Corroboration of arsenic variation over the Indian Peninsula through standardized precipitation evapotranspiration indices and groundwater level fluctuations: Water quantity indicators for water quality prediction.

The contamination of groundwater with arsenic (As) as a result of geo-morphological and hydrogeochemical factors has been the subject of comprehensive research. However, there has been limited exploration of the spread of As under the influence of dynamic elements such as floods, droughts, and rapidly declining groundwater levels. Moreover, the utilization of rapidly changing natural forces, including hydroclimatic extremes and declining groundwater levels, in conjunction with standard climate indices such as the Standard Precipitation Index (SPI) and the Standard Precipitation Evapotranspiration Index (SPEI), for the purpose of elucidating As distribution has been minimal. Accordingly, this study specifically addresses these water quantity indicators, along with Gravity Recovery and Climate Experiment (GRACE) derived groundwater levels, to expound on As contamination at a Pan-Indian scale. Significant correlations were delineated between SPI, SPEI, GRACE-derived groundwater levels, and arsenic concentrations. Clustering results unveiled the grouping of states according to agro-climatic zones, thereby underscoring the similarities in water quantity dynamics across the Indian peninsula. The study additionally computed the Saturation Index (SI) for aragonite and deliberated on the potential future saturation of this pivotal mineral. The primary contribution of this study lies in the successful demonstration of a methodology for prognosticating As distribution based on available precipitation and climatic indices, groundwater withdrawal, and the geological prospects of agroclimatic zones. The insights derived from the analysis of SPI, GRACE data, and As concentrations furnish valuable input for water resource management vis-à-vis strategies for mitigating As contamination.

Influence of Running Velocity and Hypoxic Exposure on Vastus Lateralis Muscle Oxygenation.

PURPOSE: We investigated the effects of manipulating running velocity and hypoxic exposure on vastus lateralis muscle oxygenation levels during treadmill running. METHODS: Eleven trained male distance runners performed 7 randomized runs at different velocities (8, 10, 12, 14, 16, 18, and 20 km·h-1), each lasting 45 seconds on an instrumented treadmill in normoxia (fraction of inspired oxygen [FiO2] = 20.9%), moderate hypoxia (FiO2 = 16.1%), high hypoxia (FiO2 = 14.1%), and severe hypoxia (FiO2 = 13.0%). Continuous assessment of Tissue Saturation Index (TSI) in the vastus lateralis muscle was conducted using near-infrared spectroscopy. Subsequently, changes in TSI (ΔTSI) data over the final 20 seconds of each run were compared between velocities and conditions. RESULTS: There was a significant velocity × condition interaction for ΔTSI% (P < .001, ηp2=.19), with a smaller ΔTSI% decline in normoxia compared with high hypoxia and severe hypoxia at 8 km·h-1 (g = 1.30 and 1.91, respectively), 10 km·h-1 (g = 0.75 and 1.43, respectively), and 12 km·h-1 (g = 1.47 and 1.95, respectively) (pooled values for all conditions: P < .037). The ΔTSI% decline increased with each subsequent velocity increment from 8 km·h-1 (-9.2% [3.7%]) to 20 km·h-1 (-22.5% [4.1%]) irrespective of hypoxia severity (pooled values for all conditions: P < .048). CONCLUSIONS: Running at slower velocities in conjunction with high and severe hypoxia reduces vastus lateralis muscle oxygenation levels. Muscle ΔTSI% proves to be a sensitive indicator, underscoring the potential use of near-infrared spectroscopy as a reference index of internal load during treadmill runs.

Hydrogeochemical factors influencing the dynamics of groundwater characteristics in eco-sensitive areas of the Southern Western Ghats, India.

The inter-ionic relationships of groundwater present in a region as well as various chemical and physical factors all have an impact on the geochemistry of groundwater in an aquifer. To assess the factors influencing the geochemical composition of groundwater in the eco-sensitive area of Western Ghats, Kerala, India, various weathering, and ionic indices were analyzed. Results show groundwater ranges from soft to extremely hard and acidic to alkaline, with high Mn and Fe levels. WQI analysis found 7% of samples unfit for drinking due to Fe/Mn contamination in the southeast part of the study area. Main water types are CaHCO3 (46%) and CaMgCl. Geochemical modeling indicates silicate and carbonate weathering, cation exchange, and reverse ion processes influence the aquifer. Groundwater is often supersaturated with iron minerals, saturated with carbonate minerals, and undersaturated with sulfate and chloride minerals. Cluster analysis (CA) revealed that NO3- and K+ are derived from anthropogenic sources. Principal component analysis (PCA) resulted in three factors. Factor 1 is for geogenic processes, while Factors 2 and 3 imply the anthropogenic and weathering of iron-rich minerals. Hierarchical cluster analysis defines anthropogenic input, silicate and carbonate weathering, and different patterns of mineralization in the groundwater. The study underscores the need for comprehensive management to protect groundwater quality, considering the complex interplay of natural processes and human factors.

Hydro-chemical characterization and irrigation suitability assessment of a tropical decaying river in India.

Water pollution is a major concern for a decaying river. Polluted water reduces ecosystem services and human use of rivers. Therefore, the present study aims to assess the irrigation suitability of the Jalangi River water. A total of 34 pre-selected water samples were gathered from the source to the sink of the Jalangi River with an interval of 10 km and one secondary station's data from February 2012 to January 2022 were used for this purpose. The Piper diagram exhibits that the Jalangi River water is Na+-HCO3- types, and the alkaline earth (Ca2+ + Mg2+) outperforms alkalises (Na+ + K+) and weak acids (HCO3- + CO32-) outperform strong acids (Cl- + SO42-). SAR values ranging from 0.35 to 0.64 show that water is suitable for irrigation and poses no sodicity risks. The %Na results show that 91.18% of water samples are good and acceptable for irrigation. RSC levels indicate a significant alkalinity hazard, with 94.12% of samples considered inappropriate for irrigation. PI findings show that 91.18% of water samples are suitable for irrigation. Apart from the spatial water samples, seasonal water samples exhibit a wide variations as per the nature of irrigation hazards. Gibbs plot demonstrates that the weathering of rocks determined the hydro-chemical evolution of Jalangi River water. This study identifies very little evaporation dominance for pre- and post-monsoon water. The analysis of variance (ANOVA) test illustrates that there are no spatial variations in water quality while seasonal variations are widely noted (p < 0.05). The results also revealed that river water for irrigation during monsoon is suitable compared to the pre-monsoon season. Anthropogenic interventions including riverbed agriculture, and the discharge of untreated sewage from urban areas are playing a crucial role in deteriorating the water quality of the river, which needs substantial attention from the various stakeholders in a participatory, and sustainable manner.

Associations between oxygen saturation Index and oxygenation index in neonates with congenital diaphragmatic hernia.

Objective: To explore the relationship between Oxygenation Index (OI) and Oxygen Saturation Index (OSI) among infants with Congenital Diaphragmatic Hernia (CDH), both within the first 24 h after birth and in extended observations in those who survived until their surgical intervention. Methods: Seven- years retrospective review of CDH cases at a single Level III neonatal intensive care unit. The correlations of various combinations of OI-OSI pairs were assessed using the Spearman's rho Correlation Coefficient. Additionally, during the initial 24 h, the correlations between admission (first), best (lowest), highest, and mean OI and OSI values were determined. The predictive ability of the first 24 h oxygen and oxygen saturation indices for mortality and other adverse outcomes were assessed using the Area Under the Curve (AUC) analysis. Results: Thirty-seven infants with CDH were included in the analysis. A strong correlation was observed between all pairs of OI/OSI (2,289) (Spearman's rho = 0.843), matched pairs of Postductal OI/OSI (1,232 pairs) (Spearman's rho = 0.835) and the unmatched pairs of Postductal OI and Preductal OSI (1,057 pairs) (Spearman's rho = 0.852). Using the regression equations for all pairs, matched and unmatched OI/OSI pairs, we deduced that for clinically pertinent OI thresholds of 10, 15, 20 and 40, the corresponding OSI values were 5, 8, 11, and 23, respectively. Furthermore, in the first 24 h, strong correlations were evident between OI/OSI: at admission (Spearman's rho = 0.783), best OI/OSI (Spearman's rho = 0.848), and highest OI/OSI (Spearman's rho = 0.921). The most robust correlation was observed between the mean OI/OSI with a Spearman's rho of 0.928. First (AUC = 0.849), best (AUC = 0.927), highest (AUC = 0.942) and mean day 1 OI (AUC = 0.946) were all predictive of mortality. Similarly, first (AUC = 1.00), best (AUC = 0.989), highest (AUC = 1.00) and the mean OSI in day 1 (AUC = 0.978) were all predictive of mortality. All of the OIs and OSIs in day 1 except for the admission OSI (AUC = 0.683) were predictive of pulmonary hypertension. Additionally, all of OI and OSI indices in the first 24-hour except for the best day 1 OI (AUC = 0.674) were predictive of the need for rescue HFOV. Conclusion: There were a strong correlation between the OI and OSI in infants with CDH. Oxygenation indices and OSI in the first 24 h were predictive of mortality and other adverse outcomes in infants with CDH.

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.

Peak Oxygen Uptake is Slope Dependent: Insights from Ground Reaction Forces and Muscle Oxygenation in Trained Male Runners.

BACKGROUND: The aim of this study is to explore the effect of treadmill slope on ground reaction forces and local muscle oxygenation as putative limiting factors of peak oxygen uptake in graded maximal incremental running tests. Thirteen trained male runners completed five maximal incremental running tests on treadmill at - 15%, - 7.5%, 0%, 7.5% and 15% slopes while cardiorespiratory and local muscle oxygenation responses as well as ground reaction forces were continuously recorded. Blood lactate concentration and isometric knee extensor torque were measured before and after each test. RESULTS: Peak oxygen uptake was lower at - 15% slope compared to all other conditions (from - 10 to - 17% lower, p < 0.001), with no difference between - 7.5 and + 15% slope. Maximal heart rate and ventilation values were reached in all conditions. The negative external mechanical work increased from steep uphill to steep downhill slopes (from 6 to 92% of total external work) but was not correlated with the peak oxygen uptake reduction. Local muscle oxygenation remained higher in - 15% slope compared to level running (p = 0.003). CONCLUSIONS: Similar peak oxygen uptake can be reached in downhill running up to - 7.5% slope. At more severe downhill slopes (i.e., - 15%), greater negative muscle work and limited local muscle deoxygenation occurred, even in subjects familiarized to downhill running, presumably preventing the achievement of similar to other condition's peak oxygen uptake. KEY POINTS: Trained male runners can reach like level running V̇O2peak at moderate but not at severe negative slope. Negative external mechanical work increases with increasing negative slope. At maximal intensity Vastus Lateralis muscle oxygenation is higher in steep negative slope. Knee extensor isometric muscle torque is preserved after maximal level and uphill running, but reduced after downhill running, despite lower blood lactate. Progressive reduction of V̇O2 at maximal effort with increasing negative slope might be related to the metabolic consequences of increased lower limb negative external work (i.e., eccentric muscle actions).

Comprehensive risk assessment and interactions of fluoride and boron ions in the water-sediments interface: The Red Sea, Egypt.

This study presents a baseline evaluation of the distribution, human and ecotoxicological risk, and the potential interactions of fluoride and boron in the water-sediment interface in 25 locations from incredible Red Sea tourist destinations. Results showed comparable levels of B and F in the water and sediments with previous literature. Significant positive correlation was found between B and F (r = 0.57; P<0.01). Based on the sediment/liquid partition coefficient (Kd), F is more likely to be released from the sediment into seawater (logKd< 3) than B (3< logKd< 4). pH and alkalinity may affect water-sediment interactions of B and F, respectively, while SO42- and Cl- ions had no significant effect on adsorption ability of F and B. The majority of minerals had average saturation Index (SI) > 1 referring to the over saturation of seawater with these minerals and their inability to dissolve. The formation of CF, FAP, and CFAP may be related to the high correlation between Fw (r = 0.928, P< 0.01; r = 0.527, P< 0.01; r = 0.608, P< 0.01) and Bw (r = 0.38, P< 0.05; r = 0.38, P< 0.05; r = 0.397, P< 0.05). Total hazard quotient (THQ) for children and adults were <1, revealing no health risks from exposure to B and F through ingestion and skin contact while swimming. The risk characterization ratio; RCRmix(MEC/PNEC) showed high short-term risks to aquatic organisms. Further investigations might emphasis on emerging mitigation strategies to address these concerns.

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.

Evaluation of the scaling and corrosive potential of the cooling water supply system of a nuclear power plant based on the physicochemical control dataset.

The data of physicochemical control for the cooling water supply system of the Rivne Nuclear Power Plant (Ukraine), where water samples were monitored three times a day during 2022-2023. The pH, temperature, total dissolved salts, total hardness and total alkalinity were measured using standard methods. The differences in ϕ and ψ, Langelier saturation index (LSI) and Ryznar stability index (RSI), which characterise scaling and corrosive potential, were calculated The calculated values are ϕ - ψ: 0.29 (± 0.62), LSI: 1.51 (± 0.39), and RSI 5.74 (± 0.69). According to the scaling and corrosive classification, the water is characterised as susceptible to scale formation. Moreover, to the Pearson correlation coefficient (ρ), there is a very strong relationship ρ = -0.9635 between LSI and RSI, a weak relationship ρ = -0.2370 between ϕ - ψ and RSI, and ρ = -0.2997 between ϕ - ψ and LSI.

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.

Study on inverse geochemical modeling of hydrochemical characteristics and genesis of groundwater system in coal mine area - a case study of Longwanggou Coal Mine in Ordos Basin.

The exploitation of coal resources has disturbed the equilibrium of the original groundwater system, resulting in a perturbation of the deep groundwater dynamic conditions and hydrochemical properties. Exploring the formation of mine water chemistry under the conditions of deep coal seam mining in the Ordos Basin provides a theoretical basis for the identification of sources of mine water intrusion and the development and utilization of water resources. This paper takes Longwanggou Coal Mine as the research area, collects a total of 106 groups of water samples from the main water-filled aquifers, comprehensively uses Piper trilinear diagram, Gibbs diagram, ion correlation, ion ratio coefficient and mineral saturation index analysis, and carries out inverse geochemical modeling with PHREEQC software, so as to analyze the hydrochemical characteristics and causes of the main water-filled aquifers in deep-buried coal seams in the research area. The results show that the main hydrochemical processes in the study area are leaching and cation exchange, and the groundwater is affected by carbonate (calcite, dolomite), silicate (gypsum) and evaporite. Calculations of mineral saturation indices and PHREEQC simulations have led to the conclusion that the dissolution of rock salt and gypsum in groundwater accounts for most of the ionic action. Na+, Cl- and SO42- are mainly derived from the dissolution of rock salt and gypsum minerals, while Ca2+ and Mg2+ are mostly derived from the dissolution of dolomite and calcite. The results of the inverse geochemical modeling are consistent with the theoretical analysis.

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.

Ratio of oxygen saturation index for predicting high-flow nasal cannula outcomes in emergency department for COVID-19 patients with severe hypoxemia: A retrospective study.

OBJECTIVES: High-flow nasal cannula (HFNC) oxygen therapy has been used as an initial ventilatory support for coronavirus disease 2019 (COVID-19) patients with mixed levels of acute hypoxemic respiratory failure (AHRF). However, the effectiveness of HFNC when used as initial ventilatory support in COVID-19 patients with severe AHRF exclusively is not well documented. Ratio of oxygen saturation (ROX) index (ROX = [SpO2/fraction of inspired oxygen]/respiratory rate) was shown to predict the outcome of HFNC in intensive care unit patients. Our study aimed to evaluate the utility of the ROX index for predicting HFNC therapy success/failure in COVID-19 patients with severe AHRF when HFNC is used as the first line of ventilatory support. METHODS: Retrospective study in 67 COVID-19 patients with severe AHRF receiving HFNC in the emergency department at a tertiary care academic medical center. ROX index was determined at 0, 2, 6, 12, and 24 h of HFNC onset. The need to escalate to noninvasive or invasive ventilatory support was documented. The receiver operating characteristic curves were performed and areas under the curves (AUCs) were calculated to evaluate the accuracy of ROX index for differentiating between patients who will succeed or fail HFNC therapy. RESULTS: HFNC therapy was successful in 19 patients (28.1%) and failed in 48 patients (71.6%). ROX index after 6 h of HFNC initiation had the best predictive capacity for the outcome of HFNC therapy (AUC = 0.78). ROX index >4.4 at 6 h of HFNC onset was significantly associated with HFNC success/failure. CONCLUSION: ROX index at 6 h after initiating HFNC therapy in COVID-19 patients with severe AHRF has a good predictive capacity for HFNC success/failure.

Post-occlusive reactive hyperemia in habituated caffeine users: Effects of abstaining versus consuming typical doses.

BACKGROUND: Post-occlusive reactive hyperemia (PORH) typically requires caffeine abstinence. For habitual users, it is unknown if abstinence affects PORH. OBJECTIVE: Compare PORH after habitual users consume or abstain from caffeine. METHODS: On separate visits (within-subject), PORH was measured in 30 participants without abstinence from typical caffeine doses (CAFF) and with abstinence (ABS). Measurements included baseline and peak hyperemic velocity, tissue saturation index slopes during ischemia (Slope 1) and following cuff deflation (Slope 2), resting arterial occlusion pressure (AOP), heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure. All variables were compared using Bayesian paired t-tests. BF10 = likelihood of alternative vs null. Results are mean±SD. RESULTS: Comparing baseline velocity (cm/s) between CAFF (9.3±4.8) and ABS (7.5±4.9) yielded anecdotal evidence (BF10 = 1.0). Peak hyperemic velocity (cm/s) was similar (CAFF = 77.3±16.7; ABS = 77.6±19.0, BF10 = 0.20). For slopes (TSI% /s), CAFF Slope 1 = -0.11±0.04 and Slope 2 = 1.9±0.46 were similar (both BF10≤0.20) to ABS Slope 1 = -0.12±0.03 and Slope 2 = 1.8±0.42. SBP and DBP (mmHg) were both similar (CAFF SBP = 116.0±9.8, DBP = 69.6±5.8; ABS SBP = 115.5±10.7, DBP = 69.5±5.4; both BF10≤0.22). Comparing AOP (mmHg) (CAFF = 146.6±15.0; ABS = 143.0±16.4) yielded anecdotal evidence (BF10 = 0.46). HR (bpm) was similar (CAFF = 66.5±12.3; ABS = 66.9±13.0; BF10 = 0.20). CONCLUSIONS: In habitual users, consuming or abstaining from typical caffeine doses does not appear to affect post-occlusive reactive hyperemia.

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.

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.

Prognostic value of oxygen saturation index trajectory phenotypes on ICU mortality in mechanically ventilated patients: a multi-database retrospective cohort study.

BACKGROUND: Heterogeneity among critically ill patients undergoing invasive mechanical ventilation (IMV) treatment could result in high mortality rates. Currently, there are no well-established indicators to help identify patients with a poor prognosis in advance, which limits physicians' ability to provide personalized treatment. This study aimed to investigate the association of oxygen saturation index (OSI) trajectory phenotypes with intensive care unit (ICU) mortality and ventilation-free days (VFDs) from a dynamic and longitudinal perspective. METHODS: A group-based trajectory model was used to identify the OSI-trajectory phenotypes. Associations between the OSI-trajectory phenotypes and ICU mortality were analyzed using doubly robust analyses. Then, a predictive model was constructed to distinguish patients with poor prognosis phenotypes. RESULTS: Four OSI-trajectory phenotypes were identified in 3378 patients: low-level stable, ascending, descending, and high-level stable. Patients with the high-level stable phenotype had the highest mortality and fewest VFDs. The doubly robust estimation, after adjusting for unbalanced covariates in a model using the XGBoost method for generating propensity scores, revealed that both high-level stable and ascending phenotypes were associated with higher mortality rates (odds ratio [OR]: 1.422, 95% confidence interval [CI] 1.246-1.623; OR: 1.097, 95% CI 1.027-1.172, respectively), while the descending phenotype showed similar ICU mortality rates to the low-level stable phenotype (odds ratio [OR] 0.986, 95% confidence interval [CI] 0.940-1.035). The predictive model could help identify patients with ascending or high-level stable phenotypes at an early stage (area under the curve [AUC] in the training dataset: 0.851 [0.827-0.875]; AUC in the validation dataset: 0.743 [0.709-0.777]). CONCLUSIONS: Dynamic OSI-trajectory phenotypes were closely related to the mortality of ICU patients requiring IMV treatment and might be a useful prognostic indicator in critically ill patients.

Impact of anthropogenic and land use pattern change on spatio-temporal variations of groundwater quality in Odisha, India.

The groundwater physicochemical parameters were studied to understand their spatiotemporal variations and groundwater quality, using the statistical and entropy weights methods. Out of ten parameters that were considered, F-, TDS, and Cl- appear to be the major contributors influencing the quality of groundwater. The Principal Component Analysis (PC1, PC2) indicates that the majority of ions are derived from both natural and anthropogenic sources. Studies of saturation indices of gypsum, Halite, dolomite, and calcite indicate that dissolution of these salts also affects groundwater salinization. In coastal areas, a few of the water samples also appear to be contaminated by the mixing of seawater. The entropy weights, which are free from subjective biases were used to estimate the water quality index. The entropy-based water quality index (EWQI) varies from excellent to good quality for the year 2012-13, and appears to degrade after 2015 onwards. For the year 2018-19 and 2021-22, 71.42% and 68.42% of the study areas show excellent water quality, followed by 25.33% and 24.33% (good), 2.54% and 3.54% (average), 0.7% and 3.7% study area shows as poor quality respectively. The groundwater quality, particularly in the western, central, northern, and eastern parts of the region, appears to be average, poor, and very poor in several small patches, respectively. Industrial developments, mining activities, irrigation, changing land use patterns, agricultural activities, and increased anthropogenic activities may be contributing to the degradation of the water quality.