Prevalence of Diabetes Mellitus among Haitian Americans: A Hidden Epidemic.

The prevalence of diabetes mellitus in the Haitian American population remains an important question. A recent study revealed an alarming prevalence of 39.9%. To corroborate these data, between November 2021 and September 2023 a representative sample was collected among 401 Haitian Americans in Florida, Maryland, New Jersey, and New York. Results revealed a crude prevalence rate of 36.6% (95% CI 31.85, 41.55%). The age-adjusted prevalence was 29.7% (CI 19.71%, 39.63%). This study's prevalence is nearly double the 16.8% (Z=10.48, p<.0001) rate in non-Hispanic African Americans and nearly two and a half times the 12.0% (Z=14.99, p<.0001) rate in all Americans. The crude prevalence for undiagnosed diabetes mellitus was 13.38% (CI 10.19%, 17.14%), with 17.11% age-adjusted prevalence (CI 7.53%, 26.70%). The scope of the diabetes burden, especially the high rate of undiagnosed cases, indicates a need for better strategies for the prevention, screening, treatment, and management of diabetes among Haitian Americans.

Mapping Levels of Palliative Care Service Development in Malaysian Public Hospitals Using the WHO Public Health Model of Palliative Care.

INTRODUCTION AND OBJECTIVES: This national audit involving Ministry of Health (MOH) Hospitals aimed to map out the levels of development of palliative care services and essential palliative medication availability in Malaysia. MATERIALS AND METHODS: An online survey coupled with manual follow up was conducted throughout all MOH hospitals in Malaysia. Data collected described elements of the palliative care service(PCS) based on the WHO public health model. Data was computed using a novel matrix to determine three key indices which were the 1) palliative care development score (PCDS), 2)essential medications availability score (EMAS) and 3) opioid availability score (OAS). These scores then allowed mapping of PCS according to scores of 1-4 (1=least developed, 4=most developed). FINDINGS: Out of all 140 MOH hospitals 88.6% (124) completed the PCDS survey, 120(85.7%) for the EMAS survey and 140 (100%) for the OAS survey. A total of 32(25.8%) hospitals had formal PCS with 8(25%) having resident palliative physicians (RPP), 8(25%) visiting palliative physicians(VPP) and 16(50%) no palliative physician (NPP). Out of these services, 17 (53%) had dedicated palliative care beds. In the PCDS survey, hospitals with PCS had significantly higher mean PCDS of 2.59 compared to 1.02 for non-PCS hospitals (P<0.001). The EMAS survey showed 109(90.8%) hospitals had EMAS of four and the OAS survey showed that 135(96.4%) hospitals had oral morphine available. CONCLUSION: This study shows that palliative care service development in MOH hospitals is still very limited however, majority of MOH hospitals in Malaysia have all the essential medications and oral morphine available.

To Study the Long Term Outcome of Endoscopic Septoplasty with Microdebrider Assisted Inferior Turbinoplasty (MAIT) Versus Medial Flap Turbinoplasty (MFT).

To study the long term outcome of endoscopic septoplasty with microdebrider assisted inferior turbinoplasty (MAIT) versus medial flap turbinoplasty (MFT). The present study was conducted in the Department of ENT, Government Medical College, Amritsar. Patients with symptomatic persistent nasal obstruction were recruited from ENT outdoor clinics. The nasal obstruction was persistent despite medical therapy that included a minimum 4 weeks. The study was primarily a double blinded prospective randomized control study including 120 patients, where all patients enrolled at odd numbers were taken for endoscopic septoplasty with microdebrider assisted inferior turbinoplasty and all patients with even numbers were taken for endoscopic septoplasty with MFT. Patient-scored nasal obstruction (1-5) along with blindly assessed nasal airway patency ratings (1-4) was done at 3 and 24 months postoperatively. A total of 120 patients were recruited in the study. The mean ages of the MAIT and MFT groups were 28.61 ± 14.8 and 30.25 ± 8.36 years, respectively. Average follow-up period was 21.9 ± 6.3 months. Nasal obstruction was improved in both techniques at 3 months, but after long term follow up, it was highly significant for MFT along with improvement in preoperative symptoms p < 0.001. No patients complained of worsening of their obstruction. Nasal patency at 24 months, a significant proportion of patients had a greater nasal assessment by a blind assessor with 97.1% in MFT and 81.9% MAIT with mild to no obstruction. In MAIT group 16.6% had pain/discomfort, 23.6% had discharge which were the major complications, but crusting (MAIT 10% and MFT 3.3%), adhesions (MAIT 13.8% and MFT 1.6%). The medial flap inferior turbinoplasty (MFT) is technically straight forward procedure that provides long term more effective and satisfactory the patient in relieving nasal obstruction, without significant risk of complications. The long term follow up of MAIT is required as there was increase in need of decongestion and they might require second procedure as MFT.

Comparison of the Efficacy of Intraperitoneal Instillation of Butorphanol Versus Nalbuphine as Adjuvants to Ropivacaine for Postoperative Pain Relief in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Randomized, Double-Blind Placebo-Controlled Study.

Background and Aims: Postoperative pain after laparoscopic cholecystectomy is very common complication hindering the early return of routine activity. Since agonist opioids are not easily available, the most common drug used for intraoperative analgesia is intravenous butorphanol in our institute. The purpose of our study is to compare the analgesic effect of intraperitoneal butorphanol and nalbuphine as additives with ropivacaine in laparoscopic cholecystectomy for postoperative pain. Setting and Design: Randomized, double-blind prospective study undertaken after approval from the Institutional Ethics Committee. Materials and Methods: In this study, 90 patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: group A received intraperitoneal ropivacaine 0.2% of 20 mL with butorphanol 2 mg; Group B received intraperitoneal ropivacaine 0.2% 20 mL with nalbuphine 10 mg; and Group C received intraperitoneal ropivacaine 0.2% 20 mL with 0.9% normal saline. The primary outcome was to compare the analgesic efficacy of butorphanol with nalbuphine and the duration of postoperative pain relief. The secondary outcomes included the comparison of hemodynamic parameters, frequency of rescue analgesia, and complications among the three groups. Statistical Analysis: The data analysis was carried out with ANOVA and Chi-square test using the SPSS software version 26.0. Results: The mean of the Numeric Rating Scale pain score was insignificant in Group A versus B at all-time intervals indicating similar efficacy of butorphanol and nalbuphine in terms of pain relief postoperatively. However, the time to first rescue analgesia was significantly higher in Group A (5.70 ± 3.57 h), followed by Group B (3.95 ± 2.06 h) and Group C (2.50 ± 1.24 h). Conclusion: Butorphanol is better analgesic than nalbuphine as postoperative pain-free period was relatively more with lesser complications.

Role of arterial blood gas (ABG) as a valuable assessment tool of disease severity in SARS-CoV-2 patients.

Background: COVID-19 is caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The foremost predominant complication of SARS-CoV-2 is arterial hypoxemia thereby disturbing lung compliance, requiring mechanical ventilation. The aim of the current research study is to analyze role of ABG as a valuable assessment tool of disease severity in SARS-CoV-2 patients. Methods: 170 arterial blood samples were collected from patients admitted in Intensive Care Unit (ICU) of Sri Guru Ram Das Charitable Hospital, Amritsar. They were analyzed for arterial blood gas using ABG analyzer. Parameters of ABG such as pH, pCO2, HCO3, O2 saturation, ionized calcium (iCa) and calculated ionized calcium (at pH 7.4) was calculated for all the samples. Results: Continuous variables were described as medians with interquartile ranges (IQRs) and categorical variables as percentages and frequencies. Spearman correlation test was done for calculation of correlation between pH and other ABG parameters. Analysis of arterial blood gas revealed significant negative correlation (p<0.05) between pH and pCO2 and significant positive correlation (p<0.05) between pH and HCO3 and between pH and delta ionized calcium. Low levels (98.2%) of ionized calcium were observed while monitoring the ABG findings though weak negative correlation (p<0.05) was observed between pH and iCa. Conclusions: Our study suggests that ABG analysis acts as a momentous indicator for critically ill patients admitted in Intensive Care Unit (ICU). Estimation of iCa in this critical care setting acts as a distinctive biochemical feature of SARS-CoV-2 disease, as an initial assessment tool, for hypocalcemia.

Stabilization of gamma sulfur at room temperature to enable the use of carbonate electrolyte in Li-S batteries.

This past decade has seen extensive research in lithium-sulfur batteries with exemplary works mitigating the notorious polysulfide shuttling. However, these works utilize ether electrolytes that are highly volatile severely hindering their practicality. Here, we stabilize a rare monoclinic γ-sulfur phase within carbon nanofibers that enables successful operation of Lithium-Sulfur (Li-S) batteries in carbonate electrolyte for 4000 cycles. Carbonates are known to adversely react with the intermediate polysulfides and shut down Li-S batteries in first discharge. Through electrochemical characterization and post-mortem spectroscopy/ microscopy studies on cycled cells, we demonstrate an altered redox mechanism in our cells that reversibly converts monoclinic sulfur to Li2S without the formation of intermediate polysulfides for the entire range of 4000 cycles. To the best of our knowledge, this is the first study to report the synthesis of stable γ-sulfur and its application in Li-S batteries. We hope that this striking discovery of solid-to-solid reaction will trigger new fundamental and applied research in carbonate electrolyte Li-S batteries.

Role of Dexamethasone on Oxygen Requirement, Mortality, and Survival Incidence among COVID-19 Patients: Quasi-Experimental Study.

BACKGROUND: Patients diagnosed with coronavirus disease 2019 (COVID-19) are often prone to developing systemic inflammation which eventually causes damage to the lungs and other important organs. Randomized open-label control trials carried out in the different parts of the world have highlighted the importance of corticosteroids for treating such patients. MATERIALS AND METHODS: The current quasi-experimental study was based on COVID-19-infected patients with oxygen saturation <92% and evidence of pneumonia confirmed through radiological examination. Study participants in Group A received standard care, while those in Group B received standard care along with 6 mg intravenous dexamethasone for 10 days (or until discharge, if earlier). The clinical status of the study participants was assessed on day 7 and day 14 on a 6-point ordinal scale. RESULTS: It was observed from the study that there was reduction in the intensive care unit (ICU) stay and mortality among the study participants requiring high-flow oxygen or noninvasive ventilation in Group B as compared to Group A. After 7 days of treatment, 50% of the study participants in Group B got discharged as compared to 15% of the study participants in Group A. The number of study participants requiring mechanical ventilation remained 1 in Group B as compared to 5 in Group A. After the completion of treatment schedule, 91% study participants were discharged. There was 1 case of mortality reported in Group B as compared to 6 cases of mortality in Group A. CONCLUSIONS: The current study highlighted that fewer number of COVID-19-positive study participants in Group B required high-flow oxygen supplementation and noninvasive positive pressure ventilation as compared to those included in Group A. The corticosteroid treatment also reduced the number of ICU transfer and mortality.

Diabetes Mellitus Prevalence Among Haitian American Afro-Caribbeans in the United States.

To measure the prevalence of diabetes mellitus among Haitian American Afro-Caribbeans, a quantitative descriptive cross-sectional study was conducted using a convenience sample of 151 Haitian Americans in New York, New Jersey, and Florida. The results of the study revealed an age-adjusted prevalence of diabetes mellitus of 39.9% (95% CI 29.8% - 50.1%). This is greater than the prevalence in the U.S. population (12%) (Z = 5.54, p < 0.05) and the prevalence in the Black, non-Hispanic population (16.8%) (Z = 3.35, p < 0.05). There were 79 (52.3%) individuals with diabetes mellitus, of which 21 (13.9%) were individuals who were previously undiagnosed; and 56 (37%) were individuals who were taking medication(s) for controlling glucose. At a 39.9% prevalence rate of diabetes, Haitian Americans have an age-adjusted prevalence rate of diabetes that is more than twice the prevalence rate of diabetes in Black, non-Hispanic Americans and more than 3 times the rate in White, non-Hispanics. This rate is comparable to the prevalence rate in Native Americans of the Pima tribe. An urgent need exists to confirm these findings in a larger cohort.

The Role of Al3+ -Based Aqueous Electrolytes in the Charge Storage Mechanism of MnOx Cathodes.

Rechargeable aqueous aluminium batteries are the subject of growing interest, however, the charge storage mechanisms at manganese oxide-based cathodes remain poorly understood. In essense, every study proposes a different mechanism. Here, an in situ spectroelectrochemical methodology is used to unambiguously demonstrate that reversible proton-coupled MnO2 -to-Mn2+ conversion is the main charge storage mechanism occurring at MnO2 cathodes for a range of slightly acidic Al3+ -based aqueous electrolytes, with the Al3+ hexaaquo complex playing the key role of proton donor. In Zn/MnO2 assemblies, this mechanism is associated with high gravimetric capacities and discharge potentials, up to 560 mAh g-1 and 1.65 V respectively, attractive efficiencies (CE > 99.5% and EE > 82%) and excellent cyclability (almost 100% capacity retention over 1 400 cycles at 2 A g-1 ). Finally, a critical analysis of the data previously published on MnOx cathodes in Al3+ -based aqueous electrolytes is conducted to conclude on a universal charge storage mechanism, i.e., the reversible electrodissolution/electrodeposition of MnO2 .

Can Dermoscopy and Ultrasonography be Considered a Prognostic Tool in Management of Psoriasis?

Background: Dermoscopy can reliably predict the diagnosis of plaque psoriasis. Ultrasonography has been increasingly used in dermatology in inflammatory diseases like psoriasis as a tool for evaluation. Hence, this study was done to evaluate the role of dermoscopy and ultrasonography as prognostic aid in plaque psoriasis. Aims and Objectives: To study the sonographic and dermoscopic findings of clinically diagnosed psoriatic lesions and the changes in the psoriatic lesions if any, with the treatment. How these findings can be utilized to assess the prognosis in these patients. Materials and Methods: The present study comprised 50 patients with clinically diagnosed plaque psoriasis. Lesions were assessed with Dino-Lite digital microscope AM7515MZT, followed by ultrasonography using a 15 MHz probe, and findings were recorded. All the patients included in this study were given appropriate treatment (topical/systemic) for 6 weeks and were followed up twice i.e., at 3 weeks and 6 weeks after initiating treatment. Results: Whitish scales were the most common scale color seen in our study seen in 35/50 patients (70%). All the vascular structures were reddish, red dots and globules being the predominant type and with the improvement of the lesions, brown structures increased. A total of 28 (56%) patients had a regular pattern of vessel arrangement. Mean capillary size was 0.097 ± 0.012 mm that reduced to 0.075 ± 0.019 mm at the end of the third week and 0.027 ± 0.032 mm at the end of 6 weeks. In ultrasonographic assessment, mean epidermal thickness reduced from 0.1008 to 0.0764 cm at third week and 0.068 cm at the sixth week, and mean dermal thickness reduced from 0.2692cm to 0.1906cm at the third week and then to 0.1906cm 0.1806cm at the sixth week. In our study, clinical improvement preceded dermoscopic improvement. Newer structures identified in the study are a perifollicular arrangement of capillaries and the presence of lacunar structures in the healing lesions. Conclusion: The scale distribution, capillary number, and capillary size in dermoscopic assessment, and epidermal and dermal thickness in ultrasonography showed statistically significant changes with treatment and thus may be taken as the prognostic indicators. Thus, both these noninvasive modalities may be useful in the therapeutic monitoring of plaque psoriasis.

Premedication for Induced Hypotension in Functional Endoscopic Sinus Surgeries: Intravenous Dexmedetomidine Infusion vs Oral Metoprolol vs Placebo: A Comparative Study.

BACKGROUND: Controlled hypotension has been used to reduce bleeding and the need for blood transfusions and provide a satisfactory bloodless surgical field. In this double-blind, randomized controlled trial, we are comparing intravenous (i.v.) dexmedetomidine infusion and oral metoprolol as a premedication for controlled hypotension in functional endoscopic sinus surgery (FESS) for evaluating surgical field visibility. SUBJECTS AND METHODS: A total of 90 patients undergoing FESS were randomly divided into three groups of 30 each. Group A received intraoperative i.v. infusion of dexmedetomidine (loading 1 µg.kg-1 over 10 min followed by the maintenance of 0.2-0.5 µg.kg-1.h-1), Group B received oral metoprolol 50 mg on night and 2 h before surgery as a premedication, and Group C was taken as a control group and patients received oral placebo tablet as premedication and intraoperative normal saline infusion. General anesthesia was given using sevoflurane. Intraoperative target mean arterial blood pressure was set 55-65 mmHg. Various parameters were recorded and statistically compared. RESULTS: The three groups were statistically comparable in demographics. Quality of surgical field was better in Group A compared to other two groups. Total blood loss was also less in Group A. The incidence of adverse reactions was more in Group A. CONCLUSION: Dexmedetomidine provides a better surgical field compared to oral metoprolol in FESS along with the desired hemodynamics with lesser blood loss and better outcome.

TiO Phase Stabilized into Freestanding Nanofibers as Strong Polysulfide Immobilizer in Li-S Batteries: Evidence for Lewis Acid-Base Interactions.

We report the stabilization of titanium monoxide (TiO) nanoparticles in nanofibers through electrospinning and carbothermal processes and their unique bifunctionality-high conductivity and ability to bind polysulfides-in Li-S batteries. The developed three-dimensional TiO/carbon nanofiber (CNF) architecture with the inherent interfiber macropores of nanofiber mats provides a much higher surface area (∼427 m2 g-1) and overcomes the challenges associated with the use of highly dense powdered Ti-based suboxides/monoxide materials, thereby allowing for high active sulfur loading among other benefits. The developed TiO/CNF-S cathodes exhibit high initial discharge capacities of ∼1080, ∼975, and ∼791 mAh g-1 at 0.1, 0.2, and 0.5 C rates, respectively, with long-term cycling. Furthermore, freestanding TiO/CNF-S cathodes developed with rapid sulfur melt infiltration (∼5 s) eradicate the need of inactive elements, viz., binders, additional current collectors (Al-foil), and additives. Using postmortem X-ray photoelectron spectroscopy and Raman analysis, this study is the first to reveal the presence of strong Lewis acid-base interaction between TiO (3d2) and S x2- through the coordinate covalent Ti-S bond formation. Our results highlight the importance of developing Ti-suboxides/monoxide-based nanofibrous conducting polar host materials for next-generation Li-S batteries.

The Sedative and Propofol-Sparing Effect of Dexmedetomidine and Midazolam as Premedicants in Minor Gynecological Day Care Surgeries: A Randomized Placebo-Controlled Study.

BACKGROUND AND AIMS: Ambulatory surgery is continually evolving specialty in the majority of surgical procedures. Dexmedetomidine and midazolam are newer adjuvants for sedation and reducing the dose of anesthetic agents. The aim of this study was to compare the sedative and propofol-sparing effect of dexmedetomidine and midazolam in minor gynecological day care surgeries. Observer's Assessment of Activity and Sedation, dose of additional propofol, Aldrete and street fitness score were studied as primary outcomes. Hemodynamic parameters and side effects were evaluated as secondary outcomes. MATERIALS AND METHODS: A prospective randomized placebo-controlled study was conducted on 150 American Society of Anesthesiologists ASA physical status Classes I and II gynecological patients between 18 and 50 years and were allocated into three groups of fifty each. Group A received intravenous (i.v.) dexmedetomidine 0.1 µg/kg, Group B received i.v. midazolam 0.04 mg/kg, and Group C received normal saline 10 min before induction. RESULTS: Sedation score was statistically highly significant between Group A and B (P < 0.001). Between Group A and C, it was statistically significant (P < 0.05); however, score was nonsignificant between Groups B and C (P > 0.05). During recovery at 120 min after surgery, score 5 was achieved equally by all three groups which was found to be statistically insignificant (P > 0.05). Mean dose of additional propofol used was less in Group A (14 ± 9.25) than B (25 ± 5.40) and C (53 ± 10.96). On intergroup comparison between all three groups, it was found to be statistically highly significant (P < 0.001). Comparison of bispectral index (BIS) values between Groups A and C and Groups B and C were highly significant (P < 0.001). However, it was statistically significant between Groups A and B (P < 0.05). Aldrete scoring and street fitness scores were highly significant between Groups A and B, B and C, and also between Groups A and C (P < 0.001). No significant hemodynamic derangements and side effects were noted in any of three groups. CONCLUSION: Dexmedetomidine had good sedation and better recovery characteristics than midazolam. BIS monitoring was helpful in maintaining the depth of anesthesia.

Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A novel anesthetic approach.

AIMS AND OBJECTIVES: Supplementation of dexmedetomidine produces a dose-dependent sedation, anxiolysis and analgesia without respiratory depression. This study was conducted to evaluate the possible effect of dexmedetomidine as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in upper limb surgery. SETTINGS AND DESIGN: Tertiary care institute, Department of Anaesthesiology and Intensive Care, a placebo-controlled study. MATERIALS AND METHODS: After obtaining Ethical Committee approval, a randomized, double-blind, placebo-controlled study was conducted on sixty American Society of Anesthesiologists physical status I and II patients in the age group of 18-60 years, divided randomly into two groups, Group I received 30 ml of 0.5% levobupivacaine with 1 ml of isotonic sodium chloride solution and Group II received 30 ml of 0.5% levobupivacaine and 1 ml (100 mcg) of dexmedetomidine for supraclavicular brachial plexus block. The onset and duration of sensory and motor blockade, duration of analgesia (DOA) and any adverse effects were noted. At the end of the study, data were compiled and analyzed using appropriate statistical tests. The value of P < 0.05 was considered significant. RESULTS: Demographic profile was comparable in both the groups. The time to onset of sensory and motor block was 10.54 ± 2.333 min and 12.21 ± 2.529 min in Group I while it was 3.24 ± 0.951 min and 2.83 ± 1.197 min in Group II, respectively. The duration of sensory and motor block was 7.79 ± 2.007 h and 9.18 ± 1.701 h in Group I, and it was 16.31 ± 2.606 h and 17.52 ± 2.098 h in Group II, respectively. The DOA was 678.68 ± 20.492 min in Group I and 1273.79 ± 83.139 min in Group II. On statistical comparison, these values were highly significant (P < 0.001). Side effects such as nausea, vomiting, hypoxemia, pruritis, or urinary retention were not observed in either of the groups. CONCLUSION: Dexmedetomidine shortens the onset time for sensory and motor block significantly and prolongs DOA as well when used with levobupivacaine for supraclavicular brachial plexus block, without increasing the incidence of any adverse effects.

Pilot-scale UV/H2O2 advanced oxidation process for municipal reuse water: Assessing micropollutant degradation and estrogenic impacts on goldfish (Carassius auratus L.).

Low concentrations (ng/L-µg/L) of emerging micropollutant contaminants in municipal wastewater treatment plant effluents affect the possibility to reuse these waters. Many of those micropollutants elicit endocrine disrupting effects in aquatic organisms resulting in an alteration of the endocrine system. A potential candidate for tertiary municipal wastewater treatment of these micropollutants is ultraviolet (UV)/hydrogen peroxide (H2O2) as an advanced oxidation process (AOP) which was currently applied to treat the secondary effluent of the Gold Bar Wastewater Treatment Plant (GBWWTP) in Edmonton, AB, Canada. A new approach is presented to predict the fluence-based degradation rate constants (kf') of environmentally occurring micropollutants including carbamazepine [(0.87-1.39) × 10(-3) cm(2)/mJ] and 2,4-Dichlorophenoxyacetic acid (2,4-D) [(0.60-0.91) × 10(-3) cm(2)/mJ for 2,4-D] in a medium pressure (MP) UV/H2O2 system based on a previous bench-scale investigation. Rather than using removal rates, this approach can be used to estimate the performance of the MP UV/H2O2 process for degrading trace contaminants of concern found in municipal wastewater. In addition to the ability to track contaminant removal/degradation, evaluation of the MP UV/H2O2 process was also accomplished by identifying critical ecotoxicological endpoints (i.e., estrogenicity) of the treated wastewater. Using quantitative PCR, mRNA levels of estrogen-responsive (ER) genes ERα1, ERα2, ERß1, ERß2 and NPR as well as two aromatase encoding genes (CYP19a and CYP19b) in goldfish (Carassius auratus L.) were measured during exposure to the GBWWTP effluent before and after MP UV/H2O2 treatment (a fluence of 1000 mJ/cm(2) and 20 mg/L of H2O2) in spring, summer and fall. Elevated expression of estrogen-responsive genes in goldfish exposed to UV/H2O2 treated effluent (a 7-day exposure) suggested that the UV/H2O2 process may induce acute estrogenic disruption to goldfish principally because of the possible formation of various oxidation by-products. However, prolonged exposure of goldfish (60 days) in UV/H2O2 treated effluent showed a restoration trend of ER gene expressions, especially in the summer. Collectively, our findings provide valuable indications regarding the long-term in vivo assessment of the MP UV/H2O2 process for removing/degrading endocrine disrupting compounds detected in the municipal wastewater effluents.

Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries.

BACKGROUND AND AIMS: This study aims to compare the anesthesia characteristics between buprenorphine and fentanyl when added as an adjuvant to intrathecal ropivaciane in an attempt to prolong the duration of spinal anesthesia. MATERIAL AND METHODS: The present prospective double-blind study was undertaken on ninety American Society of Anesthesiologist I and II patients between 18 and 60 years of age undergoing subarachnoid block for lower limb surgery. Group I (n = 30) patients were administered 3 ml of intrathecal solution (2.8 ml of 0.75% ropivacaine + 0.2 ml of isotonic sodium chloride), while Groups II and III patients (n = 30 each) received 2.8 ml 0.75% ropivacaine + 0.2 ml buprenorphine (60 µg) and 2.8 ml 0.75% ropivacaine + 0.2 ml fentanyl (10 µg), respectively. Following parameters were observed: Onset times and duration of sensory and motor block, time to first analgesic use, total dose of rescue analgesia, intra- and post-operative pain scores based on visual analog scale, sedation scores, hemodynamic parameters, and side effects if any. Data were analyzed by appropriate statistical tests and P < 0.05 were considered significant. RESULTS: Time to onset of sensory and motor block in all the three groups was comparable. However, duration of sensory block was significantly prolonged in Groups II and III in comparison to Group I (P < 0.05) and it was the longest in Group II (P < 0.05). The duration of motor blockade was similar in all the three groups. The time to first analgesic dose was also significantly prolonged in Groups II and III as compared to Group I (P < 0.05) but was comparable between Groups II and III. Intra- and post-operative hemodynamic parameters, as well as side effects, were comparable. CONCLUSION: Addition of buprenorphine and fentanyl as adjuvants to intrathecal 0.75% ropivacaine prolongs postoperative pain relief without causing any increase in the duration of motor blockade but buprenorphine is better as compared to fentanyl in prolonging the duration of sensory block and achieving a better outcome in terms of pain relief.

Intravenous analgesia with opioids versus femoral nerve block with 0.2% ropivacaine as preemptive analgesic for fracture femur: A randomized comparative study.

BACKGROUND AND OBJECTIVE: Femoral fractures are extremely painful and pain invariably worsens on any movement. Anesthesia for fracture femur surgery is usually provided by spinal block. This study was undertaken to compare the analgesic effects of femoral nerve block (FNB) using nerve stimulator with 0.2% ropivacaine (15 ml) and intravenous (I.V.) fentanyl before patient positioning for fracture femur surgery under spinal anesthesia. MATERIALS AND METHODS: A prospective, randomized, double-blind, comparative study was conducted on 60 American Society of Anesthesiologists I and II patients (18-60 years) scheduled for femur surgery under combined spinal epidural anesthesia. Patients in Group I (n = 30), were administered FNB using nerve stimulator with 0.2% ropivacaine (15 ml) and in Group II patients (n = 30), I.V. fentanyl 0.5 µg/kg was given as preemptive analgesia. Parameters observed included time to spinal anesthesia, intra-operative and postoperative visual analog scale (VAS) for any pain and postoperative epidural top-ups dosages. RESULTS: Demographic profile was comparable in both the groups. VAS at 2 min in Group I was 5.63 and in Group II it was 8.00. Satisfaction score was better in Group I as compared to Group II patients. Time to administer subarachnoid block was 17.80 min in patients of Group I as compared to 25.03 min in Group II patients. Postoperatively, VAS scores were lower in Group I than Group II patients. The frequency of epidural top-ups was higher in Group II than in Group I patients. CONCLUSIONS: FNB is comparatively better in comparison to I.V. fentanyl when used as preemptive and postoperative analgesic in patients being operated for fracture femur.

Enhancing Specific Energy and Power in Asymmetric Supercapacitors - A Synergetic Strategy based on the Use of Redox Additive Electrolytes.

The strategy of using redox additive electrolyte in combination with multiwall carbon nanotubes/metal oxide composites leads to a substantial improvements in the specific energy and power of asymmetric supercapacitors (ASCs). When the pure electrolyte is optimally modified with a redox additive viz., KI, ~105% increase in the specific energy is obtained with good cyclic stability over 3,000 charge-discharge cycles and ~14.7% capacitance fade. This increase is a direct consequence of the iodine/iodide redox pairs that strongly modifies the faradaic and non-faradaic type reactions occurring on the surface of the electrodes. Contrary to what is shown in few earlier reports, it is established that indiscriminate increase in the concentration of redox additives will leads to performance loss. Suitable explanations are given based on theoretical laws. The specific energy or power values being reported in the fabricated ASCs are comparable or higher than those reported in ASCs based on toxic acetonitrile or expensive ionic liquids. The paper shows that the use of redox additive is economically favorable strategy for obtaining cost effective and environmentally friendly ASCs.

Comparison of UV/hydrogen peroxide, potassium ferrate(VI), and ozone in oxidizing the organic fraction of oil sands process-affected water (OSPW).

The efficiency of three different oxidation processes, UV/H2O2 oxidation, ferrate(VI) oxidation, and ozonation with and without hydroxyl radical (OH) scavenger tert-butyl alcohol (TBA) on the removal of organic compounds from oil sands process-affected water (OSPW) was investigated and compared. The removal of aromatics and naphthenic acids (NAs) was explored by synchronous fluorescence spectra (SFS), ion mobility spectra (IMS), proton and carbon nuclear magnetic resonance ((1)H and (13)C NMR), and ultra-performance liquid chromatography coupled with time-of-flight mass spectrometry (UPLC TOF-MS). UV/H2O2 oxidation occurred through radical reaction and photolysis, transforming one-ring, two-ring, and three-ring fluorescing aromatics simultaneously and achieving 42.4% of classical NAs removal at 2.0 mM H2O2 and 950 mJ/cm(2) UV dose provided with medium pressure mercury lamp. Ferrate(VI) oxidation exhibited high selectivity, preferentially removing two-ring and three-ring fluorescing aromatics, sulfur-containing NAs (NAs + S), and NAs with high carbon and high hydrogen deficiency. At 2.0 mM Fe(VI), 46.7% of classical NAs was removed. Ozonation achieved almost complete removal of fluorescing aromatics, NAs + S, and classical NAs (NAs with two oxygen atoms) at the dose of 2.0 mM O3. Both molecular ozone reaction and OH reaction were important pathways in transforming the organics in OSPW as supported by ozonation performance with and without TBA. (1)H NMR analyses further confirmed the removal of aromatics and NAs both qualitatively and quantitatively. All the three oxidation processes reduced the acute toxicity towards Vibrio fischeri and on goldfish primary kidney macrophages (PKMs), with ozonation being the most efficient.