The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery

Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surgery.Methods:In 2019,fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan’s major referral heart institute.The patients were randomly assigned to either an intervention group or a control group.A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise(SDBRE)alongside the conventional care before CTR.The remaining 25 patients constituted the control group(50%)that had CTR following conventional care.The Visual Analogue Scale(VAS)was used to measure the participants’pain levels during three phases:before CTR(Time 1),5-min post CTR(Time 2),and 15-min post CTR(Time 2)to compare the intervention effect between the two groups.Results:The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups(H¼32.71,P<0.01;H=47.23,P<0.01)respectively.The intervention group had significantly lower pain levels than the control group at Time 2(3.50[1.20,5.30]vs.7.90[7.00,9.00],P<0.01)and Time 3(0.00[0.00,1.30]vs.3.60[2.40,4.10]P<0.01).Conclusions:Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.

Contralateral hemopneumothorax after penetrating thoracic trauma:A case report

BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.

Risk factors for development of pneumothorax in patients with COVID-19 at a government health facility in North India:An exploratory case-control study

Objective:To explore risk factors for the development of pneumothorax in patients with COVID-19 during the second COVID-19 wave at a northern Indian level 2 health facility.Methods:Patients suffering from SARS-CoV-2 infection during the second wave of the COVID-19 pandemic in India(January-June 2021)at a tertiary care teaching hospital and level 2 COVID care facility were included.Cases who suffered from SARS-CoV-2 infection but did not develop pneumothorax were selected as matched controls.All details regarding demographics,clinical presentation,treatment,and outcome were recorded in a semi-structured proforma.Results:Eleven patients with COVID-19 developed pneumothorax during the study period and 40 controls were included in the study.Five cases were smokers in comparison to only two in the control group.Type 2 diabetes mellitus was the most common comorbidity among both groups.Median change in C-reactive protein overall for cases and controls were around+14.0 and-41.9 and was statistically significant.Conclusions:Inflammatory markers like C-reactive protein have significant correlations with the development of pneumothorax in COVID-19-infected patients.There is no sex predisposition to develop pneumothorax among patients with COVID-19.

Bilothorax a Rare Incidence in Thoracic Surgery: Case Report and Literature Review

Bilothorax or Cholethorax is the accumulation of bilious effusion in the thorax. It is a rare condition in which bile passes into the pleural space from the abdominal cavity, necessitating urgent treatment. This article aims to present a case of bilothorax treated successfully in our institute and review the literature on this topic to better understand this medical problem and the best ways of dealing with it. We presented in this article a case of bilothorax after an attempt of biliary drainage in a known pancreatic cancer patient and the way we managed it. We concluded about the importance of the early recognition of this medical problem and the necessity of aggressive and early management to prevent further morbidities and mortality.

The chest tube inserted into the stomach after a transthoracic operation for esophageal cancer:case report

Surgical complications after the transthoracic operation for esophageal cancer mainly include anastomatic fistula, gastric wound thoraco-stomach fistula, stenosis of anastomosis, perforation, gastric volvulus, diaphragmatic hernia, infection, and some other pulmonary complications. Unfortunately, there are few reports about the complications caused by position change of the chest tube until now. We presented an unusual case of a patient who underwent a transthoracic operation for esophageal cancer in our department on August 17, 2006, and a lot of intragastric material was found in his chest tube 17 days later, endoscopic examination suggested that the chest tube had inserted into the stomach. We tried to discuss the etiology and clinical management for this case as well.

Thoracic injury:a review of 276 cases

Objective: Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all traumarelated deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.Methods: A total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury,injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.Results: There were 246 males ( 89.1%) and 30 females (10.9% ) ranging from 3 to 80 years with a mean age of (34 ± 17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1% ) and falling injuries (32 cases,11.6% ), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2% ) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.Conclusions: According to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.