Introduction: The aspiration of foreign bodies into the airway is rare in adults, except in the elderly with impaired consciousness or difficulty swallowing. Serious complications such as recurrent cough, infection, and pulmonary atelectasis are potentially life-threatening. Diagnosis is made based on medical history and imaging, but in some cases, a computed tomography (CT) scan is required for confirmation before definitive treatment. The use of flexible bronchoscopy under local anesthesia is effective for extracting small foreign bodies, whereas large or sharp foreign bodies require bronchoscopy under general anesthesia. Case: A 65-year-old male presented with a three-week history of coughing up white sputum without coughing up blood, fever, or shortness of breath. A month earlier, the patient was hospitalized for decreased consciousness and status epilepticus for nine days, and diagnosed with anemia, hypokalemia, and hypoalbuminemia. The patient reported losing one tooth during the treatment. On examination, oxygen saturation was 98%, and chest examination results were normal. A chest X-ray showed a dental-density foreign body in the right bronchus, which was confirmed by CT. The patient underwent a foreign body extraction procedure from the right bronchus using flexible bronchoscopy with forceps and basket tips. Conclusion: Elderly patients with tracheobronchial foreign bodies often present with multiple comorbidities, a long disease course, and are sometimes asymptomatic. The use of flexible bronchoscopy is effective and safe in removing foreign bodies from the bronchi.
Sarcoidosis is a multisystem, immune-mediated disorder of undetermined etiology, characterized by the formation of non-caseating granulomas. Pulmonary sarcoidosis exhibits highly variable clinical progression. Refractory pulmonary sarcoidosis (RPS), defined as disease unresponsive to standard first- and second-line therapies, remains poorly characterized. Evidence regarding the epidemiology, biomarkers, and prognostic indicators of RPS remains sparse, thereby underscoring a critical knowledge deficit. While the majority of existing studies focus on general pulmonary sarcoidosis, their findings can nonetheless yield valuable insights into refractory disease, in which chronic inflammation and therapeutic resistance pose formidable clinical challenges. Various etiological mechanisms are studied primarily in general sarcoidosis, but persistent inflammation and fibrosis are observed in RPS. Demographic factors influence general sarcoidosis and predispose to RPS. Smaller lung volumes, poor gas exchange, decreased walking distance, and oxygen desaturation aid the diagnosis of sarcoidosis, including RPS. Third-line treatment is indicated to treat RPS, with other options like lung transplantation. Refractory pulmonary sarcoidosis presents significant clinical challenges due to its complex etiology, variable progression, and treatment resistance, necessitating a deeper understanding of its risk factors, biomarkers, and therapeutic strategies. Addressing the knowledge gaps in this area is crucial for improving patient outcomes and guiding future research efforts.
Introduction: Endobronchial tuberculosis (EBTB) is an infection of Mycobacterium tuberculosis (MTB) in the tracheobronchial tree. This case report aimed to describe the diagnostic challenge of endobronchial TB mimicking lung malignancy and to emphasize the role of bronchoscopy in establishing the diagnosis. Case: A 28-year-old male complained of a dry cough and weight loss for 4 months and had a lump on the left side of his back and neck for 3 months. Lung palpation found decreased fremitus, dull percussion, and decreased vesicular breath sounds in the middle-left lung. Acid-fast bacilli (AFB) sputum was negative, and the finding of the lump from the fine needle aspiration biopsy (FNAB) was chronic inflammation. Chest X-ray (CXR) showed an irregular border and homogeneous opacity in the left middle lung field. Chest computed tomography (CT) suggested a lung mass with a perihilar-left peribronchial infiltrative solid lesion and enlarged subcarinal and peribronchial lymph nodes. Bronchoscopy revealed easily bleeding leukoplakia in the left upper lobe bronchus; forceps biopsy: nucleic acid amplification test (NAAT) MTB detected at very low levels, without rifampicin resistance. Malignant cells were not detected from brushing cytology and bronchoalveolar lavage (BAL). Finally, the patient was diagnosed with EBTB and received 6 months of anti-TB therapy. Conclusion: Bronchoscopy has a higher biopsy sensitivity than FNAB in diagnosing EBTB. The bronchoscopy results in this case indicated an active caseous type. Endobronchial TB therapy uses a standard anti-TB combination for 6-9 months, aiming to eradicate and prevent tracheobronchial stenosis. Hence, there needs to be early diagnosis. This patient showed clinical and radiological improvement after 6 months of therapy. In this case, bronchoscopy was significant for diagnosing EBTB.
Introduction: Chronic pulmonary aspergillosis (CPA) is a progressive, potentially life-threatening fungal infection of the lungs. Its management is complicated by comorbidities, chronicity, and diagnostic uncertainty. While antifungal therapy remains the cornerstone of treatment, surgical intervention is indicated in selected cases, especially those presenting with hemoptysis or suspicion of malignancy. Multidisciplinary evaluation and perioperative optimization are crucial, particularly in elderly or complex patients. Case: We described two patients with CPA who exhibited divergent clinical courses. Both were refractory to medical therapy and ultimately underwent surgical intervention. Thoracotomy revealed extensive necrotic cavities with high fungal burden, and histopathology confirmed chronic cavitary pulmonary aspergillosis. Debridement and postoperative antifungal therapy led to significant clinical improvement in both cases. These experiences highlight critical decision points in CPA management, including patient selection for surgery, intraoperative flexibility, and postoperative monitoring. Conclusion: Surgery remains an essential component of comprehensive CPA management, particularly when medical therapy fails or diagnostic uncertainty persists. Integrating surgical and pharmacological strategies through multidisciplinary collaboration ensures optimal outcomes, even in elderly or immunocompetent patients. Carefully timed and individualized surgical intervention provides both diagnostic confirmation and symptomatic relief in cases of advanced or refractory CPA.
The Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling cascade constitutes an intracellular communication framework that is responsive to cytokines and growth factors, whereas the mitogen-activated protein kinase (MAPK) pathway represents a signaling network activated by extrinsic stimuli such as stress, growth factors, or reactive oxygen species (ROS). This literature review synthesizes scholarly investigations into the roles of the JAK/STAT and MAPK signaling pathways in the progression of chronic obstructive pulmonary disease (COPD), with an emphasis on elucidating the molecular interactions and mechanisms that underlie deficiencies in understanding their contributions to inflammation, immune modulation, and tissue remodeling. The objectives of this review were to assess pathway activation patterns, characterize the molecular structures, and compare the therapeutic strategies. A systematic analysis of multidisciplinary studies employing in vitro, in vivo, clinical, and bioinformatics approaches was conducted. The findings revealed consistent activation of STAT3 and p38 MAPK isoforms by cigarette smoke and inflammatory stimuli, with complex crosstalk shaping macrophage polarization and cytokine production (interleukin-6/IL-6, tumor necrosis factor-α/TNF-α). Therapeutic interventions targeting JAK/STAT and MAPK signaling have the potential to reduce airway inflammation and remodeling, although clinical efficacy remains inconsistent due to corticosteroid resistance and activation of compensatory pathways. Pathway dysregulation correlates with accelerated COPD progression, particularly through epithelial-mesenchymal transition (EMT) and extracellular matrix deposition. Key challenges include balancing pathway modulation to preserve lung homeostasis while avoiding immunosuppressive effects. This analysis highlights the need for precision-targeting strategies to translate molecular insights into effective therapies, thereby providing a framework for future research on COPD pathogenesis and targeted network modulation.
Introduction: Smoking and other unhealthy behaviors, such as betel nut chewing, alcohol consumption, and vaping, are potential health problems in the eastern part of Indonesia. It is prevalent among young adolescents in Eastern Indonesia. Nevertheless, data regarding these are still rare, especially among rural Papua residents. This study aimed to examine health-impacting behaviors, such as smoking and betel nut chewing, among junior high school students in rural Sorong, West Papua, Indonesia. This study also evaluated the correlation between the adolescent’s knowledge about the dangers of smoking and smoking behavior. Methods: This study was conducted at a public junior high school in the Klamono District, rural Sorong, West Papua, Indonesia. All subjects completed the questionnaire using the Indonesian version of the Global Youth Tobacco Survey (GYTS). Results: The prevalence of cigarette smoking (29.7%), betel nut chewing (64.4%), alcohol drinking (14.4%), and vaping behavior (10.2%) among subjects was high. This study also showed a correlation between students’ knowledge about the dangers of smoking and smoking behavior. Conclusion: Cigarette smoking, betel nut chewing, alcohol drinking, and vaping were high among junior high school students in rural Sorong, West Papua, Indonesia, and could pose potential health problems in the future.
Lung cancer remains the leading cause of cancer-related mortality worldwide, with particularly high incidence in Asia, including Indonesia. The stage at diagnosis is a key determinant of prognosis. Therefore, early and accurate detection is essential to improve survival and quality of life. However, in regions with a high prevalence of infectious diseases such as tuberculosis (TB), diagnostic challenges persist due to overlapping radiographic features that may delay definitive diagnosis and treatment. Recent advancements in artificial intelligence (AI) have introduced promising tools to enhance diagnostic accuracy. Artificial intelligence models, especially those based on deep learning (DL) and convolutional neural networks (CNNs), can automatically detect and classify pulmonary nodules on chest X-rays and computed tomography (CT) scans with remarkable precision. By identifying subtle morphological changes that may be missed by human observers, AI significantly increases sensitivity and reduces interobserver variability. Beyond imaging, computational pathology enables AI to analyze histological slides and molecular profiles, providing faster and more consistent results while alleviating the workload of radiologists and pathologists. Despite these breakthroughs, however, clinical implementation of AI remains limited by data privacy concerns, cybersecurity issues, and the need for large, standardized datasets. Moreover, variations in algorithmic performance across imaging modalities highlight the need for external validation and reproducibility before integration into clinical workflows. This literature review explores the evolving role of AI in lung cancer diagnostics across imaging, pathology, and predictive analytics. Understanding these distinctions is crucial to realizing the full potential of AI in transforming diagnostic precision and improving clinical outcomes.
Introduction: Lung cancer remains the leading cause of cancer-related mortality worldwide, with most cases classified as non-small cell lung cancer (NSCLC). Genetic alterations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), Kirsten rat sarcoma viral oncogene homolog (KRAS), mesenchymal-epithelial transition (MET), and c-ros oncogene 1 (ROS1) play important roles in guiding targeted therapy strategies. This study aimed to evaluate ROS1 expression in patients with histopathologically confirmed NSCLC and to determine its association with histopathological grading and tumor subtype. Methods: This analytical observational study employed a cross-sectional design using 120 paraffin-embedded tissue samples obtained from NSCLC patients at several hospitals in Medan, Indonesia, between March 2024 and March 2025. Associations were analyzed using the Chi-square test, with p<0.05 considered statistically significant. Results: Adenocarcinoma was the predominant histopathological subtype, accounting for 75% of cases. Positive ROS1 expression was identified in 64.2% of patients. A significant association was observed between ROS1 expression and histopathological grading (p=0.048), whereas no significant association was found between ROS1 expression and histopathological subtype (p=0.742). Receiver operating characteristic (ROC) analysis demonstrated limited diagnostic performance of ROS1 expression, with an area under the curve (AUC) value of 0.451. Conclusion: The ROS1 expression was significantly associated with histopathological grading but showed no correlation with histopathological subtype in NSCLC patients. The ROS1 immunohistochemistry may serve as a practical screening tool in NSCLC, although its diagnostic performance remains limited.
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial infections, contributing to increased mortality, morbidity, and healthcare costs. Healthcare workers (HCWs) in intensive care units (ICUs) are at increased risk of MRSA colonization and may serve as vectors for transmission. Therefore, screening for MRSA carriage is essential for the prevention and control of MRSA infections. This study aimed to determine the prevalence of MRSA colonization and identify associated factors among ICU HCWs. Methods: A cross-sectional study was conducted at Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia, in June 2023. The MRSA detection was performed by polymerase chain reaction (PCR) using Xpert® MRSA NxG, with samples collected from nasal swabs. Bivariate analysis was performed to assess risk factors associated with MRSA colonization. Results: Of the 150 participants, 4% of HCWs were colonized with MRSA. Nurses (4.2%) showed a higher prevalence than doctors (3.1%). A higher prevalence of MRSA colonization was also observed in one of the ICU units (ICU Madya), with 4 out of 22 respondents (18.2%) testing positive. No risk factors were significantly associated with MRSA colonization (p>0.05), but males showed a relatively high odds ratio/OR (p=0.182, OR 3). Conclusion: A low prevalence of MRSA colonization was observed among all ICU HCWs. However, a higher prevalence was noted among staff in one of the ICU units. No significant associations were identified between potential risk factors and MRSA colonization. Nurses and male HCWs demonstrated a higher risk of MRSA colonization.
Introduction: The prevalence of asthma increases annually. In addition to pharmacological therapy, asthma management can also be achieved through non-pharmacological therapies, including physical activity such as jogging or exercise. Exercise for asthma is beneficial for strengthening respiratory muscles and improving lung function, which can be assessed by measuring peak expiratory flow (PEF) with a peak flow meter. This study aimed to determine the effect of asthma exercise on PEF in patients with asthma. Methods: This study employed a quasi-experimental pretest-posttest control group design. A convenience sampling technique was used to select 60 individuals, who were divided into two groups: an intervention group (n=30) and a control group (n=30). The intervention group performed asthma exercise, whereas the control group received no treatment. Peak expiratory flow was measured using a peak flow meter before and after the intervention. Results: A significant difference in mean PEF values was observed between the intervention and control groups. The mean increase in PEF was higher in the intervention group than in the control group (p<0.05). Conclusion: Asthma exercises significantly increased PEF in patients with asthma. Therefore, asthma exercises can be recommended as a non-pharmacological therapy to aid asthma management.
Introduction: Mouth breathing is one of the earliest manifestations of obstructive sleep apnea (OSA). Despite the availability of validated screening tools for early detection, their use remains limited in Bandung, Indonesia. This study examined the use of the mouth breathing in the daytime-mouth breathing during sleep (MBD-MBS) questionnaire to identify mouth-breathing patterns and quantify OSA risk among children in Bandung, Indonesia. Methods: This cross-sectional study included 400 children in Bandung, Indonesia. Ethical approval was obtained before data collection. Based on responses to the MBD-MBS and Pediatric Sleep Questionnaire (PSQ), children were classified as complete nose breathers (CNB), complete mouth breathers (CMB), or partial mouth breathers (PMB). The prevalence of OSA and mouth-breathing patterns, and their associations, were analyzed. Results: Complete mouth breathers was the most prevalent mouth-breathing pattern (40.75%), particularly among children aged 6-9 years old. Moreover, OSA was more common in mouth breathers (CMB: 55.21%; PMB: 71.84%) than nose breathers (5.97%), with PMB showing the strongest association (71.8% screening positive). Conclusion: Using the MDB-MBS questionnaire, mouth breathing was identified as a strong predictor of OSA in children, supporting its utility as a practical and effective tool for early screening.
Introduction: Chronic obstructive pulmonary disease (COPD) is a major global health problem and remains one of the three leading causes of death worldwide. In addition to respiratory impairment, COPD is often associated with systemic inflammation that contributes to metabolic disorders such as hypertension, diabetes mellitus (DM), dyslipidemia, and obesity. However, data on the prevalence of these comorbidities in Indonesia remain limited. This study aimed to determine the prevalence of metabolic disorders among COPD patients at Universitas Airlangga Hospital in Surabaya, Indonesia. Methods: This retrospective descriptive study reviewed the medical records of COPD patients with metabolic disorders treated at Universitas Airlangga Hospital, Surabaya, Indonesia, from January to December 2024. Thirty-two patients aged >40 years old with complete data were included. Variables assessed included age, gender, smoking history, the Brinkman Index, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, the Modified Medical Research Council (mMRC) Dyspnea Scale, and components of metabolic disorders. Patients with incomplete medical records were excluded. The findings were summarized in tables and figures. Results: All patients were male (100%), with a mean age of 61.7±7.07 years old; the majority were 61-70 years old (56.25%). A history of smoking was present in 84.38% of patients, predominantly with a moderate Brinkman Index. The GOLD stage 2 (40.63%) and mMRC grade 0 (56.25%) were the most common. Metabolic disorders were highly prevalent, including: hypertension (81.26%), obesity (50.0%), dyslipidemia (37.50%), and DM (28.13%). Most patients had multiple overlapping disorders. Conclusion: Metabolic disorders were highly prevalent among COPD patients, with hypertension being the most common. Multiple coexisting metabolic disorders were more frequent than single conditions.
Introduction: Waste landfill workers are frequently exposed to air pollutants, bioaerosols, and heavy metals, which may induce oxidative stress. Biomarkers such as isoprostanes and glutathione can be used to assess oxidative stress and antioxidant responses associated with landfill exposure. Methods: This cross-sectional study included 68 landfill workers, categorized by exposure duration into <5 years, 5-10 years, and >10 years. Isoprostane and glutathione levels were measured using an enzyme-linked immunosorbent assay (ELISA) test. A one-way analysis of variance (ANOVA) and Spearman’s correlation were used to compare biomarker levels across exposure groups and assess the relationship between biomarker levels and exposure groups. Results: Landfill workers averaged 596.01 pg/mL isoprostane. This figure is higher than the normal range of 35±6 pg/mL. The average serum glutathione level was also higher than the normal range (16.44±3.85 ng/mL). Meanwhile, the participants’ average serum glutathione level was 45.96 ng/mL. Compared to those exposed for <5 years (533.09 pg/mL), workers exposed for >10 years had higher isoprostane levels (643.94 pg/mL) (p=0.001). Thus, there was a positive correlation between exposure duration and isoprostane (r=0.331, p=0.006). Similarly, glutathione levels were higher in workers with >10 years of exposure (49.00 ng/mL) than in those with <5 years of exposure (41.20 ng/mL) (p=0.026) and showed a positive correlation (r=0.322, p=0.007). Conclusion: Long-term exposure to landfills is associated with higher serum levels of isoprostane and glutathione. It increases the risk of oxidative stress and adaptive antioxidant responses.
Introduction: Tuberculous lymphadenopathy (TBLN) is challenging to both diagnose and treat. The outcome of a complete course of anti-tuberculosis (TB) drugs (ATDs) is evaluated based on clinical presentation and symptom improvement. Many clinicians administer ATDs for more than 6 months when they find residual lymphadenopathy or a paradoxical reaction. Therefore, this study assessed whether serum adenosine deaminase (ADA) levels are a suitable marker for evaluating the response to TBLN treatment and for analyzing changes in serum ADA levels from before to after 6 months of treatment with the standard ATD regimen in patients with TBLN. Methods: This prospective analytic observational study enrolled ATD-naïve patients with TBLN who received the standard 6-month ATD regimen in the TB directly observed therapy outpatient wards at Dr. Soetomo General Academic Hospital and Universitas Airlangga Hospital, Surabaya, from May 2023 to June 2024. Serum ADA levels were determined before and after treatment and compared using the Wilcoxon signed-rank test. Results: This study enrolled 22 patients, mostly female (n=14, 63.6%), with a mean age of 29.55±8.92 years old. The median serum ADA level was 18.7 (12.5-42.5) IU/L before and 13.9 (9.6-27.1) IU/L after treatment, with a significant mean decrease of -4.55 IU/L (p=0.001). Conclusion: Treatment with the standard 6-month ATD regimen decreased serum ADA levels in patients with TBLD. Therefore, serum ADA levels can be used as a follow-up test after treatment for patients with TBLN to evaluate their response to anti-TB therapy.
Introduction: Tuberculosis (TB) is a long-term infectious disease caused by Mycobacterium tuberculosis (MTB). It can occur during pregnancy, in which its treatment can cause side effects, such as drug-induced liver injury (DILI). Tuberculous aneurysm due to TB infection is a rare occurrence, which can spread directly and hematogenously from the vascular wall. We report a case of bilateral multiple lower limb tuberculous aneurysms in a pregnant woman with DILI due to TB treatment. Case: A 27-year-old pregnant woman at 14-15 weeks of gestation presented with painless lumps on the left side of her neck and both ankles. Fine needle aspiration biopsy (FNAB) of the left cervical lymph nodes confirmed tuberculous lymphadenitis. Vascular Doppler ultrasound of both lower limbs revealed multiple aneurysms, suspected to be infected tuberculous aneurysms with intramural thrombi, located on the lateral and anterior aspects of the distal leg extending to the left ankle, compressing the distal posterior and anterior tibial arteries. After one month of category one anti-TB drug (ATD) therapy, the patient developed elevated bilirubin levels (3.76 mg/dL). Following surgical intervention, the anti-TB regimen was resumed, leading to the resolution of the pseudoaneurysms by the fifth month of treatment. Conclusion: Tuberculous aneurysm in pregnant patients with TB is a rare and potentially life-threatening condition. It is difficult to diagnose, but TB infection should be considered a possible cause in endemic countries. Surgery combined with anti-TB treatment improves outcomes.
Introduction: Acinetobacter baumannii is a nosocomial pathogen with high mortality rates in intensive care units (ICUs) and is commonly associated with ventilator-associated pneumonia (VAP). Due to declines in physiological and immune functions, A. baumannii can trigger septic shock complications, thereby increasing mortality risk. This study aimed to identify the risk factors associated with outcomes in VAP patients in the ICU of Dr. Moewardi General Hospital, Surakarta. Methods: This retrospective cohort study was conducted at Dr. Moewardi General Hospital, Surakarta, using patient medical records. Data were analyzed with Chi-square and Mann-Whitney U tests, followed by multiple logistic and linear regression to determine correlations between risk factors and outcomes (recovery, mortality, length of stay/LOS). Results: This study included 80 patients with VAP caused by A. baumannii. Most patients were under 60 years old (52.5%), had good nutritional status (75%), were on ventilators for less than 10 days (63.75%), and had mild comorbidities (51.25%). Moderate-severe comorbidities (p=0.001) and malnutrition (p=0.005) were significantly associated with increased mortality. In addition, ventilator use ≥10 days was significantly associated with LOS (p<0.001). Conclusion: Moderate-severe comorbidities and malnutrition were risk factors for mortality in patients with A. baumannii-related VAP, while ventilator use ≥10 days was a risk factor for prolonged hospitalization. Identifying these factors can help medical personnel manage conditions that worsen VAP outcomes and reduce the risk of A. baumannii-related mortality.
Introduction: Tuberculosis (TB) is a disease with a significant treatment burden. Current multidrug-resistant (MDR)-TB therapy uses the bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaL/M) combination. This combination is effective with a short treatment duration. Linezolid is one of the components of the BPaL/M regimen. However, despite its effectiveness, it has side effects that impact treatment management and success. This study aimed to find the association between characteristics and comorbidities with the incidence of linezolid side effects in patients with MDR-TB treated with the BPaL/M regimen. Methods: This was a retrospective analytic study of MDR-TB patients receiving BPaL/M combination. Data were collected from medical records and analyzed using Fisher's exact test to analyze the association between patient characteristics and comorbidities with the incidence of linezolid side effects, namely hematological disorders, peripheral neuropathy, and visual disturbances. Results: There was no significant association between overall patient characteristics and the incidence of linezolid adverse events. However, the results of bivariate analysis showed a significant association in age >50 years old with the incidence of hematological disorders, as well as in patients who have diabetes mellitus (DM) with the incidence of peripheral neuropathy as a side effect of linezolid. Conclusion: Monitoring of MDR-TB patients aged >50 years old and those with DM to minimize the incidence of side effects during treatment is essential. This effort is expected to support the success of the national TB control and treatment program.
Introduction: Distinguishing between malignant and non-malignant pleural effusions is often challenging due to overlapping biochemical profiles. Conventional diagnostic methods, including cytology and biopsy, are limited by their invasive nature, high costs, and potential complications. Emerging biomarkers, such as tissue inhibitor of metalloproteinase-1 (TIMP-1) and pleural fluid glucose levels, show promise as alternative diagnostic tools, but their clinical utility requires further validation. This study investigated the diagnostic value of TIMP-1 and pleural fluid glucose levels in differentiating malignant from non-malignant pleural effusions and explored their correlation in malignant cases. Methods: This cross-sectional analytical study included patients with exudative pleural effusion, categorized as malignant or non-malignant based on cytology and/or biopsy results. Biomarker levels of TIMP-1 and pleural fluid glucose were measured using enzyme-linked immunosorbent assay (ELISA) and biochemical analysis. Diagnostic thresholds for both biomarkers were determined using receiver operating characteristic (ROC) curve analysis. Results: Among 88 patients studied (33 malignant, 55 non-malignant), pleural fluid glucose levels were significantly lower in malignant cases (55.97 vs. 93.71 mg/dL; p=0.001), while TIMP-1 levels were notably higher (13.88 vs. 13.34 pg/mL; p<0.001). Tissue inhibitor of metalloproteinase-1 demonstrated superior diagnostic accuracy (86.5%) compared to glucose (70.6%) and the combined biomarker model (76.5%), with the sensitivity and specificity of 84.8% and 83.6%, respectively. Conclusion: Elevated TIMP-1 levels and reduced pleural fluid glucose levels are promising diagnostic biomarkers for malignant pleural effusion (MPE). Tissue inhibitor of metalloproteinase-1 exhibited the highest diagnostic accuracy, highlighting its potential as a non-invasive diagnostic tool in clinical practice.
Electronic cigarettes (e-cigarettes) are electronic tools designed to produce an inhalable aerosol from a liquid solution. Electronic cigarette or vaping use-associated lung injury (EVALI) describes any lung damage linked to the consumption of e-cigarettes or vaping products. The liquids and aerosols from e-cigarettes can include tobacco-related nitrosamines, aldehydes, metals, volatile organic compounds, phenolic compounds, polycyclic aromatic hydrocarbons, tobacco alkaloids from tobacco, flavor additives, and various medicinal compounds. Substantial evidence indicates that substances like propylene glycol, vitamin E acetate (VEA), and heavy metals such as lead and arsenic are significant constituents of e-cigarettes, contributing to lung harm. Patients with EVALI may present with sudden or gradually developing respiratory disease, presenting with non-specific signs, including breathlessness, coughing, chest discomfort, and sometimes coughing up blood. Radiological findings in EVALI are often non-specific. The most commonly observed pattern in EVALI is parenchymal organizing pneumonia (OP), identified in 56% of cases, whereby bilateral dominant ground-glass opacity (GGO) was identified, located in the inferior sections of the lungs or diffusely distributed with varying degrees of consolidation.
Introduction: Pneumothorax is characterized by the presence of air in the pleural cavity, which can result from various pulmonary conditions, including tuberculosis (TB). Conservative management, including the use of chest tubes with ambulatory water-sealed drainage (WSD), offers a viable alternative for patients who are ineligible for surgery or decline surgical intervention. This case report aimed to highlight that all treatment options should be discussed with the patient to determine their primary priority, with consideration for the least invasive option. Case: A 22-year-old woman with secondary spontaneous pneumothorax due to TB presented with shortness of breath following a cough and was found to have a >2cm lucent area on chest X-ray. Initial management included chest tube insertion and WSD. A persistent pneumothorax was identified after 13 days of admission, and surgery was advised, but the patient declined. Conservative management was continued with ambulatory drainage for a total of 34 days, and management of TB as an underlying disease, and adequate nutritional support. Over the course of a month, clinical symptoms improved, and subsequent evaluations confirmed resolution of the pneumothorax. The chest tube was removed. The patient completed 12 months of anti-TB therapy, was declared cured, and experienced no recurrence of pneumothorax. Conservative management, including ambulatory WSD, effectively manages persistent air leak (PAL) for patients unsuitable for surgery. Ambulatory WSD facilitates mobility, reduces hospital stay, and minimizes complications. Proper patient education, nutritional support, and management of underlying conditions are essential for favorable outcomes. Conclusion: The management of persistent pneumothorax should be guided by the patient’s clinical condition. Conservative management can yield favorable results, followed by best supportive management.
