Journal of Acute Disease

95-98

Authors: Pathum Sookaromdee1, Viroj Wiwanitkit

Acute cholecystitis is an important acute medical problem, so acute disorder of the gall bladder requires good clinical management. There are several etiologies of acute cholecystitis. Although it is not common, helminthic infection is one of the causes of acute cholecystitis. This condition is little mentioned in literature but it is an important issue in several tropical countries. Here, the authors performed a literature review to summarize published data available on an international database (PubMed). All available publications with complete information are summarized and extracted. In this article, the authors briefly summarized clinical features and management of acute cholecystitis and helminthic infestation. The relationship of nematode, trematode and cestode infestations with acute cholecystitis is also summarised.

106-112

Authors: Godpower Chinedu Michael1, Ibrahim Aliyu2, Ayuba Andesati3, Bukar Alhaji Grema1, Abubakar Mohammed Musa4, Rafiyat Bolanle Abu5, Hamisu Abubakar5, Haliru Ibrahim6, Emmanuel Edighotu7

Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general information such as age, gender, mode of transfer, time of presentation, symptom duration, diagnoses, treatment duration, treatment outcome (transfer to the ward, referral to another hospital, discharge or death) and date and time of discharge. Chi-square test and logistic regression analysis were used to determine the association of variables with mortality and predictors, respectively. Results: Patients were predominantly male (62.2%) with a mean age of (36.0±19.0) years. Most visits occurred in September (49.1%). The median symptom duration was 24 h (interquartile range: 4.0, 72.0 ). More incidences were caused by non-surgical (61.9%) than surgical reasons. Infectious diseases (predominantly malaria, 34.5%) and injuries from road traffic accidents (mostly head injuries, 9.4%) were the commonest non-surgical and surgical cause, respectively. The mortality rate was 9.2%. Typhoid-intestinal-perforation and sepsis contributed 45.2% of overall mortality. Age (氈 2=16.44, P<0.001), symptom duration (氈 2=22.57, P<0.001), and visiting month (Fishers exact, P=0.002) were associated with mortality. Moreover, age (≥37 years) (OR=4.60, 95%CI=1.96-10.82, P<0.001) and visiting in September/October (OR=4.01, 95%CI=1.47-10.93, P=0.007) were the predictors of mortality. Conclusions: Though most patients in emergency department survive, the mortality is still high. Appropriate hospital and community interventions should be implemented to reduce mortality.

118-122

Authors: Shadab Shahali1, Mansour Amin2,3, Masoumeh Khajeh Hassani4, Reza Yaghoobi5, Morteza Saki3,6

Objective: To compare the effect of shallomin (pure fraction of Allium hirtifolium) with podophyllin 25% solution on external genital human papillomavirus warts in women. Methods: This study was a randomized controlled trial which was performed on two groups of 25 Iranian women with external genital warts at Imam Khomeini Hospital in Ahvaz, Iran. In the first group, shallomin was used once a day for six weeks at home. In the second group, 25% podophyllin solution, was applied on the lesion once weekly for six weeks. Results: Shallomin and podophyllin resulted in wart clearance in 13/23 (56.5%), and 12/24 (50%) of patients, respectively. The clearance rate for shallomin was not significantly different from that of podophyllin (P=0.082). Six weeks after the treatment, the sizes of the lesions in the shallomin group and the podophyllin group decreased by (1.43±0.53) mm and (1.64±0.70) mm, respectively. Conclusion: Shallomin is an effective treatment for genital warts, with similar efficacy to that of podophyllin.

127-129

Authors: Soheil Ebrahimpour1, Mahmoud Sadeghi-Haddad-Zavareh1, Zeinab Darabi Ahangar1, Zeinab Mohseni Afshar2, Zeinab Sheidaie3, Parisa sabbagh1, Arefeh Babazadeh1

Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic; but if symptomatic, the symptoms will include skin rash, respiratory and gastrointestinal symptoms like abdominal pain, diarrhea, nausea and vomiting. Patient concerns: A 77-year old man presented with edema of the lower extremities and insignificant tenderness in the epigastric region. Diagnosis: The histopathology of gastric tissue showed severe inflammation and multiple ulcers in the cardia, antrum and proximal duodenum. A large number of rhabditiform larvae of S. stercoralis along with tissue hyperemia and infiltration of lymphoplasma cells, eosinophils, and neutrophils were found. Intervention: Treatment with albendazole. Outcome: Despite the albendazole treatment, the patient's condition deteriorated and eventually died because of a sepsis-like syndrome. Lesson: Physicians should remain alert to the urgency due to threadworm, especially among the elderly people and immunosuppressed cases; and should ensure accurate diagnosis, suitable treatment and careful follow-up of these cases.

53-57

Authors: Saeed Khoshnood, Azar Dokht Khosravi, Nabi Jomehzadeh, Effat Abbasi Montazeri, Moloudsadat Motahar, Fatemeh Shahi, Morteza Saki, Sakineh Seyed-Mohammadi

Objective: To evaluate the drug susceptibility profiles and the frequency of beta-lactamase encoding genes in Pseudomonas aeruginosa (P. aeruginosa) obtained from burn patients. Methods: Totally 93 non-duplicate clinical isolates of P. aeruginosa were recovered from burn patients of Taleghani Burn Hospital of Ahvaz. Antibiotic susceptibility testing was conducted by disk diffusion method according to the CLSI 2017 recommendations. PCR assay was performed by to find beta-lactamase encoding genes. Results: In this study, most clinical specimen was obtained via wound swabs [65 (69.9%)], followed by blood [14 (15.1%)] and biopsy [7 (7.5%)]. Forty-two (45.16%) patients were male and 51(54.84%) were female. High resistance was observed for most of antibiotics especially for gentamicin and ciprofloxacin (Up to 85%), whereas the highest susceptibility was reported for colistin (100.0%), followed by ceftazidime (66.7%). According to PCR results, 16.1% (15), 9.7% (9) and 14.0% (13) of isolates carried blaDHA, blaVEB and blaGES genes, respectively. It also revealed that the blaVEB gene was found to coexist within 2 isolates (2.2%). Conclusions: Antibacterial resistance is high among P. aeruginosa isolates. Colistin is highly active against multi-drug resistant P. aeruginosa isolates. Antimicrobial susceptibility testing can confine indiscriminate uses of antibiotics and resistance increase, and can improve management of treatment.

63-66

Authors: Majid Noori, Behzad Mohsenzadeh, Aghil Bahramian, Fatemeh Shahi, Habibollah Mirzaei, Saeed Khoshnood

Objective: To explore the characterization and frequency of antibiotic resistance related to membrane porin and efflux pump genes among Acinetobacter baumannii (A. baumannii) strains obtained from burn patients in Tehran, Iran. Methods: In this cross-sectional descriptive study, 100 strains of A. baumannii isolated from burn patients visiting teaching hospitals of Tehran were collected from January 2016 to November 2017. After A. baumannii strains were confirmed, antimicrobial susceptibility testing was done via Kirby-Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute guidelines. PCR amplification was performed for detection of 毬-lactamase adeR, OprD, adeS genes among A. baumannii strains. Results: All isolates (100%) were resistant to ceftazidime, cefotaxime, cefepime, ciprofloxacin, and piperacillin, and most isolates indicated high resistance (95%-97%) to meropenem, imipenem, gentamicin, ceftriaxone, trimethoprim-sulfamethoxazole, piperacillintazobactam, amikacin, and tetracycline. The most effective antibiotic against A. baumannii isolates was colistin (97% sensitivity), followed by tigecycline. The frequency of OprD, adeS, and adeR genes were 98%, 91%, and 77%, respectively. Conclusions: This study shows that the majority of A. baumannii isolates are highly resistant to the antibiotics most commonly used in burn patients. Also, high distribution of OprD and adeRS genes may be responsible for the observed resistances among A. baumannii isolates that demonstrate the possible role of both efflux pumps in simultaneous of carbapenemase production during antibiotic resistance.

72-77

Authors: Hussein Ageely

Objective: To explore the patterns and prevalence of complications of type 2 diabetes mellitus (T2DM) in Jazan region. Methods: A cross-sectional study was conducted with a sample (n=281) of the Jazan population attending Jazan Diabetes Centre. A structured questionnaire was used for data collection, and the statistical analysis was performed using SPSS ver. 17.0 (SPSS Inc., Chicago, IL, USA) software. Results: The prevalence of one or more complications due to T2DM was 42.7%, which was significantly increased with age, BMI and T2DM duration. The prevalence also differed significantly according to gender and participation in exercise (P<0.05 for all factors). The prevalence of cardiovascular complications was found to be 7.1%, higher among males (9.4%) than females (4.1%), although the difference was not significant (P>0.05). The prevalence of retinopathy was estimated as 32.4% and significantly differed according to gender, age groups, participation in exercise and BMI categories (P value < 0.05 for all). The multivariate logistic regression analysis suggested that the most important independent predictors of T2DM complications were T2DM duration (11-15 years) (P=0.028, OR=3.54) and having T2DM for more than 15 years (P=0.013, OR=5.38). Conclusions: This study reveals a high prevalence of long-term complications among T2DM patients attending Jazan Diabetes center. T2DM prevention and proper T2DM management strategies are strongly needed to minimize the burden of the disease due to T2DM complications.

82-83

Authors: Tardive phenomenon, Stroke, Dysarthria, Emergency department

Distinguishing stroke mimics constitutes a considerable challenge for clinicians in emergency department. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Through the presentation of this case, we point out tardive phenomenon as an alternative differential diagnosis of stroke. Furthermore, this case adds substantial data presenting an interesting manifestation of isolated dysarthria as a tardive phenomenon, occurring due to betahistine usage which is extremely rare in literature.

86-88

Authors: Beuy Joob, Viroj Wiwanitkit

Rationale: Acute abdomen is a medical emergency that requires prompt diagnosis and management. Lymphoma is a rare cause of acute abdomen. Patient concerns: A 54 year old patient complained of repeated episodes of acute abdominal pain over the past 3 months. Diagnosis: Mantle cell lymphoma. Interventions: Chemotherapy and stem cell transplantation.Outcomes: Abdomen pain disappeared and the patient was discharged uneventfully. Lessons: Although it is a rare cause of acute abdomen, lymphoma should be included in the differential diagnosis workup of patients with unexplained and unusual acute abdomen.

7-11

Authors: Jun-Yi Yao1# , Zhi-Qian Luo1# , Wei Zhang1 , Ying-Qing Li1 , Yong-Yan Li1 , Xiu-Ru Li1 , WeiCheng Wang1 , Zhi-Tao Liu1 , Shao-Wen Cheng1,2 , Chuan-Zhu Lyu1,3

Sepsis is a syndrome characterized by systemic inflammatory response caused by infection or toxin, with high morbidity and mortality. Different infection microflora and environment have great influence on the occurrence, development and prognosis of sepsis, but individual genetic factors also play an extremely important role. It was reported that the polymorphisms of mannose-binding lectin 2 gene were closely relevant to the occurrence and development of sepsis, but the conclusions in different studies were inconsistent. Therefore, we performed this reviews on the relevance of mannose-binding lectin 2 gene polymorphisms and sepsis.

16-20

Authors: Xin Wang, Li-Jie Qin

Acinetobacter baumannii is a major cause of nosocomial infections worldwide. By summarizing the epidemiology, molecular and drug resistance mechanisms, diagnosis and treatment strategies of Acinetobacter baumannii, the clinical outcome is finally improved.

28-33

Authors: Shweta Saxena1 , Vignesh Sounderrajan1 , Saravanan Konda Mani2 , Shakila Harshavardhan1

Objective: To explore the possible IgG1 binding receptors by protein-protein docking experiments. Methods: The protein-protein cognate interactions such as IgG with Fc Receptors (FcRs) potentiate signaling cascades to ameliorate antigen uptake, processing and presentation are studied by protein-protein docking experiments. Results: However, the propensity of IgG interactions with other cognate receptors largely remains obscure. In this direction, possibilities of IgG1 binding with various five receptors were explored. In this study, we report previously unidentified associations between IgG1 and other receptors. Herein, we show that IgG1 binds to the granulocyte-macrophage receptor, 毬 common receptor and complementary receptor(complementary receptor I and complementary receptor II) to form a complex structure. We show the binding ability and important protein-protein interactions of IgG1 with four receptors in comparison to Fc Receptor, and also find out the conserved amino acids and hydrophobic-hydrophobic interactions amongst them. Conclusions: Comparative interaction studies of IgG1 binding to various receptors revealed close similarities of IgG1 binding to its native receptor Fc. In conclusion, our study has shown the comparable binding efficiency of four receptors to IgG1 apart from the conventional Fc receptor.

38-40

Authors: Soheil Ebrahimpour1 , Zeinab Mohseni Afshar2 , Mahmoud Sadeghi-Haddad-Zavareh1 , Sahar Oladzad3 , Arefeh Babazadeh1

Sarcoidosis is a granulomatous condition with unidentified etiology. This disease should be considered in differential diagnosis if non-caseating granulomas is noted in biopsies, because numerous cases presented with no clinical symptoms. Although the lung is the most common organ involved in the disease, there also is an extra-pulmonary form (<10%). It should be noted that the presentation of sarcoidosis may be atypical. In this article, we report a systemic sarcoidosis case, with specific clinical findings: extrathoracic onset with lymph nodes.

43-44

Authors: Zeinab Mohseni Afshar1 , Arefeh Babazadeh2 , Soheil Ebrahimpour2 , Sima Golmohammadi3

Cytomegalovirus (CMV) can cause significant inflammation. Besides, it is an important cause of pancreatitis in organ transplantations. We report a case of CMV pancreatitis in a 48-year-old male kidney transplant recipient who was admitted with elevated amylase (3 337 U/L) and lipase (1 160 U/L) enzymes, and abdominal pain. CMV infection was tested by reverse transcription polymerase chain reaction and the result was positive. CMV viremia was successfully cleared with ganciclovir. Then the absence of some of more noticeable clinical symptoms of pancreatitis may not be a decisive reason not to rule out the disease in transplanted cases.

234-240

Authors: Wendy Ong Chin Feng1,2,3 , Wee Min Teh3 , Wan-Hazabbah Wan Hitam1,2, Haslina Mohammad Ali3

Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.

247-253

Authors: Ana L Rodríguez-Perea1,2 , Johanna Gutierrez-Vargas3 , Mauricio Rojas4,5, Gloria P CardonaGómez 6 , Paula A Velilla1

Objective: To evaluate the role of regulatory T cells (Tregs) at late stages of stroke. Methods: Anti-CD25 antibody (or PBS as a control) was injected to reduce the pool of Tregs in Wistar rats; then, ischemia was induced transiently by middle cerebral artery occlusion during 60 min and reperfusion was allowed for 7 d. Then, Treg frequency was analyzed in peripheral blood, spleen and lymph nodes. Neurological score (0-6) and infarct volume were also determined. Results: Nine days after injection, the CD4+ CD25+ T cells were reduced by 70.4%, 44.8% and 57.9% in peripheral blood, spleen and lymph nodes, respectively compared to PBS-treated rats. In contrast, the reduction of CD4+ FOXP3+ T cells was lower in the same compartments (38.6%, 12.5%, and 29.5%, respectively). The strongest reduction of CD25+ CD4+ T cells was observed in those FOXP3-negative cells in blood, spleen and lymph nodes (77.8%, 52.8%, and 60.7%, respectively), most likely corresponding to activated T cells. Anti-CD25-treated transient middle cerebral artery occlusion rats had a lower neurological deficit and did not develop tissue damage compared with PBS-treated animals. Conclusions: These findings suggest that treatment with anti-CD25 in our model preferentially reduce the T cell population with an activated phenotype, rather than the Treg population, leading to neuroprotection by suppressing the pathogenic response of effector T cells.

258-261

Authors: Ying Liu, Yun-En Liu, Chang-Ci Tong, Hong-Xu Jin

Objective: To study the changes of cognitive function in mouse after brain-blast injury. Methods: Fourty healthy male C57BL/6 mice were randomly divided into model group and control group. After 24 h of injury, histopathological changesc and reactive oxygen species changes were observed under microscope; while changes of inflammatory cytokines content were determined by Western-blot. Four weeks later, Morris water maze method was used to detect the cognition impairment. Results: HE staining showed blast induced brain injury in C57BL/6 mice. Compared with normal control group, the expression of IL-1毬,IL-4, IL-6 were significantly increased in brain tissue of model group whereas IL-10 was significantly decreased (P<0.05); ROS expression in the hippocampus of model group mice was significantly increased compared with that in the control group. Morris water maze showed cognition impairment in mice after brain-blast injury. Conclusions: Brain-blast injury causes cognition impairment in mice, which may be related to the occur of inflammatory change and oxidative stress in the early stage

265-267

Authors: Tomasz Wojewoda1 , Edyta Unkiewicz1 , Ewa Wojewoda-Chmiel1 , Piotr Bijak1 , Michał Bogusiewicz2

Preeclampsia is a pregnancy specific disease characterized by hypertension and proteinuria, by definition, developing after 20 weeks of pregnancy. Here we present an atypical case of severe preeclampsia complicated by generalized convulsions (eclampsia) and hemolysis, elevated liver enzymes, and low platelet count syndrome in an 18 weeks pregnant patient with chronic hypertension. Occurrence of these complications was preceded by upper right quadrant abdominal pain and severe hypertension. In this case no evidence of autoimmunity disorders or molar pregnancy was found.

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