Base Deficit as a Predictor of Mortality in Sepsis and Septic Shock.

Introduction: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. It is always difficult to have the quick prognostic marker of sepsis in busy emergency. So this study was conducted to determine whether base deficit can be used as an indicator of mortality among septic patients in emergency room set up like ours. Methods: It was a hospital-based descriptive cross-sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from March 2018 to December 2018.  Acute physiology and chronic health evaluation II score(APACHE II), Base deficit, Sequential Organ Failure Assessment(SOFA)score on first day of arrival in the emergency room were calculated. The association of 28-day outcome with Acute physiology and chronic Health Evaluation II score, Base deficit value and SOFA score were derived. Results: Out of 229 patients with septic shock 62 died (27%) and among 71 patients without septic shock,12 died(16.9%) .Overall mortality was 24.66 %(n= 74).The area under the ROC curve for Base deficit(0.864;95% C.I.=0.822-0.906), APACHE II( 0.782;95%C.I=0.718-0.848;,SOFA(0.689;95% C.I=0.620-0.757) were greater than 0.7 except for SOFA which signifies these test to  have fair efficacy to predict mortality. Conclusions: High base deficit value predicts mortality in patients with sepsis and septic shock. Keywords: Base Deficit; Sepsis; Septic Shock, Predictor, Mortality DOI: http://doi.org/10.3126/jkahs.v2i2.2516

A study on role of follow up in minor surgical procedures

Background: Minor surgical procedures are surgeries that can be performed in the clinic under local anesthesia and doesn’t require preoperative and postoperative admission. In most of the institutions in our country, we advised patients to follow up within 7 to 10 days following minor surgical procedures. Unnecessary follow up increases stress to the patients in terms of not being able to manage daily routine work and would be costly as well. As a General Practitioner, majority of the cases done are the minor surgical procedures. Methods: The study was a prospective cross-sectional study conducted in the General Surgery Department at United Mission Hospital, Palpa from Dec 2013 to May 2013. 228 patients were divided into two groups of “No follow up” group and “Follow up” group.No Follow up Group was asked pre-formed questionnaires by telephone whereas Follow-up group were asked to follow up routinely on day 7 to 10 days of surgery and asked the same questions. Statistical analysis was done using SPSS program and Microsoft Excel. P-value of <0.05 was considered statistically significant. P-value was determined by using the Chi-Square test. Result: The overall wound infection among 228 patients was found to be 14.5 percent with an infection rate of 16.4 percent in No Follow-up group and 12.7 percent in Follow-up group. The infection rate was found to be higher among the older age group of patient maximum being 36.4% in the age group of 50-59 years with a p-value of 0.053. Other risk factors like age, sex, residence, duration of surgery, socioeconomic status, history of medical illness and BMI didn’t have a significant association with the rate of infection following a minor surgical procedure. Conclusion: The routine postoperative follow up in minor surgery is unnecessary unless there are any signs suggestive of infection. Keywords: Minor surgery, Postoperative infection. DOI: http://dx.doi.org/10.3126/jkahs.v2i1.24412