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Background: Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus. Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185). Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35-18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90-5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality. The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75-51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20-21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICU mortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89-21.36). Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive care admission. Larger collaborative research is needed to address this limitation. [ABSTRACT FROM AUTHOR]

Limestone (CaC03), is a lower cost alternative to lime (CaO) for the neutralization of acid water, but the limestone neutralization reaction is impaired by iron(II), iron(III) and aluminium in solution. This paper describes the kinetics of limestone neutralizationin the presence of these metals. The reaction rate is affected by the type of metal cation, by the concentration of the cation and by pH.At pH levels below 2.0 the limestone dissolution reaction rate decreases sharply with increasing pH. In the pH range 4.0 to 5.5 the reaction rate decreases linearly with increasing pH. The pH range 2.0 to 4.0 is a transition range, from the non-linear to linear dissolution rate characteristics. Metal concentrations below 80 mg 1-1:At pH levels less than 4, iron(II) had the strongest suppressing effect followed by aluminium, while the presence of iron(III) increased the reaction rate. In the pH range 4.0 to 5.5 aluminium had the strongest suppressing effect followed by iron(III) and iron(II). Metal concentrations above 80 mg 1-1: Iron(II) and aluminium suppress the reaction rate at all pH levels. At pH levels less than 4, iron(II) had the strongest suppressing effect, followed by aluminium. In the pH range 4D to 5.5 aluminium had the strongest suppressing effectfollowed by iron(II). With iron(III) the rate is suppressed at pH levels below 2, however the rate is speeded up in the pH range 2.5 to 3.5. At higher pH levels, the iron(III) concentration is limited to less than 80 mg 1-1because of precipitation of iron(III) at pH levels higher than 2.5. The extent to which the overall neutralization reaction proceeds was modeled to assist in reactor design. The overall reaction is impaired most by aluminium, followed by iron(ID and iron(III). [ABSTRACT FROM AUTHOR]

Present day Jehovah's Witness (JW) religion accounts for 8.5 million followers. A tenant feature of the JW faith is religious objection to transfusions of blood and blood products. Interpatient variability, as it pertains to blood and blood products may occur; hence, a confidential interview will determine which products individual may consent to (Marsh and Bevan, 2002). This belief and practice place great restrictions on treating medical professionals in scenarios of life-threatening anaemia and active haemorrhage. The review to follow explores the physiological and pathophysiological consequences of severe anaemia. Non-blood transfusion practices are explored, many of which are potentially lifesaving. Particular attention is drawn to the evolving science involving artificial oxygen carriers and their use in emergency situations. A greater safety profile ensures its future use amongst religious objectors to be greatly beneficial. Intravenous iron supplementation has enjoyed a lively debate within the critical care community. A review of recent systematic and meta-analysis supports its use in the ICU; however, more investigation is needed into the complementary use of hepcidin., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Ryan Davids et al.)