Medical errors in neonatal intensive care unit at Benha University Hospital, Egypt.

This study was conducted in the neonatal intensive care unit of Benha University Hospital, Egypt from 1 August 2012 to the 31 January 2013 to identify medical errors and to determine the risk factors and consequences of these errors. Errors were detected by follow-up of neonates and review of reports including nursing followup sheets, resident progression notes and investigation reports. We detected 3819 errors that affected 97% of neonates. Types of errors included 403 medication errors (10.55% of total errors), 652 errors in daily routine procedures (17.07%), 1042 errors in invasive procedures (27.28%), 68 errors in nutrition (1.78%), 63 equipment errors (1.64%), 260 administration errors (6.8%), 656 staffing errors (17.18%), 107 environmental errors (2.8%), 448 infection control errors (11.73%) and 120 nosocomial infection errors (3.14%). Medical errors were high in low birth weight, low gestational age neonates and increased with duration of admission.

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review.

BACKGROUND: Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy. METHODS: A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023. RESULTS: A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001). CONCLUSIONS: Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.

Investigating the Adsorption Behavior of Polyaniline and Its Clay Nanocomposite towards Ammonia Gas.

Air pollution and control of gaseous air pollutants are global concerns. Exposure to these gaseous contaminants causes several health risks, especially exposure to irritant gases such as ammonia (NH3). Furthermore, the application of smart polymeric nanocomposites in environmental applications has gained significant interest in recent years. In this study, aniline was polymerized without and with clay using a carbon dioxide (CO2)-assisted polymerization technique, yielding PANI and PANC samples, respectively. The samples were characterized using different methods, such as Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscope (SEM), and Brunner Emmett Teller (BET). The synthesized nanomaterials were utilized as gas adsorbents using a fixed bed reactor to investigate their adsorption behavior towards NH3. Three inlet NH3 concentrations were tested (35-150 ppm). The results revealed that the adsorption capacities of PANC nanocomposites were higher than nanostructured PANI for the studied concentrations. The adsorption capacities were 61.34 mgNH3/gm for PANC and 73.63 mgNH3/gm for PANI at the same inlet concentration (35 ppm). The highest NH3 adsorption capacity recorded was 582.4 mg NH3/gm, for PANC. This study showed the impressive adsorption behavior of the prepared PANI and PANC nanomaterials towards NH3 gas. Consequently, nanostructured PANI and PANC can be promising adsorbents that can be utilized to control different gaseous air pollutants.

Novel aspartic-based bio-MOF adsorbent for effective anionic dye decontamination from polluted water.

In this study, a cost-effective powdered Zn l-aspartic acid bio-metal organic framework (Zn l-Asp bio-MOF) was reported as an efficient adsorbent for Direct Red 81 (DR-81) as an anionic organic dye. The prepared bio-MOF was characterized using Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), field emission transmission electron microscopy (FETEM), surface area analysis (BET), and thermal gravimetrical analysis (TGA). The resulting bio-MOF has a large surface area (180.43 m2 g-1) and large mesopore volume (0.144 cm3 g-1), as well as good chemical inertness and mechanical stability. The optimum dosage from the Zn l-Asp bio-MOF was 1.0 g L-1 at pH = 7 for 95.3% adsorption of 10 ppm DR-81 after 45 min. Thermodynamic analysis results demonstrated that the decontamination processes were done with spontaneous, thermodynamically, and exothermic nature onto the fabricated bio-MOF. Kinetic parameters were well-fitted with pseudo-second-order kinetics, and the adsorption process was described by the Freundlich isotherm. The adsorption data proved that Zn l-Asp bio-MOF is an effective adsorbent for DR-81 from aqueous solutions with high stability and recycling ability for eight cycles, as well as the easy regeneration of the sorbent.

Experimental Investigation of Fabricated Graphene Nanoplates/Polystyrene Nanofibrous Membrane for DCMD.

In recent decades, the fabrication of composite membranes using nanoparticles has played a vital role in membrane distillation (MD) technique. It could make available membranes with superior characteristics as excellent candidates for MD technique. The most well-known obstacles regarding the MD method are the low productivity and high cost. Thus, fabricating membranes with superior properties is a significant challenge. In the current study, a composite membrane has been fabricated using 0.25, 0.5, and 0.75 weight percent (wt.%) of graphene nanoparticles (GNPs) with polystyrene (PS) as a base polymer and characterized using SEM, FTIR, and contact angle. The characterization results prove the successful fabrication using electrospinning and the validity of the fabricated membranes to be applied to direct contact membrane distillation (DCMD). In addition, a DCMD experimental setup has been designed to examine the performance of the fabricated membranes and compare the performance of blank PS with composite PS/GNPs membranes. The results show that all fabricated membranes produced an approximately similar average flux of about 10 kg/m2 h, while the highest GNPs wt.% showed the highest salt rejection. Accordingly, this composite membrane has been examined at different operating parameters and showed stable performance. Moreover, feed temperature and the rate of flow have a positive impact on the overall performance of the DCMD.

Modeling and Simulation of Fabricated Graphene Nanoplates/Polystyrene Nanofibrous Membrane for DCMD.

Membrane distillation is an active technique that provides pure water with very good rejection and could be applied to water of extremely high salinity. The low productivity of membrane distillation needs intensive efforts to be competitive with other desalination techniques. In this current study, a composite (PS/GNP) membrane, which is composed of polystyrene (PS) based and 0.25% weight percent graphene nanoplates (GNP) has been fabricated via electrospinning and compared with the blank PS membrane. SEM, FTIR, contact angle and porosity characterization have been performed, and the results show that the validity of the predefined conditions, and the contact angle of the composite membrane, which is found to be 91.68°, proved the hydrophobic nature of the composite membrane. A numerical simulation using Ansys 2020 software has been introduced to study the performance of the fabricated composite membrane when used in direct contact membrane distillation (DCMD). The numerical model has been validated with experimental work from the literature and showed an excellent match. The blank PS and composite PS/GNP membranes have been investigated and compared at different operating conditions, i.e., hot water supply temperature and system flow rate. The results show that the composite PS/GNP membrane outperforms the blank PS membrane at all studied operating conditions.

Numerical Investigation of Fabricated MWCNTs/Polystyrene Nanofibrous Membrane for DCMD.

The effect of compositing multiwalled carbon nanotubes (MWCNTs) with polystyrene (PS) to fabricate nanofibrous membrane by electrospinning technique and comparing the direct contact membrane distillation (DCMD) performance of the blank and composite membranes is evaluated numerically. Surface morphology of both the pristine and the composite membrane was studied by SEM imaging while the average fiber diameter and average pore size were measured using ImageJ software. Static water contact angle and porosities were also determined for both membranes. Results showed significant enhancement in both the hydrophobicity and porosity of the composite membrane by increasing the static water contact angle from 145.4° for the pristine PS membrane to 155° for the PS/MWCNTs composite membrane while the porosity was increased by 28%. Simulation results showed that at any given feed inlet temperature, the PS/MWCNTs membrane have higher permeate flux and better overall system performance.

The CO2 photoconversion over reduced graphene oxide based on Ag/TiO2 photocatalyst in an advanced meso-scale continuous-flow photochemical reactor.

This study aims at examining the use of an advanced meso-scale continuous-flow photochemical reactor for the photocatalytic conversion of CO2 with water into fuel over TiO2 (P25), Ag/TiO2, and Ag/TiO2/RGO catalysts. The silver loaded photocatalysts were prepared by one-step process via hydrothermal method. The prepared photocatalysts were characterized by various characterization techniques in order to identify the morphological, chemical, physical, and optical properties. The photocatalytic activity of the as-prepared catalysts was firstly examined by the photoelectrochemical (PEC) measurements and secondly by the photocatalytic reduction of CO2 in the proposed setup. Liquid products were analyzed using gas chromatography-mass spectrometry (GC-MS) and total organic carbon (TOC) techniques. It was found that the ternary composite revealed an outstanding performance towards CO2 photocatalytic reduction, where its selectivity was directed towards methanol production. The incorporation of graphene nanosheets enhanced the photocatalytic reduction of CO2 by 3.3 and 9.4 times compared with Ag/TiO2 and bare TiO2, respectively, using the proposed photochemical reactor in a continuous mode. This study sheds the light on a novel type of a photocatalytic reactor where CO2 conversion over Ag/TiO2/RGO ternary composite was evaluated. A meso-scale continuous-flow photochemical reactor.

Comparison between a Conventional Anti-Biofouling Compound and a Novel Modified Low-Fouling Polyethersulfone Ultrafiltration Membrane: Bacterial Anti-Attachment, Water Quality and Productivity.

In this work, the efficiency of a conventional chlorination pretreatment is compared with a novel modified low-fouling polyethersulfone (PES) ultrafiltration (UF) membrane, in terms of bacteria attachment and membrane biofouling reduction. This study highlights the use of membrane modification as an effective strategy to reduce bacterial attachment, which is the initial step of biofilm formation, rather than using antimicrobial agents that can enhance bacterial regrowth. The obtained results revealed that the filtration of pretreated, inoculated seawater using the modified PES UF membrane without the pre-chlorination step maintained the highest initial flux (3.27 ± 0.13 m3·m-2·h-1) in the membrane, as well as having one and a half times higher water productivity than the unmodified membrane. The highest removal of bacterial cells was achieved by the modified membrane without chlorination, in which about 12.07 × 104 and 8.9 × 104 colony-forming unit (CFU) m-2 bacterial cells were retained on the unmodified and modified membrane surfaces, respectively, while 29.4 × 106 and 0.42 × 106 CFU mL-1 reached the filtrate for the unmodified and modified membranes, respectively. The use of chlorine disinfectant resulted in significant bacterial regrowth.

Performance Evaluation and Kinetic Analysis of Photocatalytic Membrane Reactor in Wastewater Treatment.

The objectives of the current study are to assess and compare the performance of a developed photocatalytic membrane reactor (PMR) in treating industrial waste (e.g., organic dye waste) against membrane distillation. The current PMR is composed of a feed tank, which is a continuous stirred photocatalytic reactor containing slurry Titanium dioxide (TiO2) particles that are activated by using ultraviolet lamp irradiation at a wavelength of 365 nm, and a poly-vinylidene flouride (PVDF) membrane cell. The experimental setup was designed in a flexible way to enable both separate and integrated investigations of the photocatalytic reactor and the membrane, separately and simultaneously. The experimental work was divided into two phases. Firstly, the PVDF membrane was fabricated and characterized to examine its morphology, surface charge, and hydrophobicity by using a scanning electron microscope, surface zeta potential, and contact angle tests, respectively. Secondly, the effects of using different concentrations of the TiO2 photocatalyst and feed (e.g., dye concentration) were examined. It is found that the PMR can achieve almost 100% dye removal and pure permeate is obtained at certain conditions. Additionally, a kinetic analysis was performed and revealed that the photocatalytic degradation of dye follows a pseudo-first-order reaction.

Triple-Layer Nanocomposite Membrane Prepared by Electrospinning Based on Modified PES with Carbon Nanotubes for Membrane Distillation Applications.

In this work, a novel triple-layer nanocomposite membrane prepared with polyethersulfone (PES)/carbon nanotubes (CNTs) as the primary bulk material and poly (vinylidene fluoride-co-hexafluoro propylene) (PcH)/CNTs as the outer and inner surfaces of the membrane by using electrospinning method is introduced. Modified PES with CNTs was chosen as the bulk material of the triple-layer membrane to obtain a high porosity membrane. Both the upper and lower surfaces of the triple-layer membrane were coated with PcH/CNTs using electrospinning to get a triple-layer membrane with high total porosity and noticeable surface hydrophobicity. Combining both characteristics, next to an acceptable bulk hydrophobicity, resulted in a compelling membrane for membrane distillation (MD) applications. The prepared membrane was utilized in a direct contact MD system, and its performance was evaluated in different salt solution concentrations, feed velocities and feed solution temperatures. The results of the prepared membrane in this study were compared to those reported in previously published papers. Based on the evaluated membrane performance, the triple-layer nanocomposite membrane can be considered as a potential alternative with reasonable cost, relative to other MD membranes.

Resting and recruitable endothelial function - Evidence of two distinct circadian patterns.

BACKGROUND: Evidence of a circadian rhythm in endothelium-dependent vasomotor function, with a nadir in Flow-Mediated Dilation (FMD) in the early morning hours, has been previously reported. These changes have been proposed to be one of the mechanisms explaining the circadian pattern in the incidence of cardiovascular events. We set out to investigate the circadian rhythm of FMD, low-flow mediated dilation (L-FMC) and sympathetic vascular tone. METHODS AND RESULTS: 10 young healthy male volunteers (mean age, 28.9±3.7 years) underwent measurements of radial artery endothelium-dependent FMD and L-FMC at 8AM, 2PM and 8PM on the same day. Sympathetic vascular tone was assessed with laser Doppler and Fourier transform analysis. Compared with 2PM and 8PM, FMD decreased markedly in the early morning (2.9±3.4%; 6.2±2.9%; 6.0±4.0%; P = 0.007). In contrast, L-FMC was maximal at 8AM, decreased significantly at 2PM, and returned to higher values at 8PM (-5.1±1.3%; -2.7±2.0%; -4.6±2.2%; P = 0.030), such that the composite endpoint of endothelial function (sum of FMD+L-FMC) was not significantly different among timepoints. Vascular sympathetic tone was maximal early in the morning and lowest in the evening (P = 0.014) without a correlation with the changes in FMD or L-FMC. CONCLUSIONS: Endothelial responsiveness (FMD) and basal tone (L-FMC) appear to follow different circadian rhythms, with an impaired responsiveness in the early morning and a nadir in baseline tone in the early afternoon.

Metal Organic Framework Based Polymer Mixed Matrix Membranes: Review on Applications in Water Purification.

Polymeric membranes have been widely employed for water purification applications. However, the trade-off issue between the selectivity and permeability has limited its use in various applications. Mixed matrix membranes (MMMs) were introduced to overcome this limitation and to enhance the properties and performance of polymeric membranes by incorporation of fillers such as silica and zeolites. Metal-organic frameworks (MOFs) are a new class of hybrid inorganic-organic materials that are introduced as novel fillers for incorporation in polymeric matrix to form composite membranes for different applications especially water desalination. A major advantage of MOFs over other inorganic fillers is the possibility of preparing different structures with different pore sizes and functionalities, which are designed especially for a targeted application. Different MMMs fabrication techniques have also been investigated to fabricate MMMs with pronounced properties for a specific application. Synthesis techniques include blending, layer-by-layer (LBL), gelatin-assisted seed growth and in situ growth that proved to give the most homogenous dispersion of MOFs within the organic matrix. It was found that the ideal filler loading of MOFs in different polymeric matrices is 10%, increasing the filler loading beyond this value led to formation of aggregates that significantly decreased the MOFs-MMMs performance. Despite the many merits of MOFs-MMMs, the main challenge facing the upscaling and wide commercial application of MOFs-MMMs is the difficult synthesis conditions of the MOFs itself and the stability and sustainability of MOFs-MMMs performance. Investigation of new MOFs and MOFs-MMMs synthesis techniques should be carried out for further industrial applications. Among these new synthesis methods, green MOFs synthesis has been highlighted as low cost, renewable, environmentally friendly and recyclable starting materials for MOFs-MMMs. This paper will focus on the investigation of the effect of different recently introduced MOFs on the performance of MOFs-MMMs in water purification applications.

Comparable investigation of polyaniline behavior towards gaseous ammonia and toluene adsorption.

With raising awareness of gaseous air pollutants and their harmful impact, adsorption is considered one of the most prominent techniques for gaseous emissions control. The usage of polyaniline as a gas adsorbent is an innovative idea. This work aims to compare the efficacy of synthesized polyaniline nanotubes (PANT) as a novel adsorbent towards inorganic gases (ammonia NH3) and volatile organic compounds (toluene vapor). PANT was prepared via a sol-gel preparation technique. The molecular structure of prepared PANT was characterized by Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). The morphological structure was confirmed using transmission electron microscopy (TEM) and scanning electron microscope (SEM). The PANT adsorbent surface area was determined using Brunner Emmett Teller (BET). Dynamic behavior of simulated feed gas mixture of NH3 and toluene in air were examined using a fixed bed adsorption arrangement. The same adsorption conditions (inlet concentration, gas mixture feed flow rate, and a fixed amount of adsorbent) were applied for both NH3 and toluene adsorption test. The NH3 and toluene removal efficiencies were 100% and 96% respectively. Consequently, PANT is an auspicious adsorbent that can be utilized to control the indoor and outdoor gaseous air emissions. Graphical Abstracts ᅟ.

Evaluation of BCL2 and TNFα as mRNA biomarkers for monitoring the immune response in critically ill children.

BACKGROUND: Hospital acquired infection (HAI) and multiple organ dysfunctions (MODS) remain a leading cause of death in pediatric intensive care unit (PICU) despite the great efforts to control it. OBJECTIVE: Our objective was to assess the mRNA of TNFα and BCL2 for prediction of HAI and/or MODS in our community. PATIENTS AND METHODS: Fifty children, admitted to PICU, were included in the study after exclusion of cases of end-stage renal failure, end-stage liver failure and congenital immune deficiency. Serial Blood samples were collected for complete blood count (CBC) and other routine investigations. Gene expression of (TNFα and BCL2) was quantified using quantitative real time PCR (qRT-PCR). Centers of disease control (CDC) criteria were used to detect HAI, and organ failure index (OFI). Pediatric logistic organ dysfunction (PELOD) and pediatric risk of mortality (PRISM) scores were used for follow up. The results were compared between the group who acquired HAI and who didn't. Gene expression was tested with a ROC curve to detect its ability to predict HAI. MAIN RESULTS: The overall complication (HAI and/or MODS) rate was 52%, Complicated cases had a significantly longer duration of stay in PICU (0.002) and in overall hospital stay (p = 0.013) and a higher death rate (p = 0.000). On day1; TNFα, BCL2 and lymphocytic count were lower in patients who developed complications (p = 0.02, p = 0.000 and p = 0.04, respectively), all had the ability to predict the complications with AUC (0.7, 0.8 and 0.67 respectively). On day 4: TNFα and BCL2 returned to normal levels while the lymphocytic count still lower in complicated cases, p = 0.001 and AUC = 0.73. CONCLUSIONS: TNFα and BCL2 on admission can predict HAI and MODS (AUC = 0.7 and AUC = 0.8), but were of no use in the follow-up, however, the lymphocytic count is a rapid, easy and cheap test to assess the immune state with a good predictive and follow up values.

Phosphate disturbance in critically ill children: Incidence, associated risk factors and clinical outcomes.

BACKGROUND: Hypophosphatemia is one of the common disorders that develop in critically ill patients. It has potential complications and is often unrecognized in those patients. OBJECTIVE: Determining the incidence of hypophosphatemia in critically ill children, its association with clinical outcomes and the possible risk factors. METHODS: 50 patients were enrolled in the study. Levels of serum phosphate were measured on day 1 and day 7 of PICU (Pediatric intensive care unit) stay. The following variables were analyzed: age, gender, diagnosis on admission, malnutrition, phosphorus intake, clinical severity score on admission OFI (Organ Failure Index) and daily scores PELOD (Pediatric Logistic Organ Dysfunction), sepsis, use of dopamine, furosemide and steroids and assessment of nutrition by z scores. RESULTS: The incidence of hypophosphatemia on admission was 42%. On seventh day of admission incidence of hypophosphatemia was 62%. Malnutrition was present in 24% of patients, serum phosphorus level was significantly lower in malnourished than in well-nourished children (p value = 0.018). Hypophosphatemia was associated with prolonged PICU length of stay (p < 0.001) but was not associated with increased mortality (p = 0.13). Cases on parenteral nutrition and insufficient oral intake while on mechanical ventilator significantly showed hypophosphatemia (p = 0.017). Hypophosphatemia was associated with the use of furosemide, dopamine, steroids and ß2 agonist. CONCLUSION: Hypophosphatemia was common in the first 7 days of PICU hospitalization and was associated with prolonged PICU stay, Significant association between hypophosphatemia and duration of use of mechanical ventilation, use of furosemide, dopamine, steroids and ß2 agonist.

Protein-Repellence PES Membranes Using Bio-grafting of Ortho-aminophenol.

Surface modification becomes an effective tool for improvement of both flux and selectivity of membrane by reducing the adsorption of the components of the fluid used onto its surface. A successful green modification of poly(ethersulfone) (PES) membranes using ortho-aminophenol (2-AP) modifier and laccase enzyme biocatalyst under very flexible conditions is presented in this paper. The modified PES membranes were evaluated using many techniques including total color change, pure water flux, and protein repellence that were related to the gravimetric grafting yield. In addition, static water contact angle on laminated PES layers were determined. Blank and modified commercial membranes (surface and cross-section) and laminated PES layers (surface) were imaged by scanning electron microscope (SEM) and scanning probe microscope (SPM) to illustrate the formed modifying poly(2-aminophenol) layer(s). This green modification resulted in an improvement of both membrane flux and protein repellence, up to 15.4% and 81.27%, respectively, relative to the blank membrane.

Effect of zinc supplementation on body mass index and serum levels of zinc and leptin in pediatric hemodialysis patients.

INTRODUCTION: Zinc is an essential trace element for human nutrition, and its deficiency is associated with anorexia, poor food efficiency, growth retardation, and impaired neurological and immune systems. The zinc-deficiency rate is particularly high in many disease states, such as with end-stage renal disease patients undertaking hemodialysis. The aim of this study was to determine the effect of zinc supplementation on body mass index (BMI) and serum levels of zinc and leptin in pediatric hemodialysis patients. PATIENTS AND METHODS: This was a prospective clinical trial study in which 60 hemodialysis patients were randomly divided into two groups: group I received 50-100 mg zinc sulfate (equivalent to 11-22 mg elemental zinc) according to age, sex, and nutritional status of the child; and group II received placebo (cornstarch) twice daily for 90 days. Anthropometric measurements were taken, and serum zinc and leptin levels were determined by colorimetric test with 5-Br-3'-phosphoadenosine-5'-phosphosulfate and enzyme-linked immunosorbent assay, respectively, at days 0 and 90 of the study. RESULTS: Zinc supplementation resulted in a significant increase in mean serum zinc level and BMI. Serum leptin decreased significantly after supplementation in children under hemodialysis. A significant negative correlation was observed between serum zinc and leptin levels as a result of zinc supplementation. CONCLUSION: There was an increase in serum zinc level and BMI and decreased serum leptin after zinc supplementation in children under hemodialysis.