ascorbic-acid and Cross-Infection

The incidence of pneumonia for elderly persons living in the community is 14 cases/1000 persons/y, whereas 33/1000 nursing home residents require hospitalization for pneumonia each year. Premorbid health status is more important than age in determining outcome from pneumonia in this age group. Two studies of mortality in the 2 years following pneumonia gave conflicting results. One study showed that the mortality rate was twice that which was expected. Both the clinical and radiographic diagnosis of pneumonia may be difficult in the elderly especially if there is co-existing congestive heart failure. Aspiration is an under-diagnosed cause of pneumonia in the elderly. Data from three randomized clinical trials indicate that intravenous antibiotic therapy can be changed to oral therapy when the patient has been afebrile (< 37.5 degrees C) for 16 hours, can take antibiotics by mouth, and has a leukocyte count returning towards normal. Adjunctive therapy with nutritional supplements and vitamin C may improve outcome in this group of patients. Yearly immunization with influenza A and B virus vaccine will reduce both the incidence of pneumonia and the rate of hospitalization for this infection. A discussion of pneumonia in the elderly is often divided into community-acquired pneumonia, which is treated at home or in a nursing home, or community-acquired pneumonia requiring hospitalization and nosocomial pneumonia. The latter is not described in this review.

Topics: Administration, Oral; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ascorbic Acid; Community-Acquired Infections; Cross Infection; Health Status; Hospitalization; Humans; Incidence; Influenza Vaccines; Injections, Intravenous; Leukocyte Count; Nursing Homes; Nutritional Support; Pneumonia, Bacterial; Pneumonia, Viral; Randomized Controlled Trials as Topic; Survival Rate; Treatment Outcome

Topics: Anti-Bacterial Agents; Ascorbic Acid; Collagen; Cross Infection; Debridement; Diet; Fibrin; Granulation Tissue; Humans; Surgical Instruments; Surgical Wound Dehiscence; Surgical Wound Infection; Sutures; Tissue Adhesives; Wound Healing; Wounds and Injuries; Zinc

The combination of ascorbic acid, corticosteroids, and thiamine has been identified as a potential therapy for septic shock.. To determine whether the combination of ascorbic acid, corticosteroids, and thiamine attenuates organ injury in patients with septic shock.. Randomized, blinded, multicenter clinical trial of ascorbic acid, corticosteroids, and thiamine vs placebo for adult patients with septic shock. Two hundred five patients were enrolled between February 9, 2018, and October 27, 2019, at 14 centers in the United States. Follow-up continued until November 26, 2019.. Patients were randomly assigned to receive parenteral ascorbic acid (1500 mg), hydrocortisone (50 mg), and thiamine (100 mg) every 6 hours for 4 days (n = 103) or placebo in matching volumes at the same time points (n = 102).. The primary outcome was change in the Sequential Organ Failure Assessment (SOFA) score (range, 0-24; 0 = best) between enrollment and 72 hours. Key secondary outcomes included kidney failure and 30-day mortality. Patients who received at least 1 dose of study drug were included in analyses.. Among 205 randomized patients (mean age, 68 [SD, 15] years; 90 [44%] women), 200 (98%) received at least 1 dose of study drug, completed the trial, and were included in the analyses (101 with intervention and 99 with placebo group). Overall, there was no statistically significant interaction between time and treatment group with regard to SOFA score over the 72 hours after enrollment (mean SOFA score change from 9.1 to 4.4 [-4.7] points with intervention vs 9.2 to 5.1 [-4.1] points with placebo; adjusted mean difference, -0.8; 95% CI, -1.7 to 0.2; P = .12 for interaction). There was no statistically significant difference in the incidence of kidney failure (31.7% with intervention vs 27.3% with placebo; adjusted risk difference, 0.03; 95% CI, -0.1 to 0.2; P = .58) or in 30-day mortality (34.7% vs 29.3%, respectively; hazard ratio, 1.3; 95% CI, 0.8-2.2; P = .26). The most common serious adverse events were hyperglycemia (12 patients with intervention and 7 patients with placebo), hypernatremia (11 and 7 patients, respectively), and new hospital-acquired infection (13 and 12 patients, respectively).. In patients with septic shock, the combination of ascorbic acid, corticosteroids, and thiamine, compared with placebo, did not result in a statistically significant reduction in SOFA score during the first 72 hours after enrollment. These data do not support routine use of this combination therapy for patients with septic shock.. ClinicalTrials.gov Identifier: NCT03389555.

Topics: Adrenal Cortex Hormones; Adult; Aged; Ascorbic Acid; Cross Infection; Drug Therapy, Combination; Female; Humans; Hyperglycemia; Hypernatremia; Male; Middle Aged; Multiple Organ Failure; Organ Dysfunction Scores; Proportional Hazards Models; Shock, Septic; Thiamine; Treatment Failure

We have evaluated whether vitamin B6 and C metabolism may be altered by infection in the elderly. Vitamin B6 and C biochemical status has been assessed for times over a period of 21 days (days 0, 7, 14, and 21) in 18 subjects > or = 75 years. The subjects were divided into 3 groups: group I (8 subjects with acute infection), group II (4 malnourished subjects), and group III (6 control subjects). Vitamin B6 status was determined by plasma pyridoxal-5'-phosphate (PLP) and erythrocyte aspartate aminotransferase activation coefficient (alpha-EAST), and vitamin C status by plasma ascorbic acid. During the 3 weeks, vitamins B6 and C values were significantly different between groups: at days 7 and 14, PLP values were significantly higher in group III than in both groups I and II, and alpha-EAST values were significantly higher in group I than in both groups II and III. Plasma ascorbate values were significantly lower in group I than in both groups II and III. These data suggest that an acute catabolic state like infection may influence vitamin B6 and C metabolism. Nevertheless, more work is needed to assert that vitamin B6 and C supplementation may be useful during infection.

Topics: Acute-Phase Proteins; Aged; Aged, 80 and over; Ascorbic Acid; Cross Infection; Female; Humans; Male; Nutrition Disorders; Pyridoxine; Time Factors