We performed a systematic review and meta-analysis for the effectiveness of Favipiravir on the fatality and the requirement of mechanical ventilation for the treatment of moderate to severe COVID-19 patients. We searched available literature and reported it by using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Until June 1, 2021, we searched PubMed, bioRxiv, medRxiv, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar by using the keywords “Favipiravir” and terms synonymous with COVID-19. Studies for Favipiravir treatment compared to standard of care among moderate and severe COVID-19 patients were included. Risk of bias assessment was performed using Revised Cochrane risk of bias tool for randomized trials (RoB 2) and ROBINS-I assessment tool for non-randomized studies. We defined the outcome measures as fatality and requirement for mechanical ventilation. A total of 2702 studies were identified and 12 clinical trials with 1636 patients were analyzed. Nine out of 12 studies were randomized controlled trials. Among the randomized studies, one study has low risk of bias, six studies have moderate risk of bias, and 2 studies have high risk of bias. Observational studies were identified as having moderate risk of bias and non-randomized study was found to have serious risk of bias. Our meta-analysis did not reveal any significant difference between the intervention and the comparator on fatality rate (OR 1.11, 95% CI 0.64–1.94) and mechanical ventilation requirement (OR 0.50, 95% CI 0.13–1.95). There is no significant difference in fatality rate and mechanical ventilation requirement between Favipiravir treatment and the standard of care in moderate and severe COVID-19 patients.
Objective Despite various clinical benefits of early extubation following congenital cardiac surgery, the feasibility of this strategy has been widely debated. In this study, we present the outcomes of our on-table extubation strategy in patients with congenital cardiac disease. Methods We performed a retrospective analysis of 91 patients from all age groups, operated on for congenital heart diseases. Patients were evaluated according to the STS-EACTS scoring system. Perioperative patient data were analyzed and correlated with the extubation status. Results Overall, 56% of the patients were extubated in the operating room. There was an association between younger age, longer bypass and cross-clamp times and on-table extubation. In addition, lactate as well as partial carbon dioxide pressure values in the blood gas analysis taken prior to extubation were shown to be significant with regards to extubation success. Patients with STAT expected mortality rates below 4.3% and estimated major complication rates below 6.9% were more likely to be extubated. Further, the blood gas analysis with lactate values below 3.9mmol/L and partial carbon dioxide pressures below 35.3mmHg would direct the strategy in favor of on-table extubation. Moreover, there was a significant correlation between a decreased length of hospital stay and on-table extubation. Conclusion The outcomes of our on-table extubation strategy for patients with congenital cardiac disease reveal the feasibility of this approach. Higher lactate levels, younger age, increased surgical complexity are indicators of on-table extubation failure. Further, this strategy is associated with shorter ICU and hospital length of stays as an additional clinical benefit.
Objectives:The immediate extubation technique in patients undergoing a Fontan operation is commonly used to reduce the negative effects of positive-pressure ventilation on pulmonary blood flow and provide a hemodynamic advantage. This study aimed to determine the correlation between the perioperative characteristics of patients undergoing a Fontan operation and the success of fast track extubation. Methods: Perioperative data from patients from all age groups undergoing a Fontan operation were retrospectively analyzed and correlated with their extubation time. Results: A table extubation was performed on 72.7% of patients undergoing a Fontan operation. Age, presence of fenestration, conduit localization, heterotaxy, cross and bypass durations, and success of ultra-fast track extubation have no significant correlation. Conclusion: Ultra-fast track extubation strategy facilitated the hemodynamic adaptation of patients to the Fontan circulation. However, the Fontan population has little variation in early extubation characteristics.
Cystic echinococcosis, a zoonotic parasitic disease, is endemic to many countries worldwide. This slowly progressing disease is seen rarely in the paediatric age group. In terms of cyst localization, cardiac involvement is infrequent. We report the case of a successful surgical and medical management of a paediatric hydatid disease patient with involvement of the heart.
Background: While prosthetic rings are commonly used for mitral valve repairs, autologous pericardium is an alternative ring material that can be used in these procedures. In this report, we aim to present a comparison of two types of rings used for mitral repair. Methods: Between January 2005 and January 2009, 107 patients who underwent mitral valve repair surgery were analyzed. Patients were divided into two groups, according to the type of ring that was used for mitral annular stabilization. Glutaraldehyde-treated pericardial rings were used for 31 patients (group 1), whereas prosthetic rings were used for 76 patients (group 2). Survival, freedom from reoperation, recurrent mitral regurgitation, and the effects of rheumatic mitral disease on these parameters were evaluated and compared for both groups. Results: Follow-up time for our cohort was 4.24±0.4 years. There were four and seven late mortalities in groups 1 and 2, respectively, and five reoperations in each group. There was no significant difference between the groups, in terms of survival, freedom from reoperation, and recurrent mitral regurgitation (log-rank analyses for both groups were P = 0.777, P = 0.346, and P = 0.781, respectively). There was no significant difference in freedom from reoperation and recurrent mitral regurgitation for both groups, in terms of underlying rheumatic valvular disease and other types of pathology. Conclusion: Pericardial ring annuloplasty shows to be a considerable alternative technique for mitral valve repair procedures in the mid- to long-term follow up. Rheumatic mitral valves had poor outcomes, when compared with other types of structural valvular pathologies in cases where pericardial rings were used in the repair procedure.
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