Navdeep Brar

Management of community-acquired pneumonia: a review and update.

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, affecting approximately 5.6 million patients annually in the USA, where the annual cost exceeds US

An immigrant with fever, chills, and pleural effusion.

12 billion. Optimal management should be based on knowledge of the most likely etiologic pathogens for each patient, based on an assessment of specific risk factors. It is also essential to assess severity of illness, to determine the appropriate site of care, and to order appropriate diagnostic testing. New developments in CAP management have focused on recognizing newly identified pathogens, such as methicillin-resistant Staphylococcus aureus and novel H1N1 influenza, understanding when to utilize new microbiological diagnostic techniques, and how to use biomarkers to direct the appropriate utilization of antibiotics and to define the duration of therapy. This paper reviews recent advances in our knowledge about the diagnosis and optimal management of CAP.

Pulmonary Cement Embolism: Rare Complication of Kyphoplasty

Aleksander Shalshin and Navdeep Brar practice in the Department of Pulmonary and Critical Care Medicine, Winthrop University Hospital, Mineola, New York. The authors have indicated no relationships to disclose relating to the content of this article. demonstrated a well-developed, wellnourished male of medium build. The head and neck examination was without abnormalities. Heart sounds S1 and S2 were appreciated, along with regular rate and rhythm. The abdomen was soft and scaphoid, with positive bowel sounds in all four quadrants. The chest examination revealed unequal breath sounds with the right side diminished. Further maneuvers elicited dullness on percussion on the right side. Testing Laboratory tests included a WBC count, which was normal but significant for monocytosis on the differential. Results of an electrolyte panel and tests for renal and liver function were within normal ranges. A rapid HIV test was negative. An ECG showed normal sinus rhythm and a heart rate of 59 beats per minute; no ST–T changes were observed, and the axis was normal. Chest radiography demonstrated a right pleural effusion, most likely loculated (Figure 1). The radiography finding was confirmed by CT, which showed a relatively large right pleural effusion, thickened pleura, and partial loculation of the fluid (Figure 2). What diagnosis do these images suggest, and what should be the next steps?