Effect of intraoperative fluid volume on postoperative pulmonary complications in thoracic surgeries: A systematic review and meta-analysis

Background and Aims: There is a lack of clear recommendations on fluid strategies in patients undergoing thoracic surgeries. The primary objective of this study was to compare the amount of intraoperative intravenous fluid (IVF) infused between those who developed postoperative pulmonary complications (PPCs) and those who did not. Methods: All studies comparing PPCs in intraoperative restrictive versus liberal fluid therapies were included. Those studies where the average fluid infused was compared between PPC and the ‘no PPC’ groups were also included. The pooled mean difference in IVF between patients with and without PPC and the pooled risk ratio of PPC in restricted versus liberal fluid arms were calculated. Results: Articles from PubMed (n = 157), EMBASE (n = 724) and citation searching (n = 4) were included. After excluding duplicates, title–abstract screening for 759 articles and full-text screening for 24 articles were done. The mean fluid infused in the 11 included articles was significantly higher in those with PPC (mean difference: 1.51 ml/kg/h, P = 0.001). The pooled proportion of PPC in liberal fluid arms was higher than in restricted fluid arms [risk ratio = 0.58 (95% confidence interval: 0.33, 1.02), P = 0.06]. There was high heterogeneity in both the meta-analyses. Conclusion: The meta-analysis showed that increased intraoperative IVF is associated with higher PPCs, and a restricted fluid strategy might be safer to reduce PPCs. However, since most studies were observational with a high risk of bias and high heterogeneity, well-conducted randomised controlled trials are needed to derive recommendations

Predictors of do-not-resuscitate order utilization in decompensated cirrhosis hospitalized patients: A nationwide inpatient cohort study

Introduction and objectives: Decompensated cirrhosis carries high inpatient morbidity and mortality. Consequently, advance care planning is an integral aspect of medical care in this patient population. Our study aims to identify do-not-resuscitate (DNR) order utilization and demographic disparities in decompensated cirrhosis patients. Patients or materials and methods: Nationwide Inpatient Sample was used to extract the cohort of patients from January 1st, 2016 to December 31st, 2017, based on the most comprehensive and recent data. The first cohort included hospitalized patients with decompensated cirrhosis. The second cohort included patients with decompensated cirrhosis with at least one contraindication for liver transplantation. Results: A cohort of 585,859 decompensated cirrhosis patients was utilized. DNR orders were present in 14.2% of hospitalized patients. DNR utilization rate among patients with relative contraindication for liver transplantation was 15.0%. After adjusting for co-morbid conditions, disease severity, and inpatient mortality, African-American and Hispanic patient populations had significantly lower DNR utilization rates. There were regional, and hospital-level differences noted. Moreover, advanced age, advanced stage of decompensated cirrhosis, inpatient mortality, and relative contraindications for liver transplantation (metastatic neoplasms, dementia, alcohol misuse, severe cardiopulmonary disease, medical non-adherence) were independently associated with increased DNR utilization rates. Conclusions: The rate of DNR utilization in patients with relative contraindications for liver transplantation was similar to patients without any relative contraindications. Moreover, there were significant demographic and hospital-level predictors of DNR utilization. This information can guide resource allocation in educating patients and their families regarding prognosis and outcome expectations

Hepatic Encephalopathy: A Review

Hepatic encephalopathy (HE) is a reversible syndrome observed in patients with liver disease. The syndrome is characterised by a spectrum of neuropsychiatric abnormalities resulting from the accumulation of neurotoxic substances in the bloodstream and ultimately in the brain. HE is a huge burden to patients, caregivers, and the healthcare system. Common treatments for HE, including rifaximin and lactulose, have been shown to reduce the risk of recurrence, frequency of hospitalisations, hospital costs, and mortality. New research and therapeutics exist, including faecal transplants and small-molecule therapies such as branched-chain amino acids. This review article provides a general overview of the current understanding of HE.</jats:p

Selective recognition of Fe³⁺ and Cr³⁺ in aqueous medium via fluorescence quenching of graphene quantum dots

Graphene quantum dots (GQDs) have been prepared from graphene oxide (GO) and characterized by standard analytical techniques. The size of the prepared GQDs ranges from 2-10 nm. Aqueous dispersion of GQDs exhibited excitation-dependent emission behavior. Emission intensity of the aqueous dispersion found stable for the examined duration of about four months. GQDs exhibited selective recognition of Fe3+ and Cr3+ out of various common ions such as alkali, alkaline-earth and transition metal ions in aqueous medium through fluorescence quenching. The lower limit of detection of Fe3+ is 1 µM and that of Cr3+ is 4 µM.</p