Objective:The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan.Methods:A prospective observational study was carried out at intensive care unit of our hospital from February 2014 to October 2015. Data was collected using a structured format and statistical analysis was done using SPSS version 20®. Regression model was applied to identify the factors contributing to the outcome of severe sepsis and septic shock. P-value less than 0.05 was considered statistically significant.Results:Majority of the patients meeting the criteria of this study were male 147 (54.9%) with a mean age of 54.8. The most common source of sepsis was lung infections (42.2%) followed by urinary tract infections (18.7%), soft tissue infections (6.3%) abdominal infections (6%) and in 6.3% patients the source remained unknown. Further analysis has revealed that increase in number of days of hospitalization was observed to be slightly associated with the outcome of the treatment (1.086 [1.002 – 1.178], 0.046). Moreover, the risk of mortality was the higher among the patients with septic shock 22.161[10.055 – 48.840], and having respiratory, kidney and central nervous system complications. Overall it is seen that septic shock alone was found responsible to cause death among 32.0% of the patients (Model 1: R2 0.32, p=0.000), and upon involvement of the organ complications the risk of mortality was observed to 42.0%.Conclusion:Chances of recovery were poor among the patients with septic shock. Moreover, those patients having respiratory and urinary tract infection are least likely to survive.

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Background: Liver dysfunction in children is variable and depends on disease severity. This study was undertaken to identify the range of hepatic involvement in children with dengue infection.Methods: It is a cross sectional observational study conducted in serologically positive dengue fever in children aged between 1-14 years. Hepatic function was studied in all suspected cases over a period of 1 year from June 2015 to June 2016.Results: Out of 55 cases admitted, liver function tests showed AST levels elevated more than 45U/L in 20 (86.9%) DF, 29 (100%) DHF, 3 (100%) DSS patients. ALT levels were elevated more than 45U/L in 16 (69.5%) DF, 24 (82.75%) DHF, 3 (100%) DSS patients. More than 10 fold increase in levels of both AST and ALT was seen in severe dengue.Conclusions: Dengue infection is associated with variable levels of liver dysfunction. The incidence of hepatic dysfunction is more in patients with dengue fever with warning signs and severe dengue. Significant elevation of transaminase levels helps in predicting the occurrence of severe dengue. It is important to be aware of this entity which needs significant attention and management.

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