Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Exosomes in Parkinson: Revisiting Their Pathologic Role and Potential Applications

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by bradykinesia, rigidity, and tremor. Considerable progress has been made to understand the exact mechanism leading to this disease. Most of what is known comes from the evidence of PD brains’ autopsies showing a deposition of Lewy bodies—containing a protein called α-synuclein (α-syn)—as the pathological determinant of PD. α-syn predisposes neurons to neurotoxicity and cell death, while the other associated mechanisms are mitochondrial dysfunction and oxidative stress, which are underlying precursors to the death of dopaminergic neurons at the substantia nigra pars compacta leading to disease progression. Several mechanisms have been proposed to unravel the pathological cascade of these diseases; most of them share a particular similarity: cell-to-cell communication through exosomes (EXOs). EXOs are intracellular membrane-based vesicles with diverse compositions involved in biological and pathological processes, which their secretion is driven by the NLR family pyrin domain-containing three proteins (NLRP3) inflammasome. Toxic biological fibrils are transferred to recipient cells, and the disposal of damaged organelles through generating mitochondrial-derived vesicles are suggested mechanisms for developing PD. EXOs carry various biomarkers; thus, they are promising to diagnose different neurological disorders, including neurodegenerative diseases (NDDs). As nanovesicles, the applications of EXOs are not only restricted as diagnostics but also expanded to treat NDDs as therapeutic carriers and nano-scavengers. Herein, the aim is to highlight the potential incrimination of EXOs in the pathological cascade and progression of PD and their role as biomarkers and therapeutic carriers for diagnosing and treating this neuro-debilitating disorder

Hematologic reference intervals for healthy adult Saudis in Riyadh

BACKGROUND: Laboratory hematological tests are widely used in clinical practice to assess health and disease conditions. Reference ranges provided by laboratory reports are considered the most authoritative medical tools to assist in the decision-making phase. International standards institutes recommend that reference ranges be established for each region. OBJECTIVES: Provide reference values of routine hematological parameters in Saudi adults according to age and gender. DESIGN: Cross-sectional SETTING: Central province of Saudi Arabia. PATIENTS AND METHODS: Apparently healthy Saudi adults were subjected to laboratory testing of routine hematological parameters (full blood count, hemostatic profile, and serum hematinics), after completing a detailed health medical questionnaire. MAIN OUTCOME MEASURES: Hematological reference values based on the local population. SAMPLE SIZE AND CHARACTERISTICS: 637 after screening 827 potentially healthy Saudi adults with ages ranging from 15 to 65 years. RESULTS: The reference values of routine hematological parameters for the full population and by gender are presented with 90% CI as the lower and upper limits. Reference ranges mostly differed from universal established ranges shown in textbooks. CONCLUSION: The reference ranges of routine hematologic parameters for accurate assessment and appropriate management will help improve the routine clinical care of the adult Saudi population. LIMITATIONS: Difficulty in assessing health status of participants, who could have subclinical illnesses not reflected in the evaluated blood measurement. Lack of ability to eliminate individuals who might be carriers for haemoglobinopathies. Studies with larger sample sizes from different areas of the country are required to achieve a more accurate representation of the whole Saudi population. CONFLICT OF INTEREST: None

Mycosynthesis, Characterization, and Mosquitocidal Activity of Silver Nanoparticles Fabricated by <i>Aspergillus niger</i> Strain

Herein, silver nanoparticles (Ag-NPs) were synthesized using an environmentally friendly approach by harnessing the metabolites of Aspergillus niger F2. The successful formation of Ag-NPs was checked by a color change to yellowish-brown, followed by UV-Vis spectroscopy, Fourier transforms infrared (FT-IR), Transmission electron microscopy (TEM), and X-ray diffraction (XRD). Data showed the successful formation of crystalline Ag-NPs with a spherical shape at the maximum surface plasmon resonance of 420 nm with a size range of 3–13 nm. The Ag-NPs showed high toxicity against I, II, III, and IV instar larvae and pupae of Aedes aegypti with LC50 and LC90 values of 12.4–22.9 ppm and 22.4–41.4 ppm, respectively under laboratory conditions. The field assay exhibited the highest reduction in larval density due to treatment with Ag-NPs (10× LC50) with values of 59.6%, 74.7%, and 100% after 24, 48, and 72 h, respectively. The exposure of A. aegypti adults to the vapor of burning Ag-NPs-based coils caused a reduction of unfed individuals with a percentage of 81.6 ± 0.5% compared with the positive control, pyrethrin-based coils (86.1 ± 1.1%). The ovicidal activity of biosynthesized Ag-NPs caused the hatching of the eggs with percentages of 50.1 ± 0.9, 33.5 ± 1.1, 22.9 ± 1.1, and 13.7 ± 1.2% for concentrations of 5, 10, 15, and 20 ppm, whereas Ag-NPs at a concentration of 25 and 30 ppm caused complete egg mortality (100%). The obtained data confirmed the applicability of biosynthesized Ag-NPs to the biocontrol of A. aegypti at low concentrations

Mycosynthesis, Characterization, and Mosquitocidal Activity of Silver Nanoparticles Fabricated by Aspergillus niger Strain

Herein, silver nanoparticles (Ag-NPs) were synthesized using an environmentally friendly approach by harnessing the metabolites of Aspergillus niger F2. The successful formation of Ag-NPs was checked by a color change to yellowish-brown, followed by UV-Vis spectroscopy, Fourier transforms infrared (FT-IR), Transmission electron microscopy (TEM), and X-ray diffraction (XRD). Data showed the successful formation of crystalline Ag-NPs with a spherical shape at the maximum surface plasmon resonance of 420 nm with a size range of 3&ndash;13 nm. The Ag-NPs showed high toxicity against I, II, III, and IV instar larvae and pupae of Aedes aegypti with LC50 and LC90 values of 12.4&ndash;22.9 ppm and 22.4&ndash;41.4 ppm, respectively under laboratory conditions. The field assay exhibited the highest reduction in larval density due to treatment with Ag-NPs (10&times; LC50) with values of 59.6%, 74.7%, and 100% after 24, 48, and 72 h, respectively. The exposure of A. aegypti adults to the vapor of burning Ag-NPs-based coils caused a reduction of unfed individuals with a percentage of 81.6 &plusmn; 0.5% compared with the positive control, pyrethrin-based coils (86.1 &plusmn; 1.1%). The ovicidal activity of biosynthesized Ag-NPs caused the hatching of the eggs with percentages of 50.1 &plusmn; 0.9, 33.5 &plusmn; 1.1, 22.9 &plusmn; 1.1, and 13.7 &plusmn; 1.2% for concentrations of 5, 10, 15, and 20 ppm, whereas Ag-NPs at a concentration of 25 and 30 ppm caused complete egg mortality (100%). The obtained data confirmed the applicability of biosynthesized Ag-NPs to the biocontrol of A. aegypti at low concentrations

Design and Synthesis of Novel Heterocyclic-Based 4H-benzo[h]chromene Moieties: Targeting Antitumor Caspase 3/7 Activities and Cell Cycle Analysis

Novel fused chromenes (4,7&ndash;11) and pyrimidines (12&ndash;16) were designed, synthesized, and evaluated for their mammary gland breast cancer (MCF-7), human colon cancer (HCT-116), and liver cancer (HepG-2) activities. The structural identity of the synthesized compounds was established according to their spectroscopic analysis, such as FT-IR, NMR, and mass spectroscopy. The preliminary results of the bioassay disclosed that some of the target compounds were proven to have a significant antiproliferative effect against the three cell lines, as compared to Doxorubicin, Vinblastine, and Colchicine, used as reference drugs. Particularly, compounds 7 and 14 exerted promising anticancer activity towards all cell lines and were chosen for further studies, such as cell cycle analysis, cell apoptosis, caspase 3/7 activity, DNA fragmentation, cell invasion, and migration. We found that these potent cytotoxic compounds induced cell cycle arrest at the S and G2/M phases, prompting apoptosis. Furthermore, these compounds significantly inhibit the invasion and migration of the different tested cancer cells. The structure-activity relationship (SAR) survey highlights that the antitumor activity of the desired compounds was affected by the hydrophobic or hydrophilic nature of the substituent at different positions

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

International audienceBackground: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/ hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH 2 O, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmH 2 O, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury