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Fulltext Transient Cortical Blindness After Coronary Angiography, Bypass Graft Angiography, and Coronary Angioplasty

Lee ZV, Arjan Singh RS

Cureus, 2021 Jan 07;13(1):e12542.
PMID: 33425567 DOI: 10.7759/cureus.12542

Transient cortical blindness after coronary angiography has long been reported in the literature; however, this condition remains rare until today. We report a case of transient cortical blindness after coronary angiography, bypass graft angiography, and coronary angioplasty, which was deemed to be secondary to contrast agent. A 60-year-old man who underwent prior coronary artery bypass grafting (CABG) started to experience recurrence of exertional and resting chest pain one year after CABG. In addition to coronary artery disease, he has underlying type 2 diabetes mellitus, hypertension, and dyslipidemia. Due to technical reasons, he was unable to undergo a computed tomography (CT) angiography of the coronary arteries and bypass grafts. Invasive coronary and bypass graft angiography were done, followed by stenting of the left circumflex artery. Thirty minutes after completion of the procedure, the patient had bilateral blurring of vision, which worsened drastically to only being able to perceive light bilaterally. The patient otherwise did not have any other neurological deficits. Binocular indirect ophthalmoscopy revealed no significant abnormalities apart from mild non-proliferative diabetic retinopathy of the left eye. A non-contrasted CT scan of the brain revealed acute subarachnoid bleed in both occipital lobes, but a subsequent magnetic resonance imaging scan of the brain revealed no evidence of intracranial bleed. The patient's vision gradually improved eight hours after the index event, and his vision completely normalized 12 hours later. The patient was discharged well two days later, and at one-month, three-month, and six-month follow-up, the patient remained angina-free, and his vision had remained stable bilaterally.
Aggressive diuretic therapy for a large solitary lung lesion

Mohd Firdaus MAB, Zulkafli H, Said MR, Hadi MF, Sukhari S, Arjan Singh RS

Med J Malaysia, 2020 11;75(6):750-751.
PMID: 33219192

Pseudotumour of the lung is a rare chest x-ray finding among patients who present with fluid overload. It is caused by loculated pleural effusion in the lung fissures. Unfortunately, the occurrence of pseudotumour can be misleading and sometimes can lead to unnecessary investigation and emotional stress to the patient. We present here a case of a 61-year-old gentleman with a known history of hypertension, diabetes mellitus and dyslipidemia who presented at University Malaya Medical Centre with symptoms of fluid overload and a right middle lobe mass on chest x-ray. The right middle lobe mass disappeared entirely after being treated with aggressive diuretic therapy. A diagnosis of pseudotumour was made and described in this case report.
Insights into size-segregated particulate chemistry and sources in urban environment over central Indo-Gangetic Plain

Singh N, Banerjee T, Murari V, Deboudt K, Khan MF, Singh RS, et al.

Chemosphere, 2021 Jan;263:128030.
PMID: 33297051 DOI: 10.1016/j.chemosphere.2020.128030

Size-segregated airborne fine (PM2.1) and coarse (PM>2.1) particulates were measured in an urban environment over central Indo-Gangetic plain in between 2015 and 2018 to get insights into its nature, chemistry and sources. Mean (±1σ) concentration of PM2.1 was 98 (±76) μgm-3 with a seasonal high during winter (DJF, 162 ± 71 μgm-3) compared to pre-monsoon specific high in PM>2.1 (MAMJ, 177 ± 84 μgm-3) with an annual mean of 170 (±69) μgm-3. PM2.1 was secondary in nature with abundant secondary inorganic aerosols (20% of particulate mass) and water-soluble organic carbon (19%) against metal enriched (25%) PM>2.1, having robust signature of resuspensions from Earth's crust and road dust. Ammonium-based neutralization of particulate acidity was essentially in PM2.1 with an indication of predominant H2SO4 neutralization in bisulfate form compared to Ca2+ and Mg2+-based neutralization in PM>2.1. Molecular distribution of n-alkanes homologues (C17-C35) showed Cmax at C23 (PM2.1) and C18 (PM>2.1) with weak dominance of odd-numbered n-alkanes. Carbon preference index of n-alkanes was close to unity (PM2.1: 1.4 ± 0.3; PM>2.1: 1.3 ± 0.4). Fatty acids (C12-C26) were characterized with predominance of even carbon with Cmax at n-hexadecanoic acid (C16:0). Low to high molecular weight fatty acid ratio ranged from 2.0 (PM>2.1) to 5.6 (PM2.1) with vital signature of anthropogenic emissions. Levoglucosan was abundant in PM2.1 (758 ± 481 ngm-3) with a high ratio (11.6) against galactosan, emphasizing robust contribution from burning of hardwood and agricultural residues. Receptor model resolves secondary aerosols and biomass burning emissions (45%) as the most influential sources of PM2.1 whereas, crustal (29%) and secondary aerosols (29%) were found responsible for PM>2.1; with significant variations among the seasons.
Fulltext Evolving trends in infective endocarditis in a developing country: a consequence of medical progress?

Sunil M, Hieu HQ, Arjan Singh RS, Ponnampalavanar S, Siew KSW, Loch A

Ann Clin Microbiol Antimicrob, 2019 Dec 17;18(1):43.
PMID: 31847847 DOI: 10.1186/s12941-019-0341-x

BACKGROUND: Staphylococcus has replaced streptococcus as the most common cause of infective endocarditis (IE) in developed health care systems. The trend in developing countries is less clear.
AIM: To examine the epidemiological trends of infective endocarditis in a developing nation.
METHODS: Single-centre, retrospective study of patients admitted with IE to a tertiary hospital in Malaysia over a 12-year period.
RESULTS: The analysis included 182 patients (n = 153 Duke's definite IE, n = 29 possible IE). The mean age was 51 years. Rheumatic heart disease was present in 42%, while 7.6% were immunocompromised. IE affected native valves in 171 (94%) cases. Health-care associated IE (HCAIE) was recorded in 68 (37.4%). IE admission rates increased from 25/100,000 admissions (2012) to 59/100,000 admissions (2017). At least one major complication on admission was detected in 59 (32.4%) patients. Left-sided IE was more common than right-sided IE [n = 159 (87.4%) vs. n = 18 (9.9%)]. Pathogens identified by blood culture were staphylococcus group [n = 58 (40.8%)], streptococcus group [n = 51 (35.9%)] and Enterococcus species [n = 13 (9.2%)]. staphylococcus infection was highest in the HCAIE group. In-hospital death occurred in 65 (35.7%) patients. In-hospital surgery was performed for 36 (19.8%) patients. At least one complication was documented in 163 (85.7%).
CONCLUSION: Staphylococcus is the new etiologic champion, reflecting the transition of the healthcare system. Streptococcus is still an important culprit organism. The incidence rate of IE appears to be increasing. The rate of patients with underlying rheumatic heart disease is still high.
Reversal of Roux-en-Y Gastric Bypass to Normal Anatomy in a Severely Malnourished Patient After Metabolic Bariatric Surgery

Sadu Singh RS, Loo GH, Muthkumaran G, Azna Ali A, Ritza Kosai N

Cureus, 2024 Oct;16(10):e71240.
PMID: 39525114 DOI: 10.7759/cureus.71240

Obesity stands as a prominent health challenge in our society, with metabolic bariatric surgery (MBS) emerging as a solution due to its efficacy in addressing obesity-related type 2 diabetes mellitus (T2DM). Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) remain the most common MBS after sleeve gastrectomy. Complications from RYGB are uncommon but include anastomotic stricture, marginal ulcers, small bowel obstruction, and nutritional complications. We present a 52-year-old lady with an initial body mass index (BMI) of 27.6 kg/m2 and poorly controlled T2DM who presented with generalized body weakness and uncontrolled weight loss after an RYGB performed four months earlier. She was cachexic with a BMI of 17 kg/m2,with generalized anasarca with a multitude of electrolyte disturbances. After nutritional optimization, she underwent a reversal surgery back to normal anatomy. Reversal of RYGB to normal anatomy is a complex surgical procedure and is often the last resort undertaken in patients experiencing severe complications from the initial surgery. Indications include malnutrition, severe dumping syndrome, excessive weight loss, and recalcitrant marginal ulcers. Our case outlines the importance of proper patient selection for MBS and highlights the preoperative management of RYGB reversal to normal anatomy. We also describe the surgical procedure using a stepwise approach. In conclusion, the reversal of RYGB to normal anatomy should only be undertaken after a careful period of prehabilitation to reduce perioperative complications. The inclusion of dietitians, endocrinologists, and physiotherapists is crucial to ensure the best possible outcome.
Fulltext Proximal Margin Involvement Following Total Gastrectomy for Seiwert III Adenocarcinoma: A Management Dilemma

Sadu Singh RS, Loo GH, Muthkumaran G, Sambanthan ST, Ritza Kosai N

Cureus, 2024 Jul;16(7):e64945.
PMID: 39156343 DOI: 10.7759/cureus.64945

Oesophagogastric junction carcinoma is now being increasingly regarded as a distinct site of neoplasia, separate from its adjacent sites. Recent advances in multimodal treatment approaches, including endoscopic procedures, oesophagectomy with three-field lymph node dissection, and definitive chemoradiotherapy, have significantly improved overall patient survival rates. Despite these advancements, the recurrence rate remains around 50% within one to three years following initial surgery. A major challenge in management arises when the resected surgical margins are involved with cancer. We present a 55-year-old man who experienced progressive dysphagia and, upon further assessment, was noted to have a Siewert III oesophagogastric junction adenocarcinoma. He underwent neoadjuvant chemotherapy before undergoing total gastrectomy with D2 lymphadenectomy with a Roux-en-Y reconstruction. Histopathological examination of the resected specimen revealed a positive proximal margin involvement. After optimization, he then underwent a salvage three-field McKeown oesophagectomy with colonic conduit reconstruction and adjuvant chemotherapy. Salvage surgery can be considered for patients with locoregional recurrence after definitive chemoradiotherapy or surgery. Other options include salvage chemoradiotherapy. Our case outlines the importance of proper patient selection for salvage surgery and highlights the choices of conduit in patients undergoing total esophagectomy post gastrectomy. In conclusion, managing proximal margin involvement of cardioesophageal junction adenocarcinoma remains a complex and multifaceted challenge, necessitating a tailored, multidisciplinary approach. The decision-making process must consider the patient's functional status, previous treatments, and specific anatomical considerations.
Fulltext Genetic linkage map of a high yielding FELDA deli×yangambi oil palm cross

Seng TY, Mohamed Saad SH, Chin CW, Ting NC, Harminder Singh RS, Qamaruz Zaman F, et al.

PLoS One, 2011;6(11):e26593.
PMID: 22069457 DOI: 10.1371/journal.pone.0026593

Enroute to mapping QTLs for yield components in oil palm, we constructed the linkage map of a FELDA high yielding oil palm (Elaeis guineensis), hybrid cross. The parents of the mapping population are a Deli dura and a pisifera of Yangambi origin. The cross out-yielded the average by 8-21% in four trials all of which yielded comparably to the best current commercial planting materials. The higher yield derived from a higher fruit oil content. SSR markers in the public domain - from CIRAD and MPOB, as well as some developed in FELDA - were used for the mapping, augmented by locally-designed AFLP markers. The female parent linkage map comprised 317 marker loci and the male parent map 331 loci, both in 16 linkage groups each. The number of markers per group ranged from 8-47 in the former and 12-40 in the latter. The integrated map was 2,247.5 cM long and included 479 markers and 168 anchor points. The number of markers per linkage group was 15-57, the average being 29, and the average map density 4.7 cM. The linkage groups ranged in length from 77.5 cM to 223.7 cM, with an average of 137 cM. The map is currently being validated against a closely related population and also being expanded to include yield related QTLs.