Journal of Acute Disease
Issue 2,2016 Table of Contents
2016(2):91-95.
DOI: 10.1016/j.joad.2015.10.001
Abstract:
Floods, hurricanes, landslides, hurricanes, tornadoes, earthquakes are events that a large group of people on earth are affected. In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city. The purpose of this study was to investigate obstacles against effective crisis management with considering service received by individuals in the Bam earthquake. In this study, domestic journals, foreign dissertations in Persian bases such as Google scholar, Magiran, IranMedex, SID and in English bases such as PubMed, Web of Science, Google scholar were used. The results of this study showed that there were many problems in various aspects of planning including: lack of coherent programs, lack of attention to the needs of health care, poor coordination between agencies and organizations and lack of appropriate training of volunteers and people.
Floods, hurricanes, landslides, hurricanes, tornadoes, earthquakes are events that a large group of people on earth are affected. In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city. The purpose of this study was to investigate obstacles against effective crisis management with considering service received by individuals in the Bam earthquake. In this study, domestic journals, foreign dissertations in Persian bases such as Google scholar, Magiran, IranMedex, SID and in English bases such as PubMed, Web of Science, Google scholar were used. The results of this study showed that there were many problems in various aspects of planning including: lack of coherent programs, lack of attention to the needs of health care, poor coordination between agencies and organizations and lack of appropriate training of volunteers and people.
2016(2):96-101.
DOI: 10.1016/j.joad.2015.11.001
Abstract:
Acute mitral regurgitation (MR) is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.
Acute mitral regurgitation (MR) is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.
2016(2):109-113.
DOI: 10.1016/j.joad.2015.11.002
Abstract:
Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appendectomy has been regarded as the gold-standard, conservative management with antibiotics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.
Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appendectomy has been regarded as the gold-standard, conservative management with antibiotics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.
2016(2):114-116.
DOI: 10.1016/j.joad.2015.11.003
Abstract:
Necrotizing fasciitis is a rare bacterial skin condition which forms a major diagnostic challenge and is associated with poor prognosis unless promptly treated. Initial clinical presentation is often misleading with characteristic features developing only late in the course of the disease. In this review, we discuss the applicability and usefulness of laboratory risk indicator for necrotizing fasciitis score in facilitating rapid diagnosis of necrotizing fasciitis in emergency department by differentiating it from other skin infections like cellulitis and abscesses. A high index of suspicion resulting from the laboratory risk indicator for necrotizing fasciitis score can facilitate early diagnosis enabling prompt antibiotic administration and timely referral to surgery for wound debridement, ultimately reducing both the morbidity and mortality.
Necrotizing fasciitis is a rare bacterial skin condition which forms a major diagnostic challenge and is associated with poor prognosis unless promptly treated. Initial clinical presentation is often misleading with characteristic features developing only late in the course of the disease. In this review, we discuss the applicability and usefulness of laboratory risk indicator for necrotizing fasciitis score in facilitating rapid diagnosis of necrotizing fasciitis in emergency department by differentiating it from other skin infections like cellulitis and abscesses. A high index of suspicion resulting from the laboratory risk indicator for necrotizing fasciitis score can facilitate early diagnosis enabling prompt antibiotic administration and timely referral to surgery for wound debridement, ultimately reducing both the morbidity and mortality.
2016(2):117-122.
DOI: 10.1016/j.joad.2015.11.004
Abstract:
Objective: To study the treatment pathway of hemodynamic unstable patients with a pelvic ring fracture and analyze the causes of death in this group. Methods: Retrospectively, all data of hemodynamic unstable patients with a pelvic ring fracture in the period 1 January 2003 till 1 June 2010 were analyzed. For all patients the treatment protocol was assessed and compared with our protocol. Results: The data of 268 patients were analyzed. Among them, 89 cases presented as hemodynamic unstable. A total of 22/89 patients died (25%). Seven patients died because of an isolated circulatory problem, 1 of an isolated neurotrauma. Fourteen patients died because of a combination of vital injuries, in which 11 sustained extensive hemorrhage. Hemorrhage contributed to mortality in 18/22 patients (82%). In 12 of the 22 patients who died, the treatment protocol was not followed. This was significantly higher than in the group survivors (P < 0.01). Conclusions: Mortality in patients with a pelvic fracture is most often caused by hemorrhage or sequelae from hemorrhage. A standardized treatment protocol reduces mortality.
Objective: To study the treatment pathway of hemodynamic unstable patients with a pelvic ring fracture and analyze the causes of death in this group. Methods: Retrospectively, all data of hemodynamic unstable patients with a pelvic ring fracture in the period 1 January 2003 till 1 June 2010 were analyzed. For all patients the treatment protocol was assessed and compared with our protocol. Results: The data of 268 patients were analyzed. Among them, 89 cases presented as hemodynamic unstable. A total of 22/89 patients died (25%). Seven patients died because of an isolated circulatory problem, 1 of an isolated neurotrauma. Fourteen patients died because of a combination of vital injuries, in which 11 sustained extensive hemorrhage. Hemorrhage contributed to mortality in 18/22 patients (82%). In 12 of the 22 patients who died, the treatment protocol was not followed. This was significantly higher than in the group survivors (P < 0.01). Conclusions: Mortality in patients with a pelvic fracture is most often caused by hemorrhage or sequelae from hemorrhage. A standardized treatment protocol reduces mortality.
6 The effects of acute gasoline vapour inhalation on some haematological indices of albino Wistar rats
2016(2):123-125.
DOI: 10.1016/j.joad.2015.11.005
Abstract:
Objective: To find out if Gasoline vapour has some effects on haematological indices when inhaled by experimental rats. Methods: The standard method for laboratory operating procedure recommended by World Health Organization was used in all the analysis done. Forty two albino Wistar rats comprising twenty one males (160–220 g) and twenty one females (140–190 g) were sampled into six groups consisting of four test groups and two control groups. The test groups were exposed to gasoline vapour for twenty one days. Test group one were exposed to gasoline for 30 min while test group two were exposed to gasoline vapour for 1 h daily. At the end of twenty one days of exposure, blood samples were collected from the rats and their haematological parameters were estimated. Statistical analysis was done using windows SPSS version 16. Results: The results showed a significant decrease (P < 0.05) in the red blood count and white blood count of exposed rats and increases in packed-cell volume, haemoglobin, mean corpuscular volume, and mean corpuscular haemoglobin respectively. These increases were significant (P < 0.05) in test group two. There was no significant change in the mean corpuscular haemoglobin concentration of the rats in the test groups when compared to the control groups of both sexes. Conclusions: The results obtained suggest that inhalation exposure to gasoline may result in pancytopaenia and a significant fluctuation in the red blood cell-dependent haematological indices.
Objective: To find out if Gasoline vapour has some effects on haematological indices when inhaled by experimental rats. Methods: The standard method for laboratory operating procedure recommended by World Health Organization was used in all the analysis done. Forty two albino Wistar rats comprising twenty one males (160–220 g) and twenty one females (140–190 g) were sampled into six groups consisting of four test groups and two control groups. The test groups were exposed to gasoline vapour for twenty one days. Test group one were exposed to gasoline for 30 min while test group two were exposed to gasoline vapour for 1 h daily. At the end of twenty one days of exposure, blood samples were collected from the rats and their haematological parameters were estimated. Statistical analysis was done using windows SPSS version 16. Results: The results showed a significant decrease (P < 0.05) in the red blood count and white blood count of exposed rats and increases in packed-cell volume, haemoglobin, mean corpuscular volume, and mean corpuscular haemoglobin respectively. These increases were significant (P < 0.05) in test group two. There was no significant change in the mean corpuscular haemoglobin concentration of the rats in the test groups when compared to the control groups of both sexes. Conclusions: The results obtained suggest that inhalation exposure to gasoline may result in pancytopaenia and a significant fluctuation in the red blood cell-dependent haematological indices.
Saber Ghaffari-Fam
,
Seyed Reza Hosseini
,
Amin Daemi
,
Hassan Heydari
,
Rahim Malekzade
,
Erfan Ayubi
,
Hossein Ali Nikbakh
2016(2):126-130.
DOI: 10.1016/j.joad.2016.01.001
Abstract:
Objective: To describe the current situation of animal bites in the Babol County, North of Iran. Methods: This was a cross-sectional study based on recently collected data of 3 798 victims bitten (656 females and 3 142 males) from 2010 to 2014 in the Health Center of Babol, Iran. The interest variables in the study included demographic variables, characteristics of animal, some of the time patterns, and some clinical patterns provided to victims. Results: The average age of victims was (33.68 ± 17.23) years. The age group with the max proportion (for males, 32.1%; for females, 26.2%) of bites occurred in 18–30 years old group for males and 30–45 years for females. The ratio of male victims to female ones was 4.78. In terms of place of incident, 2 502 (65.9%) cases of animal bites occurred in rural areas. Dogs and cats were the most dominant biters with 3 340 (87.9%) and 395 (10.4%) bites, respectively. For the kinds of biters, 3 643 (95.9%) were pets, 133 (3.5%) were strays and 22 (0.6%) were wild animals. Most of the lesions were on shoulder as well as upper organs (46.9%) and lower organs (41.0%), respectively. Conclusions: Since the average age of the subjects with injuries on the head and upper organs was lower than that of victims with other organs injured and since that pet dogs were the major biter, structured monitoring programs that focus on specified target groups in collaboration with other organizations are essential to control the animal bites.
Objective: To describe the current situation of animal bites in the Babol County, North of Iran. Methods: This was a cross-sectional study based on recently collected data of 3 798 victims bitten (656 females and 3 142 males) from 2010 to 2014 in the Health Center of Babol, Iran. The interest variables in the study included demographic variables, characteristics of animal, some of the time patterns, and some clinical patterns provided to victims. Results: The average age of victims was (33.68 ± 17.23) years. The age group with the max proportion (for males, 32.1%; for females, 26.2%) of bites occurred in 18–30 years old group for males and 30–45 years for females. The ratio of male victims to female ones was 4.78. In terms of place of incident, 2 502 (65.9%) cases of animal bites occurred in rural areas. Dogs and cats were the most dominant biters with 3 340 (87.9%) and 395 (10.4%) bites, respectively. For the kinds of biters, 3 643 (95.9%) were pets, 133 (3.5%) were strays and 22 (0.6%) were wild animals. Most of the lesions were on shoulder as well as upper organs (46.9%) and lower organs (41.0%), respectively. Conclusions: Since the average age of the subjects with injuries on the head and upper organs was lower than that of victims with other organs injured and since that pet dogs were the major biter, structured monitoring programs that focus on specified target groups in collaboration with other organizations are essential to control the animal bites.
Alireza Salimi Chirani
,
Robabeh Majidzadeh
,
Hossein Dabiri
,
Javad Rezaei
,
Ali Esmaili
,
Yasamin Abdanan Kord
,
Narges Khabazzadeh Tehrani
,
Negin Attaran
2016(2):131-142.
DOI: 10.1016/j.joad.2015.11.006
Abstract:
Objective: Nowadays, Pseudomonas aeruginosa (P. aeruginosa), the highly regarded opportunistic pathogen, is the leading cause of morbidity and mortality worldwide. The P. aeruginosa type IV pili (T4P) as a multiple functional surface organelle in the development of acute P. aeruginosa infections have been well documented. Today, in silico analysis is a quick, and cost-effective tool for vaccine development. Methods: In present study, several turns' motifs along with the chimeric protein were predicted. Based on the hydropathy analysis, numerous antibody-accessible hydrophilic regions were characterized in the chimeric protein. A synthetic chimeric gene, encoding integrated PilQ and disulphide loop region of PilA, was designed. Modeling was done to predict the 3D structure of protein. The model was validated by using Ramachandran plot statistics and by ProSA server. Identification of B-cell and T-cell corresponding epitopes was done by using appropriate servers. Results: The closer 3D model to the native form of the chimeric protein was achieved. Validation results showed that 95.1% residues were in favor region and 3.6% of amino acid residues were in the allowed region. The B-cell epitope mappings showed that almost all the epitopes had irregular enriched structures. The major histocompatibility complex binding sequence prediction identified several human major histocompatibility complex class I and II restricted T-cell epitopes. The integrated PilQ and PilA disulphide loop encoding regions in the frame of pET28a(+) vector were expressed and purified efficiently. Conclusions: We expect that the two recognized antigenic determinants from our chimeric protein, “AYHKGNWSGYGKDGNIGIKDEDGMNCGPIAGSCTFPTTGTSKSPSPFVDLGAKDATSG” and “GPIAGSCTFPTTGTSKSPSP”, can be able to evoke strong both humoral and cell-mediated immune responses in mouse models.
Objective: Nowadays, Pseudomonas aeruginosa (P. aeruginosa), the highly regarded opportunistic pathogen, is the leading cause of morbidity and mortality worldwide. The P. aeruginosa type IV pili (T4P) as a multiple functional surface organelle in the development of acute P. aeruginosa infections have been well documented. Today, in silico analysis is a quick, and cost-effective tool for vaccine development. Methods: In present study, several turns' motifs along with the chimeric protein were predicted. Based on the hydropathy analysis, numerous antibody-accessible hydrophilic regions were characterized in the chimeric protein. A synthetic chimeric gene, encoding integrated PilQ and disulphide loop region of PilA, was designed. Modeling was done to predict the 3D structure of protein. The model was validated by using Ramachandran plot statistics and by ProSA server. Identification of B-cell and T-cell corresponding epitopes was done by using appropriate servers. Results: The closer 3D model to the native form of the chimeric protein was achieved. Validation results showed that 95.1% residues were in favor region and 3.6% of amino acid residues were in the allowed region. The B-cell epitope mappings showed that almost all the epitopes had irregular enriched structures. The major histocompatibility complex binding sequence prediction identified several human major histocompatibility complex class I and II restricted T-cell epitopes. The integrated PilQ and PilA disulphide loop encoding regions in the frame of pET28a(+) vector were expressed and purified efficiently. Conclusions: We expect that the two recognized antigenic determinants from our chimeric protein, “AYHKGNWSGYGKDGNIGIKDEDGMNCGPIAGSCTFPTTGTSKSPSPFVDLGAKDATSG” and “GPIAGSCTFPTTGTSKSPSP”, can be able to evoke strong both humoral and cell-mediated immune responses in mouse models.
9 Ventriculostomy related infection in intensive care unit: Diagnostic criteria and related conditions
Sergio Casta?o Avila
,
Esther Corral Lozano
,
Javier Maynar Moliner
,
Fernando Fonseca San Miguel
,
Elena Uson García
,
Yolanda Poveda Hernandez
,
Sara Caba?es Daro-Franc ′ es
,
Goiatz Balziskueta Fl ′ orez
,
Noemi Legaristi Martínez
,
Amaia Quintano Rodero
,
Ana Tejero Mojena
,
Alberto Manzano Ramírez
2016(2):143-149.
DOI: 10.1016/j.joad.2015.12.001
Abstract:
Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions. Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P < 0.05. Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1 000 days of drainage). This group was on overage older, had more severe systemic response syndrome and a significantly higher number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia, glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (interquartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and subarachnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with 55.7% area under curve (95% CI 0.43–0.70). Conclusions: CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia and the ratio of glycorrachia/glycemia.
Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions. Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P < 0.05. Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1 000 days of drainage). This group was on overage older, had more severe systemic response syndrome and a significantly higher number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia, glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (interquartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and subarachnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with 55.7% area under curve (95% CI 0.43–0.70). Conclusions: CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia and the ratio of glycorrachia/glycemia.
2016(2):150-153.
DOI: 10.1016/j.joad.2015.12.002
Abstract:
Objective: To establish the frequency of evolution in CT appearance from an initial scan to a subsequent scan within 12 h and the prognostic significance of such deterioration. Methods: All patients who presented to Department of Neurosurgery, Liaquat National Hospital and Medical College with traumatic brain injury and received their CT scan within the first 4 h of injury were included in the study. Indications for repeat CT scan were: any deterioration in neurological status after the initial scan, potentially deteriorating lesion on initial scan with or without worsening neurology, worsening neurological status after the initial CT scan findings, or no neurological improvement after initial management in patients with normal CT scan with significant head injury. This compiled with the data of 107 patients. Results: There were 67 males and 40 females. The cause of trauma of the 70% patients was road traffic accident. In 11 patients, the lesion evolved towards resorption while 32 patients had no significant changes in the subsequent CT scan. Sixty four patients showed an increase in the size of the lesion and 65.6% of them were required surgical intervention subsequently. Conclusions: In case where the initial CT scan performed within 4 h of significant head injury was not correlated with the patient's neurology, it should be repeated within 12 h.
Objective: To establish the frequency of evolution in CT appearance from an initial scan to a subsequent scan within 12 h and the prognostic significance of such deterioration. Methods: All patients who presented to Department of Neurosurgery, Liaquat National Hospital and Medical College with traumatic brain injury and received their CT scan within the first 4 h of injury were included in the study. Indications for repeat CT scan were: any deterioration in neurological status after the initial scan, potentially deteriorating lesion on initial scan with or without worsening neurology, worsening neurological status after the initial CT scan findings, or no neurological improvement after initial management in patients with normal CT scan with significant head injury. This compiled with the data of 107 patients. Results: There were 67 males and 40 females. The cause of trauma of the 70% patients was road traffic accident. In 11 patients, the lesion evolved towards resorption while 32 patients had no significant changes in the subsequent CT scan. Sixty four patients showed an increase in the size of the lesion and 65.6% of them were required surgical intervention subsequently. Conclusions: In case where the initial CT scan performed within 4 h of significant head injury was not correlated with the patient's neurology, it should be repeated within 12 h.
Francesco Nobile
,
Serafino Carta
,
Mattia Fortina
,
Pierpaolo Santoro
,
Luigi Meccariello
,
Paolo Ferrata
2016(2):154-159.
DOI: 10.1016/j.joad.2015.12.003
Abstract:
Objective: To investigate if a locking intramedullary nail could be useful in the treatment of fractures of the humeral head in 3 and 4-fragments operated within 48 h from the trauma. Methods: During the period of February 2011–May 2013, we performed 21 cases of humeral fractures treated with the Polarus intramedullary nail (Acumed). We considered parameters such as age, sex, time of radiological healing and functional outcome, which were assessed by Constant shoulder score, University of California at Los Angeles shoulder score, Oxford shoulder score and Dash score. The study was designed as a prospective cohort study. Results: Clinical and radiographic follow-up of patients was performed at 1, 2, 3, 6, 12, and 24 months after surgery. Evidence of radiographic bone healing occurred at an average of 2.42 months post-surgery (range: 1–6 months, median 2). There were no cases of avascular necrosis of the humeral head or failure of the synthesis. The functional outcome was excellent in 6 out of 21 cases (Constant score > 86%); good in 11 out of 21 cases (Constant score 71–85); satisfactory in 3 out of 21 cases (Constant score 56–70); only in one case we recorded poor outcome (Constant score = 55). Conclusions: The nail utilized is provided with locking and multiplanar proximal screws and could be applied through a mini-invasive anterolateral approach. This enables the reduction of the fracture fragments, while preserving vascularization of the scapulohumeral joint. Our results confirm that the indication of endomedullary nail could be extended to the treatment of complex proximal humeral fractures with 3 and 4 fragments (level of evidence IV, according to the Oxford Centre for Evidence Based Medicine Levels of Evidence Working Group).
Objective: To investigate if a locking intramedullary nail could be useful in the treatment of fractures of the humeral head in 3 and 4-fragments operated within 48 h from the trauma. Methods: During the period of February 2011–May 2013, we performed 21 cases of humeral fractures treated with the Polarus intramedullary nail (Acumed). We considered parameters such as age, sex, time of radiological healing and functional outcome, which were assessed by Constant shoulder score, University of California at Los Angeles shoulder score, Oxford shoulder score and Dash score. The study was designed as a prospective cohort study. Results: Clinical and radiographic follow-up of patients was performed at 1, 2, 3, 6, 12, and 24 months after surgery. Evidence of radiographic bone healing occurred at an average of 2.42 months post-surgery (range: 1–6 months, median 2). There were no cases of avascular necrosis of the humeral head or failure of the synthesis. The functional outcome was excellent in 6 out of 21 cases (Constant score > 86%); good in 11 out of 21 cases (Constant score 71–85); satisfactory in 3 out of 21 cases (Constant score 56–70); only in one case we recorded poor outcome (Constant score = 55). Conclusions: The nail utilized is provided with locking and multiplanar proximal screws and could be applied through a mini-invasive anterolateral approach. This enables the reduction of the fracture fragments, while preserving vascularization of the scapulohumeral joint. Our results confirm that the indication of endomedullary nail could be extended to the treatment of complex proximal humeral fractures with 3 and 4 fragments (level of evidence IV, according to the Oxford Centre for Evidence Based Medicine Levels of Evidence Working Group).
2016(2):160-161.
DOI: 10.1016/j.joad.2015.10.003
Abstract:
Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 mIU/mL; free tetraiodothyronine, 5.67 ng/dL; thyroid-stimulating hormone receptor antibody, 76.9% (normal range, < 14%); and antimicrosomal antibody titer, 1:102 400 (normal range, < 1:100), suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.
Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 mIU/mL; free tetraiodothyronine, 5.67 ng/dL; thyroid-stimulating hormone receptor antibody, 76.9% (normal range, < 14%); and antimicrosomal antibody titer, 1:102 400 (normal range, < 1:100), suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.
13 Use of sodium polystyrene sulfonate in an acute-on-chronic lithium poisoned patient: A case report
Chakroun-Walha Olfa
,
Ksibi Hichem
,
Rejeb Imen
,
Boujelben Mariem
,
Chaari Adel
,
Chtara Kamilia
,
Bouaziz Mounir
2016(2):162-164.
DOI: 10.1016/j.joad.2015.10.004
Abstract:
A 35-year-old woman with an acute-on-chronic lithium overdose received multiple oral doses of sodium polystyrene sulfonate totaling 120 g over a 24-h period. During the 72 h after the institution of therapy, the serum lithium level decreased from 3.80 to 0.42 mEq/L. Multiple doses of sodium polystyrene sulfonate may be useful in lowering the serum lithium level in severely ill patients with acute renal failure, and can substitute hemodialysis.
A 35-year-old woman with an acute-on-chronic lithium overdose received multiple oral doses of sodium polystyrene sulfonate totaling 120 g over a 24-h period. During the 72 h after the institution of therapy, the serum lithium level decreased from 3.80 to 0.42 mEq/L. Multiple doses of sodium polystyrene sulfonate may be useful in lowering the serum lithium level in severely ill patients with acute renal failure, and can substitute hemodialysis.
2016(2):165-167.
DOI: 10.1016/j.joad.2015.11.007
Abstract:
Carotid blowout syndrome (CBS) is a rare and fatal complication which arises from patients who have been treated for head and neck cancer. The incidence of CBS is rare and not commonly seen by emergency physicians. We review a case of a 68-year-old woman with a history of laryngectomy and chemo-radiation therapy presenting with massive oral bleeding and hypotension. Her course and treatments are highlighted, literature referring to CBS are described and we reintroduce the approach of managing such a patient in the emergency department.
Carotid blowout syndrome (CBS) is a rare and fatal complication which arises from patients who have been treated for head and neck cancer. The incidence of CBS is rare and not commonly seen by emergency physicians. We review a case of a 68-year-old woman with a history of laryngectomy and chemo-radiation therapy presenting with massive oral bleeding and hypotension. Her course and treatments are highlighted, literature referring to CBS are described and we reintroduce the approach of managing such a patient in the emergency department.
Dana-Oliviana Geavlete
,
Oana Ionita
,
Leonard Mandes
,
Iulia Kulcsar
,
Emanuel Stoica
,
Radu Ciudin
,
Cezar Macarie
,
Ovidiu Chioncel
2016(2):168-171.
DOI: 10.1016/j.joad.2015.11.008
Abstract:
Symptomatic long QT syndrome in pediatric patients is a life-threatening condition. Sometimes, this pathology can be misdiagnosed and erroneously managed as generalized epilepsy due to similar clinical manifestations. The presented case discusses a 13-year-old female patient with generalized epilepsy since the age of 4, admitted for two episodes of resuscitated cardiac arrest due to torsades de pointes and ventricular fibrillation. The final diagnosis of congenital long QT was established and due to the patient's high-risk profile for future cardiac events, implantable cardiac defibrillator was subsequently indicated. Early recognition of congenital long QT and timing of cardiac therapy were crucial and potentially lower the incidence of fatal dysrhythmias commonly associated this condition. In high-risk patients, both medical and interventional therapy can be life-saving.
Symptomatic long QT syndrome in pediatric patients is a life-threatening condition. Sometimes, this pathology can be misdiagnosed and erroneously managed as generalized epilepsy due to similar clinical manifestations. The presented case discusses a 13-year-old female patient with generalized epilepsy since the age of 4, admitted for two episodes of resuscitated cardiac arrest due to torsades de pointes and ventricular fibrillation. The final diagnosis of congenital long QT was established and due to the patient's high-risk profile for future cardiac events, implantable cardiac defibrillator was subsequently indicated. Early recognition of congenital long QT and timing of cardiac therapy were crucial and potentially lower the incidence of fatal dysrhythmias commonly associated this condition. In high-risk patients, both medical and interventional therapy can be life-saving.
2016(2):172-173.
DOI: 10.1016/j.joad.2015.11.009
Abstract:
Ectopic pregnancy is a significant problem in women of childbearing potential and affects up to 2% of them. The most common ectopic pregnancy localization is the ampullary area of the Fallopian tube. Patient with spontaneous ectopic pregnancy located in the tubal stump after an ipsilateral adnexectomy performed with a laparotomy due to mucinous cystadenoma was operated by laparoscopy. Remnant of Fallopian tube with ectopic pregnancy was removed. The most important lecture from this case is when adnexectomy or salpingectomy is performed, it should be done in the isthmic part, without leaving any remnant.
Ectopic pregnancy is a significant problem in women of childbearing potential and affects up to 2% of them. The most common ectopic pregnancy localization is the ampullary area of the Fallopian tube. Patient with spontaneous ectopic pregnancy located in the tubal stump after an ipsilateral adnexectomy performed with a laparotomy due to mucinous cystadenoma was operated by laparoscopy. Remnant of Fallopian tube with ectopic pregnancy was removed. The most important lecture from this case is when adnexectomy or salpingectomy is performed, it should be done in the isthmic part, without leaving any remnant.
2016(2):174-176.
DOI: 10.1016/j.joad.2015.10.005
Abstract:
Periorbital necrotizing fasciitis is a rare but potentially fatal infection. It is most commonly caused by Gram-positive group A b-haemolytic Streptococci and rarely by fungal infections. In this report, we present a rare case of periorbital necrotizing fasciitis caused by Aspergillus species in an immunocompromised patient. He presented to us with a history of a slowly progressive eyelid necrosis leading to a loss of vision in one eye. The patient was started on an antibiotic and subsequently, surgical debridement and enucleation were performed. A few days post-operatively, yellow white mould colonies were noted to grow on the wound surface. Microbiology cultures identified them as Aspergillus species and intravenous amphotericin B 10 mg was added daily. However, despite the extensive medical and surgical treatments, he failed to respond and succumbed from septicaemia and multi-organ failure.
Periorbital necrotizing fasciitis is a rare but potentially fatal infection. It is most commonly caused by Gram-positive group A b-haemolytic Streptococci and rarely by fungal infections. In this report, we present a rare case of periorbital necrotizing fasciitis caused by Aspergillus species in an immunocompromised patient. He presented to us with a history of a slowly progressive eyelid necrosis leading to a loss of vision in one eye. The patient was started on an antibiotic and subsequently, surgical debridement and enucleation were performed. A few days post-operatively, yellow white mould colonies were noted to grow on the wound surface. Microbiology cultures identified them as Aspergillus species and intravenous amphotericin B 10 mg was added daily. However, despite the extensive medical and surgical treatments, he failed to respond and succumbed from septicaemia and multi-organ failure.
2016(2):177-177.
DOI: 10.1016/j.joad.2015.12.004
Abstract:
19 Acute drug allergy after getting medical treatment from a primary care unit: Comment and discussion
2016(2):178-178.
DOI: 10.1016/j.joad.2016.01.002
Abstract:
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