Journal of Acute Disease

93-97

Authors: Christine, Pui Sum Ho1, Sunny, Chi Lik Au2

Heart diseases are common life-threatening acute diseases. They are leading causes of mortality worldwide, especially significant in developed countries. Other than medications for therapies and prophylaxis, special treatment considerations with implantable cardiac devices are important to reduce mortality and medical disability. This paper aims to review indications, contraindications, efficacy, complications, and generic considerations of several commonly implanted cardiac devices including pacemakers, cardiac resynchronization devices, implantable cardiac defibrillators, left atrial appendage occlusion watchman devices, and ventricular assist devices. As various implantable therapeutic cardiac devices are sometimes carried in the bodies of patients with cardiac disease, practitioners of various specialties should be familiar with different cardiac devices on the management of different cardiac conditions while providing holistic care.

107-111

Authors: HebatAllah Fadel Algebaly1, Ahmed Abd-Elal1, Rasha El Kaffas2, Elshymaa Salah Ahmed1

Objectives: To determine the predictive value of lactate dehydrogenase (LDH) in the diagnosis of septic shock and its association with other prognostic scores in critical pediatric patients. Methods: A cross-sectional study was performed at Children’s Hospital of Cairo University between June 2019 and December 2019. A total of 200 pediatric patients were divided into the septic shock group [100 critically ill patients with septic shock from the pediatric intensive care unit (PICU)] and the control group (100 patients with only sepsis). LDH was determined in the first 24 hours of admission. The sensitivity and specificity of LDH in diagnosis of septic shock were assessed; the levels of related indicators of patients with different etiologies were compared; correlations between LDH, Paediatric Index of Mortality Ⅱ, and Pediatric Sequential Organ Failure Assessment (pSOFA) were analyzed. Results: Median LDH was 512 μL (406.50-663.00) in the septic shock group and was significantly higher than that [190 μL (160.00- 264.50)] in the control group (P<0.001). Besides, median LDH in children with chest infecion was higher than that in children with other diagnoses (P=0.047). A good positive correlation was found between pSOFA and LDH (r=0.503, P<0.001). Conclusions: LDH could be a potential inflammatory marker in the diagnosis of septic shock and is valuable for PICU admission decisions.

117-121

Authors: Basant Mostafa Gabr1, Afaf Sayed Ahmed Zamzam1, Eman Ahmed Eisa1, Ghada Foad ElBaradey2, Maii Atef Shams Eldeen1

Objectives: To identify and test the antibiotic susceptibility of nosocomial coliform bacilli and investigate the presence of oqxA and oqxB genes among the multidrug-resistant (MDR) phenotypes. Methods: One hundred and twenty different healthcare-associated infection samples were collected. Coliform bacilli were isolated, identified by conventional methods, and then antibiotic susceptibility tests were done using the VITEK2 system and disk diffusion methods. OqxAB operon was identified using a conventional PCRbased technique. oqxA and oqxB genes were compared between MDR Klebsiella pneumonia (K. pneumonia) phenotypes and MDR Escherichia coli (E. coli) phenotypes. Besides, oqxAB operons were compared between phenotypes of K. pneumonia and E. coli isolates. Results: Seventy coliform bacilli were isolated with the predominance of K. pneumonia and E. coli. Besides, 82.1% of K. pneumonia strains and 53.3% of E. coli isolates were MDR phenotypes. Significant more oqxB genes alone were found in MDR E. coli than that in MDR K. pneumoniae phenotypes (χ2=10.160, P=0.003). OqxAB operon was significantly more in MDR phenotypes of E. coli than that in the susceptible phenotypes (P<0.001). There was significantly less of this operon in susceptible E. coli isolates than that in susceptible K. pneumoniae isolates (P<0.001). OqxAB positive isolates that were also resistant to fluoroquinolones, tetracycline, trimethoprim, and chloramphenicol, most probably suggested functional pumps. Conclusions: MDR coliform bacilli are strongly implicated in healthcare-associated infection. Attention should be paid to the presence of oqxAB pump, as an important mechanism in the development of resistance against many antimicrobials because it contributes to co-resistance with other categories; therefore, this pump could be a good target for efflux pump inhibitors.

126-129

Authors: Monica Gupta1, Swati Garg1, Saurabh Gaba1, Rekha Gupta2

Rationale: Clinicians encounter multiple alcohol-related illnesses in practice, and Marchiafava-Bignami disease is a rare and devastating entity among them. It is a toxic-demyelinating disease and seen in chronic alcoholics, although it may be occasionally observed in chronically malnourished teetotalers. The clinical presentations are diverse. The symptoms and signs are non-specific, and the onset can be acute or chronic. Patient’s concerns: A 45-year-old right-handed patient suffered from alcohol use disorder with multiple non-specific neuropsychiatric manifestations. Diagnosis: Marchiafava-Bignami disease. Interventions: Thiamine, folate, vitamin B12, and steroid therapy. Outcome: The patient’s behaviour was significantly improved but dysarthria and pyramidal signs persisted. He was left with permanent cognitive impairment. Lessons: Though prompt therapy may halt the demyelinating process in this disease, the treatment remains a challenge in clinical practice. The recognition of the neuro-radiologic features is crucial to establish an early diagnosis.

133-134

Authors: Halil Onder1, Erol Erkan2

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