Microsaccadic Fixational Eye Movements as an Oculomotor Marker for Concussion

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S5.1-S5
Author(s):  
Mohammad Mortazavi ◽  
Prem Thirunagari ◽  
Saikaashyap Sarva ◽  
Monica Pita
Keyword(s):  
Eye Movements ◽  
Prior History ◽  
Eye Tracker ◽  
Independent Variables ◽  
Fixational Eye Movements ◽  
Potential Marker ◽  
Dependent Variables ◽  
History Of ◽  
The Mean ◽  
Direction Component

ObjectiveTo identify whether concussion causes abnormalities in fixational eye movements, specifically the generation of microsaccades.BackgroundMicrosaccades are microscopic rapid eye movements that occur normally with attempted fixation. However, changes in microsaccade rate, magnitude, etc have been linked with neurologic and ophthalmic pathologies.Design/MethodsWe collected baseline data for college athletes (n = 116) at Sterling College (Sterling, KS) as they reported for the physical examination before the beginning of the athletic season. None of the athletes had a prior history of concussion. Concussion patients (n = 86) were selected from patients who had an initial visit for concussion at a private concussion clinic. Patients were included if they presented within 50 days of injury. All participants were between 18 and 23 years of age. For each participant we measured the number of saccades generated, the size and speed of the micro saccades, the area covered and the ratio of vertical-to-horizontal direction component of the fixational eye movements, using a 250 Hz video-eye tracker mounted inside a HTC Vive VR headset. Participants were instructed to fixate on a central dot for 140 seconds, in 20-second intervals. We performed a logistic regression with the log-transformed oculomotor characteristics as independent variables and concussion yes/no as dependent variables. Errors are presented as standard error from the mean.ResultsThe average microsaccade magnitude was higher in concussed than in non-concussed participants (1.85 ± 0.12° vs 1.32 ± 0.06°, p < 0.001). Similarly, the fixational eye movements (microsaccades + drifts) of concussed patients tended to cover a more vertical area during fixation periods (vertical-to-horizontal ratio of 3.49 ± 0.94 vs 1.12 ± 0.04, p < 0.005).ConclusionsOculomotor testing, specifically microsaccades is a potential marker for concussion. Concussion patients present larger and more vertical eye movements during fixation.

scholarly journals Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

2021 ◽  
Vol 2 (4) ◽  
pp. 01-03
Author(s):  
Chukwubuike Kevin Emeka
Keyword(s):  
Pediatric Surgery ◽  
Testicular Torsion ◽  
Undescended Testis ◽  
Tertiary Hospital ◽  
Prior History ◽  
Testicular Pain ◽  
History Of ◽  
The Mean ◽  
Urological Emergency ◽  
The Right

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

scholarly journals THE USE OF HYDROXYETHYL STARCH 200/0,5 AS PLASMA SUBTITUTES IS SAFE IN HYPOVOLEMIC PATIENTS AS INDICATED IN CHANGES OF N-ACETYL--GLUCOSAMINIDASE AND CREATININ SERUM PARAMETERS

2016 ◽  
Vol 51 (4) ◽  
pp. 228
Author(s):  
Dewi Wara Shinta ◽  
Junaidi Khotib ◽  
Eddy Rahardjo ◽  
Mahardian Rahmadi ◽  
Budi Suprapti
Keyword(s):  
Hydroxyethyl Starch ◽  
Elective Surgery ◽  
Prior History ◽  
Creatinine Ratio ◽  
Urine Creatinine ◽  
Tissue Edema ◽  
History Of ◽  
The Mean ◽  
Baseline Characteristics ◽  
Two Parameters

Hydroxyethyl Starch (HES) is a compound that improves intravascular volume effectively and rapidly without causing tissue edema. However, HES also has renal safety profile which is still being debated. Based on clinical experience in Dr. Soetomo Hospital, the frequency of acute renal failure following HES 200/0.5 administration at a dose of less than 20 ml/kg (maximum dose) is very rare. The purpose of this study was to evaluate the effect of HES 200/0.5 at a dose of less than 20 ml/kg in patients undergoing surgery. N-acetyl-b-D-Glucosaminidase (NAG) per urine creatinine ratio and creatinine serum were used as main parameter to assess renal injury. This research was observational and prospective design in patients undergoing elective surgery at Gedung Bedah Pusat Terpadu, Dr. Soetomo Hospital, who requiring resuscitation therapy with HES 200/0.5 and met the inclusion and exclusion criteria. NAG was measured prior to surgery and 12 hours after administration of fluid therapy, while creatinine serum was observed before surgery and 48 hours after resuscitation. This study was conducted for three months, and obtained 50 subjects divided into 2 groups, crystalloid group and HES 200/0.5 group. Demographic and baseline characteristics did not differ between groups, except the total bleeding volume. Total bleeding in HES 200/0.5group was higher than crystalloid group (p <0.0001). The mean volume of fluid received in HES 200/0.5 group was 2042.0 ± 673.9 mL, higher when compared with that of crystalloid group (910.0 ± 592.0 ml). Doses of HES 200/0.5 received was 8.31 ± 4.86 ml/kg. Measurement of the of NAG/creatinine ratio and creatinine serum showed significant increase in both groups, but still within the normal range. In addition, the value of these two parameters did not differ between groups. In conclusion, HES 200/0.5 in a dose of less than 20 ml/kg is safe to use in patients who suffered from hypovolemic hemorrhage, without prior history of renal impairment.

scholarly journals Resistance to Boscalid Fungicide in Alternaria alternata Isolates from Pistachio in California

Plant Disease ◽  
2007 ◽  
Vol 91 (10) ◽  
pp. 1345-1350 ◽  
Author(s):  
Herve F. Avenot ◽  
Themis J. Michailides
Keyword(s):  
Spore Germination ◽  
Alternaria Alternata ◽  
Hyphal Growth ◽  
Conidial Germination ◽  
Prior History ◽  
In Vitro Tests ◽  
Fitness Parameters ◽  
History Of ◽  
The Mean

Boscalid is a new carboxamide fungicide recently introduced in a mixture with pyraclostrobin in the product Pristine for the control of Alternaria late blight of pistachio. In all, 108 isolates of Alternaria alternata were collected from pistachio orchards with (59 isolates) and without (49 isolates) prior exposure to boscalid. The sensitivity to boscalid was determined in conidial germination assays. The majority of isolates from two orchards without a prior history of boscalid usage had effective fungicide concentration to inhibit 50% of spore germination (EC50) values ranging from 0.089 to 3.435 μg/ml, and the mean EC50 was 1.515 μg/ml. Out of 59 isolates collected from an orchard with a history of boscalid usage, 52 isolates had EC50 values ranging from 0.055 to 4.222 μg/ml, and the mean EC50 was 1.214 μg/ml. However, in vitro tests for conidial germination and mycelial growth also revealed that seven A. alternata isolates, originating from the orchard exposed to boscalid were highly resistant (EC50 > 100 μg/ml) to this fungicide. Furthermore, in vitro tests showed no significant differences between wild-type and boscalid-resistant mutants in some fitness parameters such as spore germination, hyphal growth, sporulation, or virulence on pistachio leaves. Experiments on the stability of the boscalid-resistant phenotype showed no reduction of the resistance after the mutants were grown on fungicide-free medium. Preventative applications of a commercial formulation of boscalid (Endura) at a concentration which is effective against naturally sensitive isolates failed to control disease caused by the boscalid-resistant isolates in laboratory tests. To our knowledge, this is first report of field isolates of fungi resistant to boscalid.

Saltation and suspension trajectories of solid grains in a water stream

1977 ◽  
Vol 284 (1321) ◽  
pp. 225-254 ◽  
Keyword(s):  
Velocity Gradient ◽  
High Speed ◽  
Prior History ◽  
Water Stream ◽  
The Past ◽  
The Coefficient Of Friction ◽  
Conservation Of Momentum ◽  
History Of ◽  
The Mean ◽  
Exposure Technique

This paper continues the investigation of the motion of solitary grains in a water stream, reported by Francis (1973)- The trajectories of solid grains are photographed by a multi-exposure technique as they are propelled by water streams along the bed of a laboratory channel. Many thousands of photographs were taken and analysed to determine the positions, velocities and accelerations of the grain. The technique does not take into account the possible effect, in multi-grain transport, of intergranular collisions. The three different modes of transport of grains were all observed — rolling, saltation and suspension, and the proportion of each found for a variety of transport stage w*/w*0. The development of suspension is much less rapid than the development of saltation from rolling, but even at the highest stage used, about 3.0, there is still a small amount of rolling. The trajectory dimensions and geometry are shown in relation to the stage which uniquely determines the geometry. Experiments where the grain is suddenly entrained from a stationary position show that several features of the subsequent trajectory are the same as those of a trajectory with a prior history of movement: thus it is inferred that the start of a trajectory is by way of hydrodynamic forces rather than by the conservation of momentum of previous trajectories. Impacts and trajectories were analysed for the coefficient of friction tan cc and for the height of the effective thrust. While tan a is shown to be rather larger than has been suspected in the past, the variation of yn throws light upon predominance of slow fluid near the bed rather than high speed inrushes of fast fluid. Better information is now available for finding the mean forward speed of grains compared to that presented in the earlier paper. There are grounds for believing the existence of a * shear-drift ’ force on grains when they are in a velocity gradient, giving a force opposing gravity: but there is no evidence of a proximity effect of the bed independent of the velocity gradient.

Immunogenicity of Subcutaneous Versus Intramuscular Oka/Merck Varicella Vaccination in Healthy Children

PEDIATRICS ◽  
1991 ◽  
Vol 88 (3) ◽  
pp. 604-607
Author(s):  
Penelope H. Dennehy ◽  
Keith S. Reisinger ◽  
Mark M. Blatter ◽  
Barbara A. Veloudis
Keyword(s):  
Geometric Mean ◽  
Varicella Vaccine ◽  
Varicella Vaccination ◽  
Prior History ◽  
Healthy Children ◽  
Geometric Mean Titer ◽  
Clinical Events ◽  
History Of ◽  
The Mean ◽  
To Receive

To compare the immunogenicity and safety of varicella vaccine by either subcutaneous or intramuscular injection, 166 healthy children aged 12 months to 10 years old who had no prior history of varicella were enrolled from two pediatric practices and randomly assigned to receive 0.5 mL of a single lot of varicella vaccine. Sera from the day of and 6 weeks postvaccination were tested for varicella antibody by gpELISA. Parents recorded clinical events occurring in the 6 weeks following vaccination. In the 132 evaluable children, the mean prevaccination titer was 0.3 gpELISA units for both groups. Sixty-three (97%) of the 65 receiving varicella vaccine by the subcutaneous route seroconverted compared with 67 (100%) of 67 immunized intramuscularly. Postvaccination geometric mean titer in the subcutaneous group was 6.9 ± 7.0 gpELISA units and did not differ significantly from the geometric mean titer of 10.5 ± 4.4 in the intramuscular group. Varicella vaccine was generally well tolerated by either route; 21% of both groups complained of reactions at the injection site and 7% had a varicella-like rash. Although varicella vaccine is recommended to be given subcutaneously, the results of this study indicate that inadvertent intramuscular administration of varicella vaccine is not reason for revaccination.

scholarly journals 193. Comparison of Survival for MSSA and MRSA Endocarditis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S116-S116
Author(s):  
Emese Kanyo ◽  
Nabin K Shrestha ◽  
Steven M Gordon
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Multivariable Analysis ◽  
Cleveland Clinic ◽  
Invasive Disease ◽  
Small Sample ◽  
Prior History ◽  
Selection Of Variables ◽  
History Of ◽  
The Mean

Abstract Background Prior studies have yielded conflicting findings regarding outcomes for MRSA vs. MSSA infective endocarditis (IE). Our experience suggests that MSSA IE is not any less severe than MRSA IE. The purpose of this study was to compare survival in MSSA and MRSA IE. Methods Episodes of IE caused by Staphylococcus aureus were identified from the Cleveland Clinic Infective Endocarditis Registry. Only the first episode was included for each patient. Acceptance for surgery was considered surgical treatment. Survival from the surgical decision date was compared for MSSA vs. MRSA endocarditis using multivariable Cox proportional hazards regression. Selection of variables for the model was done by stepwise backward elimination from a collection of clinically important baseline variables. Results Between January 1, 2008 and January 1, 2010, 76 episodes of IE caused by S. aureus were identified. The mean (SD) patient age was 58 (15) years, 46 (61%) were males, 14 (18%) had a prior history of IE, 33 (43%) had diabetes mellitus, 22 (29%) had end-stage renal disease (ESRD), 27 (36%) had prosthetic valve endocarditis (PVE), 70 (92%) had left side involvement, 27 (36%) had invasive disease, 59 (78%) were referred patients, and 39 (51%) were treated surgically. The mean (SD) time to decision on surgery was 6 (7) days. Of these episodes 40 (53%) had MSSA IE and 36 (47%) had MRSA IE. There was no difference in hazard of death between MSSA and MRSA IE (HR 0.98, 95% C.I. 0.54–1.78, P-value 0.96), after adjusting for age, ESRD, prior history of IE, PVE, invasive disease, calendar year, and surgical treatment, which were the significant explanatory variables in the multivariable analysis. Survivals predicted by the model for a reference patient with MSSA IE and MRSA IE are shown in the figure. Conclusion Preliminary findings suggest that survival in MSSA IE may be similar to that in MRSA IE. The study is limited by its small sample size. The study finding will need confirmation with a larger sample. Disclosures All authors: No reported disclosures.

scholarly journals Malignancy incidences by glycemic control among diabetic patients

2018 ◽  
Vol 7 (12) ◽  
pp. 1457-1463 ◽  
Author(s):  
Daiki Kobayashi ◽  
Nagato Kuriyama ◽  
Keita Hirano ◽  
Osamu Takahashi ◽  
Hiroshi Noto
Keyword(s):  
Longitudinal Study ◽  
Glycemic Control ◽  
Time Dependent ◽  
Prior History ◽  
Diabetic Patients ◽  
Mixed Effect ◽  
History Of ◽  
The Mean ◽  
The Difference ◽  
Hba1c Levels

Background The aim of this study was to evaluate the difference in malignancy incidence by evaluating time-dependent HbA1c levels among diabetic patients in a longitudinal study. Methods We conducted a retrospective longitudinal study at large academic hospital, Tokyo, Japan, from 2006 to 2016. We included all diabetic patients who were 50 years or older and who underwent health check-ups at the Center for Preventive Medicine. Those patients with a prior history of malignancies were excluded. We categorized patients into five groups on the basis of HbA1c measurements: <5.4, 5.5–6.4, 6.5–7.4, 7.5–8.5, >8.5%. Our primary outcome was the development of any types of malignancy. Longitudinal analyses by a mixed effect model with time-dependent HbA1c levels were applied in order to take into account fluctuations in HbA1c levels within the same patient. Results In total, 2729 participants were included in this study, where the mean age was 62.6 (standard deviation (s.d.): 7.8) and 2031 (74.4%) were male. The mean disease duration of diabetes was 7.6 (s.d.: 7.6) years, and 1688 (61.8%) were prescribed medications. Median follow-up was 1443.5 (interquartile range (IQR): 2508) days and 376 (13.8%) developed malignancies. Compared to the reference range of HbA1c (5.5–6.4%), the odds ratios for developing malignancies among the other HbA1c level groups were similar and not statistically different (OR: 0.98, 95% CI:0.31–3.15 (for HbA1c <5.4%); OR: 0.88, 95% CI: 0.69–1.12 (for HbA1c 6.5–7.4%); OR: 0.88, 95% CI: 0.64–1.22 (for HbA1c 7.5–8.4%); OR 1.07, 95% CI: 0.70–1.66 (for HbA1c >8.5%)). Conclusion In our study, there was no association between glycemic control and the development of future malignancies. Compared to very strictly controlled HbA1c levels, both excessive control and good or bad control had a statistically similar risk of developing malignancies.

scholarly journals Protracted Respiratory Findings in Children Post-COVID-19 Infection

2021 ◽  
Author(s):  
Shoshana Leftin Dobkin ◽  
Joseph Collaco ◽  
Sharon McGrath-Morrow
Keyword(s):  
Lung Function ◽  
Respiratory Symptoms ◽  
Pediatric Patients ◽  
Acute Infection ◽  
Retrospective Chart Review ◽  
Exercise Intolerance ◽  
Prior History ◽  
Exertional Dyspnea ◽  
History Of ◽  
The Mean

Introduction: Although prolonged respiratory symptoms following SARS-CoV-2 infection have been reported in adults, there is a paucity of literature describing post-acute symptoms in pediatric patients following COVID-19. In this study we describe health data and respiratory findings in pediatric patients presenting with complaints of persistent respiratory symptoms following acute COVID-19 infection. Methods: This study included patients referred to Pulmonary Clinic at the Children’s Hospital of Philadelphia between December 2020 and April 2021 (n=29). Inclusion criteria included a history of SARS-CoV-2 RNA positivity or confirmed close household contact. A retrospective chart review was performed and demographic, clinical, imaging, and functional test data were collected. Results: The mean age at presentation to clinic was 13.1 years (range: 4-19 years). Patients had persistent respiratory symptoms ranging from 1.3 to 6.7 months post-acute infection. Persistent dyspnea and/or exertional dyspnea were present in nearly all (96.6%) of the patients at the time of clinic presentation. Other reported chronic symptoms included cough (51.7%) and exercise intolerance (48.3%). Fatigue was reported in 13.7% of subjects. Many subjects were overweight or obese (62.1%) and eleven subjects had a prior history of asthma. Lung function was normal in most patients. The six-minute walk test (6MWT) revealed exercise intolerance and significant tachycardia in two-thirds of children tested. Conclusion: Exertional dyspnea, cough and exercise intolerance were the most common respiratory symptoms in children with post-acute COVID-19 respiratory symptoms seen in an outpatient pulmonary clinic. Lung function, however, was mostly normal, and exertional intolerance was frequently demonstrated using the 6MWT.

scholarly journals Spontaneous primary pneumomediastinum: is it always benign?

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Berhanu N. Alemu ◽  
Ephraim T. Yeheyis ◽  
Abraham G. Tiruneh
Keyword(s):  
Case Reports ◽  
Meta Analysis ◽  
Underlying Disease ◽  
Clinical Feature ◽  
Prior History ◽  
Average Hospital ◽  
Spontaneous Pneumomediastinum ◽  
Life Threatening ◽  
History Of ◽  
The Mean

Abstract Background Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The therapeutic options also differ by the cause. This systematic review was done to provide, as far as we know, the first attempt to broadly assess the clinical feature, predisposing factors, possible management, and outcome of spontaneous primary pneumomediastinum. Methods In addition to the two patients treated at our hospital, a Pub Med Search for literature on case reports of spontaneous pneumomediastinum published in English up to November 2018 was done. We extracted data on patients' demographic characteristics, symptoms, timing, diagnosis, management, and outcome of the treatment were analyzed based on the preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) Result A total of 339 cases were reviewed. 71.7% of them were male. The Mean age affected was 22.4 ± 11.3 years. Chest pain, 196 (57.8%), is the most common presenting symptom, followed by dyspnea, 156 (46%), cough 95 (28%), neck swelling 92 (27.13%), cervical pain 88 (25.9%), dysphagia 39 (11.5%), odynophagia 37 (10.9%), and Dysphonia 14 (4.1%). Fifty-seven patients (16.8%) had a prior history of Asthma, 19 (5.6%) had Connective Tissue Disorders, and 12 (3.5%) had associated malignancy as an identified risk factor. In 35 (10.3%) patients, spontaneous pneumomediastinum was found incidentally. The mean number of days before the clinical resolution of spontaneous pneumomediastinum was 6.65 ± 11.8 days and the average hospital stay was 4.15 ± 1.93 days. Nineteen (5.6%) patients have died as a result of the underlying disease not related to SPM. Conclusion Spontaneous pneumomediastinum is uncommon, usually benign, a self-limited disorder that commonly occurs in a young adult without any apparent precipitating factor or disease. Spontaneous pneumomediastinum usually responds very well to conservative treatment without recurrence. However, secondary causes should be ruled out to minimize the unfavorable outcome.

Evaluating Eye Tracking Technology for Understanding how Medical Students Interpret a 12-Lead Electrocardiogram: A Quantitative Approach (Preprint)

2020 ◽  
Author(s):  
Mohammed Tahri Sqalli ◽  
Dena Al-Thani ◽  
Mohamed Badreldin Elshazly ◽  
‪Mohammed Al-Hijji
Keyword(s):  
Eye Movements ◽  
Medical Students ◽  
Eye Tracking ◽  
Fixation Time ◽  
Eye Tracker ◽  
Different Types ◽  
Interpretation Process ◽  
The Mean ◽  
Tracking Technology ◽  
Insight Into

BACKGROUND It is common among healthcare practitioners that accurate interpretation of a 12-lead electrocardiogram demands high levels of skill and expertise. There is a variation amongst healthcare practitioners in their ability to read ECGs accurately and quickly. Moreover, guidelines or best-practices for a standard interpretation process are inexistant. This causes a chasm between skilled interpreters and medical students who are just beginning to develop this skill. OBJECTIVE This study aims to use the eye tracking methodology to research whether eye fixation can be used to gain a deeper understanding into how medical students acquire the ECG interpretation skill. METHODS Each one of the sixteen recruited medical students was asked to interpret ten different types of 12-lead ECGs, while their eye movements were recorded using a Tobii X60 eye tracker. The device uses corneal reflection technology to non-intrusively record the interpreter’s eye movements. The frequency of sampling is 60Hz. Fixations’ heatmaps of where medical students looked at were generated from the collected dataset. A statistical analysis was conducted on the fixations’ count and duration using the Mann Whitney U test, and the Kruskal Wallis test. RESULTS A total number of 16 medical students interpreting 10 ECGs each were recorded. Each interpretation lasted for a duration of 30 seconds. The mean accuracy of the interpretations was 55.63% with a standard deviation of 4.63 %. After analyzing the average fixation duration, we find that on average students study the three lower leads (rhythm strips) the most with a top-down approach (lead II has highest fixation time (mean = 2727 ms, SD = 456) followed by leads V1 (mean = 1476 fixations, SD = 320), V5 (mean = 1301 fixations, SD = 236). We also find a strong correlation between some of the eye tracking features like the time spent fixating and the fixation count (r = 0.87). Finally, by analyzing the time to the first fixation, we understand that medical students develop a personal system of interpretation that adapts and reacts to the nature and the complexity of the diagnosis. We also find that medical students consider some leads as their guiding point towards finding a hint leading to the correct interpretation. CONCLUSIONS The use of eye tracking methodology provided a more precise insight into how medical students learn how to interpret a 12-lead ECG. CLINICALTRIAL NA

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