Difficulty In Breathing Research Articles

Utilization of the Lateral Extracavitary Approach for the Resection of a Giant Extradural Paraspinal Schwannoma: A Case Report

BACKGROUND AND IMPORTANCE: Spinal schwannomas are benign neoplasms originating from the spinal nerve sheath and account for around one-third of primary spine neoplasms. The most common treatment modality for these tumors is complete surgical resection. Compared with intradural tumors, the resection of an extradural spinal schwannoma is generally associated with a more complex approach, including longer incisions and increased lateral exposure. One useful surgical technique is the lateral extracavitary approach (LECA), which enables dorsal and ventrolateral access to the thoracolumbar spine with decreased rates of morbidity. Herein, the authors describe this approach for the resection of a giant extradural paraspinal schwannoma. CLINICAL PRESENTATION: A 74-year-old female patient presented with right flank pain and difficulty breathing during strenuous exercise. Imaging revealed a large 8.5 × 5.2 × 6.3 cm solid paraspinal lesion spanning from T11-L2 vertebral body levels, with mass effect on the right posterior diaphragm and lung. Before surgical resection, the lesion was confirmed to be a schwannoma by needle biopsy. A LECA approach was used, achieving gross total resection. At 1-month follow-up, the patient reported great symptomatic resolution. CONCLUSION: LECA proved to be an instrumental approach in a technically challenging resection of a giant extradural paraspinal schwannoma.

Fundamentals of emergency care support: a blended learning model to improve emergency and trauma care in a low-income country.

The burden of time-sensitive illnesses that require emergency care, such as heart diseases, respiratory tract infections, and road traffic injuries, is the leading cause of premature deaths. The healthcare providers of the emergency care system lack the essential knowledge and skills across different healthcare levels in our country. In this paper, we aim to describe the development and initial implementation of a blended learning curriculum for teaching and training non-EM-trained physicians working in the emergency departments of our country. We used a previously articulated curriculum designed by Patricia Thomas and David Kern. The model included general and specific need assessment, defining goals and objectives, selecting teaching and learning strategies, and implementation and evaluation plans. Based on the need assessment, a module-based blended learning model has been designed with well-defined goals and objectives covering knowledge and skills. This ten-week module-based course focuses on four areas of critically emergent conditions, i.e., trauma, shock, difficulty in breathing, and altered mental status. Evaluation will be made by comparing the pre and post-test scores of the participants. We have developed a blended course to teach non-EM-trained physicians working in the ED of our country. We hope that through this blended learning model, we will be able to adequately train our physicians working in the emergency department without any formal training in EM, which will lead to improved patient care and outcomes.

The more self-control, the more anxious?- A network analysis study of the relationship between self-control and psychological anxiety among Chinese university students.

With the growing prevalence of anxiety symptoms among university students, self-control is an important potential influence. This study aims to understand the network structure of self-control and anxiety, and to identify the core symptoms within this network. It will provide a theoretical basis for the prevention and intervention of anxiety symptoms in university students. We used network analysis to study anxiety and self-control in 3,792 university students from six schools in Heilongjiang Province, China. We checked for linear connections in the networks using a restricted cubic spline. We conducted the analyses and made graphs using R software. (i) The total sample network showed that higher levels of self-control in university students were associated with lower anxiety levels and were validated by the restrictive cubic spline. (ii) There was the strongest negative correlation (edge weight = -0.42) between Without thinking (SC7) and Panic (A5), and the edge weight coefficients of this self-control component and anxiety symptoms were greater than those of other self-control components. (iii) Physical exertion (A6) and Scared (A7) were identified as the core symptoms of the overall network, with expected influence of 1.08 and 1.08 (Z-score). (iv) A significant difference was observed between the anxiety positive network structure and the total sample network structure, with the strongest positive correlation between Iron self-control (SC3) and Breathing difficulty (A2) (edge weight = 0.22), with the strongest negative correlation between Certain things (SC2) and Situations (A4) (edge weight = -0.35). (v) The self-control component Iron self-control (SC3) had only one positive edge in the rural network, and only two positive edges in not one child network. The present study offered a new perspective on the relationship between self-control and anxiety using network analysis for the first time. The control component Without thinking (SC7) was an important concept influencing the negative correlation of anxiety, and Physical exertion (A6) and Scared (A7) were core symptoms in the total network. Heterogeneity analyses showed a tendency for the more self-controlled to be more anxious in the anxiety positive sample. These results may be a potential target for preventing and intervening anxiety in university students.

Perception of caregivers on ITNs utilisation and its effectiveness among children under 5years of age in Chikwawa district, Malawi.

In 2020, Malawi had 6.9 million malaria cases and 2551 deaths, mainly in children under five years of age. The 2017-2022 Malawi malaria control strategic plan promoted the consistent use of insecticide-treated nets through free distribution and mass campaigns. Despite widespread availability of the control strategy plan, Chikwawa District continues to suffer from high malaria burden especially among under five children, due to inconsistent insecticide-treated (ITN) net usage. For this reason, this study aimed at exploring caregivers' perceptions on insecticide-treated net utilisation and also find out about its effectiveness among those who consistently use them. This study used a sequential exploratory mixed methods design. The data used for quantitative analysis was drawn from the population of under-five children's caregivers within the catchment area of Chikwawa district hospital. The sample size was 96 participants, as determined by Cochran's formula. The data collection lasted from December 2023 to April 2024 and included four in-depth interviews and three focus group discussions to address the objectives qualitatively. The study revealed that 91.67% of households used ITNs, with 87.50% using them daily. The significant factors influencing ITN utilisation included the number of nets, user satisfaction, perceived impact, user habits, acquisition method, and usage frequency (all p values < 0.001). Under-five malaria cases were also significant (p = 0.025). The odds of the perceived net impact influencing utilisation were 4.956 times greater. Non-usage was due to heat, quality concerns, limited access, breathing difficulties, health conditions such as asthma, and misconceptions about net treatment. The study revealed a strong belief in insecticide-treated net efficacy. However, some challenges such as access, durability, and misinformation of insecticide-treated nets were discovered. These challenges affected utilisation of insecticide-treated nets in agreement with some literature reviewed. The insights found in this study will help policymakers in addressing health interventions for the reduction of malaria cases in Malawi.

Follicular Dendritic Cell Sarcoma of the Thyroid Gland: A Rare Case Report

Abstract Introduction Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm of antigen-presenting cells within the reticuloendothelial system primarily originating in lymph nodes, but in almost one-third of the patients, extranodal sites are involved including oral cavity, tonsil, gastrointestinal tract, soft tissue, and breast. The thyroid gland is an extremely rare location for FDCS and very few cases are reported in the literature. Case Report Here, we present a 39-year-old man who presented with a swelling in the neck for 3 months and difficulty in breathing for 15 days. Following left hemi-thyroidectomy, histopathologically and immunohistologically, he was diagnosed as FDCS of thyroid arising in Castleman's disease. He received adjuvant radiation treatment. The patient had favorable prognosis with no evidence of disease for 6 years after treatment till date. Conclusion The aim of this report was to present the rare site of FDCS arising in the thyroid gland, the vital role of immunohistochemistry in diagnosis, and effectiveness of multimodality treatment for favorable prognosis.

Thyroglossal cyst with intralaryngeal extension – An unusual case report

Thyroglossal duct cysts are the most prevalent congenital neck masses originating from thyroglossal duct remnants. Here, we present a case of thyroglossal dust cyst with hoarseness and difficulty breathing. A contrast-enhanced computed tomography scan confirmed the intra-laryngeal extension and airway compromise. Sistrunk procedure along with laryngeal reconstruction was done. Histopathology confirmed thyroid follicles in the cyst wall.

The effectiveness of a synthetic analogue purine nucleoside bases in the treatment of acute respiratory viral infections

Introduction. The aggravation of the comorbid background of patients with ARVI is the main reason for the addition of secondary pathogenic and conditionally pathogenic bacterial flora and, as a result, the development of local and general complications.Аim. To conduct a clinical assessment of the efficacy and safety of the drug Triazavirin based on riamilovir in the treatment of acute respiratory viral infections.Materials and methods. The study conducted on the basis of the medical center of the Federal State Budgetary Educational Institution of the Russian Ministry of Health involved 56 patients with acute recurrent viral infection. Regarding the prescribed therapy, the patients were divided into 2 groups: group 1 (n = 27) from day 2, triazavirin was taken as an antiviral drug (riamilo- vir) 250 mg (1 capsule) 3 times a day for 5 days; group 2 (n = 29) – as an antiviral drug, Kagocel took 2 tablets 3 times a day for 2 days, then 1 tablet 3 times a day for 5 days. The effect of the therapy was assessed by the severity of intoxication syndrome, rhinorrhea, difficulty in nasal breathing, decreased olfactory function, pain syndrome localized in the nasopharynx and throat, cough severity and laboratory results.Results. In patients with 7 days of therapy, the indicator of psychological health increased by 34.7 points in the first group, by 28.8 points in the second group. Vital activity increased by 33.7 points in patients of group 1 and by 23.8 points in the second group. Physical activity tended to increase by 19.5 points and 6.0 points in the first and second groups, respectively.Conclusions. The analysis of changes in the severity of clinical symptoms affecting the quality of life of patients confirmed the effectiveness and safety of the drug Triazavirin.

081. Radiofrequency Ablation for Retrosternal Thyroid Tumour: A Rare Case Report

Background: Retrosternal thyroid tumours, though uncommon, present complex diagnostic and therapeutic challenges due to their location behind the sternum. These tumours can cause significant symptoms, such as difficulty breathing and chest pressure, which can impact patient quality of life. Radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option, offering potential benefits over conventional surgical methods for retrosternal thyroid tumor. Case: A 54-year-old male with a history of right thyroid isthmolobectomy presented with a rapidly growing left-sided neck mass, causing increasing chest pressure and shortness of breath. Imaging studies, including ultrasound and CT scans, revealed a large tumour extending retrosternally and compressing the trachea. The patient opted for RFA over surgery. A core biopsy confirmed a benign struma adenomatosa. RFA was performed using the moving shoot technique, resulting in effective tumor ablation. Follow-up imaging showed a significant reduction in tumor size and symptom relief. Conclusion: This case demonstrates that RFA is a safe and effective alternative to conventional surgery for retrosternal thyroid tumours. It provides substantial symptom relief and tumour reduction with fewer complications. RFA should be considered a valuable treatment option for patients who are not ideal candidates for surgery or who prefer less invasive approaches. Continued research and long-term studies are needed to confirm its broader efficacy.

Peritoneal Leak Causing Right Sided Hydrothorax in A Case of Chronic Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis: A Case Report From Nepal

ABSTRACTContinuous ambulatory peritoneal dialysis (CAPD) is used for the maintenance dialysis in patients with end stage renal disease. Treatment's complications in CAPD generally exist, of which transudate hydrothorax falls under the minority of the cases. Here, we aim to present a case of a 51 years old female, a newly diagnosed case of chronic kidney disease (CKD) undergoing CAPD for 3 weeks who presented at our institution with complaints of difficulty in breathing. The symptom had gradually progressed after her recent CAPD session. Several investigations were sought out, of which a chest X‐ray illustrated a right sided hydrothorax. Pleural fluid analysis showed a transudate characteristic, and other diagnostic tests suggested that a peritoneal fluid leak might have caused the hydrothorax. CAPD induced hydrothorax is one of the uncommon noninfectious complications associated with peritoneal dialysis; its diagnosis can be made by studying both biochemical and radiological parameters of the patient. The definitive diagnosis is made by establishing a pleuro‐peritoneal communication using peritoneal scintigraphy. An immediate halt in CAPD will allow the remission of hydrothorax as mentioned below in our case report. The definitive management includes video assisted thorascopic surgery with mechanical pleurodesis. An appropriate diagnostic and management approach should be sought in CAPD induced transudate hydrothorax. An immediate halt in CAPD with surgical interventions can be considered as a treatment options for such complication.

Point-of-care lung ultrasound in the diagnosis of childhood pneumonia.

Lung ultrasound is emerging as a rapid, simple and safe alternative for diagnosing pneumonia since it has a higher sensitivity than X-rays and lower radiation exposure than computerized tomography. This is a prospective observational study done at a tertiary care centre in Chennai to study the diagnostic utility of lung ultrasound in pneumonia. Children aged 1 month to 12 years who were admitted to the hospital with complaints of cough, fever and/or breathing difficulty and on examination had tachypnea and/or chest indrawing were included in the study. All children underwent chest X-rays which was a standard hospital protocol. At admission, an independent investigator who was blinded to the clinical and radiological features of the child performed lung ultrasound. In all children, the final diagnosis of pneumonia was made by another independent expert paediatrician on the basis of the clinical features and chest X-ray. The test characteristics of ultrasound and chest X-ray were compared against this gold standard of physician-diagnosed pneumonia. Out of the 252 children studied, 225 (89.3%) had pneumonia while the rest 27 (10.7%) had other diagnoses. Among the 225 children with pneumonia, 223 (99.1%) were detected by ultrasound while 157 (69.8%) were detected by chest X-ray. All the test characteristics such as sensitivity, specificity, positive and negative predictive values of ultrasound were higher than those of chest X-ray. The sensitivity and specificity of ultrasound to diagnose pneumonia were 99.11% and 81.48%, respectively, while the sensitivity and specificity of X-ray for the same were 69.77% and 74.07%, respectively. Overall diagnostic accuracy for chest ultrasonography was 97.22% (94.36% to 98.88%), whereas for chest radiography, it was found to be 70.24% (64.18% to 75.81%).While both modalities were able to diagnose pneumonia significantly, ultrasound had better strength of association (Cramer's V value = 0.849) than X-ray to the final diagnosis. Lung ultrasound can be employed as a point-of-care investigation to diagnose pneumonia in suspected cases and can even replace chest X-ray in such circumstances.

ChatGPT provides safe responses to post-operative concerns following total joint arthroplasty

Introduction: Postoperative triage is a considerable financial and time burden following total joint arthroplasty (TJA). An ideal post-operative triage method would be equally as safe as triage nurses, but more cost-effective and time-efficient. Therefore, this study aimed to see if ChatGPT could serve as a safe and effective method of postoperative triage in responding to patient concerns following TJA. Methods: A list of ten potential concerns from post-operative arthroplasty patients was compiled ranging from “How much walking can I do?” to “My leg is throbbing and red, and I’m having trouble breathing. What should I do?”. These concerns were presented to trained orthopaedic triage nurses (n=3) and ChatGPT (Version 3.5). The generated responses were rated blindly by three fellowship-trained orthopaedic surgeons specializing in adult reconstruction using Likert scales ranging from 1-5 for safety and completeness (1 being highly unsafe/incomplete; 5 being highly safe/complete). The average scores were calculated for each prompt and are presented as mean±standard deviation. Results: There was no significant difference in average safety scores between ChatGPT responses (4.2±0.5) and those of triage nurses (4.3±0.4) (P=0.68). Similarly, there was no significant difference in completeness scores between ChatGPT responses (3.9±0.8) and those of triage nurses (4.0±0.6) (P=0.67). Furthermore, there were no significant differences in safety or completeness between ChatGPT and triage nurses for any of the individual prompts (all P values &gt;0.05). Conclusions: Postoperative triage is a critical component of perioperative care but represents a substantial time and cost burden. This preliminary study highlights the promising opportunity for future use of AI-enabled chatbots to provide instantaneous, safe, and complete responses to postoperative patient concerns.

Epidural anesthesia as a sole anesthetic for a parturient with cardiac disease and low ejection fraction – a case report in resource limited setup

Introduction and importance: The effective care of pregnant women with cardiac conditions relies on collaboration among the obstetrician, cardiologist, and anesthesiologist throughout the peripartum period. Limited research exists regarding the safety of specific anesthetic approaches for patients with congestive heart failure (CHF), particularly in the context of pregnancy. Case presentation: This was a 28-year-old woman who was pregnant with her third child (gravida III, para II) and has not had a menstrual period for the past 8 months. She had been receiving antenatal care at a local health center. Currently, she was experiencing symptoms including coughing, difficulty breathing, epigastric pain, and chest pain, which had been present for 1 week. Upon examination, she was diagnosed with New York Heart Association class IV CHF with pulmonary edema, and preeclampsia with severe features, and she was in the third trimester of pregnancy. Clinical discussion: Pre-existing medical conditions can adversely affect pregnancy outcomes for women and their offspring, especially in resource-poor settings in Africa. The goals of anesthetic management are avoidance of myocardial depression, maintaining normovolemia, avoiding an overdose of drugs during induction as the circulation time is slow, and avoiding sudden hypotension when regional anesthesia is the choice. Conclusion: We believe that successful management of anesthesia for this critical case depends on a thorough understanding of the pathophysiology of the disease condition, the selection of anesthetic techniques, and the decision-making of our team. We showed epidural anesthesia could be safely used to manage high-risk cardiac patients, however, further interventional study is needed to prove safety.

An adult case of breathing difficulty due to ruptured mediastinal cystic lymphatic malformation

An adult case of breathing difficulty due to ruptured mediastinal cystic lymphatic malformation

Mortality and its predictors among patients with Guillain–Barré syndrome in the intensive care unit of a low-income country, Ethiopia: a multicenter retrospective cohort study

BackgroundGuillain–Barré syndrome (GBS) is a rare autoimmune disease that affects the peripheral nervous system. It is characterized by the destruction of nerves involved in movement. This condition can lead to transient pain, changes in temperature and touch sensations, muscle weakness, loss of sensation in the legs and/or arms, and difficulty swallowing or breathing. Published data on the outcomes of critical care for patients with GBS are extremely scarce in Africa, particularly Ethiopia. Therefore, this study aimed to assess mortality and its predictors among patients with GBS in the intensive care unit (ICU) of specialized hospitals in Ethiopia, a low-income country.Materials and methodsThis retrospective cohort study was conducted at the Tibebe Ghion Specialized Hospital and the Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar, Ethiopia, from 1 January 2019 to 30 December 2023. Data were collected in the medical record rooms. Cox regression analysis was performed to identify the predictors of mortality among GBS patients in the ICU. The crude and adjusted hazard ratios (AHRs) and 95% confidence intervals (CIs) were calculated using bivariable and multivariable Cox regression models. A p-value of &amp;lt;0.05 was considered statistically significant.ResultsOf 124 GBS patients admitted to the ICU, 120 were included in the final analysis. During the follow-up, there were 23 (19.17%) deaths. The overall incidence rate of death was 1.96 (95% CI: 1.30, 2.95) per 100 person-days of observation. Traditional medicine (AHR = 3.11, 95%: 1.12, 16.70), COVID-19 infection (AHR = 5.44, 95% CI: 1.45, 73.33), pre-ICU cardiac arrest (AHR = 6.44, 95% CI: 2.04, 84.50), and ICU readmission (AHR = 4.24, 95% CI: 1.03, 69.84) were identified as the independent predictors of mortality.ConclusionThe mortality rate among GBS patients admitted to the ICU was high. Traditional medicine, COVID-19 infection, pre-ICU cardiac arrest, and readmission to the ICU were the significant predictors of mortality. Conducting large-scale studies with a prospective design in the future would yield more robust evidence.

First detection of D181 genotype of infectious bronchitis in poultry flocks of Morocco

BackgroundThis paper reports the first pathological and molecular characterization of the novel variant of infectious bronchitis virus (IBV) D181 in poultry flocks in Morocco and Africa.MethodsThe study includes six poultry farms, involving three flocks of layers aged between 28 and 67 weeks and three broiler flocks aged 27, 39 and 42 days from different regions of Morocco. In all affected layer flocks, a severe drop in egg production with poor eggshell quality was reported. Necropsy of dead birds was carried out, and samples of trachea, lungs, oviduct, ovaries, and kidneys were fixed in 10% neutral buffered formalin for histopathologic examinations, while other portions were stored at -20 °C for molecular analysis. Real time RT-qPCR for IBV gene group was performed, and IBV variants were identified. Partial S1 gene sequences were amplified by conventional RT-PCR, sequenced, and aligned for phylogenetic and amino acid similarity analysis.ResultsNecropsy of dead birds revealed misshapen and hemorrhagic ovarian follicles with an edematous oviduct and severe reaction in the cecal tonsils. A caseous material accumulation in the sinus was noted in few birds. In contrast, the broiler flocks exhibited respiratory clinical signs such as difficulty in breathing, sneezing, tracheal rales, watery eyes and lethargy, associated with a decrease in feed consumption. Mortality in broiler ranged from 2 to 15%. Histopathological analysis of samples showed a lympho-plasmocytic inflammation in the oviduct, trachea, and lungs. Individual necrosis of epithelial cells, with sloughing of the bronchial epithelium and accumulation of desquamated cells with mucus in the airways, was observed in some birds. Partial S1 gene sequencing and phylogenetic analyses showed that the Moroccan strains were very closely related to D181 strains isolated in Dutch layers and breeders in 2018. Nucleotide sequence identities reached 90.9–95% with the Dutch isolates (strain CK/NL/D181/2018).ConclusionOur sequencing results demonstrate for the first time that the D181 IBV genotype is circulating in Moroccan poultry. These findings justify permanent monitoring of circulating strains in order to appropriately adjust vaccination strategies to align with the evolving field situation.

The Effect of Heart Failure Symptom Clusters on Quality of Life: The Moderating Effect of Self-Care Behaviours.

Although heart failure (HF) symptoms affect patients' quality of life (QoL), improving patients' QoL requires certain self-care behaviours. However, the specific role of self-care behaviours in the relationship between HF symptoms and QoL has not been clarified. To evaluate the status of symptom clusters, self-care behaviours and QoL in HF patients, and to analyse and test the moderating effect of self-care behaviours between symptom clusters and QoL. This study is a cross-sectional study. A total of 320 HF patients who treated in thethree hospitals in Chengdu, China, from December 2022 to July 2023 were selected as the research subjects. The patients were evaluated using The General Information Questionnaire, Memorial Symptom Assessment Scale Heart Failure, Self-Care of Heart Failure Index and Minnesota Living with Heart Failure Questionnaire. The statistical analysis methods were exploratory factor analysis, Pearson correlation analysis, hierarchical regression analysis and simple slope analysis. There were five symptom clusters in HF patients: emotional symptom cluster (sadness, anxiety, irritability, feeling nervous), digestive symptom cluster (lack of appetite, dry mouth, weight loss, nausea, abdominal distension), ischemic symptom cluster (dizziness, chest pain, palpitations, fatigue), dyspnoea symptom cluster (difficulty breathing when lying flat, waking up breathless at night, sleep difficulty) and congestion symptom cluster (cough, shortness of breath, oedema). There was a significant correlation between HF symptom group, self-care behaviours and QoL (p < 0.05). Both self-care maintenance (β = -0.262, p < 0.001) and self-care management (β = -0.258, p < 0.001) had a moderating effect between symptom clusters and QoL. There are a variety of symptom clusters in HF patients. Improving the self-care behaviours ability of HF patients is conducive to reducing the impact of HF symptom clusters on QoL. The study used the STROBE checklist for reporting. Medical staff should focus on the impact of HF symptom clusters and self-care behaviours on QoL, and formulate corresponding interventions for HF symptom clusters and self-care behaviours to improve the QoL of patients. The head nurse of the cardiovascular department actively assisted us in collecting questionnaires from HF patients, and all HF patients surveyed participated in this study seriously.

Thyroid Gland Diffuse Lipomatosis: A Case Study and Comprehensive Literature Review.

Diffuse lipomatosis of the thyroid (DLT) is an uncommon condition where mature fat cells infiltrate the thyroid gland, disrupting its normal structure. Although rare, it typically manifests as neck enlargement or symptoms of compression, including breathing difficulties, trouble swallowing, and voice changes, which can complicate diagnosis. This report presents a case of a 61-year-old woman with DLT, who exhibited a multinodular goiter and progressive neck swelling, and examines 53 additional cases from the existing literature. The analysis indicates that DLT is frequently misdiagnosed because of its similarities with other thyroid disorders. The precise mechanism underlying its development remains uncertain, but theories include oxygen deprivation in tissues, developmental abnormalities, and disruptions in fat metabolism. Surgical removal is the preferred treatment, especially for patients experiencing symptoms, and has shown favorable long-term outcomes. Additional studies should aim to elucidate the exact cause of DLT and enhance diagnostic precision, particularly in distinguishing it from other fat-containing thyroid lesions such as amyloid goiter and adenolipomas. A deeper understanding of this condition will inform better treatment approaches and enhance patient outcomes for this uncommon but significant thyroid disorder.

Association between varicose veins and constitution of traditional Chinese medicine plus heart-failure-like symptoms.

Varicose veins are a common issue for employees in jobs that require prolonged standing compared with all other employees. However, its relationship with presentations of traditional Chinese medicine constitution is unknown. This study aimed to investigate their association. Data in the study were obtained from questionnaires of patients in Taiwan Biobank, enrolled from 2008 to 2020. The responses to the statement "I can see distorted blood vessels on my four limbs (varicose veins)." were categorized into none, mild, moderate, severe. and more severe, and the same scale was also used to classify breathing difficulties and hypotension. A total of 11,293 participants were enrolled in the study. The prevalence of women was higher in the studied group compared with the control. Patients complained of breathing difficulties with moderate (30.49%) and severe discomfort (12.44%) in the diseased group. Regarding hypotension, 28.81% and 9.82% of the patients presented with moderate and severe hypotension, respectively. The cofactor odds ratio was 1.775 for severe breathing difficulty/moderate hypotension and 2.235 for severe breathing difficulty/severe hypotension, with statistical significance. The combined impact of breathing difficulties and hypotension increased with severity. Varicose veins had a higher association with breathing difficulties and hypotension as the severity of the condition worsened. The combined impact of breathing difficulties and hypotension increased as the disease progressed. Therefore, self-reported assessments can be a useful tool for evaluating patients with asymptomatic varicose veins before the development of "heart-failure-like symptoms" to reduce the risk of underdiagnosis.

Osimertinib (Tagrisso)

Canada’s Drug Agency (CDA-AMC) recommends that Tagrisso in combination with pemetrexed and platinum-based chemotherapy should be reimbursed by public drug plans for the first-line treatment of patients with locally advanced (not amenable to curative therapies) or metastatic non–small cell lung cancer (NSCLC) which harbours epidermal growth factor receptor (EGFR) exon 19 deletions (Ex19del) or exon 21 (L858R) substitution mutations if certain conditions are met. Tagrisso plus chemotherapy should only be covered to treat adult patients (aged ≥ 18 years) who have nonsquamous NSCLC; whose tumours have spread to other parts of the body, returned after treatment, or cannot be removed by surgery or radiation; whose tumours harbour EGFR Ex19del or L858R substitution mutations; and who are in relatively good health. Tagrisso should not be covered to treat patients who have a history of breathing difficulties caused by scarring and inflammation in the lung tissue; who have a history of heart problems associated with their heart taking longer to recharge between beats or their heart beating too fast, too slow, or in an irregular way; or, who have already been treated for NSCLC with treatments affecting their entire body (except for treatments given at least 6 months before the tumour returned, as a first step to shrink a tumour before the primary treatment, or as an additional treatment after the primary treatment to lower the risk of the tumour returning). Tagrisso should only be reimbursed if it is prescribed in combination with pemetrexed and platinum-based (i.e., cisplatin or carboplatin) chemotherapy by clinicians with expertise in treating NSCLC, and the cost of Tagrisso is reduced. Reimbursement of Tagrisso plus chemotherapy should be discontinued if a patient’s cancer grows or spreads, or if treatment is unacceptably toxic to the patient.

Cedecea lapagei as an emerging extensively drug-resistant microorganism: A case report in a patient with pleural empyema and literature review

Cedecea lapagei is a Gram-negative bacterium that belongs to the Enterobacteriaceae family and is said to be pathogenic for humans. Herein, we report a case of extensively drug-resistant C. lapagei in a patient with pleural empyema and offer a literature review of the already documented case reports on individuals infected with C. lapagei. A 60-year-old female patient was brought to the emergency department at AIIMS Bathinda with a history of breathing difficulty since one day after she sustained multiple injuries from a road accident. She was diagnosed with pleural empyema. Subsequently, an intercostal drain tube was inserted into the patient, and the drain content was sent for culture, which revealed growth of C. lapagei. Our literature retrieval work gathered a total of 13 relevant cases. In conclusion, early identification of C. lapagei and administering suitable treatment is important for good patient outcome.