Journal of Acute Disease

6-9

Authors: Sourabh Aggarwal, Jesna Mathew, Harkirat Singh, Vishal Sharma

Objective: To analyze the attitude and perception of junior resident doctors’ regarding antibiotic resistance and prescribing. Methods: This cross-sectional study was conducted in two tertiary care centres in the New Delhi during the months of May-June 2012. An email based questionnaire was emailed to all the junior residents (JRs) working in the clinical setting and all the responses obtained within 2 months were included in the study. Statistical analysis was done using SPSS v.17. Results: This email based questionnaire was forwarded to 80 JRs. 53 responses were deemed appropriate for analysis with response rate of 66.25%. Forty-nine JRs (92.45%) believed that antibiotic resistance is a problem in India while 38 JRs (71.7%) believed it is a problem in their hospital. 28 JRs (52.83%) had received training regarding antibiotic prescription in last 6 months while 25 (47.17%) had not received any training. 47 JRs (88.7%) believed that Medical Council should take strict actions prohibiting irrational use of antibiotics. Only 18 JRs (33.96%) said that Government of India should go ahead with proposed plan of restricting junior doctors from prescribing third and fourth generation antibiotics without Head of Department's permission. Conclusions: Most of the junior residents believe that antibiotic resistance is an emerging problem in their hospital as also nationally. There is a large unmet need of providing education to these residents.

14-21

Authors: Mithun Singh Rajput, Neelam Balekar, Dinesh Kumar Jain

Objective: To investigate the antiatherosclerotic potential of Lagenaria siceraria (L. siceraria) by calculating percentage plaque area in aorta and grade of atheromatous lesions modulated by HMG-CoA reductase enzyme and lipoprotein lipase enzymes levels in hyperlipidemic rats. Methods: Rats were divided into different groups, fed with high cholesterol atherogenic diet and in addition supplemented with ethanolic extract of fruits of L. siceraria and standard drug atorvastatin. At the end of the treatment schedule, the atherosclerotic lesion area was measured in cross-sections of the aortic root and grading of atherosclerotic lesions was done. The blood samples from animals of different groups were evaluated for serum lipid profile determination and plasma lipoprotein lipase activity and the hepatic HMG-CoA activity was also determined. Results: Treatment of rats with ethanolic extract of fruits of L. siceraria significantly lowers the risk of atherosclerosis by lowering percentage plaque area in aorta and grade of atheromatous lesions in hypercholesterolemic rats and also serum cholesterol, triglyceride, LDL-c, VLDL-c and increased HDL-c levels as well. The extract also induced lipoprotein lipase activity and significantly decreased cholesterogenesis in liver by reducing HMG-CoA reductase activity in hypercholeaterolemic rats. Conclusion: It can be concluded that ethanolic extract of fruits of L. siceraria contains active components which ameliorates the atheromatous lesions in rat aorta and lowers the risk of atherosclerosis in hypercholesterolemic rats.

26-30

Authors: Hamid Kassiri, Ali Kassiri, Masoud Lotfi, Babak Shahkarami, Seyed-Sahar Hosseini

Objective: To determine the epidemiology of animal bites during a five-year period (2004- 2008) in Shush County, Khuzestan province, southwestern Iran. Methods: In a descriptive cross sectional study, all cases of animal bites referred to the health centers in Shush County were investigated during 2004-2008. The necessary data were recorded on the special questionnaire that contains questions about bite animal, age, sex, occupation, treatment, the bite site on the body and so forth. Results: Out of a total of 2 283 cases that underwent the animal bites during the mentioned five years, 1 771 people (77.6%) were male and 511 (22.4%) were female .Most cases were related to age groups 10-20 (33.4%) and 20-30 (22%) years. The average incidence rate of animal bite during these years was determined as 2.82 cases per 1 000 people. The highest incidence rate was related to the year 2007 with 3 cases per 1 000 people. Animal bites in the winter (29.3%) and fall (29%) were more common. Almost 86.5% and 13.5% of the cases occurred in rural areas and urban areas, respectively. Nearly 30% and 20.4% of cases were students and farmers, respectively. A total of 2 155 (94.4%) and 86 (3.8%) bites occurred by the dog and cat, respectively. The greatest bite place on the body was in the feet (81.4%) and in the hands (13%(.During the study period, 2 162 cases (94.7%) were treated with an incomplete regimen, and 120 cases (5.3%) were treated with a complete regimen. Conclusions: Because the cost of prevention after biting for the health system is high, so, preventive programs must be concentrated on public health instruction, particularly in villagers, students, farmers and the owners of the domestic animals.

36-40

Authors: S Viviyan Therasa, T Thirumalai, N Tamilselvan, E David

Objective: To study hypoglycemic effect of Phyllanthus amarus (P. amarus) leaf extract and its glucose uptake inhibition effect in rat small intestine ex-vivo and in vivo models. Methods: Hypoglycemic studies were carried out in glucose loaded and streptozotocin (STZ) induced diabetic albino rats. Blood glucose levels were estimated at I, III and IV hour time intervals after administration of aqueous leaf extract of P. amarus. The study on the effect of plant extract on intestinal glucose absorption in rat was carried out using everted gut sacs. Results: The blood glucose levels were significantly depleted in the animals administered with aqueous leaf extract of P. amarus (250 mg/kg body weight). Incubation of the rat everted intestinal sacs with the aqueous leaf extract of P. amarus resulted in the inhibition of glucose transport across the intestinal membrane. Conclusions: The kinetic studies on the glucose transport inhibition across the intestinal membrane by the plant extract was a non competitive type of inhibition of the intestinal glucose transporter protein (GLUT2 and SGLT1) revealing the probable mechanism of hypoglycaemic effect of the aqueous leaf extract of P. amarus.

46-50

Authors: Kar DM, Rout SK, Moharana L, Majumdar S

Objective: To evaluate the anticonvulsant activity of hydroalcoholic extracts of leaves and sepals of Mussaenda philippica (M. Philippica) and its fractions (methanol, dioxin and aqueous) against pentylene tetrazole (PTZ), maximal electroshock (MES), Strychnine (STR), Picrotoxin induced convulsions at different dose levels. Methods: The anticonvulsant effect of extracts was studied by the MES, PTZ, STR and Picrotoxin-induced seizure. Results: The extract at 100 and 200 mg/ kg, produced a significant (P<0.01) dose dependent increase in onset of convulsion compared to the control in MES, PTZ, strychnine and picrotoxin-induced seizures. Conclustions: The data obtained indicates that Hydroalcoholic extracts of M. philippica leaves and sepals may help to control grandmal and petitmal epilepsy.

56-58

Authors: Keka Alije, Ramosaj A, Toro. H, Azemi. M, Baloku. A, Sylaj B, Lenjani. B, Kyseni. K

Objective: To present the frequency, etiology, changes over the years of acute poisoning in children admitted to Pediatric Clinic of Pristina and to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. Methods: Retrospectively we have analyzed the epidemiology of accidental and suicidal poisonings in children hospitalization in Pediatric Clinic Department of Toxicology during the year 2012. Our data we compared with data from previous studies on acute poisoning in children in the Pediatric Clinic conducted during the years 1976-1985 and 2001. Results: During the year 2012, in Pediatric Clinic of Pristina 5 723 children were hospitalized, 136 of them or 2.3% were treated due to acute poisoning in Department of Toxicology, 82 of them was boys and 54 was girls, rate boys girls was 1.5:1. The majority of cases 101 or 74.2% were under five years with peak age three and 35% or 25.7% were over five years. The most of the cases was accidentally 97% and only 2.9% was suicidal and all of them were over the age of ten. Drugs were the most common agent causing the poisoning 71 (52.2%) followed by house cleaning products 38 (27.9%), food 10 (5.8%), pesticides 7 (5.14%), rare agent that caused poisoning were: narcotic substances, plant, heavy metals, alcohol, carbon monoxide, carburant. Poisoning occurred mostly in spring and the peak was observed in May, (1.17% of all patients). January was the month of lowest rate of poisoning. During the years 1976-1985, in Pediatric Clinic of Pristina 900 children were hospitalized due to acute poisoning, 44.11% were from drugs, 15.88% from pesticides, 65 (7.2%), while during 2001 in the unit care intensive were hospitalized 66 children due to acute poisoning, among them 51.5% were poisoning from drugs, 30.03 from pesticides, 12.2% from cleaning products. Conclusion: In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than 5 years-old, this age of children is the most susceptible in terms of morbidity. Compared with the previous studies in Pediatric Clinic of Pristina, drugs are still the most frequent cause of acute poisoning in children; the number of poisoning with pesticides has fallen but has increased the number of poisoning with cleaning products. All preventive measures against poisoning should be taken including preventive strategies of education at national level especially in drug and household product storage.

62-63

Authors: Beuy Joob, Viroj Wiwanitkit

Objective: To reassess the usefulness of microscopic stool examination for the HIV infected patients with acute diarrhea. Methods: Overall 100 HIV-infected patients receiving standard antiretroviral therapy who visited to a primary care center (for privacy reason, the name is hereby blinded) with compliant of acute diarrhea were reviewed. In all patients, the standard microscopic stool examination was performed. Results: Of interest, from overall 100 indexed cases, there is no case with determined parasite in stool samples. Conclusions: Based on our setting, it seems that there is diagnostic role of using microscopic stool examination for determining possible parasitic infestation in HIV infected patients receiving standard antiretroviral therapy who present with acute diarrhea.

69-71

Authors: Fatimah Lateef

Evaluation of arrhythmias, especially in the acute setting can be challenging. One of the most crucial steps is to accurately differentiate whether a tachyarrhythmia is of supraventricular (with aberrant conduction) or ventricular origin. A 12-lead electrocardiogram may be useful in some cases where specific morphology or features can be sought.

74-76

Authors: Sevil Arı Yuca, Cahide Yılmaz, Avni Kaya, Lokman Üstyol, Ertan Sal, Yasar Cesur, Hüseyin Caksen

The central nervous system is one of the most crucial targeted systems of hyphotiroidism where tissues undergo various broad developmental processes such as neuronal and glial cellular differentiation, migration and myelinization. However brain images are mainly normal. In this article we present findings related to a 1-year-old girl who has been referred to our outpatient clinic with complaints of slowing of movement and lack of interest. She was diagnosed with hypothyroidism. Her brain magnetic resonance image obtained during diagnosis displayed dysmyelinization. It showed improvement after Na-L thyroxin therapy during follow up.

80-81

Authors: Beuy Joob, Viroj Wiwanitkit

Hyperthyroidism is an important endocrine disorder that can be seen around the world. In this disorder, the patient is usually hyperstimulate and palpitation. The effect of thyroid hormone is the explanation. A similar effect can be seen due to adrenaline reaction. In general, the use of adrenaline in the case with hyperthyroidism has to be carefully done. In the present case study, the authors present a case of acute reaction to erroneous injection of adrenaline to the patients with hyperthyroidism.