The Math+ protocol in Covid-19

COVID19 is a highly heterogeneous and complex medical disorder; indeed, severe COVID-19 is probably amongst the most complex of medical conditions known to medical science. While there is no single ‘Silver Bullet’ to cure COVID-19, this severely disturbed pathological processes leading to respiratory failure in patients with COVID-19 organizing pneumonia will respond to the combination of Methylprednisone, Ascorbic acid, Thiamine, and full anticoagulation with Heparin (MATH+ protocol)

The Journal: Print or Electronic?

The World Nutrition Journal was conceived on the premise of  academic and clinical education for healthcare providers caring for patients that require nutritional support.[1] The journal followed the open access (OA) methodology, allowing free access everywhere in the World. The main question that some asked was “why publish this journal electronically and not printed?”.  Most of us are aware that one of the most important hallmarks of academic achievement in medicine and other areas, is publication of scholarly-written articles. When discussing publishing a manuscript, the primary question is whether the target journal should be electronic or printed version. The many advantages of having electronic publications have created a series of websites, journals, webcasts that are useful for practitioners.[2

Extreme obesity in the ICU

Morbid obesity remains an extremely serious disorder resulting in significant impairment of health all over the World. This is particularly true especially now in the setting of lockdowns and people not exercising due to the recent COVID-19 pandemic. In general, overweight and obese adults are at in increased risk of morbidity and mortality from many acute and chronic medical conditions, including hypertension, dyslipidemia, coronary heart disease, diabetes mellitus, gallbladder disease, respiratory disease, some types of cancer, gout and arthritis. Although body weight that exceeds ideal standards as determined by age, sex and height may be accounted for by a greater muscle mass or bone mass, the majority of individuals who weigh more than 20% over their calculated ideal body weight (IBW) have excessive adipose mass. What is even more alarming is the fact that the incidence of obesity in the USA has increased progressively since 1960, when the first survey was conducted. More recent data has demonstrated that the prevalence of obesity is three times higher in the USA than France, and one-and-a-half times that of England. As obesity is such a pervasive disorder in our society, and because obesity is an important risk factor for many diseases, it is not surprising that many obese patients are treated in the intensive care unit (ICU)

Perioperative hypertension management

Perioperative hypertension is commonly encountered in patients that undergo surgery. While attempts have been made to standardize the method to characterize the intraoperative hemodynamics, these methods still vary widely. In addition, there is a lack of consensus concerning treatment thresholds and appropriate therapeutic targets, making absolute recommendations about treatment difficult. Nevertheless, perioperative hypertension requires careful management. When treatment is necessary, therapy should be individualized for the patient. This paper reviews the pharmacologic agents and strategies commonly used in the management of perioperative hypertension

Intravenous clevidipine for management of hypertension

Hypertension remains one of the most prevalent diseases affecting our society, and its complications lead the list of causes of mortality all over the world. Most efforts to control the disease are unsuccessful, failing in at least two-thirds of affected patients, despite the availability of multiple drugs for its treatment. The limited number of medications available for aggressive management of hypertensive crises has intensified the search for novel drugs that can achieve a rapid decrease in blood pressure without increasing the possible complications. Clevidipine is a novel, vasculoselective, dihydropyridine calcium channel blocker characterized by a very fast onset and offset of action. Metabolism of clevidipine does not occur in the liver or kidneys, and thus there are no restrictions to using clevidipine in patients with hepatic or renal dysfunction. This agent has been widely used to reduce blood pressure when oral therapy is not appropriate, and its use in the perioperative setting has been shown to be beneficial. This manuscript reviews the key characteristics of clevidipine and its role in the management of acute hypertension

Can we treat post cardiac arrest shock by removing cytokines from circulation with high cut-off veno-venous hemodialysis?

Non peer reviewe

Bench-to-bedside review: Rhabdomyolysis – an overview for clinicians

Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration

Extreme obesity in the intensive care unit

Morbid obesity is a highly serious condition that significantly impairs health worldwide. This is especially prominent during the COVID-19 pandemic, as lockdowns and reduced physical activity contributed to the problem. Overweight and obese adults are at a higher risk of various acute and chronic medical conditions, including hypertension, heart disease, diabetes, respiratory problems, certain cancers, gout, and arthritis. While some individuals may have higher muscle or bone mass accounting for excess weight, the majority of those exceeding 20% of their ideal body weight have excessive fat. Disturbingly, obesity rates in the USA have been progressively increasing since the first survey conducted in 1960. Recent data shows that obesity prevalence in the USA is three times higher than in France and one-and-a-half times higher than in England. Given the widespread nature of obesity and its association with numerous diseases, it is not surprising that many obese patients require treatment in the intensive care unit (ICU)