Journal of Acute Disease

173-178

Authors: Li Lin, Shao-Wei Xiang, Yan-Ling Sun, Yuan Chen, Zhe Wu, Zhi-Feng Ning, Ding-Wen Shen, Xue-Qin Sima, Qi-Qiang Wen, Gui-Lai Wei, Qing-Yong He

Objective: To evaluate the efficacy of a novel coated stent in the treatment of intracranial pseudoaneurysm. Methods: MEDLINE, EMBASE, and PubMed databases were searched for literature published between 1990 and April 2022 according to PRISMA guidelines. All studies with ≥10 patients reporting successful implantation of Willis covered stent, therapeutic effect, complications, and postoperative follow-up were included. The combined incidence and corresponding 95% confidence intervals were assessed using a generalized linear mixed method and random effects model. Results: Five studies (116 patients with pseudoaneurysms) were included. The experimental groups in the selected studies showed a combined technical success rate of 81.03% (OR=18.31, 95% CI=9.39-35.69, I2=79%, P<0.001). Clinical follow-up showed that the complete cure rate was as high as 94.4% after the follow-up (OR=106.81, 95% CI=39.08-291.88, I2=0%, P=0.71). Conclusions: Willis covered stent is feasible, safe, and effective in the treatment of intracranial pseudoaneurysm.

186-191

Authors: Sarakawabalo Assenouwe, Tabana Essohanam Mouzou, Ernest Ahounou, Lidaw Déassoua Bawe, Awèréou Kotosso, Koffi Atsu Aziagbe, Eyram Makafui Yoan Amekoudi, Mamoudou Omourou, Chimene Etonga Anoudem, Komi Séraphin Adjoh

Objective: To describe the strategies and outcomes of mechanical ventilation in a poorly equipped facility. Methods: This retrospective descriptive study included patients with COVID-19 who were admitted to the intensive care unit (ICU) and mechanically ventilated between September 1, 2020, and May 31, 2021. Data were collected from medical records and databases. Results: 54 Patients aged (62.9±13.3) years were included. Among these cases, 79.6% had at least one comorbidity. On admission, all patients had hypoxia. The median peripheral oxygen saturation in room air was 76% (61%, 83%). Non-invasive ventilation (NIV) was performed in 75.9% of the patients, and invasive mechanical ventilation (IMV) in 68.5%. IMV was performed on patients due to severe coma (8.1%), failure of standard oxygen therapy (27.0%), and failure of NIV (64.9%). An arterial blood gas test was performed in 14.8% of the patients. NIV failed in 90.2% of cases and succeeded in 9.8%. IMV was successful in 5.4% of cases, vs. 94.6% of mortality. The overall mortality rate of patients on ventilation in the ICU was 88.9%. The causes of death included severe respiratory distress syndrome (85.2%), multiple organ failure (14.8%), and pulmonary embolism (13.0%). Conclusions: The ventilation management of COVID-19 patients in the ICU with NIV and IMV in a scarce resource setting is associated with a high mortality rate. Shortcomings are identified in ventilation strategies, protocols, and monitoring. Required improvements were also proposed.

198-203

Authors: Niharika Agarwal, Anamika Goyal, Nikhil Pursnani, Garima Kanaujia, Akanksha Semwal, Prabhat Agrawal, Abhishek Raj

Objective: To study cardiovascular sequelae of post-COVID-19 patients with moderate to severe computed tomography (CT) severity score. Methods: A prospective, non-randomized, observational study was conducted on 100 post-COVID-19 patients with moderate to severe CT severity scores from January 2021 to December 2021. Fifty- nine were male [mean age (54.1±12.2) years] and 41 were female [mean age (46.9±15.1) years]. Patients with previous cardiovascular disease, previous chronic lung disease, and pre-existing primary or secondary pulmonary hypertension were excluded. Patients were examined, and serial electrocardiogram and 2D echocardiography were performed to detect any cardiovascular abnormality. Results: Post-COVID-19 patients had persistent symptoms, the most common being fatigue (59%). Most of these symptoms were relieved on follow-up. A rise in systolic, diastolic blood pressure, and pulse rate was observed. The electrocardiographic evaluation revealed ST-T segment changes, sinus tachycardia, ventricular hypertrophy, and arrhythmias among a considerable number of patients. On echocardiography, left ventricular diastolic dysfunction was most common (43%). Pulmonary hypertension, as evidenced by elevated pulmonary artery systolic pressure, was seen in 15% of patients. Conclusions: The present findings reveal an increased incidence of cardiovascular complications after recovery from COVID-19 infection in those without pre-existing cardiovascular or chronic lung disease.

213-214

Authors: Shalendra Singh, Sushrut Avinash Kulkarni, Nitesh Agrawal, Abhishek Mishra

NA

131-132

Authors: Mehmet Uçar

NA

140-144

Authors: Jing Liu, Ying Zhang, Yu-Wei Luo, Yi-Yu Hong, Shuo Wang, Bin Liu, Yan-Tao Zheng

Objective: To investigate the application of heparin-binding protein along with albumin (HBP+ALB) in evaluating the severity of community-acquired pneumonia (CAP) and compares it with single HBP, white blood cells (WBCs), C-reactive protein (CRP), and procalcitonin (PCT). Methods: A total of 226 patients with CAP admitted to the Emergency Department of Zhujiang Hospital, Southern Medical University, Guangdong, China, between March 1, 2021, and March 1, 2022, were enrolled. The patients were grouped into two groups: mild CAP (n=175) and severe CAP (sCAP)(n=51). Patients' characteristics and laboratory data were obtained. ROC curve and the value of the area under the curve (AUC) were used to evaluate the predictive values of HBP, ALB, WBC, CRP, and PCT. Results: WBC count, CRP, PCT, HBP, creatinine, and D-dimer were higher in the sCAP group, while ALB was lower in the sCAP group (P<0.05) than those in the mild CAP group. The AUCs of WBC, CRP, PCT, HBP, and HBP+ALB were 0.633 (95% CI: 0.545-0.722, P<0.05), 0.635 (95% CI: 0.542-0.729, P<0.05), 0.705 (95% CI: 0.619-0.791, P<0.05), 0.809 (95% CI: 0.736-0.883, P<0.05), and 0.889 (95% CI: 0.842-0.936, P<0.05), respectively. Conclusions: HBP+ALB has a higher predictive value than single HBP, PCT, CRP and WBC used alone for the early assessment of CAP.

151-156

Authors: Mehmet Kaplan, Mesut Çelik, Muhammed Yusuf Özer

Objective: To investigate the cognitive state, psychological problems such as depression and anxiety, and pain in the musculoskeletal system among young adults with post-COVID-19 (long COVID) syndrome. Methods: This descriptive study included 361 students studying at the Vocational School of Health Services of Bingöl University in Turkey. Data were collected using the Socio-Demographic Information form, the Beck's Depression Inventory, the Cognitive Appraisal Scale, and the Visual Analogue Scale for pain. Results: Compared to those without COVID-19, the mean depression score, cognitive appraisal score, and mean Visual Analogue Scale score of the young adults with COVID-19 were significantly higher. There was no significant difference in pain assessment at rest between those with COVID-19 and those without COVID-19. Conclusions: Young adults with COVID-19 are more depressed, their cognitive functions are more easily negatively affected, and experience more pain during exercise.

163-168

Authors: Guguloth Ramesh Babu, Yagadi Srilatha

Objective: To determine the clinical and epidemiological features of pelvic fracture patients presenting to the Emergency Department. Methods: This prospective observational study was conducted in a tertiary care center in south India. Causes of injury, types of pelvic fractures, the associated injuries, and outcome at the time of discharge were recorded. Results: A total of 140 patients were included in this study. Most patients were classified as type A (n=62), followed by type B (n=48) and type C (n=30). A total of 112 patients were injured due to road traffic accidents, followed by a fall from a height (n=23) and a fall from a heavy object (n=5). Most subjects had facial injuries (n=99, 70.7%), followed by head injuries (n=51, 36.4%). Five percent of the patients were expired, 12% left against medical advice, and 83% were discharged. Conclusions: The incidence of pelvic fractures presenting to the Emergency Department is relatively high in India. Road traffic accidents are the primary cause of pelvic fractures and associated facial and head injuries. The outcomes demonstrate the need for improved prevention strategies and comprehensive management protocols to reduce mortality.

89-95

Authors: Rushikesh S. Haridas, Sheetal Shelke, Girish Patrike, Deepak Patil, Sainath Dhumal

Objective: To evaluate morphine's risk-benefit profile in the treatment of acute heart failure. Method: Different electronic databases, including PubMed, MEDLINE, Cochrane Library, and Google Scholar, as well as clinicaltrails.gov, were searched for articles published between 2012 and 2022. The risk of bias in the present study was evaluated by employing randomized controlled trials (RCTs) checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups. The two-part tool was used to address the five specific domains such as selection bias, performance bias, detection bias, attrition bias, and selective reporting bias. Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software (version 5.4), a quality assessment tool. Results: A total of 13 studies were included in the present review, in which there were 5 retrospective studies, 3 randomized-control studies, 2 prospective studies, 1 multicenter pharmacodynamics study, 1 multicenter cardiac magnetic resonance imaging study, and 1 open-label, cross-over study. The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine. Conclusions: Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine. Considering the adverse effects, including mortality associated with morphine, there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure.

102-106

Authors: Sanjana Agrawal, Abhiruchi Galhotra, Saurabh Kumar Sahu, Senthilkumar Ramasamy

Objective: To investigate the impact of COVID-19 on the mortality trends and patterns in a tertiary teaching hospital in Raipur, Chhattisgarh, India. Methods: A hospital-based retrospective study was conducted to analyze the case reports of all deaths from January 2016 to December 2021 in a tertiary teaching hospital in Raipur, Chhattisgarh, India. The socio-demographic profile and the pattern of causes of death were recorded. The deaths were classified according to the 10th revision of the International Classification of Diseases. Results: A total of 6128 deaths were registered from 2016 to 2021 and the maximum death number was observed in 2021 (38.2%) followed by 2020 (32.5%) when the country was hit by the COVID-19 pandemic. The highest number of deaths was observed in the age group of 51 to 65 years i.e., 31.1% of the total deaths. In all five years, male deaths were more than female deaths, and more than 50% occurred within three days of hospitalization during the study period. Conclusions: Even though there is a rise in the death rate due to the sudden hit of COVID-19, the burden of both communicable and non-communicable diseases remains gradually increasing over the five years. There is a need for health awareness in the community about changing lifestyles and their harmful effects on health.

114-120

Authors: Sumbul Qamar, Mohd Ayub Ansari, J. N. Mohapatra, Sana Salim Khan

Objective: To determine the association of the three umbilical cord blood parameters: umbilical cord pH, base deficit, and lactate levels, with neonatal outcomes. Methods: This prospective observational study was conducted from April 2021 to September 2022 with 100 term and late preterm (>35 weeks) neonates whose umbilical cord blood pH was <7.10, Apgar score was <7 at 1 min, and required positive pressure ventilation. Umbilical cord blood was assessed for pH, base deficit, and blood lactate levels. The neonatal outcomes of neonatal intensive care unit admission, Apgar score at 1 min, and Apgar score at 5 min were assessed. Results: The mean of umbilical cord blood pH was 7.04±0.07, mean base deficit was (–9.3±3.9) mmol/L, and mean lactate levels were (6.51±2.29) mmol/L. Neonatal intensive care unit (NICU) admission was needed in 78 (78%) neonates. The mean NICU stay length was (2.4±2.2) days ranging from 0 to 12 days with a median of 2 days. Univariate analysis showed no significant difference in cord blood pH (P=0.736) and base deficit (P=0.393) between neonates without NICU admission and neonates who required NICU admission, but lactate level was significantly higher in neonates who required NICU admission (P<0.001). There was no significant difference in cord blood pH (P=0.400) and base deficit (P>0.999) between neonates with Apgar scores 4-7 at 1 min and neonates with Apgar scores <4, but lactate level was significantly higher in neonates with Apgar scores <4 at 1 min (P<0.001). Conclusions: Umbilical cord blood pH, base deficit, and lactate levels are useful novel markers showing a significant correlation with neonatal intensive care unit admission and adverse neonatal morbidities among hypoxic newborns. Overall, lactate was a better predictor of adverse neonatal outcomes as compared to umbilical cord blood pH and base deficit.

129-130

Authors: Wai Yan Lam, Sunny Chi Lik Au

NA

45-50

Authors: Maryam Ziaei, Hojjat Rastegari Najafabadi, Mahjoubeh Keykha, Mehdi Galavi, Ali Abdolrazaghnejad, Alireza Bahmani

Objective: To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction. Methods: This study was a randomized, double-blind clinical trial. The study population included all patients who were admitted to the emergency room of Ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction. The patients (n=47) were divided into two groups: the case group (with oxygen therapy) and the control group (without oxygen therapy). The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction, mortality caused by any other cause, and re-hospitalization caused by acute myocardial infarction. Results: Out of the 47 patients, 27 were male (57.4%). The average age of the patients was (60.9±8.1) years. One month after admission, 2 patients (8.7%) in the case group and 2 patients (8.3%) in the control group died due to acute myocardial infarction. A total of 7 patients (14.9%) died three months after admission. There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months. After one month, 2 patients (8.7%) in the case group and 1 patient (4.2%) in the control group died of other causes. After three months, 4 patients (8.5%) in total died for other causes. There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months. One month after admission, 5 patients (21.7%) of the case group and 4 patients (16.7%) of the control group were re-hospitalized due to acute myocardial ischemia. During the next three months, 3 patients (13.0%) of the case group and 5 patients (20.8%) of the control group were re-hospitalized. There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months after admission. Conclusions: There is no significant relationship between oxygen therapy and death by acute myocardial ischemia, or any other causes. The relationship between oxygen therapy and the rate of re-hospitalization caused by acute myocardial ischemia is not found within one and three months after admission. The results show that oxygen therapy does not affect patients with acute myocardial ischemia within three months after admission.

57-60

Authors: Pankaj Jain, Manoj Sharma, Manoj Seval, Pramod Meena

Objective: To study epidemiology, clinical manifestations, and laboratory parameters of scrub typhus in Hadoti region of Rajasthan, India. Methods: A cross-sectional study was conducted on 50 patients with scrub typhus between August 2022 and November 2022. Scrub typhus was diagnosed by ELISA IgM scrub typhus antibody. The data about demography, vital parameters, and lab investigations were collected and analyzed. Results: Ninety-two percent of the patients were from a rural background (92%), 86% were farmers and the majority were females. Most patients were 40-60 years old. The major complaints were fever (100%), myalgia (100%), headache (82%), and body swelling (80%). Major complications were pneumonia (68%), multiple organ dysfunction syndrome (62%), hepatitis (44%), and acute kidney injury (42%). Triglyceride levels were >200 mg/dL in 80% of patients, albumin <3.5 g/dL in 98% and eschar mark was present in 24% of patients. Conclusions: Scrub typhus is a serious acute febrile illness that can lead to multi-organ dysfunction and is associated with significant mortality. Increasing awareness regarding disease in endemic regions, early screening of patients, and treatment as early as possible could help prevent the patient from severe life-threatening complications.

67-72

Authors: Mudita Sharma, Digpal Singh Chundawat, Rohit Richhariya, Sunil Kumar Tailor, Shatrughan Pareek

Objective: To assess perceived stress and coping capacity of frontline health workers from AIIMS during COVID-19 pandemic. Methods: This cross-sectional study conducted from May to July 2021 enrolled 694 participants. An online questionnaire based on Google Forms was developed to collect the data. Participants were assessed using the validated Perceived Stress Scale and the Coping Resources Inventory Scale. Results: The age of participants were 27 (23-52) years old. The majority of respondents (73.5%) felt moderately stressed. Of the 694 participants, 83.0% of the 576 participants had average stress management skills. Sex, marital status, and profession were significantly associated with perceived stress. In addition, marital status and profession were significantly associated with coping capacity. Conclusions: The majority of participants have moderate stress levels and average coping skills. Frontline healthcare workers have to maintain mental and physical health. Achieving this requires early screening and stress management for healthcare workers.

80-82

Authors: Eduardo Esteban-Zubero, Cristina García-Muro, Moisés Alejandro Alatorre-Jiménez, Carlos Arturo López-García, Alejandro Marín-Medina

Rationale: Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms. If present, the symptoms are frequently manifested as a sensation of pain and cervical tension. Its etiology is variable, including trauma, central catheterization, and hypercoagulable states, among others. Patient’s Concern: A 41-year-old female, previously healthy, was admitted to the emergency room for worsening pain in the left cervical area of 5 d. Previously, she was treated for suspected acute pharyngotonsillitis yet without improvement. Diagnosis: Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating. Ultrasound study showed thrombosis of the left internal jugular vein. A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus. Interventions: Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h. Outcomes: The patient was discharged after 3 d of treatment with vitamin K antagonists. Lessons: Venous thrombosis at the level of the internal jugular vein is an infrequent entity. Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.

87-88

Authors: Majed Abdul Basit Momin, Rathore Rahul Dev Singh, Rubina Hassan

NA

1-9

Authors: Abdel-Hady El-Gilany, Hala Abou-ElWafa

Many underdeveloped countries still struggle with the public health issue of acute illnesses, especially with the emergence of injuries as a major category of acute diseases. Control of the acute disease is challenging particularly when it occurs as an outbreak, either in isolation or as part of a wider epidemic. This narrative review summarizes the definition, epidemiologic transition, pattern and modes of spread, classification, epidemiologic measures, community burden, prevention, control, and future challenges of acute disease. This review is to provide a reference for epidemiologists, clinicians, researchers, and policymakers.

18-22

Authors: Damla Anbarli Metin, Hamdi Metin, Seref Emre Atiş

Objective: To evaluate the effect of the modified systemic inflammation score (mSIS) on prognosis in patients diagnosed with COVID-19. Methods: In this retrospective cross-sectional study, 181 patients were selected and divided into two groups: patients with and without admission to the intensive care unit (ICU). An albumin level of ≥4.0 g/dL and lymphocyte-to-monocyte ratio (LMR) of ≥3.4 was scored 0, an albumin level of <4.0 g/dL or LMR of <3.4 was scored 1, and an albumin level of <4.0 g/dL and LMR of <3.4 was scored 2. Results: A total of 242 COVID-19 positive patients were initially included in this study. Of these patients, 61 were excluded and 181 patients remained. Among the 181 participants, 94 (51.9%) were female, and the median age was 61 (51, 75) years. The mSIS scale ranged from 0 to 2. After analysis, the median score was 0 (0, 0) in the non-ICU group and 2 (0, 2) in the ICU group (P<0.001). The median white blood cell, lymphocyte counts, and albumin levels were lower in the ICU group (P<0.001, P<0.001, and P<0.001, respectively). In logistic regression analysis lymphocytopenia (OR=5.158, 95% CI=1.249-21.304, P=0.023), hypoalbuminemia (OR=49.921, 95% CI=1.843-1 352.114, P=0.020), AST elevation (OR=3.939, 95% CI=1.017-15.261, P=0.047), and mSIS=2 (OR=5.853, 95% CI=1.338-25.604, P=0.019) were identified as independent predictors of ICU admission. Conclusion: The mSIS can be used as an independent parameter for establishing the intensive care needs of patients with COVID-19.

29-34

Authors: Hamed Delam, Ahmadreza Eidi, Zahra Keshtkaran, Omid Soufı, Behzad Rezaei, Mohammad-Rafi Bazrafshan

Objective: To investigate the trend of animal bites in southern Iran from 2015 to 2019. Methods: This is a cross-sectional study of patients with animal bites who were referred to the Center for Disease Control in the three cities of Larestan, Evaz, and Khonj in Fars province, southern Iran from 2015 to 2019. The trend of animal bites incidence was analyzed using the Cochran-Armitage trend test. Results: In total, from 2015 to 2019, 1 944 cases of animal bites were reported. A total of 79.8% of the cases were men. The overall average incidence of animal bites was 142.93 per 100 000 people. The incidence of animal bites was significantly increased (Ptrend<0.001). The highest incidence was in November (79.04 per 100 000 people) followed by January (76.1 per 100 000 people) and February (69.48 per 100 000 people); also, the lowest incidence was in August (47.42 per 100 000 people) and July (50.0 per 100 000 people). Conclusions: The incidence of animal bites has significantly increased. Given the importance of rabies, control and management of animal bites should be emphasized and considered.

39-42

Authors: Rishi Agarwal, Hardeva Ram Nehara, Babulal Meena, RP Agrawal

Rationale: Pituitary apoplexy (PA) is a rare endocrine emergency that requires prompt diagnosis and management. Dengue fever-induced-thrombocytopenia may rarely predispose to PA. Patient's Concern: A 58-year-old male patient having known pituitary macroadenoma presented to the emergency department with fever, a sudden onset severe headache, and altered sensorium. Diagnosis: Pituitary apoplexy caused by dengue fever-induced-thrombocytopenia. Interventions: Conservative management with fluids, mannitol, dexamethasone and symptomatic treatment. Outcomes: The patient responded well to the treatment and was discharged uneventfully. Lessons: Although dengue hemorrhagic fever is a rare cause of pituitary apoplexy, it should be considered if a patient presents with headache and altered sensorium, and prompt initiation of treatment is crucial to prevent fatality and neuro-ophthalmic deficits.