We describe a case of Whipple's disease with pulmonary hypertension in a 72-year-old woman in whom the pulmonary hypertension resolved completely after antibiotic therapy. She was admitted to study with a 2-months history of weight loss, diarrhoea, abdominal pain, asthenia, inappetence, and fever. She did not have dyspnoea or respiratory symptoms. A casual echocardiogram showed a pulmonary artery systolic pressure of 95 mmHg. Forty days after starting antibiotic therapy, an echocardiogram showed a complete normalisation of right ventricular involvement. Whipple's disease is a rare and multisystemic disorder in which pulmonary involvement is not a well-known finding. Although Whipple's disease is not generally considered as a possible cause of pulmonary hypertension, such awareness is important because it may be potentially resolved with antibiotic therapy.
We report a case of exogenous lipoid pneumonia caused by inhalation of liquid paraffin in a fire eater young man. The patient was admitted to the Emergency Department because of acute retrosternal pain, dry cough and dyspnea. Chest radiograph showed multiple bilateral basal alveolar opacities associated to left pleural effusion; CT chest scan showed multiple bilateral areas of consolidation with cavity areas. BAL cytologic examination revealed abundant lipid-laden macrophages. Clinical symptoms resolved after corticosteroid treatment. Lipoid pneumonia is a rare and often underdiagnosed entity. The presence of lipid-laden macrophages in sputum or BAL fluid helps to confirm the diagnosis.
Emergency management and emergency care are an actual issue worldwide, a topic very difficult to treat for lacking historical data a comparability of this type of events. The ongoing Covid-19 pandemic has showed that health, social, political, economic and biological aspect of every single population has overweight. The complexity of the phenomenon and its dependence on social, cultural, political, economic context is contained in the statement "the pandemic is a complex emergency." The difficulties in applying and failure of emergency protocol and response, and our experience with SARS-CoV-2 in the first "red zone" in Lombardy, Italy, in 2020, have led us to the multidisciplinary analysis of emergency management and emergency response system. The contextualization of the event leads to the comprehension what hazard identification and risk management are, to the revision of the emergency protocols and networks. Emergency response system and emergency management are closely related and embedded to the other areas of health care and human life, especially if a complex emergency is considered. They are directly connected to the dynamics of the population not affected by the emerging pathogen, to prevention and public health, clinical care, they are conditioned by social, cultural, political, economic context. The health care system blends in all these areas that determine the outcome of emergency response on medical-biological emergency of complex type and future population health.
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