Kartagener syndrome with renal amyloidosis: a case report

Kartagener syndrome is a rare disorder caused by defective ciliary function. It is described as a triad of cystic bronchiectasis, chronic sinusitis, and situs invertus. Renal involvement, although uncommon, is reported. The available evidence in literature consists of case reports and series, which describe various patterns of renal involvement. We hereby describe a case of a young female who presented with advanced renal failure and hypertension requiring urgent hemodialysis. On evaluation, she was found to have the classic triad of bronchiectasis, chronic sinusitis, and situs invertus leading to the diagnosis of Kartagener syndrome. On workup for the cause of renal failure, we found membranoproliferative glomerulonephritis due to amyloidosis secondary to bronchiectasis. This is a rare association and only 1 case has been reported in the available literature. There are no consensus guidelines regarding treatment of this condition, due to paucity of available data and because of rarity of the condition. This disease should be reported to augment the available literature

Management of chronic empyema with unexpandable lung in poor surgical risk patients using an empyema tube

Objectives: High preoperative risk precludes decortication and other surgical interventions in some patients with chronic empyema. We manage such patients by converting the chest tube into an "empyema tube," cutting the tube near the skin and securing the end with a sterile clip to allow for open pleural drainage. The patient is followed serially, and the tube gradually withdrawn based on radiological resolution and amount of drainage. Methods: Between 2010 and 2014, patients with chronic empyema and unexpandable lung, deemed high-risk surgical candidates, had staged chest tube removal, and were included for the study. The volume of fluid drained, culture results, duration of drainage, functional status, and comorbidities were recorded. Measurements and Results: Eight patients qualified. All had resolution of infection. The tube was removed after an average of 73.6 ± 49.73 (95% confidence interval [CI]) days. The mean duration of antibiotic treatment was 5.37 ± 1.04 (95% CI) weeks. None required surgery or experienced complications from an empyema tube. Conclusion: A strategy of empyema tube drainage with staged removal is an option in appropriately selected patients with chronic empyema, unexpandable lung, and poor surgical candidacy

Concomitant tracheal and subcutaneous glomus tumor: Case report and review of the literature

Glomus tumors are unusual and generally benign neoplasms mainly found in subungeal areas. We describe a case of concomitant subcutaneous and tracheal glomus tumor that underwent successful endoscopic resection. A 48-year old male with a left forearm subcutaneous mass presented with hemoptysis. A chest CT scan demonstrated a polypoid tracheal lesion. He underwent a bronchoscopic resection. A biopsy revealed a glomus tumor, which was the same type of neoplasm that was found on the forearm biopsy. Glomus tumors are rarely found in the respiratory tract. Only 49 cases have been described. The majority of the glomus tumors arise from the lower posterior tracheal wall with no extraluminal extension. Bronchoscopic resection has been successfully used. Glomus tumors should be included in the differential diagnosis of tracheobronchial lesions. Bronchoscopic resection and adjuvant radiotherapy are valid treatment options. This is the first report of concomitant subcutaneous and tracheal glomus tumor, as well as the first reported airway glomus tumor, in Latin America. As part of this study, we also perform a literature review

Liver and renal function profile of mucormycosis cases receiving amphotericin B - A retrospective study

Background: Mucormycosis is a serious infection that needs to be treated with prescription antifungal medicine, usually amphotericin B. In the study, we have analyzed the side effects of amphotericin B because studies have revealed that the drug has toxic effects both on the liver and the kidneys. Methodology: This is a retrospective study and was conducted using a record of mucormycotic patients who were admitted at GMERS Gotri Medical College and Hospital, Vadodara. We included the patients who were admitted to the hospital from June 1, 2021, to August 31, 2021. Three reports each of liver and renal function tests (LFT and RFT) were collected. These reports were entered into the excel sheet and a result was framed. Results: A total of 64 patients were reviewed with the infection of mucormycosis. Increase in bilirubin levels and serum glutamic pyruvic transaminase (significant rise) levels and decrease in albumin levels and albumin/globulin ratio were observed in LFT 2 and LFT 3 after initiating amphotericin B therapy. Similarly, a rise in serum urea and creatinine levels was observed in RFT 2 and RFT 3. The number of patients with altered serum sodium and potassium levels did not vary much in the three consecutive RFT reports. Conclusion: Amphotericin B drug does have adverse effects on the liver and kidneys. The three consecutive RFT and LFT reports revealed liver and kidney dysfunction due to damage induced by the drug. These led to altered levels of the factors included in the respective LFT and RFT reports

Alternative and Natural Therapies for Acute Lung Injury and Acute Respiratory Distress Syndrome

Introduction. Acute respiratory distress syndrome (ARDS) is a complex clinical syndrome characterized by acute inflammation, microvascular damage, and increased pulmonary vascular and epithelial permeability, frequently resulting in acute respiratory failure and death. Current best practice for ARDS involves “lung-protective ventilation,” which entails low tidal volumes and limiting the plateau pressures in mechanically ventilated patients. Although considerable progress has been made in understanding the pathogenesis of ARDS, little progress has been made in the development of specific therapies to combat injury and inflammation. Areas Covered. In recent years, several natural products have been studied in experimental models and have been shown to inhibit multiple inflammatory pathways associated with acute lung injury and ARDS at a molecular level. Because of the pleiotropic effects of these agents, many of them also activate antioxidant pathways through nuclear factor erythroid-related factor 2, thereby targeting multiple pathways. Several of these agents are prescribed for treatment of inflammatory conditions in the Asian subcontinent and have shown to be relatively safe. Expert Commentary. Here we review natural remedies shown to attenuate lung injury and inflammation in experimental models. Translational human studies in patients with ARDS may facilitate treatment of this devastating disease

Comparison of USG guided modified rectus sheath block with intraperitoneal instillation with Inj. Bupivacaine for postoperative pain relief in diagnostic laparoscopy

Abstract Background: Laparoscopic surgery is associated with considerable postoperative pain, though it is less compared to open surgery. Post laparoscopic pain results from phrenic nerve irritation caused by residual gas, stretching of the intraabdominal cavity and peritoneal inflammation. The Modified Rectus Sheath Block (MRSB) is fairly easy and reliable procedure when performed using ultrasound guidance so it is compared with the intraperitoneal instillation method by using Inj. Bupivacaine for postoperative analgesia in diagnostic laparoscopy. Aim of the study was to assess and compare the effect of the USG guided modified rectus sheath block (MRSB) with the intraperitoneal instillation using Inj. Bupivacaine in diagnostic laparoscopy. Material and methods: It was prospective randomized study. The Patients were randomly allocated in two groups. Group A were given USG guided rectus sheath block and Group B was give

TREM-1 is induced in tumor associated macrophages by cyclo-oxygenase pathway in human non-small cell lung cancer.

It is increasingly recognized that the tumor microenvironment plays a critical role in the initiation and progression of lung cancer. In particular interaction of cancer cells, macrophages, and inflammatory response in the tumor microenvironment has been shown to facilitate cancer cell invasion and metastasis. The specific molecular pathways in macrophages that immunoedit tumor growth are not well defined. Triggering receptor expressed on myeloid cells 1 (TREM-1) is a member of the super immunoglobulin family expressed on a select group of myeloid cells mainly monocyte/macrophages. Recent studies suggest that expression of TREM-1 in tumors may predict cancer aggressiveness and disease outcomes in liver and lung cancer however the mechanism of TREM-1 expression in the setting of cancer is not defined. In this study we demonstrate that tumor tissue from patients with non-small cell lung cancer show an increased expression of TREM-1 and PGE2. Immunohistochemistry and immunofluorescence confirmed that the expression of TREM-1 was selectively seen in CD68 positive macrophages. By employing an in vitro model we confirmed that expression of TREM-1 is increased in macrophages that are co-cultured with human lung cancer cells. Studies with COX-2 inhibitors and siCOX-2 showed that expression of TREM-1 in macrophages in tumor microenvironment is dependent on COX-2 signaling. These studies for the first time define a link between tumor COX-2 induction, PGE2 production and expression of TREM-1 in macrophages in tumor microenvironment and suggest that TREM-1 might be a novel target for tumor immunomodulation