Bloody Secretions Research Articles

An unexpected bronchoscopic finding possibly induced by extracorporeal membrane oxygenation: A case report of bronchial Dieulafoy disease.

Bronchial Dieulafoy disease (BDD), a rarely reported disease, comes from dilated or abnormal arteries under the bronchial mucosa. Patients with BDD are generally asymptomatic so this disease is frequently misdiagnosed. However, the submucosal arteries may dilate and rupture for various reasons, leading to recurrent respiratory tract bleeding and potentially life-threatening conditions. With the change of reversible factors such as intravascular pressure, the arteries may return to normal, allowing patients to recover to an asymptomatic state. This phenomenon has not been mentioned and concerned in previous studies, but it may have important implications for our correct understanding of this disease. A 44-year-old female was admitted to intensive care unit with recurrent malignant arrhythmias. With the assistance of VA-extracorporeal membrane oxygenation (ECMO), both her vital signs and internal environment were all gradually stabilized. However, she had been experiencing recurrent respiratory tract bleeding. While removing the bloody secretion with a fiber bronchoscopy, a congested protruding granule on the wall of the patient's left principal bronchus was found. The patient was diagnosed with BDD and the granule was thought to be an abnormal artery of BDD. For the patient's condition, we did not implement any targeted interventions with the abnormal artery. After the weaning of VA-ECMO, the patient's granule could not be found and the bleeding had also disappeared. She gradually weaned off the mechanical ventilation and was transferred to the Department of Cardiology. Then the patient was discharged after her condition stabilized. In more than half a year, the patient is in a normal physical condition. The appearance and disappearance of abnormal artery is an interesting phenomena of BDD. The change of intravascular pressure due to various causes such as VA-ECMO may be the primary factor of it.

Clinical Features of iatrogenic Pharyngo-esophageal perforation in very low birth weight infants

BackgroundIatrogenic pharyngoesophageal perforation (IPEP) is one of the complications of gastric tube insertion and it tends to occur more frequently in premature infants. Although the frequency is significantly low, attention should be paid as it can lead to serious outcomes with high mortality. This study will help raise awareness with respect to early diagnosis, management, and prevention. MethodsWe performed a retrospective cohort study of all very low birth weight infants diagnosed with IPEP between 1993 and 2022. ResultsA total of 6 patients (0.27% of very low birth weight infants) with the diagnosis of IPEP were included. The median gestational age was 27 + 1 weeks (range 23+5–28 + 6 weeks), and the median birth weight was 823 g (range 630–1232 g). Symptoms included difficulty with gastric tube insertion, bloody secretions in the oral cavity, and increased oral secretions. X-rays revealed aberrant running of the gastric tube in all patients. In three cases, contrast studies demonstrated contrasted mediastinum tapering like a bead. Laryngoscope was used to view the perforation sites but this was not useful in the smallest patient. All patients were treated conservatively with antibiotics and survived. ConclusionsWhen inserting a gastric tube for premature infants, it is critical to remember that these infants are at risk of IPEP. In addition to a frontal X-ray, a lateral X-ray and contrast study may be useful for early diagnosis.

Extragenital transmissible venereal tumor in dog: case report

Transmissible venereal tumor (TVT) is a round cell neoplasm that affects dogs, mainly with access to the street, because tumor implantation happens during coitus or by intimate social interaction with another sick canid. It mainly affects the genital region, but there are extragenital reports. Thus, this work aims to report a case of TVT in the eyelid and cervical region of a dog, male, non-castrated, adult, SRD, with access to the street, without previous history, positive for cynomosis, which presented ectoparasites, penile bloody secretion with bulb volume increase, nodular tumor ulcerated in cervical region, left eye with third eyelid volume increase and some small nodules in upper eyelid. Through cytology and histopathology, TVT was diagnosed in the samples analyzed. For treatment, five sessions of chemotherapy with Vincristine sulfate were carried out, which the animal responded with an improvement in clinical signs one week after the first session. Therefore, the importance of cytology and histopathology for diagnostic confirmation of TVT and of care in the analysis of ocular and skin tumors is emphasized, because, even if the occurrence of this neoplasia is common only in the genital region, it can present itself in other locations.

Fístula cardiocutânea com corpo estranho em ventrículo direito: complicação tardia e rara do uso de cateter venoso central de inserção periférica

INTRODUCTION: Foreign bodies in the heart are rare and a small number of cases are reported about this event. There are different mechanisms by which objects can reach a cardiac chamber and cause myocardial perforation, so an individualized diagnostic approach must be taken to define the management of these cases. OBJECTIVES: To report the case of a five-year-old pediatric patient with a cardiocutaneous fistula caused by a caused by a fragment of a peripherally inserted central catheter (PICC) in the right ventricle (RV). CASE REPORT: A 5-year-old male patient with a history of blunt chest trauma due to a fall from his own height a year ago, followd by a chest wall abscess, after 20 days. After drainage, a recurrent outflow of serous and bloody secretion from the lesion persisted. Eleven months after the event, the patient started to present daily high fever, local hyperemia, and increased drainage secretion. The diagnostic investigation showed an Intracardiac foreign body with the presence of a cardiocutaneous fistula. Due to the past of peripherally inserted central catheter (PICC) during the neonatal period, it is believed that the catheter fragmented and remained asymptomatically lodged in the RV, with exteriorization through the skin after 5 years. CONCLUSION: Cardiocutaneous fistula caused by a foreign body in the heart is a rare event and may be caused by fracture and migration of a PICC. The diagnosis must be made through a detailed clinical history, aligned with adequate imaging exams.

Abstract 13671: A Case of Diffuse Alveolar Hemorrhage While on Systemic Anticoagulation for Impella

A 57 year old male with PMH of non-ischemic cardiomyopathy (EF 30%), atrial fibrillation, and VT s/p ICD was admitted to the cardiac intensive care unit for cardiogenic shock. His condition deteriorated necessitating Impella 5.5 implantation as bridge to cardiac transplant. Systemic heparin was started per Impella protocol with a lower anti-Xa goal of 0.2 - 0.3 given post-op bleeding at the R axillary Impella site. Five days post Impella placement he developed bloody secretions from the endotracheal tube requiring multiple blood transfusions and discontinuation of systemic heparin, while maintaining heparin purge. Labs were notable for anti-Xa 0.22, hemoglobin 9.7, and platelets 221. CT Chest demonstrated parenchymal opacities concerning for diffuse alveolar hemorrhage (DAH) which was confirmed via bronchoalveolar lavage; he had no known history of lung disease. High-dose corticosteroids were administered as a high ANA titer (1:128) and low C3 suggested capillaritis. However, decreasing ANA (1: 320) and a negative autoimmune workup decreased the likelihood of a rheumatologic cause for DAH and steroids were discontinued. DAH secondary to acquired von Willebrand syndrome (aVWS) was considered, but factor VIII and vWF activity levels were normal. The bloody secretions improved with inhaled thromboxane and systemic heparin was restarted. Orthotopic heart and kidney transplant was performed with subsequent Impella removal 104 days after Impella placement. Discussion: We present the first documented case of DAH with isolated Impella 5.5 support. Previously reported cases of DAH post-Impella were observed in patients with concurrent ECMO or RVAD. As autoimmune and coagulopathic causes of DAH were excluded, bland DAH secondary to systemic anticoagulation is most likely in this case. This raises a question about how to balance the risk of bleeding with the risk of device thrombosis, stroke and embolic events and when to switch from heparin to sodium bicarbonate purge.

School Examination Stress Precipitating Hematohidrosis in a Girl

Background: Hematohidrosis is a rare clinical disorder characterized by transient, self-limited bleeding from the eccrine sweat glands through intact skin in the absence of an underlying bleeding disorder. Clinical Description: We report a 10-year-old girl who presented with a history of bleeding from the dorsum of her right hand. The child has had recurrent episodes in the past. Many of the episodes were temporally related to her school examination. She did not have any other bleeding manifestations or susceptibility to bruising. Her general condition and systemic examination were unremarkable, and the skin underlying the bleeding site was normal and healthy. All investigations related to bleeding and coagulation parameters were within normal limits. Skin biopsy showed normal histology. Having ruled out all organic causes of bleeding, the typical history of transient episodes of bloody secretions from the skin, triggered by examination stress and normal skin histology, was consistent with a diagnosis of hematohidrosis. Management: The child responded dramatically to oral propranolol with a subsequent reduction in the frequency of the bloody sweating episodes, even during stressful times. Psychological counseling was also provided. Conclusion: In a child presenting with oozing of blood from the skin, a possibility of hematohidrosis may be considered, when all causes of bleeding diathesis have been ruled out by a thorough workup. Pediatricians need to counsel both parents and the child regarding the benign nature of the condition.

Bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis

Objective: To analyze the bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis. Methods: Clinical data of patients with pulmonary mucormycosis undergoing bronchoscopy and interventional therapy in 4 tertiary general hospitals in China from May 2006 to May 2022 were retrospectively analyzed and the literature on the subject were reviewed. Results: The data of 10 patients with pathologically diagnosed pulmonary mucormycosis undergoing bronchoscopy and interventional therapy were collected, including 8 males and 2 females. The patients' age ranged from 21 to 72 (44±15) years. The underlying diseases included 6 cases of diabetes ketoacidosis, 3 cases of leukemia, 1 case after operation of lung cancer. Bronchoscopy showed that white viscous necrotic matters grew along the airway and blocked the airway in 9 cases, accompanied by airway bleeding in 3 cases, bloody secretion blocked the airway in 1 case, and bronchopulmonary cavity fistula in 2 cases. The biopsy histopathology of white necrotic matters showed that many mucor filaments were tangled together which were named mucormycelium. Among the 10 patients, 9 were treated with systemic drugs, including intravenous application of amphotericin B deoxycholate in 5 cases, intravenous application of amphotericin B liposome in 4 cases, oral posaconazole in 6 cases and intravenous injection in 1 case. Local drug therapy included aerosol inhalation of amphotericin B deoxycholate in 8 cases and local perfusion under bronchoscope in 5 cases. Bronchoscopic interventional therapy was used to remove mucormycelium in the bronchus, including cryotherapy in 8 cases, biopsy forceps in 7 cases, snare treatment in 2 cases and foreign body forceps in 2 cases. All 10 patients were clinical cured and with no death. Conclusions: Pulmonary mucormycosis is more common in immunocompromised hosts. Bronchoscopy often showed mucormycelium blocking the airway. Systemic and local drug therapy combined with bronchoscopic interventional therapy can achieve good clinical efficacy.

CHARACTERISTICS OF THE COURSE OF THE GESTATION PERIOD, CHILDBIRTH AND NEWBORN CONDITION IN PATIENTS AT THREAT OF PREGNANCY TERMINATION IN EARLY TERMS

Despite the successes of modern obstetrics and perinatology, stillbirth occupies one of the leading places inthe structure of perinatal morbidity and mortality. Today, every 5-6 women lose a pregnancy, and the majority of spontaneous miscarriages occur in the 1st trimester of pregnancy.The aim of the study is to examine the peculiarities of the course of the gestation period, childbirth and the condition of newborns in patients with a threat of early termination of pregnancy.Materials and methods. We carried out a retrospective analysis of 100 individual charts of pregnant and parturient women with a threat of abortion in the 1st trimester of pregnancy (the main group). In 40 patients (subgroup I), the threat of termination of pregnancy was accompanied by bleeding, in 60 – the threat of termination without bleeding was diagnosed (subgroup II).The control group consisted of 50 pregnant women with the physiological course of the first trimester of pregnancy. Statisticalanalysis was performed according to generally accepted methods of variational statistics. Reliability was assessed by Student's t-test.Differences were considered significant at a significance level of p≤0.05.The conduct of research was approved by the Ethics Committee of the BSMU, which is confirmed by the protocol of the Commission on Biomedical Ethics regarding the observance of moral and legal rules for conducting medical scientific research.Processing of personal data was carried out after receiving the patient's informed consent.Results and their discussion. The research groups were representative in terms of residence, social status, and education. Menstrual and reproductive anamnesis data in the main and control groups also did not differ significantly. The rate of spontaneous abortions and terminations of pregnancy according to medical indications was significantly higher in women with threatened termination of pregnancy both with and without bleeding compared to controls. Patients of the main group had a significantly higher history of both gynecological diseases and extragenital pathology.Pregnant women with retrochorial hematoma and bleeding accounted for 70%, in 30% of women in the 1st trimester of pregnancy, in the presence of bloody secretions, retrochorial hematoma was not diagnosed. The percentage of asymptomatic retrochorial hematomas was 15%. Anomalous location of the chorion in the 1st trimester of pregnancy was diagnosed much more often in the 1st and 2nd subgroups.The analysis of the further course of pregnancy in women with episodes of miscarriage in the early stages of gestation showed that in the main group the level of perinatal complications, such as the threat of premature birth (30%), placental dysfunction (38%), preeclampsia (11%), fetal distress (20%), SZRP (19%) was significantly higher. Accordingly, the rates of premature birth (13%), fetal distress (25%), and labor anomalies (10%) were higher in childbirth.When analyzing the condition of children at birth, the level of moderate asphyxia in the main group was higher than in the control group (8±2.7% and 0%, respectively). The average weight of full-term newborns in the study group was significantly lower (3020.0±21.4) than that of children in the control group (3685.0±28.1 g) (p<0.05).Conclusions.Pregnant women with a threat of miscarriage in the first trimester of pregnancy are a high-risk group for the occurrence of perinatal complications.The level of complications in the II and III trimesters of pregnancy is significantly higher if the threat of early termination of pregnancy was accompanied by bleeding.In pregnant women with bleeding earlier (up to 8 weeks), compared to patients with bleeding at 9-13 weeks, the frequency of threatened miscarriage in the II trimester of pregnancy, premature birth, placental dysfunction, preeclampsia, and SZRP was significantly higher.

Real-World Experience of Direct Oral Anticoagulant Use in a Single Pediatric Center

Background: Pediatric venous thromboembolism (VTE), a disease comprising deep venous thrombosis and pulmonary embolism, has increased by 130-220%. Anticoagulation therapy is the mainstay of treatment, and direct oral anticoagulants (DOACs) offer several advantages. Recently, two DOACs (Dabigatran and Rivaroxaban) have been approved for use in children in the United States. Nonetheless, DOACs have been used "off-label” in children on an individualized basis, subject to approval from insurance plans. This study aims to evaluate real-world epidemiological and outcome data from a single-center cohort of pediatric patients treated with DOACs. Methods: In this single-center, IRB-approved study, 54 patients from the pediatric hematology oncology VTE database were identified and analyzed using SPSS statistical software, and a descriptive statistical analysis was conducted. Results: Epidemiological features: Of the 54 patients, 21 (39%) subjects were males, and 33 (61%) were females. Ages ranged from 4 to 22 years, with a mean age of 16.3 years. The majority of the subjects, 94%, were greater than 12 years old. Most (94%) of patients had venous thrombosis, 2% had an arterial thrombus, and 4 % had both arterial and venous. A breakdown of primary thromboembolism location highlights that the majority, 30%, had a pulmonary embolism on diagnosis, and the most common risk factors included obesity, catheterization, and infection (Tables 1 and 2). Of the 54 patients, 11% were started on DOACs as their initial anticoagulation treatment, 82% were switched to a DOAC on follow-up after initial treatment with heparin or low molecular weight heparin; four patients (7%) were started on DOACs after recurrent VTE on another anticoagulant. Twenty-one (39%) patients were on Apixaban, 32 (59%) were on Rivaroxaban, and 1 (2%) was on Dabigatran. One patient transitioned from Rivaroxaban to Apixaban due to an allergic reaction to the medication. Patients were on various durations of therapy ranging from 3 months to an extended duration depending on their clinical status and risk factors. Outcomes on DOACs: One (2%) patient had a major bleeding episode per ISTH definition. This was an episode of tonsillar artery bleeding status post tonsillectomy that required cauterization and surgical mesh placement in the operating room. Of the 33 females, two were premenarchal at the time of anticoagulation; therefore, 4 (13%) had evidence of heavy menstrual bleeding (HMB) that required medical intervention. HMB was identified by patients’ recall of menstrual bleeding; only one patient had a pictorial blood loss assessment chart (PBAC) score. Per ISTH definitions, 5 (9%) had clinically relevant non-major bleeding, including 4 patients with HMB and one additional patient with bloody diarrhea secondary to underlying ulcerative colitis that required medical intervention. One patient (2%) had minor bleeding with bloody secretions from a chest tube resulting in temporary holding of anticoagulantion. Five (9%) had recurrent VTE while on a DOAC (2 were on Apixaban, and 3 were on Rivaroxaban) and were transitioned to other forms of anticoagulation. Conclusion: The bleeding and recurrent VTE rates after DOACs appear comparable to other anticoagulants in pediatric VTE; heavy menstrual bleeding should be investigated in adolescent females. Given the recent approval of DOACs for pediatric patients, additional multi-centered outcome studies are needed to determine recurrence and bleeding risks. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

DISSEMINATED STRONGYLOIDES PRESENTING WITH DIFFUSE ALVEOLAR HEMORRHAGE

DISSEMINATED STRONGYLOIDES PRESENTING WITH DIFFUSE ALVEOLAR HEMORRHAGE

INFLAMMATORY MONOARTHRITIS AS A RARE INITIAL PRESENTATION OF GRANULOMATOSIS WITH POLYANGIITIS

INFLAMMATORY MONOARTHRITIS AS A RARE INITIAL PRESENTATION OF GRANULOMATOSIS WITH POLYANGIITIS

Otitis media with antineutrophil cytoplasmic antibody-associated vasculitis

Objective:To analyze clinical features, diagnosis and treatment of otitis media with antineutrophil cytoplasmic antibody（ANCA） -associated vasculitis（OMAAV）. Methods:This study reported three OMAAV patients and discussed the diagnosis and treatment of OMAAV combined with the recent literature. Results:Two males and one female were included. The age of these three patients ranged from 56 to 72 years. Their characteristics were as follows: ①tympanic membrane with granulation and bloody secretions in two patients; ②progressive bone-conducted hearing loss within a short period of time; ③facial palsy in two patients; ④the laboratory test of ANCA is positive; ⑤conventional treatment of otitis media is ineffective, while glucocorticoid combined with immunosuppressive therapy is effective. Conclusion:OMAAV is a rare disease and prone to misdiagnosis. Early diagnosis and treatment with corticosteroids and immunosuppressants are critical. Invasive tests and surgery during the active phase of OMAAV may aggravate symptoms and should be avoided.

Case report on the localized cutaneous leishmaniasis: intralesional treatment with meglumine antimoniate

Introduction: Leishmaniasis is a contagious disease endemic in Brazil, transmitted by a vector, and its installation and form of presentation depend on the immunological status, location, and type of transmitted protozoan. Objective: A case report of a patient with localized American tegumentary leishmaniasis. Method: Reviews of medical records, analysis of photographic records of diagnostic tests and the evolution of the treatment to which the patient was submitted and literature review were carried out. Case Report: An 85-year-old woman, with a history of a single lesion on the 4 cm right forearm, with raised borders, ulcerated and clean bottom, subcutaneous edema, local pain and heat, pruritus, bloody secretion in small amounts, and no systemic symptoms. The same did not show improvement with the use of ointments (dexamethasone, neomycin, ketoconazole) and lasted for 2 months. The diagnosis of leishmaniasis was confirmed and treatment with intralesional meglumine antimoniate was carried out, with the application of 3 injections with an interval of 15 days. Final considerations: The case reported and the studies surveyed reveal the importance of the new treatment route and show that, although the approach requires specific conditions, such as being a single lesion, it courses with fewer adverse effects, lower cost, and greater safety.

Mastite clínica decorrente de psedouciese em cadela: Relato de caso

The routine in the small animal clinic demands numerous illnesses, knowing about them leads to greater effectiveness of treatment success. The infectious and inflammatory process of the mammary glands is defined as mastitis, which causes changes in the glandular tissue, modifying physical and chemical aspects of the milk. The prognosis is mostly favourable and the treatment is based on broad-spectrum antibiotics, for the main infection, and for the secondary symptoms, non-steroidal anti-inflammatory, non-opioid analgesics. use of warm compresses, drainage of the affected glands, alleviate pain and can be used in a complementary way. In this sense, the present study aimed to evaluate a case of clinical mastitis in a female dog, due to an anterior pseudocyesis process. The work describes the case of a female dog, Poodle, weighing 8.5 kg, 9 years old and complaining of inflammation in the mammary glands. On clinical examination, inflammation of the mammary glands, pain on palpation, hyperaemia, presence of milky and bloody secretion, oedema, and blackened breast colour were observed. Treatment based on anti-inflammatory drugs and antibiotics provides greater ease due to the easy access to these medications, in addition to avoiding the use of hormones. Ovariohysterectomy as a therapeutic measure is the best form of prevention, especially for cases related to pseudopregnancy.

Diffuse Alveolar Hemorrhage: A Rare Fatal Complication of Systemic Lupus Erythematosus (A Report of Two Cases)

We report two Filipino women with systemic lupus erythematosus (SLE) who developed diffuse alveolar hemorrhage (DAH), a rare, life-threatening complication associated with a high mortality rate. DAH should be suspected in patients with SLE presenting with new pulmonary infiltrates, a decline in hemoglobin, hemoptysis, dyspnea, and persistent desaturation. The first patient is 23 years old and was diagnosed with SLE 8 years ago; initially presenting with malar rash, oral ulcers, nephritis, and positive antinuclear antibodies (ANA). She had a poorly controlled disease and was admitted for facial and bipedal edema due to lupus nephritis. She was given 1 gram of methylprednisolone intravenously (IV) for three consecutive days. She then became tachypneic producing bloody secretions, with desaturation and sudden decline in hemoglobin. She was given cyclophosphamide 1 gram IV and referred for plasmapheresis but eventually succumbed. The second patient is 56 years old with generalized body weakness. Laboratory workup showed nephritis, anemia, ANA, low C3, and high anti-dsDNA titers. Pulse methylprednisolone 1000 mg was initiated. However, there was new-onset hemoptysis and desaturation and the patient was intubated. Bronchoscopy revealed diffuse bleeding on the right middle lobe and she eventually expired. Both patients with active SLE nephritis presented in this study died within days of DAH diagnosis. Hence, aside from early recognition to improve outcomes we should anticipate its possible occurrence in patients with high disease activity.

Effect of minimally invasive premeasured suctioning on airway mucosal injury and suction-induced stress among mechanically ventilated neonates: A clinical challenge for nurses

PurposePerforming ETS to fragile neonates presents a clinical challenge and a dilemma facing nurses. The challenge is how to clear secretions successfully without causing complications. This study aimed to investigate the effect of Minimally Invasive Premeasured Suctioning (MIPS) on airway mucosal injury and suction-induced stress among mechanically ventilated neonates. Designand methods: A quasi-experimental, two groups, pre-post-test study was carried out in the NICU of University Specialized Hospital in Smouha, Alexandria. Sixty mechanically ventilated neonates were randomly assigned to two equal groups. A suction catheter was inserted into the Endotracheal Tube (ETT) until it reached the measured length then the negative pressure was applied. ResultsThe majority of neonates who received MIPS (83.3%) had no airway mucosal injury (clear secretion), while 44.4% of neonates in the deep suctioning group developed severe airway mucosal injury (bloody secretion). Moreover, 71.1% of neonates who received deep ETS developed a high-stress level compared to only 10% of the neonates in the MIPS group. ConclusionMeasuring the exact depth of suction catheter insertion effectively reduced airway mucosal injury and the subsequent level of stress among mechanically ventilated neonates.

Efficiency of laryngeal mask airway ProtectorTM and i-gel® as a conduit in Aintree catheter-guided fibreoptic tracheal intubation: a randomised clinical trial.

Fibreoptic intubation through a supraglottic airway device (SAD) is recom-mended in difficult airway management algorithms. The Difficult Airway Society published a guideline describing the details of this technique in 2011. This study was designed to compare the efficiency of two different 2nd generation SADs as a conduit for Aintree catheter-guided fibreoptic tracheal intubation. 80 adult patients with an ASA score of 1-3 undergoing elective surgical procedures were included in the study. The patients were intubated after randomization to two groups: the i-gel group and the laryngeal mask airway (LMA) Protector group. SAD insertion time and tracheal intubation time were recorded separately. Demographic data, changes in haemodynamic parameters during the procedure, and complications were noted. In the LMA Protector and i-gel groups, the number of attempts (1.14 ± 0.35 vs. 1.24 ± 0.49 times, P = 0.394), device insertion time (14.89 ± 8.11 vs. 17.84 ± 16.59 seconds, P = 0.896), and the need for an optimization manoeuvre (43.2% vs. 37.8%, P = 0.813) were similar (P > 0.05). The fibreoptic laryngeal appearance scale and haemodynamic parameters were similar (P > 0.05). However, the airway complication rate was significantly higher in the LMA Protector group than in the i-gel group (21.6% vs. 2.7%, P = 0.013). The most common complications were bronchospasm and bloody secretion on SAD. With the stable haemodynamic parameters, acceptable insertion time and lower complication rate, we concluded that the i-gel may be preferable in fibre-optic tracheal intubation. The rigid structure of the LMA Protector compared to the i-gel might contribute to this result.

Pathoanatomical findings of a green turtle (Chelonia mydas) victim of collision with a motorboat

Abstract In this paper we report the trauma suffered by a green turtle (Chelonia mydas), caused by a collision with a motorboat, and describe the case ante and post-mortem. An adult female green turtle was rescued alive on December 2, 2016 at Ponta Negra beach, municipality of Natal, Rio Grande do Norte, Brazil. The rescued animal was sent to the Marine Fauna Rehabilitation Center (PCCB-UERN), municipality of Areia Branca (RN), in Brazil. Physical examination revealed an excellent body score, noisy breathing, moderate dehydration, absence of hind limb and cloacal reflexes when stimulated by pressure, and two traumatic injuries characteristic of a collision with a motorboat. After three days of supportive treatment, the animal died and was immediately sent for necropsy. The animal had a complete fracture of the vertebral bodies (dorsal elements D9 and D10) and spinal cord section. The entire gastrointestinal tract had food content, in addition to sharp injuries in the colon caused by the bone fragments of the fractured carapace. The lungs were congested, hemorrhagic with frothy and bloody secretion, and interstitial bronchiole fibrosis. There was also present some fibrin and a large number of leukocyte cells, consisting mainly of macrophages. The liver was enlarged, with rounded edges and thickening of the capsule, multifocal areas of hepatocellular necrosis, and dissociation of the hepatocyte cords. The collision resulted in the exposure of the coelomic cavity and spinal cord, causing the animal intense pain, paralysis of the hind limbs and cloaca, septicemia, and consequently, death.

Predisposing factors for person-to-person transmission of severe fever with thrombocytopenia syndrome bunyavirus

Person-to-person transmission of severe fever with thrombocytopenia syndrome virus (SFTSV) is a new threat to human health. Here we report an outbreak of nosocomial person-to-person transmission of SFTS. Among eight persons with face-to-face contact distance ≤50 cm and/or exposure time ≥30 min to the index patient, six became infected. Only one of the 17 persons with exposure distance ≥50 cm and exposure time ≤30 min became infected (75% vs 6.25%, P < 0.001). Epidemiological investigation revealed high viral load, bloody secretions and bleeding, exposure time, and distance as the key factors in person-to-person transmission.

Aspiration pneumonia complicated by disseminated fungal sepsis in the setting of incidental esophagitis cystica: A rare autopsy case report with review of the literature

Abstract Introduction/Objective Esophageal retention cysts are presumed to arise from obstruction of the excretory ducts of the submucosal glands of the esophagus. Since the first description by Kuhne in 1899, different terminologies have been used to denote these lesions including retention cysts, mucocele, esophagitis cystica, and cyst of esophageal submucosal gland duct. Esophageal retention cysts are generally benign, asymptomatic and discovered incidentally. However, a few studies have reported symptomatic dysphagia and to date, only one autopsy case report described esophageal retention cysts contributing to aspiration pneumonia and cause of death. Methods/Case Report We present a case of aspiration pneumonia, associated with both reduced oropharyngeal tone secondary to alcohol consumption and esophageal dysphagia due to esophagitis cystica in a 69 year old female with alcohol use disorder complicated by alcoholic liver disease. The patient was found unresponsive at home with bloody oral secretions and evidence of head trauma. On autopsy all lung lobes demonstrated that large and small airways and alveoli were filled with vegetable matter, associated with prominent bacterial and fungal forms. EVG stain demonstrated vascular disruption with red blood cell extravasation, next to a focus of aspiration pneumonia. This explained the patient’s “bloody oral secretions”, originating from the respiratory tract. Demonstration of fungal hyphae in sections from lungs as well as necrotic colon was consistent with disseminated fungal sepsis. While sections from esophagus showed no varices which could explain the patient’s “bloody oral secretions” in the setting of alcoholic liver disease, there were numerous dilated esophageal submucosal cysts. Cysts were lined by a single to double layer of cuboidal epithelium with eosinophilic cytoplasm and basally-located, bland-appearing nuclei. Conclusion In summary, we present a rare case of esophageal retention cyst associated aspiration pneumonia complicated by pulmonary hemorrhage, adding to the growing body of knowledge regarding fatal complications of these usually incidental lesions.