Acute mediastinitis is a rare, potentially life-threatening condition that is most commonly seen as a complication of esophageal perforations or cardiac surgery. The term "descending necrotizing mediastinitis" (DNM) is used to describe oropharyngeal infections that spread to the mediastinum, most commonly following odontogenic infections, peritonsillar or retropharyngeal abscesses, cervical lymphadenitis, trauma, or endotracheal intubation. Infectious mononucleosis is another rare cause of DNM. The mortality of acute mediastinitis is high, while the mortality for DNM is even higher. Major determinants of mortality are delayed diagnosis and/or treatment. While DNM is seen infrequently, its severe nature makes it essential that emergency physicians consider the diagnosis in patients presenting with upper respiratory infections, chest pain, and systemic symptoms, and also in patients with a recent diagnosis of EBV, in order to mitigate a high rate of morbidity and mortality. RÉSUMÉLa médiastinite aiguë est une maladie rare, potentiellement mortelle, qui résulte la plupart du temps d'une perforation de l'oesophage ou d'une opération cardiaque. L'expression « médiastinite nécrosante descendante » (MND) fait référence aux infections oropharyngées, qui se propagent au médiastin; il s'agit en général d'infections odontogènes, de phlegmons périamygdaliens ou d'abcès rétropharyngiens, de lymphadé-nite cervicale, de traumas ou d'intubations endotrachéales. La mononucléose infectieuse donne rarement lieu à une MND. Si la mortalité attribuable à la médiastinite aiguë est élevée, celle attribuable à la MND l'est encore plus. Les principaux déterminants de la mortalité sont un retard dans la pose du diagnostic ou la mise en route du traitement. Bien que les cas de MND soient rares, la gravité de la maladie exige que les médecins d'urgence envisagent le diagnostic chez les patients présentant une infection des voies respiratoires supérieures, des douleurs thoraciques et des symptômes généraux ainsi que chez les patients chez qui une infection à virus Epstein-Barr a été diagnostiquée depuis peu, afin d'abaisser le taux élevé de morbidité et de mortalité. Keywords: EBV, Acute Necrotizing Mediastinitis, Descending Necrotizing Mediastinitis CASE REPORTA previously healthy 39-year-old male initially presented to the emergency department (ED) with an upper respiratory tract infection characterized by cough, nasal congestion, rhinorrhea, bilateral earache with drainage, sore throat, nausea and vomiting. On physical examination, he was found to have bilateral ear effusions and upper airway congestion. He had normal heart sounds and his lungs had equal and clear air entry bilaterally. He had a temperature of 37°C (98.6°F), a heart rate of 113 beats per minute, respiratory rate of 16 breaths per minute, blood pressure of 114/79 mm Hg, and an oxygen saturation of 98% on room air. His chest x-ray was normal. He was diagnosed with a suspected viral illness, likely influenza, and discharged home. Two days later, this patient returned...
Mercury (Hg) is a global pollutant that has gained monumental attention in recent decades due to its neurotoxicity and great bioaccumulation features. The atmosphere plays a key role in the movement of Hg in the environment, and residential combustion is a significant contributor to atmospheric Hg. However, there is a severe lack of research on the impact of Hg emissions from residential combustion in Southeast Asia (SEA). This study focused to illustrate the contribution of residential combustion on the level of total gaseous mercury (TGM) in a tropical megacity in southern Vietnam by conducting a short field campaign in February 2023. The mean TGM concentration during the study period was 2.27 ± 0.81 ng m-3, in which daytime TGM level (7 am – 7 pm, 2.56 ± 0.80 ng m-3) was significantly higher than at night (7 pm – 7 am, 1.58 ± 0.28 ng m-3), which could be attributed to local burning activities. The TGM concentration was also increased because of the increase in burning activities (i.e. burning joss paper and incense) during the Lantern Festival. Backward trajectory analysis suggested the domination of regional background air mass in the study area, implying that TGM concentration variation is mostly associated with local influences. We estimated that residential combustion caused a rise of around 70% in TGM concentration at the sampling site. Overall, this is the first study to illustrate the importance of Hg emissions from residential combustion in urban SEA region, laying a background for upcoming studies in atmospheric Hg in this region.
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