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Melioidosis is a tropical infectious disease with diverse clinical presentations. We aimed to investigate the characteristics and mortality risk factors of patients diagnosed with melioidosis in the past 10 years. This was a retrospective cohort study conducted at a quaternary care centre in South India. Clinical, demographic, and biochemical data in patients diagnosed with melioidosis with cultures were collected between January 2011 and December 2020 from medical records. Logistic regression analysis was performed to screen mortality risk factors of melioidosis in addition to descriptive statistics and chi-square analysis. Seventy-three melioidosis patients’ records were analysed, and the most common comorbidity was type 2 diabetes mellitus (n = 53, 72.6%). The patients showed diverse presentations: pulmonary involvement, 30 (41.1%); splenomegaly, 29 (39.7%); abscesses and cutaneous involvement, 18 (24.7%); lymph node, 10 (13.7%); arthritis and osteomyelitis, 9 (12.3%); and genitourinary infection, 4 (5.4%). The mortality was noted to be 15 (20.5%). Logistic regression analysis indicated that chronic kidney disease (OR = 14.0), CRP >100 IU/L (OR = 6.964), and S. albumin

Background Sudden cardiac arrest is the leading mode of death in the United States. Epilepsy affects 1% of Americans; yet epidemiological data show a prevalence of 4% in cases of sudden cardiac arrest. Sudden unexpected death in epilepsy (SUDEP) may share features with sudden cardiac arrest. The objective of this study was to report autopsy and genomic findings in a large cohort of SUDEP cases. Methods and Results Mayo Clinic Sudden Death Registry containing cases (ages 0–90 years) of sudden unexpected and unexplained deaths 1960 to present was queried. Exome sequencing performed on decedent cases. From 13 687 cases of sudden death, 656 (4.8%) had a history of seizures, including 368 confirmed by electroencephalography, 96 classified as SUDEP, 58 as non‐SUDEP, and 214 as unknown (insufficient records). Mean age of death in SUDEP was 37 (±19.7) years; 56 (58.3%) were male; 65% of deaths occurred at night; 54% were found in bed; and 80.6% were prone. Autopsies were obtained in 83 cases; bystander coronary artery disease was frequently reported as cause of death; nonspecific fibrosis was seen in 32.6% of cases, in structurally normal hearts. There were 4 cases of Dravet syndrome with pathogenic variants in SCN1A gene. Using whole exome sequencing in 11 cases, 18 ultrarare nonsynonymous variants were identified in 6 cases including CACNB2, RYR2, CLNB, CACNA1H, and CLCN2 . Conclusions This study examined one of the largest single‐center US series of SUDEP cases. Several cases were reclassified as SUDEP, 15% had an ECG when alive, and 11 (11.4%) had blood for whole exome sequencing analysis. The most frequent antemortem genetic finding was pathogenic variants in SCN1A ; postmortem whole exome sequencing identified 18 ultrarare variants.

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy and sleep disordered breathing (SDB) is a treatable risk factor that has been seen to occur concurrently, and is known to propagate mortality and morbidity in a number of cardiovascular disease states including heart failure, and indeed hypertrophic cardiomyopathy. In this review, we summarize past studies that explored the simultaneous occurrence of HCM and SDB, and the pathophysiology of SDB in relation to heart failure, arrhythmias, cardiac ischemia and pulmonary hypertension in HCM. The current therapeutic modalities, with the effect of obstructive sleep apnea (OSA) treatment on HCM, are then discussed along with potential future directions.

OBJECTIVES: 1. To investigate the association between PICU shock index and mortality in children with sepsis/septic shock. 2. To explore cut off values for ICU mortality, how change in shock index over the first 6 hours of ICU admission is associated with outcome. DESIGN: Prospective study. SETTING: Single centre tertiary PICU. SUBJECTS: 50 children with a diagnosis of sepsis/septic shock. METHODS AND RESULTS: From January to June 2017, 50 children who met International pediatric Sepsis Conference of 2005 criteria of sepsis were included and the overall mortality was 32%. In age group ≤ 1 year, cut off value of SI at 0 hour was 2.16, relative risk of mortality 2.01 (95% CI, 0.67 – 5.91) and cut off value of SI at 6 hours was 1.77, relative risk of mortality 2.85 (95% CI, 0.78 – 10.37). In age group > 1 to ≤ 6 year, cut off value of SI at 0 hour was 1.43, relative risk of mortality 2.14 (95% CI, 0.71 to 6.4) and cut off value of SI at 6 hours was 1.77, odds ratio 87 (95% CI, 2.95 to 2534). In age group > 6 to 12 years, cut off value of SI at 0 hour was 2.03, relative risk of mortality 7 (95% CI, 0.67 – 72) and cut off value of SI at 6 hours was 1.56, relative risk of mortality 15 (95% CI, 2.25 – 99.7). Higher SI values were associated with mortality and increasing trend of SI increases the risk of mortality. CONCLUSION: Shock index may be a promising marker of mortality in children with sepsis/septic shock. Given the higher risk of mortality with higher SI values and with the cut off values of SI above which the risk of mortality increases, children with elevated SI values and above the cut off range for mortality may benefit from more aggressive resuscitation and intensive care.

Background: While many factors are known to play a role in outcomes of sepsis, the role of micronutrients such as zinc remains a gray area. This study assesses the correlation of plasma zinc levels with mortality and severity of sepsis. Objective was to study the association between plasma zinc levels with mortality and severity of sepsis.Methods: Comparative prospective observational study which included 89 patients with proven sepsis according to the society of critical care medicine (SCCM) guidelines. The study was conducted at a tertiary care centre in South India. A total of 89 patients who were admitted into the medical ICU directly from ER, from December 2014 to August 2015 were chosen for the study after satisfying specific inclusion criteria and divided into 2 outcome groups based on mortality.Results: There was a significant association between plasma zinc (categorized as low, normal and high plasma zinc) and outcome. While the severity of sepsis as per SOFA score on admission did not have an association, there was a significant association between plasma zinc and the 48-hour SOFA score.Conclusions: Higher plasma zinc values had lower mortality and lower 48 hours SOFA score, strengthening the hypothesis regarding the role of zinc in the immune response to sepsis. More research is needed regarding the role of zinc in assessing the severity and predicting the mortality of patients with sepsis.

We present a case of hemophagocytic lymphocytosis (HLH) that occurred secondary to a combination of Epstein Barr virus (EBV) infection and systemic lupus erythematosus (SLE) in early pregnancy. A 29-years-old lady presented with complaints of fever, vomiting and loose stools. She underwent successful in-vitro fertilization (IVF) and embryo transfer 20 days prior to the onset of these symptoms. Her blood investigations revealed anemia, neutropenia, hyperferritinemia and hypertriglyceridemia, eventually resulting in a diagnosis of HLH further substantiated by bone marrow examination. Additional investigations revealed positive anti-dsDNA and EBV IgM antibodies amongst other findings, adding SLE and EBV to the diagnoses. They were considered potential triggers for HLH. However, the occurrence of these events following IVF poses the question of whether pregnancy played a role in the development of HLH. Our patient responded well to pulse steroid therapy and has had an uneventful course till date.