Sedation, narcotic and neuromuscular blockade in mechanically ventilated patients with COVID-19

Objective: To describe the sedation, narcotic and neuromuscular blockade usage in ventilated patients with COVID-19 pneumonia. Design: Single-Center Retrospective Review. Setting: George Washington University Hospital in Washington, D.C. Patients: 62 patients with COVID-19 respiratory failure requiring mechanical ventilation admitted from March 2020 to June 2020. Intervention: None. Measurements and main results: Patients with COVID-19 respiratory failure required multiple sedative/narcotic infusions to achieve sedation requirements and at doses that were significantly more when compared to a general medical-surgical ICU population (represented by the MIND-USA cohort). The most common infusions were Dexmedetomadine and Propofol. Approximately 17% of our patients required a neuromuscular blockade infusion as well. Prior to intubation, narcotic utilization was stable and low. Conclusion: Patients with COVID-19 respiratory failure requiring mechanical ventilation have higher sedation and narcotic requirements than general ICU patients

Impact on Blood Product Utilization with Thromboelastography Guided Resuscitation for Gastrointestinal Hemorrhage

BACKGROUND: Thromboelastography (TEG) can guide transfusion therapy in trauma and has been associated with decreased transfusion requirements. This population differs from the medical population where the most common bleeding source is gastrointestinal hemorrhage (GIB). The utility of TEG in patients with acute GIB is not well described. We sought to assess whether the use of TEG impacts blood product utilization in patients with medical GIB. METHODS: A retrospective study looking at all adult patients admitted with a primary diagnosis of GIB to the George Washington University Intensive Care Unit (ICU) between 01/01/2017 to 12/31/2019. The primary intervention was the use of TEG to guide blood product resuscitation in addition to standard of care (TEG arm) versus standard of care alone (non-TEG arm). RESULTS: The primary outcome was the total number of blood products utilized. Patients in the TEG arm used more blood products compared to the non-TEG arm (9.10 vs 3.60, p \u3c 0.001). There was no difference in secondary endpoints except for an increased requirement for mechanical ventilation within the TEG arm (26.2% vs 13.4%, p  =  0.018). CONCLUSIONS: The use of TEG to guide resuscitation in patients with acute GIB may be associated with increased blood product utilization without any clinical benefit to patient-centered outcomes

An overview of water desalination systems integrated with renewable energy sources

Nowadays, the growing world population, climate change, pollution, rising consumer demand, and resource exploitation have contributed to a freshwater shortage. Hence, water desalination is heavily used for freshwater production. Meeting water demands in a cost-effective, efficient, and environmentally friendly manner requires the right combination of renewable energy and desalination technology. In this paper, an extensive review of various renewable energy-based desalination technologies is presented. The different types of energy like wind, solar thermal and photovoltaic, geothermal, wave and pressure retarded osmosis are explained. These renewable energies can be used in different desalination techniques such as reverse osmosis, electrodialysis, mechanical vapour compression, multi-effect desalination, membrane distillation, etc. It is noted that the most effective desalination systems consisted of a combination of these renewable energy sources, and some had an energy storage device to maintain a uniform energy flow in the system. The prospects of using renewable energy resources for water desalination were also explored in the scope of the Gulf Cooperation Council (GCC) region. The costs of the renewable energy desalination process are presented, along with the related challenges and outlook. It is noted that the correct combination of renewable energy and desalination technologies is the key to meeting water demand in a cost-effective, efficient, and environmentally responsible manner.The authors would like to acknowledge the support of NPRP grant NPRP13S-0205-200263 . The findings achieved herein are solely the responsibility of the author[s]

Infusion of Autologous Retrodifferentiated Stem Cells into Patients with Beta-Thalassemia

Beta-thalassemia is a genetic, red blood cell disorder affecting the beta-globin chain of the adult hemoglobin gene. This results in excess accumulation of unpaired alpha-chain gene products leading to reduced red blood cell life span and the development of severe anemia. Current treatment of this disease involves regular blood transfusion and adjunct chelation therapy to lower blood transfusion–induced iron overload. Fetal hemoglobin switching agents have been proposed to treat genetic blood disorders, such as sickle cell anemia and beta-thalassemia, in an effort to compensate for the dysfunctional form of the beta-globin chain in adult hemoglobin. The rationale behind this approach is to pair the excess normal alpha-globin chain with the alternative fetal gamma-chain to promote red blood cell survival and ameliorate the anemia. Reprogramming of differentiation in intact, mature, adult white blood cells in response to inclusion of monoclonal antibody CR3/43 has been described. This form of retrograde development has been termed “retrodifferentiation”, with the ability to re-express a variety of stem cell markers in a heterogeneous population of white blood cells. This form of reprogramming, or reontogeny, to a more pluripotent stem cell state ought to recapitulate early hematopoiesis and facilitate expression of a fetal and/or adult program of hemoglobin synthesis or regeneration on infusion and subsequent redifferentiation. Herein, the outcome of infusion of autologous retrodifferentiated stem cells (RSC) into 21 patients with beta-thalassemia is described. Over 6 months, Infusion of 3-h autologous RSC subjected to hematopoietic-conducive conditions into patients with beta-thalassemia reduced mean blood transfusion requirement, increased mean fetal hemoglobin synthesis, and significantly lowered mean serum ferritin. This was always accompanied by an increase in mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in such patients. No adverse side effects in response to the infusion of autologous RSC were noted.This novel clinical procedure may profoundly modify the devastating course of many genetic disorders in an autologous setting, thus paving the way to harnessing pluripotency from differentiated cells to regenerate transiently an otherwise genetically degenerate tissue such as thalassemic blood