Over the last 40 years, the use of corticosteroids in sepsis and septic shock has evolved from the initial use of high-dose, short-duration steroid therapy in the 1980s, to the recent recommendation of using low-dose longerduration steroid therapy in refractory septic shock patients. A recent, prospective, open-label, randomized, controlled pilot trial of patients in four adult intensive care units in London-teaching hospitals showed that hydrocortisone decreased vasopressin requirements, reduced the duration and reduced the required dose, when used together in the treatment of septic shock, but it did not alter plasma vasopressin levels. The optimal dosing of hydrocortisone, about 300 mg/day, was agreed uniformly. As this dose also provides sufficient mineralocorticoid effects, the additional use of mineralocorticoid is not needed. Despite the fact that severely ill septic shock patients are given treatment, according to the current guidelines, the survival benefit is unproven. The benefits of steroids on less severely ill septic patients are still questionable. More research is highly recommended to successfully identify the benefits of steroids in septic shock.Birdem Med J 2017; 7(1): 48-59
Background: COVID-19 pandemic has set many things to new normal. Telemedicine, in its modern form, started in the 1960s. In this COVID era of isolation, lockdown and quarantine, telemedicine has emerged as an essential way to seek medical consultation. This study was designed to explore the practical utility of telemedicine. Methods: This was an observational study of real-life scenario. The data were collected from prescriptions of single, home-based, specialist clinical practice set-up. It was over a period of 26 days in the month of August 2020. The liking or disliking or preference of telemedicine was asked by the physician and was recorded. Emergency cases were not entertained. Repeat visit cases were not included in statistical analysis. The data were analyzed by SPSS 23. Results: A total of 453 cases were analysed. There were 40 COVID-19 cases and 413 non-COVID cases. COVID and non-COVID cases were analysed in different account. Thirty (75%) COVID-19 cases were RTPCR positive; asymptomatic (2, 5%), influenza-like illness (ILI) (16, 40%) and pneumonia (22, 55%). Thirty one (77.5%) were diabetic, 19 (47.%) had hypertension, 4 (10%) had bronchial asthma. Twenty four (60%) cases were treated with regimen following national guideline (dexa+antibiotic+enoxaparine). Non-COVID cases were with chronic diseases; diabetes mellitus (81.6%), hypertension (67.1%), bronchial asthma (9.2%), hypothyroidism (12.6%). Nearly half (45.8%) were insulin user. Among the respondants, 8.4% disliked service of telemedicine, 91.6% supported it but 41.9% expressed the wisdom of face to face consulation. Over half (51.8%) urged not to abandone it. Conclusion: Telemecinie may be a useful way of medical consultation where needed and indicated. Birdem Med J 2020; 10, COVID Supplement: 74-80
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