Experimental Approach of Quadriceps Strength Measurement: Implications for Assessments in Critically Ill Survivors

(1) Background: The supine testing position is suitable for early quadriceps strength (QS) assessment in intensive care unit, while a seated position is more appropriate for survivors who have regained mobility. Acquiring consistent measurements is essential for longitudinal follow-up. We compared the QS generated in different settings in healthy volunteers. (2) Methods: Isometric QS was assessed using a MicroFet2 and standardised protocols comparing different modalities. Hip and knee flexion angles were, respectively, 45° and 40° (H45-K40) in the supine position, and both at 90° (H90-K90) in the seated position. Dynamometer was either handheld (non-fixed configuration, NFC), or fixed (FC) in a cubicle. (3) Results: QS in H90–K90 and H45-K40 positions were strongly correlated, but QS was higher in the later position regardless of the configuration. Compared to H45-K40, biases of 108.2N (or 28.05%) and 110.3N (27.13%) were observed in H90-K90 position, respectively, in the NFC and FC. These biases were independently and positively associated with QS (p < 0.001). For both position, there were no significant differences between QS measured in NFC or FC. (4) Conclusions: The quadriceps was less efficient in the seated position, compared to the supine position, in healthy volunteers. These findings have practical implications for further assessments and research in critically ill patients.

Evaluation and comparison of S.T.O.N.E. and Guy’s scoring systems for predicting percutaneous nephrolithotomy outcomes in supine position

Background: Percutaneous nephrolithotomy (PCNL) was applied in the prone position until recently. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefore different scoring systems are used to evaluate outcomes of PCNL before surgery. Patients and methods: Between 2018 and 2020, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy’s scoring systems (GSS). The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. Result: In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) of patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. Conclusion: Our findings revealed that S.T.O.N.E. nephrolithometry and Guy’s score systems can be used effectively to predict stone-free rate, complications, and operation duration in supine position PCNL for renal stones.

A Telecare System for Use in Traditional Persian Medicine

Background: In Persian Medicine (PM), measuring the wrist temperature/humidity and pulse is one of the main methods for determining a person's health status and temperament. An important problem is the dependence of the diagnosis on the physician's interpretation of the above-mentioned criteria. Perhaps this is one reason why this method has yet to be combined with modern medical methods. Also, sometimes there is a need to use PM to diagnose patients remotely, especially during a pandemic. This brings up the question of how to implement PM into a telecare system. This study addresses these concerns and outlines a system for measuring pulse signals and temperament detection based on PM. Methods: A system was designed and clinically implemented based on PM that uses data from recorded thermal distribution, a temperament questionnaire, and a customized device that logs the pulse waves on the wrist. This system was used for patient care via telecare. Results: The temperaments of 34 participants were assessed by a PM specialist using the standardized Mojahedi Mizaj Questionnaire (MMQ). Thermal images of the wrist in the supine position (named Malmas in PM), the back of the hand, and the entire face were also recorded under the supervision of the physician. Also, the wrist pulse waves were evaluated by a customized pulse measurement device. Finally, the collected data could be sent to a physician via a telecare system for further interpretation and prescription of medications. Conclusion: This preliminary study focused on the implementation of a combinational hardware-software system for patient assessment based on PM. It appears that the design and construction of a customized device that can measure the pulse waves, and some other criteria, according to PM, is possible and can decrease the dependency of the diagnostic to PM specialists. Thus, it can be incorporated into a telemedicine system.

INVESTIGATION OF THE RELATIONSHIP BETWEEN ANTHROPOMETRIC MEASUREMENTS AND FOREARM POSTURES WITH GRIP STRENGTH IN YOUNG ADULTS

BACKGROUND: Grip strength is widely accepted as an indicator of maximum hand strength and contraction of active muscles of the hand and forearm. OBJECTIVE: The aim of this study was to assess the effects of forearm posture (pronation, supination and neutral) and anthropometric variation on MVC grip strength and grip endurance time in young university adults. METHODS: Fifty healthy, right-handed men volunteered to participate in this study. The experiment was characterized by measuring MVC grip strength and endurance time of 50% MVC randomly in three different postures (supine, pronation and neutral). Performance was assessed in terms of dependent variables: MVC grip strength and grip endurance time. RESULTS: MANCOVA results showed no significant effect of posture on MVC grip strength ([Formula: see text]) and grip endurance time ([Formula: see text]). There was a significant effect of age ([Formula: see text]), height ([Formula: see text]) and forearm length ([Formula: see text]) on the grip endurance time in supine position. However, palm circumference had a significant effect on MVC grip strength ([Formula: see text]) in pronation posture only. The pronation forearm posture produces 7.4% more grip strength than a supine posture. In addition, the grip endurance time was improved in the supine position, compared to the neutral and pronation forearm posture. CONCLUSIONS: This study showed that the MVC grip strength is affected by the weight and palm circumference. In addition, palm circumference was the most influential factor affecting grip strength. Thus, anthropometric and posture-specific grip strength data are essential for clinical and industrial applications. The results can be used to prepare guidelines for rehabilitation, health care, sport and medicine.

A Case of Fatal Asphyxia by a Barbell during a Bench Press

The bench press is a widespread form of weight training with few scientific reports on its associated fatalities. We herein report a case of an individual performing bench press training who was found deceased in a supine position on the bench with the shaft of the barbell resting on his neck. The bench press safety bars were set at bench height. On the basis of the postmortem computed tomography imaging and the autopsy, the cause of death was determined to be fatal traumatic asphyxia caused by a cervical compression. We wish to highlight the importance of correctly using safety devices during weight training as well as the need for developing and disseminating safe equipment that is not dependent on the manner of use. We also wish to highlight the need for a form of legal regulation on the design of devices.

Combining Non-invasive Ventilation with timed position change in the Emergency Department to improve oxygenation and outcomes in patients with COVID-19: A prospective analysis from a low resource setup

Background: Moving away from invasive ventilation towards timed position change and non-invasive ventilation is especially of benefit in low and middle income countries, where judicious use of the available healthcare resources is the need of the day. Our study was conducted prospectively to develop strategies for non-invasive ventilation in combination with timed position change of patients to see its impact on their outcome.Objectives: Non-invasive ventilation has proven to be of benefit in COVID-19 related acute lung injury. The objective of this prospective, cross sectional study was to develop a protocol for the use of non-invasive ventilation with timed position change to improve COVID-19 patients’ outcomes in the Emergency Department (ED). Methods: All patients presenting with confirmed or suspected COVID-19 were enrolled in the study from March 2020 to October 2020. Data was collected to see the effect of timed position change and non-invasive ventilation on these patients and its effect on delaying or avoiding invasive ventilation. Results: Of the 207 COVID-19 patients presenting to the IHHN ED, 109(52.7%) had oxygen saturation in the nineties in supine position followed by right lateral in 37(17.9%), sitting up in 30(14.5%), left lateral in 29(14%) and prone position in 2(1%). Maximal oxygenation was achieved with non rebreather mask (NRM) and nasal prongs in 87(42%) of the patients, followed by the use of continuous positive airway pressure (CPAP) in 29(14%). Conclusion: Most of the patients preferred to stay in the supine position and described it as the position of comfort. When used in combination supine position, patients on NRM with nasal prongs and on CPAP, had oxygen saturation in the nineties. Central obesity was found to be the prime reason for the inability to prone our patients. This needs to be followed up in the current fourth wave of COVID-19 to see the effectiveness of the said modalities. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5772 How to cite this:Ali S, Khatri A, Ghouri N, Mukhtar S, Zawawi S, Saleem SG. Combining Non-invasive Ventilation with timed position change in the Emergency Department to improve oxygenation and outcomes in patients with COVID-19: A prospective analysis from a low resource setup. Pak J Med Sci. 2022;38(2):375-379. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5772 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.