Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis.

AIM: This study was performed to investigate the association of non-thyroidal illness syndrome (NTIS) with 28-day mortality in adults with sepsis. METHODS: We performed a prospective observational analysis of adult patients with sepsis. Patients' demographic data, comorbidities, the blood test results including thyroid hormone analysis at admission, Acute Physiologic and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score were compared between 28-day survivors and non-survivors. Further patients were divided into 3 groups; non-NTIS, NTIS group A (low total tri-iodothyronine (T3) and NTIS group B (low T3 with low thyroxine (T4). Multivariate Cox proportional hazards regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 360 patients were included, and overall mortality was 30%. The mortality of non-NTIS patients was 13.4%; group A, 50.1%, and group B 69.1% (P < .001). The median T3 (IQR) in non-survivors and survivors was 0.74 (0.56-1.17) and1.58 (0.91-2.13) and median free T3 (IQR) 2.40 (1.13-3.01) and 4.03 (3.03-7.13) respectively (P < .001). In Cox proportional hazards analysis, NTIS group A (hazard ratio, 1.66; 95% confidence interval [CI], 1.00-2.76) and group B (hazard ratio, 2.57; 95% CI, 1.53-4.34). The area under the receiver-operating curve of NTIS groups was 0.68 (95% CI, 0.63-0.72). CONCLUSION: The T3 and free T3 were significantly lower in non-survivors compared with that in survivors and that a combination of low T3 with low T4 was associated with greater mortality than low T3 alone. A lower free T3 is independently associated with 28-day mortality.

Smokeless Tobacco and Stroke - A Clinico-epidemiological Follow-up Study in A Tertiary Care Hospital.

INTRODUCTION: Among the modifiable risk factors for stroke, tobacco smoking is well recognized. In some studies the use of Smokeless Tobacco (ST) has also been contributed as a risk factor for ischemic stroke. Use of ST is very common in South-East Asia. The form of ST varies according to the geographical and cultural variation. AIM: To study the various clinical symptoms and radiological findings of stroke due to different types of ST. MATERIALS AND METHODS: This was a prospective hospital based study carried out over a period of 2 years. All the cases within age group of 16 - 60 years and with a clinical and radiological diagnosis of acute stroke were included in the study. The Fagerström Test for Nicotine Dependence for ST of more than 6 was taken as the inclusion criteria. Patients having other addictions like smoked tobacco, alcohol, etc., and with important risk factors like hypertension, diabetes, dyslipidemia were excluded. The cases were extensively investigated and followed up for at least 6 months. Analysis was done using the Statistical Package for Social Sciences (SPSS- version 16.0). Descriptive statistics like percentage, mean were used wherever appropriate. RESULTS: During a period of 2 years, a total of 54 patients were studied. Forty two (77.7%) were males and 12(22.3%) were females. The mean age at presentation was 42.72(± 8.6) years and among all 96.3% patients were diagnosed as ischemic stroke. Among ST, pan was most commonly used in 21(38.9%) patients with an average of 14.6(±3.27) years of addiction. Hemiplegia was the predominant symptom on presentation (46, 85.2%). According to Oxfordshire Stroke Classification, partial anterior circulation infarct was most common in 20(38.4%). The mean Modified Rankin scale after 5 days of hospital stay was 3.83(±1.03) and after 6 months of follow-up was 2.1(±0.8). Patients were counseled for deaddiction and after 6 months follow-up 48(88.8%) patients had quit ST. CONCLUSION: ST is an important etiological factor for young ischemic stroke. This is the first study depicting clinical symptomatology of ST addicted ischemic stroke patients from India. Considering the increasing prevalence of ST use in south-east Asia, further long term studies are needed from this region.

Hyponatremia in critically ill patients.

CONTEXT: Hyponatremia is a common electrolyte disturbance in critically ill hence understanding its implications is important. AIMS: This study was carried out to ascertain frequency, predisposing conditions and outcome in critically ill patients with hyponatremia on intensive care unit (ICU) admission. SETTINGS AND DESIGN: This was an observational, prospective study of a series of ICU patients during a 12-month period. MATERIALS AND METHODS: THE PATIENTS WERE DIVIDED INTO TWO GROUPS: Hyponatremic (serum sodium < 135 mmol/L) and Eunatremic groups (135-145 mmol/L). Clinical examination included volume status and drug history, biochemistries, clinical diagnosis and cause of hyponatremia. STATISTICAL ANALYSIS USED: Fisher's exact test, unpaired t-tests Wilcoxon ranksum tests, profile-likelihood method, log-rank test and Kaplan-Meier curves were used. P < 0.05 were considered to be statistically significant. RESULTS: In the hyponatremic group, the frequency of hyponatremia on ICU admission was 34.3%, most were euvolumic, 58.96%. Females comprised of 36.5%. The mean age was 60.4 ± 17.2. The Syndrome of inappropriate Antidiuretic Hormone (SIADH) criteria was met in ninety-one patients (36.25%), peumonia being the leading cause of SIADH. Patients with severe sepsis, elective surgery patients, renal failure and heart failure, cirrhosis of liver and subarachnoid hemorrhage were other more likely etiologic causes (P < 0.05). The hyponatremic group spent a longer time in the ICU (P = 0.02), had longer mechanical ventilator days (P < 0.05) and had an increased mortality rate (P = 0.01). CONCLUSIONS: Hyponatremia present on admission to the ICU is independent risk factors for poor prognosis.