Trauma consultations are frequent at the emergency departments of hospital centers. Emergency physicians and general or trauma surgeons are the first to provide assistance in the hospital setting. Making an accurate diagnosis and timely and appropriate treatment is the basis for saving patients' lives and reducing the incidence of complications. This is why we think that the general surgeon must have in his diagnostic and therapeutic arsenal the expertise to perform Video Assisted Thoracoscopic Surgery (VATS), which has its own indication that aims at safe and quality care. The objective is to establish the scope of VATS, review the indications for the procedure, and provide practical steps for the implementation of the technique by general surgeons.
Collapse is a significant and common presenting complaint in the accident and emergency departments globally, with varying incidence and prevalence influenced by regional health profiles and healthcare systems. It is leading to almost twenty percent of all admission to an acute hospital amongst the elderly population. It encompasses a wide range of underlying causes, from benign to life-threatening conditions that need to be excluded by Acute Physicians. This case highlights the importance of maintaining metabolic equilibrium and intricated relationship to cardiovascular health. It highlights impetus for adequate vitamin D levels for overall mineral balance and bone-cardiovascular health. It summarises the regulatory mechanisms of vitamin D and its interactions with key electrolytes and hormones such as calcium, phosphate and magnesium as well as parathyroid hormone. It is important that these metabolic changes can be recognised so that the appropriate treatment and preventative measures are taken.
Background: Tuberculosis caused by Mycobacterium Tuberculosis is detected by smear microscopy, molecular tests like CBNAAT (Cartridge based nucleic Acid Amplification test) or Truenat, Line Probe assays (LPA) and phenotypic tests like solid Culture and liquid Culture. Yet every year there are many cases which go undiagnosed due to lack of information, availability, and accessibility to these tests. Presumptive examination rate helps us to understand the scenario of existing individuals having any one of the symptoms of TB diagnosing TB and thus helping in detecting Tuberculosis cases much earlier. Interventions: A quality analysis and assessment were conducted to identify the reasons for the high and low Presumptive Examination Rates across all districts in Telangana, India. The availability of CBNAATs and truenats machines at the periphery level helped in increasing the number of tests in the year 2022. The state ensured the availability of logistics such as CBNAAT cartridges and Truenat chips. Extensive IEC efforts were carried out at both district and block levels to promote the availability of NAATs, aiming for optimal utilization of the machines for patients seeking care in both the public and private sectors. Results: The Presumptive examination rate, which was significantly lower in the year 2015 gradually, increased in the year 2023 with adequate availability of logistics in the NAAT facilities. This intervention not only increased the presumptive examination rate but also boosted TB detection rates and utilization of the public sector NAAT facilities by the private sector. Conclusion: Analyzing the presumptive examination rate provides insights into the availability and accessibility of facilities, the sufficiency of logistics, and the utilization of services across all sectors. This understanding aids in developing more effective strategies to make TB diagnostics more accessible.
Background: Malignant pleural effusions (MPE) are common complications of advanced malignancy. The treatment of MPE is generally focused on palliation of respiratory symptoms. The main drawback of the traditional method of pleurodesis is the requirement for hospitalization. Objectives: To examine the safety, efficacy and economy of management of a dedicated MPE clinic. Methods and analysis: A retrospective cohort study was designed to compare complication rates, pleural effusion control, length of hospital stay, type of interventions, estimated hospital days saved between two three-year non-contemporary periods – before the implementation of MPE clinic and after. Results: Pre MPE clinic and MPE clinic group comprised of 115 and 161 patients respectively. The number of hospital admissions was lower in the MPE clinic period (42.4% vs 73.9%; p<0.0001) and the pleural effusion control was higher in the same group (65.2% versus 51.3%; p=0.02). The estimated hospital days saved was 1001 days over 3 years. Conclusion: A dedicated malignant pleural effusion (MPE) clinic is a strategy of malignant effusion management that reduces hospital admission days and, will allow patients to spend more time outside hospital, reduce costs and save healthcare resources. Outpatient MPE clinic is of particular importance in the setting of the health care system and the overcrowded hospitals. The ability to avoid a one week hospitalization for a palliative intervention and replace it with a simple and effective outpatient procedure should appeal to patients and administrators alike.
Figure 1 a.Demonstrating extraction scheme of LSC and LSC-Exo from healthy donors, created with Biorender.com.b.Demonstrating immunofluorescence staining and quantification analysis of ACE-2 on LSC and HEK.Scale bar: 50μm.n=3.c.Demonstrating Western blot quantification of ACE-2 expression in LSC and HEK, which derived from the same experiments and processed in parallel.n = 3. d.Demonstrating representative TEM images of LSC-Exo and HEK-Exo from 3 independent experiments.Scale bar: 100μm.e. Demonstrating measurements of size distribution of LSC-Exo and HEK-Exo via nanoparticle tracking analysis.Inset: 3-colar dSTORM image of CD63-Alexa Fluor®-488, PE-CD9, APC-CD81 of LSC-Exo or HEK-Exo.f.Demonstrating quantification of ACE-2 expression on LSC-Exo and HEK-Exo by flow cytometry.n=3.
Background: Accurate staging for patients with lung cancer is essential for management and prognostication. Percutaneous ultrasound-guided fine needle aspiration (US FNA) of supraclavicular lymph nodes is not always performed clinically for variety of reasons. Our study explores the utility of supraclavicular lymph node biopsy using the endobronchial ultrasound (EBUS) bronchoscope at the time of a mediastinal staging procedure as a possible alternative to US FNA. Methods: This study included 22 patients who underwent supraclavicular lymph node biopsy using the EBUS bronchoscope during lung cancer staging procedure from 2019 to 2021 at the University of Pennsylvania. Feasibility and safety of the procedure were reported. Descriptive statistics were performed for baseline demographics, imaging features, pathology results, tumor cellularity and adequacy for oncological testing. Results: The procedures were safely performed in all patients with no safety events reported. All patients were diagnosed with malignancy and EBUS-guided supraclavicular lymph node FNA showed definitive diagnosis in 19. Of the 16 patients with the final diagnosis of non-small cell lung cancer (NSCLC), 14 had tumor seen in supraclavicular lymph node sampling and 9 were upgraded to Stage IIIB disease from lower mediastinal lymph node staging. Eleven supraclavicular lymph node samples had tumor cellularity >10%. Eight samples were sent for next generation sequencing (NGS). Three of them were the only source for NGS. Conclusions: Supraclavicular lymph node biopsy using the EBUS bronchoscope is a feasible and safe procedure to perform during lung cancer staging. Sampling has significant clinical value for accurate staging and oncologic testing.
Artificial stone (AS) silicosis has emerged as a specially aggressive form of silicosis that can lead to pulmonary fibrosis and respiratory failure. The utility of positron emission tomography combined with computed tomography (PET/CT), an essential tool in oncological diseases that shows increased metabolic activity in neoplastic cells, is being evaluated in inflammatory pulmonary diseases. There are few publications about its use in silicosis, almost always referred to isolated cases in the context of studying a possible neoplasm. We present four cases of AS silicosis that underwent PET/CT and discuss its possible usefulness in this entity.
Pericardial cysts, which are frequently detected incidentally on routine chest scans, are typically considered to be congenital anomalies. They are generally asymptomatic and have a good prognosis. Pericardial cysts are usually located in the cardiophrenic area, have a thin wall, contain clear fluid, and are often not associated with the pericardium. Although it has a low malignant potential, the recommended treatment for these lesions is total excision due to the risk of recurrence. A case of pericardial cyst detected incidentally and to excised with single incision video-assisted thoracoscopic surgery (SIVATS) is presented.
Introduction: Fibrothorax, characterized by the widespread thickening of the pleura, can develop as a result of several disorders and can be seen as a consequence of empyema. After a very long latent period, reactivation or infection may occur. Hemothorax, empyema, asbestos exposure, and tuberculosis are frequent etiologies. This can occur frequently with bronchopleural fistula or pleurocutaneous fistula. In our article, we will present a case with a stable lesion containing fluid between calcified pleural sheets for many years, but a fistula has not yet developed, and recurrent hospital admissions with vague clinical findings. Case presentation: A 96-year-old man patient was admitted due to experiencing difficulty in breathing. He has been diagnosed with hypertension and heart failure and does not have a history of regular drug usage. According to his medical records, he had pulmonary tuberculosis around 65 years ago. He has been experiencing a chronic cough, expectoration of mucus, and dyspnea for approximately two decades. He received oral antibiotic treatments, but as his symptoms began to improve, he did not attend follow-up appointments. Upon reviewing the patient's past examinations, it was observed that thoracic CT scans conducted in 2010, 2022, and 2024 revealed the presence of pleural thickening, areas with fluid density, and calcifications in the right hemithorax. Additionally, areas with fluid density were consistently observed within the stable calcific mass lesion throughout this period. A close clinical monitoring protocol was instituted due to the patient's refusal to undergo thoracentesis, stable lung imaging for 14, and normal acute phase reactants and sputum cultures. Conclusion: In chronic calcified pleurisy, which is evaluated in favor of sequelae in patients with appropriate history and clinical findings, the etiology should be clarified by informing the patients, and treatment options should be evaluated without further degrading the patient's clinical.
Throughout the centuries-old history of acute pneumonia (AP), this disease was considered exclusively as an inflammatory process in the lung tissue, but in the second half of the 19th century, the intensive development of microbiology marked the beginning of the study of the etiology of AP.
Objectives: To investígate and analyze the tomographic findings in AngioCT with PET protocol. Material and method: Tomography reports of patients undergoing AngioCT for suspected PE during the period from January 2020 to December 2022 performed at the high complexity hospital were analyzed. RESULTS: The analysis showed a significant increase in findings in 2021, associated with the frequency of pulmonary embolism (PE) in patients with SARS-CoV-2 infection. The predominant age range was 60 to 79 years. There was a slight predominance of male patients compared to female patients. Among the most common are pleural or pericardial effusion, atelectasis, and the ground glass or mosaic pattern. Conclusions: The results of this study demonstrate that CT angiography with a PET protocol is a valuable diagnostic tool in patients with suspected PE. Incidental detection of these injuries raises questions about appropriate management, follow-up, and the need for medical interventions. This phenomenon has led to a growing need to develop clear guidelines and criteria for the evaluation and management of incidentalomas found on chest PET scans. In this context, it is crucial to investigate and better understand the nature and clinical implications of these findings to improve medical decision making.
Introduction: Recurrent spontaneous pneumothoraces (PSP) in association with liver disease is well known to occur with alpha 1 antitrypsin deficiency (AATD). Wilson disease (WD) association with recurrent PSP is not a known entity. Case presentation: A 42-year-old nonsmoker man with a history of recurrent PSP was admitted with a large right pneumothorax. Following intercostal chest drain (ICD) patient’s breathing improved and the lung expanded. Despite that, he continued to have a small residual pneumothorax (<2cm). Twelve years ago, he was diagnosed with WD. The patient was on treatment with D-penicillamine. After 3 years of the diagnosis of WD, the patient developed left-sided recurrent PSPs where he ended up with a left-pleurectomy in 2015. For the current event, initially expectant management was done for residual pneumothorax. All the possible causes for PSP were excluded. On follow-up, he continued to be symptomatic. A thoracic surgical referral was arranged for Video-Assisted Thoracoscopic Surgery (VATS) and redo-pleurectomy. The safety of future treatment with D-penicillamine is not concluded as there is no convincing evidence to prove it as a culprit agent for PSPs. Multidisciplinary discussion was arranged and consideration of treatment with alternative copper chelating therapy was emphasized. Conclusion: Though rare, it is important to observe for occurrence of PSP in WD patients. This case report will be eye-opening for the association of lung disease and WD and related treatment.
There is a substantial morbidity and fatality rate associated with tuberculosis meningitis (TBM). A severe consequence of tuberculosis meningitis is cerebral infarction (CI). It can be asymptomatic or symptomatic, causing stroke. In this case, large cerebral infarcts, an uncommon complication of TBM, is presented.
A comprehensive search was carried out in mainstream bibliographic databases or Medical Subject Headings, including ScienDirect, PubMed, Scopus, and ISI Web of Science. The search was applied to the articles that were published between 2021 and mid-2023. With strict literature search and screening processes, it yielded 8 articles from 349 articles of initial literature database. A number of previous studies demonstrated that KTRs or non-KTRs with renal failure markedly reduced vaccine response, whereas adaptive protocols of mRNA COVID-19 vaccination or alternative adjuvant vaccines is now not known yet. A recent study revealed that acute kidney injury and mortality could be caused by SARS-CoV-2 (COVID-19) around 50 % and 23 % of the infected KTRs. No different post-V4-T-cell response and anti-S antibody levels were detected by vaccine type combination (ChAdOx1 plus BNT162b2) among participants, whereas post-V3 seropositivity demonstrated more anti-S antibody levels if administered with BNT162b2, in comparison with ChAdOx1. In conclusion, among the immunocompromised population, including KTRs, DPs, PDs, at least three doses of mRNA-COVID-19 vaccination was recommended to be the preparation of choice. Withdrawal of the immunosuppressants in KTRs and immunocompromised individual’s prior COVID-19 vaccination and at least third dose of mRNA-COVID-19 vaccination should be performed.
