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Healthcare (Basel, Switzerland) Apr 2024Prehospital care is a fundamental component of stroke care that predominantly focuses on shortening the time between diagnosis and reaching definitive stroke management.... (Review)
Review
Prehospital care is a fundamental component of stroke care that predominantly focuses on shortening the time between diagnosis and reaching definitive stroke management. With growing evidence of the physiological parameters affecting long-term patient outcomes, prehospital clinicians need to consider the balance between rapid transfer and increased physiological-parameter monitoring and intervention. This systematic review explores the existing literature on prehospital physiological monitoring and intervention to modify these parameters in stroke patients. The systematic review was registered on PROSPERO (CRD42022308991) and conducted across four databases with citation cascading. Based on the identified inclusion and exclusion criteria, 19 studies were retained for this review. The studies were classified into two themes: physiological-monitoring intervention and pharmacological-therapy intervention. A total of 14 included studies explored prehospital physiological monitoring. Elevated blood pressure was associated with increased hematoma volume in intracerebral hemorrhage and, in some reports, with increased rates of early neurological deterioration and prehospital neurological deterioration. A reduction in prehospital heart rate variability was associated with unfavorable clinical outcomes. Further, five of the included records investigated the delivery of pharmacological therapy in the prehospital environment for patients presenting with acute stroke. BP-lowering interventions were successfully demonstrated through three trials; however, evidence of their benefit to clinical outcomes is limited. Two studies investigating the use of oxygen and magnesium sulfate as neuroprotective agents did not demonstrate an improvement in patient's outcomes. This systematic review highlights the absence of continuous physiological parameter monitoring, investigates fundamental physiological parameters, and provides recommendations for future work, with the aim of improving stroke patient outcomes.
PubMed: 38667597
DOI: 10.3390/healthcare12080835 -
Antibiotics (Basel, Switzerland) Mar 2024Worldwide, bacterial resistance is one of the most severe public health problems. Currently, the failure of antibiotics to counteract superbugs highlights the need to...
Worldwide, bacterial resistance is one of the most severe public health problems. Currently, the failure of antibiotics to counteract superbugs highlights the need to search for new molecules with antimicrobial potential to combat them. The objective of this research was to evaluate the antimicrobial activity of BS4 against Gram-negative bacteria. Thirty yeasts and thirty-two isolates were tested following the agar well-diffusion method. Four sp. strains (BS3, BS4, BS17, and BS21) showed antagonistic activity against ATCC 25922 using bacterial culture (BC) and the cell-free supernatant (CFS), where the BS4 strain stood out, showing inhibitory values of 20.50 ± 0.70 mm and 19.67 ± 0.58 mm for BC and CFS, respectively. The sp. BS4 strain can produce antioxidant, non-hemolytic, and antimicrobial metabolites that exhibit activity against several microorganisms such as , , , , , , , sp., , , and . According to the characterization of the supernatant, the metabolites could be proteinaceous. The production of these metabolites is influenced by carbon and nitrogen sources. The most suitable medium to produce antimicrobial metabolites was TSB broth. The one-factor-at-a-time method was used to standardize parameters such as pH, agitation, temperature, carbon source, nitrogen source, and salts, resulting in the best conditions of pH 7, 150 rpm, 28 °C, starch (2.5 g/L), tryptone (20 g/L), and magnesium sulfate (0.2 g/L), respectively. Moreover, the co-culture was an excellent strategy to improve antimicrobial activity, achieving maximum antimicrobial activity with an inhibition zone of 21.85 ± 1.03 mm. These findings position the BS4 strain as a promising candidate for producing bioactive molecules with potential applications in human health.
PubMed: 38666980
DOI: 10.3390/antibiotics13040304 -
Journal of Anaesthesiology, Clinical... 2024Magnesium sulfate (MgSO) has been demonstrated to have analgesic property in various clinical settings. This study explores if addition of MgSO to ropivacaine increases...
To assess the analgesic efficacy of adjuvant magnesium sulfate added with ropivacaine over ropivacaine alone as a continuous infiltration in total abdominal hysterectomy wound: A randomized controlled trial.
BACKGROUND AND AIMS
Magnesium sulfate (MgSO) has been demonstrated to have analgesic property in various clinical settings. This study explores if addition of MgSO to ropivacaine increases its analgesic efficacy when infiltrated continuously in the postsurgical wound following total abdominal hysterectomy.
MATERIAL AND METHODS
This randomized controlled trial was conducted at a tertiary care referral hospital in New Delhi, India. Fifty-two patients were randomized into two groups to receive the intervention of which 48 were able to complete the study. The first group ( = 26) received 0.25% ropivacaine infiltration and the second group ( = 26) received 0.25% ropivacaine with 5% MgSO at the incision site for 48 h postoperatively. Primary objective was to compare the total postoperative opioid (morphine) consumption by the study participants in both the groups and the secondary objectives were pain scores at rest and at movement, patient satisfaction score, and wound quality of life on the 7 postoperative day among the two groups.
RESULTS
Both the groups were comparable in their demographic characteristics. The median morphine consumed at 48 h postoperatively was 16.5 [0-77] mg in the ropivacaine group and 13[1-45] mg in the ropivacaine with MgSO group and the difference was statistically insignificant ( = 0.788). There was no statistical difference between the groups with respect to the pain scores, patient satisfaction, or wound quality of life at 7 days.
CONCLUSION
The addition of MgSO to ropivacaine does not confer any additional postoperative analgesic benefits over ropivacaine alone in continuous wound infiltration following total abdominal hysterectomy.
PubMed: 38666179
DOI: 10.4103/joacp.joacp_239_22 -
Journal of Cardiothoracic Surgery Apr 2024St. Thomas cardioplegia is commonly administered to adults, yet repeated dosing at brief intervals is required. Del Nido's cardioplegic solution provides a prolonged... (Observational Study)
Observational Study Comparative Study
BACKGROUND
St. Thomas cardioplegia is commonly administered to adults, yet repeated dosing at brief intervals is required. Del Nido's cardioplegic solution provides a prolonged duration of safe myocardial arrest, yet it was primarily intended for pediatric cardiac surgery. Recently, there has been an increasing interest in using Del Nido's in adults; this might be due to its ease of administration and extended re-dosing intervals. This study contrasted Del Nido's to modified St. Thomas cardioplegia in adults.
METHODS
This study was conducted on 200 patients. Troponin-T was the primary outcome within the first 24 and 48 h post-surgery. Cardiopulmonary bypass time, cross-clamp time, intraoperative use of inotropic support, defibrillator and/or intra-aortic balloon were the secondary outcomes of the study.
RESULTS
There was a significant reduction in post-operative Troponin-T levels in the first 24 and 48 h within Del Nido's group compared to the modified St. Thomas group. The cross-clamp and cardiopulmonary bypass times were also found to be lower within Del Nido's group.
CONCLUSION
This study has demonstrated a significant reduction in early postoperative Troponin-T levels as well as operative times favoring Del Nido's in adults.
Topics: Humans; Heart Arrest, Induced; Retrospective Studies; Male; Female; Cardioplegic Solutions; Middle Aged; Cardiac Surgical Procedures; Troponin T; Adult; Cardiopulmonary Bypass; Aged; Potassium Chloride; Treatment Outcome; Mannitol; Sodium Bicarbonate; Bicarbonates; Solutions; Magnesium Sulfate; Calcium Chloride; Lidocaine; Electrolytes; Sodium Chloride; Magnesium
PubMed: 38664851
DOI: 10.1186/s13019-024-02683-1 -
BMC Pregnancy and Childbirth Apr 2024Some studies have compared the efficacy of nifedipine with that of other tocolytic drugs in the treatment of preterm labor, but the reported results are conflicting. (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
Some studies have compared the efficacy of nifedipine with that of other tocolytic drugs in the treatment of preterm labor, but the reported results are conflicting.
OBJECTIVE
To compare the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor.
METHODS
In this systematic review and meta-analysis, PubMed/MEDLINE, Scopus, Clarivate Analytics Web of Science, and Google Scholar were searched until April 3,2024 using predefined keywords. Randomized controlled trials (RCTs) and clinical trials that compared the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor were included. Two authors independently reviewed the articles, assessed their quality and extracted the data. The quality of the included RCTs based on the Cochrane Risk of Bias Tool 1 for clinical trial studies. The risk difference (RD) with the associated 95% confidence interval (CI) was calculated. A forest plot diagram was used to show the comparative point estimates of nifedipine and other tocolytic drugs on the prevention of preterm labor and their associated 95% confidence intervals based on the duration of pregnancy prolongation. Study heterogeneity was evaluated by the I index, and publication bias was evaluated by Egger's test.
RESULTS
Forty studies enrolling 4336 women were included. According to our meta-analysis, there was a significant difference in the prolongation of preterm labor within the first 48 h between the nifedipine group and the nitroglycerine group (RD, -0.04; 95% CI, -0.08 to -0.00; I: 32.3%). Additionally, there were significant differences between nifedipine and ritodrine (RD, 0.11; 95% CI, 0.02 to 0.21; I, 51.2%) for more than one week RD, 0.10; 95% CI, 0.03 to 0.19; I, 33.2%) and for 34 weeks and more. The difference between nifedipine and magnesium sulfate was not significant in any of the four time points.
CONCLUSIONS
Considering the superiority of nifedipine over ritodrine and nitroglycerine and its similar efficacy to magnesium sulfate for tocolysis, it seems that the side effects of these options determine the first drug line.
Topics: Humans; Nifedipine; Female; Pregnancy; Obstetric Labor, Premature; Magnesium Sulfate; Ritodrine; Tocolytic Agents; Nitroglycerin; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38664622
DOI: 10.1186/s12884-024-06497-w -
Scientific Reports Apr 2024The absence of biodegradability exhibited by plastics is a matter of significant concern among environmentalists and scientists on a global scale. Therefore, it is...
The absence of biodegradability exhibited by plastics is a matter of significant concern among environmentalists and scientists on a global scale. Therefore, it is essential to figure out potential pathways for the use of recycled plastics. The prospective applications of its utilisation in concrete are noteworthy. The use of recycled plastic into concrete, either as a partial or complete substitution for natural aggregates, addresses the issue of its proper disposal besides contributing to the preservation of natural aggregate resources. Furthermore, the use of agricultural wastes has been regarded as a very promising waste-based substance in the industry of concrete manufacturing, with the aim of fostering the creation of an environmentally sustainable construction material. This paper illustrates the impact of nano sunflower ash (NSFA) and nano walnut shells ash (NWSA) on durability (compressive strength and density after exposure to 800 °C and sulphate attack), mechanical properties (flexural, splitting tensile and compressive strength) and fresh characteristics (slump flow diameter, T50, V-funnel flow time, L-box height ratio, segregation resistance and density) of lightweight self-compacting concrete (LWSCC). The waste walnut shells and local Iraqi sunflower were calcinated at 700 ± 50 °C for 2 h and milled for 3 h using ball milling for producing NSFA and NWSA. The ball milling succeeded in reducing the particle size lower than 75 nm for NSFA and NWSA. The preparation of seven LWSCC concrete mixes was carried out to obtain a control mix, three mixtures were created using 10%, 20% and 30% NWSA, and the other three mixtures included 10%, 20% and 30% NSFA. The normal weight coarse aggregates were substituted by the plastic waste lightweight coarse aggregate with a ratio of 75%. The fresh LWSCC passing capacity, segregation resistance, and filling capability were evaluated. The hardened characteristics of LWSCC were evaluated by determining the flexural and splitting tensile strength at 7, 14 and 28 days and the compressive strength was measured at 7, 14, 28 and 60 days. Dry density and compressive strength were measured after exposing mixes to a temperature of 800 °C for 3 h and immersed in 10% magnesium sulphate attack. The results demonstrated that the LWSCC mechanical characteristics were reduced when the percentages of NWSA and NSFA increased, except for 10% NWSA substitution ratio which had an increase in splitting tensile strength test and similar flexural strength test to the control mixture. A minor change in mechanical characteristics was observed within the results of LWSCC dry density and compressive strength incorporating various NSFA and NWSA` contents after exposing to temperature 800 °C and immersed in 10% magnesium sulphate attack. Furthermore, according to the findings, it is possible to use a combination of materials consisting of 10-20% NSFA and 10-20% NWSA to produce LWSCC.
PubMed: 38658797
DOI: 10.1038/s41598-024-60096-5 -
Scientific Reports Apr 2024More than 70% of the potash fertilizer globally is produced by the froth flotation process, in which 4-dodecylmorpholine (DMP) serves as a reverse flotation agent. As...
More than 70% of the potash fertilizer globally is produced by the froth flotation process, in which 4-dodecylmorpholine (DMP) serves as a reverse flotation agent. As the potash fertilizer production rapidly rises, the increased DMP levels in discharged brine pose a threat to the production of high-value chemicals. In this paper, composite particles of basic magnesium sulfate@TiO (BMS@TiO) were prepared using a simple and mild loading method. These particles were utilized for the adsorption and photocatalytic degradation of DMP in brine. Compared with normal powdered materials, the granular BMS@TiO in this study can be easily separated from liquid, and the degradation intermediates will not enter the brine without causing secondary pollution. BMS@TiO consists of 5·1·7 phase (5Mg(OH)·MgSO·7HO) whisker clusters embedding 2.3% TiO. The adsorption equilibrium of DMP on BMS@TiO particles was achieved through hydrogen bonding and pore interception with the adsorption capacity of approximately 5 mg g after 6 h. The photodegradation efficiency of DMP adsorbed on BMS@TiO reached about 92% within 16 h, which is compared with that of pure TiO nanoparticles. Additionally, excellent stability and recyclability of BMS@TiO were also observed in five cycle tests of adsorption and photocatalytic degradation of DMP, and the possible photocatalytic degradation pathways and mechanism of DMP are proposed following molecular electrostatic potential analysis. This work provides a sustainable and environmentally friendly approach for eliminating organic micropollutants from water environments.
PubMed: 38653770
DOI: 10.1038/s41598-024-59921-8 -
Heliyon Apr 2024Torsades de Pointes (TdP) is a malignant polymorphic ventricular tachycardia with heart rate corrected QT interval (QTc) prolongation, which may be attributed to...
Case report: A 56-year-old woman presenting with torsades de pointes and cardiac arrest associated with levosimendan administration and underlying congenital long QT syndrome type 1.
Torsades de Pointes (TdP) is a malignant polymorphic ventricular tachycardia with heart rate corrected QT interval (QTc) prolongation, which may be attributed to congenital and acquired factors. Although various acquired factors for TdP have been summarized, levosimendan administration in complex postoperative settings is relatively uncommon. Timely identification of potential causes and appropriate management may improve the outcome. Herein, we describe the postoperative case of a 56-year-old female with initial normal QTc who accepted the administration of levosimendan for heart failure, suffered TdP, cardiac arrest, and possible Takotsubo cardiomyopathy, further genetically confirmed as long QT syndrome type 1 (LQT1). The patient was successfully treated with magnesium sulfate, atenolol, and implantable cardioverter defibrillator implantation. There should be a careful evaluation of the at-risk populations and close monitoring of the electrocardiograms, particularly the QT interval, to reduce the risk of near-fatal arrhythmias during the use of levosimendan.
PubMed: 38644859
DOI: 10.1016/j.heliyon.2024.e29300 -
The Kobe Journal of Medical Sciences Apr 2024Hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome is one of the most severe complications of hypertensive disorders of pregnancy. HELLP...
Hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome is one of the most severe complications of hypertensive disorders of pregnancy. HELLP syndrome occurring before 22 gestational weeks (GWs) is extremely rare, and patients prevalently exhibit underlying maternal diseases or fetal abnormalities. Here, we report the case of a pregnant woman who had HELLP syndrome at 20 GWs without any obvious underlying maternal diseases or fetal abnormalities. A 38-year-old pregnant woman was referred to Kobe University Hospital from another hospital at 19 + 5/7 GWs for hypertension, proteinuria, generalized edema, and fetal growth restriction. She was diagnosed with partial HELLP syndrome according to the Mississippi classification at 20 + 2/7 GWs. The patient was managed following the Mississippi protocol, including intravenous dexamethasone, magnesium sulfate, and antihypertensive drugs. She received intensive blood pressure and laboratory data monitoring using an arterial line and additional treatments, including platelet transfusion, intravenous haptoglobin infusion, and human atrial natriuretic peptide. The pregnancy ended in an induced delivery at 20 + 3/7 GWs, and she was discharged without complications 10 days postnatal. We performed laboratory tests for diagnosing underlying diseases but identified no obvious underlying diseases. This report indicates that early and intensive treatment of patients with HELLP syndrome occurring before 22 GWs according to the Mississippi protocol may enable clinicians to complete pregnancy termination without maternal complications and provide useful information to clinical practitioners in perinatal medicine.
Topics: Adult; Female; Humans; Pregnancy; Antihypertensive Agents; Dexamethasone; HELLP Syndrome; Magnesium Sulfate; Pregnancy Trimester, Second
PubMed: 38644297
DOI: 10.24546/0100488386 -
MMWR. Morbidity and Mortality Weekly... Apr 2024Pediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during...
Pediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S. children and adolescents aged 5-18 years, using a case-control design. Too few children and adolescents received bivalent or updated monovalent vaccines to separately evaluate their effectiveness. Most case-patients (persons with a positive SARS-CoV-2 test result) were unvaccinated, despite the high frequency of reported underlying conditions associated with severe COVID-19. VE of the original monovalent vaccine against COVID-19-related hospitalizations was 52% (95% CI = 33%-66%) when the most recent dose was administered <120 days before hospitalization and 19% (95% CI = 2%-32%) if the interval was 120-364 days. VE of the original monovalent vaccine against COVID-19-related hospitalization was 31% (95% CI = 18%-43%) if the last dose was received any time within the previous year. VE against critical COVID-19-related illness, defined as receipt of noninvasive or invasive mechanical ventilation, vasoactive infusions, extracorporeal membrane oxygenation, and illness resulting in death, was 57% (95% CI = 21%-76%) when the most recent dose was received <120 days before hospitalization, 25% (95% CI = -9% to 49%) if it was received 120-364 days before hospitalization, and 38% (95% CI = 15%-55%) if the last dose was received any time within the previous year. VE was similar after excluding children and adolescents with documented immunocompromising conditions. Because of the low frequency of children who received updated COVID-19 vaccines and waning effectiveness of original monovalent doses, these data support CDC recommendations that all children and adolescents receive updated COVID-19 vaccines to protect against severe COVID-19.
Topics: Humans; Adolescent; Child; United States; COVID-19 Vaccines; COVID-19; mRNA Vaccines; Vaccine Efficacy; SARS-CoV-2; Hospitalization; RNA, Messenger
PubMed: 38635481
DOI: 10.15585/mmwr.mm7315a2