BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help ...BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement interventions.METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey"Indian National ICU Needs"assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,2018.The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate providers.By completing and submitting the survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 cities.They had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only ICUs.Representative responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were males.The consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio.More than 80%of the ICUs were open,and mixed type.Protocols followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet availability.CONCLUSION In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing patient-tonurse ratios was evident.Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized.Additionally,subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.展开更多
This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thro...This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.展开更多
BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity...BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.展开更多
BACKGROUND:A pandemic of coronavirus disease(COVID-19)has been declared by the World Health Organization(WHO)and caring for critically ill patients is expected to be at the core of battling this disease.However,little...BACKGROUND:A pandemic of coronavirus disease(COVID-19)has been declared by the World Health Organization(WHO)and caring for critically ill patients is expected to be at the core of battling this disease.However,little is known regarding an early detection of patients at high risk of fatality.METHODS:This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29,2020,to the three intensive care units(ICUs)in a designated hospital for treating COVID-19 in Wuhan.The detailed clinical information and laboratory results for each patient were obtained.The primary outcome was in-hospital mortality.Potential predictors were analyzed for possible association with outcomes,and the predictive performance of indicators was assessed from the receiver operating characteristic(ROC)curve.RESULTS:A total of 121 critically ill patients were included in the study,and 28.9%(35/121)of them died in the hospital.The non-survivors were older and more likely to develop acute organ dysfunction,and had higher Sequential Organ Failure Assessment(SOFA)and quick SOFA(qSOFA)scores.Among the laboratory variables on admission,we identifi ed 12 useful biomarkers for the prediction of in-hospital mortality,as suggested by area under the curve(AUC)above 0.80.The AUCs for three markers neutrophilto-lymphocyte ratio(NLR),thyroid hormones free triiodothyronine(FT3),and ferritin were 0.857,0.863,and 0.827,respectively.The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality(0.901 vs.0.955,P=0.085).CONCLUSIONS:Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients.Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.展开更多
Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,B...Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.展开更多
Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure r...Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.展开更多
BACKGROUND Intestinal mucosal barrier dysfunction plays an important role in the pathogenesis of ulcerative colitis(UC).Recent studies have revealed that impaired autophagy is associated with intestinal mucosal dysfun...BACKGROUND Intestinal mucosal barrier dysfunction plays an important role in the pathogenesis of ulcerative colitis(UC).Recent studies have revealed that impaired autophagy is associated with intestinal mucosal dysfunction in the mucosa of colitis mice.Resveratrol exerts anti-inflammatory functions by regulating autophagy.AIM To investigate the effect and mechanism of resveratrol on protecting the integrity of the intestinal mucosal barrier and anti-inflammation in dextran sulfate sodium(DSS)-induced ulcerative colitis mice.METHODS Male C57BL/6 mice were divided into four groups:negative control group,DSS model group,DSS+resveratrol group,and DSS+5-aminosalicylic acid group.The severity of colitis was assessed by the disease activity index,serum inflammatory cytokines were detected by enzyme-linked immunosorbent assay.Colon tissues were stained with haematoxylin and eosin,and mucosal damage was evaluated by mean histological score.The expression of occludin and ZO-1 in colon tissue was evaluated using immunohistochemical analysis.In addition,the expression of autophagy-related genes was determined using reverse transcription-polymerase chain reaction and Western-blot,and morphology of autophagy was observed by transmission electron microscopy.RESULTS The resveratrol treatment group showed a 1.72-fold decrease in disease activity index scores and 1.42,3.81,and 1.65-fold decrease in the production of the inflammatory cytokine tumor necrosis factor-α,interleukin-6 and interleukin-1β,respectively,in DSS-induced colitis mice compared with DSS group(P<0.05).The expressions of the tight junction proteins occludin and ZO-1 in DSS model group were decreased,and were increased in resveratrol-treated colitis group.Resveratrol also increased the levels of LC3B(by 1.39-fold compared with DSS group)and Beclin-1(by 1.49-fold compared with DSS group)(P<0.05),as well as the number of autophagosomes,which implies that the resveratrol may alleviate intestinal mucosal barrier dysfunction in DSS-induced UC mice by enhancing autophagy.CONCLUSION Resveratrol treatment decreased the expression of inflammatory factors,increased the expression of tight junction proteins and alleviated UC intestinal mucosal barrier dysfunction;this effect may be achieved by enhancing autophagy in intestinal epithelial cells.展开更多
BACKGROUND Severe total colonic necrosis,septic shock and venous thromboembolism secondary to ulcerative colitis (UC) are rare and life-threatening.No such severe complications have been reported in the literature.CAS...BACKGROUND Severe total colonic necrosis,septic shock and venous thromboembolism secondary to ulcerative colitis (UC) are rare and life-threatening.No such severe complications have been reported in the literature.CASE SUMMARY We report a 36-year-old woman who developed total colonic necrosis and septic shock secondary to UC.The patient was treated with emergency surgery because computed tomography showed suspicious perforations.Persistent massive ascites occurred after operation and computed tomography angiography demonstrated portal vein,mesenteric vein and splenic vein thrombosis.The patient was discharged from hospital after active treatment.CONCLUSION Clinicians should pay attention to venous thrombosis,colonic necrosis and septic shock in UC patients.Close observation of surgical indications and timely surgical intervention are the key to reduce mortality and complications in UC.展开更多
AIM To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes.METHODS This prospe...AIM To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes.METHODS This prospective cohort study included 59 patients with septic shock who received stress-dose hydrocortisone.It was performed at 2 critical care units in academic hospitals from June 1st,2015,to July 31 st,2016.Demographic data,comorbidities,medical management details,adverse effects related to corticosteroids,and outcomes were collected after the critical care physician indicated initiation of hydrocortisone.Univariate comparison between continuous and bolus administration of hydrocortisone was performed,including multivariate analysis,as well as Kaplan-Meier analysis to compare the proportion of shock reversal at 7 d after presentation.Receiver operating characteristic(ROC)curves determined the best cut-off criteria for initiation of hydrocortisone associated with the highest probability of shock reversal.We addressed the effects of the taper strategy for discontinuation of hydrocortisone,noting risk of shock relapse and adverse effects.RESULTS All-cause 30-d mortality was 42%.Hydrocortisone was administered as a continuous infusion in 54.2%of patients;time to reversal of shock was 49 h longer in patients who were given a bolus administration[59 h(range,47.5-90.5)vs 108 h(range,63.2-189);P=0.001].The maximal dose of norepinephrine after initiation of hydrocortisone was lower in patients on continuous infusion[0.19μg/kg per minute(range,0.11-0.28μg)]compared with patients who were given bolus[0.34μg/kg per minute(range,0.16-0.49);P=0.004].Kaplan-Meier analysis revealed a higher proportion of shock reversal at 7 d in patients with continuous infusion compared to those given bolus(83%vs 63%;P=0.004).There was a good correlation between time to initiation of hydrocortisone and time to reversal of shock(r=0.80;P<0.0001);ROC curve analysis revealed that the best criteria for prediction of shock reversal was a time to initiation of hydrocortisone of≤13 h after administration of norepinephrine,with an area under the curve of 0.81(P<0.001).The maximal dose of norepinephrine at initiation of hydrocortisone with the highest association with shock reversal was≤0.28μg/kg per minute,with an area under the curve of 0.75(P=0.0002).On a logistic regression model,hydrocortisone taper was not associated with a lower risk of shock relapse(RR=1.29;P=0.17)but was related to a higher probability of hyperglycemia[odds ratio(OR),5.3;P=0.04]and hypokalemia(OR=10.6;P=0.01).CONCLUSION Continuous infusion of hydrocortisone could hasten the resolution of septic shock compared to bolus administration.Earlier initiation corresponds with a higher probability of shock reversal.Tapering strategy is unnecessary.展开更多
脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊...脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。展开更多
AIM:To identify patient,cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac arrest.METHODS:A retrospective,single centre study of comatose patients admitted to our ...AIM:To identify patient,cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac arrest.METHODS:A retrospective,single centre study of comatose patients admitted to our intensive care unit(ICU)following cardiac arrest during the twenty year period between 1993 and 2012.This study was deemed by the Human Research Ethics Committee(HREC)of Monash Health to be a quality assurance exercise,and thus did not require submission to the Monash Health HREC(Research Project Application,No.13290Q).The study population included all patients admitted to ourICU between 1993 and 2012,with a discharge diagnosis including"cardiac arrest".Patients were excluded if they did not have a cardiac arrest prior to ICU admission(i.e.,if their primary arrest was during their admission to ICU),or were not comatose on arrival to ICU.Our primary outcome measure was survival to hospital discharge.Secondary outcome measures were ICU and hospita length of stay(LOS),and factors associated with surviva to hospital discharge.RESULTS:Five hundred and eighty-two comatose patients were admitted to our ICU following cardiac arrest,with 35%surviving to hospital discharge.The median ICU and hospital LOS was 3 and 5 d respectively.There was no survival difference between in-hospital and out-of-hospital cardiac arrests.Males made up 62%of our cardiac arrest population,were more likely to have a shockable rhythm(56%vs 37%,P<0.001),and were more likely to survive to hospital discharge(40%vs 28%,P=0.006).On univariate analysis,therapeutic hypothermia,regardless of method used(e.g.,rapid infusion of ice cold fluids,topical ice,"Arctic Sun",passive rewarming,"Bair Hugger")and location initiated(e.g.,pre-hospital,emergency department,intensive care)was associated with increased survival.There was however no difference in survival associated with target temperature,time at target temperature,location of initial cooling,method of initiating cooling,method of maintaining cooling or method of rewarming.Patients that survived were more likely to have a shockable rhythm(P<0.001),shorter time to return of spontaneous circulation(P<0.001),receive therapeutic hypothermia(P=0.03),be of male gender(P=0.006)and have a lower APACHEⅡscore(P<0.001).After multivariate analysis,only a shockable initial rhythm(OR=6.4,95%CI:3.95-10.4;P<0.01)and a shorter time to return of spontaneous circulation(OR=0.95,95%CI:0.93-0.97;P<0.01)was found to be independently associated with survival to hospital discharge.CONCLUSION:In comatose survivors of cardiac arrest,shockable rhythm and shorter time to return of spontaneous circulation were independently associated with increased survival to hospital discharge.展开更多
Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis r...Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis remains high,despite significant interventions and guidelines.It has been known for decades that patients with sepsis have reduced levels of antioxidants,most notably vitamin C.Furthermore,experimental data has demonstrated multiple beneficial effects of vitamin C in sepsis.In addition,corticosteroids and thiamine may have synergistic biological effects together with vitamin C.Preliminary data suggests that therapy with hydrocortisone,ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of lives.However,this intervention has met with much resistance and has not been widely adopted.Ultimately,we await the final jury verdict on this simple,safe and cheap intervention.展开更多
In the "proton pump inhibitors era",a penetrating peptic ulcer(PPU) represents an exceptional cause of abdominal pain,and was more frequently observed in the past where there was not an effective antacid tre...In the "proton pump inhibitors era",a penetrating peptic ulcer(PPU) represents an exceptional cause of abdominal pain,and was more frequently observed in the past where there was not an effective antacid treatment. Ulcer-induced pancreatitis is very rare,too,and manifests with persistent,intense pain radiating to the back. A mild to severe pancreatitis with peripancreatic fluid collection can be observed at imaging. However,only a few cases of association between PPU and emphysematous pancreatitis(EP) have been published in the literature. EP is a rare but potentially fatal form of acute necrotizing pancreatitis in which gas grows in and outside the pancreas,and typically involves the whole parenchyma in diabetic individuals.Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP.Unlike the classic form of EP,which involves the whole parenchyma and has a poor prognosis,we found that the emphysematous involvement of the pancreas by PPU has a benign course if a conservative therapy is promptly established. Gas is confined to the site of penetration,usual y the pancreatic head,and ulcers most often involve the duodenum.展开更多
Since it has been recognized that sarcoidosis(SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for...Since it has been recognized that sarcoidosis(SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for the diagnosis of the single organ involvement, and the concept has been reinforced that the exclusion of alternative causes is important to achieve the correct diagnosis. Ultrasound(US)is a useful tool to evaluate patients with suspected abdominal SA, such as of the liver, spleen, kidney, pancreas and other organs, showing findings such as organomegaly, focal lesions and lymphadenopathy. While the diagnosis of abdominal SA is more predictable in the case of involvement of other organs(e.g.,lungs), the problem is more complex in the case of isolated abdominal SA. The recent use of contrast-enhanced ultrasound and endoscopic ultrasound elastography has provided additional information about the enhancement patterns and tissue rigidity in abdominal SA. Here we critically review the role of US in abdominal SA, reporting typical findings and limitations of current evidence and by discussing future perspectives of study.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with ...BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with over 1.3 million deaths.While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence,highlight gaps in knowledge,and elucidate further meta-analyses and umbrella reviews that are yet to be performed.METHODS We explored studies based on systematic reviews and meta-analyses with the keyterms,including severe acute respiratory syndrome(SARS),SARS virus,coronavirus disease,COVID-19,and SARS coronavirus-2.The included studies were extracted from Embase,Medline,and Cochrane databases.The publication timeframe of included studies ranged between January 01,2020,to October 30,2020.Studies that were published in languages other than English were not considered for this systematic review.The finalized full-text articles are freely accessible in the public domain.RESULTS Searching Embase,Medline,and Cochrane databases resulted in 1906,669,and 19 results,respectively,that comprised 2594 studies.515 duplicates were subsequently removed,leaving 2079 studies.The inclusion criteria were systematic reviews or meta-analyses.860 results were excluded for being a review article,scope review,rapid review,panel review,or guideline that produced a total of 1219 studies.After screening articles were categorized,the included articles were put into main groups of clinical presentation,epi-demiology,screening and diagnosis,severity assessment,special populations,and treatment.Subsequently,there was a second subclassification into the following groups:gastrointestinal,cardiovascular,neurological,stroke,thrombosis,anosmia and dysgeusia,ocular manifestations,nephrology,cutaneous manifestations,D-dimer,lymphocyte,anticoagulation,antivirals,convalescent plasma,immunosuppressants,corticosteroids,hydroxychloroquine,renin-angiotensin-aldosterone system,technology,diabetes mellitus,obesity,pregnancy,children,mental health,smoking,cancer,and transplant.CONCLUSION Among the included articles,it is clear that further research is needed regarding treatment options and vaccines.With more studies,data will be less heterogeneous,and statistical analysis can be better applied to provide more robust clinical evidence.This study was not designed to give recommendations regarding the management of COVID-19.展开更多
Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis o...Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.展开更多
Dear editor,Iatrogenic hypoglycaemia is a common acute presentation;either because of misuse,self-harm or criminal intent.The most common culprits are insulin and oral hypoglycaemics(sulfonylurea,biguanides)although a...Dear editor,Iatrogenic hypoglycaemia is a common acute presentation;either because of misuse,self-harm or criminal intent.The most common culprits are insulin and oral hypoglycaemics(sulfonylurea,biguanides)although aspirin,fluoroquinolone and beta blockers can be causative agents.Common symptoms include sweating,anxiety,tremors,and palpitations.Neuroglycopenic symptoms usually arise at serum glucose concentrations of<2.8 mmol/L and include dizziness,confusion,blurred vision,somnolence and more serious symptoms can be convulsions,coma and potentially death.展开更多
Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that V...Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe?, a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining AbtheraTM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected be-tween the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.展开更多
基金This study was deemed eligible for category-2 Institutional Review Board exempt status from Mayo Clinic IRB,Mayo Clinic,Rochester,MN,55905,United States.
文摘BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city levels.AIM To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement interventions.METHODS The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey"Indian National ICU Needs"assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,2018.The survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate providers.By completing and submitting the survey,providers gave their consent for research purposes.This study was deemed eligible for category-2 Institutional Review Board exempt status.RESULTS There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 cities.They had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only ICUs.Representative responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were males.The consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse ratio.More than 80%of the ICUs were open,and mixed type.Protocols followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet availability.CONCLUSION In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing patient-tonurse ratios was evident.Sepsis was the most common diagnosis and quality and research initiatives to decrease sepsis mortality and ICU length of stay could be prioritized.Additionally,subsequent surveys can focus on digital infrastructure for standardized care and efficient resource utilization and enhancing compliance with existing protocols.
文摘This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.
文摘BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.
基金supported by the National Key Research and Development Project of the Ministry of Science and Technology,China(2018YFC1313700)“Gaoyuan”Project of Pudong Health and Family Planning Commission(PWYgy2018-6).
文摘BACKGROUND:A pandemic of coronavirus disease(COVID-19)has been declared by the World Health Organization(WHO)and caring for critically ill patients is expected to be at the core of battling this disease.However,little is known regarding an early detection of patients at high risk of fatality.METHODS:This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29,2020,to the three intensive care units(ICUs)in a designated hospital for treating COVID-19 in Wuhan.The detailed clinical information and laboratory results for each patient were obtained.The primary outcome was in-hospital mortality.Potential predictors were analyzed for possible association with outcomes,and the predictive performance of indicators was assessed from the receiver operating characteristic(ROC)curve.RESULTS:A total of 121 critically ill patients were included in the study,and 28.9%(35/121)of them died in the hospital.The non-survivors were older and more likely to develop acute organ dysfunction,and had higher Sequential Organ Failure Assessment(SOFA)and quick SOFA(qSOFA)scores.Among the laboratory variables on admission,we identifi ed 12 useful biomarkers for the prediction of in-hospital mortality,as suggested by area under the curve(AUC)above 0.80.The AUCs for three markers neutrophilto-lymphocyte ratio(NLR),thyroid hormones free triiodothyronine(FT3),and ferritin were 0.857,0.863,and 0.827,respectively.The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality(0.901 vs.0.955,P=0.085).CONCLUSIONS:Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients.Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.
文摘Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.
文摘Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.
基金Supported by the National Natural Science Foundation of China,No.81600414Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2018255969Zhejiang TCM Science and Technology Project,No.2016ZA123 and No.2018ZA013.
文摘BACKGROUND Intestinal mucosal barrier dysfunction plays an important role in the pathogenesis of ulcerative colitis(UC).Recent studies have revealed that impaired autophagy is associated with intestinal mucosal dysfunction in the mucosa of colitis mice.Resveratrol exerts anti-inflammatory functions by regulating autophagy.AIM To investigate the effect and mechanism of resveratrol on protecting the integrity of the intestinal mucosal barrier and anti-inflammation in dextran sulfate sodium(DSS)-induced ulcerative colitis mice.METHODS Male C57BL/6 mice were divided into four groups:negative control group,DSS model group,DSS+resveratrol group,and DSS+5-aminosalicylic acid group.The severity of colitis was assessed by the disease activity index,serum inflammatory cytokines were detected by enzyme-linked immunosorbent assay.Colon tissues were stained with haematoxylin and eosin,and mucosal damage was evaluated by mean histological score.The expression of occludin and ZO-1 in colon tissue was evaluated using immunohistochemical analysis.In addition,the expression of autophagy-related genes was determined using reverse transcription-polymerase chain reaction and Western-blot,and morphology of autophagy was observed by transmission electron microscopy.RESULTS The resveratrol treatment group showed a 1.72-fold decrease in disease activity index scores and 1.42,3.81,and 1.65-fold decrease in the production of the inflammatory cytokine tumor necrosis factor-α,interleukin-6 and interleukin-1β,respectively,in DSS-induced colitis mice compared with DSS group(P<0.05).The expressions of the tight junction proteins occludin and ZO-1 in DSS model group were decreased,and were increased in resveratrol-treated colitis group.Resveratrol also increased the levels of LC3B(by 1.39-fold compared with DSS group)and Beclin-1(by 1.49-fold compared with DSS group)(P<0.05),as well as the number of autophagosomes,which implies that the resveratrol may alleviate intestinal mucosal barrier dysfunction in DSS-induced UC mice by enhancing autophagy.CONCLUSION Resveratrol treatment decreased the expression of inflammatory factors,increased the expression of tight junction proteins and alleviated UC intestinal mucosal barrier dysfunction;this effect may be achieved by enhancing autophagy in intestinal epithelial cells.
文摘BACKGROUND Severe total colonic necrosis,septic shock and venous thromboembolism secondary to ulcerative colitis (UC) are rare and life-threatening.No such severe complications have been reported in the literature.CASE SUMMARY We report a 36-year-old woman who developed total colonic necrosis and septic shock secondary to UC.The patient was treated with emergency surgery because computed tomography showed suspicious perforations.Persistent massive ascites occurred after operation and computed tomography angiography demonstrated portal vein,mesenteric vein and splenic vein thrombosis.The patient was discharged from hospital after active treatment.CONCLUSION Clinicians should pay attention to venous thrombosis,colonic necrosis and septic shock in UC patients.Close observation of surgical indications and timely surgical intervention are the key to reduce mortality and complications in UC.
文摘AIM To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes.METHODS This prospective cohort study included 59 patients with septic shock who received stress-dose hydrocortisone.It was performed at 2 critical care units in academic hospitals from June 1st,2015,to July 31 st,2016.Demographic data,comorbidities,medical management details,adverse effects related to corticosteroids,and outcomes were collected after the critical care physician indicated initiation of hydrocortisone.Univariate comparison between continuous and bolus administration of hydrocortisone was performed,including multivariate analysis,as well as Kaplan-Meier analysis to compare the proportion of shock reversal at 7 d after presentation.Receiver operating characteristic(ROC)curves determined the best cut-off criteria for initiation of hydrocortisone associated with the highest probability of shock reversal.We addressed the effects of the taper strategy for discontinuation of hydrocortisone,noting risk of shock relapse and adverse effects.RESULTS All-cause 30-d mortality was 42%.Hydrocortisone was administered as a continuous infusion in 54.2%of patients;time to reversal of shock was 49 h longer in patients who were given a bolus administration[59 h(range,47.5-90.5)vs 108 h(range,63.2-189);P=0.001].The maximal dose of norepinephrine after initiation of hydrocortisone was lower in patients on continuous infusion[0.19μg/kg per minute(range,0.11-0.28μg)]compared with patients who were given bolus[0.34μg/kg per minute(range,0.16-0.49);P=0.004].Kaplan-Meier analysis revealed a higher proportion of shock reversal at 7 d in patients with continuous infusion compared to those given bolus(83%vs 63%;P=0.004).There was a good correlation between time to initiation of hydrocortisone and time to reversal of shock(r=0.80;P<0.0001);ROC curve analysis revealed that the best criteria for prediction of shock reversal was a time to initiation of hydrocortisone of≤13 h after administration of norepinephrine,with an area under the curve of 0.81(P<0.001).The maximal dose of norepinephrine at initiation of hydrocortisone with the highest association with shock reversal was≤0.28μg/kg per minute,with an area under the curve of 0.75(P=0.0002).On a logistic regression model,hydrocortisone taper was not associated with a lower risk of shock relapse(RR=1.29;P=0.17)but was related to a higher probability of hyperglycemia[odds ratio(OR),5.3;P=0.04]and hypokalemia(OR=10.6;P=0.01).CONCLUSION Continuous infusion of hydrocortisone could hasten the resolution of septic shock compared to bolus administration.Earlier initiation corresponds with a higher probability of shock reversal.Tapering strategy is unnecessary.
文摘脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。
文摘AIM:To identify patient,cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac arrest.METHODS:A retrospective,single centre study of comatose patients admitted to our intensive care unit(ICU)following cardiac arrest during the twenty year period between 1993 and 2012.This study was deemed by the Human Research Ethics Committee(HREC)of Monash Health to be a quality assurance exercise,and thus did not require submission to the Monash Health HREC(Research Project Application,No.13290Q).The study population included all patients admitted to ourICU between 1993 and 2012,with a discharge diagnosis including"cardiac arrest".Patients were excluded if they did not have a cardiac arrest prior to ICU admission(i.e.,if their primary arrest was during their admission to ICU),or were not comatose on arrival to ICU.Our primary outcome measure was survival to hospital discharge.Secondary outcome measures were ICU and hospita length of stay(LOS),and factors associated with surviva to hospital discharge.RESULTS:Five hundred and eighty-two comatose patients were admitted to our ICU following cardiac arrest,with 35%surviving to hospital discharge.The median ICU and hospital LOS was 3 and 5 d respectively.There was no survival difference between in-hospital and out-of-hospital cardiac arrests.Males made up 62%of our cardiac arrest population,were more likely to have a shockable rhythm(56%vs 37%,P<0.001),and were more likely to survive to hospital discharge(40%vs 28%,P=0.006).On univariate analysis,therapeutic hypothermia,regardless of method used(e.g.,rapid infusion of ice cold fluids,topical ice,"Arctic Sun",passive rewarming,"Bair Hugger")and location initiated(e.g.,pre-hospital,emergency department,intensive care)was associated with increased survival.There was however no difference in survival associated with target temperature,time at target temperature,location of initial cooling,method of initiating cooling,method of maintaining cooling or method of rewarming.Patients that survived were more likely to have a shockable rhythm(P<0.001),shorter time to return of spontaneous circulation(P<0.001),receive therapeutic hypothermia(P=0.03),be of male gender(P=0.006)and have a lower APACHEⅡscore(P<0.001).After multivariate analysis,only a shockable initial rhythm(OR=6.4,95%CI:3.95-10.4;P<0.01)and a shorter time to return of spontaneous circulation(OR=0.95,95%CI:0.93-0.97;P<0.01)was found to be independently associated with survival to hospital discharge.CONCLUSION:In comatose survivors of cardiac arrest,shockable rhythm and shorter time to return of spontaneous circulation were independently associated with increased survival to hospital discharge.
文摘Sepsis and septic shock remain a major cause of morbidity and mortality among patients admitted in the intensive care unit.Diabetes is a major risk factor for the development of sepsis.The global mortality of sepsis remains high,despite significant interventions and guidelines.It has been known for decades that patients with sepsis have reduced levels of antioxidants,most notably vitamin C.Furthermore,experimental data has demonstrated multiple beneficial effects of vitamin C in sepsis.In addition,corticosteroids and thiamine may have synergistic biological effects together with vitamin C.Preliminary data suggests that therapy with hydrocortisone,ascorbic acid and thiamine improves the outcome of patients with sepsis with the potential to save millions of lives.However,this intervention has met with much resistance and has not been widely adopted.Ultimately,we await the final jury verdict on this simple,safe and cheap intervention.
文摘In the "proton pump inhibitors era",a penetrating peptic ulcer(PPU) represents an exceptional cause of abdominal pain,and was more frequently observed in the past where there was not an effective antacid treatment. Ulcer-induced pancreatitis is very rare,too,and manifests with persistent,intense pain radiating to the back. A mild to severe pancreatitis with peripancreatic fluid collection can be observed at imaging. However,only a few cases of association between PPU and emphysematous pancreatitis(EP) have been published in the literature. EP is a rare but potentially fatal form of acute necrotizing pancreatitis in which gas grows in and outside the pancreas,and typically involves the whole parenchyma in diabetic individuals.Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP.Unlike the classic form of EP,which involves the whole parenchyma and has a poor prognosis,we found that the emphysematous involvement of the pancreas by PPU has a benign course if a conservative therapy is promptly established. Gas is confined to the site of penetration,usual y the pancreatic head,and ulcers most often involve the duodenum.
文摘Since it has been recognized that sarcoidosis(SA) is not an exclusive disorder of the lungs but can also affect other organs such as the liver and spleen, efforts have been made to define specific imaging criteria for the diagnosis of the single organ involvement, and the concept has been reinforced that the exclusion of alternative causes is important to achieve the correct diagnosis. Ultrasound(US)is a useful tool to evaluate patients with suspected abdominal SA, such as of the liver, spleen, kidney, pancreas and other organs, showing findings such as organomegaly, focal lesions and lymphadenopathy. While the diagnosis of abdominal SA is more predictable in the case of involvement of other organs(e.g.,lungs), the problem is more complex in the case of isolated abdominal SA. The recent use of contrast-enhanced ultrasound and endoscopic ultrasound elastography has provided additional information about the enhancement patterns and tissue rigidity in abdominal SA. Here we critically review the role of US in abdominal SA, reporting typical findings and limitations of current evidence and by discussing future perspectives of study.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with over 1.3 million deaths.While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence,highlight gaps in knowledge,and elucidate further meta-analyses and umbrella reviews that are yet to be performed.METHODS We explored studies based on systematic reviews and meta-analyses with the keyterms,including severe acute respiratory syndrome(SARS),SARS virus,coronavirus disease,COVID-19,and SARS coronavirus-2.The included studies were extracted from Embase,Medline,and Cochrane databases.The publication timeframe of included studies ranged between January 01,2020,to October 30,2020.Studies that were published in languages other than English were not considered for this systematic review.The finalized full-text articles are freely accessible in the public domain.RESULTS Searching Embase,Medline,and Cochrane databases resulted in 1906,669,and 19 results,respectively,that comprised 2594 studies.515 duplicates were subsequently removed,leaving 2079 studies.The inclusion criteria were systematic reviews or meta-analyses.860 results were excluded for being a review article,scope review,rapid review,panel review,or guideline that produced a total of 1219 studies.After screening articles were categorized,the included articles were put into main groups of clinical presentation,epi-demiology,screening and diagnosis,severity assessment,special populations,and treatment.Subsequently,there was a second subclassification into the following groups:gastrointestinal,cardiovascular,neurological,stroke,thrombosis,anosmia and dysgeusia,ocular manifestations,nephrology,cutaneous manifestations,D-dimer,lymphocyte,anticoagulation,antivirals,convalescent plasma,immunosuppressants,corticosteroids,hydroxychloroquine,renin-angiotensin-aldosterone system,technology,diabetes mellitus,obesity,pregnancy,children,mental health,smoking,cancer,and transplant.CONCLUSION Among the included articles,it is clear that further research is needed regarding treatment options and vaccines.With more studies,data will be less heterogeneous,and statistical analysis can be better applied to provide more robust clinical evidence.This study was not designed to give recommendations regarding the management of COVID-19.
文摘Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.
文摘Dear editor,Iatrogenic hypoglycaemia is a common acute presentation;either because of misuse,self-harm or criminal intent.The most common culprits are insulin and oral hypoglycaemics(sulfonylurea,biguanides)although aspirin,fluoroquinolone and beta blockers can be causative agents.Common symptoms include sweating,anxiety,tremors,and palpitations.Neuroglycopenic symptoms usually arise at serum glucose concentrations of<2.8 mmol/L and include dizziness,confusion,blurred vision,somnolence and more serious symptoms can be convulsions,coma and potentially death.
文摘Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe?, a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining AbtheraTM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected be-tween the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.
