Improvement In Oxygen Saturation Research Articles

Postinjury treatments to make early tactical aeromedical evacuation practical for the brain after TBI.

Traumatic brain injury (TBI) is common in civilians and military personnel. No potential therapeutics have been evaluated to prevent secondary injury induced by the hypobaric hypoxia (HH) environment integral to postinjury aeromedical evacuation (AE). We examined the role of allopurinol, propranolol, adenosine/lidocaine/magnesium (ALM), or amitriptyline administration prior to simulated flight following murine TBI. Mice underwent TBI and were given allopurinol, propranolol, amitriptyline, or ALM prior to simulated AE or normobaric normoxia (NN) control. Heart rate (HR), respiratory rate, and oxygen saturation (Spo2) were recorded throughout simulated AE. Mice were sacrificed at 24 hours, 7 days, or 30 days. Serum and cerebral cytokines were assessed by enzyme-linked immunosorbent assay. Motor function testing was performed with Rotarod ambulation. Immunohistochemistry was conducted to examine phosphorylated tau (p-tau) accumulation in the hippocampus at 30 days. While all treatments improved oxygen saturation, propranolol, amitriptyline, and allopurinol improved AE-induced tachycardia. At 24 hours, both propranolol and amitriptyline reduced tumor necrosis factor alpha levels while allopurinol and ALM reduced tumor necrosis factor alpha levels only in NN mice. Propranolol, amitriptyline, and ALM demonstrated lower serum monocyte chemoattractant protein-1 7 days after AE. Both amitriptyline and allopurinol improved Rotarod times for AE mice while only allopurinol improved Rotarod times for NN mice. Propranolol was able to reduce p-tau accumulation under both HH and NN conditions while ALM only reduced p-tau in hypobaric hypoxic conditions. Propranolol lowered post-TBI HR with reduced proinflammatory effects, including p-tau reduction. Amitriptyline-induced lower post-TBI HR and improved functional outcomes without affecting inflammatory response. Allopurinol did not affect vital signs but improved late post-TBI systemic inflammation and functional outcomes. Adenosine/lidocaine/magnesium provided no short-term improvements but reduced p-tau accumulation at 30 days in the HH cohort. Allopurinol may be the best of the four treatments to help prevent short-term functional deficits while propranolol may address long-term effects. Basic science article.

Effect of Changing Selected body Positions on Oxygen Saturation among Patients with Acute Stroke

Background: Body position generally effect on respiratory and stroke disease. Stroke morbidity increased by inappropriate position during the early recovery phase. Aim: To evaluate the effect of changing selected body positions on oxygen saturation among patients with acute stroke. Research design: Quasi-experiment research design applied in this study. Sitting: the study carried out at the stroke intensive care unit of the Neurological Department of Aswan University Hospitals. Sample: 60 patients with acute stroke within 24- 48 hours following mild to moderate and severe stroke allocated a randomized sequence of four positions. One hour spent in each position. SaO2 was recorded each15 minutes by pulse oximetry with a finger probe. Tools of data collection: structured interview questionnaire sheet, Glasgow Coma Scale, the Scandinavian stroke scale, and oxygen saturation monitoring record. Results: mean score of SaO2 at 2nd 15 min, 3rd 15 min, 4th min, and mean SaO2 of one hour at the semi-sitting position was higher than different positions (Supine position, Right side position, and Left side position) with statistically significant differences with p-value .008, .05, .002, and .019 respectively, the semi-sitting position was the best position of all position. Conclusion: the study finding concluded that the semi-sitting position is the best position than other positions in improving oxygen saturation after one hour from positioning among stroke patients. Recommendation: use a semi-sitting position and implicate this positioning strategy in the future to improve arterial oxygen saturation in acute stroke patients.

Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Objectives: The objectives of the study were to evaluate the benefit of awake prone positioning in COVID-19 patients hospitalized at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. Materials and Methods: Consecutive patients with COVID-19 who require supplemental oxygen to maintain oxygen saturation of ≥90% during the month of October 2020 were enrolled. Structured questionnaires were employed to collect data. Admission oxygen saturation was recorded for each patient before and after their first proning session. Analysis of descriptive and comparison statistics was done using SPSS version 25. Results: A total of 61 patients were included in the study. The mean age (+SD) for the cohort was 55.4 (+16.9) years. The average duration of proning was 5+2.5 h/session and 8+6 h/day. The average oxygen saturation before proning was 89% (SD 5.2) and 93% (SD 2.8) 1 h after proning (P < 0.001); supplemental oxygen requirements significantly decreased with prone ventilation, before proning: FiO2 0.33 (+0.14) versus 1 h after prone ventilation: FiO2 0.31 (+0.13) (P < 0.001). Oxygen improvement with prone ventilation was not associated with duration of illness or total prone position hours. When assessed at 28 days after admission, 55.7% (n = 34) had been discharged home, 1.6% (n = 1) had died, and 42.6 (n = 26) were still hospitalized. Conclusion: Awake prone positioning demonstrated improved oxygen saturation in our oxygen requiring COVID-19 patients. Even though further studies are needed to support causality and determine the effect of proning on disease severity and mortality, early institution of prone ventilation in appropriate oxygen requiring COVID-19 patients should be encouraged.

Right lateral position can improving oxygen saturation and respiratory rate on under-five children with pneumonia.

Pediatric patients with pneumonia experience respiratory distress in the form of shortness of breath and rapid breathing, which affects oxygen saturation. Oxygen saturation and respiratory rate can be increased by providing the right lateral position. Fulfillment of oxygen will affect the healing of children and can reduce the length of stay in hospital. The purpose of this study was to identify the effect of right lateral positioning on oxygen saturation and respiratory rate in under-five children with pneumonia. The study design was a quasi-experimental pre-posttest with control group design. Respondents were 32 infants with pneumonia, (right lateral=16 and control group=16), selected by consecutive sampling. Univariate and bivariate analyzes were performed. There was a significant difference in oxygen saturation before and after right lateral position (p-value=0.000) and there was a significant difference in the respiratory rate before and after right lateral position (p-value=0.000). The results can be used to improve health services by promoting the right lateral position as a selftreatment intervention for increasing oxygen saturation and stabilizing respiratory rate in infants with pneumonia.

Blow pinwheels improve oxygen saturation of preschool children with post pneumonia in outpatient pediatric departement.

This study aimed to recognize the Pursed Lips Breathing (PLB) modification effect by blowing pinwheel to the oxygen saturation of preschool children with post pneumonia. Also, to analyze the oxygen saturation value of the preschool children with pneumonia on the intervention group and the control group and to recognize the differences. This study design was quasi experimental pre-posttest with control group design. The participants were 30 preschool children with post pneumonia (15 children were in the intervention group, 15 were in the control group) and were chosen by consecutive sampling. This study showed significant differences on oxygen saturation between the intervention group and control group (p=0.018<0.05). Blowing pinwheel affected the oxygen saturation of the preschool age with pneumonia on the intervention group but none on the control group. The results of this study can be used as the basis and reference for the hospital in making policies, as founded that blowing pinwheel affected the oxygen saturation escalation of the preschool children with pneumonia after several exercises. This activity was recommended to be implemented at the hospital as the treatment for the outpatient children with pneumonia and to be carried on at home for the preschool children who were able to perform independently. The recommendation for the further study was to use a true experiment with a larger sample and was not limited to PLB but also to measure the ability to blow.

Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea.

To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance worn for a minimum of 4.5 years. This retrospective study conducted in patients with healthy baseline periodontium recruited participants among consecutive sleep apnea patients treated with an oral appliance between 2004 to 2014. Eligible participants were recalled for a follow-up visit at which a periodontal examination was performed and a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. Twenty-one patients enrolled with a mean treatment length of 7.9 ± 3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4 ± 0.5 mm, recession 0.6 ± 1.1 mm, and clinical attachment loss 0.8 ± 1.0 mm. Compared with baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1 degrees) with the continued use of an oral appliance. Gingival levels were maintained with clinically insignificant changes during the observation period. Inclination of the mandibular incisors increases significantly with the use of an oral appliance in patients with obstructive sleep apnea. Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession. Heda P, Alalola B, Almeida FR, Kim H, Peres BU, Pliska BT. Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2067-2074.

Plasma exchange followed by convalescent plasma transfusion in COVID-19 patients

BackgroundCoronavirus disease 2019 (COVID-19) is an emerged pandemic disease with no specific treatment. One of the potential treatments in newly found infectious disease is plasma exchange (PE) with convalescent plasma transfusion (CPT). This case series aimed to evaluate the primary PE and CPT in five Iranian COVID-19 patients. MethodsFive patients with confirmed COVID-19 who had acute respiratory distress syndrome and were supported by mechanical ventilation were treated with two consecutive PE containing fresh frozen plasma (FFP) of healthy donors and 0.9 % saline solution containing 5 % human albumin. Thereafter, CPT was performed just like PE, except that the FFP in this step was substituted with convalescent ABO-matched plasma. Clinical and laboratory factors were evaluated before and after treatments. ResultsThree to Four patients showed lower body temperature and improved oxygen saturation as well as reduced laboratory factors such as c-reactive protein, lactate dehydrogenase, creatine phosphokinase (total and myocardial isoform), aspartate aminotransferase, blood urea nitrogen, bilirubin (total and direct), D-dimer, interleukin-6, and CD4+/CD8 + T cells ratio initially after PE and continued to improve so that they were discharged. One patient due to secondary hemophagocytic lymphohistiocytosis and extensive lung fungal infection was expired. DiscussionOverall, the PE followed by CPT was beneficial in reducing acute inflammation led to a considerable improvement in patients’ clinical features. It seems that PE along with CPT could provide clearance of pro-inflammatory mediators as well as the positive effects of CPT. Controlled studies are required to confirm the effect of PE/CPT compared with other therapeutic approaches.

Importance of Pharmacists as a Front Line Warrior inImproving Medication Compliance in Covid 19 Patients

To explore the effect of clinical pharmacist intervention on the treatment of viral pneumonia with intravenous methyl prednisolone and others. The clinical data of 112 patients from July 2020 to September 2020 were categorized into observational group (n=56) and random group (n=56) according to the randomized double blind method. The control group with routine nursing intervention and the observational group was treated with comprehensive clinical pharmacist and nursing intervention. Quality of life, recovery time and saturation levels were assessed frequently and on a weekly basis. The observational group was found to have improved oxygen saturation levels during frequent evaluation with the saturation probes when compared with control group, as well the recovery time was also improved. The quality of life in the observation group was significantly better than that in the control group. Incorporating a clinical pharmacist as an integral member of the health care team, brings numerous benefits, one among them is significant improvement in the delay drug administration to the patient. It is undeniable that a clinical pharmacist is a drug information resource for all the health professionals working in a hospital setting.

An Observational Study to Analyze Outcome of Omentopexy in Buerger’s Disease in Tertiary Care Center

Thromboangiitis obliterans (TAO) or Buerger’s disease (BD) is a non-atherosclerotic, segmental occlusive inflammatory disease that commonly affects small and medium arteries and veins in the upper and lower limbs. Our purpose of this study was to evaluate outcome of lumbar sympathectomy and omentopexy in patients with Buerger’s disease by assessing neovascularization and good clinical recovery. Thirty consecutive patients underwent omentopexy for Buerger’s disease of lower limb from June 2019 to June 2020 in our institute. Patients were followed up for 3 months postoperatively for relief of intermittent claudication and rest pain. The ulcer and amputation site healing were assessed. The oxygen saturation level was also measured and postoperative complication was noted. The mean age was 45 ± 5.5 years and male to female ratio was 29:1. Out of 30 patients, 26 (86.7%) patients had omentopexy up to below knee level, 3 (10%) patients at ankle level, and 1 (3.3%) patient up to above knee level. All patients had relief of rest pain and 25 (83.3%) patients had relief of intermittent claudication on 3rd month. Three patients who had non-healing ulcers showed ulcer healing and 27 patients who had gangrene showed healing at amputation site at 3rd month. Omentopexy improve oxygen saturation and temperature of the affected limb and helps in clinical recovery in terms of relief in intermittent claudication, rest pain, and ulcer healing. Thus, it can be considered as an effective modality for the management of Buerger’s disease as limb salvage procedure.

The effect of Pursed Lips Breathing Exercises on the Oxygen Saturation Levels of Patients with Chronic Obstructive Pulmonary Disease in Persahabatan Hospital, Jakarta

Patients with chronic obstructive pulmonary disease can face increased resistance of airflow, air trapping, and lung hyperinflation. This condition can also cause decreased lung ventilation functions. Using a pursed lips breathing exercise can strengthen respiratory muscles that can improve oxygen saturation by maintaining airflow to bronchus and its branches and alveolus which then can prevent collapse in bronchiolus. The purpose of the study was to identify the effect of pursed lips breathing exercises on the oxygen saturation levels in patients with chronic obstructive lung disease in Persahabatan hospital, Jakarta. The design was quasi experimental, with a control group pre-post test design. A random sampling technique was used in the study. The exercise was provided to the intervention group for six days. The findings showed that the lung ventilation function is significantly different between preand post-intervention for both groups (p=0.00). Further, the average lung ventilation function in the intervention group is significantly different from that of the control group after intervention (p=0.012). In addition, while there is a significant relationship between subject age and the increase of the lung ventilation score (p=0.001), there was no relationship between height and the increase of oxygen saturation (p=0.091) and no significant relationship between sex and the increase of oxygen saturation (p=0.346). Based on these findings, the pursed lips breathing exercise is recommended to patients with chronic obstructive lung disease in order to improve the level of oxygen saturation.&#x0D; &#x0D; Keywords: Oxygen saturation, Pursed lips breathing exercise, Chronic Obstructive Pulmonary Disease.

Adjustment of high flow nasal cannula rates using real-time work of breathing indices in premature infants with respiratory insufficiency.

To assess the feasibility of real-time monitoring of work of breathing (WOB) indices and the impact of adjusting HFNC flow on breathing synchrony and oxygen stability in premature infants. A prospective, observational study of infants stable on HFNC. The flow adjusted per predetermined algorithm. Respiratory inductive plethysmography (RIP) noninvasively measured WOB. A high-resolution pulse oximeter collected oxygen saturation and heart rate data. Summary statistics and mixed linear models were used. Baseline data for 32 infants, final analysis of 21 infants. Eighty-one percent with abnormal WOB. Sixty-two percent demonstrated 20% improvement in WOB. For infants with gestational age <28 weeks, an incremental increase in HFNC flow rate decreased WOB (p < 0.001) and improved oxygen saturation and stability (p < 0.01). Premature infants do not receive optimal support on HFNC. The use of a real-time feedback system to adjust HFNC is feasible and improves WOB, oxygen saturation, and oxygen stability. This technology may improve the utility of HFNC in premature infants.

Implementation Barriers for Practicing Continuous Kangaroo Mother Care from the Perspective of Neonatologists and Nurses.

Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized. Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software. Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers. Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.

Music for pain in healthy neonates

Background The neonatal pain threshold is 30-50% lower than in adults and older children because of immature pain inhibition function in nervous centers. Acute pain in neonates results in behavioral, physiological, and cerebral blood flow changes that may lead to intraventricular bleeding and periventricular leukomalacia. Music is believed to reduce pain perception as it distracts, influencing the parasympathetic and sympathetic nervous system by decreasing pulse rate, blood pressure, and breathing, hence, promoting a relaxed state.&#x0D; Objective To evaluate effects of music intervention on physiological parameters and pain perception in healthy newborns undergoing a painful medical procedure (immunization injection).&#x0D; Methods This was a double-blind, randomized control trial study. A recorded instrumental lullaby “Nina Bobo” was given for 5 minutes to the music group and no music for control, prior injection of Hepatitis B 0. The evaluation of heart rate and SpO2 were performed at baseline, 30 seconds, and 5 minutes after injection. Pain perception were measured by Neonatal Infant Pain Scale (NIPS) at 30 seconds and 5 minutes after injection.&#x0D; Results Total of 51 subjects were enrolled. There were no difference of SpO2 and NIPS between both music and control groups. Music improved heart rate after 30 seconds and 5 minutes after injection, median 126 (range 55-149) bpm from median 136 (range 78-154) bpm, and even lower than baseline [mean 128.9 (SD 12.5) bpm; P=0.019]. The control showed no improvement of heart rate mean 124,34 (SD 18,45) from 124,73 (SD 18,39); P=0.875There were no significant differences between the 2 groups.&#x0D; Conclusion Music is not effective in improving oxygen saturation, heart rate, and is not effective in reducing the degree of pain.

Proteome Profiling of Recombinant DNase Therapy in Reducing NETs and Aiding Recovery in COVID-19 Patients

Severe coronavirus disease 2019 (COVID-19) can result in pneumonia and acute respiratory failure. Accumulation of mucus in the airways is a hallmark of the disease and can result in hypoxemia. Here, we show that quantitative proteome analysis of the sputum from severe patients with COVID-19 reveal high levels of neutrophil extracellular trap (NET) components, which was confirmed by microscopy. Extracellular DNA from excessive NET formation can increase sputum viscosity and lead to acute respiratory distress syndrome. Recombinant human DNase (Pulmozyme; Roche) has been shown to be beneficial in reducing sputum viscosity and improve lung function. We treated five patients pwith COVID-19 resenting acute symptoms with clinically approved aerosolized Pulmozyme. No adverse reactions to the drug were seen, and improved oxygen saturation and recovery in all severely ill patients with COVID-19 was observed after therapy. Immunofluorescence and proteome analysis of sputum and blood plasma samples after treatment revealed a marked reduction of NETs and a set of statistically significant proteome changes that indicate reduction of hemorrhage, plasma leakage and inflammation in the airways, and reduced systemic inflammatory state in the blood plasma of patients. Taken together, the results indicate that NETs contribute to acute respiratory failure in COVID-19 and that degrading NETs may reduce dependency on external high-flow oxygen therapy in patients. Targeting NETs using recombinant human DNase may have significant therapeutic implications in COVID-19 disease and warrants further studies.

Effectiveness of Breathing Exercises as a Play-way Method after Nebulisation vs Conventional Nebulisation on Respiratory Parameters among Children with Lower Respiratory Tract Infection- A Pilot Study

Introduction: Retained airway secretion is linked to a wide-range of respiratory illnesses. Breathing exercise plays a remarkable role in airway clearance and parenchyma expansion. Aim: To evaluate the effect of breathing exercises as a play-way method after nebulisation on respiratory parameters among Children with Lower Respiratory Tract Infection. Materials and Methods: The present study was a quasi-experimental pre-test and post test design conducted at AJ Institute of Medical Sciences, Mangaluru, Karnataka. This study selected 20 children admitted to the paediatric ward with a diagnosis of bronchitis, bronchiolitis and pneumonia from March 2020 to May 2021. The level of dyspnoea was assessed before nebulisation using a Paediatric Dyspnoea Scale (PDS). Respiratory rate per minute, oxygen saturation in percentage (%), chest expansion in centimeter (cm) and respiratory sounds were assessed after nebulisation. Interventional group was advised to blow the balloon after nebulisation for 15 minutes once a day for two days consecutively. Unpaired t-test and Analysis of Variance (ANOVA) were used to find significance in between changes of respiratory parametres in both groups and those of pre-test and post test within the group respectively. Results: In the total sample of 20 children, mean age of those in the intervention group (n=10) was 9.1±2.71 years while those in the control group (n=10) was 8.75±2.75 years. The birth order of the children was significantly dominant as second order (70%) in the control group while first order (80%) in the experimental group. Independent t-test showed that there was a statistically significant difference in the post test findings of respiratory rate (p-value=0.005), oxygen saturation (p-value=0.0004) and chest expansion (p-value=0.0006). Conclusion: The study concluded that regular practice of balloon blowing exercise improves oxygen saturation and chest expansion to a great extent in children with lower respiratory tract infection.

Importance of Pharmacists as a Front Line Warrior in Improving Medication Compliance in Covid 19 Patients

To explore the effect of clinical pharmacist intervention on the treatment of viral pneumonia with intravenous methyl prednisolone and others. The clinical data of 112 patients from July 2020 to September 2020 were categorized into observational group (n=56) and random group (n=56) according to the randomized double blind method. The control group with routine nursing intervention and the observational group was treated with comprehensive clinical pharmacist and nursing intervention. Quality of life, recovery time and saturation levels were assessed frequently and on a weekly basis. The observational group was found to have improved oxygen saturation levels during frequent evaluation with the saturation probes when compared with control group, as well the recovery time was also improved. The quality of life in the observation group was significantly better than that in the control group. Incorporating a clinical pharmacist as an integral member of the health care team, brings numerous benefits, one among them is significant improvement in the delay drug administration to the patient. It is undeniable that a clinical pharmacist is a drug information resource for all the health professionals working in a hospital setting.

Use of Tocilizumab in COVID-19: A Systematic Review and Meta-Analysis of Current Evidence.

Background and objectivesA flare-up in coronavirus disease 2019 (COVID-19) cases threatens the health of people, and though there is no proven pharmacological treatment, many analytical studies have suggested that interleukin-6 (IL-6) levels are elevated in cases of severe COVID-19 and that the anti-IL-6 biologic agent tocilizumab may be beneficial. This is a critical review of studies aiming to assess the safety and efficacy of tocilizumab as compared to the standard regimen in patients with COVID-19.Materials and methodsOnline databases (PubMed and Cochrane) were searched until June 29, 2020, for original articles investigating the immunological response in COVID-19 and its treatment with tocilizumab. Data on multiple baseline characteristics and pre-specified endpoints were extracted and pooled using a random effect model. We used Review Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014, Denmark) and Stata 11.0 (Stata Corporation LP, College Station, TX) for all analyses. Risk ratios (RR) and the weighted mean difference (WMD) with the corresponding 95% confidence interval (CI) were calculated.ResultsFrom a total of 1,246 identified articles, 13 studies were included after duplicate removal and narrowing based on title and abstract. Of the 13 included studies, seven case-control studies were shortlisted for meta-analysis (quantitative) and six-single arm studies were used in the discussion (qualitative). These studies had 766 patients (351 in the tocilizumab arm and 414 in the control arm). Their pooled analysis demonstrated that mortality was significantly lower in the tocilizumab group (RR=0.56 [0.34, 0.92]; p=0.02; I2=76%), as was the need for artificial invasive ventilation (RR=0.34 [0.12, 0.99]; p=0.05; I2=0%) as compared to the control group. No significant differences were observed between tocilizumab and control group in intensive care unit admissions (RR=0.73 [0.15, 3.59]; p=0.70; I2=60%) and risks of post-drug infection (RR=1.29 [0.41, 4.04]; p=0.66; I2=88%). In terms of efficacy outcome, improved oxygen saturation (RR=1.13 [1.04, 1.65]; p=0.02; I2=0%) was reported to be markedly significant in tocilizumab patients when compared with the standard care group.ConclusionsOur results based on pooled studies show tocilizumab to be safe and efficacious in reducing mortality among critically ill COVID-19 patients. However, due to the limited number of observational studies, the positive findings should be viewed cautiously and warrant further investigation.

Short to medium term outcomes of right ventricular outflow tract stenting as initial palliation for symptomatic infants with complete atrioventricular septal defect with associated tetralogy of Fallot.

To assess the impact of right ventricular outflow tract (RVOT) stenting as the primary palliation in infants with complete atrioventricular septal defect with associated tetralogy of Fallot (cAVSD/TOF). Historically, palliation of symptomatic patients with cAVSD/TOF has been achieved through surgical systemic to pulmonary artery shunting. More recently RVOT stenting has evolved as an acceptable alternative in patients with tetralogy of Fallot. Retrospective review of all patients with cAVSD/TOF who underwent RVOT stenting as palliation over a 13-year period from two large tertiary referral centers. Twenty-six patients underwent RVOT stenting at a median age of 57 days (interquartile range [IQR] 25.5-106.5). Median weight for stent deployment was 3.7 kg (IQR 2.91-5.5 kg). RVOT stenting improved oxygen saturations from a median of 72% (IQR 70-76%) to 90% (IQR 84-92%), p < .001. There was a significant increase in the median Z-score for both branch pulmonary arteries at median follow-up of 255 days (IQR 60-455). Eight patients required RVOT stent balloon dilatations and 8 patients required re-stenting for progressive desaturation. The median duration between reinterventions was 122 days (IQR 53-294 days). Four patients died during the follow-up period. No deaths resulted from the initial intervention. To date, definitive surgical intervention was achieved in 19 patients (biventricular repair n = 15) at a median age of 369 days (IQR 223-546 days). RVOT stenting in cAVSD/TOF is a safe and effective palliative procedure in symptomatic infants, promoting pulmonary artery growth and improving oxygen saturations.

Effect of early Mobility and Activity interventions to reduce patients' respiratory complications associated with Congestive Heart Failure at Coronary Care Unit

Background: Congestive heart failure patients suffer from dyspnea and fatigue resulting in diminished exercise tolerance, contributing to decreased physical functioning and quality of life. The aim of this study is to evaluate effect of early mobility and activity interventions to reduce patients respiratory complications associated with Congestive Heart Failure. Design: Quasi-experimental research design. Setting: Coronary Care Unit (CCU) of El-Orman Cardiology Hospital, at Assuit University Hospitals. Sample: Seventy critically ill adult males and females' patients' divided into two equal and matched groups (35 study & 35 control). Tools: - Three tools; Tool 1: Patient assessment sheet, Tool 2: Early mobility and activity levels interventions and Tool 3: Monitoring respiratory complications sheet. Results: the patients in study group had lesser dyspnea attacks, absence of abnormal lung sound and less respiratory complications as compared with the control group patients. Conclusion: Applying early mobility and activity interventions significantly improve dyspnea; improve oxygen saturation and lesser respiratory complications associated with congestive heart failure. Recommendations: Emphasize on application of the mobility and activity for patients with cardiovascular diseases to prevent complications.

Acetazolamide for OSA and Central Sleep Apnea: A Comprehensive Systematic Review and Meta-Analysis

Therapy options for OSA and central sleep apnea (CSA) are limited, thus many patients remain untreated. Clinically, acetazolamide is sometimes used for CSA; however, given overlapping pathophysiologic properties of OSA and CSA, we hypothesized that acetazolamide is equally effective for both types. Prior reviews focused on specific subtypes of sleep apnea, study designs, and languages, thus including few studies (typically≤3) limiting insights. How efficacious is acetazolamide for sleep apnea, and is its effect modified by sleep apnea type or acetazolamide dose? We queried MEDLINE, EMBASE, and ClinicalTrials.gov from inception until March 11, 2019. Any study in which adults with OSA/CSA received oral acetazolamide vsno acetazolamide (control) that reported sleep apnea-related outcomes was eligible, independent of study design or language. Two reviewers independently assessed eligibility and abstracted data. Primary outcomes were apnea-hypopnea index (AHI) and oxygen saturation nadir. Quality of evidence (QoE) was rated with the use of Grades of Recommendation Assessment, Development and Evaluation methods. We included 28 studies (13 OSA/15 CSA; NSubjects,Acetazolamide= 542; NSubjects,Control= 553) that enabled meta-analyses for 24 outcomes. Acetazolamide doses ranged from 36 to 1000mg/d and treatment duration from 1 to 90d (median, 6 d). Overall, acetazolamide vscontrol lowered the AHI by -0.7 effect sizes (95%CI, -0.83 to -0.58; I2= 0%; moderate QoE) that corresponded to a reduction of 37.7%(95%CI, -44.7 to -31.3) or 13.8/h (95%CI, -16.3 to -11.4; AHIControl= 36.5/h). The AHI reduction was similar in OSA vsCSA, but significantly greater with higher doses (at least up to 500mg/d). Furthermore, acetazolamide improved oxygen saturation nadir by+4.4%(95%CI, 2.3 to 6.5; I2= 63%; no evidence of effect modification; very low QoE) and several secondary outcomes that included sleep quality measures and BP (mostly low QoE). Short-term acetazolamide improved both OSA and CSA. Rigorous studies with long-term follow up are warranted to assess Acetazolamide's value for the chronic treatment of patients with sleep apnea. PROSPERO (CRD42019147504).