Journal of Acute Disease

271–280

Authors: Adrian´ Angel Inchauspe

Analyzing the properties of the reconciliation vessel, new questions arised about the origin of this wondrous circuit, as well as its configuration through the philosophical and cosmological basis of traditional Chinese medicine. Scrutinizing its location within Fu Hsi's octogram and according to the Yellow Emperor's coincidences in Ling Shu and Su Wen quotations, a plausible explanation raised up from a detailed methodological work embodied in this paper. Author's experience in cardiopulmonary revivals over many years takes to ponder his prospect of this situation from various angles, arising the comparison between legal, real and energy deaths against the possibility of more widespread recovery after terminal diagnosis.

286–295

Authors: Aaron Asibi Abuosi, Delali Margaret Badasu, Alfred Edwin Yawson, Francis Anderson Adzei, Deborah Atobrah4

Objective: To investigate children with acute non-communicable diseases (NCDs) and their caregivers in developing countries. Methods: A cross-sectional survey was conducted in three out of the ten regions of Ghana. A total of 1 540 caregivers/parents of children with NCDs were interviewed. Data was analysed with the aid of IBM SPSS version 20. Statistical techniques used in the analysis included frequencies, means, SD and factor analysis. Findings were analysed according to the major themes of the study. Results: Caregivers indicated that the incidence of NCDs among children is on the increase. They also believed that enemies can cause diseases in children. Caregivers tend to seek treatment in hospitals/clinics rather than from traditional or herbal medicine. However, they complement biomedical treatment with prayers for healing/deliverance. It was also found that NCDs have a negative effect on the physical and mental development of children as well as their school performance; and caring for children with NCDs also poses material, emotional and financial burden to caregivers. Conclusions: Serious attention needs to be given to the development and implementation of policies to better the lot of children with NCDs. Conscious efforts need to be made to encourage and assist the caregivers with necessary resources to cater for their children's educational and health needs in particular.

302–306

Authors: Jie Luo

Objective: To study the clinical effect of continuous blood purification on acute renal failure. Methods: A total of 46 patients with acute renal failure treated with continuous renal replacement therapy in our hospital from April 2011 to December 2015 were retrospectively analyzed. Patients choosing continuous veno-venous hemofiltration (CVVH) mode were collected into CVVH group and patients choosing continuous venovenous hemodiafiltration (CVVHDF) mode were collected into CVVHDF group, and their general condition, hospitalization conditions and blood biochemical indexes were analyzed. Results: Before and after treatment, the voided volumes and APACHE II scores of patients in CVVHDF group and CVVH group showed no differences. After treatment, the voided volumes of patients in the two groups were all higher than those before treatment and their APACHE II scores were all lower than those before treatment. The duration of continuous renal replacement therapy and the hospital stays in ICU of patients in CVVHDF group were all shorter than those in CVVH group. In CVVHDF group, the ratios of mechanical ventilation and death and the total hospitalization time had no significant differences with those in CVVH group. After treatment, the contents of blood urea nitrogen, serum creatinine, uric acid, b2 microglobulin, glutamic-pyruvic transaminase, aspartate transaminase, lactic dehydrogenase and creatine kinase isoenzyme of patients in CVVHDF group were all lower than those in CVVH group. Conclusions: Continuous blood purification therapy possesses exact curative effect on acute renal failure. The cleanup effect of CVVHDF mode on solutes and its protective effect on heart and liver were all superior to those of CVVH mode.

311–314

Authors: Cheng Zhang, Jian-Ming Li, De-Zhang Dou, Jun-Lin Hu

Objective: To study the changes of the rest energy expenditure, intracranial pressure, brain function parameters and serum indexes of acute craniocerebral injury after treated with mild hypothermia auxiliary therapy. Methods: Clinical data of 58 patients received emergency treatment for craniocerebral injury in our hospital from October 2009 to December 2014 were analyzed retrospectively. Among them, 27 cases treated with mild hypothermia therapy were included in the experiment group, while 31 cases without the therapy were considered as the control group. Their rest energy expenditure, intracranial pressure, brain function parameters and serum TNF-a, nitric oxide and myelin basic protein contents were determined. Results: The intracranial pressure [(20.3 ± 2.9) vs. (25.8 ± 3.3) mmHg], [(17.8 ± 2.7) vs. (23.1 ± 3.6) mmHg], [(14.2 ± 2.4) vs. (20.6 ± 3.1) mmHg], [(11.3 ± 1.8) vs. (16.3 ± 2.6) mmHg] and rest energy expenditure [(6 861 ± 994) vs. (14 074 ± 2 016) kJ/d], [(5 946 ± 768) vs. (15 525 ± 1 936) kJ/d], [(5 512 ± 873) vs. (5 512 ± 873) kJ/d], [(6 248 ± 906) vs. (14 413 ± 2 166) kJ/d] in patients of experiment group on the 1st, 2nd, 3rd and 4th days after treatment were all significantly lower than those of patients in the control group. After treated for 24 h, PbtO2 [(23.59 ± 4.97) vs. (15.68 ± 3.14) mmHg] and S jvO2 [(61.39 ± 9.79) vs. (46.76 ± 7.28) %] of the experiment group were distinctly higher than those of the control group, while its contents of TNF-a [(1.96 ± 0.29) vs. (3.39 ± 0.72) mg/L] and nitric oxide [(10.39 ± 2.16) vs. (24.42 ± 3.51) mg/L] and myelin basic protein [(2.19 ± 0.52) vs. (4.34 ± 0.78) mg/L] were all lower than those of the control group. Conclusions: After treated with mild hypothermia auxiliary therapy, the metabolic rate and intracranial pressure of patients with craniocerebral injury decreased obviously, their cerebral blood flow perfusion were improved evidently and the release of adverse metabolic products were also reduced conspicuously, which was beneficial to the recovery of neurological functions.

326–327

Authors: Pathoom Sukkaromdee, Viroj Wiwanitkit

Objective: To ask for history of toxoid immunization in patients with acute injury induced wound and discussed for the reliability. Methods: A total of 180 patients got wound from acute injury and got a management in a health unit were asked with a question whether he/she had history of previous toxoid immunization. Results: Based on this observational study, it can be seen that there are many problems in “answer” of the patients. Conclusions: Since toxoid is a safe and save preventive vaccination, it should be regularly given as mass vaccination for any patients who got wound from acute injury and get a management in any health units.

333–336

Authors: Guang-Yuan Liu, Qiang Li, Xiao-Jun Yang, Zhong-Hua Xiong

Objective: To explore the correlation between contents of serum transforming growth factor b1 (TGF-b1) and interleukin-6 (IL-6) and acute radiation pneumonitis (RP) in patients with lung cancer. Methods: A total of 138 patients with non-small cell lung cancer receiving threedimensional conformal radiation therapy in our hospital from May 2012 to October 2015 were selected as the research objects. According to the presence or absence of RP in the process of radiotherapy, those patients were divided into the RP group and non RP group to detect the contents of TGF-b1 and IL-6 in serum. Results: Before radiotherapy, there was no significant difference in the serum contents of TGF-b1 and IL-6 in the RP group and non RP group. At weeks 2, 4, 6, 8 and 10 after radiotherapy, the serum contents of TGF-b1 and IL-6 in patients of the RP group were all higher than those in the non RP group. Differences of the contents of TGF-b1 and IL-6 in each time point after radiotherapy between two groups had statistical significance (P < 0.05). In RP group, the higher the RP grade was, the more the serum contents of TGF-b1 and IL-6 became. Differences of the contents of TGF-b1 and IL-6 in patients with different RP grade were statistically significant in each time point (P < 0.05). Conclusions: In the process of radiotherapy, the increase of the serum contents of TGFb1 and IL-6 in patients with lung cancer is closely related to the occurrence of acute RP.

340–342

Authors: Murat Salihoglu, Ali Memis, Mesut Mutluoglu, Gunalp Uzun, Hakan Ay

Sudden sensorineural hearing loss (SSNHL) is an important acute clinical condition in children. A specific treatment is still missing. Hyperbaric oxygen (HBO) therapy is one of the recommended treatments for SSNHL in adults. Our knowledge on the use of HBO therapy in children for SSNHL is limited. Herein, we report the successful use of HBO therapy in the management of SSNHL in a 14-year-old child.

345–347

Authors: Rejeb Imen, Chakroun-Walha Olfa, Ksibi Hichem, Nasri Abdennour, Chtara Kamilia, Chaari Adel, Rekik Noureddine

A 61-year-old male was found to have a bilateral Bochdalek hernia on routine CT during admission for acute respiratory failure. The chest X-ray showed a left paracardiac mass having a diameter of 6 cm. This mass was initially considered as a mediastinal tumor. However, CT scan showed a bilateral large defect of the posteromedial portion of the diaphragm and mesenteric fat. 3D imaging was also useful for the stereographic perception of Bochdalek hernia. Although Bochdalek hernia is not rare, to our knowledge, this is the first case of Bochdalek hernia continued transverse colon observed by spiral CT 3D imaging.

350–354

Authors: Luigi Piscitelli, Michele Bisaccia, Luigi Meccariello, Gabriele Falzarano, Antonio Medici, Daniele Maiettini, Alberto Rebonato, Giuseppe Rinonapoli, Auro Caraffa

Total talus extrusion is a rare and severe injury. It is burdened by many complications as avascular necrosis and osteomyelitis even if a proper debridement of extruded talus is performed. Few case reports or case series were published, and because of the rarity of this event, there are no guidelines for treatment. We report the first case on an octogenarian man providing a long-term follow-up performing contrast enhanced magnetic resonances. The authors report the case of an octogenarian man who fell from an olive tree reporting a total talus extrusion associated with the fracture of the medial malleolus. After an accurate debridement and washing of the wound, the talus was anatomically repositioned and the fracture was treated with an external fixator. The wound healed with difficulty after 12 months and the patient developed a chronic osteomyelitis of the talar dome and avascular necrosis of talar head. We followed the patient for 24 months performing contrast enhanced magnetic resonances and evaluating the development of the avascular necrosis. Even if we encountered these complications, the treatment allowed the patient to walk without pain, using a talus type shoe and one crutch. Although the literature suggests that an anatomic replacement of talus allows avoiding main complications, we deem that the patient's age is an important biological feature to consider in the prognostic stratification. Moreover, primary talectomy and tibio-calcaneal fusion should be reserved as a salvage procedure. Talus replacement allows an overall good outcome for the patients, retaining height, and allowing a good quality of life.

185–189

Authors: Wei Wang, Zhu-Sheng Feng, Wen Yin

Traumatic injury remains the leading cause of death with bleeding in the world, representing the main cause of preventable death. But if immediate management could be applied, the outcomes will be dramatically improved. Trauma-induced coagulopathy (TIC) as an early endogenous process in many traumatic patients is driven by the multitissue injury and shock, and is associated with increased mortality and bad outcomes in the multi-trauma patients. The understanding of the mechanisms of TIC and its effect on the outcomes of severely injured patients has been developed over the past few years. Here, we aim to review the current understanding and recent findings in the pathobiology of coagulopathy. The principal causes of TIC are hypoperfusion, inflammation response and the activation of the neurohumoral system. Hypoperfusion causes the activation of many biomarkers, like protein C, syndecan-1, plasminogen, and so on. The elevation of these markers indicates the damage of the endothelium, which will lead to autoheparinization in body. When accompanied with acidosis, hypothermia, and hemodilution, the mortality of trauma patients will rise significantly. This article aims to focus on our updated acknowledges on the principal mechanisms and causes of the TIC.

194–201

Authors: Adrián Angel Inchauspe´

After almost thirty years of experience in saving patients at impending death situations and having made numerous contributions on the field, the author herein provides a reasoned survival bio-energetic circuit based on a detailed methodological and functional analysis of the Main Channels [1.4.2 meridian and collateral theory] [0.0.16 meridian and collateral (study)] and the Wondrous Vessels (Qi jing ba mai) [1.4.24 eight extra meridians] participating in it. The area researched as well as the results obtained underwent strict evaluations, both as regards statistics and risk management standards, besides having been carefully supervised by the rules and parameters of traditional Chinese medicine.

206–209

Authors: Jonathan Bayuo, Pius Agbenorku, Richcane Amankwa

Objective: To explore the phenomenon of surviving burn injury and its associated issues and concerns. Methods: A cross sectional survey approach was utilized to obtain data from one hundred burn survivors who were purposely selected. Descriptive statistics and content analysis were used to analyze data. Results: Findings from the study indicate that burns from flames stood out as a major cause of burns. Physical discomfort/pain, anxiety, needing assistance in meeting self-care needs, financial and social limitations were identified as the major impact of the injury. Furthermore, participants perceived the existence of societal stigma. In addition, hope in God or a spiritual being as well as family support were the two key resources participants relied on to cope effectively. Conclusions: Surviving burn injury is associated with varied physical, social and psychological factors and survivors may need professional assistance to fully adjust after discharge.

216–221

Authors: Hossein Ali Nikbakht, Seyed Reza Hosseini, Heidar Sharifi-fathabad, Rahmat Habibzade, Amin Daemi, Saber Ghaffari-fam

Objective: To examine the clinical epidemiology and treatment findings of tuberculosis in Babol, Northern Iran. Methods: This cross-sectional study was carried out on medical records of tuberculosis registry pertaining to health center of Babol City, Mazandaran, Iran. The investigated variables included demographic characteristics and some clinical patterns of patients. To present the findings, the descriptive statistics such as mean (and SD) and frequency (%) was used. Analytical statistics was applied by using Chi-square test and independent samples t-test. Results: The average age of 200 patients infected with tuberculosis was 47.51 years (SD = 21.36), and 58.5% of the cases were male. In both genders, the highest number of tuberculosis patient was found in 18–38 age group. During the 5-year study period, 95% of the patients received treatment protocol 1 (including new cases with positive smear, negative smear, extra-pulmonary) and in the end of treatment given to patients, 90.5% were improved or treatment period completed. The most important clinical symptoms for referring the patients to the therapeutic centers were cough (75.1%) and fever (60.9%). Conclusions: Education and giving information to general population about the most important clinical symptoms of tuberculosis such as fever and cough might be effective in early detection and prevention of Mycobacterium tuberculosis. Then treatment might be effective in decreasing the burden of the disease.

227–231

Authors: Wan Fairos Wan Yaacob, Nor Suhana Mohamad Noor, Nor Ili Che A. Bakar, Nurulhuda Afisah Mat Zin, Fahisham Taib

Objective: To examine the impact of haze in the reduction of peak expiratory flow rate (PEFR) reading and identify the risk factors affecting respiratory function due to haze. Methods: This study was conducted during haze period among secondary school students in Kota Bharu. We analyzed data on a total of 126 secondary school children measuring the respiratory health and symptoms in October 2015 using standardized questionnaire and PEFR measurement. Clinical characteristics on the risk factor and prevalence of haze effect were explored. Chi-square test and independent sample t-test was used to investigate the relationship between risk factors and haze effect and logistic regression analysis for the odds of having haze effect. Results: The findings revealed a significant reduction in PEFR reading of more than 15% from the expected PEFR values. It was also noted that the children with headache, cough, mucus and sore throat respiratory symptoms had consistently higher rates of respiratory illness of having haze effect compared to those who did not. Conclusions: Student with haze effect documented much higher symptoms during haze especially female students. Symptoms such as headache, wheezing and mucus were noted among the normal secondary school children in Kota Bharu.

237–243

Authors: Hadiza Lami Muhammad, Adamu Yusuf Kabiru, Musa Bola Busari, Abdullah Mann, Abubakar Siddique Abdullah, Abdulrazaq Taye Usman, Usman Adamu

Objective: To evaluate the use of Ceiba pentandra (C. pentandra) as a glucose lowering agent and the attendant physiological changes in albino rats. Methods: Acute oral toxicity study of the extract was carried out by the administration of 10, 100, 1 000, 1 600, 2 900, and 5 000 mg/kg body weight of C. pentandra to rats in their respective groups. Twenty healthy albino rats weighing between 140 and 150 g were randomly allotted to five groups of four rats each. 100 mg/kg body weight of alloxan monohydrate was i.p. administered to rats and rats with blood glucose
200 mg/dL were considered diabetic. 5 mg/kg body weight of standard drug, 200 and 400 mg/kg body weight of ethanol extract of C. pentandra were orally administered to diabetic rats in their respective groups once daily for 12 days while the control groups received 0.1 mL of normal saline for the same period. The blood glucose was checked after every 4 days and the experiment was terminated on the 17th day. Results: The safe dose (LD50) of the extract was greater than 5 000 mg/kg body weight. The extract treated groups exhibited a remarkable reduction in blood glucose [(87.72 ± 7.67) mg/dL for 200 mg/kg body weight dose and (86.33 ± 4.54) mg/dL for 400 mg/kg body weight dose] competitively with the normoglycemic group [(88.71 ± 4.56) mg/dL]. The body weight of the extract and standard drug treated groups appreciated significantly (P < 0.05) as compared with normoglycemic group. High density lipoprotein increased significantly in the extract treated groups with the 400 mg/kg body weight having the highest value of (18.61 ± 3.44) mg/dL and a concomitant reduction in the concentrations of low density lipoprotein, triacylglycerol, and cholesterol of same group. The 400 mg/kg body weight dose of the extract also demonstrated the highest reduction in the activities of aspartate transaminase [(59.66 ± 3.45) IU/L], alanine aminotransferase [(33.33 ± 4.34) IU/L] and alkaline phosphatase [(48.36 ± 3.41) IU/L] that elevated as a result of diabetes. The two extract treated groups demonstrated a marked reduction in Cl−, and elevation in HCO3− and Na+ levels. K+, urea, creatinine, total and conjugated bilirubin that were elevated in the diabetic untreated group were all ameliorated in the treatment groups. Conclusions: Ethanol extract of C. pentandra has glucose lowering effect and can ameliorate the biochemical abnormalities associated with diabetes mellitus.

248–249

Authors: Zeynep Konyar, Gokhan Eyupoglu, Mehmet Tatli, Ozlem Guneysel

Teratomas are the most common germ cell tumors among pediatric and female patients, which originates from germ cells layers and can be located everywhere in bodies. They are diagnosed by ultrasonography (US), which was characterized by calcification and cystic anechoic view. Our aim is to attract attention to a 21-year-old female patient with complaint of acute abdominal pain diagnosed with teratoma by early radiological imaging. The female patient admitted to the emergency department with a new onset of abdominal pain at the lower and left sides of the abdomen for a week. The suprapubic and left costovertebral angle tenderness were found in her physical examination. We firstly chose US for imaging. The US of the abdomen showed multiple cystic masses around uterus. Heterogeneous cystic and calcified lesions were detected on the patients computerized tomography scan, and considered as teratoma. A laparotomy was performed by gynecologists. At laparotomy, lobulated cystic masses were removed and the left ovary had been detorsioned. She has been discharged after two days of postoperative observation. For patients of young females with abdominal pain such as rare gynecological diseases, teratoma and ovarian torsion, in the emergency department should be considered and early imaging should be performed.

252–254

Authors: Giancarlo De Nigris, Gabriele Falzarano, Antonio Medici, Steven James Mccabe, Grubor Predrag, Maria Liberata Meccariello, Luigi Meccariello

Medical staff hardly recognize fractures of trapezium due to the small size and the complex anatomy of the wrist and the hand. Seventy percent of all carpal fractures are scaphoid's fractures. Only 0.4% of all carpal injuries are trapezial fractures. In this paper, we presented a case of a high speed trauma where there were only trapezial fractures. Origin, diagnosis, differential diagnosis, treatment and complications are evaluated and described.

258–259

Authors: Pathoom Sukkaromdee, Viroj Wiwanitkit

The sterile pyuria is an interesting problem in urology. Acute gross sterile pyuria is not a common clinical problem and is difficult to make a correct diagnosis. Here, the authors reported a case of acute gross sterile pyuria after oral ciprofloxacin treatment of urinary tract infection. The patient developed problem after complete course of 7-day acute upper urinary tract treatment. The patient was observed with cloudy whitish urine that had never seen before. The urinalysis showed sterile pyuria. This case was treated by conservative method and the problem was resolved within 7 days.

264–266

Authors: Ilkay Cakir, Serkan Senol, Yasin Simsek, Zuleyha Karaca, Kursad Unluhizarci, Fatih Tanrıverdi

Primary hyperaldosteronism, is a well-known cause of secondary hypertension, mostly idiopathic hypertension or arising from aldosterone-producing adenomas. It is characterized with resistant hypertension, hypokalemia and metabolic alkalosis related with aldosterone production excess and plasma renin activity suppression. Hypokalemic rhabdomyolysis usually presents with muscle pain, cramps, fatigability and generalized weakness. Rhabdomyolysis due to hypokalemia is a rare complication of primary hyperaldosteronism reported within a limited number of cases in medical literature. Diagnosis and treatment of primary hyperaldosteronism is fundamentally important because of the probability of certain cure with accurate surgery. Here, we report a 38- year-old female with hypertension related with primary hyperaldosteronism who presented with rhabdomyolysis most likely due to profound hypokalemia.

91–95

Authors: Mahmood Nekoei-Moghadam, Mohammadreza Amiresmaili, Zeynab Aradoei

Floods, hurricanes, landslides, hurricanes, tornadoes, earthquakes are events that a large group of people on earth are affected. In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city. The purpose of this study was to investigate obstacles against effective crisis management with considering service received by individuals in the Bam earthquake. In this study, domestic journals, foreign dissertations in Persian bases such as Google scholar, Magiran, IranMedex, SID and in English bases such as PubMed, Web of Science, Google scholar were used. The results of this study showed that there were many problems in various aspects of planning including: lack of coherent programs, lack of attention to the needs of health care, poor coordination between agencies and organizations and lack of appropriate training of volunteers and people.

102–108

Authors: Farah Iram, Sadaf Ali, Aftab Ahmad, Shah Alam Khan, Asif Husain

Dronedarone, a benzofuran containing chemical compound, is a derivative of amiodarone which is classified as a Class III antiarrhythmic agent. It is prescribed to the cardiovascular patients who have paroxysmal or persistent atrial fibrillation to lower the chances of hospitalization. Amiodarone, sotalol, procainamide dofetilide, quinidine, ibutilide, flecainide, and propafenone are the other useful medicinal products used to treat atrial fibrillation or cardiac arrhythmia. Dronedarone was approved for clinical use in atrial fibrillation by the Food and Drug Administration in 2009. The generic name for dronedarone is Multaq (Sanofi Aventis). This article briefly highlights the important pharmacological, pharmacodynamic and pharmacokinetic properties of dronedarone.

114–116

Authors: Syed Shayan Ali, Fatimah Lateef

Necrotizing fasciitis is a rare bacterial skin condition which forms a major diagnostic challenge and is associated with poor prognosis unless promptly treated. Initial clinical presentation is often misleading with characteristic features developing only late in the course of the disease. In this review, we discuss the applicability and usefulness of laboratory risk indicator for necrotizing fasciitis score in facilitating rapid diagnosis of necrotizing fasciitis in emergency department by differentiating it from other skin infections like cellulitis and abscesses. A high index of suspicion resulting from the laboratory risk indicator for necrotizing fasciitis score can facilitate early diagnosis enabling prompt antibiotic administration and timely referral to surgery for wound debridement, ultimately reducing both the morbidity and mortality.

123–125

Authors: Chukwudi Onyeka John Okonkwo, Ailende Daniel Ehileboh, Eddy Nwobodo, Charles Chijioke Dike

Objective: To find out if Gasoline vapour has some effects on haematological indices when inhaled by experimental rats. Methods: The standard method for laboratory operating procedure recommended by World Health Organization was used in all the analysis done. Forty two albino Wistar rats comprising twenty one males (160–220 g) and twenty one females (140–190 g) were sampled into six groups consisting of four test groups and two control groups. The test groups were exposed to gasoline vapour for twenty one days. Test group one were exposed to gasoline for 30 min while test group two were exposed to gasoline vapour for 1 h daily. At the end of twenty one days of exposure, blood samples were collected from the rats and their haematological parameters were estimated. Statistical analysis was done using windows SPSS version 16. Results: The results showed a significant decrease (P < 0.05) in the red blood count and white blood count of exposed rats and increases in packed-cell volume, haemoglobin, mean corpuscular volume, and mean corpuscular haemoglobin respectively. These increases were significant (P < 0.05) in test group two. There was no significant change in the mean corpuscular haemoglobin concentration of the rats in the test groups when compared to the control groups of both sexes. Conclusions: The results obtained suggest that inhalation exposure to gasoline may result in pancytopaenia and a significant fluctuation in the red blood cell-dependent haematological indices.

131–142

Authors: Alireza Salimi Chirani, Robabeh Majidzadeh, Hossein Dabiri, Javad Rezaei, Ali Esmaili, Yasamin Abdanan Kord, Narges Khabazzadeh Tehrani, Negin Attaran

Objective: Nowadays, Pseudomonas aeruginosa (P. aeruginosa), the highly regarded opportunistic pathogen, is the leading cause of morbidity and mortality worldwide. The P. aeruginosa type IV pili (T4P) as a multiple functional surface organelle in the development of acute P. aeruginosa infections have been well documented. Today, in silico analysis is a quick, and cost-effective tool for vaccine development. Methods: In present study, several turns' motifs along with the chimeric protein were predicted. Based on the hydropathy analysis, numerous antibody-accessible hydrophilic regions were characterized in the chimeric protein. A synthetic chimeric gene, encoding integrated PilQ and disulphide loop region of PilA, was designed. Modeling was done to predict the 3D structure of protein. The model was validated by using Ramachandran plot statistics and by ProSA server. Identification of B-cell and T-cell corresponding epitopes was done by using appropriate servers. Results: The closer 3D model to the native form of the chimeric protein was achieved. Validation results showed that 95.1% residues were in favor region and 3.6% of amino acid residues were in the allowed region. The B-cell epitope mappings showed that almost all the epitopes had irregular enriched structures. The major histocompatibility complex binding sequence prediction identified several human major histocompatibility complex class I and II restricted T-cell epitopes. The integrated PilQ and PilA disulphide loop encoding regions in the frame of pET28a(+) vector were expressed and purified efficiently. Conclusions: We expect that the two recognized antigenic determinants from our chimeric protein, “AYHKGNWSGYGKDGNIGIKDEDGMNCGPIAGSCTFPTTGTSKSPSPFVDLGAKDATSG” and “GPIAGSCTFPTTGTSKSPSP”, can be able to evoke strong both humoral and cell-mediated immune responses in mouse models.

150–153

Authors: Muhammad Sohail Umerani, Asad Abbas, Saqib Kamran Bakhshi, Ujala Muhammad Qasim, Salman Sharif

Objective: To establish the frequency of evolution in CT appearance from an initial scan to a subsequent scan within 12 h and the prognostic significance of such deterioration. Methods: All patients who presented to Department of Neurosurgery, Liaquat National Hospital and Medical College with traumatic brain injury and received their CT scan within the first 4 h of injury were included in the study. Indications for repeat CT scan were: any deterioration in neurological status after the initial scan, potentially deteriorating lesion on initial scan with or without worsening neurology, worsening neurological status after the initial CT scan findings, or no neurological improvement after initial management in patients with normal CT scan with significant head injury. This compiled with the data of 107 patients. Results: There were 67 males and 40 females. The cause of trauma of the 70% patients was road traffic accident. In 11 patients, the lesion evolved towards resorption while 32 patients had no significant changes in the subsequent CT scan. Sixty four patients showed an increase in the size of the lesion and 65.6% of them were required surgical intervention subsequently. Conclusions: In case where the initial CT scan performed within 4 h of significant head injury was not correlated with the patient's neurology, it should be repeated within 12 h

160–161

Authors: Chiu-Yin Yeh, Wen-Liang Yu

Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 mIU/mL; free tetraiodothyronine, 5.67 ng/dL; thyroid-stimulating hormone receptor antibody, 76.9% (normal range, < 14%); and antimicrosomal antibody titer, 1:102400 (normal range, < 1:100), suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.

165–167

Authors: Harrison K. Borno, Richard J Menendez, John C. Chaloupka, Michael T. Dalley, David A. Farcy

Carotid blowout syndrome (CBS) is a rare and fatal complication which arises from patients who have been treated for head and neck cancer. The incidence of CBS is rare and not commonly seen by emergency physicians. We review a case of a 68-year-old woman with a history of laryngectomy and chemo-radiation therapy presenting with massive oral bleeding and hypotension. Her course and treatments are highlighted, literature referring to CBS are described and we reintroduce the approach of managing such a patient in the emergency department.

174–176

Authors: Nurhayati Abdul Kadir, Syed Shoeb Ahmad, Shuaibah Abdul Ghani, Madusudhan Paramananda

Periorbital necrotizing fasciitis is a rare but potentially fatal infection. It is most commonly caused by Gram-positive group A b-haemolytic Streptococci and rarely by fungal infections. In this report, we present a rare case of periorbital necrotizing fasciitis caused by Aspergillus species in an immunocompromised patient. He presented to us with a history of a slowly progressive eyelid necrosis leading to a loss of vision in one eye. The patient was started on an antibiotic and subsequently, surgical debridement and enucleation were performed. A few days post-operatively, yellow white mould colonies were noted to grow on the wound surface. Microbiology cultures identified them as Aspergillus species and intravenous amphotericin B 10 mg was added daily. However, despite the extensive medical and surgical treatments, he failed to respond and succumbed from septicaemia and multi-organ failure.

178

Authors: Beuy Joob, Viroj Wiwanitkit

No

9–15

Authors: Syed Salman Ali, Chandra Kala, Mohd Abid, Nabeel Ahmad, Uma Shankar Sharma, Najam Ali Khan

Cardiovascular diseases are one of the leading causes of morbidity and mortality. In recent researches, it is demonstrated that microRNAs (miRNAs) are expressed extensively in cardiovascular system and regulate gene expression in various cardiovascular diseases. Here, we are giving overview on number of miRNAs involved in pathophysiology of various cardiovascular diseases, and diagnostic and therapeutic potentials of miRNAs in these diseases. MiRNAs are a group of small non-coding mRNAs with approximately 18–22 nucleotides in length that regulate gene expression post transcriptionally. MiRNAs are regulated in various cardiovascular diseases like hypertension, congestive heart failure, congenital heart defects, coronary artery disease and stroke. Some of these miRNAs also act as potential biomarker of these cardiovascular diseases. Inhibition of these miRNAs via different approaches like chemically modified antisense oligonucleotide, antagomirs, and locked nucleic acids serves as effective approaches for inactivating pathological miRNAs. Clinical trials are being conducted on therapeutic and diagnostic potentials of miRNAs. However, extensive researches are required to explore the therapeutic and diagnostic values of miRNAs as successful as classical approaches.

22–28

Authors: Monchai Siribamrungwong, Pawadee Chinudomwong

Acute kidney injury (AKI) is a serious problem during pregnancy. Once occurred, it brings about devastating maternal and fetal outcomes. Among developed nations, the trend of pregnancy-related AKI (PRAKI) is on a decline due to the advances in obstetrics care and the legality of abortion. On the contrary, this situation remains one of the major health problems in the developing countries. Though some improvements have been observed, PRAKI still causes high maternal morbidity and mortality, leading to fetal losses. This article aims to review current studies with regards to obstetrics related AKI. Most of the studies in this review were carried out in observational, both prospective and retrospective, studies. Results demonstrated a variety of major PRAKI causes such as hypertensive disorders in pregnancy, obstetric hemorrhage, sepsis, thrombotic microangiopathy and acute fatty liver in pregnancy. Aside from awareness of the etiologies of PRAKI, understanding the physiological renal adaptation during pregnancy is crucial for early detection, diagnosis, and proper management to prevent the obstetric complications.

37–40

Authors: Ibrar Rafique, Umbreen Akhtar, Umar Farooq, Mussadiq Khan, Junaid Ahmad Bhatti

Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62 530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR) = 4.41], when the poisoning occurred at home (OR = 21.84), and was related to selfharm (OR = 18.73) or assault (OR = 7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages.

46–50

Authors: Si-Jian Li, Cynthia Sau Ting Wu, Ho Ting Wong

Objectives: To explore the impact of the Lushan earthquake on the schoolchildren's health and learning environment after 2 months of the earthquake and to collect children health information and identify school environmental health risks. Methods: This was an explorative single-case study. The case was defined as the two primary schools affected by the earthquake on 20th April, 2013 and relocated in a rebuilt temporary classroom. This study collaborated with Department of Social Work, Sichuan Agricultural University located in Ya'an. With the support from the above social work station, 448 school-age children from the affected Majun and Gonghe primary schools were invited to participate in this study from July 1 to 2, 2013. Finally, 187 children participated. Data were collected through structured questionnaire, field observation and the social work station's report and analyzed by using descriptive analysis and qualitative content analysis. Results: One hundred and eighty-seven school-age children participated in this study. Participants' demographic characteristics showed that around half of the subjects (89; 47.6%) were male. Majority were aged 10 or above (114; 61%) and in grades 4–6 (108; 57.7%), whereas only 7% (13) were preschool children. Near three quarters (134.0; 71.7%) children were not living with their parents. School environmental health risks were identified including public health and school building risks. Conclusions: One hundred and eighty-seven school-age children in two primary schools were involved in this study. Baseline data for children's health status were obtained and the school health risks were identified. The findings suggested that it would be vital to develop collaborative care and service learning model to enhance children health and school safety in a disaster-prone community.

59–61

Authors: Smail Acimi

Objective: To get to know about the clinical presentation of ovarian torsion in young girls. Methods: From January 2009 to January 2014, 4 patients were treated in our hospital for ovarian torsion. The ages of the patients at surgery were 3, 9, 141, 151 months, with a mean age of 76 months. Results: In all cases, the ovary was necrotic at the time of surgery. Conclusions: Ovarian torsion is a rare gynecological emergency in children which requires an early surgical intervention to save the ovary from necrosis. Unfortunately, surgical treatment was belated in all our patients.

71–76

Authors: Sima Sadat Seyedjavadi, Mehdi Goudarzi, Fattaneh Sabzehali

Objective: To survey the frequency of blaTEM, blaSHV and blaCTX-M genotypes in extended-spectrum b-lactamase (ESBL)-producing Escherichia coli (E. coli) isolated from hospitalized patients with urinary tract infection and the determination of their antibiotic resistance patterns. Methods: During 11-month study, 100 ESBL-producing E. coli were collected from 330 patients who met the definition of urinary tract infection. The phenotypic identification of ESBL was confirmed by double disk synergy test and combined disk diffusion test. In vitro, susceptibility to ESBL isolates than 14 antimicrobial agents was performed by Kirby-Bauer disk diffusion method. The frequency of blaTEM, blaSHV and blaCTX-M ESBL-producing E. coli was assessed by PCR method. Results: The frequency of ESBL-producing E. coli was 40.8%. In vitro, susceptibility to ESBL-producing E. coli showed that the majority of isolates were highly susceptible to amikacin (74%) and imipenem (91%). The rates of resistance to other antibiotics varied from 33% to 96%. Through 100 tested isolates, the prevalence of blaTEM, blaSHV and blaCTX-M genes was determined to be 67%, 45% and 74% respectively. In comparison with other bla genes, the frequency of blaCTX-M was strikingly high. Conclusions: Due to the increase of E. coli with multiple ESBL genes, continuous surveillance in order to use appropriate antibiotics and the control of infections is necessary.

79–82

Authors: Grigorios Voulalas, Chrisostomos Maltezos

Colonic ischemia is a recognized complication of either open or endovascular abdominal aortic aneurysm repair. The clinical difficulty in establishing the diagnosis, the severity of this complication and the patient's poor physiological status may lead to a fatal outcome. We presented a case of ischemic colitis in a patient with patent hypogastric arteries that occurred after an endovascular abdominal aortic aneurysm repair as well as a review of the available literature. The patient's preoperative, intraoperative and postoperative data were recorded. A thorough search through the Google data and Medline to review similar cases or any analyses that referred to ischemic colitis after endovascular abdominal aneurysm repair was conducted. A 76-year-old male was admitted to our department for an elective endovascular repair of an 8 cm in diameter abdominal aortic aneurysm. A Zenith bifurcation graft was implanted. The whole procedure was uneventful and the final angiogram showed an accurate deployment of the endograft without endoleaks and patency of both hypogastric arteries. During the 1st postoperative day, the patient developed symptoms of acute abdomen in combination with metabolic acidosis and oliguria. He underwent an exploratory laparotomy, which revealed necrosis of the sigmoid. A Hartmann's procedure was performed; the patient was transferred to the intensive care unit where he deceased after 24 h. Postoperative ischemic colitis has been described after open abdominal aneurysm repair. The description of this complication has been reported since the early phase of endovascular abdominal aneurysm repair development with a current incidence of 1.5%–3.0%. Possible mechanisms that may contribute to ischemic colitis in spite of the presence of patent hypogastric arteries include atheroembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

86–89

Authors: Slavisa Zagorac, Aleksandar Lesic, Marko Bumbasirevic

The femoral fractures remain the great challenge for orthopedic surgeons regarding time of fixation and appropriate fixation techniques. There is a bimodal distribution of fractures occurring most frequently in young males after high-energy trauma (motor vehicle accidents) and in elderly females after falls from standing. Young patients with femoral fracture are under the great risk of multiple injuries. Hence, the great significance is optimal time of fixation. We present a case of unusual pattern of injury and fixation technique of bilateral proximal femur fracture associated with vascular injury, with very satisfied outcome.

266-273

Authors: Adrian Angel Inchauspe

This risk management project aims to apply a global preventive and predictive measure in potential victims of acute death and heart failure. Among the main causes are identified sub-diagnosed genetic mutations; prescription, interaction, self-medication or abuse of suspected drugs due to internet prospect's consult; and a parasitic pandemia, the Chagas disease (over 100000000 population is potentially infected worldwide). Promoting a global extensive determination of the torsadogenic index which was successfully published in Frontiers of Pharmacology Journal, will allow to monitor general population, set security patterns to categorize silent high risk groups of serious prognosis of tachyarrhythmias. For this purpose, applications of known QT determinations are proposed, recommending Dr. Rautaharju's formula, actually improved with gender adult versions. Torsadogenic index will allow to establish an individual traceability, obtain comparative samples that are alert to possible QT enlargements. Thus, torsadogenic index results a valuable, simple and costless resource to consider in the fight against acute death and cardiac arrest. Torsadogenic index represents a global indicator capable of predicting and preventing acute death and heart failure for most relevant reasons.

277-279

Authors: Somsri Wiwanitkit, Viroj Wiwanitkit

Acute hemorrhagic disease is an important problem in medicine that can be seen in many countries, especially those in tropical world. There are many causes of acute hemorrhagic disease and the viral infection seems to be the common cause. The well-known infection is dengue, however, there are many new identified viruses that can cause acute hemorrhagic diseases. In this specific short review, the authors present and discuss on those new virus diseases that present as “acute hemorrhagic fever”.

287-291

Authors: Poh-Chin Lai, Chun Bong Chow, Ho Ting Wong, Kim Hung Kwong, Shao Haei Liu, Wah Kun Tong, Wai Keung Cheung, Wing Leung Wong, Yat Wah Kwan

Objective: To explore socio-demographic data of the population as proxies for risk factors in disease transmission modeling at different geographic scales. Methods: Patient records of confirmed H1N1 influenza were analyzed at three geographic aggregation levels together with population census statistics. Results: The study confirmed that four population factors were related in different degrees to disease incidence, but the results varied according to spatial resolution. The degree of association actually decreased when data of a higher spatial resolution were used. Conclusions: We concluded that variables at suitable spatial resolution may be useful in improving the predictive powers of models for disease outbreaks.

298-304

Authors: Jacob Kehinde Akintunde, Olakunle Enock Bolarin

Objectives: To evaluate the toxicity of lisinopril in liver of male rats and its reversal effect of garlic capsule (GAR) and selenium-vitamin A, vitamin B, vitamin C (SACE). Methods: Thirty five adult male wistar rats were randomly assigned into 5 groups of 7 animals per group. Group I serves as the control, animals in Groups II, III, IV and V received 28 mg/kg body weight of lisinopril via oral route. Group III was co-treated with GAR at therapeutic dose of 250 mg/kg body weight per day. Group IV was co-treated with SACE at dose of 500 mg/kg body weight. Lastly, group V was co-treated with GAR and SACE at doses of 250 and 500 mg/kg body weight respectively, and the experiment last for 8 days. Results: Administration of lisinopril caused systemic toxicity in liver as well as adverse histopathologic changes in the tested tissue. While GAR and SACE significantly (P < 0.05) reversed the toxic effects induced by lisinopril. Conclusions: Collectively, the results suggest that therapeutic dose of lisinopril elicits toxicity in male rats through induction of oxidative damage and depletion of cellular adenosine triphosphate. The reversal effects of GAR and SACE during lisinopril treatment suggest that these antioxidants may find clinical application in cellular damage involving ROS and adenosine triphosphate.

309-315

Authors: Muhammad Kifayatullah, Mohd. Shahimi Mustafa, Pinaki Sengupta, Md. Moklesur Rahman Sarker, Arindam Das, Sreemoy Kanti Das

Objective: To evaluate the safety dose range of ethanolic extract from the leaves of Pericampylus glaucus (Lam.) Merr. by acute and sub-acute oral toxicity study on animal model. Methods: The acute and sub-acute toxicity study was carried out as per Organization for Economic Co-operation and Development guidelines 423 and 407. In acute toxicity study, the oral dose (300, 2000 and 4000 mg/kg) of tested plant extract was administered to three groups in single dose and general behavior, adverse effects and mortality were determined up to 72 h and compared to normal group. In sub-acute study, the tested crude plant extract was administered orally at doses of 600 and 1000 mg/kg for 28 days to the two animals groups and their body weight, hematological, serum hepatic biochemical parameters were evaluated and compared to normal group by sacrificing all group animals. Results: In acute toxicity, all treated groups’ revealed neither mortality nor any significant alteration in behavior only drowsiness, sedation and lethargy were observed in two group, i.e. 2000 and 4000 mg/kg of the tested plant extract. In sub-acute toxicity study no change in hematological, biochemical parameter and organ body weight were observed during study compared to the normal group. The kidney function parameters [serum glutamic-oxaloacetic transaminase (aspartate transaminase), serum glutamic pyruvic transaminase (alanine transaminase)] were significantly increased following administration of tested crude plant extract (600, 1000 mg/kg). Conclusions: The result indicates that the oral administration of Pericampylus glaucus (Lam.) Merr. extract did not produce any significant toxic effect in BALB/c mice. Hence, the extract can be utilized safely for therapeutic use in pharmaceutical formulations.

322-326

Authors: Bogdan Stoica, Sorin Paun, Ioan Tanase, Ionut Negoi, Mircea Beuran

Objective: To analyze trauma epidemiology, pattern of lesions or death profile in a level I east-European trauma center. Methods: Prospective observational study of patients admitted to a level I east-European trauma center and enrolled in our trauma registry, between January 2012 to January 2013, was conducted, with the inclusion criteria: (1) trauma lesions, (2) new injury severity score (NISS) higher than 15. Results: There were 141 patients admitted during the study interval, including 102 (72.3%) males, with a mean age of (43.52 ± 19.00) years, and a mean NISS of 27.58 ± 11.32. The trauma etiology was traffic-related injuries 101 (71.6%), falls 28 (19.9%) and crushing injuries 7 (5.0%). Only one case of gunshot wound was encountered in our study. Out of traffic-related injuries, the automobiles were involved in 56 (55.4%) and motorcycles in 9 (8.9%) patients. The bicyclists accounted for 2 (2.0%) of patients and pedestrians hit by vehicles were in 33 (32.7%) cases. High-velocity falls were found in 7 (25.0%) patients, whereas low-velocity falls accounted for 21 (75.0%) of cases. The overall mortality was 30.00%, and these patients presented the mean NISS of 37.63. Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

331-334

Authors: Gabriele Falzarano, Antonio Medici, Predrag Grubor, Milan Grubor, Luigi Meccariello

Objective: To investigate that if the hybrid external fixation is the definitive treatment and management of tibial extra articular and intra-articular pilon fractures of the adult in emergency. Methods: We treated 237 cases of pilon fractures using hybrid external fixation with or without minimal osteosynthesis from February 1999 to December 2014. All fractures were classified according to the Association for the Study of Internal Fixation. The three groups were represented by 108 patients (45.5%) for the Type A; 75 patients (31.8%) for Type B and 54 patients (22.7%) for Type C. Road accidents [118 patients (50.0%)] were the most common cause of tibial pilon fractures. Results: According to a mean follow-up of 7.3 years we had bone healing after 4.8 months from surgery in the 61.18% of the patients. The results were subjectively excellent, while the 54.00% were objectively excellent according to Ovadia and Beals score, and the results showed 29 complications. Conlusions: From our data hybrid external fixation with or without minimal fixation is a good surgical method to treat pilon fractures.

338-340

Authors: Wee-Min Teh, Mohtar Ibrahim

A 53-year-old male was referred from another eye hospital for right eye corneal perforation secondary to infective keratitis. A penetrating keratoplasty was performed for tectonic purposes. Forty eight hours after penetrating keratoplasty, he developed a band keratopathy located at the interpalpebral area of the corneal button. Despite stopping topical and systemic ciprofloxacin which could have contributed to this, the band keratopathy became more severe. Surgical debridement of the band keratopathy was done and there was no recurrence after that. This case of acute band keratopathy is an uncommon condition that develops within days to weeks of a particular insult to the eye. Various offending medications have been implicated, and treatment options include chelation therapy, surgical debridement and penetrating keratoplasty. Recurrence is common despite treatment and the cessation of possible offending medications. As such, it is prudent to be aware of and recognise the early symptoms and signs of this potentially sight-threatening condition.

344-346

Authors: Alexander John Scumpia, Megan Elizabeth Dekok, Daniel Michael Aronovich, Gurpaul Bajwa, Randy Barros, Randy Katz, Jordan Ditchek

Acute chest pain resulting in spontaneous idiopathic hemomediastinum is a rare, potentially life-threatening occurrence. Acute chest pain is a common chief complaint of patients, accounting for 2.4%–6.0% of adult emergency room visits. The clinician's differential diagnoses for acute chest pain rarely include complications of hiatal hernias. An 83-year-old male presented with acute chest pain and was emergently diagnosed with hemomediastinum secondary to spontaneous gastric mesenteric vessel rupture due to a non-strangulated hiatal hernia after physical exertion.