Diagnostic challenges in critical care management of fluid and electrolyte disturbances in a poor-resource setting: a survey of critical care doctors

Background: To determine the challenges in diagnostic support for adequate fluid and electrolyte (F/E) management in a poor-resource critical care setting.Methods: This cross-sectional survey was conducted between March and May 2017 in one hundred and four (104) doctors practicing in four tertiary hospitals in North-central Nigeria. These doctors were currently working in Accidents and Emergency Units (A/E), Intensive care Units (ICU) and Children Emergency Units and have worked for at least two months prior to the study. They were given a structured questionnaire to fill and return. The questionnaire among other things, addressed laboratory-related factors that affect management of F/E disturbances.Results: Unavailability of some laboratory tests, inaccuracy of laboratory results, incomplete test results and delay in obtaining results, hampered F/E management in critical care according to more than 75% of the surveyed doctors. About sixty percent of the doctors reported a turnaround time (TAT) of ≥3 hours for electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases). Also ≤25% of doctors responded that electrolytes and most emergency biochemical tests (except urine dipstick and Blood gases) were offered in the ICU/Emergency unit laboratories. Ten percent or less of doctors reported that electrolytes and the emergency biochemical test were available by Point of care testing (POCT).Conclusions: There is an urgent need for the managers of healthcare in LMICs to establish functional laboratories in ICUs, explore the use of POCT and build capacity for diagnostic critical care

Cucumeropsis mannii seed oil ameliorates Bisphenol‐A‐induced adipokines dysfunctions and dyslipidemia

From Wiley via Jisc Publications RouterHistory: received 2022-12-25, rev-recd 2023-01-07, accepted 2023-02-06, pub-electronic 2023-02-18Article version: VoRPublication status: PublishedThis study demonstrated the therapeutic potentials of Cucumeropsis mannii seed oil (CMSO) capable of alleviating BPA‐induced dyslipidemia and adipokine dysfunction. In this study, we evaluated the effects of CMSO on adipokine dysfunctions and dyslipidemia in bisphenol‐A (BPA)‐induced male Wistar rats. Six‐week‐old 36 albino rats of 100–200 g weight were assigned randomly to six groups, which received varied doses of BPA and/or CMSO. The administration of BPA and CMSO was done at the same time for 42 days by oral intubation. The adipokine levels and lipid profile were measured in adipose tissue and plasma using standard methods. BPA induced significant (p < .05) increases in triglycerides, cholesterol, leptin, LDL‐C, and atherogenic and coronary risk indices in adipose tissue and plasma, as well as a decrease in adiponectin and HDL‐C levels in Group II animals. BPA administration significantly (p < .05) elevated Leptin levels and reduced adiponectin levels. BPA plus CMSO reduced triglycerides, cholesterol, leptin, LDL‐C, and atherogenic and coronary risk indices while increasing adiponectin levels and HDL‐C in adipose tissue and plasma (p < .05). The results showed that BPA exposure increased adipose tissue as well as serum levels of the atherogenic index, triglycerides, cholesterol, coronary risk index, LDL‐C, leptin, and body weight with decreased adiponectin levels and HDL‐C. Treatment with CMSO reduced the toxicities caused by BPA in rats by modulating the body weight, adiponectin/leptin levels, and lipid profiles in serum and adipose tissue. This study has shown that CMSO ameliorates BPA‐induced dyslipidemia and adipokine dysfunctions. We suggest for further clinical trial to establish the clinical applications

Effects of trace ions on zanthate adsorption at the galena-sphalerite water inter-face

No Abstract. IJONAS Vol. 3 (2) 2007: pp. 153-15

Thermodynamic analysis of pH controlled embrittlement of mild and galvanized steels

No Abstract. IJONAS Vol. 3 (2) 2007: pp. 203-20

Revision strategy for posterior extrusion of the CHARITE polyethylene core

STUDY DESIGN: This is a case report of a posterior extrusion of the polyethylene core from a CHARITE arthroplasty. This is the first reported case of posterior dislocation of the polyethylene and the revision strategies used to correct this problem. OBJECTIVE: To report a novel failure mechanism and revision strategy for CHARITE total disc arthroplasty (TDA). SUMMARY OF BACKGROUND DATA: Case report at a Level 1 tertiary care referral center in the northeastern United States. METHODS: This is a case report and review of the literature of a patient who sustained posterior dislocation of the polyethylene core from a CHARITE TDA several months after the index procedure. RESULTS: Core dislocation is a known complication of TDA. However, of the known reported dislocations all have been anterior. This case describes the first known occurrence of posterior core dislocation and the revision strategy for this problem. CONCLUSION: This case report highlights the first known case of a posterior dislocation of a CHARITE core. It is likely that altered biomechanical forces generated over time attributed to device failure. An instrumented posterior fusion with removal of the core is what ultimately led to a stable revision construct

Treatment of experimental pancreatic cancer with 213-Bismuth-labeled chimeric antibody to single-strand DNA

Pancreatic cancer (PCa) is one of the deadliest cancers, carrying a very poor prognosis. Pancreatic ductal adenocarcinoma, synonymous to pancreatic cancer, is the 4th leading cause of cancer deaths. The “silent killer” is characterized by its metastatic behavior even before the primary tumor can be detected (1), resulting in a five-year survival rate of only 4%. Gemcitabine and erlotinib, FDA-approved drugs for pancreatic cancer treatment, improve median survival by less than six months in advanced stage patients (2-4), underscoring the need for alternative approaches. Radioimmunotherapy (RIT) relies on antigen-antibody binding to deliver cytotoxic doses of alpha- or beta radiation to tumor cells (5, 6). RIT has been successfully used to treat refractory and recurrent lymphomas, with two radiolabeled monoclonal antibodies (mAb) targeted against CD20 (Zevalin® and Bexxar®) (7). More recently FDA has approved Zevalin as a first-line therapy for newly diagnosed patients with non-Hodgkin’s lymphoma (NHL). The power of RIT in comparison with many other therapeutic modalities is its cytocidal nature, when particulate radiation emanating from the mAbs causes physical destruction of the cell. This is very different from trying to abrogate a single step in a multistep pathway as cancer cells often find alternative ways to thrive. In addition, RIT has an excellent safety record, having many fewer side effects than conventional chemotherapy, and its efficacy is not subject to multidrug resistance mechanisms. The antigens that have been traditionally targeted in PCa are surface proteins such as MUC1 or CEA (carcinoembriogenic antigen) (8, 9) which are also expressed on healthy tissues, thus limiting the dose which can be safely delivered to the tumor. Targeting of intracellular antigens that become available for mAb binding in aggressively growing tumors as a result of fast cellular turnover was first suggested two decades ago as an alternative to targeting surface antigens in RIT (10). The advantage of this approach is that mAbs to intracellular antigens have very low cross-reactivity with irrelevant surface antigens on healthy tissues, allowing high specificity and low toxicity of treatment. It is important to emphasize that when treating cancers by targeting intracellular antigens – only a limited number of cells in the tumor need to be non-viable to allow radiolabeled mAb targeting. Ionizing radiation is emitted in a 360o sphere and as alpha- and beta-particles have a range in tissue which covers at least several cells’ diameters, even distant cancer cells will be killed via the so called “cross-fire” effect (Fig. 1). In this regard a human-mouse chimeric mAb chTNT3 to single-strand DNA (ssDNA) and RNA (11) has been already used in its radiolabeled form in patients with advanced lung cancer with encouraging results (12). We hypothesized that in aggressively growing pancreatic tumors there will be a sufficient number of non-viable cells for the radiolabeled chTNT3 mAb to get access to its antigen and to deliver cytocidal radiation to the rest of the tumor. We also hypothesized that preceding RIT with administration of a chemotherapeutic agent would kill some of tumor cells thus providing more target for the radiolabeled mAb to bind, resulting in a higher radiation dose to the tumor. Here we describe our results on combining RIT with chTNT3 mAb radiolabeled with powerful alpha-emitting radionuclide 213-Bismuth (213Bi) with chemotherapy with gemcitabine or cisplatin for treatment of experimental PCa.JRC.E.5-Nuclear chemistr

Change in Systemic Arterial Pulsatility index (SAPi) during heart failure hospitalization is associated with improved outcomes

Study objective: To identify Change in Systemic Arterial Pulsatitlity index (∆SAPi) as a novel hemodynamic marker associated with outcomes in heart failure (HF). Design: The ESCAPE trial was a randomized controlled trial. Setting: The ESCAPE trial was conducted at 26 sites. Participants: 134 patients were analyzed (mean age 56.8 ± 13.4 years, 29 % female). Interventions: We evaluated the change in SAPi, (systemic pulse pressure/pulmonary artery wedge pressure) obtained at baseline and at the final hemodynamic measurement in the ESCAPE trial. Main outcome measures: Change in SAPi, (∆SAPi), was analyzed for the primary outcomes of death, heart transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and secondary outcome of DTxLVAD using Cox proportional hazards regression. Results: Median change in SAPi was 0.81 (IQR 0.20–1.68). ∆SAPi in uppermost quartile was associated with reductions in DTxLVADHF (HR 0.55 [95 % CI 0.32, 0.93]). ∆SAPi in the uppermost and lowermost quartiles combined was similarly associated with significant reductions in DTxLVADHF (HR 0.62 [95 % CI 0.41, 0.94]). ∆SAPi higher than 1.17 was associated with improved DTxLVADHF. ∆SAPi was also associated with troponin levels at discharge (regression coefficient p = 0.001) and trended with 6-minute walk at discharge (Spearman correlation r = 0.179, p = 0.058). Conclusion: ∆SAPi was strongly associated with improved HF clinical profile and adverse outcomes. These findings support further exploration of ∆ SAPi in the risk stratification of HF

Treatment of experimental pancreatic cancer with 213-Bismuth-labeled chimeric antibody to single-strand DNA in combination with cisplatin and gemcitabine

Pancreatic cancer (PCa), the 4th leading cause of cancer deaths, has a notoriously poor prognosis with the 5-year survival rate of only 4%. Novel approaches to its treatment are urgently needed. A chimeric monoclonal antibody (mAb) chTNT3 binds to single-strand DNA (ssDNA) and RNA released from the non-viable cells in fast growing tumors and already showed promise in treatment of lung and brain cancers. Methods: We investigated whether the combination of radioimmunotherapy (RIT), using chTNT3 mAb radiolabeled with the powerful alpha-emitter 213-Bismuth (213Bi), with gemcitabine or cisplatin will provide a viable treatment for experimental PCa. The pancreatic xenografts in nude mice were established using human MiaPaCa-2 cells. Results: Pre-treatment of MiaPaCa-2 cells and tumors with chemotherapy resulted in considerable killing of tumor cells and subsequent release of ssDNA (LDH and crystal violet assays). However, chemotherapy also damaged the blood vessels in the tumors preventing the increase in uptake of radiolabeled chTNT3 mAb as per biodistribution and microSPECT/CT. Therapy experiments compared 213Bi-chTNT3 alone (700 Ci), combination of 700 Ci 213Bi-chTNT3 with 3 days pretreatment with gemcitabine or cisplatin, untreated controls, “cold” chTNT3 and chemotherapeutic agents alone. Sixty five days observation period demonstrated that RIT abrogated the growth of MiaPaCa-2 tumors, while tumors grew aggressively in control groups. Chemotherapy was significantly less effective than RIT in slowing down tumor growth and was very toxic while RIT was not. Discussion: We demonstrated that RIT with 213Bi-labeled antibody to ssDNA was safe and effective in treatment of experimental PCa in comparison with two chemotherapeutic drugs. This makes alpha-RIT targeting ssDNA a promising modality for translation into the clinic.JRC.E.5-Nuclear chemistr

Cucumeropsis mannii seed oil protects against Bisphenol A‐induced testicular mitochondrial damages

Abstract There has been increasing search for the ameliorative properties of seed oils against toxicants. bisphenol A acts as an estrogenic endocrine‐disrupting chemical capable of causing male infertility. This study aimed to explore Cucumeropsis mannii seed oil effects against mitochondrial damage in rats using bisphenol A. Forty‐eight rats were randomly assigned to six groups (n = 6) of eight rats each and fed the same food and water for 6 weeks. The group A rats were given 1 mL olive oil, while the ones in group B were given bisphenol A at 100 mL/kg body weight via oral route. Group C received C. mannii seed oil 7.5 mL/kg body weight C. mannii seed oil, while group D, group E, and group F were pre‐administered bisphenol A at 100 mL/kg body weight, followed by treatment with C. mannii seed oil at 7.5, 5, and 2.5 mL/kg body weight, respectively. Antioxidant enzymes, glutathione, reactive oxygen species, testicular volume, malondialdehyde, body weight, and testicular studies were done using standard methods. The results of the bisphenol A‐administered group showed a significant decrease in the antioxidant enzymes, glutathione, body weight, and testicular volume with elevation in the levels of reactive oxygen species, malondialdehyde, and testicular indices. BPA + CMSO‐treated group showed a significant increase in GPx activity compared with BPA‐exposed rats. CMSO treatment significantly increased catalase activity in comparison with that of rats exposed to BPA. Remarkably, C. mannii seed oil and bisphenol A co‐administration significantly reversed the abnormalities observed in the dysregulated biochemical biomarkers. Our findings suggest that C. mannii seed oil has considerable antioxidant potential which can be explored in therapeutic development against systemic toxicity induced by exposure to bisphenol A. Cucumeropsis mannii seed oil protects against bisphenol A‐induced testicular mitochondria damages

<i>Cucumeropsis mannii</i> seed oil ameliorates Bisphenol‐A‐induced adipokines dysfunctions and dyslipidemia

From Crossref journal articles via Jisc Publications RouterHistory: epub 2023-02-18, issued 2023-02-18Article version: VoRPublication status: Publishe