Assessing the efficacy and safety of magnesium sulfate for management of autonomic nervous system dysregulation in Vietnamese children with severe hand foot and mouth disease.

BACKGROUND: Brainstem encephalitis is a serious complication of hand foot and mouth disease (HFMD) in children. Autonomic nervous system (ANS) dysregulation and hypertension may occur, sometimes progressing to cardiopulmonary failure and death. Vietnamese national guidelines recommend use of milrinone if ANS dysregulation with Stage 2 hypertension develops. We wished to investigate whether magnesium sulfate (MgSO4) improved outcomes in children with HFMD if used earlier in the evolution of the ANS dysregulation (Stage 1 hypertension). METHODS: During a regional epidemic we conducted a randomized, double-blind, placebo-controlled trial of MgSO4 in children with HFMD, ANS dysregulation and Stage 1 hypertension, at the Hospital for Tropical Diseases in Ho Chi Minh city. Study participants received an infusion of MgSO4 or matched placebo for 72 h. We also reviewed data from non-trial HFMD patients in whom milrinone failed to control hypertension, some of whom received MgSO4 as second line therapy. The primary outcome for both analyses was a composite of disease progression within 72 h - addition of milrinone (trial participants only), need for ventilation, shock, or death. RESULTS: Between June 2014 and September 2016, 14 and 12 participants received MgSO4 or placebo respectively, before the trial was stopped due to futility. Among 45 non-trial cases with poorly controlled hypertension despite high-dose milrinone, 33 received MgSO4 while 12 did not. There were no statistically significant differences in the composite outcome between the MgSO4 and the placebo/control groups in either study (adjusted relative risk (95%CI) of [6/14 (43%) vs. 6/12 (50%)], 0.84 (0.37, 1.92), p = 0.682 in the trial and [1/33 (3%) vs. 2/12 (17%)], 0.16 (0.01, 1.79), p = 0.132 in the observational cohort). The incidence of adverse events was similar between the groups. Potentially toxic magnesium levels occurred very rarely with the infusion regime used. CONCLUSION: Although we could not demonstrate efficacy in these studies, there were no safety signals associated with use of 30-50 mg/kg/hr. MgSO4 in severe HFMD. Intermittent outbreaks of HFMD are likely to continue across the region, and an adequately powered trial is still needed to evaluate use of MgSO4 in controlling hypertension in severe HFMD, potentially involving a higher dose regimen. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01940250 (Registered 22 AUG 2013). Trial sponsor: University of Oxford.

Synthesis of benzo[a]carbazole derivatives via intramolecular cyclization using Brønsted acidic carbonaceous material as the catalyst.

In this work, a new procedure for the synthesis of benzo[a]carbazole from 1,3-diketones, primary amines, phenylglyoxal monohydrate, and malononitrile employing a solid acidic catalyst has been developed. The multicomponent reaction provided 3-cyanoacetamide pyrrole as an intermediate and then the formation of benzo[a]carbazole via intramolecular ring closure. The reaction was carried out for 2 h at 240 °C, resulting in the desired product with 73% yield. Acidic sites on the solid acid catalyst, made from rice husk-derived amorphous carbon with a sulfonic acid core (AC-SO3H), provided the best activity. Acidic sites on the surface of the catalyst, including carboxylic, phenolic, and sulfonic acids, were 4.606 mmol g-1 of the total acidity. AC-SO3H demonstrated low cost, low toxicity, porosity, stability, and flexibility of tuning and reusability.

Fe2O3/diatomite materials as efficient photo-Fenton catalysts for ciprofloxacin removal.

In this study, we used Fe2O3/diatomite material system toward ciprofloxacin (CIP) photo-Fenton removal in water under visible light (vis) excitation. The characterization of Fe2O3/diatomite catalysts was determined by X-ray diffraction patterns, Fourier-transform infrared analysis, inductively coupled plasma mass spectrometry, and scanning electron microscopy. The photo-Fenton catalytic activity of the Fe2O3/diatomite was appraised by the removal efficiency of the CIP throughout the effect of the H2O2 with various parameters such as initial pH, catalyst amount, and H2O2 amount. The results indicate that 0.2 gL-1 Fe2O3/diatomite catalysts achieved the highest performance at approximately 90.03% with a 50 µL H2O2 concentration. Furthermore, the Fe2O3/diatomite catalysts have high stability, with over 80% CIP removed after five cycles. This study is inspired to develop a potential material for photo-Fenton degradation of antibiotics in wastewater.

Distribution of gamma radiation dose rate related with natural radionuclides in all of Vietnam and radiological risk assessment of the built-up environment.

A built-up environment utilizes building materials containing natural radionuclides that will change radiological risks. While radiological risks have been estimated from the activity concentrations of natural radionuclides in soil, it is important to evaluate the changes of these risks for the built-up environment using these building materials. Based on the direct measurements of absorbed dose rate in air and calculation of absorbed dose rate in air from activity concentrations in soil for all of Vietnam which has undergone significant economic growth in recent decades, the changes of absorbed dose rate in air and radiological risks before and after construction of many artificial structures were investigated. The results showed that the absorbed dose rates in air were clearly changed by the urbanization, and the difference ratio for all of Vietnam ranged from 0.5 to 2.1, meaning that the artificial structures have been acting as shielding materials to terrestrial gamma-rays or radiation sources. However, changes in annual effective dose in the built-up environment were small, and there was no new radiation risk from the built-up environment for Vietnam.

Impact on ambient dose rate in metropolitan Tokyo from the Fukushima Daiichi Nuclear Power Plant accident.

A car-borne survey was made in metropolitan Tokyo, Japan, in December 2014 to estimate external dose. This survey was conducted for all municipalities of Tokyo and the results were compared with measurements done in 2003. The ambient dose rate measured in the whole area of Tokyo in December 2014 was 60 nGy h(-1) (23-142 nGy h(-1)), which was 24% higher than the rate in 2003. Higher dose rates (>70 nGy h(-1)) were observed on the eastern and western ends of Tokyo; furthermore, the contribution ratio from artificial radionuclides ((134)Cs and (137)Cs) to ambient dose rate in eastern Tokyo was twice as high as that of western Tokyo. Based on the measured ambient dose rate, the effective dose rate after the accident was estimated to be 0.45 µSv h(-1) in Tokyo. This value was 22% higher than the value before the accident as of December 2014.