Normal Oxygen Saturation Research Articles

CHRONIC INFECTION AND SEVERE MITRAL REGURGITATION: A TRICKY CASE REPORT

Abstract Background Techniques of mitral valve repair has improved in the last decades. Percutaneous approach is now a reliable and safe therapy in those patients with high surgical risk. Of note, the presence of implanted prothesis may increase the risk of endocarditis, especially in those patients experiencing recurrent infection. Case Summary We describe a case of a 75–year–old with medical history of chronic lymphedema. It was characterized by periodical episode (yearly) of cellulitis, with a rapid onset of fever (38.5–39° C), lasting for a few days after paracetamol therapy. Patients had severe mitral valve regurgitation due to prolapse of the posterior leaflet (P2). In December 2022, he had percutaneous edge–to–edge mitral valve. Three months later the patient was admitted to the emergency department of our hospital due to fever without any specific symptoms. The patient was well compensated, normal blood pressure, heart rate and oxygen saturation. He had emocolture which revealed the presence of Staphilococcus lugdunensis. Transesophageal echocardiogram confirmed the presence endocarditis, showing a huge (10x12 mm) vegetation at the level of mitral device (Fig 1 and 2). Patients was then referred to cardiac surgery for urgent mitral valve replacement with mitral bioprothesis (Fig 3). He was treated with ev antibiotic for six weeks after cardiac surgery. Additionally, chronic treatment with amoxicillin 500 mg/day was also prescribed at discharge. After six months follow–up, patients had no signs of endocarditis. Conclusion The management and treatment of chronic infection is of paramount importance to reduce the risk of prothesis infection procedure in patients needing a prothesis implantation. The last European Society of Cardiology guidelines on endocarditis do not provide any recommendation regarding a long–term treatment of patients with high risk of infection (i.e. due to chronic infection) and with an implanted cardiac device/prothesis. We believe this represents an important unmeet need.

Comparison of oxygen saturation values between term and pre-term neonates.

Objective: To determine mean oxygen saturation (SpO2) values in normal newborns and compare mean Spo2 values between term and preterm infants. Study Design: Descriptive Case Series. Setting: Hameed Latif Teaching Hospital Lahore. Period: March 2023 to November 2023. Material & Methods: The study involved 100 neonates from operation theatre and labor room. Informed consent was obtained from parents. Immediately after birth, pulse oximeter was applied and serial monitoring of oxygen saturation was carried out starting at 1 minute and recording values after every 1 minute till 10 minutes of life. Results: There were 50% male and 50% female neonates. The average SpO2 values were 76.13±10.41 at first minute, 89.68±6.62 at 5 minutes & 95.84±3.65 at 10 minutes of life. Mean SpO2 was significantly high in term babies as compared to preterm babies at one minute and 5 minutes. However there was no significant difference in mean SpO2 at 10 minutes in term and preterm babies. Conclusion: The process of transition to normal postnatal oxygen saturation requires more than 5 minutes in healthy newborns. In healthy term newborn, oxygen saturation rises slowly. SpO2 monitoring may help identifying the infants requiring resuscitation to avoid overexposure to high supplemental oxygen after birth. Many newborns have SpO2 <90% during the first 5 minutes of life. This should be considered when choosing SpO2 targets for infants treated with supplemental oxygen in the delivery room.

Anterolateral Lingual Abscess in a Young Adult: A Comprehensive Case Study.

Lingual abscesses, characterized by infectious collections of pus within the tongue parenchyma, are rare and poorly understood clinical entities. Despite their potential for severe complications, literature on lingual abscesses remains limited, consisting mainly of sporadic case reports. This comprehensive case study examines the challenges and successful management of a severe anterolateral tongue abscess in a young adult, contributing to the emerging body of knowledge on this condition. A young adult male presented with a progressively worsening painful, swollen tongue and dyspnea over 2 days. Urgent intervention was necessary to prevent potential airway compromise despite maintaining normal oxygen saturation. The patient's medical history showed no prior oral infections, illnesses, or relevant medical conditions. Detailed clinical assessment, utilization of imaging modalities such as contrast-enhanced computed tomography scan and ultrasonography, and collaboration with a maxillofacial surgeon guided accurate diagnosis and successful treatment. This case study provides valuable insights into the diagnosis and management of anterolateral lingual abscess in a young adult. It underscores the importance of heightened clinical awareness, precise diagnostic techniques, and multidisciplinary collaboration for optimal patient outcomes. The report contributes to the limited literature and emphasizes the need for further research to establish evidence-based guidelines for lingual abscess management.

Giant Left Atrial Aneurysm In A Three Year Old

Background: The PA to the LA fistula is a rare cause of central cyanosis. Embryologically, incomplete degeneration of septum between the arterial and venous plexus of the pulmonary vascular bed or defective capillary loop leads to formation of thin-walled sacs resulting in formation of pulmonary arteriovenous fistula. The more restrictive the fistula is, the more subtle is the extent of cyanosis and the less evident is the clinical presentation Case Description We describe the case of three years-old patient, who presented with unresolving pneumonia, that necessitated CT imaging. CT imaging revealed a mass in the posterior mediastinum that was communicating with the left atrium. Originally it was thought that this is an aneurysmal dilation of one of the pulmonary veins, that could have resulted from mitral regurge. Echocardiography showed an aneurysmal dilation of the left atrium, with an abnormal retrograde flow across the roof of the left atrium, pulmonary hypertension and mitral regurge were excluded. 3D CT angiographic reconstruction revealed the presence of a fistulous communication between the RPA and left atrium, this explains the low normal oxygen saturations of this patient due to mixing (90-92%) and the high hemoglobin concentration (160) due to chronic subclinical hypoxia. Conclusion and learning points Aneurysmal dilation of left atrium is commonly encountered with severe mitral regurge, rare causes such as PA to LA fistulae should be thought of especially if clinical or subclinical hypoxia or polycythemia is present.

Relationship between Oxygen Saturation and Blood Cholesterol Levels in the Elderly

According to the World Health Organization (WHO), elderly people are a population group aged 60 years or more (WHO, 2015). In 2010 the number of elderly people was 18.1 million people or 17.6 percent. In 2014 the number increased to 18.8 million people. In Indonesia, elderly people in 2020 are estimated to reach 28.8 million people or 11.34 percent of the total population in the country. Based on 2018 data, Indonesia Health Research Organization (RISKESDA) stated the majority of elderly people in Indonesia have degenerative diseases and/or chronic health problems, such as diabetes and heart disease (Ministry of Health of the Republic of Indonesia, 2018). In the 21st century, a special challenge in the health sector from the continuing increase in the number of elderly people is the emergence of degenerative problems and non-communicable diseases (NCDs) such as hypercholesterolemia, diabetes mellitus, hypertension, and mental health disorders, namely depression, dementia, anxiety disorders, and sleeping disorders. These diseases will cause problems if they are not treated or prevented. Oxygen saturation is the hemoglobin fraction of oxygen saturation relative to the total hemoglobin in the blood or the oxygen level in the blood. Oxygen is bound to Hemoglobin in the Red blood cells or Erythrocytes. The human body needs and regulates a very precise and specific balance of oxygen in the blood, because the human body needs oxygen from the environment outside the body for metabolic processes and body activities. The normal arterial blood oxygen saturation level in humans is 95-100 percent. Based on data from the Global Health Observatory (GHO) from the World Health Organization (WHO), it shows that one third of ischemic heart disease is caused by high cholesterol levels. Overall, elevated cholesterol is estimated to cause 2.6 million deaths (4.5% of total deaths in the world) and 29.7 million disability-adjusted life years (DALYS), or 2% of total DALYS. (Increased ......

Carboxyhemoglobin and methemoglobin levels to diagnose hemolysis in patients supported with mechanical circulatory support devices

Decreased systemic oxygen delivery derived from gas exchange abnormalities in severe hemolysis may complicate critically ill patients supported with mechanical circulatory support devices such as the Impella device and others. Severe hemolysis releases free hemoglobin in plasma causing elevation of carboxyhemoglobin and methemoglobin levels in blood. Hemolysis induced decline in hemoglobin and oxyhemoglobin saturation may drastically reduce the arterial oxygen content in blood, therefore decreasing systemic oxygen delivery, causing or worsening lactic acidosis. These patients develop significant hypoxemia with misleadingly normal oxygen saturation measured by standard pulse oximetry. The objective of this study is to report two cases that illustrate these physiologic phenomena, emphasizing the value of monitoring carboxyhemoglobin and methemoglobin levels to readily identify and modify the management of ongoing hemolysis secondary to invasive supportive devices.

Abstract 17520: Dynamic Intrapulmonary Shunting in the Setting of Amphetamine Use

Description of Case: A 35-year-old female non-smoker with ADHD on amphetamine for the past 3 months and family history of hereditary hemorrhagic telangiectasia (HHT) presented with significant exertional dyspnea for 1 week. She was hypoxic to 82% while walking, with normal oxygen saturation at rest. Transthoracic echocardiogram with agitated saline revealed extracardiac right-to-left shunting with exercise and Valsalva. This was confirmed by dobutamine stress echocardiogram with agitated saline (Figure 1A). Transesophageal echocardiogram with agitated saline (Figure 1B) revealed no shunt through the foramen ovale, but it demonstrated bubbles entering from the left upper pulmonary vein, suggestive of an extracardiac shunt from a pulmonary arteriovenous malformation (AVM). Right heart catheterization and pulmonary angiogram revealed normal pressures, and no pulmonary abnormalities with normal pulmonary venous return. Supine right heart catheterization with exercise revealed normal pressures, although the initial pulmonary artery (PA) saturation was 28%; repeat PA saturation one minute later was 48%. Arterial saturation was 95%. Pulmonary function testing, ventilation perfusion scan, high-resolution CT chest, and coronary CT angiogram were unremarkable. The patient was instructed to avoid all stimulants, and to take a non-hormonal contraceptive. At her 3-month follow-up, she reported significant improvement in her symptoms. She underwent a 6-minute walk test, and her lowest oxygen saturation was 88%. Discussion: This patient presented with exertional hypoxia, normal saturations at rest, evidence of an extracardiac shunt only with exertion and absence of clear sources of the shunt on imaging. With her family history of HHT, this is suggestive of a small pulmonary AVM that opened by elevated PA pressures, likely triggered by amphetamine use, and its discontinuation led to symptom resolution.

Effect of maternal hyperoxygenation on neonatal outcomes among women in labour with pathological cardiotocography: an open-label randomized controlled trial

Hyperoxygenation has shown promise in improving suspicious fetal heart patterns in women in labor. However, the effect of hyperoxygenation on neonatal outcomes in women in labor with pathologic fetal heart rate tracing has not been studied. This study aimed to evaluate the effect of fractional inspiration of oxygen of 80% compared with fractional inspiration of oxygen of 40% on neonatal outcomes in women with pathologic fetal heart rate tracing. This randomized, open-label, parallel arm, outcome assessor-blinded clinical trial was conducted in a large tertiary care university hospital. Singleton parturients aged ≥18 years at term gestation in active labor (cervical dilatation of ≥6 cm) with pathologic fetal heart rate tracing were recruited in the study. Pathologic fetal heart rate tracing was defined according to the International Federation of Gynecology and Obstetrics 2015 guidelines. The International Federation of Gynecology and Obstetrics classifies fetal heart rate tracings into 3 categories (normal, suspicious, and pathologic) based on rate, variability, and deceleration. Women in the intervention arm received oxygen at 10 L/min via a nonrebreathing mask, and those in the usual care arm received oxygen at 6 L/min with a simple face mask. Oxygen supplementation was continued until cord clamping. The primary outcome measure was a 5-minute Apgar score. The secondary outcome measures were the proportion of neonatal intensive care unit admission, umbilical cord blood gas variables, level of methyl malondialdehyde in the cord blood, and mode of delivery. Overall, 148 women (74 women in the high fractional inspiration of oxygen arm and 74 in the low fractional inspiration of oxygen arm) with pathologic fetal heart rate tracing were analyzed. The demographic data, obstetrical profiles, and comorbidities were comparable. The median 5-minute Apgar scores were 9 (interquartile range, 8-10) in the hyperoxygenation arm and 9 (interquartile range, 8-10) in the usual care arm (P=.12). Furthermore, the rate of neonatal intensive care unit admission (9.5% vs 12.2%; P=.6) and the requirement of positive pressure ventilation (6.8% vs 8.1%; P=.75) were comparable. Concerning cord blood gas parameters, the hyperoxygenation arm had a significantly higher base deficit in the umbilical vein and lactate level in the umbilical artery. The cesarean delivery rate was significantly lower in women who received hyperoxygenation (4.1% [3/74]) than in women who received normal oxygen supplementation (25.7% [19/74]) (P=.00). In addition, umbilical vein malondialdehyde level in the umbilical vein was lower in the hyperoxygenation group (8.28±4.65 μmol/L) than in the normal oxygen supplementation group (13.44±8.34 μmol/L) (P=.00). Hyperoxygenation did not improve the neonatal Apgar score in women with pathologic fetal heart rate tracing. In addition, neonatal intensive care unit admission rate and blood gas parameters remained comparable. Therefore, the results of this trial suggest that a high fractional inspiration of oxygen supplementation confers no benefit on neonatal outcomes in women with pathologic fetal heart rate tracings and normal oxygen saturation.

Butamirate citrate associated methemoglobinemia

Abstract Methemoglobinemia is a potentially life-threatening disease resulting from high blood levels of methemoglobin resulting in failure of binding and delivery of oxygen to tissues. The most common causes of methemoglobinemia are oxidizing toxins, such as butamirate citrate, which is a commonly used liquid antitussive, especially in pediatric patients. Herein, we present the case of a 3-year-old girl who accidentally ingested excessive amounts of butamirate citrate. She presented with mild lip cyanosis with high methemoglobin levels (6.5%) and normal oxygen saturation (98%), and was managed by prompt gut decontamination with activated charcoal, followed by monitoring and intravenous glucose administration. Therefore, methemoglobinemia should be considered a differential diagnosis in a patient presenting with cyanosis without any underlying lung or heart disease.

#4238 UNEXPLAINED METABOLIC ACIDOSIS - A DIAGNOSTIC DILEMMA

Abstract Background and Aims Metabolic Acidosis is a common condition for which nephrology consult is sought. Most often the etiology is quite obvious like renal failure, diabetic ketoacidosis, lactic acidosis etc. We describe a case of high anion gap metabolic acidosis, unresponsive to medical management requiring hemodialysis, where finding the etiology became a diagnostic challenge because of medical and social reasons prevailing in this eastern part of India. Method A 55 year old obese gentleman came to emergency department at 3 am with complains of restlessness, pain abdomen and chest discomfort for last 4-6 hours. On clinical examination he had tachycardia with normal blood pressure and oxygen saturation. His sensorium was normal and systemic examination did not reveal any major abnormality. A possibility of acute cardiac event was considered but his ECG showed sinus tachycardia, echocardiography did not show any wall motion abnormality and Troponin I was less than 0.01 ng/mL. His blood gases showed an uncompensated metabolic acidosis with an anion gap of 21 (pH 7.19 / pCO2 44 / HCO3 15). The laboratory parameters showed a serum creatinine of 0.9 mg/dL, random blood sugar of 130 mg/dL. Any history of poisoning or drug overdose was denied by patient's attendants. Pending further workup patient was admitted in intensive care unit and correction of metabolic acidosis was started with intravenous sodium bicarbonate. Results The metabolic acidosis initially improved with medical management but within next 6 hours patient again had severe metabolic acidosis. Meanwhile patient's sensorium worsened and he had an episode of seizure. Patient was intubated and mechanical ventilation started. Within 30 minutes patient had status epilepticus which ultimately required intravenous thiopentone. Hemodialysis was started for correction of metabolic acidosis. Patient's history was re-evaluated. On persistent questioning his attendants admitted that patient had consumed alcohol 4-5 hours before the symptoms started. It is important to mention here that consumption of alcohol is a punishable offence in Bihar which a state in eastern part of India. Despite alcohol being completely banned in this part of country illicit alcohol is smuggled and consumed by some. Illicit alcohol is prone to be adulterated and sub-standard. It was because of this fact that patient's attendants suppressed the facts. Also alcohol consumption is a valid ground for rejection of medical insurance claims because of obvious reasons. After obtaining the complete history a possibility of consumption of alcohol adulterated with methyl alcohol was very likely. Serum methyl alcohol estimation was not available at our institute and patient had already received hemodialysis hence it was not done. With patient already having seizures MRI (Magnetic Resonance Imaging) of brain was done. MRI brain revealed altered hyperintense signal with cytotoxic edema in bilateral basal ganglia predominantly putamen. Subcortical white matter in bilateral cerebral hemisphere and bilateral optic nerve head showed restriction on diffusion weighted imaging. These typical features on MRI were highly suggestive of methanol toxicity. These MRI features along with the clinical scenario and history of illicit alcohol intake helped us reach the diagnosis of methanol toxicity. Patient was managed with hemodialysis sessions to remove methanol from blood until he improved clinically. Conclusion The etiology of the high anion gap metabolic acidosis turned out to be methanol toxicity. Typical MRI brain findings helped confirm the diagnosis. Our case highlights the importance of obtaining the correct medical history and how social and medicolegal issues sometimes become a hindrance to obtaining the same.

An Unusual Cause of Fever, Neck Pain, and Neck Stiffness: Acute Calcific Tendinitis of the Longus Colli Muscle

BackgroundAcute calcific tendinitis (ACT) of the longus colli muscle (LCM) is an inflammatory response due to deposition of calcium hydroxyapatite crystals. It is typically correlated with whiplash and overuse injuries. A common presentation of this inflammatory response is acute but progressive neck pain. It is a rare but important cause of neck pain that should be considered on a differential diagnosis when distinguishing between life-threatening conditions and non–life-threatening causes of neck pain. Case ReportA 51-year-old woman presented to the emergency department (ED) reporting a mild sore throat that progressed to acute neck pain and stiffness. She also reported fatigue, fever, myalgias, and nausea. In the ED, the patient was tachycardic, hypertensive, and mildly febrile with normal oxygen saturation. Examination revealed meningismus and was negative for lymphadenopathy, oropharyngeal findings, and neurologic deficits. Laboratory studies were significant for leukocytosis. Computed tomography (CT) neck was obtained and was notable for calcification of the superior left longus colli muscle with prevertebral and retropharyngeal space edema along the muscle body. Why Should an Emergency Physician Be Aware of This?ACT of the LCM is a benign, self-limited condition that can present with features overlapping emergent causes of acute neck pain. Correct diagnosis relies on characteristic radiographic findings on CT. Fortunately, patients may be discharged home with a short course of anti-inflammatories and corticosteroids with near-complete resolution of symptoms. Emergency physicians, therefore, can rule out life-threatening causes of neck pain, while also making a definitive diagnosis and initiating effective management for this pathology.

Naphthalene Poisoning in a Young Glucose 6 Phosphate Dehydrogenase Deficient Patient

Naphthalene poisoning is a rare form of toxicity that may occur after ingestion, inhalation, or dermal exposure to naphthalene-containing compounds. It is a volatile polycyclic hydrocarbon used as a household deodorizer and moth repellent.Ingestional naphthalene poisoning can leadto methaemo-globulinaemia and intravascular haemolysis with diagnostic and therapeutic challenge. Associated G6PD deficiency may make it more complicated. A 20-year-old man presented with low-grade fever, lethargy and dark urine for 4 days.His vitals showed normal temperature, tachycardia with normal blood pressure and low oxygen saturation(76%) despite having high flow oxygen (15L/min).On repeated queries, he gave a history of ingesting a few naphthalene balls after a heated conversation with his friends. Laboratory workup showed features of haemolysis, methaemoglobinaemia, haemoglobinuria and low glucose 6 phosphate dehydrogenase level. The patient was treated conservatively with intravenous fluid, packed red blood cells transfusion, N acetylcysteine andascorbic acid with full recovery. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218

The Effectiveness of Adjuvant Attangaogam (Athanam) Yoga Asana-Pranayamam Practices With Regard to Biochemical, Inflammatory, and Hematological Markers Among COVID-19 Patients at a Tertiary Care Hospital in Southern Tamilnadu.

Background and objective Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious infectious disease that has affected many countries globally. Attangaogam, known in Sanskrit as "Ashtanga yoga", is a practice associated with the spiritual and cultural heritage of India whose origins can be traced back to the very dawn of civilization; the practice of yoga promotes health,healing, and longevity.This study aimed to analyze the effects of Attangaogam (Athanam) yoga asana-Pranayamam practice on biochemical, inflammatory, and hematological markers in the management of COVID-19. Materials and methods A prospective observational study was conducted from August 2021 to February 2022 among hospitalized adult patients of both sexes who consented to participate and testedpositive for COVID-19 reverse transcription-polymerase chain reaction(RT-PCR). Convenience sampling was employed and the study was approved by Institutional Ethics Committee (VMCIEC/74/2021). Clinical details, inflammatory markers, D-dimer, lactate dehydrogenase (LDH), ferritin, procalcitonin (PCT), interleukin 6(IL-6), and complete blood count (CBC) were analyzed for all the volunteering patientson admission and before commencing yoga-pranayamam practices. Also, the parameters were recorded after practicing the scheduled protocol: on the day of discharge, and after the first and third months of discharge. Microsoft Excel 2013 was used forstatistical analysis. Results Of the 76 patients, 32 were followed up regularly; the mean age of the cohort was 50.6 ± 4.95 years, and62% were males. All the patients attained normal oxygen saturation and got discharged in 7-14 days. The comparison of clinical, hematological, inflammatory, and biochemical investigations between pre- and post-Attangaogam yoga-Pranayamam practice sessions showed statistically significant differencesand the patients attained normal levels for all variables within three months except for serum albumin. Conclusion Based on our findings, the practice ofAttangaogam yoga-Pranayamam contributed to the successful treatment of COVID-19 with the early restoration of protracted hypermetabolic and hyperinflammatory markers to normal status. Theevidence related to biomarkers revealed that the patients attained metabolic normalcy of cellhealth with the aid of personalized physical rehabilitation counteracting inflammation and promoting tissue repair thanks to holistic natural and innate immunity provided by Attangaogam yoga-pranayamam practices.

Comparison of flexible nasogastric tube and semi-rigid catheter during less invasive surfactant administration.

Various flexible and semi-rigid catheter techniques have been reported for surfactant delivery during less invasive surfactant administration (LISA) in preterm infants. Data on the effect of catheter selection on procedural success rates and adverse events are limited. Our objective was to compare the rates of success and adverse events of LISA performed with nasogastric tube and semi-rigid catheter. This was a post-hoc analysis of data from a quality improvement project. LISA was performed according to the standardized local protocol. Baseline characteristics, data on performance of LISA, degree of difficulty in laryngoscopy and vital parameters after the initiation of LISA were collected and outcomes were compared between groups. Fifty-six infants were included (21 with nasogastric tube, and 35 with semi-rigid catheter). Procedure success rate (defined as a single LISA attempt resulting in intratracheal administration of the planned dose of surfactant), incidence of adverse events, heart rate and oxygen saturation values and outcomes did not differ significantly between the two groups. When using a nasogastric tube for LISA, a significantly higher fraction of inspired oxygen was needed in the 3rd (0.62 vs. 0.48, P=0.024), 4th (0.61 vs. 0.37, P<0.001) and 5th minute (0.48 vs. 0.37, P=0.001) to maintain normal oxygen saturations. Use of the semi-rigid catheter was associated with better oxygenation during and shortly after the procedure. Our results may help neonatal units to develop local guidelines.

Clinical profile of patients with COVID-19 at Raden Mattaher General Regional Hospital Jambi

Background: Coronavirus disease 2019 (COVID-19) is a new virus that was first reported in Wuhan, Hubei. The World Health Organization (WHO) announced that COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus attacks the upper respiratory tract, then spreads to the lower respiratory tract, and continues to the gastrointestinal tract. Objectives: This study aimed to describe COVID-19 patients' profiles at Raden Mattaher Hospital, Jambi. Methods: This was an observational study that took a descriptive cross-sectional approach. It intended to describe the profiles of COVID-19 patients seeking treatment at Raden Mattaher Hospital, Jambi. This data were recorded during the period of October 2021-December 2021, with a total of 30 samples obtained. Results: Most of the COVID-19 patients' profiles revealed they were between ages 50-59 and 70-79, male, complained of respiratory system disorders, and without comorbidity. As for vital signs, most had normal pulses, tachypnea breathing, normal oxygen saturation, and normal blood pressure. Laboratory examinations showed that most had normal ALCs, suspicious NLR, positive RT-PCR results, and negative antigen swabs. Most patients had a length of stay of 8-14 days and exited with independent isolation. Conclusion: COVID-19 patients at Raden Mattaher Hospital, Jambi had different characteristics, clinical results, and laboratory tests with varying results. Most results were in accordance with the proposed theory and few had results that differed from it.

Profile of COVID-19 Patients with Persistent Respiratory Symptoms

Background and objective: COVID pandemic struck the entire world causing high mortality and morbidity. After-effects of the infection were manifested in various clinical forms for the varying duration. As the pandemic waxes and wanes, COVID has become one of the differential diagnoses for various clinical and radiological pictures and triggers for respiratory diseases. While COVID sequelae are still much to explore, this study aimed to assess the clinicoradiological profile of COVID-19 patients who have persistent symptoms pertaining to the respiratory system. Materials and methods: This prospective study was conducted for 1 year from December 2020 to December 2021. COVID-19 patients aged between 10 and 85 years with persistent respiratory symptoms were included in this study. Results: There were a total of 90 patients. The mean age was 50.79 years. Forty-eight (53.3%) patients were males and 42 (46.7%) were females. Among these patients, eight patients (8.9%) had an asymptomatic or minimal symptomatic gap of at least 2 weeks from the date of positivity to the development of full-blown symptoms. The maximum duration of symptoms reported was more than 1 year and continuing. Dyspnea on exertion was the predominant symptom, in 59 patients (65.6%). Hypoxia at rest was seen in 35 (38.9%) patients, whereas seven patients with normal oxygen saturation showed exertional desaturation. Out of the 33 patients with post-COVID changes in computed tomography (CT) of the thorax, ground-glass opacities were seen in all 33 patients (100%), consolidation in 18 patients (54.5%), septal thickening in 18 patients (54.5%), and fibrosis in 15 patients (45.4%). Predominant CT finding was that of organizing pneumonia, but a few had fibrotic picture similar to usual interstitial pneumonia (UIP) or fibrotic nonspecific interstitial pneumonia (fibrotic NSIP). Hypoxia severity was significantly associated with diabetes (p = 0.028), hypertension (p = 0.028), chronic kidney disease (p = 0.027), chronic obstructive pulmonary disease (p = 0.001), obesity (p = 0.000), and smoking (p = 0.004). CT severity scoring was significantly associated with hypoxia severity. Conclusion: After the initial weeks, COVID patients can present with varying respiratory symptoms. They can present with respiratory failure as late as 1 month after the test positivity. Although CT picture was predominantly that of organizing pneumonia, COVID lung sequelae can masquerade as UIP or fibrotic NSIP as in idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung disease, whereas atypical infections and malignancy can masquerade as COVID lung. Irreversible changes like honeycombing can occur as early as 2nd month after COVID.

Cardiac dysfunction in active pulmonary tuberculosis: Mysterious facts of TB’s pandora

&lt;b&gt;Introduction&lt;/b&gt;: Cardiac dysfunction in pulmonary tuberculosis is relatively more common and underestimated due to lack of suspicion. We have studied prevalence of cardiac dysfunction in pulmonary tuberculosis with special emphasis on echocardiography, serum cortisol and its correlation in cases with unstable cardiorespiratory parameters.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; Prospective, observational, complete workup, and one year follow up study conducted during January 2016 to December 2020 included 800 cases of active pulmonary tuberculosis with specified inclusion criteria of disproportionate tachycardia, tachypnea with or without hypoxia and shock. Cases with known risk factor for cardiac disease and taking cardiac medicines, and cases with pericardial effusion were excluded from study. All study cases were undergone protocolized analysis such as chest radiograph, pulse oximetry, ECG, sputum examination, cardiac enzymes (CPK-MB, NT-Pro-BNP, and cardiac troponins), serum cortisol, and echocardiography at entry point, at two and six months of treatment with anti-tuberculosis medicines as per NTEP. Statistical analysis was carried out by Chi-square test.&lt;br /&gt; &lt;b&gt;Observations and analysis: &lt;/b&gt;In a study of 800 pulmonary tuberculosis cases, 56.00% (448/800) cases were males, and 44.00% (352/800) cases were females. Cases with BMI&amp;lt;18 was 41.62% (333/800) and BMI&amp;gt;18 was 58.37% (467/800). Radiological patterns as unilateral disease in 33.62% (269/800) &amp;amp; bilateral disease in 66.37% (531/800). Hemoglobin less than 10 gm% were documented in 85.12% (681/800) and above 10 gm% were in 14.87% (119/800) cases. Serum albumin less than 3.5 gm% and more than 3.5 gm% were observed in 48.12% (385/800) and 51.12% (415/800) cases respectively. Hypoxia was documented 26.12% (209/800) cases and normal oxygen saturation in 73.87% (591/800) cases. cases with normal and abnormal serum cortisol were 61.37% (491/800) &amp;amp; 38.62% (309/800) respectively. Sputum examination for AFB observed in 30.00% (240/800) and gene Xpert MTB/RIF documented in 51.37% (411/800) cases respectively. Bronchoscopy guided techniques were used in 149 cases and BAL smear AFB in 44.96% (67/149) cases, gene Xpert MTB/RIF in 97.31% (145/149) cases and MGIT culture in four cases (positive in 100% cases subjected to MGIT culture). We have observed global hypokinesia is predominant cardiac dysfunction documented in 82.21% (171/208) cases, followed by left heart systolic dysfunction in 16.34% (34/208) cases and left heart diastolic dysfunction in 75% (156/208) cases. Right heart dysfunction as dilated right atrium and right ventricle documented in 52.88% (110/208) cases and pulmonary hypertension in 40.38% (84/208) cases. Covariates such as age, gender, hemoglobin, BMI, serum cortisol, serum albumin, oxygen saturation and radiological involvement has significant association with cardiac dysfunction. (p&amp;lt;0.00001) Response to treatment with antituberculosis medicines and steroids has documented as improved in 77.40% cases (161/208) cases, persistent in 13.46% (28/2028) cases and progressive in 9.13% (19/208) cases. Final outcome of cardiac dysfunction in Pulmonary tuberculosis cases has significant association with serum cortisol level (p&amp;lt;0.00086).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Cardiac dysfunction is active pulmonary tuberculosis needs prompt workup in presence of disproportionate tachypnea, tachycardia with or without hypoxia and shock. Echocardiography is basic tool to evaluate these cases and global hypokinesis is most common abnormality. Serum cortisol abnormality documented in fair number of cases and very well correlated with left ventricular dysfunction abnormalities. Steroids with antituberculosis treatment backup is mainstay protocol during management of these cases. Cardiac dysfunction is reversible in majority of cases and proportionate number shown complete improvement in cardiac dysfunction.

A study on the rapid diagnosis of chronic heart failure by measuring the difference in pulse oxygen saturation before and after arm compression.

Clinically, the pulse oxygen saturation of patients with chronic heart failure does not decrease significantly, and the clinical manifestations of labor-related dyspnea are not typical. As such, it is difficult to make a rapid diagnosis. To investigate changes in pulse oxygen saturation in patients with chronic heart failure and examine the relationship between B-type natriuretic peptide (BNP) and normal pulse oxygen saturation. A total of 80 hospitalized patients with chronic heart failure and increased BNP were randomly selected as the study group; the family members of 60 patients without dyspnea were randomly selected as the control group. The researchers measured the value of pulse oxygen saturation before and after upper arm compression, calculating the difference and analyzing the correlation between this difference and BNP values. The data were statistically analyzed using the SPSS Statistics 17.0 program. The decrease in pulse oxygen saturation in the study group was greater than in the control group; the decrease in pulse oxygen saturation of patients with chronic heart failure positively correlated with BNP. The value of pulse oxygen saturation in patients with chronic heart failure decreased more than in the control group, and this difference positively correlated with BNP. The measurement of pulse oxygen saturation before and after upper arm compression is a simple and effective method for diagnosing and evaluating chronic heart failure.

Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study.

This study aims to evaluate the effect of bilateral nasal packing on sleep oxygen saturation and its influencing factors on the first night after general anesthesia. A total of 36 adult patients who underwent bilateral nasal packing with a nonabsorbable expanding sponge after general anesthesia surgery were prospectively studied. All these patients underwent overnight oximetry tests before and the first night after surgery. The following oximetry variables were collected for analysis: the lowest oxygen saturation (LSAT), the average oxygen saturation (ASAT), the oxygen desaturation index of ≥4% (ODI4), and the percentage of time with oxygen saturation below 90% (CT90). Among the 36 patients, the incidences of both sleep hypoxemia and moderate-to-severe sleep hypoxemia increased with bilateral nasal packing after general anesthesia surgery. All the pulse oximetry variables we studied deteriorated significantly after surgery: both LSAT and ASAT decreased significantly (P < 0.05), while both ODI4 and CT90 increased significantly (P < 0.05). In a multiple logistic regression analysis, body mass index (BMI), LSAT, and modified Mallampati grade were found to be independently predictive for a larger decrease in LSAT (≥5%) after surgery (all P's < 0.05). Bilateral nasal packing after general anesthesia could induce or aggravate sleep hypoxemia, especially in patients with obesity, relatively normal sleep oxygen saturation, and high modified Mallampati grades.

Woman with dyspnea and hypoxia.

A 48-year-old female with a history of recent admission for a prolonged COVID course including a period of time on extracorporeal membrane oxygenation (ECMO), presented to our emergency department with complaints of worsening dyspnea on exertion. She was noted to have normal oxygen saturation at rest but would become significantly hypoxic to 70% with minimal exertion. Lab work at presentation was notable for leukocytosis to 25,000 without lactic acidosis. A computed tomography angiography was performed (Figure 1), as well as a bedside point-of-care ultrasound (Figure 2 and Video). Candida albicans infective endocarditis of the tricuspid valve with embolus-in-transit and right main pulmonary artery embolism. Cardiology was immediately consulted with concerns for pulmonary embolism with clot-in-transit. They performed an aspiration embolectomy and concluded that the mass was instead a large vegetation secondary to Candida albicans. She previously had candidemia while on ECMO and completed a course of fluconazole with presumed clearance of infection. After the procedure, the patient developed severe tricuspid regurgitation requiring tricuspid valve replacement and an extended course of micafungin therapy. Candida infective endocarditis (CIE) is a rare complication with a reported prevalence ranging from 1.9% to 5.9% in patients with candidemia.1 In 2017, there were roughly 23,000 cases of candidemia.2 Those with underlying valvular heart disease (native and prosthetic) are at an increased risk consistent with findings for bacterial IE, though fungal endocarditis makes up roughly 1%–10% of cases of IE.1, 3 Overall mortality associated with CIE is close to 50%, almost double the mortality of candidemia alone.1, 2 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.