Water-drinking Test in Normal Tension Glaucoma Patients with and without High Myopia

This prospective study aims to evaluate the correlation between myopic severity and normal tension glaucoma (NTG) by investigating IOP changes following water-drinking test (WDT). We reviewed 61 patients with NTG during an interval of three years, of which 31 were highly myopic (HM) and 30 were non-highly myopic (NHM). Basic characteristics such as age, gender, spherical equivalence, baseline IOP, visual field parameters, and average retinal nerve fiber layer thickness were compared between NTG patients with and without high myopia. The IOP parameters obtained following WDT were then compared between the HM and NHM NTG groups. Intragroup analysis revealed significant IOP elevation following WDT within the 45-minute duration in both groups. However, no significant differences in IOP parameters were observed between the HM and NHM NTG groups. In conclusion, although the pattern of IOP fluctuations was different, the extent of IOP fluctuations and peak IOP following WDT was similar between the HM and NHM NTG groups, suggesting that myopic severity probably has a limited role in NTG. Lastly, WDT was an effective tool for eliciting IOP peaks when 24-hour IOP monitoring is not available.

Defecation Induced by Stimulation of Sacral S2 Spinal Root in Cats

The aim of this study was to determine if stimulation of sacral spinal nerve roots can induce defecation in cats. In anesthetized cats, bipolar hook electrodes were placed on the S1-S3 dorsal and/or ventral roots. Stimulus pulses (1-50 Hz, 0.2 ms) were applied to an individual S1-S3 root to induce proximal/distal colon contractions and defecation. Balloon catheters were inserted into the proximal and distal colon to measure contraction pressure. Glass marbles were inserted into the rectum to demonstrate defecation by videotaping the elimination of marbles. Stimulation of the S2 ventral root at 7 Hz induced significantly (p<0.05) larger contractions (32±9 cmH2O) in both proximal and distal colon than stimulation of the S1 or S3 ventral root. Intermittent (5 times) stimulation (1 minute on and 1 minute off) of both dorsal and ventral S2 roots at 7 Hz produced reproducible colon contractions without fatigue, while continuous stimulation of 5-minute duration caused significant fatigue in colon contractions. Stimulation (7 Hz) of both dorsal and ventral S2 roots together successfully induced defecation that eliminated 1-2 marbles from the rectum. This study indicates the possibility to develop a novel neuromodulation device to restore defecation function after spinal cord injury using a minimally invasive surgical approach to insert a lead electrode via the sacral foramen to stimulate a sacral spinal root.

RAPID TESTING: ANALYSIS OF GNSS RAPID STATIC OBSERVATIONS SUITABILITY FOR ENGINEERING SURVEYS IN URBAN ENVIRONMENTS IN THE TIME OF COVID-19

This study aims to determine which rapid static observation durations would have acceptable accuracy for engineering surveys in urban environments (i.e. Metro Manila) in the time of COVID-19. Due to health concerns caused by the COVID-19 pandemic, Metro Manila has experienced various restrictions in mobility and time spent in public spaces in recent months. This has affected not only the lives and ways of work of the so-called front liners like nurses, doctors, and primary health care workers, but also the public at large which includes Land Surveyors. It is for this reason that this study was conducted, since a balance must be struck between the aim to get accurate engineering survey results and the health and safety of those who are conducting the measurements. Hence, the shortest possible time to conduct rapid static GNSS observation durations with acceptable results must be determined while ensuring that the conduct of the field survey would still be in compliance to the minimum health protocols (i.e. no mass gathering, maintenance of physical distancing, short time of interaction, etc.) set by the national government.For this study, rapid static observations were made at varying time intervals (i.e. 2 minutes, 5 minutes, 10 minutes, 15 minutes, 30 minuntes, 1 hour, and 2 hours) at locations (i.e. open, with minimal obstructions, with significant obstructions) that would simulate archetypal situations when conducting engineering surveys in urban environments. Results were computed using fully constrained least square adjustment and results show that if all GNSS satellites are used in the computations, all time intervals would yield acceptable RMSE values, both for the horizontal (5 mm to 2 cm) and vertical (1 cm to 4 cm), for engineering surveys. However, if not all GNSS signals are available, it is best to use at least two GNSS satellite constellations (i.e. GPS-BeiDou, GPS-Glonass, Glonass-BeiDou) so that rapid static observations with acceptable accuracy can be made for as short as 5 minutes. For the “classical” accuracy standards, all rapid static observation durations yielded Order B relative precisions for the horizontal while most, except for the 30-minute duration, which yielded Third Order level results for the vertical.

Abstract 13110: Novel Application of Thoracic Impedance to Characterize Ventilations During Cardiopulmonary Resuscitation in the Pragmatic Airway Resuscitation Trial

Introduction: Controlled ventilation is important in OHCA resuscitation, but there are few validated methods for accurate detection of ventilations. We sought to utilize changes in thoracic impedance (TI) to characterize resuscitation ventilations in the Pragmatic Airway Resuscitation Trial (PART). Methods: We analyzed CPR process files collected from adult OHCA enrolled in PART. We limited the analysis to cases with simultaneous capnography ventilation recordings at the Dallas-Ft Worth site. We identified ventilation waveforms in the thoracic impedance signal by applying automated signal processing with adaptive filtering techniques to remove overlying artifacts from chest compressions. We correlated detected ventilations with the end-tidal capnography signal. We determined the amplitudes (Ai, Ae) and durations (Di, De) of both insufflation and exhalation phases of the ventilation impedance signal (Figure 1). We compared differences between laryngeal tube (LT) and endotracheal intubation (ETI) airway management during mechanical or manual chest compressions using Mann-Whitney U-test. Results: We included 303 CPR process cases in the analysis; 209 manual (77 ETI, 132 LT), 94 mechanical (41 ETI, 53 LT). Ventilation Ai and Ae were higher for ETI than LT in both manual (ETI: Ai 0.71Ω, Ae 0.70Ω vs LT: Ai 0.46Ω Ae 0.45Ω, p<0.01 respectively) and mechanical chest compressions (ETI: Ai 1.22Ω, Ae 1.14Ω VS LT: Ai 0.74Ω, Ae 0.68Ω, p<0.01 respectively). Ventilations per minute, duration of TI amplitude insufflation and exhalation did not differ among groups. Conclusion: Compared with LT, ETI thoracic impedance ventilation insufflation and exhalation amplitude were higher while duration did not differ. TI may provide a novel approach to characterizing ventilation during OHCA.

Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center

Understanding the factors affecting survival and modifying the preventable factors may improve patient outcomes following cardiopulmonary resuscitation (CPR). The aim of this study was to assess the prevalence and outcomes of cardiac arrest and CPR events in a tertiary pediatric intensive care unit (PICU). Outcomes of interest were the return of spontaneous circulation (ROSC) lasting more than 20 minutes, survival for 24 hours post-CPR, and survival to hospital discharge. We analyzed data from the PICU CPR registry from January 1, 2011 to January 1, 2018. All patients who underwent at least 2 minutes of CPR in the PICU were included. CPR was administered in 65 PICU instances, with a prevalence of 1.85%. The mean patient age was 32.7 months. ROSC occurred in 38 (58.5%) patients, 30 (46.2%) achieved 24-hour survival, and 21 (32.3%) survived to hospital discharge. Younger age (p < 0.018), respiratory cause (p < 0.001), bradycardia (p < 0.018), and short duration of CPR (p < 0.001) were associated with better outcomes, while sodium bicarbonate, norepinephrine, and vasopressin were associated with worse outcome (p < 0.009). The off-hour CPR had no impact on the outcome. The patients' cumulative predicted survival declined by an average of 8.7% for an additional 1 minute duration of CPR (p = 0.001). The study concludes that the duration of CPR, therefore, remains one of the crucial factors determining CPR outcomes and needs to be considered in parallel with the guideline emphasis on CPR quality. The lower survival rate post-ROSC needs careful consideration during parental counseling. Better anticipation and prevention of CPR remain ongoing challenges.

Registered report protocol: Developing an artifact index for capacitive electrocardiography signals acquired with an armchair

Continuous monitoring of an electrocardiogram (ECG) in private diagnostic spaces such as vehicles or apartments allows early detection of cardiovascular diseases. We will use an armchair with integrated capacitive electrodes to record the capacitive electrocardiogram (cECG) during everyday activities. However, movements and other artifacts affect the signal quality. Therefore, an artifact index is needed to detect artifacts and classify the cECG. The unavailability of cECG data and reliable ground truth information requires new recordings to develop an artifact index. This study is designed to test the hypothesis: an artifact index can be devised, which intends to estimate the signal quality of segments and classify signals. In a single-arm study with 44 subjects, we will record two activities of 11-minute duration: reading and watching television. During recording, we will capture cECG, ECG, and oxygen saturation (SpO2) with time synchronization as well as keypoint-based movement indicators obtained from a video camera. SpO2 provides additional information on the subject’s health status. The keypoint-based movements indicate artifacts in the cECG. We will combine all ground truth data to evaluate the index. In the future, we aim at using the artifact index to exclude cECG segments with artifacts from further analysis. This will improve cECG technology for the measurement of cardiovascular parameters.

Comparative Evaluation of the Isoflurane-sparing Effects of Butorphanol and Pentazocine in Buffaloes Undergoing Diaphragmatic Herniorrhaphy

Background: Isoflurane is commonly used as an inhalant anaesthesia in animals. Foreign body syndrome ultimately results into diaphragmatic hernia which is common in buffaloes. Diaphragmatic herniorrhaphy is generally performed under isoflurane anaesthesia. But there are adverse effects of isoflurane like respiratory depression, hypotension, reduced cardiac output and its metabolites cause atmospheric pollution. So, the present study was planned with the hypothesis that inclusion of opioid analgesic in the balanced anaesthesia might have isoflurane sparing effect. Methods: The present study was conducted in 15 female buffaloes which were suffering from diaphragmatic hernia which was diagnosed by radiography and later confirmed on rumenotomy. Animals were randomly divided in three groups - group I (Atropine (0.04 mg/kg) - xylazine (0.05 mg/kg) - propofol (till effect) - isoflurane; AXPI), group II (Atropine - xylazine - butorphanol (0.03 mg/kg) - propofol - isoflurane; AXBPI) and group III (Atropine - xylazine - pentazocine (0.75 mg/kg) - propofol - isoflurane; AXPPI) having five animals in each. Group I was taken as control as no analgesic was used in anaesthetic combination for animals of this group. The total isoflurane vapour delivered (mL) for the total duration of anaesthesia was calculated and the values so obtained were equated to 400 kg body weight and 40 minute duration for each animal for statistical comparison.Result: The Mean volume of isoflurane (ml) utilized for group I (65.58±8.8) was significantly higher than in Group II (38.54±5.7) and Group III (41.01±4.8). There were no significant changes in the haematological and biochemical profile of these buffaloes among three groups.

Developing a blended learning postgraduate teaching programme in anaesthesia: pandemic and beyond

One of the many challenges facing doctors in training during the COVID-19 pandemic was a significant reduction in postgraduate medical education in the form of formal teaching. Consequently, we sought to provide a blended and asynchronous teaching programme that would be delivered to anaesthetic trainees preparing for their postgraduate examinations. Six sessions of 90-minute duration were delivered during the months July, August and September 2020. Each of the six sessions was delivered live using a variety of online educational tools in addition to traditional didactic-style teaching by the presenters. Participants submitted requests for topics to be covered by the presenters in the final of the six sessions. The sessions were recorded and later uploaded onto an online educational learning platform for viewing at the participants’ discretion. The live nature of the sessions ensured participant interaction and a sense of community that trainees had come to expect from previous face-to-face teaching sessions prior to the COVID-19 pandemic.Evaluation was via qualitative and quantitative means using preset questions using the Likert scale and a free-text comments box. The results demonstrated positive feedback across all sessions with particular relevance to the interactive element of the course, the content and delivery.This article describes the requirement for a method of continuing postgraduate medical education in an era where traditional face-to-face teaching is not possible and how the introduction of various innovative educational applications and resources can be used to further postgraduate medical education in the future.

Are HoLEP Surgical Videos on YouTube Biased and Misleading or Are They Leading the Industry?

Objective: In this study, we aim to evaluate the content and quality of the most relevant YouTube videos related to Holmium laser enucleation of the prostate (HoLEP) surgery. Materials and Methods: The keywords ‘HOLEP’, ‘laser enucleation’ and ‘prostate enucleation’ were used to perform a search on YouTube. Non-English language videos, videos with less than 4-minute duration, and repetitive videos were excluded. The reactions of the viewers to the videos were evaluated by recording the ‘total views’, ‘views/month’ and ‘likes and dislikes’ parameters. The data were divided into two groups based on the source of upload: Group 1 consisted of healthcare providers and Groups 2 comprised commercial companies and for-profit organizations. Results: A total of 117 videos were included in the study. A significant portion of the videos (77.7%) had been uploaded by healthcare providers. There was no statistically significant difference between the uploading groups in terms of the DISCERN and GQS scores (p=0.484 and p=0.108, respectively). However, the PEMAT understandability and actionability scores were statistically significantly higher in Group 2 (p=0.004 and p=0.022, respectively). In addition, when the misinformation scale was evaluated, there were significantly more videos with high-degree misinformation in Group 2 (5.5% vs 33.3, p=0.001). Conclusion: On video sharing platforms, such as YouTube, the number of reliable videos with accurate and appropriate guidance about diseases and treatments should be increased, and these videos should be allowed to be posted after they have been approved by relevant institutions, including healthcare associations and universities.

Analysis Of Extremely Low Frequency (ELF) Magnetic Field Exposure Impact On The Mass Of Great Red Chili Plant (Capsicum annum.L)

The Extremely Low Frequency (ELF) magnetic field is a component of the electromagnetic wave spectrum with a frequency of <300 Hz. This research is an experimental study with the aim of examining the effect of exposure to Extremely Low Frequency (ELF) magnetic fields on the mass of chili plants (Capsicum annum L). Data collection techniques used are direct measurements. The results showed that chilli seeds exposed to a 300µT ELF magnetic field for 30 minutes gave a fresher and drier mass than the other samples. The use of a 30-minute duration ELF 300µT magnetic field on chili seeds gave better results for fresh and dry mass of chili plants.