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Background Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. Objectives In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. Methods A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. Results Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P  = 0.015) and using excessive amounts of alcohol and tobacco (P  = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33–13.86; P  = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05–8.19, P  = 0.031) (n = 160). Conclusions VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. Systematic Review Registration Open Science Framework (https://doi.org/10.17605/OSF.IO/AJGHX). [ABSTRACT FROM AUTHOR]

Purpose: Ascorbic acid has been proposed as an alternative treatment for methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. However, its efficacy has never been compared to that of methylene blue given the inability of patients with G6PD deficiency to receive methylene blue. We present a case of methemoglobinemia treated with ascorbic acid in a patient without G6PD deficiency who had previously received methylene blue. Summary: A 66-year-old male was treated for methemoglobinemia deemed to be secondary to benzocaine throat spray. He received intravenous (IV) methylene blue but had a severe reaction: diaphoresis, lightheadedness, and hypotension. The infusion was stopped prior to completion. Approximately 6 days later he presented with methemoglobinemia following an additional overconsumption of benzocaine and was treated with ascorbic acid. In both instances his methemoglobin levels were >30% on arterial blood gas on admission and decreased to 6.5% and 7.8%, respectively, after administration of methylene blue and ascorbic acid. Conclusion: Ascorbic acid had a similar effect on decreasing the concentration of methemoglobin compared to methylene blue. Further research into use of ascorbic acid as a recommended agent for treatment of methemoglobinemia is warranted. [ABSTRACT FROM AUTHOR]

Ischemia is one of the most common injuries that is usually caused by reduced blood flow to the tissues. Following this incident, the tissue becomes deficient in oxygen and nutrients, and energy production in the affected cells stops, eventually leading to cell damage, but there is also evidence that restoring blood flow to ischemic tissues can lead to extra tissue damage known as Ischemia Reperfusion Injury (IRI). In this study, we reviewed the relationship between vitamin C intake and ischemia/reperfusion injury to investigate the relationship between vitamin C intake and ischemia/reperfusion injury. The keywords "Vitamin C" or "Ascorbic Acid" and "Ischemic" or "Ischemia" and "Reperfusion" were used in this search. The results show that vitamin C has a positive effect on ischemia treatment in the renal tissue, brain, liver, intestine, lung, ovary, pancreas, and skin. [ABSTRACT FROM AUTHOR]

Methemoglobinemia is due to oxidization of divalent ferro-iron of hemoglobin to ferri-iron of methemoglobin (MetHb) which is incapable of transferring oxygen to tissues. This disease may be acquired by intoxication with oxidizing agents or inherited with a mutation of CYB5R3, the gene coding for the methemoglobin reductase or cytochrome B5 reductase 3 responsible for the reduction of MetHb to hemoglobin. We report the case of 2 sisters aged respectively of 15 and 8 months. They were born to a second-degree consanguineous marriage with a history of precocious and unexplained deaths in 3 relatives. Both sisters presented neurological features including psychomotor retardation, microcephaly, and axial hypotonia. Cerebral magnetic resonance imaging revealed cerebral atrophy in both cases associated with hypoplasia of the corpus callosum in the younger child. The association of neurological disability, cyanosis, and hypoxemia prompted a search for methemoglobinemia, with MetHB levels respectively of 26% and 15.8%in the 2 sisters. Initial treatment was based on methylene blue, then ascorbic acid. The genetic study revealed a c.463+8G>C mutation of CYB5R3 confirming the diagnosis of methemoglobinemia type II. The diagnosis of methemoglobinemia, although rare, should be considered in the presence of psychomotor retardation with cyanosis and subacute onset hypoxemia, especially in the presence of a family history. [ABSTRACT FROM AUTHOR]

Background: Malakoplakia is a rare chronic granulomatous disease characterized by the presence of Michaelis-Gutmann bodies (MGBs) within histiocytic aggregates. It predominantly affects immunocompromised individuals, including those living with Human Immunodeficiency Virus (HIV). Case Presentation: We present a unique case of bifocal malakoplakia in a 49-year-old man, previously with Coronavirus disease 2019 (COVID-19) and HIV positive, presented with respiratory symptoms, weight loss, and lymphadenopathy. He had various infections including Non-Tuberculous Mycobacteria (NTM), Cytomegalovirus (CMV), and Candida, with evolving lung and gastrointestinal issues. Despite treatment attempts, he deteriorated due to respiratory distress, multi-organ failure, and coagulopathy, leading to his unfortunate demise. Conclusion: This report presents a distinctive and complex case of malakoplakia in an HIV-positive patient, a rare inflammatory disorder originally described by Michaelis and Gutmann in 1902. The hallmark Michaelis-Gutmann organisms were observed, confirming the diagnosis. While typically affecting the urinary tract, this case demonstrates the exceptional ability of malakoplakia to manifest in various organ systems, including pulmonary, gastrointestinal, and more. Although Escherichia coli is a prevalent associated pathogen, the exact cause remains elusive. Treatment, often involving surgical excision and antibiotic therapy, underscores the challenging nature of managing this condition in immunocompromised individuals. [ABSTRACT FROM AUTHOR]

Periodontitis is a polymicrobial disease, characterized by distinct pathogens which results in the destruction of periodontal tissues. Early identification of periodontal pathogens can aid in the rationale of conservative treatment approaches. Fluorescence in situ hybridization (FISH) is one of the rapid methods for easy identification of microbial pathogens. Nano biofusion (NBF)gel contains nanoparticles which are efficient in rapidly penetrating the cells possessing special property of substantivity, antimicrobial, and anti inflammatory activity. Chlorhexidine gel(CHX gel) has long been used in dentistry and exhibits bacteriostatic, bactericidal and anti-inflammatory properties. Hence present study aimed to compare clinical and microbiological effectiveness of locally delivered NBF gel and chlorhexidine gel as an adjunctive therapy to scaling and root planning (SRP) in the treatment of chronic periodontitis. Microbiological assessment was done suing Fluorescent In situ Hybridisation (FISH) technology to visualize, identify and quantitate Porphyromonas gingivalis (known Periodontal pathogen), Filifactor Alocis, Synergistes species (Novel pathogens). METHODOLOGY: The study sample consisted of 75 sites from Chronic periodontitis patients of both genders within the age group of 30-60 years. Study samples were divided into 3 treatment groups based on their inclusion and exclusion criteria as Group A, Group B and Group C. GROUP A comprised of 25 sites which received Full mouth scaling and root planing alone. GROUP B comprised of 25 sites which received Full mouth scaling and root planing followed by NBF gel application. GROUP C comprised of 25 sites which received full mouth scaling and root planing followed by CHX gel application. Patients in all the three groups were evaluated at baseline, 6 weeks, and 12 weeks interval and clinical parameters such as plaque index, Modified sulcular bleeding index(MSBI), Probing pocket depth(PPD) and clinical attachment level(CAL) were recorded. Subgingival samples were collected from 10 sites of each group(GROUP A, GROUP B, GROUP C) at baseline and after 6 weeks and the microbiological analysis were carried to visualize, identify and quantitate Porphyromonas gingivalis (known Periodontal pathogen), Filifactor Alocis, Synergistes species (Novel pathogens) from all the three groups using Fluorescent In situ Hybridisation (FISH) technology. RESULTS: In the present study, group B(SRP + NBF gel) and group C (SRP+CHX gel) showed progressive improvements in all the clinical and microbiological parameters on evaluated time periods. However group C (SRP+CHX) has Shown significantly higher improvement in reducing the bacterial count as compared to Group B(SRP+NBF gel) and Group A(SRP alone). In NBF gel, the NBF of propolis along withVitamin C and Vitamin E has brought about the tremendous improvement in periodontal health of the patients. Chlorhexidine (CHX) gluconate present in hexigel has both bacteriostatic abactericidal activity and also exhibits antiin flammatory properties. [ABSTRACT FROM AUTHOR]

Intravenous vitamin C (IVC) is a common therapy used by naturopathic doctors and other licensed integrative practitioners. With several proposed mechanisms of action related to cancer care, it is often used in integrative oncology settings. Despite its common use, there are no published evidence-based resources on the efficacy, safety, and procedural considerations for the use of IVC in practice. The objectives of this review are to summarize the evidence on high-dose IVC in supportive cancer care and to provide a resource of practical clinical guidance for IVC application. In cancer care, IVC is most commonly used at doses high enough to achieve a potential cancer cell cytotoxicity. This review focuses on IVC at doses of ≥15 g which we have defined as high-dose. To date, there are 23 published clinical trials evaluating the use of high-dose IVC in cancer support. Based on data from these clinical studies, IVC used concurrently with oxidative therapies, such as chemotherapy and radiotherapy, seems to produce the greatest likelihood for improvements in quality of life and additive anti-tumour effects compared with IVC as monotherapy or with non-oxidative therapies. IVC has shown promise in improving quality of life in patients with breast cancer and advanced pancreatic and ovarian cancers. Limited evidence suggests survival and/or tumour response may be improved with the inclusion of IVC in patients with advanced pancreatic cancer, non-small cell lung cancer, and RAS-mutated colorectal cancer. IVC does not offer curative potential, and further research is needed to explore its effectiveness relevant to mortality outcomes. Practical guidance including assessment, monitoring, dosing, safety, and communication with other healthcare providers is discussed. [ABSTRACT FROM AUTHOR]

Introduction: Effective glucose control and better prevention of complications resulting from diabetes could be the crucial task in managing people with diabetes mellitus during the COVID-19 pandemic for reducing the vulnerability of people with diabetes toward the disease and preventing the severe outcomes resulting from COVID-19. Materials and Methods: This is a prospective observational study conducted at a tertiary care hospital in Andhra Pradesh. The present study involved 200 diabetic patients through a convenient sampling method (males: 100 and females: 100) who presented to the tertiary care hospital of Andhra Pradesh between August 2020 and January 2021. Results: The highest age of individuals included in the study was 88 years, whereas the lowest age of participants included was 35 years. The majority of the patients (72%) have their blood glucose levels measuring <200 mg/dl. Discussion: Vitamin C is a well-known antioxidant having significant immune-modulating effects through transformation of T-cells, phagocytic function, and interferon production. Zinc is an element having several physiological functions in the human body as antioxidant and anti-inflammatory effects. Zinc is also a cofactor in the action of around 300 enzymes. Conclusion: Nutrient supplementation with zinc, Vitamin C and D can be a good option as it is a safe, low cost, and readily available measure, helpful to get along with the fear of getting infected during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

To investigate the effect of vitamin C combined with recombinant basic fibroblast growth factor (rbFGF) on inflammatory factors and oxygen environment in patients with high‐voltage electrical burns. A retrospective analysis of 98 patients with high‐voltage electrical burns admitted to our hospital from January 2021 to April 2022. A total of 98 patients were divided into research group and control group, including 49 cases treated with vitamin C combined with rbFGF and 49 cases treated with only rbFGF. The disappearance time of clinical symptoms, wound healing rate, area of granulation tissue growth, level of inflammatory factors, oxygen environment were compared between two groups after one and three courses of treatment. After treatment, the disappearance time of erythema, pain, swelling, blisters, exudate symptoms, wound healing time, scab formation time, and hospitalisation time in the research group were significantly better than those in control group (P <.05). There was no significant difference in the wound healing rate and area of granulation tissue growth between the two groups after one course of treatment (P >.05), while it is significantly better than those in control group after three courses of treatment (P <.05). The inflammatory factors, succinate dehydrogenase (SDH), lactate dehydrogenase (LDH) scores in research group were significantly better than that in control group after three courses of treatment (P <.05). Vitamin C combined with rbFGF may be worthy to reduce inflammatory factors, regulate oxygen environment, which can be popularised and applied in clinical practice. [ABSTRACT FROM AUTHOR]

During the Coronavirus disease 2019 (COVID-19) pandemic, children are less affected than adults, and underlying conditions and older age are associated with severe disease. Following the SARS-CoV-2 pandemic, outbreaks of cases with Kawasaki-like disease and a few others with the multisystem inflammatory syndrome in children related to COVID-19 (MISC) have been reported. Here, we report a two-year-old girl initially admitted to urgent pediatric care and was diagnosed with Kawasaki disease associated with COVID-19 infection to highlight the clinical features and signs. Physical examination showed a fussy infant with swelling of the hands, feet, and lips, red lips, restlessness, anorexia, and fever. According to the clinical and laboratory findings, Kawasaki disease was diagnosed. Laboratory tests for SARS-CoV-2 were positive. The patient's clinical symptoms improved after receiving medications such as IVIG and ascorbic acetyl acid. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for the COVID-19 pandemic that can lead to severe respiratory distress requiring hospitalization and can be fatal. Media have reported that various dietary supplements (DS) or their combination with different medications can prevent infection or decrease disease severity. Here, we analyzed data collected from 15,830 patient follow-up telephone interviews from the University of Arkansas for Medical Sciences COVID-19 testing sites from March 15 to August 1, 2020. Within the REDCap database, we recorded patient demographics and DS and medication use. In total, data on DS and medication use was available for 8,150 study participants, of whom 21.9% and 4.1% reported using DS or medications, respectively, to either prevent or treat COVID-19. The majority of respondents were female (64%) and non-Hispanic whites (44.5%). Most individuals (64.5%) who took DS were younger than 50 years of age. Products such as vitamin C (1,013, 33.2%), multivitamins (722, 23.6%), and vitamin D (294, 9.6%) were the most commonly used DS among the responders. Analysis of the DS use and symptom scores association did not provide a strong evidence of beneficial health effects of DS. The results of this study demonstrate that a significantly higher proportion of study participants considered usage of DS to mitigate or prevent COVID-19-related symptoms compared to those who preferred medications. However, lack of observable health benefits associated with ingestion of DS suggests that more rigorous research is needed to substantiate the label claims. [ABSTRACT FROM AUTHOR]

The article describes the case of a 2-year-old boy who presented to a hospital with a chief complaint that included the development of new onset weakness in the lower extremities over 1-week duration. Topics covered include the medical and surgical history of the patient, the findings of the physical and laboratory examinations which led to the diagnosis of scurvy, and patient outcome following ascorbic acid treatment.

A case study of 5-year-old girl was brought in to the emergency department (ED) by emergency medical services after a syncopal episode reported it to be weak and performed cardiopulmonary resuscitation. Topics include decreased oral intake and nonspecific abdominal pain for several days; and usual state of health except for an active head lice (Pediculosis capitis) infestation admitted to the pediatric intensive care unit for further observation and management.

Purpose To evaluate current evidence on the utility of hydrocortisone, ascorbic acid, and thiamine (HAT) therapy for the management of septic shock. Summary The following keyword search terms were utilized in PubMed to identify relevant articles: ascorbic acid, thiamine, hydrocortisone, shock, and critical care. Articles relevant to HAT therapy in patients with septic shock were selected. Retrospective cohorts and randomized controlled trials were included in this review; case reports/series were excluded. Data from included studies illustrating the use of HAT therapy for the management of sepsis and septic shock, including data on time to HAT therapy initiation, severity of illness at baseline, duration of vasopressor therapy, progression of organ failure, and mortality, were evaluated. Conclusion The utilization of HAT therapy for the management of sepsis and septic shock remains controversial. Hemodynamic benefits have been shown to be most pronounced when HAT therapy is initiated earlier. Future studies directed at earlier initiation may be necessary to confirm this theory. [ABSTRACT FROM AUTHOR]

Aim: Cranberries (Vaccinium macrocarpon) are traditionally used in prevention of urinary tract infections (UTIs). The authors' aim was to evaluate effects of a supplement containing cranberry extract, pumpkin seed extract, vitamin C, and vitamin B2 on recurrent uncomplicated UTIs in women and their intestinal microbiota. Methods: A prospective, uncontrolled exploratory study was conducted in women with recurrent uncomplicated UTIs. The primary exploratory outcome was the number of UTIs in a 6-month prospective observation period compared with a 6-month retrospective period. Further outcomes included number of antibiotics, quality of life (SF-36), intestinal microbiota (assessed by 16S rRNA amplicon sequencing), and evaluation questions. Parameters were assessed at baseline and after 1, 2, and 7 months (start of intake of cranberry supplement after 1 month for 6 months). p-Values were calculated with the pairwise Wilcoxon signed-rank test for a diversity and permutational multivariate analysis of variance. Results: Twenty-three women (aged 52.7 ± 12.4 years) were included in the study. Participants reported 2.2 ± 0.8 UTIs (at baseline) in the previous 6 months. After 6 months of cranberry intake, participants reported a significant decrease to 0.5 ± 0.9 UTIs (p < 0.001). Number of antibiotic therapies was also significantly (p ± 0.001) reduced by 68% during 6 months of cranberry intake (0.14 ± 0.35) when compared with 6 months retrospectively (1.14 ± 0.71). The SF-36 physical component score increased from 4 4.9 ± 5.5 at baseline to 45.7 ± 4.6 at 7 months (p = 0.16). The SF-36 mental component score decreased slightly from the baseline value of 46.5 ± 6.5 to 46.2 ± 6.4 at 7 months (p = 0.74). No significant intragroup mean changes at genus, family, or species level for a and b diversity within the intestinal microbiota were found. In the evaluation questions, participants rated the cranberry extract positively and considered it beneficial. The supplement intake was safe. Conclusions: This study shows that women with recurrent uncomplicated UTIs benefit from cranberry intake. Future larger clinical studies with further investigation of the mechanisms of action are required to determine the effects of cranberries on participants with uncomplicated UTIs. [ABSTRACT FROM AUTHOR]

During the infection and treatment of the SARS-CoV-2 viral infection, age and comorbidities play a major role in the successful management of COVID-19. The nutritional status changes which occur in the body vary with the age and underlying conditions and has a vital role in the functioning of the immune system and cellular membrane integrity, thus minimizing the vulnerability to the infection. Considering the data already published by eminent researchers, a few micronutrients have shown outstanding results as supportive therapies in the treatment of viral infections. Micronutrient like zinc improves the membrane barrier integrity, has anti-inflammatory activity, and is involved in antibody production. Vitamin A supports the phagocytic activity of macrophages, while vitamin C reduces the worsening of respiratory tract infections by restoring the dysfunctional epithelial barrier of the lungs. Vitamin D, vitamin E, selenium, and omega-3 fatty acid metabolites play a major role in immunomodulation and in the inhibition of proinflammatory cytokine production. Magnesium is involved in the synthesis of antibodies, while copper, vitamin B12, and folate have significant effects on immune cells. A few researchers suggest that iron supplementation has reduced the risk of acquiring respiratory tract infections in children. As the age of the patient increases, the need for micronutrients increases, thus leading to an imbalanced nutritional status which in turn increases the risk and fatality of the infections. The use of micronutrients in modulating the inflammatory, immune responses, and the epithelial barrier integrity is explored during the treatment of viral infections for faster recovery. [ABSTRACT FROM AUTHOR]

The article describes the case of a two-year-old male patient with the inability to bear weight on bilateral lower extremities. Topics discussed include symptoms presented by the patient, results of the patient's magnetic resonance imaging, the patient's medical history, the final diagnosis and the differential diagnosis of limb pain toddlers.

Introduction: Methemoglobin (MetHb) is the rare form of hemoglobin (Hb) produced by abnormal oxidation of Hb. Methemoglobinemia may be hereditary or acquired after exposure to certain drugs, toxins, chemicals, food, etc., Case Presentation: Here, we report a case of methemoglobinemia induced by dapsone in a young girl who presented with respiratory distress and was treated successfully with methylene blue (MB). Conclusion: MetHb levels can be seen increased inpatient on dapsone. Methemoglobinemia is a rare cause of respiratory distress and tachypnea in a patient on dapsone. MB and Vitamin C are recommended treatments in such cases. [ABSTRACT FROM AUTHOR]

A 3-year-old boy came to our outpatient department with complaints of dark urine noticed by the mother since birth. On examination, the child had dysmorphic facies, synophrys, hypertelorism, micrognathia, prominent lashes, and difficulty in vision. The weight and height were below the third centile. Urinalysis showed glucosuria; tandem mass spectrometry and gas chromatography-mass spectrometry showed high levels of homogentisic acid and glycerol-3-phosphate. Exome sequencing revealed a missense homozygous variant in the gene encoding homogentisate 1,2-dioxygenase. A diagnosis of alkaptonuria was made and the patient was started on a low-protein diet and ascorbic acid. [ABSTRACT FROM AUTHOR]

Objectives: Sepsis is a common condition in the ICU. Despite much research, its prognosis remains poor. In 2017, a retrospective before/after study reported promising results using a combination of thiamine, ascorbic acid, and hydrocortisone called "metabolic resuscitation cocktail" and several randomized controlled trials assessing its effectiveness were performed.Design: We conducted a systematic review and meta-analysis of randomized controlled trials in septic ICU patients to assess the effects of this combination therapy.Setting: PubMed, Embase, and the Cochrane library databases were searched from inception to March of 2021. Data were extracted independently by two authors. The main outcome was the change in Sequential Organ Failure Assessment score within 72 hours. Secondary outcomes included renal composite endpoints (acute kidney injury) Kidney Disease - Improving Global Outcome organization stage 3 or need for renal replacement therapy, vasopressor duration, and 28-day mortality.Subjects: We included randomized controlled trials with patients admitted to the ICU with sepsis or septic shock.Intervention: The trials compared a combination of thiamine, ascorbic acid, and hydrocortisone to standard care or placebo in patients admitted to ICU with sepsis or septic shock.Measurements and Main Results: We included eight randomized controlled trials (n = 1,335 patients). Within 72 hours, the median of mean improvement was -1.8 and -3.2 in the control and intervention groups, respectively (eight randomized controlled trials, n = 1,253 patients); weighted mean difference -0.82 (95% CI, -1.15 to -0.48). Data were homogeneous and the funnel plot did not suggest any publication bias. Duration of vasopressor requirement was significantly reduced in the intervention group (six randomized controlled trials). There was no evidence of a difference regarding the ICU mortality and the renal composite outcome (acute kidney injury KDIGO 3 or need for renal replacement therapy, seven randomized controlled trials).Conclusions: Metabolic resuscitation cocktail administrated in ICU septic patients improves change in Sequential Organ Failure Assessment score within 72 hours. However, this improvement is modest and its clinical relevance is questionable. The impact on renal failure and mortality remains unclear. [ABSTRACT FROM AUTHOR]

This scientific letter discusses a case of methemoglobinemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency and the successful treatment with ascorbic acid. G6PD deficiency is a common enzyme deficiency that can lead to oxidative stress and hemolysis in red blood cells. Methemoglobinemia occurs when there is an insufficient reduction capacity, resulting in tissue hypoxia. In this case, a 14-year-old boy presented with symptoms and was treated with intravenous hydration, ascorbic acid, and allopurinol, which resulted in improvement and normalization of methemoglobin levels. The article emphasizes the importance of considering methemoglobinemia in patients with unexplained cyanosis and the potential use of ascorbic acid in treatment. [Extracted from the article]

Chronic foot ulcers are associated with a high risk of osteomyelitis, poor quality of life, amputations and disability. Few strategies improve their healing, and amputation rates in high-risk foot services are usually over 30 %. We conducted a randomised, inactive-placebo controlled, double-blind trial of 500 mg of slow-release vitamin C in sixteen people with foot ulcers in the Foot Wound Clinic at Westmead Hospital. Nine were randomised to control and seven to vitamin C. When serum vitamin C results become available at 4 weeks, all people with deficiency were offered both vitamin C and glucosamine tablets for the next 4 weeks. Patients without baseline deficiency continued their original assigned treatment. The primary outcome was percentage ulcer healing (reduction in ulcer size) at 8 weeks. Fifty percentage of subjects had baseline vitamin C deficiency, half having undetectable levels. Healing at 8 weeks was significantly better in the vitamin C group (median 100 v. –14 %, P = 0·041). Healing without amputation occurred in all patients in the vitamin C group. In contrast, 44 % of controls had not healed their ulcer at the end of the study period. Vitamin C improved healing of foot ulcers. Further studies are needed to determine whether there is a threshold effect for serum vitamin C above which therapy is ineffective and whether there are better or lesser responding subgroups. Because of its low cost and ease of access and administration, we recommend offering vitamin C therapy to all people who have chronic foot ulcers and potentially suboptimal vitamin C intake. Trial registration number: ACTRN12617001142325. [ABSTRACT FROM AUTHOR]

Rapid wound closure is important after arthroplasty procedures to prevent postoperative complications. Platelets are rich in growth factors and leukocytes contribute to innate immunity. We hypothesized that topical leukocyte platelet‐rich plasma (L‐PRP) derived from the blood of patients would be beneficial to wound healing. In this randomized controlled trial, patients subjected to elective total hip arthroplasty (THA) were assigned by concealed allocation either L‐PRP application onto the sutured fascia or no application (control) after the THA intervention. In addition, all patients received 1.5 g protein/kg, 5 g L‐arginine, 500 mg vitamin C and 44 mg zinc daily over the 4‐week postoperative period to obtain optimal nutrition. The primary endpoint was complete healing of the skin incision. The secondary endpoints were blood transfusions, length of hospital stay, pain and wound infections. Sixteen patients in the L‐PRP group and 17 patients in the control group completed the trial. L‐PRP treatment accelerated complete wound healing after 3 weeks (seven in the L‐PRP group vs. zero in the control group, p = 0.003) and after 4 weeks (12 in the L‐PRP group vs. six in the control group, p = 0.037). No postoperative superficial wound infections occurred within 4 weeks, and there were no significant differences in the other secondary outcomes. L‐PRP generated in 10 sex‐matched healthy volunteers revealed increased concentrations of platelets (5.8‐fold) and leukocytes (2.3‐fold) compared with those in whole blood. Furthermore, the concentration of keratinocyte mitogen epidermal growth factor in L‐PRP (380 ± 130 pg/ml, mean ± SD) was higher (p < 0.001) than that in serum (130 ± 26 pg/ml). In conclusion, a single intraoperative local application of L‐PRP promoted wound healing after THA, possibly mediated by EGF receptor agonists. [ABSTRACT FROM AUTHOR]

Coronavirus infection is commonly associated with pulmonary manifestations. Extra pulmonary manifestations including gastrointestinal involvement is also well established recently in COVID positive patients. However, pancreatic involvement due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is an unusual presentation and therefore much more attention has to be given to the pancreatic injury caused by SARS-CoV-2 infection. There is different pathophysiology behind the pancreatic dysfunction associated with SARS-CoV-2 infection. It can either be the systematic inflammatory immune response causing tissue damage or direct invasion of pancreatic cells. The virus enters the host cells or tissues via its spike protein that binds to the angiotensin-converting enzyme 2 (ACE2) present in the pancreatic islets cells, which in turn leads to pancreatic injury and dysfunction. It can also occur as an adverse effect of medications like ritonavir-lopinavir that is a therapeutic option for COVID-19 patients. Here, we report a case of a patient with COVID-19-in-duced acute pancreatitis where medical history and further investigations eliminated all the other expected causes of pancreatitis. He came with complaints of hiccups for two weeks and abdominal pain. He tested positive for COVID-19 and was managed with antibiotics like mero-penem. Laboratory investigations as well as computed tomography abdomen paved way for the detection of pancreatic involvement. Pancreatic injury and COVID-19 infection were resolved during the course in hospital and the patient was discharged on medications including zinc, vitamin C supplementation, and also with ciproflox-acin. [ABSTRACT FROM AUTHOR]

Malaria is a life-threatening disease caused by Plasmodium and represents one of the main public health problems in the world. Among alterations associated with the disease, we highlight the hepatic impairment resulting from the generation of oxidative stress. Studies demonstrate that liver injuries caused by Plasmodium infection are associated with unbalance of the antioxidant system in hepatocytes, although little is known about the role of antioxidant molecules such as glutathione and vitamin C in the evolution of the disease and in the liver injury. To evaluate disease complications, murine models emerge as a valuable tool due to their similarities between the infectious species for human and mice. Herein, the aim of this study is to evaluate the effect of antioxidants glutathione and vitamin C on the evolution of murine malaria and in the liver damage caused by Plasmodium berghei ANKA infection. Mice were inoculated with parasitized erythrocytes and treated with glutathione and vitamin C, separately, both at 8 mg/kg during 7 consecutive days. Our data showed that during Plasmodium infection, treatment with glutathione promoted significant decrease in the survival of infected mice, accelerating the disease severity. However, treatment with vitamin C promoted an improvement in the clinical outcomes and prolonged the survival curve of infected animals. We also showed that glutathione promoted increase in the parasitemia rate of Plasmodium-infected animals, although treatment with vitamin C has induced significant decrease in parasitemia rates. Furthermore, histological analysis and enzyme biochemical measurement showed that treatment with glutathione exacerbates liver damage while treatment with vitamin C mitigates the hepatic injury induced by the infection. In summary, the current study provided evidences that antioxidant molecules could differently modulate the outcome of malaria disease; while glutathione aggravated the disease outcome and liver injury, the treatment with vitamin C protects the liver from damage and the evolution of the condition. [ABSTRACT FROM AUTHOR]

Objectives and Setting.: As the lethal COVID-19 pandemic enters its second year, the need for effective modalities of alleviation remains urgent. This includes modalities that can readily be used by the public to reduce disease spread and severity. Such preventive measures and early-stage treatments may temper the immediacy of demand for advanced anti-COVID measures (drugs, antibodies, vaccines) and help relieve strain also on other health system resources. Design and Participants.: We present results of a clinical study with a multi-component OTC "core formulation" regimen used in a multiply exposed adult population. Analysis of clinical outcome data from our sample of over 100 subjects − comprised of roughly equal sized regimen-compliant (test) and non-compliant (control) groups meeting equivalent inclusion criteria − demonstrates a strong statistical significance in favor of use of the core formulations. Results.: While both groups were moderate in size, the difference between them in outcomes over the 20-week study period was large and stark: Just under 4% of the compliant test group presented flu-like symptoms, but none of the test group was COVID-positive; whereas 20% of the non-compliant control group presented flu-like symptoms, three-quarters of whom (15% overall of the control group) were COVID-positive. Conclusions.: Offering a low cost, readily implemented anti-viral approach, the study regimen may serve, at the least, as a stopgap modality and, perhaps, as a useful tool in combatting the pandemic. [ABSTRACT FROM AUTHOR]

Background: Recent studies suggest that hydrocortisone, Vitamin C, and thiamine alone or in combination may improve the clinical outcomes of patients with septic shock. The aim of this study is the effects of this combination therapy on clinical outcome and sepsis biomarkers in patients with septic shock. Materials and Methods: Fifty-eight consecutive patients suffering septic shock were randomly assigned into two groups receiving the combination therapy of hydrocortisone (50 mg/6 h, intravenously), Vitamin C (1.5 g/6 h in 100 ml normal saline or DW5%, intravenously), and thiamine (200 mg/12 h in 50 ml normal saline or DW5%, intravenously) or placebo for up to 4 days. Results: The decline in procalcitonin, lactate, and leukocyte count 72 h after the initiation of treatment was significantly greater in the intervention as compared to the control group. The intervention group has a significantly lower sequential organ failure assessment score 72 h after treatment (P < 0.001). The mean duration of vasopressor dependency was shorter in the intervention group (P = 0.039). In-hospital death occurred in 10.3% of the patients who received combination therapy and 37.9% in the control group (P = 0.014). Conclusion: The administration of the triple combination of hydrocortisone, thiamine, and Vitamin C appeared to be effective in improving the clinical outcomes of patients with septic shock and of reducing vasopressor requirements with a significant increase in the rate of improvement of sepsis biomarkers. [ABSTRACT FROM AUTHOR]

Background: Systemic vitamin C supplementation after wrist fracture has been suggested to reduce the incidence of complex regional pain syndrome (CRPS). This study aimed to evaluate the effect of regional vitamin C in Bier block in the early phase of fracture on CRPS occurrence following surgery for distal radius fractures. Methods: Seventy-four patients with isolated extra-articular distal radius fracture with the plan of fixation under Bier block were enrolled. Patients were assigned randomly into two groups: receiving either 500 mg vitamin C or sterile water as a Bier block adjuvant. Both groups received 500 mg of oral vitamin C for six weeks. The patients were evaluated for CRPS signs and symptoms at 2, 4, 6, and 12 weeks post-surgery. Results: The overall incidence of CRPS 12 weeks after surgery in the vitamin C group was significantly less than the controls (22.9% vs 45.5%, p = 0.04). Logistic regression analysis showed that the only significant contribution in predicting the incidence of CRPS came from the intervention variable (OR 0.26, CI95% 0.08–0.85; P = 0.027). Conclusions: The findings suggest that adding vitamin C 500 mg to the local anesthetic in Bier block significantly reduces the incidence of CRPS following distal radius fractures. [ABSTRACT FROM AUTHOR]

Introduction: Patients with end-stage kidney disease (ESKD) suffer from functional iron deficiency where despite the presence of sufficient iron stores in the body, adequate iron is unavailable for heme synthesis. This study hypothesis was that in patients undergoing hemodialysis (HD), administration of intravenous (IV) ascorbic acid (AA) exerts a good effect on the management of anemia, either by increasing the mobilization of iron from tissue stores or acting as an antioxidant to overcome the inflammatory block and increase the erythropoietin sensitivity. Methods: Fifty patients with ESRD who were on regular HD were included in the study. Patients' ferritin levels ranged from 500 to 1200 ng/mL with transferrin saturation of 30% or more. However, all patients were anemic and received erythropoietin therapy. Iron therapy was discontinued in the first group, whereas it was continued in the second group that received IV AA. Results: A significant increase in the levels of Hb was observed in the second group after 6 months despite the decrease in ferritin levels in both the groups. Transferrin saturation decreased in both groups, the decrease being more in the first group. The levels of C-reactive protein (CRP) decreased in the second group, whereas these increased in the first group. Conclusions: Intravenous AA as an adjuvant therapy with iron exerts a favorable and significant effect on the Hb, serum ferritin, and CRP levels in patients with ESKD having anemia. The discontinuation of iron therapy only decreases the serum ferritin levels and does not improve the Hb or CRP levels. [ABSTRACT FROM AUTHOR]

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Objective To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren's syndrome (SS). Methods Forty-five patients with SS were randomly assigned to a control group (no irrigation, control, n  = 15), to irrigation of the major salivary glands with saline (saline, n  = 15) or to irrigation with saline followed by corticosteroid application (triamcinolone acetonide in saline, saline/TA, n  = 15). Unstimulated whole saliva flow (UWSF), chewing-stimulated whole saliva flow (SWSF), citric acid-stimulated parotid flow, Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) scores were obtained 1 week before (T0), and 1, 8, 16, 24, 36, 48 and 60 weeks after sialendoscopy. Data were analysed using linear mixed models. Results Irrespective of the irrigation protocol used, sialendoscopy resulted in an increased salivary flow during follow-up up to 60 weeks. Significant between-group differences in the longitudinal course of outcomes were found for UWSF, SWSF, XI and ESSPRI scores (P  = 0.028, P  = 0.001, P  = 0.03, P  = 0.021, respectively). UWSF at 60 weeks was higher compared with T0 in the saline group (median: 0.14 vs median: 0.10, P  = 0.02) and in the saline/TA group (median: 0.20, vs 0.13, P  = 0.035). In the saline/TA group SWSF at 48 weeks was higher compared with T0 (median: 0.74 vs 0.38, P  = 0.004). Increase in unstimulated salivary flow was also reflected in improved CODS, XI and ESSPRI scores compared with baseline. Conclusion Irrigation of the major salivary glands in patients with SS increases salivary flow and reduces xerostomia. [ABSTRACT FROM AUTHOR]

Glutathione synthetase (GSS) deficiency is a rare disorder, occurring with a frequency of less than 1 in 100,000 individuals worldwide. The clinical presentation may vary from mild to severe, and manifestations include hemolytic anemia, hyperbilirubinemia, metabolic acidosis, neurological problems, and sepsis. Herein, we present a case of a newborn boy with the most severe phenotype of GSS deficiency, diagnosed based on clinical features and increased urinary 5-oxoproline levels determined via gas chromatography mass spectrometry (GCMS) testing. [ABSTRACT FROM AUTHOR]

Importance: Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis.Objective: To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis.Design, Setting, and Participants: Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction. Participants were enrolled in the emergency departments or intensive care units at 43 hospitals in the United States between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020.Interventions: Participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone.Main Outcomes and Measures: The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality.Results: Among 501 participants randomized (median age, 62 [interquartile range {IQR}, 50-70] years; 46% female; 30% Black; median Acute Physiology and Chronic Health Evaluation II score, 27 [IQR, 20.8-33.0]; median Sequential Organ Failure Assessment score, 9 [IQR, 7-12]), all completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of -1 day (95% CI, -4 to 2 days; P = .85). Thirty-day mortality was 22% in the intervention group and 24% in the placebo group.Conclusions and Relevance: Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference.Trial Registration: ClinicalTrials.gov Identifier: NCT03509350. [ABSTRACT FROM AUTHOR]

To explore repurposing known natural products for managing patients with mild to moderate symptoms of COVID-19. We present a case report of a middle aged woman, who was positive to COVID 19, with mild to moderate symptoms; who self –managed at home using well formulated herbal supplement (Combi-5) taken along with vitamin C and Zinc supplements. She recovered within a short time. While we may not conclude from this report that Combi-5 was solely responsible for the recovery of the patient, we strongly believe that it played significant role through different mechanisms in facilitating early recovery from the infection. Further studies are needed to evaluate the phytochemical and pharmacological constituents of the supplement; investigate its direct effect(s) on SARS CoV-2 and conduct randomized controlled trial to elucidate its clinical benefits. [ABSTRACT FROM AUTHOR]

Aim. To investigate whether vitamin C performs well as a supplemental treatment for common cold. Method. After systematically searching through the National Library of Medicine (PubMed), Cochrane Library, Elsevier, China National Knowledge Infrastructure (CNKI), VIP databases, and Wanfang databases, 10 randomized controlled trials were selected for our meta-analysis with RevMan 5.3 software. Published in China, all 10 studies evaluated the effect of combined vitamin C and antiviral therapy for the treatment of common cold. Results. The total efficacy (RR = 1.27 , 95% CI (1.08, 1.48), P = 0.003), the time for symptom amelioration (MD = − 15.84 , 95% CI (-17.02, -14.66), P < 0.00001), and the time for healing (I , 95% CI (-14.98, -4.22), P = 0.0005) were better with vitamin C supplementation than with antiviral therapy alone. Conclusions. Vitamin C could be used as a supplementary therapy along with antiviral regimens to relieve patients from the symptoms of common cold. [ABSTRACT FROM AUTHOR]

Objective: To investigate the preventive effects of a combined antioxidant drug (N‐acetylcysteine, vitamin E, and vitamin C [NEC]) on migraine outcomes. Migraine is characterized by increased oxidative stress and neurogenic inflammation in the brain; therefore, antioxidants may have a migraine preventive effect. Design: Randomized, double‐blind, sham‐controlled pilot study. Setting: Australian community. Subjects: Adults reporting 2 to 8 migraines per month for at least a year. Methods: After a 1‐month baseline period, 35 subjects completed 3 months of treatment with NEC (n = 19) or sham (n = 16) capsules. The primary outcome was the difference in mean number of headaches per month between baseline and final month of the trial for NEC and sham groups; secondary outcomes are listed below. Results: For NEC there was a significant decrease in mean number of headaches by 3.0 per month (P = 0.004) compared with 1.4 for sham (P = 0.073); there was no significant difference in these changes between the 2 groups (P = 0.052). Average monthly headache (P = 0.041) and migraine frequency (P = 0.018) were significantly less for NEC vs. sham. In NEC subjects, there was a significant decrease in average monthly migraine days (−3.1), moderate/severe headache days (−3.2), migraine duration, headache pain scores, and acute headache medication use. Conclusions: This is the first randomized controlled trial to find that combined antioxidant therapy with NEC reduces headaches and migraines in adult migraineurs. Given the limitations of this pilot study, an adequately powered randomized controlled trial is planned to further investigate antioxidant prophylaxis in migraine. [ABSTRACT FROM AUTHOR]

Aims and objective: To study the effects of various components of "metabolic resuscitation" on the shock reversal among patients with septic shock Introduction: Sepsis is characterized by dysregulated host response to infection. Mitochondrial dysfunction which occurs early in sepsis is associated with multiorgan dysfunction. Therapies such as adequate resuscitation, early administration of antibiotics, and aggressive monitoring reduced mortality substantially but it still remains high for those with septic shock. Combination of vitamin C, hydrocortisone, and thiamine improved outcome in a retrospective study, but how effective is this therapy in isolation compared to combination has to be known before implementation. Materials and methods: This study is single-center, prospective, randomized nonblinded trial done in septic shock patients admitted to the medical intensive care unit. Subjects were randomized to three groups of hydrocortisone (H), hydrocortisone, ascorbic acid (HA), hydrocortisone, ascorbic acid, thiamine (HAT). Following randomization, they received hydrocortisone 200 mg over 24 hours as infusion, intravenous ascorbic acid 1.5 g every 6 hours, thiamine 200 mg twice daily as allotted and continued till shock reversal or death. Primary outcome is time to shock reversal and secondary outcome is time to vasopressor dose reduction from hemodynamic SOFA score 4-3. Results: Twenty seven subjects were randomized into 3 groups of 9 each, of which 17 (63%) patients met primary outcome and secondary outcome has been studied in 16 (59%) patients. Eight patients (29.5%) died and did not meet either outcome and two patients (7.5%) met secondary outcome but not primary outcome because of discharge to other hospital. There is no difference in time to shock reversal [mean, SD in H (7422, 8348), HA (2528, 3086), HAT (1860, 749), p value 0.17]. There is no difference in time to shock reversal from hemodynamic SOFA 4-3 [mean, SD in H (4935, 6406), HA (2310, 2515), HAT (1800, 1282), p value 0.35]. Conclusion: In patients with septic shock, there is no difference in time to shock reversal comparing individual components of metabolic resuscitation. [ABSTRACT FROM AUTHOR]

Objectives: Preeclampsia is a hypertensive disorder associated with pregnancy and is the leading cause of both maternal and neonatal morbidity and mortality. Recent reports suggest that free radical-induced endothelial cell injury might be an etiologic factor in the pathogenesis of preeclampsia. The aim of this study was to determine the protective effects of vitamins C and E for the prevention of preeclampsia. Methods: This clinical trial was conducted in the year 2018 in the clinical centers of Lorestan University of Medical Sciences. One hundred and sixty nulliparous women aged 18–38 years without any risk factors for preeclampsia were divided into two groups. The first group received a 400-IU/day dose of vitamin E orally and a 1000-mg/day dose of vitamin C with iron tablets during 20–24 weeks of pregnancy, while the control group received only iron tablets. Finally, the data were analyzed using descriptive statistics and frequency distribution tables. Results: The incidence of preeclampsia in the control group was 17.5% and in the intervention group was 5%, which was significantly different. The mean systolic pressures before and after intervention were 99.43 ± 7.8 and 12.44 ± 19.1, respectively, in the control group, and 99.3 ± 8.3 and 106.12 ± 13.25, respectively, in the intervention group (P < 0.001). The mean diastolic pressures before and after intervention in the control group were 62.7 ± 13.6 and 62.7 ± 4.7 (P < 0.001), respectively. Conclusion: The results of this study show that vitamins C and E have protective effects against preeclampsia by alleviating the overall blood pressure. [ABSTRACT FROM AUTHOR]

The 2019 coronavirus (SARS-CoV-2) has been declared a public health emergency of international concern by the World Health Organization. Due to the sudden appearance of this pandemic process associated with increasing morbidity and mortality worldwide, various treatments have been implemented. In this framework, high doses of vitamin C began to be used in critically ill patients. We analyze the clinical trials and/or research papers available in the literature. Although more evidence on its effectiveness is needed is important for the specialist to understand the clinical logic of this use to determine if it is correct as a concomitant treatment. Conclusions: It seems that using high doses of vitamin C parenterally is a safe, available and economical alternative especially for critically ill patients. [ABSTRACT FROM AUTHOR]

Background: Fatty liver is a reversible status, but also an origin stage to develop to other metabolic syndromes, such as diabetes and heart disease that threatens public health worldwide. Ascorbate deficiency is reported to be correlated with increasing risks for metabolic syndromes, but whether ascorbate has a therapeutic effect is unknown. Here, we investigated if ascorbate treatment alone could work on protecting from the development of steatosis and mechanisms beyond. Methods: Guinea pigs were fed with a chow diet or a high palm oil diet (HPD) respectively. HPD induced animals were administered different concentrations of ascorbate in different time intervals through water. Besides, hepatocyte-like cells derived from human embryonic stem cells and HepG2 cells were treated with palmitic acid (PA) to induce lipid accumulation for molecular mechanism study. Results: We find that ascorbate rescues HPD and PA induced steatosis and insulin tolerance in vivo and in vitro. We demonstrate that ascorbate changes cellular lipid profiles via inhibits lipogenesis, and inhibits the expression of SOCS3 via STAT3, thus enhances insulin signal transduction. Overexpression of SOCS3 abolishes the ascorbate rescue effects on insulin signal and lipid accumulation in hepatic cells. Conclusions: Ascorbate ameliorates hepatic steatosis and improves insulin sensitivity through inhibiting lipogenesis and SOCS3. [ABSTRACT FROM AUTHOR]

Objective: Septic shock is a devastating physiological state with significant mortality risk. Recently, trials have suggested clinical benefits of adjunctive treatment with iHAT. These agents may reduce oxidative stress, inflammation, mitochondrial dysfunction and endothelial injury in patients with septic shock. The primary objective of this study was to evaluate intensive care unit (ICU) and hospital mortality for patients with septic shock treated with and without intravenous hydrocortisone, ascorbic acid and thiamine (iHAT). Design: A retrospective cohort study was performed evaluating patients admitted with septic shock requiring vasopressors to the ICU treated with and without iHAT. Setting: The intensive care unit of a tertiary care academic center in Madison, WI Patients: Of 3,463 patients admitted to the ICU, 206 met inclusion criteria with 127 treated according to standard care (SC) and 79 receiving additional adjunctive iHAT. Intervention: Hydrocortisone 50 mg IV q6h, Ascorbic Acid 1500 mg IV q6h and Thiamine 200 mg IV q12h. Measurements and results: Acute Physiology And Chronic Health Evaluation (APACHE) scores were higher in the SC cohort. Observed ICU mortality was lower in the iHAT cohort compared to SC as was APACHE-adjusted ICU mortality (OR 0.44, p=0.043). APACHE-adjusted ICU mortality was lowest when iHAT was initiated within 6 hours (OR 0.08, p<0.01). Hospital mortality, vasopressor duration, initiation of renal replacement therapy and lengths of stay were not significantly different between cohorts. Conclusion: There was a time-sensitive improvement in APACHE-adjusted ICU mortality in septic shock patients treated with adjunctive iHAT. The strong temporal benefit of iHAT therapy has important implications towards future studies. [ABSTRACT FROM AUTHOR]

In this article, we discuss current evidence on some of the dietary supplements that have been most commonly used for coronavirus disease 2019 (COVID-19) prevention and/or treatment, including vitamin C, vitamin D, and zinc. [ABSTRACT FROM AUTHOR]

Oxidative stress is part of the entire pathological process that underlies the development of Alzheimer's disease (AD), including the mild cognitive impairment (MCI) stage. Twendee X (TwX) is a supplement containing a strong antioxidative mix of eight antioxidants, which has been shown to have a clinical and therapeutic benefit in AD model mice. Here, we conducted a multicenter, randomized, double-blind, and placebo-controlled prospective interventional study to evaluate the efficacy of TwX in mitigating MCI. The primary outcomes were differences in Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale-revised (HDS-R) scores between baseline and six months for placebo and TwX groups. Seventy-eight subjects with MCI were randomized into placebo (n = 37) and TwX (n = 41) groups. MMSE scores at six months differed significantly between the TwX and placebo groups (p = 0.018), and HDS-R scores for the TwX group exhibited a significant improvement at six months relative to baseline (p = 0.025). The TwX group did not show any change in affective or activities of daily living scores at six months. The present study indicates that strong antioxidative supplement TwX is clinical beneficial for cognitive function in subjects with MCI. [ABSTRACT FROM AUTHOR]