Drainage Of Secretions Research Articles

APPROACH TO THE DIFFERENTIAL DIAGNOSIS BETWEEN MULTIPLE MYELOMA OR OSTEONECROSIS: A CASE REPORT

A 67-year-old female patient, diagnosed with multiple myeloma (MM), reported intense pain in the right-side mandible and hemi-face. She was undergoing third-line chemotherapy associated with the use of zoledronic acid. Clinical exams showed drainage of purulent secretion in the gingival sulcus and gingival edema in the peri-implant region. Computed tomography showed an osteolytic lesion in the right mandible, with bone sequestration adjacent to the base of a dental implant leading to MM lesion or osteonecrosis hypothesis. Histological examination showed granulation tissue with a mixed inflammatory process and osteonecrosis with bacterial colonies. The diagnosis was osteonecrosis possibly related to peri-implantitis, occlusal trauma, and the use of bisphosphonates. Antibiotic therapy was implemented, reaching bone repair, no signs of infection, no pain, and no bone exposure. The importance of performing correct diagnoses and treating bone lesions in patients with MM, along with close follow-up, were verified. A 67-year-old female patient, diagnosed with multiple myeloma (MM), reported intense pain in the right-side mandible and hemi-face. She was undergoing third-line chemotherapy associated with the use of zoledronic acid. Clinical exams showed drainage of purulent secretion in the gingival sulcus and gingival edema in the peri-implant region. Computed tomography showed an osteolytic lesion in the right mandible, with bone sequestration adjacent to the base of a dental implant leading to MM lesion or osteonecrosis hypothesis. Histological examination showed granulation tissue with a mixed inflammatory process and osteonecrosis with bacterial colonies. The diagnosis was osteonecrosis possibly related to peri-implantitis, occlusal trauma, and the use of bisphosphonates. Antibiotic therapy was implemented, reaching bone repair, no signs of infection, no pain, and no bone exposure. The importance of performing correct diagnoses and treating bone lesions in patients with MM, along with close follow-up, were verified.

SECONDARILY INFECTED CYSTIC LESION: MICROSCOPIC MISCHARACTERIZATION MIMICKING SPINDLE CELL LESION

A 27-year-old man sought health care, complaining of discomfort and drainage of purulent secretion in the retromolar region of the mandible. Clinical examination revealed a slight volume increase of the left buccal bone plate, effacement of vestibule fundus, drainage of white/yellow content from gingival sulcus of tooth 37, and moderate painful symptoms on palpation. Radiographic examination revealed a well-delimited, multiloculated, radiolucent image, extending from the periapical region of tooth 37 to the middle portion of the mandible ramus. Diagnostic hypotheses were keratocyst and ameloblastoma. Aspiration puncture revealed reddish content. An incisional biopsy was performed, and the lesion was decompressed with a drain. Histopathological evaluation reported a lesion compatible with fusocellular injury of uncertain nature. Immunohistochemical evaluation showed positive CD34 (QBEnd10), Vimetine (VIM3B4), and low Ki67 antigen (KiS5) expression. A 3-month follow-up showed bone neoformation in the entire extension of the lesion. The final diagnosis was a secondarily infected cystic lesion. A 27-year-old man sought health care, complaining of discomfort and drainage of purulent secretion in the retromolar region of the mandible. Clinical examination revealed a slight volume increase of the left buccal bone plate, effacement of vestibule fundus, drainage of white/yellow content from gingival sulcus of tooth 37, and moderate painful symptoms on palpation. Radiographic examination revealed a well-delimited, multiloculated, radiolucent image, extending from the periapical region of tooth 37 to the middle portion of the mandible ramus. Diagnostic hypotheses were keratocyst and ameloblastoma. Aspiration puncture revealed reddish content. An incisional biopsy was performed, and the lesion was decompressed with a drain. Histopathological evaluation reported a lesion compatible with fusocellular injury of uncertain nature. Immunohistochemical evaluation showed positive CD34 (QBEnd10), Vimetine (VIM3B4), and low Ki67 antigen (KiS5) expression. A 3-month follow-up showed bone neoformation in the entire extension of the lesion. The final diagnosis was a secondarily infected cystic lesion.

Clinical implantation of 92 VACStents in the upper gastrointestinal tract of 50 patients-applicability and safety analysis of an innovative endoscopic concept.

Endoscopic vacuum therapy (EVT) has emerged as a promising treatment option for upper gastrointestinal wall defects, offering benefits such as evacuation of secretions and removal of wound debris by suction, and reduction and healing of wound cavities to improve clinical outcomes. In contrast, covered stents have a high rate of migration and lack functional drainage, while endoluminal EVT devices obstruct the GI tract. The VACStent is a novel device that combines the benefits of EVT and stent placement. Its design features a fully covered Nitinol-stent within a polyurethane sponge cylinder, enabling EVT while maintaining stent patency. This study analyzes the pooled data from three different prospective study cohorts to assess the safe practicality of VACStent placement, complete leak coverage, and effective suction-treatment of esophageal leaks. By pooling the data, the study aims to provide a broader base for analysis. In total, trans-nasal derivation of the catheter, suction and drainage of secretion via vacuum pump were performed without any adversity. In the pooled study cohort of 92 VACStent applications, the mean stent indwelling time was 5.2 days (range 2-8 days) without any dislocation of the device. Removal of the VACStent was done without complication, in one case the sponge was lost but subsequently fully preserved. Minor local erosions and bleeding and one subsequent hemostasis were recorded unfrequently during withdrawal of the device (5.4%, 5/92) but no perforation or pressure ulcer. Despite a high heterogeneity regarding primary disease and pretreatments a cure rate of 76% (38/50 patients) could be achieved. In summary, insertion and release procedure was regarded as easy and simple with a low potential of dislocation. The VACStent was well tolerated by the patient while keeping the drainage function of the sponge achieving directly a wound closure by continuous suction and improving the healing process. The implantation of the VACStent provides a promising new procedure for improved clinical treatment in various indications of the upper gastrointestinal wall, which should be validated in larger clinical studies.Clinical Trial Registration: Identifier [DRKS00016048 and NCT04884334].

THRIVE to the rescue.

Dear Editor, “Transnasal humidified rapid insufflation ventilator exchange (THRIVE)” works on the principle of ventilation without ventilator movements. With THRIVE, ventilation occurs with a noninvasive nasal cannula, with high flow humidified oxygen at 30–60 L/min. These high flows create a distending alveolar pressure or positive end-expiratory pressure (PEEP) up to 7 cm of water, which prevents airway collapse and atelectasis.[1,2] We describe two cases in which the use of THRIVE helped prevent reintubation postoperatively. Case 1: A 61-year-old male was operated for robotic radical cystectomy under general anesthesia in lithotomy and Trendelenburg position for 8 h. After extubation within a few minutes, he started to desaturate. Blood gas showed pH-7.33/pCO2-46.5/pO2-47.2/sat-76.4%. Bilateral lung basal atelectasis secondary to the position during the procedure was the probable diagnosis. In view of persistent hypoxia and the possibility of worsening oxygenation, the choice was noninvasive ventilation (NIV) or reintubation. However, NIV was logistically not possible in the OT. THRIVE (OptiFlow THRIVE system by Fisher and Paykel Healthcare Ltd, Auckland, New Zealand), was started at 30 L/min. Within few minutes, the saturation picked to 100%. Blood gas done after 30 min of THRIVE showed pH-7.38, pCO2-35, pO2-107.9, satulation-97.5%. As the patient was breathing comfortably and hemodynamically stable, he was shifted to the intensive care unit (ICU) with facemask oxygen for transfer. THRIVE was continued in the ICU for another 2 h and finally weaned off to a nasal cannula of 2 L/min. Case 2: A 61-year-old lady was operated for breast microdocectomy under general anesthesia, post-operatively the patient was extubated after which her respiratory rate was 36–38 per min with oxygen saturation of 88%–90% on 10 L oxygen non rebreathing mask and blood pressure of 213/102 mm Hg. Chest auscultation revealed bilateral crepts. Suspecting it to be pulmonary edema, injection furosemide IV was administered, and nitroglycerine (NTG) infusion was started. Her blood gas showed pH- 6.99, pCO2- 116, pO2- 85, pHCO3- 19, oxygen saturation-90%. After the initiation of THRIVE at 40 L/min over the next 10 min, her saturation started picking up to 97%–98%, and her respiratory rate settled to 18–20 per mi. Eventually her THRIVE flow was reduced to 20 L/min. Her blood gas was pH- 7.32, pCO2- 50.6, PO2 -140, HCO3-26 and was shifted to the ICU. After 2 h of THRIVE in the ICU, her blood gas was pH-7.3, pCO2- 41, pO2- 138, pHCO3- 25. Thrive delivers gases at a flow rate that exceeds the patient’s peak inspiratory flow rate.[3] It helps to recruit the lungs. It washes out the upper airway dead space, creating an oxygen reservoir and increasing the tidal volume, probably explaining the mechanism for decreasing the PCO2.[4] By increasing the end-inspiratory lung volume, it decreases the work of breathing.[5] The warm and humidified inspired gases decrease airway inflammation and improve drainage of respiratory secretions.[4] THRIVE can be an important additional tool to provide oxygen in the post-operative period to prevent reintubation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Weaning from mechanical ventilation: a narrative review

The “weaning” from mechanical ventilation is a process that involves several assessments and steps to aid a patient to reach a “liberation” from the ventilator and allow for breathing autonomy.The process of “weaning” from mechanical ventilation involves several assessments and steps to support a patient in reaching a “liberation” from the ventilator and allow for spontaneous breathing. The weaning process consists of evaluating if the patient is able to breathe with minimal or no ventilation support. This assessment is performed by a diagnostic test named spontaneous breathing trial (SBT), repeated every 24 hours to ensure extubation success. Even though many patients do not meet the eligibility criteria for starting the weaning process, they can still be weaned. For this reason, these criteria should be evaluated in order to assess a possible weaning, rather than adopting absolute standards which have to be met simultaneously. The SBT helps the healthcare professionals to understand the patient’s capacity to sustain physiological breathing once they are extubated (or on spontaneous breathing if a tracheostomy tube is maintained in place). Several patients fail to meet the weaning criteria after less than 20 minutes of the SBT. Therefore, a 30-minute trial is enough to estimate the patient’s capacity to withhold spontaneous breathing. Even if the SBT is currently the gold standard method to conduct the weaning trial, it does not prevent the occurrence of complications after extubation such as upper airways obstruction, increased resistance, loss of airway protective reflexes, cough efficiency, and drainage of tracheobronchial secretions. The preventive use of NIV or High Flow Nasal Cannula is strongly recommended for patients experiencing extubation failure and mechanically ventilated for more than 24 hours after an SBT. A well-performed SBT usually leads to definitive extubation; on the other hand, SBT failure requires a comprehensive investigation on potentially reversible conditions. Prolonged weaning is highly wasteful in terms of time and resources due to the need for a systematic and multidisciplinary approach to successfully face the weaning process.

Concordance between Microorganisms Isolated from Subglottic Secretions and Bronchoalveolar Lavage Fluid in Patients with Ventilator Associated Pneumonia in Intensive Care Unit

Introduction: Nosocomial pneumonia is a common complication in critically ill patients. Mechanical ventilation has been consistently identified as the greatest risk factor for the development of nosocomial pneumonia. Aims: The purpose of the current study is to find the concordance between microorganisms cultured from subglottic secretions and bronchoalveolar lavage fluid (BALF) and to assess the effectiveness of subglottic suctioning for prevention of ventilator-associated pneumonia (VAP). Patients and Methods: This was a prospective, interventional, cohort study. Patients between 15 and 85 years who developed VAP after receiving mechanical ventilation were enrolled in the study. They were randomly divided into two groups: Group No Subglottic Secretion Drainage (NSSD) and Group Continuous Subglottic Secretion Drainage (CSSD). Results: The mean age of the patients was 56 ± 13 years. Fifty-eight percent were males and 42% were females. The incidence of VAP among NSSD group was 41.7% and in CSSD group was 25%. The coefficient of correlation was calculated for the microorganisms cultured in subglottic and BALF using Pearson's correlation. The correlation coefficient was 0.78 for the entire population (P = 0.01). In the NSSD group, it was 0.82 (P = 0.01), and in the CSSD group, it was 0.76 (P = 0.01). The mean Intensive Care Unit (ICU) stay is maximum in NSSD group (12.9 ± 1.84 days) compared to CSSD group (9.2 ± 1.17 days). Conclusion: The concordance of organism grown in subglottic secretions and BALF culture is higher in NSSD group as compared to CSSD group. CSSD is an effective means of reducing the number of ventilator days and ICU stay.

Early mobilization in intensive care unit in Latin America: A survey based on clinical practice.

The application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America. We conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations. As many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM. This report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.

Use of an innovative cuff pressure control and subglottic secretions drainage system in COVID-19 ARDS patients undergoing pronation

We conducted a proof of concept study where Anapnoguard endotracheal tubes and its control unit were used in 15 patients with COVID-19 acute respiratory distress syndrome. Anapnoguard system provides suction, venting, rinsing of subglottic space and controls cuff pressure detecting air leakage through the cuff. Alpha-amylase and pepsin levels, as oropharyngeal and gastric microaspiration markers, were assessed from 85 tracheal aspirates in the first 72 h after connection to the system. Oropharyngeal microaspiration occurred in 47 cases (55%). Episodes of gastric microaspiration were not detected. Patient positioning, either prone or supine, did not affect alpha-amylase and pepsin concentration in tracheal secretions. Ventilator-associated pneumonia (VAP) rate was 40%. The use of the AG system provided effective cuff pressure control and subglottic secretions drainage. Despite this, no reduction in the incidence of VAP has been demonstrated, compared to data reported in the current COVID-19 literature. The value of this new technology is worth of being evaluated for the prevention of ventilator-associated respiratory tract infections.

P163 Successful management of COVID-19-associated mucormycosis in state of pernambuco, northestearn brazil: 2 case reports

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesDuring the COVID-19 pandemic, several cases of mucormycosis related to SARS-CoV-2 were reported. This association is still poorly studied due to its recent emergence and makes diagnosis and treatment challenging. Usually, patients who are affected by this infection are immunocompromised by corticosteroid treatment and uncontrolled diabetes mellitus, being mucormycosis a life-threatening opportunistic invasive fungal infection caused by mucoromycetes, which reaches a mortality rate of about 50%, even with treatment. Thus, this association requires as much information as possible about the pathogenesis and treatment.MethodsHere, we report two cases with conclusive diagnosis and positive evolution to mucormycosis associated with COVID-19 after corticosteroid therapy.ResultsThe first case was a 68-year-old woman, hypertensive and diabetic, who was affected by SARS-CoV-2, with intense ocular pain and paralysis of extrinsic ocular muscles of the right eye and eyelid. The patient underwent CT scan of the sinuses with contrast, which showed signs on maxillary. The patient was submitted to sinusectomy with orbital decompression and the material from the surgery was sent for fungal investigation, which 20% KOH direct exam showed hyaline, sparsely-septate, broad, ribbon-like hyphae with irregular right-angle branching. Rhizopus oryzae was isolated on Sabouraud agar. Mucormycosis was diagnosed in the facial sinuses, and resolution of infection was obtained with liposomal amphotericin B. The second case was a 59-year-old woman, obesity degree 3, asthmatic and history of COVID-19, with history of abscesses in oral mucosa and palate, with drainage of brown secretion after 30 days of COVID-19 resolution. After medical discharge, the patient was evaluated by an oral and maxillofacial surgeon to solve an esthetic problem, when the material was collected for biopsy of the mucosal lesions. Histopathological exam showed aseptic thick mycelial filaments presenting right angle bifurcation, suggestive of Mucorales (mucormycosis). The patient was readmitted to the hospital for mucormycosis treatment based on isavuconazole (200 mg, q8 as attack dose on Day 1 and 2, and 3 toward q24), and treatment evolved positively with no need for surgical intervention. We conclude that the extensive use of steroids associated with diabetes is the main factor for the appearance of mucormycosis after COVID-19, but with a conclusive diagnosis and correct treatment, this infection can have a good evolution, resulting in an improvement in the patient's clinical condition, reducing the risk of death for this infection.ConclusionIsavuconazole appears to be a drug with a safe profile and with curative potential for mucormycosis. The possibility of oral use from the third day at its maintenance dose (200 mg/day) with intravenous use in the first 48 h at a dose of 200 mg every 8 h. Diabetic patients are more prone to infection, but patients infected with SARS CoV 2 using corticosteroids have shown to be a risk group for this fungus.

ODONTOGENIC KERATOCYST ASSOCIATED WITH AN INCLUDED THIRD MOLAR: CASE REPORT

Odontogenic keratocyst arises from the remnants of dental lamina either in the mandible or in the maxilla. The posterior mandible is the most frequent site involved. A 19-year-old male patient undergoing dental treatment presented a well-delimited hypodense image around the crown of tooth 48 included during tomographic examination. The removal of tooth 48 and enucleation of the lesion were performed, which presented significant drainage of dark yellow secretion. Histopathologic analysis showed a cyst with a fibrous wall lined by a folded, parakeratinized epithelium of varying thickness, basal layer arranged palisaded, and the lumen of the cavity was filled with abundant keratinized content, leading to the diagnosis of odontogenic keratocyst. In the reassessment of the case 6 months after removal of the lesion, a new computed tomography was performed, in which new bone formation in the lesion area was observed, with no signs of relapse. Odontogenic keratocyst arises from the remnants of dental lamina either in the mandible or in the maxilla. The posterior mandible is the most frequent site involved. A 19-year-old male patient undergoing dental treatment presented a well-delimited hypodense image around the crown of tooth 48 included during tomographic examination. The removal of tooth 48 and enucleation of the lesion were performed, which presented significant drainage of dark yellow secretion. Histopathologic analysis showed a cyst with a fibrous wall lined by a folded, parakeratinized epithelium of varying thickness, basal layer arranged palisaded, and the lumen of the cavity was filled with abundant keratinized content, leading to the diagnosis of odontogenic keratocyst. In the reassessment of the case 6 months after removal of the lesion, a new computed tomography was performed, in which new bone formation in the lesion area was observed, with no signs of relapse.

OSTEOMYELITIS WITH PROLIFERATIVE PERIOSTITIS ASSOCIATED WITH A SECOND PRIMARY MOLAR: CASE REPORT

Osteomyelitis with proliferative periostitis, also called Garre's osteomyelitis, is a rare chronic process characterized by periosteal proliferation reactive to the presence of inflammation. A 4-year-old male patient presented with facial asymmetry on the right side with 3 months of evolution and diffuse pain. Clinical examination revealed an indurated and hyperemic facial tumor and severe trismus, in addition to a decayed second primary molar. Imaging exams revealed periosteal thickening and subperiosteal new bone formation with radiopaque lamination associated with tooth 85. Treatment involved antibiotic therapy, drainage of purulent secretions, and removal of the decayed tooth. After incisional biopsy, microscopic examination showed interconnected bone trabeculae, arranged in parallel and surrounded by osteoblasts. Multinucleated giant cells similar to osteoclasts, fibrous connective tissue with focal of lymphoplasmacytic inflammatory infiltrate, and scattered polymorphonuclear cells confirmed the diagnosis of osteomyelitis with proliferative periostitis. After 7 days there was a decrease of the edema and recovered mouth opening.

DENTIGEROUS CYST IN THE MAXILLARY SINUS DERIVED FROM AN MAXILLARY THIRD MOLAR: CASE REPORT

Dentigerous cysts are considered the most common developmental odontogenic cyst. They are often asymptomatic and are discovered on control radiographs during the investigation of delayed eruption of a retained tooth. On image examination, it is possible to observe a radiolucent and circumscribed image around the crown, which can cause tooth displacement. The aim of this work is to report the clinical case of a dentigerous cyst affecting the left maxillary sinus in an 18-year-old female patient with the main complaints of headache and spontaneous drainage of purulent secretion. During extraoral examination it was possible to observe an enlargement in the left malar region associated with soft tissue expansion at the depth of the maxillary vestibule. Aspiration puncture was performed, positive for serosanguinolent secretion, and the patient underwent a surgical approach under general anesthesia. The enucleated piece was sent to anatomopathologic study and the result was conclusive for dentigerous cyst.

Evaluation of the Preventive Effect of Protamine Sulfate Administration after Heart Surgery on Drainage of Blood Secretions

Evaluation of the Preventive Effect of Protamine Sulfate Administration after Heart Surgery on Drainage of Blood Secretions

Odontogenic Keratocyst of the maxilla: Case report

Odontogenic Keratocyst (OKC) is a pathology that presents high proliferative activity and frequent relapses after treatment. The aim of this study was to report a case of OKC with uncommon location in a 22-year-old patient presenting swelling and drainage of purulent secretion in the region of the third right upper molar. In examinations, a radiolucent density unilocular image involving impacted element 18 was observed. After excisional biopsy accompanied by severe bone curettage, the removed specimen was sent for histopathological analysis, where final diagnosis of odontogenic keratocystic was obtained. The patient has been in clinical and radiographic follow-up for more than 6 months and, to date, there are no signs of relapse.

Pneumonia After Cardiovascular Surgery: Incidence, Risk Factors and Interventions.

Postoperative pneumonia (POP) is prevalent in patients undergoing cardiovascular surgery, associated with poor clinical outcomes, prolonged hospital stay and increased medical costs. This article aims to clarify the incidence, risk factors, and interventions for POP after cardiovascular surgery. A comprehensive literature search was performed to identify previous reports involving POP after cardiovascular surgery. Current situation, predictors and preventive measures on the development of POP were collected and summarized. Many studies showed that POP was prevalent in various cardiovascular surgical types, and predictors varied in different studies, including advanced age, smoking, chronic lung disease, chronic kidney disease, cardiac surgery history, cardiac function, anemia, body mass index, diabetes mellitus, surgical types, cardiopulmonary bypass time, blood transfusion, duration of mechanical ventilation, repeated endotracheal intubation, and some other risk factors. At the same time, several targeted interventions have been widely reported to be effective to reduce the risk of POP and improve prognosis, including preoperative respiratory physiotherapy, oral care and subglottic secretion drainage. Through the review of the current status, risk factors and intervention measures, this article may play an important role in clinical prevention and treatment of POP after cardiovascular surgery.

<br/> OS BENEFÍCIOS DO DECÚBITO VENTRAL NO DOENTE COM SÍNDROME DE DIFICULDADE RESPIRATÓRIA AGUDA EM UNIDADES DE CUIDADOS INTENSIVOS<br/>

Introduction: The objective was to know the scientific evidence of the benefits of prone position in patients with Acute Respiratory Distress Syndrome in intensive care units. Methodology: It consists of a systematic literature review, based on the question “What are the benefits of prone position in patients with acute respiratory distress syndrome in intensive care units?”. The research process took place in February 2021, using the EBSCOhost platform, and descriptors properly validated in MeSH. As inclusion criteria we considered adult individuals (aged over 18 years-old) and full text with publication date 2015-2021. In the end, after the analysis process, 6 articles were selected. Results: After analyzing the 6 articles, it was found that patients with acute respiratory distress syndrome can be benefited from prone position due to better air distribution in the lungs with optimization of gas exchange, facilitating the drainage of secretions and reducing the mortality rate. It is important to select and to assess the individual risk of each patient before adopting the prone position. Conclusion: The prone position seems to work effectively in most cases of acute respiratory distress syndrome. Careful planning and proper assessment of the patient's condition can make the procedure safe and effective. Keywords: Acute Respiratory Distress Syndrome; Intensive Care Units; Prone Position.

Comparative Study of Continuous Versus Intermittent Subglottic Suction Drainage to Prevent Ventilator Associated Pneumonia in Intubated Patients

Introduction: Subglottic secretion drainage reduces the incidence of ventilator associated pneumonia (VAP). The efficacy of Continuous subglottic secretion drainage (CSSD) over Intermittent subglottic secretion drainage (ISSD) for prevention of VAP is unknown.
 Objectives: Compare the efficacy of CSSD and ISSD in terms of incidence of VAP, mortality, duration of mechanical ventilation, length of ICU stay and incidence of reintubation.
 Methodology: This was a prospective comparative study conducted at Birat Medical College and Teaching Hospital. A total number of 80 intubated patients for at least 48 hours duration were included. Continuous and intermittent endotracheal suctioning techniques were compared for prevention of VAP and secondary outcomes in terms of length of mechanical ventilation, length of ICU stay, multiorgan failure, reintubation and mortality rate.
 Results: The incidence of VAP was 15% and 22.5 % in CSSD group while it was 17.5% and 27.5% in ISSD group in first 48 hours and 96 hours of mechanical ventilation respectively.The length of mechanical ventilation was significantly less in continuous group (4.78 ± 2.50 days) than in intermittent group (7.18 ± 2.09 days) with p value of 0.023. The patients with CSSD had significantly shorter ICU stay (5.49 ± 3.16 days) as compared to the patients with ISSD (8.46 ± 2.06 days). The incidence of reintubation was significantly higher in intermittent group patients (p value 0.024). Patients in both the group had comparable incidence of multiorgan failure, spontaneous breathing trial and mortality rate.
 Conclusion: The incidences of VAP and mortality were comparable in CSSD and ISSD. However CSSD significantly decreased the duration of mechanical ventilation, length of ICU stay and incidence of reintubation..

Determination of Risk Factors for DCIS Ductal in-situ Carcinoma of Mammary Gland

Mammary gland is altered gland present in skin whose main function in females is that it acts as a lactating gland while in males it is non-functional. When the sample of tissue of mammary gland is observed under microscope it was found that there are 2 major types of tissues which are present. These tissues are epithelial and stromal tissues. The epithelial component of the breast consists of 2 major parts: terminal duct-lobular unit (TDLU) which performs the main secretory function during lactation, and large duct system which performs the function of collection and drainage of secretions; both are interconnected to each other. During the menstrual age of a female patient there are different number of tissues (connective and adipose) is present in the mammary gland these tissues mainly perform as the support system for the mammary gland. Acini, ducts, and lobule are enclosed in intralobular stroma and is mainly formed of connective tissue(loose) myxomatous stroma and some dispersed lymphocyte. The ductal carcinoma is very serious Pathology of breast which is now a major concern in developed country and to a certain extent in developing countries also. There are many major risk factors which are responsible for the same. Some may be of lifestyle based or of genetic based. The treatment for the disease is now possible with advancement in the medical science.
 Purpose for this review article is: Determine the cause affecting factors influencing factors and pathos physiological background of development of DCIS also to describe the gene involved in alteration of cell to enhance tumorous growth and the treatment therapy involved alongside the disease.

The etiology and related factors of Eustachian tube dysfunction

The Eustachian tube connects the middle ear and the nasopharynx. It's physiological functions include ventilating and balancing the pressure inside and outside the middle ear, drainage of the middle ear secretions, prevention of retrograde infection, sound suppression and noise suppression. Eustachian tube dysfunction is closely related to the occurrence and development of many diseases. It's etiologyand influencing factors are still unclear. This article reviews the recent research on etiology and related factors of Eustachian tube dysfunction,and strives to make breakthroughs in etiology and mechanism, so as to provide help for clinical intervention.

The impact of new bronchial drainage device in a complex form of respiratory disease

Abstract Drainage of secretions in patients with severe lung damage is a challenge. In many cases, due to the significant reduction in muscle mass, difficulties of this nature arise. We present the case of an 82-year-old patient, vaccinated against Severe acute respiratory syndrome coronavirus 2 (SARS COV2), anti-influenza, anti-pneumococcal and anti-haemophilus, former smoker, with no significant exposure to known professional respiratory noxes, with severe comorbidities (cardiac, ophthalmological, rheumatological, neurological, and diabetological) and a congenital pulmonary malformation – right lung hypoplasia (diagnosed in 2008), extensive cystic and varicose bronchiectasis, probably also in a congenital context, with progressive collapse of the right parenchyma and displacement of the mediastinum, complicated with recurrent respiratory infectious episodes with pathogens – Gram-negative germs, anaerobic germs, and repetitive low-amount haemoptysis for 3 years, as well as severe restrictive respiratory dysfunction. Currently, the patient is under bronchodilator treatment, and home oxygen therapy. For about 3 years, regular modern drainage sessions using the studied device have been introduced. Patient adherence was good. The benefits brought by this device on the clinical development of the patient were: efficient drainage of secretions, improvement of the quality of life, and prolongation of survival in a patient with complex pulmonary pathology and multiple comorbidities in development for 13 years. This new therapeutic drainage option has been competing with pre-existing ways (Cough Assist) for several years, demonstrating its multiple benefits in patients with chronic respiratory failure and severe comorbidities.