Thromboelastography (TEG) provides a more comprehensive global coagulation assessment than routine tests (international normalized ratio INR and platelet PLT count), and its use may avoid unnecessary ...blood component transfusion in patients with advanced cirrhosis and significant coagulopathy who have nonvariceal upper gastrointestinal (GI) bleeding. A total of 96 patients with significant coagulopathy (defined in this study as INR >1.8 and/or PLT count < 50 × 109/L) and nonvariceal upper GI bleed (diagnosed after doing upper gastrointestinal endoscopy, which showed ongoing bleed from a nonvariceal source) were randomly allocated to TEG‐guided transfusion strategy (TEG group; n = 49) or standard‐of‐care (SOC) group (n = 47). In the TEG group, only 26.5% patients were transfused with all three blood components (fresh frozen plasma FFP, PLTs, and cryoprecipitate) versus 87.2% in the SOC group (P < 0.001). Although 7 (14.3%) patients in the TEG group received no blood component transfusion, there were no such patients in the SOC group (P = 0.012). Also, there was a significantly lower use of blood components (FFP, PLTs, and cryoprecipitate) in the TEG group compared with the SOC group. Failure to control bleed, failure to prevent rebleeds, and mortality between the two groups were similar. Conclusion: In patients with advanced cirrhosis with coagulopathy and nonvariceal upper GI bleeding, TEG‐guided transfusion strategy leads to a significantly lower use of blood components compared with SOC (transfusion guided by INR and PLT count), without an increase in failure to control bleed, failure to prevent rebleed, and mortality.
Rapid industrialization, economic development, and population overgrowth are the major reasons responsible for the release of organic and inorganic substances into the environment, further leading to ...environmental pollution and contamination of water. Nowadays, it is truism that wastewater treatment has raised concern worldwide and is the need of the hour. Therefore, it is necessary to conserve sustainable energy and adopt advanced wastewater treatment technologies. Microalgae culture is gaining tremendous attention as it provides a combined benefit of treating wastewater as a growth medium and algae biomass production which can be used for several livestock purposes. Microalgae are ubiquitous and extremely diverse microorganisms which can accumulate toxic contaminants and heavy metals from wastewater, making them superior contender to become a powerful nanofactory. Furthermore, they are versatile, relatively convenient, and easy to handle, along with various other advantages such as synthesis can be performed at low temperature with greater energy efficiency, less toxicity, and low risk to the environment. Comparing with other organisms such as fungi, yeast, and bacteria, microalgae are equally important organisms in the synthesis of nanoparticles; therefore, the study of algae-mediated biosynthesis of nanometals can be taken towards a newer branch and it has been termed as phytonanotechnology. Here, an overview of recent advances in wastewater treatment processes through an amalgamation of nanoparticles and microalgae is provided.
To determine in-hospital outcomes of neonates with hypoxic ischemic encephalopathy (HIE) requiring extracorporeal membrane oxygenation (ECMO).
Single-center retrospective study from 2005 to 2016 of ...neonates ≥35 weeks gestation with moderate/severe HIE, requiring ECMO for persistent pulmonary hypertension of newborn (PPHN).
Our cohort (n = 20) received therapeutic hypothermia for moderate (n = 12), severe (n = 5), or undocumented severity (n = 3) of HIE. During ECMO, 30% (n = 6) infants developed intracranial hemorrhage at a median (IQR) duration of 24 (20) hours. Sixteen (80%) infants survived to discharge, among which 15 had MRI performed; 47% (n = 7) had normal MRI, 20% (n = 3) had intracranial hemorrhage and 13% (n = 2), 13% (n = 2) and 7% (n = 1) had NICHD stage 1, 2, and 3 pattern of brain injury respectively.
In this high-risk population of neonates, use of ECMO was safe and efficacious as demonstrated by survival and outcomes.
Do premature infants (<32 weeks gestation) undergoing delayed cord clamping (DCC) for 60 s or cord milking (cord stripped 3 times) or immediate cord clamping (ICC) have different 1-h quantitative ...measurement of electroencephalogram (EEG) and near infrared spectroscopy (NIRS) at 6 and 12 h of life?
Telemedicine is an alliance between technology and medicine. It is a prevalent practice in developed countries; it has been widely used in developing countries to address the issues of access to ...medical care. India has been experimenting with telemedicine since long to address the issues of access and availability of specialist care and in recent years, with the rapid advancement of information technology, telemedicine has become a popular concept across the country. In this article, we have reviewed the various aspects of different government-funded telemedicine models functional in 12 states across India. We have also attempted to explore the levels of care delivery and services at facilities provided through telemedicine and challenges being faced in the implementation of the models. As a way forward, the health-care community needs to realize the full potential of telemedicine facility and utilize it to their benefit. Telemedicine will work best when it is one component of a well-functioning health system and not as an isolated gap-filling application.
ABSTRACT Alopecia universalis (AU) is a rare form of hair loss characterized by the complete absence of hair on the scalp and body. It is an advanced form of alopecia areata. There is currently no ...definitive treatment for this condition, and management options are limited. This case report describes the successful treatment of a 37-year-old female patient with AU using oral tofacitinib 5 mg BID, an oral Janus kinase inhibitor. The patient experienced clinically significant hair regrowth on the scalp and eyebrows after 6 months of treatment with tofacitinib, along with the concurrent use of oral mini-pulse betamethasone, topical minoxidil 5%, and clobetasol lotion. This case highlights the potential efficacy of tofacitinib as a promising therapeutic option for AU, without notable safety concerns. Moreover, it is also well tolerated in this patient.
To determine the association of persistent pulmonary hypertension of the newborn (PPHN) with death or disability among infants with moderate or severe hypoxic ischemic encephalopathy (HIE) treated ...with therapeutic hypothermia.
We compared infants with and without PPHN enrolled in the hypothermia arm from three randomized controlled trials (RCTs): Induced Hypothermia trial, "usual care" arm of Optimizing Cooling trial, and Late Hypothermia trial. Primary outcome was death or disability at 18-22 months adjusted for severity of HIE, center, and RCT.
Among 280 infants, 67 (24%) were diagnosed with PPHN. Among infants with and without PPHN, death or disability was 47% vs. 29% (adjusted OR: 1.65, 0.86-3.14) and death was 26% vs. 12% (adjusted OR: 2.04, 0.92-4.53), respectively.
PPHN in infants with moderate or severe HIE was not associated with a statistically significant increase in primary outcome. These results should be interpreted with caution given the limited sample size.
Prospective study.
To evaluate the utility and limitations of using three-dimensional (3D)-printed models for the management of craniovertebral (CV) junction abnormalities.
In comparison to other ...bony and vascular anomalies, CV junction abnormalities are difficult to treat. For cases of irreducible atlantoaxial dislocation (AAD), posterior reduction and stabilization have replaced anterior decompression as the standard management protocol. The use of 3D models, such as those described herein, can provide surgeons with in-depth knowledge of the vertebral artery course and bony anomalies associated with CV junction abnormalities.
Clinical and radiological features of 18 patients with CV junction abnormalities were analyzed between March 2017 and February 2019 at Sawai Man Singh Medical College, Jaipur, India. Dynamic computed tomography (CT) of the CV junction and CT angiographies of the neck with respect to the vertebral artery course at the C1-C2 joints were obtained and studied. Customized 3D models of the CV junction were then made based on the CT data, and rehearsal of the surgical procedure was performed using the 3D model one day prior to performing the actual procedure.
Seventeen patients had congenital-type AAD, whereas one patient had posttraumatic AAD. Improvements in neck pain and myelopathy were seen in all patients at the follow-up, as analyzed using the Visual Analog Scale and the Japanese Orthopedic Association Scale score, respectively. There were no cases of malpositioning of screws or any direct vertebral artery injury, although in one patient, the distal flow in the dominant vertebral artery was cut off as it got compressed between the bony arch and the screw head.
Compared to computer-generated images, 3D-printed models are a more practical approach for dealing with complex CV junction abnormalities. They provide surgeons with deep insights into the complex bony anomalies as well as variations in the vertebral artery courses, thereby improving surgical outcomes.
Human absorption, distribution, metabolism, and excretion (hADME) studies of new drugs are required for global regulatory filings. Recent advances in high sensitivity analytical technologies have ...enabled microtracer hADME studies wherein very low radioactive doses can be administered to healthy volunteers to study drug pharmacokinetic profile. Microtracer hADME studies are advantageous to accelerate study timelines during drug development. However, there are limited examples in peer-reviewed journals that highlight the key chemistry, manufacturing, and control (CMC) development challenges and requirements for enabling these clinical microtracer hADME studies. The current manuscript summarizes the CMC activities, risk assessment, and mitigation strategies that were put in place and executed to enable and accelerate the microtracer hADME study of
14
C-labeled sotorasib (AMG 510, compound 1). Sotorasib is a first in class KRAS
G12C
inhibitor used to treat non-small cell lung cancer (NSCLC) in patients with a KRAS
G12C
mutation (Canon et al., Nature 575:217–223, 2019). The key CMC activities included the synthesis of low nanocurie
14
C-labeled AMG 510 drug substance, development of a drug-in-bottle (DIB) formulation, use of simulation software to predict absorption profiles, associated drug substance and drug product analytical control strategies development, and the utilization of accelerator mass spectrometry (AMS) as a CMC tool enabling low radioactive strength formulation analysis.
Acute liver failure (ALF) is a rare disease entity with a high mortality. Management is dependent on accurate prognostication.
One hundred consecutive patients presenting with ALF were prospectively ...evaluated. The King's college criteria (KCC), ALF early dynamic model (ALFED), sequential organ failure assessment (SOFA) score, and acute physiology and health evaluation II (APACHE II) scores were compared to predict mortality.
There were significant differences in means of all the scores between survivors and nonsurvivors. The SOFA 48 hours had the highest area under receiver operating characteristic curve (AUC) (0.857) closely followed by the ALFED score (0.844). The optimal cutoff for the SOFA score at 48 hours to predict subsequent survival outcome is ≥10 and for the ALFED score is ≥5. Sequential organ failure assessment 48 hours had a good sensitivity of 87%, and the ALFED score showed a good specificity of 84%. The decision curve analysis showed that between a threshold probability of 0.13 and 0.6, use of the SOFA score provided the maximum net benefit and at threshold probabilities of >0.6, the use of ALFED score provided the maximum clinical benefit.
Dynamic scoring results in better prognostication in ALF. The SOFA 48 hours and ALFED score have good prognostication value in nonacetaminophen-induced liver failure.
Saluja V, Sharma A, Pasupuleti SSR, Mitra LG, Kumar G, Agarwal PM. Comparison of Prognostic Models in Acute Liver Failure: Decision is to be Dynamic. Indian J Crit Care Med 2019;23(12):574-581.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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