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Background Tissue perfusion and oxygenation monitoring is the fundamental of management to immediately identify and properly manage (impending) organ dysfunction in septic shock. This is a study of a prospective randomized trial that aims to comparing the prognostic value of lactate clearance versus base deficit correction as an indicator of tissue perfusion in septic shock, trying to prove the superiority of one over the other. Objective To assess the clinical utility of lactate clearance and arterial base deficit correction in predicting mortality in septic shock. Patients and Methods This is a Prospective randomized observational study that was conducted to assess the clinical utility of lactate clearance and arterial base deficit in predicting mortality in septic shock. This study included forty patients who were divided into two equal groups; each of twenty patients, group I (non-survivors), and group II (survivors). Results In this study, the base deficit values revealed statistically notable difference between the two groups at admission, 18 hours, 24 hours and 2 days of admission. The values revealed no notable difference at the 3rd. 4th, and 5th day of admission. At the 6th and 7th day of admission, the base deficit started to increase again in the non-survivor group with statistically notable increase in the values as compared to the survivor group. The cutoff point of base deficit to differentiate between nonsurvivors from survivors was > 11.43 with 62% sensitivity and 100% specificity. In this study, initial serum lactate levels at admission revealed higher accuracy in prediction of mortality as compared with initial base deficit. Conclusion Lactate clearance is a better predictor of mortality and morbidity than base deficit correction.

Background sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. Common signs and symptoms of sepsis include fever, increased heart rate, increased breathing rate, and confusion. In the very young, old, and people with a weakened immune system, there may be no specific symptoms. Aim to study QT dispersion, QT interval abnormalities and corrected QT interval in septic patients in correlation with arrhythmias, hospital outcome (survival, mortality) and electrolytes. Patients and Methodology this is a prospective randomized study that was conducted on forty adult patients who were admitted in the ICU at Ahmed Maher Teaching Hospital with the diagnosis of sepsis to correlate Corrected QT interval (QTc) and QT dispersion (QTD) with arrhythmias, need for mechanical ventilation (MV), electrolytes and hospital outcome. Results forty patients were included in this study, their ages with a mean of 53.50± 13.7 years. Male patients were 24(60%) and female patients were 16 (40%). The most frequent risk factor was hypertension (62.5%). Conclusions the QTc duration may act as a risk marker in the septic patient. Patients with markedly prolonged QTc interval had significantly more episodes of inhospital ventricular tachycardia and hospital mortality. Recommendations QTc may add a useful, simple and accessible tool to be used in risk stratification of septic patients. Factors that cause QTc prolongation could be an avoidable or correctable factors; lifethreatening arrhythmia could be prevented.

Background Post-anesthetic shivering refers to spontaneous, involuntary, rhythmic, oscillating and tremor-like muscle hyperactivity that increases metabolic heat production up to 600% after general or regional anesthesia. Shivering is not only subjectively unpleasant but is physiologically stressful because it elevates blood pressure, heart rate, oxygen consumption, and plasma catecholamine concentrations. Moreover, shivering may aggravate pain and hinder wound closure by simply stretching surgical incisions. Objective The aim of this work is to compare the efficacy of intravenous tramadol VS nalbuphine for prevention of post spinal shivering during knee arthroscopy. Methods This prospective randomized double blinded study was carried in Ain Shams University hospitals on 90 patients scheduled for knee arthroscopy. Patients were randomized into three groups 30 patients each: Group C: patients received normal saline 0.9%) intravenously. Group T: Patients received Tramadol 0.5 mg/kg intravenously. Group N: Patients received nalbuphine 0.1mg/kg intravenously. All drugs were given immediately after intra thecal injection of the anaesthetic drugs and returning to the supine position. Results The study revealed that the incidence of shivering was less in the tramadol (23.3%) and nalbuphine (26.7%) groups compared to the saline group (56.7%) (P < 0.05) with no significant difference between Nalbuphine and Tramadol groups (p > 0.05). The mean grade of shivering was comparable between the three groups (P > 0.05). Shivering onset was significantly earlier in the saline group (24.1±2.9 min) compared to Nalbuphine (32.3±4.9min) and Tramadol (36.4±4.3min) groups (P < 0.05) with no significant difference between Nalbuphine and Tramadol groups (p > 0.05). There were no significant differences among the three groups as regards hemodynamics (Heart rate and mean blood pressure), respiratory rate, oxygen saturations, body temperature, the incidence of nausea or vomiting (P > 0.05). While sedation grade was significantly highest in Nalbuphine group followed by Tramadol group and least in Saline group (P < 0.001). Conclusion The current study revealed that both tramadol 0.5mg/kg and balbuphine 0.1mg/kg was effective in prevention of post spinal shivering in patients undergoing knee arthroscopy.