RESUMEN
BACKGROUND: Apart from being one of the main causes of death, sepsis has recently been considered a chronic critical illness. This has resulted in the implementation of standard treatment recommendations for management, with a focus on the initial phases of treatment. Early detection of sepsis and prognostic grading are now crucial for management. Despite the fact that sequential organ failure assessment score (SOFA), acute physiology, and chronic health evaluation II score (APACHE II) have been widely used in sepsis, there have been shortcomings such as feasibility and many lab parameters involved. As a result, this study was conducted to evaluate the role of serum lactate as an early marker and to compare it to current scoring systems for determining the outcome of sepsis. METHODS AND MATERIAL: This was an observational hospital-based study with 60 individuals recruited over a one-year period from July 2021 to June 2022. Serum lactate, as well as the other laboratory tests required for the computation of SOFA and APACHE II, were performed. The baseline data and the trend of lactate vs standard scores were examined in the first 48 hours, as well as their impact on outcomes in sepsis patients (as measured by mortality rates- patients were followed up for 28 days). The diagnostic accuracy of these scores was calculated using the area under the receiver operating characteristic (ROC) curve (AUROC). RESULTS: The study enrolled 60 people out of a total of 162 people who were screened. The mean age was 48.4 years, with the highest mortality occurring between the ages of 41 and 60 years. Of the total 60 participants, 34 (56.6%) were male, with the respiratory tract being the most common source of infection for sepsis (36.67%). In our study, 46 patients survived while 14 patients died. The mean lactate on admission was 3.1 mmol/L in survivors and 4 mmol/L in non-survivors, whereas APACHE II was 9 and 12.36, and SOFA was 3.63 and 7.79, respectively, in survivors and non-survivors. Serum lactate and prognosis scores were compared in the survivor and non-survivor groups, and the difference in diagnostic accuracy was found to be statistically significant. CONCLUSIONS: Serum lactate can be used as an early recognition marker in patients with a probability of sepsis and serial lactate monitoring has a similar diagnostic accuracy in predicting outcomes as the traditional prognostic scoring systems SOFA and APACHE II.
RESUMEN
We describe a 20-year-old male with childhood-onset seizures and a prolonged history of anti-epileptic use. The cause of his seizures remained undetected until he reached the second decade of his life. Extensive intracranial calcifications on brain imaging helped us identify hypocalcemia as a cause of seizures. He had low calcium due to primary hypoparathyroidism. He also had severe aplastic anemia at this time. There were a series of missed opportunities in his history that could have prevented prolonged anti-epileptic use and probably preserved his marrow. This is an educational case for all physicians on how parathyroid abnormalities may get missed.
RESUMEN
This article describes a case of melioidosis, a severe and potentially fatal disease caused by the Gram-negative bacillus Burkholderia pseudomallei, in a 55-year-old female in India. The disease is endemic in Southeast Asia and Northern Australia. Recently there has been an increased number of cases reported in India. The source of B. pseudomallei in India is thought to be soil and water, with the most common mode of infection being through skin contact. The clinical presentation of melioidosis in India varies greatly, making diagnosis difficult. The case presented here with a history of acute febrile illness and progressive dyspnoea, with clinical worsening leading to intensive care unit (ICU) care. We managed this acute pneumonia-like melioidosis with antibiotics and supportive care which showed rapid recovery at follow-up. This case highlights the need for a high index of suspicion and increased awareness of early diagnosis of melioidosis in the Indian subcontinent to improve the patient.
