An unusual case of hemoptysis secondary to Abernethy malformation type II and hepatopulmonary syndrome, pulmonary arterial hypertension

A twenty years old male college student came with history of hemoptysis. His chest X-ray showed diffuse infiltrative shadows and he was diagnosed as a case of a case of pulmonary tuberculosis with hemoptysis. On detailed investigations he was found to have Abernethy malformation Type-II with primitive portal vein joining extrahepatic inferior vanacava leading to cirrhosis of liver, porto-pulmonary syndrome, pulmonary arterial hypertension and hemoptysis.

Acute pulmonary embolism after short term exposure to smoke in an enclosed area

We report a case of acute pulmonary embolism (PE) following short term exposure to smoke in an enclosed area. The patient was obese and had type 2 diabetes mellitus. He developed PE as a consequence of acute systemic inflammatory response to short term exposure to smoke and an underlying chronic inflammatory milieu.

Post- COVID-19 multisystem inflammatory syndrome in children

COVID-19 is a severe acute respiratory infection affecting worldwide population. There are many cases of complications after the COVID exposure occurring nowadays. One among is Post-COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C). As per CDC report till March 1, 2021, 2617 cases of MIS-C were meeting the definite case criteria and among 33 death cases were reported. Here we report a case of COVID-19 associated Multi-system inflammatory syndrome in a child (MIS-C) interpreted with WHO case definition criteria. The patient was a 7-year-old boy, with initial presentation of moderate fever, non-itchy red blanching rashes, breathlessness, later progressed to cardiogenic shock accompanied by positive SARS-CoV-2 antigen result. The emergency cardiogenic shock treatment protocol was followed with initial stabilization and resuscitation strategy. He was successfully managed by three days of IV Immunoglobulin 2g/kgand Methylprednisolone 2mg/kg/day therapy along with other supportive treatments. The patient was discharged after 20 days of hospital stay with improved health condition. Our case report will strengthen the exposure-outcome relations between the coronavirus infection and MIS-C, moreover the strategies carried out in our case will be a future direction for the effective management of MIS-C.

Pocus as a tool to avoid diagnostic errors in covid-19 era

X-ray flips and wrong labelling has been uncomfortably common, and often results in wrong side intervention. Wrong side surgery is indeed the most dramatic and visible form of human errors. Until the 1999 Institute of Medicine report ‘To Err is Human’, the medical fraternity was largely unaware of such preventable medical errors and near misses. We herein, describe a case where X-ray flip and mislabelling led to wrong side intervention in a COVID-19 ICU. Active errors in human performance are inevitable while practising medicine in the current COVID-19 pandemic where difficulties in performing comprehensive systemic examination with the protective gear on, long working hours, work stress, emotions, and fatigue interplay with the errors in technology and increase the chances of errors. We propose the use of point of care ultrasound (POCUS) in COVID-19 ICU’s to aid in the diagnosis and management.

Effects of Sildenafil on spirometric pulmonary function parameters, pulmonary artery systolic pressure and BNP levels in patients with chronic obstructive pulmonary disease and erectile dysfunction

We aimed to investigate the effects of Sildenafil on pulmonary artery systolic pressure (PASP) as well as forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and serum brain-type natriuretic peptide (BNP) levels in stable chronic obstructive pulmonary disease (COPD) patients with erectile dysfunction (ED). This was a prospective non-controlled interventional study that recruited COPD patients with ED between the ages of 49 and 79. International Index of Erectile Dysfunction Form (IIEF-5) was used for the evaluation of ED. Patients who had pulmonary artery systolic pressure >50 mmHg were included in the study. Single-dose Sildenafil 100 mg was administered orally to the patients. Before and after the drug ingestion, spirometry and echocardiographic measurements were performed, and serum BNP levels were measured as well. Forty-five male COPD patients with ED were included. Both percent predicted, and absolute FEV1 values increased significantly after the Sildenafil administration compared with baseline values (p<0.01). Similarly, the FEV1/FVC ratio also increased significantly with the Sildenafil administration compared to baseline values (p<0.01). Pulmonary artery systolic pressure significantly decreased from its baseline value with Sildenafil administration (p<0.01). Serum BNP values significantly reduced with Sildenafil administration compared to the pre-treatment values (p<0.01). This is the first study conducted in COPD patients with erectile dysfunction who had also pulmonary hypertension. The single-dose Sildenafil administration reduced PASP and serum BNP levels significantly. For the first time in the literature, we showed that the spirometric pulmonary function tests, namely FEV1 and FEV1/FVC ratio, improved significantly with the Sildenafil administration.

Polymyxin B infusion related respiratory arrest: A case report

A 73 years old male, known hypertensive on medication, with the history of SARS-CoV-2 infection nine months ago, presented to us with mucormycosis, he was treated with Liposomal amphotericin B initially. He developed acute kidney injury with recurrent pulmonary oedema requiring ICU admission and Haemodialysis. He later developed catheter related blood stream infection that grew Carbapenem resistant Klebsiella pneumonia and was started on Polymyxin B. However from day 3 of antibiotics he started to develop recurrent respiratory arrest with no apparent cause. He required a brief period of mechanical ventilation and was successfully weaned. He had recurrent such episodes with no apparent cause. After extensive work up and literature search it was diagnosed as Polymyxin B induced respiratory failure. Polymyxins were stopped, patient was discharged in a stable condition after five days of further observation and is currently on follow up with no such episode of dyspnoea.

Burkholderia cepacia: An unusual cause of pneumonia

Burkholderia Cepacia is a gram negative organism, an uncommon cause of pneumonia. When isolated, it usually represents colonisation. In the presence of immunocompromising conditions, it can cause disease, ranging from mild illness to the highly fatal Cepacia syndrome. The organism is intrinsically resistant to many antibiotics. We report a 57 years old male farmer, who has diabetes mellitus and bronchial asthma, who presented with a acute history of high grade fever, pain abdomen and cough. He was diagnosed with a ruptured liver abscess, with the infection spreading to the right lower lobe. Laparotomy was performed. Pus culture grew Pseudomonas aeruginosa. He improved upon antibiotic therapy, only to return after one month with severe cough, chest X-ray revealing a lung abscess in the right lower lobe. Bronchoalveolar lavage culture grew Burkholderia cepacia, and sensitive antibiotics were initiated, however the patient succumbed to the illness. The implicated source of the organism was the nebulisation solution which he was using regularly. Emphasis should be laid on the need for improved aseptic practices while using medical solutions at either hospital or home setting. An index of suspicion may guide optimal antibiotic prescription practices in susceptible individuals.

Clinical presentation and management of leuconostoc bacteremia in patient with prolonged ICU stay: Case report

A 54 years old female came to emergency with the complaints of pain in abdomen, recurrent vomiting, abdominal distention and not able to pass flatus since two days. Patient was managed in intensive care unit and was empirically put on Meropenem and Targocid. She developed multiple episodes of loose motion, and stool culture was sent which was positive for Clostridium defficle. Therefore, patient was put on Vancomycin and Metrogyl. The blood cultures reported growth of Leuconostoc pseudomesenteroides. Infection with Leuconostoc may cause fever, intravenous catheter-related sepsis, bacteremia, abdominal pain, gastroenteritis, colitis or meningitis. To summarize this rare organism which is most commonly seen in immunocompromised patients, was isolated in a previously healthy individual, post Vancomycin therapy with prolonged ICU stays.