ABSTRACT
Purpose:@#Sepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.@*Methods:@#The study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38℃ or lower than 36℃, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores.@*Results:@#Among the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788-0.963) as compared with 0.75 (0.634-0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%.@*Conclusion:@#SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.
ABSTRACT
The mouth is the portal of entry of food this provides access to a wide array of microbes, the majority of which become part of the transient oral flora. Microbiological studies on samples taken from gingival pockets surrounds overdenture abutment teeth revealed different types of bacteria. The design of the overdenture prosthesis and supporting abutments affect the nature and quantity of bacterial found and that will be revealed in this study. This study was conducted to compare the microbiological changes occurring in gingival and periodontal tissue and gingival crevicular fluid as indicators of the condition of periodontium around abutments with different designs of abutment teeth of tooth supported mandibular overdenture. Subgingival bacteriological samples were taken from abutment's gingival crevice at the time of denture insertion and after three months to evaluate the effect of abutments design on the bacterial types as well as counts. The collected samples were cultured, identified and counted. A total of 20 male patients were divided into two equal groups according to abutment's length [Group I and II]. The patients' abutments were subdivided into two equal groups according to abutment's covering [A and B]. This study revealed an increase in anaerobic bacteria in both groups, with significant increase in Group I-A [patients rehabilitated with long abutments with copings] while all other groups have shown to significant difference before and after denture insertion. Insertion of overdenture accompanied with increase of anaerobic bacteria