Blood Gas Abnormalities Research Articles

Association of extreme hyperoxemic events and mortality in pediatric critical care: an observational cohort study.

Our aim was to confirm whether extreme hyperoxemic events had been associated with excess mortality in our diverse critical care population. Retrospective analysis of 9 years of data collected in the pediatric and cardiothoracic ICUs in Children's Hospital Los Angeles was performed. The analysis was limited to those mechanically ventilated for at least 24 h, with at least 1 arterial blood gas measurement. An extreme hyperoxemic event was defined as a PaO2 of ≥300 torr. Multivariable logistic regression was used to assess the association of extreme hyperoxemia events and mortality, adjusting for confounding variables. Selected a-priori, these were Pediatric Risk of Mortality III predicted mortality, general or cardiothoracic ICU, number of blood gas measurements, as well as an abnormal blood gas measurements (pH < 7.25, pH > 7.45, and PaO2 < 50 torr). There were 4,003 admissions included with a predicted mortality of 7.1% and an actual mortality of 9.7%. Their care was associated with 75,129 blood gas measurements, in which abnormal measurements were common. With adjustments for these covariates, any hyperoxemic event was associated with excess mortality (p < 0.001). Excess mortality increased with multiple hyperoxemic events (p < 0.046). Additionally, treatment resulting in SpO2 > 98% markedly increased the risk of a hyperoxemic event. Retrospective analysis of critical care admissions showed that extreme hyperoxemic events were associated with higher mortality. Supplemental oxygen levels resulting in SpO2 > 98% should be avoided.

Multiple infections secondary to immunosuppression after Chlamydia psittaci infection: a case report

This study presents the clinical profile of a 74-year-old male patient admitted to the hospital due to a 20-day history of coughing, chest tightness, and dyspnea. Upon admission, the patient presented with fever, tachycardia, and tachypnea. Clinical examination revealed evidence of lung infection, sepsis, and multi-organ dysfunction, alongside abnormal blood gas analysis and elevated C-reactive protein (CRP) levels. Pathogen testing confirmed Chlamydia psittaci (C. psittaci), infection. Throughout the treatment course, the patient developed concurrent fungal and viral infections, necessitating a comprehensive approach involving combined antibiotic and antifungal therapy. Despite encountering treatment-related complications, the patient demonstrated clinical improvement with aggressive management. This case underscores the importance of recognizing immune suppression subsequent to Chlamydia infection, emphasizing the critical role of early diagnosis, intervention, and standardized treatment protocols in enhancing patient prognosis.

Executive functions in patients with obstructive sleep apnea: exploring the prefrontal model

According to the prefrontal model, individuals with obstructive sleep apnea (OSA) manifest behaviours mimicking dysexecutive syndrome as a result of blood gas abnormalities and sleep fragmentation. To compare executive functions in OSA patients with normative values and explore their relationship with blood gas abnormalities and sleep fragmentation. Patients were recruited from the wider community and from a tertiary care hospital. The score obtained in the neuropsychological assessment was compared with Student's t-test for a sample. A multiple linear regression analysis was subsequently estimated, using polysomnographic parameters of hypercapnia, hypoxemia and sleep fragmentation as the predictor variables, and the executive function score as the variable to be predicted. Although the neuropsychological assessment performance of 26% of this sample was classified as executive impairment, indicators of sleep fragmentation and gas abnormalities failed to predict the performance of executive functions. A proportion of the patients with OSA presented performance similar to a dysexecutive syndrome; however, the factors underlying and fostering this type of cognitive manifestation remain unclear. Early treatment for this public health problem could be the best tool available for improving quality of life and preventing health risks.

Nursing Care Process for patients with Pneumonia and Arterial Hypertension in the Emergency Department of a hospital in Lima

The present study work was applied to a patient with a medical diagnosis: pneumonia and arterial hypertension in the emergency service. The objective of the present work was to apply the nursing care process to an older adult with Pneumonia. The assessment was carried out with the guide based on the 11 functional patterns of Marjori Gordon. After identifying the problems, 11 nursing diagnoses are enunciated taking into account the NANDA taxonomy and the following diagnoses are prioritized: Impairment of gas exchange related to changes in the capillary alveolus membrane evidenced by O2 Sat: 91% Abnormal arterial blood gas (PO2: 63 mmHg) abnormal respiratory pattern, respiratory rate 26 per minute, ineffective cleaning of the airways related to changes in the capillary alveolus membrane evidenced by altered respiratory pattern, altered respiratory rate and abnormal respiratory sounds, and CP Hypertension. Subsequently, planning is carried out using the NOC and NIC taxonomy, the interventions and planned activities are executed. The results obtained gave a score of +1, +2 and +2. It is concluded that the nursing care process is the application of care in a systematic and orderly manner, helping to provide quality care and humanism.

The Genesis of Dyspnea in Patients After COVID-19

Post-COVID syndrome is an actual problem at the present time. The shortness of breath is one of the most common complaints in this group of patients. Dyspnea is one of the most significant disabling symptoms that negatively affect the quality of life of patients. The causes and mechanisms for the development of dyspnea in the post-COVID period are varied. In particular, one of the main causes of dyspnea is fibrosis-like and fibrous changes in the. Fatigue and / or muscle weakness, in particular of the respiratory muscles, can also be the cause of dyspnea. Direct SARS-CoV-2 infection of skeletal muscles, drug-induced myopathy, prolonged immobilization of hospitalized patients may also result in muscle weakness. Increased risks of thrombosis and pulmonary embolism (PE) after COVID-19, creating conditions for the development of chronic thromboembolic pulmonary hypertension, represent another factors for the development of shortness of breath. In patients with no abnormalities in blood gases or any other parameters that assess the functioning of the cardiovascular and respiratory systems, hyperventilation syndrome can be the cause of dyspnea. Thus, studying pathogenetic and molecular mechanisms of dyspnea development is an urgent problem, due to the need for specialists to choose the right tactics and select effective drugs and non-drug therapy for managing patients with this complaint.

The Effects Of Wheat Pill Poisoning (Aluminum Phosphide) Dosage On Arterial Blood Gases And Their Clinical Outcome.

To analyse the effects of aluminum phosphide poisoning dosage on arterial blood gases and the clinical outcome. The cross-sectional study was conducted at the intensive care unit of Mardan Medical Complex, Mardan, Pakistan, from January 2021 to May 2022, and comprised patients of either gender who had attempted suicide using aluminum phosphide. Data was collected using a predesigned questionnaire. Data was analysed using SPSS 26. Of the 116 patients, 42(36.2%) were males and 74(63.8%) were females. There were 75(64.65) survivors; 31(41.33) males and 44(58.66) females with overall mean age 26.30±9.45 years. There were 41(35.35%) non-survivors; 11(26.82%) males and 30(73.18) females with overall mean age 28.21±11.16 years.During hospitalisation, the non- survivors showed drastically decreased levels of all arterial blood gas paramters with severe clinical outcomes (p<0.05). As the number of aluminum phosphide pills increased, the chance of survival decreased (p<0.05). The non-survivors spent an average of 32.51±16.02 hours in hospital (range: 6-59 hours). Patients who ingested more aluminum phosphide pills had more abnormal arterial blood gas parameter with severe clinical outcomes. Also, they had lower chance of survival and unfavourable response to treatment.

Priapism managed with anti-platelets after failed shunting

Priapism is a non-sexual, persistent erection characterized by little or no cavernous blood flow and abnormal cavernous blood gases [1].

Concept Analysis of the Nursing Diagnosis of Impaired Spontaneous Ventilation in Critical Patients

Introduction: In nursing practice, this concept has been identified in studies that address the nursing diagnosis of impaired spontaneous ventilation. Nursing performance facing this unwanted human response is considered essential for the maintenance and control of vital signs, cardiovascular monitoring, gas exchange and respiratory pattern, as well as constant surveillance aimed at signs of hypoventilation and inadequate ventilation. Objective: To analyze the concept of impaired spontaneous ventilation in critically ill patients in an intensive care unit. Methodology: This study is a concept analysis, according to Walker’s and Avant’s method, conducted using an integrative review. All the referential steps were followed: concept selection, determining the objectives and proposals for concept analysis, identifying the possible uses of the concept, determining the defining attributes, identifying a model case, identifying a contrary case, and identifying the precedents and consequences of the concept. Results: A sample of 38 studies was selected. The following were identified as attributes: distress and fatigue, respiratory distress, tachycardia, hemodynamic instability, altered mental status, abnormal arterial blood gas results, dyspnea, anxiety, agitation, sweating, hypoxemia and hypercapnia. Antecedents: sex, age, oxygen saturation lower than 90%, diseases of the respiratory, cardiovascular, neurological, gastrointestinal, neuromuscular, and metabolic systems, respiratory infections, trauma, poisons, toxins, and sedatives. Consequences: increased heart rate, decreased partial oxygen saturation, increased use of respiratory muscles, dyspnea, increased metabolic rate and restlessness. The model case and the contrary case were used to illustrate the attributes, antecedents, and consequences. Conclusion: The study directed the strengthening of evidence about the phenomenon and demonstrated a strong occurrence in patients who need assistance in intensive care units, thus demanding critical care.

The Value of Fetal Cerebro-umbilical Doppler Indices in Predicting Umbilical Blood Gas Abnormalities and Apgar Score in Diabetic Pregnant Women

The Value of Fetal Cerebro-umbilical Doppler Indices in Predicting Umbilical Blood Gas Abnormalities and Apgar Score in Diabetic Pregnant Women

(404) Early Experience of Penoscrotal Decompression for Refractory Ischemic Priapism and Its Impact on Sexual Function

Abstract Introduction Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours. Objective Our objectives are to report our institutional experience using penoscrotal decompression for the surgical treatment of prolonged and refractory ischaemic priapism. The primary end point is to assess priapism resolution in the patients. While the secondary end point is to assess erection recovery in those patients. Methods We prospectively evaluated refractory and prolonged ischemic priapism patients treated with proximal decompression from 2020-2022 at Alexandria Main University Hospital. Priapisms were confirmed as ischaemic based on clinical presentations, cavernosal blood gas abnormalities, and doppler ultrasound. Treatment with irrigation and injection of α-agonists in all patients had failed prior to PSD. Patient characteristics, peri-operative variables and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated. Results Thirteen patients with priapism who had treated with penoscrotal decompression from 2020 to 2022. Their age was 28-53 years. The duration of ischemic priapism was 48 hours to 10 days. Nine patients had previously undergone shunt surgery. All patients were successfully treated with Penscrotal deecompression without additional intervention and noted immediate relief of pain postoperatively. Of the 10 patients with documented sexual function status at last follow-up, six reported spontaneous erectile function adequate for penetration, while four reported erectile dysfunction. Conclusions Penoscrotal decompression proved to be an effective and safe way of managing refractory ischemic priapism. The technique showed to produce favorable results while maintaining adequate sexual function. Disclosure Yes, this is sponsored by industry/sponsor: alexandria main university hospital. Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: alexandria main university hospital.

First-day computed tomography: does it has a role in the assessment of patients with inhalation lung injury?

BackgroundInhalation lung injury occurs in almost one-third of all serious burns and is responsible for a considerable proportion of burn patient fatalities each year. History of closed space fire or unconsciousness at the accident site, occurrence of pharyngeal or facial burns, hoarseness, and wheezing, and laboratory tests that include blood gas abnormalities or Carboxyhemoglobin levels in blood ˃ 10% are used to diagnose inhalation lung injury. It is also characterized by radiological findings of alveolar or interstitial edema, atelectasis, and/or consolidations, as well as the presence of erythema with laryngeal or tracheal edema in the bronchoscope.ObjectivesTo study the diagnostic and prognostic efficacy of radiologist score and bronchial wall thickening as radiological CT findings in inhalation lung injury.MethodsThis prospective case–control study included 48 patients with inhalation lung injury (ILI) as a case group and 10 patients without ILI were selected as the control group, all recruited from the burn and plastic department. Within the first 12 h of suspected ILI, a fiberoptic bronchoscope was done to confirm the diagnosis. An initial chest X-ray was done followed by computed tomography through which the radiologist score (RADS) together with bronchial wall thickening (BWT) was done.ResultsDuration of ventilation was higher in cases than in controls (8.50 ± 3.94 vs 3.25 ± 0.50). The hospital duration was higher in cases than in controls (13.6 ± 4.68 vs9.50 ± 4.52). The BWT was 2.12 ± 0.66 (mean ± SD) in the ILI group while the control group was 1.32 ± 0.48 (mean ± SD). Correlating between baseline PaO2 and RADS score and BWT, it was found that there was a highly significant negative correlation between PaO2 and RADS score and BWT among inhalation lung injury patients (P value 0.001). The sensitivity of BWT in the detection of the need for mechanical ventilation was 83% at a cut-off point of 1.65. Its specificity was 78% and accuracy 75%.ConclusionCT done within 24 h of burn patients has a good role in the diagnosis and management of ILI from the burn.

Respiratory Rate as a Factor in Lung Injury-Not Just What You Set, but How You Set.

Respiratory Rate as a Factor in Lung Injury-Not Just What You Set, but How You Set.

Pattern of self-reported adverse events related to COVID-19 vaccines in Saudi Arabia: A nationwide study.

Vaccination against coronavirus disease 2019 (COVID-19) is the most effective way to end the pandemic. Any development of adverse events (AEs) from various vaccines should be reported. We therefore aimed to explore major and minor AEs among vaccinated individuals in Saudi Arabia. This is a nationwide report based on the Saudi Arabian Ministry of Health (MOH) registry. It included those who received COVID-19 vaccines from 17th December 2020 to 31st December 2021. The study included spontaneous self-reported adverse effects to COVID-19 vaccines where the study participants used a governmental mobile app (Sehhaty) to report their AEs following vaccination using a checklist option that included a selection of side-effects. The primary outcome was to determine AEs reported within 14 days of vaccination which included injection site itching, pain, reaction, redness, swelling, anxiety, dizziness, fever, headache, hoarseness, itchiness, loss of consciousness, nausea, heartburn, sleep disruption, fatigue, seizures, anaphylaxis, shortness of breath, wheezing, swelling of lips, face, and throat, loss of consciousness, and admissions into the intensive care unit (ICU). The study included a total number of 28,031 individuals who reported 71,480 adverse events (AEs); which were further classified into minor and major adverse events including ICU admissions post vaccination. Of the reported AEs, 38,309 (53. 6%) side-effects were reported following Pfizer-BioNTech, 32,223 (45%) following Oxford-AstraZeneca, and 948 (1.3%) following Moderna. The following reported AEs were statistically significant between the different vaccine types: shortness of breath\difficulty of breathing, dizziness, fever above 39°C, headache, hoarseness, injection site reactions, itchiness, nausea, sleep disruption, fatigue, wheezing, swelling of lips/face and\or throat, and loss of consciousness (p-value < 0.05). Fever and seizure were the only statistically significant AEs amongst the number of vaccine doses received (p-value < 0.05). Ten ICU admissions were reported in the 14 days observation period post-COVID-19 vaccination with the following diagnoses: acute myocardial infarction, pneumonia, atherosclerosis, acute respiratory failure, intracranial hemorrhage, grand mal seizure, Guillain-Barré syndrome, abnormal blood gas levels, and septic shock. This study demonstrated that the most prevalent SARS-CoV-2 vaccine side-effects among adults in Saudi Arabia were mild in nature. This information will help reduce vaccine hesitancy and encourage further mass vaccination to combat the COVID-19 pandemic, especially as booster doses are now available. Further studies are warranted to obtain a better understanding of the association between risk factors and the experiencing of side-effects post vaccination.

Risk factors for perinatal stroke in term infants: A case-control study in Australia.

The aetiology of perinatal stroke is poorly understood. This study aimed to prospectively confirm the risk factors and identify any previously unknown variables. A prospective case-control study was conducted in Australia. Univariate odds ratios (ORs), associated 95% confidence intervals (CIs) and multivariable logistic regression models fitted with backwards stepwise variable selection were used. Sixty perinatal stroke cases reported between 2017 and 2019 included 95% (57/60) with multiple risk factors. Univariate analysis identified emergency caesarean section rather than NVD (P < 0.01), low Apgar score (<7) at 1, 5 and 10min of age (P < 0.01), resuscitation at birth (P < 0.01), abnormal cord blood gas (P < 0.01), neonatal infection/sepsis (P < 0.01), congenital heart disease (P <0.01) and hypoglycaemia (P < 0.01) as significant risk factors. Multivariate analysis found smoking during pregnancy (OR: 1.48; 95% CI: 1.09-1.99), 1-min Apgar score < 7 (OR: 1.54; 95% CI: 1.15-2.08), 10-min Apgar score < 7 (OR: 1.26; 95% CI: 1.02-1.54) and hypoglycaemia (OR: 1.49; 95% CI: 1.07-2.06). Perinatal stroke is associated with multiple risk factors. Exposure to smoking, 10-min Apgar score < 7, neonatal infection and hypoglycaemia were independent risk factors. Emergency caesarean section, resuscitation at birth and abnormal cord blood gas were additional risk factors.

COVID 19 vaccine induced thrombotic thrombocytopenia, cerebral venous thrombosis and neurogenic stunned myocardium.

To the Editor, Vaccine-induced thrombotic thrombocytopenia (VITT) manifesting as cerebral venous thrombosis (CVT) is rare but life-threatening complication after COVID-19 vaccination.[1] Neurogenic stunned myocardium (NSM) is a phenomenon of cardiac abnormalities occurring due to sympathetic storm after acute neurological injury.[2] This case reporting is done after obtaining written informed consent. We describe rare manifestation of VITT, CVT, and NSM after COVID-19 vaccination and its successful management. A 19-year-old lady presented with altered sensorium for 2 days. Prior to her current visit, she had low-grade fever for 2 days and holocranial headache with vomiting for one week after COVID-19 vaccination with COVAXIN® (Bharat Biotech). On examination, she was drowsy, obeying simple commands on repeated asking, aphasic, with motor power of 3/5. Her pupils were equal and reactive. Respiratory and cardiovascular system examination was normal. Brain computed tomography showed left temporo-parietal CVT with raised intracranial pressure (ICP), midline shift to right and left transverse sinus thrombosis [Figure 1]. Laboratory tests revealed thrombocytopenia (platelet count 43,000/μL), elevated D-dimer (7457 ng/mL), and prolonged prothrombin time (18.8s). VITT associated CVT was diagnosed. In view of neurological status and imaging findings, she underwent emergency temporo-parieto-occipital decompressive craniectomy. She received four units of random donor platelet transfusion and three units of fresh frozen plasma before and during surgery. She was shifted to neuro-intensive care unit for elective ventilation and further management. VITT was managed with Fondaparinux and therapeutic plasma exchange (TPE). On 2nd postoperative day (POD), she developed persistent hypotension with tachycardia resistant to fluid therapy, with abnormal arterial blood gas (PaO2 = 40.9 mmHg, PaCO2 = 25.7 mmHg, pH = 7.48, SaO2 = 80.9%). Hence, norepinephrine was started, positive end expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) increased to 8 cm water and 0.7, respectively. Following this, her heart rate was 112/min, blood pressure was 112/80 mmHg, electrocardiogram showed sinus tachycardia and oxygen saturation was 90%. The FiO2 was gradually reduced with improvement in oxygenation. Transthoracic echocardiography (TTE) showed left ventricular global hypokinesia with ejection fraction of 34%. She was diagnosed with acute left ventricular failure from NSM. Dobutamine and furosemide infusion with oral ivabradine resulted in improvement and cardiovascular medications were tapered and stopped on 9th POD and trachea was extubated on 10th POD. After 24h observation, she was shifted to ward and subsequently discharged home with improved neurological status. Follow up TTE at discharge showed normal cardiac contractility.Figure 1: Contrast computed tomography of the brain showing large temporo-parietal hematoma due to cerebral venous thrombosis with midline shift, mass effect, and significant cerebral edema with loss of gray-white differentiationVITT is characterized as vaccine-induced immune syndrome of severe thrombosis, antibodies to platelet factor 4–polyanion complexes and thrombocytopenia.[3] VITT begins 5-10 days after vaccination and is diagnosed between 5 to 30 days.[4] It is associated with CVT, splanchnic vein thrombosis, deep venous and arterial thrombosis with thrombocytopenia, and elevated D-dimer. Treatment includes non-heparin anticoagulants such as indirect Xa inhibitors (fondaparinux, danaparoid), oral anticoagulants or thrombin inhibitors (argatroban, bivalirudin), and intravenous immunoglobulin or TPE. NSM is reported after stroke, traumatic brain injury, and subarachnoid hemorrhage but not after CVT. Catecholamine excess, systemic inflammation, and neuroendocrine derangements contribute to occurrence of NSM.[5] It is likely that the NSM in our patient was due to interplay of acute increase in ICP (neurogenic) from VITT-associated malignant CVT and systemic vaccine-induced complication-associated stress on the myocardium. Treatment is supportive to improve myocardial function and prevents cardiovascular complications including sudden death.[5] Ivabradine reduces heart rate and improves cardiac failure while dobutamine improves hemodynamic instability associated with NSM.[5,6] To conclude, VITT-associated CVT leading to NSC is rare and challenging to identify and manage. Management goals include reduction of acute intracranial hypertension, restoration of platelet function, anti-coagulation, and supporting cardiac function. Patient consent form Yes. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Non-comorbid Respiratory Factor and Work of Breathing in Pediatric COVID-19 Patient: How is Their Synergistic Correlation with the Level of Care?

Background: Work of breathing (WOB) and non-comorbidities factors in the respiratory system are the two probable findings in pediatric COVID-19 patients. However, the association of those factors with level of care was not well reported.Purpose: This study aimed to identify the relation between potential predictors including comorbidity, low nutritional fulfillment, infectious disease, shock, cough, O2 saturation reduction, abnormal blood gas analysis and sore throat with the level of care among pediatric COVID-19 patients. We also analyzed the synergistic correlation of non-comorbidities factors in the respiratory system and work of breathing to predict level of care in pediatric COVID-19 patients.Methods: A cross-sectional study was conducted in the six referral hospitals from July to September 2020 in four provinces in Indonesia. An observation checklist was used to collect data from the medical records of pediatric patients with COVID-19, including medical diagnosis, demographic, and clinical manifestation. This study included 423 participants aged from 0 to 18. The multivariate logistic regression was performed to test the adjusted odds ratios (AORs) with the 95% confidence intervals (CIs) of the association between WOB, non-comorbid respiratory, and level of care. Moreover, dummy variables (2x2) were made to analyze synergistic correlation of non-comorbid respiratory disease and WOB. The AOR with the 95% CIs was applied in the association between the complication of non-comorbid respiratory diseases and high work of breathing with level of care among pediatric patients with COVID-19.Results: Results showed that age, presence of comorbidity, nutritional fulfillment, infectious disease, shock, work of breathing, O2 saturation reduction, abnormal blood gas analysis, sore throat, and convulsive meningeal consciousness were significantly associated with the level of care (p&lt;0.05). Pediatric patients with non-comorbid respiratory and increased work of breathing had a 15.59 times higher risk of requiring PICU care level (p&lt;0.01). Meanwhile, pediatric patients who experienced both non-comorbid respiratory and increased work of breathing had a 5.76 times risk of requiring an intermediate level of care (p&lt;0.05), and 9.32 times higher risk of requiring a PICU level of care (p&lt;.05).Conclusion: It was found that both non-comorbid respiratory and increased WOB had a significant relationship with the level of care for pediatric patients with COVID-19. Nurse should take into account those clinical findings to increase the awareness in monitoring clinical deterioration in pediatric COVID-19 patients.

Association of Gut Microbiota Composition in Pregnant Women Colonized with Group B Streptococcus with Maternal Blood Routine and Neonatal Blood-Gas Analysis.

Group B Streptococcus (GBS) colonizes the vaginal and rectal mucosa in a substantial proportion of healthy women, and GBS is a risk factor for GBS-associated adverse birth outcomes, such as bacterial infection, in neonates. Whether changes in the gut microbiota of GBS-infected pregnant women are associated with maternal complete blood cell count (CBC) and neonatal blood-gas analysis is unknown. To explore the relationship between the intestinal microecological composition of pregnant women and maternal blood routine and neonatal blood-gas analysis, we collected intestinal microecology samples of 26 pregnant women in clinic. They were divided into a positive group(GBS positive,GBS +) and a negative group (GBS negative, GBS-), with 12 in the positive group and 14 in the negative group. 16S rRNA gene sequencing was used to examine the gut microbiota profile from a fecal sample of pregnant women. CBC was carried out in enrolled pregnant women and umbilical arterial blood-gas analysis (UABGA)was conducted for analysis of intestinal microbiota composition, maternal blood routine and neonatal blood gas. Our results showed significant differences in the total number of organisms and microbial diversity of intestinal microbiota between healthy pregnant women and GBS-positive pregnant women. Particularly, abundances of Lentisphaerae, Chlorobi, Parcubacteria, Chloroflexi, Gemmatimonadetes, Acidobacteria, Fusobacteria and Fibrobacteres were only detected in participants with GBS colonization. Blood-gas analysis revealed that neonates born to mothers with GBS colonization had significantly higher fractions of carboxyhemoglobin (FCOHb) and lower methemoglobin (FMetHb), and abundances of OTU80, OTU122, OTU518 and OTU375 were associated with blood-gas indicators, such as carboxyhemoglobin, methemoglobin, PCO2, PH and ABE. Interestingly, there were significant correlations between OTU levels and inflammatory indexes in pregnant women with GBS infection. Together, this study revealed for the first time that altered gut microbiota compositions are related to the inflammatory state in GBS-positive pregnant women and neonatal blood-gas indicators. GBS colonization may lead to significant changes in the gut microbiome, which might be involved in the pathogenesis of the maternal inflammatory state and neonatal blood gas abnormalities.

Non-pharmacological Management in Palliative Care for Patients With Advanced COPD.

Chronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation and lung tissue damage; its main symptoms are breathlessness, fatigue, cough, and sputum production. In the advanced stage of the disease, these symptoms may severely impact on a person's physical and psychological functioning, with some also developing chronic respiratory failure, associated with blood gas abnormalities. Non-pharmacological interventions can improve quality of life and functioning in the management of people living with advanced COPD. This article will provide an overview of common non-pharmacological methods used in the symptomatic management of severe COPD, including: breathlessness and fatigue management strategies, anxiety management, pulmonary rehabilitation (PR) and physical activity (PA), neuromuscular electrical stimulation (NMES), airway clearance techniques (ACTs), nutrition and non-invasive ventilation (NIV). The importance of a holistic and multi-disciplinary approach to people living with COPD will be discussed.

Disorders of Blood Gases, Electrolytes, Magnesium, Albumin and Calcium Metabolism in SARS-CoV-2-infected Patients

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infection is characterized by several malfunctions, including severe pulmonary disorders. Other metabolic consequences of SARS-CoV-2-infection have not been clearly defined. The present study assessed the status of blood gases, calcium metabolism, and electrolytes in SARS-CoV-2-infected individuals. One hundred and thirty-four newly diagnosed SARS-CoV-2-infected patients (age ranged 65-82years) attending Mullingar Regional Hospital, Republic of Ireland, participated in this study. They all had pulmonary disorders, pyrexia, body pains, etc. SARS-CoV-2 was confirmed in all patients using the RT-PCR molecular test method. The data of another 121 plasma samples of apparently normal, non-SARS-CoV-2-infected individuals taken before the emergence of Covid-19 served as controls. Levels of partial pressure of oxygen (pO2), saturated oxygen (SatO2), partial pressure of carbon dioxide (pCO2), and ionized calcium (Ca2+) were determined in all participants using the potentiometric method in RAPIDPOINT 500 Blood Gases System. Plasma vitamin-D was determined by immune enzymatically technique using DXi 800 Access Immunoassay System. Total calcium, phosphate, albumin, magnesium, and electrolytes were determined by the photometric method using Beckman Au680- Chemistry Analyzer. The results showed significantly (p&lt;0.05) higher levels of pCO2 and HCO3- in COVID-19-patients compared to controls. Significantly(p&lt;0.05) lower levels of pO2, SatO2, pH, K+, albumin, total-calcium, Ca2+, magnesium, and vitamin-D were observed in COVID-19 patients compared to controls. Corrected calcium, PO4-, Na+, and Cl- levels did not show significant (p&gt;0.05) changes in the COVID-19-patients compared to controls. Abnormal blood gases, acidosis, hypomagnesaemia, hypoalbuminemia, hypovitaminosis D and calcium metabolic disorders could be features of COVID-19-disease.

Multidimensional assessment and cluster analysis for OSA phenotyping.

Obstructive sleep apnea (OSA) is a heterogeneous disease with varying phenotype. A cluster analysis based on multidimensional disease characteristics, including symptoms, anthropometry, polysomnography, and craniofacial morphology, in combination with auto-continuous positive airway pressure titration response and comorbidity profiles, was conducted within a well-characterized cohort of patients with OSA, with the aim to refine the current phenotypic expressions of OSA with clinical implications. Two hundred ninety-one patients with a new diagnosis of moderate to severe OSA referred for auto-continuous positive airway pressure titration to the sleep center were included for analysis. In-laboratory polysomnography and craniofacial computed tomography scanning were performed, followed by an auto-continuous positive airway pressure titration. The symptom of excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Three patient phenotypes-normal weight, nonsleepy, moderate OSA; obese, nonsleepy, severe OSA; and obese, sleepy, very severe OSA with craniofacial limitation-were identified. Among the polysomnography parameters, only percentage of N3 time of total sleep time (N3%) and mean pulse oxygen saturation were found to be associated with the Epworth Sleepiness Scale score, and they only explained a small fraction of the variation (R2 = .136). Neck circumference and craniofacial limitation were associated with the more severe phenotype, which had a higher prevalence of hypertension and metabolic syndrome, greater diurnal blood gas abnormalities, and worse positive airway pressure titration response. Three OSA phenotypes were identified according to multiple aspects of clinical features in patients with moderate to severe OSA, who differed in their prevalence of hypertension, metabolic syndrome, diurnal blood gas parameters, and continuous positive airway pressure titration response. Self-reported excessive daytime sleepiness was not related with the severity of sleep breathing disturbance, and craniofacial limitation was associated with the more severe phenotype. These findings highlight the necessity of integrating multiple disease characteristics into phenotyping to achieve a better understanding of the clinical features of OSA. Zhang XL, Zhang L, Li YM, etal. Multidimensional assessment and cluster analysis for OSA phenotyping. J Clin Sleep Med. 2022;18(7):1779-1788.