MyMedR

A male with recurrent infections and mediastinal mass

Hamid FA, Hasbullah AHH, Ban AY

Breathe (Sheff), 2020 Dec;16(4):200065.

PMID: 33447285 DOI: 10.1183/20734735.0065-2020

Can you diagnose this patient with recurrent pneumonia and myasthenia gravis? https://bit.ly/2IBaxC1.

Single dose of rituximab causing organising pneumonia in a patient with B-cell lymphoproliferative disorder

Ban AY, Ng BH, Faisal M, Rajah R

BMJ Case Rep, 2021 Oct 28;14(10).

PMID: 34711625 DOI: 10.1136/bcr-2021-245837

Rituximab (RTX) is a monoclonal anti-CD20 antibody used to treat non-Hodgkin's lymphoma. RTX-organising pneumonia (RTX-OP) is a rare complication following treatment with RTX. We report a 49-year-old woman, with CD5-negative B-cell lymphoproliferative disorder who developed high-grade fever, dyspnoea and dry cough 3 days after the first dose of RTX. She responded poorly to antibiotics and antifungal therapy. High-resolution CT (HRCT) of the chest revealed bilateral patchy ground-glass opacities with arcade-like signs suggestive of OP. She was pulsed with intravenous methylprednisolone and RTX was discontinued. She was able to be weaned off the non-invasive ventilation (NIV) support and was discharged with maintenance prednisolone 1 mg/kg and tapered over 6 weeks. A repeated HRCT of the chest at 6 weeks showed a total resolution of OP. This highlights the early occurrence at day 3 of RTX-OP following the first dose of RTX and the complete resolution with steroid therapy.

Fulltext Letter from Malaysia

Ban AY, Ng BH, Nik Abeed NN

Respirology, 2023 Sep;28(9):890-891.

PMID: 37451809 DOI: 10.1111/resp.14554

Fulltext Organising pneumonia manifesting as a late-phase complication of COVID-19

Ng BH, Ban AY, Nik Abeed NN, Faisal M

BMJ Case Rep, 2021 Oct 29;14(10).

PMID: 34716149 DOI: 10.1136/bcr-2021-246119

Acute COVID-19 usually lasts 4 weeks from the onset of symptoms. We report two cases of COVID-19-associated organising pneumonia (OP) occurring beyond 4 weeks from the acute onset of symptoms. Both tested positive for SARS reverse transcription-PCR 2 months before presentation with a resolution of respiratory symptoms. The first case presented with residual fatigue and worsening exertional dyspnoea. Chest CT revealed an OP pattern. The second case presented with worsening cough and new-onset pleuritic chest pain with persistent radiological consolidation. A transbronchial lung biopsy confirmed OP. Both patients responded well to 12 weeks of steroid therapy. This case illustrates the rare presentation of OP as a late sequela of COVID-19 and the good response to steroid therapy.

Fulltext Marijuana "bong" pseudomonas lung infection: a detrimental recreational experience

Kumar AN, Soo CI, Ng BH, Hassan T, Ban AY, Manap RA

Respirol Case Rep, 2018 02;6(2):e00293.

PMID: 29321937 DOI: 10.1002/rcr2.293

The use of Cannabis sativa, also known as marijuana, is believed to have dated back to thousands of years B.C. More than 200 decades later, it remains a popular recreational psychoactive substance that can be smoked through a water pipe. We report a case of marijuana smoking via a "bong" device, which has resulted in severe Pseudomonas aeruginosa necrotizing pneumonia treated with conservative medical therapy. This case highlights the importance of recognizing that life-threatening pneumonia can potentially be linked to marijuana and "bong" usage. Complicated cases should be considered for early surgical intervention.

Fulltext Treatment of multiple-level tracheobronchial stenosis secondary to endobronchial tuberculosis using bronchoscopic balloon dilatation with topical mitomycin-C

Faisal M, Harun H, Hassan TM, Ban AY, Chotirmall SH, Abdul Rahaman JA

BMC Pulm Med, 2016;16(1):53.

PMID: 27080697 DOI: 10.1186/s12890-016-0209-1

Tracheobronchial stenosis is a known complication of endobronchial tuberculosis. Despite antituberculous and steroid therapy, the development of bronchial stenosis is usually irreversible and requires airway patency to be restored by either bronchoscopic or surgical interventions. We report the use of balloon dilatation and topical mitomycin-C to successful restore airway patency.

Fulltext Dental technician pneumoconiosis mimicking pulmonary tuberculosis: a case report

Tan HL, Faisal M, Soo CI, Ban AY, Manap RA, Hassan TM

BMC Pulm Med, 2016 09 07;16(1):131.

PMID: 27604085 DOI: 10.1186/s12890-016-0293-2

BACKGROUND: Dental laboratory technicians are at risk of developing occupational respiratory diseases due to exposure to various potentially toxic substances in their working environment. Since 1939, few cases of silicosis among dental technician have been reported.

CASE PRESENTATION: We illustrate a 38 year-old female, who worked in a dental laboratory for 20 years, initially treated as pulmonary tuberculosis and chronic necrotising aspergillosis without much improvement. Computed tomography guided lung biopsy and bronchoscopic transbronchial lung biopsy were performed. Lung tissue biopsies showed presence of refractile dental materials within the areas of histiocyte proliferation. The diagnosis of dental technician pneumoconiosis was obtained and our patient underwent pulmonary rehabilitation.

CONCLUSIONS: This case highlights the importance of obtaining a detailed occupational history in tuberculosis endemic area, as pulmonary tuberculosis is a great mimicker of other respiratory diseases.

Fulltext Resolution of refractory chylothorax with a combination of talc pleurodesis and CPAP

Ng BH, Nik Abeed NN, Abdul Hamid MF, Soo CI, Low HJ, Ban AY

Respirol Case Rep, 2020 Oct;8(7):e00624.

PMID: 32685169 DOI: 10.1002/rcr2.624

Chylothorax is an uncommon cause of pleural effusion. Recurrent chylous effusions are often resistant to conservative treatment and many need surgical intervention. We report a 69-year-old woman with refractory idiopathic chylothorax resistant to medium-chain triglyceride diet and intermittent thoracentesis. Lymphangiography and lymphoscintigraphy failed to identify the site of leakage. We initiated continuous positive airway pressure (CPAP) 12 h before and 48 hours after talc pleurodesis. Chest drain was removed at day 3 and she was discharged at day 5. To our knowledge, this is the first case of successful resolution of idiopathic refractory chylothorax with CPAP ventilation used in tandem with talc pleurodesis.

Fulltext Indwelling pleural catheter and successful autopleurodesis of refractory inflammatory lupus effusion

Ng BH, Nik Abeed NN, Abdul Hamid MF, Soo CI, Low HJ, Ban AY

Respirol Case Rep, 2020 Oct;8(7):e00621.

PMID: 32685166 DOI: 10.1002/rcr2.621

Indwelling pleural catheter (IPC) is a useful tool for refractory malignant pleural effusions (MPEs). It allows palliation by intermittent symptomatic relief of the effusion and improves quality of life. Its use in benign pleural effusions comes mainly from retrospective studies, case series, and case reports. Lupus effusion is common, causes minimal symptoms, and usually responds to either steroid therapy or immunosuppressants. Refractory lupus effusion is less common and treatment may require invasive surgical pleurectomy. We describe a 52-year-old woman whose first presentation of systemic lupus erythematosus (SLE) was a pleural effusion refractory to steroids and immunosuppressants. She successfully achieved spontaneous pleurodesis with intermittent IPC drainage at three months.

Fulltext Upper Gastrointestinal Bleed due to Duodenal Metastases of Lung Adenocarcinoma: Report of Two Cases and Review of Literature

Kosasih S, Muhammad Nawawi KN, Wong Z, Chia Hsin DC, Ban AY, Raja Ali RA

Case Rep Med, 2019;2019:3437056.

PMID: 31772583 DOI: 10.1155/2019/3437056

Upper gastrointestinal bleeding as a result of gastrointestinal metastases from lung cancer is extremely rare. We report two cases of patients with duodenal metastases from lung adenocarcinoma presented with recurrent melena. Histopathological examination and immunohistochemical staining of the duodenal biopsies supported the diagnosis of metastatic lung adenocarcinoma.

Fulltext Pleural anthracosis presenting with massive effusion: a rare entity

Amiseno R, Ban AY, Masir N, Hamidi LR, Faisal Abdul Hamid M

Respirol Case Rep, 2019 Feb;7(2):e00390.

PMID: 30519469 DOI: 10.1002/rcr2.390

Pleural anthracosis is rare and, in most cases, is diagnosed incidentally or at autopsy. We report a 67-year-old man with pleural anthracosis. He was initially referred for possible tuberculous pleural effusion and had recurrent admissions for symptomatic pleural effusion, which increased with each subsequent episode. A thoracoscopic examination demonstrated diffuse hyperpigmentation in both parietal and visceral pleura. Parietal pleural biopsy indicated granuloma with foreign body giant cell. A contrast-enhanced computed tomography (CECT) thorax showed focal plaques in parietal pleura with calcifications in the ipsilateral lung. Investigations for tuberculosis, fungal, and malignancy proved to be negative. With these results, a diagnosis of pleural anthracosis was made. This case highlights the unusual presentation of pleural anthracosis with pleural effusion.

Combined intrapleural alteplase and DNase therapy in complicated pleural infection arising from postsurgery oesophageal leak

Ng BH, Nik Abeed NN, Ban AY, Abdul Hamid MF

BMJ Case Rep, 2023 Aug 17;16(8).

PMID: 37591627 DOI: 10.1136/bcr-2022-249927

Managing a complicated pleural infection related to postsurgery can pose a clinical challenge, especially when initial interventions such as intercostal chest drain and antibiotics prove ineffective. We describe a man in his mid-60s who developed a recurrence of exudative pleural effusion caused by an oesophageal leak following laparoscopic total gastrectomy with Roux-y oesophagojejunostomy for gastric adenocarcinoma. Surgical repairs and oesophageal stenting were performed to address the oesophageal leak. Despite attempts at intercostal chest tube drainage, ultrasonography-guided targeted drainage of the locule and antibiotics, he did not show any improvement. He was unfit for surgical decortication. Due to the risk of bleeding, we chose a modified dose of intrapleural alteplase 5 mg and DNase 5 mg at 12-hour intervals for a total of three doses. This led to the complete resolution of the effusion. This case highlights that intrapleural tPA/DNase can be an adjunctive therapy in postsurgery-related complicated pleural effusion.

Recurrent bilateral idiopathic chylothorax: a therapeutic challenge

Ng BH, Ban AY, Nik Abeed NN, Abdul Hamid MF

BMJ Case Rep, 2023 Dec 16;16(12).

PMID: 38103910 DOI: 10.1136/bcr-2023-258049

Chylothorax is a rare condition caused by pleural effusion resulting from thoracic duct injury. Recurrent chylothorax is often resistant to conservative treatment and presents a clinical conundrum in its management. Here, we report a compelling case of recurrent chylothorax that persisted despite the administration of total parenteral nutrition, octreotide and thoracic duct embolisation. The patient eventually required thoracic duct ligation and talc pleurodesis, which resulted in the resolution of the effusion. Our case is an illustrative example of the effective multidisciplinary management of recurrent bilateral idiopathic chylothorax.

Fulltext Exhaled Carbon Monoxide Level and Practices among Tobacco and Nicotine Adult Users in Klang Valley, Malaysia

Wan Puteh SE, Mohd Ismail N, Md Isa Z, Ban AY

Int J Environ Res Public Health, 2023 Mar 02;20(5).

PMID: 36901455 DOI: 10.3390/ijerph20054443

Tobacco and nicotine derivatives uses are multiple in nature. These include conventional cigarettes (CCs), heated tobacco products (HTPs), and electronic cigarettes (ECs). This study aims to determine the practices, nicotine dependency profile, association with exhaled carbon monoxide (eCO) level, and pulmonary function (PF) among adult product users and non-smokers. This cross-sectional study involved smokers, nicotine users, and non-smokers from two public health facilities in Kuala Lumpur from December 2021 to April 2022. Data on socio-demography, smoking profile, nicotine dependency level, anthropometry, eCO monitor, and spirometer measurements were recorded. Out of 657 respondents, 52.1% were non-smokers, 48.3% were CC only smokers, poly-users (PUs) (27.3%), EC-only users (20.9%), and HTP-only users (3.5%). EC use was prevalent among the younger aged, tertiary educated, and females; HTP use was prevalent among those of an older age and CC users was common among lower educated males. The highest median eCO (in ppm) seen were as follows: in CC users only (13.00), PUs (7.00), EC users (2.00), HTP users (2.00), and the least was observed among non-smokers (1.00), which is significantly different across the groups (p <0.001). Comparison of practice between the different product users showed significant differences in age of product initiation (p <0.001, youngest in CC users in PUs), duration of product use (p <0.001, longest in exclusive CC users), cost per month (p <0.001, highest in exclusive HTP users) and attempt to quit product (p <0.001, CC use in PUs had the highest attempt to quit), while there is no significant difference in Fagerström score across the groups. Among EC users, 68.2% successfully switched from smoking CCs to ECs. The findings suggest that EC and HTP users are exhaling less CO. The use of these products in a targeted approach may manage nicotine addiction. Switching practice was higher among current EC users (from using CCs), hence emphasizing the need of switching encouragement and total nicotine abstinence later on. Lower eCO levels in the PU group, (as compared to CC-only users) and high quit attempt rate among in CC use in PUs may indicate attempt of PUs in reducing CC use through alternative modalities such as ECs and HTPs.

Fulltext Re-establishing indwelling pleural catheter patency with alteplase after failure of streptokinase

Faisal M, Nurhanis S, Nik Abeed NN, Ng BH, Ban AY

Respirol Case Rep, 2020 Oct;8(7):e00639.

PMID: 32774860 DOI: 10.1002/rcr2.639

Indwelling pleural catheter (IPC) has revolutionized the management of malignant pleural effusion (MPE). IPC is relatively safe, although complications can occur. We report a 53-year-old woman with stage IVA lung adenocarcinoma and recurrent MPE. Two months post insertion, the IPC was blocked with residual effusion and presence of new loculations. Attempts to restore patency with six doses of intrapleural (IP) streptokinase failed. She was referred to our centre for further management. We used a single dose of 2.5 mg IP alteplase which was successful in establishing patency of the IPC and draining the effusion. This case highlights the safety and efficacy of IP alteplase via IPC following a failed instillation of streptokinase.

Fulltext Bronchial thermoplasty for severe asthmatics: a real-world clinical study from Malaysia

Soo CI, Mak WW, Nasaruddin MZ, Ismail R, Ban AY, Abdul Rahaman JA

Singapore Med J, 2024 Feb 01;65(2):119-122.

PMID: 34617697 DOI: 10.11622/smedj.2021144

Fulltext Two cases of cryptogenic organizing pneumonia masquerading as tuberculosis (TB) in a TB endemic area

Abdul Hamid MF, Selvarajah SB, Nuratiqah N, Hau NB, Ban AY

Respirol Case Rep, 2022 Jan;10(1):e0883.

PMID: 34876988 DOI: 10.1002/rcr2.883

Before the era of COVID-19 pandemic, organizing pneumonia (OP) is often underdiagnosed while tuberculosis (TB) is overdiagnosed especially in an endemic area. We report two patients with cryptogenic OP mimicking TB. First, a 56-year-old lady with right upper lobe air space opacity and, second, a 37-year-old lady with left upper lobe cavitary lesion. They were treated empirically for pulmonary TB as they had chronic cough with typical chest imaging findings. As there were no improvements despite anti-TB and investigations for TB were negative, they underwent image-guided biopsy which confirmed OP. Both patients received 6 months of corticosteroids therapy and made complete recovery. These cases highlight the rare presentation of OP and serves as a reminder that patients tested negative for TB, despite typical history and chest imaging findings, warrant further investigations as many diseases may mimic TB and vice versa.

Modified Munich chronotype questionnaire for application to short-interval split sleep of non-shift workers

Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Karim NA, Ban AY, et al.

Chronobiol Int, 2021 05;38(5):659-665.

PMID: 33733959 DOI: 10.1080/07420528.2021.1887209

The Munich Chronotype Questionnaire (MCTQ) has been widely validated among various types of populations. However, determination of chronotype among individuals who have a split sleep pattern with short intervals between the first and second sleep bouts on free days has not yet been reported. This study aimed to validate the MCTQ modified for this purpose by assessing the actual sleep-wake timing against the Morningness-Eveningness Questionnaire (MEQ). The modified calculation for the midpoint of sleep on free days (MSF) of the split sleep pattern considers the second sleep bout as the total sleep duration on free days. We recruited 161 participants (mean age: 38.7 ± 7.8 years; 73% females, 29% with split sleep pattern) were recruited to administer the modified version of the MCTQ and MEQ. All of the MCTQ original parameters: midpoint of sleep on work days (MSW, r = -0.575), midpoint of sleep on free days (MSF, r = -0.568), and midpoint of sleep on free days corrected for sleep debt (MSFsc,r = -0.566) were significantly correlated with MEQ. The MEQ was further tested against MSF in four conditions of the split sleep pattern. The MSF modified for split sleep within 60 minutes after the first awakening showed highest correlation (r = -0.576) against MEQ score. The results demonstrate the modified version of MCTQ is valid to determine the chronotype in participants who practice consolidated and split sleep patterns.

Fulltext Impact of Aerobika® oscillating positive expiratory pressure in improving small airway resistance, lung function, symptoms and exercise capacity in chronic obstructive pulmonary disease

Sahardin SN, Jailaini MFM, Abeed NNN, Ban AY, Hau NB, Azmel AA, et al.

Front Med (Lausanne), 2023;10:1202380.

PMID: 37332765 DOI: 10.3389/fmed.2023.1202380

BACKGROUND: Aerobika® oscillating positive expiratory pressure (OPEP) device promotes airway clearance in many respiratory diseases. However, studies have yet to focus on its effectiveness in improving small airway resistance via impulse oscillometry (IOS) measurement in COPD subjects. We aim to evaluate the improvement of small airway resistance (via IOS), lung function (spirometry), exercise capacity [via 6-min walking test (6MWT)], symptoms [COPD assessment test (CAT)] and severe exacerbation events among COPD subjects using Aerobika® OPEP.

METHODS: This was a prospective, single-arm interventional study among COPD subjects with small airway disease. Subjects were instructed to use twice daily Aerobika® OPEP (10 min each session); for 24 weeks; as an additional to standard therapy. IOS, spirometry, 6MWT, CAT score and severe exacerbation events were evaluated at baseline, 12 weeks and 24 weeks.

RESULTS: Fifty-three subjects completed the study. Aerobika® usage showed improvement of IOS parameters; e.g. measurement of airway resistance at 5 Hz (R5), cmH20/L/s, (12-week p = 0.008, 24-week p

Fulltext Correction: Modified regimen intrapleural alteplase with pulmozyme in pleural infection management: a tertiary teaching hospital experience

Cheong XK, Ban AY, Ng BH, Abeed NNN, Ismail NAN, Fuad NFN, et al.

BMC Pulm Med, 2022 Nov 23;22(1):440.

PMID: 36418993 DOI: 10.1186/s12890-022-02251-0

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