Serum lactate is a useful predictor of death in severe sepsis and septic shock

The severe sepsis and septic shock are as common and lethal that emergency physicians routinely confront. Actually, more than two thirds of sepsis patients present initially to the ED. Only a few laboratory tests for markers of sepsis are currently available. The serum lactate level can help in determining prognosis and to risk-stratify patients with severe sepsis. This independent review of the literature includes 83 studies published in all electronic-based database such as Elsevier, PubMed, and SID during the last 18 years [40–320 patients in each]. Data gathered from English language articles and books published between 1995 and 2013. The serum lactate concentrations measured in almost all patients with severe sepsis raised at admission and were higher in patients who had the worst outcomes such as higher Apache-II and SOFA score. Serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients with severe sepsis admitted to the emergency department and intensive care unit. This review focuses on the association between initial and serial serum lactate level and mortality in patients presenting to the emergency department with severe sepsis

Vaginal versus sublingual misoprostol for labor induction at term and post term: a randomized prospective study

We want to compare the efficacy and safety of vaginal versus sublingual misoprostol for cervical ripening and induction of labor. This randomized clinical trial was performed on 140 women with medical or obstetric indications for labor induction. The patients were randomly divided into two groups: vaginal and sublingual administration of misoprostol. In first group, 25 Micro g misoprostol was placed in the posterior fornix of the vagina and second group received 25 Micro g misoprostol sublingually, every 6 hours for 24 h. Maternal and neonatal outcomes were analyzed. There was no significant difference in the demographic characteristics between two groups. The main indication for cesarean section in both groups was fetal distress, followed by absence of active labor progress. Evaluation of cesarean indication was not significantly different in two groups; including fetal distress, absence of active labor, uterine over activity and failure to progress. The maternal complication in sublingual group included residual placenta [2%], tachysystole [2%], vomiting [12%], atoni [3.3%] and abdominal pain [5.5%], although there was no significant difference between two groups. Sublingual misoprostol is as effective as vaginal misoprostol for induction of labor at term. However, sublingual misoprostol has the advantage of easy administration and may be more suitable than vaginal misoprostol

Concurrent chemoradiotherapy without brachytherapy in locally advanced cervical cancer

Concurrent chemoradiotherapy [EBRT + cisplatin] plus intracavitary brachytherapy is the standard of care in patients with advanced cervical cancer. However, a number of patients could not undergone brachytherapy due to massive residual tumor or anatomical distortion. In this study, we have evaluated the treatment outcome in patients with locally advanced cervical cancer, undergone conventional EBRT plus cisplatin based chemotherapy. In this study, we have selected patients with locally advanced cervical carcinoma [stage: IIB to IIIB] undergone external beam radiotherapy and chemotherapy without brachytherapy at our institute between October of 2007 and October of 2009. The patients have received 50 Gy within 5 weeks to whole pelvic that has followed by a localized boost dose on tumor to 70 Gy concurrently with cisplatin 35 mg/m2 weekly. The treatment has related toxicities, and survival [overall and disease free] have evaluated. 30 cases with a median age of 55 [range; 40 to 73] have been studied. According to FIGO classification, the clinical stages were as follows: stage: IIB 23, IIIA 4, and IIIB 3 cases. Three months after treatment, 19 patients [63.3%] have achieved complete response. With a median follow up time of 18 months [range; 10-33 months], 8/23 cases [34.7%] with stage IIB and 2/7 [28.5%] among stage IIIA-IIIB remained disease free at the end of follow up. Data have shown a 2- year overall survival rate of 58.7% +/- 9% and 2- year disease free survival of 37.7% +/- 9% . Most toxicities were grade I and II. 2 [6.6%] grade III diarrhea and 4 [13.3%] grade III neutropenia have recorded. Although a considerable number of patients have achieved complete response using concurrent chemoradiotherapy without brachytherapy, the overall treatment outcomes especially for stage IIIA-IIIB were unsatisfactory. Using modern radiation therapy techniques with increased delivered boost dose could improve treatment results

[Correlation between the result of leishmanin skin test and clinical forms of cutaneous leishmaniasis and species of parasite]

Cutaneous Leishmaniasis [CL] is a common parasitic skin disease which is endemic in many parts of Iran, including Khorasan. Leishmanin Skin Test [LST] is used for clinical diagnosis of previous infection. The aim of this study was to determine the correlation between the result of LST with the clinical form of CL lesion and species of causative agent in patients referred to the Parasitology laboratory, Imam Reza hospital during 2007-2008. This study was undertaken over a 12 month period. Following confirmation of diagnosis of CL in 50 patients who obtained positive result by direct smear test, their demographic, clinical and laboratory information were recorded. LST was performed for each patient. PCR [polymerase chain reaction] was used to determine the species of parasite. The result of LST read after 24, 48 and 72 hours. The collected data were statistically analyzed using SPSS. Among 30 persons with Anthroponotic Cutaneous Leishmaniasis [ACL], 60% had dry and 33% had infected moist lesions. Among 20 persons with Zoonotic Cutaneous Leishmaniasis [ZCL], dry and infected moist ulcers were observed in 30% and 65% respectively. The result of Positive LST was increased 48 and 72 hrs. After injection. There was a significant relationship between the clinical form of CL lesion and causative agent as the result of the LST; but no significant relationship was observed between causative agent and clinical form

Correlation between upper airways obstructive indexes in adenotonsilar hypertrophy with mean pulmonary arterial pressure

Hypertrophied tonsils and adenoids may cause upper airway obstruction and cardio-pulmonary complications due to pulmonary arterial hypertension. The aim of this study was to determine the correlation between mean pulmonary arterial pressure [mPAP] and selected adenotonsilar hypertrophy indexes. Thirty two patients with upper-airway obstruction resulting from hypertrophied tonsils and adenoids were included in our study. Mean pulmonary arterial pressure was measured by a non-invasive method using color doppler echocardiography. Upper airway obstruction was evaluated by clinical OSA [obstructive sleep apnea] scoring and also adenoidal-nasopharyngeal [A/N] ratio in the lateral neck radiography. Fifty percent of the patients with a normal OSA score, 20% of those with a suspected OSA score and also 50% of cases with OSA had pulmonary hypertension [mPAP>20mmHg] which was not statistically significant [P= 0.198]. Mean Adenoidal-nasopharyngeal ratio in patients with a normal mPAP [mPAP