Purpose To compare the bedside ultrasound estimation of internal jugular vein (IJV)-collapsibility index with inferior vena cava (IVC)-collapsibility index and invasively monitored central venous pressure (CVP) in ICU patients. Design prospective observational study. Setting The study was carried out in the ICU of Al Wakra and Al Khor hospitals of the Hamad Medical Corporation, Qatar. The patients were enrolled from November 2013 to January 2015. Patients Patients admitted to the ICU with central venous catheter were included. Material and methods The A-P diameter, cross-sectional area of the right IJV, and diameter of IVC were measured using bedside USG, and their corresponding collapsibility indices were obtained. The results of the IJV and IVC indices were compared with CVP. The sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the IJV collapsibility index in predicting the CVP. Results Seventy patients were enrolled, out of which 12 were excluded. The mean age was 54.34±16.61 years. The mean CVP was 9.88 mmHg (range =1–25) . The correlations between CVP and IJV-CI (collapsibility index) at 0° were r = −0.484 ( P= 0.0001), r=−0.416 ( P= 0.001) for the cross-sectional area (CSA) and the diameter, respectively, and, at 30°, the most significant correlation discovered was ( r= −0.583, P= 0.0001) for the CSA-CI and r = −0.559 ( P =0.0001) for the diameter-CI. In addition, there was a significant and negative correlation between IVC-CI and CVP (r=−0.540, P =0.0001). Conclusion The IJV collapsibility index, especially at 30° head end elevation, can be used as a first-line approach for the bedside non-invasive assessment of CVP/fluid status in critical patients. IVC-CI can be used either as an adjunct or in conditions where IJV assessment is not possible, such as in the case of a neck trauma/surgery.

The purpose of this manuscript is to provide a current overview on the Shiga Toxin / verotoxin-producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) with emphasis on the epidemiology, clinical and laboratory manifestations, pathogenesis, recommended assessment, treatment strategies and prognosis. Hemolytic uremic syndrome (HUS) is a cause of the community-acquired acute renal insufficiency in young children. The outbreak in Germany illustrated both the emerging importance of non-O157 serotypes as agents of human disease and the potential for large-scale methods of food production and distribution to result in widespread disease. Children with STEC-induced HUS typically have a prodromal illness that can rapidly develop severe and multisystem life-threatening complications. STEC infection is acquired through contaminated food or water. Thrombotic microangiopathy is the mechanism of the development of the characteristic pathologic lesion of HUS. Any patient with a recent history of diarrhea and signs of a multi-organ disorder requires a proper assessment for the possible development of HUS. Appropriate laboratory testing for both O157 and non-O157 serotypes, as well as prompt initiation of infection control procedures for confirmed or suspected cases, will facilitate follow-up investigation to identify the source of disease and will help to prevent secondary transmission. Currently, diagnostic test to predict which patients will develop HUS is not available. Supportive care and intravenous fluid replacement are the cornerstones of treatment because of the current lack of safe and specific therapeutic intervention. Culizumab and/or plasma treatment may be considered in patients with severe CNS involvement who have a poor prognosis. None of the multiple therapeutic agents including antithrombotic agents, plasma exchange and/or plasma infusion, tissue-type plasminogen activator, and oral Shiga toxin-binding agent that have been used is recommended. For most patients with uncomplicated STEC-associated gastroenteritis who are treated with supportive care, the prognosis was excellent. Public health interventions are the key to prevent STEC-associated diarrhea and HUS. Researches will improve the care of patients with different HUS types in the years to come. The identification of genetic factors associated with HUS will contribute to a better insight of the pathogenesis of HUS and will have potential therapeutic and preventive implications.

Objective. Early restoration of coronary perfusion by thrombolysis or percutaneous coronary intervention is the main modality of treatment to salvage the ischemic myocardium. The earlier the procedure is completed, the greater the benefit is in saving myocardium and restoring its functions. The aim of the study is to compare the door-to-needle time (DNT) in acute ST elevation myocardial infarction (STEMI) in the period prior to December 2008 when the site of thrombolysis was in coronary care unit (CCU) and the period after that when the site was shifted to emergency department (ED). Methods. A retrospective, descriptive study was conducted at Al Khor Hospital, Qatar, in patients with acute STEMI who underwent thrombolysis at CCU and ED from April 2005 until December 2011, to compare the DNT, duration of hospitalization, and mortality. Results. A total of 211 patients with acute STEMI were eligible for thrombolysis; 58 patients were thrombolysed in the CCU and 153 in ED. The median DNT was reduced from 33.5 minutes in the CCU to 17 minutes in the ED representing a reduction of more than 50% with a P value of < 0.0001. Conclusion. The transfer of the thrombolysis site from CCU to the ED was associated with a dramatic and significant reduction in median door-to-needle time by more than half.

Objective: Early differentiation of enteric (typhoid) fever from other febrile conditions has been difficult due to the non-specific clinical presentations and lack of substantiating laboratory clues. Transaminase alterations in enteric fever were thought to be non-specific and have not been investigated before in comparison with other febrile conditions with regards to their prevalence and the aspartate amino transferase/alanine amino transferase (AST/ALT) ratio. We sought to examine these parameters as triage markers for enteric fever. Methods: We retrospectively studied 106 patients with enteric fever diagnosed by positive blood culture. 112 febrile patients tested negative for malaria were taken as controls. The controls were matched to the test group with respect to demographic and baseline clinical features. Serum AST, ALT values on first visit to the emergency department was noted and AST/ALT ratio was determined. The values between the test and control groups were compared and the results were analyzed using appropriate statistical methods. Results: The mean AST and ALT levels were found to be significantly higher for enteric fever patients than the control group (109.91 U/L ± 76.07 vs. 29.93 U/L ± 16.74; p < 0.0001) and (83.60 U/L ± 68.04 vs. 32.12 U/L ± 21.79; p < 0.0001) respectively. The mean AST/ALT ratio was found to be higher among enteric fever patients compared to the control group (1.42 ± 0.60 vs.1.07 ± 0.44; p < 0.0001). AST/ALT ratio of ≥ 1 combined with AST of ≥ 40 U/L was found in 72.6% of enteric patients vs. 6.2% in the control group (p < 0.0001). Conclusions: As compared to other common febrile conditions, transaminase alterations in enteric fever seem to follow a specific pattern characterized by higher prevalence of mild elevations (mean levels < 3 fold the upper limit of normal) with a general trend of AST/ALT ratios ≥ 1. In the febrile adult, having an AST/ALT ratio of >1 combined with an AST level of >40 U/L, may provide a simple and cheap triage marker for blood cultures and closer observation especially in the emergency department.