No abstract

Background: Vitamin D deficiency has been proposed as a risk factors of cerebrovascular stroke. Objectives: The aim of this study was firstly, to assess the serum level of vitamin D in cerebral stroke patients and secondly, to examine if its deficiency was associated with stroke severity and outcome. Methods: We utilized a case-control study design and recruited 138 acute stroke patients and 138 age-and sexmatched controls from subjects attending outpatient clinic for other reasons. All participants were subjected to full general and neurological examination. Brain imaging CT and/or MRI was performed. Blood samples were collected for measurement of serum level of vitamin D (ng/ml) by ELISA, alkaline phosphatase, serum calcium, and phosphorous. The stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was assessed by modified Rankin Scale (mRS). Results: Stroke patients had significant lower levels of vitamin D compared with the control group. Vitamin D deficiency remained significantly associated with the NIHSS stroke severity score and the mRS 3-month stroke outcome after controlling for other significant factors such as age, dyslipidemia, and infarction size using multivariable logistic regression analysis. Conclusion: Our results demonstrated that stroke patients suffer from vitamin D deficiency, which was associated with both stroke severity and poor outcome. Vitamin D supplementation could exert a therapeutic role in the management of cerebral stroke.

No abstract

No abstract

BackgroundSpontaneous bacterial peritonitis (SBP) is a serious infection of ascitic fluid in cirrhotic patients. High mortality associated with the delay in diagnosis and treatment. There is a need for an accurate and a rapid method for SBP diagnosis. ObjectivesWe aimed to evaluate ascitic fluid calprotectin as a diagnostic marker for SBP. Patients and methodsForty four cirrhotic patients were divided into two groups, non-SBP group: 22 patients with cirrhotic ascites without evidence of SBP and SBP group: 22 patients with cirrhotic ascites and SBP diagnosed by positive ascitic fluid bacterial culture and an increase in polymorphonuclear leukocytes (PMNLs) count in ascites (≥250 cells/mm 3 ). Ascitic fluid calprotectin levels were measured using enzyme-linked immunosorbent assay. ResultsThere was a significant increase of ascitic fluid calprotectin, total leukocytic count, PMNLs, lactate dehydrogenase, and total protein in SBP group when compared to non-SBP group. There were significant positive correlations between white blood cell, ascitic fluid total leukocytic count, PMNLs, total protein, and model for endstage liver disease score values and ascitic fluid calprotectin among SBP group. Ascitic fluid calprotectin with cutoff value 620 ng/ml, showed a sensitivity of 90.91% and a specificity of 95.45%, in diagnosis of SBP with positive predictive value 95.2% and negative predictive value 91.3%. ConclusionAscitic fluid calprotectin may be valuable in rapid diagnosis of SBP.

Background: To study the epidemiology of circulatory shock secondly to assess different pattern of circulatory shock among adult critically ill patients admitted to medical ICU of internal medicine department Zagazig University during the study period and finally to study the clinical outcome (morbidity and mortality) of different pattern of circulatory shock. Methods and subjects: The current Cross-sectional cohort study had been carried out on 694 patients with circulatory shock who were admitted in medical ICU with criteria of peripheral circulatory failure. The included patients were subdivided into three groups according to the provisional and definitive diagnosis of type of circulatory shock depending on CVP, echocardiography, cardiac output and laboratory investigations as follow: Group1: hypovolemic shock group ,Group 2: cardiogenic shock group and Group 3: septic shock group. All patients were subjected to thorough medical and clinical history taking and full clinical assessment. Blood samples were withdrawn for routine investigations (Complete blood count, Kidney function tests, Liver function tests, CRP, INR, Arterial blood gases (ABG), Mean saturation of central venous oxygen (ScvO2) and serum lactate. Shock severity was assessed by using APACHE IV score and SOFA score. Results: The frequency of circulatory shock patients is 13.9% per year. Hypovolemic shock was the major cause of circulatory failure in the studied population followed by septic shock and finally cardiogenic shock. The severity assessment parameters including APPACHE IV score , SOFA score, length of hospital stay and GCS were statically significant difference among the three studied groups, with significant increase in APPACHE IV score and SOFA score in cardiogenic group. APPACHE IV score and SOFA score were significant independent predictor of survival. The outcome measures of our populations during their ICU stay and after discharge to the medical words shows that mortality increase progressively with increase the length of ICU stay, there was significant difference in survival among the three groups, the most favorable outcome is hypovolemic group, and the worst was observed in the cardiogenic shock group. Conclusions: Circulatory shock is a life threatening condition associated with high mortality so early recognition and early intervention will decrease morbidity and mortality in critically ill patients. CVP, echocardiography and laboratory investigations especially serum lactate and SCVO2 are easy, reliable and available in all emergency departments. All can help in early diagnosis of type of circulatory shock. Calculation of APPACHE IV score and SOFA score were easy and reliable which potentially allow one to diagnose life-threatening condition and treat them before laboratory results are back.

Background: Chronic liver disease and hepatocellular carcinoma (HCC) can cause a disturbance in the coagulation system. In this study, we aimed to assess the risk factors for venous thromboembolism either acquired or hereditary in patients with HCC. Results: Serum levels of proteins C and S, AT activity, and lipoprotein (a) were significantly lower in both HCC and cirrhotic patients while homocysteine levels were significantly higher in HCC patients. The prevalence of activated protein C resistance (APCR) and factor V Leiden (FVL) mutation was higher in HCC patients but with no significant differences between the studied groups. With multivariate analysis, prothrombin time, Fbg, protein C and S deficiency, increased lipoprotein (a), hyperhomocysteinemia, APCR, and FVL mutation were independent risk factors for thromboembolic complications in HCC patients. Conclusions: Thrombophilic abnormalities are prevalent in HCC patients, and they have a substantial increased risk of venous thromboembolism. Patients and methodsData were collected from cirrhotic patients with and without HCC, who were admitted to the Hepato-

No abstract