Journal of Acute Disease

7-11

Authors: Ioannis N. Mavridis, Maria Meliou, Efstratios-Stylianos Pyrgelis

Troponin (tr) elevation in aneurysmal subarachnoid hemorrhage (SAH) patients is often difficult to be appropriately assessed by clinicians, causing even disagreements regarding its management between neurosurgeons and cardiologists. The purpose of this article was to review the literature regarding the clinical interpretation of tr elevation in SAH. We searched for articles in PubMed using the key words: “troponin elevation” and “subarachnoid hemorrhage”. All of them, as well as relative neurosurgical books, were used for this review. Some type of cardiovascular abnormality develops in most SAH patients. Neurogenic stunned myocardium is a frequent SAH complication, due to catecholamine surge which induces cardiac injury, as evidenced by increased serum tr levels, electrocardiographic (ECG) changes and cardiac wall motion abnormalities. Tr elevation, usually modest, is an early and specific marker for cardiac involvement after SAH and its levels peak about two days after SAH. Cardiac tr elevation predictors include poor clinical grade, intraventricular hemorrhage, loss of consciousness at ictus, global cerebral edema, female sex, large body surface area, lower systolic blood pressure, higher heart rate and prolonged Q-Tc interval. Elevated tr levels are associated with disability and death (especially tr >1 μg/L), worse neurological grade, systolic and diastolic cardiac dysfunction, pulmonary congestion, longer intensive care unit stay and incidence of vasospasm. Tr elevation is a common finding in SAH patients and constitutes a rightful cause of worry about the patients’ cardiac function and prognosis. It should be therefore early detected, carefully monitored and appropriately managed by clinicians.

18-22

Authors: Hamid Karimi, Kamal Seyed Forootan, Gholamreza Moein, Seyed Jaber Mosavi, Batol Ghorbani Iekta

Objective: To study the result of nerve repair in the two mentioned techniques in rats to fi nd the proper answer to the existing disagreement. Methods: Twenty adult male rats were included in treatment group. Acutely disconnected sciatic nerve was repaired by Epineural technique in half of the rats; in the other half perineurial technique was applied. After 80 d, the number of grown axons of distal on the repair site was calculated through the use of an optical microscope. Additionally by studying the foot print of the rats the return of neural motor activity was evaluated. Results: In epineural group, SFI index was: (56.33±32.30) and in perineurial group: (55.71±30.31); P value=0.930 with their being no difference between these two techniques of surgery. However, in comparing epineural and perineurial groups in the groups themselves, statistical tests showed a significant difference showing functional improvement in comparison with the day before surgery P value=0.0001. Statistical tests showed that the average of axons' number distal to anastomosis site in the epineural group was (349±80) and in the perineurial group was (405±174). These groups have no significant difference regarding the number of axons (P value=0.36). Conclusion: The results of epineural and perineurial surgery techniques show no difference in nerve repair, SFI index, or axon counting in distal part.

28-31

Authors: Yusuf Alkali, A. K. Gana, Abdulkadir A, Nzelibe C. Humphrey

Objective: To study the inhibitory activity of ethanolic extract from Mimosa pigra and Ipomoea asarifolia against Trypanosoma evansi (T. evansi) calcium dependent phospholipase A2. Methods: The calcium dependent phospholipase A2 (E C 3.1.1.4) enzyme was isolated from T. evansi and purified to electrophoretic homogeneity under non denaturing conditions. It was solubilized from T. evansi cells recovered from white albino rats which were previously inoculated by intraperitoneal injection of infected camel blood. Two indigeneous ethanolic plant extracts used locally for treatment of trypanosomiasis were tested for the inhibition of phospholipases A2. Results: Double reciprocal plots of the initial velocity data of the inhibition by the indigenous plant extracts revealed a noncompetitive pattern of inhibition for the Ipomoea asarifolia and a competitive inhibition for Mimosa pigra in a dose dependent fashion. The extrapolated inhibition binding constant (Ki) of these extracts were found to be 2.0×102 µg/mL and 1.12×102 µg/mL respectively. Conclusions: The low Ki values obtained for these extracts towards this enzyme are an indication of high affinity of the extract or the active components (present in the plants) are for these enzyme and therefore, could be explored to serve as a cheap source of T. evansi PLA2 antidote and as well help in designing a novel drug with high efficiency.

37-43

Authors: Andreas Berner, Tariq Saleem Alharbi, Eric Carlström, Amir Khorram-Manesh

Objective: To develop a validated and generalized high reliability organizations collaborative tool in order to conduct common assessments and information sharing of potential risks during mass-gatherings. Methods: The Swedish resource and risk estimation guide was used as foundation for the development of the generalized collaborative tool, by three different expert groups, and then analyzed. Analysis of inter-rater reliability was conducted through simulated cases that showed weighted and unweight κ-statistics. Results: The results revealed a mean of unweight κ-value from the three cases of 0.37 and a mean accuracy of 62% of the tool. Conclusions: The collaboration tool, “STREET”, showed acceptable reliability and validity to be used as a foundation for high reliability organization collaboration in a simulated environment. However, the lack of reliability in one of the cases highlights the challenges of creating measurable values from simulated cases. A study on real events can provide higher reliability but need, on the other hand, an already developed tool.

48-50

Authors: María del Pilar Quiroga, José Daniel Charry, Nicolás Becerra, Juan Camilo Garcia, Eliana Karina Muñoz, Rodrigo Lara

Objective: To establish the risk factors associated to development of empyema posttraumatic in patients with chest trauma managed with closed thoracostomy. Methods: It was a descriptive and observational study of patients with chest trauma who were admitted between January 2013 and May 2014. The variables were evaluated and the results according to management with closed thoracostomy in patients with thoracic trauma was determined. Univariate analysis was performed and measures of central tendency were calculated. Results: In total 240 patients were analyzed. Among them, 10.4% (25) developed posttraumatic empyema. In patients who developed empyema, the mean age was 34.2 years, and the mean injury severity score was 20.6. It was identified as a risk factor closed chest trauma in 68% (17) and 84% coagulated hemothorax trauma. Empyema management thoracoscopy was in 100% of cases. Conclusions: The posttraumatic empyema is a complication that occurs in patients with thoracic trauma. One of the most important risk factors is coagulated hemothorax which could be identified and treated in time to avoid comorbidities during hospital stay.

54-58

Authors: Fahisham Taib, Bakht Jamal

Objective: To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized profo rma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients’ data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline; however, different antibiotic regimes were based on physician’s preferences. The sensitivity of the current method of UTI diagnosis remained at 64% when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.

63-67

Authors: A Haner, P Örninge, A Khorram-Manesh

Objective: To evaluate the outcome of physician-staffed ambulances in a pilot study. Methods: All physician-staffed ambulance missions conducted in Gothenburg, Sweden, in 2013 were retrospectively reviewed and evaluated for the type of missions and the need of a physician. Results: Out of 1381 physician-staffed missions, 511 were cancelled or managed by telephone. Around 239 (17%) missions required active intervention, of which only one was considered directly life-saving. Conclusions: Most of the missions neither required the interventional skills of a physician, nor could they be performed at distance. However, the added medical value of physicians was fo und to be in other prehospital situations, such as critical decision-making, staff education and research.

73-77

Authors: Mircea Beuran, Ionut Negoi, Sorin Paun, Valentina Negoita1, Bogdan Stoica, Ioan Tanase, Mihaela Vartic, Ruxandra Irina Negoi, Sorin Hostiuc

Objective: To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods: A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results: A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding fr om an internal iliac branch that was successfully angioembolized. Conclusions: Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.

83-84

Authors: Somsri Wiwanitkit, Viroj Wiwanitkit

The craniectomy is an important surgical management for the problem of acute neurological disorder. It is widely practiced by neurosurgeons around the world. The technique for craniectomy is various and there are many new reports concerning on the size of craniectomy. In this short article, the authors discuss on the important topics about neurosurgery “craniectomy size, mortality, outcome and complications.”