Adsorption of Chromium (VI) Using an Activated Carbon Derived from Petroleum Coke Feedstock.

This study aims to determine the main adsorption mechanism by which chromium (VI) is adsorbed onto the surface of a petroleum-coke sourced activated carbon, a feedstock not prevalent in current literature. The study also aims to produce an activated carbon adsorbent that is both cost-effective and efficient for the removal of chromium (VI) in neutral waters. The efficacy of thermally-treated petroleum coke-activated carbon and nitrogenated petroleum coke-activated carbon using ammonium chloride is compared to the efficacy of commercially available activated carbon. X-ray photoelectron spectroscopy of the activated carbons was obtained both before and after exposure to chromium (VI) for characterization of the materials and confirmation of chromium adsorption. The thermally-treated and nitrogenated activated carbons showed significant enhancement of chromium (VI) removal compared to the non-treated petroleum coke-activated carbon (22.4 mg/g, 21.9 mg/g, and 17.0 mg/g, respectively). However, there was no significant difference observed between the thermally-treated and nitrogenated materials. This indicates that the nitrogenation of the surface does not improve the adsorption capacity of the activated carbon, but rather the thermal treatment itself. X-ray photoelectron spectroscopy showed a significant increase in the alcohol functional groups on the surface of the activated carbon material as a result of the heat-treatment process; from 16.02 atomic percent in the non-treated activated carbon to 26.3 atomic percent in the thermally-treated activated carbon. The alcohol functional groups present on the surface allow for chromium (VI) to undergo reduction to chromium (III) under a similar mechanism to the well-known Jones Oxidation Reaction where the reduced chromium (III) species are then physisorbed to the surface of the activated carbon. XPS results are consistent with this as the chromium species present on the surface of the adsorbent is primarily Cr(OH)3 (85.6% in the standard AC and 82.5% in the thermally-treated AC). Pseudo-first-order and pseudo-second-order kinetic modeling of the adsorbents indicate that they follow a pseudo-second-order reaction where the rate-limiting step is the chemical sorption of the adsorbate itself.

Chronic Headache: a Review of Interventional Treatment Strategies in Headache Management.

PURPOSE OF THE REVIEW: To provide an overview of current interventional pain management techniques for primary headaches with a focus on peripheral nerve stimulation and nerve blocks. RECENT FINDINGS: Despite a plethora of treatment modalities, some forms of headaches remain intractable to conservative therapies. Interventional pain modalities have found a niche in treating headaches. Individuals resistant to common regimens, intolerant to pharmaceutical agents, or those with co-morbid factors that cause interactions with their therapies are some instances where interventions could be considered in the therapeutic algorithm. In this review, we will discuss these techniques including peripheral nerve stimulation, third occipital nerve block (TON), lesser occipital nerve block (LON), greater occipital nerve block (GON), sphenopalatine block (SPG), radiofrequency ablation (RFA), and cervical epidural steroid injections (CESI). Physicians have used several interventional techniques to treat primary headaches. While many can be treated pharmacologically, those who continue to suffer from refractory or severe headaches may see tremendous benefit from a range of more invasive treatments which focus on directly inhibiting the painful nerves. While there is a plethora of evidence suggesting these methods are effective and possibly durable interventions, there is still a need for large, prospective, randomized trials to clearly demonstrate their efficacy.

Rate of tympanic membrane perforation after intratympanic steroid injection.

PURPOSE: To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection. MATERIALS AND METHODS: Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation. RESULTS: One hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5days for perforation healing compared to 17.5days with no prior history of radiation and this approached statistical significance (p=0.078). CONCLUSIONS: The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation.

Prednisone Decreases Opioid Use in Adults Undergoing Benign Oropharyngeal Surgery.

OBJECTIVE: This study sought to analyze the efficacy and safety of postoperative prednisone to reduce reliance on opioids in adult benign oropharyngeal surgery. STUDY DESIGN: Prospective cohort study. SETTING: Single tertiary-care facility. METHODS: Patients undergoing tonsillectomy (T), tonsillectomy and adenoidectomy (T&A), and/or modified uvulopalatopharyngoplasty (UPPP) from December 2020 to January 2023 received the standard of care postoperative management. A prednisone taper was dependent on surgeon preference. Cohorts were based on the prescription of postoperative steroids. Patients completed a survey to assess opioid usage, pain scores, and steroid compliance. RESULTS: Seventy-two patients were included. The nonsteroid cohort (N = 29) received an average of 467 ± 94.1 morphine milligram equivalents (MME), and the steroid cohort (N = 43) received an average of 285 ± 128 MME (P < 0.001). The nonsteroid cohort consumed 1.62 times more opioids than the steroid cohort (P < 0.002). There were no significant differences in complication or refill rates between treatment groups. There were no significant differences in pain scores on the day of surgery or postoperative days 1, 5, or 10 (P = 0.34, P = 0.66, P = 0.62, and P = 0.22, respectively). Patients undergoing T&A (p = 0.019) or who had current psychiatric medication use (P < 0.006) consumed significantly more opioids. Patients who received a total opioid prescription of >300 MME (40 5-mL doses of 5 mg/5 mL liquid oxycodone) consumed 2.27 times more postoperative opioids than patients with opioid prescriptions ≤300 MME (P < 0.001). CONCLUSION: Patients who did not receive steroids consumed 1.62 times more postoperative opioids compared to those who completed a steroid taper. Corticosteroid use was not associated with changes in pain scores, refill rates, or complication rates and may be considered in a multimodal approach to pain management in adults undergoing benign oropharyngeal surgery, although further study is warranted.

Metal-Impregnated Petroleum Coke-Derived Activated Carbon for the Adsorption of Arsenic in Acidic Waters.

The efficacy of metal-impregnated petroleum coke (PC) activated carbon for the adsorption of arsenite and arsenate in acidic waters is investigated in this study. Unmodified PC activated carbon, FeCl3-loaded activated carbon, KMnO4-loaded activated carbon, and a mixed FeCl3-KMnO4-loaded activated carbon were used for evaluation. The surface characteristics of the activated carbons before and after arsenic adsorption were analyzed by X-ray photoelectron spectroscopy (XPS). Arsenate adsorption was significantly improved by the addition of an iron-manganese-loaded activated carbon, increasing adsorption from 8.12 to 50.93%. Oxidation-reduction reactions are proposed based on the observed arsenic 2p3/2, iron 2p3/2, and manganese 2p3/2 XPS peaks. While iron in the iron-loaded activated carbon is not acting as the reducing agent, it is acting as a conductor for the flow of electrons from the activated carbon to the arsenic for reduction to take place prior to the physisorption of the arsenic. In the manganese-loaded activated carbon, manganese acts as the reducing agent for arsenic prior to arsenic adsorption to the surface through physisorption. XPS of the post-arsenic(V) exposure samples showed that the Fe2O3 species were reduced from 32.18 to 1.66% in the FeMn-loaded sample, while the FeOOH species were increased from 53.16 to 81.71%. Similarly, MnO in the FeMn-loaded activated carbon dropped from 26.82 to 15.40%, while MnOOH and MnO2 increased from 39.98 and 33.20 to 43.96 and 40.64%, respectively. This is consistent with the proposed mechanism. The adsorption of arsenite was also evaluated to show that the modification of the activated carbon adsorbed not only the arsenic(V) species but also the more toxic arsenic(III) species without the need for oxidation of the arsenic prior to adsorption.

The minimally-invasive thyroidectomy incision: a histological analysis.

BACKGROUND: Minimally invasive thyroidectomy (MIT) has gained popularity in the surgical management of benign and malignant pathology of the thyroid. One of the main benefits of utilizing this technique is the use of smaller incisions resulting in increased cosmetic satisfaction. Unfortunately, the retraction required for adequate exposure during MIT may lead to skin damage, impaired wound healing and poor cosmetic outcomes. Some have proposed that excising incision edges prior to closure may improve cosmesis. A review of the literature does not reveal any histologic evidence to support this technique. MATERIAL/METHODS: In this prospective observational study, nine subjects undergoing MIT were identified. Both the superior and inferior skin edges were excised and labeled for orientation. Specimens were sent for hematoxylin and eosin staining and histologic analysis by a staff pathologist. RESULTS: All specimens showed no significant findings such as damage to the architecture of the dermis, acute inflammation, edema or evidence of hemorrhage. Focal blood vessel ectasia within the dermis was identified in three of nine subjects. CONCLUSIONS: Our findings do not yield a histological basis supporting the routine trimming of incisions during MIT. Although no significant findings were noted histologically, further studies are warranted to investigate the long-term cosmetic outcome of MIT incisions.

Influence of pharmacy practice on community pharmacists' integration of medication and lab value information from electronic health records.

OBJECTIVES: To describe how an electronic health record (EHR) was integrated into community pharmacists' patterns of patient care and to explore factors that are related to the use of medication and laboratory value information from the EHR. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: Edmonton, Canada, between November 2008 and March 2009. PARTICIPANTS: 16 pharmacists, 3 pharmacy technicians, and 2 pharmacy interns from primary care networks, long-term care settings, community independent and chain pharmacies, and grocery store pharmacies. INTERVENTION: Qualitative interviews. MAIN OUTCOME MEASURE: Pharmacists' self-reported use of EHR. RESULTS: Pharmacists in a patient-centered care practice (involving medication therapy management activities) were more likely to adopt the EHR for medication history and laboratory values, whereas pharmacists whose practice was focused on medication dispensing primarily used the EHR for patient demographic and dispensing records. Six general factors influenced the use of EHR: patients, pharmacists, pharmacy, other health professionals (i.e., physicians), EHR, and environment. Access to the medical record versus EHR and timeliness were barriers specific to pharmacists in a patient-centered practice. Factors that affected EHR use for pharmacists with primarily a dispensing practice were role understanding, dispensing versus lab records, valid reasons for using EHR, and fear of legal and disciplinary issues. CONCLUSION: Many community pharmacists embraced the EHR as a part of practice change, particularly those in patient-centered care practices. Practice type (patient-centered care or dispensing) greatly influenced pharmacists' use of EHR, specifically laboratory values. Because these qualitative findings are exploratory in nature, they may not be generalized beyond the participating pharmacies.

Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies.

Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.

A randomized trial of the traditional sitting position versus the hamstring stretch position for labor epidural needle placement.

BACKGROUND: Anecdotal and experimental evidence suggest that a sitting position with maximum knee extension, hip adduction, and forward lean (hamstring stretch position) may produce better reversal of the lumbar lordosis than a traditional sitting position. METHODS: In a randomized trial during initiation of epidural labor analgesia, we compared the traditional versus hamstring stretch positions. The primary outcome was the number of needle-bone contacts. RESULTS: The groups were equivalent with respect to the number of needle-bone contacts. CONCLUSIONS: The hamstring stretch position is equivalent to the traditional sitting position in terms of the number of needle-bone contacts encountered when placing labor epidural needles.

Device review: Pulsante™ sphenopalatine ganglion microstimulator.

Cluster headache (CH) is a primary headache disorder. The use of neuromodulation in treatment of CH is well documented. The sphenopalatine ganglion (SPG) has long been a target for management of CH. Intervention at the level of the SPG can interrupt the trigemino-autonomic reflex, which mediates CH pain. The Pulsante system is the only device on the market created for SPG stimulation. The Pulsante device consists of the device body, a lead with six stimulating electrodes placed in the pterygopalatine fossa, and a fixation plate to allow anchoring of the device to the maxilla. Stimulation is administered via a patient-controlled handheld remote control held over the cheek. SPG stimulation is an important treatment option for CH patients.

Superficial musculoaponeurotic system elevation and fat graft reconstruction after superficial parotidectomy.

OBJECTIVE/HYPOTHESIS: Elevation of the superficial musculoaponeurotic system (SMAS) with or without fat graft interposition during superficial parotidectomy prevents a concave facial deformity and Frey's syndrome. STUDY DESIGN: Retrospective, case-control study. METHODS: Charts for 248 patients who underwent superficial parotidectomy were reviewed for pathologic, radiographic, clinical, and operative data. Sixteen patients who underwent SMAS elevation and 34 patients who underwent SMAS elevation with fat graft interposition were included in two study groups. Nonreconstructed controls were randomly selected from a pool of patients who had unilateral, superficial parotidectomy and were matched based on pathologic specimen volume. Patients were surveyed for their postoperative symptoms. RESULTS: Patients undergoing SMAS elevation alone (n = 16) compared with controls (n = 19) had greater facial symmetry (12% vs. 32%, P = .147) and a lower incidence of symptomatic Frey's syndrome (6.3% vs. 18.6%, P = .382). Patients undergoing SMAS elevation and fat graft interposition (n = 34) compared with controls (n = 38) had less facial asymmetry (9% vs. 39%, P = .002) and a lower incidence of symptomatic Frey's syndrome (6% vs. 28%, P = .04). Complications among the study and control groups were comparable. CONCLUSIONS: Simultaneous reconstruction of a superficial parotidectomy defect using SMAS elevation with or without fat grafting may improve postoperative facial symmetry and decrease the incidence of symptomatic Frey's syndrome without increasing complications.

Single-stage operation for giant substernal goiter with severe coronary artery disease.

A 76-year-old female, with a history of asthma and tracheal bronchitis, presented with a non-ST elevation, myocardial infarction. Chest x-ray on admission showed a widened mediastinum, which was further evaluated with a computed tomography (CT) scan. It disclosed a giant substernal goiter compressing the trachea and the ascending aorta. Cardiac catheterization showed significant coronary disease unsuitable for percutaneous intervention; thus, the patient was scheduled for coronary artery bypass grafting. Single stage thyroidectomy immediately followed by coronary artery bypass was performed. After surgery, her upper airway symptoms were improved, and no cardiac events were noted. Collaboration between otolaryngology and thoracic surgery teams contributed to good outcomes for this patient with substernal goiter and severe cardiac disease.

Pediatric tracheostomy in conjoined twins: multidisciplinary approach.

Tracheostomy for definitive airway management in conjoined twins is a challenge for the surgeon, anesthesiologist, and support staff. A carefully choreographed multidisciplinary approach is required. A literature search finds few reports on tracheostomy in conjoined twins. We report our experience with tracheostomy with 5.5-month-old conjoined omphalopagus twins who were attached facing each other. Initial planning led to a careful rehearsal of infant positioning focused on optimizing anterior cervical exposure. A postoperative tracheostomy care plan was also addressed. Each twin was assigned his own anesthetic team and equipment early in his life to provide consistent care for the anticipated multiple surgical procedures throughout his hospital stay. Issues addressed in this report include transportation, intubation, intraoperative airway management, the mechanical ventilatory pattern of two individuals sharing a common diaphragm, and the pharmaceutical management of two children with partially shared vascular supply.

Meta-analysis of surgical techniques for preventing parotidectomy sequelae.

OBJECTIVE: To conduct a meta-analysis of the literature on surgical methods for the prevention of Frey syndrome and concave facial deformity after parotidectomy. METHODS: A PubMed search through February 2008 identified more than 60 English-language studies involving surgical techniques for prevention of these parameters. Analyzed works included 15 retrospective or prospective controlled studies reporting quantitative data for all included participants for 1 or more of the measured parameters in patients who had undergone parotidectomy. Report quality was assessed by the strength of taxonomy recommendation (SORT) score. Data were directly extracted from reports and dichotomized into positive and negative outcomes. The statistical significance was then calculated. RESULTS: The mean SORT score for all studies was 2.34, and the mean SORT score for all the analyzed studies was 1.88. Meta-analysis for multiple techniques to prevent symptomatic Frey syndrome, positive starch-iodine test results, and contour deformity favored intervention with a cumulative odds ratio (OR) of 3.88 (95% confidence interval [CI], 2.81-5.34); OR, 3.66 (95% CI; 2.32-5.77); and OR, 5.25 (95% CI, 3.57-7.72), respectively. CONCLUSION: Meta-analysis of operative techniques to prevent symptomatic Frey syndrome, positive starch-iodine test results, and facial asymmetry suggests that such methods are likely to reduce the incidence of these complications after parotidectomy.