Significant Reduction In Duration Research Articles

The effect of tracheotomy timing on short- term prognosis in hypertensive intracerebral haemorrhage patients after craniectomy: a retrospective analysis of early vs late intervention

Objective: The present study aimed to compare the clinical outcomes and short-term prognosis in patients with hypertensive intracerebral haemorrhage (HICH) with basal ganglia haematoma volume ≥ 60 mL who underwent early tracheotomy versus late tracheotomy post-craniectomy. Methods: A retrospective analysis was conducted based on the data of 102 patients with basal ganglia haematoma volume ≥ 60 mL after craniectomy between 2016 and 2021. Patients were divided into two groups: early tracheotomy and late tracheotomy. This study evaluated the effect of early tracheotomy on prognosis within 90 days and the impact of tracheotomy timing on overall survival in patients with HICH. Results: Patients in the early tracheotomy group showed a significant reduction in duration of ventilation and intracranial pressure (ICP) at 24 hours (post-tracheotomy) compared to those in the late tracheotomy group. Multivariable logistic regression indicated that late tracheotomy after craniectomy, old age, Glasgow Coma Scale (GCS) ≤ 6, large haematoma volume, and pneumonia after tracheotomy were risk factors for poor prognosis within 90 days in patients with HICH undergoing tracheotomy postoperatively. In terms of the impact of tracheotomy timing on overall survival in patients with HICH, 46 patients died within a follow-up period of 90 days; 19 in the early tracheotomy group (overall survival rate 62.7%), and 27 in the late tracheotomy group (overall survival of 47.1%). Conclusions: Early tracheotomy significantly improved the short-term prognosis of patients with HICH, with a higher overall survival rate compared to late tracheotomy within 90 days of illness.

Tranexamic acid in bleeding reduction and operative time of nasal surgeries: systematic review and meta-analysis.

Our study goal is to review the efficacy of tranexamic acid in reducing blood loss and operative time in nasal surgeries. We included randomized clinical trials using oral or intravenous tranexamic acid, excluded non-randomized studies, topic administration, coagulopathy, and using other drugs interfering in the coagulation cascade. Online databases, National Library of Medicine (MEDLINE-PubMED), Latin American and Caribbean Literature on Health Sciences (Lilacs), Cochrane Library, Embase and Google Scholar were used to perform the search. The review was registered in PROSPERO by no CRD42022310977. Two authors, independently, selected the articles meeting the inclusion criteria. They extracted the data and used RevMan 5 software to perform the meta-analysis. Our search resulted in 16 RCTs that were included in the meta-analysis totalizing 1108 patients. Studies were evaluated resulting in a low risk of bias for the five domains. The use of tranexamic acid resulted in significant reduction in duration of surgery (DOS) and intraoperative blood loss (IBL) had significant reduction. The level of evidence according to GRADE System was high in all studies and variables. Tranexamic acid has an important role in reducing intraoperative blood loss and duration of surgery. Our study has some limitations due to the low number of RCTs available in the literature.

A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics

We prospectively implemented a diagnostic stewardship care-bundle checklist, 'Sepsis-48 DSB', with the aim of reducing intervening duration of key steps of automated blood culture diagnostics (aBCD). Sepsis-48 DSB was implemented for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) during the intervention period (P2; July 2020-June 2021) and intervening durations were compared with those during the retrospective, pre-intervention period (P1; March-June 2020). During both periods, provisional blood culture reports (pBCR) were issued wherein direct microbial identification (dID) was performed in BCBs with Gram-negatives by directly inoculating conventional biochemical tests and direct antimicrobial susceptibility testing (dAST) using EUCAST RAST method. The results were compared with the standard of care (SoC) method (i.e. full incubation followed by identification and AST by VITEKⓇ-2 Compact). During P2, significant reductions in loading time (LT) [median: 63.5 vs. 32 minutes, P < 0.001], time to dID+dAST performance (TTD) [186 vs. 115 minutes, P=0.0018] and an increase in compliance to bundle targets [LT ≤45: 44% vs. 66%, P=0.006 and TTD ≤120: 34% vs. 51.7%, P=0.03] were observed. Using dID+dAST method, results were read 694 minutes earlier than SoC method. Of 176 pBCR, 165 (94%) were concordant with SoC in microbial identification of species. Categorical agreement for any drug-bug combination was 92.7% (1079/1164) and corresponding major, very major, and minor error rates were 8.8% (19/216), 4.9% (45/921), and 1.8% (21/1164), respectively. The 'diagnostic stewardship care-bundle' strategy was successfully implemented with considerable diagnostic accuracy leading to significant reductions in duration of targeted steps of aBCD.

A PROSPECTIVE STUDY TO COMPARE COMBINED USE OF INTRAVAGINAL MISOPROSTOL AND INTRACERVICAL FOLEY CATHETER VERSUS INTRAVAGINAL MISOPROSTOL ALONE FOR TERMINATION OF MID-TRIMESTER PREGNANCY IN DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY SMS MEDICAL COLLEGE, JAIPUR

Aims and Objectives: The aims and objectives of the study are to compare the mean induction to abortion interval and efficacy of intra-vaginal misoprostol alone versus combined use of intravaginal misoprostol and intracervical Foley catheter in termination of mid-trimester pregnancy. Methods: This was prospective, comparative study conducted during March 2021 to April 2022 at Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur. The study included sample size of 60 cases (30 cases in each group). 60 cases were randomly allocated to either intravaginal misoprostol alone (Group A) or combined use of intravaginal misoprostol and Foley catheter (Group B) for termination of mid-trimester pregnancy. The study included all pregnant females between 14 and 20 weeks of gestation who were admitted for termination of pregnancy. Results: Mean induction to abortion interval±standard deviation for Group A was 20.79±2.01 h and for Group B, it was 17.29±3.58 h. Mean dose of tablet misoprostol required for Group A±standard deviation was 1453.3±267.47 mcg and for Group B, it was 1053.33±267.47 mcg. Conclusion: In this study, we found that with the combined use of intravaginal misoprostol and intracervical Foley catheter, there was a significant reduction in duration of induction to abortion, total dose misoprostol required, and hospital stay than in intravagnial misoprostol alone in termination of mid-trimester pregnancy.

Comparing the clinical effects of balanced electrolyte solutions versus normal saline in managing diabetic ketoacidosis: A systematic review and meta-analyses.

The first-line treatment of diabetes ketoacidosis (DKA) involves fluid resuscitation with normal saline infusion to correct hypovolemia. Hyperchloremic metabolic acidosis from aggressive normal saline administration was associated with worse clinical outcomes in managing DKA. Other choices for normal saline include balanced electrolyte solutions (BESs). This study aimed to compare the clinical effects between BESs and normal saline in managing DKA. This study was a systematic review of probing articles published from inception to October 2021 in Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Google Scholar, and Scopus. Eight randomized controlled trials with a total of 595 individuals were included. The data were analyzed at 95% confidence level using random-effects models. For the primary outcomes, there was no difference in the duration of DKA resolution. (Mean difference [MD] -4.73, 95% confidence interval [CI] -2.72-4.92; I2 = 92%; P = 0.180). However, there was a significantly lower postresuscitation chloride concentration in the BES (MD 2.96 95% CI - 4.86 to - 1.06; I2 = 59%; P = 0.002). For the secondary outcomes, there was a significant reduction in duration for normalization of bicarbonate in the BES group (MD 3.11 95% CI - 3.98-2.23; I2 = 5%; P = 0.0004). There were no significant differences between groups in duration for recovery of pH, intensive unit admission, and adverse events (mortality and acute renal failure). Resuscitation with BES was associated with decreased chloride and increased bicarbonate values in DKA patients. It suggests that BES prevents DKA patients from hyperchloremic metabolic acidosis.

Comparative, randomized-controlled trial on efficacy and safety of Lactobacillus rhamnosus GG and Saccharomyces boulardii in treatment of acute diarrhea in Indian children (COMPARE-GG trial)

Background: Probiotics are routinely prescribed to boost gut health and reduce severity of diarrhea. This study aimed to compare the efficacy and safety of Lactobacillus rhamnosus GG (LrGG) and Saccharomyces boulardii as an adjunct treatment for acute diarrhea in Indian children aged 6–36 months. Methods: In this single-center, open label, comparative, randomized controlled study, children were randomized into three groups (n=35, each) and provided either low osmolarity oral rehydration solution (ORS) and zinc (20 mg/day) alone or ORS+Zinc supplemented with one of the two probiotic preparations, LrGG ATCC 53103 or S. boulardii CNCM 1-745. Children were monitored every 8 hours after admission and the duration of diarrhea and hospital stay, and stool frequency were evaluated. Results: Of the total 105 children enrolled in the study, majority were aged between 13–24 months (40%). LrGG significantly reduced the mean duration of diarrhea by nearly 19 hours, when compared to the control group (p=0.003), while reduction by S. boulardii was not significant. The mean hospital stay duration for control group was about 6 days, which was significantly reduced (p=0.0001) by nearly 23 hours by LrGG, and non-significantly by S. boulardii. On day 2, LrGG significantly reduced stool frequency by 32.31%, as compared to 27.44% reduction in control group. S. boulardii reduced stool frequency by 31.76%, which was not statistically significant compared to that in control group. Conclusions: LrGG showed statistically significant reduction in duration of diarrhea and hospital stay, when compared against the group receiving ORS+zinc either alone or with S. boulardii.

Treadmill exercise training improves the high-fat diet-induced behavioral changes in the male rats

The purpose of this study was to investigate the effects of treadmill exercise training on obesity-induced behavioral changes in high-fat diet (HFD)-induced male rats. In this study, 40male Sprague-Dawley rats were divided into 4 groups after they were weaned: Control (C), Exercise (E), Obese (O) and Obese + Exercise (O + E). For the obesity model % 60 high-fat diet were applied. After obesity was induced, rats were either moderate aerobic exercise (treadmill running) trained or left untrained. Different tasks to assess spatial learning and memory (Morris water maze test (MWMT)), depressive-like behavior (forced swimming test(FST), tail suspension test (TST) and anxiety-like behavior (light-dark test (LDT) and open field test (OFT)) were conducted. Exercise caused a significant reduction in duration of immobility in the O group in FST and the decrease in immobility in the O + E rats in TST. The O + E rats demonstrated a significant increase in the time spent in the light box as compared to the O group in the LDT. The O + E rats did not show any behavioral alterations as compared to all the other groups in the OFT. In the O + E group, there was a significant increase in the time spent in the target quadrant compared to the O group in the MWMT. Our results support that treadmill exercise could improve cognitive, depressive-like, anxiety-like behavioral changes in the HFD-induced obese rats.

Комплексная цифровизация, реализуемая при освоении запасов Гремячинского месторождения калийно-магниевых солей

The paper reviews the main trends in digitalization of the production processes implemented during the development of the Gremyachinskoe potassium-magnesium salt deposit. The main objective of the digital projects is to maintain competitiveness in the current market conditions. When implementing the integrated digital transformation project, the EuroChem-VolgaKaliy created a clear system of criteria to control the efficiency of the business processes and intriduced instrumental control over the actual duration of the technological cycle. Comparing more complete information on personnel with production metrics data creates objective ratings of face teams and foremen, which makes it possible to reduce production cycle time and increase average daily production volumes by 26%. An important area for further implementation of the project will be upgrading the IT-infrastructure, robotization of the office tasks, e.g. automatic generation of production requests, transfer of messages between the related divisions with no manual entry of information. After the information array is formed, it is planned to introduce the dependency analysis of production indicators with definition of equipment breakdown parameters. This will help to reduce the total number of downtime cases and increase the productivity of the mine as a whole, and will ensure a significant reduction in duration of unscheduled emergency repairs. A promising trend in activities of the Gremyachinskoe mining-and-processing integrated works is application of artificial intelligence in planning of mining operations. In order to solve these tasks it is envisaged to create 3D models, to simulate various methods and technologies of mining salt formations, to determine the design parameters of the mining method with account of the actual morphology and thixotropy of the formations.

CORRELATION BETWEEN INITIAL PRESSURE AND DURATION ON BUBBLE CPAP IN NEONATES WITH RESPIRATORY DISTRESS ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE CENTRE

Background: Continuous Positive airway pressure (CPAP) is a non-invasive form of respiratory support, which is safe and effective in neonates with respiratory distress. The purpose of this study is to predict the length of stay on bubble CPAP in neonates by correlating the initial pressure and duration on it with respect to gestational age, birth weight and respiratory distress scores. Objective: To correlate the initial pressure and duration on bubble CPAP in neonates with respiratory distress thereby predicting the length of stay on it and analyzing the factors responsible for bubble CPAP failure. Materials and Methods: A prospective longitudinal study was conducted over a period of 2 years in neonates with respiratory distress requiring bubble CPAP. Applying Pearsoncoefficient, the initial pressure and duration on bubble CPAP was correlated with respect to different variables. The statistical analysis was performed using SPSS (Version 20.0). P value of &lt;0.05 was considered as statistically significant. Results: Out of 246 neonates enrolled, 211(85.77%) neonates were successfully treated with bubble CPAP, with mean birth weight of 1.66 kg and mean duration of stay on bubble CPAP was 32.64 hours. Applying Pearson co- efficient on initial pressure and duration on bubble CPAP there was negative correlation, which was statistically significant. 35(14.23%) failed bubble CPAP. The predictors of failure were prematurity (51.43%), birth asphyxia (8.6%), age at initiation of bubble CPAP, sepsis (8.57%), Downes score and Silverman Anderson score of more than 6. Other maternal and neonatal variables did not influence the need of mechanical ventilation. Conclusion: The duration of stay on bubble CPAP and the initial pressure set are negatively correlated that is, higher the initial pressure there is significant reduction in duration on bubble CPAP thereby the length of stay can be predicted by initial pressure set.

BARICITINIB IN HOSPITALIZED PATIENTS WITH COVID-19: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to HomeboundSESSION TYPE: Original InvestigationsPRESENTED ON: 10/18/2022 02:45 pm - 03:45 pmPURPOSE: To date, only dexamethasone, tocilizumab, and casirivimab/imdevimab have been shown to reduce mortality in COVID-19 patients. Baricitinib is a selective Janus kinase 1/2 inhibitor with known anti-inflammatory and anti-viral properties. We sought to perform a meta-analysis of RCTs assessing the role of baricitinib in hospitalized patients with COVID-19 disease.METHODS: Electronic databases such as MEDLINE, EMBASE, and Cochrane Central were searched till March 20, 2022, for randomized controlled trials evaluating the efficacy of baricitinib in hospitalized COVID-19 patients. The outcomes assessed were 28-day mortality, progression to respiratory failure needing positive pressure ventilation or death, progression to mechanical ventilation or ECMO, duration of hospitalization and time to discharge.RESULTS: Four studies (with 10,815 patients) were included in the analysis. In total, 5,477 patients received baricitinib, and 5,338 patients received standard care. Pooled analysis showed a significantly decreased risk of 28-day mortality (OR 0.85, 95% CI 0.76-0.96, p=0.006) and progression to invasive mechanical ventilation or ECMO (OR 0.80, 95% CI 0.69-0.94, p=0.005) in the baricitinib arm compared to standard therapy or placebo. In addition, there was a significant reduction in duration of hospitalization (MD -1.43, 95% CI -2.46, -0.40, p=0.007) and time to recovery (MD -0.88, 95% CI -1.34, -0.41, p=0.0002).CONCLUSIONS: Baricitinib improved the patient-centric outcomes of mortality and progression to severe disease i.e., need for invasive mechanical ventilation, in hospitalized patients with COVID-19 disease compared with standard therapy alone.CLINICAL IMPLICATIONS: Baricitinib may be used in conjunction with standard of care treatments to improve morbidity and mortality in hospitalized COVID-19 patients.DISCLOSURES: No relevant relationships by Gerardo CarinoNo relevant relationships by ARKADIY FINNNo relevant relationships by Amos LalNo relevant relationships by VIJAIRAM SELVARAJ SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: To date, only dexamethasone, tocilizumab, and casirivimab/imdevimab have been shown to reduce mortality in COVID-19 patients. Baricitinib is a selective Janus kinase 1/2 inhibitor with known anti-inflammatory and anti-viral properties. We sought to perform a meta-analysis of RCTs assessing the role of baricitinib in hospitalized patients with COVID-19 disease. METHODS: Electronic databases such as MEDLINE, EMBASE, and Cochrane Central were searched till March 20, 2022, for randomized controlled trials evaluating the efficacy of baricitinib in hospitalized COVID-19 patients. The outcomes assessed were 28-day mortality, progression to respiratory failure needing positive pressure ventilation or death, progression to mechanical ventilation or ECMO, duration of hospitalization and time to discharge. RESULTS: Four studies (with 10,815 patients) were included in the analysis. In total, 5,477 patients received baricitinib, and 5,338 patients received standard care. Pooled analysis showed a significantly decreased risk of 28-day mortality (OR 0.85, 95% CI 0.76-0.96, p=0.006) and progression to invasive mechanical ventilation or ECMO (OR 0.80, 95% CI 0.69-0.94, p=0.005) in the baricitinib arm compared to standard therapy or placebo. In addition, there was a significant reduction in duration of hospitalization (MD -1.43, 95% CI -2.46, -0.40, p=0.007) and time to recovery (MD -0.88, 95% CI -1.34, -0.41, p=0.0002). CONCLUSIONS: Baricitinib improved the patient-centric outcomes of mortality and progression to severe disease i.e., need for invasive mechanical ventilation, in hospitalized patients with COVID-19 disease compared with standard therapy alone. CLINICAL IMPLICATIONS: Baricitinib may be used in conjunction with standard of care treatments to improve morbidity and mortality in hospitalized COVID-19 patients. DISCLOSURES: No relevant relationships by Gerardo Carino No relevant relationships by ARKADIY FINN No relevant relationships by Amos Lal No relevant relationships by VIJAIRAM SELVARAJ

Efficacy and safety of hydroxychloroquine in healthcare professionals with mild SARS-CoV-2 infection: Prospective, non-randomized trial

ObjectivesTo assess the efficacy and safety of hydroxychloroquine (HCQ) compared with no treatment in healthcare workers with mild SARS-CoV-2 infection. MethodsProspective, non-randomized study. All health professionals with confirmed COVID-19 between April 7 and May 6, 2020, non-requiring initial hospitalization were asked to participate. Patients who accepted treatment were given HCQ for five days (loading dose of 400mg q12h the first day followed by200mg q12h). Control group included patients with contraindications for HCQ or who rejected treatment. Study outcomes were negative conversion and viral dynamics of SARS-CoV-2, symptoms duration and disease progression. ResultOverall, 142 patients were enrolled: 87 in treatment group and 55 in control group. The median age was 37 years and 75% were female, with few comorbidities. There were no significant differences in time to negative conversion of PCR between both groups. The only significant difference in the probability of negative conversion of PCR was observed at day 21 (18.7%, 95%CI 2.0–35.4). The decrease of SARS-CoV-2 viral load during follow-up was similar in both groups. A non significant reduction in duration of some symptoms in HCQ group was observed. Two patients with HCQ and 4 without treatment developed pneumonia. No patients required admission to the Intensive Care Unit or died. About 50% of patients presented mild side effects of HCQ, mainly diarrhea. ConclusionsOur study failed to show a substantial benefit of HCQ in viral dynamics and in resolution of clinical symptoms in health care workers with mild COVID-19.

Ascertaining the Effects of Tissue Sealers on Minor Laparoscopic Procedures between Obstetrics and Gynecology Residents: A Prospective Cohort Study.

Background and Objectives: The type of instrumentation used during laparoscopic surgery might impact on the learning curve of resident surgeons. The aim of this study was to investigate differences in operator satisfaction and surgical outcomes between tissue sealers and classic bipolar instruments during gynecological laparoscopies performed by residents. Materials and Methods: A prospective cohort study conducted at two tertiary university hospitals between March 2019 and March 2021, on consecutive procedures: salpingo-oophorectomies (Group 1) and salpingectomies (Group 2), subdivided according to the utilized device: radiofrequency tissue sealers (Groups A1 and A2) or bipolar forceps (Groups B1 and B2). Results: 80 procedures were included. Concerning salpingo-oophorectomies, better visibility (8.4 ± 0.8 vs. 7.3 ± 0.9; p = 0.03), reduced difficulty (5.4 ± 1.2 vs. 7.0 ± 1.4; p = 0.02), improved overall satisfaction (9.2 ± 0.4 vs. 7.6 ± 1.0; p = 0.02) and reduced procedure time (7.8 ± 3.4 vs. 12.6 ± 3.1; p = 0.01) were reported by residents using tissue sealers. Intraoperative blood loss (12.2 ± 4.7 mL vs. 33.2 ± 9.7 mL; p = 0.01) and 24 h postoperative pain (4.5 ± 1.1 vs. 5.7 ± 1.8; p = 0.03) were lower in group A1 than B1. For salpingectomies, a significant reduction in duration was found in A2 compared to B2 (7.2 ± 3.4 min vs. 13.8 ± 2.2 min; p = 0.02). Tissue sealers enhanced visibility (8.1 ± 1.1 vs. 6.7 ± 1.4; p = 0.01), difficulty (6.5 ± 1.1 vs. 7.5 ± 0.9; p = 0.04) and improved satisfaction (9.3 ± 0.5 vs. 7.5 ± 0.6; p = 0.01). Moreover, hemoglobin loss and postoperative pain were reduced in A2 relative to B2 [(8.1 ± 4.2 % vs. 4.5 ± 1.1%; p = 0.02) and (5.1 ± 0.9 vs. 4.1 ± 0.8; p = 0.03), respectively] Conclusions: The use of sealing devices by residents was related to reduced difficulty as well improved visibility and overall satisfaction, with improved surgical outcomes.

Neuropharmacological evaluation and HPTLC fingerprint profile of phytocompound-enriched chloroform fraction of methanolic extract of Lagenaria siceraria (Molina) Standley fruits - a potent Asian ethno-medicinal vegetable plant.

Lagenariasiceraria (Molina) Standley (Cucurbitaceae) is a traditional vegetable plant, popularly known as bottle gourd (English) and lauki (Hindi). It is a climbing herb characterized with a number of therapeutic properties. Traditionally Lagenariasiceraria (LS) fruits were used for their cardioprotective, hepatoprotective, diuretic, and purgative effects, but there is very little scientific data available on its neuroprotective potential.

Partial protective effects of cannabidiol against PTZ-induced acute seizures in female rats during the proestrus–estrus transition

Approximately 70% of women with epilepsy experience additional challenges in seizure exacerbation due to hormonal changes, particularly during fluctuations of estrogen–progesterone levels in the menstrual cycle, which is known as catamenial epilepsy. In animal models of epilepsy, a sustained increase in seizure frequency has been observed in female rats during the proestrus–estrus transition when estrogen levels are high and progesterone levels are low resembling catamenial epilepsy. Cannabidiol (CBD) has been proposed to have anticonvulsant and anti-inflammatory effects, able to decrease seizure duration and increase seizure threshold in rats with epilepsy. However, most studies have used males to investigate the pharmacological effects of CBD on seizures, and the neuroprotective effects of CBD against seizures exacerbated by hormonal fluctuations in females are still little explored. Given this scenario, the aim of the present study was to investigate whether CBD would protect against acute seizures induced by pentylenetetrazole (PTZ) in female rats during a pro-convulsant hormonal phase. Therefore, CBD (50 mg/kg) or saline was administered during the proestrus–estrus transition phase, 1 h prior to induction of seizures with PTZ (60 mg/kg), and the following parameters were recorded: duration, latency to first seizure, as well as percentage of convulsing animals (incidence), mortality, and severity of seizures. Brains were processed for immunohistochemistry for microglial cells (Iba-1), and blood was collected for the analysis of cytokines (IL-1β, IL-6, IL-10, and TNF-α). Cannabidiol pre-treated rats showed a significant reduction in duration and severity of seizures, and IL-1β levels, although the latency, incidence of seizures, and mortality rate remained unchanged as well the quantification of microglia in the selected areas. Therefore, acute administration of CBD in a single dose prior to seizure induction showed a partial neuroprotective effect against seizure severity and inflammation, suggesting that female rats in the proconvulsant phase of proestrus–estrus have a low seizure threshold and are more resistant to the anticonvulsant effects of CBD. It appears that other doses or administration windows of CBD may be required to achieve a full protective effect against seizures, suggesting that CBD could be used as an adjunctive therapy during fluctuations of estrogen–progesterone levels. In this sense, considering the hormonal fluctuation as a seizure-potentiating factor, our study contributes to understand the anticonvulsant activity of CBD in females in a pro-convulsant hormonal phase, similar to catamenial seizures in humans.

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

BackgroundThe association of tracheostomy timing and clinical outcomes in ventilated COVID-19 patients remains controversial. We performed a meta-analysis to evaluate the impact of early tracheostomy compared to late tracheostomy on COVID-19 patients’ outcomes.MethodsWe searched Medline, Embase, Cochrane, and Scopus database, along with medRxiv, bioRxiv, and Research Square, from December 1, 2019, to August 24, 2021. Early tracheostomy was defined as a tracheostomy conducted 14 days or less after initiation of invasive mechanical ventilation (IMV). Late tracheostomy was any time thereafter. Duration of IMV, duration of ICU stay, and overall mortality were the primary outcomes of the meta-analysis. Pooled odds ratios (OR) or the mean differences (MD) with 95%CIs were calculated using a random-effects model.ResultsFourteen studies with a cumulative 2371 tracheostomized COVID-19 patients were included in this review. Early tracheostomy was associated with significant reductions in duration of IMV (2098 patients; MD − 9.08 days, 95% CI − 10.91 to − 7.26 days, p < 0.01) and duration of ICU stay (1224 patients; MD − 9.41 days, 95% CI − 12.36 to − 6.46 days, p < 0.01). Mortality was reported for 2343 patients and was comparable between groups (OR 1.09, 95% CI 0.79–1.51, p = 0.59).ConclusionsThe results of this meta-analysis suggest that, compared with late tracheostomy, early tracheostomy in COVID-19 patients was associated with shorter duration of IMV and ICU stay without modifying the mortality rate. These findings may have important implications to improve ICU availability during the COVID-19 pandemic.Trial registration The protocol was registered at INPLASY (INPLASY202180088).

The impact of intensive care unit physician staffing change at a community hospital.

Objectives:A high-intensity staffing model has been defined as either mandatory intensivist consultation or a closed intensive care unit in which intensivists manage all aspects of patient care. In the current climate of limited healthcare resources, transitioning to a closed intensive care unit model may lead to significant improvements in patient care and resource utilization.Methods:This is a single-center, retrospective cohort study of all mechanically ventilated intensive care unit admissions in the pre-intensive care unit closure period of 1 October 2014 to 30 September 2015 as compared with the post-intensive care unit closure period of 1 November 2015 to 31 October 2016. Patient demographics as well as outcome data (duration of mechanical ventilation, length of stay, direct costs, complications, and mortality) were abstracted from the electronic health record. All data were analyzed using descriptive and inferential statistics. Regression analyses were used to adjust outcomes for potential confounders.Results:A total of 549 mechanically ventilated patients were included in our analysis: 285 patients in the pre-closure cohort and 264 patients in the post-closure cohort. After adjusting for confounders, there was no significant difference in mortality rates between the pre-closure (40.7%) and post-closure (38.6%) groups (adjusted odds ratio = 0.82; 95% confidence interval = 0.56–1.18; p = 0.283). The post-closure cohort was found to have significant reductions in duration of mechanical ventilation (3.71–1.50 days; p < 0.01), intensive care unit length of stay (5.8–2.7 days; p < 0.01), hospital length of stay (10.9–7.3 days; p < 0.01), and direct hospital costs (US $16,197–US $12,731; p = 0.009). Patient complications were also significantly reduced post-intensive care unit closure.Conclusion:Although a closed intensive care unit model in our analysis did not lead to a statistical difference in mortality, it did demonstrate multiple beneficial outcomes including reduced ventilator duration, decreased intensive care unit and hospital length of stay, fewer patient complications, and reduced direct hospital costs.

Efficacy of Oxygen Delivered through High Flow Nasal Cannula versus Non Rebreathing Mask in Infants with Mild and Moderate Bronchiolitis: An Open-labelled Randomised Controlled Trial

Introduction: Bronchiolitis accounts for substantial portion of infant and paediatric hospital admissions worldwide. High flow nasal cannula is a relatively new, safe, comfortable and well tolerated mode of oxygen delivery for infants and children presenting with respiratory distress in emergency units and general wards. Aim: To compare the efficacy of oxygen delivered through high flow nasal cannula with non rebreathing mask in infants with mild and moderate bronchiolitis. Materials and Methods: This open-labelled randomised controlled trial was conducted among 80 infants under 12 months of age admitted with mild and moderate bronchiolitis in the well-equipped Paediatric Wards of Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from January 2017 to August 2018. Eligible recruited infants were randomised into two groups. First group receiving oxygen through Non Rebreathing Mask (NRM group) and second group receiving oxygen through High Flow Nasal Cannula (HFNC group). All the participants were followed-up with clinical examinations and investigations and outcomes were noted. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software, Chi-square test and student's t-test used, p-value &lt;0.05 was considered as statistically significant. Results: There was a significant reduction in duration of oxygen required in the HFNC group (mean duration in hours: 13.98±6.612) when compared to NRM group (mean duration in hours: 26.70±4.81). The mean length of hospital stay was lesser in HFNC group (3.65±1.460 days) when compared to NRM group (5.35±1.657 days). Comparison of heart rate between the two groups showed a statistically significant decrease in mean heart rate (144.0±7.2) as early as 2 hours (p-value 0.010) after initiation of HFNC when compared to NRM group (148.1±6.5). respiratory rate was significantly reduced when compared from 2 hours (p-value&lt;0.001) of initiation of intervention, with HFNC group showing higher percentage of reduction in respiratory rate than NRM group. Mean SpO2 levels were higher in HFNC group when compared to NRM group at various time intervals, though not significant statistically. Conclusion: High flow nasal cannula, under monitoring, could safely be used in paediatric wards in infants and children with mild and moderate bronchiolitis.

Enhanced recovery after surgery (ERAS) in patients undergoing emergency laparotomy after trauma: a prospective, randomized controlled trial

BackgroundThe role of enhanced recovery after surgery (ERAS) has been established in elective operations. However, its role in emergency operations especially in trauma is under-recognized. The aim of this study...

The Effect of Low Level Laser Therapy on Early Onset Rheumatoid Arthritis Patients

Background: Rheumatoid arthritis (RA) is a systemic chronic, inflammatory disease that may affect many tissues and organs. Objective: To investigate effectiveness and safety of Low-level-laser-therapy (LLLT) in management of early onset RA compared to symptomatic non-steroidal anti-inflammatory drugs (NSAIDS) therapy. Methods: A convenient selection 3 arms single blinded trial conducted in Al-Saraj Center for Rheumatoid Diseases in Baghdad during period between January-May 2017. Thirty-four patients with RA onset below one year were recruited. Disease activity score (DAS28) formula with American College of Rheumatology criteria (ACR20), erythrocyte sedimentation rate (ESR), visual analogue scale (VAS), complete blood count (CBC), C-reactive protein (CRP), rheumatoid factor (RF) were measured. Patients were divided into three groups: group 1 (n=12) received LLLT, group 2 (n=12) received placebo laser and naproxen and group 3 (n=10) received only naproxen. Primary outcomes measured were disease activity using DAS28 score, clinical improvement using ACR20 and pain assessment using VAS. Secondary outcomes measured were remission ACR50 and 70 and inflammatory indicators. Results: LLLT group has shown significant decrease of DAS28 (P=0.02), morning stiffness duration (p=0.05), number of tender joints (p=0.03), number of swelling joints (p=0.04), and VAS (p=0.01) compared to baseline whereas placebo laser group with naproxen and naproxen only group showed only significant reduction in duration of morning stiffness(P=0.04) and (p=0.048) respectively. There was marginal lowering of ESR (P=0.06) in LLLT group but no changes in CRP, RF. There were no reported side effects of LLLT use. Conclusion: Laser therapy is better than NSAIDS in controlling RA symptoms with no associated side effects. Therefore, it is recommended as first-line therapy in early onset RA. Keywords: laser, Low level laser therapy, rheumatoid arthritis, NSAIDS, ESR, Nerve root Citation: Al-Saraj MJA, Al-Ethary ZY, Al-Attar ZI. the effect of low level laser therapy on early onset rheumatoid arthritis patients. Iraq Iraqi JMS. 2021; 19(1): 126-133. doi: 10.22578/IJMS.19.1.16

Effect of Combined Hydrocortisone, Ascorbic Acid and Thiamine for Patients with Sepsis and Septic Shock: A Systematic Review and Meta-Analysis.

This study aims to assess the effect of HAT therapy on patients with sepsis and septic shock. We searched PubMed, Embase, and Cochrane Library for studies on HAT therapy published up to November 11, 2020. The primary outcome was the duration of vasopressor use. Secondary outcomes were change of Sequential Organ Failure Assessment (SOFA) score within 72 h; death within intensive care unit (ICU), hospital, and 28 or 30 days; length of stay in ICU and hospital; rate of procalcitonin (PCT) clearance and incidence of adverse events. We also used trial sequential analysis (TSA) to assess the reliability of the available evidence. Six randomized controlled trials (RCTs) and seven observational studies enrolling 1,559 patients were included (762 were treated with HAT, and 797 were treated with hydrocortisone alone, standard care or placebo). HAT therapy was associated with significant reductions in duration of vasopressor use (mean differences [MD], -14.68, [95% CI, -24.28 to -5.08], P = 0.003) in RCTs, but not in observational studies (MD, 11.21 [95% CI, -44.93 to 67.35], P = 0.70). HAT therapy was associated with less organ dysfunction at 72 h both in RCTs (MD, -0.86 [95% CI, -1.32 to -0.40], P < 0.001) and observational studies (MD, -2.65 [95% CI, -5.29 to -0.01], P = 0.05). HAT therapy was associated with lower hospital mortality and higher PCT clearance in observational studies. Similar results for the primary outcome were found in the sensitivity analysis. TSA results suggested more trials to reach the required information size. Among patients with sepsis and septic shock, a combination therapy of hydrocortisone, ascorbic acid, and thiamine, compared with placebo, could reduce the duration of vasopressor use and SOFA scores during the first 72 h. PROSPERO registration ID for this study is CRD42020170648 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170648).