Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index

Background In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation. Methods Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the T-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time. Results Successful extubation was significantly correlated with DE (P<0.001). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC], 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%; positive predictive value (PPV), 84.6 %; negative predictive value (NPV), 73.3% while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6%; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33% although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 breaths/min/L (AUC, 0.58; P=0.47); sensitivity, 66.7%; specificity, 53.8%; PPV, 66.7%; NPV, 53.8%). Conclusions To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF

A small molecule chemical chaperone optimizes its unfolded state contraction and denaturant like properties

Protein aggregation is believed to occur through the formation of misfolded conformations. It is expected that, in order to minimize aggregation, an effective small molecule chaperone would destabilize these intermediates. To study the mechanism of a chemical chaperone, we have designed a series of mutant proteins in which a tryptophan residue experiences different local environments and solvent exposures. We show that these mutants correspond to a series of conformationally altered proteins with varying degree of misfolding stress and aggregation propensities. Using arginine as a model small molecule, we show that a combination of unfolded state contraction and denaturant like properties results in selective targeting and destabilization of the partially folded proteins. In comparison, the effect of arginine towards the folded like control mutant, which is not aggregation prone, is significantly less. Other small molecules, lacking either of the above two properties, do not offer any specificity towards the misfolded proteins

Hand hygiene products and adverse skin reactions: A cross-sectional comparison between healthcare and non-healthcare workers of Bangladesh during COVID-19 pandemic

Background: The deadly COVID-19 pandemic has swept the globe since December 2019. Due to the significant risk of infection, frontline health workers had to use Personal Protective Equipment and hand hygiene products, to help prevent transmission of infection. The present study aims to compare the adverse skin responses between healthcare workers (HCW) and non-healthcare workers (NHCW). Materials and methods: A descriptive, cross-sectional study of HCW and NHCW throughout the country wa executed. A self-structured questionnaire was utilized to gather data from 404 HCWs and 826 NHCWs during a two-month period using multistage sampling. STATA (v16) was used to analyse the data. Results: 41.87% of the study participants experienced adverse skin reactions, which were more prevalent amongs HCW (65.10%) than NHCW (30.51%). The most frequently reported skin condition was skin dryness (34.39%), followed by skin peeling (11.71%). Users of alcohol-based hand sanitizers (ABHS) were more likely to get itch (8.13%), whereas soap water users were more likely to suffer from skin peeling (35.74%) and rash (7.46%). There was a significant (p < 0.001) association between occupation and adverse skin responses, with HCW being 3.5 times more likely to have adverse skin manifestations than NHCW. Conclusion: The research showed that healthcare workers were at a greater risk to developing skin reactions than the overall population with frequent use of hand hygiene measures being a significant risk factor