Prognostic Value of Urine Albumen/Creatinin Ratio in Sepsis in Critical Care Patients

Several scoring systems were developed for prognosis and outcome prediction in sepsis.This study aims to evaluate the urinary albumin/creatinine ratio(ACR)as a prognosticp redictorinsepsis.The study included 50 adult septic patient sinapros pectiveobser vational study. Study excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24h later for ACR1 and ACR2.Admission APACHEIVscoreandthehighestrecordedSOFAscoreoftheirdailyestimationwereconsidered.Thisstudyalsoevaluatedtheneedformechanicalventilation,inotropicorvasoactivesupport,renalreplacementtherapy(RRT),andin-hospitalmortality.InapopulationwithMean±SD51.4±16.3(19-82)yearoldwith34(68%)males,wefoundthattheACR2iscorrelatedwithbothAPACHEIVandSOFAscores(P<0.001).ACR2washigherinpatientswhoneededmechanicalventilationandinotropicorvasoactivesupport[121(21-235)and166.5(89-235)mg/grespectively]comparedto[49(22-120)and56.5(21-211)mg/g],P<0.001inboth.ΔACR,ACR2,increasing AC Rand APACHEIVwerepredictorsofmortality.TheAUCformortalitypredictionwaslargestforΔACR(1),increasingACR(0.985),ACR2(0.963)thenAPACHEIV(0.90).∆ACRandACR2of91.5mg/gand-22was88.2%&100%sensitiveand90.9%&100%specificrespectivelytopredictmortality.WeconcludedthattheurinaryACRmightbeusedasasimpletestforprognosisandmortalitypredictioninsepsis

Early evacuation of posttraumatic clotted hemothorax or retained pleural fluid: result of vats versus conventional thoracotomy

To compare the outcome of VATS versus conventional thoracotomy in the early evacuation of posttraumatic clotted hemaothorax or retained pleural fluid in patients with chest trauma after failure of the initial management with tube thoracostomy. Between January 2001 and December 2005, fifty-four patients with posttraumatic clotted hemothorax or retained pleural fluid were included in this study. They were claimed to have clotted hemothorax or retained pleural fluid after 3 to 5 days posttruama by chest roentgenogram and chest CT. The patients were divided into 2 groups, group I [VATS group] and group II [thoracotomy group]. Group I patients [VATS group] included 23 patients, VATS was performed for evacuation of posttraumatic clotted hemaothorax or retained pleural fluid. Group II patients [thoracotomy group] included 31 patients; conventional thoracotomy was performed for management of posttraumatic clotted hemothorax. There was no statistical significant difference between the mean ages of both groups, as the mean age of the VATS group patients was 33 +/- 8 years, while it was 32.7 +/- 7 years for the thoracotomy group patients. The mean preoperative ICT period was [6 +/- 1.5 days VS 7 +/- 2 days respectively]. It was statistically non-significant There was statistical significant difference [P-value

Early and mid term results of surgical repair of coarctation of the aorta: experience of Benha in 19 patients with simple coarctation of the aorta

To evaluate early and mid-term results of surgical repair of coarctation of the aorta in patients with isolated [simple] coarctation of the aorta. Between March 2000 and February 2005, nineteen patients diagnosed as cases of isolated coarctation of the aorta [with or without PDA] using Echocardiography .They underwent resection of the coarctated segment with end-to-end anastomosis. The patients were followed up for a mean period 23.8 +/- 7.4 months. In each visit, the patient was clinically evaluated for blood pressure, gradient [by echocardiography], neurological and recoarctation symptoms. The age ranged from 6 months to 9 years [mean of 4.4 +/- 2.8 gears] and 12 patients of them [63%] were males. The patients presented with different symptoms in the form of claudications in 12 patients [63%], headache in 10 patients [54%], chest pain in 3 patients [16%], and repeated chest infections in 7 patients [36%]. On examination, 14 patients [73%] had weak femoral pulse, and 11 patients [58%] had systolic continuous murmur conducted to the back. All the patients had hypertension which was defined as blood pressure greater than that of the 90th percentile for age, On measuring blood pressure, the mean upper limb blood pressure was 129/83 +/- 6.7/5.7 mm Hg, and the mean gradient was 35.4 +/- 6.8mm Hg. Operatively, the mean operative time was 149.2 +/- 14.6 minutes, the mean cross clamp time was 25.7 +/- 2.4 minutes, the mean intercostal tube [ICT] period was 2.7 +/- 0.8 days, the mean ICU stay was 1.6 + 0.6 days and the mean hospital stay was 9.9 +/- 1.6 days. There was no operative or hospital mortality. There was immediate postoperative increase in mean blood pressure which was 131/82 +/- 6/3 mm Hg, this increase was controlled with infusion of antihypertensive drugs. However, all the patients had dramatic improvement in blood pressure before discharge as the mean blood pressure on discharge was 114/67 +/- 6/4 mm Hg and the mean gradient on discharge was 13.3 +/- 5.1mm Hg. On follow up, the signs of hypertension occurred in total of 4 patients [21%], unfortunately, 2 of them died due to heart failure [11 and 15 months postoperatively]. The other 2 patients with postoperative hypertension were on one antihypertensive medication to control blood pressure. There was significance difference [P Value less than 0.05] between both mean blood pressure as well as mean gradient on admission and both on discharge, also, there was significant difference between both mean blood pressure and mean gradient on admission and both on 30 months after surgery. Surgical repair of isolated coarctation of the aorta by the technique of excision of the coarctated part with end-to-end anastomosis is essential in young patients to avoid subsequent morbidity and premature mortality. The short-term and mid-term results were satisfactory and encouraging

Comparative study between cold and warm cardioplegia in cabg operations

The objective of this study is to prospectively evaluate two different cardioplegia techniques: intermittent cold cardioplegia and warm blood cardioplegia. Between During the period between August 2002 and April 2003, 35 consecutive patients undergoing elective CABG were studied in a prospective randomized trial. The patients were randomized in 2 groups: group I [20 patients] received intermittent cold crystalloid cardioplegia [15øO] and group H [15 patients] received undiluted warm blood [37øO], antigrade cardioplegia enriched with potassium and magnesium. Patients were predominantly male and the mean age was 56-5 years in group I and 54 +/- 5 in group IL There was no significant statistical difference between the 2 groups as regard the risk factors for CAD [smoking, hypertension, diabetes and hyperlipidemia]. Preoperative ejection fraction [EF] was 54 +/- 2% in group I and 52 +/- 2% in group II with P=0.380338 [NS]. The cross clamp time was 55 +/- 5 mm in group I and 53 +/- min in group II with P 0.429421 [NS]. The CPB time was 99-16 min in group I and 95 +/- 17 min in group II with P=0.108781 [NS]. Vasocon-strictive drugs were used in 7 patients [35%] in group I as compared to 5 patients [33%] in group II with P>0.05 [NS]. The total volume of crystalloid solution infused during CPB was 1332 +/- 309 ml. for group I and 1520 +/- 227 ml for group II with P=0.000263 [HS]. Hematocrit value during CPB was 29 +/- 2% in group I and 32 +/- 3% in group II with P=0.037741 [S]. The patients continued on mechanical ventilator for 9 +/- 1 hours in group I and 8.5 +/- 1 hours in group H. The postoperative chest tubes drainage was 460 +/- 153 ml in group I and 530 +/- 59 ml in group II with P=0.086227[NS]. Hematocrit value after CR8 was 35 +/- 4% in group I and 34 +/- 3% in group II with P=0.505103[NS]. The patients stayed in the ICU for 2.9-0.6 days in group I and 3.2 +/- 0.5 days in group H with P=0.334282[NS]. There is no statistical dfference between the 2 groups before aortic cross-clamping as regard serum lactate and troponin I. One minute after unclamping, the serum lactate was 0.9 +/- 0.3 mmoles/l in group I and 0.7 +/- 0.4 mmoles/l in group H with no significant difference [P>0.05] ponin I was 0.4 +/- 0.3 g/l in group I and 0.6-0.3 g/l in group II with P>0. 05 [NS]. The findings of our study did not reveal any significant difference between the warm blood cardioplegia and the cold cardioplegia in terms of myocardial protection, either for clinical or biological data