Oxygen Saturation Levels Research Articles

Successful transcatheter treatment of large right pulmonary artery to left atrial fistula: a case series and literature review

IntroductionCyanotic congenital heart diseases are among the most serious anomalies among newborns. A rare type of this condition is direct communication between the right pulmonary artery and left atrium, which presents mostly in adolescence and adulthood. Large shunts, however, should be corrected as soon as possible, considering their potential to cause congestive heart failure.Case PresentationTwo 2- and 13-year-old patients with this pathologic communication complained of exertional dyspnea and central cyanosis. Their physical exams were prominent, with a low oxygen saturation level. The diagnostic modalities used, electrocardiogram, chest X-ray, echocardiogram, CT scan, and selective angiography of the pulmonary arteries, showed right-to-left abnormal blood flow through the right pulmonary artery and left atrium shunt. Finally, both patients were treated successfully by a transcatheter occluder without any complications or follow-up complaints.DiscussionThe right pulmonary artery and left atrium abnormal congenital connections are rare causes of central cyanosis, mostly present with exertional dyspnea and cyanosis during adolescence or early adulthood. Transthoracic echocardiography, contrast-enhanced CT scans, and angiography of the pulmonary arteries make the diagnosis. The treatment has emerged during the last two decades, shifting from surgical treatment for severe cases to interventional percutaneous strategies, leaving the surgery for cases with no appropriate location for the application of interventional therapy.ConclusionConsidering the potentially life-threatening complications of the untreated right pulmonary artery and left atrium fistulas, such as thromboembolic events, early diagnosis is crucial. However, treating these patients is not always straightforward, and strategies should be selected based on the connecting fistula’s anatomical features, location, size, and tortuosity. Although endovascular treatment is the preferred option, some patients need to be treated with surgical procedures due to their structural characteristics.

Creative music therapy in preterm infants effects cerebrovascular oxygenation and perfusion

Creative music therapy (CMT) has been shown to promote the development of brain function and structure in preterm infants. We aimed to investigate the effect of CMT on cerebral oxygenation and perfusion to examine how the brain reacts to CMT. Absolute levels of cerebrovascular oxygen saturation (StO2) were measured in clinically stable preterm-born neonates (n = 20, gestational age: ≥30 weeks and < 37 weeks) using two near-infrared spectroscopy (NIRS)-based tissue oximeters over the right prefrontal cortex and left auditory cortex. We applied the systemic physiology augmented functional NIRS approach. Each CMT session lasted 55 min and involved 9 intervals, including two 10-minute intervals during which the music therapist hummed and held the neonate. We found that CMT-induced changes in cerebrovascular StO2, perfusion and systemic physiology (i) could be classified into two groups (group 1: increase in StO2 during the first singing interval, group 2: decrease in StO2), (ii) differed in female neonates compared to male neonates, and (iii) correlated with individual blood haematocrit levels. Our exploratory study (i) demonstrates the impact of CMT on the neonate’s physiology and (ii) highlights the need to analyze functional NIRS measurements in neonates separately according to their response pattern to avoid erroneous conclusions, e.g. when only the group average of the signal change is determined.

Evaluation of the cell death markers for aberrated cell free DNA release in high altitude pulmonary edema.

The effect of high altitude (HA, altitude >2500 m) can trigger a maladaptive response in unacclimatized individuals, leading to various HA illnesses such as high altitude pulmonary edema (HAPE). The present study investigates circulating cell free (cf) DNA, a minimally invasive biomarker that can elicit a pro-inflammatory response. Our earlier study observed altered cfDNA fragment patterns in HAPE patients and the significant correlation of these patterns with peripheral oxygen saturation levels. However, the unclear release mechanisms of cfDNA in circulation limit its characterization and clinical utility. The present study not only observed a significant increase in cfDNA levels in HAPE patients (27.03 ± 1.37 ng/ml; n = 145) compared to healthy HA sojourners (controls, 14.57 ± 0.74 ng/ml; n = 65) and highlanders (HLs, 15.50 ± 0.8 ng/ml; n = 34) but also assayed the known cell death markers involved in cfDNA release at HA. The study found significantly elevated levels of the apoptotic marker, annexin A5, and secondary necrosis or late apoptotic marker, High mobility group box 1, in HAPE patients. In addition, we observed ahigher oxidative DNA damage marker, 8-hydroxy-2'-deoxyguanosine, in HAPE compared to controls, suggestive of the role of oxidative DNA status in promoting the inflammatory potential of cfDNA fragments and their plausible role in manifesting HAPE pathophysiology. Extensive in vitro future assays can confirm theimmunogenic role of cfDNA fragments that may act as a danger-associated molecular pattern and associate with markers of cellular stresses in HAPE.

Patient use of pulse oximetry to support management of COVID-19 in Greater Manchester: A non-randomised evaluation using a target trial approach.

The pandemic saw widespread use of home pulse oximeters to patients diagnosed with COVID-19 to support early detection of low oxygen saturation levels and appropriate care. Rapid implementation made conventional evaluation challenging, highlighting the need for rigorous non-randomised methods to support decision-making about future use of these technologies. We used routine data to explore the benefits of pulse oximetry in Greater Manchester, under the 'COVID-19 oximetry at home' (CO@h) programme. We used data from the Greater Manchester Secure Data Environment and defined study parameters using a 'target trial' model to compare patients receiving pulse oximetry under the CO@h programme, with matched controls using various comparator groups. Primary outcomes were unplanned hospitalisation and all-cause mortality. This study is based on data from the Greater Manchester Care Record (GMCR), using anonymised, routinely collected data provided in a de-identified format for research. Informed written consent is needed for primary care patient data to be collected for service improvement and research, before data extraction to the GMCR. The study was approved under protocol GMCR RQ-048, on 12/05/2022. As indicated by the University of Manchester ethics decision tool, formal ethical approval was not required for this study. The adjusted odds ratios for an unplanned hospitalisation were higher among patients receiving pulse oximetry: OR 1.86 (95% CI 1.54-2.25) at 28 days, 1.5 (95% CI 1.3-1.74) at 90 days and 1.63 (95% CI 1.44-1.83) at 1 year. Overall odds of mortality were lower among patients receiving pulse oximetry: adjusted ORs of 0.5 (95% CI 0.25-0.98) at 28 days, 0.5 (95% CI 0.32-0.78) at 90 days and 0.58 (95% CI 0.44-0.76) at 1 year. The results were robust to different comparison groups. Use of pulse oximetry at home under the CO@h programme, through the resulting prioritisation for appropriate care, was associated with a higher frequency of unplanned admissions and a reduction in the risk of mortality up to 1 year later. Therefore, it is likely effective for early detection of clinical deterioration and timely intervention among patients with COVID-19. Further research is needed to understand whether this is a cost-effective use of healthcare resources.

Immediate effect of sunlight exposure through blue glass on blood pressure in hypertensive patients: a randomized controlled trial.

Hypertension affects approximately 1.28 billion adults worldwide, driving the search for integrative therapeutic approaches alongside conventional treatments. While chromotherapy, particularly blue light exposure, has historical roots in traditional medicine and its specific impact on blood pressure regulation remains understudied. So, the present study aims to investigate the immediate impact of exposure to blue glass through sunlight on blood pressure in hypertensive individuals. This randomized controlled trial was carried out with a sample of 60 hypertensive patients, who were divided into two groups: a study group that received blue glass exposure for 20 min and a control group that received exposure to colourless glass. The primary outcome measures were systolic and diastolic blood pressure, pulse rate, and oxygen saturation levels. The results of the study revealed statistically significant differences in systolic blood pressure (p=0.006) and pulse rate (p=0.005) after the intervention in the study group and no such changes were noted in the control group. The findings of this study suggest that blue glass exposure has a significant impact on reducing blood pressure and pulse rate in hypertensive patients, indicating its potential use as a integrative treatment in the management of hypertension.

Predictors of adverse outcomes in patients with chronic obstructive pulmonary disease and pulmonary embolism and the predictive value of the simplified pulmonary embolism severity index

Objective: To explore the relevant factors associated with poor prognosis in patients suffering from chronic obstructive pulmonary disease (COPD) combined with pulmonary embolism (PE), and investigate the predictive value of the simplified pulmonary embolism severity index (sPESI) score on adverse outcomes in these patients. Methods: A total of 168 patients with COPD and PE who were treated at West China Hospital of Sichuan University from January 1, 2018, to December 30, 2020 were retrospectively included. Patients were divided into adverse outcome group and control group based on the occurrence of adverse outcomes [any of the following events: in-hospital death, intensive care unit (ICU) admission, and endotracheal intubation]. Correlation factors for poor prognosis were explored using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was employed to assess the predictive value of the sPESI score for adverse outcomes in COPD patients with PE. Results: A total of 168 patients were studied, with an age of (73.4±10.4) years and 119 male (70.8%). In the adverse outcome group, there were 18 cases (10.7%), including 12 in-hospital deaths, 6 ICU admission, and 1 endotracheal intubation. The control group comprised 150 cases (89.3%). Statistically significant differences were observed between two groups regarding the proportion of patients with diabetes, nephrotic syndrome, severe pneumonia, respiratory failure and lower extremity edema, and the pulse, diastolic blood pressure, pulse oxygen saturation, lactate dehydrogenase and cholesterol levels (all P<0.05). Multivariate logistic regression analysis revealed that severe pneumonia, respiratory failure, lower extremity edema, and diastolic blood pressure<60 mmHg (1 mmHg=0.133 kPa) are correlative factors of adverse outcomes in patients with COPD complicated by PE [OR (95%CI) were 7.363 (1.053-51.772), 4.077 (1.030-16.133), 4.490 (1.131-17.832), and 8.060 (1.209-53.918), respectively, all P<0.05]. The sPESI score in the adverse outcome group was higher than that in the control group [M (Q1, Q3), 2 (2, 2) vs 1 (1, 2) score, P=0.006]; the optimal cutoff value for sPESI score was 2 score, the sensitivity was 77.8%, the specificity was 54.0%, and the area under the curve (AUC) and 95%CI were 0.681 (0.554-0.809) based on the ROC curve analysis. Patients with sPESI≥2 score exhibited a 4.109-fold (95%CI: 1.292-13.063, P=0.017) increased risk of adverse prognosis compared to those with sPESI<2 score. Conclusions: Patients with COPD combined with PE have a higher incidence of adverse prognostic outcomes. Severe pneumonia, respiratory failure, lower limb edema, and diastolic pressure<60 mmHg are associated factors for poor prognosis. The sPESI score has some value in predicting adverse outcomes in COPD patients with PE.

Kangaroo Mother Care on Perfusion Index, Heart Rate, and Oxygen Saturation in Premature Infants Who were Discharged Early and Admitted to The Neonatal Intensive Care Unit: A Randomized Control Tria.

To determine the effect of kangaroo mother care (KMC) on perfusion index, heart rate, and oxygen saturation in premature infants who were discharged early and admitted to the neonatal intensive care unit (NICU) in the following days. This study has a randomized controlled experimental design and uses a pretest-posttest control group model. This study included infants between December 2019 and December 2020 who were discharged early and subsequently admitted to the NICU. Experimental (n=38) and control (n=38) groups were assigned using the simple randomization technique at the NICU of a private university hospital in Istanbul, Türkiye. Heart rate, perfusion index, and oxygen saturation levels of the experimental group in which KMC was applied and the control group in which KMC was not applied were compared. Measurements of these parameters were made at 15-minute intervals for 45 minutes (0-1, 15, 30, 45 minutes). Data were collected via the Mother and Infant Introductory Information Form, Kangaroo Mother Care Preparation Checklist, Kangaroo Mother Care Physiological Parameter Monitoring Form, and Noninvaziv Pulse Co-Oximetry. Statistics of these data were performed with the independent sample t-test, Pearson's Chi-square, Fisher's exact test. In the experimental and control groups, infants' gestational age (31.11 ± 3.25 and 31.61 ± 3.04, respectively; p = .491) and weight (1778.29 ± 436.93 and 1953.29 ± 345.74, respectively; p = .057) were similar, and the differences were statistically insignificant. Before KMC, there was no difference between the heart rate, oxygen saturation, and perfusion index values of the experimental and control groups (p > .05). From the first 15 minutes after the application of KMC to 45 minutes post-KMC, there was a significant decrease in (p=0.001) and stabilization of heart rate and oxygen saturation in the experimental group compared with the control group. The heart rates in the experimental group at 15th, 30th, and 45th minutes during KMC were lower than in the control group (147.63 ± 11.04; 142.47 ± 11.94; 136.82 ± 13.22 and 153.13 ± 8.73; 154.50 ± 7.27; 154.84 ± 7.05, respectively). Also, their oxygen saturation during KMC was higher than in the control group (96.68 ± 2.08; 97.24 ± 2.18; 97.87 ± 1.66 and 94.79 ± 1.27; 94.66 ± 1.45; 94.39 ± 1.38, respectively). This significant difference between KMC on heart rate and oxygen saturation in the experimental group compared to the control group continued for 45 minutes after KMC. The perfusion index was significantly higher at 30 minutes and 45 minutes during KMC. However, although it continued after KMC, this change in perfusion index was not statistically significant. Kangaroo mother care helps to regulate the heart rate, oxygen saturation, and perfusion index of premature infants who were discharged early and admitted to the NICU in the following days.

Multisensory stimulation to reduce procedural pain in retinopathy of prematurity: A randomized controlled trial.

Retinopathy is frequently seen in the neonatal intensive care unit (NICU), and its examination is a painful procedure for infants. This randomized active-controlled trial aimed to investigate the impact of multisensory stimulation (MSS) on neonatal pain during retinopathy of prematurity (ROP) examinations, in comparison with a white noise (WN) and control group receiving standard care. Conducted as a three-arm, randomized controlled trial, the study was implemented in the NICU of a local university hospital. Recruitment spanned from July 2023 to November 2023, with preterm infants (gestational age < 37 weeks) randomly assigned to either a MSS, WN or a control group. MSS components included visual, auditory, tactile, olfactory and gustatory stimuli, all designed to create a synergistic, comforting environment for the infant during the procedure. Procedural pain, heart rate and oxygen saturation were assessed at various stages before and after ROP examinations. Analysis of 90 participants revealed that the MSS group exhibited lower Premature Infant Pain Profile (PIPP) scores than the WN and control groups (mean difference: -2.12, 95% confidence interval [CI]: -2.62 to -1.62; odds ratio [OR]: 0.004, 95% CI [0.001, 0.012], p < 0.001). Additionally, heart rates were significantly lower in the MSS group (mean difference: -15.3 beats/min, 95% CI: -20.5 to -10.1; OR: 0.025, 95% CI [0.008, 0.073], p < .001) and oxygen saturation levels were higher (mean difference: 3.2%, 95% CI: 1.8% to 4.6%; OR: 1.12, 95% CI [1.05, 1.20], p < .001) than in the other groups. MSS emerges as a favourable, safe and non-pharmacological intervention for pain management in ROP and similar procedures. Multisensory stimulation can be effectively integrated into the routine care provided by critical care nurses during retinopathy of prematurity examinations in preterm infants. This non-pharmacological intervention offers a practical approach for critical care nurses to reduce procedural pain and improve physiological stability in this vulnerable population.

Rapid Shallow Breathing Index and Ultrasonographic Diaphragmatic Parameters as Predictors of Weaning Outcome in Critically Ill Patients on Mechanical Ventilation.

Successful weaning is a crucial element in care toward critically ill patients on mechanical ventilation. An attempt was made to propose and assess a reliable predictor of weaning outcome. A prospective observational study was conducted on 76 patients on mechanical ventilation, assessed by Acute Physiology and Chronic Health Evaluation II (APACHE II) score. For all these patients we calculate Rapid shallow breathing index (RSBI), Ultrasonographic diaphragmatic parameters namely diaphragmatic excursion (DEx), diaphragmatic thickening fraction (DTF) and diaphragmatic contraction velocity (DCV). Values were compared among patients with two groups of successful and failed weaning outcomes, respectively, and statistically analyzed. Of 76 patients included in the study, with ultrasonographic diaphragmatic parameters being measured 30 min into SBT, 71 patients tolerated spontaneous breathing test (SBT) for 2 h and were extubated. Of these, 61 patients did not require reintubation or any form of ventilatory support within 48 h after extubation. There was a statistically significant difference in APACHE II scores, duration of ventilation, oxygen saturation levels, RSBI, DEx, DTF, and DCV between groups of patients who showed successful and failed weaning from mechanical ventilation. There were a significant positive correlation between the duration of ventilation and the RSBI and a significant negative correlation between DEx, DCV, DTF, and duration of ventilation. As predictors of weaning outcome, RSBI showed the best validity, followed by DCV, DTF, and DEx. RSBI can be reliably used as a predictor of weaning outcome in critically ill patients on mechanical ventilation.

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PurposeThe purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia. DesignThis was a randomized controlled experimental trial. MethodsThe research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate. FindingsWhen the groups’ VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05). ConclusionsVR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Predicting daily net ecosystem production in shallow lakes from dissolved oxygen saturation levels: a pan-European mesocosm experiment and modelling approach

Predicting daily net ecosystem production in shallow lakes from dissolved oxygen saturation levels: a pan-European mesocosm experiment and modelling approach

Assessment of COVID-19 severity levels and associated factors among patients admitted to the treatment centers in Southern Ethiopia.

COVID-19, a highly impactful infectious disease, has been observed to result in psychological distress, organ impairment, and mortality. The severity and consequences of the illness appear to vary based on geographical location and individual characteristics. Understanding the disease and optimizing resource distribution through early classification depend on having data on the severity of COVID-19 patients. There is a dearth of information in this particular region regarding the severity of COVID-19 patients and related factors. Therefore, this study used an ordinal logistic regression model to determine the severity levels of COVID-19 and its associated components. A retrospective follow-up study was conducted on COVID-19 patients admitted between May 30, 2020, and October 15, 2021, at care centers in southern Ethiopia. 845 patients were included in this research. The mean (standard deviation) and median (interquartile range) were used to summarize the data. A multivariable ordinal logistic regression model was used to study the association between independent variables and COVID-19 severity levels. In terms of the severity of the disease, 12.07% of patients had severe COVID-19, 7.81% had critical disease, and 6.39% had moderate disease. 8.28% of the 845 patients died, while 88.88% of them made a full recovery. Older age (> = 40 years) (AOR = 5.75, 95% CI = 3.99, 8.27), comorbidities (AOR = 4.17, 95% CI = 3.03, 5.88), and low oxygen saturation (AOR = 3.44, 95% CI = 2.23, 5.56) were significantly linked to higher odds of experiencing more severe levels of COVID-19 compared to their counterparts. 7.81% of patients were critically ill, while more than one-tenth (12.07%) were considered severely ill. Low oxygen saturation, comorbidities, and advanced age were found to be significantly associated with COVID-19 severity. Therefore, it is crucial to manage comorbidities, provide special treatment, and provide COVID-19 patients with underlying medical issues more attention due to the higher risk of poor outcomes. To speed up their recovery, medical professionals should regularly monitor and provide specialized care to older COVID-19 patients. In order to identify patients who are more likely to experience a severe illness and to better manage their treatment, it is imperative that oxygen saturation levels in COVID-19 patients be promptly identified and monitored.

Cardiorespiratory and circadian clock markers in intensive care unit patients.

Biological synchronized rhythmicity is a critical physiological process. The lack of synchronized rhythms, mainly those showing a circadian basis, like sleep, the heart rate (HR) and arterial blood pressure (BP), often leads to several organic challenges, usually associated with adverse outcomes. The aim of the study was to investigate whether the intensive care unit (ICU) environment favors clock genes and cardiorespiratory changes. A total of 22 critically ill patients (16 males; 72.73%) with a mean age of 60.82 ±20.07 years and well-established cardiovascular conditions were selected from ICU. Blood samples were obtained, and total RNA was isolated and reverse-transcribed into complementary DNA (cDNA). A quantitative polymerase chain reaction (qPCR) was performed to assess the target gene expression levels. The urinary concentration levels of melatonin (MEL) were assessed. The heart rate, BP (systolic - SBP, diastolic - DBP and mean - MBP) and the oxygen saturation (SpO2) levels were assessed as continuous variables. The urinary MEL and Brain and muscle Arnt-like protein-1 (BMAL1) levels were shown to have a non-linear relationship with HR (coefficient (coef): 2.318, p = 0.032; coef: 2.722, p = 0.006, respectively) and SBP (coef: 1.000, p = 0.008; coef: 2.000, p = 0.037, respectively), with an explanatory power of up to 50.3% and 39.7% of the HR and SBP variability, respectively. Melatonin, but not BMAL1, was also shown to have a non-linear relationship with MBP (coef: 1.000, p = 0.007), with an explanatory power of up to 31.3% regarding the MBP variability. The HR and SBP oscillatory dynamics was shown to be related to changes in the genetic expression of BMAL1 and the urinary MEL concentrations. To a lower degree, MEL also impacted the variation of MBP. Our results suggest that not only are circadian functional matrices crucial for the dynamics of vital parameters in critically ill patients, but also that routinely assessed cardiovascular parameters like HR and BP may constitute important markers for the circadian timing system function. These parameters are easy to assess and have a relevant prognostic value regarding recovery outcomes, as well as the morbidity and mortality rates in ICU.

Measurement of cerebral venous oxygenation with quantitative susceptibility mapping after subarachnoid hemorrhage: A pilot study.

We measured cerebral venous oxygenation after aneurysmal subarachnoid hemorrhage (aSAH) using quantitative susceptibility mapping (QSM) to explore its relationship with cognitive function. Twenty participants, including 10 patients with aSAH and 10 healthy volunteers as the control group, were included. Patients with aSAH were evaluated at 2days, 3weeks, and 6months after aSAH. Each participant underwent magnetic resonance imaging and completed the Montreal Cognitive Assessment (MoCA) at baseline, midpoint, and endpoint. QSM was used to determine the magnetic susceptibility of the cerebral veins. Furthermore, the relationship between MoCA and oxygen saturation in the cerebral veins was examined. The first scans of the cerebral veins and straight sinus susceptibility were considerably more significant in the aSAH group than in the healthy control group. At the 6-month follow-up, the mean oxygen saturation steadily increased in the aSAH group. Cerebral venous oxygen saturation was moderately correlated with MoCA (r = 0.5319, P = .0025). QSM can be used to measure changes in cerebral venous oxygenation levels in patients with aSAH. During the acute phase of aSAH, there is a reduction in the oxygen saturation in the cerebral veins, and the shift in oxygen saturation levels may correlate with cognitive outcomes in patients with aSAH.

Management and monitoring of anesthesia during the perioperative period in a Tertiary Hospital in Bangladesh

Background: Anesthesia management is crucial for ensuring patient safety and optimal surgical outcomes during the perioperative period. In Bangladesh, the challenges faced in managing and monitoring anesthesia in tertiary care hospitals necessitate a comprehensive evaluation of current practices. This study aims to assess the anesthetic management protocols and monitoring strategies employed in a tertiary hospital in Bangladesh. Methods: This observational study was conducted in Islami Bank Medical College Hospital, Rajshahi, Bangladesh from July to December 2023. Data were collected from patients undergoing various surgical procedures requiring anesthesia. The anesthetic techniques used, intraoperative monitoring parameters, and any complications encountered were recorded. The study included a review of anesthesia charts, patient records, and interviews with anesthesia providers. Statistical analysis was performed to identify trends and correlations. Results: A total of 200 patients were included in the study. The most commonly used anesthetic technique was general anesthesia (65%), followed by regional anesthesia (30%) and local anesthesia (5%). Intraoperative monitoring parameters included heart rate, blood pressure, oxygen saturation, and end-tidal carbon dioxide levels, which were consistently documented in 95% of cases. Complications occurred in 10% of patients, primarily involving respiratory issues and cardiovascular instability. Proper adherence to monitoring protocols significantly reduced the incidence of complications. Conclusion: Effective management and monitoring of anesthesia during the perioperative period are vital for patient safety in a tertiary hospital setting. The study highlights the importance of standardized protocols and continuous monitoring to minimize complications. Recommendations for improving anesthetic practices include regular training for anesthesia providers and enhancing monitoring infrastructure to ensure optimal patient care.

Spirometry Results in Children over Five Years Old with COVID-19 at Least Six Months after Discharge

Introduction: Since it is necessary to detect changes in lung function for the follow-up of the patients with respiratory and functional complications caused by COVID-19, in this study, we decided to examine the results of spirometry in children over 5 years old with Covid-19. Methods: In this cross-sectional study, 52 over-five-year-old children, hospitalized due to COVID-19 for at least six past months, were examined. The participants’ demographic information, respiratory symptoms, underlying diseases, severity of COVID-19 according to WHO, severity of lung involvement in CT scan, type of lung involvement, oxygen saturation at admission as well as FEV1, FVC, and FEV1/FVC were collected and analyzed, the results were analyzed using SPSS version 16 software and t-test and Chi-square tests. Results: Of all investigated patients،, 26 were boys (50%) and 38 (73.1%) were 5-12 years old. The minimum age of the children was 5 years and the maximum was 18 years. The mean age of children was 3.41±10 years. The FEV1/FVC ranged from 61% to 79% in five patients (9.6%) and from 80% to 100% in 47 patients (90.4%). The FEV1 was lower than 80% in 28 and higher than 80% in 24 patients. FEV1/FVC had no significant relationship with the participants’ age, gender, clinical manifestations, and disease severity in terms of pulmonary involvement, but it had a significant association with blood oxygen saturation level (P: 0.001). Conclusion: The changes in pulmonary function tests vary in different months following contamination with COVID-19. In the present study, 9% of the patients, who were examined in the sixth month after infection, had abnormal pulmonary function test results. Based on the findings, the pulmonary function test results had no significant relationship with the patients’ age, gender, and clinical symptoms, while it was significantly associated with their blood oxygen saturation intensity.

Significance of Initial Chest CT Severity Score (CTSS) and Patient Characteristics in Predicting Outcomes in Hospitalized COVID-19 Patients: A Single Center Study.

The aim of this study is to examine the prognostic role of initial chest computed tomography severity score index (CTSS) and its association with demographic, socio-epidemiological, and clinical parameters in COVID-19 hospitalized patients. A retrospective study included patients who were hospitalized in the COVID Hospital of the Clinical Hospital Center Kosovska Mitrovica from July 2020 to March 2022. We compared patient characteristics and outcome of their hospital stay with values of CT severity score (mild, moderate, and severe form of the disease). Patients with severe disease were statistically significantly older, they treated more days, and they presented statistically significant highest mortality rate compared to mild and moderate forms. Smokers and obese were significantly more frequent among patients with higher CT, while vaccinated patients were more common among those with a mild form. Biochemical parameters at admission also showed statistical significance between the examined groups. We can conclude that by employing the initial CT severity score as the strongest predictor of mortality, it is possible to predict the outcome in hospitalized patients. A comprehensive examination of the patient upon admission, including determining the extent of inflammatory changes in the lungs using computed tomography, the levels of oxygen saturation, and other laboratory parameters, can assist doctors in making an adequate clinical evaluation and apply appropriate therapeutic protocols in the treatment of COVID-19.

Tuberculous Pleurisy in a Patient with a History of Breast Cancer: Diagnostic Challenges and Management Options

Background: Tuberculosis (TB) and cancer are increasingly prevalent diseases that can be challenging to diagnose due to similarities in clinical and radiological findings. This case report describes a 46-year-old woman with a history of breast cancer who developed tuberculous pleurisy (TP). Case presentation: A 46-year-old woman who underwent mastectomy and chemotherapy for BC in 2023 had hypertension, but no history of TB. The patient presented with dry cough, fever, and stomach discomfort, with an oxygen saturation level of 60%, but no respiratory distress before their appointment. Microscopy and culture tests were negative for Mycobacterium TB, A positive result was observed with an IFN-γ level of 0.35 IU/ml and 26% of the negative control after TB antigen stimulation. Histological analysis using hematoxylin and eosin staining showed Langhans giant cells, epithelioid cell granulomas, caseous necrosis, and necrotic foci. These findings indicate granulomatous inflammation with no signs of malignancy. Following the diagnosis, the patient received a daily dose of 300 mg isoniazid, 600 mg rifampin, 1500 mg pyrazinamide, and 10 mg pyridoxine for six months without any adverse effects. Conclusion: Physicians must employ a combination of diagnostic techniques, including morphological and microbiological confirmation, to accurately diagnose pleural effusion in this patient population.

Nursing Interventions Related to the Need for Oxygenation in Severe COVID-19 Disease in Hospitalized Adults: A Retrospective Study.

To describe the nursing interventions related to the need for oxygenation in hospitalized adults with severe COVID-19 disease in the Intensive Care Unit. This was an observational, retrospective and descriptive study in a population of 2205 patients with a convenience sample of n = 430 and based on the North American Nursing Diagnosis Association (NANDA), the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). The analysis was performed with a non-parametric test to determine the association between the nursing interventions and the need for oxygenation. The findings are aimed at improving nursing interventions with statistical associations as follow: oxygen therapy (p < 0.000), airway suctioning (p < 0.000), airway management (p = 0.029), invasive mechanical ventilation (p < 0.000) and non-invasive mechanical ventilation (p = 0.022). NOC taxonomy expected outcomes in ventilation, 34% (146), alteration in gas exchange, 33.7% (145), and respiratory status, 558.9% (253), were severely compromised. The nursing interventions to maintain the respiratory status are focused on airway care and oxygen therapy in order to increase the oxygen saturation level and decrease the severity of the need for oxygenation.

The Effectiveness of Deep Breathing Exercise Therapy on Oxygen Saturation among Patients with Ischemic Stroke

Ischemic stroke is an abnormality of central nervous system function in which blood flow decreases significantly, causing hypoxia. This systemic hypoxemia should be avoided; therefore oxygen saturation is monitored in the acute phase. One of the interventions that can be done in order to increase oxygen supply is by deep breathing exercise. The purpose of this study was to determine the effectiveness of deep breathing exercise therapy to increase oxygen saturation on patients with ischemic stroke. This study is a quasi-experimental study with one group pre-posttest design that has been implemented in the neural room of RSUP Dr. M. Djamil Padang with a sample of 16 patients with ischemic stroke who have fulfilled the inclusion criteria. Data was collected directly by measuring oxygen saturation of patients with ischemic stroke before and after a deep breathing exercise intervention. The data were processed by computer and analyzed as univariate and bivariate. Normality test results show the data is not normally distributed so that the analysis used is non-parametric test by using Wilcoxon test. The results showed that deep breathing exercise therapy was effective in increasing oxygen saturation level of patients with ischemic stroke with p = 0,000 so it can be recommended that this therapy can be used as one of the nursing interventions on patients with ischemic stroke to increase the oxygen saturation level.