Asthma is a non-communicable and long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. Symptoms of asthma are intermittent and include cough, wheeze, shortness of breath, and chest tightness. Asthma is very often underdiagnosed and under-treated in many regions, especially in developing countries. While many studies show that viral infections can precipitate asthmatic attacks, very few studies have been conducted to see if history or current asthmatic attack increases the risk of viral infections. Our study aims to determine the predisposition of asthmatics to develop various viral infections and susceptibility toward certain viruses that cause upper respiratory tract infections. We performed a literature review of both published and unpublished articles. We included case reports, case series, reviews, clinical trials, cohort, and case-control studies, written only in English. Commentaries, letters to editors, and book chapters were excluded. Our initial search yielded 948 articles, of which 826 were rejected either because they were irrelevant or because they did not meet our inclusion criteria. We finally screened 122 abstracts and identified 24 relevant articles. People with a history of asthma have an abnormal innate immune response, making them potentially slower in clearing the infection and susceptible to both infections and virus-induced cell cytotoxicity. Also, in these studies, deficiencies in the interferon alpha response of peripheral blood mononuclear cells and plasmacytoid dendritic cells have been observed in asthmatics, both adults and children. Asthmatics with a viral infection usually present with an acute exacerbation of asthma, represented by dyspnea and cough, with other prodromal symptoms including vomiting and general malaise. The review includes an update on the relevance of dysregulated immune pathways in causing viral infections in asthmatic populations. It focuses on the evidence to suggest that people with asthma are at increased risk of viral infection, and viral infections in turn are known to precipitate and worsen the asthmatic status, making this a vicious cycle. The authors also suggest that further studies be undertaken to elucidate the pathophysiology and identify the critical therapeutic steps to break this vicious cycle and improve the quality of life for people with asthma.

Introduction: A ureteral stent is crucial for managing urinary flow obstruction, ureteral reconstructive surgeries, and iatrogenic ureteral injuries. The authors aim to report a case of forgotten double-J stent for 17 years, the longest time reported in literature in a patient with solitary kidney and no typical long-term complications as stones formation and encrustation. Case presentation: A 58-year-old male with chronic kidney disease and solitary left kidney presented with left loin pain. With creatinine higher than baseline (6.2 mg/dl), he reported a neglected double-J stent placed 17 years ago in a different hospital. In addition, non-contrast computed tomography and cystoscopy revealed hydronephrosis, cystitis, and an element of infra-vesical obstruction, evident by high bladder neck. Treatment included left percutaneous nephrostomy, but he was readmitted few weeks later for cystoscopy, ureteroscopy, and a new double-J insertion. Due to worsening renal function, he was readmitted four weeks later for cystoscopic removal of the new double-J stent and Transurethral Resection of the Prostate, after which creatinine returned to baseline. Discussion: Double-J stents are vital in urological procedures, but neglecting their presence can lead to severe complications like encrustations, stone formation, stent fractures, hydronephrosis, infections, and renal function loss. Treatment of long-term complications is difficult and should consider many factors, including the type and severity of associated complications and the patient’s preoperative status. Conclusion: Preventing complications from neglected or forgotten double-J stents through patient education and follow-up is crucial, especially in those with solitary functioning kidneys due to the imminent loss of renal function.

Introduction and Importance: Achalasia, an uncommon esophageal motility disorder, presents therapeutic challenges, especially in refractory cases with a history of multiple surgeries. Here, we present a complex case illustrating the dilemmas and multidisciplinary approach required in managing such patients. This case underscores the relevance of newer techniques like robotic-assisted esophagectomy in refractory achalasia management. Case Presentation: A 53-year-old male with recurrent achalasia endured persistent dysphagia, reflux, and esophageal spasms despite undergoing Heller myotomies, fundoplications, and hiatal hernia repairs. Imaging revealed severe esophageal dilation and anatomical alterations post-surgeries. Opting for a robotic-assisted thoracoabdominal esophagectomy due to relentless symptoms, the patient faced technical hurdles due to adhesions and a dilated esophagus. Post-surgery, complications like thoracic duct injury, milky pleural effusion, atrial fibrillation, and limb ischemia arose, necessitating multidisciplinary intervention. Clinical discussion: Managing refractory achalasia poses significant challenges, particularly in extensively operated patients. Despite aggressive surgeries, debilitating symptoms persisted, emphasizing the need for a multidisciplinary approach. Complications like thoracic duct injury and atrial fibrillation further complicate management, highlighting the intricacies of such cases. Careful consideration of surgical options and the potential of newer techniques like POEM are crucial in navigating such complexities. Conclusion: Managing refractory achalasia, especially in patients with extensive surgical histories, requires a multidisciplinary approach and careful consideration of treatment options. This case underscores the evolving landscape of achalasia management and emphasizes the potential benefits of newer techniques like POEM in select cases.