Journal of Acute Disease

145-148

Authors: Mohammed Maan AbdulAzeez1? , Padilla-Zambrano Huber2 , Salima B. Alsaadi3 , Cabreras?Nanclares B. Vladimir2 , Luis Rafael Moscote Salazar4 , Samer S. Hoz5

The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adults derives from a dysfunction at the level of the eustachian tube, which provides a valve effect causing an increase in pressure at the level of the middle ear, forcing the entry of air into the dome of the skull through the opening of the occipitomastoidal suture. The process of standard pneumatization of the temporal bones, begins in the final weeks preceding birth, characterized by a decrease in the embryonic mesenchyme at the antrum level and progresses through childhood until adolescence, when the stone portion at the level of the rock is pneumatized; Normal variants have been reported, such as pneumatization that extends from the temporal scale to behind the sigmoid sinus. With regard to the process of hyperneumatization, several etiologies have been proposed that a congenital process versus an acquired process to develop this condition should be compared. The present illustrative case is a seventy-three years old male presented to the outpatient clinic with chronic recurrent occipital headache, already investigated by general practitioner for elevated blood pressure which was excluded. We had checked him to exclude the cervical spinal origin of the occipital headache which was then excluded too. This case scenario demonstrates the debate about how to deal with such cases and thus the review will bring the attention of those who take care of such radiological findings to keep in mind the possible causes and complications according to the reported cases till now. We concluded that the hyperpneumatization of the craniocervical junction is an uncommon radiological finding that is usually asymptomatic although it can entail serious complications in some instances, especially when it enlarges progressively, which may be due to an acquired process. Thus, craniocervical hyperpneumatization deserves highlighting for the managing team to gain fluent treatment and better patient outcome.

152-157

Authors: Derouiche Samir? , Rezzag Mohcen Om Selma, Serouti Asma

Objective: To evaluate the acute toxicity effect of metribuzin at low dose on liver of mother rabbits and its fetus. Methods: Pregnant female rabbits Oryctolagus cuniculus were divided into three groups (n=5). The first group of non-treated pregnancy rabbits served as control; the second group of pregnancy rabbits were treated with 1/100 LD50 of metribuzin and the third group of pregnancy rabbits were treated with 1/50 LD50 of metribuzin. Metribuzin was added in their drinking water for 60 d before and during pregnancy. Levels of liver malondialdehyde, liver glutathione S transferase, serum glutamic oxaloacetic transaminase and serum glutamic?pyruvic transaminase were determined. Liver reduced glutathione level was also determined by a colorimetric method. And hepatic homogenate was analyzed by HPLC analysis to determine the existence of traces of metribuzin. Results: Results revealed a significant increase in level of liver malondialdehyde, glutathione S transferase, serum glutamic oxalacetic transaminase and serum glutamic-pyruvic transaminase activities in mother and fetuses rabbits of both metribuzin treatment groups as compared to the control group. However the level of reduced glutathione was decreased in mother and fetuses rabbits of both groups treated with metribuzin compared to control group. Also, the results obtained by HPLC technique showed the presence of trace metribuzin in liver cells of mothers and fetuses rabbits of the both metribuzin treated groups. Conclusions: In conclusion, this study shows that exposure to metribuzin at low concentrations causes a acute toxicity in liver of mother rabbits and its fetus, also the trace of the metribuzin detected in the liver is the origin of possible malformation of the fetuses or abortion of the rabbits.

163-166

Authors: Babak Mahshidfar1 , Fatemeh Motaghed2 , Mansour Nateghi3 , Davood Farsi1 , Saeid Abbasi1 , Mani Mofidi1 , Peyman Hafezimoghadam1 , Mahdi Rezai1?

Objective: To determine the amount and type of changes in the Emergency Department, in order to hasten treatment and disposition process of patients in the Emergency Department to expedite by eliminating or minimizing such changes that decreases the cost of treatment and drug resistance Methods: In this study, 1 005 patients’ file admitted to emergency department of Rasool Akram Hospital were reviewed to see at least two different health services or two shifts of one service with written orders. Results: In total, the rate of drug changes studied cases was obtained as 5.47%. The largest pharmaceutical group in which the changes were developed was antibiotic (2.8% from all cases and 50% of total drug changes). Among the various health services, the internal service had imposed the most changes (67.3% of total drug changes). Conclusions: Considering that after the removal of trauma patients, the frequency of drug changes had been 11.47%, then it should be noted that the frequency was high and it was not desirable. The greatest change has been operated by internal services due to the fact that most treatments in this department was carried out by drugs.

175-177

Authors: Yusuf Savran1? , Tugce Mengi1 , Merve Keskinkilic2

Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, a patient who ingested high dose (15 mg) levothyroxine for suicide and admitted to intensive care unit was presented. There was a decrease in Glasgow coma score in the follow-up. The patient was intubated due to acute respiratory failure. Gastric lavage, activated charcoal, methylprednisolone, cholestyramine and therapeuthic plasma exchange were administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms resolved with appropriate treatment and the patient was discharged from the intensive care unit.

180

Authors: Beuy Joob1? , Viroj Wiwanitkit2

99-102

Authors: Tan Si Hong Shawn1 , Lim Xin Yan1 , Fatimah Lateef 2

Pulmonary embolism (PE), with the incidence of about 60 per 100 000 annually, can be a life?threatening disease if it is not treated promptly. It has been estimated that some 10% of PE patients die within the first hour of the event. Untreated PE has a mortality of about 30%. PE is a condition that is treatable if suspected and diagnosed early. The chest radiograph is still the first investigation that is ordered in patients presenting with cardiorespiratory symptoms or symptoms suggestive of PE. The CXR is also helpful in identifying or excluding other conditions or diagnoses. Thus, knowing and understanding some of the more specific CXR signs can be useful. We suggest that physicians to be aware of and utilize CXR findings such as Palla's sign, Westermark sign and Hamptons hump to help with the diagnosis of PE and to exclude other conditions that can mimic venous thrombo-embolism. Even if these signs are not common, their presence, even in an unsuspected patient without a high pretest probability of PE, should prompt further investigations such as a D-dimer test, lung scintigraphy or computed tomography pulmonary angiography as required.

108-114

Authors: Jiang-Ling Yao1 , Chang-Xi Zhou2 , Ji-Min Fu3 , Jian Fu1 , Yun-Tao Gu1 , Zhu-Long Meng1 , Lei Peng1 , Zhong-Lin Zhou

Objective: To investigate the epidemiology of trauma patients in subtropical areas of Hainan Province and the improvement of the level of trauma treatment in China trauma care training (CTCT). Methods: From 01-01-2015 to 01-01-2016, the epidemiological data of 2 476 patients with trauma were collected. From 01-01-2016 to 01-01-2017, 105 professional doctors and nurses in emergency surgery took part in CTCT, and their knowledge were compared before and after training. Results: There were 1 656 male and 820 female trauma patients with 1 614 cases in the middle and young age and 478 cases were the elderly. In terms of occupational distribution, 736 peasants, 574 workers and 458 retirees were involved. In May, the number of patients was the highest 332. October to January was the high-incidence season of trauma. In 24 hours a day: 11:00-13:00, 18:00-19:00, 23:00-03:00 were the high incidence periods. Referred to trauma sites, 904 cases of trauma happened on roads, 540 cases in family and 370 cases in restaurants or entertainment facilities. Through CTCT, the scores of the theoretical examination, the assessment of the trauma treatment skills and the field test scores of the emergency surgery practitioners were better than before (P<0.05).The misdiagnosis rate of severe trauma patients decreased from 26.21% to 15.36% (P<0.05). The mortality rate of severe trauma patients decreased from 18.67% to 13.94% (P<0.05). Conclusions: Trauma epidemiology in Hainan is closely related to its special geographical environment, which provides a reference for the prevention and treatment of trauma in Hainan, and some information for the government to formulate corresponding laws and regulations, as well as emergency plans and other relevant strategies. CTCT training improves the level of theoretical knowledge and first aid skills of medical personnel involved in trauma treatment. Health departments and medical education departments may consider extending CTCT training and continuing education programs to Hainan and other parts of China.

122-125

Authors: Tahtaci Rezan1? , Arslan Engin Deniz2 , Kavalci Cemil3

Objective: To compare the scoring systems used in intensive care units in terms of predicting the mortality in emergency patients and to determine the most appropriate scoring system for urgent care. Methods: This study was carried out by retrospectively reviewing the files of patients admitted to Ankara Numune Training and Research Hospital emergency medicine clinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admitted to any service of the hospital. This study calculated automatically with the data obtained from the patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHE 栻), Simplified Acute Physiology Score (SAPS 栻), Modified Early Warning Score (MEW) and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files were reviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded. The obtained data were entered in SPSS 18 and compared with the scores of APACHE 栻, SAPS 栻, MEW and SOFA. Results: Based on area under the curve analysis, APACE 栻 (0.799; 95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting the patients mortality. However, there was no difference between four scoring system in terms of predicting the mortality. Age (P<0.001, odd’s ratio 1.055) pulse (P<0.007, odd’s ratio 1.025) and SO2 (P<0.003, odd’s ratio 0.952) variables were found to be independent risk factors for mortality. Conclusions: Scores such as APACHE 栻, SAPS 栻, and SOFA, can not be used to make an urgent decision on the first encounter with the patient even though they are successful in predicting mortality. In this case, MEW could be recommended as the most useful system. As a result, the use of scoring systems in emergency departments is useful and necessary. But, multi-centered and large patient group studies are needed.

130-133

Authors: Kilicli Elif, Kavalci Cemil? , Findik Meliha, Muratoglu Murat

Objective: To investigate the cost analysis and hospitalization rates and modes of poisoning of patients who applied to Bakent University Ankara Hospital Adult Emergency Service. Methods: Poisoning Patients who applied to emergency service due to suicide attempt between 01.01.2011- 31.12.2014 were included in the study. Patients' age, gender, date of admission, definite diagnosis, the rate of hospitalization, and hospital costs were examined. A total of 646 patients were included in the study. 208 (32.2%) of the patients were male. The median age of the patients was 29 years. Results: The most causes of poisoning was drug intake. The median cost of the patients was 75.14 TL (IQR: 66.5). Conclusion: There was a positive correlation between age and cost (P<0.05). The majority of the patients apply to emergency dapartment with drug poisoning and female.

137-138

Authors: Dhiraj R Jadhav , Lakshmi Vijaya, Joseph Alexis, Vinay Pandit

Cardiac arrhythmias and respiratory paralysis are among the common causes of death in electric shock victims. Emergency physicians face unique challenges in stabilizing airway and spine apart from fibrillating myocardium. Early and prolonged cardiopulmonary resuscitation may result in good outcome.

69-73

Authors: Cheng Zhang, Jianming Li, Junlin Hu, Xia Zhou

Objective: To study the effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury. Method: Patients with acute craniocerebral trauma who were admitted to the third people's hospital of zigong from April 2014 to December 2016 were selected as the subjects and were randomly divided into two groups. The control group received conventional treatment, and the intervention group received large doses of vitamin C and vitamin E combined with conventional treatment. After 3th day and 7th day after treatment, peripheral blood was collected and serum was isolated, then the contents of nerve injury index NSE, S100B, NGB, UCH-L1, Tf, Ft and neurotrophic indexes NTF-α, BDNF, NGF and IGF-I were determined by Enzyme-linked immunosorbent assay kit, and the contents of SOD, GPx, CAT, OH-, O2-, MDA and AOPP were measured by radioactive immunoprecipitation kit. Results：3th day and 7th day after treatment, the contents of NSE, S100B, NGB, UCH-L1, Tf, Ft, NTF-α, BDNF, NGF, IGF-I, OH-, O2-, MDA and AOPP in the intervention group were all significantly lower than those in the control group. The content of SOD, GPx and CAT in serum in the intervention group was significantly higher than that in the control group. Conclusion: High-dose vitamin C and vitamin E treatment can alleviate nerve injury, oxidative stress response, and improve neurotrophic state in patients with acute craniocerebral injury.

78-82

Authors: Zhou Yin

Objective: To study the effect of bone marrow mesenchymal stem cell(BMSCs) on angiogenesis and inflammation in rabbits with acute cornea alkali burn. Methods: New Zealand White Rabbit were chosen, while model of cornea alkali burn was made and divided into BMSCs group and control group. Rabbits in the BMSCs group were injected with BMSCs and those in the control group received PBS Solution via ear vein. Cornea turbidity and the angiogenesis area were measured at 20 d, 40 d, 60 d. The expression of angiogenic and inflammation response cytokines were measured at 60 d. Results: At 20 d, 40 d, 60 d, the cornea turbidity in BMSCs group was lower than that in control group, and the angiogenesis area in BMSCs group was smaller than that in control group; At 60 d, the mRNA expression of HIF-1毩, VEGF, MMP2, MMP9, TLR2, TLR4, IL-1毩,IL-1毬, TNF-毩, ICAM-1 in cornea of BMSCs group was substantially Lower than that of control group, while BMSCs group was substantially higher than control group on mRNA expression of PEDF, TIMP1, TIMP2.Conclusions: BMSCs has inhibitory effect on angiogenesis and inflammatory response so that it is conducive to the healing of cornea alkali burn.

88-89

Authors: Somsri Wiwanitkit, Viroj Wiwanitkit

Pox is an important infection that can cause the acute illness with dermatological manifestation. Apart from the well-known pox infections, the emerging zoonotic pox infections become interesting new issue in infectious medicine. In this short review, the acute illness which results from new important zoonotic pox infections such as monkeypox, cowpox, raccoon pox and buffalopox is discussed and summarized.

5-14

Authors: Adrián Ángel Inchauspe

Long before the western concept of “circadian cycle” appeared, the Chinese already knew where and at what time our vital energy ran along our bodies, having in this way a surprising diagnostic as well as therapeutic certainty in their medical treatments. As a kind of “Retro- Medicine” or “Inverse Medicine”, the author of this work has been researching over decades, under an exhaustive scientific and methodological analysis, the usefulness of certain therapeutics and parameters of Chinese medicine, as a way of clarifying its treatments so as to have such techniques available for the present medicine. Far from being a mere coincidence, the effects of Yin/Yang through the solar light cycles over the meridians of acupuncture, seem to correspond with the subsequent western research, such as those referred to the circadian cycle and their pathophysiological relationship with the myocardial infarction and other severe cardiovascular conditions.

20-25

Authors: Luis Rafael Moscote-Salazar, Alexis Narvaez-Rojas, Amit Agrawal, Guru Dutta Satyarthee, Samer Hoz, Johana Maraby-Salgado, Andrei F. Joaquim

Traumatic brain injury (TBI) is the leading cause of death and neurological disability in young adults worldwide. This work aims to review the role of progesterone in traumatic brain injury and the usefulness as a possible treatment. We searched pubmed database (2000-2017) for articles containing "progesterone and brain traumatic injury". Basic science studies have advanced knowledge of the mechanisms of secondary brain injury, creating prospects for the medical and pharmacological management of TBI. Although several comparative studies evaluated both the efficacy and safety of several groups of drugs, in which, corticosteroids, tranexamic acid, 毬receptor antagonists, erythropoiesis-stimulating agents, reductase inhibitors include hydroxymethyl glutaryl-CoA inhibitors (statins), among others. Several studies even evaluated the role of progesterone in the treatment of TBI, which is providing growing evidence about its potential neuroprotective mechanisms during the acute phase of trauma. Despite recent advances in the field of management of TBI care in the emergency units, intensive care and the multiple trials for more than 20 years to find useful pharmacological treatments, most of these efforts failed in pre-clinical stages (II and III).

31-35

Authors: Shobhit Gupta, Sameek Bhattacharya, Parul Goyal

Objective: To explore the role of first day levels and subsequent trends of serum proteins as prognostic indicators in acute burns. Methods: This prospective observational study was carried on 100 burn patients (18-60 years with 20% to 60% total burned body surface area). Serum albumin, globulin and total protein were estimated on alternate days starting from first day of burn. The first day value and the trend of serial values throughout the clinical course were compared between survivor and non-survivor groups. Results: Mean day 1 serum values of albumin, globulin, and total protein were significantly higher in the survivors compared to non-survivors (P<0.000 1). Univariate logistic regression showed that increase in day one value of serum albumin, globulin and total protein by 10g /L each, significantly decreased risk of mortality by 99.4%, 98.3% and 96.6%, respectively. The serial serum values of albumin, globulin and total protein showed rising and declining trends in survivors and non-survivor respectively. Based on the ROC curve, the cut off values at any point during the course below which the prognosis was poor were 16.0 g/L, 18.0 g/L and 39.0 g/L for albumin globulin and total protein, respectively. Conclusions: The study highlights the prognostic importance of day one value and trend of serum albumin, serum globulin and total protein in acute burns. The trend of serum proteins over the course of burns should be monitored for better patient management.

43-44

Authors: Muthanna Noman Abdulqader, Ahmed Hamid Al-Tameemi, Hayder Salih, Samer S. Hoz, Abdullah H. Al Ramadan, Luis Rafael Moscote Salazar

The cisternostomy is a novel technique for the management of intracranial hypertension. Intracranial hypertension is the most frequent cause of mortality in patients with acute brain injury. The availability of a less aggressive technique compared to decompressive craniectomy is an advantage for neurosurgeons. We presented a case that demonstrates the successful use of this technique.