Echocardiography and Management for Cardiac Trauma.

Trauma is the number one cause of death among Americans between the ages of 1 and 46, costing >$670 billion a year. Blunt and penetrating trauma can lead to cardiac and aortic injuries, with the incidence of death varying upon the location of the damage. Among those who reach the hospital alive, many may survive if the hemorrhage and cardiovascular injuries are diagnosed and treated adequately in a timely fashion. Although echocardiography often is underused in the setting of cardiac trauma, it offers significant diagnosis and treatment potential because it is accessible in most settings, safe, relatively noninvasive, and can provide rapid and accurate trauma assessment in the hands of trained providers. This review article aims to analyze the pathophysiology of cardiac injuries in patients with trauma and the role of echocardiography for the accurate diagnosis of cardiac injury in trauma. This review, additionally, will offer a patient-centered, team-based, early management plan with a treatment algorithm to help improve the quality of care among these patients with cardiac trauma.

Hyperoxia After Return of Spontaneous Circulation in Cardiac Arrest Patients.

Current guidelines emphasize the use of 100% oxygen during cardiopulmonary resuscitation after cardiac arrest. When patients are ventilated for variable periods after return of spontaneous circulation (ROSC), hyperoxia causes increased morbidity and mortality by overproduction of reactive oxygen species. Various patient, volunteer, and animal studies have shown the harmful effects of hyperoxia. This mini-review article aims to expand the potential clinical spectrum of hyperoxia on individual organ systems leading to organ dysfunction. A framework to achieve and maintain normoxia after ROSC is proposed. Despite the harmful considerations of hyperoxia in critically ill patients, additional safety studies including dose-effect, level and onset of the reactive oxygen species effect, and safe hyperoxia applicability period after ROSC, need to be performed in various animal and human models to further elucidate the role of oxygen therapy after cardiac arrest.

Diabetic foot infections: Profile and antibiotic susceptibility patterns of bacterial isolates in a tertiary care hospital of Oman.

BACKGROUND: In diabetic foot infections (DFIs), the diversity of microbial profile and ever-changing antibiotic-resistance patterns emphasize accurate characterization of microbial profile and antibiotic susceptibility pattern. The aim of the study was to investigate the pathogens associated with DFI and their antibiotic susceptibility patterns. MATERIALS AND METHODS: A cross-sectional retrospective study was conducted at a tertiary-care hospital, Oman. The socio-demographic and microbiological profile and antibiotic susceptibility patterns of pathogens isolated from patients with DFIs from January 2013 to December 2018 were reviewed. Quantitative and qualitative variables were expressed as mean ± standard deviation and percentages, respectively. A Chi-square test was used for testing the association between multidrug-resistant (MDR) organisms and variables. RESULTS: In total, 233 isolates recovered from 133 clinical specimens with an average of 1.8 organisms per specimen were included in the study. Fifty-six and forty-four percent of specimens showed monomicrobial and polymicrobial growth of two or more organisms, respectively. The frequency of isolation was predominant among males (65%). Aerobic Gram-negative rods were predominantly (75%) isolated compared to Gram-positive organisms (25%). Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated Gram-positive and Gram-negative bacteria, respectively. Thirty-eight percent of them were MDR strains. Gram-negative organisms showed fairly good susceptibility ranging from 75% to 100% to carbapenems, aminoglycosides, and piperacillin-tazobactam. While doxycycline and trimethoprim-sulfamethoxazole showed good susceptibility toward Gram-positive organisms. CONCLUSION: DFIs are often polymicrobial with a predominance of Gram-negative pathogens. This study recommends the use of carbapenems and doxycycline for empirical therapy of Gram-negative and Gram-positive bacterial DFIs, respectively.

Investigation of 9000 hours multi-stress aging effects on High-Temperature Vulcanized Silicone Rubber with silica (nano/micro) filler hybrid composite insulator.

Degradation in the polymeric insulators is caused due to the environmental stresses. The main aim of this paper is to explore the improved aging characteristics of hybrid samples by adding nano/micro silica in High Temperature Vulcanized Silicone Rubber (HTV-SiR) under long term accelerated aging conditions for 9000 hours. As HTV-SiR is unable to sustain environmental stresses for a long time, thus a long term accelerated aging behavior is an important phenomenon to be considered for field application. The aging characteristics of nano/micro filled HTV-SiR are analyzed by using techniques such as Scanning Electron Microscopy (SEM), Leakage Current (LC), Fourier Transform Infrared Microscopy (FTIR), Hydrophobicity Classification (HC), and breakdown strength for the aging time of 9000 hours. FTIR and leakage currents are measured after every cycle. All the co-filled samples revealed escalated aging characteristics as compared to the neat sample except the SN8 sample (8% nano-silica+20% micro-silica) after 9000 hours of aging. The highest loading of 6% and 8% nano-silica with 20% micro-silica do not contribute to the improved performance when compared with the neat and hybrid samples. However, from the critical experimental analysis, it is deduced that SN2 sample (2% nano-silica+20% micro-silica) is highly resistant to the long term accelerated aging conditions. SN2 has no cracks, lower loss percentages in the important FTIR absorption peaks, higher breakdown strength and superior HC after aging as compared to the unfilled and hybrid samples.

Iliofemoral pulsion endarterectomy.

We present our experience with a technique of endarterectomy for use in patients with iliofemoral occlusive disease, in which the atheromatous plug is extruded from the intact artery by external manipulation (pulsion). A retrospective review of consecutive patients who underwent surgical iliofemoral pulsion endarterectomy (IFPE) in two vascular surgery units between 1998 and 2006 was performed. Primary and secondary graft patency, limb salvage, and patient survival rates were determined using Kaplan-Meier methods. Fifty-eight IFPEs were carried out successfully on 54 patients (36 men, 18 women, median age 66 years) presenting with critical limb ischemia (n=23), with claudication (n=29), or in conjunction with abdominal aortic aneurysm repair (n=6). Mean (range) follow-up was 17 months (1-69). During this period six patients (all male, mean age 64 years) underwent iliofemoral bypass using a prosthetic graft when the iliac arteries were found unsuitable for endarterectomy because of hypoplasia or heavy calcification. Two-year cumulative primary patency of IFPE was 95%, secondary patency 100%, limb salvage 98.5%, and patient survival 73%. This modification of iliac endarterectomy is a relatively simple and safe technique that eschews prosthetics and offers a durable solution for the majority of patients with extensive iliofemoral occlusive disease.