Journal of Acute Disease

53-59

Authors: Jakub Mizera, Adrian Bystron, Karolina Matuszewska, Justyna Pilch, Ugo Giordano

Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20% of mortality, especially in low and middle-income countries. This review was conducted on PubMed and Google Scholar databases with keywords sepsis, septic shock, sepsis management, and sepsis complications. Articles published up to July 2023 in English were included. Diagnosis and management should be carried out without unnecessary delay. Cooperation between various medical specialties including intensive care doctors, neurologists, hepatologists, cardiologists, and pediatric doctors is needed if a child is affected. New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.

67-73

Authors: Hoda Amiri, Khadijeh Yazdanparast, Mohsen Pourkhosravani, Maryam Rastegar

Objective: To investigate the distribution pattern of animal bites in Mirjaveh, Iran from 2015 to 2020. Methods: The data on animal bites were collected from the Department of Infectious Diseases, the provincial health center. Monthly climatic data on precipitation and temperature during the study period were also collected. The correlation between incidence and temperature, precipitation rate, land type, and altitude was also analyzed. Results: The results showed that men were more affected by animal bites than women (76.4%, P<0.001), and the highest incidence rate occurred in the age group of 5-19 years. The incidence rate of animal bites was found to be correlated with temperature and altitude. An increase in temperature was associated with a rise in the incidence rate of animal bites. The number of animal bites increased until 2019, possibly due to an increase in the number of dogs in the area. Conclusions: Targeted interventions should be implemented to reduce the incidence of animal bites, particularly among children, housewives, and students. Improving access to appropriate treatments, increasing public awareness of the hazards of animal bites, and increasing the number of vaccinated dogs in the area are essential strategies to be considered.

81-84

Authors: Shao Hui Koh, Jacqueline C. L. Tan

Rationale: Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries. One of the substances commonly ingested by suicidal patients, phosphoric acid, tends to cause multi-system derangements. Patient’s Concern: A 41-year-old male patient presented with complaints of throat discomfort, severe generalized abdominal pain, and multiple episodes of hematemesis after ingesting a restroom cleaning solution. Diagnosis: Poisoning by acute caustic ingestion (containing <30% phosphoric acid and <4% ethylene glycol). Interventions: The patient was administered 50 mL of 8.4% sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h, a hyperkalemia kit, ceftriaxone, metronidazole, omeprazole, and atropine. The patient then underwent urgent hemodialysis. Outcomes: The patient suffered gastrointestinal bleeding as a result of local caustic injury. In addition, his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes (hyperphosphatemia, hyperkalemia, and hypocalcemia). He developed multi-organ failure and eventually demised. Lessons: The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion. These patients need to be monitored closely for deterioration, and have prompt management of the various arising complications, to reduce the high morbidity and mortality associated with this condition.

3-7

Authors: Serdar Özdemir

Inflammation is a multifaceted cellular and molecular response triggered by injury, infection, or various pathological conditions. Serving as a protective defense mechanism, the inflammatory response involves clinical signs like redness, swelling, pain, and increased body temperature. Immune cells, notably neutrophils and macrophages, play key roles in orchestrating this response. The delicate balance between proinflammatory and anti-inflammatory mediators, including cytokines and chemokines, regulates the inflammatory cascade. While acute inflammation is crucial for tissue repair, chronic inflammation may indicate an imbalance, contributing to conditions like autoimmune diseases. Understanding these mechanisms is vital for developing therapeutic strategies and managing chronic diseases.

14-19

Authors: Vinodhkumar Kandibendla, G. Thiruvikrama Prakash, Subash Chandra Bose, Prafull Dhewle

Objective: To explore correlation of neutrophil-to-lymphocyte ratio (NLR) to severity of coronary artery disease (CAD) and in-hospital clinical outcomes in patients with acute coronary syndrome (ACS). Methods: In this prospective and observational study, we recruited 500 patients with ACS. For all the eligible patients, demographic details were collected, and laboratory parameters were evaluated. The CAD severity was evaluated in terms of the number of involved vessels. The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed. Results: 77.2% of Patients was male, and 52% of the patients aged between 55-70 years. Based on the type of ACS, 396 out of 500 patients had ST-elevation myocardial infarction. An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among class Ⅳ patients. The mean NLR value among the non-survivors were higher compared to the survivors (9.52±5.72 vs. 4.76±2.36; P<0.01). Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0% and a specificity of 77.3%. Conclusions: The NLR can be used as an independent prognostic marker in ACS. An elevated NLR value serves as a reliable predictor for short-term complications, notably in-hospital mortality.

26-30

Authors: Kento Nakayama, Hiroyuki Koami, Yuichiro Sakamoto

Objective: To evaluate relationship between changes in the beneficial bacteria in intensive care unit (ICU) patients and nutritional therapy type. Methods: Ten patients aged ≥18 years admitted to the ICU between January and December 2020, were included. Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding. The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group. Among all patients, five each were in the increase and decrease groups. We investigated patient background, changes in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) 栻scores, nutritional doses or methods, and clinical outcomes. Results: No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHE栻scores at the time of admission. The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group (4/5 vs. 0/5, P=0.01). Conclusions: An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition. In the future, accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.

36-39

Authors: Magdalena Pszczołowska, Monika Morawska-Kochman, Katarzyna Resler, Katarzyna Pękalska, Tomasz Zatoński

Rationale: Acute otitis media is a common disease in early childhood, and is usually caused by Streptococcus pneumoniae (S. pneumoniae). Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone (acute coalescent mastoiditis). In addition, the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells, leading to subperiosteal abscesses. Patient’s Concern: A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis (swelling and redness of the skin). Diagnosis: Bilateral acute coalescent mastoiditis caused by S. pneumoniae infection. The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides. Interventions: The patient underwent intravenous antibiotic therapy and surgical treatment. Outcomes: The patient was discharged 14 days after hospitalization with an improved condition. Lessons: Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications, sometimes serious and even life-threatening. Complications are prevalent in children under 2 years, in whom the disease progresses more rapidly and severely. The vaccination with a 13-valent vaccine may not result in sufficient immunity against S. pneumoniae, a predominant pathogen in children affected by acute coalescent mastoiditis.

43-44

Authors: Shalendra Singh, Deepak Mishra, Deepu K Peter, Munish Sood

NA

219-225

Authors: Mansoore Shariat Sarcheshme, Nayereh Esmaeilzadeh, Nasibeh Zerangian, Nooshin Peyman

Objective: To investigate the trend of animal bites between 2015-2021 in Neyshabur, Iran. Methods: In this cross-sectional descriptive study, data were retrieved from the vice-chancellery of the Neyshabur University of Medical Sciences. The data included person variables, place and time variables, and animal variables. Results: There were 13 190 cases of animal bites and the trend was increasing during 2015-2020. Most injuries were caused by dogs (86%), most animal bites (76.6%) occurred in males, and 28.1% of all cases were farmers. The most common bitten parts were the lower limbs (64.8%), often reported as a scratch (83.4%). Most of the biting animals (67.9%) were not strays, and 83.3% of them had bitten their owners. No rabies death was reported during the study period. Conclusions: The incidence of animal bites increases and is higher than the national statistics in Neyshabur, Iran. Serious attention and intervention should be given to control and prevent this health threat.

233-237

Authors: Srilatha Yagadi, Ramesh Babu Guguloth, Mathews Jacob

Objective: To determine the clinical profile of patients presenting with medication-related emergencies to the Emergency Department of our institute. Methods: This was an observational study conducted between November 2018 and September 2020 at Bangalore Baptist Hospital, Karnataka. A total of 138 subjects who satisfied the inclusion criteria were included in the study. The severity of adverse drug reactions (ADR) is assessed based on the Hurwitz severity assessment scale of ADR. Glasgow coma scale at the time of presentation and source of medication were noted. The type of drug overdose, requirement of advanced airway and vasopressors, and the outcome were also assessed. Results: Among medication-related emergencies (n=138) in our study, ADR contributed to 70.3% (n=97) of the study population, and drug overdose accounted for 29.7% (n=41). One-third of the ADR occurred in patients aged above 60 years. Most patients were hemodynamically stable and did not require vasopressors, or advanced airway in both groups. Most patients had Glasgow coma scale ranging from 13-15 in both groups. Nonsteroidal anti-inflammatory drugs were the most used medicine (17/41, 41.5%) and most medications were over the counter drugs (25/41, 61.0%) in the drug overdose group; meanwhile in the ADR group, anti-diabetic medication was the most used medicine (34/97, 35.1%) and most medications were prescribed in the ADR group (93/97, 95.9%). Conclusions: Our study shows that ADR is the most common type of medication-related emergency.

244-249

Authors: Ayimen Khalid Khan, Anam Khan, Ammar Khalid Khan, Shayan Sirat Maheen Anwar

Neurological symptoms of COVID-19 infection can be lethal if optimum intervention is not provided at the right time. However, it is extremely important to distinguish the non-specific symptoms of COVID-19 according to its severity directly or indirectly caused by the coronavirus. Here, we present five radiological case studies of COVID-19 to highlight the wide array of neurological manifestations associated with COVID-19.

254

Authors: Wai Yan Lam, Sunny Chi Lik Au

NA

179-185

Authors: Anmar Al-Taie, Zekiye Yilmaz, Ahmet Yiğit Çakiroğlu, Gülnihal Candan, Selin Bildirici

Objective: To examine the pattern of COVID-19 infection and vaccination, and to explore pregnant women's willingness and reluctance to accept a booster dose of the COVID-19 vaccine. Methods: This was a cross-sectional, descriptive study with a convenient sample size using a structured questionnaire among pregnant women attending the gynecology and obstetrics department at Acıbadem Mehmet Ali Aydinlar Hospital, Istanbul, Türkiye. The Health Belief Model scale was used to assess the intention and reluctance to accept a booster dose of the COVID-19 vaccine. Results: A total of 145 participants, with a mean age of (33.5±4.8) years, and a gestational age of (30.9±7.3) weeks, were enrolled in this study. 88.8% Received full doses of the Pfizer-BioNTech vaccination. 47.8% Participants suffered from vaccine adverse effects. Health Belief Model demonstrated a significant finding of perceived susceptibility (P<0.001), perceived severity of COVID-19 complications (P<0.001), and perceived benefits regarding a booster COVID-19 vaccination (P<0.001). Conclusions: Most pregnant women who received the COVID-19 immunization express a significant intention to receive a booster dose, regardless of the adverse effects experienced from the previous doses. However, a small percentage of the study sample express hesitancy about receiving the booster dose.

192-197

Authors: Tuncay Aslan, Serkan Emre Eroğlu, Mehmet Muzaffer İslam, Serdar Özdemir, Gökhan Aksel, Abdullah Algın

Objective: To compare the diagnostic value of the ABCD2 and ABCD3-I scoring systems in predicting the development of a 30-day neurological event in adult patients with transient ischemic attack (TIA) presenting to the emergency department. Methods: The study was observational and prospective and was conducted in a single center. The diagnostic values of the ABCD2 and ABCD3-I scores in predicting a neurological event within one month were compared in patients diagnosed with TIA in the emergency department. Results: A statistically significant difference was observed between groups with or without stroke within one month in terms of both the ABCD2 and ABCD3-I scores (P=0.044 and P=0.029, respectively). There was no statistically significant difference between the patients with and without a recurrent TIA within one month in relation to the ABCD2 score (P=0.934), but a statistically significant difference was found in the ABCD3-I scores of these groups (P<0.001). Conclusions: Both the ABCD2 and ABCD3-I scoring systems could predict ischemic stroke within 30 days of TIA, the ABCD3-I score is more effective than the ABCD2 score in the prediction of TIA recurrence.

204-212

Authors: Mehmet N. Yakar, Bişar Ergün, Aylin Erol, Özde Gökbayrak, Tekincan Ç. Aktaş, Özlem Ulusan Bağcı, Fırat Bayraktar, Eyüp S. Uçan, Begüm Ergan, Bilgin Cömert, Ayşe Caner, Safiye Aktaş, Ali N. Gökmen

Objective: To define histopathologic and immunohistochemical features of the lungs, heart, liver, and kidneys in patients who died from coronavirus disease 2019 (COVID-19), and to determine the presence of SARS-CoV-2 in all tissues, as well as the presence of fungi and parasites in lung tissues. Methods: This retrospective case study was conducted in the intensive care units of Dokuz Eylül University Hospital, and patients (≥18 years) who died due to COVID-19 between October 2020 and April 2021 were included. The biopsy samples of the patient's lung, heart, liver, and kidney tissues were studied. Results: In the study, we enrolled 12 patients (mean age: 70 years; 50% male). Alveolar epithelial cell damage and diffuse alveolar damage were predominant in lung tissues. Lobular lymphocyte infiltration, centrilobular sinusoidal dilatation, and microvesicular steatosis in the liver, together with pigmented cast, non-isometric vacuolar degeneration, and capillary plugging in the kidneys, were commonly found among the patients. SARS-CoV-2 nucleocapsid protein antibodies were detected in three lung and two kidney tissues, and so did angiotensin-converting enzyme 2 receptor positivity in one lung and more than half of the kidney tissues. The RT-PCR tests were positive in three lungs and one kidney tissue. After DNA isolation from lung tissues, Pneumocystis jirovecii was detected in nine patients, Aspergillus fumigatus in two, Microsporidia in three, and Cryptosporidium in two. Conclusions: SARS-CoV-2 is a multisystemic disease. Fungi and parasites should be investigated in critically ill COVID-19 patients prescribed corticosteroids.

133-139

Authors: Shivcharan Jelia, Banwari Lal, Divya Airan

Objective: To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning. Methods: This was a hospital-based prospective, observational study. Various biochemical tests viz. complete blood count, random blood sugar, liver and renal function tests, creatine phosphokinase, and electrolytes were performed. Patients were assessed based on the Peradeniya Organophosphate Poisoning scale. All the patients were followed till the end point like recovery/death. Results: Out of the 100 patients, 72% were males and 28% were females. The majority of the patients were farmers and 21 to 30 years of age. Suicidal was the most common manner (92, 92%). Based on the Peradeniya Organophosphate Poisoning scale, 47% were mild, 34% moderate, and 19% severe. Serum creatinine, creatine phosphokinase, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, and alkaline phosphatase levels showed a significant correlation with severity. Conclusions: Some biochemical indicators such as creatine phosphokinase, alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning. The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning.

145-150

Authors: Sanjeev Sengupta, Ashish Kumar Shukla, Kunal Kishore, Jitesh Goel, Amlan Ghosh

Objective: To investigate demography, etiology, and clinical profile and to analyze the outcomes of patients presenting with febrile encephalopathy at a tertiary care center in Eastern India. Methods: This retrospective, observational study included a total of 50 patients (>18 years) who presented with fever and encephalopathy. All patients underwent blood analysis; culture test for blood, urine, sputum, cerebrospinal fluid, and other body fluids; chest and abdominal ultrasonography; neuroimaging; polymerase chain reaction test, and other relevant tests as and when applicable. Results: The mean age of all enrolled patients was (58.0±16.0) years with male to female ratio of 1.27:1. Viral encephalitis was diagnosed in 16 (32%) patients, sepsis-associated encephalitis in 14 (28%), bacterial meningoencephalitis in 8 (16%) and tuberculosis meningoencephalitis in 5 (10%). The mean hospital stay was 10 (4, 17) days. At 6-month follow-up, 10 (20%) patients died, 10 (20%)patients recovered with sequelae (cognitive impairment, critical careneuropathy, etc.), and 30 (60%) patients recovered without sequelae. A statistically significant association was noted between GlasgowComa Scale (<8) and mortality rate (P=0.02). Conclusions: Primary central nervous system infection is the mostfrequent etiology of febrile encephalopathy and viral encephalitisis the most common etiological cause. Accurate, systematic, timelydiagnosis and management are prime factors to reduce mortality andmorbidity.

157-162

Authors: Hamed Karami, Fatemeh Jafari, Ali Khani Jeihooni, Sanaz Amiri, Tahereh Hashemifard, Asadollah Niknam

Objective: To investigate the epidemiological situation of animal bites in Rostam city of Fars province. Methods: This is a cross-sectional study. Cases of animal bites registered in health centers of Rostam city of Fars province from the beginning of 2014 to 2020 were analyzed using the census method. The tool for collecting information was the portal of the Ministry of Health and the registration offices of people who were referred to the rabies center. Results: A total of 628 cases of animal bites registered in health centers of Rostam city of Fars province from the beginning of 2014 to 2020. The mean age of the injured was (31.3 ± 20.2) years. Of the total injured cases, 414 (65.9%) were male, and 491 (78.2%) lived in villages. Most of the cases were bitten by dogs (n=420, 66.8%) and the upper limb was involved in 280 (55.2%) cases. In addition, an increasing trend was observed in the incidence of animal bites from 2015 to 2020. Conclusions: The incidence of animal bites in Rostam City is high, and most of the cases occur in rural areas. Considering the injuries caused by animal bites, the risk of rabies transmission, and the high costs of vaccination and serum therapy, it is necessary to hold control, educational, and vaccination programs.

169-172

Authors: Reena Singh, Naimish Patel, Nidhi Mehta, Gaurav Singh, Nirav Patel

Objective: To evaluate the complications of central venous catheterization (CVC). Methods: A prospective, observational study was conducted at a tertiary care center in India from December 2018 to September 2020. Critically ill patients (aged ≥18 years) in the intensive care unit undergoing CVC procedures were included in the study. Baseline demographics and detailed medical history were recorded. Chest X-rays and electrocardiography were performed on all the patients. Complications associated with CVC were recorded. Results: A total of 100 patients with the indication for centralvenous catheter insertion were included. The majority (81%) of the patients were inserted with CVC at the right internal jugular vein. Complications such as arterial puncture (2%), hematoma (4%), blood clot formation (4%), catheter kinking (3%), thoracic injury(1%), thrombophlebitis (6%), sepsis (9%) and nerve injury (1%)were reported. Conclusions: Though central venous access is preferred in management of critically ill patients, it has its risks. However, early recognition and prompt management of complications may reduce mortality and morbidity. Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications. Suitable site selection, operator experience, and proper catheter maintenance are associated with optimal outcomes.