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

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 < 0.001), R5% predicted (12-week p = 0.007, 24-week p < 0.001) and small airway resistance (R5-R20), cmH20/L/s, (12-week p = 0.021, 24-week p < 0.001). There were improvement of lung function; e.g. FEV1, L (12-week p = 0.018, 24-week p = 0.001), FEV1% predicted (12-week p = 0.025, 24-week p = 0.001), FEF25-75, L (12-week p = 0.023, 24-week p = 0.002), and FEF25-75% predicted (12-week p = 0.024, 24-week p < 0.001). CAT score improved at 12 weeks (p < 0.001) and 24 weeks (p < 0.001). Subjects had improved exercise capacity (6MWT, metres) after 24 weeks (p = 0.016). However, there was no significant difference in severe exacerbation events 24 weeks before and after Aerobika® usage. Conclusion: Aerobika® OPEP demonstrated significant improvement in small airway resistance as early as 12 weeks of usage, with sustained improvement at 24 weeks. Aerobika® OPEP administration had significantly improved lung function, 6MWT, and CAT scores over 24 weeks. There was no difference in severe exacerbation events.

Prevalence and clinical characteristics of malignant lung nodules in tuberculosis endemic area in a single tertiary centre.

BACKGROUND: Lung nodule management remains a challenge to clinicians, especially in endemic tuberculosis areas. Different guidelines are available with various recommendations; however, the suitability of these guidelines for the Asian population is still unclear. Our study described the prevalence of malignant lung nodules among nodules measuring 2-30 mm, the demographic and characteristics of lung nodules between benign and malignant groups, and the clinician's clinical practice in managing lung nodules. METHOD: Retrospective review of lung nodules from the computed tomography archiving and communication system (PACS) database and clinical data from January 2019 to January 2022. The data was analysed by using chi square, mann whitney test and simple logistic regression. RESULTS: There were 288 nodules measuring 2-30 mm identified; 49 nodules underwent biopsy. Twenty-seven (55%) biopsied nodules were malignant, (prevalence of 9.4%). Among the malignant lung nodules, 74% were adenocarcinoma (n = 20). The commonest benign nodules were granuloma n = 12 (55%). In nodules > 8 mm, the median age of malignant and benign was 72 ± 12 years and 66 ± 16 years, respectively (p = 0.024). There was a significant association of benign nodules (> 8 mm) in subjects with previous or concurrent tuberculosis (p = 0.008). Benign nodules are also associated with nodule size ≤ 8 mm, without spiculation (p < 0.001) and absence of emphysema (p = 0.007). The nodule size and the presence of spiculation are factors to make the clinicians proceed with tissue biopsy. Spiculated nodules and increased nodule size had 11 and 13 times higher chances of undergoing biopsy respectively (p < 0.001).) Previous history of tuberculosis had a 0.874 reduced risk of progression to malignant lung nodules (p = 0.013). These findings implied that these three factors are important risk factors for malignant lung nodules. There was no mortality association between benign and malignant. Using Brock's probability of malignancy, nodules ≤ 8 mm had a low probability of malignancy. CONCLUSION: The prevalence of malignant lung nodules in our centre was comparatively lower than non-Asian countries. Older age, the presence of emphysema, and spiculation are associated with malignancy. Clinical judgment is of utmost importance in managing these patients. Fleishner guideline is still being used as a reference by our clinician.

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

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.

Silicone pneumonitis after gluteal filler: a case report and literature review.

Liquid silicone (polydimethylsiloxane) is an inert material that is commonly used for cosmetic purpose. Silicone embolization syndrome (SES) can rapidly progress to pneumonitis as a consequence of the injection of nonmedical-grade liquid silicone. We describe a case of severe silicone pneumonitis complicated with acute respiratory distress syndrome and bilateral pneumothorax secondary to silicone gluteal augmentation. In this case report, we aim to discuss our experience and approach in managing an uncommon case of SES.

COVID-19 detected from targeted contact tracing, attempting to see the pattern in random happenings: early lessons in Malaysia

@#The world feels strange as we face what is for most of us ourfirst ever pandemic. The number of newly diagnosed casesrises daily in many parts of the world, and we are faced withthe reality that there are still many things to learn about thisnew disease. We share here our experience of treating ourfirst 199 COVID-19 patients in the Hospital Canselor TuankuMuhriz, Pusat Perubatan Universiti Kebangsaan Malaysia(PPUKM).

A descriptive study of the psychological experience of health care workers in close contact with a person with COVID-19

@#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.

Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur

@#Background and objective: Coronavirus Disease 2019 (COVID19) 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 thorax for early diagnosis may be reserved for patients in the older age groups, and not in younger patients.