Prediction of mortality in septic shock patients

In patients with septic shock, recently developed organ failure scores, such as the Sequential Organ Failure Assessment [SOFA] can help assess organ dysfunction or Failure over time and are useful to evaluate morbidity. We conducted a prospective study, randomized study comparing the prognostic value of SOFA score with that of C reactive protein, APACHE score, leucocytic count and lactic acid in septic shock patients admitted to intensive care unit. Our sample study population included 16 patients with septic shock; mean age was 66.6 +/- 18 years, 9 males [56%] and 7 females [44%], 6 patients [38%] had medical diagnosis and 10 [62%] had surgical diagnosis. Patients were segregated into two groups; survivors and non-survivors. SOFA score shows highly statistically significant difference between survivors and non-survivors [2.5 +/- 2.12 vs. 7.8 +/- 2.16, p= 0.032] in comparison to APACHE II score [21 +/- 4.98 vs. 21.25 +/- 7.80, p= 0.947], CRP [10.68 +/- 11.99 vs. 7.29 +/- 3.1, p=0.53], TLC [19.700 +/- 18.66 vs. 13.000 +/- 2.311, p=0.39] and lactate level [1.45 +/- 1.9 vs. 4.1 +/- 0.187, p=0.036]. SOFA score allowed a simple and effective evaluation of organ dysfunction severity profile in patients with septic shock in comparison to other prognostic markers. In addition, its repeated measurement by including alterations over time could help refine outcome prediction

Evaluation of beneficial effects of steroids in head trauma

Road traffic crashes account for most serious head injuries, and the global burden of head injury can be expected to rise with the increasing use of vehicles in Asia and Africa. The overall incidence of adrenal insufficiency in critically ill patients approximates 30%, with an incidence as high as 50 to 60% in patients with septic shock. To re-evaluate the beneficial effects of I.V. steroids [dexamethasone], for 48 hours in the critically ill head trauma patients; to assess the prevalence of adrenal insufficiency in the critically ill head trauma patients, its relation to the seventy of the lesion and outcome. Prospective randomized controlled study, included 19 cases [patients who received I.V. steroids 8mg dexamethasone within 8 hours of injury, every 8 hours for 48 hours and 22 controls [patients who did not receive steroids]. 10.53% of cases died compared to 18.18%. of controls, the difference was not statistically significant, impaired circadian rhythm defined as p.m./a.m. cortisol >0.5 was found in 84% of mild head trauma, 80% moderate head trauma and 66.67% of severe head trauma, a.m. and p.m. cortisol levels were higher in moderate than mild TBI and the difference was statistically significant p-values 0.006 and 0.023 respectively. Altered circadian rhythm and adrenal insufficiency is common among critically ill head trauma patients, steroids resulted in decreased mortality among patients who received steroids and among patients with adrenal insufficiency who received steroids, however, the difference was not statistically significant