Outcome of patients with systemic lupus erythematosus in intensive care unit.

The objective of the study was to identify the causes, outcome and prognosis of severe illness in patients with systemic lupus erythematosus (SLE) requiring intensive care unit (ICU) care in a University Hospital over a five-year period. The design was a cohort study. Forty-eight SLE patients requiring ICU management over a five-year period (January 1997-December 2001) were studied prospectively. Of 48 patients, 14 (29.2%) died, predominantly with multiorgan dysfunction syndrome (MODS). Patients whose APACHE II score was equal to or greater than 20 had higher mortality than those with APACHE score below 20 (60 versus 7.1%; and P < 0.01). All the 18 patients whose health status rated as 'good' survived, while 46.7% of 30 patients whose health rated as 'poor' died (P < 0.01). Patients who had thrombocytopenia associated with sepsis and/or disseminated intravascular coagulopathy (DIC) had the highest mortality (75%, five-year survival). In conclusion, SLE patients admitted to the ICU had a lower mortality rate than some of the previous reports. Patients with SLE with high APACHE score, > or =20, poor health status, thrombocytopenia and multiorgan dysfunction syndrome had poor prognosis in the ICU.

Enteric fever due to multi-resistant Salmonella typhi.

Five cases of enteric fever due to multi-resistant Salmonella typhi are reported. Four of these patients most probably contracted the disease in India and the fifth in Egypt. All of them were successfully treated either with ceftriaxone or ciprofloxacin.

Interaction between nabumetone--a new non-steroidal anti-inflammatory drug--and the haemostatic system ex vivo.

Twenty-six healthy volunteers were given the non-steroidal anti-inflammatory drug nabumetone (1 g/day p.o.) for 10 days. Platelet aggregation tests in response to adenosine diphosphate, adrenaline, collagen, arachidonic acid, and ristocetin and bleeding time and coagulation screening tests were performed on three occasions: (1) before drug therapy; (2) on the last day of drug therapy, and (3) 5 days after the end of therapy. No significant changes were noted in platelet aggregation, bleeding time, or the coagulation screening tests, except for a significant drop in fibrinogen during therapy and for 1 week after stopping the drug. The lack of any antiplatelet action and minimal effects on the coagulation parameters recommend the drug as a suitable antirheumatic in patients with bleeding disorders. The hypofibrinogenaemic action requires further studies.