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Introduction At the beginning of the 2020 pandemic, no criteria were in place regarding the timing of tracheostomy placement in intubated COVID-19 patients, nor were there any data pertaining to pneumothorax incidence in this population. This study examines the timing of tracheostomy placement and its correlation with patient outcomes, along with pneumothorax incidence in COVID-19 patients who underwent a tracheostomy.  Methods We performed a multi-institutional retrospective study of intubated COVID-19 patients admitted to intensive care units (ICUs) in North and South Dakota between April 2020 and December 2020. The timing of the tracheostomy was assessed, with primary outcomes being mortality, successful ventilator weaning, discharge to a long-term care facility, and overall length of stay. Patients were grouped by age, gender, ethnicity, and comorbidities. Pre- and post-tracheostomy pneumothorax was extracted from this dataset. Results We identified 85 patients who were intubated with COVID-19 and underwent a tracheostomy. The timing of tracheostomy varied widely, ranging from five to 53 days with an average time to tracheostomy being 17.3 days. Thirty-four of the patients expired, 32 patients were discharged to a long-term care hospital (LTCH), and 11 patients were discharged to an inpatient rehabilitation facility. Only three patients were discharged home. Regression analysis did not reveal statistically significant differences between patients who survived (N = 51) and patients who expired (N = 34) for almost all variables analyzed. Sixteen of the 85 patients were diagnosed with pneumothorax during their hospital stay. Half of these patients were diagnosed after a tracheostomy was placed. Conclusion This study did not demonstrate statistically significant differences in overall mortality or incidence of pneumothorax when it pertains to the timing of placement of tracheostomy. Variation in mortality was identified, in which younger patients were more likely to survive than older patients, a finding that was echoed in other studies. Considering this evidence, we cannot conclude that an association between the timing of tracheostomy and mortality from COVID-19; therefore, tracheostomy in the setting of COVID-19 can be performed at the provider's discretion., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Zweerink et al.)

Optical coherence tomography angiography (OCTA) is a non-invasive, high-resolution imaging modality with growing application in dermatology and microvascular assessment. Accepted reference values for OCTA-derived microvascular parameters in skin do not yet exist but need to be established to drive OCTA into the clinic. In this pilot study, we assess a range of OCTA microvascular metrics at rest and after post-occlusive reactive hyperaemia (PORH) in the hands and feet of 52 healthy people and 11 people with well-controlled type 2 diabetes mellitus (T2DM). We calculate each metric, measure test-retest repeatability, and evaluate correlation with demographic risk factors. Our study delivers extremity-specific, age-dependent reference values and coefficients of repeatability of nine microvascular metrics at baseline and at the maximum of PORH. Significant differences are not seen for age-dependent microvascular metrics in hand, but they are present for several metrics in the foot. Significant differences are observed between hand and foot, both at baseline and maximum PORH, for most of the microvascular metrics with generally higher values in the hand. Despite a large variability over a range of individuals, as is expected based on heterogeneous ageing phenotypes of the population, the test-retest repeatability is 3.5% to 18% of the mean value for all metrics, which highlights the opportunities for OCTA-based studies in larger cohorts, for longitudinal monitoring, and for assessing the efficacy of interventions. Additionally, branchpoint density in the hand and foot and changes in vessel diameter in response to PORH stood out as good discriminators between healthy and T2DM groups, which indicates their potential value as biomarkers. This study, building on our previous work, represents a further step towards standardised OCTA in clinical practice and research., (© 2023. The Author(s).)

Optical coherence tomography angiography (OCTA) performs non-invasive visualization and characterization of microvasculature in research and clinical applications mainly in ophthalmology and dermatology. A wide variety of instruments, imaging protocols, processing methods and metrics have been used to describe the microvasculature, such that comparing different study outcomes is currently not feasible. With the goal of contributing to standardization of OCTA data analysis, we report a user-friendly, open-source toolbox, OCTAVA (OCTA Vascular Analyzer), to automate the pre-processing, segmentation, and quantitative analysis of en face OCTA maximum intensity projection images in a standardized workflow. We present each analysis step, including optimization of filtering and choice of segmentation algorithm, and definition of metrics. We perform quantitative analysis of OCTA images from different commercial and non-commercial instruments and samples and show OCTAVA can accurately and reproducibly determine metrics for characterization of microvasculature. Wide adoption could enable studies and aggregation of data on a scale sufficient to develop reliable microvascular biomarkers for early detection, and to guide treatment, of microvascular disease., Competing Interests: The authors have declared that no competing interests exist.

Background: Perceived severity of COVID-19 (SARS-COV-2) is known to be associated with mental health of people in general and health professionals in particular in Western societies. However, its association with the mental health of students in Pakistan, which is predominantly a Muslim society, remains unclear so far. Moreover, the role of Muslim religiosity for such an association has not yet been investigated. We aimed to examine the association and report findings on the impact of perceived severity on mental health with a sample of students from all five provinces of Pakistan. Methods: We did a cross-sectional online survey from 1,525 Pakistani students in March 2020 using standardized measurement tools. We then determined the prevalence of perceived severity among students and its impact on their mental health. The strength of associations between these variables was estimated using generalized linear models, with appropriate distribution and link functions. Structural equation modeling through SmartPLS (3.0) software was utilized to analyze the results. Findings: The perceived severity of COVID-19 is significantly associated with mental health of Pakistani students, whereas Muslim religiosity is a strong mediator between perceived severity and mental health of Pakistani students. Conclusions: Though the perceived severity of COVID-19 is associated with mental health, this relationship can be better explained by the role of Muslim religiosity. When tested individually, the perceived severity accounted for only 18% variance in mental health that increased up to 57% by the mediating role of Muslim religiosity. This difference clearly indicates the mediating role of Muslim religiosity in the association between perceived severity and mental health for Pakistani students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Saleem, Bakar, Durrani and Manzoor.)

Background: Studies have demonstrated magnetic resonance imaging (MRI) safety in the presence of MRI-conditional permanent pacemakers (PPM). However, since patients' care may require serial MRIs, it is necessary to evaluate device safety and performance after multiple scans., Objectives: We evaluated safety and performance of MRI-conditional PPMs after serial MRIs over various anatomic regions performed during a multicenter, prospective, single-arm study (ProMRI)., Methods: ProMRI was a multiphase observational study designed to evaluate PPM performance after MRI scans. Our study evaluated PPM function in a cohort of patients who underwent multiple 1.5-T MRI scans. Selected patients underwent separate head, chest, and lumbar spine MRIs. Pacing capture threshold (PCT), lead impedance (LI), sensing amplitude, and battery capacity were collected before and after scanning. Freedom from serious adverse device effects (SADE) through 1 month post MRI served as a primary endpoint. Changes in PPM function parameters, including threshold success rate and sensing attenuation, were analyzed for statistical significance and clinical relevance., Results: In 81 patients no adverse events or SADE occurred. Statistically significant changes in ventricular PCT (0.034 ± 0.15 V) immediately after, ventricular LI immediately after (-18.7 ± 44.2 Ω) and 1 month post phase B (-19.8 ± 44.9 Ω), and atrial sensing attenuation immediately after (-0.27 ± 0.92 mV) and 1 month post phase B (-0.22 ± 0.92 mV) were noted. However, these changes were not clinically relevant in degree., Conclusion: These results demonstrate the safety and performance of the ProMRI PPM in patients undergoing 3 serial MRIs over various anatomic regions., (© 2020 Heart Rhythm Society. Published by Elsevier Inc.)

In this research, efforts were put to demonstrate synergistic interactions between bioenergy generation and wastewater treatment. The extent of such synergistic effect was assessed against wastewater effluents released from the beverage industry through the operation of a membrane-less truncated conical (TC) microbial fuel cell (MFC). A graphite-based reactor was operated for five cycles in batch mode using beverage industry wastewater as an organic substrate. Maximum bioelectricity produced on the fifth operating cycle corresponded to a voltage of 338 mV and a power of 1.14 mW at 100 Ω. The MFC recorded a higher substrate degradation rate (0.84 kg of chemical oxygen demand [COD]/m 3 -day) accompanied by the development of an electroactive biofilm and polarization behavior (e.g., a reduction in internal resistance from 323 Ω to 197 Ω over five operation cycles). Cyclic voltammetry showed a maximum performance of the biofilm during the fifth cycle (through its enrichment) as interpreted by oxidation and reduction currents of 2.48 and -2.21 mA, respectively. The performance of the proposed MFC was superior to other designs reported previously in both effluent treatment and bioenergy generation. A maximum treatment efficiency of 84.4% (in 385 h) was seen at an organic load (COD) of 3500 mg/L with the specific power yield (0.504 W/Kg of substrate (COD) removal) and volumetric power yield (15.03 W/m 3 ). Our experimental studies support that the proposed system could be upscaled to realize the commercial operation., Competing Interests: Declaration of Competing Interest The authors declared that there is no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To examine the relationship between psychosocial strengths (resilience, self-efficacy beliefs and social support) and perceived severity of COVID-19 and also to gauge the mediating role of self-control among frontline health care professionals of Pakistan., Methods: A cross-sectional research design was utilized from March to April 2020 from one medical teaching hospital of South Punjab. As it was a single center experience so all the doctors were approached and asked to participate in this research. In total, 284 doctors (out of 300 approx.) completed online survey. The data were collected through online google forms consisting of self-report measures i.e. Brief Resilience Scale, Short General Self Efficacy Scale, Brief Scale for Social Support, Risk Behavior Diagnostic Scale and Brief Self-Control Scale., Results: The results were analyzed by using SmartPLS (3.0), direct effect of psychosocial strengths on perceived severity of COVID-19 and indirect effect of self-control were assessed through path coefficients, t-values and r-square values. The results confirmed that there was significant negative relationship between psychosocial strengths and perceived severity of COVID-19 (β = -0.854, t =14.279) with 72% variance in perceived severity due to psychosocial strengths. Further, the results also suggest that self-control proved significant mediator between psychosocial strengths and perceived severity (β = -0.604, t = 11.004, variance in perceived severity is 74%)., Conclusion: In the time of pandemic, medical professionals are working as frontline force and can have several uncertainties regarding the risk associated with outbreak of COVID-19. This study concludes psychosocial strengths can play a significant role in subsiding the risk associated with severity of disease. Whereas, self-control can significantly contribute to buffer the negative influence of COVID-19 among frontline medical professionals. In line with findings of this study, there is a dire need to initiate psychotherapeutic studies for medical professionals to boost up their psychosocial strengths that would make them resilient against COVID-19., (Copyright: © Pakistan Journal of Medical Sciences.)

Purpose: The purpose of this study is to measure optical coherence tomography angiography (OCTA)-defined retinal vascular and choriocapillaris parameters in diabetic patients without clinically evident diabetic retinopathy., Methods: Retrospective case series of eyes in patients with a documented history of either type 1 or type 2 diabetes mellitus without any clinical signs of diabetic retinopathy seen at the Vanderbilt Eye Institute. All eyes underwent dilated funduscopic examination along with OCTA. OCTA analytics were performed to calculate vessel density, flow area, and foveal avascular zone size., Results: Thirty-seven eyes of 20 patients were included in the analysis. The mean glycated hemoglobin A1c of the 20 patients was 7.2%. All patients underwent dilated funduscopic examination by a fellowship-trained retina specialist. No patients had any overt retinopathy on clinical examination. Fifteen eyes had vascular abnormalities (microaneurysms) present on OCTA. Patients with microaneurysms and patients without microaneurysms were compared. Vessel density of the 6 × 6 mm macular cube images was significantly increased in patients with microaneurysms compared with patients without microaneurysms. There were no other significant differences in OCTA characteristics., Conclusion: OCTA can detect microvascular changes not otherwise noted on dilated clinical examination. These pre-clinical findings may facilitate earlier intervention for improved glycemic control and prevention of the onset of clinical retinopathy.

Purpose: The purpose of this study was to develop a method for real-time, fiberoptic, intracardiac imaging to serve as a platform for closed-chest, intracardiac surgery on the beating heart., Description: Fiberoptic cardioscopy of the left and right heart was conducted in a porcine model. A cardiopulmonary bypass circuit maintained systemic organ perfusion and a separate circuit replaced intracardiac blood with oxygenated, modified Krebs-Henseleit perfusate., Evaluation: Video images of structures in the left and right sides of an in vivo beating heart were obtained, including the inner surface of the left and right atria and ventricles, the mitral and aortic valves, the Thebesian veins, and the coronary sinus. Effective isolation of the heart from systemic and intracardiac blood flow and control of perfusion rates were important factors for successful image acquisition., Conclusions: Fiberoptic cardioscopy is a novel approach that allows for visualization of the structures within a nonarrested heart on bypass. It lays the groundwork for a platform that could lead to more successful percutaneous valvular and intracardiac procedures in a stable hemodynamic environment.