European Journal of Molecular & Clinical Medicine

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: Shock is one of the most dramatic, dynamic and life-threatening problems
faced by the physician in critical care setting.The mortality rate of shock in pediatric
patients has declined as a consequence of educational efforts (pediatric advance life
support), which emphasize early recognition and intervention and rapid transfer of
critically ill patients to a PICU via a transport service. To know about the risk factors in
a critically ill child with shock and its association with outcome, will give us an early
clue in identifying and prioritizing management strategies.
Material & Methods: A descriptive study done on 100 children in the age group of one
month to 12 years presenting with shock (or) who later develop shock during PICU stay
at RUHS College of Medical Sciences, Jaipur, Rajasthan, India during one year period.
Children who had received inpatient treatment prior to admission in PICU, post
cardiac arrest shock and traumatic shock / Burns were excluded in our study. During
the PICU stay periodic vital signs and other measures like urine output and oxygen
saturation were recorded. IV fluid therapy, rate and duration of inotrope and other
organ support like ventilatory support were documented.
Results: In present study the frequency of shock was found to be 1.64%.Undernutrition,
decompensated shock, cardiogenic shock, duration of shock more than 6 hours,
leucopenia, hypocalcemia, inotrope requirement, ventilator support & MODS was
present in higher proportion of children who died(36.11%, 69.44%, 27.77%, 72.22%,
22.22%, 38.88%, 94.44%, 97.23% & 69.45 respectively) when compared to those who
had survived (20.32%, 14.06%, 9.37%, 26.56%, 4.68%, 10.93%, 57.82%, 47.25% &
15.62% respectively). Oddsof different variables were measure among the children who
died, when compared tothose who had survived (2.17, 13.78, 3.56, 7.45, 5.89, 5.11, 13.87,
104.2 & 12.78 respectively.
Conclusion: We concluded that under nutrition, decompensated shock, inotrope
requirement, MODS, leucopenia and ventilatory support are independently associated
with poor outcome.

Boosted therapy of immunization against SARS-CoV2 has already been certified to
progress for humans all around the world. After having a long breakthrough of a
pandemic, the physiological response of human cells is now presenting as omnipotent
characters for their autoimmune criteria against a viral antigen, types, sub-types, strains,
and modified strains. The molecular genesis is migrated and conducts with a different
pattern of doses but specified in the same dosed to administer by injected protein
derivatives. The viral epitopes and their surface protein are concerned with the activation
of monoclonal antibodies by the artificial secondary immune response. The artificial
immunogenetic is explored by analytical research of several trials of virologists from mid-
August to December 2020.