Abstract Background Immunocompromised individuals who develop severe respiratory failure have elevated death rates. Therefore, as the number of persons hospitalized to critical care units (ICUs) rises, it is essential to comprehend the impacts of Extracorporeal Membrane Oxygenation (ECMO) in this susceptible group. Objective To compare survival and clinical outcomes between immunocompromised and immunocompetent patients receiving ECMO and to identify subgroups of immunocompromised patients who may benefit most from ECMO support. Methods A thorough query was performed in the PubMed, Cochrane Library, Web of Science, and Scopus databases until September 2025. Studies were eligible if they directly compared ECMO outcomes between immunocompromised and immunocompetent patient groups. Data quality was assessed using the ROBINS-I tool, and pooled analyses were performed using Review Manager and STATA 18. Dichotomous outcomes were pooled using odds ratios (ORs), while continuous outcomes were summarized using mean differences (MDs) with their corresponding 95% confidence intervals (CIs). Interstudy heterogeneity was quantified using the I2 statistic. When substantial heterogeneity was detected, sensitivity analyses were conducted to investigate potential sources of variability. Results Seven retrospective studies with an overall population of 4,557 patients satisfied our eligibility criteria. Immunocompromised individuals had considerably worse results relative to immunocompetent patients. Overall survival (OR: 0.58 [95% CI: 0.46 to 0.72]; p < 0.00001) and survival to hospital discharge (OR: 0.40 [95% CI: 0.26 to 0.64]; p < 0.0001) were both lower. Additionally, a lower proportion of immunocompromised individuals were successfully withdrawn from ECMO (OR: 0.51 [95% CI: 0.39 to 0.67]; p < 0.00001). No substantial variations were seen in ECMO duration or hospital length of stay. Subgroup analysis revealed particularly poor outcomes among patients with hematological malignancies, with only 4% survival and a 16% ECMO weaning rate. Conclusions Although immunocompromised patients generally experience poorer outcomes with ECMO, a subset, specifically those with autoimmune diseases, HIV, a history of solid organ transplants, and solid tumors, still achieve meaningful recovery. Therefore, immunocompromised status alone should not automatically exclude patients from ECMO consideration.
In low-flow anesthesia, automated monitoring of end-tidal oxygen (etO2) and end-tidal anesthetic agents (etAA) has been favored to reduce clinicians’ cognitive workload during anesthesia maintenance. This systematic review, therefore, aimed to determine the comparative efficacy and safety of automated end-tidal controlled anesthesia (etCA) versus manually controlled anesthesia (MCA). An electronic search was conducted across four databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus. The retrieved references were then analyzed against the studies’ screening and eligibility criteria before the full articles were included in the study. The Review Manager (RevMan 5.4.1) was then used to conduct the statistical analysis of the reported outcomes. The electronic search retrieved 965 articles, among which 10 were included in this review. The studies included a pooled sample size of 1269 who underwent surgical procedures under low-flow anesthesia. The analyzed evidence suggests with low certainty that the type of anesthesia control may not have any significant effect on both the anesthesia duration (SMD − 0.00 min; 95
Type 2 diabetes mellitus (T2DM) is commonly associated with obesity, yet marked heterogeneity exists: some individuals develop T2DM at relatively low body mass index, whereas others remain free of diabetes despite substantial adiposity. We propose that this variability is better explained by differences in individual adipose storage capacity than by body weight alone. In this hypothesis, adipose storage capacity refers to the ability of adipose tissue, particularly subcutaneous depots, to expand safely through coordinated adipogenesis, vascular adaptation, extracellular matrix remodeling, and endocrine function. When safe subcutaneous expandability becomes limited, excess energy may be partitioned toward metabolically unfavorable sites, including visceral adipose tissue and ectopic depots such as the liver, pancreas, and skeletal muscle. This process may promote hepatic insulin resistance, chronic hyperinsulinemia, and ultimately beta-cell decompensation. The model builds on the adipose tissue expandability concept but extends it by framing T2DM as a staged disorder of progressive loss of individually limited adipose buffering capacity over time. Extreme phenotypes such as lipodystrophy support the central importance of safe fat storage rather than fat mass alone. The hypothesis does not aim to explain all forms of diabetes and may be less applicable to entities such as post-transplant diabetes driven primarily by immunosuppressive toxicity, although partial convergence may occur over time. We suggest several falsifiable predictions, including that impaired subcutaneous adipose expandability should precede ectopic fat accumulation and better predict glycemic deterioration than body mass index alone.
Abstract Targeted axillary dissection (TAD) is an innovative approach for axillary staging in breast cancer patients with initially node-positive disease that converts to clinically node-negative status after neoadjuvant therapy. Optimal marking and localization techniques remain undetermined. This systematic review and meta-analysis searched PubMed, Scopus, Cochrane Library, and Web of Science through April 2025, including 59 observational studies on TAD (marked/clipped node removal plus sentinel lymph node biopsy) in such patients. Primary outcomes were identification rate, false-negative rate (FNR), concordance, and diagnostic accuracy. Using R software with random-effects models and logit transformation, TAD achieved a pooled identification rate of 95.1% (95% CI: 93.2%–96.5%). Pooled FNR was 6.37% (95% CI: 5.02%–8.04%; I² = 0.0%), with overall diagnostic accuracy of 94.68% (95% CI: 91.70%–96.63%). Targeted and sentinel nodes concorded in 73.34% (95% CI: 69.58%–76.79%). Subgroup analyses showed comparable performance across marking (clip, carbon, magnetic, radioactive seeds) and localization techniques (wire-guided, radioactive, magnetic, ultrasound-guided), with no significant differences. TAD offers high identification rates, low FNRs, reliable staging, and acceptable accuracy, with consistent results enabling implementation using locally available technologies.
BACKGROUND:High-alert medications (HAMs) cause a lot of safety issues in paediatric healthcare settings, and medication errors have three times the potential to harm this group than in adults. AIM:This quality improvement study was conducted to assess nurses' knowledge of HAMs, the barriers to safe HAM administration and the impact of targeted education. STUDY DESIGN:This quality improvement project assessed the knowledge of HAM administration before and after structured training among paediatric nurses in critical care units. Barriers to safe medication administration were identified through questionnaire responses, including both knowledge-related and organisational obstacles. Knowledge gain was measured using paired t-tests and Wilcoxon signed-rank tests. An exploratory regression analysis was conducted to investigate the associations with knowledge improvement. RESULTS:This study included 335 nurses. The improvement in knowledge regarding administration increased significantly after training, from an average score of 4.87 to 9.41. Main obstacles to safe medication administration identified include lack of knowledge (39.4%), unavailability of reference texts (34.6%) and ambiguous dose calculations (32.0%). Those under 25 years old, as well as those having less than 2 years of experience, recorded the absolute highest gains. Self-rated competency improved minimally, although those indicating low confidence dropped to below 10%. A great demand for additional education in HAMs was noticed, where 82% were asking for more training. CONCLUSIONS:Structured training significantly improved theoretical HAM knowledge and identified critical system barriers (lack of references and ambiguous protocols). Continuous education represents an essential foundation for subsequent medication safety quality improvement initiatives. RELEVANCE TO CLINICAL PRACTICE:For paediatric critical care nurses, these findings establish a knowledge foundation and identify system barriers essential for improving paediatric HAM safety.
