European Journal of Molecular & Clinical Medicine

Aim: The aim of the present study was to assess haematological and inflammatory parameters in sepsis patients.
Methods: The study was conducted at Medical intensive care unit at Dr. DY Patil medical college and hospital, DY Patil Vidyapeeth, Pimpri, Pune from October 2020 – September 2022 and 100 cases were included in the present study. Approval was taken from institutional ethics committee before commencing the study. Informed and written consent was taken from all the patients.
Results: Among the study population, 68.00% of them were male, 32.00% of them were female. On study population, 44.00% of them diagnosed with DIC. On study population, 61.00% of them were Survivors, 39.00% of them were non-survivors. The mean platelet on admission was 117624 ± 89241.13, it was 105860 ± 85661.89 at 24 hours, it was 98990 ± 83391.29 at 48 hours. The mean D Dimer at Admission was 4073.37 ± 4361.13, it was 3956.39 ± 2432.91 at 24 hours, it was 5284.33 ± 8445.54 at 48 hours. The mean Fibrinogen at Admission was 2.07 ± 0.85, it was 1.76 ± 0.86 at 24 hours, it was 1.47 ± 0.95 at 48 hours.  Among the study population, the mean ESR was 86.75 ± 97.97, the mean CRP was 73.7 ± 72.45, the mean Lactate was 28.95 ± 25.06, the mean Pro Calcitonin was 6.62 ± 3.4.
Conclusion: In uncontrolled cases of sepsis, acute organ dysfunction and shock may develop. Because of this rapid progression, it is of utmost importance that patients should be diagnosed and treated in a requisite time frame. The current literature and changing guidelines demonstrate that the bedside physical examination along with laboratory testing (haematologic and inflammatory biomarkers) are the most effective combination of parameters that clinicians can rely upon to accurately predict or diagnose sepsis in a critically ill patient.

Context: Sepsis is one of the leading causes of death in hospital settings. Timely administration of rational and effective antimicrobial therapy, as per hospital’s antibiotic policy, is one of the components of antimicrobial stewardship program. In absence of definitive pathogen identification and susceptibility pattern, initial antibiotic regimen is selected which is defined as empirical antibiotic therapy. Although an empirical antimicrobial policy is in place at our institute, it has not been evaluated since its inception for its effectiveness.
Aims: To assess the adherence to the empirical antimicrobial policy for sepsis and to evaluate its effectiveness on clinical outcome of sepsis in adult critical care patients.
Setting and study design: A prospective, cross-sectional study was conducted in adult non covid critical care units of Shree Krishna Hospital.
Methodology: Following approval from Institutional Ethics Committee, prospective cross-sectional study was conducted from 1^st August-2021 to 31st July-2022 at non-covid intensive care units. The adherence to the empirical antibiotic policy was calculated as percentage of patients with sepsis in whom antimicrobial agent was started as per the policy. The effectiveness of the antimicrobial policy was assessed on the basis of the improvement in the clinical and laboratory parameters as well as Sequential organ failure assessment (SOFA) score of the patient over a period of five days.
Statistical analysis: Microsoft Excel 2019, Version 2209 was used for data entry and data analysis. Proportions were calculated using descriptive analysis. Data was analysed using Chi-square calculation. Significance was considered at P-value <0.05.
Results: The adherence to the antimicrobial policy in sepsis was 59.80%, (n = 61 out of 102) whereas adherence to initiation of antimicrobial agent within one hour of diagnosis of clinical sepsis was 96.07% (n =98 out of 102). The antimicrobial agent started as per antibiotic policy was susceptible in culture report in 55.31% (n = 26 out of 47) of patients. Effectiveness of empirical antimicrobial policy in patients with sepsis in adult critical care units based on improvement of SOFA score after five days of diagnosis of clinical sepsis was 51.06%, (n=24 out of 47). There was no significant correlation (P ≥0.05) found between age groups, gender, risk stratification categories, type of blood stream infections and type of organisms isolated, i.e., Gram negative and Gram positive with regards to effectiveness of empirical antimicrobial policy. There was no significant difference noted between improvement in SOFA score of the patients in whom antimicrobial agent was started as per policy and in whom the antimicrobial agent was not started as per policy (P = 0.72).
Conclusion: The adherence to antimicrobial policy for sepsis was low and further studies to evaluate the reasons for low compliance need to be conducted. Although the effectiveness was not significantly different when the antimicrobial agent was started as per policy compared to when it was not started as per policy, we still recommend using antimicrobial agent as per policy in order to avoid non uniformity in prescriptions and development of antimicrobial resistance.

Aim: The aim of the present study was to assess clinical profile of ICU patients with sepsis.
Methods: The present study was conducted at Dr. D.Y. Patil medical college and hospital and research center, Pimpri, Pune from August 2020 to September 2022 and 100 patients with sepsis from ICU were included.
Results: Among the study population, 61.00% of them were 30 to 65 years, 30.00% of them were >65 years and 9.00% of them were <30 years. Among the study population, 66.00% of them were male, 34.00% of them were female. Among the study population with Present history, 90.00% of them had fever, 76.00% of them had Weakness, 57.00% of them had Abdominal Pain, 47.00% of them had Breathlessness, 29.00% of them had Burning Micturition, 27.00% of them had Altered Sensorium, 21.00% of them had Vomiting, 81.00% of them had Cough, 12.00% of them had Loose Stools, 8.00% of them had Chest Pain. Among the study population, 94.00% were febrile, 85.00% of them had pulse rate >90 bpm, 93.00% of them had respiration rate >20 cpm, 82.00% of them had SBP<=120mmHg, 81.00% of them had DBP <=80mmHg, 6.00% of them had mean arterial pressure <=65, 32.00% of them had SPO2 on RA <=90%.
Conclusion: In intensive care units, sepsis continues to be a leading cause of death. Early detection of sepsis includes symptoms and signs, such as leucocytosis or leucopenia, confusion, hypoxia, hypotension, pyrexia, and tachycardia. In general, respiratory infections are responsible for around half of all sepsis cases. Incidence of severe sepsis was high among ICU admissions and they have a high mortality. Higher SOFA scores at admission were associated with higher mortality in severe sepsis

Recent studies have also revealed that vitamin D may help protect against a number of chronic diseases, including the risk of developing diabetes, cardiovascular disease, lung disease, and other chronic illnesses, such as systemic infections. The growing body of knowledge around vitamin D has started to suggest possible associations between sepsis and vitamin D insufficiency. The understanding of the relationships between these disorders is still in its infancy.
Aim: The aim of the study was to assess the role of Vitamin D deficiency as a potential risk factor for sepsis development and correlation with qSOFA score in patient admitted to Medical ICU in MMCH, Solan.
Methodology: This was a cross sectional study conducted among 120 patients diagnosed with Sepsis presenting to the Medical ICU.
Results: The mean age of the study participants was 55.87 ± 13.07. Majority of the study participants were males. The prevalence of diabetes mellitus and hypertension were 45.8% and 40% respectively. Mortality was seen among 3.3% were alive and dead respectively. 100% of the study participants with sepsis with qSOFA score of more than 2, had Vitamin D deficiency and the mean Vitamin D level was 12.21 ± 5.38. The Vitamin D level was significantly lower among those who died than those who are alive (p=0.019).
Conclusion: 100% of the sepsis patients had Vitamin D deficiency in the present study. It has been shown that this has a detrimental effect on inpatient morbidity and death. This emphasises how crucial it is for the general public to have enough vitamin D supplements.

Introduction: Diagnosis and treatment of sepsis poses a challenge for health care providers at clinical setup. Identifying sepsis and making rational decision regarding the treatment plan is crucial to the overall survival and recovery of the affected patients. Serum procalcitonin (PCT) is an emerging biomarker for diagnosing sepsis worldwide. But serum PCT data for diagnosing sepsis from our country perspective is scarce. Present study aims to evaluate the relation between serum PCT level and the clinical state of the sepsis among Bangladeshi patients. Methods: This was a cross-sectional study conducted among 61 clinically diagnosed patients with sepsis admitted at Dhaka Medical College Hospital and Apollo Hospital Dhaka aged 18 years or older. Data were collected from the respondents using a semi-structured questionnaire through a face to face interview. Results: Blood culture positive sepsis was found among 37.7% of the respondents. Escherichia Coli was the most commonly found organisms in blood culture. Meropenem was found to be sensitive antibiotics in most cases. Among the respondents around 2/3rd had serum PCT level ≥10 ng/ml and diagnosed as patients in septic shock. Mean serum procalcitonin level for respondents with culture positive bacterial sepsis was 22.60 ng/ml and for respondents without culture positive bacterial sepsis was 8.47 ng/ml and this difference was statistically significant (p < 0.05). Conclusions: The present study indicates that serum PCT level rises more among culture positive bacterial sepsis patients than patients without culture positive bacterial sepsis. In primary health care setup, serum PCT can be used as a tool for early diagnosing culture positive sepsis. A large scale, multicenter study should be under taken to further evaluate the viability and feasibility of using serum PCT as a biomarker for diagnosing culture positive sepsis.

Introduction: Observational study to find out maternal risk factors associated with low birth weight babies & their association with the morbidity and mortality.
Materials& Methods: The maternal demographic profile, previous obstetric history, risk factors, causes of preterm labor, low birth weight babies, and delivery outcome were recorded. Similarly, the immediate neonatal morbidity and mortality were recorded. Both data of maternal and neonatal profile were pooled and analyzed by using proper statistical method.
Results: All the babies who weighed 1500g at birth were born preterm. All the mothers who were less than 40 kg in weight had delivered VLBW (<1500gms). Majority of the mother (76.5%) belong to lower & upper lower socioeconomic status according to Modified Prasad classification. 44.5% of the mothers were illiterate & 43.5% had only primary education. The morbidities found among babies were sepsis (19%), followed by jaundice (14.5%), RDS (11%), birth asphyxia (9.5%). Most common maternal risk factors were Anemia (92.5%) & improper antenatal visit (71.5%). 17 newborn (8.5%) died during their stay in hospital (within 7 days).70.5%babies were premature. Causes of mortalities in the study were probable septicemia (50%), respiratory distress syndrome (41.6%) & birth asphyxia (8.3%).
Conclusions: Present study reveals that increase in gestational age was directly proportional to birth weight. Lighter the babies more the chances are of premature birth which is statistically highly significant (p=0.00). Out of 200 LBW babies 40% were premature babies. 28.5% of mothers were booked mothers. Statistically significant correlation was found on correlating maternal demographic factor with physical parameters of baby.

Background- With sepsis as a major cause of concern in increasing ICU mortality, several prognostic scoring systems, including the Acute Physiology and Chronic Health Evaluation (APACHE)  or the Mortality Probability Models (MPM)have been used so far to assess the acute clinical condition of seriously ill patients with sepsis, to predict prognosis and to assist physicians clinical decision. 
Aim- To study the relationship of acute phase reactants level with severity of illness and mortality in patients with sepsis and its correlation with APACHE IV score
 
Study Design: Propective observational study.
Place and Duration of Study: This study was conducted at Department of General Medicine, Dr D Y Patil Medical College, Hospital and research centre, Pune from October 2020 to September 2022.
Methodology- This study conducted in a semi-urban teaching Hospital in Maharashtra, India. Study included patients admitted to ICCU of the study institute for sepsis (Sepsis is any suspected (or documented) infection and an acute increase in ≥2 sepsis-related organ failure assessment (SOFA) points.) and full filling the below mentioned inclusion and exclusion criteria.The collected data was analyzed with IBM, SPSS (IBM Corp., Statistics for Windows, version 24.0, Armonk, NY). Continuous variables were expressed as mean ± standard deviation (SD) and categorical variables were expressed as a percentage.
Results and Conclusion- Mean level of Acute phase reactants proteins like C reactive protein, ESR, lactate dehydrogenase level, D Dimer, Serum Procalcitonin, Serum lactate, Serum Ferritin, APACHE IV score was significantly higher in patients who died during the treatment as compared to patients who survived.

Background:Compared with term infants, infants born late preterm are at increased risk for neonatal intensive care unit (NICU) admission. The present study was conducted to assess early neonatal morbidity in late preterm.
Materials & Methods: 54 all live inborn late preterm infants (34 0/7 to 36 6/7 weeks) and term infants (37 0/7 to 41 6/7 weeks) of both genders were included. Group I comprised of late pre- term and group II had term infants. In all infants, mode of delivery, APGAR score, hypoglycemia, morbidity, jaundice, weight loss >10% and sepsis etc. was recorded
Results: Group I had 17 boys and 10 girls and group II had 14 boys and 13 girls. Weight loss >10% was seen in 2 in group I and 1 in group II, sepsis was seen 1 in group I, respiratory morbidity 2 in group I and 1 in group II, hypoglycemia was seen in 2 in group I and 3 in group II and jaundice in 1 in group I and 0 in group II. The difference was significant (P< 0.05). The mean gestation weeks in group I was 35.0 weeks and in group II was 38.2 weeks, mode of delivery was vaginal in 22 in group I and 15 in group II, cesarean in 5 in group I and 12 in group II, APGAR score at 1 minute was 7.32 in group I and 7.95 in group II, at 5 minute was 8.41 in group I and 8.68 in group II. The difference was significant (P< 0.05).
Conclusion: Incidence of hypoglycemia, sepsis, respiratory morbidity and jaundice and weight loss >10% was more among late preterm infants.

Background and Objective: Sepsis is characterized by multiple organ dysfunction due to inflammation. It is generally credited to pathogenic infection, but there are several cases of non-infectious sepsis. Procalcitonin is a small protein that signals increased inflammation during sepsis. This study aims to characterize the prognostic value of procalcitonin in predicting sepsis severity and discriminating infectious and non-infectious sepsis.
Methods: We performed a prospective non-Interventional study, including 75 participants suffering from sepsis. The patients were grouped according to disease severity and their procalcitonin levels measured. The biochemical and microbiological outcomes were analyzed with respect to procalcitonin levels. Results were analyzed by the chi - square test, Kruskal-Wallis test, or Mann-Whitney test. Further, the receiver operating characteristic curve (ROC) was plotted for procalcitonin levels and type of infection and the area under the ROC curve was calculated.
Results: Procalcitonin was found to be correlated with sepsis severity (p=1.80E-09). A significant relationship was observed between procalcitonin levels and the presence of infection (p=0.03996). The area under the ROC curve of procalcitonin for determining presence of infection was 65.18%. At cut-off of 0.6494 (ng/mL) the sensitivity and specificity was found to be 69.81% and 63.63%. Moreover, the presence of methicillin resistant Staphylococcus aureus conferred increased procalcitonin than methicillin sensitive variety (p= 0.0098).
Conclusion: We show that procalcitonin is a predictor of sepsis severity. It can be used to predict the type of infection in patients of sepsis in a critical care setting.

Introduction: Patients are frequently admitted to ICU (intensive care units) because of sepsis significant morbidity and death occur in intensive care unit patients with severe sepsis or shock. Sepsis has a mortality rate of 30-40%. Despite breakthroughs in sepsis treatment during the last two decades, mortality remains stable.
Aims and objectives: To study the clinical profile of sepsis cases by monitoring the clinical parameters & latest scoring systems (SOFA &qSOFA) for critically ill patients.
Materials and methods:This was a prospective observational study conducted at Sri Aurobindo Institute of Medical Sciences and PGI, Indore on 100 patients.
Results: The distribution of patients according to comorbidities. Majority of the patients were having DM (62%) followed by HTN (45%) and IHD (9).Less number of patients were having Cyanotic heart disease (1), CLD (1), CVA (1), RA (1), and sickle cell anemia (1)
The SOFA score, developed by the European Society of Intensive Care Medicine (ESICM) Working Group on Sepsis-Related Problems, can represent both individual and multiple organ failure. The effectiveness of the   SOFA score has already been examined in large cohorts of critically sick patients. Due to its ease of use and ability to incorporate easily available clinical and laboratory data, the SOFA score has a number of benefits in the emergency department.
Conclusion: Majority of the patients having age group between 51-60 years followed by 61-70 years. Least number of the patients were found in age > 70 years. Majority of the patients were having DM followed by HTN and IHD. Less number of patients were having Cyanotic heart disease, CLD, CVA, RA, and sickle cell anemia.

Background: Currently for physicians, there are limited parameters to stratify patients at risk for short term cardiovascular collapse (i.e. vasopressor dependence). The shock index (SI, heart rate divided by systolic blood pressure) is a simple formula useful for detecting changes in cardiovascular performance before the onset of systemic hypotension. It is an easily accessible, non-invasive, and non-costly risk stratification tool that may enhance current methods for differentiating severe sepsis patients at risk for imminent cardiovascular collapse.
Materials: In this study, we have taken patients who are above 18 years diagnosed to have sepsis were followed up and shock index was calculated every 6th hour. In 50 such patients who required vasopressor use within 72 hours of admission, percentage of SI elevation for each patient was determined by taking the total number of SI values greater than 0.8 and dividing this number by the total number of vital signs taken. The patients were divided into Sustained SI elevation (i.e. >or=80%) group and non-sustained SI elevation group (i.e. < 80%) and comparison was done.
Results: 80 patients were followed up, out of which 50 patient’s required vasopressor use with in 72 hours of admission. Among them 41 patients had sustained shock index elevation and 9 patients had non sustained SI elevation. It is found that sustained shock index was statistically significant in predicting vasopressor use in sepsis patients. Sustained SI had sensitivity of 82%, specificity of 83.3%, PPV of 89.13%, NPV of 73.55% and Diagnostic accuracy of 82.5% in predicting vasopressor use.
Conclusion: Patients with sepsis and a sustained SI elevation appear to have higher rates of vasopressor use short term after admission contrasted to patients without a sustained SI Elevation. A sustained SI elevation may be a promising simple, cost-efficient, and non-invasive measurement to help risk stratify patients who present with sepsis, and may complement other predictors of disease progression. A sustained SI elevation may be a useful modality to identify patients with severe sepsis at risk for disease progression.

Background: The assessment of procalcitonin not only provides valuable information about the diagnosis but is also useful in the selection of the corresponding antibiotics for the management of sepsis. The studies related to this procalcitonin role are comparatively sparse.
Objective: The present study was undertaken to observe the role of procalcitonin in the management of severe surgical patients with sepsis.
Materials and methods: A total of 50 patients diagnosed with sepsis and aged more than 18 years including both males and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study.
Results: Results were presented in Tables no 1 and 2. Table no 1 presents the gender distribution of the participants. The majority of the participants were males with 56% and females were 44%. Table no 2 presents the levels of procalcitonin levels in the participants. The majority of the participants have excessive levels of procalcitonin levels. That is procalcitonin was more than 10ng/ml in 40 patients which means nearly 80 percent of the patients have excessive levels of procalcitonin. This will testify to the importance of procalcitonin in the diagnosis of sepsis.
Conclusion: Significantly higher levels of procalcitonin levels were observed in the patients with sepsis. The study results testify to the diagnostic value of the procalcitonin. The study recommends further detailed studies in this area to support the procalcitonin in the diagnosis of sepsis.

Background: The concept, definition and understanding of sepsis may have undergone several changes in the past years, but its omniscient nature in modern day critical care medicine has made accurate diagnosis, early initiation of therapy and relatively accurate prognostication, imperative. In recent times, procalcitonin has been used to initiate, de-escalate and guide antibiotic therapy. However, the data on its ability to predict all cause mortality in patients with sepsis remains nebulous. There is adequate evidence to merit considering both sides of the story.
Methods: We studied 99 consecutive patients meeting the diagnostic criteria for sepsis according to Sepsis 3 consensus criteria. Serum procalcitonin levels were compared head to head with 30-day all-cause mortality. Chi squarepaired and unpaired T and Pearson’s coefficient were used to analyze the data. 
Results: Our study showed that patients with a higher baseline value of serum procalcitonin had higher rate of in-hospital mortality (SD – 1.8 vs SD - 0.68, 2-tailed P<0.001). However, no statistically significant association was noted between baseline PCT and duration of ICU stay.
Conclusions: The predictive value of serum PCT, for mortality has been a matter of debate and controversy with compelling evidence to both sides of the story available in contemporary literature. Our study re-enforces the dictum of early diagnosis and treatment of sepsis in conjunction with the judicious use of serum procalcitonin. On the horizon, the authors see a plethora of newer biomarkers (SUPAR and sTREM-1) which may be used standalone or in combination to improve outcomes.

Inborn errors of metabolism (IEM) are a genetically inherited disorder that has led to
significant morbidity and mortality in the newborns and infant age group. The true
prevalence of IEM in India is not known. Havingnon-specific clinical presentation and
lack of a routine screening program for newborns in India, it mostly remain
undiagnosed and under-reported. With a wide spectrum of nonspecific
symptoms,misdiagnosis or delayed diagnosis is common, so our objective is toenhance
knowledge and create awareness regarding the red flags of IEM among clinicians so
that even slight suspicion of clinical symptoms should be followed by biochemical
evaluation.
Many IEM presents with clinical features resembling sepsis but detailed investigations
and through history can help us think beyond sepsis. Workup for IEM in our case was
suggestive of Propionic acidemia (PA) and Methyl malonicacidemia (MMA).We provide
a clinical approach for such critically ill newborns diagnosis. If these cases are detected
early and given timely treatment, clinical outcomes can be improved.

BACKGROUND: Data on potentially modifiable risk factors and clinical profile of severe malnutrition for infants under 6 months of age (U6M) are needed. This is vital to design and develop better future interventions. Our study aims at identifying these risk factors and clinical profile. MATERIAL AND METHODS: Prospective Observational study was undertaken on 88 infants U6M, who attended the Inpatient and OPD for a period of 1 year. Study was done to identify risk factors and clinical profile. RESULTS: Among 88 children enrolled in the study, most babies who developed Severe Malnutrition were term babies (86.4%) with birth weight 2-2.5 kg (43.2%). Majority (40%) were among 2-3 months of age. More (63.6%) were females. Approximately 56.8% were born to young mothers (21-23 years), uneducated and house wives.  CONCLUSION: Risk factors like young maternal age, low level of education among mothers, low socio-economic status of family was contributary factors. But other factors like family size, birth order of infant, duration of breast feeding, feeding of top milk like cow or buffalo milk, mix feeding, mode of feeding, impact of NRC registration also have a significant impact on severe malnutrition in infants U6M. Further, Lack of exclusive breast feeding is also one of the perceived risk factors for severe malnutrition in infants u6m. Concerned health programs must include maternal education and knowledge about infant feeding practices as a major agenda.

Background: Sepsis and septic shock cases in the Neonatal intensive care unit (NICU)
and Pediatric intensive care unit (PICU) remain one of the most significant causes of
morbidity and mortality in pediatric patients. Therefore, studying and comparing the
clinical features and outcomes of pediatric patients with sepsis in ICUs are important,
especially in developing countries.
Methods: From 1st July 2021 to 31st December 2021, we have collected data from both of
our pediatric ICU and neonatal ICU of Shyam Shah Medical College using a preformed
proforma. Complete blood count, C - reactive protein and culture sensitivity reports
were used to diagnose or screen sepsis. We compared clinical features, laboratory data,
microbiologic results, and final outcome for patients with sepsis in both NICU and
PICU.
Results: A total 1509 and 236 cases with sepsis from both NICU and PICU respectively
are included in the study (mean duration of stay in NICU 8.9 days±4.3; in PICU 12.5
days±5.3). Among these cases, culture positive cases with sepsis were 66% and 28% in
NICU and PICU respectively. Common pathogens isolated from blood cultures were E.
coli and pseudomonas in NICU and E.coli and S. aureus in PICU. Mortality, discharges,
refers and Left against medical advice cases were compared as outcomes in our study.
Comparing with NICU (n=24, 10.1%), mortality due to sepsis in PICU (n=111, 7.3%)
was less.
Conclusion: Sepsis in children both in NICU and PICU is associated with high mortality
despite aggressive treatment strategies, but more in NICU. Early recognition and
prompt treatment is the key to improve outcome of sepsis.

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection inside ICU. The aim of the present study was to assess the Relation between levels of procalcitonin and C-reactive protein as markers with severity of sepsis and septic shock.
Patients and methods: This observational study was involved 60 patients who diagnosed with sepsis or septic shock and admitted to Surgical intensive care unit, Zagazig University Hospitals, Egypt. Procalcitonin and C-reactive protein levels were estimated in the 1^st, 3^rd, and 5^th ICU day. APACHE II as well as SOFA Scores were estimated on ICU admission.
Results: Patients were classified according to the need for mechanical ventilation (MV group and non-MV group), CRP showed no significant difference between the two groups on the first day (100.51 and 83.21 mg/dl respectively- p=0.108). The remaining readings showed a significant rise in the patients that needed invasive mechanical ventilation. Serum PCT levels showed a significant rise in the MV group throughout the all study readings (p < 0.001). Likewise, SOFA score recordings were significantly higher in the MV patients (p < 0.001). On assessment of the predictors for vasopressor need, the highest sensitivity was reported for 3rd day CRP (84.1% - cut off = 62.01 mg/dl), and 5^th  day PCT (84.1% - cutoff = 0.505 ng/ml). Slight decrease in sensitivity (81.8%) was reported with the application of 1st day PCT and 3rd day SOFA.
Conclusion: PCT and CRP can be used as a  prognostic markers for evaluating the prognosis of patients with sepsis and septic shock.regarding need for vasopressors the highest sensitivity was reported for 3^rd day CRP and fifth day PCT, however the length of stay was found to be highly correlated with 3^rd day PCT, also 1^st day PCT value was better to Predict need for Mechanical ventilation.

Background: Sepsis is a life-threatening condition in ICU with high morbidity and
mortality. Biomarkers which can act as a predictor for diagnosis, prognosis, and patient
outcome in sepsis are needed.
Aim:Aim of the study is to compare the significance of hs-C-reactive Protein (CRP),
Procalcitonin, White blood cell count, and blood culture in patients with bloodstream
infections and compare their prognostic significance with blood cultures in sepsis.
Materials and Methods: This hospital based prospective observational study was conducted
between July 2018 to July 2019 forone year with 216 cases of sepsis. Serial determination
of Procalcitonin and CRP at admission and Day 6 was done. Data was analyzed check to
compare the prognostic significance of the PCT, CRP, and WBC count.
Results:A blood culture positivity rate of 50.9% was reported with male preponderance.
WBC count has significantly reduced after 72hrs of admission (p= 0.007). CRP levels have
significantly reduced on day 6 (p = 0.043) in comparison to at the time of admission (p=
0.032). The serial determination of PCT levels at admission and on day 6 (p= 0.032) was
found to be a better prognostic indicator in patients with sepsis than at the time of
admission. The significant patient outcome in terms of mortality and reduction in length of
hospital stay has been found (p= 0.018, p=0.002). The positive correlation of PCT and CRP
and SOFA score has been reported.
Conclusion: Prognostic significance was found for the biomarkers PCT, CRP, and WBC
count with significant patient outcomes in terms of mortality and hospital stay reduction

Background:Septicemia is a potential clinical status which is a result of irresistible sickness or a
inflammatory process secondary to infection or injury. Clinical management of septicemia
requires brief research facility finding and plan of successful patient administration techniques that
might incorporate antimicrobial chemotherapy. Despite the fact that the accessible biomarkers of
septicemia, for example, CRP, procalcitonin has ended up being helpful, their disadvantages is
elevation in non-septic conditions like injury, surgery, and different conditions like systemic
inflammatory reaction disorder (SIRS), and insusceptible reaction amid septic conditions.
Considering the way that septicemia because of contamination is microbiologically affirmed just
in 30% of the cases, it is inescapable that there is requirement for different markers of septicemia.
Neopterin is one of biochemical markers of immune activity, which seems to be useful in
monitoring inflammatory diseases. Increased concentration of neopterin in serum is observed in
conditions with involvement of cell mediated immune response. Investigations on critically ill
patients on intensive care units evaluated neopterin levels as tool to discriminate patients with
systemic inflammatory response syndrome with and without infectious etiology. Neopterin levels
were found to have a specificity of 78% for discriminating infectious and noninfectious etiology of
critical illness

The rate and extent of neonatal gastrointestinal tract colonization depends on various perinatal
and neonatal factors. Colonization of gastrointestinal tract (GIT) after birth could be delayed because of
prematurity, caesarean delivery or total parental nutrition. The ill and preterm neonates in NICU acquire
intestinal flora that differ from that of healthy newborn. Objective: Hence we aim to study the factors associated
with pathological colonization of aerobic microbial flora in neonates and find pattern of pathogenic aerobic
microbial colonization of neonates. Methodology: The study was done on 94 neonates in a tertiary teaching
hospital NICU , 51 cases with pathological colonization ,43 control with normal colonization. Data collected
using Performa, Oral and rectal swabs taken Results: 68 neonates who received antibiotics 46 (90.2%) were
cases 22(51.3%) were controls. Staphylococcus aureus was predominant suggesting influence of maternal
colonization. Cases were more in babies born through LSCS and in babies whose mother had received
antibiotics Conclusion: Of all factors influencing establishment of pathological microbiota in neonatal GIT
which are interdependent , neonatal exposure to antibiotics was the most significant . Emergence of MRSA ,
ESBL are of particular concern as these are a constant threat as source of health care associated infection

The role of vitamin C in the prevention and treatment of pneumonia andsepsis has been investigated for past decades. This reviewaimsto translatethese findings into patients with severe coronavirus disease (COVID-19). It has indicatedthat patients with pneumonia and sepsis have low vitamin C status and elevated oxidative stress.Additional oral or intravenous (IV) vitamin C administered patients with pneumonia can mitigate the severity and course ofthe disease. Severely ill patients with sepsis need for intravenous administration of amounts counted in grams ofthe vitamin to achieve adequate plasma levels, an intervention that some studies suggest reduces mortality.The vitamin has physiological functions like pleiotropic, many of which are closely connected to COVID-19.These are its antioxidant, antiinflammatory, antithrombotic and immunomodulatory functions.Previous observational studies found out low vitamin C status in critically ill patients with COVID-19.A number of randomized controlled trials (RCTs) conductedworldwideevaluate intravenous vitamin C as monotherapy in patients with COVID-19. Optimization of the intervention protocolsin future trials, e.g., earlier and continuously administration, is justified to potentially improve itsefficacy. In order to the excellent safety profile, low cost, and potential for rapid enlargement of production,administration of vitamin C to patients, especially with hypovitaminosis C and severe respiratory infections,e.g., COVID-19, appears warranted. In addition, there are few new ways of concurrent using vitamin C and other manipulations or medications.

Background:Sepsis is a life-threatening organ dysfunction and the leading cause of death in critically ill patients. The use of biomarkers and scoring systems is an attempt to assist in the diagnosis and assessing the severity of multi-organ dysfunction. C-reactive protein (CRP), procalcitonin (PCT), and the currently reported marker are endocan. Endocan is a biomarker for multiorgan dysfunction in sepsis. Endocan synthesis and release are triggered by proinflammatory cytokineswhich can increase endocan levels in sepsis while the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) is a scoring method for identifying organ dysfunction in sepsis. A SOFA score ≥2 indicates organ dysfunction. Endocan and SOFA scores are both aimed at assessing multiorgan dysfunction and can determine the prognosis in sepsis. This study aims to determine the suitability of endocan levels with SOFA values in septic patients at Dr.WahidinSudirohusodoHospital Makassar.
Purpose: To determine the suitability of SOFA values with endocan levels in septic patients at the Dr.WahidinSudirohusodoHospital and its network hospital.
Methods: This cross-sectional observational study was conducted from December 2019-August 2020. The population of this study was all sepsis patients in the hospital. 
WahidinSudirohusodo. Data were analyzed descriptively. The compatibility of endocan levels with SOFA values in septic patients used the Spearman correlation test.
Results: From a total of 150 subjects, it was found that patients <60 years were 45 subjects (80.04%), men were 34 subjects (60.7%), patients with 2 comorbid were 21 subjects (37.5%), the mean Endocan levels were 361.9 ± 472.4 with tertileendocan 1 (<110.0) as many as 19 subjects (33.9%) and tertile 3 (> 232.0) as many as 19 subjects (33.9%) while SOFA scores Mean 5.6 ± 3.7 with SOFA scores 0-6 as many as 36 subjects (64.3%). The endocan level in sepsis was significantly lower than the control, namely 361.9 (p <0.01). Based on the Spearman correlation test, it was found that there was a significant negative correlation between endocan levels and the SOFA score (p <0.05). In women, there was a significant negative correlation between endocan levels and SOFA scores (p <0.05), at age <60 years, there was a significant negative correlation between endocan levels and SOFA scores (p <0.05). with the number of comorbid 1, there was a significant negative correlation between endocan levels and the SOFA score (p <0.05).
Conclusion: There is a significant negative correlation between endocan levels and SOFA score in septic patients at Dr.WahidinSudirohusodo Makassar.