The effect of artificial saliva on the control of dry mouth: a semi-experimental study on COVID-19 patients under Non-invasive mechanical ventilation.

OBJECTIVES: Since maintaining oral hygiene is essential in nursing care, the present study was conducted to determine the effect of oral care using Mucosamin artificial saliva spray to control dry mouth in ICU patients with COVID-19. MATERIALS AND METHODS: The current semi-experimental research was conducted on eighty patients with COVID-19 selected using the available sampling method. The study tool was a Beck oral assessment scale (BOAS). The case and control groups were selected from two hospitals with relatively similar conditions and treatment procedures. For patients in the intervention group, mucosamin artificial saliva spray was used in addition to the common care, while control group patients received only common care. RESULTS: Eighty patients were randomly assigned to two groups named control and intervention (40 patients in each group). The intervention was very effective in reducing the BOAS score after four days in comparison with the control group (9.23 vs. 12.05, respectively; p-value < 0.001). Based on the adjusted model, the application of artificial saliva reduced the BOAS score, indicating improvement in mouth dryness. While the BOAS score was increased in the control group, it had a declining trend in the intervention one. CONCLUSION: The study's results showed that using artificial saliva spray could effectively reduce the symptoms of dry mouth in patients with COVID-19 treated with non-invasive mechanical ventilation. CLINICAL RELEVANCE: The present study introduced an applicable solution (artificial saliva) to treat mouth dryness in ICU patients under mechanical ventilation.

Comparison of the efficacy of equivalent doses of dexamethasone, methylprednisolone, and hydrocortisone for treatment of COVID-19-related acute respiratory distress syndrome: a prospective three-arm randomized clinical trial.

BACKGROUND: This prospective controlled clinical trial aimed to compare the efficacy of methylprednisolone, dexamethasone, and hydrocortisone at equivalent doses in patients with severe COVID-19. METHODS: In total, 106 patients with mild to moderate COVID-19-related acute respiratory distress syndrome (ARDS) were randomized to receive either dexamethasone (6 mg once a day), methylprednisolone (16 mg twice a day), or hydrocortisone (50 mg thrice a day) for up to 10 days. All participants received a standard of care for COVID-19. The primary and secondary efficacy outcomes included all-cause 28-day mortality, clinical status on day 28 assessed using the World Health Organization (WHO) eight-category ordinal clinical scale, number of patients requiring mechanical ventilation and intensive care unit (ICU) care, number of ventilator-free days, length of hospital and ICU stay, change in PaO2:FiO2 ratios during the first 5 days after treatment, and incidence of serious adverse events. P-values below 0.008 based on Bonferroni's multiple-testing correction method were considered statistically significant. RESULTS: According to the obtained results, there was a trend toward more favorable clinical outcomes in terms of needing mechanical ventilation and ICU care, number of ventilator-free days, change in PaO2:FiO2 ratios during the first 5 days after treatment, clinical status score at day 28, length of ICU and hospital stay, and overall 28-day mortality in patients receiving dexamethasone compared to those receiving methylprednisolone or hydrocortisone; however, likely due to the study's small sample size, the difference between groups reached a significant level only in the case of clinical status score on day 28 (p-value = 0.003). There was no significant difference in the incidence of serious adverse events between the study groups. CONCLUSION: Based on the results, severe cases of COVID-19 treated with dexamethasone might have a better clinical status at 28-day follow-up compared to methylprednisolone and hydrocortisone at an equivalent dose. Larger multicenter trials are required to confirm our findings.

Is there any association between plasma lipid profile and severity of COVID-19?

BACKGROUND: COVID-19 is an infectious disease which caused a pandemic with many diseases and fatalities. This new variant of coronavirus called SARS-CoV-2 and is primarily characterized by respiratory symptoms. There are some data indicating that LDL-cholesterol (LDL-C) as well as HDL-cholesterol (HDL-C) levels are inversely correlated to disease severity and could act as a predictor for disease progression and unfavorable prognosis. However, the results of some other studies do not confirm this. This current study aimed to provide an answer to this question. METHODS: This prospective, single-center study analyzed 367 confirmed COVID-19 patients to find whether there are any differences in plasma lipoproteins between survivors and non-survivors patients or between the patients with a "duration of ≤10 days intensive unit care (ICU) stay" and patients with a "duration of >10 days ICU stay". RESULTS: No association between any lipid/lipoprotein parameter and the severity of COVID-19 could be found but survivors and non-survivors did differ concerning total cholesterol and LDL-C levels. CONCLUSION: Multivariate cox regression analysis could not prove any association between lipids/lipoproteins and severe events in COVID-19 patients. Significantly less non-survivors with COVID-19 were taking atorvastatin than survivors which is consistent with the majority of previous findings.

A pilot study on intravenous N-Acetylcysteine treatment in patients with mild-to-moderate COVID19-associated acute respiratory distress syndrome.

BACKGROUND: We designed this single-centre clinical trial to assess the potential benefits of N-Acetylcysteine (NAC) in patients with COVID19-associated acute respiratory distress syndrome (ARDS). METHODS: Ninety-two patients with mild-to-moderate COVID19-associated ARDS were allocated to the placebo (45-cases) or NAC groups (47-cases). Besides standard-of-care treatment, the patients received either intravenous NAC at a dose of 40 mg/kg/day or the placebo for three consecutive days. The efficacy outcomes were overall mortality over 28-day, clinical status on day 28, based on the WHO Master Protocol, the proportion of patients requiring mechanical ventilation, changes in ARDS-severity (based on the PaO2/FiO2 ratio), and Sequential Organ Failure Assessment (SOFA) scores 48 and 96 h after intervention, RESULTS: No differences were found in the 28-day mortality rate between the two groups (25.5% vs. 31.1% in the NAC and placebo groups, respectively). Although the distribution of the clinical status at day 28 shifted towards better outcomes in the NAC-treated group, it did not reach a statistical significance level (p value = 0.83). Similar results were achieved in terms of the proportion of patients who required invasive ventilator support (38.3% vs. 44.4%), the number of ventilator-free days (17.4 vs. 16.6), and median time of ICU and hospital stay. Results regarding the change in PaO2/FiO2 ratio and SOFA scores also showed no significant differences between the groups. CONCLUSIONS: Our pilot study did not support the potential benefits of intravenous NAC in treating patients with COVID-19-associated ARDS. More studies are needed to determine which COVID-19 patients benefit from the NAC administration. TRIAL REGISTRATION: The trial was registered at Clinicaltrials.gov (identifier code: IRCT20120215009014N355). Registration date: 2020-05-18.

Comparing the effect of lecture and Jigsaw teaching strategies on the nursing students' self-regulated learning and academic motivation: A quasi-experimental study.

BACKGROUND: In cooperative learning approach, the active and direct involvement of the learner in the learning process leads to a comprehensive development. Self-regulated learning and academic motivation focus on the role of the individual in the teaching-learning process. OBJECTIVES: The aim of this study was to investigate the comparing of lecture and Jigsaw teaching strategies on the nursing students' self-regulated learning and academic motivation. METHODS: This was a quasi-experimental conducted from January to November 2018 on 94 nursing students in the fourth education semester in two classrooms. A classroom was randomly assigned to the lecture group and the other as a Jigsaw group. The data collection tools were demographic data questionnaire, self-regulated learning questionnaire, and academic motivation scale. The interventions were lecture and Jigsaw teaching strategy for seven sessions lasting for 2 h in the lecture and Jigsaw groups respectively. Data was collected before and after the interventions. Finally, data was analyzed using Kolmogorov-Smirnoff test, paired t-test, independent t-test via the PASW-22 software. RESULTS: There was no statistically significant differences between the groups in terms of self-regulated learning and academic motivation before the interventions (P = 0.59, P = 0.38), but after the interventions, the mean scores of self-regulated learning and academic motivation were significantly different in Jigsaw group from that of the lecture group (P = 0.000). CONCLUSIONS: The Jigsaw teaching strategy can be used for nursing student's theoretical education to improve the self-regulated learning and academic motivation.