1.Predictors of acute neurological complication following tetralogy of Fallot operation in Serdang Hospital, Malaysia
Yap Ming Teck ; Putri Yubbu ; Yong Shao Wei ; Hing Wee Ven ; Ong Ying Seang ; Navin Kumar Devaraj ; Ani Suraya Abdul Ghan ; Koh Ghee Tiong ; Hamdan Leman,
The Medical Journal of Malaysia 2020;75(5):495-501
Background: The long waiting time for Tetralogy of Fallot
(TOF) operation may potentially increase the risk of hypoxic
insult. Therefore, the objective of this study is to determine
the frequency of acute neurological complications following
primary TOF repair and to identify the peri-operative risk
factors and predictors for the neurological sequelae.
Methods: A retrospective review of the medical and surgical
notes of 68 patients who underwent TOF repair in Hospital
Serdang, from January 2013 to December 2017 was done.
Univariate and multivariate analyses of demographics and
perioperative clinical data were performed to determine the
risk for the development of acute neurological
complications (ANC) among these patients.
Results: ANC was reported in 13 cases (19.1%) with delirium
being the most common manifestation (10/68, 14.7%),
followed by seizures in 4 (5.9%) and abnormal movements in
two patients (2.9%). Univariate analyses showed that the
presence of right ventricular (RV) dysfunction, prolonged
duration of inotropic support (≥7 days), prolonged duration
of mechanical ventilation (≥7 days), longer length of ICU
stays (≥7 days), and longer length of hospital stay (≥14
days), were significantly associated with the presence of
ANCs (p<0.05). However, multivariate analyses did not show
any significant association between these variables and the
development of ANC (p>0.05). The predictors for the
development of postoperative delirium were pre-operative
oxygen saturation less than 75% (Odds Ratio, OR=16.90,
95% Confidence Interval, 95%CI:1.36, 209.71) and duration of
ventilation of more than 7 days (OR=13.20, 95%CI: 1.20,
144.98).
Conclusion: ANC following TOF repair were significantly
higher in patients with RV dysfunction, in those who
required a longer duration of inotropic support, mechanical
ventilation, ICU and hospital stay. Low pre-operative oxygen
saturation and prolonged mechanical ventilation
requirement were predictors for delirium which was the
commonest neurological complications observed in this
study. Hence, routine screening for delirium using an
objective assessment tool should be performed on these
high-risk patients to enable accurate diagnosis and early
intervention to improve the overall outcome of TOF surgery
in this country
2.Spontaneous Subperiosteal Orbital Haemorrhage (SSOH): An Unusual Complication of Acute Coronary Syndrome Treatment
Dhashani Sivaratnam ; Wan Mariny W Md Kasim ; Kirbashini Kanasan ; Ming Teck Yap ; Siew Mooi Ching ; Navin Kumar Devaraj
Malaysian Journal of Medicine and Health Sciences 2021;17(No.4):419-421
Acute coronary syndrome is a medical emergency with a high mortality and morbidity. Reperfusion therapy is widely
used in its management. Ocular complications following reperfusion therapy is rare. A 51-year-old man treated with
streptokinase, antithrombotic and dual antiplatelet therapy, developed mild proptosis following treatment. After four
days, there was sudden worsening of the proptosis associated with orbital compartmental syndrome (OCS). The CT
scan of the orbit showed a large spontaneous subperiosteal orbital hemorrhage (SSOH) occupying half of the left
orbit. Despite performing an urgent lateral canthotomy and inferior cantholysis, the patient developed irreversible
vision loss due to compressive optic neuropathy. While a few cases of mild SSOH have been reported in the medical
literature, this is the first documented case of secondary bleed in SSOH. Early recognition and intervention by the
treating physician, is crucial in preventing blindness.
3.Survival Analysis and Prognostic Factors for Peri-ocular Malignancies in Malaysia
Dhashani Sivaratnam ; Radzlian Othman ; Navin Kumar Devaraj ; Yap Ming Teck ; Vincent Ng Teng Fung ; Ew Shao Chen ; Ramizah Md Rozi ; Nur Najlaa Baharudin ; Kirbashini Kanasan ; Abdul Hanif Khan Yusof Khan ; Vasudevan Ramachandran ; Siew Moi Ching
Malaysian Journal of Medicine and Health Sciences 2024;20(No.1):60-69
Introduction: This study aims to determine the prognostic factors and survival outcomes of patients that underwent
this surgery. Method: A retrospective review of 43 patients who underwent exenteration for periocular malignancies
over a 14-year period was carried out. Patient demographics, tumour histology, treatment details, surgical margins’
status and post-operative survival were recorded. The survival outcome examined was the overall survival (OS)
rate. Cox regression and Kaplan-Meier analysis were used to evaluate post-exenteration survival. Results: In total,
20 females and 23 males with a median age of 62 ± 17.3 years were identified. The most common indication for
exenteration was basal cell carcinoma (20.9%), followed by squamous cell carcinoma (18.6%), adenocystic carcinoma (14%), malignant melanoma (14%) and sebaceous gland carcinoma (11.6%). The independent predictors for
worse OS on multivariate analysis were Chinese ethnicity (adjusted hazard ratio [aHR] 4.95, p =0.017), sebaceous
gland carcinoma (aHR 57.61 p=0.006), adenocystic carcinoma (aHR 45.87, p=0.008), clear surgical margins (aHR
5.41, p=0.025), receiving only chemotherapy (aHR 169.13, p=0.004), and receiving both adjuvant chemotherapy
and radiotherapy (aHR 41.51, p=0.010). Conclusion: We recommend targeted public health initiatives for Chinese
patients due to their increased mortality risk from peri-ocular malignancies. In addition, we advise comprehensive
adjuvant therapy for all patients regardless of whether a clear surgical margin is achieved. Basal cell carcinoma and
adenocystic carcinoma may also benefit from genetic research. We advocate more training for ophthalmologists to
identify periocular malignancies earlier for better treatment options and increased chances of survival.