Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has emerged as one of the most dreadful viruses the mankind has witnessed.It has caused worldwide havoc and wrecked human life.In our quest to find therapeuti...Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has emerged as one of the most dreadful viruses the mankind has witnessed.It has caused worldwide havoc and wrecked human life.In our quest to find therapeutic options to counter this threat,several drugs have been tried,with varying success.Certain agents like corticosteroids,some anti-virals and immunosuppressive drugs have been found useful in improving clinical outcomes.Vitamin C,a water-soluble vitamin with good safety profile,has been tried to reduce progression and improve outcomes of patients with coronavirus disease 2019(COVID-19).Because of its anti-oxidant and immunomodulatory properties,the role of vitamin C has expanded well beyond the management of scurvy and it is increasingly been employed in the treatment of critically ill patients with sepsis,septic shock,acute pancreatitis and even cancer.However,in spite of many case series,observational studies and even randomised control trials,the role of vitamin C remains ambiguous.In this review,we will be discussing the scientific rationale and the current clinical evidence for using high dose vitamin C in the management of COVID-19 patients.展开更多
Recent years have witnessed increasing numbers of artificial intelligence(AI)based applications and devices being tested and approved for medical care.Diabetes is arguably the most common chronic disorder worldwide an...Recent years have witnessed increasing numbers of artificial intelligence(AI)based applications and devices being tested and approved for medical care.Diabetes is arguably the most common chronic disorder worldwide and AI is now being used for making an early diagnosis,to predict and diagnose early complications,increase adherence to therapy,and even motivate patients to manage diabetes and maintain glycemic control.However,these AI applications have largely been tested in non-critically ill patients and aid in managing chronic problems.Intensive care units(ICUs)have a dynamic environment generating huge data,which AI can extract and organize simultaneously,thus analysing many variables for diagnostic and/or therapeutic purposes in order to predict outcomes of interest.Even non-diabetic ICU patients are at risk of developing hypo or hyperglycemia,complicating their ICU course and affecting outcomes.In addition,to maintain glycemic control frequent blood sampling and insulin dose adjustments are required,increasing nursing workload and chances of error.AI has the potential to improve glycemic control while reducing the nursing workload and errors.Continuous glucose monitoring(CGM)devices,which are Food and Drug Administration(FDA)approved for use in non-critically ill patients,are now being recommended for use in specific ICU populations with increased accuracy.AI based devices including artificial pancreas and CGM regulated insulin infusion system have shown promise as comprehensive glycemic control solutions in critically ill patients.Even though many of these AI applications have shown potential,these devices need to be tested in larger number of ICU patients,have wider availability,show favorable cost-benefit ratio and be amenable for easy integration into the existing healthcare systems,before they become acceptable to ICU physicians for routine use.展开更多
Background and aims:GM(General-Motors)diet is a low-calorie 7-day diet plan using complex carbohydrates used for quick weight loss.Dietary optimisation is known to decrease steatosis and improve outcomes in liver dono...Background and aims:GM(General-Motors)diet is a low-calorie 7-day diet plan using complex carbohydrates used for quick weight loss.Dietary optimisation is known to decrease steatosis and improve outcomes in liver donors.We evaluated the efficacy and feasibility of using GM diet in steatotic live liver donors(LLD).Methods:LLDs who either had BMI>30 kg/m^(2),Computerised tomography liver attenuation index(CT-LAI)<0 HU,Magnetic resonance(MR)fat-fraction of>10%were started on GM diet for 1 week.Records of these LLDs and their recipients were retrieved retrospectively and analysed.Weight,liver function tests(LFT),MR fat-frac-tion,CT-LAI,hospital-stay and complications were analysed in LLDs while early graft dysfunction(EGD)and complications were assessed in recipients.Results:A total of 51 LLDs with mean age of 34.6?9.5 years with baseline mean weight of 80.6±10.8 kg and BMI of 29.1±2.78 kg/m^(2) were started on GM diet.After a week of following the GM diet,there was an average weight loss of 3.46±2.1 kg,a decrease in fat-fraction by 3.8%±2.7,and an improvement in CT-LAI by 6.7?3.7 HU.All patients could successfully undergo donor hepatectomy with an average postoperative ICU stay of 2.86±0.8 days and hospital stay of 6.82?0.81 days.No donor had steatosis>10% on intraoperative Tru-cut biopsy and their post-operative outcomes were similar to normal liver donors.There were intra-abdominal collections in 2 donors requiring drainage and one required re-exploration for intestinal obstruction.There was EGD in 8 recipients(15.6%)and mortality in 1(1.9%)recipients.Conclusion:GM diet is safe and effective regimen to reduce steatosis and increase healthy LLD pool without compromising donor or recipient safety.展开更多
文摘Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has emerged as one of the most dreadful viruses the mankind has witnessed.It has caused worldwide havoc and wrecked human life.In our quest to find therapeutic options to counter this threat,several drugs have been tried,with varying success.Certain agents like corticosteroids,some anti-virals and immunosuppressive drugs have been found useful in improving clinical outcomes.Vitamin C,a water-soluble vitamin with good safety profile,has been tried to reduce progression and improve outcomes of patients with coronavirus disease 2019(COVID-19).Because of its anti-oxidant and immunomodulatory properties,the role of vitamin C has expanded well beyond the management of scurvy and it is increasingly been employed in the treatment of critically ill patients with sepsis,septic shock,acute pancreatitis and even cancer.However,in spite of many case series,observational studies and even randomised control trials,the role of vitamin C remains ambiguous.In this review,we will be discussing the scientific rationale and the current clinical evidence for using high dose vitamin C in the management of COVID-19 patients.
文摘Recent years have witnessed increasing numbers of artificial intelligence(AI)based applications and devices being tested and approved for medical care.Diabetes is arguably the most common chronic disorder worldwide and AI is now being used for making an early diagnosis,to predict and diagnose early complications,increase adherence to therapy,and even motivate patients to manage diabetes and maintain glycemic control.However,these AI applications have largely been tested in non-critically ill patients and aid in managing chronic problems.Intensive care units(ICUs)have a dynamic environment generating huge data,which AI can extract and organize simultaneously,thus analysing many variables for diagnostic and/or therapeutic purposes in order to predict outcomes of interest.Even non-diabetic ICU patients are at risk of developing hypo or hyperglycemia,complicating their ICU course and affecting outcomes.In addition,to maintain glycemic control frequent blood sampling and insulin dose adjustments are required,increasing nursing workload and chances of error.AI has the potential to improve glycemic control while reducing the nursing workload and errors.Continuous glucose monitoring(CGM)devices,which are Food and Drug Administration(FDA)approved for use in non-critically ill patients,are now being recommended for use in specific ICU populations with increased accuracy.AI based devices including artificial pancreas and CGM regulated insulin infusion system have shown promise as comprehensive glycemic control solutions in critically ill patients.Even though many of these AI applications have shown potential,these devices need to be tested in larger number of ICU patients,have wider availability,show favorable cost-benefit ratio and be amenable for easy integration into the existing healthcare systems,before they become acceptable to ICU physicians for routine use.
文摘Background and aims:GM(General-Motors)diet is a low-calorie 7-day diet plan using complex carbohydrates used for quick weight loss.Dietary optimisation is known to decrease steatosis and improve outcomes in liver donors.We evaluated the efficacy and feasibility of using GM diet in steatotic live liver donors(LLD).Methods:LLDs who either had BMI>30 kg/m^(2),Computerised tomography liver attenuation index(CT-LAI)<0 HU,Magnetic resonance(MR)fat-fraction of>10%were started on GM diet for 1 week.Records of these LLDs and their recipients were retrieved retrospectively and analysed.Weight,liver function tests(LFT),MR fat-frac-tion,CT-LAI,hospital-stay and complications were analysed in LLDs while early graft dysfunction(EGD)and complications were assessed in recipients.Results:A total of 51 LLDs with mean age of 34.6?9.5 years with baseline mean weight of 80.6±10.8 kg and BMI of 29.1±2.78 kg/m^(2) were started on GM diet.After a week of following the GM diet,there was an average weight loss of 3.46±2.1 kg,a decrease in fat-fraction by 3.8%±2.7,and an improvement in CT-LAI by 6.7?3.7 HU.All patients could successfully undergo donor hepatectomy with an average postoperative ICU stay of 2.86±0.8 days and hospital stay of 6.82?0.81 days.No donor had steatosis>10% on intraoperative Tru-cut biopsy and their post-operative outcomes were similar to normal liver donors.There were intra-abdominal collections in 2 donors requiring drainage and one required re-exploration for intestinal obstruction.There was EGD in 8 recipients(15.6%)and mortality in 1(1.9%)recipients.Conclusion:GM diet is safe and effective regimen to reduce steatosis and increase healthy LLD pool without compromising donor or recipient safety.
