Defect Engineered Bi2Te3 Nanosheets with Enhanced Haloperoxidase Activity for Marine Antibiofouling.

Defective bismuth telluride (Bi2Te3) nanosheets, an artificial nanozyme mimicking haloperoxidase activity (hPOD), show promise as eco-friendly, bactericidal, and antimicrofouling materials by enhancing cytotoxic hypohalous acid production from halides and H2O2. Microscopic and spectroscopic characterization reveals that controlled NaOH (upto X = 250 µL) etching of the nearly inactive non-transition metal chalcogenide Bi2Te3 nanosheets creates controlled defects (d), such as Bi3+species, in d-Bi2Te3-X that induces enhanced hPOD activity. d-Bi2Te3-250 exhibits approximately eight-fold improved hPOD than the as-grown Bi2Te3 nanosheets. The antibacterial activity of d-Bi2Te3-250 nanozymes, studied by bacterial viability, show 1, and 45% viability for Staphylococcus aureus and Pseudomonas aeruginosa, respectively, prevalent in marine environments. The hPOD mechanism is confirmed using scavengers, implicating HOBr and singlet oxygen for the effect. The antimicrofouling property of the d-Bi2Te3-250 nanozyme has been studied on Pseudomonas aeruginosa biofilm in a lab setting by multiple assays, and also on titanium (Ti) plates coated with the nanozyme mixed commercial paint, exposed to seawater in a real setting. All studies, including direct microscopic evidence, exhibit inhibition of microfouling, up to ≈73%, in the presence of nanozymes. This approach showcases that defect engineering can induce antibacterial, and antimicrofouling activity in non-transition metal chalcogenides, offering an inexpensive alternative to noble metals.

Evidence-Based Approach of Biologic Therapy in Bronchial Asthma.

The emergence of biologic agents in the treatment of bronchial asthma has a wide impact on improving quality of life, reducing morbidity, and overall health care utilization. These therapies usually work by targeting specific inflammatory pathways involving type 2 inflammation and are particularly effective in severe eosinophilic asthma. Various randomized controlled trials have shown their effectiveness by reducing exacerbation rates and decreasing required glucocorticoid dosages. One of the relatively newer agents, tezepelumab, targets thymic stromal lymphoprotein and has proven its efficacy in patients independent of asthma phenotype and serum biomarker levels. This article reviews the pathophysiologic mechanism behind biologic therapy and offers an evidence-based discussion related to the indication, benefits, and adverse effects of such therapies.

Temporal Trends for Patients Hospitalized With Atrial Fibrillation in the United States: An Analysis From the National Inpatient Sample (NIS) Database 2011-2018.

BACKGROUND: Atrial fibrillation (AF) has historically been a growing burden on the global public health system. Previously, literature on the trends associated with AF-related hospitalizations has been published. However, there seems to be a gap in up-to-date information, notably within the last decade. PURPOSE: This study aims to investigate the trends, outcomes, and factors associated with AF hospitalization and the continued impact of AF on the United States health system. METHODS: Patient data were collected from the years 2011 to 2018 from the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-9 and ICD-10 codes. We selected patients hospitalized with a diagnosis of AF. Descriptive statistics, statistical analysis, and Mann-Whitney U testing were employed to compare continuous dichotomous variables. After respective adjustments, multivariate hierarchical logistic regression was used to establish mortality rates, length of stay (LOS), and hospital charges. RESULTS: The study included 509,305 patients hospitalized with a primary diagnosis of unspecified AF. The mean age of patients hospitalized with AF was 71 years. AF hospitalizations were slightly higher in women as compared to men (51.7% vs. 48.2%). The predominant race involved was Caucasians at 77.9% followed by African Americans and Hispanics at 7.4% and 5.4%, respectively. The three most frequent coexisting conditions noted were hypertension (69.9%), diabetes mellitus (24.3%), and chronic obstructive pulmonary disease (16.4%). Medicare/Medicaid was the primary payer associated with the majority of AF hospitalizations at 72.6%. Overall in-hospital mortality associated with AF hospitalizations was 0.96%. Comorbid conditions conferring the highest mortality risks included coagulopathies (644%) and cerebral vascular accidents (597%). Mean LOS was found to be 3.35 days. Hospitalization charges increased year-over-year and correlated with an increase in the national burden of cost for these patients of $3.6 billion. CONCLUSIONS: Our study investigates the national trends surrounding AF hospitalizations. Overall in-hospital mortality rates appear to be stable as compared to prior years and past literature. Comorbid conditions conferring significantly higher mortality rates included coagulopathies, cerebral vascular accidents, acute kidney injury, and end-stage renal disease. Additionally, suboptimal insurance status was also associated with increased mortality risk. The cost of hospitalization in AF patients has increased steadily, conferring a $3.6 billion burden on the US healthcare system.

Evidence-Based Mechanical Ventilatory Strategies in ARDS.

Acute respiratory distress syndrome (ARDS) remains one of the leading causes of morbidity and mortality in critically ill patients despite advancements in the field. Mechanical ventilatory strategies are a vital component of ARDS management to prevent secondary lung injury and improve patient outcomes. Multiple strategies including utilization of low tidal volumes, targeting low plateau pressures to minimize barotrauma, using low FiO2 (fraction of inspired oxygen) to prevent injury related to oxygen free radicals, optimization of positive end expiratory pressure (PEEP) to maintain or improve lung recruitment, and utilization of prone ventilation have been shown to decrease morbidity and mortality. The role of other mechanical ventilatory strategies like non-invasive ventilation, recruitment maneuvers, esophageal pressure monitoring, determination of optimal PEEP, and appropriate patient selection for extracorporeal support is not clear. In this article, we review evidence-based mechanical ventilatory strategies and ventilatory adjuncts for ARDS.

Preoperative Computed Tomography in the Adult Cardiac Surgery Patient.

Increasingly, computed tomography is requested for preoperative planning prior to cardiac surgery. Common pathologies, such as aortic and mitral annular calcification, can influence the choice of surgical technique or approach. In this article, we present a case-based review of primary and reoperative sternotomies that focuses on the clinical relevance of the common pathologies and findings in pre-operative computed tomography images, with respect to surgical decision-making and management.

Renal Microvascular Ischemia Secondary to Nonsteroidal Anti-inflammatory Drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs), widely prescribed for pain, can affect kidneys in various ways. We present a case of a 37-year-old woman with multiple NSAIDs intake over a short period for dysmenorrhea followed by the development of new-onset bilateral flank pain. Computed tomography revealed bilateral multiple renal infarcts. Renal function was normal. Investigations showed no cardiac or renal artery lesion and vasculitis work-up was negative. She was treated conservatively and further NSAID intake was avoided. Follow-up scan showed complete restoration of the blood flow in previously affected areas. Thus, microvascular ischemia secondary to NSAIDs was thought to be responsible.

A Case of Hearing Impairment with Renal Dysfunction.

Hearing impairment in a patient with renal failure is an important clue towards etiologic diagnosis of kidney disease. Variety of hereditary diseases, developmental defects, and toxins involve these two organs. However, additional retinopathy is seen in quite a few diseases which include Alport's syndrome and Muckle-Wells syndrome (MWS). We are reporting a case of middle-aged woman with childhood-onset of hearing impairment who presented with renal failure and was diagnosed to have renal amyloidosis on kidney biopsy but without any light chain restriction. During evaluation for live donor kidney transplant, her brother was also found to have hearing impairment and retinopathy however with normal renal function and urinalysis. Genetic testing of both of them was done for panel of mutations related to hereditary amyloidosis which revealed NLRP3 mutation in both. This mutation is characteristic of MWS which can lead to secondary amyloidosis and renal failure.

Electron Beam CT: A Historical Review.

OBJECTIVE. At its advent, CT was too slow to image the heart. Temporal resolution improved with electron beam CT (EBCT); subsequently, the heart could be imaged, eventually leading to the discovery of prognostic information obtained from the coronary calcium score. In the early 2000s, EBCT was replaced by MDCT. In this review, we discuss the rise and fall of EBCT and explore its legacy in cardiac imaging. CONCLUSION. Although MDCT rendered EBCT obsolete, EBCT leaves a legacy in cardiac imaging regarding both diagnosis and prognosis. The creators of MDCT emulated the strengths of EBCT and learned from its weaknesses. Moreover, EBCT showed that imaging surrogates can predict outcomes, and the origins of substrate-guided treatment can be traced to EBCT.

Effectiveness of a multi-session combined near-peer and faculty-led surgical skills course on self-perceived ability to perform basic surgical skills.

BACKGROUND: Newly qualified UK doctors report feeling unprepared to perform basic practical procedures. The Royal College of Surgeons of England (RCSEng) responded to this concern by developing a national surgical curriculum, however, a national survey of UK medical schools identified that surgical skills teaching is inconsistent throughout the UK.Peer assisted teaching sessions are delivered by senior students to junior peers and have been demonstrated to be effective in a number of settings. We aimed to develop a peer-led surgical skills course for medical students and assess its efficacy in teaching surgical skills. METHODS: Combined near-peer and faculty-led teaching sessions were delivered to medical students (N = 14). We assessed for confidence in these skills using pre- and post-course Likert scale questionnaires to determine self-perceived benefit. RESULTS: Overall, student confidence in all skills improved by +1.254 (p < 0.0001). Individually, confidence in every skill increased significantly, including continuous suturing, knot tying and excision and closure, which improved by +1.45 (p < 0.001), +1.22 (p < 0.05) and +1.59 (p < 0.0001), respectively. DISCUSSION: This study demonstrates that teaching provided through near-peer faculty improves medical student confidence in basic surgical skills. A similar course design could be implemented in other UK medical schools to improve the surgical skills of newly graduated doctors.

The bone prone team.

When the COVID-19 pandemic arrived in the United Kingdom, elective orthopaedics was halted. This article tells the tale of the orthopaedic surgeons who rose to the challenge of helping to treat coronavirus patients on the intensive care unit.

Gamma Ray Irradiation Enhances the Linkage of Cotton Fabrics Coated with ZnO Nanoparticles.

In this work, we aim to study zinc oxide (ZnO)-based functional materials over cotton fabrics and their effects after gamma ray exposure of 9 kGy. We found that the binding of the nanoparticles with cotton fabrics can be enhanced after irradiation. This could be due to the oxygen deficiency or defects created in the interface between ZnO and cotton fabrics after irradiation. Near-edge X-ray absorption fine structure and X-ray photoelectron spectroscopy (XPS) were used to detect the oxygen inadequacies generated in the interior and at the surface of the ZnO nanoparticles after gamma ray exposure. XPS results showed that the binding energy of Zn shifts by 2 eV at 1.5 kGy and by 4 eV at 9 kGy. This huge shift of about 4 eV is completely different from other works due to the reaction that takes place on the interface between ZnO nanostructures and cotton fabrics after gamma ray irradiation. Overall, this work suggests that after gamma ray irradiation, there is an enhanced level of binding between the coated functional nanoparticles and cotton fabrics, which can be advantageous for the textile industries.

Photosensitized reactive chlorine species-mediated therapeutic destruction of drug-resistant bacteria using plasmonic core-shell Ag@AgCl nanocubes as an external nanomedicine.

Due to the rapid growth of drug-resistant bacterial infections, there is an urgent need to develop innovative antimicrobial strategies to conquer the bacterial antibiotic resistance problems. Although a few nanomaterial-based antimicrobial strategies have been developed, the sensitized formation of cytotoxic reactive chlorine species (RCS), including chlorine gas and chlorine free radicals, by photo-activatable plasmonic nanoparticles for evading drug-resistant bacterial infections has not yet been reported. To address this challenge, herein, we report the synthesis of an unprecedented plasmonic core-shell Ag@AgCl nanocrystal through an in situ oxidation route for the photo-induced generation of highly cytotoxic RCS. We present the detailed in vitro and in vivo investigations of visible light activated Ag@AgCl nanostructure-mediated evasion of drug-resistant bacteria. In particular, the in vivo results demonstrate the complete reepithelialization of the methicillin-resistant Staphylococcus aureus (MRSA) infected wounds on skin upon phototherapeutic treatment mediated Ag@AgCl NCs. To the best of our knowledge, this is the first unique example of using Ag@AgCl NCs as an external nanomedicine for photo-induced generation of RCS to mediate effective killing of both Gram-positive and Gram-negative drug resistance bacteria and healing of the subcutaneous abscesses in an in vivo mouse model.

Novel coronavirus (COVID-19) infection: What a doctor on the frontline needs to know.

Coronavirus disease 2019 (COVID-19) is a zoonotic respiratory infection originating from Wuhan, China. Rapidly spreading from Wuhan to all inhabited continents of the world, the World Health Organisation declared COVID-19 a pandemic on March 11, 2019. Infected patients present with fever and cough; radiological features include bilateral infiltrates on chest x-ray and computed tomography scanning. Management is supportive with oxygen supplementation, broad-spectrum antibiotics as well as careful fluid balancing. A number of drugs, both new and old, are currently in clinical trials and being used on an experimental basis in clinical practice. The COVID-19 pandemic is the greatest worldwide public health crisis of a generation, and has led to seismic political, economic and social changes. This review provides an overview of COVID-19 for junior doctors who find themselves on a new frontline of healthcare.

Artificial Intelligence in Medicine: Where Are We Now?

Artificial intelligence in medicine has made dramatic progress in recent years. However, much of this progress is seemingly scattered, lacking a cohesive structure for the discerning observer. In this article, we will provide an up-to-date review of artificial intelligence in medicine, with a specific focus on its application to radiology, pathology, ophthalmology, and dermatology. We will discuss a range of selected papers that illustrate the potential uses of artificial intelligence in a technologically advanced future.

Artificial Intelligence, Radiology, and Tuberculosis: A Review.

Tuberculosis is a leading cause of death from infectious disease worldwide, and is an epidemic in many developing nations. Countries where the disease is common also tend to have poor access to medical care, including diagnostic tests. Recent advancements in artificial intelligence may help to bridge this gap. In this article, we review the applications of artificial intelligence in the diagnosis of tuberculosis using chest radiography, covering simple computer-aided diagnosis systems to more advanced deep learning algorithms. In so doing, we will demonstrate an area where artificial intelligence could make a substantial contribution to global health through improved diagnosis in the future.