scholarly journals Nutritional Status and the Critically Ill Patient: Gut Microbiota and Immuno-Nutrition in I.C.U. at the Time of SARS-COV 2 Pandemic

2021 ◽  
Vol 12 (2) ◽  
pp. 259-269
Author(s):  
Emidio Scarpellini ◽  
Laura Scarcella ◽  
Giorgio Romanelli ◽  
Martina Basilico ◽  
Emiliano Lattanzi ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Critically Ill ◽  
Therapeutic Approach ◽  
English Language ◽  
Case Series ◽  
Selective Decontamination ◽  
Disease Stage ◽  
Critically Ill Patient ◽  
Microbial Dysbiosis ◽  
Meta Analyses

Background: Gut microbiota is a complex ecosystem of bacteria, viruses, archaea, protozoa and yeasts in our intestine. It has several functions, including maintaining human body equilibrium. Microbial “dysbiosis” can be responsible for outbreak of local and systemic infections, especially in critically ill patients. Methods: to build a narrative review, we performed a Pubmed, Medline and EMBASE search for English language papers, reviews, meta-analyses, case series and randomized controlled trials (RCTs) by keywords and their associations: critically ill patient; nutrition; gut microbiota; probiotics; gut virome; SARS-COV 2. Results: Over the antibiotic-based “selective decontamination”, potentially responsible for drug-resistant microorganisms development, there is growing interest of scientists and the pharmaceutical industry for pre-, probiotics and their associations as safe and reliable remedies restoring gut microbial “eubiosis”. Very first encouraging evidences link different gut microbiota profiles with SARS-COV 2 disease stage and gravity. Thus, there is frame for a probiotic therapeutic approach of COVID-19. Conclusions: gut microbiota remodulation seems to be a promising and safe therapeutic approach to prevent local and systemic multi-resistant bug infections in the intensive care unit (ICU) patients. This approach deserves more and more attention at the time of SARS-COV 2 pandemic.

scholarly journals Oral White Lesions: An Updated Clinical Diagnostic Decision Tree

2019 ◽  
Vol 7 (1) ◽  
pp. 15 ◽  
Author(s):  
Hamed Mortazavi ◽  
Yaser Safi ◽  
Maryam Baharvand ◽  
Soudeh Jafari ◽  
Fahimeh Anbari ◽  
...  
Keyword(s):  
Decision Tree ◽  
English Language ◽  
Case Reports ◽  
Case Series ◽  
Oral Diseases ◽  
Diagnostic Decision ◽  
General Search ◽  
Retrospective Cohort Studies ◽  
Special Pattern ◽  
Meta Analyses

Diagnosis of oral white lesions might be quite challenging. This review article aimed to introduce a decision tree for oral white lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “mouth disease”, “oral keratosis”, “oral leukokeratosis”, and “oral leukoplakia”. Related English-language articles published since 2000 to 2017, including reviews, meta-analyses, and original papers (randomized or nonrandomized clinical trials; prospective or retrospective cohort studies), case reports, and case series about oral diseases were appraised. Upon compilation of data, oral white lesions were categorized into two major groups according to their nature of development: Congenital or acquired lesions and four subgroups: Lesions which can be scraped off or not and lesions with the special pattern or not. In total, more than 20 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.

scholarly journals Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis

2020 ◽  
Vol 11 ◽  
pp. 94 ◽  
Author(s):  
Davide Nasi ◽  
Mauro Dobran
Keyword(s):  
Decompressive Craniectomy ◽  
Lower Incidence ◽  
English Language ◽  
Meta Analysis ◽  
Case Series ◽  
Cerebrospinal Fluid Dynamics ◽  
Inclusion Criteria ◽  
Postoperative Hydrocephalus ◽  
Meta Analyses ◽  
Early Cranioplasty

Background: Do alterations of cerebrospinal fluid dynamics secondary to decompressive craniectomy (DC) lead to hydrocephalus, and can this effect be mitigated by early cranioplasty (CP)? In this meta-analysis, we evaluated whether the timing of CP decreased the incidence of postoperative hydrocephalus. Methods: We performed a systematic search of PubMed/MEDLINE, Scopus, and the Cochrane databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for English language articles (1990–2020). We included case series, case–control, and cohort studies, and clinical trials assessing the incidence of hydrocephalus in adult patients undergoing early CP (within 3 months) versus late CP (after 3 months) after DC. Results: Eleven studies matched the inclusion criteria. The rate of postoperative hydrocephalus was not significantly different between the early (=96/1063; 9.03%) and late CP (=65/966; 6.72%) group (P = 0.09). Only in the three studies specifically reporting on the rate of hydrocephalus after DC performed to address traumatic brain injury (TBI) alone was there a significantly lower incidence of hydrocephalus with early CP (P = 0.01). Conclusion: Early CP (within 90 days) after DC performed in TBI patients alone was associated with a lower incidence of hydrocephalus. However, this finding was not corroborated in the remaining eight studies involving CP for pathology exclusive of TBI.

scholarly journals Faecal Microbial Transplantation in Critically Ill Patients – Structured Review and Perspectives

2021 ◽  
Author(s):  
Ivana Cibulková ◽  
Veronika Řehořová ◽  
Jan Hajer ◽  
Frantisek Duska
Keyword(s):  
Gut Microbiota ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multiorgan Failure ◽  
Case Series ◽  
Host Susceptibility ◽  
Patient Centered ◽  
Neurocognitive Functions ◽  
Disease Case ◽  
Inflammatory Bowel

The human gut microbiota consists of bacteria, archaea, fungi, and viruses. It is a dynamic ecosystem shaped by several factors, which play an essential role in both healthy and diseased states of humans. A disturbance of the gut microbiota, also termed “dysbiosis,” is associated with increased host susceptibility to a range of diseases. Because of splanchnic ischaemia, exposure to antibiotics, and/or underlying the disease critically ill patients loose 90% of the commensal organisms in their gut within hours after the insult. This is followed by a rapid overgrowth of potentially pathogenic and pro-inflammatory bacteria altering metabolic, immune, and even neurocognitive functions and turning the gut into the driver of systemic inflammation and multiorgan failure. Indeed, restoring healthy microbiota by means of faecal microbiota transplantation (FMT) in the critically ill is an attractive and plausible concept in intensive care. Yet, available data from controlled studies are limited to probiotics and FMT for severe C. difficile infection or severe inflammatory bowel disease. Case series and observational trials generate hypothesis that FMT might be feasible and safe in immunocompromised patients, refractory sepsis, or severe antibiotic-associated diarrhea in ICU. There is a burning need to test these hypotheses in randomized controlled trials powered for determination of patient-centered outcomes.

scholarly journals Fecal Microbial Transplantation in Critically Ill Patients—Structured Review and Perspectives

Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1459
Author(s):  
Ivana Cibulková ◽  
Veronika Řehořová ◽  
Jan Hajer ◽  
František Duška
Keyword(s):  
Gut Microbiota ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fecal Microbiota Transplantation ◽  
Multiorgan Failure ◽  
Case Series ◽  
Underlying Disease ◽  
Fecal Microbiota ◽  
Host Susceptibility ◽  
Disease Case

The human gut microbiota consists of bacteria, archaea, fungi, and viruses. It is a dynamic ecosystem shaped by several factors that play an essential role in both healthy and diseased states of humans. A disturbance of the gut microbiota, also termed “dysbiosis”, is associated with increased host susceptibility to a range of diseases. Because of splanchnic ischemia, exposure to antibiotics, and/or the underlying disease, critically ill patients loose 90% of the commensal organisms in their gut within hours after the insult. This is followed by a rapid overgrowth of potentially pathogenic and pro-inflammatory bacteria that alter metabolic, immune, and even neurocognitive functions and that turn the gut into the driver of systemic inflammation and multiorgan failure. Indeed, restoring healthy microbiota by means of fecal microbiota transplantation (FMT) in the critically ill is an attractive and plausible concept in intensive care. Nonetheless, available data from controlled studies are limited to probiotics and FMT for severe C. difficile infection or severe inflammatory bowel disease. Case series and observational trials have generated hypotheses that FMT might be feasible and safe in immunocompromised patients, refractory sepsis, or severe antibiotic-associated diarrhea in ICU. There is a burning need to test these hypotheses in randomized controlled trials powered for the determination of patient-centered outcomes.

Gut Microbiota and Autoimmune Diseases: a Charming Real World Together with Probiotics

2021 ◽  
Vol 28 ◽  
Author(s):  
Andrea Piccioni ◽  
Sara Cicchinelli ◽  
Federico Valletta ◽  
Giulio De Luca ◽  
Yaroslava Longhitano ◽  
...  
Keyword(s):  
Autoimmune Disease ◽  
Gut Microbiota ◽  
English Language ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Case Series ◽  
Case Evaluation ◽  
Immune Mediated ◽  
Keywords Autoimmunity

Background: The role of gut microbiota in human disease is fascinating for hundreds of researchers worldwide. Many works have highlighted that gut microbiota modulates the immune system, and that its disruption can trigger autoimmune and inflammatory immune-mediated diseases. Probiotics are able to positively modify microbiota composition. Objective: Aim of this review is to report the most important findings regarding the effects of probiotics administration in the most common autoimmune disease and inflammatory immune-mediated diseases. Method: Literature research was performed in PubMed, Google Scholar and Medline, as well as in specific journal websites using the keywords: “autoimmunity”, “microbiota”, and “probiotics”. The article selection has been made independently by three authors, and controversies have been solved by a fourth researcher. Only English-language articles were included and preference was given to clinical trials, meta-analysis, and case series. After the review process, 68 articles have been considered. Results: Relying on this evidence, many studies have investigated the potential of probiotics in restoring gut eubiosis thus affecting pathogenesis, clinical manifestations, and course of these pathologies. Even in the light of few and sometimes contradictory studies, physicians should start to consider this preliminary findings when approaching patients suffering from autoimmune disease. After an accurate case-by-case evaluation of potential candidates, probiotics might be introduced beside the standard therapeutic plan, as supportive measures.

scholarly journals Can Transthoracic Echocardiography Be Used to Predict Fluid Responsiveness in the Critically Ill Patient? A Systematic Review

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Justin C. Mandeville ◽  
Claire L. Colebourn
Keyword(s):  
Critically Ill ◽  
Fluid Responsiveness ◽  
Transthoracic Echocardiography ◽  
English Language ◽  
Vena Cava ◽  
Critically Ill Patient ◽  
Predict Fluid Responsiveness ◽  
Mechanically Ventilated ◽  
Patient Tolerance ◽  
Fluid Load

Introduction. We systematically evaluated the use of transthoracic echocardiography in the assessment of dynamic markers of preload to predict fluid responsiveness in the critically ill adult patient.Methods. Studies in the critically ill using transthoracic echocardiography (TTE) to predict a response in stroke volume or cardiac output to a fluid load were selected. Selection was limited to English language and adult patients. Studies on patients with an open thorax or abdomen were excluded.Results. The predictive power of diagnostic accuracy of inferior vena cava diameter and transaortic Doppler signal changes with the respiratory cycle or passive leg raising in mechanically ventilated patients was strong throughout the articles reviewed. Limitations of the technique relate to patient tolerance of the procedure, adequacy of acoustic windows, and operator skill.Conclusions. Transthoracic echocardiographic techniques accurately predict fluid responsiveness in critically ill patients. Discriminative power is not affected by the technique selected.

Intensive care medicine on military operations in the resource-limited environment: a case series

2020 ◽  
pp. jramc-2019-001344
Author(s):  
Jeyasankar Jeyanathan ◽  
D O'Brien ◽  
J E Smith
Keyword(s):  
Intensive Care ◽  
United Nations ◽  
Intensive Care Medicine ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Critically Ill Patient ◽  
Military Operations ◽  
Field Hospital ◽  
Resource Limited

This paper describes a series of critically ill patients who were cared for at a UK military field hospital during Op TRENTON 4, in support of the United Nations Mission in South Sudan. These cases highlight the potential challenges in managing the critically ill patient during contingency operations that take place in an austere resource-limited environment.

Management of Odontogenic Cysts by Endonasal Endoscopic Techniques: A Systematic Review and Case Series

2018 ◽  
Vol 32 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Michael J. Marino ◽  
Amber Luong ◽  
William C. Yao ◽  
Martin J. Citardi
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Case Reports ◽  
Case Series ◽  
Odontogenic Cysts ◽  
Keratocystic Odontogenic Tumor ◽  
Endoscopic Techniques ◽  
Dentigerous Cysts ◽  
Meta Analyses

Background Odontogenic cysts and tumors of the maxilla may be amendable to management by endonasal endoscopic techniques, which may reduce the morbidity associated with open procedures and avoid difficult reconstruction. Objective To perform a systematic review that evaluates the feasibility and outcomes ofendoscopic techniques in the management of different odontogenic cysts. A case series of our experience with these minimally invasive techniques was assembled for insight into the technical aspects of these procedures. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to identify English-language studies that reported the use of endoscopic techniques in the management of odontogenic cysts. Several medical literature data bases were searched for all occurrences in the title or abstract of the terms “odontogenic” and “endoscopic” between January 1, 1950, and October 1, 2016. Publications were evaluated for the technique used, histopathology, complications, recurrences, and the follow-up period. A case series of patients who presented to a tertiary rhinology clinic and who underwent treatment of odontogenic cysts by an endoscopic technique was included. Results A systematic review identified 16 case reports or series that described the use of endoscopic techniques for the treatment of odontogenic cysts, including 45 total patients. Histopathologies encountered were radicular (n = 16) and dentigerous cysts (n = 10), and keratocystic odontogenic tumor (n = 12). There were no reported recurrences or major complications for a mean follow-up of 29 months. A case series of patients in our institution identified seven patients without recurrence for a mean follow-up of 10 months. Conclusion Endonasal endoscopic treatment of various odontogenic cysts are described in the literature and are associated with effective treatment of these lesions for an average follow-up period of >2 years. These techniques have the potential to reduce morbidity associated with the resection of these lesions, although comparative studies would better define specific indications.

scholarly journals Characteristics and Pulmonary Computerized Imaging Findings of Critically Ill Egyptian Patients with Multisystem Inflammatory Syndrome in Children

2021 ◽  
Author(s):  
Hanan Ibrahim ◽  
Shaimaa Mohammad ◽  
Eman Fouda ◽  
Khaled Ahmed ◽  
Nevin Habeeb ◽  
...  
Keyword(s):  
Critically Ill ◽  
Case Series ◽  
Lower Lobe ◽  
Cross Sectional Study ◽  
Disease Stage ◽  
Imaging Findings ◽  
Cross Sectional ◽  
Pleural Thickening ◽  
Long Term Follow Up

Objectives. This study was carried out to delineate the patients’ characteristics and the imaging findings and their relation to some biochemical markers of 31 critically ill patients with MIS-C. Design. A retrospective cross-sectional study including all critically ill MIS-C children admitted to the PICU from June 23rd to July 22nd, 2020. Results. Eighteen males and thirteen females, with a median age of 9 years (interquartile range 6-11) presented mainly with fever (100%) and hypotension (100%). Abnormalities in the chest computed tomography were detected in 22 cases (71%). Consolidation and architecture distortion were detected in 58.1% of patients; bilateral lesions and lower lobe infiltrates, each, were evident in 64.5% , while the peripheral distribution of lesions was seen in 71% of the cases. Pleural thickening and effusion were found in 51.6% of the patients. In this small case series, the presence of high ferritin was significantly associated with the bilaterality of the lesions. Elevated C-reactive protein was associated with the peripheral distribution of the lesions, in addition, thrombocytopenia and hypoalbuminemia were significantly correlated with the CT disease stage and CT severity score respectively. Conclusions. Short and long-term follow up of MIS-C cases is not only needed for the follow up of clinical and laboratory abnormalities but also for the elucidation of the outcome of CT pulmonary findings.

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