Neurological Emergencies in the Intensive Care Unit.

Neurological emergencies carry significant morbidity and mortality, and it is necessary to have a multidisciplinary approach involving the emergency physician, the neurologist, the intensivist, and the critical care nursing staff. These disorders can be broadly divided into noninfectious and infectious etiologies. In this article, we review a few of the neurological emergencies that present to the neurological intensive unit, with emphasis on convulsive status epileptics, myasthenia gravis, Guillain-Barré syndrome, meningitis, encephalitis, and brain abscess.

Development of reduced graphene oxide-supported novel hybrid nanomaterials (Bi2WO6@rGO and Cu-WO4@rGO) for green and efficient oxidative desulfurization of model fuel oil for environmental depollution.

For the first time, two new kinds of inorganic-organic hybrid nanomaterials (Bi2WO6@rGO and Cu-WO4@rGO) were fabricated by simple hydrothermal treatment and employed for green and efficient oxidative desulfurization of real fuel. The characterization of newly synthesized nanocomposites was performed by SEM, EDX, P-XRD, FT-IR and TGA. SEM and XRD analyses revealed well decoration of dopants (Cu-WO4 and Bi-WO3) on the surface of rGO with a crystallite size of <50 nm. The catalytic activity of both nanocatalysts was examined for model (dibenzothiophene) and real fuel (kerosene and diesel) by oxidative desulfurization route. Experimental findings revealed a high efficiency of over 90% under optimal reaction conditions of 0.1 g catalyst, 1 mL of oxidant, and 100 mg/L after 120 min at 30 °C. The major factors affecting desulfurization efficiency (time, temperature, catalyst amount, dibenzothiophene (DBT) concentration and amount of oxidant) and kinetic studies were described. The DBT removal via oxidative desulfurization followed pseudo first-order kinetics with an activation energy of 14.57 and 16.91 kJ/mol for Cu-WO4@rGO and Bi2WO6@rGO, respectively. The prepared catalysts showed promising reusability for the ODS process up to 5 times with no significant decrease in efficiency. In conclusion, the findings confirm the robustness of newly prepared nanocomposite for efficient production of sulfur-free oil.

The Effects of Spinal Cord Stimulators on End Organ Perfusion: A Literature Review.

Spinal cord stimulators (SCS) have been gaining momentum in the last decade as their role in the management of chronic pain has become more apparent. Our intention was to search, analyze and highlight the effects of spinal cord stimulators on end-organ perfusion. We also looked at vascular diseases of atherosclerotic and nonatherosclerotic nature by examining objective evidence of improved circulation, pain control, limb salvage, and quality of life. We paid specific attention to disease processes such as cerebral hypoperfusion, Chronic-Critical Limb Ischemia, Intractable Angina Pectoris (IAP), Raynaud's syndrome and Thromboangiitis Obliterans. We performed a Medline database search for medical literature relevant to Spinal cord stimulators encompassing the years 1950 to 2019. Search terms included "Spinal cord stimulator," plus one of the following search terms: vasculopathy, stroke, cerebral blood flow, angina pectoris, diabetic ulcers, chronic critical leg ischemia, thromboangiitis obliterans and peripheral vascular disease. We included both clinical and experimental human studies that investigated the effect of SCS's on end-organ perfusion. We also investigated the pathophysiological mechanism of action of SCS's on the vasculature. We found 497 articles of which 43 more relevant and impactful articles investigating the hemodynamic effects of SCS and its possible mechanism were selected. Animal studies were excluded from the literature review as they provided heterogeneity. In addition to reporting literature supporting the use of stimulators for currently FDA approved uses, we also actively looked for potential future uses. Spinal Cord stimulators showed improvement in cerebral blood flow, increased capillary recruitment, and better quality of life in many studies. Patients also had increased exercise capacity and a significant reduction in the use of narcotic drug use and daily anginal attacks in patients suffering from IAP.