Highlights
Viral infections such as SARS-CoV-2 (COVID-19), influenza, RSV, and many others are usually associated with increased oxidative stress leading to oxidative cellular and tissue damage resulting in multi-organ failure.
Vitamin C has demonstrated favorable therapeutic properties safety profile throughout a wide range of clinical application.
Administration of high dose of vitamin C as therapeutic agent can favorably impact patient with viral pneumonia and ARDS in severe SAR-CoV-2 infected patients by decreasing inflammation, pathogens infectiveness and virulence, optimizing immune defense, reducing tissues and organs injuries and improving the overall outcome of the disease.
Other nutraceutical antioxidants that widely available as OTC drugs or food supplements can be used to improve redox balance and reduce the tissue damages in patients with viral pneumonia and ARDS
Further clinical trials are needed to validate the effectiveness and develop an optimal therapeutic protocol for high dose of vitamin C treatment for pneumonia and ARDS in patients with viral infection.
Purpose: To review the current literature to determine which injection technique and needle portal placement provide the greatest accuracy for intra-articular access to the knee. Methods: This study followed Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in March 2020 and repeated in May 2020 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Data on the accuracy of intra-articular knee injection (successful injections/total number of injections) were collected. Only Level I studies were included. Study design, demographic variables, needle sizes, and method of validating accuracy were recorded. The Jadad score was used to assess methodologic quality, and a risk-of-bias assessment was performed. Results: A total of 12 Level I human studies (1431 patients, 1315 knees) were included in this review. Seven of the studies did a direct comparison between ultrasound-guided and blind knee injections. Ultrasound-guided injections were more accurate compared with blinded knee injections in every study. The most accurate anatomical approach was an isometric quadricep contraction method with the superolateral approach. Conclusions: This study showed that ultrasound-guided knee injections were more accurate across every anatomical needle injection site compared with blind injections. Injections made by a blind/anatomically guided method had inconsistent accuracy rates that seemed highly dependent on the portal of entry. Level of Evidence: Level I, systematic review of Level I studies.
The use of biologically based therapies is becoming a popular less-invasive therapy for relieving pain and promoting tissue regeneration. The most commonly used biologics are autologous adipose-derived products, bone marrow aspirations, and platelet-rich plasma (PRP). Birth tissue is a common allogenic source of biologics, including umbilical cord, placental membranes, and amniotic fluid. Injected biologics, depending on the indication and how they are processed, formulated, delivered, and promoted, can be subject to different regulatory pathways. The aim of this review is to provide an overview of these products and procedures and educate the musculoskeletal community about the relevant current Food and Drug Administration (FDA) regulations.
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