Seasonality of hydrogeochemical evolutions and isotopic variabilities (δ18O, δ2H and d-excess) in the surface water as well as groundwater from tropical central-south Mexico.

Due to adverse impact of the global warming on hydrological resources, we intended to document the hydrogeochemical evolutions of surface and groundwater at tropical central-south Mexico in terms of seasonality of rock-water interaction, precipitation/evaporation variation and moisture source by evaluating the major ion chemistry in Piper and Gibbs plots, Durov diagram and through estimation of the chloro-alkaline indices as well as assessing the stable isotope compositions (δ18O and δ2H) in samples from different seasons of a year. Surface water of the Lake Coatetelco shifted from mostly Ca-Mg-HCO3 facies in wet summer-autumn to Na-HCO3-Cl facies in the dry spring due to elevated Na, Cl and HCO3. Greater evaporation in spring led to a maximum δ18O enrichment of ca.7‰ compared to the other seasons, and much depleted deuterium excess (-40.92‰ to -39.20‰). Interaction of the lake water with subsurface carbonate lithologies, and comparable isotopic compositions reflected the enhanced interaction between the surface water body and aquifers in the wet autumn. Effect of seasonality, however, was unclear on the groundwater facies, and its heterogenous composition (Ca-Mg-HCO3, Na-HCO3-Cl and Na-HCO3) reflected the interactions with different lithologies. Fractionations in isotope compositions of the groundwater were caused from recharge at different elevations, seasonality of moisture sources and moisture recycling. The water-mineral saturation index was an efficient proxy of seasonality as the lake water and groundwater (avg SIcalcite > 0.5) of the dry autumn were saturated with calcite. This vital information about carbonate precipitation, pCO2 and chemical facies would be useful for the better interpretation of paleoclimate archives in this region.

Oxygenation saturation index in neonatal hypoxemic respiratory failure.

BACKGROUND: This study aimed to assess the validity of the oxygenation saturation index (OSI) and the ratio of oxygen saturation to the fraction of inspired oxygen (FIO2) (S/F ratio) with percutaneous oxygen saturation (OSISpO2 and the Sp/F ratio) and to evaluate the correlation between these values and the oxygen index (OI). It also determined their cut-off values for predicting OI in accordance with neonatal hypoxic respiratory failure severity. METHODS: We reviewed the data of 77 neonates (gestational age 31.7 ± 6.1 weeks; birthweight, 1768 ± 983 g) requiring invasive mechanical ventilation between 2013 and 2020, 1233 arterial blood gas samples in total. We calculated the OI, OSISpO2, OSI with arterial oxygen saturation (SaO2) (OSISaO2), Sp/F ratio, and the ratio of SaO2 to FIO2 (Sa/F ratio). RESULTS: The regression and Bland-Altman analysis showed good agreement between OSISpO2 or the Sp/F ratio and OSISaO2 or the Sa/F ratio. Although a significant positive correlation was found between OSISpO2 and OI, OSISpO2 was overestimated in SpO2 > 98% with a higher slope of the fitted regression line than that below 98% of SpO2. Furthermore, receiver-operating characteristic curve analysis using only SpO2 ≤ 98% samples showed that the optimal cut-off points of OSISpO2 and the Sp/F ratio for predicting OI were: OI 5, 3.0 and 332; OI 10, 5.3 and 231; OI 15, 7.7 and 108; OI 20, 11.0 and 149; and OI 25, 17.1 and 103, respectively. CONCLUSION: The cut-off OSISpO2 and Sp/F ratio values could allow continuous monitoring for oxygenation changes in neonates with the potential for wider clinical applications.

Hemochromatosis: Ferroptosis, ROS, Gut Microbiome, and Clinical Challenges with Alcohol as Confounding Variable.

Hemochromatosis represents clinically one of the most important genetic storage diseases of the liver caused by iron overload, which is to be differentiated from hepatic iron overload due to excessive iron release from erythrocytes in patients with genetic hemolytic disorders. This disorder is under recent mechanistic discussion regarding ferroptosis, reactive oxygen species (ROS), the gut microbiome, and alcohol abuse as a risk factor, which are all topics of this review article. Triggered by released intracellular free iron from ferritin via the autophagic process of ferritinophagy, ferroptosis is involved in hemochromatosis as a specific form of iron-dependent regulated cell death. This develops in the course of mitochondrial injury associated with additional iron accumulation, followed by excessive production of ROS and lipid peroxidation. A low fecal iron content during therapeutic iron depletion reduces colonic inflammation and oxidative stress. In clinical terms, iron is an essential trace element required for human health. Humans cannot synthesize iron and must take it up from iron-containing foods and beverages. Under physiological conditions, healthy individuals allow for iron homeostasis by restricting the extent of intestinal iron depending on realistic demand, avoiding uptake of iron in excess. For this condition, the human body has no chance to adequately compensate through removal. In patients with hemochromatosis, the molecular finetuning of intestinal iron uptake is set off due to mutations in the high-FE2+ (HFE) genes that lead to a lack of hepcidin or resistance on the part of ferroportin to hepcidin binding. This is the major mechanism for the increased iron stores in the body. Hepcidin is a liver-derived peptide, which impairs the release of iron from enterocytes and macrophages by interacting with ferroportin. As a result, iron accumulates in various organs including the liver, which is severely injured and causes the clinically important hemochromatosis. This diagnosis is difficult to establish due to uncharacteristic features. Among these are asthenia, joint pain, arthritis, chondrocalcinosis, diabetes mellitus, hypopituitarism, hypogonadotropic hypogonadism, and cardiopathy. Diagnosis is initially suspected by increased serum levels of ferritin, a non-specific parameter also elevated in inflammatory diseases that must be excluded to be on the safer diagnostic side. Diagnosis is facilitated if ferritin is combined with elevated fasting transferrin saturation, genetic testing, and family screening. Various diagnostic attempts were published as algorithms. However, none of these were based on evidence or quantitative results derived from scored key features as opposed to other known complex diseases. Among these are autoimmune hepatitis (AIH) or drug-induced liver injury (DILI). For both diseases, the scored diagnostic algorithms are used in line with artificial intelligence (AI) principles to ascertain the diagnosis. The first-line therapy of hemochromatosis involves regular and life-long phlebotomy to remove iron from the blood, which improves the prognosis and may prevent the development of end-stage liver disease such as cirrhosis and hepatocellular carcinoma. Liver transplantation is rarely performed, confined to acute liver failure. In conclusion, ferroptosis, ROS, the gut microbiome, and concomitant alcohol abuse play a major contributing role in the development and clinical course of genetic hemochromatosis, which requires early diagnosis and therapy initiation through phlebotomy as a first-line treatment.

Oxygenation Index and Oxygen Saturation Index for Predicting Postoperative Outcome in Patients Undergoing Emergency Surgery: A Prospective Cohort Study.

Background: The OI was originally evaluated as a prognostic tool for acute hypoxemic respiratory failure in children and was an independent predictor for mortality in adult patients with acute respiratory distress syndrome (ARDS). Methods: Oxygenation index and OSI of 201 adult patients undergoing emergency surgery were evaluated at different time points. The primary objective of this study was to find the correlation between OI and OSI. The secondary objectives were to find the prognostic utility of OI and OSI for postoperative mechanical ventilation and mortality. Results: Significant statistical correlation was found between OI and OSI both at the beginning (r 2 = 0.61; p < 0.001) and immediately after surgery (r 2 = 0.47; p < 0.001). Oxygen saturation index at the beginning [area under the receiver operating characteristics curve (AUROC) (95% CI) 0.76 (0.62-0.89); best cutoff 3.9, sensitivity 64% and specificity 45%] and immediately after surgery [AUROC (95% CI) 0.82 (0.72-0.92); best cutoff 3.57, sensitivity 79%, and specificity 62%] were reasonable predictors of the requirement of invasive ventilatory support. Exploratory analysis reported that older age (p = 0.02), higher total leukocyte count (p = 0.002), higher arterial lactate (p = 0.02), and higher driving pressure (p < 0.001) were independently associated with hospital mortality. Conclusion: In adult patients undergoing emergency laparotomy under general anesthesia, OI and OSI were found to be correlated. Both metrics demonstrated reasonable accuracy in predicting the need for invasive ventilatory support beyond 24 hours and hospital mortality. How to cite this article: Thakuria R, Ernest EE, Chowdhury AR, Pangasa N, Kayina CA, Bhattacharjee S, et al. Oxygenation Index and Oxygen Saturation Index for Predicting Postoperative Outcome in Patients Undergoing Emergency Surgery: A Prospective Cohort Study. Indian J Crit Care Med 2024;28(7):645-649.

Muscle Oxygenation and Microvascular Reactivity Across Different Stages of CKD: A Near-Infrared Spectroscopy Study.

RATIONALE & OBJECTIVE: Previous studies in chronic kidney disease (CKD) showed that vascular dysfunction in different circulatory beds progressively deteriorates with worsening CKD severity. This study evaluated muscle oxygenation and microvascular reactivity at rest, during an occlusion-reperfusion maneuver, and during exercise in patients with different stages of CKD versus controls. STUDY DESIGN: Observational controlled study. SETTING & PARTICIPANTS: 90 participants (18 per CKD stage 2, 3a, 3b, and 4, as well as 18 controls). PREDICTOR: CKD stage. OUTCOME: The primary outcome was muscle oxygenation at rest. Secondary outcomes were muscle oxygenation during occlusion-reperfusion and exercise, and muscle microvascular reactivity (hyperemic response). ANALYTICAL APPROACH: Continuous measurement of muscle oxygenation [tissue saturation index (TSI)] using near-infrared spectroscopy at rest, during occlusion-reperfusion, and during a 3-minute handgrip exercise (at 35% of maximal voluntary contraction). Aortic pulse wave velocity and carotid intima-media thickness were also recorded. RESULTS: Resting muscle oxygenation did not differ across the study groups (controls: 64.3% ± 2.9%; CKD stage 2: 63.8% ± 4.2%; CKD stage 3a: 64.1% ± 4.1%; CKD stage 3b: 62.3% ± 3.3%; CKD stage 4: 62.7% ± 4.3%; P=0.6). During occlusion, no significant differences among groups were detected in the TSI occlusion magnitude and TSI occlusion slope. However, during reperfusion the maximum TSI value was significantly lower in groups of patients with more advanced CKD stages compared with controls, as was the hyperemic response (controls: 11.2%±3.7%; CKD stage 2: 8.3%±4.6%; CKD stage 3: 7.8%±5.5%; CKD stage 3b: 7.3%±4.4%; CKD stage 4: 7.2%±3.3%; P=0.04). During the handgrip exercise, the average decline in TSI was marginally lower in patients with CKD than controls, but no significant differences were detected across CKD stages. LIMITATIONS: Moderate sample size, cross-sectional evaluation. CONCLUSIONS: Although no differences were observed in muscle oxygenation at rest or during occlusion, the microvascular hyperemic response during reperfusion was significantly impaired in CKD and was most prominent in more advanced CKD stages. This impaired ability of microvasculature to respond to stimuli may be a crucial component of the adverse vascular profile of patients with CKD and may contribute to exercise intolerance. PLAIN-LANGUAGE SUMMARY: Previous studies in chronic kidney disease (CKD) have shown that vascular dysfunction in different circulatory beds progressively deteriorates with CKD severity. This study evaluated muscle oxygenation and microvascular reactivity at rest, during an occlusion-reperfusion maneuver, and during exercise in patients with nondialysis CKD versus controls, as well as across different CKD stages. It showed that the microvascular hyperemic response after an arterial occlusion was significantly impaired in CKD and was worst in patients with more advanced CKD. No significant differences were detected in skeletal muscle oxygenation or muscle oxidative capacity at rest or during the handgrip exercise when comparing patients with CKD with controls or comparing across CKD stages. The impaired ability of microvasculature to respond to stimuli may be a component of the adverse vascular profile of patients with CKD and may contribute to exercise intolerance.

Comparison of the value of the STOP-BANG questionnaire with oxygen desaturation index in screening obstructive sleep apnea in Germany.

PURPOSE: Despite polysomnography being the gold standard method of diagnosing obstructive sleep apnea (OSA), it is time-consuming and has long waiting lists. Alternative methods including questionnaires and portable sleep devices have been developed to increase the speed of diagnosis. However, most questionnaires such as the STOP-BANG questionnaire (SBQ) are limited due to low specificity. This study evaluated the value of SBQ to screen for OSA and compared it with the oxygen desaturation index (ODI) and their combination. METHODS: This retrospective study included patients who completed the SBQ and underwent a night at the sleep lab or home sleep testing. The ODI was extracted from these sleep study reports. The combination of SBQ with ODI and their individual scores were compared with apnea-hypopnea index (AHI) in terms of their accuracy in diagnosing OSA. Sensitivity, specificity, and area under the curve (AUC) for different severities of OSA were calculated and compared. RESULTS: Among 132 patients, SBQ showed a sensitivity of 0.9 and a specificity of 0.3 to screen for OSA. As the severity of OSA increased, the sensitivity increased whilst specificity decreased for both measurements. ODI achieved an increased specificity of 0.8 and could correctly diagnose OSA 86% of the time which was better than SBQ's 60%. For all severities of OSA, ODI alone displayed a larger AUC than SBQ and similar AUC to their combination. CONCLUSION: ODI produced a higher specificity and AUC than SBQ. Furthermore, ODI combined with SBQ failed to increase diagnostic value. Therefore, ODI may be the preferred way to initially screen patients for OSA as an easy-to-use alternative compared to SBQ.

Therapeutic response of iNO in preterm infants with hypoxemic respiratory failure.

BACKGROUND: Inhaled nitric oxide (iNO) has been used as a rescue treatment for preterm infants with hypoxemic respiratory failure (HRF). However, its effectiveness remains debatable. Thus, in this study, we aimed to examine the impact of iNO therapy on HRF in extremely preterm infants. METHODS: A retrospective observational study was performed. Extremely preterm infants admitted to our neonatal intensive care unit who received iNO therapy later in their postnatal life were included. The oxygen saturation index (OSI) was used as an index of the severity of respiratory failure. RESULTS: In total, 30 extremely preterm infants were included in this study. Oxygenation was enhanced after the administration of iNO in infants with HRF. The OSI decreased by more than 20% in 12 patients (40%, positive responder) and did not decrease in 17 patients (57%, negative responder) within the first 6 h of treatment. The iNO initiation day was the significant independent factor associated with a positive response to iNO therapy in extremely preterm infants with HRF. CONCLUSIONS: iNO therapy was effective in enhancing oxygenation in extremely preterm infants with HRF. Earlier use of iNO was the significant factor associated with a positive therapeutic response to iNO, implying that iNO may be more effective in pulmonary vessels which are less damaged by shorter-term mechanical ventilation.

Groundwater pollutants characterization by geochemometric technique and geochemical modeling in tropical savanna watershed.

Multiple interactions of geogenic and anthropogenic activities can trigger groundwater pollution in the tropical savanna watershed. These interactions and resultant contamination have been studied using applied geochemical modeling, conventional hydrochemical plots, and multivariate geochemometric methods, and the results are presented in this paper. The high alkalinity values recorded for the studied groundwater samples might emanate from the leaching of carbonate soil derived from limestone coupled with low rainfall and high temperature in the area. The principal component analysis (PCA) unveils three components with an eigenvalue > 1 and a total dataset variance of 67.37%; this implies that the temporary hardness of the groundwater and water-rock interaction with evaporite minerals (gypsum, halite, calcite, and trona) is the dominant factor affecting groundwater geochemistry. Likewise, the PCA revealed anthropogenic contamination by discharging [Formula: see text] [Formula: see text][Formula: see text] and [Formula: see text] from agricultural activities and probable sewage leakages. Hierarchical cluster analysis (HCA) also revealed three clusters; cluster I reflects the dissolution of gypsum and halite with a high elevated load of [Formula: see text] released by anthropogenic activities. However, cluster II exhibited high [Formula: see text] and [Formula: see text] loading in the groundwater from weathering of bicarbonate and sylvite minerals. Sulfate ([Formula: see text]) dominated cluster III mineralogy resulting from weathering of anhydrite. The three clusters in the Maiganga watershed indicated anhydrite, gypsum, and halite undersaturation. These results suggest that combined anthropogenic and natural processes in the study area are linked with saturation indexes that regulate the modification of groundwater quality.

Distribution, geochemical behavior, and risk assessment of arsenic in different floodplain aquifers of middle Gangetic basin, India.

The present study interprets the distribution and geochemical behavior of As in groundwaters of different regions along the floodplains of Ganga river (Varanasi, Ghazipur, Ballia), Ghaghara river (Lakhimpur Kheri, Gonda, Basti), and Rapti river (Balrampur, Shrawasti) in the middle Gangetic basin, India for risk assessment (non-carcinogenic and carcinogenic). The concentration of As in groundwaters of these floodplains ranged from 0.12 to 348 µg/L (mean 24 µg/L), with around ~ 37% of groundwater samples exceeding the WHO limit of 10 µg/L in drinking water. Highest As concentration (348 µg/L) was recorded in groundwater samples from Ballia (Ganga Floodplains), where 50% of the samples had As > 10 µg/L in groundwater. In the study area, a relatively higher mean concentration was recorded in deep wells (28.5 µg/L) compared to shallow wells (20 µg/L). Most of the high As-groundwaters were associated with the high Fe, bicarbonate and low nitrate and sulfate concentrations indicating the release of As via reductive dissolution of Fe oxyhydroxides. The saturation index values of the Fe minerals such as goethite, hematite, ferrihydrite, and siderite showed the oversaturation to near equilibrium in groundwater, suggesting that these mineral phases may act as source/sink of As in the aquifers of the study area. The health risk assessment results revealed that a large number of people in the study area were prone to carcinogenic and non-carcinogenic health risks due to daily consumption of As-polluted groundwater. The highest risks were estimated for the aquifers of Ganga floodplains, as indicated by their mean HQ (41.47) and CR (0.0142) values.

Coupling hydrogeochemistry and stable isotopes (δ2H, δ18O and δ13C) to identify factors affecting arsenic enrichment of surface water and groundwater in Precambrian sedimentary rocks, eastern salt range, Punjab, Pakistan.

The study area is a part of the Salt Range, where water quality is being deteriorated by natural and anthropogenic sources. This research integrates water quality assessment, arsenic enrichment, hydrogeochemical processes, groundwater recharge and carbon sources in aquifer. Total dissolved solid (TDS) contents in springs water, lake water and groundwater are in range of 681-847 mg/L, 2460-5051 mg/L and 513-7491 mg/L, respectively. The higher concentrations of magnesium and calcium in water bodies next to sodium are because of carbonates, sulfates, halite and silicates dissolution. The average concentrations of ions in groundwater are in order of HCO3- > SO42- > Cl- > Na+ > Mg2+ > Ca2+ > K+ > NO3-, virtually analogous to springs water, but different from lake water, categorized as poor quality and unfit for drinking purposes. Based on major ions hydrochemistry, NaCl and mixed Ca-Mg-Cl type hydrochemical facies are associated with concentration of arsenic (4.2-39.5 µg/L) in groundwater. Groundwater samples (70%) having arsenic concentration (11 ≤ As ≤ 39.5 µg/L) exceeded from World Health Organization (WHO) guideline (As ≤ 10 µg/L) in near neutral to slightly alkaline (6.7 ≤ pH ≤ 8.3), positive Eh(6 ≤ Eh ≤ 204 mV), signifying its oxic condition. Eh-pH diagrams for arsenic and iron indicate that 80% of groundwater for arsenic and iron were in compartments of HAsO42- and Fe(OH)3, unveil oxic environment. Arsenic is moderately positive correlated with TDS, sodium, chloride, bicarbonate, nitrate, sulfate and weak negative with δ13CDIC in surface and groundwater, forecasting multiple sources of arsenic to aquifer. Stable isotopes of waters show recharge of groundwater from local rain and lake water. The lower δ13CDIC values of groundwater are modified by influx of CO2 produced during biological oxidation of soil natural organic matter.

Evaluating hydrogeochemical controls and noncarcinogenic health risk assessment of fluoride concentration in groundwater of Palacode and Pennagaram taluk, Dharmapuri district, Tamil Nadu, India.

This study focuses on assessing hydrochemical characteristics and non-carcinogenic health risks associated with fluoride contamination in groundwater within the Palacode and Pennagaram taluks of Dharmapuri district. The presence of fluoride in drinking water is a significant concern due to its potential health impacts on both adults and children. We collected a total of 158 groundwater samples during both the summer (SUM) and monsoon (MON) seasons in 2021 to evaluate the suitability of water for drinking purposes in this region. During the SUM season, groundwater exhibits alkaline characteristics with a pH range of 6.70 to 8.73 and a mean value of 7.43, while the MON season falls within the neutral pH range with values ranging from 6.60 to 7.60 and a mean of 7.00. Hydrogeochemical analysis reveals that fluoride concentrations during the SUM season range from 0.13 to 2.7 mg/L, with a mean of 0.82 mg/L, whereas the MON season exhibits concentrations ranging from 0.08 to 1.6 mg/L, with a mean of 0.5 mg/L. Spatial distribution analysis indicates a gradual increase in fluoride concentrations from the northeast to the central and southern parts of the study area during both seasons. Residents in these areas have been exposed to high fluoride levels for an extended period, leading to health issues related to fluorosis. Our hydrogeochemical analysis attributes fluoride dominance to the Cl--SO42- water type in both seasons. Furthermore, the relationship between fluoride and pH, HCO3-, Ca2+, and Na+ suggests the influence of geological factors in fluoride dissolution under alkaline conditions, while a reverse cation exchange process and increasing calcium concentration inhibit fluoride concentration. Saturation indices indicate that the unsaturated state of gypsum dissolution contributes to elevated fluoride levels in groundwater. Additionally, Gibbs plots highlight rock-water interactions as a significant factor influencing groundwater chemistry in the study area. Based on our hazard quotient (HQ) investigation, children are at a higher risk during both seasons compared to adults, with the central and northern regions showing alarming HQ values. These findings underscore the urgent need for enhanced groundwater quality monitoring and a comprehensive assessment of health risks, providing valuable insights for groundwater safety management in vulnerable areas of this region.

Hydrogeochemical characterisation and geospatial analysis of groundwater for drinking water quality in Ludhiana district of Punjab, India.

This study characterises the quality of groundwater for the Ludhiana district of Punjab, India by analysing water samples collected from 152 locations spread across 3767 km2. The samples were analysed for 18 parameters consisting of pH, EC, TDS, TA, TH, major anions and cations. The parameter values have been used to calculate the drinking water quality index of the study area which suggests that 2.6, 57.9, 32.9, 4 and 2.6% of the samples fall under the excellent, good, poor, very poor and unsuitable categories, respectively. The sequence of abundance for ions (in meq/l) as revealed from the laboratory tests is Na+ (37.1%) > Ca2+ (30.8%) > Mg2+ (29.1%) > K+ (2.8%) for cations and HCO3- (80%) > Cl¯ (8.9%) > CO32- (6.5%) > SO42- (3.9%) > NO3-, F-, PO43- (< 1%) for anions. The spatial variability of these parameters has been depicted through the use of interpolation maps. Evaluation of different ionic ratios indicates that carbonate weathering and silicate weathering are both significantly affecting the groundwater chemistry with a slight dominance of carbonate weathering. Also, the ion exchange process is taking place in the area as confirmed by CAI index values. In terms of saturation index, the groundwater is undersaturated with respect to halite, fluorite and sylvite, whereas it is supersaturated for calcite, dolomite and aragonite minerals. The principal components in PCA explained 75.4% of the total variance with 29.1 and 28.3% contributions from PC1 and PC2. Both of these components indicate towards the geogenic and anthropogenic influence on groundwater mineralization of the area. The analysis suggests that groundwater for the study area is suitable for drinking in most of the region expect in a few places. Such a study could be used to understand the current status of groundwater quality in the area, the results of which can be used to prevent further contamination and sustain the resource for the future.

Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study.

Background: Oxygenation index [OI = (MAP × FiO2 × 100)/PaO2] assesses the severity of hypoxic respiratory failure. Oxygen saturation index [OSI = (MAP × FiO2 × 100)/SpO2] is a noninvasive method to assesses the severity of hypoxic respiratory failure. Conventionally used PaO2/FiO2 (P/F) ratio to measure the severity of ARDS requires arterial blood gas (ABG) sampling. It tenders limited prognostic information mandating the need for better markers. Oxygenation index (needs arterial sampling) and OSI (a noninvasive method) are substitutes to provide mortality information in ARDS patients. We evaluated the correlation between P/F, OI, and OSI in invasively ventilated COVID-19 ARDS patients (C-ARDS) and looked at its relationship with mortality. Patients and methods: A retrospective study of invasively ventilated C-ARDS >18 years of age managed in COVID ICU. Ventilator settings (FiO2, mean airway pressure), pulse oximetry (SpO2), and ABG values (PaO2) were simultaneously noted at the time of sample collection. Patient outcomes (alive and deceased) were documented. Differences in parameters between survivors and nonsurvivors were assessed using independent sample t-test. Receiver operating characteristic (ROC) analysis with Youden's index was used to identify cutoff values to determine survival. Results: A total of 1557 measurements for 203 patients were collected over the maximum duration of 21 days after ventilation. About 147 (72.4%) were males and 56 (27.6%) were females. On day one of ventilation, 161 (79.3%) had P/F ratio <200, 28 (13.8%) had P/F ratio between 200 and 300, and 14 (6.9%) had P/F ratio >300. There was a linear relationship between P/F ratio and OSI (r = -0.671), P/F and OI (r = -0.753), and OSI and OI (r = 0.893) (p < 0.001). After natural log transform, the correlation between these factors became stronger [P/F ratio and OSI (r = -0.797), PF and OI (r = -0.949), and OSI and OI (r = 0.902) (p < 0.001)]. About 74 (36.5%) patients survived. Survivors had significantly higher P/F ratio as compared with nonsurvivors (p < 0.05). Oxygen saturation index and OI were significantly lower in survivors as compared with nonsurvivors. Based on day-1 reading, a higher OSI (AUC = 0.719, 95% CI = 0.648-0.790) and OI (AUC = 0.752. 95% CI = 0.684-0.819) significantly can predict mortality. On the other hand, a higher P/F ratio can predict survival (AUC = 0.734, 95% CI = 0.664-0.805). P/F ratio of 160 on day 1 can predict survival. Oxygen saturation index values above 10.4% and OI above 13.5% were the cutoff derived for day 1 values to predict mortality. Conclusion: Noninvasive OSI can be used to assess the severity of hypoxic respiratory failure in C-ARDS without arterial access in resource-limited settings. Oxygen saturation index can noninvasively provide prognostic information in invasively ventilated C-ARDS patients. How to cite this article: Vadi S, Suthar D, Sanwalka N. Correlation and Prognostic Significance of Oxygenation Indices in Invasively Ventilated Adults (OXIVA-CARDS) with COVID-19-associated ARDS: A Retrospective Study. Indian J Crit Care Med 2023;27(11):801-805.

Noninvasive Oxygenation Indices: New Tools for Resource-limited Settings?

How to cite this article: Jagiasi BG. Noninvasive Oxygenation Indices: New Tools for Resource-limited Settings? Indian J Crit Care Med 2023;27(11):784-785.

Seven days of ischemic preconditioning augments hypoxic exercise ventilation and muscle oxygenation in recreationally trained males.

This investigation sought to assess whether single or repeated bouts of ischemic preconditioning (IPC) could improve oxyhemoglobin saturation ([Formula: see text]) and/or attenuate reductions in muscle tissue saturation index (TSI) during submaximal hypoxic exercise. Fifteen healthy young men completed submaximal graded exercise under four experimental conditions: 1) normoxia (NORM), 2) hypoxia (HYP) [oxygen fraction of inspired air ([Formula: see text]) = 0.14, ∼3,200 m], 3) hypoxia preceded by a single session of IPC (IPC1-HYP), and 4) hypoxia preceded by seven sessions of IPC, one a day for 7 consecutive days (IPC7-HYP). IPC7-HYP heightened minute ventilation (V̇e) at 80% HYP peak cycling power output (Wpeak) (+10.47 ± 3.35 L·min-1, P = 0.006), compared with HYP, as a function of increased breathing frequency. Both IPC1-HYP (+0.17 ± 0.04 L·min-1, P < 0.001) and IPC7-HYP (+0.16 ± 0.04 L·min-1, P < 0.001) elicited greater oxygen consumption (V̇o2) across exercise intensities compared with NORM, whereas V̇o2 was unchanged with HYP alone. [Formula: see text] was unchanged by either IPC condition at any exercise intensity, yet the reduction of muscle TSI during resting hypoxic exposure was attenuated by IPC7-HYP (+9.9 ± 3.6%, P = 0.040) compared with HYP, likely as a function of reduced local oxygen extraction. Considering all exercise intensities, IPC7-HYP attenuated reductions of TSI with HYP (+6.4 ± 1.8%, P = 0.001). Seven days of IPC heightens ventilation, posing a threat to ventilatory efficiency, during high-intensity submaximal hypoxic exercise and attenuates reductions in hypoxic resting and exercise muscle oxygenation in healthy young men. A single session of IPC may be capable of modulating hypoxic ventilation; however, our present population was unable to demonstrate this with certainty.

Six nights of sleep extension increases regional cerebral oxygenation without modifying cognitive performance at rest or following acute aerobic exercise.

Long sleep durations (≥540 min) are associated with poor cognitive performance in ageing adults, but the underlying cause is unclear. The aim of this study was to investigate the effect of extended sleep on cognitive performance and cerebral vascular function before and then after aerobic exercise. In all, 12 adults completed 6 nights of 8- (control) and 10+-h (sleep extension) time in bed in a randomised, crossover experiment. Sleep was measured using wrist actigraphy. On the last day of each time in bed protocol, participants performed three bouts of brisk walking. Sustained attention, spatial rotation ability, mental flexibility, and working memory were assessed, while prefrontal oxygen saturation index (ΔTSI) was measured using near-infrared spectroscopy. A two-way repeated-measures analysis of variance (time in bed × before/after exercise) was used for statistical analysis. Average sleep duration was longer following sleep extension as compared to control, at a mean (SD) of 551 (16) versus 428 (20) min (p < 0.001). Sleep extension did not alter cognitive performance as compared to control, but increased ΔTSI during tests of spatial rotation ability (main effect for time in bed, p = 0.03), mental flexibility (p = 0.04), and working memory (p < 0.01). Cognitive performance was improved (main effect for exercise, p < 0.05) following brisk walking for all cognitive domains except sustained attention with no interaction with time in bed. In summary, 6 nights of extended time in bed accompanied by long sleep durations does not impair cognitive performance at rest or alter the positive effect of acute aerobic exercise on cognition but may increase frontal cerebral oxygenation during cognitive functioning.

Geochemical evolution and seasonality of groundwater recharge at water-scarce southeast margin of the Chihuahuan Desert in Mexico.

Climate models for the 21st century project further reduction in the warm season precipitation and more frequent droughts across Mexico. In the possible scenario of enhanced aridity from global warming, the δ18O (-10.6 to -6.3 ‰) and δ2H (-71.1 to -57.1 ‰) compositions and deuterium-excess (0.2-14.6‰) of shallow groundwater from two different basins (Sandia and El Potosi) with similar geological and geomorphological settings were considered to evaluate the influences of early summer rainfall and later summer tropical storms on aquifers at water-scarce southeast margin of the Chihuahuan Desert. Groundwater of the Sandia Basin was recharged mainly from tropical storms. Higher CO2 partial pressure (log pCO2: -2.70 to -1.61) caused more gypsum dissolution (Ca-Mg-SO4 facies) and the effect of irrigation return flow (Ca-Mg-Cl facies) was minor. Even though the El Potosi Basin is in proximity, its groundwater was recharged from both the early and late summer precipitations. The multivariate factor analysis helped to separate the process of rock-water interactions from the recharge seasonality. Gypsum dissolution was less as the partial pressure of CO2 was comparatively lower (log pCO2: -3.01 to -2.15), and the ion exchange along with carbonate mineral dissolutions led to Ca-Mg-HCO3 facies. Over-exploitation under the condition of reduced warm season rainfall would continue to enhance the salinity of groundwater in this region. Hence, the drought mitigation policies should prioritize sustainability of the depleted aquifers and cultivation of salinity resistant crops.

Impact of River fluvial processes on arsenic enrichment in Mid Gangetic Plains: The coining of arsenic confirming pollution markers.

The present study traces the geochemical occurrence of arsenic and heavy metals along the active oxbow formations of river Ganga in MGP. A total of 31 groundwater samples were collected, specifically in close proximity to the river profile section, to understand the high spatial enrichment pattern of arsenic. The bivariate plots reveal strong influence of silicate weathering and anthropogenic leaching of fertilizers occurring concurrently with pyrite oxidation, leading to high arsenic vulnerability. The bicarbonate enrichment plays a major role in the replacement of adsorbed arsenic while most of the carbonate minerals remain in a state of oversaturation, causing their ultimate precipitation. The steep changes in river directional profile as evident through the high bulk density of the soil (1587 kg/m3) near the oxbow formations of the river has caused high sediment deposition which is coherent with the spatial distribution of soil organic carbon stock (8-33 tons/hectare). Further, high concentration of arsenic (~100 ppb) traces the high availability of the clay content (18-40 %) and moderate iron concentration of the soil confirming the role of river led recharge in promoting oxidizing conditions. Low cation exchange capacity (9-52 mmol. c.kg-1), indicative of illite as the dominant clay mineral, further supports our concern for groundwater vulnerability in terms of enhanced cation retention in the soil. Our study is a pioneering work in understanding arsenic spatial vulnerability under fluvial forcing through developing indicators which trace the arsenic mobilizing chemistry in a more coherent and direct ways.

A physiological and biomechanical investigation of three passive upper-extremity exoskeletons during simulated overhead work.

The objective of this study was to evaluate three passive upper-extremity exoskeletons relative to a control condition. Twelve subjects performed an hour-long, simulated occupational task in a laboratory setting. Independent measures of exoskeleton, exertion height (overhead, head height), time, and their interactions were assessed. Dependent measures included changes in tissue oxygenation (ΔTSI) in the anterior deltoid and middle trapezius, peak resultant lumbar spine loading, and subjective discomfort in various body regions. A statistically significant reduction in ΔTSI between exoskeleton and control was only observed in one instance. Additionally, neither increases in spinal loading nor increases in subjective discomfort ratings were observed for any of the exoskeletons. Ultimately, the exoskeletons offered little to no physiological benefit for the conditions tested. However, the experimental task was not highly fatiguing to the subjects, denoted by low ΔTSI values across conditions. Results may vary for tasks requiring constant arm elevation or higher force demands. Practitioner summary This study quantified the benefits of upper-extremity exoskeletons using NIRS, complementary to prior studies using EMG. The exoskeletons offered little to no physiological benefit for the conditions tested. However, the experimental task was not highly fatiguing, and results may vary for an experimental task with greater demand on the shoulders. Abbreviations: WMSD: work-related musculoskeletal disorder; EMG: electromyography; NIRS: near-infrared spectroscopy; NIR: near-infrared; Hb: haemoglobin; Mb: myoglobin; TSI: tissue saturation index; ATT: adipose tissue thickness.

Simulation study of the Lower Cretaceous geothermal reservoir for aquifer thermal energy storage.

The aquifer thermal energy storage (ATES) has gained attention in several countries as an installation for increasing the energy efficiency of geothermal systems and the use of waste heat. The Lower Cretaceous reservoir is known as one of the most prospective for geothermal purposes in Poland. However, in the southern part of the Mogilno-Lódz Trough (Central Poland) is considered to have a lower geothermal potential. The aim of this paper is to study whether the Lower Cretaceous reservoir in this area is suitable for aquifer thermal energy storage. Prior to dynamic simulations in Feflow© software, a regional Petrel© static parametric model which includes a multidisciplinary approach was prepared. A methodology of fitting Petrel's structural and parametrical model to Feflow requirements is provided within this paper. The performance simulation of 4 systems has been conducted for 30 years. Increasing precipitation potential is expected for aragonite and calcite along with a temperature increase, while silica precipitation carries a much smaller risk. The paper presents potential for ATES systems in the Lower Cretaceous reservoir of the study area with the best doublet location having thermal recovery ratio of 0.47 and 0.34 for 30 and 40 K temperature differential scenario. An imbalance in heat injection/production in the storage system can cause the reservoir to cool faster than in conventional geothermal heating installation. ATES can provide a successful geothermal reservoir boosting in the case of applying a balanced injection of waste heat.