Extreme hypernatremia as a probable cause of fatal arrhythmia: a case report

BACKGROUND: Hypernatremia is a frequent occurrence among hospitalized patients. Severe hypernatremia is associated with mortality rates of over 60 %. Extreme hypernatremia, defined as sodium levels >190 mmol/l, is a rare occurrence. The literature on electrocardiographic changes occurring with this degree of hypernatremia is extremely scarce. We report the case of an 11-year-old Sri Lankan girl who presented with sodium levels of 226 mmol/l following infusion with 3 % hypertonic saline who developed diffuse QT prolongation leading to fatal ventricular tachycardia. CASE PRESENTATION: An 11-year-old Sri Lankan girl presented with fever, headache, vomiting, and altered level of consciousness. Following admission she developed generalized tonic–clonic seizures and was intubated and ventilated. She had a recent history of polyuria and polydipsia. Magnetic resonance imaging of her brain revealed hydrocephalus due to possible craniopharyngioma. A ventriculoperitoneal shunt was inserted and she was infused with 3 % hypertonic saline in an attempt to reduce intracranial pressure. The following day she became polyuric and dehydrated with tachycardia and low blood pressure. Biochemistry revealed serum sodium of 226 mmol/l, measured serum osmolality of 470 mOsm/kg, urine osmolality of 280 mOsm/kg, urine spot sodium of 116 mmol/l, blood urea of 8.1 mmol/l, and blood glucose of 8.5 mmol/l. Her serum potassium, calcium, and magnesium levels were normal. Extreme hypernatremia due to infusion of 3 % hypertonic saline in the background of cranial diabetes insipidus was considered. She was managed aggressively with 5 % dextrose infusion and clear water via nasogastric feeding to correct the fluid deficit of 7 liters over 36 hours. Her sodium levels dropped to 160 mmol/l the following day. However, she developed electrocardiographic changes with widespread gross QT prolongation with ST segment deviations followed by fatal ventricular tachycardia. CONCLUSIONS: Extreme hypernatremia is rare, and the literature on electrocardiographic changes occurring at such high levels of sodium is scarce. At present there are no established guidelines on rate and mode of correction of such high sodium levels. This case highlights the electrocardiographic changes observed during extreme hypernatremia, controversies in managing increased intracranial pressure with hypertonic saline, and dilemmas encountered in managing extreme hypernatremia

Challenges in Tea Plantation-Based Small Community Water Safety Plan Implementation – A Sri Lankan Experience

This paper presents the challenges and scientific approach adopted to overcome those challenges for Rural WSP (RWSP) implementation for the water supply schemes (WSS) in the Sri Lankan Tea Plantation sector. Factors positively and negatively impacting WSP implementation were identified through a SWOT analysis. Pooled response of the Likert scale survey of WSP team members to evaluate the impact of each contributing factor. A Spearman correlation was conducted to evaluate the correlations. Survey results confirmed that top management engagement, availability of financial resources, organizational structure, clustered community, government regulations, quality certifications, and similar cultural practices positively impact the success of WSP implementation. Poor community awareness, learning culture, communication barriers, poor sanitation and hygiene practices, inadequate stakeholder relationships, inadequate resources, skills, and lack of accountability were the factors hindering the WSP implementation. Correlation analysis showed specific relationships namely, lack of accountability with inadequate resources and skills, availability of financial support with inadequate resources and skills, and lack of awareness with a lack of resources and skills. Converting the negative factors to positive ones will make the WSP application successful in another similar plantation-based WSS. The major lesson from this intrinsic research study is that socioeconomic and cultural factors in the tea plantation are equally important as the typical technical aspects of the WSP

Kinetic Analysis of Metal Assisted-Thiolate Disulfide Exchange (M=Au, Zn)

Thiol disulfide exchange is of fundamental importance in biochemistry, including protein folding, cellular redox balance, enzyme regulation, and oxidative cell-signaling pathways. The thiophilic metals, zinc(II) and gold(I), have the potential to alter thiolate disulfide exchange. Zinc(II) is a biologically important metal ion, while the isoelectronic ion, gold(I), has been used to treat rheumatoid arthritis. NMR spectroscopic techniques are used to study the kinetics and mechanism of gold(I) and zinc(II) thiolate disulfide exchange: LMSR + R\u27SSR\u27 → LMSR\u27 + RSSR\u27 (where LM = Ph3PAu and Tp*Zn; R = p-CH3C6H4; R\u27 = p-ClC6H4 and p-O2NC6H4). The method of initial rates establishes an overall second order rate law; first order in metal thiolate and disulfide. Kinetics data in six solvents, DMSO-(d6, DMF-d7, CD3CN, CD3COCD3, CD2Cl2 and THF-d8 are analyzed using an integrated form of a second order rate law. The disulfide with the more electron withdrawing group, (O2NC6H4S)2, reacts faster than (ClC6H4S)2 in all solvents. For example, the rate constants for the reaction of Ph3PAuSR and (O2NC6H4S)2 vary from 9.61 xl0-4 M-1s-1 in THF-d8 to 3.36 M-1s-1 in DMSO-d6. For gold(I) and zinc(II), exchange rates are faster in high dielectric solvents KINETIC ANALYSIS OF METAL ASSISTED-THIOLATE DISULFIDE compared to low. This trend is opposite to that of thiolate disulfide exchange in the absence of metals. Zinc(II) thiolate disulfide exchange is approximately three times faster than gold(I). 2D (1H-1H) ROESY and NOESY NMR experiments provide evidence of close association between metal thiolate [gold(I) and zinc(II)] and disulfide. The association complex intermediate is stabilized in higher dielectric solvents. Two different side reactions were investigated in DMSO solution. GC-MS and UV-vis spectrophotometry were used to measure the amount of an impurity, dimethylsulfide, present in all samples of DMSO tested, at ca. 0.5 mM concentrations. The reaction of DMS with (O2NC6H4S)2 is explained and accounted for in the kinetic analysis. Another side reaction involved formation of Ph3PO, which depends on the reactants, the substituent group of the disulfide, and the water content of the solvents. The experimental results establish that formation of Ph3PO is slower than gold thiolate disulfide exchange and is negligible during the time frame of the kinetic experiments

Upgrading of Pannipitiya-Ratmalana 132kv transmission line to improve the current carrying capacity

A Dissertation submitted to the Department of Electrical Engineering for the MSchere is a constant increase in demand for electric energy both in industrial and domestic ectors. Meeting this demand encounters problems associated with construction of new :ansmission lines not only in urban areas but also in rural areas. In addition to the viroomental clearance, obtaining of right of way for the power lines is becoming more and lore difficult. It is therefore much advantageous if the power transmission capacity can be a creased in the existing transmission lines.// lit aim of this thesis is to examine the possibilities of using the new types of conductors ritb higher current carrying capacity in existing transmission lines with capacity restrictions. Tie replacement of conductors shall improve the line capacity while satisfying the other orditions such as ground clearance, transmission loss etc. Power interruptions necessary for he replacement work must be kept as low as possible and in order to achieve this, ncdifications required for the existing structures shall be minimized. The analysis is done for 'annipiti^a - Ratmalana 132kV transmission line which is critical in transmission network.// limits of the operation of the new conductor selected for the purpose are demarcated onsidering the design parameters of the existing line. Also the other components and tiuctures of the line are checked for their sustain ability for new loads due to the Gap type onductor and necessary modifications are identified for successful enhancement of the ansmission capacity.// By re-conductoring and improving the current carrying capacity of transmission line it :rovides significant cost savings both in keeping transmission costs down, and differing or :ven eliminating the need for new transmission line

Integrating Circular Economy Principles in Modular Construction to Enhance Sustainability

Modular construction (MC) has gained attention due to its potential for fast construction, reduced construction waste, and lower environmental impact while having several other issues on stimulating sustainability. The circular economy (CE) focuses on better resource management through a closed-loop system. Even though MC enhances sustainable practice, several pitfalls barricade sustainability in MC (high initial investment, design consideration, and technology challenges). Nevertheless, the synergy between CE and MC has not been investigated in past studies to address the issues in MC to achieve sustainability. This study investigates the integration of CE principles in MC to enhance sustainability. This study used a qualitative approach via the Delphi technique by conducting three semi-structured expert interview rounds with the use of a purposive sampling method. The collected data were analysed using manual content analysis. This study identified nine notable issues in MC to achieve sustainability, and all CE 9-R (rethink, refuse, reduce, reuse, repair, refurbish, remanufacture, recycle, and recover) principles could address those identified issues. Accordingly, thirty implementation strategies were recognised to fill the gap between the problems in MC and the potential of CE principles to solve the issues. The results provide insights for construction practitioners, policymakers, and researchers on integrating CE principles into MC processes to achieve sustainability goals. Ultimately, this study highlights the significance of a holistic approach by theoretically combining MC and CE principles as a benchmark for future studies. As a contribution, CE strives to make the planet a safe place to live by combatting resource depletion

An exploratory study of human resource aspects of international technology transfers to Sri Lankan private sector manufacturing firms

PurposeThe purpose of this paper is to explore project‐level human resource aspects of international technology transfers (ITTs) to private sector manufacturing firms in Sri Lanka.Design/methodology/approachData were collected from 35 ITT projects. A self‐administered survey questionnaire was chosen as the main mode for data collection. In addition to descriptive statistics, exploratory factor analysis and multiple regression were used to analyse data.FindingsFirms have acquired product, process and management‐system technologies from countries having different institutional environments, namely, the USA, Europe, China, Japan and India. It was found that the country from which technology was sourced and the type of technology predict several project‐level human resource aspects explored in this paper.Originality/valueThe acquisition of human resource capabilities provides the central underpinning in ITTs. There is a marked absence of research‐led literature on technology transfers at the project‐level that resulted in less developed countries in Asia.</jats:sec

An exploratory study of human resource aspects of international technology transfers to Sri Lankan private sector manufacturing firms

Purpose – The purpose of this paper is to explore project-level human resource aspects of international technology transfers (ITTs) to private sector manufacturing firms in Sri Lanka. Design/methodology/approach – Data were collected from 35 ITT projects. A self-administered survey questionnaire was chosen as the main mode for data collection. In addition to descriptive statistics, exploratory factor analysis and multiple regression were used to analyse data. Findings – Firms have acquired product, process and management-system technologies from countries having different institutional environments, namely, the USA, Europe, China, Japan and India. It was found that the country from which technology was sourced and the type of technology predict several project-level human resource aspects explored in this paper. Originality/value – The acquisition of human resource capabilities provides the central underpinning in ITTs. There is a marked absence of research-led literature on technology transfers at the project-level that resulted in less developed countries in Asia