MyMedR

Haemorrhagic transformation: A serious complication of massive ischemic stroke

Mohd Said MR, Mohd Firdaus MAB

Med J Malaysia, 2021 03;76(2):258-260.

Acute ischaemic stroke is a debilitating disease and may lead to haemorrhagic transformation associated with few factors such as high National Institute of Health Stroke Scale (NIHSS), low Modified Rankin Score (MRS), cardio-embolic clot and others.1 We report herein a 61 years old man whom presented with left sided weakness and diagnosed with acute right middle cerebral artery (MCA) infarction. Thrombolytic therapy was not offered due to low Alberta Stroke Program Early CT (ASPECT) score and hence managed conservatively. However, within 24 hours, his Glasgow Coma Scale (GCS) reduced by 4 points and urgent Computed Tomography (CT) brain confirmed haemorrhagic transformation with midline shift. He underwent emergency surgical decompression and subsequently had prolonged hospital stay complicated by ventilated acquired pneumonia. He recovered after a course of antibiotic and discharged to a nursing home with MRS of 5.

Abdominal wall necrotising fasciitis: A rare but devastating complication of the percutaneous endoscopic gastrostomy procedure

Mohd Said MR, Abdul Rani R, Raja Ali RA, Ngiu CS

Med J Malaysia, 2017 02;72(1):77-79.

PMID: 28255151 MyJurnal

Percutaneous Endoscopic Gastrostomy (PEG) tubes were often offered to patients requiring long term enteral feeding. Even though the procedure is relatively safe, it is associated with various complications such as peritonitis or even death.1 We presented a case of a 54-year-old gentleman with underlying ischemic stroke and pus discharges from a recently inserted PEG tube. Computed Topography (CT) scan confirmed abdominal wall necrotising fasciitis complicated with hyperosmolar hyperglycaemia state (HHS) and later succumbed after 48 hours of admission. Our case illustrated the rare complication related to the insertion of PEG tube; abdominal wall necrotising fasciitis that was associated with mortality.

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.

Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction

Firdaus MAM, Rahim NSA, Rusdi N, Idris NS, Mohd Said MR, Abidin IZ

Case Rep Cardiol, 2020;2020:8836627.

PMID: 32774930 DOI: 10.1155/2020/8836627

Ventricular wall rupture possesses a high mortality rate in patients with acute myocardial infarction. We presented a case of a ninety-year-old gentleman who presented with acute inferolateral myocardial infarction in cardiogenic shock and right ventricular free wall rupture. He was treated conservatively and survived.

Fulltext The effects of different postures and provocative swallow materials on the normative Chicago 3.0 metrics in a healthy Asian population

Mohd Said MR, Wong Z, Abdul Rani R, Ngiu CS, Raja Ali RA, Lee YY

J Gastroenterol Hepatol, 2021 May;36(5):1244-1252.

PMID: 33002243 DOI: 10.1111/jgh.15284

BACKGROUND AND AIM: Variations in the Chicago 3.0 normative metrics may exist with different postures and with different provocative swallow materials in a healthy Asian population.

METHOD: Eligible healthy Malay volunteers were invited to undergo the high-resolution esophageal manometry (inSIGHT Ultima, Diversatek Healthcare, Milwaukee, WI, USA). In recumbent and standing positions, test swallows were performed using liquid, viscous, and solid materials. Metrics including integrated relaxation pressure 4 s (IRP-4 s, mmHg), distal contractile integral (DCI, mmHg s cm), distal latency (DL, s), and peristaltic break (PB, cm) were reported in median and 95th percentile.

RESULTS: Fifty of 57 screened participants were recruited, and 586 saline, 265 viscous, and 261 solid swallows were analyzed. Per-patient wise, in the recumbent position, 95th percentile for IRP-4 s, DCI, DL, and PB were 16.5 mmHg, 2431 mmHg s cm, 8.5 s, and 7.2 cm, respectively. We observed that with each posture, the use of viscous swallows led to changes in DL, but the use of solid swallows led to more changes in the metrics including DCI and length of PB. Compared with a recumbent posture, anupright posture led to lower IRP-4 s and DCI values. Both per-patient analysis and per-swallow analyses yielded almost similar results when comparing the different postures and types of swallows. No major motility disorders were observed in this cohort of asymptomatic population. However, more motility disorders were reported in the upright position.

CONCLUSIONS: Variations in metrics can be observed in different postures and with different provocative swallow materials in a healthy population. The normative Chicago 3.0 metrics are also determined for the Malay population.

An exposed Cardiovascular Implantable Electronic Device (CIED) complicated with infection: A case report of unconventional experience with 'Sealed CIED'

Mohd Said MR, Gian Singh SS, Chea CY, Mohd Firdaus MAB, Narasamuloo KR, Krishinan S

Med J Malaysia, 2022 Jan;77(1):119-120.

PMID: 35087011

The rate of infected Cardiovascular Implantable Electronic Device is alarming and causes substantial socio-economic burden. A common approach involves immediate extraction of the infected device. Here, we report an unorthodox approach to this problem by 'sealing' the generator inside a sterile container as a temporary permanent pacemaker while waiting for implantation of another device. We report a 66 years old emaciated lady with underlying Sick Sinus Syndrome, who had an implanted single chamber pacemaker and presented with partial protrusion of her device. She underwent sub-pectoral implantation of the new device but subsequently re-presented with pocket site infection after a month. A decision was made to extract the infected generator from the sub-pectoral pocket and it was sealed inside a sterile container as 'bridging therapy' while awaiting arrival of a leadless pacemaker for implantation together with total extraction of the old infected device. Our clinical vignette demonstrated the difficulties we encountered and influenced on our decision for this unconventional approach despite limited supporting evidence.

Fulltext Analysis of the Biceps Brachii Muscle by Varying the Arm Movement Level and Load Resistance Band

Burhan N, Kasno M', Ghazali R, Said MR, Abdullah SS, Jali MH

J Healthc Eng, 2017;2017:1631384.

PMID: 29138687 DOI: 10.1155/2017/1631384

Biceps brachii muscle illness is one of the common physical disabilities that requires rehabilitation exercises in order to build up the strength of the muscle after surgery. It is also important to monitor the condition of the muscle during the rehabilitation exercise through electromyography (EMG) signals. The purpose of this study was to analyse and investigate the selection of the best mother wavelet (MWT) function and depth of the decomposition level in the wavelet denoising EMG signals through the discrete wavelet transform (DWT) method at each decomposition level. In this experimental work, six healthy subjects comprised of males and females (26 ± 3.0 years and BMI of 22 ± 2.0) were selected as a reference for persons with the illness. The experiment was conducted for three sets of resistance band loads, namely, 5 kg, 9 kg, and 16 kg, as a force during the biceps brachii muscle contraction. Each subject was required to perform three levels of the arm angle positions (30°, 90°, and 150°) for each set of resistance band load. The experimental results showed that the Daubechies5 (db5) was the most appropriate DWT method together with a 6-level decomposition with a soft heursure threshold for the biceps brachii EMG signal analysis.

Fulltext From darkness, a light shall spring: Zero-fluoroscopic ablation of supraventricular tachycardia in a pregnant lady

Mohd Said MR, Gian Singh SS, Lee KT, Khor LM, Chea CY, Silveraju AR, et al.

J Arrhythm, 2021 Feb;37(1):251-253.

PMID: 33664912 DOI: 10.1002/joa3.12485

Our case illustrated zero-fluoroscopic approach on AVNRT ablation in a pregnant lady.

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