Abstract Background There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions. Methods This was a secondary analysis of the MOSAICS II study, an international prospective observational study on sepsis epidemiology in Asian ICUs. Associations between qSOFA at ICU admission and mortality were separately assessed in LLMIC, UMIC and HIC countries/regions. Modified Poisson regression was used to determine the adjusted relative risk (RR) of qSOFA score on mortality at 28 days with adjustments for confounders identified in the MOSAICS II study. Results Among the MOSAICS II study cohort of 4980 patients, 4826 patients from 343 ICUs and 22 countries were included in this secondary analysis. Higher qSOFA was associated with increasing 28-day mortality, but this was only observed in LLMIC ( p < 0.001) and UMIC ( p < 0.001) and not HIC ( p = 0.220) countries/regions. Similarly, higher 90-day mortality was associated with increased qSOFA in LLMIC ( p < 0.001) and UMIC ( p < 0.001) only. In contrast, higher 3-day mortality with increasing qSOFA score was observed across all income countries/regions ( p < 0.001). Multivariate analysis showed that qSOFA remained associated with 28-day mortality (adjusted RR 1.09 (1.00–1.18), p = 0.038) even after adjustments for covariates including APACHE II, SOFA, income country/region and administration of antibiotics within 3 h. Conclusions qSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis. In LLMIC and UMIC countries/regions, qSOFA was associated with early to late mortality but only early mortality in HIC countries/regions. Graphical Abstract
Aims and Objectives:To compare epidural ropivacaine 0.75% alone and Ropivacaine 0.75% with alpha 2 agonists. Variables like block characteristics, hemodynamics, sensory and motor recovery, side effects are analysed. Materials: With Institutional ethical committee clearance, clinical Study conducted at R.L.J.H, Kolar. After obtaining informed written consent,90 patients of(American Society of Anaesthesiologists) ASA Grade I and II in age group 18 to 55 years, of either sex, posted for elective lower abdominal and lower-limb surgeries were selected. Methods:Patients were randomly allocated into 3 groups of 30 each.Epidural block was administered.Patients in group“R” received 19ml 0.75% ropivacaine with 1ml of normal saline. Group “RC” patients received 19ml 0.75% ropivacaine with 75microgram(mcg) clonidine while patients in group “RD” received 19ml0.75% ropivacaine with 75 mcg dexmedetomidine. Block characteristics like onset of analgesia, maximum level of sensory blockade, complete motor blockade, hemodynamics, time to two segment regression, time for rescue analgesia, time to complete motor recovery, side effects were analysed. Results: Results showed that onset of blockade is faster when additives are added like clonidine and dexmedetomidine. Time for two segment regression was 30-35minutes earlier in Group “RC”.(R
Diffuse alveolar hemorrhage (DAH) is a potentially life-threatening disease that can be caused due to several underlying disorders. The diagnosis and management of DAH remains challenging given its nonspecific presentation and lack of uniform criteria for the diagnosis. The management of DAH involves treating the causative underlying condition. On extensive review of the literature, only fewer than 10 cases of DAH associated with immune thrombocytopenic purpura (ITP) were found. The outcomes in DAH associated with ITP were also found to be variable in the reported cases, ranging from clinical recovery to mortality. We present a 45-year-old man with ITP who developed DAH, and a review of the available literature.
Chronic pulmonary aspergillosis can present in four distinct clinical syndromes, one of which is chronic cavitary pulmonary aspergillosis (CCPA). CCPA is generally associated with a mildly immunosuppressed state or, in immunocompetent patients, with structural lung damage. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with reactivation of previous quiescent infections such as tuberculosis and invasive fungal infections, but CCPA in a patient with COVID-19 is rarely reported. Here we present the case of a 57-year-old man with CCPA associated with COVID-19 infection in whom latent aspergilloma was most likely activated after SARS-CoV-2 infection. The patient presented with severe COVID and, after initial response to treatment, started to deteriorate due to reactivation of latent aspergilloma to a more aggressive CCPA form. After confirmation of the diagnosis, the patient was initiated on treatment with voriconazole. He showed a good response to treatment with clinicoradiological response. This case also depicts one of the common causes of clinical deterioration in otherwise recovering COVID-19 patients.
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