Recurrence of thymoma after 11 years presenting as diffuse pleural thickening.

A 50-year-old man presented with a 1-month history of dyspnea, weight loss, and pleuritic chest pain. He had environmental asbest exposure from birth to 12 years-old. Past medical history revealed maximal thymectomy operation and adjuvant radiotherapy with the diagnosis of minimally invasive lymphocytic thymoma 11 years ago. Thorax computerized tomography demonstrated a circumferential pleural thickening encasing the entire left lung and pleural effusion. VATS-pleural biopsy revealed the diagnosis invasive tymoma, Type B1, stage IVA. In conclusion, the diagnosis of invasive thymoma must be kept in mind in the differential diagnosis of diffuse pleural lesions. The recurrence of thymomas may be as long as 10 years after complete resection.

Laboratory and Imaging Evaluation of Cardiac Involvement in Patients with Post-Acute COVID-19.

BACKGROUND: In the post-acute COVID-19 syndrome, many patients suffer from palpitations, effort-associated fatigue, and even sudden death. The mechanism of heart involvement in this syndrome is uncertain. The main purpose of the study was to identify possible cardiac involvement causes in patients with post-acute COVID-19 by using biomarkers such as NT-proBNP and nitric oxide (NO) and cardiac imaging modalities. METHODS: In this cross-sectional study, a total of 105 participants were included according to the existence of symptoms, and 40 of these participants were asymptomatic patients. The ages of the participants ranged from 20 to 50 years. All patients were healthy before COVID-19. The symptoms were defined as palpitations and/or fatigue association with exercise in post-acute COVID-19 term. The comparison of the two groups was made by using biochemical parameters (NT-proBNP, Troponin I, NO) and imaging techniques (echocardiography, cardiovascular magnetic resonance (CMR) and cardiac positron emission tomography (PET)). RESULTS: The symptomatic patients had higher NT-proBNP levels compared with asymptomatic patients (132.30±35.15; 76.86±16.79, respectively; p < 0.001). Interestingly, the symptomatic patients had lower NO levels than asymptomatic patients (9.20±3.08; 16.15±6.02, respectively; p < 0.001). Echocardiography and CMR were normal. However, we found regional increased 18F-FDG uptake on cardiac PET to be compatible with myocardial fatigue. CONCLUSION: We found elevated NT-proNBP levels, low serum NO levels, and increased 18F-FDG uptake on cardiac PET in post-acute COVID syndrome. Cardiac PET could replace or be added to CMR for detecting subtle subacute/chronic myocarditis. The follow-up of patients with post-acute COVID-19 could target the possibility of risk of heart failure.

Bedside approach in the diagnosis obstructive sleep apnea using postprandial oximetry testing: A comparative study with polysomnography.

INTRODUCTION: Due to the availability and cost issues in developing countries of polysomnography (PSG), there is a need for outpatient test for an initial assessment of the patients with suspected obstructive sleep apnea (OSA). OBJECTIVES: Epworth sleepiness scale (ESS) is a widely used and best-validated scale for assessing daytime sleepiness, including dozing when sitting quietly after a lunch (no alcohol). This study introduces a novel screen test called postprandial oximetry test (POT) used during daytime. METHODS: This single-center prospective study included 101 patients (80 patients with suspected OSA and 21 patients without OSA suspicion). Berlin Questionnaire was used to determine the score/pretest probability of OSA patients, all chosen randomly. First, all the patients underwent POT in laboratory. Then we performed PSG. After lunch, while sleeping, the patients were monitored for 1 hour with pulse oximetry and standard electroencephalographic system. The oximetry saturation classification events with SpO2 was divided into two groups as normal or mild obstructive sleep apnea syndrome (OSAS), and moderate-to-severe OSAS. Below 90% SpO2 drops in a postprandial oximetry recordings were accepted as moderate-to-severe. RESULTS: The mean lowest oxygen saturation in PSG was 82.34 ± 5.99, while it in POT were 87.42 ± 1.39. A positive correlation was found between POT- and PSG-derived Apnoea-Hypopnoea Index (AHIs). The sensitivity and specificity in postprandial oximetry were 85% and 85.7%, respectively. The accuracy was 0.903 for POT. CONCLUSION: POT may be useful as an outpatient test in the initial assessment of the patients with suspected OSA, serving as a gatekeeper for PSG.

Waxing and waning pulmonary nodules and myelodysplastic syndrome.

A 53-year-old diabetic woman with the diagnosis of myelodysplastic syndrome was admitted to our hospital with symptoms of anorexia, malaise, fatigue, night sweats, and weight loss. The radiological evaluation revealed waxing and waning pulmonary nodules. A diagnosis of pulmonary tuberculosis was reached by pathologic examination of a wedge biopsy. We did not find a similar case in the literature. Clinicians should keep tuberculosis in mind as a possible etiology of waxing and waning pulmonary nodules.