Aims:We hypothesised that omega-3 fatty acids would be an appropriate adjunct therapy for alleviating the inflammatory response and clinical manifestation in hospitalised patients with Covid-19 disease. Methods: This was a single-blind randomised controlled trial in Amir-Alam hospital in Tehran. Thirty adult men and women diagnosed with Covid-19 were allocated to either control group (receiving Hydroxychloroquine) or intervention group (receiving Hydroxychloroquine plus 2 grams of Docosahexaenoic acid [DHA] + Eicosapentaenoic acid [EPA]) for 2 weeks. Primary outcome of the intervention including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) as well as clinical symptoms including body pain, fatigue, appetite and olfactory and secondary outcomes including liver enzymes were determined at the baseline and after omega-3 supplementation. Clinical signs were measured using self-reported questionnaires. There were commercial kits for determination of CRP and liver enzymes concentrations in the serum of patients. For determination of ESR automated haematology analyser was applied. The study of "Comparison of the effectiveness of omega-3 and Hydroxychloroquine on Inflammatory factors, liver enzymes and clinical symptoms in diabetic Covid-19 patients" was registered in Iranian Registry of Clinical Trials (IRCT) with ID number: IRCT20200511047399N1. Results:In comparison to control group, patients receiving omega-3 indicated favourable changes in all clinical symptoms except for olfactory (P < .001 for body pain and fatigue, P = .03 for appetite and P = .21 for olfactory). Reducing effects of omega-3 supplementation compared with control group were also observed in the levels of ESR and CRP after treatment (P < .001 for CRP and P = .02 for ESR).However, no between group differences in the liver enzymes serum concentrations were observed after supplementation (P > .05). Conclusion:Current observations are very promising and indicate that supplementation with moderate dosages of omega-3 fatty acids may be beneficial in the management of inflammation-mediated clinical symptoms in Covid-19 patients.

BACKGROUND:As the elderly population increases dramatically, the chronic age-related disease should be noted. In the elderly, chronic pain is a common health problem.METHODS:This search was performed in 3 databases (PubMed, Google Scholar, Embase). We have reviewed articles related to pain management in the elderly.RESULT:The prevalence of pain in people aged above 60 is twice that in younger people. Pain is estimated to be 45-85 per cent in the elderly. Pain is not a part of the ageing process, but many older people can experience it. Perception of pain can be affected by environmental, emotional, cultural and cognitive factors. Pain in the elderly often remains untreated and misdiagnosed.CONCLUSION:Pain management in elderly needs different approach because of unreported pain in this population, and usually they have multiple problems and comorbidities that complicate evaluation and treatment.

Some studies suggested the effects of inflammatory cytokines in reducing muscle mass and muscle strength and, performance. This study aimed to compare pro-inflammatory cytokines in sarcopenic and non-sarcopenic subjects. 120 men and women were selected out from the cross-sectional study ‘sarcopenia and its determinants among Iranian elders’ (SARIR). Sarcopenia was defined based on the first ‘European Working Group on sarcopenia in older people’ (EWGSOP1) guidelines. A fasting blood sample was taken from each participant to measure serum high-sensitivity C-reactive protein (hs-CRP), Interleukin 6 (IL-6), and tumor necrosis factor α (TNFα). A total of 120 participants were included in this study. Mean age was 66.7 ± 7.7 years and mean body mass index (BMI) was 27.3 ± 4.2 kg/m2. Forty participants had the criteria of EWGSOP1 sarcopenia. A statistically significant difference was seen between normal and abnormal groups of muscle strength in hs-CRP (P-value = 0.04). Furthermore, we did not observe any remarkable association between inflammatory biomarkers including IL-6 (OR 1.15; 95% CI 0.31–4.28), TNF-α (OR 0.68; 95% CI 0.17–2.77), and hs-CRP (OR 2.39; 95% CI 0.87–6.55) and the presence of sarcopenia even after controlling for plausible confounders. We found that inflammatory biomarkers level was not associated with odds of sarcopenia. The lack of correlation between inflammatory cytokines and sarcopenia could be due to the participants’ age and genetics. Future studies are required to confirm these findings.

Objective: We hypothesized that omega-3 fatty acids would be an appropriate adjunct therapy for alleviating the inflammatory response and clinical manifestation in hospitalized patients with covid-19 disease. Methods: This was a single-blind randomized controlled trial in Amir-Alam hospital in Tehran. Thirty adult men and women diagnosed with covid-19 were allocated to either control group (receiving Hydroxychloroquine) or intervention group (receiving Hydroxychloroquine plus 2 grams of DHA+EPA) for 2 weeks. Primary outcome of the intervention including CRP, ESR as well as clinical symptoms including body pain, fatigue, appetite and olfactory and secondary outcomes including liver enzymes were determined at the baseline and after omega-3 supplementation. Clinical signs were measured using self-reported questionnaires. There were commercial kits for determination of CRP and liver enzymes concentrations in the serum of patients. For determination of ESR automated hematology analyzer was applied. Results: In comparison to control group, patients receiving omega-3 indicated favorable changes in all clinical symptoms except for olfactory ((p<0.001 for body pain and fatigue, p= 0.03 for appetite and p=0.21 for olfactory). Reducing effects of omega-3 supplementation compared to control group were also observed in the levels of ESR and CRP after treatment (p<0.001 for CRP and p=0.02 for ESR). However, no between group differences in the liver enzymes serum concentrations were observed after supplementation (p>0.05). Conclusion: Current observations are very promising and indicate that supplementation with moderate dosages of omega-3 fatty acids may be beneficial in the management of inflammation-mediated clinical symptoms in covid-19 patients. Key words: Covid-19, omega-3, inflammation, clinical symptoms

No abstract

Background Dementia is a progressive disabling neurogenic disease resulted in serious nutritional deficiencies included dysphagia, malnutrition and weight loss. The Percutaneous Endoscopic Gastrostomy (PEG) which is a long-term enteral feeding method that routinely use in demented patients with poor food intake as a standard protocol. However, most of the evidences have not shown beneficial effects of PEG feeding on complications or survival rates in these patients. Some studies have even reported an increase in mortality. The current systematic review and meta-analysis aimed to evaluate the mortality rate and survival in primary demented patients with PEG.Methods A systemically search conducted on Pubmed and Scopus databases up to Aug 2019 without language restriction. The data were reviewed according to Cochrane handbook and preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE). Based on random-effects model, mortality rate and median survival were expressed as risk ratio and weighted mean difference (WMD) and 95% CI respectively.Results Among 13 included studies, PEG insertion in patients with primary dementia has no significant effect on 30-day, 90-day, 180-day, 1-year and 2- year mortality rate or median survival (WMD: 9.77; 95% CI: -22.43 to 41.98; P= 0.55). It seems that naso-gastric tube (NGT) feeding in compared to PEG in this population is more effective.Conclusion Further prospective studies are needed to comprehensive evaluation of mortality or survival regarding to comorbidities, underlying disease, cognitive and physical performance and nutritional problems in demented patients.

No abstract

Background Some studies emphasize the effects of inflammatory cytokines in reducing muscle mass and muscle strength and performance. This study aimed to compare pro-inflammatory cytokines in sarcopenic and non-sarcopenic subjects. Method The present study used data from the "Sarcopenia and its Determinants Among Iranian Elders" (SARIR) study. Three hundred men and women aged ≥ 55 years old who lived in the 6th district of Tehran were selected using random cluster sampling. We measured all components by using standard protocols, in addition we defined sarcopenia based on former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines. A fasting blood sample was taken from each participant to measure serum high-sensitivity C-reactive protein (hs- CRP), Interleukin 6 (IL-6), and tumor necrosis factor α (TNFα). Results Mean age and body mass index (BMI) of study participants were 66.7 ± 7.7 years and 27.3 ± 4.2 kg/m2, respectively. Thirty-one participants of the present study had the criteria of EWGSOP2-sarcopenia. A statistically significant difference was seen between normal and abnormal groups of muscle strength in hs-CRP (p-value =0.04). Furthermore, we did not observe a remarkable association between inflammatory biomarkers including IL-6, TNF-α and hs-CRP and risk of sarcopenia even after controlling for plausible confounders (OR: 1.15; 95% CI 0.31-4.28, OR 0.68; 95% CI 0.17-2.77 and OR 2.39; 95% CI 0.87-6.55). Conclusion We found that inflammatory biomarkers level was not considerably associated with odds of sarcopenia. Lack of correlation between inflammatory cytokines and sarcopenia could be due to participant’s age and genetic. Future studies are required to confirm these findings.