Lessening Organ dysfunction with VITamin C (LOVIT): protocol for a randomized controlled trial.

BACKGROUND: Sepsis is a health problem of global importance; treatments focus on controlling infection and supporting failing organs. Recent clinical research suggests that intravenous vitamin C may decrease mortality in sepsis. We have designed a randomized controlled trial (RCT) to ascertain the effect of vitamin C on the composite endpoint of death or persistent organ dysfunction at 28 days in patients with sepsis. METHODS: LOVIT (Lessening Organ dysfunction with VITamin C) is a multicenter, parallel-group, blinded (participants, clinicians, study personnel, Steering Committee members, data analysts), superiority RCT (minimum n = 800). Eligible patients have sepsis as the diagnosis for admission to the intensive care unit (ICU) and are receiving vasopressors. Those admitted to the ICU for more than 24 h are excluded. Eligible patients are randomized to high-dose intravenous vitamin C (50 mg/kg every 6 h for 96 h) or placebo. The primary outcome is a composite of death or persistent organ dysfunction (need for vasopressors, invasive mechanical ventilation, or new and persisting renal replacement therapy) at day 28. Secondary outcomes include persistent organ dysfunction-free days to day 28, mortality and health-related quality of life at 6 months, biomarkers of dysoxia, inflammation, infection, endothelial function, and adverse effects (hemolysis, acute kidney injury, and hypoglycemia). Six subgroup analyses are planned. DISCUSSION: This RCT will provide evidence of the effect of high-dose intravenous vitamin C on patient-important outcomes in patients with sepsis. TRIAL REGISTRATION: clinicaltrials.gov, NCT03680274, first posted 21 September 2018.

Myocardial Infarction as a Complication of Bronchial Artery Embolization.

Bronchial artery embolization is now a common treatment for massive pulmonary hemoptysis if flexible bronchoscopy at the bedside failed to control the bleeding. Complications of this technique range from benign chest pain to devastating neurological impairments. We report the case of a 41-year-old man who developed an ST elevation myocardial infarction during bronchial artery embolization, presumably because of coronary embolism by injected particles. In this patient who had no previously known coronary artery disease, we retrospectively found a communication between the left bronchial artery and the circumflex coronary artery. This fistula was not visible on the initial angiographic view and likely opened because of the hemodynamic changes resulting from the embolization. This case advocates for careful search for bronchial-to-coronary arterial fistulas and the need for repeated angiographic views during embolization procedures.

[An exploratory study of the point of view of women and men on the services used concerning conjugal violence]. / Etude exploratoire du point de vue des femmes et des hommes sur les services utilisés en matière de violence conjugale

Long considered a private matter, domestic violence is now viewed as a widespread social problem. Its harmful consequences on women, couples, children as well as society are now better known by the various networks of professionals summoned to work together in order to develop approaches that are more complementary and that are based on a common understanding of the problem. An analysis has been undertaken of intersectorial consultation mechanisms current in Québec with professionals involved in services concerning domestic violence in various sectors of the health and social services network. The current study-the first to analyse from a qualitative perspective the discourse of women who have been victims of domestic violence and men who have adopted violent behaviours toward their partner - has allowed to explore the perception of interventions received, their coherence, their complementarity and their impact on cessation of violence as well as the individual's progress. The results show among other things, that participants of the study, men but especially women consult an important number of professionals from a wide range of resources. However, the weight of steps taken does not come as much from the number of organizations or the path through each of these organizations, but rather from the lack of intra/inter/sectorial coordination between professionals within these agencies.