Ultrasonication-assisted synthesis of transition metal carbide of MXene: an efficient and promising material for photocatalytic organic dyes degradation of rhodamine B and methylene blue in wastewater.

Water pollutants of non-biodegradable toxic aromatic dye including Methylene blue (MB) and Rhodamine (RhB) are extremely carcinogenic thiazines used in various industries such as leather industry, paper industry, and the dyeing industry. The presence of dyes in wastewater causes severe threats to human health that are responsible for various harmful chronic or acute diseases and also shows an adverse impact on the environment as it reduces transparency and is harmful to water microorganisms. To overcome severe issues, many traditional techniques have been used to remove toxic pollutants, but these methods are insufficient to remove chemically stable dyes that remain in the treated wastewater. However, the photocatalytic degradation process is an efficient approach to degrade the dye up to the maximum extent with improved efficiency. Therefore, in this work, a new class of two-dimensional (2D) transition metal carbide of Titanium Carbide (Ti3C2Tx) MXene material was used for the organic dyes degradation such as MB and RhB using a photocatalytic process. A layered structure of hexagonal lattice symmetry of Ti3C2Tx MXene was successfully synthesized from the Titanium Aluminum Carbide of Ti3AlC2 bulk phase using an exfoliation process. Further, the XRD spectrum confirms the transformation of bulk MAX phase having (002) plane at 9.2° to Ti3C2Tx MXene of (002) plane at 8.88° confirms the successful removal of Al layer from MAX phase. A smooth, transparent, thin sheet-like morphology of Ti3C2Tx nanosheet size were found to be in the range of 70 to 150 nm evaluated from TEM images. Also, no holes or damages in the thin sheets were found after the treatment with strong hydrofluoric acid confirms the formation Ti3C2Tx layered sheets. The synthesized Ti3C2Tx MXene possesses excellent photocatalytic activity for the degradation of dyes MB, RhB, and mixtures of MB and RhB dyes. MB dye degraded with a degradation percentage efficiency of 99.32% in 30 min, while RhB dye was degraded upto 98.9% in 30 min. Also, experiments were conducted for degradation of mixture of MB and RhB dyes by UV light, and the degradation percentage efficiency were found to be 98.9% and 99.75% for mixture of MB and RhB dye in 45 min, respectively. Moreover, reaction rate constant (k) was determined for each dye of MB, RhB, and mixtures of MB and RhB and was found to be 0.0215 min-1 and 0.0058 min-1, and for mixtures, it was 0.0020 min-1 and 0.009 min-1, respectively.

Aetiology, clinical profile and management outcome of pneumothorax patients: A prospective study from Central India.

Background: Pneumothorax (PT) is defined as the presence of air in the pleural cavity. Primary spontaneous pneumothorax (PSP) arises in an otherwise healthy person without any underlying lung disease. PSP occurs in people aged 20 to 30 years, with a peak incidence in the early twenties. The recurrence rate in spontaneous PT patients is approximately 10%-20%. In the present study, 50 cases of spontaneous PT were undertaken with an aim to analyse aetiology, clinical profile and management outcome of PT patients. Materials and Methods: The present study was conducted for a period of 12 months, among 50 patients presenting with unilateral PT. The therapeutic interventions were indicated when there was a loss of volume of lungs of 32% or more, and this loss of volume was calculated using Collins method. The association between the side of PT, smoking status and size of PT were found using the Chi-square test, and the association between variables were considered significant if the P value was <0.05. Results: In the present study, the male patients were 92.0% and only 8.0% of patients were females. The further history-taking of patients had shown that the mode of onset of PT was sudden in 72.0% of patients. Although the success rate of Intracth procedure was lower in comparison with the intercoastal drainage (ICD) procedure, the complication rate of Intracath was lower when compared with extensive subcutaneous. Conclusion: PSP is less common than secondary spontaneous PT. Smoking is an independent risk factor for PT, and it delays its resorbtion.

Sepsis Due to Achromobacter xylosoxidans in a Tertiary Care Centre: Case Series.

Achromobacter xylosoxidans, also known as Alcaligenes xylosoxidans, is a low-virulence, non-fermenter gram-negative bacillus mainly found in marine environments. We report a detailed series of four high-risk cases of septicemia with the common variable of positive blood cultures for A. xylosoxidans. All four blood isolates were multi-drug resistant and susceptible to meropenem and trimethoprim-sulfamethoxazole. Two patients responded well to the treatment with meropenem and trimethoprim-sulfamethoxazole and two patients died. It should never be assumed that Achromobacter is a contaminant even though it is relatively infrequently isolated from clinical samples. This infection can progress to fatal bacteremia, even in otherwise healthy people, and it can potentially cause severe conditions in premature infants. With only a limited number of antibiotics demonstrating bactericidal properties, the possibility of failure in empirical treatment is significant. As a result, it is important to have a precise comprehension of this uncommon yet deadly illness in order to increase the probability of successful treatment.

Diabetic Ketoacidosis and COVID-19: A Retrospective Observational Study.

Background Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM), mainly type 1 DM. DM is one of the comorbidities recognized as the predictor of the severity in COVID-19-positive patients. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness (COVID-19) has a bidirectional association with DM. DM is a state of chronic inflammatory condition and hyperglycemia that predisposes one to acquire an exaggerated form of COVID-19 infection. Moreover, in recent literature, it has been established that SARS-CoV-2 is capable of directly damaging beta cells of the pancreas, thereby inducing new-onset diabetes in previously non-diabetics. Hence, new-onset diabetes and severe metabolic consequences of pre-existing diabetes, such as DKA, are seen in COVID-19-positive patients. DKA in patients with COVID-19 may increase the risk of mortality and lead to poor prognosis. Methods This retrospective observational study includes 25 patients who presented to our hospital with DKA secondary to COVID-19 infection as a triggering factor. Demographic parameters, medical history, physical examination, laboratory tests including reverse transcriptase polymerase chain reaction test (RT-PCR), chest X-ray, treatment administered, clinical course, and outcomes were recorded. All data were computed and analyzed using SPSS Version 22.0 (IBM Corp., Armonk, NY, USA). Results Of the 25 cases, 14 were females, and a statistically significant difference was seen in the values of blood sugar (367 mg/dL), D-dimer, ferritin, blood urea nitrogen (BUN), and anion gap among males and females (p < 0.050). The males had higher mean values of blood sugar (367 mg/dL), BUN (60.63 mg/dL), D-dimer (1.09 mcg/mL), and ferritin (821.23 mcg/mL) than females, whereas females had a higher anion gap (20.85) than males. A negative correlation was seen between D-dimer and the following biochemical investigations in COVID-19 patients: serum bicarbonate, anion gap, chloride, BUN, creatinine, sodium, potassium, magnesium, and phosphorous. COVID-19 can present with atypical symptoms in patients with high blood sugar levels. Diabetics are more likely to experience effects on multiple organs compared to non-diabetic patients who mainly have lung involvement. Hence, a high degree of suspicion is essential to diagnose DKA early in COVID-19 patients. Conclusion These cases show that DKA can be precipitated by COVID-19 in a significant number of patients and that the presence of diabetes can also exaggerate the underlying COVID-19 infection, a bidirectional relationship. All cases were COVID-19-positive presenting with features characteristic of DKA. SARS-CoV-2 was precipitating factor of DKA. Patients with newly diagnosed diabetes or pre-existing diabetes were equally susceptible to DKA. Due to the high prevalence of both illnesses (DM and COVID-19) in our country, a high level of suspicion is required to detect DKA early and improve the outcome of COVID-19-related life-threatening hyperglycemic consequences.

COVID-19 Vaccination a Cause of Guillain-Barré Syndrome? A Case Series.

Guillain-Barré syndrome (GBS) is a rare autoimmune neuropathic disorder of peripheral nerves usually following an infection or on rarer occasions following vaccinations, but the exact underlying pathophysiology is still unclear. The most common etiology of GBS is a bacterial infection caused by Campylobacter jejuni. Viral infections like Zika virus, Epstein-Barr virus, and Cytomegalovirus also add to the list of GBS etiology. COVID-19 (SARS-CoV-2) has also been reported to cause GBS. Vaccines like the rabies vaccine, influenza vaccine, and poliovirus vaccine account for a very small fraction of Guillain-Barré syndrome. GBS as an adverse effect of COVID-19 vaccination was not reported by the Vaccine Adverse Event Reporting System (VAERS), but an update was later released in the course of the pandemic from FDA news, reporting several patients developing GBS after receiving the COVID-19 vaccine. In this case series, we discuss five cases that developed the GBS post-COVID-19 AstraZeneca vaccine, along with its pathophysiology, management, and outcome.

Adult Onset Vanishing White Matter Disease: A Rare Case Report.

Vanishing white matter disease (VWMD) is the most common childhood-onset inheritable progressive leukodystrophy disorder, which exclusively affects the white matter of the brain. It shows mutations in one of the five eukaryotic translation initiation factor 2B1-5 genes following an autosomal recessive pattern, of which eIF2B5 mutation is the most frequent. These genes play a vital role in the translation and regulation of protein synthesis and mutation in them leads to a dysregulation of the cellular stress response, which in particular disrupts myelination and affects oligodendrocytes and astrocytes while sparing the neurons. Stressful situations, for example, head trauma, sudden fright, acute psychological stress, or infection, provoke severe and rapid neurological deterioration. Although it is more common in childhood, we report a case of an adult presenting with signs and symptoms of VWMD, such as abusive behavior, emotional liability, and motor incoordination. To our knowledge, this is the first case of adult-onset VWMD in Maharashtra, India, confirmed by magnetic resonance imaging (MRI) of the brain.

Clinical Profile of Patients Presenting With Sepsis to the Emergency Department of a Tertiary Care Hospital in Wardha During the COVID Pandemic (June 2020-June 2021).

Background Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. Septic shock, multi-organ dysfunction, and death occur in severe cases with reduced blood flow to vital organs. Sepsis contributes to 15-20% of all global deaths. Through this study, we intend to evaluate the clinical profile and study the common blood investigatory panels along with organisms causing sepsis in patients presenting with sepsis in the emergency department during the COVID pandemic. In addition, the study was also done to estimate the prevalence of sepsis and compare patients having sepsis with serum lactate, sepsis with Systemic Inflammatory Response Syndrome (SIRS) criteria, and sepsis with quick Sepsis Related Organ Failure Assessment (qSOFA) score. Method Observational retrospective study to evaluate patients presenting with sepsis diagnosed by the Third International Consensus Definitions for Sepsis and Septic Shock" criteria presenting to the emergency department of Acharya Vinoba Bhave Rural Hospital (AVBRH) affiliated to Jawaharlal Nehru Medical College (JNMC), Wardha during COVID pandemic (June 2020-June 2021). Results The majority of the patients presented with fever (42%), and very few presented with altered mental status (8%). Seventy-four percent of the study population did not show any bacterial growth on blood culture, but out of the remaining 26%, blood culture, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pnemoniae were the significant microbes. Amongst qSOFA, SIRS criteria, and serum lactate as a screening tool for sepsis, SIRS is the most sensitive for screening sepsis patients. Conclusion Staphylococcus aureus, Pseudomonas aerugenosa, and Klebsiella pneumoniae were the major contributors in the development of sepsis in COVID-19-associated infection. The presence of raised leukocyte counts and serum lactate should alarm clinicians of possible sources of infection. The timely initiation, rapid de-escalation of empirical antibiotics, and strict compliance with infection control practices should be accomplished to reduce the occurrence of multidrug resistance organisms.

Aspergilloma in Non-tuberculous Cavities in the Lung: Not to Get Startled.

Aspergillus which is normally found as a colonizer in healthy individuals can manifest in various forms in patients with diseased lung or immunocompromised status. Aspergilloma is one such manifestation whereby the fungus makes its way into preexisting cavities in the lung, the most common underlying etiology being old tuberculous cavities, especially in countries with high TB prevalence. However, we hereby report two cases of Aspergillus infestation as aspergilloma in cavities because of extremely rare causes, namely pulmonary thromboembolism and idiopathic pulmonary fibrosis, respectively.

Correlation Between Chest CT Severity Scores and Glycosylated Haemoglobin Levels and its Outcome in Patients With COVID-19: A Retrospective Study in a Tertiary Care Hospital.

Background In this study, we aimed to compare the imaging findings between coronavirus disease (COVID-19) patients with well-controlled, poorly-controlled, and non-diabetic patients and subsequently find any relation between haemoglobin A1c (HbA1c) levels and high-resolution chest computed tomography (HRCT) chest score. Methodology A total of 200 individuals with coexisting COVID-19 and type 2 diabetes mellitus were included in this retrospective cohort study. Based on their HbA1c levels, patients were divided into three groups. The imaging data and laboratory values were obtained from the online medical records of the patients. In addition, the chest computed tomography (CT) score was evaluated as the sum of individual scores from five lung lobes: scores of 0, 1, 2, 3, 4, and 5 were assigned to each lobe. Any peripheral opacification pattern was noted. Haemoglobin A1c (HbA1c) levels and HRCT scores were then analysed by multiple linear regression models using R software. Results The prevalence of diabetes in the study population was 71.5%. Of this, 56 patients had well-controlled diabetes (28%) and 87 patients had poorly controlled diabetes (43.5%); 126 (63%) patients were male and the median age was 54.45 years (95% CI: 54.45 ± 15.53). We found that diabetes status, co-presence of ground-glass appearance with mixed consolidation, and consolidation and reverse halo sign in the HRCT findings were significant predictors of the HRCT scores in patients with COVID-19. Conclusions The presence of any co-morbidities should be viewed as a high-risk case of COVID-19. Diabetes status is significantly associated with the severity of HRCT findings in lab-confirmed COVID-19 infection. Therefore, it is important to prioritise the patients who have COVID-19 along with diabetes.

The Act of Prevention: Knowledge, Attitudes, and Perception Among Caretakers of Kidney Disease Patients in Rural Wardha District of Central India.

Background There is a continual rise in the prevalence of non-cancerous conditions such as chronic kidney disease (CKD) owing to an enormous load of diabetes, hypertension, and vascular diseases. A positive attitude and healthy lifestyle for CKD prevention can only be followed when the masses are well aware and educated about the disease. This study aimed to compare, correlate, and evaluate the distribution of knowledge, attitudes, and perceptions among relatives or caretakers of patients with kidney disease or at risk of the disease. Methodology This cross-sectional study aimed at obtaining data on the knowledge, attitudes, and perceptions using the Chronic Kidney Diseases Screening Index questionnaire from the relatives of CKD patients. All data were computed and analyzed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). Results The majority of the relatives of CKD patients had poor knowledge (63.6%) and poor attitude (51.6%) levels. On the contrary, most respondents had good practices (52.8%) level toward the risk for CKD. A significant correlation was noted between education and knowledge (p < 0.050). A significant association was also observed between education and occupation with attitude (p < 0.001 and p < 0.050, respectively). Additionally, a significant association was noted between age and perception (p < 0.001). Conclusions Informed and well-educated populations are less prone to acquire or progress to CKD. From this study, we can understand the need for improvement in public knowledge, which has the potential to help in saving the lives of many patients progressing toward end-stage renal diseases.

Six-Week Hospital-Based Pulmonary Rehabilitation in Covid Pneumonia ICU Survivors: Experience from a Tertiary Care Center in Central India.

OBJECTIVE: There is very limited data on the usefulness of pulmonary rehabilitation in patients with coronavirus pneumonia who have survived intensive care unit care. The primary aim was to explore the feasibility of conducting a pulmonary rehabilitation program in patients with coronavirus disease-19 pneumonia surviving intensive care. The secondary aim was to study the impact of a hospital-based 6-week pulmonary rehabilitation program on exercise capacity, quality of life, and psychological parameters in these patients. This study was conducted at the Center for Pulmonary Rehabilitation, Department of Pulmonary Medicine of the institute. MATERIAL AND METHODS: A total of 27 patients were enrolled. Among them, 14 patients who completed the desired 12 sessions over 6 weeks constituted the pulmonary rehabilitation group and 13 patients who either did not consent or defaulted within the first 2 weeks were considered as controls. Both groups had assessments at 0 and 6 weeks that included a 6-Minute Walk Test, Incremental Shuttle Walk Test, mMRC Dyspnea Scale, Baseline Dyspnea Index, and Transitional Dyspnea Index, Saint George's Respiratory Questionnaire score, and Depression, Anxiety, Stress Scale-21 score. RESULTS: Significant improvement in dyspnea by mMRC (P = .01) and exercise capacity as measured by 6-Minute Walk Test (P <.001) and Incremental Shuttle Walk Test (P = .025) was seen in the pulmonary rehabilitation group as compared to the control group. There was no significant improvement in quality of life and psychological parameters (Depression, Anxiety, Stress Scale 21 score) after 6 weeks of pulmonary rehabilitation program as measured in our study. CONCLUSION: Pulmonary rehabilitation is feasible and appears promising in coronavirus disease acute respiratory distress syndrome survivors. However, data from other centers and a larger number of patients are required to imbibe conclusive results.

Demographic profile, clinical and microbiological predictors of mortality amongst admitted pediatric TB patients in a tertiary referral tuberculosis hospital.

BACKGROUND: Pediatric tuberculosis (TB) constitutes 8% of the total caseload of TB. Children are particularly vulnerable to dissemination of disease and mortality. AIM: To determine mortality rate, elucidate type of TB, causes and predictors of mortality, if any, in admitted pediatric TB patients. METHODS: Present retrospective study was conducted in a tertiary referral center over last 6½ year on children who died out of total TB admissions. RESULTS: Out of total 1380 pediatric (<15 years of age) TB admissions, 74 children died, a mortality rate of 5.36%. Mean age was 11.4 years with highest mortality 47 (63.51%) in patients from 11 to 14 years age group. Significant majority 58 (78.38%) patients were females (p < 0.011). Range of hospital stay was 0-113 days with 7 (9.5%), 9 (12.16%) and 27 (36.48%) children dying on day of admission, next day and 3rd-7th day respectively, therefore a total of 43 (58.11%) died within first week of admission. Most 60 (81.08%) patients belonged to poor socio-economic status. History of contact was present in 12 (16.22%) cases while none had diabetes. 31 (41.89%) patients had sepsis and severe anemia (Hb ≤ 6 g %) was present in 6 (8.11%) patients at admission, out of which 4 died on the same day of admission, even before blood could be arranged. Most patients 68 (91.89%) had pulmonary TB with 25 children having concomitant extrapulmonary involvement, while 4 (5.41%) had meningeal TB and 2 (2.70%) had disseminated TB with HIV. Microbiological confirmation was achieved in 51 (68.92%) (48 PTB and 3 EPTB) cases while 23 (31.08%) were clinically diagnosed. Bilateral extensive fibro-cavitary disease with infiltrations was the commonest. Drug resistance was confirmed in 21 (28.38%) with 2, 5, 8, 5 and 1 patient diagnosed with mono H, RR, MDR, pre-XDR and XDR respectively but results of 9 patients were received posthumously. Treatment given was category 1, category 2 and regimens for drug resistant TB in 24 (32.43%), 29 (39.19%) and 21 (28.37%) cases respectively based on prior history of ATT and drug sensitivity. Adverse drug reactions were noted in 12 (16.21%) cases. Noted immediate causes of mortality were cardio-respiratory failure, sudden pneumothorax, massive hemoptysis, sepsis, extensive pulmonary disease and aspiration pneumonia. The pointers towards mortality include female gender, severe malnutrition, anemia, extensive disseminated disease and drug resistant TB. Ignorance, dependency of children on parents, poor adherence and late referrals into the system lead to delayed diagnosis and initiation of proper regimen based treatment. CONCLUSION: Early referrals of non-responders and failures to centers equipped with programmatic management facilities are essential for proper, timely management of pediatric TB to reduce mortality.

Filariasis with Squamous Cell Carcinoma: A Hidden Surprise.

Squamous cell carcinoma (SCC) arising with chronic lymphedema is a rare condition, though literature suggests a variety of malignant tumors associated with filariasis. We present a case of 70-year-old male patient with a history of penile and scrotal SCC of filarial origin. We here discuss the unusual association of carcinoma and filariasis and its surgical treatment.