Sex difference in hospitalized patients with COVID-19 infection

The pandemic of COVID-19 infection is rapidly progressing to one of the most severe threats to human health. The different responses of the immune system in females and males to a range of infectious and inflammatory stimuli were investigated. We aimed to explore the association of sex with the course of infection among the hospitalized COVID-19 patients. This Comparative cross-sectional study was conducted on RT- PCR positive COVID-19 patients. Severe and critical patients who required hospital or ICU admission were included in the study. The total number of patients was 150 (75 males and 75 females) with mean age of 57Y±14.7. There was a statistical significance in age between both groups [mean ± SD: males 60.5 (12.2), females 54 (15.3) (p=0:0.007)]. The prevalence of diabetes mellitus, hypertension, chronic kidney disease and ischemic heart disease was higher among males but without statistical significance. Consolidation was significantly more prevalent in female group (85.3% vs 61.3% in male group). The need of mechanical ventilation was higher in men, but with no statistical significance (44% Vs 32%, p=0.302). Also, mortality rate was higher (48%) in males than in females (37.3%), but with no statistical significance (p=0.262). During the COVID-19 infection, the risk factors of severe disease and progression to the need of mechanical ventilation support in addition to mortality rate are more prevalent among males. However, radiological patterns apart from consolidation, distribution of radiological abnormalities and CT severity score in both groups did not show significant sex difference.

Open thoracotomy and decortication for chronic empyema thoracis: Our experience

Empyema thoracis is defined as the presence of pus in the pleural space or a purulent pleural effusion. Chronic empyema is characterized by thickened visceral and parietal peels, which hamper the ability of the affected lung to re-expand and require definitive surgical intervention. In a resource constraint environment like ours, open thoracotomy and decortication is the treatment of choice. We review our experience with cases of chronic empyema thoracis that had thoracotomy and decortication. This is a descriptive, retrospective, and observational study. Medical records of patients who had thoracotomy and decortication on account of chronic empyema thoracis in the Cardiothoracic surgery unit of our hospital between 2012 and 2020 were retrieved and reviewed. The information obtained from the records included sex, age, premorbid conditions, aetiology of empyema, cultures of pleural fluids, histology results of the cortex removed, duration of chest tube drainage, duration of hospital stay, postoperative complications, and outcome. One hundred and eighty-five patients diagnosed with empyema thoracis were seen in the study period. Sixty-five patients had thoracotomy and decortication on account of chronic empyema thoracis while the remaining 120 (64.9%) had closed tube thoracostomy drain insertion. Male: female was 5:1, mean age at presentation 24.24 years with age ranging from 2 years to 70 years. Fourteen (23.33%) were in the paediatric age group while the remaining (76.67%) were adults. The aetiology of empyema was pneumonia in 36 (60%). Strept pneumoniae was the commonest organism isolated from pleural fluids of these patients accounting for 23.33%. All patients underwent thoracotomy and decortication. The mean duration before surgery was 17 days with a range of 2 days to 40 days. The average duration of surgery was 2 hours. Chest tube was removed after an average of 7 days (range 5 to 33 days. Twenty-one patients (35%) had complications. The average duration of drainage was 18.87 days and that of hospital stay was 36.74 days. There were 3 mortalities (5%). The mean duration of follow-up was 3 months. Chronic empyema thoracis is still common in our environment and presentation is usually very late. In our series, open thoracotomy and decortication was found to be an excellent procedure with low morbidity and mortality. The majority of our patients had good functional outcome with few complications.

Intralobar pulmonary sequestration treated with video-assisted thoracoscopic lobectomy

Bronchopulmonary sequestration (BPS) is a rare congenital anomaly of airway in which a portion of the lung receives blood supply from an abnormal systemic artery. A 72-year-old woman had been suffering from recurrent left lower back pain and pneumonia for more than 10 years. She was diagnosed with intralobar type of BPS by computed- tomography angiogram and underwent video-assisted thoracoscopic lobectomy. BPS is a rare congenital abnormality that can accompany repeated pulmonary infection. Although asymptomatic patients may consider lifelong observation, surgical treatment of patients with symptoms is a curative option with minimal morbidity. To improve quality of the life for patients, active surgical treatment should be considered.

Necrotizing sarcoid granulomatosis: A case report

We report a case of a 22-year-old man with persistent cough and sarcoidosis-like changes in computed tomography scan. An extensive differential diagnosis is discussed and its evolution and treatment is presented.

Study on improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome

To understand the improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome, 30 HARDS patients were enrolled in the study from May 2012 to October 2013 from Qinghai Provincial People’s Hospital. All the patients received recruitment maneuvers and Pulse Contour Cardiac Output, hemodynamics monitoring including intrathoracic Blood Volume Index; Global End-diastolic Volume Index; Global ejection fraction; Pulmonary Vascular Permeability Index; Extravascular Lung Water Index; Pulse indicates cardiac Index; Stroke Volume Variation; Pulse pressure variation; Maximum pressure to increase speed; Systemic Venous Resistance Index, oxygenation and hemodynamics were determined before and after 72 hours of recruitment maneuvers. The results showed that after treatment with recruitment maneuvers and capacity limitation, PaO2/FiO2 was increased significantly compared with those before treatment [PaO2/FiO2 (mmHg): 124.70±43.37 vs 186.87±41.20, t=9.43, P<0.001], ITBVI, GEDVI, PVPI, EVLWI, SVV were reduced significantly compared with those before treatment[ITBVI (ml/m2): 1031.00±275.88 vs 907.13±242.56, t=1.26, P=0.041; GEDVI (ml/m2): 822.40±143.30 vs 722.83±169.65, t=1.75, P=0.016; PVPI (ml/kg): 2.71±1.21 vs 1.98±0.65, t=2.86, P=0.001; EVLWI (ml/kg): 12.30±4.19 vs 8.12±2.94, t=8.27, P<0.001; SVV (%):17.30±5.65 vs 10.33±3.47, t=9.17, P<0.001]. Our results indicated that recruitment maneuvers and capacity limitation have been improved oxygenation in HARDS, extravascular lung water reduced, and lung capillary permeability also improved.

Primary pleural epithelioid hemangioendothelioma

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor exceptionally involving the pleura with less than 30 cases reported in literature. We herein describe another case of pleural EHE in a 79-year-old man with medical history of chronic obstructive pulmonary disease and high blood pressure. He presented rightsided pleural effusion. Computerized tomography revealed multifocal pleural thickening and effusion. Pleural biopsy was performed. Microscopically, the tumor showed a biphasic pattern with cords and nests of epithelioid cells showing mild atypia and rare mitosis with intracytoplasmic lumina containing red blood cells. The second pattern is composed of spindle-shaped cells with occasional necrosis. The tumor cells were positive for CD34 and focally with CK7. The diagnosis of EHE was made.

Vanishing lung emphysema during chemotherapy for malignant pleural mesothelioma

We report the case of a 79-year-old man with a tobacco smoke-related left dystrophic bullous emphysema that showed a considerable recovery of the cystic abnormalities during chemotherapy for pleural malignant mesothelioma. We suggest that the disappearance of the dystrophic emphysema could be explained by the combined effect of chemotherapy and pleural disease. We briefly review the literature and we discuss the possible mechanism of this unforeseen manifestation.

Comparison of spontaneous and secondary pneumomediastinum

Pneumomediastinum (PM) is an uncommon event defined as the presence of free air in the mediastinum. Its clinical picture includes retrosternal chest pain, subcutaneous emphysema, dyspnea, dysphagia, dysphonia and asthenia. PM is further divided into two groups of patients: spontaneous PM, without any obvious primary source, and secondary PM, with a specific responsible pathologic event, such as trauma, intrathoracic infections, violation of the aerodigestive track or others. We retrospectively examined and compared backgrounds, onset, treatments and outcomes of ten and 5 patients in spontaneous and secondary PM.

Epidemiology of interstitial lung disease in Palestine: first national data

Significant progress has been made in recent years in understanding the epidemiology of interstitial lung diseases (ILD) across the world, but the amount of information available is still small compared to other respiratory diseases like obstructive lung diseases or lung cancer. In this study we tried to explore the epidemiology of ILD in a virgin area of the world (Palestine), by describing a retrospectively collected cohort of newly diagnosed ILD cases in a single – and the only – Pulmonology center in Palestine over two years.

Management of pneumothorax with oxygen therapy: a case series

Pneumothorax is relatively common condition affecting individuals of all ages. Goals of treatment of pneumothorax are removal of air from the pleural cavity and prevent its recurrence. The different strategies available at the disposal of the treating physician include observation, supplemental oxygen administration, needle aspiration, insertion of small bore chest drains and last but definitely not the least, surgery in recurrent cases. Oxygen therapy is useful in the treatment of all types of pneumothorax where it is found to be safe, effective and associated with reduced length of hospital stay. Four cases of pneumothoraces are presented here which were successfully managed with supplemental oxygen administration only.