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Papers by Adi Syazni Muhammed

International Medical Journal Malaysia, Jun 30, 2021

Hypocalcemia is a common complication after total thyroidectomy; however, hypomagnesemia is also ... more Hypocalcemia is a common complication after total thyroidectomy; however, hypomagnesemia is also frequently detected, and its role is often disregarded. We report a 72-year-old woman who underwent total thyroidectomy with neck dissection and subsequently developed atrial fibrillation due to hypocalcemia and hypomagnesemia. The pathophysiology of hypomagnesemia after total thyroidectomy and its significance in calcium homeostasis is described.

International Medical Journal Malaysia, Jul 1, 2022

INTRODUCTION: Ultrasound has been widely used to assess thyroid nodules. Although ultrasound elas... more INTRODUCTION: Ultrasound has been widely used to assess thyroid nodules. Although ultrasound elastography has been developed to improve detection of thyroid malignancy, it has received mixed responses. This study aimed to determine the efficacy of ultrasound elastography in detecting malignant thyroid nodules. MATERIALS AND METHODS: Patients with thyroid nodules were assessed using conventional ultrasound and elastography followed by fine-needle aspiration and or hemithyroidectomy. The ultrasound findings were compared with the cytology or histopathology for statistical analysis. RESULTS: Out of 156 nodules from 92 patients included in the study, 12 (7.7%) were malignant and 144 (88.8%) were benign. The elastography was found to be an independent predictor of malignancy (OR 10.35, 95% CI [1.31, 81.6], p = 0.03). Other independent predictors were taller shape and central Doppler pattern obtained using conventional ultrasound. A combination of the three independent predictors was shown to improve the sensitivity of detecting malignant thyroid nodules up to 100%, 95% CI [73.5,100] with NPV of 100%. A new scoring system incorporating the three variables was developed and an algorithm using the scoring system was proposed. CONCLUSION: Thyroid elastography is an independent predictor of thyroid malignancy. Its performance is comparable to conventional ultrasound when used alone and improved when used in combination with conventional ultrasound. It is valuable as screening and riskstratification tools for patients with thyroid nodules.

Bahrain medical bulletin, Jun 1, 2017

Amputation is usually the last resort for treatment of non-salvageable limbs due to various indic... more Amputation is usually the last resort for treatment of non-salvageable limbs due to various indications such as trauma, infection and malignancy. However, some patients still refuse surgery and reconstruction. Instead, they insist on keeping their limbs despite knowing the negative consequences including a limited or non-functioning limb. We present three cases who refused amputations: The first was a nine-year-old boy involved in a motor vehicle accident (MVA), with a left femoral midshaft open grade IIIb fracture; the mangled extremity severity score (MESS) was five. The second was a 16-year-old girl sustained a left leg crush injury, a fractured left fibula and an injury to the anterior tibial artery following an MVA; her MESS was 12. The third was a 60-year-old left-handed tractor driver presented with a fiveyear history of a slowly enlarging fungating growth over the dorsum of his left hand; biopsy confirmed basal cell carcinoma (BCC). We explore the cultural and religious reasons behind this stigma of amputation in a multiethnic community. It will help clinicians to manage these challenging situations according to the principles of medical ethics.

Journal of Endocrine Surgery

IIUM Medical Journal Malaysia

Pituitary apoplexy is a vascular event within the pituitary gland, in which haemorrhage or infarc... more Pituitary apoplexy is a vascular event within the pituitary gland, in which haemorrhage or infarction may occur, and is commonly associated with pituitary adenoma. However, concurrent cerebrovascular incident beyond the gland is rare. This article reports a case of a pituitary apoplexy complicated with subarachnoid haemorrhage and cerebral infarction in a 60-year-old lady. She presented with sudden blurring of vision and right third cranial nerve palsy. Imaging revealed pituitary apoplexy with subarachnoid haemorrhage and cerebral infarction. Failing conservative management, surgical excision was performed. Her symptoms improved and she recovered well with no major neurological deficit.

IIUM Medical Journal Malaysia, 2021

INTRODUCTION: This study aims to evaluate the diagnostic reliability of the American College of R... more INTRODUCTION: This study aims to evaluate the diagnostic reliability of the American College of Radiology Thyroid Imaging Report and Data System (ACR-TIRADS) and Total Malignancy Score (TMS) scoring system, in differentiating benign and malignant thyroid nodules. MATERIALS AND METHODS: This is a cross-sectional study involving patients with thyroid nodules treated at Hospital Canselor Tuanku Muhriz from October 2017 until October 2019. Ultrasound findings were scored according to the ACR[1]TIRADS and TMS scoring system. They were then correlated with the FNAC or histopathology report. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of both scoring system were calculated for analysis. RESULTS: A total of 150 patients with 223 thyroid nodules were included. 17% or 38 nodules were found to be malignant. The sensitivity, specificity, PPV, NPV and accuracy of ACR-TIRADS and TMS were 97.37% vs. 84.21 % , 52.97% vs. 62....

IIUM Medical Journal Malaysia, 2020

Chyle leak is a well-known complication that can occur after a thyroidectomy with neck dissection... more Chyle leak is a well-known complication that can occur after a thyroidectomy with neck dissection; however, it rarely occurs after thyroidectomy alone. Here, we report a case of chyle leak following a left hemithyroidectomy for a benign solitary thyroid nodule. Based on the literature search, this is only the second reported case of a chyle leak after a simple hemithyroidectomy without any central or lateral neck dissection. Amongst the possible causes, we hypothesize that the use of intraoperative nerve monitor may be a contributing factor. Treatment options are explored and the patient was treated successfully with nonoperative management.

Bahrain Medical Bulletin, 2017