ABSTRACT
INTRODUCTION: Prone ventilation is a well-established strategy in patients with severe ARDS as it has been shown to improve survival and mortality. However, in intubated patients with COVID-19 pneumonia, the data are limited, with no substantial evidence supporting its use. This meta-analysis is the first to examine the mortality benefit of prone ventilation in intubated COVID-19 patients. METHOD(S): A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in Medline, Embase, and Web of Science databases was conducted in January 2022 for published studies assessing the mortality benefit of prone ventilation in intubated COVID-19 patients. RESULT(S): Four hundred sixty-seven studies were identified. Of those, five studies met the inclusion criteria studies were included. The total number of patients included in the studies was 4247 patients. In four studies, ARDS prevalence was reported. The prone group had a higher prevalence of severe ARDS rates than the supine group. No significant difference was found between prone or supine groups in ICU mortality (OR: 1.39;95%CI: 0.80-2.43;p=0.24). Regarding overall mortality, No difference was detected between the prone or the supine groups (OR: 1.04;95%CI: 0.57-1.87;p = 0.9), with significant heterogeneity (I2= 93;p < 0.001). The length of hospital stay (LOS) was reported in two studies. Our analysis showed that LOS did not differ between the prone and supine groups (SMD: 0.77;95%CI: -0.33-1.86;p=0.17). CONCLUSION(S): Prone ventilation in intubated COVID-19 patients does not offer a mortality benefit. Randomized controlled trials are warranted to confirm this finding and clarify whether specific subpopulations may benefit from prone ventilation.
ABSTRACT
Medicinal plants have many applications due to their efficiency, have lower side effects and their content of phytochemicals compounds that are efficient in the treatment of many diseases such as viral diseases respiratory system. In the last decades, traditional medicine uses medicinal plants in the treatment of viral diseases especially in treatment of respiratory viruses, including (Human Respiratory Syncytial Virus (RSV), Human Parainfluenza Viruses (HPIV), Human Metapneumovirus (HMPV), Rhinovirus (HRV), Respiratory Adenoviruses (HadV), Human Coronaviruses Unrelated to SARS (CoV), SARS Coronavirus (SARS-CoV), and Human Bocavirus (HBoV)). Treatment of these diseases via using efficient medicinal plants leads to prevent or decrease infections, this occurs via various mechanisms. Most of these mechanisms exert an antiviral effect through inhibiting the transcription of respiratory viruses. In this review article, we focus on the role of twenty-one medicinal plants in treatment of respiratory viruses due to importance of this subject in the last decades in treatment of various diseases. ©2021 National Information and Documentation Center (NIDOC).
ABSTRACT
Background: medical thoracoscopy (MT) is the gold standard diagnostic test for undiagnosed exudative pleural. The definitive diagnosis of malignancy is possible on pleural fluid only in about 35% of times, and the microbiological yield of TB on pleural fluid is notoriously low. This study aimed to assess the effect of a 'straight to MT' approach on the time from presentation to definitive diagnostic test and the number of unnecessary thoracoscopies done using this approach. Methods: patients presenting with a new pleural effusion with low suspicion pleural infection or a non-pulmonary etiology (e.g. a disease known to cause pleural effusion) were offered a diagnostic aspiration to confirm the effusion was a lymphocytic exudate followed by an MT on the next day. For patients referred with a CT showing obvious pleural malignancy, results of fluid biochemical analysis were not awaited. In patients with gross appearance of pleural malignancy during thoracoscopy and a large pleural effusion at presentation, thoracoscopic pleurodesis was done. A control group of patients with undiagnosed pleural effusion and negative cytology referred to the unit for MT was used. In all patients, chest tube removal and discharge following MT was done on the same day if pleurodesis was not carried out and the patient was stable. Results: Between August and November 2020, 25 patients underwent MT;10 of whom through the straight to MT approach (group 1) and 15 through standard approach (group 2). In group 1, the median (range) time between presentation and procedure was 1 (0-2) days. The etiology was malignancy in 5/10, TB in 4/10 TB and non-specific pleuritis in 1/10. In 1/10 the pleural fluid results were conclusive (metastatic lung cancer), but this patient also underwent pleurodesis during MT. In group 2, the median time from presentation to MT was 12 (7-30) days (p<0.001). The etiology was malignancy in 10/15, non-specific pleuritis in 4/15 and TB in 1/15. None of the 25 patients experienced serious complications at or immediately after thoracoscopy and the median time (range) to discharge was 1 (0-4) days. Conclusion: A straight to MT approach reduces the waiting time to diagnosis, with a small risk of 'over-investigating'. This approach is particularly helpful in the time of COVID to keep the number of encounters with hospital staff a minimum especially with the capacity to combine diagnostic and therapeutic modalities (i.e. pleurodesis) in the same procedure.