Successful implementation of safe practice for adult intravenous push medication in a tertiary care hospital: determination of stability of four intravenous antibiotics in syringes.

In 2017, a severe shortage of infusion bags resulted in a paradigm change in medication administration practice from intermittent infusion to intravenous push. The Institute for Safe Medication Practices proposed safe practice guidelines for adult intravenous push medications. A different study showed that ready-to-administer medication prepared in the sterile area of a pharmacy reduces the risk of harm, nurses' time for medication administration and the cost of medications. Based on the recommendation of the Institute for Safe Medication Practices, we decided to conduct a pilot study on the implementation of sterile compounding and administration of intravenous push medication in adult patients admitted to the hospital. In the study, the stability of five intravenous push antibiotic syringes was also determined in the syringes.

Exploring the Potential of Nitrogen-Doped Graphene in ZnSe-TiO2 Composite Materials for Supercapacitor Electrode.

The current study explores the prospective of a nitrogen-doped graphene (NG) incorporated into ZnSe-TiO2 composites via hydrothermal method for supercapacitor electrodes. Structural, morphological, and electronic characterizations are conducted using XRD, SEM, Raman, and UV analyses. The electrochemical study is performed and galvanostatic charge-discharge (GCD) and cyclic voltammetry (CV) are evaluated for the supercapacitor electrode material. Results demonstrate improved performance in the ZnSe-NG-TiO2 composite, indicating its potential for advanced supercapacitors with enhanced efficiency, stability, and power density. Specific capacity calculations and galvanic charge-discharge experiments confirmed the promising electrochemical activity of ZnSe-NG-TiO2, which has a specific capacity of 222 C/g. The negative link among specific capacity and current density demonstrated the composite's potential for high energy density and high-power density electrochemical devices. Overall, the study shows that composite materials derived from multiple families can synergistically improve electrode characteristics for advanced energy storage applications.

Surgical removal of an ectopic haemodialysis catheter in the brachiocephalic artery: a case report.

Percutaneous central vein catheterization is commonly performed to access venous circulation for various clinical indications. However, unintentional arterial puncture may occur which can result in catastrophic complications. We report a case of an inadvertent right brachiocephalic artery cannulation in a 77-year-old lady planned for haemodialysis via a percutaneous internal jugular vein vascular access performed under ultrasound guidance. As an intravascular stent is not favourable in view of the close proximity of the right common carotid artery to the site of puncture as well as the risk of massive bleeding upon simple removal of the catheter, an open surgical removal via a median sternotomy was performed. Acquiring the competency in procedural skills, an understanding of the surgical anatomy and anticipating impending complications are of paramount importance in preventing as well as in mitigating the above complication.

Calcipotriol Nanosuspension-Loaded Trilayer Dissolving Microneedle Patches for the Treatment of Psoriasis: In Vitro Delivery and In Vivo Antipsoriatic Activity Studies.

Psoriasis, affecting 2-3% of the global population, is a chronic inflammatory skin condition without a definitive cure. Current treatments focus on managing symptoms. Recognizing the need for innovative drug delivery methods to enhance patient adherence, this study explores a new approach using calcipotriol monohydrate (CPM), a primary topical treatment for psoriasis. Despite its effectiveness, CPM's therapeutic potential is often limited by factors like the greasiness of topical applications, poor skin permeability, low skin retention, and lack of controlled delivery. To overcome these challenges, the study introduces CPM in the form of nanosuspensions (NSs), characterized by an average particle size of 211 ± 2 nm. These CPM NSs are then incorporated into a trilayer dissolving microneedle patch (MAP) made from poly(vinylpyrrolidone) and w poly(vinyl alcohol) as needle arrays and prefrom 3D printed polylactic acid backing layer. This MAP features rapidly dissolving tips and exhibits good mechanical properties and insertion capability with delivery efficiency compared to the conventional Daivonex ointment. The effectiveness of this novel MAP was tested on Sprague-Dawley rats with imiquimod-induced psoriasis, demonstrating efficacy comparable to the marketed ointment. This innovative trilayer dissolving MAP represents a promising new local delivery system for calcipotriol, potentially revolutionizing psoriasis treatment by enhancing drug delivery and patient compliance.

Upadacitinib-Induced Hepatitis B Reactivation Leading to Liver Transplant.

Hepatitis B virus (HBV) reactivation can occur with the use of immunosuppressive therapy used to treat autoimmune conditions, such as rheumatoid arthritis. Janus kinase inhibitors, such as upadacitinib, have been approved for the treatment of rheumatoid arthritis. This is the first case report of a patient who used upadacitinib without antiviral prophylaxis against HBV and developed HBV reactivation, leading to fulminant hepatic failure necessitating emergent liver transplantation.

A Clinical Study of Intraoperative Perfusion Chemotherapy in Gastric Cancer: A Prospective Cohort Study.

INTRODUCTION: Gastric cancer (GC) is the third largest cause of cancer-related death worldwide, with major geographic disparities in incidence and outcomes. Sociodemographic indicators, food habits, and genetic predispositions all add to the load. Despite advances in systemic treatments, peritoneal metastasis remains a concern, with intraperitoneal chemotherapy (IPC) emerging as a promising treatment option. METHODS: A prospective cohort research was done, with 30 GC patients receiving cytoreductive surgery (CRS) followed by lobaplatin-based intraoperative chemotherapy. The study evaluated postoperative complications, survival rates, and disease recurrence using Statistical Package for the Social Sciences (SPSS) version 25.0 (IBM SPSS Statistics, Armonk, NY) for data analysis. The purpose of this study is to assess the effectiveness, safety, and dependability of lobaplatin as an intraoperative chemotherapeutic agent in patients having gastric cancer surgery, with a particular emphasis on those patients who do not have distant metastases. RESULTS: The study population had a balanced gender distribution, with an average age of 44.83 years. Most patients had advanced-stage cancer (T3 and T4), and lobaplatin treatment resulted in a low frequency of serious postoperative sequelae. Preliminary studies suggest that lobaplatin is a safe and potentially effective IPC drug for GC, with few side effects and adequate survival rates. CONCLUSION: Lobaplatin shows promise as an intraoperative chemotherapeutic treatment for gastric cancer, necessitating more research in bigger, randomized controlled studies to determine its efficacy and safety profile. The study emphasizes the need for novel treatment strategies to enhance the prognosis of GC patients, particularly those with peritoneal involvement.

A Clinical Study of Intraoperative Perfusion Chemotherapy With Raltitrexed in Colon Cancer: A Prospective Cohort Study.

INTRODUCTION: Colorectal cancer (CRC) ranks as the second leading cause of cancer-related mortality among women and the third leading cause of cancer-associated mortality among men. Treatment of colon cancer is very crucial for a patient's survival. In this study, we assessed the reliability, efficacy, and safety of raltitrexed in intraoperative intraperitoneal chemotherapy for colon cancer. METHODOLOGY: A total of 57 patients with clinical stages II and III of colon cancer were included in the study. R0 resection surgery + hyperthermic intraperitoneal chemotherapy (HIPEC) procedure was done with raltitrexed. It was given in a dose of 3 mg/m2 in a 0.9% NS injection in a volume of 500 milliliters. Postoperative complications were observed. RESULT: The most common postoperative complication was nausea/vomiting, which was seen in 21 out of 57 patients (37%). The second most common complication was fever (18/57). None of the patients died or developed renal toxicity, hepatic toxicity, and intestinal obstruction. CONCLUSION: Raltitrexed is a reliable, efficient, and safe drug and can be used in intraoperative intraperitoneal chemotherapy of colon cancer.

Economic evaluation of clinical pharmacy service using integrated health system in tertiary care hospital.

BACKGROUND: Clinical pharmacy services are the specialized practices of pharmacists to provide pharmaceutical care. All these activities are documented as pharmacist interventions to avoid medication errors which occur during prescribing, dispensing, and administration. The purpose of this study is to conduct an economic analysis of the pharmacist interventions using integrated health system. RESEARCH DESIGN AND METHODS: A retrospective study was conducted in a tertiary care hospital. Pharmacist interventions were analyzed by an independent pharmacist. Cost-saving and cost avoidance analyses were carried out for drug-related interventions. Economic analysis was performed and tabulated both in PKR and USD. RESULTS: Out of 1330 interventions, 1250 (95%) interventions were accepted and changed the prescription upon the physician-pharmacist consultation while 71 (5%) were not accepted. Interventions related to prescribing and duplication errors were the highest of all (30 and 29% respectively). Pharmacist interventions were recorded with a 95% acceptance rate. Cost analysis showed that pharmacist interventions saved around 105,115.88 US dollars. CONCLUSION: Clinical pharmacy services provided by integrated health system are a cost saving program. The cost saved per intervention for our study is around USD 37 which is more than another similar study which quoted USD 30.35 per intervention.

Saccharomyces cerevisiae for abdominal pain and discomfort in irritable bowel syndrome patients.

Background: Irritable Bowel Syndrome (IBS) leads to significant impairment of health-related quality of life, for the alleviation of which, the efficacy of available therapies is modest. Limited data is available on the role of Saccharomyces cerevisiae in treating patients with IBS. Methods: Thirty patients with IBS as per Rome-IV criteria, visiting our outpatient department from March 2021 to October 2021, were given capsule Saccharomyces cerevisiae 500 mg twice daily for four weeks. Evaluation for abdominal pain symptoms was done every week and the patient's compliance was assessed. IBS Quality of Life (QOL) questionnaires were filled at baseline and after four weeks of treatment. The QOL and pain scales were adjusted to 0-100 for statistical analysis. Results: Seventeen patients (56.7%) were males. The age range was 21-72 years (mean ± SD: 39. 63 ± 14.32), out of which 18(60%) patients were 20-40 years old. Body Mass Index (BMI) ranged from 18-33 (25.33 ± 4.09), and 17 (56.67%) were overweight or obese. Sixteen patients had constipation predominant (53.3%), nine had diarrhea-predominant (30%), and five had mixed-type (16.7%) IBS. There was an improvement in the pain score from 63.81 at week 0 (W0) to 20.48 at the end of week 4 (W4) (p<0.001). An improvement was noted in all the eight categories of IBS QOL questionnaire, i.e., dysphoria (p<0.001), interference with activity (p<0.001), body image (p<0.001), health worry (p<0.001), food avoidance (p<0.001), social reaction (p<0.001), sexual function (p<0.001) and relationships (p<0.001). There was an overall improvement in QOL score from a mean of 24.68 at baseline to 58.09 at the end of the study duration (p<0.001). The improvement in the pain score showed a positive correlation with the improvement in quality of life (p<0.001). Conclusion: Treatment with Saccharomyces cerevisiae improved the pain and quality of life in patients with IBS and it appears to be a promising option for alleviating symptoms in these patients.

Synergistic CuCoS-PANI materials for binder-free electrodes in asymmetric supercapacitors and oxygen evolution.

In advanced electronics, supercapacitors (SCs) have received a lot of attention. Nevertheless, it has been shown that different electrode designs that are based on metal sulfides are prone to oxidation, instability, and poor conductance, which severely limits their practical application. We present a very stable, free-standing copper-cobalt sulfide doped with polyaniline as an electrode coated on nickel foam (CuCoS/PANI). The lightweight nickel foam encourages current collection as well as serving as a flexible support. The CuCoS-PANI electrode had a substantially greater 1659 C g-1 capacity at 1.0 A g-1. The asymmetric supercapacitor (ASC) can provide an impressive 54 W h kg-1 energy density while maintaining 1150 W kg-1 power. Additionally, when employed as an electrocatalyst in the oxygen evolution reaction, CuCoS/PANI exhibited a 200 mV overpotential and 55 mV dec-1 Tafel slope, demonstrating its effectiveness in facilitating the reaction.

Trends in thyrotoxicosis-related mortality in the United States from 1999 to 2020.

PURPOSE: Thyrotoxicosis is defined as a condition caused by excessive thyroid hormone concentrations, with the main cause being inappropriately increased thyroid hormone production. Existing literature indicates a correlation between thyrotoxicosis and mortality. Thus, this descriptive analysis was conducted to assess the demographic and regional trends of thyrotoxicosis-related mortality in the United States. METHODS: Death certificates from the Center of Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) from 1999 to 2020 were retrieved for thyrotoxicosis-related mortality in the United States. The crude and age-adjusted mortality rates (AAMRs) per 1,000,000 population and annual percentage change (APCs) were calculated. RESULTS: There were 33,253 thyrotoxicosis-related deaths from 1999 to 2020. Initially, the AAMR increased from 1999 to 2003 (APC: 3.09; 95% CI 0.83 to 8.16), followed by a steep decline from 2003 to 2008 (APC: -4.28; 95% CI -7.46 to -2.47), followed by a marginal decline from 2008 to 2018 (APC: -0.71; 95% CI -1.70 to 0.95), and concluded by a significant increase from 2018 to 2020 (APC: 11.72; 95% CI 5.06 to 15.32). Non-Hispanic (NH) Black or African American, Hispanic or Latino, and NH White populations demonstrated a significant rise in thyrotoxicosis-related mortality during 2018 to 2020. In contrast, the NH Asian or Pacific Islander population did not denote any significant variations within the included study timeframe. States including West Virginia, the District of Columbia, Vermont, California, and Montana were in the top 10th percentile of thyrotoxicosis-related mortality. CONCLUSION: After an extended period of decline, the recent increments in thyrotoxicosis-related mortality rates are concerning. Further consideration is urged with respect to thyroid screening, especially among females, in order to reduce the overall thyrotoxicosis-related mortality.

Pyridine 3,5-dicarboxylate-based metal-organic frameworks as an active electrode material for battery-supercapacitor hybrid energy storage devices.

Efficient energy storage and conversion is crucial for a sustainable society. Battery-supercapacitor hybrid energy storage devices offer a promising solution, bridging the gap between traditional batteries and supercapacitors. In this regard, metal-organic frameworks (MOFs) have emerged as the most versatile functional compounds owing to their captivating structural features, unique properties, and extensive diversity of applications in energy storage. MOF properties are governed by the structure and topological characteristics, which are influenced by the types of ligands and metal nodes. Herein, MOFs based on pyridine 3,5-dicarboxylate (PYDC) ligand in combination with copper and cobalt are electrochemically analyzed. Owing to the promising initial characterization of Cu-PYDC-MOF, a battery supercapacitor hybrid device was fabricated, comprising Cu-PYDC-MOF and activated carbon (AC) electrodes. The device showcased energy and power density of 17 W h kg -1 and 2550 W kg -1, respectively. Dunn's model was employed to gain deeper insights into the capacitive and diffusive contributions of the device. With their performance and versatility, the PYDC-based MOFs stand at the forefront of energy technology, ready to power a brighter future for upcoming generations.

Trends in Rheumatic Heart Disease-Related Mortality in the United States from 1999 to 2020.

There is a lack of mortality data on rheumatic heart disease (RHD) in the United States (US). In light of this, a retrospective analysis was conducted to investigate the temporal, sex-based, racial, and regional trends in RHD-related mortality in the US, ranging from 1999 to 2020. The Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) dataset was analyzed, where crude and age-adjusted mortality rates (AAMR) were identified, along with annual percentage changes (APCs) determined by Joinpoint regression. Through the period of 1999 to 2020, there were 141,137 RHD-related deaths reported, with a marginal decline from 4.05/100,000 in 1999 to 3.12/100,000 in 2020. However, the recent rise in AAMR from 2017 to 2020 has created a source of concern (APC: 6.62 [95% CI, 3.19-8.72]). Similar trends were observed in the Black or African American race from 2017 to 2020 (APC: 10.58 [95% CI, 6.29-17.80]). Moreover, the highest percentage change from 2018 to 2020 was observed in residents of large metropolitan areas (APC: 7.6 [95% CI, 2.8-10.5]). A prominent disparity was observed among states, with values ranging from 1.74/100,000 in Louisiana to 5.27/100,000 in Vermont. States within the top 90th percentile of RHD-related deaths included Alaska, Minnesota, Washington, Wyoming, and Vermont. In conclusion, it is imperative to delve deeper into the evidently rising trends of RHD-related mortality and outline the possible sources of social determinants within US healthcare in order to provide equal and quality medical care throughout the nation.

Improvement of the Self-Controlled Hyperthermia Applications by Varying Gadolinium Doping in Lanthanum Strontium Manganite Nanoparticles.

In this study, silica-encapsulated gadolinium was doped in lanthanum strontium manganite nanoparticles (NPs) with different concentrations using the citrate-gel auto-combustion method. We focused on tuning the Curie temperature and enhancing the specific absorption rate (SAR) of silica-coated gadolinium-doped lanthanum strontium manganite NPs to make them suitable for self-controlled magnetic hyperthermia. The samples were characterized by using transmission electron microscopy (TEM), X-ray diffraction, Fourier transform infrared spectroscopy (FTIR), and magnetic measurements to examine the structural, optical, and magnetic properties of the manganite NPs. While our results exhibit a successful doping of gadolinium in lanthanum strontium manganite NPs, we further prepared magnetic core NPs with sizes between 20 and 50 nm. The Curie temperature of the NPs declined with increasing gadolinium doping, making them promising materials for hyperthermia applications. The Curie temperature was measured using the magnetization (M-T) curve. Magnetic heating was carried out in an external applied AC magnetic field. Our present work proved the availability of regulating the Curie temperature of gadolinium-doped lanthanum strontium manganite NPs, which makes them promising candidates for self-controlled magnetic hyperthermia applications.

Analyzing synthesis routes for BaCuPO4: implications for hydrogen evolution and supercapattery performance.

In recent years, energy storage and conversion tools have evolved significantly in response to rising energy demands. Owing to their large surface area, superior electric and chemical stabilities, and thermal conductivities, barium copper phosphate (BaCuPO4) materials are promising electrode materials for electrochemical energy storage systems. In this study, the synthesis of nanostructures (NSs) using hydrothermal and chemical precipitation methods and exploring the electrochemical characteristics of BaCuPO4 in asymmetric supercapacitors provides a comparative investigation. Systematic characterization shows that nanomaterials prepared by applying the hydrothermal method have a more crystalline and large surface area than chemical precipitation. In the three cell arrangements, the hydrothermally prepared BaCuPO4 NSs delivered a high specific capacity (764.4 C g-1) compared to the chemical precipitation route (660 C g-1). Additionally, the supercapattery associated with the two electrode assemblages delivers an optimum specific capacity of 77 C g-1. The energy and power density of BaCuPO4//AC NSs were 52.13 W h kg-1 and 950 W kg-1, respectively. A durability test was also performed with BaCuPO4//AC NSs for 5000 consecutive cycles. Further, the coulombic efficiency and capacity retention of BaCuPO4//AC after 5000 cycles were 81% and 92%, respectively. Bimetallic phosphate is comparatively suggested for future perspectives towards HER to overcome the performance of single metal phosphate materials. This is the first approach, we are aware of, for investigating the electrochemical behavior of BaCuPO4, and our results suggest that it may be useful as an electrode material in electrochemical systems requiring high energy and rate capabilities.

A rare presentation of a gastric volvulus in an adult Bochdalek hernia: a case report.

A Bochdalek hernia is a common congenital diaphragmatic defect in infants. A late presentation during adulthood is rare with misleading signs and symptoms, resulting in misdiagnosis and errors in treatment. We describe a 30-year-old man who presented with abdominal pain and chronic choking sensation, which was previously treated as peptic ulcer disease. During the present admission, radiological imaging performed revealed loops of bowel and a gastric volvulus in the left hemithorax. The patient underwent a successful emergency surgery and repair of a Bochdalek hernia. Due to its rarity and ambiguous presentation, a symptomatic Bochdalek hernia in an adult is commonly misdiagnosed. A comprehensive evaluation is pertinent for early diagnosis and treatment, to prevent complications arising from obstruction and strangulation of herniated intraabdominal contents.

Effectiveness of Emergency versus Nonemergent Coronary Angiography After Out-of-Hospital Cardiac Arrest without ST-Segment Elevation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The optimal timing of coronary angiography (CAG) in patients after out-of-hospital cardiac arrest (OHCA) without ST-segment elevation remains controversial. Therefore, we conducted a meta-analysis of randomized control trials to investigate the effectiveness of emergency CAG versus delayed CAG in OHCA patients with a non-ST-segment elevated rhythm. PubMed, Scopus, CINAHL, Cochrane CENTRAL, and JBI databases were searched from inception to September 7, 2022. Our primary end point was survival with a good neurological outcome, whereas the secondary outcomes included short-term survival, mid-term survival, recurrent arrhythmias, myocardial infarction after hospitalization, major bleeding, acute kidney injury, and left ventricular ejection fraction. Nine randomized control trials involving 2,569 patients were included in this analysis. Our meta-analysis showed no significant difference in the improvement of neurological outcome (RR 0.96, 95% Confidence Interval [CI] [0.87, 1.06]), short-term survival (risk ratio [RR] 0.98, 95% CI [0.89, 1.08]), mid-term survival (RR 0.98, 95% CI [0.87, 1.10]), recurrent arrhythmias (RR 1.02, 95% CI [0.50, 2.06]), myocardial infarction (RR 0.66, 95% CI [0.13, 3.30]), major bleeding (RR 0.96, 95% CI [0.55, 1.69]), acute kidney injury (RR 1.20, 95% CI [0.32, 4.49]) and left ventricular ejection fraction (RR 0.89, 95% CI [0.69, 1.15]) in patients who underwent emergency CAG compared with delayed CAG patients. In conclusion, our analysis revealed that emergency CAG had no prognostic superiority over delayed CAG in patients with OHCA without ST-segment elevation.