Journal of Acute Disease

234-240

Authors: Wendy Ong Chin Feng1,2,3 , Wee Min Teh3 , Wan-Hazabbah Wan Hitam1,2, Haslina Mohammad Ali3

Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.

247-253

Authors: Ana L Rodríguez-Perea1,2 , Johanna Gutierrez-Vargas3 , Mauricio Rojas4,5, Gloria P CardonaGómez 6 , Paula A Velilla1

Objective: To evaluate the role of regulatory T cells (Tregs) at late stages of stroke. Methods: Anti-CD25 antibody (or PBS as a control) was injected to reduce the pool of Tregs in Wistar rats; then, ischemia was induced transiently by middle cerebral artery occlusion during 60 min and reperfusion was allowed for 7 d. Then, Treg frequency was analyzed in peripheral blood, spleen and lymph nodes. Neurological score (0-6) and infarct volume were also determined. Results: Nine days after injection, the CD4+ CD25+ T cells were reduced by 70.4%, 44.8% and 57.9% in peripheral blood, spleen and lymph nodes, respectively compared to PBS-treated rats. In contrast, the reduction of CD4+ FOXP3+ T cells was lower in the same compartments (38.6%, 12.5%, and 29.5%, respectively). The strongest reduction of CD25+ CD4+ T cells was observed in those FOXP3-negative cells in blood, spleen and lymph nodes (77.8%, 52.8%, and 60.7%, respectively), most likely corresponding to activated T cells. Anti-CD25-treated transient middle cerebral artery occlusion rats had a lower neurological deficit and did not develop tissue damage compared with PBS-treated animals. Conclusions: These findings suggest that treatment with anti-CD25 in our model preferentially reduce the T cell population with an activated phenotype, rather than the Treg population, leading to neuroprotection by suppressing the pathogenic response of effector T cells.

258-261

Authors: Ying Liu, Yun-En Liu, Chang-Ci Tong, Hong-Xu Jin

Objective: To study the changes of cognitive function in mouse after brain-blast injury. Methods: Fourty healthy male C57BL/6 mice were randomly divided into model group and control group. After 24 h of injury, histopathological changesc and reactive oxygen species changes were observed under microscope; while changes of inflammatory cytokines content were determined by Western-blot. Four weeks later, Morris water maze method was used to detect the cognition impairment. Results: HE staining showed blast induced brain injury in C57BL/6 mice. Compared with normal control group, the expression of IL-1毬,IL-4, IL-6 were significantly increased in brain tissue of model group whereas IL-10 was significantly decreased (P<0.05); ROS expression in the hippocampus of model group mice was significantly increased compared with that in the control group. Morris water maze showed cognition impairment in mice after brain-blast injury. Conclusions: Brain-blast injury causes cognition impairment in mice, which may be related to the occur of inflammatory change and oxidative stress in the early stage

265-267

Authors: Tomasz Wojewoda1 , Edyta Unkiewicz1 , Ewa Wojewoda-Chmiel1 , Piotr Bijak1 , Michał Bogusiewicz2

Preeclampsia is a pregnancy specific disease characterized by hypertension and proteinuria, by definition, developing after 20 weeks of pregnancy. Here we present an atypical case of severe preeclampsia complicated by generalized convulsions (eclampsia) and hemolysis, elevated liver enzymes, and low platelet count syndrome in an 18 weeks pregnant patient with chronic hypertension. Occurrence of these complications was preceded by upper right quadrant abdominal pain and severe hypertension. In this case no evidence of autoimmunity disorders or molar pregnancy was found.

186-190

Authors: Mohammed Maan AbdulAzeez1 , Ali Adnan Dolachee2 , Padilla-Zambrano Huber4 , MendozaFlorez Romario4 , Haitham Ahmed Obaid3 , Alaa H. Arakwazi3 , Mustafa M. Altaweel3 , Samer S. Hoz3

The impact of a bullet by firearm is a mortal entity that in recent years has been on the rise due to the increase in crime, confrontations, among other acts of violence. Brain injuries by firearm account for 33.3% of all fatal injuries from this type of weapon. This resulted in a significant number of disabilities with its burden cost at a global level. The types of bullet injuries to the head include: penetrating (inlet without outlet), perforating (through and through), tangential (not enter the skull, causing coupe injury), ricochet (intracranial bouncing of bullet) and careening (rare, enter skull but not brain, runs in the subdural space). There are several situations that can occur once the bullet enters the body or into the intracranial cavity. Unmatched association of the bullet trajectory with the final position of the bullet within the body raise the suspicion for additional phenomena involvement, this can be explained by either internal bullet ricochet or internal bullet migration. The former usually represents an active movement and the latter is a passive movement. Intracranial ricocheting of bullets forms up to 25% of all penetrating bullet injuries to the skull. Such bullets types are commonly tumbling and have an unpredictable trajectory. The surgical management for intracranial bullet injury developed over decades from the time of Harvey Cushing and the World War I till the present. Now, the accepted intervention ranges from simple wound care to a proper surgery that includes hematoma evacuation, removal of only accessible bone fragments and foreign bodies, dural repair and wound debridement with or without decompressive craniectomy. Also, intracranial pressure monitoring is generally indicated. We reported a thirty-three years old male, victim of homicidal bullet injury to the head, presented with Glasgow Coma Scale score of 8 (best eye response: 2, best motor response: 4, best verbal response: 2), upon examination a right parietal (near vertex) inlet without outlet was found. The poor prognostic factors in this patient included bi-hemispheric involvement, associated acute subdural hematoma with interhemispheric extension, ricochet type of injury and effacement of sulci. Intracranial ricocheted-bullet injury is a special entity of bullet injury to the head with its particular ballistics and management that deserve highlighting by the trauma team to gain fluent treatment and better outcome.

197-201

Authors: Yang-Li Liu1, Xiao-Ran Liu2, Hui Li3, Feng-Jia Chen1, Huai Liao1, Can-Mao Xie1

Objective: To determine whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can rapidly distinguish among lung cancer, tuberculosis and sarcodosis, and to explore its sensitivity and specificity. Methods: Clinical data of patients with enlarged mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA at our hospital between September 1, 2012 and June 30, 2015 for were retrospectively analyzed. The sensitivity, specificity, positive predictive value, and negative predicted value [including 95% confidence interval (CI)] were calculated.. Results: A total of 299 lymph nodes from 201 patients underwent EBUS-TBNA were selected and no serious complications occurred. EBUS-TBNA showed a sensitivity of 87.9% (124/141) (95% CI: 81%–92%), a specificity of 100.0% (124/124) (95% CI: 97%–100%), and a negative predicted value of 41.3% (95% CI: 23%–61%) in the detection of lung cancer. The sensitivity and specificity of diagnosis of mediastinal tuberculosis lymphadenitis were 72.4% (21/29) (95% CI: 53%–87%) and 100.0% (95% CI: 82%–100%); while sensitivity and specificity of diagnosis of sarcoidosis were 71.4% (5/7) (95% CI: 29%–96%) and 100.0% (95% CI: 91%–100%). Conclusions: The sensitivity and specificity of EBUS-TBNA do not significantly differ for a diagnosis of lung cancer versus tuberculosis or sarcodosis.

207-212

Authors: Vahid Rahmanian, Karamatollah Rahmanian, Narges Rahmanian, Mohammad Ali Rastgoofard, Elham Mansoorian

Objective: To determine the survival rate of tuberculosis (TB) patients and to identify the important factors associated with the survival of these patients in southern Iran. Methods: The present retrospective cohort study extracted and reviewed available medical records of 134 TB patients undergoing TB treatment centre, during 2005 to 2016. The Survival rate of patients for the outcome of the interval from diagnosis until death was plotted using life table and Kaplan-Meier survival curve. Cox proportional hazard regression model was used to examine the simultaneous effect of variables on survival rate. The significance level was considered to be 0.05. Results: In this study, 64.2% of the participants were male, 73.1% had pulmonary TB and 5.22% had HIV. The survival rate of one, five and thirteen years after diagnosis were 93%, 78% and 69%, respectively. The risk of death in patients with extrapulmonary TB (95% CI=1.96-15.83, P=0.001) was 5.58 times higher than in patients with pulmonary TB. The risk of death in smokers with TB (95% CI=1.74-2.46, P<0.001) was 2.07 times higher than in non-smoker patients, and also the risk of death increased to 1.10 times more for a one-year increase in patient age (95% CI=1.06-1.14, P<0.001). Conclusions: The risk of death in patients with extrapulmonary TB and TB smokers was higher than other patients. Therefore, timely diagnosis and proper treatment of patients with extrapulmonary TB as well as the development and integration of smoking cessation programs are underlined and emphasized in the formulation and implementation of the National Tuberculosis Control Program.

217-219

Authors: Luis Rafael Moscote Salazar1, Amit Agrawal2, Guru Dutta Satyarthee3, George Chater Cure4, Alfonso Pacheco-Hernandez1

Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition. Several factors predispose to intracranial bleeding including low body weight, female sex, advanced age, use of oral anticoagulants prior to the administration of fibrinolytic therapy, diastolic blood pressure (greater than 110 mm Hg), among others. Optimal medical management involves multidisciplinary roles of hematology, neurosurgery and critical medicine. In this illustrative case, a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial infarction.

223-224

Authors: Halil Onder

145-148

Authors: Mohammed Maan AbdulAzeez1? , Padilla-Zambrano Huber2 , Salima B. Alsaadi3 , Cabreras?Nanclares B. Vladimir2 , Luis Rafael Moscote Salazar4 , Samer S. Hoz5

The pneumatization of regions such as the apex of the temporal crag, the mastoid cells and the perilaberytic region is considered physiological in adults. The process of craniocervical pneumatization in unhealthy adults derives from a dysfunction at the level of the eustachian tube, which provides a valve effect causing an increase in pressure at the level of the middle ear, forcing the entry of air into the dome of the skull through the opening of the occipitomastoidal suture. The process of standard pneumatization of the temporal bones, begins in the final weeks preceding birth, characterized by a decrease in the embryonic mesenchyme at the antrum level and progresses through childhood until adolescence, when the stone portion at the level of the rock is pneumatized; Normal variants have been reported, such as pneumatization that extends from the temporal scale to behind the sigmoid sinus. With regard to the process of hyperneumatization, several etiologies have been proposed that a congenital process versus an acquired process to develop this condition should be compared. The present illustrative case is a seventy-three years old male presented to the outpatient clinic with chronic recurrent occipital headache, already investigated by general practitioner for elevated blood pressure which was excluded. We had checked him to exclude the cervical spinal origin of the occipital headache which was then excluded too. This case scenario demonstrates the debate about how to deal with such cases and thus the review will bring the attention of those who take care of such radiological findings to keep in mind the possible causes and complications according to the reported cases till now. We concluded that the hyperpneumatization of the craniocervical junction is an uncommon radiological finding that is usually asymptomatic although it can entail serious complications in some instances, especially when it enlarges progressively, which may be due to an acquired process. Thus, craniocervical hyperpneumatization deserves highlighting for the managing team to gain fluent treatment and better patient outcome.

152-157

Authors: Derouiche Samir? , Rezzag Mohcen Om Selma, Serouti Asma

Objective: To evaluate the acute toxicity effect of metribuzin at low dose on liver of mother rabbits and its fetus. Methods: Pregnant female rabbits Oryctolagus cuniculus were divided into three groups (n=5). The first group of non-treated pregnancy rabbits served as control; the second group of pregnancy rabbits were treated with 1/100 LD50 of metribuzin and the third group of pregnancy rabbits were treated with 1/50 LD50 of metribuzin. Metribuzin was added in their drinking water for 60 d before and during pregnancy. Levels of liver malondialdehyde, liver glutathione S transferase, serum glutamic oxaloacetic transaminase and serum glutamic?pyruvic transaminase were determined. Liver reduced glutathione level was also determined by a colorimetric method. And hepatic homogenate was analyzed by HPLC analysis to determine the existence of traces of metribuzin. Results: Results revealed a significant increase in level of liver malondialdehyde, glutathione S transferase, serum glutamic oxalacetic transaminase and serum glutamic-pyruvic transaminase activities in mother and fetuses rabbits of both metribuzin treatment groups as compared to the control group. However the level of reduced glutathione was decreased in mother and fetuses rabbits of both groups treated with metribuzin compared to control group. Also, the results obtained by HPLC technique showed the presence of trace metribuzin in liver cells of mothers and fetuses rabbits of the both metribuzin treated groups. Conclusions: In conclusion, this study shows that exposure to metribuzin at low concentrations causes a acute toxicity in liver of mother rabbits and its fetus, also the trace of the metribuzin detected in the liver is the origin of possible malformation of the fetuses or abortion of the rabbits.

163-166

Authors: Babak Mahshidfar1 , Fatemeh Motaghed2 , Mansour Nateghi3 , Davood Farsi1 , Saeid Abbasi1 , Mani Mofidi1 , Peyman Hafezimoghadam1 , Mahdi Rezai1?

Objective: To determine the amount and type of changes in the Emergency Department, in order to hasten treatment and disposition process of patients in the Emergency Department to expedite by eliminating or minimizing such changes that decreases the cost of treatment and drug resistance Methods: In this study, 1 005 patients’ file admitted to emergency department of Rasool Akram Hospital were reviewed to see at least two different health services or two shifts of one service with written orders. Results: In total, the rate of drug changes studied cases was obtained as 5.47%. The largest pharmaceutical group in which the changes were developed was antibiotic (2.8% from all cases and 50% of total drug changes). Among the various health services, the internal service had imposed the most changes (67.3% of total drug changes). Conclusions: Considering that after the removal of trauma patients, the frequency of drug changes had been 11.47%, then it should be noted that the frequency was high and it was not desirable. The greatest change has been operated by internal services due to the fact that most treatments in this department was carried out by drugs.

175-177

Authors: Yusuf Savran1? , Tugce Mengi1 , Merve Keskinkilic2

Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, a patient who ingested high dose (15 mg) levothyroxine for suicide and admitted to intensive care unit was presented. There was a decrease in Glasgow coma score in the follow-up. The patient was intubated due to acute respiratory failure. Gastric lavage, activated charcoal, methylprednisolone, cholestyramine and therapeuthic plasma exchange were administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms resolved with appropriate treatment and the patient was discharged from the intensive care unit.

180

Authors: Beuy Joob1? , Viroj Wiwanitkit2

99-102

Authors: Tan Si Hong Shawn1 , Lim Xin Yan1 , Fatimah Lateef 2

Pulmonary embolism (PE), with the incidence of about 60 per 100 000 annually, can be a life?threatening disease if it is not treated promptly. It has been estimated that some 10% of PE patients die within the first hour of the event. Untreated PE has a mortality of about 30%. PE is a condition that is treatable if suspected and diagnosed early. The chest radiograph is still the first investigation that is ordered in patients presenting with cardiorespiratory symptoms or symptoms suggestive of PE. The CXR is also helpful in identifying or excluding other conditions or diagnoses. Thus, knowing and understanding some of the more specific CXR signs can be useful. We suggest that physicians to be aware of and utilize CXR findings such as Palla's sign, Westermark sign and Hamptons hump to help with the diagnosis of PE and to exclude other conditions that can mimic venous thrombo-embolism. Even if these signs are not common, their presence, even in an unsuspected patient without a high pretest probability of PE, should prompt further investigations such as a D-dimer test, lung scintigraphy or computed tomography pulmonary angiography as required.

108-114

Authors: Jiang-Ling Yao1 , Chang-Xi Zhou2 , Ji-Min Fu3 , Jian Fu1 , Yun-Tao Gu1 , Zhu-Long Meng1 , Lei Peng1 , Zhong-Lin Zhou

Objective: To investigate the epidemiology of trauma patients in subtropical areas of Hainan Province and the improvement of the level of trauma treatment in China trauma care training (CTCT). Methods: From 01-01-2015 to 01-01-2016, the epidemiological data of 2 476 patients with trauma were collected. From 01-01-2016 to 01-01-2017, 105 professional doctors and nurses in emergency surgery took part in CTCT, and their knowledge were compared before and after training. Results: There were 1 656 male and 820 female trauma patients with 1 614 cases in the middle and young age and 478 cases were the elderly. In terms of occupational distribution, 736 peasants, 574 workers and 458 retirees were involved. In May, the number of patients was the highest 332. October to January was the high-incidence season of trauma. In 24 hours a day: 11:00-13:00, 18:00-19:00, 23:00-03:00 were the high incidence periods. Referred to trauma sites, 904 cases of trauma happened on roads, 540 cases in family and 370 cases in restaurants or entertainment facilities. Through CTCT, the scores of the theoretical examination, the assessment of the trauma treatment skills and the field test scores of the emergency surgery practitioners were better than before (P<0.05).The misdiagnosis rate of severe trauma patients decreased from 26.21% to 15.36% (P<0.05). The mortality rate of severe trauma patients decreased from 18.67% to 13.94% (P<0.05). Conclusions: Trauma epidemiology in Hainan is closely related to its special geographical environment, which provides a reference for the prevention and treatment of trauma in Hainan, and some information for the government to formulate corresponding laws and regulations, as well as emergency plans and other relevant strategies. CTCT training improves the level of theoretical knowledge and first aid skills of medical personnel involved in trauma treatment. Health departments and medical education departments may consider extending CTCT training and continuing education programs to Hainan and other parts of China.

122-125

Authors: Tahtaci Rezan1? , Arslan Engin Deniz2 , Kavalci Cemil3

Objective: To compare the scoring systems used in intensive care units in terms of predicting the mortality in emergency patients and to determine the most appropriate scoring system for urgent care. Methods: This study was carried out by retrospectively reviewing the files of patients admitted to Ankara Numune Training and Research Hospital emergency medicine clinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admitted to any service of the hospital. This study calculated automatically with the data obtained from the patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHE 栻), Simplified Acute Physiology Score (SAPS 栻), Modified Early Warning Score (MEW) and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files were reviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded. The obtained data were entered in SPSS 18 and compared with the scores of APACHE 栻, SAPS 栻, MEW and SOFA. Results: Based on area under the curve analysis, APACE 栻 (0.799; 95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting the patients mortality. However, there was no difference between four scoring system in terms of predicting the mortality. Age (P<0.001, odd’s ratio 1.055) pulse (P<0.007, odd’s ratio 1.025) and SO2 (P<0.003, odd’s ratio 0.952) variables were found to be independent risk factors for mortality. Conclusions: Scores such as APACHE 栻, SAPS 栻, and SOFA, can not be used to make an urgent decision on the first encounter with the patient even though they are successful in predicting mortality. In this case, MEW could be recommended as the most useful system. As a result, the use of scoring systems in emergency departments is useful and necessary. But, multi-centered and large patient group studies are needed.

130-133

Authors: Kilicli Elif, Kavalci Cemil? , Findik Meliha, Muratoglu Murat

Objective: To investigate the cost analysis and hospitalization rates and modes of poisoning of patients who applied to Bakent University Ankara Hospital Adult Emergency Service. Methods: Poisoning Patients who applied to emergency service due to suicide attempt between 01.01.2011- 31.12.2014 were included in the study. Patients' age, gender, date of admission, definite diagnosis, the rate of hospitalization, and hospital costs were examined. A total of 646 patients were included in the study. 208 (32.2%) of the patients were male. The median age of the patients was 29 years. Results: The most causes of poisoning was drug intake. The median cost of the patients was 75.14 TL (IQR: 66.5). Conclusion: There was a positive correlation between age and cost (P<0.05). The majority of the patients apply to emergency dapartment with drug poisoning and female.

137-138

Authors: Dhiraj R Jadhav , Lakshmi Vijaya, Joseph Alexis, Vinay Pandit

Cardiac arrhythmias and respiratory paralysis are among the common causes of death in electric shock victims. Emergency physicians face unique challenges in stabilizing airway and spine apart from fibrillating myocardium. Early and prolonged cardiopulmonary resuscitation may result in good outcome.

69-73

Authors: Cheng Zhang, Jianming Li, Junlin Hu, Xia Zhou

Objective: To study the effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury. Method: Patients with acute craniocerebral trauma who were admitted to the third people's hospital of zigong from April 2014 to December 2016 were selected as the subjects and were randomly divided into two groups. The control group received conventional treatment, and the intervention group received large doses of vitamin C and vitamin E combined with conventional treatment. After 3th day and 7th day after treatment, peripheral blood was collected and serum was isolated, then the contents of nerve injury index NSE, S100B, NGB, UCH-L1, Tf, Ft and neurotrophic indexes NTF-α, BDNF, NGF and IGF-I were determined by Enzyme-linked immunosorbent assay kit, and the contents of SOD, GPx, CAT, OH-, O2-, MDA and AOPP were measured by radioactive immunoprecipitation kit. Results：3th day and 7th day after treatment, the contents of NSE, S100B, NGB, UCH-L1, Tf, Ft, NTF-α, BDNF, NGF, IGF-I, OH-, O2-, MDA and AOPP in the intervention group were all significantly lower than those in the control group. The content of SOD, GPx and CAT in serum in the intervention group was significantly higher than that in the control group. Conclusion: High-dose vitamin C and vitamin E treatment can alleviate nerve injury, oxidative stress response, and improve neurotrophic state in patients with acute craniocerebral injury.

78-82

Authors: Zhou Yin

Objective: To study the effect of bone marrow mesenchymal stem cell(BMSCs) on angiogenesis and inflammation in rabbits with acute cornea alkali burn. Methods: New Zealand White Rabbit were chosen, while model of cornea alkali burn was made and divided into BMSCs group and control group. Rabbits in the BMSCs group were injected with BMSCs and those in the control group received PBS Solution via ear vein. Cornea turbidity and the angiogenesis area were measured at 20 d, 40 d, 60 d. The expression of angiogenic and inflammation response cytokines were measured at 60 d. Results: At 20 d, 40 d, 60 d, the cornea turbidity in BMSCs group was lower than that in control group, and the angiogenesis area in BMSCs group was smaller than that in control group; At 60 d, the mRNA expression of HIF-1毩, VEGF, MMP2, MMP9, TLR2, TLR4, IL-1毩,IL-1毬, TNF-毩, ICAM-1 in cornea of BMSCs group was substantially Lower than that of control group, while BMSCs group was substantially higher than control group on mRNA expression of PEDF, TIMP1, TIMP2.Conclusions: BMSCs has inhibitory effect on angiogenesis and inflammatory response so that it is conducive to the healing of cornea alkali burn.

88-89

Authors: Somsri Wiwanitkit, Viroj Wiwanitkit

Pox is an important infection that can cause the acute illness with dermatological manifestation. Apart from the well-known pox infections, the emerging zoonotic pox infections become interesting new issue in infectious medicine. In this short review, the acute illness which results from new important zoonotic pox infections such as monkeypox, cowpox, raccoon pox and buffalopox is discussed and summarized.