Insulin is readily concentrated from 10 to 50 ml of urine with better than 75% recovery using octadecylsilyl (ODS) silica columns (C18Sep-Pak cartridge) and can then be measured by radioimmunoassay. Fractionation on Sephadex G50 gel filtration reveals that the apparent immunoreactivity corresponds for the most part to 6000 dalton insulin. Renal clearance of insulin in 5 normal subjects does not appear to differ in the fasted or fed state and ranged from 0.34 to 0.58 ml/min with an average of 0.44 +/- 0.10 (S.D.) ml/min. Increased urinary insulin output was observed following feeding and fell during prolonged fasting. Insulin output in urine from 7 non-diabetic subjects ranged from 11 to 39 mU/24 hr, averaging 25 +/- 10 mU/24 hr. In normal subjects without renal disease a single determination of renal insulin clearance and a timed urinary insulin output appear to be sufficient for determination of mean plasma insulin during that time period. Concentration of urine using this methodology could provide the material for HPLC screening for abnormal insulins and for their subsequent purification to determine the site of change in amino acid sequence.
Adult ; Chromatography, Gel ; Diabetes Mellitus, Type 1/diagnosis ; Female ; Humans ; Insulin/blood/*urine ; Male ; Metabolic Clearance Rate ; Middle Aged ; Radioimmunoassay/*methods

Objectives: To compare the vector analysis, visual, and refractive outcomes of femtosecond-assisted laser insitu keratomileusis (LASIK) and small incision lenticule extraction (SMILE) among myopic patients with moderate myopic astigmatism. Methods: This was a single-center, retrospective, cohort study that compared eyes that underwent femtosecond LASIK or SMILE for the correction of myopia and astigmatism of 0.75 to 3.0 diopters. Vector analysis and standard graphs for reporting visual and refractive outcomes were utilized for analysis. Results: There were 82 femtosecond LASIK-treated eyes and 80 SMILE-treated eyes with similar preoperative characteristics except for slightly higher mean preoperative sphere refraction in the SMILE group (-4.2±2.4 D vs -4.9±1.6 D, p=0.03). At 3 months, femtosecond LASIK group had better mean uncorrected distance visual acuity (UDVA) (LogMAR 0.006±0.06 vs 0.06±0.09, p=0.00) and had more eyes achieving postoperative UDVA of 20/20 or better (88% versus 56%). Although there were similar postoperative spherical equivalents, residual astigmatism was higher in the SMILE group (0.11±0.22 D vs 0.32±0.30 D, p=0.00). Vector analyses showed significantly better outcomes for femtosecond LASIK than for SMILE in terms of difference vector (DV), index of success (IOS), torque, and flattening index (FI). A trend for undercorrection for higher astigmatism was seen in both groups that was greater in the SMILE group. Both groups showed high safety with the majority of eyes showing postoperative corrected distance VA (CDVA) within 1 line of preoperative CDVA (98.8% versus 91.2%). Conclusion Although femtosecond LASIK and SMILE have similar predictability at 3 months, femtosecond LASIK has relatively better efficacy and superior astigmatic outcomes than SMILE for the correction of moderate myopic astigmatism.
Astigmatism

No abstract available.
Lung Diseases, Interstitial

INTRODUCTION: It remains unclear which advanced airway device has better placement success and fewer adverse events in out-of-hospital cardiac arrests (OHCAs). This study aimed to evaluate the efficacy of the VBM laryngeal tube (LT) against the laryngeal mask airway (LMA) in OHCAs managed by emergency ambulances in Singapore. METHODS: This was a real-world, prospective, cluster-randomised crossover study. All OHCA patients above 13 years of age who were suitable for resuscitation were randomised to receive either LT or LMA. The primary outcome was placement success. Per-protocol analysis was performed, and the association between outcomes and airway device group was compared using multivariate binomial logistic regression analysis. RESULTS: Of 965 patients with OHCAs from March 2016 to January 2018, 905 met the inclusion criteria, of whom 502 (55.5%) were randomised to receive LT while 403 (44.5%) were randomised to receive LMA. Only 174 patients in the LT group actually received the device owing to noncompliance. Placement success rate for LT was lower than for LMA (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.90). Complications were more likely when using LT (OR 2.82,0 95% CI 1.64-4.86). Adjusted OR for prehospital return of spontaneous circulation (ROSC) was similar in both groups. A modified intention-to-treat analysis showed similar outcomes to the per-protocol analysis between the groups. CONCLUSION LT was associated with poorer placement success and higher complication rates than LMA. The likelihood of prehospital ROSC was similar between the two groups. Familiarity bias and a low compliance rate to LT were the main limitations of this study.
Allied Health Personnel ; Humans ; Intubation, Intratracheal ; Laryngeal Masks ; Out-of-Hospital Cardiac Arrest/therapy* ; Prospective Studies ; Singapore

OBJECTIVE

Given that rabies remains endemic in the Philippines despite government interventions and the pandemicrelated restrictions have hampered its surveillance, this study aimed to estimate the effect of human population, anti-rabies vaccination efforts, and COVID-19 situation on the spread of rabies cases in the districts of Davao City, Philippines.

A retrospective study of the canine records at Davao City Veterinarians’ Office was done from January 2018 to June 2021. Monthly rabies cases were ascertained, and the effect of the human population, COVID-19 season, and vaccination ratio on rabies cases was estimated using panel regression models adjusting for confounding factors.

The reporting of rabies cases was lower during COVID-19 than during the non-COVID-19 season, with an IRR of 0.52 [95% confidence interval (CI): 0.33–0.82]. Furthermore, rabies cases increased by 2.23% (95% CI: 0.60–3.89) per 1% increase in vaccination ratio. Additionally, high-population districts recorded more rabies cases than low-population districts.

Consistency in monitoring rabies cases during the pandemic is suggested as a roadmap for future program initiatives. Vaccination efforts should be reinforced to increase rabies awareness and ensure early response to emerging diseases. Moreover, highpopulated districts should be prioritized in implementing rabies control interventions to gain optimal development.

BACKGROUND AND OBJECTIVE

Rabies continues to be a challenge in Davao City despite the efforts of the city’s local government to vaccinate primarily the non-stray dog population. Meanwhile, studies have shown that time-dependent vaccination strategy is considered a prime factor for a cost-effective rabies control strategy. Hence, this study aims to provide information that will determine the optimal vaccination strategy targeted to the stray dog population that minimizes the rabies-infected dog population and vaccination costs using optimal control theory (OCT).

OCT is used to identify the optimal level of key rabies control, i.e., vaccination. Here, OCT was applied to a modified Susceptible-Exposed-Infectious-Vaccinated (SEIV) compartmental model. The study's key parameters were derived from published articles on rabies in Davao City and similar regions, along with the city's rabies reports.

The findings revealed that while rabies remains endemic in the city, it is possible to reduce the number of cases through consistent implementation of vaccination programs to the exposed and susceptible dog populations. Nevertheless, the feasibility of these findings relies to the effective targeting of vaccine coverage for the dog population. From the simulations performed, the exposed dog population (i.e., pre-rabid dogs) was able to reach zero observation when the transmission rate (?) is 0.001 for all values of anti-rabies vaccine coverages for exposed (?) and susceptible (b) dog populations and ? = 0.01 only when ? = 0.7 and b = 0.7, ? = 0.7 and b = 0.5, and ? = 0.5 and b = 0.7. Consequently, the number of infectious dogs will thereby decrease. Moreover, a nonlinear correspondence was also observed in all scenarios between the vaccination rate and the number of rabies-exposed dogs such that the reduction in the incidence of rabies cases becomes apparent only when the vaccination rate is at least 0.9995.

In high rabies transmissibility scenarios, a time-dependent vaccination strategy demonstrated a reduction in the number of rabies-infected dogs. However, this approach involves a trade-off, limiting the period during which monthly vaccinations can be relaxed. Consequently, a robust and timely vaccination program for dogs is crucial to manage high rabies transmission rates. Lastly, the model simulation underscores the importance of initiating monthly vaccinations.