Effect of Aviptadil, a Novel Therapy, on Clinical Outcomes of Patients with Viral-related Severe ARDS: A Retrospective Observational Study.

Background: Dealing with life-threatening viral acute respiratory distress syndrome (ARDS) has always been challenging and with the recent COVID pandemic experience, there is still the need of newer therapies to alleviate mortality. Aviptadil, has shown significant beneficial results in covid. We share our experience with this molecule by doing a retrospective study to evaluate the effect of this drug on clinical outcomes in viral-related Ards patients. Materials and methods: In this study, all patients with severe viral-related Ards received Aviptadil along with the conventional treatment. The oxygen saturation, SpO2/FiO2 (ratio of pulse oximetric saturation to fractional inspired oxygen) (S/F) ratio and PaO2/FiO2 (ratio of arterial oxygen partial pressure to fractional inspired oxygen) (p/f) ratio, before and after completion of the drug were studied. Radiological clearance and time for complete recovery from respiratory failure was noted. All variables pre- and postadministration of the drug were compared. Results: A total of 68 patients with viral pneumonias were admitted to intensive care unit (Icu) and only 6 patients had severe Ards, who received Aviptadil. The mean oxygen saturation significantly improved from 87.86% before the first Aviptadil dose to 93.43% post 3 days of infusion. Similarly, improvement was seen in PaO2 values from 54.32 to 68.4 posttherapy (p-value < 0.004). SpO2/FiO2 (ratio of pulse oximetric saturation to fractional inspired oxygen) ratio hiked from 149 to 336 at the end of the 3 days infusion (p-value < 0.003). RALE scoring system was used for radiological clearance and the mean change in the score was from 6.42 to 2.5 (p-value 0.00). The average length of stay in the Icu was 12.14 days. No adverse effects were noted. Conclusion: Aviptadil has shown to improve the clinical outcomes in patients with severe viral-related ards without any adverse effects. How to cite this article: Sampley S, Bhasin D, Sekhri K, Singh H, Gupta O. Effect of Aviptadil, a Novel Therapy, on Clinical Outcomes of Patients with Viral-related Severe ARDS: A Retrospective Observational Study. Indian J Crit Care Med 2024;28(1):70-74.

Public knowledge, use and attitude toward multivitamin supplementation: A cross-sectional study among general public.

BACKGROUND AND OBJECTIVE: The use of supplements has increased substantially in the past few decades. The present study is an effort to explore pattern of use, knowledge and attitude toward consumption of multivitamin supplements among the general public. MATERIALS AND METHODS: A descriptive cross-sectional study on 120 adult participants from the general public was conducted. The participants were interviewed and information was collected in a predesigned structured questionnaire. The data was analyzed and expressed as counts and percentages. RESULTS: Of the 120 study participants, 66 were males and 54 were females. Results revealed that 68.33% (82) of the participants were users of multivitamin supplements. Out of the users, 69.5% (57) participants consumed on the advice of doctors, 18.2% (15) were self-prescribers while 12.1% (10) relied on advice of family or friends. Among the users, 70.96% considered such supplements to be helpful. Reasons quoted for self-medication use of multivitamins were multiple such as maintenance of general health (55%), to allay weakness or fatigue (20%), to improve appetite (15%) etc. Majority of the participants were unaware regarding the correct indications for multivitamin supplementation. Regarding knowledge about the natural sources of these vitamins, as many as 76% showed ignorance. CONCLUSION: Finding from this study suggests that multivitamin use is highly prevalent and the majority of the participants were ignorant of any possible harm or drug interactions. In light of this, there is a need to adopt certain educational interventions to minimize self-directed supplement use and increase awareness regarding their correct usage.

Parenteral polymyxins: assessing efficacy and safety in critically ill patients with renal dysfunction.

OBJECTIVES: Studies have established the effectiveness and safety of polymyxins in treating multidrug resistant (MDR) pathogens. However, the challenge is whether these nephrotoxic drugs can be administered in compromised renal states. The present study was undertaken to establish their role in such patients. The effectiveness and nephrotoxicity of polymyxins in critically ill-patients harboring MDR Gram-negative bacteria with already compromised renal functions was compared with those with normal renal functions. MATERIALS AND METHODS: This retrospective cohort study (March 2008-March 2010) was conducted in the intensive care unit of a tertiary care hospital. A total of 48 eligible critically ill-patients receiving polymyxins were enrolled. A comparison was carried out (length of stay in hospital, mortality, renal function) between patients with acute kidney injury (AKI, n = 18; defined by the RIFLE classification) and patients with normal renal function (non-AKI, n = 30). RESULTS: Patients with baseline AKI had a significantly higher adjusted mortality rate at admission when compared with the non-AKI group. At the end of therapy with polymyxins, 26.66% non-AKI patients developed renal dysfunction while 38.88% of patients in the AKI group had worsening of renal function (P = 0.006). However, there was no significant difference in the length of hospital stay (23.9 ± 13.24 vs. 30.5 ± 22.50; P = 0.406) and overall mortality (44.4% vs. 36.7%; P = 0.76) between two groups. CONCLUSION: Polymyxins can be administered in AKI patients with favorable results provided used judiciously with strict monitoring of renal functions, dose modification according to creatinine clearance and aggressive fluid management.

To study the clinical efficacy and nephrotoxicity along with the risk factors for acute kidney injury associated with parenteral polymyxin B.

AIM: The aim of this study was to evaluate the clinical efficacy and nephrotoxicity along with the risk factors for acute kidney injury (AKI) associated with the parenteral polymyxin B in patients with the multidrug resistance (MDR) gram -ve infections in a tertiary Intensive care unit (ICU). MATERIALS AND METHODS: A retrospective cohort study (March 2010-October 2011) was conducted in Medical ICU of a 23 bedded tertiary care hospital in Northern India. RESULTS: Out of 71 ICU patients who were administered polymyxin B, only 32 (M:F = 1:0.8) met the inclusion criteria. Patients with concurrent administration of nephrotoxic drugs were excluded from the study. Mean age of patients was 48.53 ± 13.90 years ranging from 16 years to 68 years. 6 out of 32 (18.7%) patients progressed to AKI, whereas renal functions remained normal in 26 (81.2%) patients. No statistically significant difference was observed in mortality between AKI and non AKI patients at the end of therapy (33.3% vs. 26.9%, P value 0.756). Older age (62.33 ± 11.90 vs. 45.34 ± 2.45, P value 0.005) was found to be an independent risk factor for causing nephrotoxicity. CONCLUSION: In the present scenario of rising infections with MDR gram -ve micro-organisms, this pilot study suggests that polymyxin B can be used effectively and safely in patients not receiving other nephrotoxic drugs, with cautious administration in older patients as they are more vulnerable to nephrotoxicity caused by polymyxin B.

Colesevelam hydrochloride: A novel agent in patients with type 2 diabetes.

Hyperglycemia and hyperlipidemia are both risk factors for the development of various complications in patients with type 2 diabetes mellitus. Colesevelam hydrochloride is a novel agent that can improve both hypercholesterolemia and hyperglycemia in such patients. It is an orally administered bile acid sequestrant with high capacity for binding bile acids. This drug can offer potential new diabetes treatment along with other drugs.

Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy.

Iron deficiency with its resultant anemia is probably the most widespread micronutrient deficiency in the world. Women who are pregnant or lactating and young children are the most affected, especially in the developing world. Despite that only 1 to 3 mg of absorbed iron is required daily at different stages of life, most diets remain deficient. Failure to include iron-rich foods in the diet and inappropriate dietary intake coupled with wide variation in bioavailability (based on the presence of iron absorption inhibitors in the diet) are some of the important factors responsible for iron deficiency. Iron supplementation can be targeted to high-risk groups (eg, pregnant women) and can be cost-effective. Iron fortification of food can prevent iron deficiency in at-risk populations. Selective plant breeding and genetic engineering are promising new approaches to improve dietary iron nutrition quality.