Background:
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multi-organ condition occurring with a 1 in 3800 prevalence in Alberta. This genetic disorder leads to vascular malformations in different organs including the lungs and brain, commonly affecting pulmonary vasculature leading to pulmonary arteriovenous malformations (PAVMs). PAVMs lead to right-to-left shunts, which may be associated with neurologic complications. We aimed to evaluate and summarize the reported neurologic manifestations of individuals with HHT with pre-existing PAVMs.
Methods:
We performed a qualitative systematic review to determine available literature on neurological complications among patients with PAVMs and HHT. Published studies included observational studies, case studies, prospective studies, and cohort studies including search terms HHT, PAVMs, and various neurologic complications using MEDLINE and EMBASE.
Results:
A total of 449 manuscripts were extracted including some duplicates of titles, abstracts, and text which were screened. Following this, 23 publications were identified for inclusion in the analysis. Most were case reports (n = 15). PAVMs were addressed in all these articles in association with various neurological conditions ranging from cerebral abscess, ischemic stroke, hemorrhagic stroke, embolic stroke, and migraines.
Conclusion:
Although HHT patients with PAVMs are at risk for a variety of neurological complications compared to those without PAVMs, the quality and volume of evidence characterizing this association is low. Individuals with PAVMs have a high prevalence of neurological manifestations such as cerebral abscess, transient ischemic attack, cerebral embolism, hemorrhage, and stroke. Mitigating stroke risk by implementing proper standardized screening techniques for PAVMs is invaluable in preventing increased mortality.
Microbial fuel cells (MFCs) have drawn attention among renewable energy devices. High capital cost, poor durability, and slow oxygen reduction reaction (ORR) kinetics are the major hindrances in the commercialization of the technology. In this work, an environmentally benign approach is followed to synthesize a composite of magnesium cobaltite (MgCo 2 O 4 ) embedded in nitrogen-doped carbon to optimize the performance of MFCs. Detailed characterization confirms the formation of MgCo 2 O 4 nanostructures in the catalyst treated at 700 °C. Electrochemical studies suggest the superior performance of the MgCo 2 O 4 /NC-700 catalyst with a peak reduction current of −0.068 mA and a charge transfer resistance (R ct ) of 40.5 Ω. The performance of the air cathodes is evaluated using activated sludge as inoculum in the anode chamber in single-chamber MFCs. The power output of MFC with MgCo 2 O 4 /NC-700 as an air cathode reaching 873.81 mW m −2 is 59.56 and 216.05% higher than those of MFCs with Pt/C (547.65 mW m −2 ) and Co/NC-700 (276.48 mW m −2 ) cathodes, respectively. These findings suggest that substituting magnesium in transition metal−nitrogen−carbon composites could help realize long-term application as air cathodes for power generation and wastewater treatment in MFCs.
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