Journal of Acute Disease

183-189

Authors: Chinese Society of Emergency Medicine, Chinese Medical Association, China Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, China Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China Emergency and Trauma College, Hainan Medical University, Haikou, China Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, the Second Affiliated Hospital of Hainan Medical University, Haikou, China Key Laboratory of Trauma of Hainan Medical University, Haikou, China Key Laboratory of Hainan Trauma and Disaster Rescue, Haikou, China

194-199

Authors: Zeinab Mohseni Afshar1 , Soheil Ebrahimpour2 , Mostafa Javanian2 , Veerendra Koppolu3 , Veneela Krishna Rekha Vasigala4 , Amir Hossein Hasanpour5 , Arefeh Babazadeh2

SARS-CoV-2 is the causative agent of COVID-19. Since its outbreak in December 2019, COVID-19 has swept the globe. By 17 July 2020, the World Health Organization (WHO) had confirmed 13 119 239 cases and 573 752 deaths, and the numbers are still rising. Current evidence shows that COVID-19 is lower than severe acute respiratory syndrome and Middle East respiratory syndrome in terms of severity and mortality risk, although the infections are particularly more severe in patients with underlying medical conditions. The bulk of COVID-19 patients had close contact with confirmed cases, but an exact origin and specific transmission for COVID-19 are still unknown. As there is no approved antiviral treatment for COVID-19 infection, proper prevention and control practices are essential to control the infection. To have an insight view of COVID-19, we summarized and compared the etiology, clinical manifestations, diagnosis, treatment, and prevention measures of COVID-19, severe acute respiratory syndrome, and Middle East respiratory syndrome.

206-212

Authors: Eduardo Esteban-Zubero1 , Marta Jordán-Domingo2 , Alberto García-Noain2 , Francisco José Ruiz-Ruiz

Objective: To assess the clinical and microbiological characteristics as well as the risk factors of early readmission (<72 h) in acute pyelonephritis (APN) patients discharged from emergency department (ED). Methods: The medical records of patients discharged with a diagnosis of APN between January 1, 2014 and December 31, 2015 were reviewed. Epidemiological, clinical, ultrasound results, and laboratory characteristics were collected, and the risk factors of prompt readmission and non-prompt readmission were assessed. Results: A total of 423 APN patients were included. The mean age was (44.3±19.0) years. The bulk of the patients were women (79.9%), and 20% of cases had episodes previously. Urine cultures were requested in 77.5% of cases, with Escherichia coli being the most frequently isolated bacterium (80.1%). Resistance to one or more antibiotics was found in 68.1% of the bacteria. The most widely used antibiotics were beta-lactam with beta-lactamases inhibitor (46%), and aminoglycosides in 24.4% of cases. Altogether, 73.5% of the patients received antibiotic treatment in the ED, and 46.8% of the patients were discharged. Furthermore, 6.1% of the patients discharged from the ED had re-admission without associated risk factors. Conclusions: Given the high rate of resistance, it is important to know the profile of antibiotics in different areas. Likewise, the administration of antibiotics in the ED is useful in the prevention of early readmissions of APN (<72 h).

218-222

Authors: Faizan Iqbal , Osama Bin Zia, Noman Memon, Sajid Younus, Akram Aliuddin

Objective: To assess the effect of proximal femur nail antirotation on the functional and radiological outcome of unstable intertrochanteric fractures. Methods: This prospective observational study was conducted in the orthopedic department of a tertiary care hospital. Altogether 86 patients with unstable intertrochanteric fractures treated with proximal femur nail anti-rotation between January 2010 and January 2015 were included. Patients were followed in the outpatient clinic at regular intervals after discharge to assess the radiological union of fractures and complications. The functional outcomes were evaluated after 2 years by Harris hip score. Results: All patients achieved a radiological union of fractures after a mean duration of 24.6 weeks. The follow up showed 23 complications (systemic and local). Eight patients developed urinary tract infections, and three patients developed chest infections, two patients had screw cut-out, one patient had knee stiffness, one patient developed superficial surgical site infection, and four patients developed varus collapse and shortening subsequently. The two year follow up showed that 69 (80.2%) patients had an excellent and good functional outcome according to Harris hip score. Conclusions: With lower complication rates, proximal femur nail is a valid and reasonable option especially in treating unstable intertrochanteric fractures.

227-230

Authors: Sunny, Chi Lik Au , Edwin Chan, Simon, Tak Chuen Ko

Rationale: Primary adenocarcinoma of the lacrimal gland is rare, and its presentation as corneal perforation is even rarer. Corneal perforation is an ocular emergency that warrants urgent ophthalmic surgery, yet complete staging of lacrimal gland tumor pre-operatively is essential for optimal oncological management. Patient’s concerns: A 57-year-old man presented with left eye pain was found to have left eye proptosis and fleshy tissue mass around the eyeball. Uveal tissue was prolapsing over the perforated keratitis cornea, and the eye was full of discharge. Diagnosis: Bedside ultrasound B-scan confirmed vitreous haze, and emergency contrast computed tomography (CT) revealed soft tissue density mass (>40 mm) molding around the left globe and optic nerve without any rim enhancing abscess. Left exogenous endophthalmitis from exposure keratopathy secondary to proptosis caused by the bulky lacrimal tumor located in the confined orbital cone was diagnosed. Interventions: Emergency enucleation surgery of the left eyeball was done for this painful blind eye to control the infection from spreading. Orbital walls were biopsied intra-operatively, and tumor staging was completed by positron emission tomographyCT scan and magnetic resonance imaging. Without evidence of metastasis, left orbital exenteration was followed by adjuvant orbital chemoradiotherapy for the sake of close proximity of resection margin. Outcomes: Left exenterated orbit was fully epithelialized at around 2 months, and there was no recurrence of the disease up to present at the 1 year follow-up. Lessons: Thorough workup on the staging of the disease to minimize the number of operations for oncological patients is always a top priority, yet it may not always be possible as in our case presenting with corneal perforation.