Early coronary angioplasty fails to lower all-cause mortality in patients with out-of-hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis.

Introduction: Out-of-hospital cardiac arrest (OHCA) is defined as the loss of functional mechanical activity of the heart in association with an absence of systemic circulation, occurring outside of a hospital. Immediate coronary angiography (CAG) with percutaneous coronary intervention is recommended for OHCA with ST-elevation. We aimed to evaluate the effect of early CAG on mortality and neurological outcomes in OHCA patients without ST-elevation. Methods: This meta-analysis and systemic review was conducted as per principles of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) group. A protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, Ref No. = CRD42022327833). A total of 674 studies were retrieved after scanning several databases (PubMed Central, EMBASE, Medline, and Cochrane Central Register of Controlled Trials). Results: A total of 18 studies were selected for the final analysis, including 6 randomized control trials and 12 observational studies. Statistically, there was no significant difference in primary outcome, i.e., mortality, between early and delayed CAG. In terms of the grade of neurological recovery as a secondary outcome, early and delayed CAG groups also showed no statistically significant difference. Conclusion: Early CAG has no survival benefits in patients with no ST elevations on ECG after OHCA.

van der Waals 2D transition metal dichalcogenide/organic hybridized heterostructures: recent breakthroughs and emerging prospects of the device.

The near-atomic thickness and organic molecular systems, including organic semiconductors and polymer-enabled hybrid heterostructures, of two-dimensional transition metal dichalcogenides (2D-TMDs) can modulate their optoelectronic and transport properties outstandingly. In this review, the current understanding and mechanism of the most recent and significant breakthrough of novel interlayer exciton emission and its modulation by harnessing the band energy alignment between TMDs and organic semiconductors in a TMD/organic (TMDO) hybrid heterostructure are demonstrated. The review encompasses up-to-date device demonstrations, including field-effect transistors, detectors, phototransistors, and photo-switchable superlattices. An exploration of distinct traits in 2D-TMDs and organic semiconductors delves into the applications of TMDO hybrid heterostructures. This review provides insights into the synthesis of 2D-TMDs and organic layers, covering fabrication techniques and challenges. Band bending and charge transfer via band energy alignment are explored from both structural and molecular orbital perspectives. The progress in emission modulation, including charge transfer, energy transfer, doping, defect healing, and phase engineering, is presented. The recent advancements in 2D-TMDO-based optoelectronic synaptic devices, including various 2D-TMDs and organic materials for neuromorphic applications are discussed. The section assesses their compatibility for synaptic devices, revisits the operating principles, and highlights the recent device demonstrations. Existing challenges and potential solutions are discussed. Finally, the review concludes by outlining the current challenges that span from synthesis intricacies to device applications, and by offering an outlook on the evolving field of emerging TMDO heterostructures.

Pneumomediastinum in association with Covid-19: A less commonly considered differential diagnosis for worsening respiratory failure.

We have reported here two cases of coronavirus disease-2019 (COVID-19) patients aged 29 and 68 years who were diagnosed with pneumomediastinum (PM). PM is a rare complication that is being reported in association with COVID-19. Patients with COVID-19 can present with a variety of etiologies that make them vulnerable to PM. Respiratory complications due to COVID-19 are widely known, and it presents as mild to severe and critical illness. Spontaneous PM is a known complication of COVID-19. Despite seeming to be a lesser-known condition, PM can have a significant impact on disease progression and prognosis. We have presented here two contrasting cases of PM. The first patient was young and with moderate COVID-19 pneumonia and PM, while the second one was an old man with severe COVID-19 pneumonia manifestations. Both patients were diagnosed with PM, but their outcomes were completely different.

Impact of staffing levels and resources of intensive care units on compliance to standard mechanical ventilator guidelines: A city-wide study in times of COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has affected millions and resulted in a considerable strain on healthcare systems around the world. Intensive care units (ICUs) are reported to be affected the most because significant percentage of ICU patients requires respiratory support through mechanical ventilation (MV). AIM: This study aims to examine the staffing levels and compliance with a ventilator care bundle in a single city in Pakistan. METHODS: A cross-sectional survey of 14 ICUs including medical and surgical ICUs was conducted through a self-structured questionnaire including a standardized ventilator care bundle. We assessed the compliance of ICU staff to ventilator care bundle and calculated the correlation between staffing patterns with compliance to this bundle. RESULTS: The unit response rate was 64% (7/11 hospitals). Across these seven hospitals, there were 14 functional ICUs (7 surgical and 7 medical). The Mean (SD) numbers of beds and ventilators were 8.14 (3.39) and 5.78 (3.68) while the average patient-to-nurse and patient-to-doctor ratio was 3: 1 and 5:1 respectively. The median ventilator care bundle compliance score was 26 (IQR = 21-28) out of 30, while in medical and surgical ICUs, median scores were 24 (IQR = 19-26) and 28 (IQR = 23-30) respectively. The perceived least compliant component was head elevation in ventilated patients. Correlation analysis revealed that 24 h a day, 7 days a week onsite cover of Advanced Cardiovascular Life Support certified staff was positively correlated with the ventilator care bundle score (rs  = 0.654, p value = .011). Similarly, 24-h cover of senior ICU nurses was significantly correlated with the application of chlorhexidine oral care (rs  = 0.676, p value = .008) while routine subglottic aspiration was correlated with the number of doctors (rs  = 0.636, p value = .014). CONCLUSION: Our study suggests that ICUs in Peshawar are not well staffed in comparison with international standards and the compliance of ICUs with the ventilator care bundle is suboptimal. We found only a few aspects of ventilator care bundle compliance were related to nursing and medical staffing levels. RELEVANCE TO CLINICAL PRACTICE: Critical care staffs at most of the medical ICUs in Peshawar are not compliant with the standard guidelines for patients on mechanical ventilation. Moreover, the staffing levels at these ICUs are not in accordance with international standards. However, this study suggests that staffing levels may not be the only cause of non-compliance with standard mechanical ventilator guidelines. There is an urgent need to design and implement a program that can enhance and monitor the quality of nursing care provided to mechanically ventilated patients. Lastly, nurse staffing of ICUs in Pakistan must be increased to enable high quality care and more doctors should be trained in critical care.

Efficacy of 2-Hydroxyflavanone in Rodent Models of Pain and Inflammation: Involvement of Opioidergic and GABAergic Anti-Nociceptive Mechanisms.

The current work examined the pharmacological potential of a selected flavanone derivative 2-hydroxyflavanone as a promising remedy for the treatment and management of pain. The selected flavanone derivative (2-HF) was evaluated for its analgesic and anti-inflammatory potentials following standard pharmacological protocols including hot plate, acetic acid-induced writhing and tail immersion tests. Naloxone and pentylenetetrazol were used to evaluate the potential implication of GABAergic and opioidergic mechanisms. The anti-inflammatory potential of 2-HF was confirmed using carrageenan-, serotonin- and histamine-induced paw edema models as well as a xylene-induced ear edema model. Furthermore, the anti-neuropathic potential of 2-HF was tested using a cisplatin-induced neuropathic pain model. Our sample, at the tested concentrations of 15, 30 and 45 mg kg-1, showed considerable analgesic, anti-inflammatory effects, as well as efficacy against neuropathic pain. Naloxone and pentylenetetrazol at 1 and 15 mg kg-1 antagonized the anti-nociceptive activities of 2-hydroxyflavanone indicating the involvement of opioidergic and GABAergic mechanisms. In the static allodynia model, combination of gabapentin 75 mg kg-1 with 2-HF at 15, 30, 45 mg kg-1 doses exhibited considerable efficacy. In cold allodynia, 2-hydroxyflavanone, at doses of 15, 30 and 45 mg kg-1 and in combination with gabapentin (75 mg kg-1), demonstrated prominent anti-allodynic effects. The paw withdrawal latency was considerably increased in gabapentin + cisplatin treated groups. Moreover, cisplatin + 2-hydroxyflavanone 15, 30, 45 mg kg-1 showed increases in paw withdrawal latency. Likewise, considerable efficacy was observed for 2-hydroxyflavanone in thermal hyperalgesia and dynamic allodynia models. Our findings suggest that 2-hydroxyflavanone is a potential remedy for pain syndrome, possibly mediated through opioidergic and GABAergic mechanisms.

Role of anticoagulation in lowering the mortality in hospitalized covid-19 patients: Meta-analysis of available literature.

OBJECTIVES: To reducing the risk of venous thromboembolic (VTE) events and subsequent mortality in covid-19 patients is still a matter of research. This systematic review and meta-analysis serve the purpose of comparing the mortality associated with the intensity of anticoagulation in patients admitted with covid-19. METHODS: A total of 7120 patients were recruited in 11 studies comparing using prophylactic anticoagulants against therapeutic anticoagulants. RESULTS: Our study showed that using prophylactic anticoagulants was associated with a 42% reduction in mortality compared to therapeutic anticoagulants (OR 0.58 (95% CI:0.676-0.499), p=0.000). Also, we assessed mortality in patients using no anticoagulants against using prophylactic anticoagulants. A total of 6069 patients were recruited in 4 studies in which 2 studies significantly favored prophylactic anticoagulants in terms of reducing mortality. Cumulatively, the meta-analysis showed that using prophylactic anticoagulants was associated with a 5% reduction in mortality but without any statistical significance: (OR 1.049 [95% CI 1.237 - 0.865]) (p=0.626). CONCLUSION: Our meta-analysis favors using prophylactic anticoagulation in covid-19 patients reduces all-cause mortality in comparison to therapeutic anticoagulation however the impact on mortality when compared with no anticoagulation was not significant.PROSPERO Number: CRD42021257320.

Correction: Interlayer exciton emission in a MoS2/VOPc inorganic/organic van der Waals heterostructure.

Correction for 'Interlayer exciton emission in a MoS2/VOPc inorganic/organic van der Waals heterostructure' by Yuhan Kong et al., Mater. Horiz., 2022, DOI: 10.1039/d1mh01622a.

Interlayer exciton emission in a MoS2/VOPc inorganic/organic van der Waals heterostructure.

Heterostructures built from two-dimensional (2D) materials and organic semiconductors offer a unique platform for addressing many fundamental physics and construction of functional devices by taking advantage of both the 2D materials and organic semiconductors. We report interlayer exciton emission in the near infrared range around 1.54 eV (∼805 nm) from the heterostructure of pyramidal VOPc (p-type) and transition metal dichalcogenide monolayer MoS2 (VOPc/MoS2). This contrasts the observation of photoluminescence (PL) from the SnCl2Pc/MoS2 heterostructure despite both being type-II heterostructures. We attribute the exciton emission to the carrier transition from the generated interface mid-gap states of VOPc to the ground states of MoS2 in the heterostructure system as predicted from density functional theory (DFT) calculations. Furthermore, the observed PL signal of the VOPc/MoS2 heterostructure shows blue shift, while the PL peak of the SnCl2Pc/MoS2 heterostructure shows red shift. Our finding opens up a new avenue to tune the optoelectronic properties of the van der Waals heterojunctions consisting of 2D materials and organic semiconductors for optoelectronic applications.

Potential Drug-Drug Interactions in Hospitalized Medical Patients: Data From Low Resource Settings.

Introduction Adverse events related to Drug-Drug Interactions (DDIs) are among the few common reasons for hospitalization worldwide; however, they can be prevented with an efficient patient-centered system. Different mechanisms have successfully limited the prevalence of DDIs in developed countries. There are limited data regarding DDIs from limited-resource settings. Furthermore, there is no cost-effective system that has shown promising results in preventing them in this setting. This study aims to assess the frequency of potential DDIs in a low-resource setting and to check its association with different factors such as poly-pharmacy and demographics. Methods Through this cross-sectional study, drug charts of patients admitted to a medical unit in November 2019 were analyzed using a structured questionnaire. A list of drugs co-prescribed to each patient was entered into the Medscape Drug Interaction checker to calculate the frequency and severity of potential DDIs. Results The mean age of patients was 49 years, and on average, seven drugs were prescribed to each patient. Among 100 analyzed prescriptions, 400 potential DDIs were identified with a mean of 4±5.42 per patient. According to Medscape interaction checker classification, 2 DDIs were contraindicated, 28 were serious, 246 required close monitoring, and 124 were minor. The most frequently encountered drug interaction was "spironolactone with furosemide." There was a significant correlation of the occurrence of potential DDIs with increased numbers of prescribed drugs. Conclusion Our patient population was prescribed more drugs per patient than calculated in other settings. Poly-pharmacy is an independent risk factor for DDIs. Lastly, advancing age exposes patients to poly-pharmacy, and therefore, they are at a higher risk of developing DDIs.

Electronic properties of polymorphic two-dimensional layered chromium disulphide.

Two-dimensional (2D) Cr-based layered and non-layered materials such as CrI3, Cr2Ge2Te6, Cr2S3, CrSe, and CrOX (X = Cl and Br) have attracted considerable attention due to their potential application in spintronics. Despite few experimental studies, theoretical studies reported that 2D chromium dichalcogenide (CrS2) materials show unique properties such as valley polarization, piezoelectric coupling, and phase dependent intrinsic magnetic properties. Here, we report for the first time the synthesis of 2D layered CrS2 flakes down to the monolayer via the chemical vapor deposition (CVD) method, its phase structures and electronic properties. We observed the 2H, 1T, and 1T' phases coexisting in CVD grown monolayer CrS2. The formation of 1T' phases from 1T phases is described by dimerization of metal atoms at room temperature according to our molecular dynamics studies. The coexistence of 1T and 1T' phases with 2H phases is referred to as the 1T and 1T' puddling phenomenon. We theoretically showed that the monolayer 2H-CrS2 is a direct bandgap semiconductor with a gap of approximately 0.95 eV predicted by the PBE functional, while the 1T- and 1T'-CrS2 are metallic and semi-metallic with approximately 10 meV gap, respectively. Furthermore, 2H CrS2 exhibits nonmagnetic semiconducting properties while for ferromagnetic spin configuration, the 1T and 1T' CrS2 show magnetic characteristics with 0.531µB and 2.206µB magnetic moment per Cr atom respectively, for ferromagnetic spin configuration as predicted from DFT+U calculation. Importantly, CrS2-based field-effect transistors exhibit a p-type behavior. Our study would stimulate further exploration of 2D layered CrS2 with astonishing properties and open up a whole new avenue for the urgent need for developing multifunctional 2D materials for nanoelectronics, valleytronics, and spintronics.

Appendicular Sinus as a Cause of Chronic Psoas Abscess in a Renal Transplant Recipient: A Case Report.

A psoas abscess is a condition with vague symptomatology that is associated with potentially life-threatening suppurative myositis of the iliopsoas muscular compartment. Immunocompromised pa-tients run an increased risk of developing suppurative or chronic abscesses from acute foci. The presence of a solid-organ transplant, and the attendant need for immunosuppressant therapies and impaired renal provide additional factors that could contribute to the comorbidities of this condition. Here, we present a 61-year-old white man with a functioning renal transplant who developed a chronic psoas abscess associated with an appendicular sinus that required serial computed tomographic-guided drainages during 8 years. We highlight the difficulties and limitations of managing a psoas abscess. We conclude that a conservative approach toward managing a chronic psoas abscess may be associated with good long-term patient and graft functions, with minimal risk to the patient.

Two years and 196 million pounds later: where is Choose and Book?

BACKGROUND AND OBJECTIVES: Introduced in 2004, Choose and Book was one of the National Programme for Information Technology's vanguard initiatives. It was to transform the old booking system by combining, for the first time, electronic booking with patient choice of their first hospital appointment. However, doctors' use of the system has been reported as being persistently low. This study, carried out in London, endeavoured to explore doctor's views about the system and to see how far it has progressed. METHOD: A questionnaire was devised and administered via an email invitation, to doctors. It was sent to 1800 and completed by 105 hospital consultants and general practitioners. RESULTS: Most doctors thought that the concept of electronic booking itself was a good idea. The benefits that have been observed so far include an improvement in patient attendance at their appointments and the ability of doctors to track referrals. The biggest problems were described as an increased workload, technical problems and an uneven distribution of appointments between hospitals. In addition, most doctors thought that patient choice was a misguided concept in electronic booking and most reported that they were unsatisfied with Choose and Book overall. LIMITATIONS: The 6% response rate may make the results less likely to be representative of the whole survey population. The authors acknowledge this and have made recommendations as to how to more comprehensively test the objectives of this study, in future. CONCLUSION: In general, Choose and Book is still poorly perceived by doctors - particularly with respect to technical problems. There is still some support for the concept of electronic booking; however the patient choice element faces more resistance. Additional research is needed on this topic to further investigate the use of electronic systems in the health service.