Effect of low dose hydrocortisone on duration of vasopressor therapy in septic shock.

Background & objectives:Severe sepsis and septic shock are major health problems. Stress dose of hydrocortisone infusion reduces the time of cessation of vasopressor therapy in septic shock. This study was planned to see the role of low dose corticosteroids on duration of vasopressor therapy in patients with septic shock along with their outcome. Methods: The study was carried out in 40 patients of septic shock. The patients were randomized into two groups i.e. treatment (Group A) and the placebo (Group B) groups of 20 each. Both groups received antibiotics, vasopressors i.e. Dopamine and Norepinephrine and IV fluids along with low dose hydrocortisone being administered only to Group A. Mean values were compared statistically using t-test and z-test. Results: The mean time spent in shock (hours) in survivors was 44.00 ± 11.2 (p< 0.001) while in group B was 72.00 ± 0.00 (p< 0.05). Also, the number of survivors in group A was more with cortisol levels of 5-25 mcg/ml. Interpretation & conclusion:Low dose hydrocortisone reduced the time spent in shock in survivors of group A, thereby reducing duration of vasopressor therapy. It also reduced mortality in subgroup of patients with serum cortisol levels of 5-25 mcg/ml proving that moderately low cortisol levels are benefitted more with hydrocortisone therapy than those with relatively high cortisol levels.

Status of lipid peroxidation and plasma iron level in bronchial asthmatic patients.

Low antioxidant levels and oxidative stress due to airway inflammation may be determinant of asthma severity. The study was conducted to find the extent of lipid peroxidation and change in the levels of plasma iron in asthmatic patients with severity of disease. Study included 155 asthmatic and 156 healthy volunteers of the age groups 18-45 of either sex. Asthmatic patients were grouped into mild, moderate and severe groups on the basis of Forced Expiratory Volume in first second percent (FEV1%). Level of plasma malondialdhyde (MDA) was used as index of lipid peroxidation. A significant increase (P<0.01) in plasma MDA and plasma iron levels was found in asthmatic subjects as compared to controls. There was maximum increase in plasma MDA and iron levels in moderate asthmatic group. A positive correlation between plasma MDA and iron (r = +0.3) has been found in asthmatic patients. An increased plasma iron levels in asthmatics may contribute to aggravate lipid peroxidation.

Work place challenge: spirometric response in polyurethane (isocyanate) paint workers.

In industrialised countries, isocyanate is probably the most common cause of occupational asthma. The present study was conducted to see the effect on FEV1 in workers who were directly exposed to isocyanate. One hundred and fourteen workers of a rail coach factory who were involved in polyurethane paint spray were studied. Spirometry was done three times, first before starting the work, at two hours and then 6-8 hours after finishing the work to see immediate, late and dual responses. Positive response was considered when there was fall of 20% or more in forced expiratory volume in 1 second (FEV1) from base line. Sixteen per cent of the workers exposed to isocyanate developed immediate reaction, 10% developed late reaction and 6% developed dual reaction. Non-smokers were more prone to develop late and dual responses.

Serum lipids & lipoprotein profiles of cigarette smokers & passive smokers.

Serum lipids and lipoproteins of 50 active and passive smokers were compared with levels in 25 control subjects. Active smoking resulted in an increase in total cholesterol (Tc) and triglycerides (Tg) as compared to control group. The passive smokers also showed relatively higher levels but the effect was not significant. Active smoking raised the low density lipoprotein cholesterol (LDLc) and very low density lipoprotein cholesterol (VLDLc) levels whereas high density lipoprotein cholesterol (HDLc) content was lowered, thus resulting in decreased ratios of HDLc/Tc and HDLc/LDLc. The passive smokers also showed slightly higher levels of LDLc and VLDLc but lower levels of HDLc, and a lower HDLc/LDLc ratio. Our findings suggest that smoking alters the serum lipids and lipoproteins and these changes are related to the duration and amount of smoking.