Selected recommendations from international guidelines on obstructive sleep apnoea / Nurul Yaqeen Mohd Esa and Ahmad Izuanuddin Ismail.

Obstructive sleep apnoea (OSA) is increasingly seen as a major health threat globally. However, it is still underdiagnosed mainly among Asian population partly due to lack of understanding on the pathophysiology, and limited access to the diagnostic and management aspect of the disease. Recurring complete and/or partial collapses of the upper airways define OSA. Based on the number of apnoeas and/or hypopnoeas per hour of sleep, OSA is categorized as mild, moderate and severe. Both the American Association of Sleep Medicine (AASM) and American College of Physicians (ACP) has published guidelines regarding the management of OSA in adults. Three recommendations have been suggested by the guidelines which can be used to tailor the management of OSA. The aim of this article is to select relevant recommendations from these guidelines in epidemiology, pathophysiology, diagnostic procedures and treatment for proper management of OSA, while considering specific patient populations, such as hypertensive, diabetic, obese and Asian patients

A rare and challenging case of pulmonary mycobacterium genavense in an immunocompetent adult / Nur ‘Aini Eddy Warman and Nurul Yaqeen Mohd Esa.

Mycobacterium genavense, a non-tuberculous mycobacterium (NTM), usually affects patients severely immunodeficient from human immunodeficiency virus (HIV) infection or any other immunocompromised states. We reported a case in a 70-year-old female with well-controlled diabetes and history of proximal cystic bronchiectasis. She presented with 2 months history of cough, haemoptysis, and night sweats of which serial sputa were positive for acid-fast bacilli and the culture repeatedly grew M. genavense. Treatment with rifampicin, ofloxacin, and clarithromycin was complicated with drug-induced liver injury and intractable gastrointestinal side effects. We also presented a brief review of relevant literature

Rethinking public health pedagogy in muslim countries postcolonially

This article discusses the history of modern education in developing countries and attempts to look at Public Health (PH) education and curriculum from a Muslim and postcolonial perspective. It argues that, since modern PH pedagogical practices in Muslim countries are derived almost entirely from the western educational model and paradigm, they need reconstruction mainly for compatibility and relevance checks. The reconstruction of PH that this paper proposes aims at complementing and enriching the existing syllabi and involves three stages: fundamental, intermediate and advanced. In the first stage, students are equipped with a strong foundation of western and Islamic philosophies; the second one involves the incorporation of Islamic principles into the existing PH curriculum; while the third entails a critical analysis and deconstruction of some PH concepts and approaches in order to nurture students’ creativity in solving complex, emerging problems in the light of Islamic teachings as well as the need of Muslim sociocultural settings

Is it liver or lung cancer? An intriguing case of lung adenocarcinoma with hepatoid differentiation

We report the case of a 50-year-old man who was investigated for an incidental finding of a left lung mass following left shoulder pain over a three month period. He also had a significant raised serum alpha-fetoprotein (AFP) level of 29,000, which raised the suspicion of hepatocellular carcinoma with lung metastases. However, there was no detectable liver lesion on multiphase contrasted tomography of the liver and no significant hypermetabolic nodes or distant metastasis seen in the liver on positron emission tomography scan. A lung biopsy confirmed adenocarcinoma with hepatocellular differentiation that would explain the raised serum AFP level

Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience

The diagnosis of endobronchial tuberculosis (EBTB) is difficult as it is not well visualized radiologically, and bronchoscopy is not routinely performed for tuberculosis (TB) patients. Bronchoscopic characterization via endoscopic macroscopic features can speed up the diagnosis of EBTB and prompt immediate treatment. In this study, we identified the clinical and bronchoscopic morphology of 17 patients who were diagnosed with EBTB from 2018 to 2020. Demographics, radiological, microbiological and histopathological data were recorded. Endobronchial lesions were classified according to Chung classification. The diagnosis was made based on a histopathological examination (HPE) of endobronchial biopsy, and/or positive ‘Acid-fast bacilli’ (AFB) microscopy/Mycobacterium tuberculosis (MTB) culture on microbiological examination of bronchial alveolar lavage (BAL) and/or positive MTB culture on endobronchial biopsy specimens. Furthermore, EBTB was predominant in young women, age 20 to 49 years old, with a male to female ratio of 1 to 2. Underlying comorbidities were found in 53% of the patients. Cough, fever and weight loss were the main symptoms (23.5%). The indications for bronchoscopy are smear-negative TB and persistent consolidation on chest radiographs. Consolidation was the main radiological finding (53%). An active caseating lesion was the main EBTB endobronchial subtype (53%). The leading HPE finding was caseating granulomatous inflammation (47%). All patients showed good clinical response to TB treatment. Repeated bronchoscopy in six patients post TB treatment showed a complete resolution of the endobronchial lesion. EBTB bronchoscopic characterization is paramount to ensure correct diagnosis, immediate treatment and to prevent complication