Comparison of various oxidative treatments for removal of reactive black CNN

Decolorization of reactive black CNN by chemical oxidation and reduction using KMnO4, H2O2 and Ferrioxalate as oxidizing agents and Na2SO3 as reducing agent individually as well as in combination was studied on batch scale using UV-visible spectroscopy. Degradation of dye occurred in acidic medium with KMnO4 and in alkaline medium with H2O2 and ferrioxalate. The most efficient methods for decolorization of reactive black CNN is oxidation using KMnO4 as an oxidizing agent which removed 97.64% of dye. Maximum decolorization was obtained at 60 min of treatment under static conditions. H2O2 and ferrioxalate could remove only 50.71 and 44.21% dye, respectively. Sequential treatment was more successful with H2O2 and ferrioxalate when compared with KMnO4. Chemical oxygen demand (COD) and total organic carbon (TOC) contents of treated wastewater decreased appreciably from 83.6 to 63.7 mg/L and 86.8 to 72.8 mg/L, respectively. Additionally, Fourier Transform Infrared Spectroscopy (FTIR) study revealed the degradation of reactive black CNN after treatment into non toxic products.Keywords: Reactive black CNN, KMnO4, ferrioxalate, sodium sulphite, chemical oxygen demand (COD)

FUTURE CARDIAC EVENTS IN NORMALLY DIAGNOSED GATED MYOCARDIAL PERFUSION SPECT (GSPECT)

Coronary heart disease (CHD) is a major cause of mortality and morbidity in Europe and USA and its management consumes a large proportion of national healthcare budgets. Many studies had tested the prognostic value of a normal myocardial perfusion scintigraphy; they concluded that a normal MPI study is associated with a very low rate of future cardiac events. In view of the above this study is designed to determine the risk of future cardiac events after normal MPS in local population. Methods: This was a retrospective observational registry performed in a single center in the Kingdom of Saudi Arabia. The data were collected from the nuclear medicine database identifying all the reported normal myocardial perfusion scans between January 2008 and December 2011 . Results: There were 290 patients identified with normal cardiac nuclear scans in the pre-specified time frame. Basic patient demographics were outlined and the patients’ charts were reviewed looking for any major cardiac events such as MI or sudden death. Mean follow up was 14.8 months. There were 2 patients that were admitted with NSTEMI and went on to have diagnostic angiograms. One of those two patients underwent percutaneous coronary intervention with stenting. The other patient had nonobstructive CAD and was advised for medical management only. These findings are consistent with a 0.7% risk of cardiac events after a negative scan Conclusion: The above findings demonstrate that the risk of major cardiac events after a negative nuclear cardiac scan is low and is in keeping with the international statistics available

FUTURE CARDIAC EVENTS IN NORMALLY DIAGNOSED GATED MYOCARDIAL PERFUSION SPECT (GSPECT)

Coronary heart disease (CHD) is a major cause of mortality and morbidity in Europe and USA and its management consumes a large proportion of national healthcare budgets. Many studies had tested the prognostic value of a normal myocardial perfusion scintigraphy; they concluded that a normal MPI study is associated with a very low rate of future cardiac events. In view of the above this study is designed to determine the risk of future cardiac events after normal MPS in local population. Methods: This was a retrospective observational registry performed in a single center in the Kingdom of Saudi Arabia. The data were collected from the nuclear medicine database identifying all the reported normal myocardial perfusion scans between January 2008 and December 2011 . Results: There were 290 patients identified with normal cardiac nuclear scans in the pre-specified time frame. Basic patient demographics were outlined and the patients’ charts were reviewed looking for any major cardiac events such as MI or sudden death. Mean follow up was 14.8 months. There were 2 patients that were admitted with NSTEMI and went on to have diagnostic angiograms. One of those two patients underwent percutaneous coronary intervention with stenting. The other patient had nonobstructive CAD and was advised for medical management only. These findings are consistent with a 0.7% risk of cardiac events after a negative scan Conclusion: The above findings demonstrate that the risk of major cardiac events after a negative nuclear cardiac scan is low and is in keeping with the international statistics available

Significant impact of +105 A>C promoter polymorphism in IL-18 cytokine in patients with kidney stone disease

Background: Inflammation may be one cause of nephrolithiasis and the interleukin-18 (IL-18) encoding gene   polymorphisms at +105 A>C has been implicated in several inflammation related diseases. The aim of this study was to test whether IL-18+105 A>C polymorphisms could act as genetic marker for renal stone disease. A case-control study was conducted to observe the genotype distribution of IL-18+105 A>C, to elucidate the possible role of this SNP as risk factor in renal stone development and to examine its correlation with the clinico-pathologic variables.Methods: Using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) technique, we tested the genotype distribution of 160 nephrolithiasis patients in comparison with 200 disease free controls from the same geographical region.  Results: We observed significant differences of IL-18+105 A to C between the controls and patients with odds ratio 5.4 (P = 0.001). The prevalence of the variant genotypes AC + CC in the patients was higher than that in the controls (45% v/s 30%) and showed a significant association (P = 0.003). Moreover, the frequency per copy of the C allele of IL-18+105 A>C was found to be implicated more in patient group 0.27 as against only 0.16 in controls (P = 0.0003). Further, males and subjects with C is implicated in renal stone disease, and that the rare, C related allele is connected with higher susceptibility to nephrolithiasis.

Diffuse Alveolar Hemorrhage: A Fatal Complication of Rituximab

Pulmonary toxicity is a rare but severe adverse effect of Rituximab, associated with significant morbidity and mortality. Despite increased reporting, few case reports associated with alveolar hemorrhage due to Rituximab have been published. The authors present the case of a 61 year old Caucasian male with a diagnosis of small lymphocytic lymphoma who recently completed chemotherapy with Rituximab and Bendamustine. The patient presented to the emergency room with a one week history of nonproductive cough associated with shortness of breath and low grade fevers. Differential diagnosis at the time of presentation included health care associated pneumonia, Rituximab-induced pulmonary toxicity, and Pneumocystis jiroveci infection given his history of lymphoma and treatment with Rituximab. The patient was initiated on intravenous (IV) broad-spectrum antibiotics, oral atovaquone, and IV methylprednisolone. A CT scan showed bilateral diffuse pulmonary opacities and a video-assisted thorascopic surgery guided lung biopsy revealed early diffuse alveolar hemorrhage with no evidence for infection. However, the remaining work-up consisting of blood cultures, blood tests, and bronchopulmonary lavage did not produce any suggestive findings. Despite initiating the above aggressive therapies, the patient continued to rapidly deteriorate. An autopsy revealed diffuse alveolar hemorrhage of the lungs, thought to be secondary to Rituximab toxicity. The authors recommend emphasizing the importance of early identification of worsening pulmonary symptoms in patients receiving Rituximab, with diagnostic consideration given to Rituximab-related toxicity

Dose Optimization of Colistin: A Systematic Review

Colistin is considered a last treatment option for multi-drug and extensively resistant Gram-negative infections. We aimed to assess the available data on the dosing strategy of colistin. A systematic review was performed to identify all published studies on the dose optimization of colistin. Grey literature and electronic databases were searched. Data were collected in a specified form and the quality of the included articles was then assessed using the Newcastle-Ottawa scale for cohort studies, the Cochrane bias tool for randomized clinical trials (RCT), and the Joanna Briggs Institute (JBI) critical checklist for case reports. A total of 19 studies were included, of which 16 were cohort studies, one was a RCT, and two were case reports. A total of 18 studies proposed a dosing regimen for adults, while only one study proposed a dosing schedule for pediatric populations. As per the available evidence, a loading dose of 9 million international units (MIU) of colistin followed by a maintenance dose of 4.5 MIU every 12 h was considered the most appropriate dosing strategy to optimize the safety and efficacy of treatment and improve clinical outcomes. This review supports the administration of a loading dose followed by a maintenance dose of colistin in severe and life-threatening multi-drug Gram-negative bacterial infections

Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan

<p>Abstract</p> <p>Background</p> <p>Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated.</p> <p>Methods</p> <p>An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss ≥ 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode of delivery, possible cause of postpartum hemorrhage and medical or surgical intervention was collected. The estimation of blood loss was made via subjective and objective assessment.</p> <p>Results</p> <p>During 2008, massive postpartum hemorrhage occurred in 0.64% cases (26/4,052). No deaths were reported. The mean blood loss was 2431 ± 1817 ml (range: 1500 - 9000 ml). Emergency cesarean section was the most common mode of delivery (13/26; 50%) while uterine atony was the most common cause of massive postpartum hemorrhage (14/26; 54%). B-lynch suture (24%) and balloon tamponade (60%) were used more commonly as compared to our previously reported experience. Cesarean hysterectomy was performed in 3 cases (12%) for control of massive postpartum hemorrhage. More than 80% compliance was observed in 8 out of 10 steps of the management protocol. Initiation of blood transfusion at 1500 ml blood loss (89%) and overall documentation of management (92%) were favorably observed in most cases.</p> <p>Conclusion</p> <p>This report details our experience with the practical implementation of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in a developing country. With the exception of arterial embolization, relatively newer, simpler and potentially safer techniques are now being employed for the management of massive postpartum hemorrhage at our institution. Particular attention should be paid to the documentation of the management steps while ensuring a stricter adherence to the formulated protocols and guidelines in order to further ameliorate patient outcomes in emergency obstetrical practice. More audits like the one we performed are important to recognize and rectify any deficiencies in obstetrical practice in developing countries. Dissemination of the same is pivotal to enable an open discourse on the improvement of existing obstetrical strategies.</p

Dose optimization of β-lactams antibiotics in pediatrics and adults:A systematic review

Background: β-lactams remain the cornerstone of the empirical therapy to treat various bacterial infections. This systematic review aimed to analyze the data describing the dosing regimen of β-lactams. Methods: Systematic scientific and grey literature was performed in accordance with Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The studies were retrieved and screened on the basis of pre-defined exclusion and inclusion criteria. The cohort studies, randomized controlled trials (RCT) and case reports that reported the dosing schedule of β-lactams are included in this study. Results: A total of 52 studies met the inclusion criteria, of which 40 were cohort studies, 2 were case reports and 10 were RCTs. The majority of the studies (34/52) studied the pharmacokinetic (PK) parameters of a drug. A total of 20 studies proposed dosing schedule in pediatrics while 32 studies proposed dosing regimen among adults. Piperacillin (12/52) and Meropenem (11/52) were the most commonly used β-lactams used in hospitalized patients. As per available evidence, continuous infusion is considered as the most appropriate mode of administration to optimize the safety and efficacy of the treatment and improve the clinical outcomes. Conclusion: Appropriate antibiotic therapy is challenging due to pathophysiological changes among different age groups. The optimization of pharmacokinetic/pharmacodynamic parameters is useful to support alternative dosing regimens such as an increase in dosing interval, continuous infusion, and increased bolus doses

A Systematic Review on Clinical Safety and Efficacy of Vancomycin Loading Dose in Critically Ill Patients

Background: The clinical significance of utilizing a vancomycin loading dose in critically ill patients remains unclear. Objective: The main aim of this systematic review is to evaluate the clinical safety and efficacy of the vancomycin loading dose in critically ill patients. Methods: We performed a systematic review using PRISMA guidelines. PubMed, the Web of Science, MEDLINE, Scopus, Google Scholar, the Saudi Digital Library and other databases were searched. Studies that reported clinical outcomes among patients receiving the vancomycin LD were considered eligible. Data for this study were collected using PubMed, the Web of Science, MEDLINE, Scopus, Google Scholar and the Saudi Digital Library using the following terms: “vancomycin”, “safety”, “efficacy” and “loading dose” combined with the Boolean operator “AND” or “OR”. Results: A total of 17 articles, including 2 RCTs, 11 retrospective cohorts and 4 other studies, met the inclusion/exclusion criteria out of a total 1189 studies. Patients had different clinical characteristics representing a heterogenous group, including patients in critical condition, with renal impairment, sepsis, MRSA infection and hospitalized patients for hemodialysis or in the emergency department. Conclusions: The study shows that the target therapeutic level is achieved more easily among patients receiving a weight-based LD as compared to patients received the usual dose without an increased risk of new-onset adverse drug reactions

Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future.

Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000-2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations