Journal of Acute Disease

266-273

Authors: Adrian Angel Inchauspe

This risk management project aims to apply a global preventive and predictive measure in potential victims of acute death and heart failure. Among the main causes are identified sub-diagnosed genetic mutations; prescription, interaction, self-medication or abuse of suspected drugs due to internet prospect's consult; and a parasitic pandemia, the Chagas disease (over 100000000 population is potentially infected worldwide). Promoting a global extensive determination of the torsadogenic index which was successfully published in Frontiers of Pharmacology Journal, will allow to monitor general population, set security patterns to categorize silent high risk groups of serious prognosis of tachyarrhythmias. For this purpose, applications of known QT determinations are proposed, recommending Dr. Rautaharju's formula, actually improved with gender adult versions. Torsadogenic index will allow to establish an individual traceability, obtain comparative samples that are alert to possible QT enlargements. Thus, torsadogenic index results a valuable, simple and costless resource to consider in the fight against acute death and cardiac arrest. Torsadogenic index represents a global indicator capable of predicting and preventing acute death and heart failure for most relevant reasons.

277-279

Authors: Somsri Wiwanitkit, Viroj Wiwanitkit

Acute hemorrhagic disease is an important problem in medicine that can be seen in many countries, especially those in tropical world. There are many causes of acute hemorrhagic disease and the viral infection seems to be the common cause. The well-known infection is dengue, however, there are many new identified viruses that can cause acute hemorrhagic diseases. In this specific short review, the authors present and discuss on those new virus diseases that present as “acute hemorrhagic fever”.

287-291

Authors: Poh-Chin Lai, Chun Bong Chow, Ho Ting Wong, Kim Hung Kwong, Shao Haei Liu, Wah Kun Tong, Wai Keung Cheung, Wing Leung Wong, Yat Wah Kwan

Objective: To explore socio-demographic data of the population as proxies for risk factors in disease transmission modeling at different geographic scales. Methods: Patient records of confirmed H1N1 influenza were analyzed at three geographic aggregation levels together with population census statistics. Results: The study confirmed that four population factors were related in different degrees to disease incidence, but the results varied according to spatial resolution. The degree of association actually decreased when data of a higher spatial resolution were used. Conclusions: We concluded that variables at suitable spatial resolution may be useful in improving the predictive powers of models for disease outbreaks.

298-304

Authors: Jacob Kehinde Akintunde, Olakunle Enock Bolarin

Objectives: To evaluate the toxicity of lisinopril in liver of male rats and its reversal effect of garlic capsule (GAR) and selenium-vitamin A, vitamin B, vitamin C (SACE). Methods: Thirty five adult male wistar rats were randomly assigned into 5 groups of 7 animals per group. Group I serves as the control, animals in Groups II, III, IV and V received 28 mg/kg body weight of lisinopril via oral route. Group III was co-treated with GAR at therapeutic dose of 250 mg/kg body weight per day. Group IV was co-treated with SACE at dose of 500 mg/kg body weight. Lastly, group V was co-treated with GAR and SACE at doses of 250 and 500 mg/kg body weight respectively, and the experiment last for 8 days. Results: Administration of lisinopril caused systemic toxicity in liver as well as adverse histopathologic changes in the tested tissue. While GAR and SACE significantly (P < 0.05) reversed the toxic effects induced by lisinopril. Conclusions: Collectively, the results suggest that therapeutic dose of lisinopril elicits toxicity in male rats through induction of oxidative damage and depletion of cellular adenosine triphosphate. The reversal effects of GAR and SACE during lisinopril treatment suggest that these antioxidants may find clinical application in cellular damage involving ROS and adenosine triphosphate.

309-315

Authors: Muhammad Kifayatullah, Mohd. Shahimi Mustafa, Pinaki Sengupta, Md. Moklesur Rahman Sarker, Arindam Das, Sreemoy Kanti Das

Objective: To evaluate the safety dose range of ethanolic extract from the leaves of Pericampylus glaucus (Lam.) Merr. by acute and sub-acute oral toxicity study on animal model. Methods: The acute and sub-acute toxicity study was carried out as per Organization for Economic Co-operation and Development guidelines 423 and 407. In acute toxicity study, the oral dose (300, 2000 and 4000 mg/kg) of tested plant extract was administered to three groups in single dose and general behavior, adverse effects and mortality were determined up to 72 h and compared to normal group. In sub-acute study, the tested crude plant extract was administered orally at doses of 600 and 1000 mg/kg for 28 days to the two animals groups and their body weight, hematological, serum hepatic biochemical parameters were evaluated and compared to normal group by sacrificing all group animals. Results: In acute toxicity, all treated groups’ revealed neither mortality nor any significant alteration in behavior only drowsiness, sedation and lethargy were observed in two group, i.e. 2000 and 4000 mg/kg of the tested plant extract. In sub-acute toxicity study no change in hematological, biochemical parameter and organ body weight were observed during study compared to the normal group. The kidney function parameters [serum glutamic-oxaloacetic transaminase (aspartate transaminase), serum glutamic pyruvic transaminase (alanine transaminase)] were significantly increased following administration of tested crude plant extract (600, 1000 mg/kg). Conclusions: The result indicates that the oral administration of Pericampylus glaucus (Lam.) Merr. extract did not produce any significant toxic effect in BALB/c mice. Hence, the extract can be utilized safely for therapeutic use in pharmaceutical formulations.

322-326

Authors: Bogdan Stoica, Sorin Paun, Ioan Tanase, Ionut Negoi, Mircea Beuran

Objective: To analyze trauma epidemiology, pattern of lesions or death profile in a level I east-European trauma center. Methods: Prospective observational study of patients admitted to a level I east-European trauma center and enrolled in our trauma registry, between January 2012 to January 2013, was conducted, with the inclusion criteria: (1) trauma lesions, (2) new injury severity score (NISS) higher than 15. Results: There were 141 patients admitted during the study interval, including 102 (72.3%) males, with a mean age of (43.52 ± 19.00) years, and a mean NISS of 27.58 ± 11.32. The trauma etiology was traffic-related injuries 101 (71.6%), falls 28 (19.9%) and crushing injuries 7 (5.0%). Only one case of gunshot wound was encountered in our study. Out of traffic-related injuries, the automobiles were involved in 56 (55.4%) and motorcycles in 9 (8.9%) patients. The bicyclists accounted for 2 (2.0%) of patients and pedestrians hit by vehicles were in 33 (32.7%) cases. High-velocity falls were found in 7 (25.0%) patients, whereas low-velocity falls accounted for 21 (75.0%) of cases. The overall mortality was 30.00%, and these patients presented the mean NISS of 37.63. Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

331-334

Authors: Gabriele Falzarano, Antonio Medici, Predrag Grubor, Milan Grubor, Luigi Meccariello

Objective: To investigate that if the hybrid external fixation is the definitive treatment and management of tibial extra articular and intra-articular pilon fractures of the adult in emergency. Methods: We treated 237 cases of pilon fractures using hybrid external fixation with or without minimal osteosynthesis from February 1999 to December 2014. All fractures were classified according to the Association for the Study of Internal Fixation. The three groups were represented by 108 patients (45.5%) for the Type A; 75 patients (31.8%) for Type B and 54 patients (22.7%) for Type C. Road accidents [118 patients (50.0%)] were the most common cause of tibial pilon fractures. Results: According to a mean follow-up of 7.3 years we had bone healing after 4.8 months from surgery in the 61.18% of the patients. The results were subjectively excellent, while the 54.00% were objectively excellent according to Ovadia and Beals score, and the results showed 29 complications. Conlusions: From our data hybrid external fixation with or without minimal fixation is a good surgical method to treat pilon fractures.

338-340

Authors: Wee-Min Teh, Mohtar Ibrahim

A 53-year-old male was referred from another eye hospital for right eye corneal perforation secondary to infective keratitis. A penetrating keratoplasty was performed for tectonic purposes. Forty eight hours after penetrating keratoplasty, he developed a band keratopathy located at the interpalpebral area of the corneal button. Despite stopping topical and systemic ciprofloxacin which could have contributed to this, the band keratopathy became more severe. Surgical debridement of the band keratopathy was done and there was no recurrence after that. This case of acute band keratopathy is an uncommon condition that develops within days to weeks of a particular insult to the eye. Various offending medications have been implicated, and treatment options include chelation therapy, surgical debridement and penetrating keratoplasty. Recurrence is common despite treatment and the cessation of possible offending medications. As such, it is prudent to be aware of and recognise the early symptoms and signs of this potentially sight-threatening condition.

344-346

Authors: Alexander John Scumpia, Megan Elizabeth Dekok, Daniel Michael Aronovich, Gurpaul Bajwa, Randy Barros, Randy Katz, Jordan Ditchek

Acute chest pain resulting in spontaneous idiopathic hemomediastinum is a rare, potentially life-threatening occurrence. Acute chest pain is a common chief complaint of patients, accounting for 2.4%–6.0% of adult emergency room visits. The clinician's differential diagnoses for acute chest pain rarely include complications of hiatal hernias. An 83-year-old male presented with acute chest pain and was emergently diagnosed with hemomediastinum secondary to spontaneous gastric mesenteric vessel rupture due to a non-strangulated hiatal hernia after physical exertion.

173-177

Authors: Rudolf Schiessel

This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

180-185

Authors: Huseyin Koçak, Cuneyt Çaliskan, Edip Kaya, Omer Yavuz, Kerim Hakan Altintas

Objective: To determine certain behaviors regarding preparation of Canakkale 112 ambulance service personnel towards emergency situations and disasters. Methods: This study is an epidemiological descriptive study. The population of the study consists of 281 people working for Command Control Center and Emergency Medical Services Station of Canakkale 112 Ambulance Service. About 176 people agreed to participate in the study were interviewed within the scope of the study. Necessary information was obtained by a survey. In the statistical analysis of the study, descriptive statistics, Mann–Whitney, Kruskal–Wallis and Chi-square tests were used. Results: The participation rate of the study was 62.6% (176 people). The participants were in the range of 17–64 years of age. The average age of the participants was (31.6 ± 9.1) years. About 54% of the participants (95 people) were under the age of 29 and 54% of them (95 people) were male, 23.3% of them (41 people) held a bachelor degree and 35.7% (63 people) of them were Emergency Medical Technicians, respectively. In the study, a statistical relationship was found between some questions of the survey and some variables such as age, gender, degree, membership status for nongovernmental organizations, experience of emergency situations, being trained against disasters and desire to have such a training (P < 0.005). Conclusions: As a result of the study, a significant relationship was found between being trained related to disaster and emergency situations and development of positive attitudes about training for disasters and emergencies. This indicates that people, no matter what educational level they are in, have to be trained for disasters and emergencies.

196-201

Authors: Sotiris Kakavas, Evangelos Balis, Angeliki Papanikolaou, Nikolaos Tatsis, Marousa Kouvela, Georgios Tatsis

Objective: To assess the thyroid function in patients with acute pulmonary embolism, in order to evaluate the prognostic value of thyroid hormones. Methods: We studied 31 consecutive patients with acute pulmonary embolism. Measured variables upon admission included the ratio of the partial pressure of oxygen in arterial blood to the inspired oxygen fraction (PaO2/FiO2), acute physiology and chronic health evaluation II score, risk stratification indices and plasma levels of triiodothyronine, free thyroxine, and thyroid stimulating hormone. Results: Plasma levels of triiodothyronine were below normal level in 7 patients (22.6%). Plasma triiodothyronine correlated with PaO2/FiO2 (P < 0.05) and with acute physiology and chronic health evaluation II score (P < 0.01). In four patients (12.9%) who died, triiodothyronine levels were significantly lower (P < 0.01) than that in patients who survived. In contrast both groups had similar levels of free thyroxine, and thyroid stimulating hormone. Moreover, triiodothyronine levels negatively correlated with serum markers of right ventricular dysfunction. Accordingly, in multivariate logistic regression analysis, the only factors independently associated with an increased risk of death were triiodothyronine and PaO2/FiO2. Conclusions: Our preliminary data suggest that low plasma triiodothyronine is an independent predictor of in-hospital death in patients with acute pulmonary embolism.

205-209

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

Objective: To characterize the pattern of mortality for major trauma patients. Methods: Retrospective study of major trauma patients admitted in a Level I trauma center, during the latest 5 years was conducted. Selection criteria included (1) injury severity score (ISS) > 16 and (2) in-hospital death. Results: There were 47 patients, with a mean age of 37.2 ± 19.9 years. The mean ISS was 37.6 ± 12.7 and the mean revised trauma score was 4.5 ± 2.2. Computed tomography scan on admission was done in 18 (38%) patients, 20% being hemodynamically unstable (P = 0.001). The diagnostic peritoneal lavage was performed in 10 (22%) cases, 23.3% being hemodynamically unstable (P > 0.05). The mean number of intraabdominal injuries was 3. The need for transfusion was 8.2 ± 6.7 units. The mean time to death was 4.9 days. Early death was secondary to hemorrhagic shock (HS) (ISS = 35.2 ± 15.9, P > 0.05, revised trauma score = 3.74 ± 2.70, P = 0.008) and multiple organ failure (ISS = 36.6 ± 14.1, P > 0.05, revised trauma score = 5.94 ± 1.34, P = 0.008) was the cause for later mortality. Combined liver and splenic injuries were found in 13 cases, with secondary death through HS in 5 and multiple system organ failure (MSOF) in 8 cases. Combined liver, splenic and kidney injuries were found in 5 cases (cause of death: HS 2 cases, MSOF 3 cases). A total of 14 patients had associated head, thorax, abdomen and extremity trauma (cause of death: cerebral trauma 6 cases, MSOF 5 cases, HS 2 cases); 5 patients had thorax and abdomen trauma (cause of death: HS 5 cases); 8 patients had thorax, abdomen and extremity trauma (cause of death: MSOF 5 cases, HS 3 cases); 3 patients had abdomen and extremity trauma (HS 2 cases). We did not find a trimodal time distribution for mortality. Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments.

214-217

Authors: A.A. Ahmedov, B.M. Shakirov, H.K. Karabaev

Objective: To determine the value of the procalcitonin test used for early diagnosis of sepsis and to study the course and treatment of burn sepsis in patients with severe burns. Methods: Eighty patients in the Burn Department of Republican Scientific Centre of Emergency Medical Care, aged 17–75 years with burn injuries covering 30%–85% of the body surface, were enrolled in the study. Procalcitonin is marker of sepsis, procalcitonin > 2 ng/mL, sensitivity −89%, specific feature −94%. Results: The result showed that among septic patients with severe burns, rational use of intensive therapy for burn sepsis and septic shock in combination with parentrial ozonotherapy resulted in decreases of syndrome of poly organ insufficiency and lethal outcomes from 70% accordingly. The result allows the conclusion that the treatment examined leads to a significant increase in survival coefficient. Conclusions: This in turn confirms the efficacy of early necrectomy and auto dermoplasty of deep burn wounds in victims with sepsis.

222-225

Authors: Jangala Mohan Sidhartha, Aravinda Reddy Purma, Lomati Venkata Pavan Kumar Reddy, Nagaswaram Krupa Sagar, Marri Prabhu Teja, Meda Venkata Subbaiah, Muniswami Purushothaman

Objective: To assess the risk factors leading to medical complications of hemorrhagic stroke. Methods: We conducted an observational study in neurology, emergency and general medicine wards at a tertiary care teaching hospital in Kadapa. We recruited hemorrhagic stroke patients, and excluded the patients have evidence of trauma or brain tumor as the cause of hemorrhage. We observed the subjects throughout their hospital stay to assess the risk factors and complications. Results: During period of 12 months, 288 subjects included in the study, 89% of them identified at least 1 prespecified risk factor for their admission in hospital and 75% of them experienced at least 1 prespecified complication during their stay in hospital. Around 47% of subjects deceased, among which 64% were females. Conclusions: Our study has assessed that hypertension followed by diabetes mellitus are the major risk factors for medical complications of hemorrhagic stroke. Female mortality rate was more when compared to males.

230-235

Authors: Adewale Adewuyi, Chiagoziem A. Otuechere, Zaynab O. Oteglolade, Oluwabukola Bankole, Emmanuel I. Unuabonah

Objective: To evaluate the safety profile and antioxidant activity of fatty hydroxamic acid (FHA) from the seed oil of Cyperus esculentus (C. esculentus). Methods: FHA was synthesized from the seed oil of C. esculentus via a two-step reaction system. The FHA was later subjected to antioxidant activity test using 2, 2- diphenyl-1-picyrl hydrazyl assay. Additionally, adult male Wistar rats were randomly assigned to four groups of five rats each and were orally administered with FHA at 0, 5, 15 and 50 mg/kg for seven days. Clinical observations and serum biochemical parameters were assessed to monitor treatment–related adverse effects in the rats. Results: Fourier transform infrared spectra showed that FHA was synthesised from the seed oil of C. esculentus. The antioxidant property of FHA increased as the concentration reduced below 0.05 mg/mL. Result of oral administration of FHA revealed no adverse effect levels at the dose of 5 mg/kg/day. However, the adverse effects seen in rats receiving 15 mg/kg/day (the least observed adverse effect level) were significant increase in alkaline phosphatase activity, triglycerides, and creatinine levels. Moderate hyperalbuminemia and hypoalbuminemia resulted in an increased albumin/globulin ratio. These effects might be the result of a physiological response to exposure to a very high level of FHA which is not part of the normal diet, and are most likely not toxicologically relevant. Conclusions: C. esculentus has been presented as a potential source of feed stock for the synthesis of a relatively cheap and non toxic FHA which has antioxidant and free-radical scavenging activity.

249

Authors: Sora Yasri, Viroj Wiwanitkit

No.

252-254

Authors: Chakroun-Walha Olfa, Rejeb Imen, Kammoun Leila, Ksibi Hichem, Ayadi Adnane, Chaari Mourad, Chaari Adel, Kallel Choumous, Rekik Noureddine

Intracerebral hemorrhage (ICH) is frequent pathology in emergency departments. Coagulopathies leading to ICH are rare. We describe here the case of diagnosis of a chronic myeloid leukemia from ICH in emergencies.

91-96

Authors: Diaa-Eldin Taha, Bassem S. Wadie

Forty years ago, autologous fascial slings became the gold standard in the treatment of genuine stress incontinence. In 1996, a synthetic material sling was introduced to the urogynecological literature known as tension-free vaginal tape. Some years later, another synthetic tape was introduced through a novel trajectory: transobturator. Due the conception of most polypropylene synthetic tapes, scores of devices, applicators and tape designs evolved. Now, with reports surfacing in the urologic literature on the adverse events of synthetic tapes and their potentially fa tal complications, it is prudent to endeavor once more the place of autologous pubovaginal sling. This review addresses the evolution of pubovaginal slings and milestones of its journey to its current position in surgery of incontinence.

101-106

Authors: Michael A. Puskarich, Utsav Nandi, Nathan I. Shapiro, Stephen Trzeciak, Jeffrey A. Kline, Alan E. Jones

Objective: To externally validate the diagnostic and prognostic value of three previously identified microRNAs in emergency department patients with sepsis. Methods: Patients meeting consensus criteria for sepsis and septic shock were compared to controls. Three microRNAs (miR-150, miR-146a, and miR-223) were measured using real-time quantitative PCR, and levels of miRNAs were compared among the three cohorts. The association between miRNAs and both inflammatory markers and Sequential Organ Failure Assessment (SOFA) score were compared. To assess the prognostic value of each miRNA, unadjusted and adjusted logistic regression models were constructed using in-hospital mortality as the dependent variable. Results: Ninetythree patients were enrolled; 24 controls, 29 with sepsis, and 40 with septic shock. We found no difference in serum plasma miR-146a or miR-223 between cohorts, and found no association among these microRNAs and either inflammatory markers or SOFA score. miR-150 demonstrated a significant correlation with SOFA score (ρ= 0.31, P=0.01) and IL-10 (ρ= 0.37, P=0.001), but no IL-6 or TNF-α (P=0.046, P=0.59). Logistic regression demonstrated miR-150 to be independently associated with mortality, even after adjusting for SOFA score (P=0.003) or initial lactate (P=0.01). Conclusions: miR-146a and miR-223 demonstrated no significantly diagnostic or prognostic ability in this cohort. miR-150 was associated with inflammation, severity of illness, and mortality. Given the independent predictive value of miR-150, additional research regarding its role in sepsis is warranted.

112-116

Authors: Andreas Berner, Tariq Saleem Alharbi, Eric Carlström, Amir Khorram-Manesh

Objective: To develop a validated and generalized collaborative tool to be utilized by high reliability organizations in order to conduct common resource assessment before major events and mass gatherings. Methods: The Swedish resource and risk estimation guide was used as foundation for the development of the generalized collaborative tool, by three different expert groups, and then analyzed. Analysis of inter-rater reliability was conducted through simulated cases that showed weighted and unweight κ-statistics. Results: The results revealed a mean of unweight κ-value from the three cases of 0.44 and a mean accuracy of 61% of the tool. Conclusions: A better collaboration ability and more accurate resource assessment with acceptable reliability and validity were shown in this study to be used as a foundation for resource assessment before major events/mass-gathering in a simulated environment. However, the result also indicates the challenges of creating measurable values from simulated cases. A study on real events can provide higher reliability but needs, on the other hand, an already developed tool.

120-128

Authors: Santhrani Thakur, Pradeepthi Chilikuri, Bindu Pulugurtha, Lavanya Yaidikar

Objective: To investigate the protective effect of Hippophae salicifolia D.Don (H. salicifolia) berries extract against cerebral reperfusion injury induced neurobehavioral and neurochemical changes in a rat model of middle cerebral artery occlusion (MCAO). Methods: Rats were pretreated with alcoholic extract of H. salicifolia (250 and 500 mg/kg) for 14 d and focal cerebral ischemia was induced by MCAO. After 60 min of MCAO, reperfused for 24 h, a battery of behavioral tests were assessed the extent of neurological deficits. Infarct volume and brain edema were measured in 2,3,5-triphenyltetrazolium chloride stained brain sections. TNF-毩, oxidative stress parameters like reduced glutathione, calcium, glutamate, malondialdehyde and apoptotic parameters like caspase-3, and caspase-9 were estimated in the brain homogenates. Results: Pretreatment with alcoholic extract of H. salicifolia at doses of 250 and 500 mg/kg significantly improved the neurobehavioral alterations and reduced the infarct volume, edema induced by ischemia reperfusion injury. H. salicifolia significantly prevented ischemia induced increase in malondialdehyde, glutamate, calcium, caspase-3, caspase-9 and TNF-毩levels as compared to ischemic animals. Conclusions: Our results indicate that H. salicifolia mitigated the ischemia reperfusion induced neuronal damage.

135-140

Authors: Jayesh B. Dhodi, Deepavali R. Thanekar, Snehal N. Mestry, Archana R. Juvekar

Objective: To elucidate the mechanism of action of methanolic extract of Carissa carandas fruits (MCCF) in attenuation of diabetic nephropathy using gentamicin induced nephrotoxicity model. Methods: Extract was daily administered to Sprague Dawley rats at doses of 100, 200 and 400 mg/kg for 8 days along with intramuscular injection of gentamicin (80 mg/kg). After completion of the study, serum was analyzed for blood urea nitrogen, albumin and creatinine; urine (24 h) was analyzed for albumin and creatinine. Kidney was evaluated for its biochemical and morphological changes. Results: Extract at doses of 200 and 400 mg/kg significantly normalized the nephrotoxic biomarkers in serum and urine and increased the kidney antioxidant activities which were altered due to gentamicin toxicity. The histological findings reveal that MCCF was capable of protecting the kidney against gentamicin toxicity. Conclusions: Extract ameliorated oxidative stress generated by gentamicin administration, which is one of the mechanisms for its preventive action against diabetic nephropathy.

147-151

Authors: Heda Melinda Nataprawira, Evelyn Phangkawira

Objective: To describe the representation of pertussis diagnosis in children. Methods: A retrospective observational study was performed on pediatric pertussis and pertussis-like syndrome registry for children <14 years of age documented from October 2008 to December 2014 in Hasan Sadikin Hospital, Indonesia. Demographic data, signs and symptoms at presentation, case definition (probable, confirmed), possible pertussis contact, pertussis vaccination status, results of Bordetella pertussis (B. pertussis) culture, complications, and outcome were recorded. Results: Sixty-one probable and two confirmed pertussis were documented. Male and female ratio was 1:1, mostly presented with shortness of breath, 24 (38%) subjects had posttussive vomiting, 10 (16%) had whooping-cough. Ten patients (16%) were reported to have adult possible pertussis contact. Only 2 infants had previous pertussis vaccination. All subjects presented in the second week of illness were all diagnosed as bronchopneumonia but two. The mean age was 6 months, ranging from 0−50 months. One subject required mechanical ventilation. B. pertussis culture was performed only in 35 (56%) subjects but positive only in two. There were no fatal cases, 55 (87%) including the subject who need mechanical ventilation had good outcome. Conclusions: Mostly patients were admitted on paroxysmal phase when no more active B. pertussis could be found from nasopharyngeal secret. A rigorous history taking particularly excessive cough, posttussive vomitting, and pertussis vaccination status need to be taken into account.

155-157

Authors: Koh Shao Hui

Simultaneous bilateral posterior elbow dislocations occur rarely with only 14 cases being reported in the literature so far. Of these cases, none occurred in a patient who was pregnant. No cases of bilateral elbow dislocation with a distal radial fracture-dislocation have also been described. A case of a pregnant patient presenting with bilateral elbow dislocation, right wrist fracturedislocation is reported here and the issues involved in managing such a case are discussed.

162-164

Authors: Suraida AR, Evelyn-Tai LM, Madhusudhan, LK Thavaratnam, Mohtar Ibrahim, Wan Hazabbah WH

Herpes zoster is a reactivation of the varicella zoster virus (VZV), which may remain dormant in the dorsal root ganglion of the trigeminal nerve for decades after the patient’s initial exposure. The ophthalmic branch of the trigeminal nerve, i.e., the innervation to the ocular structures, is one of the most commonly involved dermatomes, giving rise to herpes zoster ophthalmicus (HZO). A 10-year-old indigenous Malaysian girl presented with a complaint of painful blurring of vision in the right eye for one week. It was followed a few days later by cutaneous vesicular eruptions over the right side of her face and nose and drooping of the right upper lid, associated with double vision. In children, the disease usually follows a mild course, resolving without residual damage. However, this child achieved a best corrected visual acuity of only 6/36 in the affected eye due to corneal scarring. The rashes healed by formation of disfiguring keloids over the right nasal area. This is another rarely reported complication of HZO in immunocompetent individuals.

168

Authors: Eva Genbrugge, Jayant R. Kichari

Intercostal lung herniation is an uncommon entity, defined as protrusion of lung tissue between the ribs. The disease is mostly diagnosed either congenitally or acquired following post-surgery or after chest wall trauma. A spontaneous lung herniation is rarely described.

7-11

Authors: Ioannis N. Mavridis, Maria Meliou, Efstratios-Stylianos Pyrgelis

Troponin (tr) elevation in aneurysmal subarachnoid hemorrhage (SAH) patients is often difficult to be appropriately assessed by clinicians, causing even disagreements regarding its management between neurosurgeons and cardiologists. The purpose of this article was to review the literature regarding the clinical interpretation of tr elevation in SAH. We searched for articles in PubMed using the key words: “troponin elevation” and “subarachnoid hemorrhage”. All of them, as well as relative neurosurgical books, were used for this review. Some type of cardiovascular abnormality develops in most SAH patients. Neurogenic stunned myocardium is a frequent SAH complication, due to catecholamine surge which induces cardiac injury, as evidenced by increased serum tr levels, electrocardiographic (ECG) changes and cardiac wall motion abnormalities. Tr elevation, usually modest, is an early and specific marker for cardiac involvement after SAH and its levels peak about two days after SAH. Cardiac tr elevation predictors include poor clinical grade, intraventricular hemorrhage, loss of consciousness at ictus, global cerebral edema, female sex, large body surface area, lower systolic blood pressure, higher heart rate and prolonged Q-Tc interval. Elevated tr levels are associated with disability and death (especially tr >1 μg/L), worse neurological grade, systolic and diastolic cardiac dysfunction, pulmonary congestion, longer intensive care unit stay and incidence of vasospasm. Tr elevation is a common finding in SAH patients and constitutes a rightful cause of worry about the patients’ cardiac function and prognosis. It should be therefore early detected, carefully monitored and appropriately managed by clinicians.

18-22

Authors: Hamid Karimi, Kamal Seyed Forootan, Gholamreza Moein, Seyed Jaber Mosavi, Batol Ghorbani Iekta

Objective: To study the result of nerve repair in the two mentioned techniques in rats to fi nd the proper answer to the existing disagreement. Methods: Twenty adult male rats were included in treatment group. Acutely disconnected sciatic nerve was repaired by Epineural technique in half of the rats; in the other half perineurial technique was applied. After 80 d, the number of grown axons of distal on the repair site was calculated through the use of an optical microscope. Additionally by studying the foot print of the rats the return of neural motor activity was evaluated. Results: In epineural group, SFI index was: (56.33±32.30) and in perineurial group: (55.71±30.31); P value=0.930 with their being no difference between these two techniques of surgery. However, in comparing epineural and perineurial groups in the groups themselves, statistical tests showed a significant difference showing functional improvement in comparison with the day before surgery P value=0.0001. Statistical tests showed that the average of axons' number distal to anastomosis site in the epineural group was (349±80) and in the perineurial group was (405±174). These groups have no significant difference regarding the number of axons (P value=0.36). Conclusion: The results of epineural and perineurial surgery techniques show no difference in nerve repair, SFI index, or axon counting in distal part.

28-31

Authors: Yusuf Alkali, A. K. Gana, Abdulkadir A, Nzelibe C. Humphrey

Objective: To study the inhibitory activity of ethanolic extract from Mimosa pigra and Ipomoea asarifolia against Trypanosoma evansi (T. evansi) calcium dependent phospholipase A2. Methods: The calcium dependent phospholipase A2 (E C 3.1.1.4) enzyme was isolated from T. evansi and purified to electrophoretic homogeneity under non denaturing conditions. It was solubilized from T. evansi cells recovered from white albino rats which were previously inoculated by intraperitoneal injection of infected camel blood. Two indigeneous ethanolic plant extracts used locally for treatment of trypanosomiasis were tested for the inhibition of phospholipases A2. Results: Double reciprocal plots of the initial velocity data of the inhibition by the indigenous plant extracts revealed a noncompetitive pattern of inhibition for the Ipomoea asarifolia and a competitive inhibition for Mimosa pigra in a dose dependent fashion. The extrapolated inhibition binding constant (Ki) of these extracts were found to be 2.0×102 µg/mL and 1.12×102 µg/mL respectively. Conclusions: The low Ki values obtained for these extracts towards this enzyme are an indication of high affinity of the extract or the active components (present in the plants) are for these enzyme and therefore, could be explored to serve as a cheap source of T. evansi PLA2 antidote and as well help in designing a novel drug with high efficiency.

37-43

Authors: Andreas Berner, Tariq Saleem Alharbi, Eric Carlström, Amir Khorram-Manesh

Objective: To develop a validated and generalized high reliability organizations collaborative tool in order to conduct common assessments and information sharing of potential risks during mass-gatherings. Methods: The Swedish resource and risk estimation guide was used as foundation for the development of the generalized collaborative tool, by three different expert groups, and then analyzed. Analysis of inter-rater reliability was conducted through simulated cases that showed weighted and unweight κ-statistics. Results: The results revealed a mean of unweight κ-value from the three cases of 0.37 and a mean accuracy of 62% of the tool. Conclusions: The collaboration tool, “STREET”, showed acceptable reliability and validity to be used as a foundation for high reliability organization collaboration in a simulated environment. However, the lack of reliability in one of the cases highlights the challenges of creating measurable values from simulated cases. A study on real events can provide higher reliability but need, on the other hand, an already developed tool.

48-50

Authors: María del Pilar Quiroga, José Daniel Charry, Nicolás Becerra, Juan Camilo Garcia, Eliana Karina Muñoz, Rodrigo Lara

Objective: To establish the risk factors associated to development of empyema posttraumatic in patients with chest trauma managed with closed thoracostomy. Methods: It was a descriptive and observational study of patients with chest trauma who were admitted between January 2013 and May 2014. The variables were evaluated and the results according to management with closed thoracostomy in patients with thoracic trauma was determined. Univariate analysis was performed and measures of central tendency were calculated. Results: In total 240 patients were analyzed. Among them, 10.4% (25) developed posttraumatic empyema. In patients who developed empyema, the mean age was 34.2 years, and the mean injury severity score was 20.6. It was identified as a risk factor closed chest trauma in 68% (17) and 84% coagulated hemothorax trauma. Empyema management thoracoscopy was in 100% of cases. Conclusions: The posttraumatic empyema is a complication that occurs in patients with thoracic trauma. One of the most important risk factors is coagulated hemothorax which could be identified and treated in time to avoid comorbidities during hospital stay.

54-58

Authors: Fahisham Taib, Bakht Jamal

Objective: To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized profo rma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients’ data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline; however, different antibiotic regimes were based on physician’s preferences. The sensitivity of the current method of UTI diagnosis remained at 64% when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.

63-67

Authors: A Haner, P Örninge, A Khorram-Manesh

Objective: To evaluate the outcome of physician-staffed ambulances in a pilot study. Methods: All physician-staffed ambulance missions conducted in Gothenburg, Sweden, in 2013 were retrospectively reviewed and evaluated for the type of missions and the need of a physician. Results: Out of 1381 physician-staffed missions, 511 were cancelled or managed by telephone. Around 239 (17%) missions required active intervention, of which only one was considered directly life-saving. Conclusions: Most of the missions neither required the interventional skills of a physician, nor could they be performed at distance. However, the added medical value of physicians was fo und to be in other prehospital situations, such as critical decision-making, staff education and research.

73-77

Authors: Mircea Beuran, Ionut Negoi, Sorin Paun, Valentina Negoita1, Bogdan Stoica, Ioan Tanase, Mihaela Vartic, Ruxandra Irina Negoi, Sorin Hostiuc

Objective: To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods: A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results: A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding fr om an internal iliac branch that was successfully angioembolized. Conclusions: Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.

83-84

Authors: Somsri Wiwanitkit, Viroj Wiwanitkit

The craniectomy is an important surgical management for the problem of acute neurological disorder. It is widely practiced by neurosurgeons around the world. The technique for craniectomy is various and there are many new reports concerning on the size of craniectomy. In this short article, the authors discuss on the important topics about neurosurgery “craniectomy size, mortality, outcome and complications.”