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

Giant parathyroid adenoma (GPA) is defined as adenoma larger than 3.5 g. Twenty-one cases of parathyroid mass >3.5 g in patients with primary hyperparathyroidism who underwent parathyroidectomy in Hospital Putrajaya, Malaysia were identified. Most cases presented with nephrolithiasis. Two cases are reported as parathyroid cancer. GPA has significantly higher serum calcium and iPTH levels and can be asymptomatic. Parathyroid carcinoma patients are frequently symptomatic, with large tumors. Differentiating GPA from parathyroid cancer is important as it determines the subsequent surgical intervention.
Hyperparathyroidism ; Parathyroid Neoplasms ; Parathyroidectomy ; Calcium ; Adenoma

Workplaces in tropical countries are associated with increasing temperature and humidity, thus, the workers are susceptible to heat hazards. The inability for self-cooling properly toward exposure to head hazards can lead to severe dehydration and even death. To date, there are several indices and models to assess heat stress, such as WBGT, ISO 7933, discomfort index, HIS, PhSI, etc. However, their accuracy and suitability for tropical regions are still under investigation since they are mostly developed for subtropical regions. This review assessed the indices to estimate heat exposure in tropical regions based on the various online database. Among those indices, WBGT is the most suitable despite its inability to estimate human thermal response in tropical regions with several adjustments. Based on this review, it showed that there is a need for improvement of current indexes to be used in tropical regions since they are more suitable for the subtropical countries.