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Perioperative challenges in a morbidly obese former COVID-19 patient undergoing elective spine surgery

Leo ZH, Mohammad Iskandar FF, Yeap TB, Bong CP

BMJ Case Rep, 2021 Jul 26;14(7).
PMID: 34312139 DOI: 10.1136/bcr-2021-243950

Anaesthesia for patients with severe lung fibrosis post COVID-19 infection requires special consideration. This is due to its propensity to cause perioperative anaesthetic catastrophe and possibility of cross infection among healthcare workers if not properly managed. This interesting article elaborates in detail the anaesthetic and surgical challenges in a morbidly obese patient who had a severe COVID-19 infection presenting for an elective spine surgery.
Physicochemical profile of microbial-assisted composting on empty fruit bunches of oil palm trees

Lim LY, Bong CP, Chua LS, Lee CT

Environ Sci Pollut Res Int, 2015 Dec;22(24):19814-22.
PMID: 26286798 DOI: 10.1007/s11356-015-5156-5

This study was carried out to investigate the physicochemical properties of compost from oil palm empty fruit bunches (EFB) inoculated with effective microorganisms (EM∙1™). The duration of microbial-assisted composting was shorter (∼7 days) than control samples (2 months) in a laboratory scale (2 kg) experiment. The temperature profile of EFB compost fluctuated between 26 and 52 °C without the presence of consistent thermophilic phase. The pH of compost changed from weak acidic (pH ∼5) to mild alkaline (pH ∼8) because of the formation of nitrogenous ions such as ammonium (NH4 (+)), nitrite (NO2 (-)), and nitrate (NO3 (-)) from organic substances during mineralization. The pH of the microbial-treated compost was less than 8.5 which is important to prevent the loss of nitrogen as ammonia gas in a strong alkaline condition. Similarly, carbon mineralization could be determined by measuring CO2 emission. The microbial-treated compost could maintain longer period (∼13 days) of high CO2 emission resulted from high microbial activity and reached the threshold value (120 mg CO2-C kg(-1) day(-1)) for compost maturity earlier (7 days). Microbial-treated compost slightly improved the content of minerals such as Mg, K, Ca, and B, as well as key metabolite, 5-aminolevulinic acid for plant growth at the maturity stage of compost. Graphical Abstract Microbial-assisted composting on empty fruit bunches.
Fulltext Anaesthetic challenges for a patient with huge superior mediastinal mass in prone position

Yeap TB, Teah MK, Ramly AKM, Bong CP

BMJ Case Rep, 2021 Apr 09;14(4).
PMID: 33837036 DOI: 10.1136/bcr-2021-242118

Anaesthesia for patients with huge mediastinal mass is very challenging due to the cardiorespiratory embarrassment that may occur. We present a patient with this condition, which was complicated by total airway obstruction, intraoperatively. We discuss the importance of patient positioning and the role of spontaneous ventilation.
Fulltext Acute impending compartment syndrome during elective spine surgery: a rare occurrence

Yeap TB, Shabani NS, Bong CP, Tan HS

BMJ Case Rep, 2021 Jul 13;14(7).
PMID: 34257132 DOI: 10.1136/bcr-2021-244358

Intraoperative impending compartment syndrome (ICS) is an extremely rare but lethal occurrence that can involve the upper and/or lower limb(s). It commonly occurs in patients who undergo anaesthesia in various special positions such as lithotomy, lateral decubitus or prone. We present a patient who developed an ICS of his left forearm during a cervical spine surgery in prone position. This devastating condition was fortunately identified when the pulse oximetry, intra-arterial wave form and motor-evoked potentials signal disappeared abruptly from our monitors. We discuss our perioperative challenges and management for the patient which had eventually saved the patient's limb.
Fulltext Anaesthetic challenges in the spine surgery of a young Asian man with lumbar amyloidosis

Jamil J, Tay CY, Bong CP, Yeap TB

BMJ Case Rep, 2021 Nov 29;14(11).
PMID: 34844969 DOI: 10.1136/bcr-2021-246359

Primary amyloidosis is a rare systemic disorder often associated with multiple organ dysfunction. The most common form, light chain amyloidosis, has an estimated age-adjusted incidence of 5.1-12.8 cases per million person-years. Spine involvement is extremely uncommon. We present the case of a young Asian man with newly diagnosed amyloidosis involving the lumbar spine among multiple organs with a pathological vertebral fracture that required urgent spine surgery. We believe this is the first reported case to discuss the perianaesthetic challenges in the management of lumbar spine amyloidosis.
Fulltext Case report: A rare occurrence of a huge mediastinal mass from disseminated prostate carcinoma

Teah KM, Bong CP, Mudin K, Soe MZ, Thevarajah S, Yeap BT

Ann Med Surg (Lond), 2021 Nov;71:102952.
PMID: 34703592 DOI: 10.1016/j.amsu.2021.102952

Background: Prostatic carcinoma is the commonest malignancy among men. It usually metastasizes to the spine and regional lymph nodes. However, it is extremely rare for it to metastasize to the mediastinum.
Case presentation: An elderly man presented to us with progressive onset of bilateral lower limb weakness which was associated with thoracic radiculopathy and urinary incontinence. An urgent magnetic resonance imaging (MRI) of the spine showed severe cord compression with enlarged prostate and superior mediastinal mass. A computed tomography (CT) guided biopsy of the mediastinal mass was suggestive of prostatic malignancy. An emergency posterior instrumentation and fusion (PSIF) in prone position was successfully done. Histopathological examination of the spine showed malignant glandular tissues, suggestive of prostate.
Discussion: A huge mediastinal mass can compromise the cardiorespiratory system and is very challenging for the anaesthetist to safely secure the airway for surgical procedures. Androgen deprivation therapy (ADT) for patients with metastatic prostatic carcinoma can be achieved either by medical castration or with bilateral orchidectomy.
Conclusion: It is extremely uncommon for a prostatic carcinoma to metastasize to the mediastinum. Patients with a huge mediastinal mass possess risks of cardiorespiratory collapse perioperatively. Chemoradiotherapy and androgen deprivation therapy (ADT) can be utilized for metastatic prostatic carcinoma with good outcomes.
Fulltext A rare occurrence of a metastatic urothelial carcinoma to the thoracic vertebra: A case report

Soe MZ, Bong CP, Thevarajah S, Teah KM, Yeap BT

Ann Med Surg (Lond), 2022 Feb;74:103297.
PMID: 35127072 DOI: 10.1016/j.amsu.2022.103297

Background: Urothelial carcinoma (UC) is a common urinary tract malignancy that predominantly affect the urinary bladder with a low recurrence rate after surgical removal. It usually metastasizes to the lungs, regional lymph nodes, and liver. However, it rarely spread to the thoracic spine and bones, especially in the Asian populations.
Case presentation: A 50-years-old Asian man, with a one-year history of surgically resected UC, presented to us with a complaint of worsening upper back pain for three months. Magnetic resonance imaging (MRI) showed a destructed second thoracic (T2) vertebra with lytic lesion. A thoracic vertebrectomy was performed and histopathological examination (HPE) showed high-grade infiltrating metastatic malignant UC. Postoperatively, he was well and did not have any back pain. He was followed up under combined spine and oncology clinic regularly and was planned for chemoradiotherapy.
Discussion: UC commonly metastasizes to the lungs, liver, and lymph nodes. In young Asians, thoracic spinal metastases are rare. Urgent palliative spinal surgery is indicated to prevent further deterioration of function. Intraoperative usage of targeted controlled infusion (TCI) of remifentanil and propofol as maintenance of anaesthesia are gold standard in assisting spine surgeons who are guided by neuromuscular monitoring.
Conclusion: Spinal metastasis to the thoracic vertebra is rare among young Asian men. Patients presented with acute neurological deficits and back pain are indicated for spinal surgery. Multidisciplinary approach is needed for management of patients with spinal metastasis. Targeted controlled infusion (TCI) of remifentanil and propofol are gold standard for maintenance of anaesthesia for spine surgeries which are guided by somatosensory, and motor evoked potential monitoring.
Towards low carbon society in Iskandar Malaysia: Implementation and feasibility of community organic waste composting

Bong CP, Goh RKY, Lim JS, Ho WS, Lee CT, Hashim H, et al.

J Environ Manage, 2017 Dec 01;203(Pt 2):679-687.
PMID: 27267145 DOI: 10.1016/j.jenvman.2016.05.033

Rapid population growth and urbanisation have generated large amount of municipal solid waste (MSW) in many cities. Up to 40-60% of Malaysia's MSW is reported to be food waste where such waste is highly putrescible and can cause bad odour and public health issue if its disposal is delayed. In this study, the implementation of community composting in a village within Iskandar Malaysia is presented as a case study to showcase effective MSW management and mitigation of GHG emission. The selected village, Felda Taib Andak (FTA), is located within a palm oil plantation and a crude palm oil processing mill. This project showcases a community-composting prototype to compost food and oil palm wastes into high quality compost. The objective of this article is to highlight the economic and environment impacts of a community-based composting project to the key stakeholders in the community, including residents, oil palm plantation owners and palm oil mill operators by comparing three different scenarios, through a life cycle approach, in terms of the greenhouse gas emission and cost benefit analysis. First scenario is the baseline case, where all the domestic waste is sent to landfill site. In the second scenario, a small-scale centralised composting project was implemented. In the third scenario, the data obtained from Scenario 2 was used to do a projection on the GHG emission and costing analysis for a pilot-scale centralised composting plant. The study showed a reduction potential of 71.64% on GHG emission through the diversion of food waste from landfill, compost utilisation and significant revenue from the compost sale in Scenario 3. This thus provided better insight into the feasibility and desirability in implementing a pilot-scale centralised composting plant for a sub-urban community in Malaysia to achieve a low carbon and self-sustainable society, in terms of environment and economic aspects.
A review on the potential of polyhydroxyalkanoates production from oil-based substrates

Chien Bong CP, Alam MNHZ, Samsudin SA, Jamaluddin J, Adrus N, Mohd Yusof AH, et al.

J Environ Manage, 2021 Nov 15;298:113461.
PMID: 34435568 DOI: 10.1016/j.jenvman.2021.113461

Polyhydroxyalkanoate (PHA) is a type of polyesters produced in the form of accumulated intracellular granules by many microorganisms. It is viewed as an environmentally friendly bioproduct due to its biodegradability and biocompatibility. The production of the PHA using oil substrates such as waste oil and plant oil, has gained considerable attention due to the high product yield and lower substrate cost. Nevertheless, the PHA fermentation using oil substrate is complicated due to the heterogenous fatty acid composition, varied bio-accessibility and possible inhibitory effect on the bacterial culture. This review presents the current state-of-the-art of PHA production from oil-based substrates. This paper firstly discusses the technical details, such as the choice of bacteria strain and fermentation conditions, characteristic of the oil substrate as well as the PHA composition and application. Finally, the paper discusses the challenges and prospects for up-scaling towards a cleaner and effective bioprocess. From the literature review, depending on the cell culture and the type of PHA produced, the oil platform can have a PHA yield of 0.2-0.8 g PHA/g oil substrate, with PHA content mostly from 40 to 90% of the cell dry weight. There is an on-going search for more effective oil-utilising PHA producers and lower cost substrate for effective PHA production. The final application of the PHA polymer influences the treatment needed during downstream processing and its economic performance. PHA with different compositions exhibits varied decomposition behaviour under different conditions, requiring further insight towards its management towards a sustainable circular economy.