A retrospective survey was carried out in a neonatal unit to identify babies who required oxygen for more than the first 28 days of life and to determine the cause of their oxygen dependency. A total of 9173 neonates were admitted over a three year period. Approximately 750 were ventilated. Fifteen required oxygen for more than the first 28 days. Ten (67%) of these were due to bronchopulmonary dysplasia. 2 had upper airway complications of mechanical ventilation, one had recurrent apnoea, one had recurrent pneumonia, and one who did not require ventilation had chronic oxygen dependency of unknown cause. Bronchopulmonary dysplasia was the commonest cause of chronic oxygen dependency. The incidence was 1.5% of ventilated babies.
Tracheocutaneous fistula (TCF) is a known complication of tracheostomy. It can cause problems such as saliva leak, predispose to infection from external skin into respiratory tract and cosmetically not acceptable. Treatment of the underlying infection is paramount important. Persistence of tract after sufficient duration of observation period should be surgically treated. Cases reported in the literature are mainly regarding paediatric TCF and the procedures are usually done under general anesthesia. We describe a case of surgical treatment of an adult TCF which was done under local anaesthesia.
Normal tracheal mucociliary clearance is the key to maintaining the health and defense of respiratory airway. Therefore the present of cilia and mucous blanket are important for tracheal epithelium to function effectively. In the present study, we prepared a tissue engineered respiratory epithelium construct (TEREC) made of autologous respiratory epithelium cells, fibroblast and fibrin from sheep owns blood which replaced a created tracheal mucosal defect. Scanning electron microscopy (SEM) showed encouraging result where immature cilia were present on the surface of TEREC. This result indicates that engineered respiratory epithelium was able to function as normal tissue.
We report a case of sudden hypoxaemia after intubation in a patient who had smoked a few hours prior to a surgical procedure. The cause of his desaturation was not related to bronchial secretions, bronchospasm or obstruction of the upper airways but most likely due to reduced oxygen saturation in the body prior to surgery. We managed to secure the airway and prevent prolonged desaturation by instituting remedial measures. Our conclusion is that cessation of smoking is very important and need to be emphasized in all patients having surgery under general anaesthesia. This applies to emergency cases as well.
Toxoplasmic optic neuropathy is rare and usually occurs monoocularly. This case report demonstrates a rare presentation of bilateral
juxtapapillary retinochoroiditis (Jensen disease) due to toxoplasma infection in
a young healthy patient. A 20-year-old lady presented with bilateral painless
blurring of central vision for 5 days duration. It was preceded by fever, upper
respiratory tract symptoms and headache. There was no history of contact or
being scratched by a cat. Visual acuity was counting fingers for the right eye
and 6/45 for the left eye. There was presence of relative afferent pupillary
defect in the right eye. Optic nerve functions were impaired bilaterally which
was severe in the right eye. Both eyes showed the presence of mild anterior
segment inflammation and vitritis. Fundus examination revealed juxtapapillary
retinochoroiditis bilaterally with swollen optic disc. Optical coherence
tomography (OCT) showed presence of intra-retinal and sub-retinal fluid at
macular area bilaterally. Serology for anti-toxoplasma Immunoglobulin G (IgG)
was positive with titre of 1450 IU/ml. Computed tomography scan (CT scan) of
brain and orbit was normal. A diagnosis of bilateral juxtapapillary
retinochoroiditis or Jensen disease was made. Oral azithromycin 500 mg daily
and guttae prednisolone 4 hourly for 6 weeks was commenced. Oral
prednisolone 50 mg daily (1 mg/kg/day) was added after completion of 1 week
of antibiotic and was tapered down within 5 weeks. There was improvement of
vision as early as 3 weeks post initiation of the treatment. Upon 6 weeks
completing the treatment, her vision has improved to 6/7.5 on both eyes with
resolution of optic disc swelling and sub-retinal fluid. Early recognition and
initiation of treatment in toxoplasma infection associated with juxtapapillary
retinochoroiditis usually result in good visual prognosis.
Foreign body aspiration in children is a problem that can lead to several complications, including death. In this retrospective publication review from 1970 to 2015, there were altogether 42 Malaysian children below the age of 15 y reported with foreign body (FB) ingestion. There were 31 boys and 11 girls between 2 and 177 mo of age. The incidence of FB ingestion in children varied with dietary practices. Peanut was the most common food-related substance inhaled followed by watermelon seed and coconut kernel. The most common non-food related substances were metal objects (toys, springs, hair clips) and plastic objects (ballpoint tips, pencil caps and whistles). Successful removal of FB by bronchoscopy is achieved in the vast majority of cases except for a case of impacted whistle inhalation and a neglected laryngeal FB which required a tracheostomy. One child required thoracotomy for the removal of a peanut in the right bronchus. The incidence of food-related substance inhalation was more common than non-food related substance (30:7). From this review, the key messages are two: first, prevention can be achieved by educating parents not to allow access to small objects or dangerous foods to children below 3 y age; Second, emergency first aid home measures, in the combination form of back blows in the head down position and chest or abdominal thrusts, should be early performed according to the pediatric age group and can be quite effective.
The protective effects of Mucuna pruriens seed extract (MPE) against the cardio-respiratory depressant and neuromuscular paralytic effects induced by injection of Calloselasma rhodostoma (Malayan pit viper) venom in anaesthetized rats were investigated. While MPE pretreatment did not reverse the inhibitory effect of the venom on the gastrocnemius muscle excitability, it significantly attenuated the venom-induced cardio-respiratory depressant effects (p < 0.05). The protection effects may have an immunological mechanism, as indicated by the presence of several proteins in the venom that are immunoreactive against anti-MPE. However, we cannot rule out the possibility that the pretreatment may exert a direct, non-immunological protective action against the venom.
Mucuna pruriens has been used by native Nigerians as a prophylactic for snakebite. The protective effects of M. pruriens seed extract (MPE) were investigated against the pharmacological actions of N. sputatrix (Javan spitting cobra) venom in rats. The results showed that MPE-pretreatment protected against cardiorespiratory and, to a lesser extent, neuromuscular depressant effects of N. sputatrix venom. These may be explained at least in part by the neutralisation of the cobra venom toxins by anti-MPE antibodies elicited by the MPE pretreatment.
In this era, most of us are suffering some level of respiratory problem. Respiratory system of our children is even more sensitive compare to adults. As our children spending an average of 8 hours in school, indoor air quality of the classroom become an important element. Many studies have shown that indoor air quality not only affecting the respiratory system of schoolchildren but their performance in academy as well.
Asthma is considered as heterogeneous multidimensional disorder due to variable phenotypic presentation. Phenotype is defined as a cluster of either clinical or pathologic features, which tends to be associated with the understanding the mechanisms of the disease. Asthma is typically characterized by airway inflammation, variable airway obstruction, bronchial hyper-reactivity, smooth muscle hypertrophy and apparent reversible airflow obstruction by bronchodilators. ‘Asthma syndrome’ is a term to describe complex pathophysiology of the condition which is not exclusive to allergen triggered episodes. Diagnosing childhood asthma is difficult, due to the similarity of symptoms and overlapping with other wheezing conditions. The precise mechanism for asthma exacerbation, for each individual phenotype is not fully understood. However, it is influenced by genetic interaction with variety of external environmental stimuli. The current understanding on asthma phenotypes were interpreted based on age of onset, associated triggers, clinical aspects, physiologic parameters and type of inflammation (Table 1). Due to the illdefined of the current phenotypic definition and disagreement among the respirologists, it is becoming a challenge to label specific phenotype with certainty. Accurate definition of each phenotype should therefore be helpful to provide better understanding of different mechanistic pathways and focusing on targeted therapy for individual phenotype. (Copied from article).
We report an 8-year-old male child with tetralogy of Fallot (TOF), who developed left pulmonary artery (LPA) atresia, following surgical repair of TOF and left pulmonary arterioplasty at the age of 6 years. He underwent successful radiofrequency recanalization and stenting of the LPA. The LPA exhibited satisfactory growth for 3 months, following recanalization and stenting.
Matched MeSH terms: Respiratory System Abnormalities
BACKGROUND: The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy).
OBJECTIVE: To describe the data management process and statistical analysis plan.
METHODS: The statistical analysis plan was designed by the trial executive committee and reviewed and approved by the trial steering committee. We provide an overview of the trial design with a special focus on describing the primary (28-day survival) and secondary outcomes. We describe our data management process, data monitoring committee, interim analyses, and sample size calculation. We describe our planned statistical analyses for primary and secondary outcomes as well as pre-specified subgroup analyses. We also provide details for presenting results, including mock tables for baseline characteristics, adherence to the protocol and effect on clinical outcomes.
CONCLUSION: According to best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and beginning analyses. We anticipate that this document will prevent analysis bias and enhance the utility of the reported results.
Novel coronavirus disease, the latest world pandemic is one of the most contagious viral infections to date. There has been a lack of uniformity on recognizing this condition clinically because of poorly understood pathophysiology and clinical nature. Also due to ongoing clinical trials, its management is also varied. This is a systematic review from evidence-based studies until March 1st, 2020, covering an update on its clinical features and management. This study shows the multisystem involvement of COVID-19 with dominant respiratory features followed by the musculoskeletal, gastrointestinal system and others. The clinical features varied from asymptomatic to severe forms. Major causes of fatality were acute respiratory distress syndrome, shock, acute cardiac injury, acute kidney injury, rhabdomyolysis, and arrhythmia. Major modalities of management included supportive, antiviral and antibiotic therapy. There was no direct relationship between the specific treatment and the outcome.
Much microbiome research has focused on populations that are predominantly of European descent, and from narrow demographics that do not capture the socio-economic and lifestyle differences which impact human health. Here we examined the airway microbiomes of the Orang Asli, the indigenous peoples of Malaysia. A total of 130 participants were recruited from two sites in the north-eastern state of Terengganu in Peninsular Malaysia. Using 16S rRNA sequencing, the nasal microbiome was significantly more diverse in those aged 5-17 years compared to 50+ years (p = 0.023) and clustered by age (PERMANOVA analysis of the Bray-Curtis distance, p = 0.001). Hierarchical clustering of Bray-Curtis dissimilarity scores revealed six microbiome clusters. The largest cluster (n = 28; 35.4%) had a marked abundance of Corynebacterium. In the oral microbiomes Streptococcus, Neisseria and Haemophilus were dominant. Using conventional microbiology, high levels of Staphylococcus aureus carriage were observed, particularly in the 18-65 age group (n = 17/36; 47.2% 95% CI: 30.9-63.5). The highest carriage of pneumococci was in the <5 and 5 to 17 year olds, with 57.1% (4/7) and 49.2% (30/61), respectively. Sixteen pneumococcal serotypes were identified, the most common being the nonvaccine-type 23A (14.6%) and the vaccine-type 6B (9.8%). The prevalence of pneumococcal serotypes covered by pneumococcal conjugate vaccines support introduction into a Malaysian national immunisation schedule. In addition, the dominance of Corynebacterium in the airway microbiomes is intriguing given their role as a potentially protective commensal with respect to acute infection and respiratory health.
A paramyxovirus virus termed Nipah virus has been identified as the etiologic agent of an outbreak of severe encephalitis in people with close contact exposure to pigs in Malaysia and Singapore. The outbreak was first noted in late September 1998 and by mid-June 1999, more than 265 encephalitis cases, including 105 deaths, had been reported in Malaysia, and 11 cases of encephalitis or respiratory illness with one death had been reported in Singapore. Electron microscopic, serologic, and genetic studies indicate that this virus belongs to the family Paramyxoviridae and is most closely related to the recently discovered Hendra virus. We suggest that these two viruses are representative of a new genus within the family Paramyxoviridae. Like Hendra virus, Nipah virus is unusual among the paramyxoviruses in its ability to infect and cause potentially fatal disease in a number of host species, including humans.
Intense and prolonged exercise leads to immune suppression, causing upper respiratory tract infections (URTI). A proprietary standardized dietary supplement, IQP-AS-119 has been previously developed to aid immune responses under such conditions. The current randomized, double-blind, placebo-controlled pilot study aimed to investigate the effects of IQP-AS-119 on marathon runners. A total of 80 participants were randomized equally into groups receiving either placebo (P group) or IQP-AS-119 (V group) treatment, starting 3 weeks before and for 14 days after the marathon. Benefit assessment was performed using different questionnaires. Post-marathon, the V and P groups reported 1±2.38 and 2.11±3.25 days with upper respiratory tract symptoms (URTS), respectively (P=0.038). During the 14 days post-marathon, 20.0% of the participants in the V group compared with 44.4% in the P group reported URTS (P=0.042). The V group reported significantly milder URTS compared with the P group on Days 9, 12, 13 and 14 post-marathon (P<0.05). The total Perceived Stress Questionnaire-20 score on days 2-14 were significantly lower for the V group compared with the P group (P=0.035). In the Short Form 12 Health Survey, the V group exhibited significant improvement in mental composite score on days -5 to 14 compared with the P group (P=0.038). In the overall treatment effect assessment, there were no statistically significant differences between the groups. The IQP-AS-119 was rated 'very good' or 'good' by investigators and participants, respectively, for 71 and 65% of the participants. The tolerability of IQP-AS-119 was rated as 'very good' or 'good' by both investigators and 95% of participants. No clinically relevant differences were observed between groups regarding adverse events or other safety parameters. Therefore, IQP-AS-119 was demonstrated to reduce the incidence and severity of URTI in marathon runners. Given its good tolerability profile, IQP-AS-119 may be a good nutritional supplement for the reduction of URTS in susceptible individuals.
Influenza outbreaks during mass gatherings have been rarely described, and detailed virologic assessment is lacking. An influenza outbreak occurred during World Youth Day in Sydney, Australia, July 2008 (WYD2008). We assessed epidemiologic data and respiratory samples collected from attendees who sought treatment for influenza-like illness at emergency clinics in Sydney during this outbreak. Isolated influenza viruses were compared with seasonal influenza viruses from the 2008 influenza season. From 100 infected attendees, numerous strains were identified: oseltamivir-resistant influenza A (H1N1) viruses, oseltamivir-sensitive influenza A (H1N1) viruses, influenza A (H3N2) viruses, and strains from both influenza B lineages (B/Florida/4/2006-like and B/Malaysia/2506/2004-like). Novel viruses were introduced, and pre-WYD2008 seasonal viruses were amplified. Viruses isolated at mass gatherings can have substantial, complex, and unpredictable effects on community influenza activity. Greater flexibility by public health authorities and hospitals is required to appropriately manage and contain these outbreaks.
Nipah virus is a paramyxovirus in the genus Henipavirus, which has caused outbreaks in humans in Malaysia, India, Singapore, and Bangladesh. Whereas the human cases in Malaysia were characterized mainly by neurological symptoms and a case fatality rate of ∼40%, cases in Bangladesh also exhibited respiratory disease and had a case fatality rate of ∼70%. Here, we compared the histopathologic changes in the respiratory tract of Syrian hamsters, a well-established small animal disease model for Nipah virus, inoculated oronasally with Nipah virus isolates from human cases in Malaysia and Bangladesh. The Nipah virus isolate from Bangladesh caused slightly more severe rhinitis and bronchointerstitial pneumonia 2 days after inoculation in Syrian hamsters. By day 4, differences in lesion severity could no longer be detected. Immunohistochemistry demonstrated Nipah virus antigen in the nasal cavity and pulmonary lesions; the amount of Nipah virus antigen present correlated with lesion severity. Immunohistochemistry indicated that both Nipah virus isolates exhibited endotheliotropism in small- and medium-caliber arteries and arterioles, but not in veins, in the lung. This correlated with the location of ephrin B2, the main receptor for Nipah virus, in the vasculature. In conclusion, Nipah virus isolates from outbreaks in Malaysia and Bangladesh caused a similar type and severity of respiratory tract lesions in Syrian hamsters, suggesting that the differences in human disease reported in the outbreaks in Malaysia and Bangladesh are unlikely to have been caused by intrinsic differences in these 2 virus isolates.
Children less than 6 years old are the most vulnerable group to get harm from Environmental Tobacco Smoke (ETS) exposure, especially their respiratory system. To determine the prevalence of ETS exposure and its association with asthma like symptoms among children less than 6 years old. A cross sectional study was conducted in between January till April 2014 among parents with children less than 6 years old in Selangor, Malaysia. A total of 142 parents were selected by simple random sampling and data were collected using guided questionnaire on ETS exposure and asthma like symptoms (cough and wheeze) among their children. A total of 52.8% of children found to be exposed to ETS, and 43.7% were exposed from their father. ETS exposure significantly associated with cough without cold (adjusted OR=5.46, 95% CI 2.37, 12.61), dry cough at night (adjusted OR=3.74, 95%CI 1.41, 9.95) and cough upon physical activity (adjusted OR=3.08, 95% 1.07, 8.89) among these children. Children less than 6 years old are vulnerable to respiratory problem due to ETS exposure especially on cough symptoms. More strategies should be developing to reduce the exposure to ETS.