Journal of Acute Disease

267–270

Authors: Samuel Nkachukwu Uwaezuoke

This narrative review aims to appraise the sensitivity and specificity of novel biomarkers in identifying acute kidney injury (AKI) in children. Serum creatinine represents a poor traditional biomarker for AKI due to some limitations. Although alternative reliable biomarkers that would better identify individuals at high risk for developing AKI, identify AKI early enough, monitor its progression and patients' recovery, as well as identify those patients at higher risk for poor outcomes are not yet available in renal care, the search-light has recently been focused on various novel biomarkers, some of which could provide this information in time ahead. Several studies have established their predictive value. However, none of them could solely fulfill all the criteria of the ideal biomarker. Therefore, to increase their sensitivity and specificity and enhance the diagnosis of AKI, constellations of different biomarkers with specific features are probably required. In future, the diagnostic evaluation of AKI in intensive care units will have to undergo a paradigm shift from serum creatinine as the traditional biomarker to tissue-specific injury biomarkers. A panel of these novel biomarkers employed at the bedside setting will ultimately revolutionize the diagnosis and prognostication of AKI in children.

281–285

Authors: Zhi-Guo Li, Xia Zhou

Objective: To observe the correlation between the condition of patients with acute cerebral infarction and serum b2-microglobulin (b2-MG) levels. Methods: Patients with acute cerebral infarction and healthy physical examinees selected for the prospective study were included into the cerebral infarction group and control group, respectively. Clinical data were collected and the patients' condition were evaluated, and then the contents of the b2-MG, high sensitivity C reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-a (TNF-a), intercellular cell adhesion molecule-1 (ICAM-1) and soluble CD40 Ligand (sCD40L) in serum were tested. Results: The contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1, sCD40L in patients with acute cerebral infarction were obviously higher than those in cases of the control group. The severer the condition of the disease was, the higher contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L became. The greater the volume of cerebral infarction was, the higher the contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L were. The content of serum b2-MG was positively associated with the contents of hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L. Conclusions: The level of serum b2-MG was abnormally elevated in the patients with acute cerebral infarction. The level of serum b2-MG can evaluate the severity of disease, infarction size and the degree of inflammation reaction in patients with acute cerebral infarction.

296–301

Authors: Bashir Lawal, Oluwatosin Kudirat Shittu, Florence Inje Oibiokpa, Hadiza Mohammed, Sheriff Itopa Umar

Objective: To evaluate the antimicrobial and toxicological effects of aqueous garlic (Allium sativum) bulbs extract in wister rat using biochemical and hematological parameters. Methods: A total of 20 wister rats were assigned into four (A–D) groups of five animals each. Group A served as the control and was administered 1 mL of distilled water. Groups B–C were given 300, 600 and 1 200 mg/kg body weight of garlic (Allium sativum) bulbs extract for 5 weeks. Results: Garlic bulbs extract produced significant inhibitory activities against all bacteria tested at concentrations of 120 and 160 mg/mL. However, at concentration of 80 mg/mL, the extract had no inhibitory activities against Klebsiella pneumoniae and Salmonella typhi. The minimal inhibitory concentration and minimal bactericidal concentration ranged between 80–120 mg/mL and 120–160 mg/mL respectively. Toxicological study revealed that the extract did not cause any significant (P > 0.05) alteration to serum aspartate transaminase, alkaline phosphatase activities, total bilirubins, Na, K, creatinine, red blood cell, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration, granulocyte and organs-body weight ratio. However, serum alanine transaminase activities, total proteins, direct bilirubins, Cl− concentrations and body weight gain were significantly (P < 0.05) lowered while the concentrations of urea, albumin, white blood cell, mean corpuscular hemoglobin and mean corpuscular volume count were raised significantly (P < 0.05) in rats dosed with 600 and 1 200 mg/kg of the extract. However, at a dose of 300 mg/kg only, the concentrations of Cl−, urea and albumin were mildly altered. Conclusions: The extract caused selective changes in some biochemical parameters of organ function; however, since only mild alteration was observed at a dose of 300 mg/kg, the garlic bulb may be considered to be relatively safe and could be explored as an oral remedy at this dose.

307–310

Authors: Zheng-Wei Wang, Pei-Jun Ye

Objective: To analyze the characteristic of coagulation function in non-small cell lung cancer patients with acute cerebral infarction as the initial symptom. Methods: Cases diagnosed as non-small cell lung cancer in our hospital from January 2015 to January 2016 were used for study. Fifteen cases with acute cerebral infarction as the initial symptom were included in experimental group. Thirty-three cases with no initial symptom on acute cerebral infarction were included in control group. Clinical data in patients of two groups were collected, including general information, coagulation function index, thrombelastogram index. Results: The prothrombin time (PT) [(9.69 ± 1.42) vs. (13.04 ± 1.96) s], activated partial thromboplastin time (APTT) [(30.14 ± 5.79) vs. (39.34 ± 7.63) s], international normalized ratio (INR) [(0.76 ± 0.10) vs. (1.35 ± 0.22)], coagulation reaction time (R) [(4.76 ± 0.79) vs. (6.11 ± 0.93) min], and blood clot formation time (K) [(1.73 ± 0.21) vs. (6.11 ± 0.93) min] in patients of experimental group were obviously lower than that of in control group. Fibrinogen (FIB) [(5.43 ± 0.89) vs. (2.14 ± 0.36) g/L], D-dimer [(0.84 ± 0.17) vs. 0.30 ± 0.06) mg/L], the maximum amplitude of thrombus (MA) [(65.62 ± 10.34) vs. (48.69 ± 8.61) mm], and a-angle [(68.12 ± 9.51) vs. (60.37 ± 10.29) deg] in patients of experimental group were obviously higher than that in control group. PT, APTT, INR, R value, and K value in patients of tumor node metastasis (TNM) Stage III–IV were significantly lower than that in TNM Stage I–II, and FIB, D-dimer, MA, aangle were all higher than that in patients of TNM Stage I–II. PT, APTT, INR, R value, K value in patients with lymphatic metastasis were significantly lower than that in patients with no lymph node metastasis, and FIB, D-dimer, MA, a-angle were obviously higher than that in patients with no lymph node metastasis. Conclusions: Patients with non-small cell lung cancer have hypercoagulability and hyperfibrinolysis with acute cerebral infarction as the initial symptom, and coagulation function involved in the development of lung disease.

315–325

Authors: Harini Chowdary Vadlamudi, Prasanna Raju Yalavarthi, Basaveswara Rao Mandava Venkata, Jyotsna Thanniru

Objective: To design solid self-microemulsifying drug delivery system (S-SMEDDS) of entacapone and evaluate for its anti-Parkinson's potentials. Methods: Solubility studies were performed in various vehicles i.e., oils, surfactants and co-surfactants and pseudo-ternary phase diagrams were plotted to understand the microemulsion formation region. Liquid self-microemulsifying drug delivery systems (SMEDDS) were developed using gingelly and rice bran oil as lipid vehicles, Tween 80 and Span 20 as surfactants and glycerin, propylene glycol as co-surfactants. They were characterized by Fourier transform infrared spectroscopy, pH, viscosity, zeta potential, polydispersibility index and droplet size analysis and evaluated for drug content, in-vitro release, in-vitro diffusion and ex-vivo permeation. Optimized liquid SMEDDS were converted into S-SMEDDS by adsorption and melt granulation procedures. Characterization by differential scanning calorimetry, SEM, micrometrics, reconstitution property, moisture content and evaluation by drug content, drug release kinetics and shelf-life were performed for S-SMEDDS. Parkinsonism was induced and pharmacodynamic potentials of S-SMEDDS were evaluated. Results: S-SMEDDS formulation AG8 had shown the highest drug release of 90.92% within 60 min. Pharmacodynamic studies also proved the efficiency of entacapone SSMEDDS against Parkinsonism. Conclusions: Entacapone S-SMEDDS is an effective drug delivery system that offers more predictable and extensive drug release with enhanced shelf-life in the treatment of acute Parkinsonism.

328–332

Authors: Kun Wang, Wen-Tao Wang, Jun Wang, Zhi Chen, Qing-Xin Song, Shi-Yue Chen, Qiang Hao, Da-Wei He,Hong-Xing Shen

Objective: To compare and analyze the predictive value of two kinds of classification methods, routine magnetic resonance imaging (MRI) and diffusion tensor tractography (DTT), on the diagnosis and prognosis in different degrees of acute cervical spinal cord injury (ACSCI). Methods: A total of 35 patients with ACSCI treated with surgery in our department from January 2013 to December 2014 were included and all patients had received MRI examination and diffusion tensor imaging examination before surgery. The motor score, sensory score and abbreviated injury scale (AIS) of American Spinal Injury Association were used to evaluate the neurological function of patients before and one year after surgery, respectively. Routine MRI was divided into 3 grades according to the compression and signals of spinal cords and DTT was also divided into 3 grades according to continuous levels of fibre bundle. The correlations between routine MRI grades and DTT grades and the neurological function of ACSCI before surgery and after surgery were analyzed, respectively. Results: There were no correlations between MRI grading and the motor score, sensory score and AIS of patients with ACSCI before surgery and after surgery. DTT grading showed no relations with the motor score, sensory score before surgery but were related to AIS before surgery. DTT grading was all related to the motor score, sensory score and AIS after surgery. Conclusions: The noninvasion of DTT showed spinal nerve fibers has a higher predictive value on the diagnosis and prognosis of ACSCI than routine MRI.

337–339

Authors: Alexander John Scumpia, Daniel Michael Aronovich, Megan Dekok, Katrina Lopez, Donny Perez

Hangman's fracture classically results from hyperextension/distraction of the upper cervical spine, causing the axis to break symmetrically across its pedicles or lateral masses and may involve the body of the vertebrae. Interestingly, Starr and Eismont described an atypical hangman's fracture where fracture lines are not parallel and may pass through the foramen transversarium unilaterally from a hyperextension and lateral side-bending injury, as the mechanism described herein. We present a case of an atypical hangman's fracture in a 73-year-old Caucasian female after being involved in a low-speed motor vehicle collision.

343–344

Authors: Yu-Hang Yeh, Yu-Jang Su

Ankylosing spinal disorders tend to fracture after minor trauma because of its changed biomechanical properties. Herein we presented an ankylosing spinal disorders case with cervical spine fracture in a trauma after neck protection and surgical airway application. On CT scan of cervical spine, ankylosing spondylitis with an extension C4–C5 fracture was found. The patients' family decided not to receive operation to immobilize his cervical spine, then he was admitted to our surgical intensive care unit. He was discharged against medical advice two months later with a permanent tracheostomy with ventilator dependence due to high-level spinal cord injury. Timely identification of unstable fractures is instrumental in avoiding adverse neurologic sequela.

348–349

Authors: Ethel Osei-Tutu, Ayokunle Osonuga

Incisional hernias complicate 2%–20% of laparotomies. They rarely eviscerate spontaneously, and when they do they pose a serious threat to the protruding bowel and the patient's life if timely intervention is not instituted. We reported a case of spontaneous rupture of an incisional hernia in a 56 years old female who underwent laparotomy twenty years before presentation to the Accident and Emergency Department of Cape Coast Teaching Hospital. She presented with a 4-h history of evisceration of bowel after bouts of cough. An emergency laparotomy and hernia repair was done after initial resuscitation. The patient's recovery was uneventful and shortly after tested positive for HIV I. She was however lost to follow up. Neglect for early operative intervention or delay in seeking the treatment for an incisional hernia increases the risk of rupture.

355–356

Authors: Ulvi Meral, Murat Zor, Orhan Ureyen, Nisa Cem Oren, Hilmi Gungor

Crossed renal ectopia is a rare anomaly in urological clinical practice. Patients with this anomaly are usually asymptomatic. Herein, we reported a case of acute appendicitis in a patient with crossed renal ectopia. A 22-year-old man with abdominal pain admitted to the emergency department. His physical examination revealed muscular defense and painful mass at the lower quadrant. Abdominal ultrasonography revealed crossed renal ectopia with no sign of stones and acute appendicitis. Tomography confirmed crossed renal ectopia but not acute appendicitis. On-going clinical symptoms lead to surgical intervention and acute appendicitis diagnosis. The patient was treated with appendectomy with no perioperative complications. Appendectomy is a common surgical procedure in surgical clinical practice. Acute abdominal pain must be managed carefully in patients with unusual anatomy. Also surgeons should be aware of ectopic organs in surgical procedures, to avoid iatrogenic intraoperative injuries.