Journal of Acute Disease

8-11

Authors: Farhan Haroon, Sajid Younus, Asif Peracha, Nouman Memon, Naveed Memon

Objective: To assess the utility and validation of the Surgical Apgar Score (SAS) in predicting postoperative complications of hip fractures. Methods: This prospective observational study included patients who received operations for hip fractures from 1st March 2017 to 30th June 2018 at the Department of Orthopedic Surgery, Liaquat National Hospital and Medical College. Patients were followed at the outpatient department, and complications and mortality were recorded through phone calls. The predictability of SAS for postoperative complications was assessed. Results: SAS≤4 was found as a significant predictor for postoperative pulmonary (P=0.008) and cardiac complications (P=0.042) as well as blood transfusion required to optimize postoperative hemoglobin (P=0.03) in the patients with hip fractures. Conclusions: SAS provides reliable feedback information about patients’ postoperative risk during the surgery. Hip fracture patients with scores≤4 should be monitored for major complications both during the hospital admission and after the discharge. KEYWORDS: Hip fractures; Surgical Apgar Score; Postoperative outcomes 1. Introduction The term “hip fracture” most commonly refers to the femoral neck and trochanteric fractures including intertrochanteric and subtrochanteric fractures or a combination of both. In the geriatric population, hip fractures usually occur due to minor trauma because of osteoporotic bones. Hip fracture is a major public health problem in the Asian population, which is usually associated with significant postoperative systemic complications and high mortality due to the burden of major surgery in a morbid patient[1]. For these postoperative complications, physicians need predictive tools to analyze the perioperative risk. Several algorithms have been employed for perioperative risk assessment, for example, the American Society of Anesthesiologists Physical Status Classification System (ASA classification)[2,3], the Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity[4] and Surgical Outcome Risk Tool[5]. According to Sakan et al., Surgical Apgar Score (SAS) has been shown as a proven independent predictor of major postoperative complications and mortality within 30 d after different types of surgery[6]. SAS is a simple and objective predictive tool, with three easily calculated variables, namely estimated blood loss, lowest heart rate, and lowest mean arterial pressure. These variables are derived after surgery from intraoperative anesthesia records[7]. Sakan et al. performed a retrospective study on the implementation of SAS on 43 hip fracture patients and concluded that the score≤4 was a significant predictor for the major postoperative complications within 30 d of surgery[6]. Gawande et al. performed a retrospective study on Apgar Scores for surgery on 303 patients and concluded that a 10-point score was significantly associated with major complications or death within 30 d after surgery[8]

17-22

Authors: Fatih Uzer1, Begum Uzer2, Fatma Mutlu Kukul Guven2, Idris Kirhan3, Nilay Coplu4

Objective: To investigate the chest radiography findings, hematological values and the risk factors of the mortality of coronavirus disease 2019 (COVID-19). Methods: Patients who were diagnosed with COVID-19 in a secondary-level state hospital in Turkey from March to April 2020 were included in the study. COVID-19 diagnosis was confirmed by reverse transcriptase-polymerase chain reaction. Initial routine blood tests and chest radiography findings were examined. The relationship between chest radiography findings and hematological values and risk factors of the mortality of COVID-19 were assessed. Results: In total, 94 patients with confirmed COVID-19 diagnosis were included in the study. Among them, 33 patients did not have lung involvement (RALE score of 0), and 42 had moderate lung involvement (RALE score of 1 to 4), and 19 had severe lung involvement (RALE score of 5 to 8). Patients with higher RALE scores were significantly elder (P=0.000) and had significantly lower lymphocyte count (P=0.032). Patients in need of intensive care had a lower mean number of platelets compared to patients who did not require intensive care (P=0.007). The receiver operating characteristic analysis revealed that RALE score (P=0.005), age (P=0.002), duration of symptoms (P=0.006), neutrophil-lymphocyte ratio (P=0.007), and lymphocyte percentage (P=0.012) were significantly associated with the risk of mortality. Conclusions: Patients with severe lung involvement have lower lymphocyte values and ratios. Age, RALE score, duration of symptoms, neutrophils/lymphocytes ratio, lymphocytes percentage are risk factors of mortality of COVID-19.

28-35

Authors: Johnson Oshiobugie Momoh1,2, Akinniyi Adediran Osuntoki2, Osaretin Albert Taiwo Ebuehi2, Olusola Ajibaye3

Objective: To evaluate the influence of –250G>A (rs2070895) polymorphism in hepatic lipase gene (LIPC) promoter on plasma lipid parameters of ischemic stroke patients. Methods: A total of 100 stroke patients and 100 control subjects matched for sex (59 men and 41 women) and age were selected. Hepatic lipase activity and lipid profiles were measured while lipoprotein ratios were calculated. Genotyping of the –250G>A promoter polymorphism of the LIPC was performed by the polymerase chain reaction and restriction fragment length polymorphism method combined with 2% gel electrophoresis and then confirmed by direct sequencing. The LIPC promoter gene sequencing data were compared with refseqNG011465.1 LIPC from GenBank. Results: The frequencies of GG, GA and AA genotypes of LIPC rs2070895 polymorphism were 39%, 45% and 16% for the control, 10%, 37% and 53% for the stroke subjects (P<0.0001), respectively. The frequencies of G and A alleles were 61.5% and 38.5% for the control, and 28.5% and 71.5% for the stroke subjects (P<0.0001). Our study shows that the mutant allele of the LIPC promoter was associated with dyslipidemia, lower hepatic lipase activity, and this variation contributed to the increased defective plasma highdensity lipoprotein-cholesterol (HDL-C), HDL2-C and HDL3-C concentration for both subjects. The control subjects had 6 single nucleotide polymorphism and 6 amino acid substitutions while the stroke subjects had 32 single nucleotide polymorphism and 20 amino acid substitutions. Conclusions: LIPC –250G>A polymorphism can influence plasma lipid profiles and lipoprotein ratios in patients with ischemic stroke.

39-41

Authors: Santosh Kumar Swain, Alok Das, Satyabrata Acharya, Nibi Shajahan, Rohit Agrawala

Rationale: Cavernous internal carotid artery (ICA) pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis. The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice. The management is often challenging because of anatomical inaccessibility of the bleeding point. Patient’s concern: A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis. Diagnosis: A computerized tomography (CT) scan showed a fracture in the sphenoid sinus. CT angiogram revealed cavernous ICA pseudoaneurysm. Interventions: Endovascular coil embolization. Outcomes: The patient recovered well and was discharged without any neurological deficits Lessons: Cavernous ICA pseudoaneurysm may lead to a lifethreatening situation. If a patient has a history of head trauma, posttraumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.

45-46

Authors: Vishal Mangal, Kaminder bir Kaur

none

244-247

Authors: Azadeh Haghi Navand1 , Saber Soltani2 , Mona Moghadami3 , Parastoo Hosseini2 , Sepideh Nasimzadeh1 , Milad Zandi

Diabetes, as the major cause of hyperglycemia, is a chronic metabolic disease. Immune system disorders caused by diabetes can increase the risk of respiratory diseases. Thus, diabetes is considered to be a major risk factor for viral respiratory infections such as coronavirus infections. Coronaviruses are members of the Coronaviridae, which has caused three outbreaks from 2003 to 2020. Patients with coronavirus infection in the lower and upper respiratory tract could show mild to severe symptoms. In this review, we focus on the relationship between diabetes and three coronaviruses: SARS-CoV, MERS-CoV, and SARS-CoV-2.

253-256

Authors: Shahnaz Armin1 , Abdollah Karimi1 , Fatemeh Fallah1 , Roxana Mansour Ghanaei1 , Sedighe Rafiei Tabatabaei1 , Seyed Alireza Fahimzad1 , Seyedeh Mahsan Hoseini-Alfatemi1 , Maryam Rajabnejad1 , Hamid Eshaghi2 , Gholamreza Soleimani3 , Hosein Heydari

Objectives: To evaluate clinical features, treatment strategies, and outcomes of pleural empyema for children who were treated at referral pediatric hospitals in 8 provinces of Iran. Methods: In this retrospective, multicenter cross sectional study, we retrospectively retrieved patients’ data from 8 teaching hospitals during 2010 and 2017. A questionnaire was applied and filled, and all data were statistically and descriptively analyzed. Results: In total, 191 children (109 males and 82 females) were included. Their mean age was 4.95 years and ranged from 11 months to 16 years. The majority of cases (45.1%) were 1-4 years old. Fever (70.3%), cough (65.6%), tachypnea (53.1%), chest pain (14.6%), and abdominal pain (12%) were the most common manifestations at admission. The mean length of admission in hospital was 16.4 d. Consequently, 27 patients (14.1%) were admitted into the pediatric intensive unit because of severe illness, and 15 patients (7.9%) died. Logistic regression analysis showed that younger age (less than 12 months) and presence of underlying diseases (such as cardiovascular disease, immune deficiencies, malignancies, and neuro-developmental delay) significantly increased the mortality rate of patients with pleural empyema (P=0.004 and P=0.001, respectively). Conclusions: Pleural empyema children of younger age and with underlying diseases are at higher risks of death. In addition, guidelines for treating pleural empyema should be developed.

263-269

Authors: Neeraj Agarwal, Bijit Biswas

Objective: To investigate the risk factors and protective measures of COVID-19 among policemen in an eastern state of India. Methods: This case-control study was conducted in Bihar, located in the eastern part of India. In total, 6 confirmed COVID-19 cases (the case group) and 11 negative contacts of these cases (the control group) of Bihar Military Police participated in the study. Results: All subjects were male with a median age of 51 (range: 23-60) years. Among these 6 confirmed cases, 5 cases were asymptomatic. One third (33.3%) of the case group and the majority (90.9%) of the control group reported maintenance of physical distance of at least 1 meter with others all the time, which was significantly different (P=0.028). There was no other statistically significant difference between the case group and the control group. Conclusions: Physical distancing is the most effective public health measure to control contagious diseases like COVID-19, especially in the absence of an effective vaccine in police settings.

272-274

Authors: Suman Rastogi1 , Anandhi Devendiran1 , Divankur Khanna1 , Nanda Kishore Maroju2 , KNJ Prakash Raju1

Rationale: Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries. Such enormous pressure into the rectum can lead to devastating injuries. Patient’s concern: A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus. There was diffuse subcutaneous emphysema over the neck, chest, abdomen, and extremities, and he presented with hemodynamic instability and respiratory failure. Diagnosis: Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum, pneumomediastinum, pneumothorax, and extensive subcutaneous emphysema. Intervention: In view of tension pneumoperitoneum, urgent percutaneous needle decompression was performed using 16 G needle, 5 cm superomedial to the anterior superior iliac spine. The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics. Outcome: The patient succumbed two days later due to septic shock. Lessons: This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India.

190-193

Authors: Santiago Vasquez Builes1 , Veronica Gonzalez Gonzalez2 , Alejandro Cardozo

As a diagnostic aid in emergency services, ultrasound has expanded considerably in recent years. Among its applications, ocular ultrasonography allows for a better evaluation of patients with ophthalmological emergencies. In addition, it provides a simple and easy technique to obtain clinical information that may not be easily accessible either through the clinical examination or by using the ophthalmoscope. Ocular ultrasonography can help to diagnose hemorrhage and retinal detachment and/or vitreous, eye infections, foreign bodies, retrobulbar hematomas, papilledema, and eye trauma. By measuring the diameter of the optic nerve sheath, intracranial hypertension could be screened. This article reviewed the approach to eye exam by ultrasound and common ophthalmic pathologies diagnosed with ultrasound in the emergency department.

200-205

Authors: Imee T. Macaranas1 , Kin Israel R. Notarte1 , Abbygail Therese M. Ver1 , Adriel M. Pastrana1 , Franchesca J. Chua1 , Derick Erl P. Sumalapao

Objective: To describe the epidemiological distribution of injury cases in the Philippines from 2011 to 2018. Methods: A retrospective review of records from the Online National Electronic Injury Surveillance System involving trauma cases was done, and data were collated, tabulated, and statistically analyzed. Results: A total of 668 179 injury cases were recorded, and 68.99% of these cases involved males. Vulnerable individuals belonged to the group aged 15-29 years (34.01%). The most populated regions in the country, the National Capital Region (14.90%) and Region 桇A (13.96%), incurred the highest number of recorded cases. Traffic crash (32.67%) was reported to be the major cause of injury; and open wounds (37.56%) and abrasion (26.23%) were found to be the most common types of injury. Conclusions: The burden of injury remains high in the Philippines due to the lack of resources and inadequate healthcare. The findings of the present study on the distribution of injury cases provide useful information for taking appropriate preventive measures, developing effective safety guidelines, allocating limited resources in an appropriate manner, and implementing necessary public health programs.

213-217

Authors: Cihan Bedel , Mustafa Korkut

Objective: To explore the value of complete blood count (CBC), including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte lymphocyte ratio (MLR) in diagnosis of testicular torsion (TT) and differential diagnosis from epididymo-orchitis. Methods: The study was conducted at the Antalya Training and Research Hospital Emergency Department in Turkey with acute scrotal pain patients from January 1st, 2016 to January 1st, 2018. The patients were categorized into 3 groups: the TT group who underwent an operation for TT (n=70), the epididymo-orchitis group who received epididymo-orchitis treatment (n=120), and the healthy control group (n=100). NLR, PLR, and MLR of the three groups were analysed and compared. The optimum cut-off values of NLR, MLR, and PLR were analyzed. Results: Mean NLR and MLR values were significantly higher in the epididymo-orchitis group and the TT group compared to the control group (P<0.001). Receiver operating characteristic analysis revealed a sensitivity of 77.1% and a specificity of 80% for NLR (77.1) and a sensitivity of 68.2% and a specificity of 78% for PLR (124.80). Moreover, when MLR was used to differentiate the two treatment groups, the optimal cut-off value had a sensitivity of 67.1% and a specificity of 75% (AUC: 0.677-0.826, P<0.001). Conclusions: NLR, PLR, and MLR might be associated with the diagnosis of TT. These parameters provide a useful and economical method to help diagnose TT in the emergency department.

223-226

Authors: Nikom Srikacha1 , Khakhanang Ratananikom

Objective: To assess the antibacterial activity of 5 selected plants against 4 pathogenic bacteria. Methods: Three solvents with different polarities were used to extract antimicrobial agents from the plants via maceration technique. The agar-disc diffusion technique was adopted to primarily screen antibacterial activities. Broth-dilution assay was employed to determine the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). Results: Among all extracts, the ethanol extract of Piper betle Linn showed the highest antibacterial activity against Gram-positive and the negative bacteria. MIC and MBC of the ethanol extract of Piper betle Linn against Salmonella typhimurium were the same (1 562.50 mg/L); while it showed the highest MIC and MBC against Pseudomonas aeruginosa of 6 250 mg/L and 12 500 mg/L, respectively. Conclusions: Salmonella typhimurium is the most susceptible bacteria while Pseudomonas aeruginosa is the most resistant bacteria towards the ethanol extract of Piper betle Linn. Piper betle possesses compounds with potential antibacterial activity and might be useful as an alternative to control infectious diseases.

263-269

Authors: Neeraj Agarwal, Bijit Biswas

Objective: To investigate the risk factors and protective measures of COVID-19 among policemen in an eastern state of India. Methods: This case-control study was conducted in Bihar, located in the eastern part of India. In total, 6 confirmed COVID-19 cases (the case group) and 11 negative contacts of these cases (the control group) of Bihar Military Police participated in the study. Results: All subjects were male with a median age of 51 (range: 23-60) years. Among these 6 confirmed cases, 5 cases were asymptomatic. One third (33.3%) of the case group and the majority (90.9%) of the control group reported maintenance of physical distance of at least 1 meter with others all the time, which was significantly different (P=0.028). There was no other statistically significant difference between the case group and the control group. Conclusions: Physical distancing is the most effective public health measure to control contagious diseases like COVID-19,

145-151

Authors: Rouhullah Dehghani1 , Hamid Kassiri2 , Rozhin Kasiri3 , Mousa Dehghani4 , Maral Kasiri

The five main arbovirus families that cause diseases in humans and other animals are Bunya¬viridae, Togaviridae, Flaviviridae, Reoviridae, and Rhab¬doviridae. Chikungunya arbovirus (Togaviridae: Alphavirus), an arbovirus transmitted by Aedes spp., is a well-known global health threat. It has been recognized in more than 60 countries in Asia, Africa, Europe, and the Americas. Pakistan, the eastern neighborhood of Iran, is one of the endemic foci of this disease. As the largest province of Iran, SistanBaluchestan has always been threatened by infectious diseases from abroad due to its geographical location and neighborhood with Afghanistan and Pakistan. Contagious diseases are more likely to occur in the eastern borders of Iran arising from (1) lack or limited jobs due to deprivation of the area, the harsh weather conditions, unbearable conditions, traditional society, and lack of industry development; (2) Lack or limited facilities due to the distance from the center of the country and high percentage of illiteracy or low literacy, and traffic to neighboring countries to trade goods and get a job. Therefore, health authorities should pay more attention to trafficking of illegal aliens, traveling of people to high-risk countries, smuggling of livestock, and strengthening of quarantine posts across borders, especially in the eastern borders of Iran. The first case of chikungunya disease was confirmed in Sistan-Baluchestan province in 2019, where most of the cases have been reported. The findings of the present study provide evidence of chikungunya virus in Iran and emphasize the urgency to increase the preventive standards and surveillance system.

157-160

Authors: Birasen Behera1 , Kundan Kumar Sahu1 , Priyadarsini Bhoi1 , Jatindra Nath Mohanty2

Objective: To investigate the prevalence of isolated organisms in patients with lower respiratory tract infections and the antibiotic susceptibilities at a tertiary care center. Methods: In this observational and cross-sectional analysis, 114 patients admitted in the intensive care unit were enrolled. The endotracheal aspirates and bronchoalveolar lavage were collected. The bacteria were isolated and identified, and finally, antimicrobial sensitive pattern of the isolated bacteria was examined. Results: The prevalence of infection was 72.72% in male patients and 27.28% in females. The predominant bacteria were Klebsiella pneumoniae (37.50%) followed by Acinetobacter spp. (36.36%), Pseudomonas aeruginosa (7.95%), Escherichia coli (6.81%), Proteus mirabilis (2.27%), atypical Escherichia coli (1.13%), Enterococcus spp. (1.13%), Elizabethkingia meningoseptica (1.13%), Staphylococcus aureus (1.13%), Proteus vulgaris (1.13%), Citrobacter freundii (1.13%), and Citrobacter koseri (1.13%). High resistance to cephalosporins (82.18%) was demonstrated in all Gram-negative bacteria. Bacteria showed susceptibility to colistin (88.75%) followed by tigecycline (83.11%), gentamycin (36.18%), and amikacin (49.23%). Conclusions: As the most frequent respiratory organisms, Klebsiella pneumoniae and Acinetobacter spp. have increased resistance to cephalosporins and susceptibility to colistin followed by tigecycline.

166-169

Authors: Imran Khan Mangi, Arslan Ahmed Abro , Muhammad Naveed Memon, Shahjahan Siyal, Naveed Khan, Nouman Memon, Muhammad Kazim Rahim Najjad

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type II fracture and 20 had Mason type III fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions: The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively

176-178

Authors: Neeraj Kumar1 , Pankaj Kumar2 , Prakash K Dubey3 , Abhyuday Kumar4 , Amarjeet Kumar

Rationale: Cope’s sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient’s concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope’s sign and complete heart block. Intervention: Emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.

100-104

Authors: Sonam Maheshwari , Puneet Kumar Gupta , Richa Sinha , Pravesh Rawat

Objective: To assess knowledge, attitude, and practice of medical students towards coronavirus disease 2019 (COVID-19). Methods: A self-designed questionnaire was developed and given to the students of a government medical college in Uttarakhand. The demographics, mean knowledge, attitude, and practice of the participants were investigated, and the scores were calculated. t-test and ANOVA were used for statistical analysis. Results: Out of the total participants (n=354), 50.3% were male and 54.5% were 21-23 years. Almost all the participants (96.6%) increase the frequency of washing hands under the influence of COVID-19. Although no significant relationship was found between different religions, age-categories in terms of knowledge, the participants who were aged 21-23 years had higher knowledge. In addition, gender had a significant impact on practice scores (P<0.05) while no demographic variable was found to have a significant relation with attitude score (P>0.05). Conclusions: The majority of the participants had good knowledge, positive attitude, and sufficient practice. Females and males have significantly different practices. Although the results are very positive, it is suggested that people should continue to strengthen knowledge, attitude, and practice towards COVID-19, so that India can win the battle against the disease.

109-113

Authors: Santosh Kumar Swain, Bulu Nahak, Priyanka Debta

Objective: To evaluate the clinical profiles, diagnosis, and treatment of patients with acute epiglottitis at a tertiary care teaching hospital of eastern India. Methods: This is a retrospective study in which 28 patients of acute epiglottitis participated. This study was conducted between January 2016 and October 2019. The diagnosis of acute epiglottitis was based on the clinical presentations and fiberoptic laryngoscopic examinations of the larynx and hypopharynx. Details of age, gender, personal history, clinical symptoms, treatment, and hospital stay were evaluated. Results: Out of the 28 patients with acute epiglottitis, 17 (60.71%) were male and 11 (39.29%) were female with age ranged from 4 years to 62 years and a mean age of 23.45 years. The median duration from the onset to resorting to physicians is 3 d. Among the 28 patients, 4 patients (14.29%) were under the treatment for diabetes mellitus. Four cases (14.29%) required airway management with intubation and tracheostomy. Conclusions: Acute epiglottitis is an acute infectious condition of the supraglottis and may lead to airway obstruction. Clinical presentations alone are insufficient for the diagnosis of acute epiglottitis. Fiberoptic nasopharyngolaryngoscopic examination should be performed as soon as possible for confirmation of the disease.

121-125

Authors: Atefeh Ranjkesh, Zahra Salari, Mehrab Nejati, Emad Behboudi, Ali Ramezani, Milad Zandi, Mahmood Marzban, Hadis Kiani, Mina Bavi, Mehdi Rabiei Roodsari, Yousef Esvand Zibaee, Samaneh Abbasi, Maryam Mohammadi Elyasi, Mehdi Parsanahad , Shahram Jalilian , Simin Mohammadi Gorji , Mina Owrang

Objective: To identify the pathogenic gene of Panton-Valentine leukocidin in methicillin-resistant Staphylococcus aureus strain isolated from clinical specimens of burn patients in Shaheed Zare Burn Hospital. Methods: A total of 104 samples of Staphylococcus were collected and 78 aureus samples were isolated from Zare Hospital patients from November 2016 to July 2017. All isolates were identified using a standard biochemical and laboratory methodology in accordance with CLSI principles, and disk agar diffusion antibiogram were performed to identify methicillin resistant colonies. Then the presence of the Panton-Valentine leukocidin gene was tested by PCR. Results: Of the methicillin-resistant Staphylococcus aureus samples, 80% were negative for the Panton-Valentine leukocidin gene, and only 20% of the samples had Panton-Valentine leukocidin gene. Male and female patients showed no significant difference in the positivity rate of Panton-Valentine leukocidin gene (16.12% vs. 33.33%) (P=0.25). Besides, there was no significant difference in bacterial resistance or susceptibility to antibiotics between samples with or without the Panton-Valentine leukocidin gene. Conclusions: In recent years, increased resistance has been a serious threat. The resistance or susceptibility of Staphylococcus aureus strains to different antibiotics is different in different geographical locations.

129-130

Authors: Ayse Sahin Tutak

Rationale: Levothyroxine is the most commonly used agent in thyroid hormone replacement therapy. Although there are many hypothyroid patients who use levothyroxine as a treatment, high level of thyroid stimulating hormone is found in a limited number of levothyroxine overdose cases worldwide. Patient concern: A 34-year-old male patient taking 4.5 mg levothyroxine for suicide. Diagnosis: Overdose of levothyroxine. Interventions: The patient was admitted to the intensive care unit for follow-up treatment. Cardiac rithym and vital parameters of patient were closely monitored. Outcomes: The patient discharged without any life-threatening complications. Lessons: Patient with initial high thyroid stimulating hormone levels may not be in hyperthyroidism crisis by levothyroxine poisoning.

134-135

Authors: Jamir Pitton Rissardo1,2 , Ana Letícia Fornari Caprara