Survey of drug use and its association with herd-level and farm-level characteristics on German dairy farms

The use of veterinary drugs is of similar importance to that of human drugs in addressing health challenges. In this context, pharmaceuticals and their metabolites inevitably enter soil and water in unknown quantities. Therefore, this study collects and analyzes drug data from 2020 for 50 dairy farms located in Germany. The most frequently used substance group is antibiotics (40.13%), followed by antiphlogistics (18.86%), antiparasitics (13.09%), and hormones (9.29%). Treatment frequencies record the number of days per year on which an average animal on a farm was treated with a substance. The calculated values range from 0.94 to 21.69 d/yr and are distributed heterogeneously across farms. In this study, on average, a cow was treated on 6 d in 2020: 2.34 d with antibiotics, 1.07 d with antiphlogistics, 0.76 d with antiparasitics, and 0.41 d with hormones. In addition to individual farm management practices, other factors are related to treatment frequency. Farms with a veterinary care contract used more hormonal substances than farms without a care contract. In addition, higher milk yield coincides with more frequent treatments with antiphlogistic or hormonal substances. Other related factors include grazing, longevity, farm size, and use of a claw bath. Our study represents an important first step in describing the amounts and determinants of veterinary drugs used in livestock farming. Such insights on magnitudes and farm parameters are essential to estimate potential environmental effects and derive strategies to reduce veterinary drug use.

Impact of conjugation to different lipids on the lymphatic uptake and biodistribution of brush PEG polymers

Delivery to peripheral lymphatics can be achieved following interstitial administration of nano-sized delivery systems (nanoparticles, liposomes, dendrimers etc) or molecules that hitchhike on endogenous nano-sized carriers (such as albumin). The published work concerning the hitchhiking approach has mostly focussed on the lymphatic uptake of vaccines conjugated directly to albumin binding moieties (ABMs such as lipids, Evans blue dye derivatives or peptides) and their subsequent trafficking into draining lymph nodes. The mechanisms underpinning access and transport of these constructs into lymph fluid, including potential interaction with other endogenous nanocarriers such as lipoproteins, have largely been ignored. Recently, we described a series of brush polyethylene glycol (PEG) polymers containing end terminal short-chain or medium-chain hydrocarbon tails (1C2 or 1C12, respectively), cholesterol moiety (Cho), or medium-chain or long-chain diacylglycerols (2C12 or 2C18, respectively). We evaluated the association of these materials with albumin and lipoprotein in rat plasma, and their intravenous (IV) and subcutaneous (SC) pharmacokinetic profiles. Here we fully detail the association of this suite of polymers with albumin and lipoproteins in rat lymph, which is expected to facilitate lymph transport of the materials from the SC injection site. Additionally, we characterise the thoracic lymph uptake, tissue and lymph node biodistribution of the lipidated brush PEG polymers following SC administration to thoracic lymph cannulated rats. All polymers had moderate lymphatic uptake in rats following SC dosing with the lymph uptake higher for 1C2-PEG, 2C12-PEG and 2C18-PEG (5.8%, 5.9% and 6.7% dose in lymph, respectively) compared with 1C12-PEG and Cho-PEG (both 1.5% dose in lymph). The enhanced lymph uptake of 1C2-PEG, 2C12-PEG and 2C18-PEG appeared related to their association profile with different lipoproteins. The five polymers displayed different biodistribution patterns in major organs and tissues in mice. All polymers reached immune cells deep within the inguinal lymph nodes of mice following SC dosing. The ability to access these immune cells suggests the potential of the polymers as platforms for the delivery of vaccines and immunotherapies. Future studies will focus on evaluating the lymphatic targeting and therapeutic potential of drug or vaccine-loaded polymers in pre-clinical disease models.

Functionalisation of brush polyethylene glycol polymers with specific lipids extends their elimination half-life through association with natural lipid trafficking pathways

Polymeric prodrugs have been applied to control the delivery of various types of therapeutics. Similarly, conjugation of peptide therapeutics to lipids has been used to prolong systemic exposure. Here, we extend on these two approaches by conjugating brush polyethylene glycol (PEG) polymers with different lipid components including short-chain (1C2) or medium-chain (1C12) monoalkyl hydrocarbon tails, cholesterol (Cho), and diacylglycerols composed of two medium-chain (2C12) or long-chain (2C18) fatty acids. We uniquely evaluate the integration of these lipid-polymers into endogenous lipid trafficking pathways (albumin and lipoproteins) and the impact of lipid conjugation on plasma pharmacokinetics after intravenous (IV) and subcutaneous (SC) dosing to cannulated rats. The IV and SC elimination half-lives of Cho-PEG (13 and 22 h, respectively), 2C12-PEG (11 and 17 h, respectively) and 2C18-PEG (12 h for both) were prolonged compared to 1C2-PEG (3 h for both) and 1C12-PEG (4 h for both). Interestingly, 1C2-PEG and 1C12-PEG had higher SC bioavailability (40 % and 52 %, respectively) compared to Cho-PEG, 2C12-PEG and 2C18-PEG (25 %, 24 % and 23 %, respectively). These differences in pharmacokinetics may be explained by the different association patterns of the polymers with rat serum albumin (RSA), bovine serum albumin (BSA) and lipoproteins. For example, in pooled plasma (from IV pharmacokinetic studies), 2C18-PEG had the highest recovery in the high-density lipoprotein (HDL) fraction. In conclusion, the pharmacokinetics of brush PEG polymers can be tuned via conjugation with different lipids, which can be utilised to tune the elimination half-life, biodistribution and effect of therapeutics for a range of medical applications. STATEMENT OF SIGNIFICANCE: Lipidation of therapeutics such as peptides has been employed to extend their plasma half-life by promoting binding to serum albumin, providing protection against rapid clearance. Here we design and evaluate innovative biomaterials consisting of brush polyethylene glycol polymers conjugated with different lipids. Importantly, we show for the first time that lipidated polymeric materials associate with endogenous lipoprotein trafficking pathways and this, in addition to albumin binding, controls their plasma pharmacokinetics. We find that conjugation to dialkyl lipids and cholesterol leads to higher association with lipid trafficking pathways, and more sustained plasma exposure, compared to conjugation to short and monoalkyl lipids. Our lipidated polymers can thus be utilised as delivery platforms to tune the plasma half-life of various pharmaceuticals.

Tei Index and its Relation to Outcome of Critically Ill Children on Continuous Renal Replacement Therapy

OBJECTIVES

To evaluate echocardiographic parameters, especially the Tei index as a predictor of outcome in critically ill children on continuous renal replacement therapy (CRRT).

METHODS

This cohort study included all critically ill patients admitted at the Pediatric intensive care unit (PICU) and underwent CRRT. Functional echocardiography and Pediatric Risk of Mortality Index (PRISM) III were used to evaluate the participants. Both the Tei index and the Vasoactive inotropic score (VIS) were estimated.

RESULTS

The study included 35 patients with an age range of 6 mo to 14 y. The Tei indexes, VIS, and PRISM III were reported as predictors of mortality with a sensitivity of 88%, 83%, and 94% and a specificity of 73%, 79%, and 89% respectively. In survivors, the mean Tei index score, median VIS, and mean PRISM values were 0.44 ± 0.1, 3.8 (0-40), and 12.06 ± 3.35, respectively. However, in non-survivors, the mean Tei index, median VIS, and mean PRISM score were 0.59 ± 0.16, 0.60 (0-342.5), and 22.94 ± 8.93, respectively.

CONCLUSIONS

The Tei index could be used as a predictor for poor outcomes in children receiving CRRT. It is correlated to the PRISM score and VIS.

Intra-articular Injection of a B Cell Depletion Antibody Enhances Local Exposure to the Joint-Draining Lymph Node in Mice with Collagen-Induced Arthritis

Changes to the number, type, and function of immune cells within the joint-draining lymphatics is a major contributor to the progression of inflammatory arthritis. In particular, there is a significant expansion in pathogenic B cells in the joint-draining lymph node (jdLN). These B cells appear to clog the lymphatic sinuses in the lymph node, inhibit lymph flow, and therefore, reduce the clearance of inflammatory fluid and cells from the joint. Taken together, there is potential to treat inflammatory arthritis more effectively, as well as reduce off-target side effects, with localized delivery of B-cell depleting therapies to the jdLNs. We recently reported that joint-draining lymphatic exposure of biologic disease-modifying anti-rheumatic drugs (DMARDs), including the B cell depletion antibody rituximab, is increased in healthy rats following intra-articular (IA) compared to subcutaneous (SC) or intravenous (IV) administration. This suggests that IA administration of B cell depleting antibodies may increase delivery to target cells in the jdLN and increase the effectiveness of B cell depletion compared to standard SC or IV administration. However, whether enhanced local delivery of DMARDs to the jdLN is also achieved after IA injection in the setting of inflammatory arthritis, where there is inflammation in the joint and jdLN B cell expansion is unknown. We, therefore, assessed the lymph node distribution, absorption and plasma pharmacokinetics, and B cell depletion at different sites after IA, SC, or IV administration of a fluorescently labeled mouse anti-CD20 B cell depleting antibody (Cy5-αCD20) in healthy mice compared to mice with collagen-induced arthritis (CIA). The absorption and plasma pharmacokinetics of Cy5-αCD20 appeared unaltered in mice with CIA whereas distribution of Cy5-αCD20 to the jdLNs was generally increased in mice with CIA, regardless of the route of administration. However, IA administration led to greater and more specific exposure to the jdLNs. Consistent with increased Cy5-αCD20 in the jdLNs of CIA compared to healthy mice, there was a greater reduction in jdLN weight and a trend toward greater jdLN B cell depletion at 24 h compared to 4 h after IA compared to SC and IV administration. Taken together, this data supports the potential to improve local efficacy of B cell depletion therapies through a jdLN-directed approach which will enable a reduction in dose and systemic toxicities.

Troubles thyroïdiens et pneumopathie Covid-19 : étude monocentrique à propos de 223 cas

Introduction

Les troubles de la fonction thyroïdienne au cours des viroses sont décrits dans la littérature. Le SARS-Cov2 entraîne des manifestations systémiques notamment une atteinte thyroïdienne.

Patients et méthodes

C’est une étude monocentrique type cohorte rétrospective incluant les patients hospitalisés pour une pneumopathie Covid-19 (septembre 2020–février 2022) et ayant une perturbation du bilan thyroïdien. Les patients ayant des antécédents de pathologies thyroïdiennes ont été exclus. Les caractéristiques clinico-biologiques ont été relevées.

Résultats

Durant cette période, 1237 patients ont été hospitalisé pour une pneumopathie Covid-19. Nous avons inclus 256 patients en excluant 33 patients ayant un antécédent de dysthyroïdie. Il s’agissait de 128 (57 %) femmes et 95 (43 %) hommes. L’âge moyen était de 74 ans. Il s’agissait de 191 (85,7 %) cas d’hyperthyroïdie fruste, 24 (10,7 %) cas d’hypothyroïdie fruste et 8 (3,6 %) cas d’hypothyroïdie dont 6 cas de thyroïdite d’Hashimoto avec des anticorps antithyroperoxydases positifs. Il y avait une normalisation du bilan thyroïdien des cas de dysthyroïdie fruste dont le bilan a été contrôlé à distance de l’infection.

Conclusion

L’infection Covid-19, par le billais du stress hypoxique, la sécrétion de glucocorticoïdes et la libération de cytokines pro inflammatoires, peut perturber la fonction thyroïdienne. L’atteinte semble le plus souvent spontanément réversible dans le cas des dysthyroïdies fruste mais l’attention est toujours requise chez les à haut risque de survenu de fibrillation auriculaire. Ceci augmenterait le risque thromboembolique déjà majoré par la COVID-19. D’authentique cas de thyroïdite auto-immunes ont aussi été découvertes. Ceci confirme la relation déjà soulevé entre SARS-cov2 et auto-immunité.

Comparison of the initial ovarian response, the synchrony of oestrus and ovulation and chronic stress response after administration of 100 or 250 μg of GnRH to randomly cycling Bos indicus cattle

OBJECTIVE

This study investigated the effects of administering saline, 100 or 250 μg of gonadotrophin releasing hormone (GnRH) on ovarian response, synchrony of oestrus and ovulation and chronic stress response in Bos indicus cattle.

DESIGN

Randomised control.

METHODS

Animals were either left untreated (n = 20) or on day 0 treated with an intravaginal progesterone releasing device and either saline (n = 24), 100 μg (n = 35), or 250 (n = 35) μg of GnRH, intramuscular (IM). Blood was sampled 1.4 h after administration of treatment to monitor concentrations of luteinising hormone (LH) and P4 in serum and again 5 days later. On day 5 intravaginal P4 releasing device were removed, cloprostenol was administered IM and again 8 h later. Oestrus and ovulation were then monitored with ultrasonography for 6.5 days. Hair was clipped on day 55 for analysis of hair cortisol concentrations (HCC).

RESULTS

No significant differences were found between Saline and GnRH treatments in the odds of inducing a new corpus luteum (CL) and the synchrony of oestrus or ovulation. HCC did not differ significantly between treatments. Mean concentrations of LH in serum on day 0 were less in the Saline compared to 100 and 250 μg GnRH treatments but did not differ between different doses of GnRH.

CONCLUSION

Mean concentrations of LH and the odds of inducing a new CL were not increased after administering 250 μg compared to 100 μg of GnRH. Animal handling events in the study did not influence HCC. Further research is needed to better optimise responses to GnRH in B. indicus cattle.

Serological cross-sectional survey of equine infectious anemia in Saudi Arabia

The equine infectious anaemia virus (EIAV) is one of the most serious equine diseases worldwide. There is scarce information on the epizootiology of equine infectious anaemia (EIA) in Saudi Arabia. Given the importance of the equine industry in Saudi Arabia, this cross- -sectional study aims to provide information about the prevalence of EIAV based on serological surveillance of the equine population in the country. A total of 4728 sera samples were collected (4523 horses and 205 donkeys) between December 2017 and November 2019. All samples were tested using commercially available EIAV ELISA. All tested samples showed negative results for EIAV antibodies with a 95% confidence interval. The results provided evidence that Saudi Arabia's equine populations (horses and donkeys) are currently free of EIAV. The results also suggest the need for continuous monitoring of EIAV and strict regulation when importing horses from other countries.

Investigating microbial dynamics and potential advantages of anaerobic co-digestion of cheese whey and poultry slaughterhouse wastewaters

Resource recovery and prevention of environmental pollution are key goals for sustainable development. It is widely reported that agro-industrial activities are responsible for the discharge of billions of liters of wastewater to the environment. Anaerobic digestion of these energy rich agro-industrial wastewaters can simultaneously mitigate environmental pollution and recover embedded energy as methane gas. In this study, an assessment of mono- and co-digestion of cheese whey wastewater (CWW) and poultry slaughterhouse wastewater (PSW) was conducted in 2.25-L lab-scale anaerobic digesters. Treatment combinations evaluated included CWW (R1), PSW (R2), 75:25 CWW:PSW (R3), 25:75 CWW:PSW (R4), and 50:50 CWW:PSW (R5). The digestion efficiencies of the mixed wastewaters were compared to the weighted efficiencies of the corresponding combined mono-digested samples. R4, with a mixture of 25% CWW and 75% PSW, achieved the greatest treatment efficiency. This corresponded with an average biodegradability of 84%, which was greater than for R1 and R2 at 68.5 and 71.9%, respectively. Similarly, R4 produced the highest average cumulative methane value compared to R1 and R2 at 1.22× and 1.39× for similar COD loading, respectively. The modified Gompertz model provided the best fit for the obtained methane production data, with lag time decreasing over progressive treatment cycles. PCoA and heatmap analysis of relative microbial abundances indicated a divergence of microbial communities based on feed type over the treatment cycles. Microbial community analysis showed that genus Petrimonas attained the highest relative abundance (RA) at up to 38.9% in the first two cycles, then subsequently decreased to near 0% for all reactors. Syntrophomonas was highly abundant in PSW reactors, reaching up to 36% RA. Acinetobacter was present mostly in CWW reactors with a RA reaching 56.5%. The methanogenic community was dominated by Methanothrix (84.3–99.9% of archaea). The presence of phosphate and Acinetobacter in CWW feed appeared to reduce the treatment efficiency of associated reactors. Despite Acinetobacter being strictly aerobic, previous and current results indicate its survival under anaerobic conditions, with the storage of phosphate likely playing a key role in its ability to scavenge acetate during the digestion process.

Appraisal of synthetic cationic Gemini surfactants as highly efficient inhibitors for carbon steel in the acidization of oil and gas wells: an experimental and computational approach

New cationic Gemini surfactant (CGS) molecules were synthesized and investigated as anticorrosive materials for carbon steel (CS) in 1 M HCl solution by chemical, electrochemical and theoretical studies such as DFT and MDS approaches. The anticorrosion efficacy increased with the increase in the CGS concentration. It reached 95.66% at 5 × 10⁻³ M of the CGS molecule using PDP measurements. PDP studies confirm that the CGS molecule acts as a mixed inhibitor. The EIS outcomes were explained by an equivalent circuit in which a constant phase element (CPE) rather than a double-layer capacitance (C_dl) was exploited to donate a more precise fit of the experimental outcomes. The CGS molecule follows the Langmuir isotherm as it is chemically adsorbed onto the surface of CS. To explore the kinetic and adsorption mechanisms, the thermodynamic characteristics of the activation and adsorption processes were assessed under the impact of temperature. Frontier molecular orbitals (FMOs) were achieved by the density functional theory (DFT) method. The study of interatomic interactions at the [CS (Fe(110))]/CGS level was discussed using molecular dynamics (MD) simulation.

New cationic Gemini surfactant (CGS) molecules were synthesized and investigated as anticorrosive materials for carbon steel (CS) in 1 M HCl solution by chemical, electrochemical and theoretical studies such as DFT and MDS approaches.

Investigation of the anticorrosion and adsorption properties of two polymer compounds on the corrosion of SABIC iron in 1 M HCl solution by practical and computational approaches

The anticorrosion efficiency of two polymer compounds, namely polystyrene (PS), polybutylene terephthalate (PBT), against the corrosion of SABIC iron (S-Fe) in 1.0 M HCl solution was investigated. The anticorrosion efficiency was estimated by chemical and electrochemical measurements. The anticorrosion efficiency increased with the increase in the concentration of the polymer compounds and reduction in temperature. All the obtained corrosion data confirmed the anticorrosion strength in the presence of PS and PBT compounds, such as the decreasing values of the corrosion current density, capacity of the double layer, and weight reduction, while the values of the charge-transfer resistance increased. Also, the pitting potential values moved in the noble (+) direction. The anticorrosion efficiency of the PBT compound was higher than that of the PS compound, which was 95.98% at 500 ppm concentration for PBT while for PS it was 93.34% according to polarization measurements. The anticorrosion activity occurred by the adsorption of PS and PBT compounds on the surface of S-Fe according to the Langmuir isotherm. The polarization curves indicated that the PS and PBT compounds were mixed-type inhibitors. Density functional theory (DFT) and Monte Carlo simulation (MC) were performed for the two polymer compounds. The computational quantum functions were found to be in agreement with the experimental results.

Top and side views for adsorption of the two dimers over Fe (110) surface.

Natural parsley oil as a green and safe inhibitor for corrosion of X80 carbon steel in 0.5 M H2SO4 solution: a chemical, electrochemical, DFT and MC simulation approach

This work focuses on the use of natural parsley oil as a safe, eco-friendly and cost-effective inhibitor for dissolution of X80 carbon steel (X80CS) in 0.5 M H₂SO₄ solution. Electrochemical and chemical measurements and theoretical studies were utilized to determine the inhibitory vigor of parsley oil. The inhibition efficacy increases with an increase in the parsley oil concentration and a decrease in temperature. It reached 95.68% at 450 ppm of parsley oil. The inhibition process is explained by spontaneous adsorption of the oil on the X80CS. Adsorption is described by the Langmuir isotherm model. The polarization data demonstrate that parsley oil is categorized as a mixed inhibitor with a dominant control of the cathodic reaction. Parsley oil inhibits the pitting corrosion of X80CS in the presence of NaCl solution by moving the pitting potential to a more positive mode indicating protection against pitting attack. The thermodynamic parameters for activation and adsorption were computed and interpreted. The four chemical components in natural parsley oil were examined using density functional theory (DFT). Monte Carlo (MC) simulation was performed to study the adsorption of parsley oil on the X80CS surface. The outcomes confirmed that the Apiole molecule is the most effective in the inhibition process.

This work focuses on the use of natural parsley oil as a safe, eco-friendly and cost-effective inhibitor for dissolution of X80 carbon steel (X80CS) in 0.5 M H₂SO₄ solution.

Hyperparathyroïdie au cours de la pneumopathie covid-19

Introduction

Patients et méthodes

Résultats

Discussion et conclusion

Acidocétose diabétique euglycémique au décours d’une infection covid-19

Introduction

L’empagliflozine utilisé pour le traitement du diabète de type 2 a démontré son efficacité mais peut être responsable d’effets indésirables comme l’acidocétose diabétique euglycémique (ACDeu). C’est une complication rare favorisée par la déshydratation ou un état anorexigène. Nous rapportons le cas d’ACDeu associé à l’empagliflozine au décours d’une infection Covid 19.

Observation

Il s’agit d’un homme âgé de 49 ans diabétique sous empagleflozine. Il consulte pour un syndrome grippal, dyspnée et anorexie. À l’examen, il avait une glycémie à 1,68 g/l avec une acétonurie et une glycosurie. Il était polypnéique avec une saturation périphérique en O2 à 95 %. Le reste de l’examen était sans anomalie. À la biologie, il avait une acidose métabolique non compensé avec un trou anionique à 28,55 et une insuffisance rénale aiguë fonctionnelle. Devant la dyspnée le test RT-PCR coronavirus SARS cov2 a été pratiqué et il était positif. Le diagnostic d’ACDeu iatrogène à l’empagleflozine a été retenu et il a été arrêté. Le patient a été mis sous insulinothérapie associée à une hydratation et un apport adapté en glucose avec une bonne évolution clinico-biologique.

Conclusion

L’infection Covid 19 peut être responsable d’une déshydratation, une anorexie et une perturbation du métabolisme glucidique. Ces facteurs favorisent la survenue de l’ACDeu chez le patient diabétique sous empagliflozine. La glycémie normale ou faiblement élevée n’exclut pas le diagnostic. Cette observation nous rappelle l’intérêt de l’arrêt des antidiabétiques oraux lors d’une infection Covid 19. Le pronostic est bon si la prise en charge est précoce et adaptée.

Enhancing the inhibition and adsorption performance of SABIC iron corrosion in sulfuric acid by expired vitamins. Experimental and computational approach

The inhibition potency of expired thiamine or vitamin B1 (VB1) and riboflavin or vitamin B2 (VB2) against SABIC iron corrosion in 0.5 M H₂SO₄ solutions was investigated using chemical and electrochemical techniques. Theoretical studies such as DFT and MC simulations were performed on both VB1 and VB2 inhibitors to obtain information related to the experimental results. It has been found that the inhibition efficacy assigned from all measurements used increases with increasing concentration of the two expired vitamins and reduces at elevated temperatures. It reached 91.14% and 92.40% at 250 ppm of VB1 and VB2, respectively. The inhibition was explicated by the adsorption of the complex formed between expired vitamins and ferrous ions on the SABIC iron surface. The adsorption was found to obey the Langmuir isotherm model. Galvanostatic polarization demonstrated that the two expired vitamins act as an inhibitor of the mixed type. These expired vitamins have proven effective in inhibiting the pitting corrosion induced by the presence of Cl^- ions. The pitting potential is transferred to the positive values showing resistance to pitting damage. The theoretical parameter values are consistent with experimental results.

Design, Simulation, and Development of a BioSensor for Viruses Detection Using FPGA

Objective: Impedance based biosensing provides a unique, highly sensitive electrical approach to biomolecule detection, cell growth, and other biological events. To date, an impedance change due to the cell growth has been considered as a solution to detect some changes in a cell’s behavior. The impedance change detection is normally measured via an impedance analyzer which is expensive and also cumbersome. Rapid and definitive diagnosis of viral infections is imperative in patient treatment process. Early detection followed by appropriate lifestyle and treatment may result to a longer, healthier life. Certain patients require continues monitoring that may require regular visits to hospitals which is not practical. Therefore, a continuous home healthcare device is needed to monitor and detect any change in a patient’s health condition. Methods & Results: In this research, a novel sensor and healthcare monitoring system is modeled, simulated, developed, and tested to detect viruses by detecting the change in the impedance due to antibodies and antigens binding. First, COMSOL simulation tool is used to develop a model to prove the concept. The model predicts increasing impedance during functionalization of electrodes with antibodies and after antigen binding steps. Second, to understand how nanoscale electrode size and spacing would affect biosensing assay (antibody-based affinity binding of a protein antigen), a model using COMSOL is developed. Third, Field Programmable Gate Arrays (FPGA) based signal processing system is developed as well to be connected to analog to digital converter (ADC) to acquire the current and voltage readings of the sensors over time. This healthcare monitoring system is used to continuously monitoring a patient’s condition and reports any changes in the impedance readings which represents virus detection or at least change in the cell’s behavior. Conclusions: The proposed sensor model is simulated, tested and verified via COMSOL and the FPGA prototype is tested and it verified the COMSOL model. This work reports that the proposed sensor can be used to detect viruses via detecting a change in the impedance.

Short-term outcomes of surgical myocardial revascularization on health-related quality of life: a validation of the Arabic MacNew heart disease questionnaire

Background

Impaired quality of life (QOL) is common in coronary heart disease and is the major indications for coronary artery bypass graft (CABG) operations. This study aims to compare the QOL of patients with coronary heart disease before and after CABG surgery.

Results

A translated Arabic version of the Mac-New health-related QOL questionnaire was used to evaluate QOL improvement in 446 patients who benefited from elective CABG at Nasser Institute for Research and Treatment. There was a statistically significant improvement in physical, emotional, social, and global domains of QOL, as evaluated 3 and 6 months after surgery. Follow-up was 90.4% complete. At 3 months, multiple linear regression has shown that male patients (β = 0.48, p ≤ 0.001) and rural residence (β = 0.39, p ≤ 0.001) were significant independent predictors of improvement in physical QOL domain. While hypercholesterolemia (β = −0.20, −0.49, −0.37, −0.46, p ≤ 0.001), hypertension (β = −0.29, −0.39, p ≤ 0.001, β = −0.35, −β = 0.35, p = 0.001), and smoking (β = −0.79, p ≤ 0.001, β = −0.33, p = 0.04, β = −0.69, p ≤ 0.001, β = −0.47, p = 0.005) were significant predictors of worsening in physical, emotional, social, and global domains, respectively. At 6 months, low preoperative ejection fraction (EF) ≤ 40% was the strongest predictor of improvement (β = 0.54, 0.49, 0.44, and 0.52, p ≤ 0.001) in physical, emotional, social, and global domains of QOL, respectively. But, peripheral vascular disease (PVD) (β = −0.53, p = 0.05, β = −0.81, p = 0.005, β = −0.62, p = 0.03, β = −0.76, p = 0.008) and smoking (β = −0.53, p = 0.001, β = −0.42, p = 0.01, β = −0.42, p = 0.01, β = −0.41, p = 0.02) were significant predictors of worsening in physical, emotional, social, and global domains of QOL, respectively.

Conclusions

CABG surgery improved in all domains of QOL. Further studies are required to evaluate changes in QOL at longer period intervals.

Intraventricular Tigecycline as a Last Resort Therapy in a Patient with Difficult-to-Treat Healthcare-Associated Acinetobacter baumannii Ventriculitis: a Case Report

Healthcare-associated ventriculitis and meningitis is a common complication in patients who suffer from head trauma or have undergone a neurosurgery. Healthcare-associated ventriculitis and meningitis is associated with significant morbidity and mortality. Complications of healthcare-associated ventriculitis and meningitis include persistent vegetative state, moderate and severe disability, and death. Acinetobacter baumannii is the causative pathogen in 3.6–11.2% of cases of healthcare-associated ventriculitis and meningitis. Cases of difficult-to-treat healthcare-associated A. baumannii ventriculitis and meningitis are being reported more frequently. However, in most of these cases, a combination of intravenous (IV) and intraventricular (IVT)/intrathecal colistin achieves good therapeutic outcome. This report describes a clinical case of difficult-to-treat healthcare-associated A. baumannii ventriculitis. The A. baumannii strain was sensitive to colistin and trimethoprim-sulfamethoxazole, intermediate to tigecycline, and resistant to other antibiotics. While colistin was the drug of choice in our case, the patient developed anaphylactoid reaction during the IV administration of the loading dose of colistin, which mandated us to discontinue colistin and complicated the treatment of our patient. The patient did not respond to a combination of IV antibiotics that included meropenem, trimethoprim-sulfamethoxazole, and tigecycline. However, when IVT tigecycline was added as a last-resort therapeutic option, the patient’s ventriculitis dramatically improved, and the patient was discharged from the hospital. Physicians who treat patients with healthcare-associated A. baumannii ventriculitis might resort to IVT tigecycline when they run out of therapeutic options.

Lymphatic targeting by albumin-hitchhiking: Applications and optimisation

The lymphatic system plays an integral role in the development and progression of a range of disease conditions, which has impelled medical researchers and clinicians to design, develop and utilize advanced lymphatic drug delivery systems. Following interstitial administration, most therapeutics and molecules are cleared from tissues via the draining blood capillaries. Macromolecules and delivery systems >20 kDa in size or 10-100 nm in diameter are, however, transported from the interstitium via draining lymphatic vessels as they are too large to cross the blood capillary endothelium. Lymphatic uptake of small molecules can be promoted by two general approaches: administration in association with synthetic macromolecular constructs, or through hitchhiking on endogenous cells or macromolecular carriers that are transported from tissues via the lymphatics. In this paper we review the latter approach where molecules are targeted to lymph by hitchhiking on endogenous albumin transport pathways after subcutaneous, intramuscular or intradermal injection. We describe the properties of the lymphatic system and albumin that are relevant to lymphatic targeting, the characteristics of drugs and delivery systems designed to hitchhike on albumin trafficking pathways and how to further optimise these properties, and finally the current applications and potential future directions for albumin-hitchhiking approaches to target the lymphatics.

Ramsay Sedation Scale and Richmond Agitation Sedation Scale: A Cross-sectional Study

BACKGROUND

Many sedation scales and tools have been developed and compared for validity in critically ill patients. However, selection and use of sedation scales vary among intensive care units.

OBJECTIVE

The aim of this study is to compare the reliability of 2 sedation scales-Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS)-in the adult intensive care unit.

METHOD

Four hundred twenty-five patients were recruited in the study. Informed consent had been obtained from each patient guardian/relative. However, only 290 patients (68.24%) completed the study and were independently assessed for sedation effect by investigator and bedside nurses simultaneously using Ramsay scale and RASS.

RESULTS

Agreement between the nurse and investigator scores on Ramsay scale (weighted κ = 0.449, P < .001) indicated weak level of agreement. Agreement between the nurse and investigator on RASS (weighted κ = 0.879, P < .001) indicated a strong level of agreement. Cronbach α analysis showed that 10 items of RASS had an excellent level of internal consistency (α = .989) compared with good level of internal consistency of Ramsay scale (α = .828).

DISCUSSION

Richmond Agitation-Sedation Scale showed excellent interrater agreement compared with weak interrater agreement of Ramsay scale. The results also support that RASS has consistent agreement with clinical observation and practice among different observers. The results suggest that use of RASS is linked to a more reliable assessment of sedation levels in the intensive care unit.

P6438Trends of acute kidney injury following percutaneous coronary interventions

Introduction

Acute kidney injury (AKI) is a significant in-hospital complication in patients undergoing percutaneous coronary interventions (PCI) and has been shown to be associated with poor outcomes. Prior studies have shown an upward trend of AKI post PCI which may be related to a multitude of factors. In this study, we aim to discern whether the recent changes in AKI definition, awareness of risk calculators, and preventive measures have been effective in changing the inclining trend.

Methods

Patients who underwent PCI during hospitalization were identified retrospectively in the Nationwide Readmission Database (NRD) from January 2010 to December 2014. All patients older than 18 years were included in the current study. Patient demographics and comorbidities were identified using appropriate ICD-9 codes. The primary outcome is the temporal trends of AKI following PCI and secondary outcomes are temporal trends in mortality, length of stay and hospitalization cost in patients with AKI. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages (%). All statistical tests were two-sided.

Results

Among the 2,712,473 patients who underwent PCI from 2010 to 2014, 162,286 (6%) patients developed AKI post PCI. Mean age was 69.22±12.34 years and 65% of them were males. The percentage of cases with AKI rose almost twofold from 2010 to 2014 (4.8% to 8.1%, p-value <0.005), despite the lack of a significant change in patient's demographics and comorbidities over the years. Among patients with a history of Chronic Kidney Disease (CKD) the incidence of AKI increased from 20.3% to 24.2%, and in patients without CKD history the incidence of AKI almost doubled (2.6% to 5.0%) from 2010 to 2014. There was a slight decrease in in-hospital mortality (9.4% to 8.8%) and median length of stay (7 days to 5 days), and a slight increase in the mean cost of hospitalization ($124,755.1 to $133,902.17) from 2010 to 2014.

AKI Incidence and mortality trend

Conclusion

This large cohort study shows a consistent uptrend of AKI in patients undergoing PCI from 2010 to 2014. Despite this, the mortality and length of stay are decreasing while the cost of hospitalization only slightly increased in patients with AKI. Thus, future drives to implement renal protective measures and advanced studies to identify new preventive therapies are needed to reduce the incidence of AKI post-PCI.

Numerical computation of thermoelectric effiency of graphite sheet optimal dimension

Thermoelectric Graphite sheet has been studied numerically due to their ability to convert directly heat to electricity. Electro-thermal heat transfer equations coupling to initial and boundary conditions, are solved using finite difference and finite element schemes. The obtained results of both numerical techniques show good qualitative and quantitative agreements. In addition, the results of our numerical models present good conformity with the experimental result of Luo et al.. The voltage difference, the temperature variation, the Seebeck coefficient, the figure of merit and the maximum efficiency of graphite sheet are determined numerically. The ZT of the graphite sheet is calculated to be 1.27 at a temperature of 850 K for a graphite sheet surface of 0.26×0.25 cm2.

Effect of short-term carbapenem restriction on the incidence of non-pseudomonal multi-drug resistant Gram-negative bacilli in an intensive care unit

We conducted a two-phase retrospective study to investigate the impact of a short-term carbapenem restriction on the incidence of non-pseudomonal multidrug-resistant (MDR) Gram-negative bacilli in our intensive care unit (ICU). The first phase of the study (before carbapenem restriction) was conducted between May and July 2016, and the second phase (implementation of carbapenem restriction) between September and November 2016. The incidence of all non-pseudomonal MDR Gram-negative bacilli (extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and MDR Acinetobacter baumannii) decreased significantly after carbapenem restriction. Patients positive for non-pseudomonal MDR Gram-negative bacilli before and after carbapenem restriction were comparable in terms of age, weight, Acute Physiology and Chronic Health Evaluation IV score, central venous catheter placement, and vasopressor use. This report suggests that short-term carbapenem restriction for 3 months may be an effective strategy for reducing the incidence of non-pseudomonal MDR Gram-negative bacilli.