Enhancing Photocatalytic Efficiency of Spent Tea Leaf Powder on ZnIn2S4 Incorporation: Role of Surface Charge on Dye Degradation.

Photocatalytic degradation of dye contaminants using nanocomposite adsorbents has emerged as a promising solution for wastewater treatment. Owing to its abundant availability, eco-friendly composition, biocompatibility, and strong adsorption activity, spent tea leaf (STL) powder has been extensively explored as a viable dye-adsorbent material. In this work, we report spectacular enhancement in the dye-degradation properties of STL powder on incorporation of ZnIn2S4 (ZIS). The STL/ZIS composite was synthesized using a novel, benign, and scalable aqueous chemical solution method. Comparative degradation and reaction kinetics studies were performed onto an anionic dye, Congo red (CR), and two cationic dyes, Methylene blue (MB) and Crystal violet (CV). The degradation efficiencies of CR, MB, and CV dyes were obtained to be 77.18, 91.29, and 85.36%, respectively, using the STL/ZIS (30%) composite sample after the 120 min experiment. The spectacular improvement in the degradation efficiency of the composite was attributed to its slower charge transfer resistance (as concluded by the EIS study) and optimized surface charge (as concluded by ζ potential study). Scavenger tests and reusability tests deciphered the active species (•O2-) and reusability of the composite samples, respectively. To the best of our knowledge, this is the first report to demonstrate improvement in the degradation efficiency of STL powder on ZIS incorporation.

Acquiring the Diagnosis of an Acquired Tracheoesophageal Fistula with EtCO2: A Case Discussion with Review of the Literature.

Acquired tracheoesophageal fistula (TEF) is a rare complication of esophageal or lung cancer. A 57-year-old male presented with complaints of vomiting, cough, 20 lb weight loss, and progressive dysphagia. Early laryngoscopy and CT chest showed a normal pharynx with an irregular thickness of the thoracic esophagus. The upper gastrointestinal endoscopy (UGIE) and upper endoscopic ultrasound (EUS) revealed a hypoechoic mass evolving as complete obstruction. During the procedure, minimal CO2 was used for insufflation; however, when attempts were made to traverse the obstruction, capnography revealed an end-tidal CO2 (EtCO2) estimating 90 mmHg indicating possible TEF. This case depicts the use of capnography during UGIE in diagnosing an acquired TEF.

Cardiovascular Complications of Obstructive Sleep Apnea in the Intensive Care Unit and Beyond.

Obstructive sleep apnea (OSA) is a common disease with a high degree of association with and possible etiological factor for several cardiovascular diseases. Patients who are admitted to the Intensive Care Unit (ICU) are incredibly sick, have multiple co-morbidities, and are at substantial risk for mortality. A study of cardiovascular manifestations and disease processes in patients with OSA admitted to the ICU is very intriguing, and its impact is likely significant. Although much is known about these cardiovascular complications associated with OSA, there is still a paucity of high-quality evidence trying to establish causality between the two. Studies exploring the potential impact of therapeutic interventions, such as positive airway pressure therapy (PAP), on cardiovascular complications in ICU patients are also needed and should be encouraged. This study reviewed the literature currently available on this topic and potential future research directions of this clinically significant relationship between OSA and cardiovascular disease processes in the ICU and beyond.

Management of Vasopressor-Induced Acute Limb Ischemia (VIALI) in Septic Shock.

Vasopressors used in critically ill patients with refractory shock poses a serious risk of non-occlusive peripheral limb ischemia leading to tissue necrosis and amputation. Acute limb ischemia is associated with high morbidity and mortality. Evidence-based medical literature is scarce on the prevention and management of vasopressor-induced acute limb ischemia (VIALI). Despite being a well-known and frequent complication of vasopressors, there is no standardized guideline for the prevention and management of vasopressor-induced limb ischemia. Vasopressors are required for the management of refractory shock which is defined as hypotension not responsive to intravenous fluid resuscitation alone. Distributive shock, which includes septic shock, causes inadequate tissue perfusion in adjunct with vasopressor use and is the most common cause of non-occlusive peripheral limb ischemia. This case study will focus on how early recognition and prompt treatment of VIALI are crucial in minimizing tissue necrosis and preventing amputations. We present a case of a middle-aged woman who developed distributive shock from sepsis of a urinary source secondary to obstructive uropathy (ureteral calculi). She presented with refractory shock and continued to remain in shock while undergoing emergent rigid cystoscopy with the placement of a ureteral stent. Despite adequate volume resuscitation, she required high doses of vasopressors resulting in peripheral extremity ischemia and necrosis of all her fingers and toes. By promptly initiating mitigation and preventive management strategies, we succeeded in minimizing tissue ischemia and reducing morbidity resulting from iatrogenic vasopressor-induced peripheral non-occlusive ischemia. These strategies include but are not limited to external warming of bilateral lower extremities, nitroglycerin paste application over the entire extremity, arterial assist pump, and low-dose therapeutic anticoagulation. The novel use of the arterial pump in acutely ischemic lower extremities likely helped salvage the toes which appeared to be at high risk of amputation.

A Review of the Quiz, as a New Dimension in Medical Education.

Over the years, medical education delivery has seen a change from teacher-centric to student-centric teaching-learning methods. Educators are constantly looking to develop interactive and innovative teaching-learning tools. One such supplementary tool is the use of the quiz for medical education. The Quiz has been used traditionally as a feedback assessment tool, but lately, it has found its way into the medical curriculum, mostly informally. The few available documented studies on the Quiz as a teaching and learning tool illustrate its acceptance and impact on the stakeholders. It could be one of the solutions to the endless search for a student-centric and engaging tool to deliver the medical curriculum. Commonly, the format for medical quiz is either on a case-based or image-based approach. Such an approach helps bridge the gap between traditional classroom teaching and clinical application. The Quiz is a readily acceptable tool that complements didactic lectures and improves students' learning and comprehension. Being an interactive student-centric tool, it enhances active student participation and encourages regular feedback mechanisms. It promotes healthy competition and peer-assisted learning by encouraging active discussion among students, hence improving student performance in standard examination techniques, along with teacher satisfaction. This literature review aims to enumerate the various formats of the Quiz, their role in improving the understanding and retention of knowledge among the students and assess their acceptability among the stakeholders.

Intraocular live cysticercus larva.

Ocular cysticercosis is one of the most common parasitic infections of the eye in humans. Although the adult pork tapeworm, Taenia solium, resides in the lumen of the intestine, the only structural element of an adult worm is usually found within a tissue cyst in the eye, its adenexa, or other places in the body with a single invaginated scolex. An unusual case is described in which a 13- to 14-mm live cysticercus larva was found, removed from the eye, and confirmed by histopathologic examination.