Experience of Sustained Low-Efficiency Dialysis (SLED) in an Intensive Care Unit of a Quaternary Care Hospital

BACKGROUND

In critically ill patients, sustained low-efficiency dialysis (SLED) has become a viable option for treating acute kidney injury (AKI) instead of continuous renal replacement therapy (CRRT). This study aimed to evaluate clinical outcomes in critically ill patients receiving SLED.

MATERIAL AND METHODS

In our ICU, we performed a retrospective cohort study on hemodynamically unstable patients requiring dialysis in the form of SLED. Demographics, clinical, and biochemical variables were analyzed.

RESULTS

A total of 58 patients were enrolled in the study. The mean age was 48.58 ± 15 with a male-to-female ratio of 3:1. Higher APACHE II score, high international normalized ratio, thrombocytopenia, and septic shock were found to be poor prognostic markers, with an overall observed mortality of 56.9%.

CONCLUSION

SLED can be considered as an alternative to CCRT for selected hemodynamically unstable patients requiring renal replacement therapy.

Sn-based materials in photocatalysis: A review

Development and the application of Sn-based materials have become more prevalent in recent years due to concerns regarding the energy crisis, environmental pollution, and the urgent need of constructing inexpensive and highly effective photocatalysis. The recent advancement in Sn-based materials for efficient photocatalysts, such as Sn alloys, Sn oxides, Sn sulfides, Sn selenides, Sn niobates, Sn tantalites, and Sn tungstates, is summarized in this study. Several design ideas for increasing the photoactivity of Sn-based materials in various photocatalytic applications are emphasized. In addition, we considered their present applications in energy generation (H2 evolution, CO2 reduction, and N2 fixation) and environmental remediation (air purification and wastewater treatment). As a result, the current review will deepen the reader's understanding of the properties and potential uses of Sn-based materials in photocatalysis. Hence, this paper will serve as a guide in promoting the domain of Sn-based materials for future photocatalytic technologies.

Patient and Family Satisfaction in the Intensive Care Unit of a Quaternary Care Center

Patient and family satisfaction is an indicator of quality assessment of care provided in the intensive care unit (ICU) ensuring that the quality of services provided meets not only the patients' but also their families' needs. Investigating how different variables affect their satisfaction ratings is important. We assessed patient and family satisfaction in a quaternary care center in Pakistan.

METHODS

The study was a cross-sectional survey of adult patients and families treated between December 1, 2022 and April 30, 2023 in the ICU at Pakistan Kidney and Liver Institute and Research Center (PKLI-RC), Lahore, Pakistan. We used family satisfaction in ICU 24 (FS-ICU 24) to measure satisfaction in a number of domains on a scale of 1-5 (1 = Very Dissatisfied, 5 = Fully Satisfied).

RESULTS

Of the 330 patients admitted to ICU during the study period, all patients and/or one of their family members (100%) participated in the study. Out of these, 209 (63%) were male. The mean age was 42 ± 15 years, and the overall mean patient and family satisfaction scores were 4.69 ± 0.69 and 4.55 ± 0.52, respectively. The mean score in all domains was > 4, with the exception of pain management in which it was 3.98 ± 0.53.

CONCLUSION

Patients and their families' satisfaction is an important measure of ICU quality. Not only the patients and their families were satisfied with our ICU quality of care but they also appreciated involvement in the decision-making process and quality assessment. There is a need for further research for improvement in the pain domain.

Use of Oral N-Acetylcysteine (NAC) in Non-Acetaminophen-Induced Acute Hepatic Failure

BACKGROUND

Acute liver failure (ALF) is a syndrome rather than a specific disease with several possible causes, and viral hepatitis is a major cause. The objective of the study was to assess the benefit of N-acetylcysteine (NAC) in non-acetaminophen-induced acute liver failure (NAI-ALF).

METHODS

A total of six patients with a diagnosis of acute liver failure (ALF) were included in the study. All six patients received oral NAC for 72 hrs. The parameters evaluated were demographic, clinical, biochemical, outcome, and length of ICU and hospital stay. The primary outcome was a reduction in mortality with the use of NAC in NAI-ALF. The secondary outcomes were to evaluate the safety of NAC and assess factors predicting mortality.

RESULTS

All patients improved and returned to normal or near-normal liver function with the use of NAC. No side effects were noted, and the use of NAC was associated with a shorter hospital stay.

CONCLUSION

In patients with non-acetaminophen-related acute liver failure, N-acetyl-L-cysteine (NAC) significantly improves overall survival and also decreases the length of hospital stay.

Binder-Free Zinc-Iron Oxide as a High-Performance Negative Electrode Material for Pseudocapacitors

The interaction between cathode and anode materials is critical for developing a high-performance asymmetric supercapacitor (SC). Significant advances have been made for cathode materials, while the anode is comparatively less explored for SC applications. Herein, we proposed a high-performance binder-free anode material composed of two-dimensional ZnFe₂O₄ nanoflakes supported on carbon cloth (ZFO-NF@CC). The electrochemical performance of ZFO-NF@CC as an anode material for supercapacitor application was examined in a KOH solution via a three-electrode configuration. The ZFO-NF@CC electrode demonstrated a specific capacitance of 509 F g^-1 at 1.5 A g^-1 and was retained 94.2% after 10,000 GCD cycles. The ZFO-NF@CC electrode showed exceptional charge storage properties by attaining high pseudocapacitive-type storage. Furthermore, an asymmetric SC device was fabricated using ZFO-NF@CC as an anode and activated carbon on CC (AC@CC) as a cathode with a KOH-based aqueous electrolyte (ZFO-NF@CC||AC@CC). The ZFO-NF@CC||AC@CC yielded a high specific capacitance of 122.2 F g^-1 at a current density of 2 A g^-1, a high energy density of 55.044 Wh kg^-1 at a power density of 1801.44 W kg^-1, with a remarkable retention rate of 96.5% even after 4000 cycles was attained. Thus, our results showed that the enhanced electrochemical performance of ZFO-NF@CC used as an anode in high-performance SC applications can open new research directions for replacing carbon-based anode materials.

Molecular characterization of prophenoloxidase-1 (PPO1) and the inhibitory effect of kojic acid on phenoloxidase (PO) activity and on the development of Zeugodacus tau (Walker) (Diptera: Tephritidae)

Phenoloxidase (PO) plays a key role in melanin biosynthesis during insect development. Here, we isolated the 2310-bp full-length cDNA of PPO1 from Zeugodacus tau, a destructive horticultural pest. qRT-polymerase chain reaction showed that the ZtPPO1 transcripts were highly expressed during larval-prepupal transition and in the haemolymph. When the larvae were fed a 1.66% kojic acid (KA)-containing diet, the levels of the ZtPPO1 transcripts significantly increased by 2.79- and 3.39-fold in the whole larvae and cuticles, respectively, while the corresponding PO activity was significantly reduced; in addition, the larval and pupal durations were significantly prolonged; pupal weights were lowered; and abnormal phenotypes were observed. An in vitro inhibition experiment indicated that KA was an effective competitive inhibitor of PO in Z. tau. Additionally, the functional analysis showed that 20E could significantly up-regulate the expression of ZtPPO1, induce lower pupal weight, and advance pupation. Knockdown of the ZtPPO1 gene by RNAi significantly decreased mRNA levels after 24 h and led to low pupation rates and incomplete pupae with abnormal phenotypes during the larval-pupal interim period. These results proved that PO is important for the normal growth of Z. tau and that KA can disrupt the development of this pest insect.

Structures and Properties of LaFe0.8Cu0.2O3-δ and BaFe0.8Cu0.2O3-δ as Cobalt-Free Perovskite-Type Cathode Materials for the Oxygen Reduction Reaction

Perovskite oxides with mixed electronic-ionic conduction are important catalysts for the oxygen reduction reaction in solid oxide fuel cells (SOFCs). Here, two cobalt-free perovskite oxides, LaFe0.8Cu0.2O3-δ (LFCuO) and BaFe0.8Cu0.2O3-δ (BFCuO), were synthesized and comparatively studied with respect to their phase structures, oxygen contents, chemical defects, thermal expansion coefficient (TEC), as well as electrical and electrochemical properties. Different structures and properties have been found for each oxide, which have been interpreted based on their tolerance factors and chemical defects. LFCuO showed much better overall performance than BFCuO, and it proved to be a promising cobalt-free cathode material of intermediate-temperature SOFCs with a low TEC (12.0×10-6 °C-1) that matches well with TECs of the electrolytes, high catalytic activity for the oxygen reduction reaction characterized by low area specific resistances (0.090 Ω cm2 at 800 °C and 0.20 Ω cm2 at 750 °C), and high-temperature chemical stability with electrolytes.

Overexposure analysis of pulsed distributed feedback laser source

The goal of this study is to assess the risk of overexposure, when DFB dye laser is used for medical treatment in pulsed mode operation. Results of experimental study showing an unexpected rise of energy in pulses of distributed feedback dye laser (DFDL) output due to temperature phase gratings in dye cell during passively Q switched and mode-locked operation is reported. This unintended increase in the number of pulses, pulse duration, per pulse energy may cause side effects, when used for selective photothermolysis. To probe this phenomenon the most commonly used Rh6G dye was excited with 10-20 pulses of second harmonic of a passively Q switched and mode-locked Nd:yttrium-aluminum-garnet(YAG) laser. The outputs of DFDL and Nd:YAG laser were recorded by an Imacon-675 streak camera. The peak of DFDL output pulses was found delayed proportionally from the peak of the Nd:YAG pulses by more than an interpulse period of excitation laser. A computer program was used to simulate the experimentally measured results to estimate the thermal decay constants and energy retained by medium. The delay between peaks of Nd:YAG (input) and DFDL (output) pulses was found to vary from 10 to 14 ns for various cavity lengths. It was interesting to note that for smaller inter-pulse periods the effect of gradual gain buildup satisfied the threshold conditions for some of the pulses that otherwise cannot lase. This may lead to unintended increase in energy fluence causing overexposure-induced bio effects.

A comparative study of positive pressure ventilation via laryngeal mask airway and endotracheal tube

OBJECTIVE

To investigate the use of Laryngeal Mask Airway (LMA) and its comparison with the endotracheal tube for positive pressure ventilation.

SETTING

A tertiary care teaching hospital.

METHODS

Fifty adult ASA I and II patients undergoing peripheral limb surgery were randomly allocated to 2 groups for LMA or endotracheal tube insertion. A standardized anaesthetic technique was used. The groups were then compared regarding haemodynamic changes on insertion as well as removal of LMA and ETT and any complications that occurred were noted.

RESULTS

The haemodynamic response to insertion was significantly attenuated (p < 0.05) in LMA group as compared to ETT group. The cardiovascular response to extubation was not significantly different between the groups. A higher incidence of coughing and mild hypoxaemia at extubation was noted in ETT group as compared to LMA group (p < 0.05) and blood was detected in 4 cases after LMA removal.

CONCLUSION

It is concluded that the use of LMA during positive pressure ventilation is safe in selected cases. There is an attenuated haemodynamic response to insertion of LMA as compared to endotracheal tube which will be beneficial in certain patients e.g., those with ischaemic heart disease, vascular disease and hypertensives.