Search

Objectives: Cardiac surgery using cardiopulmonary bypass contributes to a robust systemic inflammatory process. Local intrapericardial postsurgical inflammation is believed to trigger important clinical implications, such as postoperative atrial fibrillation and postsurgical intrathoracic adhesions. Immune mediators in the pericardial space may underlie such complications. Methods: In this prospective pilot clinical study, 12 patients undergoing isolated coronary artery bypass graft surgery were enrolled. Native pericardial fluid and venous blood samples (baseline) were collected immediately after pericardiotomy. Postoperative pericardial fluid and venous blood samples were collected 48-hours after cardiopulmonary bypass and compared with baseline. Flow cytometry determined proportions of specific immune cells, whereas multiplex analysis probed for inflammatory mediators. Results: Neutrophils are the predominant cells in both the pericardial space and peripheral blood postoperatively. There are significantly more CD163lo macrophages in blood compared with pericardial effluent after surgery. Although there are significantly more CD163hi macrophages in native pericardial fluid compared with baseline blood, after surgery there are significantly fewer of these cells present in the pericardial space compared with blood. Postoperatively, concentration of interleukin receptor antagonist 6, and interleukin 8 were significantly higher in the pericardial space compared with blood. After surgery, compared with blood, the pericardial space has a significantly higher concentration of matrix metalloproteinase 3, matrix metalloproteinase 8, and matrix metalloproteinase 9. The same trend was observed with transformational growth factor β. Conclusions: Cardiac surgery elicits an inflammatory response in the pericardial space, which differs from systemic inflammatory responses. Future work should determine whether or not this distinct local inflammatory response contributes to postsurgical complications and could be modified to influence clinical outcomes.

Objective: There is a paucity of data on the inflammatory response that takes place in the pericardial space after cardiac surgery. This study provides a comprehensive assessment of the local postoperative inflammatory response. Methods: Forty-three patients underwent cardiotomy, where native pericardial fluid was aspirated and compared with postoperative pericardial effluent collected at 4, 24, and 48 hours' postcardiopulmonary bypass. Flow cytometry was used to define the levels and proportions of specific immune cells. Samples were also probed for concentrations of inflammatory cytokines, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs). Results: Preoperatively, the pericardial space mainly contains macrophages and T cells. However, the postsurgical pericardial space was populated predominately by neutrophils, which constituted almost 80% of immune cells present, and peaked at 24 hours. When surgical approaches were compared, minimally invasive surgery was associated with fewer neutrophils in the pericardial space at 4 hours' postsurgery. Analysis of the intrapericardial concentrations of inflammatory mediators showed interleukin-6, MMP-9, and TIMP-1 to be highest postsurgery. Over time, MMP-9 concentrations decreased significantly, whereas TIMP-1 levels increased, resulting in a significant reduction of the ratio of MMP:TIMP after surgery, suggesting that active inflammatory processes may influence extracellular matrix remodeling. Conclusions: These results show that cardiac surgery elicits profound alterations in the immune cell profile in the pericardial space. Defining the cellular and molecular mediators that drive pericardial-specific postoperative inflammatory processes may allow for targeted therapies to reduce immune-mediated complications.

On an annual basis, heart failure affects millions of people globally. Despite improvements in medications and percutaneous interventions, heart failure secondary to ischemic cardiomyopathy remains an important health issue. A large proportion of healthcare budgets are also dedicated to complications related to ischemic cardiomyopathy and heart failure. Drugs and mechanical devices have an ever-expanding role in our management of this growing patient population. However, cardiac transplantation continues to be the gold standard for treating advanced heart failure. Since there is a limited pool of suitable donor hearts, cardiac transplantation is not a viable option for many patients. Over the past five decades, various forms of surgical ventricular restoration have been proposed as an appealing option for treating heart failure in very select and specific cases. Given the pathophysiology of ischemic cardiomyopathy, literature suggests that, in those particular settings, reasonable results can be achieved by surgically restoring the ventricle to its original geometry. Herein, we explore the evidence on different operative techniques for ventricular restoration. We also present the latest findings for surgical ventricular restoration in patients with ischemic cardiomyopathy.

Samia Kazmi,1 Ashar Alam,2 Beena Salman,2 Faiza Saeed,2 Shoukat Memon,2 Javeria Chughtai,2 Shahzad Ahmed,2 Sobia Tariq,2 Salman Imtiaz2 1Department of Internal Medicine, The Indus Hospital and Health Network, Karachi, Sindh, Pakistan; 2Department of Nephrology, The Indus Hospital and Health Network, Karachi, Sindh, PakistanCorrespondence: Samia KazmiDepartment of Internal Medicine, The Indus Hospital and Health Network, Plot C-76, Sector 31/5, Opposite Crossing, Darussalam Society Sector 39 Korangi, Karachi, Sindh, PakistanTel +923061608016Email samia.kazmi@tih.org.pkBackground: In an ESRD subset of patients, COVID-19 infection is associated with increased disease burden and higher mortality rates.Methods: We conducted a retrospective single-center cohort study in which 43 ESRD patients had a diagnosis of COVID-19. Association of risk factors with mortality was assessed by chi-square test and logistic regression analysis. Data were collected on a structured performa which included variables like age, gender, comorbid conditions, drug history, clinical presentation, hemodynamic status and laboratory parameters. Outcome variables were recovery and death. All patients received standard treatment for COVID-19 according to hospital protocols, along with hemodialysis and continuous renal replacement therapy (CRRT) when needed.Results: Those most affected were found to be male, 25 (58.1%), while the number of females affected was 18 (41.9%). The most frequent comorbid condition was hypertension (HTN), seen in 35 (81.4%) patients; however, thromboembolic complications were very few in these patients. The mortality rate in our study was 25.6%, and the population most susceptible to poor outcomes in the ESRD subgroup was elderly people (45.5%), while younger patients recovered the most from COVID-19 (53.1%). Hypoalbuminemia, leukocytosis, lymphopenia and raised LDH were also found to be associated with death in ESRD patients suffering from COVID-19 (81.8, 72.7, 100 and 100%, respectively). In multivariate logistic regression analysis, we found that the odds ratio of dying from COVID-19 was 19.5 times higher in patients aged > 65 years as compared to patients aged 18– 50 years (p=0.039). Similarly, patients with a high TLC were 24.1 times more likely to die than patients with a normal TLC (p=0.008).Conclusion: In our center, the mortality rate of ESRD patients affected with COVID-19 disease was 25.6%, and older age, leukocytosis, lymphopenia, hypoalbuminemia and high LDH were significantly associated with mortality.Keywords: ESRD, COVID-19, hemodialysis, Pakistan, CKD, CRRT

Abstract Surface area and surface active sites are two important key parameters in enhancing the gas sensing as well as photocatalytic properties of the parent material. With this motivation, herein, we report a facile synthesis of Reduced Graphene Oxide/Tungsten Oxide RGO/WO3 hierarchical nanostructures via simple hydrothermal route, and their validation in accomplishment of improved H2S sensing and highly efficient solar driven photo-degradation of RhB Dye. The self-made RGO using modified Hummer’s method, is utilized to develop the RGO/WO3 nanocomposites with 0.15, 0.3 and 0.5 wt% of RGO in WO3 matrix. As-developed nanocomposites were analyzed using various physicochemical techniques such as XRD, FE-SEM, TEM/HRTEM, and EDAX. The creation of hierarchic marigold frameworks culminated in a well affiliated mesoporous system, offering efficient gas delivery networks, leading to a significant increase in sensing response to H2S. The optimized sensor (RGO/WO3 with 0.3 wt% loading) exhibited selective response towards H2S, which is ~ 13 times higher (Ra/Rg = 22.9) than pristine WO3 (Ra/Rg = 1.78) sensor. Looking at bi-directional application, graphene platform boosted the photocatalytic activity (94% degradation of Rhodamine B dye in 210 min) under natural sunlight. The RGO’s role in increasing the active surface and surface area is clarified by the H2S gas response analysis and solar-driven photo-degradation of RhB dye solution. The outcome of this study provides the new insights to RGO/WO3 based nanocomposites’ research spreadsheet, in view of multidisciplinary applications.

In this study, we report a straightforward method for synthesizing semi-cubical nanostructures of tungsten trioxide (WO3) loaded with reduced graphene oxide (rGO) via a hydrothermal approach. Furthermore, the systematic investigations were made towards the improved gas sensing capabilities of these nanostructures for acetone. The use of semi-cubical rGO/WO3 nanostructures demonstrate the provision of efficient gas diffusion routes via a meticulously arranged mesoporous framework. Hence, it leads to a significant improvement in the sensing response towards acetone. The analysis of the sensing capabilities demonstrates that the response of the sensor is influenced by variations in operating temperature and gas concentration. It is seen that the inclusion of rGO not only enhances the sensing response but also gives quick response and recovery, which are measured to be 12 and 33 s, respectively. The WO3 sensor loaded with 0.1 wt% rGO demonstrates a discerning reaction to acetone, exhibiting a high response of 93.60% than that of the unmodified WO3 sensor (76.30%). The gas sensing properties are explained through the role of rGO and the structural and morphological properties of the developed nanostructures. [ABSTRACT FROM AUTHOR]

The COVID-19 outbreak has affected numerous facets of human life. It is still an ongoing epidemic with multiple variants emerged since its first outbreak. To detect COVID-19 machine learning and the Internet of Things are the most widely proposed methods in the literature showing favorable performance. This paper presents a complete mapping and assessment of recent research efforts on COVID-19 detection using both machine learning techniques and the Internet of Things devices. The objective of this research work is to identify machine learning techniques and IoT devices that are used in combination to effectively detect COVID-19 and its variants. The synthesis of the mapping study is provided as the analysis of the IoT devices, and the effectiveness of machine learning techniques in disease detection. This study will help the researchers and health practitioners in deploying an effective method for detecting COVID-19, and its variants using machine learning techniques and IoT devices. [ABSTRACT FROM AUTHOR]