Journal of Acute Disease

93-99

Authors: Rouhullah Dehghani , Hamid Kassiri , Niusha Kasiri , Mousa Dehghani

West Nile virus (WNV) is found in 26 provinces of Iran in humans, horses, and birds. Due to lack of vaccines, the only method to reduce the risk of the disease in communities is to increase people’s awareness. Lack of killing and overhunting of animals does not alter the infected-blood transmission from animals to humans by mosquito bites, but can reduce disease transmission risks including the transmission of West Nile fever (WNF) to humans. WNV is an enveloped Flavivirus that in nature has an enzootic cycle between mosquitoes and birds. The virus has occasional epizootic spillover causing disease in humans and horses. WNV-transmitting mosquitoes are widespread around the world, and the geographical range of transmission and the disease has increased over the past seven decades. Most human infections with WNV are asymptomatic, but severe neurological disease may develop resulting in long-term complications or death. Given the increasing trend of reported human WNF cases, it is necessary to implement surveillance programs and increase awareness of people and health staff about the function of biological factors including carnivores in the hunting of infected animals and collecting their carcass from nature. Hunting and killing of birds and dogs living near humans increase both the risk of deviation of blood-feeding of the zoophilic mosquitoes to humans and the outbreak of the disease.

105-108

Authors: Ghazwan A. Lafta, Ali A. Dolachee, Alyaa K. Al-Zubaidi

Objective: To evaluate the factors resulting in the poor outcomes in patients with extradural hematoma (EDH). Methods: The study was conducted at the Neurosurgery Teaching Hospital in Baghdad with a group of 100 surgically treated EDH patients and was carried prospectively from February 1st, 2015 to May 1st, 2017. The baseline information (gender, age, cause of injury, time interval between injury and reception, Glasgow coma scale, etc.) of the patients was recorded, and the variables affecting the outcomes were analyzed. Results: In the study, 80% of patients were male; 54% were between 10-29 years old; the commonest cause of injury was fall accounting for 51%; 78% of the patients got good functional recovery, and 10% had a residual disability; 12% died. Better functional recovery was found among patients with a shorter time interval (≤3 h) (P=0.001), while the longer time interval (>3 h) increased the residual disability (P=0.005). In addition, functional recovery increased six times with higher Glasgow coma scale (P=0.001), and inversely related to mortality (P=0.005). Conclusions: Age between 10 and 29 years, male gender, and depth of hematoma more than 5 cm are at higher risks of poor outcomes of patients with surgically treated EDH. Neurological conditions on admission and time interval between injury and reception are also important factors.

114-120

Authors: Yousef Alimohamadi , Seyed Mohsen Zahraei , Manoochehr Karami , Mehdi Yaseri , Mojtaba Lotfizad , Kourosh Holakouie-Naieni

Objective: To define the level of alarm threshold for pertussis aberrations and to detect the aberrations of the reported suspected cases of pertussis from the Mazandaran province in the north of Iran. Methods: The included cases were composed of the suspected pertussis patients who came from Mazandaran province and registered in the Center for Disease Control and Prevention from 20 March 2012 to 20 March 2018. A discrete wavelet transformbased method was used to detect the aberrations. All analyses were performed using MATLAB Software version 2018a and Excel 2010. Results: A total of 1 162 cases were recruited in the study, including 545 (46.90%) males and 617 (53.10%) females, with median age of 1.47 (0.22-9.56) years. The median age of males was 1.18 (0.21-8.24) years, while that of females was 1.82 (0.21- 10.75) years. Concerning the level of the alarm threshold, it was 1.28 case/d when k=2, while it was 1.34 case/d when k=3. The total detected aberration days were 123 d and 57 d by considering k=2 and 3, respectively. The most defined alarm threshold was related to spring (>2 cases/d) and summer (>1 case/d), respectively. Conclusions: The sensitivity of the surveillance system is subjected to a different time. Thus, determining the level of alarm threshold periodically using different methods is recommended.

126-128

Authors: Mariam Jmal, Maroi Dammak, Olfa Chakroun-Walha , Noureddine Rekik

Rationale: Acute complications of cirrhosis can be lifethreatening. One of the less common acute complications is hepatic hydrothorax whose medical management is rarely successful and is still controversial. Patient concerns: A 51-year-old patient presenting to the emergency room for a massive pleural effusion. Diagnosis: A hepatic hydrothorax with a placed chest tube whose removal was not possible. Interventions: Increased doses of diuretics with a strict salt-free diet. Outcomes: An improvement of the clinical state, with no recurrent pleural effusion up to one month. Lessons: Medical management of hepatic hydrothorax is possible.

131-133

Authors: Sunny, Chi Lik Au

Rationale: Symptoms of floaters and signs of retinal hemorrhages are common acute visual complaints and diagnoses. Diabetic or hypertensive retinopathy is prevalent, yet their differential of Valsalva retinopathy is rare. Patient concerns: A 32-year-old lady presented with floaters was found to have bilateral multi-layered retinal hemorrhages one day after laparoscopic surgery under general anesthesia. Diagnosis: Bilateral Valsalva retinopathy after general anesthesia. Interventions: The patient was offered observational conservative treatment. Outcomes: Multi-layered retinal hemorrhages resolved, but with residual left eye metamorphopsia from epiretinal membrane formation. Lessons: Valsalva retinopathy can be differentiated from common diabetic or hypertensive retinopathy by its characteristics of multilayered hemorrhage. Valsalva retinopathy after general anesthesia is a rare disease. General anesthesia can cause Valsalva retinopathy in a few ways: intubation, positioning, iatrogenic Valsalva maneuver intra-operatively, post-operative coughing or vomiting, etc. In addition, permanent visual impairment could sometimes occur.

136

Authors: Beuy Joob, Viroj Wiwanitkit