scholarly journals The role and place of glucocorticosteroids in treatment of COVID-19 pneumonia without hypoxemia

2021 ◽  
pp. 162-172
Author(s):  
V. V. Salukhov ◽  
E. V. Kryukov ◽  
A. A. Chugunov ◽  
M. A. Kharitonov ◽  
Yu. V. Rudakov ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Symptoms ◽  
Severe Form ◽  
Main Group ◽  
Control Group ◽  
Low Doses ◽  
Comprehensive Therapy ◽  
Early Use ◽  
Small Doses

Introduction. The article presents the problems of the use of glucocorticosteroids in the treatment of patients with coronavirus– associated pneumonia (COVID-19) without hypoxemia. The experience of the preemptive use of low doses of glucocorticosteroids in the treatment of such patients in a hospital is described. Simplification of a unified scheme of pathogenetic therapy with glucocorticosteroids in the above patients is urgent. The article highlights the effectiveness of the early use of low doses of glucocorticosteroids in the treatment of a specific cohort of patients with COVID-19.Objective. To assess the clinical efficacy and safety of early use of small doses of methylprednisolone in the comprehensive therapy of patients with moderate to severe COVID-19 pneumonia to prevent the development of complications and improve the outcomes of the disease.Materials and methods. The study included 40 hospitalized patients from 37 to 68 years (average age 52. years) with a diagnosis of moderate to severe COVID-19 pneumonia. Patients were randomized into two groups: the main group (n = 20) and the control group (n = 20). The main group additionally received methylprednisolone: 4 mg tablets, 7 tablets per day, divided into 2 doses (4 tablets in the morning and 3 tablets at lunchtime). The effectiveness of the therapy was evaluated based on the primary combined endpoint of the study, which included progression of the disease to an extremely severe form or the occurrence of pulmonary and extrapulmonary complications that required transfer to the intensive care unit, or death of the patient during the followup period. The secondary combined endpoint of the study was resolution of clinical symptoms of the disease or achievement of reference values of laboratory and instrumental indicators.Results. No lethal outcomes were observed in the compared groups, there were no cases of development of an extremely severe course, complications requiring transfer to the intensive care unit in the main group.Conclusion. Early use of small doses methylprednisolone of in comprehensive therapy of patients with moderate and severe COVID-19 pneumonia reduces the incidence of life-threatening complications and improves the outcomes of the disease. 

scholarly journals Optimization of rehabilitation measures after artificial abortion as the result of immunomodulator aminodihydrophthalasindione sodium apply in comprehensive therapy

2019 ◽  
pp. 156-161
Author(s):  
E. A. Voroshilova
Keyword(s):  
Marked Reduction ◽  
Clinical Effect ◽  
Comparison Group ◽  
Clinical Symptoms ◽  
Randomized Study ◽  
Main Group ◽  
Control Group ◽  
Comprehensive Therapy ◽  
Effect Of Treatment ◽  
Artificial Abortion

The article presents the results of a comparative randomized study, the purpose of which was to evaluate the effectiveness of the use of aminodihydrophthalasindione sodium (Galavit, LLC SELVIM, Russia) in the treatment of patients undergoing an abortion. Included in the study, 48 women were divided into two groups, 24 patients of the main group in addition to the standard rehabilitation were treated with aminodihydrophthalasindione sodium in the comparison group – 24 patients underwent only standard rehabilitation. In this study, all patients (100%) of the main group who were treated with aminodihydrophthalasindione sodium in addition to the standard therapy marked reduction of the clinical symptoms of the disease and positive dynamics was observed at ultrasound. In the control group, the full clinical effect of treatment was observed only in 10 patients (52.6%). 9 women (47,4%) required repeated therapy. Ultrasound studies in 12 patients (63.2%) showed changes equivalent to endometritis.

scholarly journals Infliximab and Intravenous Gammaglobulin in Hospitalized Severe COVID-19 Patients in Intensive Care Unit

2021 ◽  
Vol 24 (2) ◽  
pp. 139-143
Author(s):  
Mohsen Farrokhpour ◽  
Nader Rezaie ◽  
Najmeh Moradi ◽  
Fatemeh Ghaffari Rad ◽  
Shirin Izadi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Combination Therapy ◽  
Clinical Symptoms ◽  
Observational Research ◽  
Control Group ◽  
Therapeutic Effects ◽  
Significant Difference ◽  
Intravenous Gammaglobulin ◽  
Underlying Diseases

Background: Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU). Methods: In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11). Results: There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; (P = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all P < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, P = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, P = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, P = 0.071). Conclusion: According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.

scholarly journals Evaluation of the effect of melatonin in patients with COVID-19-induced pneumonia admitted to the Intensive Care Unit: A structured summary of a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ali Ameri ◽  
Masoomeh Frouz Asadi ◽  
Manoochehr Kamali ◽  
Majid Vatankhah ◽  
Ava Ziaei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Standard Treatment ◽  
Clinical Symptoms ◽  
Intervention Group ◽  
Control Group ◽  
Open Label ◽  
Full Protocol ◽  
Bandar Abbas

Abstract Objectives We investigate the effects of melatonin, compared to the usual therapeutic regimen on clinical symptoms and laboratory signs in severely ill patients with confirmed COVID-19 who are admitted to the Intensive Care Unit (ICU). Trial design This is a single-center, open-label, randomized, clinical trial with a parallel-group design. This study is being conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran. Participants All patients admitted to the ICU of Shahid Mohammadi Hospital, Bandar Abbas, Iran, will be screened for the following criteria. Inclusion criteria 1. Age >20 years 2. Definitive diagnosis of COVID-19 based on RT-PCR or/and serological testing 3. Severe pneumonia and lung involvement in imaging 4. Signing informed consent Exclusion criteria 1. Underlying diseases, including convulsive disorders, chronic hepatic and renal diseases 2. Use of mechanical ventilation 3. History of known allergy to Melatonin 4. Pregnancy and breastfeeding Intervention and Comparator Intervention group: The standard treatment regimen for COVID-19, according to the Iranian Ministry of Health and Medical Education’s protocol, along with Melatonin soft gelatin capsule (Danna Pharmaceutical Company) at a dose of 5 mg twice a day for a period of seven days. Control group: The standard treatment for COVID-19 based on the Iranian Ministry of Health and Medical Education’s protocol for a period of seven days. Main outcomes The primary outcomes are the recovery rate of clinical symptoms and checking arterial blood gas (ABG), C-reactive protein (C-RP), Ferritin, Lactate dehydrogenase (LDH) within seven days of randomization. The secondary outcomes are time to improvement of clinical and paraclinical features and length of stay in the ICU, need for mechanical ventilation, and mortality rate within seven days of randomization. Randomization Included patients will be allocated to one of the study arms using block randomization in a 1:1 ratio (each block consists of 6 patients). This randomization method ensures a balanced allocation between the arms during the study. A web-based system will generate random numbers for the allocation sequence and concealment of participants. Each number relates to one of the study arms. Blinding (masking) This is an open-label trial without blinding and placebo control. Numbers to be randomized (sample size) A total of 60 participants randomizes (30 patients allocated to the intervention group and 30 patients allocated to the control group). Trial Status The protocol is Version 1.0, February 16, 2021. Recruitment began February 28, 2021, and is anticipated to be completed by July 31, 2021. Trial registration The trial protocol has been registered in the Iranian Registry of Clinical Trials (IRCT). The registration number is “IRCT20200506047323N7”. The registration date was February 16, 2021. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

scholarly journals Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Asli Okbay Gunes ◽  
Emre Dincer ◽  
Nilgun Karadag ◽  
Sevilay Topcuoglu ◽  
Guner Karatekin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Breast Milk ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Control Group ◽  
Study Group ◽  
Intake Rate ◽  
Informed Consent Form ◽  
Group 2

Abstract Objectives To find out if the expressed breast milk delivery rate to neonatal intensive care unit (NICU) for babies who were hospitalized for any reason other than COVID-19, and exclusive breastfeeding (EB) rates between discharge date and 30th day of life of those babies were affected by COVID-19 pandemic. Methods Babies who were hospitalized before the date first coronavirus case was detected in our country were included as control group (CG). The study group was divided into two groups; study group 1 (SG1): the mothers whose babies were hospitalized in the period when mother were asked not to bring breast milk to NICU, study group 2 (SG2): the mothers whose babies were hospitalized after the date we started to use the informed consent form for feeding options. The breast milk delivery rates to NICU during hospitalization and EB rates between discharge and 30th day of life were compared between groups. Results Among 154 mother-baby dyads (CG, n=50; SG1, n=46; SG2, n=58), the percentage of breast milk delivery to NICU was 100%, 79% for CG, SG2, respectively (p<0.001). The EB rate between discharge and 30th day of life did not change between groups (CG:90%, SG1:89%, SG2:75.9; p=0.075). Conclusions If the mothers are informed about the importance of breast milk, the EB rates are not affected by the COVID-19 pandemic in short term, even if the mothers are obligatorily separated from their babies. The breast milk intake rate of the babies was lowest while our NICU protocol was uncertain, and after we prepared a protocol this rate increased.

Topical Lidocaine Patch for Postthoracotomy and Poststernotomy Pain in Cardiothoracic Intensive Care Unit Adult Patients

2019 ◽  
Vol 39 (5) ◽  
pp. 51-57 ◽  
Author(s):  
Michael Liu ◽  
Mabel Wai ◽  
James Nunez
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Standard Care ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Control Group ◽  
Lidocaine Group ◽  
Lengths Of Stay ◽  
Topical Lidocaine

Background Transdermal lidocaine patches have few systemic toxicities and may be useful analgesics in cardiac surgery patients. However, few studies have evaluated their efficacy in the perioperative setting. Objective To compare the efficacy of topical lidocaine 5% patch plus standard care (opioid and nonopioid analgesics) with standard care alone for postthoracotomy or poststernotomy pain in adult patients in a cardiothoracic intensive care unit. Methods A single-center, retrospective cohort evaluation was conducted from January 2015 through December 2015 in the adult cardiothoracic intensive care unit at a tertiary academic medical center. Cardiac surgery patients with new sternotomies or thoracotomies were included. Patients in the lidocaine group received 1 to 3 topical lidocaine 5% patches near sternotomy and/or thoracotomy sites daily. Patches remained in place for 12 hours daily. Patients in the control group received standard care alone. Results The primary outcome was numeric pain rating for sternotomy/thoracotomy sites. Secondary outcomes were cardiothoracic intensive care unit and hospital lengths of stay and total doses of analgesics received. Forty-seven patients were included in the lidocaine group; 44 were included in the control group. Mean visual analogue scores for pain did not differ between groups (lidocaine, 2; control, 1.9; P = .58). Lengths of stay were similar for both groups (cardiothoracic intensive care unit: lidocaine, 3.06 days; control, 3.11 days; P = .86; hospital: lidocaine, 8.26 days; control, 7.61 days; P = .47). Conclusions Adjunctive lidocaine 5% patches did not reduce acute pain in postthoracotomy and post-sternotomy patients in the cardiothoracic intensive care unit.

scholarly journals INVESTIGATING EFFECT OF NURSING INTERVENTIONS, BASED ON WELLS SCORE RESULTS, ON THE INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

2018 ◽  
Vol 11 (5) ◽  
pp. 377
Author(s):  
Morteza Habibi Moghadam ◽  
Marzieh Asadizaker ◽  
Simin Jahani ◽  
Elham Maraghi ◽  
Hakimeh Saadatifar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Deep Vein Thrombosis ◽  
Intervention Group ◽  
Control Group ◽  
Nursing Interventions ◽  
Vein Thrombosis ◽  
Wells Score ◽  
Deep Vein ◽  
Pitting Edema

 Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

scholarly journals Evaluation of the effectiveness of ARVI treatment regimen including etiotropic (enisamium iodide) and symptomatic treatment

2020 ◽  
Vol 92 (3) ◽  
pp. 50-55
Author(s):  
D. A. Lioznov ◽  
E. J. Karnaukhova ◽  
T. G. Zubkova ◽  
E. V. Shakhlanskaya
Keyword(s):  
Influenza A ◽  
Viral Infections ◽  
Clinical Symptoms ◽  
Randomized Study ◽  
Antiviral Drug ◽  
Main Group ◽  
Average Score ◽  
Control Group ◽  
Symptomatic Therapy ◽  
Respiratory Viral Infections

Aim. To assess the effectiveness of the use of the antiviral drug enisamium iodide in the complex treatment of acute respiratory viral infections (ARVI) caused by various pathogens in routine clinical practice. Materials and methods. А prospective randomized study included 134 patients who were treated in the epidemic season of influenza and ARVI in 20182019. All patients were examined for the presence of influenza A and B viruses, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, coronaviruses, rhinoviruses, adenoviruses in nasopharyngeal swabs by PCR. Patients of the main group received enisamium iodide along with symptomatic therapy, the control group received only symptomatic therapy. The primary parameter of the effectiveness of therapy was evaluated on the scale of the general severity of the manifestations of ARVI (Total Symptom Score TSS) from the 2nd to the 4th day and by the secondary criteria of effectiveness: assessment of the duration of ARVI, the severity of fever, the proportion of patients with normal body temperature, the duration of the main clinical symptoms of acute respiratory viral infections, the proportion of patients in whom complications requiring antibiotics were noted, the dynamics of interferon status on the 6th day. To conduct a statistical analysis, depending on the efficiency parameter, the ANCOVA method with a fixed group factor and an initial score on the TSS severity scale was used as covariates, a criterion for comparing quantitative indicators in two independent groups. Results. According to the results of the analysis of the primary efficacy parameter, the median (interquartile range) of the average score on the scale of the general severity of ARVI manifestations in the main group was 4.33 (3.675.83), in the comparison group 6.00 (4.677.25; p0.001). The duration of systemic and local manifestations of acute respiratory viral infections was statistically significantly less in the main group (p=0.002 and p=0.019, respectively). Prescription of additional therapy was required in 2 (2.9%) patients of the main group (patients taking enisamium iodide), compared with 8 (11.9%) patients in the control group. Serum levels of interferon  and interferon  on the last day of treatment were statistically significantly higher in patients of the main group compared with the control group (p0.001). Treatment (excellent) was evaluated by 42 (62.7%) patients, while in the control group only 17 (25.8%) patients gave similar ratings. Both patients (p0.001) and doctors (p0.002) rated therapy tolerance better in the study group. Conclusion. The results confirmed the safety and effectiveness of enisamium iodide as a treatment for ARVI and influenza. The antiviral, interferonogenic and anti-inflammatory properties of the drug are involved in the formation of an antiviral response and reduce the risk of complications, which makes it possible to reduce the number of symptomatic agents used.

scholarly journals Perception of Stress and Styles of Coping with It in Parents Giving Kangaroo Mother Care to Their Children during Hospitalization in NICU

2021 ◽  
Vol 18 (23) ◽  
pp. 12694
Author(s):  
Barbara Zych ◽  
Witold Błaż ◽  
Ewa Dmoch-Gajzlerska ◽  
Katarzyna Kanadys ◽  
Anna Lewandowska ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Parental Stress ◽  
Neonatal Intensive Care ◽  
Premature Baby ◽  
Hospital Environment ◽  
Control Group ◽  
Skin Contact ◽  
Task Oriented

The experience of hospitalization of a newborn in the Neonatal Intensive Care Unit (NICU) may become distressing both for the baby and parent. The study aimed to assess the degree of parental stress and coping strategies in parents giving KMC to their babies hospitalized in NICU compared to the control group parents not giving KMC. The prospective observational study enrolled a cohort of 337 parents of premature babies hospitalized in NICU in 2016 in Eastern Poland. The Parental Stressor Scale: Neonatal Intensive Care Unit, Coping Inventory for Stressful Situations were used. The level of stress in parents giving KMC was defined as low or moderate. Analysis confirmed its greater presence in the group of parents initiating KMC late (2–3 weeks) compared to those starting this initiative in week 1 of a child’s life. An additional predictor of a higher level of stress in parents initiating KMC “late” was the hospital environment of a premature baby. Task oriented coping was the most common coping strategy in the study group. KMC and direct skin-to-skin contact of the parent with the baby was associated with a higher level of parental stress only initially and decreased with time and KMC frequency.

scholarly journals A prospective study of foetomaternal outcome in placenta praevia

2019 ◽  
Vol 8 (10) ◽  
pp. 4028
Author(s):  
Somika Kaul ◽  
Bijal Rami
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Neonatal Death ◽  
Maternal Morbidity ◽  
Neonatal Intensive Care ◽  
Placenta Praevia ◽  
Bladder Injury ◽  
Control Group ◽  
A Prospective Study

Background: Placenta praevia is one of the serious obstetric problems with far reaching effects and a major cause of antepartum haemorrhage. The aim of the study was to evaluate the foetomaternal outcome of pregnancies with placenta praevia.Methods: The present study was a prospective case control study conducted in the Department of Obstetrics and Gynaecology, Lal Ded Hospital, Srinagar from August 2009 to October 2010.Results: Among the 100 cases of placenta praevia studied bleeding per vaginum was the most common presenting symptom. Major placenta praevia was more common (53%) than minor placenta praevia. 43% of the cases of placenta praevia delivered before 37 completed weeks as compared to only 6% in the control group. All cases of placenta praevia delivered by caesarean section. Maternal morbidity in terms of postpartum haemorrhage (32%), intraoperative bowel and bladder injury (2%) and intensive care unit admission (1%) was more in cases of placenta praevia. Foetal complications in terms of neonatal intensive care unit admission (19%), neonatal death (10%) and stillbirth (5%) were more in pregnancies with placenta praevia as compared to controls. 48% of patients with placenta praevia required transfusion of blood and blood products as compared to 4.5% among controls.Conclusions: There is a significant increase in maternal morbidity in pregnancies complicated with placenta praevia. Also, there is a higher incidence of foetal complications and neonatal death. Managing a case of placenta praevia is a challenge in present day obstetrics and it creates a huge burden on the health care system.

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