Low Oxygen Saturation Levels Research Articles

Clinical Characteristics of Obstructive Sleep Apnea and Comorbid Primary Aldosteronism

To explore the characteristics of patients with obstructive sleep apnea (OSA) and comorbid primary aldosteronism (PA) and to explore the relevant factors affecting plasma aldosterone concentration. A total of 105 patients diagnosed with PA and admitted at West China Hospital, Sichuan University between January 2016 and December 2021 were retrospectively analyzed. The subjects were divided into a PA with comorbid snoring group (n=20) and a PA with comorbid OSA group (n=85) based on the results of polysomnography (PSG). The PA with comorbid OSA group was further divided into mild, moderate, and severe subgroups according to the apnea-hypopnea index (AHI). A total of 85 outpatients diagnosed with OSA were included as the control group. Demographic, clinical, biochemical, and PSG data were compared between the groups. Compared with patients with only OSA, a significantly higher proportion of patients with OSA and comorbid PA had hypertension and elevated levels of systolic and diastolic blood pressure (P<0.05). In addition, patients with OSA and comorbid PA had significantly increased AHI and significantly decreased mean oxygen saturation and sleep efficiency (P<0.05). The more severe the OSA was, the higher levels of BMI, cholesterol, low-density lipoprotein, and uric acid the PA patients had. Linear regression analysis showed that the lowest oxygen saturation (β=－0.222, P=0.045) was negatively correlated with plasma aldosterone concentration. Comorbidity with PA can aggravate the clinical manifestations of OSA, while OSA further disrupted the metabolism of lipids and uric acid in PA patients. Plasma aldosterone concentrations in patients with comorbid OSA and PA were affected by the lowest oxygen saturation level.

Demographic and clinical characteristics and outcomes of COVID-19 patients admitted to a university hospital in the west of Iran: a retrospective study in the third wave

BackgroundCOVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of this infectious disease vary from a country to another and from one peak to the next. The aim of the present study was to describe the COVID-19 patients hospitalized in Kermanshah, a city in the west of Iran, in the third peak of the disease and to identify in-hospital mortality determinants in this disease. MethodsIn this retrospective study, the clinical and demographic characteristics, laboratory findings, prescribed treatments and outcome of all COVID-19 patients (definitive, suspected, and probable) were collected from the medical records department of Farabi Hospital affiliated with Kermanshah University of Medical Sciences, Kermanshah, Iran from 22 October to 20 November 2020. ResultsIn total, 665 COVID-19 patients (265 females and 400 males, mean age: 58.7 years) were enrolled, including 479 confirmed (72%), 156 probable (23.5%), and 30 suspected cases (4.5%). About 84% of the patients presented with low oxygen saturation levels. The most common comorbidities were hypertension (15%), diabetes (10%), and cardiovascular disease (3%). The median (IQR) length of hospital stay was 6 (4–8) and 7 (2–14) day in discharged and deceased patients, respectively. Eighty-two out of 655 patients admitted to the hospital and 39 of the 60 patients admitted to the ICU died. In total, in-hospital mortality rate was 12.33%. Regarding lab variables, in the adjusted model, no significant difference was observed between discharged and deceased patients.The results of multivariable logistic regression showed that each one-unit increase in oxygen saturation (SPO2) increased the odds of survival by 0.88 times (95% CI 0.78–0.99, p = 0.043). Moreover, each one-day increase in the length of ICU stay reduced the odds of mortality by 0.49 times (95% CI 0.26–0.95, p = 0.035). ConclusionHospitalized COVID-19 patients were generally more ill during the third peak so that about 85% of the patients had SPO2 < 93%. The in-hospital mortality rate was also high. Demographic and paraclinical variables (except SPO2 level) were not suitable predictors of mortality.

Adherence to Continuous Positive Airway Pressure Therapy in Pediatric Patients with Obstructive Sleep Apnea: A Meta-Analysis.

Obstructive sleep apnea (OSA) is a public health problem that affects children. Although continuous positive airway pressure (CPAP) therapy is effective, the CPAP adherence rate in children is varied. This study aimed to evaluate the CPAP adherence rate and factors associated with CPAP adherence in children with OSA using a systematic review. The inclusion criteria were observational studies conducted in children with OSA and assessed adherence of CPAP using objective evaluation. The literature search was performed in four databases. Meta-analysis using fixed-effect model was conducted to combine results among included studies. In all, 34 studies that evaluated adherence rate and predictors of CPAP adherence in children with OSA were included, representing 21,737 patients with an average adherence rate of 46.56%. There were 11 calculations of factors predictive of CPAP adherence: age, sex, ethnicity, body mass index, obesity, income, sleep efficiency, the apnea-hypopnea index (AHI), severity of OSA, residual AHI, and lowest oxygen saturation level. Three different factors were linked to children with adherence and non-adherence to CPAP: age, body mass index, and AHI. The CPAP adherence rate in children with OSA was 46.56%. Young age, low body mass index, and high AHI were associated with acceptable CPAP adherence in children with OSA.

Can polysomnography be replaced by ApneaGraph200 for OSA diagnosis? A protocol for systematic review and meta-analysis.

It is yet unknown if the ApneaGraph200 system can replace the Polysomnography system (PSG), which is now the gold standard for obstructive sleep apnea (OSA) diagnosis. We performed a meta-analysis to evaluate the difference in apnea hypopnea index and lowest oxygen saturation levels between the AG200 system and PSG system. Utilizing PubMed, Elsevier, Wanfang, and China National Knowledge Internet (CNKI), a thorough literature search was carried out. Eligible studies contrasting the AG200 system and the PSG system were found by two separate researchers. Review Manager (version 5.3) was adopted for data synthesis. The meta-analysis A pooled the comparison of AHI between the AG and PSG groups, and included seven studies involving a total of 419 participants, which revealed that there was a significant difference in AHI between the above two diagnostic methods (standard mean difference (SMD) = -0.19, 95% confidence interval (CI) = -0.32 to -0.05, P = 0.008). As a supplementary, meta-analysis B pooled the comparison of lowest oxygen saturation between the AG and PSG groups and included five studies involving a total of 224 participants. It revealed that there was no significant difference between the AG group and the PSG group (SMD = 0.09, 95% CI -0.24 to 0.43, P = 0.58). The ApneaGraph200 system can be used for the initial screening of OSA patients, but it is not a complete alternative to polysomnography for the diagnosis and severity of the OSA condition.

Hastanede yatan COVID-19 hastalarında hastalığın ilerlemesini ve mortalite riskini tahmin etmede ETCO2 değerlerinin kullanılabilirliği

Aim: End-tidal CO2 (ETCO2) levels are reflective of the ventilatory and metabolic/perfusion status of a patient, regardless of his/her SpO2 values. This study aimed to investigate the utility of ETCO2values in predicting the need for intubation, ICU admission, and mortality in hospitalized patients with COVID-19 pneumonia. &#x0D; Material and Method: A total of 108 hospitalized patients with COVID-19 pneumonia were included. Data on respiratory parameters (oxygen saturation, ETCO2, and respiratory rate [RR]- with and without O2 [w/wo O2]) and laboratory parameters were recorded. &#x0D; Results: The need forintensive care unit(ICU) admission was associated with significantly higher ETCO2 values (wO2:27.9 (4.6) vs. 18.6(8.4), p=0.040; woO2: 30.1(4.9) vs. 23.8(6.9), p=0.040). Mortality was associated with higher likelihood of higher RR (wO2:32.4(5.8) vs. 24.6(6.8), p=0.002) and lower oxygen saturation (wO2:92.9(3.8) vs. 95.5(4.2), p=0.025; woO2:87.1(5.7) vs. 91.8(6.6), p=0.013). Presence vs. lack of intubation need was associated with significantly increased likelihood of saturation (wO2:93.1(5.3) vs. 95.9(3.8), p=0.013; woO2:87.6(8.3) vs. 92.3(5.9), p=0.007). Hospital discharge vs. ICU stay was associated with significantly higher ETCO2 values (wO2:27.9 (4.6) vs. 18.6(8.4), p=0.040; woO2: 30.1(4.9) vs. 23.8(6.9), p=0.040)&#x0D; Conclusion: Our findings revealed the association of decreased ETCO2 (w/wo O2) values with a lower likelihood of hospital discharge and increased likelihood of ICU transfer. Low oxygen saturation levels related the increased risk of both intubation need and mortality in hospitalized COVID-19 patients.

Clinical and morphological features of arterial duct in premature newborns

The open arterial duct has a pathological significance in premature newborns. Closure of the ductus arteriosus is a complex process that includes functional and anatomical closure.Purpose. To identify the features of arterial duct remodeling in premature newborns.Material and methods. We conducted a retrospective clinical and morphological analysis of 35 deceased premature newborns. During their lifetime, all children were examined using clinical and laboratory-instrumental methods. In all cases, autopsies of deceased children were performed with a complex of morphological studies of the arterial duct.Results. It has been established that the open arterial duct in premature newborns plays an important role in increasing respiratory failure. It also necessitates the appointment and conduct of invasive respiratory therapy. The functioning of the arterial duct is facilitated by low partial pressure and blood oxygen saturation levels. Morphofunctional features of arterial duct remodeling were revealed. A positive correlation was established between the indicators of the gas composition of the child’s blood and the thickness of the duct wall.Conclusion. Risk factors for an open arterial duct in premature newborns are the age of the mother over 35 years, threatened miscarriage, prenatal discharge of amniotic fluid, gestational diabetes mellitus, fetoplacental insufficiency, and severe asphyxia at birth. Morphological changes in the form of thickening of the endothelial layer and the formation of intimal pillows, fragmentation and focal necrosis of the internal elastic membrane with the accumulation of mucoid matter, proliferation and migration of smooth muscle cells into the subendothelial space reflect the processes of remodeling of the arterial duct.

Attention Network Changes of High-Altitude Migrants.

INTRODUCTION: The present study aimed to explore whether there are changes in the alerting, orienting, and executive network efficiencies of attention function between high altitude immigrants and low altitude residents.METHODS: Event-related potentials (ERP) were acquired during an attention network test (ANT). The high-altitude (HA) group comprised 22 college student immigrants who were born and raised at low altitudes and had lived at a HA (11,975 ft/3650 m) for 26 mo (tests were conducted when they returned to HA for 3 mo). The low-altitude (LA) group comprised 23 college students who had never visited HA areas before.RESULTS: Compared with the LA group, the HA group had a higher pulse rate, lower oxygen saturation level, and decreased alerting and orienting effects in the behavioral results. The ERP results of the HA group showed a smaller P1 in the occipital area, a larger N1 both in the parietal and occipital areas of the alerting network, and a smaller P1 and larger N1 in the orienting network than the LA group. In the executive control network, the N2 amplitude of the HA group was more negative and the P3 amplitude of the HA group decreased in incongruent conditions.DISCUSSION: Together, these findings suggest that high-altitude migrants are less effective at alerting and orienting than low-altitude residents. For executive control function, changes in the P3 amplitudes of incongruent conditions indicated a decrease in conflict inhibition underlying the executive-control network.An X, Tao G, Zhang X, Ma H, Wang Y. Attention network changes of high-altitude migrants. Aerosp Med Hum Perform. 2022; 93(11):791-799.

Synergy between pH- and hypoxia-responsiveness in antibiotic-loaded micelles for eradicating mature, infectious biofilms

Antibiotic-loaded PEG/PAE-based micelles are frequently considered for eradicating infectious biofilms. At physiological pH, PEG facilitates transport through blood. Near an acidic infection-site, PAE becomes protonated causing micellar targeting to a biofilm. However, micellar penetration and accumulation is confined to the surface region of a biofilm. Especially matured biofilms also possess hypoxic regions. We here designed dual-responsive PEG/PAE-b-P(Lys-NBCF) micelles, responding to both acidity and low oxygen-saturation level in matured biofilms. Dual, pH- and hypoxia-responsive micelles targeted and accumulated evenly over the depth of 7- to 14-days old biofilms. Delineation demonstrated that pH-responsiveness was responsible for targeting of the infection-site and accumulation of micelles in the surface region of the biofilm. Hypoxia-responsiveness caused deep penetration in the biofilm. Dual, pH- and hypoxia-responsive micelles loaded with ciprofloxacin yielded more effective, synergistic eradication of 10-days old, matured Staphylococcus aureus biofilms underneath an abdominal imaging-window in living mice than achieved by ciprofloxacin in solution or single, pH- or hypoxia responsive micelles loaded with ciprofloxacin. Also, wound-healing after removal of window and its frame proceeded fastest after tail-vein injection of ciprofloxacin-loaded, dual, pH- and hypoxia-responsive micelles. Concluding, pH- and hypoxia-responsiveness are both required for eradicating mature biofilms and advancing responsive antibiotic nanocarriers to clinical application. Statement of significancepH-responsive antibiotic nanocarriers have emerged as a possible new strategy to prevent antimicrobial-resistant bacterial infections from becoming the leading cause of death. In this paper, we show that commonly studied, pH-responsive micellar nanocarriers merely allow self-targeting to an infectious biofilm, but do not penetrate deeply into the biofilm. The dual-responsive (acidic pH- and hypoxia) antibiotic-loaded micelles designed here not only self-target to an infectious biofilm, but also penetrate deeply. The in vitro and in vivo advantages of dual-responsive nanocarriers are most obvious when studied in infectious biofilms grown for 10 viz a viz the 2 days, usually applied in the literature. Significantly, clinical treatment of bacterial infection usually starts more than 2 days after appearance of the first symptoms.

Hyoid bone position as an indicator of severe obstructive sleep apnea

BackgroundThe objective of this study was to evaluate the relationship between hyoid bone position and severity of obstructive sleep apnea (OSA), and to investigate its value as a complementary diagnostic method.MethodsA total of 133 patients who were diagnosed as OSA with an apnea-hypopnea index ≥ 5 were included. Clinical examination, level I polysomnography (PSG) and lateral cephalographic analysis were done. Comprehensive PSG characteristics were compared according to hyoid bone position and the predictive power of the distance between the mandible and hyoid was assessed.ResultsThe distance between the hyoid bone and mandibular plane was significantly longer in the severe OSA group (p = 0.013). The distance from hyoid bone to third vertebrae (C3) and hyoid bone to mentum were also longer in the severe OSA group but the difference did not reach statistical significance. The distance between hyoid bone and mandibular plane was effective in predicting severe OSA, with a cut-off value of 19.45 mm (AUC = 0.623, p = 0.040). When grouped according to a distance cut-off value of 19.45 mm, those with a longer distance between the hyoid bone and mandibular plane showed more respiratory disturbance, lower oxygen saturation levels, less deep slow wave sleep, and more fragmented sleep with arousals.ConclusionsThe distance between the hyoid bone and mandibular plane derived from cephalometric analysis can be a valuable diagnostic parameter that can be easily applied in differentiating severe OSA patients.

SMART WRIST PULSE OXIMETER

In the present day we live in, a catastrophic virus COVID-19 has drastically changed the day to day living of a human being. The virus causes hypoxemia (shortness of breath), sometimes even severe cases. Hypoxemia is caused due to low oxygen saturation (SpO2) levels and in order to monitor SpO2 levels we utilize the method of Pulse Oximetry. It has played a major role in monitoring oxygen levels in a continuous and accurate manner. Patients who are diagnosed during the early stages with the virus are able to monitor their SpO2 levels at home and take the prescribed medicines. This reduced the need for hospital beds and chaos during the pandemic as patients were able to self-isolate and monitor themselves. The principle that Oximetry is contingent on is light reflectance. The fingertip model is the most common technique used to display the blood oxygenation level. However, the finger model is not as comfortable and does not promote continuous monitoring of SpO2 levels. Factors such as nail polish can play a role in the accuracy of the reading. The proposed design is a non-invasive medical device that can measure the oxygen saturation level in a person’s blood. Wrist wearing is preferrable to finger models as it is a comfortable site for measuring than that of the latter, therefore enabling continuous monitoring of oxygen saturation level. Most devices in application today are inaccurate and used for non-clinical use. Therefore, it is aimed to achieve better accuracy by avoiding readings that are influenced by factors such as motion artifacts by utilizing sensors that are appropriate through an accelerometer and gyroscope. The sensors have been utilized to its maximum potential as the model also detects heart rate levels. Providing device connectivity to the proposed wrist pulse oximeter through a Wi-Fi module has advanced its functionality by transmitting notifications that alert an individual with the levels of oxygen saturation, fall detection and heart rate levels.

Acute respiratory distress syndrome among patients with severe COVID-19 admitted to treatment center of Wollega University Referral Hospital, Western Ethiopia.

BackgroundAcute respiratory distress syndrome is a life-threatening condition that has a significant effect on the occurrence of morbidity and mortality among patients with severe Coronavirus disease 2019 (COVID-19). To the best of researchers’ knowledge, there is no Study on ARDS of COVID-19 in Ethiopia. Therefore, this study aimed to identify the prevalence of ARDS and associated factors among severe COVID-19 patients at Wollega University Referral Hospital.MethodsAn institution-based retrospective cross-sectional study was conducted from September 20, 2020, to June 10, 2021. Real-Time Reverse transcription-polymerase Chain Reaction (rRT-PCR) test was used to test Patients for COVID-19. Epi-data version 3.2 was used for data entry, and the final data analysis was through STATA version 14. After checking the assumption P-value<0.25 in the bivariable analysis was used to select a candidate variable for multi-variable analysis, and a p-value of <0.05 was used to declare statistical significance.ResultsIn this study, the prevalence of ARDS was 32%. Almost all the patients had the clinical feature of cough (93.7%), followed by shortness of breath (79.9%), fever (77.7%), and headache (67%). Age older than 65 years (AOR = 3.35, 95%CI = 1.31, 8.55), male gender (AOR = 5.63, 95%CI = 2.15, 14.77), and low oxygen saturation level (AOR = 4.60, 95%CI = 1.15, 18.35) were the independent predictors of ARDS among severe COVID-19 patients.ConclusionThe prevalence of ARDS among patients with severe COVID-19 was high in the study area. Therefore, elders and patients with critical conditions (low oxygen saturation) better to get special attention during COVID-19 case management to enhance good care and monitoring of the patients.

Length of stay in intensive care unit and characteristics of COVID-19 patients: a single-center observational retrospective study in Hospital Metropolitano, Quito, Ecuador

Introduction: COVID-19 has been identified by the World Health Organization as a global pandemic. Objectives: The study aims at presenting data on COVID-19 hospitalization cases from march 2020 to January 2021 in Hospital Metropolitano of Quito, Ecuador. Methods: Retrospective study in 515 hospitalization records from adult subjects. Results: We included 332 males and 183 females, 91 patients were admitted to the intensive care unit (ICU) and the mean (±SD) length of ICU stay was 13.5 ± 8.2 days and mean (±SD) length of hospital stay was 5.9 (±3.3) days. It was observed 7.2% of deaths. Thirty-four percent of the patient admitted in ICU died and had a higher mean age compared to survivors (65.6 ± 13.4 vs 56.3 ± 16.1, P = 0.000). The most prevalent comorbidities were hypertension, hypothyroidism and diabetes. There were significant differences in the neutrophil counts, D-dimer levels, creatinine, glucose, IL6, triglycerides (TGL), lactate dehydrogenase (LDH), troponin, sodium and potassium count between survivors and non survivors. The most frequent symptoms were dyspnea, fever and cough. Conclusions: Patients admitted to the intensive care unit had longer length of stay, were older and with lower oxygen saturation level. The laboratory parameters were significantly higher in patients who died. Abnormal count of neutrophils and LDH as well as age were risk factors for mortality in these patients.

Pulmonary Hypertension in Adult Congenital Heart Disease in Asia: A Distinctive Feature of Complex Congenital Heart Disease.

BackgroundThe epidemiology of pulmonary hypertension (PH) in patients with adult congenital heart disease in Western countries is already known. We investigate clinical characteristics of PH in adult congenital heart disease with emphasis on complex congenital heart disease (CHD) from an Asian cohort in Taiwan.Methods and ResultsAll adult patients (aged >18 years) diagnosed with CHD between January 2007 and July 2018 qualified for the study. PH was determined by cardiac catheterization data or echocardiography reports. In accord with the World Symposia on Pulmonary Hypertension, CHD was further categorized as simple, severe, or complex CHD (including pulmonary atresia‐ventricular septal defect and single‐ventricle anomalies).There were 4301 patients (55.6% women), 15.7% with severe and 3.9% with complex CHD. The cumulative incidence of PH was 4.4% (95% CI, 3.8–5.0). Our multivariable regression model indicated 4.2‐fold mortality increase (95% CI, 3.0–5.9) in the presence of PH, with age, female sex, and severe or complex CHD linked to higher incidence of PH. Only 49% of patients received PH‐specific therapy. Five‐ and 10‐year survival rates of patients with PH (n=190) were 72.3% (95% CI, 65.1%–78.4%) and 58.8% (95% CI, 50.1%–66.5%), respectively. Survival rates in those with Eisenmenger syndrome, PH after defect correction, and complex CHD were similar. Low oxygen saturation and high uric acid levels were associated with increased mortality.ConclusionsIn this sizable Asian adult CHD cohort, the cumulative incidence of PH was aligned with that of Western countries. Mortality proved higher in patients with PH versus without PH. Although complex CHD carried greater risk of PH compared with other adult CHD subsets, survival rate was similar.

The Effectiveness of National Early Warning Score, Quick Sequential Organ Failure Assessment, Charlson Comorbidity Index, and Elixhauser Comorbidity Index Scores in Predicting Mortality Due to COVID-19 in Elderly Patients.

Introduction: As the mortality rate in coronavirus disease 2019 (COVID-19) patients older than 65 years is considerable, evaluation of in-hospital mortality is crucial. This study aimed to evaluate in-hospital mortality in COVID-19 patients older than 65 years using the National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (q-SOFA), Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI).Methods: This retrospective study included data from 480 patients with confirmed COVID-19 and age over 65 years who were evaluated in a university emergency department in Turkey. Data from eligible but deceased COVID-19 patients was also included. NEWS, q-SOFA, CCI, and ECI scores were retrospectively calculated. All clinical data was accessed from the information management system of the hospital, retrieved, and analyzed.Results: In-hospital mortality was seen in 169 patients (169/480). Low oxygen saturation, high C-reactive protein (CRP) and urea levels, and high q-SOFA and ECI scores helped us identify mortality in high-risk patients. A statistically significant difference was found in mortality estimation between q-SOFA and ECI (p <0.001), respectively.Conclusion: Q-SOFA and ECI can be used both easily and practically in the early diagnosis of in-hospital mortality in COVID-19 positive patients over 65 years of age admitted to the emergency department. Low oxygen saturation, high CRP and urea levels, and high q-SOFA and ECI scores are helpful in identifying high-risk patients.

Risk Factors Associated with In-Hospital Mortality in Iranian Patients with COVID-19: Application of Machine Learning

Abstract Introduction: Predicting the mortality risk of COVID-19 patients based on patient’s physiological conditions and demographic characteristics can help optimize resource consumption along with the provision of effective medical services for patients. In the current study, we aimed to develop several machine learning models to forecast the mortality risk in COVID-19 patients, evaluate their performance, and select the model with the highest predictive power. Material and methods: We conducted a retrospective analysis of the records belonging to COVID-19 patients admitted to one of the main hospitals of Qazvin located in the northwest of Iran over 12 months period. We selected 29 variables for developing machine learning models incorporating demographic factors, physical symptoms, comorbidities, and laboratory test results. The outcome variable was mortality as a binary variable. Logistic regression analysis was conducted to identify risk factors of in-hospital death. Results: In prediction of mortality, Ensemble demonstrated the maximum values of accuracy (0.8071, 95%CI: 0.7787, 0.8356), F1-score (0.8121 95%CI: 0.7900, 0.8341), and AUROC (0.8079, 95%CI: 0.7800, 0.8358). Including fourteen top-scored features identified by maximum relevance minimum redundancy algorithm into the subset of predictors of ensemble classifier such as BUN level, shortness of breath, seizure, disease history, fever, gender, body pain, WBC, diarrhea, sore throat, blood oxygen level, muscular pain, lack of taste and history of drug (medication) use are sufficient for this classifier to reach to its best predictive power for prediction of mortality risk of COVID-19 patients. Conclusions: Study findings revealed that old age, lower oxygen saturation level, underlying medical conditions, shortness of breath, seizure, fever, sore throat, and body pain, besides serum BUN, WBC, and CRP levels, were significantly associated with increased mortality risk of COVID-19 patients. Machine learning algorithms can help healthcare systems by predicting and reduction of the mortality risk of COVID-19 patients.

Development of a Score for Predicting Severe Acute Pancreatitis at Admission.

The identification of patients at risk of developing a severe form of acute pancreatitis is a major issue. The goal of this study was to identify parameters at admission associated with severe pancreatitis to develop a predictive severity score. We conducted a retrospective study at Caen University Hospital between January 2014 and December 2017, including 504 patients hospitalized for acute pancreatitis, of whom 74 had a severe form. We developed a predictive score named Admission Severe Acute Pancreatitis (ASAP) score based on parameters associated with a severe form in multivariate analysis. We validated our score in an independent validation cohort of 80 patients. Hypothermia, low oxygen saturation or albumin levels, and high creatinine levels were significantly associated with severe pancreatitis. The ASAP score showed notable predictive accuracy (area under receiver operating characteristic, 0.82), which was significantly higher than Sequential Organ Failure Assessment, persistent Systemic Inflammatory Response Syndrome, and Balthazar. Using the -2.1742 threshold, the ASAP score had a sensitivity and specificity of 74% and a negative predictive value of 95%. These predictive performances for ASAP score were confirmed in the validation cohort. The ASAP score demonstrates remarkable predictive accuracy in distinguishing severe forms of acute pancreatitis.

Pattern of liver function test variations in COVID-19 infection & its clinical significance: A study from a dedicated COVID-19 tertiary care centre from India.

Coronavirus disease 2019 (COVID-19) affects respiratory, gastrointestinal, cardiovascular and other systems disease. Studies describing liver involvement and liver function test (LFT) abnormalities are sparse from our population. This study was undertaken to estimate the LFT abnormalities in patients with COVID-19 in a tertiary care set up in India. In this retrospective study conducted at a tertiary care centre in Mumbai, India, all consecutive patients with proven COVID-19 by reverse transcriptase-PCR from March 23 to October 31, 2020 were enrolled. Of the 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Overall 681 (46%) patient had deranged LFTs. Hepatocellular type of injury was most common (93%). Patients with deranged LFTs had more probability of developing severe disease (P<0.001) and mortality (P<0.001). Advanced age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), lower oxygen saturation levels at admission (P<0.001), higher neutrophil-lymphocyte ratio (P<0.001), history of diabetes mellitus and cirrhosiss were associated with deranged LFTs. Acute liver injury was seen in 65 (4.3%) cases on admission and 57 (3.5%) cases during hospital stay. On multivariate analysis for predicting mortality, age >60 yr serum creatinine >2 mg%, PaO2/FiO2 ratio ≤200 and raised AST >50 IU/l (OR: 2.34, CI: 1.59-3.48, P<0.001) were found to be significant. In COVID-19, LFT abnormalities were common, and derangement increased as severity progressed. The presence of deranged LFT worsens the clinical outcome and predicts in-hospital mortality.

IoT &amp; AI Enabled Three-Phase Secure and Non-Invasive COVID 19 Diagnosis System

Corona is a viral disease that has taken the form of an epidemic and is causing havoc worldwide after its first appearance in the Wuhan state of China in December 2019. Due to the similarity in initial symptoms with viral fever, it is challenging to identify this virus initially. Non-detection of this virus at the early stage results in the death of the patient. Developing and densely populated countries face a scarcity of resources like hospitals, ventilators, oxygen, and healthcare workers. Technologies like the Internet of Things (IoT) and artificial intelligence can play a vital role in diagnosing the COVID-19 virus at an early stage. To minimize the spread of the pandemic, IoT-enabled devices can be used to collect patient’s data remotely in a secure manner. Collected data can be analyzed through a deep learning model to detect the presence of the COVID-19 virus. In this work, the authors have proposed a three-phase model to diagnose covid-19 by incorporating a chatbot, IoT, and deep learning technology. In phase one, an artificially assisted chatbot can guide an individual by asking about some common symptoms. In case of detection of even a single sign, the second phase of diagnosis can be considered, consisting of using a thermal scanner and pulse oximeter. In case of high temperature and low oxygen saturation levels, the third phase of diagnosis will be recommended, where chest radiography images can be analyzed through an AI-based model to diagnose the presence of the COVID-19 virus in the human body. The proposed model reduces human intervention through chatbot-based initial screening, sensor-based IoT devices, and deep learning-based X-ray analysis. It also helps in reducing the mortality rate by detecting the presence of the COVID-19 virus at an early stage.

Morbidity Pattern, Physiologic Parameters and Outcome among Elderly Patients Attending Selected Primary Healthcare Facilities in an Urban Region of Lagos

Background: In Nigeria, the elderly account for 4.97% of the total population and as one ages, the physiological status of the body gradually declines.Hypertension, cataract, osteoarthritis and neurological problems, constitute the commonest cause of morbidity among elderly. This results in inadequate medical attention leading to development of multiple health conditions and the inability to control certain physiological functions. Objective: This study aimed to describe the morbidity pattern, physiologic parameters and outcome among elderly patients attending the primary healthcare centres in Kosofe Local Government Area of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional consisting of 210 participants selected through systematic sampling. Data on morbidity pattern, physiologic parameters and disposition decisions were collected and analyzed using Epi-info, version 7.2. Proportions, means and frequencies were calculated and presented with Tables while Chi-square was used to test for association between morbidity and gender, age and outcome, vital signs and age, and disposition decision and sex. P-value &lt; 0.05 was considered statistically significant. Results: Disease such as hypertension (51.4%), malaria (18.5%) and osteoarthritis (6.6%) constituted the major reasons of visit of the elderly to primary healthcare facilities. There were statistically significant associations between cardiovascular condition and gender (p=0.005), and between musculoskeletal condition and age of the respondents (p=0.005). There were statistically significant associations between the urological conditions and outcome of the respondents (p= 0.001), between the pulse and age of the respondents (p=0.001), between respiratory rate and age (p=0.001) and between percentage oxygen saturation of haemoglobin and age (p=0.001). Conclusion: Diseases such as hypertension, osteoarthritis and malaria constitute the major cause of visits to primary healthcare facilities among the elderly. Those with cardiovascular disease were more likely to be females. Those with age range of 75-79 years may likely have a pulse rate less than 60 bpm. Those within the age of 70–74 years are more likely to have a low blood oxygen saturation level. Those with urological condition were more likely to be referred.

Dissolved Oxygen in Heterogeneous Environments Dictates the Metabolic Rate and Thermal Sensitivity of a Tropical Aquatic Crab

Oxygen availability, together with water temperature, greatly varies in coastal habitats, especially in those characterized by elevated primary production. In this study, we investigate the combined role of dissolved oxygen and temperature on the thermal physiological response of the mud crab Thalamita crenata living in an equatorial system of coastal habitats. We sampled temperature, oxygen and salinity in T. crenata habitats, mangrove creeks and fringes and seagrass meadows, at Gazi Bay (Kenya). We found that seagrass meadows exhibited higher temperature and oxygen saturation than the mangrove habitats during the day, creating conditions of oxygen supersaturation. By investigating the effect of different levels of oxygen saturation on the thermal response of T. crenata, we demonstrated that the respiratory physiology of this ectotherm has a pronounced resistance to heat, directly influenced by the amount of dissolved oxygen in the water. Under low oxygen saturation levels, the mud crab significantly reduced its metabolism, becoming temperature-independent. This result shows that aquatic species can modulate their thermal response in a stringent dependency with water oxygen saturation, corroborating previous findings on the thermal response of T. crenata under supersaturation. This contribution provides further support for the need to adopt an ecologically-relevant approach to forecast the effect of climate change on marine ectothermal species.