Treading water: Coping with uncertainty during a novel pandemic

The abruptness with which the COVID-19 pandemic has changed the delivery of healthcare will have a lasting effect on patients and families of intensive care unit survivors. Using the best science and epidemiology healthcare systems developed protocols and policies to implement the highest level of care but mitigate disease spread. Out of these initiatives the “no visitor” policy was born. The impact of COVID-19 causing florid respiratory failure immediately derailed the lives of a happily retired couple. While on mechanical ventilation for sixteen days, Betty was unable to connect with her husband of over 40 years. In that time, the critical care team became familiar with techniques to treat COVID patients all the while understanding that self-care will be vital in preventing burnout during this pandemic. The balance between reducing the spread of a pathogen and giving our patients and families a human connection will be an on-going challenge in the months ahead. Experience Framework This article is associated with the Staff & Provider Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Corneal Disease and Air Pollution Levels in Detroit: Preliminary Results and Future Directions​

Purpose: To determine if Detroit zip codes with elevated air pollution levels demonstrate increased incidence of corneal disease. Background: 82 million people in the United States live in counties with air quality concentrations above the National Ambient Air Quality Standards. Air pollution’s detrimental effects on an individual’s health has been well documented. Much of this research has focused on the pulmonary system. The eye, another mucous membrane exposed to the external environment, has been largely ignored Methods: After an initial literature review of similar studies, 14 corneal diseases and 5 pollutants were selected to be evaluated. Kresge Eye Institute’s patient list was used to find patients with the diagnoses of interest, and the 50 most recent individuals were chosen for initial evaluation. Pollutant levels were evaluated by zip code-level data published by the Michigan Department of Environmental Quality. Zip codes were compared based on pollutant levels and the corresponding incidence of corneal disease. Results: Preliminarily, zip codes 48202, 48234 and 48044 have three cases of corneal disease each, which represents the maximum value. The study’s results were limited by small sample size and inclusion of patients with corneal disease secondary to an unrelated ophthalmic condition, such as post-cataract surgery dry eye and side effects of timolol used for glaucoma treatment. These patients must be excluded from future studies. Conclusion: It is too early to conclude that air pollution levels in Detroit are sufficiently elevated to lead to an increased incidence of corneal disease among residents

Kilohertz ultrasound as a potential therapy for dental repair

Biological effects are known to occur with ultrasound energy at kilohertz frequencies. This has led to research into its use as a non-invasive tool for tissue healing and repair. The aim of this research is to investigate the in vitro application of kilohertz ultrasound and to measure the biological responses using models of dental pulp cells which play an important role in dental repair. Ultrasound emitted from a longwave therapy instrument (DuoSon, SRA Developments Ltd) was characterised and measured identifying the range and intensity of the field. These measurements, coupled with biological data, identified the difficulties when conducting research with kilohertz ultrasound in vitro and indicated that the use of multi-well culture plates is not appropriate when investigating the effects of kilohertz ultrasound in cell culture. An improved method for in vitro kilohertz ultrasound application was devised enabling the investigation of non-thermal ultrasound effects on primary human dental cells. Cell proliferation, viability and gene expression, including the dental-related and biomechanically-responsive gene, dentine matrix protein-1, responded in a dose-dependent manner with respect to the duration of ultrasound application. These findings highlight the complexity of the biophysical interaction of kilohertz ultrasound with cells and demonstrate the need for further clarification of specific ultrasound settings for optimal therapeutic application. This study has demonstrated a positive effect of kilohertz ultrasound on human dental pulp cells and has identified methods to improve in vitro cell culture models to capture robust data to develop a novel therapy for dental repair

Rediscovery, resurrection and lectotypification of endemic Isoetes sampathkumarnii L. N. Rao from India

An interesting species of Isoetes was collected from Jambughoda, Wildlife Sanctuary, Gujarat. After a review of literature and comparison of the morphological characters with type specimens, it was identified as I. sampathkumarnii L. N. Rao. It is endemic species of south India and rediscovered after a lapse of 63 years. The species shows several features that make it unique in the genus. Earlier, I. sampathkumarnii was also treated as synonym of I. coromandelina L.f. and I. sahyadrii Mahabala. However, it has an idiosyncratic velum character and spore ornamentation that makes it different from other species. Hence, the authors resurrected it as a distinct species. The original material is ambiguous hence, a lectotype of I. sampathkumarnii has been designated here

Development and validation of dissolution method for carvedilol compression-coated tablets

The present study describes the development and validation of a dissolution method for carvedilol compression-coated tablets. Dissolution test was performed using a TDT-06T dissolution apparatus. Based on the physiological conditions of the body, 0.1N hydrochloric acid was used as dissolution medium and release was monitored for 2 hours to verify the immediate release pattern of the drug in acidic pH, followed by pH 6.8 in citric-phosphate buffer for 22 hours, to simulate a sustained release pattern in the intestine. Influences of rotation speed and surfactant concentration in medium were evaluated. Samples were analysed by validated UV visible spectrophotometric method at 286 nm. 1% sodium lauryl sulphate (SLS) was found to be optimum for improving carvedilol solubility in pH 6.8 citric-phosphate buffer. Analysis of variance showed no significant difference between the results obtained at 50 and 100 rpm. The discriminating dissolution method was successfully developed for carvedilol compression-coated tablets. The conditions that allowed dissolution determination were USP type I apparatus at 100 rpm, containing 1000 ml of 0.1N HCl for 2 hours, followed by pH 6.8 citric-phosphate buffer with 1% SLS for 22 hours at 37.0 ± 0.5 ºC. Samples were analysed by UV spectrophotometric method and validated as per ICH guidelines.O presente estudo descreve o desenvolvimento e a validação de método de dissolução para comprimidos revestidos de carvedilol. O teste de dissolução foi efetuado utilizando-se o aparelho para dissolução TDT-06T. Com base nas condições fisiológicas do organismo, utilizou-se ácido clorídrico 0,1 N como meio de dissolução e a liberação foi monitorada por 2 horas para se verificar o padrão de liberação imediata do fármaco em condições de pH baixo, seguidas por pH 6,8 em tampão cítrico-fosfato por 22 horas, para simular o padrão de liberação controlada no intestino. Avaliou-se a influência da velocidade de rotação e a concentração de tensoativo no meio. As amostras foram analisadas por método espectrofotométrico UV-visível validado, em 286 nm. O laurilsulfato sódico a 1% (SLS) mostrou-se ótimo para aumentar a solubilidade do carvedilol em pH 6,8 em tampão cítrico-fosfato. A análise da variância não mostrou diferença significativa entre os resultados obtidos a 50 e a 100 rpm. O método da dissolução discriminante foi desenvolvido com sucesso para os comprimidos revestidos de carvedilol. As condições que permitiram a determinação da dissolução foram: aparelho USP tipo I a 100 rpm, contendo 1000 mL de HCL 0,1 N por 2 horas, seguido de pH 6,8 com tampão cítrico-fosfato, com 1% de SLS por 22 horas a 37,0 ± 0,5 ºC. Amostras foram analisadas por método espectrofotométrico e validadas pelas normas ICH

Association of OSTA index with bone mineral density (BMD) and its comparison with calcaneal quantitative ultrasound for the prediction of low BMD in peri-menopausal Indian women

Background: Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fractures with advancing age in postmenopausal women. BMD measurements with dual energy X-ray absorptiometry (DEXA) are costly and not widely available The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a simple tool based on age and body weight to predict low BMD and identify women at risk of osteoporosis. The objective was to study the association of OSTA index with BMD (T-score) and to validate OSTA index in comparison with calcaneal Quantitative Ultrasound (QUS) for the prediction of low BMD in peri-menopausal Indian women.Methods: This was a prospective, cross-sectional, descriptive study carried out in department of physiology of a tertiary care teaching hospital (Navi Mumbai). Seventy two peri-menopausal women between 40 to 55 years with no previous diagnosis of osteoporosis were included. Participants’ socio-demographic detail, anthropometric measurements, OSTA index and QUS-based BMD was recorded. Pearson’s correlation test was used. Sensitivity, specificity, positive and negative predictive value was calculated.Results: OSTA index did not correlate with BMD in the entire samples. On subgroup analysis, OSTA index significantly correlated in a positive direction with BMD (T-score) in women in the age group of 50-55 years. OSTA index had a sensitivity of 70 %, and specificity of 84.62 % at T-score cutoff value of < -1.Conclusions: OSTA index is a simple risk assessment tool that can be used to identify women with low BMD in the age group of 50-55 years.

Doppler predictors of perinatal outcome in intra-uterine growth retarded foetuses

Background: The study aims at early detection of intrauterine growth retarded fetuses which are at high risk of perinatal complications. It can help obstetricians take appropriate preventive steps and prevent serious perinatal complications.Methods: The study undertaken over 100 pregnant women with pregnancy induced hypertension between 28-36 weeks subjected to umbilical artery and uterine artery doppler. The outcome data including gestational age at birth, birth height, APGAR score, admission to NICU, need for positive pressure ventilation and neonatal mortality.Results: The study shows that 58% mothers with IUGR foetuses were primigravida; gestational age at delivery is 34.2 weeks and 82% of IUGR foetuses were delivered by C-section. Average birth weight of foetus with abnormal doppler was significantly lower and there was high incidence of NICU admission. The study also shows that oligohydroamnios was common with abnormal doppler group.Conclusions: Umbilical artery doppler velocity in addition to uterine artery velocity doppler should be considered as a primary tool for foetal surveillance in pregnancy induced hypertension patients and for planning management of IUGR foetuses