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New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report

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World Journal of Transplantation 2024年第1期14卷 210-214页

作者： Belinda Sánchez Pérez maría Pérez Reyes Jose Aranda Narvaez Julio Santoyo Villalba Jose Antonio Perez daga Claudia Sanchez-Gonzalez Julio Santoyo-Santoyo Hepatobiliary and Trasplantation Unit General and Digestive Surgery DepartmentUniversity Regional HospitalMalaga 29010Spain Department of General and Digestive Surgery Regional University Hospital of MalagaMalaga 29010Spain

BACkGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome(HPS)after liver transplant(LT),this case adds information and experience on this issue along with a treatment with positive *** is a complication of end-stage liver disease,with a 10%-30%incidence in cirrhotic *** can reverse the physiopathology of this process and restore normal ***,in some cases,refractory hypoxemia persists,and extracorporeal membrane oxygenation(ECMO)can be used as a rescue therapy with good *** SUMmarY A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for *** had good liver function(Model for End-Stage Liver Disease score 12,Child-Pugh class B7).He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%.The macroaggregated albumin test result was>*** demonstrated a forced expiratory volume in one second(FEV1)of 78%,forced vital capacity(FVC)of 74%,FEV1/FVC ratio of 81%,diffusion capacity for carbon monoxide of 42%,and carbon monoxide transfer coefficient of 57%.He required domiciliary oxygen at 2 L/min(16 h/d).The patient was admitted to the intensive care unit(ICU)and extubated in the first 24 h,needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide *** was needed after 72 *** to the non-response to supportive therapies,installation of ECMO was decided with progressive recovery after 9 *** was possible on the tenth day,maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 *** was discharged from ICU on postoperative day(POD)20 with a 90%-92%oxygen *** recycling was needed twice for acute *** patient was discharged from hospital on POD 27 with no symptoms,with an 89%-90%oxygen *** Due to the favorable results observed,ECMO could bec

关键词： Liver transplantation Hepatopulmonary syndrome Refractory hypoxemia Treatment Extracorporeal membrane oxygenation Case report

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Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux

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World Journal of Gastroenterology 2007年第11期13卷 1706-1710页

作者： Bhavneesh Sharma Manisha Sharma mradul k.mar daga Gopal krishan Sachdev Elliott Bondi Brookdale University Hospital and Medical Center Division of Pulmonary and Critical Care Medicine State University of New York Brooklyn New York 11212 United States University of Delhi Maulana Azad Medical College Divisions of Pulmonary Medicine and Gastroenterology New Delhi 110002 India

AIM： To study the effect of combined omeprazole（Ome） and domperidone（Dom） therapy on asthma symptoms and pulmonary function in asthmatics with gastroesoph- ageal reflux. METHODS： We selected 198 asthmatics with gastro- esophageal reflux diagnosed by 24-h esophageal pH moni- toring to receive Ome 20 mg twice daily and Dom 10 mg three times daily or placebo for 16 wk （1：1 double-blind randomization）. Spirometry was done at baseline and after 16 wk of treatment. The primary outcome measures were： mean daily daytime and nighttime asthma symptom scores. Mean daily reflux symptom scores, albuterol use as rescue medication （number of puffs）, daytime and nighttime peak expiratory flow rate （PEFR）, postbronchodilator forced expiratory volume in 1 second （FEVl） and postbronchodilator forced vital capacity （FVC） were secondary outcome measures. RESULTS： Comparison of mean change from baseline between antireflux therapy and placebo groups revealed significant reduction in daytime asthma symptom score （17.4% vs 8.9 %）, nighttime asthma symptom score （19.6% vs 5.4%）, reflux symptom score （8.7% vs 1.6%） and rescue medication use （23.2% vs 3.1%） after antireflux therapy compared to mean change in placebo group （P 〈 0.001）. There was significant improvement in morning PEFR （7.9% vs 0.2%）, evening PEFR （9.8% vs 0.5%）, FEW （11.1% vs 3.78%） and FVC （9.3%vs 1.52%） in the antireflux therapy group compared to placebo on comparng the mean change from baseline after 16 wk （P 〈 0.01） CONCLUSION： Combined therapy with Ome and Dom in adult asthmatics with gastroesophageal reflux may be beneficial by reducing asthma symptoms, rescuing medi- cation use, and improving pulmonary function.

关键词： Asthma Reflux Gastroesophageal reflux disease Antireflux therapy Prokinetic Omeprazole

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Multi-detector computed tomography imaging of large airway pathology:A pictorial review

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World Journal of Radiology 2015年第12期7卷 459-474页

作者： Tejeshwar Singh Jugpal Anju Garg Gulshan Rai Sethi mradul k.mar daga Jyoti k.mar Department of Radiodiagnosis Maulana Azad Medical College and associated Lok Nayak Hospital Department of Pediatrics Maulana Azad Medical College and associated Lok Nayak Hospital Department of Medicine Maulana Azad Medical College and associated Lok Nayak Hospital

The tracheobronchial tree is a musculo-cartilagenous framework which acts as a conduit to aerate the lungs and consequently the entire body. A large spectrum of pathological conditions can involve the trachea and bronchial airways. These may be congenital anomalies, infections, post-intubation airway injuries, foreign body aspiration or neoplasms involving the airway. Appropriate management of airway disease requires an early and accurate diagnosis. In this pictorial essay review, we will comprehensively describe the various airway pathologies and their imaging findings by multi-detector computed tomography.

关键词： Multi detector computed tomography Trachea Bronchial tree Airway abnormality virtual bronchoscopy

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Critical care practice in India:Results of the intensive care unit need assessment survey(ININ2018)

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World Journal of Critical Care Medicine 2020年第2期9卷 31-42页

作者： Rahul kashyap kirtivardhan Vashistha Chetan Saini Taru Dutt Dileep Raman Vikas Bansal Harpreet Singh Geeta Bhandari Nagarajan Ramakrishnan Harshit Seth Divya Sharma Premk.mar Seshadri mradul k.mar daga Mohan Gurjar Yash Javeri Salim Surani Joseph Varon 无 Department of Anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Department of Infectious Disease Mayo ClinicRochesterMN 55905United States Department of Internal Medicine Allegheny General HospitalPittsburghPA 15212United States Department of Radiology Mayo ClinicRochesterMN 55905United States Department of Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 14061United States Department of Neurology Mayo ClinicRochesterMN 55905United States and Department of PsychiatryHennepin County Medical CenterMinneapolisMN 55415United States Department of Medicine Cloud Physician HealthcareBangalore 560038India Department of Critical Care Medicine Mayo ClinicRochesterMN 55905United States Department of Internal Medicine Maulana Azad Medical College&Associated HospitalsNew DelhiDelhi 110002India Department of Anesthesiology Government Medical CollegeHaldwaniNainital 263129India Department of Critical Care Medicine Apollo HospitalsChennai 600006India Department of Hospitalist Medicine Allegany ClinicAllegany Health NetworkPittsburghPA 15222United States Premk.mar Seshadri Department of MedicineMAAGF HealthcareChennai 600024India Department of Internal Medicine and Center for Occupational and Environment Health Maulana Azad Medical CollegeNew DelhiDelhi 110002India Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014India Department of Critical Care Medicine Regency Super Speciality HospitalLucknow 208005India Nayati Healthcare New DelhiDelhi 110065India Department of Pulmonary and Critical Care Medicine Texas A&M UniversityCollege StationTX 77843United States Department of Critical Care United Memorial Medical CenterHoustonTX 77091United States ININ-2018 Investigators Team

BACkGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city *** To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement *** 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,*** 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 *** completing and submitting the survey,providers gave their consent for research *** study was deemed eligible for category-2 Institutional Review Board exempt *** 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 *** had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only *** responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were *** 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 *** than 80%of the ICUs were open,and mixed *** 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 *** In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing

关键词： Intensive care unit Critical care India Survey Intensive care unit survey Intensive care unit needs

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