Predictors of cognitive impairment and its association with mortality in maintenance hemodialysis patients: A prospective follow-up study.

Objective: To determine predictors of cognitive impairment (CI) and its association with mortality in maintenance haemodialysis (MHD) patients. Methods: This prospective follow up study was conducted at HD Department, Mayo Hospital, Lahore from September, 2021 to November, 2022. All patients undergoing MHD for more than three months and having age between 18-65 years were included while those with dialysis duration less than three months, history of neuropsychiatric illness was excluded. Cognitive function was assessed using British Columbia Cognitive Complaints Inventory (BC-CCI) questionnaire. CI was defined on Likert scale as mild, moderate, and severe. Patients were followed up to one year regarding outcome measures. Results: One hundred and four patients were included in the study. Mean age was 45.86±11.11 years and Diabetes Mellitus (DM) was the most common cause of End Stage Renal Disease (ESRD) in 39(37.5%) patients. CI was found in 86(82.7%) patients in following order of severity: mild 61(58.7%), moderate 19(18.3%) and severe 6(5.9%). Increasing age (≥50 years), gender (female), Diabetes Mellitus (DM), unemployment and education <10th grade were found as significant predictors of CI (p<0.05). Significant positive correlations of CI score with age (r=0.338, p<0.001) and MHD duration (r=0.211, p=0.032) were found. However, the CI was not significantly associated with mortality (p=0.302). Conclusion: CI was common in MHD patients. Factors affecting CI were increasing age, female gender, DM, unemployment and low education level. CI was not associated with mortality in MHD patients.

Comparative phytochemical study of methanolic and ethanolic extracts of Thymus linearis and their antibacterial and antioxidant potential.

Thymus linearis (Thyme) is a medicinal plant widely distributed throughout Asia. Various parts of thyme are utilized for diverse medicinal purposes, including its use as a tonic and diuretic, for cough relief, as a flavoring agent, in treating dysentery, and for alleviating stomach disorders. Numerous studies have been conducted to explore the unexploited potential of thyme. Thyme was collected from the northern region of Pakistan, and sun-mediated extraction was conducted. Phytochemical analysis, utilizing GC-MS, revealed numerous bioactive phytochemical constituents with disease-preventing roles, including detoxifying agents, antioxidants, anticancer compounds, dietary fiber, neuropharmacological agents, and immunity-potentiating agents, in the methanolic and ethanolic (14 days) extracts of the flower, leaf, and stem. The 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay results indicated that the ethanolic and methanolic extracts of the stem exhibited the highest antioxidant activity, reaching up to 67.34% and 62.73%, respectively, while the values for the flower and leaf extracts (both methanol and ethanol) were around 60%. The IC50 (half maximal inhibitory concentration) values were also calculated for all the samples, ranging between 7 and 9 µg/mL. Positive antibacterial and antifungal effects against Bacillus subtilis and Escherichia coli, as well as Aspergillus niger (fungi), were observed only in the extracts of the flower (both methanol and ethanol). The sun-mediated technique was used for extraction for the first time in this study. Therefore, this study introduces a novel approach to the extraction of bioactive compounds from medicinal plants, ultimately contributing to the development of herbal drugs with more convenient and cost-effective methods.

A rare case of hyperchloraemic normal anion gap metabolic acidosis due to absorption of normal saline irrigation fluid during holmium laser enucleation of prostate.

Holmium laser enucleation of the prostate (HoLEP) is the preferred technique for surgical management of benign prostatic hyperplasia in prostates over 80 cc in size. A 72-year-old male underwent a HoLEP for catheter-dependent urinary retention in the context of a 204 cc prostate. At the end of the procedure he was clinically overloaded and had developed a combined respiratory and hyperchloremic normal anion gap metabolic acidosis secondary to excessive absorption of normal saline irrigation fluid. He was transferred to the ICU for diuresis and supportive care where he made a full recovery.

Hydrothermal synthesis of V2O5/TiO2 decorated graphitic carbon nitride nanocomposite for biomolecule oxidation inhibition and dye degradation applications.

Oxides of vanadium, titanium and graphitic carbon nitride (g-C3N4) are well known for their catalytic activities. In order to achieve synergic catalytic effects, a novel nanocomposite (NC) i.e. V2O5/TiO2/g-C3N4 has been synthesized by a very simple, ecofriendly and nonhazardous hydrothermal method. The fabricated NC was characterized employing UV-Visible, FTIR, SEM, and XRD techniques. UV-Visible and FTIR analysis indicated the formation of the nanocomposite and XRD analysis confirmed the association of V2O5 and TiO2 with g-C3N4 in nanocomposite. SEM study indicated the hetero-structure of NC having size ranging from 50 to 80 nm and it was found having hexagonal crystallite structure. The synthesized nanocomposite exhibited excellent scavenging of free radicals DPPH● (91%) and ABTS●+ (64%) that are responsible for the oxidation of biomolecules. Therefore, NC can be claimed having biomolecule oxidation protective potential. In addition, photocatalytic ability for the degradation of methylene blue (MB) and methyl orange (MO) was also achieved up to 94% and 89% respectively. The synthesized novel nanocomposite exhibited excellent potential to remove free radicals and dyes from aqueous medium which can be further used for the environmental remediation.

The Effects of Probiotics on Cholesterol Levels in Patients With Metabolic Syndrome: A Systematic Review.

The prevalence of metabolic syndrome has been increasing over the past few years, especially in the United States. As a result, it increases the risk of heart disease, stroke, and diabetes mellitus, thus causing significant health issues. Probiotics have been studied to have effects on maintaining blood cholesterol levels by altering the gut microbiota. This systematic review aims to find the effects that probiotics would have on lipid levels when given to patients with metabolic syndrome. In total, articles collected from PubMed, Google Scholar, and ScienceDirect were analysed. The results of the majority of the studies revealed that probiotics have some significant effects on cholesterol levels. It has shown a reduction in triglycerides and lower-density lipoprotein (LDL), thereby decreasing cholesterol levels in the blood. However, further investigations must be carried out so in order to create a more detailed and specific explanation of the effects and mechanisms of probiotics on maintaining cholesterol levels in the blood.

Biomolecule Protective and Photocatalytic Potential of Cellulose Supported MoS2/GO Nanocomposite.

In the current study, cellulose/MoS2/GO nanocomposite has been synthesized by a hydrothermal method. Reports published regarding efficiency of Mo and graphene oxide-based nanocomposites for environmental remediation motivated to synthesize cellulose supported MoS2/GO nanocomposite. Formation of nanocomposite was initially confirmed by UV-visible and FTIR spectroscopic techniques. Particle size and morphology of the nanocomposite were assessed by scanning electron microscopy (SEM), and it was found having particle size ranging from 50 to 80 nm and heterogeneous structure. The XRD analysis also confirmed the structure of the nanocomposite having cellulose, MoS2, and GO. The synthesized nanocomposite was further tested for biomolecule protective potential employing different radical scavenging assays. Results of radical DPPH● (50%) and ABTS ●+ (51%) scavenging studies indicate that nanocomposites can be used as a biomolecule protective agent. In addition, nanocomposite was also evaluated for photocatalytic potential, and the results showed excellent photocatalytic properties for the degradation of 4-nitrophenol up to 75% and methylene blue and methyl orange up to 85% and 70%, respectively. So, this study confirmed that cellulose supported/stabilized MoS2/GO nanocomposite can be synthesized by an ecofriendly, cost-effective, and easy hydrothermal method having promising biomolecule protective and photocatalytic potential.

Recyclable Cu-Ag bimetallic nanocatalyst for radical scavenging, dyes removal and antimicrobial applications.

An ecofriendly and cost effective green method has been used for the synthesis of recyclable, high functional nanoparticles. Bimetallic nanoparticles (BmNPs), Cu-Ag, have been synthesized using beetroot extract as reducing and capping agent. Formation of BmNPs was initially confirmed by UV-visible analysis, having distinct peaks of Ag at 429 nm and Cu at 628 nm. FTIR analysis also confirmed the association of bioactive phytochemicals with Cu-Ag nanoparticles. Crystallinity and morphology of BmNPs was determined through X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), dynamic light scattering (DLS) and energy dispersion X-ray spectroscopy (EDAX). The size of spherical shape Cu-Ag BmNPs was found to be 75.58 nm and EDAX studies confirmed the percent elemental composition of Cu and Ag in synthesized nanocatalyst. Results of different analysis provided supported evidences regarding the formation of BmNPs. Catalytic potential of BmNPs was tested for the degradation of rhodamine B (Rh-B), methylene blue (MB) and methyl orange (MO) dyes. Cu-Ag BmNPs exhibited outstanding catalytic activity for the degradation of selected organic dyes and percent degradation was recorded more than 90% for each dye. In addition, antiradical property of BmNPs was tested employing DPPH● and ABTS●+ assays and it was found to be promising. Synthesized BmNPs also exhibited strong antimicrobial activity against Salmonella typhimurium and Bacillus subtilis. Recyclability of nanoparticles was also evaluated and recovery from dye degradation reaction mixture was successfully achieved. The recovered nanoparticles exhibited same catalytic potential for the degradation of Rh-B. The objective of the current study was to synthesize BmNPs Cu-Ag employing a cost effective green method having promising catalytic, antiradical and antimicrobial potential. Further, BmNPs were reused after recovery from catalytic reactions, proving that BmNPs can be recycled having the same efficiency as that of a freshly prepared Cu-Ag BmNPs.

Green synthesis of graphene-based metal nanocomposite for electro and photocatalytic activity; recent advancement and future prospective.

The presence of pollutants in waste water is a demanding problem for human health. Investigations have been allocated to study the adsorptive behavior of graphene-based materials to remove pollutants from wastewater. Graphene (GO) due to its hydrophilicity, high surface area, and oxygenated functional groups, is an effective adsorbent for the removal of dyes and heavy metals from water. The disclosure of green synthesis opened the gateway for the economic productive methods. This article reveals the fabrication of graphene-based composite from aloe vera extract using a green method. The proposed mechanism of GO reduction via plant extract has also been mentioned in this work. The mechanism associated with the removal of dyes and heavy metals by graphene-based adsorbents and absorptive capacities of heavy metals has been discussed in detail. The toxicity of heavy metals has also been mentioned here. The Polyaromatic resonating system of GO develops significant π-π interactions with dyes whose base form comprises principally oxygenated functional groups. This review article illustrates a literature survey by classifying graphene-based composite with a global market value from 2010 to 2025 and also depicts a comparative study between green and chemical reduction methods. It presents state of art for the fabrication of GO with novel adsorbents such as metal, polymer, metal oxide and elastomers-based nanocomposites for the removal of pollutants. The current progress in the applications of graphene-based composites in antimicrobial, anticancer, drug delivery, and removal of dyes with photocatalytic efficacy of 73% is explored in this work. It gives a coherent overview of the green synthesis of graphene-based composite, various prospective for the fabrication of graphene, and their biotoxicity.

Investigation on the role of graphene-based composites for in photocatalytic degradation of phenol-based compounds in wastewater: a review.

The ineptitude of conventional water management systems to eradicate noxious compounds leads to the development of advanced treatment systems. The disclosure of graphene-based photocatalytic degradation for the eradication of phenolic compounds has become the "apple of the eye" for many researchers. This review article describes the advanced research progress during the period of 2008-2021 in graphene-based nanocomposites and discusses their different synthesis methods. We will also talk about the applications of nanocomposite in water splitting, dye degradation, solar fuel generations, and organic transformations. Multicomponent heterojunction structure, co-catalyst cohering, and noble metal coupling have been inspected to enhance the photocatalytic performance of graphene-based composite by increasing charge separation and stability. The photocatalytic system's remarkable stability has been described in terms of facile recyclability. The adsorption ability of phenolic compounds has been addressed in the form of Langmuir and Freundlich adsorption isotherm with various factors (pH, concentration, the intensity of light, the effect of catalyst, the effect of time, etc.). The purpose of this review is to survey mechanisms and processes that enlist graphene-based composite in terms of efficacy and dose of catalyst required to attain 99% degradation. Nanoparticles may cause toxicity and a pretext for their toxicity has been mentioned. Finally, it is anticipated that this article could allocate consequential knowledge to fabricating graphene-based composites that are in crucial demand of being discussed in future research.

Fabrication of graphene-oxide and zeolite loaded polyvinylidene fluoride reverse osmosis membrane for saltwater remediation.

Incorporation of inorganic and organic materials in polymer has contributed well towards the development of advanced reverse-osmosis membranes; with greater permeation, and salt rejection potential. We are reporting, Zeolite/GO/PVDF based thin-film composite membranes that were successfully synthesized by solution casting process, an eco-friendly, low-cost, and biocompatible technique. PVDF membranes modified with different ratios of GO/Zeo (0.03, 0.05 and 0.07) were characterized by FTIR, SEM, XRD, TGA, and DSC. Membranes were then tested for its potential for water permeation and salt rejection abilities. As prepared membranes owe better pore-distribution, a moderate degree of crystallinity and high absorption capability that is highly needed for micro-filtration phenomena used for desalination of saline water. The modified membranes exhibited enhanced water permeability up to 28.9 L/m2h as compared to pure PVDF membrane having water permeability flux of 15.6 L/m2h. Salt-rejection ability was found increasing for the membranes (up to 98%) modified with different concentration of GO/Zeo, as compare to pure PVDF membrane (82%). During water permeation and salt rejection studies, no deleterious impact was noted for modified PVDF membranes. This development will entail an efficient approach to furnish high-level performance reverse-osmosis membranes, with greater osmotic-pressure bearing capacity and higher stability.

Using Echocardiography and Biomarkers to Determine Prognosis in Peripartum Cardiomyopathy: A Systematic Review.

Peripartum cardiomyopathy (PPCM) is a rare but debilitating form of heart failure that affects pregnant women. Although PPCM has a high rate of complete resolution, some patients often have a progressive disease and develop significant morbidity and mortality. Making an accurate prediction of outcomes and identifying those patients at the highest risk has proven difficult over the years. This study aimed to establish if we can use echocardiographic parameters and biomarkers as reliable indicators of prognosis. A predetermined systematic search strategy was employed in four databases: PubMed, Google Scholar, Science Direct, and Cochrane Library to include articles from the last 15 years (January 2007 to January 2022). Data from 12 studies were synthesized and included in this study. Although no parameter proved consistent in all the studies, echocardiographic parameters, including strain profiles and biomarkers, proved significant in the prognostication of patients with PPCM in the various studies evaluated. Therefore, a holistic approach is still needed in the risk stratification of patients with PPCM. Future studies should evaluate these parameters as well as clinical characteristics in a larger cohort study with a long follow-up period of more than one year in order to potentially develop prognostic score criteria that can be used to accurately identify those patients at the highest risk of developing severe disease or death to allow for timely and targeted therapies to improve outcomes in these patients.

The Role of Glucosamine and Chondroitin Sulfate in the Prevention of Colorectal Cancer: A Systematic Review.

Currently, colorectal cancer is the third most common cancer in the world. Recently, glucosamine and chondroitin have gained popularity for their beneficial effects on cancer. They have already been recognized for their therapeutic role in osteoarthritis. This systematic review aims to analyze the relationship between the combined consumption of glucosamine and chondroitin and the prevention of colorectal cancer. Three databases: PubMed, Google Scholar, and Science Direct, were searched to collect relevant articles. After screening full-text articles, seven studies were included in the systematic review. The review found a supportive association between glucosamine and chondroitin and the decreased incidence of colorectal cancer. Through an anti-inflammatory effect on the cell signaling pathway, the supplementation caused a reduction in colorectal cancer occurrence. The dose, frequency of usage of the supplement, and weight of individuals, along with the use of non-steroidal anti-inflammatory drugs, also affected the efficacy. To further assess this relationship, it is necessary to conduct double-blind, randomized controls trials for the supplements in cancer prevention and further explore their safety and efficacy with different ethnicities, drugs, doses, and weight individuals.

Transcatheter Occluder Devices for the Closure of Atrial Septal Defect in Children: How Safe and Effective Are They? A Systematic Review.

Atrial septal defect (ASD) is a hole in the interatrial septum (IAS) of the heart that is one of the most common congenital heart diseases (CHD). Percutaneous transcatheter device occlusion is one of the techniques that have been developed for the closure of atrial septal defects. The primary objective of this study is to assess the safety and efficacy of septal occluder devices in the management of atrial septal defect in children. We searched PubMed, Science Direct, and Google Scholar databases to collect relevant articles according to a predetermined eligibility criteria and included 21 papers of different study designs in this systematic review. We found that transcatheter closure is safe and effective in most children with ASD. The major complications reported could be avoided by comprehensive clinical assessment and echocardiographic evaluation to determine appropriate device size and implantation strategy per individual child. Further research involving more clinical trials with larger sample size and longer duration of followup is required to improve the safety of existing devices for their use in all children with ASD despite their weight and defect size, and also the efficacy of newer devices such as biodegradable septal occluders.

Amalgamation and Scrutinizing of Leucine Derivatives Schiff Bases Complexes as Antimicrobial Agent.

The enhanced applications of Schiff bases metal complexes of amino acid derivatives have captured the attention of researchers for the synthesis of leucine derivatives of Schiff bases metal complexes. Amino acids are considered to be essential part of food supplements as well as derivatives of Schiff bases in coordination chemistry due to their donor ability. The leucine derivatives Schiff bases ligand have been synthesized by condensation reaction between amine of leucine with aldehyde or ketone bearing molecules attached with them. These complexes were characterized by different spectroscopic tools in order to confirm their structural geometries. The structural geometries are considered to be very important in order to improve the antimicrobial potential of leucine derivative metal complexes. By taking into account the antimicrobial potential of titled compounds, a comprehensive review of leucine derivatives of Schiff bases metal complexes has been compiled.

COVID-19 Vaccination-Associated Myocarditis: A Literature Review.

Myocarditis is defined as a non-ischemic inflammation of the middle layer of the heart. It ensues changes that can lead to acute heart failure, dilated cardiomyopathy, and sudden death. Myocarditis is caused by several infectious and non-infectious agents. Vaccines are also known to cause myocarditis. The use of the coronavirus disease (COVID-19) vaccination was started to combat the severity of the COVID-19 infection and reduce the mortality and morbidity associated with it. The vaccination, however, caused side effects like myocarditis, among others. In order to investigate the association between the COVID-19 vaccination and myocarditis in adults and adolescents, we conducted a literature review by searching three databases: Google Scholar, PubMed, and ScienceDirect. From the published literature, we found that, though it is rare, the various vaccinations available can cause symptoms of myocarditis as a side effect more commonly in patients who have received both doses of a particular vaccine and that there are significant changes in cardiac magnetic resonance imaging (CMRI) and other biochemical markers, with young males being more commonly affected. Further prospective trial-based studies are required to establish a concrete relationship between myocarditis and the COVID-19 vaccine.

Enhanced visible light photocatalytic activity of TiO2 co-doped with Fe, Co, and S for degradation of Cango red.

The photocatalytic activity of TiO2 was enhanced under visible light when it was co-doped with Fe, Co, and S through the sol-gel method. The resultant nano photocatalysts were characterized by XRD, EDX coupled with SEM, FT-IR, UV-Vis, and UV-DRS. The concentration ratio of precursor salts of Fe and S was kept at 1% each and of Co varied between 0.5% -1.5%. The photodegradation of Congo red was carried out and various factors like the concentration of catalyst, initial concentration of dye, pH, and irradiation time were also investigated to optimize the degradation process. Under optimized degradation conditions, 99.3% of Congo red (30 ppm) was degraded at slightly acidic pH, with 0.14 g of photocatalyst within 70 min of irradiation time.

Hereditary haemochromatosis, haemophagocytic lymphohistiocytosis and COVID-19.

BACKGROUND: Syndromes of iron overload have been shown to increase the risk of severe clinical disease in viral infections. Immune dysfunction is similarly described in hereditary haemochromatosis (HH). We present here the case of a 51-year-old man who developed severe coronavirus disease 2019 (COVID-19) complicated by suspected haemophagocytic lymphohistiocytosis (HLH). He was found to have HH post-mortem and we propose a link between his iron overload and the development of severe COVID-19. CASE REPORT: The initial clinical presentation consisted of cough, shortness of breath and fever. Pancytopenia, markedly elevated ferritin and d-dimer were present. Computed tomography (CT) showed bilateral ground glass changes consistent with COVID-19, widespread lymphadenopathy and splenomegaly. A subsequent combined nose and throat swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). HLH was suspected based upon the H-score and Anakinra, an IL-1 receptor antagonist, was commenced. Liver function acutely worsened and magnetic resonance cholangiopancreatography (MRCP) revealed hepatic haemosiderosis. Intense splenic and cervical lymph node uptake were seen on a positron emission tomography (PET) scan and high doses of intravenous steroids were administered due to concerns over haematological malignancy. RESULTS: Day fourteen of admission heralded the start of progressive clinical deterioration with rapid increase in oxygen demands. Continuous positive airway pressure (CPAP) was trialled without success and the patient unfortunately died seventeen days into admission. Results returned after his death showed homozygous C282Y mutation of the HFE gene consistent with a diagnosis of HH. Post-mortem examination revealed widespread haemosiderin deposition in the liver along with lung pathology in keeping with severe COVID-19 and widespread splenic infarctions. CONCLUSION: An association between HH and COVID-19 is not currently described in the literature. What does exist, however, is an evidence base for the detrimental impacts iron overload has on viral infections in general and the negative effects of HH on the immune system. We therefore postulate that the underlying metabolic and immune disturbances seen in HH should be considered a potential risk factor for the development of severe COVID-19. This case also adds to the evidence that hyperinflammation appears to be a unique and interesting characteristic of this novel viral disease.

Presentation of pleural effusion and dilated cardiomyopathy in a case of dystrophic epidermolysis bullosa.

Epidermolysis Bullosa (EB), a genetic disorder of the skin that presents with eruptive lesions accompanied by blistering has multiple types. We present a case of dystrophic and epidermolysis bullosa (DEB), a rare variant of the disease with the underlying pathophysiology involving a mutation of type VII collagen that serves as an anchoring protein for basement membrane to the dermis. The patient presented with palmoplantar hyperkeratosis with blistering extending on multiple sites of the body, bilateral pleural effusion and an ejection fraction of 23% with moderate mitral regurgitation. The patient was treated symptomatically with diuretics and inotropic medication for the dilated heart, along with draining of pleural spaces. No case of DEB with pleural effusion has been reported prior to this one. We believe this is the first case that presented with both pleural effusion and dilated cardiomyopathy.

Hyperinflammation with COVID-19: The key to patient deterioration?

BACKGROUND: The potential risk of cytokine storm in patients with coronavirus disease 2019 (COVID-19) has been described [1]; we write to share our experience treating a 17-year-old male with haemophagocytic lymphohistiocytosis (HLH) secondary to COVID-19 infection. CASE REPORT: This patient presented with cough, sore throat, anorexia and pyrexia. On examination, he had gross cervical lymphadenopathy and palpable splenomegaly. Nose and throat swab for SARS-CoV-2 was positive and blood tests revealed pancytopaenia with very high ferritin, triglyceride and d-dimer levels. The patient's H-Score [2] was calculated at 220, suggesting probability of HLH of 93-96%. Considering Russell and colleagues' [3] comments about potential harm of corticosteroid use in patients with COVID-19 infection, the patient was commenced on treatment with the selective IL-1 receptor antagonist drug, Anakinra, and a two-day course of intravenous immunoglobulin. RESULTS: The patient responded rapidly to treatment, becoming apyrexial after 24 h. His lymph nodes and spleen began to normalise after the first 48 h, at which time point the ferritin also started to decrease. He was discharged after 11 days feeling fit and well. CONCLUSION: This case certainly illustrates the importance of hyperinflammation syndromes in COVID-19. It also raises the question - is the severe pneumonitis seen in patients with COVID-19 an immunological phenomenon? We know that the viral load of patients with COVID-19 seems to peak in the early stages of illness [4,5]; however, patients deteriorate later in the disease course, at around days 10-14. This patient, who had risk factors for deterioration (male, pancytopaenic), did not develop an oxygen requirement and clinically and biochemically improved rapidly on Anakinra with no adverse events. We might suggest Anakinra to the scientific community as a treatment option in COVID-19 infection.