sepsis

Introduction: Factor VII (FVII) deficiency, a rare bleeding disorder, can manifest as an autosomal recessive congenital or an acquired coagulopathy. Acquired FVII deficiency, although infrequently reported, presents unique challenges in understanding its mechanisms and identifying underlying causes. Case presentation: We present a case of acquired FVII deficiency discovered in a 23-year-old female patient with no apparent underlying disease. The patient exhibited spontaneous ecchymosis and gingival hemorrhage, along with low FVII activity and isolated prolongation of prothrombin time. Extensive laboratory investigations excluded liver dysfunction, familial deficiency, vitamin K deficiency, and inhibitory antibodies. Prompt treatment with Fresh Frozen Plasma (FFP) and bypassing agents resulted in a favorable response and resolution of hematomas. Conclusion: Acquired FVII deficiency was identified with bleeding symptoms in association with prolonged prothrombin time and a low level of FVII activity. In literature, this deficiency has been associated with various conditions such as sepsis, aplastic anemia, stem cell transplantation, and neoplasms, although approximately 14% of cases remain idiopathic. Clinical outcomes remain generally poor, with limited complete remissions reported.

Catheter-Related Bloodstream Infections (CRBSIs) are severe healthcare-associated complication that occurs when bacteria enter the bloodstream through a catheter. The risk of CRBSIs is influenced by various factors. Prolonged catheter placement increases the risk, as each day increases the potential for bacterial colonization and bloodstream infection. Proper aseptic technique and a sterile environment during catheter insertion are essential to minimize infection risk. Stringent infection control measures during insertion, including sterile gloves, thorough hand hygiene, and appropriate skin disinfection, are crucial. Inadequate catheter site care and suboptimal catheter management can contribute to CRBSIs. Regular cleaning, disinfection, and dressing changes are necessary to reduce the risk of infection. The type of catheter used also affects infection risk. Central Venous Catheters (CVCs) and arterial catheters, especially those inserted into the jugular or subclavian vein, carry a higher risk of CRBSIs compared to peripheral venous catheters. Individuals with compromised immune systems, such as chemotherapy patients, organ transplant recipients, and those with HIV/AIDS, are more susceptible to CRBSIs. Patients with existing infections, like pneumonia or urinary tract infections, are at a heightened risk of acquiring CRBSIs due to potential cross-contamination. Healthcare professionals who fail to practice thorough hand hygiene before and after catheter-related procedures can introduce pathogens into the bloodstream. Leaving catheters in place when no longer necessary or using them unnecessarily elevates the risk of infection. To prevent CRBSIs, strict infection control protocols, including effective hand hygiene, sterile catheter insertion techniques, routine site care, and prompt catheter removal when no longer needed, are imperative. Healthcare facilities often implement specific protocols to mitigate CRBSI risk and enhance patient safety.

Sepsis, a life-threatening condition triggered by infection, poses a significant healthcare challenge with high mortality rates. The interplay between genetics and the immune response in sepsis, particularly in surgical and trauma patients, is complex and critical. Genetic polymorphisms, particularly in cytokine genes like TNF-α, IL-6, and IL-8, have been extensively studied for their influence on sepsis susceptibility, severity, and outcomes. Polymorphisms can alter gene expression and cytokine production, leading to variations in immune responses. Studies have also explored polymorphisms concerning sepsis in genes encoding CD86, TLR4, and SIRT6. This review highlights the association between genetic polymorphisms and inflammatory responses, focusing on their impact on sepsis outcomes in surgical and trauma patients. Genetic variations play a significant role in sepsis risk, severity, and prognosis, with potential implications for personalized therapeutic strategies. Biomarkers such as cytokine gene polymorphisms may aid in predicting sepsis risk and guiding treatment decisions. Complementary therapies like acupuncture and novel biomarkers like microvesicles carrying mitochondrial content provide additional avenues for personalized sepsis management. Furthermore, multiomics approaches offer promise in predicting postoperative outcomes in surgical patients. Understanding the genetic basis of sepsis is essential for improving prevention, diagnosis, and treatment, ultimately leading to better clinical outcomes. Combining genomics, bioinformatics, and clinical expertise, precision medicine can revolutionize sepsis management by tailoring interventions to individual genetic profiles, thus enhancing patient care and outcomes.

Background: Cesarean section at the second stage of labor occurs when the mother requires delivery with full dilatation of the cervix by cesarean section (CS), which poses a risk to the mother and fetus.Purpose: To study the maternal and fetal outcomes of second-stage cesarean section. Methods: This comparative study was conducted at Alhasahisa Teaching Hospital from August 2021 to January 2022. The study sample comprised 226 women who fulfilled the inclusion criteria, including 113 who delivered by second-stage cesarean section and 113 who delivered by first-stage labor cesarean section as controls. Data were collected using a questionnaire filled out by doctors after informed consent was obtained. Results: The common indications in women who delivered via second-stage cesarean section were fetal distress in 62(51.9%), obstructed labor in 26(23%), and failure to progress in 25(22.1%). In women who underwent first-stage cesarean section, the common indications were failure to progress in 85(75.2%), fetal distress in 16(14.2%), and chorioamnionitis in 12(10.6%) (p < 0.05).  The reported maternal complications in women who underwent second-stage cesarean section were postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in eight (7.1%), extended tears in four (3.5%), umbilical cord prolapse in three (2.7%), and episiotomy in three (2.7%). The admission to the neonatal intensive care unit (NICU) and the causes of admission were more common among the babies of the women delivered by second-stage cesarean section than the babies of the women delivered by first-stage cesarean section (p value < 0.05). Maternal complications in women who underwent second-stage cesarean section included postpartum hemorrhage in 34(30.1%), sepsis in 11(9.7%), prolonged labor in 8(7.1%), uterine extension in 4(3.5%), umbilical cord prolapse in 3(2.7%), and episiotomy in 3(2.7%) (p < 0.05).Conclusion: Second-stage labor cesarean section showed more complications of postpartum hemorrhage, sepsis, and extended tears, as well as more fetal complications, such as admission to the neonatal intensive care unit, fresh stillbirths, low Apgar scores, and birth asphyxia.

Severe alcoholic hepatitis is an ethical and clinical conundrum, wherein a liver transplant is often recommended. The adequacy of medical treatment versus the risk of recidivism after transplant is often debated. Complete recovery in 26 of 27 patients with severe alcoholic hepatitis was observed, and hence the data was retrospectively analysed.Methods: 27 patients, with severe alcoholic hepatitis, with Maddrey's discriminant function between 59.7 to 165.2 (mean 107.53), from June 2017 to May 2022, were followed up for between 11 months to 6 years. INR ranged from 1.99 to 3.7 (mean 2.709), and bilirubin was between 7.6 to 37.01, (mean 20.859). 8 patients had pre-existing liver cirrhosis. All patients received probiotics, nutritional support, physical rehabilitation, saturated fat (clarified butter/ desi ghee) supplementation, and anti-oxidant support. At 90 days, total bilirubin improved to between 1.0 to 6.8 (mean 2.625). ALT (Alanine Transaminase/ SGPT) ranged from 65 to 550 (mean ALT – 197); and AST (Aspartate Transaminase / SGOT) ranged from 58 to 810 (mean AST – 271.51). Both the AST and ALT were near normal after 90 days. One patient died due to bacterial pneumonia and sepsis; the remaining 26 patients made a complete recovery. All patients including those with diagnosed liver cirrhosis, had complete resolution of their ascites, and near-normal liver function. At the last outpatient visit, none had ascites, edema, or encephalopathy, and had normal albumin levels and INR values. Conclusion: Probiotics, nutrition, a saturated fat diet, and exercise; all have shown benefits in patients with severe alcoholic hepatitis when tested individually. Concomitant use of all the above has not been reported in the treatment of alcoholic hepatitis. The role of nutrition alone versus the contribution of nutritional deficiencies and the role of gut-derived endotoxemia need to be studied in detail. How to identify patients who need a transplant, if it is needed at all, remains a challenge.

Previable Preterm Premature Rupture of Membranes (PPROM) before 24 weeks of gestation in dichorionic diamniotic (DCDA) twin pregnancies is a rare and challenging obstetric complication. Three cases are presented in this case series, all involving prolonged latency periods of 74, 98, and 158 days following membrane rupture. The management strategy employed was expectant, utilizing antibiotic prophylaxis and close monitoring to prevent infection. Neonatal outcomes varied, with pulmonary hypoplasia and respiratory distress observed in some cases. One twin from Case 2 died due to sepsis, while the remaining twins in all three instances survived after extended neonatal intensive care. This series highlights the potential for extended latency and favorable outcomes in select cases, though neonatal morbidity remains a significant risk, underscoring the need for individualized counseling and vigilant care.

Bartholinitis, or Bartholin's gland abscess, is a relatively common gynecological condition among women of reproductive age. Its annual incidence is estimated at approximately 0.5 per 1,000 women, which corresponds to a lifetime cumulative risk of about 2%. The condition primarily affects patients between 20 and 50 years old, with a peak frequency observed between 35 and 50 years.After menopause, due to the natural involution of the gland, Bartholin's cysts and abscesses become less frequent, although they can still occur. Moreover, in women over 50, the appearance of a new mass in the gland region should prompt caution, as it may, in rare cases, indicate a carcinoma of the Bartholin's gland or an adjacent vulvar cancer. Therefore, for patients over 40 presenting with a newly emerged cyst or abscess, clinical guidelines recommend performing a biopsy or excision to rule out malignancy. We present the case of a 50-year-old woman with no significant medical history, who was urgently referred to the gynecological emergency department due to confusion, unexplained fever of 40 °C, and resistant leucorrhoea following a week of corticosteroid antibiotic therapy. Clinical examination revealed a large, tender right vulvar mass, indicative of an acute Bartholin's abscess. The patient exhibited signs of septic shock and was admitted to the ICU. Following a diagnosis of sepsis, broad-spectrum antibiotic therapy was initiated, alongside fluid resuscitation and norepinephrine support. Surgical drainage of the abscess confirmed the presence of E. coli. The patient's condition improved rapidly, and she was discharged on postoperative day 8 with no complications. This case underscores that while Bartholin's abscess is typically benign, severe complications, including septic shock, can occur—especially in patients over 50. The appearance of a new Bartholin's region mass in older women should prompt consideration of malignancy, necessitating biopsy or excision. Recent studies compare various therapeutic approaches including simple incision and drainage, Word catheter placement, marsupialization, silver nitrate application, and complete gland excision. Each method has its advantages and drawbacks, with marsupialization offering lower recurrence rates and higher patient satisfaction in many instances. 

Stress in acute stroke may increase mortality and complications, but there is a paucity of information on the efficacy of beta blockers  over other anti-hypertensive. To report efficacy of metoprolol over amlodipine in reducing mortality, disability and infections in acute stroke. CT/MRI confirmed stroke patients within 3 days of onset were included whose age was 18 to 75 years. Patients with secondary intracerebral hemorrhage, organ failure, pregnancy, malignancy, and immunosuppressant or on beta-blocker/amlodipine were excluded. Stroke risk factors, Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score and CT/MRI findings were noted. Patients with a blood pressure of > 160/90 mm of Hg were randomized using 1:1 randomization to metoprolol (25 mg on day 1, 50 mg if BP is not controlled) or amlodipine (2.5 mg on day 1, then 5 mg then 10 mg on, subsequent days if BP is not controlled). Other standard treatment was continued. The primary outcome was mortality at 1 month; secondary outcomes included  were in-hospital gastrointestinal hemorrhage, pneumonia, sepsis and 3 months functional outcome based on modified Rankin Scale (mRS). Side effects were noted. 18 (14.4%) patients died; 6 (9.7%) in metoprolol and 12 (19%) in amlodipine (p = 0.20) group. At 3-months, 66 patients had good outcome; 45 (80.4%) in metoprolol and 21 (43.3%) in amlodipine group (p < 0.001). The other secondary outcomes were comparable between the two groups. Metoprolol was withdrawn in 6 patients due to bradycardia, and amlodipine in 5 due to hypotension and in 1 due to allergic reaction. Metoprolol is associated with improved functional outcomes in acute stroke  compared to amlodipine.