A-study-on-improved-patient-outcomes-in-septic-shock-with-use-of-hydrocortisone

Management of sepsis is a time critical procedure; the consequences of improperly managed sepsis and septic shock can cause multiple organ dysfunction and death. The aim of this study was to evaluate of the role of hydrocortisone. Ÿ Sepsis is dened as life-threatening condition causing multi-organ dysfunction by a dysregulated host response to infection. Septic shock is a subset of sepsis with circulatory and cellular or metabolic dysfunction associated with a higher risk of mortality . Ÿ Sepsis is said to effect the hypothalamic pituitary adrenal axis, causing a relative adrenal insufficiency resulting in cardiovascular instability, metabolic disorders, and a sustained pro- inammatory state. Ÿ The role of pro-inammatory pathways suggests a potential use for corticosteroids as an adjuvant therapy in the treatment of sepsis and septic shock . The Surviving Sepsis campaign guidelines recommend that if adequate uid resuscitation and vasopressors have not restored the hemodynamic stability, it was postulated in limited data to use inj hydrocortisone 100mg i/v 8 hourly for 7 days . Ÿ There was an improvement in the overall survival and reduction in the mortality and morbidity of patients, as observed by early weaning off from vasopressor support, reduction in total leucocyte counts and

Characteristics & outcomes of cancer patients with COVID-19: A multicentre retrospective study from India

Background & objectives: High mortality has been observed in the cancer population affected with COVID-19 during this pandemic. We undertook this study to determine the characteristics and outcomes of cancer patients with COVID-19 and assessed the factors predicting outcome. Methods: Patients of all age groups with a proven history of malignancy and a recent diagnosis of SARS-CoV-2 infection based on nasal/nasopharyngeal reverse transcriptase (RT)-PCR tests were included. Demographic, clinical and laboratory variables were compared between survivors and non-survivors groups, with respect to observed mortality. Results: Between May 11 and August 10, 2020, 134 patients were included from the three centres and observed mortality was 17.1 per cent. The median age was 53 yr (interquartile range 39-61 yr) and thirty four patients (25%) were asymptomatic. Solid tumours accounted for 69.1 per cent and breast cancer was the most common tumour type (20%). One hundred and five patients (70.5%) had received chemotherapy within the past four weeks and 25 patients (19.3%) had neutropenia at presentation. On multivariate analysis, age [odds ratio (OR) 7.99 (95% confidence interval [CI] 1.18-54.00); P=0.033], haemoglobin [OR 6.28 (95% CI 1.07-37.04); P=0.042] neutrophil–lymphocyte ratio [OR 12.02 (95% CI 2.08-69.51); P=0.005] and baseline serum albumin [OR 18.52 (95% CI 2.80-122.27); P=0.002], were associated with higher mortality. Recent chemotherapy, haematological tumours type and baseline neutropenia did not affect the outcome. Interpretation & conclusions: Higher mortality in moderate and severe infections was associated with baseline organ dysfunction and elderly age. Significant proportion of patients were asymptomatic and might remain undetected

Idiopathic Horner’s Syndrome: An Enigma.

Horner’s syndrome (Bernard-Horner’s syndrome or oculosympathetic palsy) is a clinical syndrome caused by paralysis of the cervical sympathetic trunk. It is characterized by miosis, ptosis, enophthalmos and anhidrosis. Most of the cases are due to vascular causes, trauma or cancer. Occasionally, Horner’s syndrome is encountered in a patient where no cause can be ascertained. Here, we describe one such case.