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Ng BH, Low HJ, Nuratiqah NA, Soo CI, Imree A, Mas FMJ, Azat AA, Faisal AH, Andrea BYL. Predictive risk factors for pneumothorax following fluoroscopic-guided transbronchial lung biopsy. Med J Malaysia 2023; 78:897-900. [PMID: 38159925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Fluoroscopic-guided transbronchial lung biopsy (FG-TBLB) is routinely performed via bronchoscopy to diagnose focal peripheral lesions and diffuse lung disease. Identifying the risk factors of FG-TBLB-related pneumothorax can assist the operator in taking pre-emptive measures to prepare for this potential complication. MATERIALS AND METHODS We retrospectively analysed data from 157 patients who underwent FG-TBLB, with the primary outcome being procedure-related pneumothorax. We assessed several risk factors for pneumothorax following FG-TBLB: patient characteristics, location of biopsy, number of biopsies and computed tomography pattern. Univariate and multivariate logistic regression analyses were performed. RESULTS One-hundred fifty-seven patients were included [mean (SD) age 57.9 (16.2) years; 60.5% male]. The most common location for FG-TBLB was the right upper lobe (n=45, 28.7%). The mean (SD) number of biopsy samples was 6.7 (2.1). Radiographic evidence of pneumothorax was reported in 12 (7.6%) patients, with 11 of those requiring intercostal chest tube intervention (mean air leak time: 5.7 days and 1 had persistent air leak requiring autologous blood patch pleurodesis. None experienced pneumothorax recurrence. Female gender and upper lobe location of the biopsy were identified as predisposing factors for pneumothorax. In the multivariable analysis, upper lobe biopsies were associated with a higher risk of pneumothorax (OR 0.120; 95% CI 0.015-0.963; p = 0.046). CONCLUSION The overall rate of pneumothorax is low. We recognise the increased risk of pneumothorax associated with upper lobe biopsy. These findings suggest that clinicians should exercise caution when performing FGTBLB in this region and consider alternative biopsy locations whenever feasible. We suggest adequate planning and preparation should be implemented to minimise the risk of pneumothorax following FG-TBLB.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Medicine, Respiratory Unit, Kuala Lumpur, Malaysia.
| | - H J Low
- Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Anaesthesia and Critical Care, Kuala Lumpur, Malaysia
| | - N A Nuratiqah
- Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- Universiti Malaya, Faculty of Medicine, Department of Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - A Imree
- Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Radiology, Kuala Lumpur, Malaysia
| | - F M J Mas
- Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - A A Azat
- Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - B Y L Andrea
- Hospital Sultanah Bahiyah, Respiratory Department, Kedah, Malaysia
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Ng BH, Low HJ, Nuratiqah NA, Faisal AH, Fairuz AS, Shahrir MS, Andrea YLB. A case series of pulmonary alveolar proteinosis: Response differently to whole lung lavage. Med J Malaysia 2022; 77:261-263. [PMID: 35338641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disease and its prognosis can be improved by whole lung lavage (WLL). Herein, we present three cases with idiopathic PAP treated successfully with either single or double WLL in the same setting. All three of them presented with exertional dyspnoea with radiographic findings of pulmonary infiltrates. They showed a marked clinical and physiologic improvement post WLL. Two of them were in remission. These three cases were diagnosed using different lung biopsy modalities, including video-assisted thoracoscopic lung biopsy, computed tomography-guided percutaneous transthoracic tru-cut needle lung biopsy, and transbronchial forceps lung biopsy (TBLB), respectively. The current cases have shown that TBLB may provide adequate diagnostic yield, and the invasive surgical lung biopsy may not be necessary to achieve a definitive diagnosis.
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Affiliation(s)
- B H Ng
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia
| | - H J Low
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Anaesthesiology and Critical Care, Malaysia
| | - N A Nuratiqah
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia
| | - A H Faisal
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia
| | - A S Fairuz
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Anaesthesiology and Critical Care, Malaysia
| | - M S Shahrir
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Rheumatology Unit, Malaysia
| | - Y L B Andrea
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia
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Ng BH, Andrea YLB, Nuratiqah NA, Faisal AH, Low HJ. Clots in tuberculosis. Med J Malaysia 2021; 76:953-955. [PMID: 34806695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Tuberculosis (TB) is a common communicable disease. Active TB infection may be complicated by both venous and arterial thrombosis which are often under-recognised. We report two patients with incidental TB associated thrombosis involving different venous systems. Both responded to anticoagulant and anti-tuberculous therapy (ATT). Patients with tuberculosis are at risk of VTE and careful monitoring for venous thromboembolism (VTE) is needed during ATT. Our case illustrates the importance of having a high index of suspicion for silent VTE as it may complicate active TB infection.
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Affiliation(s)
- B H Ng
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia
| | - Y L B Andrea
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia.
| | - N A Nuratiqah
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia
| | - A H Faisal
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Internal Medicine, Respiratory Unit, Malaysia
| | - H J Low
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Anaesthesiology and Critical Care, Malaysia
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Ng BH, Low HJ, Nik Nuratiqah NA, Faisal AH, Soo CI, Periyasamy P, Ban AYL. Understanding of Coronavirus Disease 2019 (COVID-19) and the practice of preventive measures among doctors and nurses in a university teaching hospital- A cross-sectional study. Med J Malaysia 2021; 76:454-460. [PMID: 34305104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Knowledge and adequate practice of preventive measures among health care workers (HCWs) are important to reduce the risk of COVID-19 transmission. METHODS A cross-sectional study was conducted among doctors and nurses in the medical department in Pusat Perubatan Universiti Kebangsaan Malaysia between November 18, 2020 and December 18, 2020 during the third wave of COVID-19 epidemic in Malaysia. We studied the knowledge and practice of preventive measures of COVID-19 among doctors and nurses in the COVID-19 or sudden acute respiratory infection (SARI) wards and general medical wards. Data was collected using a validated self-designed google form online-questionnaire. RESULTS A total of 407 subjects completed the study and 80.8% were females; 55.8% were aged between 30-39 years; 46.4% were medical doctors. The main source of COVID-19 knowledge was the Ministry of Health Malaysia (MOH) website (35.1%). Majority (97%) had sufficient knowledge and 82% practiced proper preventive measures. Doctors had a higher mean knowledge score compared to nurses (p < 0.001). HCWs working in COVID-19 or SARI wards scored higher in knowledge questions compared to those in the general medical wards (p = 0.020). Nurses practiced better preventive measures (p < 0.001). Good knowledge could not be predicted based on professions (OR: 0.222, 95% CI: 0.048 - 1.028, p = 0.054). Majority were unable to recall the proper steps of donning (85.8%) and doffing (98.5%). CONCLUSIONS Although majority had good knowledge and practiced proper preventive measures, there was a poor recall in donning and doffing steps regardless of place of practice. The MOH website is a useful platform for tailored continuous medical education and regular updates on COVID-19. Regular training and retraining on donning and doffing of PPE is needed to bridge this gap.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - H J Low
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Anaesthesiology and critical care, Kuala Lumpur Malaysia
| | - N A Nik Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur Malaysia
| | - A Y L Ban
- University of Malaya, Faculty of Medicine, Department of Surgery, Division of Paediatric Surgery, Kuala Lumpur, Malaysia.
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Ng BH, Tan YS, Pavitratha P, A Hing C, Zainul NH, Lim CH. Angiosarcoma - a rare fatal cause of recurrent pericardial effusions. Med J Malaysia 2020; 75:759-761. [PMID: 33219196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 40-year-old man presented to the Hospital Sultanah Bahiyah, Alor Setar, Kedah, with constitutional and respiratory symptoms. Physical examination and echocardiogram demonstrated massive pericardial effusion. Patient required multiple attempts of pericardiocentesis due to recurrent pericardial effusion. Initial workup including pericardial fluids examination and computed tomography imaging did not reveal any apparent cause. Magnetic resonance imaging showed a suspicious mass infiltrating into the right atrium. Autoimmune screening was negative. Patient was subsequently treated as having tuberculous pericarditis. However, his disease progressed rapidly and he eventually passed away due to right atrial rupture. Postmortem revealed a ruptured right atrial tumour leading to massive haemothorax. Histopathological examination confirmed the diagnosis of primary pericardial angiosarcoma.
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Affiliation(s)
- B H Ng
- Hospital Raja Permaisuri Bainun, Department of Internal Medicine, Ipoh, Perak Darul Ridzuan, Malaysiaa.
| | - Y S Tan
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
| | - P Pavitratha
- Hospital Sultanah Bahiyah, Department of Pathology, Alor Setar, Kedah Darul Aman, Malaysia
| | - C A Hing
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
| | - N H Zainul
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
| | - C H Lim
- Hospital Sultanah Bahiyah, Department of Internal Medicine, Alor Setar, Kedah Darul Aman, Malaysia
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Ng BH, Andrea YLB, Nuratiqah NA, Faisal AH, Soo CI, Najma K, Periyasamy P. COVID-19 detected from targeted contact tracing, attempting to see the pattern in random happenings: early lessons in Malaysia. Med J Malaysia 2020; 75:582-584. [PMID: 32918430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The world feels strange as we face what is for most of us our first ever pandemic. The number of newly diagnosed cases rises daily in many parts of the world, and we are faced with the reality that there are still many things to learn about this new disease. We share here our experience of treating our first 199 COVID-19 patients in the Hospital Canselor Tuanku Muhriz, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM).
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - Y L B Andrea
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia.
| | - N A Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Respiratory Unit, Kuala Lumpur, Malaysia
| | - K Najma
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Disease Unit, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Disease Unit, Kuala Lumpur, Malaysia
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Ng BH, Nuratiqah NA, Faisal AH, Soo CI, Low HJ, Najma K, Periyasamy P, Mustafa N, Andrea YLB. A descriptive study of the psychological experience of health care workers in close contact with a person with COVID-19. Med J Malaysia 2020; 75:485-489. [PMID: 32918414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND COVID-19 has the potential to affect the mental health of health care workers (HCWs). It is known that HCWs who serve as front-liners during the COVID-19 pandemic experience stress and have the fear of contracting the infection. Little is known of how being a positive contact affects HCWs. OBJECTIVE We examined the experience of HCWs who were quarantined following a close unprotected contact with a COVID-19 positive colleague and explore the psychological impact especially as the timing of the quarantine coincided with the Eid (annual Muslim festival) celebration in Malaysia. METHODS This was a cross-sectional on-line questionnaire study, involving HCWs exposed to a COVID-19 positive colleague in Universiti Kebangsaan Malaysia Medical Centre, a teaching hospital. Data on demographics, levels of depression, anxiety and stress using a validated depression, anxiety, and stress scale (DASS-21) questionnaire, aspects of quarantine, wearing of masks, hand hygiene practice and swab experience were collected. RESULTS Twenty-two HCWs participated. Eighteen (81.8%) were between 30-39 years and 17 (77.3%) were women. Majority 19 (86.3%) were Malays. There were twelve (54.5%) medical officers, 5 (22.7%) specialists and 5(22.7%) allied health staff. Eighteen out of 22 (81.8%) felt they were able to do home quarantine adequately. All tested negative with a mean (Standard Deviation) hour of contact of 2.56±2.38 hours. Eighteen reported their biggest concern was infecting their families. CONCLUSION HCWs undergoing contact swabbing and quarantine are vulnerable to depression, anxiety and stress. The ability of the HCW to adequately home quarantine should not be taken for granted. Psychological support should be offered to HCWs who are positive contacts.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - N A Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - H J Low
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Anaesthesiology and critical care, Kuala Lumpur, Malaysia
| | - K Najma
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
| | - N Mustafa
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Endocrine Unit, Kuala Lumpur, Malaysia
| | - Y L B Andrea
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia.
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Faisal M, Farhan R, Cheong XK, Ng BH, Nuratiqah N, Andrea Yl B. Short-course modified regimen intrapleural alteplase and pulmozyme (DNase) in pleural infection. Respir Med Case Rep 2020; 31:101168. [PMID: 32714827 PMCID: PMC7372138 DOI: 10.1016/j.rmcr.2020.101168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 11/16/2022] Open
Abstract
Pleural infection is a common clinical condition leading to hospitalisation. In the last decade, advances in pleural research have led to a paradigm shift in the treatment of complex effusion from a surgical approach to a less invasive non-surgical approach using a combination of intrapleural fibrinolytics and pulmozyme (DNase). We report 3 patients with pleural infection. Intercostal chest catheter failed to drain the complex effusion. They were subsequently treated with a modified short-course regimen of alteplase and DNase. They received 3 cycles of 16 mg alteplase with 5 mg DNase each within 24 hours and all three had a favourable outcome with no adverse effects. This modified regimen appears effective with good safety profile and adds to the current literature on the safety and effectiveness of different dose combinations of alteplase and DNase.
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Affiliation(s)
- M Faisal
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - R Farhan
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - X K Cheong
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - B H Ng
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - N Nuratiqah
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
| | - Ban Andrea Yl
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
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Ng BH, Nuratiqah NA, Andrea YLB, Faisal AH, Soo CI, Najma K, Shahizon MM, Isa AZ, Kamazuraman L, Yusuf AS, Abdul GH, Mustafa N, Nafisah WY, Azmin S, Khoo CS, Hemalatha M, Ching ZH, Low HJ, Periyasamy P. Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur. Med J Malaysia 2020; 75:368-371. [PMID: 32723996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Coronavirus Disease 2019 (COVID- 19) was first reported in Malaysia in March 2020. We describe here the clinical characteristics and computed tomography (CT) patterns in asymptomatic young patients who had laboratory-confirmed COVID-19. METHODS This is a retrospective observational study where 25 male in-patients with laboratory-confirmed COVID-19 in Hospital Canselor Tuanku Muhriz. Demographics, clinical data and CT images of these patients were reviewed by 2 senior radiologists. RESULTS In total there were 25 patients (all males; mean age [±SD], 21.64±2.40 years; range, 18-27 years). Patients with abnormal chest CT showed a relatively low normal absolute lymphocytes count (median: 2.2 x 109/L) and absolute monocyte count (median: 0.5 x 109/L). Lactate dehydrogenase was elevated in 5 (20%) of the patients. The procalcitonin level was normal while elevated levels of alanine aminotransferase, total bilirubin, platelet and C-reactive protein were common. Baseline chest CT showed abnormalities in 6 patients. The distribution of the lesions were; upper lobe 3 (12%) lower lobe 3 (12%) with peripheral distribution 4 (16%). Of the 25 patients included, 4 (16%) had ground glass opacification (GGO), 1 (4%) had a small peripheral subpleural nodule, and 1 (4%) had a dense solitary granuloma. Four patients had typical CT features of COVID-19. CONCLUSION We found that the CT imaging showed peripheral GGO in our patients. They remained clinically stable with no deterioration of their respiratory symptoms suggesting stability in lung involvement. We postulate that rapid changes in CT imaging may not be present in young, asymptomatic, non-smoking COVID-19 patients. Thus the use of CT thoraxfor early diagnosis may be reserved for patients in the older agegroups, and not in younger patients.
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Affiliation(s)
- B H Ng
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - N A Nuratiqah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - Y L B Andrea
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia.
| | - A H Faisal
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - K Najma
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
| | - M M Shahizon
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Radiology, Kuala Lumpur, Malaysia
| | - A Z Isa
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Radiology, Kuala Lumpur, Malaysia
| | - L Kamazuraman
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - A S Yusuf
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - G H Abdul
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Kuala Lumpur, Malaysia
| | - N Mustafa
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Endocrine Unit, Kuala Lumpur, Malaysia
| | - W Y Nafisah
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Neurology Unit, Kuala Lumpur, Malaysia
| | - S Azmin
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Neurology Unit, Kuala Lumpur, Malaysia
| | - C S Khoo
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Neurology Unit, Kuala Lumpur, Malaysia
| | - M Hemalatha
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - Z H Ching
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - H J Low
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Anaesthesiology and critical care, Kuala Lumpur, Malaysia
| | - P Periyasamy
- Universiti Kebangsaan Malaysia Medical Centre, Faculty of Medicine, Department of Internal Medicine, Infectious Diseases Unit, Kuala Lumpur, Malaysia
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Lim KY, Rajah R, Ng BH, Soo CI. High intensity non-invasive positive pressure ventilation for refractory decompensated acute hypercapnic respiratory failure in advanced chronic obstructive pulmonary disease. Med J Malaysia 2020; 75:430-432. [PMID: 32724009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a debilitating progressive lung disease characterised by irreversible airflow obstruction. In addition to an increase in morbidity and mortality, exacerbation also results in frequent hospital visits, which place a burden on healthcare systems. Non-invasive positive pressure ventilation (NPPV) with conventional inspiratory pressures is the standard ventilatory support for patients in exacerbation. At present, the use of higher inspiratory pressures through high intensity noninvasive positive pressure ventilation (Hi-NPPV) during an exacerbation remains unknown. We describe a novel application of Hi-NPPV in a patient with acute exacerbation who was refractory to conventional NPPV.
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Affiliation(s)
- K Y Lim
- UKM Medical Centre, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia.
| | - R Rajah
- UKM Medical Centre, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - B H Ng
- UKM Medical Centre, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
| | - C I Soo
- UKM Medical Centre, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
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Ng BH, Tan JK, Andrea Ban YL, Faisal AH. Intra-pleural Instillation of Autologous Blood - Fine-tuning Techniques for Better Success Rate: Two Case Reports. Med J Malaysia 2020; 75:181-183. [PMID: 32281606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the past, many case series have reported the effectiveness of autologous blood patch pleurodesis (ABPP) in recurrent secondary spontaneous pneumothorax (SSP), particularly in those who were unfit for surgery. We describe two cases of persistent air leak in pneumoconiosis and pulmonary fibrosis with bronchiectasis, whereby the techniques employed had improved the success rate of ABPP. The determining factors that lead to the success of ABPP were determined by the volume of autologous blood instilled, Trendelenburg position post instillation, and early chest physiotherapy with mobilisation by application of pneumostat.
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Affiliation(s)
- B H Ng
- University Kebangsaan Malaysia Medical Center, Department of Medicine, Respiratory Division, Kuala Lumpur, Malaysia.
| | - J K Tan
- University Kebangsaan Malaysia Medical Center, Department of Medicine, Respiratory Division, Kuala Lumpur, Malaysia
| | - Y L Andrea Ban
- University Kebangsaan Malaysia Medical Center, Department of Medicine, Respiratory Division, Kuala Lumpur, Malaysia
| | - A H Faisal
- University Kebangsaan Malaysia Medical Center, Department of Medicine, Respiratory Division, Kuala Lumpur, Malaysia
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Faisal AH, Ng BH. Ways to overcome non-draining indwelling pleural catheter in malignant pleural effusion. Med J Malaysia 2019; 74:555-557. [PMID: 31929490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The indwelling pleural catheter (IPC) is a 16-Fr-multifenestrated catheter. It has become an accepted practice in the management of malignant pleural effusion, especially in patients with non-expandable lung. However, IPC blockage or not draining is common. A 53-year-old female with malignant pleural effusion presented to us with blocked IPC and symptomatic pleural loculation one month after IPC insertion. After failing saline flushing and low-pressure wall suction, intrapleural alteplase was instituted through the IPC with a favourable outcome, and she continued to drain daily thereafter. The present case highlights the safety of intrapleural alteplase via IPC in the non-expandable lung.
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Affiliation(s)
- A H Faisal
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia.
| | - B H Ng
- Pusat Perubatan Universiti Kebangsaan Malaysia, Department of Medicine, Pulmonology Unit, Kuala Lumpur, Malaysia
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Ng BH, Tan HX, Vijayasingham S. Kounis syndrome following solenopsis (fire ant) bite. Med J Malaysia 2019; 74:344-346. [PMID: 31424048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Anaphylaxis is rarely associated with the vasospastic acute coronary syndrome with or without the presence of underlying coronary artery disease. We report here a case of Kounis syndrome in a man with no known cardiovascular risk developed acute ST-elevation myocardial infarction complicated with complete heart block following Solenopsis (fire ant) bite.
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Affiliation(s)
- B H Ng
- University Kebangsaan Malaysia Medical Center, Department of Medicine, Kuala Lumpur, Malaysia.
| | - H X Tan
- Melaka General Hospital, Department of Medicine, Melaka, Malaysia
| | - S Vijayasingham
- Melaka General Hospital, Department of Medicine, Melaka, Malaysia
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Abstract
Gripping is a major challenge faced in the tensile testing of tendons. As soft and aqueous materials, tendons are prone to slip and experience premature failure during mechanical testing. Several gripping methods were attempted and evaluated, including serrated jaw, sandpaper, frozen ends, and air-dried ends. It was found that 1 kN pneumatic grips (Shimadzu Company) lined with cardboard provided an adequate grip without perceptible slip and damage to the tendons. It was found that using the pneumatic grips with cardboard lining the stress concentration at the grip-specimen interface reduced substantially. An analysis of specimens that failed at the grip-specimen interface versus those that failed at mid-substance shows that there was no significant difference in their tensile properties.
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Affiliation(s)
- B H Ng
- School of Mechanical and Production Engineering, Nanyang Technological University, Singapore
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Abstract
The purpose of this study is to evaluate the effect of strain rate on the failure properties of tendons. Seventy-five chicken flexor digitorum profundus (FDP) tendons were tensile tested at 15 strain rates, ranging from 0.05 to 150 per cent/s. Results showed that strain rate had little effect on the shape of the stress-strain curve. No significant change was observed in the toe region, while the slope of the linear region increased with the increase in strain rate. Generally, the ultimate tensile strength (UTS) and elastic modulus increased significantly as strain rate increased (p < 0.01), while no significant change in strain at UTS (p > 0.01) was observed. It was found the change in failure properties of tendons was not significant, with small change in strain rate.
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Affiliation(s)
- B H Ng
- School of Mechanical and Production Engineering, Nanyang Technological University, Singapore
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Magosso E, Yuen KH, Choy WP, Ling SSN, Ng BH, Ur-Rahman N, Wong JW. Comparative bioavailability study of a generic sustained release diclofenac sodium tablet. Med J Malaysia 2004; 59:352-6. [PMID: 15727381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The bioavailability of a generic diclofenac sodium sustained release tablet preparation (Zolterol, SR) was compared with the innovator product, Voltaren, SR. Twelve healthy adult male volunteers participated in the study, which was conducted according to a randomized, two-way crossover design with a wash out period of one week. The bioavailability of diclofenac was compared using the parameters area under the plasma concentration-time curve (AUC(0-infinity)), peak plasma concentration (Cmax) and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed for both logarithmically transformed AUC(0-infinity), Cmax values and Tmax value of the two preparations.
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Affiliation(s)
- E Magosso
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
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