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Pushing the frontiers of military medical excellence: updates, progress and future needs. Mil Med Res 2022; 9:27. [PMID: 35681166 PMCID: PMC9183759 DOI: 10.1186/s40779-022-00388-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 12/25/2022] Open
Abstract
Since its establishment in 2014, Military Medical Research has come a long way in becoming a premier journal for scientific articles from various different specialties, with a special emphasis on topics with military relevance. The field of military medicine may be obscure, and may not be readily encountered by the typical clinician on a day-to-day basis. This journal aims not only to pursue excellence in military research, but also keep current with the latest advancements on general medical topics from each and every specialty. This editorial serves to recap and synthesize the existing progress, updates and future needs of military medical excellence, discussing foremostly the unique traits of literature published in this journal, and subsequently presenting the discourse regarding wartime and peacetime medicine, the role of the military in a public health emergency, as well as wound healing and organ regeneration. Special attention have been devoted to military topics to shed light on the effects of Chemical, Biological, Radiological and Explosive (CBRE) warfare, environmental medicine and military psychiatry, topics which rarely have a chance to be discussed elsewhere. The interconnectedness between military combat and soldier physical and mental well-being is intricate, and has been distorted by pandemics such as coronavirus disease 2019 (COVID-19). This journal has come a long way since its first article was published, steadily contributing to the existing knowledge pool on general medical topics with a military slant. Only with continuous research and sharing, can we build upon the work of the scientific community, with hopes for the betterment of patient care.
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Sedhai YR, Shrestha DB, Budhathoki P, Memon W, Acharya R, Gaire S, Pokharel N, Maharjan S, Jasaraj R, Sodhi A, Kadariya D, Asija A, Kashiouris MG. Vasopressin versus norepinephrine as the first-line vasopressor in septic shock: A systematic review and meta-analysis. J Clin Transl Res 2022; 8:185-199. [PMID: 35813900 PMCID: PMC9260345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 10/25/2022] Open
Abstract
Background and Aim Norepinephrine is currently the first-line vasopressor for septic shock. We conducted this meta-analysis to examine the outcomes of adult patients with septic shock who received vasopressin instead of norepinephrine. Methods We selected studies in adults with septic shock that compared the outcomes of patients treated with vasopressin versus norepinephrine. Cochrane ROB 2.0 and the Joanna Briggs Institute quality assessment tools were used to assess the risk of bias in RCTs and observational studies. Meta-analysis was conducted using RevMan 5.4. Results Eight studies were included in this meta-analysis. There were no significant differences in 28-day mortality rates (OR, 1.07; CI, 0.80-1.44) and intensive care unit (ICU) mortality (OR, 0.74; CI, 0.21-2.67) between the two groups. Similarly, length of ICU stay, length of hospital stay, mean arterial pressure at 24 h, urine output at 24 h, and serious adverse events also did not differ significantly. However, the odds of renal replacement therapy (RRT) requirement in the vasopressin group were substantially lower than in the norepinephrine group (OR, 0.68; CI, 0.47-0.98). Conclusion There were no differences in mortality, duration of hospitalization, and adverse effects in adults with septic shock across the two groups. However, the patients treated with vasopressin had lower chances of requiring RRT. Relevance for Patients Vasopressin use as the first-line vasopressor in septic shock showed a significant reduction in RRT, though there were no significant differences in terms of mortality and other adverse events. Therefore, vasopressin can be considered as a first-line vasopressor in septic shock patients with other risk factors which may contribute to renal failure requiring RRT.
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Affiliation(s)
- Yub Raj Sedhai
- 1Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, United States
| | - Dhan Bahadur Shrestha
- 2Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, United States,Corresponding author: Dhan Bahadur Shrestha Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, United States.
| | - Pravash Budhathoki
- 3Department of Internal Medicine, Bronxcare Health System, Bronx, New York, United States
| | - Waqas Memon
- 4Department of Internal Medicine, Division of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia, United States
| | - Roshan Acharya
- 5Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, North Carolina, United States
| | - Suman Gaire
- 6Department of Emergency Medicine, Palpa Hospital, Palpa, Nepal
| | - Nisheem Pokharel
- 7Department of Emergency Medicine, KIST Medical College, Lalitpur, Nepal
| | - Swojay Maharjan
- 8Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Ranjit Jasaraj
- 2Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, United States
| | - Amik Sodhi
- 9Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, University of Wisconsin, Madison, Wisconsin, United States
| | - Dipen Kadariya
- 10Attending Physician, Pulmonary Disease and Critical Care Medicine, Independent Practitioner
| | - Ankush Asija
- 11Department of Internal Medicine, West Virginia University, Morgan Town, West Virginia, United States
| | - Markos G. Kashiouris
- 12Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, VCU School of Medicine, Richmond, Virginia, United States
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Zhong L, Ji XW, Wang HL, Zhao GM, Zhou Q, Xie B. Non-catecholamine vasopressors in the treatment of adult patients with septic shock-evidence from meta-analysis and trial sequential analysis of randomized clinical trials. J Intensive Care 2020; 8:83. [PMID: 33292658 PMCID: PMC7603734 DOI: 10.1186/s40560-020-00500-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Norepinephrine (NE) has currently been the first-choice vasopressor in treating septic shock despite generally insufficient for patients with refractory septic shock. The aim of this update meta-analysis was to assess the safety and efficacy of a combination of non-catecholamine vasopressors (vasopressin/pituitrin/terlipressin/selepressin/angiotensin II) and NE versus NE in managing adult septic shock patients. METHODS We conducted this study of literatures published from the inception to April 30, 2020, using PubMed, Embase, and the Cochrane Library databases without language restriction. Randomized controlled trials comparing NE with non-catecholamine vasopressors among adult septic shock patients were included in this meta-analysis. Pooled effects of relative risk (RR) or standard mean difference (SMD) and corresponding 95% confidence interval (CI) were calculated using a random-effects model. RESULTS Twenty-three studies covering 4380 participants were finally enrolled. The combined analysis of non-catecholamine vasopressors resulted in a nonsignificant reduction in 90-day/ICU/hospital mortality except for a decreased in 28-day mortality (n = 4217; RR, 0.92; 95% CI 0.86-0.99; P = 0.02). This favorable result was subsequently verified by the subgroup analyses of low risk of bias studies (RR = 0.91, 95% CI = 0.84 to 0.98; P = 0.02) and catecholamine-resistant refractory shock patients group (RR, 0.84; 95% CI = 0.70-1.00; P = 0.048). The pooled analysis of non-catecholamine vasopressors showed a 14% higher success rate of shock reversal at 6 h, a 29% decreased risk of continuous renal replacement therapy, but a 51% increased risk of hyponatremia and a 2.43 times higher risk of digital ischemia. Besides, the pooled data showed that non-catecholamine vasopressors decreased heart rate (HR) (SMD, - 0.43; 95% CI - 0.66 - - 0.19; P < 0.001), serum creatinine (- 0.15; 95% CI - 0.29 - - 0.01; P = 0.04), and the length of mechanical ventilation (MV) (- 0.19; 95% CI - 0.31 - - 0.07; P < 0.01, but there was no significant difference in other parameters. CONCLUSIONS Current pooled results suggest that the addition of NE to non-catecholamine vasopressors was associated with a marginally significant reduction in 28-day mortality. Moreover, they were able to shorten the length of MV, improved renal function, decreased HR, and increased the 6-h shock reversal success rate at the expense of increased the risk of hyponatremia and digital ischemia.
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Affiliation(s)
- Lei Zhong
- grid.411440.40000 0001 0238 8414Department of Intensive Care Units, Huzhou Central Hospital, Affiliated Central Hospital, HuZhou University, 198 Hongqi Rd, Huzhou, 313000 Zhejiang PR China
| | - Xiao-Wei Ji
- grid.411440.40000 0001 0238 8414Department of Intensive Care Units, Huzhou Central Hospital, Affiliated Central Hospital, HuZhou University, 198 Hongqi Rd, Huzhou, 313000 Zhejiang PR China
| | - Hai-Li Wang
- grid.411440.40000 0001 0238 8414Department of Obstetrics and Gynecology, Huzhou Central Hospital, Affiliated Central Hospital, Huzhou University, Huzhou, 313000 Zhejiang PR China
| | - Guang-Ming Zhao
- grid.268415.cDepartment of Intensive Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou, 225000 Jiangsu Province PR China
| | - Qing Zhou
- grid.411440.40000 0001 0238 8414Department of Intensive Care Units, Huzhou Central Hospital, Affiliated Central Hospital, HuZhou University, 198 Hongqi Rd, Huzhou, 313000 Zhejiang PR China
| | - Bo Xie
- Department of Intensive Care Units, Huzhou Central Hospital, Affiliated Central Hospital, HuZhou University, 198 Hongqi Rd, Huzhou, 313000, Zhejiang, PR China.
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Zhang Z, Chen K. Vasoactive agents for the treatment of sepsis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:333. [PMID: 27713891 PMCID: PMC5050188 DOI: 10.21037/atm.2016.08.58] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine. Levosimendan is a relatively new agent exerting its inodilator effect by increasing sensitivity of myocardium to calcium. Some preliminary studies showed a promising result of levosimendan on reducing mortality.
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Affiliation(s)
- Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Kun Chen
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
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Li CJ, Zhang G, Zhang Y, Cong H, Zhang BL. Clinical efficacy of Xinkeshu Pian on coronary heart disease and mood disorder complications after PCI. Int J Clin Exp Med 2014; 7:1887-1890. [PMID: 25126196 PMCID: PMC4132160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/30/2014] [Indexed: 06/03/2023]
Abstract
AIM To assess the efficacy and safety of combining Xinkeshu tablet treatment with routine Western medicine treatment for patients with coronary heart disease (CHD) and mood disorders after PCI postoperative period. METHOD 100 patients were randomly divided into treatment group of 50 cases, and control group of 50 cases. The control group was given routine Western medical treatment, whereas the treatment group was given routine Western medical treatment in combination with Xinkeshu tablets. Eight weeks after treatment, the patients underwent SF-36 life quality evaluation, self-rating depression scale (SDS) evaluation, and self-rating anxiety scale (SAS) evaluation. RESULT After the eight-week treatment, the SF-36 life quality scores, SAS scores, SDS score, as well as the reduction in heart creatinine levels of the two groups were compared. The results show statistical significance (P<0.05). CONCLUSION Xinkeshu can effectively address the PCI postoperative mood disorders in patients with coronary heart disease and improve the quality of life.
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Affiliation(s)
- Chun-Jie Li
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin 300193, China
- Tianjin Chest HospitalTianjin, China
| | - Guanwei Zhang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin 300193, China
| | | | | | - Bo-Li Zhang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin 300193, China
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