RESUMO
Background: sepsis is a major cause of morbidity and mortality, and the incidence is rising, probably due to the growing elderly population, antibiotic resistance, immunosuppressive medication and, invasive surgery. Pneumonia is the most common infection leading to sepsis, followed by urinary tract infections and abdominal infections. These infections are usually localized and controlled by the immune system, but they can sometimes spread and cause sepsis. Mean platelet volume [MPV] is a measurement that describes the average size of platelets in blood. MPV is ordered routinely as part of the complete blood count panel by an automated flow cytometry machine. In septic shock, most of the coagulation factors are depleted and platelet count is decreased, a close relationship between sepsis severity and thrombocytopenia has already been documented
Aim of the work: this work aimed to find a relation between the mean platelet volume and mortality in patients with sepsis in correlation with C-reactive protein and total leukocyte count
Methods: 80 adult critically ill patients of both sexes with sepsis and sever sepsis who admitted to the units of Critical Care Medicine Ain Shams University Hospitals. The mean platelet volume [MPV] evaluated and correlated to both total leukocyte count [TLC] and C-reactive protein [CRP] on a daily basis starting from the day of admission and over 14 days. In addition, patients observed regarding outcomes including mortality and discharge from ICU
Results: MPV was able to detect sepsis prognosis with high statistical significance from admission, CRP also was a good predictor and on the contrary TLC had poor prognostic value on admission and after 24 hours, but for the whole hospital stay a significant association was found
Conclusion: elevated MPV on admission is an important marker for sepsis diagnosis and prognosis. Progressively elevated MPV during hospital stay correlates well with mortality. Decreased platelet count after admission is significantly associated with mortality in septic patients. MPV and platelet count can be used as prognostic markers for sepsis and indicators of mortality on daily basis
RESUMO
Background: DSE is considered one of the good options in clinical practice but due to some limitations new promising modalities like speckle tracking echocardiography [STE] was introduced. STE is a new imaging technique that allows evaluation of global and regional myocardial function independently from the angle of acquisition and from cardiac translational movements
Objectives: Determine optimal cutoff values for longitudinal, radial and circumferential strains at peak DSE for detection of significant stenosis on CA. Also investigate incremental value of combining strain measurements to wall motion analysis. Methods: The study population comprised 100 patients [age 50 +/- 9 years] underwent high dose DSE, STE followed by CA. DSE and STE results were compared and added to each other and finally compared to CA result
Results: GLS cutoff points [-16.75%] showed significantly higher accuracy when compared to GCS and GRS, with highest balanced sensitivity and specificity to predict CAD. GLS, GRS and GCS reduced the DSE false positivity by 83%, 72.2% and 66.6% respectively. STE also showed better Agreement with CA than DSE in detecting coronary territorial affection especially LAD [Kappa= 0.775]
Conclusions: STE is feasible during DSE, it helps increasing the diagnostic accuracy of DSE and decreasing its false positivity. Both global and segmental longitudinal strain can offer accurate, feasible and non invasive assessment of CAD