Association between dietary antioxidant quality score and severity of coronavirus infection: a case-control study.

The purpose of this study was to examine the association between the dietary antioxidant quality score (DAQS) and the severity of Coronavirus disease 2019 (COVID-19). The present case-control study was carried out on 295 patients diagnosed with COVID-19 (≥18 years old), including 104 critical patients (Intensive care unit [ICU] admission) and 191 COVID-19 patients without severe complications (Non-intensive care unit [Non-ICU] patients) as cases. Dietary intake was assessed by a 147-item, semi-quantitative food frequency questionnaire (FFQ). Logistic regression was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) for the considered risk factors. Our outcomes (after multivariate adjustment) suggested that higher adherence to DAQS was significantly associated with a decreased risk of COVID-19 infection severity (OR = 0.12; 95% CI: 0.04-0.29, p < 0.001). Similar results were seen when analyzed by sex [men (OR = 0.02; 95% CI: 0.002-0.15, p < 0.001) and women (OR = 0.21; 95% CI: 0.06-0.68, p = 0.012)]. A significant association between vitamin D3 intake and decreased risk of COVID-19 severity (OR = 0.91; 95% CI: 0.89-0.94, p < 0.001) was also observed. Moreover, multivariate results revealed that there were no significant associations between vitamin C (OR = 1.00; 95% CI: 0.99-1.00, p = 0.067), vitamin E (OR = 0.98; 95% CI: 0.86-1.11, p = 0.798), zinc (OR = 1.02; 95% CI: 0.86-1.20, p = 0.805), and selenium (OR = 0.99; 95% CI: 0.99-1.00, p = 0.077) intakes with the risk of COVID-19 severity. However, subgroup analyses by sex suggested a significant association between vitamin C intake and the risk of COVID-19 infection severity in women (OR = 1.00; 95% CI: 1.00-1.00, p = 0.028). Our findings showed a negative association between DAQS adherence and the risk of COVID-19 infection severity. Our results may be used to develop potential dietary therapies to decrease COVID-19 severity.

Effect of tofacitinib on clinical and laboratory findings in severe and resistant patients with COVID-19.

BACKGROUND: The efficacy and safety of a strong Janus kinase inhibitor, tofacitinib, in individuals suffering from severe coronavirus disease 2019 (Covid-19) pneumonia are not definite well. METHODS: In this non-randomized and non-blinded trial, a total of 52 Iranian patients with severe COVID-19 associated with decreased oxygen saturation, elevated C-reactive protein, and/or persistent fever were included. A total of 52 patients were included in this study. Tofacitinib was administered to 29 patients (55.8%) in addition to the standard care treatments, whereas 23 patients (44.2%) were treated with the standard of care alone (mostly antiviral agents and corticosteroids). Tofacitinib was administered at a dose of 5 mg twice daily for up to 10 days. The primary outcomes were mortality rate, oxygen saturation level, CT findings, rate of breath, heart rate, and level of consciousness. Inflammatory cytokines and blood biomarkers were considered as the secondary outcomes. RESULTS: Death from any cause through day 14 occurred in 51.7% of the tofacitinib group and 65.2% of the control group. There was no significant difference in lung radiographic findings between the intervention and control groups at the first day of the study and after the study period. However, a significant decrease was observed in the extent of lung tissue involvement in the intervention group after administration of tofacitinib. Regarding cell and blood biomarkers, a significant decrease in the CPK levels in the intervention group and Hct and ACE levels in the control group was observed after fourteen days of the study. Moreover, a significant increase in SGOT and ferritin values was detected in the control group 14 days after the beginning tofacitinib administration. Comparing control and intervention groups, there was a significant difference in hemoglobin, SGOT, LDH, ferritin, and ACE values between groups before the intervention, while after fourteen days of the study, no significant difference was found. In case of DHEAS and TSH levels, a significant decrease was seen in the intervention group compared to the control after the study period. No other significant improvement was detected in other outcomes of the tofacitinib group compared to the control. CONCLUSIONS: The administration of tofacitinib combined with corticosteroids, is not effective enough to treat severe COVID-19 patients and the use of this medication should be considered before the disease deterioration.

Variable Levels of Oxytocin During Sepsis: The Role of Oxytocin in Sepsis Pathophysiology.

BACKGROUND: Although the role of oxytocin in the pathophysiology of sepsis is still unknown, rising preclinical evidence suggests that oxytocin is possibly involved. However, no direct clinical studies have measured the levels of oxytocin during sepsis. In this preliminary study, the serum oxytocin levels were evaluated throughout the duration of sepsis. METHOD: Twenty-two male patients over 18 years of age with a SOFA score of 2 points or more who were admitted to the ICU were included. Patients with a history of neuroendocrine, psychiatric, and neurologic disorders, cancer, an infection caused by COVID-19, shock due to reasons other than sepsis, a history of psychiatric or neurologic medication use, and those who died during the study were excluded. The main endpoint included the measurement of serum oxytocin levels using radioimmunoassay at 6, 24, and 48 h of the ICU admission. RESULTS: Mean serum oxytocin level was higher at 6 h of ICU admission (41.27 ± 13.14 ng/L) than after 24 and 48 h of ICU admission (22.63 ± 5.75 and 20.97 ± 7.61 ng/L respectively) (P-value < .001). CONCLUSION: Our study, while reporting increased serum oxytocin levels in the initial phase of sepsis and decline afterward, supports the possible contribution of oxytocin in the pathophysiology of sepsis. Given that oxytocin seems to modulate the innate immune system, future investigations are necessary to assess the potential role of oxytocin in the pathophysiology of sepsis.

Infliximab and Intravenous Gammaglobulin in Hospitalized Severe COVID-19 Patients in Intensive Care Unit.

BACKGROUND: Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU). METHODS: In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11). RESULTS: There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; (P = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all P < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, P = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, P = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, P = 0.071). CONCLUSION: According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.

Serum level of Vitamin D is associated with COVID-19 mortality rate in hospitalized patients.

BACKGROUND: Due to widespread of coronavirus disease 2019 (COVID-19) infection, identification of its risk factors and clinical characteristics are important. The aim of the present study was to assess Vitamin D levels in individuals with severe acute respiratory syndrome coronavirus-19 infection and to report on its potential as a predictive marker. MATERIALS AND METHODS: All patients, diagnosed with COVID-19 infection from February 16 to March 21, 2020, and referred to Firoozgar Hospital, Tehran, Iran, were enrolled in this study. Vitamin D analysis was undertaken on patient serum samples using a commercial kit (Pars Azmoon Co., Tehran, Iran). SPSS v. 22 was used for statistical analysis. RESULTS: Vitamin D serum concentration was analyzed in a total of 317 patients whose mean age ± standard deviation was 62.05 ± 15 years and with 62.5% being male. A significant association of Vitamin D level and death was observed. Higher levels of serum Vitamin D had protection against death (odds ratio = 0.955 [95% confidence interval = 0.923-0.988], P = 0.008). CONCLUSION: As a preliminary study in the Iranian population who suffered COVID-19 disease, we identified that Vitamin D deficiency was associated with a higher death rate and intensive care unit admission.

Intraocular Pressure and Corneal Biomechanical Changes after Water-Drinking Test in Glaucoma Patients.

PURPOSE: To evaluate intraocular pressure (IOP) and corneal biomechanical changes after water-drinking test (WDT) in glaucomatous and normal eyes using Ocular Response Analyzer (ORA). METHODS: This prospective study included 30 medically controlled, 30 surgically treated glaucoma patients and 30 normal individuals. Baseline measurements included central corneal thickness (CCT), ORA-derived corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg). Measurements were repeated 15, 30, and 60 min after drinking 1000 mL of water. Changes in ORA parameters were compared among the groups. RESULTS: All groups showed a significant increase in IOPg and IOPcc at all test points. Peak IOP occurred at 15 min and decreased gradually over time but did not reach the baseline values at 60 min. The surgery group had significantly lower baseline IOPg and IOPcc (10.7 ± 3.1 and 12.8 ± 3.7 mmHg, P = 0.001 and 0.01), lower peak IOPg and IOPcc (14.4 ± 4.6 and 16.2 ± 4.6 mmHg, P = 0.003 and 0.034), and lower percent IOPg and IOPcc fluctuations (13 ± 5.6 and 15 ± 5.9, P = 0.0001 and 0.002), respectively, compared to the medical group. Baseline CH and its fluctuations were not significantly different among the groups. CH decreased to a trough corresponding to peak IOPcc. There was a significant negative correlation between IOPcc and CH (r = -0.609, P < 0.001). The medical group showed more CRF fluctuations compared to normal group.(P = 0.039). CONCLUSION: Surgically treated glaucomatous eyes show less IOP fluctuations and lower peak IOP after WDT compared to medically controlled and normal eyes.

Recruitment bronchoscopy by trans-glottic approach successfully treated lung collapse in an intubated mechanically ventilated patient.

Pulmonary lower lobe atelectasis/collapse is a common problem in patients undergoing mechanical ventilation. It also occurs in non-intubated patients with traumatic brain or spinal cord injuries, morbid obesities and chest wall disorders. Conventional manoeuvres such as chest physiotherapy, bronchodilators and positive-end expiratory pressure (PEEP) administration are frequently used in its management with variable success rates. However, despite the reported success of bronchoscopic recruitment manoeuvres, selective intrabronchial air insufflation during fiberoptic bronchoscopy to re-expand collapsed lungs is an underutilised practice. Here, we report an example of successful selective intrabronchial air insufflation in an intubated patient with bilateral lower lobe collapses after surgery for an incarcerated hernia. To our knowledge, this is the first successful report of recruitment manoeuvre by trans-glottic bronchoscopy in an intubated, mechanically ventilated patient.

Thermal Solid Sample Introduction-Fast Gas Chromatography-Low Flow Ion Mobility Spectrometry as a field screening detection system.

The potential of Thermal Solid Sample Introduction (TSSI)-Fast Gas Chromatography (GC)-Low Flow Ion Mobility Spectrometry (LF-IMS) having been designed and constructed in Engineering Research Center of Esfahan, detector group was investigated for chemical detection capabilities. Customizing the configuration of fast GC-IMS as a high technology, provides unique solutions for rapid detection of a broad range of chemical mixtures in many operational environments. TSSI configuration provides fast and easily applied method for direct detection with no additional sample preparation or extraction. The time required for total analysis, less than 265 s, was determined by the wide range of solid matrixes, including nitrate esters, nitroaromatics, and a nitramine. The fast extraction together with the short separation time limits degradation of the thermally labile compounds and decreases the peak widths, which results in larger peak intensities and a simultaneous improvement in detection limits. For signal-to-noise ratio equals to 5, the detection limits for instrument for TNT, DNT and RDX were attained 15, 10 and 50 ng/µl respectively. The combination of short analysis time and low detection limits make this instrument a potential candidate for field screening techniques.