Impact of vitamin C supplementation on post-cardiac surgery ICU and hospital length of stay

Background: Prolonged intensive care unit (ICU) and hospital stay after cardiac surgery is vitally important and is influenced by both intraoperative and postoperative factors.Objectives: This randomized clinical trial study was designed to assess whether vitamin C supplementation could reduce the length of ICU and hospital stay in post-cardiac surgery patients.Patients and Methods: Two hundred and ninety patients scheduled for adult cardiac surgery including coronary, valve and congenital operations were randomized into two groups: an intervention group, who received 2 g of vitamin C (ascorbic acid) intravenously, immediately before surgery in the operating theatre, followed by 1 g daily oral doses for the first 4 postoperative days; and a placebo group,who received an equal number of identical tablets in the same shape and size. Results: Hospital length of stay was significantly different between the two groups (10.17 ± 4.63 days in the intervention group vs. 12 ± 4.51 days in the placebo group; P = 0.01), while there was no significant difference in the ICU stay between the groups (3.42 ± 1.06 days in intervention group vs. 3.43 ± 1.09 days in the placebo group; P = 0.88). There were significant differences in the intubation time and the drainage volume in the ICU and the first 24 postoperative hours between the two groups (P for both = 0.003). Conclusions: Vitamin C can decrease the length of hospital stay, drainage volume in the ICU and in the first 24 postoperative hours, intubation time and some complications in patients after cardiac surgery; perhaps by decreasing inflammatory factors. Background: Prolonged intensive care unit (ICU) and hospital stay after cardiac surgery is vitally important and is influenced by both intraoperative and postoperative factors.Objectives: This randomized clinical trial study was designed to assess whether vitamin C supplementation could reduce the length of ICU and hospital stay in post-cardiac surgery patients.Patients and Methods: Two hundred and ninety patients scheduled for adult cardiac surgery including coronary, valve and congenital operations were randomized into two groups: an intervention group, who received 2 g of vitamin C (ascorbic acid) intravenously, immediately before surgery in the operating theatre, followed by 1 g daily oral doses for the first 4 postoperative days; and a placebo group,who received an equal number of identical tablets in the same shape and size. Results: Hospital length of stay was significantly different between the two groups (10.17 ± 4.63 days in the intervention group vs. 12 ± 4.51 days in the placebo group; P = 0.01), while there was no significant difference in the ICU stay between the groups (3.42 ± 1.06 days in intervention group vs. 3.43 ± 1.09 days in the placebo group; P = 0.88). There were significant differences in the intubation time and the drainage volume in the ICU and the first 24 postoperative hours between the two groups (P for both = 0.003). Conclusions: Vitamin C can decrease the length of hospital stay, drainage volume in the ICU and in the first 24 postoperative hours, intubation time and some complications in patients after cardiac surgery; perhaps by decreasing inflammatory factors. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Dietary total antioxidant capacity and its association with renal function and kidney stones: Results of a RaNCD cohort study

There is evidence to support the hypothesis that dietary antioxidants have shown protective effects against chronic kidney disease (CKD). The purpose of this study was to determine the association between the dietary total antioxidant capacity (DTAC), renal function, and development of CKD and kidney stones in Ravansar Non-Communicable Diseases (RaNCD) cohort study, Kermanshah, Iran. This cross-sectional study was conducted using the recruitment baseline data of the RaNCD cohort study on 9,777 individuals aged 35-65 years. Food frequency questionnaire (FFQ) was performed to assess diet. DTAC scores were calculated using the ferric reducing antioxidant power (FRAP) of selected foods. Renal function was assessed by the estimated glomerular filtration rate (eGFR), blood urea nitrogen, and serum creatinine concentration. Prevalent CKD was based on an eGFR less than <60 ml/min per 1.73 m(2). Incidence of kidney stones was also assessed by self-reporting. Out of 9,777 participants, 1,747 subjects (eGFR: 18.50 ml/min per 1.73 m(2); 95 confidence interval (CI): 17.72-19.30) had CKD. The mean DTAC score in this study was 0.24 +/- 0.16 mu mol TE/100 g (micromole of Trolox Equivalents). We showed a significant trend for eGFR across quartiles of DTAC, i.e., participants in the fourth quartile had a higher glomerular filtration rate (GFR) than those in the first one (DTAC (Q4 vs Q1) = 82.20 versus 72.20 ml/min per 1.73 m(2), p < .001). Another finding is that high DTAC scores were not associated with having kidney stones after adjusting for confounders. We revealed that higher DTAC scores have positive effects on the renal function. Interestingly, our findings showed that a high DTAC score had nonsignificant correlation with odds of kidney stones

COLORECTAL CANCER IN IRAN: EPIDEMIOLOGY AND MORPHOLOGY TRENDS

Colorectal cancer is one of the most prevalent cancers in different countries, including Iran. No comprehensive study has been done in the country for colorectal cancer, but information on the incidence and trends is essential to planning. This study aimed to evaluate the occurrence and morphology of colorectal cancer and its trend in Iran. This study was conducted using data from the national cancer registry system in Iran from 2003-2008. We used joinpoint regression analysis for assessing incidence time trends and morphology change percentage. Of all cases of colorectal cancer, 61.83 were colon cancer, 27.54 rectal cancer, 7.46 rectosigmoid cancer, and 3.10 anal cancer. The most common histological types with the frequencies of 80.85 was related to adenocarcinoma, NOS. The Annual percentage changes (APC) in ASIR for colorectal cancer significantly increased in both men and women. APC in ASIR was 13.7 (CI: 10.5-17.1) in women and 16.4 (CI: 12.4-20.5) in men. APC of adenocarcinoma in villous adenoma showed significant declining trend (p<0.05), while APC of adenocarcinoma, NOS had a constant trend. The incidence of the cancer in recent years has increased in Iran because of changes in lifestyle and diet. Therefore, further studies are necessary to detect the cause of this cancer and perform preventive measures

Worldwide prevalence of fungal coinfections among COVID-19 patients: a comprehensive systematic review and meta-analysis

Microbial coinfections can increase the morbidity and mortality rates of viral respiratory diseases. Therefore, this study aimed to determine the pooled prevalence of fungal coinfections in coronavirus disease 2019 (COVID-19) patients. Web of Science, Medline, Scopus, and Embase were searched without language restrictions to identify the related research on COVID-19 patients with fungal coinfections from December 1, 2019, to December 30, 2020. A random-effects model was used for analysis. The sample size included 2,246 patients from 8 studies. The pooled prevalence of fungal coinfections was 12.60. The frequency of fungal subtype coinfections was 3.71 for Aspergillus, 2.39 for Candida, and 0.39 for other. The World Health Organization's Regional Office for Europe and Regional Office for Southeast Asia had the highest (23.28) and lowest (4.53) estimated prevalence of fungal coinfection, respectively. Our findings showed a high prevalence of fungal coinfections in COVID-19 cases, which is a likely contributor to mortality in COVID-19 patients. Early identification of fungal pathogens in the laboratory for COVID-19 patients can lead to timely treatment and prevention of further damage by this hidden infection

Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. Funding: Bill & Melinda Gates Foundation