Frequency of Low Cardiac Output Syndrome Following on Pump Coronary Artery Bypass Grafting Surgery and it's Association with Degree of Pre-operative Left Ventricular Dysfunction

Background Low cardiac output syndrome (LCOS) is a serious complication after coronary artery bypass grafting (CABG) surgery. It is associated with 10 times to 17 times increase in mortality and markedly increase morbidity. Objective To find out the frequency of Low cardiac output syndrome following on pump coronary artery bypass grafting surgery, to determine the association of Low cardiac output syndrome with degree of pre-operative left ventricular dysfunction and to compare in hospital outcomes of coronary bypass surgery with and without low cardiac output syndrome. Method This prospective, descriptive study enrolled 200 patients who underwent on pump coronary artery bypass grafting surgery using antegrade St Thomas blood cardioplegia. Pre-operatively grouped into two groups consisting Group A of 100 patients with pre-operative left ventricular ejection fraction (LVEF) ≥ 40% and group B of 100 patients with pre-operative left ventricular ejection fraction (LVEF) < 40%. Post-operatively frequency of low cardiac output syndrome was compared between the groups and in-hospital outcomes were studied. Result The mean age of the patients in the study was 53.50±7.57 years. Male to female ratio was 1.8:1. Results showed overall frequency of low cardiac output syndrome was 21.5%. The frequency of LCOS was 15 vs 28% (p - 0.038) in patients with preoperative LV EF ≥ 40% and < 40% respectively. The outcomes of coronary artery bypass grafting surgery were stroke (3.82 vs. 30.23%, p - 0.001), acute kidney injury (5.09 vs. 23.25%, p - 0.001), respiratory failure (6.36 vs. 34.88%, p - 0.001), ICU stay days (4.75 ± 1.28 vs. 7.44 ± 4.66, p - 0.018), hospital stay days (9.56 ± 2.40 vs. 15.22 ± 3.89, p - 0.001) and mortality (4.45 vs. 32.55%, p - 0.001) in patients without and with low cardiac output syndrome respectively. Conclusion The frequency of low cardiac output syndrome following coronary artery bypass surgery is 21.5%. Left ventricular dysfunction pre-operatively is associated with high frequency of low cardiac output syndrome following surgery. There is significantly poor outcome of coronary artery bypass surgery with low cardiac output syndrome in terms of stroke, respiratory failure, acute kidney injury, mortality and significant ICU stay, hospital stay in compare to patients without low cardiac output syndrome.

Modification of the drug resistance of emerging milk-borne pathogens through sodium alginate-based antibiotics and nanoparticles

Streptococcus agalactiae and Klebsiella pneumoniae are emerging as major milk-borne pathogens. Additionally, resistance to antibiotics of pathogens is of concern. Therefore, this study investigated the prevalence and drug resistance of S. agalactiae and K. pneumoniae in mastitis milk samples and assessed the antimicrobial potential of sodium alginate (G)-stabilized MgO nanoparticles (M) and antibiotics (tylosin [T] and ampicillin [A]) against both of these pathogens. A total of n = 200 milk samples from cattle were collected using purposive sampling, and standard microbiological approaches were adopted to isolate target bacteria. Parametric and non-parametric statistical tests were used to analyze the obtained data. Four preparations, GT (gel-stabilized tylosin), GA (gel-stabilized ampicillin), GTM (tylosin and MgO nanoparticles stabilized in gel), and GAM (ampicillin and MgO nanoparticles stabilized in gel), were evaluated against both bacteria through well diffusion and broth microdilution method. The analysis revealed that 45.24% (95/210) of the milk samples were positive for mastitis, of which 11.58% (11/95) were positive for S. agalactiae and 9.47% (9/95) were positive for K. pneumoniae. S. agalactiae had a significantly higher zone of inhibition (ZOI) than K. pneumoniae against penicillin, tetracycline, and amoxicillin, whereas the opposite was observed against imipenem and erythromycin. All gel (G)-based preparations showed an increase in the percentage of ZOI compared with antibiotics alone, with GTM presenting the highest of all, i.e., 59.09 and 56.25% ZOI compared with tylosin alone against S. agalactiae and K. pneumoniae, respectively. Similarly, in a broth microdilution assay, the lowest MIC was found for K. pneumoniae (9.766 ± 0.0 μg/mL) against GTM, followed by GT, GAM, and GA after incubation for 24 h. A similar response was noted for preparations against S. agalactiae but with a comparatively higher MIC. A significant reduction in MIC with respect to incubation time was found at 8 h and remained until at 20 h against both pathogens. The cytotoxicity of the MgO nanoparticles used in this study was significantly lower than that of the positive control. Overall, this study found that K. pneumoniae and S. agalactiae appeared higher in prevalence and antimicrobial resistance, and sodium alginate-based antibiotics and MgO nanoparticles were effective alternative approaches for tackling antimicrobial resistance.

Graphene Oxide-Doped MgO Nanostructures for Highly Efficient Dye Degradation and Bactericidal Action

Various concentrations (0.01, 0.03 and 0.05 wt ratios) of graphene oxide (GO) nanosheets were doped into magnesium oxide (MgO) nanostructures using chemical precipitation technique. The objective was to study the effect of GO dopant concentrations on the catalytic and antibacterial behavior of fixed amount of MgO. XRD technique revealed cubic phase of MgO, while its crystalline nature was confirmed through SAED profiles. Functional groups presence and Mg-O (443 cm-1) in fingerprint region was evident with FTIR spectroscopy. Optical properties were recorded via UV-visible spectroscopy with redshift pointing to a decrease in band gap energy from 5.0 to 4.8 eV upon doping. Electron-hole recombination behavior was examined through photoluminescence (PL) spectroscopy. Raman spectra exhibited D band (1338 cm-1) and G band (1598 cm-1) evident to GO doping. Formation of nanostructure with cubic and hexagon morphology was confirmed with TEM, whereas interlayer average d-spacing of 0.23 nm was assessed using HR-TEM. Dopants existence and evaluation of elemental constitution Mg, O were corroborated using EDS technique. Catalytic activity against methyl blue ciprofloxacin (MBCF) was significantly reduced (45%) for higher GO dopant concentration (0.05), whereas bactericidal activity of MgO against E. coli was improved significantly (4.85 mm inhibition zone) upon doping with higher concentration (0.05) of GO, owing to the formation of nanorods.

Bactericidal behavior of chemically exfoliated boron nitride nanosheets doped with zirconium

In this work, boron nitride nanosheets (BNNS) were produced through chemical exfoliation of bulk boron nitride (BN). Furthermore, hydrothermal technique was used to incorporate various concentrations (2.5, 5, 7.5, and 10 wt%) of zirconium (Zr) as a dopant. The prepared undoped and doped BN samples were evaluated for its antimicrobial activity against E. coli and S. aureus. Structural analysis was undertaken using x-ray diffraction which identified the presence of hexagonal BN. FTIR and Raman spectroscopy were utilized to outline IR fingerprint and electronic properties of the synthesized material. Morphological information was obtained through micrographs extracted using field emission scanning electron spectroscope (FESEM) and high resolution transmission electron microscope (HRTEM), while d-spacing was also calculated through HRTEM analysis. Optical properties and emission spectra were examined by applying UV–vis and photoluminescence spectroscope (PL); whereas, band gap analysis was carried out via Tauc plot. Zr-doped BN nanosheets at increasing concentrations (0.5, 1.0 mg/50 μl) revealed enhanced antibacterial activity against E. coli compared to S. aureus (p < 0.05).

TiO2 Co-doped with Zr and Ag shows highly efficient visible light photocatalytic behavior suitable for treatment of polluted water

The objective of this study is to analyze the effects of zirconium (Zr) and silver (Ag) doping on the photoactivity of titania (TiO₂). Zr–Ag (ZA) co-doped TiO₂ products were fabricated via sol–gel technique and their properties (structural and chemical) were characterized. The weight ratio of TiO₂ was fixed, while weight ratios of Zr and Ag were varied from 2 to 4, 6 and 8 wt% while synthesized samples were calcined at 400 °C for 3 h. The XRD results demonstrated that the incorporation of metal doping agents failed to alter the host material's lattice structure, however, its crystallite size was reduced from 13.54 to 5.05 nm with increasing Zr⁴⁺ and Ag⁺ concentrations. FTIR spectroscopy was used to examine various functional groups. In the attained spectra, an ample absorption peak between 500 and 1000 cm⁻¹ was recorded, which was ascribed to Ti–O–Ti linkage vibration mode present within TiO₂. Surface morphology, microstructure, SAED patterns and elemental composition were examined with FE-SEM, HR-TEM and EDX, which served to confirm the ZA-doped TiO₂ product. Band gap energy of the co-doped material was significantly reduced as indicated by a higher wavelength redshift in the spectra. The photoactivity and kinetics of photo-products were investigated by observing photo-decolorization of methylene blue (MB) under a radiation source. Photodecomposition of MB was dramatically enhanced when titania co-doped with Zr and Ag was employed compared to un-doped or mono-doped TiO₂. The ZA (8 wt%) co-doped TiO₂ photocatalyst depicted the maximum MB removal efficiency (∼93%) within 90 min under a light source.

The objective of this study is to analyze the effects of zirconium (Zr) and silver (Ag) doping on the photoactivity of titania (TiO₂).

Interventions for infantile haemangiomas of the skin: abridged Cochrane systematic review and GRADE assessments

BACKGROUND

Infantile haemangiomas (IH) are soft swellings of the skin that occur in 3-10% of infants. When haemangiomas occur in high-risk areas or when complications develop, active intervention is necessary.

OBJECTIVE

To update a Cochrane Review assessing the interventions for the management of IH in children.

METHODS

We searched for randomized controlled trials in CENTRAL, MEDLINE, Embase, LILACS, AMED, PsycINFO, CINAHL and six trials registers up to February 2017. We included 28 trials (1728 participants) assessing 12 interventions.

RESULTS

We downgraded evidence from high to moderate/low for issues related to risk of bias and imprecision. Oral propranolol (3 mg kg^-1 daily) probably improves clinician-assessed clearance vs placebo [risk ratio (RR) 16·61, 95% confidence interval (CI) 4·22-65·34; moderate quality of evidence (QoE)]; we found no evidence of a difference in terms of serious adverse events (RR 1·05, 95% CI 0·33-3·39; low QoE). We found the chance of reduction of redness may be improved with topical timolol maleate (0·5% gel applied twice daily) when compared with placebo (RR 8·11, 95% CI 1·09-60·09; low QoE). We found no instances of bradycardia or hypotension for this comparison.

CONCLUSIONS

Our key results indicate that oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other measures of resolution, or both, without an increase in harm.

Understanding the healthcare experiences of teenaged cancer patients and survivors

BACKGROUND

Despite literature supporting a client and family-centred approach to healthcare delivery in paediatric facilities, there is little information about healthcare delivery from the perspective of teenagers in the oncology setting. The objective of this study is to describe the healthcare experiences of teenagers with cancer.

METHODS

As part of a larger study on teen-centred care delivery in paediatric oncology, a survey included several open-ended questions to learn about the following: (1) what teenagers liked about the cancer care they received; (2) what they disliked about the cancer care received; and (3) what they would include if they could design the perfect cancer centre for teenagers. The survey was completed by 200 teenagers (aged 12-20 years) from three paediatric hospitals in Canada. Answers to these questions were coded and developed into themes and subthemes using a thematic analysis approach.

RESULTS

The number of patients providing answers was 89% for question 1, 63% for question 2 and 68.5% for question 3. Likes and dislikes were conceptualized in terms of four key themes as follows: (1) staff at the treatment centre; (2) the cancer care they received; (3) the treatment centre itself; and (4) social activities. The most common suggestions for the perfect cancer centre included having access to better entertainment, more social opportunities to interact with peers, and a more comfortable environment for themselves and their families.

CONCLUSION

Understanding teenagers' experiences in the paediatric oncology setting provides information that could be used to shape the delivery of healthcare in a way that is tailored to their needs. Further research in this area is required in order to improve existing oncology care.

Nuclear signatures in high-order harmonic generation from laser-driven muonic atoms

High-order harmonic generation from muonic atoms exposed to intense laser fields is considered. Our particular interest lies in effects arising from the finite nuclear mass and size. We numerically perform a fully quantum mechanical treatment of the muon-nucleus dynamics by employing modified soft-core and hard-core potentials. It is shown that the position of the high-energy cutoff of the harmonic spectrum depends on the nuclear mass, while the height of the spectral plateau is sensitive to the nuclear radius. We also demonstrate that gamma-ray harmonics can be generated from muonic atoms in ultrastrong VUV fields, which have potential to induce photonuclear reactions.