R0 (R naught) is the basic reproduction number, also known as basic reproduction ratio or rate which is an epidemiological metric used to measure the transmissibility of infectious agents. R0 is a ...derivative of the following variables-the duration of infectivity after the patient gets infected, the likelihood of transmission of infection per contact between a susceptible person and an infectious individual, and the contact rate. R0 is usually estimated retrospectively from serial epidemiological data or using theoretical mathematical models. Epidemiologists can calculate R0 using contact-tracing data, the most common method is to use cumulative incidence data. When mathematical models are used, R0 values are estimated using ordinary differential equations. R0 of COVID-19 as initially estimated by the World Health Organization (WHO) was between 1.4 and 2.4. The forecast is of critical importance as it will help the governments to have an estimate as well as strategize quickly to avoid any unfavorable condition. HOW TO CITE THIS ARTICLEAchaiah NC, Subbarajasetty SB, Shetty RM. R0 and Re of COVID-19: Can We Predict When the Pandemic Outbreak will be Contained? Indian J Crit Care Med 2020;24(11):1125-1127.
Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation ...practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools. Bispectral index (BIS) monitors, which are based on the processing of electroencephalographic signals, may overcome the restraints of the sedation scales and provide a more reliable and consistent guidance for the titration of sedation depth.The benefits of BIS monitoring of patients under general anaesthesia for surgical procedures have already been confirmed by another Cochrane review. By undertaking a well-conducted systematic review our aim was to find out if BIS monitoring improves outcomes in mechanically ventilated adult intensive care unit (ICU) patients.
To assess the effects of BIS monitoring compared with clinical sedation assessment on ICU length of stay (LOS), duration of mechanical ventilation, any cause mortality, risk of ventilator-associated pneumonia (VAP), risk of adverse events (e.g. self-extubation, unplanned disconnection of indwelling catheters), hospital LOS, amount of sedative agents used, cost, longer-term functional outcomes and quality of life as reported by authors for mechanically ventilated adults in the ICU.
We searched CENTRAL, MEDLINE, Embase, CINAHL, ProQuest, OpenGrey and SciSearch up to May 2017 and checked references citation searching and contacted study authors to identify additional studies. We searched trial registries, which included clinicaltrials.gov and controlled-trials.com.
We included all randomized controlled trials comparing BIS versus clinical assessment (CA) for the management of sedation in mechanically ventilated critically ill adults.
We used Cochrane's standard methodological procedures. We undertook analysis using Revman 5.3 software.
We identified 4245 possible studies from the initial search. Of those studies, four studies (256 participants) met the inclusion criteria. One more study is awaiting classification. Studies were, conducted in single-centre surgical and mixed medical-surgical ICUs. BIS monitor was used to assess the level of sedation in the intervention arm in all the studies. In the control arm, the sedation assessment tools for CA included the Sedation-Agitation Scale (SAS), Ramsay Sedation Scale (RSS) or subjective CA utilizing traditional clinical signs (heart rate, blood pressure, conscious level and pupillary size). Only one study was classified as low risk of bias, the other three studies were classified as high risk.There was no evidence of a difference in one study (N = 50) that measured ICU LOS (Median (Interquartile Range IQR) 8 (4 to 14) in the CA group; 12 (6 to 18) in the BIS group; low-quality evidence).There was little or no effect on the duration of mechanical ventilation (MD -0.02 days (95% CI -0.13 to 0.09; 2 studies; N = 155; I
= 0%; low-quality evidence)). Adverse events were reported in one study (N = 105) and the effects on restlessness after suction, endotracheal tube resistance, pain tolerance during sedation or delirium after extubation were uncertain due to very low-quality evidence. Clinically relevant adverse events such as self-extubation were not reported in any study. Three studies reported the amount of sedative agents used. We could not measure combined difference in the amount of sedative agents used because of different sedation protocols and sedative agents used in the studies. GRADE quality of evidence was very low. No study reported other secondary outcomes of interest for the review.
We found insufficient evidence about the effects of BIS monitoring for sedation in critically ill mechanically ventilated adults on clinical outcomes or resource utilization. The findings are uncertain due to the low- and very low-quality evidence derived from a limited number of studies.
R
(R naught) is the basic reproduction number, also known as basic reproduction ratio or rate which is an epidemiological metric used to measure the transmissibility of infectious agents. R
is a ...derivative of the following variables-the duration of infectivity after the patient gets infected, the likelihood of transmission of infection per contact between a susceptible person and an infectious individual, and the contact rate. R
is usually estimated retrospectively from serial epidemiological data or using theoretical mathematical models. Epidemiologists can calculate R
using contact-tracing data, the most common method is to use cumulative incidence data. When mathematical models are used, R
values are estimated using ordinary differential equations. R
of COVID-19 as initially estimated by the World Health Organization (WHO) was between 1.4 and 2.4. The forecast is of critical importance as it will help the governments to have an estimate as well as strategize quickly to avoid any unfavorable condition.
Achaiah NC, Subbarajasetty SB, Shetty RM. R
and R
of COVID-19: Can We Predict When the Pandemic Outbreak will be Contained? Indian J Crit Care Med 2020;24(11):1125-1127.
Given the current lack of an approved and effective treatment or vaccine for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), repositioning old drugs for use as an antiviral treatment is ...an interesting strategy because knowledge about these drugs' safety profile, posology, and drug interactions is already known. Chloroquine and hydroxychloroquine, widely used as antimalarial and autoimmune disease drugs, have recently been reported as a potential broad-spectrum antiviral drug.
The
antiviral activity of chloroquine has been identified since the late 1960s. However, antiviral mechanisms of chloroquine remain speculative. Several clinical trials have been conducted to test the efficacy and safety of chloroquine or hydroxychloroquine in the treatment of COVID-19-associated pneumonia. The quality of the studies and the outcomes are evaluated in this systematic review and meta-analysis.
Literature review revealed 23 clinical studies. Only 9 of 23 studies were randomized controlled trials. Of nine randomized controlled trials, only study by Skipper et al. was deemed to be at low risk of bias. All studies evaluated variedwith different outcomes. Mechanical ventilation and virological clearance were the only common outcomes evaluated in more than two studies. Virological clearance odds ratio (OR) was 1.25 (95% confidence interval CI of 0.57-2.73; Chi
= 0.83; I
= 0%). GRADE quality of evidence was downgraded by three levels to very low due to concerns about the risk of bias, inconsistency, and imprecision. For mechanical ventilation, OR was 1.09 (95% CI 0.80-1.50; Chi
= 0; I
= 0). GRADE quality of evidence was downgraded by two levels to low due to concerns about the risk of bias and imprecision. There was no statistically significant difference between the groups for these two outcomes.
As per the available evidence, based on our review, we conclude that hydroxychloroquine/chloroquine has not shown to be beneficial when used for the treatment of patients with COVID-19 pneumonia.
Shetty RM, Namachivayam A. Evidence for Chloroquine/Hydroxychloroquine in the Treatment of COVID-19. Indian J Crit Care Med 2021;25(4):441-452.
Aim: Dental professionals are prone to have hearing impairment due to prolonged exposure of noise in dental college. The aim of the study was to assess the hearing ability of dental personnel working ...in Yenepoya Deemed to be University, Mangaluru, Karnataka, India. Materials and Methods: A cross-sectional exploratory study was conducted on 60 subjects (30 male and 30 female). Audiometric analysis was carried out using pure-tone audiometry (PTA) and otoacoustic emission test (OAE). Statistical Analysis: Data were calculated and analyzed using two-way analysis of variance and Tukey's honestly significant difference test. Results: No statistically significant difference was observed between hearing loss and its association with age, gender, working experience, mean daily working time, and specialization. PTA results showed a statistically significant hearing loss in the left ear, showing a dip at frequency of 4000 Hz among working experience group of 11-15 years and at 6000 Hz for 21-25 years. Also, a statistically significant hearing loss was observed in the left ear at 6000 and 8000 Hz for the age-group of 51-55 years. OAE results were consistent with PTA findings. Conclusion: Dentists and dental personnel are at a higher risk of noise-induced hearing loss. As the working experience increases, the threshold shift is seen to shift from 4000 to 6000 Hz, which is indicative of sensorineural hearing loss due to noise-induced dental environment.
Aim: Zirconia-based restoration is successfully replacing metal ceramic restorations in posterior areas. Although higher mechanical properties of zirconia, their use in compromised situation is ...questionable. Hence, there is a need to modify the design which to strengthen the framework. The aim of this in vitro study was to evaluate the influence of lingual collar design on the flexural strength of CAD/CAM-fabricated posterior three-unit zirconia framework. Materials and Methods: A mandibular metallic stainless steel master mold is designed for a three-unit fixed partial denture framework. All CAD-milled 20 samples are divided into two groups based on the design. Group A--with collar (10 samples) and Group B--without collar (10 samples), tested using universal testing machine to calculate the mean fracture load and flexural strength. Statistical Analysis Used: Descriptive statistics and independent sample t test were used to find the difference between the groups, and simple linear regression was used to find the relationship between load and displacement between the groups. Results: The result of the mean flexural strength for Group A was 11328.06 ± 3770MPa and for Group B was 7633.95 ± 3196 MPa; the mean fracture strength observed for Group A was 1274.04 ± 424 MPa and for Group B was 858.80 ± 359 MPa. A statistically significant difference was observed in flexural strength between Groups A and B (P < 0.05). Conclusion: Zirconia framework with connector dimension of 7 mm2 with lingual collar design can be successfully incorporated in compromised situation where an ideal connector dimension of 9 mm2 cannot be placed.
Aim: The aim of this study was to evaluate and compare the compressive strength, Vickers microhardness number, and wear resistance of amalgam (DPI), Filtek Z350 nanohybrid (3M ESPE), and Zirconomer ...(Shofu) restorative materials after 24 h and 3 months. Methodology: The restorative materials were divided into Zirconomer (Group I), Filtek Z350 (Group II), and amalgam (Group III). These materials were placed in cylindrical molds to prepare the specimens. The specimens were stored in distilled water at 37°C. The specimens were tested at 24 h and 3 months for compressive strength, wear resistance, and microhardness. Results: Group I showed significantly less maximum load (N) and compression strength (MPa) when compared with Group III (control) and Group II (P < 0.01). There was no significant difference in microhardness between the three groups. Group I showed significantly more wear (weight loss g) and wear (weight loss %) when compared with Group III (control) and Group II. Conclusion: The study concludes that amalgam and nanohybrid composite performed better than Zirconomer at the end of 24 h and 3 months.
In this paper, a simple single variable shear deformable nonlocal theory for bending of micro- and nano-scale rectangular beams is presented. To incorporate small size effects, the theory uses ...Eringen’s nonlocal differential constitutive relations. The theory has only one fourth-order governing differential equation involving a single unknown variable. The governing equation and the expressions for the bending moment and shear force of the present theory are strikingly similar to those of nonlocal Euler-Bernoulli Beam Theory (
EBT
) formulated based on Eringen’s nonlocal elasticity theory. The theory assumes that the axial and lateral displacements have bending and shear components such that the bending components do not contribute towards shear force, and the shear components do not contribute towards bending moment. Also, the chosen displacement functions of the theory give rise to a realistic parabolic transverse shear stress distribution across the beam cross-section. Efficacy of the proposed theory is demonstrated through bending of simply supported, cantilever and clamped-clamped micro- and nano-scale beams of rectangular cross-section. The numerical results obtained by using the present theory are compared with those predicted by other nonlocal first-order and higher-order shear deformation beam theories. The results obtained are quite accurate.
Bilioptysis or the presence of bilirubin in sputum or bronchial secretions is thought to be secondary to the presence of a broncho-biliary fistula. Bilioptysis is not well described in; literature, ...likely due to the rare nature of its incidence. There have been reports of bilioptysis secondary to other conditions such as hyperbilirubinaemia associated with liver cirrhosis, alcohol-related hepatitis, and haemolysis associated with sickle cell disease without demonstrable evidence of the presence of a fistula . The clinical implications of bilioptysis as well as the effect on the prognosis of the patient are still unclear and warrant further investigation. Here we present the first case of bilioptysis demonstrated on a bronchoalveolar aspirate (BAL) fluid sample in a patient with a brain tumour and possible associated neurogenic ARDS and sepsis.
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