Bilirubin in wound healing: A double-edged sword.

The impact of bilirubin levels on wound healing remains a topic of controversy. The present study is a literature review that examines the impact of increased levels of bilirubin in the bloodstream on the process of wound healing. The physiological pathways and their interrelationships, as well as the relevant research publications, were comprehensively addressed in our discussion. The present study undertook a comprehensive review of the extant literature pertaining to the impact of bilirubin concentration on the process of wound healing, with particular emphasis on its association with reactive oxygen species. This scholarly article provides an overview of several studies that elucidate the mechanisms and correlation between bilirubin and the process of wound healing. The impact of bilirubin on wound healing has been observed, and it appears to function as a modulator. This review demonstrates that there exists a spectrum of bilirubin concentrations that can function as precise regulators, although this range falls under pathological hyperbilirubinemia. Further research is required to determine the precise boundary of this range. Within a certain range, bilirubin serves as a positive regulator in the process of wound healing. Beyond this range, it has the potential to function as a negative regulator.

Deliberating a Re(n)al-world Research Setting.

How to cite this article: Choudhary N, Magoon R, Jose J. Deliberating a Re(n)al-world Research Setting. Indian J Crit Care Med 2023;27(4):297.

Fibrinolysis and D-dimer in COVID-19: A Twisted Plot!

Coronavirus disease-2019 (COVID-19) and the associated pathophysiological perturbations continue to bewilder the fraternity at large. In this context, the thromboembolic predisposition in COVID-19 has particularly emerged as a matter of an ardent debate. The index commentary aims to present an account of the recent developments in the understanding of the immunothrombosis in the enigmatical setting of COVID-19. How to cite this article: Magoon R, Choudhary N, Jose J. Fibrinolysis and D-dimer in COVID-19: A Twisted Plot! Indian J Crit Care Med 2022;26(2):164-166.

Comparative evaluation of dexmedetomidine and fentanyl in total intravenous anesthesia for laparoscopic cholecystectomy: A randomised controlled study.

BACKGROUND AND AIMS: Laparoscopic cholecystectomy is one of the commonly performed ambulatory surgeries. The selection of anesthetic agents for ambulatory surgeries should be done bearing in mind the need for early discharge. Opioids form an integral component of total intravenous anesthesia (TIVA) but their associated side effects may result in an increased hospital stay. Hence, we planned a study to compare the opioid (fentanyl) and non-opioid (dexmedetomidine) based technique of TIVA for laparoscopic surgery. MATERIAL AND METHODS: Ninety ASA I and II patients between 18-60 years of either sex posted for laparoscopic cholecystectomy were randomly allocated into two groups namely group D (Dexmedetomidine) and group F (Fentanyl). Patients received propofol infusion along with group specific drug infusion, after which an appropriate size proseal laryngeal mask airway was placed. The patients were assessed for discharge time from post-anesthesia care unit (PACU), on table recovery time, time to first rescue analgesia, hemodynamic parameters, incidence of postoperative nausea and vomiting (PONV) and any other complication. RESULTS: Demographic profile of both the groups was comparable. Group D had longer on table recovery time (13.00 ± 2.34 min vs 6.29 ± 2.46 min; P < 0.001) and time to discharge from PACU (6.80 ± 3.96 min vs 2.36 ± 1.67 min; P < 0.001) compared to group F. Group F had better hemodynamic stability compared to group D. In group D, 77% patients required rescue analgesia in first one hour post surgery, unlike 22% in group F. No patient in group D had PONV. CONCLUSION: Opioid based technique (Fentanyl) of TIVA is superior over non-opioid based (dexmedetomidine) technique with faster recovery, early discharge, decreased postoperative pain scores and better hemodynamic stability. PONV is observed with opioids which can be treated successfully with antiemetics.

High-performance flexible asymmetric supercapacitor based on rGO anode and WO3/WS2 core/shell nanowire cathode.

Flexible smart electronics require their energy storage device to be flexible in nature. Developing high-performance flexible energy storage devices require direct integration of electrode active materials on current collectors to satisfy the high electronic/ionic conductivity and long-term durability requirements. Herein, we develop a flexible all-solid-state asymmetric supercapacitor comprised of reduced graphene oxide (rGO) and core/shell tungsten trioxide/tungsten disulfide (WO3/WS2) nanowire based electrodes. The electrodes synthesized via electrochemical deposition and chemical vapor deposition avoided the necessity to use non-conductive binders and offered excellent cyclic stability. The structural integrity provided by the rGO and WO3/WS2 electrodes facilitated excellent electrochemical stability with capacitance retention of 90% and 100% after 10 000 charge-discharge cycles, respectively. An all-solid-state device provides a voltage window of 1.5 V and more than 70% capacitance retention after 10 000 charge-discharge cycles. Providing 97% capacitance retention upon mechanical bending reveals its potential to be used as an energy storage devices in flexible electronics.

Pulmonary Vascular Permeability Indices: Fine Prints of Lung Protection?

How to cite this article: Choudhary N, Magoon R, Walian A, Kohli JK. Pulmonary Vascular Permeability Indices: Fine Prints of Lung Protection? Indian J Crit Care Med 2020;24(6):473-474.

Novel mesoporous electrode materials for symmetric, asymmetric and hybrid supercapacitors.

Electrochemical capacitors or supercapacitors have achieved great interest in the recent past due to their potential applications ranging from microelectronic devices to hybrid electric vehicles. Supercapacitors can provide high power densities but their inherently low energy density remains a great challenge. The high-performance supercapacitors utilize large electrode surface area for electrochemical double-layer capacitance and/or pseudocapacitance. To enhance the performance of supercapacitors, various strategies have been adopted such as electrode nanostructuring, hybrid electrode designs using nanocomposite electrodes and hybrid supercapacitor (HSC) configurations. Nanoarchitecturing of electrode-active materials is an effective way of enhancing the performance of supercapacitors as it increases the effective electrode surface area for enhanced electrode/electrolyte interaction. In this review, we focus on the recent developments in the novel electrode materials and various hybrid designs used in supercapacitors for obtaining high specific capacitance and energy density. A family of electrode-active materials including carbon nanomaterials, transition metal-oxides, transition metal-nitrides, transition metal-hydroxides, electronically conducting polymers, and their nanocomposites are discussed in detail. The HSC configurations for attaining enhanced supercapacitor performance as well as strategies to integrate with other microelectronic devices/wearable fabrics are also included.

Single-point versus double-point injection technique of ultrasound-guided supraclavicular block: A randomized controlled study.

BACKGROUND AND AIMS: This study aims to compare the single-point injection and double-point injection technique of ultrasound-guided supraclavicular block with regard to the success rate, time taken to perform the procedure, onset and duration of sensory and motor block, and complications. MATERIAL AND METHODS: A total of 60 American Society of Anesthesiologists physical status I and II patients between 20 and 50 years of age, with body mass index ≤30 kg/m2 posted for forearm surgeries, with anticipated surgical duration more than 1 h were randomly divided into two groups: group S (single-point injection) and group D (double-point injection technique). After locating the brachial plexus with ultrasound, needle was inserted from lateral to medial direction to reach the plexus. In group D, 20 ml of inj. bupivacaine 0.5% was deposited as 10 ml each in superior (in the cluster) and inferior pocket (corner pocket) between the plexus and subclavian artery with the help of hydrodissection while in group S the total 20 ml was deposited in the superior (in the cluster) pocket. The onset of sensory and motor block was assessed using pin prick method and modified Bromage scale. Adequacy of block was ensured by assessing the ulnar, radial, and median nerve distribution. Procedural time was defined from the point of scanning the plexus till the drug was injected completely. Total sensory, motor duration, and complications if any were noted. RESULTS: Group D had higher success rate compared to group S (96.7 vs. 83.3%; P < 0.0001). The total procedural time was significantly more in group D compared to group S (14.6 ± 2.7 vs. 10.1 ± 1.7 min; P < 0.0001). The onset of sensory and motor block was faster and the duration of sensory and motor block was significantly longer in group D. CONCLUSION: The adequacy of block, sensory, and motor duration was significantly high in newer double-point injection technique. However, it requires longer procedural time compared to single-point injection technique.

Centimeter-Scale 2D van der Waals Vertical Heterostructures Integrated on Deformable Substrates Enabled by Gold Sacrificial Layer-Assisted Growth.

Two-dimensional (2D) transition metal dichalcogenides (TMDs) such as molybdenum or tungsten disulfides (MoS2 or WS2) exhibit extremely large in-plane strain limits and unusual optical/electrical properties, offering unprecedented opportunities for flexible electronics/optoelectronics in new form factors. In order for them to be technologically viable building-blocks for such emerging technologies, it is critically demanded to grow/integrate them onto flexible or arbitrary-shaped substrates on a large wafer-scale compatible with the prevailing microelectronics processes. However, conventional approaches to assemble them on such unconventional substrates via mechanical exfoliations or coevaporation chemical growths have been limited to small-area transfers of 2D TMD layers with uncontrolled spatial homogeneity. Moreover, additional processes involving a prolonged exposure to strong chemical etchants have been required for the separation of as-grown 2D layers, which is detrimental to their material properties. Herein, we report a viable strategy to universally combine the centimeter-scale growth of various 2D TMD layers and their direct assemblies on mechanically deformable substrates. By exploring the water-assisted debonding of gold (Au) interfaced with silicon dioxide (SiO2), we demonstrate the direct growth, transfer, and integration of 2D TMD layers and heterostructures such as 2D MoS2 and 2D MoS2/WS2 vertical stacks on centimeter-scale plastic and metal foil substrates. We identify the dual function of the Au layer as a growth substrate as well as a sacrificial layer which facilitates 2D layer transfer. Furthermore, we demonstrate the versatility of this integration approach by fabricating centimeter-scale 2D MoS2/single walled carbon nanotube (SWNT) vertical heterojunctions which exhibit current rectification and photoresponse. This study opens a pathway to explore large-scale 2D TMD van der Waals layers as device building blocks for emerging mechanically deformable electronics/optoelectronics.

Vertically oriented MoS2 nanoflakes coated on 3D carbon nanotubes for next generation Li-ion batteries.

The advent of advanced electrode materials has led to performance enhancement of traditional lithium ion batteries (LIBs). We present novel binder-free MoS2 coated three-dimensional carbon nanotubes (3D CNTs) as an anode in LIBs. Scanning transmission electron microscopy analysis shows that vertically oriented MoS2 nanoflakes are strongly bonded to CNTs, which provide a high surface area and active electrochemical sites, and enhanced ion conductivity at the interface. The electrochemical performance shows a very high areal capacity of ~1.65 mAh cm-2 with an areal density of ~0.35 mg cm-2 at 0.5 C rate and coulombic efficiency of ~99% up to 50 cycles. The unique architecture of 3D CNTs-MoS2 is indicative to be a promising anode for next generation Li-ion batteries with high capacity and long cycle life.

Prediabetes in children and adolescents: A ticking bomb!

Prediabetes in children and adolescents is on the rise which has drawn significant attention over the past decade. It is an early warning sign of the underlying pathophysiological changes which in due course of time might compound into type II diabetes mellitus. The incidence of prediabetes in adolescents ranges from 4%-23% which is alarmingly high and requires active intervention from the system. We have discussed early identification of high-risk patients, prompt screening and active intervention to manage this growing problem.

Ketodex for MRI sedation in syndromic children with congenital cardiac anomalies - A case series.

Safe paediatric sedation in a magnetic resonance imaging (MRI) suite can be challenging. The challenges intensify in uncooperative syndromic children compounded by an accentuated risk of periprocedural cardio-respiratory complications with anaesthetic sedation in this peculiarly predisposed subset. Amidst ardent debates on the ideal sedative agent for paediatric MRI, we report an encouraging application of ketamine-dexmedetomidine combination (ketodex) sedation for MRI in our case-series including syndromic children with coexistent congenital cardiac anomalies.

Self-Rolled-Up Aluminum Nitride-Based 3D Architectures Enabled by Record-High Differential Stress.

Aluminum nitride (AlN) continues to kindle considerable interest in various microelectromechanical system (MEMS)-related fields because of its superior optical, mechanical, thermal, and piezoelectric properties. In this study, we use magnetron sputtering to tailor intrinsic stress in AlN thin films from highly compressive (-1200 MPa) to highly tensile (+700 MPa), with a differential stress of 1900 MPa. By monolithically combining the compressive and tensile ultrathin AlN bilayer membranes (20-60 nm) during deposition, perfectly curved three-dimensional (3D) architectures are spontaneously formed upon dry-releasing from the substrate via a 3D MEMS approach: the complementary metal-oxide-semiconductor (CMOS)-compatible strain-induced self-rolled-up membrane (S-RuM) method. The thermal stability of the AlN 3D architectures is examined, and the curvature of S-RuM microtubes and helical structures as a function of the cumulative membrane thickness and stress are characterized experimentally and simulated using a finite-element physiomechanic method. By combining AlN with various materials such as metal (Cu) and silicon nitride (SiNx), AlN-based hybrid S-RuM microtubes with diameters as small as ∼6 µm are demonstrated with a near-unity yield (∼99%). Compared with other stressed thin films for S-RuMs, including PECVD SiNx, magnetron-sputtered AlN-based S-RuMs show better structural controllability and versatility, probably due to the high Young's modulus and stress uniformity. This work establishes the sputtered AlN thin film as a superior stress-configurable S-RuM shell material for high-performance applications in miniaturizing and integrating electronic components beyond those based on other materials such as SiNx. In addition, for the first time, a single-crystal Al1-xScxN/AlN bilayer grown by molecular beam epitaxy is successfully rolled-up with the diameter varying from ∼9 to 14 µm, paving the way for 3D tubular Al1-xScxN piezoelectric devices.

The role of magnesium in perioperative management of intracranial aneurysm surgery: A case series.

As the motivation to potentially allow for a more expansive role of opioid-sparing anaesthesia in various surgical specialities transpire with new zeal, promising evidence needs to be accumulated to substantiate the same. Appropriate to this context, the index case series highlight the beneficial effects of an intraoperative magnesium sulphate infusion on perioperative hemodynamic profile and postoperative recovery in patients undergoing intracranial cerebral aneurysm surgery.

A hospital-based cross-sectional study on suicidal poisoning in Western Uttar Pradesh.

BACKGROUND AND AIMS: Poisoning is most common method of committing suicide in India. Objectives of this study to assess prevalence of suicidal poisoning among all poisoning cases, its socio-demographic profile and its reasons in all admitted cases of suicidal poisoning in hospital. METHODS: A cross-sectional study was conducted on cases of poisoning of any age group admitted in the Chhatrapati Shivaji Subharti Hospital, Meerut. Poisoning cases with history or evidence of suicide were further interviewed. A semi-structured interview schedule in Hindi was used to collect data. Microsoft Excel 365 and R software version 3.6.0 were used for data entry and analysis respectively. RESULTS: Among total 135 poisoning cases admitted in hospital, 126 provided consent and included in the study. Prevalence of suicidal poisoning was 77.7% (98). Most common age group involved was 11-20 years (36.7%) and 21-30 years (35.7%) and most of the participants were males (59.2%). Most suicidal poisoning cases took Aluminum Phosphide (31.6%), followed by Organophosphates (20.4%) as poison. Most frequent reasons for suicide as described by participants were 'Family quarrel or family unhappiness' (29.6%), 'failure in examination or interview or business' (23.5%), 'ill treatment by spouse or in laws' (16.3%) and 'unemployment' (9.2%). CONCLUSION: Our study shows that consuming Agriculture poisons (Aluminum Phosphide and Organophosphates) are most common (52%) poisons consumed by suicidal poisoning cases. Agriculture poisons (Aluminum Phosphide and Organophosphates) are easily available in markets in India. There should be some restriction on their purchase to reduce suicidal incidences.