Anesthetic challenges in patients with ankylosing spondylitis requiring lower limb surgery – A case report and literature review

Ankylosing spondylitis is one of the global top health burdens and patients affected by it frequently require surgery related to disease progression, such as orthopedic surgery. These patients may prove difficult to manage from an anesthetic standpoint, regardless of the anesthetic technique employed, mainly given the potential for difficult airway access and related comorbidities. We present the case of a 52-year-old male posted for urgent cemented total hip arthroplasty with associated bilateral pulmonary fibrosis and an anticipated difficult airway in whom regional anesthesia was performed with satisfactory results, with a favorable intraoperative and postoperative course. The literature review explores the anesthetic techniques employed when a tailored approach is required in managing patients with ankylosing spondylitis

Lab Scale Investigation of Gaseous Emissions, Performance and Stability of an Aviation Turbo-Engine While Running on Biodiesel Based Sustainable Aviation Fuel

The research experimentally examines the viability of biodiesel obtained from pork fat (BP) as a sustainable aviation fuel (SAF) when mixed with kerosene (Ke)—Jet-A aviation fuel + 5% Aeroshell 500 oil. Various blends of biodiesel and kerosene (10, 20, and 30% vol. of BP added in Ke) were subjected to testing in an aviation micro turbo-engine under different operational states: idle, cruise, and maximum power. During the tests, monitoring of engine parameters such as burning temperature, fuel consumption, and thrust force was conducted. The study also encompassed the calculation of crucial performance indicators like burning efficiency, thermal efficiency, and specific consumption for all fuel blends under maximum power conditions. Combustion temperatures ahead of the turbines rise with an increase in biodiesel concentration, particularly in the idle regime, without compromising engine integrity. However, for regimes 2 and 3, the temperature in front of the turbine decreases with rising biodiesel concentration, accompanied by an increase in fuel flow rate. This phenomenon is reflected in the elevated specific consumption. Notably, for regime 3, there is a noticeable rise in specific consumption, starting from S = 0.0264 kg/Nh when the turbo-engine operates solely with Ke, to S = 0.0266 kg/Nh for Ke + 10% BP, S = 0.0269 kg/Nh for Ke + 20% BP, and S = 0.0275 kg/Nh for Ke + 30% BP. Physical–chemical properties of the blends, encompassing density, viscosity, flash point, and calorific power, were determined. Furthermore, elemental analysis and FTIR were used for chemical composition determination. The amount of CO2 produced during the stoichiometric combustion reaction with air showed variations. Initially, when using only Ke, it amounted to 3.12 kg per kilogram of fuel. Upon adding 10% BP, this value decreased to 3.09 kg, further reducing to 3.05 kg with 20% BP. The lowest value was observed with 30% BP, reaching 3.04 kg. Experimental assessments were performed on the Jet Cat P80® micro-turbo-engine, covering aspects such as starting procedures, sudden acceleration, sudden deceleration, and emissions of pollutants (NOx, CO, and SO2) during several engine operational phases. The outcomes reveal that the examined fuel blends exhibited stable engine performance across all tested conditions. This indicates that these blends hold promise as sustainable aviation fuels for micro turbo-engines, presenting benefits in terms of diminished pollution and a more ecologically sound raw material base for fuel production

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Investigating the Use of Recycled Pork Fat-Based Biodiesel in Aviation Turbo Engines

This paper presents an analysis of the possibility of using recycled pork fat-based biodiesel as fuel for aviation turbo-engines. The analysis consists of the assessment of four blends of Jet A kerosene with 10%, 30%, 50%, and 100% biodiesel and pure Jet A that was used as reference in the study. The first part of the paper presents the physical-chemical properties of the blends: density, viscosity, flash point, freezing point, and calorific power. Through Fourier transform infrared spectroscopy (FTIR) analysis, a benchmark was performed on the mixtures of Jet A with 10%, 20%, 30%, 50%, and 100% biodiesel compared with Jet A. The second part of the paper presents the test results of these blends used for fuelling a Jet Cat P80 turbo engine at the Turbo Engines Laboratory of the Aerospace Engineering Faculty of Polyethnic University of Bucharest. These functional tests were performed using different operating regimes as follows: idle, cruise, intermediate, and maximum. For each regime, a testing period of around 1 min was selected and the engine parameters were monitored during the test execution. The burning efficiency was calculated for the maximum regime for all mixtures. To evaluate the functioning stability of the turbo engine using biodiesel, two accelerometers were mounted on the engine support that recorded the radial and axial vibrations. Moreover, to assess the burning stability and to identify other acoustic spectral components when biodiesel is used, two microphones were placed near the jet region. A comparative analysis between blends was made by taking the Jet A fuel as reference

Biodiesel from Recycled Sunflower and Palm Oil—A Sustainable Fuel for Microturbo-Engines Used in Airside Applications

An experimental assessment of burning behavior of some aviation fuel and biodiesel obtained from waste oil mixture has been performed within this paper. The biodiesel was obtained from sunflower and palm waste oil (SFP) and the mixtures consisted of 10, 30 and 50% biodiesel in regular aviation fuel. The aviation fuel is a mixture of Jet A fuel + 5% Aeroshell 500 oil (called Ke) with the oil being added for turbo-engine’s lubrication. So, the used fuels were: Ke, Ke + 10% SFP, Ke + 30% SFP, Ke + 50% SFP. In first step, SFP was characterized in terms of: density, kinematic viscosity, flash and freezing points and calorific power. Also a deeper analysis was made by using FTIR for all the fuels involved in the experiments. The second step consisted of assessing the chemical reactions that occur during the burning process. Thus starting from the known elemental analysis, the air needed for a stoichiometric reaction has been calculated for each fuel mixtures. Also the resulting CO2 and water has been calculated from the reactions. The third step consisted of experimental testing the burning behavior of the above mentioned fuels on a micro turbo-engine. The used engine was Jet Cat P80® provided by Gunt Hamburg, Barsbüttel, Germany. The variation of: rpm vs. time, burning temperature vs. time and fuel debit vs. rpm are presented for starting and yield procedures. The tests have been conducted at 8 different working regimes of the engine. For each regime, an 1 min testing period was chose, during which burning temperature vs. rpm, fuel debit vs. rpm and thrust force vs. rpm were monitored. For maximum regime, only calculus for burning, thermal efficiencies and specific consumption have been made. As a main conclusion, the engine working behavior was steady throughout the entire range of rpm and for all the blends fed, thus the studied fuel blends may be considered as sustainable fuel for applications that are using micro turbo-engines with main advantages related to pollution and raw materials allowing the production of this type of fuel

Toxic-Induced Nonthyroidal Illness Syndrome Induced by Acute Low-Dose Pesticides Exposure—Preliminary In Vivo Study

Background and Objectives: Conditions such as trauma, burns, sepsis, or acute intoxications have considerable consequences on the endocrine status, causing “sick euthyroid syndrome”. Organophosphate exposure may induce an increase in acetylcholine levels, thus altering the thyroid’s hormonal status. The present study aims to identify the effects of acetylcholinesterase inhibition on thyroid hormones. Material and methods: A prospective experimental study was conducted on twenty Wistar rats. Blood samples were drawn to set baseline values for thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4). Chlorpyrifos 0.1 mg/kg was administered by oral gavage to induce acetyl-cholinesterase inhibition. After exhibiting cholinergic symptoms, blood samples were collected to assess levels of cholinesterase and thyroid hormones using ELISA. Results: Butyrylcholinesterase levels confirmed major inhibition immediately after intoxication compared to the baseline, certifying the intoxication. A significant increase in T4 levels was noted (p = 0.01) both at 2 h and 48 h after administration of organophosphate in sample rats. Similarly, T3 almost doubled its value 2 h after poisoning (4.2 ng/mL versus 2.5 ng/mL at baseline). Surprisingly, TSH displayed acute elevation with an afterward slow descending trend at 48 h (p = 0.1), reaching baseline value. Conclusions: This study demonstrated that cholinesterase inhibition caused major alterations in thyroid hormone levels, which may be characterized by a transient hypothyroidism status with an impact on survival prognosis

Biodetoxification Using Intravenous Lipid Emulsion, a Rescue Therapy in Life-Threatening Quetiapine and Venlafaxine Poisoning: A Case Report

The administration of intravenous lipid emulsion (ILE) is a proven antidote used to reverse local anesthetic-related systemic toxicity. Although the capacity of ILE to generate blood tissue partitioning of lipophilic drugs has been previously demonstrated, a clear recommendation for its use as an antidote for other lipophilic drugs is still under debate. Venlafaxine (an antidepressant acting as a serotonin–norepinephrine reuptake inhibitor (SNRI)) and quetiapine (a second-generation atypical antipsychotic) are widely used in the treatment of psychotic disorders. Both are lipophilic drugs known to induce cardiotoxicity and central nervous depression. We report the case of a 33-year-old man with a medical history of schizoaffective disorder who was admitted to the emergency department (ED) after having been found unconscious due to a voluntary ingestion of 12 g of quetiapine and 4.5 g of venlafaxine. Initial assessment revealed a cardiorespiratory stable patient but unresponsive with a GCS of 4 (M2 E1 V1). In the ED, he was intubated, and gastric lavage was performed. Immediately after the admission to the intensive care unit (ICU), his condition quickly deteriorated, developing cardiovascular collapse refractory to crystalloids and vasopressor infusion. Junctional bradycardia occurred, followed by spontaneous conversion to sinus rhythm. Subsequently, frequent ventricular extrasystoles, as well as patterns of bigeminy, trigeminy, and even episodes of non-sustained ventricular tachycardia, occurred. Additionally, generalized tonic–clonic seizures were observed. Alongside supportive therapy, antiarrhythmic and anticonvulsant therapy, intravenous lipid emulsion bolus, and continuous infusion were administered. His condition progressively improved over the following hours, and 24 h later, he was tapered off the vasopressor. On day 2, the patient repeated the cardiovascular collapse and a second dose of ILE was administered. Over the next few days, the patient’s clinical condition improved, and he was successfully weaned off ventilator and vasopressor support. ILE has the potential to become a form of rescue therapy in cases of severe lipophilic drug poisoning and should be considered a viable treatment for severe cardiovascular instability that is refractory to supportive therapy

Hemorrhagic Cardiac Tamponade—An Unusual Threat in the COVID-19 Recovery Phase

Cardiac tamponade is a rare presentation in patients with COVID-19, which may be induced by the associated exacerbated inflammatory response. The onset of cardiac tamponade may be concomitant with the acute phase of the disease or may develop subsequently as a new health condition secondary to the disease. We report four cases of cardiac tamponade that occurred late after the acute phase of the disease. One of them may be considered a post-acute complication of the disease, and three of them may be classified as a new health condition induced by COVID-19. Only two cases had a history of severe respiratory distress due to COVID-19. In all four cases, pericardiocentesis was imposed, and surprisingly, in every case, hemorrhagic fluid was evacuated. In this case, series, immune-mediated etiology is supported by histopathological results, where the main identified feature was fibrous pericarditis with inflammatory infiltrate. Only one patient included in this report died, and three of them were discharged after anti-inflammatory treatment was initiated