A 36-year-old lady presented with four episodes of right sided pneumothorax during pregnancy requiring multiple chest drain insertion. It was complicated with persistent air leak despite low pressure high volume suction applied to the chest drainage. She delivered safely through spontaneous vaginal delivery with chest drainage. Further imaging by high resolution computed tomography (HRCT) scan of thorax done revealed bilateral scattered pulmonary cysts and sub pleural bullae and was later followed up with respiratory unit. She had no further episodes of pneumothorax postpartum. This case highlights the vital importance of prompt recognition and management of pneumothorax in pregnancy as the patient involved is at higher risk for acute respiratory failure leading to maternal and/or foetal mortality. It is essential for early involvement of obstetric team and to expedite the delivery for a better perinatal and maternal outcome.
Pneumothorax ; Pregnancy

Postpartum bleeding of the uterus is an important cause of maternal death. It is thought that the inhibitory effect of the majority of potent inhalation anesthetics on uterine contraction is often responsible (Munson, 1970; Lim et al., 1971; Kim, 1972). There have been numerous reports that ketamine stimulates uterine contraction clinically Chodoff and Stella, 1966; Little et al, 1972; Galbert and Gardner, 1973; Corssen, 1974). Jawalekar and associates(1972) reported that ketamine increased resting tension, contractile amplitude and frequency of the uterine strips of pregnant mice. And Kim(1975) reported research on the effects of ketamine on the isolated uterus of rabbits. According to Kim(1975), ketamine exerted .a stimulatory action on the uterus under the influence of progesterone. This progesterone-depenent uterine stimulatory action of ketamine is not concerned with adrenergic and cholinergic mechanisms but appears to have a direct effect on the uterine muscle. The present study was undertaken to determine whether or not ketamine also exerted a stimlatory action on the uterus of the guinea pig and to follow up whether or not stimulatory action of ketamine also depends upon progesterone in the guinea pig. Adult female non-pregnant guinea pigs and rabbits weighing approximately 0, 5 kg and 2. 0 kg respectively were employed in this experiment. At the end of 10 to 14 days following bilateral oophorectomy, non-pregnant guinea pigs and rabbits were injected intramusculary with estradiol benzoate (2,000 I.U./kg) or progesterone (Smg/kg) once a day for four consecutive days, A uterine strip, about 1.5~2,0cm in length, was carefully isolated from the experimental animals and suspended in a muscle chamber containing 50 ml of Lockes solution, maintained at constant temperature of 38C. It was aerated with 100% oxygen bubbling through the bathing fluid by means of a sintered glass plate at the bottom of the muscle chamber. One end of the uterine strip was attached to the bottom of the muscle chamber and the other end to a lever. Motility and tonus were recorded on kymograph paper. After being washed several times with fresh Locke's solution, the uterine strip attained a constant motility and tonus. Ketamine then was added in various concentrations to the chamber. The results are as follows: 1. The uterine mctility of guinea pig shows a higher amplitude and lower frequency compared with that of rabbit. 2. Effects of ketamine on isolated uterine strips of guinea pig pre-treated with estrogen showed no change using 1~20 gamma/ml of ketamine, but with 50 gamma/ml or more, the amplitude of uterine contractions was depressed. 3. On isolated uterine strips of guinea pig pre-treated with progesterone, there was no effect with 1100 gamma/ml of ketamine, depressed amplitude of uterine contractions with 150 gamma/ml and markedly depressed amplitude of uterine contraction with 200 gamma/ml. 4. On isolated uterine strips of rabbit pre-treated with estrogen, there was no effect with 20 gamma/ml of ketamine, but depressed amplitude of uterine contraction using 50 gamma/ml. 5. On isolated uterine strips of rabbit pretreated with progesterone, there was an increase in amplitude and frequency of uterine contractions with up to 150 gamma/ml of ketamine, but depressed amplitude with 200 gamma/ml or more. From the above results it may be concluded that ketamine exerted a stimulatory action on the uterus of rabbit under the influence of progesterone but not on the uterus of guinea pig. The large amount of ketamine depressed the amplitude of uterine contraction in guinea pig and rabbit and this depressing dose is higher in the animals (guinea pig and rabbit) pre-treated with pr ogesterone than with estrogen.
Adult ; Anesthetics, Inhalation ; Animals ; Baths ; Benzoates ; Estradiol ; Estrogens ; Female ; Follow-Up Studies ; Glass ; Guinea Pigs* ; Guinea* ; Hemorrhage ; Humans ; Ketamine* ; Maternal Death ; Mice ; Myometrium ; Ovariectomy ; Oxygen ; Postpartum Period ; Progesterone ; Rabbits ; Uterine Contraction ; Uterus*

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.

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.

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).