Συμπληρώματα μικροθρεπτικών συστατικών στο σύνδρομο ευθραυστότητας: μια συστηματική ανασκόπηση και μέτα-ανάλυση τυχαιοποιημένων κλινικών δοκιμών

Εισαγωγή: Τα άτομα με σύνδρομο ευθραυστότητας βρίσκονται σε κίνδυνο για αυξημένη νοσηρότητα και θνησιμότητα. Τα χαμηλά επίπεδα πολλών βιταμινών και μετάλλων έχουν συσχετιστεί με μεγαλύτερη επίπτωση και βαρύτητα του συνδρόμου ευθραυστότητας. Συχνά στην κλινική πράξη χρησιμοποιούνται από του στόματος συμπληρώματα χωρίς επαρκείς ενδείξεις. Στόχοι: Να καθορίσουμε το αποτέλεσμα των συμπληρωμάτων μικροθρεπτικών συστατικών σε μέτρα σωματικής ευθραυστότητας, στην θνησιμότητα και άλλες εκβάσεις που σχετίζονται με τον ασθενή. Μέθοδοι: Τον Σεπτέμβριο του 2022 πραγματοποιήθηκε μια συστηματική αναζήτηση στις βάσεις δεδομένων PubMed και Embase και συμπεριλήφθηκαν τυχαιοποιημένες κλινικές που διερεύνησαν την επίδραση της συμπλήρωσης μικροθρεπτικών συστατικών σε άτομα με σύνδρομο ευθραυστότητας. Η βεβαιότητα των διαθέσιμων στοιχείων (certainty of evidence) καθορίστηκε βάσει των κατευθυντήριων οδηγιών GRADE. Αποτελέσματα: Συμπεριλάβαμε 18 μελέτες που περιγράφονται σε 30 δημοσιευμένα άρθρα. Όλες οι μελέτες αναφέρονταν σε συμπληρώματα βιταμίνης D, είτε σε πολυσυμπληρώματα που περιείχαν έναν αριθμό μικροθρεπτικών. Μόνο 7 από τις 18 μελέτες χρησιμοποίησαν μια καθιερωμένη κλίμακα ευθραυστότητας για την αξιολόγηση των συμμετεχόντων. Όσον αφορά τον κίνδυνο συστηματικού σφάλματος, η συνολική ποιότητα των μελετών ήταν μέτρια. Για τα συμπληρώματα βιταμίνης D, 7 μελέτες (2600 συμμετέχοντες) ανέφεραν την ολική θνησιμότητα (RR: 1.04, 95% CI: 0.83 to 1.31, I2=35%) με μέτριο βεβαιότητα, ενώ μόνο μία μελέτη ανέφερε τις αλλαγές των επιπέδων ευθραυστότητας. Για τα πολυσυμπληρώματα, βρήκαμε 4 μελέτες (180 συμμετέχοντες) για την θνησιμότητα (δεν πραγματοποιήθηκε ποσοτική σύνθεση) και 2 μελέτες για τις αλλαγές των επιπέδων ευθραυστότητας (MD= -0.28, 95% CI: -0.71 to 0.16, I2=0%) με πολύ χαμηλή βεβαιότητα και για τις δύο εκβάσεις. Συμπεράσματα: Η λήψη συμπληρωμάτων βιταμίνης D πιθανώς οδηγεί σε μικρή ή καθόλου αλλαγή στη θνησιμότητα από κάθε αιτία και στη συχνότητα πτώσης, ενώ μπορεί να οδηγήσει σε μικρή διαφορά στα κατάγματα σε άτομα με σύνδρομο ευθραυστότητας. Για πολυσυμπληρώματα, η βεβαιότητα των διαθέσιμων στοιχείων ήταν πολύ χαμηλή για τις κύριες και τις δευτερεύουσες εκβάσεις. Η μελλοντική έρευνα για το σύνδρομο ευθραυστότητας θα πρέπει να επικεντρωθεί σε εκβάσεις που σχετίζονται με τον ασθενή, όπως η αλλαγή στα επίπεδα αδυναμίας, η γνωστική λειτουργία και σε λειτουργικά μέτρα.Introduction: Frail individuals are at risk of high morbidity and mortality. Low levels of a number of vitamins and minerals has been associated with higher frailty incidence and severity. Oral supplementation of these micronutrients is often used in clinical practice without enough backing evidence. Objectives: To determine the effect of micronutrient supplementation on measures of physical frailty, mortality and other patient-related outcomes. Methods: A systematic search in PubMed and Embase was conducted on September 2022 and randomized controlled trials investigating the effect of micronutrient supplementation in frail individuals were included. The GRADE guidelines were used to assess the certainty of available evidence. Results: We included 18 studies described in 30 published articles, reporting on the effect of either Vitamin-D supplementation or multicomponent supplementation, which consisted of a number of micronutrients. Only 7 of 18 studies used a an established frailty scale to assess participants. Regarding risk of bias, overall quality of studies was moderate. For Vitamin D supplementation, 7 studies (2600 participants) reported all-cause mortality (RR: 1.04, 95% CI: 0.83 to 1.31, I2=35%) with moderate certainty of evidence, while only one study reported on change in frailty levels. For multicomponent supplementation, we found 4 studies (180 participants) on mortality and 2 studies on change in frailty levels (MD= -0.28, 95% CI: -0.71 to 0.16, I2=0%) with very low certainty of evidence for both outcomes. Conclusion: Vitamin D supplementation probably leads to little or no change in all-cause mortality and fall incidence, while it may lead to little difference in fractures in frail individuals. For multicomponent supplementation, the certainty of evidence was very low for our main and secondary outcomes. Future research in frailty should focus on patient-related outcomes, such as change in frailty levels, cognitive function and functional measures

Evaluation of admission chest X-ray findings in patients with respiratory infection during the COVID-19 pandemic

AIMS: To evaluate the prevalence of X-ray findings in hospitalized patients requiring hospitalization with suspected Coronavirus disease 2019 (COVID-19) infection and potential differences in the laboratory values and clinical outcomes related to the presence of abnormal chest X-ray (CXR) findings. METHODS: RESULTS: CONCLUSION: CXR is a routine examination in all patients with symptoms of lower respiratory tract disease and its findings relate to in-hospital mortality and Pa

SARS-CoV-2 infection in adults and HIV: an update

Aim COVID-19 pandemic caused by SARS-CoV-2 is spreading throughout the world affecting both healthy individuals and people with underlying immune-deficiencies. People living with human immunodeficiency virus (HIV) consist a group multiply affected by this universal crisis. Methods Literature search aiming to identify relevant publications referring to the consequences of the COVID-19 pandemic in HIV infected population. Results A body of literature is rapidly growing in regard to epidemiological data, the interaction between HIV and SARS-CoV-2, and clinical outcome in people living with HIV. Intensive research is warranted to identify any interactions of the co-existence of the two viruses in the immune system of HIV infected patients as common pathophysiology and molecular aspects are recognized. Human relations are diminished as a result of the social measures, and detailed recording of the consequences in this population is needed. Conclusion Further research could shed light on the common underlying molecular mechanisms of both conditions in an attempt to discover treatment regimens for SARS-CoV-2 infection

The role of soluble urokinase plasminogen activator receptor (suPAR) in patients with cancer: a review of the current literature

Aim Several biomarkers are currently used as diagnostic and prognostic tools in patients with cancer. Soluble urokinase plasminogen activator receptor (suPAR) is elevated in acute and chronic inflammatory procedures and several observational studies during the last 20 years have investigated its role in oncology. The purpose of this article was to review the current literature regarding suPAR’s role in clinical practice. Methods A systematic literature search of PubMed, Scopus, OpenGrey and Cochrane Library databases through September 2021 was conducted using the following search terms: “supar”or “soluble urokinase plasminogen receptor” and “cancer” or “malignancy”. Original articles reporting on suPAR’s role in the diagnosis, prognosis and prediction of therapeutic outcomes in patients with confirmed or suspected cancer were included. Results Among 45 found articles, the most were observational cohort studies. The included studies were further categorized by cancer site. SuPAR level was higher in patients with cancer compared to healthy controls, but its diagnostic and prognostic accuracy differs depending on the site of cancer. Conclusion SuPAR has promising aspects in the field of oncology and public health and future research should further investigate its use in clinical practice. As it is elevated in different types of cancer, it could potentially serve as an adjunctive tool for the mass screening of patients with non-specific signs of cancer, but larger cohort studies that support these findings must be conducted

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Sepsis and the muscle tissue. A narrative review

Sepsis and septic shock are considered major factors in the development of myopathy in critically ill patients, which is correlated with increased morbidity rates and ICU length of stay. The underlying pathophysiology is complex, involving mitochondrial dysfunction, increased protein breakdown and muscle inexcitability. Sepsis induced myopathy is characterized by several electrophysiological and histopathological abnormalities of the muscle, also has clinical consequences such as flaccid weakness and failure to wean from ventilator. In order to reach definite diagnosis, clinical assessment, electrophysiological studies and muscle biopsy must be performed, which can be challenging in daily practice. Ultrasonography as a screening tool can be a promising alternative, especially in the ICU setting. Sepsis and mechanical ventilation have additive effects leading to diaphragm dysfunction thus complicating the patient’s clinical course and recovery. Here, we summarize the effects of the septic syndrome on the muscle tissue based on the existing literature

Cardiac biomarkers alterations in patients with SARS-CoV-2 infection

Reliable biomarkers are necessary for the risk stratification of patients infected with SARS-CoV-2. This novel coronavirus is now established to affect several organs in addition to the lungs, most prominently the heart. This is achieved through direct damage to the myocardium and indirect immune-associated effects during the cytokine storm. We performed a literature review aiming to identify the prognostic value of alterations of cardiac biomarkers in SARS-CoV-2 infection. Cardiac biomarkers are significantly elevated in patients with severe COVID-19 and are independent predictors of mortality. High-sensitivity troponin I and T are correlated with multiple inflammatory indexes and poor outcomes. Although cut-off values have been established for most of cardiac biomarkers, lower limits for troponins may have better prognostic values and longitudinal monitoring of cardiac biomarkers can help the clinician assess the patient’s course. Additional measurements of NT-proBNP, can detect the subgroup of patients with poor prognosis

Impact of Bacterial Infections on COVID-19 Patients: Is Timing Important?

Background: Along with important factors that worsen the clinical outcome of COVID-19, it has been described that bacterial infections among patients positive for a SARS-CoV-2 infection can play a dramatic role in the disease process. Co-infections or community-acquired infections are recognized within the first 48 h after the admission of patients. Superinfections occur at least 48 h after admission and are considered to contribute to a worse prognosis. Microbiologic parameters differentiate infections that happen after the fifth day of hospitalization from those appearing earlier. Specifically, after the fifth day, the detection of resistant bacteria increases and difficult microorganisms emerge. Objectives: The aim of the study was to evaluate the impact of bacterial infections in patients with COVID-19 on the length of the hospital stay and mortality. Methods: A total of 177 patients hospitalized due to COVID-19 pneumonia were consecutively sampled during the third and fourth wave of the pandemic at a University Hospital in Greece. A confirmed bacterial infection was defined as positive blood, urinary, bronchoalveolar lavage (BAL) or any other infected body fluid. Patients with confirmed infections were further divided into subgroups according to the time from admission to the positive culture result. Results: When comparing the groups of patients, those with a confirmed infection had increased odds of death (odds ratio: 3.634; CI 95%: 1.795–7.358; p < 0.001) and a longer length of hospital stay (median 13 vs. 7 days). A late onset of infection was the most common finding in our cohort and was an independent risk factor for in-hospital death. Mortality and the length of hospital stay significantly differed between the subgroups. Conclusion: In this case series, microbial infections were an independent risk factor for a worse outcome among patients with COVID-19. Further, a correlation between the onset of infection and a negative outcome in terms of non-infected, community-acquired, early hospital-acquired and late hospital-acquired infections was identified. Late hospital-acquired infections increased the mortality of COVID-19 patients whilst superinfections were responsible for an extended length of hospital stay.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

N-acetylcysteine efficacy in patients hospitalized with COVID-19 pneumonia: a systematic review and meta-analysis

BACKGROUND: N-acetylcysteine (NAC) is a mucolytic agents with anti-inflammatory properties that has been suggested as an adjunctive therapy in patients with COVID-19 pneumonia. OBJECTIVES: We conducted a systematic review and meta-analysis to evaluate available evidence on the possible beneficial effects of NAC on SARS-CoV-2 infection. METHODS: In September 2022, we conducted a comprehensive search on Pubmed/Medline and Embase on randomized controlled trials (RCTs) and observational studies on NAC in patients with COVID-19 pneumonia. Study selection, data extraction and risk of bias assessment was performed by two independent authors. RCTs and observational studies were analyzed separately. RESULTS: We included 3 RCTs and 5 non-randomized studies on the efficacy of NAC in patients with COVID-19, enrolling 315 and 20826 patients respectively. Regarding in-hospital mortality, the summary effect of all RCTs was OR: 0.85 (95% CI: 0.43 to 1.67, I2=0%) and for non-randomized studies OR: 1.02 (95% CI: 0.47 to 2.23, I2=91%). Need for ICU admission was only reported by 1 RCT (OR: 0.86, 95% CI:0.44-1.69, p=0.66), while all included RCTs reported need for invasive ventilation (OR:0.91, 95% CI:0.54 to 1.53, I2=0). Risk of bias was low for all included RCTs, but certainty of evidence was very low for all outcomes due to serious imprecision and indirectness. CONCLUSION: The certainty of evidence in the included studies was very low, thus recommendations for clinical practice cannot be yet made. For all hard clinical outcomes point estimates in RCTs are close to the line of no effect, while observational studies have a high degree of heterogeneity with some of them suggesting favorable results in patients receiving NAC. More research is warranted to insure that NAC is both effective and safe in patients with COVID-19 pneumonia.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Knowledge and Attitudes of Healthcare Workers towards Antibiotic Use and Antimicrobial Resistance in Two Major Tertiary Hospitals in Western Greece

Antibiotic resistance (ABR) and antimicrobial stewardship arethe two sides of the same coin that constitute a public health hydra. This study aimed to assessthe knowledge and attitude of healthcare workers (HCWs), on antibiotic use and antimicrobial resistance in Western Greece. A total of 200 healthcare workers (doctors, nurses, and others) from the two largest tertiary hospitals in Western Greece were included in our survey. HCWs seem not to decide based on patient opinion in order to prescribe antibiotics. Approximately 97% of them are aware of their main adverse effects. Remarkably, 25% of respondents prescribe antibiotics due to diagnostic uncertainty, and 32.5% of them prescribe antibiotics based on their experience. HCWs statedthat they do not report adverse effects often. Inappropriate antibiotic prescriptions were mentioned as the main reason for bacterial resistance to antimicrobials. Monitoring the patient’s treatment progress, using electronic prescriptions, and adhering to international guidelines were suggested as solutions to the problem. Post Hoc analysis showed that nursing staff apply to the national guidelines (p: 0.011) and use electronic prescriptions (p: 0.003) less often compared to consultants, doctor directors, and trainees. The findings of our survey may be useful for the development of future national education programs and interventions thatmay improve healthcare workers’ knowledge and ability to manage antibiotics