Journal of Acute Disease

1-4

Authors: Song Chen, Yun-Qiang Chen, Shao-Wen Cheng, Zhi-Qian Luo, Wei Zhang, Zeng-Lin Cao, Jin-Zhong Wang, Chuan-Zhu Lv

To further improve the ability of pre-hospital and in-hospital collaborative treatment, strengthen emergency multidisciplinary cooperation and construct a scientific, rational and efficient emergency system, under the support of former chairman Yu Xue-zhong, Dr. Li Chun-sheng and numerous colleagues in the industry, the Emergency Medicine Society of the Chinese Medical Association appeal to us to draft Construction of Emergency and Pre-hospital Platform. Based on this background, the platform of emergency and pre-hospital first aid helps to build a "one horizontal and one Longitudinal" treatment model, using the horizontal and longitudinal patterns to integrate emergency medical resources to satisfy the automatic information integration and intelligent analysis sharing, realizing the emergency management visualization and medical information digitization, simplifying the medical process and establishing a perfect standard for the emergent diseases, thereby ultimately achieving efficient diagnosis and scientific treatment.

15-19

Authors: Ionut Negoi, Mircea Beuran, Cezar Ciubotaru, Adelina Cruceru, Sorin Hostiuc, Massimo Sartelli, Matthew Hernandez, Mihaela Vartic

The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in abdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

26-30

Authors: Rudolf Schiessel

The treatment of rectal cancer has been improved a great deal within the last 20 years. Major progress has been made in the preoperative evaluation by introducing MRI- imaging as a basis for the further management. Neoadjuvant radiochemotherapy has been shown to be effective in downstaging of advanced tumours. The surgical technique has been improved in many respects.- Total mesorectal excision has reduced local recurrences, sphincter saving techniques such as low anterior resection and intersphincteric resection reduced the need for a permanent stoma to 10%-20%. Recently the introduction of minimal invasive techniques and the application of robotic systems have reduced the surgical trauma.

36-42

Authors: Oluwatosin Kudirat Shittu, Shaba Yisa Aaron, Mariam Damilola Oladuntoye, Bashir Lawal

Objective: To investigate the improved antitrypanocidal activity and toxicity of diminazene aceturate modified Nano drug in experimental rats. Methods: Aqueous leaf extract of Hyptis suaveolens was used to reduce gold tetrachloride to its nanoparticle size and this was characterized and formulates with naturally synthesized polyhydroxybutyrateas a Nano carrier. A total of thirty (30) albino rats were group into 6 (A-F) of 5 rats each & infected intraperitoneally with 0.2 mL of the inoculum containing about 1伊103 Trypanosoma brucei brucei parasites per 0.2 mL of blood. Groups A and B were treated with 3 and 6 minutes released orange PHB, Groups C and D were treated with 15 and 30 minutes released mango PHB formulated tablet while Groups E and F were negative (untreated) and standard drug (Dininazene aceturare) respectively. Results: The free drug and modified orange synthesized polyhydroxy butyrate shows antitrypanocidal activities by reducing the replicating rate of the parasite as compared to infect untreated. While the modified- mango synthesized shows increasing order of replication. There were significant increases in all the haematological parameter evaluated in the infected treated groups compared to infect untreated. But no significant difference (P<0.05) observed in the Catalase activity in the serum and liver of all the groups whereas, the modified orange synthesized shows significant decrease in other enzymes activities evaluated when compared with the free drug, mango synthesized and the infected untreated groups. Conclusion: Orange synthesized modified diminazene aceturate show efficacy as free drug with limited toxicity that can enhance the therapeutic.

45-48

Authors: Xin-Yan Huang, Yu-Kun Kuang, Jian-Qiang Huang, Yu-Biao Guo

Hemoptysis is a common emergency symptom for pulmonary embolism. It's important to differential diagnosis for this symptom. This article reports a case of pulmonary vein stenosis. The patient was transferred to a number of hospitals for medical treatment, but was misdiagnosed for 7 months. This article aims to improve clinician's ability to differentially diagnose hemoptysis, and to deepen the knowledge of pulmonary vein stenosis.

241-244

Authors: Jin Qian, Dong-Mei Sun, Qi-Feng Huang, Xiao-Ran Liu

Acute lung injury (ALI) is a common complication of sepsis with characteristics of acute onset, rapid change in the disease and high mortality. Since current clinical treatment can only alleviate the unfavorable condition to a certain extent but cure, we urgently need to find an effective treatment. Most scholars believe that sepsis-induced ALI is associated with extensive mitochondrial damage. In recent years, a widely studied pluripotent stem cell that is mesenchymal stem cell has been proved to alleviate and treat sepsis-induced ALI by transporting mitochondria via nanotubes in a microtubule-dependent manner. Research progress in this field will be reviewed in this study.

255-259

Authors: Satinder Kakar, Vishal Kumar, Ramandeep Singh

Etiology of nephrotic syndrome is somewhat complex in nature. It may range from primary to secondary forms. Nephrotic syndrome patients often need immunosuppressive treatment although it has some side effects and may lead to renal disease which may be acute or severe. This review deals with herbal treatment and other recent approaches for treating symptoms of nephrotic syndrome.

264-267

Authors: Maryam Salehi, Farzin Sadeghi, Javad Shokri Shirvani, Elahe Ferdosi Shahandashti, Soraya Khafri, Ramezan Rajabnia

Objective: To assess the relation between acute gastrointestinal disease and Helicobacter pylori (H. pylori) infections. Methods: Over the 18-month period, a total of 323 patients referred to three hospitals in Babol (north of Iran) were enrolled in this cross-sectional study. H. pylori status (rapid urease test), endoscopic findings in the patients, personal habits (smoking or alcohol intake) and administration of drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs) were analyzed using standard Chi-square test and multinomial logistic regression analysis. Results: Results showed that acute gastric ulcer patients had a significant association with alcohol (P=0.001, OR=6.183), opium (P=0.022, OR=2.823), smoking (P=0.016, OR=2.579) and NSAIDs (P=0.046, OR=2.071). However, patients with in acute duodenal ulcer have a significant association with opium (P=0.023, OR=2.326) and alcohol (P=0.003, OR=3.888). As well as, gastric cancer had significant association with alcohol (P<0.05, OR=6.937), smoking (P=0.012, OR=2.738), family history (P=0.005, OR=4.380) and gender (P≤0.05, OR=5.103). Conclusions: Current investigation shows that H. pylori infection, alcoholism, male gender, age and family history have an additive impact on the incidence of gastric cancer. In addition, alcoholism, opium usage, NSAIDs and family history have more impact on the incidence of acute gastric ulcer and acute duodenal ulcer in patients.

272-277

Authors: Hamid Kassiri, Masoud Lotfi, Atefe Ebrahimi

Objective: To determine the incidence, epidemiology and demography of acute animal bites referred to Abdanan health centers in the years 2009 to 2013. Methods: This study was a descriptive analytical research. Questionnaires for each case of acute animal bite was completed. Data about age, gender, kind of animal, residency, site of bite, etc taken from Abdanan health centers were analyzed. Data were analyzed in SPSS by using descriptive statistics. Results: Total number of exposed persons to acute animal bites was reported 67 in 2009 and 69 in 2013. The average incidence rate was 1.2 per 1 000 population. Bites were frequent among the age group of 20-30 years. Most of the cases were self-employment. Around 83.8% of cases were bitten by dogs. Of total 309 studied patients, 73.8% were male. Feet (71.5%) and hands (22.7%) were the most common body part affected. About 53.1% of cases were in rural population. Conclusions: Dogs seems to play a very important role in the epidemiology of rabies in Abdanan, Iran. No cases of human rabies were observed in our study. This may be because of increasing public awareness and the upgrading of health and treatment centers, all of which in study region provide post-exposure anti-rabies treatment including vaccination, immunoglobulin and wound washing.

193-197

Authors: Derouiche Samir, Zeghib Khaoula, Gharbi Safa, Khelef Yahia, Feriani Anouar

Objective: To investigate the protective effects of Aristolochia longa (A. longa) and Aquilaria malaccensis (A. malaccensis) on acute hepatotoxicity induced by lead in female albino rats. Methods: Twenty five (25) apparently healthy female Wistar rats were randomly divided into five groups of five rats in each: control, Pb, Pb + A. longa (Ar), Pb+ A. malaccensis (Aq), and Pb+ A. longa (Ar) + A. malaccensis (Aq) lead (100 mg/kg b.w.) as Pb (C2H3O2)2 added in their drinking water for 75 days. A. longa (rhizome powder at a dose of 10 g/kg of diet ) and A. malaccensis (heartwood powder at a dose 10 g/kg of diet) were added to the feed during the last 15 days of lead exposed in the animals. Results: Obtained results revealed that lead treatment caused a significant increase in serum GOT, GPT and ALP activities and in liver of MDA level and CAT activity. In contrast, it led to an decrease in the liver GOT, GPT and GST activities and in GSH level in rats. Also, the results clearly showed that lead causes alterations of hepatic tissue in comparison with controls. Our results showed that treatment with A. malaccensis and A. longa a partial correction of the previous parameters. The histological observations confirmed the hepatoprotection results by the biochemical parameters. Conclusions: Results demonstrated beneficial effects of A. longa and A. malaccensis treatment in Pb-induced oxidative stress and tissue damage in liver.

205-209

Authors: Dong-Mei Sun, Qing-Fei Zhong, Qian-E Du, Jia-Qi Xu, Fu-Jiang Liu, Xiao-Ran Liu

Objective: To explore the characteristics of medical emergency disease spectra in Emergency Department of Haikou, China; and to provide clinical data for emergent disease treatment as well as emergency department personnel and equipment management. Methods: A total of 11 870 patients (over 16 years old) who visited Emergency Departments of the First Affiliated Hospital of Hainan Medical University, Haikou city from January 1, 2015, through December 31, 2015 were selected. Data on patients' age, sex, diagnosis, treatment duration, and treatment month were analyzed with Microsoft Excel. Results: Peak treatment times were from 18:00 to 24:00. The top four diseases were involved with respiratory, digestive, nervous, and cardiovascular systems, respectively. Respiratory problems peaked from November to February and digestive problems peaked from February to August. Temperatures ranging from >22.5 曟to 26°曟 and high humidity exacerbated respiratory and digestive system diseases. Conclusion: The frequency of specific diseases that require emergency room care are affected by the local climate of Hainan Province.

214-217

Authors: Gianmarco Lotito, Ionut Negoi, Mircea Beuran

Objective: To detail the pattern of postoperative morbidity in patients with acute complications of liver hydatidosis. Methods: We retrospectively studied all patients with liver hydatidosis, managed in a tertiary university centre between January 2011 and December 2016. Results: Fifty-three patients with cystic liver echinococcosis and a mean age of (43.64依17.54) years were selected. The mean diameter of the cyst was (8.11依 4.84) cm. Thirty-five (66%), 12 (22.6%), 4 (7.5%), and 2 (3.8%) patients had one, two, three, or four cysts, respectively. Nine (17%) patients were admitted in an emergency setting. The surgical approach was by laparotomy in 43 (81.1%) and by laparoscopy in 10 (18.9%) patients. Eleven (20.8%) patients developed postoperative complications: Class I – 3 (5.7%), Class II – 7 (13.3%), Class III – 1 (1.9%), Class IV – 1 (1.9%) patient according to Clavien-Dindo classification. Four (7.5%) patients developed long-term complications. 18 (34%) patients had more than one hospital admissions. Conclusions: Acute complications of the liver hydatid disease are associated with significant post-therapeutic morbidity, which correlates with the cyst's type according to Gharbi classification.

222-226

Authors: Giuseppe Rollo, Andrea Pasquino, Paolo Pichierri, Michele Bisaccia, Alessandro Stasi, Marco Giaracuni, Niki Cazzella, Luigi Meccariello

Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy). Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator; the time taked to treat the ankle associated lesions; the time of skin healing; the ankle alignment; the subjective/objective Ovadia and Beals score; and complications. The Endpoint assessment was set at the days of the definitive surgery. Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score. Conclusion: Pilon fractures are complex and often present complications; the damage control treatment, in emergency, with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy.

229-231

Authors: Anna Chiara Iolanda Contini, Tamara Caldaro, Giovanni Federici di Abriola, Erminia Romeo, Valerio Balassone, Francesca Rea, Filippo Torroni, Paola De Angelis, Simona Faraci, Giulia Angelino, Renato Tambucci, Luigi Dall'Oglio

Meckel diverticulum, a common congenital anomaly of the small intestine, can be responsible of several complications due to the presence of ectopic gastric mucosa and represents a challenge for diagnosis. We present the case of a 11-year boy suffering from intestinal pain and bleeding in which radiological examinations unexpectedly raised the suspicion of Meckel diverticulum. The diagnosis was confirmed using 99mTc-pertechnetate scintigraphy. At surgery, a fistulous tract between Meckel diverticulum and an inflamed appendix was found. The authors discuss the role of medical nuclear imaging which, notwithstanding its limitations, is of fundamental importance to achieve a correct and timely diagnosis. This is of particular relevance in unusual cases, as the one presented, in which Meckel diverticulum is found concurrently with other intestinal abnormalities.

235-236

Authors: Sunil Kumar Garg, Pragya Garg

Neurological manifestations are rare as initial presentation in acute promyelocytic leukemia (APL). This case illustrates status epilepticus as initial presentation in this disease. Atypical cells on peripheral smear led to the diagnosis of leukemia.

239-240

Authors: Sunil Garg

Staphylococcus cohnii is not known to causes meningitis. We present a case of mennigitis due to this organism. We are highlighting this case not only for its rarity but rapidity of worsening also. This report indicates that Staphylococcus cohnii are not as innocuous as once thought to be and these organisms should not be disregarded as possible skin contaminants. Before labelling them as contaminants their possible association with disease should be ruled out.

145-153

Authors: Vaibhav Dubey, Richard Owusu-Apenten, Shipra Tripathi, Udaya Pratap Singh, Alok Semwal

Prostate cancer (PC) is one of the most common and leading cancer amongst the males all around the world. Depending upon it long latency and cost involved in its management and treatment, there is extensive need for more personalized and economical therapeutic approach for its effective therapy. The current review here discusses agents from natural dietary sources and drug class Non-Steroidal Antinflammatory (NSAIDS) that bears chemopreventive potential to regulate PC progression & tumour development and therefore could be devised into effective future treatment strategy against PC along with its metastatic castration-resistant form. Based on the literature search the therapeutic scope of selected agents are delineated, sighting their previous activity and prospects as epigenetic moderators in specific to particular PC causing biomarkers like over expression of AKR1C3, lost intracellular glutathione/glutathione-stranferases(GSH/GST) expression, DNA hypermethylation, aberrant cell proliferation and other related factors that are thought to potentiate and aggravate the onset of PC like smoking and use of other narcotics products.

163-168

Authors: Sheng Yu, Tian-Xiao Hu, Jun Jin, Sheng Zhang

with lung recruitment maneuver (RM) in the treatment patients with acute respiratory distress syndrome (ARDS). Methods: Totally 74 patients with ARDS admitted to the Department of Intensive Care Unit, Changshu Second People's Hospital in Jiangsu Province between September 2010 and June 2013 were selected and randomly divided into lung recruitment group and non-lung recruitment group, and the initial ventilation solution for both groups was synchronized intermittent mandatory ventilation (SIMV). For RM, SIMV mode (pressure control and pressure support) was adopted. Positive end expiratory pressure (PEEP) was increased by 5 cm H2O every time and maintained for 40-50 s before entering the next increasing period, and the peak airway pressure was kept below 45 cm H2O. After PEEP reached the maximum value, it was gradually reduced by 5 cm H2O every time and finally maintained at 15 cm H 2O for 10 min. Results: A total of 74 patients with mean age of (49.0±18.6) years old were enrolled, 36 patients were enrolled in lung recruitment maneuver (RM) group and 38 patients were enrolled into non-lung recruitment maneuver (non-RM) group. 44 were male and accounted for 59.5% of all the patients. For the indicators such as PEEP, pressure support (PS), plateau airway pressure (Pplat), peak airway pressure (Ppeak), vital capacity (VC) and fraction of inspired oxygen (FiO2), no statistical differences in the indicators were found between the RM group and non-RM group on D1, D3 and D7 (P>0.05), except that only FiO2 of RM group on D7 was significantly lower than that of non-RM group (47.2±10.0) vs. (52.2±10.5), P<0.05]. For the indicators of blood gas analysis, including pH, arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2) and oxygenation index (PaO2/FiO2), PaO2 and PaO2/FiO2 of RM group were significantly higher than those of non-RM group on D7, and the values were [(90.2±16.1) mmHg vs. (76.4±11.3) mmHg, P<0.05] and [(196.5±40.7) mmHg vs. (151.7±37.3) mmHg, P<0.05] respectively. There was no statistical difference in heart rate (HR), cardiac index (CI), central venous pressure (CVP) or mean arterial pressure (MAP) between RM group and non-RM group on D1, D3 and D7 (P>0.05). 28-day mortality, ICU mortality and in-hospital mortality were 25% vs. 28.9%, 25% vs. 26.3% and 36.1% vs. 39.5% respectively between RM group and non-RM group (all P>0.05). Conclusion: Protective lung ventilation strategy combined with lung recruitment maneuver can improve the indicators such as PaO 2, FiO2 and PaO2/FiO2 on D7, but failed to improve the final outcomes such as 28-day mortality, ICU mortality and in-hospital mortality.

175-180

Authors: Elham Shahnazi, Habib Mohammadzadeh, Chiman Daneshyar, Alireza Chavshin, Shahram Khademvatan

Objective: To obtain the frequency of trichomoniasis and molecular diagnosis among women referred to a laboratory in Urmia (north west Iran). Methods: In the cross sectional study during the year 2014-2015, women with complaints of abnormal discharge, itching, irritation and unpleasant odor were studied using convenience sampling. These people were referred to one of the laboratories in city by gynecologist. After preparing the checklist of underlying data, vaginal wet smear samples was prepared to direct microscopy and molecular assess. Results were analyzed with statistical tests. Results: Totally 39.2% of referred cases were 30-40 years old, and about 54.8% of referred were illiterate and primitive. The frequency of trichomoniasis was 11.1% and statistically there was no significant difference. There was no significant difference among the age, education level, method of contraception, marriage age, location, employment status and the number of delivery with T. vaginalis. Conclusion: T. vaginalis compared to other studies have a moderate frequency among women of Urmia. Because of the concordance of this infection with other sexual transmitted diseases, it is recommended further studies about the prevalence of trichomoniasis in Urmia.

187-192

Authors: Xiao-Xuan Fan, Xiao-Ping Zhao, Xin-Rong Guo, Hai-Feng Duan, Ge-Ting Liang

Objective: To study the intervention effect of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma (ASDH). Methods: 160 SD rats were randomly divided into four groups, and the ASDH model rats were made by stereotactic autoblood injection, and sham operation group received craniotomy without blood injection. Sham operation group and model group were normally bred after model establishment, and 6 h after model establishment, the treatment group received intragastric administration of Peiyuan Huayu Decoction, and control group received intragastric administration of Piracetam Tablets, 1 time a day. On the 1d, 3d, 5d and 7d after model establishment, the general conditions of rats (activity, food intake and mental state) were observed, blood was collected via auricula dextra, ELISA method was used to determine peripheral plasma NSE and S100毬 protein contents, routine HE staining was conducted after perfusion fixation, the neurons in blood injection side of brain tissue were counted, and the neuron damage was observed. Results: 26 rats were dead in the experiment. The general conditions of sham operation group were significantly better than those of other groups, treatment group was significantly better than model group and control group on the 5d group (P<0.05), and there was no significant difference on the 1d, 3d and 7d (P>0.05); neuron count of sham operation group was basically stable, treatment group was not different from model group and control group on the 1d (P>0.05), treatment group was better than model group (P<0.05), and not different from control group (P>0.05) on the 3d, and treatment group was better than model group and control group on the 5d and 7d (P<0.05); peripheral plasma S100毬 protein and NSE contents of sham operation group were at lower levels, treatment group was not significantly different from model group and control group on the 1d (P>0.05), S100毬 protein and NSE contents decreased significantly on the 3d, and treatment group was significantly different from model group and control group (P<0.05), S100毬 protein and NSE contents increased on the 5d and 7d, the increase in treatment group was slower than that in model group and control group, and there was significant difference (P<0.05). Conclusion: Peiyuan Huayu Decoction has obvious protective effect on the neurons in ASDH model rats, and this effect may be based on the inhibition of secondary neuron damage.