The Emerging Role of Vitamin C in the Prevention and Treatment of COVID-19

Investigation into the role of vitamin C in the prevention and treatment of pneumonia and sepsis has been underway for many decades. This research has laid a strong foundation for translation of these findings into patients with severe coronavirus disease (COVID-19). Research has indicated that patients with pneumonia and sepsis have low vitamin C status and elevated oxidative stress. Administration of vitamin C to patients with pneumonia can decrease the severity and duration of the disease. Critically ill patients with sepsis require intravenous administration of gram amounts of the vitamin to normalize plasma levels, an intervention that some studies suggest reduces mortality. The vitamin has pleiotropic physiological functions, many of which are relevant to COVID-19. These include its antioxidant, anti-inflammatory, antithrombotic and immuno-modulatory functions. Preliminary observational studies indicate low vitamin C status in critically ill patients with COVID-19. There are currently a number of randomized controlled trials (RCTs) registered globally that are assessing intravenous vitamin C monotherapy in patients with COVID-19. Since hypovitaminosis C and deficiency are common in low–middle-income settings, and many of the risk factors for vitamin C deficiency overlap with COVID-19 risk factors, it is possible that trials carried out in populations with chronic hypovitaminosis C may show greater efficacy. This is particularly relevant for the global research effort since COVID-19 is disproportionately affecting low–middle-income countries and low-income groups globally. One small trial from China has finished early and the findings are currently under peer review. There was significantly decreased mortality in the more severely ill patients who received vitamin C intervention. The upcoming findings from the larger RCTs currently underway will provide more definitive evidence. Optimization of the intervention protocols in future trials, e.g., earlier and sustained administration, is warranted to potentially improve its efficacy. Due to the excellent safety profile, low cost, and potential for rapid upscaling of production, administration of vitamin C to patients with hypovitaminosis C and severe respiratory infections, e.g., COVID-19, appears warranted.

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COVID-19: Up to 82% critically ill patients had low Vitamin C values

Nutrition Journal ◽

10.1186/s12937-021-00727-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Teresa Maria Tomasa-Irriguible ◽

Lara Bielsa-Berrocal

Keyword(s):

Vitamin C ◽

Critically Ill ◽

Potential Role ◽

Plasma Vitamin ◽

Single Center ◽

Berlin Definition ◽

Single Center Study ◽

Prevention And Treatment ◽

Center Study

AbstractThere are limited proven therapeutic options for the prevention and treatment of COVID-19. We underwent an observational study with the aim of measure plasma vitamin C levels in a population of critically ill COVID-19 adult patients who met ARDS criteria according to the Berlin definition. This epidemiological study brings to light that up to 82% had low Vitamin C values. Notwithstanding the limitation that this is a single-center study, it nevertheless shows an important issue. Given the potential role of vitamin C in sepsis and ARDS, there is gathering interest of whether supplementation could be beneficial in COVID-19.

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Withholding and Withdrawal of Life-Sustaining Treatments in critically ill ICU patients: A study on attitude of Physicians of Bangladesh

Bangladesh Critical Care Journal ◽

10.3329/bccj.v7i2.43448 ◽

2019 ◽

Vol 7 (2) ◽

pp. 66-72

Author(s):

Mohammad Omar Faruq ◽

ARM Nooruzzaman ◽

Rownak Jahan Tamanna ◽

Amina Sultana ◽

Uzzwal Kumar Mallick ◽

...

Keyword(s):

Low Income ◽

International Study ◽

Legal Rights ◽

Asian Countries ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Icu Physicians ◽

Real Chance

Background : This study is a sub analysis of data submitted on behalf of Bangladesh in an International study ( ACME 2012) involving physicians working in Asian ICUs. Objective : To describe attitude of physicians of ICUs of Bangladesh toward withholding and withdrawal of life sustaining treatments in end of life care, to assess factors associated with these observations and to compare the findings especially with those of physicians of low – middle income Asian ICUs. Method : Self-administered pre-set structured and scenario based survey conducted among 101 physicians working in 38 ICUs of Bangladesh. Results : For patients with no real chance of recovering a meaningful life, 20 of 101 respondents reported that they almost always or often withheld life-sustaining treatments and 18 of 101 respondents almost always or often withdrew life-sustaining treatments.44 respondents in our study reported that they almost always or often withheld life sustaining treatments whereas 10 respondents almost always or often withdrew life sustaining treatments. 72% of all our respondents would implement DNR orders. In Bangladesh, religion (Islam) does not influence decision of complying with DNR order requested by family. Our study showed 71% of physicians were more likely to “do everything” if a patient with hypoxic-ischaemic encephalopathy developed septic shock. In our study, physicians were more ready to withdraw vasopressors and hemo dialysis than enteral feeding and intravenous fluids. Physicians from Bangladesh generally perceived more legal risk with limitation of life sustaining treatments because of lack of legislation for such practices. When it comes to limit aggressive lifesaving treatments, Bangladeshi physicians were less likely accede to families request to withdraw them on financial ground. Conclusion : Like physicians of low-middle income countries of Asia, Bangladeshi ICU physicians’ self-reported practice of limiting life sustaining treatments, role of families and surrogates and perception of legal rights were significantly different than physicians of high income countries of Asia. However unlike physicians from other low income Asian countries, physicians from Bangladesh were less likely to accede to families request to withdraw life sustaining treatments on financial ground. Bangladesh Crit Care J September 2019; 7(2): 66-72

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Role of vitamin C in critically ill patients with COVID-19: is it effective?

Acute and Critical Care ◽

10.4266/acc.2020.00416 ◽

2020 ◽

Vol 35 (4) ◽

pp. 307-308

Author(s):

Siddique Mohyud Din Chaudhary ◽

Robert Matthew Wright ◽

Gabriel Patarroyo-Aponte

Keyword(s):

Vitamin C ◽

Critically Ill ◽

Critically Ill Patients

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Risk factors and predictors of mortality of candidaemia among critically ill patients: role of antifungal prophylaxis in its development and in selection of non-albicans species

Infection ◽

10.1007/s15010-017-1050-z ◽

2017 ◽

Vol 45 (5) ◽

pp. 651-657 ◽

Cited By ~ 4

Author(s):

Matthaios Papadimitriou-Olivgeris ◽

Anastasia Spiliopoulou ◽

Fotini Fligou ◽

Iris Spiliopoulou ◽

Lora Tanaseskou ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Antifungal Prophylaxis ◽

Predictors Of Mortality ◽

Selection Of

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The Prevalence, Risk Factors, and Outcomes of Sepsis in Critically Ill Patients in China: A Multicenter Prospective Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2020.593808 ◽

2020 ◽

Vol 7 ◽

Author(s):

Meiping Wang ◽

Li Jiang ◽

Bo Zhu ◽

Wen Li ◽

Bin Du ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Cohort Study ◽

Critically Ill ◽

Fluid Resuscitation ◽

Low Income ◽

Critically Ill Patients ◽

Low Income Countries ◽

Icu Mortality ◽

Tertiary Hospitals

Background: Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China.Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital.Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46–0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30–0.63) improved the outcome in patients with septic shock.Conclusions: Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.

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Role of stakeholders in Nigeria’s tobacco control journey after the FCTC: lessons for tobacco control advocacy in low-income and middle-income countries

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054344 ◽

2018 ◽

Vol 28 (4) ◽

pp. 386-393 ◽

Cited By ~ 1

Author(s):

Catherine O Egbe ◽

Stella A Bialous ◽

Stanton Glantz

Keyword(s):

Tobacco Control ◽

Low Income ◽

Tobacco Industry ◽

High Income ◽

Legislative Process ◽

International Organisations ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries

IntroductionNigeria ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005. Tobacco control advocates in Nigeria achieved some success in countering tobacco industry interference to implement the FCTC.MethodsWe triangulated interviews with key informants from local and international organisations who worked in Nigeria with documentation of the legislative process and Nigerian newspaper articles. Data were analysed and interpreted using the Policy Dystopia Model and WHO categories of tobacco industry interference that had been developed mostly based on experience in high-income countries.ResultsAs in high-income countries, the tobacco industry continued to oppose tobacco control policies after Nigeria ratified the FCTC, including weakening Nigeria’s 2015 National Tobacco Control Act. Both tobacco control advocates and industry used discursive (argument-based) and instrumental (activity-based) strategies. The industry argued self-regulation and the economic importance of tobacco. They exploited legislative procedures, used front groups and third parties to push for pro-industry changes. Advocates, with help from international organisations, mobilised prominent Nigerians and the public. Advocates pre-empted and countered the industry through traditional and social media, monitoring and exposing tobacco industry activities, and by actively engaging lawmakers and citizens during the legislative process.ConclusionThe Policy Dystopia Model and WHO categories of industry interference provide a helpful framework for understanding tobacco control debates in low/middle-income countries (LMICs) as in high-income countries. One difference in LMIC is the important role of international tobacco control advocates in supporting national tobacco control advocates. This partnership is important in pushing for FCTC-compliant legislation and countering industry activities in LMIC.

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Factors Associated with the Incidence and Severity of New-Onset Atrial Fibrillation in Adult Critically Ill Patients

Critical Care Research and Practice ◽

10.1155/2017/8046240 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Péricles A. D. Duarte ◽

Gustavo Elias Leichtweis ◽

Luiza Andriolo ◽

Yasmim A. Delevatti ◽

Amaury C. Jorge ◽

...

Keyword(s):

Atrial Fibrillation ◽

Critically Ill ◽

Low Income ◽

Critically Ill Patients ◽

Morbidity And Mortality ◽

Low Income Countries ◽

Vasoactive Drugs ◽

Onset Atrial Fibrillation ◽

New Onset

Background. Acute Atrial Fibrillation (AF) is common in critically ill patients, with significant morbidity and mortality; however, its incidence and severity in Intensive Care Units (ICUs) from low-income countries are poorly studied. Additionally, impact of vasoactive drugs on its incidence and severity is still not understood. This study aimed to assess epidemiology and risk factors for acute new-onset AF in critically ill adult patients and the role of vasoactive drugs. Method. Cohort performed in seven general ICUs (including cardiac surgery) in three cities in Paraná State (southern Brazil) for 45 days. Patients were followed until hospital discharge. Results. Among 430 patients evaluated, the incidence of acute new-onset AF was 11.2%. Patients with AF had higher ICU and hospital mortality. Vasoactive drugs use (norepinephrine and dobutamine) was correlated with higher incidence of AF and higher mortality in patients with AF; vasopressin (though used in few patients) had no effect on development of AF. Conclusions. In general ICU patients, incidence of new-onset AF was 11.2% with a high impact on morbidity and mortality, particularly associated with the presence of Acute Renal Failure. The use of vasoactive drugs (norepinephrine and dobutamine) could lead to a higher incidence of new-onset AF-associated morbidity and mortality.

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