Journal of Acute Disease
Issue 4,2016 Table of Contents
2016(4):267-270.
DOI: 10.1016/j.joad.2016.06.001
Abstract:
This narrative review aims to appraise the sensitivity and specificity of novel biomarkers in identifying acute kidney injury (AKI) in children. Serum creatinine represents a poor traditional biomarker for AKI due to some limitations. Although alternative reliable biomarkers that would better identify individuals at high risk for developing AKI, identify AKI early enough, monitor its progression and patients' recovery, as well as identify those patients at higher risk for poor outcomes are not yet available in renal care, the search-light has recently been focused on various novel biomarkers, some of which could provide this information in time ahead. Several studies have established their predictive value. However, none of them could solely fulfill all the criteria of the ideal biomarker. Therefore, to increase their sensitivity and specificity and enhance the diagnosis of AKI, constellations of different biomarkers with specific features are probably required. In future, the diagnostic evaluation of AKI in intensive care units will have to undergo a paradigm shift from serum creatinine as the traditional biomarker to tissue-specific injury biomarkers. A panel of these novel biomarkers employed at the bedside setting will ultimately revolutionize the diagnosis and prognostication of AKI in children.
This narrative review aims to appraise the sensitivity and specificity of novel biomarkers in identifying acute kidney injury (AKI) in children. Serum creatinine represents a poor traditional biomarker for AKI due to some limitations. Although alternative reliable biomarkers that would better identify individuals at high risk for developing AKI, identify AKI early enough, monitor its progression and patients' recovery, as well as identify those patients at higher risk for poor outcomes are not yet available in renal care, the search-light has recently been focused on various novel biomarkers, some of which could provide this information in time ahead. Several studies have established their predictive value. However, none of them could solely fulfill all the criteria of the ideal biomarker. Therefore, to increase their sensitivity and specificity and enhance the diagnosis of AKI, constellations of different biomarkers with specific features are probably required. In future, the diagnostic evaluation of AKI in intensive care units will have to undergo a paradigm shift from serum creatinine as the traditional biomarker to tissue-specific injury biomarkers. A panel of these novel biomarkers employed at the bedside setting will ultimately revolutionize the diagnosis and prognostication of AKI in children.
2016(4):271-280.
DOI: 10.1016/j.joad.2016.06.004
Abstract:
Analyzing the properties of the reconciliation vessel, new questions arised about the origin of this wondrous circuit, as well as its configuration through the philosophical and cosmological basis of traditional Chinese medicine. Scrutinizing its location within Fu Hsi's octogram and according to the Yellow Emperor's coincidences in Ling Shu and Su Wen quotations, a plausible explanation raised up from a detailed methodological work embodied in this paper. Author's experience in cardiopulmonary revivals over many years takes to ponder his prospect of this situation from various angles, arising the comparison between legal, real and energy deaths against the possibility of more widespread recovery after terminal diagnosis.
Analyzing the properties of the reconciliation vessel, new questions arised about the origin of this wondrous circuit, as well as its configuration through the philosophical and cosmological basis of traditional Chinese medicine. Scrutinizing its location within Fu Hsi's octogram and according to the Yellow Emperor's coincidences in Ling Shu and Su Wen quotations, a plausible explanation raised up from a detailed methodological work embodied in this paper. Author's experience in cardiopulmonary revivals over many years takes to ponder his prospect of this situation from various angles, arising the comparison between legal, real and energy deaths against the possibility of more widespread recovery after terminal diagnosis.
2016(4):281-285.
DOI: 10.1016/j.joad.2016.04.002
Abstract:
Objective: To observe the correlation between the condition of patients with acute cerebral infarction and serum b2-microglobulin (b2-MG) levels. Methods: Patients with acute cerebral infarction and healthy physical examinees selected for the prospective study were included into the cerebral infarction group and control group, respectively. Clinical data were collected and the patients' condition were evaluated, and then the contents of the b2-MG, high sensitivity C reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-a (TNF-a), intercellular cell adhesion molecule-1 (ICAM-1) and soluble CD40 Ligand (sCD40L) in serum were tested. Results: The contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1, sCD40L in patients with acute cerebral infarction were obviously higher than those in cases of the control group. The severer the condition of the disease was, the higher contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L became. The greater the volume of cerebral infarction was, the higher the contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L were. The content of serum b2-MG was positively associated with the contents of hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L. Conclusions: The level of serum b2-MG was abnormally elevated in the patients with acute cerebral infarction. The level of serum b2-MG can evaluate the severity of disease, infarction size and the degree of inflammation reaction in patients with acute cerebral infarction.
Objective: To observe the correlation between the condition of patients with acute cerebral infarction and serum b2-microglobulin (b2-MG) levels. Methods: Patients with acute cerebral infarction and healthy physical examinees selected for the prospective study were included into the cerebral infarction group and control group, respectively. Clinical data were collected and the patients' condition were evaluated, and then the contents of the b2-MG, high sensitivity C reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-a (TNF-a), intercellular cell adhesion molecule-1 (ICAM-1) and soluble CD40 Ligand (sCD40L) in serum were tested. Results: The contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1, sCD40L in patients with acute cerebral infarction were obviously higher than those in cases of the control group. The severer the condition of the disease was, the higher contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L became. The greater the volume of cerebral infarction was, the higher the contents of serum b2-MG, hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L were. The content of serum b2-MG was positively associated with the contents of hsCRP, IL-6, IL-8, TNF-a, ICAM-1 and sCD40L. Conclusions: The level of serum b2-MG was abnormally elevated in the patients with acute cerebral infarction. The level of serum b2-MG can evaluate the severity of disease, infarction size and the degree of inflammation reaction in patients with acute cerebral infarction.
Aaron Asibi Abuosi
,
Delali Margaret Badasu
,
Alfred Edwin Yawson
,
Francis Anderson Adzei
,
Deborah Atobrah
,
John Kwasi Anarfi
2016(4):286-295.
DOI: 10.1016/j.joad.2016.05.005
Abstract:
Objective: To investigate children with acute non-communicable diseases (NCDs) and their caregivers in developing countries. Methods: A cross-sectional survey was conducted in three out of the ten regions of Ghana. A total of 1540 caregivers/parents of children with NCDs were interviewed. Data was analysed with the aid of IBM SPSS version 20. Statistical techniques used in the analysis included frequencies, means, SD and factor analysis. Findings were analysed according to the major themes of the study. Results: Caregivers indicated that the incidence of NCDs among children is on the in- crease. They also believed that enemies can cause diseases in children. Caregivers tend to seek treatment in hospitals/clinics rather than from traditional or herbal medicine. However, they complement biomedical treatment with prayers for healing/deliverance. It was also found that NCDs have a negative effect on the physical and mental development of children as well as their school performance; and caring for children with NCDs also poses material, emotional and financial burden to caregivers. Conclusions: Serious attention needs to be given to the development and implementa- tion of policies to better the lot of children with NCDs. Conscious efforts need to be made to encourage and assist the caregivers with necessary resources to cater for their children's educational and health needs in particular.
Objective: To investigate children with acute non-communicable diseases (NCDs) and their caregivers in developing countries. Methods: A cross-sectional survey was conducted in three out of the ten regions of Ghana. A total of 1540 caregivers/parents of children with NCDs were interviewed. Data was analysed with the aid of IBM SPSS version 20. Statistical techniques used in the analysis included frequencies, means, SD and factor analysis. Findings were analysed according to the major themes of the study. Results: Caregivers indicated that the incidence of NCDs among children is on the in- crease. They also believed that enemies can cause diseases in children. Caregivers tend to seek treatment in hospitals/clinics rather than from traditional or herbal medicine. However, they complement biomedical treatment with prayers for healing/deliverance. It was also found that NCDs have a negative effect on the physical and mental development of children as well as their school performance; and caring for children with NCDs also poses material, emotional and financial burden to caregivers. Conclusions: Serious attention needs to be given to the development and implementa- tion of policies to better the lot of children with NCDs. Conscious efforts need to be made to encourage and assist the caregivers with necessary resources to cater for their children's educational and health needs in particular.
Bashir Lawal
,
Oluwatosin Kudirat Shittu
,
Florence Inje Oibiokpa
,
Hadiza Mohammed
,
Sheriff Itopa Umar
,
Garba Muhammed Haruna
2016(4):296-301.
DOI: 10.1016/j.joad.2016.05.002
Abstract:
Objective: To evaluate the antimicrobial and toxicological effects of aqueous garlic (Allium sativum) bulbs extract in wister rat using biochemical and hematological parameters. Methods: A total of 20 wister rats were assigned into four (A–D) groups of five animals each. Group A served as the control and was administered 1 mL of distilled water. Groups B–C were given 300, 600 and 1200 mg/kg body weight of garlic (Allium sativum) bulbs extract for 5 weeks. Results: Garlic bulbs extract produced significant inhibitory activities against all bacteria tested at concentrations of 120 and 160 mg/mL. However, at concentration of 80 mg/mL, the extract had no inhibitory activities against Klebsiella pneumoniae and Salmonella typhi. The minimal inhibitory concentration and minimal bactericidal concentration ranged between 80–120 mg/mL and 120–160 mg/mL respectively. Toxicological study revealed that the extract did not cause any significant (P > 0.05) alteration to serum aspartate transaminase, alkaline phosphatase activities, total bilirubins, Na, K, creatinine, red blood cell, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration, granulocyte and organs-body weight ratio. However, serum alanine transaminase activ- ities, total proteins, direct bilirubins, Cl − concentrations and body weight gain were significantly (P < 0.05) lowered while the concentrations of urea, albumin, white blood cell, mean corpuscular hemoglobin and mean corpuscular volume count were raised significantly (P < 0.05) in rats dosed with 600 and 1200 mg/kg of the extract. However, at a dose of 300 mg/kg only, the concentrations of Cl − , urea and albumin were mildly altered. Conclusions: The extract caused selective changes in some biochemical parameters of organ function; however, since only mild alteration was observed at a dose of 300 mg/kg, the garlic bulb may be considered to be relatively safe and could be explored as an oral remedy at this dose.
Objective: To evaluate the antimicrobial and toxicological effects of aqueous garlic (Allium sativum) bulbs extract in wister rat using biochemical and hematological parameters. Methods: A total of 20 wister rats were assigned into four (A–D) groups of five animals each. Group A served as the control and was administered 1 mL of distilled water. Groups B–C were given 300, 600 and 1200 mg/kg body weight of garlic (Allium sativum) bulbs extract for 5 weeks. Results: Garlic bulbs extract produced significant inhibitory activities against all bacteria tested at concentrations of 120 and 160 mg/mL. However, at concentration of 80 mg/mL, the extract had no inhibitory activities against Klebsiella pneumoniae and Salmonella typhi. The minimal inhibitory concentration and minimal bactericidal concentration ranged between 80–120 mg/mL and 120–160 mg/mL respectively. Toxicological study revealed that the extract did not cause any significant (P > 0.05) alteration to serum aspartate transaminase, alkaline phosphatase activities, total bilirubins, Na, K, creatinine, red blood cell, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration, granulocyte and organs-body weight ratio. However, serum alanine transaminase activ- ities, total proteins, direct bilirubins, Cl − concentrations and body weight gain were significantly (P < 0.05) lowered while the concentrations of urea, albumin, white blood cell, mean corpuscular hemoglobin and mean corpuscular volume count were raised significantly (P < 0.05) in rats dosed with 600 and 1200 mg/kg of the extract. However, at a dose of 300 mg/kg only, the concentrations of Cl − , urea and albumin were mildly altered. Conclusions: The extract caused selective changes in some biochemical parameters of organ function; however, since only mild alteration was observed at a dose of 300 mg/kg, the garlic bulb may be considered to be relatively safe and could be explored as an oral remedy at this dose.
2016(4):302-306.
DOI: 10.1016/j.joad.2016.06.002
Abstract:
Objective: To study the clinical effect of continuous blood purification on acute renal failure. Methods: A total of 46 patients with acute renal failure treated with continuous renal replacement therapy in our hospital from April 2011 to December 2015 were retro- spectively analyzed. Patients choosing continuous veno-venous hemofiltration (CVVH) mode were collected into CVVH group and patients choosing continuous venovenous hemodiafiltration (CVVHDF) mode were collected into CVVHDF group, and their general condition, hospitalization conditions and blood biochemical indexes were analyzed. Results: Before and after treatment, the voided volumes and APACHE II scores of patients in CVVHDF group and CVVH group showed no differences. After treatment, the voided volumes of patients in the two groups were all higher than those before treatment and their APACHE II scores were all lower than those before treatment. The duration of continuous renal replacement therapy and the hospital stays in ICU of patients in CVVHDF group were all shorter than those in CVVH group. In CVVHDF group, the ratios of mechanical ventilation and death and the total hospitalization time had no sig- nificant differences with those in CVVH group. After treatment, the contents of blood urea nitrogen, serum creatinine, uric acid, β 2 microglobulin, glutamic-pyruvic trans- aminase, aspartate transaminase, lactic dehydrogenase and creatine kinase isoenzyme of patients in CVVHDF group were all lower than those in CVVH group. Conclusions: Continuous blood purification therapy possesses exact curative effect on acute renal failure. The cleanup effect of CVVHDF mode on solutes and its protective effect on heart and liver were all superior to those of CVVH mode.
Objective: To study the clinical effect of continuous blood purification on acute renal failure. Methods: A total of 46 patients with acute renal failure treated with continuous renal replacement therapy in our hospital from April 2011 to December 2015 were retro- spectively analyzed. Patients choosing continuous veno-venous hemofiltration (CVVH) mode were collected into CVVH group and patients choosing continuous venovenous hemodiafiltration (CVVHDF) mode were collected into CVVHDF group, and their general condition, hospitalization conditions and blood biochemical indexes were analyzed. Results: Before and after treatment, the voided volumes and APACHE II scores of patients in CVVHDF group and CVVH group showed no differences. After treatment, the voided volumes of patients in the two groups were all higher than those before treatment and their APACHE II scores were all lower than those before treatment. The duration of continuous renal replacement therapy and the hospital stays in ICU of patients in CVVHDF group were all shorter than those in CVVH group. In CVVHDF group, the ratios of mechanical ventilation and death and the total hospitalization time had no sig- nificant differences with those in CVVH group. After treatment, the contents of blood urea nitrogen, serum creatinine, uric acid, β 2 microglobulin, glutamic-pyruvic trans- aminase, aspartate transaminase, lactic dehydrogenase and creatine kinase isoenzyme of patients in CVVHDF group were all lower than those in CVVH group. Conclusions: Continuous blood purification therapy possesses exact curative effect on acute renal failure. The cleanup effect of CVVHDF mode on solutes and its protective effect on heart and liver were all superior to those of CVVH mode.
2016(4):307-310.
DOI: 10.1016/j.joad.2016.06.003
Abstract:
Objective: To analyze the characteristic of coagulation function in non-small cell lung cancer patients with acute cerebral infarction as the initial symptom. Methods: Cases diagnosed as non-small cell lung cancer in our hospital from January 2015 to January 2016 were used for study. Fifteen cases with acute cerebral infarction as the initial symptom were included in experimental group. Thirty-three cases with no initial symptom on acute cerebral infarction were included in control group. Clinical data in patients of two groups were collected, including general information, coagulation function index, thrombelastogram index. Results: The prothrombin time (PT) [(9.69 ± 1.42) vs. (13.04 ± 1.96) s], activated partial thromboplastin time (APTT) [(30.14 ± 5.79) vs. (39.34 ± 7.63) s], international normalized ratio (INR) [(0.76 ± 0.10) vs. (1.35 ± 0.22)], coagulation reaction time (R) [(4.76 ± 0.79) vs. (6.11 ± 0.93) min], and blood clot formation time (K) [(1.73 ± 0.21) vs. (6.11 ± 0.93) min] in patients of experimental group were obviously lower than that of in control group. Fibrinogen (FIB) [(5.43 ± 0.89) vs. (2.14 ± 0.36) g/L], D-dimer [(0.84 ± 0.17) vs. 0.30 ± 0.06) mg/L], the maximum amplitude of thrombus (MA) [(65.62 ± 10.34) vs. (48.69 ± 8.61) mm], and a -angle [(68.12 ± 9.51) vs. (60.37 ± 10.29) deg] in patients of experimental group were obviously higher than that in control group. PT, APTT, INR, R value, and K value in patients of tumor node metastasis (TNM) Stage III–IV were significantly lower than that in TNM Stage I–II, and FIB, D-dimer, MA, a - angle were all higher than that in patients of TNM Stage I–II. PT, APTT, INR, R value, K value in patients with lymphatic metastasis were significantly lower than that in patients with no lymph node metastasis, and FIB, D-dimer, MA, a -angle were obviously higher than that in patients with no lymph node metastasis. Conclusions: Patients with non-small cell lung cancer have hypercoagulability and hyperfibrinolysis with acute cerebral infarction as the initial symptom, and coagulation function involved in the development of lung disease.
Objective: To analyze the characteristic of coagulation function in non-small cell lung cancer patients with acute cerebral infarction as the initial symptom. Methods: Cases diagnosed as non-small cell lung cancer in our hospital from January 2015 to January 2016 were used for study. Fifteen cases with acute cerebral infarction as the initial symptom were included in experimental group. Thirty-three cases with no initial symptom on acute cerebral infarction were included in control group. Clinical data in patients of two groups were collected, including general information, coagulation function index, thrombelastogram index. Results: The prothrombin time (PT) [(9.69 ± 1.42) vs. (13.04 ± 1.96) s], activated partial thromboplastin time (APTT) [(30.14 ± 5.79) vs. (39.34 ± 7.63) s], international normalized ratio (INR) [(0.76 ± 0.10) vs. (1.35 ± 0.22)], coagulation reaction time (R) [(4.76 ± 0.79) vs. (6.11 ± 0.93) min], and blood clot formation time (K) [(1.73 ± 0.21) vs. (6.11 ± 0.93) min] in patients of experimental group were obviously lower than that of in control group. Fibrinogen (FIB) [(5.43 ± 0.89) vs. (2.14 ± 0.36) g/L], D-dimer [(0.84 ± 0.17) vs. 0.30 ± 0.06) mg/L], the maximum amplitude of thrombus (MA) [(65.62 ± 10.34) vs. (48.69 ± 8.61) mm], and a -angle [(68.12 ± 9.51) vs. (60.37 ± 10.29) deg] in patients of experimental group were obviously higher than that in control group. PT, APTT, INR, R value, and K value in patients of tumor node metastasis (TNM) Stage III–IV were significantly lower than that in TNM Stage I–II, and FIB, D-dimer, MA, a - angle were all higher than that in patients of TNM Stage I–II. PT, APTT, INR, R value, K value in patients with lymphatic metastasis were significantly lower than that in patients with no lymph node metastasis, and FIB, D-dimer, MA, a -angle were obviously higher than that in patients with no lymph node metastasis. Conclusions: Patients with non-small cell lung cancer have hypercoagulability and hyperfibrinolysis with acute cerebral infarction as the initial symptom, and coagulation function involved in the development of lung disease.
2016(4):311-314.
DOI: 10.1016/j.joad.2016.04.003
Abstract:
Objective: To study the changes of the rest energy expenditure, intracranial pressure, brain function parameters and serum indexes of acute craniocerebral injury after treated with mild hypothermia auxiliary therapy. Methods: Clinical data of 58 patients received emergency treatment for craniocerebral injury in our hospital from October 2009 to December 2014 were analyzed retrospec- tively. Among them, 27 cases treated with mild hypothermia therapy were included in the experiment group, while 31 cases without the therapy were considered as the control group. Their rest energy expenditure, intracranial pressure, brain function parameters and serum TNF- a , nitric oxide and myelin basic protein contents were determined. Results: The intracranial pressure [(20.3 ± 2.9) vs. (25.8 ± 3.3) mmHg], [(17.8 ± 2.7) vs. (23.1 ± 3.6) mmHg], [(14.2 ± 2.4) vs. (20.6 ± 3.1) mmHg], [(11.3 ± 1.8) vs. (16.3 ± 2.6) mmHg] and rest energy expenditure [(6861 ± 994) vs. (14074 ± 2016) kJ/d], [(5946 ± 768) vs. (15525 ± 1936) kJ/d], [(5512 ± 873) vs. (5512 ± 873) kJ/d], [(6248 ± 906) vs. (14413 ± 2166) kJ/d] in patients of experiment group on the 1st, 2nd, 3rd and 4th days after treatment were all significantly lower than those of patients in the control group. After treated for 24 h, P bt O 2 [(23.59 ± 4.97) vs. (15.68 ± 3.14) mmHg] and S jv O 2 [(61.39 ± 9.79) vs. (46.76 ± 7.28) %] of the experiment group were distinctly higher than those of the control group, while its contents of TNF- a [(1.96 ± 0.29) vs. (3.39 ± 0.72) m g/L] and nitric oxide [(10.39 ± 2.16) vs. (24.42 ± 3.51) mg/L] and myelin basic protein [(2.19 ± 0.52) vs. (4.34 ± 0.78) m g/L] were all lower than those of the control group. Conclusions: After treated with mild hypothermia auxiliary therapy, the metabolic rate and intracranial pressure of patients with craniocerebral injury decreased obviously, their cerebral blood flow perfusion were improved evidently and the release of adverse metabolic products were also reduced conspicuously, which was beneficial to the re- covery of neurological functions.
Objective: To study the changes of the rest energy expenditure, intracranial pressure, brain function parameters and serum indexes of acute craniocerebral injury after treated with mild hypothermia auxiliary therapy. Methods: Clinical data of 58 patients received emergency treatment for craniocerebral injury in our hospital from October 2009 to December 2014 were analyzed retrospec- tively. Among them, 27 cases treated with mild hypothermia therapy were included in the experiment group, while 31 cases without the therapy were considered as the control group. Their rest energy expenditure, intracranial pressure, brain function parameters and serum TNF- a , nitric oxide and myelin basic protein contents were determined. Results: The intracranial pressure [(20.3 ± 2.9) vs. (25.8 ± 3.3) mmHg], [(17.8 ± 2.7) vs. (23.1 ± 3.6) mmHg], [(14.2 ± 2.4) vs. (20.6 ± 3.1) mmHg], [(11.3 ± 1.8) vs. (16.3 ± 2.6) mmHg] and rest energy expenditure [(6861 ± 994) vs. (14074 ± 2016) kJ/d], [(5946 ± 768) vs. (15525 ± 1936) kJ/d], [(5512 ± 873) vs. (5512 ± 873) kJ/d], [(6248 ± 906) vs. (14413 ± 2166) kJ/d] in patients of experiment group on the 1st, 2nd, 3rd and 4th days after treatment were all significantly lower than those of patients in the control group. After treated for 24 h, P bt O 2 [(23.59 ± 4.97) vs. (15.68 ± 3.14) mmHg] and S jv O 2 [(61.39 ± 9.79) vs. (46.76 ± 7.28) %] of the experiment group were distinctly higher than those of the control group, while its contents of TNF- a [(1.96 ± 0.29) vs. (3.39 ± 0.72) m g/L] and nitric oxide [(10.39 ± 2.16) vs. (24.42 ± 3.51) mg/L] and myelin basic protein [(2.19 ± 0.52) vs. (4.34 ± 0.78) m g/L] were all lower than those of the control group. Conclusions: After treated with mild hypothermia auxiliary therapy, the metabolic rate and intracranial pressure of patients with craniocerebral injury decreased obviously, their cerebral blood flow perfusion were improved evidently and the release of adverse metabolic products were also reduced conspicuously, which was beneficial to the re- covery of neurological functions.
Harini Chowdary Vadlamudi
,
Prasanna Raju Yalavarthi
,
Basaveswara Rao Mandava Venkata
,
Jyotsna Thanniru
,
Vandana K.R.
,
Sundaresan C.R.
2016(4):315-325.
DOI: 10.1016/j.joad.2016.05.004
Abstract:
Objective: To design solid self-microemulsifying drug delivery system (S-SMEDDS) of entacapone and evaluate for its anti-Parkinson's potentials. Methods: Solubility studies were performed in various vehicles i.e., oils, surfactants and co-surfactants and pseudo-ternary phase diagrams were plotted to understand the microemulsion formation region. Liquid self-microemulsifying drug delivery systems (SMEDDS) were developed using gingelly and rice bran oil as lipid vehicles, Tween 80 and Span 20 as surfactants and glycerin, propylene glycol as co-surfactants. They were characterized by Fourier transform infrared spectroscopy, pH, viscosity, zeta potential, polydispersibility index and droplet size analysis and evaluated for drug content, in-vitro release, in-vitro diffusion and ex-vivo permeation. Optimized liquid SMEDDS were converted into S-SMEDDS by adsorption and melt granulation procedures. Character- ization by differential scanning calorimetry, SEM, micrometrics, reconstitution property, moisture content and evaluation by drug content, drug release kinetics and shelf-life were performed for S-SMEDDS. Parkinsonism was induced and pharmacodynamic potentials of S-SMEDDS were evaluated. Results: S-SMEDDS formulation AG8 had shown the highest drug release of 90.92% within 60 min. Pharmacodynamic studies also proved the efficiency of entacapone S- SMEDDS against Parkinsonism. Conclusions: Entacapone S-SMEDDS is an effective drug delivery system that offers more predictable and extensive drug release with enhanced shelf-life in the treatment of acute Parkinsonism.
Objective: To design solid self-microemulsifying drug delivery system (S-SMEDDS) of entacapone and evaluate for its anti-Parkinson's potentials. Methods: Solubility studies were performed in various vehicles i.e., oils, surfactants and co-surfactants and pseudo-ternary phase diagrams were plotted to understand the microemulsion formation region. Liquid self-microemulsifying drug delivery systems (SMEDDS) were developed using gingelly and rice bran oil as lipid vehicles, Tween 80 and Span 20 as surfactants and glycerin, propylene glycol as co-surfactants. They were characterized by Fourier transform infrared spectroscopy, pH, viscosity, zeta potential, polydispersibility index and droplet size analysis and evaluated for drug content, in-vitro release, in-vitro diffusion and ex-vivo permeation. Optimized liquid SMEDDS were converted into S-SMEDDS by adsorption and melt granulation procedures. Character- ization by differential scanning calorimetry, SEM, micrometrics, reconstitution property, moisture content and evaluation by drug content, drug release kinetics and shelf-life were performed for S-SMEDDS. Parkinsonism was induced and pharmacodynamic potentials of S-SMEDDS were evaluated. Results: S-SMEDDS formulation AG8 had shown the highest drug release of 90.92% within 60 min. Pharmacodynamic studies also proved the efficiency of entacapone S- SMEDDS against Parkinsonism. Conclusions: Entacapone S-SMEDDS is an effective drug delivery system that offers more predictable and extensive drug release with enhanced shelf-life in the treatment of acute Parkinsonism.
2016(4):326-327.
DOI: 10.1016/j.joad.2016.01.003
Abstract:
Objective: To ask for history of toxoid immunization in patients with acute injury induced wound and discussed for the reliability.
Methods: A total of 180 patients got wound from acute injury and got a management in a health unit were asked with a question whether he/she had history of previous toxoid immunization.
Results: Based on this observational study, it can be seen that there are many problems in “answer” of the patients.
Conclusions: Since toxoid is a safe and save preventive vaccination, it should be regularly given as mass vaccination for any patients who got wound from acute injury and get a management in any health units.
Objective: To ask for history of toxoid immunization in patients with acute injury induced wound and discussed for the reliability.
Methods: A total of 180 patients got wound from acute injury and got a management in a health unit were asked with a question whether he/she had history of previous toxoid immunization.
Results: Based on this observational study, it can be seen that there are many problems in “answer” of the patients.
Conclusions: Since toxoid is a safe and save preventive vaccination, it should be regularly given as mass vaccination for any patients who got wound from acute injury and get a management in any health units.
Kun Wang
,
Wen-Tao Wang
,
Jun Wang
,
Zhi Chen
,
Qing-Xin Song
,
Shi-Yue Chen
,
Qiang Hao
,
Da-Wei He
,
Hong-Xing Shen
2016(4):328-332.
DOI: 10.1016/j.joad.2016.04.004
Abstract:
Objective: To compare and analyze the predictive value of two kinds of classification methods, routine magnetic resonance imaging (MRI) and diffusion tensor tractography (DTT), on the diagnosis and prognosis in different degrees of acute cervical spinal cord injury (ACSCI). Methods: A total of 35 patients with ACSCI treated with surgery in our department from January 2013 to December 2014 were included and all patients had received MRI ex- amination and diffusion tensor imaging examination before surgery. The motor score, sensory score and abbreviated injury scale (AIS) of American Spinal Injury Association were used to evaluate the neurological function of patients before and one year after surgery, respectively. Routine MRI was divided into 3 grades according to the compression and signals of spinal cords and DTT was also divided into 3 grades ac- cording to continuous levels of fibre bundle. The correlations between routine MRI grades and DTT grades and the neurological function of ACSCI before surgery and after surgery were analyzed, respectively. Results: There were no correlations between MRI grading and the motor score, sensory score and AIS of patients with ACSCI before surgery and after surgery. DTT grading showed no relations with the motor score, sensory score before surgery but were related to AIS before surgery. DTT grading was all related to the motor score, sensory score and AIS after surgery. Conclusions: The noninvasion of DTT showed spinal nerve fibers has a higher pre- dictive value on the diagnosis and prognosis of ACSCI than routine MRI.
Objective: To compare and analyze the predictive value of two kinds of classification methods, routine magnetic resonance imaging (MRI) and diffusion tensor tractography (DTT), on the diagnosis and prognosis in different degrees of acute cervical spinal cord injury (ACSCI). Methods: A total of 35 patients with ACSCI treated with surgery in our department from January 2013 to December 2014 were included and all patients had received MRI ex- amination and diffusion tensor imaging examination before surgery. The motor score, sensory score and abbreviated injury scale (AIS) of American Spinal Injury Association were used to evaluate the neurological function of patients before and one year after surgery, respectively. Routine MRI was divided into 3 grades according to the compression and signals of spinal cords and DTT was also divided into 3 grades ac- cording to continuous levels of fibre bundle. The correlations between routine MRI grades and DTT grades and the neurological function of ACSCI before surgery and after surgery were analyzed, respectively. Results: There were no correlations between MRI grading and the motor score, sensory score and AIS of patients with ACSCI before surgery and after surgery. DTT grading showed no relations with the motor score, sensory score before surgery but were related to AIS before surgery. DTT grading was all related to the motor score, sensory score and AIS after surgery. Conclusions: The noninvasion of DTT showed spinal nerve fibers has a higher pre- dictive value on the diagnosis and prognosis of ACSCI than routine MRI.
2016(4):333-336.
DOI: 10.1016/j.joad.2016.05.003
Abstract:
Objective: To explore the correlation between contents of serum transforming growth factor β 1 (TGF- β 1) and interleukin-6 (IL-6) and acute radiation pneumonitis (RP) in patients with lung cancer.
Methods: A total of 138 patients with non-small cell lung cancer receiving three- dimensional conformal radiation therapy in our hospital from May 2012 to October 2015 were selected as the research objects. According to the presence or absence of RP in the process of radiotherapy, those patients were divided into the RP group and non RP group to detect the contents of TGF- β 1 and IL-6 in serum.
Results: Before radiotherapy, there was no significant difference in the serum contents of TGF- β 1 and IL-6 in the RP group and non RP group. At weeks 2, 4, 6, 8 and 10 after radiotherapy, the serum contents of TGF- β 1 and IL-6 in patients of the RP group were all higher than those in the non RP group. Differences of the contents of TGF- β 1 and IL-6 in each time point after radiotherapy between two groups had statistical significance (P < 0.05). In RP group, the higher the RP grade was, the more the serum contents of TGF- β 1 and IL-6 became. Differences of the contents of TGF- β 1 and IL-6 in patients with different RP grade were statistically significant in each time point (P < 0.05).
Conclusions: In the process of radiotherapy, the increase of the serum contents of TGF- β 1 and IL-6 in patients with lung cancer is closely related to the occurrence of acute RP.
Objective: To explore the correlation between contents of serum transforming growth factor β 1 (TGF- β 1) and interleukin-6 (IL-6) and acute radiation pneumonitis (RP) in patients with lung cancer.
Methods: A total of 138 patients with non-small cell lung cancer receiving three- dimensional conformal radiation therapy in our hospital from May 2012 to October 2015 were selected as the research objects. According to the presence or absence of RP in the process of radiotherapy, those patients were divided into the RP group and non RP group to detect the contents of TGF- β 1 and IL-6 in serum.
Results: Before radiotherapy, there was no significant difference in the serum contents of TGF- β 1 and IL-6 in the RP group and non RP group. At weeks 2, 4, 6, 8 and 10 after radiotherapy, the serum contents of TGF- β 1 and IL-6 in patients of the RP group were all higher than those in the non RP group. Differences of the contents of TGF- β 1 and IL-6 in each time point after radiotherapy between two groups had statistical significance (P < 0.05). In RP group, the higher the RP grade was, the more the serum contents of TGF- β 1 and IL-6 became. Differences of the contents of TGF- β 1 and IL-6 in patients with different RP grade were statistically significant in each time point (P < 0.05).
Conclusions: In the process of radiotherapy, the increase of the serum contents of TGF- β 1 and IL-6 in patients with lung cancer is closely related to the occurrence of acute RP.
2016(4):337-339.
DOI: 10.1016/j.joad.2015.09.001
Abstract:
Hangman's fracture classically results from hyperextension/distraction of the upper cer- vical spine, causing the axis to break symmetrically across its pedicles or lateral masses and may involve the body of the vertebrae. Interestingly, Starr and Eismont described an atypical hangman's fracture where fracture lines are not parallel and may pass through the foramen transversarium unilaterally from a hyperextension and lateral side-bending injury, as the mechanism described herein. We present a case of an atypical hangman's fracture in a 73-year-old Caucasian female after being involved in a low-speed motor vehicle collision.
Hangman's fracture classically results from hyperextension/distraction of the upper cer- vical spine, causing the axis to break symmetrically across its pedicles or lateral masses and may involve the body of the vertebrae. Interestingly, Starr and Eismont described an atypical hangman's fracture where fracture lines are not parallel and may pass through the foramen transversarium unilaterally from a hyperextension and lateral side-bending injury, as the mechanism described herein. We present a case of an atypical hangman's fracture in a 73-year-old Caucasian female after being involved in a low-speed motor vehicle collision.
2016(4):340-342.
DOI: 10.1016/j.joad.2015.09.002
Abstract:
Sudden sensorineural hearing loss (SSNHL) is an important acute clinical condition in children. A specific treatment is still missing. Hyperbaric oxygen (HBO) therapy is one of the recommended treatments for SSNHL in adults. Our knowledge on the use of HBO therapy in children for SSNHL is limited. Herein, we report the successful use of HBO therapy in the management of SSNHL in a 14-year-old child
Sudden sensorineural hearing loss (SSNHL) is an important acute clinical condition in children. A specific treatment is still missing. Hyperbaric oxygen (HBO) therapy is one of the recommended treatments for SSNHL in adults. Our knowledge on the use of HBO therapy in children for SSNHL is limited. Herein, we report the successful use of HBO therapy in the management of SSNHL in a 14-year-old child
2016(4):343-344.
DOI: 10.1016/j.joad.2015.10.006
Abstract:
Ankylosing spinal disorders tend to fracture after minor trauma because of its changed biomechanical properties. Herein we presented an ankylosing spinal disorders case with cervical spine fracture in a trauma after neck protection and surgical airway application. On CT scan of cervical spine, ankylosing spondylitis with an extension C4–C5 fracture was found. The patients' family decided not to receive operation to immobilize his cervical spine, then he was admitted to our surgical intensive care unit. He was discharged against medical advice two months later with a permanent tra- cheostomy with ventilator dependence due to high-level spinal cord injury. Timely identification of unstable fractures is instrumental in avoiding adverse neurologic sequela.
Ankylosing spinal disorders tend to fracture after minor trauma because of its changed biomechanical properties. Herein we presented an ankylosing spinal disorders case with cervical spine fracture in a trauma after neck protection and surgical airway application. On CT scan of cervical spine, ankylosing spondylitis with an extension C4–C5 fracture was found. The patients' family decided not to receive operation to immobilize his cervical spine, then he was admitted to our surgical intensive care unit. He was discharged against medical advice two months later with a permanent tra- cheostomy with ventilator dependence due to high-level spinal cord injury. Timely identification of unstable fractures is instrumental in avoiding adverse neurologic sequela.
Rejeb Imen
,
Chakroun-Walha Olfa
,
Ksibi Hichem
,
Nasri Abdennour
,
Chtara Kamilia
,
Chaari Adel
,
Rekik Noureddine
2016(4):345-347.
DOI: 10.1016/j.joad.2015.10.007
Abstract:
A 61-year-old male was found to have a bilateral Bochdalek hernia on routine CT during admission for acute respiratory failure. The chest X-ray showed a left paracardiac mass having a diameter of 6 cm. This mass was initially considered as a mediastinal tumor. However, CT scan showed a bilateral large defect of the posteromedial portion of the diaphragm and mesenteric fat. 3D imaging was also useful for the stereographic perception of Bochdalek hernia. Although Bochdalek hernia is not rare, to our knowl- edge, this is the first case of Bochdalek hernia continued transverse colon observed by spiral CT 3D imaging.
A 61-year-old male was found to have a bilateral Bochdalek hernia on routine CT during admission for acute respiratory failure. The chest X-ray showed a left paracardiac mass having a diameter of 6 cm. This mass was initially considered as a mediastinal tumor. However, CT scan showed a bilateral large defect of the posteromedial portion of the diaphragm and mesenteric fat. 3D imaging was also useful for the stereographic perception of Bochdalek hernia. Although Bochdalek hernia is not rare, to our knowl- edge, this is the first case of Bochdalek hernia continued transverse colon observed by spiral CT 3D imaging.
2016(4):348-349.
DOI: 10.1016/j.joad.2016.02.001
Abstract:
Incisional hernias complicate 2%–20% of laparotomies. They rarely eviscerate sponta- neously, and when they do they pose a serious threat to the protruding bowel and the patient's life if timely intervention is not instituted. We reported a case of spontaneous rupture of an incisional hernia in a 56 years old female who underwent laparotomy twenty years before presentation to the Accident and Emergency Department of Cape Coast Teaching Hospital. She presented with a 4-h history of evisceration of bowel after bouts of cough. An emergency laparotomy and hernia repair was done after initial resuscitation. The patient's recovery was uneventful and shortly after tested positive for HIV I. She was however lost to follow up. Neglect for early operative intervention or delay in seeking the treatment for an incisional hernia increases the risk of rupture.
Incisional hernias complicate 2%–20% of laparotomies. They rarely eviscerate sponta- neously, and when they do they pose a serious threat to the protruding bowel and the patient's life if timely intervention is not instituted. We reported a case of spontaneous rupture of an incisional hernia in a 56 years old female who underwent laparotomy twenty years before presentation to the Accident and Emergency Department of Cape Coast Teaching Hospital. She presented with a 4-h history of evisceration of bowel after bouts of cough. An emergency laparotomy and hernia repair was done after initial resuscitation. The patient's recovery was uneventful and shortly after tested positive for HIV I. She was however lost to follow up. Neglect for early operative intervention or delay in seeking the treatment for an incisional hernia increases the risk of rupture.
Luigi Piscitelli
,
Michele Bisaccia
,
Luigi Meccariello
,
Gabriele Falzarano
,
Antonio Medici
,
Daniele Maiettini
,
Alberto Rebonato
,
Giuseppe Rinonapoli
,
Auro Caraffa
2016(4):350-354.
DOI: 10.1016/j.joad.2016.04.001
Abstract:
Total talus extrusion is a rare and severe injury. It is burdened by many complications as avascular necrosis and osteomyelitis even if a proper debridement of extruded talus is performed. Few case reports or case series were published, and because of the rarity of this event, there are no guidelines for treatment. We report the first case on an octoge- narian man providing a long-term follow-up performing contrast enhanced magnetic resonances. The authors report the case of an octogenarian man who fell from an olive tree reporting a total talus extrusion associated with the fracture of the medial malleolus. After an accurate debridement and washing of the wound, the talus was anatomically repositioned and the fracture was treated with an external fixator. The wound healed with difficulty after 12 months and the patient developed a chronic osteomyelitis of the talar dome and avascular necrosis of talar head. We followed the patient for 24 months per- forming contrast enhanced magnetic resonances and evaluating the development of the avascular necrosis. Even if we encountered these complications, the treatment allowed the patient to walk without pain, using a talus type shoe and one crutch. Although the literature suggests that an anatomic replacement of talus allows avoiding main compli- cations, we deem that the patient's age is an important biological feature to consider in the prognostic stratification. Moreover, primary talectomy and tibio-calcaneal fusion should be reserved as a salvage procedure. Talus replacement allows an overall good outcome for the patients, retaining height, and allowing a good quality of life.
Total talus extrusion is a rare and severe injury. It is burdened by many complications as avascular necrosis and osteomyelitis even if a proper debridement of extruded talus is performed. Few case reports or case series were published, and because of the rarity of this event, there are no guidelines for treatment. We report the first case on an octoge- narian man providing a long-term follow-up performing contrast enhanced magnetic resonances. The authors report the case of an octogenarian man who fell from an olive tree reporting a total talus extrusion associated with the fracture of the medial malleolus. After an accurate debridement and washing of the wound, the talus was anatomically repositioned and the fracture was treated with an external fixator. The wound healed with difficulty after 12 months and the patient developed a chronic osteomyelitis of the talar dome and avascular necrosis of talar head. We followed the patient for 24 months per- forming contrast enhanced magnetic resonances and evaluating the development of the avascular necrosis. Even if we encountered these complications, the treatment allowed the patient to walk without pain, using a talus type shoe and one crutch. Although the literature suggests that an anatomic replacement of talus allows avoiding main compli- cations, we deem that the patient's age is an important biological feature to consider in the prognostic stratification. Moreover, primary talectomy and tibio-calcaneal fusion should be reserved as a salvage procedure. Talus replacement allows an overall good outcome for the patients, retaining height, and allowing a good quality of life.
2016(4):355-356.
DOI: 10.1016/j.joad.2015.08.007
Abstract:
Crossed renal ectopia is a rare anomaly in urological clinical practice. Patients with this anomaly are usually asymptomatic. Herein, we reported a case of acute appendicitis in a patient with crossed renal ectopia. A 22-year-old man with abdominal pain admitted to the emergency department. His physical examination revealed muscular defense and painful mass at the lower quadrant. Abdominal ultrasonography revealed crossed renal ectopia with no sign of stones and acute appendicitis. Tomography confirmed crossed renal ectopia but not acute appendicitis. On-going clinical symptoms lead to surgical intervention and acute appendicitis diagnosis. The patient was treated with appendectomy with no perioperative complications. Appendectomy is a common surgical procedure in surgical clinical practice. Acute abdominal pain must be managed carefully in patients with unusual anatomy. Also surgeons should be aware of ectopic organs in surgical procedures, to avoid iatrogenic intraoperative injuries.
Crossed renal ectopia is a rare anomaly in urological clinical practice. Patients with this anomaly are usually asymptomatic. Herein, we reported a case of acute appendicitis in a patient with crossed renal ectopia. A 22-year-old man with abdominal pain admitted to the emergency department. His physical examination revealed muscular defense and painful mass at the lower quadrant. Abdominal ultrasonography revealed crossed renal ectopia with no sign of stones and acute appendicitis. Tomography confirmed crossed renal ectopia but not acute appendicitis. On-going clinical symptoms lead to surgical intervention and acute appendicitis diagnosis. The patient was treated with appendectomy with no perioperative complications. Appendectomy is a common surgical procedure in surgical clinical practice. Acute abdominal pain must be managed carefully in patients with unusual anatomy. Also surgeons should be aware of ectopic organs in surgical procedures, to avoid iatrogenic intraoperative injuries.
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