Assessment of reliability and quality of YouTube® exercise videos in people with rheumatoid arthritis.

BACKGROUND: YouTube®, one of the busiest video-sharing platforms, may lack sufficient or accurate information on health information and practices given the absence of a rigorous evaluation process. PURPOSE: This study aims to evaluate the reliability of information and quality of exercise videos on YouTube® for rheumatoid arthritis. METHODS: Video features and the source of the upload were sorted. Reliability of the information shared in the videos was evaluated using the mDISCERN too, and quality was assessed using the Global Quality Scale and JAMA scoring system. Videos were independently analyzed by two physiotherapists specialized in rheumatologic rehabilitation. Any bias was resolved by an independent third assessor. RESULTS: One hundred thirty-four exercise videos were included. A hundred and twenty-six (94%) of the 134 exercise videos were found to be useful, and 8 (6%) were misleading. The useful and misleading videos had similar numbers of views, likes, comments, and subscribers (p > .05), while video duration and time since upload were higher for useful videos (p < .05). Cohen's Kappa scores demonstrated that the level of agreement between the assessors were moderate (mDISCERN = 0.417, Global Quality Scale = 0.582, and JAMA = 0.555). There was a significant difference in JAMA scores (p = .013) between the sources of the videos. However, no significant difference was found in mDISCERN (p = .104) and Global Quality Scale (p = .128) scores. CONCLUSION: YouTube® exercise videos provide partially reliable and moderate-quality information for people with rheumatoid arthritis. However, patients should be cautious and not rely directly on YouTube® exercise videos. Instead, they should consult a physician or physical therapist for exercises.

Comparison of Anakinra and Tocilizumab in Anticytokine Therapy in the Treatment of Coronavirus Disease-2019.

Background: It is known that coronavirus disease-2019 (COVID-19) pneumonia causes cytokine storm, and treatment modalities are being developed on inhibition of proinflammatory cytokines. We aimed to investigate the effects of anticytokine therapy on clinical improvement and the differences between anticytokine treatments. Materials and methods: A total of 90 patients with positive COVID-19 polymerase chain reaction (PCR) test were divided into three groups, group I (n = 30) was given anakinra, group II (n = 30) was given tocilizumab, and group III (n = 30) was given standard treatment. Group I was treated with anakinra for 10 days; tocilizumab, intravenously, was given in group II. Group III patients were selected from those who did not receive any anticytokine treatment other than the standard treatment. Laboratory values, Glasgow coma scale (GCS), and PaO2/FiO2 values were analyzed on days 1, 7, and 14. Results: The seventh-day mortality rates were 6.7% in group II, 23.3% in group I, and 16.7% in group III. In group II, the ferritin levels on the 7th and 14th days were significantly lower (p = 0.004), and the lymphocyte levels on the seventh day were significantly higher (p = 0.018). Examining the changes between the first intubation days, in the early period (seventh day), group I was found to be 21.7%, group II was 26.9%, and group III was 47.6%. Conclusion: We observed the positive effects of the use of tocilizumab on clinical improvement in the early period; mechanical ventilation requirement was delayed and at a lower rate. Anakinra treatment did not change mortality and PaO2/FiO2 rates. Mechanical ventilation requirements occurred earlier in the patients who were not receiving any anticytokine therapy. Studies with larger patient populations are needed to demonstrate the potential efficacy of anticytokine therapy. How to cite this article: Ozkan F, Sari S. Comparison of Anakinra and Tocilizumab in Anticytokine Therapy in the Treatment of Coronavirus Disease-2019. Indian J Crit Care Med 2022;26(10):1091-1098.

The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors.

BACKGROUND: Unintended perioperative hypothermia, defined as core body temperature less than 36°C, is closely related to many complications such as cardiovascular diseases, peroperative hemorrhagic diathesis and impairment of drug metabolism. Determination of the incidence of perioperative hypothermia and examination of risk factors may help to prevent hypothermia and its complications. METHODS: We conducted a prospective, observational study of 2015 patients who underwent various operations under general anesthesia, and the risk factors of developing hypothermia were analysed. RESULTS: The incidence of perioperative hypothermia was 78.6%. The incidence of hypothermia within 2 hours was 56.6%, and after 2 hours, it was 100%. Mean age was 49.36 ± 16.10, and 17.8% were over 65 years old. The mean body mass index (BMI) was 27.96 ± 3.94 kg/m2 ; 60.8% of the patients had American Society of Anesthesiologists (ASA) I score, 33.4% had ASA II and 5.8% had ASA III; 35.8% of the patients had co-morbidities. Intravenous and irrigation fluids were unwarmed; 99.9% of the patients were warmed passively, and only 0.1% of patients received active heating intraoperatively. The incidence of hypothermia was higher in overweight (BMI ≥ 25 kg/m2 ), elderly (>65 years) patients and those with co-morbidities. High American Society of Anesthesiologists (ASA) scores, grade 3-4 surgery, endoscopic surgery, duration of anesthesia >2 hours, infusion or irrigation >1000 mL significantly increased the incidence of hypothermia. CONCLUSION: The incidence of perioperative hypothermia found was high. Important risk factors were found as prolonged duration of anesthesia and surgery, advanced age, overweight, high ASA scores, major surgeries, endoscopic operations and unwarmed fluid administration. High incidence may be reduced by raising awareness, considering fossible risk factors and following the recommendations of the guidelines on prevention of perioperative hypothermia.

Transbrachial coil occlusion of the large branch of an internal mammary artery coronary graft.

Percutaneous transbrachial insertion of two complex coils into the intercostal branch of the left internal mammary artery resulted in the relief of severe angina in a 45-year-old man who had coronary artery bypass surgery 2 years before. The diagnosis of coronary artery steal was made clinically. This case illustrates the importance of recognizing coronary steal in patients who redevelop angina after coronary artery surgery with the use of an incompletely prepared left internal mammary artery as a conduit. Brachial or radial artery should be preferred to reach left internal mammary artery (LIMA) for cannulation easily. The preoperative angiographic imaging of LIMA is important to detect the side branches and their sizes. The patient was treated without the need for further surgery.