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Invasive Pulmonary Aspergillosis with Spontaneous pneumothorax and systemic dissemination(Thyroid and Spleen) after receiving Tocilizumab:A case report

Invasive pulmonary aspergillosis in critical ill patients with viral pneumonia has been reported in the past and as well with Cov id-19 pneumonia. Such presentation was rarely reported in Cov id-19 patients who received Tocilizumab (IL-6, inhibitor) [1]. We are reporting an invasive pulmonary aspergillosis and spontaneous pneumothorax in a patient with severe covid pneumonia after re ceiving a single dose of Tocilizumab and who do not require me chanical ventilation.

Thymectomy in Red Cell Aplasia – a case report

1.1. Background: Pure Red Cell Aplasia (PRCA) is a very rare syndrome responsible for severe anemia due to absence or signifi cant reduction of erythroid precursors in the bone marrow. It’s eti ology is variable, ranging from a congenital disease to an acquired one. Secondary acquired PRCA may be associated with several conditions, including Thymic Tumors.

Acute kidney injury in patients undergoing on-pump cardiac surgery: a single center experience

1.1. Background: Cardiopulmonary bypass (CPB) was one of the risk factors for acute kidney injury (AKI) in patients undergoing cardiac surgery. Previous studies indicated that the incidence of AKI in on-pump surgery varied from 1% to 64%, according to different criteria of AKI and types of surgery. Fuwai Hospital is a prominent center for cardiac surgery in China. The incidence of AKI in patients undergoing cardiac surgery with CPB in our center remained unknown. Therefore, we wanted to summarize the incidence of acute kidney injury (AKI) in patients undergoing on-pump cardiac surgery at Fuwai Hospital and analyze the risk factors and preventive and therapeutic measures for AKI. 1.2. Methods: Relevant articles were searched from China Nation al Knowledge Infrastructure (CNKI), VIP Data, WANFANG Data, Sino-Med, PubMed, Ovid, and Embase, using the search terms: (“Fuwai” OR “fuwai”) AND (“acute kidney injury” OR “renal dysfunction” OR” renal failure” OR “renal replacement therapy” OR” dialysis” OR “blood urea nitrogen” OR “creatinine”) AND (“cardiopulmonary bypass” OR “ extracorporeal circulation”). 1.3. Results: Seventeen studies were included in this analysis. The incidence of on-pump cardiac surgery-induced AKI ranged from 25.6% to 77.6%. Risk factors for AKI in adults included increased age, prolonged cardiopulmonary bypass (CPB) duration, elevated body mass, male sex, history of hypertension, total red blood cell infusion, aortic dissection, and total arch replacement combined with frozen elephant trunk implantation. In pediatric patients, the risk factors for AKI were preoperative cardiac dysfunction, ear ly fluid overload, higher preoperative estimated creatinine clear ance, higher postoperative day neutrophil-to-lymphocyte ratio, postoperative day renal hypoperfusion pressure, and a previous bidirectional Glenn procedure. In addition, urine neutrophil gelati nase-associated lipocalin was a highly predictive early biomark er of AKI. Levosimendan reduced the incidence of postoperative AKI in critically ill patients undergoing on-pump coronary artery bypass grafting. The aortic balloon occlusion technique decreased the incidence of postoperative AKI. A lower threshold of hypother mic-indexed oxygen delivery was negatively associated with AKI. A longer duration from diagnosis to surgical repair and a higher preoperative albumin level helped lower the risk of AKI in pediat ric patients with left coronary reimplantation

A Tale of Two Abscesses: A Case Report of Recurrent Pyogenic Liver Abscess Formation After Successful Liver Transplantation

The development of pyogenic liver abscess (PLA) after liver transplant is rare. Studies have commonly reported hepatic artery thrombosis and biliary tract pathologies as risk factors for PLA formation. Whilst other modifiable etiologies include diabetes and immunosuppression. This is a case of a 71-year-old male with a history of hepatitis B, diabetes mellitus, and hepatocellular carci noma who presented with PLA formation 14 years and 21 years after successful liver transplantation without biliary tract recon struction. Post-transplant biliary cholangiopathy and hepatic ar tery thrombosis were not present in both instances. Intravenous antibiotics and abscess drainage were performed for both PLAs with complete resolution. This case highlights the importance of early recognition of liver abscess and management of diabetes mellitus glycemic control, immunosuppressive drugs, and periop erative antibiotics prophylaxis to prevent future PLA formation in post-liver transplant patients.

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