Hypercapnia Research Articles

Analysis of Wood Density to Compare the Amount of Accumulated Carbon Dioxide in the Stems of Selected Non-Native Tree Species in Poland

One of the priorities in European policy is the greater use of wood. In this context, it is important to know the total amount of CO2 absorbed by the tree and accumulated in the wood. In the timber industry, butt logs are mainly processed. The aim of this study is to analyze diameter at breast height (DBH), wood density (WD), and the amount of CO2 in grand fir (GF), Douglas fir (DF), northern red oak (NRO), and black locust (BL) wood. The DBH and bark thickness were measured, and cores were taken to study WD and calculate the amount of CO2. Analyses were conducted in three age classes of trees. It was found that in the youngest age class, DF had a significantly larger DBH compared to NRO and BL, and GF had a significantly larger DBH compared to NRO. The wood density of coniferous species was significantly lower compared to broadleaved species. DF absorbed the most CO2. In Class III, DF had significantly larger DBH and significantly lower wood density compared to NRO and BL. DF absorbed significantly more CO2 compared to NRO. In Classes IV and V, DF had larger DBH compared to NRO and lower wood density. The amount of CO2 absorbed by both species was similar. Taking into account the amount of absorbed CO2, the durability of the wood, and aspects related to sustainable forest management of the four studied non-native tree species, Douglas fir seems to be the best choice for cultivation in Polish forests.

Carbon capture from controlled degassing of deep meromictic lakes: Insights to techno-economic and environmental feasibility, from the "killer lakes" in Cameroon.

Carbon dioxide (CO2) accumulation and emission are well-known features of deep lakes, making them a significant unavoidable carbon source to the atmosphere. In the case of meromictic lakes, degassing devices are installed to controllably release through a pipe the CO2 trapped in the bottom waters. Otherwise, the gas is emitted diffusely at the air-water surface or accidentally through a limnic eruption when the saturation limit is reached. This controlled degassing operation gives rise to an end-of-pipe carbon capture opportunity that has yet to be explored. In the perspective of promoting negative emission technologies, as this is required to reach the near-term global carbon neutrality objective, this study outlines an end-of-pipe solid sorbent-based carbon capture technique that targets the CO2 released through controlled degassing of deep meromictic lakes. A direct air capture (DAC) system astutely dimensioned and optimised by the vacuuming of air enriched with CO2 from the controlled degassing of the lake is therefore proposed and its technical, economic, and environmental feasibility discussed based on the cases of lakes Nyos and Monoun in Cameroon. It resulted that, even on a small scale, capturing CO2 from lake degassing at 8vol% (80,000ppm) can achieve a life cycle cost of 15bar-compressed CO2 between $200 and $350tCO2-1, two to three times less than that of conventional DAC depending on the energy source used, with potentially attractive marginal abatement costs of CO2, especially if natural gas, hydro or solar PV are considered.

Impact of Relative Permeability Hysteresis on CO2 Storage in Saline Aquifers

ABSTRACTThe urgent challenge of climate change, driven by rising carbon emissions, necessitates innovative strategies for carbon capture and storage (CCS). This study examines the impact of hysteresis in relative permeability on CO2 entrapment efficiency within saline aquifers, known for their significant storage capabilities. An aquifer model was analyzed through numerical simulation by varying hysteresis values from 0.2 to 0.5 to evaluate their impact on CO2 plume behavior, retention during water‐alternating‐gas (WAG) injection, and plume morphology. The CO2 plume exhibits a funnel‐shaped configuration at low hysteresis with a narrow, pointed base, indicating a concentrated upward migration trajectory. In contrast, a hysteresis value of 0.5 results in diminished gas movement toward the upper aquifer, transforming the plume into a more oval shape. Results from the land trapping model further support our findings, revealing an inverse relationship where increased hysteresis enhances residual CO2 entrapment, reflected in trapping coefficient values ranging from 0.5 to 4. This underscores the model's efficacy in verifying gas trapping efficiency and safety during sequestration. Moreover, increased water flow generates stronger forces, pushing CO2 into narrower pore spaces, where it becomes trapped. Our findings indicate that increased hysteresis enhances CO2 retention by limiting vertical migration and significantly influences plume geometry, promoting stable and predictable distribution patterns. At higher hysteresis values, CO2 migration is significantly restricted, resulting in near‐complete immobilization of the injected gas. This research highlights hysteresis's critical role in refining injection methodologies and enhancing plume stability for long‐term CO2 storage. © 2024 Society of Chemical Industry and John Wiley & Sons, Ltd.

High velocity nasal insufflation vs non-invasive positive pressure ventilation in the management of acute hypercapnic respiratory failure

ABSTRACT Introduction High-velocity nasal insufflation (HVNI) is a type of high-flow nasal cannula that depends on the dead-space clearance. HVNI utilizes small-bore nasal cannulae resulting in high velocity flow greater than the flow of the wider bore cannulae that were previously in use. Aim Assess the efficacy of high-velocity nasal insufflation in managing acute hypercapnic respiratory failure and compare between high-velocity nasal insufflations and noninvasive positive pressure ventilation (NIPPV) regarding efficacy and outcome in managing acute hypercapnic respiratory failure. Patients and Methods Over 12 months 48 patients admitted with a diagnosis of acute hypercapnic respiratory failure were enrolled in the study. Twenty-four patients were managed with HVNI, and the other 24 patients were managed with non-invasive ventilation. Patients were closely monitored in the respiratory intensive care unit (RICU). Oxygen saturation, respiratory rate, and Arterial Blood Gases (ABG) were measured before the start of treatment, then 1 hour, 4 hours, 2 days, and 3 days after treatment. Patients were allowed to crossover to the other arm of treatment or endotracheal intubation according to the clinical situation. Results pH, P Co2 levels showed similar changes in the two studied groups and improved with time. Treatment failure and mortality rates were also comparable in the two groups. Failure of treatment occurred in 16% in the group managed with HIVNI and in 33% in the group managed with NIPPV. Intubation at the end of 72 hourswas 16.7% in the group managed with HVNI and 25% in the group managed with NIPPV. Conclusion High velocity nasal insufflation is effective in managing acute hypercapnic respiratory failure. HVNI offers an effective way alternative to NIPPV in managing acute hypercapnic respiratory failure.

High-velocity nasal insufflation versus noninvasive positive pressure ventilation for moderate acute exacerbation of chronic obstructive pulmonary disease in the emergency department: A randomized clinical trial.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) involve dyspnea, cough, and chest discomfort; frequent exacerbations are associated with increased mortality and reduced quality of life. Noninvasive positive pressure ventilation (NiPPV) is commonly used to help relieve symptoms but is limited due to patient intolerance. We aimed to determine whether high-velocity nasal insufflation (HVNI) is noninferior to NiPPV in relieving dyspnea within 4 h in ED patients with acute hypercapnic respiratory failure. This randomized control trial was conducted in seven EDs in the United States. Symptomatic patients with suspected COPD, partial pressure of carbon dioxide (pCO2) ≥ 60 mm Hg, and venous pH 7.0-7.35 were randomized to receive HVNI (n = 36) or NiPPV (n = 32). The primary outcome was dyspnea severity 4 h after the initiation of study intervention, as measured by the Borg score. Secondary outcomes included vital signs, oxygen saturation, venous pCO2, venous pH, patient discomfort level, and need for endotracheal intubation. Sixty-eight patients were randomized between November 5, 2020, and May 10, 2023 (mean age 65.6 years; 47% women). The initial pCO2 was 77.7 ± 13.6 mm Hg versus 76.5 ± 13.6 mm Hg and the initial venous pH was 7.27 ± 0.063 versus 7.27 ± 0.043 in the HVNI and NiPPV groups, respectively. Dyspnea was similar in the HVNI and NiPPV groups at baseline (dyspnea scale score 5.4 ± 2.93 and 5.6 ± 2.41) and HVNI was noninferior to NiPPV at the following time points: 30 min (3.97 ± 2.82 and 4.54 ± 1.65, p = 0.006), 60 min (3.09 ± 2.70 and 4.07 ± 1.77, p < 0.001), and 4 h (3.17 ± 2.59 and 3.34 ± 2.04, p = 0.03). At 4 h, there was no difference between the groups in the pCO2 mm Hg (68.76 and 67.29, p = 0.63). Patients reported better overall comfort levels in the HVNI group at 30 min, 60 min, and 4 h (p = 0.003). In participants with symptomatic COPD, HVNI was noninferior to NiPPV in relieving dyspnea 4 h after therapy initiation. HVNI may be a reasonable treatment option for some patients experiencing moderate acute exacerbations of COPD in the ED.

ANALYSIS OF HYDROCARBON GASES OF MUD VOLCANOES OF THE LOWER KURA TROUGH

Based on the detailed analysis of the existing geological-geophysical material, the distribution area of the mud volcanoes developed in the depression, and the geochemical characteristics of their eruption products were studied. The aim is to determine the gases contained in the wastes thrown by volcanoes onto the earth's surface and to study of distribution along the territory. For this reason, the capacity of methane gas, heavy hydrocarbons, nitrogen and carbon dioxide of erupted materials on the surface was studied. Based on the results obtained during the analysis, the composition of the gases of the mud volcanoes located in the depression consists mostly of methane. The content of methane in the eruptive materials of Agzibir volcano varies from 86.3% to 98.88% (Kalamaddin mud volcano). The average mark of methane gas ranges from 86.6% (Akhtarmaardi) to 91.3% (Harami). In addition, maps were drawn up to determine the distribution of gases in the eruptive materials along the study area. Besides, a map of the location of the Galmaz mud volcano, a geological profile passing through the mud volcano was created. The content of gases emitted into the atmosphere was determined based on the analysis of mud volcano eruptive wastes in the south-west and north-east parts of the Galmaz field. As a result of geological-geophysical studies was determined that the chemical composition of the eruption materials of the Galmaz mud volcano is different. The analysis show that, most of the gases emitted from the volcano to the atmosphere consist of methane (CH4) gas. Content of it is up to 97.42% and more. The content of other gases is relatively small, so heavy hydrocarbons is 0.04%, nitrogen is 0.48%, CO2 is 2.06%. The individual deposits related with mud volcano are mainly massive, structural and tectonically screened types. However, hydrocarbons accumulated within traps are formed oil-gas and gas individual deposits. Keywords: Galmaz field, mud volcano eruption, methane gas content, content of nitrogen, carbon dioxide, crushing zones, heavy hydrocarbons, oil and gas accumulations.

Rapamycin improves satellite cells' autophagy and muscle regeneration during hypercapnia.

Both CO2 retention, or hypercapnia, and skeletal muscle dysfunction predict higher mortality in critically ill patients. Mechanistically, muscle injury and reduced myogenesis contribute to critical illness myopathy, and while hypercapnia causes muscle wasting, no research has been conducted on hypercapnia-driven dysfunctional myogenesis in vivo. Autophagy flux regulates myogenesis by supporting skeletal muscle stem cell - satellite cell - activation, and previous data suggest that hypercapnia inhibits autophagy. We tested whether hypercapnia worsens satellite cell autophagy flux and myogenic potential and if autophagy induction reverses these deficits. Satellite cell transplantation and lineage-tracing experiments showed that hypercapnia undermined satellite cells' activation, replication, and myogenic capacity. Bulk and single-cell sequencing analyses indicated that hypercapnia disrupts autophagy, senescence, and other satellite cell programs. Autophagy activation was reduced in hypercapnic cultured myoblasts, and autophagy genetic knockdown phenocopied these changes in vitro. Rapamycin stimulation led to AMPK activation and downregulation of the mTOR pathway, which are both associated with accelerated autophagy flux and cell replication. Moreover, hypercapnic mice receiving rapamycin showed improved satellite cell autophagy flux, activation, replication rate, and posttransplantation myogenic capacity. In conclusion, we have shown that hypercapnia interferes with satellite cell activation, autophagy flux, and myogenesis, and systemic rapamycin administration improves these outcomes.

Development and validation of hydrophobic molded pulp nursery pots made of hemp hurd

Biodegradable nursery pots (BNPs) composed of 50 % hemp hurd and 50 % recycled cardboard fibers (w/w dry basis) were produced using a custom-built handheld molded pulp device. Milling followed by sequential peracetic acid and sodium hydroxide delignification treatment reduced lignin content of hemp hurd from 23.76 % to 2.39 %, liberating cellulose and hemicellulose fibers for enabling the formation of interfiber interactions in molded pulp formulations. Beeswax and precipitated calcium carbonate based hydrophobic coating at ∼10 μm thickness significantly enhanced hydrophobicity of the BNPs, as indicated by the surface contact and sliding angle of 116.25° and 34.82°, respectively. Anaerobic biodegradability of BNP was confirmed via carbon dioxide and methane gas accumulation measurements. Developed BNPs were successfully validated through an eleven week greenhouse planting trial. This study introduced a new biodegradable molded pulp formulation made from hemp hurd and validated its application as an alternative to single use plastic nursery pots for growing seedlings.

Comparison of the Competitiveness for Danish, Dutch, and German Piglet Producers under Consideration of Country-Specific Methods of Piglet Castration with Anesthesia

Pig producers in Europe adopt different production methods for male pig fattening. More than half of the animals are surgically castrated. The different interpretations of animal welfare in different countries lead to market differentiation and economically different production conditions, which do not restrict trade, but economically lead to drastic competitive changes for local producers. While the Netherlands has already implemented surgical castration for the export market, using CO2 narcosis (NL), Denmark and Germany are each introducing their strategies with local anesthesia (DK) and isoflurane anesthesia (DE), respectively. Using typical pig farms from the agri benchmark Pig Network, the additional costs and economic impacts of animal welfare regulations are calculated. In Germany, isoflurane anesthesia increases costs by EUR 28.54 to EUR 49.86 per sow, or EUR 1.93 to EUR 3.81 per male piglet. This corresponds to a cost increase of around 5% per piglet. In Denmark, the costs of local anesthesia with procaine increase more moderately by EUR 3.55 to EUR 5.05 per sow, or around EUR 0.30 per male piglet. The cost increase here is less than 1% per piglet. The additional costs are leading to a loss of competitiveness for Denmark and Germany compared to the Netherlands. However, Germany is also losing profit significantly compared to Denmark. This study highlights that animal welfare regulations can negatively impact the competitiveness of the pig sector. It emphasizes the need for countries to implement such regulations carefully, ensuring that they do not lead to the loss of production or international competitiveness. A balanced approach that supports both animal welfare and economic sustainability is essential.

New algorithm of three-phase equilibrium calculations for CO2-hydrocarbon-water systems

In this century, global warming caused by the accumulation of atmospheric carbon dioxide has become an essential concern. The industry has two main decarbonization options: CO2 capture for permanent storage in geological formations and CO2 utilization for enhancing oil recovery (EOR). Both methods require accurate reservoir simulation to correctly describe the fluids flowing process and design an optimal injection plan. However, existing reservoir simulation practices often neglect the interaction and dissolution of CO2 and hydrocarbon components in water, leading to inaccurate predictions. Neglecting CO2 dissolution in water undermines storage estimation for capture and results in unreliable EOR descriptions. Therefore, to address this, our study focuses on developing a reliable and accurate phase equilibrium calculation package for hydrocarbon-CO2-water three-phase systems, which meets the demanding efficiency and robustness criteria of reservoir simulation. In this paper, we first introduce the methodology of the three-phase equilibrium calculation algorithm, then illustrate the numerical techniques employed to improve computational efficiency and finally demonstrate superior robustness of this algorithm through comprehensive case studies. Our research contributes three key improvements. First, we have increased the reliability of phase behavior descriptions by considering the dissolution of CO2 and hydrocarbon components in water. Second, we have enhanced the robustness of the three-phase equilibrium calculations algorithm, enabling accurate determination of three-phase statuses and fluid behaviors where standard commercial software may fail. Third, our algorithm exhibits notable efficiency improvements, ensuring its suitability for three-phase compositional simulations. The findings of this research provide valuable insights into the accurate modeling of hydrocarbon-CO2-water three-phase systems and offer practical solutions for designing effective CO2 reduction strategies.

A 4IR-Driven operational risk model for CO2 storage in deepwater abandoned hydrocarbon reservoirs

This study presents the development of an advanced operational risk model that leverages Fourth Industrial Revolution (4IR) technologies to optimize carbon dioxide (CO2) storage within deepwater abandoned hydrocarbon reservoirs. The model systematically combines Artificial Neural Networks (ANN) with the optimization capabilities of Genetic Algorithms (GA) and the probabilistic analysis strengths of a Bayesian Network (BN) to perform dynamic and comprehensive risk assessments. By applying the model to a dataset covering a 200-year timeframe, it effectively forecasts CO2 storage capacities while simultaneously evaluating associated risks across different operational scenarios. One of the key innovations of this model is the introduction of a novel loss function designed to precisely manage forecast deviations and enhance the efficiency of operational processes. This function is critical in ensuring that the model remains robust and accurate in real-time risk assessments, allowing for more reliable decision-making in CO2 storage operations. In addition, the study conducts an economic evaluation that underscores the crucial role of 45Q tax credits in bolstering the financial sustainability of carbon sequestration projects. The analysis highlights how these credits significantly reduce the economic barriers to adopting carbon utilization, storage, and sequestration (CUSS) technologies, making large-scale implementation more feasible. The model's performance is underscored by its ability to achieve a 49% CO2 retention rate over two centuries, with an impressively low average error margin of 0.249%. These results highlight the model's impressive efficiency and accuracy, while also demonstrating its capacity to markedly improve the predictability of CO2 storage outcomes. The findings suggest that this model could play a pivotal role in advancing global sustainability efforts by optimizing CO2 storage processes, thereby contributing to the reduction of atmospheric CO2 levels and supporting long-term climate goals.

High-Flow Nasal Oxygen in Patients with Acute Hypercapnic Respiratory Failure: A Narrative Review of the Physiological Rationale and Clinical Evidence.

Acute hypercapnic respiratory failure is a life-threatening condition caused by alveolar hypoventilation. It is mostly caused by an acute exacerbation of chronic obstructive pulmonary disease or conditions yielding muscle dysfunction. Noninvasive ventilation through a facemask is the cornerstone first-line strategy to support hypercapnic patients with acidemia, and current guidelines strongly recommend this intervention to improve survival and long-term clinical outcomes. Because of its benefits related to carbon dioxide washout from the upper airways and the enhanced comfort, high-flow nasal oxygen has been proposed as a respiratory support strategy in patients with hypercapnic respiratory failure, both as an alternative to and in combination with noninvasive ventilation. When compared to noninvasive ventilation as a first-line intervention, high-flow nasal oxygen shows a higher rate of failure. Hence, if not contraindicated, the use of noninvasive ventilation should be preferred. After the resolution of acidemia with noninvasive ventilation, high-flow nasal oxygen showed promising physiological effects compared to conventional oxygen. During weaning from mechanical ventilation in patients with or at risk of developing hypercapnia, high-flow nasal oxygen showed encouraging results, especially when applied alternating with sessions of noninvasive ventilation. Optimal settings of high-flow nasal oxygen in hypercapnic patients include the use of a smaller-size cannula, flows ranging between 30 and 40 L/min, and FiO2 adjusted to obtain SpO2 between 88% and 92%. Specific interfaces, such as asymmetric cannulas, may further enhance the benefits of a high flow in terms of carbon dioxide clearance. In this narrative review, we provide an updated overview of the physiological rationale and clinical evidence concerning the use of high-flow nasal oxygen in patients with acute hypercapnic respiratory failure.

Long-term mortality in patients with chronic obstructive pulmonary disease requiring acute non-invasive ventilation with and without obstructive sleep apnoea

IntroductionChronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome (OVS) is associated with higher mortality compared with COPD alone in stable outpatients. However, the prognosis of patients hospitalised with...

Brewery CO2 conversion into acetic acid at an optimized set of microbial electrosynthesis process parameters

Direct utilization of unpurified industrial CO2 is desired to minimize feedstock transportation and purification costs and develop cost-efficient carbon utilization technologies. To this end, utilization of brewery CO2, which is a readily available yet underexplored carbon source, is feasible via microbial electrosynthesis (MES) technology, though the productivity indicators remain lower. This study provides insights into enhancing the MES productivity from unpurified brewery CO2 through optimization of feed rate and cathode potential (Ecathode), besides assessing the impact of catholyte recirculation on overall production parameters. At an Ecathode of –1 V, the Acetobacterium-dominated enriched mixed microbial culture produced up to 6.6 g/L acetic acid at 85 % coulombic efficiency and cell voltage (Ecell) of 2.98 V from brewery CO2 fed continuously at 0.7 L/d rate. Acetic acid production decreased at the lower or higher Ecathode and gas feed rate conditions, emphasizing the importance of maintaining an optimal balance between the gas flow rate and Ecathode to achieve efficient H2-mediated production. With the catholyte recirculation loop in reactors operated under the optimized Ecathode and feed rate conditions, acetate production enhanced further to 7.6 ± 0.65 g/L at 92 % coulombic efficiency and 2.9 V Ecell. The improved productivity can be attributed to better mixing and retention of CO2 and H2 in MES reactors, besides the enhanced growth and dominance of key CO2-fixing acetogens belonging to Acetobacterium and Eubacterium genera under the catholyte recirculation condition. The findings suggest that fine-tuning various process parameters is pivotal to achieving the desired MES productivity.

GEOCHEMISTRY OF GROUNDWATERS AND SURFACE WATERS, AND GROUND ICE OF THE OKA PLATEAU, EASTERN SAYAN (RUSSIA)

The study area is located in the Eastern Sayan hydrogeological folded area. The objects of the study were groundwaters, surface waters and ground ice in the Sentsa River basin on the Oka Plateau. Cold and thermal groundwaters are associated with Proterozoic and Paleozoic metamorphic and igneous rocks. Their discharge as springs occurs in the river valleys along fault zones. Ground ice was studied in mineral frost mounds (lithalsas) composed of clays, clayey silts and silts of lacustrine-alluvial and fluvioglacial genesis. It has been established that thermal and cold groundwaters have HCO3 Ca-Na compositions, river and lake waters, as a rule, have HCO3 Ca-Na compositions, and ground ice melts – HCO3, SO4-HCO3 and NH4-HCO3 Ca. Thermal waters are largely enriched in Li, Be, B, Si, Mn, Ga, Ge, Se, As, Br, Rb, Sr, Cs, Ba and all REE relative to river and rain waters, and have the highest values of trace elements enrichment factor (EFREE). The latter shows that atmospheric precipitation participates in the formation of the composition of groundwaters (cold and thermal) and surface waters. The specificity of the geochemistry of ground ice is determined by the composition of precipitation, the injection of ice-forming groundwater from taliks, the interaction in the water-rock system, and the presence of organic matter in unconsolidated sediments. The participation of river water and groundwater in the formation of the frost mound ice core is also evidenced by similar values of stable isotopes (δ18O, δD) in surface water, groundwater and ground ice. The 3He/4He ratio points to a possible influx of mantle helium into thermal waters, and δ13С points to the magmatic and thermometamorphic mechanisms of carbon dioxide accumulation in thermal waters. The 87Sr/86Sr ratio in travertines indicates a significant contribution of intrusive rocks to the formation of fluid composition.

Long-term reliable wireless H2 gas sensor via repeatable thermal refreshing of palladium nanowire

The increasing significance of hydrogen (H2) gas as a clean energy source has prompted the development of high-performance H2 gas sensors. Palladium (Pd)-based sensors, with their advantages of selectivity, scalability, and cost-effectiveness, have shown promise in this regard. However, the long-term stability and reliability of Pd-based sensors remain a challenge. This study not only identifies the exact cause for performance degradation in palladium (Pd) nanowire H2 sensors, but also implements and optimizes a cost-effective recovery method. The results from density functional theory (DFT) calculations and material analysis confirm the presence of C = O bonds, indicating performance degradation due to carbon dioxide (CO2) accumulation on the Pd surface. Based on the molecular behavior calculation in high temperatures, we optimized the thermal treatment method of 200 °C for 10 minutes to remove the C = O contaminants, resulting in nearly 100% recovery of the sensor’s initial performance even after 2 months of contamination.

7378 Glargine Induced Neuroglycopenia in Patients with End-Stage Renal Disease: Importance of Insulin Regimen Optimization in Haemodialysis Patients

Abstract Disclosure: M. Shrivastava: None. L. Kaur: None. B. Armendariz: None. R. Kaur: None. A. Shetty: None. In patients with end stage renal disease (ESRD), hypoglycemia accounts for up to 3.6% of all the admissions with mortality rates of up to 30%. A combination of impaired insulin clearance, changes in glucose metabolism and dialysis process makes the patients with end stage renal disease vulnerable to neuroglycopenia.Case description:53 year old female with past medical history of insulin dependent type 2 diabetes mellitus, ESRD secondary to diabetes, on hemodialysis(HD) thrice weekly since two years, presented to the emergency with altered mental status, respiratory distress, tachycardia. Lab work revealed blood glucose(BG) of 23 mg/dl, HbA1c of 8.4%, eGFR of 6, and arterial blood gas showed hypercapnic respiratory acidosis. Patient received dextrose, with no improvement of symptoms. Eventually she developed acute hypercapnic respiratory failure requiring endotracheal intubation with mechanical ventilation, and was transferred to the ICU. As per family, a night prior to presentation, last recorded BG after dinner was 253 mg/dl, she took her night time glargine, which was recently increased by her primary care for poorly controlled HbA1c levels. Brain MRI and long term EEG monitoring findings were consistent with underlying extensive brain injury secondary to prolonged hypoglycemia. Unfortunately, the patient's condition did not improve despite HD and BG correction, eventually she underwent compassionate extubation. Case Discussion:The insulin requirements in ESRD patients are reduced by approximately 50%, regardless of residual insulin secretion. Malnutrition and acidosis reduce hepatic glycogen stores and availability of gluconeogenic precursor, expected compensatory renal gluconeogenesis is compromised by decreased renal function causing hypoglycemia, which is further worsened by inappropriately high plasma insulin levels caused by reduced renal insulin breakdown. Diabetes mellitus patients with ESRD are frequently managed with basal-bolus insulin regimen, and HD up to thrice weekly, leaving them without HD for up to 3 days especially over the weekend. This can result in accumulation of insulin metabolites causing delayed insulin clearance as seen in our patient. In such cases even long acting insulin, such as glargine, can have compounding effects, which could possibly cause fatal complications such as neuroglycopenia. In such patients continuous glucose monitor use with tapering dose glargine regimen may help eliminate this compounding effect. Conclusion: Neuroglycopenia is a rare manifestation of diabetes mellitus with ESRD. Compromised renal gluconeogenesis and impaired insulin clearance can cause inappropriately high plasma levels of insulin. In such patients continuous glucose monitoring along with tapering dose of long acting insulin should be utilized for proper glycemic control to limit compounded effect of insulin metabolite accumulation. Presentation: 6/3/2024

Comparing the Outcome of Using High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for Chronic Obstructive Pulmonary Disease Patients with Acute Hypercapnic Respiratory Failure

Abstract Background Noninvasive ventilation (NIV) is frequently employed as a treatment option for acute hypercapnic respiratory failure (AHRF) resulting from chronic obstructive pulmonary disease (COPD). Limited research has substantiated the claims made in recent studies regarding the feasibility of employing high flow nasal cannula (HFNC). Aim Our study assessed the outcome of using HFNC versus NIV for COPD patients with AHRF. Patients and Methods Eighty COPD patients with AHRF were confined to the respiratory intensive care unit (RICU) at Ain Shams university hospitals from December 2021 to 2023 and subdivided into 2 groups (40/group), where the first group was placed on NIV, while the second group was placed on HFNC. Data during their hospital stay as demographic data, vital data, arterial blood gases, device duration, treatment failure and mortality were recorded. Results The majority were males with mean age 63.75 ± 9.05 years along with treatment failure and complications 25%,27.5% in NIV versus 45%,10% in HFNC respectively, with longer hospital stay in NIV (10-15 days) to (7-10 days) in HFNC with no difference in mortality rate in both groups. Conclusion NIV and HFNC were both modalities for treating COPD with AHRF with no confirmed superiority of any of them; as treatment failure was apparently lower in NIV than HFNC along with apparently faster improvement in ventilatory and respiratory status but significantly NIV group was superior in length of hospitalization and incidence of complications than HFNC with no difference in mortality in both groups.

Understanding and Managing Adenotonsillar Hypertrophy in Pediatric Otolaryngology

Adenotonsillar hypertrophy (ATH) is a common pediatric condition marked by the growth of lymphoid tissues within the Waldeyer’s ring, which includes adenoids, palatine tonsils, and lingual tonsils. These tissues surround the upper airway and food passage, and play an immunological role, enlarging until about age 12, before gradually reducing during adolescence and adulthood. Untreated or poorly managed ATH can severely impact multiple health aspects of children. It is the primary cause of upper airway obstruction and obstructive sleep apnea (OSA) syndrome in children, which disrupts sleep and can severely impair cognitive development, school performance and behaviour. Chronic mouth breathing from ATH can alter dental arches and facial growth, known as adenoid facies. More severe outcomes include increased pulmonary pressures and the potential development of pulmonary hypertension and cor pulmonale due to chronic hypoxia and CO2 retention. As a result, tonsillectomy, with or without adenoidectomy (T&amp;A), has become one of the most frequently performed surgeries in North America, with over 530,000 operations performed annually on children under age 15. This paper discusses the significant impact of ATH on pediatric health and the frequent need for surgical intervention. It covers the immunophysiology, influence of atopy, community-based assessments prior to specialist referrals, and an overview of available medical and surgical treatment options. Additionally, it outlines general indications for referring patients to otolaryngology.

Study of Knowledge, Attitude, and Practices of Use of Masks among Health-care Workers at a Tertiary Care Center in Mumbai

ABSTRACT Introduction: Airborne transmission of infectious diseases poses a significant public health challenge. Nosocomial outbreaks of airborne infections such as influenza H1N1, H5N1, and drug-resistant tuberculosis (TB) variants have been documented, with substantial morbidity and mortality attributed to inadequate airborne infection control strategies. N-95 respirators and surgical masks (face masks) are the examples of personal protective equipment that are used to protect the wearer from airborne particles and liquid contamination of the face. Aim and Objectives: The aim of this study was to assess the knowledge, practices, and attitude of health-care workers (HCWs) regarding the use of mask, especially N-95 mask. Materials and Methods: A prospective, was conducted over a period of 6 months at a tertiary care hospital. This study was carried out in the department of microbiology of a tertiary care hospital over a period of 6 months. A total of 500 HCWs from various departments of the hospital were included in the study. HCWs were given a questionnaire based on N-95 respirator usage, and participation was voluntary. Results: The analysis of survey data provides insightful perspectives on respondents’ comprehension and attitudes toward airborne infection transmission and the usage of N-95 masks. 68.6% of respondents recognized that all listed diseases (measles, TB, and chickenpox) were spread by the airborne route. 55.6% of respondents correctly acknowledged that all masks, including surgical masks, N-95 masks, and cotton masks, do not offer airborne protection. 76.0% of respondents acknowledged that N-95 masks possess a high filtration efficiency against 0.3-micron particles, 58.3% correctly identified that “N” in N-95 stands for “not resistant to oil,” and 90.8% acknowledged that the N-95 respirator as the most common type of respirators. 41.7% correctly acknowledged that N-95 masks with an exhalation valve are not recommended for use. 22.2% of respondents incorrectly believe that wearing a face mask can lead to carbon dioxide poisoning, and 52.1% of respondents correctly identified that pulmonary TB patients need not be provided with N-95 masks in isolation rooms. 76.8% of respondents understood that fit testing is required every time one dons an N-95 mask. 95.5% of respondents recognized the necessity of hand hygiene before donning and after doffing N-95 masks. 82.7% of respondents agreed regarding the necessity for consultation before N-95 mask usage for chronic lung disease and asthma patients. 93.7% are aware that there is a protocol for donning and doffing N-95 masks. 71.3% of respondents understood that extended use involves wearing the same N-95 respirator for repeated close contact encounters without removing the mask between patient encounters, while 64.4% correctly define reuse as using the same N-95 respirator for multiple encounters but removing it after each encounter.