MyMedR

Virtual Bronchoscopic Navigation Guided Recanalization of Chronic Total Post-Tuberculosis Bronchial Stenosis

Kho SS, Nasaruddin MZ, Abdul Rahaman JA

Arch Bronconeumol, 2022 Nov;58(11):768-769.

PMID: 35606265 DOI: 10.1016/j.arbres.2022.05.003

Effects of preeclampsia on the yield of hematopoietic stem cells obtained from umbilical cord blood at delivery

Wahid FS, Nasaruddin MZ, Idris MR, Tusimin M, Tumian NR, Mahdy ZA

J Obstet Gynaecol Res, 2012 Mar;38(3):490-7.

PMID: 22381102 DOI: 10.1111/j.1447-0756.2011.01740.x

To compare the numbers of cord blood CD34(+) hematopoietic stem cells (HSC) between preeclampsia (PE) and control (non-PE) subjects and to determine the factors that may influence this observation.

Fulltext The more you give, the worse it gets

Kho SS, Nyanti LE, Muhammad NA, Nasaruddin MZ, Abdul Rahaman JA

Breathe (Sheff), 2021 Sep;17(3):210083.

PMID: 35035553 DOI: 10.1183/20734735.0083-2021

Persistent tachypnoea despite resolution of bronchospasm in a patient with acute asthma exacerbation after administration of inhaled short acting β2-receptor agonist should alert the clinician to this potential diagnosis. https://bit.ly/385VU2Q.

Fulltext Successful drainage of complex haemoserous malignant pleural effusion with a single modified low-dose intrapleural alteplase and dornase alfa

Ng BH, Mohd Aminudin NH, Nasaruddin MZ, Abdul Rahaman JA

BMJ Case Rep, 2021 Feb 05;14(2).

PMID: 33547099 DOI: 10.1136/bcr-2020-239702

Patients with symptomatic complex malignant pleural effusion (MPE) are frequently unfit for decortication and have a poorer prognosis. Septations can develop in MPE, which may lead to failure of complete drainage and pleural infection. Intrapleural fibrinolytic therapy (IPFT) is an alternative treatment. The use of IPFT in patients with anaemia and high risk for intrapleural bleeding is not well established. We report a successful drainage of complex haemoserous MPE with a single modified low-dose of intrapleural 5 mg of alteplase and 5 mg of dornase alfa in a patient with pre-existing anaemia with no significant risk of intrapleural bleeding.

Clinical and radiological outcomes of SARS-CoV-2 related organising pneumonia in COVID-19 survivors

Kho SS, Lim KC, Muhammad NA, Nasaruddin MZ, Ismail I, Daut UM, et al.

Med J Malaysia, 2023 Mar;78(2):131-138.

PMID: 36988520

INTRODUCTION: COVID-19 patients frequently demonstrate radiological organising pneumonia (OP) pattern. The longterm outcome and treatment options for this group of patients remain uncertain. We aim to describe the clinical and radiological outcomes of patients with COVID-19-related OP and identify possible clinical factors associated with inferior radiological outcome.

MATERIALS AND METHODS: Post-COVID-19 clinic attendees, consisting of post-COVID-19 patients discharged from major hospitals in the state of Selangor during the third pandemic wave of COVID-19 in Malaysia, were enrolled in this retrospective study for 6 months. Physician-scored Modified Medical Research Council (mMRC), patient self-reported quality of life (EQ-VAS) score and follow-up CT scan were evaluated.

RESULTS: Our cohort comprised 131 patients, with a median age of 52 (IQR 39-60) years and median BMI of 29.40 (IQR 25.59-34.72). Majority (72.5%) had co-morbidities, and 97.7% had severe disease requiring supplementary oxygen support during the acute COVID-19 episode. 56.5% required intensive care; among which one-third were invasively ventilated. Median equivalent dose of methylprednisolone prescribed was 2.60 (IQR 1.29-5.18) mg/kg during admission, while the median prednisolone dose upon discharge was 0.64 (IQR 0.51-0.78) mg/kg. It was tapered over a median of 8.0 (IQR 5.8-9.0) weeks. Upon follow-up at 11 (IQR 8-15) weeks, one-third of patients remained symptomatic, with cough, fatigue and dyspnoea being the most reported symptoms. mMRC and EQ-VAS scores improved significantly (p<0.001) during follow-up. Repeat CT scans were done in 59.5% of patients, with 94.8% of them demonstrating improvement. In fact, 51.7% had complete radiological resolution. Intensive care admission and mechanical ventilation are among the factors which were associated with poorer radiological outcomes, p<0.05.

CONCLUSION: Approximately one-third of patients with SARSCoV- 2-related OP remained symptomatic at 3 months of follow-up. Majority demonstrated favourable radiological outcomes at 5-month reassessment, except those who required intensive care unit admission and mechanical ventilation.

Fulltext Inflammatory endobronchial polyps unleashing recurrent pneumothorax: A case report

Daut UN, Faisal Thena MH, Hui-Xin T, Nasaruddin MZ, Abdul Rahaman JA

Respirol Case Rep, 2024 Jan;12(1):e01278.

PMID: 38239333 DOI: 10.1002/rcr2.1278

Inflammatory endobronchial polyps (IEPs) are rare benign lesions that originate from the bronchial mucosa. While pneumothorax is a well-known complication of various pulmonary conditions, its association with IEPs is exceedingly uncommon and poorly understood. This case report presents a unique and explosive encounter of a patient with an inflammatory endobronchial polyp who experienced a pneumothorax, shedding light on the clinical presentation, diagnostic challenges, and management strategies for this rare entity.

Fulltext Utilizing medical thoracoscopy for the diagnosis of myelomatous pleural effusion: 2 case reports

Ng KL, Tan SN, Huan NC, Nasaruddin MZ, Othman N, Rahaman JAA

Respirol Case Rep, 2024 Mar;12(3):e01333.

PMID: 38528948 DOI: 10.1002/rcr2.1333

Multiple myeloma (MM) is characterized by neoplastic proliferation of monoclonal antibody producing plasma cells. In clinical practice, pleural effusion is seen in up to 6% of MM patients, with many causative factors. Nevertheless, true myelomatous pleural effusion, defined as infiltration of the pleura by myeloma cells, is very rare. In this case report, we present two patients with biopsy proven myelomatous pleural effusion. The first patient developed myelomatous pleural effusion as initial presentation while the second patient's pleural effusion occurred during disease relapse. In both cases, prompt diagnosis via medical thoracoscopy (MT) followed by early commencement of myeloma specific chemotherapy led to clinical, biochemical, and radiological resolution and therefore were crucial steps in the management of myelomatous pleural effusion.

Fulltext Pulmonary mucormycosis masquerading as endobronchial tumour in an immunocompetent pregnant young lady

Ng KL, Huan NC, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA

Respirol Case Rep, 2021 Feb;9(2):e00704.

PMID: 33364028 DOI: 10.1002/rcr2.704

Pulmonary mucormycosis is a rare but rapidly progressing and life-threatening fungal infection, usually affecting immunocompromised patients. We report a case of a previously healthy young lady who presented with prolonged cough, weight loss, and haemoptysis. Imaging showed left hilar mass with infiltration into the left main bronchus and concurrent mediastinal lymphadenopathy. Flexible bronchoscopy revealed an endobronchial mass occluding the left main bronchus. Tumour debulking was performed using rigid bronchoscopy with cryoprobe and snares. Histopathological examination revealed inflamed tissue with fungal organism. Fungal polymerase chain reaction (PCR) confirmed Rhizopus microsporus. She was treated with two weeks of intravenous amphotericin-B with complete clinical and radiological resolution.

Fulltext Conservative management of airway tear as a complication of silicone endobronchial stenting in bronchomalacia secondary to endobronchial tuberculosis

Huan NC, Ng KL, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA

Respirol Case Rep, 2020 Dec;8(9):e00684.

PMID: 33194207 DOI: 10.1002/rcr2.684

Tracheobronchial stenosis due to tuberculosis (TSTB) is a potentially debilitating complication of endobronchial tuberculosis (EBTB). Endobronchial interventions including silicone stent insertion is an acceptable approach to improve quality of life among patients with TSTB. However, little is known about the optimal management strategy for patients with bronchomalacia secondary to EBTB (B-EBTB) and whether stent-related complication rates are higher among this group of patients. Herein, we report two patients with B-EBTB who unfortunately developed bronchial tear related to silicone endobronchial stenting. Both patients were successfully managed conservatively without the need for emergency open surgery. We hypothesize that endobronchial intervention might be more beneficial for patients with pure TSTB and might be riskier in cases of bronchomalacia with reduced airway thickness and loss of airway cartilaginous support. More future studies are needed to bridge the current gap in knowledge regarding the optimal management and role of endobronchial interventions among patients with B-EBTB.

Fulltext Topical mitomycin-C as an adjuvant to multimodal endoscopic treatment for tracheobronchial stenosis secondary to endobronchial tuberculosis

Huan NC, Ng KL, Nasaruddin MZ, Muhammad NA, Daut UN, Abdul Rahaman JA

Respirol Case Rep, 2021 Mar;9(3):e00711.

PMID: 33532074 DOI: 10.1002/rcr2.711

Tracheobronchial stenosis secondary to endobronchial tuberculosis (TSTB) is a rare but debilitating complication of endobronchial tuberculosis (EBTB). Topical mitomycin-C (TMC) has been successfully utilized to restore airway patency and to prevent recurrence of TSTB, although little is known about its exact efficacy. Here, we report the biggest case series to date involving seven patients who received TMC as part of multimodality endoscopic treatment for TSTB with varying levels of success. All patients presented with dyspnoea during or after treatment completion for pulmonary tuberculosis (PTB). Four patients had short-segment concentric membranous TSTB while two patients had concurrent bronchomalacia. Another one patient had a thick fibrotic band adjacent to luminal opening. We hypothesize that TMC is more efficacious in short membranous stenosis without concurrent bronchomalacia and/or thick fibrotic bands. More studies are needed to bridge the current gaps in knowledge regarding the optimal role and benefits of TMC for TSTB patients.

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 Interventional Pulmonology and COVID-19: Experience from a Malaysian Tertiary Hospital

Huan NC, Ng KL, Tang JT, Kua HN, Daut UN, Muhammad NA, et al.

Ann Acad Med Singap, 2020 12;49(12):1013-1017.

PMID: 33463660 DOI: 10.47102/annals-acadmedsg.2020364

The ongoing pandemic of COVID-19 has presented multiple challenges to global healthcare services, dictating changes in almost every aspect of daily medical practice. Performing aerosol generating procedures (AGPs) in the field of interventional pulmonology can lead to profound formation of aerosols, leading to a high risk of infection among healthcare workers (HCWs). We share our experiences on performing AGPs in the midst of a COVID-19 pandemic by focusing on changes in AGP practices. In a pandemic, HCWs ought to adapt to the ever-changing situation and use available resources to provide the best possible healthcare to patients, ensure safety of staff, and continue medical education of future pulmonologists.

Personalised management of Chronic Obstructive Pulmonary Disease (COPD): Malaysian consensus algorithm for appropriate use of inhaled corticosteroid (ICS) in COPD patients

Marzuki NM, Jaeb MZM, Ban A, Ismail AI, Ali IAH, Razali NM, et al.

Med J Malaysia, 2020 11;75(6):717-721.

PMID: 33219183

BACKGROUND: Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a "preferred therapy" according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients.

OBJECTIVE: To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence.

METHODS: A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group.

RESULTS: According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy.

CONCLUSION: A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

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