Journal of Acute Disease

1-12

Authors: Satinder Kakar, Deepa Batra, Ramandeep Singh, Ujjwal Nautiyal

Magnetic microspheres hold great promise for reaching the goal of controlled and site specific drug delivery. Magnetic microspheres as an alternative to traditional radiation methods which uses highly penetrating radiations that is absorbed throughout the body. Its use is limited by toxicity and side effects. Now days, several targeted treatment systems including magnetic field, electric field, ultrasound, temperature, UV light and mechanical force are being used in many disease treatments (e.g. cancer, nerve damage, heart and artery, anti-diabetic, eye and other medical treatments). Among them, the magnetic targeted drug delivery system is one of the most attractive and promising strategy for delivering the drug to the specified site. Magnetically controlled drug targeting is one of the various possible ways of drug targeting. This technology is based on binding establish anticancer drug with ferrofluid that concentrate the drug in the area of interest (tumor site) by means of magnetic fields. There has been keen interest in the development of a magnetically target drug delivery system. These drug delivery systems aim to deliver the drug at a rate directed by the needs of the body during the period of treatment, and target the activity entity to the site of action. Magnetic microspheres were developed to overcome two major problems encountered in drug targeting namely: RES clearance and target site specificity.

22-28

Authors: M. Kalaiselvi, D. Gomathi, G. Ravikumar, K. Devaki, C. Uma

Objective To Ananus comosus (A. comosus), has demonstrated a wide variety of biological activities which make it a good plant source for the treatment of many oxidative stress mediated diseases. The present study was aimed to evaluate therapeutic potential by assaying the activities of oxidative stress parameters in 7, 12 dimethylbenz(α)anthracene induced breast cancer rats. Methods Animals were divided into five groups of six animals. Group I served as control, group II induced mammary carcinogenesis by 7, 12 dimethylbenz(α)anthracene, group III and IV are treatment groups (plant extract 250 mg/kg body weight and standard drug 10 mg/kg body weight) and group V served as animals treated with plant extract alone. All the animals were sacrificed after 30 days treatment and breast tissues are used for the analysis of protein content, enzymic and non-enzymic antioxidants using standard protocols. Results The oral administrations of ethanolic peel extract of A. comosus (250 mg/kg body weight) to breast cancer bearing rats for 30 days demonstrated a significant (P<0.05) increased in body weight, tissue weight, protein content, enzymatic and non enzymatic levels. The altered activities of lipid peroxidation and tumor weight in breast tissue of control and experimental cancer bearing rats were significantly (P<0.05) were reverted to near normal levels by the administration of ethanolic extract suggesting that the extract have quenching capacity against free radicals thereby exhibiting anticancer potential of A. comosus in breast cancer bearing rats. Conclusions Thus, modulatory effects of A. comosus on attenuating the lipid peroxidation and upregulation of oxidative stress key enzymes like enzymatic and non-enzymatic antioxidants, protein content afford a pledge for widespread use for the treatment of breast cancer in the future.

33-36

Authors: Dinesh K. Patel, Sairam Krishnamurthy, S. Hemalatha

Objective: To investigate glucose utilization capacity of bioactivity guided fractions of Hybanthus enneaspermus (H. enneaspermus) and Pedalium murex (P. murex) in isolated rat hemidiaphragm. Methods: Dried coarsely powdered plant material was extracted in ethanol using soxhlation technique, further extract was fractionated using solvents of varying polarity. Glucose utilization capacity of bioactivity guided fractions using isolated rat hemidiaphragm was performed in the present study. Results: The entire tested fraction showed increased glucose uptake capacity, and was found to be maximum in case of chloroform fraction of P. murex extract (CHPM) which was quite comparable to standard insulin (P<0.05). Conclusions: In vitro glucose uptake by hemidiaphragm study showed increased utilization of the glucose by hemidiaphragm in the presence of different fractions. From these findings we can conclude that that different fraction of both plant materials had some extra pancreatic mechanism like glucose uptake by peripheral tissues.

40-43

Authors: Milivoje Vuković, Neboj ša Moljević, Sini ša Crnogorac

Objective: To investigate the conventional technique involves treatment of femoral hernia an approximation inguinal ligament to pectineal ligament. In technique which uses mesh closure for femoral canal without tissue tension. Method: A prospective study from January 01. 2007-May 30. 2009. We analyzed 1 042 patients with inguinal hernia, of which there were 83 patients with 86 femoral hernia. Result: Femoral hernias were present in 7.96% of cases. Males were 13 (15.66%) and 70 women (84.34%). The gender distribution of men: women is 1:5.38. Urgent underwent 69 (83%), and the 14 election (17%) patients. Average age was 63 years, the youngest patient was a 24 and the oldest 86 years. Ratio of right: left hernias was 3.4:1. With bilateral femoral hernias was 3.61% of cases. In 7 patients (8.43%) underwent femoral hernia repair with 9 Prolene plug. Conclusions: The technique of closing the femoral canal with plug a simple. The plug is made from monofilament material and is easily formed. This technique allows the reduction of recurrence and can be used safely, quickly and easily in elective and emergency situations.

48-51

Authors: Nora Burda , Vilma Mema , Ejup Mahmudi , Brikena Selimi , Sulejman Zhugli , Basri Lenajni , Illaz Bunjaku

Objective: The purpose of the study is to prescribe and analyze the correlation of dry eye and Diabetes Mellitus Tip II, at Polyclinic of Specialties Nr. 2 Ophthalmology service ,between May 2011 and June 2012. Methods: A total number of 223 patients diagnosed with Diabetes Mellitus Tip II underwent ocular examinations including 120 male and 103 female, aged from 24-73 years old. To confirm the presence of diabetes among these patients fasting blood glucose level was performed (normal limit < 110 mg/dL). History of disease, duration of diabetes, age, and sex was obtained by reviewing the medical records and direct patient interview. Also the patients complains: tearing photophobia, red eye , itching ,foreign body sensation, blurred vision was recorded. From the study were excluded all conditions which affects the tear film stability and contact lens wearer. Results: A total of 118 patients (58 male /61 female) were diagnosed with dry eye syndrome of varying degrees.. The diagnosis was made by heaving two or more positive tests performed as mentioned above, and referring to patients complains. Fourteen patients represent pinpoint corneal dye with fluorosceini , forty-six patients was positive to cotton swab test diminution of corneal sensitivity, eighty-nine patients was positive to Schirmmer test less than 10 mm, positive TBUT test less than 9 s was found to be the amount of seventy-one patients. Positive tear meniscus at inferior lid margin was found at fifty-six patients. Dry eye is a disorder of tear film because of tear deficiency or excessive tear evaporation which causes damage to the inter palpaberal ocular surface and is associated with symptoms of ocular discomfort. This ocular disorder is very common among general population with 28% of the adults having dry eye syndrome. Early diagnosis and timely treatment, complications as secondary microbial infection and corneal ulceration could be avoided.Conclusions: In our study the Dry Eye Syndrome showed to have a high correlation with Diabetes Mellitus Tip II ( about 52.9%). Prevalence of Dry Eye was significantly higher at patients with longer duration of diabetes. Dry Eye seems to be an important contributing factor related to corneal abnormalities. Age and sex not seem to play any important role in this condition. Good glycemic control is important for prevention and control of Dry Eye Syndrome.

56-60

Authors: Kaylene J Logan, Patrice M. Weiss, Catherine Hagan-Aylor, Bob Herbertson

Objective: To compare our institution with national benchmark times, and identify rate-limiting steps in the process by conducte a retrospective review of the turnaround times in 2009 at the Carilion Clinic Breast Care Center (CCBCC). To evaluate patient satisfaction with the turn around times. Methods: A retrospective chart review was performed to evaluate the time intervals from abnormal screening mammogram to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to MRI, and MRI to surgery of all patients seen for breast cancer in 2009. A patient survey was mailed out to all patients (131) managed from abnormal screening to surgery in 2009, assessing their satisfaction with the turnaround times from screening mammogram to call back, call back to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to results call, biopsy result to MRI appointment, MRI appointment to surgery consult, and surgery consult to surgery; and assessing possible reasons why patients may perceive the process to be delayed. The MEANS procedure was applied to evaluate the turnaround times, and a Box and Whisker Plot statistical comparison was made between patient satisfaction and turnaround times. Results: The mean turnaround time at the CCBCC in 2009 from abnormal screening mammogram to surgery was 45 d. This falls within the 75th %ile of the National Quality Measures for Breast Centers (NQMBC), established by the National Consortium of Breast Centers (NCBC). Of 131 surveys mailed out, 57 were returned (44%). The patient satisfaction rates for each interval ranged from 96%-100%, with an overall satisfaction rate of 98% for abnormal screening mammogram to surgery. Discussion: The CCBCC ranks at the 75%ile in overall turnaround times; however, this turnaround time included an interval of MRI, not previously measured in NQMBC benchmark. Rate-limiting steps were identified as the time from screening mammogram to diagnostic mammogram, and biopsy to surgery-specifically, the sub-interval MRI to surgery. Since 2009, the CCBCC has already improved the process for obtaining insurance approval and preauthorization for MRIs; and has added an additional breast surgeon to share the burden of benign cases, and a nurse practitioner to see post-op and follow up patients, improving the accessibility to the primary breast surgeon specialist. Consideration should be given to future time interval studies that evaluate breast cancer turnaround time including MRI to help establish benchmarks.

66-69

Authors: Siti Hajar Mat Abu, Hanizasurana Hashim, Tara Mary George, Norfariza Ngah, Adil Hussein

Fifty-seven years old Malay lady, post menopausal with co-morbid of diabetes mellitus and hypertension presented with three months history of bilateral painful red eyes associated with double vision. Examination revealed both eyes proptosis, corkscrew vessels with present of bruit, secondary narrow angle with raised intraocular pressure, 6th cranial nerve palsy, and bilateral venous stasis retinopathy. CT angiogram showed bilateral dilated superior ophthalmic veins with cerebral angiogram findings of bilateral indirect carotid cavernous fistula involving small meningeal vessels. Indirect or dural cavernous sinus Fistula can easily be missed or misdiagnosed. Trivial injury especially in the predisposing patient can initiate the occurrence.

73-75

Authors: Fesih Aktar, Sinan Akbayram, Necmettin Akdeniz, Sirac Aktar, Cihangir Akg ün, Murat Doğan, H üseyin Çaksen, Ahmet Faik Oner

Herpes zoster (HZ) is often associated with painful erythematous vesicular eruptions of the skin or mucous membranes. Approximately 10% to 30% of the population will suffer from HZ during their lifetime. HZ is infrequent in healthy children. However, diminished cellular immunity seems to increase risk of reactivation because incidence increases with age and in immunocompromised states. We report a 7-year-old girl with acute myeloblastic leukemia HZ infection on the right palmar, elbow and forearm region (C7, C8 and T1 dermatomes). We want to indicate unusual localization of HZ on the acute myeloblastic leukemia child patient.

79-81

Authors: Rachita Sarangi, Surjeet Sahoo, Satyasunder Mohapatra

Psychotic manifestations are uncommon in neurocysticercosis. This article describes a ten year girl presented with manic– psychotic manifestation for which she was under treatment with antipsychotics for eight months. Eventually she developed generalized tonic clonic seizure and CT scan of brain revealed small isodense right posterior parietal lesion of 5 mm size with perifocal edema. CECT revealed intense nodular post contrast enhancement. This highlights the possible misdiagnosis of a case of neurocysticercosis as an organic psychotic disorder so it should be considered as a differential diagnosis in patients with neurological as well as psychiatric manifestations in endemic area like India.

85–89

Authors: Feroz Ahmad, Nahida Tabassum

Both in vitro and in vivo liver models have been developed in the past years to study the hepatoprotective agents. These systems measure the ability of the test drug to prevent or cure liver toxicity (induced by various hepatotoxins) in experimental animals. In in vitro models fresh hepatocytes are treated with hepatotoxin and the effect of the test drug on the same is evaluated. In in vivo models, a toxic dose or repeated doses of a known hepatotoxin are administered to induce liver damage in experimental animals. The test substance is administered along with, prior to and/or after the toxin treatment. Various chemical agents normally used to induce hepatotoxicty in experimental animals for the evaluation of hepatoprotective agents include carbon tetrachloride, paracetamol, Acrylamide, adriamycin, alcohol, antitubercular drugs etc. The present article explains the mechanism of action of various hepatotoxic chemical/drugs, their dosage and route of administration.

94–99

Authors: Sema Yilmaz, Dinçer Yildizdas, Kenan Daglioglu, Arbil Acikalin, Can Acipayam, Ibrahim Bayram, Derya Gumurdulu, Atila Tanyeli

Objective To investigate salbutamol effects on histopathologic features of acute respiratory distress syndrome (ARDS). Methods ARDS was designed in Wistar albino male rats, 250–300 g in weight, by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats with ARDS were pressure-controlled ventilated. At the end of the 210 minutes, two hours past and nebulized salbutamol inhalation was tried. All rats were assigned to two groups: Group 1 (n=10) control group, given no treatment, group 2 (n=10) received salbutamol. Nebulized salbutamol inhalation was given in the dosage of 0, 15 mg/kg/dose. Rats were continued to be on ventilator through the experiment. After the last inhalation, two hours past and their both lungs were excised for histopathological examination. Results Rat-model ARDS had similar histopathological appearance occuring during the acute phase of the acute respiratory distress syndrome in humans. A statistical difference was seen between control and salbutamol group (P=0.002) for HM. The margination of leukocytes was decreased in salbutamol group. The difference was significant (P<0.042). Hemorrhage and interstitial/intraalveolar edema were much lower in 0.15 mg/dose nebulized salbutamol group than that of control group. There was a significant difference statistically between two groups (P<0.001). Conclusions Inhaled salbutamol therapy for ARDS is may be associated with the improvement of inflamation. Besides known effects of salbutamol, the reducing of infiltration of polymorphonuclear neutrophil leukocytes, interstitial/intraalveolar edema, perivascular and/or intraalveolar hemorrhage and hyaline membrane formation should be emphasized.

107–109

Authors: Basri Lenjani , Salih Krasniqi, Njiazi Gashi, Ilaz Bunjaku, Thaxhedin Zaimi

Objective To assess the predictors of fatal road traffic accidents following the war during the year 1999. Methods The period January 2007-December 2010 has been considered for this research. The used criterion for this research was the distribution of vehicle accidents on a yearly basis, injuries based on systems, vehicle drivers based on their sex, age, causes, accident location, road type, accident type and presence of driving permit. Results The injured in traffic accidents who have sought emergency medical assistance in the Emergency Center from January 2008 until December 2010. In the period January to December 2007 was 44 111, from which 2 235 or 5.06% were the injured in the road traffic accidents. In the period January to December 2008 the total number of sick, injured and poisoned persons who have sought emergency medical assistance in the Emergency Center was 43 610, with a total number of 2 148 or 5.00% injured in the road traffic accidents. In the period January to December 2009 the total number of sick, injured and poisoned persons who have sought emergency medical assistance in the Emergency Center was 44 228, and the total number of injured in the road traffic accidents was 2 774, or 6.27%. In the period January to December 2010 the total number of sick, injured and poisoned who have sought emergency medical assistance in the Emergency Center was 41 614, and injured from road traffic accidents were 2 384, or 5.72%. Conclusions Young age, high speed, and alcohol are predictors of fatal road traffic accidents in Pristine district.

115–119

Authors: Muhammad Aliyu, Oyeronke A. Odunola, Ahsana D. Farooq, Ahmed M. Mesaik, Muhammad I. Choudhary, Ochuko L. Erukainure, Shahida Perveen, Almas Jabeen

Objective To investigate the effects of fractionation of acacia honey on its antioxidant potential in contrast with the pure honey from whole blood, brain and liver in vitro. Methods Honey was partitioned into three fractions (dichloromethane, ethyl acetate and aqueous). Their immuno-modulatory effect on whole blood was assayed using Luminol-amplified chemiluminescence technique. Their antioxidant activities on rat brain and hepatic tissues which covers for catalase, SOD activities and lipid peroxidation. Results Fractions of the honey enhanced the production of radicals with no significant (P>0.05) antioxidant activity on whole blood where as pure honey does. Pure honey significantly (P<0.05) stimulates SOD and Catalase activity with no significant (P>0.05) effects on lipid peroxidation. Conclusions Fractionation of acacia honey negatively affects its antioxidant potential thereby making it a radical generating agent in contrast with the unfractionated.

126–129

Authors: A Abdullahi, RU Hamzah, AA Jigam, A Yahya, AY Kabiru, H Muhammad, S Sakpe, FS Adefolalu, MC Isah, MZ Kolo

Objective To study the inhibitory effect of various extracts from Crateva adansonii (C. adansonii) used traditionally against several inflammatory diseases such as rheumatism, arthritis, and gout, was investigated on purified bovine milk xanthine oxidase (XO) activity. Methods Xanthine oxidase inhibitory activity was assayed spectrophotometrically and the degree of enzyme inhibition was determined by measuring the increase in absorbance at 295 nm associated with uric acid formation. Enzyme kinetics was carried out using Lineweaver-Burk plots using xanthine as the substrate. Results Among the fractions tested, the chloroform fraction exhibited highest potency (IC50 20.2±1.6 μg/mL) followed by the petroleum ether (IC50 30.1±2.2 μg/mL), ethyl acetate (IC50 43.9±1.4 μg/mL) and residual (IC50 98.0±3.3 μg/mL) fractions. The IC50 value of allopurinol used, as the standard was 5.7±0.3 μg/mL. Conclusions Enzyme inhibition mechanism indicated that the mode of inhibition was of a mixed type. Our findings suggest that the therapeutic use of these plants may be due to the observed Xanthine oxidase inhibition, thereby supporting their use in traditional folk medicine against inflammatory-related diseases, in particular, gout.

135–140

Authors: Rabiat U. Hamzah, Adebimpe A. Odetola, Ochuko L. Erukainure, Ademola A. Oyagbemid

Objective To investigate the antidiabetic and antioxidant properties of Peperomia pellucida (P. pellucida) in alloxan-induced diabetic rats. Methods Beside mouse chow, two diets were designed to contain 10%w/w and 20%w/w P. pellucida as supplements respectively. Diabetes was induced in groups of five male albino rats by a single intraperitoneal injection of alloxan. Two groups of diabetic rats and normo rats were each fed one of these diets respectively, while two other groups served as positive and negative controls respectively. A seventh group was fed pelletized mouse chow. Results Diabetic rats on diets supplemented with 10%w/w and 20%w/w of P. pellucida for 28 d resulted in reduction of blood glucose level. The level of total serum cholesterol, triglycerides and LDL-cholesterol decreased significantly (P<0.05) with the supplementation diets compared to the untreated diabetic rats. Also treatment with glibenclamide and P. pellucida (10% and 20%w/w) led to increased activities of SOD, CAT and GSH respectively. There was significant (P<0.05) reduction in the level of HDL-cholesterol, Catalase, SOD activities and GSH concentration in diabetic untreated rats. The supplemented diets significantly (P<0.05) reduced lipid peroxidation, which was elevated in untreated diabetic rats. Significant decrease (P<0.05) in the activities of AST, ALT and ALP was also observed in rats fed P. pellucida supplemented diets. Conclusions The results from this study indicate that P. pellucida has an antidiabetic and antioxidant properties in experimental diabetes mellitus and thus justifies the acclaimed traditional antidiabetic use.

144–145

Authors: Michael Charlesworth , Abhirami Kanapathyraja, Susie Waddingham, John D. Holmes

Delirium is an acute and reversible condition that is common in hospitalised patients. Patients with delirium have extended lengths of stay, double the mortality of matched controls and an increased risk of permanent cognitive decline. We present the case of a patient with severe hypoactive delirium on a background of Alzheimer's dementia with a significant lasting cognitive deficit. This case presents the devastating impact of delirium on the lives of patients and relatives. The need for more awareness of delirium amongst health care professionals, more routine risk assessment and more studies aimed at managing hospitalised patients with delirium is also implicated.

148–149

Authors: Milivoje Vuković, Nebojša Moljević, Siniša Crnogorac

A surgical drainage simple surgical procedure that enables elimination of pathological effluent from operative wounds or other anatomical spaces, as well as removal of possible pathological exudates (blood, pus, enteric content, pancreatic juice, etc.). Nowadays, silicone drains are used for draining of the peritoneal cavity. In this study we presented a case of 42-year old female patient who underwent surgery after traumatic injury of intraabdominal organs and fracture of pelvic ring bone structure. Postoperative drain placed into the rectovesical space could not be removed on day 17 post surgery. Additional diagnostics could not identify the actual reason of failing to remove the drain, thus relaparotomy was required. Intraoperative diagnosis revealed incarceration of the antimesenteric part of the appendix into two circumjacent side perforations in the drain, without signs of acute inflammation. This paper presents an unusual and rare case of peritoneal drainage complication. The drainage of peritoneal cavity should be performed only in appropriate clinical situations, i.e. when the procedure is surgically indicated.

152–153

Authors: Koray Daş, Selim Sözen, Abdurrahman Selçuk Uzun, Ebru Menekşe, Faruk Karateke, Ilhan Bali

We report a case of strain-induced spontaneous rupture of hydatid cyst. Hydatid cyst rupture was diagnosed in a 19-year-old girl who presented with swelling and pain in the the right upper quadrant of sudden onset after straining for defecation.

156–158

Authors: Binod C. Raulo, Chidananda Dash, Shakti Rath, Sukumar Chakrabarty, Padmanav Rautray, Jagannath Sahoo, Rabindra N. Padhy

This is an attempt of using in vitro cultured mesenchymal stem cells (MSCs) from bone marrow in joining of a fracture non-union. Bone marrow cells were obtained and differentially centrifuged for MSCs that were grown in vitro in mesenchymal stem cell basal medium aseptically, for 10 d. The cell mass was injected around the fracture non-union. Healthy conditions of development of tissue regeneration at the trauma site and due bone joining were recorded. It is concluded that in vitro cultured MSCs had a blithesome effect on the fracture non-union.

162–164

Authors: Chui Yain Chen, Raja Azmi, Adil Hussein

Terson's syndrome is a condition of vitreous haemorrhage occurring in association with subarachnoid haemorrhage (SAH). This condition is uncommon during pregnancy. We report a fatal case of Terson's syndrome in a pregnant lady. She presented with an episode of seizure and complained of blurring of vision in the right eye after the seizure. Examination revealed subhyaloid haemorrhage in the right eye. The left fundus was normal. Subsequent investigations revealed a posterior communicating artery aneurysm. We would like to highlight that any case of non-traumatic vitreous haemorrhage with neurological symptoms and signs must be worked up as neuro-ophthalmic emergency.

168

Authors: Taro Shimizu, Koichi Kitamura, Yusuke Tsuchiya, Naoki Fujiwara

A 77-year-old man on warfarin therapy for persistent atrial fibrillation presented with bilateral anterior femoral pain and weakness. The pain was located in his bilateral thighs and groins. We concluded that the patient bilateral femoral pain and weakness were due to bilateral iliopsoas hematomas with anticoagulation therapy.

1–6

Authors: Frédéric Garcin, Julien Textoris, Benoit Ragonnet, François Antonini, Claude Martin, Marc Leone

Objective To assess the appropriateness of empirical antimicrobial therapy in trauma patients treated with selective digestive decontamination (SDD) who developed ventilator-associated pneumonia (VAP). Methods Retrospective study comparing 199 trauma patients receiving SDD and 99 non-trauma patients not receiving SDD hospitalized in a polyvalent intensive care unit (ICU) of a university hospital. Results Early-onset VAP were recorded in 76 (35%) patients. Late-onset VAP occurred in 86 (72%) trauma patients receiving SDD and 56 (56%) non-trauma patients not receiving SDD (P = 0.02). The empirical antimicrobial therapy was appropriate in 108 (91%) trauma patients receiving SDD and 82 (83%) non-trauma patients not receiving SDD (P = 0.1). In the patients who developed late-onset VAP, the empirical antimicrobial therapy was appropriate in 77 (90%) trauma patients receiving SDD and 49 (88%) non-trauma patients not receiving SDD (P = 0.9). De-escalation was performed in 52 (44%) trauma patients receiving SDD and 37 (37%) non-trauma patients not receiving SDD (P = 0.4). Recurrences were observed in 26 (22%) trauma patients receiving SDD and 18 (18%) non-trauma patients not receiving SDD (P = 0.6). These episodes were due to easy-to-treat pathogens in 75 (63%) trauma patients and 33 (33%) non-trauma patients (P = 0.01). Conclusions SDD is not associated with a rise in the rate of inappropriateness of the empirical antimicrobial therapy in trauma patients developing late-onset VAP.

13–17

Authors: Ulf Martin Schilling

Objective To assess the capability of operating abdominal and orthopaedic surgeons to analyze a set of standardized ECG. Methods Twenty operating abdominal and orthopaedic surgeons at a university hospital were included. Each participant analyzed a set of five standardized ECG with an answering scheme for eight different items, giving a maximum score of 40. The answers were matched according to specialty and experience of the doctors of less than 5 years, between 5 and 10 years or more than 10 years. The reference standard was set by two independent consultants in cardiology. Results The mean overall score was 25.25 (63.13%±4.78%) varying between 38 (95%) and 20(50%). Abdominal surgeons performed a mean score of 27.625 (69.06%±9.53%), and orthopaedic surgeons 23.67 points (59.17%±3.69%). The difference between the performance of abdominal and orthopaedic surgeons was not significant (P=0.09). 20/20 surgeons identified ST-elevation and no surgeon accepted the ECG showing acute ST-elevation myocardial infarction as normal. Conclusions Abdominal and orthopaedic surgeons provided an answering scheme are able to interprete the ECG and identify both the normal and the ECG showing life-threatening pathology. The hypothesis that surgeons were unable to interprete the ECG must be rejected.

23–25

Authors: CS Wonga, AK Al-Ajamib, M Boshahria, SA Naqvia

Objective To evaluate the best diagnostic tool (clinical, radiological, laboratory, or endoscopy) used to reach a final diagnosis of four most common presentations of acute abdomen to the surgical unit in the Limerick University Hospital, Limerick, Ireland. Methods Data was analyzed retrospectively of prospective collected data of all patients who had been admitted at a single academic institution from July 2011 till September 2011. Radiology, operating theatre and histopathology, haematology and endoscopy databases were searched from the Hospital Inpatient Enquiry (HIPE) department for patients who had presented with acute abdominal pain. Patients' charts were searched manually and final diagnosis of each patient was recorded. Results Out of 30 confirmed final diagnosis of appendicitis or appendicular mass, 9/30 (30.0%) were diagnosed with radiological (either on ultrasonography or CT scan). The remaining 21 cases (70.0%) were diagnosed clinically. Majority cases of diverticulitis 16/22 (72.7%) was diagnosed radiologically compared to only 6/22 (27.3%) of those confirmed by endoscopy. All diagnosis of gallstone-related diseases (cholecytitis, biliary colic, or cholelithiasis and/or choledocholithiasis) and bowel obstruction were confirmed by radiological investigation. Conclusions Appendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.

31–34

Authors: Madhusudhana, Yanti Muslikana, Nabilah Ismailb, Adil Husseina

Objective To determine the microbiological aetiology of acute dacryocystitis presented to the Hospital University Sains Malaysia, Kubang Kerian, Kelantan in 5 years duration from 2005 until 2010. Methods This is a retrospective analysis of patients who were clinically diagnosed as acute dacryocystitis from 2005 until 2010 to determine the regional microbiological pattern. The age, gender, predisposing factors, intravenous antibiotics and their microbiological results of discharge from punctal expression were collected. The laboratory procedures were in accordance with the Clinical and Laboratory Standards Institute guidelines. Results There were 23 patients admitted to the eye ward during study period. Females (n=17) outnumbered males (n=6). Majority of isolates were Gram-positive bacteria (n=10, 43.4%) followed by Gram-negative isolates (n=2, 12.9%). The most predominant isolates were Streptococcus pneumonia (S. pneumonia) (21.7%) followed by Staphylococcus epidermidis (S. epidermidis) (13.0%). Conclusions S. pneumoniae was the commonest gram positive organism identified in our study. 47.8% patients showed resistant to initial empirical treatment.

38–41

Authors: LYW Kevina, AH Hussinb, I Zharib, JH China

Objective To examine the sub-acute (14 d) oral toxic effects of methanol leaves extract of Catharanthus roseus (C. roseus) (Family: Apocynaceae) on liver and kidney functions in Sprague Dawley (SD) rats. Methods Twenty four female SD rats were used throughout the experiment. The first group was orally treated with distilled water and served as control, whereas the remaining three groups were orally treated with single dose daily of 0.1 g/kg, 0.5 g/kg, 1 g/kg of C. roseus extract, respectively for 14 d. Cage-side observations were done daily. Any animal died during the experiment was dissected for gross organ examination. Body weight changed, food consumption and water intake were recorded weekly. Blood was collected via cardiac puncture on day-15 and used for determination of serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, creatinine and urea. The relative organ weights were also measured. All results were expressed as mean ± S.E.M and analysed using Dunnett's test. The level of significance was set at P<0.05 when compared to the control group. Results Repeated oral administration of 0.5 g/kg and 1 g/kg of methanol leaves extract of C. roseus caused mortality and diarrhoea in rats after few days of treatment. There were no significant changes observed in serum biochemical markers, body weight changed, water and food intake and relative organ weight in rats treated with a single dose daily of 0.1 g/kg of C. roseus extract treatment for 14 d when compared to control group. Conclusionds Fourteen days repeated oral administration of 0.1 g/kg of methanol leaves extract of C. roseus was safe in female SD rats without causing any significant damages to liver and kidney.

47–50

Authors: Dinesh K Patel, Kanika Patel, SP Dhanabal

Objective To examine the phytochemical parameters of Aloe vera (A. vera) L. which can be used as a tool for its standardization. Methods The phytochemical analysis, solubility test, heavy metal analysis, antimicrobial study and quantitative analysis of gallic acid and berberine by HPTLC method were included in present study. Results Phytochemical analysis revealed the presence of alkaloid, carbohydrate, tannin, steroid, triterpenoid and glycoside. Total flavonoid and phenol content was found to be 1.9% and 13.11%. Concentartion of lead, arsenic, mercury and cadmium was found to be under the limit. Total bacterial count, yeast and moulds contents were found to be under the limit whereas Escherichia coli (E. coli) and salmonella was found to be absent in the extract. Quantitative analysis through HPTLC revealed the presence of 2.74% and 0.543% w/w of berberine and gallic acid. Conclusions The results indicate that the plant extract are rich in berberine and gallic acid implying their importance to human health. This investigation could be used as source of standard parameters which can play an important role in its standardization.

58–64

Authors: Nero C Wabo, P Örtenwall, A Khorram-Manesh

Objective Malfunction in hospitals' complex internal systems, or extern threats, may result in a hospital evacuation. Factors contributing to such evacuation must be identified, analyzed and action plans should be prepared. Our aims in this study were 1) to evaluate the use of risk and vulnerability analysis as a basis for hospital evacuation plan, 2) to identify risks/hazards triggering an evacuation and evaluate the respond needed and 3) to propose a template with main key points for planning, performance and evaluation of such evacuation. Methods A risk and vulnerability analysis at two county hospitals along with a systematic online literature search based on the following keywords; “evacuation/closure”, “hospitals/medical facilities” and “disaster/hazards” alone or with “planning”, was conducted. Results We found that although all hospitals have a disaster plan, there is a lack of knowledge and appropriate instruments to plan, perform and evaluate a hospital evacuation. Risk and vulnerability analysis can be used to reveal threats leading to an evacuation (e.g. on-going climate changes and terror actions). These key points can later be used to plan, perform and evaluate such evacuation. Conclusion There is a need for an elaborated evacuation planning for hospitals. An evacuation plan should continuously be drilled based on a risk and vulnerability analysis. A general guide can be used as foundation to plan, perform and evaluate such plan.

68–69

Authors: Fabrizio Sansone

The aim of this short discussion is to open the question of the AR in case of ECMO implantation. This is the case of a young male admitted to the hospital for acute cardiac failure in chronic dilated cardio-myopathy due to aortic regurgitation (AR): the patient had previously refused aortic valve replacement (AVR) for the fear of postoperative outcome. Further studies are required to assess this topic and the perspectives to increase the use of the peripheral ECMO and the percutaneous ventricular venting through the interatrial septum may be of interest to improve the outcome of such ill patients.

72–74

Authors: Sunita, Manpreet Singh, Dheeraj Kapoor

Meningococcal disease is the major health problem in developing world. The clinical presentation is varied, ranging from transient fever and bacteraemia to fulminant disease with death ensuing within hours of the onset of clinical symptoms. The classical clinical manifestations of meningococcal disease have been well described, but atypical presentations if unrecognized, may lead to a delay in treatment and fatal outcome. We here report a case presented with atypical presentation of meningococcal meningitis without classical rash, which was diagnosed and managed successfully.

77–81

Authors: Massimo Sartelli, Cristian Tranà

Biliary infections are very common intra-abdominal infections. Laparoscopic cholecystectomy for acute cholecystitis and endoscopic retrograde management of acute cholangitis play important roles in the treatment of biliary infections. Also antimicrobial therapy is nevertheless important in the overall management of biliary infections. A multidisciplinary team of physicians, including surgeons trained in laparoscopic techniques, interventional gastroenterologists, and interventional radiologists may improve outcomes of patients with biliary infections. This review focuses the clinical presentation, diagnosis, and state of the art management of acute cholecystitis and acute cholangitis.