Journal of Acute Disease

245-254

Authors: Farah Iram, Shah Alam Khan, Aftab Ahmad, Anees A. Siddiqui, Asif Husain

Eslicarbazepine acetate (ESL) is a new, once daily, orally administered, third generation antiepileptic drug which is indicated in the treatment of partial-onset seizures. ESL is known to exert it’s anticonvulsant effect by blocking the voltage-gated sodium channels. Several clinical trials and pharmacological studies have revealed that seizure control was better with ESL monotherapy (1 200 or 1 600 mg once daily) following a switch from other antiepileptic drugs in comparison with pseudo-placebo patients. The studies have indicated the ESL to be well tolerated and produced only mild to moderate emergent adverse events with the therapy. Being a dibenzazepine family member, structure and chemistry of ESL resembles more or less to carbamazepine and oxcarbazepine. ESL differs structurally from carbamazepine and oxcarbazepine at the 10, 11 position of dibenazepine nucleus. This molecular variation results in differences in metabolism and thus helps to prevent the formation of toxic epoxide metabolites. ESL following oral administration is rapidly metabolised to active metabolite namely S-licarbazepine which is responsible for its pharmacological activity. ESL exhibits acceptable pharmacokinetic profile and shows insignificant drug-drug interactions. In phase III clinical program, ESL was found to be efficacious and well tolerated in adult patients with partial onset seizures previously not controlled with treatment with one or two other antiepileptic drugs.

260-263

Authors: Xian-Li Liu, Xiao-Ran Liu, Chuan-Zhu Lu

Paraquat (PQ, methyl viologen) was widely used in agricultural production throughout the world in 1962 for its efficient herbicidal activity. PQ was also highly toxic drug. About 5 mL medicine including 20% paraquat was life-threatening that can cause poisoning. In 1966, some people died because of PQ poisoning. Most patients had acute respiratory distress syndrome after 2 wk, and 70% of them died due to the lack of effective detoxification drugs. Thus, it was particularly important to understand the pathogenesis of PQ poisoning and give some effective treatments. This article will review the toxicological mechanism and treatment on PQ poisoning of acute lung injury.

268-271

Authors: Jason Imperato, Daniel J Henning, Patrick J McBee, Leon D Sanchez

Objective: To assess the utility and relative strength of markedly abnormal vital signs thresholds (triggers) in prediction of the needs for intensive care unit (ICU) admission from the emergency department (ED). Methods: A retrospective cohort study performed in a 37 000 annual visit, urban, community teaching ED. All adult patient encounters from July 10, 2011 to July 9, 2013 were eligible for inclusion. The primary outcome was ICU admission from the ED. We collected the incidence of trigger vital signs (heart rate>130 bpm, heart rate<40 bpm, respiratory rate>30 breaths per minute, respiratory rate< breaths 8 per minute, oxygen saturation<90%, systolic blood pressure<90 mmHg) as binary variables for each patient enrolled. Univariate and multi-variable logistic regression models were created to determine the ability of the trigger vital signs to predict ICU admission. Results: Total of 68 554 patient encounters were included in the analysis. Of these, 2 355 [3.4%, 95% confidence intervals (CI) 3.3%-3.6%] patients exhibited trigger vital signs, and 1 135 (1.7%, 95% CI 1.6%-1.8%) patients were admitted to ICU. All trigger vital signs were strongly associated with admission to the ICU and demonstrated higher odds of ICU admission with HR<40 (odds ratio 5.2, with 95% CI 2.7-10.1) being the best predictor among the studied covariates. The likelihood of ICU admission increased in a linear fashion with the number of trigger vital signs exhibited. Conclusions: Trigger vital signs serve as predictors that an ED patient may need admission to the ICU and may serve as a tool to expedite disposition of these resource-intensive patients.

278-283

Authors: Faizan Iqbal, Akram Ali Uddin, Sajid Younus, Osama Bin Zia, Naveed Khan, Asmatullah

Objective: To compare surgical outcomes of acute acetabular transverse fracture using ilioinguinal and Stoppa approach. Methods: Twenty five patients who managed with ilioinguinal approach (group A) at a mean follow-up of (32.3±4.6) mo and 30 patients who managed with Stoppa approach (group B) at a mean follow-up of (29.7±3.8) mo were prospectively reviewed. The study was approved by the hospital ethical review committee (IRB approval no: 0189-2007). Patients were called for routine follow up and follow-up durations were set. End points of the study were: (1) blood loss was measured intraoperatively by measuring the blood loss in the suction drain and counting blood stained gauze and postoperatively by assessing hemoglobin after 6 h of surgery; (2) functional outcome was demonstrated using the Harris hip score; (3) reduction quality and radiological results were demonstrated by Matta scoring system. Results: Mean blood loss (intraoperatively + postoperatively) was (1 175.8±310.2) mL and (1 115.7±285.1) mL in patients operated with ilioinguinal and Stoppa approach, respectively. Mean operative time was (242.3±60.8) min and (198.9±50.3) min in patients operated with ilioinguinal and Stoppa approach, respectively. Functional outcome, radiological outcome and reduction quality showed no significant difference between two approaches. Complication rate was 36.0% in group A (9 patients) and 13.3% in group B (4 patients). Conclusions: Our study concludes that Stoppa approach allows less blood loss and operative time with fewer complications.