MyMedR

INTRODUCTION: The poor prognosis of lung cancer has been largely attributed to the fact that most patients present with advanced stage disease. Although low dose computed tomography (LDCT) is presently considered the optimal imaging modality for lung cancer screening, its use has been hampered by cost and accessibility. One possible approach to facilitate lung cancer screening is to implement a risk-stratification step with chest radiography, given its ease of access and affordability. Furthermore, implementation of artificial-intelligence (AI) in chest radiography is expected to improve the detection of indeterminate pulmonary nodules, which may represent early lung cancer.

MATERIALS AND METHODS: This consensus statement was formulated by a panel of five experts of primary care and specialist doctors. A lung cancer screening algorithm was proposed for implementation locally.

RESULTS: In an earlier pilot project collaboration, AI-assisted chest radiography had been incorporated into lung cancer screening in the community. Preliminary experience in the pilot project suggests that the system is easy to use, affordable and scalable. Drawing from experience with the pilot project, a standardised lung cancer screening algorithm using AI in Malaysia was proposed. Requirements for such a screening programme, expected outcomes and limitations of AI-assisted chest radiography were also discussed.

CONCLUSION: The combined strategy of AI-assisted chest radiography and complementary LDCT imaging has great potential in detecting early-stage lung cancer in a timely manner, and irrespective of risk status. The proposed screening algorithm provides a guide for clinicians in Malaysia to participate in screening efforts.

Fulltext The contemporary role of transoesophageal echocardiography in emergency surgery for massive pulmonary embolism

Sachithanandan A, Abdul Muis J, Zurah Z, Mohd R

Med J Malaysia, 2013 Dec;68(6):475-6.

PMID: 24632918 MyJurnal

No abstract available.

Fulltext Surgery for isolated non-inflammatory chronic total occlusion of the left main coronary artery: a case report and literature review

Azam AF, How LA, Nor A, Badmanaban B, Sachithanandan A

Med J Malaysia, 2011 Oct;66(4):374-5.

PMID: 22299565 MyJurnal

Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is a rare manifestation of coronary artery disease (CAD) and defined by a total absence of antegrade blood flow to the left anterior descending (LAD) and circumflex (Cx) system. Patients are at high risk of myocardial ischaemia as a sizeable area of myocardium is at risk and thus require urgent intervention. Surgery is the treatment of choice especially with CTO lesions as percutaneous coronary intervention has limited success with a high restenosis rate. We report a rare case of a young Chinese male who presented acutely with a myocardial infarction and discuss the aetiology and peri-operative technical considerations for successful surgery with this condition.

Fulltext Successful anticoagulation with fresh frozen plasma for cardiopulmonary bypass in a patient with heparin resistance: a cautionary tale

Badrin O, Kushairi S, Zakaria Z, Sachithanandan A

BMJ Case Rep, 2013;2013.

PMID: 23632185 DOI: 10.1136/bcr-2013-009112

Heparin resistance (HR) is an increasingly common occurrence due to a greater awareness of the benefits of antithrombosis prophylaxis in hospitalised patients with low molecular weight and unfractionated heparin. Furthermore as more high-risk patients with prior heparin exposure undergo cardiac surgery we can expect to encounter more such cases. Adequate anticoagulation is essential for the safe conduct of any operation requiring cardiopulmonary bypass and is usually achieved with systemic heparinisation. We report a case of successful anticoagulation with the intraoperative administration of fresh frozen plasma in a high-risk coronary patient with HR and highlight the perils of unwitting overheparinisation in such cases. This case highlights the importance of clinical awareness of this phenomenon and the available alternative anticoagulants.

Fulltext Suboptimal Therapy for Dyslipidaemia in Coronary Bypass Surgical Patients with Premature Ischaemic Heart Disease

Yong Sheng Tan NH, Sachithanandan A

Med J Malaysia, 2015 Apr;70(2):114-5.

PMID: 26162393 MyJurnal

The incidence of premature multi-vessel coronary artery disease (CAD) is on the rise in Malaysia. The pathogenesis of coronary atherosclerosis is multi-factorial with dyslipidaemia being one such risk factor. Elevated total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglycerides (TG) levels are primarily responsible. We analysed the fasting pre-operative lipid profiles of coronary artery bypass graft (CABG) patients with symptomatic severe premature CAD. A majority of patients had an elevated LDL cholesterol level despite being on a statin. Similarly, no patient with an elevated TG level was prescribed a fibrate. Pre-operative control of known dyslipidaemia was suboptimal in young adults with angiographially proven severe symptomatic CAD. This is either due to subtherapeutic dose prescribing or failure to commence appropriate anti-lipid drugs. Collectively, general practitioners, cardiologists and cardiac surgeons must be more diligent in monitoring lipid profiles in such patients and be more meticulous in prescribing therapeutic doses to achieve target control.

Fulltext Single stage minimally invasive bilateral video assisted thoracoscopic surgery for simultaneous bilateral primary spontaneous pneumothorax

Sachithanandan A, Nur Ezrin I, Badmanaban B

Med J Malaysia, 2012 Apr;67(2):226-7.

PMID: 22822653 MyJurnal

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare life-threatening condition that requires rapid diagnosis and treatment. Most cases are secondary to various underlying lung pathology but a primary SBSP may occur due to rupture of subpleural blebs or bullae. Surgery via an open or minimally invasive approach provides definitive treatment and can be undertaken as a staged or simultaneous procedure. We report our experience with two such rare cases utilizing a single stage minimally invasive bilateral video assisted thoracoscopic (VATS) approach. The pathogenesis of this rare condition and intra-operative technical considerations for a successful outcome are discussed.

Fulltext Screening for peripheral arterial disease in prospective coronary bypass surgical patients

Sachithanandan A

Med J Malaysia, 2013 Aug;68(4):379.

PMID: 24145277

Fulltext Screening for lung cancer in Malaysia: are we there yet?

Sachithanandan A, Badmanaban B

Med J Malaysia, 2012 Feb;67(1):3-6.

PMID: 22582540 MyJurnal

Screening for Lung Cancer in High-Risk Non-Smokers: A Step too Far or Time to Address an Unmet Need?

Sachithanandan A

Med J Malaysia, 2023 Nov;78(6):847-848.

PMID: 38031230