فهرست مطالب parsa mohammadi

Anemia, a common symptom in pregnancy, can lead to life-threatening cardiomyopathy. A 30-years old gravida 2 para 1 woman was admitted at 34 weeks of gestational age with asymptomatic pancytopenia and vitamin B12 deficiency in the laboratory tests. She also had a diet-controlled gestational diabetes, megaloblastic changes in Bone marrow aspiration and cardiomyopathy shown by echocardiography. The patient recovered from pancytopenia and cardiomyopathy after one week treatment with vitamin B12 and folate. In this case, cardiomyopathy worsened with anemia. By treating vitamin B12 deficiency, cardiomyopathy can be prevented or controlled during pregnancy. Careful consideration is needed when assessing anemia in pregnant women on vegetarian diet and at higher risk.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. The first known receptor for this virus in the human body is angiotensin-converting enzyme 2 (ACE2), the same receptor for the SARS virus.

A total of 38 hospitalized adult (18 years) patients with laboratory or clinically confirmed coronavirus disease 2019 (COVID-19) were identified in the infectious disease ward of Tehran Imam Khomeini hospital complex in this single-center cross - sectional study. A blood sample was taken at the time of hospitalization and a second one was taken 48 hours later. Blood samples are kept frozen at -80 degrees Celsius. After the complete collection of samples, the ACE2 level of the samples was measured using a serum sACE2 detection ELISA kit. The data were analyzed using SPSS v26. P value of 0.05 was considered statistically significant. An analysis of covariance was performed to examine the mean differences in day 7 serum ACE2 concentration among the 2 groups after adjusting for the baseline serum ACE2 concentration. The 1-way multivariate analysis of variance was used to determine whether there were any differences between independent groups (mechanical ventilation yes/no) on serum ACE2 levels at 3 different times.

The mean age of patients was 64.13 ± 16.49 years, 21 patients (55.3%) were men, 16 patients (42%) were polymerase chain reaction test positive, and 15 patients (39.5%) died. A total of 35 individuals (92.1%) had chest computed tomography images that indicated lung involvement. A comparison of the 2 groups of patients who died and were discharged revealed that serum ACE2 at the first (p=0.033) and third (7th day) measurements were statistically different (p=0.026). Patients had a mean of serum ACE2. The results indicated that the day 7 serum ACE2 concentration did significantly differ between the 2 groups after controlling for the baseline serum ACE2 concentration (p=0.023). The model explained about 73.61% of the variance in the 7-day serum ACE2 concentration. Specifically, after adjusting for the baseline concentration, survived patients had the lowest level of serum ACE2 concentration (1 ± 0.65) on the 7th day compared with the deceased patient group (2.83 ± 1.12).

Soluble ACE2 in the serum of COVID-19 patients who died, later on, was significantly higher than the discharged patients when the samples were taken seven days after admission. It is suggested that serum soluble ACE2 level could be used as a prognostic factor for COVID-19 patients’ outcomes and also their need for mechanical ventilation.

 Challenges concerning patient management exist worldwide, particularly in the critical care. In this review, we have summarized some studies regarding respiratory physiotherapy and exercise in COVID-19 patients.   

 For searching related articles, PubMed, Google Scholar, Embase, and the Web of Science databases were used. Keywords such as "respiratory physiotherapy" and "COVID-19," "exercise," "effect of exercise in COVID-19," and "respiratory physiotherapy for COVID-19 in ICU" were used to identify related papers until December 2021. The abstracts and entire texts were evaluated by 3 separate reviewers.  

 During the symptomatic phase, individuals may benefit from brief durations of bed rest. Exercise appears to provide both emotional and physical benefits for individuals in the early stages of infection. As a result, it may lower viral load, minimize cytokine storm, shorten the acute phase, and expedite recovery. Mild exercise may also increase the autophagy pathway, which improves the immune system function in response to COVID-19 infection. Keeping this in mind, intense activity, especially without the guidance of an expert physical therapist, is not advantageous during the inflammatory period and may even be regarded a second hit phenomenon. Mild exercises during bed rest (e.g., acute phase) may reduce the risk of pulmonary capillary coagulation and deep vein thrombosis.  

 Although respiratory physiotherapy and prone positioning in hospitalized patients, particularly in critical care, can be challenging for medical staff, they are cost-effective and noninvasive approaches for COVID-19 patients. Early physiotherapy and muscle training exercise for patients in the intensive care unit (ICU) seems to be beneficial for patients and may reduce bed rest-induced weakness, improve oxygenation, and reduce length of stay. Finally, breathing exercises can improve some symptoms of COVID-19, like dyspnea and weakness.

Accumulating evidence suggests the potential use of chloroquine, an anti-malaria medication, as a neuroprotective agent. Moreover, several studies have reported that the endogenous opioids and nitric oxide (NO) may mediate the chloroquine’s effects. In the present study, effects of chloroquine on hyoscine-induced memory impairment were assessed. Furthermore, the possible involvements of opioids and NO were evaluated. Chloroquine was administered intraperitonially (i.p.) at doses of 0.1, 0.5, 1, 3, 10, and 20 mg/kg to hyoscine-treated (1mg/kg, i.p.) mice, and the spatial and fear memories were evaluated using Y-maze and passive-avoidance tasks, respectively. Also, to provide further evidence about chloroquine’s mechanism of action, the opioid receptors and the NO production were blocked using two nonselective antagonist’s naltrexone and L-NAME, respectively. Chloroquine at doses of  0.5, 10 and 20 mg/kg furtherly damaged the impaired memory of hyoscine-treated mice and at doses of 10 and 20 mg/kg impaired the memory of saline-treated mice in the passive-avoidance task. Additionally, chloroquine at doses of 0.5 and 1 mg/kg improved the spatial memory in hyoscine-treated mice in Y-maze test. In addition, naltrexone (3 mg/kg) reversed the neuroprotective effect of chloroquine (1 mg/kg) in hyoscine-treated mice in Y-maze task. It could be concluded that chloroquine at low doses may improve cognitive performances by involving the opioid receptors; as a result, blocking the opioid receptors may reverse chloroquine’s neuroprotective effect. Notably, chloroquine at high doses did not improve the memory and in combination with hyoscine, it caused even more damage to the long-term memory.

Since the announcement of the COVID-19 pandemic by the world health organization, various issues concerning COVID-19 patients have been analyzed. However, some simple issues like exercise (1) and nutrition support in COVID-19 patients are yet to be discussed. It has been revealed that malnutrition is associated with the poor prognosis of critically ill patients (2). According to the early evidence from China (3), the prevalence of malnutrition in COVID-19 patients was 52.7%, accounting for more than half of the patients. Also, the high prevalence of malnutrition among COVID-19 patients supports the idea that malnutrition is a frequent problem among them and can be considered a prognostic factor (4,5).

Novel coronavirus 2019 is the cause of the 2020 pandemic that was announced by the world health organization in March 2020. Coronavirus attacks the respiratory system and causes mild to severe hypoxemia. Therefore, a fraction of COVID-19 patients may need intubation and mechanical ventilation.

We performed a narrative review via searching in articles that were published in PubMed, Google Scholar, Scopus, web of scenic, Cochrane library, and Embase that mentioned to time of intubation COVID-19 patients and intubation techniques, manual searching was also completed. All the selected reviews and studies were limited to humans and the English language.

First data from China mention that 5% of patients requiring intubation and mechanical ventilation (MV), there has been substantial debate about the time of intubation to patients with acute respiratory failure and intubation technique. At first, the specialists recommended early intubation. Although we are more familiar with the pathophysiology of coronavirus, the drawbacks versus the benefits of early intubation are still controversial. In addition, the intubation process itself is an aerosol-generating procedure and a high risk for patients and health care providers. In this review, we aim to review the previous studies and guidelines recommendations related to the time of intubation and intubation technique for COVID-19 patients.

Some previous studies suggested early tracheal intubation in severe COVID-19 patients may have the priority, while other studies advocate late intubation due to poor outcomes of intubation and weaning difficulties. However, intubation timing should be based on personalized medicine and case by case decision making to keep the best care and benefit of patients. And relying only on theoretical justification may have not good consequences.