SpO2 Levels Research Articles

Increased Serum Thromboxane A2 and Prostacyclin but Lower Complement C3 and C4 Levels in COVID-19: Associations with Chest CT Scan Anomalies and Lowered Peripheral Oxygen Saturation

COVID-19 patients suffer from hypercoagulation and activated immune-inflammatory pathways. The current study examined the relationship between specific complements and coagulation abnormalities associated with chest CT scan anomalies (CCTAs) and peripheral oxygen saturation (SpO2) in COVID-19 patients. Serum levels of complement C3 and C4, and thromboxane A2 (TxA2) and prostacyclin (PGI2) were measured using an ELISA and albumin, calcium, and magnesium by using the spectrophotometric method in 60 COVID-19 patients and 30 controls. C3 and C4 were significantly decreased (p < 0.001), and TxA2 and PGI2 significantly increased (p < 0.001) in the COVID-19 patients compared with the controls with the highest levels in the CCTA patients’ group. Neural networks showed that a combination of C3, albumin, and TxA2 yielded a predictive accuracy of 100% in detecting COVID-19 patients. SpO2 was significantly decreased in the COVID-19 patients and was inversely associated with TxA2 and PGI2, and positively with C3, C4, albumin, and calcium. Patients with positive IgG results show significantly higher SpO2, TxA2, PGI2, and C4 levels than IgG-negative patients. CCTAs were accompanied by lower SpO2 and albumin and increased PGI2 and TxA2 levels, suggesting that interactions between immune-inflammatory pathways and platelet hyperactivity participate in the pathophysiology of COVID-19 and, consequently, may play a role in an enhanced risk of hypercoagulability and venous thromboembolism. These mechanisms are aggravated by lowered calcium and magnesium levels.

Effects of fetal haemoglobin on systemic oxygenation in preterm infants and the development of retinopathy of prematurity PacIFiHER Report No. 2

Background/aimsFetal haemoglobin (HbF) has an oxyhaemoglobin dissociation curve that may affect systemic oxygenation and the development of retinopathy of prematurity (ROP). The study aim is to characterise the effects of...

Spinal anesthesia during foot surgery

Purpose of the study. To improve the results of treatment of patients with diabetic foot syndrome by substantiating the optimal type of spinal anesthesia during foot surgery.
 Materials and methods. 70 patients undergoing treatment in the department of purulent surgery were examined. Patient groups: Group 1 – patients operated on under conditions of unilateral spinal anesthesia; Group 2 – patients operated on under traditional spinal anesthesia.
 Research methods. Assessment of the level and intensity of pain, concentration of catecholamines in urine in the first postoperative day, monitoring of blood pressure (BP), heart rate (HR), peripheral blood oxygen saturation (SpO2), Doppler scanning of peripheral blood flow in the foot, skin temperature integument of the foot during anesthesia and statistical.
 Results. In group 1, pain sensitivity during movement of the lower limb after anesthesia was 21% less pronounced than in group 2. In group 2, the heart rate decreased by 4,8% during anesthesia. The SpO2 level 20 minutes after the onset of anesthesia decreased in group 2 by 5,1% compared to group 1. The mean arterial pressure in group 2 decreased during anesthesia by 9,9%, in contrast to patients in group 1. After performing anesthesia, systolic blood pressure in the toe increased by 18,3%, and the temperature of the skin on the lateral surface of the leg increased by 3,7%. The concentration of adrenaline in the daily portion of urine in the next postoperative day in group 2 is 35,1% higher than in group 1.
 Conclusions. During anesthesia, the blood pressure, heart rate and SpO2 in group 1 did not change in comparison with the initial values (on the operating table before anesthesia). After anesthesia, an improvement in peripheral blood flow in the operated limb was noted. Unilateral spinal anesthesia, in comparison with traditional spinal anesthesia, has a positive effect on the stress response of the patient's body to surgery.

Early Detection of Symptom Exacerbation in Patients With SARS-CoV-2 Infection Using the Fitbit Charge 3 (DEXTERITY): Pilot Evaluation.

BackgroundSome patients with COVID-19 experienced sudden death due to rapid symptom deterioration. Thus, it is important to predict COVID-19 symptom exacerbation at an early stage prior to increasing severity in patients. Patients with COVID-19 could experience a unique “silent hypoxia” at an early stage of the infection when they are apparently asymptomatic, but with rather low SpO2 (oxygen saturation) levels. In order to continuously monitor SpO2 in daily life, a high-performance wearable device, such as the Apple Watch or Fitbit, has become commercially available to monitor several biometric data including steps, resting heart rate (RHR), physical activity, sleep quality, and estimated oxygen variation (EOV).ObjectiveThis study aimed to test whether EOV measured by the wearable device Fitbit can predict COVID-19 symptom exacerbation.MethodsWe recruited patients with COVID-19 from August to November 2020. Patients were asked to wear the Fitbit for 30 days, and biometric data including EOV and RHR were extracted. EOV is a relative physiological measure that reflects users’ SpO2 levels during sleep. We defined a high EOV signal as a patient’s oxygen level exhibiting a significant dip and recovery within the index period, and a high RHR signal as daily RHR exceeding 5 beats per day compared with the minimum RHR of each patient in the study period. We defined successful prediction as the appearance of those signals within 2 days before the onset of the primary outcome. The primary outcome was the composite of deaths of all causes, use of extracorporeal membrane oxygenation, use of mechanical ventilation, oxygenation, and exacerbation of COVID-19 symptoms, irrespective of readmission. We also assessed each outcome individually as secondary outcomes. We made weekly phone calls to discharged patients to check on their symptoms.ResultsWe enrolled 23 patients with COVID-19 diagnosed by a positive SARS-CoV-2 polymerase chain reaction test. The patients had a mean age of 50.9 (SD 20) years, and 70% (n=16) were female. Each patient wore the Fitbit for 30 days. COVID-19 symptom exacerbation occurred in 6 (26%) patients. We were successful in predicting exacerbation using EOV signals in 4 out of 5 cases (sensitivity=80%, specificity=90%), whereas the sensitivity and specificity of high RHR signals were 50% and 80%, respectively, both lower than those of high EOV signals. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in 1 patient via consistently high EOV signals.ConclusionsThis pilot study successfully detected early COVID-19 symptom exacerbation by measuring EOV, which may help to identify the early signs of COVID-19 exacerbation.Trial RegistrationUniversity Hospital Medical Information Network Clinical Trials Registry UMIN000041421; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047290

Laboratory evaluation of performance of pulse oximeters from six different manufacturers during motion artifacts produced by Fluke 2XL SpO2 simulator.

We performed laboratory evaluation of six pulse oximeters from different manufacturers using the Fluke 2XL SpO2 simulator. The pulse oximeter probes were labeled 1 through 6 and tested using the two pre-programed preset functions of the Fluke 2XL SpO2 simulator, level 01 and level 02, for their performance in the presence of motion artifacts. The pulse oximeters were also tested at low perfusion index (PI) settings. The accuracy of the individual probes was ranked as good, mediocre, or poor based on the degree of deviation of the measured SpO2 and pulse rate (PR) by the probes from that generated by the simulator in both the presence and absence of motion artifacts and at lower PI. In preset level 01, probes numbered 1, 2, and 6 performed flawlessly, probes numbered 3, 4, and 5 performed poorly. In preset level 02, all probes performed well in the absence of motion artifacts. When probes were attached in the absence of motion, but readings were recorded after the emergence of motion artifacts, probes 1, 2, and 6 continued to perform well. However, the performance of probes 3, 4, and 5 deteriorated. When probes were attached directly in the presence of motion artifacts, probes 2 and 6 performed well, whereas all other probes performed poorly. Successively lowering the PI degraded performance of probes 3, 4, and 5 at extremely low PI. It is observed that during motion and/or low PI conditions, multiple probes see deterioration in performance.

The effect of hemoperfusion on the outcome, clinical and laboratory findings of patients with severe COVID-19: a retrospective study

Hemoperfusion is a method of blood filtering to remove toxins and inflammatory factors. Cytokine storms and high levels of inflammatory factors play a role in the pathogenesis of coronavirus disease 2019 (COVID-19). The present study aims to evaluate the effect of hemoperfusion on the clinical and laboratory findings and outcomes of patients with severe COVID-19. Forty-eight patients with severe COVID-19 and a positive PCR test, who were admitted to the intensive care unit (ICU), participated in the study. All patients were treated by routine treatment protocol for COVID-19. Hemoperfusion was performed for 24 patients in addition to treatment with conventional antiviral therapies. The other 24 patients made up the control group. Demographic data, laboratory findings and patient outcomes before and after treatment were retrospectively collected and analysed. There was no significnt difference in mortality or length of hospital stays between the control group and the hemoperfusion group. The breathing rate (P-vaalue = 0.001) and heart beat rate (P-value = 0.028) of patients decreased after hemoperfusion. The hemoperfusion resulted in a significant increase in the SpO2 levels and a significant decrease in the CRP of patients compared to the conventional treatment (P-value = 0.009). Hemoperfusion can improve respiratory distress. It can reduce the CRP in patients with severe COVID-19 but has no effect on mortality.

Oxygen use and saturation targets in patients with COVID-19: Are we giving too much or aiming too low?

Oxygen use and saturation targets in patients with COVID-19: Are we giving too much or aiming too low?

Influence of the correctness of prosthetic equipment in a person with a motor organ dysfunction in relation to its mobility – pilot studies

Introduction: Movement organ dysfunctions generate a number of deficits in the physical, mental and social spheres, making it difficult to fulfill selected roles in social and professional life. The work focuses on the acquired motor organ dysfunction with a directly damaged motor apparatus as a result of an accident. The technical possibility of returning to professional activity of people after lower limb amputation was analyzed. Materials and methods: The research involved a test of the gait process in relation to the correctness of the gait cycle and the measurement of oxygen saturation in blood and pulse as indicators of the organism's involvement in the implementation of the locomotion process. Two people participated in the study. The first statistically represented a person (without amputation) aged 30-35. The second person represented a person after lower limb amputation at the level of the thigh equipped with an artificial lower limb prosthesis. Pilot tests were carried out in a laboratory using a sports treadmill on which locomotor activity was carried out in the form of walking at selected speeds. The load distribution in the foot as well as the heart rate and blood oxygen saturation with SpO2 were recorded. The study allowed to determine the correctness of gait during the implementation of the motion function of a person having a direct impact on their mobility. Results: The loads occurring in individual limbs for a healthy person showed a slight dispersion in relation to each other. The values of this dispersion did not exceed 4% for both mean and peak values. During the dynamic gait of the person wearing the prosthesis between the limbs, a 30% spread was recorded for the load. Observation of the participants' performance parameters were similar. In the process of realizing the longest gait cycle, the heart rate did not exceed 112 in a healthy person and 120 in a person with a motor organ dysfunction. An increase in the degree of blood oxygen saturation (saturation) was recorded in a healthy person at the SpO2 level of 1% and in a person with motor organ dysfunction at the SpO2 level of 3%. Conclusions: The conducted research has shown that a person with a motor organ dysfunction properly equipped with a prosthesis, according to his own level of activity, slightly increases the organism's involvement in the locomotion process. The results of the pilot studies showed that a correctly selected prosthesis together with a correctly re-learned gait can perform all the processes of locomotion at a similar energy expenditure as a healthy person. Properly selected prosthetic equipment for a person with a motor dysfunction means that the inconvenience of having an artificial lower limb does not significantly affect its mobility and the possibility of undertaking professional activity.

The effect of recruitment maneuver on the development of expansion defect and atelectasis after lobectomy: A double-blind randomized controlled trial

Background/Aim: In pulmonary lobectomy operations, the operation is performed with one-lung ventilation by collapsing the related lung. Postoperative expansion failure on the deflated side is a critical issue. We aimed to correct the expansion failure and atelectasis with the recruitment maneuver performed at the end of the operation. Methods: A total of 61 cases who underwent elective lobectomy under one-lung ventilation were included in this double-blind and prospective study. They were randomized into two groups comprising thirty and thirty-one cases. The first group included patients in whom the cycling recruitment maneuver (cRM) was performed, and the second group comprised patients who underwent the manual recruitment maneuver. Both groups were ventilated similarly during the one-lung ventilation period. After switching to double-lung ventilation, a standardized cycling recruitment maneuver was performed in the first group, and a high-volume manual recruitment maneuver with an anesthetic reservoir bag was used in the second group. Preoperative and postoperative inspiratory and hemodynamic parameters, wakefulness level, pain scores, developments of complications and durations of the hospitalization were noted. Expansion failure and atelectasis were evaluated both with chest radiography and thorax computerized tomography. Results: There was no statistically significant difference among the two groups in terms of age, smoking, duration of operation, preoperative forced expiratory volume in 1 second (FEV1), SpO2 levels, respiratory and hemodynamic parameters noted during the operation, invasive arterial pressure monitoring results, electrocardiogram (ECG) findings, modified Aldrete score (MAS), and visual analogue scores (VAS) (P>0.05 for all). The gender distribution and types of operations performed were also similar. No complications were observed. Expansion failure was seen in 23.3% and 48.8% (P=0.042) of the patients in the cRM and mRM groups, respectively. Additional procedures were needed in 4 patients (13.3%) in the cRM group and in 11 patients (35.5%) in the mRM group. The duration of hospital stay was significantly shorter in the cRM group (P=0.045). Regression analysis revealed a 3.08-times increase in the incidence of expansion failure in the mRM group compared to group cRM. Conclusion: In pulmonary lobectomy operations, we observed that with the utilization of the recruitment maneuver which is performed after switching to double-lung ventilation, the rate of expansion failure, the need for additional procedures and duration of hospital stay decreased.

Comparison of Different Wavelengths for Estimating HbA1c and SpO₂ Noninvasively Using Beer-Lambert Law and Photon Diffusion Theory Derived Models

Photoplethysmography (PPG) is a widely used method for detecting the blood volume changes in the limbs of human body using different wavelengths of light. Many physiological parameters are estimated through the use of the PPG signals in recent studies including glycated hemoglobin (HbA1c) and blood oxygenation (SpO2). However, the processes of estimating the physiological parameters are dependent on the wavelengths of light used to acquire the PPG signal. In this study, we compare wavelengths from 300nm to 1100nm for four models to estimate HbA1c and SpO2 levels with higher accuracy. These four models were constructed from Beer-Lambert and photon diffusion theories. From the analyses of 300nm to 1100nm, it is seen that the best sets of wavelengths are found to be {426nm, 721nm, 1100nm} and {426nm, 678nm, 1100nm} for two Beer-Lambert based models, respectively. On the other hand, for both of the photon diffusion-based models, the {426nm, 384nm, 1100nm} set is found to be the best performing wavelengths. Moreover, from the analysis of the six widely used wavelengths in different PPG systems, the {465nm, 525nm, 660nm} is found to be the best performing set of wavelengths that results in higher accuracy for HbA1c and SpO2 estimation using all four models.

Lung perfusion changes in COVID-19 pneumonia: a dual energy computerized tomography study.

Objective:There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings.Methods:Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student’s t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant.Results:Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1–19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlationConclusions:Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity.Advances in knowledge:Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.

The effect of resistant hypertension on in-hospital mortality in patients hospitalized with COVID-19.

Hypertension is a major concomitant disease in hospitalized patients with COVID-19 (Coronavirus disease 2019) infection. The adverse effect of hypertension on prognosis in COVID-19 is known. Nevertheless, it is not known how COVID-19 progresses in resistant hypertensive patients. In this study, we aimed to examine the effect of resistant hypertension (ResHT) on in-hospital mortality in patients hospitalized with COVID-19. In our single-center retrospective study, included 1897 COVID-19 patients. The patients were divided into three groups according to the non-hypertensive (n = 1211), regulated HT (RegHT) (n = 574), and ResHT (n = 112). These three groups were compared according to demographic features, clinical signs, laboratory findings, and follow-up times. The median age of the study population was 62 (50–72 IQR) and 1000 (52.7%) of patients were male. The total mortality of the study population was 18.7% (n = 356). Mortality rates were similar in the hypertensive patient group (27.5% for the RegHT and 32.1% for ResHT, p = 0.321). In a multivariable analysis, ResHT was independently associated with a significantly increased risk of in-hospital mortality of COVID-19, while no significant increased risk was observed with RegHT [respectively, Odds Ratio (OR) = 2.013, Confidence Interval (CI) 1.085–3.734, p = 0.026 and OR = 1.194, CI 0.795–1.794, p = 0.394]. Also, age, male gender, chronic renal failure, lymphocyte, procalcitonin, creatinine, and admission SpO2 levels were determined as independent predictors of in-hospital mortality. In our study, it was found that ResHT was an independent predictor of mortality in patients hospitalized with COVID-19; however, this situation was not found in RegHT.

B-PO05-020 REMODELING IMPROVES EXERCISE CAPACITY IN DOGS WITH AV BLOCK

Children with congenital complete atrioventricular block (AVB) do not often report exercise intolerance due to compensatory mechanisms. The effect of cardiac remodeling being absent and present after AV block on exercise capacity has not yet been reported. We studied the cardiorespiratory changes due to exercise at three different timepoints after inducing AV block in dogs. Mongrel dogs (n=8) were placed on a treadmill with a 10% incline in a custom-build closed chamber and performed a moderate exercise protocol (10 minutes at a speed of 6 km/h). Dogs ran at sinus rhythm (SR), at two days after AV block (AVB2d) lacking cardiac remodeling, and at three and six weeks of chronic AV block (CAVB) remodeling (CAVB3 and CAVB6, respectively). ECG tracings were recorded via electrodes on the back. Stroke volume and cardiac output were recorded via a thoracic electrical bioimpedance-based device (PhysioFlow®). pO2, pCO2, SpO2 and pH levels were determined from venous blood samples. O2 consumption (VO2) and CO2 production (VCO2) were measured within the chamber. All dogs completed the exercise protocol at SR, CAVB3 and CAVB6, but 5/8 dogs failed at AVB2d (average run duration: 7min23sec, SD: 2min38sec), due to ventricular tachycardia and/or staggering. Changes in heart rate, stroke volume and cardiac output upon exercise were not different between the timepoints after AV block. At AVB2d, pO2 was lower (3.3±1.1 vs. 5.2±0.7 kPa (SR), p<0.01), the SpO2 was decreased (31±16 vs. 67±7 % (SR), p<0.001), the pCO2 was higher (7.3±1.4 vs. 5.5±0.3 kPa (SR), p<0.01), and the pH was decreased (7.23±0.06 vs. 7.36±0.02 (SR), p<0.001) at 2min exercise. Similar values were found at 5min exercise e.g., for pCO2 (6.8±1.8 vs. 5.1±1.3 kPa (SR), p<0.05) and pH (7.22±0.08 vs. 7.37±0.03 (SR), p<0.001). Venous blood parameters were not different between SR, CAVB3 and CAVB6 at rest and during exercise. At the end of the run (at steady state), VO2 and VCO2 are lowest at AVB2d with a 10% and 5% decrease, respectively, compared to SR (p=0.05 and 0.33). Dogs without remodeling after AV block have a reduced exercise capacity, which seems to be reflected in changes in cardiorespiratory parameters. Remodeling after chronic AV block improves the exercise capacity in dogs.

End-tidal capnographic monitoring during flexible bronchoscopy under fentanyl and midazolam sedation.

Bronchoscopic examination including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well established for lung cancer diagnosis and staging. Sedation using fentanyl and midazolam is recommended during bronchoscopic examinations. Meanwhile, inadvertent oversedation is a clinical problem. The objective of this research was to estimate the frequency of apnea episodes by end-tidal capnography under fentanyl and midazolam sedation during bronchoscopy. Eighty-five patients were enrolled retrospectively between August 2017 and March 2018 at Okayama Medical Center. Apnea was defined as the cessation of airflow for more than 10 seconds. We reviewed medical records, including capnographic data, by cap-ONE YG-227T (NIHON KOHDEN, Tokyo, Japan) during flexible bronchoscopy under fentanyl and midazolam sedation. Patients received 49.4±20.6 µg of fentanyl [mean ± standard deviation (SD)] and 4.35±2.0 mg of midazolam (mean ± SD). The patients included 52 males and 33 females; the median age was 71 (range, 31-88) years were enrolled. Apnea episodes were recorded (median duration 18 seconds) in 85 patients (100%). Prolonged apnea episodes with more than 30 seconds occurred in 56 patients (65.8%). Furthermore, the median time was 32 (range, 5-102) seconds whose delay between the onset of an apnea episode and decline in the SpO2 level of ≥4% from baseline. End-tidal capnography, cap-ONE YG-227T was effective for detecting the occurrence of apnea in patients undergoing a bronchoscopic examination under fentanyl and midazolam sedation. Monitoring might be useful for preventing inadvertent oversedation.

PULSE OXIMETER USAGE IN PATIENT COVID-19 TREATMENT : AT A GLANCE

Background: The end of 2019, Wuhan experienced an insurgence of coronavirus within two months of this prolong pandemic. Patients with Covid-19 have chance in suffering a serious damage of respiratory system, which then lead to hypoxemia. The harmful of silent hypoxemia is that either the patients are remain untreated or they will not seek any treatment at all, though their blood oxygen levels (SpO2 levels) slowly decrease. Especially those who isolated at home. Pulse oximeter is a mini device that evaluate the level of arterial blood saturation. Purpose: This article gives a short review about the principle, application, advantage, and disadvantage of pulse oximetry in maintaining the Covid-19 patients with hypoxemia. Review: Two basic principles of pulse oximetry that are important: (a) to differentiate the oxyhemoglobin (HbO2 ) and deoxyhemoglobin (HHb), (b) to get the value of SpO2 from arterial compartment blood. How pulse oximeter detects SpO2 is based on the amount of red and IR light absorbed. Pulse oximeter can detect an abnormality of respiratory system in Covid-19 patients that may cannot be detected earlier. Pulse oximeter also helps diagnosing some severe pneumonia cases. It also can be realiable to diagnose an ARDS (Acute Respiratory Distress Syndroms) if the devices are found limited (WHO, 2020). Beside the advantages of pulse oximeter, there are some erroneous of readings. Conclusion: Pulse oximeter is a mini device which offers many advantages over its limitations. Limitation of pulse oximeter can be early detected and overcame with an introduction evaluation of clinical conditions of each patients.

Peripheral oxygen measurements in suspected elderly COVID-19 patients can be an effective tool for alerting physicians

Background: Since December 2019 the world has been facing a newly identified corona virus named SarsCov-2 which is the causative agent of COVID-19 that produces different symptoms. One of these symptoms is asymptomatic hypoxia, particularly in elderly patients. Despite the absence of signs of respiratory distress, many patients evolve to respiratory failure. The cause of this asymptomatic hypoxia remains unclear. Objective: Our goal was to evaluate the utility of peripheral oxygen measurements using oximetry in elderly patients with suspected COVID-19 and with no apparent signs of shortness of breath, during 10 consecutive days. Method: Every elderly patient with suspected COVID-19 who sought medical care at one of the 12 Primary Health Unit (PHU) in the South-West area of Campinas, Sao Paulo State was enrolled in the 10-days monitoring report. Each patient had the levels of oxygen saturation (SpO2) monitored by pulse ox meter from the fifth to the tenth days after the onset of symptoms and, when possible twice a day. Results: 1297 patients (pts) were followed during the period from August 2020 to February 2021. A total of 9023 measurements were carried out using a SpO2 pulse ox meter. 163 (12.5%) cases were referred to the Emergency Room and 37 (3%) had to be hospitalized. The highest frequencies of symptoms occurred during the 6th and 8th day and included cough (16.8%), fatigue (12.8%), headache (9.7%), loss of taste and/or smell (6.8%). Among the patients who were hospitalized, 13 died (1%). Conclusion: The asymptomatic hypoxia remains unclear; however, the measurement of SpO2 levels appears to be a cheap and effective tool to be used as an alert system or further evaluation.

Effect of N95 filtering facepiece respirators on dental health professionals with an emphasis on pulmonary function and heart rate: an intrasubject comparison

Despite the ubiquitous use of N95 filtering facepiece respirators (N95 FFR), published literature on the topic remains scarce, especially in relation to dental professionals. This study assesses the impact of N95 FFRs on blood oxygen saturation and heart rate of dental health professionals while performing procedures requiring varying degrees of physical exertion in an aerosol-rich environment. A total of 51 participants, consisting of 43 men and eight women aged between 23 and 31 years were recruited into the study. All subjects were well-versed in wearing personal protective equipment (PPE). A clinical grade pulse oximeter was used with a clamp placed around the fingertip or the earlobe of the participant. The selection of N95 FFR was based on fit and leakage. All data were collected once from the same participants using a surgical mask as a control. Data were collected again from the same subjects after 1, 2, and 3 hours of use. There were significant differences in both oxygen saturation (SpO2) and heart rate between the two groups after 1, 2, and 3 hours of wearing the respective masks. In healthy young individuals, wearing an N95 FFR for an extended period of time during clinical dental procedures reduced the SpO2level and increased the heart rate compared with a standard surgical mask. However, SpO2 levels remained within a healthy range of more than 95%, and heart rate was within acceptable limits.

N-TERMINAL PRO BRAIN NATRIURETIC PEPTIDE: A POTENTIAL PREDICTOR FOR INTENSIVE CARE ADMISSIONS IN PATIENTS WITH ACUTE EXACERBATION OF COPD.

BACKGROUND: Cardiovascular disease is one of the major causes of mortality and is frequently unrecognized in COPD patients. Serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) is an established risk factor in patients with Heart failure. However NT-pro BNP levels may also be elevated during acute exacerbation of COPD(AECOPD) even without heart failure. Objectives of the study are-(a)To nd the levels of Serum NT-pro BNP in AECOPD patients. (b) To nd out the association of Serum NT-pro BNP with clinical and physiological parameters in AECOPD patients. METHODS: This cross-sectional study was carried out on 60 AECOPD patients admitted in department of Respiratory Medicine, Institute of Respiratory Diseases, SMS Medical College, Jaipur during July 2019–June 2020. Clinical data including vitals, Electrocardiogram (ECG), arterial blood gas analysis (ABG), Serum NT-pro BNP levels were assessed. Previous ECG and spirometry details were also recorded. RESULTS: The mean levels of Serum NT-pro BNP were higher in very severe COPD patients. The association of Serum NT-pro BNP were signicantly higher with AECOPD patients having increased exacerbations per year, longer hospital stay duration, decreasing Spo2 levels and decreasing blood pH levels. CONCLUSION: Patients with AECOPD who had elevated Serum NT-pro BNP levels had higher likelihood of ICU admission and longer hospital stay. Thus elevated NT-pro BNP levels warrants the need of Intensive care for early and better management of COPD patients.

Predictive Modeling of Morbidity and Mortality in Patients Hospitalized With COVID-19 and its Clinical Implications: Algorithm Development and Interpretation.

BackgroundThe COVID-19 pandemic began in early 2021 and placed significant strains on health care systems worldwide. There remains a compelling need to analyze factors that are predictive for patients at elevated risk of morbidity and mortality.ObjectiveThe goal of this retrospective study of patients who tested positive with COVID-19 and were treated at NYU (New York University) Langone Health was to identify clinical markers predictive of disease severity in order to assist in clinical decision triage and to provide additional biological insights into disease progression.MethodsThe clinical activity of 3740 patients at NYU Langone Hospital was obtained between January and August 2020; patient data were deidentified. Models were trained on clinical data during different parts of their hospital stay to predict three clinical outcomes: deceased, ventilated, or admitted to the intensive care unit (ICU).ResultsThe XGBoost (eXtreme Gradient Boosting) model that was trained on clinical data from the final 24 hours excelled at predicting mortality (area under the curve [AUC]=0.92; specificity=86%; and sensitivity=85%). Respiration rate was the most important feature, followed by SpO2 (peripheral oxygen saturation) and being aged 75 years and over. Performance of this model to predict the deceased outcome extended 5 days prior, with AUC=0.81, specificity=70%, and sensitivity=75%. When only using clinical data from the first 24 hours, AUCs of 0.79, 0.80, and 0.77 were obtained for deceased, ventilated, or ICU-admitted outcomes, respectively. Although respiration rate and SpO2 levels offered the highest feature importance, other canonical markers, including diabetic history, age, and temperature, offered minimal gain. When lab values were incorporated, prediction of mortality benefited the most from blood urea nitrogen and lactate dehydrogenase (LDH). Features that were predictive of morbidity included LDH, calcium, glucose, and C-reactive protein.ConclusionsTogether, this work summarizes efforts to systematically examine the importance of a wide range of features across different endpoint outcomes and at different hospitalization time points.

Comparative Study of Hemodynamic Infusion of Dexmedetomidine With Alternative Sufentanil-Midazolam Injection for Sedation of Patients Undergoing Cataract Surgery

In order to induce sedation during cataract surgery, various medications with different side effects are used in separation or in combination. Dexmedetomidine has no effect on the respiratory system, but being dependent on dosage, it may cause cardiovascular disorders. The present study aims to compare the hemodynamic and sedative effects of dexmedetomidine and the combination of sufentanil-midazolam on patients undergoing cataract surgery. In a randomized clinical trial study, 60 patients were randomly divided into two dexmedetomidine and sufentanil-midazolam groups. In sufentanil-midazolam group, dexmedetomidine (DEX infusion at 0.5 μg/ kg for 10 minutes, then adjusted to 0.2 µg/kg/h) was prescribed. In the sufentanil-midazolam group, sufentanil (0.1 μg/kg for 5 minutes) and midazolam (0.2 µg/kg) were injected five minutes before the operation. Hemodynamic variables (Systolic blood pressure, diastolic blood pressure, heart rate), complications (nausea, vomiting, hypoxia), sedation level, and pain intensity were recorded (at the beginning of the study, 5, 10 minutes after anesthesia, at the start of surgery, 5, 10, 15 minutes after the surgery) as well as patient’s satisfaction, surgeon's satisfaction, and complications. Results suggest that apart from gender, other primary characteristics of patients, including age, history of blood pressure, diabetes history, ASA score, mean of systolic, diastolic blood pressure, heart rate, and SPO2 levels, were similar in both groups (P&gt;0.05). Systolic blood pressure patients receiving dexmedetomidine declined significantly more than that of patients receiving sufentanil-midazolam (P&gt;0.5). Diastolic blood pressure suddenly fell 5 minutes after the infusion of sufentanil-midazolam (P&gt;0.05), but then a relative increase and finally a relative decrease occurred, while diastolic blood pressure in patients receiving dexmedetomidine decreased steadily. The mean heart rate in patients receiving dexmedetomidine and sufentanil-midazolam declined gently (P&gt;0.05). SPO2 was reduced significantly in the sufentanil-midazolam group (P&lt;0.05). Drugs used in both groups reduced pain intensity equally (P&gt;0.05). From the beginning of the study, dexmedetomidine produced a relatively stable sedation level (score 2) based on Ramsay's criteria, while the combination of sufentanil-midazolam-medications causes deeper sedation (score 3) in patients (P&lt;0.05). Despite this fact, 23.33% of the patient receiving sufentanil-midazolam could have movements during the surgery, which was 6.66% higher in patients receiving dexmedetomidine (P=0.071). The satisfaction of patients receiving dexmedetomidine was significantly higher (P=0.044), while the surgeon's satisfaction was almost identical in both anesthesia procedures (P=0.94). In the end, the results of the present study showed that although dexmedetomidine is associated with few respiratory problems and higher satisfaction of patients, it decreases blood pressure and heart rate progressively. However, it seems that this medicine is more effective than a combination of midazolam-sufentanil because of more patient satisfaction, lack of hypoxia, fewer complications, and more suitable immobility.