AbstractBackground.Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics & outcome.Methods. We conducted a prospective, before-after case series study on 16 septic shock patients requiring high doses of vasopressors admitted in two ICUs from Cairo, Egypt. All of our patients received TPE within 4 hours of ICU admission. The fresh frozen plasma exchange volume = 1.5 × plasma volume.Results. In the 16 patients included in the study, mean arterial pressure was significantly improved after the initial TPE (p < 0.002) and norepinephrine dose which significantly reduced post TPE (p < 0.001). In addition, norepinephrine dose to mean arterial pressure significantly improved (p < 0.001). There was reduction of a net 6 hours fluid balances following the first TPE were observed in all the patients (p < 0.03) by a mean of 757 ml. Systemic vascular resistance index was markedly improved post-TPE along with statistically improved cardiac index (p < 0.01). Stroke volume variance was also significantly decreased after the TPE sessions (p < 0.01). C-reactive protein significantly improved after TPE (P < 0.01).Conclusion. Early initiation of TPE in severe septic shock patients might improve hemodynamic measures.

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Paraesophageal hiatus hernia is an extremely rare variety of hiatus hernia and it is rarely seen in the paediatric age group. We present an instance of this hernia in which an 8-month-old female infant was admitted with a history of ongoing vomiting and irritability since past 7 days. The subsequent imaging study showed paraesophageal hiatus hernia with twisting of the stomach along its longitudinal axis (organoaxial volvulus). Subsequent surgical repair led to the resolution of symptoms. This kind of volvulus is rare in hiatus hernia and once detected it requires prompt surgical management. Given the asymptomatic presentation of hiatus hernia clinicians need to realise that this can be associated with volvulus of stomach which, if left unrepaired, can lead to severe complications. Thus, prompt consideration is necessary with timely surgical referral to alleviate this rare but important variety of hiatus hernia.

This book contains the findings from the third wave of a migration focused panel survey in Bangladesh. It examines the interrelationships between labour migration, poverty, and development based on 6,100 interviews including international labour migrants, internal migrants and non-migrant households spanning 20 districts of Bangladesh. The first wave of survey (2014) found that among these three groups poverty level is much lower for international labour migrant households. The second wave (2017), demonstrated that between 2014 and 2017 poverty rates among all three household types reduced further. This book presents findings of the third wave of the panel survey (2020) which was fielded amidst the COVID-19 pandemic and multiple climate related disasters. It finds that sample households are remarkably resilient to these shocks and that the trend in poverty reduction continues across sample waves. Throughout the survey poverty rates have been the lowest among international migrant households. Nonetheless, the poverty rate declines most rapidly and consistently among internal migrant households. This finding has major policy ramifications. It asserts that migration – both internal and international - can be a core element of transformation to economic sustainability. These results show that it is imperative that policy makers to give just as much consideration to facilitating and supporting internal migration as is given to international migration. All three waves of the panel surveys have been supported by Embassy of Switzerland.

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