Infections in acute liver failure - Assessment, prevention, and management.

Infections in acute liver failure (ALF) increase the associated morbidity and mortality, and often hamper the possibility of transplantation. Two-thirds of the infections in ALF are bacterial while one-third is fungal. High suspicion for infection is essential whenever there is clinical deterioration.

Clinical study on the predictive utility of high flow CPAP in weaning from prolonged mechanical ventilation in critical paediatric surgery patients.

Introduction And Objectives: Weaning paediatric patients from mechanical ventilation (MV) often results in extubation failure (EF) (14%-22%) and 2% of patients will require tracheostomy (2%).

Methods: We performed an observational study in 115 critically ill patients in whom a novel high-flow CPAP (CPAP-ANRI) system was connected to the tracheal tube during ventilation (CPAP + TI). After extubation, the same system was connected to various interfaces.

Verapamil inhibits ferroptosis in septic acute lung injury by blocking L-type calcium channels.

Acute lung injury (ALI) and its severe form, acute respiratory distress syndrome (ARDS), result from pulmonary edema and alveolar-capillary barrier disruption due to inflammation, often triggered by conditions like sepsis. Sepsis-induced ALI (SALI) involves extensive damage to vascular endothelium and alveolar epithelium, leading to respiratory failure. Our study explores ferroptosis, an iron-dependent cell death pathway, and calcium dysregulation in SALI.

Veno-venous extracorporeal membrane oxygenation as a bridge in central airway obstruction: experience from a high-volume center.

Background: Perioperative airway management and oxygenation maintenance during central airway obstruction (CAO) treatment pose great challenges. While veno-venous extracorporeal membrane oxygenation (V-V ECMO) shows promise as a bridge therapy, optimal implementation and management strategies remain lacking. We present our experience with V-V ECMO in CAO management from a high-volume center.

Surgical anesthesia in a patient with a pheochromocytoma crisis supported by ECMO: a case report.

Pheochromocytoma is rare in clinical practice, with patients typically presenting with headache, high blood pressure and sweating. Patients who develop a pheochromocytoma crisis are particularly rare. This report describes the case of a patient in a pheochromocytoma crisis who presented with severe cardiogenic shock, acute respiratory failure, and acute coronary syndrome.

Metastatic SMARCA4-deficient undifferentiated tumor in the small mesentery: case report.

Background: SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a rare and highly malignant primary tumor characterized by the loss of SMARCA4 expression. Despite advancements in oncology, diagnosing and treating SMARCA4-UT remain significant clinical challenges.

Case Demonstration: A 67-year-old male with a history of smoking presented to the hospital with complaints of abdominal distention and pain lasting for more than four days.

Associations of intraoperative end-tidal CO levels with postoperative outcome-secondary analysis of a worldwide observational study.

Background: Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO (etCO). We examined the association of intraoperative etCO levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently-sized international, prospective study named 'Local ASsessment of Ventilatory management during General Anesthesia for Surgery' (LAS VEGAS).

Methods: Patients at high risk of PPCs were categorized as 'low etCO' or 'normal to high etCO' patients, using a cut-off of 35 mmHg.

Risk prediction models for non-invasive ventilation failure in patients with chronic obstructive pulmonary disease: A systematic review.

Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition with high morbidity and mortality. Noninvasive mechanical ventilation (NIV) is often used to manage acute COPD exacerbations, but failure can lead to worse outcomes. This systematic review aimed to evaluate risk prediction models for NIV failure in patients with COPD.

Retrieval of patent ductus arteriosus device embolization using hybrid approach: a case report.

Background: Patent ductus arteriosus (PDA) is a congenital heart defect that requires closure to prevent complications like heart failure and pulmonary hypertension. Catheter-based closure using devices such as the Amplatzer duct occluder is the preferred method due to its minimally invasive nature. However, device embolization is a rare but recognized complication, particularly in small children or high-flow PDAs.

Intra-abdominal Hypertension Is a Strong Predictor of Mortality and Poor Clinical Outcome in Severe Acute Pancreatitis.

Background: Acute pancreatitis is one of the leading causes of mortality and morbidity. Most acute pancreatitis scoring systems have no pathophysiologic basis when evaluating severity. Such a limitation led to an interest in measuring intra-abdominal pressure (IAP) as a method to predict outcomes in patients with acute pancreatitis.

Coronary calcium score and emphysema extent on different CT radiation dose protocols in lung cancer screening.

Objectives: To assess the consistency of automated measurements of coronary artery calcification (CAC) burden and emphysema extent on computed tomography (CT) images acquired with different radiation dose protocols in a lung cancer screening (LCS) population.

Materials And Methods: The patient cohort comprised 361 consecutive screenees who underwent a low-dose CT (LDCT) scan and an ultra-low-dose CT (ULDCT) scan at an incident screening round. Exclusion criteria for CAC measurements were software failure and previous history of CVD, including coronary stenting, whereas for emphysema assessment, software failure only.

Efficacy and safety of a 72-h infusion of prostacyclin (1 ng/kg/min) in mechanically ventilated patients with pulmonary infection and endotheliopathy-protocol for the multicenter randomized, placebo-controlled, blinded, investigator-initiated COMBAT-ARF trial.

Background: Acute respiratory failure (ARF) is common in critically ill patients, and 50% of patients in intensive care units require mechanical ventilation [3, 4]. The COVID-19 pandemic revealed that COVID-19 infection induced ARF caused by damage to the microvascular pulmonary endothelium. In a randomized clinical trial, mechanically ventilated COVID-19 patients with severe endotheliopathy, as defined by soluble thrombomodulin (sTM) ≥ 4 ng/mL, were randomized to evaluate the effect of a 72-h infusion of low-dose prostacyclin 1 ng/kg/min or placebo.

Severe Adult-Onset Non-Dystrophic Myotonia With Apnea and Laryngospasm Due to Digenic Inheritance of and Variants: A Case Report.

Objectives: To report a case of adult-onset non-dystrophic myotonia complicated by recurrent episodes of laryngospasm.

Methods: The patient is a 35-year-old man who was admitted to our hospital for recurrent episodes of apnea requiring endotracheal intubation with mechanical ventilation. He underwent extensive evaluation, including EMG, laryngoscopy, muscle biopsy, and genetic testing, which revealed a diagnosis of non-dystrophic myotonia.

Mortality Rate and Its Contributing Factors in Post-Surgical and Medical Patients with AKI Underwent CRRT.

Background: Acute kidney injury (AKI) requires continuous renal replacement therapy (CRRT), which is one of the most important problems in medical and surgical patients. Therefore, it is very important to identify the influencing factors to reduce the dimensions of the problem. This study was conducted to investigate the mortality rate in medical and surgical patients with AKI requiring CRRT treatment.

"My Voice Sounds Different": A Case of Acute Idiopathic Velopharyngeal Insufficiency.

This report details a case of acute idiopathic velopharyngeal insufficiency in a previously healthy eight-year-old girl, presenting with sudden voice alteration and nasal regurgitation following mild respiratory symptoms. Physical examination identified unilateral velar paralysis with open rhinolalia, without additional neurological deficits. Extensive diagnostic evaluation, including nasopharyngoscopy, cerebral and cervical imaging, and infectious serologies, yielded unremarkable findings.

Clinical Profile and Outcomes of Pediatric Snakebite Envenomation: A Three-Year Retrospective Study From a Rural Tertiary Care Center in South India.

Background Snakebite envenomation remains a significant public health challenge in tropical countries, particularly affecting the pediatric population. Children are especially vulnerable because of their smaller body mass, outdoor activities, and delayed presentation to healthcare facilities. This study aimed to analyze the clinical profile, demographic patterns, and envenomation characteristics of snakebites in children aged 1-16 years presenting to a tertiary care center.

Understanding Medical Students' Perceptions of Failure in Medical School.

This paper explores medical students' perceptions of failure through a qualitative approach, using semi-structured interviews to gather insights from six students across different academic years at Queen Mary University of London. The study aims to understand how students define failure, its causes, and its impact on their academic and personal lives. Key findings reveal that failure is perceived as multifaceted, influenced by internal and external expectations, and evolves throughout medical school.

Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty.

Introduction: Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls.

Acute Tracheal Obstruction Secondary to Cervical Liposarcoma Metastasis.

Tracheal obstruction can arise from multiple conditions, including chronic obstructive pulmonary disease, asthma, foreign bodies, tumors, and acute heart failure. We report a case of a 43-year-old man with cervical liposarcoma who, following surgical excision, chemotherapy, and radiation, presented with severe dyspnea and was admitted to our hospital. A CT scan detected an endotracheal mass causing significant obstruction, suspected to be malignant.

Effect of the COVID-19 pandemic on unmet healthcare needs after hospital discharge in acute respiratory failure survivors: A multicenter prospective cohort study.

Survivors of acute respiratory failure (ARF) have complex healthcare needs postdischarge, frequently resulting in unmet needs. This prospective multicenter study explores the association between COVID-19 status and unmet healthcare needs in survivors of ARF following hospital discharge. We analyzed patient characteristics and unmet healthcare needs by COVID-19 status using a multivariable regression model with propensity weights.

Cervical spinal cord injury following osteophyte excision for respiratory distress caused by diffuse idiopathic skeletal hyperostosis associated with ossification of posterior longitudinal ligament: a case report and literature review.

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic non-inflammatory disorder characterized by enthesopathy and osteophyte formation. DISH can also cause several other symptoms. Limited range of motion (ROM) is the most common symptom; however, dysphagia and respiratory distress are clinically important symptoms.

Depressed TFAM promotes acetaminophen-induced hepatotoxicity regulated by DDX3X-PGC1α-NRF2 signaling pathway.

Background: Acetaminophen (APAP)-induced acute liver injury (AILI) is the most prevalent cause of acute liver failure and mitochondrial dysfunction plays a dominant role in the pathogenesis of AILI. Mitochondrial transcription factor A (TFAM) is an important marker for maintaining mitochondrial functional homeostasis, but its functions in AILI are unclear. This study aimed to investigate the function of TFAM and its regulatory molecular mechanism in the progression of AILI.

[Interpretation of connotation of Yuebi Plus Banxia Decoction based on severe cases and modern pathophysiological mechanisms and experience of treating severe pulmonary infection, acute exacerbation of chronic obstructive pulmonary disease, and respiratory failure with this decoction].

Yuebi Plus Banxia Decoction is derived from the Synopsis of the Golden Chamber(Jin Gui Yao Lue) by ZHANG Zhong-jing. With the effects of ventilating lung, discharging heat, descending adverse Qi, and relieving cough and asthma, this prescription is mainly used to treat pulmonary distension caused by phlegm heat obstructing the lungs. Currently, it is commonly used in clinical practice for the treatment of acute exacerbation of chronic obstructive pulmonary disease, acute bronchitis, pneumonia, bronchial asthma, pulmonary heart disease, and pertussis.

Bi-allelic variants in DAP3 result in reduced assembly of the mitoribosomal small subunit with altered apoptosis and a Perrault-syndrome-spectrum phenotype.

The mitochondrial ribosome (mitoribosome) synthesizes 13 protein subunits of the oxidative phosphorylation system encoded by the mitochondrial genome. The mitoribosome is composed of 12S rRNA, 16S rRNA, and 82 mitoribosomal proteins encoded by nuclear genes. To date, variants in 12 genes encoding mitoribosomal proteins are associated with rare monogenic disorders and frequently show combined oxidative phosphorylation deficiency.