Journal of Acute Disease

445–449

Authors: Gentian Vyshka, Dritan Muzha, Meri Papajani, Maksim Basho

Paraplegia and spinal cord injuries are issues of major concern to the actual medicine. But recent advances have raised hopes for a better prognosis, which has always been poor or infaust since medicine was practiced. However and interestingly enough, some concepts and definitions on the occurrence have survived for millennia. Once encountered as an issue, traumatic or non-traumatic paraplegia needs a multidisciplinary approach and a careful staging of the problem. Different scales are available with Frankel's and American Spinal Injury Association most widely used as alternatives or complementary tools. The authors discuss therapeutic options with a special focus on the stem cell therapy which has seen an impressive increase on the number of trials for a successful treatment. Sourcing and yielding of stem cells are made possible through a number of techniques, with material aspirated from bone marrow or adipose tissue, which are used along with other sources of neuronal precursors such as olfactory ensheathing cells. Nevertheless, large and multicenter studies are still lacking. However, with the quality of the ongoing work and research, the optimistic attitude seems warranted. Meanwhile, other rehabilitation and medical care interventions, always at hand, need to be applied in every individual suffering from paraplegia and spinal cord injury.

454–457

Authors: Adegbolagun Temitope Adeoye, Adeolu Alex Adedapo, Matthew Oluwole Abatan

Objective: To evaluate the antiulcer and analgesic effects of the aqueous root extract of Lonchocarpus cyanescens (L. cyanescens) since the plant is said to have medicinal properties. Methods: The filtrate of the aqueous root extract of the plant (100 mg/mL) was used to evaluate for antiulcer activity in 20 rats divided into five groups of four rats each, which were Groups A, B, and C that received 100, 200 and 300 mg/kg doses respectively, while Group D was served as negative control and animals of Group E received 20 mg/kg dose of ranitidine. Indomethacin at a dose of 15 mg/kg was used to induce ulcer on the day of sacrifice. For acetic writhing test (antinociception), same design was used except that Group E received 100 mg/kg dose of acetyl salicylic acid as standard drug. Abdominal contractions were induced in the animals by intraperitoneal administration of 10 mL/kg of 0.6% of acetic acid. Results: The aqueous root extract of L. cyanescens at all doses (100, 200 and 300 mg/ kg) showed significant (P < 0.05) decrease in ulcer parameters compared with the negative control. The extract also produced a significant (P < 0.05) decrease in the number of writhing reflexes in treated rats compared with negative control. Conclusions: The aqueous root extract of L. cyanescens exhibited both antiulcer and analgesic effects justifying folklore claim for the health benefits of this plant.

462–465

Authors: Devid Belalla, Nikollaq Kaçani, Arben Gjata

Objective: To evaluate the preoperative radiotherapy and its role in anastomotic leakage. Methods: A total of 327 patients who had an anterior resection (AR) in elective surgery for a rectal carcinoma were selected and operated in our clinic of surgery during the period from 2003 to 2015. Among them, 135 patients had a low anterior resection (LAR) and the other 192 had an AR. This is a retrospective study. Chi-squared test was used to evaluate statistical differences and the P < 0.05 was considered statistically significant. Results: A total of 126 patients had radiotherapy before surgery, and 50 of them had a LAR. In the other 201 patients, surgery was the first treatment modality, and 83 of them had a LAR. We had an overall anastomotic leakage of 7.95% or 26% patients. Anastomotic leakage was found in 14 patients with LAR, 9 of which had radiotherapy before surgery. From the 12 patients with AR who had an anastomotic leakage, 6 of them had radiotherapy before surgery. Conclusions: Radiotherapy may affect anastomotic healing and increase the risk of leakage. This risk is higher in low anterior anastomoses where a protective stoma may be considered. A better evaluation and support for patients with preoperative radiotherapy is needed in order to diminish the concomitant risk factors as much as possible.

470–482

Authors: Kaddour Taı€r, Omar Kharoubi, Oussama Anouar Taı€r, Nouria Hellal, Im´ene Benyettou, Abdelkader Aoues

Objective: To study the antioxidative and protective properties of aqueous extract of Hammada scoparia (H. scoparia) against the effects of sub-chronic aluminium (Al) intoxication on mnemonic process and some neurochemical markers. Methods: Al was administered intraperitoneally (50 mg/kg body weight, three times a week), and H. scoparia and malic acid were given orally by gavage at a daily dose (100 mg/kg body weight) to rats for 90 days. Results: Al caused significant short-term and long-term memory disturbances, a decrease in locomotor activity, a significant inhibition of acetylcholinesterase activity in brain and a significant depletion of antioxidant enzymes (catalase, glutathione reductase and glutathione peroxidase) and glutathione. It significantly increased lipid peroxidation levels in cerebrum and cerebellum. However, treatment with H. scoparia extract protected efficiently the neurological functions of intoxicated rats by considerably increasing antioxidants levels and decreasing production of thiobarbituric acid reactive substances by 4.26% compared to untreated group. We noted some controversial results with malic acid. It showed some positive results but it was not as efficient as H. scoparia extract. Current results were consistent with histopathological observations including neurodegeneration and vacuolated cytoplasm (spongiosis) in Al treated sections when H. scoparia and malic acid treated sections showed marked neuroprotection signs. Conclusions: This study strongly suggested that H. scoparia extract could possibly restore the altered neurological capacities and antioxidant power in rats, and it could even be a good alternative to chelating agents or other chemical medicines against Al-induced neurotoxicity.

488–492

Authors: Towhid Babazadeh, Hossein Ali Nikbakhat, Amin Daemi, Mohsen Yegane-kasgari, Saber Ghaffari-fam, Morteza Banaye-Jeddi

Objective: To describe the epidemiological aspects of animal bites and to calculate the financial burden resulting from rabies vaccination in Chalderan City. Methods: In this cross-sectional study, records of all victims of animal bites in a seven-year period were reviewed. Studied variables included demographic information of victims, biters' profile, time and place patterns, clinical aspects of the victims and the cost of vaccination. Results: Most of bites were observed in men in the age group of 10–19 years old, at rural areas and occupational group of farmers. The vast majority of animal bites happened by dogs and domestic animals. The average age of victims with head and neck injuries was lower than that of victims with injuries in the lower extremities, shoulders and hands (P = 0.001). The cost of vaccination was 11665 dollars with three doses of rabies vaccine and 849 dollars for five doses, and the 12514 dollars cumulative frequency in the studied period. Based on the results of trend test, the incidence of animal bites was increased significantly during the study period (P = 0.02). Conclusions: The results of this study showed that due to the increasing incidence of animal bites and the financial burden resulting from animal bite vaccination, it is necessary to design and implement preventive measures in order to reduce the animal bites.

497–501

Authors: Michele Bisaccia, Luigi Meccariello, Mattia Manni, Gabriele Falzarano, Antonio Medici, Giuseppe Rinonapoli, Salvatore Di Giacinto, Giovanni Colleluori, Cristina Ib´añez Vicente, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa

Objective: To evaluate the follow-up of the fractures treated by external fixator. Methods: A total of 31 children aged 6–15 years with proximal humeral fractures Grade IV according to Neer–Horowitz classification were treated. The medium follow-up was 24 months. Results: In all cases, a good stability of the fracture and a quick healing process were obtained. The mean time of follow-up was 24 months. The external fixation was removed after 6 weeks (5–8 weeks) on average. Constant shoulder score was proposed to all patients and the average result was 97.5 (84–100). Conclusions: Advantages of the external fixation are rapid mobilization of the joint, low invasiveness, a single surgery and the possibility to correct any secondary displacement. It is important to underline that the positioning of external fixator should be implanted by expert surgeons and that the patients must cooperate during the entire process up to the time of the removal of the fixator.

507–511

Authors: Wei Zhang

Objective: To study the effects of Shuxuetong injection in adjuvant treatment of ischemic stroke on the degree of nerve injury, lipid metabolism and blood coagulation function. Methods: Patients with ischemic stroke admitted in our hospital during the period from May 2012 to May 2015 were selected for retrospective analysis. They were divided into the control group receiving regular treatment and the Shuxuetong group receiving adjuvant treatment with Shuxuetong injection. One and the three months after treatment, serum was collected and nerve injury molecules, indexes of lipid metabolism and blood coagulation function were measured. Results: One month after treatment, the contents of neuron-specific enolase, S100 calcium binding protein B, total cholesterol, triglyceride, low-density lipoprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The contents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Three months after treatment, the contents of neuron-specific enolase, S100 calcium binding protein B, total cholesterol, triglyceride, low-density lipoprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The contents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Conclusions: Adjuvant treatment with Shuxuetong injection can reduce the injury of nerve function of patients with ischemic stroke and improve blood lipid metabolism and blood coagulation function, which is an effective drug for the treatment of ischemic stroke.

517–520

Authors: Dana Elliot Srither, Fatimah Lateef

The study aims to validate that a smartphone application can assist in the learning and skills retention for cardiopulmonary resuscitation training. This cardiopulmonary resuscitation feature of the Crowdsav platform is designed to record the chest compression performance as well as the rate of compressions of the trainee. Crowdsav is available for downloading in the public domain. The application, once downloaded can be utilised during training and be replayed by the trainee at his/her own will or via reminders from the training centre. The goal of using this application is to minimise the decay of the knowledge and compression skills and perhaps even reduce the resource for recertification, as skills and performance can be kept up, maintained and monitored remotely by a training centre using the application.

524–526

Authors: Qi Zhe Ngoo, Li Min Evelyn Tai, Wan Hazabbah Wan Hitam, John Tharakan

We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy in an immunocompetent patient. A 64-year-old Malay gentleman with no medical comorbidities presented with acute bilateral blurring of vision for a week, which was associated with generalised throbbing headache and low grade fever. He also had somnolence and altered consciousness. Visual acuity in both eyes was no perception of light with poor pupillary reflexes. Extraocular muscle movements were normal. Anterior segments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc swelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement or mass. Cerebrospinal fluid opening pressure was normal, while its culture grew Cryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic neuropathy was made. Patient was treated with a six-week course of intravenous fluconazole and started concomitantly on a fortnight's course of intravenous amphotericin B. After that, his general condition improved, but there was still no improvement in his visual acuity. On reviewing at two months post-initiation of treatment, fundi showed bilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis was rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal medication alone may not be sufficient to manage this condition. However, evidence for other treatment modalities is still lacking and further clinical studies are required.

357–363

Authors: Wissem Aidi Wannes, Brahim Marzouk

The use of the medicinal plants in treating diabetes is frequent in Africa, especially in Tunisia, and it is ritually transmitted from generation to generation within cultures. Many of Tunisian medicinal plants have been experimentally validated. A comprehensive review was conducted to pile up information from scientific journal articles, including indigenous knowledge researches, about Tunisian medicinal plants used for the treatment of diabetes. The aim of this review article is to provide the reader with information concerning the importance of Tunisian medicinal plants in the treatment of diabetes and to draw attention of the health professionals and scientists working in the field of pharmacology and therapeutics to develop new drug formulations to cure different kinds of diabetes. 1. Introduction

382–385

Authors: Nan-Bin Yu

Objective: To investigate the effect of anisodamine combining with conventional therapy on the degree of lung injury and inflammatory reaction of patients with acute pulmonary contusion. Methods: A total of 48 patients with acute pulmonary contusion treated in our hospital emergency department from April 2011 to October 2015 were enrolled as the research object and were divided into experimental group and control group by using a method of random number table. Experimental group received anisodamine combining with conventional therapy and control group received conventional therapy. In the process of the treatment, the mechanical ventilation time, hospital stays in intensive care unit and the number of cases developed into acute respiratory distress syndrome and multiple organ dysfunction syndromes of patients in two groups were observed. Oxygenation indexes of patients were respectively calculated on Days 1, 2 and 3 after treatment. The contents of inflammatory mediators in serum were detected on Day 3 after treatment. Results: The mechanical ventilation time and hospital stays in intensive care unit [(9.52 ± 1.41) vs. (14.57 ± 2.51) days] of patients in experimental group were significantly shorter than those in control group, and the number of cases developed into acute respiratory distress syndrome [1 (4.17%) vs. 9 (37.50%)] and multiple organ dysfunction syndrome [1 (4.17%) vs. 7 (29.17%)] was significantly less than those in control group. Oxygenation indexes (294.52 ± 41.26 vs. 257.63 ± 38.52; 357.74 ± 47.74 vs. 279.87 ± 31.46; 396.71 ± 55.12 vs. 279.87 ± 31.46) of patients were respectively calculated on Days 1, 2 and 3 after treatment, which were significantly higher than those in the control group. On Day 3 after treatment, the contents of serum C-reactive protein [(7.94 ± 1.05) vs. (14.49 ± 2.97) mg/L], tumor necrosis factor a [(264.69 ± 41.58) vs. (417.87 ± 64.51) ng/L], interleukin-6 (IL-6) [(147.72 ± 21.36) vs. (257.68 ± 41.54) ng/L], IL-8 [(93.68 ± 12.52) vs. (145.62 ± 22.65) ng/L], IL-10 [(205.64 ± 31.56) vs. (336.62 ± 51.38) ng/L] and myeloid cells-1 (73.32 ± 10.39 vs. 114.45 ± 18.51) of patients in experimental group were significantly lower than those in the control group. Conclusions: The anisodamine combining with conventional therapy can relieve the degree of lung injury caused by acute pulmonary contusion, improve ventilatory function, lower the incidence of acute respiratory distress syndrome and multiple organ dysfunction syndrome and inhibit the activation of inflammatory reaction and the release of inflammatory mediators.

393–396

Authors: Xiao-Yan Zhu, Rong-Yao Hou, Shun-Chang Sun, Xi-Yan Zhou

Objective: To analyze the serum levels of miR-126, miR-146a and its relationship with infarction area, severity of disease and inflammatory reaction degree in patients with acute cerebral infarction (ACI). Methods: A total of 75 cases with ACI treated in our hospital from April 2014 to October 2015 and 80 healthy cases were respectively selected as ACI group and control group for retrospective study. Patients' clinical data were collected, and the serum levels of miR-126, miR-146a, tumor necrosis factor-a (TNF-a), interleukin-1b (IL-1b) and IL-6 were detected. Results: Serum contents of miR-126 (0.286 ± 0.078 vs. 1.000 ± 0.169) and miR-146a (0.337 ± 0.084 vs. 1.000 ± 0.158) in patients of ACI group were significantly lower than those of control group. Contents of IL-1b [(68.4 ± 10.3) vs. (22.7 ± 5.8) ng/L], TNFa [(126.9 ± 22.4) vs. (49.6 ± 8.4) ng/L] and IL-6 [(89.3 ± 14.7) vs. (34.8 ± 5.9) ng/L] were obviously higher than those of control group. The bigger the infarction area was, the more severer the degree of nerve defect could be. The lower the serum levels of miR-126, miR-146a were, the higher the levels of TNF-a, IL-1b, IL-6 could be. Levels of miR-126 and miR-146a were negative correlation with levels of TNF-a, IL-1b and IL-6. Conclusions: An abnormal decrease in serum levels of miR-126 and miR-146a in patients with ACI was closely related to the severity of disease. Through regulating the generation of inflammatory factors TNF-a, IL-1b and IL-6, miR-126 and miR-146a may get involved in the changes of cerebral infarction condition.

402–407

Authors: Chiedozie Onyejiaka Ibegbulem, Paul Chidoka Chikezie, Agwu Igwe Ukoha, Chinwe Ngozi Opara

Objective: To study the effects of diet containing monosodium glutamate on visceral organ weights, acute blood steroidal sex hormone levels, serum lipid profile (SLP) and erythrocyte antioxidant enzymes activities of Wistar rats. Methods: The Wistar rats were grouped into two groups of six rats each. The ones in Group 1 (control group) were placed on water and pelletized standard guinea feed ad libitum, whereas Group 2 was regarded as test group [Wistar rats (WR)-monosodium glutamate (MSG) group] and the Wistar rats received water, compounded diet of MSG and pelletized standard guinea feed ad libitum. After 33 days of feeding study, rat body weight was obtained. Rats were sacrificed and the incisions were made into the thoracic cavity and blood samples were drawn by cardiac puncture as a terminal event. Plasma was assayed for estradiol and testosterone concentrations, SLP and erythrocyte peroxidase and catalase activities. Visceral organ weights were also measured. Results: WR-MSG exhibited marginal alterations in blood estradiol and testosterone concentrations. Elevation of serum triacylglycerol concentration inWR-MSGwas corresponded to 77.7%. Increases in serum concentrations of very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol in WR-MSG were corresponded to 70.6% and 41.0% respectively. Erythrocyte peroxidase and catalase activities showed marginal alterations. Alterations in visceral organs-to-body weights ratios were not profound. Conclusions: Blood testosterone and estradiol concentrations were not significantly (P > 0.05) altered, which may not be connected with the low dose of MSG in the diet. Marginal alterations of SLP did not indicate atherogenicity in WR-MSG. The visceral organs were not atrophic or hypertrophic because of the comparatively low dose of MSG consumed by WR-MSG and the duration of the feeding experiment.

413–418

Authors: Mallikarjuna Rao Talluri, Rajananda Swamy Tadi, Ganga Rao Battu

Objective: To evaluate the antioxidant and thioacetamide induced liver toxicity using extracts of aerial parts of Balanites roxburghii (B. roxburghii). Methods: The in-vitro antioxidant activity was estimated for different extracts on superoxide, hydroxyl and 1,1- diphenyl-2-picrylhydrazyl free radicals and the hepatoprotective activity of the selected plant extracts was evaluated by using thioacetamide-induced liver intoxication in rats model. Results: There were no visible signs of toxicity, mortality and no behavioral changes were observed for the selected plant extracts (hydroalcoholic, ethyl acetate and hexane) at 2000 mg/kg body weight. The plant extracts showed dose-dependent effectiveness in the inhibition of free radicals generation and hepatoprotective nature. The hydroalcoholic extract showed more scavenging activity as compared to other extracts with IC50 values of (332.50 ± 1.30) mg, (302.00 ± 1.50) mg and (230.40 ± 1.10) mg on superoxide, hydroxyl and 1,1- diphenyl-2-picrylhydrazyl free radicals. Aerial parts of B. roxburghii at three dose levels such as 125 mg/kg, 250 mg/kg and 500 mg/kg showed dose dependent percentage protection as standard drugs and on enhancement activities of serum biomarker enzymes (aspartate aminotransferase, alanine transaminase, alkaline phosphatase, total bilirubin and total protein) observed in thioacetamide-induced hepatotoxicity. The hydroalcoholic extract showed significant results at 500 mg/kg body weight as compared to other extracts (P < 0.05) with 65.65%, 62.39%, 59.89%, 55.90% and 54.61% on aspartate aminotransferase, alanine transaminase, alkaline phosphatase, total bilirubin and total protein levels. Conclusions: It was observed that the B. roxburghii plant extracts are non-toxic and have capacity to restore the physiological changes caused by the hepatotoxic compounds.

423–429

Authors: Basiru Olaitan Ajiboye, Oluwafemi Adeleke Ojo, Oluwatosin Adeyonu, Oluwatosin Imiere, Isreal Olayide, Adewale Fadaka, Babatunji Emmanuel Oyinloye

Objective: To investigate the in vitro antioxidant activity of ethanolic extract of Artocarpus heterophyllus (A. heterophyllus) stem bark and its inhibitory effect on a-amylase and a-glucosidase. Methods: The A. heterophyllus stem bark was extracted using methanol and tested for antioxidative activity. Results: The results revealed that the ethanolic extract has polyphenolics and free radical scavenging compounds which were significantly higher (P < 0.05) than their respective standard, at concentration dependent manner. The ethanolic extract of A. heterophyllus stem barkwas observed to showinhibitory activities on a-amylase and a-glucosidase with IC50 of (4.18 ± 0.01) and (3.53 ± 0.03) mg/mL, respectively. The Lineweaver-Burk plot revealed that ethanolic extract of A. heterophyllus stem bark exhibited non-competitive inhibition for a-amylase and uncompetitive inhibition for a-glucosidase activities. Also, gas chromatography– mass spectrometry showed the presence of different bioactive compounds in extract. Conclusions: Therefore, it can be inferred from this study that ethanolic extract of A. heterophyllus stem bark may be useful in the management of diabetes mellitus probably due to bioactive compounds observed in the extract.

434–436

Authors: Ebisa Bekele, Bethel Shiferaw, Alexandra Sokolova, Arpan Shah, Phillip Saunders, Alida Podrumar, Javed Iqbal

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancreatitis triggering TTP is very rare. A 71 years old female presented with abdominal pain of 3 days, followed by dark urine. She had icteric sclera, petechial rash and mild epigastric tenderness. Lab findings were significant for hemolytic anemia, thrombocytopenia and elevated lipase. CT of abdomen showed evidence of pancreatitis and cholelithiasis. After admission, patient developed symptoms of stroke. Further investigation showed elevated lactate dehydrogenase and normal coagulation studied with peripheral blood smear showed 5–6 schistocytes/high power field. Disintegrin and metalloproteinase with thrombospondin motifs-13 (ADAMTS13) activity showed less than 3% with high ADAMTS13 inhibitor 2.2. Patient required 6–7 weeks of daily plasmapheresis until she showed complete response. Our patient presented with clinical features of pancreatitis prior to having dark urine and petechial rash. Therefore, we strongly believe that our patient had pancreatitis which was followed by TTP. Patient's ADMTS13 activity was 6% after 10 plasma exchanges, signifying refractory TTP and higher risk for morbidity and mortality. There are limited data and consensus on the management of refractory TTP. TTP and acute pancreatitis are associated. However, refractory TTP following acute pancreatitis is rarely mentioned in the literature. We would like to emphasize the importance of having higher clinical suspicion of the association of both disease entities.

439–441

Authors: Yuen Keat Gan, Syed Shoeb Ahmad, Sheena Mary Alexander, Amir Samsudin

Necrotizing scleritis is an uncommon but potential disastrous infection to the eye. It is commonly caused by vaso-occlusive autoimmune diseases such as rheumatoid arthritis or surgically-induced, and rarely due to infections. In this article, we presented a rare case of necrotizing scleritis caused by herpes infection in an immunocompromised patient. A 49 years old, retroviral positive gentleman presented to our clinic with a painful, red right eye associated with watering, photophobia and blurring of vision. His right eye rapidly deteriorated leading to an impending perforation of the sclera despite intensive antimicrobial therapy. The patient was started on acyclovir ointment and subsequently improved remarkably salvaging the eye from the need of an evisceration. Although the visual prognosis was poor, structural integrity of the eye was achieved.

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.

179–184

Authors: Paul Chidoka Chikezie, Charles Uche Ekechukwu

Methaemoglobin is formed when the haem iron of deoxyhaemoglobin is oxidized from its ferrous (Fe2+) to the ferric state (Fe3+) resulting in a haemoglobin molecule that is structurally and functionally altered, which leads to tissue hypoxia and metabolic acidosis. Classifications of methaemoglobinemia are based on clinical history, causative agents, pattern of transmission and optical spectrum presentation of blood specimen and level of erythrocyte NADH-methaemoglobin reductase activity. Two major types of molecular/metabolic events leading to the presentation of methaemoglobinemia have been identified. The majority of the chemically induced-methaemoglobinemias are outcome of the presence of relatively high concentrations of oxidizing agents that overwhelm protective cellular reductive capacity of NADH-methaemoglobin reductase activity rather than inhibition of the enzyme. The control of physiologic levels of methaemoglobin is intricately intertwined with glucose metabolism for the supply of NADH and NADPH to provide electrons and protons for enzymatic reduction of methaemoglobin in concert with auxiliary antioxidant systems. The management and amelioration of methaemoglobinemia involves exchange transfusion and/or methylene blue administration.

190–193

Authors: Emerito Carlos Rodriguez-Merchan

Objective: To analyze conservative treatment of knee pain in patients with osteoarthritis. Methods: A Cochrane Library search related to knee osteoartritis was analyzed. Five main strategies for the conservative treatment of knee osteoartritis have been reviewed: medical treatment, physical medicine and rehabilitation, intra-articular injections, and acupuncture. Results: Regarding medical treatment, non-steroidal antiinflammatory drugs (ibuprofen, diclofenac, arthrotec, celecoxib, naproxen, rofecoxib) were superior to acetaminophen. The benefits of tramadol or tramadol/paracetamol, non-tramadol opioids, glucosamine, diacerine, and doxycicline were small. Herbal topical treatment with preparations from medical plants seemed to improve pain. Concerning oral herbal therapy, Piascidine ad extracts of Boswellia serrata had a short-term effect on osteoarthritis symptoms. Regarding physical medicine and rehabilitation, there was limited evidence that a brace had additional beneficial effect compared with medical treatment alone. Land-based therapeutic exercise and aquatic exercise had at least a small short term benefit. Therapeutic ultrasound may be beneficial (low quality of evidence). The effectiveness of transcutaneous electrostimulation for pain relief has not been demonstrated. Electrical stimulation therapy may provide significant improvements. Regarding intra-articular injections, viscosupplementation seemed to be an effective treatment for pain relief in the short-term (months). The short-term (weeks) benefit of intra-articular corticosteroids in the management of knee osteoarthritis has been demonstrated. The benefits of acupuncture were small. Self-management education programs resulted in no or small benefits on pain relief. Conclusions: Five main strategies for the conservative treatment of knee osteoarthritis exist that must be used before indicating surgical treatment: medical treatment, physical medicine and rehabilitation, intra-articular injections, acupuncture, and self-management education programs.

202–205

Authors: Yu-Fu Zhou, Bin Chen

Objective: To observe the correlation of serum endothelin content in patients with acute radiation lung injury and with the degree of inflammatory reaction and the lung functional level. Methods: 68 Patients with non-small cell lung cancer who received the radiotherapy in treatment from May 2013 to October 2015 in our hospital were selected as the object of study. 25 patients who had acute radiation induced lung injury within 24 months of the radiotherapy were rolled in the radiation induced lung injury group (RILI group), and the rest of 43 without acute lung injury were rolled in the negative control group (NC group). The contents of endothelin, tumor necrosis factor a, interleukin-1 b, interleukin-6 in serum and the partial pressure of oxygen in artery, partial pressure of carbon dioxide in artery, vital capacity, forced expiratory volume in one second, maximal ventilatory volume, and diffusion capacity for carbon monoxide were tested. Results: The content of serum endothelin of the patients in the RILI group [(69.3 ± 7.5) pg/mL] were all obviously higher than that of the NC group [(24.1 ± 2.9) pg/mL]; the content of the serum tumor necrosis factor a [(49.6 ± 5.1) ng/mL vs. (22.7 ± 3.1) ng/mL], interleukin-1 b [(29.4 ± 3.3) ng/mL vs. (15.7 ± 1.8) ng/mL], interleukin-6 [(163.4 ± 20.3) pg/mL vs. (89.4 ± 10.2) pg/mL] and the partial pressure of carbon dioxide in artery [(49.2 ± 5.2) mmHg vs. (40.3 ± 4.8) mmHg] were all obviously higher than that of the NC group, which were positively correlated with the serum endothelin content. But the partial pressure of oxygen in artery [(68.4 ± 7.8) mmHg vs. (87.3 ± 9.5) mmHg], vital capacity [(1 203.4 ± 136.5) mL vs. (2 034.8 ± 238.5) mL], forced expiratory volume in one second [(38.4 ± 4.1)% vs. (58.3 ± 6.2)%], maximum minute ventilation [(33.7 ± 3.8) L/min vs. (66.1 ± 7.9) L/min] and diffusing capacity of the lungs for carbon monoxide [(79.3 ± 8.9)% vs. (86.7 ± 9.4)%)] were obviously lower than that of the NC group, which were negatively correlated with the serum endothelin content. Conclusion: The elevated content of the endothelin in the serum of patients with acute radiation induced lung injury could assess the degree of inflammatory reaction and the lung functional level.

210–215

Authors: Hao Tang, Dong Liu, Hua-Yu Zhang, Shi-Jin Sun, Xiu-Zhu Zhang, Dong-Po Jiang, Lian-Yang Zhang

Objectives: To investigate the relationship between sepsis prevalence and disease types in intensive care units (ICUs), as well as the effect of knowledge of the health care workers about the sepsis guidelines on sepsis morbidity and mortality. Methods: A one-day cross-sectional survey was conducted in five ICUs in the cities of Chongqing and Guizhou, China. The included patients were divided into three groups: the internal medicine group (Group A), surgery group (Group B), and trauma group (Group C). Sepsis was diagnosed by the 2012 Sepsis Guidelines, and the prevalence and 28-day mortality were statistically analyzed. The relationship between the knowledge of health care workers about sepsis and morbidity and mortality was analyzed. Results: Among the enrolled 71 patients, the sepsis prevalence rate was 81.5%, 66.7%, and 87.0% in Groups A, B, and C, respectively. In total, the 28-day mortality rate was 36.4%, 42.9% and 20.0% in Groups A, B, and C, respectively, indicating no significant difference. The sepsis prevalence was 66.7%, 90.0%, 90.9%, 100.0% and 76.9% in the five ICUs. The average cognitive score of each hospital was 68.5 ± 15.4, 65.7 ± 16.7, 69.0 ± 23.3, 25.0 ± 8.4, and 61.4 ± 19.9 points in the five ICUs. Cognitive scores were not associated with prevalence of sepsis, but they were negatively related with sepsis mortality. Conclusions: Sepsis prevalence and mortality are not associated with diseases types within ICUs, but the knowledge of sepsis of health care workers is associated with the prognosis of sepsis patients.

222–226

Authors: Jian-Ming Li, Cheng Zhang

Objective: To study the value of serum OPN levels in patients with acute cerebral hemorrhage for assessment of neurological impairment. Methods: A total of 48 patients with cerebral hemorrhage admitted to the Emergency Department of our hospital from April 2014 to August 2015 were selected as the cerebral hemorrhage group, and 50 cases who took health examination were selected as the control group. Then, their clinical data were collected and the contents of OPN, S-100b, NSE, SOD, T-AOC and MDA were detected. Results: The contents of serum OPN [(24.52 ± 2.85) vs. (10.38 ± 1.25) pg/mL], S-100b [(1.77 ± 0.20) vs. (0.59 ± 0.07) pg/mL] and NSE [(24.52 ± 2.85) vs. (10.38 ± 1.25) pg/mL] in the cerebral hemorrhage group were significantly higher than those of the control group, while its SOD [(42.31 ± 5.45) vs. (67.65 ± 7.26) IU/mL] and T-AOC [(12.16 ± 1.42) vs. (20.35 ± 2.35) IU/mL] were all distinctly lower than those of the control group. The greater the amount of hemorrhage was, the more the contents of OPN [(5.75 ± 0.67) vs. (7.92 ± 0.91) vs. (10.36 ± 1.16) ng/mL], S-100b [(1.03 ± 0.12) vs. (1.79 ± 0.20) vs. (2.85 ± 0.30) pg/mL], NSE [(17.86 ± 2.14) vs. (23.94 ± 2.61) vs. (30.14 ± 3.48) pg/mL], MDA [(4.03 ± 0.51) vs. (6.18 ± 0.81) vs. (9.59 ± 1.05) nmol/mL] were and the less the contents of SOD [(52.44 ± 5.94) vs. (41.39 ± 5.26) vs. (25.52 ± 3.12) IU/mL] and T-AOC [(16.59 ± 1.83) vs. (13.04 ± 1.63) vs. (8.39 ± 0.92) IU/mL] became. The contents of serum OPN [(13.23 ± 1.63) vs. (6.95 ± 0.81) ng/mL], S-100b [(3.24 ± 0.52) vs. (0.91 ± 0.10) pg/ mL], NSE [(41.32 ± 5.14) vs. (16.61 ± 1.89) pg/mL] and MDA [(11.18 ± 1.26) vs. (4.28 ± 0.54) nmol/mL] in patients with early deterioration were obviously higher than those in patients without early deterioration, while their SOD [(15.25 ± 1.79) vs. (40.59 ± 5.33) IU/mL] and T-AOC [(5.25 ± 0.77) vs. (16.25 ± 1.92) IU/mL] contents were all evidently lower. The content of serum OPN was positively associated with S-100b, NSE and MDA, but negatively correlated with SOD and T-AOC. Conclusions: The level of serum OPN in patients with acute cerebral hemorrhage increased significantly. The level of serum OPN could estimate the bleeding volume and the severity of nerve function impairment for patients with acute cerebral hemorrhage

232–236

Authors: Tian-Xiao Hu, Qing-Ying Tan, Yun Ruan, Yong Ruan, Xiu-Jing Wang, Jia-Qi Yao, Hui-Ling Wang, Jing Wang

Objective: To study the change of serum C-reactive protein (CRP) levels and its correlation with ketosis in type 2 diabetes mellitus patients with acute ketosis intoxication. Methods: A retrospective analysis was conducted for the patients with type 2 diabetes mellitus from August 2015 to January 2016. The patients combined with ketosis were included into diabetic ketosis group and the patients without ketosis were included into negative control group. The clinical data were collected from two groups including general data, blood pressure, liver function and the levels of blood fat, glycosylated hemoglobin, blood ketone, b-hydroxybutyric acid and CRP. The discrepancy of clinical data between two groups was analyzed. Results: The levels of glycosylated hemoglobin [(11.6 ± 2.1)% vs. (8.3 ± 1.9)%], blood ketone [0.65 (0.3, 1.75) vs. 0.1 (0.1, 0.2) mmol/L], b-hydroxybutyric acid [0.595 (0.303, 1.775) vs. 0.08 (0.06, 0.15) mmol/L] and CRP [0.595 (0.303, 1.775) vs. 0.08 (0.06, 0.15) mmol/L] were significant higher than those of negative control group, while the levels of blood pressure, blood fat and aminopherase had no significant difference. The serum CRP levels showed positive correlation with blood ketone and b-hydroxybutyric acid (r = 0.490 and r = 0.478, respectively). Conclusions: Poor blood glucose control for a long time and strengthening inflammatory response are correlated with the status of acute ketosis in type 2 diabetes mellitus patients. The CRP levels in ketosis patients were significantly elevated and could be used to evaluate the degree of ketosis.

244–247

Authors: Ruslan Zinchenko, Nicolaas Jacobus Prinsloo, Anton Zarafov, Maciej Grzesiak, Anthony Cohn

Objective: To explore the attitudes toward the use of local anesthetic (LA) in arterial blood gas sampling and the awareness and adherence to British Thoracic Society guidelines. Methods: An anonymous eight-item survey was distributed among medical professionals in two teaching and two district general hospitals. Results: In total 153 medical professionals were surveyed. Sixty-five percent have never had any training in administering LA. Most thought that arterial blood gas sampling was either “quite painful” (61%) or “extremely painful” (20%). However, 58% believed that patients should only “sometimes” be offered LA. Over half of the respondents (56%) never used LA before arterial blood gas sampling and 34% only used it “sometimes”. The majority (53%) stated that they would “sometimes” use LA in the future and 23% said that they would never use it. Conclusions: Our results demonstrated that British Thoracic Society guidelines are not followed across the four hospitals. Despite the acknowledgment of arterial sampling being a painful procedure and the belief that patients should be offered LA at least “sometimes”, over half of the respondents never use it. Addressing the above-mentioned issues by introducing local guidelines and teaching sessions, as well as making LA more available, will help make this practice routine.

250–251

Authors: Mohamed Al Khayarin, Mohamed Al Ateeq Al Dosari, Shibly Abdul Basith, Mohammed Waseemuddin

Trans-scaphoid volar dislocation of the lunate with displacement into the distal forearm proximal to the radiocarpal joint is an extremely rare, high energy injury with extensive ligament disruption. They are unstable and require open reduction and internal fixation with repair of ligaments. They are associated with significant morbidity and loss of function. We report the case of a patient with this injury. Open reduction, internal fixation and ligament repair were done. The patient had a good functional outcome.

255–257

Authors: Fatimah Lateef

Ischaemic stroke during or just after cardiac catheterisation is rare but catastrophic to the patient when it happens. The incidence rate is low in the range of 0.08%–0.40%. Risk factors include diabetes mellitus, hypertension, increased age, prior stroke and renal impairment. The type of catheter used, catheter manipulation technique, emergency procedures and use of intra-aortic balloon pumps are some predictors of this complication. We report a case of a 57-year-old lady with acute myocardial infarction who developed stroke on the cardiac catheterisation table. The case illustrates the need for a protocol of care, vigilant cardiologist and staff who can recognise the symptoms and signs as well as good collaborative efforts between the cardiology, neurology and, at times, the interventional radiology teams.

260–263

Authors: Alejandro Cardozo, Federico Puerta, Libardo Valencia

The extended-focused assessment with sonography in trauma is still recognized as a technique approach to patients whose trauma involves the chest and the abdomen, with the aim of ruling out conditions as pneumothorax, hemothorax, pericardial effusion/ cardiac tamponade, and intraperitoneal free fluid. Although CT is the gold standard test, the inconvenience of moving unstable patients and the amount of time it takes to carry it out, makes it not always possible in the Emergency Department, which positions the ultrasound as an ideal tool in the evaluation of patients with trauma in the Emergency Department. In this case report, we presented the case of a patient who complains of multiple stab wounds, and the extended-focused assessment with sonography in trauma confirmed the diagnostic impressions.

Konrad Futyma, Andrzej Wrobel, Aleksandra Filipczak, Tomasz Rechberger

Authors: 172–173

Ectopic pregnancy is a significant problem in women of childbearing potential and affects up to 2% of them. The most common ectopic pregnancy localization is the ampullary area of the Fallopian tube. Patient with spontaneous ectopic pregnancy located in the tubal stump after an ipsilateral adnexectomy performed with a laparotomy due to mucinous cystadenoma was operated by laparoscopy. Remnant of Fallopian tube with ectopic pregnancy was removed. The most important lecture from this case is when adnexectomy or salpingectomy is performed, it should be done in the isthmic part, without leaving any remnant.

96–101

Authors: Rengin Çetin Guvenç, Tolga Sinan Guvenç

Acute mitral regurgitation (MR) is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.

109–113

Authors: Fernando Resende, Ana Beatriz Almeida, Jose Costa Maia, Renato Bessa Melo

Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appendectomy has been regarded as the gold-standard, conservative management with antibiotics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.

117–122

Authors: Erik Hermans, Jan Biert, Arie Barend van Vugt, Michael John Richard Edwards

Objective: To study the treatment pathway of hemodynamic unstable patients with a pelvic ring fracture and analyze the causes of death in this group. Methods: Retrospectively, all data of hemodynamic unstable patients with a pelvic ring fracture in the period 1 January 2003 till 1 June 2010 were analyzed. For all patients the treatment protocol was assessed and compared with our protocol. Results: The data of 268 patients were analyzed. Among them, 89 cases presented as hemodynamic unstable. A total of 22/89 patients died (25%). Seven patients died because of an isolated circulatory problem, 1 of an isolated neurotrauma. Fourteen patients died because of a combination of vital injuries, in which 11 sustained extensive hemorrhage. Hemorrhage contributed to mortality in 18/22 patients (82%). In 12 of the 22 patients who died, the treatment protocol was not followed. This was significantly higher than in the group survivors (P < 0.01). Conclusions: Mortality in patients with a pelvic fracture is most often caused by hemorrhage or sequelae from hemorrhage. A standardized treatment protocol reduces mortality.

126–130

Authors: Saber Ghaffari-Fam, Seyed Reza Hosseini, Amin Daemi, Hassan Heydari, Rahim Malekzade, Erfan Ayubi, Hossein Ali Nikbakht

Objective: To describe the current situation of animal bites in the Babol County, North of Iran. Methods: This was a cross-sectional study based on recently collected data of 3 798 victims bitten (656 females and 3 142 males) from 2010 to 2014 in the Health Center of Babol, Iran. The interest variables in the study included demographic variables, characteristics of animal, some of the time patterns, and some clinical patterns provided to victims. Results: The average age of victims was (33.68 ± 17.23) years. The age group with the max proportion (for males, 32.1%; for females, 26.2%) of bites occurred in 18–30 years old group for males and 30–45 years for females. The ratio of male victims to female ones was 4.78. In terms of place of incident, 2 502 (65.9%) cases of animal bites occurred in rural areas. Dogs and cats were the most dominant biters with 3 340 (87.9%) and 395 (10.4%) bites, respectively. For the kinds of biters, 3 643 (95.9%) were pets, 133 (3.5%) were strays and 22 (0.6%) were wild animals. Most of the lesions were on shoulder as well as upper organs (46.9%) and lower organs (41.0%), respectively. Conclusions: Since the average age of the subjects with injuries on the head and upper organs was lower than that of victims with other organs injured and since that pet dogs were the major biter, structured monitoring programs that focus on specified target groups in collaboration with other organizations are essential to control the animal bites.

143–149

Authors: Sergio Castaño Avila´ , Esther Corral Lozano, Javier Maynar Moliner, Fernando Fonseca San Miguel, Elena Uson García,´ Yolanda Poveda Hernandez, Sara Cabañes Daro-Franc´ es, Goiatz Balziskueta Fl´ orez, Noemi Legaristi Martínez,´ Amaia Quintano Rodero, Ana Tejero Mojena, Alberto Manzano Ramírez

Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions. Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P < 0.05. Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1 000 days of drainage). This group was on overage older, had more severe systemic response syndrome and a significantly higher number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia, glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (interquartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and subarachnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with 55.7% area under curve (95% CI 0.43–0.70). Conclusions: CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia and the ratio of glycorrachia/glycemia.

154–159

Authors: Francesco Nobile, Serafino Carta, Mattia Fortina, Pierpaolo Santoro, Luigi Meccariello, Paolo Ferrata

Objective: To investigate if a locking intramedullary nail could be useful in the treatment of fractures of the humeral head in 3 and 4-fragments operated within 48 h from the trauma. Methods: During the period of February 2011–May 2013, we performed 21 cases of humeral fractures treated with the Polarus intramedullary nail (Acumed). We considered parameters such as age, sex, time of radiological healing and functional outcome, which were assessed by Constant shoulder score, University of California at Los Angeles shoulder score, Oxford shoulder score and Dash score. The study was designed as a prospective cohort study. Results: Clinical and radiographic follow-up of patients was performed at 1, 2, 3, 6, 12, and 24 months after surgery. Evidence of radiographic bone healing occurred at an average of 2.42 months post-surgery (range: 1–6 months, median 2). There were no cases of avascular necrosis of the humeral head or failure of the synthesis. The functional outcome was excellent in 6 out of 21 cases (Constant score > 86%); good in 11 out of 21 cases (Constant score 71–85); satisfactory in 3 out of 21 cases (Constant score 56–70); only in one case we recorded poor outcome (Constant score = 55). Conclusions: The nail utilized is provided with locking and multiplanar proximal screws and could be applied through a mini-invasive anterolateral approach. This enables the reduction of the fracture fragments, while preserving vascularization of the scapulohumeral joint. Our results confirm that the indication of endomedullary nail could be extended to the treatment of complex proximal humeral fractures with 3 and 4 fragments (level of evidence IV, according to the Oxford Centre for Evidence Based Medicine Levels of Evidence Working Group).

162–164

Authors: Chakroun-Walha Olfa, Ksibi Hichem, Rejeb Imen, Boujelben Mariem, Chaari Adel, Chtara Kamilia, Bouaziz Mounir, Rekik Noureddine

A 35-year-old woman with an acute-on-chronic lithium overdose received multiple oral doses of sodium polystyrene sulfonate totaling 120 g over a 24-h period. During the 72 h after the institution of therapy, the serum lithium level decreased from 3.80 to 0.42 mEq/L. Multiple doses of sodium polystyrene sulfonate may be useful in lowering the serum lithium level in severely ill patients with acute renal failure, and can substitute hemodialysis.

168–171

Authors: Dana-Oliviana Geavlete, Oana Ionita, Leonard Mandes, Iulia Kulcsar, Emanuel Stoica, Radu Ciudin, Cezar Macarie, Ovidiu Chioncel

Symptomatic long QT syndrome in pediatric patients is a life-threatening condition. Sometimes, this pathology can be misdiagnosed and erroneously managed as generalized epilepsy due to similar clinical manifestations. The presented case discusses a 13-year-old female patient with generalized epilepsy since the age of 4, admitted for two episodes of resuscitated cardiac arrest due to torsades de pointes and ventricular fibrillation. The final diagnosis of congenital long QT was established and due to the patient's high-risk profile for future cardiac events, implantable cardiac defibrillator was subsequently indicated. Early recognition of congenital long QT and timing of cardiac therapy were crucial and potentially lower the incidence of fatal dysrhythmias commonly associated this condition. In high-risk patients, both medical and interventional therapy can be life-saving

177

Authors: Amin Zarghami, Hamid Shafi, Mostafa Mostafazadeh-Bora

No