Journal of Acute Disease

93-96

Authors: Noor-Ahmad Latifi, Hamid Karimi

Objective: To review low-voltage, high-voltage and lightening electrical burns in adults and children, identify novel areas that are not recognized and improve treatments results and outcome. Methods: An extensive literature search on electrical burn injuries was performed using Ovid Medline, PubMed and Embase databases from 1976 to 2016. Studies related to electrical injury in the adult and children (< 15 years of age) population were included in our study. Fifty-one research papers and review articles were identified and included in this study. Results: Total occurrence of electrical injury among burn injuries ranged from 3.5% to 15.0%. Most of them were low voltage (73%) and one fourth were high voltage and percentage of lightening injuries were very low around 2%–4% of total cases of electrical injury. Mortality is somehow higher among high voltage electrical injuries and lightening. Most of complications of them were morbid in kidney, heart, extremities (including amputations) and nervous systems. Long-term psychological problems were reported with greater incidence rates in highvoltage injuries. Psychological and posttraumatic stress disorders were also reported. Mortality rates from electrical injuries were 2.6% in low voltage and 5.2% in high voltage. Conclusions: High-voltage injury leads to greater morbidity and mortality than low-voltage one. Lightening has mortality of about 32%, higher rates of complications and specialty longterm complications. Strict multi-specialty treatment and rehabilitations are required for proper treatment of electrical injuries.

101-102

Authors: Pathoom Sukkaromdee, Viroj Wiwanitkit

Living in the dormitory is usually the requirement for university students who live far from the university. The medical disorder occurring at night among the university students is rarely reported. The acute problem due to accident is a topic of interest. Here, the authors summarize on pattern of accident at night of university students in a dormitory.

107-111

Authors: Fei Luo

Objective: To study the effect of surgery combined with nerve growth factor preparation treatment of acute cerebral hemorrhage on nerve cytokines and nerve injury. Methods: 68 patients with acute cerebral hemorrhage who received emergency minimally invasive evacuation of hematoma in Zigong No. 4 People’s Hospital between August 2014 and September 2016 were selected and randomly divided into mNGF group and control group, mNGF group received postoperative mouse nerve growth factor preparation combined with conventional therapy, and control group accepted routine postoperative treatment. 10d, 20d and 30d after treatment, the serum was collected to determine the levels of nerve cytokines and nerve injury molecules. Results: 10d, 20d and 30d after treatment, serum BDNF (5.29±0.88 vs. 3.58±0.61, 6.94±0.93 vs. 3.78±0.55, 9.28±1.13 vs. 4.57±0.62 ng/ml), NTF-α (2.94±0.52 vs. 1.35±0.18, 3.88±0.58 vs. 1.51±0.20, 5.21±0.72 vs. 2.95±0.46 ng/ml), NGF (0.89±0.11 vs. 0.62±0.08, 1.02±0.15 vs. 0.78±0.09, 1.45±0.18 vs. 0.92±0.12 ng/ml) and VEGF (147.53±19.52 vs. 110.38±14.28, 184.95±22.51 vs. 121.29±17.85, 237.49±31.28 vs. 145.38±18.31 pg/ml) levels of mNGF group were significantly higher than those of control group while S100β (1.27±0.20 vs. 2.19±0.33, 0.94±0.14 vs. 1.76±0.25, 0.71±0.09 vs. 1.32±0.17 ng/ml), GFAP (2.08±0.36 vs. 4.42±0.55, 1.65±0.25 vs. 3.57±0.51, 1.31±0.17 vs. 2.93±0.42 pg/ml), NSE (34.21±5.82 vs. 73.19±9.35, 27.58±4.12 vs. 58.76±8.28, 22.12±3.25 vs. 39.52±5.28 ng/ml), MBP (5.28±0.93 vs. 11.28±1.86, 3.89±0.51 vs. 9.12±1.14, 3.12±0.41 vs. 6.79±0.94 ng/ml), MDA (6.97±0.93 vs. 14.21±1.87, 5.02±0.78 vs. 11.75±1.76, 3.57±0.62 vs. 8.12±0.99 μmol/L), AOPP(65.19±9.68 vs. 155.62±19.63, 48.59±7.21 vs. 118.75±16.85, 37.83±5.28 vs. 82.11±10.18 μmol/L) and 8-OHdG (4.77±0.67 vs. 10.28±1.52, 3.52±0.51 vs. 9.38±1.15, 2.33±0.41 vs. 6.52±0.92 ng/ml) levels were significantly lower than those of control group. Conclusion: Surgery combined with nerve growth factor preparation treatment of acute cerebral hemorrhage can improve neural nutritional status and reduce nerve injury degree, and it is beneficial to the recovery of neural function.

120-125

Authors: Elham Yousefi, Masoud Foroutan, Roya Salehi, Shahram Khademvatan

Objective: Since pre-transfusion screening for Toxoplasma gondii is not performed on blood packs, thalassemia patients are susceptible to acquiring toxoplasmosis; thus, the aim of this study was to evaluate the seroprevalence status of T. gondii in individuals who suffer from thalassemia in comparison to healthy persons in the southwest of Iran. Methods: In this case-control study, 117 thalassemia patients and 205 healthy persons participated. All samples were tested for the presence of specific IgG and IgM antibodies against T. gondii using ELISA technique. Data were analyzed using Chi-square test. Results: Seroprevalence of anti-T. gondii IgG was detected in 30.76% (36/117) of patients and 20% (41/205) of healthy individuals (P=0.04), also anti-T. gondii IgM in these groups was detected 1.70% (2/117) and 0.48% (1/205), respectively (P=0.3). In present study, nine related risk factors with toxoplasmosis infection were evaluated and data analysis showed that only contact with cat was significantly correlated with IgG seroprevalence (P=0.02). Conclusions: Current research suggests thalassemia patients are more prone than normal persons to acquiring T. gondii infection (P=0.04, OR:1.77). Due to limited studies in this high risk group, further studies are recommended.

131-133

Authors: Norihan Ibrahim, Baharuddin Abdullah, Regunath Kandasamy, Nor Hayati Othman, Mohtar Ibrahim, Adil Hussein

Inverted papilloma is an uncommon histopathological finding of maxillary sinus tumor. We reported here a rare case of inverted papilloma of maxillary sinus presented initially with ipsilateral proptosis. A middle-aged lady with history of having allergic rhinitis presented with progressive left eye proptosis. Assessment revealed presence of orbital mass arising from paranasal sinus, in which the histopathological examination was initially inconclusive, and later it turned up to be inverted papilloma, partly with malignant transformation. High index of suspicion is necessary especially in those patients with recurrent non-specific sinonasal symptoms, which may need repeated biopsy and histopathological examination. Ocular manifestation signifies a more advance disease.

137-140

Authors: Noor Shirlyna Irma Ngah, Ramiza Ramza Ramli, Adil Hussein, Hasnan Jaafar

Primary non Hodgkin’s lymphoma of the lacrimal sac is uncommon but potentially delay in diagnosis as it may mimic the presentation of primary post saccal nasolacrimal duct obstruction. In this article, we reported a case of primary non Hodgkin’s lymphoma of the lacrimal sac presented with recurrent acute dacryocystitis in a young lady. A 28 years old Malay lady had history of persistent epiphora on left eye for 4 years. Prior to presentation to our clinic, it was preceded by progressive recurrent painful medial canthal swelling for 6 months duration. Clinical diagnosis of post saccal naso lacrimal duct obstruction was made and otorhinolaryngology assessment revealed intranasal mass. Endoscopic excision was done showed diffuse large B cell lymphoma on histology. The patient was started on 6 cycles of chemotherapy which subsequently result in no recurrence of the tumour post chemotherapy. Any case of post saccal nasolacrimal duct obstruction should be investigated thoroughly as it may become as a presentation of other sinister pathology.

47-52

Authors: Syed Shoeb Ahmad

Lens-induced factors are important and common mechanisms causing acute elevation of intraocular pressure. While in most cases, the diagnosis and management are straight-forward, in others it is difficult and can lead to improper procedures, complications and poor visual outcomes. This review was done with the aim of studying the various types of lens-induced glaucomas, classifying them in an easy way to understand manner, their clinical features, current management and future possibilities.

57-61

Authors: Yi-Jun Shi

Objective: To investigate the postoperative inflammatory reaction, stress reaction and immune response of laparoscopic surgery and laparotomy for acute gastric perforation. Methods: Forty-four patients with acute gastric perforation receiving emergency surgery in our hospital from May 2012 to December 2015 were selected and retrospectively analyzed. Among these patients, there were 19 patients treated with laparoscopic surgery (LS group) and 25 patients treated with laparotomy (laparotomy group). At the first day after surgery, their serums were collected and the indexes of inflammatory reaction and stress reaction were detected. Mononuclear cells and red blood cells in peripheral blood were collected and detected for the immune function indexes. Results: At day 1 after surgery, the contents of serum interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10, cortisol, norepinephrine, epinephrine, renin and angiotensin-II of patients in the LS group were all significantly lower than those of the laparotomy group; fluorescence intensities of CD3, CD4, CD16 and CD56 of mononuclear cells in peripheral blood were all obviously higher than those of the laparotomy group; and the numbers of red blood cell C3bR and immune complex resette and the fluorescence intensities of complement receptor type 3, CD58 and CD59 were obviously higher than those of the laparotomy group. Conclusions: Emergency laparoscopic surgery used to treat acute gastric perforation shows slight postoperative inflammatory reaction and stress reaction and presents weak nonspecific immune response, specific immune response and erythrocyte immune response, which makes less trauma than laparotomy.

66-69

Authors: Zhi-Yong Lu

Objective: To investigate the effect of adjuvant therapy with ginkgo-damole on apoptosis, nerve injury and platelet aggregation of patients with acute cerebral infarction. Methods: A total of 74 patients with acute cerebral infarction treated in our hospital from March 2014 to December 2015 were retrospectively analyzed, and they were divided into ginkgo-damole group and conventional treatment group according to a therapeutic schedule that whether ginkgo-diyidamolum were included. At Week 2 and Week 4 after treatment, contents of apoptosis molecule, nerve injury molecule and index of platelet aggregation in serum were detected. Results: At Week 2 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients’ sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. At Week 4 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients’ sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. Conclusions: Adjuvant therapy with ginkgo-damole can inhibit the apoptosis of neuron cells and neurogliocyte and reduce the neural function injury and the situation of platelet aggregation.

74-77

Authors: Xiao-Yan Zhu, Rong-Yao Hou, Shun-Chang Sun, Xi-Yan Zhou

Objective: To study the expression quantity of serum miR-146a and miR-146b in patients with acute cerebral infarction before and after the intervention of rosuvastatin and its correlation with toll-like receptor 2 (TLR2) and TLR4 signaling pathways. Methods: A total of 65 patients with acute cerebral infarction treated in our hospital from December 2015 to August 2016 were selected for prospective study. They were treated with lipid-lowering rosuvastatin, and peripheral blood samples were collected at 8th week before and after treatment, respectively. Serum was separated and expression quantity of miR-146a and miR-146b and contents of TNF-α, interleukin (IL)-1β, IL-6 and IL-17 were determined. Peripheral blood mononuclear cells were isolated and fluorescence intensities of TLR2, TLR4, myeloid differentiation primary response gene 88 (MyD88), interleukin-1 receptor-associated kinase 1 (IRAK-1) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) were measured. Results: At 8th week of intervention of rosuvastatin, expression quantity of serum miR-146a [(0.762 ± 0.092) vs. (0.346 ± 0.053)] and miR-146b [(0.714 ± 0.088) vs. (0.317 ± 0.047)] in patients with acute cerebral infarction was significantly higher than those before the intervention. Fluorescence intensities of peripheral blood mononuclear cells such as TLR2 [(10.34 ± 1.27) vs. (16.94 ± 1.94)], TLR4 [(11.37 ± 1.54) vs. (24.35 ± 3.26)], IRAK [(9.34 ± 0.92) vs. (15.32 ± 1.82)], MyD88 [(4.42 ± 0.56) vs. (9.41 ± 1.03)] and NF-kB [(6.65 ± 0.78) vs. (13.49 ± 1.76)] and contents of inflammatory factors such as TNF-α [(64.26 ± 8.29) μg/L vs. (106.39 ± 13.84) μg/L], IL-1β [(37.91 ± 5.24) μg/L vs. (64.23 ± 8.33) μg/L], IL-6 [(34.28 ± 4.85) ng/L vs. (82.46 ± 11.97) ng/L] and IL-17 [(56.75 ± 7.49) ng/L vs. (98.31 ± 11.36) ng/ L] of serum were all significantly lower than those before the intervention. Expression quantity of serum miR-146a and miR-146b had a negative correlation with fluorescence intensities of TLR2, TLR4, IRAK, MyD88 and NF-kB. Fluorescence intensities of TLR2 and TLR4 in peripheral blood mononuclear cells had a positive correlation with contents of TNF-α, IL-1β, IL-6 and IL-17 in serum. Conclusions: Treatment with rosuvastatin can up-regulate the expression quantity of serum miR-146a and miR-146b in patients with acute cerebral infarction and further inhibit the secretion of IRAK, MyD88, NF-kB, TNF-α, IL-1β, IL-6 and IL-17 mediated by TLR2 and TLR4.

82-84

Authors: Joseph Yorke1,2, Pius Agbenorku1,3*, Ronald Awoonor-Williams2, Kofi Baah Nyamekye4, George Amoah4, Offoe Michael Adinku2, Charles Appiah2, Amoah Edward Boateng2, Esinam Anita Agbeko2, Papa Kwesi Sonsomir Fiifi-Yankson2, Dorcas Ahulu5, Daniel Anning Gyawu2, Dennis Afful Yorke6

We reported a case of a 30-year-old man who reportedly sustained electrical burns and fell from a high voltage electric pole about 50 meter high onto a metal that caused impalement injury. In addition, he sustained full-thickness burns of the right upper limb (7%), the right hemithorax, the perineum (sparing the penis), the anterior abdominal wall and the lateral aspect of both thighs. There was 43% burned surface area in total. Radiographic examination revealed a slender curved object extending from his perineum into the pelvis. The management of this case was a challenging one which was described in this article.

87-88

Authors: Mehmet Tatli, Gökhan Eyüpoğlu, Hilal Hocagil

Cyanide is a toxin and one of the most rapidly acting fatal poisons that human being is aware. If it is not treated promptly, encountering to cyanide poison will lead to die in minutes. Cyanide avoids cellular oxygen usage by inactivating mitochondrial cytochrome oxidase thus inhibits cellular respiration. In this case, we represent a case report describing uncommon cyanide intoxication owing to consumption of a few portion of apricot kernels and its rapid treatment with dicobalt edetate after suspection of cyanide poisoning.

92

Authors: Hasan Tahsin Gozdas

No.

1-5

Authors: Ionut Negoi, Sorin Paun, Massimo Sartelli, Fausto Catena, Luca Ansaloni, Ruxandra Irina Negoi, Mircea Beuran

Objective: To summarize the current evidence about the hypertriglyceridemia–induced acute pancreatitis (HAP). Methods: Systematic review of the English language literature was conducted using PubMed/ Medline database from its inception until August 2016. As a searching methodology, we have used a combination of ‘acute pancreatitis' and ‘hypertriglyceridemia' as keywords into the title. Results: The diagnosis of HAP should be based on two out of the three criteria recommended by the international guidelines: characteristic clinical picture, serum pancreatic enzymes, and appropriate imagistics. The diagnosis of HAP should be distinguished between mild hypertriglyceridemia (> 150 mg/dL), which accompanies around one-third of all-causes acute pancreatitis, and severe hypertriglyceridemia (> 1 000 mg/dL) which generates acute pancreatitis. There is mixed evidence regarding a worse prognosis for patients with HAP, and a clear conclusion cannot be drawn. Similar to all the other etiologies, in HAP the initial treatment efforts should be nonspecific and addressed to acute pancreatitis, while pharmacologic and mechanical techniques should be added to lower the serum triglycerides as soon as possible. Conclusions: We may conclude that HAP should be managed to respect all the general principles, also adding all the available resources to lower the serum triglycerides value, as early as possible in the acute setting and on long-term to prevent recurrences.

12-17

Authors: Serafino Carta, Gabriele Falzarano, Giuseppe Rollo, Predrag Grubor, Mattia Fortina, Luigi Meccariello, Antonio Medici, Alberto Riva, Luca Sampieri, Paolo Ferrata

Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group. P ≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. Results: The P < 0.05 in favor of the THA group was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. Conclusions: Our experience shows that the THA treatment for acetabular fractures in the elderly is to be preferred.

23-27

Authors: Sema Yilmaz, Riza Dincer Yildizdas, Oguz Dursun, Bulent Karapinar, Tanil Kendirli, Demet Demirkol, Agop Citak, Alphan Kupesiz3, Hakan Tekguc, Muhterem Duyu, Pinar Yazici, Ufuk Yukselmis, Caglar Odek, Ayhan Yaman, Suleyman Bayraktar, Guntulu Şık, Fatma Betul Cakir

Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/FiO2 ratios were (164.22 ± 37.24) and (126.80 ± 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation.

33-35

Authors: Yolercy Vásquez, José Daniel Charry, Juan Daniel Ochoa, Ana María Gómez, Karen Herrera, Jorman Harvey Tejada, Jose Domingo Alarcón

Objective: To describe the clinical and sociodemographic characteristics of geriatric patients who were treated at a university hospital in southern Colombia. Methods: A database of trauma patients over 65 admitted between June 2014 and December 2015 was constructed. Univariate analysis was performed. Measures of central tendency and dispersion for continuous variables were calculated. Results: A total of 760 patients were analyzed, the median age was 74 years (65–98). The median injury severity score was 9 (4–25) the 71.97% were men, and overall mortality was 25.39%. The 92.10% was blunt trauma, and the main mechanism of injury was falls. Conclusions: Trauma in the elderly is a common condition with high risk of mortality. It is important to know the frequency of these injuries to provide the best possible handling. In our hospital we found that geriatric trauma is a common disease, the main cause is falls without embargos traffic accidents are common in this population.

41-42

Authors: Hasan Tahsin Gozdas, Mehmet Dinek

Acute pyelonephritis is a serious infection in pregnancy. It is presented with fever, shaking chills and flank pain. Intravenous hydration and antimicrobial therapy are sufficient in the treatment unless pyelonephritis is complicated. In case of fever persisting for more than 48 h despite appropriate antimicrobial treatment, a possible complication such as urinary tract obstruction, abscess or phlegmon should be considered. Here, we present an 18-year-old pregnant woman with acute pyelonephritis whose persistent fever returned to normal after double-J ureteral stent was placed even if she had no finding of such a complication.

45-46

Authors: Yu-Hang Yeh, Yu-Jang Su

A febrile and unconscious man was sent to our emergency department. On physical examinations, some dark red ecchymosis/discoloration over the trunk and track mark in the left-sided groin region were seen. Brain CT scan showed septic emboli complicated with hemorrhage. Chest X-ray revealed pulmonary emboli. Aortic valve vegetation was found by echocardiography. Although aggressive treatment and resuscitation were taken, he died of methicillin-sensitive Staphylococcus aureus sepsis and multiple organ failure. Intravenous drug users are susceptible to right-sided infective endocarditis. In our case, leftsided infective endocarditis with lung and brain embolism resulting in fatality was relatively uncommon. Review of literature was also made for this article.

445–449

Authors: Gentian Vyshka, Dritan Muzha, Meri Papajani, Maksim Basho

Paraplegia and spinal cord injuries are issues of major concern to the actual medicine. But recent advances have raised hopes for a better prognosis, which has always been poor or infaust since medicine was practiced. However and interestingly enough, some concepts and definitions on the occurrence have survived for millennia. Once encountered as an issue, traumatic or non-traumatic paraplegia needs a multidisciplinary approach and a careful staging of the problem. Different scales are available with Frankel's and American Spinal Injury Association most widely used as alternatives or complementary tools. The authors discuss therapeutic options with a special focus on the stem cell therapy which has seen an impressive increase on the number of trials for a successful treatment. Sourcing and yielding of stem cells are made possible through a number of techniques, with material aspirated from bone marrow or adipose tissue, which are used along with other sources of neuronal precursors such as olfactory ensheathing cells. Nevertheless, large and multicenter studies are still lacking. However, with the quality of the ongoing work and research, the optimistic attitude seems warranted. Meanwhile, other rehabilitation and medical care interventions, always at hand, need to be applied in every individual suffering from paraplegia and spinal cord injury.

454–457

Authors: Adegbolagun Temitope Adeoye, Adeolu Alex Adedapo, Matthew Oluwole Abatan

Objective: To evaluate the antiulcer and analgesic effects of the aqueous root extract of Lonchocarpus cyanescens (L. cyanescens) since the plant is said to have medicinal properties. Methods: The filtrate of the aqueous root extract of the plant (100 mg/mL) was used to evaluate for antiulcer activity in 20 rats divided into five groups of four rats each, which were Groups A, B, and C that received 100, 200 and 300 mg/kg doses respectively, while Group D was served as negative control and animals of Group E received 20 mg/kg dose of ranitidine. Indomethacin at a dose of 15 mg/kg was used to induce ulcer on the day of sacrifice. For acetic writhing test (antinociception), same design was used except that Group E received 100 mg/kg dose of acetyl salicylic acid as standard drug. Abdominal contractions were induced in the animals by intraperitoneal administration of 10 mL/kg of 0.6% of acetic acid. Results: The aqueous root extract of L. cyanescens at all doses (100, 200 and 300 mg/ kg) showed significant (P < 0.05) decrease in ulcer parameters compared with the negative control. The extract also produced a significant (P < 0.05) decrease in the number of writhing reflexes in treated rats compared with negative control. Conclusions: The aqueous root extract of L. cyanescens exhibited both antiulcer and analgesic effects justifying folklore claim for the health benefits of this plant.

462–465

Authors: Devid Belalla, Nikollaq Kaçani, Arben Gjata

Objective: To evaluate the preoperative radiotherapy and its role in anastomotic leakage. Methods: A total of 327 patients who had an anterior resection (AR) in elective surgery for a rectal carcinoma were selected and operated in our clinic of surgery during the period from 2003 to 2015. Among them, 135 patients had a low anterior resection (LAR) and the other 192 had an AR. This is a retrospective study. Chi-squared test was used to evaluate statistical differences and the P < 0.05 was considered statistically significant. Results: A total of 126 patients had radiotherapy before surgery, and 50 of them had a LAR. In the other 201 patients, surgery was the first treatment modality, and 83 of them had a LAR. We had an overall anastomotic leakage of 7.95% or 26% patients. Anastomotic leakage was found in 14 patients with LAR, 9 of which had radiotherapy before surgery. From the 12 patients with AR who had an anastomotic leakage, 6 of them had radiotherapy before surgery. Conclusions: Radiotherapy may affect anastomotic healing and increase the risk of leakage. This risk is higher in low anterior anastomoses where a protective stoma may be considered. A better evaluation and support for patients with preoperative radiotherapy is needed in order to diminish the concomitant risk factors as much as possible.

470–482

Authors: Kaddour Taı€r, Omar Kharoubi, Oussama Anouar Taı€r, Nouria Hellal, Im´ene Benyettou, Abdelkader Aoues

Objective: To study the antioxidative and protective properties of aqueous extract of Hammada scoparia (H. scoparia) against the effects of sub-chronic aluminium (Al) intoxication on mnemonic process and some neurochemical markers. Methods: Al was administered intraperitoneally (50 mg/kg body weight, three times a week), and H. scoparia and malic acid were given orally by gavage at a daily dose (100 mg/kg body weight) to rats for 90 days. Results: Al caused significant short-term and long-term memory disturbances, a decrease in locomotor activity, a significant inhibition of acetylcholinesterase activity in brain and a significant depletion of antioxidant enzymes (catalase, glutathione reductase and glutathione peroxidase) and glutathione. It significantly increased lipid peroxidation levels in cerebrum and cerebellum. However, treatment with H. scoparia extract protected efficiently the neurological functions of intoxicated rats by considerably increasing antioxidants levels and decreasing production of thiobarbituric acid reactive substances by 4.26% compared to untreated group. We noted some controversial results with malic acid. It showed some positive results but it was not as efficient as H. scoparia extract. Current results were consistent with histopathological observations including neurodegeneration and vacuolated cytoplasm (spongiosis) in Al treated sections when H. scoparia and malic acid treated sections showed marked neuroprotection signs. Conclusions: This study strongly suggested that H. scoparia extract could possibly restore the altered neurological capacities and antioxidant power in rats, and it could even be a good alternative to chelating agents or other chemical medicines against Al-induced neurotoxicity.

488–492

Authors: Towhid Babazadeh, Hossein Ali Nikbakhat, Amin Daemi, Mohsen Yegane-kasgari, Saber Ghaffari-fam, Morteza Banaye-Jeddi

Objective: To describe the epidemiological aspects of animal bites and to calculate the financial burden resulting from rabies vaccination in Chalderan City. Methods: In this cross-sectional study, records of all victims of animal bites in a seven-year period were reviewed. Studied variables included demographic information of victims, biters' profile, time and place patterns, clinical aspects of the victims and the cost of vaccination. Results: Most of bites were observed in men in the age group of 10–19 years old, at rural areas and occupational group of farmers. The vast majority of animal bites happened by dogs and domestic animals. The average age of victims with head and neck injuries was lower than that of victims with injuries in the lower extremities, shoulders and hands (P = 0.001). The cost of vaccination was 11665 dollars with three doses of rabies vaccine and 849 dollars for five doses, and the 12514 dollars cumulative frequency in the studied period. Based on the results of trend test, the incidence of animal bites was increased significantly during the study period (P = 0.02). Conclusions: The results of this study showed that due to the increasing incidence of animal bites and the financial burden resulting from animal bite vaccination, it is necessary to design and implement preventive measures in order to reduce the animal bites.

497–501

Authors: Michele Bisaccia, Luigi Meccariello, Mattia Manni, Gabriele Falzarano, Antonio Medici, Giuseppe Rinonapoli, Salvatore Di Giacinto, Giovanni Colleluori, Cristina Ib´añez Vicente, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa

Objective: To evaluate the follow-up of the fractures treated by external fixator. Methods: A total of 31 children aged 6–15 years with proximal humeral fractures Grade IV according to Neer–Horowitz classification were treated. The medium follow-up was 24 months. Results: In all cases, a good stability of the fracture and a quick healing process were obtained. The mean time of follow-up was 24 months. The external fixation was removed after 6 weeks (5–8 weeks) on average. Constant shoulder score was proposed to all patients and the average result was 97.5 (84–100). Conclusions: Advantages of the external fixation are rapid mobilization of the joint, low invasiveness, a single surgery and the possibility to correct any secondary displacement. It is important to underline that the positioning of external fixator should be implanted by expert surgeons and that the patients must cooperate during the entire process up to the time of the removal of the fixator.

507–511

Authors: Wei Zhang

Objective: To study the effects of Shuxuetong injection in adjuvant treatment of ischemic stroke on the degree of nerve injury, lipid metabolism and blood coagulation function. Methods: Patients with ischemic stroke admitted in our hospital during the period from May 2012 to May 2015 were selected for retrospective analysis. They were divided into the control group receiving regular treatment and the Shuxuetong group receiving adjuvant treatment with Shuxuetong injection. One and the three months after treatment, serum was collected and nerve injury molecules, indexes of lipid metabolism and blood coagulation function were measured. Results: One month after treatment, the contents of neuron-specific enolase, S100 calcium binding protein B, total cholesterol, triglyceride, low-density lipoprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The contents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Three months after treatment, the contents of neuron-specific enolase, S100 calcium binding protein B, total cholesterol, triglyceride, low-density lipoprotein, oxidized low-density lipoprotein, thromboxane B2, fibrinogen and D-dimer in the serum of patients from Shuxuetong group were significantly lower than those of control group. The contents of high-density lipoprotein and 6-keto prostaglandin F1a were significantly higher than those of control group. Conclusions: Adjuvant treatment with Shuxuetong injection can reduce the injury of nerve function of patients with ischemic stroke and improve blood lipid metabolism and blood coagulation function, which is an effective drug for the treatment of ischemic stroke.

517–520

Authors: Dana Elliot Srither, Fatimah Lateef

The study aims to validate that a smartphone application can assist in the learning and skills retention for cardiopulmonary resuscitation training. This cardiopulmonary resuscitation feature of the Crowdsav platform is designed to record the chest compression performance as well as the rate of compressions of the trainee. Crowdsav is available for downloading in the public domain. The application, once downloaded can be utilised during training and be replayed by the trainee at his/her own will or via reminders from the training centre. The goal of using this application is to minimise the decay of the knowledge and compression skills and perhaps even reduce the resource for recertification, as skills and performance can be kept up, maintained and monitored remotely by a training centre using the application.

524–526

Authors: Qi Zhe Ngoo, Li Min Evelyn Tai, Wan Hazabbah Wan Hitam, John Tharakan

We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy in an immunocompetent patient. A 64-year-old Malay gentleman with no medical comorbidities presented with acute bilateral blurring of vision for a week, which was associated with generalised throbbing headache and low grade fever. He also had somnolence and altered consciousness. Visual acuity in both eyes was no perception of light with poor pupillary reflexes. Extraocular muscle movements were normal. Anterior segments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc swelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement or mass. Cerebrospinal fluid opening pressure was normal, while its culture grew Cryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic neuropathy was made. Patient was treated with a six-week course of intravenous fluconazole and started concomitantly on a fortnight's course of intravenous amphotericin B. After that, his general condition improved, but there was still no improvement in his visual acuity. On reviewing at two months post-initiation of treatment, fundi showed bilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis was rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal medication alone may not be sufficient to manage this condition. However, evidence for other treatment modalities is still lacking and further clinical studies are required.

357–363

Authors: Wissem Aidi Wannes, Brahim Marzouk

The use of the medicinal plants in treating diabetes is frequent in Africa, especially in Tunisia, and it is ritually transmitted from generation to generation within cultures. Many of Tunisian medicinal plants have been experimentally validated. A comprehensive review was conducted to pile up information from scientific journal articles, including indigenous knowledge researches, about Tunisian medicinal plants used for the treatment of diabetes. The aim of this review article is to provide the reader with information concerning the importance of Tunisian medicinal plants in the treatment of diabetes and to draw attention of the health professionals and scientists working in the field of pharmacology and therapeutics to develop new drug formulations to cure different kinds of diabetes. 1. Introduction

382–385

Authors: Nan-Bin Yu

Objective: To investigate the effect of anisodamine combining with conventional therapy on the degree of lung injury and inflammatory reaction of patients with acute pulmonary contusion. Methods: A total of 48 patients with acute pulmonary contusion treated in our hospital emergency department from April 2011 to October 2015 were enrolled as the research object and were divided into experimental group and control group by using a method of random number table. Experimental group received anisodamine combining with conventional therapy and control group received conventional therapy. In the process of the treatment, the mechanical ventilation time, hospital stays in intensive care unit and the number of cases developed into acute respiratory distress syndrome and multiple organ dysfunction syndromes of patients in two groups were observed. Oxygenation indexes of patients were respectively calculated on Days 1, 2 and 3 after treatment. The contents of inflammatory mediators in serum were detected on Day 3 after treatment. Results: The mechanical ventilation time and hospital stays in intensive care unit [(9.52 ± 1.41) vs. (14.57 ± 2.51) days] of patients in experimental group were significantly shorter than those in control group, and the number of cases developed into acute respiratory distress syndrome [1 (4.17%) vs. 9 (37.50%)] and multiple organ dysfunction syndrome [1 (4.17%) vs. 7 (29.17%)] was significantly less than those in control group. Oxygenation indexes (294.52 ± 41.26 vs. 257.63 ± 38.52; 357.74 ± 47.74 vs. 279.87 ± 31.46; 396.71 ± 55.12 vs. 279.87 ± 31.46) of patients were respectively calculated on Days 1, 2 and 3 after treatment, which were significantly higher than those in the control group. On Day 3 after treatment, the contents of serum C-reactive protein [(7.94 ± 1.05) vs. (14.49 ± 2.97) mg/L], tumor necrosis factor a [(264.69 ± 41.58) vs. (417.87 ± 64.51) ng/L], interleukin-6 (IL-6) [(147.72 ± 21.36) vs. (257.68 ± 41.54) ng/L], IL-8 [(93.68 ± 12.52) vs. (145.62 ± 22.65) ng/L], IL-10 [(205.64 ± 31.56) vs. (336.62 ± 51.38) ng/L] and myeloid cells-1 (73.32 ± 10.39 vs. 114.45 ± 18.51) of patients in experimental group were significantly lower than those in the control group. Conclusions: The anisodamine combining with conventional therapy can relieve the degree of lung injury caused by acute pulmonary contusion, improve ventilatory function, lower the incidence of acute respiratory distress syndrome and multiple organ dysfunction syndrome and inhibit the activation of inflammatory reaction and the release of inflammatory mediators.

393–396

Authors: Xiao-Yan Zhu, Rong-Yao Hou, Shun-Chang Sun, Xi-Yan Zhou

Objective: To analyze the serum levels of miR-126, miR-146a and its relationship with infarction area, severity of disease and inflammatory reaction degree in patients with acute cerebral infarction (ACI). Methods: A total of 75 cases with ACI treated in our hospital from April 2014 to October 2015 and 80 healthy cases were respectively selected as ACI group and control group for retrospective study. Patients' clinical data were collected, and the serum levels of miR-126, miR-146a, tumor necrosis factor-a (TNF-a), interleukin-1b (IL-1b) and IL-6 were detected. Results: Serum contents of miR-126 (0.286 ± 0.078 vs. 1.000 ± 0.169) and miR-146a (0.337 ± 0.084 vs. 1.000 ± 0.158) in patients of ACI group were significantly lower than those of control group. Contents of IL-1b [(68.4 ± 10.3) vs. (22.7 ± 5.8) ng/L], TNFa [(126.9 ± 22.4) vs. (49.6 ± 8.4) ng/L] and IL-6 [(89.3 ± 14.7) vs. (34.8 ± 5.9) ng/L] were obviously higher than those of control group. The bigger the infarction area was, the more severer the degree of nerve defect could be. The lower the serum levels of miR-126, miR-146a were, the higher the levels of TNF-a, IL-1b, IL-6 could be. Levels of miR-126 and miR-146a were negative correlation with levels of TNF-a, IL-1b and IL-6. Conclusions: An abnormal decrease in serum levels of miR-126 and miR-146a in patients with ACI was closely related to the severity of disease. Through regulating the generation of inflammatory factors TNF-a, IL-1b and IL-6, miR-126 and miR-146a may get involved in the changes of cerebral infarction condition.

402–407

Authors: Chiedozie Onyejiaka Ibegbulem, Paul Chidoka Chikezie, Agwu Igwe Ukoha, Chinwe Ngozi Opara

Objective: To study the effects of diet containing monosodium glutamate on visceral organ weights, acute blood steroidal sex hormone levels, serum lipid profile (SLP) and erythrocyte antioxidant enzymes activities of Wistar rats. Methods: The Wistar rats were grouped into two groups of six rats each. The ones in Group 1 (control group) were placed on water and pelletized standard guinea feed ad libitum, whereas Group 2 was regarded as test group [Wistar rats (WR)-monosodium glutamate (MSG) group] and the Wistar rats received water, compounded diet of MSG and pelletized standard guinea feed ad libitum. After 33 days of feeding study, rat body weight was obtained. Rats were sacrificed and the incisions were made into the thoracic cavity and blood samples were drawn by cardiac puncture as a terminal event. Plasma was assayed for estradiol and testosterone concentrations, SLP and erythrocyte peroxidase and catalase activities. Visceral organ weights were also measured. Results: WR-MSG exhibited marginal alterations in blood estradiol and testosterone concentrations. Elevation of serum triacylglycerol concentration inWR-MSGwas corresponded to 77.7%. Increases in serum concentrations of very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol in WR-MSG were corresponded to 70.6% and 41.0% respectively. Erythrocyte peroxidase and catalase activities showed marginal alterations. Alterations in visceral organs-to-body weights ratios were not profound. Conclusions: Blood testosterone and estradiol concentrations were not significantly (P > 0.05) altered, which may not be connected with the low dose of MSG in the diet. Marginal alterations of SLP did not indicate atherogenicity in WR-MSG. The visceral organs were not atrophic or hypertrophic because of the comparatively low dose of MSG consumed by WR-MSG and the duration of the feeding experiment.

413–418

Authors: Mallikarjuna Rao Talluri, Rajananda Swamy Tadi, Ganga Rao Battu

Objective: To evaluate the antioxidant and thioacetamide induced liver toxicity using extracts of aerial parts of Balanites roxburghii (B. roxburghii). Methods: The in-vitro antioxidant activity was estimated for different extracts on superoxide, hydroxyl and 1,1- diphenyl-2-picrylhydrazyl free radicals and the hepatoprotective activity of the selected plant extracts was evaluated by using thioacetamide-induced liver intoxication in rats model. Results: There were no visible signs of toxicity, mortality and no behavioral changes were observed for the selected plant extracts (hydroalcoholic, ethyl acetate and hexane) at 2000 mg/kg body weight. The plant extracts showed dose-dependent effectiveness in the inhibition of free radicals generation and hepatoprotective nature. The hydroalcoholic extract showed more scavenging activity as compared to other extracts with IC50 values of (332.50 ± 1.30) mg, (302.00 ± 1.50) mg and (230.40 ± 1.10) mg on superoxide, hydroxyl and 1,1- diphenyl-2-picrylhydrazyl free radicals. Aerial parts of B. roxburghii at three dose levels such as 125 mg/kg, 250 mg/kg and 500 mg/kg showed dose dependent percentage protection as standard drugs and on enhancement activities of serum biomarker enzymes (aspartate aminotransferase, alanine transaminase, alkaline phosphatase, total bilirubin and total protein) observed in thioacetamide-induced hepatotoxicity. The hydroalcoholic extract showed significant results at 500 mg/kg body weight as compared to other extracts (P < 0.05) with 65.65%, 62.39%, 59.89%, 55.90% and 54.61% on aspartate aminotransferase, alanine transaminase, alkaline phosphatase, total bilirubin and total protein levels. Conclusions: It was observed that the B. roxburghii plant extracts are non-toxic and have capacity to restore the physiological changes caused by the hepatotoxic compounds.

423–429

Authors: Basiru Olaitan Ajiboye, Oluwafemi Adeleke Ojo, Oluwatosin Adeyonu, Oluwatosin Imiere, Isreal Olayide, Adewale Fadaka, Babatunji Emmanuel Oyinloye

Objective: To investigate the in vitro antioxidant activity of ethanolic extract of Artocarpus heterophyllus (A. heterophyllus) stem bark and its inhibitory effect on a-amylase and a-glucosidase. Methods: The A. heterophyllus stem bark was extracted using methanol and tested for antioxidative activity. Results: The results revealed that the ethanolic extract has polyphenolics and free radical scavenging compounds which were significantly higher (P < 0.05) than their respective standard, at concentration dependent manner. The ethanolic extract of A. heterophyllus stem barkwas observed to showinhibitory activities on a-amylase and a-glucosidase with IC50 of (4.18 ± 0.01) and (3.53 ± 0.03) mg/mL, respectively. The Lineweaver-Burk plot revealed that ethanolic extract of A. heterophyllus stem bark exhibited non-competitive inhibition for a-amylase and uncompetitive inhibition for a-glucosidase activities. Also, gas chromatography– mass spectrometry showed the presence of different bioactive compounds in extract. Conclusions: Therefore, it can be inferred from this study that ethanolic extract of A. heterophyllus stem bark may be useful in the management of diabetes mellitus probably due to bioactive compounds observed in the extract.

434–436

Authors: Ebisa Bekele, Bethel Shiferaw, Alexandra Sokolova, Arpan Shah, Phillip Saunders, Alida Podrumar, Javed Iqbal

Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancreatitis triggering TTP is very rare. A 71 years old female presented with abdominal pain of 3 days, followed by dark urine. She had icteric sclera, petechial rash and mild epigastric tenderness. Lab findings were significant for hemolytic anemia, thrombocytopenia and elevated lipase. CT of abdomen showed evidence of pancreatitis and cholelithiasis. After admission, patient developed symptoms of stroke. Further investigation showed elevated lactate dehydrogenase and normal coagulation studied with peripheral blood smear showed 5–6 schistocytes/high power field. Disintegrin and metalloproteinase with thrombospondin motifs-13 (ADAMTS13) activity showed less than 3% with high ADAMTS13 inhibitor 2.2. Patient required 6–7 weeks of daily plasmapheresis until she showed complete response. Our patient presented with clinical features of pancreatitis prior to having dark urine and petechial rash. Therefore, we strongly believe that our patient had pancreatitis which was followed by TTP. Patient's ADMTS13 activity was 6% after 10 plasma exchanges, signifying refractory TTP and higher risk for morbidity and mortality. There are limited data and consensus on the management of refractory TTP. TTP and acute pancreatitis are associated. However, refractory TTP following acute pancreatitis is rarely mentioned in the literature. We would like to emphasize the importance of having higher clinical suspicion of the association of both disease entities.

439–441

Authors: Yuen Keat Gan, Syed Shoeb Ahmad, Sheena Mary Alexander, Amir Samsudin

Necrotizing scleritis is an uncommon but potential disastrous infection to the eye. It is commonly caused by vaso-occlusive autoimmune diseases such as rheumatoid arthritis or surgically-induced, and rarely due to infections. In this article, we presented a rare case of necrotizing scleritis caused by herpes infection in an immunocompromised patient. A 49 years old, retroviral positive gentleman presented to our clinic with a painful, red right eye associated with watering, photophobia and blurring of vision. His right eye rapidly deteriorated leading to an impending perforation of the sclera despite intensive antimicrobial therapy. The patient was started on acyclovir ointment and subsequently improved remarkably salvaging the eye from the need of an evisceration. Although the visual prognosis was poor, structural integrity of the eye was achieved.