Outcome of different modes of non-invasive ventilation in chronic obstructive pulmonary disease patients with type II respiratory failure

Background: Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory airway disorder often leading to type II respiratory failure (RF). Non-invasive ventilation (NIV) is crucial in COPD management. This study compares T (Timed), ST (Spontaneous-Timed), and iVAPS (Intelligent volume assured pressure support) modes. Method: A prospective, experimental, comparative study spanned two years. One hundred COPD patients with Type 2 RF were randomized into three groups: T mode (n=33), ST mode (n=33), and iVAPS mode (n=34). Outcome assessment included clinical, hematological parameters, and intubation rate. Result: The study revealed varying degrees of success among the three modes of NIV. iVAPS mode demonstrated the highest success rate, with 79.4% of cases achieving positive outcomes. Noteworthy improvements were observed in respiratory rate (RR) and oxygen saturation (SpO2) in the iVAPS group after 12 hours of NIV. Both the ST mode and iVAPS mode showed significant increases in pH levels, with a more pronounced improvement seen in the iVAPS group. Additionally, a substantial reduction in pCO2 levels after BiPAP was noted in the iVAPS group. The intubation rate was lowest in the iVAPS group, though the difference did not reach statistical significance. Conclusions: iVAPS mode demonstrated superior outcomes, including significant improvements in RR, SpO2, pH, and pCO2. While the intubation rate was lowest in the iVAPS group, statistical significance was not achieved. iVAPS emerges as a promising alternative, potentially averting the need for invasive ventilation. Larger, diverse studies are needed to validate these findings

Second Primary Lung Cancer with Glottic Laryngeal Cancer as Index Tumor – A Case Report

Patients with laryngeal cancer have a high risk of developing lung cancer in the future. A patient presented with a complaint of left-sided chest pain for the last 3 months. Chest X-ray posterior-anterior view showed a homogeneous opacity in the left upper lung field with elevation of the diaphragm on the left side. CECT thorax revealed a heterogeneously enhancing soft tissue density mass lesion in the superior segment of the lingular lobe. On histopathological examination of the mass lesion, it was diagnosed as adenocarcinoma of the lung. About 10 months previously, the patient was treated for a laryngeal squamous cell carcinoma. Patients with laryngeal cancer should be routinely screened during follow-up with chest X-ray or CT scan for the early detection of lung cancer

Vibration-based damage detection in beam-type structures by using a Bayesian data fusion based technique

The study in the field of damage detection in civil, marine, mechanical and aerospace engineering structures has always acquired great interest in order to avoid risks related to ageing of the structure and linked possibility for damage accumulation. Therefore health monitoring is becoming ever more important for these structures. Numerous non-destructive damage identification techniques are available which are highly effective on local basis. However, damage being typically unknown in both presence and location, make them ineffective especially for large and complex structures. Vibration-based damage detection (VBDD) is an active research area, which as compared to local non-destructive evaluation methods, does not require prior knowledge about the damage location. Most of these methods are model-based which requires information from either the undamaged structure itself or to compare with a numerical model which makes the methods inflexible. However a number of techniques are available which consider the damaged structure only, to identify damage but the unavoidable noise in the measurements creates a detrimental effect on these techniques. The research in this thesis presents a noise reduction technique with the help of which a study is done to evaluate two conventional VBDD methods i.e., Gapped-Smoothing method (GSM) and Modal Strain Energy method (MSEM) in beam-type structures, without using the baseline information about the structure.The developed method uses the damage indices provided by GSM and MSEM for synthesizing a set of likelihood function that is processed under a Bayesian approach in order to reduce the effect of the noise and other uncertainty sources. The quality of the damage detection for the beams under consideration is examined by investigating optimal sampling size analytically and then through numerical simulation and experiments. The study comprises of testing a steel beam with multiple transverse edge cracks and a glass fibre reinforced plastic (GFRP) beam with a through-width delamination. It is demonstrated that by using a suitable sample size, the developed method can be successfully employed to detect the location of the damage using both GSM and MSEM without any baseline information. Furthermore, it is observed that as compared to MSEM, the developed method with GSM works better on edge cracks. Conversely, the developed method with MSEM provides better results for the localisation of delamination than with GSM

Recurrent pneumothorax: A rare complication of miliary tuberculosis

Context: Recurrent pneumothorax is common in cavitory pulmonary tuberculosis, but it is extremely rare in miliary tuberculosis. Case Report: A 25 year old female patient presented to us with the complains of shortness of breath since 3 days. She was also having fever and cough since 3 months. Chest roentgenogram (PA view) on admission showed a left sided pneumothorax with miliary mottling. An intercostals tube drainage was done on the left side resulting in relief of symptoms. Two days post intercostals tube drainage chest X ray (PA view) showed complete resolution of pneumothorax, and intercostals tube was removed. Patient was discharged on antitubercular drugs. After 1 month patient again presented to us with severe breathlessness, on repeat chest X ray pneumothorax again developed on left side, urgent intercostals tube drainage was done, and patient relieved immediately. Patient was kept in the hospital for 12 days and, and was discharged after intercostals tube removal. Conclusion: If a patient of miliary tuberculosis presents with shortness of breath diagnosis of pneumothorax should be considered