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AbstractThe sonochemical synthesis of nano-sized cobalt(III) complexes [Co(Hbig)3]1.5Cl3.5(L)·2H2O (1 N), [Co(Hbig)3](L1)3·H2O (2 N), [Co(Hbig)3](L2)3·H2O (3 N), and [Co(Hbig)3](L3)3·4H2O (4 N) have been carried out by reacting probe sonicated [Co(Hbig)3]Cl3·H2O (Hbig = biguanide) with bath sonicated sodium phenolates (L = phenolate, L1 = 4-nitrophenolate, L2 = 2,4-dinitrophenolate, or L3 = 2,4,6-trinitrophenolate) in aqueous medium. All the complexes were initially characterized by physiochemical and spectroscopic (UV-Visible, NMR and FTIR) studies. The stoichiometric ratio between cation and anion in all the complexes were further confirmed by Job’s Plot using continuous variation method. The morphology (size, shape, and topology) of the complexes was analyzed by FESEM, AFM, DLS and PXRD. All the complexes have sizes of 7–140 nm and shape varying from 1D rods to 2D sheets. The stabilities of all the complexes were tested at different temperature (25 °C–55 °C), time (0–24 h), and pH (2–14) using UV-visible spectroscopy. Further, all the complexes and their respective reactants have been tested for antimicrobial activities against Gram negative bacteria (P. aeruginosa, E. coli, K. pneumoniae, S. typhi), Gram positive bacteria (B. subtilis, S. epidermidis), and antifungal activities against C. Herbarum, A. alternata, and F. oxysporum. Among the tested complexes 1 N shows maximum antibacterial (E. coli, 40.3 ± 0.2 mm) and antifungal (A. alternata, 36.3 ± 0.2 mm) activities. [ABSTRACT FROM AUTHOR]

Accessible tourism has received much attention in recent years, both in terms of research and news attention. An accessible environment raises the quality of tourism offerings and the level of the neighbourhood. This paper intends to analyse the development of accessible tourism as a subject of study and gets close to possible trends. In order to accomplish this goal, bibliometric analysis was used to assess and analyse publications from the Scopus database between 2000 and 2021. Through the Scopus database, there are 254 articles on accessible travel used. The Visualisation of Similarities (VOS) viewer software was used to process the data and provide the most cited articles, the number of publications each year, the co-occurrence of author keywords in papers, the coupling of bibliographies, and historical and prospective trends. The analysis enables us to assess the potential and industry growth of accessible tourism continuously. [ABSTRACT FROM AUTHOR]

Background: Various forms of commonly used noninvasive respiratory support strategies have considerable effect on diaphragmatic contractile function which can be evaluated using sonographic diaphragm activity parameters. Objective: To compare the magnitude of respiratory workload decreased as assessed by thickening fraction of the diaphragm and longitudinal diaphragmatic strain while using high‑flow nasal cannula (HFNC) and noninvasive ventilation (NIV) modes [nasal intermittent positive pressure ventilation (NIPPV) and bilevel positive airway pressure (BiPAP)] in pediatric patients after cardiothoracic surgery. Methodology: This prospective randomized controlled trial was performed at a tertiary care surgical intensive care unit in postcardiac surgery patients aged between 1 and 48 months, who were randomly allocated into three groups: 1) HFNC (with flows at 2 L/kg/min), 2) NIPPV via RAMS cannula in PSV mode (pressure support 8 cmH2O, PEEP 5 cmH2O), and 3) BiPAP in nCPAP mode (CPAP of 5 cmH2O). Measurements were recorded at baseline after extubation (R0) and subsequently every 12 hourly (R1, R2, R3, R4, R5) at 12, 24, 36, 48, and 60 hours respectively until therapy was discontinued. Results: Sixty patients were included, with 20 patients each in the NIPPV group, HFNC group, and BiPAP group. Longitudinal strain at crura of diaphragm was lower in the BiPAP group as compared to HFNC group at R2‑R4 [R2 (‑4.27± ‑2.73 vs ‑ 8.40± ‑6.40, P = 0.031), R3 (‑5.32± ‑2.28 vs ‑8.44± ‑5.6, P = 0.015), and R4 (‑3.8± ‑3.42 vs ‑12.4± ‑7.12, P = 0.040)]. PFR was higher in HFNC than NIPPV group at baseline and R1‑R3[R0 (323 ± 114 vs 264 ± 80, P = 0.008), R1 (311 ± 114 vs 233 ± 66, P = 0.022), R2 (328 ± 116 vs 237 ± 4, P = 0.002), R3 (346 ± 112 vs 238 ± 54, P = 0.001)]. DTF and clinical parameters of increased work of breathing remain comparable between three groups. The rate of reintubation (within 48 hours of extubation or at ICU discharge) was 0.06% (1 in NIPPV, 1 in BiPAP, 2 in HFNC) and remain comparable between groups (P = 1.0). Conclusion: BiPAP may provide better decrease in work of breathing compared to HFNC as reflected by lower crural diaphragmatic strain pattern. HFNC may provide better oxygenation compared to NIPPV group, as reflected by higher PFR ratio. Failure rate and safety profile are similar among different methods used. [ABSTRACT FROM AUTHOR]

This paper aims at to explore the perceptual factors that shapes the attitude of an impaired/disabled traveler towards accessible tourism and how that attitude does leads to willingness to travel. In order to achieve the objective of this study, the theoretical framework is tested using Structural Equation Modeling. The measurement scales are revised to meet the requirements of the study. Data is collected from 186 participants. This study supports the literature by establishing a direct relationship between the factors underpinning travelers' perception and attitude regarding accessible tourism, as well as travelers' attitudes and willingness to travel. However, Indian accessible tourism has not been studied from the standpoint of consumer behavior. The study emphasizes the importance of positive and negative elements in the creation of attitude about accessible tourism. It has been found that perceived risk and perceived price display a negative, but a significant effect on attitude towards accessible tourism. Perceived destination image and perceived value show a positive association with the attitude towards accessible tourism. Once an attitude towards accessible tourism is formed, the study concludes that impaired/disabled travellers are willing to travel to a particular destination. [ABSTRACT FROM AUTHOR]

Aim and Background: Delirium is highly prevalent in the immediate postoperative period following cardiac surgery and adversely impacts outcomes. Melatonin has been increasingly used in pharmacological prevention of delirium. We aimed to synthesize the available evidence concerning the role of melatonin and melatonin agonists in preventing delirium in patients after cardiac surgery. Materials and methods: PubMed, Google Scholar, and Web of Science databases were searched for relevant randomized and non-randomized trials in adults undergoing cardiac surgery investigating melatonin agonists to prevent delirium. Studies incorporating transplants, preoperative organ support, prophylactic antipsychotics, or children were excluded. Risk-of-bias was assessed using Cochrane ROB 2.0 and ROBINS-I tools. A systematic review and meta-analysis were conducted, calculating pooled odds ratio (OR) for the incidence of postoperative delirium using a random effects model with the Mantel--Haenszel method with restricted maximum-likelihood estimator. Trial sequential analysis was also carried out for the primary outcome. Results: Six randomized trials and one non-randomized trial involving 1,179 patients were included. Incidence of delirium was 16.7 and 29.6% in the intervention and comparator groups respectively, indicating a pooled OR of 0.44 [95% confidence interval (CI) 0.27 -- 0.71, p = 0.04] favoring melatonin. Two studies had a high risk of bias, and I2 statistics indicated significant heterogeneity. However, publication bias was insignificant, and trial sequential analysis indicated the significance of the attained effect size. Conclusion: Based on available studies, perioperative melatonin use significantly decreases postoperative incidence of delirium after adult cardiac surgery. However, the available quality of evidence is low, and larger trials with standardization of nonpharmacological delirium prevention interventions, in high-risk cohorts, and exploring various dosages and regimens should be carried out. [ABSTRACT FROM AUTHOR]

Changes in RA function correlates with pulmonary arterial (PA) pressures and clinical outcomes in both adult and paediatric patients with pulmonary hypertension (PH). We compared speckle-tracking echocardiography derived strain indices of phasic RA function to conventional echocardiographic predictors of PA pressures in congenital heart disease (CHD) associated PH. We registered (NCT05699681) and conducted this study including children up to 12 years undergoing elective repair of CHD with left-to-right shunts and echocardiographic evidence of PH. RA reservoir, conduit and contractile strain along with conventional measures of RV function and PA pressure were measured using transthoracic echocardiography after induction of anaesthesia. Pre-and post-repair invasive PA pressures were measured after surgical exposure. 51 children aged between 4 months to 12 years were included. Contractile RA strain showed moderate correlation with pre-repair systolic (r = 0.59, 95%CI 0.38 - 0.75) as well as mean PA pressures (r = 0.61, 95%CI 0.40-0.75). Right ventricular systolic pressure (RVSP) measured from tricuspid regurgitation jet also showed a moderate correlation (r = 0.53, 95%CI 0.22-0.75) with systolic PA pressures but was not always measurable. Pulmonary artery acceleration time (PAAT) showed only weak correlation (r = -0.34, 95%CI -0.56 - -0.07) with PA pressures. Contractile RA strain and RVSP had the highest inclusion probabilities in a multivariable linear regression model for systolic PA pressure. The stronger correlation of contractile RA strain with invasively measured PA pressures as compared to PAAT and RVSP suggests a possible utility of RA strain in echocardiographic assessment of PH in CHD, and a need for deeper exploration. [ABSTRACT FROM AUTHOR]

Renal artery disease is the most common cause for surgically curable form of hypertension. In a small subset of patients with severe aortic disease where the aorta is not suitable for endovascular technique and to provide an arterial inflow, an extra-anatomic renal bypass surgery (EARBS) is an option. Anesthetic management of such procedures has not been described so far in the literature. We retrospectively analyzed the anesthetic techniques used in all patients who underwent EARBS between February 1998 and June 2008 at this institute. We also further analyzed data concerning blood pressure (BP) control and renal function response following surgery as outcome variable measures. A total of 11 patients underwent EARBS during this period. Five received oral clonidine with premedication. During laryngoscopy, esmolol was used in 4 patients, while lignocaine was used in remaining 7 patients. Of 11 patients, 7 showed significant hemodynamic response to laryngoscopy and intubation; among these, one had oral clonidine with premedicant, and 6 received lignocaine just before laryngoscopy. Intravenous vasodilators were used to maintain target BP within 20% of baseline during perioperative period. All patients received renal protective measures. During follow-up, 10% were considered cured, 70% had improved BP response, while 20% failed to show improvement in BP response. Renal functions improved in 54.5%, remain unchanged in 36.5%, and worsened in 9% of patients. Use of clonidine during premedication and esmolol before laryngoscopy were beneficial in attenuating hemodynamic response to laryngoscopy, while use of vasodilators to maintain target BP within 20% of baseline, and routine use of renal protective measures appear to be promising in patients undergoing EARBS.

Ebstein′s anomaly (EA) is the most common cause of congenital tricuspid regurgitation. The associated anomalies commonly seen are atrial septal defect or patent foramen ovale and accessory conduction pathways. Its association with coexisting mitral stenosis (MS) has uncommonly been described. The hemodynamic consequences and anesthetic implications, of a combination of EA and rheumatic MS, have not so far been discussed in the literature. We report successful anesthetic management of a repair of EA and mitral valve replacement in a patient with coexisting Wolff-Parkinson-White (WPW) syndrome.