Eco-friendly approaches for mitigating plastic pollution: advancements and implications for a greener future.

Plastic pollution has become a global problem since the extensive use of plastic in industries such as packaging, electronics, manufacturing and construction, healthcare, transportation, and others. This has resulted in an environmental burden that is continually growing, which has inspired many scientists as well as environmentalists to come up with creative solutions to deal with this problem. Numerous studies have been reviewed to determine practical, affordable, and environmentally friendly solutions to regulate plastic waste by leveraging microbes' innate abilities to naturally decompose polymers. Enzymatic breakdown of plastics has been proposed to serve this goal since the discovery of enzymes from microbial sources that truly interact with plastic in its naturalistic environment and because it is a much faster and more effective method than others. The scope of diverse microbes and associated enzymes in polymer breakdown is highlighted in the current review. The use of co-cultures or microbial consortium-based techniques for the improved breakdown of plastic products and the generation of high-value end products that may be utilized as prototypes of bioenergy sources is highlighted. The review also offers a thorough overview of the developments in the microbiological and enzymatic biological degradation of plastics, as well as several elements that impact this process for the survival of our planet.

Characterization of Detergent-Compatible Lipases from Candida albicans and Acremonium sclerotigenum under Solid-State Fermentation.

The purpose of this study was to compare and explore the potential of two distinct lipases at industrial levels after their production using wheat bran substrate in solid-state fermentation. Lipases from Candida albicans (C. albicans) and Acremonium sclerotigenum (A. sclerotigenum) were characterized to assess their compatibility and suitability for use in laundry detergents. The effects of pH, temperature, metal ions, inhibitors, organic solvents, and various commercially available detergents on these lipases were studied in order to compare their activity and stability profiles and check their stain removal ability. Both lipases remained stable across the wide pH (7-10) and temperature (30-50 °C) ranges. C. albicans lipase exhibited optimum activity (51.66 U/mL) at pH 7.0 and 37 °C, while A. sclerotigenum lipase showed optimum activity (52.12 U/mL) at pH 8.0 and 40 °C. The addition of Ca2+ and Mg2+ ions enhanced their activities, while sodium dodecyl sulfate (SDS) and ethylenediamine tetraacetic acid (EDTA) reduced their activities. Lipase from both strains showed tolerance to various organic solvents and considerable stability and compatibility with commercially available laundry detergents (>50%); however, A. sclerotigenum lipase performed slightly better. Characterization of these crude lipases showed nearly 60% relative activity after incubation for 2 h in various detergents, thus suggesting their potential to be employed in the formulation of laundry detergents with easy and efficient enzyme production. The production of thermostable and alkaline lipases from both strains makes them an attractive option for economic gain by lowering the amount of detergent to be used, thus reducing the chemical burden on the environment.

A comprehensive review on pharmacological applications and drug-induced toxicity of valproic acid.

Valproic acid, a branching short chain fatty acid, is a popular drug to treat epilepsy and acts as a mood-stabilizing drug. The obstruction of ion channels and Gamma Amino Butyrate transamino butyrate GABA has been linked to antiepileptic effects. Valproic acid has been characterized as a Histone deacetylase inhibitor, functioning directly transcription of gene levels by blocking the deacetylation of histones and increasing the accessibility of transcription sites. Study has been extensively focused on pharmaceutical activity of valproic acid through various pharmacodynamics activity from absorption, distribution and excretion particularly in patients who are resistant to or intolerant of lithium or carbamazepine, as well as those with mixed mania or rapid cycling.

Trigger related outcomes of takotsubo syndrome in a cancer population.

Background: Takotsubo syndrome (TTS) occurs more frequently in cancer patients than in the general population, but the effect of specific TTS triggers on outcomes in cancer patients is not well studied. Objectives: The study sought to determine whether triggering event (chemotherapy, immune-modulators vs. procedural or emotional stress) modifies outcomes in a cancer patient population with TTS. Methods: All cancer patients presenting with acute coronary syndrome (ACS) between December 2008 and December 2020 at our institution were enrolled in the catheterization laboratory registry. Demographic and clinical data of the identified patients with TTS were retrospective collected and further classified according to the TTS trigger. The groups were compared with regards to major adverse cardiac events, overall survival and recovery of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) after TTS presentation. Results: Eighty one of the 373 cancer patients who presented with ACS met the Mayo criteria for TTS. The triggering event was determined to be "cancer specific triggers" (use of chemotherapy in 23, immunomodulators use in 7, and radiation in 4), and "traditional triggers" (medical triggers 22, and procedural 18 and emotional stress in 7). Of the 81 patients, 47 died, all from cancer-related causes (no cardiovascular mortality). Median survival was 11.9 months. Immunomodulator (IM) related TTS and radiation related TTS were associated with higher mortality during the follow-up. Patients with medical triggers showed the least recovery in LVEF and GLS while patients with emotional and chemotherapy triggers, showed the most improvement in LVEF and GLS, respectively. Conclusion: Cancer patients presenting with ACS picture have a high prevalence of TTS due to presence of traditional and cancer specific triggers. Survival and improvement in left ventricular systolic function seem to be related to the initial trigger for TTS.

Amiodarone Related Skin Toxicity -The Blue Man Syndrome; a Case Report and Review of Literature.

Amiodarone induced blue-gray syndrome is a rare condition. It develops over years of use of amiodarone and can lead to discontinuation of the drug. It tends to develop over the sun exposed areas of the body typically involving the face and neck. Published medical literature is scarce with regard to the pathogenesis, clinical implications and management of this potential association. We chronicle here the case of a patient with amiodarone induced blue-grey discoloration of skin from our clinical experience. Furthermore, a systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 9 cases fulfilled the inclusion criteria. The data on patients' characteristics, epidemiology, clinical features, comorbid conditions, diagnosis, clinical course and outcome were analyzed. The present review outlines our current understanding of the epidemiology and risk factors for amiodarone induced-blue man syndrome, the pathophysiology of this condition and currently available management options.

Ethical Dilemma: Should Continuous Intravenous Drug Use Affect Appropriate Management in Prosthetic Valve Endocarditis?

Drug use is a major challenge that negatively impacts many aspects of health. The issue of drug use is growing with every passing day. Efforts to mitigate its use are countered by even more people succumbing to the intravenous drug use due to their relatively easy availability and patients' poor insight into their medical condition. Infective endocarditis (IE) is a condition with high mortality and morbidity. It requires prolonged treatment with antibiotics, and, under some special circumstances, surgical management is also necessitated. Intravenous drug users who get valve replacement after index IE episode may continue to use drugs despite our utmost efforts to prevent it. They can subsequently develop prosthetic valve endocarditis (PVE), which is one of the indications for surgical valve replacement, hence requiring a redo surgery. However, their irregular behavior can create reservations while considering a repeat valvular surgery and delay the appropriate treatment. This can increase morbidity and mortality from PVE in intravenous drug users with otherwise no or few comorbidities.

The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis.

Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.

Axillary Approach for Venoarterial Extracorporeal Membrane Oxygenation Cannulation.

Extracorporeal membrane oxygenation support (ECMO) is a form of mechanical circulatory support that is used in patients with severe dysfunction of heart or lung or both. Depending on whether it is venovenous or venoarterial support, it can temporarily substitute for circulation and ventilation while the underlying cause is addressed. Traditional approach for cannulation usually involves the femoral vessels. This is due to the easy accessibility, larger lumen of vessels, and physician expertise and training in femoral approach. However, in certain circumstances like critical lower extremity ischemia, crush injury or trauma to lower extremity, and lower extremity infections (like necrotizing fasciitis), this approach is not practical. In these situations, axillary vasculature provides a good substitute for ECMO cannulation.

Pulmonary Valve Replacement in an Adult Jehovah's Witness with Tetralogy of Fallot.

The refusal of Jehovah's Witnesses to use blood products can limit access to cardiac surgery, as patients may not be offered surgery for complex disease, especially revision surgery. We report a successful, complex adult congenital heart disease (ACHD) surgery with intraoperative and perioperative optimization. We have tried to highlight through this case that complex ACHD surgeries can be performed in Jehovah's Witness patients with skilled perioperative and intraoperative management. The role of bovine hemoglobin in this population is being defined and was found helpful in this case.

A Novel Case of Idiopathic Restrictive Cardiomyopathy.

Restrictive cardiomyopathy (CM) usually develops and progresses slowly, over a course of years. The rapid development of idiopathic restrictive CM immediately following a liver transplant is unusual. We describe the case of a patient who developed idiopathic restrictive CM fairly rapidly following a liver transplant. It progressed within a few months to the point where the patient required scheduled paracenteses and dialysis. The morphological definition of restrictive CM consists of bi-atrial dilation with non-dilated and non-hypertrophic ventricles. A cardiac biopsy may be needed when the underlying cause is not evident. When a cardiac biopsy is not able to identify a specific cause, then the word "idiopathic" is used to describe the CM.

Acute Paraspinal Compartment Syndrome in an Unconscious Patient.

Compartment syndrome can be a limb-threatening emergency that may require immediate intervention. It usually involves the extremities but any closed compartment of the body is susceptible to it. Paraspinal compartment extends on both sides of the spine. Prolonged lying on the back in unconscious patients leads to muscle edema which eventually leads to increase pressure in the compartment. Neurovascular comprise is a dreaded complication of compartment syndrome. Paraspinal compartment is a potential site of compartment syndrome particularly in unconscious patients and it requires prompt diagnosis, careful monitoring, immediate medical attention and even warranting surgical intervention in certain cases.

The Mystery of Low Phosphate: Marijuana is the Smoking Gun.

Hypophosphatemia is a rarely reported side-effect of cannabis use. The potential mechanisms of hypophosphatemia include enteric malabsorption/loss, excessive urinary excretion, or rapid trans-cellular shifts. Severe hypophosphatemia from daily marijuana use is a rare side-effect. A trans-cellular shift is the most likely proposed mechanism. Although it tends to self-correct fairly rapidly, close observation for the dreaded consequences related to hypophosphatemia is required. Both the users and providers must be aware of this rare association of hypophosphatemia with daily marijuana use.

Awareness Among Healthcare Professionals Regarding Contaminated Stethoscopes as a Source of Nosocomial Infections.

Objectives The objective of this study was to determine the awareness among healthcare professionals regarding stethoscopes as a source of nosocomial infections, their cleaning practices in this regard before or after examination, and to find out about the existence of any guidelines and accountability criteria issued by the hospitals in this regard. Methodology A descriptive cross-sectional study of 243 healthcare professionals using non-probability convenience sampling was done to include consultants, residents, final-year medical students, and nursing staff and excluding medical students from pre-clinical years as well as doctors of those departments with infrequent use of a stethoscope. The study was conducted for a period of nine months at tertiary health care facilities of Rawalpindi and Islamabad. A self-administered structured questionnaire was used for data collection. Results Participants from both genders included 54 participants (22.2%) from the final year, 48 (19.8%) house officers, 106 (43.6%) postgraduate trainees, nine (3.7%) specialists, and 26 (10.7%) nurses. A total of 210 (86.4%) were aware of stethoscopes as a source of nosocomial infections. Among participants, 23 (9.5%) cleaned their stethoscope per patient, 50 (20.6%) did it daily, 48 (19.8%) did it weekly, 41 (16.9%) did it monthly, 12 (4.9%) participants cleaned it six-monthly while 69 (28.4%) respondents had never cleaned their stethoscope. Almost 127 participants (52.3%) used alcohol wipes to clean their stethoscopes, 11 (4.5%) used a wet cloth, six (2.5%) used tissue paper. Sixty-one (24.9%) agreed that the hospital issued protocols for the decontamination of stethoscopes while 189 (77.8%) did not. A total of 241 (99.2%) believed that there were no accountability criteria set for the assessment of the cleanliness of stethoscopes in their hospitals. Conclusion A majority of the participants were aware of stethoscopes being a source of nosocomial infections and believed in cleaning stethoscopes regularly. However, a majority of the participants believed that their hospital did not issue any protocols for the decontamination of stethoscopes. Further research can expand our recommendations.

Management of Pulmonary Artery Aneurysms in Pulmonary Hypertension: A Single-Center Review of 3 Cases.

Pulmonary artery aneurysms (PAAs) are defined as having pulmonary artery diameter of greater than 40 mm. PAAs are rare and can occur in various pulmonary diseases. There are no clear-cut guidelines regarding the management of PAAs, and recommendations for management are made based on expert consensus opinion, case reports, and institutional experience. This series highlights three patients with pulmonary hypertension (PH) and PAA. The clinical course and diagnostic findings and the decision-making involved in the treatment are reviewed. An overview of three distinct management strategies including medical management, heart/lung transplant, and surgical aneurysm repair is presented.