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Background: The optimal timing of intubation has been debated among healthcare professionals, current studies do not show any differences between early and late intubation. most studies failed to show any significant difference in clinical outcomes between early or late intubation. Methods: The study was conducted as a retrospective review of subjects with confirmed coronavirus disease 2019 admitted to the Dubai Hospital intensive care unit (ICU). Study variables included time to intubation, duration of supplemental oxygen requirement>15L/min, and cumulative duration of tachypnea and tachycardia while on the aforementioned oxygen requirement on this oxygen usage level. Each time duration was assessed for correlation with clinical variables including mortality and length of stay in ICU and hospital. Results: Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival (P = 0.03). Subjects who have tachypnea on the aforementioned oxygen requirement for 6–19.5 h (P = 0.01) before they require intubation have better survival. No duration of tachycardia has any significant effect on survival. Only the duration of invasive mechanical ventilation (MV) correlated with the hospital length of stay. Conclusions: Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival. The optimal time for intubation is after tachypnea of 6 h but before 19.5 h. No duration of tachycardia has any significant effect on survival. Only the duration of invasive MV correlated with the hospital length of stay. [ABSTRACT FROM AUTHOR]

Objective: To evaluate if children with ASD, or mothers of ASD children have elevated CRP during pregnancy. Background: Autism spectrum disorder (ASD) is a neuro developmental disorder with incidence of 1 in 68 children occur in all racial, ethnic, and socioeconomic groups. Economic burden between $11.5 billion - $60.9 billion and family average medical expenditures of $4110–$6200 per year. Conflicting evidence exist about role of maternal CRP during pregnancy with ASD child. Methods: Searches on database; Pubmed, Medline, Embase and google scholar using key words; C reactive protein (CRP), Maternal CRP, ASD, autism, autistic disorder, Inflammation. All English-language studies published between 1960 and 2019 pertaining to CRP and ASD. All Studies which provided data on CRP levels during pregnancy (mCRP) of Mothers of offsprings with ASD and (mCRP) of mothers of normal subjects were selected. Data were extracted in the form of odd ratios of having high mCRP in mothers of children with ASD versus mCRP of mothers of normal controls. Since these odd ratios were adjusted, therefore no Meta regression were attempted. Significant heterogeneity was found; therefore, random effect model was employed. Results: Review of CRP levels in children with ASD showed higher level in children with ASD than control, although different methodology and absence of numerical data did not allow metanalysis. Regarding mCRP and ASD, three studies were identified that provide data on mCRP and ASD. Four datasets were created from these 3 studies as the study by Zerbo et al. provided data in 2 subsets. Total number of subjects were 5258 (Brown, N = 677, Zerbo = 416, Koks = 4165) extracted data from these studies was pooled for analysis. Random effect model was employed and substantial heterogeneity among the studies was observed 11. Mothers of children with ASD have adjusted Odd ratio of 1.02 (0.948 to 1.103, I2 = 75, P = 0.558) to have high mCRP comparing mothers of control. Conclusion: Mothers of children with ASD appear not to have elevated CRP during pregnancy. Children with ASD appear to have higher levels of CRP levels. [ABSTRACT FROM AUTHOR]

Until a randomized prospective controlled trial is available, the clinician should exercise clinical judgment regarding extubation in VA-ECMO patients as it may result in adverse outcome (this study has about 25% extubation failure). Patients with extubation had a higher prevalence of ventilator-associated pneumonia than those who did not have extubation (Supplementary Table 2 in [1]). The authors studied the benefit of ventilator liberation in patients treated with venoarterial extracorporeal membrane oxygenation therapy (VA-ECMO). [Extracted from the article]

Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT). Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intimamedia thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ⩾5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from -0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, (P < 0.0001). Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process. [ABSTRACT FROM AUTHOR]

The authors illustrated that "Biomarkers of systemic inflammation are associated with longer delirium duration, higher delirium severity, and in-hospital mortality." Delirium is a complex and dynamic process determined by many variables; patient risk factors, disease-related factors, treatment-related factors, environment, and surrounding related factors. [Extracted from the article]

Although ultrasound is emerging gold standard for critically ill patient at bedside, many physicians frequently consider CT scan to confirm diagnosis, especially for disorders like pulmonary gangrene as soon as patient becomes stable to undergo CT scanning because patient will have to be moved for surgery anyway. B Rashid Nadeem, MD FACP FCCP FAASM b B Rami Mohammed Osman Abdalla Satti, MD, CCUST b Department of Intensive Care, Dubai Hospital, Dubai, United Arab Emirates Footnotes 1 The authors have disclosed that they do not have any potential conflicts of interest. [Extracted from the article]

Shinn et al (1) reported prevalence of ALgI (mucosal ulceration or granulation tissue in the larynx) in 57% of patients, which appears to be high for patients who have prolong MV for only greater than 12 hours. We noticed that supplementary material titled as standard protocols for nasolaryngoscopy provided all standard protocols for ICU patient although there was no standard protocol defined for intubation or nasolaryngoscopy. [Extracted from the article]

The authors have done a great job of reporting prevalence and outcome trends in care of patients with variceal bleeding admitted to ICU. Majeed et al ([1]) excluded; same episode hospital readmission, transfers and patients with unknown outcomes, what was the proportion of these patients?. [Extracted from the article]

Increase in post discharge, out of hospital mortality suggests that patients on midodrine may be discharged with subclinical hypoperfusion secondary to pseudo-normalization of vital signs, although it may be more complex. Last, authors mention that among the 909 patients (81%) who survived to hospital discharge, 53% (484/909) received midodrine in the 24 hours before hospital discharge and midodrine was listed on 34% (311/909) of the hospital discharge summaries. [Extracted from the article]

Highlights from the article: Rinehart et al. [1] studied blood pressure variability in surgical and intensive care unit patients. 2 NR Pandey, YY Bian, ST Shou, Significance of blood pressure variability in patients with sepsis, World J Emerg Med, 5, 1 2014, 42-47.

Purpose: The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies. Materials and method: A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs. Results: A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times. Conclusion: Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies. [ABSTRACT FROM AUTHOR]

An abstract of the study "Comparison of Treatment Compliance for Latent Tuberculosis (TB) Infection Among Patients of an Urban Chicago Community" by Hasnain Bawaadam et al. is presented.

An abstract of the case study "Chest Pain, ST Elevation, and Increasing Troponin: Is It Really Myocardial Infarction?" by Kovid Trivedi and colleagues is presented.