Laboratory Abnormalities in Patients with Organophosphorous Poisoning.

Organophosphorous (OP) poisoning is an ever increasing and troublesome situation in the developing countries and is a major health care challenge in the 21st century. Hundred patients who attempted suicide with organophosphates, admitted to the emergency services were included in the study. They were graded (grade 0,1,2,3) according to clinical findings and examined for parameters like RBS, serum urea, serum creatinine, liver function tests, serum amylase, serum cholinesterase and LDH . The APACHE (II) of the cases were determined and correlated with severity of the clinical manifestations. A significant decline in serum cholinesterase (ChE) with increasing grades of intoxication(p <0.05) was observed along with raised levels of random blood sugar, serum urea, creatinine, hepatic enzymes and amylase. APACHE(II) score, showed a significant rise with severity of the degree of intoxication (p<0.001) and a negative correlation with serum cholinesterase. The findings of this study highlighted usefulness of biochemical and clinical indices in the management of organophosphorous poisoning thereby recognizing the complications early and facilitating early management.

The prevalence of organ failure and its risk factors in patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To determine the prevalence of organ failure and its risk factors in patients with severe acute pancreatitis(SAP). Method A retrospective analysis was conducted in 186 patients, who were hospitalized in the intensive care unit of Jinzhong First People's Hospital with SAP between March 2000and October 2009. SAP patients met the diagnostic criteria of SAP set by Surgery Society of Chinese Medical Association in 2006. The variables included age, gender, etiology of SAP, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CT Severity Index ( CTSI ), abdomen compartment syndrome (ACS) ,the number of organ failure and the number of death. The prevalence and mortality of organ failure were calculated. The above-mentioned variables were analyzed by unconditional multivariate logistic regression analysis to determine the independent risk factors for organ failure in SAP. Results Of 186 patients, 96had organ failure. In 96 patients with organ failure, 47 died. There was a significant association between the prevalence of organ failure and age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis, CTSI, ACS. An increase in age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis correlated with an increase in the number of organ failure. Age, the number of comorbidit, APACHE Ⅱ score,CECT pancreatic necrosis, CTSI and ACS went into the unconditional multivariate logistic regression equation. Conclusions Organ failure occurred in 51.6% of 186 patients with SAP. The mortality of SAP with organ failure is 49.0%. Age, the number of comorbidit, APACHE Ⅱ score, CECT pancreatic necrosis,CTSI and ACS are independent risk factors of organ failure.

Significance of serum cytokines concentrations and APACHE scores in evaluating the illness state for Critical patients / 中国基层医药

Objective To investigate the clinical significance of serum cytokines concentrations and A- PACHE scores in evaluating the illness state for critical trauma patients.Methods A clinical prospective self-control trial was performed,in which 36 patients admitted to ICU by SIRS were enrolled.Objects were divided into mild and severe trauma group according to APACHE score.The TNF-?and IL-6 concentrations were determined on the 1st, 3rd and 5th day of admission,the APACHE score were assessed at the same time.Statistic analysis was performed according to this group.Results The TNF-?concentrations decreased continuously in the following days while IL-6 decreased from the 7th day in the mild trauma group.In the severe trauma group the TNF-?and IL-6,APACHE score concentrations kept increasing.There was a significant difference of TNF-?and IL-6 concentrations between severe trauma and mild trauma group.Conclusion Dynamic measurement of TNF-?and IL-6 concentrations with APACHE score provide great help to evaluate the illness state and predict the prognosis.

Significance of APACHE Score in Patients with a Gastrointestinal Perforation

BACKGROUND: The APACHE scoring system of the Health Care Financing Administration (HCFA) has been being used for serious patients. The scoring system is composed of acute physiologic variables and chronic disease. METHODS: Among patients who underwent emergency operations from 1992 to 1997 because of gastrointestinal perforation, we analyzed 110 cases with five kinds of diseases: duodenal ulcer perforation, small bowel perforation, perforated appendicitis, gastric ulcer perforation and colon perforation. RESULTS: The results were as follows: 1) The preoperative APACHE II scores ranged from 0 to 21. The scores of 64 cases (60.9%) were from 0 to 5. 2) There were no death in case for which pre-peration APACHE II score was from 0 to 10, 25% of the mortality occurred in cases with scores from 11 to 15, 50% in those with scores from 16 to 20, and 100% in those with scores above 21. 3) The APACHE II score decreased continuously from the 3rd to the 7th postoperative day. 4) The preoperative APACHE II scores in gastric ulcer perforation patients were significantly higher than those in duodenal ulcer perforation patients. In the cases of gastric and duodenal ulcer perforations, the APACHE II scores in patients who underwent primary closure were higher than the scores in those who underwent a more definitive operation. 5) In death cases, all of their APACHE II scores were higher at the 3rd postoperative than at the 7th postoperative day, but their APACHE III scores continuously increased postoperatively. CONCLUSIONS: It is thought that the APACHE scoring system is more reliable than clinical experience in the classification of patients by operative risk and in estinating the result and giving a prognosis. Thus, the principle of treatment should be established by estinating patient's score before the operation. Careful preoperative management is necessary for patients with scores more than 10. Because patientswith scores more than 21 have very a high mortality, operative time and method must be carefully decided. The APACHE III scoring system seems to be more sensitive than the APACHE II scoring system in predicting deaths and further investigations and clinical applications should be performed.