Objective To prospectively survey the well-known experts of critical care and endocrine secretion to summarize their experience in treating diabetes mellitus complicated by sepsis for the purpose of providing guidance of theory and practice in making treatment schemes of traditional Chinese medicine for such disease.Methods The questionnaires were designed and submitted to the experts.The statistic analysis was undertook to investigate the rules.Results A total of 30 questionnaires were released and 28 were retrieved.The experts generally believed that eight-principle syndrome differentiation was the most useful method in the syndrome differentiation and treatment of this disease.The heat,stasis and toxin were usually acted as the main pathogenic factors while damp and phlegm commonly act as secondary pathogenic factors.They thought that weak body resistance under the invading of evil was the key mechanisms in the deterioration of the disease and they chose clearing heat,activating blood and detoxication as 3 core treatment principles.Conclusions The summarized opinions from the experts should be act as important reference in treating this disease,but its effectiveness and possibility for further generalization need to be validated in the clinical practice.

We evaluated the diagnostic accuracy of PCT to distinguish between gram-negative (GN) and gram-positive (GP) bloodstream infections nosocomial pneumonia (NP) patients and compared PCT levels with the pneumonia severity index (PSI) for predicting mortality.Data were collected retrospectively for blood culture-positive NP patients between January 2014 and August 2016. PCT levels were compared between patients with GN versus GP infections. Outcome variables included 28- and 60-day mortality.PCT level was higher in GN infections than in GP infections. PCT could differentiate between GN and GP infections with an AUC value of 0.706. At a PCT cutoff of 5.4 ng/mL, the specificity for GN infections were 80.3%. The AUCs for 28- and 60-day mortality were 0.758 and 0.759 for PSI, and 0.620 and 0.634 for PCT. Serum PCT level was less predictive of mortality in GN NP patients compared with that for GP NP patients. There was a significantly positive correlation between PCT and PSI, and the correlation in GP NP patients was better than that in GN NP patients.PCT could differentiate between GN and GP bloodstream infections in patients with NP. However, PCT levels were less predictive of mortality compared with the PSI.

The use of drugs in suicide attempts is becoming more and more frequent among adolescents. Intentional intoxication with propafenone is very rare and mainly reported in adults associated with other drugs. The therapeutic approach is symptomatic, since there is no specific antidote for propafenone. We present a pediatric case of intentional ingestion of 1.8 g of propafenone that caused refractory cardiogenic shock. The patient was successfully rescued with extracorporeal cardiopulmonary resuscitation in the emergency department of a secondary level peripheral hospital.

In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score.This retrospective cohort study was conducted between 2016 and 2021.Two university hospitals in Brazil.Patients with sepsis.Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities.In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis.A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes >12,000 or <4,000 cells/mm3 (OR = 1.61), encephalic vascular accident (OR = 1.88), age >60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis >7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction.Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.En este estudio, nuestro objetivo fue evaluar los factores de riesgo de muerte de los pacientes incluidos en el protocolo de sepsis, utilizando datos clínicos de qSOFA, SIRS y comorbilidades, así como el desarrollo de un puntaje de riesgo de mortalidad.Este estudio de cohorte retrospectivo se llevó a cabo entre 2016 y 2021.Dos hospitales universitarios en Brasil.Pacientes con sepsis.Se recopilaron varios datos clínicos y de laboratorio centrados en SIRS, qSOFA y comorbilidades.La mortalidad intrahospitalaria fue la variable de resultado primaria. Se desarrolló un puntaje de riesgo de mortalidad después del análisis de regresión logística.Se incluyeron un total de 1,808 pacientes con una tasa de mortalidad del 36%. Diez variables permanecieron como factores independientes relacionados con la muerte en el análisis multivariado: temperatura ≥38 °C (odds ratio [OR] = 0.65), sepsis previa (OR = 1.42), qSOFA≥2 (OR = 1.43), leucocitos >12,000 o <4,000 células/mm3 (OR = 1.61), accidente cerebrovascular encefálico (OR = 1.88), edad >60 años (OR = 1.93), cáncer (OR = 2.2), duración de la estancia hospitalaria antes de la sepsis >7 días (OR = 2.22), diálisis (OR = 2.51) y cirrosis (OR = 3.97). Considerando la ecuación del análisis de regresión logística binaria, el puntaje presentó un área bajo la curva de 0.668, un modelo débil para la predicción de la muerte.Varios factores de riesgo se asocian de forma independiente con la mortalidad, lo que permite el desarrollo de una puntuación de predicción basada en datos de qSOFA, SIRS y comorbilidades; sin embargo, el rendimiento de esta puntuación es bajo.