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A nationwide survey on awareness and knowledge about Bronchial Provocation Test amongst doctors in Malaysia

Ng KL, Huan NC, Mohammad FA, Mohd Aminudin NH, Mohammad FA, Abdul Rahaman JA

Med J Malaysia, 2022 Jan;77(1):33-40.
PMID: 35086992

BACKGROUND: Bronchial provocation test (BPT) is widely used internationally not only to evaluate bronchial responsiveness in conditions especially asthma, but is also utilized as a marker of control, severity and prognosis for asthma. However, the uptake of BPT in certain countries including Malaysia remains low. We aimed to explore this lack of knowledge by assessing the current level of awareness and knowledge on BPT amongst doctors in Malaysia.
MATERIALS AND METHODS: A nationwide web-based questionnaire targeting doctors was sent through social media (Facebook, WhatsApp and Telegram) and Malaysian Medical Association (MMA) mailing lists between 1 October 2020 - 5 February 2021.
RESULTS: In all 415 survey responses were analysed from doctors of various grades namely medical officers to consultants. A total of 404 (97.35%) encountered patients with asthma in their daily practice. According to specialty: 169 (40.72%) were from primary care, 121 (29.16%) internal medicine, 50 (12.05%) pulmonary medicine and 75 (18.07%) others. Only 163 (39.28%) were aware of BPT as a tool to diagnose asthma. 232 (55.90%) and 124 (29.88%) regarded BPT as an important test and felt confident to refer patients for BPT respectively. Of those participants who were not confident to refer: 35.17% were unsure of BPT indications, 33.21% were unsure of centres providing BPT, 8.17% cited logistic reasons, 6.04% were concerned of possible BPT side effects. 387 (93.25%) wanted more training in BPT. The median BPT knowledge score was 20% (1 out of 5). Awareness and knowledge were affected by specialty but not by: region of practice, gender, age and grade from logistic regression analysis.
CONCLUSION: Various national level programs and targeted local interventions are much needed to increase the awareness, knowledge and uptake of BPT in Malaysia.
Fulltext Successful drainage of complex haemoserous malignant pleural effusion with a single modified low-dose intrapleural alteplase and dornase alfa

Ng BH, Mohd Aminudin NH, Nasaruddin MZ, Abdul Rahaman JA

BMJ Case Rep, 2021 Feb 05;14(2).
PMID: 33547099 DOI: 10.1136/bcr-2020-239702

Patients with symptomatic complex malignant pleural effusion (MPE) are frequently unfit for decortication and have a poorer prognosis. Septations can develop in MPE, which may lead to failure of complete drainage and pleural infection. Intrapleural fibrinolytic therapy (IPFT) is an alternative treatment. The use of IPFT in patients with anaemia and high risk for intrapleural bleeding is not well established. We report a successful drainage of complex haemoserous MPE with a single modified low-dose of intrapleural 5 mg of alteplase and 5 mg of dornase alfa in a patient with pre-existing anaemia with no significant risk of intrapleural bleeding.
Fulltext Unveiling a rare haemorrhagic malignant pleural effusion: The role of medical thoracoscopy in diagnosing primary pleural angiosarcoma

Chong AR, Ng KL, Huan NC, Mohd Aminudin NH, Ahmad Sharifuddin M, Raja Rahaizat RNA, et al.

Respirol Case Rep, 2024 Nov;12(11):e70068.
PMID: 39588325 DOI: 10.1002/rcr2.70068

Primary pleural angiosarcoma (PPA) is a rare and challenging tumour to diagnose, often mistaken for other malignancies such as mesothelioma and lung cancer due to overlapping clinical and imaging features. We report a 52-year-old woman who presented with progressive shortness of breath and pleuritic chest pain. Imaging studies and thoracentesis revealed a large haemorrhagic left pleural effusion. Medical thoracoscopy (MT) showed a thickened and lobulated parietal pleura with multiple nodular lesions. Histopathological examination confirmed a diagnosis of angiosarcoma, characterized by pleomorphic tumour cells, a high Ki67 proliferation index and positive immunohistochemical markers, including CD31, D2-40, Vimentin, and Factor VIII. Tragically, the patient developed a hospital-acquired infection and passed away before any definitive treatment for the angiosarcoma could be initiated. This case underscores the diagnostic complexities of PPA and highlights the utility of MT in identifying this rare malignancy.
Utilizing medical thoracoscopy for the diagnosis of B-cell lymphoma presenting with pleural effusion: A case series

Huan NC, Ng KL, Nyanti LE, Khaw JY, Lee JH, Mohd Aminudin NH, et al.

Respirol Case Rep, 2024 Nov;12(11):e70061.
PMID: 39563685 DOI: 10.1002/rcr2.70061

A third of patients with non-Hodgkin's lymphoma (NHL) develop pleural effusion during the disease course for various reasons. In most cases, lymphoma-related pleural effusion is a manifestation of widespread systemic disease, signifying a high tumour burden and therefore, a poorer prognosis. On the other hand, primary pleural lymphomas (PPLs) exhibit exclusive or dominant involvement of serous cavities, without detectable solid tumour masses. PPL is an uncommon disease and is of two types: primary effusion lymphoma (PEL) and diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI). PPLs not related to PELs and DLBCL-CIs are exceedingly rare. Herein, we describe four patients with biopsy proven B-cell NHL. One had no extra-pleural involvement at the time of diagnosis, indicating PPL. In all cases, histopathological examination of pleural biopsies obtained via medical thoracoscopy (MT) were crucial in clinching the final diagnosis. Clinicians are alerted to the potential relationship between exudative effusion and NHL as well as the role of MT in the diagnosis of B-cell NHL.