Clinical profile and outcome of paraquat poisoning at a tertiary care centre in North Karnataka, a retrospective observational study

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.

Unusual clinical presentations of scrub typhus, a neglected tropical disease: A case series from north India

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.

Effects of massive blood transfusion on inflammatory factors, islet B cell function, MODS incidence and mortality in patients with severe traumatic hemorrhage / 中国输血杂志

【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.

Epidemiology of sepsis and its various characteristics in a tertiary care adult-multidisciplinary ICU in South India: a retrospective study

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.

A Study of Radiological Appearances of Septic Pulmonary Embolism in Contrast Enhanced Computed Tomography Thorax

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.

Clinical Efficacy of Modified Qingyitang Combined with Blood Purification on Severe Acute Pancreatitis Complicated with Multiple Organ Dysfunction Syndrome / 中国实验方剂学杂志

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.

Analysis of risk factors for multiple organ dysfunction syndrome in patients with type 2 diabetes mellitus complicated with infection / 中华内分泌外科杂志

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.

Clinical Profile And Outcome Of Paraquat Poisoning Induced Acute Kidney Injury

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%.

Protective effects of AGM through inflammatory cytokines mediated on MODS mice / 中国免疫学杂志

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.

Incidencia de mycobacterium tuberculosis en muestras extrapulmonares procesadas por el ensayo MODS ­ TB en el Instituto SELADIS de junio del 2015 a diciembre del 2016 / Incidence of Mycobacterium Tuberculosis in Extrapulmonary Specimens Processed by the MODS - TB Assay Seladis Institute from June 2015 to December 2016

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.

Predictive value of serum lactate combined with PIRO score in prognosis of septic patients / 中华急诊医学杂志

Objective To investigate the predictive value of serum lactate combined with PIRO (Predisposition,Infection,Response and Organ dysfunction) score in the development of multiple organs dysfunction syndrome (MODS) in septic patients and to study procalcitonin (PCT),in order to provide guidelines for clinical care.Methods From April 2015 to July 2016,a total of 752 sepsis patients were enrolled and divided into MODS group (n =488) and non-MODS group (n =264) according to the criteria of MODS.At 28 d after admission,these patients were divided into survival group (n =477) and death group (n =275).PCT and lactate levels in serum were measured,and PIRO score of these patients was calculated.Then the differences in levels of PCT and lactate in serum were compared among patients at different PIRO score categories.ROC was constructed to observe the clinical values of the biomarkers,PIRO score and lactate combined with PIRO score in predicting prognosis.Result PCT,lactate levels in serum and PIRO score were significantly higher in MODS group and death group,showing significant positive correlation.The areas under ROC curves (AUCs) of serum lactate combined with PIRO score for predicting MODS were 0.906,which was significantly higher than that of serum PCT (0.716),serum lactate (0.851) and PIRO score (0.840) alone (all P ＜ 0.05).Serum PCT,serum lactate and PIRO score were the independent predictors of MODS.Conclusions Serum lactate in combination with PIRO score was a valuable indicator in predicting development of MODS in septic patients.

Tuberculosis extrapulmonar: breve revisión general y nuevas alternativas de diagnóstico / Extrapulmonary tuberculosis: brief general review and new diagnosis alternatives

La tuberculosis (TB) extrapulmonar constituye el 10-20% del total de casos de tuberculosis que padecen los enfermos especialmente inmunocompetentes, esta frecuencia se incrementa notablemente en las personas portadoras de algún grado de inmunodeficiencia. La coinfección TB-VIH en la que los pacientes están severamente inmunodeprimidos pueden presentar localizaciones extrapulmonares hasta en un 60% de los casos. Se entiende como tuberculosis extrapulmonar a la infección por Mycobacterium tuberculosis en cualquier localización fuera del pulmón: ganglionar, urogenital, osteoarticular y otros, sin dejar de ser el foco inicial el pulmón. El diagnóstico de este tipo de tuberculosis está basado en la clínica y pocos son los métodos que permiten un diagnóstico certero y rápido ya que las muestras son generalmente paucibacilares.El tratamiento de la tuberculosis extrapulmonar solo es diferente en ciertas situaciones especiales como la tuberculosis meníngea, aunque es muy raro encontrar tuberculosis extrapulmonar farmacorresistentes se vio algunos casos que se verán en este artículo. La tuberculosis extrapulmonar suele estar asociada con enfermedades que causan trastorno en el sistema inmunitario, la principal de estas es el VIH la cual en nuestro medio ha venido aumentando con los años. Una alternativa para el diagnóstico es el ensayo MODS (Microscopic Observation Drug Susceptibility), el mismo que tiene como fundamento la observación del desarrollo de cordones tempranos característica desarrollada solo por Mycobacterium tuberculosis, los mismos que son visualizados con un microscopio invertido, este ensayo ofrece una posible solución al problema de la tardanza y falta de confiabilidad en los métodos tradicionales de cultivo microbiológico.

Extrapulmonary Tuberculosis (TB) constitute 10-20% of the TB sufferers immunocompetent patients , this frequency is greatly increased in people who carry some degree of immunodeficiency. TBHIV co-infection patients who are severely immunocompromised may have extrapulmonary sites by up to 60% of cases. It is understood as extrapulmonary tuberculosis a Mycobacterium tuberculosis infection in any location outside the lung: Nodal, urogenital, osteoarticular and others. While always the initial focus being the lung. The diagnosis of this type of tuberculosis is based on clinical and few methods that doesn´t allow an accurate diagnosis because samples are usually paucibacillary. The diagnosis of this type of tuberculosis is based on clinical and few methods that allow rapid and accurate diagnosis because samples are usually paucibacillary. The treatment of extrapulmonary tuberculosis is only different for certain special situations such as meningeal tuberculosis, although it is very rare to find drug-resistant tuberculosis extrapulmonary some cases to be argued in this article was.Extrapulmonary tuberculosis is often associated with diseases that cause disorder in the immune system, the principal of these is HIV in our midst which it was found that the incidence of this disease increases with age. An alternative diagnosis is the MODS test (microscopic observation drug susceptibility) based on the observation of the development of early cords, feature developed only by Mycobacterium tuberculosis, they are visualized with an inverted microscope, this essay offers a possible solution to the problem of delays and unreliability in the traditional methods of microbiological culture.

Comparative study between BISAP and Ransons score in predicting severity of acute pancreatitis

Background: Acute pancreatitis is an acute inflammation of the pancreas is an increasingly common abdominal disorder presenting as major surgical challenge to general surgeons worldwide. Early identification of patients at risk of developing a severe attack has great importance for instituting therapeutic interventions and improved outcome. Accurate prediction of severity is important in order to improve survival. There are several assessment criteria in order to predict prognosis and severity of acute pancreatitis, which help in guiding patient triage and management. However, nothing is proven to perform significantly better in clinical settings than good clinical judgment. Ideal predicting criteria should, therefore be simple, non-invasive, accurate and quantitative and assessment tests are easily available. Aim and objectives: It was a prospective study to assess the accuracy of BISAP scoring system vs Ranson’s scoring system in predicting Severity in an attack of acute pancreatitis and to compare predictability of organ failure, necrosis and mortality between BISAP scoring and Ranson’s Scoring system. Materials and methods: All patients admitted to Govt. Stanley Hospital with complaints of pain abdomen diagnosed to have Acute Pancreatitis on clinical examination and further investigations. Sample size consists of 100 patients with acute pancreatitis. BISAP score and Ranson’s score is calculated in all such patients based on data obtained within 24 hours of hospitalization and at 48 hours. Results: In this study, the two different scoring systems (BISAP and Ranson’s) were compared and analyzed to assess the severity in patients with acute pancreatitis. An attempt also made to compare this study with previous similar studies done by others. Acute pancreatitis found to be 10 times more J. Lalithkumar, T. Chitra, N. Kodieswaran. Comparative study between BISAP and Ranson’s score in predicting severity of acute pancreatitis. IAIM, 2016; 3(9): 23-33. Page 24 common in males than females in this study. The mean length of hospital stay was 12.03 ± 6.8 days in this study. In this study, increasing BISAP and Ranson’s scores was correlated well with the duration of hospital stay. In this study, 86 patients were diagnosed to have mild and moderately severe acute pancreatitis grouped under MAP, and 14 patients found to have severe acute pancreatitis. All the 14 patients were correctly predicted by BISAP score. The scores were assessed by correlating the scores with three factors: organ failure, necrosis and mortality. The analysis for organ failure showed BISAP score has sensitivity of 71.43%, specificity of 95.35%, PPV of 71.43%, NPV of 95.35%, diagnostic accuracy of 92%; whereas Ranson’s score has sensitivity of 78.57%, specificity of 74.42%, PPV of 43.33%, NPV of 95.52 %, diagnostic accuracy of 88%. In this study, 7/20 patients with BISAP> 3 and 8/14 patients with Ranson’s >3, developed pancreatic necrosis. The statistical analysis for the prediction of necrosis has sensitivity of (81.82%, 90.91%), specificity of (94.35%, 77.53%), PPV of (64.29%, 43.56%), NPV of (97.67%, 98.57%), diagnostic accuracy of (93%, 91%) for BISAP and Ranson’s respectively. In this study, 4 patients with severs acute pancreatitis were expired. All 4 deaths were correctly predicted by BISAP score. The statistical analysis for the prediction of necrosis has sensitivity of (100%, 88.57%), specificity of (95.83%, 64.42%), PPV of (50%, 31.33%), NPV of (100%, 96.52%), diagnostic accuracy of (96%, 93%) for BISAP and Ranson’s respectively. In this study, patients developed pancreatic necrosis, acute renal failure, MODS, septicemia. These complications were more likely seen in patients with BISAP ≥ 3, and Ranson’s > 3, hence concluded that these are the patients in high risk group, who requires intensive monitoring and probably early intervention if necessary. Conclusion: From this study, alcohol (59%) was found to be the most common etiological factor for acute pancreatitis. Males were more commonly affected than females with a ratio of 10:1. The most common age groups of patients affected were in 4th decade of life. The overall mortality in patients with severe acute pancreatitis was 4% BISAP score is equally effective in finding out the frequency of severity and predicting mortality in patients with acute pancreatitis as Ranson's score. Moreover, its components are easily available and it does not require 48 hours for completion of assessment as compared to Ranson's score. It is an accurate tool to classify patients into mild and severe disease; it is easy to perform and can be done on the bedside of patients with acute pancreatitis in every setup.

The clinical value of early mechanical ventilation in treatment of patients with severe acute pancreatitis / 中国基层医药

Objective To study the effect of early mechanical ventilation in treatment of patients with severe acute pancreatitis(SAP).Methods Fifty-two patients with SAP admitted in the First People's Hospital of Zhaoqing from January 2010 to January 2015 were randomly allocated into two groups (n =26),early mechanical ventilation group(observation group) and conventional mechanical ventilation group(control group).Patients in the observation group treated with early lung protective ventilation when PaO2 ＜ 13.3kPa.Patients in the control group treated without mechanical ventilation untill PaO2 ＜ 8kPa.The symptoms,the extent of inflammatory reaction,the severity of lung lesions and the mortality of two groups were compared through monitoring vital signs,abdominal circumference,APACHE Ⅱ score,bladder pressure,oxygenation index (PaO2/FiO2),C reactive protein (CRP),procalcitonin (PCT),hospital stay and mortality.Results No statistically significant differences in the APACHE Ⅱ score,bladder pressure,oxygenation index,CRP and PCT in two groups before treatment were observed(P ＞ 0.05).The APACHE Ⅱ score (12.8 ± 7.6) points,bladder pressure (14.9± 7.9) cmH2O,CRP (48.8 ± 30.1) rmg/L,PCT (1.25 ± 0.55) μg/L,mortality (3.84％) of the observation group after treatment were significantly lower than those of the control group (t =2.057,2.091,3.252,2.697,x2 =4.305,all P ＜ 0.05),while the oxygenation index in the observation group [(300.0 ± 34.9) mmHg] was significantly higher than that in the control group [(278.1 ± 32.8) mmHg],the difference of the two groups was statistically significant (t =3.322,P ＜ 0.05).Conclusion Early lung protective ventilation is safe and effective for treatment of the patients with SAP.

Prognostic value of procalcitonin in patients with acute paraquat intoxication / 中华急诊医学杂志

Objective To study the prognostic value of procalcitonin (PCT) level in the outcome of patients with paraquat poisoning (PQ).Methods The clinical data of 128 patients with acute PQ admitted to emergency department were collected from March 2013 through March 2014.The patients were divided into two groups:the death group and the survival group (survival of 28 days).Poisoning doses,urine concentration of PQ,time elapsed from poisoning to admission,and time elapsed from poisoning to gastrolavage were documented.And on the 1 st day,the 3rd day and the 7th day after poisoning,serum PCT were detected.The level of PCT was used to investigate the prognostic values in patients with acute PQ in the death group and survival group.Results Of 128 cases,72 (56.3％) survived and 56 died in 28 days.Among them,the level of PCT increased to some extent in the first day in 90 cases,and 48 patients died.According to trend analysis,the levels of PCT in death group on the 1st day,the 3rd day and the 7th day after PQ were significantly higher than those in survival group [ld:(0.96 ±0.13) vs.(0.08 ±0.01),3d:(1.12 ±0.14) vs.(0.28 ±0.05),7d:(1.22 ±0.14) vs.(0.20 ±0.03),P ＜0.01].There was a trend of escalating PCT levels in death group,whereas the PCT level reached the peak on the 3st day and decreased gradually in the following days in survival group.The early PCT level was obviously related to poisoning doses,urine concentration,CRP,WBC,ALT,CR (the coefficient of association were 0.794,0.723,0.724,0.332,0.700,0.414,respectively,P＜0.01).Conclusions The serum level of PCT increased in patients with acute PQ was significantly positively correlated with the oral dose and urine concentration of paraquat,and it can be used as an indicator for PQ severity.There is important clinical significance in detecting the change of serum level of PCT for estimating the condition of patients and evaluating the prognosis.

Effect of Shengmai injection combined with norepinephrine on apoptosis of lym-phocyte and apoptosis protein in MODS rats / 中国免疫学杂志

Objective:To study the effect of the Shengmai injection combined with norepinephrine on cellular immunity in rats with multiple organ dysfunction syndrome .Methods:40 healthy male rats were randomly divided into the control group ,the Shengmai injection group ,the norepinephrine group and the Shengmai injection combined with norepinephrine group of 10 rats in each group after MODS rat model were established by intraperitoneal injection of zymosan .The plasma level of TNF-α, IL-1β, IL-12 and IL-2 were detected by ELISA ,and the protein expression of caspase-3,caspase-9 and caspase-8 in spleen were tested by IHC during 6 h,24 h,48 h.And the lymphocyte number of apoptosis and the ratio of Th 1/Th2 were tested by flow cytometry.Results: ① Compared with the control group, the plasma concentrations of TNF and IL-1βwere not significant increased in the Shengmai injection group , the norepinephrine group and the Shengmai injection combined with norepinephrine group ,as the extension of treatment time ,the plasma concentration of TNF and IL-1βwere significant lower in treatment groups than control group .While the plasma concentration of IL-12 and IL-2 were significantly increased in treatment groups , and the combined treatment group was more obvious .② Compared with control group,the protein expression of caspase-3,caspase-9 and caspase-8 in spleen were decreased in the Shengmai injection group , the norepinephrine group and the Shengmai injection combined with norepinephrine group ,and the combined treatment group was more obvious.③The lymphocyte number of positive apoptosis were significantly decreased , and the Th1/Th2 ratio were increased in the Shengmai injection group ,the norepinephrine group and the Shengmai injection combined with norepinephrine group ,and the combined treatment group was more obvious .Conclusion: The Shengmai injection combined with norepinephrine can reduce the inflammatory reaction and improve the immune function in the rat with multiple organ dysfunction .

Research on warning indexes for percutaneous nephroscope complicated septic shock and multiple organ dysfunction syndrome and prevention countermeasures / 中国生化药物杂志

Objective To evaluate early warning indexes of percutaneous nephroscope complicated with septic shock and multiple organ dysfunction syndrome and prevention countermeasures.Methods Thirty patients with PCNL complicated with septic shock and MODS were selected from January 2004 to December 2014, and 35 patients suffering from MODS after PCNL were divided into the control groups, and the levels of platelet (PLT), D-dimer (DD), serum albumin (ALB), cholinesterase (CHE) and troponin T (TNT) of patients in two groups were detected.Results PLT, CHE and ALB of patients in observation group were (103.25 ±35.27) ×109/L, (2313.38 ±231.65) U/L and (22.43 ±5.38)g/L, respectively, being significantly lower than those of patients in control group, and TNT and DD were (0.67 ±0.17) ng/mL and (2.56 ±0.93) mg/L, respectively, being significantly higher than those of patients in control group, the differences were statistically significant (P<0.05).PLT, CHE and ALB of death patients in observation group were (87.32 ±21.27) ×109/L, (2109.26 ±219.41) U/L and (19.38 ±4.28) g/L, respectively, being significantly lower than those of survived patients, TNT and DD were (0.78 ±0.13) ng/mL and (3.04 ±0.77) mg/L, respectively, being significantly higher than those of survived patients, the differences were statistically significant (P<0.05).The fatality rate of patients with two organ dysfunctions more than 41.67%.The fatality rate of patients with three organ dysfunctions was 44.44%.The fatality rate of patients with organ dysfunctions more than 4 was 100%. Conclusions for Platelets, D-dimer, serum albumin, cholinesterase and calcium muscular,organ dysfunction number may serve as early warning indexes of patients with postoperative percutaneous nephroscope complicated septic shock and multiple organ dysfunction syndromes.

Chemokine receptor 7 implications of spleen dendritic cells in multiple-organ dysfunction syndrome in mice / Implicaciones del receptor de la quimiocina de tipo 7 de las células dendríticas del bazo en el síndrome de disfunción orgánica múltiple en ratones

OBJECTIVE: This study aims to explore the chemokine receptor 7 (CCR7) expression of spleen dendritic cells (DCs) and their role in the changes of migration and activity of spleen DCs in multiple-organ dysfunction syndrome (MODS). METHODS: The MODS model of mice was reproduced. The mice were randomly assigned to the following groups: normal, three-hour to six-hour, 24-hour to 48-hour, and 10-day to 12-day postzymosan injection. CD11c and CD205 were analysed by immunohistochemistry; the expressions of CD86 and CCR7 of DCs were studied using flow cytometry analyses. RESULTS: In normal mice, many DCs were found at the margin between the red and white pulp. In the three-hour to six-hour and 24- to 48-hour group, DC effectively upregulated CD86 and CCR7, and they were distributed in T-cell areas. In the 10-day to 12-day group, DCs were distributed at the margin by the immature form. CONCLUSION: The CCR7 expression level of DCs had close correlations with the migration of DCs. Chemokine receptor 7 can be used to evaluate the migration and functional activity of DCs in MODS.

OBJETIVO: Este estudio persigue explorar la expresión del receptor de la quimiocina 7 (CCR7) de células dendríticas del bazo (CD), y su papel en los cambios de la migración y la actividad del las células DC del bazo en el síndrome de disfunción orgánica múltiple (SDOM). MÉTODOS: Se reprodujo el modelo SDOM de los ratones. Los ratones fueron asignados aleatoriamente a los siguientes grupos de inyección de post-zymosan: hora normal, tres a seis horas, 24 horas a 48 horas, y de 10 a 12 días. CD11c y CD205 fueron analizados mediante inmunohistoquímica. Las expresiones de CD86 y CCR7 de CD se estudiaron mediante análisis de citometría de flujo. RESULTADOS: En los ratones normales, muchas células CD fueron encontradas en el margen entre la pulpa roja y la blanca. En el grupo de tres a seis horas y el grupo de 24 a 48 horas, CD86y CCR7 fueron efectivamente sobre-regulados en CD, y distribuidos en las áreas de células T. En el grupo de 10 a 12 días, las CDs fueron distribuidas en el margen por la forma inmadura. CONCLUSIÓN: El nivel de expresión CCR7 de las CDs tuvo estrecha correlación con la migración de las CDs. El receptor de la quimiocina de tipo 7 puede utilizarse para evaluar la migración y la actividad funcional de las CDs en SDOM.

MODS Culture for Primary Diagnosis of Tuberculous Meningitis and HIV-Associated Pulmonary Tuberculosis in Indonesia.

Aims: To compare the microscopic observation drug susceptibility (MODS) culture with microscopy and solid culture for diagnosis of TB meningitis and HIV-associated pulmonary tuberculosis (TB). Study Design: Comparative study. Place and Duration of Study: Department of Clinical Pathology, Hasan Sadikin Hospital, Bandung, Indonesia, between 2010 and 2012. Methodology: Two groups of patients were included. The first group consisted of 167 consecutive HIV-infected patients presenting with suspected pulmonary TB. The second group consisted of 88 patients with clinical suspicion of TB meningitis. Sputum samples from HIV-associated pulmonary TB patients and cerebrospinal fluid (CSF) from patients with TB meningitis were analyzed using microscopy of Ziehl-Neelsen (ZN) stained smears, culture on solid medium (Ogawa), and MODS culture. Results: MODS showed the highest detection rate in both patient groups. Among HIV-associated pulmonary TB patients, positivity of MODS was 31.2% compared with 26.9% for Ogawa and 20.6% for ZN. Among TB meningitis patients, positivity of MODS was 41.2% compared with 38.8% for Ogawa and 8.3% for ZN. The median time to culture positivity was significantly shorter for MODS compared to Ogawa, both for sputum (median 11 vs 21 days) and CSF (14 vs 33 days). In 14 days, MODS detected significantly more cases compared with Ogawa in both patients group (79.2% vs 2.4% and 68.6% vs 0%, respectively). Laboratory staff readily used MODS after two weeks of training. Conclusion: We were able to implement MODS culture as a robust, sensitive, and rapid method for diagnosis of HIV-assoicated pulmonary TB and TB meningitis in a hospital setting in Indonesia. Further studies may be needed to assess the feasibility of MODS culture in other settings and assess its impact on case detection and timely treatment of both forms of TB.

The value of PCT, CRP, TNF-α and free DNA in predicting the development of MODS in patients with multiple trauma / 中华急诊医学杂志

Objective To explore the value of peripheral blood serum levels of PCT,CRP,TNF-α and free DNA of cells in predicting the development of MODS in patients with multiple trauma.Methods Complete detail clinical data of 54 casualties with multiple trauma admitted within 24 hours after accident from January 2011 through January 2012 were collected for retrospective study.The patients were divided into MODS group and non-MODS group according the criteria set forth by the Chinese Society of Critical Care and Emergency Medicine in 1995 national conference.The data of two groups are comparable,and data of another 20 healthy subjects undertaking routine annual physical examination were taken as control.The peripheral blood levels of PCT,CRP,TNF-α and free DNA of patients of two groups were determined 1 d,2 d,3 d,and 5 days after admission.Then the results were analyzed and compared between groups.Results Compared with non MODS group,the levels of PCT,CRP,free DNA of cells in MODS group were significantly higher (P ＜ 0.05),but there was no deference in TNF-α between MODS group and non-MODS group (P ＞ 0.05).When the relative risks of increased PCT (PCT≥6 mg/L),increased CRP (CRP≥ 130 mg/L)、and increased free DNA of cells (free DNA ≥ 10 0005/L) were analyzed,the presence of these 3 biomarkers with high levels occurred at the same time was the most accurate way to predicts MODS in 6.00 relative risk (RR),and the positive predictive value was 100％.Conclusions PCT,CRP,free DNA of cells could be the predictors of MODS in patients with severe multiple trauma,and the presence of high levels of these three biomarkers appearing together had high sensitivity and specificity for prediction.