Internal Medicine Commons^™

A Retrospective Study Of Procalcitonin Utilization In Clinical Practice, Tanner Norris, Matthew Yurkewicz, Patrick Jenkins, Beth Hicks, Dmitriy Scherbak

Continental, MidAmerica, & Mountain Divisions Research Day 2024

No abstract provided.

Role Of Soluble Urokinase Type Plasminogen Activator Receptor (Supar) In Predicting Mortality, Readmission, Length Of Stay And Discharge In Emergency Patients: A Systematic Review And Meta Analysis, Syeda Tayyaba Rehan, Hassan Ul Hussain, Eman Ali, Kanwal Ashok Kumar, Shehroze Tabassum, Muhammad Hasanain, Asim Shaikh, Gibran Ali, Zohaib Yousaf, Muhammad Sohaib Asghar

Section of Internal Medicine

Background: Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker that is used to predict mortality, readmission, early discharge, and LOS, thus, serves as a useful tool for ED physicians. Our study aims to analyze the efficacy of suPAR in predicting these prognostic markers in ED.
Methods: We performed a comprehensive search on 6 databases from the inception to 30th November 2022, to select the following eligibility criteria; a) observation or triage trial studies investigating the role of suPAR levels in predicting: 30 day and 90-day mortality, 30-day readmission, early discharge (within 24hr), and LOS in patients coming to …

Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness In Non-Intubated Septic Patients A Prospective Observational Study, Anne Githaiga, Wangari Siika, Jeilan Mohamed, Vitalis Mung’Ayi, Idris Chikophe

Anaesthesiology, East Africa

Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed.

Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa.

Methodology: A prospective observational study which recruited non-intubated …

Decreasing Rate Of Clabsi At Medical City North Hills With Implementation Of A “Central Line Cart”, William Mangin, Hong Lou, David Maldonado

North Texas Research Forum 2023

Central line associated blood stream infections (CLABSI) impart both a significant increase in mortality but also a substantial financial burden onto hospitals. Several processes have been shown to reduce the rate of CLABSIs, most of which have already been implemented at Medical City North Hills (MCNH) Hospital. Key areas of improvement are in those of compliance; namely, the implementation of a dedicated central line cart and a reminder check list to help staff. The project involved implementation of a dedicated line cart at MCNH Hospital. The cart contains supplies for placement of central lines, including trialysis catheters, and arterial lines. …

Unexpected Complications Involving A Subdermal Facial Piercing In A Patient With Tricuspid Endocarditis, A Case Report, Andrew Kim, Cristian Valdez, Tony Alarcon

Far West Division Research Day 2023

No abstract provided.

Performance Of Amiodarone As A First-Line Pharmacologic Agent To Treat New Onset Atrial Fibrillation In Patients With Sepsis And Septic Shock: A Retrospective Cohort Study In A Large U.S. Hospital System, Blerina Asllanaj, Elizabeth Benge, Don Pepito

Far West Division Research Day 2023

No abstract provided.

Cardiac Tamponade In The Setting Of Severe Sepsis And Adrenal Insufficiency, Ayesha Choudhry, Matthew Cardeiro, Angelina Hong, Adekunle Bamgboye

East Florida Research Day 2023

Introduction: Pericardial effusions can have various etiologies, including infectious, autoimmune, drug induced, endocrinologic, among others. Cardiac tamponade occurs when large effusions compress the heart and can lead to obstructive shock.

Case Description: A 48-year-old female with a history of hypothyroidism and pituitary adenoma resection presented with subjective fevers and generalized weakness for the past 5 days. She was lethargic with muffled heart sounds on exam. Vitals showed a heart rate 95 beats per minute, blood pressure 63/51, respiratory rate 18 breaths per minute, with normal temperature. Labs on admission were significant for white blood cell count of 11,500/L, hemoglobin 10.8 …

An Analytical Study Of The Risk Factors Affecting The Platelet Aggregation In Patients With Sepsis, Vishnu Priya, Jitender M. Khunger, Anupma Arora

Journal of Medicine in Scientific Research

Objectives (a) To determine the correlation of platelet count and aggregation with sepsis severity and (b) to find the risk factors affecting the platelet aggregation in sepsis. Patients and methods The present observational cross-sectional study was conducted on 30 patients of sepsis over a period of 18 months. All patients underwent complete blood counts, and platelet aggregation to ADP. Pearson correlation coefficient was used to assess the association of Sequential Organ Failure Assessment (SOFA) score and aggregation to ADP and platelet. Linear regression was done to determine the risk factors affecting platelet aggregation in sepsis. A P value of less …

Lactate/Albumin Ratio As A Predictor Of Mortality In Patients With Sepsis And Septic Shock: A Meta-Analysis Study, Fahri Ahmad Baihaqi, Dinda Olinda Delarosa, Rezki Ramadhan

Jurnal Penyakit Dalam Indonesia

Introduction. The lactate/albumin ratio is an inflammatory biomarker that has been widely used and suggested as a predictor of mortality in patients with sepsis and septic shock. However, the results are inconsistent. This meta-analysis aimed to evaluate the prognostic value of lactate/albumin ratio as a predictor of mortality in patients with sepsis and septic shock.Methods. The study protocol was registered with PROSPERO (CRD42021286242). A literature search was performed using PubMed, Ovid EMBASE, Ovid MEDLINE, SCOPUS, and Web of Sciences to find all studies evaluating the association between lactate/albumin ratio and mortality in patients with sepsis and septic shock. Meta-analysis was …

Comparison Of Hospital Mortality, Length Of Stay, Renal Recovery, And Needs For Hemodialysis In Acute Kidney Injury (Aki) Patients Due To Septic And Non-Septic, And Factors Affecting Patients’ Mortality, Mochammad Jalalul Marzuki, Nursamsu Nursamsu, Achmad Rifai

Jurnal Penyakit Dalam Indonesia

Introduction. Acute kidney injury (AKI) is a major complication in critically ill patients that affects mortality. Sepsis is a major predisposing factor for AKI and provides a poor prognosis and high mortality rate. Thisstudy aimed toidentifythe difference of hospital mortality, length of stay, renal recovery, and needs for hemodialysis between AKI patients due to sepsis and non-sepsis, as well as to determine the factors that influence the mortality of patients with AKI.Methods. An analytical observational study was conducted among patients with AKI according to the KDIGO criteria and aged ≥40 years old. Data were obtained from patients’ medical records in …

Frequency And Types Of Healthcare Encounters In The Week Preceding A Sepsis Hospitalization: A Systematic Review, Alexander H. Flannery, Chad M. Venn, Amanda Gusovsky, Stephanie Henderson, Adam S. Kiser, Hallie C. Prescott, Chanu Rhee, Chris Delcher, Peter E. Morris

Pharmacy Practice and Science Faculty Publications

OBJECTIVES: Early recognition and treatment are critical to improving sepsis outcomes. We sought to identify the frequency and types of encounters that patients have with the healthcare system in the week prior to a sepsis hospitalization.

DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and the Cochrane Library.

STUDY SELECTION: Observational cohort studies of patients hospitalized with sepsis or septic shock that were assessed for an outpatient or emergency department encounter with the healthcare system in the week prior to hospital admission.

DATA EXTRACTION: The primary outcome was the proportion of patients with a healthcare encounter …

The Role Of Albumin And Hemoglobin As Predictors Of 28-Day Mortality In Elderly Sepsis Patients In Mohammad Hoesin Hospital Palembang, Widya Mandala Sari Gultom, Nur Riviati, Rizky Perdana, Syarif Husin

Jurnal Penyakit Dalam Indonesia

Introduction. Sepsis is defined as organ dysfunction caused by dysregulation of the host’s response to infection. The majority of sepsis are experienced by elderly patients with high mortality rates. In the condition of sepsis, there are various body mechanisms that cause a decrease in albumin and hemoglobin. This study is to determine the predictive value of albumin and hemoglobin levels on 28-day mortality of elderly sepsis patients.

Secondary Bacterial Pneumonias And Bloodstream Infections In Patients Hospitalized With Covid-19, Max W Adelman, Divya R Bhamidipati, Alfonso C Hernandez-Romieu, Ahmed Babiker, Michael H Woodworth, Chad Robichaux, David J Murphy, Sara C Auld, Colleen S Kraft, Jesse T Jacob

Journal Articles

No abstract provided.

Vasopressin In Conjunction With Norepinephrine In Septic Shock: A Retrospective Cohort Study From A Low Middle-Income Country, Hussain Ahmed Raza, Ainan Arshad, Ahmed Ayaz, Mohummad H R. Raja, Fatima Gohar, Maria Khan, Bushra Jamil

Medical College Documents

Objectives: Guidelines recommend use of norepinephrine as the first-line treatment for fluid-refractory septic shock and if septic shock persists vasopressin may be initiated. Since there are limited data from low middle-income countries with high disease burden of sepsis, we aimed to compare the outcomes of using vasopressin adjunct to norepinephrine in comparison with norepinephrine alone.
Design: Retrospective cohort study.
Setting: Aga Khan University Hospital, Karachi, Pakistan.
Patients: Six-hundred fifty-three patients diagnosed with septic shock from January 2019 to December 2019, with 498 given norepinephrine only and 155 given norepinephrine-vasopressin combination.
Interventions: None.
Measurements and main results: Primary outcome was in-hospital …

Development, Expansion And Role Of Myeloid-Derived Suppressor Cells In Post-Sepsis Immune Suppression, Tuqa Alkhateeb

Electronic Theses and Dissertations

Myeloid-derived suppressor cells (MDSCs) numbers increase significantly in sepsis and are associated with high mortality rates. These myeloid cell precursors promote immunosuppression, especially in the late (post sepsis) stage. However, the mechanisms that underlie MDSC expansion and programming are not completely understood. To investigate these mechanisms, we used a cecal-ligation and puncture (CLP) mouse model of polymicrobial sepsis that progresses from an early/acute proinflammatory phase to a late/chronic immunosuppressive phase. Previous studies in our laboratory showed that microRNA (miR)-21 and miR-181b elevate levels of the transcription factor nuclear factor 1 (NFI-A) that promotes MDSC expansion. We report here that miR-21 …

Prevalence Of Risk Factors Of Acute Kidney Injury In A Tertiary Care Hospital In Pakistan, Ainan Arshad, Ahmed Ayaz

Section of Internal Medicine

The objective of this study was to determine the prevalence of preventable risk factors of acute kidney injury in a tertiary care hospital in Pakistan. All patients admitted at Aga Khan University Hospital, Karachi with diagnosis of acute kidney injury were included out of which 134 were selected via random sampling. Patients with existing CKD were excluded. Data was then collected retrospectively from medical records of these patients. Mean age was 60±11.7 years while mean serum creatinine on admission was 2.4±1.3 (mg/dl). Sepsis played a role in almost half of the patients [60 (45%)]. Other factors included diarrhoea [23 (17%)], …

Pasteurella Multocida Bacteremia Secondary To Multiple Cat Scratches, Charles Boadu, Andrea Hernandez, Bassem Zeidan, John T. Young, Johnathan Frunzi

West Florida Division Virtual Research Day 2020

Pasteurella multocida(P. multocida)is part of the normal gastrointestinal and upper respiratory flora of domestic and wild animals such as dogs, cats, rabbits, opossums, boars, tigers, lions and horses ^{(1, 2)}. Transmission of P. multocidais usually through scratches and bites leading to infections of the soft tissue and skin ^(3,4). P. multocida bacteremia is rare, but occurs in individuals with major risk factors including chronic pulmonary disease, diabetes mellitus, end state renal disease (ESRD), and an immunocompromised state ^(3,4). Non traumatic infections of P. multocida in immunocompromised individuals,are more likely to require care in the intensive care unit …

Modern Ventilator Management In Surgical/Trauma Patients, Errington C. Thompson

Marshall Journal of Medicine

Physicians have a lot to consider when they place a patient on the ventilator. This article reviews the literature and provides the physician with a clear guide to managing the ventilator in the ICU. This manuscript is meant to be a practical guide to managing the ventilator at the patient's bedside.

Comparison Of Mortality Between Intravenous Albumin And No Intravenous Albumin In Sepsis Patients With Hypoalbuminemia Conditions And Factors That Influence The Mortality Of Sepsis Patients, Mochammad Jalalul Marzuki, Supriono Supriono, Bogi Pratomo, Syifa Mustika

Jurnal Penyakit Dalam Indonesia

Introduction. Hypoalbuminemia is a strong predictor of mortality in nonoperative and operative patients. Albumin plays a role in maintaining oncotic pressure in critical conditions such as sepsis. The administration of exogenous Human Serum Albumin (HSA) in sepsis with hypoalbuminemia conditions is still controversial with varying outcomes.This study aimed to know the mortality ratio between intravenous albumin administration and no intravenous albumin administration in sepsis patients with hypoalbuminemia conditions and also to know the factors that influence the mortality of sepsis patients. Methods. An observational study with a prospective approach involving 75 research subjects aged >18 years with sepsis accompanied by …

Ammonia Vs. Lactic Acid In Predicting Positivity Of Microbial Culture In Sepsis: The Alps Pilot Study, Yazan Numan, Yasir Jawaid, Hisham Hirzallah, Damir Kusmic, Mohammed Megri, Obadah Aqtash, Ahmed Amro, Haitem Mezughi, Emmon Maher, Yonas Raru, Jamil Numan, Sutoidem Akpanudo, Zeid Khitan, Yousef Shweihat

Zeid J. Khitan

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients.

Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days.

Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 …

Ammonia Vs. Lactic Acid In Predicting Positivity Of Microbial Culture In Sepsis: The Alps Pilot Study, Yazan Numan, Yasir Jawaid, Hisham Hirzallah, Damir Kusmic, Mohammed Megri, Obadah Aqtash, Ahmed Amro, Haitem Mezughi, Emmon Maher, Yonas Raru, Jamil Numan, Sutoidem Akpanudo, Zeid Khitan, Yousef Shweihat

Sutoidem Akpanudo

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients.

Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days.

Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 …

Cause Of The Low Positivity Of Blood Culture In Septic Patients, Krishna Yana, Bachti Alisjahbana, Yovita Hartantri

Jurnal Penyakit Dalam Indonesia

Introduction. Sepsis due to bacterial infection is one of the main causes of high disease morbidity and mortality. Management of sepsis, the detection of bacteriemia by examination of blood cultures has an important role, but until now the positivity of blood culture results at Hasan Sadikin Hospital (RSHS) is still low (13.45%). The purpose of this study was to determine profile the causes of low positivity of blood culture results in sepsis patients in RSHS. Methods. A cross sectional study was conducted on sepsis patient treated in Emergency Un it (ER) and inpatient of Hasan Sadikin hospital Internal Medicine from …

The Association Of Qsofa, Sofa, And Sirs With Mortality In Emergency Department Pneumonia, Ian D. Mecham, Nathan C. Dean, Emily L. Wilson, Al R. Jephson, Michael J. Lanpsa

The University of Louisville Journal of Respiratory Infections

Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission.

Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for …

A Case Of Secondary Hemophagocytic Lymphohistiocytosis In An Adult Patient Treated With Concurrent Dexamethasone And Interleukin-1 Receptor Blockade, Vikas Sunder, Md

The Medicine Forum

INTRODUCTION

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, life-threatening syndrome of overwhelming inflammation caused by activation and proliferation of T-lymphocytes and hemophagocytic macrophages. This uncontrolled proliferation of macrophages creates a cytokine storm with resultant tissue damage. HLH is associated with clinical and laboratory findings which include fever, cytopenias, hepatic dysfunction, splenomegaly, and marked hyperferritinemia.1-3 There exists limited epidemiologic data on adult (age ≥ 18 years) cases of HLH, and its incidence is uncertain. HLH can be due to inherited mutations causing immune system dysregulation or secondary to underlying malignancy, infection, or rheumatologic condition. Macrophage activation syndrome (MAS) refers to HLH that …

Liver Abscess Turned Metastatic Infection In An Otherwise Healthy Patient: A Case Report, Samik Shah, Md, Ritu Nahar, Md, Neha Bansal Etherington, Md

The Medicine Forum

INTRODUCTION

The most common type of visceral abscesses are liver abscesses, which have a mortality rate of at least 2.5 percent.1,2 Most liver abscesses are polymicrobial, containing both facultative and anaerobic enteric pathogens, and develop secondary to another infection such as peritonitis and cholangitis, or from hematogenous spread.2-4 Liver abscesses are sometimes associated with systemic diseases such as colorectal cancer and diabetes mellitus.5,6 Rarely, as in our case presentation, primary liver abscesses occur spontaneously in patients with no identifiable precipitating or predisposing conditions.

Ammonia Vs. Lactic Acid In Predicting Positivity Of Microbial Culture In Sepsis: The Alps Pilot Study, Yazan Numan, Yasir Jawaid, Hisham Hirzallah, Damir Kusmic, Mohammed Megri, Obadah Aqtash, Ahmed Amro, Haitem Mezughi, Emmon Maher, Yonas Raru, Jamil Numan, Sutoidem Akpanudo, Zeid Khitan, Yousef Shweihat

Internal Medicine

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients.

Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days.

Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 …

Evaluation Outcomes Of A Modified Early Warning System For Early Identification Of Sepsis In The Adult Population Requiring Acute Care, Gavin M. Turpin

DNP Projects

Objectives: To examine the use of a Modified Early Warning System (MEWS) for sepsis identification and evaluate its effects on treatment and outcomes for those patients diagnosed with sepsis after admission, during their stay at an acute care facility.

Design: A retrospective chart audit was conducted on the electronic medical records (EMRs) of patients who developed, and were diagnosed with, sepsis post admission. Specifically, a retrospective separate sample pretest posttest design was used to examine the accuracy of the MEWS, differences in outcomes (ICU days, length of hospital stay, qSOFA Score and mortality rates), and treatment initiation time (fluid resuscitation, …

A 30 Years Old Woman With Sepsis, Skin And Soft Tissueinfection, And Obesity, Franzeska Adm Widinartasari, Muhammad Ali Sodiq, Muchlis Au Sofro

Jurnal Penyakit Dalam Indonesia

Obesity increases morbidity and mortality through its multiple efects on nearly every human system. Obesity has efect on the immune response which leads to susceptibility to infections. ß lactamases are bacterial enzymes that inactivate ß-lactam antibiotics by hydrolysis. One group of ß lactamases, extended-spectrum ß lactamases (ESBLs), have the ability to hydrolyse and cause resistance to various types of the newer ß-lactam antibiotics. The management of skin and soft tissue infection with polymicrobial infection and multi drug resistance can be challenging problem. We present a case of an obese patient with polymicrobial SSTI. bPatient showed clinical sign of sepsis with …

Peran Procalcitonin Sebagai Penanda Inflamasi Sistemik Pada Sepsis, Dana Dharaniyadewi, Khie Chen Lie, Suhendro Suwarto

Jurnal Penyakit Dalam Indonesia

Terapi antibiotika awal dan tepat merupakan faktor yang penting untuk kesintasan pasien sehingga diperlukan pemeriksaan yang cepat dan akurat untuk deteksi adanya bakteri di sirkulasi. PCT merupakan biomarker yang paling sering dipelajari dan rutin digunakan dalam praktik klinik dan rekomendasi saat ini di beberapa negara. Kadar PCT serum meningkat pada sepsis. Kadar PCT normal di bawah 0,5 ng/mL dan kadar PCT > 2 ng/mL memiliki risiko tinggi untuk sepsis. PCT lebih unggul daripada CRP untuk diagnosis dan prognosis sepsis pada pasien kritis tetapi penggunaannya harus tetap diiringi dengan penilaian secara klinis. Hal ini terutama penting pada awal infeksi atau pasien dengan …

Maternal And Neonatal Outcomes By Labor Onset Type And Gestational Age, Jennifer L Bailit, Kimberly D Gregory, Uma M Reddy, Victor H Gonzalez-Quintero, Judith U Hibbard, Mildred M Ramirez, D Ware Branch, Ronald Burkman, Shoshana Haberman, Christos G Hatjis, Matthew K Hoffman, Michelle Kominiarek, Helain J Landy, Lee A Learman, James Troendle, Paul Van Veldhuisen, Isabelle Wilkins, Liping Sun, Jun Zhang

Journal Articles

OBJECTIVE: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.

STUDY DESIGN: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.

RESULTS: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor.

CONCLUSION: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction …