Search

Background: Noninvasive ventilation (NIV) has been used as one of the most promising methods to treat hypoxic respiratory failure in COVID-19. Methods: In this study, the clinical outcomes of 80 patients with acute respiratory failure caused by COVID-19 were evaluated. The disease was confirmed in two methods: clinical and radiographic confirmation of disease in patients with an acute respiratory infection (highly suspected) or in some cases with a positive PCR test. The rate of discharge from the ICU without the need for intubation was evaluated as the primary outcome and based on that, the patients were divided into two groups: NIV failure and NIV success. Mortality rate, length of stay in ICU, frequency of intubated patients and laboratory factors of patients as secondary outcomes in two groups were compared. Results: Regarding the outcome of death and discharge, there was a statistically significant difference between the two groups. Therefore, all patients with corona who were admitted to ICU and received NIV and were intubated due to non-responsiveness to NIV died and the patients were discharged from the hospital without intubation. All the patients investigated in this study, had received antiviral, antibiotic, and glucocorticoid treatment during hospitalization. In this study, the patients who were in the NIV success group and were not intubated had a lower mean age compared to the group without NIV success (54 vs. 67 years, respectively). The number of white blood cells in the NIV success group was 3945.28±10011.21 and in the group without NIV success was 9242.38±17296.16, which was statistically significant (P=0.004). The number of blood neutrophils in the successful and unsuccessful NIV groups was 12.19±83.04 and 4.31±89.49, respectively (P=0.034). The mean APACHEII score in patients in the NIV success group (11.07±5.05) was significantly lower than the group without NIV success (20.16±4.96). Conclusion: Mortality was higher in the intubated group than in the NIV group. The combination of APACHEII score and respiratory rate one hour after receiving NIV can predict success with NIV.

Background: Sporadic lymphangioleiomyomatosis (S-LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle cells (LAM cells) in the lungs (pulmonary LAM). There are two types of LAM, sporadic and LAM with tuberous sclerosis, which is an autosomal dominant genetic disease caused by mutations in the Tsc1 and Tsc2 genes. The most common manifestation of this disease is pneumothorax due to cyst rupture. Median transplant-free survival for pulmonary LAM is 23 years from diagnosis. Factors associated with a poor prognosis are often those associated with a more rapid decline in lung function. Case Presentation: The patient was a 24-year-old woman who presented with pneumothorax and multiple bullae in both lungs. The patient had no family history of respiratory disease, and the patient herself had no symptoms other than mild shortness of breath following activity from a year ago. A lung CT scan was performed for the patient and multiple bullae were evident in both lungs, which confirmed the diagnosis. There was no evidence of involvement of other organs but the lung. For the patient in the ICU with the diagnosis of left pneumothorax, a chest tube was inserted and she underwent mechanical ventilation. Finally, after 24 days of hospitalization, oxygen therapy of the patient was performed with a normal mask, and she underwent left lung pleurodesis with talcum powder, and a few days later, right lung pleurodesis was performed on the patient. On the 36th day of hospitalization, her general condition improved and she was discharged from the ICU. The patient was discharged in good general condition and had no problem on her four months follow-up. Conclusion: Fortunately, with the diagnosis of LAM for the patient according to the CT scan of the patient's lung, she was treated with insertion of a chest tube and by performing pleurodesis, the recurrence of pneumothorax was prevented. In a young woman with spontaneous pneumothorax, sporadic LAM is one of the differential diagnoses.

BACKGROUND AND OBJECTIVE: Gastric residual volume is considered as an important parameter for gastric emptying and feeding tolerance. This volume is measured before each time of feeding and it has direct effect on the volume and time of the next feeding. Ginger is one of the medicinal plants that have effect on gastric emptying rate. This study aims to compare the effect of erythromycin and ginger extract on gastric residual volume in patients receiving enteral nutrition order in the intensive care unit. METHODS: This randomized clinical trial was conducted among 74 patients hospitalized in the intensive care unit. Patients were fed with similar nutrition formula every 3 hours for 24 hours. Before each gavage feeding, the gastric residual volume of patients was aspirated and recorded. The gastric residual volume of 28 patients (more than 200 cc) was allocated to one of the groups of erythromycin (n = 13) and ginger (n = 15). Patients were fed with 2.5 mg/kg erythromycin in 4 divided doses or 2 grams per day ginger extract in 4 divided doses. The gastric residual volume was recorded for 4 consecutive days and the data obtained from the two groups were compared (IRCT: 201505257494N13). FINDINGS: The mean difference of gastric residual volume in erythromycin group was 111.71±7.04 cc before the intervention and 4 days after that, which was not statistically significant. This difference was 108.61±11.47 cc in ginger group. Results demonstrated that mean gastric residual volume in erythromycin and ginger groups were 98.52±27.88 cc and 95.71±18.91 cc, respectively during the first 4 days and there was not a statistically significant difference between these two groups. CONCLUSION: Results of the study demonstrated that the effect of ginger is very similar to erythromycin. Therefore, ginger can be a proper substitute for erythromycin to prevent increased gastric residual volume in patients hospitalized in the intensive care unit.

Background: IFNβs are known as one of the most promising drugs used for COVID-19 treatment. This study aimed to investigate the effects of treatment with INF-β 1-a (interferon beta-1a) and IFN-β 1-b (interferon beta-1b) on COVID-19 inpatients., Methods: In this study, we retrospectively evaluated the clinical treatment outcomes of 100 patients with COVID-19 who received IFN-β 1-a and IFN-β 1-b during their hospitalization period. The rate of discharge from the hospital was considered equal to the clinical improvement and then evaluated as a primary outcome. Moreover, mortality, ICU admission and length of ICU stay, frequency of intubation and use of mechanical ventilation, duration of hospitalization, laboratory factors, and medications were assessed as secondary outcomes., Results: The median discharge time of IFN-β 1a recipients was approximately equal to that of IFN-β 1-b recipients as 9 (5-10) days and 7 (5-11) days, respectively (HR = 2.43, P = 0.75). Mortality rate was also estimated as 10% among IFN-β 1-a recipients and 14% among IFN-β 1-b recipients, which was not statistically significant (p = 0.190). ICU hospitalization rate for the IFN-β 1-a recipients and IFN-β 1-b recipients was 26% and 36%, respectively. In addition, no significant difference was found between these two intervention groups in terms of ICU length of stay (1 (0-2) vs. 1 (0-4.25(, respectively,) P = 0.357). There was no significant difference between the two study groups in terms of frequency of mechanical ventilation and length of hospital stay., Conclusion: There was no significant difference between the two groups in terms of shortening the disease time, clinical improvements and other outcomes., (Copyright © 2021. Published by Elsevier B.V.)