Patient Experienced Chest Pain Research Articles

APPLICATION OF COX PROPORTIONAL HAZARD REGRESSION FOR ANALYZING FACTORS INFLUENCING THE RECOVERY RATE OF PULMONARY TUBERCULOSIS PATIENTS

Pulmonary tuberculosis is a serious disease that requires special attention from the community and the Government of Indonesia, especially the Maluku Province. One commonly used analytical method in the health field is survival analysis. Survival analysis is a statistical method related to observing the period until the occurrence of an event or events. This study aims to model and identify factors that affect the recovery rate of patients with pulmonary tuberculosis in Ambon City using Cox Proportional Hazard regression. The results of the Hazard Ratio interpretation show that the variables that have a significant influence are chest pain and night sweats. Specifically, patients experiencing chest pain exhibit a recovery rate 0.487264 times faster than those devoid of such symptoms. Similarly, patients experiencing night sweats demonstrate a recovery rate of 0.619839 times faster than their counterparts not experiencing this symptom. This study highlights the imperative of recognizing and addressing symptoms like chest pain and night sweats in managing pulmonary tuberculosis in Ambon City.

Spontaneous Pneumomediastinum in Children: Underdiagnosis and Overtreatment

Background: Spontaneous pneumomediastinum (SPM) is a rare and benign self-limiting condition characterized by the presence of air in the mediastinum without an apparent cause. Boerhaave syndrome, on the other hand, is a rare condition caused by spontaneous esophageal perforation due to severe vomiting. The mediastinum is a complex anatomical region housing vital organs, making clinical comprehension challenging. Objectives: There is no established approach to diagnosing and treating children with SPM. Despite similarities in the presence of air in the mediastinum, SPM and Boerhaave syndrome are distinct entities. However, the primary challenge for patients is ruling out esophageal perforation. We aimed to highlight this rare issue by presenting the results of our patient series to guide further examination in pediatric patients with mediastinal air. Methods: We included twenty-four pediatric patients diagnosed with SPM between 2014 and 2022. Demographic and clinical characteristics, diagnostic procedures, treatments, and follow-up details were retrospectively recorded. Results: The mean age of the twenty male and four female patients was 14 years. Common triggers included coughing (45%), increased physical exertion (33%), and retching/vomiting (8%). All patients experienced chest pain, with additional symptoms such as dyspnea (50%), neck pain (30%), and dysphagia (12%). Symptoms resolved within two days of hospitalization. Patients were often misdiagnosed and received inappropriate treatment at other centers before being transferred to our hospital. A fluoroscopic esophagogram conducted within an average of 22 hours from admission revealed no abnormalities. Oral feeding was withheld for an average of 28 hours. The mean duration of symptom-free hospitalization without treatment was 32 hours. Conclusions: It appears that emergency department physicians may lack familiarity with pneumomediastinum. Surgeons' concerns about missing Boerhaave's syndrome may lead to unnecessary tests, prolonged fasting, and hospital stays for patients with SPM.

Clinical Profile of Post-COVID-19 Patients with Persistent Chest Pain: A Cross-sectional Study

Introduction: Chest pain in post-COVID-19 patients can be due to serious alarming post-COVID-19 sequelae, such as Coronary Artery Disease (CAD), pulmonary embolism, myocarditis, etc. Approximately one-fifth of patients attending clinical Outpatient Department (OPD) following COVID-19 recovery present with persistent chest pain. There is limited knowledge about the clinical profile of patients experiencing persistent post-COVID19 chest pain. Aim: To describe the clinical profile of such patients to fill the knowledge gap and acquire new insights into patients with post-COVID-19 persistent chest pain. Materials and Methods: A cross-sectional study was conducted, enrolling a total of 259 patients with persistent chest pain (i.e., chest pain lasting more than 24 weeks after COVID-19 diagnosis). After detailed history-taking and clinical and laboratory examinations, observed data were collected, compiled, evaluated, and analysed to achieve the study objectives. Results: Out of 259 patients, 133 (51.4%) had cardiac {85 (32.8%)} or pulmonary {48 (18.5%)} abnormalities. Among patients with cardiac abnormalities, CAD, arrhythmia, myocarditis/cardiomyopathy, pericarditis, and PAH were detected in 38 (14.6%), 18 (6.9%), 7 (2.7%), 11 (4.2%), and 11 (4.2%), respectively. Meanwhile, among patients with pulmonary abnormalities, 36 (13.9%) patients had organic residual lesions in the lung parenchyma, 7 (2.7%) had pleuritis, and 28 (10.8%) had pulmonary function abnormalities. The remaining 126 (48.6%) patients experienced chest pain due to non cardiopulmonary aetiologies like gastrointestinal {45 (17.3%)}, musculoskeletal {38 (14.6%)}, psychomotor {35 (13.5%)}, autonomic {8 (3.3%)}, etc. Conclusion: This study found that chest pain in post-COVID-19 patients arises due to multisystemic aetiologies such as cardiac, pulmonary, visceral, autonomic, psychomotor, musculoskeletal, etc. A wide spectrum of serious cardiac abnormalities (such as CAD, arrhythmia, myocarditis, pericarditis, PAH, etc.) contributes to about 1/3rd of cases of persistent chest pain in post-COVID-19 patients.

MYOCARDIAL INFARCTION UNDER METHOTREXATE IN A PATIENT WITH LOW RISK GESTATIONAL TROPHO BLASTIC NEOPLASIA: A CASE REPORT

Background: Methotrexate, an antifolateantimetabolite, finds extensive application in the field of oncology as well as for managingvariousautoimmunediseases. It isconsidered as backbone treatment for bothlow and high risk, trophoblasticgestationalneoplasia, as mono therapy or in combination withothercytotoxic agents.Whileitisconsideredcardioprotective, datas regardingmethotrexate-inducedcardiomyopathy are rare. we report the case of a woman, initiallydiagnosedwithlow-risk trophoblasticgestationalneoplasia, whosuffered a myocardial infraction after the second course of methotrexate. Case Presentation:A 47-year-old woman, with no othercomorbidities, wasinitiallydiagnosedwith a low-risktrophoblasticgestationalneoplasia, characterized by a Bhcg value of 12,022. Shewasundergoingmethotrexatemonotherapy for the condition. Following the second course of chemotherapy, the patient experiencedchest pain, and an electrocardiogramrevealed an elevation of the ST segment. As a result, thrombolytictreatmentwasadministered at H9 of pain onset.Due to the uncertaintysurrounding the relationbetween Methotrexate and the myocardialinfarction and consideringpotential interactions betweennonsteroidal anti-inflammatorydrugs (NSAIDs) and methotrexate, a decisionwas made to switch to Actinomycin D.The evolutionwas favorable, the patient isstillunder surveillance aftertwoyears of follow up. Conclusion:This case report highlights a possible methotrexateinducedmyocardial infraction. Inthis setting our attitude was to switch for anotherdrug, whichwasverywelltolerated, withgood oncologicincome for our patient.

Ischemic heart scombroid syndrome: how to recognize what you know

Mistreated fish products ingestion can lead to a histaminergic illness known as scombroid syndrome. The disease usually causes cutaneous rash, gastrointestinal, breathing disorders, hypotension with further histamine-related symptoms. Although cardiac complications are infrequent, some patients experienced chest pain consistent with an acute coronary syndrome on admission to hospital. The pathomechanism seems related to a transient coronary artery vasospasm. We performed a literature search for all cases published in the literature from 1997 to 2022 with suspected ischemic heart scombroid syndrome. Overall, 18 studies describing 25 patients were recognized and the main pathophysiological, clinical, diagnostic, therapeutic and prognostic features are discussed. A simplified diagnostic flowchart has also been proposed. Even though this syndrome can lead to hemodynamic instability in the acute phase, also in the young, prognosis is rather good.

Factors related to under-triage of patients with acute coronary syndrome in the emergency department: A retrospective study

IntroductionThis study aimed to provide fundamental data to avoid under-triage in the initial severity classification of patients with suspected acute coronary syndrome (ACS) by analyzing factors associated with patients who visited the emergency department (ED). MethodsThis retrospective study identified factors related to under-triage by comparing the characteristics of participants diagnosed with ACS and appropriately classified those who were under-triaged. ResultsThe probability of under-triage increased 5.402 times in patients who visited the ED immediately than in those who visited the ED through an outpatient clinic. The probability of under-triage decreased in patients who visited the ED by ambulance rather than using their personal vehicle. Furthermore, when patients experienced chest pain, the tendency for under-triage decreased. The under-triage tendency increased 8.315 times in patients with dementia. ConclusionsMedical staff training on the classification of non-specific symptoms accompanying diseases is needed. Patients with ACS need to be aware of the symptoms that require visiting the ED and the appropriate route and method. Therefore, it is possible to avoid under-triage for possible ACS during the initial triage, and triage can be performed quickly and accurately.

Distant embolisation in infective endocarditis: characteristics and outcomes.

Infective endocarditis is asevere and potentially lethal cardiac disease. Recognition of the clinical features of endocarditis, such as distant embolisation, and adequate treatment should be initiated promptly given the grim perspective of upcoming virulent pathogens. We report on our registry-based experience with outcomes of consecutive patients with infective endocarditis with distant embolisation. We aimed to describe the patient characteristics of infective endocarditis complicated by distant organ embolisation and the safety aspects of continuing endocarditis treatment at home in these patients. From November 2018 through April 2022, 157consecutive patients were diagnosed with infective endocarditis. Of them, 38patients (24%) experienced distant embolisation, either in the cerebrum (n = 18), avisceral organ (n = 5), the lungs (n = 7) or the myocardium (n = 8). Pathogens identified in blood cultures were predominantly streptococcal variants (43%), with only one culture-negative endocarditis case. Of the 18patients with cerebral embolisation, 12had neurological complaints and most often discrete abnormal findings on neurological examination. Six of the 8cardiac embolism patients experienced chest pain before admission. Visceral organ and pulmonary embolism occurred silently. Of the 38patients with distant embolisation, 17could be discharged earlier by providing antibiotic treatment at home without complications. This registry-based single-centre experience showed an incidence of distant embolisation in daily care of 24%. Cerebral and coronary embolisation provoked symptoms, while visceral emboli remained silent. Pulmonary emboli may present with inflammatory signs. Distant embolisation was not in itself acontra-indication for outpatient endocarditis@home treatment.

Analysis of Clinical Features of Kounis Syndrome Induced by Cephalosporin.

BackgroundCephalosporins are an increasingly encountered cause of Kounis syndrome. The present study examined the clinical features of cephalosporin-induced Kounis syndrome and provided references for diagnosis, prevention, treatment, and prognosis.MethodsWe collected cephalosporin-induced Kounis syndrome case reports by searching Chinese and English databases from the establishment of the database to October 31, 2021.ResultsTwenty-five patients (17 males and eight females) were included, with a median age of 61 years (range 33–92). Cephalosporins were administered via oral, intravenous and intramuscular routes. All reactions occurred within 30 min, except in two patients. Fourteen patients experienced chest pain, 19 experienced hypotension, 16 had cutaneous reactions, 10 had respiratory symptoms, and seven had gastrointestinal symptoms. Thirteen patients had elevated troponin levels, and eight patients had elevated serum tryptase levels. The electrocardiogram showed ST-segment elevation in 13 patients, depression in four patients, and elevation and depression in six patients. Coronary angiography showed normal results in 12 patients and abnormal results in 13 patients. The skin prick test was positive for cephalosporin in three patients. Twenty-four of the 25 patients recovered after being given anti-allergic and acute coronary syndrome treatment, and there was one death.ConclusionsKounis syndrome is a serious adverse reaction to cephalosporin. Clinicians should consider Kounis syndrome in every patient receiving cephalosporin and presenting with acute chest pain or anaphylactic symptoms.

Observational study on chest pain during the Covid-19 pandemic: changes and characteristics of visits to a Norwegian emergency department during the lockdown

BackgroundFollowing the spread of the Covid-19 pandemic in 2020, reports emerged on decreasing emergency department (ED) visits in many countries. Patients experiencing chest pain was no exception. The aim of the current study was to describe how the Covid-19 pandemic and the subsequential lockdown impacted the chest pain population in a Norwegian ED.MethodsAll patients presenting to the ED with chest pain during the study period were included. Data were collected retrospectively from the time period January 6th to August 30th, 2020, and compared to the corresponding period in 2019, assessing variations in the number of ED visits, severity, gender, and age.ResultsFewer patients with chest pain were seen in the ED following the national lockdown in Norway, compared to the corresponding 2019 period (week 13: 38% fewer; weeks 11–27: 16% fewer). By week 28, the rate normalized compared to 2019 levels. There was a relative increase in lower acuity patients among these patients, while fewer moderate acuity patients were seen. During the initial period following lockdown, the median age was lower compared to the corresponding 2019 period (58 years (IQR 25) vs 62 years (IQR 24), respectively). Admissions due to acute coronary syndromes (ACS) remained proportionally stable.ConclusionsSucceeding the Covid-19 outbreak and the subsequent national lockdown in Norway, fewer chest pain patients presented to the ED. Paradoxically, the patients seemed to be less severely ill and were on average younger compared to 2019 data. However, the proportion of patients admitted with ACS was stable during this period. This could imply that some patients may have failed to seek medical advice despite experiencing a myocardial infarction.

Comparison the Effects of Gabapentin and Oxazepam on Sleep Quality, Anxiety, and Pain in Unstable Angina Patients Admitted to Coronary Care Unit of Hazrat Rasool Akram Hospital.

Background:This study aimed to compare the efficacy of gabapentin and oxazepam on sleep quality, the severity of anxiety, and pain level in patients admitted to the coronary care unit (CCU).Materials and Methods:This double-blind randomized clinical trial was done on the patients with unstable angina (UA) admitted to the CCU of Hazrat Rasool Akram Hospital in Tehran. A total of 56 patients were entered the study and randomly divided into two groups of 26. The first group was given a gabapentin capsule at a dose of 300–1200 mg/day, and the second group was given 10–20 mg of oxazepam tablets per day until hospitalization in the CCU. On the first and 4th days of hospitalization, Groningen sleep quality score (GSQS), Beck Anxiety Inventory, and severity of pain experienced by Visual Analogue Scale were recorded, and the mean frequency of chest pains was calculated in 24 h during the first 4 days. The amount of drug (morphine) prescription in CCU also compared between the two groups.Results:There was no significant difference in GSQS scores between both groups. The mean score of Beck's anxiety scale did not differ significantly between the two groups. However, the incidence of chest pain was significantly lower in the gabapentin-receiving group than in the oxazepam-receiving group (<0.001). The days that the patients experienced chest pain were significantly less in the gabapentin-receiving group than in the oxazepam-receiving group (<0.001).Conclusion:The results of our study showed that gabapentin compared to oxazepam could significantly reduce chest pain in patients with UA.

A RARE CASE OF INTERNAL JUGULAR VEIN THROMBOSIS AFTER MRNA COVID-19 VACCINE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: SARS-CoV-19 pandemic is a global health emergency and burden. Millions of people worldwide have been affected and cases continue to rise. Health organizations have focused on creating vaccines to combat SARS-CoV-19 and have successfully formulated new vaccines to distribute globally. However, rare blood clots have been reported on patients receiving viral vector vaccines, halting the distribution and restricting the vaccine's use to limited population. BNT162b1/BNT162b2 mRNA vaccines have been introduced to the world and early studies reported no safety profile against thrombotic events [1,3]. We report a rare case of internal jugular vein thrombosis (IJT) occurring who received his first dose of BNT162b2 mRNA vaccine and subsequently developed clot in his internal jugular vein. CASE PRESENTATION: 38-year-old with history of opioid abuse on suboxone received his first BNT162b2 mRNA vaccine on April 18, 2021. Two days later patient experienced chest pain, dyspnea, left neck swelling and dry cough with odynophagia. Outpatient work up with ultrasonography evaluation revealed a clot and was referred for further evaluation. Carotid US confirmed noncompressible internal jugular vein and CT chest demonstrated left innominate vein thrombus. Laboratory work was notable for elevated PT, PTT, leukocytosis, thrombophilia, elevated LDH and D-Dimer. Intranasal PCR was negative for SARS-CoV-2 and other respiratory viruses. Malignancy workup during hospital admission was negative. DISCUSSION: mRNA vaccines have been reported as a safe and efficacious new type of vaccine to combat SARS-CoV-19. Until recently, no thrombotic events were reported from any BNT162b1/ BNT162b2 mRNA vaccines [2]. To the best of our knowledge, this is the first case of a rare blood clot seen after the first dose of any mRNA vaccine. Given our patient's symptom onset within 1 week of his first dose with documented thrombus and elevated inflammatory markers and in the absence of comorbid conditions, we hypothesize that BNT162b2 likely triggered an extreme immune inflammatory response culminating in our patient's IJT. Patient only received 1 dose of the vaccine but response to the vaccine varies by individual. Careful monitoring of patients for post-vaccine is appropriate given the lack of long-term safety profile. This report will hopefully provide some insight into a potential complication of the newly developed mRNA vaccine that was not discovered during the initial investigative studies. CONCLUSIONS: The adenovirus SARS-CoV-2 vaccine recently became associated with pathologic thrombosis and, although rare, thrombosis may also be a complication of the mRNA vaccines. Close monitoring and possible prophylactic treatment may be considered in patients receiving these vaccines who are at high risk for thrombosis. REFERENCE #1: Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez Marc G, Moreira ED, Zerbini C, Bailey R, Swanson KA, Roychoudhury S, Koury K, Li P, Kalina WV, Cooper D, Frenck RW Jr, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Tresnan DB, Mather S, Dormitzer PR, Sahin U, Jansen KU, Gruber WC; C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020 Dec 31;383(27):2603-2615. doi: 10.1056/NEJMoa2034577. Epub 2020 Dec 10. PMID: 33301246; PMCID: PMC7745181. REFERENCE #2: Carli G, Nichele I, Ruggeri M, Barra S, Tosetto A. Deep vein thrombosis (DVT) occurring shortly after the second dose of mRNA SARS-CoV-2 vaccine. Intern Emerg Med. 2021;16(3):803-804. doi:10.1007/s11739-021-02685-0 REFERENCE #3: Walsh EE, Frenck RW Jr, Falsey AR, Kitchin N, Absalon J, Gurtman A, Lockhart S, Neuzil K, Mulligan MJ, Bailey R, Swanson KA, Li P, Koury K, Kalina W, Cooper D, Fontes-Garfias C, Shi PY, Türeci Ö, Tompkins KR, Lyke KE, Raabe V, Dormitzer PR, Jansen KU, Sahin U, Gruber WC. Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates. N Engl J Med. 2020 Dec 17;383(25):2439-2450. doi: 10.1056/NEJMoa2027906. Epub 2020 Oct 14. PMID: 33053279; PMCID: PMC7583697. DISCLOSURES: No relevant relationships by Matthew Fata, source=Web Response No relevant relationships by Brian Hanly, source=Web Response No relevant relationships by Sung Hong, source=Web Response No relevant relationships by Karan Omidvari, source=Web Response No relevant relationships by Mehek Rahim, source=Web Response

A 26-Year-Old Pregnant Woman With Ventricular Tachycardia and Shock

(N Engl J Med. 2021;384:272–282) A 26-year-old patient, pregnant with monochorionic, diamniotic twins at 32 weeks gestation, was transferred to the hospital following cardiac arrest caused by ventricular tachycardia. This was the patient’s third pregnancy and the previous 2 were uncomplicated. One week before presenting to the hospital, the patient had a cough, sore throat and ear pain, and new edema in her legs. She was prompted to seek care at an emergency department when pain in her right leg progressed. While in the emergency department, painful contractions began, the cervix was 2 cm dilated, and preterm labor management began. There was no further cervical dilation after 24 hours but the patient remained hospitalized. After 5 days the edema had worsened, and an occlusive thrombus was found in the left peroneal vein. Intravenous heparin was administered. The next day, the patient experienced chest pain before becoming unresponsive. Monomorphic ventricular tachycardia was detected. Spontaneous circulation resumed after epinephrine and cardioversion were administered. The patient underwent tracheal intubation and then emergency cesarean section, which resulted in 2 health male infants and an intraoperative blood loss of 1600 mL.

Left atrial \u0131ntramural hematoma after radiofrequency catheter ablation of left lateral accessory pathway

We report a case of left atrial hematoma after ablation of left lateral concealed accessory pathway. A 46-year-old male patient experienced chest pain after radiofrequency ablation. Transthoracic echocardiography and computed tomography revealed the intramural mass consistent with hematoma in the left atrium. He was hemodynamically stable, and conservative approach was decided. Atrioventricular groove is a vulnerable part of left atrium, and ablation of left free wall accessory pathway may require targeting both atrial and ventricular surfaces of the mitral annulus. Avoidance of forceful catheter manipulation during the electrophysiological procedure is important for prevention of this complication. Optimal periprocedural anticoagulation might reduce the risk of procedure-related thromboembolic complications, but electrophysiologists should always pay attention to an intramural hematoma that may occur after radiofrequency catheter ablation.

Hughes-Stovin: A rare entity and challenging therapeutic management

Hughes Stovin is a rare disorder first described in 1959. It's usually diagnosed along Behcet disease (BD), with a High mortality rate that results from the ruptured pulmonary aneurysm. To investigate the course and spectrum of Hughes Stovin syndrome in BD and to assess the clinical and imaging features, treatment, and outcomes. A 38 year-old male, with a family history of AngioBehçet disease (brother who passed away) presented to the hospital with Hemoptysis in the context of a 1 year neglected history of genital/oral aphtae and pseudofolliculitis. CT angiography showed multiple pulmonary arterial aneurysms ( Fig. 1 ), pulmonary embolism along a right brachiocephalic vein thrombosis. A diagnosis of Hughes Stovin syndrome (HSS) associated with Behcet disease was made. Treatment was initiated with methylprednisolone IV 1 g daily for three days then discharged from hospital with prescription of Colchicine. Six months later, the patient had recurrence of his hemoptysis with a CT revealing an alveolar hemorrhage. Corticosteroid and immunosuppressant were the mainstay of therapy but the patient wasn’t compliant to treatment. 1 year later, without any follow-up meanwhile, the patient experienced chest pain and hemodynamic instability, CT revealed an increase in aneurysmal size and intraalveolar hemorrhage. The patient was immediately stabilized and an embolization of the right lower pulmonary artery was performed along immunosuppressants and corticoids. Few months later, the patient had a similar hospitalization that led to the embolization of right upper pulmonary artery with success. He is now still being monitored. HSS is a rare disease affecting mostly male patients between 12 and 40 years of age. Co-morbid conditions like Behçet disease and Hughes Stovin make medical management complicated and very challenging, as the history of this disease is unpredictable.

Multiple spontaneous coronary artery dissections associated with intravenous daunorubicin treatment for acute myelocytic leukaemia: a case report.

BackgroundMultiple spontaneous coronary artery dissection (SCAD) is a rare condition which may lead to serious consequences such as sudden cardiac death, acute myocardial infarction (AMI), and acute heart failure.Case summaryIn this paper, we report the case of a 57-year-old woman with acute myelocytic leukaemia who was undergoing her second phase of chemotherapy. After the first induction cycle of intravenous infusion of daunorubicin, the patient experienced chest pain, shortness of breath, and low blood pressure. The electrocardiograms revealed significant ST-elevation in the D1, aVL, and V2–V6 leads, which indicated AMI. Coronary catheterization showed spontaneous coronary dissection in the mid-left descending coronary artery and first obtuse marginal artery of the circumflex. The patient died immediately.DiscussionThis is the first reported case of multiple SCAD associated with intravenous (IV) daunorubicin infusion. We also reviewed the literature and proposed the mechanism of this complication.

Safety and efficacy profile of povidone iodine pleurodesis in patients with spontaneous pneumothorax

Introduction: Multiple agents are being used for the purpose of chemical pleurodesis with varied success and risks. Povidone iodine was also a successful agent in inducing pleurodesis in pleural effusions and pneumothoraces. Aims and Objectives: To evaluate the efficacy and safety of povidone iodine pleurodesis through intercostal tube drainage (ICD) in patients with spontaneous pneumothorax. Materials and Methods: This was a prospective study where povidone iodine was infused into pleural cavity through ICD in patients with spontaneous pneumothorax. Success of procedure and adverse events recorded. Patients were followed up for 12 months for recurrence of pneumothorax. Results: A total of 38 patients with mean age of 58.6 12.5 years were included in study. 28 patients had successful first procedure, six patients required repeat pleurodesis, three had failed pleurodesis and two had recurrent pneumothorax after 6 months. All patients experienced chest pain of varying severity. Two patients had ARDS. Conclusion: Povidone iodine can be used as effective and safe agent for chemical pleurodesis in spontaneous pneumothorax. Keywords: Pleurodesis, Pneumothorax, Povidone iodine, ARDS, Intercostal tube drainage, Talc.

Sex differences of the association between marital status and coronary artery disease in patients experiencing chest pain: The Korean Women's Chest Pain Registry.

Marriage is an important social practice that predicts various health outcomes, including those of cardiovascular disease. This study investigated the sex-specific association between marital status and coronary artery disease (CAD) in patients experiencing chest pain. Study data were obtained from a nationwide registry of patients with suspected CAD who underwent coronary angiography. We dichotomized all participants according to marital status as follows: without a spouse (single, divorced, or widowed), and with a spouse. Significant CAD was defined as greater than 50% narrowing of the lumen diameter in any of the coronary arteries. The presence of significant CAD was significantly higher in female participants without a spouse than in female participants with a spouse. However, there was no significant difference in the presence of CAD in men between the two groups. Interestingly, there was also no significant difference in the presence of CAD between women without a spouse and men without a spouse. After adjustment for all possible confounding factors, women without a spouse had a 1.62-fold increased hazard for significant CAD in multivariate regression analysis. In contrast to men, a without spouse status is independently associated with significant CAD in women experiencing chest pain. Women with a spouse had the lowest presence of CAD among all groups. In the management of female patients experiencing chest pain, clinicians should consider their social characteristics, including marital status, to predict subsequent cardiovascular disease and determine the appropriate treatment. : Video Summary:http://links.lww.com/MENO/A567.

Treating children with achalasia using per-oral endoscopic myotomy (POEM): Twenty-one cases in review

BackgroundPer-oral endoscopic myotomy (POEM), a modern treatment for achalasia, has only recently emerged as an option for pediatric patients. Here we describe and characterize the success of POEM in children with achalasia. MethodsA single-institution prospective cohort study was performed of patients <18 years old who underwent POEM from 2014 to 2019. Main outcomes were success at one year (Eckardt ≤3), procedure duration, complications, reintervention. ResultsThe median age of patients (n = 21) was 13 years (range 2–17). Median procedure duration was 92 min (range 52–259) with case duration plateau of 87.4 min and learning rate of 15.5 cases. Intraoperative complications included capnoperitoneum requiring needle decompression and mucosotomy requiring additional clips. One patient experienced chest pain with small capnoperitoneum seen on chest radiography, and three patients had extraluminal carbon dioxide found incidentally on routine radiography. All were managed with observation. Pre- versus 1-month postprocedure Eckardt scores were significantly improved (7 ± 2 versus 1 ± 2, p < 0.0001, and median ± SD) with 100% symptomatic relief at one year. To achieve this, 13 patients required further dilation(s), one required laparoscopic Heller myotomy, and two required repeat POEM. ConclusionsPOEM is a viable and safe treatment for pediatric patients with achalasia. We demonstrate improvement in symptoms and procedure proficiency with minimal intra- and postoperative complications. Type of studyProspective cohort study. Level of evidenceLevel II.

Safety and efficacy of denosumab in the treatment of pulmonary metastatic giant cell tumor of bone

BackgroundGiant cell tumor (GCT) of bone is an intermittent and locally aggressive tumor with increasing pulmonary metastatic potential. In this study, we evaluated the interim clinical outcome of denosumab in patients with pulmonary metastatic GCT.Materials and methodsWe retrospectively reviewed seven patients with pulmonary metastatic GCT who received denosumab treatment after local tumor surgery during January 2014 and July 2016. Denosumab treatment for all patients lasted for at least 12 months. Serial chest computerized tomography scan was used to monitor the drug response and RECIST 1.1 standard was used to evaluate the therapeutic efficacy.ResultsAll patients experienced chest pain relief in the first month of treatment. Three patients showed partial response. Four patients got stable disease after denosumab treatment. Adverse events included one patient with hypocalcemia and two patients with fever. No treatment-related deaths were reported. No patient with metastatic disease progression was found during an average of 28.6 months follow-up period.ConclusionWe presented a promising interim clinical outcome using denosumab to treat patients with pulmonary metastatic GCT. Denosumab might be considered as the first-line treatment for patients with inoperable metastatic pulmonary GCT. However, Phase II clinical study with larger number of patients and longer follow-up period is needed to detect the further efficacy and safety of this drug for lung metastatic GCT.

Takayasu\u2019s arteritis associated with eosinophilic gastroenteritis, possibly via the overactivation of Th17

BackgroundTakayasu’s arteritis (TA) is a large-vessel vasculitis pathologically characterized by granulomatous necrotizing vasculitis with giant cells. Although the cause of TA is still unclear, genetic factors as well as immunological abnormalities, particularly the overactivation of Th1 and Th-17, are considered to play important roles in the pathogenesis of this disease. Eosinophilic gastroenteritis (EGE) is a type of refractory inflammation in which numerous eosinophils infiltrate the inflammatory area. It is known that the overactivation of Th2 is associated with the pathogenesis of EGE, although the cause of EGE is still unclear. The immunological abnormalities in TA are therefore thought to be different from those in EGE. To date, no cases of complication of TA and EGE have been reported.Case presentationsAn 18 year-old female was diagnosed with EGE and treated with prednisolone. At 6 months after completion of the treatment, the patient experienced chest pain, and was diagnosed with TA. TH1 and TH17 immunity are thought to be involved with TA, while TH2 are considered to be involved with EGE. In this case, the expression of IL-17 mRNA in the colon mucosa greatly decreased after prednisolone treatment for EGE.ConclusionsThis is the first report of TA complicated with EGE, and the overactivation of TH17 is considered to be associated with the pathogenesis of these two diseases.