Aim: Critical ill patients experience catabolic stress which results in the systemic inflammatory response. The inflammatory response is associated with increased complications including infection, multi-organ dysfunction, increased length of ICU stays, and mortality. L-Carnitine supplementation may play an important role in these patients by regulating inflammatory cell function. The purpose of the present study was to investigate the effect of L-Carnitine supplementation on clinical status, inflammatory markers, and mortality rate in critically ill patients admitted in the intensive care unit(ICU) Methods: This randomized, double-blind, placebo-controlled trial was performed on critically ill patients. Subjects were randomly assigned into placebo (n=27) and L-Carnitine (n=27) groups. L-Carnitine (3000mg/day) was administered via nasogastric tube for the intervention group for 7 days while the other group received a placebo for the same duration. Serum levels of inflammatory markers including C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Nutritional status and the acute physiology and chronic health evaluation (APACHE) score, sequential organ failure assessment (SOFA) score, and 28-day mortality were also recorded. Results: Fifty-one critically ill patients completed the study. L-Carnitine supplementation significantly reduced the levels of CRP (mean change± SE: -34.9 ± 6.5) and IL-6 (mean change ±SE: -10.64 ± 2.16) compared to the baseline, which are both statistically significant compared with the control group (p<0.05). The SOFA and APACHE scores were significantly reduced in the L-Carnitine group compared with the placebo group (p=0.02 and p<0.001, respectively). Conclusions: L-Carnitine supplementation has substantial beneficial effects on inflammatory and clinical outcomes of critically ill patients.

Background: The prevalence of diabetes has been increasing, imposing massive costs on nations. Diet and physical activity are recommended for diabetes management. Evidence suggests theory-based interventions are more efficacious than non-theory approaches. This study aimed to test the effectiveness of an integrated theoretical model-based intervention to encourage compliance for low-fat food consumption, carbohydrate counting, and physical activity in adults with type 2 diabetes. Methods: A 4-week parallel randomized control trial was conducted in Iran. Data were collected using a self-report questionnaire at baseline and 8-weeks post-intervention. This survey assessed the Theory of Planned Behaviour (TPB) constructs of attitude, subjective norm (others’ approval), and perceived behavioural control (PBC). We also assessed risk perceptions (motivational) and planning (volitional) from the Health Action Process Approach (HAPA). Furthermore, weight, body mass index, triglyceride (TG), and LDL-cholesterol were measured. Results: For both low-fat food consumption and physical activity, only planning revealed a significant improvement over time for intervention rather than control participants (F=8.78, p≤0.001 for low-fat vs. F=11.26, p≤0.001 for physical activity). For carbohydrate counting, significant effects were found for behavior (F=4.37, p=0.03), intention (F=8.14, p≤0.001), PBC (F=7.52, p≤0.001), and planning (F=4.54, p=0.03), reflecting improvements over time in the intervention participants compared to controls. Further, the effects of the intervention on behavior were partially mediated via participants’ degree of planning (B=0.10, SE=0.06, CI=0.01 to 0.26). The serum TG level was significantly reduced from pre to post-intervention for intervention rather than for control participants (F=18.69, p≤0.001). Conclusions: This intervention was promising for carbohydrate counting but did not show improvements for low-fat diet nor physical activity. Given the improvement in psychological measures and self-reported behaviour for carbohydrate counting, coupled with the findings for TG, future research is needed to demonstrate longer-term improvements. Current theory-based educational strategies can be adopted for the management of carbohydrate intake in diabetes.

The number of cases and mortality from COVID-19 is changing rapidly worldwide. We analyzed the case fatality rate (CFR) and recovery rate (RR) from COVID-19 using recent data. By using the information of CFR and RR, we made a comparison between high and middle or low-income countries to understand the current global outbreak. We further ranked the countries based on their CFR and RR from higher to lower.

Enteral immunomodulatory nutrition is suggested as an adjuvant therapy for patients admitted in intensive care units (ICU), but its effectiveness remains debated. The aim of this systematic review and meta-analysis is to examine the effect of dietary immunomodulatory formula on the clinical outcomes and risk of overall mortality in critically ill patients. PubMed, Scopus and ISI web of Knowledge databases were searched until September 2019. Randomized Controlled Trials (RCTs) that used immunomodulatory diet containing omega-3 fatty acid, γ-linolenic acid and antioxidants in ICU were included. Ten RCTs including 1166 participants were included in the meta-analysis. Immunomodulatory diet containing omega-3 fatty acid, γ-linolenic acid and antioxidants led to significantly reduce the duration of ICU stays (WMD: −2.97 days; 95%CI: -5.59, -0.35), duration of mechanical ventilation (WMD = -2.20 days, 95%CI: -4.29, -0.10), SOFA (sequential organ failure assessment) and MOD (multiple organ dysfunction) score (Hedge’s g: -0.42 U/L; 95% CI: -0.74, -0.11). The 28 days’ overall mortality was remarkably decreased following Immunomodulatory supplement in critically ill patients (RR = 0.74, 95% CI: 0.58, 0.91) and extended the ICU- free days (WMD: 4.06 days, 95%CI: 0.02, 8.09). However, immunomodulatory formula had no significant effect on length of hospital stays, ventilator- free days and level of oxygenation.Immunomodulatory diet containing omega-3 fatty acid, γ-linolenic acid and antioxidants might have beneficial effects for the patient’s residing in ICU; However, further well-designed RCTs with larger sample size are recommended to confirmed its effect.