Foreign body (tooth) retrieval in polytrauma patient, using single use bronchoscopy and retrieval basket, a case report

Foreign body aspiration can be a life-threatening emergency and it is uncommon entity in adults. For foreign body extraction, rigid bronchoscopy is superior to flexible bronchoscopy for operative manipulation. However, in view of maxillofacial trauma, rigid bronchoscopy is a risk for patient. Herein we describe our successful experience using single use flexible bronchoscopy with retrieval basket in removal of huge foreign body aspiration in a polytrauma patient

A systematic review on factors associated with health-related quality of life among chronic obstructive pulmonary disease patients

Health-Related Quality of Life (HRQOL) is an important data in managing Chronic Obstructive Pulmonary Disease (COPD). Therefore, it is essential to determine factors that associated with HRQOL and identify the gaps for future research. A systematic search using PubMed, Science Direct and Scopus was performed to discover factors that could impact HRQOL among COPD patients. Socio-demographic factors like age, gender, educational level, smoking status, income were found associated with HRQOL. Other factors included Body Mass Index (BMI), comorbidities, sleep quality and exercise capability also could influence HRQOL of COPD patients. Other than that, lung function, dyspnea and exacerbation also found closely related with HRQOL. However, future study is needed to explore more factors such as nutritional status. Besides that, the finding only focused on general population and very little information on elderly population

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

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

Short-acting β2-agonist prescription patterns and clinical outcomes in Malaysia: A nationwide cohort of the SABINA III study

Introduction: SABINA III assessed short-acting β2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Methods: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1–2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27–0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44–2.89). Conclusion: The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern

Spontaneous pneumothorax and pneumomediastinum after a trivial injury: a case report

Spontaneous pneumothorax and pneumomediastinum is defined as presence of free air or gas in the pleural cavity and mediastinal structures respectively. Spontaneous pneumothorax seems to be associated with anatomical abnormalities such as subpleural blebs or bullae, however not for spontaneous pneumomediastinum which may developed without an apparent precipitating cause. Both usually may occur in young healthy adults without serious underlying lung disease. We report a case of spontaneous pneumothorax and pneumomediastinum after a trivial injury. He was initially presented with dyspnea after two weeks of initial trivial trauma. Chest radiograph showed left apical pneumothorax with pneumomediastinum with no evidence of rib fracture. His condition was deemed non-traumatic by surgical colleague, thus admitted to medical ward for observation and eventually discharged well

Dietary nutrient intake and meal-related situations among elderly outpatients with chronic obstructive pulmonary disease from respiratory clinics, Malaysia

Introduction: Chronic obstructive pulmonary disease (COPD) patients usually have dietary problems leading to malnutrition issues. Therefore, this study aimed to determine macro and micronutrient intakes and meal-related situations among outpatients COPD elderly and its adequacy according to their requirements. Methods: 140 patients were included in this cross-sectional study at Respiratory Clinics of Hospital Serdang and Institut Perubatan Respiratori. Socio-demographic and health status data were collected by interviewing patients and reviewing their medical records. A three-day diet history (two-day on weekdays, one day on weekend) was analysed using Nutritionist Pro and compared against their requirements. Meal-related situation was assessed using three open-ended questions that related to food shopping, cooking and eating and analysed using content analysis. Results: Patients were 70±7 years old, 97% male, 59% Malay, 48% had primary education, 75% married, 72% ex-smokers and 54% presented with comorbidities. Majority of them had no episode of exacerbation for the past one year and in moderate stage of the COPD severity. Mean energy intake was 916±221 kcal/day with 98% of them have under-reported their intake. Almost all patients had inadequate macro and micronutrient intake; energy (97%), protein (97%), carbohydrate (86%), fat (99%), vitamin A (95%), C (86%), D (99%) and E (99%). The meal-related situation reported patients had difficulties with food shopping and preparation and problems during mealtime. Conclusion: COPD elderly reported inadequate intake of macro and micronutrients and had problems during mealtime. This indicates the need for Malaysian nutrition guidelines specific to COPD patients and nutrition intervention in the primary setting

Health-related quality of life of elderly with chronic obstructive pulmonary disease from selected government institution

Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD. Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status. Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10. Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life

Central airway obstruction tumour debulking using rigid bronchoscopy and cryotherapy: a case report

Sarcomas usually frequented in the head and neck region of young adults. Trachea is a rare site, and due to scarce clinical data, its clinical outcome is unclear. We reported a case of 60-year old patient presented with progressive worsening shortness of breath, cough, and progressive worsening dysphagia. Computer tomography scan revealed extensive 2 lobulated soft tissue lesions within and surrounding the trachea at the T4 level. Rigid bronchoscopy with mass cryo-debulking was performed and ultimately synovial sarcoma was diagnosed. Shortness of breath was completely relieved post-procedure

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

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

Nose stud screw aspirationa - a tiny foreign body with potentially huge disaster: 2 cases with different ways of retrieval

Foreign body aspiration refers to accidental inhalation of foreign body into the respiratory tract. More commonly observed in children, foreign body aspiration is less common in adults. Traditionally observed amongst Indian women, nose piercing and jewelleries are gaining popularity in various communities for the past decade. Aspiration of tiny nose jewelleries such as nose stud screws is a serious and potentially fatal event. Small foreign bodies may dislodge further into the subsegmental bronchus, rendering bronchoscopic retrieval technically challenging. Herein, we report the first 2 cases of nose stud screw aspiration. Both of our patients were asymptomatic. Both foreign bodies were successfully retrieved via bronchoscopy using different tools and methods