Journal of Acute Disease

185-190

Authors: Surendar Ravipragasam, Deepika Chandar, Vinay R Pandit, Anusha Cheriyan

Objectives: To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital, South India. Methods: This prospective observational study was conducted between December 2016 and May 2017 among all patients above 12 years old, who suffered witnessed cardiac arrest, after arrival in the emergency department. A semi-structured questionnaire was used to collect data (socio demographic details, chief complaints, comorbidities). Initial documented rhythm, duration of CPR, use of defibrillator, and presumed cause of cardiac arrest and others were collected from the case records. Results: The study cohort contained 252 participants. The age was (50.0+17.2) years and male patients accounted for 54.4%. The most common complaint was breathlessness (29%), followed by chest pain (20.2%) and trauma (17.5%). The proportion of non-shockable rhythm (77.4 %) was higher than shockable rhythm (22.6%). Pulseless electrical activity (53.9%) was the most common initially documented rhythm. The predominant presumed cause of arrest was cardiac origin (29.7%). The overall rate of survival to discharge was 17.5%. Logistic regression analysis showed age >60 years [odds ratio (OR): 3.4, 95% confidence interval (CI): 1.03-11.22, P=0.04], males (OR: 3.45, 95% CI: 1.00-11.44; P=0.04), presumed respiratory cause (OR: 11.8, 95% CI: 1.0-160.0, P=0.05), initial rhythm ventricular fibrillation (OR: 9.1, 95% CI: 1.0-92.0, P=0.05) as individual predictors of survival rate to discharge after in-hospital cardiac arrest. Conclusions: Our study shows that less than one-fifth of patients survive to discharge after inhospital cardiac arrest. This signifies the need to identify and to make the necessary changes at all levels of organization, service delivery and patient care, so as to improve the overall survival rate following cardiac arrest.

195-199

Authors: Ali Dehghani1, Seyed Ali Pourmostafavi Ardakani2, Sara Jambarsang2, Fatemeh Majidpour2, Ahmad Karimi3, Ali Akbar Tajfirouzeh4, Seyed Mohammad Hoseini4

Objective: To investigate the epidemiological pattern of animal bites in Yazd Province, central Iran. Methods: In this cross-sectional study, 8 545 individuals with animal bites who were referred to the Yazd Province Rabies Treatment Center were investigated using the census method from April 2013 to March 2017. The variables included: demographic information, household living condition, the type of biting animals, the domesticated and wild animals, the time of biting based on year, the residence location (urban or rural), and the treatment status. Data were analyzed by descriptive statistics using Excel 2013, SPSS version 25 and Arc GIS 14.1 Software. Results: A total of 8 545 cases of animal bites were reported in Yazd province from 2013 to 2017. The most animal bites (with 4 253 case of bites) and the lowest animal bites (with 121 case of bites) occurred in Yazd and Bahabad district, respectively. The incidence of animal bites was 168.4 per 100 000 people during the five-year period. Most of cases (73.9%) occurred in urban areas. Dog and cat bites accounted for 47.6% and 47.4% of all cases, respectively. Most of animal bites were reported in the summer (29.4%). Sixty percent of the cases received incomplete treatments, while 40% of them received complete treatments. During this study, three positive cases of fatal rabies from dog bites were reported. Conclusions: The incidence of animal bites is high in Yazd province, and more patients are bitten by dog and cat. Hence, educational, preventive, and informative programs are required to reduce the incidence of animal bites.

204-207

Authors: Santosh Kumar Swain1, Alok Das1, Jatindra Nath Mohanty2

Objective: To assess acute otitis media with facial nerve paralysis, its prognosis, and treatment. Methods: It is a retrospective study. Thriteen patients of acute otitis media associated with facial nerve paralysis attended the outpatient department of otorhinolaryngology between May 2017 and April 2019. All patients were clinically assessed with appropriate investigations, prognosis, and treatment. Results: Out of 13 patients, 2 were identified with complete facial paralysis and the remaining 11 patients presented with incomplete paralysis. Medical treatment including antibiotics and corticosteroids failed, while myringotomy and facial nerve decompression were done with a favorable outcome. Eleven patients recovered to grade-I (House-Brackmann) and 2 cases to grade-II (House-Brackmann). Conclusion: Peripheral facial nerve paralysis in acute otitis media is rare. Antibiotics and steroids yield good outcome as conservative

215-220

Authors: Yasser Mohammed Hassanain Elsayed

Rationale: Acute myocardial infarction in the presence of right bundle branch block. Patient concerns: A 70-year-old, male heavy smoker presented with angina and hypertension. Interventions: Electrocardiography, intravenous nitroglycerin infusion, intravenous streptokinase infusion. Diagnosis: Acute myocardial infarction in the presence of with changeable trifascicular heart block. Outcomes: Dramatic clinical improvement with electrocardiographic ST-segment (whether elevation or reciprocal ST-depression) resolution. Lessons: Acute myocardial infarction may be associated right bundle branch block. Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block with left axis deviation and post-streptokinase left posterior fascicular block with right axis deviation.