Hepatitis C virus (HCV) infection is one of the considerable health problems affecting huge number of population worldwide with a prevalence varying from 0.05%-0.36% in the United States and Europe. This ratio tends to be higher in developing countries especially in Egypt. 1 Egypt is a low-/middle-income country and was estimated to have the highest HCV prevalence rate in the world in 2013 and 5th highest number of HCV-infected individuals in 2017 2,3 with a prevalence rate of 14.7% and treatment costs amounting to around 1.4% of the gross national product 4,5 All six HCV genotypes are implicated in paediatric populations. 6 HCV genotype (GT)-4 represents 12%-15% (15-18 million) of the total global chronic HCV infection. 7 Its distribution has traditionally been confined to

ObjectiveFollow-up of cardiac index and systemic vascular resistance index by bedside echocardiography until resuscitation.MethodsA set of hemodynamic parameters was obtained, including cardiac output, stroke volume, cardiac index, systemic vascular resistance index, velocity time integral, myocardial performance index, capillary refill time, and heart rate at 0 hours after fluid boluses before the start of inotropes, and followed up after 6 hours and 24 hours.ResultsIncluded were 45 patients with community-acquired septic shock. Septic foci were gastroenteritis (24%), intestinal perforation requiring emergency surgery (24%), pneumonia (20%), central nervous system infection (22%) and soft tissue infection (8%). Klebsiella and Enterobacter were the most frequent isolates. We estimated the factors affecting the cardiac index: high central venous pressure at zero time (r = 0.33, p = 0.024) and persistently high heart rate at hour 6 (r = 0.33, p = 0.03). The systemic vascular resistance index was high in most patients at 0 and 24 hours and at the time of resuscitation and inversely affected the cardiac index as well as affecting the velocity time integral (r = -0.416, -0.61, 0.55 and -0.295). Prolonged capillary refill time was a clinical predictor of the low velocity time integral at 24 hours (r = -0.4). The mortality was 27%. Lower systemic vascular resistance index and higher cardiac output were observed in nonsurviving patients.ConclusionThere was a persistently high systemic vascular resistance index in cold shock patients that influenced the stroke volume index, cardiac index, and velocity time integral. The use of echocardiograms for hemodynamic measurements is important in pediatric septic shock patients to adjust dilators, and vasopressor doses and achieve resuscitation targets in a timely manner.

Background: Fluids are an integral line of management of septic shock as circulatory instability and myocardial dysfunction are the major causes of death in septic shock. Several indicators of fluid responsiveness (FR) have been proposed. Aim of the Work: to assess predictive value of assessment of fluid responsiveness on outcome of children with sepsis. Methods: This study was a prospective observational cohort study which was conducted on 25 children who were admitted to Pediatric Intensive Care Unit with septic shock at Children Hospital, Cairo University from February 2020 to May 2020. All underwent bedside echocardiography assessment of fluid responsiveness (FR) using inferior vena cava's (IVC) diameter: distensibility, collapsibility, variability indices and time velocity integral across aortic valve before and after fluid resuscitation. Results:The mean age ± SD of the studied cohort was 33.72 ± 39.65 months, 17 (68%) were males and 8 (32%) were females. All patients presented by septic shock, of them 13 (52%) were fluid responsive and 12(48%) were fluid nonresponsive (p=0.118). FR was different between ventilated patients and non-ventilated patients as regards IVC variability % before and after IV fluids (p= 0.001) and (p=0.001) respectively, stroke volume and cardiac output after IV fluids (p =0.033) and (p=0.001) respectively. FR correlated with central venous pressure measurements (p=0.000017) and inotropic support (p=0.0074) but not with main diagnosis of septic shock, mechanical ventilation of patients or not and not with number of system failure. Ten (40%) of them were on mechanical ventilation and inotropes. Nineteen (76%) improved and 6 (24%) died. There was no correlation between FR and outcome (p= 0.316). Conclusion: Bedside echocardiography may be a useful non-invasive method for follow up, evaluation of fluid responsiveness in children septic shock and to assess CI which helps in assessment of fluid response, make decision on medication, and help evaluate the different forms of shock, but it has no significant relation to the outcome of these children. Outcome of septic shock is multifactorial, depends on timing of diagnosis, fluid administration, inotropic support, and cardiac condition not fluid responsiveness only.