Comparison and agreement between arterial versus venous blood gas analysis and pulse oxymetry in children with acute asthma

Background: Blood gas analysis is critical in managing children in intensive care unit primarily in respiratory disorders. This study aimed to ascertain agreement between the arterial and peripheral venous measurement of pH, pCO2, pO2 and bicarbonate levels along with SpO2 in acute asthma.Methods: Hospital based cross sectional analytical study was conducted at Pushpagiri Institute of Medical Sciences in 50 children within the age group of 5-15 years who presented with symptoms suggestive of acute asthma with a modified PSI>6 after informed consent from parents and assent from child. SpO2 monitoring and ABG simultaneously with VBG were done immediately after admission. Statistical analysis was done to find out any correlation using Pearson correlation coefficient and Bland Altman plots were drawn to assess agreement.Results: 50 children in the age group 5 years to 15 years were included in the study. Arterial pH and venous pH were found to be correlated significantly, Pearson correlation coefficient r=0.438. There was a good correlation between the arterial and venous pCO2 with r= 0.610, bicarbonate values r=0.608. There was poor correlation between arterial PO2 and venous PO2 values (r=0.030). The bias plot for pH and pCO2 showed moderate agreement in with 95% limits of agreement being in acceptably narrow range. The mean bias in pH was 0.0242 (SD=0.04912, 95% limits of agreement = -0.0721 to 0.12045); bias in pCO2 was -4.04400 (SD=5.53616, 95% limits of agreement = -14.8949 to 6.8069), and in bicarbonate levels -0.0940 (SD=2.09, 95% limits of agreement = -4.1998 to 4.0119).Conclusions: Even though there was a good correlation and a moderate agreement between ABG and VBG parameters like pH, pCO2 and bicarbonate, VBG cannot be replaced for ABG in acute asthma. Pulse oximetry also has limitations in children with acute severe asthma as compared to ABG value.

Anatomy and physiology of cisternostomy

Cisternostomy is defined as opening the basal cisterns to atmospheric pressure. This technique helps to reduce the intracranial pressure in severe head trauma as well as other conditions when the so-called sudden "brain swelling" troubles the surgeon. We elaborated the surgical anatomy of this procedure as well as the proposed physiology of how cisternostomy works. This novel technique may change the current trends in neurosurgery

Promoting versatile vaccine development for emerging pandemics

The ongoing COVID-19 pandemic has demonstrated the importance of rapid and versatile development of emergency medical countermeasures such as vaccines. We discuss the role of platform vaccines and prototype pathogen research in modern vaccine development, and outline how previous pathogen-specific funding approaches can be improved to adequately promote vaccine R&D for emerging pandemics. We present a more comprehensive approach to financing vaccine R&D, which maximises biomedical pandemic preparedness by promoting flexible vaccine platforms and translatable research into prototype pathogens. As the numerous platform-based SARS-CoV-2 vaccines show, funders can accelerate pandemic vaccine development by proactively investing in versatile platform technologies. For certain emerging infectious diseases, where vaccine research can translate to other related pathogens with pandemic potential, investment decisions should reflect the full social value of increasing overall preparedness, rather than just the value of bringing a vaccine to market for individual pathogens