Erythroderma and Skin Desquamation in Paederus Dermatitis

Exfoliative erythroderma is rare but serious condition, which requires close supervision. We report a rare case of 28-year-old man with kissing lesions of Paederus dermatitis at his right side of neck. The rash caused by Paederus beetle was improved after treatments. However, the patient developed generalized erythema with desquamation and scaling. The patient was successfully treated topically with moisturizing liquid soap and topical moisturizer with emollients and humectants, and triamcinolone lotion was applied on the bright red lesion. The patient was also treated with oral replacement solution and tropical azelaic cream was applied on the hyperpigmented kissing lesion. This case report shows the importance of a diagnostic practice with follow-up examination.

Theoretical analysis of R22 substitution with R417 on board of fishing vessels - thermodynamic, environmental and Islamic aspects

R22 is a refrigerant that has dominated marine refrigeration onboard fishing vessels till 1 January 2015. Because in its composition exist ozone-depleting chlorine atoms, this refrigerant needs acceptable substitution solutions, to achieve the ozone protection desiderate. For R22 was not found a unique replacement solution. This paper investigates the opportunity to substitute R22 with the refrigerant R 417A, due to its very close thermodynamic properties to R22 and, moreover to its friendly behavior to the ozone layer. Seafood consumption is permitted for Muslims, fishing activity being important for these communities. Fishing depends on vapor compression refrigeration technology, equipment known to be an important energy consumer. In this paper, it is shown that environmental preservation is important in the refrigeration industry and in Islam, as well. The theoretical analysis developed in this paper focuses on the seawater cooling system onboard fishing vessels while catching in tropical waters. The investigation has energetic, environmental, and Islamic components. The comparison between the plant working with R22 and with R417A reveals that the ecologic refrigerant represents a wise solution for retrofitting existing plants.

Therapeutic Plasmapheresis: Seven Year Experience of an Intensive Care Unit in Portugal

Introduction: Therapeutic plasmapheresis is a therapeutic procedure in which the patient’s blood is passed through a medical device which separates out plasma from other components of blood. The plasma is removed and replaced with a replacement solution. Studies on the use of plasmapheresis in critically ill patients are scarce. The aim of this study was to review all therapeutic plasmapheresis sessions carried out in the Hospital Beatriz Ângelo intensive care unit.Material and Methods: An observational retrospective study was conducted between April 2012 and March 2019. All patients who underwent therapeutic plasmapheresis in the intensive care unit were included, and plasmapheresis sessions held outside the intensive care unit were excluded.Results: Of 46 patients, 63% were men (n = 29), with a median age of 53 years. The most frequent diagnoses were hypertriglyceridemia-induced pancreatitis, vasculitis, autoimmune haemolytic anaemia, and atypical haemolytic-uremic syndrome. A total of 198 plasmapheresis sessions were carried out in the intensive care unit. Most of the used replacement solutions were fresh frozen plasma (34.4%), albumin/crystalloid (24.2%), and albumin/fresh frozen plasma (19.2%). The most common complications were hydroelectrolytic changes (84; 42.4%) and coagulation disorders/thrombocytopenia (65; 32.8%). There was no need to interrupt any plasmapheresis session due to complications related to the patient.Discussion: Therapeutic plasmapheresis is an urgent procedure that can reduce morbidity and mortality in critically ill patients. This justifies that 37% of patients started the technique before the diagnostic confirmation. The indications for plasmapheresis and the choice of replacement solution were in agreement with the guidelines. Despite the risk of bleeding, no haemorrhagic complications were recorded.Conclusion: Therapeutic plasmapheresis is a complex technique that requires specific training. The indications are diverse, and some are not consensual. Complications were frequent, but they did not increase morbidity.

A target-oriented algorithm for maintaining serum calcium stability automatically in regional citrate anticoagulation

Background: Regional citrate anticoagulation (RCA) for renal replacement therapy is widely practiced in critically ill patients. However, concern exists regarding its labor-intensiveness for monitoring and the associated hypocalcemia. In this study, we provided an algorithm for prescribing RCA and evaluated its safety in patients. Methods: During 18 hemofiltration treatments with calcium-free replacement solution, participants were randomized to receive algorithm-based or trial-and-error RCA protocol. The effluent volume, post-filter and in vivo ionized calcium (iCa), and calcium in the sera and effluents were periodically measured at an interval of 1 to 2 h. Results: For patients received algorithm-based RCA protocol, no one had a serum iCa less than 0.9 mmol/L, and none needed calcium supplement adjustment to maintain serum calcium stability. For patients accepted trial-and-error protocol, all patients had a serum iCa below 0.9 mmol/L, their serum iCa and calcium levels fluctuated dramatically, and all patients need additional calcium supplement adjustment during RCA. None of the participants showed a post-filter iCa > 0.4 mmol/L. Conclusion: We provided a safe algorithm for calculating calcium supplementation doses that could maintain serum calcium stability without additional adjustment during RCA.

Effect of Acid Concentration on the Activation of Bayah Natural Zeolite for Palm Kernel Shell Pyrolysis Application

Biooil is the main product in the pyrolysis process which is expected to be a liquid fuel replacement solution. But the resulting biooil cannot be directly used as a result of high oxygenated compounds, high viscosity, corrosive, and unstable. Addition of activated natural zeolite catalyst to the pyrolysis process is expected to improve the quality of biooil in order to be used as a renewable liquid fuel. The research aims to determine the influence of acid concentrations on zeolite modification to the characteristics of pyrolysis products. Result of catalyst characterization indicates that zeolite activation using acid will increase Si/Al ratio as well as open the surface of previously hindered zeolite. The yield of char produced in this study tends not to undergo significant changes between the catalytic and noncatalytic pyrolysis by 33% wt. Addition of zeolite catalyst in pyrolysis proved to be able to increase the content of phenol and decrease the content of acetic acid in bio-oil by 6% . Meanwhile, yield of CO2 increases by 20% in the use of catalysts due to the release of oxygen in the oxygenate compounds. The results of this study showed that the resulting biooil still does not meet the specifications of liquid fuels but can be utilized as a renewable chemical feedstock.Keywords: pyrolysis; biomass; natural zeolite;modified

Simplified Regional Citrate Anticoagulation Using a Calcium-Containing Replacement Solution for Continuous Renal Replacement Therapy: A Randomized Controlled Trial

Introduction A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient to be used in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial (RCT) to compare the safety and efficacy between calcium-free and calcium-containing replacement solution in CRRT with RCA. Methods Of the 64 patients receiving RCA-based post-dilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017-2019, 35 patients were randomized to calcium-containing group and 29 to calcium-free replacement solution group. Primary endpoint was circuit lifespan. Secondary endpoints included mortality, kidney function recovery and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total and ionized calcium concentration were measured during CVVHDF. Results Total 149 circuits (82 in calcium-containing group and 67 in calcium-free group) and 7609 circuit hours (4335 versus 3274 hours) were included. Mean circuit lifespan was 58.1 hours (95% CI 53.8-62.4) in calcium-containing group versus 55.3 hours (95% CI 49.7-60.9, log rank P=0.89) in calcium-free group. The serum total (tCa) and ionized (iCa) calcium concentration was slightly lower in calcium-containing group during CRRT, whereas the post-filter iCa concentration was lower in calcium-free group. Moreover, mean 4% trisodium citrate solution infusion doses had no difference between groups (171.1±15.9 versus 169.0±15.1 ml/h, P=0.49). The mortality (40.0% versus 44.8%, P=0.70) and kidney function recovery rates (54.3% versus 48.3%, P=0.63) were similar in calcium-containing and calcium-free group during hospitalization, respectively. Six (3 in each group) patients showed the signs of citrate accumulation in this study. Conclusions When compared with calcium-free replacement solution, RCA based CVVHDF with calcium-containing replacement solution had similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and large dose of intravenous calcium solution preparation for continuous calcium supplement, it is more convenient to be applied in RCA-CRRT practice.Trial registration Chinese Clinical Trial Registry. ChiCTR-IPR-17012629, registered on 10th September 2017. http://www.chictr.org.cn/showprojen.aspx?proj=17644

Artificial neural network: A data mining tool in pharmacovigilance

Introduction: Pharmacovigilance ensures patient safety as well as drug safety. In India, there is still a lot to be done and learned to ensure that the work and activities done in the area of pharmacovigilance are safely implemented. The key issue in India is that adverse drug reaction (ADR) has been underreported. The number of patients who are hospitalized is growing due to adverse drug effects and figuring out the exact cause of ADRs is a problem, if a patient is treated concurrently with several medicines. Methods: In the analysis, we will analyze the various types of evaluation scale to conduct the ADR evaluation and identify the trigger agents. For situations where various approaches may not be adequate prognostic models, neural networks emerged as advanced data processing devices. Results: However, it is essentially statistical modeling tools that are used in neural network models, as the term implies. Conclusions: These models are thus a replacement solution, offering resources that learn by themselves, while not requiring experts or advanced computer programs, to solve problems and discern patterns.

Therapeutic Plasma Exchange as a Treatment for Autoimmune Neurological Disease

Introduction. Therapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (ANDs), and its main objective is the removal of pathogenic autoantibodies. Our aim was to describe the clinical profile and the experience with the usage of TPE in patients with ANDs at our institution. Methods. This is an observational retrospective study, including medical records of patients with diagnosis of ANDs who received TPE, between 2011 and 2018. Characteristics of TPE, such as number of cycles, type of replacement solution, and adverse effects, were evaluated. The modified Rankin Scale (mRS) was applied to measure the clinical response after the therapy. Results. 187 patients were included with the following diagnoses: myasthenia gravis (MG), n = 70 (37%); Guillain–Barré syndrome (GBS), n = 53 (28.3%), neuromyelitis optica spectrum disorders (NMOSD), n = 35 (18.7%); chronic inflammatory demyelinating polyneuropathy (CIDP), n = 23 (12.2%); and autoimmune encephalitis (AE), n = 6 (3.2%). The most used types of replacement solution were albumin (n = 131, 70%) and succinylated gelatin (n = 45, 24%). All patients received a median of five cycles (IQR 5-5). Hypotension and hydroelectrolytic disorders were the main complications. After TPE, 99 patients (52.9%) showed improvement in the mRS scores and a statistical significance (p<0.05) was seen between the admission score and after TPE for every diagnosis except for CIDP. Conclusion. TPE has an adequate safety profile, and improvement in functionality in treated patients reflects its effectiveness.

P1074SIMPLIED REGIONAL CITRATE ANTICOULATION USING A CALCIUM-CONTAINING REPLACEMENT SOLUTION FOR RENAL REPLACEMENT THERAPY: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Background and Aims A simplified protocol for Regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without a continuous calcium infusion, is more efficient to be used in continuous renal replacement therapy (CRRT). We aim to design a randomized prospective pilot trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solution in CRRT with RCA. Method Of the 59 patients who requiring CRRT and being treated with RCA-based continuous venovenous hemodiafiltration (CVVHDF) enrolled, 31 patients were randomized to calcium-containing group and 28 to calcium-free replacement solution group. Primary endpoints were filters lifespan. Secondary endpoints were mortality, kidney function recovery and severe complications rates. Time spent on fluids preparation before CRRT and the amount of 4% trisodium citrate solution pumped during CRRT were recorded. Serum and effluent citrate and calcium concentration during CVVHDF were measured during CRRT. Results Filters lifespan were superior for calcium-containing group (mean 58.06 versus 47.12 hours, P=0.05). Mortality and renal outcome were comparable between groups during hospitalization: 10/31 (33.26%) of calcium-containing group patients died versus 13/28 (46.43%) of calcium-free group patients, and 16/31 (51.61%) of calcium-containing group patients had kidney function recovery versus 15/28 (53.57%) of calcium-containing group (P = 0.265). Only 5 patients showed the symptoms and signs of hypocalcemia or citrate toxicity in this study. The mean CRRT preparation time in calcium-containing group: 25.5 minutes, was significantly shorter than calcium-free group: 43.7 minutes (p&lt;0.001). The serum and effluent calcium concentration was slightly lower in calcium-containing group during CRRT. While, the mean 4% trisodium citrate solution infusion rate was similar between groups (161.5 mL/h versus 157.4 mL/h, P=0.376). Conclusion Patients treated with calcium-containing or calcium-free replacement solution have similar clinical outcomes. Since the calcium-containing replacement solution based RCA has longer filter lifespan and obviates the need for a separate venous catheter and intravenous calcium preparation for continuous intravenous calcium infusion, it is more efficient to be used in clinical practice and superior to the calcium-free replacement solution.

The use of local structural similarity of distant homologues for crystallographic model building from a molecular-replacement solution

The performance of automated protein model building usually decreases with resolution, mainly owing to the lower information content of the experimental data. This calls for a more elaborate use of the available structural information about macromolecules. Here, a new method is presented that uses structural homologues to improve the quality of protein models automatically constructed using ARP/wARP. The method uses local structural similarity between deposited models and the model being built, and results in longer main-chain fragments that in turn can be more reliably docked to the protein sequence. The application of the homology-based model extension method to the example of a CFA synthase at 2.7 Å resolution resulted in a more complete model with almost all of the residues correctly built and docked to the sequence. The method was also evaluated on 1493 molecular-replacement solutions at a resolution of 4.0 Å and better that were submitted to the ARP/wARP web service for model building. A significant improvement in the completeness and sequence coverage of the built models has been observed.