and how to ensure fairness in the distribution of resources. We discuss these issues and suggest approaches to resolve these dilemmas as we anticipate the next pandemic.
Communicable Disease Control ; Communicable Diseases ; epidemiology ; Disease Outbreaks ; ethics ; Ethics, Medical ; Global Health ; Humans ; Pandemics ; ethics ; Public Health Practice ; ethics ; Quarantine ; Sentinel Surveillance ; Singapore ; epidemiology

Malaria is endemic across lowland Papua New Guinea (PNG) and case management has been based on symptomatic diagnosis and presumptive treatment of fever cases with an antimalarial. This study aimed to investigate the prevalence of malaria infection among fever cases presenting to 5 purposely selected sentinel health facilities in order to estimate the proportion of patients requiring antimalarial drugs. A total of 1807 fever patients were screened. Overall, 45% of fever patients had a positive malaria blood slide; 35% were infected with Plasmodium falciparum, 9% with P. vivax and 2% with P. malariae. Slide positivity was highest in Dreikikir (75%) and lowest in Wipim (2%). Among patients aged 1-4 years, 22% had moderate to severe anaemia (Hb < 8 g/dI) and 21% of children 2-9 years of age showed signs of splenomegaly (Hackett score 1-5). Comorbidity differed significantly between study sites and was not closely correlated with malaria infection. Clinical diagnosis by health facility staff was malaria for 67% of all fever cases, including 89% of slide-positive and 48% of slide-negative patients. 70% of rapid diagnostic test-negative cases were treated with an antimalarial. It is estimated that due to the lack of parasitological diagnosis the selected health facilities reported an excess of 18% (Dreikikir) to 98% (Wipim) malaria patients on average each month. In consideration of the significant differences in malaria-attributable fevers between study sites, the implementation of parasitological diagnosis in health facilities and administration of antimalarials only to test-positive patients has the potential to significantly improve the management of fever cases and reporting of malaria. A better tailoring to different settings may increase the effectiveness of malaria control interventions.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Fever/*parasitology ; Humans ; Infant ; Malaria/complications/diagnosis/*epidemiology ; Male ; Papua New Guinea/epidemiology ; Young Adult

To determine the prognostic factors such as age, diagnosis, number of cycle attempts and semen parameters on the pregnancy rate of controlled ovarian hyperstimulation (COH) /intrauterine insemination (IUI). Three hundred and seventeen women who underwent 507 consecutive COH/IUI cycles were recruited from 1st January 2002 to 31st December 2005 inclusively. This retrospective study was done in University Malaya Medical Centre, a tertiary care academic centre. The main outcome measure was pregnancy rate according to age, infertility diagnosis, duration of infertility, semen parameters, and the number of treatment cycles. The overall pregnancy rates were 16.9% per cycle and 25.9% per couple. Pregnancy rates decreased with advancing maternal age. Pregnancy rate was also significantly lower in patient with postwash total motile sperm count (TMSC) < or = 20 million/ml compared to those with TMSC >20 million/ml. The cumulative pregnancy rates varied greatly by diagnosis from 16% for patients with male factor infertility to 60% for patients with ovulatory disorder. Pregnancies among patients with male infertility, tubal factors infertility and endometriosis were achieved during the first three cycles. There is a clear age-related decline in fecundity associated with COH/IUI treatment. Women of > 40 years old, couple with postwash TMSC < or = 20 million/ml, severe endometriosis and tubal factors have a particularly poor prognosis.
Pregnancy ; Infertility ; Intrauterine artificial insemination ; /mL ; Diagnostic

BACKGROUND: The practice of Unang Yakap or Essential Intrapartum and Newborn Care (EINC) during the COVID-19 pandemic poses a safety concern with regards to a newborn’s exposure to their COVID-19 suspected mother. OBJECTIVES: This study aims to describe the experiences of COVID-19-suspected mothers and explore the factors influencing their decision to allow healthcare professionals to practice full EINC. Specifically, it aims to: 1) describe the experiences of mothers prior to, during, and immediately after delivery, and during postpartum care leading to their decision; and 2) explore the factors that influence the participant’s decision to practice EINC amidst the pandemic. METHODOLOGY: For this phenomenological case study, online interviews with nine (9) participants were conducted using a 13-item questionnaire describing their experience. Thematic analysis using the inductive and semantic approach was conducted to identify the common themes or factors. RESULTS: Of the nine (9) participants, five (5) experienced EINC, while four (4) did not. The COVID-19 status and the choice to undergo Unang Yakap were not a causal relationship. Two main influences, mother-related factors, and hospital-related factors, were identified and were found to have weight in decision-making. The mother-related factors include prior knowledge and perception towards EINC, COVID-19 status, personal beliefs, and information from social media; while the hospital-related factors are hospital facilities, hospital protocols, and HCW-patient relationship. CONCLUSION By delineating the different factors that influence mothers’ decisions, this study allows for the identification of possible bottlenecks in the practice of EINC, as well as effective and efficient means to encourage its practice.
COVID-19

BACKGROUND: Welders are exposed to many known and suspected carcinogens. An excess lung cancer risk among welders is well established, but whether this is attributable to welding fumes is unclear. Excess risks of other cancers have been suggested, but not established. We investigated welding cancer risks in the population-based Canadian Census Health and Environmental Cohort. METHODS: Among 1.1 million male workers, 12,845 welders were identified using Standard Occupational Classification codes and followed through retrospective linkage of 1991 Canadian Long Form Census and Canadian Cancer Registry (1992–2010) records. Hazard ratios (HRs) were calculated using Cox proportional hazards models based on estimated risks of lung cancer, mesothelioma, and nasal, brain, stomach, kidney, and bladder cancers, and ocular melanoma. Lung cancer histological subtypes and risks by industry group and for occasional welders were examined. Some analyses restricted comparisons to blue-collar workers to minimize effects of potential confounders. RESULTS: Among welders, elevated risks were observed for lung cancer [HR: 1.16, 95% confidence interval (CI): 1.03–1.31], mesothelioma (HR: 1.78, 95% CI: 1.01–3.18), bladder cancer (HR: 1.40, 95% CI: 1.15–1.70), and kidney cancer (HR: 1.30, 95% CI: 1.01–1.67). When restricted to blue-collar workers, lung cancer and mesothelioma risks were attenuated, while bladder and kidney cancer risks increased. CONCLUSION: Excess risks of lung cancer and mesothelioma may be partly attributable to factors including smoking and asbestos. Welding-specific exposures may increase bladder and kidney cancer risks, and particular sources of exposure should be investigated. Studies that are able to disentangle welding effects from smoking and asbestos exposure are needed.
Asbestos ; Brain ; Carcinogens ; Censuses* ; Classification ; Cohort Studies* ; Humans ; Kidney ; Kidney Neoplasms ; Lung Neoplasms ; Male ; Melanoma ; Mesothelioma ; Occupational Diseases ; Occupational Exposure ; Proportional Hazards Models ; Retrospective Studies ; Smoke ; Smoking ; Stomach ; Urinary Bladder ; Urinary Bladder Neoplasms ; Welding