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luid samples, and 7.32% of pleural fluid samples were positive for an infectious microorganism. For cytology/histopathology, 0.00% of BAL samples, 5.41% of pleural fluid samples, and 7.32% of tissue samples were positive for an underlying infective etiology. Conclusion For the study and analysis of the microbiological samples, a myriad of all three different modalities of diagnosis is essential. However, tissue sampling is the preferred modality of diagnosis for cytology/histopathology owing to its ability to detect positive cases that might otherwise evade prompt detection.Objective The critical mediastinal mass syndrome (CMMS) is a life-threatening condition and is challenging for physicians. We analyse the clinicopathological profile and outcome of CMMS from a large tertiary-care pediatric oncology center in Pakistan. Methods We retrospectively reviewed the medical record of a tertiary-care hospital in Pakistan from April 2017 to September 2019 for all children (1 month-16 years) who presented with an anterior mediastinal mass (AMM). A CMMS case is defined as a child with an AMM presenting with cardiorespiratory compromise and needing intensive care support. Demographic data, clinical profile, pathological diagnosis, and outcome of all such children were recorded. Descriptive statistics were applied using the Statistical Package for the Social Sciences (SPSS), version 22 (IBM Corp., Armonk, NY). Results Of the total 221 mediastinal masses, 61 children were diagnosed as CMMS and enrolled in the study. The mean age was 9 ± 3.3 years, and 68.9%% were male; 65.6% of patients had ous breathing is ideal. Tumour lysis syndrome was the most common morbidity in our cohort.The supply of personal protective equipment (PPE) is inadequate throughout the United States and the world. This is especially true of N95 respirators. The cost of PPE is high. There are numerous cases of providers working with inadequate PPE and being disciplined on complaining. In the United States, thousands of providers have contracted COVID-19, in part due to inadequate PPE. Extended use and reuse of N95 respirators has been permitted by the Centers for Disease Control and Prevention (CDC). The N95 respirators can be sterilized utilizing vaporized hydrogen peroxide, ultraviolet germicidal irradiation, or dry heat at 70°C-80°C. The risk to providers due to inadequate PPE increases with their age and presence of comorbidities. African-Americans and Latinos are at a greater risk. CDC recommends that in the absence of appropriate PPE, "exclude healthcare personnel at higher risk for severe illness from COVID-19 from contact with known or suspected COVID-19 patients." Providing care without appropriate PPE should not be a condition of employment for any provider, especially for the ones in high-risk category.Pembrolizumab is an immune checkpoint inhibitor (programmed cell death 1) approved for use in non-small cell lung carcinoma (NSCLC). Pembrolizumab has shown remarkable results in regression of the size of tumors in NSCLC and has shown survival advantage. However, immune-related adverse effects are a serious negative outcome of therapy. Compound Library The number of immune-related adverse effects with pembrolizumab has increased significantly over the recent past. We present a case of type 1 diabetes mellitus and autoimmune thyroiditis with pembrolizumab treatment for NSCLC.Although intraoperative tachyarrhythmias are relatively common, their appropriate management is pertinent to reducing morbidity and mortality. In certain clinical scenarios, the initial steps of managing intraoperative tachyarrhythmias may be ambiguous. Emergency manuals (EMs) are cognitive aids that improve the outcome of critical events by providing current, medically established guidelines on management. The case of a patient with an intraoperative supraventricular tachycardia with narrow, irregular QRS complexes and refractory hypotension is described here. Relevant sections of Stanford Anesthesia Emergency Manual were activated immediately and guided the anesthesiologists in treating the patient's arrhythmia. The utilization of an EM allowed rapid selection of a pharmacologic agent that achieved hemodynamic stability. EMs allow healthcare providers to respond more appropriately and efficiently during critical events and thus directly improve patient care.Afferent loop syndrome is an uncommon complication of Whipple procedure. The often vague and non-specific presentation results in difficulty and/or delay in diagnosis, which may lead to bowel ischemia or perforation. CT can demonstrate characteristic features, yield the diagnosis of afferent loop syndrome, and predict the cause before surgical intervention. We present a rare etiology of acute afferent loop syndrome in a patient 6 weeks after Whipple procedure who was reportedly recovering well, which resulted in prompt surgical intervention.Clinical manifestation of coronavirus disease (COVID-19) varies from asymptomatic to severe clinical forms that can result in acute respiratory distress syndrome or in multiple organ dysfunction syndromes. There are no guidelines, based on randomized controlled trials, for the treatment of COVID-19 patients. The treatment is based on antiviral drugs, invasive and non-invasive ventilation supports, and anticoagulant therapy. This is a pictorial essay covering the multiple adverse events encountered during the treatment of COVID-19 patients in an area with a high pandemic incidence. Adverse events are defined as unexpected events following treatment for the infection. The cases described would be useful in aiding early diagnosis, limiting and improving the management of serious complications for patients, and allowing rapid and appropriate treatment.Cholecystectomies are one of the most common surgical procedures performed in the United States, with complications being relatively common. We submit a case of a ruptured mycotic aneurysm of the hepatic artery, a complication of a recent cholecystectomy which was successfully treated with the use of transarterial thrombin.
The purpose of this study is to assess the performance of radiologists using a new software called "COVID-19 score" when performing chest radiography on patients potentially infected by coronavirus disease 2019 (COVID-19) pneumonia. Chest radiography (or chest X-ray, CXR) and CT are important for the imaging diagnosis of the coronavirus pneumonia (COVID-19). CXR mobile devices are efficient during epidemies, because allow to reduce the risk of contagion and are easy to sanitize.

From February-April 2020, 14 radiologists retrospectively evaluated a pool of 312 chest X-ray exams to test a new software function for lung imaging analysis based on radiological features and graded on a three-point scale. This tool automatically generates a cumulative score (0-18). The intra- rater agreement (evaluated with Fleiss's method) and the average time for the compilation of the banner were calculated.

Fourteen radiologists evaluated 312 chest radiographs of COVID-19 pneumonia suspected patients (80 males and 38 females) with an average age of 64, 47 years.
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