Journal of Acute Disease

1–8

Authors: Adam Miklos Feher, Zoltan Bajory

Testicular torsion (TT) is a severe acute urological emergency caused by twisting of the spermatic cord. It requires prompt diagnosis and treatment. Unfortunately, its importance is still underestimated in everyday life: early-detected TT can be cured in almost every case, whereas late identification may lead to loss of the testicles. We present a comprehensive review of TT, including the aetiology, risk factors, diagnosis, treatment and outcome, based on recently published articles. The novel and the major controversial aspects of this topic are highlighted. The PubMed and ScienceDirect databases were searched with the following keywords: TT, torsion of the spermatic cord and acute scrotum, particular stress being placed on articles published in the last 5 years. The genetic aspects of TT are discussed, together with the diagnostic possibilities, such as sonography, radionuclide and fluorescent imaging techniques. The effective surgical techniques and potential drugs for reducing molecular injuries were surveyed. Finally, the major controversial aspects of TT are considered. The new concepts of TT demonstrate that certain features remain unclear. New, more accurate diagnostic tools and prompt management may contribute to a better prognosis and prevent the loss of the testicles.

16–21

Authors: Ionut Negoi, Sorin Paun, Bogdan Stoica, Ioan Tanase, Mihaela Vartic, Ruxandra Irina Negoi, Sorin Hostiuc, Mircea Beuran

Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly difficult to manage due to the frequent altered mental status of the patients and severity of associated injuries. The review article aims to make an uptodate study of the current strategies for therapeutic approach of abdominal injuries in polytrauma setting. Review of the medical literature is up to 2015, by using the PubMed/Medline, Science Direct, Cochrane Library and Web of Science databases. We have used different combinations of the keywords of “abdominal trauma”, “liver”, “spleen”, “renal”, to review the reference list of retrieved articles for further relevant studies. Nowadays, we are facing a major change in abdominal trauma therapeutic approach, due to the continuous extending indications and very high successful rate of selective nonoperative management, completed or not with minimally invasive techniques like angiography and angiographic embolization. New imaging methods offer a high-quality characterization of solid organ injuries, being a secure support for decision algorithm in polytrauma patients. After a continuous decrease in number of laparotomies for trauma, new techniques should be developed for maintaining and developing the trauma surgeons' skills. According to the current standards, for a low morbidity and mortality, the trauma patients may be approached by a multidisciplinary and experienced trauma team. Even if nonoperative management is continuously expanding, this may be applied only by a trained and skillful trauma surgeon, who is able to perform difficult surgical techniques at any moments.

29–36

Authors: Ines Anselmo da Costa, Bastian Amend, Arnulf Stenzl, Jens Bedke

Renal injury occurs in 1%–5% of all traumas, causing disability or even death. The American Association for the Surgery of Trauma (AAST) renal injury scale should be used when injuries are reported. Although there is a consensus regarding handling of lower-grade injuries conservatively, the same cannot be said for the higher-grades, for which different specialists handle either conservatively or surgically. A search of the MEDLINE database was undertaken by using the following filters: English language articles, full-text availability, last five years, humans. Pediatric studies were excluded. For most renal injuries in hemodynamically stable, patients can be safely handled conservatively. An organized assessment and treatment system can reduce the need for nephrectomy in most other cases, as has occurred in the last two decades. The AAST injury scale should be updated in light of the advancements in imaging techniques, in order to fine tune grading and treatment.

41–45

Authors: Kholoud Kahime, Samia Boussaa, Abderrahmane Laamrani-El Idrissi, Haddou Nhammi, Ali Boumezzough

Objective: To describe and compare the epidemiological features of anthroponotic cutaneous leishmaniasis (ACL) caused by Leishmania tropica, and zoonotic cutaneous leishmaniasis (ZCL) due to Leishmania major in Morocco. Methods: We performed a retrospective study of ZCL and ACL cases reported during the last ten years in Morocco (2004–2013). Epidemiological data were analyzed by using Pearson's correlation method as well as Tukey test and digital maps were produced for incidence repartition calculated by using ArcMap GIS version 10. Results: A total of 41 656 cases of cutaneous leishmaniasis were notified between 2004 and 2013 in Morocco. The mean incidence was 139 cases/100 000 population/10 years and it was significantly higher in 2010. In the spatial context, ACL form was the most common in Morocco, while ZCL was the most important in terms of the number of reported cases. For both forms, the highest incidence occurred in females and children (0– 14 years). When analyzed according to the number of cases in each province, Errachidia (8 728 cases) and Azilal (3 523 cases) were the most affected by ZCL and ACL, respectively, while the highest incidence was noted in Zagora (231 cases/100 000 population/10 years) and in Chichaoua (97 cases/100 000 population/10 years), for ZCL and ACL, respectively. Maps of incidence repartition were performed to identify the risk area of ZCL and ACL. Conclusions: ZCL and ACL are still major health problems in Morocco. We highlight the spatiotemporal change of cutaneous leishmaniasis incidence through the country during the last ten years and we underline the correlation between ZCL incidence and the percentage of rural population in Morocco.

51–58

Authors: Chiedozie Onyejiaka Ibegbulem, Paul Chidoka Chikezie, Ezeikel Chinemerem Dike

Objective: To ascertain the functional integrity of renal and hepatic tissues of Wistar rats fed with processed cocoa bean-based beverages and raw cocoa bean products-containing diets by using biochemical and histological methods. Methods: Thirty Wistar rats were designated on the basis of experimental diets which were given for 28 days. At the end of the feeding period, blood samples were drawn, and renal and hepatic tissues were excised from the experimental rat groups for functional tests and histological examinations, respectively. Results: Serum alanine aminotransferase activities of the experimental rat groups showed no significant difference (P > 0.05) and were within a relatively narrow range of (32.17 ± 4.98) IU/L to (41.00 ± 10.85) IU/L, whereas serum aspartate aminotransferase activities gave wide variation within the range of (15.67 ± 2.13) IU/L to (34.83 ± 8.31) IU/L with P < 0.05. Serum bilirubin concentrations of experimental rat groups were less than 1 mg/dL. Serum total protein and albumin concentrations varied within a relatively narrow range. Serum creatinine concentration was significantly lower (P < 0.05) than serum urea concentration. Histology showed evidence of moderate disarrangement of hepatic tissue architecture and degenerated tubules as well as glomerular turfs. Conclusions: The pattern of alanine aminotransferase activity being more active than aspartate aminotransferase one in serum appeared to correlate with the extent of disarrangement of hepatic tissue architecture. The experimental rat groups exhibited no hyperbilirubinemia. Also, diets containing processed cocoa bean and raw cocoa bean products did not substantially interfere with the capacity of the hepatocytes to biosynthesize plasma proteins and the functionality of renal tissues.

62–70

Authors: Janet Mobolaji Olaniyan, Hadiza Lami Muhammad, Hussaini Anthony Makun, Musa Bola Busari, Abubakar Siddique Abdullah

Objective: To evaluate the acute and sub-acute toxicity of aqueous and methanol extracts of Nelsonia campestris (N. campestris) in rats. Methods: Acute oral toxicity study of aqueous and methanol extracts was carried out by administration of 10, 100, 1 000, 1 600, 2 900 and 5 000 mg/kg body weight of N. campestris extracts to rats in the respective groups. Sub-acute toxicity study was conducted by oral administration of the extracts at daily doses of 100, 300 and 600 mg/kg body weight to another group of rats for 28 days, while rats in the control group received 0.5 mL of normal saline. Results: The LD50 of the N. campestris extracts in rats was determined to be greater than 5 000 mg/kg body weight. There was no significant difference (P > 0.05) between the test groups administered with aqueous and methanol extracts in relation to the control group for serum electrolytes (Na+, K+, Cl−, HCO3−), serum albumin, total and conjugated bilirubin. Similarly, mean organ-to-body weight ratio and all haematological parameters (white blood cell, red blood cell, mean cell volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, packed cell volume) evaluated were not significantly different (P > 0.05) from the control. There was a significant increase (P < 0.05) in the activity of serum liver enzymes (aspartate aminotransferase, alkaline phosphatase), serum urea and creatinine of rats administered with 300 and 600 mg/kg body weight of the aqueous extract. Methanol and aqueous extracts at 600 mg/kg body weight resulted in a significant increase (P < 0.05) in serum urea and total protein, respectively. The activity of serum alanine aminotransferase decreased significantly (P < 0.05) when the rats received 100 and 300 mg/kg body weight of both extracts. Histopathological examination revealed mild to moderate hepatic and cortical necrosis of liver and kidney respectively on administration of both extracts at 100 and 600 mg/kg body weight. A moderate dose of 300 mg/kg body weight of the aqueous and methanol extracts caused lymphocytic infiltration and portal congestion, respectively. Conclusions: Intake of high doses of this plant extracts may exhibit mild organ toxicity.

77–78

Authors: Sora Yasri, Viroj Wiwanitkit

Quinine is a classical antimalarial drug that is used worldwide. It is also used for preexposure of malaria before visiting to the jungle in the endemic area of malaria. In this article, the authors reported a case of acute allergic reaction to oral quinine for malarial prevention.

83–85

Authors: Federico Bianchi, Quintino Giorgio D'Alessandris, Roberto Pallini, Eduardo Fernandez, Liverana Lauretti

The authors reported on a 63-year-old diabetic male who developed a strange wandering hemiparesis affecting first left side and then right side, not consistent with a right parasagittal meningioma nor with ischemic stroke. The subsequent rapid worsening of clinical picture, with occurrence of paraparesis, urinary incontinence and midthoracic sensory level, together with the evidence of leucocytosis, led to the diagnosis of a T6-T7 spondylodiscitis with spinal cord compression. The authors underlied the difficulties in diagnosing this condition in the setting of general hospital practice and the importance of clinical and neurological examination.