Recurrent Episodes Of Infection Research Articles

Spontaneous Resolution of an Endobronchial Mass

ABSTRACT Bronchial adenomas are a heterogeneous group of tumors accounting for 5% of primary pulmonary neoplasms. We report the case of a 21-year-old woman with recurrent episodes of lower respiratory tract infections requiring hospitalization since 2008. She was diagnosed with right middle lobe and lower lobe atelectasis and underwent fiber-optic bronchoscopy for further evaluation, which revealed a red, smooth, pedunculated mobile mass in the right bronchus intermedius. The post-bronchoscopy patient had hemoptysis. A review bronchoscopy performed for surgical management surprisingly revealed the disappearance of mass. The patient probably expectorated the mass during the episode of hemoptysis. Such incidence has been reported only once in the literature.

ВЗК-ПОДОБНЫЕ ЗАБОЛЕВАНИЯ У ПАЦИЕНТОВ С Х-СЦЕПЛЕННОЙ АГАММАГЛОБУЛИНЕМИЕЙ: АНАЛИЗ КЛИНИЧЕСКИХ НАБЛЮДЕНИЙ

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency (PID) characterized by defective B cell maturation, low serum immunoglobulin concentrations and recurrent infectious episodes. The disease is caused by defects of the BTK gene, which encodes Bruton's tyrosine kinase. Along with frequent infections, autoimmune complications of XLA are an important issue. Inflammatory bowel disease-like syndromes (IBD) represent a special group of complications of XLA, their pathophysiology largely unknown. Materials and methods used: Authors conducted a retrospective data analysis of 56 patients with XLA followed at the National Scientific and Practical Center for Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev (Moscow, Russia) in 2011-2022. Results: IBD-like disease was diagnosed in 11 of 56 (19.6%) patients with XLA, based on medical history, endoscopic picture, histological and laboratory studies. The median onset of the first clinical manifestations of IBD was 7 years (2;14). The most common symptoms were weight loss (7/11, 64%), chronic diarrhea (7/11, 64%) and recurrent abdominal pain (5/11, 45%). Blood in the stool was detected in a quarter of the patients (3/11, 27%). Upon implementation of anti-inflammatory therapy, the majority of patients available for assessment (7/10, 70%) demonstrated improvement. Complete response to therapy with mesalazine was achieved in 2 patients out of 9 who used it (22%). Complete response to treatment with adalimumab was observed in 1 out of 4, with infliximab in 1/3, and with vedolizumab in 1/2. A single patient had refractory IBD without response to all treatment modalities, which served as an indication for allogeneic hematopoietic stem cell transplantation (HSCT), which unfortunately resulted in fatal outcome due to early post-transplant complications. Conclusion: intestinal symptoms in XLA require special vigilance and a multidisciplinary approach. In the study group, the use of variable anti-inflammatory therapy in the majority of patients was shown to be effective and did not lead to the development of additional infectious complications. Analysis of a larger number of patients with XLA and IBD would allow standardization of anti-inflammatory therapy selection in this complex group.

Hepatolithiasis: Epidemiology, presentation, classification and management of a complex disease.

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts, above the hilar confluence of the hepatic ducts. The disease is more prevalent in Asia, mainly owing to socioeconomic and dietary factors, as well as the prevalence of biliary parasites. In the last century, owing to migration, its global incidence has increased. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary strictures, creating a self-sustaining cycle that perpetuates the disease, frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of "recurrent pyogenic cholangitis". Furthermore, long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma. Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment. The management of symptomatic patients and those with complications can be complex, and relies upon a multidisciplinary team of hepatologists, endoscopists, interventional radiologists and hepatobiliary surgeons, with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications. This comprehensive review provides insight on various aspects of hepatolithiasis, with a focus on epidemiology, new evidence on pathophysiology, most important clinical aspects, different classification systems and contemporary management.

Cystinuria: A rare cause of bladder stone

Cystinuria is an inherited metabolic disorder progressing with recurrent kidney stones due to impaired reabsorption of dibasic amino acids and arises from mutations in the SLC3A1 and SLC7A9 on chromosome 2. Here, we present the case of a 1-year 10-month-old male child with recurrent episodes of urinary tract infections. On evaluation, duplex kidneys and a large bladder calculus were found which was surgically managed. Stone analysis and the genetic study were suggestive of cystinuria.

X-Linked Lymphoproliferative Syndrome: A Spectrum of Clinical and Immunological Profile and Novel Pathogenic Variants from Chandigarh, India

Introduction: X-linked lymphoproliferative syndrome (XLP) is a rare primary immune deficiency. Two types of XLP have been described: XLP-1 and XLP-2. Methods: We found 7 patients with XLP (3 had XLP-1 and 4 had XLP-2) after reviewing the data from Pediatric Immunodeficiency Clinic from 1997 to 2021. Results: Mean age at diagnosis was 3.8 years, and mean delay in diagnosis was 2.6 years. Five patients had recurrent episodes of infections. Four patients developed at least one episode of hemophagocytic lymphohistiocytosis (HLH) (2 with XLP-1 and 2 with XLP-2). Of these, 2 had recurrent HLH (both with XLP-2). Epstein-Barr virus (EBV) infection was detected in 2 (1 with XLP-1 and 1 with XLP-2). Both these patients had HLH. One child with XLP-2 had inflammatory bowel disease. Hypogammaglobulinemia was seen in 3 (2 with XLP-1 and 1 with XLP-2). Genetic analysis showed previously reported variants in 5, while 2 had novel variants (one in exon 7 of XIAP gene [c.1370dup p.Asn457Lysfs Ter16] and other had splice site variant in intron 1 of SH2D1A gene [c.138-2_138-1insG]). Episodes of HLH were managed with intravenous immunoglobulin (IVIg), methylprednisolone, oral prednisolone, cyclosporine, and rituximab. Inflammatory bowel disease was managed using oral prednisolone and azathioprine. One patient underwent haploidentical hematopoietic stem cell transplantation. One child with XLP-2 and WAS died because of fulminant pneumonia. Discussion/Conclusions: XLP should be considered as a strong possibility in any patient with features of HLH, repeated infections with hypogammaglobulinemia, persistent EBV infection, and early-onset IBD.

Two young adults presenting with breathlessness and recurrent chest infection: a major miss!!!

Dyspnea is of multi-factorial etiology, and in young adults, obstructive airway disease is the commonest cause. We are reporting two cases of young adults who presented with breathlessness and recurrent episodes of respiratory tract infections since childhood associated with poor physical development. They were referred to our hospital for an evaluation of suspected lung collapse. The evaluation revealed it to be an unusual case of right lung hypoplasia presenting in the second decade, and which was not associated with any other systemic anomaly in the first case, while the second case was diagnosed as a case of left pulmonary aplasia with right tracheal bronchus and double SVC drainage. The treating physicians should have a high clinical suspicion about developmental pulmonary disorders while treating young patients with recurrent episodes of pneumonia.

Supracardiac Total Anomalous Pulmonary Venous Connection in Adolescence.

Background Supracardiac total anomalous pulmonary communication (TAPVC) constitutes a rare congenital cardiac anomaly. Most babies with supracardiac TAPVC are diagnosed in infancy and undergo complete surgical repair during infancy. Delayed presentation of supracardiac TAPVC is rare, and the surgical outcomes are not well known. This retrospective study was conducted to determine the presentation and surgical outcome of supracardiac TAPVC among adolescents, which constitutes an extremely rare subgroup of TAPVC. Methodology This retrospective analysis was conducted among 15 adolescent patients with supracardiac TAPVC who underwent surgical repair in the cardiothoracic surgery department of a tertiary care center in India. This study aimed to assess the intraoperative, postoperative, immediate, early, and late outcomes of adolescent patients with supracardiac TAPVC who had undergone surgical repair between 2010 and 2014 in a tertiary care center in India. Results The study included 15 patients with a diagnosis of isolated supracardiac TAPVC. A mild degree of cyanosis was present in eight patients, recurrent episodes of lower respiratory tract infections were present in five patients, and dyspnea (New York Heart Association I/II) was noted in 12 patients. Mean oxygen saturation was 92% (range = 85-93%), and mean pulmonary artery pressure was 24 mmHg (range = 15-50 mmHg). After median stenotomy, a wide anastomosis was made between the common pulmonary venous chamber and the posterior wall of the left atrium. A fenestration was made in the Dacron patch in three patients who had raised pulmonary vascular resistance (PVR) preoperatively. Twelve patients were weaned off cardiopulmonary bypass (CPB) with minimal inotropic support. Three patients who had high preoperative PVR had difficulty in weaning from CPB. The mean CPB and cross-clamp time was 75 ± 12 minutes and 58 ± 9 minutes, respectively. Atrial fibrillation was noted in five (33.3%) patients in the early postoperative period, and three (20%) patients had pulmonary artery hypertensive crises postoperatively. There was no superficial or deep sternal wound infection in the postoperative period. Mild and moderate right ventricular dysfunction was present in four (26.67%) and two (13.3%) patients, respectively, in the postoperative period. On two-dimensional echocardiography during follow-up at the end of one year, there was no gradient across the anastomosis, and pulmonary artery pressure was normal in all patients. Conclusions Surgical repair of supracardiac TAPVC in adolescence has an excellent outcome. Survival of patients with supracardiac TAPVC until adolescence depends on the presence of a dilated vertical vein and a large atrial septal defect facilitating unobstructed pulmonary venous flow. The aim of the surgical repair should be to create a wide anastomosis between the left atrium and the pulmonary venous chamber which should be bigger than the size of the mitral valve orifice indexed to the body surface area as it would amount to no or negligible anastomotic gradient postoperatively.

Risk factors of recurrent respiratory infections in early school-age children

Acute respiratory infections (ARIs) annually rank first in the structure of infectious diseases both in Ukraine and worldwide. ARIs are the leading cause of disability and death in preschool children, and with recurrent episodes, they can impact the physical and psychological aspects of children's health, imposing a significant medical burden on families, healthcare systems, and society as a whole. Preventing recurrent respiratory infections (RRIs) can only be achieved through timely intervention in risk factors.Aim: to determine the influence of risk factors on the development of recurrent episodes of acute respiratory infections in children aged 5 to 7 years and to develop preventive measures for their control in primary healthcare settings.Materials and Methods. The authors retrospectively analyzed medical records of 342 children aged 5 to 7 years. The main group included children with RRIs (264), and the control group consisted of children with sporadic illness episodes (78). Results: the incidence of RRIs in children has two peaks at ages 3 and 6, which is likely associated with the commencement of attendance in childcare settings (kindergarten and school). Key prenatal and postnatal, clinical-anamnestic, and social risk factors that increase the likelihood of recurrent respiratory infections in younger school-age children were identified.Conclusions. factors significantly increasing the likelihood of developing RRIs in a child include: ARI episode within the first 6 months of life (OR = 22, 95% CI 11.6 - 41.7), previous pneumonia (OR = 12, 95% CI 3.7 - 40), and the presence of chronic infection foci in the form of tonsillitis (OR = 8.2, 95% CI 4.3 - 15.6), p=0.0001. Primary healthcare practitioners should follow strategies to modify these risk factors and not wait for further depletion of the child's adaptive potential (sanitation of chronic infection foci, promotion of breastfeeding, and tobacco cessation).

Microtopographic superhydrophobic polymer surface to prevent urinary tract infections causing nosocomial drug-resistant bacterial adhesion

Catheter-associated urinary tract infections (CAUTIs) are one of the most prevalent forms of healthcare-associated infections worldwide. Recurrent episodes of infections and development of antibiotic resistance/tolerance among biofilm-forming bacteria are well documented. We developed a simple method of making superhydrophobic micro-structured antibacterial polymer surfaces for coating-free catheters. A two-step fabrication approach was used to turn the hydrophobic polydimethylsiloxane (PDMS) into superhydrophobic surfaces. The nanosecond pulsed Nd:YAG laser was used to fabricate two types of structures (holes and grooves) on a steel mold. The soft-molding technique was adopted to replicate these structures on PDMS films. The pillar structured PDMS surface exhibited a water droplet contact angle (WDCA) of 169○ ± 3° with a low sliding angle of 12○, whereas the grooved surface had 142○ ± 5° contact angle. Moreover, the Luria Broth which is media for bacterial growth shows contact angle of 141○ ± 2° and 120○ ± 3°, respectively. Theoretically, the micro-pillar structures with selected dimensions could sustain the Cassie–Baxter state. The crystal violet binding assay was used to assess the anti-biofilm activity of structured surfaces (grooved and pillared) against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), as well as clinical isolates of Klebsiella pneumonia (K. pneumoniae), E. coli, and S. aureus. Furthermore, the attachment and interaction of bacteria with surfaces were investigated through filed emission scanning electronic microscope (FE-SEM) and confocal microscopy. Overall, the pillar-structured surface reduces the average bacterial attachment more efficiently than a grooved surface (>80% vs. >50% reduction) compared to a plain PDMS surface due to its higher water-repellent property. This work will give new insights into the development of coating-free, long-lasting antibacterial surfaces for polymeric medical devices.

Darier’s disease exhibits a unique cutaneous microbial dysbiosis associated with inflammation and body malodour

BackgroundDarier’s disease (DD) is a genodermatosis caused by mutations of the ATP2A2 gene leading to disrupted keratinocyte adhesion. Recurrent episodes of skin inflammation and infections with a typical malodour in DD indicate a role for microbial dysbiosis. Here, for the first time, we investigated the DD skin microbiome using a metabarcoding approach of 115 skin swabs from 14 patients and 14 healthy volunteers. Furthermore, we analyzed its changes in the context of DD malodour and the cutaneous DD transcriptome.ResultsWe identified a disease-specific cutaneous microbiome with a loss of microbial diversity and of potentially beneficial commensals. Expansion of inflammation-associated microbes such as Staphylococcus aureus and Staphylococcus warneri strongly correlated with disease severity. DD dysbiosis was further characterized by abundant species belonging to Corynebacteria, Staphylococci and Streptococci groups displaying strong associations with malodour intensity. Transcriptome analyses showed marked upregulation of epidermal repair, inflammatory and immune defence pathways reflecting epithelial and immune response mechanisms to DD dysbiotic microbiome. In contrast, barrier genes including claudin-4 and cadherin-4 were downregulated.ConclusionsThese findings allow a better understanding of Darier exacerbations, highlighting the role of cutaneous dysbiosis in DD inflammation and associated malodour. Our data also suggest potential biomarkers and targets of intervention for DD.EhK5eJ71-7TH2Y6eFWuNwdVideo

CpxA/R-Controlled Nitroreductase Expression as Target for Combinatorial Therapy against Uropathogens by Promoting Reactive Oxygen Species Generation.

The antibiotic resistances emerged in uropathogens lead to accumulative treatment failure and recurrent episodes of urinary tract infection (UTI), necessitating more innovative therapeutics to curb UTI before systematic infection. In the current study, the combination of amikacin and nitrofurantoin is found to synergistically eradicate Gram-negative uropathogens in vitro and in vivo. The mechanistic analysis demonstrates that the amikacin, as an aminoglycoside, induced bacterial envelope stress by introducing mistranslated proteins, thereby constitutively activating the cpxA/R two-component system (Cpx signaling). The activation of Cpx signaling stimulates the expression of bacterial major nitroreductases (nfsA/nfsB) through soxS/marA regulons. As a result, the CpxA/R-dependent nitroreductases overexpression generates considerable quantity of lethal reactive intermediates via nitroreduction and promotes the prodrug activation of nitrofurantoin. As such, these actions together disrupt the bacterial cellular redox balance with excessively-produced reactive oxygen species (ROS) as "Domino effect", accelerating the clearance of uropathogens. Although aminoglycosides are used as proof-of-principle to elucidate the mechanism, the synergy between nitrofurantoin is generally applicable to other Cpx stimuli. To summarize, this study highlights the potential of aminoglycoside-nitrofurantoin combination to replenish the arsenal against recurrent Gram-negative uropathogens and shed light on the Cpx signaling-controlled nitroreductase as a potential target to manipulate the antibiotic susceptibility.

#6056 NEPHROLOGIC INVOLVEMENT IN A SURGICAL COMPLICATION: WHEN TO SUSPECT A PYELO-DUODENAL FISTULA

Abstract Background and Aims Spontaneous pyeloduodenal fistula is a rare condition occurring primarily after urologic events, in most cases infected kidney stones, pyonephrosis, xanthogranulomatous pyelonephritis, renal tumors, and infected renal cysts, with nowadays 80 cases described. The close relationship between the kidney and the duodenum is a facilitating condition. Method We describe the case of a 78 yo woman admitted in April 2022 for Acute Kidney Injury associated with fever, vomiting, oliguria and metabolic alkalosis. Over the last two years the patient reported recurrent febrile episodes associated with abdominal tenderness and weight loss. Urine cultures showed recurrent bacterial growth and she received antibiotics for recurrent episodes of pyelonephritis and lower urinary tract infections (K. Pneumonie ESBL +, E. Faecalis, P. Mirabilis). She was under nephrologic follow-up with a renal function demonstrating eGFR CKD-EPI of 35-30 ml/min/1.73 m2. In past medical history she reported atrial fibrillation in DOAC, heart failure with preserved ejection fraction, hypertension, previous left occipito-parietal ischemic stroke and right parotid adenoma. On physical examination of the abdomen there was no tenderness, mild pain in the right hypochondrium, Giordano's maneuver mild positive on the right side. Because of the evidence of lithiasis in the right kidney on ultrasound with grade III hydroureteronephrosis, we performed a CT scan with contrast, finding imaging compatible with right pyelonephritis with associated grade IV hydronephrosis, in particular lithiasic formation localized at the level of the right pyelo-ureteral junction (2 × 1cm), with partial involvement of the proximal portion of the ureter, severe calico-pyelic dilatation with overall reduction of the cortico-medullary thickness; diffuse inhomogeneity of the middle and lower thirds of the renal parenchyma, with evidence of some bubbles in contextual areas and inhomogeneity of the perirenal adipose tissue. Reduced nephrographic effect in the post-contrastographic phases and lack of elimination of the contrast in the urographic phase (12 min) were reported. She was started on antibiotics piperacillin-tazobactam and underwent right percutaneous nephrostomy placement. During the procedure we evidenced a communication between the calyx of the right upper calyceal group and an intestinal loop, probably the duodenum (Fig. 1). Results The patient underwent elective laparotomic surgery for right nephrectomy (Fig. 2) and closure of the intestinal fistula with duodenoraffia and omental patch. She was admitted to a post-operative intensive care unit, given comorbidities and the complexity of the operation. She was discharged in 9 days without post-operative complications, with stable renal function. One month after discharge the patient died of pneumonia. Conclusion Pyeloduodenal fistula is an infrequent condition causing occasional or continuous passing of materials between the alimentary canal and urinary tract. The presence of gastrointestinal symptoms and urinary tract alterations may be misinterpreted when occurring. Management of this case required collaboration between several specialists, with particular skills on AKI and CKD, infective complications, interventional radiology and surgical procedures. The outcome was strongly affected by the patient's general condition and comorbidities, with a good short-term outcome but complications on the long-term follow-up. The occurrence of air in the urinary tract is strongly suggestive of communications across the renal pelvis and the gastrointestinal tract. In particular if occurring in the setting of recurrent infections and nephrolithiasis, the diagnosis of pyelo-intestinal fistula should be considered.

Primary clear-cell adenocarcinoma in women

Objectives: A literature review of clear cell adenocarcinoma (CCA) of the female urethra, which is a urinary tract neoplasm of low prevalence that can affect the urethra in rare occasions. Material and methods: A case report of CCA in a 59-year-old female with low urinary tract symptoms associated with two episodes of acute urinary retention and recurrent urinary tract infection (UTI) with the finding of a periurethral tumor in magnetic resonance image (MRI). Results: After cystectomy, double adnexectomy, urethrectomy, bilateral iliac-obturator lymphadenectomy, and ureteroileal deviation, the diagnosis of urethral CCA spread to lymph nodes was made. The case was discussed in the Urologic Oncology committee, indicating external radiotherapy and cisplatin as adjuvant treatment. Conclusions: Because of its aggressiveness, CCA is a rare tumor that requires radical surgery.

ВЗК-ПОДОБНЫЕ ПОРАЖЕНИЯ У ПАЦИЕНТОВ С Х-СЦЕПЛЕННОЙ АГАММАГЛОБУЛИНЕМИЕЙ: ОБЗОР ЛИТЕРАТУРЫ И КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency that refers to defects in the humoral link and is characterized by severe recurrent infectious episodes as well as low concentration of serum immunoglobulins up to their complete absence. BTK (Bruton tyrosine kinase), a protein coding gene is responsible for this disease, whose mutations lead to impaired maturation of B-lymphocytes followed by a defect in antibody production. The survival rate of patients with early diagnosis and timely replacement therapy with intravenous (IVIG) and subcutaneous (SCIG) immunoglobulins is quite high. Though patients in this group are predisposed to immune complications such as IBD-like lesions of the gastrointestinal tract (GIT) in addition to recurrent infectious episodes. The differentiation of such complications if often of diagnostic and therapeutic difficulties. This group of patients is being actively studied at the moment aimed to the search for therapeutic options. The Article represents a bibliographical review and clinical case of the development of IBD-like lesions of the GIT in a patient with XLA.

Surgical treatment of pulmonary bullous diseases.

Sir, We read with interest, the article by Rastin et al. published in the September-October 2022 issue of Lung India on the results of the surgical treatment of pulmonary bleb and bullous disease.[1] We have also been interested in the treatment of bullous diseases.[2-5] After discussion of treatment options, we also performed surgical resection of two young patients with recurrently infected bullae. We paid attention to indications for resection and preoperative infection control but as a result there was no recurrence. One of them had an uneventful 6 years postoperatively, during which time she gave birth to three children. With this background, we ask the authors following the three questions. First, we would like to ask about indications for surgical resection in bulla patients with pneumonia. Especially in young patients, there is a concern that resection might reduce respiratory function. It is also necessary to pay attention to postoperative infection control. Should recurrent episodes of infection or hemoptysis be considered indications? Second, the authors reported multiple bullae in 19 (27.1%) patients and those with pneumonia complications in 24 (34.3%) patients. The authors emphasized the importance of intraoperative complete drainage if the fluid retention within the bulla. Please, let us know if there are any points that should be especially noted as preoperative measures for such patients. Third, it would be beneficial to know whether there were any patients with recurrent development of bullae after surgery. Please, let us know whether there were any patients in particular have recurrences of infected bullae. Declaration of patient consent The authors certify that appropriate patient consent was obtained. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Проблемы и возможности лечения инфекций верхних дыхательных путей у детей на сегодняшний день

This article presents the resolution and materials of the Expert Council meeting held in Saint Petersburg on May 24, 2023. The meeting was devoted to topical issues of treatment of oropharyngeal infections in children. Leading infectious disease specialists, pediatricians and immunologists from Moscow, Saint Petersburg, Kazan, and other cities of Russia took part in the discussion. According to the resolution, today in the Russian Federation there is a high incidence of acute respiratory infections among children with a high frequency of complications, and fatal outcomes are registered. Numerous cases of active herpesvirus infections are recorded, especially among frequently ill children. The current clinical guidelines for the treatment of acute respiratory viral infections lack algorithms for differentiated therapeutic approaches that reduce disease duration, prevent the development of complications and recurrent episodes of respiratory infections. In clinical practice, there is excessive, often unjustified prescription of antimicrobial therapy, which aggravates intestinal disorders, reducing colonization and immune resistance, and provokes oral infections and inflammations caused by opportunistic pathogens. Based on the presented data, it is necessary to correct clinical recommendations for the treatment of acute respiratory viral infections in children with the introduction of indications for prescribing benzydamine in cases of tonsillitis, pharyngitis (tonsillopharyngitis) and stomatitis as a first-choice medication for sore mouth and throat. It also seems necessary to include data on the efficacy of inosine pranobex in symptoms of acute respiratory viral infections of various etiologies, including COVID-19 and active herpesvirus infections. Key words: benzydamine, herpesvirus infections, inosine pranobex, microbiome, acute respiratory viral infections, ARI, tonsillitis, tonsillopharyngitis, pharyngitis, COVID-19, SARS-CoV-2

Successful Management of Recurrent Tunneled Dialysis Catheter Infections with the Hemodialysis Reliable Outflow Graft Device

The hemodialysis reliable outflow (HeRO) graft was designed for patients with failed arteriovenous accesses caused by an obstructed central venous outflow or patients who have exhausted all upper arm options. We describe a patient with severe stenosis of the superior vena cava (SVC) who experienced recurrent episodes of infection of permanent tunneled catheters, resulting in repeated hospitalizations. We successfully used the HeRO graft after angioplasty of the SVC. This indication for placing the HeRO graft has not been emphasized and mentioned previously in the literature. We also reviewed the literature regarding comparisons of this technique with other options.

A case report Case Report of Idiopathic Pulmonary Haemosiderosis in a Child with recurrent chest infections

Idiopathic Pulmonary Hemosiderosis (IPH) is a rare condition, usually occurring in children and teenagers. The classic presentation is of haemoptysis, iron deficiency anaemia and diffuse pulmonary infiltrates. We report a case of IPH in an 8 year old boy, who presented with recurrent episodes of fever, cough and respiratory infections without any trigger since childhood.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ ЛЕЧЕНИЯ ПАЦИЕНТА С ВТОРИЧНЫМ ПУЗЫРНО-МОЧЕТОЧНИКОВЫМ РЕФЛЮКСОМ

In order to help outpatient pediatric physicians, the authors present a clinical case with reasoning when a urological examination of children is necessary if markers of vesicoureteral reflux (VUR) are identified, which are recurrent episodes of urinary tract infection. Among the reasons there are anomalies in the development of the ureterovesical anastomosis, microbial-inflammatory process of the urinary system organs and dysfunction of the bladder of various origins. In VUR, a combination of these factors is diagnosed rather often. An observation of a pediatric patient with dysfunctional urination of inorganic genesis is given. The presence of dysfunctional urination contributes to the development of VUR as a consequence of impaired bladder function and the development of infection.

Kartagener Syndrome: A Case Report

Kartagener syndrome (KS) is a rare autosomal recessive disorder characterized by a clinical triad of situs inversus, chronic sinusitis, and bronchiectasis. Impaired ciliary motility due to abnormal ciliary structure or function is the main pathophysiological problem in KS. A 38-year-old woman presented to our outpatient clinic with a productive cough, fever, and shortness of breath for 1 month. She has had recurrent episodes of respiratory tract infections since childhood. Clinical investigations revealed situs inversus, sinusitis, and bronchiectasis. She was diagnosed with KS and treated with antibiotics, mucolytics, bronchodilators, and chest physiotherapy. Patients with KS present with chronic recurrent respiratory tract infections due to ineffective mucociliary clearance. Early diagnosis is important to improve prognosis. The main goals in the management of KS are to prevent the progression of the disease, preserve pulmonary function, and improve quality of life.