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Background This multicenter multinational RCT designed to compare the efficacy of suppository indomethacin and NAC for prevention of PEP. Methods: During a 6-month period, all of the ERCP cases in seven referral centers were randomly assigned to receive either 1200 mg oral NAC, indomethacin suppository 100 mg, 1200 mg oral NAC plus indomethacin suppository 100 mg or placebo 2 hours before ERCP. The primary outcomes were the rate and severity of any PEP. Results: A total of 432 patients included (41.4% male). They were originally citizens of 6 countries (60.87% Caucasian). They were randomly allocated to receive either NAC (group A, 84 cases), rectal indomethacin (group B, 138 cases), NAC + rectal indomethacin (group C, 115 cases) or placebo (group D, 95 cases). The rate of PEP in groups A, B and C in comparison with placebo were 10.7%, 17.4%, 7.8% vs 20% (P=0.08, 0.614 & 0.01 respectively). The NNT for NAC, indomethacin and NAC + indomethacin was 11, 38 and 8 respectively. Conclusion: Oral NAC is more effective than rectal indomethacin when compared to placebo for prevention of PEP and the combination of NAC and Indomethacin had the lowest incidence of PEP and may have synergistic effect in preventing of PEP (IRCT20201222049798N1; 29/12/2020). RESUMO Contexto: Este estudo randomizado, controlado multicêntrico e multinacional foi projetado para comparar a eficácia da indometacina supositório e N-acetil cisteína (NAC) para prevenção de pancreatite pós colangiografia endoscópica. Métodos: Durante um período de 6 meses, todos os pacientes submetidos à CPRE em sete centros de referência foram aleatoriamente atribuídos para receber 1200 mg de NAC oral, supositório de indometacina 100 mg, 1200 mg de NAC oral mais supositório de indometacina 100 mg ou placebo 2 horas antes do procedimento. Os resultados primários foram a taxa e a gravidade de qualquer pancreatite pós procedimento (PPP). Resultados: Um total de 432 pacientes foram incluídos (41,4% do sexo masculino). Eram originalmente cidadãos de seis países (60,87% caucasianos). Foram alocados aleatoriamente para receber NAC (grupo A, 84 casos), indometacina retal (grupo B, 138 casos), NAC + indometacina retal (grupo C, 115 casos) ou placebo (grupo D, 95 casos). A taxa de PPP nos grupos A, B e C em comparação com o placebo foi de 10,7%, 17,4%, 7,8% vs 20% (P=0,08, 0,614 e 0,01, respectivamente). Conclusão A NAC oral é mais eficaz do que a indometacina retal quando comparado ao placebo para prevenção de PPP e a combinação de NAC e indometacina teve a menor incidência de PPP e pode ter efeito sinérgico na sua prevenção de PPP. (IRCT20201222049798N1; 29/12/2020).

Hemoptysis in the patients suffered from pulmonary tuberculosis (TB) may be resulted by active TB or the complications of such disease which appears as bronchiectasis, fungal lesions deployed in tuberculosis cavities or Rasmussen aneurysm, Bronchiolitis or relapse and sometimes, it may be considered as caused by reasons irrelevant to TB. In this report, the patient is a 69-year-old man as complained of hemoptysis with a treated TB experience that was found as normal in the preliminary review of X-ray and CT. During bronchoscopy, a live leech (bloodsucker) was found in hypopharynx area that was swallowed after repeated attempts to remove it through the gastrointestinal tract and its suction signs were appeared as a mucosal mass in the hypopharynx area. The patient had no symptoms during his stay in the hospital.

Diffuse large B cell lymphoma is the most common type of non-Hodgkin's lymphoma, representing nearly one-third of all cases. Any organ can be involved, making a diagnostic biopsy imperative. When the lungs are the involved organs, it is called primary pulmonary lymphoma (PPL). Hereby, we present a case of PPL that demonstrated a single large mass on chest CT and had metastatic skin lesions. The diagnosis of PPL was performed by histopathology and immunohistochemistry staining of the transthoracic lung biopsy and skin lesion specimens. This case highlighted an unusual and subtle clinical presentation, and the importance of new onset pulmonary symptoms and a large lung mass on chest X-ray. Review of the literature on the patient`s radiographic presentation revealed various findings, the most common of which were single or multiple nodular lesions in one or two lungs. It highlighted the fact that this diagnosis should be considered in all cases with a lung mass and skin lesions.