Journal of Acute Disease

49-50

Authors: Saurabh R Shrivastava1 , Prateek S Shrivastava2

56-60

Authors: Halil Onder

Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.

67-72

Authors: Ekong Raymond Eworo1 , Edmund Richard Egbe2 , Zibril A. Okhormhe1 , Bassey K. Offor1 , Bassey Ikoedem Uduak1 , Andeshongkwe Dauda3

Objectives: To determine the anthropometric indices, lipopolysaccharide-binding proteins (LBP), and lipid profile in patients with metabolic endotoxemia. Methods: The study comprised of 47 patients with metabolic endotoxemia (the metabolic endotoxemia group) and 43 controls (the control group). Patients in the metabolic endotoxemia group were categorized further into three subgroups including the normal weight group (n=8), the overweight group (n=12) and the obese group (n=27). Height, weight, waist, and hip circumference were measured, and waist-hip ratio (WHR) and body mass index (BMI) were calculated. LBP was determined by ELISA and total cholesterol, triglycerides, high density lipoprotein by the respective enzymatic colorimetric methods. In addition, low density lipoprotein and very low density lipoprotein were determined by Friedewald’s formula. Results: The mean waist circumference (WC), hip circumference (HC), BMI, total cholesterol, low density lipoprotein, and LBP of the metabolic endotoxemia group were significantly higher (P<0.05) than those of the control group. WHR, TG, high density lipoprotein and very low density lipoprotein of the metabolic endotoxemia group were not significantly different (P>0.05) from those of the control group. The mean WC, HC, WHR, and BMI of the obese group with metabolic endotoxemia were significantly higher (P<0.05) than those of the overweight group and the normal weight group with metabolic endotoxemia. Significant positive correlations were obtained between BMI and LBP (r=0.610, P=0.001), total cholesterol and LBP (r=0.385, P=0.007), TG and LBP (r=0.356, P=0.014) in patients with metabolic endotoxemia. Conclusions: Metabolic endotoxemia arising from increased circulating level of bacterial derive particles consequent to perturbation in the gut microbial community and the elevated serum level of LBP may precede the development of obesity, characterized by dyslipidemia, dysregulation of gut energy harvest, and metabolic energy imbalance.

78-82

Authors: Sana H. Mohamed1 , Rasha R. Binni2 , Bashir A. Yousef2,3

Objective: To evaluate the management of early-onset sepsis at Saad Abul-Ella Teaching Hospital, Sudan. Methods: A descriptive retrospective hospital-based study was carried out at the Nursery Department of Saad Abul-Ella Teaching Hospital. All medical records of neonates with suspected or confirmed sepsis during the year 2017 were reviewed to evaluate the management of antibiotics for sepsis using a data collection form. Results: Out of the 205 cases, 82 neonates (40%) were diagnosed as early-onset sepsis, among which the majority was male (68%). All neonates were given cefotaxime plus vancomycin as empirical therapy which was changed to other antibiotics in 23% of the cases. The common risk factors associated with early-onset sepsis wereprolonged rupture of membrane (41.8%), preterm delivery (26.3%) and low birth weight (15.1%). Blood cultures were performed in 168 cases, and 19% had bacterial growth of Staphylococcus aureus which is the most common isolated pathogen. Conclusions: Cefotaxime plus vancomycin are the main empirical antibiotic for sepsis, and Staphylococcus aureus is the most common pathogen associated with early-onset sepsis.

89-92

Authors: Chang Chee Yik

Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality and is endemic across tropical areas, especially in Southeast Asia and northern Australia. Patient concern: A 24-year-old diabetic male complained of fever and left upper quadrant abdominal pain for one-week duration. Diagnosis: Melioidosis with ruptured splenic abscess and splenic vein thrombosis. Interventions: Antimicrobial therapy (intensive therapy: intravenous ceftazidime, eradication therapy: oral trimethoprimsulfamethoxazole), and anti-coagulation (enoxaparin, then warfarin). Outcomes: Resolution of splenic abscess and splenic vein thrombosis. Lessons: Both splenic abscess and splenic vein thrombosis are uncommon but severe complications associated with melioidosis. Ultrasound is useful for diagnosis and monitoring response to treatment in such cases.