Journal of Acute Disease

179-184

Authors: Tayebe Aghamohammadi1, Mostafa Khaleghipour2, Farahnaz Mohammadi Shahboulaghi3, Asghar Dalvandi4, Sadat Seyed Bagher Maddah4

Objective: To determine the effect of self-management program on the health status of elderly patients with heart failure. Methods: The present study was a single-blind, randomized clinical trial, and conducted on 90 patients with heart failure of stages II-III at one teaching hospital in eastern Iran in 2017. The participants were randomly assigned into two groups: the intervention group and the control groups, with 45 patients in each group. Self-management programs including awareness and recognition, problem-solving process, diet, exercise, and stress management were carried out. The participants were trained for six weeks and were followed for two months. Data of the health status were collected before, after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire. Data analysis by chi-square, independent t-test, Fisher, ANOVA with repeated measures was conducted. Results: Patients in both groups were matched in terms of demographic characteristics before the intervention. There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention. However, the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001). Conclusions: Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms). Therefore, this supportive method can be used to improve the health of patients and manage problems caused by heart failure.

191-194

Authors: Tufan Akin Giray1, Afsin Emre Kayipmaz2, Erkin Sonmez3, Kemal Murat Haberal4, Cem Yilmaz3, Cemil Kavalci5, Hakan Oguzturk2

Objective: To retrospectively analyze patients aged 65 years and over, who were admitted to a level II trauma center in Turkey due to minor spinal trauma in a period of 4 years. Methods: The study included 64 patients aged 65 years and over, who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma. The information of the patients was obtained from the medical records. The clinical characteristics of patients including localizations and types of fracture, presence of additional system injuries and treatment options were investigated. Results: The most common cause was fall, accounting for 51 (79.7%), with 7 (10.9%) due to intra-vehicle traffic accident, and 6 (9.4%) due to out-of-vehicle pedestrian injury. The most common site of trauma was the lumbar region. Of the fractures, 46.9% (n=30) were in the lumbar region, 37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region. Fourteen (21.9%) patients had an additional injury. Given the fracture types, 47 fractures (74.6%) were compression, 14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures. Twenty patients (31.2%) had multilevel vertebral fractures. Conclusions: The results of our study demonstrated the importance of vertebral fractures in the geriatric age group. In this age group, falls and motor vehicle accidents are the leading causes of vertebral traumas. Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.

200-203

Authors: Arezoo Sarani1, Zahra Esamaeili Abdar2, Hojjat Sheikhbardsiri3, Fatemeh Hasani4, Behzad Razavi4

Objective: To determine the frequency and causes of injuries from sharp instruments contaminated by blood in hospital staff. Methods: The study was cross-sectional and conducted at an educational hospital supervised by Kerman University of Medical Sciences in 2018. Using a researcher-made questionnaire, we determine the frequency and causes of injuries from sharp instruments contaminated by blood in 142 hospital staff. Results: Of the 142 patients, 68 persons (48%) did not have a history of needle stick injury, but 74 persons (52%) had suffered needle stick injury 1 to more than 5 times. Among those who suffered a needle stick, 74.3% were trained, while 70.7% of those who did not suffer needle stick had been trained. The results indicated that the needle was the most common sharp instrument causing needle stick injury. Conclusions: The study showed a high prevalence of needle stick injury among hospital personnel specifically in ICU, orthopaedic and surgery departments. Supportive measures such as improving injection practices, modification of working schedule, planning training programs targeted at using personal protective equipment, and an adequate number of safety facilities for the effective prevention of needle stick injury incidents are needed.

208-214

Authors: Wendy Ong Chin Feng1, Logandran Vijaya Kumar1, Mohd Ezane Aziz2, Faezahtul Arbaeyah Hussain3, Wan-Hazabbah Wan Hitam1

Dorsal midbrain syndrome or Parinaud syndrome is a supranuclear brainstem syndrome involving the vertical gaze centre. These are case series with three patients who were diagnosed with dorsal midbrain syndrome secondary to pineal gland tumours. The prognosis varied depending on tumour types, age of presentation and treatment received. All of them were presented with life-threatening obstructive hydrocephalus. Our first patient was successfully treated with emergency surgery followed by radiotherapy. He regained normal visual acuity and full recovery of his ocular movement. Second and third patients had undergone surgery for raised intracranial pressure. Both had an inoperable pineal gland tumour. As for our second patient, we detected a worsening of vertical gaze during his four years follow-up. However, his bilateral good visual acuity was preserved. The third patient passed away as a result of uncontrolled enlarging tumour. We also briefly reviewed the clinical presentation, diagnosis, and therapeutic approach of the three patients. One of the caveats is that urgent radiological study is crucial to differentiate the tumour type via the pathognomonic features and to delineate the tumour extension. The preferable treatment options vary among each tumour type. A multidisciplinary approach is crucial in early detection, in addition to treatment initiation and long term follow up to achieve a better outcome.

133-141

Authors: Mohammad Hossein Feiz Haddad1, Azar Shokri2, Habib Habibpour3, Seyede Manizhe Heidar Nejadi4

Acanthamoeba keratitis, a vision-threatening disease, is caused by a free-living amoeba of genus Acanthamoeba. Amoeba is widely distributed all around the world. Several cases of Acanthamoeba keratitis have been reported from the Middle East and Iran as well. The infection is mainly caused by inappropriate use of contact lens; therefore, it is more common among lens wearers. The number of reported cases worldwide is increasing annually due to the increasing number of contact lens wearers for medical or cosmetic reasons. It is known that early diagnosis and treatment can reduce consequent damages, while the delay in these processes will deteriorate the vision. Nowadays contact lens wearing, surgery and use of corticosteroids are known to predispose to Acanthamoeba keratitis, and it was also believed that trauma was the main cause. Increasing public knowledge about Acanthamoeba infection, inquiring the history of patients, clinical signs and laboratory findings can be helpful to early diagnosis and better treatment. Regardless of the increasing knowledge of diagnosis and treatment, this disease is still a challenge. Considering the long curative time, and insufficient efficacy of available treatments, it seems that the prevention is more important than the treatment. This review aimed to explain Acanthamoeba keratitis in the Middle East and Iran from the aspects of epidemiology, diagnosis, and therapeutic treatment.

146-152

Authors: Eman Hussein Hussein Elfeky, Maii Atef Shams Eldeen, Amel Abd El-Tawab Hashish, Azza Mahmoud Hassan

Objective: To compare the inhibitory effect between DL-tryptophan and bovine lactoferrin on biofilm formed by isolated Pseudomonas aeruginosa strains. Methods: The study was carried out on 40 patients suffering from surgical site infection. Wound pus was collected using sterile swabs after isolation, and identified by common bacteriological methods. Isolated Pseudomonas aeruginosa strains were grown on biofilm enhancing materials, and then the inhibitory effects of different concentrations of DL-tryptophan and lactoferrin were tested using scanning electron microscopy and microtitre plate methods. Results: There was no significant difference in the inhibitory effect between DL-tryptophan and lactoferrin at 0.5 mg/mL. While in concentration of 1 mg/mL and 2 mg/mL, tryptophan showed more significant inhibitory effect than lactoferrin. Conclusions: Both DL-tryptophan and bovine lactoferrin have inhibitory effect on Pseudomonas aeruginosa biofilm formation in a dose dependent manner, and the inhibitory effect of DL- tryptophan is stronger.

160-164

Authors: Ibrahim Aliyu1, Godpower Chinedu Michael2, Haliru Ibrahim3, Zainab F Ibrahim4, Umma Idris5, Bashir Mariat Zubayr6, Halima Umar Ibrahim

Objectives: To assess the basic knowledge of cardiopulmonary resuscitation (CPR) among health workers in a tertiary health facility in a semi-rural county. Methods: A questionnaire based, cross sectional study involving health care professionals was performed in Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria from April to July 2017. A purposive sampling method was adopted for subject selection. A pretested self-administered questionnaire was distributed; this included knowledge on basic life support; participation in basic life supportand outcomes. It was adopted from the American Heart Association guidelines for CPR and emergency cardiac care. Results: One hundred and two respondents were recruited (40 doctors and 62 nurses). There were 50 males (49%) and 52 females (51%). Their age ranged from 23 to 54 years with mean of (34.9± 7.4) years. Only 20% of the respondents were aware of circulation, airway and circulation in adult resuscitation; however, 61.0% of all respondents were aware of airway, breathing and circulation of resuscitation in children. Furthermore, only 10% of the respondents were aware of the correct steps of single rescuer resuscitation. Their knowledge was poor about chest compression and ventilation for both adult and children resuscitation. The overall knowledge score ranged from 0.0% to 100% with mean knowledge score of (21.2±18.6)%. The date of last training about CPR had no relationship with the knowledge scores (χ2=2.951, P=0.300). The cadre of the respondents (doctors and nurses) had no relationship with their knowledge score (χ2=0.100, P=0.633 for doctors and nurses; ,χ2=7.074, P=0.225 for doctors cadre; XX2=3.868, P=0.677 for nurses cadre) respectively. Conclusions: The knowledge about CPR among health workers is poor; furthermore, the last date of training about CPR and the cadre of staffs have no relationship with knowledge of CPR.

170-172

Authors: Keyvan Kiakojuri1, Mojtaba Taghizadeh Armaki2, Ramazan Rajabnia3, Abazar Pournajaf3, Mohsen Karami2, Saeid Mahdavi Omran2

Rationale: Stevens-Johnson syndrome is a disorder mostly attributed to drug use, which can cause different skin problems. Patient concerns: A 31-year-old woman presented with severe pain and pounding in the left ear. Diagnosis: Fluconazole-induced Stevens-Johnson syndrome with fungal infection in ear. Intervention: Surgical and systemic antibiotic therapy. Outcomes: The patient recovered and resumed her normal life. Lessons: The prescription of fluconazole for patients with underlying conditions should be done with caution.

176-178

Authors: Morteza Dehnokhalaji1, Mahnaz Abavisani2, Zohreh Sarchahi2

Rationale: Necrotizing fasciitis is a rare infection of fascia tissues. It progresses quickly and has high morbidity and mortality. In this study, we aimed to explore a case of necrotizing fasciitis in a diabetic patient. Patient concerns: A 46-year-old woman presented with severe pain and inflammation in the left leg, and with fever and chills. Diagnosis: Necrotizing fasciitis in the left leg. Intervention: Broad debridement of infectious tissues and broad-spectrum venous antibiotics. Outcomes: The patient was discharged without pain, inflation, or fever. Lesson: This disease is a surgical emergency, therefore, early diagnosis and quick and invasive treatment could significantly decrease morbidity and mortality.

89-94

Authors: Luis Rafael Moscote-Salazar1, Ali Adnan Dolachee2, Alexis Narvaez-Rojas3, Hayder Ali AlSaadi4, Arjan A. Najim4, Aysar Khudhair jassam4, Alyaa Khadim Abdulreda4, Ali Odai Mahmood4, Haya Jasim Mohammed4, Samer S. Hoz

Skull-base tumors are generally difficult to access compared with many other cranial lesions. Usually surgery remains the gold standard treatment for the majority of these tumors. However, in many cases, surgical resection is a challenge because the disease usually is already in the advanced stage by the time of diagnosis. Additionally, there are hypervascular lesions which cause excessive loss of blood, then results in multiple blood transfusions and prolonged operative time, increases the risk of neural injury and prevents complete excision. In order to reduce blood loss intraoperatively, many alternatives were available with the neurosurgical armamentarium, such as head elevation, intravenous use of tranexamic acid, total intravenous anesthesia and even preoperative embolization of tumors. However, preoperative embolization carries variable results, potentially aggravating edema and increasing tumor size. To ascertain the current status and the up-to-date indications, an evaluation of the therapeutic role of preoperative embolization was performed in the current study.

99-105

Authors: Sedigheh Rafiei Tabatabaei1, Ahmad Reza Shamshiri2, Mohammad Javad Nasiri3, Daniel M. Weinberger4, Masoud Dadashi5, Abdollah Karimi1

Objective: To estimate the frequency of pneumococcal meningitis among patients with bacterial meningitis in Iran. Methods: PubMed, Embase, Web of Science and Scientific Information Database (www. sid.ir) were searched from 2000 to 2016 to identify studies on the frequency or prevalence of pneumococcal meningitis in Iran. Stata 14.0 (StataCorp, College Station, Texas, USA) was used to analyze the data. Results: Of the 131 records identified from the databases, 21 studies fulfilled the eligibility criteria. The analyses showed that 25.0% (95% CI: 19.0-32.0; I2=71%) of the confirmed bacterial meningitis (including children and adults) cases were caused by pneumococcus. Conclusions: The large fraction of meningitis cases caused by pneumococcus demonstrates that pneumococcal meningitis is a major public health problem in Iran, and the introduction of pneumococcal vaccines merits further attention from health authorities.

113-117

Authors: Miaad K. Alkhudhairy1, Morteza Saki2,3, Sakineh Seyed-Mohammadi2,3, Nabi Jomehzadeh4, Saeed Khoshnood5, Mina Moradzadeh2, Sajjad Yazdansetad6

Objective: To investigate the frequency of integrase genes intI1, intI2 and intI3 of Escherichia coli strains, and their association with resistance to routinely used antibiotics. Methods: A total of 120 Escherichia coli strains were collected from patients with urinary tract infection in Ahvaz, Southwest of Iran. Antibiotic susceptibility testing was performed. The presence of intI1, intI2, and intI3 genes was determined by polymerase chain reaction. Results: Antibiotic susceptibility testing disclosed the highest resistance rate to ampicillin (91.7%) followed by trimethoprim/sulfamethoxazole (65.8%), and ceftazidime (56.7%). The imipenem susceptibility rate was 91.7%. IntI1 and intI2 were identified in 74 (61.6%) and 8 (6.6%) of Escherichia coli strains, respectively, but intI3 was not found in any isolates. The presence of integrons was significantly associated with resistance to ampicillin, trimethoprim/ sulfamethoxazole, ceftazidime, and ciprofloxacin antibiotics (P<0.05). Conclusions: The high resistant Escherichia coli isolates harboring class 1 integrons (intI1) were detected in patients with urinary tract infection in our region. Therefore, preventive strategies are necessary to restrict further dissemination of resistant strains.

123-126

Authors: Yasser Mohammed Hassanain Elsayed

Rationale: Pulmonary embolism is a severe cardiovascular disease. Acute pulmonary embolism is an extremely common and potentially the serious pattern of venous thromboembolic disease. Unfortunately, missed diagnosis of pulmonary embolism is lethal and common because of its non-specific symptoms and signs. Patient concerns: A 42-year-old male patient presented with acute chest pain that was treated as gastroesophageal reflux disease. Diagnosis: Suspected acute pulmonary embolism. Interventions: O2 inhalation, urgent electrocardiography, and cardiopulmonary resuscitation. Outcomes: Deterioration and sudden cardiac death. Lessons: Physicians should pay much attention to the symptoms and signs of pulmonary embolism to reduce the rate of missed diagnosis.

130-132

Authors: Halil Dogan, Bilginar Kovanci

Rationale: Necrotizing fasciitis is an aggressive infection of subcutaneous tissues, which tends to spread rapidly through the fascial planes. Colonic diverticulosis is a common disease in advanced age, although it rarely causes a lethal necrotizing soft-tissue infection. Patient concerns: A 58-year-old woman complained of left leg pain for 15 d without abdominal pain. Diagnosis: Diverticulitis perforation presented as necrotizing fasciitis of the left thigh. Interventions: Extensive debridement. Outcomes: The patient died due to sepsis-induced multiple organ failure and severe metabolic acidosis. Lessons: Clinicians should be aware of presentations of diverticulitis in patients who have a soft-tissue infection in lower extremity even though patients may not have had a history of diverticulosis or abdominal pain.

45-52

Authors: G Visveswari, Bernadette Tan Qiao Min, Fatimah Lateef

Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding. J Acute Dis 2019; 8(2): 45-52 Journal of Acute Disease journal homepage: www.jadweb.org This is an open

58-62

Authors: Meliha Findik, Cemil Kavalci, Afsin Emre Kayipmaz, Murat Muratoglu, Elif Kilicli

Objective: To specify the clinical and sociodemographic characteristics, risk factors, factors affecting mortality including hematologic parameters, and red blood cell distribution width to platelet ratio (RPR) in patients with pulmonary thromboembolism, and to reduce the mortality. Methods: The archive records of patients diagnosed with pulmonary embolism were retrospectively examined. The histories, risk factors, physical examination findings, arterial blood gas analysis, X-rays, laboratory, and computed tomography reports of all cases were obtained via the hospital information system. Logistic regression analysis was performed to determine the independent variables affecting early mortality. Results: A total of 146 patients with a definitive diagnosis of pulmonary thromboembolism were included. Thirteen point seven percent (n=20) of the deceased patients died at early term. Ninety percent of patients with early mortality was 65 years or older. There were significantly differences in age, RPR, D-dimer, creatinine, lymphocyte, pH, and body temperature between patients with and without early mortality (P=0.017, P<0.001, P=0.019, P=0.025, P=0.042, P=0.013, P=0.017, respectively). Logistic regression analysis showed that RPR was a statistically significant and independent risk factors of mortality [P=0.026, OR: 0.254., 95% CI (0.326-5.056)]. In addition, there was a significant difference in pulmonary embolism severity index classification between patients with and without early mortality(P<0.034). Conclusions: RPR is an independent risk factor of mortality of pulmonary embolism patients and may help emergency physician to stratify mortality risks of pulmonary embolism patients.

67-71

Authors: Sema Yilmaz, Aysegul Kuskucu, Ozden Ozgur Horoz, Oznur Suakar, Nergiz Imamova, Gizem Gongor, Dincer Yildizdas

Objective: To examine if hypoxia-inducible factor-1毩 (Hif-1毩) polymorphisms are associated with pediatric acute respiratory distress syndrome (PARDS). Methods: Twenty two patients with PARDS and 11 non-PARDS controls were examined in pediatric intensive care unit in Cukurova University Balcali Hospital. Blood polymorphism was used to assess the Hif-1毩 C1772T and G1790A polymorphisms of Hif-1毩 gene, and differences in genotypes between the 2 groups were compared. Results: Hif-1毩 C1772T polymorphism was observed only in one case of PARDS group but non-PARDS group didn't show any C1772T polymorphism. Particularly, the difference in number of cases with Hif-1毩 G1790A polymorphism was not significant between PARDS and non-PARDS groups. In addition, Hif-1毩 G1790A polymorphism was significantly related to the distribution of lung opacities in children with PARDS (P<0.05). Conclusions: Our results indicate that Hif-1毩 G1790A polymorphism is related to an increased susceptibility to pulmonary for PARDS children. The detection of G1790A polymorphism could help pediatricians to predict the extensity of PARDS early in lung tissue.

78-81

Authors: Tommaso Valobra, Umberto Ceratti, Alessandra Cernuschi

Shoshin syndrome is a rare fulminating heart failure caused by thiamine deficiency. In Japanese “sho” means acute damage and “shin” means heart. It consists of a rare and hyperacute manifestation of beriberi that was first described in polished white rice-eating communities in various locations across Asia including China, Japan and Indonesia. In a totally different context, ‘Shoshin’ is a word from Zen Buddhism meaning "beginner's mind”, which is considered the necessary attitude to approach the Zen practice. This case report is a prime example of clinical manifestations of thiamine deficiency for the presence of both cardiological and neurological disorders, for hyperacute onset of cardiac failure (shoshin syndrome), for the simultaneous involvement of peripheral and central nervous system, and for the dramatic global recovery after thiamine replacement therapy. We therefore explain why the physician should adopt a beginner’s mind in clinical practice.

84-85

Authors: Mandla Gowtham, Chandrasekar Supriya, Dudekula Seetharambabu, Gopineni Divya

Uncontrolled diabetes gives rise to severe systemic complications that affect different systems of our body. Among those complications, hemiballismus is a rare manifestation that occurs due to hyperglycemia and can be reversible in most cases by decreasing elevated sugar levels to normal range. Here, we present a case of a patient with diabetic history since 10 years ago, who presented with uncontrolled jerky movements on one side of his body since 15 d, and he recovered after appropriate therapy. Medication adherence in diabetic patients and regular monitoring of blood sugar levels are important.

1-6

Authors: Quiñones-Ossa GA1 , Padilla-Zambrano H2 , Pal R3 , Ghosh A4 , Moscote-Salazar LR5 , Kiran Kumar VA6 , Agrawal A6

Biomarkers have been used to diagnose, prognose, evaluate, and identify the severity and outcomes in traumatic brain injury (TBI) patients. This study explored if it is possible to predict the outcome of TBI patients by estimating the biomarkers in cerebrospinal fluid and serum. We searched data bases and literature about biomarkers, and found forty epidemiologic studies from 92 potentially relevant articles. However, limited data are available about postanoxic encephalopathy. It showed that presently, neurofilament, S100B, glial fibrillary acidic protein, and ubiquitin carboxyl terminal hydrolase-L1 seemed to have the best potential as diagnostic biomarkers for distinguishing focal and diffuse injury, whereas C-Tau, neuron-specific enolase, S100B, glial fibrillary acidic protein, and spectrin breakdown products appear to be candidates for reflective biomarkers of TBI. Point-of-care biomarkers are needed in TBI which is one of the most important additional risk factors in road traffic injuries. In a holistic approach, more researches about biomarkers of TBI are required. These biomarkers are very useful for treatment of patients with TBI.

12-15

Authors: Gentian Vyshka1 , Tefta Shaqiri2 , Bujar Cakani3 , Artan Distafa4

Acute ethanol intoxication has a diversity of clinical pictures that extend from mere euphoria to severe neurological impairment culminating in coma. Although the majority of cases have a reversible and benign course, the situation needs a careful medical monitoring. Authors describe pharmacological aspects of the acute ethanol intoxication, with organs and systems affected during the consumption of exaggerated quantities. Correlations between blood alcohol concentration and neurological symptomatology are given, and a brief discussion of the criteria for the acute intoxication is made. The fact that this occurrence has been of little attention is due not only to the reversibility of the majority of symptoms, but also because that medical research has been ever since focused more on chronic diseases related to alcohol abuse, withdrawal syndrome and recently with hangover as an independent situation. With no specific antidote actually at hand, treatment is symptom-oriented and the pharmacological armamentarium is richer when it comes to dealing with withdrawal, abstinence and other chronic complications of ethanol abuse.

21-27

Authors: Abdulhakim Abubakar1 , Abdullahi Balarabe Nazifi2 , Fatima Ismail Hassan1,3, Kehinde Andem Duke1 , Theophillus Danjuma Edoh1

Objective: To explore the toxicological profile of methanol extract of Chlorophytum alismifolium (MECA) tubers in Wistar rats. Methods: MECA was subjected to acute and subacute studies which were conducted according to Organization for Economic Co-operation and Development (OECD 425 and 407 guidelines respectively). In the acute toxicity experiment, a limit test (5 000 mg/kg) was administered to five rats and monitored for 2 weeks. The subacute studies were conducted on 4 groups of rats. The first group served as control, while the 2nd, 3rd and 4th groups received MECA (150, 300 and 600 mg/kg respectively). The treatments were given orally and daily for 4 weeks. At the end of the experiment (29th day), the animals were euthanized to obtain blood samples and organs for haematological, biochemical and histological evaluations. Results: Acute toxicity study showed that the oral median lethal dose was >5 000 mg/kg. In the sub-acute studies, the results showed no significant (P>0.05) changes in the haematological, hepatic and renal indices compared to control animals. In the fourth week, a significant (P<0.01) increase in body weight of the rats was observed at 150 mg/kg and 600 mg/kg compared to week one. However, there were no major changes in the organ/ body weights of the rats. Histological examination of the kidney showed slight glomerular adhesion and tubular distortion. Moderate hepatic necrosis was observed at 150 mg/kg and 300 mg/kg. Conclusions: The results of this research revealed that the MECA tubers is virtually non-toxic after acute administration and it has low sub-acute toxicity potential in rats.

34-37

Authors: Xiao-Peng Shi, Li-Jie Qin , Yu-Xia Chang, Fa-Liang Li, Peng Wang

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9 305 687 from 2007 to 2016 in Zhengzhou, of which 418 882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups: emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

41-42

Authors: Manel Weli1 , Mouna Jerbi2 , Olfa Chakroun-Walha3 , Bayen Maalej1 , Lamia Gargouri1 , Noureddine Rekik4 , Abdelmajid Mahfoudh1

Acute intoxication with nicotine is possible to cause nonspecific clinical signs and may be serious and lead to the death. We report a rare and severe form of acute nicotine poisoning secondary to dermal absorption of tobacco.