Haemodynamic Monitoring in the Intensive Care Unit

Monitoring is a cognitive aid that allows clinicians to detect the nature and extent of pathology and helps assessment of response to therapy. The cardiovascular system is the most commonly monitored organ system in the critical care setting. It helps identify the presence and nature of shock and guides response to resuscitation by detection of cardiac rate and rhythm, evaluation of volume state, cardiac contractility and systemic vascular resistance. Newer technologies allow greater assessment of oxygen delivery to vulnerable tissues. We discuss the nature, history, modalities and interpretation of the most commonly available haemodynamic monitoring methods in clinical use currently

Herbs Having Analgesic Activity

Healthcare maintains a high priority on pain management, and research to develop safer and more potent analgesics is ongoing. Natural goods, especially plants, have recently attracted renewed interest as potential sources of analgesic medications. In this study, various techniques are used to measure pain. The rich source of analgesics found in medicinal plants includes Moringa oleifera, Aloe barbadensis, Curcuma longa, Eugenia caryophyllata, Adhatoda vasica, Mentha piperita, Ocimum sanctum, Zingiber officinale, Lavandula angustifolia, Epilobium angustifolium, Dialium guineense, Sida acuta, Stylosanthes fruticose, Bougainvilla spectabilis, Ficus glomerata, Polyalithia longifolia, Calotropis gigantea, Tinospora cordifolia, Ageratina glabrata, Mangifera indica, Peperomia pellucida, Jatropha gossypifolia, Leonotis leonurus, Mimosa rubicaulis, Cussonia paniculate, Biebersteinia multifida, Alternanthera sessislis, Mentha arvensis, Oroxylum indicum, Tamarindus indica, Cucurbita maxima, Cucumis sativus, Emblica officinalis, Angiopteris evecta, Parastrephia lephidophylla, Peperomia pellucida, Scoparia dulcis, Ficus racemose, Eremostachys laciniata, Phlogacanthus thyrsiflorus, Kigelia pinnata, Molineria capitulate, Manihot esculenta, Ficus religiosa, Dalbergia sissoo, Grangea maderaspatana, Nothospondias staudtii, Rhodiola rosea, Juniperus communis, Erythrina variegate etc. The results reported in this review paper represent scientific knowledge that may be applied in the future to isolate potentially active molecules from some of these medicinal plants

Cerebritis: An unusual complication of Klebsiella pneumoniae

Cerebritis is part of a continuum of brain infection and is difficult to diagnose. Cerebritis caused by Klebsiella in immunocompetent adults without predisposing factors such as neurosurgery or penetrating brain injury has not been reported before. We report a case of Klebsiella cerebritis in an adult patient with a proven extracranial focus of infection. We suggest considering cerebritis as a differential diagnosis for altered level of consciousness in patients of severe sepsis, even if an extracranial source of infection is proven

Stone–Wales Decorated Phagraphene: A Potential Candidate for Supercapacitor Electrodes and Thermal Transport

Carbon-based electrical double-layer capacitors or EDLC supercapacitors have recently gained much attention due to their cost-effectiveness, environment friendliness, and stable energy supply. However, the total capacitance of the supercapacitors is limited by the quantum capacitance (QC) of the electrodes. In this work, we have addressed the effect of defect-induced modifications of QC of EDLC supercapacitors by introducing Stone–Wales (SW) defects in pristine phagraphene. The stability of the structure has been confirmed in terms of its dynamical, thermal, and mechanical attributes. A systematic investigation of the electronic and transport properties of SW-decorated phagraphene has been carried out using density functional theory calculations and machine learning approaches. The electronic nature of the structure becomes metallic due to the change in the local symmetry with a modified orbital contribution near the Fermi energy. Besides, a significantly high Debye temperature (2606 K) indicates good thermal transport of the system. The lattice thermal conductivity of the structure was calculated using a machine learning interatomic potential (MLIP) approach. Good thermal conductivity strengthens their potential in next-generation device applications. Interestingly, large specific surface area (SSA), high density of states (DOS) near Fermi energy, and good electrical conductivity of these structures indicate their suitability as supercapacitor electrodes. Considerably high QC and total surface storage charge calculations suggest their applications as anodes in asymmetric supercapacitors. We believe these results will deliver valuable insights into the understanding of carbon-based two-dimensional (2D) metallic structures

Removal of cadmium by in-situ Cu nanoparticle enhanced ceramic-supported-polymeric composite NF membrane

A novel ceramic-polymer composite nanofiltration membrane was fabricated using in-situ generated Cu nanoparticles by dip coating over modified ceramic support tube. The prepared membrane was used for Cd (II) removal from contaminated water. Generation of in-situ Cu NPs on/in the membrane was characterized by SEM and XPS analysis. Incorporation of NPs formed by in-situ chemical reduction technique improved the pore size of modified ceramic substrate towards NF range (similar to 1 nm). The positively charged composite NF membrane exhibited satisfactory performance with respect to pure water permeability (8.09 L m(-2) h(-1) bar(-1)) and Cd(II) rejection of 95.5%. (C) 2021 Elsevier Ltd. All rights reserved

Development of high performance pervaporation desalination membranes: A brief review

Water scarcity rises as the level of water pollution continues to increase with the progress of urbanization, industrialization and exponential growth of population. Therefore, saline water of the sea should also be made suitable rather than river water to meet the huge global demand of clean and safe drinking water. Pervaporation (PV) desalination, among many purification and separation processes, is a promising technology to reduce the crisis of global drinking water supply. From this perspective, the key success of PV desalination relies on its remarkable salt rejection from highly saline water with appropriate flux to obtain fresh water by using a suitable membrane. In this review we aim to provide a comprehensive assessment of PV desalination membrane materials, transport phenomena, the advantages of the process over comparable technologies (e.g., fractional distillation, membrane distillation, reverse osmosis) and the advantages of crosslinking during the preparation of composite membranes. This review further highlights the advantages of inorganic ceramic substrates as a support of composite membranes and the use of hydrophilic polymers as active layer for preparing stable and robust crosslinked PV desalination membranes.(c) 2022 Institution of Chemical Engineers. Published by Elsevier Ltd. All rights reserved

Removal of heavy metals by surface tailored copper ion enhanced ceramic-supported-polymeric composite nanofiltration membrane

Ceramic-supported-polymeric (CSP) composite membranes combine the benefits of robust ceramic support with tunable surface properties of polymeric active layer. The present work reports the fabrication of novel CSP composite nanofiltration membranes wherein surface ionization of the membrane active layers has been carried out by a facile process of chelating copper ions with the crosslinked polyethyleneimine polymer matrix of membrane top layer. Different concentrations of copper chloride solutions were used and their effect on mem-brane surface properties was investigated using EDX, XPS and AFM analyses. Performance of the membranes in removal of both cationic and anionic heavy metals, namely, Ni(II), Cd(II), Pb(II), Zn(II), As(V) and Cr(VI) from aqueous solution was studied. Excellent removal (> 95%) of all the heavy metals and optimum flux was achieved in case of GPCu0.5 membrane (surface modified with 0.5 wt% copper chloride solution). No significant decrease in flux and rejection rate of the membrane during 10 h high pressure (8 bar) operation suggested longevity of the membrane. The slow release of copper ions indicated the much-expected anti-biofouling nature of the mem-brane. Appreciable rejection behavior of the copper ion enhanced CSP composite membrane towards multiple heavy metals demonstrates its potential for practical water treatment application

Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study

BACKGROUND: Some patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide. The clinical implications of this remain unclear. OBJECTIVE: To determine the incidence and duration of delayed ICU discharge, identify the reasons for delay and evaluate the clinical consequences. METHODS: Prospective multi-centre observational study involving five ICUs over a 3-month period. Delay in discharge was defined as >6 hours from the planned discharge time. The primary outcome measure was hospital length stay after ICU discharge decision. Secondary outcome measures included ICU discharge after-hours, incidence of delirium, survival to hospital discharge, discharge destination, the incidence of ICU acquired infections, revocation of ICU discharge decision, unplanned readmissions to ICU within 72 hours, review of patients admitting team after ICU discharge decision. RESULTS: A total of 955 out of 1118 patients discharged were included in analysis. 49.9% of the patients discharge was delayed. The most common reason (74%) for delay in discharge was non-availability of ward bed. The median duration of the delay was 24 hours. On univariable analysis, the duration of hospital stay from the time of ICU discharge decision was significantly higher in patients who had ICU discharge delay (Median days-5 vs 6; p = 0.003). After-hours discharge was higher in patients whose discharge was delayed (34% Vs 10%; p<0.001). There was no statistically significant difference in the other secondary outcomes analysed. Multivariable analysis adjusting for known confounders revealed delayed ICU discharge was independently associated with increased hospital length of stay. CONCLUSION: Half of all ICU patients experienced a delay in ICU discharge. Delayed discharge was associated with increased hospital length of stay