High-dose intravenous vitamin C decreases rates of mechanical ventilation and cardiac arrest in severe COVID-19.

Intravenous vitamin C (IV-VitC) has been suggested as a treatment for severe sepsis and acute respiratory distress syndrome; however, there are limited studies evaluating its use in severe COVID-19. Efficacy and safety of high-dose IV-VitC (HDIVC) in patients with severe COVID-19 were evaluated. This observational cohort was conducted at a single-center, 530 bed, community teaching hospital and took place from March 2020 through July 2020. Inverse probability treatment weighting (IPTW) was utilized to compare outcomes in patients with severe COVID-19 treated with and without HDIVC. Patients were enrolled if they were older than 18 years of age and were hospitalized secondary to severe COVID-19 infection, indicated by an oxygenation index < 300. Primary study outcomes included mortality, mechanical ventilation, intensive care unit (ICU) admission, and cardiac arrest. From a total of 100 patients enrolled, 25 patients were in the HDIVC group and 75 patients in the control group. The average time to death was significantly longer for HDIVC patients (P = 0.0139), with an average of 22.9 days versus 13.7 days for control patients. Patients who received HDIVC also had significantly lower rates of mechanical ventilation (52.93% vs. 73.14%; ORIPTW = 0.27; P = 0.0499) and cardiac arrest (2.46% vs. 9.06%; ORIPTW = 0.23; P = 0.0439). HDIVC may be an effective treatment in decreasing the rates of mechanical ventilation and cardiac arrest in hospitalized patients with severe COVID-19. A longer hospital stay and prolonged time to death may suggest that HDIVC may protect against clinical deterioration in severe COVID-19.

Hernia recurrence and infection rate in elective complex abdominal wall repair using biologic mesh.

BACKGROUND: Elective complex ventral hernia repairs, done using synthetic mesh in patients with comorbidities, can result in mesh related complications such as hernia recurrence or infection. We studied hernia recurrence and surgical site occurrences after elective complex repairs in predominately clean cases using biologic mesh and examined the impact of several comorbidities. METHODS: A retrospective chart review was completed on patients who underwent elective repair with biologic mesh in clean/clean-contaminated settings between 2012 and 2015 with a minimum of 1-year follow-up. Multiple comorbid conditions, including diabetes, chronic obstructive pulmonary disease, steroid use, smoking history and previous hernia repairs were identified. Post-operative complications including recurrence and infections were ruled out by computed tomography, clinical exam, and/or by telephone survey. RESULTS: 40 patients were identified. 85% (n = 34) had class 1 wounds. 25% (n = 10) experienced a hernia recurrence. 10% (n = 4) of patients developed postoperative infection, none required mesh explantation or re-operation. No statistically significant association was found between the comorbidities assessed and recurrence/infection rates. CONCLUSIONS: We present the first study analyzing clinical outcomes of complex ventral hernia repairs using biologic mesh in predominately clean settings. This study being non-comparative limits definitive conclusions, but our aim is to add to the growing literature on biologic mesh to help future researchers performing comparative trials of synthetic versus biologic meshes.

Integrating Concepts in Biology Textbook Increases Learning: Assessment Triangulation Using Concept Inventory, Card Sorting, and MCAT Instruments, Followed by Longitudinal Tracking.

The purpose of this study was to examine the educational impact of an intervention, the inquiry-focused textbook Integrating Concepts in Biology (ICB), when used in a yearlong introductory biology course sequence. Student learning was evaluated using three published instruments: 1) The Biology Concept Inventory probed depth of student mastery of fundamental concepts in organismal and cellular topics when confronting misconceptions as distractors. ICB students had higher gains in all six topic categories (+43% vs. peers overall, p < 0.01). 2) The Biology Card Sorting Task assessed whether students organized biological ideas more superficially, as novices do, or based on deeper concepts, like experts. The frequency with which ICB students connected deep-concept pairs, or triplets, was similar to peers; but deep understanding of structure/function was much higher (for pairs: 77% vs. 25%, p < 0.01). 3) A content-focused Medical College Admission Test (MCAT) posttest compared ICB student content knowledge with that of peers from 15 prior years. Historically, MCAT performance for each semester ranged from 53% to 64%; the ICB cohort scored 62%, in the top quintile. Longitudinal tracking in five upper-level science courses the following year found ICB students outperformed peers in physiology (85% vs. 80%, p < 0.01).