Journal of Acute Disease

91–95

Authors: Mahmood Nekoei-Moghadam, Mohammadreza Amiresmaili, Zeynab Aradoei

Floods, hurricanes, landslides, hurricanes, tornadoes, earthquakes are events that a large group of people on earth are affected. In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city. The purpose of this study was to investigate obstacles against effective crisis management with considering service received by individuals in the Bam earthquake. In this study, domestic journals, foreign dissertations in Persian bases such as Google scholar, Magiran, IranMedex, SID and in English bases such as PubMed, Web of Science, Google scholar were used. The results of this study showed that there were many problems in various aspects of planning including: lack of coherent programs, lack of attention to the needs of health care, poor coordination between agencies and organizations and lack of appropriate training of volunteers and people.

102–108

Authors: Farah Iram, Sadaf Ali, Aftab Ahmad, Shah Alam Khan, Asif Husain

Dronedarone, a benzofuran containing chemical compound, is a derivative of amiodarone which is classified as a Class III antiarrhythmic agent. It is prescribed to the cardiovascular patients who have paroxysmal or persistent atrial fibrillation to lower the chances of hospitalization. Amiodarone, sotalol, procainamide dofetilide, quinidine, ibutilide, flecainide, and propafenone are the other useful medicinal products used to treat atrial fibrillation or cardiac arrhythmia. Dronedarone was approved for clinical use in atrial fibrillation by the Food and Drug Administration in 2009. The generic name for dronedarone is Multaq (Sanofi Aventis). This article briefly highlights the important pharmacological, pharmacodynamic and pharmacokinetic properties of dronedarone.

114–116

Authors: Syed Shayan Ali, Fatimah Lateef

Necrotizing fasciitis is a rare bacterial skin condition which forms a major diagnostic challenge and is associated with poor prognosis unless promptly treated. Initial clinical presentation is often misleading with characteristic features developing only late in the course of the disease. In this review, we discuss the applicability and usefulness of laboratory risk indicator for necrotizing fasciitis score in facilitating rapid diagnosis of necrotizing fasciitis in emergency department by differentiating it from other skin infections like cellulitis and abscesses. A high index of suspicion resulting from the laboratory risk indicator for necrotizing fasciitis score can facilitate early diagnosis enabling prompt antibiotic administration and timely referral to surgery for wound debridement, ultimately reducing both the morbidity and mortality.

123–125

Authors: Chukwudi Onyeka John Okonkwo, Ailende Daniel Ehileboh, Eddy Nwobodo, Charles Chijioke Dike

Objective: To find out if Gasoline vapour has some effects on haematological indices when inhaled by experimental rats. Methods: The standard method for laboratory operating procedure recommended by World Health Organization was used in all the analysis done. Forty two albino Wistar rats comprising twenty one males (160–220 g) and twenty one females (140–190 g) were sampled into six groups consisting of four test groups and two control groups. The test groups were exposed to gasoline vapour for twenty one days. Test group one were exposed to gasoline for 30 min while test group two were exposed to gasoline vapour for 1 h daily. At the end of twenty one days of exposure, blood samples were collected from the rats and their haematological parameters were estimated. Statistical analysis was done using windows SPSS version 16. Results: The results showed a significant decrease (P < 0.05) in the red blood count and white blood count of exposed rats and increases in packed-cell volume, haemoglobin, mean corpuscular volume, and mean corpuscular haemoglobin respectively. These increases were significant (P < 0.05) in test group two. There was no significant change in the mean corpuscular haemoglobin concentration of the rats in the test groups when compared to the control groups of both sexes. Conclusions: The results obtained suggest that inhalation exposure to gasoline may result in pancytopaenia and a significant fluctuation in the red blood cell-dependent haematological indices.

131–142

Authors: Alireza Salimi Chirani, Robabeh Majidzadeh, Hossein Dabiri, Javad Rezaei, Ali Esmaili, Yasamin Abdanan Kord, Narges Khabazzadeh Tehrani, Negin Attaran

Objective: Nowadays, Pseudomonas aeruginosa (P. aeruginosa), the highly regarded opportunistic pathogen, is the leading cause of morbidity and mortality worldwide. The P. aeruginosa type IV pili (T4P) as a multiple functional surface organelle in the development of acute P. aeruginosa infections have been well documented. Today, in silico analysis is a quick, and cost-effective tool for vaccine development. Methods: In present study, several turns' motifs along with the chimeric protein were predicted. Based on the hydropathy analysis, numerous antibody-accessible hydrophilic regions were characterized in the chimeric protein. A synthetic chimeric gene, encoding integrated PilQ and disulphide loop region of PilA, was designed. Modeling was done to predict the 3D structure of protein. The model was validated by using Ramachandran plot statistics and by ProSA server. Identification of B-cell and T-cell corresponding epitopes was done by using appropriate servers. Results: The closer 3D model to the native form of the chimeric protein was achieved. Validation results showed that 95.1% residues were in favor region and 3.6% of amino acid residues were in the allowed region. The B-cell epitope mappings showed that almost all the epitopes had irregular enriched structures. The major histocompatibility complex binding sequence prediction identified several human major histocompatibility complex class I and II restricted T-cell epitopes. The integrated PilQ and PilA disulphide loop encoding regions in the frame of pET28a(+) vector were expressed and purified efficiently. Conclusions: We expect that the two recognized antigenic determinants from our chimeric protein, “AYHKGNWSGYGKDGNIGIKDEDGMNCGPIAGSCTFPTTGTSKSPSPFVDLGAKDATSG” and “GPIAGSCTFPTTGTSKSPSP”, can be able to evoke strong both humoral and cell-mediated immune responses in mouse models.

150–153

Authors: Muhammad Sohail Umerani, Asad Abbas, Saqib Kamran Bakhshi, Ujala Muhammad Qasim, Salman Sharif

Objective: To establish the frequency of evolution in CT appearance from an initial scan to a subsequent scan within 12 h and the prognostic significance of such deterioration. Methods: All patients who presented to Department of Neurosurgery, Liaquat National Hospital and Medical College with traumatic brain injury and received their CT scan within the first 4 h of injury were included in the study. Indications for repeat CT scan were: any deterioration in neurological status after the initial scan, potentially deteriorating lesion on initial scan with or without worsening neurology, worsening neurological status after the initial CT scan findings, or no neurological improvement after initial management in patients with normal CT scan with significant head injury. This compiled with the data of 107 patients. Results: There were 67 males and 40 females. The cause of trauma of the 70% patients was road traffic accident. In 11 patients, the lesion evolved towards resorption while 32 patients had no significant changes in the subsequent CT scan. Sixty four patients showed an increase in the size of the lesion and 65.6% of them were required surgical intervention subsequently. Conclusions: In case where the initial CT scan performed within 4 h of significant head injury was not correlated with the patient's neurology, it should be repeated within 12 h

160–161

Authors: Chiu-Yin Yeh, Wen-Liang Yu

Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 mIU/mL; free tetraiodothyronine, 5.67 ng/dL; thyroid-stimulating hormone receptor antibody, 76.9% (normal range, < 14%); and antimicrosomal antibody titer, 1:102400 (normal range, < 1:100), suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.

165–167

Authors: Harrison K. Borno, Richard J Menendez, John C. Chaloupka, Michael T. Dalley, David A. Farcy

Carotid blowout syndrome (CBS) is a rare and fatal complication which arises from patients who have been treated for head and neck cancer. The incidence of CBS is rare and not commonly seen by emergency physicians. We review a case of a 68-year-old woman with a history of laryngectomy and chemo-radiation therapy presenting with massive oral bleeding and hypotension. Her course and treatments are highlighted, literature referring to CBS are described and we reintroduce the approach of managing such a patient in the emergency department.

174–176

Authors: Nurhayati Abdul Kadir, Syed Shoeb Ahmad, Shuaibah Abdul Ghani, Madusudhan Paramananda

Periorbital necrotizing fasciitis is a rare but potentially fatal infection. It is most commonly caused by Gram-positive group A b-haemolytic Streptococci and rarely by fungal infections. In this report, we present a rare case of periorbital necrotizing fasciitis caused by Aspergillus species in an immunocompromised patient. He presented to us with a history of a slowly progressive eyelid necrosis leading to a loss of vision in one eye. The patient was started on an antibiotic and subsequently, surgical debridement and enucleation were performed. A few days post-operatively, yellow white mould colonies were noted to grow on the wound surface. Microbiology cultures identified them as Aspergillus species and intravenous amphotericin B 10 mg was added daily. However, despite the extensive medical and surgical treatments, he failed to respond and succumbed from septicaemia and multi-organ failure.

178

Authors: Beuy Joob, Viroj Wiwanitkit

No