A Prospective Observational Study Comparing Oxygen Saturation/Fraction of Inspired Oxygen Ratio with Partial Pressure of Oxygen in Arterial Blood/Fraction of Inspired Oxygen Ratio among Critically Ill Patients Requiring Different Modes of Oxygen Supplementation in Intensive Care Unit.

Background: Intensive care unit (ICU) patients face a significant rise in mortality rates due to acute hypoxemic respiratory failure (AHRF). The diagnosis of AHRF is based on the PF ratio, but it has limitations in resource-constrained settings. Instead, the Kigali modification suggests using the oxygen saturation/fraction of inspired oxygen (SF) ratio. This study aims to correlate SF ratio and arterial oxygen pressure (PF) ratio in critically ill adults with hypoxemic respiratory failure, who required O2 therapy through different modes of oxygen supplementation. Materials and methods: In an ICU, a prospective observational study included 125 adult AHRF patients receiving oxygen therapy, with data collected on FiO2, PaO2, and SpO2. The SF ratio and PF ratio were calculated, and their correlation was assessed using statistical analysis. The receiver operator characteristics (ROC) curve analysis was conducted to assess the diagnostic precision of the SF ratio in identifying AHRF. Results: Data from a total of 250 samples were collected. The study showed a positive correlation (r = 0.622) between the SF ratio and the PF ratio. The SF threshold values of 252 and 321 were established for PF values of 200 and 300, respectively, featuring a sensitivity of 69% and specificity of 95%. Furthermore, it is worth noting that the PF ratio and SF ratio are interchangeable, regardless of the type of oxygen therapy, as the median values of both the PF ratio and SF ratio displayed statistical significance (p < 0.01) in both acidosis and alkalosis conditions. Conclusion: For patients with AHRF, the noninvasive SF ratio can effectively serve as a substitute for the invasive PF ratio across all oxygen supplementation modes. How to cite this article: Alur TR, Iyer SS, Shah JN, Kulkarni S, Jedge P, Patil V. A Prospective Observational Study Comparing Oxygen Saturation/Fraction of Inspired Oxygen Ratio with Partial Pressure of Oxygen in Arterial Blood/Fraction of Inspired Oxygen Ratio among Critically Ill Patients Requiring Different Modes of Oxygen Supplementation in Intensive Care Unit. Indian J Crit Care Med 2024; 28(3):251-255.

Endotracheal Intubation with King Vision Video Laryngoscope vs Macintosh Direct Laryngoscope in ICU: A Comparative Evaluation of Performance and Outcomes.

Background: Endotracheal intubation to protect airway patency in critically ill patients with the use of videolaryngoscopes has been emerging and their expertise to handle is crucial. Our study focuses on the performance and outcomes of King Vision video laryngoscope (KVVL) in intensive care unit (ICU) compared to Macintosh direct laryngoscope (DL). Materials and methods: This comparative study was conducted by randomizing 143 critically ill patients in ICU into two groups: KVVL and Macintosh DL (n = 73; n = 70). The intubation difficulty was assessed by Mallampati score III or IV, apnea syndrome (obstructive), cervical spine limitation, opening mouth <3 cm, coma, hypoxia, anesthesiologist nontrained (MACOCHA) score. The primary endpoint was the glottic view measured by Cormack-Lehane (CL) grading. The secondary endpoints were a first-pass success, the time required for intubation, airway morbidities, and manipulations required. Results: The KVVL group showed the primary endpoint of significantly improved glottic visualization measured in terms of CL grading compared with the Macintosh DL group (p < 0.001). In the KVVL group, the first pass success rate was higher (95.7%) compared to the Macintosh DL group (81.4%) (p < 0.05). The time required for intubation in the KVVL group (28.77 ± 2.63 seconds) was significantly less compared with Macintosh DL (38.84 ± 2.72 seconds) group (p < 0.001). The airway morbidities observed were similar in both groups (p = 0.5) and the manipulation required for endotracheal intubation was significantly less (p < 0.05) in our KVVL group (16 cases; 23%) compared to the Macintosh DL group (8 cases; 10%). Conclusion: We found that the performance and outcomes of KVVL in intubating critically ill ICU patients were promising when handled by experienced operators who are experts in anesthesiology and airway management. How to cite this article: Dharanindra M, Jedge PP, Patil VC, Kulkarni SS, Shah J, Iyer S, et al. Endotracheal Intubation with King Vision Video Laryngoscope vs Macintosh Direct Laryngoscope in ICU: A Comparative Evaluation of Performance and Outcomes. Indian J Crit Care Med 2023;27(2):101-106.

Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study).

Background: Critically ill patients are frequently transported to various locations within the hospital for diagnostic and therapeutic purposes, which increases the risk of adverse events (AEs). This multicenter prospective observational study was undertaken to determine the incidence of AEs related to intrahospital transport, their severity, and their effects on patient outcomes. Patients and methods: We included consecutive unstable critically ill patients requiring intrahospital transport, across 15 Indian tertiary care centers over 5 months (October 11, 2022-February 20, 2023). Apart from the demographics and severity of illness, data related to transport itself, such as indications and destination, incidence of AEs, their category and treatment required, and patient outcomes, were recorded in a standard form. Results: Eight hundred and ninety-three patients were transported on 1065 occasions out of the intensive care unit (ICU). The mean (SD) acute physiology and chronic health evaluation II score of the patients was 15.38 (±7.35). One hundred and two AEs occurred, wherein cardiovascular instability was the most common occurrence (31, 30.4%). Two patients had cardiac arrest immediately after transport. Acute physiology and chronic health evaluation II [odds ratio (OR): 1.02, 95% confidence interval (CI) - 1.00-1.05, p = 0.04], emergent transport (OR: 5.11, 95% CI - 3.32-7.88, p = 0.00), and team composition (OR: 5.34, 95% CI - 1.63-17.5, p = 0.00) during transport were found to be independent predictors of AEs. Conclusion: We found a high incidence of AEs during intrahospital transport of critically ill patients. These events were more common during emergent transports and when the patients were transported by doctors. Transport by itself was not related to ICU mortality. We feel that stabilization of the patients before transport and adherence to a standardized protocol may help in minimizing the AEs, thereby enhancing patient safety. How to cite this article: Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Dixit SB, Munjal M, et al. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study). Indian J Crit Care Med 2023;27(9):635-641.

Stress Level and Its Determinants among Staff (Doctors and Nurses) Working in the Critical Care Unit.

Background: Very few extensive studies regarding job stressors among doctors and nurses have been conducted in India. It is important to explore the workplace to understand various stressors that adversely affect the well-being of an individual and also affect health care and needs of patients and relatives. Considering this, the present study was planned to determine stress among doctors and nurses from the critical care unit (CCU) and to find the association of stress with selected variables. Materials and methods: This observational cross-sectional study was conducted among all staff (doctors and nurses) from the CCU. Data were collected with a pilot-tested, predesigned, validated questionnaire using the Google survey tool consisting of sociodemographic details and the ICMR work stress questionnaire. Analysis of data was done with SPSS version 25. Results: Of 105 participants, 57 (54.3%) were doctors and 48 (45.7%) were nurses. A total of 48.6% (51) of participants scored 32 of 64, that is, managed stress very well, and 51.4% of participants (54) scored 65 of 95, that is, having a reasonably safe level of stress, but certain areas need improvement. Conclusion: Stress was significantly more among females and those who have sleep problems. No statistically significant difference was found between the level of stress and age, relationship with seniors, exercise, and comorbidities. How to cite this article: Patil VC, Patil SV, Shah JN, Iyer SS. Stress Level and Its Determinants among Staff (Doctors and Nurses) Working in the Critical Care Unit. Indian J Crit Care Med 2021;25(8):886-889.

Sono-Maceration - a rapid and inexpensive method for the isolation of ursolic acid from Neolamarckia cadamba leaves.

This article records for the first time the isolation of Ursolic acid from the leaves of Neolamarckia cadamba (Roxb.) Bosser (Family: Rubiaceae) using ultrasonic waves. This bioactive triterpenic acid was isolated without its isomer, oleanolic acid, in a very convenient way with good yield. The structure was identified by means of one dimensional Nuclear Magnetic Resonance (NMR) spectroscopic techniques like 1H NMR, 13C NMR, distortionless enhancement by polarization transfer (DEPT) and two dimensional NMR spectroscopic method for example, heteronuclear single quantum coherence (HSQC). It was also assayed for antidiabetic and antioxidant potencies. About 71.5 mg of pure ursolic acid was isolated from 2.6 grams of ethyl acetate soluble fraction using sono-maceration as an extraction technique.

Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India.

BACKGROUND: This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. METHODS: We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson's correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. RESULTS: In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. CONCLUSIONS: The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

Platelet derived exosomes disrupt endothelial cell monolayer integrity and enhance vascular inflammation in dengue patients.

Background: Thrombocytopenia is the most notable phenomenon in dengue. Activation status of platelets and interaction of platelets with endothelium contribute towards dengue disease pathogenesis. Platelets are the major cell types known to release extracellular vesicles, especially exosomes in circulation. However, the role of platelet derived exosomes (PLT-EXOs) in endothelial dysfunction during dengue infection remains unknown. Methods: In this study, we recruited 28 healthy subjects and 69 dengue patients categorized as WS- (n=31), WS+ (n=29) and SD (n=9). Platelets were isolated from platelet rich plasma of dengue patients and their activation was assessed by flow cytometry. PLT-EXOs were isolated by ultracentrifugation method. Western blot analyses were performed to characterize the exosomes. Exosome uptake experiment was carried out to see the internalization of exosomes inside endothelial cells (HUVECs). To observe the effect of exosomes on endothelial cells, exosomes were added on HUVECs and expression of adherens and tight junctional proteins were examined by immunofluorescence assay and western blot. Expression levels of vascular injury markers were measured in the culture supernatants of Exosome-HUVEC coculture and sera of dengue patients by MSD-multiplex assay. Results: As compared to healthy subjects, CD41/CD61 expression was significantly reduced (p<0.0001) and CD62p expression was significantly increased (p<0.0001) on platelets in dengue patients. PLT-EXOs isolated from the dengue patients showed higher expression of CD63 and CD9 proteins than the healthy subjects. With in-vitro immunofluorescence assays, we illustrated the internalization of PLT-EXOs by the HUVECs and observed disruption of endothelial cell monolayer integrity in the presence of PLT-EXOs from WS+ and SD patients. Furthermore, the significant reduction in the expressions of ZO-2, VE-Cadherin and CD31 in endothelial cells following exposure to PLT-EXOs from the dengue patients provide direct evidence of PLT-EXOs mediated vascular permeability. PLT-EXOs stimulated the release of inflammatory markers CRP, SAA, sVCAM-1 and sICAM-1 in the supernatants of HUVEC cells. Importantly, significantly higher levels of CRP, sVCAM-1 and sICAM-1 in the sera of severe than mild dengue patients (p<0.0001) suggest their role in disease severity. Conclusions: In summary, our data suggest that PLT-EXOs promote vascular leakage via release of proinflammatory mediators and compromise vascular barrier integrity in dengue patients.

Click gold quantum dots biosynthesis with conjugation of quercetin for adenocarcinoma exertion.

We developed a cost-effective and eco-friendly click biosynthesis of small molecule quercetin-gold quantum dots (QRT-AuQDs) involving quick conjugation using an ultrasonication method at ambient temperature by utilizing QRT and gold ions in the proportion of 0.1 : 1 (molar ratio). A comparatively very short amount of time (60 seconds) was required as compared to conventional procedures. The present biomimetics research relates to the isolation of bioactive QRT by the circularly spread silica gel layer technique (CSSGLT) and characterization (UV-Vis, FTIR, NMR and DSC analysis). Characterization of the synthesized QRT-AuQDs conjugated complex was carried out by UV-Vis, HR-TEM, DLS, zeta potential and X-ray diffraction. The main objective of the present work was to study the comparative anticancer activity of QRT and QRT-AuQDs on human lung cancer HOP-62 and leukemia K-562 cell lines. The results suggested that QRT-AuQDs showed potential for applications in anticancer treatment and were found to be a more cytotoxic agent in comparison to QRT, causing > 50% inhibition of cancer cells at the concentration < 10-7 M. Hence, small molecule conjugated QRT-AuQDs can be used as a promising material for biomedical, bioengineering and anti-infectives applications.

Economical gold recovery cycle from bio-sensing AuNPs: an application for nanowaste and COVID-19 testing kits.

We report the controlled growth of biologically active compounds: gold nanoparticles (AuNPs) in various shapes, including their green synthesis, characterization, and studies of their applications towards biological, degradation and recycling. Using spectroscopic methods, studies on responsive binding mechanisms of AuNPs with biopolymers herring sperm deoxyribonucleic acid (hsDNA), bovine serum albumin (BSA), dyes degradation study, and exquisitely gold separation studies/recovery from nanowaste, COVID-19 testing kits, and pregnancy testing kits are discussed. The sensing ability of the AuNPs with biopolymers was investigated via various analytical techniques. The rate of degradation of various dyes in the presence and absence of AuNPs was studied by deploying stirring, IR, solar, and UV-Vis methods. AuNPs were found to be the most active cytotoxic agent against human breast cancer cell lines such as MCF-7 and MDAMB-468. Furthermore, an economical process for the recovery of gold traces from nanowaste, COVID-19 detection kits, and pregnancy testing kits was developed using inexpensive and eco-friendly α-cyclodextrin sugar. This method was found to be easy and safest in comparison with the universally accepted cyanidation process. In the future, small gold jewelry makers and related industries would benefit from the proposed gold-recycling process and it might contribute to their socio-economic growth. The methodologies proposed are also beneficial for trace-level forensic investigation.

Deciphering the sensing of α-amyrin acetate with hs-DNA: a multipronged biological probe.

In this study, we focus on the biomimetic development of small molecules and their biological sensing with DNA. The binding of herring sperm deoxyribonucleic acid (hs-DNA) with naturally occurring bioactive small molecule α-amyrin acetate (α-AA), a biomimetic - isolated from the leaves of Ficus (F.) arnottiana is investigated. Collective information from various imaging, spectroscopic and biophysical experiments provides evidence that α-AA is a minor groove sensor of hs-DNA and preferentially binds to the A-T-rich regions. Interactions of different concentrations of small molecule α-AA with hsDNA were evaluated via various analytical techniques such as UV-Vis, circular dichroism (CD) and fluorescence emission spectroscopy. Fluorescence emission spectroscopy results suggest that α-AA decreases the emission level of hsDNA. DNA minor groove sensor Hoechst 33258 and intercalative sensor EB, melting transition analysis (T M) and viscosity analysis clarified that α-AA binds to hs-DNA via a groove site. Biophysical chemistry and molecular docking studies show that hydrophobic interactions play a major role in this binding. The present research deals with a natural product biosynthesis-linked chemical-biology interface sensor as a biological probe for α-AA: hs-DNA.

Nanocomposite of functional silver metal containing curcumin biomolecule model systems: Protein BSA bioavailability.

Curcumin, a constituent of Curcuma longa L-Zingiberaceae is used in traditional Indian and worldwide medicine and shows anticancer and antioxidant properties. Curcumin has numerous biological and pharmacological activities but due to its hydrophobic nature, the major drawback is poor absorption and rapid elimination, rendering curcumin with the tag of a poor biomaterial. Hence, there is a need to develop functional metal containing curcumin model systems (FMCCMS) as a metallo-biomolecule to enhance the bioavailability of curcumin. We designed the interaction of silver metal ion with curcumin to form curcumin-silver nanocomposite (CURC-AgNCP) via ultrasonic synthetic route. Formations of FMCCMS were characterized by spectroscopic techniques. The crystalline face-centered cubic pattern and particle size of the nanocomposite was evaluated using X-ray diffraction and high-resolution transmission electron microscopy. The bonding of silver metal to curcumin was confirmed by X-ray photon spectroscopy. Interaction of the nanocomposite with bovine serum albumin (BSA) protein was performed using excitation, emission, and circular dichroism spectroscopy. In binding interaction of BSA, the negative value of ∆S° (-358.04 J mol-1 K-1) and ∆H° (-129.42 KJ mol-1) demonstrates the hydrophilic nature of the nanocomposite. The binding distance r evaluated according to the Forster resonance energy transfer theory and was 4.69 nm for CURC-AgNCP, which suggested non-radiative transfer of energy between CURC-AgNCP and BSA. The role of FMCCMS metallo-biomolecule CURC-AgNCP in medicine for cancer activity can have immense importance and hence we performed Sulphorhodamine B based in-vitro cytotoxicity assay on human breast cancer Michigan Cancer Foundation-7 cell line.

Hydrophobic interpenetrating polyamide-PDMS membranes for desalination, pesticides removal and enhanced chlorine tolerance.

Hydrophobic membranes for desalination and toxic organic pollutant removal have been fabricated using polyamide - PDMS (polydimethylsiloxane) chemistries in a one-step protocol. The curing of polyamide and PDMS are orthogonal and co-curing both networks imparts hydrophobicity to the thin film composite membranes. The membranes exhibit increased adsorption of pesticides from the feed water along with maintaining excellent salt rejection capability (97% NaCl rejection), thus giving the membranes a multifunctional character. Three toxic pesticides have been used in this study to demonstrate the viability of combining osmosis desalination technology with organic matter adsorption. The membranes also show excellent resistance to fouling by toxic pesticides (85% salt rejection vs 67% for commercial membranes in the presence of pesticides) and significantly improved chlorine tolerance (93.8% salt rejection vs 86.5% for commercial membranes after 20 h of exposure to sodium hypochlorite solution).

Revisiting the phylogenetic position of Synchroma grande.

Two new classes Synchromophyceae and Picophagea, belonging to the heterokonts, have been proposed recently in separate studies of 18S rRNA phylogenies. Here we revise the 18S phylogeny of these classes by including all available sequenced species and applying Bayesian and maximum likelihood methods; Synchroma grande groups with the photophagotrophic Chlamydomyxa labyrinthuloides with high statistical support. This clade is sister to Chrysophyceae, together they share a common ancestry. Our results show that the creation of class Synchromophyceae by Horn et al. was premature, because they did not include data from the closely related C. labyrinthuloides and Picophagus flagellatus species. A revision of these classes should include additional species and most likely multigene phylogenies.

Synthesis, spectral and biological studies on some mixed ligand Ni(II) complexes.

Mixed ligand Ni(II) complexes of the type [M(Q)(L) x 2H2O] have been synthesized by using 8-hydroxyquinoline (HQ) as a primary ligand and N- and/or O- donor amino acids (HL) such as L-serine, L-isoleucine, L-proline, 4-hydroxy-L-proline and L-threonine as secondary ligands. The metal complexes have been characterized on the basis of elemental analysis, electrical conductance, room temperature magnetic susceptibility measurements, spectral and thermal studies. The electrical conductance studies of the complexes in methanol at 10(-3) M concentration indicate their non-electrolytic nature. Room temperature magnetic susceptibility measurements revealed paramagnetic nature of the complexes. Electronic absorption spectra of the complexes show intra-ligand, charge transfer and d-d transitions, respectively. The thermal analysis data of the complexes indicate the presence of coordinated water molecules. Tube dilution method has been used to study the antibacterial activity of the complexes against the pathogenic bacteria C. diphtheriae, S. aureus and C. albicans. The results have been compared with those of control tetracycline, which was screened simultaneously and indicated mild antibacterial activity of the complexes.

The lived experience of Australian opioid replacement therapy recipients in a community-based program in regional Victoria.

INTRODUCTION AND AIMS: Treatment of opioid dependence through opioid replacement therapy is widely recognised as effective. Nonetheless, while there has been a community-based program in the state of Victoria for over two decades, consumer experiences have received little attention. This study aimed to describe the experiences of opioid replacement therapy consumers living in rural and regional areas of the state. DESIGN AND METHODS: A qualitative design employed an interpretative phenomenological approach. Sixteen consumers were interviewed. Thematic analysis was conducted by the researchers to examine the phenomena of consumers' experiences and findings were verified by a stakeholder group. RESULTS: Findings centred on themes of consumers' experience of becoming recipients; consumer perceptions of pharmacists and pharmacy settings and psychosocial impacts on consumers. A majority of participants believed opioid replacement therapy brought increased normality to their life, however systemic and psychosocial barriers impacted on well-being. The pharmacy setting itself as a public dosing space commonly provoked feelings of stigma and discrimination among consumers. Other barriers prominently reported were restrictions on number of takeaways, cost of dispensing and lack of access to medical practitioners and allied supports. DISCUSSION AND CONCLUSIONS: There were psychosocial impacts on opioid replacement therapy consumers relating to financial and social burdens, stigma and discrimination. Access to medical care and a choice of pharmacy appeared to be restricted in rural regions. The findings suggest a need to address, in particular, the financial and dispensing point burdens experienced by consumers to facilitate program retention.

Towards sustainable production of biofuels from microalgae.

Renewable and carbon neutral biofuels are necessary for environmental and economic sustainability. The viability of the first generation biofuels production is however questionable because of the conflict with food supply. Microalgal biofuels are a viable alternative. The oil productivity of many microalgae exceeds the best producing oil crops. This paper aims to analyze and promote integration approaches for sustainable microalgal biofuel production to meet the energy and environmental needs of the society. The emphasis is on hydrothermal liquefaction technology for direct conversion of algal biomass to liquid fuel.

Prevalence of Hypocalcemia in Seizures in Infancy.

A one-year prospective study on developmentally normal children between 1-mo to 2-y with seizures was done to study the prevalence of hypocalcemia. The contribution of hypovitaminosis-D to hypocalcemia was also studied. Of 78 infants (51 boys) enrolled, 18 (23.1%) had hypocalcemia. Fifteen (19.2%) had hypocalcemia secondary to hypovitaminosis-D and 3 (3.8%) had hypomagnesemia. In infants aged less than 6 mo who were exclusively breastfed, 15 (41.67%) had hypocalcemia in comparison to other two age groups [2 (10.53%) in 6-12 mo age-group and 1 (4.35%) in 1-2 y age-group]. This association was statistically significant (p = 0.001).