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Background: The global effort to cure COVID-19 is still ongoing. Thus, a prospective, block-balanced, open-label, randomized controlled trial was conducted to evaluate how Tenofovir Alafenamide Fumarate affects hospitalized COVID-19 patients' outcomes. Methods: The intervention and control groups of 60 hospitalized COVID-19 patients were randomly allocated. Along with normal medication, the intervention group received 25 mg of tenofovir orally daily for seven days. The control group got normal therapy, including remdesivir and corticosteroids. ICU hospitalization duration, laboratory data, fever, dyspnea, arterial blood oxygen saturation with and without an oxygen face mask, mechanical ventilation, and mortality were the outcomes. Results: Sixty of 236 eligible patients between September 2020 and February 2021 were enrolled. The intervention group had a mean age (±SD) of 61.33 (±13.09) years and the control group 60.03 (±18.03). Sixteen (53.3%) intervention patients and 15 (50.0%) control patients were males. The intervention group had fewer mechanical ventilation and ICU days. Tenofovir Alafenamide Fumarate did not improve fever, dyspnea, oxygen saturation with or without a face mask or nasal cannula, or laboratory data including WBC, ESR, CRP, AST, ALT, AlkP, total and direct bilirubin, in COVID-19 patients. Conclusion: According to this pilot trial, Tenofovir Alafenamide Fumarate, along with conventional treatment, significantly reduced mechanical ventilation and ICU stay in COVID-19 patients. Further thorough research is necessary to verify this conclusion. [ABSTRACT FROM AUTHOR]

Blood clotting caused by COVID-19 has made this disease much more severe than other respiratory diseases. An alarming number of COVID-19 patients developed blood clots that trigger heart attack, stroke, and other disasters. Currently, blood thinner medicines are the only treatment. While blood thinners lower the blood's ability to clot, they cannot disassemble existing blood clots. Many patients were not helped by them. Here we report our finding: Strong magnetic field can disassemble blood clots safely and effectively. This is attributed to the magnetic property of red cells and their unique disk shape. Hence, we have proposed a new treatment for patients with thrombosis: applying a strong magnetic field along the patients' arm or leg. When the blood clots come to the magnetic field, they are disassembled safely; red cells recover their oxygen function; the blood viscosity along the flow direction is reduced, turbulence in blood circulation is suppressed, and the incidence of heart attack and stroke can be prevented. With thrombosis occurring in COVID-19 patients, the magnetic treatment will resolve this urgent issue and greatly help the patients to recover. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does targeting a Pao2 of 60 mm Hg vs 90 mm Hg affect the number of days alive without life support in intensive care unit patients with COVID-19 and severe hypoxemia? Findings: In this randomized trial including 726 patients, targeting a Pao2 of 60 mm Hg resulted in 80.0 days alive without support at 90 days compared with 72.0 days when targeting a Pao2 of 90 mm Hg. This difference was statistically significant. Meaning: A Pao2 target of 60 mm Hg vs 90 mm Hg resulted in more days alive without life support in intensive care unit patients with COVID-19 and severe hypoxemia. Importance: Supplemental oxygen is ubiquitously used in patients with COVID-19 and severe hypoxemia, but a lower dose may be beneficial. Objective: To assess the effects of targeting a Pao2 of 60 mm Hg vs 90 mm Hg in patients with COVID-19 and severe hypoxemia in the intensive care unit (ICU). Design, Setting, and Participants: Multicenter randomized clinical trial including 726 adults with COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 11 ICUs in Europe from August 2020 to March 2023. The trial was prematurely stopped prior to outcome assessment due to slow enrollment. End of 90-day follow-up was June 1, 2023. Interventions: Patients were randomized 1:1 to a Pao2 of 60 mm Hg (lower oxygenation group; n = 365) or 90 mm Hg (higher oxygenation group; n = 361) for up to 90 days in the ICU. Main Outcomes and Measures: The primary outcome was the number of days alive without life support (mechanical ventilation, circulatory support, or kidney replacement therapy) at 90 days. Secondary outcomes included mortality, proportion of patients with serious adverse events, and number of days alive and out of hospital, all at 90 days. Results: Of 726 randomized patients, primary outcome data were available for 697 (351 in the lower oxygenation group and 346 in the higher oxygenation group). Median age was 66 years, and 495 patients (68%) were male. At 90 days, the median number of days alive without life support was 80.0 days (IQR, 9.0-89.0 days) in the lower oxygenation group and 72.0 days (IQR, 2.0-88.0 days) in the higher oxygenation group (P =.009 by van Elteren test; supplemental bootstrapped adjusted mean difference, 5.8 days [95% CI, 0.2-11.5 days]; P =.04). Mortality at 90 days was 30.2% in the lower oxygenation group and 34.7% in the higher oxygenation group (risk ratio, 0.86 [98.6% CI, 0.66-1.13]; P =.18). There were no statistically significant differences in proportion of patients with serious adverse events or in number of days alive and out of hospital. Conclusion and Relevance: In adult ICU patients with COVID-19 and severe hypoxemia, targeting a Pao2 of 60 mm Hg resulted in more days alive without life support in 90 days than targeting a Pao2 of 90 mm Hg. Trial Registration: ClinicalTrials.gov Identifier: NCT04425031 This randomized clinical trial assesses the effect of targeting a lower vs higher oxygenation level on 90-day survival without need for life support among intensive care unit patients with COVID-19 and severe hypoxemia. [ABSTRACT FROM AUTHOR]

Background: The Handling Oxygenation Targets in the Intensive Care Unit (HOT‐ICU) trial was a multicentre, randomised, parallel‐group trial of a lower oxygenation target (arterial partial pressure of oxygen [PaO2] = 8 kPa) versus a higher oxygenation target (PaO2 = 12 kPa) in adult ICU patients with acute hypoxaemic respiratory failure; the Handling Oxygenation Targets in coronavirus disease 2019 (HOT‐COVID) tested the same oxygenation targets in patients with confirmed COVID‐19. In this study, we aim to evaluate the long‐term effects of these oxygenation targets on cognitive and pulmonary function. We hypothesise that a lower oxygenation target throughout the ICU stay may result in cognitive impairment, whereas a higher oxygenation target may result in impaired pulmonary function. Methods: This is the updated protocol and statistical analysis plan of two pre‐planned secondary outcomes, the long‐term cognitive function, and long‐term pulmonary function, in the HOT‐ICU and HOT‐COVID trials. Patients enrolled in both trials at selected Danish sites and surviving to 1 year after randomisation are eligible to participate. A Repeatable Battery for the Assessment of Neuropsychological Status score and a full‐body plethysmography, including diffusion capacity for carbon monoxide, will be obtained. The last patient is expected to be included in the spring of 2024. Conclusion: This study will provide important information on the long‐term effects of a lower versus a higher oxygenation target on long‐term cognitive and pulmonary functions in adult ICU patients with acute hypoxaemic respiratory failure. [ABSTRACT FROM AUTHOR]

Background: Prone positioning may improve oxygenation in acute hypoxemic respiratory failure and was widely adopted in COVID‐19 patients. However, the magnitude and timing of its peak oxygenation effect remain uncertain with the optimum dosage unknown. Therefore, we aimed to investigate the magnitude of the peak effect of prone positioning on the PaO2:FiO2 ratio during prone and secondly, the time to peak oxygenation. Methods: Multi‐centre, observational study of invasively ventilated adults with acute hypoxemic respiratory failure secondary to COVID‐19 treated with prone positioning. Baseline characteristics, prone positioning and patient outcome data were collected. All arterial blood gas (ABG) data during supine, prone and after return to supine position were analysed. The magnitude of peak PaO2:FiO2 ratio effect and time to peak PaO2:FIO2 ratio effect was measured. Results: We studied 220 patients (mean age 54 years) and 548 prone episodes. Prone positioning was applied for a mean (±SD) 3 (±2) times and 16 (±3) hours per episode. Pre‐proning PaO2:FIO2 ratio was 137 (±49) for all prone episodes. During the first episode. the mean PaO2:FIO2 ratio increased from 125 to a peak of 196 (p <.001). Peak effect was achieved during the first episode, after 9 (±5) hours in prone position and maintained until return to supine position. Conclusions: In ventilated adults with COVID‐19 acute hypoxemic respiratory failure, peak PaO2:FIO2 ratio effect occurred during the first prone positioning episode and after 9 h. Subsequent episodes also improved oxygenation but with diminished effect on PaO2:FIO2 ratio. This information can help guide the number and duration of prone positioning episodes. [ABSTRACT FROM AUTHOR]

Background: Information on the performance of oxygenation indices (OIs) and risk scores in patients requiring invasive mechanical ventilation (IMV) is limited. We determine the performance of the OIs and risk scores in hospitalized patients with COVID-19 to predict the requirement of IMV and death at 28 days after admission. Methods: A retrospective study of diagnostic tests in patients admitted to the emergency department, hospitalization, and intensive care unit diagnosed with COVID-19. The receiver operating characteristic curve (ROC-curve) were built with the OIs and risk scores to predict IMV and mortality. Results: A total of 1402 subjects entered the final analysis, of whom 19.5% (274/1402) received IMV and 23.0% (323/1402) died at 28 days. The ROC-curve of the delta PaO2/FiO2 ratio for the requirement of IMV and mortality at 28-day was 0.589 (95% CI: 0.546–0.632) and 0.567 (95% CI: 0.526–0.608), respectively. PaO2/FiO2 ≤ 300 shows a ROC curve of 0.669 (95% CI: 0.628–0.711) to predict IMV. PaO2/FiO2 ≤ 300 and 4 C mortality score in mortality at 28 days showed an ROC-curve of 0.624 (95% CI: 0.582–0.667) and 0.706 (95% CI: 0.669–0.742), respectively. Conclusion: PaO2/FiO2 ≤ 300, 4 C mortality score ≥ 8, SOFA score ≥ 4 y SaO2/FiO2 ≤ 300 were weak predictors of the IMV requirement from admission, and 4 C mortality score ≥ 8 was weak predictors of the mortality from admission in patients with pulmonary involvement by COVID-19. [ABSTRACT FROM AUTHOR]

Background: Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients. Methods: We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05. Results: Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value < 0.001). There was no difference in PaO2/FiO2 (MD = 3.591[− 40.881, 48.062]; P-value = 0.874) and SpO2 percent (MD = 1.641[− 4.441, 7.723]; P-value = 0.597). Conclusion: Prone positioning can be recommended in conscious ICU patients with COVID-19 pneumonia to reduce mortality and intubation. Systematic review registration: PROSPERO registration number: CRD42022326951. Registered 25 April 2022. [ABSTRACT FROM AUTHOR]

INTRODUCTION: COVID-19 is an inflammatory disease with variable symptoms. Critical cases with ARDS on invasive mechanical ventilation benefit from prone positioning. The aim of the review is to determine the effect of prone position in spontaneously breathing patients with COVID-19. METHODS: The PubMed database was used for article research using the following search string: (prone position) AND (COVID-19). After the evaluation of eligibility of the initial number of articles, 31 studies were used for the current review. RESULTS: The population of the patients, methods of oxygenation, inclusion and exclusion criteria for participating in each study, outcomes and results of the studies are examined and presented. CONCLUSIONS: The majority of evidence showed beneficial effect of prone positioning in hypoxemia in non-intubated spontaneously breathing patients with COVID-19, although the heterogeneity of study designs limits the safe conduct of conclusions, indicating the need for large scale randomized control studies to ensure the credibility of the results. [ABSTRACT FROM AUTHOR]

Background: Prone position is used in acute respiratory distress syndrome and in coronavirus disease 2019 (Covid-19) acute respiratory distress syndrome (ARDS). However, physiological mechanisms remain unclear. The aim of this study was to determine whether improved oxygenation was related to pulmonary shunt fraction (Q's/Q't), alveolar dead space (Vd/Vtalv) and ventilation/perfusion mismatch (V'A/Q'). Methods: This was an international, prospective, observational, multicenter, cohort study, including six intensive care units in Sweden and Poland and 71 mechanically ventilated adult patients. Results: Prone position increased PaO2:FiO2 after 30 min, by 78% (83–148 mm Hg). The effect persisted 120 min after return to supine (p < 0.001). The oxygenation index decreased 30 min after prone positioning by 43% (21–12 units). Q's/Q't decreased already after 30 min in the prone position by 17% (0.41–0.34). The effect persisted 120 min after return to supine (p < 0.005). Q's/Q't and PaO2:FiO2 were correlated both in prone (Beta -137) (p < 0.001) and in the supine position (Beta -270) (p < 0.001). V'A/Q' was unaffected and did not correlate to PaO2:FiO2 (p = 0.8). Vd/Vtalv increased at 120 min by 11% (0.55–0.61) (p < 0.05) and did not correlate to PaO2:FiO2 (p = 0.3). The ventilatory ratio increased after 30 min in the prone position by 58% (1.9–3.0) (p < 0.001). PaO2:FiO2 at baseline predicted PaO2:FiO2 at 30 min after proning (Beta 1.3) (p < 0.001). Conclusions: Improved oxygenation by prone positioning in COVID-19 ARDS patients was primarily associated with a decrease in pulmonary shunt fraction. Dead space remained high and the global V'A/Q' measure could not explain the differences in gas exchange. [ABSTRACT FROM AUTHOR]

Granulocyte-macrophage colony stimulating factor (GM-CSF) inhalation may alleviate pulmonary inflammation caused by viral pneumonia. To investigate this, we evaluated its efficacy on COVID-19 pneumonia. This double-blind, randomised, placebo-controlled study (ClinicalTrials.gov: NCT04642950) evaluated patients in the first half of 2021 at seven Japanese hospitals. Hospitalised patients with COVID-19 pneumonia with moderate hypoxaemia inhaled sargramostim or placebo for 5 days. The primary endpoint was days to achieve a ≥ 2-category improvement from baseline on a modified 7-category ordinal scale. Secondary endpoints included degree of oxygenation, defined by amount of oxygen supply, and serum CCL17 level. Seventy-five patients were randomly assigned in a 2:1 ratio to receive sargramostim or placebo, of which 47 and 23 were analysed, respectively. No difference was observed between groups regarding the primary endpoint (8.0 and 7.0 days for sargramostim and placebo, respectively) or in the secondary endpoints, except for CCL17. A post hoc sub-analysis indicated that endpoint assessments were influenced by concomitant corticosteroid therapy. When the cumulative corticosteroid dose was ≤500 mg during Days 1–5, recovery and oxygenation were faster in the sargramostim group than for placebo. Bolus dose corticosteroids were associated with temporarily impaired oxygenation and delayed clinical recovery. The increase in serum CCL17, a candidate prognostic factor, reflected improvement with sargramostim inhalation. The number of adverse events was similar between groups. Two serious adverse events were observed in the sargramostim group without causal relation. Inhaled sargramostim was likely to be effective for COVID-19 pneumonia unless the concomitant corticosteroid dose was high. [ABSTRACT FROM AUTHOR]

Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 – 0.958, p = 0.000; OR 0.987; 95%CI: 0.885–0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself. [ABSTRACT FROM AUTHOR]

Aims and Methods: We evaluated an ultrasound score from 0 to 32 points in eight pulmonary regions to monitor critically ill COVID-19 patients. The score was correlated to surrogate parameters of disease severity, i.e., the oxygenation index, respiratory support, mortality, plasma interleukin-6, and WHO and ARDS classifications. Results: A total of 27 patients were repeatedly examined, and 71 examinations were evaluated. Patients with severe COVID-19 scored higher (median 17) than those with moderate disease (median 11, p < 0.01). The score did not differentiate between stages of ARDS as defined by the Berlin criteria (p = 0.1) but could discern ARDS according to the revised ESICM definition (p = 0.002). Non-survivors had higher ultrasound scores than survivors (median 18.5 vs. 14, p = 0.04). The score correlated to the oxygenation index (ρ = −0.56, p = 0.03), and changes in the score between examinations correlated to changes in oxygenation (ρ = −0.41, p = 0.16). The correlation between the score and interleukin-6 was ρ = 0.35 (p < 0.001). The interrater reliability for the score was ICC = 0.87 (p < 0.001). Conclusions: The ultrasound score is a reliable tool that might help monitor disease severity and may help stratify the risk of mortality. [ABSTRACT FROM AUTHOR]

Several recently published randomized controlled trials have evaluated various noninvasive oxygenation strategies for the treatment of acute hypoxemic respiratory failure. Which available noninvasive oxygen strategies are effective for acute hypoxic respiratory failure? A systematic review of Medline, Embase, Cochrane CENTRAL, CINAHL, Web of Science, MedRxiv, and Research Square was conducted from inception to October 1, 2022. A random effects frequentist network meta-analysis was performed, and the results are presented using absolute risk difference per 1,000 patients. The Grading of Recommendations, Assessment, Development and Evaluation framework was used to rate the certainty of the evidence. Mortality, invasive mechanical ventilation, duration of hospitalization and ICU stay, ventilator-free days, and level of comfort are reported. Thirty-six trials (7,046 patients) were included. It was found that helmet CPAP probably reduces mortality compared with standard oxygen therapy (SOT) (231 fewer deaths per 1,000; 95% CI, 126-273 fewer) (moderate certainty). A high-flow nasal cannula (HFNC) probably reduces the need for invasive mechanical ventilation (103.5 fewer events per 1,000; 95% CI, 40.5-157.5 fewer) (moderate certainty). All noninvasive oxygenation strategies may reduce the duration of hospitalization as compared with SOT (low certainty). Helmet bilevel ventilation (4.84 days fewer; 95% CI, 2.33-7.36 days fewer) and helmet CPAP (1.74 days fewer; 95% CI, 4.49 fewer-1.01 more) may reduce the duration of ICU stay as compared with SOT (both low certainty). SOT may be more comfortable than face mask noninvasive ventilation and no different in comfort compared with an HFNC (both low certainty). A helmet interface for noninvasive ventilation probably reduces mortality and the risk of mechanical ventilation, as well as the duration of hospital and ICU stay. An HFNC probably reduces the risk of invasive mechanical ventilation and may be as comfortable as SOT. Further research is necessary to understand the role of these interfaces in acute hypoxemic respiratory failure. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Yoga is known to promote health and wellness in all. Pranava Pranayama is a useful sound based yogic breathing technique with reported benefits such as potentiating vagal tone. Subjects and Methods: This single blinded randomized self-controlled cross-over study was done with 58 participants. The immediate effect of Pranava Pranayama on saturation of oxygen in the blood (SpO2) and heart rate (HR) was determined before and after intervention using pulse oximeter. To avoid extraneous influences due to recording on different days, one half of the subjects were randomized to perform quiet sitting on day 1 while other half did Pranava Pranayama which was then reversed on day 2. Results: Intra group comparison showed significant changes (p < 0.001) in both SpO2 and HR following Pranava Pranayama whereas in the quiet sitting group, there was an insignificant fall in the SpO2 readings but HR was found significant (p < 0.001). Intergroup comparison showed significant differences between groups (p-0.032). Discussion: Cardiovascular changes following Pranava Pranayama may be as a result of audible chanting improving baroreflex sensitivity along with increased endogenous nitric oxide production. This promotes vasodilatation resulting in reduction of BP. The decrease in vascular resistance and an increase in capillary perfusion results in increased oxygen saturation with lesser demand on the heart. Conclusion: This study provides evidence that Pranava Pranayama is an effective technique in enhancing SpO2 and our findings may have therapeutic applications especially in the current pandemic situation. [ABSTRACT FROM AUTHOR]

The mortality of COVID-19 patients has left the world devastated. Many scoring systems have been developed to predict the mortality of COVID-19 patients, but several scoring components cannot be carried out in limited health facilities. Herein, the authors attempted to create a new and easy scoring system involving mean arterial pressure (MAP), PF Ratio, or SF ratio-respiration rate (SF Ratio-R), and lymphocyte absolute, which were abbreviated as MPL or MSLR functioning, as a predictive scoring system for mortality within 30 days for COVID-19 patients. Of 132 patients with COVID-19 hospitalized between March and November 2021, we followed up on 96 patients. We present bivariate and multivariate analyses as well as the area under the curve (AUC) and Kaplan–Meier charts. From 96 patients, we obtained an MPL score of 3 points: MAP < 75 mmHg, PF Ratio < 200, and lymphocyte absolute < 1500/µL, whereas the MSLR score was 6 points: MAP < 75 mmHg, SF Ratio < 200, lymphocyte absolute < 1500/µL, and respiration rate 24/min. The MPL cut-off point is 2, while the MSLR is 4. MPL and MSLR have the same sensitivity (79.1%) and specificity (75.5%). The AUC value of MPL vs. MSLR was 0.802 vs. 0.807. The MPL ≥ 2 and MSLR ≥ 4 revealed similar predictions for survival within 30 days (p < 0.05). Conclusion: MPL and MSLR scores are potential predictors of mortality in COVID-19 patients within 30 days in a resource-limited country. [ABSTRACT FROM AUTHOR]

High-flow nasal cannula oxygen therapy (HFNC) is recommended for patients with COVID-19. However, the increasing use of HFNC brings a risk of delayed intubation. The optimal timing of switching from HFNC to invasive mechanical ventilation (IMV) remains unclear. An effective predictor is needed to assist in deciding on the timing of intubation. Respiratory rate and oxygenation (ROX) index, defined as (SpO 2 /FiO 2) / respiratory rate, has already shown good diagnostic accuracy. Modified ROX (mROX) index, defined as (PaO 2 /FiO 2) / respiratory rate, might be better than the ROX index in predicting HFNC failure. The aim was to evaluate the predictive value of mROX for HFNC failure in patients with COVID-19. Severe or critical patients with COVID-19 treated with HFNC were enrolled in two clinical centers. Laboratory indicators, respiratory parameters, and mROX index at 0 h and 2 h after initial HFNC were collected. Based on the need for IMV after HFNC initiation, the patients were divided into an HFNC failure group and an HFNC success group. The predictive value of mROX index for IMV was evaluated by the area under the receiver operating characteristic curve (AUROC) and logistic regression analysis. We performed Kaplan–Meier survival analysis using the log-rank test. Sixty patients with COVID-19 (mean ± SD age, 62.8 ± 14.1 years; 42 patients were male) receiving HFNC were evaluated, including 18 critical and 42 severe cases. A total of 33 patients had hypertension; 14 had diabetes; 17 had chronic cardiac disease; 11 had chronic lung disease; 13 had chronic kidney disease; and 17 had a history of stroke. The AUROC of mROX index at 2 h was superior to that of other respiratory parameters to predict the need for IMV (0.959; p < 0.001). At the mROX index cutoff point of 4.45, predicting HFNC failure reached the optimal threshold, with specificity of 94% and sensitivity of 92%. Logistic regression analysis showed that 2-h mROX index < 4.45 was a protective factor for IMV (odd radio 0.18; 95% CI 0.05–0.64; p = 0.008). In the HFNC failure group, the median time from HFNC to IMV was 22.5 h. The 28-day mortality of the late intubation patients (≥ 22.5 h) was higher than that of the early intubation patients (< 22.5 h) (53.8% vs. 8.3%; p = 0.023). mROX at 2 h is a good early warning index of the need for IMV in patients with COVID-19 after HFNC initiation. Early intubation may lead to better survival in patients with 2-h mROX index < 4.45. [ABSTRACT FROM AUTHOR]

Delirium (DEL) and depression (DEP) may impair the course and severity of acute respiratory illness. The impact of such syndromes on respiratory and outcome parameters in inpatients with COVID-19 needs clarification. To clarify the relationship between DEL and DEP and respiratory outcome measures, we enrolled 100 inpatients from COVID-19 units of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome. Participants were divided into those with DEL, DEP, or absence of either delirium or depression (CONT). Delirium severity was assessed with the Neelson and Champagne Confusion Scale (NEECHAM). Psychopathology was assessed with the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), and the Brief Psychiatric Rating Scale (BPRS). Dependent variables include: (a) respiratory parameters, i.e., partial pressure of oxygen in arterial blood (PaO2), oxygen saturation (SpO2), ratio between arterial partial pressure of oxygen (PaO2), and fraction of inspired oxygen (PaO2/FiO2); (b) outcome parameters, i.e., duration of hospitalization and number of pharmacological treatments used during the hospitalization. We investigated between-group differences and the relationships between severity of delirium/depression and the dependent variables. Duration of hospitalization was longer for DEL than for either DEP or CONT and for DEP compared to CONT. NEECHAM and HAM-D scores predicted lower PaO2 and PaO2/FiO2 levels in the DEL and DEP groups, respectively. In DEP, BPRS scores positively correlated with duration of hospitalization. Delirium impacted the course of COVID-19 more severely than depression. The mechanisms by which delirium and depression worsen respiratory parameters differ. [ABSTRACT FROM AUTHOR]

The COVID-19 omicron variant has a low affinity for the lower respiratory tract. However, upper respiratory tract symptoms, such as nasal discharge and sore throat, characterize the infection with this variant. Therefore, in laryngeal stenosis, disease severity assessment through blood oxygen saturation has not been useful. We report the case of "omicron laryngitis" in a 59-year-old male who visited the ear, nose, and throat (ENT) clinic with complaints of a sore throat and difficulty in swallowing saliva that persisted for a day. Laryngoscopy revealed severe swelling of the transglottic region and exudates on the larynx. He was then diagnosed with COVID-19 and subjected to emergency tracheostomy for airway management. Until the emergence of the omicron variant, COVID-19 showed mainly lower airway and mild upper airway inflammatory features. However, upper airway stenosis should be suspected in cases presenting with "muffled speech," "dysphagia," "severe pain on swallowing," and "inspiratory dyspnea or stridor." Therefore, laryngeal and pharyngeal evaluation using a flexible laryngoscope under appropriate infection control measures is necessary, considering the possibility of progression to fatal laryngeal stenosis, as noted in this case. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to detect the therapeutic effects of galbanum oil plus dry cupping (a Persian medicinebased method) in hospitalized patients with coronavirus disease-2019 (COVID-19). Materials and Methods: In this randomized controlled trial, 60 hospitalized COVID-19 patients with positive polymerase chain reaction test (PCR), pulmonary involvement and blood oxygen saturation (SpO2) ≤93 mmHg, were randomly assigned into two groups to take the standard therapeutic regimen alone or alongside cupping and topical galbanum oil (Ferula gommosa oleo-gum resin) for 3-5 days. The SpO2 level, the severity of signs and symptoms of patients and laboratory parameters were compared between the two groups. Results: Fifty-eight patients were analyzed. The SpO2 level changed from 89.27±3.82 to 90.29±3.09 mmHg (p=0.038) in control group, while it increased from 88.74±3.45 to 94.23±2.1 mmHg (<0.001) in galbanum group with a significant difference between the groups (p<0.001). Fever, cough, dyspnea, and anorexia alleviated in the galbanum group more than the control (p=0.003, 0.001, 0.01, and 0.04, respectively). No adverse effects were reported due to galbanum oil and cupping therapy. Conclusion: Dry cupping with galbanum oil alongside the routine therapeutic regimen could be more effective than the routine therapeutic regimen alone for improving SpO2 level and alleviating fever, cough, and dyspnea in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background & Objective: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of tachypnea, hypoxemia, and loss of lung compliance. Clinicians have employed various means to improve oxygenation in these patients. We evaluated the effect of self-proning with a high-flow nasal cannula in patients with ARDS on oxygenation and the incidence of intubation. Methodology: Ninety patients, aged above 18 y old, patients with BMI below 30 kg/m², from both genders, suffering from COVID-19 and mild ARDS, participated in this prospective, randomized, double-blind clinical trial at Ain Shams University hospitals. Participants were allocated into two equal groups; Group 1: Patients were subjected to HFNC with a target SpO2 ≥ 90% with FiO2 < 0.6. Group 2: Patients were subjected to HFNC with a target of SpO2 > 90% with FiO2 ≤ 0.6, and combined with self proning. Upon ICU admission, age, weight, BMI, sex, baseline PcO2/FiO2 (P/F) ratio, baseline SpO2 and baseline heart rate were noted. During ICU stay, hemodynamic data and respiratory rate, ABG's were recorded on admission and every six hours after therapy 6, 12, 24, 48, and 96 h till the patient was discharged from ICU. CXR was obtained on admission and at 24 h, and assessed by Berlin criteria. Assuming a rate of intubation of 50% in the group without prone position setting power at 80% and alpha error at 0.05, a sample size of 45 patients per group was needed. Results: HFNC with proning was effective in improving oxygenation of the mild ARDS patients and decreasing the incidence of intubation; 11 patients in Group 1 and 4 in Group 2 needed to be intubated. Regarding mortality 35 patients survived in Group 1 compared to 42 in Group 2. The median ICU stay was significantly shorter in Group II, 12 (10-12) days compared to Group I, 19 (18-21); P = 0.000. Conclusion: The use of high-flow nasal cannula and proning reduced the frequency of intubation in mild ARDS patients in ICU, and also decreased the ICU stay and improved the outcome of patients with mild ARDS. Abbreviations: ARDS: Acute Respiratory Distress Syndrome; ICU: Intensive Care Unit; HFNC: High-Flow Nasal Cannula; NIV: Non-Invasive Ventilation [ABSTRACT FROM AUTHOR]

Key Clinical Message: The differential diagnosis of post‐COVID‐19 syndrome is important in patients with symptoms of biliary obstruction. This patient had severe COVID‐19 who underwent ERCP and mimicked cholangiocarcinoma. Patients with severe coronavirus disease 2019 (COVID‐19) manifest liver injuries with pathological changes because of lowered blood oxygen saturation, cardiac malfunction, hepatotoxic drugs during treatment, and cellular injury. This paper reports a patient with a history of severe COVID‐19 who mimics cholangiocarcinoma after undergoing endoscopic retrograde cholangiopancreatography (ERCP). It was shown that differential diagnosis of post‐COVID‐19 syndrome is greatly important mostly in patients with symptoms of biliary obstruction. [ABSTRACT FROM AUTHOR]

Background: The SARS‐CoV‐2 virus has impacted life in many ways, one change being the use of face masks. Their effect on MRI‐based measurements of cerebral oxygen levels with quantitative susceptibility mapping (QSM) and cerebral blood flow (CBF) is not known. Purpose: This study investigated whether wearing a face mask leads to changes in CBF and cerebral venous oxygen saturation measured with MRI. Study Type: Repeated‐measures cohort study. Population: A total of 16 healthy volunteers (eight male, eight female; 22–36 years) were recruited for the 3‐ply study. Ten of the 16 participants (five male, five female; 23–36 years) took part in the KN95 study. Field Strength/Sequence: A 3 T, single‐delay 3D gradient‐and spin‐echo pseudo‐continuous arterial spin labeling (pCASL) scan for CBF quantification, and gradient‐echo for QSM and oxygenation quantification. Assessment: Gray matter CBF and magnetic susceptibility were assessed by masking the pCASL CBF map and the QSM map to the T1‐weighted gray matter tissue segmentation. Venous oxygenation was determined from venous segmentation of QSM maximum intensity projections. Statistical Tests: Paired Student's t‐tests and Cohen's d effect sizes were used to compare the face mask and no face mask scans for gray matter CBF, gray matter magnetic susceptibility, and cerebral venous oxygen saturation. Standard t‐tests were used to assess whether the order of scanning with and without a mask had any impact. A statistical cut off of P < 0.05 was used. Results: The 3‐ply masks increased gray matter CBF from an average of 43.99 mL/(100 g*min) to 46.81 mL/(100 g*min). There were no significant changes in gray matter magnetic susceptibility (P = 0.07), or cerebral venous oxygen saturation (P = 0.36) for the 3‐ply data set. The KN95 masks data set showed no statistically significant changes in gray matter CBF (P = 0.52) and magnetic susceptibility (P = 0.97), or cerebral venous oxygen saturation (P = 0.93). Data Conclusion: The changes in blood flow and oxygenation due to face masks are small. Only CBF increased significantly due to wearing a 3‐ply mask. Evidence Level: 2 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Novel cloth face masks to mitigate the spread of COVID-19 have been developed and tested for particle (0.1 μm in size) filtration efficiency, bacterial filtration efficiency, breathability, leakage, heart rate, and blood oxygen level, and then compared with the available N95 masks and surgical masks. It was found that this novel mask had better filtration efficiency than that of surgical masks and was very close to that of N95 masks. The breathability was also improved and was in the range of the designated levels for barrier face coverings. The flow visualization technique was utilized to study the leakage of the mask and it was found to have significantly lower leakage as compared to surgical masks. Heart rate and blood oxygen level tests were performed by wearing the mask during 10-minute walking sessions and it was found that wearing the mask did not adversely affect heart rate or blood oxygen levels or add any other strain on the wearer. It is believed that this novel face mask would reduce the spread of COVID-19 as well as provide an environmentally and economically conscious alternative to the N95 respirators for the public. The mask developed in this study can be washed, reused, and therefore worn for longer periods of time. [ABSTRACT FROM AUTHOR]

The health effects of playing golf on the athlete's body is an interesting topic. The effect of golf on increasing blood saturation has low presence in the literature. This paper demonstrates the correlation of playing golf on improving health status after COVID-19 while this positive information has a potential to be used by the marketing management of various organisations to improve economics of golf activities. We analyse the change in saturation and heart rate after playing an 18-hole course, measured by pulse oximetry (% SpO2). Then we investigate the different aspects that have the greatest health benefit in golf. By following the effect of playing golf on blood oxygen saturation and heart rate in athletes we build a linear regression model explaining the impact 14 factors have on blood oxygen saturation. An 18-hole golf course caused a 1 ± 1.49% (p<0.001) increase in venous blood O2 concentration and a 6 ± 8.09% (p<0.001) increase in resting heart rate. Golf has the positive effect on the health status of athletes after recovery or vaccination for COVID-19 disease. [ABSTRACT FROM AUTHOR]

Objective: In the follow-up of Coronavirus disease 2019 (COVID-19), the predictors of prognosis and mortality are important for early initiation of treatments to reduce the severity of disease and for preventing death. There are many biochemical parameters used as early mortality markers in COVID-19 patients. However, there is not a sufficient number of studies on the predictive role of oxygen markers. Methods: Prospectively designed study which was approved by the local ethics committee (2021/514/200/33) included 122 patients with COVID-19-associated acute respiratory distress syndrome (CARDS). The patients were divided into two groups discharged (Group-D) and deceased (Group-E). Demographic data och oxygenation and biochemical values of the patients, length of stay in intensive care unit (ICU), intubation duration, the status of discharge and mortality were recorded for each patient. Results: There was no significant difference between the two groups in terms of the values of Oxygen saturation, partial pressure of oxygen, and arterial oxygen content first measured at the ICU. On the other hand, a significant difference was observed between the two groups in the parameters of oxygenation index (OI), oxygenation saturation index (OSI), P/F, S/F, ScvO2, and the APACHE II and SOFA scores, the number of intubated days, and lactate, ferritin, and IL-6 (p<0.05). ROC curve and logistic regression analyses were performed for these variables and cut-off points were calculated. The OI (>7, AUC: 0.798, p=0.001) and OSI (>4.5, AUC: 0.805, p=0.001) indicators were determined to be the strongest independent variables for mortality. It was observed that mortality increased 23 times when OI ≥7, and 40 times when OSI ≥4.5. Conclusion: OI and OSI were found to be significant independent variables in predicting mortality in ICU admissions with the diagnosis of CARDS. In addition, in our study, it was determined that among these noninvasively studied parameters, the S/F ratio was as valuable as P/F and OI was as a strong predictor as OSI. [ABSTRACT FROM AUTHOR]

Platypnea-orthodeoxia syndrome (POS) is a rare disorder associated with coronavirus disease 2019 (COVID-19) pneumonia. However, POS may be underdiagnosed. We report the case of a 59-year-old female patient with POS complicated by pulmonary embolism in COVID-19. Imaging revealed ground-glass opacities predominantly in the lower lobes and a pulmonary embolus in the right upper lobe. She was diagnosed with POS due to marked postural discrepancies between supine and upright oxygen saturations and blood oxygenation. Intracardiac shunt, one of the etiologies of POS, was not detected by bubble contrast echocardiography, and postural de-saturation gradually improved with methylprednisolone and edoxaban administration. In our literature review, only 3 of the 16 patients with POS associated with COVID-19 had cardiac shunting, suggesting that moderate to severe COVID-19 causes POS without cardiac shunts. COVID-19-associated vasculopathy and lower lung lesion predominance in COVID-19 pneumonia may cause ventilation-perfusion mismatch due to gravitational shunting of blood into the poorly ventilated lower lungs in the upright position, which may ultimately cause POS. Hypoxemia impedes rehabilitation, whereas early initiation of supine positioning in bed, with knowledge of the pathophysiology of POS, may have a positive effect. [ABSTRACT FROM AUTHOR]

Background/Aim: We investigated the association of noninvasive oxygenation support [high flow nasal cannula (HFNC) and BiPAP], timing of invasive mechanical ventilation (IMV), and inpatient mortality among patients hospitalized with COVID-19. Methods: Retrospective chart review study of patients hospitalized with COVID-19 (ICD-10 code U07.1) and received IMV from March 2020-October 2021. Charlson comorbidity index (CCI) was calculated; Obesity defined as body mass index (BMI) ≥ 30 kg/m2; morbid obesity was BMI ≥ 40 kg/m2. Clinical parameters/vital signs recorded at time of admission. Results: 709 COVID-19 patients underwent IMV, predominantly admitted from March-May 2020 (45%), average age 62±15 years, 67% male, 37% Hispanic, and 9% from group living settings. 44% had obesity, 11% had morbid obesity, 55% had type II diabetes, 75% had hypertension, and average CCI was 3.65 (SD = 3.11). Crude mortality rate was 56%. Close linear association of age with inpatient-mortality risk was found [OR (95% CI) = 1.35 (1.27–1.44) per 5 years, p<0.0001)]. Patients who died after IMV received noninvasive oxygenation support significantly longer: 5.3 (8.0) vs. 2.7 (SD 4.6) days; longer use was also independently associated with a higher risk of inpatient-mortality: OR = 3.1 (1.8–5.4) for 3–7 days, 7.2 (3.8–13.7) for ≥8 days (reference: 1–2 days) (p<0.0001). The association magnitude varied between age groups: 3–7 days duration (ref: 1–2 days), OR = 4.8 (1.9–12.1) in ≥65 years old vs. 2.1 (1.0–4.6) in <65 years old. Higher mortality risk was associated with higher CCI in patients ≥65 (P = 0.0082); among younger patients, obesity (OR = 1.8 (1.0–3.2) or morbid obesity (OR = 2.8;1.4–5.9) (p<0.05) were associated. No mortality association was found for sex or race. Conclusion: Time spent on noninvasive oxygenation support [as defined by high flow nasal cannula (HFNC) and BiPAP] prior to IMV increased mortality risk. Research for the generalizability of our findings to other respiratory failure patient populations is needed. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) started in December 2019 in Wuhan, China. No specific drug has been accepted for COVID-19 treatment up to now. Favipiravir as an antiviral drug affects RNA viruses like influenza and Ebola. Accordingly, the aim of this study is the evaluation of favipiravir's effect on COVID-19 outcomes. Method: This is a randomized controlled study including 97 patients with COVID-19 randomly allocated into favipiravir or control groups. The primary outcomes were improvement of clinical manifestations and atrial oxygen saturation (SpO2), and the secondary outcome was the length of hospitalization. Results: Clinical manifestations recovery of COVID-19 patients was better in the favipiravir group, and the mortality rates were less than in the control group (P = 0.0001 for both). The level of blood oxygen saturation (SpO2) was significantly higher in the favipiravir group (P = 0.0001). The mean lymphocyte count was lower in the control group (P = 0.004). In addition, levels of blood urine nitrogen (BUN) were higher in the favipiravir group (P = 0.033). The length of hospitalization was similar in both groups (P = 0.586). Conclusion: Favipiravir can be effective for clinical and laboratory improvement of COVID-19 patients, and it is a promising drug for decreasing of mortality rate in these patients. [ABSTRACT FROM AUTHOR]

Covid-19 patients experience several symptoms such as shortness of breath, abnormal heart rate, lung function abnormalities that are similar to pneumonia symptoms. These symptom conditions indicate that the saturation of oxygen (O2) levels dissolved in the blood is not normal. To measure oxygen levels in the blood using a medical device, one of which is a Pulse Oximeter. Covid- 19 patients in the Sapta Taruna Health Center were 665 patients, of which this patient was counted from January 2022 to April 2022. Based on information obtained from the Sapta Taruna Health Center, the only patients that were counted were those who did the PCR/Swab test, while the people who were suspected infected with Covid-19 there are still many who do not do PCR/Swab tests, this refusal is due to fear because Hoax information is spread in the community such as: PCR/Swab tests are painful, if the PCR/Swab test results are positive, fear of being ostracized, feel healthy and other reasons. other. Patients who have been tested positive for Covid-19 will be given drugs such as fever medicine, antibiotics, anti-virus, Vitamin C, and others according to the level of symptoms they feel, if the symptoms are felt at a moderate, mild or even asymptomatic stage, they will be advised to isolate independently (Isoma) at home, but there is no further monitoring from the Sapta Taruna Health Center, even though patients who are self-isolating at home may experience a decrease in blood oxygen levels drastically, so these patients need medical devices such as pulse oximetry so that patients who are isoma can perform independent checking, henceforth the current pulse oximetry cannot provide remote information related to the condition of oxygen saturation in the patient's blood. Judging from the problems above, the research team made a product, namely Pulse Oximetry based on IoT, this tool is to measure oxygen saturation in the patient's blood and the data from the measurements made by the patient will be automatically sent to the server and can be viewed on the Sapta Taruna Health Center website, so that the Sapta Taruna Health Center can monitoring the condition of the patient in real time without having to meet directly with the patient. [ABSTRACT FROM AUTHOR]

COVID-19 is an ongoing pandemic and has been extensively studied. However, the effects of COVID-19 during pregnancy, particularly on placental function, have not been verified. In this study, we used blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) to evaluate whether COVID-19 incidence during pregnancy has any lasting effects with respect to placental oxygenation. This is a case-control study, in which eight cases of singleton pregnancies before 30 weeks gestation with COVID-19 mothers were included. Placental oxygenation was evaluated using BOLD-MRI after 32 weeks of gestation. BOLD-MRI was consecutively performed under normoxia (21% O2), hyperoxia (100% O2), and normoxia for 4 min each. Individual placental time–activity curves were evaluated to calculate the peak score (peakΔR2*) and the time from the start of maternal oxygen administration to the time of peakΔR2* (time to peakΔR2*). Eighteen COVID-19-free normal pregnancies from a previous study were used as the control group. No significant differences were found between the two groups regarding maternal background, number of days of delivery, birth weight, and placental weight. The parameter peakΔR2* was significantly decreased in the COVID-19 group (8 ± 3 vs. 5 ± 1, p <.001); however, there was no significant difference in time to peakΔR2* (458 ± 74 s vs. 471 ± 33 s, p =.644). In this study, BOLD-MRI was used to evaluate placental oxygenation during pregnancy in COVID-19-affected patients. COVID-19 during pregnancy decreased placental oxygenation even post-illness, but had no effect on fetal growth; further investigation of the possible effects of COVID-19 on the fetus and mother is warranted. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to evaluate differences in clinical features and laboratory parameters in critically ill pregnant women with acute respiratory distress syndrome (ARDS) compared to moderate and severe pregnant women with coronavirus disease-2019 (COVID-19) but without ARDS. Methods This was a retrospective multicenter study of all pregnant women with COVID-19 diagnosed with ARDS between February 15, and May 1, 2020 in nine level III maternity centers in Iran (ARDS group). The control COVID-19 pregnant women were selected from 3 of 9 level III maternity centers between March 15 and April 20, 2020. Univariate statistics were used to look at differences between groups. Cluster dendrograms were used to look at the correlations between clinical and laboratory findings in the groups. A value of p <.05 was considered statistically significant. Results Fifteen COVID-19 infected women with ARDS were compared to 29 COVID-19 positive and ARDS negative control (moderate: (n = 26) 89.7% and severe: (n = 3)10.3%). The mean maternal age (35.6 vs. 29.4 years; p = .002) and diagnosis of chronic hypertension (20.0% vs. 0%, p = .034) were significantly higher in the ARDS group. There was no significant difference between the two groups in their presenting symptoms. The ARDS group had a significantly higher prevalence of tachypnea (66.6% vs. 10.3%, p = .042) and blood oxygen saturation (SpO2) <93% (66.6% vs. 10.3%, p = .004) at presentation. Relative lymphopenia (lymphocyte ratio < 10.5%, 66.6% vs. 17.2%, p = .002), lymphocytes to leukocytes ratio (11.3% vs. 17.7%, p = .010), and neutrophils to lymphocytes ratio (NLR) >7.5 were significantly different between the two groups (all p < .05). Conclusion Our data demonstrate that symptom-based strategies for identifying the critically ill pregnant women with SARS-CoV-2 are insufficient; however, vital signs and laboratory data might be helpful to predict ARDS in critically ill COVID-19 pregnant patients. [ABSTRACT FROM AUTHOR]

It is not known if the degrees of improvement in oxygenation obtained by CPAP can predict clinical outcomes in patients with COVID-19 pneumonia. This was a retrospective study conducted on patients with severe COVID-19 pneumonia treated with CPAP in three University hospitals in Milan, Italy, from March 2020 to March 2021. Arterial gas analysis was obtained before and 1 h after starting CPAP. CPAP failure included either death in the respiratory units while on CPAP or the need for intubation. Two hundred and eleven patients (mean age 64 years, 74% males) were included. Baseline median PaO2, PaO2/FiO2 ratio (P/F), and the alveolar-arterial (A-a) O2 gradient were 68 (57–83) mmHg, 129 (91–179) mmHg and 310 (177–559) mmHg, respectively. Forty-two (19.9%) patients died in the respiratory units and 51 (24.2%) were intubated. After starting CPAP, PaO2/FiO2 increased by 57 (12–113; p < 0.001) mmHg, and (A-a) O2 was reduced by 68 (−25–250; p < 0.001) mmHg. A substantial overlap of PaO2, P/F, and A-a gradient at baseline and during CPAP was observed in CPAP failures and successes; CPAP-associated improvements in oxygenation in both groups were similar. In conclusion, CPAP-associated improvements in oxygenation do not predict clinical outcomes in patients with severe COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Even after two years since the declaration of the new virus Coronavirus Disease 19 (COVID-19), the reported cases are still considerably high in many countries, including Malaysia. The health authorities cannot monitor the health condition and track the location of every homemonitored patient at once due to many confirmed cases in a day. In order to overcome the shortage of manpower, an Internet of Things (IoT)-based self-quarantine system with Radio Frequency Identification (RFID) and Global Positioning System (GPS) tracking is proposed in this paper to monitor the health conditions of the Covid-19 patients and track their real-time location via mobile application. Biomedical sensors are used to measure health conditions such as temperature, pulse oximetry, and heart-rate monitor. In addition, the RFID readers are used to detect patients that intend to leave the quarantine area, and the GPS modules are used to track their actual geometrical location so that the authorities can take further action. The real-time data is automatically pushed to the cloud server for the authorities to remotely view the patient's health condition and location on the Google map using smart devices. Finally, a hardware prototype and a mobile application have been successfully developed in this project. The system is able to display the temperature, heartbeats, and blood oxygen saturation properly on a liquid crystal display (LCD) screen. All these measured values, together with the information from RFID detection and GPS location tracking, can be viewed on a smartphone. [ABSTRACT FROM AUTHOR]

Background: As the pandemic unfolds, major concerns remain with those in disadvantaged positions who may be disproportionately affected. This paper aimed to present the characteristics of COVID-19 immigrant patients and investigate whether they were disproportionately affected by COVID-19 pandemic. Methods: A cross-sectional study was performed using data on 589,146 patients diagnosed with COVID-19 in Iran. Descriptive analyses were used to summarize the study population's characteristics. Chi-squared test and logistic regression model were applied. Results: After accounting for possible confounding covariates, being an immigrant was significantly associated with increased risk of death due to COVID-19 (OR 1.64, CI 1.568–1.727). When compared to Iranian-born patients, the prevalence of low blood oxygen levels on admission was higher among immigrant patients (53.9% versus 47.7%, P value < 0.001). Moreover, greater proportions of immigrants who were diagnosed with COVID-19 were admitted to an ICU (17% versus 15.8%, P value < 0.001). Patients aged 65 and above were the largest age category in both populations. However, there was a significant difference between the age profiles of patients, with children under the age of eighteen presenting 16% of immigrant patients vs 6.6% of Iranian-born patients (P value < 0.001). In both groups, more men were affected by COVID-19 than women, yet the sex bias was more prominent for migrant patients (P value < 0.001). Conclusion: The evidence from this study revealed that immigrant patients infected with COVID-19 were more likely to suffer from severe health outcome of the disease compared to Iranian-born patients. [ABSTRACT FROM AUTHOR]

The worldwide outbreak of the novel Coronavirus (COVID-19) has highlighted the need for a screening and monitoring system for infectious respiratory diseases in the acute and chronic phase. The purpose of this study was to examine the feasibility of using a wearable near-infrared spectroscopy (NIRS) sensor to collect respiratory signals and distinguish between normal and simulated pathological breathing. Twenty-one healthy adults participated in an experiment that examined five separate breathing conditions. Respiratory signals were collected with a continuous-wave NIRS sensor (PortaLite, Artinis Medical Systems) affixed over the sternal manubrium. Following a three-minute baseline, participants began five minutes of imposed difficult breathing using a respiratory trainer. After a five minute recovery period, participants began five minutes of imposed rapid and shallow breathing. The study concluded with five additional minutes of regular breathing. NIRS signals were analyzed using a machine learning model to distinguish between normal and simulated pathological breathing. Three features: breathing interval, breathing depth, and O2Hb signal amplitude were extracted from the NIRS data and, when used together, resulted in a weighted average accuracy of 0.87. This study demonstrated that a wearable NIRS sensor can monitor respiratory patterns continuously and non-invasively and we identified three respiratory features that can distinguish between normal and simulated pathological breathing. [ABSTRACT FROM AUTHOR]

Background: LUS is a validated tool for the management of COVID-19 pneumonia. Chair positioning (CP) may have beneficial effects on oxygenation and lung aeration, and may be an easier alternative to PP. This study assessed the effects of a CP session on oxygenation and lung aeration (LA) changes in non-intubated COVID-19 patients. Methods: A retrospective multicenter study was conducted in an ICU. We analyzed data from LUS exams and SpO2:FiO2 performed before/after a CP session in non-intubated COVID-19 patients. Patients were divided into groups of responders or non-responders in terms of oxygenation or LA. Results: Thirty-three patients were included in the study; fourteen (44%) were oxygenation non-responders and eighteen (56%) were oxygenation responders, while thirteen (40.6%) and nineteen (59.4%) patients were classified as LA non-responders and responders, respectively. Changes in oxygenation and LA before/after a CP session were not correlated (r = −0.19, p = 0.3, 95% CI: −0.5–0.17). The reaeration scores did not differ between oxygenation responders and non-responders (1 (−0.75–3.75) vs. 4 (−1–6), p = 0.41). The LUS score was significantly correlated with SpO2:FiO2 before a CP session (r = 0.37, p = 0.04, 95% CI: 0.03–0.64) but not after (r = 0.17, p = 0.35, 95% CI: −0.19–0.50). Conclusion: A CP session was associated with improved oxygenation and LA in more than half of the non-intubated COVID-19 patients. [ABSTRACT FROM AUTHOR]

Vital signs are critical in assessing the severity and prognosis of infections, for example, COVID-19, influenza, sepsis, and pneumonia. This study aimed to evaluate a new method for rapid camera-based non-contact measurement of heart rate, blood oxygen saturation, respiratory rate, and blood pressure. Consecutive adult patients attending a hospital emergency department for suspected COVID-19 infection were invited to participate. Vital signs measured with a new camera-based method were compared to the corresponding standard reference methods. The camera device observed the patient's face for 30 s from ∼1 m. Between 1 April and 1 October 2020, 214 subjects were included in the trial, 131 female (61%) and 83 male (39%). The mean age was 44 years (range 18–81 years). The new camera-based device's vital signs measurements were, on average, very close to the gold standard but the random variation was larger than the reference methods. The principle of contactless measurement of blood pressure, pulse, respiratory rate, and oxygen saturation works, which is very promising. However, technical improvements to the equipment used in this study to reduce its random variability is required before clinical implementation. This will likely be a game changer once this is sorted out. Universal Trial Number (UTN) U1111-1251-4114 and the ClinicalTrials.gov Identifier NCT04383457. [ABSTRACT FROM AUTHOR]

Objective: To investigate the correlation between capillary blood oxygen saturation and Computerized tomography (CT) severity index in patients with Covid-19 pneumonia. Study Design: Cross Sectional study. Setting: Ibne-sina Hospital Multan Medical & Dental College Multan. Period: 1st June 2020 to 1st June 2021. Material & Methods: A cross-sectional analytical study was conducted at the COVID-19 ward of Ibne-sina hospital Multan Medical & Dental College Multan for 1 year. At the time of admission, all capillary oxygen saturation of all the included patients was measured. Pulmonary CT scans were then performed on these patients and CT severity index was calculated. SPSS was used for data analysis. Results: A total of 170 COVID-19 infected patients were included in the study. At the time of admission, the mean oxygen saturation was found to be 88.9% ± 6.53%. Whereas, the mean severity index was15.01 ± 7.79. 22 patients had hypoxia when presented in hospital and a significantly high iCT severity index was found in these patients (p=0.001). Chronic obstructive pulmonary disease (COPD), hypertension, and diabetes were significantly related to reduced blood oxygen saturation (p<0.05). Whereas, patients with hypertension had significantly raised CT scores. A significant inverse correlation was found between capillary oxygen saturation and CT severity index (r = -0.41, p < 0.01). Conclusions: The study revealed a significant inverse correlation between capillary oxygen saturation and CT severity index. Moreover, it was found that underlying commodities (I.e past medical history) can also affect the CT severity index. [ABSTRACT FROM AUTHOR]

Background and objectives: Acute respiratory distress syndrome (ARDS) is the most common complication occurring in COVID-19 patients admitted to the ICU. Given the increased respiratory work of these patients, it is necessary to evaluate their actual breathing efforts. The aim of this study is to report the incidence and determinants of increased effort of breathing (EOB) in critical COVID-19 patients. Materials and Methods: This was a retrospective study of COVID-19 patients admitted to the ICU during the year of 2020. Respiratory rate (RR) was chosen as an indicator of EOB. The cut-off value was set at more than 20 breaths per minute. ROC-AUC analysis was performed to identify the accuracy of the PaO2 and PaCO2 to determine increased EOB. Furthermore, multivariate regression analysis was performed to reveal the determinants of increased EOB. Results: 213 patients were included in the study. Mean RR in the population was 24.20 ± 6.28. 138 (64.8%) of the patients had increased EOB. The ROC-AUC analysis revealed the PaO2 (0.656 (CI 95%: 0.579–0.734, p < 0.001) as more accurate predictor of EOB than PaCO2 (0.584 (CI 95%: 0.505–0.662, p = 0.043). In the final multivariate model, the SpO2 (exp(B) = 0.922, CI 95%: 0.874–0.97 p = 0.033), PaO2/FiO2 ratio (exp(B) = 0.996, CI 95%: 0.922–1.000, p = 0.003) and PaO2 (exp(B) = 0.989 CI 95%: 0.982–0.996 p = 0.003) prevailed as independent predictors of increased EOB. Conclusions: To conclude, PaO2 was revealed as a more accurate predictor of increased EOB than PaCO2. Further investigation revealed the independent determinants of EOB: blood oxygen saturation, PaO2 and PaO2/FiO2 ratio. [ABSTRACT FROM AUTHOR]

The recent dramatic expansion of the COVID-19 outbreak is placing enormous strain on human society as a whole. Numerous biomarkers are being investigated in an effort to track the condition of the patient. This could interfere with signs of many other illnesses, making it more difficult for a specialist to diagnose or predict the severity level of the case. As a result, the focus of this research was on the development of a multiclass prediction system capable of dealing with three severity cases (severe, moderate, and mild). The lymphocyte to CRP ratio (C-reactive protein blood test) and SpO2 (blood oxygen saturation level) indicators were ranked and used as prediction system attributes. A machine learning model based on SVMs is created. A total of 78 COVID-19 patients were recruited from the Azizia primary health care sector/Wasit Health Directorate/Ministry of Health to form different combinations of COVID-19 clinical dataset. The outcomes demonstrate that the proposed approach had an average accuracy of 82%. The established prediction system allows for the early identification of three severity cases, which reduces deaths. [ABSTRACT FROM AUTHOR]

The review of recent papers devoted to actively developing methods of photoplethysmographic imaging (the PPGI) of blood volume pulsations in vessels and non-contact two-dimensional oximetry on the surface of a human body has been carried out. The physical fundamentals and technical aspects of the PPGI and oximetry have been considered. The manifold of the physiological parameters available for the analysis by the PPGI method has been shown. The prospects of the PPGI technology have been discussed. The possibilities of non-contact determination of blood oxygen saturation SpO2 (pulse saturation O2) have been described. The relevance of remote determination of the level of oxygenation in connection with the spread of a new coronavirus infection SARS-CoV-2 (COVID-19) has been emphasized. Most of the works under consideration cover the period 2010–2021. [ABSTRACT FROM AUTHOR]

BACKGROUND: Measurement of blood oxygen saturation is a vital part of monitoring coronavirus 2019 (COVID-19) patients. Pulse oximetry is commonly used to measure blood oxygen saturation and pulse rate for appropriate clinical intervention. But the majority of direct-to-consumer grade pulse oximeters did not pass through in-vivo testing, which results in their accuracy being questionable. Besides this, the ongoing COVID-19 pandemic exposed the limitations of the device in resource limited areas since independent monitoring is needed for COVID-19 patients. The purpose of this study was to perform an in-vivo evaluation of a newly developed smartphone powered low-cost pulse oximeter. METHODS: The new prototype of a smartphone powered pulse oximeter was evaluated against the standard pulse oximeter by taking measurements from fifteen healthy volunteers. The accuracy of measurement was evaluated by calculating the percentage error and standard deviation. A repeatability and reproducibility test were carried out using the ANOVA method. RESULTS: The average accuracy for measuring spot oxygen saturation (SPO2) and pulse rate (PR) was 99.18% with a standard deviation of 0.57 and 98.78% with a standard deviation of 0.61, respectively, when compared with the standard pulse oximeter device. The repeatability and reproducibility of SPO2 measurements were 0.28 and 0.86, respectively, which is in the acceptable range. CONCLUSION: The new prototype of smartphone powered pulse oximeter demonstrated better performance compared to the existing low-cost fingertip pulse oximeters. The device could be used for independent monitoring of COVID-19 patients at health institutions and also for home care. [ABSTRACT FROM AUTHOR]

Objectives: ICUs have had to deal with a large number of patients with acute respiratory distress syndrome COVID-19, a significant number of whom received prone ventilation, which is a substantial consumer of care time. The selection of patients that we have to ventilate in prone position seems interesting. We evaluate the correlation between the percentage of collapsed dependent lung areas in the supine position, monitoring by electrical impedance tomography and the oxygenation response (change in Pao2/Fio2 ratio) to prone position.Design: An observational prospective study.Setting: From October 21, 2020, to 30 March 30, 2021. At the Sainte Anne military teaching Hospital and the Timone University Hospital.Patients: Fifty consecutive patients admitted in our ICUs, with COVID-19 acute respiratory distress syndrome and required mechanical, were included. Twenty-four (48%) received prone ventilation. Fifty-eight prone sessions were investigated.Interventions: An electrical impedance tomography recording was made in supine position, daily and repeated just before and just after the prone session. The daily dependent area collapse was calculated in relation to the previous electrical impedance tomography recording. Prone ventilation response was defined as a Pao2/Fio2 ratio improvement greater than 20%.Measurement and Main Results: The main outcome was the correlation between dependent area collapse and the oxygenation response to prone ventilation. Dependent area collapse was correlated with oxygenation response to prone ventilation (R2 = 0.49) and had a satisfactory prediction accuracy of prone response with an area under the curve of 0.94 (95% CI, 0.87-1.00; p < 0.001). Best Youden index was obtained for a dependent area collapse greater than 13.5 %. Sensitivity of 92% (95% CI, 78-97), a specificity of 91% (95% CI, 72-97), a positive predictive value of 94% (95% CI, 88-100), a negative predictive value of 87% (95% CI, 78-96), and a diagnostic accuracy of 91% (95% CI, 84-98).Conclusions: Dependent lung areas collapse (> 13.5%), monitored by electrical impedance tomography, has an excellent positive predictive value (94%) of improved oxygenation during prone ventilation. [ABSTRACT FROM AUTHOR]

Atmospheric ozone is produced when nitrogen oxides react with volatile organic compounds. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome contains a unique N-terminal fragment in the Spike protein, which allows it to bind to air pollutants in the environment. 'Our approach in this review is to study ozone and its effect on the SARS-CoV-2 virus and patients with coronavirus disease 2019 (COVID-19). Article data were collected from PubMed, Scopus, and Google Scholar databases. Ozone therapy has antiviral properties, improves blood flow, facilitates the transfer of oxygen in hypoxemic tissues, and reduces blood coagulation phenomena in COVID-19 patients. Ozone has immunomodulatory effects by modulating cytokines (reduction of interleukin-1, interleukin-6, tumor necrosis factor-α, and interleukin-10), induction of interferon-γ, anti-inflammatory properties by modulating NOD-, LRR- and pyrin domain-containing protein 3, inhibition of cytokine storm (blocking nuclear factor-κB and stimulating nuclear factor erythroid 2-related factor 2 pathway), stimulates cellular/humoral immunity/phagocytic function and blocks angiotensin-converting enzyme 2. In direct oxygen-ozone injection, oxygen reacts with several biological molecules such as thiol groups in albumin to form ozonoids. Intravenous injection of ozonated saline significantly increases the length of time a person can remain hypoxic. The rectal ozone protocol is rectal ozone insufflation, resulting in clinical improvement in oxygen saturation and biochemical improvement (fibrinogen, D-dimer, urea, ferritin, LDH, interleukin-6, and C-reactive protein). In general, many studies have shown the positive effect of ozone therapy as a complementary therapy in the recovery of COVID-19 patients. All the findings indicate that systemic ozone therapy is nontoxic and has no side effects in these patients. [ABSTRACT FROM AUTHOR]