Eosinopenia as a diagnostic marker of sepsis in critically ill patients

Background: sepsis refers to the presence of a serious infection that correlates with systemic and uncontrolled immune activation. Few studies had analyzed eosinophil count as a prognostic marker of outcome in patients with infection. Eosinopenia is an interesting biomarker because the eosinophil count is always measured in clinical practice and the additional costs would therefore be negligible

The aim of this wrk: this study aimed to test the value of eosinopenia in the diagnosis of sepsis in critically ill patients admitted to ICUs

Patients and Methods: this prospective observational, randomized study was conducted on 50 adult critically ill patients who were admitted to ICU of Ahmed Maher Teaching Hospital in the period from March 2017to July 2017. They either had sepsis on admission or not. An informed written consent was obtained from patients and/or relatives before starting this study

Inclusion criteria were patients more than 18 years old and less than 60 years that were critically ill either in sepsis or not

Exclusion criteria were patients less than 18 years old and more than 60 years old, patient or relatives who refused to be included in this study, those with hematological cancer, HIV infection, bronchial asthma and other atopic disorders like hay fever, atopic dermatitis and allergic conjunctivitis and increased levels of eosinophil count as part of any parasitic infection or trauma patients

Results: comparison between infected and non-infected studied patients was statistically significant as regard variables of SOFA score, APACHE II score at admission, TLC and Eosinophil count at admission [p-value?0.05]. There were no statistical significant differences as regard length of ICU stay [p?0.05]. Multivariate regression analysis showed statistically significant differences and was independent predictors for infection as follow: total leucocytic count, eosinophil count at admission and SOFA score. The AUC for eosinophil count to predict was 95% with optimal cut off value was 50 cells/mm3 with a sensitivity of 92.85% and specificity of 93.33% with P value <0.001

Conclusion: the result of the present study revealed that eosinophil counts was <50 cells/mm3 at admission time to ICU was a predictor for diagnosis of sepsis in critically ill patients. However, eosinophil counts at admission time to ICU were not a specific indicator of mortality. Recommendations: eosinophil counts are cheap and easily accessible test can be used to guide for sepsis diagnosis and treatment.Larger studies are needed to determine the prognostic value of this test and establish better cutoff values

Acute biliary pancreatitis: diagnosis and treatment

Gallstones are the commonest cause of acute pancreatitis [AP], a potentially life-threatening condition, worldwide. The pathogenesis of acute pancreatitis has not been fully understood. Laboratory and radiological investigations are critical for diagnosis as well prognosis prediction. Scoring systems based on radiological findings and serologic inflammatory markers have been proposed as better predictors of disease severity. Early endoscopic retrograde cholangiopancreatography [ERCP] is beneficial in a group of patients with gallstone pancreatitis. Laparoscopic cholecystectomy with preoperative endoscopic common bile duct clearance is recommended as a treatment of choice for acute biliary pancreatitis. The timing of cholecystectomy, following ERCP, for biliary pancreatitis can vary markedly depending on the severity of pancreatitis

Management of malignant cerebral infarction

Malignant cerebral infarction had a fatal outcome in the majority of cases. The associated brain edema with subsequent rise of intracranial pressure [ICP] and transtentorial herniation is the most leading cause of death in those patients. So we used mechanical hyperventilation to verify its effect in management of those patients by its effect in lowering the ICP. Prospective descriptive study was done in Intensive care unit of Mansoura Emergency Hospital, 20 patients with malignant cerebral infarction were subjected to the maximum conservative measures without controlled hyperventilation, were compared to the same number of patients under the same measures but with controlled hyperventilation for 24 hours [maintain PaCO[2] 28-32 mmHg]. We found that: no one with GCS < 9 survived without hyperventilation, while 4 [66.7%] of the survivors of hyperventilated group were semi-comatosed with GCS < 9. None of the unventilated patients who showed deterioration of their initial consciousness survived, while 3 [17.6%] of deteriorated patients in hyperventilated group survived. None of patients with pan-hemispheric infarction and/or with mid-line shift and compression on perimesencephalic cistern survived without hyperventilation, while 2 [25%] of patients with hemispheric infarction and also 3 [23%] of patients with mid-line shift and compression on perimesencephalic cistern survived in hyperventilated group

impact of IFN beta 1a and IFN beta-1b on the clinical and MRI responses in patients with relapsing-remitting multiple sclerosis

Multiple Sclerosis [MS] is a common demyelinating and inflammatory disease of the CNS with a presumed autoimmune etiology. IFN beta-1a and IFN beta-1b have a proven treatment effect on RRMS presumably through its regulatory properties on T-cell activation and cytokines production. Here we studied the clinical and MRI effects of these drugs in four groups of clinically and laboratory [Cerebrospinal fluid evaluation revealed elevation of immunoglobulin [IgG] synthesis rate and oligoclonal bands] definite RRMS patients for 18 months. In IFN beta-1a group [n = 25], the patients used IFN beta-la 30 micro g [6MU] intramuscular once a week, the other three groups of IFN beta-1a [n = 25] 22 micro g [6MU], IFN beta-la 44 micro g [n = 25] and IFN beta-1b 8MU [0.25 mg] [n = 25] were injected subcutaneously 3-time a week. In comparison with the pre-treatment values, reduction in the relapse rate was statistically significant in IFN beta-la 44 micro g, IFN beta-la 30 micro g and IFN beta-lb 8MU groups more than IFN beta-la 22 micro g [P < 0.001, 0.008, 0.001 and > 0.5 respectively], and the mean EDSS significantly reduced in the IFN beta-lb [P < 0.001], IFN beta-la intramuscular [P < 0.02] and 44 micro g IFN beta-la [P < 0.001], in contrast to 22 micro g IFN beta-la treated patients [P > 0.5]. Moreover, IFN beta-lb [P < 0.001] and 44ug IFN beta-la [P < 0.003] groups showed highly statistical significant reduction in MRI disease activity load [p < 0.05] in comparison with 22micro g IFN beta-1a [p < 0.5] and IFN beta-la intramuscular groups [p < 0.07]. The study confirmed also the effect of beta-IFNs on the short term physical disability scale [p < 0.01] while they have no significant effect on long term disability scale [p > 0.64]. Additionally, beta-IFNs groups showed no statistically significant severe drugs adverse effects [p > 0.8] while revealed significant effects of recovered side effects [p < 0.01]. The common adverse effects of lFN beta that were significantly found [p < 0.01], are flu-like symptoms, fatigue, chills and fever, injection site pain and local redness, headache, irregular menses and mild depression specially with IFN beta-la intramuscular. No difference in the clinical suspicions of binding antibodies development to beta-IFNs was found. On the whole, all groups showed significant reduction of relapse frequency and MRI load with different values [p < 0.01]. In summary, this study does make available meaningful and helpful clinical and radiological data to the clinician regarding the relative efficacy of each therapy in RRMS. First, the results of our study suggest that IFN beta-lb 8MU and IFN beta-1a 44 micro g may be more optimal choices than IFN beta-la 30 micro g Intramuscular and IFN beta-la 22 micro g at the currently available dose in treatment of RRMS patients. Secondly, the results do not differ from remarks made after 18 months of treatment in larger and more rigorously controlled studies. Thirdly, therapy does construct a difference and early treatment should be encouraged

Drug and substance abuse in refractory epilepsy

Drugs and substances abuse in patients with refractor epilepsy were investigated in this study which includes 924 patients with intractable epilepsy were studied for serum levels of antiepileptic drugs and for drugs and substances abuse. Positive results for abuse were detected in 246 patients [26.62%], 56.5% of them were in the age group 20 - 30 years. Males outnumbered females with a sex ratio 1.46: 1. Cannabis was the first abused drug as it was detected in 29.27% followed by opiates in 21.95%, alcohol in 17.88%, benzodiazepine in 16.26%, tricylic in 8.54%, barbiturates in 6.1%. So, a screening test for drugs and substances abuse must be done in cases with resistant epilepsy even if patients deny the use of them