Perceived responsibility for mechanical ventilation and weaning decisions in intensive care units in the Kingdom of Saudi Arabia.

Background: Optimizing patient outcomes and reducing complications require constant monitoring and effective collaboration among critical care professionals. The aim of the present study was to describe the perceptions of physician directors, respiratory therapist managers and nurse managers regarding the key roles, responsibilities and clinical decision-making related to mechanical ventilation and weaning in adult Intensive Care Units (ICUs) in the Kingdom of Saudi Arabia (KSA). Methods: A multi-centre, cross-sectional self-administered survey was sent to physician directors, respiratory therapist managers and nurse managers of 39 adult ICUs at governmental tertiary referral hospitals in 13 administrative regions of the KSA. The participants were advised to discuss the survey with the frontline bedside staff to gather feedback from the physicians, respiratory therapists and nurses themselves on key mechanical ventilation and weaning decisions in their units. We performed T-test and non-parametric Mann-Whitney U tests to test the physicians, respiratory therapists, and nurses' autonomy and influence scores, collaborative or single decisions among the professionals. Moreover, logistic regressions were performed to examine organizational variables associated with collaborative decision-making. Results: The response rate was 67% (14/21) from physician directors, 84% (22/26) from respiratory therapist managers and 37% (11/30) from nurse managers. Physician directors and respiratory therapist managers agreed to collaborate significantly in most of the key decisions with limited nurses' involvement (P<0.01). We also found that physician directors were perceived to have greater autonomy and influence in ventilation and waning decision-making with a mean of 8.29 (SD±1.49), and 8.50 (SD±1.40), respectively. Conclusion: The key decision-making was implemented mainly by physicians and respiratory therapists in collaboration. Nurses had limited involvement. Physician directors perceived higher autonomy and influence in ventilatory and weaning decision-making than respiratory therapist managers and nurse managers. A critical care unit's capacity to deliver effective and safe patient care may be improved by increasing nurses' participation and acknowledging the role of respiratory therapists in clinical decision-making regarding mechanical ventilation and weaning.

Low testosterone is associated with disability in men with multiple sclerosis.

BACKGROUND: Gonadal steroids may modulate disease course in multiple sclerosis (MS). OBJECTIVE: To assess the prevalence and clinical associations of hypogonadism in men with MS. METHODS: Male patients, aged 18-65 years, with relapsing-remitting MS (RRMS) or clinically-isolated syndrome (CIS) and their first symptom < 10 years prior were selected from a longitudinal clinical study. We measured their hormones in stored morning blood samples, and collected their Expanded Disability Status Scale (EDSS) scores every 6 months and their Symbol Digit Modalities Test (SDMT) results annually. RESULTS: Our analysis included 96 men with a mean age of 40 years, EDSS of 1.1 and disease duration of 4.6 years. Of these men, 39% were hypogonadal (total testosterone < 288 ng/dL); none showed compensatory elevations in luteinizing hormone. Their low testosterone levels and testosterone:estradiol ratios were negatively correlated with body mass index (BMI) and leptin, and showed no correlation with 25-hydroxy-vitamin D levels. In our primary cross-sectional analyses, there was a negative age-adjusted correlation between total testosterone and EDSS (p = 0.044). In the age-adjusted longitudinal analyses, higher baseline testosterone levels were associated with less decline in SDMT (p = 0.012). CONCLUSIONS: Men with MS may experience hypogonadotropic hypogonadism. Low testosterone levels may be associated with worse clinical outcomes. A potential neuroprotective role for testosterone warrants further investigation.

Thermocatalytic Hydrogen Production Through Decomposition of Methane-A Review.

Consumption of fossil fuels, especially in transport and energy-dependent sectors, has led to large greenhouse gas production. Hydrogen is an exciting energy source that can serve our energy purposes and decrease toxic waste production. Decomposition of methane yields hydrogen devoid of COx components, thereby aiding as an eco-friendly approach towards large-scale hydrogen production. This review article is focused on hydrogen production through thermocatalytic methane decomposition (TMD) for hydrogen production. The thermodynamics of this approach has been highlighted. Various methods of hydrogen production from fossil fuels and renewable resources were discussed. Methods including steam methane reforming, partial oxidation of methane, auto thermal reforming, direct biomass gasification, thermal water splitting, methane pyrolysis, aqueous reforming, and coal gasification have been reported in this article. A detailed overview of the different types of catalysts available, the reasons behind their deactivation, and their possible regeneration methods were discussed. Finally, we presented the challenges and future perspectives for hydrogen production via TMD. This review concluded that among all catalysts, nickel, ruthenium and platinum-based catalysts show the highest activity and catalytic efficiency and gave carbon-free hydrogen products during the TMD process. However, their rapid deactivation at high temperatures still needs the attention of the scientific community.

Longitudinal BMI trajectories in multiple sclerosis: Sex differences in association with disease severity.

BACKGROUND: Adolescent obesity is a risk factor for multiple sclerosis (MS), but little is known about changes in body mass index (BMI) after MS onset. OBJECTIVE: To assess the relationship between MS and longitudinal changes in BMI. METHODS: We analyzed prospectively collected BMIs in a cohort of patients with adult-onset MS and matched adult healthy controls (HC) gathered from the same hospital network central clinical data registry. RESULTS: We made three main observations. First, at baseline MS patients had a significantly higher BMI than HC (age- and sex- adjusted mean difference=0.57; 95% CI: 0.15, 0.99; p=0.008). Second, a significant age by MS status interaction was observed (p<0.0001), such that in MS, BMIs did not increase significantly higher in older individuals, whereas BMIs in HCs were higher with increasing age. Third, we observed sex-specific associations with disease severity: higher BMI was associated with higher cross-sectional EDSS in women, but with lower EDSS in men (p=0.003, N=758). There were no longitudinal associations between BMI and EDSS in either sex or in the entire cohort (p=0.65, N=772). CONCLUSION: After MS onset, patients may not experience age-expected increases in BMI. BMI may have sex-specific associations with MS disability scores. More refined measures of body composition are warranted in future studies to distinguish adiposity from muscle mass.

Influence of nutritional supplements on keratinolysis by Amycolatopsis keratinophila.

Keratinolytic potential of A. keratinophila (DSM 44409T), a newly described Amycolatopsis sp. isolated from cultivated soil in Kuwait, was demonstrated using keratinazure as the sole source of carbon and nitrogen as estimated by gel diffusion assay. Effects of 12 various nutritional supplements on the keratinolytic and azocollytic activities were determined. NH4H2PO4 and KNO3 in the medium supported a significantly higher keratinolytic activity than other supplements. However, azocollytic activities in all the supplemented media and the control were same. Best combination of carbon and nitrogen supplements (galactose and NH4H2PO4 respectively) used to evaluate the dynamics of growth and enzymes (keratinase and protease) activities of the isolate revealed a luxuriant growth with optimal keratinolytic activity occurring during the log phase. Other parameters of the fermentation medium, including pH, biomass accumulation, total protein and free amino acid concentrations were also studied.

Elevated relapse rates in pediatric compared to adult MS persist for at least 6 years.

OBJECTIVE: To compare relapse rates in pediatric-onset multiple sclerosis (POMS) and adult-onset multiple sclerosis (AOMS) over the first 6-years of disease. METHODS: Patients with relapsing-remitting disease onset were identified from the Partners Pediatric MS Center, Massachusetts General Hospital and Partners MS Center, Brigham and Women's Hospital. 84 POMS and 258 AOMS patients were included. Annualized relapse rates (ARR) for each individual year from year 1 to year 6, after first attack were compared using Poisson regression, as was expanded disability status scale (EDSS) score at the visit closest to each year interval. RESULTS: ARR was significantly higher in POMS compared to AOMS at individual years (except year 4), and was not significantly affected by adjustment for gender, race and proportion of time on treatment. Despite a 2.30 times higher relapse rate over 6-years, EDSS between groups did not differ. ARR in years 1-5 did not impact year 5 disability measured by EDSS in POMS. CONCLUSIONS: Our findings demonstrate that higher ARR in POMS relative to AOMS is sustained over 6-years, suggesting a more inflammatory nature and potential disconnect between relapses and disability measured by EDSS early in POMS. This data may be useful when designing clinical trials for POMS.

Wool-colonizing micro-organisms capable of utilizing wool-lipids and fatty acids as sole sources of carbon and energy.

Two keratinolytic fungi, Chrysosporium keratinophilum and Malbranchea anamorph of Uncinocarpus reesii, and another three wool-colonizing fungi not previously reported to be keratinolytic, Aspergillus fumigatus, A. Flavus and Scopulariopsis candida, were isolated from soil samples baited with animal wool. These fungi were tested for their ability to utilize wool-lipids as sole source of carbon and energy. The lipid contents of wool of various animals ranged between 2 and 5%. The different lipid extracts were similar in composition; they contained steryl esters, sterols, fatty acids, fatty alcohols and monoacylglycerols. The predominant acyl moiety in wool-lipids of different animals was linolenic acid (18:2). The five fungi tested grew well on an inorganic medium supplemented with total wool-lipids as sole sources of carbon and energy. Individual lipid classes fractionated by preparative thin layer chromatography and suspended into inorganic medium were able to support fungal growth as sole carbon sources. These fungi and another eight wool-colonizing strains, C. tropicum, C. zonatrum, C. anamorph of Arthroderma curryei, Microsporum canis, M. distortum, Trichophyton interdigitale, Emmonsia parva and Myceliophthora vellerae could also utilize standard lipids and fatty acids (cholesterol and palmitic and linoleic acids). Evidence fo the uptake and degradation of cholesterol by C. keratinophilum is presented.

Aspergillus helicothrix, sp. nov.

Aspergillus helicothrix sp. nov. is described. The species is based on a single-spore isolate obtained from the type culture of Aspergillus ellipticus Raper et Fennell. It is characterized by conspicuously echinate conidia and cup-shaped sclerotia with coiled setae.

Distribution of keratinophilic fungi in animal folds in Kuwait.

Soil samples from seventeen animal herds (camels, goats, sheep, cows) were surveyed for the occurrence of keratinophilic fungi. Twenty four species related to eleven genera were recovered on defatted wool baits. Eleven Chrysosporium species were reported in the following order of dominance: C. keratinophilum, C. tropicum, C. indicum, C. queenslandicum, C. pannicola, C. carmichaelii, C. state of Arthroderma curreyi, C. zonatum, C. state of A. cuniculi and Chrysosporium state of Renispora flavissima. The Aphanoascus teleomorph of C. keratinophilum, C. indicum and C. tropicum were frequently reported in soils from cow and sheep folds. Scopulariopsis, Cephaliophora and Sepedonium, although not keratinolytic, were also recorded on wool baits of soils from cow herds which are slightly acidic. The frequency and distribution of these fungi are discussed in relation to animal species and the general ecological conditions of desert soils.

Distribution of keratinophilic fungi in desert soil of Kuwait.

Forty soil samples from different desert localities in Kuwait were surveyed for keratinophilic and geophilic dermatophytic fungi. Sixteen species classified in 9 genera were recovered on wool baits. Chrysosporium species were the most common fungi: Chr. tropicum (60%), Chr. pannicola (32.5%), Chr. queenslandicum (27.5%), Chr. keratinophilum (25%), Chr. indicum (20%) and the Chrysosporium anamorph of Arthroderma cuniculi. The second dominant genus was Malbranchea (27%) represented by two species; followed by Myceliophthora (10%). A number of cleistothecial keratinophilic species were also reported in restricted areas. Ctenomyces serratus Eidam and its Myceliophthora anamorph were new records to Kuwait. The frequency and distribution of these fungi have been discussed in relation to ecological conditions of desert soils.

A report on the predominant occurrence of a dermatophyte species in cultivated soil from Kuwait.

From several soil samples screened for the occurrence of keratinolytic fungi, soils cultivated with ornamental plants were found to contain strains of the dermatophytic fungus Microsporum gypseum. One soil sample was dominated by this species.