Cm Of Water Research Articles

Novel Geophone Array Measures Exact Location of Fluid Movement Behind Casing

This article, written by JPT Technology Editor Judy Feder, contains highlights of paper SPE 197560, “Enhanced Well Remedial Decisions From Exact Location of Fluid Movement Behind Casing Identification,” by Marcel Croon, SPE, Perry Huber, SPE, and Jacob Wright, SPE, Weatherford, SPE, prepared for the 2019 Abu Dhabi International Petroleum Exhibition and Conference, Abu Dhabi, 11-14 November. The paper has not been peer reviewed. Historically, acoustic wellbore monitoring is among the primary methods of detecting fluid movement behind the casing. However, analysis of the complex acoustic environment in the wellbore can be challenging. A standard hydrophone noise tool is unable to measure flow directions (vertical and horizontal) and cannot detect low flow, low-pressure sporadic events, or multiple sources. The complete paper discusses a geophone array, including four, three-component geophones deployed by wireline, that provides a solution for this problem by creating a 3D map of the acoustic environment. Introduction Well-integrity issues such as a poor cement bond can lead to undesirable fluid movements behind the casing, which could have negative effects with regard to health, safety, and the environment. A detailed understanding of annular fluid movement is critical in identifying potential source locations for wells with surface-casing vent-flow (SCVF) issues. Applicable scenarios include the following: Planned well-intervention activities for wells with multiple-source vent/flow situations Confirming the presence of flow (gas/oil/water) behind the casing Identifying areas with suspected crossflow between zones Integrity confirmation for gas storage caverns or zones Identifying unwanted flow for well-abandonment activities Well abandonment is bound by stringent regulations in some countries where the testing and repair of SCVF and gas-migration (GM) issues before final abandonment are required. An ex-ample is western Canada, where surface casing vents must be tested through a bubble test at minimum. This involves connecting a small container with 2.54 cm of water using fittings to the surface casing vent and monitoring for gas bubbles for 10 minutes. Often the flow rates are very low (less than 35 cu ft/d) with minimal pressure buildup. If bubbles are detected during the monitoring period, the well is deemed to have a positive vent flow. Consequently, the source of the vent flow must be identified by a survey as approved by the energy regulator, which could be conducted by means of acoustic logs, temperature logs, or gas- isotope analysis. Additionally, GM measurements must be conducted before final abandonment in specific areas within western Canada but are recommended for all wells. The complete paper details this process.

Clinical efficacy of assisted intranasal ventilation after polysegmental pneumonia caused by the SARS-CoV-2 virus

BACKGROUND: The development of ways of rehabilitation of patients after polysegmental viral pneumonia that enable the collapsed alveoli being transferred to a ventilated and actively perfused state is certainly relevant. In this regard, non-invasive respiratory support can be considered as a reasonable additional method of treatment for these patients.
 AIMS: Assess the feasibility of non-invasive assisted ventilation of the lungs after suffering polysegmental pneumonia caused by the SARS-CoV-2 virus.
 MATERIALS AND METHODS: The study included 40 patients after bilateral polysegmental pneumonia caused by the SARS-CoV-2 virus. The first group of patients (21 people), in addition to the standard treatment, underwent non-invasive assisted intranasal ventilation in the BiPAP mode with a final expiratory pressure of 48 cm of water. Art. 60 minutes three times a day for 1012 days. The second group (19 people) did not receive ventilation benefits. Before the start of therapy and at the end of the course, spirometry, computed tomography of the chest organs were performed with the calculation of the volume of the affected lung tissue according to the Thoracic VCAR program.
 RESULTS: Upon completion of the course of treatment and rehabilitation measures in patients of the first group, the following was observed: a decrease in atelectatic changes and pneumofibrosis, an increase in the volume of ventilated areas of the lungs, the volume of the affected lung tissue according to computed tomography significantly decreased (on average, up to 269.8%; p 0.05). There was a significant improvement in the indicators of spirometry in the first group. The increase in the volume of forced exhalation in one second was 2532%, while vital capacity of the lungs was 2731%. When evaluating long-term pulse oximetry, the average saturation at night in these patients increased from 91.22.1 to 96.41.8 (p 0.05). Clinical improvement in patients of the first group led to a decrease in bed-days to an average of 15.4, while in patients of the second group it averaged 23.4 days.
 CONCLUSION: The use of assisted intranasal ventilation restores the ventilation-perfusion ratio, which is confirmed by a significant improvement in clinical and instrumental parameters.

Minimum water requirements of Japanese lawngrass for survival during prolonged drought

AbstractWater restrictions on irrigation are rarely science based and may cause irreversible damage to turfgrass or inadvertently waste water. Our objectives were to evaluate effects of minimum water applications to ‘Meyer’ Japanese lawngrass (Zoysia japonica Steud.) on (a) canopy performance during prolonged drought and (b) survival and recovery thereafter. Meyer was watered weekly with 0–30% reference evapotranspiration (ETo) replacement for ≥56 d in two consecutive summers under a rainout shelter near Manhattan, KS. Soil moisture and canopy performance (normalized difference vegetation index [NDVI], percentage green cover [PGC], and turfgrass quality) were measured weekly. Results indicated 20–30% ETo slowed the decline in canopy performance compared with no water inputs. Irrigation at 30% ETo maintained Meyer at >75% PGC throughout the first year, but even Meyer at 0 and 5% ETo recovered after full irrigation resumed. In the second year, 30% ETo maintained Meyer at >25% PGC throughout the drought and recovered thereafter, but plots with 0 and 5% ETo only recovered to 30–42% PGC after 50 d of full irrigation. Depending on the weather, reducing irrigation from the recommended 60% ETo for warm‐season turfgrasses to 30% ETo saved 9–11 cm of water; further reductions to 20% ETo saved another 3–4 cm during the droughts of ≥56 d with insignificant additional PGC reductions (<18%). Water restrictions during severe droughts, such as limiting weekly irrigation of Meyer Japanese lawngrass to 20–30% ETo, could reduce turfgrass damage and conserve water.

Prevalence of stress urinary incontinence and intrinsic sphincter deficiency in patients with stage IV pelvic organ prolapse.

To determine the prevalence of stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) in women with stage IV pelvic organ prolapse. Retrospective analysis of women with stage IV prolapse who underwent multichannel urodynamic testing. Abdominal leak point pressures (ALPP) and maximum urethral closure pressures (MUCP) were recorded. ISD was defined as ALPP ≤60 cm of water and/or MUCP ≤20 cm of water. Percentages were used to present the proportion of subjects diagnosed with SUI and ISD. A total of 145 patients met inclusion criteria. Mean age was 69 years; most patients were Caucasian (56%). Eighty-two (56%) patients were found to have SUI on urodynamic testing. Thirty-six (44%) of these were asymptomatic and identified as having occult SUI. Sixteen (19.5%) patients were diagnosed with ISD using ALPP and/or MUCP. Six (37%) of the ISD patients had at least one MUCP value ≤20 cm of water and 12 (75%) had observed leakage with at least one ALPP value ≤60 cm of water. The number of patients with leakage at ALPP ≤60 cm of water increased with increasing bladder volumes. Five ISD patients (31%) had ALPP ≤60 cm of water at 200 mL, six (37.5%) had ALPP ≤60 cm of water at 300 mL and seven (43.8%) had ALPP ≤60 cm of water at 400 mL. Greater than 50% of patients with stage IV pelvic organ prolapse had SUI on urodynamic testing, and 20% were found to have ISD. Of the patients diagnosed with SUI, 40% were asymptomatic. These findings may assist in counseling and preoperative planning for women with stage IV prolapse.

Dural venous sinus thrombosis after lumbar puncture in a patient with idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is one of the most common causes of papilloedema seen by ophthalmologists and neurologists. Patients with IIH routinely undergo lumbar puncture (LP) for diagnosis. Dural venous sinus thrombosis (DVST) is a rare complication of cerebrospinal fluid pressure (CSF)-lowering procedures such as lumbar puncture and epidural and may be an intracranial complication of IIH. A 29-year-old obese woman was diagnosed with severe idiopathic intracranial hypertension (IIH) after she presented with new-onset headache, pulsatile tinnitus and blurred vision. Magnetic resonance imaging (MRI) and venography (MRV) were normal apart from signs of intracranial hypertension. Lumbar puncture (LP) revealed an opening pressure of 40 cm of water. Due to the severity of the papilloedema and vision loss, she was referred for a ventriculoperitoneal shunt and found to have venous sinus thrombosis involving the superior sagittal sinus on the pre-operative computed tomography (CT) head 5 days after the LP. CT venography (CTV) one day later and MRV 3 days later showed significant worsening as the thrombosis extended into the deep venous system. She was started on therapeutic heparin and her symptoms and vision improved and she did not develop any neurological complications. DVST should be considered in IIH patients who have worsening papilloedema or symptoms of intracranial hypertension. Repeat venous imaging can prevent devastating consequences such as venous infarcts of haemorrhage in these patients.

Incidence and predictive factors for developing vesicoureteric reflux in individuals with suprasarcral spinal cord injury: a historical cohort study.

A historical cohort study OBJECTIVES: The aim of the study was to examine the incidence of and predictive factors for VUR in individuals with suprasacral spinal cord injury (SCI). Srinagarind Hospital, Khon Kaen University, Thailand METHODS: Medical records were reviewed for all individuals with SCI and neurogenic bladder admitted for urological check-up between 1996 and 2016. The primary outcome was the cumulative incidence of VUR. The statistical tests used included the Nelson-Aalen Estimator and Cox Proportional Hazard Ratio. Harrell's C concordance statistic was used to evaluate the discrimination ability of the predictive model. 293 participants with SCI (102 tetraplegic and 191 paraplegic) were included. Most participants were male (67%), and the median age was 52 years. The overall incidence of VUR was 7.5 cases per 100 person-years (95% CI, 6.15-9.4). In the multivariate analysis, the predictive factors for VUR were: (1) maximum detrusor pressure at first visit ≥ 75 cm of water (HRadj: 2.4 [95% CI: 1.4-4.1]); (2) indwelling urethral catheterization (IUC) (HRadj: 11.1 [95% CI: 3.9-31.7]) and clean intermittent catheterization (CIC) (HRadj: 6.5 [95% CI: 2.2-18.7]); (3) age ≥ 60 years at onset of SCI (HRadj: 1.7 [95% CI: 1.1-2.8]); and, (4) absence of antimuscarinic medication (HRadj: 3.8 [95% CI: 2.4-6.1]). The predictive model had an overall C-index of 0.78. The incidence of VUR was high up to 12 years after SCI. High maximum detrusor pressure, IUC, age ≥ 60 years and absence of antimuscarinic medication were predictive factors for VUR.

Clinical and demographic differences between idiopathic intracranial hypertension patients with mild and severe papilledema.

PURPOSE:The purpose of this study was to evaluate whether papilledema severity is associated with specific demographic or clinical factors in patients with idiopathic intracranial hypertension (IIH).MATERIALS AND METHODS:A retrospective cohort study of consecutive IIH patients seen at one tertiary care institution between 1989 and March 31, 2017 was performed. IIH patients were classified as mild (Frisén Grade 1 or 2) or severe (Frisén Grade 4 or 5) based on grading of fundus photographs obtained at first presentation. Demographic and clinical variables including age, body mass index (BMI), gender, visual acuity, Humphrey visual field mean deviation, and cerebrospinal fluid (CSF) opening pressure were extracted from patient medical records for statistical analyses.RESULTS:A total of 239 patients were included in the study: 152 with mild papilledema and 87 with severe papilledema. There was no difference in age, race, BMI, or male gender between the mild and severe papilledema groups. CSF opening pressure was significantly higher in the severe papilledema group (41.89 cm of water vs. 33.69, 95% confidence interval [CI]: −10.79–−5.62, P < 0.0001). There was a significant difference in the Humphrey mean deviation (−6.38 dB compared to − 3.25 dB, 95% CI: −4.82–−1.44 dB, P < 0.001) and average logarithm of the minimum angle of resolution visual acuity at final follow-up (0.21 vs. 0.045, 95% CI: −0.299–−0.040 , P = 0.01).CONCLUSION:Age, race, sex, and BMI were similar in IIH patients with mild versus severe papilledema, emphasizing the importance of a dilated fundus examination to reliably stratify patients. Patients with severe papilledema are at higher risk of visual acuity and visual field loss at final follow-up.

SMOKE EVERYWHERE, FROM LUNGS TO SPINE!

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: E-Cigarette/Vaping associated Lung Injury (EVALI) has presented with no pattern of disease progression.Availability of e-cigarettes since 2007 in the US have seen a rise in demand in younger age group, reported use by 20.8% high schoolers in 2018. (1) CASE PRESENTATION: 19-year-old male presented with nausea, vomiting, diarrhea, dyspnea, chest pain.Physical examination-saturation 77% on room air, decreased bilateral breath sounds, crackles and sinus tachycardia. Initial chest x-ray(CXR) showed bilateral pneumothorax, pneumomediastinum, extensive subcutaneous emphysema to neck, upper back. CT chest was consistent with CXR and diffuse bilateral ground glass opacities on lower lobes. No evidence of recent travel, infections, drug use, smoking history was reported. Boerhaave syndrome from vomiting was ruled out with CT oral contrast without esophageal leak. He eventually admitted to vaping tetrahydrocannabinoid (THC) products three times daily for last 3-4 weeks. Started on high dose methylprednisone 125 mg every 6hours. He worsened to severe acute respiratory distress syndrome requiring bilateral 32Fr chest tubes, with PaO2/FiO2 69 while on ventilatory support with PEEP of 10cm of water, FiO2 100%.CT head and spine showed air in the subcutaneous tissues of skull base, neck, orbits and epidural space of spinal canal confirming to our knowledge the first ever case of Pneumorrhachis secondary to EVALI. DISCUSSION: EVALI is worldwide phenomenon with more concentration in Illinois and Wisconsin.EVALI is diagnosis of exclusion in absence of infectious/autoimmune causes and direct correlation with vaping THC with/without nicotine.Different combinations used are nicotine, THC, dank vapes, dabbing, cannabinoid oil.[1,2]Unregulated THC products contain Vitamin E acetate which is the culprit agent. An accurate pathophysiology is still to be determined but possibility of lipoid pneumonia,subacute bronchial toxicity,respiratory bronchiolitis–interstitial lung disease, bronchiolitis obliterans organizing pneumonia, diffuse alveolar hemorrhage, acute eosinophilic and acute hypersensitivity pneumonia have been discussed.[3]Although controversial due to nonspecific,evidence of macrophages with lipid deposition in bronchoalveolar lavage(BAL) is seen.Urine has higher sensitivity compared to BAL for THC analysis.CT ranges from infiltrates, consolidations, air bronchograms, ground glass opacities more in lower lobes. Pneumorrhachis, an extremely rare phenomenon of air in the spinal canal, is likely result of high-pressured alveolar rupture.This however, is likely the first ever reported case of pneumorrhachis secondary to EVALI. Like EVALI,no guidelines exist for pneumorrhachis due to rare incidence but conservative course has been reported previously. CONCLUSIONS: These findings in a healthy young male show, vulnerability and unpredictable disease course of EVALI, with no recommended guidelines for management yet. Reference #1: Dinardo P, Rome ES. Vaping: The new wave of nicotine addiction. Cleve Clin J Med. 2019;86(12):789-798. doi:10.3949/ccjm.86a.19118 Reference #2: Kalininskiy A, Bach CT, Nacca NE, et al. E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. Lancet Respir Med. 2019;7(12):1017-1026. doi:10.1016/S2213-2600(19)30415-1 Reference #3: Ghinai I, Pray IW, Navon L, et al. E-cigarette Product Use, or Vaping, Among Persons with Associated Lung Injury - Illinois and Wisconsin, April-September 2019. MMWR Morb Mortal Wkly Rep. 2019;68(39):865-869. Published 2019 Oct 4. doi:10.15585/mmwr.mm6839e2 DISCLOSURES: No relevant relationships by Habiba Hussain, source=Web Response No relevant relationships by Matthew Sehring, source=Web Response No relevant relationships by Deepak Taneja, source=Web Response

Water Balance for a Tropical Lake in the Volcanic Highlands: Lake Tana, Ethiopia

Lakes hold most of the freshwater resources in the world. Safeguarding these in a changing environment is a major challenge. The 3000 km2 Lake Tana in the headwaters of the Blue Nile in Ethiopia is one of these lakes. It is situated in a zone destined for rapid development including hydropower and irrigation. Future lake management requires detailed knowledge of the water balance of Lake Tana. Since previous water balances varied greatly this paper takes a fresh look by calculating the inflow and losses of the lake. To improve the accuracy of the amount of precipitation falling on the lake, two new rainfall stations were installed in 2013. The Climate Hazards Group Infrared Precipitation Version two (CHIRPS-v2) dataset was used to extend the data. After reviewing all the previous studies and together with our measurements, it was found that the period of 1990–1995 likely had the most accurate gauged discharge data. During some months in this period, the lake water balance was negative. Since the river inflow to the lake cannot be negative, water was either lost from the lake via the subsurface through faults, or the outflow measurements were systematically underestimated. Based on the evaporation rate of 1650 mm, we found that unaccounted loss was 0.6 km3 a−1, equivalent to 20 cm of water over the lake area each year. This implies the need for reliable rainfall data and improved river discharge measurements over a greater portion of the basin both entering and exiting the lake. Also, integrated hydrological and geologic investigations are needed for a better understanding of the unaccounted water losses and quantifying the amount of subsurface flow leaving the lake.

Urodynamic Pressure-Flow Study (Pfs) for the Prediction of Surgical Outcome in Bph With Urinary Retention

Introduction: Urinary retention can be either chronic or acute in onset. Urinary retention can result from impaired detrusor contractility or obstruction of bladder outlet. Twenty five to 30% of men with decreased flow are not obstructed 1. Either uroflowmetry or post-void residue (PVR) can not differentiate obstruction from impaired detrusor contractility. In this study, an effort has been paid to know the usefulness of pressure-flow study in urinary retention due to suspected benign prostatic hyperplasia(BPH) cases for predicting the outcome of surgery. Methods: This is a before after clinical study, conducted in Bangabandhu Sheikh Mujib Medical University, Dhaka. Total 32 patients were selected for the study. Patients age ranges from 49-78 years.Patients with chronic and refractory urinary retention due to BPH were enrolled for the study. They were divided into group A (pre-operative) and group B (Post-operative). TURP was done in all 32 patients by single surgeon. Study variables were detrusor pressure at maximum flow (Pdet@Qmax), bladder outlet obstruction index(BOOI), bladder contractility index( BCI) and post void residue (PVR). Result: Total number of patients was 32. Age ranges from 49-78 years. Twenty one (65.6%) had BPH with chronic retention and 11 (34.4%) had BPH with refractory retention.Pdet@Qmax between Group A and Group B was highly significant (p=0.001). But difference is not significant in Pdet@Qmax d” 40 subgroup of patients (p=0.673). Bladder outlet obstruction index between Group A and Group B is highly significantly (p=0.001), but, that does not observed in BOOI &lt;20 subgroup(p=0.600). Bladder contractility index in both Normal (BCI 100-150) and strong ( BCI &gt;150 ) subgroups are significant ( p=0.001 and 0.001 respectively ). But it is not significant in BCI&lt;100 sub group (p=0.021). Post void residue between Group A and Group B is highly significant (p=0.001). But in PVR &gt;300m subgroup, difference is insignificant (p=0.120). Conclusion: In this study, overall favorable outcome observed in all patients after TURP but Pdet@Qmax &lt;40 cm of water, BOOI &lt;20, BCI &lt;100 and PVR &gt;300 ml groups of patients are at high risk of unfavorable clinical outcome after TURP. With the help of presence flow study (PFS) prior knowledge of these factors, it is possible to predict postoperative outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.74-77

Association of Detrusor Muscular Activity With the Outcome of Transurethral Resection of Prostate in Patients With Severity of Bladder Outflow Obstruction

Objective: To evaluate the association of detrusor muscular activity with outcome of TURP in patients with severity of bladder outflow obstruction. Methods: This is a hospital based cross sectional study conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka.Elderly male patients having lower urinary tract symptoms (IPSS=20-35) with no retention (non-catheterized patient), who attended in Dhaka Medical College Hospital, were included in the study. A total of 73 patients meeting the enrollment criteria were included in the study. They were evaluated by history, physical examination including DRE and necessary investigations to identify the potential candidates for TURP. Then the potential participants were counseled for Urodynamic study. All patients underwent TURP by expert surgeon. Three months after TURP, repeat Urodynamic study was done and the results were compared to see the outcome. Afterward the data were plotted for the clarification of detrusor contractility at three levels: normal detrusor contractility (voiding pressure 40-60cm of water), detrusor over activity (voiding pressure &gt;60cm of water) and detrusor under activity (voiding pressure &lt;40 cm of water). According to the provisional ICS nomogram for the analysis of voiding, patients were divided into three classes. In BOO Index(PdetQmax-2Qmax),obstructed(BOOI &gt; 40); equivocal(BOOI=20-40);Unobstructed(BOOId” 20) are taken into consideration. The test statistic used to analyze the data was descriptive statistics and ANOVA test. The level of significance was set at 0.05 and P&lt;O.05 was considered significant. Results: Out of 73 patients 8 didn’t attend follow up session and hence excluded keeping 65 for final analysis. The mean age was 66.3 ± 9.7 years (50- 87 years) .Detrusor over activity was present in 13(20%), normal detrusor contractility was observed in 46(70.8%) and weak contractility in 6(9.2%). Peak urinary flow rate was almost similar among patients of different groups. However, voided volume and residual volume were lowest in overactive group and highest in underactive group, while normal group was in between two (p = 0.007 and p = 0.046 respectively). Maximum urinary flow rate and voided urine between patients of moderate and severe bladder outlet obstruction were almost comparable (p =0.120 and p = 0.270 respectively). However, residual urine volume was much higher in the patients of moderate BOO than that in severe BOO (p = 0.001).The patients of OAB experienced a significant improvement in percentage of reduction of residual urine volume compared to normal and underactive bladder (p = 0.002), However, there were no significant difference among the patients with overactive, normal and underactive bladder with respect to peak urinary flow rate and voided urine volume (p = 0.499 and p = 0.847 respectively). Conclusion: TURP is an effective surgical procedure for treatment of BPH, especially for patients with severe degree of BOO with normal or overactive detrusor contraction. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.56-61

Evaluating the effect of biochar on salt leaching and nutrient retention of Yellow River Delta soil

AbstractBiochar has the potential to decrease salinity and nutrient loss of saline soil. We investigated the effects of biochar amendment (0–10 g kg−1) on salinity of saline soil (2.8‰ salt) in NaCl leaching and nutrient retention by conducting column leaching experiments. The biochar was produced in situ from Salix fragilis L. via a fire‐water coupled process. The soil columns irrigated with 15 cm of water showed that biochar amendment (4 g kg−1) decreased the concentration Na+ by 25.55% in the first irrigation and to 60.30% for the second irrigation in sandy loam layer over the corresponding control (CK). Meanwhile, the sodium adsorption ratio (SAR) of soil after the first and second irrigation was 1.62 and 0.54, respectively, which were 15.2% and 49.5% lower than CK. The marked increase in saturated hydraulic conductivity (Ks) from 0.15 × 10–5 cm s−1 for CK to 0.39 × 10–5 cm s−1, following 4 g kg−1 of biochar addition, was conducive to salt leaching. Besides, biochar use (4 g kg−1) increased NH4+‐N and Olsen‐P by 63.63% and 62.50% over the CK, but accelerated NO3–‐N leaching. Since 15 cm hydrostatic pressure would result in salt accumulation of root zone, we would recommend using 4 g kg−1 of biochar, 30 cm of water to ease the problem of salt leaching from the surface horizon to the subsoil. This study would provide a guidance to remediate the saline soil in the Yellow River Delta by judicious application of biochar and irrigation.

Effect of Soil Moisture Stress at Panicle Initiation and Flowering Stages on Early Morning Leaf Temperature in Rice

Field investigation on the influence of soil moisture stress (MS) on leaftemperature of rice at 0600 hours was made in Tamil Nadu AgriculturalUniversity, Coimbatore during Kuruvai (July-November) 2019 and Navarai(December-March) 2019-20 seasons. The treatments are T1: MS for 10days from PI, T2: MS for 15 days from PI, T3: MS for 20 days from PI, T4: MSfor 25 days from PI, T5: MS for 10 days from flowering, T6: MS for 15 daysfrom flowering, T7: MS for 20 days from flowering, T8: MS for 25 days fromflowering and T9: Control (Maintaining 2cm of water throughout the cropperiod). The experiment was laid-out in Randomized Completely Block Designwith three replications. Leaf temperature was measured using an infraredthermometer at 0600 hours. Moisture stress had a significant influence onthe leaf temperature of rice in the early morning hours. In Kuruvai season,an increase in leaf temperature was to the tune of 0.13oC to 2.20oC duringPanicle Initiation (PI) stage (T1, T2, T3 and T4) and 0.16oC to 2.27oC duringflowering stage (T5, T6, T7 and T8) over control due to MS. Similarly, increasedleaf temperature to the tune of (0.13oC to 2.97oC and 0.07oC to 2.96oCduring PI stage and flowering stage, respectively) was observed due to MStreatments than MS relieved treatments and control during Navarai season.The results confirmed that the direct influence on leaf temperature of rice wasdue to MS irrespective of the stages and seasons. The correlation betweengrain yield and leaf temperature due to the MS was found to be negative.

"Six-dial Strategy"-Mechanical Ventilation during Cardiopulmonary Resuscitation.

ABSTRACTAs per current guidelines, whenever an advanced airway is in place during cardiopulmonary resuscitation, positive pressure ventilation should be provided without pausing for chest compression. Positive pressure ventilation can be provided through bag-valve resuscitator (BV) or mechanical ventilator (MV), which was found to be equally efficacious. In a busy emergency department, with less trained personnel use of MV is advantageous over BV in terms of reducing human errors and relieving the airway manager to focus on other resuscitation tasks. Currently, there are no guidelines specific to MV settings in cardiac arrest. We present a concept of “six-dial ventilator strategy during CPR” that encompasses the evidence-based settings appropriate during chest compression. We suggest use of volume control ventilation with the following settings: (1) positive end-expiratory pressure of 0 cm of water (to allow venous return), (2) tidal volume of 8 mL/kg with fraction of inspired oxygen at 100% (for adequate oxygenation), (3) respiratory rate of 10 per minute (for adequate ventilation), (4) maximum peak inspiratory pressure or Pmax alarm of 60 cm of water (to allow tidal volume delivery during chest compression), (5) switching OFF trigger (to avoid trigger by chest recoil), and (6) inspiratory to expiratory time ratio of 1:5 (to provide adequate inspiratory time of 1 second).How to cite this article: Sahu AK, Timilsina G, Mathew R, Jamshed N, Aggarwal P. “Six-dial Strategy”—Mechanical Ventilation during Cardiopulmonary Resuscitation. Indian J Crit Care Med 2020;24(6):487–489.

CPAP Added to Oxygen Administration Avoid Intubation in Acute Respiratory Distress in COVID-19 Pneumonia. Case Report.

It was recently described that COVID-19 pneumonia patients had an atypical form of the ARDS syndrome and required gentle ventilation. We report here on benefits of CPAP treatment in a patient with COVID-19 pneumonia. A 63-year-old patient of African origin presented to the emergency room with COVID-19 pneumonia. Fever had started 5 days before her admission. On day 4, rapid clinical deterioration associated to a high respiratory rate and increased oxygen requirements was noted. The patient was working in an intensive care unit and refused to be intubated. Oxygen was administered at a rate of 15 litres per minute via a Boussignac valve, which initially restored normal oxygen saturation, but this treatment was poorly tolerated and the patient withdrew it after 2 h. A CPAP set at a pressure of 8 cm of water (Goodknight®) was then introduced with better tolerance, allowing the patient to wear it almost continuously for more than 38 h. The patient also benefited from the administration of methypredinsolone 40 mg. Concerning tolerance, a substantial advantage was noted for CPAP machine compared to the Boussignac valve with in addition, a clear decrease in respiratory rate. We would like to encourage the use of CPAP, better tolerated for extended hours with lower oxygen flows, in patients with COVID-19 pneumonia, where acute respiratory distress all too often leads to patient intubation and the genesis of deleterious lung lesions.

Environmental and Diagnostic Study of External Parasites of Some Fish of Lower Zab River and Development Ponds Fishes in Kirkuk Governorate

The study was conducted in the laboratories of College of Education for women/University of Tikrit and Environmental Laboratory in Science College/University of Kirkuk, for the period from July 2018 until end of December 2018, during which 773 fish were collected, including 358 fish from fishes of education ponds (Cyprinus carpio and Barbus lutens) and 415 from Lower Zab River fish (Barbus sharpeyi, Barbus xanthopterus, Silurus glanis). The results recorded the infection of fish with three types of external primary parasites: Trichodina elegini in B. xanthopterus and breeding pond fish (C. carpio and donkeys), Chilodonella cyprinid by 7.9% in C. carpio fish from ponds and B. xanthopterus fish by 7.5% and 5.4% in B. sharpeyi fish, and there was no infection in S. glanis and B. lutens fish , Einaria sinensis, 14.8% in S. glanis fish, 9.589% in C. carpio fish from ponds, 8.17% in B. xanthopterus and 6.081% in B. sharpeyi fish. Changes were recorded in some of physical and chemical properties of water samples, as fluctuations in the average temperature of water were recorded between 26.7-11.5 ° C in river stations and 28-19 ° C in ponds stations, and the discretion values ​​showed site rates ranging from 28.9-21.6 NTU to water in river stations and 24. 6-20 NTU in ponds stations, a rate of electrical conductivity was recorded565-369micemens /cm for water in river stations and 690-408 micrometers / cm in ponds stations, pH values ​​ranged between 8.3-7.2 in river sites and 8.4-7 in ponds, and scored Variations in oxygen biomarker values ​​between 4.4-0.6 mg / l in river stations and 5.2-1.9 in ponds .

Lumbo-peritoneal shunt as treatment modality for visual symptoms in idiopathic intracranial hypertension: A single institution experience.

To evaluate the efficacy of lumbo-peritoneal shunt (LPS) in patients of idiopathic intracranial hypertension presenting with visual symptoms. Between Apr. 2014 and Mar. 2018, 70 patients of Idiopathic Intracranial Hypertension (IIH) underwent treatment at our institution. Patients were evaluated for neurological and ophthalmological status and were subjected to LPS depending on their symptoms. Mean opening pressure was 29.97±5.33cm of water and mean Body-Mass Index (BMI) was 26.51±3 and the two were significantly correlated (p-value 0.006). All patients with visual symptoms (23) underwent LPS and others (47) were managed medically. All patients with LPS and 25 of medically managed patients improved, while 22 medically-managed patients required LPS due to deterioration in visual symptomatology. The proportion of patients showing complete resolution of features of IIH was significantly different between the three groups. Of the 7 patients with shunt extrusion/migration, only 2 required revision. LPS is an equally effective and more technically familiar modality for treatment of IIH for neurosurgeons and should be offered to asymptomatic patients with objective visual signs. Shunt extrusion/migration may not always warrant revision due to "mini-shunt" that drains Cerebro-Spinal Fluid (CSF) through shunt tract even after extrusion.

1216 Markedly decreased ictal discharges with positive airway pressure (PAP) treatment in a patient with refractory epilepsy and severe obstructive sleep apnea

Abstract Introduction Individuals with epilepsy are at increased risk for obstructive sleep apnea (OSA). Treatment of OSA with positive airway pressure (PAP) can result in decreased seizure frequency in patients with epilepsy, possibly due to decreased sleep disruption and normalization of oxygenation saturation levels when using PAP. The following case report demonstrates an example in which treatment of OSA with PAP resulted in a dramatic improvement of electroencephalographic seizures. Report of Case A 32 year-old man with refractory epilepsy presented to our office complaining of loud snoring, witnessed apneas, and excessive daytime sleepiness. Despite prior left frontal and left anterior temporal lobectomy, vagus nerve stimulator treatment, and excellent treatment adherence to four different antiepileptic medications, the patient continued to have 1-3 clinical seizures per day. Physical examination was notable for obesity (BMI=39.4 kg/m2), high arched palate and Mallampati class 4 airway. Long-term eletroencephalogram (EEG) monitoring was significant for frequent interictal discharges during wakefulness and sleep, as well as frequent subclinical seizures during sleep characterized by C3/P3 polyspike bursts followed by brief rhythmic fast activity. A diagnostic polysomnogram revealed severe OSA (AHI=69/hour). The patient subsequently underwent a PAP titration study with extended EEG montage, which was notable for a marked decrease in polyspike discharges on effective PAP pressures, from an average of 24 polyspike discharges per hour on PAP pressures &amp;lt; 15 cm of water to an average of 3 polyspike discharges per hour on PAP pressures ≥ 15 cm of water. PAP treatment was initiated following the titration study. Conclusion This case demonstrates that effective treatment of OSA can lead to a reduction of abnormal EEG discharges in a patient with intractable epilepsy. Additional clinical follow up is needed to assess whether PAP treatment also resulted in decreased frequency of clinical seizures.

SUN-596 A Rare Presentation of Early Onset Wernicke Encephalopathy Following Sleeve Gastrectomy

Background: Wernicke encephalopathy (WE) has been reported after malabsorptive bariatric surgeries but is an uncommon complication of sleeve gastrectomy. Since 2011, the number of patients receiving a sleeve gastrectomy has tripled, with almost 60% of patients undergoing bariatric surgery receiving a sleeve gastrectomy in 2017 (1). We present a case of WE in a young woman as a rare and early complication of sleeve gastrectomy. Clinical Case: A 32-year old female with a past medical history significant for hypertension, pseudotumor cerebri, and morbid obesity status post sleeve gastrectomy two months prior presented to the emergency department with complaints of blurry vision and lower extremity numbness. Physical examination showed sluggish light reflex and decreased extraocular movements. Given history of pseudotumor cerebri, patient underwent a therapeutic lumbar puncture with removal of 13 ml of CSF. Opening pressure was 20 cm of water and patient experienced no relief of her symptoms. Ophthalmology consult did not offer an explanation for the blurry vision. MRI-brain with and without contrast showed findings highly suggestive of WE. It showed faint linear symmetric hyperintensities along the bilateral mesial thalamus, dorsal midbrain and periaqueductal gray matter, which were determined to be acute in nature in comparison with a MRI performed three weeks prior. Upon further investigation, thiamine level was low at 43.6 nmol/L [66.5 – 200] confirming the diagnosis of WE. Thiamine supplementation was started immediately and patient reported improvement of her vision the next day with return to baseline in 3 days. Conclusion: There have been a handful of cases of WE reported in literature as a complication of sleeve gastrectomy. Zheng, L also reported a case of WE 7 weeks after sleeve gastrectomy (2). Although sleeve gastrectomy does not directly affect the primary absorptive pathway of thiamine in the gastrointestinal tract, it is imperative to consider WE in patients presenting with suspicious neurologic symptoms after a recent sleeve gastrectomy. WE was suspected in our case due to typical MRI findings and neurological presentation after bariatric surgery, which was later confirmed by low serum thiamine level. Early detection and thiamine supplementation resulted in complete reversal of symptoms in our patient. WE is a rare but severe and preventable consequence of bariatric surgery that warrants attention given its rapid onset and detrimental course. Reference: (1) Estimate of Bariatric Surgery Numbers, 2011-2017. (2018, June 26). Retrieved from https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. (2) Zheng, L. (2016).Wernicke Encephalopathy and Sleeve Gastrectomy. American Journal of Therapeutics, 23(6).

Photosynthesis, growth, and water use of Hydrangea paniculata ‘Silver Dollar’ using a physiological-based or a substrate physical properties-based irrigation schedule and a biochar substrate amendment

Developing management practices that make more efficient use of irrigation is important for improving the sustainability of nursery crop production. Integrating refined irrigation scheduling with a substrate amendment like biochar can improve irrigation efficiency. The objective of this research was to evaluate the impact of biochar and need-based irrigation scheduling on gas exchange, plant water relations, and biomass gain of container-grown Hydrangea paniculata ‘Silver Dollar’ with the goal of reducing water use and maintaining or shortening production cycles. Containers were filled with pine bark and amended with either 10% or 25% by volume of hardwood biochar. Plants were automatically irrigated by one of the three irrigation schedules. The irrigation schedules were conventional irrigation, delivering 1.8 cm of water in one event each day, and two on-demand, need-based irrigation schedules. The first was based on the moisture characteristic curve for each of the three substrates developed via the evaporative method. The second was a plant physiology-based irrigation scheduling regime built on the relationship between photosynthesis and substrate moisture content. Scheduling irrigation using a plant physiology or substrate physical properties basis, in combination with biochar, reduced the water requirement for ‘Silver Dollar’ hydrangea without any negative effect on plant dry weight by maintaining sufficient plant water status and gas exchange even just prior to irrigation. Automated irrigation systems coupled with a plant physiology or substrate-based actuation and a water retentive substrate amendment have the potential to reduce nursery crops water use.