Intravenous Vitamin C as an Add-on Therapy for the Treatment of Sepsis in an Intensive Care Unit: A Prospective Cohort Study.

Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". The increased presence of free radicals causes an increase in oxidative stress. Vitamin C is an essential water-soluble vitamin with antioxidant activity and immunoregulatory effects that plays a potential role in the treatment of bacterial infections. Our aim was to evaluate the effectiveness of adding vitamin C to the conventional treatment of sepsis to decrease its mortality rate. Materials and Methods: In a prospective cohort study, we included patients with a diagnosis of sepsis and a SOFA score ≥ 9 who were evaluated in an Intensive Care Unit at a secondary-care hospital. According to the intensive care specialist, they were treated using two different strategies: Group 1-patients with sepsis treated with conventional treatment without vitamin C; Group 2-patients with sepsis with the addition of vitamin C to conventional treatment. Results: We included 34 patients with sepsis. The incidence of mortality was 38%, and 47% of patients used vitamin C as an adjuvant to the basic treatment of sepsis. In the basal analyses, patients treated with use of vitamin C compared to patients treated without vitamin C required less use of glucocorticoids (75% vs. 100%, p = 0.039). At follow-up, patients treated without vitamin C had higher mortality than patients treated with vitamin C as an adjuvant for the treatment of sepsis (55.6% vs. 18.8%, p = 0.03). We observed that the use of vitamin C was a protective factor for mortality in patients with sepsis (RR: 0.54, 95% CI: 0.31-0.96, p = 0.03). Conclusions: The use of vitamin C as an adjuvant to treatment decreases the risk of mortality by 46% in patients with sepsis and SOFA ≥ 9 compared to patients treated without vitamin C as an adjuvant to sepsis.

[Comparison of epicardial fat thickness in diabetic patients compared to non-diabetics with acute myocardial infarction and ST-segment elevation (AMI-STEMI)]. / Comparación del grosor de la grasa epicárdica entre pacientes diabéticos versus no diabéticos con infarto agudo al miocardio con elevación del segmento ST (IAM CEST).

INTRODUCTION: Visceral fat has deleterious metabolic effects and has been associated with myocardial ischemia. OBJECTIVE: To compare epicardial fat thickness in diabetic versus non-diabetic patients with acute myocardial infarction with ST-segment elevation. MATERIAL AND METHODS: We performed a cross-sectional study in 60 patients with acute myocardial infarction with ST-segment elevation (30 diabetic and 30 non-diabetic). Cardiovascular risk factors and Thrombolysis in Myocardial Infarction (TIMI) score were registered. Using echocardiography, left ventricle ejection fraction and epicardial fat measured in the interventricular septum, right ventricle outflow tract, apex, and right ventricle free wall was evaluated. RESULTS: Epicardial fat at the apex (6.1 vs. 5.8 mm; p = 0.038) and in the interventricular septum (7.0 vs. 5.7 mm; p = 0.033) was higher in diabetic versus non-diabetic patients. In diabetic patients, plasmatic glucose correlated with TIMI score (R: 0.49; p = 0.005) and body mass index (R: -0.50; p = 0.004). The TIMI score (4.5 vs. 3.4; p = 0.04), body mass index (29.3 vs. 26.4; p = 0.008), epicardial fat in the interventricular septum (6.8 vs. 4.7; p = 0.000004) and in the right ventricle outflow tract (6.8 vs. 5.0; p = 0.000042) were higher in patients with fat in apex ≥ 6 mm. CONCLUSIONS: In diabetic patients with acute myocardial infarction with ST-segment elevation, interventricular septum and apex epicardial fat was higher compared with non-diabetic patients.

Echocardiographic measurements of epicardial adipose tissue and comparative ability to predict adverse cardiovascular outcomes in patients with coronary artery disease.

The present study aimed to compare echocardiography measurements of epicardial adipose tissue (EAT) thickness and other risk factors regarding their ability to predict adverse cardiovascular outcomes in patients with coronary artery disease (CAD). Outcomes of 107 patients (86 males, 21 females, mean age 63.6 years old) submitted to diagnostic echocardiography and coronary angiography were prospectively analyzed. EAT (measures over the right ventricle, interventricular groove and complete bulk of EAT) and left ventricle ejection fraction (LVEF) were performed by echocardiography. Coronary complexity was evaluated by Syntax score. Primary endpoints were major adverse cardiovascular events (MACE's), composite of cardiovascular death, myocardial infarction, unstable angina, intra-stent re-stenosis and episodes of decompensate heart failure requiring hospital attention during a mean follow up of 15.94 ± 3.6 months. Mean EAT thickness was 4.6 ± 1.9 mm; and correlated with Syntax score and body mass index; negatively correlated with LVEF. Twenty-three cases of MACE's were recorded during follow up, who showed higher EAT. Diagnostic ability of EAT to discriminate MACE's was comparable to LVEF (AUROC > 0.5); but higher than Syntax score. Quartile comparison of EAT revealed that measurement of the complete bulk of EAT provided a better discrimination range for MACE's, and higher, more significant adjusted risk (cutoff 4.6 mm, RR = 3.91; 95% CI 1.01-15.08; p = 0.04) than the other risk factors. We concluded that echocardiographic measurement of EAT showed higher predicting ability for MACE's than the other markers tested, in patients with CAD. Whether location for echocardiographic measurement of EAT impacts the diagnostic performance of this method deserves further study.