1.Malaysian internship a reflection of undergraduate training: time to go back to basics.
Singapore medical journal 2012;53(5):364-author reply 364
3.Contemporary Surgical Management of Advanced End Stage Emphysema: An Evidence Based Review
Anand Sachithanandan ; Balaji Badmanaban
The Medical Journal of Malaysia 2012;67(3):253-258
Emphysema is a progressive unrelenting component of
chronic obstructive pulmonary disease and a major source of
mortality and morbidity globally. The prevalence of
moderate to severe emphysema is approximately 5% in
Malaysia and likely to increase in the future. Hence advanced emphysema will emerge as a leading cause of hospital admission and a major consumer of healthcare resources in this country in the future. Patients with advanced disease have a poor quality of life and reduced survival. Medical therapy has been largely ineffective for many patients however certain subgroups have disease amenable to surgical palliation. Effective surgical therapies include lung volume reduction surgery, lung transplantation and bullectomy. This article is a comprehensive evidence based review of the literature evaluating the rationale, efficacy, safety and limitations of surgery for advanced emphysema highlighting the importance of meticulous patient selection
and local factors relevant to Malaysia.
4.Post-Operative Immunohistochemical Diagnosis of Two Synchronous Primary Non-Small Cell Lung Cancers in A Single Lobe
Anand Sachithanandan ; Nor Yatizah
The Medical Journal of Malaysia 2013;68(2):175-176
Synchronous primary non-small cell lung cancers (NSCLC)
are rare and may be discovered unexpectedly following lung
resection. Discrimination from intrapulmonary metastases
is important to guide treatment and prognosis but is difficult solely on clinical or radiological findings. Histopathological evaluation with immunohistochemistry (IHC) markers can prove decisive and should feature in the diagnostic algorithm of such patients. We report a rare case of two synchronous primary NSCLCs diagnosed post operatively following pathological examination of the resected lobe, highlighting the value of IHC and discuss the management of such patients.
5.Suboptimal Therapy for Dyslipidaemia in Coronary Bypass Surgical Patients with Premature Ischaemic Heart Disease
Yong Sheng Tan ; Anand Sachithanandan
The Medical Journal of Malaysia 2015;70(2):114-115
The incidence of premature multi-vessel coronary artery
disease (CAD) is on the rise in Malaysia. The pathogenesis
of coronary atherosclerosis is multi-factorial with
dyslipidaemia being one such risk factor. Elevated total
cholesterol (TC), low density lipoprotein cholesterol (LDL-C)
and triglycerides (TG) levels are primarily responsible. We
analysed the fasting pre-operative lipid profiles of coronary
artery bypass graft (CABG) patients with symptomatic
severe premature CAD. A majority of patients had an
elevated LDL cholesterol level despite being on a statin.
Similarly, no patient with an elevated TG level was
prescribed a fibrate.
Pre-operative control of known dyslipidaemia was
suboptimal in young adults with angiographially proven
severe symptomatic CAD. This is either due to
subtherapeutic dose prescribing or failure to commence
appropriate anti-lipid drugs. Collectively, general
practitioners, cardiologists and cardiac surgeons must be
more diligent in monitoring lipid profiles in such patients
and be more meticulous in prescribing therapeutic doses to
achieve target control.
Coronary Artery Disease
6.Allergic reaction to stainless steel sternotomy wires requiring removal: A case report and literature review
Jacinta Marie Lopez ; Anand Sachithanandan ; Margaret Leow Poh Gaik
The Medical Journal of Malaysia 2016;71(3):142-143
Hypersensitivity to stainless steel sternal sutures are an
uncommon occurrence. We present a case of such a patient
who developed chronic tissue overgranulation over a
sternotomy wound eight weeks post-operatively. Primary
suspicion was infection, a more common complication
however radiological and laboratory investigation showed
otherwise. Conservative management provided limited
ephemeral success. After ensuring adequate sternal bone
healing, the sutures and granulation tissue were eventually
surgically removed without complication and the reoperated
wound healed well.
7.Minimally invasive thoracoscopic mesh repair of diaphragmatic fenestrations for catamenial pneumothorax due to likely thoracic endometriosis: a case report.
Cieslik, Luke ; Haider, Sazaly Syed ; Fisal, Liza ; Rahmaan, Jamalul Azizi Abdul ; Sachithanandan, Anand
The Medical Journal of Malaysia 2013;68(4):366-7
8.Smoking amidst the COVID-19 Pandemic - the invisible threat?
The Medical Journal of Malaysia 2020;75(3):309-310
A curious observation during the ongoing pandemic is the
remarkably low proportion of smokers amongst hospitalized
COVID-19 patients. Data from China suggests smokers
account for only 6.5% of such patients despite a high
smoking rate (26.6 %) in the general population.
1,2 Similarly,
the Center for Disease Control and Prevention (CDC) found
only 1.3% of 7,162 Covid-positive hospitalized Americans
were smokers against a national smoking prevalence of
14%.
3 Could nicotine have a protective effect against COVID19, or are these disproportionately low figures due to varying
definitions and inaccurate reporting of smoking status
amidst an emerging and overwhelming epidemic? Patients
might be too sick or fearful to provide an honest or coherent
report of tobacco use. Doctors may be too busy to take a
detailed history. Smoking is more prevalent among lower
socioeconomic classes where affordable access to hospital
care might be an issue.
9.Acute kidney injury following coronary artery bypass graft surgery in a tertiary public hospital in Malaysia: an analysis of 1228 consecutive cases
Hiew Khee Chun ; Anand Sachithanandan ; Mohamad Arif Muhammad Nor ; Balaji Badmanaban ; Abdul Muiz Jasid ; Faisal Ismail ; Hamdan Leman ; Evi Diana Omar
The Medical Journal of Malaysia 2016;71(3):126-130
Background: Acute kidney injury (AKI) following cardiac
surgery is well established but the reported incidence is
variable due to varying definitions and criteria. Furthermore
there is a paucity of such data from Southeast Asia.
Objectives: To determine the incidence of AKI, the
associated risk factors, and its impact on early mortality and
intensive care unit/hospital stay.
Method: This is a single centre retrospective observational
study to evaluate outcomes on 1260 consecutive patients
from a multi-ethnic Southeast Asian population who
underwent a primary isolated coronary artery bypass graft
(CABG) operation. Data was collected from the hospital’s
electronic database and analysed using basic descriptive
statistics and logistic regression.
Results: Overall incidence was 36.2% including 5.5% of
patients who required renal replacement therapy (RRT).
Multivariate analysis identified age, insulin-dependent
diabetes mellitus (IDDM), baseline serum creatinine level
(SCr), recent myocardial infarction (MI), cardiopulmonary
bypass (CPB) time and intra-aortic balloon pump (IABP) use
as independent risk factors for AKI. For patients who
required RRT, the SCr and IDDM remained independent
predictors. Early 30-day mortality (11.5% vs 0.9%) was
significantly higher in patients who developed AKI following
CABG. Similarly, AKI was associated with a slight but
statistically significant increase in intensive care unit (ICU)
and hospital stay.
Conclusion: Better prognostication and preventative
strategies are required to better risk stratify patients
undergoing CABG and optimise utilisation of limited
healthcare resources.
Acute Kidney Injury