Journal of Acute Disease
Issue 2,2020 Table of Contents
2020(2):47-48.
DOI: 10.4103/2221-6189.278654
Abstract:
The Coronavirus Disease-2019 (COVID-19) outbreak has become a global health emergency owing to its magnitude, attributed deaths, and its propensity to spread across the world. In-fact, owing to its quick spread across international boundaries and the resulting caseload, the disease has been declared as a Public Health Emergency of International Concern on 30 January 2020. It is worth noting that out of the 395 cases detected in other nations, 165 (41.8%) have a positive history of travel to China. As of now, the World Health Organization has not recommended for any restrictions on the travel or trade aspects, but has clearly specified that implementation of International Health Regulations should be strictly done at the airports and seaports. In conclusion, the COVID- 19 outbreak has created an alarm across the globe as the causative virus is novel in nature. However, strengthening of standard infection control practices and adoption of preventive measures for travelers can significantly minimize the threat of further transmission of the disease.
The Coronavirus Disease-2019 (COVID-19) outbreak has become a global health emergency owing to its magnitude, attributed deaths, and its propensity to spread across the world. In-fact, owing to its quick spread across international boundaries and the resulting caseload, the disease has been declared as a Public Health Emergency of International Concern on 30 January 2020. It is worth noting that out of the 395 cases detected in other nations, 165 (41.8%) have a positive history of travel to China. As of now, the World Health Organization has not recommended for any restrictions on the travel or trade aspects, but has clearly specified that implementation of International Health Regulations should be strictly done at the airports and seaports. In conclusion, the COVID- 19 outbreak has created an alarm across the globe as the causative virus is novel in nature. However, strengthening of standard infection control practices and adoption of preventive measures for travelers can significantly minimize the threat of further transmission of the disease.
2020(2):49-50.
Abstract:
2020(2):51-55.
DOI: 10.4103/2221-6189.281312
Abstract:
Objective: To investigate the efficacy of Jintiange capsule in the treatment of acute bone atrophy due to wrist fractures. Methods: Participants were randomly allocated into two groups, i.e. the treatment group and the control groups. All patients received functional rehabilitation exercise. Patients in the treatment group received Jintiange capsule orally, while the control group received placebos. At 3 and 6 months after the treatment, Cooney score, hand grip and pinch strength were measured. The visual analogue scale (VAS) was applied, and safety events were recorded. Results: No loss occurred during 6 months of follow-up after treatment. Before the treatment, there was no statistically significant difference between the two groups in Cooney score, hand grip strength, hand pinch strength or VAS score (all P>0.05). At 3 and 6 months after the treatment, the Cooney core, hand grip and pinch strength increased, and the VAS were decreased in all patients. The treatment group showed significantly greater improvement than the control group (P<0.05). In additional, both groups showed few side effects. Conclusions: Jintiange capsule can improve the function of the wrist joint and alleviate the pain of fracture. It is safe and effective for treating acute bone atrophy.
Objective: To investigate the efficacy of Jintiange capsule in the treatment of acute bone atrophy due to wrist fractures. Methods: Participants were randomly allocated into two groups, i.e. the treatment group and the control groups. All patients received functional rehabilitation exercise. Patients in the treatment group received Jintiange capsule orally, while the control group received placebos. At 3 and 6 months after the treatment, Cooney score, hand grip and pinch strength were measured. The visual analogue scale (VAS) was applied, and safety events were recorded. Results: No loss occurred during 6 months of follow-up after treatment. Before the treatment, there was no statistically significant difference between the two groups in Cooney score, hand grip strength, hand pinch strength or VAS score (all P>0.05). At 3 and 6 months after the treatment, the Cooney core, hand grip and pinch strength increased, and the VAS were decreased in all patients. The treatment group showed significantly greater improvement than the control group (P<0.05). In additional, both groups showed few side effects. Conclusions: Jintiange capsule can improve the function of the wrist joint and alleviate the pain of fracture. It is safe and effective for treating acute bone atrophy.
2020(2):56-60.
DOI: 10.4103/2221-6189.281313
Abstract:
Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.
Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.
2020(2):61-66.
DOI: 10.4103/2221-6189.281319
Abstract:
Objective: To investigate the relationship between serum C-reactive protein (CRP) level and left ventricular function in patients with acute ST-elevation myocardial infarction. Methods: This study is a descriptive-analytic study and was conducted on patients with ST-elevation myocardial infarction, who were admitted to the Urmia Hospital in Seyed Alshohada Hospital, and underwent primary percutaneous coronary intervention from October to March 2018. Demographic, angiographic, echocardiographic data were evaluated based on the patients’ records. All patients were evaluated for 90 min and CRP levels were measured during the first 6 h after the primary percutaneous coronary intervention. Results: A total of 114 patients were studied, among whom 71.9% (82 patients) were male, and their mean age was (57.86±9.57) years old. The mean BMI was (26.1±3.8) kg/m2. Altogether 38.6% (44 patients) had a history of smoking, 17.5% (20 patients) of diabetes, 38.6% (44 patients) of hypertension, 5.3% (6 patients) of hyperlipidemia and 7.0% (8 patient) of coronary artery disease. The results showed a significantly negative correlation between ejection fraction and CRP, left atrial volume and CRP (P<0.05), and a significantly positive correlation between the global longitudinal strain level and CRP. The CRP level was significantly different at various diastolic grades (P=0.001). The level of CRP in patients with grade 2 diastolic dysfunction was higher than grade 1 diastolic dysfunction, while the level of CRP in diastolic grade 1 diastolic dysfunction was higher than the normal function. Conclusions: High CRP levels are associated with ejection fraction, global longitudinal strain loss and left atrial volume.
Objective: To investigate the relationship between serum C-reactive protein (CRP) level and left ventricular function in patients with acute ST-elevation myocardial infarction. Methods: This study is a descriptive-analytic study and was conducted on patients with ST-elevation myocardial infarction, who were admitted to the Urmia Hospital in Seyed Alshohada Hospital, and underwent primary percutaneous coronary intervention from October to March 2018. Demographic, angiographic, echocardiographic data were evaluated based on the patients’ records. All patients were evaluated for 90 min and CRP levels were measured during the first 6 h after the primary percutaneous coronary intervention. Results: A total of 114 patients were studied, among whom 71.9% (82 patients) were male, and their mean age was (57.86±9.57) years old. The mean BMI was (26.1±3.8) kg/m2. Altogether 38.6% (44 patients) had a history of smoking, 17.5% (20 patients) of diabetes, 38.6% (44 patients) of hypertension, 5.3% (6 patients) of hyperlipidemia and 7.0% (8 patient) of coronary artery disease. The results showed a significantly negative correlation between ejection fraction and CRP, left atrial volume and CRP (P<0.05), and a significantly positive correlation between the global longitudinal strain level and CRP. The CRP level was significantly different at various diastolic grades (P=0.001). The level of CRP in patients with grade 2 diastolic dysfunction was higher than grade 1 diastolic dysfunction, while the level of CRP in diastolic grade 1 diastolic dysfunction was higher than the normal function. Conclusions: High CRP levels are associated with ejection fraction, global longitudinal strain loss and left atrial volume.
Ekong Raymond Eworo
,
Edmund Richard Egbe
,
Zibril A. Okhormhe
,
Bassey K. Offor
,
Bassey Ikoedem Uduak
,
Andeshongkwe Dauda
2020(2):67-72.
DOI: 10.4103/2221-6189.281320
Abstract:
Objectives: To determine the anthropometric indices, lipopolysaccharide-binding proteins (LBP), and lipid profile in patients with metabolic endotoxemia. Methods: The study comprised of 47 patients with metabolic endotoxemia (the metabolic endotoxemia group) and 43 controls (the control group). Patients in the metabolic endotoxemia group were categorized further into three subgroups including the normal weight group (n=8), the overweight group (n=12) and the obese group (n=27). Height, weight, waist, and hip circumference were measured, and waist-hip ratio (WHR) and body mass index (BMI) were calculated. LBP was determined by ELISA and total cholesterol, triglycerides, high density lipoprotein by the respective enzymatic colorimetric methods. In addition, low density lipoprotein and very low density lipoprotein were determined by Friedewald’s formula. Results: The mean waist circumference (WC), hip circumference (HC), BMI, total cholesterol, low density lipoprotein, and LBP of the metabolic endotoxemia group were significantly higher (P<0.05) than those of the control group. WHR, TG, high density lipoprotein and very low density lipoprotein of the metabolic endotoxemia group were not significantly different (P>0.05) from those of the control group. The mean WC, HC, WHR, and BMI of the obese group with metabolic endotoxemia were significantly higher (P<0.05) than those of the overweight group and the normal weight group with metabolic endotoxemia. Significant positive correlations were obtained between BMI and LBP (r=0.610, P=0.001), total cholesterol and LBP (r=0.385,P=0.007), TG and LBP (r=0.356, P=0.014) in patients with metabolic endotoxemia. Conclusions: Metabolic endotoxemia arising from increased circulating level of bacterial derive particles consequent to perturbation in the gut microbial community and the elevated serum level of LBP may precede the development of obesity, characterized by dyslipidemia, dysregulation of gut energy harvest, and metabolic energy imbalance.
Objectives: To determine the anthropometric indices, lipopolysaccharide-binding proteins (LBP), and lipid profile in patients with metabolic endotoxemia. Methods: The study comprised of 47 patients with metabolic endotoxemia (the metabolic endotoxemia group) and 43 controls (the control group). Patients in the metabolic endotoxemia group were categorized further into three subgroups including the normal weight group (n=8), the overweight group (n=12) and the obese group (n=27). Height, weight, waist, and hip circumference were measured, and waist-hip ratio (WHR) and body mass index (BMI) were calculated. LBP was determined by ELISA and total cholesterol, triglycerides, high density lipoprotein by the respective enzymatic colorimetric methods. In addition, low density lipoprotein and very low density lipoprotein were determined by Friedewald’s formula. Results: The mean waist circumference (WC), hip circumference (HC), BMI, total cholesterol, low density lipoprotein, and LBP of the metabolic endotoxemia group were significantly higher (P<0.05) than those of the control group. WHR, TG, high density lipoprotein and very low density lipoprotein of the metabolic endotoxemia group were not significantly different (P>0.05) from those of the control group. The mean WC, HC, WHR, and BMI of the obese group with metabolic endotoxemia were significantly higher (P<0.05) than those of the overweight group and the normal weight group with metabolic endotoxemia. Significant positive correlations were obtained between BMI and LBP (r=0.610, P=0.001), total cholesterol and LBP (r=0.385,P=0.007), TG and LBP (r=0.356, P=0.014) in patients with metabolic endotoxemia. Conclusions: Metabolic endotoxemia arising from increased circulating level of bacterial derive particles consequent to perturbation in the gut microbial community and the elevated serum level of LBP may precede the development of obesity, characterized by dyslipidemia, dysregulation of gut energy harvest, and metabolic energy imbalance.
2020(2):78-82.
DOI: 10.4103/2221-6189.281323
Abstract:
Objective: To evaluate the management of early-onset sepsis at Saad Abul-Ella Teaching Hospital, Sudan. Methods: A descriptive retrospective hospital-based study was carried out at the Nursery Department of Saad Abul-Ella Teaching Hospital. All medical records of neonates with suspected or confirmed sepsis during the year 2017 were reviewed to evaluate the management of antibiotics for sepsis using a data collection form. Results: Out of the 205 cases, 82 neonates (40%) were diagnosed as early-onset sepsis, among which the majority was male (68%). All neonates were given cefotaxime plus vancomycin as empirical therapy which was changed to other antibiotics in 23% of the cases. The common risk factors associated with early-onset sepsis wereprolonged rupture of membrane (41.8%), preterm delivery (26.3%) and low birth weight (15.1%). Blood cultures were performed in 168 cases, and 19% had bacterial growth of Staphylococcus aureus which is the most common isolated pathogen. Conclusions: Cefotaxime plus vancomycin are the main empirical antibiotic for sepsis, and Staphylococcus aureus is the most common pathogen associated with early-onset sepsis.
Objective: To evaluate the management of early-onset sepsis at Saad Abul-Ella Teaching Hospital, Sudan. Methods: A descriptive retrospective hospital-based study was carried out at the Nursery Department of Saad Abul-Ella Teaching Hospital. All medical records of neonates with suspected or confirmed sepsis during the year 2017 were reviewed to evaluate the management of antibiotics for sepsis using a data collection form. Results: Out of the 205 cases, 82 neonates (40%) were diagnosed as early-onset sepsis, among which the majority was male (68%). All neonates were given cefotaxime plus vancomycin as empirical therapy which was changed to other antibiotics in 23% of the cases. The common risk factors associated with early-onset sepsis wereprolonged rupture of membrane (41.8%), preterm delivery (26.3%) and low birth weight (15.1%). Blood cultures were performed in 168 cases, and 19% had bacterial growth of Staphylococcus aureus which is the most common isolated pathogen. Conclusions: Cefotaxime plus vancomycin are the main empirical antibiotic for sepsis, and Staphylococcus aureus is the most common pathogen associated with early-onset sepsis.
2020(2):83-88.
DOI: 10.4103/2221-6189.281324
Abstract:
Objective: To explore the antibacterial activity of fresh fruit juices against drug-resistant pathogens. Methods: Fresh juices were prepared by squeezing 7 fruits [Citrus sinensis, Citrus aurantifolia (C. aurantifolia), Punica granatum (P. granatum), Malus domestica, Ananas comosus, Fragaria ananasia, and Actinidia deliciosa]. The antibacterial activities were studied by using well-diffusion, minimum inhibitory (MIC), and minimum bactericidal (MBC) assays against 7 clinical pathogens: Grampositive, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis; Gram-negative, 2 strains of Pseudomonas aeruginosa, 2 strains of Klebsiella pneumoniae. Results: The diffusion test revealed that Malus domestica juice had no antibacterial activity against the tested pathogens; Citrus sinensis and Ananas comosus revealed low antibacterial activity; Fragaria ananasia and Actinidia deliciosa revealed moderate antibacterial activity; P. granatum and C. aurantifolia exhibited high antibacterial activity against most of the clinical strains. MIC and MBC tests exhibited that P. granatum and C. aurantifolia had noticeable bactericidal effects with MBC/MIC values ranging between 2 to 4. Conclusions: The crude fresh juices of P. gronatum and C. aurantifolia have potential as natural therapeutic agents against some multidrug resistant bacteria and they could prevent pathogenic diseases.
Objective: To explore the antibacterial activity of fresh fruit juices against drug-resistant pathogens. Methods: Fresh juices were prepared by squeezing 7 fruits [Citrus sinensis, Citrus aurantifolia (C. aurantifolia), Punica granatum (P. granatum), Malus domestica, Ananas comosus, Fragaria ananasia, and Actinidia deliciosa]. The antibacterial activities were studied by using well-diffusion, minimum inhibitory (MIC), and minimum bactericidal (MBC) assays against 7 clinical pathogens: Grampositive, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis; Gram-negative, 2 strains of Pseudomonas aeruginosa, 2 strains of Klebsiella pneumoniae. Results: The diffusion test revealed that Malus domestica juice had no antibacterial activity against the tested pathogens; Citrus sinensis and Ananas comosus revealed low antibacterial activity; Fragaria ananasia and Actinidia deliciosa revealed moderate antibacterial activity; P. granatum and C. aurantifolia exhibited high antibacterial activity against most of the clinical strains. MIC and MBC tests exhibited that P. granatum and C. aurantifolia had noticeable bactericidal effects with MBC/MIC values ranging between 2 to 4. Conclusions: The crude fresh juices of P. gronatum and C. aurantifolia have potential as natural therapeutic agents against some multidrug resistant bacteria and they could prevent pathogenic diseases.
2020(2):89-92.
DOI: 10.4103/2221-6189.281326
Abstract:
Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality and is endemic across tropical areas, especially in Southeast Asia and northern Australia. Patient concern: A 24-year-old diabetic male complained of fever and left upper quadrant abdominal pain for one-week duration. Diagnosis: Melioidosis with ruptured splenic abscess and splenic vein thrombosis. Interventions: Antimicrobial therapy (intensive therapy: intravenous ceftazidime, eradication therapy: oral trimethoprimsulfamethoxazole), and anti-coagulation (enoxaparin, then warfarin). Outcomes: Resolution of splenic abscess and splenic vein thrombosis. Lessons: Both splenic abscess and splenic vein thrombosis are uncommon but severe complications associated with melioidosis. Ultrasound is useful for diagnosis and monitoring response to treatment in such cases.
Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality and is endemic across tropical areas, especially in Southeast Asia and northern Australia. Patient concern: A 24-year-old diabetic male complained of fever and left upper quadrant abdominal pain for one-week duration. Diagnosis: Melioidosis with ruptured splenic abscess and splenic vein thrombosis. Interventions: Antimicrobial therapy (intensive therapy: intravenous ceftazidime, eradication therapy: oral trimethoprimsulfamethoxazole), and anti-coagulation (enoxaparin, then warfarin). Outcomes: Resolution of splenic abscess and splenic vein thrombosis. Lessons: Both splenic abscess and splenic vein thrombosis are uncommon but severe complications associated with melioidosis. Ultrasound is useful for diagnosis and monitoring response to treatment in such cases.
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