Notes

Overdue cable clamping: Time for physiologic execution.
BACKGROUND UVC has been used to inactivate several pathogens. Unlike the conventional 254-nm UVC, 222-nm UVC is harmless to mammalian cells. AIM To investigate the disinfection efficacy of 222-nm UVC against human pathogens which are commonly found in the environment and healthcare facilities. METHODOLOGY Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Salmonella enterica subsp. serovar Typhimurium, Campylobacter jejuni, Bacillus cereus (vegetative cells and endospores), Clostridium sporogenes (vegetative cells and endospores), Clostoridioides difficile (endospores), Candida albicans (yeast), Aspergillus niger (hyphae and spores), Trichophyton rubrum (hyphae and spores), feline calicivirus and influenza A virus were irradiated with 222-nm UVC at various doses. The remaining live bacterial and fungal cells, and the viral infectivity were evaluated. The efficiency of 222-nm UVC germicidal effect was compared to that of the conventional 254-nm UVC. RESULTS The 222-nm UVC showed potent germicidal effect to vegetative bacterial cells, yeast and viruses as efficient as the 245-nm UVC. The 222-nm UVC exhibited more potent germicidal effect to bacterial endospores, compared with the 254-nm UVC. The fungicidal effect of 222-nm UVC against the fungal spores and hyphae was weaker than that of 254-nm UVC. CONCLUSIONS The 222-nm UVC is able to inactivate a wide spectrum of microbial pathogens. In comparison with the conventional 254-nm UVC, the germicidal effect of 222-nm UVC to the fungal hyphae and spores is low, but the 222-nm UVC exhibits strong germicidal effect to the bacterial endospores. As of March 24, 2020, novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for 379,661 infection cases with 16,428 deaths globally, and the number is still increasing rapidly. Herein, we present four critically ill patients with SARS-CoV-2 infection who received supportive care and convalescent plasma. Although all four patients (including a pregnant woman) recovered from SARS-CoV-2 infection eventually, randomized trials are needed to eliminate the effect of other treatments and investigate the safety and efficacy of convalescent plasma therapy. BACKGROUND Whether hydrocortisone, vitamin C, and thiamine treatment can reduce the mortality of patients with sepsis is controversial. RESEARCH QUESTION To evaluate the efficacy and safety of hydrocortisone, vitamin C, and thiamine combination treatment for patients with sepsis or septic shock STUDY DESIGN AND METHODS This single-blind, randomized controlled trial evaluated treatment with hydrocortisone (50 mg every 6 h for 7 days), vitamin C (1.5 g every 6 h for 4 days), and thiamine (200 mg every 12 h for 4 days) vs placebo (normal saline) in patients with sepsis. The intention-to-treat analysis was used. Primary outcome was 28-day all-cause mortality, and secondary outcomes were organ protection, procalcitonin reduction, and adverse events related to hydrocortisone, vitamin C, and thiamine. RESULTS Eighty patients were randomized to receive combination treatment (n = 40) or normal saline (n = 40). No difference in 28-day all-cause mortality was observed (27.5% vs. 35%; P = 0.47), although treatment was associated with a significant improvement of 72-h ΔSOFA score (P = 0.02). In adverse events analysis, the treatment group exhibited more incidents of hypernatremia (P = 0.005). dcemm1 chemical structure In prespecified subgroup analysis, patients of the treatment subgroup diagnosed with sepsis within 48 h showed lower mortality than those in the control subgroup (p = 0.02). The study was terminated after the mid-term analysis. INTERPRETATION Among patients with sepsis or septic shock, the combination of hydrocortisone, vitamin C, and thiamine did not reduce mortality compared with placebo. BACKGROUND There remains uncertainty in the optimal prognostication and management of patients with intermediate-risk PE. Transthoracic echocardiography can identify right ventricular (RV) dysfunction to recognise intermediate-high risk patients. RESEARCH QUESTION The aim of this study was to test whether echocardiography-derived stroke volume index (SVI) is associated with death or cardiopulmonary decompensation in intermediate-risk patients with pulmonary embolism (PE). STUDY DESIGN AND METHODS We retrospectively evaluated echocardiographic-derived variables including SVI in normotensive patients with acute pulmonary embolism admitted between January 2012 and March 2017. SVI was determined using the Doppler velocity-time integral in the left or right ventricular outflow tract. The primary outcome was in-hospital PE-related death or cardiopulmonary decompensation. We used logistic regression to determine the association between SVI and outcomes, and receiver operating characteristic analysis to compare the performance of SVI and other echocardiographic measures. RESULTS The primary outcome occurred in 26 (3.9%) of the 665 intermediate-risk PE patients. Univariate logistic regression showed an odds ratio of 1.37 (95% CI, 1.23-1.52, p less then 0.001) per 1 mL/m2 decrease in SVI for the primary outcome. Bivariate logistic regression showed that SVI was independent of age, sex, heart rate, VTI and Bova score. SVI had the highest C-statistic of 0.88 (95% CI, 0.81-0.96) of all echocardiographic variables with a Youden's J-statistic identifying an optimal cut-point of 20.0 mL/m2, which corresponds to positive and negative likelihood ratios of 6.5 (95% CI, 5.0-8.6) and 0.2 (95% CI, 0.1-0.5) for the primary outcomes, respectively. INTERPRETATION Low SVI was associated with in-hospital death or cardiopulmonary decompensation in acute PE. SVI had excellent performance compared to other clinical and echocardiographic variables. BACKGROUND Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure but indications, devices and ventilatory modes are in constant evolution. RESEARCH QUESTION To describe changes in prevalence, and indications for NIV over a 15 year period; to provide a comprehensive report of characteristics of the population treated (age, comorbidities, anthropometric data), mode of implementation and follow-up, devices, modes and settings used, physiological data, compliance, and data from ventilator software. DESIGN cross-sectional observational study, designed to include all subjects under NIV followed by all structures involved in NIV in the Cantons of Geneva and Vaud (1'288'378 inhabitants) RESULTS 489 patients under NIV were included. Prevalence increased 2.5-fold since 2000 reaching 38/105 inhabitants. Median age was 71 years, 31% being over 75. Patients had been under NIV for a median of 39 months, had an average of 3±1.8. comorbidities; 55% were obese. COPD (including overlap syndrome) was the most important patient group, followed by obesity -hypoventilation (OHS, 26%).
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