Heliox for Pediatric Critical Asthma: A Multicenter, Retrospective, Registry-Based Descriptive Study

Background: In cases of critical asthma (CA), heliox may be applied as an adjunctive rescue therapy to avoid invasive mechanical ventilation (MV), improve deposition of aerosolized medications, and enhance laminar airflow through obstructed airways. Using the Pediatric Health Information System (PHIS) registry, we evaluate heliox prescribing and explored for differences in MV rates and hospital length of stay (LOS) among children with and without heliox exposure. Methods: We performed a retrospective cohort study using PHIS data from 42 pediatric intensive care units among children 5-17 years of age admitted for CA from 2010 through 2019. Primary outcomes were heliox prescribing rates and trends. Secondary outcomes were invasive MV rates and LOS assessed in a subgroup of children receiving ≥ 1 adjunctive intervention(s). Results: Of the 19,780 studied, heliox was prescribed in 12.5% and linearly declined from 16.1% in 2010 to 5.6% in 2019. The overall MV rate was 12.8% and was lower in subjects receiving heliox alone (4.9%) compared to heliox plus alternative adjunctive therapies [31.2%] or children receiving non-heliox adjunctive therapies [22.1%], P < .01). Accounting for MV, no difference in LOS was observed. In exploratory adjusted models, MV free hospitalization was associated with heliox-only exposure (OR: 0.33, 95% CI: 0.17-0.63, P < .01) and exposure to multiple adjunctive therapies was associated with MV (OR: 2.48, 95% CI: 1.56-3.94, P < .01). Conclusions: In this multicenter retrospective study from 42 children’s hospitals, heliox prescribing for CA declined over the last decade. Subjects receiving multiple adjunctive therapies more commonly required invasive MV perhaps indicating a greater severity of illness. At this time, prospective trials needed to identify the role of heliox for pediatric CA.

Vitamin C and COVID-19: should clinical trials be prioritised for low income settings and vitamin C-deficient populations?

TO THE EDITOR: Managing coronavirus disease 2019 (COVID-19) in resource-limited settings requires a number of considerations, including reducing or preventing requirements for respiratory support.1 Vitamin C is a low cost, readily available therapy that the World Health Organization has highlighted for further research as an adjunctive intervention with biological plausibility for improving the clinical outcome of patients with COVID-19

Stress reduction intervention and the initial periodontal therapy outcome in chronic periodontitis patients. a randomized controlled pilot study

Background: Psychosocial stress, have been implicated as risk indicators for periodontal disease. Minimal evidence in literature exists to assess the effect of stress reduction therapy (SRT) in the outcome of non-surgical periodontal therapy (NSPT).Objective: Hence, we aimed to explore the possibility of employing SRT in stressed patients as an adjunctive intervention in the management NSPT.Materials and Methods: Sixty male patients divided into Group 1 comprised of 20 unstressed chronic periodontitis patients receiving non-surgical periodontal therapy alone, Group 2a (20 stressed chronic periodontitis patients) received intervention focused on SPT with NSPT and Group 2b (20 stressed chronic periodontitis patients) received only NSPT without SPT. Their stress level was evaluated using a standard questionnaire method and salivary cortisol levels, at baseline and 3 months along with periodontal parameters.Results: There was significant reduction in stress parameters for Group 2a patients. The reduction of total periodontitis affected sites was highest in Group I patients (55.4%), followed by Group 2a patients (53.2%) and Group 2b patients (38%).Conclusion: SRT may result in comparable treatment outcome to unstressed chronic periodontitis patients. This study opens new avenues to investigate the effects of stress management as an adjunctive to conventional NSPT, which should be explored further.

Treating Suicidal Thoughts and Behaviors Within an Emotional Disorders Framework: Acceptability and Feasibility of the Unified Protocol in an Inpatient Setting

We provide a theoretical rationale for applying a transdiagnostic, shared mechanism treatment (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders [UP]) to suicidal thoughts and behaviors. We also present results from a proof of concept study examining the feasibility and acceptability of adding a modified UP to treatment as usual (TAU) in an inpatient setting for individuals reporting a recent suicide attempt or active suicidal ideation. Participants ( N = 12) were randomly assigned to receive UP + TAU or TAU alone. Findings indicate good feasibility and acceptability of the adjunctive intervention. Among participants who were responsive to contact attempts postdischarge ( n = 6), there were no observable differences in suicidal thoughts or behaviors during a 6-month follow-up. This application represents a promising initial extension of a cognitive-behavioral, emotion-focused treatment to suicidal individuals within an inpatient setting. Future studies adequately powered to speak to efficacy of the modified UP intervention are warranted.