Contrasting treatment and outcomes of septic shock: presentation on hospital floors versus emergency department / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Patients with septic shock have a high mortality. This study used the Surviving Sepsis Campaign (SSC) database to compare characteristics, treatments and outcomes of septic shock patients diagnosed in the emergency department (ED) to patients developing septic shock on hospital floors (HF).</p><p><b>METHODS</b>The studied population included patients admitted to the intensive care unit (ICU) of an urban tertiary care medical center over an 18-month period. Acute physiology and chronic health evaluation (APACHE II) scores, need for mechanical ventilation (MV), performance on four of the SSC resuscitation bundle indicators, ICU length of stay (LOS), hospital LOS and in-hospital mortality were ascertained.</p><p><b>RESULTS</b>Sixty-six ED and 27 HF septic shock patients were included in this study. Urinary tract infections (UTI) and pneumonia were the two most common sites of infection in the ED patients. The sources of infection for HF septic shock patients were fairly well distributed across etiologies. The time to achieve superior vena cava oxygen saturation (ScvO(2)) > 70% in HF patients ((10.8 ± 9.1) hours) was longer when compared to the ED patients ((6.6 ± 6.1) hours) (P < 0.05). Hospital mortality for the ED and HF patients were 25.8% and 59.3%, respectively (P < 0.05). Use of MV during the first 24 hours of shock was 44% in the ED patients and 70% in the HF patients (P < 0.05) and was linked to mortality.</p><p><b>CONCLUSIONS</b>When compared to HF patients, ED septic shock patients have lower in-hospital mortality, there was less use of MV during the first 24 hours following onset of septic shock and the HF patients required a longer time to achieve target ScvO(2). The need for mechanical ventilation is independently associated with increased mortality.</p>

Effect of terminalia arjuna on isoproterenol induced myocardial infarction.

Terminalia arjuna has been reported as a cardio tonic in the ancient literature. Its bark is used in many commercial formulations. Its effect on isoproterenol induced myocardial infarction has been studied. Treatment of albino rats with T. arjuna bark showed a marked cardio protective effect. The administration of isoproterenol significantly increased the levels of SGOT, SGPT, CPK and alkaline phosphatase. T. arjuna treatment prevented the elevation of the activities of these enzymes. Further, the treatment with T. arjuna alone caused a marked decrease in the basal activities of SGOT, SGPT and alkaline phosphatase, bringing them below the normal levels, present in control animals. It also affected the serum HDL and triglyceride levels overcoming the adverse effect of isoproterenol on these parameters. These effects were further substantiated by the histopathological studies of cardiac tissues. These data suggest that T. arjuna can be used as a general cardio tonic and can be beneficial in the prevention and treatment of heart ailments