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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.
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.

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