ABSTRACT
Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved sig-nificantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusion(s): Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.Copyright © 2022, Author(s).
ABSTRACT
Objective: To design an optimal formulation for quercetin and vitamin C nano-phytosome. Method(s): Nano-phytosomes are prepared by the thin layer hydration technique using a 2-level-5-factor design experimental. A total of 32 experimental formulas were used for data analysis. The ratio of quercetin: soy lecithin (X1), the ratio of quercetin: cholesterol (X2), stirring speed (X3), stirring temperature (X4), and stirring time (X5) were used as independent factors, while globule size as a dependent factor. Data analysis was carried out by Design Expert12 application. Characterization of the optimal formula included physicochemical evaluation, globule size analysis, zeta potential, polydispersity index, entrapment efficiency, Transition Electron Microscopy (TEM) analysis, and FTIR analysis. Result(s): The optimal formula consisted of quercetin: vitamin C: lecithin: cholesterol ratio of 1: 1: 1.046: 0.105 mol;stirring speed 763.986 rpm;stirring time of 59 min, at temperature 51.73 degreeC which produced 59.26 nm average globule size, PDI value 0.66;zeta potential value-35.93+/-0.95 mV and average SPAN value 0.61. This formulation showed entrapment efficiency of quercetin 91.69+/-0.18 % and vitamin C 90.82+/-0.13 %. The TEM and FITR analysis showed the morphological of the globules and interactions between the drugs, soy lecithin, and cholesterol to form nano-phytosomes. Conclusion(s): The conditions to obtain the optimal formula for quercetin vitamin C nano-phytosome consisted of quercetin: vitamin C: lecithin: cholesterol ratio of 1: 1: 1.046: 0.105 mol;stirring speed 763.986 rpm;stirring time of 59 min, and at temperature 51.73 degreeC.Copyright © 2023 The Authors.
ABSTRACT
Background: Neutrophil extracellular traps (NETs) are composed of processed chromatin bound to granular and selected cytoplasmic proteins and released by neutrophils. NETs consist of smooth filaments composed of stacked nucleosomes. Fully hydrated NETs have a cloud-like appearance and occupy a space 10-15-fold larger than the volume of the cells they originate from. DNases are the enzymes that cleave extracellular DNA including NETs. Together with their protective role in microbial infections, NETs are involved in multiple pathological processes and represent key events in a variety of pathologies including cancer, autoimmunity, and cardiovascular disease. Sites of NETs concentration are dangerous for the host if the process of NETs formation becomes chronic or the mechanism of NETs removal does not work. NETosis has been linked to the development of periodontitis, cystic fibrosis, type 2 diabetes, COVID-19 or rheumatoid arthritis as well as cancer progression. Purpose(s): Thus, the destruction of NETs is of primary significance in many pathologies. In our approach, we are focusing on mimicking one of the natural mechanisms of destroying excessive NETs by delivering deoxyribonuclease I to the specific site of pathological NETs accumulation by modifying the nanoparticles using an anti-nucleosome monoclonal antibody (2C5). The antibody is specific to nucleosomes and can recognize histones in NETs. DNase I is U.S. Food and Drug Administration (FDA)-approved active component and is commonly used in therapeutic methods of modern medicine for cystic fibrosis to clear extracellular DNA fibers in the lungs and systemic lupus erythematosus. Recent findings have also shown the effectiveness of DNase I in the digestion of NETs. However, the low serum stability and fast deactivation by environmental stimuli have been considered as the limiting factors for clinical applications of DNase I, which can be overcome by its targeted specific delivery in pharmaceutical nanocarriers. Method(s): In this study, we generate NETs in vitro using human neutrophils and HL-60 cells differentiated into granulocyte-like cells. We used interleukin-8, lipopolysaccharide from E.Coli (LPS), phorbol myristate acetate (PMA), and calcium ionophore A23187 (CI) to generate the NETs. We confirmed the specificity of 2C5 toward NETs by ELISA, which showed that it binds to NETs with the specificity like that for purified nucleohistone substrate. We further utilized that feature to create two delivery systems (liposomes and micelles) for DNAse I enzyme to destroy NETs, which was confirmed by staining NETs with SYTOX Green dye and followed by flow cytometric measurements and microscopic images. Conclusion(s): Our results suggest that 2C5 could be used to identify and visualize NETs and serve as a ligand for NET-targeted diagnostics and therapies. Also, we proved that our carrier can successfully deliver DNase to NETs to provide their degradation.
ABSTRACT
Introduction: Pancreatitis is a very common gastrointestinal disease that results in hospital admission. Early detection and treatment leads to better outcomes. This is the first reported case of pancreatitis secondary to elevated tacrolimus in a patient with prior renal transplantation after receiving Paxlovid for a COVID-19 infection. Case Description/Methods: A 57-year-old male with past medical history of 4 renal transplants secondary to posterior urethral valves who presented to the emergency room with acute onset epigastric pain for 24 hours. He was on tacrolimus 5 mg every 48 hours monotherapy for his immunosuppression. 10 days prior to his presentation he had developed chills and anxiety. He tested positive for COVID-19 at that time on a home rapid test. His symptoms had not significantly improved and given his immunosuppressed state he was given Paxlovid (Nirmatrelvir/ritonavir). He took 2 days of Paxlovid, however after his second day of treatment he developed severe epigastric pain requiring him to go to the emergency room. On admission his labs were notable for a lipase of 150 U/L (ULN 63 U/L). He underwent a CT scan was notable for an enlarged pancreatic head and neck with peripancreatic fat stranding (Figure). He also had a right upper quadrant ultrasound without any cholelithiasis and only trace sludge noted. His creatinine was noted to be 1.81 mg/dl which was above his baseline of 1.2 mg/dl. His tacrolimus trough level resulted at a level 45.6 ng/ml and later peaked at 82.2 ng/ml. His liver enzymes were normal. He was treated as acute pancreatitis with hydration and his tacrolimus was held with overall clinical improvement. Discussion(s): Tacrolimus is one of the most common medications used in solid organ transplantation. It is a calcineurin inhibitor that inhibits both T-lymphocyte signal transduction and IL-2 transcription. It is metabolized by the protein CYP3A and levels are monitored closely. Paxlovid is currently prescribed as an antiviral therapy for COVID-19 infection. The ritonavir compound in Paxlovid is potent inhibitor of CYP3A. Currently the guidelines do not recommend Paxlvoid as a therapeutic in patients taking tacrolimus as there is concern about increased drug levels. There have been several case reports of pancreatitis in setting of tacrolimus. This case report helps to demonstrate the need for close monitoring of therapeutics levels, especially in medications with high risk of drug to drug interaction to help prevent serious side effects such as tacrolimus induced pancreatitis.
ABSTRACT
Background: Crystalloid fluid administration has traditionally played an important role in prevention of hemorrhagic cystitis with high dose cyclophosphamide. Cryopreservation of stem cells in the era of the COVID pandemic has further led to an increase in crystalloid use. Excess fluid administration over a short duration could lead to volume overload, respiratory failure and impact overall survival. Method(s): A retrospective chart review was conducted on patients receiving PtCy following Haplo SCT at UVA Medical Center from September 2016 through August 2022. Internal BMT quality audit in June 2021 identified increased rate of ICU transfers and respiratory failure amongst patient receiving PtCy due to fluid overload. Hence our PtCy hydration was reduced, with IV fluid administration decreasing from 200 mL/ hr over 62 hours to 100 mL/hr over 12 hours. Urine output parameters placed to administer Cytoxan were also removed. We present our quality improvement project demonstrating outcomes pre and post intervention. Result(s): All demographic patient and transplant-related data was collected during the period of hospitalization for Haplo SCT [Table 1]. Pre-intervention spanned 9/2016-8/2021. Our analysis identified higher than expected rates of respiratory (Table Presented) failure prompting intervention on 8/2021. Post-intervention spanned 8/2021-8/2022. Pre-intervention, 45% of patients receiving Haplo SCT developed respiratory failure (defined as a new hypoxia) in the 30 day post-transplant period. Of these, 93% had volume overload. Mechanical ventilation was required in 21%. Complication rates included ICU transfer - 30%, AKI - 39%, and renal replacement therapy - 18%. Three percent (1 pt) developed hemorrhagic cystitis requiring bladder irrigation. Median LOS was 31.0 days. Post-intervention, average IV crystalloid received was reduced by about 15L. Median diuretic use reduced by 40%. No instances of respiratory failure, mechanical ventilation, ICU transfer, AKI or renal replacement therapy occurred in this group. Median LOS was 26.5 days. There were no cases of hemorrhagic cystitis. Please refer Figure 1. (Figure Presented) (Figure Presented) Conclusion(s): This single center quality improvement initiative shows that reducing IV crystalloid administration with PtCy is associated with a reduction in respiratory failure and other adverse clinical outcomes, without observed increase in hemorrhagic cystitis. Larger multi-center studies are needed to validate this finding.Copyright © 2023 American Society for Transplantation and Cellular Therapy
ABSTRACT
Aim To assess the safety and efficacy of extracorporeal therapy in patients with COVID-19. The study included 27 patients aged 67+/-9.7 [min 38, max 87] years with a laboratory-confirmed SARS-CoV-2 and bilateral polysegmental pneumonia, various concomitant chronic diseases who were admitted to Intensive Care Unit and received extracorporeal therapies. All patients had the mean NEWS score of 6.9+/-2.7 [min 4, max 9] and the mean SOFA score of 8.1+/-3.1 [min 3, max 16] at admission Methods to the ICU. 19 patients (70.4%) had severe lung lesions over 75% according to the chest CT scans. 48 extracorporeal therapies were performed using the Multifiltrate (Fresenius Medical Care, Germany) and Aquarius (Nikkiso Aquarius RCA, Great Britain) medical devices. Indications for extracorporeal therapy initiation included cytokine storm associated with acute respiratory distress syndrome and septic shock. Generally, each patient received at least one extracorporeal therapy. 11 patients underwent 2 to 6 sessions. Isolated plasma separation and hemoperfusion helped to reduce vasopressor / cardiotonic support, slightly improved ventilation parameters, with a significant, but not long-term decrease in the levels of inflammation markers. Combining different modalities of extracorporeal therapy that provide rapid elimination of agents, controlled temperature response and hydration, maintaining Results homeostasis and detoxification, appeared to be most optimal. Extracorporeal therapy did not improve the volume of lung parenchyma or lung parenchyma damage. However, 19 (70.4%) patients who received extracorporeal therapy transitioned from mechanical ventilation to spontaneous breathing, whereas 8 (29.6%) patients had severe lung lesions (over 75%) according to the repeated chest CT scans. The mean length of stay in the ICU among survivors was 9+/-3.5 [min 4, max 22]. The 28-day mortality and in-hospital mortality rate was 25.9% (7). Prolonged extracorporeal therapy in patients with SARS-Cov-2 has demonstrated Conclusion efficacy in relieving organ dysfunctions and shock states, but did not significantly affect the remaining lung parenchyma damage.Copyright © 2022 University of Latvia. All Rights Reserved.
ABSTRACT
Background: Exercise intolerance de novo is one of the most common reported symptoms in patients (pts) recovering from COVID-19. Purpose(s): The present study determines etiological and pathophysiological factors influencing the mechanism of exercise intolerance in the COVID-19 survivors. Therefore, the factors affecting percent predicted oxygen uptake at peak exercise VO2 (%VO2pred) in pts after COVID-19 with normal left ventricular ejection fraction were assessed. Methods and Results: The 120 consecutive patients from the Department of Cardiology recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examinations, laboratory test results, echocardiography using Vivid E95 - GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), and spiroergometry using The MetaSoft Studio application were analysed. The subjects were divided into the two following groups: Study i.e. pts with worse oxygen uptake (%VO2pred <80%;N=47) and control including these cases with %VO2pred >=80% (N=73) - Table 1. Pts with %VO2pred <80% presented significantly lower global peak systolic strain (GLPS) [p=0.03], tricuspid annular plane systolic excursion (TAPSE) [p=0.002] and late diastolic filling velocity (A) [p=0.004] compared to controls - Figure 1. The male gender (p=0.007) and the percent of total body water content (TBW %) (p=0.02) were significantly higher in study in comparison to the control group. The results of multiple logistic regression model independently associated with %VO2pred were as follows: A (OR 0.4, 95% CI: 0.17-0.95;p=0.03) and gender (OR 2.52, 95% CI: 1.07-5.91;p=0.03). Conclusion(s): Males have over twice risk of persistent limited exercise tolerance after COVID-19 infection than females. The lower late diastolic filling velocity, tricuspid annular plane systolic excursion, worse global peak systolic strain, and hydration status are connected with limited exercise tolerance after COVID-19 in patients with normal left ventricular ejection fraction.
ABSTRACT
Africa bears the highest burden of infectious diseases, yet the continent is heavily reliant on First World countries for the development and supply of life-saving vaccines. The COVID-19 pandemic was a stark reminder of Africa's vaccine dependence and since then great interest has been generated in establishing mRNA vaccine manufacturing capabilities on the African continent. Herein, we explore alphavirus-based self-amplifying RNAs (saRNAs) delivered by lipid nanoparticles (LNPs) as an alternative to the conventional mRNA vaccine platform. The approach is intended to produce dose-sparing vaccines which could assist resource-constrained countries to achieve vaccine independence. Protocols to synthesize high-quality saRNAs were optimized and in vitro expression of reporter proteins encoded by saRNAs was achieved at low doses and observed for an extended period. Permanently cationic or ionizable LNPs (cLNPs and iLNPs, respectively) were successfully produced, incorporating saRNAs either exteriorly (saRNA-Ext-LNPs) or interiorly (saRNA-Int-LNPs). DOTAP and DOTMA saRNA-Ext-cLNPs performed best and were generally below 200 nm with good PDIs (<0.3). DOTAP and DDA saRNA-Int-cLNPs performed optimally, allowing for saRNA amplification. These were slightly larger, with higher PDIs as a result of the method used, which will require further optimization. In both cases, the N:P ratio and lipid molar ratio had a distinct effect on saRNA expression kinetics, and RNA was encapsulated at high percentages of >90%. These LNPs allow the delivery of saRNA with no significant toxicity. The optimization of saRNA production and identification of potential LNP candidates will facilitate saRNA vaccine and therapeutic development. The dose-sparing properties, versatility, and manufacturing simplicity of the saRNA platform will facilitate a rapid response to future pandemics.
ABSTRACT
Introduction: The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. Objective(s): To determine knowledge regarding heat stress and practice of PPE among HCWs during the COVID-19 pandemic. Material(s) and Method(s): A cross-sectional observational study was done among 115 HCWs using a self-designed questionnaire to identify their thoughts on heat stress caused by PPE wear during the COVID-19 pandemic. The ambient temperature, relative humidity (RH), and dew point in their respective locations were recorded using data loggers (EL-USB-2-LCD+, Lascar Electronics, Salisbury, UK). R version 3.6.2 was used to examine the frequency and descriptive statistics from the survey findings. Pearson's chi-square was used to determine associations. A p value of <0.05 was considered statistically significant. Result(s): The average wet bulb globe temperature (WBG) reported was 30.0oC (IQR 29.1-31.8oC) according to the heat exposure data. The majority of the 115 HCWs were involved in medical consulting (39%), followed by nursing (29%). The researchers discovered that 50% of the workers (n=57) were wearing 5-6 PPEs and had a fourteen-fold increased risk of developing an undesirable thermal health symptom (95 % CI: 0.77 to 280.24;p=0.0737). In addition, 36% of the participants (n=42) worked between 8 and 10 hours every shift with little or no rest. It was also important to note that 76% (n=88) of them worked in non-air-conditioned environments, and 33% (n=38) of them had excessive workloads, which could add to the employees' heat burden. More than half of them agreed that wearing PPE is extremely inconvenient, and they avoided taking breaks to maintain infection control. The impression of thermal stress was reported by 96% of the participants (n=111), and it was found to be substantially linked with the job they were engaged [OR 0.0654 (95% CI: 0.003- 1.246) P=0.001]. More than half of the participants strongly agreed that appropriate rest and hydration before work could help them lower their thermal stress. Conclusion(s): HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Ice slurry ingestion could be a practical and effective method for promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.
ABSTRACT
PurposeIn the present article, the authors have conducted a review on some of the recent developments given in the literature pertaining to the passive protection of concrete structures using intumescent coatings. Here, the main thrust is placed on the spalling phenomenon of concrete elements when exposed to elevated temperatures and fires.Design/methodology/approachIn this context, it has been long established that prolonged thermal insult on concrete members will lead to egress of water, both physically bound as well as those present as water of hydration within the concrete matrix, in the form of steam through microchannels and associated pathways of least resistance, often resulting in the flaking of the surface of the structure. The latter process can ultimately lead to the exposure of the ferrous-based reenforcement elements, for instance, to higher temperatures, thus inducing melting. This, in turn, can result in substantial loss of strength and load-bearing capacity of the structural element that is already undergoing disintegration of its base matrix owing to heat/fire. Even though spalling of concrete structures has long been recognized as a serious problem that can often lead to catastrophic failure of infrastructures, such as buildings, bridges and tunnels, the utility of intumescent coating as a mitigation strategy is relatively new and has not been explored to its fullest possible extent. Therefore, in the latter parts of the review, the authors have endeavored to discuss the different types of intumescent coatings, their modes of actions and, in particular, their wider applicability in terms of protecting concrete elements from detrimental effects of severe or explosive spalling.FindingsGiven that spalling of concrete components is still a very serious issue that can result in loss of lives and destruction of critical infrastructures, there is an urgent need to formulate better mitigating strategies, through novel means and methods. The use of the intumescent coating in this context appears to be a promising way forward but is one that seems to be little explored so far. Therefore, a more systematic investigation is highly warranted in this area, especially, as the authors envisage a greater activity in the building and commissioning of more infrastructures worldwide incommensurate with augmented economic activities during the post-COVID recovery period.Originality/valueThe authors have conducted a review on some of the recent developments given in the literature pertaining to the passive protection of concrete structures using intumescent coatings. The authors have also included the results from some recent tests carried out at the facilities using a newly commissioned state-of-the-art furnace.
ABSTRACT
Seventy-three-year-old diabetic male was a high-risk transfer from Alaska for respiratory decompensation in the setting of progressive bulbar and proximal weakness. He was diagnosed with COVID-19 two months prior and viral mononucleosis 1 month prior to presentation. While the patient had a fall 3 months prior to presentation, and decreased mobility at home, there was abrupt onset of progressive upper/lower extremity weakness, dysphagia, and difficulties managing secretions 2 weeks prior to presentation. Initial exam was notable for MRC 3-4/5 proximal upper/lower extremity weakness, areflexia, and negative inspiratory force of 224 to 230 cm H20. A subtle periorbital heliotrope rash was documented. Lumbar puncture demonstrated albumino-cytologic dissociation (protein 142 mg/dL, 6 WBCs) and CK remained elevated (1930 U/L) despite intravenous hydration. Outside electrodiagnostic testing demonstrated a sensorimotor axonal neuropathy with questionable myopathic features on needle electromyography. Given concern for an inflammatory neuropathy and concomitant inflammatory myopathy, intravenous immunoglobulin 2G/kg and IV methylprednisolone 1G/day over 5 days was started. He was transferred for further diagnostic workup and supportive care 6 days after presentation and required intubation within 24 hours of admission. Exam showed progressive proximal and distal weakness of the extremities and general areflexia/hyporeflexia. Repeat electromyography confirmed a severe sensorimotor axonal polyneuropathy without acquired demyelinating features and normal repetitive nerve stimulation. While the patient could no longer activate muscles voluntarily, proximal muscles had increased spontaneous activity with predominant myotonia. Neuroaxis imaging was notable only for enhancement of the lumbar nerve roots. Combined vastus lateralis muscle biopsy and serologic testing confirmed a second pathologic process contributing to the patient's weakness. This case highlights the cooccurrence of 2 distinct neuropathological entities, with potential relation to a prior viral infection, and the importance of ancillary testing to guide treatment for acute causes of neuromuscular respiratory failure.
ABSTRACT
Aim: The COVID-19 pandemic has seen hospitals isolating suspect cases. Geriatric populations are at a risk of severe COVID-19 disease and often present with concomitant geriatric syndromes requiring holistic interdisciplinary care. However, isolation of older people poses challenges to care delivery. This study shares the experience of Singapore's first acute geriatric isolation facility geriatric PARI (Pneumonia-Acute Respiratory Infection) ward and describes the geriatric-related outcomes and pitfalls in care delivery. Method(s): This is a retrospective cross-sectional study performed in 7 negative pressure isolation rooms in an acute care public hospital in Singapore. 100 patients admitted consecutively to the geriatric PARI ward were included. Patient demographics, presenting symptoms and geriatric-related adverse outcomes associated with hospitalisation were collected and analysed. Result(s): Patients' mean age was 86.4 years (standard deviation [SD]: 6.8) with significant comorbidities being hypertension (81%), hyperlipidaemia (74%) and renal disease (70%). 51% of patients had dementia and 24% had behaviour and psychological symptoms of dementia (BPSD). 27% of patients presented atypically with delirium and 15% presented with a fall. Delirium was associated with restraint use (OR: 3.88;p-value 0.01). Falls rate was 1.64 per 1000 occupied bed. 1 patient screened positive for COVID-19. Conclusion(s): The geriatric PARI ward is essential for curbing nosocomial transmission of COVID-19. This is important in the older people with comorbidities who are more likely to develop morbidity and mortality. Our study reveals challenges in delivering person-centred care to the older patients in isolation rooms, especially in the management of delirium and falls prevention. Innovative strategies should be developed to minimise isolation-related adverse outcome.Copyright © The Author(s) 2022.
ABSTRACT
The profession of pharmacist involves a continuous effort to combat diseases and preserve social health in various urban and rural communities. Pharmacists are exposed to a variety of risk factors while performing their professional activity. The COVID-19 pandemic period introduced an additional risk among occupational risk factors. The aim of the study is to identify occupational risk factors among pharmacists and the health problems they face at work. The study also seeks to propose some recommendations for risk prophylaxis and to facilitate the activity in conditions of good professional practice and to minimize exposure to occupational risk factors. The proposed questionnaire aims to highlight the level of health and habits, lifestyle practices and perceptions of the typology of healthy living in this professional group. The application of the questionnaire can also be the sign for the transition point from the state of health to the pathological status. The correlation of professional and non-professional factors led to the profiling of relationships between all risk factors induced by the specific of the profession and theorizing a set of prophylactic or curative intervention measures. Compliance with a physical activity program and a lifestyle according with the standards of relevant domestic and international bodies will increase the quality of life of these specialists as well as the quality of professional acts in the service of public health.Copyright © 2023, Romanian Society for Pharmaceutical Sciences. All rights reserved.
ABSTRACT
Following the global pandemic of COVID-19, in August 2021, Indonesia achieved a total of 3.930.300 cases, the highest in Southeast Asia. However, the government is keen on promoting the new normal phase and planning to open schools and permit face-to-face learning, from elementary up to universities. This means that public facilities and infrastructures will be used and can be the medium for virus transmission, as it will require 48 to 72 hours for the virus to be inactive on those surfaces. This will make people reluctant to touch surfaces, especially when it comes to public facilities that can provide for their needs. One of the most important is the need for hydration which is often overlooked. About 25% of college students were found dehydrated, and 37,5% showed signs of it. Dehydration could prove a serious threat to health had it been overlooked and could affect physical and cognitive performance, having more effects on students and lectures, requiring both in their activities. To support the needs of hydration amidst the pandemic, this research developed a touchless water dispenser system using the waterfall model, utilizing a cloud database with ESP32, controlled by users through an android application. The design is easy and cheap to install, even on regular dispensers, making it an effective and efficient alternative public facility providing hydration service to support the new normal phase © IJASEIT is licensed under a Creative Commons Attribution-Share Alike 4.0 International License
ABSTRACT
H-bond networks at heterogeneous interfaces play crucial roles in bioseparation, biocatalysis, biochip array profiling, and functional nanosystem self-assembly, but their precise modulation and enhancement remain challenging. In this study, we have discovered that interfacial hydrophobic hydration significantly enhances H-bond networks at the interface between a glycan-modified adsorbent and a methanol-water-acetonitrile ternary solution. The enhanced H-bond networks greatly promote the adsorbent-solution heterogeneous glycan-glycan recognition and interaction. This novel hydrophobic hydration-enhanced hydrophilic interaction (HEHI) strategy improves the affinity and efficiency of intact glycopeptide enrichment. Compared with the commonly used hydrophilic-interaction enrichment strategy, 23.5 and 48.5% more intact N- and O-glycopeptides are identified, and the enrichment recoveries of half of the glycopeptides are increased >100%. Further, in-depth profiling of both N- and O-glycosylation occurring on SARS-CoV-2 S1 and hACE2 proteins has been achieved with more glycan types and novel O-glycosylation information involved. Interfacial hydrophobic hydration provides a powerful tool for the modulation of hydrophilic interactions in biological systems.
Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Glycosylation , Glycopeptides/chemistry , Polysaccharides/chemistry , Hydrophobic and Hydrophilic InteractionsABSTRACT
INTRODUCTION: Using co-design processes, we aimed to develop an evidence-based decision guide for family carers and hospital professionals to support decision-making about eating and drinking for hospital patients with severe dementia. METHODS: Following a systematic review, we interviewed people with mild dementia, family carers and hospital professionals in England. We then held co-design workshops with family carers and hospital professionals. In parallel with the workshops, we used a matrix to synthesize data from all studies and to develop a decision guide prototype. The prototype was iteratively refined through further co-design workshops and discussions among researchers and Patient and Public Involvement (PPI) representatives. We conducted user testing for final feedback and to finalize the decision guide. RESULTS: Most participants acknowledged the limited benefits of tube feeding and would not use or want it for someone with severe dementia. However, they found decision-making processes and communication about nutrition and hydration were emotionally demanding and poorly supported in acute hospitals. The co-design groups developed the aims of the decision guide to support conversations and shared decision-making processes in acute hospitals, and help people reach evidence-based decisions. It was designed to clarify decision-making stages, provide information and elicit the values/preferences of everyone involved. It encouraged person-centred care, best-interests decision-making and multidisciplinary team working. From user testing, family carers and hospital professionals thought the decision guide could help initiate conversations and inform decisions. The final decision guide was disseminated and is being used in clinical practice in England. CONCLUSION: We used rigorous and transparent processes to co-design the decision guide with everyone involved. The decision guide may facilitate conversations about nutrition and hydration and help people reach shared decisions that meet the needs and preferences of people with severe dementia. Future evaluation is required to test its real-world impacts. PATIENT OR PUBLIC CONTRIBUTION: People with mild dementia, family carers and hospital professionals contributed to the design of the decision guide through the interviews and co-design workshops. PPI members helped design study procedures and materials and prepare this manuscript.
Subject(s)
Dementia , Humans , Dementia/psychology , Caregivers/psychology , England , HospitalsABSTRACT
PURPOSE: This study determined fluid intake and physical activity behaviors among college students during the COVID-19 pandemic. METHODS: College students (n = 1014; females, 75.6%) completed an online survey during the Spring 2020 academic semester following the initial global response to the COVID-19 pandemic. Academic standing, habitation situation, and University/College responses to COVID-19 were collected. Participants completed the Godin Leisure-Time Exercise Questionnaire and a 15-item Beverage Questionnaire (BEVQ-15) to determine physical activity level and fluid intake behaviors, respectively. RESULTS: Females (1920 ± 960 mL) consumed significantly less fluid than males (2400 ± 1270 mL, p < 0.001). Living off-campus (p < 0.01) and living with a spouse/partner (p < 0.01) was associated with increased consumption of alcoholic beverages. 88.7% of participants reported being at least moderately active; however, Black/African American and Asian participants were more likely to be less active than their Caucasian/White counterparts (p < 0.05). Participants reporting no change in habitation in response to COVID-19 had a higher fluid intake (p = 0.002); however, the plain water consumption remained consistent (p = 0.116). While there was no effect of habitation or suspension of classes on physical activity levels (p > 0.05), greater self-reported physical activity was associated with greater fluid intake (std. ß = 0.091, p = 0.003). CONCLUSIONS: Fluid intake among college students during the initial response to the COVID-19 pandemic approximated current daily fluid intake recommendations. Associations between COVID-19-related disruptions (i.e., suspension of classes and changes in habitation) and increased alcohol intake are concerning and may suggest the need for the development of targeted strategies and programming to attenuate the execution of negative health-related behaviors in college students.
ABSTRACT
Biomimetic strategies can be adopted to improve biopharmaceutical aspects. Subsequently, Biomimetic reconstitutable pegylated amphiphilic lipid nanocarriers have high translational potential for systemic controlled drug delivery;however, such an improvised system for systemic aspirin delivery exploring nanotechnology is not available. Systemic administration of aspirin and its controlled delivery can significantly control blood clotting events, leading to stroke, which has immediate applications in cardiovascular diseases and Covid-19. In this work, we are developing aspirin sustained release pegylated amphiphilic self-assembling nanoparticles to develop reconstitutable aspirin injections by solvent-based co-precipitation method with phase inversion technique that leads to novel "biomimetic niosomal nanoparticles (BNNs).” DOE led optimization is done to develop Design of space for optimized particles. Upon reconstitution of solid powder, the particle size was 144.8 ± 12.90 nm with a surface charge of -29.2 ± 2.24 mV. The entrapment efficiency was found to be 49 ± 0.15%, wherein 96.99 ± 1.57% of the drug was released in 24hr showing super case II transport-based drug release mechanism. The formulation has the least hemolysis while showing significant suppression of platelet aggregation. MTT assay does not show any significant cytotoxicity. This is a potential nanoparticle that can be explored for developing aspirin injection, which is not available.
ABSTRACT
"Ethics is knowing the difference between what you have a right to do and what is right to do.” -Potter Stewart. In their position paper, "Ethical Aspects of Artificially Administered Nutrition and Hydration: An ASPEN Position Paper”, [1] Schwartz et al. eloquently communicate key ethical concepts surrounding the care of patients receiving artificially administered nutrition and hydration (AANH). Ethically, all clinicians have the right and responsibility to provide nutrition-related access and resources to individuals in their care. At the same time, AANH is not always the right treatment to offer or provide. This revised position paper, published in Nutrition in Clinical Practice (NCP) in April 2021 [1], is the work of the American Society for Parenteral and Enteral Nutrition (ASPEN) International Clinical Ethics Position Paper Update Workgroup. It represents a comprehensive update of the Ethics Position Paper of the ASPEN Ethics Position Paper Task Force, published in NCP in 2010. [2] The revised position paper includes a detailed discussion of important ethical considerations not covered in the 2010 paper: cancer and AANH, eating disorders and AANH, ethical considerations raised during the COVID-19 pandemic, and an international perspective on ethics and AANH. The position paper also references the Cartagena Declaration of 2019, which "stresses the recognition that nutrition care is a human right” [1,3] and comments that "extrapolating from this document, it appears to support resource allocation in a fair, transparent and consistent fashion” [1,3]. This commentary summarizes the position paper and serves as a "call to action”. All medical professionals can and should engage in ethical aspects of AANH. Roles may vary depending on professional discipline and setting, but each interdisciplinary team member provides critical value. We also strongly encourage all readers to engage in conversations surrounding the topic of AANH and ethics: disseminating the principles in the position paper via local, regional, and national conference presentations, journal club discussions, grand rounds, and within the fundamental educational preparation of all clinicians involved in nutrition therapy practice. © 2022 The Author(s)
ABSTRACT
Periorbital swelling is a clinical presentation with a broad differential and potentially deleterious consequence. Causes range from benign, including allergic reaction, to vision-and life-threatening, including orbital cellulitis and orbital infarction. The recent climate of SARS-CoV-2 has further complicated this differential, as the virus poses broad clinical presentations with new manifestations reported frequently. Rapid identification of the underlying etiology is crucial, as treatment approaches diverge greatly. Here, we report the case of an African American adolescent male with a history of homozygous sickle cell anemia presenting to an inner city hospital with bilateral periorbital swelling amid the coronavirus pandemic. Differentials including orbital cellulitis, COVID-MIS-C, orbital inflammatory syndrome, Hoagland sign, and orbital infarction secondary to sickle cell crisis are contrasted. We contrast our case with 12 case reports of orbital infarction in the setting of sickle cell crisis within the past 10 years, highlighting how these presentations, along with commonly reported findings of orbital infarction, compare with our patient. Copyright © 2022 Tehran University of Medical Sciences.