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Background: Paraquat is a herbicide commonly used for controlling weeds in India. The primary target organs for paraquat poisoning are the lungs and the kidneys. Acute cases of poisoning with paraquat are admitted to the hospital with various stages of acute kidney injury. Aim: To study the clinical presentation and outcome of paraquat poisoning in a tertiary care setting. Materials and Methods: A retrospective observational study was conducted at SDM College of Medical Sciences and Hospital, Dharwad. In this study we included the data of all patients admitted to the hospital with paraquat poisoning for a period of three-year and four months between January 2018 to April 2021. Results: A total of 12 participants were included in the final analysis. All the patients consumed paraquat with the suicidal intention only. The quantity of paraquat ingested was quite varied, ranging from as low as 5ml to as high as 200ml. Acute Kidney Injury (AKI) was diagnosed in 58.3% of patients. Among which three patients were in stage 1, one was in stage 2, and three were in stage 3. The mortality rate was 58.33%. The major cause of death for these patients was multiple organ dysfunction syndromes (71.42 %). Conclusion: Acute kidney injury is the major clinical outcome of paraquat poisoning other than lung injury. This may result in multiple organ dysfunction syndrome (MODS) and mortality. Paraquat poisoning is due to consumption with suicidal intent. Most of them were young. Early management with hemoperfusion may have a positive effect on reducing mortality.
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Background & objectives: Scrub typhus is a neglected tropical disease common in Asia and Africa. It usually presents with non-specific symptoms like fever, rashes, and lymphadenopathy. It has a varying range of clinical picture that often leads to misdiagnosis and initiation of non-specific treatment. This disease is thus associated with high morbidity and mortality. We aim to highlight the uncommon presentations of this common disease to create awareness regarding the unusual presentations of scrub typhus. Methods: This prospective study was performed over a period of two months enrolling eleven adult patients with serological evidence of anti-scrub typhus IgM antibodies. Results: All enrolled 11 cases [5 males (45.5%) and 6 females (54.5%)] were positive for anti-ST IgM antibodies and negative for other tested microbial agents. 7/11 (63.6%) patients were admitted with a clinical diagnosis of acute encephalitis syndrome (AES as per standard WHO definition), 3/11 (27.3%) patients presented with jaundice and 1/11 (9.1%) patients presented with rashes. Two out of 7 (28.6%) AES cases had developed peripheral gangrene of extremities. Interpretation & conclusion: Scrub typhus is a common tropical disease that can have various unusual clinical presentations like meningoencephalitis, vasculitis, acute kidney injury, jaundice, MODS. It closely mimics other infective etiologies making its diagnosis difficult. A high index of suspicion and clinical awareness is required in clinical practice to identify the different presentations of this disease so that early treatment can be initiated to reduce morbidity and mortality associated with this disease.
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【Objective】 To explore the effect of massive blood transfusion on inflammatory factors, islet B cell function, incidence and mortality of multiple organ dysfunction syndrome (MODS) in patients with severe traumatic hemorrhage. 【Methods】 214 traumatic hemorrhage patients who received blood transfusion and were hospitalized in the Third People′s Hospital of Xingtai from January 2015 to June 2019 were enrolled and divided into the routine blood transfusion group (n=118) and massive blood transfusion group (n=96) according to the amount and method of blood transfusion. The changes of the inflammatory factors such as TNF α and IL-6, the functional indexes of Islet B cells such as HOMA-B and Δ INS30 / Δ GLU30, and the incidence and mortality of MODS in two groups 3 d after blood transfusion were observed. 【Results】 The level of TNF α(ng/L), IL-6(ng/L), HOMA-B and Δ INS30 / Δ GLU30 were (64.21±8.41) vs (30.75±5.26), (216.52±17.99) vs (152.45±16.26) (58.55±10.23) vs (103.47±17.48) and (2.95±0.69) vs (5.87±1.30) in the massive transfusion group and routine transfusion group, respectively (P<0.01). The incidence of MODS was 63.54%(61/96) vs 40.07%(52/118)(P<0.01) while the mortality of MODS was 46.88%(40/118) vs 33.90% (P>0.05). 【Conclusion】 The massive blood transfusion could increase the incidence of MODS in patients with severe traumatic hemorrhage by promoting inflammatory reaction and dysfunction of islet B cells.
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Background: The incidence of sepsis is increasing, especially in elderly populations with more comorbidities. It is now estimated that sepsis is a leading cause of mortality and critical illness worldwide. The Epidemiological data regarding sepsis, septic shock and organ involvement is mainly from western literature. Data from India, especially south India, are less when compared to western data. In this background authors conducted a retrospective study in tertiary care hospital in south India. Objectives of the study was epidemiology of sepsis and its various characteristics in a tertiary care adult-Multi disciplinary ICU in South India.Methods: This study was a retrospective observational study, conducted during the time period of June 2016 and May 2017. The study population was patients above 18 yrs admitted in MDICU with sepsis. The study was conducted in a tertiary care adult -Multidisciplinary ICU in South India. Various characteristics like age group, comorbidities, organ involvement, septic shock, sofa score, need for ventilatory support, RRT support and outcome data was collected.Results: In this study, 497 patients who satisfied the Surviving Sepsis Campaign guidelines were included. The majority of the patients (59.8%) were male; the majority was above 60 yr (range 18 to 92 yr). 76.3% Patients had comorbid disease. Hypertension was the most common co-morbid (62%) followed by diabetes mellitus (51.3%). Chronic Kidney Disease was found in 132 patients (26.6%) and Coronary artery disease in 121 patients (24.3%). 186 patients (46.5%) had single organ involvement 140(35%) patients had 2 organ involvement. 74(18.5%) patients had more than 2 organ involvement. Septic shock was found in 155 patients (31.2%). Renal involvement was the most common organ involvement found in 279 patients(59.9%). Most common source for sepsis was the respiratory system found in 230 patients (46.3%), followed by urinary tract infection in 117 patients (23.5%). The study shows a significant association between SOFA score and mortality (p-value 0.001) 52% of mortality happened in group of patients with SOFA score more than 15 and mortality was 28 % in group with a SOFA score of 10-15.Conclusions: In this retrospective study of sepsis, authors found that the most common source of sepsis was pneumonia (46.3%) followed by urinary tract infection (23.5%). Majority of the patients had one organ involvement (46.5%). Among the organ involvement, Acute Kidney injury was the most common organ involvement (56.1%) followed by septic shock (31.2%) and respiratory support (29.6%). Mortality in this study was higher with higher SOFA score.
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Introduction:Septic embolism, though dangerous and life threatening thenumber of cases reported are seldom. To diagnose septicembolism clinic-radiological correlation is must. Studyaimed to depict various radiological appearances of septicthromboembolism according to there frequency of occurenceand using clinical history to strengthen the suspicion of SPEin patients as SPE have grave prognosis if not detected early.Material and methods: Study was done in the GovernmentMedical College Surat including the subjects of clinicallysuspected septic pulmonary thromboembolism and studyingthe radiological pattern of their presentation during the year2018-2019.Results: In this study the most common radiologicalpresentation is feeding vessel sign seen in (90%) of patientsCT, the most common cause is liver abscess constituting (40%)of cases, the most common primary cause in the patients withcomplications and mortality is pneumonia and most commonsequelae is acute respiratory failure constituting (66%) ofmortality and most common chronic ailment association isdiabetes mellitus seen in (60%) of patients.Conclusion: Septic pulmonary embolism is life threateningbut diagnosis is difficult as there are no specific clinicalcomplaints and radiological features but for benefit of patientquick diagnosis and management must be started as it has highmortality rate. SPE should be considered in the differentialdiagnosis of patients presenting extrapulmonary infectivefocus, respiratory symptoms, and parenchymal pulmonarynodules on imaging studies of the chest.
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Objective::To explore the effect of modified Qingyitang combined with continuous blood purification in the adjuvant treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction (MODS) caused by heat accumulation of viscera. Method::Totally 100 cases of patients of SAP complicated with MODS, who were diagnosed as heat accumulation of viscera by traditional Chinese medicine(TCM) and treated in ICU of the First Affiliated Hospital of Hunan University of Chinese Medicine during May 2015 and May 2019, were randomly divided into two groups, namely control group and observation group, with 50 cases in each group. The patients in control group were treated with fasting and abstinence, gastrointestinal decompression, inhibition of trypsin secretion, gastric mucosal protection, early jejunal nutrition, reduction of inflammatory reaction, continuous blood purification (CBP), mechanical ventilation and circulatory support. The patients in observation group were treated by nasojejunal tube according to syndrome differentiation in addition to routine comprehensive therapy. Modified Qingyitang was injected for 7 days. The remission time of abdominal pain and distention, the time of first exhaust and defecation, the time of ICU residence, the number of samples falling off, the cause of death and the number of cases were recorded. Relevant indexes were measured before treatment, on the 3rd and 7th day of treatment, including the evaluation indexes of pancreatitis: blood amylase (AMS), blood lipase (LPS), and modified computed tomography severity index (MCTSI), inflammatory response indexes were interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP). Organ function indexes included APACHE-Ⅱ, arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), glutamyltransferase (γ-GGT), urine volume, creatinine (CREA), urea nitrogen (UREA), glomerular filtration rate (GFR), creatine kinase (CK), creatine kinase isoenzymes (CKMB), lactate dehydrogenase (LDH), myoglobin (Mb). Tissue perfusion evaluation indexes included acute physiology and chronic health score, serum lactic acid (Lac) and central venous pressure (CVP). TCM treatment score was based on the syndrome score of acute pancreatitis with heat accumulation of viscera syndrome. Result::The total effective rate of TCM syndromes was 86.67%(39/45) in observation group and 73.91%(34/46) in control group (χ2 =13.524, P<0.01). On the 7th day of treatment, the symptoms and indicators of the two groups were improved. Compared with before treatment, AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT and AST were improved on the 3rd and 7th day after treatment in observation group and control group. The levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). Compared with control group on the 3rd and 7th day, the levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). CREA, UREA, GFR, CK, CKMB, LDH and Mb were significantly improved (P<0.05). Compared with control group, the abdominal pain, abdominal distension relief time, first exhaust/defecation time, ICU stay time in observation group were significantly shortened (P<0.05), and the mortality rate in observation group was significantly reduced (P<0.05). Conclusion::Patients of SAP accompanied with MODS can be treated with blood purification combined with modified Qingyitang by promoting pancreas repair, inhibiting inflammation and improving organ function. It plays an important role in improving symptoms, alleviating TCM syndromes, delaying progression of disease, reducing hospital stay and reducing mortality.
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Objective To investigate the risk factors for multiple organ dysfunction syndrome (MODS) in patients with type 2 diabetes mellitus (T2DM) complicated with infection.Methods The clinical data of 115 patients with T2DM complicated with infection in our hospital from Jan.2016 to Jan.2018 were retrospectively reviewed,including 60 patients with MODS(study group) and 55 patients without MODS(the control group).The related risk factors were analyzed by single factor and multi-factor logistic regression analysis.Results Single factor analysis showed that HbAlc[(5.47±0.86) vs (8.67±1.34)],hs-CRP[(8.31±2.18) vs (19.03±2.13)],PCT [(4.59±1.46) vs (13.42±2.67)],lac[(3.69±0.99) vs (6.58±1.18)],APACHE Ⅱ [(14.94±1.83) vs (24.98±3.19)],MBG[(9.81±0.62) vs (8.72±0.44)],SDBG[(3.43±0.20) vs (2.65±0.22)],MACE [(4.31±0.36) vs (2.93±0.19)],LAGE[(10.55±0.89) vs (6.49±0.19)],and MODD [(3.28±0.34) vs (2.05±0.25)] had statistical difference between the control group and the study group (P＜0.05).There was no significantly difference of blood glucose between the study group and the control group.Multi-factor logistic regression analysis showed that HbAlc,CRP,PCT,lac,APACHE Ⅱ],SDBG,LAGE,course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection (P＜0.05).Conclusion HbAlc,CRP,PCT,lac,APACHE Ⅱ,SDBG,LAGE,and course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection.
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Paraquat poisoning is one of the causes of AKI, the mechanism of toxicity being the production of reactive oxygen species,thereby causing toxicity at the cellular level. The aim of this study is to determine the requirement of haemodialysis and the severity of toxicity, depending upon the amount ingested.It is found that in Paraquat poisoning, the intervention with pre–emptive haemodialysisis not useful in decreasing the mortality. Ingestion under the influence of alcohol has higher mortality.Amount of poison ingested has a great impact and is directly proportional to the mortality. Oral ulcers, hepatic involvement, ARDS and MODS all reflected grave prognosis ultimately leading to death. The overall mortality in the study is 51%.
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Objective:To explore the protective effect of agmatine on mice with multiple organ failure (MODS) induced by yeast polysaccharide(ZYM) on the expression of inflammatory factors.Methods:ZYM induced inflammation model was established by intraperitoneal injection of ZYM in mice.All mice were divided into blank group,ZYM group and ZYM+AGM group.The mice feeding, white cell count,heart rate and so on were observed before and after the modeling to determine whether the model was successful.The liver function of mice,renal function,myocardial enzymes and other biochemical indicators were detected after the success of the model;and through the qPCR and ELISA method for detection of blood tumor necrosis factor alpha (TNF-alpha),interleukin 1 beta (IL-1 beta),interleukin 6 (IL-6),IL-10 gene and protein secretion level.Results: After the injection of ZYM,mice looked disorganized, activity and reduce consumption;the functional serological indexes of various organs of the mice were detected,which showed that the function of the viscera was serious.Compared with the blank control group,the serum parameters of ZYM group and ZYM+AGM group were significantly higher,and the inflammatory factors TNF-α,IL-1,IL-6 and IL-10 were significantly increased (P<0.05).Compared with ZYM group,ZYM+AGM serum markers of organ function decreased,inflammatory factor TNF-α,IL-1β,IL-6 decreased significantly (P<0.05),while there was no significant difference in IL-10 (P>0.05); and the mouse spirit,eating and activity had no significant change.Conclusion:Intraperitoneal injection of 500 mg/kg ZYM can successfully construct a model of MODS,AGM by reducing the release of inflammatory factors,play a protective role in the function of various organs of MODS mice.
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La tuberculosis extrapulmonar es una manifestación de la tuberculosis que se da cuando la bacteria Mycobacterium tuberculosis pasa del parénquima pulmonar a otros órganos por vía hematógena, linfática o por contigüidad. Entre diversos métodos de detección del bacilo de Koch en sitios diferentes al parénquima pulmonar, el ensayo de Susceptibilidad a Fármacos mediante Observación Microscópica para tuberculosis (MODS TB) consiste en un cultivo en medio líquido selectivo para M. tuberculosis y que permite además hallar el perfil de susceptibilidad a Isoniacida y Rifampicina. En este estudio se recurrió a los reportes del laboratorio de Microbiología Molecular del Instituto SELADIS, tomando en cuenta las muestras ingresadas de junio del 2015 a diciembre del 2016, hallándose los siguientes resultados: la incidencia de tuberculosis extrapulmonar es del 17,16% en muestras de origen extrapulmonar; el líquido cefalorraquídeo (LCR), líquido ascítico y líquido pleural son los tipos de muestra extrapulmonar con mayor incidencia de Mycobacterium tuberculosis (con 65%, 21,74% y 8,7% de resultados positivos respectivamente); los pacientes de género masculino, adultos (de 27 a 59 años de edad) y procedentes de la Ciudad de La Paz son los que presentan mayor incidencia de tuberculosis extrapulmonar. Los resultados de este estudio permiten tener un panorama de la situación de la tuberculosis extrapulmonar en La Paz, contando con la herramienta MODS TB, cuya sensibilidad y especificidad ha sido reportada en otros trabajos y ha sido validada en el laboratorio de Microbiología Molecular del Instituto SELADIS, donde se realizó este trabajo. La información proporcionada permitirá además aumentar el conocimiento científico epidemiológico que se tiene de la tuberculosis extrapulmonar e incentivar la investigación en este campo.
Extrapulmonary tuberculosis manifests tuberculosis that happens when the bacteria Mycobacterium tuberculosis crosses the pulmonary parenchyma to other organs through hematogenous, lymphatic vias or by contiguity. Among diverse detection methods of the Koch bacillus in different place's trough pulmonary parenchyma, the Microscopic Observation Drug Susceptibility Assay (MODS TB) consists in a liquid medium selective culture for M. tuberculosis that allows finding susceptibility profiles for Isoniazid and Rifampicin. In this study we appealed to the Molecular Microbiology laboratory reports of SELADIS Institute, from June 2015 to December 2016. Found out the following results: the incidence of extrapulmonary tuberculosis is of 17,16% in samples of extrapulmonary origin; cerebrospinal fluid (LCR), ascetic liquid and pleural liquid are the kinds of extrapulmonary samples with the highest incidence of Mycobacterium tuberculosis (with 65%, 21,74% and 8,7% of positive results respectively); male patients, adults (from 27 to 59 years-old) and citizens from La Paz City showed a higher occurrence of extrapulmonary tuberculosis. The results of this study allow having an overview of extrapulmonary tuberculosis in La Paz. Counting with the MODS TB tool, wich sensitivity and specificity has been reported in other jobs and has been standardized at the Molecular Microbiology laboratory of SELADIS Institute, where this this research accomplished. The provided information will allow to increase the cientific epidemiological knowledge that we have about extrapulmonary tuberculosis and encourage the research in this field.