Chylothorax: a rare complication of tube thoracostomy.

BackgroundChylothorax resulting from chest tube injury to the thoracic duct is very rare and underreported.ObjectiveThe purpose of this case report is to exemplify this rare but potentially significant complication of chest tube thoracostomy.Case reportAn 86-year-old woman presented with sepsis and a massive right pleural effusion; she developed a chylous effusion with the pleural fluid triglyceride level of 158 mg/dL 2 days after a traumatic chest tube insertion. All investigations excluded common causes of non-traumatic chylothorax. The chylothorax improved after fasting and implementation of a medium-chain triglyceride diet.ConclusionThe optimal depth of insertion of the chest tube typically ranges from 5 to 15 cm, ensuring all sideports are within the chest and the proximal port is at least 2 cm beyond the rib margin. Traumatic chylothorax secondary to chest tube insertion should be included in the differential diagnosis of patients presenting with chylothorax after a thoracostomy tube

Chylothorax: a rare complication of tube thoracostomy.

BackgroundChylothorax resulting from chest tube injury to the thoracic duct is very rare and underreported.ObjectiveThe purpose of this case report is to exemplify this rare but potentially significant complication of chest tube thoracostomy.Case reportAn 86-year-old woman presented with sepsis and a massive right pleural effusion; she developed a chylous effusion with the pleural fluid triglyceride level of 158 mg/dL 2 days after a traumatic chest tube insertion. All investigations excluded common causes of non-traumatic chylothorax. The chylothorax improved after fasting and implementation of a medium-chain triglyceride diet.ConclusionThe optimal depth of insertion of the chest tube typically ranges from 5 to 15 cm, ensuring all sideports are within the chest and the proximal port is at least 2 cm beyond the rib margin. Traumatic chylothorax secondary to chest tube insertion should be included in the differential diagnosis of patients presenting with chylothorax after a thoracostomy tube

The Role of Mean Platelet Volume as a Predictor of Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis

Background. An increase in the mean platelet volume (MPV) has been proposed as a novel prognostic indicator in critically ill patients. Objective. We conducted a systematic review and meta-analysis to determine whether there is an association between MPV and mortality in critically ill patients. Methods. We did electronic search in Medline, Scopus, and Embase up to November 2015. Results. Eleven observational studies, involving 3724 patients, were included. The values of initial MPV in nonsurvivors and survivors were not different, with the mean difference with 95% confident interval (95% CI) being 0.17 (95% CI: −0.04, 0.38; p=0.112). However, after small sample studies were excluded in sensitivity analysis, the pooling mean difference of MPV was 0.32 (95% CI: 0.04, 0.60; p=0.03). In addition, the MPV was observed to be significantly higher in nonsurvivor groups after the third day of admission. On the subgroup analysis, although patient types (sepsis or mixed ICU) and study type (prospective or retrospective study) did not show any significant difference between groups, the difference of MPV was significantly difference on the unit which had mortality up to 30%. Conclusions. Initial values of MPV might not be used as a prognostic marker of mortality in critically ill patients. Subsequent values of MPV after the 3rd day and the lower mortality rate unit might be useful. However, the heterogeneity between studies is high

Exercise Performance as a Predictor for Balance Impairment in COPD Patients

Background and objective: Six-minute walk test (6-MWT) is a widely used test for assessing exercise performance in chronic obstructive pulmonary (COPD). However, the association between reduced walking distance and balance impairment in COPD has not been directly investigated. Therefore, the aim of this study was to identify exercise performance as a predictor for balance impairment in COPD. Materials and Methods: The cross-sectional study was conducted at a single visit involving stable COPD patients in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. The 6-MWT was measured for in all subjects. The prognostic confounding factors were also collected for all subjects. Balance test was measured using the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. A cut-off score of BBS < 46 and/or the TUG ≥ 13.5 s was classified as balance impairment. Multivariable logistic regressions were performed to identify the six-minute walk distance (6-MWD) as a predictor for balance impairment in COPD. Results: Of the 176 COPD subjects assessed for eligibility, 118 COPD patients were enrolled including 86 males (72.9%) with a mean age of 73.5 ± 8.1 years. Thirty-three (28.0%) cases were classified with a balance impairment. The 6-MWD < 300 m was the predictor of balance impairment in COPD with an adjusted risk ratio of 10.10 (95%CI; 2.87, 35.61, p-value < 0.001). Conclusions: The 6-MWT is not only useful for evaluation of exercise performance, but also for prediction of balance impairment in patients with COPD. Our study suggests that the 6-MWD < 300 m is an important risk factor for balance impairment in COPD

Effect of the Application of the Global Lung Initiative 2012 Spirometry Reference Equation on the Diagnosing and Classifying Degree of Airway Obstruction in Thai Adults Aged 40 to 80 Years Old

Background and objective: Changing to a different spirometry reference equation can result in misinterpretation of spirometric findings. Currently, there is limited data about any discordance between the interpretations of airway obstruction (AO) using the Global Lungs Initiative (GLI) 2012 and the currently employed Thai reference equations (Siriraj) in Thai adults. Therefore, this study aimed to determine differences in diagnosis around AO and classification of the severity of AO using the GLI2012 and Siriraj reference equations in Thai adults. Materials and Methods: We analyzed spirometric results from Thai adults aged 40–80 years old (n = 2084), which were collected at the Lung Health Center, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between January 2005 and December 2015. The diagnoses concerning the AO were interpreted using the GLI2012 and Siriraj reference equations. The severity of AO in each case was classified into five grades, including mild, moderate, moderately severe, severe, or very severe. McNemar’s test was used to analyze differences in diagnosis of AO and classification of the level of severity. The Kappa statistic was used to determine agreements of diagnosis of AO and classification of severity between the two reference equations. Results: There were significant differences in both diagnosis of AO and their classifying severity level between the two reference equations (p-value < 0.001). However, the levels of agreement between the two reference equations were moderate to very good in different age and sex groups (Kappa values ranged from 0.62 to 0.78 for the diagnosis of AO and 0.54 to 0.89 for the classification of severity). Conclusions: Changing from the Siriraj to the GLI2012 reference equations underestimates the proportion of airway obstruction in Thai adults

Influence of Particulate Matter during Seasonal Smog on Quality of Life and Lung Function in Patients with Chronic Obstructive Pulmonary Disease

The impact of outdoor air pollution on the quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients, as measured by the COPD assessment test (CAT) questionnaire, is limited. The aim of this study was to determine the impact of a short-term increase in outdoor particulate matter in which the particles are less than 10 microns in diameter (PM10) during a seasonal smog period on QoL, symptoms, and lung function in COPD patients. This prospective observational study was conducted at Chiang Dao Hospital, Chiang Mai, Thailand between March and August 2016. Measurement of QoL, severity of dyspnea, forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1) were performed at both high and low PM10 periods. Fifty-nine patients met the inclusion criteria for enrollment into the study, with the mean age being 71.5 ± 8.0 years. Total CAT score, but not mMRC score, was statistically higher during the high PM10 period. The two lung function parameters, FVC and FEV1, were significantly lower at the high PM10 compared to the low PM10 period. We concluded that exposure to PM10 during the seasonal smog period resulted in short-term negative impact on the quality of life and lung function in COPD patients