Atorvastatin versus placebo in ICU patients with COVID-19: ninety-day results of the INSPIRATION-S trial

Background In the INSPIRATION-S trial, atorvastatin versus placebo was associated with a nonsignificant 16% reduction in 30-day composite of venous/arterial thrombosis or death in intensive care unit (ICU) patients with COVID-19. Thrombo-inflammatory response in coronavirus disease 2019 (COVID-19) may last beyond the first 30 days.Methods This article reports the effects of atorvastatin 20 mg daily versus placebo on 90-day clinical and functional outcomes from INSPIRATION-S, a double-blind multicenter randomized trial of adult ICU patients with COVID-19. The main outcome for this prespecified study was a composite of adjudicated venous/arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause mortality. Functional status was assessed with the Post-COVID-19 Functional Scale.Results In the primary analysis, 587 patients were included (age: 57 [Q1–Q3: 45–68] years; 44% women). By 90-day follow-up, the main outcome occurred in 96 (33.1%) patients assigned to atorvastatin and 113 (38.0%) assigned to placebo (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.60–1.05, p = 0.11). Atorvastatin in patients who presented within 7 days of symptom onset was associated with reduced 90-day hazard for the main outcome (HR: 0.60, 95% CI: 0.42–0.86, p interaction = 0.02). Atorvastatin use was associated with improved 90-day functional status, although the upper bound CI crossed 1.0 (ORordinal: 0.64, 95% CI: 0.41–1.01, p = 0.05).Conclusion Atorvastatin 20 mg compared with placebo did not significantly reduce the 90-day composite of death, treatment with ECMO, or venous/arterial thrombosis. However, the point estimates do not exclude a potential clinically meaningful treatment effect, especially among patients who presented within 7 days of symptom onset (NCT04486508).Thrombosis and Hemostasi

Environmental risk assessment of a dam during construction phase

The present study was conducted to assess the possible risks induced by construction of Gavi Dam in Ilam Province; western part of Iran, using MIKE-11 model and technique for order of preference by similarity to ideal solution. For this purpose, vulnerable zone of the dam site against the flooding risk of Gavi River was calculated for different return periods. The flooding zones were stimulated by MIKE-11 model. In order to check whether or not the dam construction could affect the quality of the Gavi River, the physicochemical quality of the river water was also tested. Afterwards, a questionnaire was prepared containing an inventory of possible risks supposed to be induced by construction of Gavi Dam. The questionnaires were placed at disposal of experts to score the items based on their importance. The questionnaires were then analyzed using SPSS Software, version 16. According to which, a total number of 12 risk factors were identified. The dam construction risks were qualitatively assessed by preliminary hazard analysis. Based on the results, 3 of 12 identified risks were recognized unacceptable. The shortlisted risks were prioritized at final step using technique for order of preference by similarity to ideal solution. "Habitat fragmentation" with a weight of 0.3002, "water pollution" with a weight of 0.295, and "impacts on aquatics" with a weight of 0.293 were identified as three top priority flooding risks. Among the most important corrective measures for mitigation of the risks at construction phase can be pointed to "restoration of the land cover", “conservation of areas surrounding the dam as a new wildlife habitat", “prevention of water contamination”, and "conservation of fish spawning sites"

A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP)

Introduction: Nausea and vomiting of pregnancy (NVP) are one of the most common complains of the early pregnancy period and are bothersome for pregnant women. Some prefer to use herbal medicine instead of chemical agents. Objective: The purpose of the present study was to compare the effects of ginger, pyridoxine (vitamin B6), and placebo for the treatment of NVP. Method: The study was performed as a triple blind clinical trial on pregnant women suffering mild to moderate NVP between 6 and 16 weeks of pregnancy. In these women ginger, 500 mg twice daily, vitamin B6 40 mg twice daily and placebo twice daily were administered for 4 d. Rhodes questionnaire was used for evaluation of the severity of symptoms. The severity of NVP was evaluated 24 h before entering the study and up to 4 d after using medications and results were compared among the three groups. Results: Seventy-seven women finished the study (28 in the Ginger group, 26 in the B6 group, and 23 in the placebo group). The women of the three groups did not have significant differences according to age, gestational age, parity, and severity of each symptom before treatment and educational status. Total score of Rhodes questionnaire for nausea was decreased significantly in three groups after treatment. (p <.001, p =.012, and p =.03 for ginger, vitamin B6, and placebo, respectively.) Also total score of Rhodes questionnaire for vomiting was decreased in three groups (p =.03 for ginger, p =.02 for B6, and p =.04 for placebo). Ginger and vitamin B6 could reduce the severity of all items of Rhodes questionnaire significantly; however, placebo was significantly effective only on the frequency of nausea, intensity of vomiting and frequency of retching. Ginger and vitamin B6 were more effective than placebo (p =.039 and p =.007, respectively); however, total score of Rhodes did not show significant difference between ginger and vitamin B6 (p =.128). Ginger was more effective for nausea (intensity and distress) and distress of vomit. Conclusion: Ginger is more effective than placebo for the treatment of mild to moderate NVP and is comparable with vitamin B6. Trial registration number and registry website: IRCT2015020320923N1. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group

A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP)

Introduction: Nausea and vomiting of pregnancy (NVP) are one of the most common complains of the early pregnancy period and are bothersome for pregnant women. Some prefer to use herbal medicine instead of chemical agents. Objective: The purpose of the present study was to compare the effects of ginger, pyridoxine (vitamin B6), and placebo for the treatment of NVP. Method: The study was performed as a triple blind clinical trial on pregnant women suffering mild to moderate NVP between 6 and 16 weeks of pregnancy. In these women ginger, 500 mg twice daily, vitamin B6 40 mg twice daily and placebo twice daily were administered for 4 d. Rhodes questionnaire was used for evaluation of the severity of symptoms. The severity of NVP was evaluated 24 h before entering the study and up to 4 d after using medications and results were compared among the three groups. Results: Seventy-seven women finished the study (28 in the Ginger group, 26 in the B6 group, and 23 in the placebo group). The women of the three groups did not have significant differences according to age, gestational age, parity, and severity of each symptom before treatment and educational status. Total score of Rhodes questionnaire for nausea was decreased significantly in three groups after treatment. (p <.001, p =.012, and p =.03 for ginger, vitamin B6, and placebo, respectively.) Also total score of Rhodes questionnaire for vomiting was decreased in three groups (p =.03 for ginger, p =.02 for B6, and p =.04 for placebo). Ginger and vitamin B6 could reduce the severity of all items of Rhodes questionnaire significantly; however, placebo was significantly effective only on the frequency of nausea, intensity of vomiting and frequency of retching. Ginger and vitamin B6 were more effective than placebo (p =.039 and p =.007, respectively); however, total score of Rhodes did not show significant difference between ginger and vitamin B6 (p =.128). Ginger was more effective for nausea (intensity and distress) and distress of vomit. Conclusion: Ginger is more effective than placebo for the treatment of mild to moderate NVP and is comparable with vitamin B6. Trial registration number and registry website: IRCT2015020320923N1. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group

Investigation of Meconium Aspiration Syndrome in Newborns, after NRP Protocol Changing

Meconium is a thick green-black odorant substance, which is produced in the embryo's gut at the 12th week of gestation, and then stored in the colon throughout the pregnancy. Meconium can lead to pulmonary injury by various mechanisms, which in the presence of respiratory distress and other radiological findings in neonates born with meconium-stained amniotic fluid (MSAF), are defined as meconium aspiration syndrome (MAS). Given the frequent need for newborns to be resuscitated at birth, educated people are needed to resuscitate them. In the United States, the Neonatal Resuscitation Program (NRP) is a training guideline for newborns. The purpose of the NRP is to provide the cognitive, technical, and behavioral skills needed to resuscitate neonates after delivery.Due to the changes of NRP 6 and 7 guidelines in using PPV, Tracheal intubation and suctioning and using both guidelines in Shahid Mostafa Khomeini and Taleghani hospitals of Ilam, during 2015-2019, we decided to compare these two methods in terms of infant mortality and morbidity over the mentioned years. In this study, we aimed to determine the Meconium Aspiration Syndrome in neonates, born between the years 2015 and 2019, in Shahid Mostafa Khomeini and Taleghani Hospitals of Ilam, before and after the NRP protocol change

Serological Study of Toxoplasma gondii Infection Using IFA Method in Renal Transplant Recipients

Toxoplasmosis is a wide distributed opportunistic infection caused by Toxoplasma gondii. This was a cross-sectional study of T. gondii antibody titer, which was conducted from June 2003 to August 2004 on renal transplant recipients in Iran. A total of 551 serum samples were obtained from randomly selected population referred from different areas all over the country to Shafa Central Clinic in Tehran. Patient’s information was recorded in a questionnaire before sampling. Two samples of finger-prick blood were collected from each person and antibody titer against Toxoplasma was assessed by Indirect Fluorescence Antibody (IFA) technique on serum samples. Totally 39 cases (7.1%) of samples were positive for antibody by the titer of 1: 20 and higher. On investigation of risk factors, no significant difference was found between consumption of under-cooked meat, close contact with animals, and the source of drinking water and seropositivity rate of toxoplasmosis. The relatively low seroprevalence rate of Toxoplasma infection shows the successful approaches to awareness of transplant recipients about the potential risks of acquisition of infectious diseases due to regular administration of suppressive drugs. However, the regular surveillance through serological screening of Toxoplasma antibody in kidney transplant recipients is advisable

The correlation between cardiac magnetic resonance T2* and left ventricular global longitudinal strain in people with β-thalassemia

Background: Heart failure is the biggest cause of mortality and morbidity in people with thalassemia, and iron deposition in cardiac tissue impairs cardiovascular function. Therefore, early detection of cardiac involvement is important to improve the prognosis in these individuals. Method: Two- and three-dimensional echocardiography was performed to evaluate left ventricular ejection fraction (LVEF), left ventricular volumes and diameters, and global longitudinal strain (GLS) in 130 individuals with β-thalassemia using the speckle tracking method. Magnetic resonance imaging (MRI) was carried out on both the heart and liver. The participants were divided into 2 groups based on cardiac T2* values (normal and abnormal cardiac iron load), and the correlation between cardiac T2* MRI and GLS was evaluated. Results: The statistical analysis showed a significant correlation between cardiac T2* MRI and left ventricular global longitudinal strain. There was a significant difference in global longitudinal strain (P <.0001), liver MRI T2*(P <.0001), and left ventricular ejection fraction (P <.001) between the 2 groups. The optimal cutoff value for GLS was �18.5 with sensitivity and specificity 73.0 and 63.0, respectively (postitive predictive value = 50, negative predictive value = 82.3, AUC = 0.742, std. error = 0.046) which predicts T2* value of <20 ms, according to cardiac MRI. Conclusions: The participants with cardiac iron overload had a lower GLS than those without one. This suggests that GLS may be a useful method to predict myocardial iron overload particularly in β-thalassemia patients with subclinical cardiac involvement. © 2018, Wiley Periodicals, Inc

The correlation between cardiac magnetic resonance T2* and left ventricular global longitudinal strain in people with β-thalassemia

Background: Heart failure is the biggest cause of mortality and morbidity in people with thalassemia, and iron deposition in cardiac tissue impairs cardiovascular function. Therefore, early detection of cardiac involvement is important to improve the prognosis in these individuals. Method: Two- and three-dimensional echocardiography was performed to evaluate left ventricular ejection fraction (LVEF), left ventricular volumes and diameters, and global longitudinal strain (GLS) in 130 individuals with β-thalassemia using the speckle tracking method. Magnetic resonance imaging (MRI) was carried out on both the heart and liver. The participants were divided into 2 groups based on cardiac T2* values (normal and abnormal cardiac iron load), and the correlation between cardiac T2* MRI and GLS was evaluated. Results: The statistical analysis showed a significant correlation between cardiac T2* MRI and left ventricular global longitudinal strain. There was a significant difference in global longitudinal strain (P <.0001), liver MRI T2*(P <.0001), and left ventricular ejection fraction (P <.001) between the 2 groups. The optimal cutoff value for GLS was �18.5 with sensitivity and specificity 73.0 and 63.0, respectively (postitive predictive value = 50, negative predictive value = 82.3, AUC = 0.742, std. error = 0.046) which predicts T2* value of <20 ms, according to cardiac MRI. Conclusions: The participants with cardiac iron overload had a lower GLS than those without one. This suggests that GLS may be a useful method to predict myocardial iron overload particularly in β-thalassemia patients with subclinical cardiac involvement. © 2018, Wiley Periodicals, Inc