Omalizumab rescue therapy in refractory status asthmaticus.

INTRODUCTION: Refractory status asthmaticus (RSA) is a severe, life-threatening form of asthma exacerbation that persists despite aggressive treatment with systemic corticosteroids, bronchodilators, and other supportive measures. Omalizumab, a monoclonal antibody that targets IgE, has been approved for treating severe allergic asthma and is effective in reducing the frequency of exacerbations and improving asthma control. Limited evidence exists regarding the use of Omalizumab in RSA, but some studies have suggested that it may have a role in its management. CASE: A 39-year-old male with a decade-long history of asthma presented to the emergency department intubated and unresponsive to pharmacological therapy. The patient's IgE levels were elevated, and Omalizumab was administered after a comprehensive evaluation. The patient made a dramatic recovery and was successfully weaned off the ventilator within 24 h of receiving Omalizumab. He made an uneventful recovery and was discharged home on Omalizumab once every two weeks with regular follow-ups. DISCUSSION AND CONCLUSION: Per our literature search, only 3 cases have been reported where Omalizumab was administered to patients with RSA to wean them off ventilatory support successfully. This case study adds to the existing data on the potential benefits of Omalizumab in managing RSA. It suggests it may be a valuable treatment option for patients who do not respond to standard therapy. However, further research is needed to determine the efficacy and safety of Omalizumab in this population.

MULTIPLE RIB FRACTURES, PLEURAL EFFUSION AND RIGHT-SIDED DIAPHRAGMATIC HERNIATION OF THE COLON INTO THE CHEST ASSOCIATED WITH CHRONIC COUGH AFTER COVID-19.

Rib fractures are an infrequent consequence of severe cough. In some patients, undetected rib fractures can lead to life-threatening outcomes. The case of a 73-year-old man who presented with shortness of breath and a worsening dry cough from a SARS-CoV-2 infection for 4 weeks is described. In the emergency department, he was found to be hypoxic and hypotensive. Imaging studies revealed a large right pleural effusion, multiple rib fractures, and right-sided herniation of the colon into the chest. He was admitted to the cardiothoracic intensive care unit where he underwent a flexible bronchoscopy, right video-assisted thoracoscopic surgery, evacuation of a haemothorax, complete decortication, and repair of a diaphragmatic hernia. This case is an unusual presentation of an amalgamation of rare complications resulting from an unrelenting, poorly controlled SARS-CoV-2 infection cough that prompted rapid recognition and swift action. LEARNING POINTS: Physical examination and plain radiography frequently miss costal arch fractures if no bone pathology or history of trauma is present.Controlling cough is important, and decreases the chances of complications and rupture of organs.New-onset chest pain with a background of chronic cough makes cough-induced rib fracture a probable differential diagnosis. Pleural effusion in a patient presenting with cough and a rib fracture should make clinicians suspect haemothorax.

"Peanut saves the day": an innovative solution to massive, cryptogenic haemoptysis-a case study.

Massive (or life-threatening) haemoptysis is a time-sensitive emergency encountered by a physician that requires an interdisciplinary, collaborative effort to arrest the bleeding in a prompt and timely manner. Placement of an endobronchial Watanabe spigot (EWS) to halt haemoptysis is a relatively recent technique finding its wide application in airway pathology, with the current extension of its use to bronchial bleeding. However, the lack of immediate access to EWS gives rise to the need to innovate with day-to-day materials used in routine surgical practice and available in resource-limited settings, which may serve the purpose of a spigot. In this report, we bring to light a case of life-threatening, cryptogenic haemoptysis that was managed by a novel technique of using peanut gauze as a spigot resulting in a successful endobronchial tamponade.