Purpose Prediction of high flow nasal cannula (HFNC) failure in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) may improve clinical management and stratification of patients for optimal treatment. We performed a systematic review and meta-analysis to determine performance of ROX index as a predictor of HFNC failure. Materials and methods Systematic search was performed in electronic databases (PubMed, Google Scholar, Web of Science and Cochrane Library) for articles published till 15 June 2021 investigating ROX index as a predictor for HFNC failure. Quality In Prognosis Studies (QUIPS) tool was used to analyze risk of bias for prognostic factors, by two independent authors. Results Eight retrospective or prospective cohort studies involving 1301 patients showed a good discriminatory value, summary area under the curve (sAUC) 0.81 (95% CI, 0.77–0.84) with sensitivity of 0.70 (95% CI, 0.59–0.80) and specificity of 0.79 (95% CI, 0.67–0.88) for predicting HNFC failure. The positive and negative likelihood ratio were 3.0 (95% CI, 2.2–5.3) and 0.37 (95% CI, 0.28–0.50) respectively, and was strongly associated with a promising predictive accuracy (Diagnostic odds ratio (DOR) 9, 95% CI, 5–16). Conclusion This meta-analysis suggests ROX index has good discriminating power for prediction of HFNC failure in COVID-19 patients with AHRF.

Maneb (MB) and paraquat (PQ) are environmental toxins that have been experimentally used to induce selective damage of dopaminergic neurons leading to the development of Parkinson's disease (PD). Although the mechanism of this selective neuronal toxicity in not fully understood, oxidative stress has been linked to the pathogenesis of PD. The present study investigates the mechanisms of neuroprotection elicited by Withania somnifera (Ws), a herb traditionally recognized by the Indian system of medicine, Ayurveda. An ethanolic root extract of Ws was co-treated with the MB-PQ induced mouse model of PD and was shown to significantly rescue canonical indicators of PD including compromised locomotor activity, reduced dopamine in the substantia nigra and various aspects of oxidative damage. In particular, Ws reduced the expression of iNOS, a measure of oxidative stress. Ws also significantly improved the MB + PQ mediated induction of a pro-apoptotic state by reducing Bax and inducing Bcl-2 protein expression, respectively. Finally, Ws reduced expression of the pro-inflammatory marker of astrocyte activation, GFAP. Altogether, the present study suggests that Ws treatment provides nigrostriatal dopaminergic neuroprotection against MB-PQ induced Parkinsonism by the modulation of oxidative stress and apoptotic machinery possibly accounting for the behavioural effects.

Parkinson's disease (PD) is a neurodegenerative disorder and these days a lot of emphasis is given on the treatment of this disease using herbal medicines. The present study evaluates the neuroprotective effect of Withania somnifera (Ws) root extract on Parkinsonian mice. The mice were divided into three groups; the first group served as control, the second group was given maneb (MB) and paraquat (PQ) and the last group was administered MB-PQ along with Ws root extract for 3, 6 and 9 weeks. The behavioral studies showed a significant improvement in the motor movement patterns and gripping ability of Ws root extract exposed Parkinsonian mice. Tyrosine hydroxylase (TH) immunostaining was reduced in the substantia nigra of MB-PQ exposed mice, while Ws co-exposure restored TH immunostaining significantly. Additionally, our results also demonstrate generation of oxidative stress in the nigrostriatal region of MB-PQ exposed mice. There was a marked decline in the level of catalase and a simultaneous increase in the level of nitrite and lipid peroxidation in Parkinsonian mice. Thus, the Ws root extract have shown to counteract the pro-oxidants and their associated oxidative stress in the PD model studied here. Our results clearly indicate the usefulness of Ws root extract in providing protection against MB-PQ induced nigrostriatal dopaminergic neurodegeneration and marked improvement in the behavioral, anatomical and the biochemical deformities.

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