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Resection and reconstruction of the superior vena cava (SVC) are required in a selected group of patients with anterior mediastinal tumors and lung neoplasms. We present the case of a 63-year-old woman who underwent invasive type B2 thymoma resection and a rare type of reconstruction of the superior vena cava using a patch of the left brachiocephalic vein (LBV). The various types of reconstruction of the superior vena cava are discussed.

Convection monitoring and forecasting are crucial for air traffic management as they can lead to the development of intense thunderstorms and hazards such as severe turbulence and icing, lightning activity, microbursts and hail that affect aviation safety. The airport of Burgas is located in southeast Bulgaria on the Black Sea coast and occurrences of intense thunderstorms are mainly observed in the warm season between May and September. This work presents an analysis of severe convection over southeast Bulgaria on 17 September 2022. In the late afternoon, a gust front was formed that reached the Burgas airport with a wind speed exceeding 45 m/s, the record for the past 50 years, damaging the instrument landing system of the airport. To analyse the severe weather conditions, we combine state-of-the-art observations from satellite and radar with the upper-air sounding and surface. The studied period was dominated by the presence of a very unstable air mass over southeast Bulgaria ahead of the atmospheric front. As convection developed and moved east towards Burgas, it had four characteristics of severe deep convection, including gravitational waves at the overshooting cloud top, a cold U-shape, a flanking line and a cloud top temperature below −70 °C. The positive integrated water vapour (IWV) rate of change preceded the lightning activity peak by 30 min. Analysis of integrated vapour transport (IVT) gives higher values by a factor of two compared to climatology associated with the atmospheric river covering the eastern Mediterranean sea.

BACKGROUND:Ultrasound-guided transthoracic core needle biopsy (US-TCNB) is a promising method for establishing the correct diagnosis of mediastinal masses. However, the existing studies in this area are scant and with small samples. PURPOSE:To evaluate the diagnostic value and the complication rate of US-TCNB, particularly large bore cutting biopsy in patients with mediastinal lesions. MATERIAL AND METHODS:This retrospective study includes 566 patients with mediastinal lesions suspicious of malignancy evaluated between March 2004 and December 2018. Inclusion criteria: 1. Patients with mediastinal lesions detected on thoracic CT scan; 2. Lesions more than 15 mm; 3. Negative histological diagnosis after bronchoscopic biopsy; 4. Normal coagulation status; 5. Cooperative patient; 6. Written informed consent. US visualization of the mediastinal lesions was successful in 308 (54.4%). In all of them, US-TCNB was performed. All patients with mediastinal lesions unsuitable for US visualization were evaluated for a CT-guided transthoracic needle biopsy (CT-TTNB), which was done if the presence of a safe trajectory was available (n = 41, 7.2%). All patients inappropriate for image-guided TTNB were referred to primary surgical diagnostic procedures (n = 217, 38.3%). RESULTS:The US-TCNB is a highly effective (accuracy 96%, sensitivity 95%) and safe tool (2.6% complications) in the diagnosis of all subgroups mediastinal lesions. It is non-inferior to CT-TTNB (90%) and comes close to the effectiveness of surgical biopsy techniques (98.4%), but is less invasive and with a lower complication rate. CONCLUSION:US-TCNB of mediastinal lesions is highly effective and safe tool which is particularly helpful in critically ill patients.

The authors present a rare clinical case of a patient with Bardet-Biedl syndrome and chronic kidney disease, who reached end-stage renal disease (ESRD) and underwent a long-term hemodialysis treatment, during which infections with Hepatitis C Virus (HCV) infection and Cytomegalovirus (CMV) infection were established. Kidney transplantation from an alive unrelated donor was performed. Later, an adenocarcinoma of the esophagus was diagnosed at an early stage, treated surgically with resection of the esophagus and gastroesophagoplasty afterward. Seven months later, a rare complication of the immunosuppressive therapy with Cyclosporin A occurred, which consisted of spontaneous bilateral pleural hemorrhage. The same, as well as the postoperative ventral hernia, was successfully resolved. Concomitant HCV was also treated. Rare autosomal recessive syndrome with severe complications, adenocarcinoma of the esophagus, spontaneous bilateral pleural hemorrhage after the operation, and successful treatment were discussed.

Abstract Background Female sex workers (FSW) are at increased risk for HIV and other STI due to occupation-related risks and exposures. Long-distance truck drivers have been implicated in the spread of HIV, but less is known about HIV/STI risks of FSW servicing truck drivers, especially in North America. As part of an international collaborative pilot study, we interviewed FSWs servicing truck driver clients along two major transportation corridors to explore factors associated with recent STI symptoms. Methods A cross-sectional study of 200 FSW was conducted in Mexico: 100 from Nuevo Laredo (U.S. border); 100 from Ciudad Hidalgo (Guatemalan border). Eligibility criteria included age ≥18 years, speaking English or Spanish, and having ≥1 truck driver client in the past month. The main outcome was reporting any recent STI symptoms, defined as experiencing genital/anal warts, genital ulcers/sores, genital itching, or abnormal vaginal discharge in the past 6 months. Logistic regression was used to identify correlates of recent STI symptoms. Results Median age of FSW was 29 years, 74% were single, 87% had th grade education, and median income was 4000 pesos/month ($300 USD). Sex work occurred at a bar/cantina for 70%. One-quarter had never been tested for HIV, 53% reported lifetime drug use, 22% reported drinking alcohol before/during transactional sex and 17% reported recent STI symptoms. After controlling for age and study site, factors associated with STI symptoms were lifetime drug use (AOR 2.9, 95% CI 1.2-6.9), drug use before/during sex (AOR 2.8, 95% CI 1.1-7.1), alcohol use before/during sex (AOR 5.2, 95% CI 2.2, 12.6), forced sex ever (AOR 2.6, 95% CI 1.1-6.1), lifetime history of arrest (AOR 2.3, 95% CI 1.0-5.0), and being surveyed in Nuevo Laredo rather than Ciudad Hidalgo (AOR 4.8, 95% CI 2.0-10.0). Conclusions The associations we observed between recent STI symptoms and drug and alcohol use suggest that interventions are needed that promote consistent and effective safer sex practices, especially while under the influence of alcohol or other substances.

Abstract Background Sterile syringe access is a critical component of HIV prevention programs. Although retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. We sought to obtain an objective measure of syringe access in Tijuana, Mexico, where IDUs report being denied or overcharged for syringes at pharmacies. Methods Trained "mystery shoppers" attempted to buy a 1 cc insulin syringe according to a predetermined script at all retail pharmacies in three Tijuana neighborhoods. The same pharmacies were surveyed by telephone regarding their syringe sales policies. Data on purchase attempts were analyzed using basic statistics to obtain an objective measure of syringe access and compared with data on stated sales policies to ascertain consistency. Results Only 46 (28.4%) of 162 syringe purchase attempts were successful. Leading reasons for unsuccessful attempts were being told that the pharmacy didn't sell syringes (35.3%), there were no syringes in stock (31.0%), or a prescription was required (20.7%). Of 136 pharmacies also surveyed by telephone, a majority (88.2%) reported selling syringes but only one-third (32.5%) had a successful mystery shopper purchase; the majority of unsuccessful purchases were attributed to being told the pharmacy didn't sell syringes. There was similar discordance regarding prescription policies: 74 pharmacies said in the telephone survey that they did not require a prescription for syringes, yet 10 of these pharmacies asked the mystery shopper for a prescription. Conclusions IDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission.

This retrospective study analyzed 230 pediatric opioid exposures from a statewide poison control center over a 5-year period. Most exposures involved pharmaceutical opioids and children below 2-years-old. Narrative details were reviewed to identify uncommon sources of opioids involved in poisoning and highlight the need for tailored prevention strategies and guidance., Competing Interests: Declaration of Competing Interest No funding was secured for this study. The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The objective of this study was to update and expand on previous studies of opioid exposures among young children reported to America's Poison Centers®, and to describe how fentanyl and medications for opioid use disorder have contributed., Methods: This retrospective study investigated 34,632 reports of single-substance opioid exposure from 2016 to 2023 involving pediatric patients aged one month to six years old. Descriptive statistics, tests for data normality, and significance testing were performed where applicable., Results: Of 34,632 reported exposures, 96.7% were unintentional. The median age of exposure was 2.0 years (IQR 1.33-3.0 years). Reported exposures decreased by 57.5% over the study period ( r  = -0.96; P  <0.001). However, there was a 300% absolute increase in deaths and major effects ( r  = 0.96; P  <0.001). Exposures resulting in minor, no effect, not followed, or unable to follow decreased 66.2% ( r  = -0.99; P  <0.001). Buprenorphine was most frequently involved, comprising 23.4% of reported exposures. Buprenorphine (OR 1.93; P  <0.001) and methadone (OR 14.98; P  <0.001) were associated with an increased risk of severe effects when compared to other prescription drugs (OR: 1). There was an absolute increase of 512% over time in reports of heroin, fentanyl, synthetic non-pharmaceutical opioids ( r  = 0.92; P  <0.001), which were also associated with severe effects (OR 20.1; P  <0.001)., Discussion: Pediatric opioid exposures have previously been reported to be relatively stable. It is likely the 57.5% reduction is exaggerated due to underreporting from health care providers. However, decreases in exposures are presumed to be balanced throughout the dataset and, therefore, without differential impact on other points of analysis. Our study highlights the continued need for enhanced poisoning prevention strategies., Conclusions: The relative severity of poisonings reported to poison centers worsened over the study period. The opioids implicated have shifted away from hydrocodone, oxycodone, and tramadol, and towards fentanyl and buprenorphine.