Prone positioning effect on tracheal intubation rate, mortality and oxygenation parameters in awake non-intubated severe COVID-19-induced respiratory failure: a review of reviews

BACKGROUND

Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients.

METHODS

We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05.

RESULTS

Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value < 0.001). There was no difference in PaO2/FiO2 (MD = 3.591[- 40.881, 48.062]; P-value = 0.874) and SpO2 percent (MD = 1.641[- 4.441, 7.723]; P-value = 0.597).

CONCLUSION

Prone positioning can be recommended in conscious ICU patients with COVID-19 pneumonia to reduce mortality and intubation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42022326951. Registered 25 April 2022.

Are Iranian obese women candidate for bariatric surgery different cognitively, emotionally and behaviorally from their normal weight counterparts?

OBJECTIVE

The purpose of the present study was to examine the cognitive, emotional and behavioral differences between obese and normal weight women.

METHODS

The participants consisted of 60 obese women (BMI ≥ 35, Mean age 35.83) who were candidates for bariatric surgery and 60 normal weight women (BMI ≤ 24.90, Mean age 33.38) who were selected through convenient sampling method. The two groups were matched with respect to age and education. Measures included the Young Schema Questionnaire-Short Form, Difficulties in Emotion Regulation Scale (DERS) and the Binge Eating Scale. Independent sample t test and Mann-Whitney U tests were conducted to compare the two groups' scores on early maladaptive schemas, DER and binge eating.

RESULTS

Results indicated that obese women candidate for bariatric surgery scored significantly higher on emotional deprivation, mistrust, failure, dependency, enmeshment, self-sacrifice, especially abandonment, social isolation, vulnerability, self-control and subjugation schemas, but not on shame, entitlement, emotional inhibition and unrelenting standards. Obese women also displayed higher scores on three subscales of DERS, i.e., goal, impulse and strategies. BE scores were significantly higher in obese women than normal weight ones.

CONCLUSION

The findings showed that obese women candidates for bariatric surgery suffered from more cognitive, emotional and behavioral vulnerability compared to women with normal weight. Addressing these vulnerabilities among obese women could improve outcomes of weight loss surgeries and cognitive behavioral interventions so that weight regain is minimized and better outcomes are achieved.

Evaluation of the level of house dust mite allergens, Der p 1 and Der f 1 in Iranian homes, a nationwide study

BACKGROUND

Exposure to house dust mites (HDMs) is a major risk factor for the development of allergic symptoms. HDMs are worldwide in distribution. Assessing these allergens in each area is a critical step in evaluating the risk of sensitisation and controlling allergic symptoms. The aim of the present study was to evaluate the level of major HDMs, Der p 1 and Der f 1, in various parts of Iran.

METHODS

In 2009, 257 dust samples were obtained from living rooms' carpets in seven cities throughout Iran with different geoclimatic conditions. The level of Der p 1 and Der f 1 was measured by commercial ELISA.

RESULTS

Detectable level of Der p 1 and Der f 1 levels were only found in Gorgan and Sari, two cities near the Caspian Sea with moderate temperatures and high relative humidity. In both of these cities, Der f 1 was more frequent than Der p 1 (100% vs. 85%) and was found to be at a higher level than Der p 1 (geometric mean 3128 vs. 439ng/g dust, P<0.001).

CONCLUSION

The results of this study confirm that house dust mites in Iran are restricted to the Caspian Sea coastal areas, and in other parts, due to seasonal variations of temperature and humidity mites are not able to grow well and therefore are not an important risk factor for sensitisation and respiratory allergies.