Clinical Outcomes of Community-Acquired Severe Sepsis after Implementation of a Simple Severe Sepsis Fast Track.

Background: Severe sepsis and septic shock are the most common causes of in-hospital death in Songkhla Provincial Hospital and half of the patients are transferred from community hospitals. A simple severe sepsis and septic shock fast track had been implemented in all community hospitals in Songkhla Province and in Songkhla Provincial Hospital in December 2013. Objective: Evaluate the clinical outcomes and predictors of mortality of severe sepsis and septic shock patients after implementation of the simple severe sepsis and septic shock fast track. Material and Method: A retrospective study of all available medical records between December 2013 and May 2014 of hospitalized patients aged older than 15 years with a final diagnosis of severe sepsis or septic shock. Results: Of 723 patients diagnosed as community acquired sepsis, 228 (31.5%) patients were diagnosed with severe sepsis or septic shock. A simple severe sepsis and septic shock fast track were activated in 69.3%. Patients in the activated fast track group had significantly lower mortality than the non-activated fast track group (21.0% vs. 42.9%, p = 0.001). After adjusted analysis, the four independent risk factors associated with increased mortality in severe sepsis and septic shock were initial presentation with systolic blood pressure lower than 90 mmHg (adjusted odds ratio [aOR] 2.57), central nervous system failure (aOR 7.33), acute renal failure (aOR 5.07), and received norepinephrine (aOR 2.87). Two factors associated with a significant decrease in mortality were the simple fast track activated at the emergency department (aOR 0.22) or at the ward (aOR 0.09) and received appropriate initial antibiotics (aOR 0.09). Conclusion: Early recognition and early resuscitation in case of severe sepsis and septic shock can reduce mortality. A simple severe sepsis and septic shock fast track should be implemented in all community hospitals. It is a simple clinical diagnosis with simple management that is possible in every community hospital before transfer to a secondary or tertiary care hospital.

Effects of long-term use of HAART on oral health status of HIV-infected subjects.

BACKGROUND: The aim of this study was to determine the effects of long-term use of highly active antiretroviral therapy (HAART) on oral health status of HIV-infected subjects. METHODS: Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in HIV-infected subjects with and without HAART, and in non-HIV individuals. The following data were recorded; duration and risk of HIV infection, type and duration of HAART, CD4 cell count, viral load, presence of orofacial pain, oral dryness, oral burning sensation, oral lesions, cervical caries, and periodontal pocket. Multiple logistic regression analysis was performed to determine the effects of long-term use of HAART on oral health status of HIV-infected subjects. RESULTS: One hundred and fifty-seven HIV-infected subjects - 99 on HAART (age range 23-57 years, mean 39 years) and 58 not on HAART (age range 20-59 years, mean 34 years) - and 50 non-HIV controls (age range 19-59 years, mean 36 years) were enrolled. The most common HAART regimen was 2 NRTI + 2 NNRTI. HIV-infected subjects without HAART showed greater risks of having orofacial pain, oral dryness, oral lesions, and periodontal pockets than those with short-term HAART (P < 0.01). The subjects with long-term HAART were found to have a greater risk of having oral lesions than those with short-term HAART (P < 0.05). The unstimulated and stimulated salivary flow rates of the subjects with HAART were significantly lower than in those without HAART (P < 0.05). CONCLUSION: We conclude that long-term HAART has adverse effects on oral health status of HIV-infected subjects.