Comparison of Saans neonatal continuous positive airway pressure against standard of care for intra-hospital transport of neonates with respiratory distress syndrome

Background: CPAP (continuous positive airway pressure) therapy, effective in managing neonates with respiratory distress. While CPAP therapy is indicated right from birth, existing CPAP systems are designed for/installed in, NICUs. As a result, most neonates with RD (respiratory distress) are managed with only oxygen therapy during transportation in low resource settings. This study compares a novel, low-cost, portable neonatal CPAP system for use in transport from the labor room to the NICU, against conventional oxygen therapy in low resource settings.Methods: This was an open-label, 2 arm study with a treatment arm (low-cost indigenous CPAP device for therapy) and a control group (oxygen therapy). A total of 132 neonates were assigned with 66 in (matched-control study), in each group.Results: Both arms (CPAP and oxygen) had similar gestational age. gender distributions and initial SAS scores. The CPAP group had higher use of antenatal steriods (38 versus 26) compared to oxygen group and a lower need for surfactant (28 versus 40). Also, a larger number of neonates required ventilation in oxygen group (42) versus CPAP group (15), with the p=0.000561 the result is significant at p<0.05.Conclusions: CPAP therapy induced in labor room measurably improves neonates health and reduces respiratory distress. The indigenous low-cost CPAP device (Saans) used in this study effectively provides CPAP therapy to neonates during transport from the labor room to the NICU, reducing respiratory distress and the need for mechanical ventilation, making useful addition to labor rooms.

Evaluation of role of remdesivir in covid-19 patients outcome: A retrospective analysis

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Remdesivir, a broad spectrum antiviral agent, is currently the only drug that is approved by the Food and Drug Administration for the treatment of COVID-19. It is recommended for use in hospitalized patients who require supplemental oxygen. There are insufficient data either for or against to recommend for routine use of Remdesivir in high risk patients who doesn’t require supplemental oxygen. To evaluate the efficacy of Remdesivir in covid positive patients. A retrospective analysis of 300 patients was done, out of which 150 patients belong to Group 1 and 150 patients belong to Group 2. Group 1-Elderly patients with comorbidities who doesn’t require supplemental oxygen Group 2- Patients requiring oxygen supplementation (SpO2 88% to 94% on room air).Group 1 patients were discharged earlier than Group 2 patients.Elective use of Remdesivir has a definitive role in prevention of progression of disease especially in high risk susceptible individuals.

Pneumonia-targeted lopinavir/ritonavir-based treatment for patients with COVID-19: an early-period retrospective single center observational study

Background Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential. Methods A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group). Results In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067–0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128–8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021–1.202; P = 0.014). Conclusions Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.

Association of Flow Rate of Prehospital Oxygen Administration and Clinical Outcomes in Severe Traumatic Brain Injury

The goal of this study was to investigate the association of prehospital oxygen administration flow with clinical outcome in severe traumatic brain injury (TBI) patients. This was a cross-sectional observational study using an emergency medical services-assessed severe trauma database in South Korea. The sample included adult patients with severe blunt TBI without hypoxia who were treated by EMS providers in 2013 and 2015. Main exposure was prehospital oxygen administration flow rate (no oxygen, low-flow 1~5, mid-flow 6~14, high-flow 15 L/min). Primary outcome was in-hospital mortality. A total of 1842 patients with severe TBI were included. The number of patients with no oxygen, low-flow oxygen, mid-flow oxygen, high-flow oxygen was 244, 573, 607, and 418, respectively. Mortality of each group was 34.8%, 32.3%, 39.9%, and 41.1%, respectively. Compared with the no-oxygen group, adjusted odds (95% CI) for mortality in the low-, mid-, and high-flow oxygen groups were 0.86 (0.62–1.20), 1.15 (0.83–1.60), and 1.21 (0.83–1.73), respectively. In the interaction analysis, low-flow oxygen showed lower mortality when prehospital saturation was 94–98% (adjusted odds ratio (AOR): 0.80 (0.67–0.95)) and ≥99% (AOR: 0.69 (0.53–0.91)). High-flow oxygen showed higher mortality when prehospital oxygen saturation was ≥99% (AOR: 1.33 (1.01~1.74)). Prehospital low-flow oxygen administration was associated with lower in-hospital mortality compared with the no-oxygen group. High-flow administration showed higher mortality.

NIR-MID Reflectance and Emissivity Study at Different Temperatures of Sodium Carbonate Minerals: Spectra Characterization and Implication for Remote Sensing Identification

Recent satellite observations and the deconvolution of remote sensing data have shown the existence of various carbonate minerals in different solar system bodies. Emissivity, from 403 to 803 K, and reflectance spectra at 300 and 193 K of selected carbonates minerals with different ratios of Na:Ca and water amounts were respectively collected at 3–20 μm and at 1–16 μm. All reflectance spectra show absorption features in the 1.9–2.5 and 3.4–4.0 μm areas due to overtone and a combination of CO32− and fundamental vibrational models at ≈9.09, 11.35, 7.06, and 14.7 μm. The increase of the Na:Ca ratio in anhydrous samples produces a shift of the absorption features in the 3.4–4.0 μm area toward shorter wavelengths, and the peak at 3.9 μm doubles in the presence of a CO32− oxygen group shared with two cations in minerals having more complex structures. The comparison of the bands at ≈669 and ≈794 cm−1 in the emissivity spectra collected at high temperatures indicates that around 600 K, phase transitions occurred in natrite and thermonatrite. The reflectance spectra measured at 193 K reveal a fine structure compared to spectra collected at room temperature. The comparison of laboratory results with the spectrum of Ceres’s brightest crater Occator from the Dawn mission, taken as a case study, showed how the anhydrous samples, shortite and nyerereite, studied in this work can also be hypothesized for Ceres’s surface beyond that already suggested (trona, natrite, thermonatrite).

Non-invasive ventilation versus high-flow nasal oxygen for postextubation respiratory failure in ICU: a post-hoc analysis of a randomized clinical trial

Background In intensive care units (ICUs), patients experiencing post-extubation respiratory failure have poor outcomes. The use of noninvasive ventilation (NIV) to treat post-extubation respiratory failure may increase the risk of death. This study aims at comparing mortality between patients treated with NIV alternating with high-flow nasal oxygen or high-flow nasal oxygen alone. Methods Post-hoc analysis of a multicenter, randomized, controlled trial focusing on patients who experienced post-extubation respiratory failure within the 7 days following extubation. Patients were classified in the NIV group or the high-flow nasal oxygen group according to oxygenation strategy used after the onset of post-extubation respiratory failure. Patients reintubated within the first hour after extubation and those promptly reintubated without prior treatment were excluded. The primary outcome was mortality at day 28 after the onset of post-extubation respiratory failure. Results Among 651 extubated patients, 158 (25%) experienced respiratory failure and 146 were included in the analysis. Mortality at day 28 was 18% (15/84) using NIV alternating with high-flow nasal oxygen and 29% (18/62) with high flow nasal oxygen alone (difference, − 11% [95% CI, − 25 to 2]; p = 0.12). Among the 46 patients with hypercapnia at the onset of respiratory failure, mortality at day 28 was 3% (1/33) with NIV and 31% (4/13) with high-flow nasal oxygen alone (difference, − 28% [95% CI, − 54 to − 6]; p = 0.006). The proportion of patients reintubated 48 h after the onset of post-extubation respiratory failure was 44% (37/84) with NIV and 52% (32/62) with high-flow nasal oxygen alone (p = 0.21). Conclusions In patients with post-extubation respiratory failure, NIV alternating with high-flow nasal oxygen might not increase the risk of death. Trial registration number The trial was registered at http://www.clinicaltrials.gov with the registration number NCT03121482 the 20th April 2017.

Hydrogen/oxygen therapy for the treatment of an acute exacerbation of chronic obstructive pulmonary disease: results of a multicenter, randomized, double-blind, parallel-group controlled trial

Background To investigate whether the administration of hydrogen/oxygen mixture was superior to oxygen in improving symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This prospective, randomized, double-blind, controlled clinical trial in 10 centres enrolled patient with AECOPD and a Breathlessness, Cough, and Sputum Scale (BCSS) score of at least 6 points. Eligible patients were randomly assigned (in a 1:1 ratio) to receive either hydrogen/oxygen mixture or oxygen therapy. Primary endpoint was the change from baseline in BCSS score at day 7. Adverse events (AEs) were recorded to evaluate safety. Results Change of BCSS score in Hydrogen/oxygen group was larger than that in Oxygen group (− 5.3 vs. − 2.4 point; difference: − 2.75 [95% CI − 3.27 to − 2.22], meeting criteria for superiority). Similar results were observed in other time points from day 2 through day 6. There was a significant reduction of Cough Assessment Test score in Hydrogen/oxygen group compared to control (− 11.00 vs. − 6.00, p < 0.001). Changes in pulmonary function, arterial blood gas and noninvasive oxygen saturation did not differ significantly between groups as well as other endpoints. AEs were reported in 34 (63.0%) patients in Hydrogen/oxygen group and 42 (77.8%) in Oxygen group. No death and equipment defects were reported during study period. Conclusions The trial demonstrated that hydrogen/oxygen therapy is superior to oxygen therapy in patient with AECOPD with acceptable safety and tolerability profile. Trial registration: Name of the registry: U.S National Library of Medicine Clinical Trials; Trial registration number: NCT04000451; Date of registration: June 27, 2019-Retrospectively registered; URL of trial registry record: https://www.clinicaltrials.gov/ct2/show/study/NCT04000451?term=04000451&draw=2&rank=1.

Association of flow rate of prehospital oxygen administration and clinical outcomes in severe traumatic brain injury

Background To prevent hypoxia during prehospital phase is important in severe traumatic brain injury (TBI) but optimal flow rate of prehospital oxygen supply is controversial. The goal of this study is to investigate the association of prehospital oxygen administration flow on clinical outcome in severe TBI patients. Methods This is a cross-sectional observational study using emergency medical services assessed severe trauma database in South Korea. In 2013 and 2015, adult patients with severe blunt TBI (abbreviated injury scale ≥3 in head lesion) without hypoxia (< 94% of oxygen saturation in prehospital pulse oximetry) were included. Main exposure was prehospital oxygen administration flow rate (no oxygen, 1~5 L/min, 6~14 L/min, 15 L/min). Primary outcome was in-hospital mortality. A multivariate logistic regression model was used to association of prehospital oxygen supply and outcomes. Results 1,842 patients with severe TBI were included. The number of patients with no oxygen, low-flow oxygen (1~5 L/min), mid-flow oxygen (6~14 L/min), high-flow oxygen (15 L/min) was 244, 573, 607 and 418. Mortality of each group was 34.8%, 32.3%, 39.9% and 41.1%. Compared with no-oxygen group, adjusted odds (95% CI) for mortality in the low, mid, high-flow oxygen groups were 0.86 (0.62–1.20), 1.15 (0.83–1.60) and 1.21 (0.83–1.73). In the interaction analysis, low-flow oxygen showed lower mortality when prehospital saturation was 94-98% (adjusted odds ratio(AOR): 0.80 [0.67–0.95]) and ≥99% (AOR: 0.69 [0.53–0.91]). High-flow oxygen (15 L/min) showed higher mortality when prehospital saturation was ≥99% in pulse oximetry (AOR: 1.33[1.01~1.74]). Conclusions Prehospital low-flow oxygen administration was associated with lower in-hospital mortality compared with the no-oxygen group in severe TBI patients. High-flow oxygen administration showed higher mortality. Optimal flow of prehospital oxygenation according prehospital saturation could reduce mortality in severe TBI. Trial registration This study used cases retrospectively registered in the emergency medical services assessed severe trauma database.

Microstructure and Properties of Poly(ethylene glycol)-Segmented Polyurethane Antifouling Coatings after Immersion in Seawater

Polyurethane has a microphase separation structure, while polyethylene glycol (PEG) can form a hydrated layer to resist protein adsorption. In this paper, PEG was introduced to polyurethane to improve the antifouling properties of the polyurethane, providing a new method and idea for the preparation of new antifouling polyurethane materials. The mechanical properties, hydrophilicity, swelling degree, microphase separation and antifouling performance of the coatings were evaluated. The response characteristics of the polyurethane coatings in a seawater environment were studied, and the performance changes of coatings in seawater were tested. The results showed that the crystallized PEG soft segments increased, promoting microphase separation. The stress at 100% and the elasticity modulus of the polyurethane material also markedly increased, in addition to increases in the swelling degree in seawater, the water contact angle decreased. A total of 25% of PEG incorporated into a soft segment can markedly improve the antibacterial properties of the coatings, but adding more PEG has little significant effect. After immersion in seawater, the coatings became softer and more elastic. This is because water molecules formed hydrogen bonding with the amino NH, which resulted in a weakening effect being exerted on the carbonyl C=O hydrogen bonding and ether oxygen group crystallization.