Background Empyema thoracis is defined as accumulation of pus in the pleural space. Despite advanced medical diagnostic and therapeutic methods, thoracic empyema remains a common clinical entity and a serious problem all over the world with significant associated morbidity and mortality. Aim The aim of this work was to study the efficacy and safety of medical thoracoscopy (MT) in the management of empyema. Patients and methods This study included 30 inpatients with empyema. Included patients had frank pus on aspiration (turbid purulent fetid fluid) with or without positive Gram stain smear and microbiological culture findings or pH less than 7.20, with signs of sepsis. Patients were managed by MT. MT using rigid thoracoscopy was performed with evacuation of the purulent fluid, visualization of the pleural space, assessment of adhesions and purulent material, forceps adhesiolysis, and irrigation by normal saline with partial debridement of accessible parietal pleural surface. Results The present study included 30 patients with empyema (17 men, 13 women with a mean age of 47.4±14.5 years; range, 18–70 years); 19 (63.3%) patients had free-flowing empyema (by computed tomography/ ultrasonography) and 11 (36.7%) patients had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess (6.7%), and no cause was identified in nine patients (spontaneous pleural infection) (30%). MT was considered successful without subsequent interventional procedures in 26 of 30 (86.7%) patients, including all patients with free-flowing empyema (19 patients), 63.6% of patients with multiloculated empyema (seven patients), and four (13.3%) patients required surgical intervention (surgical decortication). No procedure-related mortality or chronic morbidity occurred in this study. Conclusion MT is a simple, safe, minimally invasive, and effective modality in the management of empyema.
Background: Coronaviruses are ribonucleic acid viruses, in humans the viruses may infect the respiratory, gastrointestinal, hepatic, and central nervous systems. Infection with four of the most common coronaviruses strains. usually lead to mild, self-limiting upper respiratory tract infections However, other corona viruses, are associated with severe acute respiratory syndrome (SARS-CoV) and the Middle East respiratory syndrome (MERS-CoV). Aim: to assess the use of systemic steroid either pulse steroid or regular dose of steroid in patient with severe form of covid 19 as regard hospital stay, need for mechanical ventilation. Methods: a cross sectional study, carried out on 50 patients who were suspected with covid 19 by history, laboratory investigation, chest imaging and confirmed with PCR selected from the critical care unit and isolation critical care unit at Benha university Hospital. And were classified into two groups, Group1: 25 patients were received dexamethasone (8 mg per day) and Group 2: 25 patients were received solumedrol (2mg per Kg). All data will be tabulated and statistically analyzed. Results: the mean ICU length of stay in critically ill patients who received Dexamethasone was 12.5±4.286 versus 14.68±7.851 in critically ill patients who received Methylprednisolone (p-value=0.08). Patients in Dexamethasone group, by the 10th day, had a significantly better D dimer (1153.04±725.34 vs 1633.12±1244.8, p=0.020), ferritin, (899.14±344.22 vs 1523.8±994.44, p<0.001), NLR (3.108±0.430 vs 3.506±0.536, p<0.001), however, Methyl prednisolone group had lower mortality rate (p0.001). Conclusion Covid 19 is global pandemic with worldwide mortality rate that need urgent interventions from all world to face this catastrophe. However, ICU stay, d dimer, ferritin, NLR among patients who treated with Dexamethasone lower than among patients who treated with Methylprednisolone, those treated with Methylprednisolone had better mortality rates.
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