Introduction: The goal of Surviving sepsis campaign is to improve the patients’ outcome who suffers from sepsis that makes it vital to have defined policies and protocols to detect sepsis at the earliest and treat. The global burden of sepsis in relationship to mortality and morbidity ratio is increasing. But there is very minimal data about its occurrence in India. It is been estimated that more than 30 million people are affected by sepsis globally among which 6 million death happens every year. This triggers the need for early detection. There are various predictive tools used to detect sepsis and mortality. SOFA score one among them which is in use since 1994. qSOFA is also a predictive tool which was recommended by the Sepsis-3 consensus to be used as a predictor outside the ICU. Sepsis related mortality is more in India as compared with its western counterparts. The aim of the research is to compare and determine the predicting ability of the tools qSOFA and SOFA when used upon patients with suspected infection at Emergency department and critical care units in the setting of tertiary care teaching hospitals at Navi Mumbai. Methodology: The researcher conducted prospective observational non-experimental quantitative study on 100 patient samples. This study compared two tools to detect the effectiveness in predicting sepsis at the earliest. This study is conducted at Emergency department using qSOFA score and is conducted at critical care unit using SOFA criteria, at selected tertiary care teaching hospitals at Navi Mumbai. These institutions were selected for the study on the basis of ease in availability of the sample, researcher’s accessibility and familiarity with the institutions. The sensitivity and specificity of qSOFA and SOFA were assessed by area under the receiver operating curve (AUROC). The calculated sensitivity of qSOFA was 100%, with AUROC 0.70 (81.47% to 100% CI) and the specificity of qSOFA was 37.50%. The recorded sensitivity of SOFA was 95.45% with AUROC of 0.68 (77.16% to 99.88% CI). Results: In patients with suspected infection the AUROC of qSOFA in predicting sepsis was 0.70 (81.47% to 100% CI) with 100% sensitivity and 37.50% specificity in comparison to the AUROC of SOFA score which was 0.68 (81.47% to 100% CI) with 95.45% sensitivity and 39.29% specificity. The outcome was measured on the basis of patient shifted to ward, shifted to critical care unit and in hospital death. Conclusion: According to the observation made our study concludes that qSOFA has 100% sensitivity to detect sepsis at the earliest when applied on patients with suspected infection at emergency department in comparison to SOFA score when applied on patients with suspected infection at critical care units of tertiary care teaching hospital emergency department and critical care unit at Navi Mumbai. The researcher also found that the hurdle to the early detection is the signs and symptoms that are noticed during the normal course of infection leads to the increase of false positive. In spite of that the researcher found it is recommended to detect sepsis at the earliest with pre planned protocols utilizing effective tools and local healthcare policies as it is a global burden with a complex nature. Further research in this arena is highly recommended to generalize the findings. Keywords: Sepsis; qSOFA; SOFA; Predictive tools.
The complexity of cancer patients and the use of advanced and demolitive surgical techniques frequently need post operatory intensive care hospitalization. In order to increase safety and to select the best medical strategies for each single patient, a multidisciplinary team consisting of anesthesiologists, cancer surgeons, pharmacists, psychologists, statisticians and nurses has performed a new peri operatory assessment, arising from evidence-based literature data. The team focused the attention on supramesocolic peridiaphragmatic cancer surgery, such as esophagectomy, lobectomy and pneumonectomy, hepatic metastasectomy, pancreatectomy, gastrectomy and splenectomy. The clinical data concerning patients hospitalized in 2018 in postoperative ICU of the Cancer Institute Giovanni Paolo II of Bari were retrospectively analyzed. The following case report aim sat demonstrating how a perioperative evaluation is necessary to predict complications related to surgical treatment versus nonmultidisciplinary and unstructured assessments. Our first results will be confirmed by an ongoing retrospective study on a large number of patients and by future prospective studies. Keywords: Perioperative period; Patient assessment; Cancer surgery
Introduction: Sepsis can be caused by various infections, and coexistence of Disseminated Intravascular Coagulation (DIC) exacerbates mortality. Reportedly, anticoagulant therapy could be associated with a survival benefit in patients witshe psis-associated DICT.h e use of Antithrombin (AT) replacement therapy and Recombinant Thrombomodulin (RTM) preparations are typically applied as part of anticoagulant therapy, but which therapeutic modality should be prioritized is unclear. Objectives: Thsist udy aimed to clarify whether anticoagulant therapies affect mortality depending on the source of infection and identify the suitable treatment, AT or RTM, based on the source of infection. Patients and Methods: Thiss ingle-center retrospective cohort study involved 297 patients with sepsis-associated DIC treated by either AT replacement therapy or RTM preparation. Participants ewre categorized tino the following five groups according to the source of infection: pulmonary, intestine-related, biliary tract, urinary tract, and catheter-related bloodstream infection groups. To assess the clinical efficacy of AT or RTM depending on the source of infection, 90-day mortality was examined using a Cox proportional hazard model. Results: AT replacement therapy reduced the mortality in pulmonary infection (Haazrd Ratio (HR), 0.461; 95% Confidence Interval (CI), 0.215–0.992; P=0.048), and RTM preparation did in biliary tract infection (HR, 2.675; 95% CI, 1.037–6.900; P=0.042). Conclusion: The impact of anticoagulant therapies showed different influence depending on the source of infection, and we suggest that it is necessary to properly use of AT replacement therapy and RTM preparations. Keywords: Thrombomodulin; Antithrombin; Polymyxin- B Hemoperfusion; Pulmonary infection; Biliary tract infection.
Antibiotic acts by attacking the pathogenic bacteria on different levels in the human body. These medicines prevent bacterial infection. Overuse or misuse of antibiotics increases the risk of the spread of resistant strains of bacteria. Antibiotic resistance occurs when bacteria change in some way that eliminates the effects of drugs chemicals which are providing to cure or prevent infections. Aim: This study will help nurses to increase the knowledge, attitude, and practice regarding antibiotics. Background: Examining the knowledge, attitude, and practice of the nurses regarding antibiotic resistance and usage can help us in commendable proper educational involvements for nurses. Methods: This study is done on 105 tests of nurses out of 600 nurses by Colvin's strategy and is conducted by exploiting a cross-sectional method that incorporates a distinctive Likert scale rating. Results: Senior staff nurse and generic nurses have a good knowledge regarding antibiotic resistance as compared to diploma nurses. Conclusions: Demoralization is considered to be further investigated for better understanding.
Objective: Granulocyte colony-stimulation factor (G-CSF) is a chemokine that stimulates granulocyte proliferation and maturation and mobilizes bone marrow-derived stem cells into the bloodstream. G-CSF treatment has been shown to enhance tissue repair in various conditions characterized by chronic wounds; however, the mechanisms by which this cytokine promotes chronic wound healing remain unclear. The effect of recombinant G-CSF on wound healing was examined in six patients with intractable chronic cutaneous ulcers. Methods G-CSF was topically applied at 6 µg/cm2 over the ulcers daily for 14 days. The wound conditions were assessed using DESIGN-R, a comprehensive scoring system established by the Japanese Society of Pressure Ulcers that monitors ulcers’ severity and healing states. Results The mean plasma concentration of G-CSF increased from 34.5 ± 14.1 µg/ml on day 0 to 70.8 ± 61.6 µg/ml on day 7; this increase was positively correlated with that of the WBC count. Total cutaneous ulcers graded with DESIGN-R scores significantly improved on day 7 (p < 0.05). Conclusions Topical administration of G-CSF induces amelioration of refractory cutaneous ulcers, probably via flare-up of inflammation without any damaging side effects.
Background: The study aimed to analyze the demographic, comorbidities, biomarkers, pharmacotherapy, and ICU-stay with the mortality outcome of COVID-19 patients admitted in the intensive care unit of a tertiary care hospital in a low-middle income country, Bangladesh. Methods: The retrospective cohort study was done in Holy Family Red Crescent Medical College Hospital from May to September 2020. All 112 patients who were admitted to ICU as COVID-19 cases (confirmed by RT-PCR of the nasopharyngeal swab) were included in the study. Demographic data, laboratory reports of predictive biomarkers, treatment schedule, and duration of ICU-stay of 99 patients were available and obtained from hospital records (non-electronic) and treatment sheets, and compared between the survived and deceased patients. Results: Out of 99 patients admitted in ICU with COVID-19, 72 were male and 27 were female. The mean age was 61.08 years. Most of the ICU patients were in the 60 - 69 years of age group and the highest mortality rates (35.89%) were observed in this age range. Diabetes mellitus and hypertension were the predominant comorbidities in the deceased group of patients. A significant difference was observed in neutrophil count, creatinine and, NLR, d-NLR levels that raised in deceased patients. There was no significant difference as a survival outcome of antiviral drugs remdesivir or favipiravir, while the use of cephalosporin was found much higher in the survived group than the deceased group (46.66% vs 20.51%) in ICU. Conclusions: Susceptibility to developing critical illness due to COVID-19 was found more in comorbid males aged more than 60 years. There were wide variations of the biomarkers in critical COVID-19 patients in a different population, which put the healthcare workers into far more challenge to minimize the mortality in ICU in Bangladesh and around the globe during the peak of the pandemic.
Coronavirus disease 19 (COVID19) has forced the rapid evolution of ICU care including re-evaluation of ICU triage, resource utilization, staffing models and in the most stark manner end of life care. Family members, usually present on rounds and in waiting rooms, are suddenly absent, making family meetings nearly impossible and critical decisions challenging. It would be not only understandable, but also expected if communication broke down during this time. Across countries and hospital systems, the importance of communication and the need for end of life care when required has become paramount. However, translating that to direct patient care can remain nebulous. We present three tangible strategies, implemented during the COVID-19 pandemic to enhance communication in the ICU, that have now become routine in our ICUs. Those strategies include making family updates a daily occurrence and integrated into the workflow of ICU rounds, documenting these conversations in the medical record, and the expansive use of technology and telehealth to further bridge the physical gap that now exists between family members and ICU teams. These strategies are straight forward and pragmatic but if implemented can change care patterns both in a positive and lasting way.
Sepsis is a life-threatening emergency caused by massive immune response to bacterial infection that gets into the blood, which often leads to organ failure or injury, and quick treatment can rely on people at home noticing something is wrong and acting on their instincts to get help. In a different context sepsis is linked to coronavirus (COVID-19) because sepsis is one of the ways that COVID-19 can cause serious illness and death.
Background: Septic shock is a medical emergency causing significant morbidity and mortality. Multiple factors affect the outcome of septic shock in a particular clinical setting. Identifying factors associated with poor treatment outcomes is crucial for the improvement of medical care in patients with septic shock. Objectives: The aim of this study was to determine the outcome of septic shock treatment and to determine factors associated with poor outcome. Methods: A hospital based medical record review of patients admitted to the University of Gondar Hospital with the diagnosis of septic shock from January 2014 to October 2016 was conducted. Socio-demographic, clinical history and laboratory data were collected. Data entry and analysis was done using SPSS version 20. Results: Ninety eight cases of septic shock fulfilled the criteria for analysis. The most common source of infection was the gastrointestinal tract. The in Hospital mortality rate of septic shock is 42 %. Longer duration of illness, presence of co morbidity and corticosteroid use negatively affected the outcome of septic shock. The types of vasopressor used had no effect on the outcome of septic shock. Conclusion and recommendations: Septic shock has high mortality in Gondar, Ethiopia, where nearly half of the patients had died. Strategies shall be paved to let patients with possible septic shock visit health facilities early and patients with co-morbidities need a more vigilant care. Management strategies with prompt goal directed therapy is essential for a better outcome. It is highly recommended to have a hospital protocol for septic shock management. There is an urgent need for in depth analysis of the management approach and identifying the gaps and improving the patient care.
Coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family Coronaviridae. The human coronavirus infections are mild, the epidemics of the two β-coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have caused more than ten thousand cumulative cases in the past two decades. There is a new public health crises threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV). The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province in China during the month of December 2019.
A 43-year-old male with a history of hypertension, obesity, and alcoholism presented with respiratory failure secondary to COVID-19 and was subsequently intubated. The patient was placed on therapeutic enoxaparin to treat the prothrombotic state caused by SARS-CoV-2. After the patient was weaned from the ventilator a neurological examination had revealed an acute ischemic stroke despite being on therapeutic anti-coagulation. Prior to discharge, a right upper extremity ultrasound also revealed a cephalic vein thrombus. This was consistent with both arterial and venous thrombotic complications.
Background: Preventing healthcare-associated infections, such as Catheter- Associated Urinary Tract Infection (CAUTI), is a high priority for health care institutions. Each day the indwelling urinary catheter remains, a patient has a 3%-7% increased risk of acquiring CAUTI. This study primarily aims to focus on determining the effect of simulation-based learning to the reduction of CAUTI's. Method: This quasi-experimental study was conducted for eighty-six (86) staff nurses working in two critical care units at King Saud Medical City in Saudi Arabia within Riyadh region. The two areas have critically ill patients who have different medical and surgical health- related problems. Results: The results showed that there was no significant difference in reducing CAUTI rates and Device Utilization Ratios (DUR’s) (P=0.67, P=0.60). However, simulation training shows superiority in improving staff nurses’ knowledge compared to the traditional method of teaching (P=0.005). Results also showed a strong correlation with increased participants’ level of satisfaction and selfconfidence (R=0.889, 0.962 respectively) as well as the improvement on staff nurses’ performance related to CAUTI prevention. Conclusion: Simulation training is not associated with reducing CAUTI rates and DUR. Nevertheless, simulation training proved to be an effective teaching methodology in improving staff nurses’ knowledge, satisfaction, confidence, and level of performance related to CAUTI prevention.
Background: This article discusses the challenges and controversies in the management of the unique respiratory failure caused by COVID-19 pneumonia. Many uncertainties prevail in the treatment of this disease. There remains no clear consensus on the timing of intubation and trial of noninvasive therapies prior to intubation. We will discuss here the surrogate markers of deteriorating respiratory function and pulmonary infiltrates that could be utilized to prevent delayed intubation. We also discuss the proposal by Gattinoni et al. in employing a rather high tidal volume and low PEEP technique. Main study: We review the importance of consideration of work of breathing, P-SILI and ultrasound lung in decision-making process. We discuss the ill effects of high tidal volumes in inducing lung strain with larger dynamic deformations and the benefit of high PEEP in homogenizing the strain distribution. The article proposes that the ground glass opacities seen in COVID-19 pneumonia could pose as ‘stress raisers’? If so, there may be importance to high PEEP in the L phenotype despite lower recruitability. The article also questions the appropriate tidal volume to be applied to this ‘larger baby lung’ in L phenotype. Conclusion: Measures to avoid delays in recognition of need for intubation and escalation of care are key to avoid further damage from P-SILI. Clinical assessment of work of breathing and intubating at the earliest signs of respiratory distress may prevent P-SILI. While optimum ventilation strategy for ‘L’ phenotype remains a matter of ongoing discussion, risks of inducing lung injury with the approach employing the high tidal volume and low PEEP technique need to considered. The COVID-19 respiratory failure poses more questions and challenges our traditional protocols of ARDS management. Perhaps, forgoing protocols and a more individualized and prescribed mechanical ventilation setting may not only show more respect and appreciation for its varied presentations but may also translate into better patient outcomes.
Stroke can occur at any age, but with advancing age, risk for acute ischemic stroke increases by many fold. Mortality in acute stroke has reduced in last few years. The reason for the success are multi-factorial which includes preventive approach and improved care within the first few hours of acute stroke through thrombolysis with IV rtPA. However, thrombolysis for ischemic stroke in elderly beyond 80 years has been a debatable issue. We recently thrombolysed a 91 years old female with history of stroke in window period. Post thrombolysis, she regained full motor power without complications. In conclusion, very elderly age with Diabetes Mellitus and/or history of stroke should not be a contraindication for IV alteplase treatment in patients with acute ischemic stroke. We should weigh the risks and benefits of IV alteplase to treat acute ischemic stroke in such patients.
