Risk Of Respiratory Distress Syndrome Research Articles

Vitamin A and pregnancy: myths and reality; prospects for the use in patients with endometriosis. A review

BACKGROUND: Retinol in its various forms, being a powerful antioxidant, has a multifaceted effect on the functioning of body systems. Replenishment of the daily requirement for the vitamin is possible only when it is supplied from outside sources. Both excess intake and deficiency of retinol are associated with adverse effects.
 AIM: The aim of this study was to assess the role of vitamin A in the functioning of the female reproductive system, its effect on pregnancy, and the prospects of using it as a pathogenically justified therapy for endometriosis.
 MATERIALS AND METHODS: We performed this review, analyzing articles from such electronic databases as PubMed, ScienceDirect, and Cyberleninka, published in the period from 2000 to 2020.
 RESULTS AND CONCLUSIONS: Vitamin A plays an important role in pregnancy; its deficiency is associated with a number of malformations, the risk of respiratory distress syndrome and disorders of the immune system development in the fetus. Despite the alleged risk of using vitamin A in pregnant women, it can be prescribed both at the planning stage and during pregnancy in safe therapeutic doses, up to 10,000 IU / day, in order to reduce the number of congenital malformations, to give birth to children with higher Apgar scores, and to prevent anemia. Retinol has antiproliferative and antitumor effects and affects the biosynthesis of estrogens, which justifies the possibility of its involvement in the pathogenesis of genital endometriosis. Given the ability of vitamin A to inhibit the proliferation of endometrioid ovarian cysts, to reduce the size of endometrioid heterotopias, and to modulate the synthesis of proinflammatory cytokines, it can be considered as a perspective therapy in the combined treatment of genital endometriosis.

Global Longitudinal Strain to Predict Respiratory Failure and Death in Patients Admitted for COVID-19–Related Disease

Evidence of the involvement of the cardiovascular system in patients with COVID-19 is increasing. The evaluation of the subclinical cardiac involvement is crucial for risk stratification at admission, and left ventricular global longitudinal strain (LVGLS) may be useful for this purpose. A total of 87 consecutive patients admitted to the COVID Center were enrolled from December 2020 to April 2021. A complete echocardiography examination was performed within 72 hours from admission. The main outcome was the need for mechanical ventilation by way of orotracheal intubation (OTI) and mortality, and the secondary outcome was the worsening of the respiratory function during hospitalization, interpreted as a decrease of the ratio between the partial pressure of oxygen and the fraction of inspired oxygen (P/F) <100. Of 87 patients, 14 had severe disease leading to OTI or death, whereas 24 had a P/F <100. LVGLS was significantly impaired in patients with severe disease. After adjustment for risk factors, by considering LVGLS as continuous variable, the latter remained significantly associated with severe acute respiratory distress syndrome (P/F <100) (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.18 to 1.88, p = 0.001) and OTI/death (HR 1.63, 95% CI 1.13 to 2.38, p = 0.012). When using an LVGLS cutoff of −16.1%, LVGLS ≥ −16.1% was independently associated with a higher risk of severe acute respiratory distress syndrome (HR 4.0, 95% CI 1.4 to 11.1, p= 0.008) and OTI/death (HR 7.3, 95% CI 1.6 to 34.1, p = 0.024). LVGLS can detect high-risk patients at the admission, which can help to guide in starting early treatment of the admitted patients.

Association between inflammatory biomarkers and acute respiratory distress syndrome or acute lung injury risk : Asystematic review and meta-analysis.

BackgroundThe relationship between acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) and levels of certain inflammatory factors remains controversial. The purpose of this meta-analysis was to summarize the available studies evaluating the association between levels of inflammatory factors and ARDS/ALI incidence.MethodsWe searched the PubMed, EmBase, and Cochrane databases for studies published up to July 2017. For each inflammatory factor, a random effects model was employed to pool results from different studies.ResultsWe identified 63 studies that included 6243 patients in our meta-analysis. Overall, the results indicated that the levels of angiopoietin (ANG)-2 (standard mean difference, SMD: 1.34; P < 0.001), interleukin (IL)-1β (SMD: 0.92; P = 0.012), IL‑6 (SMD: 0.66; P = 0.005), and tumor necrosis factor (TNF)-α (SMD: 0.98; P = 0.001) were significantly higher in patients with ARDS/ALI than in unaffected individuals. No significant differences were observed between patients with ARDS/ALI and unaffected individuals in terms of the levels of IL‑8 (SMD: 0.61; P = 0.159), IL-10 (SMD: 1.10; P = 0.231), and plasminogen activator inhibitor (PAI)-1 (SMD: 0.70; P = 0.060).ConclusionsARDS/ALI is associated with a significantly elevated levels of ANG‑2, IL-1β, IL‑6, and TNF‑α, but not with IL‑8, IL-10, and PAI‑1 levels.Supplementary InformationThe online version of this article (10.1007/s00508-021-01971-3) contains supplementary material, which is available to authorized users.

Bacterial genotype and clinical outcomes in solid organ transplant recipients with Staphylococcus aureus bacteremia.

Outcomes from Staphylococcus aureus bacteremia (SAB) in solid organ transplant (SOT) recipients are poorly understood. This is a prospective cohort study comparing the bacterial genotype and clinical outcomes of SAB among SOT and non-transplant (non-SOT) recipients from 2005 to 2019. Each subject's initial S. aureus bloodstream isolate was genotyped using spa typing and assigned to a clonal complex. A total of 103 SOT and 1783 non-SOT recipients with SAB were included. Bacterial genotype did not differ significantly between SOT and non-SOT recipients (p=.4673), including the proportion of SAB caused by USA300 (13.2%vs. 16.0%, p=.2680). Transplant status was not significantly associated with 90-day mortality (18.4%vs. 29.5%; adjusted odds ratio [aOR] 0.74; 95% confidence interval [CI]: 0.44, 1.25), but was associated with increased risk for septic shock (50.0%vs. 21.8%; aOR 2.31; 95% CI: 1.48, 3.61) and acute respiratory distress syndrome (21.4%vs. 13.7%; aOR 2.03; 95% CI: 1.22, 3.37), and a significantly lower risk of metastatic complications (33.0%vs. 45.5%; aOR 0.49; 95% CI: 0.32, 0.76). No association was found between bacterial genotype and 90-day mortality (p=.6222) or septic shock (p=.5080) in SOT recipients with SAB. SOT recipients with SAB do not experience greater mortality than non-SOT recipients. The genotype of S. aureus bloodstream isolates in SOT recipients is similar to that of non-SOT recipients, and does not appear to be an important determinant of outcome in SOT recipients with SAB.

Pre-hospitalization proton pump inhibitor use and clinical outcomes in COVID-19.

Severe acute respiratory syndrome coronavirus-2 may escape the inactivation by gastric acid because of hypochlorhydria caused by proton pump inhibitors (PPIs), which could predispose the patients to severe COVID-19. We studied the association between prehospitalization PPI exposure and clinical outcomes among hospitalized COVID-19 patients. A total of 295 hospitalized COVID-19 patients were included in the study. 15.6% of hospitalized COVID-19 patients were on PPIs at home. Mortality among PPI-users was 2.3 times higher than non-users, along with 2.3 times higher risk of acute respiratory distress syndrome after adjusting for confounding variables. We found that prehospitalization PPI-exposure is independently associated with worse clinical outcomes, including mortality in COVID-19 patients, regardless of the presence of cardiovascular comorbidities.

Effects of prenatal oral l-arginine on birth outcomes: a meta-analysis

Adverse birth outcomes are associated with elevated mortality and morbidity rates throughout life. This meta-analysis of randomised controlled trials examined whether prenatal oral l-arginine has effects on birth outcomes. A total of 45 overall good quality studies were extracted from 10 finally eligible articles. In comparison to controls, providing oral l-arginine to women with a history of poor pregnancy outcomes significantly reduced risks of intrauterine growth retardation neonates, pre-term birth and respiratory distress syndrome (n = 7, 3 and 3, respectively) and significantly increased birthweight and gestational age (n = 8 and 5, respectively) l-Arginine significantly increased Apgar score in women at high risk of pre-eclampsia or with pre-eclampsia or gestational or mild chronic hypertension in comparison to controls (n = 4). l-Arginine showed no significant effect on any other outcome examined (n = 2). The quality of evidence was at least medium or high. Consequently, oral l-arginine may be at least moderately recommended for women with a history of poor pregnancy outcomes and at high risk of pre-eclampsia or with pre-eclampsia or gestational or mild chronic hypertension. However, further studies are required to provide stronger conclusions, partly due to small study effects.

Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study.

BackgroundUnhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19.ObjectiveWe aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, BMI, race/ethnicity, and pattern of alcohol use modify the risk.MethodsIn this observational cross-sectional study that took place between January 1, 2020, and December 31, 2020, we ran a digital machine learning classifier on the electronic health record of patients who tested positive for SARS-CoV-2 via nasopharyngeal swab or had two COVID-19 International Classification of Disease, 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, we then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level (ie, emergency department admission, emergency department admission with ventilator, or death). We used a predefined cutoff with optimal sensitivity and specificity on the digital classifier to compare disease severity in patients with and without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status.ResultsEach incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease (odds ratio 1.15, 95% CI 1.10-1.20). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (odds ratio 1.89, 95% CI 1.17-3.06), suggesting that UAU was associated with an 89% increase in the odds of being in a higher severity category.ConclusionsIn patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death.

179 Association of CX3CR1 and Myeloid-derived Suppressor Cell with Survival of Sepsis Patients and Risk of Acute Respiratory Distress Syndrome

Peripheral blood immune micro-environment has been shown to influence survival outcomes in sepsis patients. However, the association of immune micro-environment with clinical outcomes of immune-suppression induced by sepsis remains unclear. Here we performed comprehensive analysis of immune cell infiltration and clinically validated association of CX3CR1 and Myeloid-derived suppressor cell (MDSC) with survival of sepsis patients and risk of acute respiratory distress syndrome (ARDS). This study analyzed discovering cohort including all sepsis patients, which grouped by survival status and ARDS occurrence, from the Gene Expression Omnibus database (GSE10474, GSE32707, GSE66890). Core differential expressed genes (DEGs) and immune cell were selected between groups using LASSO and Random Forest machine learning algorithm. Most survival correlated gene and immune cell were validated in validating cohort (GSE65682) using Kaplan-Meier survival analysis. Since gene and immune cell were selected, patients from discovering cohort were divided into higher and lower group. To further explore underlying mechanism, weighted gene co-expression network analysis (WGCNA) were applied. For functional and pathway enrichment analysis, clusterProfiler R package was used for Gene Ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG) analyses. Among 133 sepsis patients from discovering cohort, 110 down-regulated genes and 76 up-regulated genes were identified as DEGs based on the survival status, while 177 down-regulated genes and 89 up-regulated genes were identified as DEGs based on the ARDS risk, respectively. After combining the DEGs screened out via the LASSO and RF algorithms, 13 DEGs between survival status and 16 DEGs between ARDS risk, were selected simultaneously by these two algorithms. The gene of CX3CR1 and immune cell of MDSC were significantly higher in alive group and none-ARDS group, and they two were correlated most (Spearman r = 0.69 p<0.01). Among 479 patients in validating cohort, higher CX3CR1 was associated with better 28-day survival benefit (hazard ratio [HR] 2.657, 95% CI 1.838-3.843) and higher MDSC associated with better 28-day survival benefit (HR 2.205, 95% CI 1.516-2.206). Using the gene modules of WGCNA that correlated most with CX3CR1 expression level and MDSC proliferation level, biological processes of T cell cytokine production and regulation of glial cell migration were significantly enriched. We demonstrated that CX3CR1 and MDSC can predict ARDS risk and contribute survival benefit for sepsis patients. MDSC might be important component of the immune micro-environment and should be integrated into predictive biomarker panels for immune therapy and be validated in future prospective clinical trials.

ACE gene I/D polymorphism and severity of SARS-CoV-2 infection in hospitalized patients: a meta-analysis

Background: Hypertension and type 2 diabetes increase the risk of severe SARS-CoV-2 infection. On the other hand, homozygous ACE deletion polymorphism (DD) has been associated with these two diseases and risk of acute respiratory distress syndrome. The aim of the study was to conduct a meta-analysis of the association between ACE gene I/D polymorphism (DD, II and DI) and severity of SARS-CoV-2 infection in hospitalized patients. Material and methods: We searched PubMed, EMBASE and Google Scholar for studies published between January 2020 and April 2021. We included case-control studies evaluating the association between ACE I/D and severity of SARS-CoV-2 infection in hospitalized patients, were there was sufficient genotype or allele frequency data to calculate IRR (incidence rate ratio) and 95% confidence intervals (CIs). Results: Five studies were included (mean age 58.5 years and 61% men), combining to a total of 786 patients. Four studies were conducted in Caucasians. Overall, patients who had homozygous co-dominance genotype DD were at 47% higher risk of severe COVID-19 compared with II or ID (IRR: 1.47; 95% CI: 1.15–1.89; p = 0.002). Conclusions: The ACE DD genotype may confer a greater risk of severe COVID-19 in hospitalized patients. Further studies including more diverse ethnic groups are necessary to fully establish this association.

Gastrointestinal Symptoms Associated with Unfavorable Prognosis of Covid-19 Patients

Background: COVID-19 pandemic or coronavirus is a systemic disease taken into consideration for vascular system-specific tropism where microcirculation alteration has a significant pathogenic role. The coronavirus affects the gastrointestinal tract, abdominal manifestation, and hepatobiliary system. Aim: the aim of the present study was to evaluate the association of gastrointestinal symptoms with unfavorable prognosis of coronavirus patients. Materials and Methods: This single-center cross-sectional study was carried out on 486 patients with or without gastrointestinal symptoms and was conducted for six months duration from January to June 2021 at Gastroenterology department, Isra University Hospital, Hyderabad. All these patients were categorized into two main groups; group-I patients exposed to coronavirus with gastrointestinal symptoms while group-II patients exposed to COVID-19 without gastrointestinal symptoms. Gastrointestinal symptoms were associated with acute respiratory distress syndrome (ARDS), continuous renal replacement therapy (CRRT), non-invasive ventilator treatment, tracheotomy, and tracheal intubation. Multivariable and unilateral regression models were utilized for data analysis. Results: Of the total 486 patients, 157 (32.3%) were with gastrointestinal symptom patients while 329 (67.7%) were without GI symptoms. Propensity scores were analyzed in both groups. Both groups were equally susceptible to higher mortality risks but COVID-19 patients with gastrointestinal symptoms were at high risk of acute respiratory distress syndrome. Of the 157 patients with GI symptoms, 44 (28.03%) were initially diagnosed and 113 (71.97%) were diagnosed in hospital. The prevalence of vomiting or nausea, diarrhea, abdominal distention, and abdominal pain were 30 (19.1%), 83 (52.9%), 18 (11.5%), and 26 (16.6%) respectively. Dyspnea, fatigue, fever, chest tightness, and cough were common COVID-19 symptomatic patients. The prevalence of GI symptoms patients had dyspnea 23 (14.6%), fatigue 45 (28.7%), fever 128 (81.5%), chest tightness 25 (15.9%), and cough 72 (45.9%) were statistically significant and higher compared to the no symptoms of gastrointestinal disease patients. Conclusion: Our study found the high prevalence of COVID-19 patients with gastrointestinal symptoms compared to without gastrointestinal symptoms in COVID-19 patients and associated with non-invasive mechanical ventilation and risks of acute respiratory distress syndrome. Hence, COVID-19 patients with gastrointestinal symptoms should be taken care of in healthcare protection. Keywords: COVID-19, Gastrointestinal symptoms, ARDS or acute respiratory distress syndrome

Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study.

Interventional trials aimed at pediatric acute respiratory distress syndrome prevention require accurate identification of high-risk patients. In this study, we aimed to characterize the frequency and outcomes of children meeting "at risk for pediatric acute respiratory distress syndrome" criteria as defined by the Pediatric Acute Lung Injury Consensus Conference. Planned substudy of the prospective multicenter, international Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study conducted during 10 nonconsecutive weeks (May 2016-June 2017). Thirty-seven international PICUs. Three-hundred ten critically ill children meeting Pediatric Acute Lung Injury Consensus Conference "at-risk for pediatric acute respiratory distress syndrome" criteria. None. We evaluated the frequency of children at risk for pediatric acute respiratory distress syndrome and rate of subsequent pediatric acute respiratory distress syndrome diagnosis and used multivariable logistic regression to identify factors associated with subsequent pediatric acute respiratory distress syndrome. Frequency of at risk for pediatric acute respiratory distress syndrome was 3.8% (95% CI, 3.4-5.2%) among the 8,122 critically ill children who were screened and 5.8% (95% CI, 5.2-6.4%) among the 5,334 screened children on positive pressure ventilation or high-flow oxygen. Among the 310 at-risk children, median age was 2.1 years (interquartile range, 0.5-7.3 yr). Sixty-six children (21.3%) were subsequently diagnosed with pediatric acute respiratory distress syndrome, a median of 22.6 hours (interquartile range, 9.8-41.0 hr) later. Subsequent pediatric acute respiratory distress syndrome was associated with increased mortality (21.2% vs 3.3%; p < 0.001) and longer durations of invasive ventilation and PICU care. Subsequent pediatric acute respiratory distress syndrome rate did not differ by respiratory support modality at the time of meeting at risk criteria but was independently associated with lower initial saturation:Fio2 ratio, progressive tachycardia, and early diuretic administration. The Pediatric Acute Lung Injury Consensus Conference "at-risk for pediatric acute respiratory distress syndrome" criteria identify critically ill children at high risk of pediatric acute respiratory distress syndrome and poor outcomes. Interventional trials aimed at pediatric acute respiratory distress syndrome prevention should target patients early in their illness course and include patients on high-flow oxygen and positive pressure ventilation.

Effects of Metformin on Clinical outcomes in Patients with Type 2 Diabetes and Covid-19

Background: The effects of metformin therapy on the prognosis of patients with coronavirus disease 2019 (COVID-19) are unclear. Objective: To review effects of metformin on clinical outcomes, particularly mortality, in patients with type 2 diabetes and COVID-19. Methods: Review of English literature by PUBMED search until April 20, 2021. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, and consensus guidelines are reviewed. Results: All available studies in this area are retrospective. Two population-based studies did not find significant association between metformin use and susceptibility to COVID-19. Most, but not all studies, suggest that metformin use prior to hospital admission might be associated with significant decrease in mortality in patients with type 2 diabetes and COVID-19. Continuing metformin use after hospital admission did not have significant impact on COVID-19 related death but may decrease risk of acute respiratory distress syndrome (ARDS). Meanwhile, in-hospital metformin administration may be associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking ≥2 gm/d of metformin, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Conclusions: Although most retrospective studies suggest that metformin administration may be associated with decreased risk of COVID-19 mortality, these data should be confirmed by randomized trials. In patients with type 2 diabetes and COVID-19 admitted to the hospital, metformin use should be avoided in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR &lt; 60 ml/min/1.73m2), and in daily doses of ≥ 2 gm due to increased risk of lactic acidosis.

Linear Association Between Hypoalbuminemia and Increased Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults.

Retrospective analysis of prospective cohort. Medical, surgical, and cardiovascular ICUs at Vanderbilt University Medical Center. Patients (n = 993) with serum albumin measured for clinical reasons within 24 hours of study enrollment on ICU day 2 were included. The primary outcome was presence of acute respiratory distress syndrome at any time during the first 4 days in the ICU, as defined by the Berlin definition. Secondary outcomes included ventilator-free days and ICU length of stay. In an unadjusted analysis, lower serum albumin levels were associated with a higher occurrence rate of acute respiratory distress syndrome (p < 0.001). In a multivariable analysis controlling for prespecified confounders, lower serum albumin was independently associated with an increased risk of acute respiratory distress syndrome (odds ratio, 1.48 per 1-g/dL decrease in albumin; 95% CI, 1.14-1.94; p = 0.004). Additionally, lower serum albumin was associated with increased mortality (odds ratio, 1.56 per 1-g/dL decrease in albumin; 95% CI, 1.19-2.04; p = 0.001), increased ICU length of stay (incidence rate ratio, 1.19; 95% CI, 1.15-1.23; p < 0.001), higher Sequential Organ Failure Assessment score (p < 0.001), and fewer ventilator-free days (incidence rate ratio, 1.21; 95% CI, 1.19-1.24; p < 0.001). Among adult ICU patients, lower serum albumin was independently associated with increased risk of acute respiratory distress syndrome after controlling for severity of illness and potential confounders. These findings support the hypothesis that low plasma oncotic pressure contributes to pulmonary edema formation in patients at risk for acute respiratory distress syndrome, independent of severity of illness.

Income‐driven socioeconomic status and presenting illness severity in children with acute respiratory failure

Children living in low socioeconomic communities are vulnerable to poor health outcomes, especially when critically ill. The purpose of this study was to investigate the association between socioeconomic status (SES) and illness severity upon pediatric intensive care unit (PICU) admission in children with acute respiratory failure. This secondary analysis of the multicenter Randomized Evaluation of Sedation Titration for Respiratory Failureclinical trial includes children, 2 weeks to 17 years old, mechanically ventilated for acute respiratory failure; specifically, subjects who had parental consent for follow-up and residential addresses that could be matched with census tracts (n = 2006). Subjects were categorized into quartiles based on income, with a median income of $54,036 for the census tracts represented in the sample. Subjects in the highest income quartile were more likely to be older, non-Hispanic White, and hospitalized for pneumonia. Subjects in the lowest income quartile were more likely to be Black, younger, and hospitalized for asthma or bronchiolitis, to have age-appropriate baseline functional status, and history of prematurity and asthma. After controlling for age group, gender, race, and primary diagnosis, there were no associations between income quartile and either Pediatric Risk of Mortalityscores or pediatric acute respiratory distress syndrome. As measured, income-based SES was not associated with illness severity upon PICU admission in this cohort of patients. More robust and reliable methods for measuring SES may help to better explain the mechanisms by which socioeconomic affect critical illness.

Elective cesarean section on maternal request without indication: reasons for it, and its advantages and disadvantages

Aim: The aim of this study was to analyze the available research evidence on the reasons for, and advantages and disadvantages of elective cesarean section on maternal request. Design: Literature review. Methods: The review was conducted using Web of Science, PubMed, Embase, Scopus, ProQuest, and Google Scholar from 2009 to 2020, based on PRISMA guidelines, and Mesh keywords. All types of studies reporting on the subject of the research were included, excepting case reports. STROBE and JBI checklists were used to assess the quality of studies. Sixteen studies were included in this literature review. Results: Fear of complications during vaginal delivery was the most frequent maternal reason for elective cesarean section. Fear of physical injury to the infant during vaginal delivery was the most frequent neonatal reason for elective cesarean section. Birth experiences of family, friends, or relatives was the most frequent social maternal reason given for elective cesarean section. The most common advantage of cesarean section was reduction in neonatal injuries. The incidence of maternal wound infection and risk of neonatal respiratory distress syndrome were the most common disadvantages of cesarean section. Conclusion: Identifying the reasons for cesarean section on maternal request can help create a more precise roadmap for increasing awareness in women of the advantages of vaginal delivery, preventing prenatal complications, and reducing costs in healthcare systems.

Using pulmonary artery acceleration time to evaluate pulmonary hemodynamic changes on preterm infants with respiratory distress syndrome.

BackgroundPulmonary artery acceleration time (PAAT) is a reliable and non-invasive method for assessing pulmonary hemodynamics. To date, few studies have used PAAT to assess preterm infants, especially those with respiratory distress syndrome (RDS). This study aimed to assess changes in PAAT among preterm infants with RDS undergoing pulmonary surfactant (PS) therapy or not, and determine its potential effects on the pulmonary vascular disease (PVD) outcomes of preterm infants with RDS in the late postnatal period.MethodsThe risk of RDS was reviewed in 62 preterm infants with a gestational age of 26–31 weeks. The infants receiving PS therapy were allocated to the PS group, and the others were allocated to the control group. PAAT, right ventricular ejection time (RVET), and other ultrasonic parameters at 3 different time points after birth were studied and compared.ResultsInfants in the PS group had a significantly lower PAAT (52.7±5.9 vs. 59.6±8.7; P=0.001) and PAAT/RVET (0.30±0.03 vs. 0.33±0.03; P=0.001) than those in the control group at 36 weeks postmenstrual age (PMA). No significant increases in PAAT/RVET were detected at 3 different times for the PS group (P=0.117), but both PAAT and PAAT/RVET increased significantly with time after birth in the control group (P<0.001).ConclusionsPreterm infants with RDS might still have PVD in the late postnatal period and thus require long-term follow-up observation. PAAT appears to be a reliable non-invasive screening measure for evaluating pulmonary hemodynamics in preterm infants with RDS and late PVD.

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

ObjectiveThis meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies.MethodsThe PubMed, Embase, Web of Science and Cochrane Library databases were searched...

Optimal Timing of Remdesivir Initiation in Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Administered With Dexamethasone.

BackgroundEvidence is lacking about any additional benefits of introducing remdesivir on top of dexamethasone, and the optimal timing of initiation.MethodsIn a territory-wide cohort of 10,445 COVID-19 patients from Hong Kong who were hospitalized between 21st January 2020 and 31st January 2021, 1544 patients had received dexamethasone during hospitalization. Exposure group consisted of patients who had initiated remdesivir prior to dexamethasone (n=93), or co-initiated the two drugs simultaneously (n=373); whereas non-exposure group included patients who were given remdesivir after dexamethasone (n=149), or those without remdesivir use (n=929). Multiple imputation and inverse probability of treatment weighting for propensity score were applied and hazard ratios (HR) of event outcomes were estimated using Cox regression models.ResultsTime to clinical improvement (HR=1.23, 95%CI 1.02-1.49, p=0.032) and positive IgG antibody (HR=1.22, 95%CI 1.02-1.46, p=0.029) were significantly shorter in the exposure group than that of non-exposure. The exposure group had a shorter hospital length of stay by 2.65 days among survivors, lower WHO clinical progression scale scores from five days of follow-up onwards, lower risks of in-hospital death (HR=0.59, 95%CI 0.36-0.98, p=0.042) and composite outcomes; and without experiencing an increased risk of ARDS. Differences in the cumulative direct medical costs between groups were no longer significant from 17 days of follow-up onwards.ConclusionsInitiation of remdesivir prior to or simultaneously with dexamethasone was associated with significantly shorter time to clinical improvement and positive IgG antibody, lower risk of in-hospital death, in addition to shorter length of hospital stay in patients with moderate COVID-19.

Vitamin D and T- regulator cells are not independent factors for RDS in premature neonates

Background The high morbidity and mortality of premature neonates remain significant problem in Indonesia with respiratory distress syndrome (RDS) as one of the most common problem. Vitamin D plays an important role in lung maturity. Vitamin D deficiency causes epithelial cell inflammation, leading to a higher risk of RDS. Previous studies suggest that T regulatory cells (Treg) in inflammatory diseases, such as RDS in neonates, are possibly linked to vitamin D deficiency.&#x0D; Objective To determine the role of vitamin D on RDS and Treg cells in very premature or very low birth weight neonates.&#x0D; Methods A prospective cohort study conducted on premature neonates in Neonatology Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Umbilical cord blood samples were collected to evaluate total vitamin D 25-OH levels and Treg cells. Subjects with RDS were evaluated until the end of the observation period.&#x0D; Results The mean umbilical cord vitamin D level was 15.79 (SD 6.9) ng/mL, and 53% of the subjects were found to be deficient. As much as 65.1% of neonates had RDS. The mean Treg level was 11.38 (SD 2.45)%. No significant correlation was observed between vitamin D level and the occurrence of RDS (RR 0.87; 95%CI 0.56 to 1.34; P=0.53); vitamin D level and the dysregulation of Treg cells (RR 1.30; 95%CI 0.76 to 2.21; P=0.31) as well as between Treg dysregulation and RDS (RR 1.11; 95%CI 0.70 to 1.75; P=0.64). However, we found that RDS group had a lower gestational age and higher presentation of dysregulation Treg.&#x0D; Conclusion In very premature or very low birth weight neonates, no association between occurence of RDS and vitamin D deficiency as well as Treg cell dysregulation.

Associations of influenza, chronic comorbid conditions, and severe maternal morbidity among pregnant women in the United States with influenza at delivery hospitalization, 2000–2015

Chronic comorbid conditions increase the risk of influenza-related morbidity. Whether this holds for pregnant women who are at a high risk of complications from influenza remains to be determined. This study aimed to determine whether chronic comorbid conditions are associated with an increased risk of severe maternal morbidity among pregnant women with an influenza diagnosis at delivery hospitalization. We performed a cross-sectional analysis of delivery hospitalizations complicated by an influenza diagnosis using the National Inpatient Sample from 2000 to 2015. We assessed 4 prevalent chronic comorbid conditions associated with increased influenza complications outside of pregnancy, obstructive lung disease (asthma and chronic obstructive pulmonary disease), chronic hypertension, obesity, and pregestational diabetes mellitus, overall and individually. The primary outcome was severe maternal morbidity, excluding transfusion as defined by the Centers for Disease Control and Prevention, and the secondary outcomes were specific severe maternal morbidity measures that were recognized as influenza-related complications, acute respiratory distress syndrome, mechanical intubation and ventilation, and sepsis and shock. Multivariable survey-weighted log-linear models were used, adjusting for patient, hospital, and clinical characteristics. Of 62.7 million delivery hospitalizations, 144,572 (0.2%) were complicated by an influenza diagnosis at delivery hospitalization (23 cases of influenza per 10,000 delivery hospitalizations) and 36,054 (24.9%) with ≥1 chronic comorbid conditions, of which 77.4% included obstructive lung disease. Pregnant women with an influenza diagnosis at delivery hospitalization with chronic comorbid conditions had a slightly higher risk of severe maternal morbidity than those without (2.6% vs 1.7%; adjusted risk ratio, 1.11; 95% confidence interval, 1.03-1.21) and acute respiratory distress syndrome (0.9% vs 0.5%; adjusted risk ratio, 1.42; 95% confidence interval, 1.23-1.64) and mechanical intubation and ventilation (0.2% vs 0.1%; adjusted risk ratio, 1.92; 95% confidence interval, 1.37-2.69) but a lower risk of sepsis and shock (0.2% vs 0.3%; adjusted risk ratio, 0.57; 95% confidence interval, 0.45-0.73). Regarding specific conditions, obstructive lung disease was associated with an increased risk of severe maternal morbidity (adjusted risk ratio, 1.21; 95% confidence interval, 1.11-1.32) and acute respiratory distress syndrome (adjusted risk ratio, 1.54; 95% confidence interval, 1.32-1.79) and mechanical intubation and ventilation (adjusted risk ratio, 2.80; 95% confidence interval, 2.00-3.91). Chronic hypertension was associated with an increased risk of acute respiratory distress syndrome (adjusted risk ratio, 1.70; 95% confidence interval, 1.16-2.49) but a lower risk of sepsis and shock (adjusted risk ratio, 0.34; 95% confidence interval, 0.13-0.85). Obesity was associated with a lower risk of severe maternal morbidity (adjusted risk ratio, 0.84; 95% confidence interval, 0.74-0.97). Pregestational diabetes mellitus was not associated with severe maternal morbidity. Among women with a diagnosis of influenza at delivery hospitalization, chronic comorbid conditions may increase the risk of severe maternal morbidity and particularly outcomes related to influenza. These results can inform efforts to increase influenza vaccination for all pregnant women, in particular those with chronic comorbidities.