MgSO4 Research Articles

A national survey of medication utilization for cardiac resuscitation in the emergency department: A survey of emergency medicine pharmacists.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Vasoactive medications are used during advanced cardiac life support (ACLS) to shunt oxygenated blood to vital organs and after return of spontaneous circulation (ROSC) to maintain hemodynamic goals. However, limited evidence exists to support vasoactive medication recommendations in such scenarios, and it is unknown how practices vary among emergency departments across the US. A survey questionnaire (15 questions) was electronically distributed to emergency medicine pharmacists (EMPs) in the US through various professional listservs. Demographic information, American Heart Association ACLS algorithm medication use, and use of continuous vasopressor infusions and adjunct medications following ROSC were assessed and are reported descriptively. The survey was distributed to 764 EMPs, with a 23% response rate from a wide geographic distribution and 48% of respondents practicing in academic medical centers. Epinephrine dosing and administration during cardiac arrest were reported by most to be in accordance with ACLS cardiac arrest algorithms. Calcium, magnesium sulfate, and sodium bicarbonate were the most common adjunct intravenous medications given during cardiac arrest. Norepinephrine was the first-choice vasopressor (81%) for post-ROSC hypotension, while epinephrine was preferred less frequently (17%). Antibiotics and sodium bicarbonate were the most frequently administered post-ROSC adjunct medications. This survey of a geographically diverse group of EMPs demonstrated high ACLS algorithm adherence for epinephrine during cardiac arrest with frequent additional administration of nonalgorithm medications. Sodium bicarbonate and calcium were the most frequently administered adjunct medications during cardiac arrest, while sodium bicarbonate and antibiotics were the most frequently used adjunct medications following ROSC. Norepinephrine was the most commonly used vasopressor following ROSC.

Investigating the stability of aromatic carboxylic acids in hydrated magnesium sulfate under UV irradiation to assist detection of organics on Mars

The Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals (SHERLOC) instrument onboard the Mars 2020 Perseverance rover detected so far some of the most intense fluorescence signals in association with sulfates analyzing abraded patches of rocks at Jezero crater, Mars. To assess the plausibility of an organic origin of these signals, it is key to understand if organics can survive exposure to ambient Martian UV after exposure by the Perseverance abrasion tool and prior to analysis by SHERLOC. In this work, we investigated the stability of organo-sulfate assemblages under Martian-like UV irradiation and we observed that the spectroscopic features of phthalic and mellitic acid embedded into hydrated magnesium sulfate do not change for UV exposures corresponding to at least 48 Martian sols and, thus, should still be detectable in fluorescence when the SHERLOC analysis takes place, thanks to the photoprotective properties of magnesium sulfate. In addition, different photoproduct bands diagnostic of the parent carboxylic acid molecules could be observed. The photoprotective behavior of hydrated magnesium sulfate corroborates the hypothesis that sulfates might have played a key role in the preservation of organics on Mars, and that the fluorescence signals detected by SHERLOC in association with sulfates could potentially arise from organic compounds.

An analytical method using salting-out assisted liquid-liquid extraction to quantify ceftriaxone from micro volumes of human serum.

Ceftriaxone (CTRX) is a commonly used cephalosporin antibiotic. It is suggested that monitoring plasma/serum concentrations is helpful for its safe use. This study aimed to develop and validate an analytical method for measuring CTRX concentrations in human serum according to International Conference on Harmonization guideline M10. Ten microliters of serum sample was purified using a salting-out assisted liquid-liquid extraction procedure with magnesium sulfate. The upper layer was then diluted threefold and analyzed using a liquid chromatography-tandem mass spectrometry-based method with a total run time of 12 min. The linear calibration curve was obtained over the concentration range 5-500 μg/ml. The within-run accuracy varied from 0.2 to 6.5%, and the precision was ≤8.0%. The between-run accuracy and precision ranged from 0.7% to 5.6% and ≤6.4%, respectively. Significant carryover was resolved by injecting four blanks after high-concentration CTRX samples. The recovery rates from spiked serum at low and high concentrations were 44.4 and 43.4%, respectively. Other factors, including selectivity, matrix effects, stability, dilution integrity and reinjection reproducibility also met the acceptance criteria. Serum concentrations in 14 samples obtained from two participants receiving 2 g/day of CTRX were successfully determined using this method.

An analytical method using salting-out assisted liquid-liquid extraction to quantify ceftriaxone from micro volumes of human serum.

Ceftriaxone (CTRX) is a commonly used cephalosporin antibiotic. It is suggested that monitoring plasma/serum concentrations is helpful for its safe use. This study aimed to develop and validate an analytical method for measuring CTRX concentrations in human serum according to International Conference on Harmonization guideline M10. Ten microliters of serum sample was purified using a salting-out assisted liquid-liquid extraction procedure with magnesium sulfate. The upper layer was then diluted threefold and analyzed using a liquid chromatography-tandem mass spectrometry-based method with a total run time of 12 min. The linear calibration curve was obtained over the concentration range 5-500 μg/ml. The within-run accuracy varied from 0.2 to 6.5%, and the precision was ≤8.0%. The between-run accuracy and precision ranged from 0.7% to 5.6% and ≤6.4%, respectively. Significant carryover was resolved by injecting four blanks after high-concentration CTRX samples. The recovery rates from spiked serum at low and high concentrations were 44.4 and 43.4%, respectively. Other factors, including selectivity, matrix effects, stability, dilution integrity and reinjection reproducibility also met the acceptance criteria. Serum concentrations in 14 samples obtained from two participants receiving 2 g/day of CTRX were successfully determined using this method.

Study on the Preparation and Compressive Strength of Boron Mud-Based Basic Magnesium Sulfate Cement.

The direct discharge of boron mud poses significant environmental hazards to soil and groundwater. Despite extensive research efforts, the reprocessing of boron mud has not yielded significant advancements. Recently, the development of magnesium cement has spurred interest in the reutilization of boron mud. However, the direct treatment of boron mud remains challenging, necessitating pre-treatment in most studies to achieve substantial results. Consequently, research on the direct incorporation of untreated boron mud is scarce. This study explores the feasibility of using uncalcined boron mud as a base material in basic magnesium sulfate cement (BMSC), composed of lightly calcined magnesia and magnesium sulfate heptahydrate. The effects of varying boron mud content on the compressive strength of the BMSC system were investigated. The results indicate that the 5·1·7 phase is the primary strength phase of BMSC. When the boron mud content is 30%, the uncalcined boron mud has a minimal impact on the formation of the 5·1·7 phase. Additionally, the 28 days compressive strength of BMSC-B30 showed a slight difference compared to the control group BMSC-C, registering at 66.7 MPa. TG-DSC analysis revealed that the presence of a small amount of boron mud inhibits the micro-expansion trend of the BMSC structure. Furthermore, XRD and SEM analyses confirmed that the addition of uncalcined boron mud does not significantly alter the phase structure of the 5·1·7 phase in BMSC. This study provides a foundational basis for the long-term development of direct boron mud treatment.

Comparative Study between Rocuronium And Magnesium Sulfate as Adjutants to Regional Anesthesia for Ophthalmic Surgeries using Peribulbar Block

Abstract Background Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, it has the disadvantages of a slower onset of orbital akinesia and the frequent requirement for block supplementation. Aim of the Work To evaluate the effect of addition of magnesium sulfate and rocuronium to standard local anesthetics mixture on the time of onset of globe and lid akinesia and corneal anesthesia for peribulbar block in ophthalmic surgeries. Patients and Methods This Prospective Double-blinded Randomized Study was carried out in the ophthalmic surgery unit, Ain Shams university hospital from January 2019 to April 2020. After institutional Ethical Board approval and obtaining written informed patients’ consents, 75 patients from both sexes, ASA physical status I-III, aged 40-80 years and having an Axial globe length less than or equals 26 mm scheduled for cataract surgery under peribulbar block were included in the study. Results Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00±1.22) than control group and magnesium sulfate group (9.00±1.47 and 9.00±1.15) respectively, (p < 0.001); Moreover, no statistically significant difference was reported between control group and magnesium sulfate group. In addition, no significant difference was reported regarding duration of surgery between groups Conclusion Adding Rocuronium to local anesthetic mixture in peribulbar block during cataract surgery enhances ocular akinesia and corneal anesthesia and reduces the need for supplementary injections with no side effects and that was significantly better than Magnesium sulfate in term of rapid onset and time needed to achieve adequate condition to begin surgery. However, adding Magnesium sulfate showing good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery.

Ultrasound Guided Erector Spinae Block Using Bupivacaine – Magnesium Sulphate versus Bupivacaine – Dexmedetomidine for Postoperative Analgesia in Lumbar Spine Surgeries

Abstract Purpose Lumbar spine surgeries are associated with significant postoperative pain. Erector Spinae Plain Block (ESPB) is a new ultra-sound guided block technique for such surgeries . We aimed to explore the analgesic effect of adding dexmedetomidine and magnesium sulfate as adjuvants to bupivacaine in ESP. Patients and Methods Fifty two patients scheduled for lumbar spine surgery were randomly allocated into two groups to receive an ESP block., A total volume of 25 ml, [10 mL 0.5% bupivacaine diluted in normal saline (NS) and 2 mg/kg MgSO4 in group (MG group) and 10 mL 0.5% bupivacaine in NS with 2 μg/kg dexmedetomidine in group (DEX group)] were injected. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 12 hours. Results The demographic data including age, gender, height, weight and BMI showed no difference between both groups, also, ASA classification and duration of surgeries done showed no difference between the studied groups (P > 0.05). There were no recorded complications in both groups (P > 0.05). There was no significant difference among both groups regarding basal, and follow up period at 15 min values of heart rate, and basal value of mean arterial pressure (P > 0.05), but for the intraoperative hemodynamic parameters including MAP and HR, both parameters decreased significantly in the group which received dexmedetomidine in comparison to the other group except follow up values at 180 and 210 min, as no significant differences were recorded among both groups (P > 0.05). Regarding postoperative pain, the visual analogue score (VAS) was used to record it postoperatively every 2 hours while we found a statistically significant difference regarding the VAS from 4 to 6 hours postoperatively as P < 0.005, but, we found no difference regarding the postoperative total consumption of nalbuphine (P < 0.005) . As for patient satisfaction in the studied groups, an anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient). Dexmedetomidine group was associated with a significant increase in satisfaction compared to MG group (P < 0.05). Conclusion Magnesium sulphate and dexmedetomidine seem to be both effective adjuvants to bupivacaine in ESP blocks for postoperative analgesia in patients undergoing lumbar spine surgeries, with slightly better analgesia provided by dexmedetomidine.

Clinical effects of perineural dexmedetomidine or magnesium sulphate as adjuvants to ropivacaine in dogs undergoing tibial plateau leveling osteotomy

The study aimed to compare the quality of perioperative analgesia, the motor block duration, and the effects on main cardiovascular parameters of dexmedetomidine (1 μg/kg/nerve block) or magnesium sulphate (2 mg/kg/nerve block) as adjuvants to 0.3% ropivacaine for sciatic and saphenous nerves block in dogs undergoing tibial plateau leveling osteotomy (TPLO). Dogs randomly received perineural dexmedetomidine-ropivacaine (D group), magnesium sulphate-ropivacaine (M group), or ropivacaine (C group). Fentanyl was administered in case of intraoperative nociception. Postoperative pain was assessed using the Short Form-Glasgow Composite Measure Pain Scale (SF-GCMPS) and VAS scale. The duration of motor blockade and intra- and postoperative cardiovascular parameters were also recorded. Group M required significantly more fentanyl than D group (p = 0.04). Group M had a significantly higher SF-GCMPS score than group C at 4 (p = 0.002) and 5 h after extubation (p = 0.01), and a significantly higher VAS score than group D at 3 h after extubation (p = 0.03), and at 4 h if compared to group C (p = 0.009). No significant differences regarding the duration of motor blockade were detected between groups (p = 0.07). The heart rate was significantly lower in group D than in M and C groups intraoperatively and during the first 1.5 h post extubation. The addition of dexmedetomidine or magnesium sulphate as adjuvants to perineural ropivacaine did not improve the quality of perioperative analgesia and did not prolong the motor blockade in dogs undergoing sciatic and saphenous nerves block for TPLO surgery.

Efficacy of antenatal magnesium sulfate in the prevention of necrotizing enterocolitis: A randomized case-control study in preterm neonates.

Objective: To assess the efficacy of administering antenatal magnesium sulfate in reducing the occurrence of necrotizing enterocolitis in preterm infants. Study Design: Randomized Case-control study. Setting: Hameed Latif Hospital Lahore. Period: August 2023- February 2024. Methods: The study including 80 preterm neonates (26 to 32 weeks gestation) was conducted at Neonatology & Gynaecology Unit Hameed Latif Hospital, Lahore. These neonates were divided into two groups: Group A included infants whose mothers were given magnesium sulfate before preterm birth, while Group B comprised of infants whose mothers did not receive magnesium sulfate. The primary outcome was the incidence of NEC in infants born to mothers exposed to magnesium sulfate, with secondary outcomes covering other neonatal morbidities and maternal side effects. Data analysis utilized SPSS Statistics software version 24, employing t-tests and multivariate logistic regression to evaluate the association between antenatal magnesium sulfate exposure and NEC incidence, considering a significant p-value of ≤ 0.05. Results: The overall NEC incidence was 5%(n=2). No NEC cases were reported in the control group. The difference in neonatal outcomes between both groups was statistically insignificant (p>0.05). Conclusion: Administering antenatal magnesium sulfate has no effect in decreasing the incidence of NEC in preterm infants.

Prereferral management of preeclampsia with severity features in a low-income country—characteristics and challenges in a Sub-Saharan setting: a mixed method study

Background: Preeclampsia continues to be a major cause of maternal and perinatal mortality and morbidity, globally. Although pre-referral treatment constitutes a bigger part of the management package for preeclampsia with severity features in low-income settings, little is known regarding the characteristics and challenges of preeclampsia pre-referral and referral management in the Sub-Saharan setting. ObjectiveTo determine the characteristics and challenges of pre-referral and referral management of preeclampsia with severity features Study design: We conducted a mixed method study on the pre-referral management of pregnant women who complicated by preeclampsia with severity features in Ethiopia. We prospectively collected data on clinical characteristics, management outcomes, and pre-referral characteristics of pregnant women who complicated by preeclampsia with severity features. Data were collected using a structured questionnaire. For the qualitative part of our study, we conducted 20-30 minutes, semi-structured, qualitative face-face in depth-interview with 14 health professionals. Quantitative data were analyzed using SPSS version 23 and simple descriptive statistics was employed. We used thematic analysis on Open Code 4.03 software to analyze the qualitative data. - ResultsA total of 261 pregnant women who had preeclampsia with severity features were included in the study and 14 care providers were interviewed on existing challenges with pre-referral management for patients with preeclampsia with severity features. The mean systolic and diastolic blood pressures were 154.3mmHg and 100.3mmHg, respectively. The total perinatal mortality was 6.5% (17/261). Three mothers (1.1%) complicated by intra-cranial hemorrhage and other three (1.1%) other women developed pulmonary edema. Out of 261 patients, only 41 patients (15.7%) received magnesium sulphate. Similarly, antihypertensive was given only to 35 patients constituting 13.4%. Eight mothers convulsed (3.1%) during referral. Two mothers (0.8%) developed pulmonary edema when they arrived at recipient health institutions after referral. Likewise, another two (0.8%) women developed disseminated intravascular coagulation (DIC) by the time of arrival from referring health institution. Up on qualitative data analysis, three overarching themes were recognized: (i) challenges related Patient and family resistance, (ii) Challenges related to healthcare providers’ knowledge, skill and confidence, and (iii) health system related challenges. Low utilization of magnesium sulphate and ant-hypertensive drugs, patient misperceptions regarding reasons for referral, providers lack of knowledge on the pre-referral management, inadequate communication between referring and recipient health institution, and non-existence of uniform pre-eclampsia pre-referral and referral management protocols among the referring institutions were the identified gaps. ConclusionWe found a significant gap in pre-referral management for patients with preeclampsia with severity features. Preeclampsia management policy reforms should include introduction of adequate patients counselling platforms, increasing community awareness creation, providing in-service training on pre-referral management of preeclampsia for health personnel, ensuring constant availability of anti-convulsant and antihypertensive drugs and uniform implementation of preeclampsia pre-referral management protocols across health institutions.

Altering the optical, physical, and TL Dosimetric properties of MgSO4:Dy2O3:B2O3 transparent glass ceramic system: Evaluating the impact of roughness control and ZnO inclusion

This research examines the influence of surface roughness and the incorporation of ZnO (0.05–0.20 mol%) on the magnesium sulfate: dysprosium oxide: boron oxide (0.1 < x < 0.5) glass ceramic system for dosimeter applications. The parent glasses were prepared using the melt-quenching technique, with all samples melted at 1350 °C, except for B, which was melted at 700 °C. The crystallization, roughness, and optical properties were further determined using X-ray Diffraction (XRD), Atomic Force Microscopy (AFM), and UV–Visible Spectrophotometry, respectively. The glass ceramics were exposed to 2.97 mGy of X-ray radiation ten cycles to assess specific dosimetric capabilities. Among the doped samples, MgSO4:Dy2O3-(0.2B2O3:0.05ZnO) exhibited the most promising performance as a dosimeter. Notably, the Thermoluminescence Dosimetry (TLD) readings of the pre- and post-polished 0.2MDB were 1041.96 nC and 1278.84 nC, respectively, with roughness values of 1.83 nm and 54.7 nm. Similarly, the TLD readings of the pre- and post-polished 0.05MDBZ were 1888.33 nC and 3262.63 nC, respectively, with roughness values of 17.3 nm and 19.8 nm. This work highlights that surface roughness significantly enhances trapping efficiency, underscoring the importance of dosimeter polishing as a beneficial step in enhancing their performance.

Altering the optical, physical, and TL Dosimetric properties of MgSO4:Dy2O3:B2O3 transparent glass ceramic system: Evaluating the impact of roughness control and ZnO inclusion

This research examines the influence of surface roughness and the incorporation of ZnO (0.05–0.20 mol%) on the magnesium sulfate: dysprosium oxide: boron oxide (0.1 < x < 0.5) glass ceramic system for dosimeter applications. The parent glasses were prepared using the melt-quenching technique, with all samples melted at 1350 °C, except for B, which was melted at 700 °C. The crystallization, roughness, and optical properties were further determined using X-ray Diffraction (XRD), Atomic Force Microscopy (AFM), and UV–Visible Spectrophotometry, respectively. The glass ceramics were exposed to 2.97 mGy of X-ray radiation ten cycles to assess specific dosimetric capabilities. Among the doped samples, MgSO4:Dy2O3-(0.2B2O3:0.05ZnO) exhibited the most promising performance as a dosimeter. Notably, the Thermoluminescence Dosimetry (TLD) readings of the pre- and post-polished 0.2MDB were 1041.96 nC and 1278.84 nC, respectively, with roughness values of 1.83 nm and 54.7 nm. Similarly, the TLD readings of the pre- and post-polished 0.05MDBZ were 1888.33 nC and 3262.63 nC, respectively, with roughness values of 17.3 nm and 19.8 nm. This work highlights that surface roughness significantly enhances trapping efficiency, underscoring the importance of dosimeter polishing as a beneficial step in enhancing their performance.

Magnesium Sulfate Versus Dexmedetomidine in Controlled Hypotension During Spine Surgeries

Magnesium Sulfate Versus Dexmedetomidine in Controlled Hypotension During Spine Surgeries

The Effect of Addition of Magnesium Sulfate on Neutrophil/lymphocyte Ratio in Patients Undergoing Lower Abdominal Surgery Under General Anesthesia

The Effect of Addition of Magnesium Sulfate on Neutrophil/lymphocyte Ratio in Patients Undergoing Lower Abdominal Surgery Under General Anesthesia

A Case of Partial Molar Pregnancy Complicated by HELLP and PRES

Introduction: The term gestational trophoblastic disease encompasses premalignant and malignant conditions arising from trophoblastic cells. Premalignant disorders include complete or partial hydatidiform mole, whereas malignant disorders include invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. Partial hydatidiform moles are triploid in nature and occur when 2 sperm fertilize a single ovum. Preeclampsia is a syndrome complicating 2-8% of pregnancies which presents as new-onset hypertension plus proteinuria. The occurrence of hemolysis, elevated liver enzymes and low platelet count, referred to as HELLP syndrome, is a severe form of preeclampsia. A related severe manifestation is posterior reversible encephalopathy syndrome (PRES) - a clinicoradiological syndrome characterized by symptoms including headache, seizures, altered consciousness and visual disturbances. PRES is commonly associated with acute hypertension. The symptoms of PRES vary widely: i.e., the visual disturbance can vary from blurred vision and homonymous hemianopsia to cortical blindness. Seizures and status epilepticus are common. Although preeclampsia and HELLP syndrome rarely occur before 20-weeks of gestation, reports have suggested early occurrences of these hypertensive disorders specifically in the setting of a molar pregnancy. Case Report: The patient is a 23-year-old, female gravida 1 at 16 week 5 days who presented to an outside emergency department with a 3-day history of progressive abdominal pain which radiated to her back, arms, and shoulders. At the outside facility, the patient had multiple systolic blood pressures greater than 160 mmHg and had a witnessed 30-second seizure which resolved with an intravenous (IV) injection of 2-mg of Lorazepam and 4-gram magnesium sulfate loading dose. She was initiated on magnesium sulfate maintenance pending transfer to our institution. On admission, the patient met criteria for eclampsia and HELLP (platelets 79,000 K/uL, AST 144 U/L, ALT 96 U/L, LDH 482 U/L, Hemoglobin 8.7 g/dL). The beta human chorionic gonadotropin level (HCG) was greater than 200,000 mIU/mL. Bedside ultrasound suggested the presence of an enlarged cystic placenta and a growth restricted fetus (estimated fetal weight 124g, 2%). The patient and her family were counseled and the decision was made to proceed with misoprostol induction and termination of the pregnancy due to maternal indications. During the induction, the patient developed significant vaginal bleeding and was taken to the operating room for an uncomplicated dilation and evacuation. After the procedure, the patient developed progressive visual blurring with 4+ hyperreflexia. Magnetic resonance imaging (MRI) of the brain with and without contrast was obtained with findings significant for PRES. The MRI revealed T2 high-signal lesions within the cortex of the bilateral occipital lobes. Neurology was consulted and recommended blood pressure control and initiation of levetiracetam for seizure prophylaxis. She was initiated on long-acting nifedipine with subsequent blood pressure control. Patient’s visual symptoms and hyperreflexia resolved. Her liver function tests, platelets, and LDH also returned to normal. The patient received contraceptive counseling to prevent pregnancy during gestational neoplastic disease surveillance period. She underwent weekly beta-hCG until negative, followed by three weekly consecutive negative levels before spacing measurements to every 3 months for a period of six months per National Comprehensive Cancer Network (NCCN) guidelines. The pathology results indicated the presence of chorionic villi composed of both large hydropic and smaller normal-appearing villi, a 69.3-gram female fetus compatible with caudal neurocutaneous defect with abnormal localization of brain tissue. The genetic profile of the villous tissue consisted of two sets of dispermic paternal alleles in addition to one set of maternal alleles consistent with a partial mole diagnosis. Discussion: There is an association between preeclampsia and molar pregnancy. Of partial hydatidiform molar pregnancies, 41.9% will develop the symptoms of preeclampsia if left untreated. Although the pathophysiology of eclampsia spectrum disorders is incompletely understood, some evidence points to the role of increased death of trophoblasts and the maternal inflammatory response to trophoblast deportation. Additional evidence points to angiogenic factor imbalance and interestingly, molar placentas produce high levels of antiangiogenic factors. Other causative agents include placental factors that trigger maternal endothelial activation. It is known that trophoblastic debris shed from the placenta into the maternal blood is associated with this condition. It has been demonstrated that trophoblastic debris from molar pregnancies also induces endothelial cell activation through heat-shock protein 70 (HSP70) expressed on a hydatidiform molar placenta, which may be a pathogenic signal to endothelial cells. This case reiterates the association between hydatidiform moles and the hypertensive disorders of pregnancy possibly supporting the theories that such disorders may share an etiologic linkage through trophoblast debris and angiogenic factor imbalance. This case also supports screening molar pregnancies for severe preeclampsia syndrome.

A Case of Partial Molar Pregnancy Complicated by HELLP and PRES

Introduction: The term gestational trophoblastic disease encompasses premalignant and malignant conditions arising from trophoblastic cells. Premalignant disorders include complete or partial hydatidiform mole, whereas malignant disorders include invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. Partial hydatidiform moles are triploid in nature and occur when 2 sperm fertilize a single ovum. Preeclampsia is a syndrome complicating 2-8% of pregnancies which presents as new-onset hypertension plus proteinuria. The occurrence of hemolysis, elevated liver enzymes and low platelet count, referred to as HELLP syndrome, is a severe form of preeclampsia. A related severe manifestation is posterior reversible encephalopathy syndrome (PRES) - a clinicoradiological syndrome characterized by symptoms including headache, seizures, altered consciousness and visual disturbances. PRES is commonly associated with acute hypertension. The symptoms of PRES vary widely: i.e., the visual disturbance can vary from blurred vision and homonymous hemianopsia to cortical blindness. Seizures and status epilepticus are common. Although preeclampsia and HELLP syndrome rarely occur before 20-weeks of gestation, reports have suggested early occurrences of these hypertensive disorders specifically in the setting of a molar pregnancy. Case Report: The patient is a 23-year-old, female gravida 1 at 16 week 5 days who presented to an outside emergency department with a 3-day history of progressive abdominal pain which radiated to her back, arms, and shoulders. At the outside facility, the patient had multiple systolic blood pressures greater than 160 mmHg and had a witnessed 30-second seizure which resolved with an intravenous (IV) injection of 2-mg of Lorazepam and 4-gram magnesium sulfate loading dose. She was initiated on magnesium sulfate maintenance pending transfer to our institution. On admission, the patient met criteria for eclampsia and HELLP (platelets 79,000 K/uL, AST 144 U/L, ALT 96 U/L, LDH 482 U/L, Hemoglobin 8.7 g/dL). The beta human chorionic gonadotropin level (HCG) was greater than 200,000 mIU/mL. Bedside ultrasound suggested the presence of an enlarged cystic placenta and a growth restricted fetus (estimated fetal weight 124g, 2%). The patient and her family were counseled and the decision was made to proceed with misoprostol induction and termination of the pregnancy due to maternal indications. During the induction, the patient developed significant vaginal bleeding and was taken to the operating room for an uncomplicated dilation and evacuation. After the procedure, the patient developed progressive visual blurring with 4+ hyperreflexia. Magnetic resonance imaging (MRI) of the brain with and without contrast was obtained with findings significant for PRES. The MRI revealed T2 high-signal lesions within the cortex of the bilateral occipital lobes. Neurology was consulted and recommended blood pressure control and initiation of levetiracetam for seizure prophylaxis. She was initiated on long-acting nifedipine with subsequent blood pressure control. Patient’s visual symptoms and hyperreflexia resolved. Her liver function tests, platelets, and LDH also returned to normal. The patient received contraceptive counseling to prevent pregnancy during gestational neoplastic disease surveillance period. She underwent weekly beta-hCG until negative, followed by three weekly consecutive negative levels before spacing measurements to every 3 months for a period of six months per National Comprehensive Cancer Network (NCCN) guidelines. The pathology results indicated the presence of chorionic villi composed of both large hydropic and smaller normal-appearing villi, a 69.3-gram female fetus compatible with caudal neurocutaneous defect with abnormal localization of brain tissue. The genetic profile of the villous tissue consisted of two sets of dispermic paternal alleles in addition to one set of maternal alleles consistent with a partial mole diagnosis. Discussion: There is an association between preeclampsia and molar pregnancy. Of partial hydatidiform molar pregnancies, 41.9% will develop the symptoms of preeclampsia if left untreated. Although the pathophysiology of eclampsia spectrum disorders is incompletely understood, some evidence points to the role of increased death of trophoblasts and the maternal inflammatory response to trophoblast deportation. Additional evidence points to angiogenic factor imbalance and interestingly, molar placentas produce high levels of antiangiogenic factors. Other causative agents include placental factors that trigger maternal endothelial activation. It is known that trophoblastic debris shed from the placenta into the maternal blood is associated with this condition. It has been demonstrated that trophoblastic debris from molar pregnancies also induces endothelial cell activation through heat-shock protein 70 (HSP70) expressed on a hydatidiform molar placenta, which may be a pathogenic signal to endothelial cells. This case reiterates the association between hydatidiform moles and the hypertensive disorders of pregnancy possibly supporting the theories that such disorders may share an etiologic linkage through trophoblast debris and angiogenic factor imbalance. This case also supports screening molar pregnancies for severe preeclampsia syndrome.

Quantification and analyses of seven tyrosine kinase inhibitors targeting hepatocellular carcinoma in human plasma by QuEChERS and UPLC-MS/MS

Tyrosine kinase inhibitors (TKIs) are commonly used to treat various cancers. Literature suggests that the blood concentration of TKIs strongly correlates with their efficacy and adverse effects. Therefore, establishing a Therapeutic Drug Monitoring (TDM) methodology for TKI drugs is crucial to improving their clinical efficacy and minimizing the treatment-related adverse effects. However, quantifying their concentrations in the plasma using existing methods to avoid potential toxicity is challenging. Herein, seven TKIs, namely sorafenib tosylate, axitinib, erlotinib, cediranib, brivanib, linifanib, and golvatinib, were successfully analyzed in human plasma by following a quick, easy, cheap, effective, rugged, and safe (QuEChERS) pretreatment method combined with ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Briefly, biological samples were extracted using 1 mL of methanol, followed by the sequential addition of 250 mg of anhydrous magnesium sulfate and 25 mg of N-propylethylenediamine (PSA) for salinization and purification by adsorption, respectively. In this study, dovitinib was used as the internal standard. The seven TKIs were detected by the gradient elution method for 4 min in the positive ion electrospray mode. The mobile phase comprised methanol (phase A) and 0.1 % aqueous formic acid solution (phase B) on the Agilent Zorbax RRHD Stablebond Aq, (2.1 × 50 mm; 1.8 μm). Brivanib, linifanib, axitinib, sorafenib tosylate, and golvatinib exhibited good linearity in the range of 5–500 ng/mL, and erlotinib and cediranib exhibited good linearity in the range of 10–1000 ng/mL, with linear correlation coefficients (R2) ≥ 0.99. The limits of detection and quantification were 0.60–0.18 ng/mL and 5–10 ng/mL, respectively. The intraday and interday accuracy values ranged from −6.12 % to 7.31 %, with a precision (RSD) of ≤ 10.57 %. The method was rapid, accurate, specific, simple, reproducible, and suitable for the quantitative determination of the seven TKIs in human plasma.

Innovative stimuli-responsive membrane MSF brine rejection dilution by tertiary treated sewage effluent

In this study, treated wastewater and Multi-Stage Flash (MSF) brine were integrated into the Forward Osmosis (FO) system using pressure stimuli-responsive Nanofiltration (PSRNF) membranes to dilute magnesium, calcium, and sulfate MSF plant brine reject. The deposition of magnesium sulfate and calcium sulfate in the heat exchanger is one of the main issues affecting the performance and efficiency of MSF thermal desalination plants. Reducing the concentration of the divalent ions can minimize scale formation and deposition to a level that allows the MSF plant to operate at high top brine temperature (TBT) and without scale problems. The PSRNF membranes were chosen in the FO process because of their high water permeability, rejection of divalent and monovalent ions, small structure parameter (S), and inexpensiveness compared to commercial FO membranes. Three PSRNF membranes were tested in the FO process with the feed solution facing the active membrane layer to avoid active layer delamination. Although the PSRNF membrane exhibited negligible water flux at 0 bar, it increased when a 2–4 bar was applied to the feed solution. The wastewater temperature was set at 25 °C while 40 °C was the brine operational temperature to mimic the field situation. A maximum average water flux of 39.5 L/m2h was recorded at 4 bar feed pressure when the PSRNF membrane was used for the brine dilution, achieving up to 42% divalent ions dilution at 0.02 kWh/m3 specific power consumption. The average water flux in the PRSNF membrane was 35% higher than that in the commercial TFC FO membrane. Notably, the PSRNF membrane is ten times cheaper than commercial FO membranes. Notably, the PSRNF membrane is ten times cheaper than commercial FO membranes, achieving substantial cost reductions and pioneering advancements in FO purification technology.

Influence of recycled rubber and glass aggregates on magnesium sulfate resistance of geopolymers: Physio-mechanical properties and mechanisms

Recycled rubber aggregates (RRA) and recycled glass aggregates (RGA) are sustainable alternatives to natural aggregates. However, the influences of RRA and RGA on the magnesium sulfate resistance of geopolymers remain unclear. Previous studies have focused on the influences of binder type and composition on magnesium sulfate resistance but have neglected the role of aggregates. This study bridges this gap and demonstrates the influences of RRA and RGA on the magnesium sulfate resistance of geopolymers. This study investigated the physical properties, mechanical properties and phases of FA and GBFS-based geopolymers containing 0:10 – 10:0 RRA and RGA after being exposed to 5 % MgSO4 solution for 90 days. The results showed that compared to 100 % RGA, the 90-day length and mass of 100 % RRA increased by 50.48 and 33.22 times, respectively, and the 90-day compressive, flexural and splitting tensile strengths of 100 % RRA decreased by 65 %, 43.28 % and 56.75 %, respectively. However, the changes in length and mass of 100 % RGA were very small, and the mechanical properties even slightly increased rather than decreased. RRA + RGA showed an interval performance between 100 % RRA and 100 % RGA. The different magnesium sulfate resistance of RRA and RGA were attributed to the following mechanisms. RRA caused much higher drying shrinkage of geopolymers than RGA because the soft nature of RRA increased uncoordinated deformation, leading to micro-cracks in the matrix before magnesium sulfate exposure. The pre-existing micro-cracks served as physical transportation paths for external ions to diffuse into the interior of specimens, leading to expansive gypsum crystals formed in these micro-cracks. The accumulation of expansive gypsum crystals enlarged these micro-cracks and facilitated their propagation, leading to the expansion, cracking and degraded mechanical properties. By contrast, RGA reduced drying shrinkage due to its hard nature, which limited the availability of micro-cracks as physical transportation paths for external ions and therefore reduced the formation of expansive gypsum crystals and improved the magnesium sulfate resistance of geopolymers.

The performance of the practices associated with the occurrence of severe intraventricular hemorrhage in the very premature infants: data analysis from the Chinese neonatal network

BackgroundThe occurrence of severe intraventricular hemorrhage (sIVH) was high in the very preterm infants (VPIs) in China. The management strategies significantly contributed to the occurrence of sIVH in VPIs. However, the status of the perinatal strategies associated with sIVH for VPIs was rarely described across the multiple neonatal intensive care units (NICUs) in China. We aim to investigate the characteristics of the perinatal strategies associated with sIVH for VPIs across the multiple NICUs in China.MethodsThis was a retrospective analysis of data from a prospective cohort of Chinese Neonatal Network (CHNN) dataset, enrolling infants born at 24+0—31+6 from 2019 to 2021. Eleven perinatal practices performed within the first 3 days of life were investigated including antenatal corticosteroids use, antenatal magnesium sulphate therapy, intubation at birth, placental transfusion, need for advanced resuscitation, initial inhaled gas of 100% FiO2 in delivery room, initial invasive respiratory support, surfactant and caffeine administration, early enteral feeding, and inotropes use. The performances of these practices across the multiple NICUs were investigated using the standard deviations of differences between expected probabilities and observations. The occurrence of sIVH were compared among the NICUs.ResultsA total of 24,226 infants from 55 NICUs with a mean (SD) gestational age of 29.5 (1.76) and mean (SD) birthweight of 1.31(0.32) were included. sIVH was detected in 5.1% of VPIs. The rate of the antenatal corticosteroids, MgSO4 therapy, and caffeine was 80.0%, 56.4%, and 31.5%, respectively. We observed significant relationships between sIVH and intubation at birth (AOR 1.52, 95% CI 1.13 to 1.75) and initial invasive respiratory support (AOR 2.47, 95% CI 2.15 to 2.83). The lower occurrence of sIVH (4.8%) was observed corresponding with the highest utility of standard antenatal care, the lowest utility of invasive practices, and early enteral feeding administration.ConclusionsThe current evidence-based practices were not performed in each VPI as expected among the studied Chinese NICUs. The higher utility of the invasive practices could be related to the occurrence of sIVH.