68 research outputs found

    Anesthetic Concerns in Psychiatric Disease

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    As the prevalence of mental health illnesses rises worldwide, the use of psychotropic medications follows. Undoubtedly, many patients using psychotropic medications will undergo procedures requiring anesthesia both in the operating room and outside of it. This chapter focuses on psychotropic medications that may complicate the surgical and postoperative course of patients undergoing anesthesia. Toward this aim, we performed a literature review using targeted key terms. Relevant articles were cited, and findings are summarized in this narrative review. We begin with discussing psychotropic medication pharmacology, drug-drug interactions, and side effects, emphasizing their interaction with anesthetic agents. We summarize the current recommendations for managing these medications in the perioperative period. In the discussion section, we focus on highlighting future directions for the intersection between psychotropic medications and anesthesia. Overall, we provide insight into the perioperative management of patients taking psychotropic medications, the point of intersection between the fields of psychiatry and anesthesia

    Comparative Analysis of the Indian and Canadian Real Estate Markets

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    Financial and real estate crises have been the most prevalent forms of economic catastrophe over the past three decades. In 2008, India endured a financial crisis unprecedented in its history. Canada seems to be creating a real estate bubble recently; Bloomberg Economics puts Canada as the OECD’s second greatest housing bubble in 2019 and 2021. In the case of the Indian real estate bubble, the capital and large cities saw the largest increase in house prices initially, then comparable increase spread gradually to smaller towns and provinces. Thus, this paper conducts a comparative study of the real estate markets in India and Canada and presents a basic analysis of the Canadian real estate market based on the Indian experience with the real estate crisis. Specifically, the article explores the recent economic history and deduces the elements that contributed to the real estate catastrophe. After collecting data and gaining a thorough knowledge of both nations’ real estate markets, the article performs a comparison study employing indices such as the housing index, the corruption rate, and the Business Survey Index (BSI). The research indicates that property prices in Canada are projected to rise because of a significant association between corruption and house prices and a decline in the BSI index. The research provides some recommendations to avert a full-fledged real estate meltdown

    Outpatient Management of Chronic Pain

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    In this chapter, we provide an overview of the most current techniques in the evaluation, diagnosis, and treatment of pain in the outpatient setting. We performed a targeted literature review by searching for the terms such as “chronic pain” and “pain management.” Relevant articles were cited, and findings were described in the chapter text. Additionally, we supplemented our review with images from the Spine and Pain Associates’ offices at St. Luke’s University Health Network (SLUHN) in Bethlehem, PA, as well as medical illustrations by our authors. We begin the review with a description of pain—its definition, components, complexity, and classifications and then provide a stepwise outline of the pharmacologic approach beyond nonsteroidal anti-inflammatory drugs before delving into newer interventional pain management procedures. Subsequently, this chapter is not comprehensive as it does not provide extensive discussion on older, more established procedures such as epidural steroid injections as well as practices falling out of favor such as discograms and neurolysis. Instead, we focus on newer subacute to chronic nonmalignant pain interventions. Finally, we attempt to highlight future directions of the growing field. Overall, we provide an overview of the management of chronic by providing insights into updates to chronic pain management

    Impact of antimicrobial therapy on the gut microbiome

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    The gut microbiome is now considered an organ unto itself and plays an important role in health maintenance and recovery from critical illness. The commensal organisms responsible for the framework of the gut microbiome are valuable in protection against disease and various physiological tasks. Critical illness and the associated interventions have a detrimental impact on the microbiome. While antimicrobials are one of the fundamental and often life-saving modalities in septic patients, they can also pave the way for subsequent harm because of the resulting damage to the gut microbiome. Contributing to many of the non-specific signs and symptoms of sepsis, the balance between the overuse of antimicrobials and the clinical need in these situations is often difficult to delineate. Given the potency of antimicrobials utilized to treat septic patients, the effects on the gut microbiome are often rapid and long-lasting, in which case full recovery may never be observed. The overgrowth of opportunistic pathogens is of significant concern as they can lead to infections that become increasingly difficult to treat. Continued research to understand the disturbances within the gut microbiome of critically ill patients and their outcomes is essential to help develop future therapies to circumvent damage to, or restore, the microbiome. In this review, we discuss the impact of the antimicrobials often used for the treatment of sepsis on the gut microbiota

    3D Object Recognition in Real Time Using Machine Learning

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    Object recognition, a small branch of computer vision, deals with making computers detect and analyze objects in either a picture, a saved video, or a real time video feed. The major challenge in the task of object recognition is obtaining efficiency. There are several object recognition algorithms currently in place which provide astonishing results with varying efficiency. There are several libraries in the world today that provide implemented solutions to help with applications concerning object recognition; two of the most popular of these libraries are OpenCV and TensorFlow. This research focuses on two broad aspects – understanding the working of neural networks, more specifically, convolutional neural networks by experimenting with different models for object classification that use them and implementing real time object detection using pre-trained models and machine learning libraries

    N-1-Secure Dispatch Strategies of Embedded HVDC Using Optimal Power Flow

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    With the ongoing changes in the European electrical energy systems, redispatch measures are more often required to maintain system security. The introduction of HVDC transmission can potentially reduce necessary redispatch not only by providing additional transmission capacity but also with its inherent controllability. This work analyzes the effect of HVDC dispatch in regard to preventive and curative redispatch measures using a security constrained optimal power flow calculation. For this, a mixed ac/dc benchmark network with predefined contingencies is examined with different redispatch options for pre- and post-contingency operation. Results show, that the required redispatch measures can be reduced significantly by an adaptation of HVDC set points and even further, when post-contingency redispatch measures could be applied

    A 10-Year Experience of Therapeutic Drug Monitoring (TDM) of Linezolid in a Hospital-wide Population of Patients Receiving Conventional Dosing: Is there Enough Evidence for Suggesting TDM in the Majority of Patients?

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    A retrospective study was conducted to assess our 10-year experience of therapeutic drug monitoring (TDM) of linezolid in a large patient population to establish whether conventional dosing may result in adequate drug exposure in the majority of patients. Patients included in this study underwent TDM of linezolid trough concentration (Cmin ) during treatment with conventional doses of 600 mg every 12 hr in the period between January 2007 and June 2016. The desired range of Cmin was set between 2 and 7 mg/L (under-exposure, Cmin 7 mg/L). Multivariate logistic regression analysis investigated variables potentially correlated with linezolid Cmin . One thousand forty-nine patients had 2484 linezolid Cmin assessed during treatment with conventional doses. Median (IQR) linezolid Cmin was 5.08 mg/L (2.78 - 8.52 mg/L). Linezolid Cmin were within the desired range in 50.8% of cases (1262/2484). Over-exposure (n=821; 33%) occurred much more frequently than under-exposure (n=401;16.2%), and was severe (> 20 mg/L) in 3.9% of cases (98/2484). Linezolid over-exposure was significantly associated with CrCLC-G estimates 64 40 mL/min (OR 1.463; 95% CI 1.124 - 1.904, P = 0.005). Linezolid under-exposure resulted significantly associated with CrCLC-G estimates > 100 mL/min (OR 3.046; 95% CI 2.234 - 4.152, P < 0.001. Linezolid Cmin was not correlated linearly to CrCLC-G (R(2) = 0.061). Variability in renal function explained only partially the very wide interindividual linezolid Cmin variability. Our study suggests that TDM could represent a valuable approach in optimizing linezolid exposure in the majority of patients. This article is protected by copyright. All rights reserved

    Primary Upper Urinary Tract Small Cell Carcinoma: A Case Series and Literature Review

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    Background: Primary upper urinary tract small cell carcinoma (SCC) is exceedingly rare with \u3c 30 cases reported in the literature. Little is known about the incidence, diagnosis, treatment, and outcomes in these patients. We present a series of three patients with primary upper tract SCC. Case Presentation: Patient 1 is an 89-year-old Caucasian male who presented with hydroureteronephrosis and a mass in the proximal right ureter. Biopsy revealed SCC. Without further intervention, the patient died 2 months after his diagnosis. Patient 2 is a 67-year-old Caucasian female who underwent left laparoscopic nephroureterectomy for primary distal ureteral SCC, pT4N1M0. She developed lymphadenopathy and completed external beam radiation to the pelvis and four courses of cisplatin-based chemotherapy. She died from metastatic disease 7 months after diagnosis. Patient 3 is a 45-year-old female who underwent open right radical nephrectomy, retroperitoneal lymph node dissection, and hepatic metastasectomy for metastatic primary upper tract SCC, pT3N1M1. She underwent two subsequent retroperitoneal debulking procedures for recurrence followed by treatment with octreotide. She developed widespread metastasis and was treated with temozolomide and capecitabine before her death 80 months after diagnosis. Conclusion: This series contributes to the limited knowledge of the management and natural course of primary upper tract SCC. Patient 1 represents the first disease-specific mortality reported in a patient who received no therapy. Patient 3 represents the longest reported survival with metastatic disease, and the first treated with octreotide. The patient was managed with aggressive repeat surgical resection and exhibited 2 years of progression-free survival on octreotide. Emphasis should be placed on aggressive resection of all visible disease combined with the use of multimodal adjuvant chemoradiation for selected patients in this rare disease
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