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: The transversus abdominis plane [TAP] block provide effective postoperative analgesia in lower abdominal surgery. Subcostal TAP block as a new technique to provide analgesia for the supraumbilical abdomen. Traditionally, pain relief for these patients is provided by epidural analgesia or IV opioid analgesia. Although epidural analgesia is currently the "gold standard" for postoperative pain treatment, associated complications and contraindications may limit its use. IV opioid analgesia may cause opioid-related side effects and be associated with inadequate analgesia
Aim of the Work: This study aimed at clinically evaluating and statistically comparing between lumber epidural versus transversus abdominus plane block as postoperative Analgesia for laparoscopic sleeve gastrectomy. Also, our goal was to figure out the most possible effective technique for this kind of procedure with most benefits and least side effects
Patients and Methods: This single blinded randomized clinical trial was carried out at Ain Shams University hospitals on 60 adult Bariatric patients undergoing elective Laparoscopic sleeve Gastrectomy, aged 20 to 50 years, ASA III, BMI equal or less than 45 Kg/m[2]
Results: Patients in the Lumber Epidural group had significantly less pain score when compared to the other TAP group [p-value < 0.001]. And, they had longer time to first request rescue analgesia [nalbuphin] [P = 0.0013]. Also, total dose of nalbuphin consumption was less in Lumber Epidural group than TAP group [P < 0.001]
Conclusion: This study concluded that TAP block was effective in pain relief after Laparoscopic sleeve gastrectomy, however, Lumber Epidural was superior in pain relief, less narcotic consumption and overall more patient satisfaction