Outcomes following cardiopulmonary resuscitation in an emergency department of a low- and middle-income country

Background

Cardiopulmonary resuscitation (CPR) is a key component of emergency care following cardiac arrest. A better understanding of factors that influence CPR outcomes and their prognostic implications would help guide care. A retrospective analysis of 800 adult patients that sustained an in- or out-of-hospital cardiac arrest and underwent CPR in the emergency department of a tertiary care facility in Karachi, Pakistan, between 2008 and 15 was conducted.

Methods

Patient demographics, clinical history, and CPR characteristics data were collected. Logistic regression model was applied to assess predictors of return of spontaneous circulation and survival to discharge. Analysis was conducted using SPSS v.21.0.

Results

Four hundred sixty-eight patients met the study’s inclusion criteria, and overall return of spontaneous circulation and survival to discharge were achieved in 128 (27.4%) and 35 (7.5%) patients respectively. Mean age of patients sustaining return of spontaneous circulation was 52 years and that of survival to discharge was 49 years. The independent predictors of return of spontaneous circulation included age ≤?49 years, witnessed arrest, ≤?30 min interval between collapse-to-start, and 1–4 shocks given during CPR (aOR (95% CI) 2.2 (1.3–3.6), 1.9 (1.0–3.7), 14.6 (4.9–43.4), and 3.0 (1.4–6.4) respectively), whereas, age ≤?52 years, bystander resuscitation, and initial rhythm documented (pulseless electrical activity and ventricular fibrillation) were independent predictors of survival to discharge (aOR (95% CI) 2.5 (0.9–6.5), 1.4 (0.5–3.8), 5.3 (1.5–18.4), and 3.1 (1.0–10.2) respectively).

Conclusion

Our study notes that while the majority of arrests occur out of the hospital, only a small proportion of those arrests receive on-site CPR, which is a key contributor to unfavorable outcomes in this group. It is recommended that effective pre-hospital emergency care systems be established in developing countries which could potentially improve post-arrest outcomes. Younger patients, CPR initiation soon after arrest, presenting rhythm of pulseless ventricular tachycardia and ventricular fibrillation, and those requiring up to four shocks to revive are more likely to achieve favorable outcomes.

     

Magnetic phase transition from paramagnetic in Nb2AlC-MAX to superconductivity-like diamagnetic in Nb2C-MXene: an experimental and computational analysis

Transition metal carbides (TMCs) have recently emerged as competent members among the family of two-dimensional (2D) materials, owing to their promising applications. There are many promising applications of MXenes; however, their magnetic properties lack a wide margin, both experimentally as well as theoretically, which needs to be investigated for potential use in spintronics. In this study, we carried out a comprehensive etching process via selective extraction of Al layers from Nb₂AlC-MAX using a wet electrochemical route under well-optimized conditions to obtain fine 2D-Nb₂C MXene sheets. Structural analysis using X-ray diffraction (XRD) confirms the effective removal of Al followed by confirmation of a 2D layered structure from morphological analysis using scanning electron microscopy (SEM). Zero-field-cooled (ZFC) and field-cooled (FC) measurements of MAX and MXene at different field strengths were performed using a superconducting quantum interference device (SQUID). Magnetic measurements reveal the paramagnetic nature of Nb₂AlC-MAX measured under 5 mT; however, this changes to a clear superconductor-like diamagnetic behavior with a shift of the magnetization from positive to negative values at low temperatures when measured under 5 mT and 10 mT for Nb₂C MXene. The diamagnetism, however, is changed to paramagnetism at 100 mT, which shows the existence of critical fields known typically for a type-II superconductor. To gain an insight into this unusual behavior in MXene, density functional theory (DFT) first-principles calculation was also performed in Wein2K software using spin-polarized generalized gradient approximation (sp-GGA). The magnetic moment of the compound is calculated to be negative, which corresponds well with the experimental finding and suggests that the negative magnetic moment originated from the d-orbital of Nb₂C. The present report provides a pathway to deeply understanding the existence of superconductivity-like diamagnetic behavior in Nb₂C MXene, which is useful for future magnetic applications.

Transition metal carbides (TMCs) have recently emerged as competent members among the family of two-dimensional (2D) materials, owing to their promising applications.

In two-dimensional (2D) materials, magnetism at the nanoscale is at the forefront of many cutting-edge technological applications, such as spintronic devices. Naguib et al. have synthesized a new class of two-dimensional materials, known as MXenes (M_nX_n+1), discovered in 2011, giving a possibility of magnetism in such 2D materials and their promising uses in spintronic devices.¹ These 2D layer structured early transition metal carbides and/or nitrides are known as MXenes, so named to indicate their structural similarities with graphene.² MXenes are derived from 3D MAX phases (space group P6₃/mmc) in which “M” is an early transition metal, e.g., Ti, Ta, V, etc.; “A” is mainly a group 13 or group 14 element (group III-A or IV-A), e.g., Si, Al; “X” is a carbide, nitride or can be both; and n = 1, 2, 3 represents the number of layers, forming 211, 312 and 413 phases.^3–5 Over the past decade, this new material has gained enormous attention, thus developing an entirely new research field to disclose the properties of the 2D state of this material. The materials in the 2D regime own a cluster of astonishing physical properties as compared to the 3D nature, but intrinsic two-dimensional magnetism has proved to be challenging. As 2D semiconductors have revamped the field of electronics, similarly, magnetism in 2D materials could remodel spintronic devices that can employ a spin degree of freedom.^6,7Nb₂C MXene was first synthesized by Naguib et al., but they just reported its electrochemical activity as a promising electrode material.⁴ Further work has been reported in Nb₂C with various biomedical applications, energy storage, supercapacitors, and nanoelectronics.^9–19 As far as the magnetism in such 2D MXenes is concerned, it remains less investigated, and this research void needs to be filled. Recently, Babar et al. reported the observation of superconductivity in as-prepared powdered Nb₂C for the first time, with the highest onset transition temperature T_c,onset = 12.5 K among the MXene family. However, the authors did not discuss the magnetic nature of the parent Nb₂AlC MAX itself and did not reason for the presence of unusual magnetic effects in MXene.⁸ MXenes are favorable members of 2D magnetism, and different magnetic natures are computationally predicted in various carbide and nitride MXenes.^7,20 The existence of novel room-temperature ferromagnetic order in doped MXene and the coexistence of different magnetic phases in MXene, along with experimental evidence, indicate its potential of hosting diverse magnetic natures.^21,22 Considerable research has been focused on these 2D structures due to their importance and favorable applications, such as spintronics. MXene could provide a vast platform for exploring the magnetic properties and is one of the best candidates that can host superconductivity as compared to other members of the 2D family. Experimental studies are generally dependent upon numerous variables, thus affecting the research pace. However, density functional theory-based first principles calculation and theoretical simulations are a successful way to examine and foresee the properties of low-dimensional materials. This provoked us to theoretically explore superconductivity in Nb₂C and their validation through superconductivity measurements of experimentally synthesized Nb₂C MXene. In this work, we report a systematic etching mechanism of Nb₂C MXene to obtain fine 2D sheets via a chemical etching route using hydrofluoric (HF) acid. Structural and morphological studies using the X-ray diffraction technique (XRD), scanning electron microscopy (SEM) and elemental analysis by energy-dispersive X-ray spectroscopy (EDX) show the effective removal of Al from the parent 3D-Nb₂AlC MAX, thus revealing an accordion-like sheet structure. Optical analysis indicates a significant reduction in bandgap after chemical etching. Magnetic properties were carried out to observe the signatures of superconductivity (a perfect diamagnetic state, negative magnetic moment) and its magnetic nature at room temperature. To study the magnetic nature of as-prepared powder-form Nb₂C, density functional theory (DFT) first principles calculation was carried out through Wein2K using spin-polarized generalized gradient approximation (sp-GGA). The magnetic moment of the compound is calculated to be −0.00485, which although but small is important, as the value is negative, which is an indication of the presence of diamagnetism in Nb₂C. Here, the detailed chemical etching process, magnetic properties of Nb₂AlC MAX and its effect on magnetic phase of Nb₂C MXene, and the density functional theory calculation are reported, which were not discussed by Babar et al. in ref. 8.     

Micronutrients and Dengue

Dengue virus infection is the most widespread mosquito-borne viral infection in humans and has emerged as a serious global health challenge. In the absence of effective treatment and vaccine, host factors including nutritional status, which may alter disease progression, need investigation. The interplay between nutrition and other infections is well-established, and modulation of nutritional status often presents a simple low-cost method of interrupting transmission, reducing susceptibility, and/or ameliorating disease severity. This review examines the evidence on the role of micronutrients in dengue virus infection. We found critical issues and often inconsistent results across studies; this finding along with the lack of sufficient literature in this field have limited our ability to make any recommendations. However, vitamins D and E have shown promise in small supplementation trials. In summary, the role of micronutrients in dengue virus infection is an exciting research area and needs to be examined in well-designed studies with larger samples.     

Aprotinin in pediatric neuromuscular scoliosis surgery

Reduction of blood transfusions in patients with neuromuscular scoliosis can decrease potential complications such as immune suppression, infection, hemolytic reaction and viral transmission. Aprotinin (Trasylol^®, Bayer), an antifibrinolytic, has proven to be effective in reducing blood loss in cardiac and liver surgery, but little data exists in patients undergoing spinal fusion for neuromuscular scoliosis. The purpose of this study was to evaluate the safety and efficacy of aprotinin in pediatric neuromuscular scoliosis patients undergoing spinal fusion. The medical records of all patients undergoing initial spinal fusions for neuromuscular scoliosis between January 1999 and March 2003 were reviewed to determine demographic data, perioperative data, wound drainage and number of transfusion required. Cases were compared to a matched group of historical controls. We had 14 patients in the aprotinin group and 17 in the control group. Total blood loss in the aprotinin group was significantly lower compared to the control group (715 vs. 2,110 ml; P = 0.007). Significantly less blood loss occurred in the aprotinin group when blood loss per kilogram was evaluated as well (23 vs. 60 ml/kg, respectively; P = 0.002). Intra-operative packed red blood cell (PRBC) transfusions were also significantly lower in the aprotinin group (1.25 vs. 3.16 units; P = 0.001). No clinical evidence of anaphylaxis, deep vein thrombosis (DVT) or renal failure was observed in the aprotinin group. After considering the price of drug therapy, operating room time, and the cost of blood products, the use of aprotinin saved an average of $8,577 per patient. In our series, the use of aprotinin resulted in decreased blood loss and a decreased rate of transfusions in children with neuromuscular scoliosis undergoing extensive spinal fusion. At out institution, the use of aprotinin is safe and cost effective for patients with neuromuscular scoliosis.     

Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery

The safety and side-effects profile of epidural administration of a hydrophilic (morphine), highly lipophilic (fentanyl) and a drug with intermediate hydrophilic and lipophilic activity (hydromorphone) were compared in 90 children undergoing orthopaedic procedures. Ninety patients were randomly assigned (30 in each group) to receive epidural morphine, hydromorphone, or fentanyl for postoperative analgesia. Respiratory effects, nausea, somnolence, urinary retention, pruritus and visual pain scales were evaluated and compared during a 30-h period following surgery. In the morphine group, 25% showed respiratory depression with oxygen saturation below 90% but there was no incidence of respiratory depression in the fentanyl or hydromorphone groups. Somnolence was prominent in some of the patients in all the groups, but was more prolonged in the morphine group. Statistically, there was no significant difference in nausea between the groups, but pruritus was more severe and frequent in the morphine group. The incidence of urinary retention in the morphine group was higher compared with the fentanyl and hydromorphone groups. In conclusion, epidural hydromorphone, demonstrating less side-effects, is preferable to morphine and fentanyl for epidural analgesia in children.     

The Effect of MIpaste Plus and Reminpro on Incipient Caries Using DIAGNOdent and SEM: An Invitro Study

Background

The remineralization of early caries lesion has an effective role on decreasing caries. For initial remineralization of caries lesion, using Compounds of Casein phosphopeptides (CPP) in different studies has been proposed. REMINPRO including Fluoride, Xylitol and Calcium phosphate has just been offered in the market. This study aims to investigate the efficacy of Reminpro and MI paste plus in terms of remineralization of early enamel lesions.