Comparative study between femoral arterial doppler and echocardiography in fluid responsiveness assessment in septic shock patients

Background: Fluid replacement is considered the cornerstone of resuscitation in critically ill patients especially in patients with septic shock. However, only about 50% of critically ill hemodynamically unstable patients are responsive to fluids. Furthermore, both under resuscitation and overzealous fluid administration adversely affect the outcome. Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients’ intravascular volume status and their volume responsiveness

Aim of the Study: The aim of this study is to compare between the femoral arterial doppler and Echocardiography in fluid responsiveness assessment in septic shock patients

Methodology: The study was conducted on 30 adult male and female patients admitted to Critical Care Department in Ain shams University Hospitals with the diagnosis septic shock. All patients in this study have the Criteria of Septic shock. Echocardiographic examination and femoral Doppler were done for all included patients. Velocity time integral on left ventricle outflow tract and Velocity time integral on femoral artery were measured before and after fluid resuscitation, after infusion of 30 ml/kg over 3 hours

Results: These results show that there were 23 patients were responded clinically to fluid resuscitation from all total number of 30 patients. From all total number of patients whom clinically responded, 22 patients responded to fluid resuscitation by transthoracic echocardiography and 23 patients responded by femoral Doppler

Conclusion: These results showed that femoral Doppler parameters were a reliable predictor to fluid responsiveness in patients with severe sepsis and septic shock as well as transthoracic echocardiography in dynamic monitoring of the change in stroke volume after a maneuver that increases or decreases venous return [preload]. However femoral Doppler seems to be easier and rapid tools to be used by junior staff

Screening for metabolic liver diseases crucial to increase SVR to patients with CHC

Liver diseases and its complications is common health problem worldwide. The emergence of metabolic disorders as a cause after exclusion of viral hepatitis nowadays is important. This is retrospective study on 200 patient's age range from 6 months to 18 years old [50 females and 150 males]. The patients divided into 2 groups according to age < 5 years and >5 years and all investigations done was collected and statistically processed. Abdominal enlargement was observed in 166/200 of all patients, 48/166 [67.6%] in patients <5 years old and 118/166 [91.5%] in patients >5years old with statistical significant, jaundice was present in 34/200 of patients, 23/34 [32.4%] in patients <5 years old and 11/34 [8.5%] in patients >5 years old, with statistical significant difference, CBC was normal in 58/200 of all age groups. 10/58 [14.1%] in patients <5 years old, 48/58 [73.2%] in patients <5 years old, with statistical significant difference and abnormal CBC in 142/200 [61/142, 62.8%] in age group > 5 years old, 81/142 [85.9%] in age group <5 years. Metabolic disorders was normal in 124/200 of all age groups, 23/124 [32.4%] in patients <5 years old. Metabolic disorders was abnormal in 76/200 of all, 48/76 [67.6%] in patients >5 years old and 28/76 [21.7%] in patients < 5 years old, with statistical significant difference and for both age groups. The sensitivity of modalities used in the diagnosis of liver disease was as follow for US, study of metabolic profile, abnormal liver functions and abnormal CBC, 83.1%, 65.2%, 61.6% and 66.1% consequently

Effect transfusional of iron overload on hepatic fibrosis in Egyptian beta-thalassemia major patients

Multitransfused beta-thalassemia patients constitute a population with high prevalence of Hepatitis C virus [HCV] infection, because of transmission of HCV from infected blood donors. Increased hepatic iron is assumed to potentiate progression towards liver fibrosis in chronic HCV infection. The aim of the present work is to evaluate the potentiating effect of marked hepatic iron overload and chronic HCV infection on hepatic fibrosis in Thalassemia patients. Sixty eight patients, previously diagnosed to have homozygous beta-thalassemia and followed up at the Hematology Clinic of the New Children's Hospital of Cairo University [44 hepatitis C positive and 24 hepatitis C negative patients], were selected to participate in this study after signing a written informed consent. Their age ranged between 6 and 27 years with a mean age of 9.7 +/- 2.1 years and compared to a group of 42 non thalassemic chronic HCV patients whose age ranged between 7 and 27 years with a mean age of 10.9 +/- 1.5 years [control group]. Liver Biopsies were done for all patients for estimation of stage of hepatic fibrosis and liver iron content [LIC]. The results were then correlated to liver function tests and serum ferritin. The stage of fibrosis and LIC were significantly higher in beta-thalassemia patients than the non thalassemia HCV patients [p = 0.005, p<0.0001 respectively]. There was no significant difference between the two groups of thalassemia as regards staging of fibrosis. The degree of hepatic fibrosis was significantly correlated to the LIC in hepatitis negative thalassemic group while it was significantly correlated to serum ferritin in thalasemic patients with positive HCV. Hepatic iron overload has a potentiating effect on hepatic fibrogenesis in beta-thalassemia major. The proper use of chelating agents is of great importance in delaying progression of liver disease in these patients