RESUMO
The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in mechanically ventilated patients with the coronavirus disease (COVID-19) has not been well-defined. This randomized controlled trial included 175 eligible adult patients with COVID-19 who were treated with mechanical ventilation at the University Hospital of Split between October 2020 and June 2021. Patients were randomized and allocated to a control group (no routine inhalation) or one of the treatment arms (inhalation of N-acetylcysteine; 5% saline solution; or 8.4% sodium bicarbonate). The primary outcome was the incidence of VAP, while secondary outcomes included all-cause mortality. Routine inhalation therapy had no effect on the incidence of bacterial or fungal VAP nor on all-cause mortality (p > 0.05). Secondary analyses revealed a significant reduction of Gram-positive and methicillin-resistant Staphylococcus aureus (MRSA) VAP in the treatment groups. Specifically, the bicarbonate group had a statistically significantly lower incidence of Gram-positive bacterial VAP (4.8%), followed by the N-acetylcysteine group (10.3%), 5% saline group (19.0%), and control group (34.6%; p = 0.001). This difference was driven by a lower incidence of MRSA VAP in the bicarbonate group (2.4%), followed by the N-acetylcysteine group (7.7%), 5% saline group (14.3%), and control group (34.6%; p < 0.001). Longer duration of ventilator therapy was the only significant, independent predictor of any bacterial or fungal VAP in the multivariate analysis (aOR 1.14, 95% CI 1.01−1.29, p = 0.038 and aOR 1.05, 95% CI 1.01−1.10, p = 0.028, respectively). In conclusion, inhalation therapy had no effect on the overall VAP incidence or all-cause mortality. Further studies should explore the secondary findings of this study such as the reduction of Gram-positive or MRSA-caused VAP in treated patients.
RESUMO
BACKGROUND: Knowledge of oral health is a fundamental prerequisite for healthy behavior, allowing individuals to take measures to protect their overall health. This cross-sectional study aimed to examine the knowledge of oral health as well as to assess the oral hygiene habits among healthcare and non-healthcare students. METHODS: The study was based on a questionnaire and was conducted among 1088 students. Most of the students, 67.6% were non-healthcare students. Data were processed by Mann-Whitney or Kruskal-Wallis one-way ANOVA test. RESULTS: The correct median score and interquartile range were 11 (9-13) for all surveyed students, 11 (9-12) for students in non-healthcare programs and 13 (11-14) for students in healthcare programs. Students did not significantly differ in the knowledge of oral health by gender (p = 0.082) but did differ by age, study program, and year of study (p ≤ 0.001). Students whose family members work in the field of dental medicine also showed better oral health knowledge (p ≤ 0.001). CONCLUSION: The results showed good oral health knowledge among tested university students. However, it is important to emphasize that students who showed better knowledge more often used additional aids to maintain oral hygiene; therefore, the obtained data underline the importance of students' further education in order to better understand and maintain oral health.
