World Sepsis Day 2019

13 September 2019

Malaysian Sepsis Alliance Marks World Sepsis Day 2019






WORLD SEPSIS DAY, 13th SEPTEMBER, AWARENESS SAVE LIVES

Lisa knew something was not right with her mother. She was becoming confused and breathless to a point that speaking short phrases was challenging. It had been two weeks since her cough worsened with on and off fever. After visiting a local clinic a week before, she came home with a plastic full of medicine including antibiotic and her usual diabetic medications. Despite completing the medications Lisa’s mother seems to be getting worst. Worried, Lisa brought her mother to the hospital. What happened next was unexpected for Lisa. Her mother was immediately brought to the critical zone and next thing she knew her mother was put to sleep with a tube inserted into her lung to aid her breathing. It was a case of a bad lung infection or Pneumonia and her mother was fighting for her life because of it.

What is sepsis?
Sepsis is a deadly condition triggered by an infection. Infection happens when there is an invasion and multiplication of germs such as bacteria or viruses in our body. In a normal reaction, our body will gather its army known as immune system and attempt to fight these intruders. Sepsis occurs when the body’s response to an infection injures its own tissues and organs. This condition may lead to multiple organs in the body to fail and deteriorate to cause death. Sepsis is the only disease that can be prevented and fully recovered
Death from sepsis is avoidable by recognizing the signs of sepsis early and initiate treatment promptly. So how do we know that a person may be in sepsis? There are six signs that might indicate sepsis known as SEPSIS:
S – Slurring of speech or confusion
E – Extreme shivering, muscle pain or fever
P – Passing no urine
S – Severe breathlessness
I – It feels like you’re going to die
S – Skin mottling or discoloured
There are various types of Infection can happen in our body. The most common infection is meningitis (infection of the protective layer of the brain), pneumonia (infection of the lung), skin or soft tissue infection, urinary tract infection and infections originating from organs in abdomen. There are also instances where the origin of infection is unknown. It is important to recognize sepsis and seek medical attention as commencing on treatment such as antibiotics early may make a difference in outcome and saves lives.

Uniting against sepsis with World Sepsis Day
30 million people develop sepsis every year with one death happens every 3.5 seconds due to sepsis. It is one of the most poorly acknowledged healthcare disasters. Realizing the gap in knowledge, Global Sepsis Alliance (GSA) initiated World Sepsis Day in the effort to provide opportunity for people worldwide to unite in the fight against sepsis. Today, World Sepsis Day is observed every year on 13th September and encourages people to wear pink as show of support to this momentous endeavour.

The aim of World Sepsis Day is to raise awareness on this condition. Treatment is generally available worldwide but needs to be started timely. Once a person is recognized to have sepsis, it is advocated that treatment be started within the first hour of their arrival to hospital.  Sepsis is lethal when left untreated. This condition is undeniably alarming but it can be prevented. Be sure to practise good personal hygiene and updates yourself with vaccination against pneumonia and flu. Let join us on World Sepsis Day, dress in pink and spread the awareness on sepsis to everybody around you. Together we can stop sepsis and save lives.


MEMERANGI BAHAYA SEPSIS DI HARI SEPSIS SEDUNIA, 13 SEPTEMBER


Ianya bermula dengan hanya batuk. Pada mulanya sedikit, lama-kelamaan kerap dan lebih teruk. Pernafasan menjadi sukar seakan sesuatu tersekat diruang nafas. Tubuh menjadi panas dengan suhu yang makin lama makin meningkat. Ubat yang diberi dari klinik minggu lalu sudah habis namun keadaan masih juga tidak pulih. Ada sesuatu tidak kena, lalu dibawa ke hospital. Apa yang berlaku seterusnya sukar untuk diterima. Terus sahaja ditolak ke zon kritikal. Satu persatu doktor datang untuk melihat dan akhirnya ditidurkan melalui pemberian ubat. Satu tiub dimasukkan ke salur pernafasan untuk membantu memberikan oksigen yang secukupnya. Itulah jangkitan kuman yang teruk pada paru-paru, atau lebih dikenali sebagai Pneumonia. Selepas satu minggu bertarung nyawa, akhirnya tewas kepada kepada keadaan yang dinamakan sepsis.
Mengenali Sepsis
Apa itu sepsis? Sepsis adalah satu keadaan yang merbahaya dan boleh meragut nyawa. Keadaan ini kebiasaannya dimulai dengan jangkitan kuman seperti bakteria, virus dan kulat. Dalam reaksi normal tubuh badan, sistem imunisasi badan akan mempertahankan badan dengan melawan jangkitan kuman ini. Sepsis terjadi apabila sistem pertahanan ini mula mencederakan tisu dan organ badan sendiri. Seterusnya menyebabkan kegagalan pelbagai organ didalam badan dan membawa kematian.
Kematian berpunca daripada sepsis boleh dielakkan dengan mengenali tanda-tanda sepsis dan memulakan rawatan diperingkat awal. Bagaimana kita boleh mengetahui seseorang itu mungkin menghidapi sepsis? Antara 6 tanda-tanda awal adalah:
1. Kurang tahap kesedaran
2. Demam, sakit-sakit badan dan menggeletar teruk
3. Kurang air kencing
4. Susah bernafas
5. Kulit bercapuk atau berubah warna

Terdapat beberapa organ badan dimana jangkitan kuman boleh berlaku. Antara jangkitan kuman yang selalu terjadi adalah di selaput otak (“meningitis”), paru-paru (“pneumonia”), kulit atau tisu badan, salur kencing dan organ-organ didalam abdomen. Terdapat juga keadaan dimana punca jangkitan tidak dapat dikenalpasti. Amat penting untuk kita mengenali sepsis supaya rawatan seperti antibiotik dapat dimulakan diperingkat awal jangkitan kuman lagi. Ini adalah kerana rawatan awal dapat menyelamatkan nyawa.
Bersama memerangi sepsis di Hari Sepsis Sedunia
Terdapat 30 juta orang menghidapi sepsis setiap tahun di seluruh dunia. Kematian berpunca daripada sepsis adalah satu setiap 3.5 saat. Sepsis adalah satu bencana kesihatan yang melanda dunia namun kesedaran mengenai sepsis masih ditahap rendah. Menyedari kekurangan ini, Global Sepsis Alliance (GSA) memulakan inisiatif untuk memberi platform kepada orang ramai untuk bersatu memerangi sepsis melalui Hari Sepsis Sedunia. Orang ramai dijemput bersama-sama meggunakan warna merah jambu sebagai tanda sokongan kepada Hari Sepsis Sedunia yang diadakan pada 13 September setiap tahun.  
Tujuan utama Hari Sepsis Sedunia ini adalah untuk meningkatkan kesedaran terhadap bahaya sepsis. Rawatan untuk jangkitan kuman tidaklah sukar untuk didapati tetapi rawatan ini perlulah dimulakan secepat yang mungkin. Sepsis boleh menyebabkan kematian jika tidak dirawat. Keadaan ini ternyata membimbangkan akan tetapi ianya boleh dicegah. Penjagaan kebersihan dan mengambil vaksinasi adalah salah satu cara menghindari sepsis berpunca daripada jangkitan paru-paru dan selsema. 
Sepsis melemahkan tubuh badan seseorang walaupun selepas rawatan. Untuk tubuh badan pulih sepenuhnya selepas menghidapi sepsis mengambil masa yang lama. Rasa penat yang berpanjangan, lemah otot, depresi, sukar menumpukan perhatian dan sukar tidur adalah antara beberapa masalah yang boleh dihadapi oleh seseorang yang baru pulih daripada sepsis. 
Oleh yang demikian, di Hari Sepsis Sedunia ini marilah kita sama-sama memakai warna merah jambu dan bantu menyebarkan kesedaran berkenaan sepsis. Bersama kita mampu memerangi sepsis dan mengurangkan kematian yang berpunca dari sepsis. 


世界败血症日 (九月十三日),及早别识败可拯救生命!


丽莎发现她的母亲不对劲。 母亲得气喘和精神困惑,说话也蛮困难的。她已经咳嗽和发烧了两个星期,情况恶化。在一周前访问当地一家诊所后,医生为她开了抗生素和糖尿病的药物回家。尽管完成了药物治疗,的母亲病情似乎变得越来越糟糕。在担心之下,丽莎带她的母亲去医院。接下来发生的事情令丽莎感到意外。她的母亲立即被带到紧急抢救区,接下来她知道的是她的母被被插入肺管以帮助她呼吸。这是一个很严重的肺部感染或肺炎和她的母亲因此而为生命而战。
什么是败血症?
败血症(SEPSIS)是一种由感染引发的致命疾病。当我们体内存在细菌或病毒等细菌的入侵和繁殖时就会发生感染。在正常的反应中,我们的身体将聚集其被称为免疫系统的军队并试图对抗这些入侵者。败血症发生当身体对感染的反应损,伤害其自身组织和器官时。这种情况可能导致身体多个器官衰竭并恶化导致死亡。败血症是唯一一个可以避免和完全可康复的疾病。

通过及早别识败血症的症状并立即开始治疗,可以避免脓毒症死亡。那么我们怎么知道一个人可能在败血症?有六个迹象可能表明败血症称为败血症:

S – slur speech言语混乱或混乱
E – extreme shivering极度颤抖,肌肉疼痛或发烧
P – pass out no urine无尿
S - Severe breathlessness严重呼吸困难
I - It feels like you’re going to die感觉就像你要死
S - Skin mottling or discoloured皮肤斑驳或变色

我们体内可能发生各种类型的感染。最常见的感染是脑膜炎(脑部保护层感染),肺炎(肺部感染),皮肤或软组织感染,尿路感染和腹部器官的感染。还有一些未知感染起源的情况。重要的是要早识别败血症并寻求医疗关注,因为及早开始抗生素治疗可能会对治疗败血症,并挽救生命。
与世界脓毒症日联合反抗败血症

每年有三千万人患上败血症,由于败血症,每3.5秒就有一例死亡。这是一个影藏的秘密杀手, 医药界的灾难之一。全球败血症联盟, Global Sepsis Alliance(GSA)和亚太败血症联, Asia Pacific Sepsis Alliance (APSA)盟意识到别识上的差距,启动了世界败血症日,努力为全世界人民提供联合抗击败血症。今天,世界败血症日被定在每年的九月十三日 (红色九月),并在当天鼓励人们穿粉红色作为支持世界败血症日这一重大努力。
世界败血症日的目的是提高对这种状况的认识。治疗通常在全球范围内提供,但需要及时开始。一旦一个人被认出患有败血症,就建议他们立刻到医院, 医生应在第一个小时内开始治疗。  败血症未得到治疗是致命的。无可否认,这种情况令人担忧,但可以预防。一定要保持良好的个人卫生习惯和提高自己对肺炎和流感疫苗的知识。

*********************************************************************************

Malaysian Sepsis Alliance 2019

World Sepsis Day 2019 Photo booth Activities














Ebook "Sepsis Management: A Quick Guide"

31 July 2019



Finally, our ebook for sepsis management in our local setting was published!

Confuse about how to identify sepsis?

Confuse about how and when to use qSOFA score?

But eager to know the cheapest and simplest ways to monitor and manage sepsis in a busy and limited resources setting?

"Sepsis Management: A Quick Guide", this ebook is customised to suit our local setting and other low-middle income countries to provide you with the answer.

The book contains side by side illustrations with texts to unfold the complexity of sepsis and easy to understand. It also contains important pitfalls and tips while managing sepsis. Furthermore, the book is also equiped with google translation tool to accommodate readers of different languages.

This book is suitable for:

1. Doctors who work in district, Emergency Departments, ICU and Critical care unit. It also suitable for Infection disease specialists, pharmacists and healthcare providers,  especially those from low-middle income countries.

2. Paramedics and Nursing personals.

3. Scientists who is currently doing or wishing to do clinical research in sepsis.

Get a copy at Google Play Book Store with offer price at this link. (support for both ios and android user)

https://books.google.com.my/books/about?id=rvSiDwAAQBAJ&redir_esc=y











Sepsis Resuscitation and Monitoring Chart (SRMC) in Low-Middle Income Country Setting

27 Jun 2019
Due to the limited resources, our society had come out a simplified sepsis resuscitation chart for a appropriate goal directed and guided sepsis resuscitation management in emergency department and critical care unit. It is guided using pulse oximetry plethysmographic waveform analysis, Modified SOFA score and Frank Stratling Curve. This make sepsis management more easy and organised in our setting.



Link to download

PDF: https://drive.google.com/file/d/1bkZR5UBRRXL5jlKqcAFpZF7QoLPD0v5e/view?usp=sharing



PNG : https://drive.google.com/file/d/1orZRtnWwmt5KZbgLOo61nnq9sudvEtbT/view?usp=sharing

2nd Malaysian Sepsis Evolution (MySE) Seminar



*********************************************************************************

We are proudly present to you our 2nd Malaysian Sepsis Evolution (MySE pronouce as mice) Seminer. FINAL ANNOUNCEMENT.

The registration already open. Please come and join us. 

Click here for registration.








Sepsis Management Update- Advanced Level 

Organised by: Malaysia Sepsis Alliance
Speaker: Dr Tan Toh Leong
Senior Lecturer and Emergency Department
AMS UKMMC Committee
SIGMARIS MALAYSIA

Malaysia Sepsis Alliance in conjunction with Emergency Department of Universiti Kebangsaan Malaysia Medical Centre had organized a Sepsis Management Update Course on 18th January 2019. It involved specialist around Malaysia which included expert from emergency department, microbiology department, biochemistry department and etc. In this course, the understanding of sepsis was enlightened by all of expert from various field. Sepsis Identification and Management was greatly emphasized in this course where quick identification of Sepsis or Septic Shock in suspected patients, determination state of sepsis either SIRS, CARS or MARS, obtained suggested biomarkers and management of sepsis by initiate 1 hour bundle while maintaining the volume and cardiac contractility.









Intermediate Sepsis Workshop and Advance Hemodynamic Monitoring in ED (sponsor by Edward Lifescience) 

Speaker: Dr Tan Toh Leong
Senior Lecturer and Emergency Department
AMS UKMMC Committee
SIGMARIS MALAYSIA

On 14th December 2018, The Emergency Department of Universiti Kebangsaan Malaysia Medical Centre held an Intermediate Sepsis Workshop for all emergency physicians and post graduate doctors. It's a great pleasure to have this workshop sponsored by Edward Lifescience. The definition of sepsis and its clinical stages characterisation have been changing for the past decades until most recently in 2018. It remains high mortality rate and healthcare provider find it challenging to understand and manage sepsis. Thus, this workshop was held to augment the understanding and management on sepsis with an ultimate aim to identify and treat sepsis as early as possible based on the latest Survival Sepsis Campaign Guideline. In conjunction to the workshop, Edward Lifescience took this opportunity to introduce non-invasive ClearSight system which extends the benefits of continuous hemodynamic monitoring includes measuring stroke volume, stroke volume variation, cardiac output, systemic vascular resistance and continuous blood pressure.







Surviving Sepsis Campaign Guideline- 1 hour bundle 2018

Surviving Sepsis Campaign Guideline- 1 hour bundle 2018

The management of sepsis is challenging. Guideline had been form to facilitate this. MySepsis are supporting the recent updated Surviving Sepsis Campaign Guideline recommended by Society of Critical Medicine . We hope this will enhance the sepsis management in our local setting. #MySepsis

Please find the protocol at the following link


http://www.survivingsepsis.org/Guidelines/Pages/default.aspx

Marik Cocktail - a "cure" of sepsis?

Vitamin C, Thiamin and Steriod improve organ failure rec


The components of Marik’s life-saving sepsis cocktail are simply steroids and vitamins, a therapy, which many have said is harmless, but may improve sepsis survival dramatically. Steroids for sepsis have been around decades, and although there have been several trials evaluating its benefits in the septic patient; it is safe to say that the use of steroids remains controversial. The recently completed HYPRESS trial did not demonstrate a benefit for steroids in patients with sepsis.  How about the use of vitamin C and thiamine? This is not a new concept and there are studies demonstrating benefit so perhaps, combining all these “harmless” therapies would work on the deranged physiologic pathways that are present in the septic patient.

So the conjecture here is that Marik’s new cocktail has little patient harm because the individual components are individually benign and have been studied before. In fact, Marik himself has made the claim that withholding this therapy while waiting for a multicenter trial to be completed would be unethical. In support of his statement he has even invoked the infamous “parachute analogy” where some therapies are so obvious that it would be illogical to test them in a clinical trial.

Abstract 
Adapted from (Marik et al 2016)
Background: The global burden of sepsis is estimated as 15 to 19 million cases annually
with a mortality rate approaching 60% in low income countries.

Methods: In this retrospective before-after clinical study, we compared the outcome and
clinical course of consecutive septic patients treated with intravenous vitamin C,
hydrocortisone and thiamine during a 7-month period (treatment group) compared to a
control group treated in our ICU during the preceding 7 months. The primary outcome was
hospital survival. A propensity score was generated to adjust the primary outcome.

Findings: There were 47 patients in both treatment and control groups with no significant
differences in baseline characteristics between the two groups. The hospital mortality was
8.5% (4 of 47) in the treatment group compared to 40.4% (19 of 47) in the control group (p
< 0.001). The propensity adjusted odds of mortality in the patients treated with the vitamin
C protocol was 0.13 (95% CI 0.04-0.48, p=002). The SOFA score decreased in all patients in
the treatment group with none developing progressive organ failure. Vasopressors were
weaned off all patients in the treatment group, a mean of 18.3 ± 9.8 hours after starting
treatment with vitamin C protocol. The mean duration of vasopressor use was 54.9 ± 28.4
hours in the control group (p<0.001).

Conclusion: Our results suggest that the early use of intravenous vitamin C, together with
corticosteroids and thiamine may prove to be effective in preventing progressive organ
dysfunction including acute kidney injury and reducing the mortality of patients with
severe sepsis and septic shock. Additional studies are required to confirm these
preliminary findings.

The clinical trial paper can be found at this link

https://digitalcommons.odu.edu/cgi/viewcontent.cgi?article=1127&context=bioelectrics_pubs

For those who want to get a quick glance on this topic, please kindly go to this link (credits to R.E.B.E.L EM group making the topic easy to understand):

http://rebelem.com/the-marik-protocol-have-we-found-a-cure-for-severe-sepsis-and-septic-shock/




Sepsis Interprofessional Workshop Nottingham University 2018

Once a year, we will conduct a sepsis workshop for the pharmacy students from Nottingham University UK, China and Malaysia. The workshop aim to share our clinical experiances in managing sepsis with the future pharmacist-to-be. The workshop aim to expose the Pharmacist-to-be to recognize the important of sepsis and how to approach Sepsis in the interprofessional manner. Our team comprise of  an Emergency Physician Dr Tan Toh Leong, a senior asistant Medical Officer, Mr Muhammad Kamarul and a senior Nurse Mdm Premalatha who are all very enthusiastic in sepsis care. The workshop was successful delivered and the students love it so much.

The syllabus and contents are originated from SEPSIS TRUST, United Kingdom, which Sepsis Six was introduced.

The link : https://sepsistrust.org/professional-resources/education-resources/

THE SEPSIS MANUAL Edited by Dr Ron Daniels and Dr Tim Nutbeam, provides detailed education free of charge for every healthcare professional in the UK. It includes UKST’s ‘Sepsis Six’ pathway (which halves the risk of patients dying). You may download the pdf file at the link provided.

 https://sepsistrust.org/wp-content/uploads/2018/06/Sepsis_Manual_2017_web_download.pdf

With the alignment with aim of Global Sepsis Allince and Asia Pacific Sepsis Alliance, we are at  our best to increase sepsis awareness in our country (Malaysia).













SepsiDot (Trademark) Bacterial Rapid Diagnostic kit (10min) using sPLA2-IIa

Bacterial Rapid Diagnostic kit (10min) using sPLA2-IIa

Malaysia Sepsis Research Group had found a potential solution for rapid bacterial detection with 2 to 3 drops of blood within 10min. It can be done via a trienzymes biosensor with a portable digital reader. We found that secretary phospholipase A2 group IIa (sPLA2-IIa)  have a very high sensitivity and specitivity (AUC=0.97, Sn=94%, Sp=94%)  in distinguishing bacterial infection from viral (Tan et al 2016, Tan et al 2018).




We also pilot a second study involving 211 patient presented tovalidating the sPLA2-IIa against procalcitonin (PCT). The report was presented to the Annual Scientific Meeting in Emerging Infection And Treat 2017

Distinguish:      Sepsis     Bacterial
AUC
sPLA2-IIA          0.81.        0.93         
PCT                     0.79         0.89





In a lower middle income country, we don't have a much resource to investigate sofisticate sepsis. We in need a very rapid diagnostic method to distinguish bacterial sepsis and initiate antibiotic as to compliance to 1 hours antibiotic SSC guideline.

Video explaining how the test kit work:

Pay it forward: Sepsis no more.
A method to rapidly detect sepsis and a revolution the way how we approach sepsis.
















We had filed a patent on the invention. The publication (2018) on this POCT can be reach at below link


https://www.mdpi.com/1424-8220/18/3/686/html


The bedsite point-of-care will be expected to come out as soon after complete a proper clinical trail.

We are welcome any enquiry. Any enquiry, please email to sigmarismalaysia@gmail.com