Effect of atropine 0.01% on myopia control in children aged 6-13 years during the 2022 lockdown in Shanghai.

Purpose: To compare the myopic progression in children treated with 0. 01% atropine and those who discontinued atropine during the 2022-home quarantine in Shanghai. Methods: In this retrospective study, children aged 6-13 years with follow-up visits before (between January 2022 and February 2022) and after the lockdown (between July 2022 and August 2022) were included. Cycloplegic refraction and axial length (AL) were measured at both visits. The atropine group had continuous medication during the lockdown while the control group discontinued. The 0.01% atropine eyedrops were administered daily before bedtime. The types of spectacle lens were recorded: single vision (SV) spectacles or defocus incorporated multiple segments lenses (DIMS). Results: In total, 41 children (81 eyes) in the atropine group and 32 children (64 eyes) in the control group were enrolled. No significant difference was found in the demographic characteristics, spherical diopter, spherical equivalent (SE), AL, and follow-up time between the two groups before the lockdown in 2022 (all p > 0.1). After the home confinement, a greater myopia progression was observed in the control group (-0.46 ± 0.42 D) compared to atropine group (-0.26 ± 0.37 D; p = 0.0023). Axial elongation was also longer in the control group than that in children sustained with atropine (0.21 ± 0.17 vs. 0.13 ± 0.15 mm, p = 0.0035). Moreover, there was no significant change of spherical diopter and SE during lockdown in the atropine + DIMS combined subgroup (0.03 ± 0.033 D for spherical diopter, p = 0.7261 and 0.08 ± 0.27 D for SE, p = 0.2042, respectively). However, significant myopic shift was observed in the atropine + SV subgroup during the quarantine time (-0.31 ± 0.39 D for SE and 0.15 ± 0.16 mm for AL, both p < 0.001). Conclusion: Children treated with 0.01% atropine had slower myopia progression during the lockdown period in Shanghai compared with children discontinued. Moreover, the effect of atropine on myopic prevention can be strengthened with DIMS lenses.

A Review Study on Associated Factors Ofmyopia Amongschool Goingchildren

Myopia is a prevalent yet confusingocular disorder. Myopia,formerlyconsidered abenignrefractivecondition, is nowassociatedwithanincreasedriskofdevelopingseveraloculardisorders,evenatmodestlevels.Myopiaisaglobalproblemthatexpe rts have documented. Despite the fact that the specific cause of myopia remains a mystery, it appears to be a combinationof genetic and environmental factors, making the prevention and treatment of the condition difficult and highly personalised.Myopia can have a positive impact on both the quality of life and the health of the eyes if it is prevented. Progressive additionlenses (PAL), topical atropine, ortho-k (orthokeratology) lenses and multifocal contact lenses are some of the most commoncontrol options currently available. Myopia has gained prominence in optometry studies as a result of its high prevalence. It ismore common for children to suffer from problems, such as extreme myopia and myopic macular degeneration, if they begindevelopingmyopiaatanearlyage.Thepurposeofthisstudywillbetoconductaninquiryintotheepidemiologyandriskfactorsfor myopiainschool-agedchildren(aged 6-19years)aroundtheworld.Copyright © 2022, Anka Publishers. All rights reserved.

Myopia control and prevention: From lifestyle to low-concentration atropine. The 2022 Josh Wallman Memorial Lecture.

The purpose of this study was to explore the findings from the Hong Kong Children Eye Study and the Low Concentration Atropine for Myopia Progression (LAMP-1) Study. The incidence of myopia among schoolchildren in Hong Kong more than doubled during the COVID-19 pandemic, with outdoor time decreased significantly and screen time increased. The change in lifestyle during the COVID-19 pandemic aggravated myopia development. Low-concentration atropine (0.05%, 0.025% and 0.01%) is effective in reducing myopia progression with a concentration-related response. This concentration-dependent response was maintained throughout a 3-year follow-up period, and all low concentrations were well tolerated. An age-dependent effect was observed in each treatment group with 0.05%, 0.025% and 0.01% atropine. Younger age was associated with a poor treatment response to low-concentration atropine. Additionally, low-concentration atropine induced choroidal thickening along a concentration-dependent response throughout the treatment period. During the third year, continued atropine treatment achieved a better effect across all concentrations compared with the washout regimen. Stopping treatment at an older age and receiving lower concentration were associated with a smaller rebound effect. However, differences in the rebound effect were clinically small across all the three concentrations studied.

CASE SERIES OF SEVERE BRADYCARDIA IN COVID-19 PATIENTS: AN UNUSUAL CARDIAC MANIFESTATION

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Cardiac manifestations of coronavirus disease 2019 (COVID-19) including bradyarrhythmias (BA) are well documented. Postulated mechanisms include direct myocardial injury through viral invasion, myocyte hypoxia, angiotensin-II receptor downregulation, hypercytokinemia and medication-related adverse events. Currently, there are no clear guidelines on the management of severe BA in the setting of COVID-19, including the threshold for permanent pacemaker (PPM) placement. We present a retrospective case series involving five COVID-19 patients with no prior history of cardiovascular disease, who developed severe BA of heart rate < 45 beats per minute. CASE PRESENTATION: Three females and two males were included in the series, with a median age of 50 years (IQR 36-61.5). Sinus bradycardia and high degree heart block were seen in two patients each. Most of the patients were noted to have sinus pauses. Inflammatory markers including D-dimer, LDH, and CRP were elevated. The median CRP in our patients was 106 mg/L (IQR 83.2-208.1) and median D-dimer was 5.63 ug/ml (IQR 1.8-13.2). All patients were treated with dexamethasone and remdesivir. However only one patient was on remdesivir on the day of onset of bradycardia. Four patients were critically ill, requiring ICU care with mechanical ventilation. Two patients required temporary transvenous pacing, one was supported on extracorporeal membrane oxygenation, and one was given atropine. No patient required PPM placement. Two deaths were observed but were not due to BA. DISCUSSION: In this single center, retrospective case series, 5 patients with COVID-19 infection developed severe BA prompting intervention. Laboratory findings demonstrated significantly elevated inflammatory markers in all our patients. The median CRP and D-Dimer in our patients was higher than the median inflammatory markers seen in a systematic review of patients with COVID-19 associated bradycardia showing that the patients in our series were suffering from severe inflammatory state. It was also observed that despite having no prior cardiac history, those more critically ill with COVID-19 infection developed severe BA requiring intervention. Conservative management and reversal of the underlying etiology prevented need for PPM implantation despite two patients developing high-grade atrioventricular-block, and one recurrent asystole. CONCLUSIONS: This preliminary data suggests that even severe BA that develops after COVID-19 infection may not require PPM placement. Further studies are required to elucidate implications, assess the reversibility, and clarify potential therapeutic targets including the indications for PPM in COVID-19 associated bradycardia. Reference #1: Nagamine, Todd et al. "Characteristics of bradyarrhythmia in patients with COVID-19: Systematic scoping review.” Pacing and clinical electrophysiology : PACE, 10.1111/pace.14466. 19 Feb. 2022, doi:10.1111/pace.14466 Reference #2: Chinitz, Jason S et al. "Bradyarrhythmias in patients with COVID-19: Marker of poor prognosis?.” Pacing and clinical electrophysiology : PACE vol. 43,10 (2020): 1199-1204. doi:10.1111/pace.14042 DISCLOSURES: No relevant relationships by Dipanjan Banerjee No relevant relationships by Monika Bernas No relevant relationships by Sandeep Randhawa No relevant relationships by Parthav Shah

Effect of COVID-19 lockdown on refractive errors in children aged 5-12 years: a retrospective study

Purpose : To explore whether the COVID-19 lockdown increased the incidence of myopia among age-school children. Methods : Retrospective study recruiting children aged 5-12. Selection: random. Inclusion criteria: healthy children presenting for an eye exam since 2016. Exclusion criteria: presence of ocular comorbidities other than refractive error, spherical equivalent (SE) less than -4D or greater than +4D, BCVA less than 20/20, blepharoptosis, media opacities, corneal or retinal dystrophies, strabismus, amblyopia, nystagmus, or concurrent therapy with atropine 0.01%. Outcome measure: age measured in months, SE of the right eye (RE) measured in diopters (D) under cycloplegia (cyclopentolate 1%). Statistical analysis: ANOVA, Chi-square, Tukey's test. Significance: p < .05. Results : A total of 803 children. In the years prior to COVID-19, the mean SE ± SD diopters in the RE: 0.54 ± 1.49 D in 2016 (n = 160), 0.43 ± 1.84 D in 2017 (n = 145), 0.34 ± 1.41 D in 2018 (n = 152), 0.35 ± 1.75 D in 2019 (n = 166) (ANOVA, p = .659) (Fig. 1). In 2021 (n = 180), the mean SE was -0.08 ± 1.44 D (ANOVA, p = .005). Using the Tukey's test, the mean SE of 2021 changed by -0.619 D 95% CI [-1.091, -0.147] and -0.501 D 95% CI [-0.986, -0.016] as compared to the SE of 2016 and 2017, respectively (Fig. 2). Mean age was comparable in all groups (ANOVA, p = .307). The decrease of the mean SE of the 2021 group corresponds to an increase in the percentage of myopes (≤-0.5D) and a decrease in the percentage of hyperopes (≥ 2D). Myopes represent the 24.10% of children aged 60-96 months, and 63.86% of children aged 97-144 months. Hyperopes represent 9.64% of children aged 60-96 months, and 6.02% of children aged 97-144 months. This represents a statistically-significant increase in the number of myopes (Chi-square, p = .016) and decrease in the number of hyperopes (Chi-square, p = .001), as compared to the previous years (2016- 2019). Conclusions : This retrospective study shows a statistically-significant decrease in the mean SE in children aged 5-12 in the year following the COVID-19 lockdown (2021). The percentage of myopes has increased significantly, while the percentage of hyperopes has decreased. Children aged 8-12 years showed the greatest refractive change. The lifestyle changes imposed by the lockdown were likely responsible for the increased prevalence of myopia observed in 2021.

Anticholinergic poisoning associated with frozen spinach

Objective: In some countries the Thursday before Easter is called Green Thursday according to the Christian calendar, and in this tradition, a green meal should be eaten on this day to ensure good health throughout the coming year. A few days before Easter the National Toxicological Information Centre (NTIC) registered an increased number of toxicological consultations following consumption of deep-frozen spinach puree which was sold in retail chains throughout Slovakia. Symptoms were characteristic of tropane alkaloid intoxication and experts suspected the spinach was contaminated with Jimson weed (Datura stramonium). Methods: A retrospective analysis of all telephone calls concerning frozen spinach products from the database of the NTIC from 1 March 2021 to 30 April 2021 was conducted. Results: The NTIC received 93 telephone calls from people who had consumed frozen spinach, of which 64 people (7 children) had mild symptoms of intoxication (PSS1) and 5 moderate poisoning (PSS2). The most commonly reported symptoms were malaise, dizziness, dry mouth, mydriasis and blurred vision that appeared within 1 to 2 hours after ingestion. Patients with moderate symptoms of intoxication were confused, disoriented and had hallucinations. The symptoms disappeared spontaneously within 48 hours. The country was in a state of emergency that had been declared before Easter due to COVID-19 and people were afraid to attend hospitals. Therefore, only 7 out of 69 people with symptoms arrived in hospital. Only 3 patients were hospitalised. Treatment was symptomatic, without the administration of an antidote physostigmine. The other patients were treated at home. Unfortunately, an increased number of consultations was recorded on Good Friday afternoon, when it was very difficult to initiate a wide scale alert informing the public through the media. Over the Easter weekend, the NTIC alerted the public to avoid the contaminated spinach via social media and the NTIC website. The State Veterinary and Food Administration of the Slovak Republic arranged analyses of contaminated frozen spinach samples in an accredited laboratory and this confirmed the presence of atropine and scopolamine. Conclusion: Datura stramonium grew with spinach in the field as a weed and contaminated the spinach due to insufficient entry and exit controls. As a result of promptly spreading information and informing the public about the contaminated spinach product in the media, further cases of poisoning over the Easter holidays were successfully averted.

Screening and Structure-Activity Relationship of Potential Compounds against Proposed Targets of COVID-19 Infection

Background: With reference to COVID-19 pandemic prevailing across the globe, chloroquine and hydroxychloroquine were reported as effective against the disease to some extent. This effectiveness can be attributed to the glycosylation interruption of the Angiotensin-converting enzyme 2 (ACE2) recep-tor, which is a known target for SARS-CoV-2 entery. On the other hand, studies suggest that the inhibition of ACE2 can be lethal in certain cases, thereby causing cardiovascular disorders, especially in patients already suffering from heart-related diseases. Methods: In this study, the most probable targets (other than ACE2) have been proposed for the treatment of COVID-19 infection by taking chloroquine and hydroxychloroquine as reference drugs. Swiss Tar-getPrediction and PASSonline tools were used in order to achieve this objective. Known drugs against each target possessing close relation to either viral infections or lung disorders were assessed from the DrugBank database, and simultaneous efficacy of these drugs towards other proposed targets has been analyzed. By taking the most effective drugs as a reference, similar compounds were screened from the ChEMBL library by using the Swiss Similarity tool. Finally, molecular docking studies were performed through MOE software by using screened compounds against proposed targets. Results: Four most probable targets have been proposed, which include chemokine receptors (CCRs), dipeptidyl peptidase 4 (DPP4), muscarinic acetylcholine receptors (CHRMs), and histamine N-methyltransferase (HNMT). Furthermore, it has been evaluated that quinacrine and vildagliptin are effective against most of the proposed targets. By taking vildagliptin as well as quinacrine as reference drugs, further eight compounds with similar effectiveness against these targets have been screened from the ChEMBL library. Molecular docking studies with CCR5, DPP4, and CHRM5 suggest that the quinacrine and its analogue (ChEMBL1782742) as well as vildagliptin and its analogue (ChEMBL511785) are the most suitable compounds as HITs for these targets. Conclusion: It has been established that the quinacrine, ChEMBL1782742, vildagliptin, ChEMBL511785, mavorixafor, atropine, and N-(2-aminoethyl)-1-aziridineethanamine in descending order can be considered as effective drugs for the treatment of COVID-19 infection.

Temporary sinus bradycardia and COVID-19 Report of a case and review of the bibliography

A cytokine storm, probably due to an imbalance in T-cell activation, could contribute to cardiovascular disease in COVID-19. Cohort studies estimated that 7-80% of hospitalized patients presented acute myocardial injury, with a greater expression in patients admitted to the intensive care unit vs. those who did not (22.2% vs. 2.0%), and in those who died vs. survivors (59% vs 1%). The first reports from China suggested an incidence of arrhythmias in hospitalized patients of 17%, rising in critical care to 44%. We present the case of a patient with a positive swab for SARS-CoV-2 infection with an interstitial-alveolar parenchymal infiltrate distributed in a genera-lized way in both lung fields, who required respiratory mechanical assistance. On the fourth day of hospitalization, he developed sinus bradycardia, requiring treatment with atropine and infu-sion of isoproterenol, resolving the clinical picture after 24 hours. The causal mechanism of sinus bradycardia is not exactly known, it is believed that it could be multifactorial, including severe hypoxia, hypotension, intrinsic imbalances of the autonomic nervous system, alteration in the regulation of the angiotensin-converting enzyme 2, drug interactions and immune-inflammatory direct damage on the sinus node.

Effectiveness of ketofol versus propofol induction on hemodynamic profiles in adult elective surgical patients: A Randomized Controlled Trial

Background: Most of the time propofol and ketamine have been used as an induction agent in adult surgical patients but propofol may cause cardiorespiratory depression while ketamine increases heart rate and arterial blood pressure. On the other hand, the clinical effects of propofol and ketamine seem to be complementary. Ketofol is most commonly used for procedural sedation hence exploring its effectiveness for induction will be paramount for the clinical care of surgical patients. Objective: This study aims to compare the hemodynamic changes between ketofol and propofol within 30 min after induction of general anesthesia for elective surgical patients. Methodology: A Double-blind Randomized Controlled Trial was done on 62 patients aged between 18 and 65 years and the American Society of Anesthesiologist class I & II those have been allocated randomly into ketofol and propofol groups. A change in systolic blood pressure, mean arterial pressure, and heart rate within 30mins was followed for both groups. After the normal distribution of data was tested analytic statistics were calculated for variables in the study using Mixed ANOVA, Independent samples T-test, and Mann Whitney U test as appropriate, and for categorical data Chi-square test or fisher's exact test was used for analysis. P-value < 0.05 is considered statistically significant with a power of 90%. Results: Both the mean systolic blood pressure and mean arterial pressure were significantly decreased in the propofol group immediately after induction, at 5th minute, 10th minute, and 15th minute compared to the baseline value with a statistically significant value of (p < 0.05). There was a significant increase in mean heart rate in the ketofol group immediately after induction and on the 5th minute after induction compared to the baseline value (p = 0.001 and p = 0.022 respectively). Conclusion and recommendations: We conclude the administration of ketofol (0.75 mg/kg of ketamine and 1.5 mg/kg of propofol) for induction of general anesthesia has better hemodynamic stability than propofol during the first 30 min after induction. We recommend to researchers to do further randomize controlled trials, with invasive blood pressure measurement and multicenter study.

Retrograde cerebral air embolism in a patient on venovenous ECMO

INTRODUCTION: Retrograde cerebral air embolism (CAE) is rarely described in literature that may be associated with manipulation of central or peripheral venous catheters. During a literature review, there were no described occurrences of CAE in patients on veno-venous (V-V) ECMO. DESCRIPTION: A 42-year-old male with ARDS secondary to COVID-19 pneumonitis was cannulated for V-V ECMO outside our facility and transferred to our cardiovascular intensive care unit. Upon arrival, he was noted to have a right femoral drainage cannula and right internal jugular (RIJ) venous antegrade cannula. On day 10 of his hospital stay he was converted to a RIJ Protek duo cannula and the right femoral drainage cannula was removed. This cannula was repositioned multiple times after placement due to flow issues. Due to poor oxygenator membrane function, it became necessary to exchange the oxygenator on day 25. During the exchange, the patient experienced sudden-onset bradycardia that progressed to several seconds of asystole. He regained spontaneous cardiac activity after a bolus dose of IV glycopyrrolate. Following this, he had several episodes of bradycardia and eventually asystole that resolved after one round of ACLS and IV atropine. The bradycardic episodes continued after this event and were associated with hypertension. On day 25, the patient suffered a decline in neurologic status from a GCS of 11T to 3T. The patient was sent emergently for non-contrast CT head. This scan revealed pneumocephalus with diffuse foci of air emboli in the subarachnoid and intraventricular spaces, the choroid plexus, and dural venous sinuses. After a family discussion, care was withdrawn from the patient on day 27. DISCUSSION: This patient suffered a massive retrograde CAE peri-ECMO circuit oxygenator exchange. It is our understanding that this a novel clinical situation for this phenomenon and not previously described in literature. This emphasizes that manipulation of any vascular cannula may result in the entrainment of air in a retrograde venous fashion into the cerebral vasculature.

Emergent temporary transvenous pacemakers were infrequently needed for patients presenting with complete heart block at a regional hospital

Introduction: Patients presenting with Complete heart block (CHB) are emergently referred for placement of a temporary transvenous pacemaker (TTVP) for hemodynamic stability. Data on the immediate management and outcomes of such patients are lacking. Methods: Data collected;through retrospective chart review of patients presenting to the Emergency Department (ED) at a regional hospital from October 2017 to January 2021 with a diagnosis of new CHB;included age, sex, clinical, laboratory and ECG data, medications, interventions and length of stay. Results: There were 71 patients (31 women) of whom 19 were on beta blocker or Calcium channel blockers. Data (see Table 1) for all variables was available in 68 patients. Syncope, lightheadedness and dyspnea were common symptoms. The median age was 77 years. The median heart rate was 41bpm. Atropine was used in 13 patients. Five patients with initial Systolic Blood Pressure (SBP) < 100mmHg received sympathomimetics. Syncope with pause occurred in 3 patients. A TTVP was placed in 12 patients. Among 22 patients with initial SBP > 160mmHg one patient with a recent TAVR had a TTVP placed. All but five were managed in the ICU setting. On Univariate logistic regression (R statistical software 3.6.1) initial SBP, SBP < 100mmHg and Initial Serum K level were clinically significant. In multivariate analysis, SBP was significant with a lower SBP predicting need for a TTVP [OR 0.96 (CI 0.91-0.99, p = 0.019)]. A permanent pacemaker (PPM) prior to discharge was placed in 64 patients on average in 1.6 days from presentation. 3 patients with STEMI and TTVP did not need a PPM. 1 transitioned to hospice and 1 patient died of sepsis. In 1 it was attributed to COVID-19 infection. Conclusions: TTVP was infrequently needed (16.66%) among patients presenting to the ED with CHB. Initial SBP and Serum K were clinically relevant factors. Prospective data related to the acute management of CHB is needed to identify predictors that can improve the care for such patients.