The use of rotational thromboelastometry to guide management following Bitis nasicornis envenoming.

A man in his thirties presented following Bitis nasicornis envenoming. His coagulation was assessed using rotational thromboelastometry (ROTEM). It identified a subtle abnormality, not detected using standard laboratory assessments of coagulation, and influenced ongoing management. The abnormality resolved following treatment with antivenom. There are few documented cases of using ROTEM to assess patients following haemotoxic envenoming. This case highlights some of the potential benefits and limitations of doing so.

Cognitive domains affected post-COVID-19; a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation. METHODS: A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection. Studies were deemed high-quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders. RESULTS: Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cognitive domains were assessed by enough high-quality studies to facilitate meta-analysis. Medium effect sizes indicating impairment in patients post-COVID-19 versus controls were seen across executive function (standardised mean difference (SMD) -0.45), learning and memory (SMD -0.55), complex attention (SMD -0.54) and language (SMD -0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD -0.70). A narrative synthesis of the 56 low-quality studies also suggested no obvious pattern of impairment. CONCLUSIONS: This review found moderate impairments across multiple domains of cognition in patients post-COVID-19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain-specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter-study comparisons, whilst also accounting for the interactions between COVID-19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.

Effective anaerobic treatment of produced water from petroleum production using an anaerobic digestion inoculum from a brewery wastewater treatment facility.

Produced water is a major waste problem in oil production yet it also represents a potential water source if treated properly, especially in arid regions. In this study, we investigate the anaerobic treatability of an oil-produced water with extremely high chemical oxygen demand (COD) and total dissolved organic carbon (TOC) from Wyoming's Greater Green River Basin using anaerobic microcosms inoculated with a microbial consortium derived from a brewery wastewater treatment facility. The results demonstrate that for this water and an appropriate microbial inoculation, high-COD/TOC can be effectively removed with concomitant energy recovery as a form of methane. 93% and 89% of the COD and TOC were removed with a final high methane yield of 33.9 mmol/g carbon (848 µmol/g carbon/day). Chemical analyses showed that the ethylacetate-extractable compounds were much more amenable to biodegradation than the CH2Cl2 extractable compounds. Furthermore, compounds that were added during drilling and completion remained in the water and contributed significantly to the COD and anaerobic degradability. This study demonstrates that produced waters are amenable to anaerobic biological treatment and also that thorough chemical analyses are necessary to fully understand the potential for treatment.