Introduction. Left ventricular dysfunction is quite common in septic shock. Speckle-tracking echocardiography (STE) is a novel, highly sensitive method for assessing left ventricular function, capable of detecting subclinical myocardial dysfunction, which is not identified with conventional echocardiography. We sought to evaluate subclinical left ventricular systolic function in patients with septic shock using speckle-tracking echocardiography. Methods. From May 2017 to December 2018, patients aged ≥18 years admitted to the intensive care unit with the diagnosis of sepsis and septic shock based on the sepsis-3 definition were included. Patients with other causes of cardiac dysfunction were excluded. Transthoracic echocardiography was performed for all the patients within 24 hours of diagnosis. Left ventricular systolic function was assessed using conventional echocardiography and speckle-tracking echocardiography. Results. Patients with septic shock (n = 90) (study group) and 37 matched patients with sepsis but no septic shock (control group) were included. Left ventricular ejection fraction (LVEF) by conventional echocardiography showed no significant difference between two groups (58.2 ± 9.9 vs. 58.6 ± 8.3, p=0.804). The global longitudinal strain (GLS) by STE was significantly reduced in patients with septic shock compared with that in the control (−14.6 ± 3.3 vs. −17.1 ± 3.3, p<0.001). Based on the cutoff value of GLS ≥ −15% for the definition of subclinical left ventricular systolic dysfunction, this dysfunction was detected in 50 patients with septic shock (55.6%) and in 6 patients in the control group (16.2%) (p<0.05). Conclusions. Speckle-tracking echocardiography can detect early subclinical left ventricular systolic dysfunction via the left ventricular global longitudinal strain compared with conventional echocardiographic parameters in patients with septic shock.

Backgroud: Subarachnoid hemorrhage (SAH) is sudden bleeding into the subarachnoid space. The most common cause of spontaneous SAH is a ruptured aneurysm. Symptoms include sudden, severe headache, usually with loss or impairment of consciousness. It has a lot of dangerous complications especially re-bleeding and vasospasm which are the major causes of death and disability. Objective: To study on clinical characteristics, computed tomography brain imaging, causes and complications of subarachnoid hemorrhage. Subject and method: A cross-sectional prospective study on 202 patients who suffered from subarachnoid hemorrhage admitted to the Stroke Center, 108 Military Central Hospital from June 2018 to January 2020. Result and conclusion: The average age was 60.5 years. The most common age group was among the aged 45-64 years (71.2%). The most common symptoms of SAH was sudden severe headache (98%); neck stiff (86.1%), followed by consciousness disorders (56.9%), systolic blood pressure above 160mmHg (50.5%), focal neurologic deficits (20.3%). The Fisher classification: Grade 1 (4.5%), grade 2 (17.3%), grade 3 (19.3%), grade 4 (58.9%). The ruptured cerebral aneurysm accounted for 89.6% of the causes of SAH. The most common site of aneurysm was in the anterior communicating artery (34.8%), followed by the middle cerebral artery (21.5%) and in the internal carotid artery (16.6%). Posterior cerebral circulation accounted for 12.7%; 4.4% of patients had multiple aneurysms. The most common complications of SAH was cerebral vasospasm (26.2%) and typically occurred between 5 and 7 days after SAH, followed by rebleeding accounted for 7.9%, the most cases occurred within the first 24 hours, acute and subacute hydrocephalus (10.4%), hyponatremia (11.4%) and seizures (5.4%).

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