Background: Sepsis, a syndrome of dysregulated host response to infection leading to life-threatening organ dysfunction, is having a substantial burden in health system. The outcome in sepsis is often time dependent. None of the clinical manifestations nor the age-old markers like ESR, CRP, etc. have proven diagnostic or prognostic of sepsis. This study aims to assess the role of neutrophil: lymphocyte ratio (NLR) in assessing the severity of sepsis within the initial 24 hrs of admission. Methods: Authors did a retrospective observational study in 208 sepsis patients admitted in the MDICU. The NLR was calculated and the study population was grouped into those with an NLR of more than or equal to 5 and those with less than 5. The patients were also grouped based on the number of organs impaired due to sepsis. The association between these groups were then assessed. Results: 46 patients (60.5%) with single organ involvement had NLR <5; 30 patients (39.5%) had NLR >5; 27 patients (42.2%) with two organ involvement had NLR <5 and 37 patients (57.8%) had NLR >5. Among patients with more than two organ involvement, 8 patients (21.6%) had NLR <5 and 29 patients (78.4%) had NLR >5. It was found that there is statistically significant association between increase in number of organs involved and NLR more than 5. The chi square test value was 15.691 with a p value was less than 0.001. Conclusions: In the current study, we have evaluated the role of NLR in sepsis. NLR calculated on the day of admission is a simple parameter that helps to stratify patients into severe risk category. A significant association was found with higher NLR and the number of organs impairment in sepsis.
Meningitis after spinal and epidural anaesthesia is rare but serious complication which requires early diagnosis and treatment. We report two cases of probable chemical meningitis, which developed within few hours after subarachnoid block. CSF pattern was suggestive of chemical meningitis. Both the patients recovered next day without any neurological sequelae. Meningitis should always be considered as a differential diagnosis in patients having post spinal headache, convulsions and changes in mental status. Despite thorough knowledge and practice of aseptic technique, aseptic meningitis can occur. INTRODUCTION:Meningitis after spinal and epidural anaesthesia is rare but serious complication which requires early diagnosis and treatment. Despite thorough knowledge and practice of aseptic technique, aseptic meningitis can occur. We report two cases of aseptic meningitis following subarachnoid block probably due to the drug used for intrathecal injection.
BACKGROUND A rising trend has been reported in Acute Kidney Injury (AKI) in both developed and developing countries and there is an independent association with increased morbidity and mortality with sepsis being the most common predisposing factor. Sepsis and cardiovascular causes resulted in a high incidence of AKI, and older age was also an important risk factor. Our study aims to determine the incidence, outcome and comorbidities associated with AKI in sepsis patients. Sepsis is a serious medical condition characterized by a whole-body inflammatory state (systemic inflammatory-response syndrome) and the presence of a known or suspected infection that has severe consequences, including multiple organ failure. METHODS We did a retrospective observational study in 497 sepsis patients admitted in MDICU. Acute kidney injury in these patients was identified and studied using RIFLE criteria between June 2016 and May 2017. RESULTS A total of 497 patients were studied. Mean age was 60 yrs. 59.8% were males and 40.2% were females. 279 have acute kidney injury; so, incidence of AKI in our study is 56.1%. Significant comorbidities associated with AKI are diabetes mellitus 61.6% (p= 0.001), hypertension 76.7% (p= 0.001), CKD 43.3% (p= 0.001), CAD 28.3% (p 0.020). Out of 279 AKI cases, 167 (59.9%) were under RISK, 94 (33.7%) were under kidney injury, 18 (6.5%) under renal failure. 246 (88.1%) received conservative management and 33 (11.9%) received renal replacement therapy. Out of 33 patients receiving RRT, 18 patients (54.5%) expired during the study period (p value 0.011). 14 patients (50%) of those who received early RRT died and 14 patients (50%) survived, whereas in late RRT 4 (80%) died and 1 patient (20%) survived. There is no statistically significant (p= 0.25) association between mortality and early or late initiation of RRT. CONCLUSIONS As the incidence of AKI is 56.1% and there is significant association between sepsis patients with AKI and comorbidity, high RIFLE score and mortality, RRT and mortality. So Specific goals for reducing incidence and mortality of acute kidney injury has to be formulated and uniform guidelines regarding initiating RRT should be formed.
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.
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