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https://www.readbyqxmd.com/read/28223040/red-blood-cell-exchange-as-an-approach-for-treating-a-case-of-severe-tacrolimus-overexposure
#1
Valentina Spallanzani, Lucia Bindi, Irene Bianco, Arianna Precisi, Paolo DeSimone, Alessandro Mazzoni, Gianni Biancofiore
Immunosuppressive medication dosing errors are not unfrequent and may present a number of challenges to transplant clinicians. Tacrolimus (TAC) is a widely used immunosuppressant with a narrow therapeutic index and potential severe side effects, including neurotoxicity and kidney injury. We herein report a case of 60-year-old woman who underwent deceased-donor liver transplantation at our center and due to inadvertent TAC overexposure was admitted to the Intensive Care Unit because of severe neurologic impairment, kidney injury and arterial hypotension...
February 2, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28222805/use-of-activity-tracking-in-major-visceral-surgery-the-enhanced-perioperative-mobilization-epm-trial-study-protocol-for-a-randomized-controlled-trial
#2
Steffen Wolk, Theresa Meißner, Sebastian Linke, Benjamin Müssle, Ann Wierick, Andreas Bogner, Dorothée Sturm, Nuh N Rahbari, Marius Distler, Jürgen Weitz, Thilo Welsch
BACKGROUND: Enhanced recovery after surgery (ERAS) programs are aimed at minimizing postoperative stress and accelerating postoperative recovery by implementing multiple perioperative principles. "Early mobilization" is one such principle, but the quality of assessment and monitoring is poor, and evidence of improved outcome is lacking. Activity trackers allow precise monitoring and automatic feedback to the patients to enhance their motivation for early mobilization. The aim of the study is to monitor and increase the postoperative mobilization of patients by giving them continuous automatic feedback in the form of a step count using activity-tracking wristbands...
February 21, 2017: Trials
https://www.readbyqxmd.com/read/28220780/bacterial-infections-change-natural-history-of-cirrhosis-irrespective-of-liver-disease-severity
#3
Elena Dionigi, Matteo Garcovich, Mauro Borzio, Gioacchino Leandro, Avik Majumdar, Aikaterini Tsami, Vasiliki Arvaniti, Davide Roccarina, Massimo Pinzani, Andrew K Burroughs, James O'Beirne, Emmanuel A Tsochatzis
OBJECTIVES: We assessed the prognostic significance of infections in relation to current prognostic scores and explored if infection could be considered per se a distinct clinical stage in the natural history of cirrhosis. METHODS: We included consecutive patients with cirrhosis admitted to a tertiary referral liver unit for at least 48 h over a 2-year period. Diagnosis of infection was based on positive cultures or strict established criteria. We used competing risk analysis and propensity score matching for data analysis...
February 21, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28217513/clinical-and-epidemiological-study-of-stress-hyperglycemia-among-medical-intensive-care-unit-patients-in-central-india
#4
Jitendra Sharma, Sachin Chittawar, Ram Singh Maniram, T N Dubey, Ambrish Singh
BACKGROUND: Stress hyperglycemia is common in patients presenting at the emergency medical ward and is associated with poor prognosis and increased risk of mortality. AIMS AND OBJECTIVE: To study and determine the prevalence and factors associated with stress hyperglycemia. MATERIALS AND METHODS: A cross-sectional observational study was performed on 536 nondiabetic patients presented to the Intensive Care Unit (ICU) at Gandhi Medical College and allied Hamidia Hospital, Bhopal, between March 31, 2015, and May 28, 2015...
January 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28213828/screening-for-non-alcoholic-fatty-liver-disease-in-children-and-adolescents-with-type-1-diabetes-mellitus-a-cross-sectional-analysis
#5
Sebastian Kummer, Dirk Klee, Gerald Kircheis, Michael Friedt, Joerg Schaper, Dieter Häussinger, Ertan Mayatepek, Thomas Meissner
: The liver is intensely involved in glucose metabolism and is thereby closely related to diabetes pathophysiology. Adult patients with type 1 diabetes mellitus (DM) are at an increased risk for non-alcoholic fatty liver disease (NAFLD). Here, we studied the prevalence of NAFLD in a cohort of children and adolescents with type 1 DM in a tertiary care paediatric diabetes centre in Germany. We screened 93 children and adolescents with type 1 DM using ultrasound, laboratory investigations, and liver stiffness measurements (Fibroscan® [FS] and acoustic radiation force imaging [ARFI])...
February 17, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28210759/-acute-on-chronic-liver-failure-a%C3%A2-diagnostic-and-therapeutic-challenge-for-intensive-care
#6
REVIEW
P Hübener, G Braun, V Fuhrmann
Acute-on-chronic liver failure (ACLF) is an emerging clinical syndrome in patients with underlying liver disease that is usually triggered by one or multiple insults and characterized by progressive hepatic and nonhepatic organ failure, a significant risk of infections, and high short-term mortality rates. Despite our incomplete understanding of the underlying pathophysiology, ACLF requires timely diagnostic and therapeutic measures aiming at the identification and elimination of causative factors as well as the prevention of complications to improve the prognosis of affected patients...
February 16, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28208022/protein-requirements-for-critically-ill-patients-with-renal-and-liver-failure
#7
Jayshil J Patel, Craig J McClain, Menaka Sarav, Jill Hamilton-Reeves, Ryan T Hurt
Diseases leading to critical illness induce proteolysis resulting in muscle wasting and negative nitrogen balance. Muscle wasting has been associated with poor intensive care unit (ICU)-related outcomes, including an increased risk for mortality. Acute kidney injury (AKI) represents a common organ dysfunction associated with ICU-related disorders, such as sepsis, trauma, and respiratory failure. AKI and renal replacement therapy lead to amino acid loss. Decompensated liver cirrhosis (DLC) and acute liver failure (ALF) represent more severe forms of liver dysfunction leading to ICU admission...
February 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28191374/klebsiella-pneumoniae-liver-abscess-a-case-report-and-review-of-literature
#8
Faisal Kamal, George Williams, Hina Akbar, Muhammad Ali Khan, Dipen Kadaria
Klebsiella pneumoniae (K.pneumoniae) is a known cause of pyogenic liver abscess (PLA) in the absence of hepatobiliary disease. In settings of hepatic infection, it has also been known to cause disseminated infections including meningitis and endopthalmitis. Several groups of patients are particularly susceptible to infection, including patients with diabetes mellitus, those from Southeast Asia and those with the preexisting hepatobiliary disease. We present a case of K.pneumoniae PLA with bacteremia. A 39-year-old Vietnamese male with no previous medical history who presented with complaints of abdominal pain, nausea, vomiting, diarrhea and fever...
January 10, 2017: Curēus
https://www.readbyqxmd.com/read/28190602/prevention-of-acute-kidney-injury-in-intensive-care-units
#9
S Mas-Font, J Ros-Martinez, C Pérez-Calvo, P Villa-Díaz, S Aldunate-Calvo, E Moreno-Clari
Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition...
February 9, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28186429/financial-impact-of-the-robotic-approach-in-liver-surgery-a-comparative-study-of-clinical-outcomes-and-costs-between-the-robotic-and-open-technique-in-a-single-institution
#10
Despoina Daskalaki, Raquel Gonzalez-Heredia, Marc Brown, Francesco M Bianco, Ivo Tzvetanov, Myriam Davis, Jihun Kim, Enrico Benedetti, Pier C Giulianotti
BACKGROUND: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. METHODS: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013...
February 10, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28183444/effects-of-lifestyle-interventions-on-clinical-characteristics-of-patients-with-non-alcoholic-fatty-liver-disease-a-meta-analysis
#11
Christina N Katsagoni, Michael Georgoulis, George V Papatheodoridis, Demosthenes B Panagiotakos, Meropi D Kontogianni
BACKGROUND/OBJECTIVES: Although lifestyle modifications remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD), the optimal lifestyle intervention is still controversial. The aim of this meta-analysis was to evaluate the effect of exercise and/or dietary interventions, type or intensity of exercise and type of diet, on liver function outcomes (liver enzymes, intrahepatic fat and liver histology), as well as on anthropometric and glucose metabolism parameters in NAFLD patients...
March 2017: Metabolism: Clinical and Experimental
https://www.readbyqxmd.com/read/28167225/no-child-left-behind-liver-transplantation-in-critically-ill-children
#12
Abbas Rana, Michael Kueht, Moreshwar Desai, Fong Lam, Tamir Miloh, Jennifer Moffett, N Thao N Galvan, Ronald Cotton, Christine O'Mahony, John Goss
BACKGROUND: Advances in critical care prolong survival in children with liver failure, allowing more critically ill children to undergo orthotopic liver transplantation (OLT). In order to justify the use of a scarce donor resource and avoid futile transplants, we sought to determine survival in children who undergo OLT while receiving pre-OLT critical care. STUDY DESIGN: We analyzed 13,723 pediatric OLTs using the United Network for Organ Sharing (UNOS) database from 1987 to 2015, including 6,746 recipients in the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) era (2002 to 2015)...
February 3, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28165033/micheliolide-provides-protection-of-mice-against-staphylococcus-aureus-and-mrsa-infection-by-down-regulating-inflammatory-response
#13
Xinru Jiang, Yuli Wang, Yifei Qin, Weigang He, Adel Benlahrech, Qingwen Zhang, Xin Jiang, Zhenhui Lu, Guang Ji, Yuejuan Zheng
A major obstacle to therapy in intensive care units is sepsis caused by severe infection. In recent years gram-positive (G(+)) bacteria, most commonly staphylococci, are thought to be the main pathogens. Micheliolide (MCL) was demonstrated to provide a therapeutic role in rheumatoid arthritis, inflammatory intestinal disease, colitis-associated cancer, and lipopolysaccharide (LPS, the main component of G(-) bacterial cell wall) induced septic shock. We proved here that MCL played an anti-inflammatory role in Staphylococcus aureus (S...
February 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28159955/respiratory-morbidity-following-pediatric-orthotopic-liver-transplantation
#14
Shahzad Alam, Anilkumar Sapare, Sanjay Rao, Rajiv Aggarwal, Ashley L D'cruz
We evaluated the pulmonary complications following orthotopic liver transplantation in children (age <18 y). Twenty-two patients (49%) developed respiratory complications. Pediatric end-stage liver disease(PELD) score >25 and positive fluid balance were independent risk factors. Patients with respiratory complication had significantly higher mortality and intensive care unit stay.
February 2, 2017: Indian Pediatrics
https://www.readbyqxmd.com/read/28152680/recommendations-for-the-delivery-of-focal-tumor-ablation-services
#15
Cassandra McKay, Jonathan Wang, Fulvia Baldassarre, Amanda Wong, Deanna Langer, John Kachura, Julian Dobranowski
: 106 Background: The objective of this work was to develop recommendations for the organization and delivery of focal tumor ablation services. New, minimally-invasive ablation technologies such as radiofrequency ablation (RFA), microwave ablation (MWA), and transcatheter arterial chemoembolization (TACE) offer treatment options for patients with a variety of cancers. These emerging therapies can improve patient care (minimize side-effects, offer more rapid recovery with comparable or enhanced outcomes) compared to traditional approaches...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28151948/model-for-end-stage-liver-disease-excluding-inr-meld-xi-score-in-critically-ill-patients-easily-available-and-of-prognostic-relevance
#16
Bernhard Wernly, Michael Lichtenauer, Marcus Franz, Bjoern Kabisch, Johanna Muessig, Maryna Masyuk, Uta C Hoppe, Malte Kelm, Christian Jung
PURPOSE: MELD-XI, an adapted version of Model for End-stage Liver Disease (MELD) score excluding INR, was reported to predict outcomes e.g. in patients with acute heart failure. We aimed to evaluate MELD-XI in critically ill patients admitted to an intensive care unit (ICU) for prognostic relevance. METHODS: A total of 4381 medical patients (66±14 years, 2862 male) admitted to a German ICU between 2004 and 2009 were included and retrospectively investigated. Admission diagnoses were e...
2017: PloS One
https://www.readbyqxmd.com/read/28134717/despair-of-treatment-a-qualitative-study-of-cirrhotic-patients-perception-of-treatment
#17
Reza Shabanloei, Hossein Ebrahimi, Fazlollah Ahmadi, Eesa Mohammadi, Roya Dolatkhah
Cirrhotic patients are exposed to illness progression and life-threatening side effects. The nature of the disease, its incurability, limitations of liver transplantation, and the intensity of threatening conditions lead to psychological distress for the patients and change in their perception of the treatment. To provide holistic care, it is necessary to clarify the patient's perception of the treatment. The aim of this study was to clarify cirrhotic patients' perception of their treatment. This qualitative study was carried out through a content analysis approach...
January 2017: Gastroenterology Nursing: the Official Journal of the Society of Gastroenterology Nurses and Associates
https://www.readbyqxmd.com/read/28131021/acute-liver-failure-an-up-to-date-approach
#18
REVIEW
Filipe S Cardoso, Paulo Marcelino, Luís Bagulho, Constantine J Karvellas
Acute liver failure is a rare but potentially devastating disease. Throughout the last few decades, acute liver failure outcomes have been improving in the context of the optimized overall management. This positive trend has been associated with the earlier recognition of this condition, the improvement of the intensive care unit management, and the developments in emergent liver transplantation. Accordingly, we aimed to review the current diagnostic and therapeutic approach to this syndrome, especially in the intensive care unit setting...
January 19, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28124458/hepatic-ischemia-reperfusion-injury-associates-with-acute-kidney-injury-in-liver-transplantation-prospective-cohort-study
#19
Ina Jochmans, Nicolas Meurisse, Arne Neirynck, Marleen Verhaegen, Diethard Monbaliu, Jacques Pirenne
: Solid clinical prospective studies investigating the association between hepatic ischemia reperfusion injury and acute kidney injury after liver transplantation are missing. Hepatic ischemia reperfusion injury -reflected by transaminase release- induces acute kidney injury in rodents and retrospective studies suggest a similar association in man. This prospective cohort study determined risk factors for acute kidney injury in 80 adult liver-only recipients. Acute kidney injury -defined by RIFLE-criteria- developed in 21 (26%) recipients at 12 hours postreperfusion [inter quartile range: 6 hours-postoperative day 1]; 13 progressed from "Risk" to "Injury"; 5 to "Failure"...
January 25, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28114104/aki-clif-sofa-a-novel-prognostic-score-for-critically-ill-cirrhotic-patients-with-acute-kidney-injury
#20
Dan-Qin Sun, Chen-Fei Zheng, Wen-Yue Liu, Sven Van Poucke, Zhi Mao, Ke-Qing Shi, Xiao-Dong Wang, Ji-Dong Wang, Ming-Hua Zheng
Critically ill cirrhotic patients with acute kidney injury (AKI) are associated with high mortality rates. The aims of this study were to develop a specific prognostic score for critically ill cirrhotic patients with AKI, the acute kidney injury - Chronic Liver Failure - Sequential Organ Failure- Assessment score (AKI-CLIF-SOFA) score. This study focused on 527 cirrhotic patients with AKI admitted to intensive care unit and constructed a new scoring system, the AKI-CLIF-SOFA, which can be used to prognostically assess mortality in these patient population...
January 19, 2017: Aging
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