MyMedR

Incidental congenitally corrected transposition of the great arteries (ccTGA) in an adult with suspected coronary artery disease: review on radiological features and pathophysiology

Sayuti KA, Azizi MYSB

BMJ Case Rep, 2020 Apr 22;13(4).

PMID: 32327461 DOI: 10.1136/bcr-2019-234225

We report a case of a 46-year-old woman who has presented to a peripheral hospital with progressive exertional dyspnoea and chest discomfort. The resting ECG showed features of left-sided ventricular hypertrophy. The initial chest radiograph was reported as cardiomegaly. Initial echocardiography revealed left atrial dilatation and 'left ventricular' hypertrophy with normal ejection fraction. She was treated as possible coronary artery disease and was subsequently referred to our centre for CT coronary angiography. Findings from the CT scan were consistent with congenitally corrected transposition of the great arteries (ccTGA). This report describes the radiological features of ccTGA, its associated cardiovascular anomalies, pathophysiology and potential complications.

Unilateral opaque chest radiograph in paediatrics: A case series

Raja Mamat TA, Sayuti KA, Nadarajan C, Mohd Zain MR

SA J Radiol, 2021;25(1):2164.

PMID: 34522433 DOI: 10.4102/sajr.v25i1.2164

Pulmonary underdevelopment is a rare congenital disease which manifests as persistent hemithorax opacification at chest radiography. We present three patients with different types of pulmonary underdevelopment, their imaging features and associated anomalies. Case 1 is a premature neonate with persistent respiratory distress. Further imaging confirmed right pulmonary hypoplasia, associated with a patent foramen ovale, patent ductus arteriosus and vertebral anomalies. Case 2 is a 6-year-old child with corrected anorectal malformation, and recurrent pneumonia. Further imaging confirmed left pulmonary aplasia, associated with an aberrant right subclavian artery and vertebral anomaly. Case 3 is a full term neonate who developed excessive drooling of saliva and respiratory distress. Further imaging confirmed right pulmonary agenesis, associated with an atrial septal defect, patent ductus arteriosus and tracheo-oesophageal fistula. Pulmonary underdevelopment is classified into three types: hypoplasia, aplasia and agenesis. The majority of them have associated anomalies. This condition should be considered a differential diagnosis in paediatric patients with an opaque hemithorax on chest radiography.

Investigation of random walks knee cartilage segmentation model using inter-observer reproducibility: Data from the osteoarthritis initiative

Hong-Seng G, Sayuti KA, Karim AH

Biomed Mater Eng, 2017;28(2):75-85.

PMID: 28372262 DOI: 10.3233/BME-171658

BACKGROUND: Existing knee cartilage segmentation methods have reported several technical drawbacks. In essence, graph cuts remains highly susceptible to image noise despite extended research interest; active shape model is often constraint by the selection of training data while shortest path have demonstrated shortcut problem in the presence of weak boundary, which is a common problem in medical images.

OBJECTIVES: The aims of this study is to investigate the capability of random walks as knee cartilage segmentation method.

METHODS: Experts would scribble on knee cartilage image to initialize random walks segmentation. Then, reproducibility of the method is assessed against manual segmentation by using Dice Similarity Index. The evaluation consists of normal cartilage and diseased cartilage sections which is divided into whole and single cartilage categories.

RESULTS: A total of 15 normal images and 10 osteoarthritic images were included. The results showed that random walks method has demonstrated high reproducibility in both normal cartilage (observer 1: 0.83±0.028 and observer 2: 0.82±0.026) and osteoarthritic cartilage (observer 1: 0.80±0.069 and observer 2: 0.83±0.029). Besides, results from both experts were found to be consistent with each other, suggesting the inter-observer variation is insignificant (Normal: P=0.21; Diseased: P=0.15).

CONCLUSION: The proposed segmentation model has overcame technical problems reported by existing semi-automated techniques and demonstrated highly reproducible and consistent results against manual segmentation method.

Left aorto-ventricular tunnel: A differential diagnosis to aortic regurgitation

Wong AR, Amelia A, Mohd Zain MR, Sayuti KA

Med J Malaysia, 2022 Jan;77(1):101-103.

PMID: 35087005

Left aorto-ventricular tunnel is a rare congenital heart disorder. A then 19-year-old young lady was referred to our clinic for chronic rheumatic heart disease with aortic regurgitation. However, because of an almost continuous murmur, and an unusual transthoracic echo, she underwent various investigations, finally revealing a rare type 2 left aorto-ventricular tunnel. She had been variously diagnosed as chronic rheumatic heart disease with aortic regurgitation, bicuspid aortic valve with aortic regurgitation, and then possibly coronary arterial (cameral) fistula (based on 2D transthoracic echo) and finally left aorto-ventricular tunnel. This is the first case described in South East Asia who is asymptomatic, apart from a murmur, and her long journey to this final diagnosis illustrates the need to "chase shadows" on echoes, to come to a proper conclusion for the patient.

Beating the odds: a rare case of supracardiac total anomalous pulmonary venous return (TAPVR) in an adult patient

Talib N, Sayuti KA, Abdullah MS, Mohd Zain MR

BMJ Case Rep, 2018 Mar 05;2018.

PMID: 29507009 DOI: 10.1136/bcr-2017-221074

Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect, and patients are usually symptomatic at a very young age. Survival to adulthood without surgical correction is extremely rare. We report a 33-year-old woman with a heart murmur and a history of a successful pregnancy. Echocardiogram revealed a large atrial septal defect with suspicious pulmonary vein anomaly. Chest radiograph demonstrated classical 'snowman' configuration. Cardiac catheterisation was consistent with anomalous pulmonary venous drainage. Cardiac CT confirmed supracardiac TAPVR, whereby all the pulmonary veins drain into the anomalous vein and finally to the superior vena cava. She remained asymptomatic and underwent a successful surgical repair.

Benzodiazepines for Treatment-Resistant Major Depressive Disorder and Obsessive-Compulsive Disorder With Comorbid Mega Cisterna Magna

Ismail A, Ab Razak A, Sayuti KA, Phoa PKA

Cureus, 2023 Oct;15(10):e46670.

PMID: 37942372 DOI: 10.7759/cureus.46670

This article discusses the case of an adult woman with comorbid major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Due to her poor response to initial treatment regimens, a brain computed tomography (CT) was performed, revealing mega cisterna magna (MCM). Subsequently, she responded well to the addition of lorazepam, a benzodiazepine, along with fluvoxamine and quetiapine XR. The clinical significance of MCM and MDD-OCD remains partially understood. Thus, this case report aims to contribute to the literature and review the treatment of benzodiazepines in relation to MCM, MDD, and OCD comorbidities.

Angiomyolipoma during pregnancy: A forgotten risk factor for rupture and massive haemorrhage - A case report

Sayuti KA, Mat Rasid SA, Abdullah MS, Muhammad SJ

Malays Fam Physician, 2024;19:27.

PMID: 38725613 DOI: 10.51866/cr.399

Benign renal lesions are relatively rare. Angiomyolipoma (AML) is the most commonly encountered benign renal lesion. One of the complications of AML is rupture, which results in retroperitoneal haemorrhage with a mortality rate of up to 20%. Pregnancy poses a major risk for the rupture of AML. This is attributed to its hormonal effect, which causes the tumour to grow rapidly during pregnancy. The possibility of AML rupture should be considered when encountering pregnant patients with hypovolemic shock but with normal initial obstetric ultrasound findings. We present a case of a pregnant patient who was admitted with hypovolemic shock and CT scan confirmed rupture of AML.

Fulltext Right-sided patent ductus arteriosus with bovine aortic arch, tetralogy of Fallot, dextrocardia and situs inversus

Sayuti KA, Shamsuddin AM, Mamat AZ, Zain MRM, Ramli N, Mokhtar AM, et al.

J Surg Case Rep, 2021 Jul;2021(7):rjab307.

PMID: 34316346 DOI: 10.1093/jscr/rjab307

A neonate with cyanosis at birth was found to have a rare type of tetralogy of Fallot. Echocardiography showed dextrocardia, left aortic arch with constricting and tortuous patent ductus arteriosus (PDA). Computed tomography angiography thorax revealed visceroatrial situs inversus, mirror image dextrocardia, tetralogy anatomy and tortuous right PDA arising from bovine brachiocephalic artery. In view of severe cyanosis, emergency division of PDA and modified right Blalock-Taussig shunt through median sternotomy were performed under cardiopulmonary bypass. Post-operatively, the sternum was left open and he developed pulmonary overcirculation requiring prolonged ICU stay. He was discharged well at Day 26 post surgery. This case highlights a rare association tetralogy of Fallot, dextrocardia and situs inversus, with concomitant unilateral right PDA and bovine aortic arch.

Unifying the seeds auto-generation (SAGE) with knee cartilage segmentation framework: data from the osteoarthritis initiative

Gan HS, Sayuti KA, Ramlee MH, Lee YS, Wan Mahmud WMH, Abdul Karim AH

Int J Comput Assist Radiol Surg, 2019 May;14(5):755-762.

PMID: 30859457 DOI: 10.1007/s11548-019-01936-y

PURPOSE: Manual segmentation is sensitive to operator bias, while semiautomatic random walks segmentation offers an intuitive approach to understand the user knowledge at the expense of large amount of user input. In this paper, we propose a novel random walks seed auto-generation (SAGE) hybrid model that is robust to interobserver error and intensive user intervention.

METHODS: Knee image is first oversegmented to produce homogeneous superpixels. Then, a ranking model is developed to rank the superpixels according to their affinities to standard priors, wherein background superpixels would have lower ranking values. Finally, seed labels are generated on the background superpixel using Fuzzy C-Means method.

RESULTS: SAGE has achieved better interobserver DSCs of 0.94 ± 0.029 and 0.93 ± 0.035 in healthy and OA knee segmentation, respectively. Good segmentation performance has been reported in femoral (Healthy: 0.94 ± 0.036 and OA: 0.93 ± 0.034), tibial (Healthy: 0.91 ± 0.079 and OA: 0.88 ± 0.095) and patellar (Healthy: 0.88 ± 0.10 and OA: 0.84 ± 0.094) cartilage segmentation. Besides, SAGE has demonstrated greater mean readers' time of 80 ± 19 s and 80 ± 27 s in healthy and OA knee segmentation, respectively.

CONCLUSIONS: SAGE enhances the efficiency of segmentation process and attains satisfactory segmentation performance compared to manual and random walks segmentation. Future works should validate SAGE on progressive image data cohort using OA biomarkers.

Fulltext Coughing on palpation: A rare complication of vagal schwannoma

Samarakkody ZM, Sayuti KA, Mat Zin AA, Wan Abdul Wahab W, Mohamad I

Malays Fam Physician, 2018;13(3):40-43.

PMID: 30800234

Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia, dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused any surgical intervention, conservative management was used.

Elephant attack - A rare case of survival

Syahmi WM, Mafauzy MM, Baharuddin KA, Ikhwan SM, Sayuti KA, Mohd Shukruddeen S

Med J Malaysia, 2021 Sep;76(5):741-743.

PMID: 34508386

Conflict of human-wild elephant is not uncommon in Malaysia. Most of the human victims usually succumb to death due to internal organ injuries. Here we report a case of a woman who was the victim of an elephant attack and successfully survived to share our experience in managing this type of polytrauma.

Lichenoid uvula mass as a rare cause of hot potato voice and progressive dysphagia

Kandiah R, Aziz A, Nik Min NFA, Rahim MR, Zawawi N, Sayuti KA, et al.

Malays J Pathol, 2021 Dec;43(3):457-461.

PMID: 34958068

Lichenoid uvula mass is an unusual entity and the clinicopathologic entities are important for the diagnosis. In this case report, we report an elderly lady presented with dysphagia and "hot potato voice" due to a lichenoid uvula mass. Apart from muffled voice, the other associated symptoms are dysphagia, sore throat, globus pharyngeus and snoring. She was a non-smoker, and not on any medications except for hypertension and dyslipidaemia. Apart from the enlarged uvula, other parts of the oral cavity, oropharynx and larynx were normal. She has no other signs such as cutaneous lesions. The mass was excised under general anaesthesia followed by resolution of symptoms. Awareness of this entity, the clinical and histopathological features should be highlighted to differentiate it from other diagnosis.

Fulltext Orbital Apex Syndrome Secondary to Huge Primary Ethmoidal Sinus Mucocele: A Case Report

Loh SA, Wan Hitam WH, Ramli RR, Sayuti KA, Sonny Teo KS

Cureus, 2023 Feb;15(2):e34853.

PMID: 36923171 DOI: 10.7759/cureus.34853

Ethmoidal sinus mucoceles are benign expansile lesions that may progressively invade the orbit causing optic nerve compression and its nearby structures. We report a rare case of primary ethmoidal sinus mucocele instigating orbital apex syndrome. A 40-year-old man presented with right eye (RE) progressive blurring of vision with diplopia for 2 weeks. It was preceded by right-sided facial pain for 3 months. Clinical examination revealed RE proptosis with multiple cranial nerves palsy involving right cranial nerves II, III, IV, V, and VI, suggestive of right orbital apex syndrome. Magnetic resonance imaging (MRI) demonstrated right eye proptosis and right ethmoidal mucocele with intracranial and right intraorbital extension compressing the right medial rectus and optic nerve. The patient underwent an uncomplicated endoscopic sinus surgery resulting in a return to normal appearance and function post-operation. Thus, ethmoidal mucoceles are benign and curable with early recognition and intervention.

The Zurkurnai ECG Pattern: A Novel ECG Pattern of the High-Risk Features of Acute Pulmonary Embolism

Othman MK, Yusof Z, Ismail ZKA, Sayuti KA, W Isa WYH

Cureus, 2024 Jan;16(1):e52889.

PMID: 38274596 DOI: 10.7759/cureus.52889

Acute pulmonary embolism is an important differential diagnosis in patients presenting with acute shortness of breath. However, the overlapping clinical presentation between acute coronary syndrome, aortic dissection, pneumonia, and heart failure made the diagnosis of pulmonary embolism very challenging in a limited resources center. We present a case of acute pulmonary embolism with an uncommon ECG pattern that was initially misdiagnosed as acute coronary syndrome. The authors made the appropriate diagnosis using the Zurkurnai ECG pattern in acute pulmonary embolism, which is defined as the presence of right axis deviation, deep symmetrical T wave inversion in V1 to V5, II, III, and AVF with the maximum at V3-V4 and poor R wave progression, which indicates the high-risk features of acute pulmonary embolism.

Interactive knee cartilage extraction using efficient segmentation software: data from the osteoarthritis initiative

Gan HS, Tan TS, Wong LX, Tham WK, Sayuti KA, Abdul Karim AH, et al.

Biomed Mater Eng, 2014;24(6):3145-57.

PMID: 25227024 DOI: 10.3233/BME-141137

In medical image segmentation, manual segmentation is considered both labor- and time-intensive while automated segmentation often fails to segment anatomically intricate structure accordingly. Interactive segmentation can tackle shortcomings reported by previous segmentation approaches through user intervention. To better reflect user intention, development of suitable editing functions is critical. In this paper, we propose an interactive knee cartilage extraction software that covers three important features: intuitiveness, speed, and convenience. The segmentation is performed using multi-label random walks algorithm. Our segmentation software is simple to use, intuitive to normal and osteoarthritic image segmentation and efficient using only two third of manual segmentation's time. Future works will extend this software to three dimensional segmentation and quantitative analysis.

Fulltext Medical image visual appearance improvement using bihistogram Bezier curve contrast enhancement: data from the Osteoarthritis Initiative

Gan HS, Swee TT, Abdul Karim AH, Sayuti KA, Abdul Kadir MR, Tham WK, et al.

ScientificWorldJournal, 2014;2014:294104.

PMID: 24977191 DOI: 10.1155/2014/294104

Well-defined image can assist user to identify region of interest during segmentation. However, complex medical image is usually characterized by poor tissue contrast and low background luminance. The contrast improvement can lift image visual quality, but the fundamental contrast enhancement methods often overlook the sudden jump problem. In this work, the proposed bihistogram Bezier curve contrast enhancement introduces the concept of "adequate contrast enhancement" to overcome sudden jump problem in knee magnetic resonance image. Since every image produces its own intensity distribution, the adequate contrast enhancement checks on the image's maximum intensity distortion and uses intensity discrepancy reduction to generate Bezier transform curve. The proposed method improves tissue contrast and preserves pertinent knee features without compromising natural image appearance. Besides, statistical results from Fisher's Least Significant Difference test and the Duncan test have consistently indicated that the proposed method outperforms fundamental contrast enhancement methods to exalt image visual quality. As the study is limited to relatively small image database, future works will include a larger dataset with osteoarthritic images to assess the clinical effectiveness of the proposed method to facilitate the image inspection.

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