Search Results (62)

Background: Sodium–glucose cotransporter-2 (SGLT2) inhibitors are widely used to manage type 2 diabetes mellitus (T2DM) because of their glucose-lowering and cardioprotective effects. However, euglycemic diabetic ketoacidosis (euDKA) is an uncommon but serious adverse event. EuDKA is characterized by metabolic acidosis and ketosis with only mild-to-moderate hyperglycemia, making diagnosis challenging. The risk of this interaction may be increased with the concurrent use of glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly during periods of reduced caloric intake or the presence of gastrointestinal symptoms. Case: A 38-year-old woman with newly diagnosed T2DM presented with five days of fatigue, poor oral intake, nausea, and vomiting. She had recently initiated semaglutide (GLP-1RA) for weight loss and practiced prolonged intermittent fasting. One week prior, she had started metformin and enavogliflozin, a selective SGLT2 inhibitor. Laboratory results showed a glucose level of 137 mg/dL, urine ketones (+++), lactate level of 4.87 mg/dL, HbA1c of 9.3%, C-peptide of 0.88 ng/mL, and high anion gap metabolic acidosis. She was diagnosed with euDKA and treated with IV fluids, insulin infusion, dextrose, and potassium supplementation. Her symptoms resolved, and she was discharged in a stable condition. Conclusion: This case highlights the importance of recognizing euDKA in patients using SGLT2 inhibitors and GLP-1RAs, particularly those with fasting or gastrointestinal symptoms. Clinicians should suspect euDKA even without significant hyperglycemia to enable prompt diagnosis and management, thereby preventing complications. Full article

Background and objectives: Antibiotic resistance in Cutibacterium acnes is undermining topical macrolides and clindamycin, prompting renewed interest in zinc oxide nanoparticles (ZnO-NPs) as non-antibiotic alternatives. We aimed to (i) determine the antimicrobial and anti-inflammatory performance of topical ZnO-NP formulations across in vitro, animal and early human models; (ii) identify physicochemical parameters that modulate potency and tolerance; and (iii) delineate translational gaps and priority design elements for randomised trials. Methods: We systematically searched PubMed, Scopus and Web of Science until 1 June 2025 for in vitro, animal and human studies that evaluated ≤100 nm ZnO-NPs applied topically to C. acnes cultures, extracting data on bacterial load, lesion counts, biophysical skin parameters and acute toxicity. Eight eligible investigations (five in vitro, two animal, one exploratory human) analysed particles 20–50 nm in diameter carrying mildly anionic zeta potentials. Results: Hyaluronic acid-coated ZnO-NPs achieved a sixteen-fold higher selective kill ratio over Staphylococcus epidermidis at 32 µg mL¹, while centrifugally spun polyvinyl alcohol dressings reduced C. acnes burden by 3.1 log₁₀ on porcine skin within 24 h, and plant-derived nanogels generated inhibition zones that were 11% wider than benzoyl-peroxide’s 5%. In human subjects, twice-daily 0.5% hyaluronic–ZnO nanogel cut inflammatory-lesion counts by 58% at week four and lowered transepidermal water loss without erythema. Preclinical safety was reassuring, zero mortality among animals at 100 µg mL¹ and no irritation among patients, although high-dose sunscreen-grade ZnO (20 nm) delayed rat wound closure by 38%, highlighting dose-dependent differences. Conclusions: Collectively, the evidence indicates that nanoscale reformulation markedly augments zinc’s antibacterial and anti-inflammatory performance while maintaining favourable acute tolerance, supporting progression to rigorously designed, adequately powered randomised trials that will benchmark ZnO-NPs against benzoyl peroxide and retinoids, optimise dosing for efficacy versus phototoxicity, and establish long-term dermatological safety. Full article

Metabolic acidosis is a common complication of chronic kidney disease (CKD). The kidneys play a crucial role in acid–base balance, maintaining pH within the normal range (isohydria) by following mechanisms: bicarbonate reabsorption, ammogenesis, and titratable acidity. The anion gap describes the amount of unmeasured anions and is classically evaluated as the difference between the major cation (sodium) and the sum of the two major anions (chloride and bicarbonate). Metabolic acidosis can be divided into two types: normal anion gap metabolic acidosis and high anion gap metabolic acidosis. A high anion gap level is considered unfavorable in terms of prognosis as it is associated with increased mortality. Treatment of metabolic acidosis in patients with chronic kidney disease, despite available therapeutic options, is a challenge. Supplementation with bicarbonates does not improve prognosis on the one hand, and on the other hand, it may be harmful. The new KDIGO guidelines for 2024 have been significantly modified compared to 2012 after negative results of studies on bicarbonate supplementation. Bicarbonate supplementation is currently recommended only when levels are less than 18 mmol/L. This review provides an overview of the current knowledge on the pathophysiology, classification, and therapeutic options, including dietary recommendations and new pharmacology agents. Full article

Electrochemical separations use an ionic current to drive the flow of ions across an ion exchange membrane to produce dilute and concentrated streams. The economics of these systems is challenging because passing an ionic current through a dilute solution often requires a small cell gap to lower the ionic resistance and the use of a low current density to minimize the voltage drop across the dilute product stream. Lower salt concentration in the product stream improves the fraction of the salt recovered but increases the electricity cost due to high ohmic losses. The electricity cost is managed by lowering the current density which greatly increases the balance of the plant. The cell configuration demonstrated in this study eliminates the need to pass an ionic current through the diluted product stream. Ionic current passes only through the concentrated product stream, which allows use of high current density and smaller balance of the plant. The cell has three chambers with an anion and cation membrane separating the cathode and anode, respectively, from the concentrated product solution. The device uses zero-gap membrane electrode assemblies to improve the cell voltage and system performance. As ions concentrate in the center compartment, the solution resistance decreases, and the product is recovered with a lower voltage penalty compared to traditional electrodialysis. This lower voltage drop allows for faster feed flow rates and higher current density. Additionally, the larger cell gap for the product provides opportunities for systems with solids suspended in solution. It was found that the ion collection efficiency increased with current due to enhanced convective mass transfer in the feed streams. Full article

Spectrally selective emitters (SSEs) have attracted considerable attention, because of radiative cooling, which could dissipate the heat from earth to outer space through the atmospheric window without any energy input. Intrinsically inorganic SSEs have significant advantages to other SSEs, such as the low fabrication cost due to the extremely simple structures and long life span under solar exposure. However, few inorganic materials can act as intrinsic SSEs due to the limited emissions in the atmospheric window. Here, we propose a strategy to design intrinsic SSEs by complementing the IR-active phonons in atmospheric window with anion groups. Accordingly, we demonstrate borates containing both [BO₃]³⁻ and [BO₄]⁵⁻ units can exhibit high emissivity within the whole atmospheric window, because the IR-active phonons of [BO₃]³⁻ units usually locate around 8 and 13 μm, while those of [BO₄]⁵⁻ units distribute in 9~11 μm. Furthermore, K₃B₆O₁₀Cl and BaAlBO₄ are selected as two examples to display their near-unity emissivity (>95%) within the whole atmospheric window experimentally. These results not only offer a new strategy for the design of intrinsic SSEs, but also endow wide band-gap borates containing both [BO₃]³⁻ and [BO₄]⁵⁻ units with great potential applications for radiative cooling. Full article

Background/Objectives: In diabetic ketoacidosis (DKA), absolute insulin deficiency and elevation of counter-regulatory hormones may cause osmotic diuresis and water and electrolyte loss, which may lead to dehydration and renal failure. Fluids with high Na content are preferred in the DKA fluid therapy algorithm due to the association of Na with β-Hydroxybutyrate (β-HB) and the renal excretion of Na-β-HB. However, these fluids may cause hyperchloremic metabolic acidosis due to their high chloride concentration. In the literature, base-excess chloride (BE_Cl) has been suggested as a better approach for assessing the effect of chloride on acid–base status. Our aim in this study was to investigate the effect of fluids with BE_Cl values less than zero versus those with values equal to or greater than zero on the metabolic acid–base status in the first 6 h of DKA. Methods: This retrospective study included DKA cases managed in the tertiary intensive care units of five hospitals in the last 10 years. Patients were divided into two groups according to the Na-Cl difference of the administered fluids during the first 6 h of treatment: Group I [GI, fluids with Na-Cl difference = 0, chloride-rich group] and Group II [GII, fluids with Na-Cl difference > 32 mmol, chloride non-rich group]. Demographic data, blood gas analysis results, types and amounts of administered fluids, urea–creatinine values, and urine ketone levels were recorded. Results: Thirty-five patients with DKA in the ICU were included in the study (GI; 22 patients, GII; 13 patients). There was no difference between the patients in the two groups in terms of age, gender, and LOS-ICU. According to the distribution of the administered fluids, the main fluid administered in GI was 0.9% NaCl, whereas in the GII, it was bicarbonate, Isolyte-S, and 0.9% NaCl. In GI, the chloride load administered was higher; the BE_Cl level of the fluids was lower than in GII. At the end of the first 6 h, although sodium and strong ion gap values were similar, patients in GI were more acidotic due to iatrogenic hyperchloremia and, as a result, were more hypocapnic than GII. Conclusions: In conclusion, administering chloride-rich fluids in DKA may help reduce unmeasured anion acidosis. Still, risks cause iatrogenic hyperchloremic acidosis, which can hinder the expected resolution of acidosis and increase respiratory workload. Therefore, it is suggested that DKA guidelines be revised to recommend an individualized approach that avoids chloride-rich fluids and includes monitoring of metabolic parameters like Cl and BE_Cl. Full article

Gas evolution in lithium-ion batteries represents a pivotal yet underaddressed concern, significantly compromising long-term cyclability and safety through complex interfacial dynamics and material degradation across both normal operation and extreme thermal scenarios. While extensive research has focused on isolated gas generation mechanisms in specific components, critical knowledge gaps persist in understanding cross-component interactions and the cascading failure pathways it induced. This review systematically decouples gas generation mechanisms at cathodes (e.g., lattice oxygen-driven CO₂/CO in high-nickel layered oxides), anodes (e.g., stress-triggered solvent reduction in silicon composites), electrolytes (solvent decomposition), and auxiliary materials (binder/separator degradation), while uniquely establishing their synergistic impacts on battery stability. Distinct from prior modular analyses, we emphasize that: (1) emerging systems exhibit fundamentally different gas evolution thermodynamics compared to conventional materials, exemplified by sulfide solid electrolytes releasing H₂S/SO₂ via unique anionic redox pathways; (2) gas crosstalk between components creates compounding risks—retained gases induce electrolyte dry-out and ion transport barriers during cycling, while combustible gas–O₂ mixtures accelerate thermal runaway through chain reactions. This review proposes three key strategies to suppress gas generation: (1) oxygen lattice stabilization via dopant engineering, (2) solvent decomposition mitigation through tailored interphases engineering, and (3) gas-selective adaptive separator development. Furthermore, it establishes a multiscale design framework spanning atomic defect control to pack-level thermal management, providing actionable guidelines for battery engineering. By correlating early gas detection metrics with degradation patterns, the work enables predictive safety systems and standardized protocols, directly guiding the development of reliable high-energy batteries for electric vehicles and grid storage. Full article

The genus Spiraea is well represented in the Russian flora. Several phytochemical and bioactivity studies, completed so far with several individual species of this genus, indicate young Spiraea shoots as a promising source of pharmaceutically and nutraceutically active natural products. Therefore, a broad-scale phytochemical analysis of shoot extracts from multiple Russian Spiraea species (i.e., profiling of secondary metabolites and assignment of their structures), complemented with comprehensive activity screening, might give access to valuable information on the structure–activity relationship (SAR) of their constituents. However, despite a lot of phytochemical and bioactivity information on individual species being available, these data are mostly fragmentary and do not allow for building a general picture, and in-depth comprehensive studies are still missing. Therefore, to fill this gap, here, we present a comprehensive metabolite profiling study accomplished with 15 of the most widely spread Russian Spiraea species, which was complemented with appropriate bioactivity screening of their first-year shoot alcoholic extracts. A chromatography–mass spectrometric (LC-MS) analysis revealed 33 major constituents of the shoot isolates, which were dominated by flavonoids (quercetin and kaempferol derivatives) and hydroxycinnamic acids (caffeic, ferulic, and coumaric acid derivatives). Their relative quantification indicated that most of the identified major components were distributed among all of the studied extracts with minimal overlap in their composition and relative abundance. The antioxidant activity screening revealed the high efficiency of all of the extracts as potential redox protectors, acting at the levels of radical scavenging (DPPH assay) and quenching cation radicals (TEAC assay) and superoxide anion radicals (NBT assay). Screening the antiviral and antimicrobial activity of the same extracts revealed significant antiviral activity at a concentration of 2 µg/mL, and high (MIC < 1 mg/mL) or moderate (1 mg/mL ≤ MIC ≤ 4 mg/mL) antibacterial activity against Gram-positive and Gram-negative strains. The structures responsible for the manifestation of the studied types of activity were tentatively assigned using a bioinformatics-based strategy. This analysis revealed the most bioactive Spiraea species that might be promising for further in-depth phytochemical analysis and evaluations of their structure–activity relationships (SARs). In this context, we consider S. humilis, which simultaneously showed antioxidant, antimicrobial, and antiviral activity; S. media, with marked antioxidant, antimicrobial, and cytotoxic properties; S. ussuriensis, a strong antioxidant and cytotoxic species; and S. trilobata, with a combination of antioxidant and antiviral properties. Full article

This study presents a novel high-performance liquid chromatography–tandem mass spectrometry (HPLC–MS/MS) method for simultaneous determination of oxyclozanide (OXY) and levamisole hydrochloride (LEV) residues in ovine tissues, addressing the critical gap in cross-class antiparasitic drug monitoring. Leveraging dual solid-phase extraction strategies—MAX anion-exchange for lipophilic OXY and MCX cation-exchange for hydrophilic LEV—we achieved efficient purification of these pharmacokinetically divergent compounds from complex matrices (muscle, liver, kidney, and perirenal adipose). The method demonstrated superior sensitivity with limits of detection (1.5 μg/kg) and quantification (2.5 μg/kg) below international maximum residue limits (MRLs), validated through Codex Alimentarius guidelines (CAC/GL 71-2009). Linear responses (2.5–1000 μg/kg, R² > 0.9900) and robust precision (intra-day RSD: 1.44–12.51%; inter-day RSD: 0.29–17.70%) were maintained across spiked concentrations (LOQ, 0.5×, 1×, and 2 × MRLs), with recoveries of 80.94–115.36% confirming matrix-agnostic accuracy. Stability assessments under diverse storage conditions further validated method reliability. Applied to pharmacokinetic profiling in medicated sheep, this protocol established a 28-day withdrawal period for edible tissues, reconciling regulatory compliance with food safety requirements. As the first reported simultaneous quantification platform for OXY and LEV antiparasitics, our methodology advances veterinary residue analytics by enabling efficient multi-class surveillance and evidence-based withdrawal period optimization. Full article

The growing interest in sodium-ion batteries (SIBs) is driven by scarcity and the rising costs of lithium, coupled with the urgent need for scalable and sustainable energy storage solutions. Among various cathode materials, layered transition metal oxides have emerged as promising candidates due to their structural similarity to lithium-ion battery (LIB) counterparts and their potential to deliver high energy density at reduced costs. However, significant challenges remain, including limited capacity at high charge/discharge rates and structural instability during extended cycling. Addressing these issues is critical for advancing SIB technology toward industrial applications, particularly for large-scale energy storage systems. This review provides a comprehensive analysis of layered sodium transition metal oxides, focusing on their structural properties, electrochemical performance, and degradation mechanisms. Special attention is given to the intrinsic and extrinsic factors contributing to their instability, such as structural phase transitions, and cationic/anionic redox behavior. Additionally, recent advancements in material design strategies, including doping, surface modifications, and composite formation, are discussed to highlight the progress toward enhancing the stability and performance of these materials. This work aims to bridge the knowledge gaps and inspire further innovations in the development of high-performance cathodes for sodium-ion batteries. Full article

Ferrocene (Fc) has long been celebrated for its remarkable redox properties and structural versatility, making it a cornerstone of electrochemical sensor development. While extensive research has focused on cation detection using Fc-based systems, the equally critical recognition of neutral and anionic molecules remains underexplored despite their significance in biological, environmental, and industrial contexts. This review addresses this gap by exploring the latest advancements in Fc-based electrochemical sensors designed to overcome the unique challenges posed by these species—including diverse geometries, high hydration enthalpies, and the absence of formal charge. Molecular architectures such as amide-functionalised receptors, urea derivatives, Lewis acid-containing receptors, triazolium, and carboxylic acid-containing systems are examined, highlighting how these sensors achieve high selectivity and sensitivity. Furthermore, the influence of solvent environments on sensor performance is discussed, providing a critical analysis of how different receptor functionalities and solvents affect sensor behaviour. Emphasising the advantages of redox-based detection, this review aims to inspire further innovation in developing Fc-based technologies for detecting neutral and anionic species. Full article

Sodium bicarbonate has been used in the treatment of different pathologies, such as hyperkalemia, cardiac arrest, tricyclic antidepressant toxicity, aspirin toxicity, acute acidosis, lactic acidosis, diabetic ketoacidosis, rhabdomyolysis, and adrenergic receptors’ resistance to catecholamine in patients with shock. An ongoing debate about bicarbonate’s efficacy and potential harm has been raised for decades because of the lack of evidence supporting its potential efficacy. Despite the guidelines’ restrictions, sodium bicarbonate has been overused in clinical practice. The overuse of sodium bicarbonate could be because of the desire to correct the arterial blood gas parameters rapidly instead of achieving homeostasis by treating the cause of the metabolic acidosis. Moreover, it is believed that sodium bicarbonate may reverse acidosis-induced myocardial depression, hemodynamic instability, ventricular arrhythmias, impaired cellular energy production, resistance to catecholamines, altered metabolism, enzyme suppression, immune dysfunction, and ineffective oxygen delivery. On the other hand, it is crucial to pay attention to the potential harm that could be caused by excessive sodium bicarbonate administration. Sodium bicarbonate may cause paradoxical respiratory acidosis, intracellular acidosis, hypokalemia, hypocalcemia, alkalosis, impaired oxygen delivery, cerebrospinal fluid acidosis, and neurologic dysfunction. In this review, we discuss the pathophysiology of sodium bicarbonate-induced adverse effects and potential benefits. We also review the most recent clinical trials, observational studies, and guidelines discussing the use of sodium bicarbonate in different pathologies. Full article

Background and Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus (DM). The primary objective of this study was to identify relevant clinical and biochemical predictors and create a predictive score for in-hospital DKA mortality. Materials and Methods: A 6-year retrospective cohort study of adult patients diagnosed with DKA and admitted to Chiang Mai University Hospital, a tertiary care center in Chiang Mai, Thailand, from 1 January 2015 to 31 December 2021, was conducted. Baseline clinical data and laboratory investigations were collected. The primary outcome was in-hospital mortality. Multivariable logistic regression analysis, clustered by type of diabetes, was performed to identify significant predictors. A predictive risk score was created using significant predictive factors identified by multivariable analysis. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs), with a significant p-value set at <0.05. Results: Ninety-three patients diagnosed with DKA were included in the study. Ten patients died during admission. Significant predictors for in-hospital mortality of DKA included age > 55 years (OR 7.8, p = 0.007), female gender (OR 3.5, p < 0.001), anion gap > 30 mEq/L (OR 2.6, p = 0.003), hemoglobin levels < 10 g/dL (OR 16.9, p < 0.001), and the presence of cardiovascular disease (OR 1.3, p = 0.046). The predictive risk score ranged from 1 to 14 for low risk, and 14.5–23.5 for high risk of in-hospital mortality. The predictive performance of the scoring system was 0.82 based on the area under the curve, with a sensitivity of 73.8% and specificity of 96.4%. Conclusions: Multiple clinical and biochemical factors, along with a predictive risk score, could assist in predicting in-hospital mortality of DKA and serve as a guide for physicians to identify patients at high risk. Nevertheless, as the predictive score was internally validated with data from a single institution, external validation in diverse healthcare settings with larger datasets or prospective cohorts is crucial to confirm the model’s generalizability and predictive accuracy. Full article

Background: Methyl alcohol poisoning (MAP) is a common commercial compound that can lead to significant morbidity and mortality when exposed to high levels. This study aims to describe MAP-related electrocardiography (ECG) changes and post-acute late complications. Materials and Methods: The study was conducted through a retrospective data review between 2017 and 2023. Patient data were recorded, including demographic information, medication use, and laboratory results. Twelve-lead ECG recordings were evaluated and the results were recorded. The cases included in the study were grouped according to QTc distance, ECG findings, late-term complications, treatment status, and mortality. Results: The mean age of all cases included in the study (n = 227) was 43.23 ± 11.11 years, 8 (3.5%) cases were female, and the age distribution was between 19 and 68 years (p = 0.792). The age distribution of QTc groups was not significant (p = 0.792). The mean QTc distance was 442.7 ± 60.1 ms in all cases (n = 227) and 514.08 ± 5.45 ms in cases with mortality (n = 49) (p < 0.001). The mean time to application of the patients to the hospital (n = 227) was 19.1 ± 4.61 h, and blood sugar was 130.7 ± 32.09 mg/dL (p < 0.001). In addition, the mean pH of the cases (n = 227) was 7.14 ± 0.2, bicarbonate was 17.17 ± 4.86 mmol/L, the base deficit was −6.21 ± 3.18 mmol/L, the anion gap was 19.36 ± 7.31 mmol/L, and lactate was 4.82 ± 2.45 mmol/L (p < 0.001). Mortality occurred in 49 (21.6%) of the patients, and all of them were in-hospital deaths. In all cases where mortality occurred, pH was below 6.93 ± 0.22 and severe acidosis was directly related to death. MAP, sinus tachycardia in 31 (13.7%) cases, bradycardia in 8 (3.5%), atrial fibrillation in 5 (2.2%), accelerated idioventricular rhythm in 3 (1.3%), and 11 (4.8%), left bundle branch block, and right bundle branch block were detected in 22 (9.7%). All of these ECG findings were newly developed conditions with no previous history. In the 6-month follow-up after discharge, 4 (1.8%) of the cases developed neurological deficit, 15 (6.6%) had acute coronary syndrome and severe heart failure, 23 (10.1%) had permanent blindness, 6 (2.7%) had renal failure, and 6 (2.7%) had pancreatitis. Conclusions: Methyl alcohol poisoning can cause various ECG changes; sinus tachycardia, nonspecific changes, and QTc prolongation are the most common findings. These changes are more pronounced in cases of severe acidosis. Patients should be warned of late signs of MAP. Full article

Background: Inborn errors of glutathione metabolism may cause high anion gap metabolic acidosis due to pyroglutamic acid accumulation. Since 1988, cases of this acidosis have been reported in individuals without these defects. Methods: Given the poorly characterized predisposing factors, presentation, management, and prognosis of acquired pyroglutamic acidosis, we conducted a systematic review using the National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar databases. Results: A total of 131 cases were found. Most patients were females (79%), adults (92%) aged 51 years or older (66%) with pre-existing conditions (74%) such as undernutrition, alcohol-use disorder, or kidney disease, and had an ongoing infection (69%). The clinical features included diminished consciousness (60%), Kussmaul breathing (56%), and nausea or vomiting (27%). At least 92% of patients were on paracetamol therapy for >10 days at an appropriate dose, 32% on a β-lactamase-resistant penicillin, and 2.3% on vigabatrin. Besides severe anion gap acidosis, patients also presented with hypokalemia (24%) and kidney function deterioration (41%). Management involved discontinuing the offending drug (100%), bicarbonate (63%), acetylcysteine (42%), and acute kidney replacement therapy (18%). The fatality rate was 18%, which was higher without acetylcysteine (24%) compared to with it (11%). Conclusions: Acquired pyroglutamic acidosis is a rare, potentially fatal metabolic derangement, which usually occurs after paracetamol use, frequently combined with a β-lactamase-resistant penicillin or vigabatrin. This condition predominantly affects adults, especially women with factors like undernutrition, alcohol-use disorder, or kidney disease, often during infection. Increased awareness of this rare condition is necessary. Full article