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

Perceived Stress, Life Satisfaction and Self-Esteem among Women Studying in Co-Education and Uni- Gender Institutions

The aim of the current study is to assess the perceived stress, life satisfaction and self-esteem of women studying in co-education and uni-gender institutions. The sample size of the research was 200 women students, in which 100 were from uni-gender institution and 100 were from co-educational institutions. Convenience and purposive sampling strategy was used to collect the data. A Standardized psychological Urdu version of Perceived Stress Scale, Satisfaction with Life Scale and Self- esteem scale was used to collect the responses of the students. SPSS 19th version was used to analyze the results. Findings showed that women studying in uni-gender have more stress as compared to the students of co-education institution but their self-esteem and life satisfaction was not affected. Results indicated that there is a significant difference between perceived stress, life satisfaction and self-esteem among women students. It also revealed that stress and self-esteem would affect life satisfaction of women studying in co-education and uni-gender institutions. The results also showed significant relationships between perceived stress, life satisfaction and self-esteem. The study will be helpful in improving the educational systems, so that women students would get better environment to boost up their confidence and self-concept

Effect of Glycine Betaine as a Growth Promoter and Stress Mitigator in Brassica oleraceavar. Italica

Glycine betaine performs a crucial role as an osmoprotectant and, also acts as a cytoplasmic osmotic solute specifically in the members of family Gramineae and Chenopodiaceae. Brassica oleracea var. Italica due to the presence of glucosinolates and various other chemicals, plays vital roles for humans. GB when applied to broccoli mitigate the stress effects and increase the shoot fresh and dry weight, shoot length, root dry weight, shoot calcium, potassium, nutrient uptake of sodium, calcium, potassium, SOD, peroxidase, and total soluble proteins of broccoli (Brassica oleracea var. Italica). Implementation of GB also enhanced the performance of various parameters such as antioxidant photosynthetic pigments (chlorophyll a, b, a/b, carotenoids, and total chlorophyll), and mineral nutrient use efficiency, nutrient uptake of sodium, calcium and catalase activity

Configuration of Polymorphic Single Crystal Er2Si2O7 and Its Comparison with C-type & D-type Single Crystals

Structure of polymorphic Er2Si2O7 single crystal grain is determined using X-Ray diffrectiometer (Bruker Kappa ApexII). Crystal structure is refined through the use of software Shelxl. Findings declared also three dimensional view of the compound under study. The crystal crystallizes in space group (C2/m) with monoclinic symmetry. Bond length between erbium and oxygen is 2.24(A0), bond length of oxygen and silicon is 1.62(A0). The bond angle between Er-O-Er is 1010, O -Er-O is 85.130 and Er -O

Sonographic Association of Uterine Artery Pulsatility Index with Hypertension During Third Trimester of Pregnancy

Background: Hypertension (HTN) in pregnancy is the second most basic reason for maternal death and cause obstetric complications in 5-10% of all pregnancies. HTN directly affects the blood flow of uterine artery.  Doppler screening test is a valuable method to do safe and non-invasive detection and has high reliability in the detection of uterine artery blood flow characteristics. Objective: The purpose of the present study is to find association between predictive value of uterine artery pulsatility index in normal and hypertensive pregnancy during third trimester. Methods: A descriptive cross-sectional study was conducted with the sample size of 138 patients by selecting the convenient sampling from Ghurki Trust Teaching Hospital, Lahore. The pulsatility index of uterine artery of all the women with normal singleton pregnancy and hypertensive during third trimester of pregnancy were obtained using Doppler ultrasound. Data was analyzed with the help of Anova .The results were derived by mean, frequency and standard deviation . Results: The significance between groups was 0.002. The mean values of right and left uterine artery pulsatility index of 36 hypertensive patients were 1.40 and 1.41 and standard deviation 0.4 and 0.5 respectively whereas the mean values of right and left uterine artery pulsatility index of 102 normal patients were 0.739 and 0.77 and standard deviation 0.23 and 0.5 respectively Conclusion: Our study concluded that there was an association between uterine atery pulsatility index and hypertension during pregnancy. The uterine artery pulsatiltiy index has increased with hypertension in third trimester of pregnancy. Keywords: Hypertension, Pulsatility Index, Doppler Ultrasound DOI: 10.7176/JHMN/72-07 Publication date:March 31st 202

The cross-sectional study of anxiety levels and ratio of severity of thirteen symptoms of anxiety among medical students

Background: Anxiety is defined as physical, behavioral, social and psychological response to treat self-concept characterized by subjective, consciously perceived feelings of tension. Nowadays anxiety is most commonly found among medical students. This study was conducted to find out the anxiety levels and ratio of severity of thirteen symptoms of anxiety.Methods: A questionnaire based study was conducted among 178 medical students which tests the level of anxiety and severity of symptoms of anxiety. The questionnaire used was hamilton anxiety rating scale (HAM-A).Results: Out of 178 students, 80 (44.94%) students scored mild anxiety levels, 63 (35.39%) students scored moderate anxiety levels and 35 (19.66%) students scored severe anxiety levels.Conclusions: Mild form of anxiety is much more common among medical students and majority of these medical students are females. Moreover, the symptoms of anxiety including tension, anxious mood, depressed mood, insomnia, fear and CVS symptoms appear with moderate severity in majority of medical students while on the other hand some symptoms including general somatic muscular and sensory symptoms, difficulties in concentration and memory, genitor-urinary symptoms, respiratory symptoms, GIT symptoms and other autonomic symptoms appear with least severity among majority of medical students

Surface Science of Graphene-Based Monoliths and Their Electrical, Mechanical, and Energy Applications

Ceramic monoliths are applied in many insulating and high resistive engineering applications, but the energy application of ceramics monoliths is still vacant due to less conductivity of monolithic ceramics (for example, in silica- and alumina-based hybrids). This book chapter is a significant contribution in the graphene industry as it explains some novel and modified fabrication techniques for ceramics-graphene hybrids. The improved physical properties may be used to set ceramics-graphene hybrids as a standard for electrical, mechanical, thermal, and energy applications. Further, silica-rGO hybrids may be used as dielectric materials for high-temperature applications due to improved dielectric properties. The fabricated nano-assembly is important for a technological point of view, which may be further applied as electrolytes, catalysts, and conductive, electrochemically active, and dielectric materials for the high-temperature applications. In the end, this chapter discussed porous carbon as a massive source of electrochemical energy for supercapacitors and lithium-ion batteries. Carbon materials which are future of energy storage devices because of their ability to store energy in great capacity, so sustainability through smart materials got a huge potential, so hereby keeping in view all the technological aspects, this chapters sums up important contribution of graphene and porous carbon for applied applications

Advanced Carbon Functional Materials for Superior Energy Storage

In the developing world, energy crisis is the main reason for less progress and development. Renewable and sustainable energy may be of bright future for scientific lagging and low-income countries; further, sustainability through smart materials got a huge potential; so, hereby keeping in view the energy crisis which the developing world is facing for many decades, we are proposing to write a chapter project for obtaining energy through cheap, sustainable, and functional advanced carbon materials. Carbon materials are the future of energy storage devices because of their ability to store energy in great capacity. The graphene is a material with amazing properties like no band gap, which turns graphene a wonderful candidate for use in the photovoltaic. Shortly, this chapter will discuss how superior energy storage may be obtained through various routes like using pyrrolic (N5) and pyridinic (N6) doping in advanced carbon functional materials, or superior energy by KOH activation in carbon materials, or through carbonization in organic matter, respectively. Further, for the advanced carbon functional materials, the superior energy storage using pyrrolic (N5) and pyridinic (N6) doping, or KOH activation, or through carbonization will be discussed one by one for lithium ion batteries, supercapacitors, and relevant energy devices, respectively