Journal of Acute Disease

95-98

Authors: Pathum Sookaromdee1, Viroj Wiwanitkit

Acute cholecystitis is an important acute medical problem, so acute disorder of the gall bladder requires good clinical management. There are several etiologies of acute cholecystitis. Although it is not common, helminthic infection is one of the causes of acute cholecystitis. This condition is little mentioned in literature but it is an important issue in several tropical countries. Here, the authors performed a literature review to summarize published data available on an international database (PubMed). All available publications with complete information are summarized and extracted. In this article, the authors briefly summarized clinical features and management of acute cholecystitis and helminthic infestation. The relationship of nematode, trematode and cestode infestations with acute cholecystitis is also summarised.

106-112

Authors: Godpower Chinedu Michael1, Ibrahim Aliyu2, Ayuba Andesati3, Bukar Alhaji Grema1, Abubakar Mohammed Musa4, Rafiyat Bolanle Abu5, Hamisu Abubakar5, Haliru Ibrahim6, Emmanuel Edighotu7

Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general information such as age, gender, mode of transfer, time of presentation, symptom duration, diagnoses, treatment duration, treatment outcome (transfer to the ward, referral to another hospital, discharge or death) and date and time of discharge. Chi-square test and logistic regression analysis were used to determine the association of variables with mortality and predictors, respectively. Results: Patients were predominantly male (62.2%) with a mean age of (36.0±19.0) years. Most visits occurred in September (49.1%). The median symptom duration was 24 h (interquartile range: 4.0, 72.0 ). More incidences were caused by non-surgical (61.9%) than surgical reasons. Infectious diseases (predominantly malaria, 34.5%) and injuries from road traffic accidents (mostly head injuries, 9.4%) were the commonest non-surgical and surgical cause, respectively. The mortality rate was 9.2%. Typhoid-intestinal-perforation and sepsis contributed 45.2% of overall mortality. Age (氈 2=16.44, P<0.001), symptom duration (氈 2=22.57, P<0.001), and visiting month (Fishers exact, P=0.002) were associated with mortality. Moreover, age (≥37 years) (OR=4.60, 95%CI=1.96-10.82, P<0.001) and visiting in September/October (OR=4.01, 95%CI=1.47-10.93, P=0.007) were the predictors of mortality. Conclusions: Though most patients in emergency department survive, the mortality is still high. Appropriate hospital and community interventions should be implemented to reduce mortality.

118-122

Authors: Shadab Shahali1, Mansour Amin2,3, Masoumeh Khajeh Hassani4, Reza Yaghoobi5, Morteza Saki3,6

Objective: To compare the effect of shallomin (pure fraction of Allium hirtifolium) with podophyllin 25% solution on external genital human papillomavirus warts in women. Methods: This study was a randomized controlled trial which was performed on two groups of 25 Iranian women with external genital warts at Imam Khomeini Hospital in Ahvaz, Iran. In the first group, shallomin was used once a day for six weeks at home. In the second group, 25% podophyllin solution, was applied on the lesion once weekly for six weeks. Results: Shallomin and podophyllin resulted in wart clearance in 13/23 (56.5%), and 12/24 (50%) of patients, respectively. The clearance rate for shallomin was not significantly different from that of podophyllin (P=0.082). Six weeks after the treatment, the sizes of the lesions in the shallomin group and the podophyllin group decreased by (1.43±0.53) mm and (1.64±0.70) mm, respectively. Conclusion: Shallomin is an effective treatment for genital warts, with similar efficacy to that of podophyllin.

127-129

Authors: Soheil Ebrahimpour1, Mahmoud Sadeghi-Haddad-Zavareh1, Zeinab Darabi Ahangar1, Zeinab Mohseni Afshar2, Zeinab Sheidaie3, Parisa sabbagh1, Arefeh Babazadeh1

Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic; but if symptomatic, the symptoms will include skin rash, respiratory and gastrointestinal symptoms like abdominal pain, diarrhea, nausea and vomiting. Patient concerns: A 77-year old man presented with edema of the lower extremities and insignificant tenderness in the epigastric region. Diagnosis: The histopathology of gastric tissue showed severe inflammation and multiple ulcers in the cardia, antrum and proximal duodenum. A large number of rhabditiform larvae of S. stercoralis along with tissue hyperemia and infiltration of lymphoplasma cells, eosinophils, and neutrophils were found. Intervention: Treatment with albendazole. Outcome: Despite the albendazole treatment, the patient's condition deteriorated and eventually died because of a sepsis-like syndrome. Lesson: Physicians should remain alert to the urgency due to threadworm, especially among the elderly people and immunosuppressed cases; and should ensure accurate diagnosis, suitable treatment and careful follow-up of these cases.