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https://www.readbyqxmd.com/read/27899205/development-and-validation-of-the-new-icnarc-model-for-prediction-of-acute-hospital-mortality-in-adult-critical-care
#1
Paloma Ferrando-Vivas, Andrew Jones, Kathryn M Rowan, David A Harrison
PURPOSE: To develop and validate an improved risk model to predict acute hospital mortality for admissions to adult critical care units in the UK. MATERIALS AND METHODS: 155,239 admissions to 232 adult critical care units in England, Wales and Northern Ireland between January and December 2012 were used to develop a risk model from a set of 38 candidate predictors. The model was validated using 90,017 admissions between January and September 2013. RESULTS: The final model incorporated 15 physiological predictors (modelled with continuous nonlinear models), age, dependency prior to hospital admission, chronic liver disease, metastatic disease, haematological malignancy, CPR prior to admission, location prior to admission/urgency of admission, primary reason for admission and interaction terms...
November 21, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27887981/predictors-of-mortality-in-the-critically-ill-cirrhotic-patient-is-the-model-for-end-stage-liver-disease-enough
#2
Alagappan Annamalai, Megan Y Harada, Melissa Chen, Tram Tran, Ara Ko, Eric J Ley, Miriam Nuno, Andrew Klein, Nicholas Nissen, Mazen Noureddin
BACKGROUND: Critically ill cirrhotics urgently require liver transplantation but are at high risk for perioperative mortality. The Model for End-Stage Liver Disease (MELD) score, recently updated to incorporate serum sodium, estimates survival probability in patients with cirrhosis but needs further evaluation in the critically ill. The purpose of this study was to evaluate the predictive power of intensive care unit (ICU) admission MELD scores and identify clinical risk factors associated with increased mortality...
November 22, 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27866601/assessment-of-state-perinatal-hepatitis-b-prevention-laws
#3
Lindsay A Culp, Lisa Caucci, Nancy E Fenlon, Megan C Lindley, Noele P Nelson, Trudy V Murphy
INTRODUCTION: Identifying pregnant women with hepatitis B virus (HBV) infection for post-exposure prophylaxis of their infants is critical to preventing mother-to-child transmission of HBV infection. HBV infection in infancy results in premature death from chronic liver disease or cancer in 25% of affected infants. Universal screening of pregnant women for HBV infection is the standard of care, and in many states is supported by laws for screening and reporting these infections to public health...
December 2016: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/27846856/ethno-medicinal-survey-of-important-plants-practiced-by-indigenous-community-at-ladha-subdivision-south-waziristan-agency-pakistan
#4
Muhammad Abdul Aziz, Muhammad Adnan, Amir Hasan Khan, Atiq Ur Rehman, Rahmatullah Jan, Jafar Khan
BACKGROUND: Medicinal flora plays a vital role in treating various types of ailments in living beings. The present study was planned to investigate and document systematically the indigenous knowledge in a scientifically little explored area of Ladha sub-division, South Waziristan agency, Pakistan. Hence, this study would contribute positively to the field of ethnopharmacology. METHODS: Prior to ethnomedicinal data collection, regular field visits were conducted during the month of May and June 2015 to locate the sites and respondents from where the traditional knowledge was to be recorded...
November 15, 2016: Journal of Ethnobiology and Ethnomedicine
https://www.readbyqxmd.com/read/27830927/observational-clinical-study-on-organ-dysfunction-associated-with-dosing-of-antibiotics-in-a-paediatric-intensive-care-unit
#5
Sascha Tafelski, Alexander Gratopp, Florian Richter, Sylvia Kramer, Claudia Spies, Klaus D Wernecke, Irit Nachtigall
BACKGROUND: Medication errors are of concern especially in paediatric patients. This study investigates impact of dosing errors of antibiotics on outcome in critically ill paediatric patients. METHODS: Retrospective study including all consecutive patients admitted to one university paediatric intensive care unit (PICU) in 2010 with length of PICU stay >24hrs, age <18 years and antibiotic therapy. Antibiotic dosages were evaluated for compliance with recommended dosing individually adapted for bodyweight, age and organ function...
November 10, 2016: Minerva Pediatrica
https://www.readbyqxmd.com/read/27827549/advances-in-identifying-urine-serum-biomarkers-in-alpha-1-antitrypsin-deficiency-for-more-personalized-future-treatment-strategies
#6
Ilaria Ferrarotti, Angelo Guido Corsico, Jan Stolk, Stefania Ottaviani, Marco Fumagalli, Sabina Janciauskiene, Paolo Iadarola
Alpha1-antitrypsin deficiency (AATD) is a genetic disorder characterized by reduced serum levels of alpha1-antitrypsin (AAT) and increased risk for developing both early-onset lung emphysema and chronic liver disease. Laboratory diagnosis of AATD is not just a matter of degree, although the AAT serum level is the most important determinant for risk of lung damage. While being a single-gene disease, the clinical phenotype of AATD is heterogeneous. The current standard of care for patients affected by AATD-associated pulmonary emphysema is replacement therapy with weekly i...
November 9, 2016: COPD
https://www.readbyqxmd.com/read/27826789/avoiding-complications-in-bone-and-soft-tissue-ablation
#7
A Nicholas Kurup, Grant D Schmit, Jonathan M Morris, Thomas D Atwell, John J Schmitz, Adam J Weisbrod, David A Woodrum, Patrick W Eiken, Matthew R Callstrom
As with percutaneous ablation of tumors in the liver, lungs, and kidneys, ablation of bone and non-visceral soft tissue tumors carries risk, primarily from collateral damage to vital structures in proximity to the target tumor. Certain risks are of particular interest when ablating bone and non-visceral soft tissue tumors, namely neural or skin injury, bowel injury, fracture, and gas embolism from damaged applicators. Ablation of large volume tumors also carries special risk. Many techniques may be employed by the interventional radiologist to minimize complications when treating tumors in the musculoskeletal system...
November 8, 2016: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27804912/emerging-therapies-for-acute-intermittent-porphyria
#8
Antonio Fontanellas, Matías A Ávila, Pedro Berraondo
Acute intermittent porphyria (AIP) is an autosomal dominant metabolic disease caused by hepatic deficiency of hydroxymethylbilane synthase (HMBS), the third enzyme of the heme synthesis pathway. The dominant clinical feature is acute neurovisceral attack associated with high production of potentially neurotoxic porphyrin precursors due to increased hepatic heme consumption. Current Standard of Care is based on a down-regulation of hepatic heme synthesis using heme therapy. Recurrent hyper-activation of the hepatic heme synthesis pathway affects about 5% of patients and can be associated with neurological and metabolic manifestations and long-term complications including chronic kidney disease and increased risk of hepatocellular carcinoma...
November 2, 2016: Expert Reviews in Molecular Medicine
https://www.readbyqxmd.com/read/27759843/septic-pulmonary-embolism-requiring-critical-care-clinicoradiological-spectrum-causative-pathogens-and-outcomes
#9
Deng-Wei Chou, Shu-Ling Wu, Kuo-Mou Chung, Shu-Chen Han, Bruno Man-Hon Cheung
OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed...
October 1, 2016: Clinics
https://www.readbyqxmd.com/read/27750389/new-concepts-in-acute-on-chronic-liver-failure-implications-for-liver-transplantation
#10
Antonella Putignano, Thierry Gustot
Acute-on-Chronic Liver Failure (ACLF) is a recently defined syndrome that occurs frequently in patients with cirrhosis and is associated with a poor short-term prognosis. Currently, management of patients with ACLF is mainly supportive. Despite medical progress, this syndrome frequently leads to multi-organ failure, sepsis, and, ultimately, death. The results of attempts to use liver transplantation (LT) to manage this critical condition have been poorly reported but are promising. Currently, selection criteria of ACLF patients for LT, instructions for prioritization on the waiting list, and objective indicators for removal of ACLF patients from the waiting list in cases of clinical deterioration are poorly defined...
October 17, 2016: Liver Transplantation
https://www.readbyqxmd.com/read/27747458/acute-on-chronic-liver-failure
#11
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame...
December 2016: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/27741059/intensive-care-management-of-pediatric-acute-liver-failure
#12
Riad Lutfi, Kamal Abulebda, Mara E Nitu, Jean P Molleston, Molly A Bozic, Girish Subbarao
Pediatric acute liver failure is rare but life-threatening illness that occurs in children without preexisting liver disease. The rarity of the disease, along with its severity and heterogeneity, presents unique clinical challenges to the physicians providing care for pediatric patients with acute liver failure. In this review, practical clinical approaches to the care of critically ill children with acute liver failure are discussed with an organ system specific approach. The underlying pathophysiological processes, major areas of uncertainty, and approaches to the critical care management of pediatric acute liver failure are also reviewed...
October 12, 2016: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/27722110/the-epidemiology-and-outcome-of-critical-illness-in-mongolia-a-multicenter-prospective-observational-cohort-study
#13
Naranpurev Mendsaikhan, Tsolmon Begzjav, Ganbold Lundeg, Martin W Dünser
CONTEXT: The epidemiology and outcome of critical illness in Mongolia remain undefined. AIM: The aim of this study was to evaluate the epidemiology and outcome of critical illness in Mongolia. SETTINGS AND DESIGN: This is a multicenter, prospective, observational cohort study including 19 Mongolian centers. MATERIALS AND METHODS: Demographic, clinical, and outcome data of patients >15 years admitted to the Intensive Care Units (ICUs) were collected during a 6-month period...
July 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/27709556/prognosis-of-cirrhotic-patients-admitted-to-the-general-icu
#14
Gaël Piton, Claire Chaignat, Mikhael Giabicani, Jean-Paul Cervoni, Fabienne Tamion, Emmanuel Weiss, Catherine Paugam-Burtz, Gilles Capellier, Vincent Di Martino
BACKGROUND: The prognosis of cirrhotic patients admitted to the ICU is considered to be poor but has been mainly reported in liver ICU. We aimed to describe the prognosis of cirrhotic patients admitted to a general ICU, to assess the predictors of mortality in this population, and, finally, to identify a subgroup of patients in whom intensive care escalation might be discussed. RESULTS: We performed a retrospective monocentric study of all cirrhotic patients consecutively admitted between 2002 and 2014 in a general ICU in a regional university hospital...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27706466/effect-of-conservative-vs-conventional-oxygen-therapy-on-mortality-among-patients-in-an-intensive-care-unit-the-oxygen-icu-randomized-clinical-trial
#15
RANDOMIZED CONTROLLED TRIAL
Massimo Girardis, Stefano Busani, Elisa Damiani, Abele Donati, Laura Rinaldi, Andrea Marudi, Andrea Morelli, Massimo Antonelli, Mervyn Singer
Importance: Despite suggestions of potential harm from unnecessary oxygen therapy, critically ill patients spend substantial periods in a hyperoxemic state. A strategy of controlled arterial oxygenation is thus rational but has not been validated in clinical practice. Objective: To assess whether a conservative protocol for oxygen supplementation could improve outcomes in patients admitted to intensive care units (ICUs). Design, Setting, and Patients: Oxygen-ICU was a single-center, open-label, randomized clinical trial conducted from March 2010 to October 2012 that included all adults admitted with an expected length of stay of 72 hours or longer to the medical-surgical ICU of Modena University Hospital, Italy...
October 18, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27672280/clinical-management-of-acute-liver-failure-results-of-an-international-multi-center-survey
#16
Liane Rabinowich, Julia Wendon, William Bernal, Oren Shibolet
AIM: To assess the practice of caring for acute liver failure (ALF) patients in varying geographic locations and medical centers. METHODS: Members of the European Acute Liver Failure Consortium completed an 88-item questionnaire detailing management of ALF. Responses from 22 transplantation centers in 11 countries were analyzed, treating between 300 and 500 ALF cases and performing over 100 liver transplants (LT) for ALF annually. The questions pertained to details of the institution and their clinical activity, standards of care, referral and admission, ward- based care versus intensive care unit (ICU) as well as questions regarding liver transplantation - including criteria, limitations, and perceived performance...
September 7, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/27650268/biliary-atresia-indications-and-timing-of-liver-transplantation-and-optimization-of-pre-transplant-care
#17
Shikha S Sundaram, Cara L Mack, Amy G Feldman, Ronald J Sokol
Biliary Atresia is a progressive, fibro-obliterative disorder of the intra and extrahepatic bile ducts in infancy. The majority of affected children will eventually develop end-stage liver disease and require liver transplantation. Indications for liver transplant in biliary atresia include failed Kasai portoenterostomy, significant and recalcitrant malnutrition, recurrent cholangitis, and the progressive manifestations of portal hypertension. Extra-hepatic complications of this disease, such as hepatopulmonary syndrome and portopulmonary hypertension, are also indications for liver transplantation...
September 21, 2016: Liver Transplantation
https://www.readbyqxmd.com/read/27634140/micafungin-versus-anidulafungin-in-critically-ill-patients-with-invasive-candidiasis-a-retrospective-study
#18
Patrick J van der Geest, Nicole G M Hunfeld, Sophie E Ladage, A B Johan Groeneveld
BACKGROUND: In critically ill patients the incidence of invasive fungal infections caused by Candida spp. has increased remarkably. Echinocandins are recommended as initial treatment for invasive fungal infections. The safety and efficacy of micafungin compared to caspofungin is similar, but no comparison is made between anidulafungin and micafungin concerning safety and efficacy. We therefore performed a retrospective study to assess these aspects in critically ill patients with invasive candidiasis...
September 15, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27628103/significance-of-frailty-for-predicting-adverse-clinical-outcomes-in-different-patient-groups-with-specific-medical-conditions
#19
Martin Ritt, Karl-Günter Gaßmann, Cornel Christian Sieber
Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians...
October 2016: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/27621111/relevance-of-serum-sclerostin-concentrations-in-critically-ill-patients
#20
Alexander Koch, Ralf Weiskirchen, Sebastian Ludwig, Lukas Buendgens, Jan Bruensing, Eray Yagmur, Christer Baeck, Ulf Herbers, Christian Trautwein, Frank Tacke
PURPOSE: Sclerostin is a negative regulator of bone metabolism and associated with chronic morbidities. We investigated circulating sclerostin in critically ill patients. METHODS: A total of 264 patients (170 with sepsis) were studied prospectively upon admission to the medical intensive care unit (ICU) and on day 7. Patients' survival was followed for up to 3 years. RESULTS: Sclerostin serum levels were significantly elevated in critically ill patients at ICU admission compared with 99 healthy controls...
August 22, 2016: Journal of Critical Care
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