Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge

BackgroundProne positioning has a beneficial role in COVID-19 patients receiving ventilation but lacks evidence in awake non-ventilated patients, with most studies being retrospective, lacking control populations and information on subjective tolerability.MethodsWe conducted a prospective, single-centre study of prone positioning in awake non-ventilated patients with COVID-19 and non-COVID-19 pneumonia. The primary outcome was change in peripheral oxygenation in prone versus supine position. Secondary outcomes assessed effects on end-tidal CO2, respiratory rate, heart rate, and subjective symptoms. We also recruited healthy volunteers to undergo proning during hypoxic challenge.Results238 hospitalised patients with pneumonia were screened; 55 were eligible with 25 COVID-19 patients and 3 non-COVID-19 patients agreeing to undergo proning – the latter insufficient for further analysis. 10 healthy control volunteers underwent hypoxic challenge. Patients with COVID-19 had a median age of 64 years (interquartile range [IQR] 53–75). Proning led to an increase in SpO2 compared to supine position (difference +1.62%; p=0.003) and occurred within 10 min of proning. There were no effects on end-tidal CO2, respiratory rate, or heart rate. There was an increase in subjective discomfort (p=0.003), with no difference in breathlessness. Among healthy controls undergoing hypoxic challenge, proning did not lead to a change in SpO2 or subjective symptom scores.ConclusionIdentification of suitable patients with COVID-19 requiring oxygen supplementation from general ward environments for awake proning is challenging. Prone positioning leads to a small increase in SpO2 within 10 min of proning though is associated with increased discomfort.

Definition of the Snoring Episode Index Based on the Analyses of Snoring Parameters and the Apnea Hypopnea Index

Objective Although snoring is the most common subjective symptom in obstructive sleep apnea (OSA), an international consensus on the definition of snoring is lacking. This study aimed to define snoring by analyzing correlations between snoring parameters and the apnea hypopnea index (AHI). Methods We retrospectively analyzed the polysomnography data of patients with OSA. A snoring event was defined when airflow pressure was >200 microbar. We included four snoring parameters. Snoring percentage was defined as the cumulative time of snoring events divided by total sleep time. A snoring episode was defined as the occurrence of ≥3 consecutive snoring events, and the snoring episode index was defined as the number of snoring episodes per hour. The average and longest durations of snoring episodes were also investigated. Results The study enrolled 5,035 patients. Their mean AHI was 26.5/h and the mean snoring episode index was 19.2/h. Although the four snoring parameters showed significant correlations with the AHI, the snoring episode index showed the strongest positive correlation with the AHI (r = 0.741, P < 0.001). Conclusion The snoring episode index may be used as a definition of snoring from the perspective of a highly positive correlation with the AHI.

COMPARATIVE STUDY OF THE EFFICACY OF TOPICAL LOTEPREDNOL ETABONATE AND FLUOROMETHOLONE IN THE TREATMENT OF VERNAL KERATOCONJUNCTIVITIS : A RANDOMISED CONTROLLED STUDY

Introduction:Vernal keratoconjunctivitis(VKC) is a chronic, recurrent, inammatory disease of ocular surface showing seasonal exacerbation, affecting young children. Topical steroids are the mainstay in the treatment of ocular allergy, but their use should be judicious since they carry serious side effects . Loteprednol and uorometholone carry better safety prole. Present study was conducted with the aim of comparing the efcacy of these two widely used steroids.Objectives:To compare total subjective symptom score (TSSS), total objective sign score (TOSS) and side effects of medications before and after treatment at each visit.Materials & Methods:A prospective randomised controlled study was performed on 92 patients of VKC over four weeks. Patients were allotted to either of the two arms of treatment (i.e. LP 0.5% or FML 0.1%). Subjective and objective assessments of the signs and symptoms of VKC were done using standard scoring methodologies at 7, 14, 21 and 28 days post treatment. The main outcome measure was measured in terms of TSSS and TOSS before and after treatment at each visit. Secondary outcomes included side effects. Statistical analysis of the data collected was carried out.Results: Loteprednol showed greater reduction in symptoms initially but by the end of study there was no statistically signicant difference in effect between the two drugs.Conclusions: Final improvement in clinical features and safety prole, at the end of 4 weeks was similar in eyes treated with either of the two drugs. Hence, both the drugs can be safely used in the treatment of VKC.

Natural Language Processing as an Emerging Tool to Detect Late-Life Depression

Late-life depression (LLD) is a major public health concern. Despite the availability of effective treatments for depression, barriers to screening and diagnosis still exist. The use of current standardized depression assessments can lead to underdiagnosis or misdiagnosis due to subjective symptom reporting and the distinct cognitive, psychomotor, and somatic features of LLD. To overcome these limitations, there has been a growing interest in the development of objective measures of depression using artificial intelligence (AI) technologies such as natural language processing (NLP). NLP approaches focus on the analysis of acoustic and linguistic aspects of human language derived from text and speech and can be integrated with machine learning approaches to classify depression and its severity. In this review, we will provide rationale for the use of NLP methods to study depression using speech, summarize previous research using NLP in LLD, compare findings to younger adults with depression and older adults with other clinical conditions, and discuss future directions including the use of complementary AI strategies to fully capture the spectrum of LLD.

Pulse oximetry to predict the onset of acute mountain sickness: a literature review

Acute mountain sickness (AMS) is a common illness affecting people ascending to high altitudes. AMS may progress rapidly, and can be fatal if symptoms are neglected, acclimatisation processes fail or if the ascent continues. For many patients with AMS or AMS symptoms, medical assistance is given by mountain rescue and allied health professionals. Currently, the prediction of AMS in the high-altitude environment relies upon recognising and tracking subjective symptoms. However, owing to psychophysical factors commonly associated with high-altitude travel, such as stress and fatigue, subjective symptom recall is innately at risk of bias. There is no objective method for predicting AMS. This scoping literature review analyses the accuracy of pulse oximetry as a tool for predicting the onset of AMS.

Delayed vitreous prolapse after cataract surgery: clinical features and surgical outcomes

This study investigates the etiology and clinical features of delayed vitreous prolapse after cataract surgery and evaluates the long-term surgical and visual outcomes. Consecutive patients with vitreous prolapse into the anterior chamber occurring ≥ 3 months after cataract surgery at two hospitals between December 2006 and June 2020 were retrospectively reviewed. The primary outcome was associated ophthalmological events that triggered delayed vitreous prolapse. Secondary outcomes included long-term visual and subjective symptom changes after treatment. Among 20 eyes (20 patients), all had visual symptoms, the most common being blurry vision (12 patients; 60%). Five (25%) were detected after YAG laser capsulotomy, three (15%) had a history of intraocular lens(IOL) implantation in sulcus due to intraoperative posterior capsular tears, three (15%) had prolapsed vitreous alongside dislocated IOLs, and three (15%) were aphakic after previous cataract surgeries. After surgical treatment, the mean corrected distance visual acuity improved from 20/50 to 20/31(P = 0.02) and the mean preoperative intraocular pressure (IOP) that was 26.4 mmHg decreased to 15.6 mmHg, remaining stable until the last follow-up. All reported symptoms were relieved. YAG laser capsulotomy or a history of defective posterior capsule from iatrogenic causes may trigger delayed vitreous prolapse. The long-term outcomes were favorable, particularly after posterior vitrectomy, with improved IOP control and symptom resolution.

Importance and challenges of neuropathic pain

Background: Pain is a complex and subjective symptom frequently encountered in many clinical fields. Acute pain is usually physiological, but chronic pain is a pathological condition that seriously affects the patientsʼ normal daily activities and quality of life. In addition, chronic pain has profoundly detrimental effects on their family and social relationship as well as a national healthcare system.Current Concepts: Neuropathic pain is accompanied by diverse neurological disorders in the central and peripheral nervous systems. Neuropathic pain is also a type of chronic pain and has mechanisms unresolved completely yet. Despite recent advances in basic and clinical researches of neuropathic pain including an individualized therapy, the treatment has not been satisfactory. Another problem is the increasing prevalence of neuropathic pain because of the rapid increase of the elderly population as in the case of Korea.Discussion and Conclusion: The clinician should be aware of a clinical entity of neuropathic pain to make an accurate diagnosis and to treat the patients more effectively.

Effects of Theracurmin® consumption on liver function, fatigue, and sleep: a randomized, double-blind, placebo- controlled, parallel-comparison study

Objective: To evaluate the effects of the eight-week consumption of Theracurmin® on liver function, fatigue, and sleep.Methods: This was a randomized, double-blind, placebo-controlled, parallel-comparison study involving 68 healthy Japanese adults. Subjects were allocated into either the active (Theracurmin®) or placebo group (n = 34 each) using a random number generator. Subjects consumed two capsules per day of either the active or placebo food for eight weeks. The primary outcome was the serum alanine aminotransferase (ALT) levels at eight weeks, whereas the secondary outcomes were the biomarkers of liver function, comparison of the percentages of improvement in liver function based on the decision criteria, OSA sleep inventory MA version (OSA-MA), and visual analog scale of fatigue.Results: Each group included 33 subjects in the full analysis set. ALT levels in the per protocol set analysis, except for subjects drinking quantities of alcohol that increase the risk of lifestyle-related disease onset, showed a significant decrease in ALT compared to the placebo group (P < 0.05). The subjective symptom in the fatigue recovery factor of OSA-MA was significantly improved through the intervention (P < 0.05). The fatigue recovery effect of Theracurmin® was prominent in the subjects aged ≤ 45 years, the age group defined by the Ministry of Health, Labour and Welfare as middle-aged and older persons in the Act on Stabilization of Employment of Elderly. No adverse event was observed.Conclusions: These results suggest that the consumption of Theracurmin® or eight weeks improved liver function and fatigue recovery at awakening in healthy Japanese adults.Trial registration: UMIN-CTR: UMIN000039319.Foundation: Theravalues CorporationKeywords: highly bioavailable curcumin, liver function, alanine aminotransferase (ALT), OSA sleep inventory MA version, fatigue recovery

A Study On Fatigue Classification By Logistic Regression Method: Based On Data of Tongue And Pulse

Purpose: Fatigue is a subjective symptom which is hard to quantify, it is prevalent in sub-health and disease population, and there is still no accurate and stable method to distinguish disease fatigue from sub-health fatigue. Tongue and pulse diagnoses are the reflection of the overall state of the body, and the modern researches of tongue and pulse diagnoses have made great progress. This study aims to explore the distribution rules of tongue and pulse data in disease fatigue and sub-health fatigue population, and evaluate the contribution rate of tongue and pulse data to fatigue diagnosis through modeling. Methods: Tongue and Face Diagnosis Analysis-1 instrument and Pulse Diagnosis Analysis-1 instrument were used to collect tongue image and pulse sphygmogram of sub-health fatigue population (n=252) and disease fatigue group(n=1160), we mainly analyzed the tongue and pulse characteristics and constructed the classification model based on logistic regression method. Results: The results showed that sub-health fatigue people and disease fatigue people had different characteristics of tongue and pulse, and the logistic regression model based on tongue and pulse data showed a better classification effect. The accuracy of healthy controls & sub-health fatigue, sub-health fatigue & disease fatigue, health controls & disease fatigue model were 65.70%, 65.10%, 78.90%, and the AUC were 0.678, 0.834, and 0.879 respectively. Conclusion: This study provided a new non-invasive method for the fatigue diagnosis from the perspective of objective tongue and pulse data, the modern tongue and pulse diagnoses have a good application prospect.