Chylothorax is the accumulation of lymphatic fluid (chyle) in the pleural space, as a result of obstruction, injury or leakage of the thoracic duct or one of its tributaries.The frequency of causes of chylothorax depends on the type of hospital and the population served but there are few reports of this complication in people with end-stage renal disease and the outcomes with different interventions.We report the case of a 35-years-old man from a low-altitude agricultural community in northwest Nicaragua, diagnosed with end-stage chronic kidney disease (CKD) of nontraditional etiology three months before admission who developed chylothorax after dysfunction of central venous catheter (CVC) at the right internal jugular vein for hemodialysis.After multidisciplinary approach, we found no cause of the chylothorax other than pulmonary Aspergillosis with mediastinal adenopathy and possible external pressure to the thoracic duct as a mechanism similar described in pulmonary tuberculosis, sarcoidosis and histoplasmosis.Chylothorax resolved with the treatment for aspergillosis and performance of lymphangiography with lipiodol after conservative treatment for chylothorax failed and before we continued to embolization of the thoracic duct, which allowed us to performance pleurodesis with iodine without complications.We reviewed the etiologies of chylothorax in patients with end-stage renal disease in hemodialysis reported so far and found no reports of aspergillosis as a cause of chylothorax.
Introduction:Ventilator-associated pneumonia (VAP) occurs in 9.0% to 27.0% of patients on mechanical ventilation (MV) and has a global mortality rate of 13.0%.VAP is the most frequent infection acquired in the intensive care unit (ICU) among patients submitted to this ventilatory support, resulting in mortality rates' ranging from 20.0% to 70.0%, with the use of antibiotics is presented in the literature as the most effective prophylactic measure.Objective: The primary objective of this study was to review national and international scientific literature on preventive measures and pneumonia associated with mechanical ventilation.The secondary objective was to discuss the efficacy of preventive measures for ventilator-associated pneumonia. Methods:After literary search criteria with the use of Mesh terms: pneumonia, antibiotics, prophylactic antibiotics, mechanical ventilation, patients at risk, major care, contamination and clinical trials and use of the bouleanos "and" between mesh terms and "or" among the historical findings.In the main databases such as Pubmed, Medline, Bireme, EBSCO, Scielo, etc., a total of 56 papers that were submitted to the eligibility analysis were cross-checked and after that 21 studies were selected, following the rules of systematic review-PRISMA. Results:The results suggest that the use of intravenous and technological support that the surgical patient needs on the day of ICU admission is a risk factor for the development of VAP, as well as the prior use of antibiotics.In addition, the results confirm that VAP significantly increases the mechanical ventilation time and the time of ICU injection.Conclusion: EPI is an important cause of increased morbidity and mortality in severe ICU patients.Enteral nutrition was an important risk factor and previous use of antibiotic protection factor for the development of VAP.Studies to determine incidence and risk factors are useful in guiding the implementation of measures to improve diagnostic accuracy and to implement preventive measures.
Introduction:The association of reduced lung functions and diabetes mellitus has been described for many years suggesting that the lung could be a target organ in diabetes mellitus.Chronic obstructive Pulmonary Disease is considered as a disease that goes beyond lung involvement giving it an expression of multisystem inflammatory disease.Diagnosis of Chronic Obstructive Pulmonary Disease in diabetics may have difficulties due to superimposition of restrictive abnormality associated with diabetes mellitus.Aim: To study pulmonary function test in type 2 Diabetics and in COPD with type 2 Diabetes. Materials and Methods:The study was conducted in Department of Pulmonary Medicine at Dr. Shankar rao Chavan Govt Medical College, Nanded.After inclusion criteria were met, patients were divided into 3 groups (40 type 2 diabetes with COPD (Group A), 40 type 2 diabetics (Group B), and 40 healthy controls (Group C) who are nonsmoker and having no history of any acute or chronic respiratory illness.)which underwent clinical evaluation and spirometry was performed. Results:The spirometric parameters shows that among 40 patients of DM with COPD 22 (55%) had restrictive, 12 (30%) had obstructive,06 (15%) had mixed and 0 patients were normal and among 40 patients of DM 26 (65%) had restrictive,06 (15%) had obstructive,06 (15%) had mixed and 02 (05%) patients were normal spirometric findings.We also compared duration of diabetes with spirometric findings (FEV1, FVC, FEV1/FVC) in both the groups so we found no correlation between them (p>0.05). Conclusion:The finding in our study proved that patients with type 2 DM with COPD showed additional restriction pattern on spirometry with compared usual obstructive pattern, also further we found that in patients with Type 2 DM we also found restrictive pattern.So we can conclude that DM being a systemic disease, also affects lung causing restrictive type of ventilatory changes.The restrictive changes probably because of glycosylation of connective tissues reduced pulmonary elastic recoil and inflammatory changes in lungs.
Objectives: This study aimed to elucidate the characteristics of swallowing function, including swallowing muscle activity, and the residual factors of dysphagia in elderly patients with community-acquired pneumonia (CAP). Study design: A total of 163 subjects were included in the study. The subjects were classified into an oral intake independent group (severe aspiration), which comprises subjects who have a total fiberoptic endoscopic evaluation of swallowing (FEES) score of seven or more, and an oral intake restriction group (no aspiration or mild aspiration), which comprises subjects who have a total FEES score of less than seven. These two groups were compared, and the residual factors of dysphagia were analyzed. Results: Significant differences between the two groups were found in the repetitive saliva swallowing test, geriatric nutritional risk index, pneumonia severity, swallowing muscle activity, and respiratory rate fasting period. Multivariate logistic regression analysis revealed that the duration of swallowing muscle activity (OR 15.7, 95% CI 1.29 to 19.66; P=0.031) and respiratory rate (OR 1.22, 95% CI 1.03 to 1.58; P=0.026) were the residual factors of dysphagia in elderly people with CAP. Conclusions: This study highlighted the importance of an early approach that focuses on swallowing function and respiratory rate in the rehabilitation of elderly people with dysphagia and CAP. The results for the residual factors of dysphagia provide new evidence in the field of rehabilitation and will help reduce hospitalization and readmission for pneumonia.
Nivolumab is a recently approved medication that shows significant clinical activity for various types of malignancies such melanoma, renal cell carcinoma and non-small cell carcinoma. Pneumonitis is a rare, but, possibly fatal manifestation that still remains ambiguous. This article presents a case of nivolumab induced pneumonitis in a patient with melanoma and discusses management plans.
