Talk:Sepsis

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[edit] Septic

Is there a reason why Septic is a redirect to Sepsis? I don't quite understand it from the article text. --Timc 03:22, 6 Jun 2004 (UTC)

I believe septic is a term used to describe someone or something with sepsis. Vansice 23:15, 2 June 2006 (UTC)


[edit] Post-sepsis

I can't find anything related to what happens to babies born with sepsis, I was born with sepsis, and I turned out to be a very withdrawn child who was very afraid of people. --86.18.156.77 16:28, 25 December 2006 (UTC)

I am not sure if your psychological development is related to having sepsis as a baby. What makes you think you turned out this way for that reason? Grim Faerie (talk) 14:05, 31 January 2008 (UTC)

[edit] Abdomenal GSWs and sepsis

I think the article should mention the high incidence of sepsis following gunshot wounds to the abdomen. My understanding is that this is caused by wholesale leaking of GI material from punctured (or eviscerated) bowel and colon into the abdominal cavity, and that left unchecked death from massive sepsis can occur with 24-36 hours. This article discusses GSWs in Lagos (where prompt surgery and antibiotics clearly aren't always available). Also, I understand a large number of battlefield deaths in WW1 (particularly at the beginning, before they figured out surgical methods for treating abdominal injuries) were due to gunshot-related sepsis. -- Finlay McWalter | Talk 00:53, 19 Aug 2004 (UTC)


[edit] Septicemia

Could someone who knows about septicemia please make a separate article instead of a redirect?

Please sign your name. Septicicaemia is a form of sepsis, and creating a seperate page would lead to Balkanisation of the relevant information. Just keep it here. JFW | T@lk 07:08, 15 Jun 2005 (UTC)

[edit] Question

My 2 month pregnant, 26 year old friend died last week. It started 3 weeks ago with up and down fever and head pain.After one week in the hospital she could not speak any more and a week later she died. The death certificate announce: SEPTICEMIA, UTI, MAJOR DEPRESSIVE MOOD WITH PHYCITOSIS. Can a young person like her die that fast from it? Tom Philippines April.06

Toxic shock syndrome which is a very aggressive condition, can be fatal within 24 hours. Although I don't know what you friend had (it sounds like the infection started as a urinary tract infection) any person with a severe infection can die. I have seen enough examples of that.Holland Nomen Nescio 06:37, 6 April 2006 (UTC)
Sorry to hear about your friend. The description you give sounds like it was a very tragic case. Any case, to answer the question-- septicemia can cause death and it can be quite quick, even in the young. Dying from sepsis is rarer in the young but does happen. A typical scenario would be-- a person with a bad burn--getting a bad infection and then sepsis. As for the other things-- (depression and psychosis) --they probably made the situation more difficult and possibly were the bit that tipped them over the edge. The urinary tract infection (UTI) -- is possibly where it all started... that is somewhat speculative. Nephron  T|C 20:35, 15 April 2006 (UTC)

[edit] Clear definition?

It seems to me that the article is lacking a clear definition of what sepsis "is" (as opposed to what it does, or how it is diagnosed.) As far as I know, sepsis is when the perfectly clean, antiseptic state of the inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct? Either way, the page needs a better definition than the non-definition of "sepsis is a serious medical condition caused by a severe infection." I mean, I reread the article and there is literally no section describing what it is the article is talking about! I would fix this myself, but I only have the shaky definition I wrote above. 65.94.230.83 17:48, 15 April 2006 (UTC)

Quote: ...inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct?
The definition is quite clear-- it is in the Definition of sepsis section. Sepsis is sort of a catch all things-- and can be caused by a lot of different things. Sometimes the cause is not known and doctors just know that things are NOT right and there is an infection. As for ...food actually entering the bloodstream... that seems rather unlikely to me. What can enter the bloodstream is a bacteria and that may come indirectly from food that is ingested and ends-up going through a hole in the stomach or the duodenum. Any time the gastrointestinal tract is perforated there is a high risk of infection (which can lead to sepsis). Nephron  T|C 20:24, 15 April 2006 (UTC)
If such is the case, I suggest mentioning in the article that sepsis is a catch-all term. Currently the definition section starts with "Sepsis can be diagnosed if" followed by a list of conditions. If there is no one definition of sepsis, perhaps this should be noted at the beginning, and the "Definition of Sepsis" section renamed to "Diagnosis of Sepsis". Unless medical conditions are always defined by their method of diagnosis? In which case, is there not some way of describing sepsis in layman terms? MrHumperdink 17:06, 29 April 2006 (UTC)
It is not "a catch-all term," since it only means that when infection (what kind can't be defined since all infections, if severe, potentially have this effect) is so severe that if the used criteria apply, we call it sepsis. Beyond that, we have septic shock.Holland Nomen Nescio 17:34, 29 April 2006 (UTC)
Nescio is right --it isn't a catch-all. If you re-read what I wrote you'll notice I used the weasel words sort of before catch-all. Any case, I'll try and answer your questions.
Unless medical conditions are always defined by their method of diagnosis?
Medical conditions are always defined by some set of criteria and always relative to what is considered normal/healthy (based on age and sex). Most medical conditions have several criteria and are typically defined by signs and symptoms. Sometimes the criteria for a condition are exclusionary (i.e. social phobia can not be diagnosed if the patient has body dismorphic disorder).
In which case, is there not some way of describing sepsis in layman terms?
I don't think there is a good way to describe it in layman terms-- but I'll give it a try:
A person has sepsis when doctors can prove that the person has an infection with a disease causing organism (e.g. a bacterium that normally isn't found in a healthy person) and some of the person's vital signs and blood levels are abnormal.
A person with sepsis is very sick. 00:42, 30 April 2006 (UTC)

Under the "Symptoms" heading, the definition appears more to be "signs" than actual symptoms. Symptoms should be what the patient experiences or can report about his/her condition, signs would be what the doctor can conclude from tests or observation. I would like to see more discussion of what symptoms patients normally experience, such as the ones discussed on this page, like high fever, pain, difficulty breathing, etc., under the "Symptoms" heading. And then perhaps the heading should read "Signs and Symptoms," instead. My mother just died of sepsis due ultimately to multiple myeloma, and we thought she had bronchitis, the symptoms were similar. Kelelain 16:23, 25 January 2007 (UTC)Kelelain, 25 January 2007

[edit] Necessary additions

This article needs a timeline or something like that, to tell how long a person with sepsis has to live. Sepsis is also very common from gunshot wounds, which is not present in the article.

There's no way to make such predictions, so there's no way to make such a timeline. People with sepsis survive diferrent lengths of time - or recover - based on many, many variables relating to their age, their state of health, the nature of the sepsis, and treatment, as well as other factors. - Nunh-huh 06:19, 17 April 2006 (UTC)
I think the question is a fair one and despite what is above I think the outcome can be predicted to some degree. APACHE II is one way of predicting outcome-- yet not specific to sepsis per se. Survival depends on many factors-- age, co-morbidity (i.e. other health problems), pregnant/non-pregnant, type of infection et cetera.
I don't think sepsis from gunshot wounds it that common. Sepsis in GSW is seen approx. in 4-5% of patients. That said, it is lethal in approx. 50% of cases. Briusov PG, Frantsuzov VN, Novozhilov AA. [Modern aspects of wound sepsis in war surgical trauma] Khirurgiia (Mosk). 1999;(10):35-8. PMID 10540551, Nechaev EA, Revskoi AK. [Gunshot wound sepsis] Khirurgiia (Mosk). 1993 Mar;(3):27-32. PMID 8089965.,
Overall death due to sepsis seems to be quite low-- vascular injuries are much more lethal. Feliciano DV, Burch JM, Spjut-Patrinely V, Mattox KL, Jordan GL Jr. Abdominal gunshot wounds. An urban trauma center's experience with 300 consecutive patients. Ann Surg. 1988 Sep;208(3):362-70. PMID 3421760. Nephron  T|C 22:11, 17 April 2006 (UTC)
If you'll read what I wrote, I think you'll find I had the APACHE variables in mind, but an APACHE score indicates relative risk, not time till death, which is what the questioner was asking for. And even if the APACHE score permitted such a calculation, the fact that there are so many variables would still make a timeline of no use. - Nunh-huh 00:21, 18 April 2006 (UTC)
You wrote: If you'll read what I wrote, I think you'll find I had the APACHE variables in mind, but an APACHE score indicates relative risk, not time till death... - survival is very much figuring-out 'til time of death i.e. die in the next week or die in twenty years from now. Doctors very often speak of time 'til death (even when it is based on estimates of a relative risk comparing survival at a point in time) doctors say to a patient with Gioblastoma multiforme you have about one year to live with best treatment (as that is the mean survival) as opposed to 3 months if one doesn't treat it.
You wrote: ... the fact that there are so many variables would still make a timeline of no use. A precise prediction cannot be made, but there is a critical period (a few days to a week) after which one can say the person will most certainly live. Hospital discharge data and length of stay... go some distance in that way. Age, severity of injury etc. can be accounted for. Lazarus HM, Fox J, Burke JP, Lloyd JF, Snow GL, Mehta RR, Evans RS, Abouzelof R, Taylor C, Stevens MH. Trauma patient hospital-associated infections: risks and outcomes. J Trauma. 2005 Jul;59(1):188-94. PMID 16096562. While variable, AFIAK, the time 'til resolution of sepsis is relatively short --when compared to something like Guillain-Barre syndrome which typically has a course of several weeks 'til resolution. Nephron  T|C 02:13, 18 April 2006 (UTC)
APACHE scores were developed to predict the likelihood of leaaving the ICU and being discharged alive, and not to predict the time frame within which that would occur or not occur. If you feel you can make a meaningful "time line for survival with sepsis", go ahead and make it. I think you'll quickly find it a waste of time. - Nunh-huh 03:57, 18 April 2006 (UTC)
APACHE scores were developed to predict the likelihood of leaaving the ICU and being discharged alive, and not to predict the time frame within which that would occur or not occur. Sure-- but the variables are probably important in time course. Any case, they are are still working on this.[1] Time of stay is a cost predictor--and it is important. Someone knows how long an average sepsis admission is... and my point is that the problems are related. I'll go back to what you said... There's no way to make such predictions, so there's no way to make such a timeline. -- I don't think that's right. The information just isn't talked about much. Any case, the following reference suggests the time course is two weeks or less[2] and possibly could be predicted by cytokine levels. Nephron  T|C 06:11, 18 April 2006 (UTC)
That's just it: talking about an "average" sepsis admission is meaningless when applied to a specific sepsis admission. When the range is wide, an average is not particularly informative. But as you feel you can produce an informative or useful timeline, we await it. - Nunh-huh 06:33, 18 April 2006 (UTC)

[edit] Sepsis in long-term renal transplant patients as a result of improperly targeted primary infection

Pt History: ESRF 1961-1977: Renal transplant 10.3.1977. Perfect renal function. Due to immunosuppressant therapy I am of course at higher risk of opportunistic infections. UTIs are common (transplant isolated from native renal system via renal urostomy). In April-June 2002, severe recurrent e.coli infections were treated with Keflex and Augmentin Duo-Forte with limited success (multiple hospital admissions). Ciprofloxacin intervention as last resort (hospital was worried about its cost) cleared infection up, but during maintenance course symptoms worsened unexpectedly with elevated bilirubin. Higher level blood tests showed sepsis had developed. Hospital misdiagnosed it as e.coli and was pressued to do blood cultures. From these, it was established that bacteremia (MSSA/methycillin sensitive staphyloccocus aureus) present, with secondary minor tricuspic endocarditis proven by TOE. Treatment with Flucloxacillin over 10 weeks (2 weeks in situ hospital and 8 weeks hospital-in-the-home) via PICC line to vena carva. Recovery full and uneventful and renal transplant unaffected by it.

The BIG question: Where did it come from? A battery of radiological (isotope) investigations proved all of inconclusive. Bone scans and radiography failed to find any entry point ie. through sores or skin lesions. Possible exposure to animals carrying infection (?). Specialists considered it unusual the source could not be identified. Another possibility was a systemic complication from earlier and recurring infections.

Long after recovery, in June 2003, my 13-year old dog developed a severe illness. Ill for a long time with periodontitis and associated complications, he did not respond well to antibiotics and his condition rapidly worsened. Taken to the vet, blood tests revealed poor liver function and he died shortly after from cardiac arrest. Pathological tests revealed he had p. aeruginosa and a more severe sepsis of golden staph, both of which had taken over his liver and contributed to heart failure.

I informed my treating Specialists of this discovery, which raised a a flurry of questions regarding my exposure to animals, as they had earlier speculated. It is known for certain that animals do carry some infections on their coats, particularly p. aeruginosa, e.coli et al, all of which are a recognised risk of bacterial sepsis to immunocompromised patients.

[edit] Septicemia

I had a baby 14 months ago and due to neglegence of the hospital I ended up with septicemia. Had 4 ops in two weeks including debridements and a historectomy. Nowhere in this talk does it say anything about what sepsis does afterwards. During my septic period i had considerable pain in my right hip and leg. As soon as the white blood cell count came down the pain would go away, when the count picked up it would be back. After the historectomy the count came down to almost normal and I was sent home. I still today have lots and lots of problems with my hip and my leg, can't sit crossed legged, can't sit stand or lie down for long periods without moving. No site that I have visited actually gives you information on what happens after this illness. Maybe you can look at doing something like this. —The preceding unsigned comment was added by 168.209.98.68 (talk • contribs) 2006-07-25t11:02:37z.


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-- Jeandré, 2006-08-08t21:50z

Sounds like the past while has been very difficult, perhaps even the worst you've experienced ever. To me, it sounds like you might have had some endometritis, something that happens approximately 2% of the time after a vaginal delivery and at much higher rates after a C-section;[3] I'm guessing this by the fact that you had a baby and eventually required a hysterectomy-- but this is merely speculative.
I revised the related conditions/complications section of the article and tried to simplify the language a bit. AFAIK, the outcome of sepsis can be everything from dead to perfectly healthy after-- so what is “typical” is hard to say. Sounds like you may have had a septic hip (that is septic arthritis) as a complication. I'm not a doctor and I don't think any one can diagnose that over the internet... so take what I say with a good dose of salt. I suggest you talk with your doctor about what it is that happened to you. Any case, I hope your baby is alright. Also, I hope that you're now better since the hospitalization. Feel free to tweak the article if you feel there is something that's missing or unclear--this is the encyclopedia that any one can edit. Nephron  T|C 03:47, 9 August 2006 (UTC)

Minor edit: When the infection crosses into sepsis, the symptoms of tachycardia, tachypnea, fever and/or decreased urination.

to

When the infection crosses into sepsis, the resulting symptoms are tachycardia, tachypnea, fever and/or decreased urination. DanMcScience 20:01, 17 April 2007 (UTC)

Post: Re: clear definition; septic; septicemia:

Sepsis is a medical term that refers to combination of conditions. If a person has those conditions, then we may refer to that person as "septic".

Understanding sepsis, and how it relates to infection is important because it can sometimes develop into severe, life-threatening illness, such as septic shock or multi-organ dysfunction syndrome, which are very often deadly.

The presence of sepsis requires that 2 things must be present at the same time:

             1) some sort of infection
             2) the body reacting to the infection in a certain way.


The infection can originate anywhere in the body, but most often it starts in the lungs or in the urinary tract. Occasionally, it can be the result of a wound which then gets dirty, such as a gunshot wound, a surgical wound, or even a cut from broken glass, where bacteria or rarely fungus start to grow and multiply.

Normally, the immune system will contain the infection and destroy the offending bacteria right where they are. The area where the bacteria are multiplying may get hot, tender and red - this is evidence of INFLAMMATION. INFLAMMATION is tissue damage from a combination of toxins produced by the bacteria, and toxins produced by the immune system (that damage both bacteria, as well as surrounding tissue cells). If the infection is large enough, or lasts long enough, these toxins can enter the bloodstream by being absorbed into nearby veins. When this happens, it is called toxemia or septicemia (the suffix "-emia" means something "in the bloodstream"). These toxins travel through the bloodstream to distant organs and are responsible for making you feel sick, fatigued, achy, and nauseous. When they reach the brain in enough amounts, they signal the brain to raise the temperature of your body, and you will shiver uncontrollably. This is why people feel "chills" and experience what nurses and doctors call "rigors". Eventually your temperature will rise, and you will have a fever. This combination of fever, rapid heart rate, fast breathing is the body's response to a serious infection, and this is what we call SEPSIS. When this occurs, it usually means the infection is worsening.

Other changes can occur as well, some of which will only show as abnormalities on lab tests, such as increased white blood cell count, increased acid in the blood (acidemia), increased platelets, and an increase in certain proteins called "acute phase reactants". Doctors can test the blood and guess how severe an infection is by how severe someone's reaction to it is. Normally an infection will have to be quite severe or widespread before sepsis occurs.

However, everyone is different, and may react differently to the same amount of bacteria or toxin. Similarly, some bacteria produce very large amounts of or extremely toxic chemicals, that will mean sepsis occurs much earlier than in another case. As it progresses, you may experience more and more of the symptoms of sepsis, and they will become more and more severe. Hence, there are varying degrees of sepsis, from mild to severe. A person with a viral throat infection may have a rapid heart rate and a low-grade fever (less than 39 celsius) and feel fatigued. Their blood may have an increased number of white cells. Such a person could be said to be "mildly septic". This would be very different from someone with severe sepsis, who has a fever of 41, and a heart rate of 170 beats per minute, who is confused and delerious. That is to say, there are varying degrees of sepsis, from mild to severe.

To confuse matters, some people will NOT develop all of the signs or symptoms of sepsis before they progress to more severe forms. Many people, especially the very young and the elderly, for example, can even develop septic shock without ever having a fever. Some people take medications which slow the heart rate or suppress inflammation, which can mask some of the other signs and symptoms. Some people, such as organ-transplant recipients, have comprimised immune systems. It can be very difficult to diagnose sepsis in these cases. Usually however, there will be enough evidence for a doctor or other health care professional to recognize what is happening before things get out of hand.

Occasionally, the immune system will be unable to contain the bacteria before they leak into the bloodstream. This produces a very dangerous condition called bacteremia. The bacteria can lodge in distant organs such as joints, liver, kidneys, spleen, even in the heart valves. This can make it very difficult to tell where the original infection came from. It also makes the infection very difficult to treat.

This is more dangerous however, because it can activate the immune system in many places in the body all at once. However, you dont necessarily need bacteria in the blood to cause this. An infection can become so severe that large amounts of toxins are released into the blood stream. Usually by this time, however the blood will be colonized by the organism which caused the infection. widespread tissue damage, and affects the ability of the blood vessells to keep blood cells and plasma inside them. This will often result in a drop in blood pressure. When this happens, sepsis is said to be "severe sepsis". At this stage, unless the condition is diagnosed and rapidly treated, then death can be imminent. Doctors will often use intravenous fluids to raise the blood pressure of someone with severe sepsis. If this does not work, and the blood pressure stays below normal, the person is said to be in "Septic Shock".

When the blood and plasma begin to leak out of the blood vessells, they can no longer be pumped effectively to organs. Then, the organs no longer work properly and can produce even MORE toxic chemicals as they malfunction and their cells begin to die. This state is a further progression of severe sepsis and is called Multi-Organ Dysfunction, or MODS.

This response to inflammation, and progression to MODS is NOT always caused by infection: anyone with a serious allergy can attest that during a reaction, they feel as if their whole body is reacting similarly, and indeed it is. Doctors noticed over the years that regardless of the cause, there is a clear sequence of events following widespread activation of the immune system that can lead to death if not treated. Sometimes this progression halts itself, but the farther along you get, the less likely it will stop on its own. This is why doctors have carefully defined these terms and use them in a very specific way. It is vital to diagnose and treat infections before they progress to sepsis. Likewise, it is very important and recognize when someone is having a widespread immune reaction to something other than infection, a state called "Systemic Inflammatory Response Syndrome", or "SIRS".

SIRS can be caused by many things, including advanced cancer, trauma, burns, pancreatitis, severe allergic reactions (when it is called "anaphylaxis") and infection. When infection causes SIRS, we call that "sepsis". Sepsis and SIRS can lead to other things such as fluid in the lungs and the blood to spontaneously clot.

The Systemic Inflammatory Response Syndrome has a very precise definition, as does "sepsis" when it is used by doctors. Unfortunately, without understanding what SIRS is, the technical definition of sepsis is difficult to understand. Add to that the fact that most people have some idea of what is meant by sepsis, and it makes attempting a definition quite difficult. The definition of "SIRS" is at least 2 of the following 4:


1. fever defined as temperature greater than 38 celsius (or less than 36) 2. heart rate greater than 90 beats per minute 3. breathing rate greater than 20 breaths per minute 4. white blood cell (leucocyte) count greater than 12 cells/microlitre or less than 4

  cells/microlitre

The techinical definition of "sepsis", as used by doctors, is: SIRS, plus evidence of infection.

(adapted from --- American College of Chest Physicians: Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 20:864-875, 1992)

What exactly is evidence of infection? Certain things are obvious, such as culturing bacteria from a normally bacteria-free site (such as blood, urinary tract, knee joint), or having signs or symptoms of common infections like pneumonia, bronchitis, and cystitis (bladder infection). However as many as half of people with severe bacterial infections will not grow bacteria from blood cultures, and most doctors can diagnose many common infections without even obtaining a blood sample. Consequently, this part of the definition is not agreed upon by every doctor. The best agreed upon definitions leave some room for error, by saying "strong clinical suspicion of infection" rather than "evidence of infection". Clearly, it is better to treat too much rather than too little when the stakes are so high.

To summarize, sepsis is widespread inflammation caused by your immune system responding to a serious (but not always life-threatening) infection. Sepsis is a special case of the more general condition, "SIRS". Sepsis can be very difficult to diagnose in the young, the elderly and those taking immune-suppressing medications. Recognizing it early is important because it can be deadly if left untreated. Even without causing death it can permanently damage organs such as the liver, kidneys, and heart. It may have other long-term effects, depending on the site of the infection, but these are more likely to be caused by the infection itself. Most people with sepsis will get better once the infection clears up; but it is important to be assessed by your doctor or other health care professional to find out for sure.

142.162.71.240 20:48, 20 June 2007 (UTC) CWR B.Sc, M.D. (Canada)

[edit] Septicemia vs Sepsis

Does anyone actually use the term septicemia clinically anymore? Medline Plus basically states that it is synonymous with bacteremia with sepsis, which seems more to the point and less obfuscatory, and which I think should replace all instances of septicemia in the article. And septicemia doesn't fit the pattern for similar words like bacteremia, fungemia, or viremia, which basically denote something floating around in the blood stream (something + Gk 'emia' blood). If you say septicemia, what exactly is the thing that is floating around?

Aswang (talk) 20:14, 26 February 2008 (UTC)


      Hi there, as an ITU nurse i can respond to this by saying that "Septicaemia" is very rarely used within the clinical setting.

Sepsis and Septic are used more widely to describe the huge spectrum of possible causes and as "Septicaemia" is actually directly related to blood poisoning it can lead to relatives percieving their loved ones to have a medical condition that they don't actually have. A person does not have to have bacteria in their blood stream in order to become septic. For example a great many septic patients become unwell from something as simple as a chest infection which does not respond to treatment at home, the infection then progresses quite aggressively and soon becomes a pneumonia. Not at anytime when blood cultures are taken is any bacteria detected in the blood stream. It must be highlighted that in most cases it is the bodies own reaction that causes a great many of the problems we face when fighting sepsis today. I fear that the piece is severely lacking a comprehensive "Physiology/pathophysiology" section and (even though i am quite new to this) i covered sepsis in some detail during my ITU course and would be happy to provide something if others to believe it would be helpful.

Septicaemia today is used (to the best of my knowledge) for the description of Bacterial Menningicoccal Spepticaemia as this is an infiltration of the blood by a highly fatal and aggressive bacteria. Septicaemia is characterised by discolouration of the skin due to the rapidly flowing toxins and with Meningicoccal infection can often lead to the loss of limbs due to the rapid cell death.

I would also like to add that it is documented that a respiratory rate of over 20 and PaCo2 of less that 4.3kpa is one symptom when in my practice it is a RR exceeding 30 that can severely compromise Co2 levels and that high Co2 levels are also indicative of sepsis. I do have many hundreds of references that may be of use but its 11 o clock at night and i have just finished a very busy late shift so you will forgive me for not having a moment to dig out the more useful ones right now, however if anyone feels i could be of use to this article then i would be happy to help (i have a huge facination with the topic).

It may also be useful to include something on the now hugely publisised Surviving Sepsis Campaign and Sepsis Care Bundles??? --Basha440 (talk) 22:16, 3 April 2008 (UTC)