الفهرس 
List of ContentsOnly 14 pages are availabe for public view
 |  | from | 135 |  |  |
| | | from | 135 | | |
Abstract
Background : Respiratory distress is a frequent cause of admission of children with congenital heart diseases to Emergency department either due to heart failure, pneumonia or both. The diagnosis of the cause of respiratory distress in children with congenital heart diseases is challenging due to the overlapping symptoms of cough, shortness of breath, crying & abnormal chest imaging. Respiratory infections are well-known precipitant factors for heart failure.In recent years, procalcitonin has emerged as a promising tool for early and accurate diagnosis of pneumonia and, interestingly, for guiding antibiotic therapy in patients with acute heart failure in adults. The aim of the work : to investigate the role of PCT in differentiation of the cause of respiratory distress either acute heart failure only, chest infection only, or acute heart failure with superadded infection. Type of study: observational case control study. Materials and Methods: Total 70 patients with diagnosis of different structural heart defects by echocardiography were classified into groups according to the presence or absence of chest infection & acute heart failure . Another 30 healthy child as a control group. They all have been subjected to full history and clinical examination ,Radiological investigation including chest x-ray and laboratory investigation including procalcitonin level ,CBC including total leucocyte count & CRP . The final diagnosis for these cases have been established by expert clinicians based on history, symptomatology, physical signs, radiological findings ,other laboratory investigation & using Ross classification of heart failure in children. 2ml serum have been withdrown for procalcitonin assay using ELISA kit based on standard sandwich enzyme-linked immune-sorbent assay technology. Results: Procalcitonin level has been statistically significant higher in HF group vs. controls. Also it was statistically significant higher in chest infection group and heart failure with infection group versus controls. Also it was statistically significant higher in both chest infection group and heart failure with infection group versus heart failure only group. PCT level was statistically significant higher in bacterial infection than viral type. This results demonstrated that PCT may enhance the clinician ability to diagnose an infectious etiology of shortness of breath in patients presenting with dyspnea. On the other hand there was no statistically significant difference in heart failure with infection group versus chest infection only group.There was statistically significant difference between PCT levels in cases who discharged versus those who died.There was statistically significant positive correlation between PCT and duration of admission. Conclusion : Procalcitonin provided good discrimination for the diagnosis of chest infection in patients with comorbid heart failure and may be used for guiding antibiotic therapy. Also ,procalcitonin allowed for good discrimination of bacterial and viral infection. Moreover,it was a good predictor of duration hospital stay and mortality. Recommendations : * Increase the number of cases and serial measurement of PCT level for prediction of prognosis and response to antibiotic therapy. * Clinical trials should be done for evaluation of PCT guided antibiotic therapy versus traditional protocol. * Following up the patients for readmission and short term or long term mortality and correlating this with PCT level for evaluating its prognostic value.