Features Of Shock Research Articles

Functional echocardiography for management of shock in neonates - study protocol for a randomized controlled trial

Background: Shock is common in sick neonates and is associated with a high mortality. Detection and management of shock by monitoring clinical parameters may be inadequate due to inconsistent association with tissue perfusion. We hypothesize that objective assessments of cardiac functions may help to match the pathophysiology of shock with the pharmacological action of a vasoactive drug. This may lead to earlier resolution of shock and reduced incidence of mortality or brain injury. To test this hypothesis, this study aims to evaluate the efficacy of adding functional echocardiography to standard clinical assessment in improving short-term outcome of neonates with clinical features of shock. Methods: This study will be an open-labeled randomized controlled trial, conducted in all inborn neonates born at >27 weeks of gestation who develop clinical signs of shock. Enrolled neonates will be randomized into two groups: the echo group and the control group. Neonates in the echo group will be assessed for management of shock by both standard clinical evaluation and functional echocardiography. Neonates in the control group will be assessed for the management of shock by standard clinical evaluation. Primary outcome will be survival without requirement of inotropic support at 72 hours of randomization. Secondary outcomes include time to hemodynamic stability, duration of inotropic support and incidence of abnormal cranial ultrasound. Results: Among the 154 patients in the Clinical Trial Group, 70/154 (45%) continued to have proteinuria, while 84/154 (55%) had no proteinuria (remission) compared to 41 (28%) in remission and 104 (72%) with continued proteinuria in the Usual Care group (p<0.001). Conclusions: The trial intends to deduce the advantages, if any, of addition of functional echocardiography to standard clinical assessment to guide management of shock among preterm and term neonates. Trial registration: CTRI number: CTRI/2023/08/056672.

War shock and the economy

AbstractThe main features of war shock are substantially different from those of the preceding COVID-19 shock. The EU economy is showing important elements of resilience. The existing structural forces and adaptive capacity of the EU economy are clear indications that it is capable of transformation and avoiding recession.The dynamics of the war is also crucial in terms of economic impacts. There are still many uncertainties about the future course of the war and its ramifications. The fundamental question is whether the war is heading in the direction of escalation or de-escalation. Unless the war spreads beyond Ukraine and the conventional means of warfare, its global economic consequences may be limited after the initial shock. New adjustment processes in the field of green and digital transition can be set in motion in parallel with the suffering and turmoil of war shock. New market players could emerge in the energy markets.The prolonged war continues to challenge the Ukrainian economy, but it can remain viable with massive external support. The Russian economy could suffer serious erosion, with its comparative advantage being wasted.There is a real threat of deglobalisation and the emergence of a fragmented world economy, but the counteracting factors appear to be much stronger. However, the prolonged war continues to pose major and unpredictable threats to the countries affected directly and indirectly, to Europe and to the world economy.

ВОПРОСЫ БЕЗОПАСНОСТИ ПАЦИЕНТОВ ПРИ ПРИМЕНЕНИИ ЭЛЕКТРОХИРУРГИЧЕСКИХ ТЕХНОЛОГИЙ

n the organization of modern surgical practice, one of the main and undoubtful trends is to ensure and control the safety of patients undergoing surgery, which, in turn, serves as the basis for the proper level of quality of medical care. The development of modern surgery is inconceivable without the use of the latest technologies. But along with their high efficiency, there are also certain dangers. A wide range of equipment used in surgery requires deep knowledge of medical personnel on its safe use. It should be noted that the increase in the volume of new technologies will only increase. This is primarily associated with the progress in surgery. The article discusses the basics of monopolar and bipolar electrocoagulation. The possible effects of electrocoagulation depending on the settings of high-frequency electrosurgical devices are described. The causes of alternative electrical current output from the patient's body and electrical burns are considered. The variants and procedure for installing neutral electrodes are presented. The features of electric shock during laparoscopic surgeries are described. The recommendations for electrical safety of patients during surgical interventions are given.

Advancing Human iPSC-Derived Cardiomyocyte Hypoxia Resistance for Cardiac Regenerative Therapies through a Systematic Assessment of In Vitro Conditioning.

Acute myocardial infarction (MI) is a sudden, severe cardiac ischemic event that results in the death of up to one billion cardiomyocytes (CMs) and subsequent decrease in cardiac function. Engineered cardiac tissues (ECTs) are a promising approach to deliver the necessary mass of CMs to remuscularize the heart. However, the hypoxic environment of the heart post-MI presents a critical challenge for CM engraftment. Here, we present a high-throughput, systematic study targeting several physiological features of human induced pluripotent stem cell-derived CMs (hiPSC-CMs), including metabolism, Wnt signaling, substrate, heat shock, apoptosis, and mitochondrial stabilization, to assess their efficacy in promoting ischemia resistance in hiPSC-CMs. The results of 2D experiments identify hypoxia preconditioning (HPC) and metabolic conditioning as having a significant influence on hiPSC-CM function in normoxia and hypoxia. Within 3D engineered cardiac tissues (ECTs), metabolic conditioning with maturation media (MM), featuring high fatty acid and calcium concentration, results in a 1.5-fold increase in active stress generation as compared to RPMI/B27 control ECTs in normoxic conditions. Yet, this functional improvement is lost after hypoxia treatment. Interestingly, HPC can partially rescue the function of MM-treated ECTs after hypoxia. Our systematic and iterative approach provides a strong foundation for assessing and leveraging in vitro culture conditions to enhance the hypoxia resistance, and thus the successful clinical translation, of hiPSC-CMs in cardiac regenerative therapies.

Comparison of clinical features of septic shock in children with hematological malignancies versus children without malignant tumors

Objective: To investigate the clinical features of septic shock in children with hematological malignancies compared with those without malignant tumor in the pediatric intensive care unit (PICU). Methods: This retrospective study enrolled children with septic shock at the PICU of Capital Institute of Pediatrics' Children's Hospital from June 2015 to July 2022. According to the presence of hematological malignancies, patients were divided into the hematological malignancies group and without malignant tumor group. Clinical data were compared between the two groups, and logistic regression analysis was used to identify related factors for mortality. Results: A total of 164 children (97 males and 67 females) with a median age of 3.6 (interquartile range 0.8, 7.8) years were enrolled, including 75 (45.7%) patients with hematological malignancies and 89 (54.3%) patients without malignant tumors. Patients in the hematological malignancies group were older [6.0(3.6, 9.4) years vs 1.2 (0.4, 4.3) years, P<0.001] and more experienced hospital-acquired infections [48.0%(36/75) vs 21.3%(19/89),P=0.001], compared with patients without malignant tumors. Surgical emergencies were more frequent in patients without malignant tumors (32.6% vs 14.7%, P=0.013). Patients with hematological malignancies mainly had blood stream infections (58.7%), with Gram-negative bacilli (46.7%), meanwhile, patients without malignant tumors more experienced Gram-positive cocci infections (22.5%) of the respiratory system (40.4%) or digestive system (28.1%). There were significant differences regarding the infection sites (P<0.001) and pathogens (P=0.001). The types of antibacterial agents (P<0.001) and the frequency of noradrenaline (P=0.013) used in patients with hematological malignancies were significantly higher than those without malignant tumors. Patients with hematological malignancies had a higher incidence of multiple organ dysfunction (MODS) [100.0%(75/75) vs 80.9%(72/89), P<0.001] and higher 28-day mortality [34.8%(23/66) vs 19.0%(15/79),P=0.048]. Multivariate logistic regression analysis showed that Pediatric Critical Illness Score (PCIS) was an independent factor for death (odds ratio, OR=1.387, 95%CI: 1.161-1.657, P<0.001) in patients with hematological malignancies, and PCIS (OR=1.419, 95%CI: 1.140-1.767, P=0.002) and the 6-hour lactate clearance rate (OR=65.857, 95%CI: 2.953-1 468.638, P=0.008) were independent factors for death in patients without malignant tumors. Conclusions: Children with hematological malignancies were older, more frequently experienced bloodstream infections, and had a higher incidence of MODS and higher 28-day mortality. PCIS is related to poor prognosis of septic shock in children.

Health characteristics and factors associated with transition shock in newly graduated registered nurses: a latent class analysis

BackgroundTransition shock occurs at a vulnerable time in newly graduated registered nurses’ careers and has a clear impact on both newly graduated registered nurses’ productivity and patient recovery outcomes. Identifying classification features of transition shock and targeting interventions to support newly graduated registered nurses is imperative. The study aimed to explore potential transition shock subgroups of newly graduated registered nurses and further explore the impact of population characteristics and two indices of health on transition shock.MethodsA descriptive, cross-sectional design was conducted. An online questionnaire was sent via WeChat to newly graduated registered nurses who started work in 2021 at seven hospitals between August and November 2021, and 331 nurses filled out the questionnaire. Latent class analysis was used to identify the potential class of the transition shock of newly graduated registered nurses, and multinomial logistic regression analyses were used to determine the factors of potential classification.ResultsThe study identified four classes of transition shock in newly graduated registered nurses, namely, “high transition shock”, “physical fatigue-lack of knowledge”, “development adaptation” and “low transition shock-worry” groups. Newly graduated registered nurses who urinated less than 4 times per day (OR = 0.051, 95% CI = 0.005–0.502) were likely to be in the “high transition shock” group. Newly graduated registered nurses who did not delay urination (OR = 4.267, 95% CI = 1.162–11.236) were more likely to belong to the “low transition shock-worry” group. Newly graduated registered nurses without sleep disturbance were more likely to be in the “physical fatigue - lack of knowledge” (OR = 3.109, 95% CI = 1.283–7.532), “development adaptation” (OR = 8.183, 95% CI = 2.447–27.066), and “low transition shock-worry” (OR = 8.749, 95% CI = 1.619–47.288) groups than in the ‘high transition shock’ group.ConclusionsThis study highlights potential patterns of transition shock among newly graduated registered nurses. Two indices of health, namely, delayed urination and sleep disturbance, can predict the subgroups of newly graduated registered nurses with transition shock.

Corpus luteal cyst rupture presenting as massive spontaneous hemoperitoneum in women with dengue infection: A case series

Corpus luteal cyst rupture presents with acute pain abdomen, hemoperitoneum and features of shock. The condition clinically closely mimics acute rupture ectopic pregnancy but has negative urine pregnancy test. Massive hemoperitoneum requires urgent surgical exploration and achievement of hemostasis. Here is a case series describing 3 cases of corpus luteal cyst rupture in patients with diagnosed dengue fever presenting with features of acute abdomen with or without shock at emergency. All were managed surgically, did well in postoperative period, had transfusions of blood and blood products and finally discharged in satisfactory condition. The objective of this series is to highlight the importance of this condition as a differential diagnosis in patients with acute abdomen which is not much described in medical literature.

The BE-ALIVE score: predicting 30-day mortality in patients presenting with acute coronary syndromes and cardiogenic shock

Abstract Aims The aim of this study was to create and validate a simple scoring system for predicting 30-day mortality in patients presenting with acute coronary syndromes (ACS) and any sign of shock at their moment of admission. Methods and results 2407 consecutive patients presenting to Harefield Hospital with clinical features of cardiogenic shock, from January 2011 to December 2020, were studied to build the training set. 30-day mortality was 17.2%. A scoring algorithm was built using binary logistic regression of variables available on admission and then converted to an additive risk score. The resultant scoring system is the BE-ALIVE score, which incorporates the following factors: Base Excess (1 point for &amp;lt; -2 mmols/L), Age (&amp;lt;65 years: 0 points, 65-74: 1 point, 75-84: 2 points, ³85: 3 points), Lactate (&amp;lt;2 mmols/L: 0 points, 2 - 4.9: 1 point, 5 - 9.9: 3 points, ³10: 6 points), Intubated (2 points), Left Ventricular function (mildly impaired or better: -1 point, moderately impaired: 1 point, severely impaired: 3 points) and External / out of hospital cardiac arrest (1 point). The scoring system was validated using a testing set of 515 patients presenting to Harefield hospital. The validation metrics were excellent with an AUC of 0.9, Brier score of 0.06 versus a naïve classifier of 0.15, Spiegelhalter’s z-statistic probability of 0.267 and a calibration slope of 1.08. Conclusion The BE-ALIVE score is a simple and accurate scoring system to predict 30-day mortality in patients presenting with ACS and shock.

Abstract 317: Development of a Swine Model of Rapidly-Induced Septic Shock Using Single Lipopolysaccharide Infusion and Titratable Inhaled Nitric Oxide to Prevent Severe Pulmonary Vasoconstriction

Objective: A serious limitation of LPS-induced swine models of septic shock is severe pulmonary vasoconstriction triggered, in part, by the pulmonary release of thromboxane A2. Efforts to overcome this limitation have included a stepwise increase in LPS dosing, intravenous aspirin derivatives, and inhaled nitric oxide (NO). We studied the effects of titrated inhaled NO given coincident with rapid LPS-infusion aimed at inducing the key features of septic shock over a shorter time period. Methods: We developed a LabVIEW-controlled system for inhaled NO delivery and monitoring. Exploratory studies showed that an NO concentration of up to 300 ppm sufficed to prevent significant pulmonary vasoconstriction despite delivery of a full LPS dose (12.6 μg/kg) in 30 minutes. We used this approach in 6 male domestic pigs (39.2 - 41.1 kg) and assessed hemodynamic and metabolic effects over 6 hours. NO and LPS infusion were started concurrently. Fluid resuscitation and vasopressor therapy were guided by macrohemodynamic measurements using custom-developed LabVIEW-controlled closed-loop algorithms. Results: Shown are medians with IQ25 and IQ75. LPS infusion increased pulmonary vascular resistance from 112 [72, 127] at baseline to 213 [120, 313] dynes-sec/cm 5 after 20 minutes. NO (139 [131, 166] ml/min) rapidly blunted the effect preventing the mean pulmonary artery pressure from exceeding 30 mmHg, avoiding detrimental effects on right ventricular function throughout the experiment. NO was rapidly de-escalated over 30 minutes using a closed-loop algorithm developed to prevent the mean pulmonary artery pressure from exceeding 30 mmHg. Within 60 minutes of LPS infusion start, animals began to develop key features of septic shock including tachycardia, hypotension, and systemic vasodilation triggering fluid resuscitation and norepinephrine administration. Additionally, blood lactate increased from 1.06 [0.90, 1.45] at baseline to 4.14 [2.43, 8.78] mmol/l after 3 hours remaining stable for an additional hour and subsequently decreasing in 3 and increasing in the other 3 animals, with half of the animals surviving the 6-h period. Conclusion: We developed a swine model of rapidly-induced key features of septic shock useful to explore early septic shock management.

Abstract 370: Oral-Mucosal PCO 2 During Hemorrhagic Shock Closely Monitors Its Time Course, Severity, and Reversal Outperforming Blood Lactate Measurement

Objective: Oral-Mucosal PCO 2 (P OM CO 2 ) has been shown to closely correlate with the splanchnic mucosal PCO 2 and provide information on its microcirculation. We used a swine model of controlled hemorrhagic shock to assess the potential clinical relevance of monitoring P OM CO 2 to assess its clinical course, severity, and treatment effect. Methods: The study was performed on six male domestic pigs (37.9±1.4 kg). P OM CO 2 was measured using a non-invasive disposable sensor clipped to the cheek, developed by ExoStat Medical. Blood was removed over 120 minutes from the right atrium using a LabVIEW-controlled pump according to a mono-exponential decay curve modeling spontaneous bleeding and reinfused in 20 minutes observing the animal for a total of 180 minutes. Results: A total of 1,491±193 ml corresponding to 65.5% of the estimated blood volume were removed inducing the characteristic hemodynamic features of hemorrhagic shock including tachycardia, hypotension, reduced cardiac output, and reduced systemic oxygen delivery with increased systemic oxygen extraction. P OM CO 2 closely paralleled the time course of blood removal showing an early and steady increase from 85±5 mmHg at baseline to 144±32 mmHg after 120 minutes. Blood reinfusion rapidly reduced the P OM CO 2 to 130±17 mmHg after 20 minutes and 96±14 mmHg at the end of 180 minutes, coincident with reversal of hemorrhagic shock. P OM CO 2 also closely tracked changes in systemic oxygen extraction. Concurrent measurements of blood lactate demonstrated a slower increase during the hemorrhagic shock period (from 1.1±0.3 to 3.0±0.3 mmol/l) with further increase (not decrease) to 5.4±2.0 mmol/l after blood reinfusion, remaining at 4.3±0.8 mmol/l by the end of the 180-minute observation period. Conclusions: The study demonstrated capability of P OM CO 2 to closely and non-invasively track hemodynamic and metabolic changes occurring during hemorrhagic shock. P OM CO 2 outperformed blood lactate which exhibited a slower and delayed response. Thus, P OM CO 2 may provide a clinically practical and non-invasive means to monitor hemorrhagic shock assessing its severity, clinical course, and treatment effect.

Effectiveness of the WHO Protocol for the Management of Shock in Children With Severe Acute Malnutrition.

Background The WHO protocol for the management of shock in children with severe acute malnutrition (SAM) is not supported by physiological evidence. In this study, we aimed to assess the effectiveness of the WHO treatment protocol in the management of shock in children with SAM. Methodology This cohort study included children aged 2-60 months with WHO-defined SAM and fulfilling the WHO criteria for identification of shock. The exclusion criteria included severe anemia (hemoglobin <4 g/dL), congenital anomalies, congenital heart defects, and chronic diseases. The WHO treatment protocol for the management of shock was used, and features of resolution of shock were assessed at eight and 24 hours. Oliguria was recorded at eight and 24 hours along with in-hospital mortality.Multiple logistic regression was used to determine predictors of mortality. Results Of 53 children, 40 (75.4%) were discharged and 13 (24.5%) expired. We observed significant resolution of features of shock at 24 hours compared to eight hours (35 (71.4%) vs. 10 (18.8%), p < 0.0001). Further analysis revealed a significant resolution of features of shock (p = 0.03) at 24 hours in both fluid-responsive (24 vs. 10) and fluid-refractory children (11 vs. 27) compared to eight hours. Multivariate analysis revealed that mechanical ventilation was positively related to death (odds ratio (OR) = 85, 95% confidence interval (CI) = 8.49, 860, p < 0.0001), and inotrope scores <20 (OR = 0.053, 95% CI = 0.004, 0.64, p = 0.021) and blood transfusion (OR = 0.025, 95% CI = 0.001, 0.61, p = 0.024) had favorable outcomes. Conclusions The WHO protocol for the management of shock in children with SAM is effective in fluid-responsive shock whereas evidence was inconclusive in fluid-refractory shock.

Monoclonal antibodies neutralizing alpha-hemolysin, bicomponent leukocidins, and clumping factor A protected against Staphylococcus aureus-induced acute circulatory failure in a mechanically ventilated rabbit model of hyperdynamic septic shock.

Patients with septic shock caused by Staphylococcus aureus have mortality rates exceeding 50%, despite appropriate antibiotic therapy. Our objectives were to establish a rabbit model of S. aureus septic shock and to determine whether a novel immunotherapy can prevent or halt its natural disease progression. Anesthetized rabbits were ventilated with lung-protective low-tidal volume, instrumented for advanced hemodynamic monitoring, and characterized for longitudinal changes in acute myocardial dysfunction by echocardiography and sepsis-associated biomarkers after S. aureus intravenous challenge. To demonstrate the potential utility of this hyperdynamic septic shock model for preclinical drug development, rabbits were randomized for prophylaxis with anti-Hla/Luk/ClfA monoclonal antibody combination that neutralizes alpha-hemolysin (Hla), the bicomponent pore-forming leukocidins (Luk) including Panton-Valentine leukocidin, leukocidin ED, and gamma-hemolysin, and clumping factor A (ClfA), or an irrelevant isotype-matched control IgG (c-IgG), and then challenged with S. aureus. Rabbits challenged with S. aureus, but not those with saline, developed a hyperdynamic state of septic shock characterized by elevated cardiac output (CO), increased stroke volume (SV) and reduced systemic vascular resistance (SVR), which was followed by a lethal hypodynamic state characterized by rapid decline in mean arterial pressure (MAP), increased central venous pressure, reduced CO, reduced SV, elevated SVR, and reduced left-ventricular ejection fraction, thereby reproducing the hallmark clinical features of human staphylococcal septic shock. In this model, rabbits pretreated with anti-Hla/Luk/ClfA mAb combination had 69% reduction in mortality when compared to those pretreated with c-IgG (P<0.001). USA300-induced acute circulatory failure-defined as >70% decreased in MAP from pre-infection baseline-occurred in only 20% (2/10) of rabbits pretreated with anti-Hla/Luk/ClfA mAb combination compared to 100% (9/9) of those pretreated with c-IgG. Prophylaxis with anti-Hla/Luk/ClfA mAb combination halted progression to lethal hypodynamic shock, as evidenced by significant protection against the development of hyperlactatemia, hypocapnia, hyperkalemia, leukopenia, neutropenia, monocytopenia, lymphopenia, as well as biomarkers associated with acute myocardial injury. These results demonstrate the potential utility of a mechanically ventilated rabbit model that reproduced hallmark clinical features of hyperdynamic septic shock and the translational potential of immunotherapy targeting S. aureus virulence factors for the prevention of staphylococcal septic shock.

Seasonal and Mach Number Variation of the Martian Bow Shock Structure

AbstractLike its terrestrial counterpart, the Martian bow shock can exhibit foot, ramp, and overshoot substructures. The shock extent is known to vary with solar wind and season, but it remains an open question whether other features of the bow shock also vary seasonally. By comparing parameters of the shock during different seasons and solar wind conditions, we investigated whether the presence of seasonal planetary ions has any effect on the shock structure. We utilized a series of algorithms to automatically collect and analyze 7056 shock crossings from MAVEN spacecraft data between November 2014 and 2019. We compared the magnetic shock jump and overshoot amplitude as functions of upstream parameters and season. We found that the magnetic shock jump agrees to first order with Rankine‐Hugoniot predictions, and that the overshoot amplitude dependence on critical ratio, beta and Alfvén Mach number agree with the results of previous studies. These trends are identical for all seasons. We also found that the shock jump and fast Mach number correlate primarily with solar zenith angle, whereas overshoot amplitude correlates primarily with shock extent. We found that the most likely cause of the latter was an unexpected strong correlation between overshoot amplitude and the solar wind flow fast Mach number. The seasonal variability of the Sun‐Mars system does not appear to be strongly reflected in the resulting shock structure. The bow shock structure is controlled mainly by the properties of the solar wind, rather than by Mars' location in its orbit around the Sun.

ЭТИОЛОГИЧЕСКИЕ И КЛИНИЧЕСКИЕ ОСОБЕННОСТИ АНАФИЛАКТИЧЕСКОГО ШОКА У ПАЦИЕНТОВ, ГОСПИТАЛИЗИРОВАННЫХ В КЛИНИКУ ЭКСТРЕННОЙ МЕДИЦИНЫ

Introduction. Anaphylaxis is a severe generalized hypersensitivity reaction affecting more than one organ system that can start very quickly and symptoms can be severe or life-threatening. The profile of triggers and cofactors for anaphylaxis is age dependent and varies across geographies. The clinical manifestations of anaphylaxis are diverse, one of its most severe clinical phenotypes is anaphylactic shock. Aim. To assess the significance of various groups of triggers, cofactors and clinical features of anaphylactic shock in patients hospitalized in the Department of Allergology and Immunology of the Kazan City Clinical Hospital No. 7. Material and methods. A retrospective analysis of 107 medical records of inpatients hospitalized in the Department of Allergology and Immunology of City Clinical Hospital No. 7 with a diagnosis of anaphylactic shock (T78.0, T78.2, T80.5, T88.6) was carried out for three calendar years (from 01.01.2018 to 31.12.2020). Statistical data processing was carried out using the Statistical Package for Social Sciences (v.18.0). Results and discussion. It has been shown that medicines were the most common trigger for anaphylactic shock in hospitalized patients, while food and insect bites led to the development of shock much less frequently and with approximately the same frequency. The vast majority of patients did not have concomitant diseases, and also did not take concomitant therapy, which are risk factors for the severe course of anaphylaxis. Skin changes were the most frequent symptom, supplementing the clinic of anaphylactic shock, followed, approximately with equal frequency, by gastrointestinal and respiratory symptoms, neurological symptoms were most rarely recorded. Conclusion. To verify the trigger as the cause of anaphylactic shock, it is necessary to conduct an allergological examination after the resolution of its symptoms. To assess the influence of exogenous and endogenous cofactors on the occurrence of anaphylaxis and the severity of its course, it is necessary to conduct prospective studies.

Business dynamism, sectoral reallocation and productivity in a pandemic

Asymmetric effects across sectors are the distinctive features of the Covid-19 shock. An Epidemiological-Industry Dynamic model with heterogeneous firms and endogenous firms dynamics mimics the deep recession suffered by sectors characterized by high exposure, the reallocation of entry and exit opportunities across sectors, and the dynamics of aggregate productivity during the first wave of the pandemic. The cleansing effect induced by the Covid-19 crisis is sector-specific. Monetary policy and sticky wages are central ingredients to capture reallocation effects. Social distancing, by smoothing out cleansing in the social sector, slows down the reallocation process and prolongs the recession, but saves lives.

The Outcome of Sepsis Patients Admitted to the Surgical Intensive Care Unit

Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The main objective of this study was to identify the outcome of patients with sepsis and septic shock.&#x0D; Methods: A prospective observational study was done in a surgical ICU over a period of one year. We included all adult patients admitted to ICU with features of sepsis and septic shock. Data related to demography, co-existing illnesses, parameters to assess Sequential Organ Failure Assessment (SOFA) scores, other relevant laboratory data, source of infection, organ failures and supportive measures instituted were recorded. Patients were followed till discharge or death from the ICU.&#x0D; Results: 160 patients were included in this study. The mortality rate was significantly higher among females compared with males. The most common co-existing illnesses were hypertension and type II diabetes mellitus. The SOFA scores at admission were high among non-survivors. Older age, presence of anaemia (defined as haemoglobin less than 13 g/dL in males and 12 g/dL in females), renal dysfunction (creatinine level more than 1.3 g/dL), and acute respiratory distress syndrome (ARDS) were associated with higher mortality. Haematocrit, total leucocyte count, serum bilirubin and SOFA scores were significantly higher among non-survivors.&#x0D; Conclusion: Our findings suggest that septic shock occurs frequently in ICU patients and mortality remains high. Several critical scoring systems are useful for the early prediction of mortality. A sepsis mortality based on SOFA scores and haemoglobin has greater predictive power.

Penetrating cardiac injury presentation and management in resource-limited settings: A case series from Ethiopia

Introduction and importancePenetrating cardiac injury is rare (0.1 % of trauma admissions) but fatal. Presentation is with features of cardiac tamponade or hemorrhagic shock. Urgent clinical evaluation, ultrasound, temporizing pericardiocentesis or surgical repair with cardiopulmonary bypass as back up consist of standard management. In this paper, experience of management of penetrating cardiac injury from a resource limited country is presented. Case presentationsThere were seven patients, five had a stab injury and two had gunshot wound. All were men with mean age of 31.1 years. Patients arrived within 30 min (3), 2 h (2), 4 h (1) and 18 h (1) after injury. Mean initial blood pressure and pulse rates were 83/51 mm Hg and 121, respectively. One patient had pericardiocentesis before referral. Exploration was via left anterolateral thoracotomy. Four (57.1 %) had right ventricle perforation, one had both right and left ventricle, and two (28.5 %) had left ventricle perforation. Suture repair (6) and pericardial patch (1) were done without bypass machine as back up. Mean duration of stay in the intensive care unit and in the surgical wards were 4.4 days (range: 2–15) and 10.8 days (range: 1–48), respectively. All were discharged improved. Clinical discussionPenetrating cardiac injury presents with low blood pressure and tachycardia after stab or gunshot wounds. Right ventricle is mostly affected. Pericardiocentesis can be done as temporary measure. While having bypass machine as back up is recommended, the absence of it should not preclude intervention. Suture repair can be done with left anterolateral thoracotomy. ConclusionPenetrating cardiac injury can be managed in resource limited settings without back up of cardiopulmonary bypass. Early identification and surgical intervention results in favorable outcome.

Investigation of dust ion acoustic shock and solitary waves in a viscous dusty plasma

A viscous dusty plasma containing Kappa-(κ − ) distributed electrons, positive warm viscous ions, and constant negatively charged dust grains with viscosity have been considered to study the modes of dust-ion-acoustic waves (DIAWs) theoretically and numerically. The derivations and basic features of shock and solitary waves with different plasma parameters like Mach number, finite temperature coefficient, unperturbed dust streaming velocity, the kinematic viscosity of dust, etc of this DIAWs mode have been performed. Considering the dynamical equation from Korteweg-de Vries(KdV) equation, a phase portrait has been drawn and the position of the saddle point or col. and center have also been discussed. This type of dusty plasma can be found in celestial bodies. The results of this research work can be applied to study the properties of DIAWs in various astrophysical situations where κ-distributive electrons are present and careful modification of the same model can help us to understand the nature of the DIAWs of laboratory plasma as well.

Waterhouse-Friderichsen syndrome, septic adrenal apoplexy.

Waterhouse-Friderichsen syndrome is a rare but potentially fatal disorder of the adrenal gland characterized by bilateral adrenal hemorrhage. It is classically a result of meningococcal sepsis and presents acutely with features of shock, petechial rashes, abdominal pain, and non-specific symptoms such as headache, fatigue, and vomiting. Treatment consists of fluid resuscitation, corticosteroid replacement, and possibly surgery. The prognosis is poor despite treatment. This chapter will review the etiology, pathogenesis, clinical features, and management of the disease.

Rhabdomyolysis induced by low voltage extended electric shock in a bovine

Electric fences are great alternatives in the management of cattle pasture; however, they require extra attention when cherishing for the animals’ safety. Electric shocks caused by an artificial source are known as eletroplession or electrocution. Cases associated with electric fences often occur due to incorrect handling or even herd dispersion during panic. This study aims to report the epidemiological, clinical, and pathological features of prolonged electric shock in a bovine from Santa Catarina state, Brazil. The animal was found with its pelvic members stuck in the low-voltage electric fence. Twenty-four hours after the incident, the bovine showed clinical signs of apathy, depression, anorexia, and reluctance to move. In 96 hours, it was found in a lateral decubitus, with pedaling movements and nystagmus. After another 48 hours, there was no clinical improvement, and the animal was euthanized due to the unfavorable prognosis. Necropsy was performed, and fragments of all organs were collected for histopathological analysis. Gross and microscopic lesions associated with clinical signs demonstrated acute rhabdomyolysis due to electric shock, which resulted in the animal's recumbency. Histopathological analysis also revealed neurological damage due to the electric shock. Prolonged and low-voltage electrical discharges can cause acute rhabdomyolysis in bovines. This condition should be considered with a reserved to unfavorable prognosis due to the neurological disorders and possible kidney damage.