Accumulation Of Pus Research Articles

Efficacy and Safety of Intrapleural Fibrinolytic Therapy in Empyema Thoracis: A Meta-Analysis of Clinical Outcomes

Background: Empyema thoracis is a severe pulmonary condition characterized by pus accumulation in the pleural space. Intrapleural fibrinolytic therapy is used adjunctively to break down loculations and facilitate lung re-expansion. This meta-analysis evaluated the efficacy and safety of this treatment in adults with empyema thoracis. Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted (January 2013 - December 2023) for randomized controlled trials (RCTs) comparing intrapleural fibrinolytics with placebo or no fibrinolytic therapy in adults with empyema. Primary outcomes were treatment success (radiographic improvement and/or clinical resolution), duration of hospital stay, and mortality. Secondary outcomes included major bleeding and bronchopleural fistula. Data were pooled using a random-effects model, and risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated. Results: Six RCTs (n=623 patients) met the inclusion criteria. Intrapleural fibrinolytic therapy showed a significantly higher treatment success rate than the control (RR 1.42, 95% CI 1.18-1.72, p=0.001) and significantly reduced hospital stay (MD -2.84 days, 95% CI -3.36 to -2.33, p<0.001). No significant difference in mortality was found (RR 0.95, 95% CI 0.46-1.93, p=0.93). The incidence of major bleeding and bronchopleural fistula was similar between the groups. Conclusion: Intrapleural fibrinolytic therapy significantly improves treatment success and reduces hospital stays without increasing mortality or major complications. These findings support its use as an adjunctive therapy for drainage in managing empyema thoracis in adults.

Augmented pathogen detection in brain abscess using metagenomic next-generation sequencing: a retrospective cohort study.

Brain abscess is a severe infection characterized by the accumulation of pus within the brain parenchyma. Accurate identification of the causative pathogens is crucial for effective treatment and improved patient outcomes. This 10-year retrospective, single-center study aimed to compare the detection performance of conventional culture methods and metagenomic next-generation sequencing (mNGS) in brain abscess. We reviewed 612 patients diagnosed with brain abscess and identified 174 cases with confirmed etiology. The median age was 52 years, with 69.5% males. Culture tests predominately identified gram-positive bacteria, particularly Streptococcus spp. Gram-negative bacteria, including Klebsiella spp., were also detected. However, mNGS revealed a more diverse pathogen spectrum, focusing on anaerobes (e.g., Fusobacterium spp., Parvimonas spp., Porphyromonas spp., Prevotella spp., and Tannerella spp.). mNGS exhibited significantly higher overall pathogen-positive rates in pus samples (85.0% vs 50.0%, P = 0.0181) and CSF samples (84.2% vs 7.9%, P < 0.0001) compared to culture. Furthermore, the detection rates for anaerobes displayed a notable disparity, with mNGS yielding significantly higher positive detections in both pus samples (50.0% vs 10%, P = 0.0058) and CSF samples (18.4% vs 0%, P = 0.0115) when compared to culture methods. The assistance of mNGS in pathogen detection, particularly anaerobes in brain abscess, was evident in our findings. mNGS demonstrated the ability to identify rare and fastidious pathogens, even in culture-negative cases. These results emphasize the clinical value of mNGS as a supplement for brain abscess, enabling more comprehensive and accurate pathogen identification.IMPORTANCEThe accurate identification of pathogens causing brain abscess is crucial for effective treatment and improved patient outcomes. In this 10-year retrospective study, the detection performance of conventional culture methods and metagenomic next-generation sequencing (mNGS) was compared. The study analyzed 612 patients with brain abscess and confirmed etiology in 174 cases. The results showed that culture tests predominantly identified gram-positive bacteria, while mNGS unveiled a broader diverse pathogen spectrum, particularly anaerobes. The mNGS method exhibited significantly higher overall rates of pathogen positivity both in pus and cerebrospinal fluid (CSF) samples, surpassing the culture methods. Notably, mNGS detected a significantly higher number of anaerobes in both pus and CSF samples compared to culture methods. These findings underscore the clinical value of mNGS as a supplement for brain abscess diagnosis, enabling more comprehensive and accurate pathogen identification, particularly for rare and fastidious pathogens that evade detection by conventional culture methods.

Cardiac tamponade in a patient with chagas disease and pericardiocentesis. Case report

Introduction: Cardiac tamponade is considered a medical emergency, which is characterized by the accumulation of fluid, pus, blood or clots in the pericardial space. Chagas disease is considered one of the potential causes of cardiac tamponade due to the myocarditis and pericarditis it can produce.Clinical case: 58-year-old male patient who went to the emergency department, with a condition characterized by: dizziness, fatigue, productive cough with whitish expectoration, moderate dyspnea, general and mild chest discomfort. With a history of Chronic Chagas, smoker. A P-A chest x-ray, electrocardiogram and transthoracic echocardiogram were performed, confirming the diagnosis of cardiac tamponade. Discussion: Although Beck's triad can guide the diagnosis, it occurs in a small percentage of cases. In our case, after diagnosis, ultrasound-guided pericardiocentesis was performed and allowed the evacuation of blood content, improving the hemodynamic condition after performing the procedure and stable vital parameters. Conclusions: Chronic Chagas and some associated risk factors triggered the development of plugging. The pericardiocentesis was successful, allowing the evacuation of blood content, improving the hemodynamic condition and avoiding complications. Atypical presentation requires multidisciplinary management, early diagnosis related to clinical and ultrasound findings are essential for management, these will be determining factors in the evolution and prognosis of our patients

Swollen speech: a case study of tongue abscess detected via imaging technology

BackgroundA tongue abscess is a rare but serious condition marked by a localized accumulation of pus within the tongue’s tissues. Despite the tongue’s frequent exposure to trauma, bites, and foreign objects, it typically resists infections. However, an acute lingual abscess can be life-threatening due to the risk of airway obstruction from tongue swelling. Common symptoms include increasing pain, fever, swelling, immobility, edema, and redness of the tongue. The case report aimed to highlight the unusual clinical presentation and location of a deep-seated abscess in the anterior third of the tongue, as well as the radiographic approach to diagnosing the lesion.Case presentationA 30-year-old female patient presented with sudden onset tongue pain and swelling persisting for 4–5 days. Clinical examination revealed a solitary diffuse swelling in the anterior two-thirds of the tongue, approximately 3 × 2 cm in size. Diagnostic imaging, including a plain radiograph, ultrasound (USG), and MRI, was conducted. The patient was hospitalized for incision and drainage of the abscess, followed by a 5-day course of intravenous antibiotics.ConclusionsA tongue abscess, though rare, is a serious condition indicated by tongue swelling, pain, fever, dysphagia, and dyspnea. Diagnosis involves physical examinations and imaging studies like ultrasound or MRI. Immediate treatment includes maintaining airway patency, draining the abscess, and administering broad-spectrum antibiotics. Prompt recognition and treatment are essential to prevent severe complications such as airway obstruction and sepsis. Regular follow-up ensures complete resolution and prevents recurrence.

AUTOMATED PNEUMONIA IDENTIFICATION THROUGH CNN-BASED ANALYSIS

Pneumonia, a condition caused by infectious agents such as bacteria, viruses, fungi, or parasites, results in lung infections and the accumulation of pus in affected tissues. Incorrect diagnosis or improper treatment can significantly impact a patient's quality of life. This project focuses on the precise identification and categorization of pneumonia-afflicted patients through the analysis of their chest X-rays. Leveraging advancements in deep learning, healthcare experts can make more accurate diagnostic decisions for various illnesses. This study presents an innovative approach utilizing Convolutional Neural Networks (CNN) to predict and distinguish between patients affected by pneumonia and those who are not, based on chest X-ray images. The methodology involves a series of convolutional and max pooling layers activated using the ReLU activation function. Subsequently, the processed data is passed through dense layers, culminating in the activation of the output neuron through the sigmoidal function. During the training process, the model exhibits increasing accuracy and decreasing loss, demonstrating its effectiveness. To prevent overfitting, data augmentation techniques are applied before model fitting. These strategies collectively enhance the robustness and reliability of the deep learning models, resulting in accurate and persuasive detection of pneumonia from chest X-ray images. Keywords: Pneumonia, CNN, VGG-16, VGG-19, Chest X-rays, Classification, Deeep learning, Data augmenatation, ReLU, softmax.

Periodontal Abscess Occurrence Post Wire Splint Therapy on Mobile Teeth

Tooth mobility is one of the cases of periodontal disease caused by the destruction of the bone that supports the teeth. Stabilization of loose teeth using splinting wire can be one of the treatment options. The use of splinting wire may increase plaque accumulation and is sometimes difficult to clean. Plaque accumulation will cause bacterial invasion into the surrounding tissues of the periodontal pockets which will eventually develop into an inflammatory process. As time goes by, connective tissue destruction and pus formation will occur which eventually leads to a periodontal abscess. Periodontal abscess is a localized accumulation of pus in the gingival wall of a periodontal socket with periodontal tissue destruction. The purpose of this case report is to report the incidence of periodontal abscess after wire splinting application in a case of tooth unsteadiness. A 76-year-old female patient came to RSGM with complaints of feeling uncomfortable because some of her teeth were loose. The complaint has been felt approximately 1 year ago. The complaint was accompanied by pain when used to eat and toothbrushing. Objective examination showed reddish gingiva, rounded interdentals, soft consistency, and unstippling texture on the labial and lingual side of teeth 33, 32, 31, 41, 42 and 43 with BOP (+) at all points. The patient's Oral Hygiene Index (OHI) was 2.16 and PI was 18.67%. Probing depth average was 3 mm, recession was 3 mm, and tooth decay was grade 2. Supportive examination showed horizontal bone destruction in the anterior region of the mandible. The first visit was carried out wire splinting on the lingual part of the loose tooth, at the time of control there was a periodontal abscess on the labial side so the splinting was moved to the labial side. The increase in socket depth and the appearance of periodontal abscesses are caused by plaque accumulation which eventually makes bacteria invade the periodontal tissue. Periodontal therapy really needs to pay attention to the patient's OHI, therefore plaque control and removal of bacterial deposits must be carried out by scaling and root planning regularly and carrying out other periodontal therapies such as curettage if tissue destruction is severe enough

Assessment of Surgical Outcome of Trocar versus Blunt Dissection Technique for Intercostal Drainage Insertion: A Prospective Interventional Study

Introduction: Chest tube insertion is a common procedure designed to alleviate the accumulation of air, fluid, pus, or blood in the pleural cavity. Despite being a bedside procedure often performed by emergency residents, Intercostal Drain (ICD) tube insertion carries associated risks, if not executed with care. Complications such as misplacement, organ injury, bleeding and pain are noteworthy concerns. Aim: To assess surgical outcome of Trocar versus Blunt dissection technique for ICD insertion. Materials and Methods: The present prospective interventional study was conducted in the Department of General Surgery, M S Ramaiah Hospitals, Bengaluru, India, from September 2018 and August 2020, with a sample size of 64 after obtaining Institutional Ethical Committee approval. Patients requiring ICD insertion were divided into two groups: Blunt (group A) and Trocar (group B) dissection, with 32 participants in each group. Demographic, clinical and diagnostic data were meticulously documented. Statistical analyses, including descriptive statistics, t-tests and Chi-square test, were employed to compare variables such as insertion time, complications and pain scores. Both groups were assessed for the time required for insertion and complications with each method during and after the procedure. Results: The mean age among subjects with the Blunt dissection method and Trocar method was 45.53±14.85 years and 45.06±10.46 years, respectively. In the Blunt dissection technique, 6 (18.8%) were females and 26 (81.3%) were males, while of those who underwent the Trocar method of insertion, 7 (21.9%) were females and 25 (78.1%) were males. The present study findings revealed that the Trocar method demonstrates comparable surgical outcomes to the Blunt dissection method. Trocar insertion proves notably quicker, especially in obese patients. The time taken for insertion was significantly longer (p-value&lt;0.001) with the Blunt dissection method (17.53±8.835 min) compared to the Trocar method (2.31±0.998 min). Significantly more pain was experienced by patients with the Blunt dissection method compared to the Trocar method on day 1 (p-value&lt;0.001). There was no statistically significant difference found between Visual Analog Scale (VAS) score and method of insertion postprocedure. There was a statistically significant difference found between malposition and method of insertion. With the conventional method of insertion, 43.8% of patients had malposition, whereas with the Trocar method of insertion, 18.8% had malposition. Postprocedural complications, including bleeding and infection rates, were comparable between the two methods. Conclusion: In conclusion, the Trocar method exhibits similar surgical outcomes to the Blunt dissection method, with added advantages of reduced insertion time and reduced malposition. Proper training plays a pivotal role in mitigating potential complications, making the Trocar method a clinically viable option for ICD procedures.

Laporan Kasus: Pyometra Pada Anjing Ras Labrador

Pyometra is one of the important causes of infertility in female animals, including dogs. Pyometra is accumulation of pus in the uterus caused by bacteria that are normally in the uterus but in certain circumstances become pathogens due to hormonal influences. This case report aims to determine the etiology, clinical symptoms, diagnosis, prognosis and treatment of pyometra disease in dogs. The examination method that is carried out is physical examination and investigations, hematology, blood chemistry, and ultrasound. Based on a physical examination in the form of inspection of the lesions on the vulva and abdominal enlargement. Palpation of the mesogastrium and hypogastrium is the presence of abdominal tension. Hematologic results show leukocytosis, neutrophilia, and hyperchromic normocytic anemia. Blood chemistry examination results showed azotemia, increased AST, ALP and GGT. Ultrasound examination results show that an anechoic period is accumulation of uterine fluid and thickening of the uterine wall. The diagnosis of this case is pyometra. The therapy performed is ovariohisterectomy surgery. After surgery animals were given medicines including Cephalexine, Meloxicam, Ursodeoxycholic acid, and S-adenosylmethionine (SAMe). On the sixth day the animal surgery post improves again and is allowed to be taken home.

Incision and Drainage Versus Needle Aspiration for Peritonsillar Abscess: A Prospective Randomized Controlled Trial

Background and Objectives Peritonsillar abscess (PTA) is an accumulation of pus between the palatine tonsil and pharyngeal constrictor muscle. It is a common cause of emergency on-call consultations among ENT doctors and occurs due to the possibility of sepsis, airway obstruction, and progression to deep neck infection. This study aims to compare the effectiveness of needle aspiration (NA) to incision &amp; drainage (I&amp;D) for the treatment of PTA.Subjects and Method From September 2018 to March 2020, 58 patients with PTA were admitted to our ENT Department. After a comprehensive diagnostic procedure, 38 patients were enrolled in the study and they underwent either I&amp;D (20 patients) or NA (18 patients) treatment. Patients were discharged when edema decreased on the endoscopic findings and their symptoms improved, with a visual analogue scale (VAS) score &lt;3 points. For each patient, we evaluated the abscess volume, age, body mass index, hypertension, diabetes mellitus, smoking and drinking history, abscess size, and duration of hospitalization. White blood cell (WBC) count, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) were estimated on the 1st, 3rd, and 5th days of hospitalization.Results The mean age of participants was 42.8±15.5 years and 40.3±14.7 years in the I&amp;D and NA groups, respectively. Except for ESR, the mean hospitalization duration, initial volume of abscess size, VAS pain score, WBC count and the CRP level were not different between the groups.Conclusion Our study revealed no significant differences in hospital stay duration, VAS score, WBC counts or in the CRP level among patients admitted for PTA, whether they underwent I&amp;D or NA.

Cholecystitis Complication : Gallbladder Empyema and Hydrops

Acute cholecystitis, or acute inflammation of the gallbladder, is commonly caused by gallstone obstruction. The two major complications that can arise are empyema and hydrops of the gallbladder. Gallbladder empyema is defined as the accumulation of pus in the gallbladder, resulting from prolonged bacterial infection. On the other hand, hydrops of the gallbladder is a condition where serous fluid accumulates in the gallbladder, typically due to chronic obstruction. This article provides an overview of both conditions, including their etiology, clinical manifestations, pathophysiology, diagnosis, and treatment. Emphasis is placed on the importance of early diagnosis and appropriate management to minimize morbidity and mortality. The prognosis for hydrops and gallbladder empyema is influenced by factors such as age and underlying health conditions.

Quantitative investigation of the bacterial content of periodontal abscess samples by real-time PCR

ObjectivesPeriodontal abscesses, which are part of the acute periodontal disease group characterized by the destruction of periodontal tissue with deep periodontal pockets, bleeding on probing, suppuration, and localized pus accumulation, cause rapid destruction of tooth-supporting tissues. This study aimed to evaluate the microbial content of periodontal abscesses by specific and culture-independent qPCR. MethodsThis study was conducted on 30 volunteers diagnosed with periodontal abscesses and presenting with complaints of localized pain, swelling, and tenderness in the gingiva. Genomic DNA was isolated from the samples taken. Escherichia coli bacteria were used for the standard curve created to calculate the prevalence of target bacteria in the total bacterial load. 16S rRNA Universal primers were used to assess the total bacterial load and prevalence. Bacterial counts were analyzed with Spearman's rank correlation coefficients (ρ) matrix. ResultsFrom the analysis of Real-Time PCR, Porphyromonas gingivalis (30, 100%), Prevotella intermedia (30, 100%), and Fusobacterium nucleatum (30, 100%) were detected in all samples. Campylobacter rectus (29, 96.6%), Porphyromonas endodontalis (29, 96.6%), Tannerella forsythia (28, 93.3%), Filifactor alocis (28, 93.3%), and Actinomyces naeslundii (28, 93.3%) were also frequently detected. ConclusionsPeriodontal abscesses were found to be polymicrobial, and not only periodontal pathogens appeared to be associated with the development of periodontal abscesses. The presence, prevalence, and number of Porphyromonas endodontalis and Propionibacterium acnes in the contents of periodontal abscesses were determined for the first time in our study. Further studies are needed to better understand the roles of bacteria in periodontal disease, including abscesses.

Clinical Profile and Outcome of Children with Empyema Thoracis in Tertiary Hospital

Introduction: Empyema thoracis (ET) is an accumulation of pus in the pleural space. It is a common condition in childhood having significant morbidity and mortality. The clinical manifestations of empyema are high grade fever with chills and rigors, cough, breathlessness, chest pain. The present study analyses the epidemiological aspects of the disease, etiological agents, clinical features and associated lesions in diagnosis of empyema and the outcome of early Video-assisted thoracoscopic surgery (VATS) on morbidity of disease in children.&#x0D; Objectives: To study various demographic characteristic and to evaluate various management strategies and outcome in children with empyema thoracis.&#x0D; Methodology: This is a prospective hospital based observational study, conducted at Nobel Medical College Teaching Hospital Biratnagar, from December 2021 to November 2022. All children in the age group of 1month to 16 years diagnosed pyogenic empyema by lights criteria during the study are included in the study. Children below 1 month of age and pleural effusion not meeting the criteria for exudative pleural effusion by Light's criteria are excluded from the study.&#x0D; Results: Majority of the study population are in the age group of &gt;5 years. Males are more common than females. Most common clinical feature was fever followed by cough, chest pain and shortness of breath. Culture is positive in 68% out of which 32% is staphylococcus aureus, 20% is mycobacterium tuberculosis ,16% is streptococcus pneumonia. Duration of illness is &lt;1week in 48% of the children, 1-2weeks in 40% and &gt;3weeks in 12% of the children. In 80% of the children there is unilateral involvement in the x- ray chest. In the children who are uncomplicated all of them had intercoastal chest tube drain (ICD) usage,76.4% had urokinase therapy and 5.8% had undergone thoracotomy and none of them had need for surgery. In the children with complication 87.5% had ICD usage and urokinase therapy,25% of them had undergone thoracotomy and 12.5% had need for surgery.&#x0D; Conclusion: Empyema thoracis is more commonly seen in the males of the group&gt;5 years with duration of illness &lt;1 week maned mostly by ICD usage, where there was mostly unilateral involvement in x ray chest.

Percutaneous management of complicated empyema thoracis using pigtail, report of a case from University Hospital of Nepal: a case report.

A 66-year-old female presented with complaints of cough, fever, and chest pain. A clinical examination was done and relevant investigations were sent. She was then treated in the line of left-sided empyema thoracis. A pigtail catheter was inserted into the loculated empyema via the left 9th intercostal space through a posterolateral approach with ultrasonography guidance. The main aim of this article is to provide an overview of a rare management approach for empyema, a condition characterized by the accumulation of pus in the pleural cavity of the lungs. In this case report, the authors have focused on pigtail catheter drainage over traditionally performed chest tube drainage, and image-guided drainage has been performed over blind drainage ensuring accurate placement and reducing the risk of damage to surrounding tissues. Another notable change in empyema management is the shift in drainage sites from the safety triangle to other sites based on the site of loculations under ultrasonography guidance.

ABSES SUBMANDIBULA

The purpose of this literature review is as an additional reference in diagnosing and managing submandibular abscess. The writing of this article was obtained from various sources in the form of books, scientific journals and guidelines for related institutions. Source searches were carried out on various online portals such as Medscape, NCBI Google Scholar and other health websites. Submandibular abscess is an inflammation accompanied by accumulation of pus in the potential space between deep neck fascia which is an anatomically very complex space. Nearly all odontogenic infections that cause abscesses are caused by a mixture of aerobic and anaerobic microbes. Necrosis of the dental pulp as a result of deep caries provides an entry channel for bacteria into the periapical tissues. After periapical inoculation of bacteria, infection develops which will spread in all directions, but more in areas of lowest resistance. The main priority for deep neck abscesses is to maintain airway patency, followed by intravenous antibiotics and then surgical drainage.

Piometra em cadela de 10 meses: Relato de caso

Pyometra is a potentially fatal infectious pathology that affects the endometrium of female dogs, characterized by the accumulation of pus in the uterine lumen. In general, this pathology occurs in the period of diestrus, due to the ascending bacterial infection that finds a favorable environment for its multiplication in the endometrium that has suffered cystic hyperplasia as a result of the cumulative and prolonged stimulus of female hormones. Normally, it does not have a racial predisposition and affects more middle-aged and elderly animals, from the 4th estrous cycle onwards. Young animals rarely present this pathology and, when it occurs, it is usually associated with the use of exogenous progestogens. The objective of this work is to report the case of a female English Bulldog, 10 months old, who did not use exogenous progestogens, diagnosed with pyometra. The patient was attended to by the Veterinary Hospital of the Federal Rural University of Rio de Janeiro with a mucohemorrhagic vulvar discharge for 24 hours. According to the tutor, the bitch had presented her first heat 13 days before the appointment. In the general physical examination, the patient presented clinical parameters within normal limits, with the exception of temperature (fever), respiratory rate (tachypnea), heart rate (tachycardia), and blood lactate (increased). Due to the presence of systemic inflammatory response syndrome (tachypnea, tachycardia and fever) associated with a possible infectious focus, a complete blood count and renal and hepatic serum biochemistry were requested. In the hemogram, neutrophilic leukocytosis was evaluated, indicating an inflammatory/infectious process and, in the serum biochemistry, hepatic dysfunction was observed. Abdominal ultrasonography was also performed to assess the presence of anechoic content within the uterine horns, suggestive of pyometra. The patient was then referred to surgery for an ovariohysterectomy where the infectious focus was removed. Then, sterile uterine material was collected for culture and antibiogram, obtaining a positive result for two types of bacteria, Streptococcus sp and non-fermenting Gram-negative Rod. Antibiotics, non-steroidal anti-inflammatory drugs and analgesics were prescribed postoperatively, in addition to daily bandage, surgical clothing and protective collar. There were no intercurrences in the trans or postoperative period of the patient, who had no recurrence of clinical signs, and was discharged 10 days after surgery.

A POST SURGICAL STENT FOR MANDIBULAR MULTILOCULAR CYST–A CASE REPORT

Cyst is a pathological cavity filled with fluid, semifluid or gaseous content lined by epithelium and not created by the accumulation of pus. Cysts of the jaws are treated by enucleation and marsupialization. After the removal of the cyst, space-occupying stent is fabricated for faster healing and patient comfort. Stents are appliances constructed to cover the tissues or the teeth for their protection, to carry medicaments, radium material, to control bleeding, to determine radiographically the prospective site of dental implant. Stents are used for shaping the alveolar process or positioning of gingival tissues. It enhances faster healing of the wound by preventing food impaction. We are reporting a case of mandibular multilocular cyst that was treated by enucleation and post-surgical stent.

Intrapulmonary Use of Hydrogen Peroxide in Respiratory Obstruction: Initial Results Demonstrate the Possibility of Airway Recanalization and Blood Reoxygenation through the Lungs: An Update

It is reported that the interaction of hydrogen peroxide and sodium bicarbonate solution with thick sputum, mucus, pus and blood clots leads to their rapid transformation into a fluffy oxygenated foam. This mechanism of action allows repurposing hydrogen peroxide from antiseptic to expectorant and oxygen forming antihypoxant, which can find application for recanalization of airways and increasing blood oxygenation in acute respiratory syndrome. It is reported that acute respiratory distress syndrome in COVID-19 can be caused by excessive accumulation of thick sputum, mucus and pus in the airways, which complicates intra-pulmonary oxygenation of blood, causes hypoxia and causes death, since there are no drugs for urgent recanalization of the airways today. At the same time, the first evidence emerged that alkaline hydrogen peroxide solution can claim to be an inhaled expectorant and oxygen-producing drug for urgent recanalization of the airways when they are blocked by mucus, sputum, pus, blood and other colloidal fluid containing the enzyme catalase.

Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report

BackgroundPerigastric abscess caused by delayed perforation after endoscopic submucosal dissection is a very rare complication. In principle, delayed perforation after endoscopic submucosal dissection is treated surgically. Herein, we report a case of perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection that was treated conservatively, without perforation closure, and in which the patient was discharged from hospital in a short period.Case presentationA-74-year-old Asian man was diagnosed with having early gastric cancer on follow-up endoscopy and was admitted to our hospital for endoscopic resection. Endoscopic submucosal dissection was performed without intraoperative complications. On postoperative day 2, the patient complained of a slight abdominal pain localized to the epigastric region and a small amount of melena. A computed tomography scan revealed the presence of free air in the peritoneal cavity, and a little fluid collection abutting the dorsal area of the stomach. An endoscopy examination showed a deep ulcer with the accumulation of pus, suggesting a perforation in the post-endoscopic submucosal dissection ulcer. We diagnosed a perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, and opted for conservative treatment, leaving the perforation site open to allow spontaneous drainage from the abscess into the stomach. A follow-up computed tomography scan revealed an encapsuled and localized perigastric abscess on postoperative day 5, and the disappearance of the free air and the regression of the perigastric abscess on postoperative day 7. A follow-up endoscopy examination on postoperative day 7 showed the closure of the perforation. Finally, surgery was avoided, and the patient was discharged on postoperative day 14, after a relatively short hospital stay.ConclusionRegarding the treatment of perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, leaving the perforation site open to allow spontaneous drainage may shorten the conservative treatment period.

Pyogenic liver abscess following endoscopic retrograde cholangiopancreatography procedure for choledocholithiasis

Pyogenic liver abscess (PLA) is a condition in which there is pus accumulation in the liver. It usually develops in the context of portal pyemia, through hematogenous seeding as well as via biliary disease. PLA is a rare, but important complication following biliary instrumentation such as endoscopic retrograde cholangiopancreatography (ERCP). We report a case of a 44-year-old man who initially presented with clinical features of ascending cholangitis. Laboratory investigations revealed leukocytosis as well as hyperbilirubinemia. Diagnosis of choledocholithiasis was then confirmed with an ultrasound examination, showing a 1×1 cm stone in the common bile duct. ERCP was performed and achieved stone clearance. However, the patient returned 1 month later with similar symptoms of right upper quadrant pain, fever and jaundice. Suspecting recurrent choledocholithiasis, an emergency ERCP was performed and showed pooling of radio-opaque contrast in the extra-biliary space. There were also multiple CBD stones seen. An urgent CT Abdomen was done and revealed multiple liver abscesses in bilateral liver lobes, with the largest measuring 4.5x5.9x2.1cm. The patient was treated conservatively with Augmentin and repeat ultrasound at 4 weeks interval showed no residual liver abscess.

Iatrogenic Causes of Cardiac Tamponade Resulting From Surgical Procedures: An Overview.

Cardiac tamponade is one of the most severely life-threatening emergencies encountered, mainly because of its significant impact on the pumping capacity of the heart by compressing the cardiac chambers due to the rapid accumulation of blood, fluid, pus, or clots in the pericardial sac. These accumulations may be collected following traumas, malignancies, uremia, and many other medical conditions as well as surgical procedures. Numerous errors and medicolegal aspects have been identified in diagnosing and treating cardiac tamponade associated with cardiac-related procedures such as valve replacement surgeries, cardiac pacemaker implantation, pericardiocentesis, and other non-cardiac related procedures such as peri-hiatal surgeries. Patients taking anticoagulants or anticancer medications are especially susceptible to developing cardiac tamponade when undergoing surgical procedures, raising the question of preoperative screening to avoid errors. Misdiagnosis, treatment delay or failure to deliver the utmost quality of treatment, lack of complication screening and follow-ups for those at risk, surgeons rushing to complete cases, burnout, and other human factors are predispositions to the development of cardiac tamponade. Fortunately, most of these errors occurring within healthcare settings are avoidable and must be prevented for eliminating any risks toreduce the incidence and mortality of cardiac tamponade cases resulting from iatrogenic etiology. It is an intricate condition where precision and caution are crucial.