History Of Oxygen Therapy Research Articles

CHARACTERISTICS OF RETINOPATHY OF PREMATURITY IN MAKASSAR BETWEEN JANUARY 2020 AND DECEMBER 2022

Introduction & Objectives : Introduction: Retinopathy of Prematurity (ROP) is one of the leading causes of irreversible visual impairment in infants, especially in premature infants. Preterm birth leads to incomplete development of retina that will cause ROP. ROP screening is an early strategy to prevent irreversible blindness in ROP. Objective: The purpose of this study was to describe the characteristics of ROP in Makassar between January 2020 and December 2022.
 Methods : A multi-center observational descriptive study at ten hospitals in Makassar.
 Results : The total patients in this study were 168 infants (336 eyes) included 53.25% male and 46.15% female. The incidence of ROP in Makassar between January 2020 and December 2022 was 14.87%. Most of the patients had history of preterm birth with gestational age ranged from 28 to 33 weeks and low birth weight less than 1500 gram in 50% patients. Majority of patients had history of oxygen therapy (77.98%), and other risk factors such as sepsis, twin birth, history of transfusion, or apnea. About 98.81% patients had bilateral ROP and 33.93% were diagnosed with stage 3 at first screening. Photocoagulation laser was done in 41 patients (24.40%).
 Conclusion : The ROP screening in Makassar had a good outcome in managing the premature infants, so they can be diagnosed and got treated earlier. A sustainable screening program is required to prevent the irreversible blindness due to ROP.

Mucormycosis Associated with Global Coronavirus Disease-19 Pandemic: A Study of Fungal Profile from a Tertiary Health-care Center

Background and Aim: In this era of the coronavirus disease (COVID) pandemic, new health issues appear quickly and cause an outbreak in India. Here, we focus on invasive fungal infections (IFA), namely mucormycosis, aspergillosis, and candidiasis. Hence, in this article, we focus on conventional techniques for early diagnosis of fungus to help clinicians start empirical treatment for the patient and take necessary steps thereby. Materials and Methods: This observational study was conducted for 1 month, from May 2021 to June 2021, on 200 patients admitted to our mucormycosis ward. Samples were first examined microscopically using potassium hydroxide (KOH) wet mounts followed by culture on sabouraud dextrose agar and the gross appearance of the growth was observed. Further identification of species was achieved through the use of lactophenol cotton blue mounts and slide culture technique. Results: Out of 200 patients, 65.5% were male and 34.5% female. We divided these patients into three age groups, i.e., 20–30 years (15%), 40–60 years (54%), and 60–80 years (31%). Seventy-four percent of patients presented with a history of diabetes mellitus, 50% had a history of steroids taken in their past, and 48% had a history of oxygen therapy taken at the time of COVID-19 positivity (52%) samples positive for mucormycosis. Forty-one percent were KOH-positive for Mucorales and 35.5% were culture positive. The most commonly isolated fungus was Rhizopus, followed by Mucor, Lichthemia, Aspergillus spp., and Candida spp. Conclusion: To improve test sensitivity and enable early diagnosis, other serum biomarkers such as galactomannan, beta-D-glucan, cryptococcal antigenemia, and blood quantitative polymerase chain reaction for Aspergillus or Mucorales should be implemented.

Epidemiology, Clinical Profile, and Analysis of Risk Factors in COVID Associated Rhino-orbito-cerebral Mucormycosis Patients - An Observational Study.

To study the clinico-epidemiological profile and identify risk factors for the development of COVID-19-associated mucormycosis (CAM) among the patients treated at our regional mucormycosis center. This was a cross-sectional single-centre observational study. All CAM patients admitted to Government Rajaji Hospital, Madurai from April 2021- August 2021 were included in the study. Information regarding clinical features, potential risk factors, diagnostic workup, and comorbid illness was collected. A total of 164 patients of CAM were admitted to our hospital with a mean age of 51.7 years. Out of 164 patients, 12 patients were not covid positive, based on imaging and RT-PCR, however subclinical infection could not be ruled out. Out of the 164 patients studied, 160 patients had diabetes, out of which 66% (n = 105) patients had a previous history of diabetes, and 34% (n = 55) had newly detected diabetes. Most of the patients admitted with mucormycosis had uncontrolled diabetes (94%) and were not on insulin therapy, but were on oral antidiabetic drugs alone. The majority of the patients (68%) have received steroids (IV/oral) during the COVID-19 illness. 74% of these patients were under hospitalization for COVID-19 disease. Only 30% (n = 50) of CAM patients had a history of oxygen therapy and 7% of these patients were treated in ICU during active COVID-19 illness. 59% of patients used cloth masks without adequate hygiene, rest 41% (n = 67) patients reused disposable masks. We also found that 87% of the patients developing mucormycosis had exposure to organic material in the convalescence period of COVID-19 illness. From our study, we found steroid use, poorly controlled diabetes mellitus, reuse of masks, daily steam inhalation, and exposure to organic matter to be more associated with CAM, but oxygen therapy was less associated with CAM. Hence, we could suggest screening for hyperglycemia and daily use of disposable surgical masks to be continued for at least 4 weeks post-COVID-19. It is preferable to continue insulin in titrated doses along with OHA for at least 4 weeks following steroid cessation in the post-COVID-19 period as there is are considerably increased inflammatory cytokine levels in the convalescence phase. Clean environmental hygiene would also help prevent CAM.

CLINICAL OUTCOME OF POST COVID MUCORMYCOSIS PATIENTS IN A TERTIARY CARE CENTRE IN UTTARAKHAND, INDIA

Objective – To study clinical outcome of post COVID mucormycosis patients in a tertiary care centre in Uttarakhand, India A Methodsretrospective observational study conducted at tertiary care centre Haldwani, Uttarakhand, India between May18, 2021 and July2, 2021 in current, recent, or remote history of COVID19 with diagnosed mucormycosis. 31 patients pre Results- sented with mucormycosis, 29 had association with COVID-19,out of which 6 were active cases of COVID-19 and 23 were post COVID. All the patients had sino-nasal involvement and ethmoid sinus was the most common sinus affected. Intra-orbital extension was seen in 53 per cent of cases out of which 39% were 3c category while intracranial extension was seen in 20 per cent. Diabetes mellitus was present in 26 of 31 cases. Around 38% patients had history of oxygen therapy ( NRM/cannula) and 47% had history of steroids use. Around 13% underwent surgery, despite the use of liposomal Amphotericin B therapy .Surgery mainly consisted of exentration with or without open maxillectomy and ethmoidectomy The association between Conclusioncoronavirus and mucormycosis is a life threatening complication. Uncontrolled diabetes and over-zealous use of steroids are two main factors aggravating the illness. Despite all the medical and surgical efforts the illness carries high mortality rate. As we are learning more about the new and long-term manifestations of the Covid-19 infection, further research is required to establish if COVID19 itself predisposes to mucormycosis.

Intravitreal bevacizumab to treat retinopathy of prematurity in 865 eyes: a study to determine predictors of primary treatment failure and recurrence.

This study aimed to evaluate the rate and risk factors for primary failure and recurrence after intravitreal anti-VEGF injection in retinopathy of prematurity (ROP). This retrospective study was performed on 865 eyes from 441 patients with retinopathy of prematurity receiving intravitreal bevacizumab from 2012 to 2019. Medical records of patients were evaluated. Mean gestational age (GA) and birth weight of patients were 28 ± 2weeks and 1121 ± 312g, respectively. Thirty-five eyes (4.04%) had a primary failure, including 18 eyes from 187 eyes in zone 1 (9.6%) and 17 eyes from 678 eyes in zone 2 (2.5%). The mean time of retreatment was 16.64 ± 13.68days in eyes without regression ROP. The remaining 830 eyes (95.95%) were included in recurrence analysis. The recurrence occurred in 33 eyes (3.97%) of them in 20 patients, with the meantime of 77.52days after the first treatment (IVB). The presence of plus disease, history of oxygen therapy or phototherapy, and GA less than 32 were associated with significantly increased prevalence of treatment failure. The risk factors predicting recurrence are lower birth weight, zone 1 pretreatment, history of intubation, anemia, and sepsis. Intravitreal anti-VEGF is a successful treatment for ROP with a low rate of primary failure and recurrence. Awareness of risk factors for treatment failure and recurrence may help clinicians to schedule more vigilant approach in susceptible cases.

Predictors for mucormycosis in COVID era: A case-control study from Gujarat.

Mucormycosis has been increasingly described in the coronavirus disease (COVID-19) era, however, there is a lack of robust epidemiological studies to understand the predictors for the development of mucormycosis from India. To document the risk factors of mucormycosis with or without COVID-19 and estimate the strength of association of various risk factors. A case-control study was conducted in the Ahmedabad districts of Gujarat from June to August 2021. One hundred participants (25 cases with mucor, 75 without mucor) were enrolled in the study. The cases and controls were then matched based on age and gender. Ethical approval was sought from the Institutional Ethics Committee of the Indian Institute of Public Health Gandhinagar, Gujrat, India. Data were collected using the Epi Collect 5 application, and the descriptive, inferential analysis was done using the SPSS version 21 statistical software. About 68% of the cases were from a rural area and had past comorbidity conditions. About 80% of the cases reported a previous history of COVID-19, whereas 67% of the controls reported the same. The factors which remained significant after applying the hierarchical model were rural residents (OR = 3.2 [95% CI: 1.05-10.3]) and history of oxygen therapy (OR = 5.42 [95% CI: 1.24-23.8]). This study concludes that mucormycosis is independent of the COVID-19 status. Rural residents and oxygen therapy were found to be the most significant risk factors for mucormycosis. The findings of this study are also not conclusive to establish an association; thus, further exploration and in-depth research with larger samples are recommended.

A clinicoepidemiological study of orbital mucormycosis in COVID-19 pandemic at a tertiary healthcare hospital, North-West Rajasthan, India

Background Mucormycosis is an opportunistic fungal infection with high morbidity and mortality. Purpose The aim of this study was to determine the risk factors, clinical presentation, management, and outcome of management of orbital mucormycosis during the coronavirus disease 2019 (COVID-19) pandemic. Patients and methods This is a prospective hospital-based observational study that was conducted on cases of rhino-orbital cerebral mucormycosis (ROCM) presented to a tertiary health-care center in North-West Rajasthan, India, during the second wave of COVID-19 over a period of 1 month (May 26, 2021 to June 25, 2021). The patients were followed up for 3 months. A total of 40 cases fulfilling the clinical, radiological, and pathological or microbiological criteria for the diagnosis of ROCM were included in the study. Results Out of a total of 126 mucormycosis patients, 40 had ocular manifestations ranging from lid edema, chemosis, and ptosis to severe manifestations such s ophthalmoplegia, optic neuritis, and cavernous sinus thrombosis. Rare presentations of corneal eschar and corneal ulcer were also reported. Among the 40 patients of orbital mucormycosis, 57.5% were in the age group of 51–65 years, 65% were males, 62.5% were COVID positive, 37.5% had a history of oxygen therapy during the COVID-19 illness, and 85% were not vaccinated against COVID-19. All patients with orbital involvement had rhinitis at presentation. Intravenous Amphotericin B was given to all patients. Functional endoscopic sinus surgery was done in 92.5% of the cases and orbital exenteration was done in 35% of the patients to prevent the spread of mucor and to reduce mortality. In 32.5% of the patients, retrobulbar Amphotericin B was given. The mean length of hospital stay was 24.62±11.70 days and 70% of the patients were discharged from the hospital on oral antifungal therapy. A total of 30% of the patients with cerebral involvement passed away. During the follow-up of 3 months, three (7.5%) more patients who discontinued treatment progressed to advanced disease and died, while 62.5% (25 out of 40) patients were alive with stable/regressed disease. The survival rate with retrobulbar Amphotericin B was 92.30% and with exenteration was 92.85%, which was statistically significant compared with the 5% survival rate in the cases in whom no such intervention was done. Conclusion Early diagnosis and treatment of ROCM reduced morbidity and mortality in mucormycosis patients.

Right ventricular contractility decreases during exercise in patients with non-advanced idiopathic pulmonary fibrosis.

Early right ventricular dysfunction in patients with non-advanced idiopathic pulmonary fibrosis (IPF) has not been fully elucidated. Thus, we aimed to assess right ventricular functions in IPF patients and controls by speckle-tracking strain echocardiography at rest and peak exercise.We screened 116 IPF patients from February to August 2019 to include 20 patients with no history of oxygen therapy, peripheral saturation levels ≥92% at rest, Gender-Age-Physiology Index score ≤5, and modified Medical Research Council score ≤3. Additionally, we enrolled 10 matched controls. Transthoracic echocardiography images were acquired at rest and during a cardiopulmonary exercise test. We analyzed 2-dimensional echocardiographic parameters and right ventricular function using the global longitudinal strain assessed by the 2-dimensional speckle-tracking technique.In the control group, we found normal values of right ventricle longitudinal strain (RVLS) at rest and at peak exercise, the latter being much more negative (−23.6 ± 2.2% and −26.8 ± 3.1%, respectively; P < .001). By contrast, RVLS values in the IPF group increased from −21.1 ± 3.8% at rest to −17.0 ± 4.5% at peak exercise (P < .001). The exercise revealed a difference between the 2 groups as the mean RVLS values moved during peak exercise in opposite directions. Patients with IPF got worse, whereas control patients presented improved right ventricular contractility.Right ventricular dysfunction was unveiled by speckle-tracking echocardiography during exercise in non-advanced IPF patients. We suggest that this reflects an inadequate right ventricular-arterial coupling decreasing the right ventricular longitudinal contraction during exercise in these patients. This parameter may be useful as an early index of suspected pulmonary hypertension.

Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study

ABSTRACT Background Little is known about right ventricular dysfunction in non-advanced idiopathic pulmonary fibrosis (IPF) patients without hypoxemia at rest. We evaluated it at rest and during exercise. Research design and methods 123 IPF patients were evaluated, and 27 met all the following criteria: Gender-Age-Physiology Index score ≤5, modified Medical Research Council dyspnea score ≤3, peripheral oxygen saturation ≥92% at rest, and no history of oxygen therapy. They were submitted to two-dimensional speckle-tracking echocardiography at rest and during cardiopulmonary exercise to analyze right ventricular global longitudinal strain. Results Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular (RV) dysfunction. No patients had abnormalities observed in conventional echocardiographic parameters. Significant differences in mPAP were observed between patients with RV dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002). Conclusions RV dysfunction was detected in 37% of non-advanced IPF patients and early recognition was only possible using speckle-tracking echocardiography. Special attention should be given to these patients as RV dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.

The relationship between the first episode of wheezing and matrix metalloproteinases-9 and MMP-2 and tissue inhibitors of MMP-1 levels in preterm infants

AIMS:Matrix metalloproteinases (MMP) have been associated with neonatal lung morbidity and MMP dysregulation contributes to the pathology of chronic and acute lung disorders. Most of the previous studies were performed in the 1st weeks of life of the preterm newborns. There are no data on the serum levels of MMP-2, MMP-9 or tissue inhibitors of matrix metalloproteinases (TIMP-1) from preterm infants recovering from lung morbidities. We aimed to compare MMP-2, MMP-9 and TIMP-1 levels in preterm and term infants hospitalized with their first episode of wheezing.METHODS:We prospectively evaluated 18 preterm infants with a history of chronic lung disease, respiratory distress syndrome or oxygen therapy and 14 age- and sex-matched term infants who were admitted for a first episode of wheezing. We quantified total serum concentrations of MMP-2, MMP-9 and TIMP-1 to assess whether these serum markers levels were associated with the first episode of wheezing in infants with a history of oxygen therapy during the neonatal period.RESULTS:Upon hospitalization, MMP-2 and TIMP-1 levels were higher in preterm infants than in term infants. In contrast, there was no significant relationship between MMP-9 levels or the MMP-9/TIMP-1 ratio between preterm and term infants. The area under the receiver operating characteristic curve for MMP-2 was 0.70 (95% confidence interval [CI] 0.51-0.89). The area under the curve for TIMP-1 was 0.78 (95% CI 0.61-0.94). MMP-9, MMP-2 and TIMP-1 levels did not correlate with gestational age, gender or severity of wheezing.CONCLUSION:The negative proportion of MMP-9 to TIMP-1 that we detected in term infants was not present in preterm infants. The balance of MMP-9 to TIMP-1 may have been disrupted by lung damage in the premature infants. Overproduction of MMP-2 and TIMP-1 in the serum may be associated with the pathogenesis of wheezing in preterm infants.

1711 The Relationship between the First Episode of Wheezing and Matrix Metalloproteinases-9 and –2 and Timp-1 Levels in Preterm Infants

BackgroundElevated concentrations of matrix metalloproteinases (MMP) have been associated with neonatal morbidity. There are no data on the serum levels of MMP-2, MMP-9, tissue inhibitors of matrix metalloproteinase (TIMP-1) from...

Oxygen Titration Strategies in Chronic Neonatal Lung Disease

The history of oxygen therapy in neonatology has been littered with error. Controversies remain in a number of areas of oxygen therapy, including targets and strategies in supplemental oxygen therapy in Chronic Neonatal Lung Disease (CNLD). This article reviews some of these controversies, and makes some recommendations based on the available evidence. In graduates of neonatal units who are left with CNLD, oxygen saturation should be kept above 93-95%, with levels below 90% being avoided as far as possible. Titration of oxygen should be done using oximetry recordings which include periods of different activities. Weaning of oxygen supplementation should only be done based on satisfactory recordings during a trial of a lower flow. There is insufficient evidence to say whether weaning for increasing hours a day or stepwise weaning to a continuous lower flow is a better method.

The centennial of oxygen-therapy (1902 - 2002)--reassessing its history. Part I: "The long way of oxygen"--from its discovery to its implementation as a rational therapy in anaesthesia and emergency-medicine

This historical survey in two parts analyses the history of inhalative oxygen therapy and its interactions with the history of anaesthesiology. For this purpose, we will start with illustrating "the long way of oxygen" from its first isolation by Carl Wilhelm Scheele (1772) and Joseph Priestley (1774) to its breakthrough for therapeutic application in the 20th century. We will show that the two main factors delaying the successful implementation of a truly rational oxygen therapy were of technical nature: The complicated and costly production of the gas and insufficient means to apply it continuously and with reliable and sufficient dosages to the patients. Both problems could not be satisfactorily solved until 1902. From this year on, however, the "Linde Process" allowed cheap mass-production of oxygen. Simultaneously, various inventions of modern pressure gas technology allowed to solve the application problems. Here, a special significance is to be awarded to pressure reducing valves. These were first introduced into medical technology by Draeger Inc. (Lübeck/Germany) on a significant scale, proving particularly successful in anaesthesia and rescue-devices (e. g. in the "Roth-Draeger Anaesthesia Apparatus" [1902]). Critically discussing earlier research on the history of oxygen therapy, we therefore propose a historical reassessment, accepting the year 1902 as the internationally decisive "turning point" towards the development of modern oxygen therapy.

The importance of oxygen free radicals in the neonatal period

OBJECTIVE: Oxygen free radicals are extremely reactive species and they can lead to injury and cell death. The aim of this review is to study the main biochemical aspects of free radical formation and their role as an intermediate mechanism of injury in several neonatal diseases.METHODS: A brief history of oxygen therapy in neonatology and its relationship with complications associated with the production of free radicals. Definition, mechanism of action and antioxidant systems were described. Next, the neonatal factors of increased risk of free radical oxidative injury and the diseases associated with oxygen free radical toxicity were reviewed.RESULTS: Oxygen free radicals are reactive species that although crucial to normal biological processes, can lead to injury and cell death. They are implicated in the pathogenesis of many neonatal diseases such as perinatal asphyxia, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, intracranial hemorrhage, pulmonary hypertension and persistence of ductus arteriosus. Birth is associated with transition to a hyperoxic environment in comparison with uterine environment, which leads to increased generation free radicals. The newborn has undeveloped antioxidant systems and, therefore, may be at increased risk of free radical oxidative injury.CONCLUSIONS: The understanding of neonatal factors involved in the pathogenesis of "oxygen free radical diseases" will lead to the development of new therapies for prevention and treatment of these neonatal diseases.

Interpretation of Statistical Nonsignificance and Retrolental Fibroplasia

An important and well-documented Supplement to Pediatrics was published in April 1976 entitled "History of Oxygen Therapy and Retrolental Fibroplasia."1 It was prepared by the Committee on the Fetus and the Newborn, with the aid of several consultants, and was edited by L. Stanley James, M.D., and Jonathan T. Lanman, M.D. Unfortunately, there is a misprint on page 612 that has caused serious confusion and misunderstanding. A key study by Lanman et al2 is misquoted as follows: "Mortality in the low oxygen group was somewhat higher than in the high oxygen group, but the difference was not statistically (p .03)."