ABSTRACT
Purpose:@#Sepsis is a common acute life-threatening condition that emergency physicians routinely face. Diagnostic options within the Emergency Department (ED) are limited due to lack of infrastructure, consequently limiting the use of invasive hemodynamic monitoring or imaging tests. The mortality rate due to sepsis can be assessed via multiple scoring systems, for example, mortality in emergency department sepsis (MEDS) score and sepsis patient evaluation in the emergency department (SPEED) score, both of which quantify the variation of mortality rates according to clinical findings, laboratory data, or therapeutic interventions. This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.@*Methods:@#The study is a cross-sectional, prospective study including 61 sepsis patients in ED in Suez Canal University Hospital, Egypt, from August 2017 to June 2018. Patients were selected by two steps: (1) suspected septic patients presenting with at least one of the following abnormal clinical findings: (a) body temperature higher than 38℃ or lower than 36℃, (b) heart rate higher than 90 beats/min, (c) hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg, and (d) white blood cell count higher than 12,000/μL or lower than 4000/μL; (2) confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment (SOFA) score following infection. Other inclusion criteria included adult patients with an age ≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection. Patients were shortly follow-up for the 28-day mortality. Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome. The receiver operating characteristic curves were also done for MEDS and SPEED scores.@*Results:@#Among the 61 patients, 41 died with the mortality rate of 67.2%. The mortality rate increased with a higher SPEED and MEDS scores. Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors (p = 0.004 and p < 0.001, respectively), indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients. Thereafter, the receiver operating characteristic curves were plotted, which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87 (0.788-0.963) as compared with 0.75 (0.634-0.876) for MEDS. Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system. For every one unit increase in SPEED score, the odds of 28-day mortality increased by 37%.@*Conclusion:@#SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients. Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.
ABSTRACT
Background: There are many hundred carries for hepatitis B virus [HBV] and hepatitis D virus [HDV] is a defective virus that requires hepatitis B surface antigen [HBs Ag] for replication and transmission. Coinfection of HBV and HDV are usually acute, self limited infections. In contrast, a super infection causes a generally sever and acute hepatitis that most often results in chronic hepatitis D, with the suppression of HBV replication but persistence of HDV replication
The aim of the work: detection of infection with HDV among HBsAg positive blood donors in Regional Blood Transfusion Center in Minia governorate
Patients and methods: We evaluated ten thousand volunteer blood donors in Minia regional blood transfusion center in the period from October 2009 to May 2010. Blood screening for HBsAg was done using plasma of the blood donors. Any blood sample was seropositive for HBsAg, was subjected to detection of antibodies to hepatitis delta antigen [anti-HD] in plasma samples and confirmed the diagnosis of hepatitis B DNA by doing PCR test to all positive [anti-HD] cases. Also detection of HCV by MEIAs was done
Results: Out of the 10000 samples, 200 samples were reactive to HBsAg. Out of the 200 blood samples, 21[10.5%] were anti-HD positive. 21 positive anti- HD samples were HBV DNA positive [100%] and 2% were positive to HCV while
ABSTRACT
A growing body of evidence suggests the involvement of inflammatory mediators including cytokines, adhesive molecules and other inflammatory markers [e.g. leucocytes, ESR, CRP] in the development of ischemic brain lesions. Some pro-inflammatory cytokines and adhesion molecules were found to be elevated in peripheral blood as well as cerebrospinal fluid [CSF] of pateints with ischemic stroke. Quantification of the serum and CSF levels of tumour necrosis factor-alpha [TNF-alpha] and the soluble intercellular adhesion molecule-1 [sICAM-1] were done using sandwich EIA and semiquantitative serum C-reactive protien [CRP] levels were determined in 50 ischemic stroke patients within 48 hours of the attack .On the basis of the Canadian Stroke scale [CSS] used for neurological assessment, study patients were classified according to disease severity into three groups ['A' mild, 'B' moderate and 'C' sever]. Functional outcome of stroke was assessed with the Modified Rankin Scale [MRS] by scoring as good or bad outcomes. TNF-alpha, sICAM-1, CRP were increasesd significantly in sera of patients compared to those of controls [P<0.05, 0.00, 0.01 respectively]. On comparing CSF levels of TNF-alpha, sICAM-1 in the different groups of patients, there were statisically significant differences between whole patients, moderate and severe stroke groups [P0.001 for both]. Comparison between serum and CSF levels of TNF-alpha, sICAM-1 in groups B and C showed statistically higher levels in serum than CSF of both groups [p<0.01 for both]. Correlation analysis revealed that serum and CSF levels of TNF-alpha were positively correlated with stroke severity and outcome [clinical deterioration] [P<0.05 for both] while serum sICAM-1 was not. The ESR 1[st] h, ESR 2[nd] h, platelets and leucocytic counts were significantly higher in patients than controls and were significantly correlated with stroke severity and outcome [P<0.01 for all]. On the other hand, there were no significant correlation between the levels of serum and CSF TNF-alpha, sICAM-1 and CRP. The results of the present study indicated that serum TNF-alpha and sICAM-1 could act as useful parameters for prediction of stroke prognosis and may be considered as promising targets for stroke immunotherapy by monoclonal antibodies