Recent progress in ZnCr and NiCr layered double hydroxides and based photocatalysts for water treatment and clean energy production

In pursuit of advancing photocatalysts for superior performance in water treatment and clean energy generation, researchers are increasingly focusing on layered double hydroxides (LDHs) which have garnered significant attention due to their customizable properties, morphologies, distinctive 2D layered structure and flexible options for modifying anions and cations. No review has previously delved specifically into ZnCr and NiCr LDH-based photocatalysts and therefore, this review highlights the recent surge in ZnCr and NiCr-based LDHs as potential photocatalysts for their applications in water purification and renewable energy generation. The structural and fundamental characteristics of layered double hydroxides and especially ZnCr-LDHs and NiCr-LDHs are outlined. Further, the various synthesis techniques for the preparation of ZnCr-LDHs, NiCr-LDHs and their composite and heterostructure materials have been briefly discussed. The applicability of ZnCr-LDH and NiCr-LDH based photocatalysts in tackling significant issues in water treatment and sustainable energy generation is the main emphasis of this review. It focuses on photocatalytic degradation of organic pollutants in wastewater, elucidating the principles and advancements for enhancing the efficiency of these materials. It also explores their role in H2 production through water splitting, conversion of CO2 into valuable fuels and NH3 synthesis from N2, shedding light on their potential for clean energy solutions. The insights presented herein offer valuable guidance for researchers working towards sustainable solutions for environmental remediation and renewable energy generation.

Microplastic pollutants in water: A comprehensive review on their remediation by adsorption using various adsorbents

Microplastics (MPs), as emerging pollutants, have attracted the attention of environmentalists, statespersons, and the scientific community over the last few decades. To address the spread of MPs in the environment, it is imperative to develop various removal techniques and materials that are effective, scalable, and ecologically benign. However, to the best of our knowledge, no review has systematically examined the removal of MPs using adsorption or provided an in-depth discussion on various adsorbents. Adsorption is an inexpensive and effective technology for wastewater treatment. Recently, many researchers have conducted studies on MP remediation using diverse adsorbent materials, such as biochar, activated carbon, sponges, carbon nanotubes, metal-layered oxides, metal-organic frameworks (MOFs), and zeolites. Each adsorbent has advantages and disadvantages. To overcome their disadvantages, researchers have been designing and developing hybrid adsorbents for MP remediation. This review provides insights into these individual adsorbents and also discusses hybrid adsorbents for MP removal. Finally, the review elaborates on future possibilities and ways to enable more efficient, scalable, and environmentally friendly MP cleanup. Overall, this review bridges the gap between contemporary MP remediation using adsorption techniques and adsorbent development.

Synthesizing pectin-crosslinked gum ghatti hydrogel for efficient adsorptive removal of malachite green

Pectin-crosslinked gum ghatti hydrogel (PGH) has been synthesized utilizing pectin and gum ghatti through an uncomplicated and inexpensive copolymerization method. X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM-elemental mapping), Brunauer-Emmett-Teller (BET), and X-ray photoelectron spectroscopy (XPS) characterization techniques have been employed to determine various structural, chemical and compositional characteristics of fabricated PGH. Three different weight ratios (1:1, 2:1, or 1:2 for pectin and gum ghatti, respectively) were employed to synthesize three distinct types of PGH. Swelling studies has been done to determine the best ratios for PGH fabrication. PGH has been assessed as an adsorbent for the removal of malachite green dye from aqueous solutions. The effects of PGH dosage (100-400 mg/L), dye concentration (10-160 mg/L), pH (2-9 pH), adsorption time (0-480 min), and temperature (25-55 °C) has been examined through batch solutions. According to Langmuir isotherm analysis, the maximum adsorption capacity is 658.1 mg/g. By using pseudo-second-order kinetics and the Freundlich adsorption isotherm, the adsorption process could be well explained. After five consecutive cycles, PGH had an adsorption percentage of 86.917 % for the malachite green dye. It is safe for the environment and may be used to remove malachite green (MG) dye from aqueous solutions.

Harnessing the potential of data-driven strategies to optimise transfusion practice

No one doubts the significant variation in the practice of transfusion medicine. Common examples are the variability in transfusion thresholds and the use of tranexamic acid for surgery with likely high blood loss despite evidence-based standards. There is a long history of applying different strategies to address this variation, including education, clinical guidelines, audit and feedback, but the effectiveness and cost-effectiveness of these initiatives remains unclear. Advances in computerised decision support systems and the application of novel electronic capabilities offer alternative approaches to improving transfusion practice. In England, the National Institute for Health and Care Research funded a Blood and Transplant Research Unit (BTRU) programme focussing on 'A data-enabled programme of research to improve transfusion practices'. The overarching aim of the BTRU is to accelerate the development of data-driven methods to optimise the use of blood and transfusion alternatives, and to integrate them within routine practice to improve patient outcomes. One particular area of focus is implementation science to address variation in practice.

Advances in photocatalytic NO oxidation by Z-scheme heterojunctions

The fast development of urbanisation and industrialisation has led to a rise in nitrogen oxide (NOx) emissions, specifically nitric oxide (NO). One effective method for reducing the harmful effects of this dangerous air pollutant on both human health and the environment is the photocatalytic oxidation of NO. Z-scheme heterojunctions enhance incident light utilisation and increase photocatalytic activity, eventually leading to better NO oxidation performance by encouraging the effective separation of charges and migration. A comprehensive discussion of Z-scheme-based heterojunctions is provided in this review paper, with a focus on their applications in the photocatalytic oxidation of NO. Significant progress has been made in the fabrication of efficient photocatalytic devices in recent years, with Z-scheme-based heterojunctions proving to be particularly successful. The review looks into the various methodologies used to create Z-scheme-based heterojunctions as well as photocatalytic NO oxidation mechanisms. Recent studies on photocatalysts employing Z-scheme heterojunctions for the photocatalytic oxidation of NO are also discussed. The possibilities for new opportunities as well as the present challenges, barriers, advances, and solutions have been emphasized.

Recent advances in perovskite-based Z-scheme and S-scheme heterojunctions for photocatalytic CO2 reduction

The dramatic rise in carbon dioxide levels in the atmosphere caused by the continuous use of carbon fuels continues to have a significant impact on environmental degradation and the disappearance of energy reserves. Past few years have seen a significant increase in the interest in photocatalytic carbon dioxide reduction because of its ability to lower CO2 releases from the burning of fossil fuels while also producing fuels and important chemical products. Because of their excellent catalytic efficiency, great uniformity, lengthy charge diffusion layers and texture flexibility that enable accurate band gap and band line optimization, perovskite-based nanomaterials are perhaps the most advantageous among the numerous semiconductors proficient in accelerating CO2 conversion under visible light. Firstly, a brief insight into photocatalytic CO2 conversion mechanism and structural features of perovskites are discussed. Further the classification and selection of perovskites for Z and S-scheme heterojunctions and their role in photocatalytic CO2 reduction analysed. The efficient modification and engineering of heterojunctions via co-catalyst loading, morphology control and vacancy introduction have been comprehensively reviewed. Third, the state-of-the-art achievements of perovskite-based Z-scheme and S-scheme heterojunctions are systematically summarized and discussed. Finally, the challenges, bottlenecks and future perspectives are discussed to provide a pathway for applying perovskite-based heterojunctions for solar-to-chemical energy conversion.

Tailoring Homogeneous Hydrogel Nanospheres by Facile Ultra-Sonication Assisted Cross-Linked Copolymerization for Rhodamine B Dye Adsorption

The present paper describes the design of shape-oriented hydrogel nanospheres using a facile ultrasonication-supported crosslinked copolymerization technique. The effect of variable monomer concentration on the homogeneity of hydrogel nanospheres was investigated. The chitosan-cl-poly(MMA) hydrogel nanospheres were well characterized using various techniques such as FTIR, XRD, TGA, SEM, and TEM. The chitosan-cl-poly(MMA) hydrogel nanospheres were studied for their swelling behavior and could potentially be used as a novel adsorbent for rhodamine B dye remediation from aqueous media. The study found that utilizing chitosan-cl-poly(MMA) nanohydrogel spheres at the optimal pH 5 increased RhB dye adsorption capacity from 7.9 to 17.8 mg/g (pH 2 to 5), followed by a slight reduction. Furthermore, when nanohydrogel concentration increased, adsorption capacity dropped from 18.03 to 2.8 mg/g, but adsorption percentage climbed from 90.2% to 97.8%. At an initial dye concentration of 140 mg/L, rhodamine B adsorption achieved 204.3 mg/g in 60 min. The rhodamine B dye adsorption study includes adsorption kinetics, isotherm, and thermodynamics analyses. The interpretation of the adsorption study revealed that Langmuir isotherms fit best with a qmax value of 276.26 mg/g, which is in close approximation with the experimental value, whereas pseudo-second-order kinetics explains the adsorption process rate. The interaction of RhB dye with chitosan-cl-poly(MMA) hydrogel nanospheres involves multiple forces such as electrostatic interactions, hydrogen bonding, van der Waals forces, etc.

Rare Earth Doped ZnO Nanoparticles as Spintronics and Photo Catalyst for Degradation of Pollutants

Antibiotic water contamination is a growing environmental problem in the present day. As a result, water treatment is required for its reduction and elimination. Due to their important role in resolving this issue, photocatalysts have drawn a great deal of interest over the past few decades. When non-biodegradable organic matter is present in polluted water, the photo catalytic process, which is both environmentally friendly and an improved oxidation method, can be an effective means of remediation. In this regard, we report the successful synthesis of pure phased rare earth doped ZnO nanoparticles for tetracycline degradation. The prepared catalysts were systematically characterized for structural, optical, and magnetic properties. The optical band gap was tailored by rare earth doping, with redshift for Sm and Dy doped nanoparticles and blueshift for Nd doped ZnO nanoparticles. The analysis of photoluminescence spectra revealed information about the defect chemistry of all synthesised nanoparticles. Magnetic studies revealed that all synthesized diluted magnetic semiconductors exhibit room temperature ferromagnetism and can be employed for spintronic applications. Moreover, Dy doped ZnO nanoparticles were found to exhibit a maximum degradation efficiency of 74.19% for tetracycline (TCN) removal. The synthesized catalysts were also employed for the degradation of Malachite green (MG), and Crystal violet (CV) dyes. The maximum degradation efficiency achieved was 97.18% for MG and 98% for CV for Dy doped ZnO nanoparticles. The degradation mechanism involved has been discussed in view of the reactive species determined from scavenging experiments.

"Magnetic Ni-Zn ferrite anchored on g-C3N4 as nano-photocatalyst for efficient photo-degradation of doxycycline from water"

In the present work, mixed-spinel ferrite anchored onto graphitic carbon nitride (GCN) was synthesized for mineralization of antibiotic pollutant from waste water. A Z-scheme g-C₃N₄/Ni_0.5Zn_0.5Fe₂O₄ nano heterojunction was fabricated by three step procedure: pyrolysis, solution combustion and mechanical grinding followed by annealing. The prepared photocatlyst was tested for degradation of Doxycycline (DC) drug under the natural sun light. Results revealed that the prepared heterojunction has maximum degradation efficiency of 97.10% pollutant in 60 min experiment. The Z-scheme heterojunction between g-C₃N₄ and Ni-Zn ferrite improves the photoinduced charges separation and protection of redox capability and therby increases the photo degradation efficiency. The scavenging experiments suggested that O₂^-● and h⁺ as main active species responsible for degradation of the antibiotic. In addition, the dopant variation can drive the shists in band gap and energy band positiong too which makes then excellent candidates for synthesizing tunable heterostructures with organic semiconductors. The work focusses on designing and developing of saimpler but efficient magnetic heterojunctions with superior redox capability for solar powered waste water treatment.

Constructing a Visible-Active CoFe2O4@Bi2O3/NiO Nanoheterojunction as Magnetically Recoverable Photocatalyst with Boosted Ofloxacin Degradation Efficiency

Constructing visible-light-active Z-scheme heterojunctions has proven fruitful in enhancing the photocatalytic activity of photocatalysts for superior water clean-up. Herein, we report the fabrication of a CoFe2O4@Bi2O3/NiO (CBN) Z-scheme nanoheterojunction. The obtained CBN heterojunction was used for visible-light-assisted degradation of ofloxacin (OFL) in water. The OFL degradation efficiency achieved by the CBN heterojunction was 95.2% in 90 min with a rate constant of kapp = 0.03316 min-1, which was about eight times that of NiO and thirty times that of CoFe2O4. The photocatalytic activity of a Bi2O3/NiO Z-scheme heterojunction was greatly enhanced by the visible activity and redox mediator effect of the cobalt ferrite co-catalyst. Higher charge-carrier separation, more visible-light capture, and the Z-scheme mechanism in the Z-scheme system were the important reasons for the high performance of CBN. The scavenging experiments suggested ●O2- as an active species for superior OFL degradation. The possible OFL degradation pathway was predicted based on LC-MS findings of degradation intermediate products. The magnetic nature of the CBN helped in the recovery of the catalyst after reuse for six cycles. This work provides new insights into designing oxide-based heterojunctions with high visible-light activity, magnetic character, and high redox capabilities for potential practical applications in environmental treatment.

Gum Acacia-Crosslinked-Poly(Acrylamide) Hydrogel Supported C3N4/BiOI Heterostructure for Remediation of Noxious Crystal Violet Dye

Herein, we report the designing of a C₃N₄/BiOI heterostructure that is supported on gum acacia-crosslinked-poly(acrylamide) hydrogel to fabricate a novel nanocomposite hydrogel. The potential application of the obtained nanocomposite hydrogel to remediate crystal violet dye (CVD) in an aqueous solution was explored. The structural and functional analysis of the nanocomposite hydrogel was performed by FTIR (Fourier transform infrared spectroscopy), X-ray diffraction (XRD), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). The different reaction parameters, such as CVD concentration, nanocomposite hydrogel dosage, and working pH, were optimized. The C₃N₄/BiOI heterostructure of the nanocomposite hydrogel depicts Z-scheme as the potential photocatalytic mechanism for the photodegradation of CVD. The degradation of CVD was also specified in terms of COD and HR-MS analysis was carried to demonstrate the major degradation pathways.

Polymorphisms in vitamin B12 and folate metabolising genes and their association with adverse pregnancy outcome: secondary analysis of a population based case control study

Vitamin B12 and folate deficiency leads to accumulation of homocysteine that increases the risk of adverse pregnancy outcomes like preterm birth and low birth weight (LBW) of the neonate. We explored the association of genetic variants of key vitamin B12 and folate metabolising enzymes (MTHFR C677T and A1298C, MTR A2756G, TCN-2 C776G) with preterm birth and LBW in South Indian women. MTHFR A1298C heterozygotes (AC) were at higher risk for preterm delivery, whereas TCN-2 C776G heterozygotes (CG) were at higher risk for both preterm delivery and LBW. MTHFR C677T, A1298C and MTR A2756G haplotype CAG was protective for preterm delivery (p=.036, OR = 0.475; 95% CI: 0.233-0.97), whereas, haplotype CCG increasing the risk of preterm birth by 1.8 folds (p=.018, OR = 1.81; 95% CI: 1.09-2.98). These results underscore the significance of vitamin B12 and folate in the pathophysiology of preterm birth and LBW.Impact StatementWhat is already known on this subject? Polymorphisms of vitamin B12 and folate metabolising genes have been reported to influence preterm birth and LBW, but the reports are not consistent.What do the results of this study add? We observed a relationship of MTHFR A1298C and TCN-2 C776G with preterm birth, and significant association of TCN-2 C776G with LBW in infants.What are the implications of these findings for clinical practice and/or further research? Identification of women carrying these polymorphic risk alleles may benefit from early nutritional modifications.

Robust magnetic ZnO-Fe2O3 Z-scheme hetereojunctions with in-built metal-redox for high performance photo-degradation of sulfamethoxazole and electrochemical dopamine detection

This work reports synthesis of a dual-function facile heterojunction and investigation of role of the charge transfer dynamism between individual semiconductor components for superior photocatalytic and electrochemical sensing application. The bio-benevolent and sturdy ZnO/Fe₂O₃ heterojunctions were utilized for visible light facilitated photo-degradation of sulfamethoxazole (SMX) antibiotic and electrochemical sensing of dopamine drug (DA). The fabricated heterojunction were characterized for structural, optical, and magnetic properties. Structural studies revealed the formation of nano heterojunction containing both phases. Magnetic studies confirmed the highly pure magnetic nature of photocatalysts. ZnO/30 wt%Fe₂O₃ heterojunction (S2) shows 95.2% SMX degradation under visible light and high retention of performance under solar light. The scavenging experiments infer that OH radicals are the active species responsible for degradation. A Z-scheme photocatalytic mechanism was predicted for higher performance with protection of high potential VB of ZnO and CB of Fe₂O₃ for high generation of reactive oxygen species. LC-MS was employed to predict a plausible degradation route. The sample modified glassy carbon electrodes (GCE) were used for electrochemical sensing of dopamine via cyclic voltammetry (CV) and differential pulse voltammetry (DPV). The S2 junction exhibited 0.18 μM limit of detection with concentration range of 1 μM-50 μM. The stability test was successfully carried out at room temperature for 15 days. In addition, the S2 modified electrodes were spiked in real urine samples and good results were obtained. DPV reveals that S2 modified electrode is best sensor for dopamine sensing among all synthesized heterojunctions. The detection mechanism was also discussed in detail. The in-built metal redox i.e Zn²⁺/Zn⁺ and Fe³⁺/Fe²⁺ facilitate the Z-scheme transfer, improve the charge transfer capacity and reduce the recombination. This study is beneficial because it reports utilization of popular and well-tested semiconductor metal oxides to form heterojunctions with dual capabilities of environmental detoxification and cost-effective electrochemical detection of biomolecules.

Prevalence and experience of fatigue in survivors of critical illness: a mixed-methods systematic review

We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the extracted data into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately one month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92-59.97). They improved over time but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors' quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed.

RAM assessment of the repairable industrial structure with genuine human-mistake working conditions with generalized fuzzy numbers

Purpose

The present paper investigated a skim milk powder production plant with genuine human mistake for analyzing its performance in terms of its reliability, availability and maintainability (RAM) indices along with mean time between failure (MTBF) and expected number of failure (ENOF).

Design/methodology/approach

In the proposed work, the generalized fuzzy lambda–tau methodology has been used to carry out the analysis of the repairable structure using the improved arithmetic operations for generalized fuzzy numbers by considering the degree of confidence levels.

Findings

RAM indices along with MTBF and ENOF are obtained to increase the quality of skim milk powder manufacturing structures of a dairy plant with genuine human-mistake working conditions.

Originality/value

In the present paper, a mathematical model for a complex industrial system based on fuzzy has been developed. Finally, the results are more realistic and comprehensive for the decision-maker for farther application.

The role of intra-operative cell salvage in patient blood management for revision hip arthroplasty: a prospective cohort study

Cell salvage is an important component of blood management in patients undergoing revision hip arthroplasty surgery. However concerns regarding efficacy and patient selection remain. The aims of this study were to describe intra-operative blood loss, cell salvage re-infusion volumes and red blood cell transfusion rates for revision hip procedures and to identify factors associated with the ability to salvage sufficient blood intra-operatively to permit processing and re-infusion. Data were collected from a prospective cohort of 664 consecutive patients undergoing revision hip surgery at a single tertiary centre from 31 March 2015 to 1 April 2018. Indications for revision surgery were aseptic (n = 393 (59%)) fracture (n = 160 (24%)) and infection (n = 111 (17%)). Salvaged blood was processed and re-infused when blood loss exceeded 500 ml. Mean (SD) intra-operative blood loss was 1038 (778) ml across all procedures. Salvaged blood was re-infused in 505 of 664 (76%) patients. Mean (SD) re-infusion volume was 253 (169) ml. In total, 246 of 664 (37%) patients received an allogeneic red blood cell transfusion within 72 h of surgery. Patients undergoing femoral component revision only (OR (95%CI) 0.41 (0.23-0.73)) or acetabular component revision only (0.53 (0.32-0.87)) were less likely to generate sufficient blood salvage volume for re-infusion compared with revision of both components. Compared with aseptic indications, patients undergoing revision surgery for infection (1.87 (1.04-3.36)) or fracture (4.43 (2.30-8.55)) were more likely to generate sufficient blood salvage volume for re-infusion. Our data suggest that cell salvage is efficacious in this population. Cases where the indication is infection or fracture and where both femoral and acetabular components are to be revised should be prioritised.

Gestational impaired glucose tolerance (GIGT)-induced suppression of fetal thyroid secretion: effect on fetal outcome

INTRODUCTION

Gestational impaired glucose tolerance (GIGT) is a milder form of gestational diabetes mellitus (GDM), which is often poorly managed. Although, GDM is known to be associated with increased incidence of thyroid dysfunction, no study has been done to study the effect of GIGT on thyroid status and its effect on fetal outcome. Here, we carried out a study to assess thyroid function and glycemic status in both maternal and cord blood of the subjects with GIGT, and to find their association with the fetal outcome.

MATERIALS AND METHODS

Women who came to the hospital for safe confinement during 37-40th weeks of gestation were recruited in the study. Based on the 2 hours post prandial blood glucose levels with 75 grams OGTT, done at 24-28 weeks of gestation, all the subjects were stratified into two groups: (1) Cases or GIGT group - women with blood glucose levels between 120 and 140 mg/dl and (2) Controls - women with blood glucose levels of less than 120 mg/dl. Three milliliters of venous blood was collected from mothers and 3 ml of cord blood was collected during delivery. New-borns were assessed for birth weight, head circumference, abdominal circumference, thigh circumference, and crown-heel length. Glycated hemoglobin was carried out using immunoturbidimetry (DiaSys Diagnostic Systems GmbH, Holzheim, Germany) and fructosamine was estimated using dye binding method (Biosystems, Spain). Estimation of total T₃ (TT3), free T₃ (FT₃), total T₄ (TT₄), free T₄ (FT₄), and TSH was done by chemiluminescence in Siemens Advia Centaur CP using competitive immunoassay.

RESULTS

Although within the normal reference range, GIGT mothers had higher concentration of free and total T₄ than controls. Cord fructosamine levels were significantly higher in babies of GIGT mothers than controls, indicating the reflection of maternal hyperglycemia. There was a positive correlation between the maternal glycated hemoglobin and cord blood fructosamine in the GIGT group. Statistically significant lower levels of total T₃ and T₄ with high TSH levels were found in babies with GIGT mothers, indicating the suppressive effect of maternal hyperglycemia on fetal thyroid function. Birth weight, head circumference, and thigh circumference were significantly higher in babies born to mothers with GIGT, which may be a combined effect of maternal hyperglycemia and fetal thyroid suppression.

CONCLUSIONS

Maternal hyperglycemia, even in milder form of GIGT may cause suppression of fetal thyroid function. Both these factors may predispose to change in fetal anthropometry, leading to a large baby. Therefore, it is recommended to evaluate maternal and cord thyroid function for timely management strategies.

Cation distribution: a key to ascertain the magnetic interactions in a cobalt substituted Mg–Mn nanoferrite matrix

The effect of Co²⁺ substitution into nanocrystalline Mg–Mn ferrite synthesized by a solution combustion technique has been studied.

Magnetically recoverable ZrO2/Fe3O4/chitosan nanomaterials for enhanced sunlight driven photoreduction of carcinogenic Cr(vi) and dechlorination & mineralization of 4-chlorophenol from simulated waste water

In this laboratory-scale experiment we report the treatment of carcinogenic Cr(vi) and 4-chlorophenol by ferromagnetic ZrO₂/Fe₃O₄ nano-heterojunctions supported on chitosan.

Thrombocytopenia in pregnancy

Thrombocytopenia during pregnancy is quite common. Evaluation of blood counts of pregnant women has shown that thrombocytopenia is the second most common haematological problem in pregnancy, after anaemia. While mostly thrombocytopenia has no consequences for either the mother or the foetus, in some cases it is associated with substantial maternal and/or neonatal morbidity and mortality. It may result from a number of diverse aetiologies. Adequate knowledge of these causes will help the clinicians in making proper diagnosis and management of thrombocytopenia in pregnancy. The evaluation of thrombocytopenia is essential to rule out any systemic disorders that may affect pregnancy management as thrombocytopenia can present as an isolated finding or in combination with underlying conditions. In this concise review, we have provided the overview of thrombocytopenia diagnosed during pregnancy.

Markers of Oxidative Stress in Pregnant Women with Sleep Disturbances

OBJECTIVE

The quality and duration of sleep is impaired during pregnancy. Our study aimed to determine whether maternal sleep deprivation occurring during the second and third trimester of pregnancy could alter fetal well-being with respect to birth weight and APGAR score by altering the inflammatory status and oxidative stress in the mothers. .

METHODS

Sleep adequacy was assessed using the Pittsburgh Sleep Quality Index (PSQI). We investigated the inflammatory status and oxidative stress at term in the blood of pregnant subjects with and without sleep deprivation by measuring the levels of protein-bound sialic acid (PBSA), high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA) and protein carbonyl (PCO). Homocysteine (Hcy) and its vitamin determinants were also measured. Fetal outcome with respect to birth weight and APGAR score were compared between study subjects. .

RESULTS

A significant increase was observed in the levels of hsCRP, PBSA, Hcy, MDA, and PCO, in the sleep-deprived group when compared to the control group. Fetal outcome at birth showed a significant difference between the cases with high sleep deprivation and those with low sleep deprivation. .

CONCLUSION

Sleep deprivation in pregnancy leads to an increase in the inflammatory parameters, oxidative stress, and Hcy levels. Fetal outcome at birth was affected more in mothers with high sleep deprivation than those with low sleep deprivation. Follow-up in these babies are needed to reveal any differences in their growth and development.

Sternocostoclavicular Joint Swelling; Diagnosis of a Neglected Entity

BACKGROUND

Sternocostoclavicular joint (SCCJ) swelling is an underdiagnosed, albeit important entity in clinical practice. The present study was conducted in order to identify the incidence and common causes of this entity.

METHODS

Patients presenting to the Orthopaedic Clinic with a swelling of the sternocostoclavicular joint, during the study period of two years were included, and detailed history was obtained from the patient. Baseline investigations (total and differential leukocyte count, ESR, CRP, X-ray and CT) wereperformed. Magnetic resonance imaging,FNAC or joint aspiration was performed whenever clinically or radiologically indicated.

RESULTS

A total of 21 patients were enrolled into the study for a duration of 2 years. Patients mainly presented with both pain and swelling of the SCCJ with predominant right sided involvement. Osteoarthritis was the most frequent diagnosis followed by infections, primary bone/cartilage tumor, and metastasis.

CONCLUSIONS

Although most of the patients with SCCJ swelling have a benign etiology, it is not wise to dismiss thisswelling as degenerative changes. Serious conditions like septic arthritis or neoplasia, may masquerade with similar presentations such as osteoarthritis. It would be therefore imperative to rule out all of these potentially life threatening conditions using thorough clinic-radiological workups.

Clinical and haematological predictors of acute hematogenous Methicillin Resistant Staphylococcus aureus (MRSA) osteomyelitis & septic arthritis

INTRODUCTION

In the present study, we observed differences in the clinical and haematological parameters in patients of MRSA and non MRSA acute osteoarticular infection.

METHODOLOGY

For the patients of acute haematogenous osteomyelitis/septic arthritis, clinical features, haematological parameters and blood & aspirate cultures were recorded.

RESULTS

Of 81 patients enrolled in the study, 61 were culture positive (22% MRSA). Statistically significant difference was found only in CRP (P < 0.001). ROC curve analysis shows that CRP levels of >13.9 mg/L, MRSA bone and joint infection could be predicted with 92.9% sensitivity and 79.1% specificity (AUC = 89.1).

CONCLUSION

Estimation of serum CRP levels at the time of presentation can aid in distinguishing MRSA osteomyelitis from non MRSA one.

Overlap syndromes: an emerging diagnostic and therapeutic challenge

Overlap syndrome in hepatology is emerging as a diagnostic and therapeutic challenge, which is further complicated by the present gaps in the information regarding the immunopathogenesis of these diseases. The present review represents a concise review of literature on overlap syndromes with emphasis on prevalence, etiopathogenesis, clinical presentation, diagnosis, and management of true overlap syndromes.

Homocysteine and serotonin: association with postpartum depression

Postpartum depression (PPD) is a disorder of multifactorial origin with significant consequences on both maternal and child health. One of the biological factors implicated is perturbed methionine-homocysteine metabolism. Since this metabolic pathway plays a significant role in myelination of nerve fibers, the growth and development of the child would also be adversely affected. We carried out this study in 103 women (58 with PPD and 45 without PPD) who delivered their child in our institute from December 2010 to November 2011. The study group was evaluated for PPD using Edinburgh postnatal depression scale with a cut-off score of 10. Assessment of fetal well being was done by APGAR score assessed immediately after birth. Serum folic acid, vitamin B12, homocysteine and serotonin was done by ELISA. We found significantly elevated levels of homocysteine in women with PPD as compared to those without PPD, both at 24-48h as well as six weeks after delivery, although no associations were found with folate and vitamin B12 levels. Also, there was a significant negative correlation between serum homocysteine and serotonin levels in the postpartum depression group with a significant negative correlation between homocysteine and serotonin. Our study showed a significantly lower APGAR score in the infants born to mothers with PPD. Our study also shows that homocysteinemia is associated with PPD whether at the first week or sixth week, while low serum serotonin may play a role in depression during the first week, but may not have a role in depression status at the sixth week. Also, PPD in the mother is related to a low APGAR score in infants born to these mothers emphasizing the significance of both mental as well as nutritional status of the mother.

A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database

OBJECTIVES

The aim of this study was to establish the relative safety and balance of risks for antidepressant treatment in older people. The study objectives were to (1) determine relative and absolute risks of predefined adverse events in older people with depression, comparing classes of antidepressant drugs [tricyclic and related antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and other antidepressants] and commonly prescribed individual drugs with non-use of antidepressant drugs; (2) directly compare the risk of adverse events for SSRIs with TCAs; (3) determine associations with dose and duration of antidepressant medication; (4) describe patterns of antidepressant use in older people with depression; and (5) estimate costs of antidepressant medication and primary care visits.

DESIGN

A cohort study of patients aged 65 years and over diagnosed with depression.

SETTING

The study was based in 570 general practices in the UK supplying data to the QResearch database.

PARTICIPANTS

Patients diagnosed with a new episode of depression between the ages of 65 and 100 years, from 1 January 1996 to 31 December 2007. Participants were followed up until 31 December 2008.

INTERVENTIONS

The exposure of interest was treatment with antidepressant medication. Antidepressant drugs were grouped into the major classes and commonly prescribed individual drugs were identified.

MAIN OUTCOME MEASURES

There were 13 predefined outcome measures: all-cause mortality, sudden cardiac death, suicide, attempted suicide/self-harm, myocardial infarction, stroke/transient ischaemic attack (TIA), falls, fractures, upper gastrointestinal bleeding, epilepsy/seizures, road traffic accidents, adverse drug reactions and hyponatraemia.

RESULTS

In total, 60,746 patients were included in the study cohort. Of these, 54,038 (89.0%) received at least one prescription for an antidepressant during follow-up. The associations with the adverse outcomes were significantly different between the classes of antidepressant drugs for seven outcomes. SSRIs were associated with the highest adjusted hazard ratios (HRs) for falls [1.66, 95% confidence interval (CI) 1.58 to 1.73] and hyponatraemia (1.52, 95% CI 1.33 to 1.75), and the group of other antidepressants was associated with the highest HRs for all-cause mortality (1.66, 95% CI 1.56 to 1.77), attempted suicide/self-harm (5.16, 95% CI 3.90 to 6.83), stroke/TIA (1.37, 95% CI 1.22 to 1.55), fracture (1.63, 95% CI 1.45 to 1.83) and epilepsy/seizures (2.24, 95% CI 1.60 to 3.15) compared with when antidepressants were not being used. TCAs did not have the highest HR for any of the outcomes. There were also significantly different associations between the individual drugs for seven outcomes, with trazodone, mirtazapine and venlafaxine associated with the highest rates for several of these outcomes. The mean incremental cost (for all antidepressant prescriptions) ranged between £51.58 (amitriptyline) and £641.18 (venlafaxine) over the 5-year post-diagnosis period.

CONCLUSIONS

This study found associations between use of antidepressant drugs and a number of adverse events in older people. There was no evidence that SSRIs or drugs in the group of other antidepressants were associated with a reduced risk of any of the adverse outcomes compared with TCAs; however, they may be associated with an increased risk for certain outcomes. Among individual drugs trazodone, mirtazapine and venlafaxine were associated with the highest rates for some outcomes. Indication bias and residual confounding may explain some of the study findings. The risks of prescribing antidepressants need to be weighed against the potential benefits of these drugs.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Predictors of pilosebaceous unit responsiveness to testosterone therapy in patients with hypogonadotrophic hypogonadism

Testosterone replacement therapy is the mainstay of treatment in male patients with isolated hypogonadotrophic hypogonadism (HH) to achieve virilisation. However, responsiveness of pilosebaceous unit (PSU) to testosterone replacement therapy in these patients is quite variable. Androgen action is inversely proportional to the number of CAG repeats in exon 1 of androgen receptor gene; therefore, we hypothesised that CAG repeat length contributes to testosterone responsiveness in patients with HH. The CAG repeat length in 21 well-virilised men (hair score > 30, responders) and 25 poorly virilised men (hair score ≤ 30, non-responders) with HH on optimal testosterone replacement therapy at least for a period of 1 year was analysed. Serum LH, FSH, testosterone and 17 β oestradiol were estimated. Polymerase chain reaction (PCR) amplification of exon 1 of androgen receptor gene was performed from genomic DNA, and these PCR-amplified products were sequenced for the number of CAG repeats. The difference between number of CAG repeats in responders and non-responders was statistically significant (19.19 ± 3.25 and 22.24 ± 2.65, P = 0.001) and showed a strong negative correlation with total body hair score (r = -0.538 and P = 0.0001). In conclusion, these results suggest that the number of CAG repeats influences the responsiveness of PSU to testosterone treatment in patients with HH.