Hyperchloremia in critically Ill patients in ICU: Review Article

Background: Chloride (Cl) is required for the regulation of blood pressure, renal function, gastrointestinal homeostasis and decarboxylation/gas transport. "Dyschloremia" or levels of serum Cl beyond the normal range, is a frequent occurrence in intensive care units and seems to be mostly caused by iatrogenic procedures (i.e. intravenous infusion of fluids rich in Cl). Hypochloremia and hyperchloremia seem to be related to high risk of death in specified intensive care unit (ICU) groups, although the data is inconclusive. Hyperchloremia may be associated with higher hemodynamic unstable changes and need for vasopressors, in addition to hyperchloremic metabolic acidosis (e.g., following major surgeries). Nonetheless, the direct or indirect mediation of these effects is still uncertain. Additionally, new research suggests that individuals with advanced hyperchloremia have a higher risk of acute renal damage and require renal replacement treatment. Objective: The purpose of this study was to describe significant chloride-related outcomes in critical illness and to evaluate their relevance for everyday clinical practice and therapeutic alternatives. Conclusion: One may conclude that the concern about understanding the impact of chloride disorders on negative outcomes is rising; there seems to be a link between chloride disorders and negative outcomes, particularly death, in the ICU setting; one could theorize the need to rationalize the use of solutions with electrolyte components separate from the physiological solutions; and consider the presence or the development of hyperchloremia as a prognostic factor, without taking into consideration the severity of the critical patien

Mechanical ventilation in critically ill patients in ICU: Review article

Background: Mechanically ventilating is frequently performed life-saving procedure in the emergency room (ER). With the duration of stay of ventilated patients in ERs rising, it is critical for emergency physicians to have a firm grasp on procedures for optimizing mechanical ventilation and minimizing consequences. Numerous positively pressured ventilation techniques are available; they are derived from different permutations of triggered volume- and pressure-cycled ventilations and supply ventilation at a variety of rates, pressures and volumes. Inadequate ventilatory treatment may result in significant respiratory and extrapulmonary injury that may go undetected.Objective: The aim of this review article was to highlight mechanical ventilation in critically ill patients in ICU.Conclusion: Non-invasive ventilation is an excellent first-line therapy for hypoxemic or hypercapnic respiratory failure in critically ill patients, failure of non-invasive ventilation necessitates introduction of intubation and invasive mechanical ventilation as second line therapy

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Greenness appraisal and development of validated spectrophotometric methods for assay of amprolium: Comparative study using Analytical Eco-Scale, GAPI, and AGREEmetric approaches

Intestinal coccidiosis is a serious parasitic disease in poultry. Amprolium hydrochloride(AMP) is widely used for the treatment and prevention of coccidiosis. Three simple and green spectrophotometric methods have been developed for assay of AMP in bulk powder and in dosage form. The first method relies on measuring the first derivative (D1) spectrum at Δλ= 3 nm of AMP. This D1 spectrum possesses a characteristic peak at 234 nm. The second method relies on measuring the difference spectrophotometry (ΔA) and its first derivative (ΔD1) spectra of the drug solutions in 0.1 N HCl against the corresponding solutions in 0.1 N NaOH. The value of amplitudes of ΔA and ΔD1 (∆λ = 3 nm) were measured at 248 and 240 nm, respectively. The third method involves a colorimetric reaction with KMnO4 in alkaline medium and measuring the colored product at 610 nm. The developed methods were validated in accordance with ICH guidelines and evaluated for greenness using three greenness metrics; Analytical Eco-Scale (AES), Analytical GREEness calculator (AGREE), and Green Analytical Procedure Index (GAPI). All proposed methods showed excellent simplicity as they don't require sophisticated instrumentation or tedious analytical procedure steps

Prevalence of Antibiotic Resistant Aeromonas and Molecular Identification of Aeromonas hydrophila Isolated from Some Marketed Fish in Egypt

      Aeromonas hydrophila, is an important foodborne bacterial disease in the aquaculture. The present study aimed to investigate the prevalence of Aeromonas species, virulence genes associated in A. hydrophila and to determine the antimicrobial susceptibility of Aeromonas spp. isolated from fish samples (tilapia, mugil, tuna, saurus, pagrus and shrimp) collected from Zagazig city markets, Sharkia Governorate, Egypt. Aeromonas spp. was isolated with a percentage of 39.3% of all examined fish samples. Four Aeromonas species (A. hydrophila, A. caviae, A. fluvials and A. sobria) were isolated from the tested fish samples (12%, 15.3%, 2.7% and 9.3%, respectively). A. hydrophila was only isolated from Tilapia, Saurus and Shrimp samples (16%, 28% and 28%, respectively). Aerolysin (aerA) and haemolysin (ahh1) were expressed in 100% and 75% of the A. hydrophila isolates. Antibiotic susceptibility testing of Aeromonas spp. revealed marked resistant for testing antibiotics; Ampicillin (100 %), Erythromycin (100 %), Tetracycline (83.3 %), Sulphamethoxazol (75 %), Cefotaxime (50 %) and Cephalothin (50 %). Dipping of Nile tilapia in lemon juice 5% for 2 h reduced A. hydrophila counts by 0.45 log cfu/g (64.44%). In conclusion, the present study confirms contamination of fish by Aeromonas spp. Immersion of fish in in lemon juice 5% is an efficient policy for reducing A. hydrophila in fish

Photocrosslinkable gelatin-treated dentin matrix hydrogel as a novel pulp capping agent for dentin regeneration: I. synthesis, characterizations and grafting optimization

Abstract Background In recent years, treated dentin matrix (TDM) has been introduced as a bioactive hydrogel for dentin regeneration in DPC. However, no study has introduced TDM as a photocrosslinkable hydrogel with a natural photoinitiating system. Therefore, the present study aimed to explore the synthesis, characterizations and grafting optimization of injectable gelatin- glycidyl methacrylate (GMA)/TDM hydrogels as a novel photocrosslinkable pulp capping agent for dentin regeneration. Methods G-GMA/TDM hydrogel was photocrosslinked using a new two-component photoinitiating system composed of riboflavin as a photoinitiator under visible light and glycine as a first time coinitiator with riboflavin. The grafting reaction conditions of G-GMA/TDM e.g. GMA concentration and reaction time were optimized. The kinetic parameters e.g. grafting efficiency (GE) and grafting percentage (GP%) were calculated to optimize the grafting reaction, while yield (%) was determined to monitor the formation of the hydrogel. Moreover, G-GMA/TDM hydrogels were characterized by swelling ratio, degradation degree, and cytotoxicity. The instrumental characterizations e.g. FTIR, 1H-NMR, SEM and TGA, were investigated for verifying the grafting reaction. Statistical analysis was performed using F test (ANOVA) and Post Hoc Test (P = 0.05). Results The grafting reaction dramatically increased with an increase of both GMA concentration and reaction time. It was realized that the swelling degree and degradation rate of G-GMA/TDM hydrogels were significantly reduced by increasing the GMA concentration and prolonging the reaction time. When compared to the safe low and moderate GMA content hydrogels (0.048, 0.097 M) and shorter reaction times (6, 12, 24 h), G-GMA/TDM with high GMA contents (0.195, 0.391 M) and a prolonged reaction time (48 h) demonstrated cytotoxic effects against cells using the MTT assay. Also, the morphological surface of G-GMA/TDM freeze-dried gels was found more compacted, smooth and uniform due to the grafting process. Significant thermal stability was noticed due to the grafting reaction of G-GMA/TDM throughout the TGA results. Conclusions G-GMA/TDM composite hydrogel formed by the riboflavin/glycine photoinitiating system is a potential bioactive and biocompatible system for in-situ crosslinking the activated-light pulp capping agent for dentin regeneration

Investigation of Structural, Physical, and Attenuation Parameters of Glass: TeO₂-Bi₂O₃-B₂O₃-TiO₂-RE₂O₃ (RE: La, Ce, Sm, Er, and Yb), and Applications Thereof

A novel series of glass, consisting of B2O3, Bi2O3, TeO2, and TiO2 (BBTT) containing rare earth oxide RE2O3, where RE is La, Ce, Sm, Er, and Yb, was prepared. We investigated the structural, optical, and gamma attenuation properties of the resultant glass. The optical energy bands, the linear refractive indices, the molar refractions, the metallization criteria, and the optical basicity were all determined for the prepared glass. Furthermore, physical parameters such as the density, the molar volume, the oxygen molar volume, and the oxygen packing density of the prepared glass, were computed. Both the values of density and optical energy of the prepared glass increased in the order of La2O3, Ce2O3, Sm2O3, Er2O3, and then Yb2O3. In addition, the glass doped with Yb2O3 had the lowest refractive index, electronic polarizability, and optical basicity values compared with the other prepared glass. The structures of the prepared glass were investigated by the deconvolution of infrared spectroscopy, which determined that TeO4, TeO3, BO4, BO3, BiO6, and TiO4 units had formed. Furthermore, the structural changes in glass are related to the ratio of the intensity of TeO4/TeO3, depending on the type of rare earth. It is also clarified that the resultant glass samples are good attenuators against low-energy radiation, especially those that modified by Yb2O3, which exhibited superior shielding efficiency at energies of 622, 1170, and 1330 keV. The optical and gamma ray spectroscopy results of the prepared glass show that it is a good candidate for nonlinear optical fibers, laser solid material, and optical shielding protection

Protective Potential of <i>Saussurea costus</i> (Falc.) Lipsch. Roots against Cyclophosphamide-Induced Pulmonary Injury in Rats and Its In Vitro Antiviral Effect

Diseases and infections of the respiratory tract are common global causes of morbidity and mortality. Our study attempts to elucidate a novel remedy for respiratory ailments, in addition to identifying and quantifying the metabolites of Saussurea costus root extract (SCRE) using HPLC. Then, in vitro antiviral and in vivo lung protective effects were elucidated. The in vitro antiviral potential of SCRE was analyzed via plaque assay against the low pathogenic human coronavirus (HCoV-229E) and human influenza virus (H1N1). The value of the half maximal inhibitory concentrations (IC50) of SCRE against HCoV-229E and H1N1 influenza virus were 23.21 ± 1.1 and 47.6 ± 2.3 µg/mL, respectively. SCRE showed a histological improvement, namely a decrease in inducible nitric oxide synthase (iNOS) and caspase-3 immunoexpression in in vivo cyclophosphamide (CP)-induced acute lung injury (ALI). Moreover, there was a considerable decline in microRNA-let-7a gene expression and a significant rise in heme oxygenase-1 (HO-1) gene expression, with a marked decrease in the malondialdehyde (MDA) level. Molecular docking studies revealed that the major constituents of SCRE have a good affinity for caspase-3, HO-1, and iNOS proteins. In conclusion, a traditional plant SCRE could be a promising source of novel therapeutic agents for treating and protecting respiratory tract diseases. More future investigations should be carried out to reveal its efficacy clinically

Identification of a Potential Vaccine against <i>Treponema pallidum</i> Using Subtractive Proteomics and Reverse-Vaccinology Approaches

Syphilis, a sexually transmitted infection, is a deadly disease caused by Treponema pallidum. It is a Gram-negative spirochete that can infect nearly every organ of the human body. It can be transmitted both sexually and perinatally. Since syphilis is the second most fatal sexually transmitted disease after AIDS, an efficient vaccine candidate is needed to establish long-term protection against infections by T. pallidum. This study used reverse-vaccinology-based immunoinformatic pathway subtractive proteomics to find the best antigenic proteins for multi-epitope vaccine production. Six essential virulent and antigenic proteins were identified, including the membrane lipoprotein TpN32 (UniProt ID: O07950), DNA translocase FtsK (UniProt ID: O83964), Protein Soj homolog (UniProt ID: O83296), site-determining protein (UniProt ID: F7IVD2), ABC transporter, ATP-binding protein (UniProt ID: O83930), and Sugar ABC superfamily ATP-binding cassette transporter, ABC protein (UniProt ID: O83782). We found that the multiepitope subunit vaccine consisting of 4 CTL, 4 HTL, and 11 B-cell epitopes mixed with the adjuvant TLR-2 agonist ESAT6 has potent antigenic characteristics and does not induce an allergic response. Before being docked at Toll-like receptors 2 and 4, the developed vaccine was modeled, improved, and validated. Docking studies revealed significant binding interactions, whereas molecular dynamics simulations demonstrated its stability. Furthermore, the immune system simulation indicated significant and long-lasting immunological responses. The vaccine was then reverse-transcribed into a DNA sequence and cloned into the pET28a (+) vector to validate translational activity as well as the microbial production process. The vaccine developed in this study requires further scientific consensus before it can be used against T. pallidum to confirm its safety and efficacy

Impact of SARS-CoV-2 pandemic on pancreatic cancer services and treatment pathways: United Kingdom experience.

INTRODUCTION The SARS-CoV-2 pandemic presented healthcare providers with an extreme challenge to provide cancer services. The impact upon the diagnostic and treatment capacity to treat pancreatic cancer is unclear. This study aimed to identify national variation in treatment pathways during the pandemic. METHODS A survey was distributed to all United Kingdom pancreatic specialist centres, to assess diagnostic, therapeutic and interventional services availability, and alterations in treatment pathways. A repeating methodology enabled assessment over time as the pandemic evolved. RESULTS Responses were received from all 29 centres. Over the first six weeks of the pandemic, less than a quarter of centres had normal availability of diagnostic pathways and a fifth of centres had no capacity whatsoever to undertake surgery. As the pandemic progressed services have gradually improved though most centres remain constrained to some degree. One third of centres changed their standard resectable pathway from surgery-first to neoadjuvant chemotherapy. Elderly patients, and those with COPD were less likely to be offered treatment during the pandemic. CONCLUSION The COVID-19 pandemic has affected the capacity of the NHS to provide diagnostic and staging investigations for pancreatic cancer. The impact of revised treatment pathways has yet to be realised