A novel quantity assessment of landscape ecological risk using human-nature driving mechanism for sustainable society.

The rapid advancement of global economic integration and urbanization has severely damaged the stability of the ecological environment and hindered the ecological carbon sink capacity. In this study, we evaluated the spatiotemporal evolution pattern of landscape ecological risk (LER) in the Loess Plateau from 2010 to 2020. This was examined under the driving mechanism of human and natural dual factors. We combined the random forest algorithm with the Markov chain to jointly simulate and predict the development trend of LER in 2030. From 2010 to 2020, LER on the Loess Plateau showed a distribution pattern with higher values in the southeast and lower values in the northwest. Under the interaction of human and natural factors, annual precipitation exerted the strongest constraint on LER. The driving of land use and natural factors significantly influenced the spatial differentiation of the LER, with a q-value >0.30. In all three projected scenarios for 2030, there was an increase in construction land area and a significant reduction in cultivated land area. The urban development scenario showed the greatest expansion of high-risk areas, with a 5.29 % increase. Conversely, the ecological protection scenario showed a 1.53 % increase in high-risk areas. The findings have provided a reference for ecological risk prevention and control, and sustainable development of the ecological environment in arid regions.

National expert consensus on short-acting beta2-agonist overreliance in asthma care in Malaysia.

OBJECTIVE: Inappropriate use of short-acting beta2-agonists (SABA) in asthma has been associated with undesired outcomes. This national expert consensus was developed to increase awareness of SABA overuse and provide recommendations on the ways to eliminate SABA overprescription and overreliance in Malaysia. DATA SOURCES: This expert consensus was developed by searching the PubMed database, using index terms to identify SABA overuse-related burden and recommendations made in asthma guidelines. Consensus recommendations were made via the Delphi method, involving a Malaysian expert committee comprising 13 healthcare professionals (five pulmonologists, four family medicine specialists, two emergency medicine physicians and two pharmacists). STUDY SELECTIONS: The articles reviewed include randomized controlled trials, systematic reviews, meta-analyses, observational studies, guidelines, and surveys, with abstracts in English and published up until June 2023. Relevant recommendations were also sourced from verified websites of medical organizations and societies. RESULTS: Eleven consensus statements were developed, each statement achieving a priori agreement level of at least 70%. The statements reflect SABA overreliance in asthma care, as well as recommendations to eliminate SABA overprescription and overreliance in Malaysia. Supporting evidence in the literature as well as expert committee discussions leading to the development of the finalized statements were elaborated. CONCLUSION: This national expert consensus discussed the burden of SABA overreliance and made specific recommendations to eliminate SABA overprescription and overreliance in the Malaysian context. This consensus document is anticipated to impart better awareness among Malaysian healthcare providers and contribute to the continuous improvement of asthma care in the country.

Introduction of Aedes aegypti mosquitoes carrying wAlbB Wolbachia sharply decreases dengue incidence in disease hotspots.

Partial replacement of resident Aedes aegypti mosquitoes with introduced mosquitoes carrying certain strains of inherited Wolbachia symbionts can result in transmission blocking of dengue and other viruses of public health importance. Wolbachia strain wAlbB is an effective transmission blocker and stable at high temperatures, making it particularly suitable for hot tropical climates. Following trial field releases in Malaysia, releases using wAlbB Ae. aegypti have become operationalized by the Malaysian health authorities. We report here on an average reduction in dengue fever of 62.4% (confidence intervals 50-71%) in 20 releases sites when compared to 76 control sites in high-rise residential areas. Importantly the level of dengue reduction increased with Wolbachia frequency, with 75.8% reduction (61-87%) estimated at 100% Wolbachia frequency. These findings indicate large impacts of wAlbB Wolbachia invasions on dengue fever incidence in an operational setting, with incidence expected to further decrease as wider areas are invaded.

Social isolation, loneliness, and mental health among older adults during COVID-19: a scoping review.

COVID-19 continues to have detrimental effects worldwide, especially on vulnerable populations. The burden of mental health concerns and psychological well-being resulting from social isolation and loneliness induced by COVID-19 are increasingly recognized in old age. The aim is to determine the extent of social isolation and loneliness among older adults, the methodologies used, the effect on mental health during COVID-19, and review intervention strategies and lifestyle changes to improve the current situation through the recommendations of the studies included. The articles published on PubMed, ProQuest, and Scopus databases from December 2019 to December 2021 with the following keywords ("Older Adults" "Social Isolation," "Loneliness," "Mental Health," "COVID-19") in English were included. Older adults have faced a serious burden of social isolation and adverse mental health effects during COVID-19. Anxiety, depression, stress, and insomnia are the major mental health concerns among older adults worldwide. It is suggested that spousal support and social networks, adaptive organizational change, and a responsive public sector are critical in reducing the obstacles to older adults. COVID-19 resilience among the aging population can be remarkable if adequately cared for with senior-friendly pandemic-related intervention strategies, policies and legislation.

Enhancing floc size and strength with a hybrid polymer of zinc oxide, acrylamide, and tannin in textile wastewater.

This study involved synthesising new hybrid polymers called ZOPAT, made up of zinc oxide, acrylamide, and tannin, using a blended technique. The effectiveness of ZOPAT in treating textile wastewater was then tested by measuring floc growth rate, flocculation index, strength factor, and recovery factor under optimised conditions. The study also identified the zeta potential, morphology, elemental composition, and functional groups of the polymers. Response surface methodology determines the optimal pH and ZOPAT dose, resulting in 93% colour, 80% chemical oxygen demand (COD), 100% turbidity, and suspended solids (SS) removal at pH 9.22 and 737 mg/L ZOPAT. The study found that ZOPAT was more effective than commercial Polyaluminium chloride in reducing colour and COD, producing larger and stronger flocs, and requiring a shorter coagulation time of 17.5 min. ZOPAT was also easy to homogenise and operate due to its one-unit dosing system. The study attributes the success of ZOPAT to the presence of Zn, N, and K, which create electrostatic attraction with opposite charged particles, and the formation of dye-particle-dye with amide, hydroxyl, and carboxyl groups in ZOPAT, which remove colour, turbidity, COD, and SS. Overall, the study concludes that ZOPAT has significant potential for textile wastewater treatment.

Variability of PM10 level with gaseous pollutants and meteorological parameters during episodic haze event in Malaysia: Domestic or solely transboundary factor?

Haze has become a seasonal phenomenon affecting Southeast Asia, including Malaysia, and has occurred almost every year within the last few decades. Air pollutants, specifically particulate matter, have drawn a lot of attention due to their adverse impact on human health. In this study, the spatial and temporal variability of the PM10 concentration at Kelang, Melaka, Pasir Gudang, and Petaling Jaya during historic haze events were analysed. An hourly dataset consisting of PM10, gaseous pollutants and weather parameters were obtained from Department of Environment Malaysia. The mean PM10 concentrations exceeded the stipulated Recommended Malaysia Ambient Air Quality Guideline for the yearly average of 150 µg/m3 except for Pasir Gudang in 1997 and 2005, and Petaling Jaya in 2013. The PM10 concentrations exhibit greater variability in the southwest monsoon and inter-monsoon periods at the studied year. The air masses are found to be originating from the region of Sumatra during the haze episodes. Strong to moderate correlation of PM10 concentrations was found between CO during the years that recorded episodic haze, meanwhile, the relationship of PM10 level with SO2 was found to be significant in 2013 with significant negatively correlated relative humidity. Weak correlation of PM10-NOx was measured in all study areas probably due to less contribution of domestic anthropogenic sources towards haze events in Malaysia.

Investigation of structural, electronic and optical properties of two-dimensional MoS2-doped-V2O5 composites for photocatalytic application: a density functional theory study.

In the present research, the structural, electronic and optical properties of transition metal dichalcogenide-doped transition metal oxides MoS2-doped-V2O5 with various doping concentrations (x = 1-3%) of MoS2 atoms are studied by using first principles calculation. The generalized gradient approximation Perdew-Burke-Ernzerhof simulation approach is used to investigate the energy bandgap (Eg) of orthorhombic structures. We examined the energy bandgap (Eg) decrement from 2.76 to 1.30 eV with various doping (x = 1-3%) of molybdenum disulfide (MoS2) atoms. The bandgap nature shows that the material is a well-known direct bandgap semiconductor. MoS2 doping (x = 1-3%) atoms in pentoxide (V2O5) creates the extra gamma active states which contribute to the formation of conduction and valance bands. MoS2-doped-V2O5 composite is a proficient photocatalyst, has a large surface area for absorption of light, decreases the electron-hole pairs recombination rate and increases the charge transport. A comprehensive study of optical conductivity reveals that strong peaks of MoS2-doped-V2O5 increase in ultraviolet spectrum region with small shifts at larger energy bands through increment doping x = 1-3% atoms of MoS2. A significant decrement was found in the reflectivity due to the decrement in the bandgap with doping. The optical properties significantly increased by the decrement of bandgap (Eg). Two-dimensional MoS2-doped-V2O5 composite has high energy absorption, optical conductivity and refractive index, and is an appropriate material for photocatalytic applications.

Protocol for a systematic review of the associations between inflammatory markers and lung function, muscle force and exercise capacity in people with COPD.

INTRODUCTION: The prevalence of chronic obstructive pulmonary disease (COPD) has been on the rise, with acute exacerbation of COPD associated with the highest burden and multiple pulmonary and systemic consequences. People with COPD have been found to have an abnormal response of systemic inflammation. To date, although limited, there are studies that suggest negative associations between inflammatory markers and important clinical outcomes such as exercise capacity and muscle force. This protocol aims to systematically review the evidence for (i) the associations between inflammatory markers and lung function, muscle force and exercise capacity and (ii) the influence of other factors (eg, hospitalisation, exercise programme) on the level of inflammatory markers in people with COPD. METHODS AND ANALYSIS: Scopus, PubMed, Cochrane, Web of Science and ProQuest will be searched from database inception to February 2023 using PEO search strategy (Population: adults with COPD; Exposure: inflammatory markers; Outcomes: lung function, muscle force and exercise capacity). Four reviewers working in pairs will independently screen articles for eligibility and extract data that fulfilled the inclusion criteria. Depending on the design of the included studies, either Cochrane risk-of-bias version 2 or the Newcastle-Ottawa Scale tools will be used to rate the methodological quality of the included studies. Effect sizes reported in each individual study will be standardised to Cohen's d and a random effects model will be used to calculate the pooled effect size for the association. ETHICS AND DISSEMINATION: Ethical approval is unnecessary as this study will only use publicly available data. The findings will be disseminated through publication in peer-reviewed journals and conferences. PROSPERO REGISTRATION NUMBER: CRD42022284446.

APPLICATION OF FUZZY DELPHI METHOD TO VALIDATE CONTENT OF SPIRITUAL INTELLIGENCE INSTRUMENT FOR MUSLIM NURSES.

Background & Purpose: This study aims to consolidate expert views and validated 371 items for developing spiritual intelligence instrument for Muslim nurses guided by the Spiritual Intelligence Model for Human Excellence (SIMHE). Methods: A Fuzzy Delphi Method (FDM) was used to validate these items and analyzed with Triangular Fuzzy Numbers and Defuzzification process. Views from 20 experts from three different backgrounds, namely, theology/Sufism, psychology and Islamic counseling, and evaluation and measurement, were also included in the validation process. Results: All items fulfilled the prerequisite of a threshold level of (d) ≤ 0.2, which obtained more than 75% of expert consensus and α-cut value ≥ of 0.5. Conclusion: The FDM analysis results indicated that all items could further validate the instrument using Rasch measurement analysis.

Effects of Multiple Reflow on the Formation of Primary Crystals in Sn-3.5Ag and Solder Joint Strength: Experimental and Finite Element Analysis.

The growth and formation of primary intermetallics formed in Sn-3.5Ag soldered on copper organic solderability preservative (Cu-OSP) and electroless nickel immersion gold (ENIG) surface finish after multiple reflows were systematically investigated. Real-time synchrotron imaging was used to investigate the microstructure, focusing on the in situ growth behavior of primary intermetallics during the solid-liquid-solid interactions. The high-speed shear test was conducted to observe the correlation of microstructure formation to the solder joint strength. Subsequently, the experimental results were correlated with the numerical Finite Element (FE) modeling using ANSYS software to investigate the effects of primary intermetallics on the reliability of solder joints. In the Sn-3.5Ag/Cu-OSP solder joint, the well-known Cu6Sn5 interfacial intermetallic compounds (IMCs) layer was observed in each reflow, where the thickness of the IMC layer increases with an increasing number of reflows due to the Cu diffusion from the substrate. Meanwhile, for the Sn-3.5Ag/ENIG solder joints, the Ni3Sn4 interfacial IMC layer was formed first, followed by the (Cu, Ni)6Sn5 IMC layer, where the formation was detected after five cycles of reflow. The results obtained from real-time imaging prove that the Ni layer from the ENIG surface finish possessed an effective barrier to suppress and control the Cu dissolution from the substrates, as there is no sizeable primary phase observed up to four cycles of reflow. Thus, this resulted in a thinner IMC layer and smaller primary intermetallics, producing a stronger solder joint for Sn-3.5Ag/ENIG even after the repeated reflow process relative to the Sn-3.5Ag/Cu-OSP joints.

Short-acting ß2-agonist prescription patterns and clinical outcomes in Malaysia: A nationwide cohort of the SABINA III study.

Introduction: SABINA III assessed short-acting ß2-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. Method: 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.

Effect of Isothermal Annealing on Sn Whisker Growth Behavior of Sn0.7Cu0.05Ni Solder Joint.

This paper presents an assessment of the effect of isothermal annealing of Sn whisker growth behavior on the surface of Sn0.7Cu0.05Ni solder joints using the hot-dip soldering technique. Sn0.7Cu and Sn0.7Cu0.05Ni solder joints with a similar solder coating thickness was aged up to 600 h in room temperature and annealed under 50 °C and 105 °C conditions. Through the observations, the significant outcome was the suppressing effect of Sn0.7Cu0.05Ni on Sn whisker growth in terms of density and length reduction. The fast atomic diffusion of isothermal annealing consequently reduced the stress gradient of Sn whisker growth on the Sn0.7Cu0.05Ni solder joint. It was also established that the smaller (Cu,Ni)6Sn5 grain size and stability characteristic of hexagonal η-Cu6Sn5 considerably contribute to the residual stress diminished in the (Cu,Ni)6Sn5 IMC interfacial layer and are able to suppress the growth of Sn whiskers on the Sn0.7Cu0.05Ni solder joint. The findings of this study provide environmental acceptance with the aim of suppressing Sn whisker growth and upsurging the reliability of the Sn0.7Cu0.05Ni solder joint at the electronic-device-operation temperature.

Mechanical Performance, Microstructure, and Porosity Evolution of Fly Ash Geopolymer after Ten Years of Curing Age.

This paper elucidates the mechanical performance, microstructure, and porosity evolution of fly ash geopolymer after 10 years of curing age. Given their wide range of applications, understanding the microstructure of geopolymers is critical for their long-term use. The outcome of fly ash geopolymer on mechanical performance and microstructural characteristics was compared between 28 days of curing (FA28D) and after 10 years of curing age (FA10Y) at similar mixing designs. The results of this work reveal that the FA10Y has a beneficial effect on strength development and denser microstructure compared to FA28D. The total porosity of FA10Y was also lower than FA28D due to the anorthite formation resulting in the compacted matrix. After 10 years of curing age, the 3D pore distribution showed a considerable decrease in the range of 5-30 µm with the formation of isolated and intergranular holes.

Frequency of nurse-provided spiritual care: An international comparison.

AIMS AND OBJECTIVES: To compare the frequency of nurse-provided spiritual care across diverse cultures. BACKGROUND: Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement. DESIGN: This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument. METHODS: Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed. RESULTS: Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics. CONCLUSIONS: In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care. RELEVANCE TO CLINICAL PRACTICE: Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Dearth of influenza among older adults admitted with respiratory symptoms in Malaysia during the coronavirus disease 2019 pandemic in 2021.

Introduction: Influenza is a common respiratory virus which leads to over 400,000 annual deaths globally. Mortality from influenza is highest among those aged 75 years and over living in Africa and Southeast Asia. Objective: To determine the burden of influenza among older adults presenting to public hospitals with severe acute respiratory infection (SARI) during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This multi-center, prospective, observational study recruited individuals aged 65 years and over who presented to four Malaysian hospitals with SARI from 1 January to 31 December 2021. Those with prior confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were excluded. SARS-CoV-2 was detected through real-time polymerase chain reaction (PCR) with routine diagnostic kits. Influenza A, influenza B and respiratory syncytial virus (RSV) viruses were detected with Xpress Flu/RSV kits using the GeneXpert rapid real-time PCR system (Cepheid, USA). Results: Samples were obtained from 512 participants, comprising 296 (57.8%) men and 216 (42.2%) women, with a mean age (SD) of 74.0 (7.1) years. Inpatient death occurred in 48 (9.6%) individuals. Significant differences existed in age, ethnicity, and comorbidities across study sites. One (0.2%) case of influenza A, two (0.4%) cases of RSV and 63 (12.5%) cases of SARS-CoV-2 infection were detected over the 1-year period. Cases of COVID-19 mirrored national trends derived from open source data, while the dearth of influenza cases mirrored national and global Flunet figures. Conclusion: Our observational study conducted during the COVID-19 pandemic detected only one case of influenza, alongside a high SARS-CoV-2 positivity rate. The poor uptake of influenza vaccination nationally, worsened by the recent pandemic restrictions, could lead to waning immunity from the absence of seasonal exposure. Potentially deadly outbreaks may then occur when lockdown and infection control measures are eventually removed.

Correlation between blood pressure and lung function in Malaysian adult population.

INTRODUCTION: The correlation between pulmonary function and hypertension remains ambiguous. This study therefore determined the relationship between pulmonary function and hypertension among adult subgroup in Malaysia. MATERIALS AND METHODS: Data for this study were obtained from an ongoing Prospective Urban Rural Epidemiology- Rural Urban Study (PURE RUS) , which is a prospective cohort study done by MARA University of Technology (UiTM) Medical Faculty research team to track risk factors, changing lifestyles, and chronic diseases in rural and urban population. The inclusion criteria included: Malaysian citizen, age 18-80 years, not on any anti-hypertensive agents, and able to perform lung function test. 1640 participants satisfied the criteria and were recruited in this study. RESULTS: From the studied population, males comprised 43.5% of them and female comprised 56.5%. A significant inverse relationship was found between pulmonary function and systolic blood pressure in both sexes measured by forced vital capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1). A substantial inverse relationship was also found between pulmonary function and age, and there was a profound positive association between blood pressure and age. No major disparities were significant in pulmonary function between hypertensive and age-matched normotensive participants. CONCLUSION: Even though a substantial inverse relationship was evident between systolic blood pressure and pulmonary function, its precise clinical importance needs to be further explored particularly when age can influence both pulmonary function and blood pressure. Clearly, the impact of age has to be removed before FVC can be used as a prognosticator of hypertension.

Degradation of Xenobiotic Pollutants: An Environmentally Sustainable Approach.

The ability of microorganisms to detoxify xenobiotic compounds allows them to thrive in a toxic environment using carbon, phosphorus, sulfur, and nitrogen from the available sources. Biotransformation is the most effective and useful metabolic process to degrade xenobiotic compounds. Microorganisms have an exceptional ability due to particular genes, enzymes, and degradative mechanisms. Microorganisms such as bacteria and fungi have unique properties that enable them to partially or completely metabolize the xenobiotic substances in various ecosystems.There are many cutting-edge approaches available to understand the molecular mechanism of degradative processes and pathways to decontaminate or change the core structure of xenobiotics in nature. These methods examine microorganisms, their metabolic machinery, novel proteins, and catabolic genes. This article addresses recent advances and current trends to characterize the catabolic genes, enzymes and the techniques involved in combating the threat of xenobiotic compounds using an eco-friendly approach.

Managing Post COVID-19 Patient with Breathlessness.

Background: Chronic respiratory disease may be associated with severity of coronavirus disease 2019 (COVID-19) infection. We review a case of chronic obstructive pulmonary disease (COPD) patient who developed acute breathlessness post COVID-19 infection, also focusing on the diagnostic approach. Case: A 69-year-old gentleman with background history of COPD GOLD D and ischemic heart disease was admitted with severe COVID-19 infection. He required high-flow nasal cannula upon presentation. A computed tomography pulmonary angiography (CTPA) thorax at day 10 of illness revealed moderate organizing pneumonia (OP) with emphysematous changes, without pulmonary embolism. He received oral baricitinib and intravenous methylprednisolone for 3 days, which was then followed by tapering prednisolone starting dose of 1 mg/kg/day (60 mg/day) with reduction of 10 mg prednisolone every 3 days. COPD pharmacotherapy was optimized with early utilization of dual bronchodilators and inhaled corticosteroid was withheld. He underwent inpatient pulmonary rehabilitation and was discharged with home oxygen therapy. Unfortunately, he was re-admitted after 2 weeks with shortness of breath and fever for 3 days. Blood results revealed leucocytosis with raised C-reactive protein. A repeat CTPA showed increase reticulations and crazy paving pattern with reduction in lung volume. Multidisciplinary team discussion concluded it as interstitial pneumonia with COVID-19 OP and fibrosis progression. Prednisolone was stopped and he responded well with antibiotics. A follow-up at 3 months post COVID-19 infection showed improvement of clinical symptoms with radiological resolution of ground glass changes. Conclusion: Corticosteroid inhaler should be cautioned in this case, in view of recent pneumonia and non-elevated serum eosinophil count. These groups of patients should be closely followed up to unmask interstitial lung disease that may present prior to COVID-19 and worsen post-infection. Optimizing pre-existing medical conditions should be the paramount intervention.

Development of bullous lung disease with pneumothorax following SARS-CoV-2 infection.

Cystic lung formation secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was described during coronavirus disease pandemic, but with relatively low prevalence. A rare yet under-recognized complication is that these cystic areas may progress to bullae, cavities and pneumothorax. We reported two cases of ruptured bullae with pneumothorax following SARS-CoV-2 infection. Two patients were discharged following SARS-CoV-2 pneumonia, which did not require invasive mechanical ventilation (IMV). However, both patients presented again a month later with shortness of breath. Repeated computed tomography (CT) thorax showed development of bullous lung disease and pneumothorax. The first patient underwent surgical intervention whilst the second patient was treated conservatively. Development of bullous lung disease following SARS-CoV-2 infection is rare but may be associated with serious morbidity. Patients whose general condition permits should be offered surgical intervention whilst conservative management is reserved for non-surgical candidates.

Primary Systemic Amyloidosis With Cardiac and Renal Involvement.

Systemic amyloidosis is a life-threatening disorder with a poor prognosis. Accurate and early diagnosis of the condition is of paramount importance as early initiation of therapy improves the prognosis and survival rate. A 49-year-old gentleman presented with recurrent right exudative pleural effusion. Thoracocentesis revealed unexplained exudative pleural effusion. Pleuroscopy and pleural biopsy showed chronic inflammatory changes with no atypical cells. Echocardiography revealed global dilated cardiomyopathy with an ejection fraction (EF) of 35%. He also had nephrotic range proteinuria of 2.83g/dL. A cystoscopy examination was performed due to macroscopic haematuria, and the bladder biopsy revealed focal acellular eosinophilic material within the stroma. Salmon red staining and apple-green birefringence were noticed under polarizing microscopy, suggestive of amyloidosis. Serum protein electrophoresis revealed raised alpha 1 globulin and alpha 2 globulins which support the diagnosis of primary systemic amyloidosis. Unfortunately, the patient passed away before the initiation of treatment due to cardiogenic shock. Early and less invasive tests for diagnosing systemic amyloidosis, such as abdominal fat pad aspiration and salivary gland biopsy, can be done. Given its systemic nature, early complications screening may benefit patients whereby targeted treatment can be given.