Skip to content

Volume 13, Issue 5

VOLUME 13, ISSUE 5
IMPACT FACTOR 4.428

1) Common Symptom due to Uncommon Cause: A Case of Unusual Cause of Bronchial Artery Aneurysm due to Pulmonary Aspergillosis
Author’s Details:D Madegedara1,Buddhika Dassanayake2, S Wijesinghe3, M G D N Bandara4
1-Consultant Respiratory Physician 2- Consultant surgeon 3-Medical Officer 4-Research Assistant
Respiratory Treatment & Research Unit, National Hospital, Kandy, Sri Lanka
Corresponding Author- Prof Dushantha Madegedara, Respiratory Treatment & Research Unit, National Hospital Kandy, Sri Lanka.

Abstract:
A 59-year-old patient with type 2 diabetes mellitus who presented with massive hemoptysis two weeks after being treated for pneumonia complicated by apparent right lung abscess. Patient experienced persistent symptoms of cough associated with recurrent hemoptysis needing multiple hospital admissions. Contrast-enhanced computed tomography (CECT) chest revealed a right lower lobe mass with a concurrent right bronchial artery aneurysm. Elevated ESR associate with a high CRP persisted throughout the period.  The patient underwent thoracic surgical intervention, including right lung lobectomy with ligation of the bronchial artery aneurysm. Histopathological analysis of the resected specimen confirmed the diagnosis of pulmonary aspergillosis. The patient was initiated on systemic antifungal treatment and scheduled for regular clinic follow-up. This case underscores the importance of considering pulmonary aspergillosis as a potential cause of massive hemoptysis in patients with a history of unresolved pneumonia, and highlights the successful management through appropriate timely surgical intervention and antifungal therapy preventing serious consequences like death
Keywords: massive hemoptysis, unresolved pneumonia, pulmonary aspergillosis

[Download Full Paper] [Page 01-04]
================================================================================

2) Common Presentation of a Rare Etiology: A Case Report of Drug-Induced Bilateral Pleural Effusion
Author’s Details: D Madegedara1, S Shafee2, M G D N Bandara3
1-Consultant Respiratory Physician 2-Medical Officer 3-Research Assistant
Respiratory Treatment  & Research Unit, National Hospital Kandy, Sri Lanka
Corresponding Author- Prof Dushantha Madegedara, Respiratory Treatment  & Research Unit, National Hospital, Kandy, Sri Lanka

Abstract:
A 64-year-old patient with chronic myeloid leukemia presented with a three-month history of cough and shortness of breath. She had no fever, paroxysmal nocturnal dyspnea, edema, or other sinister symptoms. She was mildly dyspnoic at rest with clinical features suggestive of bilateral pleural effusions, predominantly on the right side. Biochemical investigations adequately ruled out ongoing infections, hypoproteinaemias, organ insufficiencies, and D-dimer was negative. Radiologically, bilateral moderate pleural effusion was detected with a normal 2D echocardiography. Pleural fluid analysis revealed exudative effusion with reactive cytology and abundant red blood cells with no detectable leucocytes.  Pleural fluid adenosine de-aminase level was within normal. Further evaluation with fibro-optic thoracoscopy exhibited a nodular pleura of the right costo-phrenic angle, with no adhesions or fibrotic bands. Chronic and acute bacterial infections were excluded with microbiological examination including gram staining, bacterial cultures, and mycobacterial investigations of pleural fluid and thoracoscopic biopsy specimens of the pleura. Malignant infiltrations were sufficiently excluded. The possibility of drug-induced effusion was considered. The drug dasatinib was suspected as the possible course of the effusion. The drug was changed over to Imatinib. Drastic improvement and complete resolution of the effusion were achieved. Finally, the diagnosis of dasatinib-induced pleural effusion was confirmed, thus concluding as the first such reported case in Sri Lanka.
Keywords: Rare Etiology, Drug-Induced Bilateral Pleural Effusion

[Download Full Paper] [Page 05-10]
================================================================================

3) The Benefits and Challenges of Last-Mile Delivery: A Review
Author’s Details:(1)Mohammed Said Sulaiman Al Ruheili (2) Dr. Asadullah
(1)(2)Department of Management Studies, Middle East College, Muscat, Oman

Abstract:
Last-mile delivery, the final step in the logistics process where goods are transported from a distribution centre to the end customer, plays a pivotal role in the e-commerce and retail industries. This phase significantly influences customer satisfaction and operational efficiency. This study explores the critical aspects of last-mile delivery, highlighting its impact on the supply chain and the evolving strategies to mitigate associated challenges. The research follows a literature review-based methodology, aimed at synthesizing existing knowledge on the benefits and challenges of last-mile delivery. This qualitative approach involves systematic identification, evaluation, and synthesis of relevant literature to provide a comprehensive understanding of the topic. The findings of the study suggest that the benefits of last-mile delivery include enhanced customer convenience, faster delivery times, and the potential for increased brand loyalty. However, it also presents numerous challenges such as high operational costs, logistical complexities in urban areas, and environmental concerns. Balancing the advantages and difficulties requires innovative solutions like the use of advanced technologies, optimized routing algorithms, and sustainable delivery methods.
Keywords: Customer satisfaction, E – commerce, Last-mile delivery, Logistics, Operational efficiency, Urban logistics, Environmental impact

[Download Full Paper] [Page 11-19]
================================================================================