BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilizatio...BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.展开更多
Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary patho...Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients.展开更多
With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are im...With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are immune-compromised and have other chronic co-morbid conditions.Despite the recent advances in practice and improvement in diagnostic surveillance and treatment modalities,a major portion of these patients continue to be affected by post-transplant infections.Of these,fungal infections are particularly notorious given their vague and insidious onset and are very challenging to diagnose.This mini-review aims to discuss the incidence of fungal infections following liver transplantation,the different fungi involved,the risk factors,which predispose these patients to such infections,associated diagnostic challenges,and the role of prophylaxis.The population at risk is increasingly old and frail,suffering from various other co-morbid conditions,and needs special attention.To improve care and to decrease the burden of such infections,we need to identify the at-risk population with more robust clinical and diagnostic parameters.A more robust global consensus and stringent guidelines are needed to fight against resistant microbes and maintain the longevity of current antimicrobial therapies.展开更多
Liver transplant has been shown to significantly improve mortality and quality of life in various liver diseases such as acute liver failure,end-stage liver disease,and liver cancer.While the organ transplant demand i...Liver transplant has been shown to significantly improve mortality and quality of life in various liver diseases such as acute liver failure,end-stage liver disease,and liver cancer.While the organ transplant demand is continuing to rise,the organ donation supply remains unmatched.The organ shortage,high cost,and long waiting lists have stimulated a desire for routes that may be unethical.This process which is named transplant tourism is the term used to describe traveling to another country to purchase an organ for transplant.Liver transplant tourism has been associated with post-transplant complications and higher mortality compared to a domestic liver transplant.Improper pre-and post-transplant infectious screening,inadequate opportunistic infection prophylaxis,and loss to follow-up were noted in patients who travel abroad for a liver transplant.It is crucial to understand the risk of transplant tourism to prevent morbidity and mortality.展开更多
文摘BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.
文摘Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients.
文摘With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are immune-compromised and have other chronic co-morbid conditions.Despite the recent advances in practice and improvement in diagnostic surveillance and treatment modalities,a major portion of these patients continue to be affected by post-transplant infections.Of these,fungal infections are particularly notorious given their vague and insidious onset and are very challenging to diagnose.This mini-review aims to discuss the incidence of fungal infections following liver transplantation,the different fungi involved,the risk factors,which predispose these patients to such infections,associated diagnostic challenges,and the role of prophylaxis.The population at risk is increasingly old and frail,suffering from various other co-morbid conditions,and needs special attention.To improve care and to decrease the burden of such infections,we need to identify the at-risk population with more robust clinical and diagnostic parameters.A more robust global consensus and stringent guidelines are needed to fight against resistant microbes and maintain the longevity of current antimicrobial therapies.
文摘Liver transplant has been shown to significantly improve mortality and quality of life in various liver diseases such as acute liver failure,end-stage liver disease,and liver cancer.While the organ transplant demand is continuing to rise,the organ donation supply remains unmatched.The organ shortage,high cost,and long waiting lists have stimulated a desire for routes that may be unethical.This process which is named transplant tourism is the term used to describe traveling to another country to purchase an organ for transplant.Liver transplant tourism has been associated with post-transplant complications and higher mortality compared to a domestic liver transplant.Improper pre-and post-transplant infectious screening,inadequate opportunistic infection prophylaxis,and loss to follow-up were noted in patients who travel abroad for a liver transplant.It is crucial to understand the risk of transplant tourism to prevent morbidity and mortality.
