The six scoring systems' prognostic value in predicting 24-hour mortality in septic patients.

OBJECTIVE: The use of scoring systems contributes to the faster identification of septic patients, especially those at a high risk of a fatal outcome. The best scoring system does not exist, so the search for the optimal one is always current. The aim of this study is to estimate the prognostic value of the six scoring systems in predicting 24-hour mortality among septic patients presented at the emergency department. PATIENTS AND METHODS: An observational retrospective study was conducted in the Emergency Triage Room (ETR) of the Emergency Center (EC) at the University Clinical Center of Serbia (UCCS) in Belgrade. Consecutive septic patients, according to the Sepsis-3 definition, with or without shock, presented to the ETR and then hospitalized in Intensive Care Units were included in the study. Mortality data within 24 h and on the 28th day were extracted from the Hospital information system or the National mortality database. Scoring systems including sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS), National early warning score (NEWS), sepsis patient evaluation in the emergency department (SPEED), and mortality in emergency department sepsis (MEDS) were analyzed for all patients utilizing the available data. The primary outcome of this study was death within 24 hours of triage. Receiver operating characteristic (ROC) analysis was used to determine the most effective scoring system. Lactate was then added to this system to enhance its predictive accuracy. RESULTS: Nineteen out of 120 patients included in the study (15.8%) experienced death within 24 hours of triage. The twenty-eight-day mortality rate was 55%. SOFA score demonstrated the highest predictive value for 24-hour mortality but was only moderately predictive overall, with an area under the receiver operating curve (AUC) of 0.755 (95% CI 0.625-0.885). SPEED, MEDS, and NEVS exhibited modest discriminatory power [0.673 (95% CI 0.543-0.803), 0.665 (95% CI 0.536-0.794), 0.630 (95% CI 0.528-0.724)], while SIRS and qSOFA remained insignificant in predicting 24-hour mortality. The predictive value of the SOFA score was increased by the addition of lactate (AUC 0.865, 95% CI 0.736-0.995; p=0.0081). All scores demonstrated better and satisfactory predictive power for 28-day mortality. CONCLUSIONS: SOFA, with the addition of lactate, is a complex but reliable tool for the early stratification of septic patients who are presenting at an emergency department.

Effects of chronic nicotine exposure on Δ9-tetrahydrocannabinol-induced locomotor activity and neural activation in male and female adolescent and adult rats.

RATIONALE: High rates of comorbid tobacco and cannabis use in adolescents and young adults may be related to functional interactions between the nicotinic cholinergic and cannabinoid systems in the brain during development. This study examined the effects of chronic exposure to nicotine (the psychoactive component in tobacco) on acute exposure to delta-9-tetrahydrocannabinol (THC) (the psychoactive component of cannabis). METHODS: Male and female adolescent and adult Sprague-Dawley rats (N = 112) were injected daily with nicotine (1 mg/kg, i.p.) or vehicle for 14 days, followed by a 14-day drug-free period. On test day, rats were injected with THC (5 mg/kg, i.p.) or vehicle, locomotor activity was recorded for 2 h, and brains harvested for c-Fos immunoreactivity (IR). RESULTS: Locomotor activity and c-Fos IR changes induced by THC challenge were altered by nicotine pre-exposure and modified by age and sex. THC-induced suppression of locomotor activity was attenuated by nicotine pre-exposure in adult but not adolescent males. THC-induced suppression of locomotor activity was potentiated by nicotine pre-exposure in female adolescents, with no effects of THC or nicotine observed in female adults. THC increased c-Fos IR in the caudate, nucleus accumbens, stria terminalis, septum, amygdala, hypothalamus, and thalamus. Nicotine pre-exposure potentiated this effect in all regions. Several brain regions showed age and sex differences in c-Fos IR such that expression was greater in adults than adolescents and in females than males. CONCLUSIONS: Chronic nicotine pre-exposure produces lasting effects on cannabinoid-mediated signalling in the brain and on behaviour that are mediated by age and sex. FUNDING SUPPORT: NSERC.

[Dynamics of returning the injured and ill to military and work responsibilities in wartime]. / Dinamika vracanja povredenih i obolelih na vojne i radne duznosti u ratu.

Returning of the injured and diseased to military and working duties in war have been trained and tested in the final training of members of the School of Reserve Medical Officers of the Military Medical Academy in the period 1985-1989. The time of returning of the injured and diseased members of the armed forces depends directly on the organization of the military medical and public health service, and especially of the preparedness of health personnel, well equipped military medical units and health institutions and the consistent application of the unique military doctrine.

[Organization of the care of the wounded and ill under conditions of nuclear radiation and radioactive contamination]. / Prilog organizaciji zbrinjavanja povredenih i obolelih u uslovima nuklearne radijacije i radioaktivne kontaminacije.

Organization of management of the wounded and sick has been presented at the joint training of the military medical and public health services under conditions of defense of big cities in daily light, in winter, under unfavourable meteorological conditions. The aim of the training was to check organization and preparedness of all structures of General National Defense in removing consequences after the nuclear plant accident during combat for defense of a big city. General conditions of training, casualty assessment, distribution of casualties according to the spatial distribution of radiation and radioactive contamination are given. Health institutions, military medical units and institutions, and other participants in health protection as well as their tasks are reported. Protective measures which should be applied at the level of "N" nuclear plant and organization in the defense of a big city are recommended.