Plasma Glycated Hemoglobin A1c Could Predict 30-Day All-cause Mortality of Intensive Care Unit Patients with Hyperglycemia

Background: An increased serum glucose level is a common finding among patients admitted to hospital with acute illness, including the intensive care unit (ICU), even without a history of previous diabetes mellitus (DM]. Glycated hemoglobin (HbAlc) is not only a diagnostic tool for DM but may also has prognostic value for diabetic and non-diabetic populations. Objective(s): To assess the relationship between HbA1c level on admission and clinical outcome among patients admitted to the ICU due to cardiopulmonary disorders with hyperglycemia. Method(s): Patients consecutively admitted to the ICU due to cardiopulmonary disorders who presented with hyperglycemia at admission were evaluated during a 6-month period. HbAlc and serum glucose levels were tested on admission and during the first 24-48 hours of hospitalization. Patients were divided according to HbA1c and compared in term of demographics. We evaluated the effect of HbA1c levels at admission on the clinical outcomes. Result(s): Of patients with cardiopulmonary disorders who presented with hyperglycemia at admission to the ICU, 73 had HbA1c levels 6%, 92 had HbA1c levels < 6%: 63/165 (38.2%) known as diabetic patients. The 30-day all-cause mortality was higher in the group with high HbA1c levels;38/73 vs. 32/98 (P= 0.02). Increased length of stay in the ICU and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were associated with HbA1 c 6% (P < 0.022 and P < 0.026), respectively Conclusion(s): HbAlc 6% has an important clinical prognostic value among diabetic and non-diabetic patients with cardiopulmonary disorders and hyperglycemia. Copyright © 2022 Israel Medical Association. All rights reserved.

Nutraceuticals in Personalized and Precision Medicine – a preliminary scoping review indicates efficacy for disease treatment, general wellbeing, and defense against Covid-19 (preprint)

Nutraceuticals have taken the spotlight during the past two decades as evidenced by the exponential publications on them. Long a part of routine in Traditional Medicine Systems, the rise of their mainstream use globally raises both safety concerns and need for better understanding of efficacious dosing. We attempt to answer these questions in this preliminary scoping review by an analysis of current literature on nutraceutical use as a personalized or prescription medicine. Using Covidence, Rayyan, and manual searches of PubMed, 598 unique publications were selected. 32 are systematic reviews, of which we overview the scope. We also overview 30 papers that address adverse drug reactions. To obtain an unbiased landscape of the 598 papers, we analyzed keywords using multiple methods. Expectedly, the most frequent keywords were probiotics and vitamins. Unexpectedly and remarkably, among the highest keyword yield was ‘COVID’. Further exploring this aspect, we review 15 pertinent papers, that not only provide robust evidence for nutraceutical benefits as part of SARS-CoV-2 treatment, but also amplify the notion that nutraceuticals are protective. Overall, the strident note is that further robust targeted research is needed in order to reap the full benefits of nutraceuticals in a safe and efficacious manner.

Extracorporeal Membrane Oxygenation in Pregnant Women With COVID-19.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and lung involvement is common. Patients with COVID-19 may progress to acute respiratory distress syndrome (ARDS) for which they may require mechanical ventilation. When conventional ventilation strategies are unable to achieve the desired oxygenation and gas exchange, extracorporeal membrane oxygenation (ECMO) might be an option in selected patients. The literature on the use of ECMO in peripartum women with COVID-19 is limited. We present a series of ten cases involving pregnant and recently pregnant women who rapidly developed ARDS after the onset of COVID-19 for which they received ECMO. Nine of the 10 patients survived intensive care unit discharge after a gradual recovery of their pulmonary function and weaning from mechanical ventilation and ECMO. In addition, 9 out of the 10 delivered neonates survived neonatal intensive care unit discharge.

All-textile inspired-folded dipole antennas for on/off-body communications medical applications

Two textile-based printed inspired Folded Dipole Antennas (FDAs) are presented in this paper for health monitoring of Covid-19 infected patients. The first antenna has an overall size of 80 mm × 20 mm and is mounted on the human's chest, while the second one is backed by a 2 × 4 textile Artificial Magnetic Conductor (AMC) array structure and is mounted on a surgical mask that covers the human’s mouth. The first antenna is designed to work at center frequency, bandwidth, and gain of 2.45 GHz, 116.6 MHz and −2.45 dB, respectively. The second antenna works at 2.4 GHz with bandwidth of 76.6 MHz and gain of 2.71 dB. The SAR results equal 0.524 W/Kg and 0.255 W/Kg at 1 g and 10 g, respectively, for the first antenna and 0.0174 W/Kg and 0.0091 W/Kg, respectively, for the second one. The previous specifications of the two antennas enable them to be utilized in wearable applications and Wi-Fi services.

Higher rates of COVID-19 but less severe infections reported for patients on Dupilumab: a Big Data analysis of the World Health Organization VigiBase.

OBJECTIVE: Dupilumab (Dupixent®) is a monoclonal antibody that inhibits IL-4 and IL-13 signaling used for the treatment of allergic diseases. Whilst biologic therapy is traditionally regarded as immunosuppressive and capable to increase the infectious risk, Dupilumab does not display these characteristics and may be even protective in certain cases. We investigated the link between Dupilumab therapy and SARS-CoV-2 infection. MATERIALS AND METHODS: We carried out a comprehensive data mining and disproportionality analysis of the WHO global pharmacovigilance database. One asymptomatic COVID-19 case, 106 cases of symptomatic COVID-19, and 2 cases of severe COVID-19 pneumonia were found. RESULTS: Dupilumab treated patients were at higher risk of COVID-19 (with an IC0.25 of 3.05), even though infections were less severe (IC0.25 of -1.71). The risk of developing COVID-19 was significant both among males and females (with an IC0.25 of 0.24 and 0.58, respectively). The risk of developing COVID-19 was significant in the age-group of 45-64 years (with an IC0.25 of 0.17). CONCLUSIONS: Dupilumab use seems to reduce COVID-19 related severity. Further studies are needed to better understand the immunological mechanisms and clinical implications of these findings. Remarkably, the heterogenous nature of the reports and the database structure did not allow to establish a cause-effect link, but only an epidemiologically decreased risk in the patients subset treated with dupilumab.

Don't close the book on tocilizumab for the treatment of severe COVID-19 pneumonia-the jury is still out: The Kuwait experience.

PURPOSE: This cross-sectional observational study aims to report preliminary data from the first experience using tocilizumab for patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in three of Kuwait's largest public hospitals City. PATIENTS AND METHODS: This chart review study examined the benefits of tocilizumab treatment among 127 patients diagnosed with severe coronavirus disease of 2019 (COVID-19) pneumonia. RESULTS: 90 of 127 patients (71%) survived. Mortality was highest in the elderly with multiple medical conditions. CONCLUSION: Despite the small sample size and retrospective nature of the work, our findings are consistent with recent studies suggesting tocilizumab administration in patients presenting with severe COVID pneumonia with associated hyperinflammatory features conferred mortality benefit.

COVID-19 convalescent plasma treatment of moderate and severe cases of SARS-CoV-2 infection: A multicenter interventional study.

OBJECTIVE: To study the effectiveness of COVID-19 convalescent plasma (CCP) therapy for patients with moderate and severe COVID-19 disease. METHODS: This non-randomized prospective cohort study was conducted from May 21 to June 30, 2020, at four major tertiary hospitals in Kuwait. CCP was administered to 135 patients. The control group comprised 233 patients who received standard treatment. All patients (N = 368, median age 54 [range 15-82]) had laboratory-confirmed SARS-CoV-2 infection and either moderate or severe COVID-19 disease. RESULTS: CCP treatment was associated with a higher rate of clinical improvement in patients with moderate or severe disease. Among those with moderate COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 8 days in the control group (p = 0·006). For severe COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 15.5 days in the control group (p = 0·003). In the adjusted analysis, patients with moderate disease treated with CCP had a significantly lower 30-day mortality rate. Compared to the control group, oxygen saturation improved within 3 days of CCP transfusion, and lymphocyte counts improved from day 7 in patients with moderate COVID-19 disease and day 11 in patients with severe disease. C-reactive protein levels declined throughout the first 14 days after CCP transfusion. None of the CCP patients developed a serious transfusion reaction. CONCLUSIONS: The data show that administration of CCP is a safe treatment option for patients with COVID-19 disease with a favorable outcome in the rate of, and time to, clinical improvement.