Survival implications vs. complications: unraveling the impact of vitamin D adjunctive use in critically ill patients with COVID-19—A multicenter cohort study

BackgroundDespite insufficient evidence, vitamin D has been used as adjunctive therapy in critically ill patients with COVID-19. This study evaluates the effectiveness and safety of vitamin D as an adjunctive therapy in critically ill COVID-19 patients.MethodsA multicenter retrospective cohort study that included all adult COVID-19 patients admitted to the intensive care units (ICUs) between March 2020 and July 2021. Patients were categorized into two groups based on their vitamin D use throughout their ICU stay (control vs. vitamin D). The primary endpoint was in-hospital mortality. Secondary outcomes were the length of stay (LOS), mechanical ventilation (MV) duration, and ICU-acquired complications. Propensity score (PS) matching (1:1) was used based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analyses were employed as appropriate.ResultsA total of 1,435 patients were included in the study. Vitamin D was initiated in 177 patients (12.3%), whereas 1,258 patients did not receive it. A total of 288 patients were matched (1:1) using PS. The in-hospital mortality showed no difference between patients who received vitamin D and the control group (HR 1.22, 95% CI 0.87–1.71; p = 0.26). However, MV duration and ICU LOS were longer in the vitamin D group (beta coefficient 0.24 (95% CI 0.00–0.47), p = 0.05 and beta coefficient 0.16 (95% CI −0.01 to 0.33), p = 0.07, respectively). As an exploratory outcome, patients who received vitamin D were more likely to develop major bleeding than those who did not [OR 3.48 (95% CI 1.10, 10.94), p = 0.03].ConclusionThe use of vitamin D as adjunctive therapy in COVID-19 critically ill patients was not associated with survival benefits but was linked with longer MV duration, ICU LOS, and higher odds of major bleeding

Prevalence and risk factors of dry eye disease among adults in Saudi Arabia

Background: Environmental and epidemiological factors increase the risk of dry eye in Saudi Arabia, but most studies have limited generalizability. Objective: To determine the prevalence of dry eye disease (DED) among adults across Saudi Arabia and the associated risk factors. The secondary objective was to estimate the economic burden of DED by calculating lubricant usage and its annual costs. Methods: This cross-sectional study invited adults from across Saudi Arabia to complete a questionnaire that collected data regarding demographics, symptoms related to DED, previous diagnosis of DED, use of contact lenses, and use of eye lubricants. Results: A total of 2042 responses were received, of which 784 (38.4%) respondents had previously been diagnosed with DED and 752 (36.8%) were symptomatic but undiagnosed. Between the DED diagnosed and symptomatic-undiagnosed groups, a significant difference was found in terms of age (P < 0.001), gender (P = 0.002), presence of diabetes mellitus (P = 0.004), smoking status (P = 0.007), duration of electronic screen use (P = 0.05), number of ocular complaints (P < 0.001), and frequency of lubricants use (P < 0.001). Between the DED-diagnosed and non-DED groups, significant differences were found in terms of age (P < 0.001), gender (P < 0.001), presence of diabetes mellitus (P = 0.001), allergy (P = 0.001), autoimmune disease (P = 0.005), smoking status (P < 0.001), and history of refractive surgery (P < 0.001). The mean estimated annual cost of using lubricating agents was SAR 328.2 ± 210.3 (USD 87.5 ± 56.1), and this was significantly higher in the diagnosed group (P = 0.01) than the symptomatic-undiagnosed group. Conclusions: The prevalence of DED is high among adults in Saudi Arabia. High-risk population include elderly, female, and using electronic screens for >2 hours/day

Antioxidant and anti-inflammatory potentials of aerial and floral parts of Neurada procumbens extracts: In vitro and in vivo studies

Neurada procumbens (Neuradaceae) is an importent plant of the Cholistan desert and is traditionally been used for the treatment and control of diabetes, fever, inflammations and jaundice. The aim of the current project is to investigate the bioactive compounds, free radical scavenging capacity and the anti-inflammatory potential of Neurada procumbens separately for its aerial and floral parts in six different extracts. The phytochemical profile (total bioactive contents, HPLC polyphenolic quantification), anti-oxidant (DPPH and FRAP assays), anti-inflammatory (HRBC stabilization) activities of the Aqu, MetOH, n-But, EtAc, n-Hex, and DCM extracts from the aerial and floral parts of Neurada procumbens were quantified. Based on the current results, the aerial and floral parts of N. procumbens extracts have found to contain a significant amount of active metabolites including polyphenolic compounds such as 2,3 di MeO benzoic acid, p-coumaric acid, chlorogenic acid, quercetin dihydrate and t-ferrulic acid. The total phenolic and total flavonoid contents of the plant were found to range from 28.13 to 78.9 GAE mg/g of plant and 17.23 to 68.23 RE mg/g of plant, respectively. DCM and n-But extracts of floral part exhibited comparatively higher antioxidant potential in DPPH (IC50 < 100 μg/ml) and FRAP (IC50 < 55 μg/ml) assays compared to aerial part. The dichloromethane floral extract demonstrated impressive anti-inflammatory activity in the hemolytic red blood cell lysis assay, with 83 % protection of HRBC lysis at an IC50 of 469.6 µg/ml (p < 0.01). In vivo, a 300 mg/kg body weight of DCM floral extract reduced carrageenan-induced paw oedema by 8.51 ± 0.35 mm to 7.65 ± 0.38 mm, a highly significant difference (p < 0.001).The toxicity studies revealed that the floral-DCM dose extract was found to be safe up to 2000 mg/kg BW, while its lethal dose (LD50) was found to be 4472.13 mg/kg BW in rats. Due to quite low toxicity effects, the floral part of the plant could be recommended as a safe pharmacological agent for various therapeutic applications