The impact of continuous positive airway pressure on radiation dose to heart and lung during left-sided postmastectomy radiotherapy when deep inspiration breath hold technique is not applicable: a case report

Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH. In this report, authors applied CPAP instead of FB during left-sided breast cancer RT including internal mammary node in a patient who was unable to tolerate DIBH, and substantially decreased radiation dose the heart and lung with CPAP compared to FB.

Acute renal failure in a patient with both leptospirosis and dengue fever

The spectrum of tropical nephropathies includes Acute Renal Failure [ARF] or Acute Kidney Injury [AKI] due to infective agents that are endemic in the tropics which include Leptospira [LS] and Dengue Viruses [DV]. The major histological feature is Acute Tubular Necrosis [ATN]. 1, 2 We report the case of a patient who presented ARF with coinfection with both agents. The clinical manifestations were consistent with both diseases. A renal treatment was supportive and the outcome was positive. We conclude that co-infection with these two tropical agents was possible. It may have been overlooked when the diagnosis of one agent was confirmed, especially that aware of the possibility of coinfection, as the management may be different. Spontaneous full recovery in these circumstances is still possible with supportive treatment