155 research outputs found
(Desi)re A. Balasubramaniam, Zarina Bhimji, Allan deSouza, Subba Ghosh, Sheila Makhijani, Ranjani Shettar, Anjum Singh, Alia Syed
No full textWeaning from mechanical ventilation in chronic obstructive pulmonary disease: Keys to success
No full textInvasive mechanical ventilation (IMV) for management of chronic obstructive pulmonary disease (COPD) associated respiratory failure is increasing in Intensive Care Units. However, IMV is not without its own complications. Hence, aim of managing such patients is to get them off the ventilator as early as possible. This bridging process from IMV to extubation is called weaning in which mechanical ventilation is gradually withdrawn and the patient resumes spontaneous breathing. Many objective parameters have been defined for weaning success. Many of these patients are difficult-to-wean because of various pathophysiologic mechanisms that are of particular relevance to patients of COPD. The following review focuses on these mechanisms and how to troubleshoot patients who are difficult-to-wean
Pulmonary sarcoidosis
No full textPulmonary sarcoidosis is an enigma due to its similarities with many other diseases in terms of presentation and hence the disease may require repeated reconsideration and revision of diagnosis. It is largely a diagnosis of exclusion. In India, exclusion of tuberculosis (TB) in every new suspected case of pulmonary sarcoidosis is a colossal task due to overlapping features and the high burden of TB. However, pulmonary sarcoidosis may be associated with extrapulmonary organ involvement, and in such cases, diagnosis can be made with greater certainty. Once diagnosed, whether to treat or not, and with what agent, and for how long are questions unsettled despite 150 years of the disease being known to mankind. This is due to a lack of randomized controlled trials as well as a dissimilar natural course of the disease among patients with a similar clinicoradiological presentations. This makes a generalization about treatment impossible and hence, individualized decisions need to be made utilizing predictors of future worsening by multidisciplinary experts. Oral steroids form the core of treatment but longterm side effects of oral steroids ultimately dictate the use of steroidsparing agents and discontinuation of steroids once the disease stabilizes and the goals of treatment are achieved. Some patients with a benign course of sarcoidosis may not require any treatment. There remains a gap in our knowledge of sarcoidosis, especially in the context of India, as it features as a common cause of interstitial lung disease and a close differential of TB. We need to intervene before the condition worsens, as this may reduce the survival significantly. However, this is not always possible and more research including longitudinal studies are needed to define and understand the course of the disease
Glued lungs: Sticky and tricky
No full textWe report a male patient who underwent bronchoscopic instillation of glue to control moderate hemoptysis which later led to the development of postobstructive pneumonia and extensive foreign body reaction in the bronchial wall and the lung distal to the glue application. He continued to have intermittent hemoptysis and underwent bronchial artery embolization. However, recurrent moderate hemoptysis eventually led to pneumonectomy, which showed severe foreign body reaction in bronchi- and post-obstructive changes in the lung parenchyma and the draining lymph nodes. This case highlights a serious complication of intrabronchial cyanoacrylate gluing to control bleeding in hemoptysis, which might warrant its very cautious use in moderate hemoptysis although surgical modality is considered the definitive treatment in life-threatening hemoptysis
Deep Reinforcement Learning based Path-Planning for Multi-Agent Systems in Advection-Diffusion Field Reconstruction Tasks
No full textMany environmental processes can be represented mathematically using spatial-temporal varying partial-differential equations. Timely estimation and prediction of processes such as wildfires is critical for disaster management response, but is difficult to accomplish without the availability of a dense network of stationary sensors. In this work, we propose a deep reinforcement learning-based real-time path-planning algorithm for mobile sensor networks traveling in a formation through a spatial-temporal varying advection-diffusion field for the task of field reconstruction. A deep Q-network (DQN) agent is trained on simulated advection-diffusion fields to direct the mobile sensor network to travel along information-rich trajectories. The field measurements made by the mobile sensor network along their trajectories enable identification of field advection parameters, which are required for field reconstruction. A cooperative Kalman filter developed in previous works is employed to receive estimates of the field values and gradients, which are essential for reconstruction as well as for the estimation of the diffusion parameter. A mechanism is provided that encourages exploration in the field domain once a stationary state is reached, which allows the algorithm to identify other information-rich trajectories that may exist in the field improving reconstruction performance significantly. Two simulation environments of different fidelities are provided to test the feasibility of the proposed algorithm. The low-fidelity simulation environment is used for training of the DQN agent. The high-fidelity simulation environment is based on Robot Operating System (ROS) and simulates real robots. We provide results of running sample test episodes in both environments which demonstrate the effectiveness and feasibility of the proposed algorithm
A Drug Utilization Surveillance Study to Assess the Clinical Impact of Digital Dose Counter pMDIs on Bronchial Asthma: DUSS Analyses; DUSS - Digital pMDI Utilization Surveillance Study
No full textRecurrent non‐traumatic idiopathic chylothorax: a diagnostic dilemma with therapeutic challenge
No full textIntravenous anidulafungin followed optionally by oral voriconazole for the treatment of candidemia in Asian patients: results from an open-label Phase III trial
No full textBackground: Candidemia is a significant cause of morbidity and mortality in hospitalized patients, particularly in Asia. Anidulafungin has been reported to be an effective treatment for candidemia in Western populations, but little is known about its efficacy in Asian patients, where the clinical presentation and epidemiology may be different.
Methods: An open-label study of anidulafungin for the treatment of candidemia was recently conducted in several Asian countries. Treatment was initiated with intravenous anidulafungin, given for at least 5 days, with the option to complete treatment with oral voriconazole. The primary endpoint was global (clinical and microbiological) response, and the primary analysis was the proportion of patients in the modified intent-to-treat population with successful global response at the end of therapy. Secondary analyses included proportion with successful global response in clinically relevant patient subgroups. The safety and tolerability profile of anidulafungin and voriconazole in this population was also investigated.
Results: Forty-three patients were studied, including 42 in the modified intent-to-treat population. Eighteen patients were > 65 years, the largest age subgroup, and 21 had central venous catheters. The most common Candida species causing infection were C. tropicalis (n = 18) and C. albicans (n = 10). In the primary analysis, 73.8% had a successful global response at end of therapy. Success rates in subgroups were: 72.2% for C. tropicalis and 71.4% for C. albicans infection, 58.8% for patients > 65 years, and 81.0% for patients with central venous catheters. Safety and tolerability were comparable with the known profiles for anidulafungin (and voriconazole).
Conclusions: Although the epidemiology of Candida infections was different in this open-label study, the efficacy of anidulafungin in Asian patients with documented candidemia was consistent with previous studies in Western populations. No new safety concerns were identified
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