Percutaneous decannulation reduces procedure length and rates of groin wound infection in patients on venoarterial extracorporeal membrane oxygenation.

Objective: Open decannulation from femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) carries high risk of morbidity, including groin wound infection. This study evaluated the impact of percutaneous decannulation on rates of groin wound infection in patients decannulated from femoral VA-ECMO. Methods: Between January 1, 2022, and April 30, 2023, 47 consecutive patients received percutaneous femoral VA-ECMO and survived to decannulation. A percutaneous suture-mediated closure device was used for decannulation in patients with relatively smaller arterial cannulas. Patients with larger arterial cannulas or unsuccessful percutaneous closures underwent surgical cutdown and repair of the femoral artery. The primary outcome was arterial site wound infection following decannulation. Results: Among the 47 patients who survived to decannulation from VA-ECMO, 21 underwent percutaneous decannulation and 27 underwent surgical cutdown. One patient underwent 2 VA-ECMO runs, one with percutaneous decannulation and one with surgical cutdown. Percutaneous decannulation was attempted in 22 patients, with 21 of 22 (95.5%) success rate. Decannulation procedure length was significantly shorter in the percutaneous group (79 minutes vs 148 minutes, P = .0001). The percutaneous group had significantly reduced rates of groin wound complications (0% vs 40.7%, P = .001) and groin wound infections (0% vs 22.2%, P = .03) when compared with the surgical cutdown group. Three patients (14.3%) in the percutaneous group experienced vascular complications, including pseudoaneurysm at the distal perfusion catheter site and nonocclusive thrombus of the common femoral artery. Conclusions: Percutaneous decannulation may reduce decannulation procedure length and rate of groin wound infection in patients who survive to decannulation from VA-ECMO.

Demand-side load forecasting in smart grids using machine learning techniques.

Electrical load forecasting remains an ongoing challenge due to various factors, such as temperature and weather, which change day by day. In this age of Big Data, efficient handling of data and obtaining valuable information from raw data is crucial. Through the use of IoT devices and smart meters, we can capture data efficiently, whereas traditional methods may struggle with data management. The proposed solution consists of two levels for forecasting. The selected subsets of data are first fed into the "Daily Consumption Electrical Networks" (DCEN) network, which provides valid input to the "Intra Load Forecasting Networks" (ILFN) network. To address overfitting issues, we use classic or conventional neural networks. This research employs a three-tier architecture, which includes the cloud layer, fog layer, and edge servers. The classical state-of-the-art prediction schemes usually employ a two-tier architecture with classical models, which can result in low learning precision and overfitting issues. The proposed approach uses more weather features that were not previously utilized to predict the load. In this study, numerous experiments were conducted and found that support vector regression outperformed other methods. The results obtained were 5.055 for mean absolute percentage error (MAPE), 0.69 for root mean square error (RMSE), 0.37 for normalized mean square error (NRMSE), 0.0072 for mean squared logarithmic error (MSLE), and 0.86 for R2 score values. The experimental findings demonstrate the effectiveness of the proposed method.

Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score.

BACKGROUND: Left ventricular assist devices (LVAD) improve survival for patients with cardiac failure, but LVAD specific infections (VSI) remain a challenge with poorly understood predictive risk factors. Furthermore, the indications and utility of escalating medical treatment to surgical debridement and potential flap reconstruction are not well-characterized. STUDY DESIGN: A retrospective review of consecutive patients undergoing primary LVAD implantation at a tertiary academic center was performed. The primary outcomes measures were 90-day and overall mortality after VSI. Cox proportional hazards regression was used to generate a risk-prediction score for mortality. RESULTS: Of the 760 patients undergoing primary LVAD implantation, 255 (34%) developed VSI; of these 91 (36%) were managed medically, 134 (52%) with surgical debridement, and 30 (12%) with surgical debridement and flap reconstruction. One-year survival after infection was 85% with median survival of 2.40 years. Factors independently associated with increased mortality were diabetes (hazard ratio (HR) 1.44, p=0.04), methicillin-resistant Staphylococcus aureus infection (HR 1.64, p=0.03), deep space (pump pocket/outflow cannula) involvement (HR 2.26, p<0.001) and extra-corporeal membrane oxygenation after LVAD (HR 2.52, p<0.01. Factors independently associated with decreased mortality were flap reconstruction (HR 0.49, p=0.02) and methicillin-sensitive Staphylococcus aureus infection (HR 0.63, p=0.03). A clinical risk prediction score was developed using these factors and showed significant differences in median survival, which was 5.67 years for low-risk (score 0-1), 3.62 years for intermediate-risk (score 2), and 1.48 years for high-risk (score >3) (p<0.001) patients. CONCLUSIONS: We developed a clinical risk prediction score to stratify VSI patients. In selected cases, escalating surgical treatment was associated with increased survival. Future work is needed to determine if early surgical debridement and flap reconstruction can alter outcomes in select cases of VSI.

GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context.

INTRODUCTION: The prevalence of hyperthyroidism in Pakistan is 2.9%, which is two times higher than in the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) used internationally originate from high-income countries in the West. Local CPGs in Pakistan are not backed by transparent methodologies. We aimed to produce comprehensive, high-quality CPGs for the management of hyperthyroidism in Pakistan. METHODS: We employed the GRADE-ADOLOPMENT approach utilizing the 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis as the source CPG. Recommendations from the source guideline were either adopted as is, excluded, or adapted according to our local context. RESULTS: The source guideline included a total of 124 recommendations, out of which 71 were adopted and 49 were excluded. 4 recommendations were carried forward for adaptation via the ETD process, with modifications being made to 2 of these. The first addressed the need for liver function tests (LFTs) amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs (ATDs). The second pertained to thyroid status testing post-treatment by radioactive iodine (RAI) therapy for Graves' Disease (GD). Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management. CONCLUSION: Our newly developed hyperthyroidism CPGs for Pakistan contain two context-specific modifications that prioritize patients' finances during the course of hyperthyroidism management and to limit the overuse of laboratory testing in a resource-constrained setting. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations.

Scalable Lead Acetate-Based Perovskite Thin Films Prepared via Controlled Nucleation and Growth under Near Ambient Conditions.

Lead acetate (PbAc2) is a promising precursor salt for large-scale production of perovskite solar cells, as its high solubility in polar solvents enables the use of scalable deposition methods such as inkjet printing and dip coating. In this study, uniform (40-230 nm) PbAc2 thin films were prepared via dip coating under near ambient lab conditions by tuning the PbAc2 precursor concentration. In a second step, these PbAc2 films were converted to methylammonium lead iodide (MAPI) perovskite by immersing them into methylammonium iodide (MAI) solutions. The nucleation and growth processes at play were controlled by altering key parameters, such as air humidity during the lead acetate deposition and MAI concentration when converting the PbAc2 film to MAPI. The research revealed that lead acetate is sensitive toward humidity and can undergo hydroxylation reactions affecting the reproducibility and quality of the produced solar cells. However, drying the PbAc2 films under low relative humidity (<1%) prior to conversion enables the production of high-quality MAPI films without the need of glovebox processing. Furthermore, SEM characterization revealed that the surface coverage of the MAPI film increased significantly with an increase of the MAI concentration at the conversion stage. The resulting morphology of the MAPI films can be explained by a standard nucleation and growth mechanism. Preliminary solar cells were produced using these MAPI films as the active layer. The best performing devices were obtained with a 140 nm thick lead acetate film converted to MAPI using a 12 mg/mL MAI solution, as these parameters resulted in a good surface coverage of the MAPI film. The results show that the methodology holds potential toward large-scale production of perovskite solar cells under near ambient conditions, which substantially simplifies the fabrication and lowers the production costs.

Physiologic benefits of veno-pulmonary extracorporeal membrane oxygenation for COVID-19 ARDS: A single center experience.

BACKGROUND: A subset of patients with COVID-19 acute respiratory distress syndrome (ARDS) require extracorporeal membrane oxygenation (ECMO). Veno-pulmonary (VP) ECMO provides support to the right ventricle and decreased risk of recirculation. METHODS: A retrospective analysis of patients with COVID-19 ARDS and VP ECMO was performed. Patients were separated into groups by indication (1) "right ventricular (RV) failure," (2) "refractory hypoxemia," and (3) "recurrent suck-down events (SDEs)." Pre- and post-configuration vasoactive inotropic scores (VIS), fraction of inspired oxygen (FIO2), and resolution of SDEs were reported. A 90-day mortality was computed for all groups. Patients were also compared to those who underwent conventional venovenous (VV) ECMO. RESULTS: Forty-seven patients underwent VP ECMO configuration, 18 in group 1, 16 in group 2, and 8 in group 3. Ninety-day mortality was 66% for the entire cohort and was 77.8%, 81.3% and 37.5% for groups 1, 2, and 3, respectively. Mean VIS decreased in group 1 (8.3 vs 2.9, p = 0.005), while mean FIO2 decreased in the group 2 and was sustained at 72 h (82.5% vs 52.5% and 47.5%, p < 0.001). Six of the eight (75%) of patients with recurrent SDEs had resolution of these events after configuration to VP ECMO. Patients with VP ECMO spent more days on ECMO (33 days compared to 18 days, p = 0.004) with no difference in mortality (66% compared to 55.1%, p = 0.28). CONCLUSION: VP ECMO in COVID-19 ARDS improves hemodynamics in patients with RV failure, improves oxygenation in patients with refractory hypoxemia and improves the frequency of SDEs.

Advanced Respiratory Support Days as a Novel Marker of Mortality in COVID-19 Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation.

Emerging evidence suggests prolonged use of noninvasive respiratory support may increase mortality of patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome who require extracorporeal membrane oxygenation (ECMO). Using a database of adults receiving ECMO for COVID-19, we calculated survival curves and multivariable Cox regression to determine the risk of death associated with pre-ECMO use of high-flow nasal oxygen (HFNO), noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) days. We investigated the performance of a novel variable, advanced respiratory support days (composite of HFNO, NIV, and IMV days), on Respiratory ECMO Survival Prediction (RESP) score. Subjects (N = 146) with increasing advanced respiratory support days (<5, 5-9, and ≥10) had a stepwise increase in 90 day mortality (32.2%, 57.7%, and 75.4%, respectively; p = 0.002). Ninety-day mortality was significantly higher in subjects (N = 121) receiving NIV >4 days (81.8% vs. 52.4%, p < 0.001). Each additional pre-ECMO advanced respiratory support day increased the odds of right ventricular failure (odds ratio [OR]: 1.066, 95% confidence interval [CI]: 1.002-1.135) and in-hospital mortality (1.17, 95% CI: 1.08-1.27). Substituting advanced respiratory support days for IMV days improved RESP score mortality prediction (area under the curve (AUC) or: 0.64 vs. 0.71). Pre-ECMO advanced respiratory support days were associated with increased 90 day mortality compared with IMV days alone. Adjusting the RESP score for advanced respiratory support days improved mortality prediction.

Recurrence of portosystemic encephalopathy in cirrhotic patients and its risk factors.

Objectives: Recurrent episodes of Portal Systemic Encephalopathy (PSE), poses a significant burden of illness on the patients and healthcare system. The objective of this study was to assess the recurrence of PSE in cirrhotic patients after index episode of PSE and to identify various risk factors associated with it. Methods: A retrospective, single-centre study was conducted at Aga Khan University Hospital over a span of one year. Patients who were admitted first time with PSE and admitted within three months of index PSE were enrolled in the study. Variables assessed were demographic data, associated comorbid conditions, aetiology of cirrhosis, Child-Turcotte-Pugh (CTP) score, Model of End-Stage Liver Disease (MELD) score, PSE grade, laboratory tests, ascites with spontaneous bacterial peritonitis (SBP), variceal bleeding. Statistical analysis was done and variables of those who developed recurrence were compared with those who did not. Results: Fifty one patients were recruited. Thirty three (64.7%) were readmitted with PSE. On comparative analysis of both groups; infection, Meld score, low albumin, and raised total bilirubin showed significant P-value (<0.05). Conclusion: Identification of risk factors during assessment can reduce the recurrence of PSE. We would recommend to validate result of our study on a large scale prospectively.

Antioxidant, carbonic anhydrase inhibition and diuretic activity of Leptadenia pyrotechnica Forssk. Decne.

Background: Leptadenia pyrotechnica Forssk. Decne is a member of family Apocynaceae and locally known as 'Khipp'. It is found in dry, sandy habitat of Pakistan and in several other regions around the world including Asia, Tropical Africa, Western Gulf and Mediterranean countries. It has nutritional value, containing 4 % lipids, 23 % proteins, 28 % carbohydrates, 4 % fibers, vitamin E and several minerals. Traditionally, this plant has been used by several communities for pain, different inflammatory and kidney disorders. Ethno-botanical studies have reported the use of L. pyrotechnica in nephrolithiasis, kidney disorders and induction of diuresis, which requires a detailed pharmacological study to validate the folkloric use of L. pyrotechnica as diuretic. Methods: The 70 % methanolic L. pyrotechnica (Lp.Cr) extract was prepared and qualitatively checked for the presence of various phytochemicals. Phenolic, flavonoid, tannin and saponin contents were quantified. GC-MS analysis of Lp.Cr was also performed. Antioxidant potential of Lp.Cr was evaluated by DPPH, ABTS and nitrite radical scavenging assays. CUPRAC and FRAP assay described the reducing potential of Lp.Cr. Diuretic activity was performed in both acute and prolonged models at different doses followed by the estimation of electrolytes, urea and creatinine levels. The mechanism of diuresis was described by pre-treatment with atropine, l-NAME, indomethacin and carbonic anhydrase inhibition. Results: Lp.Cr. indicated high phenolic and flavonoid contents which correlated with good antioxidant activity. GC-MS analysis showed the presence of 104 compounds from different phytochemical classes. Diuretic activity was performed at 10-300 mg/kg concentrations where the dose of 100 and 300 mg/kg showed good diuretic and saluretic activity comparable to furosemide. Lp.Cr exhibited diuresis both in acute and prolonged study protocols which can be attributed to carbonic anhydrase inhibition, effect on prostaglandins and cholinergic pathways. Conclusion: L. pyrotechnica contained several phytochemicals and exhibited good antioxidant activity. It induced diuresis and saluretic activity which was comparable to furosemide at higher doses. Diuretic activity can be attributed to carbonic anhydrase inhibition, prostaglandin synthesis and cholinergic pathways.

Design and performance assessment of modular multi-band photonic-integrated WSS.

Today, optical transport and data center networks extensively utilize photonic integrated systems due to their large bandwidth and a high degree of reconfigurability. In addition to these properties, photonic integrated-based systems can deliver an overall low fabrication cost, a small footprint, and low power consumption. In this perspective, we present a modular photonic integrated multi-band wavelength selective switch (WSS) capable of managing a wide spectrum, covering the three S+C+L bands, and potentially scalable to larger numbers of output fibers and routed channels. We propose a complete description of the device starting from the physical level, commenting on the device's internal structure and design-related issues. Then, we move to the transmission level, providing a complete abstraction of the proposed WSS in the context of software-defined optical networks by providing a deterministic model to evaluate the routing controls, thermal spectral tunability, and the quality of transmission degradation. Finally, a transmission scenario operating on 400ZR standards and a network case study are also demonstrated to evaluate the performance of the proposed WSS in a single or multistage cascade setup.

Efficacy and Tolerability of Semaglutide in Patients With Type-2 Diabetes Mellitus: Experience of a Tertiary Care Hospital, Pakistan.

Background: Semaglutide, a Glucagon-like peptide 1 (GLP-1) is highly effective as an anti-diabetic medication along with additional benefits of significant reduction in cardiovascular events and weight. Objectives: There is a lack of reliable evidence confirming the benefits of Semaglutide in the Pakistani cohort. Our study aims to ascertain the efficacy of Semaglutide in the Pakistani cohort and patient satisfaction. Methods: An ambi-directional cohort study was conducted from August 2022 to January 2023 at The Aga Khan University Hospital, Karachi, Pakistan. A chart review was done for all patients with Type 2 diabetes who were prescribed Semaglutide, and baseline data was recorded. Patients were followed prospectively in the endocrinology clinics after at least 3 months for the change in HbA1c, BMI, adverse effects profile, treatment satisfaction questionnaire for medications (TSQM-9) and medication effect score. Mean + STD or median with IQR were computed for continuous data, while categorical variables and percentages were measured. The association between variables was assessed by applying the chi-square test. Results: A total of 112 patients were recruited who took the medication for at least 3 months. The mean age of the patients was 50.9 ± 10.5 years with 51.2% females. The mean difference in weight, body mass index, fasting blood glucose, HbA1c, and medication effect score were decreasing from baseline to follow-up (-4.0 kg, -1.5 kg/m2, -23.1 mg/dl, -1.2%, -0.4) respectively. A decrease in appetite was reported in 72.7% of the participants. The major adverse effects observed were dyspepsia (21.4%) followed by nausea (20.5%) and constipation (19.6%). Medication was discontinued in 9.8% of patients due to gastrointestinal side effects. The majority (72.3%) of patients were satisfied with their medication. Conclusion: Semaglutide is effective in reducing HbA1c and weight in Pakistani population with measurable tolerability and patient satisfaction.

Exposure to, understanding of and interest in interventional radiology among Pakistani medical students: a cross-sectional study.

Background: Medical students need more awareness regarding minimally invasive image-guided procedures carried out by interventional radiological approach. This study analyzed the knowledge and attitudes of medical students regarding interventional radiology (IR) and the factors influencing their decision to choose IR as a specialty in the future. Methods: A cross-sectional, web-based study was conducted among medical students across Pakistan. The data were collected from October 14, 2021, to November 14, 2021. The questionnaire included demographic variables, exposure, interest, and self-reported knowledge of IR, interventions, instruments utilized in IR, and the responsibilities of the interventional radiologist. Variables affecting the possible choice of IR as a future career were analyzed using logistic regression analysis. Results: The median age was 22 years, with a male predominance. 65.5% exhibited an interest in radiology, and 20.2% in IR. The majority, 83.5%, perceived IR. As having good to adequate prospects. Male participants preferred IR more as compared to females. Participants willing to attend IR rotation and had an excellent view of IR as a specialty had higher propensity towards IR as a future career than their counterparts. The majority opted for IR as a better-paying job with lots of intellectual stimulation and career flexibility. Conclusion: IR is a demanding specialty with rigorous routines but reasonable monetary compensation. Lack of infrastructure and low numbers of trained specialists limit medical students' exposure to IR in developing health economies like Pakistan. Clinical rotations in IR departments would help raise awareness about the field and bridging this gap.

Characterization of de novo malignancy after orthotopic heart transplantation: single-centre outcomes over 20 years.

OBJECTIVES: Malignancy is the leading cause of late mortality after orthotopic heart transplantation (OHT), and the burden of post-transplantation cancer is expected to rise in proportion to increased case volume following the 2018 heart allocation score change. In this report, we evaluated factors associated with de novo malignancy after OHT with a focus on skin and solid organ cancers. METHODS: Patients who underwent OHT at our institution between 1999 and 2018 were retrospectively reviewed (n = 488). Terminal outcomes of death and development of skin and/or solid organ malignancy were assessed as competing risks. Fine-Gray subdistribution hazards regression was used to evaluate the association between perioperative patient and donor characteristics and late-term malignancy outcomes. RESULTS: By 1, 5 and 10 years, an estimated 2%, 17% and 27% of patients developed skin malignancy, while 1%, 5% and 12% of patients developed solid organ malignancy. On multivariable Fine-Gray regression, age [1.05 (1.03-1.08); P < 0.001], government payer insurance [1.77 (1.20-2.59); P = 0.006], family history of malignancy [1.66 (1.15-2.38); P = 0.007] and metformin use [1.73 (1.15-2.59); P = 0.008] were associated with increased risk of melanoma and basal or squamous cell carcinoma. Age [1.08 (1.04-1.12); P < 0.001] and family history of malignancy [2.55 (1.43-4.56); P = 0.002] were associated with an increased risk of solid organ cancer, most commonly prostate and lung cancer. CONCLUSIONS: Vigilant cancer and immunosuppression surveillance is warranted in OHT recipients at late-term follow-up. The cumulative incidence of skin and solid organ malignancies increases temporally after transplantation, and key risk factors for the development of post-OHT malignancy warrant identification and routine monitoring.

Computational Studies on Diverse Characterizations of Molecular Descriptors for Graphyne Nanoribbon Structures.

Materials made of graphyne, graphyne oxide, and graphyne quantum dots have drawn a lot of interest due to their potential uses in medicinal nanotechnology. Their remarkable physical, chemical, and mechanical qualities, which make them very desirable for a variety of prospective purposes in this area, are mostly to blame for this. In the subject of mathematical chemistry, molecular topology deals with the algebraic characterization of molecules. Molecular descriptors can examine a compound's properties and describe its molecular topology. By evaluating these indices, researchers can predict a molecule's behavior including its reactivity, solubility, and toxicity. Amidst the captivating realm of carbon allotropes, γ-graphyne has emerged as a mesmerizing tool, with exquisite attention due to its extraordinary electronic, optical, and mechanical attributes. Research into its possible applications across numerous scientific and technological fields has increased due to this motivated attention. The exploration of molecular descriptors for characterizing γ-graphyne is very attractive. As a result, it is crucial to investigate and predict γ-graphyne's molecular topology in order to comprehend its physicochemical characteristics fully. In this regard, various characterizations of γ-graphyne and zigzag γ-graphyne nanoribbons, by computing and comparing distance-degree-based topological indices, leap Zagreb indices, hyper leap Zagreb indices, leap gourava indices, and hyper leap gourava indices, are investigated.

Unlocking the Mysteries, Bridging the Gap, and Unveiling the Multifaceted Potential of Stem Cell Therapy for Cardiac Tissue Regeneration: A Narrative Review of Current Literature, Ethical Challenges, and Future Perspectives.

Revolutionary advancements in regenerative medicine have brought stem cell therapy to the forefront, offering promising prospects for the regeneration of ischemic cardiac tissue. Yet, its full efficacy, safety, and role in treating ischemic heart disease (IHD) remain limited. This literature review explores the intricate mechanisms underlying stem cell therapy. Furthermore, we unravel the innovative approaches employed to bolster stem cell survival, enhance differentiation, and seamlessly integrate them within the ischemic cardiac tissue microenvironment. Our comprehensive analysis uncovers how stem cells enhance cell survival, promote angiogenesis, and modulate the immune response. Stem cell therapy harnesses a multifaceted mode of action, encompassing paracrine effects and direct cell replacement. As our review progresses, we underscore the imperative for standardized protocols, comprehensive preclinical and clinical studies, and careful regulatory considerations. Lastly, we explore the integration of tissue engineering and genetic modifications, envisioning a future where stem cell therapy reigns supreme in regenerative medicine.

In Situ Synthesis of Crystalline MoS2@ZIF-67 Nanocomposite for the Efficient Removal of Methyl Orange Dye from Aqueous Media.

The zeolitic imidazolate framework-67 (ZIF-67) adsorbent and its composites are known to effectively remove organic dyes from aqueous environments. Here, we report a unique crystalline MoS2@ZIF-67 nanocomposite adsorbent for the efficient removal of methyl orange (MO) dye from an aqueous medium. In situ synthetic techniques were used to fabricate a well-crystalline MoS2@ZIF-67 nanocomposite, which was then discovered to be a superior adsorbent to its constituents. The successful synthesis of the nanocomposite was confirmed using XRD, EDX, FTIR, and SEM. The MoS2@ZIF-67 nanocomposite exhibited faster adsorption kinetics and higher dye removal efficiency compared with its constituents. The adsorption kinetic data matched well with the pseudo-second-order model, which signifies that the MO adsorption on the nanocomposite is a chemically driven process. The Langmuir model successfully illustrated the MO dye adsorption on the nanocomposite through comparing the real data with adsorption isotherm models. However, it appears that the Freundlich adsorption isotherm model was also in competition with the Langmuir model. According to the acquired thermodynamics parameters, the adsorption of MO on the MoS2@ZIF-67 nanocomposite surface was determined to be spontaneous and exothermic. The findings of this research open an avenue for using the MoS2@ZIF-67 nanocomposite to efficiently remove organic dyes from wastewater efflux.

Effect of Electrocoagulation and Direct Pressure Application on Bleeding from Liver Bed During Laparoscopic Cholecystectomy.

OBJECTIVE: To compare the efficacy of electrocoagulation and direct pressure application in controlling haemorrhage from the liver bed during laparoscopic cholecystectomy. STUDY DESIGN: Randomized controlled trial. Place and Duration of the Study: Department of General Surgery, Sir Ganga Ram Hospital, Lahore, Pakistan, from July 2021 to December 2021. METHODOLOGY: A total of 218 patients of either gender, aged 18 to 60 years and with bleeding from the liver bed during laparoscopic cholecystectomy were randomly allocated to two groups of haemorrhage control techniques. In group A, electrocoagulation was used and in group B, direct pressure was applied to the bleeding area for 5 minutes. Efficacy in controlling bleeding was compared in both groups. RESULTS: The mean age of all study participants was 44.6 + 13.5 years. The majority of the patients were females (89%). The mean body mass index (BMI) of all participants was 25.3 ± 3.09 kg/m2. Intraoperative bleeding was secured in 86.2% of patients in Group A vs. 81.7% of patients in Group B. However, the difference was not statistically significant (p=0.356). In 27 (12.4%) cases, bleeding could not be controlled by both of these techniques. In these cases, endosuturing was applied in 19 (70.4%) cases, spongostan in 6 (22.2%) cases, and endo-clips in 2 (7.4%) cases. Intraoperative drain and conversion to open procedure was required in 1 patient each, both belonging to the direct pressure application group. CONCLUSION: The efficacy of electrocoagulation in securing haemorrhage from the liver bed is better than the direct pressure application technique. KEY WORDS: Laparoscopic cholecystectomy, Haemorrhage, Electrocoagulation, Surgical hemostasis, Liver bed.