Reflections and understanding of the extracorporeal organ support in critically illpatients with COVID-19 / 西安交通大学学报(医学版)

SARS-CoV-2 can cause multiple organ injuries in some susceptible people in a short time, which seriously threatens the health and safety of people, and intensive care and multiple extracorporeal organ support are important means of treatment. Although many experts’ consensus and clinical guidelines have been published, a series of clinical problemsstill exist during the treatment procedure, and no consensushas not been reached until now. Therefore,in this paper wemake some reflections and explorations to provide experience and help for clinicians.

Assessment of pSOFA-L score in predicting the clinical outcome of critically ill children

Background: Recently Pediatric Sequential Organ Failure Assessment (pSOFA) score was adapted and validated in critically ill children to predict the clinical outcome. This study was aimed to evaluate the lactate level association with the outcome and thereby formulating pSOFA-L score to predict the clinical outcome better in critically ill children.Methods: This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka. Requirement of oxygen, inotrope support and other parameters were studied and compared the score with clinical outcome. A total of 75 cases were studied.Results: In this study total of 51 children had high serum lactate levels (68%). Out of 28 expired children 23 children had higher serum lactate levels that accounts for about 82.14% which is statistically significant (p<0.001). ROC curve of pSOFA-L score in predicting the mortality yielded AUC: 0.92 and cut off value: 10.5 which is statistically significant (p<0.001). In the present study mortality rate was 26.09% in children whose pSOFA-L score was less than 9 and mortality rate of 38.89% and 50.00% in children whose pSOFA-L score was 9 to 11 and more than 11 respectively.Conclusions: In this study increase in pSOFA-L score is associated with high mortality and poor outcome. The findings of the present study validate and emphasize that, pSOFA-L score helps in accurate prediction of mortality of critically ill children.

Spectrum of multi-organ system involvement in perinatal asphyxia in neonatal intensive care unit department of Pediatrics, King George hospital, Visakhapatnam, Andhra Pradesh, India

Background: The objective of the current study to find out the maternal risk factors associated and spectrum of involvement of multiorgan dysfunction in perinatal asphyxia.Methods: This is a prospective study comprises of 102 asphyxiated neonates. At the time of admission blood samples were taken for complete blood picture, random blood sugar, serum electrolytes, septic screen & blood culture. For the assessment of the central nervous system a neurosonogram would be carried out in all asphyxiated new-borns. Computed tomography scan was done who had abnormal neurosonogram. Chest x ray was done for all respiratory cases. Echocardiogram was done for cardiac assessment. Renal system evaluated by serum creatinine and urine output.Results: Of these 102 babies, 59 were males and 43 were females. Major risk factors in the study were meconium stained amniotic fluid cases, eclampsia, pregnancy induced hypertension, premature rupture of membranes and prolonged second stage of labour. central nervous system (CNS) involvement occurred in all 102 (100%) neonates. Hypoxic ischemic encephalopathy was the most common presentation of CNS involvement. Respiratory involvement was noted in 42 (41.5%). Renal involvement was seen in 27 (26.5%). Cardiovascular system involvement was observed in 26 (25.5%). Gastrointestinal involvement was observed in 16 (15.68%). Hematological abnormalities were seen in 14.7%.Conclusions: Multiorgan dysfunction is common in neonates with perinatal asphyxia. Overall mortality was 24.5%, which clearly indicates the need for early detection of maternal risk factors, better obstetric management and the prompt resuscitator measures.

Eschar and IgM ELISA in the diagnosis of scrub typhus

Scrub typhus is one of the leading causes of acute febrile illness in India. This study aimed to determine the best diagnostic tool for the identification of scrub typhus and study the possible association between diagnostics and clinical characteristics. Patients with fever of ?15 days admitted to the hospital satisfying the case definition of 47 kDa quantitative polymerase chain reaction (qPCR) positivity OR scrub typhus IgM ELISA positivity along with the presence of eschar OR Scrub typhus IgM ELISA positivity along with defervescence of fever within 72 h of initiation of specific therapy were recruited. Of the 116 patients satisfying the case definition, 47 kDa qPCR was positive in 43 (37%) patients, whereas IgM ELISA was positive in 104 (90%) patients and eschar was seen in 59 (51%) patients. The median duration of fever was 7.5 days (interquartile range 6� days). Multiorgan dysfunction syndrome (MODS) was described in 44 (37.9%) patients. Two patients (1.8%) succumbed to the illness. Presence of eschar and IgM ELISA positivity were detected in 106 (91%) cases. Scrub typhus, even with MODS, has low mortality because of immediate institution of specific therapy due to physician awareness. The presence of eschar and IgM ELISA positivity can be used to detect a majority of cases of scrub typhus.

A Severe Case of Reye's Syndrome with Multiorgan Dysfunction after Epstein-Barr Virus Infection / 中国医学科学杂志(英文版)

A 20-month-old male infant with multiorgan dysfunction after Epstein-Barr virus (EBV) infection developed Reye's syndrome. He also suffered from acute liver failure, life-threatening cerebral edema, severe disseminated intravascular coagulation (DIC), and myocardial involvement. EBV infection aggravated the progress of Reye's syndrome, leading to death despite full supportive and symptomatic therapy. This critical case suggested that pediatricians should pay attention to multiorgan involvement of severe EBV infection.

Sepsis en pediatría: nuevos conceptos / Sepsis in pediatrics: New concepts

La sepsis es una de las principales causas de mortalidad en adultos y en niños. El impacto es negativo en la salud de la población, y los gastos generados en el sistema de salud se los calcula en varios miles de millones de dólares. La muerte infantil a nivel mundial representa por décadas una compleja y progresiva enfermedad inflamatoria secundaria a un agente infeccioso, la cual origina disoxia tisular y eventualmente falla celular y orgánica, sin necesariamente pasar por hipotensión en etapas tempranas sino en etapas tardías de enfermedad. En la presente publicación se actualiza las definiciones realizadas a partir del Tercer Consenso de Definiciones de Sepsis y Choque Séptico y las Campañas Internacionales Sobreviviendo a la Sepsis, tomando como referencia un mejor entendimiento de la patobiología de la enfermedad. Se aborda la necesidad de usar un puntaje de disfunción de órganos en niños para valorar y predecir la mortalidad de una mejor manera y realizar ensayos clínicos. El objetivo de este artículo es dar a conocer el estado actual del conocimiento en la parte operacional de definiciones y la sugerencia de adaptar los conceptos a las guías clínicas nacionales.

Sepsis is one of the leading causes of mortality in adults and children. It has a negative impact on the population's health, and the expenses for the healthcare system are estimated at several billion dollars. Worldwide, infant death has represented for decades a complex and progressive inflammatory disease secondary to an infectious agent, which causes tissue dysoxia and eventually cell and organ failure, without necessarily going through hypotension in the early stages but in later stages of the disease. This review updates the definitions from the Third Consensus on Definitions of Sepsis and Septic Shock and the International Surviving Campaigns, which provide us a better understanding of the pathobiology of the disease. It elaborates on the need to use a score of organ dysfunction in children for better appraisal and prediction of mortality, and to conduct clinical trials. The objective of this article is to present the current status of knowledge of the operational definitions and to suggest the adaptation of the concepts in the national clinical guidelines.

To Study the Clinical Spectrum and Prognostic Factors of Scrub Typhus Fever In a Tertiary Care Centre in Kumoun Region of Uttrakhand.

Background: Scrub typhus is caused by Orentia (formerly Rickettsia) tsutsugamushi. It is an infectious disease of variable severity .Scrub typhus has a wide geographical distribution. Scrub typhus is grossly under diagnosed in India due to its nonspecific clinical presentation, limited awareness and low index of suspicion. Methods: This study was a cross sectional observational study conducted in Department of Medicine Government Medical College, Haldwani .The duration of this study was two years i.e. from November 2013 to October 2015 and 103 patients included in study. Results: 36 patients were found to be scrub typhus positive. It was commonly seen in males in the age group of 20-30 years. Besides fever, cough, myalgia and headache were the common presenting symptoms. Scrub typhus was seen most commonly in farm worker in our study. Most common complication was hepatitis followed by multiorgan dysfunction. In our study, out of 36 positive patients, 5 (13.8%) patients died and 31 patients ultimately recovered completely without any complication whatsoever. Conclusion: Scrub typhus is not a uncommon disease in India more so in hilly areas. So high index of suspicion should be there while dealing a patient of fever in these regions.

A Clinical Study of Febrile Thrombocytopenia: A Hospital-based Retrospective Study.

Introduction: Febrile thrombocytopenia is a usually condition commonly caused by infections. The present study is intended to know the underlying etiology of febrile thrombocytopenia in our community, the various presentations and relationship between platelet count and severity of disease and prognosis. Material and methods: The study was conducted on 190 patients who presented with fever and thrombocytopenia and were admitted in Sri Ram Murti Smarak Institute of Medical Sciences (SRMS-IMS), Bhojipura, Bareilly, Uttar Pradesh from January 2011 to December 2011. Results and observations: Febrile thrombocytopenia affected all age group ranging from 18 to 88 years of age but was common in 18-40 years age group (52%) with male-to-female ratio 66.3:38.9%. It was common during the months of July to September. Fifty percent patients were having platelet > 50,001/mm3. Malaria was the commonest cause constituting 32.6%, which was closely followed by septicemia forming 31.2%. About 76.8% patients had good recovery. In 18 mortality cases, 83.33% were due to septicemia with multiorgan dysfunction and 16.67% were due to complicated malaria. Conclusion: Febrile thrombocytopenia is an important clinical condition commonly caused by malaria and septicemia.

Clinical analysis of hyperlipidemic sever acute pancreatitis / 中国综合临床

Objective To investigate the clinical characteristics of sever acute pancreatitis (SAP) with high triglyceride(TG). Methods 82 patients with onset of SAP within 72 hours were involved in this study. These patients were divided into high TG group (n=26) and normal TG group (n=56) according to serum TG lev-els tested (high TG group≥1.7 mmoL/L;normal TG group<1.7 mmol/L on admission). Results 31.71% (26/82) SAP patients were discovered with high TG APACHE-Ⅱ grade of high TG group was higher than that of normal TG group on admission[(14.62±7.58) vs (10.68±5.21),P<0.01]. Within the onset of 72 hours,the incidence of cardiac,pulmonary and kidney dysfunction in high TG group was higher than those of normal TG group (34.62%,34.62% and 19.23% vs 5.36%,3.57% and 1.79%,P<0.01),and the incidence of pancreatic pseudocysts was higher in high TG group than that of normal group(42.31% vs 7.14%,P<0.01). No emergency and early-stage surgical cases in high TG group but 13 cases(23.21%) in normal group. There were 2 cases of high TG group and 4 of normal group averting to operation. Conclusion SAP patients with high TG have high incidence of early-stage organ dysfunction and local complication,in this case nonsurgical intervention is the first choice.

The changes and clinical significance of thyroid hormone levels in old patients with sepsis / 中国综合临床

Objective To investigate the changes of thyroid hormone levels and its relationship with prognosis in old patients with sepsis. Methods APACHE Ⅱ score and SIRS score were documented in 140 old patients with sepsis,who were divided into Multiorgan dysfunction syndrome (MODS) group and non MODS group. Results The levels of FT3 and FT4 descended obviously and APACHE Ⅱ score and SIRS score increased remarkably in old patients with severe sepsis(P <0.05 or P <0.01). The level of FT3 and FT4 in death group and MODS group was much lower than that in the survival group (P < 0.05). Conclusion Inflammatory resction and eytokines may effect the hypothalamic- pituitary-thyroid axis. The levels of thyroid hormone can reflect old patients with sepsis condition. The patients with severer conditions may have lower levels of thyroid hormone who will be more likely to died of MODS.

Application of low-dose glucocorticoids In septic shock / 中国综合临床

Objective To study the role of low-dose glucocorticoids in improving prognosis and adjusting septic shock. Methods A total of 46 patients with a confirmed diagnosis of septic shock were retrospaetivley analyzed. 24 patients without glucocorticoids treatment were taken as control group; 22 patients with glucocorticoids as therapy group (n = 22). The two group received standard treatment for septic shock. Results The percentage of shock reversal on day 7 was higher in therapy group than that in control group (P <0.05). However,there were notstatistical significances in the duration of mechanical ventilation, the length of ICU stay, the incidence of multiple or-gan dysfunction syndrome (MODS) and mortality between the two groups (P > 0.05). Conclusion Low-dose glucocorticoids can effectively accelerate refractory septic shock reversal and vasopreasor withdrawal. This seems to be related to the reduced production of CRP but the beneficial effects of low-dose steroids regimens on long-term outcome have not yet be determined.