Predictive Value of Frailty Index in Comparison to Traditional Markers of Sepsis in Predicting Mortality among Elderly Admitted in Tertiary Care Hospital

Introduction: The frailty index’s potential as a prognostic marker of sepsis is so far been untapped. Here we studied the predictive value of frailty index in the elderly with sepsis. Methods: This prospective cohort study was conducted in a tertiary level hospital in North India. The duration of the study was 18 months starting from January 2020 to July 2021. The frailty index was calculated along with traditional markers of sepsis such as sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), and systemic inflammatory response syndrome (SIRS) within 24 hours of admission in elderly patients suspected to have sepsis. The area under the receiver operating characteristic (AUROC) of frailty index, SOFA, qSOFA, and SIRS was compared for in-hospital and 3-month mortality. Results: There was no significant difference between the performance of the frailty index and SOFA (DeLong’s test p = 0.242) in predicting in-hospital mortality, but there was a statistical difference between the AUROC of SOFA score (AUC = 0.548) and frailty in predicting 3-month mortality (DeLong’s test p ?0.001). Conclusion: The frailty index had greater sensitivity and negative predictive value among the other scores in predicting in-hospital mortality, whereas SOFA had higher specificity in predicting in-hospital mortality. The frailty index was superior to SOFA and the other prognostic markers of sepsis in predicting 3-month mortality.

Early Initiation of Low-Dose Hydrocortisone Therapy for Septic Shock in Geriatric Patients: A Randomized Control Trial

Background: The management of septic shock has undergone significant modifications in the past decade. Various studies have concluded that while corticosteroids reduce the duration of shock, they do not have any proven mortality benefit. Moreover, the time of initiation of corticosteroids has been debatable. Since, little literature is available on geriatric patients, we have designed a randomized trial to assess the importance of early initiation of low dose hydrocortisone comparing with the standard therapy. Objectives: To determine the efficacy of early initiation of low dose hydrocortisone in reducing mortality in septic shock in geriatric patients. Methods: We conducted a single blinded, randomized controlled trial at a tertiary care hospital in India. Geriatric patients (age>60 years) fulfilling the criteria for septic shock were included in the study. All the participants were randomly assigned to two arms- intervention and standard therapy group. The outcomes were studied in terms of 28-day mortality, duration of ICU stay, duration of vasopressor requirement and need for mechanical ventilation Results: Total 120 patients were randomized to either Intervention arm (N=61) or the Standard therapy arm (N=59). The number of patients with reversal of shock was higher in the intervention arm (53.4%) but no statistically significant association (p= 0.575) was found. There was no significant difference between the two groups in terms of 28- day mortality, length of ICU stay, need for mechanical ventilation and duration of vasopressor support. Conclusion: This single centre trial demonstrated that there was no survival benefit associated with the early initiation of low dose hydrocortisone treatment in patients with vasopressor-dependent septic shock. It raised the concern that whether steroids are safe in elderly patients with septic shock.

Factors affecting outcomes in compound depressed frontal bone fractures: Institutional study

xIntroduction: Compound depressed frontal bone fractures exhibits some peculiarities such as frequent involvement of frontal sinus and olfactory nerve and tract, which lie on the floor of the anterior cranial fossa. The primary aim of our study is analyzing factors influencing the outcomes in compound depressed fractures of frontal bone .This will help in improving outcomes and management of compound depressed frontal bone fracture. Material and methods: Study was conducted at tertiary care institute by collecting data of 40 patients operated surgically from August 2018 to July 2019. The study included patients who were diagnosed with compound depressed frontal bone fracture and underwent surgical management at our institute. Follow-up was performed at least 3 months after the trauma. The variables evaluated were mortality, GOS, occurrence of rhinorrhea, meningitis, late post-traumatic epilepsy and smell disturbances. Results: Most of our patient with GCS 13-15 was discharged with good clinical outcome and no complication on follow-up. Patient with low GCS and delayed presentation are at risk and adds up morbidity and mortality. Conclusion: Early surgical intervention in patients with GCS 13-15 is associated with good outcomes and low complication rate associated with meningitis or CSF leak.

Evaluation of Androgen Receptor in Breast Carcinoma and its Correlations with Er, Pr, Her2/Neu, Triple Negative Receptor Status and Clinical Parameters

Background: Breast cancer is the second most common malignancy in Indian women. Among the members of the steroid receptor superfamily the role of estrogen and progesterone receptors (ER and PR) is well established in breast cancer in predicting the prognosis and management of therapy, however, little is known about the clinical significance of androgen receptor (AR) in breast carcinogenesis. The present study was aimed to evaluate the expression of AR in breast cancer and to elucidate its clinical significance by correlating it with other hormonal receptors and clinical parameters. Methods: It was a prospective study which include 30 patients of histopathologically proven breast cancer  admitted to department of surgery at  S.N Medical College Agra .Expression of AR, ER, PR, HER2/ neu receptor  by immunohistochemistry (IHC) and clinical parameters were studied. Results: AR expression is related to ER(P<0.015), PR(p<0.008) and triple negative breast cancer patients (p <0.008). There is significant correlation between AR and menopausal status(p<0.006) while  no significant correlation was found with age and parity. Conclusions: Since there is significant association of AR  in triple negative and post-menopausal women so we can say that AR expression possibly help in confirming their predictive role for therapeutic response in breast cancer patients

Renal hematoma: An unusual cause of acute abdomen and fetal demise in severe Pre-Eclampsia.

Retroperitoneal hematoma occurs rarely in an obstetric patient. Renal hematoma may present with signs and symptoms, which may mimic the clinical presentation of abruptio placentae or rupture uterus. Although renal hematoma is sometimes a surgical emergency due to hypovolemic shock, conservative management by angiographic embolization may be done. Timely diagnosis and management is required to decrease the maternal mortality and morbidity. We hereby report a case of spontaneous renal hematoma in a patient with severe pre-eclampsia who presented with acute abdomen and intrauterine fetal death.