MyMedR

Evaluation of irradiated salivary gland function in patients with head and neck tumours treated with radiotherapy

Baharudin A, Khairuddin A, Nizam A, Samsuddin AR

J Laryngol Otol, 2009 Jan;123(1):108-13.

PMID: 18452635 DOI: 10.1017/S0022215108002466

Radiotherapy is an important treatment modality for head and neck tumours. One of its major drawbacks is post-treatment salivary gland hypofunction. This study was performed to objectively evaluate the salivary gland function in post-irradiated head and neck tumour patients.

Fulltext Spontaneous Omental Infarction: An Unusual Etiology of Abdominal Pain

Khairuddin A, Teng WW, Azizan N, Hayati F, Sahid NA, Kadir F

Kathmandu Univ Med J (KUMJ), 2019 10 1;17(68):347-349.

PMID: 33311048

A 49-year-old lady with previous scars complained of acute abdominal pain for two days. Her right hypochondrium was tender and guarding upon assessment. The laboratory investigations were unremarkable. Due to a diagnostic incongruity, computed tomography of the abdomen was performed showing a suspicious lesion at anterolateral aspect of the ascending colon. Surgical intervention was decided and intraoperative finding was consistent with spontaneous omental infarction. Omentectomy was undertaken and final histology was compatible with the intraoperative diagnosis. Although it is exceptional, omental infarction should be considered as part of the differential diagnoses of right-sided acute abdominal pain with normal laboratory investigations. This case highlights its unexpected discovery and we describe its literature reviews.

The opposing roles of NOTCH signalling in head and neck cancer: a mini review

Yap LF, Lee D, Khairuddin A, Pairan MF, Puspita B, Siar CH, et al.

Oral Dis, 2015 Oct;21(7):850-7.

PMID: 25580884 DOI: 10.1111/odi.12309

NOTCH signalling can exert oncogenic or tumour suppressive effects in both solid and haematological malignancies. Similar to T-cell acute lymphoblastic leukaemia (T-ALL), early studies suggested a pro-tumorigenic role of NOTCH in head and neck squamous cell carcinoma (HNSCC), mainly based on the increased expression levels of the genes within the pathway. Recently, data from exome sequencing analyses unexpectedly pointed to a tumour suppressor role for NOTCH in HNSCC by identifying loss-of-function mutations in the NOTCH1 gene in a significant proportion of patients. These data have questioned the accepted role of NOTCH in HNSCC and the possible rationale of targeting NOTCH in this disease. This review summarises the current information on NOTCH signalling in HNSCC and discusses how this pathway can apparently exert opposing effects within the same disease.

Fulltext Trapped cystofix: Laparoscopic modality to untie

Muhamad A, Johan S, Khairuddin A, Hayati F, Payus AO, Zainal Abidin ZA

Urol Case Rep, 2021 Jan;34:101448.

PMID: 33088720 DOI: 10.1016/j.eucr.2020.101448

Suprapubic catheterization (SPC) is a temporary measure to relieve acute urinary retention (AUR). Despite being effective, it can lead to complications such as colon perforation, haematuria, and bladder wall spasm. We present a 52-year-old lady with cystofix for underlying urethral stricture presented with AUR. A new SPC was inserted to drain the urine. However, the SPC had looped and entangled with her cystofix, and laparoscopic removal of cystofix and insertion of a new SPC was done. In conclusion, trapped cystofix to the SPC tube is a potential complication during SPC insertion that can be avoided with appropriate care.

Fulltext Jejunojejunal intussusception secondary to inflammatory fibroid polyp: A rare cause of small bowel obstruction

Tan JS, Teah KM, Hoe VC, Khairuddin A, Sellapan H, Hayati F, et al.

Ann Med Surg (Lond), 2020 Nov;59:251-253.

PMID: 33088499 DOI: 10.1016/j.amsu.2020.10.009

Background: Adult intussusception is a relatively rare clinical entity. The majority of cases of intussusception in adults are due to a pathologic condition that serves as a lead point and requires surgery. Small bowel intussusception is usually caused by benign or malignant neoplasms appearing at the head of the invagination. Inflammatory fibroid polyp (IFP) of the small bowel is an unusual benign neoplastic lesion that has been rarely reported to cause intussusception, especially in the jejunum.

Case presentation: We present a rare case of adult intussusception who presented with a triad of intestinal obstruction. Computed tomography revealed small bowel intussusception with bowel ischemia. Intraoperatively, she required resection of the small bowel and primary anastomosis. Macroscopic examination revealed a single pedunculated polyp, which is the lead point of intestinal obstruction and confirmed histologically.

Conclusion: Inflammatory fibroid polyp should be considered as a cause of intussusception among adults with small bowel obstruction.

Fulltext Incidental hepatic tuberculosis during planned resection of locally advanced ampullary carcinoma: a case report

Hoe VC, Khairuddin A, Tan JS, Sharif MS, Azizan N, Hayati F

BMC Surg, 2020 Jun 30;20(1):145.

PMID: 32605613 DOI: 10.1186/s12893-020-00806-8

BACKGROUND: Tuberculosis (TB) is classified according to the site of disease as pulmonary or extrapulmonary. Extrapulmonary TB is less common than its counterpart in which it can be found anywhere in the body including the liver. Similar to ampullary carcinoma, TB liver can manifest with jaundice and deranged liver function tests, particularly in the obstructed biliary systems.

CASE PRESENTATION: A 43-year-old gentleman with locally advanced ampullary carcinoma was noticed to have multiple suspicious liver nodules intraoperatively during curative ampulla resection. The surgery was then abandoned after a biopsy. The histology was consistent with chronic granulomatous inflammation. He was then subjected to a Whipple pancreaticoduodenectomy procedure after initiation of anti-tubercular treatment. He recovered well with no evidence of tumour recurrence and worsening TB.

CONCLUSIONS: A high index of suspicion and quick decision making can help to diagnose a possible extrapulmonary TB masquerading as a malignant disease in a patient with curative intention of ampullary carcinoma.

Fulltext Emergency laparoscopic resection of spontaneous rupture of hepatocellular carcinoma: A case report

Khairuddin A, Ong GH, Tan JS, Johan S, Hoe VC, Sharif MS, et al.

Int J Surg Case Rep, 2020;66:104-106.

PMID: 31830742 DOI: 10.1016/j.ijscr.2019.11.055

INTRODUCTION: Laparoscopic liver resection is currently performed as a therapeutic modality in hepatocellular carcinoma (HCC). In an emergency setting such as bleeding or rupture, however it has not been well documented.

PRESENTATION OF CASE: We describe a 55-year-old lady who presented to the emergency department with epigastric pain and symptoms of anaemia for one day duration. She was normotensive but tachycardic. Blood investigations revealed haemoglobin level of 6.5 g/dL and serum alpha-fetoprotein of 3136 g/dL. Contrast enhanced computed tomography scan revealed ruptured HCC of segment 2 and 3. She underwent emergency laparoscopic resection of the ruptured HCC. The postoperative recovery was uneventful and she was discharged well on postoperative day 7. Histology confirmed a 10 cm ruptured HCC with 3 mm tumour-free resection margin.

DISCUSSION: Ruptured HCC is associated with a high mortality rate of 25-75 %. Traditional treatment involves initial stabilization and hemostasis through transarterial embolization followed by staged hepatic resection. However, laparoscopic liver resection has been shown to be superior than open surgery in terms of postoperative outcomes.

CONCLUSION: Laparoscopic resection of bleeding HCC is achievable and can be considered in the treatment algorithm of selected patients.

An automated malaria cells detection from thin blood smear images using deep learning

Sukumarran D, Hasikin K, Mohd Khairuddin AS, Ngui R, Wan Sulaiman WY, Vythilingam I, et al.

Trop Biomed, 2023 Jun 01;40(2):208-219.

PMID: 37650409 DOI: 10.47665/tb.40.2.013

Timely and rapid diagnosis is crucial for faster and proper malaria treatment planning. Microscopic examination is the gold standard for malaria diagnosis, where hundreds of millions of blood films are examined annually. However, this method's effectiveness depends on the trained microscopist's skills. With the increasing interest in applying deep learning in malaria diagnosis, this study aims to determine the most suitable deep-learning object detection architecture and their applicability to detect and distinguish red blood cells as either malaria-infected or non-infected cells. The object detectors Yolov4, Faster R-CNN, and SSD 300 are trained with images infected by all five malaria parasites and from four stages of infection with 80/20 train and test data partition. The performance of object detectors is evaluated, and hyperparameters are optimized to select the best-performing model. The best-performing model was also assessed with an independent dataset to verify the models' ability to generalize in different domains. The results show that upon training, the Yolov4 model achieves a precision of 83%, recall of 95%, F1-score of 89%, and mean average precision of 93.87% at a threshold of 0.5. Conclusively, Yolov4 can act as an alternative in detecting the infected cells from whole thin blood smear images. Object detectors can complement a deep learning classification model in detecting infected cells since they eliminate the need to train on single-cell images and have been demonstrated to be more feasible for a different target domain.

Fulltext Intramyocardial Dissecting Hematoma in Patients with Ischemic Cardiomyopathy: Role of Multimodality Imaging in Three Patients Treated Conservatively

Roslan A, Jauhari Aktifanus AT, Hakim N, Megat Samsudin WN, Khairuddin A

CASE (Phila), 2017 Aug;1(4):159-162.

PMID: 30062271 DOI: 10.1016/j.case.2017.05.004

• IDH is an infrequent complication of myocardial infarction. • IDH can be diagnosed with echocardiography and multimodality imaging. • Conservative management is a viable option in patients with poor LVEF and DCM.

Fertility-sparing approach in concurrent gliomatosis peritonei and growing teratoma syndrome in a young woman

Ahmad Nasfy SN, Abdul Hamid H, Md Khairuddin A, Mohamad Fauzi MK

BMJ Case Rep, 2024 Apr 16;17(4).

PMID: 38627058 DOI: 10.1136/bcr-2023-257326

Gliomatosis peritonei (GP) and Growing Teratoma Syndrome (GTS) are rare and clinically significant conditions often associated with ovarian teratomas. GP involves the development of benign glial implants on the peritoneal surface, while GTS is characterised by the growth of benign, yet enlarging peritoneal implants following chemotherapy for malignant germ cell tumours. These implants are typically histologically mature teratomas devoid of malignancy. Our report documents a unique case where both GP and GTS manifested in a patient undergoing treatment for an immature ovarian teratoma. This dual occurrence is scarcely reported in the existing literature. The patient, a nulliparous woman in her 20s, developed a tumour indicative of GTS immediately after completing three cycles of bleomycin, etoposide and cisplatin therapy. This chemotherapy regimen followed fertility-sparing surgery for a stage IIIb ovarian immature teratoma. Given that total tumour resection is pivotal in positively influencing the prognosis of GTS, early minimally invasive surgical intervention before significant tumour growth is essential. This approach is particularly crucial considering that ovarian germ cell tumours are commonly present in younger patients, necessitating a focus on fertility preservation in most cases.

Fulltext Echocardiography and strain analysis in Malaysian elite athletes versus young healthy adults

Roslan A, Stanislaus R, Yee Sin T, Aris FA, Ashari A, Shaparudin AA, et al.

Int J Cardiol Heart Vasc, 2023 Aug;47:101242.

PMID: 37576081 DOI: 10.1016/j.ijcha.2023.101242

BACKGROUND: Athletes have changes that can mimic pathological cardiomyopathy.

METHODS: Echocardiographic study of 50 male, female athletes (MA, FA) and non-athletes (MNA, FNA) age 18 to 30 years. These athletes participate in sports with predominantly endurance component. All participants exhibit no known medical illnesses or symptoms.

RESULTS: MA have thicker wall (IVSd) than MNA. No MA have IVSd > 1.2 cm and no FA have IVSd > 1.0 cm. Left ventricle internal dimension (LVIDd), left ventricle end diastolic volume index (LVEDVi) is bigger in athletes. None have LVIDd > 5.8 cm. Right ventricle fractional area change (FAC) is lower in athletes. (MA vs MNA, p = 0.013, FA vs FNA, p = 0.025). Athletes have higher septal and lateral e' (Septal e'; MA 13.57 ± 2.66 cm/s vs MNA 11.46 ± 2.93 cm/s, p 1.2 cm and/or LVIDd > 5.8 cm. There is no difference in GLS, RVFWS and GCS but athletes have smaller LArS and LAbS.

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