Mean Pulse Rate Research Articles

Pilot study for non-invasive diabetes detection through classification of photoplethysmography signals using convolutional neural networks

Diabetes is a chronic disorder affecting vascular health, often altering pulse wave characteristics. Traditional pulse wave analysis (PWA) methods face challenges such as variability and complexity of signals. This study aims to overcome these limitations by leveraging deep learning models for more accurate and efficient classification. The methodology used in this study involves four key steps: data collection, data preprocessing, Convolutional Neural Network (CNN) model development, and model evaluation. Primary data were collected using a multipara patient monitor, including finger photoplethysmography (PPG) signals, blood pressure, mean arterial pressure, oxygen saturation, and pulse rate. Single pulse wave cycles from 60 healthy individuals and 60 patients with type 2 diabetes underwent preprocessing. The CNN model was trained using 50 PPG images from each group and achieved a training accuracy of 92%. The prediction capability of the model was evaluated using 20 unseen images, comprising 10 healthy and 10 diabetes PPG images. It attained a 90% overall test accuracy in distinguishing between PPG images of individuals with diabetes and those who are healthy. These findings suggest that CNN-based analysis of PPG signals provides a precise, non-invasive tool for diabetes screening. To further enhance accuracy, future studies should focus on increasing the dataset size and performing hyperparameter tuning to optimize the CNN model.

The Effect of Iron Deficiency Anemia on Hemoglobin Glycation in Diabetics and Non-diabetics.

Background Iron deficiency anemia (IDA) is the most prevalent form of nutritional anemia worldwide, affecting a substantial portion of the population. It has significant negative effects on health and the economy, especially in poorer nations, and is more prevalent than anemia alone. Although hemoglobin A1c (HbA1c) is frequently used to track long-term glycemic management, several variables, including iron deficiency, might affect its values.For proper diabetic care, it is essential to comprehend this link. The purpose of this study is to evaluate the impact of IDA on HbA1c levels in individuals with and without diabetes. Materials and methods A hospital-based cross-sectional study was conducted at Shri B. M. Patil Medical College, BLDE (Deemed to be University). Group 1 consists of diabetic patients with IDA, Group 2 consists of diabetic patients without IDA, and Group 3 consists of non-diabetics with IDA. A total of 108 patients were involved in the study. A complete hemogram, anemia profile, and HbA1c values were also a part of the data-gathering process. IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York) was used for the statistical analysis, with a significance level of p < 0.05. Results The study found no significant changes in the mean age, gender distribution,hypertension prevalence, weight, height, pulse rate, or blood pressure across the groups. Group 2 exhibited considerably higher hemoglobin levels than Groups 1 and3. Group 1 showed substantially higher mean blood sugar and HbA1c levelsthan Group 3 (p < 0.05). Diabetic individuals had higher HbA1c levels than non-diabetic individuals, with the greatest levels found in diabetic patients with IDA. Conclusion This study found that IDA had a significant influence on HbA1c levels in diabetic patients, indicating that iron deficiency should be addressed when interpreting HbA1c levels in these individuals. These findings underscore the need for more study to better understand the processes behind this connection and the consequences for clinical management.

Multiplexing intensity and frequency sensations for artificial touch by modulating temporal features of electrical pulse trains.

In neural prostheses, intensity modulation of a single channel (i.e., through a single stimulating electrode) has been achieved by increasing the magnitude or width of each stimulation pulse, which risks eliciting pain or paraesthesia; and by changing the stimulation rate, which leads to concurrent changes in perceived frequency. In this study, we sought to render a perception of tactile intensity and frequency independently, by means of temporal pulse train patterns of fixed magnitude, delivered non-invasively. Our psychophysical study exploits a previously discovered frequency coding mechanism, where the perceived frequency of stimulus pulses grouped into periodic bursts depends on the duration of the inter-burst interval, rather than the mean pulse rate or periodicity. When electrical stimulus pulses were organised into bursts, perceived intensity was influenced by the number of pulses within a burst, while perceived frequency was determined by the time between the end of one burst envelope and the start of the next. The perceived amplitude was modulated by 1.6× while perceived frequency was varied independently by 2× within the tested range (20-40 Hz). Thus, the sensation of intensity might be controlled independently from frequency through a single stimulation channel without having to vary the injected electrical current. This can form the basis for improving strategies in delivering more complex and natural sensations for prosthetic hand users.

Effect of casozepine administration on stress in dogs during a veterinary examination – A randomized placebo-controlled trial

The aim of the study was to investigate the stress-reducing effect of a casozepine before a veterinary examination in dogs. It should be examined whether the dogs are less stressed during a standardized veterinary examination after an oral application of casozepine over 2 days and whether the administration has an influence on the salivary concentrations of the stress hormones vasopressin and cortisol. Across the study group (n=36), a significantly lower stress score (P=0.0026) and lower mean (P=0.01) and maximum (P=0.024) pulse rates were seen at follow-up after casozepine administration, in contrast to the placebo group (n=26). Salivary vasopressin concentrations increased during follow-up in the placebo group (P=0.04), whereas they remained the same in the casozepine group. Cortisol concentrations increased during follow-up in the casozepin group (P=0.01). The results indicate that although dogs in both groups remained excited at follow-up, short-term casozepine administration before a veterinary visit had a weak stress-reducing effect in dogs based on subjective stress scoring and pulse rate.

Perfusion index: could it be a new tool for early identification of pulmonary embolism severity?

Perfusion index (PI) is a promising indicator for monitoring peripheral perfusion. The present study aimed to compare the efficiency of PI and PESI score in estimating the 30-day mortality and treatment needs of patients diagnosed with pulmonary embolism in the emergency department. This study was prospective and observational. The demographic features of the patients, comorbidities, vital signs, PESI score, PI, treatment applied to the patient and airway management, right ventricular diameter/left ventricular diameter ratio, length of hospital stay, outcome, and 30-day mortality were recorded. A total of 94 patients were included. All patients' vital signs and PI values were recorded on admission. The mean pulse rate (p = 0.001) and shock index (p = 0.017) values of deceased patients were statistically significantly higher, while the mean PI (p = 0.034) was statistically significantly lower. PESI score and PI were statistically significant to predict the need for mechanical ventilation (PI, p = 0.004; PESI score, p < 0.001), inotropic treatment (PI, p = 0.047; PESI score p = 0.005), and thrombolytic therapy (PI, p = 0.035; PESI score p = 0.003). According to the ROC curve, the mortality prediction power of both PESI (AUC: 0.787, 95% CI 0.688-0.886, cutoff: 109.5, p < 0.001) and PI index (AUC: 0.668, 95% CI 0.543-0.793, cutoff: 1, p = 0.011) were determined as statistically significant. PI might be helpful in clinical practice as a tool that can be applied to predict mortality and treatment needs in PE.

The Relationship Between FTP And VO2max Ability and Strength and Flexibility in Cyclists

The study aimed to investigate the relationship between VO2max and FTP in female road cyclists with strength (right/left-hand grip, back, leg), flexibility, and anthropometric variables. Descriptive statistics are presented as median and interquartile range. The median values of the participants were as follows: height 158.5 cm, body weight 54.9 kg, body fat percentage 19.6%, and body muscle mass 41.5 kg. The participants’ leg strength was measured at 70 kg, while their back strength was found to be 50 kg. Their right-hand grip strength was 29.1 kg, and their left-hand grip strength was 29.6 kg. The participant's flexibility was measured at 32 cm. Their VO2max was found to be 58.2 ml/kg/min, with a VO2max pulse of 189 beats/min and a VO2max workload of 262 watts. During the FTP test, the participant's mean pulse rate was 181 beats/min, mean cadence was 83 rpm, mean workload was 184 watts, normalized power was 185 watts, and relative power was 3.1 watts/kg. The study found a moderate positive correlation between VO2max and back strength and a strong negative correlation with flexibility. Additionally, a strong positive relationship was observed between VO2max workload value and body muscle mass, as well as right- and left-hand grip strength. No relationship was found between VO2max HR, AnT VO2, AnT HR, and AnT workload. Furthermore, the study found a moderate positive correlation between FTP value and body muscle mass and a very strong positive correlation with calendar age. The study also found significant correlations between mean FTP cadence and body muscle mass, as well as between mean FTP workload and body muscle mass. Additionally, a very strong positive correlation was observed between mean FTP workload and calendar age. Finally, a strong negative correlation was found between FTP relative strength and flexibility. The study concluded that as the strength of the back muscles in the group increased, so did their VO2max and FTP values, along with an increase in body muscle mass. The results suggest that back strength and body muscle mass are important variables for the participants in the study.

Perioperative analgesic management in patients with bladder exstrophy: A clinical study

Background: Bladder exstrophy is a complex, rare congenital malformation with an incidence of 3.3 cases in every 100000 live births and is slightly more common in males. Primary surgical repair requires many hours of surgery with fluid and blood loss. Because of wide fluctuations in hemodynamics, a longer duration of surgery, smaller age, risk of hypothermia and post-operative intensive care may be required. We evaluated the use of continuous caudal epidural infusion of bupivacaine and fentanyl under general anesthesia for urinary bladder exstrophy-epispadias surgery in children. Aims and Objectives: Aim of the study was to evaluate the postoperative analgesia in patients undergoing surgery for bladder exstrophy. The primary objective was to assess the postoperative pain using FLACC scale and sedation score after successful caudal administration. Secondary objective was to assess the hemodynamic changes after caudal administration. Materials and Methods: A total of 13 patients aged between 9months and 13 years of either sex, weighing between 5kg to 30kg, belonging to ASA grade II to IV, underwent surgery for epispadias–exstrophy complex. Initial bolus 0.75ml/kg of 0.25% bupivacaine with fentanyl 1ug/kg was given through epidural. Postoperative analgesia was maintained by continuous infusion of 0.0625% bupivacaine @0.1ml/kg/hr in young children and 0.125% bupivacaine with fentanyl 1ug/ml in older children for 4-5 days with the help of ON-Q pump or infusion pump. Baseline hemodynamic parameters including MAP, heart rate and SpO2 was recorded at various time intervals. Postoperative pain was assessed using face, legs, activity, cry and consolability (FLACC) pain scale and sedation score was assessed by using ramsay sedation score. Results: There was a statistically significant decrease in mean pulse rate in the study group from baseline to thirty minutes after reversal (p&lt;0.001). Similar observation was made for mean arterial pressure which also showed statistically significant decrease from baseline to thirty minutes after reversal (p&lt;0.001). No change was observed in SpO2 from baseline to any other follow-up interval. Conclusion: Perioperative anesthetic and analgesic management of the bladder exstrophy patient can improve the success rate. Epidural bupivacaine with or without fentanyl infusions for short duration can provide safe analgesia.

Clemastine as a Main Sedative Drug in Colonoscopy

Background: Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber-optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis. Methods: In this study, clemastine plus fentanyl was compared with fentanyl plus midazolam in analgesia during colonoscopy. Patients were monitored for pain and hemodynamic changes. The mean age in the group treated with clemastine was 52 years and in the group treated with midazolam was 54 years. There were 56 males and 35 females in the study. There was no significant difference in gender in the two groups. Systolic blood pressure was 109.9 mmHg before and 109.35 mmHg after clemastine administration, which showed no significant difference. Results: Diastolic blood pressure was 72.2 mmHg before and 73.7 mmHg after clemastine administration, which showed no significant difference. No change in mean pulse rate (PR) was seen (84/min before and after clemastine administration). In the group receiving midazolam, systolic and diastolic blood pressure changes were not significant, but changes in PR and arterial oxygen saturation were significantly different. Meanwhile, the two groups had a significant lower pain level after colonoscopy in the group receiving clemastine compared to midazolam. Conclusion: Based on the results of the present study, clemastine can be used as a main drug for sedation during colonoscopy.

COMPARATIVE ANALYSIS OF THYROID FUNCTION PROFILES BETWEEN POLYCYSTIC OVARY SYNDROME PATIENTS AND HEALTHY CONTROLS: A COMPREHENSIVE STUDY

Objective: To assess the thyroid function status of patients with Polycystic Ovary Syndrome (PCOS) and to compare it with that of healthy women. Methods: This was a descriptive cross-sectional study conducted in the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynecology of a tertiary care hospital in Northern India. 30 patients diagnosed to have polycystic ovarian syndrome on the basis of the Rotterdam criteria were included in this study as cases (Group P). 30 healthy women were enrolled as the control group (Group H). The mean age and marital status of the patients were assessed. The body mass index of all the patients was also determined and compared. Systolic blood pressure, diastolic blood pressure, and pulse rate were also compared. A thyroid function test was done in both groups. The mean triiodothyronine (T3), T4, and thyroid-stimulating hormone (TSH) levels were compared in both groups. p&lt;0.05 was taken as statistically significant. Results: The mean age of patients with PCOS and healthy individuals was 22.10±3.97 years and 23.76±3.97 years, respectively. The mean ages of both groups were found to be comparable in both studies (p=0.1108). The mean body mass index (BMI) of groups P and H was found to be 27.23±5.82 and 23.15±4.12, respectively. The women in group P were found to have a higher BMI as compared to women in group H, and the difference was found to be statistically significant (p=0.0027). The mean pulse rate, systolic blood pressure, and diastolic blood pressure values were found to be comparable. The mean FT3 levels in groups P and H were found to be 3.11±0.88 and 3.13±0.42 ng/mL, whereas the mean free thyroxine levels in groups P and H were found to be 0.96±0.16 and 0.89±0.15, respectively, μg/dL. The mean T3 and T4 levels of both groups were found to be comparable in both groups. However, the mean TSH level in groups P and H was found to be 4.95±2.24 and 2.50±1.19 0.3–4.5 μIU/ml, respectively. The mean TSH level in group P was found to be higher than group H, and the difference was found to be statistically significant (p&lt;0.001). Conclusion: The prevalence of subclinical hypothyroidism was found to be significantly high in women with PCOS, making it necessary to do periodic thyroid function tests in PCOS.

Sugammadex shortens operation time and improves operation turnover efficacy in video-assisted thoracoscopic surgery.

This study compared sugammadex and neostigmine as agents for routine neuromuscular blockade reversal in video-assisted thoracoscopic surgery (VATS) to determine the optimal choice that achieves a shorter operation time and improved turnover efficiency while enhancing postoperative outcomes and ensuring patient safety during thoracic surgery. This prospective study, conducted from July 2022 to March 2023, compared the effect of sugammadex and neostigmine on operation time and turnover efficiency in VATS, involving 60 participants randomly assigned to either group, with the primary objective of identifying the optimal anesthesia reversal choice for improved outcomes and patient safety during thoracic surgery. In the study, the sugammadex group showed a significantly shorter total operation room occupancy time (130 ± 7 vs 157 ± 7 minutes; p = 0.009) than the neostigmine group. Patients in the neostigmine group had higher mean pulse rates when leaving the operation room (85 ± 3 vs 73 ± 3 beats/min; p = 0.002) and 120 minutes later in the postanesthesia care unit (76 ± 2 vs 68 ± 2; p = 0.016). This study's findings suggest that sugammadex may enhance total operating room occupancy time, operation turnover efficacy, and respiratory recovery outcomes in VATS, potentially improving patient care and anesthesia management.

Noninvasive Blood Pressure Monitoring via a Flexible and Wearable Piezoresistive Sensor.

In the present global context, continuous blood pressure (BP) monitoring is paramount in addressing the global mortality rates attributed to hypertension. Achieving precise insights into the human cardiovascular system necessitates accurate measurement of BP, and the accuracy depends on the faithful recording of oscillations or pulsations. This task ultimately depends on the caliber of the pressure sensor embedded in the BP device. In this context, we have fabricated a flexible resistive pressure sensor based on reduced graphene oxide (rGO) and a polydimethylsiloxane (PDMS) sponge that is highly flexible and sensitive. The designed device operates effectively with a minimal bias voltage of 500 mV, at which point it showed its maximum relative change in current, reaching approximately 25%. Additionally, the sensing device showed a notable change in resistance values, exhibiting almost 100% change in resistance when subjected to a pressure of 400 mmHg and high sensitivity of 0.27 mmHg-1. After promising outcomes were obtained during static pressure measurement, the sensor was used for BP monitoring in humans. The sensor accurately traced the oscillometric waveform (OMW) for distinct systolic blood pressure (SBP) and diastolic blood pressure (DBP) combinations to cover a range of medical situations, including hypotension, standard or normal, and hypertension. The values of SBP, DBP, and MAP were derived from the sensor's output using the MAA technique, and the errors in these values concerning the simulator and the traditional BP monitor follow the universal AAMI/ESH/ISO protocols. Bland-Altman (B&A) correlation and scatter plots were used to compare the sensor's results and further validate the proposed sensor. The sensor showed the mean and standard deviation error in the SBP, DBP, and MBP of -0.2 ± 5.9, -0.5 ± 7, and -0.9 ± 4.7 mmHg when compared with the noninvasive blood pressure (NIBP) simulator. The pulse rate (PR) was also calculated from the same OMW for the specified value of 80 beats per minute (bpm) given by the simulator and reported a mean PR value of ∼81 bpm, close to the reference value. The findings show that the flexible resistive sensing device can accurately measure BP and replace the existing sensors of BP devices.

Post-Operative Outcomes of Coronary Artery Bypass Surgery in Young Adults

Background: CABG is extensively studied surgical procedure but the data shows little about younger population. The gold standard for treating TVCAD is coronary bypass surgery with better long-term outcomes and lesser reintervention. Young adults who have coronary arteries revascularized are a specific category of sufferers, with research on cardiovascular proceedings. Aim: To identify the risk factors and to determine the postoperative outcomes in young patients encountering CABG. Methodology: This retrospective empirical groundwork was carried out at Peshawar institute of cardiology, included (n=95) adults, who were diagnosed with coronary artery disease and underwent CABG surgery. Data was extracted from electronic medical record (EMR) and by using SPSS version 26.0, the data was analyzed. Results: Mean age of the patients (43.24±3.940), mean BMI (27.8249±4.32135), mean pulse rate (80.79±13.808), mean systolic BP (134.40±19.168), mean diastolic BP (83.86±13.901). Major risk factors observed were both DM and HTN 33.7%, use of tobacco and HTN20%. Correlation of age showed significant linear relationship with ventilation time, ICU stay, CCS class with NYHA at P&lt;0.01. Similarly, previously diagnosed STEMI patients showed significant linear relationship with mortality at P&lt;0.05. Conclusion: According to the consequences of the study it is presumed that in young patient’s lower rates of morbidity and in hospital mortality was observed as compared to older counterparts. Furthermore, detailed multicenter study in this area is needed with higher sample size and long-term effects for extended periods of time to confirm better results. Keywords: Coronary artery disease,Percutaneous coronary intervention, Cardiopulmonary bypass

Comparative effects of intravenous esmolol and lidocaine on bispectral index during propofol-fentanyl induction in patients scheduled for elective surgeries under general anaesthesia

INTRODUCTION: Laryngoscopy and endotracheal intubation at induction of anaesthesia have been associated with awareness and haemodynamic fluctuations. Agents that can mitigate these effects should create better anaesthetic conditions. This study aimed to compare the effects of intravenous esmolol and lidocaine on the bispectral index (BIS) and haemodynamic responses during induction of general anaesthesia with propofol/fentanyl in adult patients scheduled for elective surgical procedures.&#x0D; METHODS: This was a prospective randomized controlled study in ninety patients aged 18-65 years who were randomized into three groups to receive either IV esmolol 0.5 mg/kg, IV lidocaine 1.5 mg/kg or normal saline prior to induction of general anaesthesia.&#x0D; RESULTS: The esmolol group had a significantly shorter induction time (p&lt;0.0001) and a lower dose of propofol consumed (p&lt;0.0001) than the lidocaine group. The mean pulse rate was significantly lower at the 1st min to 4th min post-intubation in esmolol and lidocaine groups compared to the control group (p values; 1 min= 0.005, 2 min= 0.008, 3 min= 0.023, 4 min= 0.018). There was a significant difference in the systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in the three groups at 2 min post-intubation.&#x0D; CONCLUSION: Pre-induction intravenous esmolol 0.5 mg/kg was more effective than intravenous lidocaine 1.5 mg/kg in reducing the induction dose of propofol and the induction time. Esmolol also prevented increases in BIS better than lidocaine following endotracheal intubation but both agents were equally effective in attenuating the haemodynamic changes associated with laryngoscopy and endotracheal intubation.

Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A Split-Mouth Randomized Crossover Clinical Trial.

This crossover clinical trial was conducted with eligible 6-8-year-old children requiring bilateral mandibular molar pulpotomy. At the first treatment visit, pulpotomy was performed for 15 children using VR glasses distraction while the other 15 children received a pulpotomy without any VR glasses; this trend was reversed at the second session and pulpotomy was performed for the contralateral tooth. Pulse rate (PR) and Modified Child Dental Anxiety Scale (MCDAS) measured the anxiety levels. Wong-Baker Faces Pain Scale (WBFP) assessed the pain perception before and after the intervention. Data were analyzed by Statistical Package for the Social Sciences version 25 using the Mann-Whitney and χ2 tests. The mean PR was not significantly different between the two groups. However, the test group showed significantly lower scores of MCDAS (P value = 0.02) and WBFP (P value = 0.001) compared with the control group. The present results suggest that VR headsets can decrease the level of pain and anxiety of patients during primary mandibular pulpotomy. This trial is registered with IRCT20200315046782N1.

Prediction of outcomes of chest trauma using chest trauma scoring system at a rural tertiary health-care facility

Background: In India, trauma is the most common cause of death. The third most common cause of traumatic death is thoracic trauma. Thoracic trauma accounts for 10% of all trauma admissions, and the mortality rate is reported to range from 10% to 60%. Thoracic trauma patients are likely to be assessed and cared for consistently under a well-designed classification system. Aims: This study aims To investigate Chest Trauma Score (CTS)-based prognostic and predictive outcomes following chest trauma in the Indian subpopulation sustaining chest injuries. Setting and Design: This prospective observational study, Department of General Surgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, was included a total of 50 individuals with thoracic trauma. Materials and Methods: When a patient is admitted to the emergency department or trauma unit, a complete clinical assessment, detailed history, vital signs, and all appropriate investigations - including chest radiographs, computed tomography, or high-resolution computed tomography (HRCT) chest (if hemodynamics are stable on admission) - are performed. Age, pulmonary contusion (on HRCT chest), number of rib fractures, and presence of bilateral rib fracture were the four factors used to calculate the CTS. Statistical Analysis: Data were expressed as mean (standard deviation) and percentage (%). Chi-square, Student’s t-test, and analysis of variance were used to compare measured variables. Results: The mean pulse rate (beats/min) and respiratory rate (/min) of patients were significantly higher, and systolic blood pressure (mmHg) and diastolic blood pressure (mmHg) were significantly lower in the nonsurvivor group compared with the survivor group. More than 5 rib fractures and intubation were significantly found more in nonsurvivor group. The mean Glasgow Coma Scale (GCS) was significantly decreased in nonsurvivor group (11.67 ± 1.37) as compared to survivor group (14.55 ± 1.13). Conclusion: Traffic accidents were more frequently (60%) responsible for chest trauma. The mean GCS was significantly associated with patient mortality.

Tuberculosis Mortalities Among In-patients at a Tertiary Hospital in Zambia Between 2018 and 2019 - The Spectrum of Clinical Presentations

Background: Tuberculosis (TB) has remained one of the most important public health diseases and a leading cause of mortality from a single infectious agent in the world. In-patient mortalities have remained relatively high despite massive investment towards TB elimination. This prompted us to undertake a TB mortality review aimed at understanding the spectrum of clinical presentations in TB mortalities among in-patients in a local hospital set up in Zambia.&#x0D; Methods: Files of 74 in-patient TB related mortalities that had occurred at Kitwe Teaching Hospital over a 12-month period between June 2018 and June 2019 were audited using a structured questionnaire. The data was analyzed using SPSS v 16.0 statistical software while descriptive statistics and cross tabulation was used to determine the frequencies and cross relationships among the variables followed by univariate logistic regression whose significance was set at a p-value of 0.05 and a 95 percent confidence interval. Variables that were found to be significant at univariate logistic regression were fitted into the multivariable logistic regression.&#x0D; Results: The audit revealed that 50 (67.6%) of the files were for male patients with a mean age of 39.2 ± 11.6 years. 60(80%) were HIV positive, 60(80%) resided in high-density residential areas. On presentation to hospital, the commonest symptoms included productive cough and fever [31(41.9%) and 30(40.5%) respectively]. HIV positive male patients were presenting in hyperdynamic state (mean pulse rate of 117.2 ± 32.4 per minute, p = .001) and HIV positive females presented with mean arterial pressure (72.3 ± 19.5 mmHg, p = .002). Other findings included signs of multi-organ involvement [hypoalbuminemia 9(12.2%), deranged renal function 8(10.8%) and deranged liver enzymes 9(12.2%)] before mortality occurred.&#x0D; Conclusion: The spectrum of clinical presentations among in-patients with TB in a tertiary hospital include the following; male gender, age younger than 50 years, being HIV positive, residing in a high-density residential area and presenting with unstable hemodynamics. There is a need to focus strategies targeted at strengthening early recognition of clinical instability among admitted TB patients for at-risk populations, including young to middle aged males who are HIV positive.

Effect of virtual reality simulation as a teaching strategy on nursing students’ satisfaction, self-confidence, performance, and physiological measures in Jordan

IntroductionVirtual reality (VR) simulation is an intervention used to enhance satisfaction, self-confidence and performance in nursing education. This study aimed to evaluate the effect of VR simulation as a teaching strategy on students’ satisfaction, self-confidence, performance and physiological measures in Jordan. MethodsA pre–post-test control group was used, and 102 nursing students enrolled in community and pediatric nursing courses from Al-Zaytoonah University were recruited. The sample was randomly distributed into intervention (n = 52) and control (n = 50) groups. ResultsFindings showed a significant difference between intervention and control groups pre- and post-VR simulation intervention for satisfaction (t = −24.623, p < 0.001), self-confidence (t = −12.572, p < 0.001) and performance (t = −11.480, p < 0.001). Additionally, there were normal physiological measures for the intervention group before and after conducting procedures in realistic situations. There was a statistically significant improvement in satisfaction, self-confidence and performance as a result of VR simulation. ConclusionsVR simulation is a teaching strategy that provides nursing students with a safe and effective teaching environment. Thus, VR simulation should be incorporated with traditional teaching in nursing clinical courses to enhance nursing students’ satisfaction, self-confidence and performance in clinical settings, in addition to controlling physiological measures (mean arterial pressure and pulse rate) in realistic clinical situation.

Chronic renal failure as predictive factor for acute elevation of systolic blood pressure after fluorescein angiography in patients with retinal diseases

PurposeTo investigate the influence of fluorescein angiography (FA) on blood pressure (BP) in patients with retinal diseases, and analyze the predictive factors for acute elevation of systolic BP after FA. Designand Methods: A prospective study was conducted with 636 patients undergoing FA between April 2021 and October 2021. BP and pulse were measured in each patient before and 20 min after FA. The baseline characteristics of patients who developed an acute elevation in systolic BP (>10 mmHg) were compared with those of the remaining patients to detect factors that may predict this acute elevation. ResultsOverall, mean systolic BP changed from 142 ± 17 mmHg to 140 ± 20 mmHg after 20 min (p = 0.1). Mean diastolic BP changed from 79 ± 15 mmHg to 78 ± 13 mmHg after 20 min (p = 0.45). Mean pulse rate changed from 73 ± 14 bpm to 70 ± 12 bpm after 20 min (p = 0.001). 103 patients (16 %) had acute elevation of systolic BP (>10 mmHg). Mean systolic BP changed from 143 ± 17 mmHg to 162 ± 19 mmHg after 20 min in this group (p = 0.001). Patients in this group were significantly older compared to the rest (73 ± 12 vs 67 ± 15, p = 0.001). The rate of chronic renal failure was significantly higher in this group compared to the rest of the patients (42/7.8 % vs 15/14.6 %, p = 0.01). ConclusionsThis study demonstrated that fluorescein angiography is a relatively safe procedure with regards to blood pressure changes. However, chronic renal failure could be considered as predictive factor for acute elevation of systolic blood pressure after this procedure.

Toxicity of environmentally relevant concentration of PFAS chemicals in Lumbriculus variegatus (Oligochaeta, Lumbriculidae) – A multi-bioindicator study

PFAS, or per- and polyfluoroalkyl substances, are a family of man-made chemicals found in a variety of products from non-stick cookware and food wrappers to firefighting foams. PFAS are persistent and widely distributed in the environment, including aquatic environments. In this study we examined the impact of PFAS chemicals on the physiological and behavioral endpoints of Lumbriculus variegatus (i.e., blackworms). Lumbriculus variegatus is a species of freshwater annelid worm that plays key roles in shallow freshwater ecosystems. At an environmentally relevant concentration of 1 μg/L, 12-day aqueous exposure to long chain PFAS, including PFOA, PFOS and PFDA, each markedly slowed the pulse rate of the dorsal blood vessel in L. variegatus, indicating a suppressive effect on blood circulation. The mean pulse rate was reduced from 9.6 beats/minute to 6.2 and 7.0 beats/min in PFOA and PFOS, respectively (P < 0.0001). Further, PFOA, PFOS and PFDA reduced the escape responsiveness of L. variegatus to physical stimulation. The percentage of worms showing normal escape behavior was reduced from 99.0% in control to 90.6% in the PFOS exposed group (P < 0.01). In a chronic (4 week) growth study, exposure to overlying water and sediment spiked with PFOA, PFOS or PFDA reduced the total biomass and the number of worms, indicating a suppressive effect on worm population growth. For instance, PFOA and PFDA reduced the total dry biomass by 26.3% and 28.5%, respectively, compared to the control (P < 0.05). The impact of PFAS on blackworm physiology is accompanied by an increase in lipid peroxidation. The level of malondialdehyde (MDA), an indicator of lipid peroxidation, and catalase, a major antioxidant enzyme, were markedly increased in PFOA, PFOS and PFDA exposed groups. Interestingly, exposure to PFHxA, a short chain PFAS, had no detectable effect on any of the measured endpoints. Our results demonstrate that L. variegatus is highly sensitive to the toxic impact of long chain PFAS chemicals as measured by multiple endpoints including blood circulation, behavior, and population growth. Such toxicity may have a detrimental impact on L. variegatus and the freshwater ecosystems where it resides.

A COMPARATIVE DOSE-RESPONSE STUDY BETWEEN INTRATHECAL NALBUPHINE (0.8 MG, 1.4 MG) WITH BUPIVACAINE HEAVY 0.5% 3.5 CC IN LOWER ABDOMINAL SURGERIES

Aims: To study the efficacy of various doses of nalbuphine as an additive in sub-arachnoid block for lower abdominal surgeries. Methods: This comparative study was conducted by the addition of two different doses of nalbuphine as an adjuvant: 0.8 mg nalbuphine hydrochloride to 0.5% bupivacaine (heavy) and 1.4 mg nalbuphine hydrochloride to 0.5% bupivacaine (heavy), the onset, maximum level, duration of sensory blockade, motor blockade, and hemodynamic parameters were studied. Results: It was discovered that group B (1.4 mg of nalbuphine added to 0.5% bupivacaine [H]) results in a later onset and greater degree of sensory and motor blockage. This group also considerably extended the time of analgesia, sensory and motor blockage, and both. The statistical examination of the mean blood pressure and mean pulse rate, together with the study of hemodynamic parameters, revealed that the p value was significant for the mean pulse rate and diastolic blood pressure but negligible for the systolic blood pressure. Conclusion: It can be concluded that intrathecal 0.5% bupivacaine (H)+nalbuphine (1.4 mg) when compared to intrathecal 0.5% bupivacaine (H)+nalbuphine (0.8 mg) in the patients undergoing lower abdominal surgeries.