Reduce Recovery Time Research Articles

COMPARISON OF RACECADOTRIL WITH ORAL REHYDRATION SOLUTION IN ACUTE WATERY DIARRHEA UNDER 5 YEARS OF AGE

BACKGROUND: A significant share (18%) of paediatric mortality is caused by diarrheal diseases. Children under the age of five are most susceptible to viral diarrhoea. In cases of acute watery diarrhoea, racecadotril, an anti-secretory medication, can limit fluid and electrolyte loss from the intestine without compromising intestinal motility.
 OBJECTIVE: To compare the number of loose stools within the first 48 hours of admission between the children treated with and without Racecadotril, as well as the mean recovery time in children in both groups, in order to determine the efficacy of Racecadotril in treating acute watery diarrhoea in children aged 6 months to 5 years.
 METHOD: It was a Randomized Controlled Trial that ran from October 2020 to March 2021 at the Paediatrics Department at LGH/PGMI/AMC Lahore. Patients were divided into two equal groups at random using a computer-generated random number table. Racecadotril (1.5 mg/kg body weight, orally three times per day for 5 days or until diarrhoea ceases, whichever happens first) was given to 100 patients in group A coupled with Low Osmolality ORS, while Low Osmolality ORS was given to 100 patients in group B. For testing of blood haemoglobin, blood urea and creatinine, blood sugar, serum electrolytes, and stool (pH, microscopic inspection, culture, and sensitivity), blood samples were sent to a hospital pathology lab. As per operational definition, recovery time was documented.
 RESULTS: In our study, the mean recovery time was 37.88 hours in group A (racecadotril plus low osmolality ORS) and 47.40 hours in group B (low osmolality ORS), demonstrating a substantial reduction in recovery time of 20.08 percent (p value = 0.0026). The mean 48-hour stool frequency was 11.34 episodes in the Racecadotril + low osmolality ORS group and 14.98 episodes in the low osmolality ORS group, demonstrating a statistically significant decrease in stool frequency of 24.29 percent with the Racecadotril group (p value = 0.025). Faster recovery (20.08 percent) and a reduction of 20.52 percent in ORS consumption, which is comparable with earlier trials on Racecadotril conducted in children with acute watery diarrhoea.
 CONCLUSION: In managing children under the age of five who have acute watery diarrhoea, we came to the conclusion that there is a substantial difference in the mean recovery time when Racecadotril and Low Osmolality Oral Rehydration Solution (ORS) are used in combination

Implementation of the Aldrete score reduces recovery time after non-anesthesiologist-administered procedural sedation in gastrointestinal endoscopy.

Background and study aims Procedural sedation and analgesia (PSA) by trained non-anesthesiologist physicians and/or nurses is often performed during endoscopic procedures. Discharge from the recovery area after monitored observation is frequently based on fixed time parameters or subjective clinical assessment. In this study, the effect of implementation of the Aldrete score on recovery time after procedural sedation was analyzed in a real-life setting. Patients and methods A prospective observational study of patients undergoing procedural sedation and analgesia during gastroscopy, colonoscopy or endoscopic ultrasound was performed. All procedures were randomly included to represent a real-life situation with different endoscopists, recovery nurses, endoscopy systems and indications. After a first observation period, all endoscopy nurses were trained to implement the Aldrete score when discharging patients, followed by a second observation period. Results During the first observation period, the average time spent in the recovery area was 59 ± 22 minutes after procedural sedation. After implementation of the Aldrete score, the recovery time decreased significantly to 47 ± 25 minutes ( P < 0.01) with identical doses of procedural sedation and analgesia. The decrease in time was between 19 % and 35 % for the different endoscopic procedures. Conclusions Implementation of the Aldrete score after procedural sedation and analgesia significantly reduces the time spent in the recovery area. The score can be used to safely implement a discharge policy that provides more efficient and standardized management for an endoscopy service.

Inhibition of p38 signaling curtails the SARS-CoV-2 induced inflammatory response but retains the IFN-dependent antiviral defense of the lung epithelial barrier

SARS-CoV-2 is the causative agent of the immune response-driven disease COVID-19 for which new antiviral and anti-inflammatory treatments are urgently needed to reduce recovery time, risk of death and long COVID development. Here, we demonstrate that the immunoregulatory kinase p38 MAPK is activated during viral entry, mediated by the viral spike protein, and drives the harmful virus-induced inflammatory responses. Using primary human lung explants and lung epithelial organoids, we demonstrate that targeting p38 signal transduction with the selective and clinically pre-evaluated inhibitors PH-797804 and VX-702 markedly reduced the expression of the pro-inflammatory cytokines IL6, CXCL8, CXCL10 and TNF-α during infection, while viral replication and the interferon-mediated antiviral response of the lung epithelial barrier were largely maintained. Furthermore, our results reveal a high level of drug synergism of both p38 inhibitors in co-treatments with the nucleoside analogs Remdesivir and Molnupiravir to suppress viral replication of the SARS-CoV-2 variants of concern, revealing an exciting and novel mode of synergistic action of p38 inhibition. These results open new avenues for the improvement of the current treatment strategies for COVID-19.

Rate of change in longitudinal EMG indicates time course of an individual's neuromuscular adaptation in resistance-based muscle training.

An individual's long-term neuromuscular adaptation can be measured through time-domain analyses of surface electromyograms (EMG) in regular resistance-based training. The perceived changes in recruitment, such as those measured during muscle fatigue, can subsequently prolong the recovery time in rehabilitation applications. Thus, by developing quantifiable methods for measuring neuromuscular adaptation, adjuvant treatments applied during neurorehabilitation can be improved to reduce recovery times and to increase patient quality of care. This study demonstrates a novel time-domain analysis of long-term changes in EMG captured neuromuscular activity that we aim to use to develop a quantified performance metric for muscle-based intervention training and optimization of an individual. We measure EMG of endurance and hypertrophy-based resistance exercises of healthy participants over 100 days to identify trends in long-term neuromuscular adaptation. Particularly, we show that the rate of EMG amplitude increase (motor recruitment) is dependent on the training modality of an individual. Particularly, EMG decreases over time with repetitive training - but the rate of decrease is different in hypertrophy, endurance, and control exercises. We found that the EMG peak contraction decreases across all subjects, on average, by 8.23 dB during hypertrophy exercise and 10.09 dB for endurance exercises over 100 days of training, while control participants showed negligible change. This represents approximately 2 dB difference EMG activity when comparing endurance and hypertrophy exercises, and >8 dB change when comparing to our control cases. As such, we show that the slope of the long-term EMG activity is related to the resistance-based exercise. We believe this can be used to identify person-specific performance metrics, and to create optimized interventions using a measured performance baseline of an individual.

Utilidad de los corticoides en el choque séptico

Introducción: Los corticoides se han utilizado en el manejo del choque séptico con inestabilidad hemodinámica, sin embargo, su utilidad aún requiere mayor evidencia, en relación con los riesgos y beneficios asociados. Objetivo: Describir la utilidad de los corticoides en el manejo del choque séptico. Metodología: Revisión teórica de artículos publicados en las bases de datos Pubmed, Elsevier y Google Scholar, de los últimos diez años, con diseño analítico, revisiones sistemáticas o metaanálisis. Adicionalmente, se recolectaron los datos de trazabilidad de las investigaciones seleccionadas: autor/año país, revista, volumen, diseño y dirección URL/Doi. Resultados: Se incluyeron 19 artículos. En diez (52,6 %), el uso de corticoides no redujo la mortalidad. En tres (15,8 %) se sugiere que pudiera relacionarse con una reducción modesta de la mortalidad a los 28 días. En ocho (42,1 %) se plantea que el uso de corticoides pudiera ser beneficioso en la reducción del tiempo de resolución del choque, y en cuatro (21,1 %) se describe como principal complicación la hiperglucemia. Conclusión: No se encontró evidencia que sustente la efectividad de los corticoides en la reducción de la mortalidad en adultos con choque séptico; pero reducen el tiempo de recuperación. Aunque se describen efectos adversos, no influyen en el pronóstico y se consideran manejables. En definitiva, es preciso el desarrollo de investigaciones que aporten evidencia robusta acerca de la efectividad de los corticoides en el manejo del choque séptico.

Enhanced Recovery after Surgery (ERAS) Practices in Minimally Invasive Gynecologic Surgery: A National Survey

<h3>Study Objective</h3> Enhanced Recovery After Surgery (ERAS) pathways are evidence-based practices aimed at minimizing perioperative physiologic stress responses. This reduces recovery time, hospital-stay length, postoperative complications, and hospital cost per patient. The objective of this study was to assess the Canadian application of and adherence to ERAS protocols during minimally invasive gynecologic surgery. We also aimed to identify facilitators and barriers to ERAS uptake in our population. <h3>Design</h3> A self-administered cross-sectional survey was distributed via three listservs (Canadian Ob/Gyn residency programs, CanSAGE, and the Society of Obstetricians and Gynecologists of Canada [SOGC]) between February 2021 to January 2022. The survey assessed 14 perioperative components as per the American Association of Gynecologic Laparoscopists (AAGL) ERAS consensus guidelines. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Canadian Ob/Gyn residents, fellows, and attendings. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> 157 responses were analyzed. Majority of respondents (77%) are attendings and work in academic hospitals (48%). Only 41% of respondents work within an established ERAS program. Majority of respondents engage in preoperative anemia optimization, although targets varied with 43% targeting Hemoglobin>120g/L. The proportion of respondents that engaged in other preoperative interventions (e.g., lifestyle modification) varied. While most counselled on hyperglycemia and obstructive sleep apnea, a smaller proportion (16-39%) addressed obesity, smoking cessation, and alcohol intake; notably, this was consistent across sites with and without established ERAS programs. Respondents had a high adherence to intraoperative practices including VTE prophylaxis (83%), early feeding (98%), and early ambulation (89%). There was poor adherence to perioperative fasting times, preoperative carbohydrate loading, and intraoperative IV fluids. Most respondents felt ERAS pathways were safe (98%) and improved patient outcomes (82%). <h3>Conclusion</h3> While the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners engage in various ERAS components as per consensus guidelines. Future and targeted research around ERAS components with lower adherence would be beneficial in identifying and addressing barriers to optimize surgical care.

Benefits of Implementing an Enhanced Recovery After Surgery Protocol in Ambulatory Surgery.

Enhanced recovery after surgery (ERAS) protocols in orthopaedic surgery have garnered significant focus due to their ability to control pain adequately in the immediate postoperative window, allowing for earlier mobilization, shorter hospital stays, and fewer complications. Virginia Commonwealth University created a multimodal pain management approach in which patients receive a preoperative femoral nerve block followed by periarticular intraoperative local injection anesthesia consisting of bupivacaine, ketamine, and ketorolac. We hypothesized that implementation of the ERAS protocol will decrease postoperative pain scores, decrease recovery time in the postanesthesia care unit (PACU), and decrease opioid use in anterior cruciate ligament (ACL) reconstruction. Cohort study; Level of evidence, 3. Two patient cohorts were involved: before ERAS implementation (pre-ERAS) and after (post-ERAS). Patients with ACL reconstruction only and patients with ACL reconstruction with meniscal repair were analyzed separately. Post-ERAS patients received an intraoperative periarticular injection of bupivacaine, ketamine, and ketorolac and a postoperative multimodal pain regimen. Outcomes included time spent in the PACU, short-term and long-term opioid consumption, and pain score at discharge from the PACU. Compared with pre-ERAS patients, post-ERAS patients had decreased pain (2.1 vs 0.84 out of 10, respectively), spent less time in the PACU (79.4 vs 62.8 minutes, respectively), and had less opioid consumption in the immediate postoperative period (4.55 vs 2.26 total morphine milligram equivalents [MMEs], respectively) (P < .001 for all). After ERAS implementation, long-term MME use decreased from 410 to 321 between 0 and 2 weeks postoperatively, 92.6 to 1.69 between 2 and 6 weeks, and 494.5 to 323 between 0 and 6 weeks (P < .001 for all). All domains showed significant improvements for both the ACL and the ACL plus meniscal repair cohorts, with the exception of pain at discharge in the ACL plus meniscal repair group. The study findings suggest that an enhanced recovery pathways protocol that includes a standardized intraoperative periarticular bupivacaine, ketamine, and ketorolac injection improves pain scores in the immediate postoperative window, decreases opioid consumption, and reduces recovery time in the PACU for patients undergoing ACL reconstruction.

MXene-based flexible pressure sensor with piezoresistive properties significantly enhanced by atomic layer infiltration

The flexible pressure sensor has been credited for leading performance including higher sensitivity, faster response/recovery, wider detection range and higher mechanical durability, thus driving the development of novel sensing materials enabled by new processing technologies. Using atomic layer infiltration, Pt nanocrystals with dimensions on the order of a few nanometers can be infiltrated into the compressible lamellar structure of Ti3C2Tx MXene, allowing a modulation of its interlayer spacing, electrical conductivity and piezoresistive property. The flexible piezoresistive sensor is further developed from the Pt-infiltrated MXene on a paper substrate. It is demonstrated that Pt infiltration leads to a significant enhancement of the pressure-sensing performance of the sensor, including increase of sensitivity from 0.08 ​kPa−1 to 0.5 ​kPa−1, extension of detection limit from 5 ​kPa to 9 ​kPa, decrease of response time from 200 ​ms to 20 ​ms, and reduction of recovery time from 230 ​ms to 50 ​ms. The mechanical durability of the flexible sensor is also improved, with the piezoresistive performance stable over 1000 cycles of flexure fatigue. The atomic layer infiltration process offers new possibilities for the structure modification of MXene for advanced sensor applications.

Enhanced Recovery After Surgery (ERAS) practices in minimally invasive gynecologic surgery: A national survey

Objectives: Enhanced Recovery After Surgery (ERAS) pathways are evidence-based practices aimed at minimizing perioperative physiologic stress responses. They have been shown to reduce recovery time, postoperative complications, and hospital cost per patient. The objective of this study was to assess the Canadian application of and adherence to ERAS protocols during minimally invasive gynecologic surgery (MIGS). We also aimed to identify facilitators and barriers to ERAS uptake in our population.

A 4-Year Retrospective Claims Analysis of Oral Corticosteroid Use and Health Conditions in Newly Diagnosed Medicare FFS Patients with COPD.

PurposeWe analyzed population-level administrative claims data for Medicare fee-for-service (FFS) beneficiaries to provide insights on systemic oral corticosteroid (OCS) use patterns and associated health conditions and acute events among patients newly diagnosed with chronic obstructive pulmonary disease (COPD).BackgroundCOPD is a progressive inflammatory disease of the lungs, characterized by acute exacerbations that may lead to increased mortality. Short courses of systemic corticosteroids (SCS) are recommended to reduce recovery time from exacerbations, although SCS use has been associated with increased risk of adverse events.MethodsThis study used 2013–2019 Medicare 100% FFS research identifiable files, which contain all Medicare Parts A, B, and D paid claims incurred by 100% of Medicare FFS beneficiaries. Descriptive statistics for patients newly diagnosed with COPD were analyzed, including OCS use, select health conditions and acute events, and COPD exacerbations. Statistical models were used to analyze the relationship between the incidence of select health conditions and events and cumulative OCS dosage.ResultsOf Medicare FFS patients newly diagnosed with COPD, 36% received OCS in the 48 months following diagnosis, and 38% of OCS episodes lasted longer than the recommended 5–7 days. Patients had a variety of health conditions or acute events in the 24-month period prior to new COPD diagnosis, such as hypertension, depression/anxiety, type 2 diabetes, or osteoporosis, that could heighten the risks of OCS use. Patients treated with >1000 mg of prednisolone equivalent OCS in the 48 months following COPD diagnosis had a higher incidence of new conditions or events, including cardiovascular disease, heart failure, hypertension, obesity, dyspepsia, infections, and depression/anxiety, than patients with no OCS use.ConclusionThese results highlight the potential risks of OCS in COPD treatment, including prolonged use among complex Medicare patients, and reinforce the importance of preventive treatment strategies and therapy optimization early in the disease course.

Therapeutic Exercises and Modalities in Athletes With Acute Hamstring Injuries: A Systematic Review and Meta-Analysis.

Hamstring strain is a common injury to the lower limbs. Early intervention in the acute phase aids with restoring hamstring function and prevents secondary related injury. To systematically review and summarize the effectiveness of exercise-based interventions combined with physical modalities currently used in athletes with acute hamstring injuries. Five databases (EMBASE, Medline, Cochrane Library, SPORTDiscus, and Web of Science) were searched from inception to July 2021. A total of 4569 studies were screened. Nine randomized controlled trials (RCTs) on the effect of therapeutic exercise programs with and without physical agents in athletes with acute hamstring injuries were identified for meta-analysis. Systematic review and meta-analysis. Level 1. The studies were screened, and the evidence was rated using the PEDro scale. Nine RCTs with PEDro scores ranging between 3 and 9 were included and extracted pain intensity, time to return to play (TTRTP), and reinjury rate in the study. Loading exercises during extensive lengthening were shown to facilitate TTRTP at P < 0.0001 but did not prevent recurrence (P = 0.17), whereas strengthening with trunk stabilization and agility exercise did not reduce the duration of injury recurrence (P = 0.16), but significantly reduced the reinjury rate (P < 0.007) at a 12-month follow-up. The results of the stretching programs and solely physical modalities could not be pooled in the statistical analysis. The meta-analysis indicated that a loading program helps athletes to return to sports on a timely basis. Although strengthening with trunk stabilization and agility exercise cannot significantly reduce recovery time, the program can prevent reinjury. The clinical effects of stretching programs and pure physical modality interventions could not be concluded in this study due to limited evidence. CRD42020183035.

Overview of the Current Literature on the Most Common Neurological Diseases in Dogs with a Particular Focus on Rehabilitation.

Simple SummaryThis paper aims to report an overview of the most common neurological diseases (intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis), with a main focus on rehabilitative options and outcomes, reported in recent veterinary literature. Literature seems to be positively oriented on the efficacy of the rehabilitation approach, reporting a careful and prudent choice of the protocol to be applied for the correct recovery of the patient. However, blinded, controlled, prospective studies are still necessary, above all for degenerative myelopathy, fibrocartilaginous embolism, and polyradiculoneuritis.Intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism and polyradiculoneuritis often affect dogs; and physiotherapy may improve the patient’s quality of life and/or reduce recovery times. The aim of this review was to evaluate the current scientific outcomes on these four neurological diseases and on their physiotherapy approaches. From the analysis of the published articles, it emerged that intervertebral disc herniation can be treated, with different rates of success, through a conservative or a surgical approach followed by physiotherapy. The literature is generally oriented toward the efficacy of the rehabilitation approach in this specific canine disease, often proposing intensive post-surgery physiotherapy for the most severe conditions with the absence of deep pain perception. When degenerative myelopathy, fibrocartilaginous embolism or polyradiculoneuritis occur, the existing literature supports the use of a physiotherapeutic approach: allowing a delay in the onset and worsening of the clinical signs in degenerative myelopathy, physical improvement, and, sometimes, complete remission during fibrocartilaginous embolism or acute idiopathic polyradiculoneuritis. However, papers on rehabilitation in dogs affected by polyradiculoneuritis are currently limited to single clinical cases and further blinded, controlled, prospective studies are still advisable for all four neurological diseases.

Minimal surgery for tractional retinal detachment secondary to branch retinal vein occlusion: a case report

BackgroundTractional retinal detachment secondary to retinal vein occlusion is a complex entity that can be extremely difficult to manage due to an intricate association of the retinal tissue with the fibrovascular proliferation, making vitreous dissection an extraordinarily difficult procedure. Minimal surgery without endo-tamponade can reduce recovery time and avoid complications of surgery, which in some cases can lead to blindness and even phthisis.Case presentationA 64-year-old Indian woman presented with progressive worsening of vision (right eye) due to fovea involving tractional retinal detachment secondary to supero-temporal branch retinal vein occlusion. After anterior, core and peripheral vitrectomy, the epicenter of the fibrous bridge causing foveal split was identified and released. The corrected distance visual acuity improved from 6/60 pre-operatively to 6/12 post-operatively. At the 5-year follow-up, the patient remains stable both anatomically and visually.ConclusionsThis case illustrates how careful identification of the epicenter of traction helps maximize visual gain in patients with minimal risk of iatrogenic retinal tears and eliminates the need for endo-tamponade with either gas or silicone oil. Minimal surgery for tractional detachment provides excellent visual gains with minimal risks in select cases.

Assessing Postoperative Recovery With Volatile Gas Versus Total Intravenous Anesthesia in Patients With and Without Obstructive Sleep Apnea.

To determine if there is a recovery time difference between patients with and without obstructive sleep apnea (OSA) when using total intravenous anesthesia (TIVA) compared to volatile gas inhalational anesthesia. OSA and Non-OSA patients were identified at a tertiary institution between January 2019 and November 2020. Non-OSA patients were defined as those who have not been formerly diagnosed with OSA. A modified STOP-BANG score (MSBS) was performed to screen Non-OSA patients for OSA. Recovery was measured by Phase I recovery time, or time it took a patient to reach ≥9/10 on the Aldrete scoring system. A total of 334 patients were included with 142 in the OSA cohort (59 TIVA, 83 inhalational anesthesia) and 192 in the Non-OSA cohort (119 TIVA, 73 inhalational anesthesia). In OSA patients, there was a 41.29-minute recovery time reduction when using TIVA versus sevoflurane (P < .0001). Non-OSA patients recovered faster than OSA patients when undergoing inhalational anesthesia by 46.76 minutes and TIVA by 18.58 minutes (P < .0001 and P = .0907, respectively). Non-OSA patients with a MSBS < 3 and ≥3 had a shorter recovery time compared to OSA patients when both underwent sevoflurane anesthesia (57.27 minutes, P < .0001 and 56.23 minutes, P = .040, respectively). Non-OSA patients with a MSBS of <3 had a decrease in recovery time of 26.68 minutes when compared to OSA patients who underwent TIVA (P = .0004). When utilizing TIVA over inhalational anesthesia, patients with OSA have significantly increased benefit in terms of reduced Phase I recovery times as compared to Non-OSA patients.

Reducing Recovery Times in Outpatient Liver Biopsies: Role of the GI Nurse.

This project is aimed to identify whether recovery times could be reduced in patients undergoing an outpatient liver biopsy. Liver biopsies are typically performed in a hospital setting, and many facilities require patients to recover for multiple hours, sometimes ranging from 4 to 6 hours. This can discourage the patient from undergoing the biopsy. Multiple studies have examined recovery times and determined patients can safely recover and be discharged within 1-2 hours post-liver biopsy. In this retrospective review, the data of 60 outpatients who underwent a liver biopsy from June to December 2020 were analyzed. Analysis included comparing vital signs and symptoms at the 2-hour recovery period and 4-hour discharge time also to see whether there were any hospital admissions 1 week post-liver biopsy. Descriptive statistics were utilized for the data collected in this study. Results demonstrated that after 2 hours, 55 (91.7%) patients had vital signs within safe parameters, pain less than 5 on a 10-point pain scale and denied any other symptoms. The remaining five patients (8.3%) did not meet discharge criteria at the 2-hour mark because of pain greater than 5 on the pain scale yet were still discharged safely at the 4-hour mark.

Outcomes of Patients Undergoing Total Knee Arthroplasty with Spinal Anesthesia: A Comparison of Mepivacaine versus Bupivacaine

Introduction: Previous literature indicates that mepivacaine used for spinal anesthesia may lead to reduced recovery time and urinary retention compared to bupivacaine in patients undergoing total knee arthroplasty (TKA). We sought to compare outcomes between spinal anesthetics in our high-volume joint institution. Materials and Methods: A retrospective review of 553 unilateral primary TKA patients who received spinal anesthesia was conducted. Patients were divided by their receipt of mepivacaine or bupivacaine. Univariate comparisons before and after propensity score matching were used to compare outcomes for TKA patients receiving mepivacaine with those who did not. Results: Of the 553 patients, 102 received mepivacaine, and 451 received bupivacaine. After propensity score matching, patients who received bupivacaine experienced longer lengths of stay, received more oral morphine milligram equivalents (OMMEs), and were less likely to be discharged home. No differences in rates of nausea, urinary retention, or 30-day readmissions were observed between the groups. Discussion: In patients undergoing TKA with a spinal anesthesia, after adjusting for potentially confounding factors using propensity score matching, the use of mepivacaine was associated with shorter length of stay, less overall OMME requirements, and increased likelihood of home discharge, with no increase in complication rates. Based on these results, mepivacaine appears to be a viable alternative to bupivacaine for use in TKA rapid recovery protocols.

Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience.

BackgroundThe second wave of COVID-19 pandemic was not only associated with a rapid and severe surge in the number of cases but also limited availability of recommended medicines. Baricitinib has been known to reduce recovery time in COVID-19 pneumonia in association with remdesivir. Tofacitinib, with limited evidence, was used in severe COVID-19 pneumonia based on its similarity of action with baricitinib.MethodsData of all patients admitted to the COVID-19 intensive care unit in the month of April were accessed and analyzed. Data of patients who were on other immunomodulators, invasive ventilation, or suffering from end-stage organ diseases were excluded from the analysis.ResultsOut of 73 patients, data of 50 were analyzed. Twenty-five received tofacitinib and the other 25 were managed with standard of care. Age, comorbidities, and gender distribution between the two groups were similar. On day 7 of admission, the change in SpO2/FiO2 ratio was 1.26 ± 1 and 0.72 ± 1 in the tofacitinib group and control group, respectively. Similarly, a higher number of subjects in the control group showed worsening in the World Health Organization (WHO) ordinal scale (36 vs 12%, p = 0.01). The clinical objective improvement was similar in the two groups. The intubation rates in the tofacitinib group were significantly lower than that in the control group (32% vs 8%, p = 0.034).ConclusionTofacitinib, in this retrospective single-center experience, was found to be associated with reduced intubation rates and reduced worsening in the WHO ordinal scale. There was no difference in mortality in the two groups.How to cite this articleSingh PK, Lalwani LK, Govindagoudar MB, Aggarwal R, Chaudhry D, Kumar P, et al. Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience. Indian J Crit Care Med 2021;25(10):1108–1112.

Hyperbaric Oxygen Therapy: An Overview

Hyperbaric Oxygen Therapy (HBOT) has been a recognised treatment for a multitude of injuries for decades and presents significant opportunities for the improvement of wound healing, blood vessel restoration, reduction in recovery time after surgery, treatment of neurological and neurodegenerative disorders, improvement of memory and cognition, sports injury rehabilitation, cartilage regeneration, and overall quality of life. This paper aims to investigate HBOT and its indications for use, both as an adjuvant with other established treatments and independently, in order to provide an overview of treatment avenues with immense possibilities and versatility.

비소세포폐암 환자에서의 수술 전후 호흡재활치료

Pulmonary rehabilitation (PR) a safe and feasible option for patients with non-small cell lung cancer (NSCLC) before and after lobectomy or pneumonectomy. Pulmonary function test and oxygen consumption should be evaluated in these patients before and after the PR sessions. For those who are not eligible for surgery due to poor physical performance may have the chance to to receive surgical treatment by improving their exercise capacity after preoperative PR sessions. At the same time, pre-operative PR reduces post-operative morbidity and mortality. Also, post-operative PR enhances functional regain after surgery, and reduces recovery time, post-operative complication, and hospital stays.

Methods of surgical treatment of urolithiasis in modern urological practice

In connection with the introduction of endoscopic surgery and minimally invasive methods in modern urological practice, there is a tendency for reduction of upfront surgeries, which can significantly improve the patients’ quality of life,reduce recovery time in the postoperative period and decrease the percentage of complications in the first 5 years after surgery. The article presents a literature review of modern methods of surgical treatment of urolithiasis with calculi localization in the kidneys. When choosing methods of surgical treatment of urolithiasis, it is necessary to take into account the clinical features of the patient and the characteristics of the calculus itself: the size, shape, calculus composition, the presence of concomitant metabolic disorders and diseases associated with stone formation, infectious complications, the state of urodynamics and anomalies of the urinary tract.