Comparison of Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment, and Quick Sequential Organ Failure Assessment Scores to predict Mortality in Sepsis

Objectives: Sepsis-3 criteria define sepsis as ?2 points rise of Sequential Organ Failure Assessment (SOFA) score, either from zero or a known baseline. We compared the efficacies of quick Sequential Organ Failure Assessment (qSOFA), SOFA, and Systemic Inflammatory Response Syndrome (SIRS) scores to predict sepsis mortality.Methods: Prospective, hospital-based study was undertaken to determine the efficacies of various sepsis-scoring systems to predict mortality in sepsis. The “Sepsis-2” criteria of “severe sepsis” and “septic shock” were used as selection criteria as they correspond to “sepsis” and “septic shock” of “Sepsis-3”. Statistical analysis was done by SPSS Statistics version-16. Mortality predictions were made using receiver operator characteristic curve testing. Results: We included 122 sepsis patients diagnosed by “Sepsis-2” definition; 78.68% (n = 98) of whom met “Sepsis-3” criteria for sepsis. All-cause mortality was 50%. On univariate analysis, we found age over 60 years [odds ratio (OR) = 4.244, 95% confidence interval (CI) = 1.309–13.764, p = 0.016], invasive mechanical ventilation (OR = 7.0076, 95% CI = 3.053–16.0809, p<0.0001), and presence of acute respiratory distress syndrome (ARDS) (OR = 2.757, 95% CI = 1.0091–7.535, p = 0.048) were significant predictors of mortality. The SOFA score yielded the best result with “area under the curve” (AUC) of “receiver operating characteristic” (ROC) curve of 0.868. On comparing AUCs between these scores difference between both SOFA and qSOFA was highly significant (p < 0.0001) compared to SIRS. However, such statistical difference was not found between AUCs of SOFA and qSOFA. Conclusions: Both SOFA and qSOFA are superior prognostication tools compared to SIRS to predict sepsis mortality; SOFA being better than qSOFA.

Carcinoma Of Male Breast: A Rare Case Report From North East India With Review Of Literature

Male breast cancer is a rare entity and accounts for 1% of all breast cancer cases with an average age of onset 67 years. Several risk factors have been identified, such as genetic and hormonal abnormalities. Even though more data is emerging about this disease, the poor level of awareness often results in late presentation and delayed diagnosis in our country. The present study reported the case of a 63 year old man who was diagnosed with an advanced invasive ductal carcinoma without any important risk factors. The case is presented for the rarity and to discuss awareness, regarding early diagnosis and proper management.

Association between Clinical Malaria and Blood Lipids in North Eastern India.

Background: Changes in lipid profile are seen in many patients infected with malaria parasite. The malaria parasite causes hepatocellular damage and disturbs lipid handling by the liver. Inside hepatocytes and erythrocytes the parasite replicates rapidly scavenging cholesterol and lipids required for its growth and metabolism from the host. It also requires host lipids for detoxification of free heme to form the malarial pigment, haemozoin. The important question is whether these changes are characteristic for malaria infection or are they simply part of an acute phase reaction? This study analyzes the correlation between malaria infection and derangements in lipid profiles. Materials and Methods: This study comprised of 29 confirmed malaria cases, and 29 subjects in apparent good health, without the infection were included as control cases. Malaria cases were confirmed using rapid antibody-based diagnostic card tests that detect histidine-rich protein 2 (HRP2) or lactate dehydrogenase antigens in finger-prick blood samples followed by microscopic confirmation of malaria parasite. A 12 -hour fasting lipid profile was estimated by enzymatic method on day 2. Data obtained were statistically analyzed using Student’s t Test, assuming p<0.05 as significant. All issues related to ethics were taken care of during the whole course of study. Results: As compared with control subjects, patients with malaria showed low HDL (16.48±6.490 mg/dL versus 41.38±15.110 mg/dL), low LDL (70.45±22.720 mg/dL versus 104.46±27.353 mg/dL), low cholesterol (103.52±35.331 mg/dL versus 169.45±34.040 mg/dL) and elevated triglycerides (214.24±109.365 mg/dL versus 131.15±30.813 mg/dL). The observations show a statistically significant difference in HDL, LDL, cholesterol and triglycerides between malaria patients and control subjects (p<0.05). Conclusion: These results show a characteristic pattern of derangements of lipid profile in malaria. Further studies are required to understand the diagnostic, prognostic and therapeutic implications of these derangements.

Valproic acid induced pancreatitis: a case report.

Valproic acid is a commonly used antiepileptic drug. Apart from its common side effect there is definite association between valproic acid therapy and acute pancreatitis. Since 1979, many cases of acute pancreatitis induced by valproic acid have been published in medical literature. Here we are reporting a case of valproic acid induced acute pancreatitis in a 27 years old boy. The treatment is supportive, re-challenge is hazardous and should be avoided.