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Novoa J, Hardy G, Aramendi I, Manzanares W. Intravenous Vitamin C in Critically Ill Adult Patients With Burns: An Integrative Review. Nutrition 2025; 134:112728. [PMID: 40081106 DOI: 10.1016/j.nut.2025.112728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 01/14/2025] [Accepted: 02/16/2025] [Indexed: 03/15/2025]
Abstract
Early fluid resuscitation may cause fluid overload in seriously ill burn patients, which is associated with losses of micronutrients and poor clinical outcomes. Over the past two to three decades, several animal studies and clinical trials have demonstrated that high-dose intravenous vitamin C may reduce fluid requirements, body weight gain, and wound edema, improving gas exchange and renal function in the acute phase after burn injury. Vitamin C is a scavenger of oxygen free radicals in the endothelium, which can limit the inflammatory response and ischemia-reperfusion injury, promoting wound healing. Nonetheless, current knowledge is not entirely conclusive. Research that leads to a better understanding of the vitamin's pharmacokinetics/dynamics is a first requirement before embarking on well-powered, well-designed clinical trials that still need to be conducted. This review aims to summarize vitamin C status in burn patients and its biological properties, in order to evaluate the rationale and most current evidence for routine supplementation, as recommended by current clinical guidelines, and the potential for high-dose vitamin C as a pharmaconutrient in critically ill burn patients.
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Affiliation(s)
- Juan Novoa
- Intensive Care Unit, Department of Critical Care, Hospital de Clínicas (University Hospital), Faculty of Medicine, Universidad de la República, Montevideo, Uruguay; Burn Center, Centro Nacional de Quemados (CENAQUE), Hospital de Clínicas (University Hospital), Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
| | - Gil Hardy
- Ipanema Trust, Auckland. New Zealand
| | - Ignacio Aramendi
- Intensive Care Unit, Department of Critical Care, Hospital de Clínicas (University Hospital), Faculty of Medicine, Universidad de la República, Montevideo, Uruguay; Burn Center, Centro Nacional de Quemados (CENAQUE), Hospital de Clínicas (University Hospital), Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - William Manzanares
- Intensive Care Unit, Department of Critical Care, Hospital de Clínicas (University Hospital), Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
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Greenhalgh DG. Current Thoughts on Burn Resuscitation. Adv Surg 2024; 58:1-17. [PMID: 39089770 DOI: 10.1016/j.yasu.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The optimal treatment of burn shock is still unresolved. The problem of "fluid creep" continues despite modern devices that fail to improve outcomes over hourly urine output. Colloids, especially albumin, reduce fluid requirements. Albumin can be used either immediately at the start of resuscitation, or as a "rescue" when crystalloid use is excessive. Several studies confirm that when crystalloid resuscitation is "out of control" the majority of caregivers will add albumin to reduce fluid rates. A multi-center trial is underway comparing crystalloids with albumin to confirm the benefit of colloids. The next question is whether albumin or plasma is as the better colloid choice.
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Affiliation(s)
- David G Greenhalgh
- Burn Department, Shriners Children's Northern California, 2425 Stockton Boulevard, Sacramento, CA 95817, USA; Emeritus, Department of Surgery, University of California, Davis, CA, USA.
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Choi DH, Basu S, Levine M, Steinhorn D. Plasma Ascorbic Acid Levels in Critically Ill Pediatric Patients. J Pediatr Intensive Care 2024; 13:119-126. [PMID: 38919697 PMCID: PMC11196147 DOI: 10.1055/s-0041-1741401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022] Open
Abstract
Ascorbic acid, or vitamin C, is a physiological antioxidant that has been found to be deficient in critically ill adults with sepsis and acute respiratory distress system. In adults, ascorbic acid supplementation has been shown to reduce the need for vasopressors and mechanical ventilation. This study aimed to describe the prevalence of ascorbic acid deficiency in critically ill pediatric patients. This prospective, single-centered study analyzed 34 patients aged 1 month to 18 years old with septic shock and/or acute respiratory failure requiring mechanical ventilation in a quaternary, urban, pediatric intensive care unit. Plasma ascorbic acid levels were measured by high-performance liquid chromatography within 24 hours of meeting eligibility criteria. The median level was 23.34 µM (IQR [11.45, 39.14]). Twenty-three patients had repeat samples that were collected 3 to 5 days later. The median for repeat samples was higher at 42.41 µM (IQR [13.08, 62.43]). Patients who were enterally fed had significantly higher levels than those who were not (62.4 ± 7.7 µM vs. 32.4 ± 7.1 µM; p = 0.03). Ascorbic acid levels vary widely among critically ill children with septic shock and/or respiratory failure requiring mechanical ventilation, but one-half of our patients had deficient levels that are typically seen in scurvy. Further studies are warranted to investigate the significance of low levels as well as the impact of normalizing levels through nutritional support.
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Affiliation(s)
- Daniel Horim Choi
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, United Sates
| | - Sonali Basu
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, United Sates
| | - Mark Levine
- Molecular and Clinical Nutrition Section, Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - David Steinhorn
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, United Sates
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Qamar R, Choubisa R, Sen A, Parikh M, Bishnoi S, Yadav M, Srivastava SS, Sayed HS, Choudhary C. Exploring Ascorbic Acid's Role in Orthopedic Practices: Present Theories, Innovative Approaches, and Prospects. Cureus 2024; 16:e60164. [PMID: 38868284 PMCID: PMC11166896 DOI: 10.7759/cureus.60164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/14/2024] Open
Abstract
In the human body, ascorbic acid (AA) is known for its potent antioxidant and reducing properties and also plays a vital role in supporting the growth of bones and cartilage. It has been used extensively in orthopedic surgery. Ongoing studies under the umbrella of ascorbic acid research investigate its impact on bone and tendon physiology, as well as its influence on joint replacement and postoperative pain. The majority of both laboratory and human studies link the usage of ascorbic acid to enhanced bone health and improved tendon healing. Recent literature suggest that ascorbic acid administration may have a positive impact on the outcome of orthopedic procedures. On the other hand, controversy exists regarding the efficacy of ascorbic acid in reducing the incidence of complex regional pain syndrome. In brief, the effectiveness of ascorbic acid in enhancing orthopedic procedure outcomes remains a subject of ongoing investigation. Although certain studies have hinted at the potential positive influence of ascorbic acid on these outcomes, further research is required to validate its effectiveness and ascertain the ideal dosage and method of administration for maximizing its anticipated advantages. To establish the efficacy of ascorbic acid in improving orthopedic procedure outcomes, rigorous human trials of high quality are imperative. The aim of this review was to provide an overview of ascorbic acid's utilization in orthopedic practices and to pinpoint prospective areas for future research.
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Affiliation(s)
- Rayed Qamar
- Orthopedics and Traumatology, Geetanjali Medical College and Hospital, Udaipur, IND
| | | | - Akshit Sen
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Mit Parikh
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
| | | | - Mayank Yadav
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
| | | | - Haseeb S Sayed
- Orthopedics, Geetanjali Medical College and Hospital, Udaipur, IND
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Malinkina ON, Shmakov SL, Shipovskaya AB. Structure, the energy, sorption and biological properties of chiral salts of chitosan with l- and d-ascorbic acid. Int J Biol Macromol 2024; 257:128731. [PMID: 38101672 DOI: 10.1016/j.ijbiomac.2023.128731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/18/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
The influence of l- and d-ascorbic acid diastereomers on the structure, supramolecular ordering, energy, sorption and biological properties of heterochiral (D-L) and homochiral (D-D) salt complexes of chitosan (d-glucan)-acid was studied. The thermal effect of dissolving chitosan in l-ascorbic acid and the protonation degree of (D-L)-salts were lower than those in the medium of the d-isomer. Homochiral (D-D) salts, in contrast to heterochiral (D-L) ones, are distinguished by a more developed system of intermolecular and intramolecular contacts, a more ordered and equilibrium supramolecular organization of macrochains, a higher crystallinity degree, and a smaller amount of crystallization water. The sorption isotherms of chiral salts were approximated by the thermal equation of sorption and the superposition of the Langmuir and Flory-Huggins isotherms. Significant differences were found in the limiting value and energy of sorption, the constant of adsorption equilibrium, the limiting sorption capacity of the localized mode of water, and the Gibbs mixing energy. Biotesting on non-vascular (Scenedesmus quadricauda) and vascular eukaryotes (Linum usitatissimum) revealed the growth-stimulating effect of the D-D salts. The obtained results confirm our hypothesis of the homochiral salt complexes d-glucan-d-ascorbic acid best corresponding to the principles of the functional organization of biological objects.
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Affiliation(s)
- Olga N Malinkina
- Institute of Chemistry, Saratov State University, Astrakhanskaya 83, Saratov 410012, Russian Federation.
| | - Sergei L Shmakov
- Institute of Chemistry, Saratov State University, Astrakhanskaya 83, Saratov 410012, Russian Federation
| | - Anna B Shipovskaya
- Institute of Chemistry, Saratov State University, Astrakhanskaya 83, Saratov 410012, Russian Federation
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Asuku M, Shupp JW. Burn wound conversion: clinical implications for the treatment of severe burns. J Wound Care 2023; 32:S11-S20. [PMID: 37121662 DOI: 10.12968/jowc.2023.32.sup5.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The identification of novel treatments for severe burn wounds relies on accurate clinical assessments of the extent of injury. However, evaluation of burn wound depth can be challenging due to the tendency for burn wounds to progress over time in a little-understood process known as 'burn wound conversion'. Local factors affecting the burn wound, such as inflammation, oxidative stress-induced tissue damage, vasostasis and bacterial infections, lead to increased cell death by apoptosis or oncosis, while systemic events may promote burn wound conversion. Acute shock, metabolic derangements, age or immunomodulation can modify cytokine secretion, lower immune responses, decrease blood flow or cause bacterial infection at the burn wound site. Therefore, therapeutic approaches targeting specific mechanisms that reduce cell death, improve wound reperfusion and promote tissue regrowth should favourably enhance burn wound healing, and long-term functional and aesthetic outcomes. Our current understanding of these mechanisms mostly comes from animal studies, underscoring the need for extensive research in humans. A streamlined approach would be to investigate the parallels in other disease states that exhibit ischaemia and potential reperfusion, such as ischaemic stroke and myocardial infarction. Moreover, in view of the limited knowledge available on the subject, the need exists for further clinical research into burn wound conversion and novel target pathways to ameliorate its effects. This review describes events that affect the viability of cells at the burn wound site resulting in burn wound conversion, and identifies potential targets for clinical interventions that may diminish burn wound conversion.
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Affiliation(s)
| | - Jeffrey W Shupp
- Department of Surgery, Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, US
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Guo J, Lou X, Gong W, Bian J, Liao Y, Wu Q, Jiao Q, Zhang X. The effects of different stress on intestinal mucosal barrier and intestinal microecology were discussed based on three typical animal models. Front Cell Infect Microbiol 2022; 12:953474. [PMID: 36250050 PMCID: PMC9557054 DOI: 10.3389/fcimb.2022.953474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Recent studies have revealed that the effect of intestinal microecological disorders on organismal physiology is not limited to the digestive system, which provides new perspectives for microecological studies and new ideas for clinical diagnosis and prevention of microecology-related diseases. Stress triggers impairment of intestinal mucosal barrier function, which could be duplicated by animal models. In this paper, pathological animal models with high prevalence and typical stressors—corresponding to three major stressors of external environmental factors, internal environmental factors, and social psychological factors, respectively exemplified by burns, intestinal ischemia-reperfusion injury (IIRI), and depression models—were selected. We summarized the construction and evaluation of these typical animal models and the effects of stress on the organism and intestinal barrier, as well as systematically discussed the effects of different stresses on the intestinal mucosal barrier and intestinal microecology.
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Affiliation(s)
- Junfeng Guo
- Department of Clinical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
| | - Xiaokun Lou
- Department of Clinical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
| | - Wenyan Gong
- Department of Clinical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
| | - Jing Bian
- Department of Clinical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
| | - Yuhan Liao
- Department of Clinical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
| | - Qi Wu
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Qibin Jiao
- Department of Clinical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Xingwei Zhang, ; Qibin Jiao,
| | - Xingwei Zhang
- Department of Clinical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University, Hangzhou, China
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- *Correspondence: Xingwei Zhang, ; Qibin Jiao,
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Jacobs R, Wise RD, Myatchin I, Vanhonacker D, Minini A, Mekeirele M, Kirkpatrick AW, Pereira BM, Sugrue M, De Keulenaer B, Bodnar Z, Acosta S, Ejike J, Tayebi S, Stiens J, Cordemans C, Van Regenmortel N, Elbers PWG, Monnet X, Wong A, Dabrowski W, Jorens PG, De Waele JJ, Roberts DJ, Kimball E, Reintam Blaser A, Malbrain MLNG. Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review. Life (Basel) 2022; 12:1390. [PMID: 36143427 PMCID: PMC9502789 DOI: 10.3390/life12091390] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND General pathophysiological mechanisms regarding associations between fluid administration and intra-abdominal hypertension (IAH) are evident, but specific effects of type, amount, and timing of fluids are less clear. OBJECTIVES This review aims to summarize current knowledge on associations between fluid administration and intra-abdominal pressure (IAP) and fluid management in patients at risk of intra-abdominal hypertension and abdominal compartment syndrome (ACS). METHODS We performed a structured literature search from 1950 until May 2021 to identify evidence of associations between fluid management and intra-abdominal pressure not limited to any specific study or patient population. Findings were summarized based on the following information: general concepts of fluid management, physiology of fluid movement in patients with intra-abdominal hypertension, and data on associations between fluid administration and IAH. RESULTS We identified three randomized controlled trials (RCTs), 38 prospective observational studies, 29 retrospective studies, 18 case reports in adults, two observational studies and 10 case reports in children, and three animal studies that addressed associations between fluid administration and IAH. Associations between fluid resuscitation and IAH were confirmed in most studies. Fluid resuscitation contributes to the development of IAH. However, patients with IAH receive more fluids to manage the effect of IAH on other organ systems, thereby causing a vicious cycle. Timing and approach to de-resuscitation are of utmost importance, but clear indicators to guide this decision-making process are lacking. In selected cases, only surgical decompression of the abdomen can stop deterioration and prevent further morbidity and mortality. CONCLUSIONS Current evidence confirms an association between fluid resuscitation and secondary IAH, but optimal fluid management strategies for patients with IAH remain controversial.
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Affiliation(s)
- Rita Jacobs
- Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Robert D. Wise
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Discipline of Anesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
- Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU Oxford, UK
| | - Ivan Myatchin
- Intensive Care Department, University Hospital Brussels, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- Emergency Medicine Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Domien Vanhonacker
- Intensive Care Department, University Hospital Brussels, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Andrea Minini
- Intensive Care Department, University Hospital Brussels, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- Department of Anesthesiology and Intensive Care, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Michael Mekeirele
- Intensive Care Department, University Hospital Brussels, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Andrew W. Kirkpatrick
- Departments of Critical Care Medicine and Surgery, The Trauma Program, University of Calgary, Victoria, BC V8W 2Y2, Canada
- The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, AB T3H 3W8, Canada
| | - Bruno M. Pereira
- Department of Surgery, Health Applied Sciences, Vassouras University, Vassouras 27700, Brazil
- Campinas Holy House Residency Program, Terzius Institute, Campinas 13010, Brazil
| | - Michael Sugrue
- Donegal Clinical Research Academy and Emergency Surgery Outcome Advancement Project (eSOAP), F94 A0W2 Donegal, Ireland
| | - Bart De Keulenaer
- Department of Intensive Care, Fiona Stanley Hospital; Professor at the School of Surgery, The University of Western Australia, Perth, WA 6907, Australia
- Department of Intensive Care at SJOG Murdoch Hospital, Murdoch, WA 6150, Australia
| | - Zsolt Bodnar
- Consultant General Surgeon, Letterkenny University Hospital, F92 AE81 Letterkenny, Ireland
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Janeth Ejike
- Department of Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, CA 92354, USA
| | - Salar Tayebi
- Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), 1040 Etterbeek, Belgium
| | - Johan Stiens
- Department of Intensive Care, AZ Sint-Maria Hospital, 1500 Halle, Belgium
| | - Colin Cordemans
- Department of Intensive Care Medicine, Campus Stuivenberg, Ziekenhuis Netwerk Antwerpen, 2050 Antwerp, Belgium
| | - Niels Van Regenmortel
- Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Intensive Care Medicine, Campus Stuivenberg, Ziekenhuis Netwerk Antwerpen, 2050 Antwerp, Belgium
| | - Paul W. G. Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Vrije Universiteit, 1081 Amsterdam, The Netherlands
| | - Xavier Monnet
- Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, FHU SEPSIS, 94275 Le Kremlin-Bicêtre, France
| | - Adrian Wong
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Department of Critical Care, King’s College Hospital NHS Foundation Trust London, London SE5 9RS, UK
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Philippe G. Jorens
- Intensive Care Department, Antwerp University Hospital, 2650 Edegem, Belgium
- University of Antwerp, Laboratory of Experimental Medicine and Pediatrics (LEMP), 2000 Antwerpen, Belgium
| | - Jan J. De Waele
- Intensive Care Unit, University Hospital Ghent, 9000 Ghent, Belgium
| | - Derek J. Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 1H3, Canada
| | - Edward Kimball
- Department of Surgery and Critical Care, U Health OND&T, Salt Lake City, UT 84105, USA
- Department of Surgical Critical Care SLC VA Medical Center, Salt Lake City, UT 84148, USA
| | - Annika Reintam Blaser
- Department of Anesthesiology and Intensive Care, University of Tartu, 50090 Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, 6110 Lucerne, Switzerland
| | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
- Medical Data Management, Medaman, 2440 Geel, Belgium
- International Fluid Academy, 3360 Lovenjoel, Belgium
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Omer AK, Khorshidi S, Mortazavi N, Rahman HS. A Review on the Antiviral Activity of Functional Foods Against COVID-19 and Viral Respiratory Tract Infections. Int J Gen Med 2022; 15:4817-4835. [PMID: 35592539 PMCID: PMC9112189 DOI: 10.2147/ijgm.s361001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Due to the absence of successful therapy, vaccines for protection are continuously being developed. Since vaccines must be thoroughly tested, viral respiratory tract infections (VRTIs), mainly coronaviruses, have seriously affected human health worldwide in recent years. In this review, we presented the relevant data which originated from trusted publishers regarding the practical benefits of functional foods (FFs) and their dietary sources, in addition to natural plant products, in viral respiratory and COVID-19 prevention and immune-boosting activities. As a result, FFs were confirmed to be functionally active ingredients for preventing COVID-19 and VRTIs. Furthermore, the antiviral activity and immunological effects of FFs against VRTIs and COVID-19 and their potential main mechanisms of action are also being reviewed. Therefore, to prevent COVID-19 and VRTIs, it is critical to identify controlling the activities and immune-enhancing functional food constituents as early as possible. We further aimed to summarize functional food constituents as a dietary supplement that aids in immune system boosting and may effectively reduce VRTIs and COVID-19 and promote therapeutic efficacy.
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Affiliation(s)
- Abdullah Khalid Omer
- Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
- Razga Company, Sulaimaniyah, Kurdistan Region, Iraq
| | - Sonia Khorshidi
- Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Negar Mortazavi
- Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Heshu Sulaiman Rahman
- Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Iraq
- Department of Medical Laboratory Sciences, Komar University of Science and Technology, Sulaimaniyah, Iraq
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Paediatric Partial-Thickness Burn Therapy: A Meta-Analysis and Systematic Review of Randomised Controlled Trials. Life (Basel) 2022; 12:life12050619. [PMID: 35629287 PMCID: PMC9144506 DOI: 10.3390/life12050619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Paediatric second-degree burn injuries are a significant source of medical challenges to the population that may cause severe, lifelong complications. Currently, there are dozens of therapeutic modalities and we aimed to summarise their reported outcomes and determine their effectiveness, compared to the widely used silver sulphadiazine (SSD). Methods: We conducted the meta-analysis and systematic review of randomised controlled trials (RCTs), which investigated the performance of dressings in acute paediatric partial-thickness burns. The evaluated endpoints were time until wound closure, grafting and infection rate, number of dressing changes and length of hospitalisation. Results: Twenty-nine RCTs were included in the qualitative and 25 in the quantitative synthesis, but only three trials compared SSD directly to the same intervention (Biobrane). Data analysis showed a tendency for faster healing times and a reduced complication rate linked to biosynthetic, silver foam and amnion membrane dressings. A substantial difference was found between the number of dressing changes associated with less pain, narcosis and treatment duration. Conclusions: Considerable between-study heterogeneity was caused by the unequal depth subcategory ratio and surface area of the injuries; therefore, no significant difference was found in the main outcomes. Further research is necessary to establish the most effective treatment for these burns.
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11
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Soltany A, Al Aissami M. A scoping review of the role of ascorbic acid in modifying fluid requirements in the resuscitation phase in burn patients. Ann Med Surg (Lond) 2022; 75:103460. [PMID: 35386786 PMCID: PMC8978049 DOI: 10.1016/j.amsu.2022.103460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Accurate fluid resuscitation in burn patients is the main therapy in improving clinical outcomes. The standard target is to provide adequate end-organ perfusion, taking into consideration the possible risks of fluid creep and over-resuscitation. Anti-oxidant therapies, especially vitamin C, have been evaluated as an adjuvant therapy in resuscitating burn patients in the acute phase. Methods A scoping search in PubMed and Google Scholar was done using the search terms "ascorbic acid" "burn patients", "vitamin C″, "burn", and "fluid requirements". They were either searched individually or in combination. All relevant articles, of any study design (published till mid-October 2021), were included and narratively discussed in this paper. Results Ten articles were reviewed in this paper. Through these articles, we provided in detail the beneficial effects of vitamin C on burn patients in reducing fluid requirements in the resuscitation phase. Additionally, we summarized the pathophysiology of vitamin C in this entity, shedding light on the potential adverse effects and the importance of conducting similar clinical trials. Conclusion We cannot deny the beneficial effects of vitamin C on burn patients. Therefore, each burn center should conduct clinical trials until reaching, at the end, an evidence-based guideline providing a clear protocol in terms of its administration and dosage, aiming to minimize possible adverse effects.
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Affiliation(s)
- Amjad Soltany
- Department of Plastic and Reconstructive Surgery, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Maen Al Aissami
- Department of Plastic and Reconstructive Surgery, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
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12
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Siddiqi M, Evans T, Guiab K, Capron G, Roberts A, Messer T, Bokhari F. Vitamin C in the Management of Burn Patients: A Systematic Review of the Risks and Benefits. Am Surg 2021; 88:752-757. [PMID: 34743580 DOI: 10.1177/00031348211054060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mahwash Siddiqi
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Teresa Evans
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Keren Guiab
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Gweniviere Capron
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Andrew Roberts
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Thomas Messer
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Faran Bokhari
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
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Abstract
ABSTRACT Burn injuries are a common form of traumatic injury that leads to significant morbidity and mortality worldwide. Burn injuries are characterized by inflammatory processes and alterations in numerous organ systems and functions. Recently, it has become apparent that the gastrointestinal bacterial microbiome is a key component of regulating the immune response and recovery from burn and can also contribute to significant detrimental sequelae after injury, such as sepsis and multiple organ failure. Microbial dysbiosis has been linked to multiple disease states; however, its role in exacerbating acute traumatic injuries, such as burn, is poorly understood. In this article, we review studies that document changes in the intestinal microbiome after burn injury, assess the implications in post-burn pathogenesis, and the potential for further discovery and research.
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Affiliation(s)
- Marisa E. Luck
- Burn & Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Integrative Cell Biology Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
| | - Caroline J. Herrnreiter
- Burn & Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Biochemistry and Molecular Biology Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
| | - Mashkoor A. Choudhry
- Burn & Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Department of Surgery, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Integrative Cell Biology Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
- Biochemistry and Molecular Biology Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
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14
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Flores E, Sánchez-Sánchez M, Gutierrez C, Estébanez B, Millán P, Gutierrez C, Gonzalez A, Garcia de Lorenzo A. High Dose Ascorbic Acid During Acute Resuscitation in Critically Burn Patients. J Burn Care Res 2021; 43:149-155. [PMID: 34142146 DOI: 10.1093/jbcr/irab088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Ascorbic acid (AA) is a potent oxygen-free radical scavenger. We hypothesized that treating severe burn patients with high doses of AA (HDAA) can reduce fluid resuscitation requirements and prevent organ dysfunction. We performed a unicentric, retrospective case-control study of 75 burn patients: 25 patients admitted from 2018 to 2019 with more than 30% Total Surface Body Surface Area (TSBA) burned who received HDAA (66 mg/kg/h as soon as possible after admission until 36 h after injury), and 50 patients admitted from 2014 to 2017 with similar Abbreviated Burn Severity Index (ABSI)/Baux scores who were treated with the same protocol but did not receive HDAA. During the first 24 hours of burn resuscitation the HDAA group required less fluids than the control group (3.06 ± 0.87 ml/kg/%TBSA vs 4.32 ± 1.51 P < .05), but the overall reduction of fluid requirements during the first 72 hours was not significant. There were no significant differences in Sequential Organ Failure Assessment (SOFA), other hemodynamic parameters, complications, or mortality. We also did not find an increase acute kidney injury in patients who received HDAA even though the mean urine oxalate/creatinine ratio was 0.61 (0.02-0.96). We conclude that in severe burn patients treated with a restrictive fluid therapy protocol, administration of HDAA can decrease only the initial fluid requirements but not total fluid intakes. We did not find differences in severity score after resuscitation or in mortality. Nor did we find an increase in renal failure in patients administered with HDAA.
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Affiliation(s)
- Eva Flores
- Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain
| | - Manuel Sánchez-Sánchez
- Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain
| | - Claudio Gutierrez
- Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain
| | - Belen Estébanez
- Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain
| | - Pablo Millán
- Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain
| | - Carola Gutierrez
- Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain
| | - Alvaro Gonzalez
- Department of Plastic and Reconstructive Surgery, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain
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15
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Chuklin S, Chuklin S. Витамин С при критических состояниях: от эксперимента к клинике (часть 2). EMERGENCY MEDICINE 2021; 17:6-13. [DOI: 10.22141/2224-0586.17.1.2021.225708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Витамин С (аскорбиновая кислота) играет важную физиологическую роль в многочисленных метаболических функциях. Он также является кофактором в синтезе важных веществ, в частности катехоламинов и вазопрессина. Снижение уровня аскорбиновой кислоты отмечено при различных заболеваниях и часто сопровождает тяжелое состояние больного. Целью этой статьи является обзор современных представлений о применении высоких доз витамина С при критических состояниях у хирургических больных. Для поиска литературных источников использовалась база Medline на платформе Pubmed по ключевым словам: витамин С, сепсис, шок, травма, ожоги.
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16
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Howell AP, Parrett JL, Malcom DR. Impact of High-Dose Intravenous Vitamin C for Treatment of Sepsis on Point-of-Care Blood Glucose Readings. J Diabetes Sci Technol 2021; 15:309-316. [PMID: 31766883 PMCID: PMC8256056 DOI: 10.1177/1932296819889638] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Intravenous vitamin C therapy has been associated with reduced mortality in patients with sepsis. Of potential concern with this therapy are falsely elevated point-of-care (POC) blood glucose values vs laboratory analyzed (LA) readings. The purpose of this study was to compare POC and LA blood glucose measurements in patients receiving intravenous vitamin C therapy. METHODS All adults (≥18 years old) admitted from January 2017 to December 2018 who received at least two doses of intravenous vitamin C and had at least one paired blood glucose collection were eligible for inclusion. The primary endpoint was the accuracy in paired blood glucose values determined using the International Organization for Standardization (ISO) 15197:2013 criteria. Paired values were assessed for clinical impact using the Parkes consensus error grid analysis. A subgroup analysis was conducted to determine the impact of impaired renal function on outcomes. RESULTS Fourteen patients were included for analysis with 46 paired blood glucose levels. Compliance with ISO15197:2013 criteria was met in 34 (73.9%) paired values, which did not meet the minimum criteria for accuracy. Subgroup analysis showed that the paired values from patients with impaired renal function did not meet the minimum requirements for compliance, while those from patients without impaired renal function did. The Parkes error grid showed that the variation in POC measurements likely had minimal clinical impact. CONCLUSIONS Our study suggests that most patients receiving vitamin C for sepsis may still be monitored at POC with the glucose meter used in our study with minimal clinical impact.
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Affiliation(s)
| | - Jenna L. Parrett
- Department of Pharmacy, Baptist Health
Louisville, Louisville, KY, USA
| | - Daniel R. Malcom
- Department of Clinical and
Administrative Sciences, Sullivan University College of Pharmacy and Health
Sciences, Louisville, KY, USA
- Daniel R. Malcom, Sullivan University
College of Pharmacy and Health Sciences, Department of Clinical and
Administrative Sciences, 2100 Gardiner Ln, Louisville, KY 40205, USA.
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17
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Burmeister DM, Smith SL, Muthumalaiappan K, Hill DM, Moffatt LT, Carlson DL, Kubasiak JC, Chung KK, Wade CE, Cancio LC, Shupp JW. An Assessment of Research Priorities to Dampen the Pendulum Swing of Burn Resuscitation. J Burn Care Res 2020; 42:113-125. [PMID: 33306095 DOI: 10.1093/jbcr/iraa214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
On June 17 to 18, 2019, the American Burn Association, in conjunction with Underwriters Laboratories, convened a group of experts on burn resuscitation in Washington, DC. The goal of the meeting was to identify and discuss novel research and strategies to optimize the process of burn resuscitation. Patients who sustain a large thermal injury (involving >20% of the total body surface area [TBSA]) face a sequence of challenges, beginning with burn shock. Over the last century, research has helped elucidate much of the underlying pathophysiology of burn shock, which places multiple organ systems at risk of damage or dysfunction. These studies advanced the understanding of the need for fluids for resuscitation. The resultant practice of judicious and timely infusion of crystalloids has improved mortality after major thermal injury. However, much remains unclear about how to further improve and customize resuscitation practice to limit the morbidities associated with edema and volume overload. Herein, we review the history and pathophysiology of shock following thermal injury, and propose some of the priorities for resuscitation research. Recommendations include: studying the utility of alternative endpoints to resuscitation, reexamining plasma as a primary or adjunctive resuscitation fluid, and applying information about inflammation and endotheliopathy to target the underlying causes of burn shock. Undoubtedly, these future research efforts will require a concerted effort from the burn and research communities.
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Affiliation(s)
- David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Susan L Smith
- The Warden Burn Center, Orlando Regional Medical Center, Orlando, Florida
| | | | - David M Hill
- Firefighters' Burn Center, Regional One Health, Memphis, Tennessee
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia.,The Burn Center, MedStar Washington Hospital Center; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Deborah L Carlson
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Kubasiak
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Charles E Wade
- Center for Translational Injury Research, and Department of Surgery, McGovern School of Medicine and The John S. Dunn Burn Center, Memorial Herman Hospital, Houston, Texas
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia.,The Burn Center, MedStar Washington Hospital Center; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
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18
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Sumsuzzman DM, Choi J, Khan ZA, Hong Y. Protective Effects of Melatonin against Severe Burn-Induced Distant Organ Injury: A Systematic Review and Meta-Analysis of Experimental Studies. Antioxidants (Basel) 2020; 9:antiox9121196. [PMID: 33261180 PMCID: PMC7760393 DOI: 10.3390/antiox9121196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
Extensive burns result in a local wound response and distant-organ injury (DOI) caused by oxidative-stress and inflammation. Melatonin (MT) shows promise in alleviating oxidative-stress and inflammation, but its role in thermal injury is largely unexplored. The present systematic review and meta-analysis were designed to assess the effects of MT on oxidative-stress and inflammatory markers against severe burn-induced DOI. Mean difference (MD)/standard mean difference (SMD) with 95% confidence interval (CI) were estimated using fixed-effect/random-effects models. Eighteen experimental studies met the inclusion criteria. Compared with the control group, MT significantly decreased the levels of malondialdehyde (SMD, −1.03; 95% CI, −1.30, −0.76, p < 0.00001) and 4-hydroxynonenal (MD, −1.06; 95% CI, −1.57, −0.56, p < 0.0001). Additionally, MT increased the levels of glutathione (SMD, 1.94; 95% CI, 1.27, 2.61, p < 0.00001) and superoxide-dismutase (SMD, 0.76; 95% CI, 0.08, 1.45, p = 0.03). Finally, MT significantly decreased the levels of tumor necrosis factor-α (SMD, −1.34; 95% CI, −1.92 to −0.77; p < 0.00001) and C-reactive protein (MD, −12.67; 95% CI, −16.72 to −8.62; p < 0.00001). Meta-analysis indicates that severe burn followed by immediate MT (10 mg/kg) intervention shows significant beneficial effects after 24-h against DOI by regulating oxidative-stress and the inflammatory response.
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Affiliation(s)
- Dewan Md. Sumsuzzman
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Jeonghyun Choi
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Zeeshan Ahmad Khan
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Yonggeun Hong
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
- Department of Medicine, Division of Hematology/Oncology, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Correspondence: ; Tel.: +82-55-320-3681; Fax: +82-55-329-1678
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19
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Abobaker A, Alzwi A, Alraied AHA. Overview of the possible role of vitamin C in management of COVID-19. Pharmacol Rep 2020; 72:1517-1528. [PMID: 33113146 PMCID: PMC7592143 DOI: 10.1007/s43440-020-00176-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
The mainstay of management of coronavirus disease 2019 (COVID-19) is mainly supportive as to date there is no effective antiviral treatment, apart from remdesivir which has been approved by Food and Drug administration (FDA) for treatment of COVID-19, or vaccine. Supplementation with micronutrients, such as vitamins and minerals, has gained an increasing interest as part of the supportive management of COVID-19. Vitamin C levels in serum and leukocytes are depleted during the acute stage of infection owing to increased metabolic demands. High-dose vitamin C supplement helps to normalise both serum and leukocytes vitamin C levels. Vitamin C has multiple pharmacological characteristics, antiviral, anti-oxidant, anti-inflammatory and immunomodulatory effects, which make it a potential therapeutic option in management of COVID-19. The use of high dose of intravenous vitamin C for management of COVID-19 in China and the United Stated has shown promising results. There were no reported adverse reactions with the short-term use of high dose of vitamin C. Given the fact that vitamin C is cheap, available and safe drug with beneficial effects in management of viral infections and critically ill patients reported in previous clinical trials, it is sensible to add it to COVID-19 management protocol particularly if the current ongoing clinical trials testing the effect of vitamin C in management of COVID-19 show positive results.
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Affiliation(s)
- Anis Abobaker
- Spire Fylde Coast Hospital, St Walburgas road, Blackpool, FY3 8BP, UK.
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20
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Blaauw R, Osland E, Sriram K, Ali A, Allard JP, Ball P, Chan LN, Jurewitsch B, Logan Coughlin K, Manzanares W, Menéndez AM, Mutiara R, Rosenfeld R, Sioson M, Visser J, Berger MM. Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper. JPEN J Parenter Enteral Nutr 2020; 43 Suppl 1:S5-S23. [PMID: 30812055 DOI: 10.1002/jpen.1525] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. METHODS Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. RESULTS The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. CONCLUSION Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.
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Affiliation(s)
- Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Krishnan Sriram
- US Department of Veterans Affairs, Regional Tele-ICU System (VISN 23), Hines, Illinois, USA
| | - Azmat Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Johane P Allard
- Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Ball
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Lingtak-Neander Chan
- Department of Pharmacy School of Pharmacy, and Graduate Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Brian Jurewitsch
- Specialized Complex Care Program, St. Michael's Hospital, Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Kathleen Logan Coughlin
- Center for Human Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Manzanares
- Department of Critical Care, Faculty of Medicine. Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | | | - Rina Mutiara
- Pharmacy Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ricardo Rosenfeld
- Nutrition Support Department, Casa de Saude Sao Jose, Associacao Congregacao de Santa Catarina, Rio de Janeiro, Brazil
| | - Marianna Sioson
- Section of Nutrition, Department of Medicine, The Medical City Hospital, Pasig City, Metro Manila, Philippines
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mette M Berger
- Faculty of Biology and Medicine, Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland
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21
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Two known therapies could be useful as adjuvant therapy in critical patients infected by COVID-19. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN (ENGLISH EDITION) 2020. [PMCID: PMC7203037 DOI: 10.1016/j.redare.2020.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pneumonia caused by coronavirus, which originated in Wuhan, China, in late 2019, has been spread around the world already becoming a pandemic. Unfortunately, there is not yet a specific vaccine or effective antiviral drug for treating COVID-19. Many of these patients deteriorate rapidly and require intubation and are mechanically ventilated, which is causing the collapse of the health system in many countries due to lack of ventilators and intensive care beds. In this document we review two simple adjuvant therapies to administer, without side effects, and low cost that could be useful for the treatment of acute severe coronavirus infection associated with acute respiratory syndrome (SARS-CoV-2). Vitamin C, a potent antioxidant, has emerged as a relevant therapy due to its potential benefits when administered intravenous. The potential effect of vitamin C in reducing inflammation in the lungs could play a key role in lung injury caused by coronavirus infection. Another potential effective therapy is ozone: it has been extensively studied and used for many years and its effectiveness has been demonstrated so far in multiples studies. Nevertheless, our goal is not to make an exhaustive review of these therapies but spread the beneficial effects themselves. Obviously clinical trials are necessaries, but due to the potential benefit of these two therapies we highly recommended to add to the therapeutic arsenal.
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22
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Hernández A, Papadakos PJ, Torres A, González DA, Vives M, Ferrando C, Baeza J. Two known therapies could be useful as adjuvant therapy in critical patients infected by COVID-19. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:245-252. [PMID: 32303365 PMCID: PMC7156242 DOI: 10.1016/j.redar.2020.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pneumonia caused by coronavirus, which originated in Wuhan, China, in late 2019, has been spread around the world already becoming a pandemic. Unfortunately, there is not yet a specific vaccine or effective antiviral drug for treating COVID-19. Many of these patients deteriorate rapidly and require intubation and are mechanically ventilated, which is causing the collapse of the health system in many countries due to lack of ventilators and intensive care beds. In this document we review two simple adjuvant therapies to administer, without side effects, and low cost that could be useful for the treatment of acute severe coronavirus infection associated with acute respiratory syndrome (SARS-CoV-2). VitaminC, a potent antioxidant, has emerged as a relevant therapy due to its potential benefits when administered intravenous. The potential effect of vitaminC in reducing inflammation in the lungs could play a key role in lung injury caused by coronavirus infection. Another potential effective therapy is ozone: it has been extensively studied and used for many years and its effectiveness has been demonstrated so far in multiples studies. Nevertheless, our goal is not to make an exhaustive review of these therapies but spread the beneficial effects themselves. Obviously clinical trials are necessaries, but due to the potential benefit of these two therapies we highly recommended to add to the therapeutic arsenal.
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Affiliation(s)
- A Hernández
- Director Anaesthesia & ICU, Grupo Policlínica, Ibiza, Islas Baleares, España.
| | - P J Papadakos
- Director Critical Care Medicine, University of Rochester, Professor Anesthesia, Surgery, Neurology, and Neurosurgery, Rochester, Nueva York, Estados Unidos
| | - A Torres
- Senior Consultant in Respiratory and Intensive Care Unit, Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona. IDIBAPS, CIBERES, ICREA, Barcelona, España
| | - D A González
- Consultant in Anaesthesia & ICU, Clínica Universitaria de Navarra, Pamplona, España
| | - M Vives
- Consultant in Anaesthesia & ICU, Hospital Universitari Dr. Josep Trueta, Girona, España
| | - C Ferrando
- Head of Surgical Intensive Care Unit, Hospital Clínic, Universitat de Barcelona. CIBERES, Barcelona, España
| | - J Baeza
- Vice president World Federation of Ozone Therapy. Presidente de la Sociedad Española de Ozonoterapia. Profesor de Anatomía humana, Facultad de Medicina, Universidad de Valencia, Valencia, España
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23
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Houschyar M, Borrelli MR, Tapking C, Maan ZN, Rein S, Chelliah MP, Sheckter CC, Duscher D, Branski LK, Wallner C, Behr B, Lehnhardt M, Siemers F, Houschyar KS. Burns: modified metabolism and the nuances of nutrition therapy. J Wound Care 2020; 29:184-191. [PMID: 32160092 DOI: 10.12968/jowc.2020.29.3.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To review the effects of burn injury on nutritional requirements and how this can best be supported in a healthcare setting. METHOD A literature search for articles discussing nutrition and/or metabolism following burn injury was carried out. PubMed, Embase and Web of Science databases were searched using the key search terms 'nutrition' OR 'metabolism' AND 'burn injury' OR 'burns'. There was no limitation on the year of publication. RESULTS A total of nine articles met the inclusion criteria, the contents of which are discussed in this manuscript. CONCLUSION Thermal injury elicits the greatest metabolic response, among all traumatic events, in critically ill patients. In order to ensure burn patients can meet the demands of their increased metabolic rate and energy expenditure, adequate nutritional support is essential. Burn injury results in a unique pathophysiology, involving alterations in endocrine, inflammatory, metabolic and immune pathways and nutritional support needed during the inpatient stay varies depending on burn severity and idiosyncratic patient physiologic parameters.
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Affiliation(s)
- Madeline Houschyar
- 1 Institute of Agricultural and Nutrition Sciences, Martin Luther University of Halle-Wittenberg, Germany
| | - Mimi R Borrelli
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Christian Tapking
- 3 Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US.,4 Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Zeshaan N Maan
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Susanne Rein
- 5 Department of Plastic and Hand Surgery, Burn Center, Sankt Georg Hospital, Leipzig, Germany
| | - Malcolm P Chelliah
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Clifford C Sheckter
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Dominik Duscher
- 2 Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, US
| | - Ludwik K Branski
- 3 Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, Galveston, US
| | - Christoph Wallner
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Bjö Behr
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | - Frank Siemers
- 8 Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Khosrow S Houschyar
- 7 Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
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Abstract
Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.
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Affiliation(s)
- Marc G Jeschke
- Ross Tilley Burn Center, Department of Surgery, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
- Departments of Surgery and Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Mashkoor A Choudhry
- Burn and Shock Trauma Research Institute, Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole S Gibran
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarvesh Logsetty
- Departments of Surgery and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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26
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Nakajima M, Kojiro M, Aso S, Matsui H, Fushimi K, Kaita Y, Goto H, Yamaguchi Y, Yasunaga H. Effect of high-dose vitamin C therapy on severe burn patients: a nationwide cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:407. [PMID: 31831039 PMCID: PMC6909452 DOI: 10.1186/s13054-019-2693-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vitamin C is a well-documented antioxidant that reduces oxidative stress and fluid infusion in high doses; however, the association between high-dose vitamin C and reduced mortality remains unclear. This study evaluates the effect of high-dose vitamin C in severe burn patients under two varying thresholds. METHODS We enrolled adult patients with severe burns (burn index ≥ 15) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2016. Propensity score matching was performed between patients who received high-dose vitamin C within 1 day of admission (vitamin C group) and those who did not (control group). High-dose vitamin C was defined as a dosage in excess of 10 g or 24 g within 2 days of admission. The primary outcome was in-hospital mortality. RESULTS Eligible patients (n = 2713) were categorized into the vitamin C group (n = 157) or control group (n = 2556). After 1:4 propensity score matching, we compared 157 and 628 patients who were administered high-dose vitamin C (> 10-g threshold) and controls, respectively. Under this particular threshold, high-dose vitamin C therapy was associated with reduced in-hospital mortality (risk ratio, 0.79; 95% confidence interval, 0.66-0.95; p = 0.006). In contrast, in-hospital mortality did not differ between the control and high-dose vitamin C group under the > 24-g threshold (risk ratio, 0.83; 95% confidence interval, 0.68-1.02; p = 0.068). CONCLUSIONS High-dose vitamin C therapy was associated with reduced mortality in patients with severe burns when used under a minimum threshold of 10 g within the first 2 days of admission. While "high-dose" vitamin C therapy lacks a universal definition, the present study reveals that different "high-dose" regimens may yield improved outcomes.
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Affiliation(s)
- Mikio Nakajima
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan. .,Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan.
| | - Morita Kojiro
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shotaro Aso
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Goto
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Reactive Oxygen Species Scavenging Potential Contributes to Hypertrophic Scar Formation. J Surg Res 2019; 244:312-323. [DOI: 10.1016/j.jss.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022]
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28
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Qin FJ, Hu XH, Chen Z, Chen X, Shen YM. Protective effects of tiopronin against oxidative stress in severely burned patients. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2827-2832. [PMID: 31496659 PMCID: PMC6698164 DOI: 10.2147/dddt.s215927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
Objective Tiopronin is an antioxidant. This study investigated the protective effect of tiopronin on oxidative stress in patients with severe burns. Method Patients aged between 16 and 65 years old with >30% body surface area burns admitted to our burn unit from July 2011 to September 2016 were randomly divided into 3 groups: group A treated with tiopronin (15 mg/kg. 24 hrs), group B with vitamin C (792 mg/kg. 24 hrs), the other group with standard treatment (group C). All 3 groups also received standard treatment. Blood superoxide dismutase (SOD), malondialdehyde (MDA), and the biochemical indexes of liver, kidney, and heart were determined before treatment and 24 and 48 hrs after treatment. Samples from 8 normal healthy adult volunteers were also measured. The resuscitation fluid volume requirement for the first 24 hrs was calculated for 3 groups. Results The serum levels of MDA and the biochemical indexes in severely burned patients were higher than those in healthy volunteers (P<0.01). The serum SOD level of burn patients was lower (P<0.01). After treatment, the levels of SOD increased, the levels of MDA decreased, and the biochemical indexes of heart, liver, and kidney improved; these changes were more obvious in group A and group B compared to group C (P<0.05), and these changes were more obvious in group A compared to group B (P<0.05) at 48 hrs after treatment. There is less resuscitation fluid volume requirement to maintain adequate stable hemodynamic and urine output in the first 24 hrs in group A and group B compared to group C (P<0.05). Conclusion Treatment with tiopronin could exert protective effects against burn-induced oxidative tissue damage and multiple-organ dysfunction, and also could reduce the volume of required fluid resuscitation in severely burned patients.
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Affiliation(s)
- Feng-Jun Qin
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Xiao-Hua Hu
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Zhong Chen
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Xu Chen
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Yu-Ming Shen
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
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Fluid Resuscitation in Burns: 2 cc, 3 cc, or 4 cc? CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-00166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Nabzdyk CS, Bittner EA. Vitamin C in the critically ill - indications and controversies. World J Crit Care Med 2018; 7:52-61. [PMID: 30370227 PMCID: PMC6201324 DOI: 10.5492/wjccm.v7.i5.52] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/04/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
Ascorbic acid (vitamin C) elicits pleiotropic effects in the body. Among its functions, it serves as a potent anti-oxidant, a co-factor in collagen and catecholamine synthesis, and a modulator of immune cell biology. Furthermore, an increasing body of evidence suggests that high-dose vitamin C administration improves hemodynamics, end-organ function, and may improve survival in critically ill patients. This article reviews studies that evaluate vitamin C in pre-clinical models and clinical trials with respect to its therapeutic potential.
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Affiliation(s)
- Christoph S Nabzdyk
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
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