Dry Membranes Research Articles

PVC/CNT Electrospun Composites: Morphology and Thermal and Impedance Behavior.

Due to their mechanical robustness and chemical resistance, composite electrospun membranes based on polyvinyl chloride (PVC) are suitable for sensor applications. Aiming to improve the electrical characteristics of these membranes, this work investigated the effects of the addition of carbon nanotubes (CNTs) to PVC electrospun membranes, in terms of morphology and thermal and impedance behavior. Transmission electron microscopy images evidenced that most of the nanotubes were encapsulated within the fibers and oriented along them, while field-emission scanning electron micrographs revealed that the membranes consisted of uniform fibers with an average diameter of 339 ± 31 nm, regardless of the addition of the carbon nanotubes. With respect to the neat resin, the addition of nanotubes caused a significant lowering of the glass transition temperature (up to 20 °C) and a marked change in the second degradation step of PVC. Nyquist plots from electrical impedance spectra showed a charge transfer resistance (RCT) of 38 and 40 MΩ for neat PVC and PVC/CNT 3 wt.% membranes, respectively, indicating that, in the dry state, the encapsulation of CNTs in the fibers and the high porosity of the membranes prevented the formation of a percolation network, increasing the electrical resistance. In the wet state, however, there was a greater change in the impedance behavior, decreasing the resistance RCT to 4.5 and 1.1 MΩ, for neat PVC and PVC/CNT 3 wt.% membranes, respectively. The results of this study, showing a significant variation in impedance behavior between dry and wet membranes, are relevant for the development of various types of sensors based on PVC composites.

8269 Euglycemic Diabetic Ketoacidosis Secondary to Rapid Weight Loss in a Patient on Dapagliflozin

Abstract Disclosure: A. Sridhar: None. A. Iqbal: None. A. Prabha Kumar: None. F. Haider: None. M. Babic: None. Background: Euglycemic DKA (eDKA) is a potentially life-threatening complication in patients taking SGLT 2 inhibitors (SGLT2i). Common precipitating factors include strenuous exercise, carbohydrate restriction, starvation, and alcohol use. Clinical case: The patient is a 71-year-old female with past medical history of Type 2 diabetes mellitus (DM), gastro-esophageal reflux disease, hypertension, hyperlipidemia, coronary artery disease and chronic pain syndrome. She presented with complaints of nausea, vomiting, reduced appetite and generalized weakness for the past 4 days. She also reported an intentional weight loss of 35 pounds in the last 6 weeks achieved with daily exercise and a carbohydrate restricted diet. She had been taking Dapagliflozin-Metformin 5-1000 mg twice daily and pioglitazone 30 mg once daily for 2 years and Ozempic subcutaneous injection 1 mg weekly for 6 months. Physical examination in the ED showed normal vital signs, dry mucous membranes, and trace bilateral lower extremity edema. Blood work was significant for venous blood gas pH 7.24, bicarbonate 9 mmol/L, anion gap 30 mmol/L, blood glucose 94 mg/dL, HbA1c 5.8 % and WBC 13.2 K/uL. Urinalysis was positive for glucose and ketones. The patient was admitted for management of eDKA and was started on intravenous 10% dextrose infusion and insulin infusion. Endocrinology was consulted and they recommended following DKA protocol and stopping Dapagliflozin at discharge. She was maintained on insulin infusion for 48 hours after which her anion gap normalized, and she was transitioned to subcutaneous insulin with Lantus 8 units and sliding scale insulin. During this time the patient’s symptoms resolved, and she was able to tolerate oral diet. She eventually resumed her home medications with oral Metformin 1000 mg twice daily and pioglitazone 30 mg once daily. Dapagliflozin and Ozempic were discontinued at discharge. Strenuous exercise and carbohydrate restriction which caused rapid weight loss, were likely the triggers for eDKA in our patient. A diabetes educator was involved at discharge and the patient was counseled to avoid possible triggers and identify warning signs and symptoms in the future. The patient was discharged with a follow up appointment with her Endocrinologist. Conclusion: High index of clinical suspicion is important to promptly diagnose eDKA in patients taking SGLT2i. Patient education on avoiding precipitating factors and early recognition of signs and symptoms is necessary to reduce mortality. Presentation: 6/3/2024

8472 A Little Too Much Of Tums: A Unique Presentation Of Milk Alkali Syndrome

Abstract Disclosure: Z. Al-Hiti: None. A. Misbah: None. Milk-Alkali Syndrome is characterized by a triad of hypercalcemia, metabolic alkalosis, and renal dysfunction. Historically associated with the excessive consumption of milk and alkali-containing antacids, it has re-emerged in recent years due to the widespread use of calcium and vitamin D supplements. It primarily results from an imbalance between calcium intake and renal excretion, leading to elevated calcium levels in the bloodstream. We present a case of milk-alkali syndrome with persistent renal dysfunction after normalizing calcium levels. We present the case of a 65-year-old male who presented to the emergency department with generalized weakness, poor oral intake, and confusion for 3 days. He was noted to have been more adherent with taking his prescribed medications over the last 2 weeks, which include calcitriol 0.5 mcg BID, calcium acetate 667 mg TID, and calcium carbonate 800 mg TID. On admission, he was afebrile and hemodynamically stable. . On examination, he had dry mucous membranes. He had no focal neurological deficits but he was confused and lethargic, and was only oriented to self. Other examination was noncontributory. Complete blood count and urinalysis were largely unremarkable. Chemistry demonstrated an elevated calcium level of 16.0 (8.3-10.6 mg/dL), ionized calcium of 7.3 (4.6-5.3 mg/dL), sodium of 134 (135-145 mmol/L), potassium of 5.4 (3.5-5.1 mmol/L), high phosphorus of 5.3 (2.4-5.1 mg/dL), and bicarbonate of 36 (20-31 mEq/L). Creatinine was elevated at 2.9 (0.6-1.1 mg/dL) from baseline of 1.3 to 1.4 mg/dL, and he had a BUN of 40(9-23 mg/dL). Venous blood gas showed a pH of 7.54( 7.32-7.42), pCO2 of 56 (40-52 mm Hg), and bicarbonate of 38 (23-28 mEq/L), indicating metabolic alkalosis. TSH was elevated at 36.15 (0.55- 4.78 uIU/mL) with a level of 140 two weeks back. Chest X-ray, renal ultrasound and CT head all showed no acute disease. Further work-up revealed a low PTH level of 6.3 (18.4-80 pg/mL), normal PTHrP level and 25-OH Vitamin D. There was no monoclonal gammopathy. Management included aggressive IV fluid resuscitation and IV calcitonin. However, no zoledronic acid was given due to a history of parathyroidectomy and risk of hypocalcemia. His serum calcium improved and eventually normalized. His confusion resolved. However, his creatinine and BUN increased to 3.4 mg/dL and 77, respectively, and did not improve to his baseline. This case highlights the importance of recognizing Milk-Alkali Syndrome as a potential consequence of over-the-counter calcium supplementation and highlights the potential for acute kidney injury which could be irreversible. Healthcare providers should be vigilant in identifying patients at risk, which includes older patients and patients with chronic kidney disease. Early recognition and appropriate management are crucial to prevent further renal deterioration and improve outcomes in individuals with Milk-Alkali Syndrome. Presentation: 6/2/2024

9332 Breathless Struggle: Unraveling The Interplay Between DKA And Acute Respiratory Distress Syndrome

Abstract Disclosure: S. Zahra: None. R. Subramani: None. M. Abbas: None. K.Y. Hasan: None. F. Manas: None. C. Bajracharya: None. Introduction: Diabetic Ketoacidosis (DKA) is a life threatening emergency with mortality rate of 0.15%-0.30%. Acute Respiratory Distress Syndrome (ARDS) is a rare complication of DKA which presents as a sudden onset of dyspnea and progressive hypoxia. It is an inflammatory process that damages the alveolar-capillary membrane leading to the fluid leakage into the alveolar space. The incidence of ARDS in DKA remains unknown. It is more commonly seen in adolescents and young adults. The exact pathogenesis of ARDS in DKA is currently unknown. Some proposed mechanisms are that a severe metabolic acidosis in DKA along with increased cytokines production due to long standing hyperglycemia leads to increased capillary membrane permeability allowing fluid to accumulate in the alveolar space. TNF-a and IL-6 along with other pro-inflammatory cytokines are known to cause endothelial damage and increase pulmonary permeability leading to pulmonary edema. However most DKA patients with severe metabolic acidosis do not develop ARDS. Case Presentation:Case 1: A 19 year old male with uncontrolled type I diabetes mellitus presented with altered mental status. On examination, he was tachycardic and tachypneic with dry mucous membranes. Lab workup revealed leukocytosis, severe hyperglycemia, and severe anion gap metabolic acidosis with beta hydroxybutyrate level of 14.20 mmol/L (normal: 0.02-0.27 mmol/L). He was diagnosed with DKA and started on intravenous fluids, and insulin as per institutional DKA protocol. Approximately 12 hours post-admission, the patient experienced sudden-onset dyspnea with deteriorating hypoxia, necessitating emergent intubation and mechanical ventilation. Chest radiography displayed bilateral patchy ground-glass opacifications consistent with acute respiratory distress syndrome (ARDS). Despite the administration of 8 liters of intravenous fluids, the patient exhibited a negative net fluid balance of 2.3 liters, implicating fluid shift. Further investigations, including bronchoscopy and bronchoalveolar lavage, revealed an unobstructed airway, minimal secretions, and no evidence of hemorrhage or infection. Comprehensive infectious work-ups yielded negative results as well, reinforcing the diagnosis of DKA as the underlying cause of ARDS. Conclusion: Acute Respiratory Distress Syndrome is a rare but potentially fatal complication of Diabetic Ketoacidosis. Early recognition of this serious pulmonary complication of DKA and its prompt management is essential to prevent respiratory failure and mortality. Presentation: 6/1/2024

9334 Pancreatic Adenocarcinoma Presenting As Diabetic Ketoacidosis

Abstract Disclosure: J. Alvarez: None. M.H. Horani: None. Background: Pancreatic adenocarcinoma is often diagnosed at an advanced stage due to late onset of clinical features including poor appetite, weight loss, weakness, epigastric pain, and rarely impaired glucose tolerance. In patients who present with impaired glucose tolerance or diabetic ketoacidosis without prior history of diabetes, pancreatic adenocarcinoma should be considered. Clinical Case: Patient is a 45-year woman with depression, HTN, irritable bowel syndrome who was found unresponsive by family and presented to the ED for acute encephalopathy. On exam, she was obtunded, tachypneic, with fruity-smelling breath and dry mucous membranes. Initial labs showed glucose of 950 mg/dL (70-99 mg/dL), lipase 539 U/L (8-78 U/L), lactic acid 4 mmol/L 0.5-2 mmol/L), ketone-BHB 170.75 mg/dL (0-2.81 mg/dL), A1c 16.5%. She had no prior history or family history of diabetes. She was admitted to hospital for DKA management.CXR to evaluate dyspnea showed bilateral opacities so CT chest/abdomen/pelvis without contrast was ordered. This showed bilateral multilobar pneumonia, trace pleural effusions, 6.7 x 3.8 cm lobulated fluid collection along pancreatic tail, 12.1 x 6.6 x 4.4 cm RLQ cystic lesion and 4.4 cm lesion vs loculation along the right pelvic sidewall.Initially, GI recommended repeat imaging of the pancreas in 4-6 weeks. OBGYN was consulted for pelvic masses and recommended IR-guided biopsy of right pelvic mass which showed rare mildly atypical mucinous epithelium present, cystic mucinous neoplasm cannot be excluded.CEA and CA125 tumor markers returned elevated. These biopsies showed adenocarcinoma (solid component) and rare atypical mucinous epithelium consistent with cystic mucinous neoplasm (cystic fluid). Patient was deemed medically stable for discharge with recommended follow-up to appropriate specialists. Following discharge, she was officially diagnosed with Stage III (cT4, cN0, cM0) pancreatic adenocarcinoma and started on appropriate chemotherapeutic regimen. Discussion: The current understanding is long-standing type 2 diabetes mellitus as a risk factor for pancreatic cancer based on previous studies.The inverse relationship of pancreatic cancer causing new onset diabetes is more rare, but if cancer is suspected in these patients it could potentially help in the diagnosis of early stage adenocarcinoma. Other case reports have suggested implementation of the enriching new-onset diabetes for pancreatic cancer (ENDPAC) score in addition to CT and EUS as screening for pancreatic cancer may help with earlier diagnosis.

7761 Unmasking The Uncommon: A Case Of Primary Adrenal Insufficiency Presenting As Severe Hypercalcemia

Abstract Disclosure: A. Misbah: None. Z. Al-Hiti: None. A. Saleh: None. M. Joda: None. K. Rajamani: None. Adrenal insufficiency is a recognized but uncommon cause of hypercalcemia. The exact mechanism remains unknown; however, it is thought to be a combination of the hypovolemic state in adrenal insufficiency leading to decreased urinary clearance, as well as increased bone resorption. We present a case of primary adrenal insufficiency presenting with severe hypercalcemia. A 41 year old female with a past medical history of osteopenia, recently diagnosed postural orthostatic tachycardia syndrome (POTS), and hyponatremia attributed to SIADH presented with complaints of weakness and poor oral intake. She also reported a history of nausea, vomiting, weight loss, fatigue, and dizziness, for the last few months. She reported feeling well prior to a COVID-19 infection a few months back. At presentation, she was hypotensive with a blood pressure of 70/50 mmHg, while her other vital signs were stable. She appeared ill, and was noted to have dry oral mucous membranes. There was no increased pigmentation noted on exam. Initial laboratory evaluation revealed sodium of 130 (135-145 mmol/L), potassium of 5.3 (3.5-5.1 mmol/L), and creatinine of 1.7 (0.5-0.8 mg/dL). She had severe hypercalcemia with a calcium level of 15.5 (8.3-10.6 mg/dL) and had a blood glucose level of 53 (70-100 mg/dL). Venous blood gas indicated metabolic acidosis. Morning cortisol was low at 1 (3-23 ug/dL). Serum ACTH was elevated at 775 (0-46 pg/mL). Cosyntropin stimulation test confirmed primary adrenal insufficiency. She underwent work-up for hypercalcemia, which revealed a suppressed PTH, normal levels of PTHrP, vitamin D, and vitamin A. Serum and urine protein electrophoresis was normal. She was initially managed in the ICU and received aggressive fluid resuscitation. She was started on stress dose of hydrocortisone, which was then tapered to physiological doses of oral hydrocortisone and fludrocortisone. Subsequent improvements were observed in blood pressure, laboratory abnormalities, and normalized serum calcium levels. She was discharged home on hydrocortisone and fludrocortisone. On follow-up, she was doing well with the resolution of her symptoms. This case highlights the importance of recognizing adrenal insufficiency as one of the causes of hypercalcemia. Although hypercalcemia as a consequence of adrenal insufficiency is well-documented, the exact prevalence is not known but is estimated to be around 6%. After excluding more common diseases such as primary hyperparathyroidism and malignancy, the possibility of adrenal insufficiency should be considered as a cause of hypercalcemia. Treatment involves hormone replacement as well as hydration, bringing resolution to symptoms. Her presentation was unique, also due to the fact that her initial symptoms were diagnosed as POTS as well as SIADH. Given the onset of symptoms after a COVID-19 infection a few months ago, there could also be a potential link between the two. Presentation: 6/3/2024

Gelatin Enhances the Wet Mechanical Properties of Poly(D,L-Lactic Acid) Membranes.

Biodegradable (BP) poly(D,L-lactic acid) (PDLLA) membranes are widely used in tissue engineering. Here, we investigate the effects of varying concentrations of PDLLA/gelatin membranes electrospun in 1,1,1,3,3,3-hexafluoro-2-propanol (HFIP; C3H2F6O) solvent on their mechanical and physical properties as well as their biocompatibility. Regardless of the environmental conditions, increasing the gelatin content resulted in elevated stress and reduced strain at membrane failure. There was a remarkable difference in strain-to-failure between dry and wet PDLLA/gelatin membranes, with wet strains consistently higher than those of the dry membranes because of the hydrophilic nature of gelatin. A similar wet strain (εw = 2.7-3.0) was observed in PDLLA/gelatin membranes with a gelatin content between 10 and 40%. Both dry and wet stresses increased with increasing gelatin content. The dry stress on PDLLA/gelatin membranes (σd = 6.7-9.7 MPa) consistently exceeded the wet stress (σw = 4.5-8.6 MPa). The water uptake capacity (WUC) improved, increasing from 57% to 624% with the addition of 40% gelatin to PDLLA. PDLLA/gelatin hybrid membranes containing 10 to 20 wt% gelatin exhibited favorable wet mechanical properties (σw = 5.4-6.3 MPa; εw = 2.9-3.0); WUC (337-571%), degradability (11.4-20.2%), and excellent biocompatibility.

Study of the structure and characterization of membranes reinforced with CuO-NPs/Graphene Oxide using bacterial cellulose extracted from Sargassum sp. for water nanofiltration system

Bacterial cellulose membranes find extensive applications in industries involving water purification, wastewater treatment, and biomedical uses. Nevertheless, prevailing membranes suffer from drawbacks like water flow hindrances and fouling susceptibility. Hence, the pressing need for more efficient and robust BC membranes. This study aims to assess the impact of a hybrid treatment involving Copper Oxide nanoparticles (CuO-NPs) and Graphene Oxide (GO) on bacterial nanocellulose membranes. The research employed two treatments: (1) control (BNCA), and (2) Bacterial cellulose infused with 0.5 wt% CuO-NPs/GO. The nanocellulose production involved a high-pressure homogenizer, followed by acetate nanocellulose synthesis and nanocomposite membrane functionalization with CuO nanoparticles. SEM, FTIR, and XRD analyses characterized the membranes. Successfully formed seaweed-derived bacterial cellulose had a thickness of 1-3 cm. Characterization showed it belonged to Cellulose type I with a crystalline degree ranging from 82.3% to 83.1%. FTIR analysis of dry BNCA membranes indicated changes in transmittance at 1738, 1554, and 764 cm-1 due to CuO-NPs/GO addition, altering the O-H bond in bacterial cellulose. Based on the results of the above research, it is evident that the Membrane Reinforced with CuO-NPs/Graphene Oxide has been successfully developed and holds potential as a water nanofiltration system.

Anticholinergic Toxidrome due to Thorn Apple Seed Ingestion in an Elderly Couple.

Sudden onset of reduced consciousness, psychomotor agitation and mydriasis are all indicative of an anticholinergic toxidrome. It is important to note that numerous drugs, as well as certain herbs and plants, possess anticholinergic properties. An 84-year-old female patient had sudden nocturnal onset of uncoordinated hand movements and altered mental status. Shortly after, the patient's 83-year-old husband developed symptoms of dysarthria, gait ataxia, vertigo, and delirium. Anticholinergic syndrome consists of a combination of central and peripheral anticholinergic symptoms. Physostigmine given intravenously resulted in rapid reversal of symptoms. Thorn apple seeds had been accidentally ingested and were identified as the cause. The clinical presentation of an anticholinergic toxidrome includes both central and peripheral symptoms such as altered consciousness, mydriasis, dry mucous membranes and skin, and tachycardia.Prompt recognition of anticholinergic toxidrome and the administration of physostigmine can lead to rapid reversal of symptoms and improved patient outcomes.Treatment with physostigmine is indicated when a patient with an agitated delirium does not respond adequately to titrated benzodiazepines.

Heavy Metal Remediation by Dry Mycelium Membranes: Approaches to Sustainable Lead Remediation in Water.

Lead contamination poses significant and lasting health risks, particularly in children. This study explores the efficacy of dried mycelium membranes, distinct from live fungal biomass, for the remediation of lead (Pb(II)) in water. Dried mycelium offers unique advantages, including environmental resilience, ease of handling, biodegradability, and mechanical reliability. The study explores Pb(II) removal mechanisms through sorption and mineralization by dried mycelium hyphae in aqueous solutions. The sorption isotherm studies reveal a high Pb(II) removal efficiency, exceeding 95% for concentrations below 1000 ppm and ∼63% above 1500 ppm, primarily driven by electrostatic interactions. The measured infrared peak shifts and the pseudo-second-order kinetics for sorption suggests a correlation between sorption capacity and the density of interacting functional groups. The study also explores novel surface functionalization of the mycelium network with phosphate to enhance Pb(II) removal, which enables remediation efficiencies >95% for concentrations above 1500 ppm. Scanning electron microscopy images show a pH-dependent formation of Pb-based crystals uniformly deposited throughout the entire mycelium network. Continuous cross-flow filtration tests employing a dried mycelium membrane demonstrate its efficacy as a microporous membrane for Pb(II) removal, reaching remediation efficiency of 85-90% at the highest Pb(II) concentrations. These findings suggest that dried mycelium membranes can be a viable alternative to synthetic membranes in heavy metal remediation, with potential environmental and water treatment applications.

Systematic experiments and multiscale simulation calculations reveal chemical stability differences in dry/wet nanofiltration membranes

This study investigated the chemical stability differences between dry and wet nanofiltration membranes when immersed in strong acid and base environments. Systematic experimental studies were conducted on both types of nanofiltration (NF) membranes, supplemented by Molecular Dynamics (MD) simulations and Density Functional Theory (DFT) calculations. The results indicate that wet NF membranes, soaked in deionized water for a week, exhibit higher chemical stability compared to dry membranes treated only with air. Traditional air heating causes membrane pore contraction and excessive crosslinking. However, after a week of immersion in water, the polyamide (PA) layer gradually becomes a loose and well-extendable PA layer. MD simulations revealed that H+ and OH− ions possess lower diffusion coefficients and extended residence times in dry NF membranes, making them more prone to damage. Additionally, DFT calculations disclosed that the Gibbs free energy (ΔG) for amide bond hydrolysis in wet NF membranes, in the presence of water molecules, is elevated, significantly delaying their hydrolysis rate under extreme conditions. This study highlights the pivotal role of membrane wetness in the chemical durability of NF membranes and offers a novel perspective for improving membrane lifespan and efficiency.

Exploiting the Features of Clinical Judgment to Improve Assessment of Disease Severity in the Emergency Department: An Acutelines Study.

Clinical judgment, also known as gestalt or gut feeling, can predict deterioration and can be easily and rapidly obtained. To date, it is unknown what clinical judgement precisely entails. The aim of this study was to elucidate which features define the clinical impression of health care professionals in the ED. A nominal group technique (NGT) was used to develop a consensus-based instrument to measure the clinical impression score (CIS, scale 1-10) and to identify features associated with either a more severe or less severe estimated disease severity. This single-center observational cohort study included 517 medical patients visiting the ED. The instrument was prospectively validated.. The predictive value of each feature for the clinical impression was assessed using multivariate linear regression analyses to adjust for potential confounders and validated in the infection group. The CIS at the ED was associated with ICU admission (OR 1.67 [1.37-2.03], p < 0.001), in-hospital mortality (OR 2.25 [1.33-3.81], p < 0.001), and 28-day mortality (OR 1.33 [1.07-1.65], <0.001). Dry mucous membranes, eye glance, red flags during physical examination, results of arterial blood gas analysis, heart and respiratory rate, oxygen modality, triage urgency, and increased age were associated with a higher estimated disease severity (CIS). On the other hand, behavior of family, self-estimation of the patient, systolic blood pressure, and Glascow Coma Scale were associated with a lower estimated disease severity (CIS). We identified several features that were associated with the clinical impression of health care professionals in the ED. Translating the subjective features and objective measurements into quantifiable parameters may aid the development of a novel triage tool to identify patients at risk of deterioration in the ED.

Study on ammonia transport and separation in Aquivion® perfluoro sulfonated acid membranes

The present study reports the results of a series of sorption and permeation tests of pure ammonia as well as nitrogen and hydrogen carried out on Aquivion C87-05 (short-side chain perfluoro sulfonic acid ionomer). Such material is indeed of interest for possible applications in sustainable processes for ammonia production, either as base material for polymer electrolyte membranes in low-temperature electrochemical ammonia synthesis or as a membrane for effective product separation.NH3, N2, and H2 permeation tests are performed at different temperatures (20, 35, and 50 °C) and both in dry and humid conditions (R.H. up to 80%), aiming to assess the influence of these parameters on the resulting permeabilities, while ammonia sorption is inspected at the same temperatures, and pressures up to near saturation conditions.Pure ammonia permeability reached outstanding values around 7000 Barrer in dry Aquivion membranes, revealing an increasing trend with upstream pressure, while it decreased with temperature. The same behavior is recorded for NH3 solubility, indicating that sorption drives the ammonia transport through the membrane.The obtained separation performances are found to be significantly better than those of other polymeric membranes proposed for the same separations, as compared to a permeability-selectivity plot.

Understanding and addressing the cholera outbreak in Zambian communities

Cholera is a bacterial infection caused by the Vibrio cholera bacterium, primarily transmitted through contaminated water and food. The effects of cholera on health can be severe and potentially life-threatening. The hallmark symptom of cholera is acute watery diarrhea, which can lead to rapid dehydration and electrolyte imbalance. As the body loses large amounts of fluid and essential salts, individuals with cholera often experience intense thirst, dry mucous membranes, sunken eyes, and lethargy. If left untreated, the dehydration can progress rapidly, causing a dangerous condition known as choleric dehydration and in most cases death. Hence, the study was conducted to analyze the effects of cholera on health in selected communities of Lusaka district in Zambia. The study employed both qualitative and quantitative methods and a descriptive survey design that sampled 42 participants purposively and conveniently. Data was obtained from the respondents by means of questionnaires and record reading. The data was analyzed by the use of software; Statistical Package for Social Sciences (version 26) and Microsoft Excel (version 16). Frequency tables, graphs, figures, and pie charts were also used to analyze the data. The findings revealed that the effect of cholera on health extends beyond dehydration, affecting various organ systems. Severe cases may lead to hypovolemic shock, characterized by a significant drop in blood pressure and inadequate perfusion of organs. The study also found that Cholera outbreaks pose significant public health challenges, particularly in areas with inadequate sanitation and limited access to clean water. The study therefore recommended that since cholera is highly contagious, primarily through contaminated water and food, those affected should be isolated to prevent the spread of the bacteria. Additionally, Proper hygiene, such as regular handwashing, is essential to reduce the risk of transmission.

Acute kidney injury in a dog diagnosed with leishmaniasis: case report

A 3 years old, 40.8 kg, intact male American Bully, diagnosed with acute kidney injury in a private clinic in Serbia was referred for hemodialysis therapy. The dog was presented with the following symptoms: lethargy, appetite loss, vomiting, diarrhea, weight loss, dehydration (8 10%, Considerable loss of skin turgor), rectal temperature of 38.8oC and dry mucous membranes. Arterial blood pressure was elevated 218-220 mmHg systolic, using Doppler method. The biochemistry revealed elevated ALT 191 (RR: 10-118 U/L), AMY 1390 (RR: 200-1200 U/L), BUN 94 (RR: 7 25 mg/dL), CREA 3.6 (RR: 0.4-1.2 mg/dL), PHOS 9.8 (RR: 2.9-6.6 mg/dL), GLU 121 (RR: 60-110 mg/dL), K 3.3 (RR: 3.4-5.6 mmol/L). Urine analysis was performed with UPC 0.2-0.5 (borderline proteinuric), pH 5.5, microalbumin &gt;25 mg/L, creatinine &gt;26.4 mmol/L. The infestation with Leishmania infantum was confirmed using quantitative PCR. The patient was stabilized using fluid therapy and parenteral feeding. Hemodialysis was decided as an extracorporeal replacement therapy for sustaining renal function. A central venous catheter was placed under a light sedation with oxygen therapy. Hemodialysis was performed for three times in a period of 11 days. A key treatment for acute kidney injury in canine patients is represented by intensive care, fluid therapy and hemodialysis therefore, the values were reduced in BUN from 94 mg/dL to 30 mg/dL and CRE from 3.6 mg/dL to 1.8 mg/dL. The BUN and CREA reached normal values 39 days after that the patient was discharged.

Electrochemical Properties and Structure of Membranes from Perfluorinated Copolymers Modified with Nanodiamonds.

In this study, we aimed to design and research proton-conducting membranes based on Aquivion®-type material that had been modified with detonation nanodiamonds (particle size 4-5 nm, 0.25-5.0 wt. %). These nanodiamonds carried different functional groups (H, OH, COOH, F) that provided the hydrophilicity of the diamond surface with positive or negative potential, or that strengthened the hydrophobicity of the diamonds. These variations in diamond properties allowed us to find ways to improve the composite structure so as to achieve better ion conductivity. For this purpose, we prepared three series of membrane films by first casting solutions of perfluorinated Aquivion®-type copolymers with short side chains mixed with diamonds dispersed on solid substrates. Then, we removed the solvent and the membranes were structurally stabilized during thermal treatment and transformed into their final form with -SO3H ionic groups. We found that the diamonds with a hydrogen-saturated surface, with a positive charge in aqueous media, contributed to the increase in proton conductivity of membranes to a greater rate. Meanwhile, a more developed conducting diamond-copolymer interface was formed due to electrostatic attraction to the sulfonic acid groups of the copolymer than in the case of diamonds grafted with negatively charged carboxyls, similar to sulfonic groups of the copolymer. The modification of membranes with fluorinated diamonds led to a 5-fold decrease in the conductivity of the composite, even when only a fraction of diamonds of 1 wt. % were used, which was explained by the disruption in the connectivity of ion channels during the interaction of such diamonds mainly with fluorocarbon chains of the copolymer. We discussed the specifics of the mechanism of conductivity in composites with various diamonds in connection with structural data obtained in neutron scattering experiments on dry membranes, as well as ideas about the formation of cylindrical micelles with central ion channels and shells composed of hydrophobic copolymer chains. Finally, the characteristics of the network of ion channels in the composites were found depending on the type and amount of introduced diamonds, and correlations between the structure and conductivity of the membranes were established.

THU376 Isotretinoin Related DKA In Type 2 Diabetes

Abstract Disclosure: N. Radovanovic: None. R.J. Comi: None. A. Crawford: None. Introduction: Isotretinoin is a well-established treatment for acne, known to have a wide variety of adverse effects including hypertriglyceridemia, decreased HDL, and, as per some reports, increased insulin resistance. Rapid worsening of underlying diabetes after treatment with isotretinoin has been described in the literature in patients with type 1 diabetes. Clinical Case: A 45-year-old man was referred to the Endocrinology clinic in February 2022 for an urgent consultation due to rapidly worsening hyperglycemia, acidosis, hypertriglyceridemia and refusal to be evaluated in ED as recommended by his PCP. He was diagnosed with pre-diabetes in April 2021 with an HgbA1c of 6.4% and instructed to make lifestyle changes. He presented 6 months later with HgbA1c of 7.3% and the diagnosis of diabetes prompted him to initiate earlier proposed lifestyle changes. He joined an online weight loss program and was very pleased to achieve a rapid weight loss of 80 lbs within 4 months. Upon initial telephone consultation with the patient, he reported feeling well and refused our recommendations to go to the ED, but agreed to come to our clinic the next day. Upon initial in-person assessment, he denied nausea, vomiting, abdominal pain, or change in mentation but reported polyuria and polydipsia worsening in the months prior. He reported being started on isotretinoin for the treatment of acne 4 months prior. On physical exam, he was mildly tachycardic with stable blood pressure, and signs of dehydration including dry mucous membranes. Labs prior to this visit confirmed hyperglycemia, hypertriglyceridemia, elevated anion gap, low bicarbonate, and elevated ketones concerning for underlying DKA which finally convinced the patient to present to ED where he met the criteria for hospitalization. Isotretinoin was stopped immediately after admission. In spite of a low c-peptide level (0.8 ng/ml) during hospitalization, immunology testing for type 1 diabetes was negative. However, 4 months later a fasting c-peptide increased to a normal level (3.4 ng/ml). Treatment with basal-bolus insulin in the subsequent months markedly improved his diabetes and he was able to achieve HgbA1c of 5.7%. Conclusion: Rapid worsening of diabetes and presentation with DKA is usually associated with a natural course of type 1 diabetes. In the case of our patient who presented with rapid worsening of diabetes, was asymptomatic while in DKA, had negative type 1 diabetes-related antibodies, and presented with marked hypertriglyceridemia. We suspect isotretinoin to be the culprit in the setting of underlining type 2 diabetes. In contrast to reports of isotretinoin increasing insulin resistance, in our case, there was apparently suppression of insulin release. We would like to bring attention to this case with a proposal for close monitoring of the glycemia and lipid levels in patients with underlying diabetes started on isotretinoin. Presentation: Thursday, June 15, 2023

THU374 Fulminant Type 1 Diabetes Mellitus And DKA Secondary To Pembrolizumab

Abstract Disclosure: I. Iqbal: None. M. Khan: None. M. Ahmad: None. R. Mehreen: None. Introduction: Pembrolizumab is a programmed cell death receptor (PD-1) binder on T cells, which promotes their activation against cancer cells. It can also cause unwanted T cell activation against the body’s own cells, leading to type 1 diabetes mellitus (DM1), among other autoimmune phenomena. We are reporting a case of a new onset pembrolizumab-induced fulminant DM1 who presented with diabetic ketoacidosis (DKA). Despite the emerging data on immune checkpoint inhibitors (ICPI), fulminant DM1 with DKA in a previously nondiabetic patient is still uncommon. Case Presentation: A 66-year-old female with a history of recurrent metastatic non-small cell lung cancer (NSCLC) presented to the emergency room (ER) with an extensive itchy rash. She was enrolled in a clinical trial for NSCLC, where she received immunotherapy with pembrolizumab for five months. Rash was treated outpatient for scabies, with no improvement. She was then started on prednisone 40mg daily and betamethasone 0.05% cream. She applied the cream daily but took prednisone orally for only one day, after which she could not tolerate it due to anxiety and restlessness. She ran out of betamethasone three days before coming to ER. On admission, vitals were: Heart rate 90 beats per minute, blood pressure 119/95 mmHg, respirations 20/minute. The exam showed flushed cheeks, red and dry macules on the skin with excoriations, and dry mucus membranes. Random blood glucose levels (BSL) were 660mg/dl. Labs were; HCO3 16mmol/L, Beta-hydroxy butyrate 20mmol/L, anion gap 17mmol/L, Hemoglobin A1c: 5.6%. For DKA, we started an insulin drip. Workup revealed very low C-peptide levels of 0.2ng/ml, with a concomitant BSL of 500mg/dL. Anti-islet cell and anti-glutamic acid decarboxylase antibodies (anti-GAD) were positive with levels of 0.04 nmol/L and 0.07 nmol/L, respectively. Once she stabilized and the anion gap closed, she was transitioned to subcutaneous insulin and discharged on 42 units of Lantus, along with 12 units of premeal Lispro and sliding-scale insulin. She was removed from the clinical trial due to complications. Unfortunately, she got readmitted with influenza A, Staphylococcus aureus bacteremia, and another episode of DKA, complicated with respiratory failure, and she decided on hospice. The patient passed away after two days. Conclusion: Immune-related adverse event of new-onset fulminant DM1, leading to DKA, is a serious and potentially fatal complication of pembrolizumab. For patients receiving pembrolizumab, who have uncontrolled BSL, we suggest checking the anti-islet cell and anti-GAD antibody levels and DKA risk stratification to allow the timely initiation of insulin and prevent further complications. Presentation: Thursday, June 15, 2023

SAT188 Atypical Parathyroid Adenoma: A Diagnostic Challenge Of Primary Hyperparathyroidism

Abstract Disclosure: S. Bendaram: None. L. Dulipsingh: None. Introduction: Atypical parathyroid adenomas(APA) are parathyroid neoplasms with some atypical histological features and of indeterminate malignant potential. They may occur sporadically or as a part of hereditary syndromes and contribute to 1.2-1.3% cases of Primary Hyperparathyroidism (PHPT). Here, we present an interesting case of hypercalcemia secondary to PHPT due to an underlying APA. Case Presentation: 28 year old white female with no known significant past medical history presented to ED with symptoms of nausea, vomiting and dizziness on standing. Physical examination was unremarkable except for dry mucous membranes and decreased bowel sounds. Initial labs revealed a total calcium of 19.6 mg/dl (8.4-10.2), PTH of 1161pg/ml (10-65), creatinine 1.2mg/dl (0.5-1.0), albumin 5.0 g/dl (3.5-5.0), ionized calcium 2.37 mmol/L (1.19-1.35), phosphorus 3.4 mg/dl (2.5-4.5), magnesium 1.6 mg/dl (1.7-2.8) TSH 0.51 uIU/ml (0.35-5.5), 25-hydroxy Vitamin D 24 ng/ml (30-100),1,25-dihydroxy Vitamin D 68 pg/ml (20-79) and PTHrP 19 pg/ml (11-20). Family history was negative for hypercalcemia, hyperparathyroidism, fragility fractures, pancreatic disease or any genetic syndromes. Inpatient treatment included IV fluids, 2 doses of calcitonin and Pamidronate 60 mg IV. Subsequently, over the hospital course, calcium improved to 11.9 mg/dl with improvement in her symptoms and she was discharged home. 24-hour urine calcium checked on an outpatient visit, after vitamin D replacement, revealed low urine calcium of 31 mg/24 hr. Ultrasound Thyroid demonstrated a 3.7 cm mass inferior to the right hemithyroid, suspicious for parathyroid adenoma versus abnormal lymph node. CT Parathyroid with and without contrast revealed normal thyroid and bilateral inferior parathyroid adenomas, right larger than left. She underwent en-bloc resection of right thyroid and right inferior parathyroid gland with final pathology showing atypical parathyroid adenoma, without evidence for obvious parathyroid carcinoma or metastatic disease. Genetic testing for a total of 53 genes including MEN, BRCA1, BRCA2 were negative. PTH levels normalized post-surgery. Conclusion: Atypical Parathyroid Adenomas have a clinical and biochemical profile more severe that the typical adenomas and, to some extent, similar but less severe to that of patients with parathyroid carcinoma, creating an overall diagnostic challenge. The molecular mechanisms are unclear, with germline CDC73 mutations appearing to be the most common defect. Due to uncertain malignant potential, a close and careful monitoring is recommended for these patients. Presentation: Saturday, June 17, 2023

PXLink: A simulation program of polymer crosslinking to study of polyamide membrane

Crosslinked network polymers have numerous important applications in engineering, biomedicine, and the environment. Establishing a crosslinked polymer network is an essential initial step toward studying the structure and function of polymer membranes. In this study, we developed a Python script named PXLink that integrates with GROMACS software to simulate the crosslinked aromatic polyamide (PA) membrane, which is widely used in desalination and water treatment. PXLink can create chemical bonds between the neighboring carboxyl and amine groups and relax the system during the crosslinking, utilizing energy minimization and molecular dynamics simulations implemented in GROMACS. The accuracy of our protocol has been successfully validated through a benchmark study of water diffusivity and the structural properties of a solvated membrane, including pore size distribution, membrane density, and the stacking of aromatic benzene rings (density profile and ordering). Moreover, the comparison between the dry and wet polymer membranes reveals that the swelling of the membrane surface leads to the expansion of subnanopores and the increased ordering of local structures. After the swelling of the membrane, the number of pores with a radius around the main region of 0.2 nm decreases, while more pores in the range of 0.22–0.38 nm are observed. There is also an increase in the orderliness of local structures, as evidenced by the increasing order parameter of aromatic ring pairs with a distance ranging from 0.7 to 0.8 nm. Our developed script will be a valuable tool for designing and discovering crosslinked polymers. Program summaryProgram Title: PXLinkCPC Library link to program files:https://doi.org/10.17632/yjw2ghfzmh.1Developer's repository link:https://github.com/zchinet30/PXLinkLicensing provisions: GNU General Public License 3Programming language: PythonNature of problem: The formation of a crosslinked polymer network is essential for theoretical studies and numerous practical applications. However, simulating the polymer crosslinking process using conventional molecular dynamic simulations presents challenges due to its intricate nature, which involves a complex interplay of physical processes and chemical reactions within a large-scale system.Solution method: To address this limitation, we developed PXLink, a python-based script, which integrates with the molecular dynamics software of GROMACS for the simulation of polymer crosslinking.