Journal of Acute Disease

186-190

Authors: Mohammed Maan AbdulAzeez1 , Ali Adnan Dolachee2 , Padilla-Zambrano Huber4 , MendozaFlorez Romario4 , Haitham Ahmed Obaid3 , Alaa H. Arakwazi3 , Mustafa M. Altaweel3 , Samer S. Hoz3

The impact of a bullet by firearm is a mortal entity that in recent years has been on the rise due to the increase in crime, confrontations, among other acts of violence. Brain injuries by firearm account for 33.3% of all fatal injuries from this type of weapon. This resulted in a significant number of disabilities with its burden cost at a global level. The types of bullet injuries to the head include: penetrating (inlet without outlet), perforating (through and through), tangential (not enter the skull, causing coupe injury), ricochet (intracranial bouncing of bullet) and careening (rare, enter skull but not brain, runs in the subdural space). There are several situations that can occur once the bullet enters the body or into the intracranial cavity. Unmatched association of the bullet trajectory with the final position of the bullet within the body raise the suspicion for additional phenomena involvement, this can be explained by either internal bullet ricochet or internal bullet migration. The former usually represents an active movement and the latter is a passive movement. Intracranial ricocheting of bullets forms up to 25% of all penetrating bullet injuries to the skull. Such bullets types are commonly tumbling and have an unpredictable trajectory. The surgical management for intracranial bullet injury developed over decades from the time of Harvey Cushing and the World War I till the present. Now, the accepted intervention ranges from simple wound care to a proper surgery that includes hematoma evacuation, removal of only accessible bone fragments and foreign bodies, dural repair and wound debridement with or without decompressive craniectomy. Also, intracranial pressure monitoring is generally indicated. We reported a thirty-three years old male, victim of homicidal bullet injury to the head, presented with Glasgow Coma Scale score of 8 (best eye response: 2, best motor response: 4, best verbal response: 2), upon examination a right parietal (near vertex) inlet without outlet was found. The poor prognostic factors in this patient included bi-hemispheric involvement, associated acute subdural hematoma with interhemispheric extension, ricochet type of injury and effacement of sulci. Intracranial ricocheted-bullet injury is a special entity of bullet injury to the head with its particular ballistics and management that deserve highlighting by the trauma team to gain fluent treatment and better outcome.

197-201

Authors: Yang-Li Liu1, Xiao-Ran Liu2, Hui Li3, Feng-Jia Chen1, Huai Liao1, Can-Mao Xie1

Objective: To determine whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can rapidly distinguish among lung cancer, tuberculosis and sarcodosis, and to explore its sensitivity and specificity. Methods: Clinical data of patients with enlarged mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA at our hospital between September 1, 2012 and June 30, 2015 for were retrospectively analyzed. The sensitivity, specificity, positive predictive value, and negative predicted value [including 95% confidence interval (CI)] were calculated.. Results: A total of 299 lymph nodes from 201 patients underwent EBUS-TBNA were selected and no serious complications occurred. EBUS-TBNA showed a sensitivity of 87.9% (124/141) (95% CI: 81%–92%), a specificity of 100.0% (124/124) (95% CI: 97%–100%), and a negative predicted value of 41.3% (95% CI: 23%–61%) in the detection of lung cancer. The sensitivity and specificity of diagnosis of mediastinal tuberculosis lymphadenitis were 72.4% (21/29) (95% CI: 53%–87%) and 100.0% (95% CI: 82%–100%); while sensitivity and specificity of diagnosis of sarcoidosis were 71.4% (5/7) (95% CI: 29%–96%) and 100.0% (95% CI: 91%–100%). Conclusions: The sensitivity and specificity of EBUS-TBNA do not significantly differ for a diagnosis of lung cancer versus tuberculosis or sarcodosis.

207-212

Authors: Vahid Rahmanian, Karamatollah Rahmanian, Narges Rahmanian, Mohammad Ali Rastgoofard, Elham Mansoorian

Objective: To determine the survival rate of tuberculosis (TB) patients and to identify the important factors associated with the survival of these patients in southern Iran. Methods: The present retrospective cohort study extracted and reviewed available medical records of 134 TB patients undergoing TB treatment centre, during 2005 to 2016. The Survival rate of patients for the outcome of the interval from diagnosis until death was plotted using life table and Kaplan-Meier survival curve. Cox proportional hazard regression model was used to examine the simultaneous effect of variables on survival rate. The significance level was considered to be 0.05. Results: In this study, 64.2% of the participants were male, 73.1% had pulmonary TB and 5.22% had HIV. The survival rate of one, five and thirteen years after diagnosis were 93%, 78% and 69%, respectively. The risk of death in patients with extrapulmonary TB (95% CI=1.96-15.83, P=0.001) was 5.58 times higher than in patients with pulmonary TB. The risk of death in smokers with TB (95% CI=1.74-2.46, P<0.001) was 2.07 times higher than in non-smoker patients, and also the risk of death increased to 1.10 times more for a one-year increase in patient age (95% CI=1.06-1.14, P<0.001). Conclusions: The risk of death in patients with extrapulmonary TB and TB smokers was higher than other patients. Therefore, timely diagnosis and proper treatment of patients with extrapulmonary TB as well as the development and integration of smoking cessation programs are underlined and emphasized in the formulation and implementation of the National Tuberculosis Control Program.

217-219

Authors: Luis Rafael Moscote Salazar1, Amit Agrawal2, Guru Dutta Satyarthee3, George Chater Cure4, Alfonso Pacheco-Hernandez1

Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition. Several factors predispose to intracranial bleeding including low body weight, female sex, advanced age, use of oral anticoagulants prior to the administration of fibrinolytic therapy, diastolic blood pressure (greater than 110 mm Hg), among others. Optimal medical management involves multidisciplinary roles of hematology, neurosurgery and critical medicine. In this illustrative case, a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial infarction.

223-224

Authors: Halil Onder