scholarly journals Evaluating the Neuroprotective Effect of Melatonin on Patients with Hemorrhagic Stroke Using Serum S100B Protein as a Prognostic Marker

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hamidreza Sharifnia ◽  
Mojtaba Mojtahedzadeh ◽  
Mehrnoush Dianatkhah ◽  
Atabak Najafi ◽  
Arezoo Ahmadi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hemorrhagic Stroke ◽  
Neuroprotective Effect ◽  
Plasma Concentrations ◽  
Control Group ◽  
P Value ◽  
Neuroprotective Agents ◽  
Icu Stay ◽  
Baseline Values ◽  
Length Of Icu Stay

Background: Intracerebral hemorrhage (ICH) is one of the most debilitating kinds of stroke. Recent evidence shows that the proper initiation of neuroprotective agents might save at risk neurons and improve the outcome. Objectives: The focus of this study is to evaluate the neuroprotective effect of melatonin on patients with hemorrhagic stroke. Methods: Forty adult patients with confirmed nontraumatic ICH, who were admitted to the ICU within 24 hours of the stroke onset were enrolled in this study. Subjects in the melatonin group received 30 mg of melatonin every night for 5 consecutive nights. In order to evaluate the intensity of the neuronal injury, S100B was assessed once on day 1 and, day 5 post ICU admission. Additionally, the length of ICU stay, mortality, and the duration of mechanical ventilation were also recorded. Results: Forty patients completed the study. In both groups the plasma concentrations of S100B decreased after 5 days compared with their baseline values. However, this reduction was more significant in the melatonin compared to the control group (P-value < 0.05). The duration of mechanical ventilation and length of ICU stay was shorter in the melatonin group, and this difference was statistically significant for the length of ICU stay (P-value < 0.05), and marginally significant for the duration of mechanical ventilation (P-value = 0.065). The in-ICU mortality rate of the melatonin group was 15%, almost half of that of the control group (30%). However, this difference was not statistically significant. Conclusions: In conclusion, melatonin can be considered as a harmless and effective nueroprotective agent with some unique features which has made it an appropriate adjunctive medicine for critically ill intubated patients.

Effect of Growth Hormone on Outcome of Pediatric Burn Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Gihan Seif El Nasr Mohamed ◽  
Salwa Omar ElKhattab Amin ◽  
Mohamed Mohamed Kamal ◽  
Sherif Hany Adly Loka
Keyword(s):  
Growth Hormone ◽  
Conventional Treatment ◽  
Control Group ◽  
P Value ◽  
Time Interval ◽  
Burn Patients ◽  
Icu Stay ◽  
Co Morbidity ◽  
Stay Time ◽  
Inhalational Injury

Abstract Background A burn is a thermal injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. There are several ways of classifying burns: Classification by mechanism or cause, Classification by the degree and depth of a burn, Classification by extent of burn the extent of burn. Objectives The objective of this study was to determine the safety and efficacy of using recombinant human growth hormone (rhGH) in the treatment of pediatric burn victims and their ICU length of stay, mortality and morbidity. Patients and Methods This study was an Interventional randomized controlled Double Blind Study in which Patients subdivided randomly into 2 groups: Group A received somatotropine hormone after their 3 days of resuscitation besides their conventional treatment during their stay in the Burn ICU. Group B received the conventional treatment only in the Burn ICU. Results The comparison between the GH group and the control group showed that the mean ICU stay in days in GH group was 10.88 while in the control group 13.59 with P value 0.018 as a significant result as the GH group showed a less ICU stay time than the control group with approximately 20%. Mortality in the GH group was 6.2% from the total number of the group while in control group 18.8% from the total number of the group with P value 0.033 as a significant result yet the mortality may also depend on other factors as the degree of burn and the area of burn and the associated events like inhalational injury or delay post burn or any other co-morbidity. Morbidity results seen was 0% in control group and 4.7% in GH group with P value 0.080 as a non-significant result, morbidity was in the form of hyperglycemia. Conclusion The use of recombinant Growth hormone with a dose of 0.2 mg/Kg SQ 2 days per week with 3 days time interval in pediatric burn patients after their primary resuscitation from the burn injury, shows a marvelous improvement concerning the ICU stay time as the patient received the growth hormone showed an approximately 20% time less ICU stay than the control group this may be accounted for the faster wound healing and readiness for grafting and even faster graft healing, also a decreased mortality in a significant way, although mortality may depend on many factors in burn patients like degree of burn and the area of burn and the associated events like inhalational injury or any other co-morbidity.

scholarly journals Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 708 ◽  
Author(s):  
Harri Hemilä ◽  
Elizabeth Chalker
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Vitamin C ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Practical Significance ◽  
Controlled Trials ◽  
Elective Cardiac Surgery ◽  
Icu Stay ◽  
Length Of Icu Stay

A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1–3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail.

scholarly journals Protective effect of HTK solution on postoperative pulmonary function in infants with CHD and PAH

2017 ◽  
Vol 37 (6) ◽  
Author(s):  
Jindong Li ◽  
Yanhong Wu ◽  
Xudong Tian ◽  
Jiantang Wang ◽  
Mingfeng Dong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Inflammatory Cells ◽  
Pathological Examination ◽  
Control Group ◽  
Lung Protection ◽  
Arterial Perfusion ◽  
Icu Stay ◽  
Htk Solution ◽  
Pulmonary Arterial ◽  
Postoperative Mechanical Ventilation

Objective: In the present study, we aimed to investigate the effect of pulmonary arterial perfusion (PAP) with Histidine–tryptophan–ketoglutarate (HTK) on lung protection in infants with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH) after cardiopulmonary bypass (CPB). Methods: Fifty infant patients with CHD and PAH at our hospital from January, 2016 to February, 2017 were randomly divided into control group and HTK group. The levels of interleukin-6 (IL-6), malondialdehyde (MDA), and endothelin-1 (ET-1) in serum were detected using ELISA Kit. Oxygen index (OI) and respiratory index (RI) were calculated at each time point. The time of postoperative mechanical ventilation and ICU stay was counted, and the right lower lung tissues in patients were taken for pathological examination. Results: Compared with preanesthesia, the levels of IL-6, MDA, and ET-1 in the two groups were significantly increased after CPB, and their levels in HTK group were significantly lower than that in control group. Moreover, OI in control group decreased markedly and RI in control group increased significantly after CPB. Compared with control group, the postoperative mechanical ventilation time, postoperative ICU stay, and total hospital stay in HTK group were markedly short. In addition, inflammatory cells infiltration decreased and pulmonary interstitial showed mild edema in HTK group. Conclusion: PAP with HTK could effectively reduce CPB-induced lung injury and improve lung function.

scholarly journals ADDITIVE NEUROPROTECTIVE EFFECT OF 3-HYDROXYPYRIDINE DERIVATIVES AND HUMAN ERYTHROPOETIN ANALOGUE ON A HEMORRHAGIC STROKE MODEL IN RATS

2020 ◽  
Vol 8 (3) ◽  
pp. 169-180
Author(s):  
P. D. Kolesnichenko ◽  
O. V. Scheblykina ◽  
N. I. Nesterova ◽  
D. V. Scheblykin ◽  
A. V. Nesterov ◽  
...  
Keyword(s):  
Survival Rate ◽  
Hemorrhagic Stroke ◽  
Neuroprotective Effect ◽  
Cerebrovascular Disorders ◽  
Neuroprotective Activity ◽  
Control Group ◽  
Stroke Model ◽  
Combined Use ◽  
Perifocal Edema ◽  
The Brain

The correction of free radical oxidation processes is one of the most promising strategies of neuroprotection in acute cerebrovascular disorders.The aim of the study is an experimental study of the neuroprotective effects of 3-hydroxypyridine and erythropoietin derivatives, as well as their combined use.Materials and methods. The study was performed on 109 male Wistar rats. The neuroprotective effect of the substances was studied on a hemorrhagic stroke model. The study drugs were administered to the animals intraperitoneally. Carbamylated darbepoetin was administered three times in advance at the dose of 100 µg/kg within intervals of 3 days, the last injection took place 1 hour before the operation (the total dose was 300 mg/kg). Etoxidol was administered once 1 hour before the surgery at the dose of 50 mg/kg. The survival rate, behavioral features and the state of the animals on the 1st, 3rd, 7th and 14th days were recorded, and the morphological assessment of the brain was carried out.Results. The investigated substances had a positive effect on both the survival rate of the animals during the first day and on the 14th day. The best survival rates on the 14th day were recorded in the group of a combined use of ethoxydol and carbamylated darbepoetin (75%). Thus, in this group of rats, a faster recovery of neurological disorders was already distinguished from the first day on. By the 7th day, more than 50% of the rats receiving the combination of the studied drugs, had had a slight neurological deficit (up to 3 points on the McGrow scale); by the 14th day there had been only minor changes in the neurological status in the rats of this group. A pronounced neuroprotective effect of the combination of 3-hydroxypyridine and erythropoietin derivatives has been confirmed by a histological examination of brain slices – a more rapid decrease in the size of perifocal edema and microcirculation disorders, less damage to neurons and glial elements, and faster processes of resorption and organization of hemorrhage. A macroscopic examination of the brain sections stained with triphenyltetrazolium chloride of the dying rats, showed that perifocal necrosis had been the main cause of high mortality in the control group after the 3rd day.Conclusion. As a result of the experiment, the nephroprotective effect of the studied derivatives of 3-hydroxypyridine and erythropoietin has been proved. Moreover, the combination of these drugs has shown a greater neuroprotective activity than their isolated use. The additive effect of these drugs was due to their action mechanism resulting from the synergism of various structures and components of the cells.

scholarly journals INFLUENCE OF NURSING CLINICAL PATHWAY IMPLEMENTATION TO LENGTH OF STAY OF NON HEMORRHAGIC STROKE PATIENTS IN BUKITTINGGI ACHMAD MOCHTAR HOSPITAL

2018 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Fitrianola Rezkiki
Keyword(s):  
Length Of Stay ◽  
Nursing Care ◽  
Clinical Pathway ◽  
Hemorrhagic Stroke ◽  
Average Length ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Stroke Patients ◽  
Nursing Clinical

<p><em>Lenght of stay is indicator of serving quality and nursing care to measure hospital efficiency level. Neurology ward is one of the wards that experience increasing of length of stay from 5,91 to 7,38. The cause of length of stay increasing is nursing care management that according to Calhoun can be formulated to nursing clinical pathway. The purpose of this study is to analyze influence of nursing clinical pathway implementation to length of stay of non hemorrhagic stroke patients in neurology ward Bukitttinggi Achmad Mochtar Hospital. The designs of this study used non-equivalent post test only control group design approach. Sample of this study were taken by purposive sampling with total of 32 samples consist of 16 sample as intervention group and another 16 samples as control group. Data analyzing used t-test independent. The result shows that there is significant influence for average length of stay of stroke non hemorrhagic patients that were given nursing clinical pathway compared to the group that is not given nursing clinical pathway with p value 0,001 (p value ≤ 0,05. According to this study, hospital should implement nursing clinical pathway when doing nursing care to patients in ward and also hospital should make policy related to nursing clinical payhway implementation..</em></p><p><em> </em></p>

scholarly journals Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Priyam Batra ◽  
Kapil Dev Soni ◽  
Purva Mathur
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

Off-Hours Admissions and Mortality in PICU Without 24-Hour Onsite Intensivist Coverage

2018 ◽  
Vol 35 (7) ◽  
pp. 694-699 ◽  
Author(s):  
Farah Chedly Thabet ◽  
Faisal Ahmed alHaffaf ◽  
Iheb Mohamed Bougmiza ◽  
Hend Ali Bafaqih ◽  
May Said Chehab ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Icu Stay ◽  
Risk Of Mortality ◽  
Public Holidays ◽  
Time Of Admission ◽  
Pediatric Icu ◽  
Length Of Icu Stay

Objective: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. Design: Prospective cohort study. Setting: A 34-bed tertiary PICU. Patients: All consecutive nonelective patients aged 0 to 14 years admitted from January 2012 to June 2015. Measurements and Main Results: A total of 1254 patients were nonelectively admitted to the PICU. They were categorized according to time of PICU admission as either office hours (07:30 to 16:30 from Sunday to Thursday and whenever an intensivist is present in the ICU) or off-hours (16:30 to 07:30, Friday and Saturday and public holidays). Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Risk of Mortality (PRISM2) score. Multivariate logistic regression was used to assess the effect of time of admission on outcome after adjustment for severity of illness using the PRISM2. The mortality observed in the office-hours group was 9.4% and in the off-hours group was 8.1%. The PRISM2-based SMR was 0.83 (95% confidence interval [CI]: 0.43-1.47) for the office-hours group and 0.68 (95% CI: 0.34-1.36) for the off-hours group. No significant differences in length of ICU stay or duration of mechanical ventilation were observed between patients admitted during off-hours and those admitted during office hours. In the logistic regression model, off-hours admission was not significantly associated with a higher mortality (odds ratio: 0.85, 95% CI: 0.57-1.27; P = .44). Conclusions: The absence of an in-house intensivist during off-hours is not associated with an increase in mortality, length of ICU stay, or duration of mechanical ventilation for patients admitted to our pediatric ICU.

scholarly journals Annexin V Levels as an Indicator of Myocardial Cell Death after Myocardial Infarction

2020 ◽  
Vol 19 (2) ◽  
pp. 78-84
Author(s):  
Mohammed Karem Ahmed ◽  
◽  
Adil Hassan Mohammed ◽  
Amed Medb Athab
Keyword(s):  
Myocardial Infarction ◽  
Cell Death ◽  
Apoptotic Cell ◽  
Plasma Concentrations ◽  
Annexin V ◽  
Myocardial Cell ◽  
Early Morning ◽  
Control Group ◽  
P Value ◽  
The Mean

Background:Myocardial ischemia is associated with apoptosis of cardiomyocyte and because of apoptotic cell death is characterized by externalization of Phosphatidylserine on the cell membrane, so it is amenable to targeting by Annexin V. Objective: To compare plasma concentrations of Annexin V in patients who had an early infarct with patients without infarction. And to analyze the plasma concentration of Annexin V in relationship to cardiovascular risk factors. Patients and Methods: A Case-control study of 100 patients (case) who are diagnosed with Myocardial Infarction (MI) and admitted to the coronary care unit of Baqubah Teaching Hospital and another 100 patients homogenous in terms of age and gender and who attended the hospital for other cause than myocardial infarction is selected as the control group during a period between the first of April and the first of July 2019. A special questionnaire used to collect the required information, an early morning blood sample is taken to measure the level of Annexin V by ELISA, Student’s t-test, ANOVA test and Chi_square test to find an association and differences between variables. Results: The results showed that The mean Annexin V level is significantly higher in cases (10.48155ng/ml) than control (1.28803ng/ml) with p-value =0.001 and a sample taken within 24 hours after MI is significantly higher in the mean level of Annexin V then the sample taken after 24 hours of MI. Conclusion: Generally, the measurement of Annexin V level has provided a good diagnostic test to evaluate myocardial infarction. Keywords: Myocardial infarction, Annexin V, Phosphatidylserine, Apoptosis

Sign in / Sign up

Export Citation Format

Share Document