Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: October CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Lobar Pneumonia
- Necrotizing Pneumonina
- PCP Pneumonia with Pneumatocele
- Pneumothorax
- Pleural Effusion
- Parapneumonic Effusion
- Aortic Transection
- Lung Mass
- ARDS
Infective Endocarditis as a Complication of Ventriculoatrial Shunting for Hyd...asclepiuspdfs
Our aim is to present a rare cause of tricuspid valve infective endocarditis (IE) in grown-up age due to cerebrospinal fluid shunt-associated infection. A 32-year-old woman, with a history of hydrocephalus that was treated with ventriculoperitoneal (VP) shunt at the age of 4, was admitted to a hospital due to fever. The VP shunt was replaced several times due to dysfunction and replaced with ventriculoatrial (VA) shunt 3 months before admission. Transesophageal echocardiogram revealed two separate VA catheters in the right atrium, with two floating echo formations, one attached to the tip of one catheter and the other to the anterior leaflet of tricuspid valve. Blood cultures grew methicillin-susceptible Staphylococcus aureus. Computed tomography scan showed bilateral pneumonia. The patient was treated with antibiotics followed by partial extraction of the VA shunt. After 8 weeks, the patient was discharged, without signs of infection. Two months later, she was readmitted due to fever, echocardiographic signs of catheter infection, and septic pulmonary embolization. Complete extraction of VA catheter was done and treatment was continued with antibiotics with complete recovery. Early diagnosis and optimal management that combines both conventional and surgical approaches is crucial for reducing the high embolic risk, risk of complications, and mortality risk.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: October CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Lobar Pneumonia
- Necrotizing Pneumonina
- PCP Pneumonia with Pneumatocele
- Pneumothorax
- Pleural Effusion
- Parapneumonic Effusion
- Aortic Transection
- Lung Mass
- ARDS
Infective Endocarditis as a Complication of Ventriculoatrial Shunting for Hyd...asclepiuspdfs
Our aim is to present a rare cause of tricuspid valve infective endocarditis (IE) in grown-up age due to cerebrospinal fluid shunt-associated infection. A 32-year-old woman, with a history of hydrocephalus that was treated with ventriculoperitoneal (VP) shunt at the age of 4, was admitted to a hospital due to fever. The VP shunt was replaced several times due to dysfunction and replaced with ventriculoatrial (VA) shunt 3 months before admission. Transesophageal echocardiogram revealed two separate VA catheters in the right atrium, with two floating echo formations, one attached to the tip of one catheter and the other to the anterior leaflet of tricuspid valve. Blood cultures grew methicillin-susceptible Staphylococcus aureus. Computed tomography scan showed bilateral pneumonia. The patient was treated with antibiotics followed by partial extraction of the VA shunt. After 8 weeks, the patient was discharged, without signs of infection. Two months later, she was readmitted due to fever, echocardiographic signs of catheter infection, and septic pulmonary embolization. Complete extraction of VA catheter was done and treatment was continued with antibiotics with complete recovery. Early diagnosis and optimal management that combines both conventional and surgical approaches is crucial for reducing the high embolic risk, risk of complications, and mortality risk.
Empyema Complicating Pleural Pseudo-Tumour in Human Immunodeficiency Viral Di...semualkaira
Empyema is suppurative infection in the pleural cavity associated with accumulation of pus in the pleural cavity.
It is common among people with immunosuppression.
Subclinical thyroiditis related to COVID-19: A case report and literature reviewkomalicarol
COVID-19 can cause different clinical manifestation by affecting
different organs in the body. Involvement of thyroid gland is very
rare in COVID-19 infection than any other systems of the body.
We described a 41-year-old female with subclinical thyroiditis
most likely related to corona virus infection and reviewed literatures regarding cases of thyroiditis due to COVID-19 have been
reported. The objective of this article is to create awareness regarding this novel entity and the association with thyroid dysfunction
A Case Study on Hospital Acquired Stenotrophomonas MaltophiliaYogeshIJTSRD
Stenotrophomonas maltophilia xanthomonas is a multidrug – resistant, aerobic non fermentative negative bacillus that is an opportunistic pathogen, particularly a common coloniser of the respiratory tract in hospitalised patients. This hospital acquired organism emerged as an important nosocomial pathogen associated with high mortality rates. This case study is based on an elderly patient diagnosed with Type 2 Respiratory Failure, who was on mechanical ventilation and had multiple organisms found in ET minibal. The patient was treated with beta lactams, macrolide, carbapenem, antifungal and fluoroquinolone. The patient was then found to be hemodynamically and clinically stable. Dr. Blessy Rachal Boban | Dr. Sheethal R Johnson "A Case Study on Hospital Acquired Stenotrophomonas Maltophilia" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd41174.pdf Paper URL: https://www.ijtsrd.commedicine/other/41174/a-case-study-on-hospital-acquired-stenotrophomonas-maltophilia/dr-blessy-rachal-boban
A review of literature covering current knowledge areas about pathophysiology and progression of CoVid-19 in humans. I gave a day to day disease account along with serum markers and clinical condition of patients. My objectives are: Appreciate the background knowledge about CoVid-19 in most recent literature.
Explain the progression of CoVid-19 disease in a human body based on current literature.
Correlate the known risk factors for adverse outcomes with pathogenesis of CoVid-19.
Describe the pharmacologic mechanisms being used to halt disease progression and prevent adverse outcomes.
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...navasreni
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...clinicsoncology
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...pateldrona
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...georgemarini
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...SarkarRenon
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...komalicarol
In this case report we describe the detection of very early ultrasonographic signs of lung involvement in a patient who presented no clinical signs of Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS-CoV-2) pneumonia, but who developed respiratory symptoms and tested
positive for SARS-CoV-2 infection 22 days later
Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...AnonIshanvi
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
The human microbiota is an extremely large system with its majority inhabitin...semualkaira
Human microbiota is the system englobing more than 100 trillion
microorganisms living in symbiosis with the hosting body [1, 2].
The majority of the human microbiota inhabits the gastrointestinal
tract especially the colon
COVID-19 Infection Occurring in The Postoperative Period in A Patient Who Und...semualkaira
While the coronavirus-associated Covid-19 infection remains a
risk for people all over the world as a pandemic, it is also a major
catastrophic clinical situation for patients undergoing surgery in
hospitals. If patients encounter this infection picture, especially
after severe operations such as heart surgery, the life-threatening
rates increase gradually.
Incisional Hernia Occurring after Ventriculoperitoneal Shunt Fixationsemualkaira
Ventriculo-peritoneal shunt is the procedure of choice for hydrocephalus. Various complications of ventriculoperitoneal shunts
were reported. Abdominal complications involving the distal tip
of the catheter make the majority of the complications. In this case
report we present a case of incisional hernia occurring in a patient
who underwent fixation of ventriculoperitoneal shunt followed by
revision of the shunt after a while.
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Empyema Complicating Pleural Pseudo-Tumour in Human Immunodeficiency Viral Di...semualkaira
Empyema is suppurative infection in the pleural cavity associated with accumulation of pus in the pleural cavity.
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A Case Study on Hospital Acquired Stenotrophomonas MaltophiliaYogeshIJTSRD
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A review of literature covering current knowledge areas about pathophysiology and progression of CoVid-19 in humans. I gave a day to day disease account along with serum markers and clinical condition of patients. My objectives are: Appreciate the background knowledge about CoVid-19 in most recent literature.
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Correlate the known risk factors for adverse outcomes with pathogenesis of CoVid-19.
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Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...navasreni
The increasing interest in Lung Ultrasound (LUS) over the last years led to a great diffusion and better experience in using this technique, which became an essential tool for clinicians. During the current Coronavirus Disease 2019 (COVID-19) pandemic, LUS is being extensively applied to the evaluation and monitoring....
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Can Lung Ultrasound in Patients with Fever of Unknown Origin Detect Early Sig...pateldrona
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The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
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Human microbiota is the system englobing more than 100 trillion
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COVID-19 Infection Occurring in The Postoperative Period in A Patient Who Und...semualkaira
While the coronavirus-associated Covid-19 infection remains a
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
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Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
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To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Volume 8 Issue 4 -2021 Case Report
m2 and she had fine moist rales in her right lung. The laboratory
data, including routine blood test, C-reactive protein, erythrocyte
sedimentation rate (ESR), biochemical indexes, procalcitonin, and
anti-HIV antibody were normal. T-SPOT test was negative. No ab-
normality was found in echocardiography. She underwent thora-
coscopic lobectomy of the right middle lobe plus segmentectomy
for anterior segment of her right upper lobe. Histological exam-
ination of the resected specimens revealed multifocal and chronic
granulomatous inflammation with partial necrosis (Figure 2A) and
positive acid-fast bacilli (Figure 2B), indicating mycobacterial in-
fection. Identification of mycobacterium species by fluorescence
quantitative polymerase chain reaction (PCR)-probe melting
curve technique revealed Mycobacterium intracellular. She then
received treatment for nontuberculous mycobacterium pulmonary
infection with azithromycin, amikacin, rifampicin, ethambutol and
moxifloxacin for 15 months. No bronchiectasis or other abnormal
lesions were found in both lungs of her thoracic CT reexamina-
tion following drug withdrawal (Figure 1D). So far, the patient has
been followed up for nearly one year and a half without hemopty-
sis after drug withdrawal.
Figure 1: An initial thoracic computed tomography scan demonstrated mild localized bronchiectasis with a tree-in-bud sign at the middle lobe of her
right lung.
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Figure 2: Histological examination of the resected specimens revealed multifocal and chronic granulomatous inflammation with partial necrosis and
positive acid-fast bacilli indicating mycobacterial infection.
4. Discussion
Due to the increased presence of advanced diagnostic techniques
and increased awareness among clinicians, the incidence of NTM
infection has dramatically increased in the past two decades glob-
ally, which is also true in China [2-4]. Mycobacterium avium
complex (MAC) is ubiquitous and has become a common finding
worldwide in respiratory secretions and tissues [5]. The majority
of humans infected with NTM develop a chronic illness that slow-
ly progresses. Middle-aged patients are more likely to be infected
with NTM, especially in female, which is referred to as Lady Wind-
ermere syndrome. Reich and other researchers [6] first described
the syndrome in 1992, which was named after a fussy character in
Oscar Wild’s plays, “Lady Windermere’s Fan”. It is characterized
that female patient without apparent predisposing pulmonary dis-
ease has habit of voluntary suppression of cough which induces to
unable to clear the secretions from the right middle and left lingual
lobe of lung. Since then, dozens of cases have been reported, pri-
marily from the West (more likely to be the Caucasian) [7], though
a few were reported from Southeast Asia [8, 9] and Taiwan [10].
However, no cases have been reported from China.
Postmenopausal women who are tall and have a thin morphotype
and low BMI, scoliosis, pectus excavatum and mitral valve pro-
lapse are prone to this disease, which is a unique phenotype for this
disease. Host factors of NTM PD also include rheumatoid arthri-
tis and use of immunomodulatory drugs. Moreover, warm, humid
environments with high atmospheric vapor pressure contribute to
population risk [2]. Although the pathophysiology for susceptibili-
ty to NTM lung disease in these patients remains unclear, multiple
factors interacting endocrine systems have the potential to con-
tribute to Lady Windermere syndrome by modulating immune re-
sponses to NTM [11]. Another study identified that rare variants in
MST1R contribute to Lady Windermere syndrome by decreasing
airway ciliary function and reducing IFN-γ production in response
to NTM [12].
The diagnosis comprises three components of microbiologic,
radiographic, and clinical criteria. The clinical criteria include
cough, sputum, occasional hemoptysis, and febrile episodes. Ra-
diologically, chest X-ray or CT scans show a spectrum of reticu-
lonodular opacities, a tree-in-bud nodularity, and cavitary lesions
superimposed on cylindrical bronchiectasis of the right middle
lobe and left lingular segments. Furthermore, sputum culture or
bronchoalveolar lavage culture demonstrates the infection caused
by MAC. In the present case, the patient had a low BMI, was
perimenopausal and had repeated hemoptysis as the main clini-
cal manifestation. The patient’s imaging demonstrated progressed
bronchiectasis, and MAC lung disease was confirmed by postop-
erative pathology, which was found to be in accordance with Lady
Windermere syndrome.
Regarding the treatment of NTM lung disease, it is important to
assess the pathogenicity of the organism, risks and benefits of
therapy, the patient’s wishes and ability to receive treatment. The
American Thoracic Society (ATS) guidelines suggest initiation
of treatment in patients who meet the diagnostic criteria for NTM
pulmonary disease, especially in the context of positive acid-fast
bacilli sputum smears or cavitary lung disease. In this regard, the
ATS strongly recommends that the initial therapy for patients with
macrolide-susceptible MAC lung disease consist of a minimum
three-drug regimen that includes azithromycin rather than clari-
thromycin [13]. Although medical therapy remains the primary
treatment modality for patients with pulmonary NTM disease, pul-
monary resection may reduce the incidence of symptomatic dis-
ease recurrence [14]. Surgical resection is appropriate in cases of
localized disease or resistant to medical therapy [15].
5. Conclusion
Whereas bronchiectasis is a common respiratory disorder encoun-
tered in clinical practice, NTM infections should be considered in
atypical scenarios. When patients with repeated hemoptysis and
bronchiectasis seek health care, especially in middle-aged women
with bronchiectasis in the right middle lobe and lingular segments,
clinicians should suspect the possibility of NTM diagnosis.
6. Acknowledgement
The authors thank the patient and her family members for their
generosity and cooperation.
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