Journal of Acute Disease

90–93

Authors: Fatimah Lateef

Of late much has been said about emerging infectious diseases and the threat of bioterrorism. The focus has been on continuous public health surveillance for early detection of outbreaks and potential threats. Preparedness is the way forward and relevant institutions and organizations need to make the necessary investments early. Familiarity, good coordination, active participation and a change of mindset amongst personnel is crucial to make the system work. We also share a general approach to using electronic Emergency Department data for syndromic surveillance.

100–106

Authors: Bal Kishan Gupta, Kailash Chandra Nayak, Sunil Kumar, Surendra Kumar, Anjli Gupta, Parul Prakash

Objective To report a comparative clinical and histopathological study on oliguric and non-oliguric acute renal failure (ARF) in malaria. Method 311 consecutive cases of malaria out of which 74 (23.79%) had ARF as per WHO criteria were conducted. Mean age was 32.58 (range 15–60 years) and male: female was 2:1. Result Most of the cases developed ARF within 10 d of onset. 18 cases (11 falciparum, 2 mixed, 5 vivax) presented with oliguric and 56 (41 falciparum, 6 mixed, 9 vivax) with non-oliguric renal failure. Associated major manifestations were jaundice (75.68%), cerebral malaria (41.89%), bleeding manifestations (32.43%), severe anemia (27.03%), hypotension (25.68%), multi-organ failure (18.92%), severe thrombocytopenia (12.16%), and ARDS (8.11%). Kidney biopsy (n=20) showed acute tubular necrosis (n=7), Mesangioproliferative glomerulonephritis (n=4) or both (n=9). Hemodialysis was done in 8 cases of oliguric renal failure out of which 4 survived (average no. of session 2.9). Conclusion Most of the cases recovered within 3 weeks. Total mortality was 28.38% (n=21) and mortality was more in oliguric renal failure (72.22%) as compare to non-oliguric renal failure (14.29%).

110–114

Authors: Nora Burd, Vilma Mem, Ejup Mahmudi M, Brikena Selimi, Sulejman Zhugli, Basri Lenajni, Illaz Bunjaku

Objective 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. 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, 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 118 patients were diagnosed with Dry Eye Syndrome of varying degrees. 58 male/61 female. 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.

120–125

Authors: Scott O Fayemi, Adeleke Osho, Olubunmi Atolani

Objective To investigate the preliminary phytochemical screening and antioxidant properties of the methanolic extract of Mezoneuron benthamianum (M. benthamianum). Method The anti-candidal potential and minimum inhibition concentration (MIC) were evaluated on fresh isolates of Candida species using disc diffusion method. While the lipophilic free radical scavenging activity was examined using the spectrophotometric assay on the reduction of 1,1-diphenyl-2-picrylhydrazyl (DPPH) and compared with standard antioxidant, α-tocopherol. Result The anti-candidal activities of M. benthamianum root and leaf revealed zones of inhibition (ZI) against Candida glabrata as (13.6±1.00) mm and (13.7±1.00) mm respectively while, Candida krusei ZI against root (13.7±1.00) mm and leaf (11.8±0.80) mm as the most significant among other candida species (Candida stellatoidea, Candida albicans and Candida torulopsis). Phytochemicals present in the plant extracts includes saponin, anthracquinones, flavonoids and tannins. The antioxidant potential of the plant was significant and dose dependent at the concentrations tested. The extract has IC50 values of 781 μg/mL while the standard, α-tocopherol has 222.3 μg/mL. Conclusions The result from this research suggests that M. benthamianum is a potent anti-candida and antioxidant plant and may be a potential anti-candida plant for future prospect in drug development.

130–134

Authors: Olubunmi Atolani, Joshua Omere, C.A. Otuechere, A. Adewuyi

Objective To propose a natural remedy for the some acute diseases the fatty acids profile, antioxidant and cytotoxicity potentials of seed oils from natural sources have been examined. Methods The fatty acids profile of seed oils from sweet orange, grape, lime and watermelon obtained by soxhlet extraction were trans-esterified and examined by gas chromatography-mass spectrometry (GC-MS). The antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl assay were examined and compared with gallic acid and α-tocopherol while the cytotoxicity were examined via the brine shrimp cytotoxicity assay using cyclophosphamide as a reference standard. Results Sweet orange seed contained 9,12-octadecadienoic acid (62.18%), grape seed, erucic acid (43.17), lime seed, oleic acid (52.42%) and watermelon seed linoleic acid (61.11%) as the major fatty acid present. Among the four oils tested, grape seed oil had the highest acute toxicity with LC50 value of (156.2 ± 0.37) μg/mL while orange seed oil had the highest lethal toxicity with LC50 (7.59 ± 0.35) μg/mL value. Lime seed oil IC50 (14.49 ± 3.54) μg/mL showed the highest antioxidant potential of about 70% at 1 mg/mL concentration which was more significant than the reference compounds gallic acid and α-tocopherol with IC50 value of (201.10 ± 1.65) and (54.86 ± 2.38) μg/mL respectively. The yield of oil from these seeds varied from 9.583% to 24.790% with the oils being rich in essential fatty acids. Conclusion Utilization of the seeds will reduce wastes, improve commercialization and procures hitherto neglected substances for technological and nutritional applications.

141–143

Authors: Dinesh K. Patel, Kanika Patel, S.P. Dhanabal

Objective To develop a novel qualitative and quantitative technique, which can pave the way for rapid and selective determination of different phytoconstituents of Gymnema sylvestre (G. sylvestre). Methods Phytochemical test, TLC analysis, solubility study, total phenol and flavonoid content and antimicrobial study were performed in the present investigation. Fingerprint analysis and quantitative analysis of quercetin were also performed through hptlc method. Results Alkaloid, saponin, tannin, triterpenoid and flavonoid were found to be present in the G. sylvestre extract. Solubility in water and alcohal, moisture content and gymnemic acid content were found to be 86.36%, 88.24%, 4.20%, and 26.24% w/w. total phenol and flavonoid content were found to be 0.80% and 1.90%. Microbiological assay showed that E. coli and salmonella were found to be absent whereas total bacterial count and yeast & moulds contents were found to be 650 and 60 cfu/g. quantitative analysis through hptlc revealed the presence of 2.95% w/w of quercetin. Conclusions In future this study will be helpful for the quantitative analysis of phytoconstituents as well as standardization of the G. sylvestre.

146–147

Authors: Abdurrahim Dusak

We report a case of left heart failure caused by a sliding hiatus hernia compressing on left atrium. A 95-year-old woman was admitted with recurrent episodes of shortness of breath and chest pain. The cause was uncertain as she had normal cardiothoracic ratio on chest radiography. Computed tomography (CT) of the thorax revealed an intrathoracic mass behind the left atrium causing external compression of the left atrium suggestive of sliding hiatus hernia. We present such a case and possible mechanisms of heart failure.

150–151

Authors: Baris Dogu Yildiz, Barlas Sulu

Gunshot might have unexpected findings in the victim owing to the ballistics of the injury. The trajectory of the bullet plays a central role in the surprising findings in gunshot injuries. We are presenting a case with pellets seen in the stomach after a gunshot.

154–155

Authors: Firat Bektas,Secgin Soyuncu

Anticoagulation is very effective for primary and secondary prevention of thromboembolic events. Warfarin sodium is the well known and the most widely used anticoagulant. Sublingual hematoma is the rare complication and can cause the airway obstruction. We present the case of sublingual hematoma secondary to usage of Warfarin therapy.

159–161

Authors: Abhrajit Ganguly, Saibal Das, Jayanta Kumar Dey, Somnath Mondal

With increasing incidence of Clostridium difficile (C. difficile) associated diarrhea and pseudomembranous colitis, several extra-intestinal manifestations of the organism have been unmasked which include-bacteremia, brain abscess, pericarditis etc. We report a rare and interesting case of C. difficile bacteremia and subsequent meningitis in a 10 year old child. The child was immune competent, which further raises the question about the virulent possibilities of the organism and its implications in the near future. The condition resulted from a prolonged treatment with intravenous (I.V.) cefotaxime for staphylococcal pyogenic arthritis. The child recovered from the septic arthritis but on the 7th day post-admission developed features of bacteremia. The child was later treated with intravenous metronidazole and vancomycin and he was discharged on the 21st day post-admission. No recurrence of symptoms was noted.

165–167

Authors: Uttam Kumar Sarkar, Utpala Mitra, Mamta Chawla Sarkar, Shanta Dutta, Himanish Roy, Mrinal Kanti Chatterjee, Phalguni Dutta

Horizontal transmission of H1N1/09 virus infection is very common however; transmission through this route has not been reported in newborns. To our knowledge, this is the first case report of newborn who acquired infection of novel H1N1/09 virus horizontally through asymptomatic family members or hospital staff during epidemic period in Kolkata, India. Baby recovered without antiviral therapy but received antibiotic for bacterial co-infection.

7–12

Authors: A Bhallaa, V Suria, P Singhb, S Varmaa, NK Khandelwalb

Abstract Objective To compare the efficacy of cranial imaging techniques in adult patients with acute febrile encephalopathy. Methods We enrolled one hundred and two patients presenting to the emergency with fever of shorter than 15-day duration and altered sensorium. All the patients were subjected to routine investigations, detailed cerebrospinal fluid analysis, computerized tomograms (Non contrast followed by contrast enhanced) and Magnetic resonance imaging of the brain. Final diagnosis was reached after considering the clinical, biochemical findings, imaging results and response to therapy. The positive yield of radiological investigations was compared against the final diagnosis. Results The patients were divided into three groups. Of these patients, 48 had evidence of meningoencephalitis, 22 patients had pyogenic meningitis, and 20 were combined together in others group. In other 12 patients, a definitive diagnosis could not be made. Only 37% patients were detected to have abnormal computerized tomograms and the commonest abnormality was diffuse edema, which failed to point to an etiological diagnosis. Magnetic resonance imaging was abnormal in 62.75% cases and was able to suggest an etiological diagnosis in 100% cases of cerebral venous thrombosis, tubercular meningitis, 95% cases of meningoencephalitis and 45% with meningitis. Conclusions Magnetic resonance imaging provides better information than computerized tomography in adult patients with acute febrile encephalopathy.

18–22

Authors: AN Kuzovlev, VV Moroz, AM Goloubev, SG Polovnikov, VV Stec, VV Varvarin

Objective To estimate the efficacy and safety of nebulized tobramycin (NT) as an adjunct to systemic antibiotics in the treatment of severe nosocomial pneumonia (NP). Methods 25 mechanically ventilated patients (out of 150 screened) were enrolled in the current observational single-center study. They were randomized to receive either NT (300 mg, BID; group 1, n=15) as an adjunct to systemic antibiotics or for a correction of the regimen of systemic antibiotics (group 2, n=10). The primary outcome measure was resolution of NP and acute respiratory insufficiency. The CPIS, signs of systemic inflammatory response syndrome (SIRS) and oxygenation index were used as objective indicators of the clinical progress. Results The following signs of NT efficacy were detected in 87% of group 1 patients: a decrease of SIRS and CPIS scores within (2.3±1.2) d of NT therapy (P<0.05); decrease of microbes titer to 103–104 CFU/mL (P<0.05); increase of microbes sensitivity to systemic antibiotics in 40% of patients; positive X-ray dynamics in 60% of patients within (9.0±2.5) d of NT therapy. No serious side effects of NT were observed. Conclusions Administration of NT as an adjunct to systemic antibiotics is efficient and safe in 87% of patients with severe NP caused by multiresistant gram-negative bacteria.

26–30

Authors: N Habilaa, HM Inuwaa, IA Aimolaa, OI Lasisib, DG Checheta, IA Okafora

Objective To investigate the neurotransmitter enzyme Acetylcholinesterase (AChE) activity in the brain and blood of rats infected with Trypanosoma congolense (T. congo). Methods Presence and degree of parasitemia was determined daily for each rat by the rapid matching method. AChE activity was determined by preparing a reaction mixture of brain homogenate and whole blood with 5, 5-dithiobisnitrobenzioc acid (DTNB or Ellman's reagent) and Acetylthiocholine (ATC). The increase in absorbance was recorded at 436 nm over 10 min at 2 min intervals. Trypanosome species identification (before inoculation and on day 10 post infection) was done by Polymerase chain reaction using specific primers. Results The AChE activity in the brain and blood decreased significantly as compared with the uninfected control. The AChE activity dropped to 0.32 from 2.20 μmol ACTC min−1mg protein−1 in the brain and 4.57 to 0.76 μmol ACTC min-1mg protein−1 in the blood. The animals treated with Diminaveto at 3.5 mg/kg/d were observed to have recovered significantly from parasitemia and were able to regain AChE activity in the blood but not in the brain as compared to the control groups. We also observed, that progressive parasitemia resulted to alterations in PCV, Hb, RBC, WBC, neurophils, total protein, lymphocytes, monocytes and eosinophil in acute infections of T. congo. Polymerase chain reaction (PCR) of infected blood before inoculation and on day 10 post infection revealed 600 bp on agarose gel electrophoresis. Conclusions This finding suggest that decrease in AChE activity increases acetylcholine concentration in the synaptic cleft resulting to neurological failures in impulse transfer in T. congo infection rats.

35–37

Authors: Md. Fazal Karima, Mamun Al-Mahtabb,Salimur Rahmanb, Faroque Ahmeda

Objective To investigate the etiology and other factor in development of hepatocellular carcinoma (HCC) in Bangladesh. Method Data from past studies were compared with our data to assess the etiology and other factor in development of HCC. Mainly four studies were compared which were done in different time. Ultrasonography was principle modality of primary diagnosis. Fine needle aspiration cytology was done in all cases to have tissue diagnosis. Results Previous studies demonstrate hepatitis B in at least 46.9% cases. Recent studies demonstrate at least 61% association of HCC with hepatitis B infection. Our data which include 39 patients (M: F = 29: 10, Age 22–75 years, mean 51 year) demonstrate HBsAg positivity was present in 16 (41%), Anti HCV positivity in 2 (5%), both negativity in 8 (20.5%) and secondary carcinoma in 13 (33.3%) cases. If only primary HCC is considered then hepatitis B virus (HBV) related HCC constituted 61.5%. Alpha feto-protein was > 350 ng/mL in 11 out of 26 cases (42.3%). Conclusions Though the study populations are small, they reflect that the prevalence of HBV related HCC correlates with the existing prevalence of HBsAg positivity in general population. Also the etiology has not changed over years and prevalence of hepatitis B related HCC is more or less a static as compared with previous studies.

42–46

Authors: Ochuko L Erukainurea, Folasade O Adeboyejoa, Gloria N Elemoa, Osaretin AT Ebuehib

Objective To investigate the effect of feeding fibre – enriched biscuit on the antioxidant and hypolipidemic activities in brain tissues of diabetic rats. Method Diabetes was induced by a single intraperitoneal injection of alloxan. Treatment lasted for 14 d, after which the rats were sacrificed by cervical dislocation. Brain tissues were used for the assessment of GSH, catalase, SOD and lipid peroxidation as well as lipid profiles. Result Induction of diabetes led to a significant decrease in GSH level, elevated SOD and catalase activities. These were significantly modified by the biscuits. There was an elevated level of malondialdehyde in the brain tissues of the untreated diabetic rats; this was significantly reduced by the biscuits. There was a significant decrease in HDL and a significant increase in LDL levels, total cholesterol and triglycerides in the untreated (diabetic) rats. Feeding with fibre – enriched biscuits led to decrease in the levels of total cholesterol, triglyceride, LDL – cholesterol and caused a significant increase in the levels of HDL. Conclusions These results suggest a therapeutic and protective effect of the fibre – enriched biscuits against diabetic – induced brain toxicity in rats.

51–57

Authors: RN Krongdai Unhasuta

Objective To improving trauma nursing practice in Thailand and other countries. Methods As part of a larger study of 164 ER nurses, 83 nurses provided narrative responses to questions of CNPG utilization and barriers to implementation. Using a qualitative descriptive design and analysis, three major themes were identified: Guidelines reflect good practice; Nurses do not always follow guidelines; and System problems limit use. Results The results suggest optimized guideline adherence would require using judgment in following CNPG; ensuring organized teamwork is essential; and providing maximum resources would promote optimal care. Conclusion Clinical nursing practice guidelines (CNPG) have been developed in Thailand for resuscitation care of emergency room (ER) trauma patients. However, many nurses do not use guidelines effectively.

65–67

Authors: Vaibhav Kumar Singh, Shailendra Upadhyay

A 66-year-old Caucasian female presented with headaches. MRI brain revealed white matter changes confined to her hindbrain that completely resolved within two weeks. Various case reports have been published attributing multiple causes for reversible posterior leukoencephalopathy syndrome (RPLE), a condition that this patient had. No obvious causes except for mild hypertension were responsible for her presentation. Even in absence of reported causes, diagnosis of RPLE should be entertained in right clinical scenario and suggestive radiologic findings. Such patients should be closely followed since on rare occasional the condition may be irreversible.

70–71

Authors: Wei-Chun Tseng, Cheng-Ting Hsiao, Yu-Cheng Hung

Adult intussusception is rare with variable clinical presentation. We reported a case of adult intussusception presenting with symptoms mimicking acute appendicitis. The patient presented as an abdominal pain from epigastric area with shifting gradually to RLQ. The atypical presentation of adult intussusception remains a diagnostic challenge to the emergency physician.

75–76

Authors: Karthick C Annamalai, A Shrikiran, Suneel C Mundkur, PV Chaitanya Varma

Naphthalene moth ball poisoning in children can present with diagnostic and therapeutic challenges. A 2 year old boy who had accidentally consumed unknown number of moth balls presented 3 d later with vomiting, seizures, methemoglobinemia, hemolytic anemia and altered sensorium. He was managed with red blood cell transfusion, IV Methylene blue and Sodium bicarbonate. Clinical and laboratory parameters normalized. We describe this case as ingestional naphthalene poisoning with rare manifestation of metabolic acidosis, with a good outcome after treatment.

82–84

Authors: Fatimah Lateef

Practice-based learning involves on- the-job learning as well as learning ‘of-the job’ in its realistic setting. It gives trainees and interns the exposure to a diversity of encounters as well as an understanding of the different workplace models, strategies and capabilities. It is now very commonly utilized in teaching and training in medical disciplines. The whole process emphasizes active learning, with collaboration between learners and supervisors, for the eventual delivery of best clinical care to patients.