Effectiveness of Curcumin on Outcomes of Hospitalized COVID-19 Patients: A Systematic Review of Clinical Trials

Despite the ongoing vaccination efforts, there is still an urgent need for safe and effective treatments to help curb the debilitating effects of COVID-19 disease. This systematic review aimed to investigate the efficacy of supplemental curcumin treatment on clinical outcomes and inflammation-related biomarker profiles in COVID-19 patients. We searched PubMed, Scopus, Web of Science, EMBASE, ProQuest, and Ovid databases up to 30 June 2021 to find studies that assessed the effects of curcumin-related compounds in mild to severe COVID-19 patients. Six studies were identified which showed that curcumin supplementation led to a significant decrease in common symptoms, duration of hospitalization and deaths. In addition, all of these studies showed that the intervention led to amelioration of cytokine storm effects thought to be a driving force in severe COVID-19 cases. This was seen as a significant (p < 0.05) decrease in proinflammatory cytokines such as IL1β and IL6, with a concomitant significant (p < 0.05) increase in anti-inflammatory cytokines, including IL-10, IL-35 and TGF-α. Taken together, these findings suggested that curcumin exerts its beneficial effects through at least partial restoration of pro-inflammatory/anti-inflammatory balance. In conclusion, curcumin supplementation may offer an efficacious and safe option for improving COVID-19 disease outcomes. We highlight the point that future clinical studies of COVID-19 disease should employ larger cohorts of patients in different clinical settings with standardized preparations of curcumin-related compounds.

Effi cacy and safety of carboxytherapy in patients with ischemic stroke

The modern integrated approach to the treatment of ischemic stroke (IS), in addition to pharmacotherapy, provides for the impact of physical factors. Among them is injectable carboxytherapy (ICBT). Objective. The aim of the study was to evaluate the effi cacy and safety of using ICBT in combination with a standard treatment program in patients with acute ischemic stroke. Material and methods. The main group (MG) included 39 patients with acute IS, the comparison group (GC) — 31 patients. On the second day of hospitalization, patients with MG underwent ICBT on the background of standard therapy, and GC — procedures that mimic ICBT. Clinical, laboratory and instrumental data, IS outcomes, complications, timing were assessed.Results. There were no statistically signifi cant diff erences in physiological parameters (heart rate, blood pressure, SpO2) between MG and GC during and after the course of treatment. Positive dynamics of the neurological status was observed in both groups in the form of a decrease in the NIHSS score — in the MG from 6 to 4 (p = 0.047), in the GC — also from 6 to 4 (p = 0.25). In patients with MG, trophic disorders were less likely to develop in comparison with GC — 1 (2.6%) versus 6 (19.4%), p = 0.039. ICBT did not aff ect the duration of hospitalization of patients, the duration of treatment in the intensive care unit and carrying of resuscitation and also did not contribute to reducing mortality. Changes in the indicators of the acid-base state of the blood were compensatory in nature and did not lead to changes in the pH of the blood. The decrease in pH from 7.5 to 7.4 in 30–90 minutes after the procedures was a physiological reaction of the body to the introduction of CO2 and was not accompanied by negative consequences. Conclusions. ICBT is a safe method, does not aff ect the duration of hospital stay and mortality, help lower the likelihood of complications.

Comparison of Outcomes among Chronic Kidney Disease V Patients with COVID-19 at the National Kidney and Transplant Institute: A Retrospective Cohort Study

Background. There is very little published data on outcomes of COVID-19 among chronic kidney disease (CKD) patients. We compared the outcomes of COVID-19 in a tertiary care renal hospital among CKD V patients on hemodialysis (HD), peritoneal dialysis (PD), and dialysis initiation, in terms of duration of hospitalization, in-patient mortality, and 30-day mortality. Methods. A total of 436 CKD V patients, on either HD, PD, or dialysis initiation, with COVID-19 who were admitted at the National Kidney and Transplant Institute (NKTI) from March 13, 2020, to August 31, 2020, were included. Kaplan–Meier survival analysis was performed. Comparison of probability of mortality by group was performed using Log-Rank test. p values ≤0.05 were considered statistically significant. Results. Among 436 CKD V patients, 298 (68%) were on HD, 103 (24%) were on PD, and 35 (8%) required dialysis initiation. Overall in-hospital mortality was 34%; 38% were on HD, 20% on PD, and 37% on dialysis initiation. Total 30-day mortality was 27%; 32% were on HD, 26% on PD, and 16% on dialysis initiation. Median follow-up was 24 days. Among the 137 deaths recorded, total median time to death was 10 days; 8.5 days, 15.5 days, and 9 days for HD, PD, and dialysis initiation groups, respectively. Probability of mortality was significantly higher in HD patients versus PD patients ( p < 0.00001 ) and in the dialysis initiation group compared to PD patients ( p = 0.0234 ). Mortality probability, however, was not significantly different in HD patients versus the dialysis initiation group ( p = 0.63 ). Conclusion. Among CKD V patients diagnosed with COVID-19 at the NKTI, those on HD and on dialysis initiation had significantly higher in-hospital and 30-day mortality, compared to patients on PD.

Efficacy of prophylactic parenteral paracetamol to decrease rate of ductus patency in preterm infants.

Objective: To find out the effectiveness of prophylactic parenteral paracetamol to minimize rates of ductus patency among preterm infants. Study Design: Case-control study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: March 2020 to February 2021. Material & Methods: A total of 70 neonates (35 cases and 35 controls) having gestational age less than or equal to 34 weeks were enrolled. All 35 cases were administered prophylactic parenteral paracetamol as 20 mg per kg stat and 7.5 mg per kg 6 hourly for 1st 3 days of life while all controls were given no drugs. Echocardiography was performed in all 70 neonates after 1st three post-natal days to identify PDA. Data was analyzed using SPSS 26.0. Results: In a total of 70 neonates, 37 (52.9%) were male and 33 (47.1%) female. Overall, mean gestational age was noted to be 32.1+1.47 weeks while mean body weight was recorded to be 1424.6+229.7 grams. There were 6 neonates (17.1%) among cases who were found to have PDA in comparison to 23 (65.7%) in controls (p<0.0001). Four (11.4%) neonates died in case group in comparison to 7 (20.0%) among controls (p=0.3245). Mean duration of hospitalization was recorded to be 20.52+8.2 days in case group in comparison to 24.81+4.6 days among controls (p=0.0088). Conclusion: Prophylactic parenteral paracetamol was found to prevent ductus patency among preterm neonates. In comparison to controls, duration of hospital stay was significantly short among neonates who were administered prophylactic parenteral paracetamol.

Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study

The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88–1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89–0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.

The Influence of Approaches to Early Mobilization of Cardiosurgical Patients on the Duration of Hospitalization

The purpose of the study was to compare the impact of approaches to early mobilization of cardiac surgery patients on the duration of hospitalization. Materials and methods. Early mobilization of patients after cardiac surgery and study of its effectiveness is an important issue of physical therapy. The beginning of the development of cardiac surgery was characterized by the fact that patients after surgery were in the intensive care unit on a bed rest for several days to improve recovery and prevent complications. The benefits of early mobilization were later recognized, and patient verticalization began earlier. The study involved 90 patients (over 18 years old). Patients were divided into two groups. The first group of mobilization (GM1, n = 49) included patients who underwent surgery on Monday or Tuesday, performed standing and if possible walking on the spot on the first postoperative day with a physical therapist. The second group of mobilization (GM2, n = 41) included patients who underwent surgery on Friday, were mobilized to sit in bed on the first postoperative day; performed standing and walking on the spot on the second or third postoperative day with the participation of medical staff. In addition, other early mobilization points (chamber walking and corridor walking) were performed statistically later in GM2. Patients did not differ in other features of physical therapy. All patients were told during the preoperative consultation with a physical therapist that if they were operated on Friday, they would perform mobilization and therapeutic exercises with medical staff on weekends. Patient case data (age, sex, study protocols and operations) were studied. Results and discussion. Among GM1 patients, the part of men was 69.39%, and in the GM2 group – 78.05% (χ² = 0.856; p = 0.355). Groups of patients did not have significant differences in age, anatropometric parameters, key results of preoperative studies, characteristics of surgical interventions. The study did not establish the effect of more progressive early mobilization performed in GM1 on the length of stay in the postoperative ward (7 (6; 8) nights versus 7 (5; 8) nights; p=0.428) and the total duration of postoperative hospitalization (9 (8; 10) nights against 10 (7; 11) nights; p=0.733). Statistically better indicators of the GM1 group were obtained in the number of nights spent in intensive care (all patients – two nights, except 3 patients in GM1 and 11 in GM2 – three nights; p=0.007), but this advantage should be considered taking into account the impact of patient logistics, namely longer stay in intensive care on weekends. Conclusion. The data confirmed the same effectiveness of approaches to early mobilization of cardiac surgery patients in terms of duration of postoperative hospitalization

Therapeutic effects of synbiotic on neonates with gestational age over 34 weeks admitted for jaundice

BACKGROUND: Hyperbilirubinemia is a common problem in neonates. The aim of this study was to evaluate the effect of synbiotic in addition to routine phototherapy on the treatment of neonatal jaundice. METHOD: This double-blind clinical trial, was performed on 194, 3–14 days old neonates. Neonates were divided into intervention and placebo groups. The intervention group received 5 drops of oral synbiotic daily along with phototherapy and the placebo group underwent phototherapy plus a placebo. Gestational age, age, weight, sex, initial and daily bilirubin level, frequency of defecation, mode of delivery, and length of hospitalization were assessed. RESULTS: The rate of bilirubin reduction on the first day of admission was significantly higher in the intervention group (2.9±1.81 vs. 2.06±1.93, p = 0.002). The mean level of bilirubin on the second (9.8±1.92 vs. 10.88±2.26) and third days (8.06±1.54 vs. 9.86±1.7) was lower in the intervention group (p = 0.001). The proportion of discharged patients in the third and fourth days was higher in the intervention group compared to the control (65% vs. 41%, 99% vs. 86.5%, respectively, p = 0.001). However, the duration of hospitalization was shorter in the intervention group compared to the control (2.36±0.5 vs. 2.74±0.74, p = 0.001). CONCLUSION: Based on our results, daily treatment with 5 drops of synbiotic along with phototherapy can be a safe and effective modality in faster bilirubin reduction, decreasing the hospitalization period and phototherapy. Therefore, it seems that it can be used as an adjunct therapy for neonates with jaundice.

Ambulatory Endoscopic Thyroidectomy via a Chest-Breast Approach Has an Acceptable Safety Profile for Thyroid Nodule

IntroductionWith the growing esthetic requirements, endoscopic thyroidectomy develops rapidly and is widely accepted by practitioners and patients to avoid the neck scar caused by open thyroidectomy. Although ambulatory open thyroidectomy is adopted by multiple medical centers, the safety and potential of ambulatory endoscopic thyroidectomy via a chest-breast approach (ETCBA) is poorly investigated.Material and MethodsPatients with thyroid nodules who received conventional or ambulatory ETCBA at Xiangya hospital, Central South University from January 2017 to June 2020 were retrospectively included. The incidence of postoperative complications, 30-days readmission rate, financial cost, duration of hospitalization, mental health were mainly investigated.ResultsA total of 260 patients were included with 206 (79.2%) suffering from thyroid carcinoma, while 159 of 260 received ambulatory ETCBA. There was no statistically significant difference in the incidence of postoperative complications (P=0.249) or 30-days readmission rate (P=1.000). In addition, The mean economic cost of the ambulatory group had a 29.5% reduction compared with the conventional group (P&lt;0.001). Meanwhile, the duration of hospitalization of the ambulatory group was also significantly shorter than the conventional group (P&lt;0.001). Patients received ambulatory ETCBA showed a higher level of anxiety (P=0.041) and stress (P=0.016). Subgroup analyses showed consistent results among patients with thyroid cancer with a 12.9% higher complication incidence than the conventional ETCBA (P=0.068).ConclusionAmbulatory ETCBA is as safe as conventional ETCBA for selective patients with thyroid nodules or thyroid cancer, however with significant economic benefits and shorter duration of hospitalization. Extra attention should be paid to manage the anxiety and stress of patients who received ambulatory ETCBA.

Comorbidities Associated with Complicated Hospital Course and Death in COVID-19 Patients: A Retrospective Study from Iran

Objective There are limited data regarding the impact of comorbidities on hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran. Methods We evaluated the risk of serious adverse outcomes in 1368 Iranian COVID-19 patients, admitted to five academic hospitals in Tehran between February-June 2020. The composite end-points were defined as admission to an intensive care unit, invasive ventilation, or death. The Cox proportional survival model determined the potential comorbidities associated with death. Results Overall, 576 patients (42.3%) reached the composite end-point (280 death). Adjusted for age, sex, duration of hospitalization, and the presence of the other comorbidities, patients with diabetes (RR=1.25, 95%CI; 1.08-1.44), heart failure (RR=1.45, 95%CI; 1.10-1.91), chronic kidney disease (RR=1.32, 95%CI; 1.04-1.67), malignancy (RR=1.79, 95%CI; 1.41-2.28), and lung diseases (RR=1.53, 95%CI; 1.27-1.84) were more likely to reach the composite end-point than those without the very comorbidity. Moreover, patients aged less than 65 years had a greater risk of death in the presence of two (HR=2.68, 95%CI; 1.46-4.95, p=0.002) or more (HR=3.47, 95%CI; 1.69-7.12, p=0.001) comorbidities, compared to those without any comorbidity. Conclusion To conclude, having two or more comorbidities in patients less than 65 years is associated with a greater risk of death during hospitalization.

Đánh giá kết quả sớm điều trị ung thư đại tràng bằng phẫu thuật nội soi

TÓM TẮT Đặt vấn đề: Ung thư đại tràng là một bệnh lý hay gặp ở Việt Nam, đứng hàng thứ hai sau ung thư dạ dày trong ung thư đường tiêu hóa. Điều trị ung thư đại tràng chủ yếu là phẫu thuật cắt đoạn đại tràng mang theo khối u kèm hạch và hóa chất bỗ trợ. Phẫu thuật nội soi điều trị ung thư đại tràng mang lại nhiều hiệu quả và ngày càng được ứng dụng rộng rãi. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả 35 bệnh nhân được chẩn đoán là ung thư đại tràng được phẫu thuật nội soi tại bệnh viện Trung ương Huế cơ sở 2 từ tháng 1/2019 đến 6/2021. Kết quả: Tuổi trung bình 62,4 ± 17,8 (34 - 82), giới tính nam/nữ: 1,2. Vị trí u bao gồm: u đại tràng phải chiếm 31,4%, đại tràng ngang 11,5%, đại tràng trái 25,7%, đại tràng sigma 31,4%. Hình ảnh quan sát qua nội soi đại tràng thể sùi chiếm tỷ lệ cao nhất 82,9%. Nồng độ CEA tăng trước mổ chiếm 42,9%. Theo TNM u tập trung ở giai đoạn II, III chiếm tỉ lệ cao nhất 80%. Thời gian phẫu thuật trung bình: 168,7 ± 31,4 phút, thời gian nằm viện sau mổ trung bình: 10,8 ± 4,9 ngày. Tai biến trong mổ không có, biến chứng sớm sau phẫu thuật có 5/35 bệnh nhân nhiễm trùng vết mổ. Kết luận: Phẫu thuật nội soi điều trị ung thư đại tràng là một phương pháp hiệu quả, an toàn, tỉ lệ tai biến và biến chứng sau mổ ít. ABSTRACT OPERATIVE OUTCOMES OF LAPAROSCOPIC SURGERY FOR COLON CANCER Background: Colon cancer is a common disease in Vietnam, ranking second after gastric cancer in gastrointestinal cancers. Treatment of colon cancer is mainly based on surgery to excise the colon with tumor and adjuvant chemotherapy. Laparoscopic surgery for colon cancer increasingly shows its effectiveness and is widely used. Methods: A prospective, descriptive study was conductedon 35 patients with colon cancer who were treated by laparoscopicsurgery at the Hue Central Hospital - Branch 2 from January 2019 to June 2021. Result: The mean age was 62.4 ± 17.8 (34 - 82); the male/ female ratio was 1.2. The sites of cancer were: right colon 31.4%; transverse colon 11.5%; left colon 25.7%; sigma colon 31.4%. Protrusive tumors were accounted for 82.9% by diagnostic colonoscopy. Elevation of CEA serum level wasfound in 42.9% preoperatively. TNM stage of II and III were the most 80%. The mean operativetime was 168.7 ± 31.4 minutes. The mean duration of hospitalization was 10.8 ± 4.9 days. No intraoperative complications were found. The rate of wound infection was 14.3%. Conclusion: Laparoscopic surgery for colon cancer is a safe and effective surgical technique with less postoperative pain and a low rate of postoperative complications. Keywords: Colon cancer, laparoscopic.