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Abstract There is no current consensus on the follow up of kidney function in patients undergoing cardiopulmonary bypass (CPB). The main objectives of this pilot study is to collect preliminary data on kidney function decline encountered on the first postoperative visit of patients who have had CPB and to identify predictors of kidney function decline post hospital discharge. Design: Retrospective chart review. Adult patients undergoing open heart procedures utilizing CPB. Patient demographics, type of procedure, pre-, intra-, and postoperative clinical, hemodynamic echocardiographic, and laboratory data were abstracted from electronic medical records. Acute kidney disease (AKD), and chronic kidney disease (CKD) were diagnosed based on standardized criteria. Interval change in medications, hospital admissions, and exposure to contrast, from hospital discharge till first postoperative visit were collected. AKD, and CKD as defined by standardized criteria on first postoperative visit. 83 patients were available for analysis. AKD occurred in 27 (54%) of 50 patients and CKD developed in 12 (42%) out of 28 patients. Older age was associated with the development of both AKD and CKD. Reduction in right ventricular cardiac output at baseline was associated with AKD (OR: 0.5, 95% CI: 0.3, 0.79, P = 0.01). Prolongation of transmitral early diastolic filling wave deceleration time was associated with CKD (OR: 1.02, 95% CI: 1.01, 1.05, P = 0.03). In-hospital acute kidney injury (AKI) was a predictor of neither AKD nor CKD. AKD and CKD occur after CPB and may not be predicted by in-hospital AKI. Older age, right ventricular dysfunction and diastolic dysfunction are important disease predictors. An adequately powered longitudinal study is underway to study more sensitive predictors of delayed forms of kidney decline after CPB.

Antimicrobial resistance in the intensive care unit is an ongoing global healthcare concern associated with high mortality and morbidity rates and high healthcare costs. Select groups of bacterial pathogens express different mechanisms of antimicrobial resistance. Clinicians face challenges in managing patients with multidrug-resistant bacteria in the form of a limited pool of available antibiotics, slow and potentially inaccurate conventional diagnostic microbial modalities, mimicry of non-infective conditions with infective syndromes, and the confounding of the clinical picture of organ dysfunction associated with sepsis with postoperative surgical complications such as hemorrhage and fluid shifts. Potential remedies for antimicrobial resistance include specific surveillance, adequate and systematic antibiotic stewardship, use of pharmacokinetic and pharmacodynamic techniques of therapy, and antimicrobial monitoring and adequate employment of infection control policies. Novel techniques of combating antimicrobial resistance include the use of aerosolized antibiotics for lung infections, the restoration of gut microflora using fecal transplantation, and orally administered probiotics. Newer antibiotics are urgently needed as part of the armamentarium against multidrug-resistant bacteria. In this review we discuss mechanisms and patterns of microbial resistance in a select group of drug-resistant bacteria, and preventive and remedial measures for combating antibiotic resistance in the critically ill.

This study aimed to assess the efficacy and safety of bedside removal of tunnelled hemodialysis catheter (TDC) by noninterventional nephrologists among adult patients. It is a retrospective study that involved 53 patients from March 2020 to February 2022 at the King Abdulaziz University Hospital (KAUH) Hemodialysis Centre in Jeddah, Saudi Arabia. Of the 53 participants, 60.4% were male and 40.6% female, and their mean age was 50.94 ± 18.89 years. The most common comorbidities were hypertension (HTN) in 47 (88.7%), diabetes mellitus (DM) in 24 (45.3%), and DM and HTN together in 23 (43.4%) patients. The most common site of TDC removal was the right internal jugular vein (77.4%). In 84.9% of the cases, the TDC was removed as an inpatient procedure, and in the majority of the cases (64.2%), the TDC was removed by a noninterventional nephrologist. The most common reasons for TDC removal were sepsis or clinical concerns for infection (64.2%) and TDC not needed (20.8%) due to recovery of the renal function or access maturation. Most patients (96.2%) suffered no complications; only one of 34 (%) patients with catheter removal by a noninterventional nephrologist had bleeding, which required more observation and monitoring before discharge on the same day. Our study revealed that the bedside TDC removal was well tolerated with a minimal complication rate.

Background: Implementation of an anesthesiology-led cardiac implantable electronic device (CIED) service can be viewed to have economic and efficiency challenges. This study evaluates the cost savings of an anesthesiology-led CIED service. Methods: A total of 830 patients presented in the pre-implementation period from 1 March 2016 to 31 December 2017, and 1981 patients presented in the post-implementation period from 1 January 2018 to 31 October 2021. Interrupted time-series analysis for single-group comparisons was used to evaluate the cost savings resulting from reduction in operating room (OR) start delays for patients with CIEDs. Results: OR start-time delay was reduced by 10.6 min (95%CI: −20.5 to −0.83), comparing pre- to post-implementation. For an OR cost of USD 45/min, we estimated the direct cost to the department to be USD 1.68/min. The intervention translated into a total cost reduction during the intervention period of USD 250,000 (USD 18,000 to USD 470,000) per year for the institution and USD 9800 (USD 730 to USD 17,000) per year for the department. The yearly cost of employing a full-time team of CIED specialists would have been USD 135,456. The service triggered electrophysiology consultation on 13 device malfunctions. Conclusions: An anesthesiology-led CIED service resulted in substantial cost savings, increased OR efficiency and patient safety.

Background: Electronic dashboards measure intensive care unit (ICU) performance by tracking quality indicators, especially pinpointing sub-standard metrics. This helps ICUs scrutinize and change current practices in an effort to improve failing metrics. However, its technological value is lost if end users are unaware of its importance. This results in decreased staff participation, leading to unsuccessful initiation of the dashboard. Therefore, the purpose of this project was to improve cardiothoracic ICU providers’ understanding of electronic dashboards by providing an educational training bundle in preparation for an electronic dashboard initiation. Methods: A Likert survey assessing providers’ knowledge, attitudes, skills, and application of electronic dashboards was conducted. Subsequently, an educational training bundle, consisting of a digital flier and laminated pamphlets, was made available to providers for four months. After bundle review, providers were assessed using the same pre-bundle Likert survey. Results: A comparison of summated scores from pre-bundle (mean = 38.75) and post-bundle surveys (mean = 46.13) yielded an increased summated score overall (mean = 7.38, p ≤ 0.001). Conclusion: An educational bundle improved providers’ understanding and increased their likelihood of using electronic dashboards upon its initiation. Further studies are needed to continue increasing staff participation such as providing specific education to navigate the interface for data retrieval and interpretation.

The association of gender with mortality in trauma remains a subject of debate. Geriatric trauma patients have a higher risk of mortality compared to younger patients. We sought to evaluate the association of gender with mortality in a group of geriatric trauma patients presenting to an academic level 1 trauma center (trauma center designated by New York State capable of handling the most severe injuries and most complex cases). Methods: We performed a retrospective review of geriatric trauma patients who were admitted to our trauma center between January 2018 and December 2020. Data collected included vital signs, demographics, injury, and clinical characteristics, laboratory data and outcome measures. The study controlled for co-morbidities, injury severity score (ISS), and systolic blood pressure (SBP) in the ED. Multivariable logistic regression analysis was performed to evaluate the association of gender and mortality. Results: 4432 geriatric patients were admitted during the study period, there were 1635 (36.9%) men and 3859 (87.2%) were White with an average age of 81 ± 8.5 years. The mean ISS was 6.7 ± 5.4 and average length of stay was 6 ± 6.3 days. There were 165 deaths. Male gender (OR 1.94, 95% CI 1.38 to 2.73), ISS (OR 1.12, 95% CI 1.09 to 1.14), Emergency Department SBP less than 90 mmHg (OR 6.17, 95% CI 3.17 to 12.01), and having more than one co-morbidity (OR 2.28, 95% CI 1.55 to 3.35) were independently predictive of death on multivariable logistic regression analysis. Conclusion: Male gender, Emergency Department systolic blood pressure less than 90 mmHg, having more than one co-morbidity, and injury severity are independent predictors of mortality among geriatric trauma patients.

Postovulatory aging is a major problem that limits the success of many assisted reproductive technologies (ARTs). Oxidative stress is a leading cause of oocyte aging. This study investigated the effects of lycopene supplementation of in vitro maturation (IVM) medium during the aging of mouse oocytes on the oocytes’ morphology and oxidative stress status. Mouse cumulus-oocyte complexes (COCs) were collected and cultured in the IVM medium either for 17 h, (freshly matured oocytes), or for 48 h, (in vitro-aged oocytes), with or without lycopene. The rate of fragmented and degenerated oocytes and the oocyte levels of hydrogen peroxide (H2O2), malondialdehyde (MDA), total antioxidant capacity (TAC), reduced glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD) were estimated and compared. Oocytes aged with 200 nM lycopene revealed significantly less fragmentation and degeneration, lower H2O2 and MDA levels, and higher TAC, GSH and SOD levels than those aged without lycopene. CAT levels were unchanged by lycopene treatment. Taken together, our data showed beneficial effects of lycopene during in vitro aging of mouse oocytes by reducing the oxidative stress damages that lead to their apoptosis. The present study introduces lycopene as a natural supplement to reduce the postovulatory aging-dependent abnormalities of mammalian oocytes.

OBJECTIVES/GOALS: Insulin dosing is crucial for regulating blood glucose in cardiac surgery patients, yet it requires the use of cumbersome insulin dosing charts. To streamline this process, an electronic insulin calculator (IC) is trialed in the cardiac operating rooms and intensive care unit. This study compares glycemic control prior to and after institution of IC. METHODS/STUDY POPULATION: Using the EHR, a retrospective population of 3,164 cardiac surgery patient charts from 12/19/19 - 11/06/20 were obtained. Baseline, intra-operative, and ICU blood glucose values were obtained from each patients admission. Using this data, a baseline level of glycemic control throughout a cardiac surgery patients stay was established. A preliminary cohort of 244 patients were then chosen to be managed with the new IC. Baseline, intra-operative, and ICU blood glucose values were obtained in this group for comparison. Paired t tests were used to compare the IC group of patients to the retrospective group of patients. Additional subgroup analysis was performed to assess IC efficacy for on pump vs off pump cardiac surgeries. RESULTS/ANTICIPATED RESULTS: The 244 patients managed with the IC showed significantly reduced average blood glucose values during their time in the ICU compared to those previously not managed with the IC (185 mg% vs 153 mg%, p= 0.02). Additionally, a trend towards a reduction in last operating room blood glucose level was also noted. Lastly, average blood glucose levels were significantly reduced for patients undergoing on pump cardiac surgeries compared to off pump surgeries (157 mg% vs 149 mg%, p = 0.03). DISCUSSION/SIGNIFICANCE: Preliminary results suggest IIC to be associated with better intra and postoperative blood glucose control. More data is being collected to test its association with outcomes.

This theoretical study explores the potential of digital currencies as a hedging tool against inflation risks in the context of globalized economic activity. With the increasing interconnectedness of economies and the volatility of traditional currencies, investors and businesses are seeking alternative ways to protect their wealth from the eroding effects of inflation. Digital currencies, with their unique characteristics such as decentralization and limited supply, have emerged as a potential solution. This research investigates the theoretical underpinnings of using digital currencies for inflation hedging, analyzing their correlation with traditional assets and their performance during periods of high inflation. By examining the factors influencing the effectiveness of digital currencies as a hedge, this study aims to provide insights for investors and policymakers seeking to navigate the complexities of the global economic landscape. [ABSTRACT FROM AUTHOR]

This study aims to investigate the impact of geopolitical, financial, and human factors on foreign direct investment flows. The results revealed that the reality of foreign direct investment explains the political, financial, and human factors, in varying proportions, with significant significance. The positive impact of each of them is on controlling corruption. Governments use foreign direct investment activity as a main tool for growth and development. State and local governments are often responsible for attracting foreign direct investment, and foreign investors prefer countries that enjoy stability and have predictable investment environments by providing clear standards for dealing and having predictable legislation and regulatory parties in which the negotiating parties are clear, and that The absence of clear parties for implementation regarding ownership, taxes, dispute settlement, and instructions, so the investor is afraid of interfering with burdensome administrative resources and unpredictable laws and instructions. [ABSTRACT FROM AUTHOR]

Early embryonic loss, caused by reduced embryo developmental competence, is the major cause of subfertility in humans and animals. This embryo developmental competence is determined during oocyte maturation and the first embryo divisions. Therefore, it is essential to identify the underlying molecules regulating these critical developmental stages. Cathepsin L (CTSL), a lysosomal cysteine protease, is involved in regulating cell cycle progression, proliferation and invasion of different cell types. However, CTSL role in mammalian embryo development is unknown. Using bovine in vitro maturation and culture systems, we show that CTSL is a key regulator for embryo developmental competence. We employed a specific CTSL detection assay in live cells to show that CTSL activity correlates with meiotic progression and early embryo development. Inhibiting CTSL activity during oocyte maturation or early embryo development significantly impaired oocyte and embryo developmental competence as evidenced by lower cleavage, blastocyst and hatched blastocyst rates. Moreover, enhancing CTSL activity, using recombinant CTSL (rCTSL), during oocyte maturation or early embryo development significantly improved oocyte and embryo developmental competence. Importantly, rCTSL supplementation during oocyte maturation and early embryo development significantly improved the developmental competence of heat‐shocked oocytes/embryos which are notoriously known for reduced quality. Altogether, these results provide novel evidence that CTSL plays a pivotal role in regulating oocyte meiosis and early embryonic development. [ABSTRACT FROM AUTHOR]

IFNT is important in establishing pregnancy in ruminants. Secreted IFNT in the uterus induces the expression of an interferon-stimulated gene (ISG) in uterine tissues and peripheral blood leukocytes (PBLs). In our previous study, increased lysosome and lysosomal cathepsin (CTS) activity and mRNA expression were observed in PBLs of pregnant cows on day 18 of pregnancy. However, the mechanism of IFNT stimulation in PBLs is unclear. Here, we explored the IFNT-mediated lysosomal activation mechanisms in PBLs during early pregnancy in dairy cows. PBLs collected from the peripheral blood of Holstein cows on day 18 post artificial insemination, after confirmation of their pregnancy status, were used to detect the expression of lysosomal-associated membrane protein (LAMP) 1, 2, CTSB and CTSK. Expression of all genes was significantly higher in PBLs of pregnant cows than in nonpregnant cows. In vitro IFN-mediated stimulation of PBLs collected from cows that did not undergo AI significantly increased lysosomal acidification and expression of LAMP1 and 2, as well as the activities of CTSB and CTSK. Immunodetection analysis showed an increase in LAMP1 and CTSK levels in the PBLs of day 18 pregnant cows. JAK inhibitor significantly decreased lysosomal acidification, CTSK activity, LAMP1, 2, and CTSK expression in the presence of IFNT. These results suggest that IFNT regulates lysosomal function via a type 1IFN-mediated pathway in PBLs during pregnancy recognition. [ABSTRACT FROM AUTHOR]

Abstract Background Attention deficit hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder in children who experience delayed language development. This work aimed to study electroencephalographic (EEG) changes in children with ADHD and establish a strategy for prompt identification and suitable management in the future. Methods This descriptive cross-sectional study was conducted on 100 children aged between 5 and 12 years old, both sexes, diagnosed with ADHD according to DSM-V Criteria, diagnosed as ADHD children with the Arabic version of Conner’s Parent Rating Scale. Psychometric evaluation by intelligence quotient (IQ) using Stanford Binet Intelligence test. The Receptive Expressive Arabic Language Scale was used to assess language profile. Results There was a significant negative correlation between the severity of ADHD and IQ scores. There was an insignificant negative correlation between ADHD and scaled receptive language score and scaled expressive language score. There was an insignificant positive correlation between ADHD and scaled expressive language score. There was a significant difference between EEG changes and combined subtype of ADHD and scaled score of receptive language (P

Background: Diabetic nephropathy is a clinical syndrome characterized by a set of structural and functional kidney abnormalities in patients with diabetes mellitus and is the leading cause of end stage renal failure. Objective: This study aimed to evaluate VCAM-1 as a marker of microvascular dysfunction in patients with diabetic nephropathy. Methods: The present study was conducted through the duration between December 2022 and July 2023. The patients were selected from Diabetes and the Nephrology Outpatient Clinics and inpatients of the Internal Medicine Department, at Menoufia University Hospitals. This study included 36 diabetic patients divided into 3 groups according to urinary albumin excretion: Group 1 included 15 diabetic patients with normoalbuminuria, group 2 included 11 diabetic patients with microalbuminuria and group 3 included 10 diabetic patients with macroalbuminuria. In addition to fourteen apparent healthy subjects as a control group. Results: The mean VCAM-1 levels were higher in diabetics compared to controls. There was a highly significant difference between the three diabetic subgroups as regards serum VCAM-l. There was a highly positive correlation between VCAM-1 and serum creatinine. Also, there was a highly significant positive correlation between VCAM-1and urinary albumin excretion in whole diabetic patients as well as patients with diabetic nephropathy. Receiver operating characteristic (Roc) graph revealed that the best cut off of serum VCAM-1 to differentiate between diabetics and control subjects was 646.5ng/ml as the diagnostic sensitivity was 80.6%, specificity was 64.3%, and diagnostic accuracy was 76%. The area under the ROC curve was 0.789. The best cut off of serum VCAM-1to detect diabetic nephropathy was 792.5 ng/ml as the diagnostic sensitivity was 100 %, specificity was 80%, and diagnostic accuracy was 91.7%. The area under the Roc curve was 0.917. Conclusion: VCAM-1 could potentially serve as a marker for diabetic nephropathy. [ABSTRACT FROM AUTHOR]