Mohamed Megahed

Delta neutrophil index versus lactate clearance: Early markers for outcome prediction in septic shock patients

Abstract Background This study was carried out to evaluate, compare the clinical utility of delta neutrophil index (DNI) values and lactate-6h-clearance as early indicators for outcome prediction in septic shock patients and to find out and correlate the specificity and sensitivity of each to the patients mortality. Methods The study was carried out in Alexandria Main University Hospital on 53 adult patients with severe sepsis/septic shock after taking an informed written consent and approval of the ethics committee. All patients received all standard therapy and resuscitation measures. Arterial blood samples were obtained for measurement of DNI using an ADVIA 2120 automated cell analyzer. Initial arterial serum lactate level and arterial lactate after 6 h from admission were measured for lactate-6h-clearance calculation. Primary outcome measures were hospital mortality (non-survivors) and discharge or transfer to a general medical ward (survivors). Data were analyzed by SPSS® software using (“t” test and chi-square χ2) P < 0.05 was considered significant. Results A total of 53 severe sepsis/septic shock patients were enrolled in the study, patients were (36) survivors and (17) non-survivors. This study demonstrated the reliability of DNI and lactate-6h-clearance as predictors of negative outcome. Variables identified by the backward logistic regression model as significantly correlated with negative outcome were lactate-6h-clearance <15%; (sensitivity, 92.5%; specificity, 85.0%; positive predictive value, 90.0%; and negative predictive value, 88.0%) and DNI value >5.2; (sensitivity, 95.0%; specificity, 90.0%; positive predictive value, 92.0%; and negative predictive value, 95.0%). Conclusion Monitoring of lactate-6h-clearance can be used to identify patients with severe sepsis/septic shock at high risk of mortality. DNI may serve as a more useful diagnostic and prognostic marker for early diagnosis of disease severity in patients with severe sepsis/septic shock, it is suggested that, increased DNI value should alert clinicians to apply more aggressive therapy.

Acute ischemic stroke prognostication, comparison between Glasgow Coma Score, NIHS Scale and Full Outline of UnResponsiveness Score in intensive care unit

Abstract Background Stroke is the second most common cause of death worldwide and a frequent cause of adult disability in developed countries. No single outcome measure can describe or predict all dimensions of recovery and disability after acute stroke. Several scales have proven reliability and validity in stroke trials. Objectives The aim of the work was to evaluate the FOUR score predictability for outcome of patients with acute ischemic stroke in comparison with the NIHSS and the GCS. Methods 127 adult patients with acute ischemic stroke were enrolled. NIHSS, GCS, and FOUR score were collected at 24 and 72 h. Patients were prospectively followed up for the following outcomes; In-hospital or 30 days mortality and Modified Rankin Scale (mRS) at 3 months. The areas under receiver operating characteristic curve (AUC) were compared between the three scores. Results Twenty-five (19.7%) patients died, and seventy-two (56.7%) had unfavourable outcome. The NIHSS, the GCS, and the FOUR score were not different in predicting in-hospital mortality (AUC: 0.783, 0.779, 0.796 at 24-h and 0.973, 0.975, 0.977 at 72-h). The NIHSS, the GCS, and the FOUR score done at 24-h were not different in predicting unfavourable outcome (AUC: 0.893, 0.868, and 0.865, respectively). However, the NIHSS done at 72-h showed significantly higher AUC than the GCS score (0.958 versus 0.931, p = 0.041), and higher than the Four score (0.958 versus 0.909, p = 0.011). Conclusions The GCS and the FOUR score are accurate predictors of mortality after acute ischemic stroke, and are equal in prediction to the NIHSS. The NIHSS is more accurate than the GCS and the FOUR score in predicting poor neurologic outcome.

12-Gb/s low-power voltage-mode driver for multi-standard serial-link applications

This paper presents a 12-Gb/s power-efficient voltage-mode driver for multi-standard serial-link applications. The proposed driver combines the advantages of voltage-mode drivers and those of variable-output-swing ones into a single architecture for multi-standard operation. This is achieved by having a reconfigurable pull-up network and a fixed shared pull-down network. In addition, this technique is combined with a modified 3-tap feed-forward equalizer (FFE) to support the de-emphasis required by several standards. The proposed driver is implemented using 65-nm CMOS technology and supports a variable output voltage swing of 0.3 Vpp to 1 Vpp, while achieving data rates ranging from 1.5 Gb/s to 12 Gb/s. The driver consumes 1.25 mW for an output swing of 0.5 Vpp, which is the minimum achievable power consumption for voltage-mode drivers.

Importance of ferritin in sera and cerebrospinal fluid as both a predictive and an etiodiagnostic biomarker in ischemic stroke: a single-center prospective study

Background and aim Trace metals such as iron and its storage protein ferritin are known to play an important role in stroke and other neurologic disorders. This prospective study was designed to determine whether cerebrospinal fluid (CSF) ferritin levels aid in evaluation of stroke severity and its prognosis. Patients and methods Thirty-two patients with a diagnosis of acute stroke due to intrinsic or atherosclerotic vessel pathology were included in the study within 24 h from onset of symptoms. Immediately after admission, the clinical condition of the patient was evaluated using the Canadian Stroke Scale and was determined periodically during follow-up. Serum and CSF ferritin levels were assayed and correlated with the known biomarker amyloid β protein 1-42. Results Serum ferritin level revealed significantly greater values in patients with larger-sized lesions (P<0.01) and deteriorated neurologic condition during clinical follow-up. CSF and serum ferritin levels were correlated with neurologic deficit (r=0.50, P<0.001). There was no significant correlation between amyloid β protein 1-42 and ferritin levels (r=0.07, P=0.7). Serum ferritin level and large-sized lesions were independently associated with stroke due to Intracranial atherosclerotic disease pathology. Increased serum ferritin levels correlated with severity of stroke and the size of the lesion. Conclusion Our results revealed that elevated values of CSF and serum ferritin may indicate a poor prognosis in terms of neurologic deterioration in intracranial atherosclerotic (ICAD)-induced stroke patients.

Red blood cell distribution width as a prognostic factor in mechanically ventilated patients with severe sepsis in comparison with Sequential Organ Failure Assessment score

Background Sepsis is a major health concern worldwide. Within the last decade, several trials and protocols have focused on this condition, aiming to establish better measures for its management and prevention of potential complications. Higher values of red blood cell distribution width (RDW) have been found to be associated with sepsis severity and early mortality function and activation. Patients and methods A sample of 50 patients with severe sepsis who were admitted to Alexandria University Hospital were selected. The patients were divided into two groups: group A and group B. Group A patients met the inclusion and exclusion criteria with high RDW and group B patients met the inclusion and exclusion criteria with normal RDW. Both groups were compared with Sequential Organ Failure Assessment (SOFA) score as a prognostic marker. RDW was measured every other day. Patients were followed up until death or discharge from the ICU for a total of 28 days. Results A total of 50 adult patients with severe sepsis were enrolled in the study, comprising 12 women (48.0%) and 13 men (52.0%) in group A and 11 women (44.0%) and 14 men (56.0%) in group B. Chest infection was the most common source of sepsis in both group A (36%) and group B (44%). High RDW was associated with prolonged duration of mechanical ventilation (MV) of 13.60±4.76 days, compared with 9.96±3.91 days for normal RDW. High RDW was associated with prolonged ICU stay of 20.0±4.43 days compared with 14.20±3.34 days for normal RDW. High RDW was associated with poor outcome (68% mortality) compared with normal RDW (40% mortality). There was a positive correlation between high RDW with SOFA on day 0 (P=0.002), day 2 (P≤0.001), day 4 (P<0.001), day 6 (P≤0.001), day 14 (P≤0.001), day 20 (P≤0.001), and on average (P=0.001), and in normal RDW on day 0 (P=0.045), day 2 (P=0.033), day 4 (P=0.003), day 6 (P=0.008), day 14 (P=0.042), day 20 (P=0.005), and on average (P=0.010). There was a negative correlation between high RDW and platelet count on day 0 (P=0.0001), day 2 (P=0.002), day 4 (P=0.002), day 6 (P=0.005), and on average (P=0.001), as well as in normal RDW on day 0 (P=0.008), day 2 (P=0.010), day 4 (P=0.029), day 6 (P=0.015), and on average (P=0.012). Conclusion RDW at admission is an important biomarker in severe sepsis with increased mortality, prolonged duration of MV, and prolonged ICU stay in patients with high RDW at admission. There was positive correlation between RDW and SOFA on days 0, 2, 4, 6, 14, 20, and on average and negative correlation between RDW and platelet on days 0, 2, 4, 6, and on average.

Partially coherent digital matched filters

Abstract The structure and performance of digital matched filters (DMFs) with partial phase estimation, i.e., partial coherent (PC) DMFs, are considered in this paper. The case of a PC-DMF with one-bit digitization and matched to a binary phase modulated signal is investigated. The filter structure is derived as an approximation to Viterbis optimum PC analog detector structure and is shown to be a generalization of Turins noncoherent (NC) DMF structure. The performance of the PC-DMF is investigated in detail for three types of interference, namely, the Gaussian noise, the noncoherent constant amplitude interference (NCAI), and the coherent constant amplitude interference (CCAI). The results are compared with those of the two coherence limiting cases, i.e., the NC-DMF and the coherent DMF case.