Decrease In Oxygen Saturation Research Articles

Prevalence and complication of COVID-19 in patients with ankylosing spondylitis (AS) and its relationship with TNF-a inhibitors.

Ankylosing spondylitis (AS) is a condition that is treated with nonsteroidal anti-inflammatory drugs and biological drugs such as anti tumor necrosis factor alpha (TNF-α). This study examined the prevalence of COVID-19 among individuals with AS and compare it between those receiving and not receiving TNF-α inhibitors. A cross-sectional study was conducted at the rheumatology clinic of Imam Khomeini Hospital in Tehran, Iran. The study included patients with AS who sought treatment at the clinic. Demographic information, laboratory and radiographic findings, and disease activity were recorded through interviews and examinations using a questionnaire. A total of 40 patients were studied over the course of 1 year. Among them, 31 patients were administered anti-TNF-α drugs, with 15 patients (48.3%) receiving subcutaneous Altebrel (Etanercept), 3 patients (9.6%) receiving intravenous Infliximab, and 13 patients (41.9%) receiving subcutaneous Cinnora (Adalimumab). Of the total, 7 patients (17.5%) tested positive for COVID-19, 1 of whom was confirmed through both CT scan and polymerase chain reaction (PCR) testing, while the remaining 6 patients were confirmed only through PCR testing. All patients tested positive for COVID-19 were male, and 6 of them had received Altebrel. Among the 9 AS patients who did not receive TNF inhibitors, 1 patient contracted SARS-CoV-2. The clinical symptoms experienced by these patients were mild, and hospitalization was not required. However, 1 patient who had insulin-dependent type 1 diabetes and was receiving Infliximab required hospitalization. This patient exhibited more severe COVID-19 symptoms, including high fever, pulmonary involvement, dyspnea, and decreased oxygen saturation. No cases of COVID-19 were reported in the Cinnora treatment group. The use of any of the drugs did not demonstrate a significant relationship with the occurrence of COVID-19 in patients. The use of the TNF-α inhibitors in patients with AS, may be associated with reduced hospitalization and death rate in COVID-19 cases.

The Effect Of Prone Position On Oxygen Saturation In Premature Infants

Preterm labor is labor that occurs when the gestational age is less than 37 weeks so that it can result in respiratory distress syndrome. One of the signs and symptoms is a decrease in oxygen saturation. If the oxygen saturation is low, it can cause reduced tissue oxygen. One way to increase oxygen saturation in premature babies is the prone position. This Literature Review discusses the increase in oxygen saturation in premature infants who are given the prone position. This research uses a literature review study with a search strategy using the PICOS framework in the pubMed, researchgate, garuda, and google scholar databases in the 2018-2023 timeframe. The results of the ten articles analyzed were the duration of the pronation position between 1-3 hours with monitoring of oxygen saturation in the first and second 10 to 60 minutes. There is an effect of the prone position on increasing oxygen saturation in premature infants with a significance value of p<0.05. The average oxygen saturation of premature babies after being given a prone position has increased by 94% -99%. There is an increase in oxygen saturation in premature infants after the prone position is performed.

Oxygen and pCO2 in the Surface Waters of the Atlantic Southern Ocean in 2021–2022

The carbon dioxide concentration in the atmosphere has progressively risen since pre-industrial times. About one-third of the anthropogenically generated CO2 is absorbed by the waters of the World Ocean, whereas the waters of the Southern Ocean take up about 40% of this CO2. The concentrations of oxygen and carbon dioxide dissolved in seawater are sensitive to climate changes, transferring anthropogenic pressures with consequences for the biogeochemical cycles in the World Ocean. The Southern Ocean is a key region for the exchange of oxygen and carbon between the surface water and the atmosphere and for their transfer with cold water masses to the deep layers of the Ocean. In this paper, we discuss the dynamics of the carbon dioxide partial pressure (pCO2) and dissolved oxygen (O2) in the surface waters of the Atlantic Southern Ocean based on data collected during the 87th cruise of the R/V “Academik Mstislav Keldysh”. The study area includes the Bransfield Strait, Antarctic Sound, the Powell Basin, the Weddell, and Scotia Seas. We have analyzed the spatial distribution of pCO2 and oxygen for the areas of transformation of water masses and changes in biogeochemical processes. In the zone of Scotia and Weddell Seas, we have observed an increase in pCO2 and a decrease in oxygen concentrations at the transect from the Weddell Sea at 56° W to the Powell Basin. From the Antarctic Sound to the Bransfield Strait, a decrease in oxygen saturation and an increase in pCO2 has been traced. The surface waters of the Bransfield Strait have revealed the greatest variability of hydrochemical characteristics due to a complex structure of currents and intrusions of different water masses. In general, this area has been characterized by the maximum pCO2, while the surface waters are undersaturated with oxygen. The variability of the AOU/ΔpCO2 (w-a) ratio has revealed a pCO2 oversaturation and an O2 undersaturation in the waters of the Bransfield Strait. It is evidence of active organic carbon decomposition as the major controlling process. Yet, photosynthesis is the major biogeochemical process in the studied areas of the Weddell and Scotia seas, and their waters have been undersaturated with pCO2 and oversaturated with O2. As it comes from the analysis of the distribution and correlation coefficients of AOU and the sea-air gradient of pCO2 with other physical and biogeochemical properties, the predominance of the biotic processes to the dynamics of O2 and pCO2 in the surface water layer has been demonstrated for the studied areas. Yet, there is evidence of additional sources of CO2 not associated with the production and destruction processes of organic matter.

Sudden life-threatening laryngeal edema in pregnancy: a case report

BackgroundSevere laryngeal edema during pregnancy is uncommon but can be encountered, particularly in patients with preeclampsia accompanied by other comorbidities. Careful consideration must be given to balance the urgency of securing the airway with the safety of the fetus and the patient’s long-term health consequences.Case presentationA 37-year-old Indonesian woman was brought to the emergency department at 36 weeks gestation due to severe dyspnea. Her condition worsened a few hours later during intensive care unit admission, with tachypnea, decreased oxygen saturation, and inability to communicate, necessitating intubation. Due to the edematous larynx, we could only use 6.0-sized endotracheal tube. The use of a small-sized endotracheal tube was expected to be short-lived, so she was considered for tracheostomy. Nevertheless, we decided to perform a cesarean section first after lung maturation because it would be safer for the fetus, and laryngeal edema usually improves after delivery. Cesarean section was performed under spinal anesthesia for the safety of the fetus, and 48 hours after delivery, she underwent a leakage test with a positive result, so extubation was performed. Stridor was no longer audible, breathing pattern was within normal limits, and vital signs were stable. The patient and her baby both recovered well with no long-term health consequences.ConclusionThis case demonstrates that unexpected life-threatening laryngeal edema can occur during pregnancy, in which upper respiratory tract infections may trigger it. The decision between conservative and aggressive immediate airway management should be made with careful consideration of securing the patient’s airway, the safety of the fetus, and the patient’s long-term health consequences.

High-Flow Nasal Oxygen (Optiflow) 10 L/min Therapy for an Unexpected Desaturation during Awake Craniotomy

Providing adequate sedation while ensuring normoventilation is a challenge during an awake craniotomy. The use of sedative agents may cause hypoventilation and apnea, inducing hypoxemia and hypercapnia. High-flow humidified nasal oxygen delivery devices have shown positive results in various clinical areas. Here, we present two case reports of patients undergoing awake craniotomy who experienced a sudden decrease in oxygen saturation while receiving dexmedetomidine sedation. Despite being aroused to take deep breaths, the patients’ oxygen saturation did not return to baseline. Arterial blood gas analysis (ABGA) revealed a significant fall in partial pressure of oxygen. To address the hypoxemia, we initiated high-flow nasal oxygen (Optiflow) 10 L/min instead of conventional oxygen treatment via nasal prong. Follow-up ABGA results showed that Optiflow 10 L/min effectively provided adequate oxygenation and prevented the retention of carbon dioxide. Optiflow 10 L/min was successful in managing the patients’ hypoxemia while maintaining adequate oxygenation, ventilation, and sedation during awake craniotomy.

Determination of minimum infusion rate of propofol in combination with electroacupuncture in goats

Total intravenous anesthesia (TIVA) is frequently used anesthetic protocol in animals when inhalation anesthesia is not available. To date, it has not yet been known whether electroacupuncture (EA) can affect propofol-based TIVA in goats. Therefore, the present paper aims to determine the minimum infusion rate (MIR) of propofol, in combination with EA, required to preclude purposeful movement of the extremities in response to standardized noxious stimulation in goats. Twelve clinically healthy goats weighing 17.45 ± 2.15 kg were randomly allocated into two groups with six goats each. Propofol alone (P group) and propofol combined with EA (EA-P group). In the EA-P, propofol was given 30 min after EA stimulation. For induction of anesthesia, a bolus of propofol was administered at 4 mg/kg IV, and an infusion dose of 0.4 mg/kg/min was initially set for maintenance. The MIR of propofol in both groups was determined by testing for responses to stimulation (clamping on a digit with Vulsellum forceps) at 10-min intervals after inducing anesthesia until the end period of the experiment. Cardiorespiratory variables and nociceptive threshold were measured throughout anesthesia. The median propofol MIR was significantly lower in the EA-P group than the P group [0.520 (0.467–0.572) and 0.650 (0.600–0.677)], respectively; p = 0.0013). In the P group, goats anesthetized with MIR showed a significant increase in heart rate and cardiac index (p = 0.0010 and p < 0.0001, respectively), and a decrease in respiratory rate (p = 0.0001). Additionally, the EA-P showed a significant decrease in hemoglobin oxygen saturation following the initial infusion rate at 2 min (p = 0.0023) and 10 min (p = 0.0007) as compared to the P group. A significant increase in nociceptive threshold was recorded in the EA-P threshold than that of the P group (p < 0.005). EA combined with propofol provides antinociception, decreases the MIR of propofol-based TIVA, and subsequently lessens the negative cardiorespiratory consequences related to propofol anesthesia in goats.

A Case of Kounis Syndrome Caused by Anaphylaxis During Surgery

Kounis syndrome is a hypersensitivity coronary disorder associated with several triggers, such as drugs, foods, environmental, coronary stents and other factors. It was originally proposed by the Greek cardiologist Nicholas Kounis in 1991. Kounis syndrome is a life-threatening and challenging emergency disease, which is constantly being recognized and studied. It is a disease that is constantly being recognized and Kounis syndrome can be classified into three types, involving coronary artery spasm, plaque rupture or stent thrombosis respectively. Most patients with coronary artery spasm caused by allergies can recover completely after active treatment, and the prognosis is good. If not, it may cause severe myocardial damage and even myocardial infarction, which threatens the patient's life. In our case, a 56-year-old female patient was scheduled to undergo right pelvic resection. A few minutes after the start of intravenous succinylated gelatin infusion, she was experienced a decrease in heart rate, blood pressure, oxygen saturation and ST elevation on 2-lead. An anaphylactic reaction was suspected after rapid differential diagnosis and gradually recovered with treatment. In this context, a rapid differential diagnosis and a highly suspicious become essential, because the management of Kounis syndrome is different from the traditional acute coronary syndrome. Kounis syndrome requires simultaneous diagnosis and treatment of both allergic reaction and acute coronary syndrome based on their manifestations and risk factors. This case describes the onset, development, and recovery of Kounis syndrome in this patient in detail, and illustrates the classification, pathophysiology, and treatment of Kounis syndrome. It is hoped that through the management of this case, the occurrence of Kounis syndrome can be rapidly identified and treated accordingly so that avoiding disaster for patients.

An IoT Enabled Cost Effective Smart Healthcare for Real-Time COVID- 19 Patient Early Identification and Monitoring System Using Smartphone

Introduction: The SARS-CoV-2 virus causes COVID-19, a highly contagious disease. Meetings between COVID-19 patients, their families, and medical professionals are no longer safe. To meet their patients, doctors and patients' families must take extreme precautions. Even with these stringent safety precautions, there is a chance that he or she will be affected by COVID-19. In this context, remote patient monitoring via IoT devices can be a highly effective system for today's healthcare system with no safety concerns. Methods: This paper describes an IoT-based system for remote monitoring of COVID-19 patients that uses measured values of the patient's heart rate, body temperature, and oxygen saturation, the most critical measures required for critical care. This device can monitor the observed body temperature, heart rate, and oxygen saturation level in real time and can be easily synchronized with a ThingSpeak IoT cloud platform channel for instant access through a smartphone. When the sensor value exceeds the system's safe threshold, the system will send an email alert to the system user. Some people may notice a decrease in oxygen saturation without any symptoms or respiratory problems. This system can be very useful for early COVID-19 identification in this case. The proposed IoT-based technique is based on an Arduino Uno system and has been tested and validated by a large number of human test participants. As an example, five sample results are shown in this paper. Results: The system yielded promising results. When compared to other commercially available devices, the system's results were found to be accurate, with a maximum error rate of less than 5%, which is quite acceptable. The system's data can be saved in the ThingSpeak cloud server for further analysis. This system requires a unique email and password verification to maintain system security and user data privacy. This patient monitoring system has grown in popularity during this COVID-19 pandemic due to its uniqueness and diverse medical applications. Many people's lives are impacted daily when illnesses are not identified in a timely and accurate manner, denying us the opportunity to provide medical care. To deal with such scenarios, this system will help to monitor a COVID-19 patient's specific parameters, predict the patient's status on a regular basis, and send an email alert to the system user if something abnormal occurs. Conclusion: As a result, this IoT-based smart healthcare solution could help save lives during the current COVID-19 pandemic. This technology is easy to use and reduces the need for human intervention.

Massive Venous Air Embolism in a Case of Hysteroscopy: A Rare Grave Complication in a Comparatively Simple Procedure

Hysteroscopic surgery has gained popularity but lethal complication like gas or venous air embolism can occur. It can be recognized by a decrease in oxygen saturation and sudden drop in end-tidal carbon dioxide and may sometimes lead to severe organ failure and death depending on the amount of air embolism. We report the case of a 55-year-old female with no comorbidities posted for evaluation of postmenopausal bleeding by diagnostic hysteroscopy. The procedure was performed under spinal anesthesia using normal saline as distending media. Midway between the procedures, the patient developed severe bradycardia and desaturation. Hence, with the diagnosis of massive pulmonary embolism, the patient was resuscitated but could not be revived. The fatal outcome from a comparatively simple procedure is not uncommon. Complications are to be kept in mind and possible precautionary measures are to be taken at all times. As the eye cannot see what the mind does not know.

Pengaruh Pemberian Nebulizer Dan Deep Breating Exercise Terhadap Perubahan Saturasi Oksigen Pada Pasien PPOK Di RS Paru Jember

Chronic Obstructive Pulmonary Disease (COPD) is a respiratory disease indicated by airflow limitation due to airway abnormalities. COPD patients are identical with airway obstruction or decreased lung function to carry out the exchange of oxygen and carbon dioxide which is characterized by cyanosis, hypoxemia, decreased concentration and mood changes. This condition results in a decrease in oxygen saturation which causes the percentage of hemoglobin and oxygen binding in the arteries to decrease to &lt;85 %. One of the treatments used in COPD patients is the administration of a nebulizer and deep breathing exercise. This study aims to identify the effect of giving a nebulizer and deep breathing exercise to changes in oxygen saturation of COPD patients. This study has 20 respondents using a sampling technique that is purposive sampling. This research design uses a quasi-experimental type with a one group pretest and posttest approach. Bivariate analysis in this study using Paired T Test. The results of this study are the average oxygen saturation before giving a nebulizer and deep breathing to COPD patients is 92.70, the average oxygen saturation after giving a nebulizer and deep breathing to COPD patients at Jember Lung Hospital is 94.05, and there is an effect of giving a nebulizer and deep breathing to changes in oxygen saturation of COPD patients at Jember Lung Hospital with p-value = 0.001 (p&lt;0.05). This research is expected to be an input for additional information based on data and theory to improve the quality of physiotherapy services by making standard procedures in performing nebulizers and deep breathing, especially in COPD patients

UPGRADING OF LAPAROSCOPIC INTERVENTION OF THE PROSTATE GLAND TUMORS

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

THE VALUE OF METHODS FOR DIAGNOSING ALVEOLAR RHABDOMYOSARCOMA: A CLINICAL CASE

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

THE VALUE OF METHODS FOR DIAGNOSING ALVEOLAR RHABDOMYOSARCOMA: A CLINICAL CASE

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

UPGRADING OF LAPAROSCOPIC INTERVENTION OF THE PROSTATE GLAND TUMORS

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.&#x0D; The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).&#x0D; Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.&#x0D; Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).&#x0D; Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

Ultrafiltration during intermittent hemodialysis in dogs with acute kidney injury.

Ultrafiltration is performed to alleviate fluid overload in dogs with acute kidney injury (AKI) undergoing intermittent hemodialysis (IHD). To describe prescription patterns for ultrafiltration in dogs receiving IHD for AKI and risk factors for ultrafiltration-related complications. Seventy-seven dogs undergoing 144 IHD treatments between 2009 and 2019. Medical records of dogs receiving IHD for AKI were reviewed. The initial 3 IHD treatments in which ultrafiltration was prescribed were included. Ultrafiltration-related complications were defined as those requiring an intervention such as transient or permanent discontinuation of ultrafiltration. Mean fluid removal rate per treatment was 8.1 ± 4.5mL/kg/h. Ultrafiltration-related complications occurred in 37/144 (25.7%) of treatments. Hypotension was rare (6/144, 4.2% of treatments). No ultrafiltration-related complications resulted in deaths. The mean prescribed fluid removal rate per treatment was higher in dogs with ultrafiltration-related complications than without (10.8 ± 4.9mL/kg/h vs 8.8 ± 5.1mL/kg/h, respectively; P=.03). The mean delivered fluid removal rate per treatment was significantly lower in dogs with UF-related complications compared to those without complications (6.8 ± 4.0mL/kg/h vs 8.6 ± 4.6mL/kg/h, respectively; P=.04). Variables associated with ultrafiltration-related complications (P < .05) included central venous oxygen saturation, body temperature before IHD treatment, total extracorporeal circuit volume and BUN at the end of IHD treatment. Ultrafiltration during IHD in dogs with AKI is overall safe. Higher prescribed ultrafiltration rates were associated with increased risk of complications. Decrease in central venous oxygen saturation is associated with ultrafiltration-related complications, emphasizing the utility of in-line blood monitoring.

Perinatal intermittent hypoxia increases early susceptibility to ANG II-induced hypertension in adult male but not in female Sprague-Dawley rats.

Prenatal, perinatal, and adulthood exposure to chronic intermittent hypoxia (IH) increases blood pressure in rodents. Males exposed to chronic IH have higher blood pressure versus females. However, it is unknown if this same-sex difference exists with acute perinatal IH. We tested the hypothesis that acute perinatal IH increases baseline blood pressure and enhances sensitivity to angiotensin II (ANG II)-induced hypertension in male Sprague-Dawley rats. Male and female pups were randomized to control (room air) or IH (10 min of ∼10% O2 for 3 times/day) for the first 8 days of life. IH decreased oxygen saturation, as confirmed via a pulse oximeter. Pups were weaned at postnatal day 21. Blood pressure was measured via telemetry beginning at 14 wk of age and analyzed separately into light and dark phases to assess circadian rhythm. Osmotic minipumps to deliver ANG II were implanted at 15 wk of age. Perinatal IH exposure did not alter baseline blood pressure. One week of ANG II treatment increased blood pressure in light and dark periods in males exposed to IH versus control; there was no effect in females. Blood pressure among the groups was comparable following 2 wk of ANG II infusion. Perinatal IH did not change the circadian rhythm. Following ANG II treatment, indexes of renal injury were measured. Perinatal IH did not alter kidney size, structure, nephron number, or creatinine clearance. These data indicate that acute perinatal IH enhances early ANG II-induced hypertension in males, independent of nephron loss or decreases in body weight or kidney function.NEW & NOTEWORTHY The impact of acute intermittent hypoxia (IH) in early life on blood pressure in adulthood is unknown. This study used a new model exposing female and male rat pups to acute IH in the first 8 days of life, without exposing the dam. Although baseline blood pressure was not altered in adulthood, IH increased susceptibility to angiotensin II hypertension only in males, supporting increased susceptibility of males exposed to IH to a second cardiovascular stressor.

Unraveling the Underlying Molecular Mechanism of 'Silent Hypoxia' in COVID-19 Patients Suggests a Central Role for Angiotensin II Modulation of the AT1R-Hypoxia-Inducible Factor Signaling Pathway.

A few days after being infected with SARS-CoV-2, a fraction of people remain asymptomatic but suffer from a decrease in arterial oxygen saturation in the absence of apparent dyspnea. In light of our clinical investigation on the modulation of molecules belonging to the renin angiotensin system (RAS) in COVID-19 patients, we propose a model that explains 'silent hypoxia'. The RAS imbalance caused by SARS-CoV-2 results in an accumulation of angiotensin 2 (Ang II), which activates the angiotensin 2 type 1 receptor (AT1R) and triggers a harmful cascade of intracellular signals leading to the nuclear translocation of the hypoxia-inducible factor (HIF)-1α. HIF-1α transactivates many genes including the angiotensin-converting enzyme 1 (ACE1), while at the same time, ACE2 is downregulated. A growing number of cells is maintained in a hypoxic condition that is self-sustained by the presence of the virus and the ACE1/ACE2 ratio imbalance. This is associated with a progressive worsening of the patient's biological parameters including decreased oxygen saturation, without further clinical manifestations. When too many cells activate the Ang II-AT1R-HIF-1α axis, there is a 'hypoxic spillover', which marks the tipping point between 'silent' and symptomatic hypoxia in the patient. Immediate ventilation is required to prevent the 'hypoxic spillover'.

Rapid Response Team Activation Triggers in Adults and Children: An Integrative Review.

This integrative review aims to identify the triggers for rapid response team (RRT) activation and their outcomes in pediatric patients and to compare them with those of adult patients. In addition, this integrative review synthesizes the outcomes of cardiopulmonary resuscitation (CPR), intensive care unit (ICU) admission, length of hospital stay, and mortality following RRT activation. An integrative review using the Whittemore and Knafl methodology was undertaken with a search of three large databases (PubMed, Ovid MEDLINE, and CINAHL) and found 25 relevant studies published in the years 2017 through 2022. Tachypnea, decreased oxygen saturation, tachycardia, changes in blood pressure, and level of consciousness were the most common triggers in both populations. However, specific activation triggers differed between children and adults. The most common triggers for RRT are detectable through vital signs monitoring; therefore, vigilant tracking of patients' vital signs is critical and can provide early clues to clinical deterioration.

Atrial Fibrillation in Obstructive Sleep Apnea Patients: Mechanisms, Risk Factors, and Management Strategies.

Obstructive sleep apnea (OSA) is identified by apnea or hypopnea of the upper respiratory tract, which is associated with decreased oxygen saturation or awakening from sleep. A severe and prevalent association with OSA is atrial fibrillation (AF). This review article outlined numerous studies to understand the pathogenic pathways linked with developing OSA-associated AF and the therapeutic and preventive options available to reduce AF. The article looked for multiple risk factors common to OSA and AF. In addition, it has reviewed several therapeutic modalities such as continuous positive air pressure (CPAP), weight loss, upper airway stimulation (UAS), and other novel treatment options to find their efficiency in decreasing the outcome of AF in OSA patients. Since OSA often goes undiagnosed, this article emphasizes the importance of early screening in patients with AF and other comorbid conditions such as obesity, advanced age, diabetes, hypertension, and many more. The article focuses on the importance of preventive approaches that can be easily implemented, such as behavioral modifications.

Impact of Electronic Cigarette use on Cardiovascular Health: Current Evidence, Causal Pathways, and Public Health Implications.

Electronic cigarette (e-cigarette) use is increasing in Europe and the USA. While mounting evidence exists regarding an array of associated adverse health effects, to date limited evidence exists regarding the health effects of e-cigarette use on cardiovascular (CV) disease (CVD). The present review summarizes the effects of e-cigarette use on CV health. A search strategy of in vivo experimental, observational studies (including population-based cohort studies), and interventional studies was conducted in PubMed, MEDLINE, and Web of Science (April 1, 2009-April 1, 2022). The main findings revealed that the influence of e-cigarette on health are attributed mainly to the individual and interactive effects of flavors and additives used in e-cigarette fluids, along with the extended heating. The above collectively stimulate prolonged sympathoexcitatory CV autonomic effects, such as increased heart rate and diastolic blood pressure (BP), as well as decreased oxygen saturation. Hence, e-cigarette users are at increased risk of developing atherosclerosis, hypertension, arrhythmia, myocardial infarction, and heart failure. Such risks are anticipated to increase, especially among the young who are increasingly adopting e-cigarette use particularly with flavored additives. Further investigations are urgently needed to evaluate the long-term effects of e-cigarette use, particularly among susceptible population groups such as youth.