Assessment of human cytomegalovirus co-infection in Egyptian chronic HCV patients

Human cytomegalovirus (HCMV) is the most common cause of severe morbidity and mortality in immune- compromised individuals. This study was conducted to determine the incidence of HCMV infection in HCV patients who either spontaneously cleared the virus or progressed to chronic HCV infection. The study included a total of eighty four cases (48 females and 36 males) that were referred to blood banks for blood donation with an age range of 18-64 years (mean age 37.62 ± 10.03 years). Hepatitis C virus RNA and HCMV DNA were detected in sera by RT-nested PCR and nested PCR respectively in all subjects. Immunoglobulin G levels for HCV and HCMV were determined. Besides, IgM antibodies for HCMV infection were also determined in subjects' sera. Fifty three out of 84 cases (63%) were positive for HCV-RNA while 31 (37%) cases had negative HCV RNA. Forty six (87%) and 13 (25%) cases out of 53 HCV RNA positive patients were positive for HCMV IgG and IgM antibodies respectively. While 20 of 53 cases (38%) had detectable HCMV DNA. To examine the role of HCMV infection in HCV spontaneous resolution, two groups of HCV patients, group 1) chronic HCV infection (positive HCV RNA and positive IgG antibodies) vs group 2) spontaneous resolution (negative HCV RNA and positive IgG antibodies) were compared. The percentages of positive CMV IgG and IgM results is higher in chronic HCV patient than those in spontaneously cleared HCV patients and the difference is highly statistically significant (P value < 0.001). Also, there is a general trend towards elevated levels of CMV IgG antibodies in HCV chronic patients than those in spontaneously cleared HCV patients (P value < 0.02). HCMV DNA detection in group 1 was more than twice the value observed in group 2 (38% vs 14.3%, P value < 0.001). Moreover, levels of liver enzymes were significantly higher in HCV RNA positive cases co-infected with HCMV DNA than HCMV negative cases (P value < 0.001). The results indicate the role of HCMV in the liver pathogenesis. We conclude that chronic HCV patients co-infected with HCMV infection can be regarded as high risk groups for liver disease progression where they should be monitored for the long term outcome of the disease

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Experimental Mixed-Gas Permeability, Sorption and Diffusion of CO2-CH4 Mixtures in 6FDA-mPDA Polyimide Membrane: Unveiling the Effect of Competitive Sorption on Permeability Selectivity

The nonideal behavior of polymeric membranes during separation of gas mixtures can be quantified via the solution-diffusion theory from experimental mixed-gas solubility and permeability coefficients. In this study, CO2-CH4 mixtures were sorbed at 35 &deg;C in 4,4&prime;-(hexafluoroisopropylidene)diphthalic dianhydride (6FDA)-m-phenylenediamine (mPDA)&mdash;a polyimide of remarkable performance. The existence of a linear trend for all data of mixed-gas CO2 versus CH4 solubility coefficients&mdash;regardless of mixture concentration&mdash;was observed for 6FDA-mPDA and other polymeric films; the slope of this trend was identified as the ratio of gas solubilities at infinite dilution. The CO2/CH4 mixed-gas solubility selectivity of 6FDA-mPDA and previously reported polymers was higher than the equimolar pure-gas value and increased with pressure from the infinite dilution value. The analysis of CO2-CH4 mixed-gas concentration-averaged effective diffusion coefficients of equimolar feeds showed that CO2 diffusivity was not affected by CH4. Our data indicate that the decrease of CO2/CH4 mixed-gas diffusion, and permeability selectivity from the pure-gas values, resulted from an increase in the methane diffusion coefficient in mixtures. This effect was the result of an alteration of the size sieving properties of 6FDA-mPDA as a consequence of CO2 presence in the 6FDA-mPDA film matrix

Synthesis and Gas-Permeation Characterization of a Novel High-Surface Area Polyamide Derived from 1,3,6,8-Tetramethyl-2,7-diaminotriptycene: Towards Polyamides of Intrinsic Microporosity (PIM-PAs)

A triptycene-based diamine, 1,3,6,8-tetramethyl-2,7-diamino-triptycene (TMDAT), was used for the synthesis of a novel solution-processable polyamide obtained via polycondensation reaction with 4,4&#8242;-(hexafluoroisopropylidene)bis(benzoic acid) (6FBBA). Molecular simulations confirmed that the tetrasubstitution with ortho-methyl groups in the triptycene building block reduced rotations around the C&#8315;N bond of the amide group leading to enhanced fractional free volume. Based on N2 sorption at 77 K, 6FBBA-TMDAT revealed microporosity with a Brunauer&#8315;Emmett&#8315;Teller (BET) surface area of 396 m2 g&#8722;1; to date, this is the highest value reported for a linear polyamide. The aged 6FBBA-TMDAT sample showed moderate pure-gas permeabilities (e.g., 198 barrer for H2, ~109 for CO2, and ~25 for O2) and permselectivities (e.g., &#945;H2/CH4 of ~50) that position this polyamide close to the 2008 H2/CH4 and H2/N2 upper bounds. CO2&#8315;CH4 mixed-gas permeability experiments at 35 &#176;C demonstrated poor plasticization resistance; mixed-gas permselectivity negatively deviated from the pure-gas values likely, due to the enhancement of CH4 diffusion induced by mixing effects

Polymers of intrinsic microporosity derived from bis(phenazyl) monomers

Novel polymers of intrinsic microporosity (PIMs) are prepared from bis(phenazyl) monomers derived from readily available bis(catechol)s. One of the polymers (termed PIM-7) has an excellent combination of properties with high internal surface area, good film-forming characteristics, and gas transport properties that make it a suitable candidate for gas separation membranes. The high gas permeability and good ideal selectivity of PIM-7 place it above Robeson's upper-bound for a number of commercially important gas pairs (e.g., O2/N2, CO2/CH4, and CO2/N2)

Synthesis of Highly Gas-Permeable Polyimides of Intrinsic Microporosity Derived from 1,3,6,8-Tetramethyl-2,7-diaminotriptycene

A simple synthetic route to a novel sterically hindered triptycene-based diamine, 1,3,6,8-tetramethyl-2,7-diaminotriptycene (TMDAT), and its use in the preparation of high molecular weight polyimides of intrinsic microporosity (PIM-PIs) are reported. The organosoluble TMDAT-derived polyimides displayed high Brunauer–Emmett–Teller surface areas ranging between 610 and 850 m2 g–1 and demonstrated excellent thermal stability of up to 510 °C. Introduction of the rigid three-dimensional paddlewheel triptycene framework and the tetramethyl-induced restriction of the imide bond rotation resulted in highly permeable polyimides with moderate gas-pair selectivity. The best performing polyimide made from TMDAT and a triptycene-based dianhydride showed gas transport properties located between the 2008 and 2015 polymer permeability/selectivity trade-off curves with H2 and O2 permeabilities of 2858 and 575 barrer combined with H2/N2 and O2/N2 selectivities of 24 and 4.8, respectively, after 200 days of physical aging

High-performance membranes from polyimides with intrinsic microporosity

Membranes with high permeability to gases are formed from polyimides with rigid backbones that incorporate a spiro-centre (see figure). A route to this new range of high-free-volume polyimides is demonstrated, and exceptional performance is obtained for a polymer containing a dimethyl binaphthyl unit

Solution-Processed, Organophilic Membrane Derived from a Polymer of Intrinsic Microporosity

A polymer with a rigid, randomly contorted molecular structure (see Figure), incorporating fused rings connected by spiro-centres, may be precipitated or cast from solution to give microporous powders and membranes stable up to temperatures of 350 °C, with apparent surface areas > 600 m2 g–1. Organophilic membranes may be formed, as demonstrated by the separation of phenol from water by pervaporation