Abstract 13699: Cyclohexanone Contamination of Medical Plastics is Associated With Worse Congenital Heart Surgery Outcomes

Introduction: Cyclohexanone, an industrial medical plastic fabrication contaminant, can leach from medical plastics including the cardiopulmonary bypass (CPB) circuit. Effects of neonatal perioperative cyclohexanone exposure on hospital-based outcomes have not been explored. Hypothesis: We hypothesize that serum cyclohexanone during congenital heart surgery with CPB is associated with worse morbidity. Methods: The study was a secondary analysis of 107 neonates enrolled in the NHLBI-funded Corticosteroid Therapy in Neonates Undergoing Cardiopulmonary Bypass trial. Blood samples were collected preoperatively, post-CPB, and 12 hours postoperatively, and concentrations of cyclohexanone and its metabolites were quantified using mass spectrometry. Using the geometric mean of cyclohexanone concentrations, the effects of an interquartile range (IQR) increase in concentration on hospital-based outcomes was assessed using adjusted linear and Poisson regression, for continuous and dichotomous outcomes, respectively. Estimates were reported as % differences (linear regression) or relative risks (Poisson regression) with 95% confidence intervals. Results: In adjusted analyses, an IQR increase in mean cyclohexanone concentration was associated with greater time spent on mechanical ventilation (40.1%: 7.34%, 82.9%), in the ICU (20.1%: 1.36%, 42.2%), and in the hospital (20.8%: 3.28%, 41.3%), and less time spent alive and out of the hospital 90 days post-surgery (-17%: -30.9%, -0.36%). An IQR increase in mean cyclohexanone was associated with a 61% (RR: 1.61; 1.19, 2.17) greater risk of the trial primary morbidity-mortality composite outcome (death, cardiac arrest, ECMO, renal or hepatic insufficiencies, and lactic acidosis). An IQR increase in mean cyclohexanone metabolites was associated with a 29% (RR: 1.29; 1.07, 1.55) greater risk of developing low cardiac output syndrome. Conclusions: This study showed that in neonates, circulating cyclohexanone was associated with unfavorable hospital-based outcomes following cardiac surgery with CPB, suggesting that medical plastic contamination may contribute to morbidity. Therefore, reducing exposure to cyclohexanone perioperatively may improve congenital heart surgery outcomes.

Parametric Optimization of Medical Plastic Wastes Conversion into Transportation Fuel using Mamdani Fuzzy Inference Systems (FIS)

Rapid growth of medical plastic wastes required attention for its scientific disposal along with conversion into value added products. Pyrolysis method is found suitable process for such conversion of such wastes into liquid oil. The experiment was carried out with the medical plastic wastes collected from local medicals and treated in a batch reactor taking appropriate range of temperature change and use of Calcium bentonite (CB) and Zeolite-A (ZA) as catalysts. The yield of liquid oil, gas and char produced from the process are collected in scale. The yield of liquid fuel in this process was influenced by factors such as temperature, catalyst concentration and acidity of catalyst. It was observed that yield of liquid fuel in this process were significantly dependent on temperature, nature of catalyst and catalyst concentration. The maximum yield of oil reported at 500 C and even increased by adding 20% by weight of CB as catalyst and 10% by weight of Z-A. In this study, Mamdani Fuzzy inference System (FIS) is used in order to measure the performance of the process and can be analyzed with more objectives, oriented through mathematical modelling and simulation. Mamdani Fuzzy inference was also introduced to identify the significant factors affecting the response and helps to determine the best possible factor level of combination. Finally, a regression model for liquid fuel from catalytic degradation of medical plastic wastes has been developed and mapped as a function of process parameters.

Medical Plastic Waste Disposal by Using in Bituminous Road Construction

The measure of plastic in the solid waste generated is increasing due to increase in factors such as urbanization, various development activities and changes in life style of humans which is leading to an unrestricted scattering on the landscape. Thus the disposal of these waste plastic has become a severe issue globally due to their non-biodegradability nature. Another area of concern is the deteriorating quality of roads due to the increase in traffic and their lower resistant’s to withstand adverse climatic conditions. Studies are being carried out to develop suitable alternatives for providing good, conventional road constructional materials for providing eco-friendly roads which have good design life. In this work, autoclaved medical plastic waste in the form of shredded syringes used in road construction is tested. The main objective of this work is to study how to use shredded Biomedical Plastic waste (BMPW) in Bituminous Mix and to compare the performance of the aggregate and bitumen when modified with bio-medical plastic waste. The results from the case studies showed improved properties for Plastic Coated Aggregate when compared to normal aggregates. There by showing that by using biomedical waste in bituminous road construction could bitterly change the quality of road and also the design life of bituminous roads by improving their properties.

Necrólise epidérmica tóxica associada ao lúpus eritematoso sistêmico: um relato de caso

Objetiva-se descrever o caso clínico de uma paciente com Necrólise Epidérmica Tóxica, tendo como enfoque oacompanhamento da evolução das lesões cutâneas; discutir o acompanhamento da evolução da doença e o uso dascoberturas disponíveis para a realização dos curativos; e analisar a eficácia do tratamento empregado com Polihexanidabetaina (PHMB) e placas de hidrofibra com prata. Trata-se de um relato de caso realizado em um hospital federal do estadodo Rio de Janeiro sob autorização por escrito da paciente. O curativo era realizado diariamente, pela Comissão Terapêuticade Feridas (CTF) e médicos da Cirurgia Plástica. No curativo do corpo, que apresentava áreas com descolamento total daepiderme e muito friáveis inicialmente foi utilizada como cobertura primária Sulfadiazina de prata a 1%. Conduta que foimantida por 07 dias, não havendo melhora aparente do quadro. Foi então realizada antissepsia com o PHMB e utilizadasplacas de hidrofibra em todo o corpo. Após 15 dias, na terceira troca do curativo, evidenciou-se melhora significativa, nãosendo necessário uso de hidrofibra. Concluí-se que ficou clara a eficácia do tratamento empregado e evidente a importânciado uso da cobertura adequada para cada demanda, sendo vantajoso e benéfico para todas as partes envolvidas.Palavras-chave: Doenças Autoimunes; Lúpus Eritematoso Sistêmico; Ferimentos e Lesões. ABSTRACTThe aim is to describe the clinical case of a patient with Toxic Epidermal Necrolysis focusing on the evolution ofcutaneous lesions; to discuss the disease progression and the use of covers available for the curative; and to analyzethe effectiveness of the treatment employed with Polihexanide Betaine Solution (PHMB) and Hydrofiber plates withSilver. This is a case report held in a federal hospital in the state of Rio de Janeiro. The patient in question authorizedthis report through The Free Informed Consent Form, according to Resolution 466/12. The curative was performeddaily, in the Surgical Center by the Therapeutic Committee of Wounds (TCW) and Medical Plastic Surgery. In thebody curative, which presented areas with complete detachment of the epidermis initially friable was performedprimary cover with Silver Sulfadiazine 1% cream. This conduct was maintained for 07 days. There was no apparentimprovement. Then antisepsis was performed with PHMB and was used plates throughout the body. After 15 days,in the third dressing exchange, a significant improvement was evidenced, not requiring the use of Hydrofiber. Itconcludes that the efficacy of the treatment used was clear and it is evident the importance of using the appropriatecoverage for each demand, being advantageous and beneficial to the patient, the teams involved and the institution.Keywords: Autoimmune Diseases; Lupus Erythematosus, Systemic; Wounds and Injuries.