ractice of recommendation is sub-optimal. Further initiatives are required to facilitate awareness and compliance to colorectal cancer screening. Thoracoscopy allows visualization of the pleural cavity including diaphragm, visceral pleura, and lungs. It provides the physician with information about the disease extent and it has the ability to get a biopsy from these lesions to differentiate between tumors and fibrotic reactions. This study aims to compare minithoracoscopy and medical thoracoscope in patients with exudative pleural effusion as regards the diagnostic yield, safety, complications, and duration of hospital stay. Sixty patients were diagnosed with exudative pleural effusion and were randomly divided into 2 equal groups Group (1) included 30 patients who underwent minithoracoscopy and Group (2) included the remaining 30 cases who underwent the standard thoracoscope. Pathological examination of the sample revealed that biopsy size was 2.02 and 1.25 in group 1 and group 2 was respectively with highly statistically significant between both groups (  < .001). Group 1 revealed TB, malignant, chronic nonspecific pleurisy, Staph aureus, Klebsiella, and Pseudomonas in 30% (9), 30% (9), 33.3% (10), 69% (9), 15% (2), and 15% (2) of cases respectively. While group 2 reveled TB, malignancy, chronic nonspecific pleurisy, Staph aureus, Klebsiella, Pseudomonas, and other causes in 40% (12), 23.3% (7), 23.3% (7), 67% (8), 8% (1), 8% (1), and 16% (2) respectively with no statistically significant differences between both groups (  > .05). Minithoracoscopy is well tolerated by patients as minimal pain and early hospital discharge could be achieved by that approach.Minithoracoscopy is well tolerated by patients as minimal pain and early hospital discharge could be achieved by that approach.Hyperammonemia is the pathological accumulation of ammonia in the blood, which can occur in many different clinical settings. this website Most commonly in adults, hyperammonemia occurs secondary to hepatic dysfunction; however, it is also known to be associated with other pathologies, surgeries, and medications. Although less common, hyperammonemia has been described as a rare, but consistent complication of solid organ transplantation. Lung transplantation is increasingly recognized as a unique risk factor for the development of this condition, which can pose grave health risks-including long-term neurological sequelae and even death. Recent clinical findings have suggested that patients receiving lung transplantations may experience postoperative hyperammonemia at rates as high as 4.1%. A wide array of etiologies has been attributed to this condition. A growing number of case studies and investigations suggest disseminated opportunistic infection with Ureaplasma or Mycoplasma species may drive this metabolic disturbance in lung transplant recipients. Regardless of the etiology, hyperammonemia presents a severe clinical problem with reported mortality rates as high as 75%. Typical treatment regimens are multimodal and focus on 3 main avenues of management (1) the reduction of impact on the brain through the use of neuroprotective medications and decreasing cerebral edema, (2) augmentation of mechanisms for the elimination of ammonia from the blood via hemodialysis, and (3) the diminishment of processes producing predominantly using antibiotics. The aim of this review is to detail the pathophysiology of hyperammonemia in the setting of orthotopic lung transplantation and discuss methods of identifying and managing patients with this condition. Bipolar disorder (BD) is typically treated by pharmacotherapy. However, pharmacotherapy alone is often not adequate to cope with the variety of symptoms associated with BD. The present case report describes the therapeutic effects of manual acupuncture on a patient with chronic BD, and multiple concurrent physical symptoms, that did not improve with standard pharmacotherapy. A 41-year-old woman with type II BD presented with depression, anxiety, and multiple physical symptoms. Her symptoms had first appeared 12 years prior, and she was diagnosed with type II BD 3 years after symptom onset. Although she received standard treatment, including medication and psychotherapy, her symptoms did not improve. Acupuncture treatment aimed at improving psychiatric and physical symptoms was performed weekly for 12 weeks. Depression and anxiety symptoms were evaluated using the Himorogi Self-Rating Depression Scale (HSDS) and Himorogi Self-Rating Anxiety Scale (HSAS) respectively. A visual analog scale (VAS) was used to evaluate physical symptoms including diarrhea, insomnia, and general malaise. Outcome measures were evaluated before each treatment. Throughout the course of the acupuncture intervention, no changes were made to the patient's psychotropic medication regimen. HSDS and HSAS scores decreased after 12 weeks of acupuncture treatment and improvements in all physical symptoms, as measured by the VAS, were observed. Furthermore, psychiatric symptoms with hypomanic or mixed features were not exacerbated. In this patient, acupuncture was effective in improving psychiatric and physical symptoms of type II BD. This non-pharmacological intervention may be a viable option for the treatment of BD-associated symptoms.In this patient, acupuncture was effective in improving psychiatric and physical symptoms of type II BD. This non-pharmacological intervention may be a viable option for the treatment of BD-associated symptoms.Post-cardiac injury syndrome (PCIS) is presumed to be an immune-mediated process. It affects the pericardium and, to a lesser extent, the epicardium, myocardium, and pleura. It has been rarely reported following pacemaker insertion with an estimated incidence of 1% to 2%. We present the case of a 62-year-old female who developed PCIS 8 weeks following pacemaker insertion. She presented with impending cardiac tamponade requiring pericardiocentesis; recurrent pleural effusions subsequently complicated her condition. The pleural effusion recurred despite trials of steroids, eventually requiring talc pleurodesis. This case highlights the need to consider PCIS as a possible etiology of recurrent pleural effusion following pacemaker insertion.