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Background: Acute respiratory failure is a dreaded complication of interstitial lung disease (ILD) and is the most significant reason for mortality in most forms of ILDs. Knowledge of outcome predictors that can be assessed early after intensive care unit (ICU) admission would help guide the use of specific treatments. The present study attempts to identify the baseline characteristics of ILD patients admitted due to acute respiratory failure to ICU and to evaluate the cause of acute respiratory failure in these patients, management, and the outcomes. Materials and Methods: An observational cohort study was carried out in a tertiary care center in North India on 50 previously diagnosed patients of ILD hospitalized due to acute respiratory failure between January and December 2022. All relevant clinical, investigational, and treatment data were collected from the hospital information system. Results: The baseline mean FVC and 6-min walk distance were lower for non-survivors. The baseline mean DLCO was significantly lower among non-survivors. Comparatively, the radiology pattern of both groups showed that the usual interstitial pneumonia (UIP) pattern was associated with highest mortality. However, this difference was not statistically significant. Mortality was higher in those with lower PaO2/FiO2 ratio than among the survivors. Sputum culture positivity had a statistically significant impact on mortality. The mean hospital stay time was considerably higher in patients with idiopathic pulmonary fibrosis (IPF) and in patients with Type 2 respiratory failure. Conclusion: Baseline lung function tests, comorbidities, and exacerbating factors are invaluable in predicting the clinical outcomes. It is essential to perform all the diagnostic examinations at the earliest to ensure prompt initiation of the most appropriate therapy and lower hospital mortality. Distinguishing those patients who have a known cause for their ILD from those who do not was found to be crucial for deciding the most appropriate management.

Abstract Endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) is a widely used procedure in interventional pulmonology, known for its diagnostic accuracy and low complication rates. We report a rare complication of EBUS-TBNA involving the damage of the TBNA needle during sampling of a mediastinal lymph node, resulting in an impacted needle spring in the airway. Despite its rarity, awareness of such potential issues is crucial for all practitioners performing EBUS-TBNA to ensure patient safety and optimal outcomes.

BackgroundContactless monitoring of vital signs, especially the breathing of children, in the hospital is performed on a priority basis because their organs and immune system are immature. Therefore, continuous monitoring of their vital signs with a sensor that is directly attached to their body is not possible, as it irritates the sensitive newborn skin and causes discomfort. A contactless frequency-modulated continuous-wave (FMCW) radar-based device can wirelessly monitor the breathing rate and pattern of a child in the hospital or at home. Signal-processing capability can be added to this device to process breathing data and analyze the apnea condition arising due to irregular breathing patterns. ObjectiveThis study will develop a contactless FMCW radar-based system to accurately monitor the breathing rate and pattern of neonates and infants in hospitals and at home in order to provide a noninvasive, nonintrusive and contactless alternative to conventional sensor-based methods and address a critical need in neonatal care, potentially improving health outcomes for vulnerable infants. MethodsThe radar transmits a signal toward the body, and the time taken by the signal received to travel from the body to the receiving antenna is analyzed. This time is proportional to the distance between the radar and the body, and the breathing pattern is recognized as a slight, periodic variation in this distance. We will use this concept with multiple antenna systems to monitor the breathing of neonates with improved sensitivity. The radar-based device will be installed, in addition to conventional breathing monitors, in the neonatal intensive care unit. The signals received at the radar and the respiration signals from conventional monitors will be recorded in a database. Signal-processing techniques will be applied to extract breathing signals from the signals received at the radar. ResultsThis study was funded in January 2023 by the Science and Engineering Research Board (SERB) of India. The device was designed by May 2024, and a working proof-of concept was verified in the Indian Institute of Technology (IIT) Ropar laboratory. Implementation of the proposed method for initial study began in December 2024. Results are expected to be published in the first quarter of 2025. ConclusionsThe contactless FMCW radar-based system will provide reliable estimation of the breathing rate and pattern, which is close to the conventional reference device values most of the time. Our device will also provide a seamless breathing-monitoring system to be used both in hospitals and at home for newborns and premature babies until they are fully healthy and fit. International Registered Report Identifier (IRRID)PRR1-10.2196/59532

Abstract Laryngotracheal mucormycosis presents a rare but critical challenge, particularly in immunocompromised individuals. This report details the case of a 31-year-old diabetic male who experienced central airway obstruction due to mucormycosis. Despite the complexity of managing airway involvement, a multidisciplinary approach involving airway debridement surgery, liposomal amphotericin B, and posaconazole resulted in successful airway mucor treatment and resolution. This case underscores the importance of early recognition, aggressive intervention, and collaborative care in managing life-threatening conditions.

Abstract Patients with malignant central airway obstruction often present with dyspnea and sometimes with frank respiratory failure. Airway stenting has become a routine modality in the management of these patients. A correctly placed airway stent will give good relief in dyspnea and respiratory failure and will even improve the patient's ECOG (Eastern Cooperative Oncology Group) performance score. The common complications associated with stents are migration, fracture, infection, and obstruction by tumors, granulation tissue, and secretions. These complications are more pronounced with metallic stents. Surveillance bronchoscopy should ideally be done in these patients at least 4–6 weeks post-stent insertion. Removal of granulation tissue has been attempted with modalities like lasers, Argon plasma coagulation, cryotherapy, and snare electrocautery. Here, we present a novel case of post-stent granulation tissue, which was removed and debulked with the help of electrocoagulation bronchoscopy biopsy forceps (hot biopsy forceps). Conclusion Hot biopsy forceps can be safely and easily used for the removal of granulation tissue in patients post-tracheobronchial stent insertion.

Non-resolving consolidation refers to the persistence of radiographic abnormalities beyond the anticipated timeframe. Conditions such as infection, malignancy, inflammatory disorders, and connective tissue diseases can all manifest as non-resolving consolidation. We share a clinicopathological case study involving a 30-year-old male who exhibits non-resolving consolidation accompanied by hepatosplenomegaly.

Integrating unmanned aerial vehicles (UAVs) with terrestrial networks can enable high-speed communication in various applications. UAVs can serve as aerial base stations (ABSs), offering several benefits to the existing terrestrial networks, such as enhanced coverage, increased capacity, rapid deployment, and mobile communication support. However, this integration presents various technical challenges, including coordination, interference management, and dynamic allocation of resources. To address these key challenges, in this paper, we maximize the network utility by jointly optimizing the scheduling and cell association, transmit power of all base stations, and ABS deployment locations in the presence of co-channel interference. A two-stage approach is proposed to obtain a solution. In the first stage, we propose a heuristic solution by using the clustering algorithm to determine the initial ABS locations and user scheduling while ignoring the co-channel interference. In the second stage, we utilize the solution obtained in the first part and develop an interference-aware iterative scheme to jointly optimize user scheduling, resource allocation, and ABS placement. Given the non-convex nature of this problem, we employ the successive convex approximation technique to approximate the non-convex objectives and constraints. Numerical results show the proposed approach's insights and effectiveness over other schemes. Specifically, our proposed approach provides an average of 25% improvement over the benchmark schemes.

Abstract Tube thoracostomy stands as the conventional treatment for pleural diseases. Nevertheless, pigtail catheters have gained traction due to their smaller size, potentially resulting in reduced complications. Despite the enhanced safety and ease of insertion associated with pigtail catheters, it is crucial to recognize that procedural complications can arise irrespective of the drainage method employed. Complications related to small-bore pigtail catheters encompass the possibilities of dislodgment, kinking, and, though rarely, breakage. Our case serves as a reminder for medical practitioners to select appropriately sized pleural tubes based on the specific pleural condition. In this instance, we present the utilization of a semi-rigid thoracoscope to extract a broken pigtail catheter from the pleural cavity. To the best of our knowledge, this is the first case report of removing a broken pleural catheter using semi-rigid medical thoracoscopy.

In wireless communication, signal demodulation under non-ideal conditions is one of the important research topic. In this paper, a novel non-coherent binary phase shift keying demodulator based on deep neural network, namely DeepDeMod, is proposed. The proposed scheme makes use of neural network to decode the symbols from the received sampled signal. The proposed scheme is developed to demodulate signal under fading channel with additive white Gaussian noise along with hardware imperfections, such as phase and frequency offset. The time varying nature of hardware imperfections and channel poses a additional challenge in signal demodulation. In order to address this issue, additionally we propose transfer learning based DeepDeMod scheme. Pilot symbols along with data is transmitted in a packet which is used to learn the time varying parameters from the pilot reception followed by data demodulation. Results show that compared with the conventional demodulators and other machine learning based demodulators, our proposed DeepDeMod provides significantly better performance in term of bit error rate. We also implement the proposed DeepDeMod on software defined radio and present the experimental results.

Abstract Background Cedecea neteri is a gram-negative, oxidase-negative bacillus, a rare pathogen. Few reports are emerging globally about its antimicrobial resistance pattern especially in immunocompromised individuals with comorbidities. Case presentation In this paper, we report the first case of C. neteri causing urinary tract infection in a pregnant woman at a specialty care hospital in the Northern Emirates of Ras al Khaimah, UAE. Discussion and conclusion C. neteri is a rare and unusual pathogen, unlike routine gram-negative urinary tract pathogens from the family of Enterobacteriaceae and therefore may be missed or misidentified by routine laboratories using conventional microbiology identification techniques. Hence, Cedecea infections may be under-reported. Physicians and microbiology technicians must be aware of such a rare pathogen, as most of the isolates are multi-drug-resistant and require combined antibiotic treatment with beta-lactamase inhibitors and hence pose a treatment challenge especially in immunocompromised patients with comorbidities. In recent years, it has been reported as an emerging opportunistic pathogen.

Introduction: The donor vigilance program is intended to collect and assess information on unexpected or undesirable effects or reactions resulting from blood donation. In this report, we discuss the analysis of the blood donor adverse reactions (DARs) reported in the National Blood Donor Vigilance Programme of India during the first 2 years of implementation. Materials and Methods: DAR reporting form prepared and approved by the National Executive Committee of the Haemovigilance Programme of India was used to capture the data by the blood centers and submitted to Donor-Vigil software prepared and hosted by the official website of the National Institute of Biologicals. Data reported for the years 2016 and 2017 were reviewed, analyzed, and validated by independent transfusion medicine experts. Results: During this period, a total of 19,98,101 donations denominator data were reported, in which 1,622,600 (80.9%) were valid. A total of 6091 DARs were reported, out of which 3980 (65.35%) were found valid. Only validated numerator and denominator data were included in the analysis. Generalized DARs were the most common type of DARs reported (83.7%), followed by “others” type (7.7%), localized (7.6%), allergic (0.4%), and complications related to apheresis (0.4%). The overall DAR rate was 2.45/1000 blood donations, which was higher in apheresis donations (3.07/1000) as compared to whole blood donations (2.39/1000). The DARs rates were higher in females (3.5/1000) compared to male donors (2.3/1000) and in the first time (2.5/1000) compared to repeat donors (2.15/1000). Conclusion: In this report, we concluded that younger age, first time, and female donors are more prone to DARs as compared to older age, repeat, and male donors. During the analysis of the data, we found some limitations, which can be improved by upgrading the reporting form and conducting regular continuing medical education (CMEs) of participant blood centers.

BACKGROUND: Autoimmune hemolytic anemias (AIHA) are characterized by the destruction of red cells following the production of autoantibodies directed against them. Although AIHA in children is usually self-limiting, many still succumb to the illness due to delay in the diagnosis and treatment. AIHA in children may be secondary to autoimmune diseases, drugs, or immune deficiencies. Early diagnosis and appropriate immunohematological evaluation can aid in the diagnosis and treatment.OBJECTIVE: To analyze the evaluation, treatment, and outcome of AIHA in children.METHODS: Prospective data of patients aged 0–18 years diagnosed with AIHA between June 2017 and May 2019 were collected.INTERVENTION: Prednisolone was the first-line agent in all; second-line agents included cyclosporine and rituximab. Red cell transfusion was given in those with severe anemia with cardiac decompensation.RESULTS: Eleven patients were diagnosed during the study period. Hemoglobin ranged from 1.2 to 9 g/dl. The initial presentation was severe anemia in 8 children and moderate anemia with thrombocytopenia in 3. The trigger was infection in 5. Polyspecific direct coomb's test (DCT) was positive in 10 patients. 2/10 polyspecific DCT-positive cases on further evaluation had immunoglobulin G (IgG) and C3d positivity, whereas rest 8 had only IgG. One infant was diagnosed with DCT-negative immunoglobulin A-mediated AIHA. 4/11 attained remission following the short course of prednisolone. Cyclosporine was used as the second-line agent in 2 and rituximab was used in 3. Seven children are in sustained remission and off medication. One died within 12 h of diagnosis.CONCLUSION: AIHA is not an uncommon problem in children and can vary in its clinical severity. Early and correct diagnosis helps in deciding appropriate treatment.

Serological screening for antibody against SARS-CoV-2 has been gaining more attention in view of selection for an appropriate donor for COVID-19 convalescent plasma, documenting the past/ recent infection due to the virus as well as now for evaluating the immune response to the vaccination. In beginning of the pandemic an indigenous ELISA kits were developed in India to screen for IgG type of antibody against the whole-cell virus particle. Our retrospective analysis provides a head-to-head comparison of an indigenous ELISA kits (COVID KAWACH IgG MICROLISA) and CLIA (SARS-CoV-2 IgG by Abbott) platform for screening of IgG type of antibody. Total 380 samples from adults were screened on both the platforms, out of which 250 had a history of a positive RT-PCR report and 130 were RT-PCR negative but with a history of symptoms suggestive of COVID-19 or exposure to COVID-19 individual. The overall concordance of detection IgG type of antibody by both the platforms was 52.2% (higher in individuals with known RT-PCR positivity; 70%). The median S/CO ratio (on CLIA) was 3.34 in concordant positive samples and 2.48 in cases of CLIA yield samples. Our study highlights the variation in detection of the antibody by both the platforms due to inherent difference in the design of these platforms and kits.

Alloimmunization to red cell antigens is a taxing complication of thalassemia major and intermedia patients who receive routine blood transfusions. The data on alloimmunization in beta-thalassemia are sparse from developing countries. The risk of alloimmunization is higher in thalassemia patients who received their first transfusion after the age of 3 years. We describe the presentation and outcome of a 4.5-year-old girl who presented with massive hemolysis following the first transfusion received following the diagnosis of beta-thalassemia intermedia. Despite best efforts with all available therapeutic modalities, hemolysis could not be controlled and she succumbed to the illness. The case is being presented as such severe hemolysis caused by alloimmunization to a blood group antigen is rare and posed a challenge for both diagnosis and treatment.

Fostering students' mathematical creativity is important for their understanding and success in mathematics courses as well as their persistence in STEM, but it necessitates intentional instructional actions, such as designing and implementing tasks that have the potential to foster creativity. As teaching innovation requires support for instructors who implement them, we developed a creativity-fostering task design framework that can be used by instructors of undergraduate mathematics courses. In this paper, we share this framework and its research-based development process. The framework includes research-based task features and aligns with the Creativity-in-Progress Reflection (CPR) on problem-solving, a formative assessment instrument. We share two creativity-fostering task samples for Calculus 1 courses as we notice that this course could be enhanced with such tasks. We also discuss ways in which Calculus 1 instructors utilized task features and framework as they designed their own tasks. We observed that the multiple answers and open-ended features of creativity-fostering tasks were frequently incorporated in instructors' tasks; meanwhile, the framework provided opportunities for instructors to be intentional about creating tasks that incorporate mathematical actions such as making connections and taking risks.