Pulmonary Hydatid Cyst with Complicating Aspergillus Infection Presenting as a Refractory Lung Abscess

Background Hydatid disease is rare in the United States. Rarely the hydatid cyst can become infected with mycotic organisms, such as Aspergillus . We describe a young male who presents with clinical features of suppurative lung abscess whose workup diagnosed hydatid cyst complicated by Aspergillus co-infection. Case presentation A 27-year-old Peruvian male was hospitalized because of fever, chills, and productive cough of three months’ duration. Clinical features were consistent with a suppurative lung abscess. Significant findings included leukocytosis with eosinophilia and a chest x-ray showing a large lingular lobe thick walled cavity with a wavy irregular fluid level. The patient ultimately underwent surgical resection of the lingular lobe. Examination of the surgical specimen revealed the cavity to be a hydatid cyst. Histologic examination of the cyst wall showed intense inflammation and several septate hyphae of Aspergillus species. The patient recovered fully and has remained in good health. Conclusion A thick-walled cavity and a wavy meniscus constitute unusual features for an ordinary pyogenic lung abscess and suggests other possibilities. Endogenous cases of hydatid disease are uncommon in the United States, with the majority of cases occurring in immigrants. There are few published case reports describing incidental findings of Aspergillus in a hydatid cyst. The rare occurrence of such a condition can lead to a delay in diagnosis and treatment

Inhibition of Transglutaminase 2 activity increases cisplatin cytotoxicity in a model of human hepatocarcinoma chemotherapy

Transglutaminase 2 (TG2) is a ubiquitous multifunctional enzyme whose expression has been found to be altered in numerous studies of apoptosis and cell survival; its activity has been found to be increased in many types of cancer, where it is often over-expressed. Cisplatin has long been used as an effective therapeutic drug to treat numerous cancers. Although its activity is based on cross-linking of DNA, cisplatin may also operate via other mechanisms that involve modification and alteration in the activity of protein and RNA modulators of the cell cycle and apoptotic processes; these mechanisms are less well characterised. In this study, we investigated the effects of cisplatin-induced apoptosis on TG2 expression and activity in the human hepatocarcinoma (HepG2) cell line. Through a combination of Western blotting, enzymatic activity assays, flow cytometry and fluorescence microscopy we provide evidence that TG2 is inhibited during initiation of apoptosis by cisplatin, an observation that was reversed by increasing the expression of TG2, by treating cells with retinoic acid. We also report, for the first time, that cisplatin can directly inhibit transglutaminase activity in vitro. Collectively, these studies increase our understanding of the mechanism(s) of action of cisplatin, as cisplatin–mediated reduction in TG2 activity appears to act as an early activator of apoptosis during chemotherapeutic treatment of hepatocarcinoma cells. This observation suggests an explanation as to how increased levels of TG2 activity in cancer cells could contribute to chemotherapeutic resistance to cisplatin, and so has implications for novel approaches to cisplatin therap

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries