1.Kounis syndrome following solenopsis (fire ant) bite
Boon Hau Ng ; Hui Xin Tan ; Shalini Vijayasingham
The Medical Journal of Malaysia 2019;74(4):344-346
Anaphylaxis is rarely associated with the vasospastic acute
coronary syndrome with or without the presence of
underlying coronary artery disease. We report here a case of
Kounis syndrome in a man with no known cardiovascular
risk developed acute ST-elevation myocardial infarction
complicated with complete heart block following Solenopsis
(fire ant) bite.
2.Ways to overcome non-draining indwelling pleural catheter in malignant pleural effusion
Mohamed Faisal Abdul Hamid ; Boon Hau Ng
The Medical Journal of Malaysia 2019;74(6):555-557
The indwelling pleural catheter (IPC) is a 16-Fr-multifenestrated catheter. It has become an accepted practice in
the management of malignant pleural effusion, especially in
patients with non-expandable lung. However, IPC blockage
or not draining is common. A 53-year-old female with
malignant pleural effusion presented to us with blocked IPC
and symptomatic pleural loculation one month after IPC
insertion. After failing saline flushing and low-pressure wall
suction, intrapleural alteplase was instituted through the IPC
with a favourable outcome, and she continued to drain daily
thereafter. The present case highlights the safety of
intrapleural alteplase via IPC in the non-expandable lung.
3.High intensity non-invasive positive pressure ventilation for refractory decompensated acute hypercapnic respiratory failure in advanced chronic obstructive pulmonary disease
Kuan Yee Lim ; Rathika Rajah ; Boon Hau Ng ; Chun Ian Soo
The Medical Journal of Malaysia 2020;75(4):430-432
Chronic obstructive pulmonary disease (COPD) is a
debilitating progressive lung disease characterised by
irreversible airflow obstruction. In addition to an increase in
morbidity and mortality, exacerbation also results in frequent
hospital visits, which place a burden on healthcare systems.
Non-invasive positive pressure ventilation (NPPV) with
conventional inspiratory pressures is the standard ventilatory
support for patients in exacerbation. At present, the use of
higher inspiratory pressures through high intensity noninvasive positive pressure ventilation (Hi-NPPV) during an
exacerbation remains unknown. We describe a novel
application of Hi-NPPV in a patient with acute exacerbation
who was refractory to conventional NPPV.
4.Intra-pleural Instillation of Autologous Blood – Fine-tuning Techniques for Better Success Rate: Two Case Reports
Boon Hau Ng ; Juen Kiem Tan ; Yu-Lin Andrea Ban ; Mohamed Faisal Abdul Hamid
The Medical Journal of Malaysia 2020;75(2):181-183
In the past, many case series have reported the
effectiveness of autologous blood patch pleurodesis (ABPP)
in recurrent secondary spontaneous pneumothorax (SSP),
particularly in those who were unfit for surgery. We describe
two cases of persistent air leak in pneumoconiosis and
pulmonary fibrosis with bronchiectasis, whereby the
techniques employed had improved the success rate of
ABPP. The determining factors that lead to the success of
ABPP were determined by the volume of autologous blood
instilled, Trendelenburg position post instillation, and early
chest physiotherapy with mobilisation by application of
pneumostat.
5.Incidence and risk factors of delirium in patients with acute ischaemic stroke
Boon Hau Ng ; Zhe Kang Law ; Rabani Remli ; Hui Jan Tan ; Norlinah Mohamed Ibrahim ; Azman Ali Raymond ; Wan Asyraf Wan Zaidi ; Syed Zulkifli Syed Zakaria ; Nafisah Wan Yahya ; Ramesh Sahathevan
Neurology Asia 2019;24(4):295-302
Background & Objectives: The reported incidence of post-stroke delirium varies substantially in current
medical literature. The impact of delirium on mortality and morbidity is significant and there is need
for sustained research on the topic. We aimed to determine the incidence, risk factors and outcome of
delirium in acute ischaemic stroke. Methods: We conducted a cross-sectional observational study on
consecutive patients with ischaemic stroke. The Confusion Assessment Method was used to diagnose
delirium within seven days of stroke onset. Results: Two hundred and eighty patients were recruited
(mean age 63.6 years) and 36 (12.9%) developed delirium. After adjustments for covariates, age >65
years (odds ratio, OR 5.2; 95% confidence interval 1.6-17.5); pre-existing dementia (6.5; 1.1-38.2);
TACI (7.2; 1.5-35); and a National Institute of Health Stroke Scale of ≥10 (6.8; 1.7-26.4), were
independently associated with a risk of developing delirium. Lacunar infarcts were not associated with
delirium (0.07; 0.03-0.16). The majority of patients with delirium were cared for in a dedicated stroke
unit but this proportion was not significant compared to those without delirium (69.4% vs 58.2%,
p=0.20). Delirious patients had significantly higher in-patient mortality (8.3% vs 0%, p=0.002) and
longer length of hospital stay (6.94 vs 3.98 days, p< 0.001).
Conclusions: One in 8 patients with ischaemic stroke in our centre developed delirium. Older age,
pre-existing dementia and severe stroke were independent predictors of delirium. Patients with lacunar
infarcts did not develop delirium as often as those with other stroke types. Delirium significantly
increased in-patient mortality and length of hospital stay.
6.Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur
Boon Hau Ng ; Nik Nuratiqah Nik Abeed ; Andrea Ban Yu Lin ; Mohamed Faisal Abdul Hamid ; Lydia Kamaruzaman ; Muhammad Yusuf Abu Shamsi ; Halim Gafor ; Norlaila Mustafa, ; Wan Nur Nafisah Wan Yahya ; Shahrul Azmin ; Khoo Ching Soong ; Hemalatha Munusamy ; Zhen Hao Ching ; Hsueh Jing Low ; Petrick Periyasamy
The Medical Journal of Malaysia 2020;75(4):368-371
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.
7.A descriptive study of the psychological experience of health care workers in close contact with a person with COVID-19
Boon Hau Ng ; Nik Nuratiqah Nik Abeed ; Mohamed Faisal Abdul Hamid ; Chun Ian Soo ; Hsueh Jing Low ; Najma Kori ; Petrick Periyasamy ; Norlaila Mustafa ; Andrea Ban Yu-Lin
The Medical Journal of Malaysia 2020;75(5):485-489
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.
8.COVID-19 detected from targeted contact tracing, attempting to see the pattern in random happenings: early lessons in Malaysia
Boon Hau Ng ; Andrea Ban Yu-Lin ; Nik Nuratiqah Nik Abeed ; Mohamed Faisal Abdul Hamid, ; Chun Ian Soo ; Najma Kori ; Petrick Periyasamy,
The Medical Journal of Malaysia 2020;75(5):582-584
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).