Unusual Case of Plastic Bronchitis Presenting with Pneumopericardium.

BACKGROUND Lymphatic circulation in the thorax enters the systemic blood flow at the subclavian vein. Instances where diversion occurs leads to complications such as pleural effusion. A rare complication of lymphatic diversion results in fluid accumulation in the bronchial tree, causing plastic bronchitis. The following case is the first ever report of plastic bronchitis presenting with pneumopericardium. CASE REPORT A 24-year-old female presented to our Emergency Department with an asthma exacerbation. After initiating bronchodilators, a chest radiograph (CXR) showed extensive subcutaneous emphysema, pneumomediastinum, and pneumothorax with atelectasis of the left lung. Chest tomography supported the CXR findings, as well as a finding of pneumopericardium. A thoracostomy tube was placed and a mediastinal window and pericardial window procedure were performed in an attempt to relieve the pressure upon the collapsed lung. Despite these invasive procedures, there was minimal improvement of lung volume with further respiratory deterioration; the patient eventually required mechanical ventilation. Bronchoscopy was performed, which evacuated a white chalky and rubbery substance that created a mold of the bronchial airways. Following the bronchoscopy, the patient's respiratory status improved, requiring less ventilator support, and that patient was successfully extubated. CONCLUSIONS This case highlights the most crucial management of a patient presenting with pneumomediastinum, pneumothorax, and pneumopericardium due to plastic bronchitis. Plastic bronchitis should be high on the list of differential diagnoses. The management of plastic bronchitis with bronchoscopy is supported by the fact that no invasive therapy such as thoracostomy tube or mechanical ventilator alleviated the problem, however, bronchoscopy removed the worm-like cast lodged within the lumen of the bronchial tree.

Medication as a Cause of Acute Pancreatitis.

BACKGROUND Acute pancreatitis is an inflammatory condition of the pancreas characterized clinically by epigastric abdominal pain and elevated levels of pancreatic enzymes in the blood. Drug-induced pancreatitis has recently gained more attention and as a result, physicians are screening more frequently for medications as a cause of acute pancreatitis. CASE REPORT We report the case of a 74-year-old man with a significant past medical history for coronary artery disease, sleep apnea, and gastroesophageal reflux disease who presented with epigastric pain radiating to the back. After a careful history was taken, it was found the patient recently started furosemide; therefore, a diagnosis of furosemide-induced acute pancreatitis was made. CONCLUSIONS Furosemide and other medications should be strongly considered in the differential diagnosis of patients presenting with acute pancreatitis.

Attitudes and beliefs about mental illness among church-based lay health workers: experience from a prevention of mother-to-child HIV transmission trial in Nigeria.

Common mental disorders are prevalent in Nigeria. Due to stigma and a limited number of trained specialists, only 10% of adults with mental illness in Nigeria receive any care. The Healthy Beginning Initiative is a community-based maternal/child health program that includes screening for perinatal depression and was implemented by lay, volunteer, church-based health advisors (CHAs). The aim of the study was to assess the beliefs and attitudes about mental illness among the CHAs. The study used a cross-sectional survey of 57 CHAs, who completed a 43-item, self-administered questionnaire that assessed their beliefs and attitudes about mental illness. The response rate was 71%. Respondents were mostly female (79%), married (83%) and aged 40-49 years (M = 41.16 SD = 10.48). Most endorsed possession by evil spirits (84%), traumatic events (81%) and witchcraft (60%) as causes of mental illness. A majority (69%) believed that people with mental illness were a nuisance, and less than half (46%) believed that mental disorders were illnesses like any other illness. It is concluded that stigmatizing attitudes and beliefs about mental illness are common among the CHAs. Training for lay health workers in Nigeria should include education on the known bio-psycho-social basis of mental disorders and the role of social inclusion in recovery.