Role of N-Acetylcysteine in Clearance of Secretions in Mechanical Ventilated Patients

Objective: To determine the role of nebulized N-acetylcysteine in mechanical ventilation in clearing the airway of these patients Study Design: A Randomized Control Trial. Place and Duration of Study: Department of Anaesthesia and Intensive Care Unit Nishtar Medical University Hospital and Jinnah Hosptal, Lahore. From January 2017 to July 2018. Material and Methods: In this project total 50 patients were enrolled by consecutive sampling who remained on mechanical ventilation for more than 24 hours and were between ages 15 to 80 years old. Written consent of this project was taken from relative of each patient. These patients were divided into two groups by lottery method into case and control. The case group received 2 ml of NAC 20% with 8 ml normal saline 3 times a day for 1 day. The control group only received 10 ml normal saline via their nebulizers 3 times a day at 8 AM, 2 PM, and 9 PM. Data was collected and was analyzed. SPSS 22 was used for this purpose. All numerical variables of this research such as mean FiO2, mean peak and plateau pressure of airway, mean blood pressure, mean age and importantly mean density of secretions were calculated. In these values t test was applied and p value was calculated. If it was less than .005, then it was considered significant. Similarly, qualitative data such as type of disease were calculated in percentage and chi square test was used to check the significance. Results: The mean O2 saturation of baseline, 12 hours and 24 hours of the controls was 93.84±2.28, 94.27±2.33 and 94.08±1.81 respectively. The mean peak airway pressure of baseline, 12 hours and 24 hours of the controls was 23.16±3.49, 25.38±8.86 and 24.01±4.91 respectively. The mean plateau airway pressure of baseline, 12 hours and 24 hours of the controls was 19.04±7.79, 21.37±4.86 and 21.85±8.93 respectively. The mean secretion density of baseline, 12 hours and 24 hours of the controls was 1.04±0.024, 1.05±0.03 and 1.03±0.002 respectively. While, the mean O2 saturation of baseline, 12 hours and 24 hours of the cases was 93.08±2.37, 94.61±2.56 and 94.11±2.34 respectively. The mean peak airway pressure of baseline, 12 hours and 24 hours of the cases was 26.58±5.81, 23.81±8.28 and 24.34±6.15 respectively. The mean plateau airway pressure of baseline, 12 hours and 24 hours of the cases was 21.88±78.01, 24.88±6.67 and 23.51±7.55 respectively. The mean secretion density of baseline, 12 hours and 24 hours of the cases was 1.01±0.021, 1.08±0.022 and 1.008±0.0195 respectively. The differences were statistically insignificant. P-value ≤ 0.05 is considered as significant. Conclusion: It is concluded from our observations that use of N-acetylcysteine in patients on mechanical ventilation is very effective in clearance of secretion and to maintain airway clear. Key words: N-acetylcysteine, mechanical ventilation, airway clearance, normal saline DOI: 10.7176/JMPB/54-07 Publication date: April 30th 201

Relationship of platelet-lymphocyte ratio with severity of obstructive sleep apnea syndrome.

Objective: Objective of study was to assess the inflammation in obstructive sleep apnea syndrome patients by using platelet lymphocyte ratio and relationship between platelet lymphocyte ratio and severity of obstructive sleep apnea. Study Design: Cross sectional study Place and Duration: Pulmonology department of Nishtar Hospital Multan and Jinnah Hospital, Lahore  from June 2018 to March 2019. Methods: This cross sectional study was conducted in Pulmonology department of Nishtar Hospital Multan from June 2016 to March 2017.Total 280 patients were selected by non-probability consecutive sampling. All patients underwent whole night polysomnography. Patients were divided into control group (AHI <5), mild OSAS group (AHI 5-15), moderate OSAS group (AHI 15-30) and sever OSAS group (AHI >30) according to their AHI score. Numerical variables like age, body mass index, white cell count, platelets, hemoglobin (Hb) and platelet lymphocyte ratio were statistically analyzed by mean and standard deviation and t-test applied to assess their significance. Qualitative variables like gender and smoking status were statistically analyzed by frequency and percentage. Chi square test was applied to check the significance. P value <0.05 was regarded as significant. Results: Platelet lymphocyte ratio was significantly raised in patients with obstructive sleep apnea syndrome. There was significant correlation between platelet lymphocyte ratio and AHI (p<0.05). So study showed that there was significant association between obstructive sleep apnea syndrome severity (represented by AHI) and systemic inflammation (represented by PLR). Significant differences were found between age (p =0.000), ESR (p =0.000), CRP (p =0.003), Cholesterol (p =0.000), Platelets (p =0.048), Hb (p =0.000), PLR (p =0.000) and white blood cells (p =0.000), in groups. Association was found between gender (p =0.000) and smoking status (p =0.030) in groups. So, gender and smoking were the effect modifiers. Conclusion: the observations of our study suggest that Platelet lymphocyte ratio was significantly raised in patients with obstructive sleep apnea syndrome. There was significant correlation between platelet lymphocyte ratio and AHI (p<0.05). So study showed that there was significant association between obstructive sleep apnea syndrome severity (represented by AHI) and systemic inflammation (represented by PLR). Key words: Obstructive sleep apnea syndrome, Platelet lymphocyte ratio, polysomnography DOI: 10.7176/JMPB/54-08 Publication date: April 30th 201

Generation of electrical energy using lead zirconate titanate (PZT-5A) piezoelectric material: Analytical, numerical and experimental verifications

Energy harvesting is the process of attaining energy from the external sources and transforming it into usable electrical energy. An analytical model of piezoelectric energy harvester has been developed to determine the output voltage across an electrical circuit when it is forced to undergo a base excitation. This model gives an easy approach to design and investigate the behavior of piezoelectric material. Numerical simulations have been carried out to determine the effect of frequency and loading on a Lead zirconate titanate (PZT-5A) piezoelectric material. It has been observed that the output voltage from the harvester increases when loading increases whereas its resonance frequency decreases. The analytical results were found to be in good agreement with the experimental and numerical simulation results

Impact of Project Leadership on Project Success: Mediated by Project Governance and Moderated by Goal Clarity

This study investigates the connections between project leadership, governance, goal clarity, and project success in Pakistan's Civil Engineering (Private) sector. Data was collected from employees using a quantitative approach. A questionnaire was distributed to gather information on project governance, goal clarity, and project success. The results showed a strong relationship between project leadership and project success, with a robust governance framework impacting project leadership effectiveness. Goal clarity moderated the relationship, emphasising the importance of well-defined objectives. The study emphasises the critical role of project leadership in Pakistan's civil engineering sector, emphasising the importance of solid project management frameworks and clear objectives. This information is crucial for organisations and project managers seeking to improve project performance in the dynamic environment of Pakistani civil engineering projects

Recombinant deoxyribonucleoside kinase from Drosophila melanogaster can improve gemcitabine based combined gene/chemotherapy for targeting cancer cells

A recombinant deoxyribonucleoside kinase from Drosophila melanogaster with a deletion of the last 20 amino acid residues (named DmdNKΔC20) was hypothesized as a potential therapeutic tool for gene therapy due to its broad substrate specificity and better catalytic efficiency towards nucleosides and nucleoside analogs. This study was designed to evaluate the effect of DmdNKΔC20 for sensitizing human cancer cell lines towards gemcitabine and to further investigate its role in reversal of acquired drug resistance in gemcitabine-resistant cancer cell line. The DmdNKΔC20 gene was delivered to three different cancer cell lines, including breast, colon and liver cancer cells, using lipid-mediated transfection reagent. After transfection, gene expression of DmdNKΔC20 was confirmed by reverse transcription quantitative PCR (qRT-PCR) and the combined effect of DmdNKΔC20 and gemcitabine based cytotoxicity was observed by cell viability assay. We further evolved a gemcitabine-resistant breast cancer cell line (named MCF7-R) through directed evolution in the laboratory, which showed 375-fold more resistance compared to parental MCF7 cells. Upon transfection with DmdNKΔC20 gene, MCF7-R cells showed 83-fold higher sensitivity to gemcitabine compared to the control group of MCF7-R cells. Moreover, we observed 79% higher expression of p21 protein in transfected MCF7-R cells, which may indicate induction of apoptosis. Our findings highlight the importance and therapeutic potential of DmdNKΔC20 in combined gene/chemotherapy approach to target a wide range of cancers, particularly gemcitabine-resistant cancers

Knowledge, Attitude and Practices about Blood Donation among Undergraduate Medical Students in Karachi

Background: Blood donation is a major concern to the society as donated blood is lifesaving for individuals who need it. In Pakistan, the concept of voluntary blood donors is almost non-existent due to the absence of blood donor motivation and retention strategies. The healthy, active and receptive huge student population can be potential blood donor to meet the safe blood requirements. The objective of this study was to determine the knowledge, attitude and practices about blood donation among undergraduate medical students in Karachi. Methods: A cross sectional study was conducted in two public and one private medical college in Karachi from January to March 2012. A total of 600 medical students were interviewed with the help of structured questionnaire. Data analysis was performed in SPSS version 19. Multiple regressions were used to examine the effect of different independent variables on a single dependent variable to test the statistical significance at 95% confidence level. Results: The majority of participants (92%) had appropriate knowledge regarding the various aspects of blood donation. Attitude domain showed that around 42% of students were positive about blood donation. Around 50% of students showed willingness to donate blood. After adjusting for potential confounders, male gender was associated with appropriate knowledge, positive attitude and willingness for blood donation when compared against female gender. Conclusion: Good knowledge about blood donation practices is not transforming in donating blood. Interactive awareness sessions on blood donation should be organized during undergraduate years and opportunities for blood donation should be created for the students, which can greatly enhance the movement for voluntary non-remunerated blood donation-, to ensure good quality of blood and safe modern medical care.sch_pod2pub3848pub

Thermal-aware resource allocation in earliest deadline first using fluid scheduling

Thermal issues in microprocessors have become a major design constraint because of their adverse effects on the reliability, performance and cost of the system. This article proposes an improvement in earliest deadline first, a uni-processor scheduling algorithm, without compromising its optimality in order to reduce the thermal peaks and variations. This is done by introducing a factor of fairness to earliest deadline first algorithm, which introduces idle intervals during execution and allows uniform distribution of workload over the time. The technique notably lowers the number of context switches when compare with the previous thermal-aware scheduling algorithm based on the same amount of fairness. Although, the algorithm is proposed for uni-processor environment, it is also applicable to partitioned scheduling in multi-processor environment, which primarily converts the multi-processor scheduling problem to a set of uni-processor scheduling problem and thereafter uses a uni-processor scheduling technique for scheduling. The simulation results show that the proposed approach reduces up to 5% of the temperature peaks and variations in a uni-processor environment while reduces up to 7% and 6% of the temperature spatial gradient and the average temperature in multi-processor environment, respectively

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Green Chemistry - From Potential Boron Cluster Based Cathodes to Clumped Isotopes

Green chemistry encompasses a broad range of topics that enable us to understand and address major environmental issues. This dissertation advances multiple green chemistry topics through three independent projects: 1) Development of boron cluster-based cathode materials for use in developing a new approach to lithium-ion based energy storage. 2) Application of a quantitative probing technique for kinetic isotope effects, using the dual-clumped isotope proxy, to evaluate dissolved inorganic carbon transformation at geological sites being considered for use as CO2 storage sinks. 3) Advancing dual clumped isotopes as a next-generation probing technique to determine if terrestrial cave carbonate samples can be used to study climate through palaeothermometry and study kinetic isotope effects in speleothems. Novel boron-cluster based molecules were synthesized for use as cathodes in lithium-ion batteries. The B12(OC7H6COOH)12 cluster exhibited the greatest potential for use as a cathode material in lithium-ion batteries. This novel molecule served as a scaffold for post-modification to enhance cyclability in the solid state. B12(OC7H6COOLi)12, a derivative of B12(OC7H6COOH)12, was deemed compatible with cell design and reversibly cycled for one redox event at an E1/2 of 3.4 V vs Li/Li+ in an in situ swagelock cell setup. However, this cluster suffered from specific capacity issues associated with only one (out of 2) reversible redox event and a high molecular weight relative to traditional metal oxides used in current generation cells. CaCO3 samples recovered from The Cedars, peridotite-associated springs located in Northern California, were analyzed using the novel dual clumped isotope proxy to evaluate CO2 transformation processes and kinetic isotope effects and biases. Surface floe samples begin to precipitate out of solution within the first hour of CO2 absorption, and the DIC pool requires a residence time of approximately 100 hours to achieve isotopic equilibria. The D47/D48 slope of samples from the Cedars (-2.803�0.500; 1.s.e.) agrees with published values from lab experiments designed to constrain CO2 hydrolysis-related kinetic fractionation (-2.911�0.200). Ancient travertine samples that are close to equilibrium in the D47-D48 space yield an average temperature of 8.3�1.1 �C, suggesting that the conditions during that time were approximately 10�C colder than present day temperature. The consistency of slopes in the multi-isotope space suggests the D47-D48 dual carbonate clumped isotope framework can be applied to study CO2-absorption processes in applied systems including sites of interest for geological sequestration. CaCO3 samples from terrestrial cave sites at 13 localities from around the world were analyzed using dual clumped isotope (D47-D48) system. Data showed that 27 samples exhibited isotopic equilibrium with the majority having D47-T predicted temperatures matching measured temperatures. 17 samples exhibited isotopic disequilibria in the D47-D48 space. Of the latter suite of samples, 15 fell within quadrant 3, 1 within quadrant 2, and 1 within quadrant 1 in the DD47-DD48 space. Samples that fell within quadrant 2 exhibited traditional degassing disequilibria consistent with previous speleothem studies. Samples which fell within quadrants 1 and 3 were identified to have oxygen and carbon isotope exchange within the Rayleigh distillation model approach, however the specific type of exchange could only be resolved in the DD47-DD48 space. Samples within quadrant 1 were identified to have oxygen isotope exchange while samples within quadrant 3 had carbon isotope exchange. Cave raft samples collected from Mexico exhibited the largest carbon isotope exchange phenomenon with magnitudes of disequilibria into quadrant 3 correlating to the relative ventilation from caves that they were recovered from. This study suggests the D47-D48 dual carbonate clumped isotope framework can be applied to varying types of cave carbonate samples enabling quick identification of (dis)equilibria for use in paleoclimate reconstruction applications

Performance impact of relay selection in WiMAX IEEE 802.16j multi-hop relay networks

Worldwide Interoperability for Microwave Access network accepts the challenge of last mile wireless access for internet. IEEE 802.16 standard, commercially known as WiMAX provide wireless broadband experience to the end subscribers and challenges many wired solutions like Digital Subscriber Line (DSL) and cable internet. Wireless network has many inherent issues like coverage holes; capacity optimization and mobility are few of them. Adding relays to multi-hop WiMAX IEEE 802.16j network present an effective solution to address them to some extent but this amendment does not elaborate any algorithm regarding the relay selection and narrate no performance guarantees. In this work, we proposed linear model that fairly allocates wireless resources among subscribers in 802.16j network. A relay selection algorithm is also presented to optimally select nodes with higher signal-to-noise ratio as relay station for nodes with lower signal-to-noise ratio objectively maximize overall network capacity. This scheme further extends network coverage area and improves network availability. We also did extensive performance evaluation of the proposed linear model. Results show that optimal relays selection scheme do provide a substantial increase of up to 66% in overall network capacity in the fixed WiMAX network. This improvement is substantial at places where network condition is not optimal. Investigating the problem further leads to the conclusion that the relay selection criterion is the key to achieve maximum network capacity. © 2018 The Science and Information (SAI) Organization Limited