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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.

Blood transfusion is the mainstay for management of hemoglobinopathies, including thalassemia and sickle cell disease (SCD). Apart from other transfusion related adverse effects, immunization is a significant complication, particularly in multitransfused recipients. Alloimmunization rates vary widely, both in thalassemia and SCD patients. Alloimmunization complicates the management in form of hemolytic transfusion reactions, difficulty in finding compatible units, delays in transfusion and increasing costs. Exact pathogenesis and prevention modality have not been elucidated. Apart from antigenic differences, immunomodulatory effects and inflammation also play a role in pathogenesis. Ethnic heterogeneity between donors and recipients predisposes to higher alloimmunization.Transfusion management of hemoglobinopathies across the globe is fragmented, with different levels of care. Guidelines propose red cell antigen profiling, transfusion of leucoreduced red cells, preferably matched for Rh and Kell antigens, over and above ABO-D matching. For alloimmunized patients, corresponding antibody negative red cells need to be transfused. However, patients from different backgrounds are variably transfused with whole blood/red cells, which may or may not be leukoreduced. Prophylactic antigen matching reduces the risk of alloimmunization, however, has limitations. RH variants may not be picked up by phenotyping alone. Moreover, the approach of prophylactic antigen matching is expensive, labour intensive, time consuming and may cause delays in transfusions. There is limited, low quality evidence on best practices for transfusion management of SCD and thalassemia. The review analyses the magnitude of problem, factors contributing and modalities for prevention and management of immunization.

Abstract The limitations of TB treatment are the long duration and immune-dampening effects of anti-tuberculosis therapy. The Cell wall plays a crucial role in survival and virulence; hence, enzymes involved in its biosynthesis are good therapeutic targets. Here, we identify Mycobacterium tuberculosis (Mtb) GlmM, (GlmM Mtb ) engaged in the UDP-GlcNAc synthesis pathway as an essential enzyme. We generated a conditional knockdown strain, Rv-glmM kD using the CRISPR interference-mediated gene silencing approach. Depletion of GlmM Mtb affects the morphology and thickness of the cell wall. The Rv-glmM kD strain attenuated Mtb survival in vitro, in the host macrophages (ex vivo), and in a murine mice infection model (in vivo). Results suggest that the depletion of GlmM Mtb induces M1 macrophage polarization, prompting a pro-inflammatory cytokine response, apparent from the upregulation of activation markers, including IFNɣ and IL-17 that resists the growth of Mtb. These observations provide a rationale for exploring GlmM Mtb as a potential therapeutic target.

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.

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.

Asthma is a prevalent chronic respiratory disease affecting all age groups globally, causing significant morbidity and mortality. Small airway involvement, often undetected by traditional spirometry, has emerged as a critical aspect of asthma pathophysiology, especially in severe cases. This retrospective observational study aimed to assess small airway dysfunction using impulse oscillometry (IOS) in 94 severe asthma patients. Results indicated that 27.3% of patients had small airway obstruction. While spirometry showed no statistical differences between groups, IOS parameters were significantly different, highlighting its sensitivity in detecting small airway disease. Patients with small airway involvement exhibited poorer asthma control, emphasizing the clinical relevance of identifying and addressing small airway dysfunction. The study underscores the need for comprehensive evaluation tools like IOS alongside spirometry, especially in severe asthma management. Further large-scale studies are warranted to validate IOS's utility in optimizing therapeutic strategies and improving asthma control, particularly in resource-limited settings. Recognizing and addressing small airway involvement could lead to individualized management approaches and better outcomes in severe asthma patients.

Introduction: Obesity is worldwide health concern, with its prevalence rising steeply specially in low and middle-income countries in the past decade. World Obesity Federation estimates that one in five women and one in seven men - will be obese by 2030.Obesity numbers are expected to double during same year in South and South Asian countries, with obesity in children over age of five estimated to be at forty-five million. Methods: Relevant articles, full text and abstract pertaining to childhood obesity, pediatric obesity, technology in childhood obesity and specifically articles on obesity in children in South Asian countries were obtained from search engines like PUBMED, Google Scholar and Cochrane data base. The full text relevant articles and abstracts and the cross references after verification suitable to the topic were used to draft this review. Results: The double burden of undernutrition and obesity poses a unique public health challenge in Southeast Asia. In recent decades, South and Southeast Asia have experienced a period of rapid nutrition and lifestyle transition, leading to a proportional rise in the burden of obesity and Type 2 diabetes. The traditional diets of whole grains and vegetables in this region are being replaced by highly processed fast food due to rapid urbanization and westernisation in this region.There is growing and unrelenting burden of health risks in adulthood like diabetes, heart disease, hypertension, dyslipidaemia and mental health issues due to childhood obesity. Therapy mainly focuses on lifestyle changes underpinned by underlying behaviour changes, addressing emotional stress and sleep issues, pharmacotherapy and metabolic surgery in certain situations. Personalisation of therapy remains corner stone of therapeutics in childhood obesity. Conclusion: This comprehensive review aims at addressing the risk factors, complications, treatment and highlights effective preventive strategies for childhood obesity in South Asia.

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.

The growing demand for Electric Vehicles (EVs) necessitates the advancement of efficient charging systems. While dynamic charging models exhibit superior efficiency in Wireless Power Transfer (WPT) systems compared to static charging, however, the inherent challenges impede the effective operation of EV charging. This research aims to effectively address the existing research gap causing coil misalignment and sub-optimal efficiency in wireless charging systems for EVs by proposing a circuit design integrating an enhanced LCC compensation topology specifically tailored for wireless charging systems. The key innovation lies in the inclusion of a dual transmitter winding which optimizes power transmission between receiver and transmitter coils while ensuring high efficiency. The duo transmitter winding is split into sub windings one connected to the inverter and the other left open which further enhances performance, enabling operation under higher misalignment conditions while maintaining elevated efficiency levels. The advantage of both open and closed inductance in the circuit configuration significantly improves performance, overcoming previous constraints and providing a more robust and reliable charging solution. The circuit design implements Zero Voltage Switching (ZVS) to minimize energy losses in the Snubber MOSFET capacitance, typically used as a switch. Additionally, a ZVS feedback mechanism is incorporated to dynamically adjust the series capacitor on the receiver side, suggesting the presence of a resonant circuit. This approach aims to optimize the switching characteristics of the MOSFET, reduce losses, and enhance the overall efficiency of the power electronic system, potentially for applications such as wireless power transfer or power supplies. By enhancing the effectiveness and reliability of wireless power transfer in EVs, this study contributes to advancing the ease and feasibility of charging electric vehicles, potentially revolutionizing the EV industry's charging infrastructure.

Background Existing literature lacks high-quality evidence regarding the ideal intraoperative positive end-expiratory pressure (PEEP) to minimize postoperative pulmonary complications (PPCs). We hypothesized that applying individualized PEEP derived from electrical impedance tomography would reduce the severity of postoperative lung aeration loss, deterioration in oxygenation, and PPC incidence. Methods A pilot feasibility study was conducted on 36 patients who underwent open abdominal oncologic surgery. The patients were randomized to receive individualized PEEP or conventional PEEP at 4 cmH2O. The primary outcome was the impact of individualized PEEP on changes in the modified lung ultrasound score (MLUS) derived from preoperative and postoperative lung ultrasonography. A higher MLUS indicated greater lung aeration loss. The secondary outcomes were the PaO2/FiO2 ratio and PPC incidence. Results A significant increase in the postoperative MLUS (12.0 ± 3.6 vs 7.9 ± 2.1, P < 0.001) and a significant difference between the postoperative and preoperative MLUS values (7.0 ± 3.3 vs 3.0 ± 1.6, P < 0.001) were found in the conventional PEEP group, indicating increased lung aeration loss. In the conventional PEEP group, the intraoperative PaO2/FiO2 ratios were significantly lower, but not the postoperative ratios. The PPC incidence was not significantly different between the groups. Post-hoc analysis showed the increase in lung aeration loss and deterioration of intraoperative oxygenation correlated with the deviation from the individualized PEEP. Conclusions Individualized PEEP appears to protect against lung aeration loss and intraoperative oxygenation deterioration. The advantage was greater in patients whose individualized PEEP deviated more from the conventional PEEP.

By integrating energy-efficient AIoT-based biosensor networks, healthcare systems can now predict COVID-19 outbreaks with unprecedented accuracy and speed, revolutionizing early detection and intervention strategies. Therefore, this paper explores the rapid growth of electronic technology in today’s environment, driven by the proliferation of advanced devices capable of monitoring and controlling various healthcare systems. However, these devices’ limited resources necessitate optimizing their utilization. To tackle this concern, we propose an enhanced Artificial Intelligence of Things (AIoT) system that utilizes the networking capabilities of IoT biosensors to forecast potential COVID-19 outbreaks. The system aims to efficiently collect data from deployed sensor nodes, enabling accurate predictions of possible disease outbreaks. By collecting and pre-processing diverse parameters from IoT nodes, such as body temperature (measured non-invasively using the open-source thermal camera TermoDeep), population density, age (captured via smartwatches), and blood glucose (collected via the CGM system), we enable the AI system to make accurate predictions. The model’s efficacy was evaluated through performance metrics like the confusion matrix, F1 score, precision, and recall, demonstrating the optimal potential of the IoT-based wireless sensor network for predicting COVID-19 outbreaks in healthcare systems.

Throughout history, herbalists and traditional healers have wielded the power of plant-based remedies, an ancient practice now embraced by modern science. Delving into the therapeutic properties of conventional herbs and spices is a recent pursuit. Galactogogues, compounds known for their ability to heighten prolactin levels by modulating dopamine receptors, stand as agents amplifying milk production—a vital function for lactation. This study endeavors to meticulously explore medicinal spices and herbs recognized for their remarkable capacity to augment breast milk production. Methodologically, information pertaining to medicinal herbs and spices recognized for promoting lactation was extracted from reputable literature. A meticulous exploration across multiple academic databases, encompassing PubMed, Science Direct, Scopus, Google Scholar, and Web of Science, was undertaken to authenticate the impacts of these medicinal plants on lactation, considering their identified pharmacological properties. The findings underscored the potency of Trigonella foenum-graecum L., Asparagus racemosus W., Zingiber officinale Roscoe, Moringa oleifera L., Cuminum cyminum L., and Trachyspermum ammi L., contribute to increased lactation. They achieve this through mechanisms such as phytoestrogenic effects, vasodilation, stimulation of mammary growth, and facilitation of breast milk production. In conclusion, the fusion of traditional wisdom with contemporary scientific inquiry offers a promising avenue for discovering potent phyto pharmaceuticals that effectively boost breast milk production. Leveraging this amalgamation may yield impactful advancements in maternal health and lactation support.

ABSTRACT The host immune responses play a pivotal role in the establishment of long-term memory responses, which effectively aids in infection clearance. However, the prevailing anti-tuberculosis therapy, while aiming to combat tuberculosis (TB), also debilitates innate and adaptive immune components of the host. In this study, we explored how the front-line anti-TB drugs impact the host immune cells by modulating multiple signaling pathways and subsequently leading to disease relapse. Administration of these drugs led to a reduction in innate immune activation and also the cytokines required to trigger protective T cell responses. Moreover, these drugs led to activation-induced cell death in the mycobacterial-specific T cell leading to a reduced killing capacity. Furthermore, these drugs stalled the T cell differentiation into memory subsets by modulating the activation of STAT3, STAT4, FOXO1, and NFκB transcription factors and hampering the Th1 and Th17-mediated long-term host protective memory responses. These findings suggest the urgent need to augment directly observed treatment, short-course (DOTS) therapy with immunomodulatory agents to mitigate the adverse effects linked to the treatment.IMPORTANCEAs a central component of TB eradication initiatives, directly observed treatment, short-course (DOTS) therapy imparts immune-dampening effects during the course of treatment. This approach undermines the host immune system by delaying the activation process and lowering the immune response. In our investigation, we have unveiled the impact of DOTS on specific immune cell populations. Notably, the signaling pathways involving STAT3 and STAT4 critical for memory responses and NFκβ associated with pro-inflammation were substantially declined due to the therapy. Consequently, these drugs exhibit limited effectiveness in preventing recurrence of the disease. These observations highlight the imperative integration of immunomodulators to manage TB infection.

Among congenital cyanotic heart diseases (CHDs), situs inversus totalis with transposition of great vessels with a large ventricular septal defect (VSD) has a very low incidence of around 1 in 10,000. Hereby, we present a 16-year-old man with the aforementioned cardiac anomaly with cardiac arrhythmias, septic shock, and a history of road traffic accident-causing osteomyelitis of the left thigh requiring incision and drainage. The patient was admitted to the intensive care unit with a high-grade fever, narrow pulse pressure, and atrial fibrillation. The patient was operated on under general anesthesia with endotracheal intubation after optimization. Invasive monitoring, antiarrhythmics, and vasopressors were required intraoperatively, and surgery progressed uneventfully. Furthermore, the patient had undergone a series of debridements after 8 days, which were performed under regional anesthesia uneventfully. This case report represents a plan of action for perioperative anesthetic management and anticipates the difficulties for CHD patients in the course of surgery and subsequential prudence.