Hemoglobin Saturation Research Articles

Individual red blood cell nitric oxide production in sickle cell anemia: Nitric oxide production is increased and sickle shaped cells have unique morphologic change compared to discoid cells

Sickle cell anemia (SCA) is characterized by decreased red blood cell (RBC) deformability due to polymerization of deoxygenated hemoglobin, leading to abnormal mechanical properties of RBC, increased cellular adhesion, and microcirculatory obstruction. Prior work has demonstrated that NO• influences RBC hydration and deformability and is produced at a basal rate that increases under shear stress in normal RBC. Nevertheless, the origin and physiological relevance of nitric oxide (NO•) production and scavenging in RBC remains unclear. We aimed to assess the basal and shear-mediated production of NO• in RBC from SCA patients and control (CTRL) subjects. RBCs loaded with a fluorescent NO• detector, DAF-FM (4-Amino-5-methylamino- 2′,7′-difluorofluorescein diacetate), were imaged in microflow channels over 30-min without shear stress, followed by a 30-min period under 0.5Pa shear stress. We utilized non-specific nitric oxide synthase (NOS) blockade and carbon monoxide (CO) saturation of hemoglobin to assess the contribution of NOS and hemoglobin, respectively, to NO• production. Quantification of DAF-FM fluorescence intensity in individual RBC showed an increase in NO• in SCA RBC at the start of the basal period; however, both SCA and CTRL RBC increased NO• by a similar quantity under shear. A subpopulation of sickle-shaped RBC exhibited lower basal NO• production compared to discoid RBC from SCA group, and under shear became more circular in the direction of shear when compared to discoid RBC from SCA and CTRL, which elongated. Both CO and NOS inhibition caused a decrease in basal NO• production. Shear-mediated NO• production was decreased by CO in all RBC, but was decreased by NOS blockade only in SCA. In conclusion, total NO• production is increased and shear-mediated NO• production is preserved in SCA RBC in a NOS-dependent manner. Sickle shaped RBC with inclusions have higher NO• production and they become more circular rather than elongated with shear.

Relative variability in muscle activation amplitude, muscle oxygenation, and muscle thickness: Changes with dynamic low-load elbow flexion fatigue and relationships in young and older females

In repetitive upper limb activities, variability of muscle activity (a feature of motor variability) is linked to upper limb fatigability. Prior studies suggest that the variability response may change with age and could be related to the oxygen saturation of hemoglobin within the muscle. We determined, in female adults, how age affects adjustments in movement-to-movement variability of electromyograph (EMG) amplitude (RMS), oxygenation, and thickness with fatigue, and explored how these responses were related.Fifteen young (23.3 ± 3.1 years) and ten older (62.8 ± 6.9 years) females completed repeated trials of low-load, isokinetic, concentric/eccentric elbow flexion until maximal torque ≤ 70% of baseline. Movement-to-movement variability of EMG RMS in concentric phases of movement was quantified by the coefficient of variation (EMG CV), and muscle oxygenation and thickness (MTH) were quantified using near-infrared spectroscopy, and B-mode ultrasonography. Age*Time and Spearman ρ analyses were conducted.Age did not affect fatigability or Time-related changes in muscular measures (p > 0.05). Biceps brachii and brachialis EMG CV decreased, biceps brachii HbO2 decreased and did not fully recover, and biceps brachii and brachialis MTH increased. Higher initial brachialis EMG CV was related to less blunted oxygenation in young females (p = 0.021). Oxygenation responses were related to altered anterior deltoid EMG CV in young females but altered biceps brachii and brachialis EMG CV in older females.Age was not associated with changes in EMG CV, oxygenation, or thickness at similar performance fatigability in the concentric/eccentric elbow flexion task studied. Adjustments in biceps brachii oxygenation were linked to changes in EMG CV more local to the site of fatigue with older age.

Microvascular imaging and monitoring of hemodynamic changes in the skin during arterial-venous occlusion using multispectral raster-scanning optoacoustic mesoscopy

The ability to monitor oxygen delivery in microvasculature plays a vital role in measuring the viability of skin tissue and the probability of recovery. Using currently available clinical imaging tools, it is difficult to observe non-invasive hemodynamic regulation in the peripheral vessels. Here we propose the use of a novel multispectral raster-scanning optoacoustic mesoscopy (RSOM) system for noninvasive clinical monitoring of hemodynamic changes in the skin microvasculature’s oxy- (HbO2) and deoxy-hemoglobin (Hb), total hemoglobin (HbT) and oxygen saturation (rsO2). High resolution images of hemoglobin distribution in the skin microvasculature from six healthy volunteers during venous and arterial occlusion, simulating systemic vascular diseases are presented. During venous occlusion, Hb and HbO2 optoacoustic signals showed an increasing trend with time, followed by a drop in the values after cuff deflation. During arterial occlusion, an increase in Hb value and decrease in HbO2 values was observed, followed by a drop in Hb and jump in HbO2 values after the cuff deflation. A decrease in rsO2 values during both venous and arterial occlusion was observed with an increase in value after occlusion release. Using this proof of concept study, hereby we propose multispectral RSOM as a novel tool to measure high resolution hemodynamic changes in microvasculature for investigating systemic vascular diseases on peripheral tissues and also for monitoring inflammatory skin diseases, and its therapeutic interventions.

Self-preference music for gagging patient: Effect on physiology and oral health-related quality of life during dental impression

BackgroundGagging condition is among factors contributing to avoidance behavior to seek the dental treatment, and rigorous management is still under investigation. This study aims to explore the effect of listening to the self-preference music in reducing the gagging condition during dental impression procedure towards gagging patient. Physiology and psychological impact to the procedure with and without musical intervention are investigated. Method and materialA group of twenty-five patients that will undergo impression procedure was randomly selected. Self-reported Gagging Problem Assessment (GPA-pa-SF) questionnaires was then administered to determine the severity of gagging. Maxillary impression was taken twice within the same patient in two different time intervals (1st without any intervention and 2nd with musical intervention). During both procedures, the pulse rate/minutes (BPM) and arterial oxygen saturation of haemoglobin (SpO2%) were recorded and psychometric assessment was evaluated through the Oral Health Impact Profile (OHIP-14). ResultMean value of BPM was significantly reduced with music (p < 0.05) while SpO2 was considerably has positive effect although was found no significant. The OHIP 14 demonstrated that functional limitation and psychological disability were the most affected before the intervention. Overall, musical stimuli had a significant effect on stress reduction in both physiological (p < 0.05) and psychological (p < 0.05) outcomes except for social disability and handicap items. ConclusionListening to self-preference music during impression taking had improved physiology and psychology of gagging patients thus, can be attributed to the better dental management.

Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis

In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. Ferric carboxymaltose (FCM) is a relatively novel intravenous iron formulation used in different clinical settings, although scarce data exist in NDD-CKD patients. Primary objective of this study was to retrospectively evaluate the efficacy of FCM compared with oral ferrous sulfate for the treatment of iron-deficiency anemia in a cohort of NDD-CKD patients, considering also the treatment costs. This was a monocentric, retrospective observational study reviewing 349 NDD-CKD patients attending an outpatient clinic between June 2013 and December 2016. Patients were treated by either FCM intravenous infusion or oral ferrous sulfate. We collected serum values of hemoglobin, ferritin and transferrin saturation (TSAT) and ESAs doses at 12 and 18 months. The costs related to both treatments were also analysed. 239 patients were treated with FCM intravenous infusion and 110 patients with oral ferrous sulfate. The two groups were not statistically different for age, BMI and eGFR values. At 18 months, hemoglobin, serum ferritin and TSAT values increased significantly from baseline in the FCM group, compared with the ferrous sulfate group. ESAs dose and rate of infusion decreased only in the FCM group. At 18 months, the treatment costs, analysed per week, was higher in the ferrous sulfate group, compared with the FCM group, and this was mostly due to a reduction in ESAs prescription in the FCM group. Routine intravenous FCM treatment in an outpatient clinic of NDD-CKD patients results in better correction of iron-deficiency anemia when compared to ferrous sulfate. In addition to this, treating NDD-CKD patients with FCM leads to a significant reduction of the treatment costs by reducing ESAs use.

Sedative and analgesic effects of two subanaesthetic doses of ketamine in combination with methadone and a low dose of dexmedetomidine in healthy dogs

ObjectiveTo evaluate the sedative, analgesic and recovery characteristics of two subanaesthetic ketamine doses in combination with dexmedetomidine and methadone for intramuscular sedation in healthy Beagles. Study designRandomized, blinded, crossover, experimental study. AnimalsSix healthy adult Beagles. MethodsDogs were randomly given three treatments: dexmedetomidine (3 μg kg–1) and methadone (0.3 mg kg–1) combined with ketamine at 1 and 2 mg kg–1 (K1 and K2, respectively) or saline (K0), intramuscularly. Sedation score, response to tail clamping and rectal temperature were recorded at baseline, 5, 15, 25, 35, and 45 minutes posttreatment. Pulse rate (PR), respiratory rate, oxygen haemoglobin saturation and noninvasive blood pressure were also recorded at baseline and every 5 minutes until 45 minutes posttreatment. Onset and duration of recumbency, response to venous catheterization and recovery quality were also assessed. Sedation and physiological variables were compared between treatments and within treatments compared to baseline (analysis of variance). Nonparametric data were analysed with the Friedman and Cochran’s Q tests; p < 0.050. ResultsIncreased sedation was found at 15 (K0 and K1), 25 (all treatments) and 35 (K1) minutes compared with baseline. Sedation score, onset (3–12 minutes) and duration of recumbency (29–51 minutes) were similar between treatments. Recovery quality was considered acceptable in all cases. Response to tail clamping was inconsistent within treatments with no differences between them. None of the dogs responded to venous catheterization. There were no differences between treatments in physiological variables, except for PR which was higher in K2 than in K0. Oxygen supplementation was required in five and three dogs administered saline and ketamine, respectively. Conclusions and clinical relevanceThe addition of 1 or 2 mg kg–1 of ketamine to methadone and dexmedetomidine combination did not enhance sedation or antinociception in healthy dogs. Recovery quality was unaffected.

Near-Infrared Spectroscopy: Clinical Use in High-Risk Neonates.

In this review, we describe the near-infrared spectroscopy (NIRS) technology and its clinical use in high-risk neonates in critical care settings. We searched databases (e.g., PubMed, Google Scholar, EBSCOhost) to find studies describing the use of NIRS on critically ill and high-risk neonates. Near-infrared spectroscopy provides continuous noninvasive monitoring of venous oxygen saturation. It uses technology similar to pulse oximetry to measure the oxygen saturation of hemoglobin in a tissue bed to describe the relative delivery and extraction of oxygen. Near-infrared spectroscopy can be a valuable bedside tool to provide clinicians indirect evidence of perfusion. It may prompt early interventions that promote oxygen delivery, which can improve high-risk neonatal outcomes.

АВТОМАТИЧЕСКИЙ ПЛАЗМАФЕРЕЗ У ПАЦИЕНТОВ С COVID-19-АССОЦИИРОВАННОЙ ПНЕВМОНИЕЙ. ПЕРВЫЙ ОПЫТ ПРИМЕНЕНИЯ

Objective. To determine the possibility of using automatic plasmapheresis in patients with COVID-19- associated bilateral polysegmental pneumonia. Methods. The treatment of three patients with COVID-19-associated pneumonia with application of the Autopheresis-C™ automatic plasmapheresis machine (the USA) has been analyzed. The patients’ age was 47. 49 and 55 years. The patients’ case histories included factors aggravating the course of pneumonia (diabetes mellitus, chronic cardiovascular pathology with heart failure, obesity). The condition of all patients was severe. The effectiveness estimation of the given technique was carried out 6 hours after the manipulation and included a general clinical blood test, a biochemical blood test, hemodynamic parameters, and objective data. Results. After the first application of automatic plasmapheresis, all patients occurred a decrease in temperature and the level of respiratory failure, which was accompanied by an increase in hemoglobin saturation; a decrease in the severity of dyspnea was also reported, which was the reason for the changing patient position from prone to supine. All patients had a blood pressure reduction. Positive changes in the hemodynamic situation were the basis for reducing the dosage of antihypertensive drugs. Along with this, in the course of manipulation, a gradual decrease in the severity of tachycardia was noted in all patients: a reduction of heart rate was recorded. On the second day after the manipulation, the main blood parameters (leukocytosis, c-reactive protein) decreased. The observed positive effects contributed to the early transfer (by 10-15 days) of patients from the intensive care unit to the general somatic departments. Conclusion. The early inclusion of automatic plasmapheresis in the complex therapy of patients with COVID-19- associated bilateral polysegmental pneumonia leads to the stabilization of hemodynamic parameters, decline of the severity of respiratory failure, which made it possible to avoid the mechanical ventilation. What this paper adds For the first time, the clinical effectiveness of the method of automatic plasmapheresis in the framework of the complex therapy of COVID-19- associated polysegmental pneumonia is shown, which is expressed in a decrease in the manifestations of functional and metabolic disorders of vital systems for maintaining homeostasis. It was found that the inclusion of this technology in the complex therapy contributed to the stabilization of respiratory and hemodynamic parameters, which made it possible to avoid the mechanical ventilation.

Effect of Red Nail Polish on Pulse Oximetry Reading

Background: Pulse oximetry is a beat-to-beat, non-invasive and virtually risk-free method of assessing continuous arterial hemoglobin saturation. It is now a standard for monitoring care in the operating room and the post-anesthesia care unit. It is also widely used in the critical care setting. Numerous factors including dark skin, pigmentation, henna dye, nail polish etc. could lead to inaccuracy or ambiguous information about oxygen saturation. In many cultures, women decorate their fingernails with different colors of nail polish.&#x0D; Objectives: The purpose of this study was to determine the effect of red nail polish on the measurement of oxygen saturation.&#x0D; Materials and Methods: One hundred young women were recruited for this study and red nail polish was used to color the index finger of the non-dominant hand; the middle finger of the same hand was the control. Blood oxygen saturation was simultaneously measured by two calibrated pulse oximeters with two minutes interval for 30 minutes.&#x0D; Results: Red nail polish did not affect pulse oximetry measurement of oxygen saturation. There was no statistically significant difference between the control and the red nail polished fingers.&#x0D; Conclusion: Application of red nail polish does not cause statistically significant error in the measurement of oxygen saturation in young healthy individuals.&#x0D; KYAMC Journal Vol. 11, No.-4, January 2021, Page 181-183

Temperature Dependence of Infrared Light Time Course Under Oxygenation and Deoxygenation of the Blood in Vitro

Spectrometric hemoglobin saturation measurements are urgent now due to the need to monitor blood saturation in human beings’ serious state. Pulse oximeters typically used for these purposes have two or more wavelengths (in the red and infrared range). Under in vitro oxygenation of a blood sample, the intensity of red light (650 nm) scattered backward increases, reaching a plateau at high degrees of blood saturation with oxygen. Infrared (IR) light (λ≈808 nm), close to the isosbestic point 805 nm, often used as reference wavelength in oximeters, should not show any changes in the backscattered intensity or show a slight decrease during oxygenation and an increase during deoxygenation. We study temperature (19°C - 39 °C) dependence of the time course of IR signal in oxygenation and deoxygenation of donor's blood sample by the homemade oximeter. The setup allows us to measure light intensity (LED with two wavelengths - 650 and 808 nm) scattered back under continually stirring. When the red signal increases under oxygenation in the air atmosphere, we register a pronounced decrease in IR intensity (i.e., increase of absorbance). Our assessments show that the IR intensity minimum is achieved at approximately 50 % of hemoglobin saturation. The time from the start of oxygenation to the IR minimum and its depth increase with temperature increasing, which corresponds to a shift in the hemoglobin dissociation curve. Moreover, after such a decreasing of IR intensity, for temperature 19 - 32 °С, we observed the growth of IR intensity, and for 35 - 39 °С - signal flattening. We believe that these a pronounced changing of intensity is related to conformational changing of hemoglobin structure, the release of 2,3 bisphosphoglycerate, and membrane fluidity changing (crystallization) at low temperature.

Assessment of pulse co-oximetry technology after in vivo adjustment in anaesthetized dogs

ObjectiveTo compare values of haemoglobin concentration (SpHb), arterial haemoglobin saturation (SpO2) and calculated arterial oxygen content (SpOC), measured noninvasively with a pulse co-oximeter before and after in vivo adjustment (via calibration of the device using a measured haemoglobin concentration) with those measured invasively using a spectrophotometric-based blood gas analyser in anaesthetized dogs. Study designProspective observational clinical study. AnimalsA group of 39 adult dogs. MethodsIn all dogs after standard instrumentation, the dorsal metatarsal artery was catheterised for blood sampling, and a pulse co-oximeter probe was applied to the tongue for noninvasive measurements. Paired data for SpHb, SpO2 and SpOC from the pulse co-oximeter and haemoglobin arterial oxygen saturation (SaO2) and arterial oxygen content (CaO2) from the blood gas analyser were obtained before and after in vivo adjustment. Bland–Altman analysis for repeated measurements was used to evaluate the bias, precision and agreement between the pulse co-oximeter and the blood gas analyser. Data are presented as mean differences and 95% limits of agreement (LoA). ResultsA total of 39 data pairs were obtained before in vivo adjustment. The mean invasively measured haemoglobin–SpHb difference was –2.7 g dL−1 with LoA of –4.9 to –0.5 g dL−1. After in vivo adjustment, 104 data pairs were obtained. The mean invasively measured haemoglobin–SpHb difference was –0.2 g dL−1 with LoA of –1.1 to 0.6 g dL−1. The mean SaO2–SpO2 difference was 0.86% with LoA of –0.8% to 2.5% and that between CaO2–SpOC was 0.66 mL dL–1 with LoA of –2.59 to 3.91 mL dL–1. ConclusionsBefore in vivo adjustment, pulse co-oximeter derived values overestimated the spectrophotometric-based blood gas analyser haemoglobin and CaO2 values. After in vivo adjustment, the accuracy, precision and LoA markedly improved. Therefore, in vivo adjustment is recommended when using this device to monitor SpHb in anaesthetised dogs.

Changes in Diffuse Optical Tomography Images During Early Stages of Neoadjuvant Chemotherapy Correlate with Tumor Response in Different Breast Cancer Subtypes.

This study's primary objective was to evaluate the changes in optically derived parameters acquired with a diffuse optical tomography breast imaging system (DOTBIS) in the tumor volume of patients with breast carcinoma receiving neoadjuvant chemotherapy (NAC). In this analysis of 105 patients with stage II-III breast cancer, normalized mean values of total hemoglobin ([Formula: see text]), oxyhemoglobin ([Formula: see text]), deoxy-hemoglobin concentration ([Formula: see text]), water, and oxygen saturation ([Formula: see text]) percentages were collected at different timepoints during NAC and compared with baseline measurements. This report compared changes in these optical biomarkers measured in patients who did not achieve a pathologic complete response (non-pCR) and those with a pCR. Differences regarding molecular subtypes were included for hormone receptor-positive and HER2-negative, HER2-positive, and triple-negative breast cancer. At baseline, [Formula: see text] was higher for pCR tumors (3.97 ± 2.29) compared with non-pCR tumors (3.00 ± 1.72; P = 0.031). At the earliest imaging point after starting therapy, the mean change of [Formula: see text] compared with baseline ([Formula: see text]) was statistically significantly higher in non-pCR (1.23 ± 0.67) than in those with a pCR (0.87 ± 0.61; P < 0.0005), and significantly correlated to residual cancer burden classification (r = 0.448; P < 0.0005). [Formula: see text] combined with HER2 status was proposed as a two-predictor logistic model, with AUC = 0.891; P < 0.0005; and 95% confidence interval, 0.812-0.969. This study demonstrates that DOTBIS measured features change over time according to tumor pCR status and may predict early in the NAC treatment course whether a patient is responding to NAC.

Role of blood oxygenation saturation in ovarian cancer diagnosis using multi-spectral photoacoustic tomography.

In photoacoustic tomography (PAT), a tunable laser typically illuminates the tissue at multiple wavelengths, and the received photoacoustic waves are used to form functional images of relative total haemoglobin (rHbT) and blood oxygenation saturation (%sO2 ). Due to measurement errors, the estimation of these parameters can be challenging, especially in clinical studies. In this study, we use a multi-pixel method to smooth the measurements before calculating rHbT and %sO2 . We first perform phantom studies using blood tubes of calibrated %sO2 to evaluate the accuracy of our %sO2 estimation. We conclude by presenting diagnostic results from PAT of 33 patients with 51 ovarian masses imaged by our co-registered PAT and ultrasound system. The ovarian masses were divided into malignant and benign/normal groups. Functional maps of rHbT and %sO2 and their histograms as well as spectral features were calculated using the PAT data from all ovaries in these two groups. Support vector machine models were trained on different combinations of the significant features. The area under ROC (AUC) of 0.93 (0.95%CI: 0.90-0.96) on the testing data set was achieved by combining mean %sO2 , a spectral feature, and the score of the study radiologist.

ОСОБЕННОСТИ ГЕМОДИНАМИКИ У ЗДОРОВЫХ МУЖЧИН В ГИПОМАГНИТНЫХ УСЛОВИЯХ

Hemodynamics was studied in essentially healthy resting 8 male subjects exposed to an experimental hypomagnetic environment (HME). The cardio-respiratory system functioning was evaluated by 8-hour continuous monitoring of heart rate (HR), blood pressure (BP) fluctuations during every cardiac cycle, Kerdo autonomic index (KAI) and blood oxygenation (SpO2) in the Earth's natural magnetic field and a field attenuated in approximately 1,000 times. Comparative analysis of the measurements made in the control and HME tests elicited different trends. Thus, the HR average reduction amounted to 4 bpm; BP dropped significantly, i.e. diastolic BP by 11 mmHg and systolic BP, 16 mmHg on average. In HME, KAI rose commonly 20 %. Hemoglobin saturation did not change. The paper contains graphic interpretations of the KAI dependence on duration of the HME exposure. Mathematical modeling suggests a physiological interpretation of these results. More often than not sitting at rest in HME reduced substantially the modulating effect of parasympathetic regulation on the cardiovascular system in comparison with the control test in the normal geomagnetic field.

ПРИМЕНЕНИЕ ФОТОМОДИФИКАЦИИ КРОВИ НИЗКОИНТЕНСИВНЫМ ОПТИЧЕСКИМ ИЗЛУЧЕНИЕМ В КОМПЛЕКСНОМ ЛЕЧЕНИИ ПАЦИЕНТОВ С НЕСТАБИЛЬНОЙ СТЕНОКАРДИЕЙ

The in vivo effect of low-intensity optical radiation (LIOR) on the blood of patients with unstable angina (UA) was studied. The integration of LIOR in the combined therapy of patients with UA proved to result in positive changes in the oxygen uptake system. Changes in the absorption spectra of the patients' blood samples, blood oxygenation characteristics, and the proportion of metabolic products were studied at all stages of light exposure. The absorption of LIOR by the blood was found to lead to its photomodification, which was manifested in changes of the partial pressure of blood gases, the content of oxyhemoglobin and the degree of saturation of hemoglobin with oxygen. LIOR affects the oxygen exchange in the body of patients with UA, changes the delivery and consumption of oxygen by tissues, initiates positive changes in the balance between the production of reactive oxygen intermediates, acting as physiologically active compounds, and their inhibition by antioxidant systems.

A study on inter-finger variation and hand dominance in peripheral capillary oxygen saturation values recorded from the different fingers of the hands by pulse oximetry

Background: To measure percentage of oxygen saturation of hemoglobin in the capillary blood (SpO2), pulse oximeter is used as an imperative noninvasive device. There is lack of reported study evaluating the hand dominance and inter-finger variation of SpO2 readings. Aim and Objectives: Our study aims at providing comparison of peripheral capillary blood oxygen saturation of hemoglobin (SpO2 values) among every finger of the two hands in healthy subjects with different hand dominance. Materials and Methods: In this study, 100 healthy subjects of age group between 18 and 30 years were enrolled, in which 76 subjects were right handed, 24 subjects were left handed. No subject was identified as ambidextrous. After 5 min of rest, they were monitored. After collecting different relevant demographic parameters such as age, sex, height, weight, noninvasive blood pressure, heart rate, body temperature and fasting period, SpO2 values were recorded from every finger of two hands with the same pulse oximeter. All the SpO2 values were measured providing at least 1 min of interval after each recording. Total 1000 SpO2 recordings were obtained from 100 subjects. Results: Our result shows that highest average SpO2 values were obtained from middle finger in both the left and right handed subjects. There was no statistically significant difference in the SpO2 values between the middle finger of dominant and non-dominant hand in both the right handed and left handed subjects. Again, thumb showed the second highest average SpO2 value. There was no statistically significant difference in the SpO2 values between the thumbs in right handed and left handed subjects. Lowest SpO2 values were obtained in little fingers of both the hands without showing significant difference of hand dominance. Conclusion: While recording the SpO2 by pulse oximeter, the middle fingers show the highest values followed by the thumbs. Lowest values are recorded from the little fingers. Again, result depicts that there is no statistically significant difference in SpO2 values between corresponding fingers of dominant and non-dominant hand.

To assess increases in overall and Differential Leukocyte Count (DLC), as well as oxygen saturation of haemoglobin in stable smokers and non-smokers: An observational study

To assess increases in overall and Differential Leukocyte Count (DLC), as well as oxygen saturation of haemoglobin in stable smokers and non-smokers: An observational study

Determination of Safe Apnoea Period in Relation to Haemoglobin Concentration at Komfo Anokye Teaching Hospital

The induced cessation of ventilation or suspension of external breathing is a common occurrence in anaesthetic practice. During the period of induced apnoea, there is no movement of the muscles of inhalation and lung volumes initially remain unchanged. Maintaining haemoglobin saturation during airway management is critical to guarantee the safety of patients. However, there has been little quantitative study of apnoea especially on the rate of change in oxygen saturation in relation to haemoglobin concentration in the apnoeic period of induction of anaesthesia. The study sought to determine the safe apnoea period in relation to haemoglobin concentration. The study showed that patients with low haemoglobin concentration took less time to reach 100% oxygen saturation, while those with high haemoglobin concentration took more time to reach 100% oxygen saturation during pre-oxygenation. The study found that the average safe apnoea period for patients in relation to haemoglobin concentrations to desaturation (from 100% - 92%) following the administration of suxamethonium was 7.0 - 9.9 g/dl was 3:15.07 minutes, 10.0 - 12.9 g/dl was 3:43.05 minutes and 13.0 - 16 g/dl was 4:23.04 minutes. And the overall safe apnoea time for the patients was 3:27.02 minutes. All the patients who attained 100% oxygen saturation without inhaling 100% oxygen were living in mountainous areas. The mean induction period (6:52.26 ms) of the patients was higher than the mean safe apnoea period (3:27.02 ms). The study recommends that anaemia should be corrected before induction of anaesthesia and people living at high altitude should be advised to occasionally move down to areas of low altitude to improve tissue oxygenation.

Efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphataemia in chronic kidney disease in Asturias. FOSFASTUR study

Alterations in bone and mineral metabolism are very common in chronic kidney disease (CKD). The increase in phosphate levels leads to bone disease, risk of calcification and greater mortality, so any strategy aimed at reducing them should be welcomed. The latest drug incorporated into the therapeutic arsenal to treat hyperphosphataemia in CKD is Sucroferric Oxyhydroxide (SFO). ObjectiveTo analyse the efficacy and safety of OSF in three cohorts of patients, one with advanced chronic kidney disease not on dialysis (CKD-NoD), another on peritoneal dialysis (PD) and the last on haemodialysis (HD), followed for six months. MethodsA prospective, observational, multicentre study in clinical practice. Clinical and epidemiological variables were analysed. The evolution of parameters relating to alterations in bone and mineral metabolism and anaemia was analysed. ResultsEighty-five patients were included in the study (62 ± 12 years, 64% male, 34% diabetic), 25 with CKD-NoD, 25 on PD and lastly, 35 on HD. In 66 patients (78%), SFO was the first phosphate binder; in the other 19, SFO replaced a previous phosphate binder due to poor tolerance or efficacy. The initial dose of SFO was 964 ± 323 mg/day. Overall, serum phosphate levels saw a significant reduction at three months of treatment (19.6%, P < 0.001). There were no differences in the efficacy of the drug when the different populations analysed were compared. Over the course of the study, there were no changes to levels of calcium, PTHi, ferritin, or the transferrin and haemoglobin saturation indices, although there was a tendency for the last two to increase. Twelve patients (14%) withdrew from follow-up, ten due to gastrointestinal adverse effects (primarily diarrhoea) and two were lost to follow-up (kidney transplant). The mean dose of the drug that the patients received increased over time, up to 1147 ± 371 mg/day. ConclusionsSFO is an effective option for the treatment of hyperphosphataemia in patients with CKD both in the advanced phases of the disease and on dialysis. We found similar efficacy across the three groups analysed. The higher their baseline phosphate level, the greater the reduction in the serum levels. A notable reduction in phosphate levels can be achieved with doses of around 1000 mg/day. Diarrhoea was the most common side effect, although it generally was not significant.

Effects of impaired microvascular flow regulation on metabolism-perfusion matching and organ function.

Impaired tissue oxygen delivery is a major cause of organ damage and failure in critically ill patients, which can occur even when systemic parameters, including cardiac output and arterial hemoglobin saturation, are close to normal. This review addresses oxygen transport mechanisms at the microcirculatory scale, and how hypoxia may occur in spite of adequate convective oxygen supply. The structure of the microcirculation is intrinsically heterogeneous, with wide variations in vessel diameters and flow pathway lengths, and consequently also in blood flow rates and oxygen levels. The dynamic processes of structural adaptation and flow regulation continually adjust microvessel diameters to compensate for heterogeneity, redistributing flow according to metabolic needs to ensure adequate tissue oxygenation. A key role in flow regulation is played by conducted responses, which are generated and propagated by endothelial cells and signal upstream arterioles to dilate in response to local hypoxia. Several pathophysiological conditions can impair local flow regulation, causing hypoxia and tissue damage leading to organ failure. Therapeutic measures targeted to systemic parameters may not address or may even worsen tissue oxygenation at the microvascular level. Restoration of tissue oxygenation in critically ill patients may depend on restoration of endothelial cell function, including conducted responses.