#Journal of Pulmonary & Respiratory

[juniperpublishersijoprs-blog]

Happy Easter

[covid-safer-hotties]

Almost 10% of US lung transplants go to COVID-19 patients. Researchers are learning why - Published Aug 21, 2024

Researchers from Michigan State University and Corewell Health, in collaboration with the Cleveland Clinic, have made a significant breakthrough in understanding post-COVID-19 lung complications.

The study, by Xiaopeng Li of MSU, Reda Girgis of Corewell Health and Kun Li of Cleveland Clinic's Florida Research and Innovation Center, was published in the American Journal of Respiratory Cell and Molecular Biology and highlights the role of a gene called ATP12A in promoting lung damage and excessive mucus production following COVID-19 infection.

COVID-19 infection activates this gene in the lungs, initiating progressive lung scarring that can eventually require a lung transplant. The collaboration investigated the biology behind climbing lung transplant rates among patients with post-COVID pulmonary fibrosis. Almost 10% of all lung transplants in the United States now go to COVID-19 patients, according to data from the United Network for Organ Sharing, or UNOS.

"Understanding how and why some individuals develop severe lifelong complications is critical to developing more effective post-COVID lung damage treatment," said Xiaopeng Li, associate professor in the MSU College of Human Medicine's Department of Pediatrics and Human Development.

Collaborating with Kun Li, Xiaopeng Li investigated ATP12A expression in lung samples from individuals undergoing lung transplantation. Clinical samples provided by Reda Girgis, medical director of Corewell Health's lung transplant program and a professor at MSU, confirmed elevated ATP12A levels in individuals with post-COVID-19 pulmonary fibrosis, akin to fibrosis unrelated to COVID-19.

"At Cleveland Clinic, we confirmed COVID-19 infection directly caused ATP12A levels to increase and contributed to pulmonary fibrosis," noted Kun Li.

This discovery lays the groundwork for potential therapeutic interventions, aiming to benefit all pulmonary fibrosis patients, irrespective of their condition's origin. The next step for the researchers is to unravel how infection elevates ATP12A levels and its contribution to pulmonary fibrosis, paving the way for improved treatments in the future.

Find the (paywalled) study at either link!

[darkmaga-returns]

By Nicolas Hulscher, MPH

Last week, the study titled Effects of Microplastic Exposure on Human Digestive, Reproductive, and Respiratory Health: A Rapid Systematic Review by Chartres et al was published in the journal Environmental Science and Technology:

Microplastics are ubiquitous environmental contaminants for which there are documented human exposures, but there is a paucity of research evaluating their impacts on human health. We conducted a rapid systematic review using the “Navigation Guide” systematic review method. We searched four databases in July 2022 and April 2024 with no restriction on the date. We included studies using predefined eligibility criteria that quantitatively examined the association of microplastic exposure with any health outcomes. We amended the eligibility criteria after screening studies and prioritized digestive, reproductive, and respiratory outcomes for further evaluation. We included three human observational studies examining reproductive (n= 2) and respiratory (n = 1) outcomes and 28 animal studies examining reproductive (n = 11), respiratory (n = 7), and digestive (n = 10) outcomes. For reproductive outcomes (sperm quality) and digestive outcomes (immunosuppresion) we rated overall body evidence as “high” quality and concluded microplastic exposure is “suspected” to adversely impact them. For reproductive outcomes (female follicles and reproductive hormones), digestive outcomes (gross or microanatomic colon/small intestine effects, alters cell proliferation and cell death, and chronic inflammation), and respiratory outcomes (pulmonary function, lung injury, chronic inflammation, and oxidative stress) we rated the overall body of evidence as “moderate” quality and concluded microplastic exposure is “suspected” to adversely impact them. We concluded that exposure to microplastics is “unclassifiable” for birth outcomes and gestational age in humans on the basis of the “low” and “very low” quality of the evidence. We concluded that microplastics are “suspected” to harm human reproductive, digestive, and respiratory health, with a suggested link to colon and lung cancer. Future research on microplastics should investigate additional health outcomes impacted by microplastic exposure and identify strategies to reduce exposure.

[killed-by-choice]

“Marjorie Roe” 32 (USA ~1972)

“Marjorie” was a 32-year-old white woman admitted to a hospital to have her gallbladder out. Other than the fairly recent issues that led to doctors deciding to remove it, she had “no previous significant illnesses except for two abortions” that she had traveled to another state to undergo. (These legal induced abortions had, interestingly, been noted by doctors under the “significant illness” category.) The second abortion had been only a few weeks before Marjorie came to the hospital.

When the hospital performed a pre-op examination, Marjorie appeared to be healthy enough to undergo surgery. What the doctors didn’t realize was how strongly her recent abortion would affect her post-operative outcome.

The gallbladder (and to a lesser extent, the appendix) were confirmed to have been diseased upon removal. Marjorie began to recover and it seemed that she would be fine, but then a latent side effect of the recent abortion began to manifest. When she tried to walk, she went into respiratory distress and quickly became unresponsive. CPR failed and she died two days after what should have been a fairly uneventful surgery.

Marjorie’s autopsy, performed two hours after her death, finally revealed what was happening even before being admitted to the hospital. Her left thigh was mottled and unusually enlarged. A branched, firm clot impacted in her pulmonary conus had distended the right atrium and ventricle of her heart. The clot was analyzed and found to be a thromboembolus. She had been killed by a post-abortion pulmonary embolism. It was concluded that an occult venous thrombus had been formed before the gallbladder removal (with her recent abortion as a significant contributing factor and likely cause), which was then dislodged from her left leg and blocked the pulmonary conus.

In addition to the embolism itself, Marjorie had slight serosanguineous peritoneal effusions, congestion of the lungs and pulmonary edema. Her left ovary contained a hemorrhagic corpus luteum.

The doctors who submitted Marjorie’s case to a medical journal wrote that “The current increase in abortions necessitates specifie inquiry and careful examination in young women and probably should indicate delay of all except emergency surgery for a period of at least six months.”

[bluecoolr]

Cheryl Eddington

A/N: I got lazy and decided to just dump all the info I have on baby girl.

Birth name: Cheryl Catacutan

Cheryl from French “cherie”, meaning “beloved”

Catacutan, Hispanicized from Filipino “katakutan”, meaning “fear (verb)”.

Adoptive surname Eddington, inspired by British astrophysicist Arthur Eddington, who posited the concept of the arrow of time. Eddington proposed that entropy - the state of disorder, randomness, and uncertainty - increased with time.

Nicknames: Silver Cheryl, Butcher of Blythe

Birthday: November 1st (Age 17)

Residence:

[Formerly] Port Allenham

US Territory

Burnt lime/Quicklime District - people hauled limestone from the bay and crushed them up for calcium oxide production

Majority of the city burnt down after a series of large scale lime kilns exploded.

Cheryl suffered severe respiratory trauma from the fire and calcium oxide in the atmosphere. She got a pulmonary edema that had to be drained. Ever since, she's had chronic respiratory problems and periodically uses a nebulizer.

Her parents died in the fire.

Blythe, New York

Carthage School, Connecticut

Former all-boys private preparatory school, slowly transitioning into a co-ed setup.

Elias Cross Reform School, New York

Detention center for juvenile violators of federal law, serves mostly as a holding point until they're old enough to be transferred to prison.

Physical Appearance

Height: 5 feet 7 in

Weight: 58 kg

Hair color: Dark brown

Eye color: Dark brown

Skin color: Fair

Distinguishing characteristics: large, wide nose, choppy hair

Hobbies & Interests

Journaling

Research and experimentation

Equestrian sports

Horror games

Likes:

Checklists

Checking items off lists

Start of term

Writing essays

Explosives

Industrial chemistry

Dislikes:

Skirts

Crowded communal showers

Boring hunter courses

Her adoptive parents

Ambitions:

USMC Sabotage and Demolition Expert

Petroleum Engineer on an offshore oil rig

Trivia:

Really doesn’t like animals that much. Is okay with her horse, Agamemnon, because she treats him like a person.

Social smoker.

Literally only adopted to fill in the spot of her deceased cousin. Esentially lives two lives. One as the shining multi-talented heiress and just plain old Cheryl, who lives in a dusty garrett room.

[jcsmicasereports]

Successful Jatene procedure for great arteries transposition correction in newborn with SARSCoV-2 infection by Guillermo Careaga-Reyna MD in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Pandemic of COVID-19 represents a challenge for treatment of patients with congenital herat disease. We present a newborn with great vessels transposition and positive SARS-CoV-2 PCR test. The patient was submitted to a successful surgical treatment with corrective Jatene procedure, requiring opened chest wall during 72 h of postoperative period and 43 days of total in-hospital lenght of stay.

KEY-WORDS: COVID-19, SARS-CoV-2, great vessel transposition, Jatene procedure, congenital heart disease.

Introduction

Coronaviruses are single stranded ribonucleic acid viruses with a diameter of 60–140 nm and a high rate of genetic mutations and recombinations, rendering them capable of escaping from the immune system and causing novel infections (1). In less than six months, the coronavirus disease 2019 (COVID-19) pandemic has swiftly spread from one city in China to over 190 countries worldwide (2-4). Neonatal infections with SARS-CoV-2 have been described although robust data on vertical transmission are lacking. In most instances where neonatal infection has been reported, close contact with infected mother or caregiver is postulated to have occurred (4).

In newborns, the case is regarded as positive for infection if any of the following conditions occurs, (1): positive PCR for SARS-CoV-2 in respiratory tract or blood samples, high homology of viral gene sequences of the samples from the respiratory tract or blood to the COVID-19 sequence.

We present a case of a newborn with great vessel transposition and SARS-CoV-2 infection.

Case Report

We present a new born with great arteries transposition associated to aquired SARS-COV-2 infection.

The patient was refrerred to our hospital, with a positive SARS-CoV-2 test, with mechanical ventilatory support in order to confirm a complex congenital heart disease.

The diagnosis was established via echocardiographic evaluation which showed normal venous return, concordance atrio-ventricular and ventriculo-arterial discordance. It was concluded: great arteries transposition, patent ductus arteriosus and permeability of foramen oval.

The patient was recovered from a septic shock with no evidence of systemic inflammatory response requires inotropic support and after stabilization in neonatal intensive care unit, at 10 day in-hospital stay,  was submitted to an open heart surgery consisted in anatomic correction with Jatene procedure. The aortic cross-clamping time was 119 min, with cardiopulmonary bypass (CPB) of 181 min. It was decided to maintain in postoperative period opened chest wall, and after 72 the chest wall closure was succesfully realized with favorable posoperative evolution. After 32 days of postoperative, the patient was discharged from hospital. Actually, two years after surgery, the patient is doing well, only with mild pulmonary stenosis without hemodinamic or clinical repercusion.

Discussion

For infants born to COVID positive mothers should be reasonable to separate him from the mother if will need cardiac surgery to try avoid post-natal infection.

In fact, there is minimal evidence of placental vertical transmisión. In this case, the patient has a positive test for SARS-CoV-2 infection and evolved with septic shock in the preoperative period.

It may also be reasonable to do serial testing on the infant, but there is no consensus on the correct timing surgery should be scheduled with advice from a multidisciplinary team of experts including cardiac medical, cardiac surgical, and infectious diseases as indicated. After evaluation of the clinical conditions for a heart team in our hospital, it was decided to realize the surgical procedure in order to avoid progression of heart damage and irreversible heart failure.

However we must remember that, if prudent, surgery should be delayed until the patient’s symptoms have improved and/or testing has been repeated (often after 14 days) and is negative (5).

On the other side, in older patients the inflammatory response due to SARS-CoV-2 infection has been a frequent complication.

In our patient, probably due to the age, it was no presented even with the septic shock o posteriorly associated to the use of CPB during the surgical procedure

It was concluded taht COVID-19 may affect all age patients. However with cautious evaluation and treatment of associated disease as in our case, the patient improves survival, despite severity of viral illness, and during this pandemic period, patients with active COVID-19, at neonatal period we have no treated any other.

[109moons]

Here are my days.

5:30am: Lab comes to take blood. All of my bird veins are black, blue, mustard, indigo. If I am still sedated enough, I cry without realizing tears are rolling down my face. The exhaustion is too much to bother acknowledging crying.

7am: Shift change. My night nurse updates daytime of how low my oxygen is and to be careful with my blood pressure. She reminds them that I need plasma at an incredibly specific time to try to influence my INR numbers for the day. Adriana says goodbye for the morning and says she hopes she doesn’t see me later, but we both know I will still be here.

7:30am: Meds. Magnesium drip. Platelets. Potassium. Steroids. Anxiety medication. Muscle relaxers. Blood pressure medication. Nausea medication for the blood pressure medication. Iodine up the nose. Propanol shot down the hatch.

8:30am-ish: Breakfast. Eggs taste like plastic and I cannot have salt. My eyes are dry from my oxygen cannula blowing up in my face.

8:35am then every 15 minutes: Random person from respiratory pops their head in and encourages me to take deep breaths. I contemplate creative forms of murder. My liver hurts. I force myself to pee in a bed pan and act like my kidneys are not shriveled and my back feels like a vacuum trying to strain to urinate.

8:40am: I really do not want dialysis.

9am: Rounds. Pulmonary wants a chest tube. Respiratory wants me to “just breathe”. Hepatology is here and avoiding giving answers about my transplant. My Mom is crying. I am stoic. Nephrology gives themselves more gray hairs and stresses out over my kidneys. Cardiology says things about “shunts” and bubble tests.

I just think about inhaling and exhaling and how badly it hurts with one lung.

10am-ish: Internal medicine comes by and apologizes profusely for the disagreement between teams and why I have not been given a chest tube yet. I usually cry again here. This is the definition of being in between a rock and a hard place, but I’m circling the drain between these places.

11am: Probably lunch. Probably also gross. Probably fighting with my Mom and regretting asking for her support. I would rather be alone.

Twilight zone: This is usually the hours between doctors where I let my respiration get really low and rest. I sip on my protein shake. I nest with my squishmallows and blankets. I journal. I think about the man I truly loved and how when I die, if I die, I have to be sure to not take it to my grave how I feel. The bed feels warmer, pretending he’s here under my fall blankets and surrounded with flowers and creature comforts.

People visit after this usually. I laugh until I can’t because it hurts too badly. I feel self conscious in my pajamas with my dirty hair. I feel like I have to entertain, even though I don’t. I insist it does not make me tired, but it does - but it makes me happy.

5pm: Labs. Time to find another vein to stab. Usually a chest X-ray here too. It feels great laying on a hard board for an X-ray everyday on a ribcage that has been punctured five times in ten days. But please, I know your ribs hurt so bad. Meds. More diuretics. Have to pee every ten minutes. Hope visitors are not here, because I feel less than human peeing in a bed pan with friends here.

Somewhere through the rest of the night, my Mother will decide to remind me that I deserve to be dying. That I am ungrateful, or unappreciative, or I removed the joy from her life. I am humbled and reminded of how small I am. My nurse usually kicks her out then and brings me a cup of vanilla and chocolate ice cream, because who wants to pick?

I’ll slowly chew up my grisly dinner, take my sleeping medication, and get ready for my oxygen to plummet overnight. The bed is exploding with comforts and I know if I go in my sleep, I will be as soft as I was coming in to this world.

Then it will be September 25th, 2023, and I’ll do it all again.

[ayushyaa]

Acupuncture for Lungs: Improving Respiratory Health Naturally

Acupuncture is an ancient Chinese practice that has been used to treat various ailments for thousands of years. One of the many benefits of acupuncture is its ability to improve lung function and treat respiratory disorders. Acupuncture can be a valuable addition to conventional treatments for respiratory issues such as asthma, chronic obstructive pulmonary disease (COPD), and bronchitis.

According to traditional Chinese medicine, the lungs are associated with the metal element, and they govern the body's qi or energy flow. When the lungs are functioning properly, they are responsible for bringing in oxygen and expelling carbon dioxide. However, when lung function is compromised, it can lead to respiratory difficulties.

Acupuncture stimulates specific points on the body to improve the flow of energy and promote healing. In the case of respiratory issues, acupuncture can help to open up the airways, reduce inflammation, and improve lung function. It can also help to strengthen the immune system, which can be beneficial for people with chronic respiratory conditions.

Research has shown that acupuncture can be an effective treatment for asthma, COPD, and bronchitis. A study published in the Journal of Alternative and Complementary Medicine found that acupuncture was effective in reducing symptoms of asthma and improving lung function. Another study published in the International Journal of Chronic Obstructive Pulmonary Disease found that acupuncture improved lung function and quality of life in people with COPD.

Here are some key points to consider:

Acupuncture can help open up airways and improve lung function by stimulating specific points on the body.

Studies have shown that acupuncture can be effective in reducing symptoms and improving lung function in people with respiratory conditions such as asthma, COPD, and bronchitis.

Acupuncture can also help reduce inflammation and strengthen the immune system, which can be especially helpful for people with chronic respiratory conditions.

Acupuncture is a safe and non-invasive treatment that can be used alongside other therapies for better respiratory health.

It is important to work with a licensed acupuncturist who can provide personalised treatment based on your specific needs and symptoms.

 Overall, acupuncture can be a valuable addition to a treatment plan for respiratory conditions. If you are interested in exploring acupuncture for your lung health, be sure to seek out a qualified practitioner who can help you find the right approach for your needs.

[myrawjcsmicasereports]

 Clinical Case Reports – 1970 by P. Syamasundar Rao in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

In this paper five case reports were presented and include congenital pulmonary cyst, Wilson-Mikity syndrome, diaphragmatic eventration; foreign body in the bronchus, and cor pulmonale that developed after implantation of a ventriculo-atrial shunt with a Pudenz-Heyer valve for treatment of hydrocephalus. For each case report, clinical, chest x-ray, electrocardiogram and other pertinent findings were presented. This was followed by discussion of etiology, diagnosis, and treatment options, as appropriate.

Keywords: congenital pulmonary cyst; diaphragmatic eventration; Wilson-Mikity syndrome; foreign body in the bronchus; cor pulmonale

Introduction

During the academic clinical practice for over five decades, the author had the unique opportunity to observe and document many interesting clinical case scenarios. The purpose of this review is to revisit these interesting cases. Because of the voluminous amount of this material, the material may be divided into a five-part series. Each of these case reports, while rare and important clinical observations, do demonstrate a clinical point that is useful to the pediatricians, pediatric cardiologists and/or other physicians.

Congenital Pulmonary Cyst

Case Report

A female infant with a birth weight of  6 lb 7 oz, born after a full-term, normal pregnancy and delivery with an Apgar score of 9 presented at three weeks of age with a two-week history of tachypnea. There were no other symptoms and the infant’s physical examination was normal except for tachypnea (respiratory rate of 50 per minute) and mild inter-costal and sub costal retractions. A chest roentgenogram was obtained (Figure 1) which was interpreted as pulmonary cyst. The heart was pushed to the right by the cyst (dextroposition of the heart). At thoracotomy, a huge lung cyst, involving the lower lobe of the left lung, was found, and was resected and the patient made an uneventful recovery.

Chest x-ray in posterio-anterior (A) and lateral (B) views demonstrating a large pulmonary cyst, marked with arrows. Note that the heart is pushed to the right, dextroposition of the heart. Reproduced from Rao PS. Amer J Dis Child 1970; 119:341-2.

Discussion

Congenital pulmonary cysts in the neonate are uncommon and are considered as errors in embryological development. They are of several categories namely, bronchogenic cell, alveolar cell, and combined cell types, based on the cellular component of the cell wall of the cyst. The symptoms depend largely upon the size of the cyst. These patients may not be discovered until a chest x-ray is performed for other reasons or may present with symptoms of tachypnea, dyspnea, and cyanosis in the neonatal period secondary to compression of lung tissue. The findings depend upon the size and location of the cyst. Dextroposition of the heart or tracheal shift and hyper-resonance, diminished breath sounds, and rales may be detected on physical examination. The chest x-ray findings may demonstrate a cyst, as in our case (Figure 1) or may be misinterpreted as pneumothorax. Other conditions simulating the cyst are staphylococcal pneumonia, diaphragmatic hernia, congenital lobar emphysema, sequestrated lobe, and hydro-pneumothorax or pyo-pneumothorax. In symptomatic cases, cystectomy, segmentectomy, lobectomy, or pneumonectomy, depending upon the size and location of the cyst is suggested. Percutaneous aspiration of the cyst is not recommended except as an emergency measure to relieve the tension. Some authorities advocate no surgical intervention because of the possibility of spontaneous regression of the pulmonary cysts, but most authorities recommend surgical excision of the cysts [1].

Late Respiratory Distress in a Premature Infant

Case Report

A premature male infant was born at 25 weeks of gestation and weighed 2 lb 12 oz at birth. Abruptio placenta and prolapse of the umbilical cord complicated the delivery and required resuscitation with oxygen. The chest x-ray was normal at that time. The baby was placed in an incubator in 35 percent oxygen, which was discontinued within 24 hours. At the age of 31 days,��tachypnea and recurrent apnea with cyanosis developed. Auscultation revealed bilateral rales in the chest, again necessitating resuscitation with O2, administered by bag and mask. Chest x-ray (Figure 2) revealed a diffuse parenchymal reticular pattern with multifocal areas of radiolucency. This roentgenographic pattern, along with the clinical findings, is essentially diagnostic of the Wilson-Mikity syndrome.

Discussion

Wilson an Mikity originally described this condition in 1960, and is now called Wilson-Mikity syndrome.2 The etiology is not clearly understood but is considered to be due to pulmonary dysmaturity with uneven postnatal development of pulmonary alveoli in the premature infants.2 No consistent relationship with O2 therapy has been established. Bronchopulmonary dysplasia is another condition seen in the neonatal period and should be distinguished from Wilson-Mikity syndrome. The cystic appearance on the chest x-ray in the third stage of bronchopulmonary dysplasia resemble those of Wilson-Mikity syndrome; however, it follows treatment of severe hyaline membrane disease with high concentrations of O2 and artificial ventilation.2 The clinical presentation of Wilson-Mikity syndrome is characteristic in that the infant is premature with minimal or no respiratory distress at birth but, develops progressive respiratory distress, with dyspnea, tachypnea, cough, cyanosis, and rales in a few days to weeks. Diffuse reticular pattern of both lungs with areas of multifocal radiolucency are usually seen, similar to those seen in figure 2. Progressive pulmonary insufficiency with signs of right heart failure develop in patients with fatal outcome. But, about half of the patients eventually recover from their pulmonary disease. Pulmonary function studies are abnormal with decreased lung compliance, increased expiratory flow resistance, and increased breathing effort. Respiratory acidosis develops in spite of increased minute volume. Arterial O2 desaturation is thought to be secondary to intrapulmonary right-to-left shunting.2 The treatment is largely supportive [2].

Fever, Vomiting and Dome-Shaped Density in Right Thorax

Case Report

A four-month-old boy presented with a history of fever, poor feeding, vomiting, and slight cough for two days. Past history is essentially normal except for an Apgar score of 6 at birth. Breath sounds were diminished at the right base. Laboratory studies were normal. Chest x-ray (Figure 3) was performed which revealed a dome-shaped density in the right thorax which did not coincide with any pulmonary lobe or segment. The elevation of the inferior liver margin in the abdomen indicated that the abnormal shadow was liver. Based on these findings eventration of the right hemi-diaphragm was suspected. To confirm the diagnosis, a diagnostic pneumoperitonium was performed (Figure 4) which confirmed the diagnosis.

 Chest x-ray in posterio-anterior (A) and lateral (B) views showing a dome-shaped density in the right thorax (the x-ray was reversed by the printer). The distribution of the density did not coincide with any pulmonary lobe or segment. The elevation of the inferior hepatic margin in the abdomen indicated that the abnormal shadow was liver. Reproduced from Rao PS and Patel JK. Chest 1970; 58:89-90.

 Diagnostic pneumoperitonium with chest x-ray in lateral view. This demonstrated air below the diaphragm suggesting eventration of the diaphragm instead of pneumonia or other lung pathology. Modified from Rao PS and Patel JK. Chest 1970; 58:89-90.

Discussion

Eventration of the diaphragm is classified into adult and infantile types [3]. It is generally thought to be the result of congenital mal-development of the diaphragmatic musculature. However, such an abnormality may occasionally be caused by phrenic nerve injury during birth. The true incidence of eventration is not known, but in mass x-ray surveys of adults, it was found to be one in 10,000 [3]. Total eventration is thought to be more common on the left side and partial eventration on the right [3].

Clinical findings largely depend on the extent of eventration. There may be no symptoms or the patient may present with dyspnea, tachypnea, and cyanosis in the newborn period, requiring immediate treatment. Seesaw cyclic motions of the epigastrium with respiration and Hoover's sign (uninhibited divergence of costal margin from midline on inspiration), if present, are helpful in making the diagnosis. Percussion on the affected side may be dull or tympanic depending on the organs migrated under the diaphragm.

Fluoroscopy and chest x-rays are generally useful in arriving at the diagnosis. In right-sided eventrations, the lesser amount of liver shadow in the abdomen, i.e., elevation of the inferior margin of the liver helps to distinguish eventration from the other conditions [3]. Diagnostic pneumoperitonium is likely to establish the diagnosis, but the current availability of ultrasound technology, diagnostic pneumoperitoneum may not be necessary at the present time.

Symptomatic newborns with diaphragmatic eventration should be treated surgically; plication of the eventrated diaphragm is successful in relieving the symptoms with good long-term results. Some authorities suggest that asymptomatic patients also should be addressed surgically [3].

Foreign Body (Peanut) in The Left Main Stem Bronchus

Case Report

A 13-month-old girl with a history of poor appetite, loss of weight, cough, and intermittent low grade fever was admitted to the hospital for evaluation and treatment. No history of choking episodes was elicited. History revealed that a relative who had active pulmonary tuberculosis lived with the infant's family for a short period of time four months prior to the current admission. Because of this reason, the local health department performed tuberculin skin test which was positive and treatment with isoniazid was initiated. On examination her weight and height were between the third and tenth percentile. Decreased breath sounds on auscultation and hyper tympanic note on percussion were noted over the left side of the chest.

Intermediate strength purified protein derivative (PPD) was positive. Chest roentgenograms were obtained (Figure 5). Based on the history, physical examination, and chest x-ray findings, a diagnosis of endobronchial tuberculosis was entertained. However, prior to beginning treatment, bronchoscopy was performed to appraise the extent of airway encroachment.

Discussion

Autoimmune encephalitis is a condition that can be easily missed as it is not commonly considered in the differential diagnosis of various medical presentations. However, such diagnosis should be always taken into consideration when a person, particularly a child, presents with a new onset of refractory status epilepticus (NORSE) and/or new behavioral or psychiatric conditions. An early diagnosis of AE is essential, as the treatment is different from other conditions. With correct timely interventions the outcome is frequently favorable.

Though SARS-Cov-2 virus rarely invades the nervous system, Covid-19 infection frequently causes neurological symptoms like headache, delirium, anosmia, and dysgeusia [14]. One of the mechanisms of indirect nervous system involvement is through inflammatory response and immune dysregulation. There are few recorded cases of indirect involvement of CNS by auto-antibodies that are directed against the surface and synaptic protein. This case is one of the rare cases of Anti NMDA antibody autoimmune encephalitis that is associated with Covid-19 infection [15]. It indicates that in the era of COVID-19, high vigilance is required as a possible association may increase AE incidence.

A recent systemic review that analyzed 16 studies, including a total of 161 patients with NORSE [16], showed that the most frequent cause was AE. In addition to the well-known association with teratoma and cancer, AE, and specifically Anti-NMDA receptor Ab encephalitis, could be associated with a SARS‑CoV‑2 infection, either concomitantly or as post-infection manifestation. In this reported case, immunotherapy, in addition to anti-seizure medication, showed to be effective.

The main limitation of this report is the relatively short follow-up period. Observation of the child is ongoing to detect possible medium- or long-term consequences.

 Chest x-ray in posterio-anterior (A) and lateral (B) views showing hyper-aeration of the left lung and a slight shift of the heart and mediastinum to the right. The left diaphragm is also flattened. There are no areas of infiltration or consolidation in the lung, but prominent densities (arrows in A and B) suggestive of enlarged lymph nodes were also seen. Modified from Rao PS, et al. Amer J Dis Child 1970; 120:51-52.

Positive PPD in an infant with poor appetite, loss of weight, and fever is suggestive of primary tuberculosis. This is particularly so given the patient's exposure to a subject with active pulmonary tuberculosis. The x-rays show hyper aeration of the left lung with a shift of the heart and mediastinum to the right. The left leaf of the diaphragm is also flattened. While there are no areas of infiltration or consolidation were seen, prominent shadows suggesting enlarged lymph nodes were seen (arrows in figure 5). Endobronchial tuberculosis with compression of the bronchus by adenopathy may produce changes seen figure 5.

Discussion

Even though there was no history of choking or aspiration, the possibility of foreign body aspiration should be considered in this age group. Consequently, bronchoscopy was performed which revealed a peanut in the left main stem bronchus and was extracted during bronchoscopy. The peanut and the adjacent edema of the bronchus caused partial bronchial obstruction and acted as a check valve, so the air entered the left lung but, unable to leave the left lung since the bronchus becomes smaller during expiration, producing the roentgenographic appearance shown in figure 5. The baby improved and the treatment with isoniazid was continued because of the positive PPD.

Cor Pulmonale as a Complication of Ventriculoatrial Shunts

Introduction

Cerebral ventricle-to-right atrial shunts with Pudenz-Heyer or Spitz-Holter valves were widely used to treat hydrocephalus in the 1960s. Development of pulmonary hypertension with chronic cor pulmonale is rare with these shunts. We reported a patient who developed such a complication along with description of specialized pulmonary function studies in the early detection of such complication [5].

Case Report

An 11-year-old white boy was hospitalized in April 1969 with a history of progressive weakness, dyspnea, and pedal edema. He was diagnosed to have hydrocephalus and had a ventriculo-atrial shunt with a Pudenz-Heyer valve implanted at the age of 6 months. The shunt was thought to be functioning well when he was evaluated at the age of 2 years. He was asymptomatic until he was 9.5 years old, when he developed signs of congestive heart failure (CHF) and was treated at another hospital with digitalis and diuretics with some improvement. Right heart catheterization at the same institution revealed a mean right atrial pressure of 35 mmHg and right atrial angiography revealed slow emptying of the contrast, filling defects on the right lateral atrial wall and in the right and left pulmonary arteries. The ventriculo-atrial shunt was removed shortly thereafter. The patient was referred to our group for further evaluation and management [5].

Pertinent findings on examination included height and weight below the third percentile, head circumference above the 97th percentile, pretibial edema, prominent “a” wave in the left side of the neck, no venous pulsations on the right side, palpable right ventricular heave, markedly accentuated single second heart sound, an audible fourth heart sound at left lower sternal border, a Grade I/VI ejection systolic murmur at the mid-left sternal border, liver edge palpable 5 cm below the right costal margin, clear lung fields on auscultation, and normal neurological examination.

Electrocardiogram (ECG) (Figure 6) and the vectorcardiogram (not shown) revealed right atrial and ventricular hypertrophy. Chest roentgenogram (Figure 7) showed moderate cardiomegaly and prominent main pulmonary artery (PA) segment and clear lung fields. Lung scan with 131I-labeled macro-aggregated albumin was suggestive of multiple pulmonary emboli. Blood gas analysis showed pH 7.56; PaO2 80 mmHg, PaCO2 23 mmHg and bicarbonate 24 mEq/liter. Routine pulmonary function studies revealed restrictive lung disease. The ratio of wasted ventilatory volume (physiological dead space) to tidal volume (VD:VT) using Bohr's equation was 0.58 (normal 0.3 or less).

Electrocardiogram shows right axis deviation with right atrial hypertrophy and marked right ventricular hypertrophy. Reproduced from Rao PS, et al. J Neurosurg 1970; 33:221-225.

Chest x-ray in posteroanterior view demonstrating cardiomegaly and prominent main pulmonary artery segment (arrow). The peripheral pulmonary vasculature is diminished. Modified from Rao PS, et al. J Neurosurg 1970; 33:221-225.

Vigorous treatment with digitalis and diuretics resulted in only temporary relief. During the next year, he continued to deteriorate and died of intractable right ventricular failure. Postmortem revealed right atrial thrombosis, severe right ventricular hypertrophy, multiple thrombo-emboli in the large and medium-sized pulmonary arteries, and intimal proliferation of the pulmonary arterioles.

Discussion

The case presented demonstrated development of cor pulmonale secondary to pulmonary thrombo-embolism which was produced by thrombi that arose following a ventriculo-atrial shunt with a Pudenz-Heyer valve for treatment of hydrocephalus. The causes of thrombo-embolic complications were not well understood, but the hypotheses, as reviewed by us [5], include infection, periarteritis due to autoimmune reaction of the pulmonary vessels to protein of cerebrospinal fluid, release of brain thromboplastin resulting in thrombosis at the point of contact with plasma coagulation factors, and simply the presence of a foreign body in the cardiovascular system for prolonged periods of time.

Early detection of pulmonary hypertension by periodic (every six months) evaluation by chest x-ray and ECG studies was suggested by some investigators, but early detection of pulmonary hypertension is of limited value since obstruction of 60% of the pulmonary vascular bed occurs by the time pulmonary hypertension develops [5]. Detection of multiple filling defects on radioisotope scanning in a child with a ventriculo-atrial shunt would be suggestive of pulmonary embolization and might be useful in early identification. Based on the observations of Nadel and associates [6] and those of ours [5], we suggested that specialized pulmonary function studies such as VD:VT, pulmonary diffusing capacity, pulmonary capillary blood volume, blood gas, and pH be performed periodically to detect obstruction of pulmonary vasculature prior to the development of pulmonary hypertension and cor pulmonale [5]. However, it should be noted that ventriculo-atrial shunts are no longer performed to treat hydrocephalus, but instead ventriculo-peritoneal shunts are used at the present time.

In summary, a rare case of pulmonary thrombo-embolism with resultant pulmonary hypertension and cor pulmonale following ventriculo-atrial shunt for hydrocephalus was presented with the recommendation to use of special pulmonary function studies for early detection and if found to be positive, immediate removal of the shunt system may eliminate further embolization into the lungs and prevent irreversible pulmonary vascular disease.

[abhishekhospital]

Are You Breathing Right? How an Asthma Specialist in Jaipur Can Improve Your Quality of Life

Introduction

Most people consider it quite normal to breathe. On the other hand, asthmatics have to struggle to breathe just to carry out basic movements like walking upstairs or simply going outside. If you are asthmatic, then you should not continue to suffer from asthma. Consulting an experienced asthma specialist in Jaipur can help you manage your symptoms and greatly enhance your quality of life. Let us look at how asthma specialists and Abhishek Hospital will assist you in breathing easily again.

Things you must know about asthma

Asthma is a disorder occurring out of inflammation of the airways, leading to heat contraction and overproduction of mucus. Symptoms include wheezing, coughing, a feeling of tightness in the chest, and breathlessness. While asthma cannot be cured, with a suitable treatment plan one can maintain an asthma-free life. 

Common Triggers Of Asthma

Asthma triggers vary from one patient to another. The most common among them are:

Allergens (dust mites, pollen, pet dander).

Pollution and smoke

Respiratory infections

Stress and exercise

Weather changes

An asthma specialist in Jaipur can guide you in identifying and avoiding these triggers.

Why You Need An Asthma Specialist

Medical Diagnosis And Care Of High Quality

Jaipur-based asthma specialists will ensure an authentic diagnosis and tailor-made treatment plan addressing your needs, and pulmonary functions will probably be one of the modern tools to assess what level the condition is.

Personalized Treatment Plans

Asthma cannot be diagnosed by merely providing a static form for the assessment, where the doctor fills in the context. The specialist ensures that your treatment plan has taken all the personal factors into account: what triggers you, the lifestyle you lead, and your medical history. 

Preventive Care

Besides relieving your symptoms, this treatment will teach you how to avoid these triggers, along with what to do during an attack. 

How an Asthma Specialist in Jaipur Can Help You

1. Correct Diagnosis

Since asthma is often confused with other respiratory disorders, this thus results in improper treatment. An asthma specialist in Jaipur conducts thorough evaluations to confirm your diagnosis and rule out other conditions.

2. Medication Management

Asthma medications fall into two basic groups: 

Relievers: Used for quick relief during an asthma attack.

Controllers: These reduce inflammation that can lead to further flare-ups.

The asthma specialist assures you that you are on the optimum combination of medications to provide better control.

3. Allergy Testing

The specialist may recommend you undergo allergy testing if allergies trigger your asthma. Identifying and managing your triggers could considerably reduce symptoms.

4. Breathing Techniques and Rehabilitation

An asthma specialist typically teaches breathing techniques to rehabilitate the chest and work on overall respiratory health.

5. Emergency Action Plans

An individually tailored action plan gives you the edge to recognize early warning signs of an impending asthma attack and acts as a manual on what steps to take to handle it correctly.

Why Choose Jaipur for Asthma Treatment?

Jaipur has some of the best assistance in the country: world-class facilities and patient-centric care now that the city has become a hotspot for respiratory treatment. Abhishek Hospital is leading the way in this regard, with a team of qualified specialists and full-fledged asthma care. 

Tips for Managing Asthma

1. Identify Your Triggers

Keep a journal to document what the causes of your symptoms are and avoid them whenever possible.

2. Use Your Inhaler Correctly

Despite being a facility most users are very aware of, many patients who have this condition do not use their inhalers correctly, rendering them ineffective. An asthma specialist in Jaipur can guide you on the correct technique.

3. Staying Active

While it is true that exercise-induced asthma is commonplace, staying active can actually improve lung strength. Speak with your specialist about safe activities.

4. Keep Your Environment Clean

A clean environment helps to minimize exposure to dust mites and mould and also reduces the concentration of different types of allergens.

5. Pay Attention to Your Symptoms

You should really watch for those signs and symptoms of asthma to execute some preemptive action if an attack is likely to strike.

Benefits of Consulting An Asthma Specialist

Quality of Life: The possible best treatment may allow you to lead a more active, fun life.

Number of Attacks: Specialists help reduce the incidence and severity of flare-ups.

Reduced Need for ER Visits: Asthma care means fewer trips to the hospital for emergency treatment.

Uninterrupted Sleep: Say goodbye to sleepless nights by breathing free.

When to See an Asthma Specialist

Consulting an asthma specialist in Jaipur becomes due when

The severity of your symptoms increases despite taking medication.

You awaken at night due to asthma.

Your asthma attacks take place more than twice a week.

Your activities of daily living are disrupted.

Conclusion

Breathing is essential to life, and no one should struggle for it. By consulting an experienced asthma specialist in Jaipur, you can take charge of your condition and lead a healthier, more active life. Abhishek Hospital has very well-trained and conscious staff, totally assured in their care and support for you every step of the way. Schedule a consultation today and get back that freer smile. 

[swldx]

RNZ Pacific 1309 28 Nov 2024

7390Khz 1259 28 NOV 2024- RNZ PACIFIC (NEW ZEALAND) in ENGLISH from RANGITAIKI. SINPO = 54333. English, s/on w/bellbird int. until pips and news @1300z anchored by Lydia Lewis. § A new study on plastic consumption warns that business as usual will result in nearly double the amount of plastic pollution. World leaders, including the Pacific, are currently meeting in South Korea to try agree on a new international treaty to fight plastic pollution. Neil Nathan, one of the authors of the study, Pathways to reduce global plastic waste mismanagement and greenhouse gas emissions by 2050, which was published in the journal Science, said business as usual means plastic waste will continue to grow exponentially. § Tongan Prime Minister Hu'akavameliku Siaosi Sovaleni is facing a second vote of no confidence next week. The prime minister has pointed out that this is happening just 11 months before the next election, which would leave a new government little time to do anything before parliament is dissolved ahead of the poll. The vote was instigated by 'Aisake Eke, who also initiated a similar motion last year. Hu'akavameliku easily defeated the previous vote. § The son of Fiji's former prime minister Frank Bainimarama has been sentenced to 28 months in jail after violently attacking an ex-girlfriend in Sydney, leaving her with a ruptured ear drum. § In Fiji, funding for baiting of homes from the infestation of termites will be made available to families with income less than $30,000 after Cabinet endorsed the expansion of the termite baiting programme. § A "huge" police presence is in the small Bay of Plenty community of Matapihi as Mongrel Mob gang members gather for the tangi of one of their own. According to local reporter for Aukaha News, Ripeka Timutimu, the community has responded to the influx of police with mixed views - but the majority are angry, and say there was not enough consultation about how big the operation was going to be. The tangi comes just a week after a new law was introduced, banning gang members from wearing patches and gang insignia in public. § US President-elect Donald Trump's vow to impose tariffs on China and Mexico unless they stem the flow of fentanyl and migrants across the US border could impel deeper cooperation from those governments on drug policing, experts said. § A new clinical trial has unveiled a promising way to treat severe asthma and chronic obstructive pulmonary disease (COPD) attacks. The study, published in The Lancet Respiratory Medicine journal, indicates that an injection of benralizumab could work better than the current steroid tablet treatment. Researchers have hailed this development as the first significant breakthrough in managing these chronic lung conditions in over 50 years. § Sports. @1308z "Pacific Waves" anchored by female announcer. QRM=slight heterodyne. Backyard fence antenna, JRC NRD-535D. 100kW, beamAz 35°, bearing 240°. Received at Plymouth, MN, United States, 12912KM from transmitter at Rangitaiki. Local time: 0659.

[darkmaga-returns]

by Nicolas Hulscher, MPH

The McCullough Foundation study, authored by epidemiologist Nicolas Hulscher and Dr. Peter McCullough, titled, Delayed Fatal Pulmonary Hemorrhage Following Covid-19 Vaccination: Case Report, Batch Analysis, And Proposed Autopsy Checklist, was just published after successful peer-review in the International Journal of Innovative Research in Medical Science:

Abstract COVID-19 vaccines have been previously associated with pulmonary hemorrhage, typically observed shortly after vaccination. We present a healthy, 47-year-old Caucasian male that died unexpectedly from acute pulmonary hemorrhage 555 days after completing the BNT162b2 (Pfizer) COVID-19 vaccination primary series. Before death, he exhibited symptoms of a mild respiratory infection. Despite a healthy medical history and no medication use, the patient’s condition rapidly deteriorated and he experienced severe respiratory distress, followed by cardiopulmonary arrest with evidence of profuse pulmonary bleeding. Autopsy findings revealed massive lung congestion without embolism, normal heart size, and moderate coronary atherosclerosis without myocardial infarction. Despite these findings, the medical examiner determined the cause of death was attributed to atherosclerotic and hypertensive cardiovascular disease, without considering the recent pulmonary hemorrhage and unremarkable medical history. The autopsy failed to investigate potential contributions from the COVID-19 vaccine, such as the presence of the Spike protein, vaccine mRNA, or related antibodies. A batch analysis revealed the BNT162b2 vaccine batch this patient received is among the top 2.8% for number of reported deaths out of all Pfizer COVID-19 vaccine batches and is associated with fatal cardiovascular adverse events including cardiac arrest. The evidence suggests that this man died of a cardiopulmonary arrest most likely as a result of acute pulmonary hemorrhage, with the COVID-19 vaccine potentially playing a role in the development of cardiopulmonary pathology and hemorrhage. We propose autopsy protocols for deceased individuals that have received one or more COVID-19 vaccines to help improve diagnostic accuracy in future cases.

[killed-by-choice]

“Dottie Roe,” 30 (USA 1965)

“Dottie” was a New Yorker seeking medical attention because she had started bleeding in the second trimester. She had suffered two miscarriages in the past and likely feared that she might lose this baby too. Unfortunately, the doctor’s dubious course of action would end her baby’s life and her own.

The medical journal that recorded Dottie’s case does not specify what the diagnosis was, but the doctor decided to put Dottie through a hysterotomy abortion and a tubal ligation. This was a questionable course of action considering that hysterotomy abortion is associated with a very high maternal mortality rate. But since it qualified under the health exemption (“life of the mother” exception), it was completely legal.

The report of Dottie’s death raises questions. She was under general anesthesia for the abortion and tubal ligation, but would never wake up. The journal states that “Cardiac arrest ensued during the procedure, and the patient expired following completion of a tubal ligation, never having regained consciousness.”

Later research found that the risk of hysterotomy abortion concurrent with surgical sterilization was unjustified even in someone perfectly healthy. Today, medical knowledge has advanced beyond the antiquated approach of abortion for pregnancy complications— the recommendation that failed Dottie and her child.

Other pre-Roe legal abortions that were meant as “life/health of the mother” exceptions and killed the patient instead include:

“Carolyn” and “Caroline Roe”: Both died in North Carolina in 1970 or 1971 after abortions for “health indications”

“Bonnie Roe”: Put through an abortion because her heart condition, then died because of drugs for the abortion that were contraindicated in heart patients

“Molly Roe”: Her killers were rebuked by a maternal health committee for a saline abortion that was more dangerous to the young lupus patient than her pregnancy

“Rita Roe”: A cardiac patient who died from multiple pulmonary emboli after an abortion at 12 weeks pregnant

Caro Lena Grasso: An Italian immigrant with a chronic respiratory illness who died of infection caused by the abortion meant to stabilize her

Erika Charlotte Wullschleger: At 28, she was in a tank respirator at Scripps Memorial Hospital. She was just starting to get better before dying from the abortion that her husband, not she, signed the consent forms to.

Barbara Riley: After a doctor told her to have an abortion instead of giving birth again, she reluctantly underwent the highly dangerous saline abortion that took both lives.

(Sources below)

New York State Medical Journal, January 1974

[snehalblog]

Plethysmograph Market: Exploring Key Trends, Competitive Landscape, and Future Opportunities in Healthcare Monitoring - UnivDatos

According to a new report by UnivDatos Market Insights, The Plethysmograph Market was valued at USD 101.2 Million in 2022 and is expected to grow a CAGR of 4.5% during the forecast period (2023-2030). A plethysmograph is a medical tool that detects volume changes within an organ or body part. It's commonly utilized in respiratory studies to measure alterations in lung air volume. This device plays a crucial role in diagnosing respiratory ailments and evaluating lung function. Several factors are contributing to the growth of such diagnostics including the increased consumption of alcohol and tobacco, the surge in awareness programs regarding respiratory disorders, and rising investments in diagnostic departments are driving the growth of the healthcare sector. Apart from these factors, rising strategic collaborations are leading the market of medical devices in this forecast period. For instance, the incidence of bradycardia was reported to be approximately 1 in 600 individuals worldwide in September 2020 according to the American Journal of Cardiology.

Access sample report (including graphs, charts, and figures): https://univdatos.com/get-a-free-sample-form-php/?product_id=54390&utm_source=LinkSJ&utm_medium=Snehal&utm_campaign=Snehal&utm_id=snehal

The report suggests that the Rising Expenditure on the Healthcare Sector is one of the major factors driving the growth of the medical device market during the forthcoming years. Money is essential for gaining prominence in the market, and the medical device industry is gaining much of it. This expenditure is driving the market for the development of new technological advancements in the field of diagnostics. In recent years, there has been an increasing number of company and government collaborations focused on plethysmographs. For instance, in November 2023, the Association of Indian Medical Device Industry (AIMED) and the Centre for the Development of Russia Strategic Partnership (DRISP) signed a Memorandum of Understanding (MoU) to promote bilateral trade between both nations. It also provides hope for patients to get better care and support through plethysmography, also it can serve as a doorway to opportunities for offering better diagnostic options in the future.

Body Plethysmographs Gaining Maximum Traction in the Market:

Body plethysmographs continue to be significant tools in respiratory physiology and pulmonary function testing. These devices play a crucial role in assessing lung function by accurately measuring lung volumes and capacities. Body plethysmographs are considered a standard tool in pulmonary function testing laboratories and respiratory clinics. They provide precise measurements of lung volumes, aiding in diagnosing and monitoring various respiratory conditions such as asthma, COPD, restrictive lung diseases, and other pulmonary disorders. In the plethysmograph market, while advancements in technology have led to the development of other techniques and devices for assessing lung function, body plethysmographs maintain their importance due to their accuracy and reliability in measuring lung volumes. Companies involved in the production and development of pulmonary function testing equipment often include body plethysmographs in their product portfolios, emphasizing their role in comprehensive respiratory diagnostics.

North America has shown its potential in several arenas, and plethysmographs are one of them. A plethysmograph is a medical instrument used to track volume variations in organs or body parts. Primarily applied in respiratory analysis, it measures changes in lung air volume. This device aids in diagnosing respiratory conditions and assessing lung functionality. There have been significant collaborations between pharmaceutical organizations to facilitate the exchange of resources and knowledge to provide enhanced pulmonary care to patients in the nation. For instance, in November 2023, the Association of Indian Medical Device Industry (AIMED) and the Centre for the Development of Russia Strategic Partnership (DRISP) signed a Memorandum of Understanding (MoU) to promote bilateral trade between both nations.

One of the pivotal areas of growth in the U.S. plethysmograph market is advancements in diagnostics. These technologies, along with advancements in bioinformatics and data analysis, contribute significantly to identifying, characterizing, and utilizing plethysmographs for diagnosis, prognosis, and personalized treatment strategies. Traditionally, the U.S. has chased up accessibility and affordability issues concerning lung diagnostic services, but the presence of a diagnostic system that will more efficiently prevent metastatic cells from progressing is still a challenging factor. The U.S. pharmaceutical sector is known for its significant contribution to innovative healthcare services globally and is slowly stepping into the arena of innovative diagnostic procedures through multiple ongoing clinical trials to provide appropriate therapeutics. For instance, in March 2023, the Mayo Clinic started a clinical trial to evaluate whether undergoing gender-affirming care will impact the way the lung function using plethysmography. Also, in September 2023, the University of Pittsburgh started a clinical trial to study coronary artery disease in patients with Friedreich's ataxia using plethysmography.

Click here to view the Report Description & TOC : https://univdatos.com/get-a-free-sample-form-php/?product_id=54390&utm_source=LinkSJ&utm_medium=Snehal&utm_campaign=Snehal&utm_id=snehal

Conclusion

The global plethysmograph market is a rapidly growing field, with advancements in technology leading to improved outcomes for patients with the initial stage of the disease. The global plethysmograph market is expected to continue to grow in the coming years, as new technologies are developed. Overall, the global plethysmograph market represents a significant opportunity for medical device industries, which are making strategic alliances to design effective diagnostics for respiratory disorders. With continued research and development, even more effective and personalized treatments will likely become available in the future, leading to improved outcomes for patients and doctors through plethysmography.

[jcsmicasereports]

Granulomatosis with Polyangiitis (Wegener’s granulomatosis) manifesting with Cranial Nerve Palsies and Pachymeningitis: A Case report by Christian Matta in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

We present a case of a 78-year-old male patient diagnosed with pachymeningitis secondary to Wegener's granulomatosis (WG), also known as granulomatosis with polyangiitis (GPA), associated with p-ANCA positivity. This case report aims to highlight the clinical presentation and diagnosis, of pachymeningitis in WG and provide a review of the literature on this manifestation.

Introduction: Wegener's granulomatosis (WG) is a systemic small-vessel vasculitis characterized by necrotizing granulomatous inflammation, primarily affecting the upper and lower respiratory tracts and kidneys. (1) Central nervous system (CNS) involvement is uncommon, occurring in approximately 2-8% of cases, with the most common manifestation being peripheral neuropathy. However, pachymeningitis is a rare manifestation of GPA, characterized by thickening of the dura mater. (2,3) We present a case of pachymeningitis due to GPA, providing simultaneously a literature review.

Case Presentation: In February 2020, a 78-year-old male patient presented with binocular diplopia, bitemporal headache and a progressive vision loss in the left eye accompanied by a bilateral serous otitis media. A brain computed tomography (CT) was performed, however no significant findings were found.  After a progressive degradation of his visual field, a brain MRI with gadolinium enhancement was performed in 2021 and demonstrated a subdural hematoma of the left convexity with a diffuse, thick dural enhancement suggestive of pachymeningitis. A set of laboratory tests was performed to including autoimmune antibodies: anti-nuclear antibodies, antibodies against extractable nuclear antigens, anti-double- and singlestranded DNA; anti-neutrophil cytoplasmic antibodies, anticyclic citrullinated peptide antibodies, anti-MOG, and antiaquaporin-4 (AQP4), all proved negative. The blood levels of vitamin B12, B9, thyroid-stimulating hormone, and the angiotensin-converting enzyme (ACE) were normal. Lumbar puncture revealed an opening pressure of 20 cmH2o, elevated protein of 1.3g/L, normal glucose levels and normal WCC in the cerebrospinal fluid (CSF), with a sterile culture. In March 2022, the patient presents a progressive onset of visual loss in the right eye. Ophthalmic examination showed a visual acuity at 2/10 without papillitis. A brain MRI found pachymeningitis with atrophy of the left optic nerve (Figure 2). A CT scan of the chest showed the presence of a nodular shadow with some cavitation involving the middle lobe of the left lung in favor of vascular malformation. Salivary gland biopsy showed sialadenitis. A blood patch for suspicion of CSF hypotension was performed as a therapeutic test but without clinical benefit. In May 2022, a brain and whole-body FDG-PET was performed and showed the presence of moderately hypermetabolic bilateral hilar lymph nodes, and the progression of left frontal pachymeningitis associated with moderate hypermetabolism affecting bilateral internal temporal regions. The patient was started on intravenous methylprednisolone (1 g/day) for 3 days, without ocular improvement and with poor tolerance of his diabetes The patient was re-hospitalized for a follow-up evaluation in January 2023. A whole-body Positron emission tomography (PET) imaging with F-18-labelled 2-fluoro 2-deoxy-D glucose (F18 FDG) showed a hypermetabolic nodule of the walls of the trachea, the right main bronchus, the subcarinal, the pulmonary hiles, and the nasal septum. A cerebral F-18 FDG PET showed intense hypermetabolism of the right optic nerve, associated with marked encephalic hypermetabolism, predominantly in the temporal and supratentorial regions (Figure 3 and 4). Laboratory test showed Erythrocyte sedimentation rate (ESR) of 65 mm/h (normal range: 0-20 mm/h), C-reactive protein (CRP) of 45 mg/L (normal range: <10 mg/L), and a white blood cell count of 14,000 cells/µL (normal range: 4,000-11,000 cells/µL) with neutrophil predominance. Lumbar puncture revealed an elevated opening pressure, elevated protein, and normal glucose levels in the cerebrospinal fluid (CSF), with a sterile culture. Autoimmune and infectious tests were re-performed, and all proved negative including the Anti-neutrophil cytoplasmic antibodies directed to proteinase3 (c-ANCA) but not the Perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA) which was positive. So, the patient was diagnosed with granulomatosis with angiitis.

Discussion: Previously known as Wegener’s Granulomatosis, this systemic necrotising vasculitis is associated with cANCA PR3. Predominantly afflicting small vessels, the multisystem disease is classically recognized to affect the renal system alongside upper and lower respiratory tracts. (4) Pachymeningitis, a rare manifestation of granulomatosis with polyangiitis (GPA). It can present with various neurological symptoms and is associated with ANCA (antineutrophil cytoplasmic antibody) positivity. It was reported by Nagashima et al. (2000). Where they presented a case study of a patient with P ANCA Wegeners granulomatosis who had pachymeningitis and multiple cranial neuropathies. (5) This case report discussed the association of pachymeningitis with P-ANCA-positive Wegener's granulomatosis, associated with the imaging pattern of WG on 18-FDG PET Scan. It emphasizes the diagnostic challenge and the need for timely management. These findings underscore the significance of recognizing pachymeningitis in the context of GPA and its association with p ANCA positivity for appropriate diagnosis and management. It highlights the importance of retesting for ANCA when symptoms and imaging are highly suggestive of the diagnosis.

Conclusion: In conclusion, pachymeningitis is a rare and challenging manifestation of WG. A high index of suspicion, along with a combination of clinical, laboratory, and radiological findings, is essential for accurate diagnosis and prompt initiation of appropriate treatment.