Journal of Acute Disease
Issue 1,2014 Table of Contents
2014(1):1-5.
DOI: 10.1016/S2221-6189(14)60001-9
Abstract:
C -reactive protein ( CRP ) is a commonly used tool in emergency department ( ED ) , especially in febrile and infectious patients. I t was identified in 1930 and was subsequently classified into an "acute phase protein", an early indicator of infectious or inflammatory situations in the ED , CRP must be a diagnostic reference and no single value can be indicated to rule in or rule out a specific diagnosis or disease. CRP is a comprehensively assisted tool for evaluation and diagnosis of tissue damage ( rheumatologic diseases, stroke, cancer, pancreatitis, burn injury, sepsis and gout ) and infection ( urinary tract infection, pelvic inflammatory disease, meningitis and lung infection ) . I t can be used for treatment monitoring and severity evaluation in pneumonia, pancreatitis, pelvic inflammatory disease ( PID ) , and urinary tract infections ( UTI ) . O therwise, it also plays the role of prognostic indicator of acute coronary syndrome. C -reactive protein adds little to the diagnosis of pneumonia, urinary tract infections, and pancreatitis. A single CRP value should not straightly make the decision to treat these patients. T hat is, CRP has no role in diagnosing these clinical entities, and a normal CRP level should never delay antibiotic coverage in ED . F aster and more interpretable tools such as image studies ( X -ray, sonography and computed tomography ) are available to help diagnose suspected cases of aortic dissection, appendicitis, cholecystitis, pancreatitis, pneumonia and stroke in ED.
C -reactive protein ( CRP ) is a commonly used tool in emergency department ( ED ) , especially in febrile and infectious patients. I t was identified in 1930 and was subsequently classified into an "acute phase protein", an early indicator of infectious or inflammatory situations in the ED , CRP must be a diagnostic reference and no single value can be indicated to rule in or rule out a specific diagnosis or disease. CRP is a comprehensively assisted tool for evaluation and diagnosis of tissue damage ( rheumatologic diseases, stroke, cancer, pancreatitis, burn injury, sepsis and gout ) and infection ( urinary tract infection, pelvic inflammatory disease, meningitis and lung infection ) . I t can be used for treatment monitoring and severity evaluation in pneumonia, pancreatitis, pelvic inflammatory disease ( PID ) , and urinary tract infections ( UTI ) . O therwise, it also plays the role of prognostic indicator of acute coronary syndrome. C -reactive protein adds little to the diagnosis of pneumonia, urinary tract infections, and pancreatitis. A single CRP value should not straightly make the decision to treat these patients. T hat is, CRP has no role in diagnosing these clinical entities, and a normal CRP level should never delay antibiotic coverage in ED . F aster and more interpretable tools such as image studies ( X -ray, sonography and computed tomography ) are available to help diagnose suspected cases of aortic dissection, appendicitis, cholecystitis, pancreatitis, pneumonia and stroke in ED.
2 Attitude and perception of junior resident doctors ’ regarding antibiotic resistance - A pilot study
2014(1):6-9.
DOI: 10.1016/S2221-6189(14)60002-0
Abstract:
Objective: T o analyze the attitude and perception of junior resident doctors’ regarding antibiotic resistance and prescribing. Methods: T his cross-sectional study was conducted in two tertiary care centres in the N ew D elhi during the months of M ay- J une 2012 . A n email based questionnaire was emailed to all the junior residents ( JR s ) working in the clinical setting and all the responses obtained within 2 months were included in the study. S tatistical analysis was done using SPSS v. 17 . Results: T his email based questionnaire was forwarded to 80 JR s. 53 responses were deemed appropriate for analysis with response rate of 66 . 25 % . F orty-nine JR s ( 92 . 45 %) believed that antibiotic resistance is a problem in I ndia while 38 JR s ( 71 . 7 %) believed it is a problem in their hospital. 28 JR s ( 52 . 83 %) had received training regarding antibiotic prescription in last 6 months while 25 ( 47 . 17 %) had not received any training. 47 JR s ( 88 . 7 %) believed that M edical C ouncil should take strict actions prohibiting irrational use of antibiotics. O nly 18 JR s ( 33 . 96 %) said that G overnment of I ndia should go ahead with proposed plan of restricting junior doctors from prescribing third and fourth generation antibiotics without H ead of D epartment's permission. Conclusions: M ost of the junior residents believe that antibiotic resistance is an emerging problem in their hospital as also nationally. T here is a large unmet need of providing education to these residents.
Objective: T o analyze the attitude and perception of junior resident doctors’ regarding antibiotic resistance and prescribing. Methods: T his cross-sectional study was conducted in two tertiary care centres in the N ew D elhi during the months of M ay- J une 2012 . A n email based questionnaire was emailed to all the junior residents ( JR s ) working in the clinical setting and all the responses obtained within 2 months were included in the study. S tatistical analysis was done using SPSS v. 17 . Results: T his email based questionnaire was forwarded to 80 JR s. 53 responses were deemed appropriate for analysis with response rate of 66 . 25 % . F orty-nine JR s ( 92 . 45 %) believed that antibiotic resistance is a problem in I ndia while 38 JR s ( 71 . 7 %) believed it is a problem in their hospital. 28 JR s ( 52 . 83 %) had received training regarding antibiotic prescription in last 6 months while 25 ( 47 . 17 %) had not received any training. 47 JR s ( 88 . 7 %) believed that M edical C ouncil should take strict actions prohibiting irrational use of antibiotics. O nly 18 JR s ( 33 . 96 %) said that G overnment of I ndia should go ahead with proposed plan of restricting junior doctors from prescribing third and fourth generation antibiotics without H ead of D epartment's permission. Conclusions: M ost of the junior residents believe that antibiotic resistance is an emerging problem in their hospital as also nationally. T here is a large unmet need of providing education to these residents.
2014(1):10-13.
DOI: 10.1016/S2221-6189(14)60003-2
Abstract:
Objectives: Aortic dissection is a truly emergency in daily practice, and for gender factor, we want to compare the epidemiology, biomarkers, symptoms and outcome. Methods: A retrospective review six-year AD cases in a northern Taiwan medical center from January, 1, 2005 to December, 31, 2010. by gathering data of 134 AD patients including gender, age, episodes of time, season, vital signs, symptoms (chest pain, chest tightness ( CP / CT ) , abdominal pain, neurological symptoms ) , S tanford classifications, and outcome. Comparisons are made by gender of AD groups. 85 cases with complete data are strictly enrolled into our study. We used student t test and one way ANOVA for statistical analyses, and significance was set at a P value less than 0 . 05 ( 2 -tailed ) . Results: There are 64 male and 21 female enrolled into our study with the mean ± standard deviation ( SD ) of age is ( 64 . 1 ± 14 . 0 ) years old. I n AD patients with female gender are older than male AD patients ( 71 . 5 vs. 61 . 6 years old, P value< 0 . 01 ) . I n symptoms of presentation, female AD patients have more neurologic symptoms than male AD patients ( 38 . 1 % vs. 12 . 5 % , P< 0 . 01 ) . F emale AD patients have longer hospital stay and higher mortality rate than male AD patients ( 16 . 8 vs. 13 . 4 d; 38 . 1 % vs. 18 . 8 % , P= 0 . 39 ; P= 0 . 07 ) . Conclusion: F emale AD patients are ten-year older in age than male, and have more common neurologic symptoms in presentations, and female AD patient have 2 -fold mortality rate than male AD patients.
Objectives: Aortic dissection is a truly emergency in daily practice, and for gender factor, we want to compare the epidemiology, biomarkers, symptoms and outcome. Methods: A retrospective review six-year AD cases in a northern Taiwan medical center from January, 1, 2005 to December, 31, 2010. by gathering data of 134 AD patients including gender, age, episodes of time, season, vital signs, symptoms (chest pain, chest tightness ( CP / CT ) , abdominal pain, neurological symptoms ) , S tanford classifications, and outcome. Comparisons are made by gender of AD groups. 85 cases with complete data are strictly enrolled into our study. We used student t test and one way ANOVA for statistical analyses, and significance was set at a P value less than 0 . 05 ( 2 -tailed ) . Results: There are 64 male and 21 female enrolled into our study with the mean ± standard deviation ( SD ) of age is ( 64 . 1 ± 14 . 0 ) years old. I n AD patients with female gender are older than male AD patients ( 71 . 5 vs. 61 . 6 years old, P value< 0 . 01 ) . I n symptoms of presentation, female AD patients have more neurologic symptoms than male AD patients ( 38 . 1 % vs. 12 . 5 % , P< 0 . 01 ) . F emale AD patients have longer hospital stay and higher mortality rate than male AD patients ( 16 . 8 vs. 13 . 4 d; 38 . 1 % vs. 18 . 8 % , P= 0 . 39 ; P= 0 . 07 ) . Conclusion: F emale AD patients are ten-year older in age than male, and have more common neurologic symptoms in presentations, and female AD patient have 2 -fold mortality rate than male AD patients.
2014(1):14-21.
DOI: 10.1016/S2221-6189(14)60004-4
Abstract:
Objective: T o investigate the antiatherosclerotic potential of Lagenaria siceraria ( L. siceraria ) by calculating percentage plaque area in aorta and grade of atheromatous lesions modulated by HMG - C o A reductase enzyme and lipoprotein lipase enzymes levels in hyperlipidemic rats. Methods: R ats were divided into different groups, fed with high cholesterol atherogenic diet and in addition supplemented with ethanolic extract of fruits of L. siceraria and standard drug atorvastatin. A t the end of the treatment schedule, the atherosclerotic lesion area was measured in cross-sections of the aortic root and grading of atherosclerotic lesions was done. T he blood samples from animals of different groups were evaluated for serum lipid profile determination and plasma lipoprotein lipase activity and the hepatic HMG - C o A activity was also determined. Results: T reatment of rats with ethanolic extract of fruits of L. siceraria significantly lowers the risk of atherosclerosis by lowering percentage plaque area in aorta and grade of atheromatous lesions in hypercholesterolemic rats and also serum cholesterol, triglyceride, LDL -c, VLDL -c and increased HDL -c levels as well. T he extract also induced lipoprotein lipase activity and significantly decreased cholesterogenesis in liver by reducing HMG - C o A reductase activity in hypercholeaterolemic rats. Conclusion: I t can be concluded that ethanolic extract of fruits of L. siceraria contains active components which ameliorates the atheromatous lesions in rat aorta and lowers the risk of atherosclerosis in hypercholesterolemic rats.
Objective: T o investigate the antiatherosclerotic potential of Lagenaria siceraria ( L. siceraria ) by calculating percentage plaque area in aorta and grade of atheromatous lesions modulated by HMG - C o A reductase enzyme and lipoprotein lipase enzymes levels in hyperlipidemic rats. Methods: R ats were divided into different groups, fed with high cholesterol atherogenic diet and in addition supplemented with ethanolic extract of fruits of L. siceraria and standard drug atorvastatin. A t the end of the treatment schedule, the atherosclerotic lesion area was measured in cross-sections of the aortic root and grading of atherosclerotic lesions was done. T he blood samples from animals of different groups were evaluated for serum lipid profile determination and plasma lipoprotein lipase activity and the hepatic HMG - C o A activity was also determined. Results: T reatment of rats with ethanolic extract of fruits of L. siceraria significantly lowers the risk of atherosclerosis by lowering percentage plaque area in aorta and grade of atheromatous lesions in hypercholesterolemic rats and also serum cholesterol, triglyceride, LDL -c, VLDL -c and increased HDL -c levels as well. T he extract also induced lipoprotein lipase activity and significantly decreased cholesterogenesis in liver by reducing HMG - C o A reductase activity in hypercholeaterolemic rats. Conclusion: I t can be concluded that ethanolic extract of fruits of L. siceraria contains active components which ameliorates the atheromatous lesions in rat aorta and lowers the risk of atherosclerosis in hypercholesterolemic rats.
2014(1):22-25.
DOI: 10.1016/S2221-6189(14)60005-6
Abstract:
Objective: T o evaluate the in vivo effect of 14 d repeatedly oral administration of Clinacanthus nutans ( C. nutans ) methanol leaves extract ( 250 mg/kg, 500 mg/kg and 1 000 mg/kg bw ) on the acetylcholinesterase ( AC h E ) activity in male B alb/ C mice. Method: F irst group was served as control group, orally treated with distilled water as vehicle and group 2 - 4 were orally treated with a single daily dose of 250 mg/kg, 500 mg/kg and 1 000 mg/kg bw of C. nutans extract, respectively for 14 d. E ach group consisted of six animals ( n= 6 ) . T he activity of acetylcholinesterase in brain, liver, kidney and heart of mice was determined according to E llman method ( 1961 ) . Results: F rom the results obtained, the AC h E activity was found to be highest in mice liver, followed by brain, kidney and heart. M ethanol extract of C. nutans leaves at 250 mg/kg ( P< 0 . 001 ) , 500 mg/ kg ( P< 0 . 001 ) and 1 000 mg/kg ( P< 0 . 001 ) showed a significant increase in the AC h E activity in mice kidney, liver and heart. O n the other hand, the AC h E activity obtained from the mice brain showed insignificant difference between the control group and treatment group. H owever, there was no abnormal behavioural change and adverse effect related to the central nervous system observed in all treated mice during 14 d experimentation period. Conclusion: I n conclusion, 14 d oral administration of C. nutans was able to modulate cholinergic neurotransmission by activating AC h E activity in mice kidney, liver and heart. C ompounds that responsible for the induction of AC h E activity in mice liver, heart and kidney and its mechanism needs to be elucidated.
Objective: T o evaluate the in vivo effect of 14 d repeatedly oral administration of Clinacanthus nutans ( C. nutans ) methanol leaves extract ( 250 mg/kg, 500 mg/kg and 1 000 mg/kg bw ) on the acetylcholinesterase ( AC h E ) activity in male B alb/ C mice. Method: F irst group was served as control group, orally treated with distilled water as vehicle and group 2 - 4 were orally treated with a single daily dose of 250 mg/kg, 500 mg/kg and 1 000 mg/kg bw of C. nutans extract, respectively for 14 d. E ach group consisted of six animals ( n= 6 ) . T he activity of acetylcholinesterase in brain, liver, kidney and heart of mice was determined according to E llman method ( 1961 ) . Results: F rom the results obtained, the AC h E activity was found to be highest in mice liver, followed by brain, kidney and heart. M ethanol extract of C. nutans leaves at 250 mg/kg ( P< 0 . 001 ) , 500 mg/ kg ( P< 0 . 001 ) and 1 000 mg/kg ( P< 0 . 001 ) showed a significant increase in the AC h E activity in mice kidney, liver and heart. O n the other hand, the AC h E activity obtained from the mice brain showed insignificant difference between the control group and treatment group. H owever, there was no abnormal behavioural change and adverse effect related to the central nervous system observed in all treated mice during 14 d experimentation period. Conclusion: I n conclusion, 14 d oral administration of C. nutans was able to modulate cholinergic neurotransmission by activating AC h E activity in mice kidney, liver and heart. C ompounds that responsible for the induction of AC h E activity in mice liver, heart and kidney and its mechanism needs to be elucidated.
2014(1):26-30.
DOI: 10.1016/S2221-6189(14)60006-8
Abstract:
Objective: T o determine the epidemiology of animal bites during a five-year period ( 2004 - 2008 ) in S hush C ounty, K huzestan province, southwestern I ran. Methods: I n a descriptive cross sectional study, all cases of animal bites referred to the health centers in S hush C ounty were investigated during 2004 - 2008 . T he necessary data were recorded on the special questionnaire that contains questions about bite animal, age, sex, occupation, treatment, the bite site on the body and so forth. Results: O ut of a total of 2 283 cases that underwent the animal bites during the mentioned five years, 1 771 people ( 77 . 6 %) were male and 511 ( 22 . 4 %) were female . M ost cases were related to age groups 10 - 20 ( 33 . 4 %) and 20 - 30 ( 22 %) years. T he average incidence rate of animal bite during these years was determined as 2 . 82 cases per 1 000 people. T he highest incidence rate was related to the year 2007 with 3 cases per 1 000 people. A nimal bites in the winter ( 29 . 3 %) and fall ( 29 %) were more common. A lmost 86 . 5 % and 13 . 5 % of the cases occurred in rural areas and urban areas, respectively. N early 30 % and 20 . 4 % of cases were students and farmers, respectively. A total of 2 155 ( 94 . 4 %) and 86 ( 3 . 8 %) bites occurred by the dog and cat, respectively. T he greatest bite place on the body was in the feet ( 81 . 4 %) and in the hands ( 13 %( . D uring the study period, 2 162 cases ( 94 . 7 %) were treated with an incomplete regimen, and 120 cases ( 5 . 3 %) were treated with a complete regimen. Conclusions: B ecause the cost of prevention after biting for the health system is high, so, preventive programs must be concentrated on public health instruction, particularly in villagers, students, farmers and the owners of the domestic animals.
Objective: T o determine the epidemiology of animal bites during a five-year period ( 2004 - 2008 ) in S hush C ounty, K huzestan province, southwestern I ran. Methods: I n a descriptive cross sectional study, all cases of animal bites referred to the health centers in S hush C ounty were investigated during 2004 - 2008 . T he necessary data were recorded on the special questionnaire that contains questions about bite animal, age, sex, occupation, treatment, the bite site on the body and so forth. Results: O ut of a total of 2 283 cases that underwent the animal bites during the mentioned five years, 1 771 people ( 77 . 6 %) were male and 511 ( 22 . 4 %) were female . M ost cases were related to age groups 10 - 20 ( 33 . 4 %) and 20 - 30 ( 22 %) years. T he average incidence rate of animal bite during these years was determined as 2 . 82 cases per 1 000 people. T he highest incidence rate was related to the year 2007 with 3 cases per 1 000 people. A nimal bites in the winter ( 29 . 3 %) and fall ( 29 %) were more common. A lmost 86 . 5 % and 13 . 5 % of the cases occurred in rural areas and urban areas, respectively. N early 30 % and 20 . 4 % of cases were students and farmers, respectively. A total of 2 155 ( 94 . 4 %) and 86 ( 3 . 8 %) bites occurred by the dog and cat, respectively. T he greatest bite place on the body was in the feet ( 81 . 4 %) and in the hands ( 13 %( . D uring the study period, 2 162 cases ( 94 . 7 %) were treated with an incomplete regimen, and 120 cases ( 5 . 3 %) were treated with a complete regimen. Conclusions: B ecause the cost of prevention after biting for the health system is high, so, preventive programs must be concentrated on public health instruction, particularly in villagers, students, farmers and the owners of the domestic animals.
Basri Lenjani
,
Nehat Baftiu
,
Kelmend Pallaska
,
Kadir Hyseni
,
Njazi Gashi
,
Nexhbedin Karemani
,
Ilaz Bunjaku
,
Taxhidin Zaimi
,
Arianit Jakupi
,
Besnik Elshani
2014(1):31-35.
DOI: 10.1016/S2221-6189(14)60007-X
Abstract:
Objective: T o investigate application of cardiopulmonary resuscitation ( CPR ) measures within the golden minutes in E urope. Methods: T he material was taken from the U niversity C linical C enter of K osovo - E mergency C entre in P ristina, during the two ( 2 ) year period ( 2010 - 2011 ) . T he collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic. Results: D uring the 2010 to 2011 in the emergency center of the CUCK in P ristina have been treated a total of 269 patients with cardiac arrest, of whom 159 or 59 . 1 % have been treated in 2010 , and 110 patients or 40 . 9 % in 2011 . O f the 269 patients treated in the emergency centre, 93 or 34 . 6 % have exited lethally in the emergency centre, and 176 or 65 . 4 % have been transferred to other clinics. I n the total number of patients with cardiac arrest, males have dominated with 186 cases, or 69 . 1 % . T he average age of patients included in the survey was 56 . 7 year old SD ± 16 . 0 years. O f the 269 patients with cardiac arrest, defibrillation has been applied for 93 or 34 . 6 % of patients. I n the outpatient settings defibrillation has been applied for 3 or 3 . 2 % of patients. P atients were defibrillated with application of one to four shocks. O f 27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home, 3 or 11 . 1 % of them have suffered cardiac arrest on the street, and 24 or 88 . 9 % of them have suffered cardiac arrest in the hospital. 5 out of 27 patients survived have ended with neurological impairment. C ardiac arrest cases were present during all days of the week, but frequently most reported cases have been on M onday with 32 . 0 % of cases, and on F riday with 24 . 5 % of cases. Conclusions: A ll survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care ( with an opportunity to provide the emergent health care ) the rate of survival is higher.
Objective: T o investigate application of cardiopulmonary resuscitation ( CPR ) measures within the golden minutes in E urope. Methods: T he material was taken from the U niversity C linical C enter of K osovo - E mergency C entre in P ristina, during the two ( 2 ) year period ( 2010 - 2011 ) . T he collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic. Results: D uring the 2010 to 2011 in the emergency center of the CUCK in P ristina have been treated a total of 269 patients with cardiac arrest, of whom 159 or 59 . 1 % have been treated in 2010 , and 110 patients or 40 . 9 % in 2011 . O f the 269 patients treated in the emergency centre, 93 or 34 . 6 % have exited lethally in the emergency centre, and 176 or 65 . 4 % have been transferred to other clinics. I n the total number of patients with cardiac arrest, males have dominated with 186 cases, or 69 . 1 % . T he average age of patients included in the survey was 56 . 7 year old SD ± 16 . 0 years. O f the 269 patients with cardiac arrest, defibrillation has been applied for 93 or 34 . 6 % of patients. I n the outpatient settings defibrillation has been applied for 3 or 3 . 2 % of patients. P atients were defibrillated with application of one to four shocks. O f 27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home, 3 or 11 . 1 % of them have suffered cardiac arrest on the street, and 24 or 88 . 9 % of them have suffered cardiac arrest in the hospital. 5 out of 27 patients survived have ended with neurological impairment. C ardiac arrest cases were present during all days of the week, but frequently most reported cases have been on M onday with 32 . 0 % of cases, and on F riday with 24 . 5 % of cases. Conclusions: A ll survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care ( with an opportunity to provide the emergent health care ) the rate of survival is higher.
2014(1):36-40.
DOI: 10.1016/S2221-6189(14)60008-1
Abstract:
Objective: T o study hypoglycemic effect of Phyllanthus amarus (P. amarus) leaf extract and its glucose uptake inhibition effect in rat small intestine ex-vivo and in vivo models. Methods: H ypoglycemic studies were carried out in glucose loaded and streptozotocin ( STZ ) induced diabetic albino rats. B lood glucose levels were estimated at I , III and IV hour time intervals after administration of aqueous leaf extract of P. amarus. T he study on the effect of plant extract on intestinal glucose absorption in rat was carried out using everted gut sacs. Results: T he blood glucose levels were significantly depleted in the animals administered with aqueous leaf extract of P. amarus ( 250 mg/kg body weight ) . I ncubation of the rat everted intestinal sacs with the aqueous leaf extract of P. amarus resulted in the inhibition of glucose transport across the intestinal membrane. Conclusions: T he kinetic studies on the glucose transport inhibition across the intestinal membrane by the plant extract was a non competitive type of inhibition of the intestinal glucose transporter protein ( GLUT 2 and SGLT 1 ) revealing the probable mechanism of hypoglycaemic effect of the aqueous leaf extract of P. amarus.
Objective: T o study hypoglycemic effect of Phyllanthus amarus (P. amarus) leaf extract and its glucose uptake inhibition effect in rat small intestine ex-vivo and in vivo models. Methods: H ypoglycemic studies were carried out in glucose loaded and streptozotocin ( STZ ) induced diabetic albino rats. B lood glucose levels were estimated at I , III and IV hour time intervals after administration of aqueous leaf extract of P. amarus. T he study on the effect of plant extract on intestinal glucose absorption in rat was carried out using everted gut sacs. Results: T he blood glucose levels were significantly depleted in the animals administered with aqueous leaf extract of P. amarus ( 250 mg/kg body weight ) . I ncubation of the rat everted intestinal sacs with the aqueous leaf extract of P. amarus resulted in the inhibition of glucose transport across the intestinal membrane. Conclusions: T he kinetic studies on the glucose transport inhibition across the intestinal membrane by the plant extract was a non competitive type of inhibition of the intestinal glucose transporter protein ( GLUT 2 and SGLT 1 ) revealing the probable mechanism of hypoglycaemic effect of the aqueous leaf extract of P. amarus.
2014(1):41-45.
DOI: 10.1016/S2221-6189(14)60009-3
Abstract:
Objective: T o identify during intrauterine congenital malformations; S urgery to dysraphism and hydrocephalus neurological benefit, the ability to live independently; F orecast possibility of lowering birth rates with congenital malformations. Methods: E pidemiological and congenital malformations of the spinal dysraphism were included in this prospective clinical study- research. I ts forms were manifested by the appearance of hydrocephalus in N eurosurgical C linic in P ristina for the period 2010 - 2012 . A ll cases of spinal dysraphism operated in the N eurosurgery C linic in P rishtina for the period 2010 - 2012 were analyzed. Results: I n the N eurosurgery C linic at UCC since 2010 to 2012 are operated total 55 cases of spinal dysraphism; T he largest number of operations were recorded in 2011 with 20 operated cases or 36 . 36 % , while smaller in 2010 with 17 operated cases or 30 . 91 % , N umber of patients varies by year, with some variations of the graph, where at the beginning of the graph have gradually increased over the years, following the continuous growing and finally landing back with graph; B y sex and years, the largest number of cases in male gender with spinal dysraphism were registered in 2012 with 14 cases or 37 . 8 % , while the smallest number in 2010 with 11 cases or 29 . 7 % , W hereas the female gender, number of large backlog of cases was registered in 2011 with 8 cases or 44 . 4 % , while the smallest number in 2012 with 4 cases or 22 . 2 % . D ivided by types of spinal dysraphism total were identified: 13 with spinal dysraphism meningocele or 23 . 6 % and 42 spinal dysraphism myelomeningocele or 76 . 4 % of which were male dominance in relation to female sex ratio ( M : F = 40 : 15 occasions ) , by gender and spinal dysraphism species, the males are identified with many cases, the spinal dysraphism meningocele 8 or 20 % and 32 with spinal dysraphism myelomeningocele or 80 % , E ksterioizm S hanti where the body rejects foreign body system as the one we had at 1 patient. Conclusions: S hant meningitis due to infection or eventual reduction in immune intervention, was warned to 5 patients; H ematoma bilateral subdural due to excessive absorption of the system is evidenced in 1 patient.
Objective: T o identify during intrauterine congenital malformations; S urgery to dysraphism and hydrocephalus neurological benefit, the ability to live independently; F orecast possibility of lowering birth rates with congenital malformations. Methods: E pidemiological and congenital malformations of the spinal dysraphism were included in this prospective clinical study- research. I ts forms were manifested by the appearance of hydrocephalus in N eurosurgical C linic in P ristina for the period 2010 - 2012 . A ll cases of spinal dysraphism operated in the N eurosurgery C linic in P rishtina for the period 2010 - 2012 were analyzed. Results: I n the N eurosurgery C linic at UCC since 2010 to 2012 are operated total 55 cases of spinal dysraphism; T he largest number of operations were recorded in 2011 with 20 operated cases or 36 . 36 % , while smaller in 2010 with 17 operated cases or 30 . 91 % , N umber of patients varies by year, with some variations of the graph, where at the beginning of the graph have gradually increased over the years, following the continuous growing and finally landing back with graph; B y sex and years, the largest number of cases in male gender with spinal dysraphism were registered in 2012 with 14 cases or 37 . 8 % , while the smallest number in 2010 with 11 cases or 29 . 7 % , W hereas the female gender, number of large backlog of cases was registered in 2011 with 8 cases or 44 . 4 % , while the smallest number in 2012 with 4 cases or 22 . 2 % . D ivided by types of spinal dysraphism total were identified: 13 with spinal dysraphism meningocele or 23 . 6 % and 42 spinal dysraphism myelomeningocele or 76 . 4 % of which were male dominance in relation to female sex ratio ( M : F = 40 : 15 occasions ) , by gender and spinal dysraphism species, the males are identified with many cases, the spinal dysraphism meningocele 8 or 20 % and 32 with spinal dysraphism myelomeningocele or 80 % , E ksterioizm S hanti where the body rejects foreign body system as the one we had at 1 patient. Conclusions: S hant meningitis due to infection or eventual reduction in immune intervention, was warned to 5 patients; H ematoma bilateral subdural due to excessive absorption of the system is evidenced in 1 patient.
2014(1):51-55.
DOI: 10.1016/S2221-6189(14)60011-1
Abstract:
Objective: T o investigate the prevalence rate and epidemiological aspects of animal bite in A hvaz C ounty ( western part ) , K huzestan P rovince, S outhwestern I ran during the 2 nd half 2003 - 2007 . Methods: I n this descriptive cross-sectional investigation a questionnaire was completed for each victim. T he questionnaire included questions like, occupation, gender, age group, attacker animal, vaccination type ( complete or non-complete ) , bite place on the body, type of dog bite ( stray or domestic dog ) , residential area ( urban or rural ) . D ata analysis was done by SPSS software using descriptive statistics. Results: T he total number of 4 186 cases had been found. T he highest number of bitten persons were in 2007 ( 1 079 cases ) and 2005 ( 1 032 cases ) . T he maximum prevalence rate belonged to 2005 ( 2 . 04 / 1 000 population ) . A lso, M ost of the victims were males ( 80 %) . E ighty percent of the bites were from urban regions. T he majority of cases were related to 10 - 19 years age group ( 32 . 8 %) . T he highest frequencies of bites were students ( 28 . 9 %) . U pper extremities were the most common bite place ( 61 . 4 %) . A bout 91 . 3 % of cases were injured by dogs. F urthermore, around 83 . 7 % of animal bites treated by incomplete rabies prophylaxis regimen. N o cases of human rabies were observed in our study. Conclusions: T he dogs were the major attacker animal, affecting mostly the age group 10 - 19 years old and men. T herefore, we should pay more attention about controlling this problem.
Objective: T o investigate the prevalence rate and epidemiological aspects of animal bite in A hvaz C ounty ( western part ) , K huzestan P rovince, S outhwestern I ran during the 2 nd half 2003 - 2007 . Methods: I n this descriptive cross-sectional investigation a questionnaire was completed for each victim. T he questionnaire included questions like, occupation, gender, age group, attacker animal, vaccination type ( complete or non-complete ) , bite place on the body, type of dog bite ( stray or domestic dog ) , residential area ( urban or rural ) . D ata analysis was done by SPSS software using descriptive statistics. Results: T he total number of 4 186 cases had been found. T he highest number of bitten persons were in 2007 ( 1 079 cases ) and 2005 ( 1 032 cases ) . T he maximum prevalence rate belonged to 2005 ( 2 . 04 / 1 000 population ) . A lso, M ost of the victims were males ( 80 %) . E ighty percent of the bites were from urban regions. T he majority of cases were related to 10 - 19 years age group ( 32 . 8 %) . T he highest frequencies of bites were students ( 28 . 9 %) . U pper extremities were the most common bite place ( 61 . 4 %) . A bout 91 . 3 % of cases were injured by dogs. F urthermore, around 83 . 7 % of animal bites treated by incomplete rabies prophylaxis regimen. N o cases of human rabies were observed in our study. Conclusions: T he dogs were the major attacker animal, affecting mostly the age group 10 - 19 years old and men. T herefore, we should pay more attention about controlling this problem.
2014(1):56-58.
DOI: 10.1016/S2221-6189(14)60012-3
Abstract:
Objective: T o present the frequency, etiology, changes over the years of acute poisoning in children admitted to P ediatric C linic of P ristina and to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. Methods: R etrospectively we have analyzed the epidemiology of accidental and suicidal poisonings in children hospitalization in P ediatric C linic D epartment of T oxicology during the year 2012 . O ur data we compared with data from previous studies on acute poisoning in children in the P ediatric C linic conducted during the years 1976 - 1985 and 2001 . Results: D uring the year 2012 , in P ediatric C linic of P ristina 5 723 children were hospitalized, 136 of them or 2 . 3 % were treated due to acute poisoning in D epartment of T oxicology, 82 of them was boys and 54 was girls, rate boys girls was 1 . 5 : 1 . T he majority of cases 101 or 74 . 2 % were under five years with peak age three and 35 % or 25 . 7 % were over five years. T he most of the cases was accidentally 97 % and only 2 . 9 % was suicidal and all of them were over the age of ten. D rugs were the most common agent causing the poisoning 71 ( 52 . 2 %) followed by house cleaning products 38 ( 27 . 9 %) , food 10 ( 5 . 8 %) , pesticides 7 ( 5 . 14 %) , rare agent that caused poisoning were: narcotic substances, plant, heavy metals, alcohol, carbon monoxide, carburant. P oisoning occurred mostly in spring and the peak was observed in M ay, ( 1 . 17 % of all patients ) . J anuary was the month of lowest rate of poisoning. D uring the years 1976 - 1985 , in P ediatric C linic of P ristina 900 children were hospitalized due to acute poisoning, 44 . 11 % were from drugs, 15 . 88 % from pesticides, 65 ( 7 . 2 %) , while during 2001 in the unit care intensive were hospitalized 66 children due to acute poisoning, among them 51 . 5 % were poisoning from drugs, 30 . 03 from pesticides, 12 . 2 % from cleaning products. Conclusion: I n our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than 5 years-old, this age of children is the most susceptible in terms of morbidity. C ompared with the previous studies in P ediatric C linic of P ristina, drugs are still the most frequent cause of acute poisoning in children; the number of poisoning with pesticides has fallen but has increased the number of poisoning with cleaning products. A ll preventive measures against poisoning should be taken including preventive strategies of education at national level especially in drug and household product storage.
Objective: T o present the frequency, etiology, changes over the years of acute poisoning in children admitted to P ediatric C linic of P ristina and to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. Methods: R etrospectively we have analyzed the epidemiology of accidental and suicidal poisonings in children hospitalization in P ediatric C linic D epartment of T oxicology during the year 2012 . O ur data we compared with data from previous studies on acute poisoning in children in the P ediatric C linic conducted during the years 1976 - 1985 and 2001 . Results: D uring the year 2012 , in P ediatric C linic of P ristina 5 723 children were hospitalized, 136 of them or 2 . 3 % were treated due to acute poisoning in D epartment of T oxicology, 82 of them was boys and 54 was girls, rate boys girls was 1 . 5 : 1 . T he majority of cases 101 or 74 . 2 % were under five years with peak age three and 35 % or 25 . 7 % were over five years. T he most of the cases was accidentally 97 % and only 2 . 9 % was suicidal and all of them were over the age of ten. D rugs were the most common agent causing the poisoning 71 ( 52 . 2 %) followed by house cleaning products 38 ( 27 . 9 %) , food 10 ( 5 . 8 %) , pesticides 7 ( 5 . 14 %) , rare agent that caused poisoning were: narcotic substances, plant, heavy metals, alcohol, carbon monoxide, carburant. P oisoning occurred mostly in spring and the peak was observed in M ay, ( 1 . 17 % of all patients ) . J anuary was the month of lowest rate of poisoning. D uring the years 1976 - 1985 , in P ediatric C linic of P ristina 900 children were hospitalized due to acute poisoning, 44 . 11 % were from drugs, 15 . 88 % from pesticides, 65 ( 7 . 2 %) , while during 2001 in the unit care intensive were hospitalized 66 children due to acute poisoning, among them 51 . 5 % were poisoning from drugs, 30 . 03 from pesticides, 12 . 2 % from cleaning products. Conclusion: I n our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than 5 years-old, this age of children is the most susceptible in terms of morbidity. C ompared with the previous studies in P ediatric C linic of P ristina, drugs are still the most frequent cause of acute poisoning in children; the number of poisoning with pesticides has fallen but has increased the number of poisoning with cleaning products. A ll preventive measures against poisoning should be taken including preventive strategies of education at national level especially in drug and household product storage.
12 HPTLC evaluation of oleanolic acid and ursolic acid from the methanol extract of Wattakaka volubilis
2014(1):59-61.
DOI: 10.1016/S2221-6189(14)60013-5
Abstract:
Objective: T o find out the secondary metabolites present in the methanol extract of Wattakaka Volubilis ( W. volubilis ) . Methods: H igh performance thin layer chromatography method for the quantification of triterpenoids in soxhlet methanol extract of W. volubilis is described by densitometric scanning. T he linear regression data from the calibration curve was plotted over the range of 10 - 25 μg/m L , r 2 = 0 . 992 46 , 0 . 950 42 respectively. A mixture of toluene: methanol ( 9 : 1 ) was used as mobile phase for oleanolic acid were petroleum ether: chloroform: ethyl acetate: methanol ( 4 : 1 : 0 . 1 : 0 . 1 ) were used for ursolic acid. Results: T he results showed that the presence of oleanolic acid and ursolic acid in methanol extract. T he content found to be 218 . 30 ng and 509 . 99 ng/ 10 mg of extract. Conclusion: F or conclusion, above study scientifically validated as a useful traditional medicine with the identification of bioactive secondary metabolites.
Objective: T o find out the secondary metabolites present in the methanol extract of Wattakaka Volubilis ( W. volubilis ) . Methods: H igh performance thin layer chromatography method for the quantification of triterpenoids in soxhlet methanol extract of W. volubilis is described by densitometric scanning. T he linear regression data from the calibration curve was plotted over the range of 10 - 25 μg/m L , r 2 = 0 . 992 46 , 0 . 950 42 respectively. A mixture of toluene: methanol ( 9 : 1 ) was used as mobile phase for oleanolic acid were petroleum ether: chloroform: ethyl acetate: methanol ( 4 : 1 : 0 . 1 : 0 . 1 ) were used for ursolic acid. Results: T he results showed that the presence of oleanolic acid and ursolic acid in methanol extract. T he content found to be 218 . 30 ng and 509 . 99 ng/ 10 mg of extract. Conclusion: F or conclusion, above study scientifically validated as a useful traditional medicine with the identification of bioactive secondary metabolites.
2014(1):62-63.
DOI: 10.1016/S2221-6189(14)60014-7
Abstract:
Objective: T o reassess the usefulness of microscopic stool examination for the HIV infected patients with acute diarrhea. Methods: O verall 100 HIV - infected patients receiving standard antiretroviral therapy who visited to a primary care center ( for privacy reason, the name is hereby blinded ) with compliant of acute diarrhea were reviewed. I n all patients, the standard microscopic stool examination was performed. Results: O f interest, from overall 100 indexed cases, there is no case with determined parasite in stool samples. Conclusions: B ased on our setting, it seems that there is diagnostic role of using microscopic stool examination for determining possible parasitic infestation in HIV infected patients receiving standard antiretroviral therapy who present with acute diarrhea.
Objective: T o reassess the usefulness of microscopic stool examination for the HIV infected patients with acute diarrhea. Methods: O verall 100 HIV - infected patients receiving standard antiretroviral therapy who visited to a primary care center ( for privacy reason, the name is hereby blinded ) with compliant of acute diarrhea were reviewed. I n all patients, the standard microscopic stool examination was performed. Results: O f interest, from overall 100 indexed cases, there is no case with determined parasite in stool samples. Conclusions: B ased on our setting, it seems that there is diagnostic role of using microscopic stool examination for determining possible parasitic infestation in HIV infected patients receiving standard antiretroviral therapy who present with acute diarrhea.
2014(1):64-68.
DOI: 10.1016/S2221-6189(14)60015-9
Abstract:
Objective: T o evaluate the aldose reductase ( AR ) inhibitory activity of different fractions from Houttuynia cordata ( H. cordata ) which used as a medicinal salad for lowering of blood sugar level. Methods: AR inhibitory activity along with protein content was evaluated in vitro in rat lens. T otal phenol and flavonoid contents were also determined in all the fractions. Results: A ll the four fractions were found to inhibit lens AR activity, but to different extent. F rom dose response curve ( DRC ) , aqueous fraction ( AQ ) was found to be the most effective AR inhibitor followed by ethyl acetate ( EA ) , chloroform ( CL ) and hexane fraction ( HEX ) . T he IC 50 values of AQ , EA , CL and HEX were calculated to be ( 64 . 62 ± 3 . 90 ) , ( 90 . 69 ± 7 . 50 ) , ( 134 . 59 ± 4 . 90 ) and ( 151 . 58 ± 3 . 30 ) μ g/m L respectively. Q uercetin was taken as positive control which exhibited AR inhibition with an IC 50 value of ( 3 . 21 ± 0 . 60 ) μg/m L in a non-competitive manner. Conclusion: T hese findings indicated that, AQ fraction of H. cordata exhibited significant inhibitory effect on AR in a non-competitive manner, which may be attributed to the presence of high phenolic and flavonoid contents. T hus, the plant H. cordata may act as a promising source in the treatment of secondary complications like cataract associated with diabetes.
Objective: T o evaluate the aldose reductase ( AR ) inhibitory activity of different fractions from Houttuynia cordata ( H. cordata ) which used as a medicinal salad for lowering of blood sugar level. Methods: AR inhibitory activity along with protein content was evaluated in vitro in rat lens. T otal phenol and flavonoid contents were also determined in all the fractions. Results: A ll the four fractions were found to inhibit lens AR activity, but to different extent. F rom dose response curve ( DRC ) , aqueous fraction ( AQ ) was found to be the most effective AR inhibitor followed by ethyl acetate ( EA ) , chloroform ( CL ) and hexane fraction ( HEX ) . T he IC 50 values of AQ , EA , CL and HEX were calculated to be ( 64 . 62 ± 3 . 90 ) , ( 90 . 69 ± 7 . 50 ) , ( 134 . 59 ± 4 . 90 ) and ( 151 . 58 ± 3 . 30 ) μ g/m L respectively. Q uercetin was taken as positive control which exhibited AR inhibition with an IC 50 value of ( 3 . 21 ± 0 . 60 ) μg/m L in a non-competitive manner. Conclusion: T hese findings indicated that, AQ fraction of H. cordata exhibited significant inhibitory effect on AR in a non-competitive manner, which may be attributed to the presence of high phenolic and flavonoid contents. T hus, the plant H. cordata may act as a promising source in the treatment of secondary complications like cataract associated with diabetes.
2014(1):69-71.
DOI: 10.1016/S2221-6189(14)60016-0
Abstract:
Evaluation of arrhythmias, especially in the acute setting can be challenging. O ne of the most crucial steps is to accurately differentiate whether a tachyarrhythmia is of supraventricular ( with aberrant conduction ) or ventricular origin. A 12 -lead electrocardiogram may be useful in some cases where specific morphology or features can be sought.
Evaluation of arrhythmias, especially in the acute setting can be challenging. O ne of the most crucial steps is to accurately differentiate whether a tachyarrhythmia is of supraventricular ( with aberrant conduction ) or ventricular origin. A 12 -lead electrocardiogram may be useful in some cases where specific morphology or features can be sought.
2014(1):72-73.
DOI: 10.1016/S2221-6189(14)60017-2
Abstract:
A cute hepatitis is a common problem in medical practice. T his problem can be fatal if there is no proper management. F or management, the investigation for the cause is necessary. I n the case report, the authors present an interesting male case presenting with unexplained acute hepatitis. T he routine laboratory investigation cannot reveal the cause of hepatitis. T he additional toxicological drug test can reveal the unexplained increased level of phenytoin.
A cute hepatitis is a common problem in medical practice. T his problem can be fatal if there is no proper management. F or management, the investigation for the cause is necessary. I n the case report, the authors present an interesting male case presenting with unexplained acute hepatitis. T he routine laboratory investigation cannot reveal the cause of hepatitis. T he additional toxicological drug test can reveal the unexplained increased level of phenytoin.
Sevil Ar? Yuca
,
Cahide Y?lmaz
,
Avni Kaya
,
Lokman üstyol
,
Ertan Sal
,
Yasar Cesur
,
Hüseyin Caksen
2014(1):74-76.
DOI: 10.1016/S2221-6189(14)60018-4
Abstract:
T he central nervous system is one of the most crucial targeted systems of hyphotiroidism where tissues undergo various broad developmental processes such as neuronal and glial cellular differentiation, migration and myelinization. H owever brain images are mainly normal. I n this article we present findings related to a 1 -year-old girl who has been referred to our outpatient clinic with complaints of slowing of movement and lack of interest. S he was diagnosed with hypothyroidism. H er brain magnetic resonance image obtained during diagnosis displayed dysmyelinization. I t showed improvement after N a- L thyroxin therapy during follow up.
T he central nervous system is one of the most crucial targeted systems of hyphotiroidism where tissues undergo various broad developmental processes such as neuronal and glial cellular differentiation, migration and myelinization. H owever brain images are mainly normal. I n this article we present findings related to a 1 -year-old girl who has been referred to our outpatient clinic with complaints of slowing of movement and lack of interest. S he was diagnosed with hypothyroidism. H er brain magnetic resonance image obtained during diagnosis displayed dysmyelinization. I t showed improvement after N a- L thyroxin therapy during follow up.
18 Stromal opacity secondary to preservative in dilating drops - A case report and review of literature
2014(1):77-79.
DOI: 10.1016/S2221-6189(14)60019-6
Abstract:
T his patient is a 64 -year-old man who presented with painless progressive blurring of vision for one year. A fter a routine fundoscopy preceded by dilatation of both eyes with a drop of topical tropicamide, the left eye was noted to have stromal edema temporally. T his was attributed to the preservative ( BAC ) in the medication. T he stromal oedema persisted over the following weeks despite administration of a topical steroid, and was associated with deterioration in visual acuity to 6 / 30 ( PH 6 / 21 ) . T his case reminds us that clinicians should be vigilant during instillation of any preservative-containing drops, even in routine practices like dilatation. F ar from being restricted to chronic use of preservative-containing drugs, toxicity with BAC can occur even upon a single application. I deally, all eyedrops should be single-use topical drug formulations, but in the absence of this option, it is imperative that ophthalmic drug prescription be done with adequate clinical justification.
T his patient is a 64 -year-old man who presented with painless progressive blurring of vision for one year. A fter a routine fundoscopy preceded by dilatation of both eyes with a drop of topical tropicamide, the left eye was noted to have stromal edema temporally. T his was attributed to the preservative ( BAC ) in the medication. T he stromal oedema persisted over the following weeks despite administration of a topical steroid, and was associated with deterioration in visual acuity to 6 / 30 ( PH 6 / 21 ) . T his case reminds us that clinicians should be vigilant during instillation of any preservative-containing drops, even in routine practices like dilatation. F ar from being restricted to chronic use of preservative-containing drugs, toxicity with BAC can occur even upon a single application. I deally, all eyedrops should be single-use topical drug formulations, but in the absence of this option, it is imperative that ophthalmic drug prescription be done with adequate clinical justification.
2014(1):80-81.
DOI: 10.1016/S2221-6189(14)60020-2
Abstract:
H yperthyroidism is an important endocrine disorder that can be seen around the world. I n this disorder, the patient is usually hyperstimulate and palpitation. T he effect of thyroid hormone is the explanation. A similar effect can be seen due to adrenaline reaction. I n general, the use of adrenaline in the case with hyperthyroidism has to be carefully done. I n the present case study, the authors present a case of acute reaction to erroneous injection of adrenaline to the patients with hyperthyroidism.
H yperthyroidism is an important endocrine disorder that can be seen around the world. I n this disorder, the patient is usually hyperstimulate and palpitation. T he effect of thyroid hormone is the explanation. A similar effect can be seen due to adrenaline reaction. I n general, the use of adrenaline in the case with hyperthyroidism has to be carefully done. I n the present case study, the authors present a case of acute reaction to erroneous injection of adrenaline to the patients with hyperthyroidism.
2014(1):82-84.
DOI: 10.1016/S2221-6189(14)60021-4
Abstract:
W e report the case of a 46 -year-old J apanese man who was brought to the hospital with fever, hypotension and diffuse erythematous rash with multiple organ damage. T hree weeks before he had undergone orthopaedic surgery for left leg fracture and comorbid compartment syndrome. F asciorrhaphy was performed successfully 2 weeks before, but the next day he became feverish and hypotensive with signs of systemic low perfusion. H e was referred to the hospital for further evaluation and treatment. O n arrival, high fever, hypotension and diffuse erythroderma were observed. L ab results revealed multi-organ dysfunction. C linical manifestations led to the diagnosis of toxic shock syndrome ( TSS ) . T he patient was treated with extensive hydration, local drainage and antibiotics. A fter 2 weeks of intensive care, he recovered and was successfully discharged from the hospital. A culture of the wound tissue revealed the presence of MRSA with positive TSST – 1.
W e report the case of a 46 -year-old J apanese man who was brought to the hospital with fever, hypotension and diffuse erythematous rash with multiple organ damage. T hree weeks before he had undergone orthopaedic surgery for left leg fracture and comorbid compartment syndrome. F asciorrhaphy was performed successfully 2 weeks before, but the next day he became feverish and hypotensive with signs of systemic low perfusion. H e was referred to the hospital for further evaluation and treatment. O n arrival, high fever, hypotension and diffuse erythroderma were observed. L ab results revealed multi-organ dysfunction. C linical manifestations led to the diagnosis of toxic shock syndrome ( TSS ) . T he patient was treated with extensive hydration, local drainage and antibiotics. A fter 2 weeks of intensive care, he recovered and was successfully discharged from the hospital. A culture of the wound tissue revealed the presence of MRSA with positive TSST – 1.
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