A new strategy of using dielectric barrier discharge plasma in tubular geometry for surface coating and extension to biomedical application.

There has always been a quest for nanotechnology to develop inexpensive coating methods with the capability of depositing biocompatible nanomaterials on biomedical and surgical tools. In this mini-report, a plasma-based innovative idea of coating a solid surface with antibacterial/antimicrobial nanosilver is floated and experimentally realized. The desired antibacterial nanosilver was obtained from laser ablation and directly entrained in an outflowing plasma jet, excited in the flow of argon at 10 l min-1 using 20 kV/20 kHz. Under these conditions, the jet can protrude 15 mm deeply into ambient air. The quality of the surface coating can be described by sparsely distributed particles or densely agglomerated clusters, controlled by the plasma length and the surface separation. Apart from the coating, plasma interaction leads to the sterilization of the exposed surface. The idea is essentially important to extend and upscale for coating biomedical and surgical devices in a flexible open processing environment.

Availability of Personal Protective Equipment (PPE) Among US and Pakistani Doctors in COVID-19 Pandemic.

Background The coronavirus disease (COVID-19) pandemic has put an excessive strain on healthcare systems across the globe, causing a shortage of personal protective equipment (PPE). PPE is a precious commodity for health personnel to protect them against infections. We investigated the availability of PPE among doctors in the United States (US) and Pakistan. Methods A cross-sectional study, including doctors from the US and Pakistan, was carried out from April 8 to May 5, 2020. An online self-administered questionnaire was distributed to doctors working in hospitals in the US and Pakistan after a small pilot study. All analysis was done using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results After informed consent, 574 doctors (60.6% from Pakistan and 39.4% from the US) were included in the analysis. The majority of the participants were females (53.3%), and the mean age of the participants was 35.3 ± 10.3 years. Most doctors (47.7%) were from medicine and allied fields. Among the participants, 87.6% of doctors from the US reported having access to masks/N95 respirators, 79.6% to gloves, 77.9% to face-shields or goggles, and 50.4% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. The reuse of PPE was reported by 80.5% and 60.3% physicians from the US and Pakistan, respectively. More doctors from Pakistan (50.6%) reported that they had been forced to work without PPE compared to doctors in the US (7.1%). Conclusion There is a lack of different forms of PPE in the US and Pakistan. Doctors from both countries reported that they had been forced to work without PPE. Compared to the US, more doctors from Pakistan reported having faced discrimination in receiving PPE.

Neonatal Nonketotic Hyperglycinemia: A Rare Case from Pakistan.

Nonketotic hyperglycinemia (NKH) is an autosomal recessive disorder caused by a defect in glycine cleavage enzyme. It leads to the accumulation of glycine in the body tissues, blood, and cerebrospinal fluid (CSF). Most NKH cases are diagnosed during the natal period of life and are fatal if not promptly diagnosed and managed. Here we present a case of a two-day-old child who presented with reluctant feeding and lethargy. She had reduced tone in all four limbs and a Glasgow Coma Scale score of 9. Keeping an infectious etiology in mind, she was started on cefotaxime and amikacin. The patient was shifted to the neonatal intensive care unit; however, no improvement in the patient's condition was seen and antibiotics were changed to linezolid and meropenem along with initiation of acyclovir. The patient's blood and CSF cultures were negative. Serum amino acid chromatography showed elevated levels of glycine, and a diagnosis of NKH was made. The patient was managed symptomatically but expired on the 22nd day of admission. The case highlights the importance of prompt diagnosis and management of aminoacidopathies. Nearly all metabolic disorders have similar clinical presentations, and an early diagnosis can improve the outcome in patients.

Intraosseous infusion and pulmonary fat embolism.

OBJECTIVES: To determine the incidence of pulmonary fat embolism after the intraosseous (IO) infusion of normal saline and drugs and to determine whether pulmonary capillary blood is a predictor of lung fat embolism. DESIGN: A randomized, prospective, animal study. SETTING: Animal research laboratory of a university hospital. SUBJECTS: Twenty-eight mixed breed piglets (average weight 30.9 kg). Interventions and Methods: Animals were anesthetized, intubated, mechanically ventilated, and instrumented. IO needles were placed in the tibial bone. Animals were assigned to one of four groups: Group 1 received fluid (20 mL/kg) under 300 mm Hg pressure (n = 6); group 2 received fluid (20 mL/kg) at free flow under gravity (n = 6); group 3 received 100 mL of fluid over 20 mins (n = 8); and group 4 received 100 mL of fluid over 7 mins (n = 8). MEASUREMENTS AND MAIN RESULTS: Buffy coat samples were obtained from pulmonary arterial catheter in the occluded position at baseline, after IO needle placement, and at the end of infusion. Lung specimens (both upper and lower lobes) were obtained at the end of the infusion. Specimens were stained with oil red O and graded for fat emboli by a pathologist blinded to experimental conditions. Fat emboli (one to three emboli per high power field) were found in about 30% of the lung specimens. The difference in number of fat emboli between groups was not statistically significant. Buffy coat stains yielded fat emboli, which were distributed sporadically in all groups. CONCLUSION: Fat embolism is common; however, the method of IO fluid administration does not influence the number of emboli. Our study therefore implies that the risk of fat embolization is of concern, but its clinical relevance is unclear. Until the clinical significance of pulmonary fat emboli and the prevalence of fat emboli syndrome are delineated more precisely, the IO route is an effective but not necessarily safe route for delivery of fluids and drugs.

Comparison of plasma levels and pharmacodynamics after intraosseous and intravenous administration of fosphenytoin and phenytoin in piglets.

OBJECTIVE: To compare plasma drug levels and pharmacodynamics of fosphenytoin or phenytoin when given intraosseously or intravenously in doses relevant to children. DESIGN: Prospective controlled randomized study. SETTING: University hospital animal laboratory. SUBJECTS: A total of 40 mixed-breed piglets (age, 4-6 months; weight, 20-40 kg). INTERVENTIONS: The animals were anesthetized, after which they underwent intubation, instrumentation, and mechanical ventilation. A central venous catheter and an arterial catheter were placed for monitoring and blood sampling. A peripheral intravenous catheter with a 15-gauge intraosseous needle was inserted for drug infusion. A total of 40 animals (ten per group) were randomly assigned to receive intravenous or intraosseous phenytoin or fosphenytoin infusions. Phenytoin (20 mg/kg) was infused over 20 mins, and fosphenytoin (20 mg phenytoin equivalent kg) was infused over 7 mins. All infusions were followed by the administration of a 5-mL normal saline flush. MEASUREMENTS AND MAIN RESULTS: Blood samples (3 mL) were drawn for use in determining drug levels before infusions (baseline) and 0, 5, 10, 15, 20, 30, 40, 50, 60, and 75 mins after the infusion had been completed. Repeated measures of analysis of variance were used to evaluate statistical significance (p <.05). Phenytoin levels were undetected at baseline. Free (10 to 20 &mgr;g/mL) and total (80 to 110 &mgr;g/mL) phenytoin levels were well above the therapeutic range (free, 1 to 2 &mgr;g/mL; total, 10 to 20 &mgr;g/mL) after infusion in the animals that received fosphenytoin. Significant differences in values were seen in free phenytoin levels at 0 to 10 mins (p <.05) and in total phenytoin levels at 0 to 20 mins (p <.05) between intraosseous phenytoin or fosphenytoin administration. Similar differences were also seen when piglets that received intravenous phenytoin were compared with those that received intravenous fosphenytoin. From 20 to 75 mins, all groups had free and total levels within the therapeutic range. There were no significant differences among heart rate and blood pressure in the groups. CONCLUSION: There is no need to adjust standard drug doses of phenytoin when given intraosseously. The initial high levels of phenytoin in the fosphenytoin groups are of concern because neurologic toxic effects may occur in humans at those levels. Slower infusion rates of fosphenytoin may be needed to avoid toxic levels.