Thoracoscopic blood patch instillation for persistent air leak in pneumothorax: a case series and systematic review.

Persistent air leaks in patients with pneumothorax can lead to significant morbidity. If a patient with persistent air leak is medically unfit for thoracic surgery, medical pleurodesis via chest tube or thoracoscopy is either an option. Thoracoscopy offers the advantage of visualizing the site of the air leak and enabling direct instillation of the pleurodesis agent or glue at that location. Autologous blood patch instillation via chest tube has been reported to be a cheap and very effective technique for the management of persistent air leaks. However, thoracoscopic blood patch instillation has not been reported in the literature. We report two cases of secondary spontaneous pneumothorax in which patients had persistent air leaks for more than seven days and were subjected to thoracoscopy to locate the site of the leak. In the same sitting, 50 mL of autologous blood patch was instilled directly at the leak site. Post-procedure, the air leak subsided in both patients, and the chest tube was removed with complete lung expansion. We also conducted a systematic review of the use of medical thoracoscopic interventions for treating persistent air leaks.

Geriatric tuberculosis in India-challenges and solutions.

India has the highest burden of tuberculosis (TB) in the world. Despite a national program for control and elimination of TB, there is a lot to achieve to effectively diagnose and treat TB. One important aspect that often remains ignored is geriatric TB. This article focuses on the challenges in clinical presentation, diagnosis and treatment of geriatric TB along with some suggested solutions.

Pattern of serum protein capillary electrophoretogram in SARS- CoV-2 infection.

BACKGROUND AND AIMS: Monoclonal/biclonalgammopathy of unknown significance (MGUS/BGUS) is observed in COVID-19. This study was conducted to determine the changes in serum protein electrophoresis (SPEP) in COVID-19. MATERIALS AND METHODS: In this descriptive (cross-sectional) study, serum inflammatory markers (CRP, IL-6 and ferritin) were measured and SPEP was carried out by capillary electrophoresis method in 35 controls and 30 moderate & 58 severe COVID-19 cases. RESULTS: Serum inflammatory markers were increased in COVID-19 cases with severity. M-band(s), ß-γ bridging and pre-albumin band(s) on SPEP were observed in 15.5, 11 & 12% of severe cases and 3, 4 & 0% moderate COVID-19 cases respectively. Area under curve (AUC) of α 1 and α 2 bands of SPEP increased significantly in severe COVID-19. CONCLUSIONS: We conclude that SPEP changes like the appearance of M-band(s) indicating MGUS(BGUS), ß- γ bridging indicating the presence of fast-moving immunoglobulins, pre-albumin band indicating the rise in serum transthyretin level and the increase in AUC of α 1 and α 2 bands indicating the rise in positive acute phase reactants occur in COVID-19. The occurrence and magnitude of these changes are higher in severe COVID-19 than that in moderate COVID-19. The diagnostic and prognostic significance of these SPEP changes are worth exploring.

Cytodiagnostic aspects of bronchioloalveolar carcinoma manifesting with small cell morphology on respiratory specimens: a case report.

BACKGROUND: Exfoliation of bronchioloalveolar carcinoma (BAC) cells with small cell morphology in respiratory specimens can cause a diagnostic dilemma, particularly in patients with a history of bronchorrhea. CASE: A 59-year-old man presented with cough, breathlessness, and bronchorrhea. Clinically, he was diagnosed to have right-sided pulmonary consolidation. His sputum and bronchial washing specimens examined on multiple occasions revealed a varied number of single and loose aggregates of atypical cells, along with rare micropapillary and glandlike structures. The cells were small, round, and fairly monomorphic with a high nucleus to cytoplasm ratio and scant to moderate cytoplasm. Chromatin was uniformly distributed, with no appreciable nucleoli. At places, a vague nuclear molding was noted. Clinically, bronchorrhea and the diffuse infiltrative nature of the lesion favored BAC. Cytologically, prominent small cell morphology and nuclear molding suggested a possibility of small cell neuroendocrine tumor. However, careful cytologic examination of subsequent respiratory samples and biopsy revealed features of a nonmucinous type of BAC. CONCLUSION: Despite the small cell morphology of neoplastic cells on exfoliative respiratory cytology, a clinical history of bronchorrhea should prompt a cytodiagnosis of BAC. A glandlike arrangement of cells and greater amount of cytoplasm should also assist avoiding misinterpretation in such instances.