Purpose. Obesity has been associated with an increased risk of respiratory complications and other systemic illnesses. Respiratory dynamics in an obese patient, combined with modified lung physiology of ARDS, present a significant challenge in managing obese patients with ARDS. Many physicians think of obesity as a relative contraindication to ECMO. We performed a meta-analysis to see the effect of obesity on weaning from ECMO and survival to hospital discharge. Methods. We searched online databases for studies on ECMO and obesity. The search yielded 49 citations in total; after extensive review, six studies were assessed and qualified to be included in the final analysis. Patients were stratified into BMI >30 kg/m2 (obese) and BMI < 30 kg/m2 (nonobese). Results. In meta-analysis, there was a total sample population of 1285 patients, with 466 in the obese group and 819 in the nonobese group. There was no significant difference in weaning from ECMO when compared between obese and nonobese patients, with a risk ratio of 1.03 and 95% confidence interval (CI) of 0.94–1.13 (heterogeneity: chi2 = 7.44, df = 4 ( p = 0.11 ), I2 = 46%). There was no significant difference in survival rates between obese and nonobese patients who were treated with ECMO during hospitalization, with a risk ratio of 1.04 and 95% CI of 0.86–1.25 (heterogeneity: Tau2 0.03, chi2 = 14.61, df = 5 ( p = 0.01 ), I2 = 66%). Conclusion. Our findings show no significant difference in survival and weaning from ECMO in obese vs. nonobese patients. ECMO therapy should not be withheld from obese patients, as obesity is not a contraindication to ECMO.
Background and Objective: Melanoma is a disease notorious for the development of brain metastases, with consequently poor outcomes for patients who develop melanoma brain metastases (MBM). The treatment options for patients with MBM were limited to radiotherapy and surgery. MBM patients, particularly those with symptomatic disease, were excluded from clinical trials of immune checkpoint inhibitors (ICI) and BRAF/MEK inhibitors. Recent post-approval studies have, demonstrated important roles for existing systemic ICIs and BRAF/MEK inhibitors in untreated MBM, dramatically altering the landscape of melanoma patients in general and MBM in particular. These trials have also identified key areas for which more effective strategies are needed including: symptomatic MBM, and leptomeningeal disease (LMD).Methods: PubMed, Scopus and Embase databases were systematically queried to obtain records pertaining to the etiology of and treatment for MBM. Clinical trial databases were reviewed to obtain details regarding MBM clinical trials.
ABSTRACT… Objectives: Despite in techniques advancement to patient care for respiratory tracts are instrumented may complicate the IAP course up to 50% in patients with mechanical ventilation. It requires rapid diagnoses and treatment that is appropriate as per patient condition. Many studies revealed negative impact with delayed administration and antibiotic treatment in IAP patients may increase the hospital mortality and morbidity. The primary objective of the study was to estimate the incidence of IAP in the patient admitted in ICU of tertiary care hospitals in Rawalpindi Pakistan. Study Design: Observational cross sectional study. Setting: ICU units of various tertiary care hospitals in Rawalpindi, Pakistan. Period: One year from Dec 2016-Dec 2017. Materials and Methods: A total 450 subjects were enlisted for the study; these patients were selected randomly. The exclusion criteria include all patients with Acute Respiratory Distress Syndrome (ARDS) or those on long-term antibiotic or steroid therapy and all the pregnant women whereas all the patients of both sexes, kept on ventilator for more than 48 h and above the age of 18 years were included in this study. Results: We enrolled a total of 450 patients for this study. The average age of all the participants was 61.51 + 12.8 with range 36-91. 230(51.1%) of the patients were male whereas 220(48.9%) were females. The Trauma-Pulm contusion was absent in all patients. In ICU 150 (33.3%) were diagnosed with COPD, 150(33.3%) with Asthma, 220(48.9%) with ARDS, 10 (2.2%) with head trauma and 310 (68.8%) with diabetes.200 (44.4%) smokers, 40(8.8%) were having lung cancer, 310(68.8%) were hypertensive and 20 (4.4%) were with Pneumothorax -requiring Chest Tube. Conclusion: We may conclude from our study that ICU associated Pneumonia is a serious issue, that developed with longer hospital stay, duration of mechanical ventilation and re-intubation. By reducing the mechanical ventilation duration, pneumonia can be controlled.
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