MyMedR

Fulltext Letter to the Editor: Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report

Payus AO, Mustafa N

J Korean Med Sci, 2020 Nov 09;35(43):e381.

PMID: 33169561 DOI: 10.3346/jkms.2020.35.e381

A Case Report on Cholestatic Jaundice Secondary to Adverse Effect of Phaleria macrocarpa (Mahkota Dewa)

Rahim MFA, Payus AO

Acta Med Indones, 2019 Oct;51(4):344-347.

PMID: 32041919

Drug induced cholestatic liver injury can posed a great diagnostic difficulty as a result of its long non-exhaustive list of potential offending causes which can be either prescribed or over-the-counter medications, such as medicinal herbs and remedies. Phaleria macrocarpa, or more commonly known as the 'God's crown' by the local people of South East Asia, is not listed as one of the causes. This medicinal plant extract has been increasingly used for traditional treatment for various ailments. Here, we report a case of a young man who has no known medical illness presented with cholestatic pattern of liver injury which caused by chronic ingestion of Phaleria macrocarpa. The objective of this case report is to share the uncommon side effect of taking this traditional product which may have been under-reported due to the unknown effect.

Fulltext "Two Stones on One Bird": A Case Report on Severe Biphasic Anaphylaxis Masquerading as Life-Threatening Acute Asthma

Payus AO, Ibrahim A, Mustafa N

Open Access Maced J Med Sci, 2018 Nov 25;6(11):2136-2138.

PMID: 30559876 DOI: 10.3889/oamjms.2018.317

BACKGROUND: Anaphylaxis often misdiagnosed and treated as acute asthma, especially when it has a predominant respiratory symptom, and there are no obvious precipitants or previous allergic history. This morbid outcome is preventable if the level of suspicion for anaphylaxis is high among healthcare provider when treating a patient who is not responding to the standard management of acute asthma. A proportion of anaphylactic patient shows a biphasic reaction which potentially fatal when it is under-anticipated and prematurely discharge without adequate observation period after the recovery of the initial episode.

CASE REPORT: Here, we present a case of a young man who has childhood asthma with the last attack more than 10 years ago presented with symptoms suggestive of acute exacerbation of bronchial asthma. As the symptoms failed to improve after standard asthma management, anaphylaxis was suspected, and he was given intramuscular adrenaline 0.5 mg which leads to symptom improvement. However, he developed another attack shortly after improvement while under observation.

CONCLUSION: The objective of this case report is to emphasise the importance of keeping anaphylaxis in mind whenever a patient has treatment-refractory asthma, and also the anticipation of biphasic reaction that warrants adequate observation period especially those who are likely to have developed it.

Fulltext Group B Streptococcal Meningitis in a Healthy Young Woman: A Case Report

Payus AO, Clarence C, Azman Ali R

Int J Gen Med, 2020;13:861-864.

PMID: 33116778 DOI: 10.2147/IJGM.S277394

Group B streptococcus (GBS) is a rare cause of meningitis in adults that commonly affects patients with multiple underlying comorbidities. Although it is uncommon, it typically progresses very rapidly and has a high mortality rate as compared to other causes of bacterial meningitis. Here, we report a patient with GBS meningitis who had no underlying medical illness and presented with multiple episodes of seizure within hours of developing fever. Cerebrospinal fluid analysis results were consistent with bacterial meningitis, and blood cultures grew GBS. She was treated with intravenous ceftriaxone for 2 weeks and made a great recovery without any sequalae. In conclusion, although GBS meningitis is uncommon in adults, it is a serious medical disease and associated with a high mortality rate. To the best of our knowledge, this patient represents one of the few reported cases of GBS meningitis in a previously healthy young adult.

Fulltext An uncommon side effect of a very commonly used medication: A case report on hydrocortisone-induced bradycardia

Payus AO, Chai AC, Mustafa N

Clin Case Rep, 2021 Aug;9(8):e04678.

PMID: 34430027 DOI: 10.1002/ccr3.4678

Sinus bradycardia is a rare but important side effect of high-dose hydrocortisone. It is a self-limiting condition that recovered spontaneously upon stopping the medication and did not recur with other types of corticosteroids.

The poorly understood yet potent risk of pulmonary artery thrombosis in-situ in Post-Acute COVID-19 syndrome

Payus AO, Lin CLS, Ibrahim A

J Cardiothorac Surg, 2023 Jan 20;18(1):42.

PMID: 36658637 DOI: 10.1186/s13019-023-02147-y

Pulmonary artery thrombosis in-situ is a term used to describe a pulmonary embolism occurs in the absence of deep vein thrombosis in the lower extremities. Most cases occur in a patient who had a recent traumatic injury to the chest. Other risk factors include the presence of hypercoagulable conditions, including inflammatory state, hypoxia and vascular endothelial injury. Although it has been discussed extensively in the acute COVID-19 disease, pulmonary artery thrombosis in-situ that occur in the setting of Post-Acute COVID-19 syndrome is not commonly reported and poorly understood.

Fulltext Guillain-Barré syndrome

Payus AO, Jan TH, Raymond AA

Clin Med (Lond), 2020 Nov;20(6):e281.

PMID: 33199345 DOI: 10.7861/clinmed.Let.20.6.6

Fulltext A Promising Intervention for Comprehensive Pulmonary Rehabilitation for Asthma COPD Overlap Syndrome

Ahmedy F, Hayati F, Abdul Rahim SSS, Payus AO

Oman Med J, 2021 Jan;36(1):e232.

PMID: 33628466 DOI: 10.5001/omj.2021.14

Fulltext The Value of Preoperative Diagnosis in Leiomyosarcoma of the Vulva

Hayati F, Soe MZ, Azizan N, Payus AO

Oman Med J, 2021 Mar;36(2):e256.

PMID: 33976908 DOI: 10.5001/omj.2021.68

Fulltext Venous thromboembolism in women: new challenges for an old disease

Payus AO, Lin CLS, Ibrahim A, Mustafa N

J Vasc Bras, 2021;20:e20200181.

PMID: 34290754 DOI: 10.1590/1677-5449.200181

Hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism: an uncommon cause of acute muscle paralysis

Payus AO, Liew SL, Tiong N, Mustafa N

BMJ Case Rep, 2021 Jun 24;14(6).

PMID: 34167974 DOI: 10.1136/bcr-2020-240666

Hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism is an uncommon clinical phenomenon characterised by lower limb paralysis secondary to hypokalaemia in the background of subclinical hyperthyroidism. In this article, we report a patient who presented with progressive lower limb muscle weakness secondary to hypokalaemia that was refractory to potassium replacement therapy. He has no diarrhoea, no reduced appetite and was not taking any medication that can cause potassium wasting. Although he was clinically euthyroid, his thyroid function test revealed subclinical hyperthyroidism. His 24-hour urine potassium level was normal, which makes a rapid transcellular shift of potassium secondary to subclinical hyperthyroidism as the possible cause. He was successfully treated with potassium supplements, non-selective beta-blockers and anti-thyroid medication. This case report aimed to share an uncommon case of hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism, which to our knowledge, only a few has been reported in the literature.

Fulltext Pulmonary Embolism Masquerading as Severe Pneumonia: A Case Report

Payus AO, Rajah R, Febriany DC, Mustafa N

Open Access Maced J Med Sci, 2019 Feb 15;7(3):396-399.

PMID: 30834009 DOI: 10.3889/oamjms.2019.114

BACKGROUND: De novo pulmonary embolism (DNPE) is a term used when pulmonary embolism (PE) occur in the absence of deep vein thrombosis (DVT). Most DNPE cases occur in a patient who had a recent injury to the chest.

CASE PRESENTATION: However, here we report a case of DNPE with a slightly different presentation where there is no preceding trauma and has symptoms that mimic severe pneumonia. He presented with high fever, dyspnoea and pleuritic chest pain. Despite on 10 L of oxygen supplementation via high flow mask and already given bolus intravenous antibiotic, the patient still tachypnoeic and was persistently in type I respiratory failure. His chest X-ray showed consolidative changes. Upon further investigation revealed no evidence of DVT on Doppler ultrasound and normal D-dimer level. Due to the high index of suspicion by the attending physician, PE was suspected and later confirmed with computed tomography pulmonary angiography scan. He was successfully treated with anticoagulation therapy. The objective of this case report is to share the difficult experience of diagnosing PE when the presentation highly atypical and mimics severe pneumonia.

CONCLUSION: And with such a masquerading presentation, one can easily miss the diagnosis. To the best of our knowledge, there are very few similar cases reported.

Colo-appendico-duodenal fistula: Rare presentation of extrapulmonary tuberculosis

Gan DEY, Sibin R, Payus AO, Hayati F

Clin Case Rep, 2021 Oct;9(10):e04797.

PMID: 34631061 DOI: 10.1002/ccr3.4797

A colo-appendico-duodenal fistula is a rare occurrence that results from extrapulmonary tuberculosis (TB) complications, especially in the endemic region.

Fulltext 'Crescendo transient ischemic attack'-an uncommon presentation of a very common disease: a case report on capsular warning syndrome

Payus AO, Ibrahim A, Sheaker VC, Yahya WNNW

Oxf Med Case Reports, 2022 Jan;2022(1):omab129.

PMID: 35083048 DOI: 10.1093/omcr/omab129

Capsular warning syndrome is a rare presentation of transient ischaemic attack, which described as recurrent episodes of motor and/or sensory deficits which typically sparring the cortical function. It has a significant risk to progress into a massive stroke with permanent disability, thus important to be recognise early. Here, we report a middle-age gentleman with no known medical illness presented with eight episodes of transient ischaemic attack within the span of 24 h. He was treated with double anti-platelet for 21 days and was not subjected to thrombolysis at time of presentation because it was outside the window period of 4.5 h, and has fully recovered after each episode. The purpose of this case report is to share the uncommon clinical presentation of transient ischaemic attack, which is still not fully understood and warrant more studies especially on the treatment that can affect the progression of the disease.

Fulltext SARS-CoV-2-induced liver injury: A review article on the high-risk populations, manifestations, mechanisms, pathological changes, management, and outcomes

Payus AO, Mohd Noh M, Azizan N, Muthukaruppan Chettiar R

World J Gastroenterol, 2022 Oct 21;28(39):5723-5730.

PMID: 36338886 DOI: 10.3748/wjg.v28.i39.5723

The novel coronavirus disease 2019 is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was declared a global pandemic with more than 500 million reported cases and more than 6 million deaths worldwide to date. Although it has transitioned into the endemic phase in many countries, the mortality rate and overall prognosis of the disease are still abysmal and need further improvement. There has been evidence that shows the significance of SARS-CoV-2-related liver injury. Here, we review the literature on the various spectrum of SARS-CoV-2 infection-induced liver injury and the possible mechanisms of damage to the hepatobiliary system. This review aimed to illustrate the latest understanding regarding SARS-CoV-2-induced liver injury including the high-risk populations, the characteristic clinical manifestations, the possible pathogenic mechanism, the pathological changes, the current suggestions for clinical treatment for various spectrum of populations, and the prognosis of the condition. In conclusion, SARS-CoV-2 patients with a liver injury warrant close monitoring as it is associated with the more severe and poorer outcome of the infection.

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 Huge Retroperitoneal Cyst Masquerading as Ovarian Tumour: A Case Report

Johan S, Hassan MF, Hayati F, Azizan N, Payus AO, Edwin See UH

Front Surg, 2020;7:585411.

PMID: 33195391 DOI: 10.3389/fsurg.2020.585411

Retroperitoneal cystic mass is a rare surgical condition that is often misdiagnosed preoperatively. Here, we report a case of a 56-year-old woman who presented with abdominal swelling for a 1-year duration, which was associated with lower abdominal pain for 6 months. Her abdominal radiograph showed a huge radiopaque lesion, and contrast-enhanced computed tomography scan of the abdomen reported it as a left ovarian serous cystadenoma causing local mass effect to the left ureter leading to mild left hydronephrosis. She underwent exploratory laparotomy and noted there was a huge retroperitoneal cystic mass. The histopathological assessment finding was consistent with a benign retroperitoneal cyst. This case report aims to share the rare case of primary retroperitoneal lesions, which can cause a diagnostic challenge preoperatively to all clinicians despite advanced achievement in medical imaging.

Fulltext Myasthenic Crisis as the First Presentation of Myasthenia Gravis: A Case Report

Payus AO, Leow Wen Hsiang J, Leong JQ, Ibrahim A, Raymond AA

Am J Case Rep, 2021 Jan 20;22:e928419.

PMID: 33468985 DOI: 10.12659/AJCR.928419

BACKGROUND Myasthenic crisis is a condition characterized by the sudden onset of myasthenic weakness involving the respiratory muscles and requires ventilatory support to prevent death. This is a case report of respiratory failure in a 43-year-old man as the first presentation of myasthenia gravis. CASE REPORT A 43-year-old man with underlying hypertension and a lacunar stroke with good muscle-power recovery presented with severe community-acquired pneumonia, complicated with respiratory failure requiring invasive ventilatory support. He responded well to the intravenous antibiotic therapy and after 1 week of treatment, he was hemodynamically stable and his septic parameters improved. However, he persistently failed to maintain adequate spontaneous respiratory effort after the removal of the ventilatory support and had to be reintubated multiple times. There was no other identifiable cause for the worsening respiratory failure. He had no clinical features or muscle weakness suggestive of myasthenia gravis. However, his blood test was positive for serum anti-acetylcholine receptor antibodies and repetitive nerve stimulation tests showed the characteristic decremental response of compound muscle action potential amplitude, in keeping with the diagnosis of myasthenia gravis. He responded well to intravenous immunoglobulin and was discharged with anticholinesterase inhibitors and long-term immunosuppression therapy. CONCLUSIONS This report demonstrates that when patients are admitted to the hospital with acute respiratory failure without any underlying pulmonary disease and with weakness of the respiratory muscles, the diagnosis of myasthenia gravis presenting with a myasthenic crisis should be considered.

Re: Rare case of wandering spleen causing intra-thoracic megacolon

Hayati F, Azizan N, Ng CY, Payus AO, Syed Abdul Rahim SS

ANZ J Surg, 2021 01;91(1-2):214.

PMID: 33590622 DOI: 10.1111/ans.16380

Fulltext Unusual Presentation of Cerebral Lupus: A Case Report of Parkinsonism in Cerebral Lupus

Chang CK, Mohd Noh M, Liew Sat Lin C, Payus AO

Case Rep Neurol, 2021 09 13;13(3):591-594.

PMID: 34703447 DOI: 10.1159/000518912

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement that follows a relapsing and remitting course. It is characterized by an immune-mediated response to own body defense mechanism and mistakenly attacked healthy cells of the skin, joints, kidneys, blood cells, and nervous system. Cerebral lupus refers to a constellation of neurological and/or behavioral clinical syndromes in patients with SLE. The spectrum of presentation can vary widely ranging from mild symptoms such as headaches, slight cognitive dysfunction, and mood disorders to more serious conditions like seizures, stroke, or coma. This case report is about a case of cerebral lupus manifested with symptoms of Parkinsonism. The purpose of this case report is to share an uncommon occurrence of cerebral lupus which manifested as Parkinsonism and to highlight the importance of early diagnosis of the condition which is potentially reversibility with prompt treatment [4].

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