Effectiveness of "Resuscitation Cover All" in Minimizing COVID-19 Transmission to Health-Care Workers during Cardiopulmonary Resuscitation.

Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious disease transmitted by contact, droplets, and aerosols. Front line health-care workers (HCWs), particularly emergency physicians and acute care providers, are vulnerable to being exposed while treating their sick patients. Despite appropriate personal protective equipment use, HCW gets infected, suggesting the need for multiple layers of protection such as barrier devices. Methods: We aimed to determine the effectiveness of our novel "Resuscitation Cover All"(RCA) in reducing the exposure of HCW to simulated respiratory particles and its feasibility during cardio pulmonary resuscitation (CPR). This was a pilot simulation-based study. Five CPR simulation sessions were performed in Standard and RCA protocols, individually. Exposures through contact, droplets, and aerosols were simulated using a standardized volume of liquid detergent. Under Wood's lamp illumination, exposures of participants were compared between the protocols. Rate and depth of chest compressions, time taken to intubate, interruptions in CPR, and first-pass success were analyzed. Results: Overall mean exposure in standard protocol was 4950.4 ± 1461.6 (95%confidence interval [CI]:3135.7-6765.2) sq.pixels and RCA protocol was 2203.6 ± 1499.0 (95%CI: 342.4-4064.9) sq.pixels (P = 0.019). In standard, chest compressor had the highest exposure of 3066.6 ± 1419.2 (95%CI: 2051.3-4081.9) sq.pixels followed by defibrillator assistant 1166.4 ± 767.4 (95%CI: 617.4-1715.4) sq.pixels. Chest compressor of RCA had reduced exposure compared to that of standard (P < 0.001). Hands were the most frequently exposed body part. Airway manager of RCA had no exposure over head and neck in any session. No significant difference in CPR performance metrics was observed. Conclusion: This pilot simulation-based study shows that the novel RCA device could minimize the exposure of HCW to simulated respiratory particles during CPR. Also, it might not alter the high-quality CPR performance metrics. We need more real-life evidence.

Nanotechnology based solutions to combat zoonotic viruses with special attention to SARS, MERS, and COVID 19: Detection, protection and medication.

Zoonotic viruses originate from birds or animal sources and responsible for disease transmission from animals to people through zoonotic spill over and presents a significant global health concern due to lack of rapid diagnostics and therapeutics. The Corona viruses (CoV) were known to be transmitted in mammals. Early this year, SARS-CoV-2, a novel strain of corona virus, was identified as the causative pathogen of an outbreak of viral pneumonia in Wuhan, China. The disease later named corona virus disease 2019 (COVID-19), subsequently spread across the globe rapidly. Nano-particles and viruses are comparable in size, which serves to be a major advantage of using nano-material in clinical strategy to combat viruses. Nanotechnology provides novel solutions against zoonotic viruses by providing cheap and efficient detection methods, novel, and new effective rapid diagnostics and therapeutics. The prospective of nanotechnology in COVID 19 is exceptionally high due to their small size, large surface-to-volume ratio, susceptibility to modification, intrinsic viricidal activity. The nano-based strategies address the COVID 19 by extending their role in i) designing nano-materials for drug/vaccine delivery, ii) developing nano-based diagnostic approaches like nano-sensors iii) novel nano-based personal protection equipment to be used in prevention strategies.This review aims to bring attention to the significant contribution of nanotechnology to mitigate against zoonotic viral pandemics by prevention, faster diagnosis and medication point of view.

Ecofriendly biopolymers and composites: Preparation and their applications in water-treatment.

Over the past few decades, the term polymer has been repeatedly used in several industries for their immense characteristics in different applications. Polymers and their composites which were prepared from chemical monomer sources turned out to be potentially harmful to the environment due to their tedious degradation process. Biopolymers are natural substitutes for synthetic polymers which can be efficiently extricated from natural sources. They are predominantly available as polymeric units as well as monomeric units that are linked covalently. These environment-friendly biopolymers and their composites can be categorized based on their numerous sources, different methods of preparation and their potential form of usage. They were found to be biocompatible and biodegradable which make them exceptionally useful in environment based applications, mainly in the process of water treatment, both potable and wastewater. Further, the biopolymer and biopolymer composites easily fit into different parts of the treatment process by acting as filtration media, adsorbents, coagulants and as flocculants. The primary focus of this review is to provide a comprehensive information of biopolymers and biopolymer composites from synthesis to their usefulness for their productive application in water treatment processes. On the whole, it can be substantiated that the biopolymers were identified to play a notable adversary to the synthetic polymers in treating waters with an indispensable need for an elaborative study in the production of the biopolymers.

Defining the Antimalarial Activity of Cipargamin in Healthy Volunteers Experimentally Infected with Blood-Stage Plasmodium falciparum.

The spiroindolone cipargamin, a new antimalarial compound that inhibits Plasmodium ATP4, is currently in clinical development. This study aimed to characterize the antimalarial activity of cipargamin in healthy volunteers experimentally infected with blood-stage Plasmodium falciparum Eight subjects were intravenously inoculated with parasite-infected erythrocytes and received a single oral dose of 10 mg cipargamin 7 days later. Blood samples were collected to monitor the development and clearance of parasitemia and plasma cipargamin concentrations. Parasite regrowth was treated with piperaquine monotherapy to clear asexual parasites, while allowing gametocyte transmissibility to mosquitoes to be investigated. An initial rapid decrease in parasitemia occurred in all participants following cipargamin dosing, with a parasite clearance half-life of 3.99 h. As anticipated from the dose selected, parasite regrowth occurred in all 8 subjects 3 to 8 days after dosing and allowed the pharmacokinetic/pharmacodynamic relationship to be determined. Based on the limited data from the single subtherapeutic dose cohort, a MIC of 11.6 ng/ml and minimum parasiticidal concentration that achieves 90% of maximum effect of 23.5 ng/ml were estimated, and a single 95-mg dose (95% confidence interval [CI], 50 to 270) was predicted to clear 109 parasites/ml. Low gametocyte densities were detected in all subjects following piperaquine treatment, which did not transmit to mosquitoes. Serious adverse liver function changes were observed in three subjects, which led to premature study termination. The antimalarial activity characterized in this study supports the further clinical development of cipargamin as a new treatment for P. falciparum malaria, although the hepatic safety profile of the compound warrants further evaluation. (This study has been registered at ClinicalTrials.gov under identifier NCT02543086.).

Optimization of ultrasound assisted extraction of pectin from custard apple peel: Potential and new source.

Pectin was extracted from the waste custard apple peel using ultrasound technique and optimized the extraction process by RSM. The various significant process parameters such as liquid-solid ratio, ultra-sonication time, temperature and pH of solution were studied in the range of 10-25 mL g-1, 10-30 min, 50-80 °C, and 1-3, respectively. The maximum yield of pectin (8.93%) was attained at the optimum condition of 23.52 mL g-1 of liquid-solid ratio, 18.04  min of ultra-sonication time, 63.22 °C of temperature and 2.3 pH of solution. The extracted and commercially available fresh pectin (for comparison purposes) were characterized by various analytical techniques namely, FTIR, DSC, XRD, SEM, and NMR to evaluate their functional groups, thermal properties, crystallinities, morphological and structural characteristics, respectively. The extracted pectin was a toxic free compound as determined by its anti nutritional property study and about 20 mg/mL of antioxidant presented in it.

Enhanced wound healing by PVA/Chitosan/Curcumin patches: In vitro and in vivo study.

Biocompatible polymers are being used in recent times for treating skin injuries and burn wounds. Polymers like Poly Vinyl Alcohol and Chitosan are proven to be biocompatible with least toxic to treat injuries with minimal side-effects. Curcumin, a primary component of turmeric has anti-inflammatory properties and anti-microbial activity but has extremely low bioavailability. Converting Curcumin to its nano form increased its bioavailability exponentially allowing it to play a vital role in the process of wound healing. This PVA/Chi/Cur patch increased cell proliferation as shown by the results of cell line studies and MTT assay. Its anti-bacterial activity against four major bacterial strains commonly found in wound sites and water retainability indicates it to be a perfect material for wound treatment. Results of in-vivo studies conducted on wistar rats by testing the patch's healing ability on a surgically induced wound displayed its superiority over commercial ointment. This treatment for epidermal wounds reduces the frequency in which the patch has to be replaced and increases the rate of wound rehabilitation.

Pediatric Trauma - An Emerging Epidemic.

We enrolled 911 children aged <12 years presenting to the trauma center of a tertiary-care hospital (over a period of 18 months) with history of injuries. Majority (582; 63.9%) of children had sustained injuries at home; 56 (6.1%) had severe injuries based on Pediatric Trauma Score. Of road traffic accidents victims (n=232), majority (40.5%) were two-wheeler pillion riders or pedestrians (31.9%). More Indian data are required and efforts are needed to prioritize injury prevention efforts in children.

Ultrasound assisted pectic polysaccharide extraction and its characterization from waste heads of Helianthus annus.

The main aim of this current work is to extract pectin from waste heads of Helianthus annus by ultrasound and optimize the process variables (ultrasound power (USP), pH, time of sonication (TS) and ratio of solid to liquid (RSL) on maximal recovery of pectin using central composite statistical experimental design. In addition to that, extracted pectin at optimal condition was characterized and compared with commercial pectin. The optimal extraction process condition was USP of 375w, pH of 3.2, TS of 32min and RSL of 1:15g/ml. Mean experimental pectin yield of 8.89±0.024% was well accord with predicted pectin yield (8.91%). Analysis of chemical composition and Fourier transform infrared spectroscopy of extracted pectin did not show any significant difference with commercial pectin. XRD analysis illustrated a similar crystalline profile in both extracted and commercial pectin. Morphological analysis was performed on fresh and extracted samples using scanning electron microscopy.

Blunt Trauma Neck with Complete Tracheal Transection - A Diagnostic and Therapeutic Challenge to the Trauma Team.

Survival following trachea-esophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. The most important take-home message from this case report is that every Emergency physician should have the ability to predict "difficult airway" and recognize "failed airway" very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails. Any delay at any step in the "failed airway" management algorithm may not save the critically ill dying patient. Here, we report a case of blunt trauma following high-velocity road traffic accident, presenting in the peri-arrest state, in whom we noticed "failed airway" which turned out to be due to complete tracheal transection. In our patient, although we had secured the airway immediately, he had already sustained hypoxic brain damage. This scenario emphasizes the importance of prehospital care in developing countries.

Ultrasound assisted citric acid mediated pectin extraction from industrial waste of Musa balbisiana.

The objectives of the present work are to extract pectin from industrial waste of Musa balbisiana by ultrasound assisted citric acid mediated extraction method and optimization was done through central composite statistical experimental design under response surface methodology. The outcomes of this study exhibited that, process variables (ultrasound power, pH and extraction time) had considerable influence on the pectin extraction. Second order mathematical equation was constructed to predict the data through regression analysis. The optimal extraction process condition was ultrasound power of 323w, pH of 3.2, extraction time of 27min and SL (solid-liquid) ratio of 1:15g/ml. The mean experimental yield of pectin (8.99±0.018%) was fine accord among predicted yield of pectin (9.02%).

Ultrasound assisted extraction of pectin from waste Artocarpus heterophyllus fruit peel.

Four factors three level face centered central composite response surface design was employed in this study to investigate and optimize the effect of process variables (liquid-solid (LS) ratio (10:1-20:1ml/g), pH (1-2), sonication time (15-30min) and extraction temperature (50-70°C)) on the maximum extraction yield of pectin from waste Artocarpus heterophyllus (Jackfruit) peel by ultrasound assisted extraction method. Numerical optimization method was adapted in this study and the following optimal condition was obtained as follows: Liquid-solid ratio of 15:1ml/g, pH of 1.6, sonication time of 24min and temperature of 60°C. The optimal condition was validated through experiments and the observed value was interrelated with predicted value.

Modeling of polysaccharide extraction from Gossypium arboreum L. seed using central composite rotatable design.

The present study investigates the effect of independent variables such as extraction temperature (35-55 °C), time (1-5h) and solid-liquid ratio (1:5-1:25 g/ml) over the extraction yield of polysaccharide from Gossypium arboreum L. seeds was investigated and optimized. Aqueous extraction method was opted for the extraction of polysaccharide. Central composite response surface design was utilized for developing the experimental design. A second order polynomial mathematical model was developed from the obtained results. From the results, Significance of process variables over the extraction process can be clearly depicted. At the extraction temperature of 45 °C, extraction time of 3h and solid-liquid ratio of 1:15 g/ml maximum yield of polysaccharide (8.67%) from Gossypium arboreum L. seed was obtained. Characteristics of the extracted polysaccharide are analyzed through physico-chemical property analysis and Fourier Transform Infrared Spectroscopy (FTIR).

Multivariate statistical analysis and optimization of ultrasound-assisted extraction of natural pigments from waste red beet stalks.

In this study, ultrasound-assisted extraction (UAE) of natural pigment extraction from waste red beet stalks were optimized under four factors (extraction temperature, ultrasonic power, extraction time and solid-liquid ratio) by using three level Box-Behnken response surface design. Extraction temperature, ultrasonic power and solid-liquid ratio were significantly influenced the extraction yield of pigments. Extraction temperature of 53 °C, ultrasonic power of 89 w, extraction time of 35 min and SL ratio of 1:19 g/ml was identified as the optimal condition. Under this condition, the actual yield of (betacyanin of 1.28 ± 0.02 and betaxanthin of 5.31 ± 0.09 mg/g) pigments was well correlated with predicted values (betacyanin was 1.29 mg/g and betaxanthin was 5.32 mg/g).

Extraction of natural anthocyanin and colors from pulp of jamun fruit.

In this present study, natural pigment and colors from pulp of jamun fruit were extracted under different extraction conditions such as extraction temperature (40-60 ˚C), time (20-100 min) and solid-liquid ratio (1:10-1: 15 g/ml) by aqueous extraction method. Three factors with three levels Box-Behnken response surface design was employed to optimize and investigate the effect of process variables on the responses (total anthocyanin and color). The results were analyzed by Pareto analysis of variance (ANOVA) and second order polynomial models were developed to predict the responses. Optimum extraction conditions for maximizing the extraction yield of total anthocyanin (10.58 mg/100 g) and colors (10618.3 mg/l) were found to be: extraction temperature of 44 °C, extraction time of 93 min and solid-liquid ratio of 1:15 g/ml. Under these conditions, experimental values are closely agreed with predicted values.

Microwave-assisted extraction of pectic polysaccharide from waste mango peel.

This present study investigates the extraction characteristics and optimal parameters of the microwave-assisted extraction of pectin from waste mango peel (WMP). Microwave power, pH, time and solid-liquid ratio were selected as the extraction parameters and was studied by using Box-Behnken response surface design. The experimental data was analyzed by least square regression analysis method and a second order polynomial model was constructed for response from the experimental data. The constructed model was adequate to explain the relationships between independent variables and response. All studied factors had great influence on the yield of pectin by individually and interactively. The optimum microwave assisted extraction conditions for the highest pectin yield (28.86%) from WMP was found to be: microwave power of 413W, pH of 2.7, time of 134s and solid-liquid ratio of 1:18g/ml. The experimental value was well correlated with predicted value at the optimal condition.

Process variables influence on microwave assisted extraction of pectin from waste Carcia papaya L. peel.

The objectives of the present study were to evaluate and optimize the influence of process variables such as microwave power, pH, time and solid-liquid ratio on the extraction of pectin from waste Carcia papaya L peel. The experiments were carried out based on a four factors three level Box-Behnken response surface design. A quadratic model was developed from the experimental data in order to predict the pectin yield. The optimal condition was found to be: microwave power of 512 w, pH of 1.8, time of 140 s and solid-liquid ratio of 1:15 g/ml with maximum pectin yield (25.41%).

Comparison of response surface methodology and artificial neural network approach towards efficient ultrasound-assisted biodiesel production from muskmelon oil.

The present study is to evaluate and compare the prediction and simulating efficiencies of response surface methodology (RSM) and artificial neural network (ANN) based models on fatty acid methyl esters (FAME) yield achieved from muskmelon oil (MMO) under ultrasonication by two step in situ process. In first in situ process, free fatty acid content of MMO was reduced from 6.43% to 0.91% using H2SO4 as acid catalyst and organic phase in the first step was subjected to second reaction by adding KOH in methanol as basic catalyst. The influence of process variables (methanol to oil molar ratio, catalyst concentration, reaction temperature and reaction time) on conversion of FAME (second step) was investigated by central composite rotatable design (CCRD) of RSM and Multi-Layer Perceptron (MLP) neural network with the topology of 4-7-1. Both (RSM and ANN) were statistically compared by the coefficient of determination, root mean square error and absolute average deviation, based on the validation data set. The coefficient of determination (R(2)) calculated from the validation data for RSM and ANN models were 0.869 and 0.991 respectively. While both models showed good predictions in this study. But, the ANN model was more precise compared to the RSM model and it showed that, ANN is to be a powerful tool for modeling and optimizing FAME production.

Response surface optimization of ultrasound assisted extraction of pectin from pomegranate peel.

Ultrasound assisted extraction of pectin from waste pomegranate peel was investigated and optimized using Box-Behnken response surface design coupled with numerical optimization technique. The individual and interactive effect of process variables (solid-liquid ratio, pH, extraction time and temperature) on the pectin yield was studied. The experimental data obtained were analyzed by Pareto analysis of variance (ANOVA) and second-order polynomial models were developed using multiple regression analysis. The models developed from the experimental design were predictive and good fit with the experimental data with high coefficient of determination (R(2)) value. The optimal extraction condition was found to be 1:17.52 g/ml of solid-liquid ratio, 1.27 of pH, 28.31 min of extraction time and 61.90 °C of extraction temperature respectively. Under the optimal conditions, experimental yield was very close to the predicted values.

Statistical optimization of aqueous extraction of pectin from waste durian rinds.

The objectives of this present study was to investigate and optimize the aqueous extraction conditions such as solid-liquid (SL) ratio (1:5-1:15 g/ml), pH (2-3), extraction time (20-60 min) and extraction temperature (75-95 °C) on maximum extraction of pectin from durian rinds using four factors, three levels Box-Behnken response design. The experimental data obtained were fitted to a second-order polynomial equation using multiple regression analysis and analyzed by analysis of variance (ANOVA). The optimum extraction condition was found to be as follows: SL ratio of 1:10 g/ml, pH of 2.8, extraction time of 43 min and extraction temperature of 86 °C respectively. Under the optimal conditions, the experimental pectin yield (9.1%) was well correlated with predicted yield (9.3%).