Effect of High-Dose Thiamine Injection on Shock Reversal in Septic Patients

INTRODUCTION: Thiamine (TH) is a co-factor for pyruvate dehydrogenase, an enzyme necessary for pyruvate entry into the Krebs cycle, and without this enzyme, pyruvate would be converted to lactate. Elevated lactate, which is often used as a marker of perfusion, is proportionally associated with increased mortality in septic shock. The few publications on TH in septic shock are inconclusive. This study aims to ascertain if there is benefit to adding TH to standard of care (SOC) in the management of septic shock. METHOD(S): IRB-approved, multicenter, retrospective review from 2016 to 2021. Adult patients admitted to the ICU for septic shock and receiving >= 400 mg a day of IV TH (in divided doses) were included. Patients < 18, pregnant, admitted for SARS-COV-2, or whom received < 400 mg of TH daily were excluded. Two matched cohorts were evaluated, SOC plus TH versus SOC alone. The primary endpoint is time to shock reversal, defined as off vasopressors for at least 12 hrs and alive. Secondary endpoints include time to lactate clearance (< 2 mmol/L), lactate trends at 6, 12, 24, 48 hrs, and end of therapy, hospital and ICU lengths of stay, new end organ dysfunction, and in-hospital mortality. RESULT(S): Data from 50 patients were analyzed: 25 in the SOC plus TH and 25 in the SOC arm. The TH arm had greater number of vasopressors (2 vs. 1, p=.019), and greater utilization of stress-dose steroids (72% vs. 8%, p<.001), however there was no difference in cumulative vasopressor dose in norepinephrine equivalents at baseline (BL) (30.1 vs. 25.8 mcg/min, p=.248). There was no difference in SOFA score at ICU admission (10 vs. 8.5, p=.106) or lactate level at ICU admission (5.9 vs. 3.9 mmol/L, p=.055). There was a longer time to shock reversal from vasopressor initiation time in the TH arm (93 vs. 37.1 hrs, p=.023). Lactate clearance was slower in the TH arm (44.75 vs. 15.8 hrs, p=.027), and there was increased in-hospital mortality in the TH arm (13 vs. 5, p=.018). CONCLUSION(S): Compared to SOC alone, TH treated patients had longer times to shock reversal. However, this outcome may have been confounded by differences at BL with regard to number of vasopressors, and stress-dose steroid utilization, which indicate these patients were sicker at BL. Larger, prospective studies are required to confirm these findings.

Vaccine knowledge, attitudes, and practices among New York State healthcare providers

Background. Vaccine attitudes of healthcare providers (HCPs) influence patient vaccine acceptance. We sought to characterize vaccine knowledge, attitudes, and practices (KAP) among HCPs in NYS. Methods. An electronic survey was developed to assess vaccine KAP among HCPs. The questionnaires were sent to members of various national medical organizations via local chapter administrators. Results. 864 surveys were returned from 672 (78%) physicians and 192 (22%) mid-level practitioners (MLPs). 624/724 (86%) of HCPs report always recommending routine vaccines to eligible patients, yet only 76% recommend influenza vaccine (IV) and 77% strongly recommend HPV vaccine at 11-12 yrs. MLPs had a higher mean agreement level that recommending vaccines (4.6 vs 4.2 p < 0.01) or promoting HPV vaccine (4.2 vs. 3.9 p < 0.05) is within their scope of practice. Physicians had a higher mean agreement level that: vaccine benefits outweigh risks (4.9 vs 4.6 p < 0.01), HPV vaccine prevents cancer (4.7 vs 4.5 p < 0.01), and COVID-19 vaccine is safe (4.8 vs 4.5 p < 0.01) and effective (4.8 vs 4.7 p < 0.01). 82% (680/825) of HCPs knew that vaccines should not be deferred for mild illness. 14/836 (2%) believed that HPV vaccine could increase sexual activity, while 273/705 (39%) knew that the most common HPV associated malignancy is oropharyngeal cancer. HCPs who correctly answered >= 5/7 questions (462/507 91%) were more likely to recommend all vaccines to eligible patients than HCPs with lower scores (22/40 50% p < 0.05). Routine IV recommendation was more likely among HCPs who: strongly disagree that influenza is not serious enough for vaccination (292/397 (74%) vs 137/249 (55%) p < 0.01), strongly agree that it prevents severe disease (267/352 (76%) vs 162/294 (55%) p < 0.01), and receive annual IV (423/629 (67%) vs 6/17 (35%)) p < 0.01). HPV vaccine recommendation at 11-12 years was more likely among HCPs who strongly agree that the vaccine prevents cancer (273/326 (84%) vs 48/86, 56% p < 0.01) and those who stated that vaccination does not increase risk of unprotected sex (316/392 (79%) vs 3/12 (25%) p < 0.01). Conclusion. Vaccine recommendation practices are influenced by HCP vaccine misperceptions and hesitancy. Interventions to reduce misperceptions and improve vaccine confidence are needed.

Obesity risk throughout collective quarantine for the COVID-19

The novel coronavirus outbreak (COVID-19) presented an opportunity to conduct an online survey to research the relationships between changes in body weight, physical activity and lifestyle during an unprecedented occurrence of forced isolation or quarantine among the population of Jadara University. We distributed an electronic questionnaire (cross-sectional) in Jadara University, Jordan, between March and May 2020, where a total of 200 students were approached (43.8% males and 56.2% females). Of 200 questionnaires returned, during the period of semi-lockdown, both females and males increased body weight significantly (p<0.05). Changes in body weight are inversely correlated with changes in the number of meals and increased stress during the quarantine. Quarantine carries some long-term effects on the rate of food intake and sleeping also affects the total body weight. With the prolonged quarantine, these figures are subject to increase consequently and the drawback on health status may drop to a considerably large percentage in the community. Copyright © 2022 The Authors. Romanian Journal of Diabetes, Nutrition and Metabolic Diseases published by Sanatatea Press Group on behalf of the Romanian Society of Diabetes Nutrition and Metabolic Diseases.

Preferences of Students for Online Education on Pramuka Island Thousand Island DKI Jakarta during the COVID-19 Pandemic

The implementation of Online Learning to date has made students accustomed to using technology in the learning process which will also change the habit of using student preferences in the learning process in choosing non-print information sources because of the ease of access. The thing that is very important at this time during the Covid-19 pandemic and the learning process at home is that the most accessible source of information is via the internet or non-print, so that it is very possible for students' preferences for information sources to change from print to non-print will increase, sources of information Online is the main source of information used amidst social and physical restrictions during the Covid-19 pandemic. This study focuses on the e-learning platform that is implemented in area of the Thousand Islands DKI Jakarta using a theoretical framework to evaluate e-learning performance. The method used is factor analysis used to find factors that built the success of implementation and regression analysis to build an e-learning evaluation model. The results obtained indicate that there are a number of main factors, namely intelligent content, content development, content governance, content innovation which can then be used to build mathematical models that describe the current system performance and predictions in the future, and can be used to build a system development plan in the future with the value is 7.540 (from a scale of 0.000 - 10.000) © 2022 IEEE.