Journal of Acute Disease
Volume ,2025 Issue 14
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2025(14):1-9, DOI: 10.4103/jad.jad_96_24
Abstract:
Objective: To study the clinical profiles of children with febrile seizures, comparing those with single episodes to recurrent cases, and identify predictors of recurrence. In addition, to develop a scoring system to predict recurrence after the first febrile seizure, and identify modifiable risk factors to mitigate recurrence risks.
Methods: This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures, seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital. Data were collected via parent interviews, physical exams, and laboratory tests. The questionnaire covered demographics, antenatal, natal, and postnatal events, seizure history, family history, immunization, daycare attendance, and fever management. Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge. Laboratory tests assessed anemia, dyselectrolytemia, and hypoglycemia. Data were analyzed in SPSS Version 25 using descriptive statistics, t-tests, Chi-square tests, and odds ratios with 95% confidence intervals (CI), with significance set at P<0.05.
Results: 451 children were included in this study. Low birth weight (OR=2.60, 95% CI=1.12-6.33, P=0.026), age at first episode>2 months (OR=0.28, 95% CI=0.16-0.48, P=0.001), family history of febrile seizure (OR=5.21, 95% CI=2.92-9.28, P=0.001), no intermittent prophylaxis (OR=15.25, 95% CI=7.05- 32.90, P=0.001), treatment for fever (OR=0.26, 95% CI=0.13- 0.51) and low socioeconomic status (OR=5.87, 95% CI=3.32- 10.38) were significantly associated with recurrent febrile seizures. Conclusions: Low birth weight, age at first episode ≤12 months, family history of febrile seizure, no intermittent prophylaxis, inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.
Objective: To study the clinical profiles of children with febrile seizures, comparing those with single episodes to recurrent cases, and identify predictors of recurrence. In addition, to develop a scoring system to predict recurrence after the first febrile seizure, and identify modifiable risk factors to mitigate recurrence risks.
Methods: This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures, seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital. Data were collected via parent interviews, physical exams, and laboratory tests. The questionnaire covered demographics, antenatal, natal, and postnatal events, seizure history, family history, immunization, daycare attendance, and fever management. Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge. Laboratory tests assessed anemia, dyselectrolytemia, and hypoglycemia. Data were analyzed in SPSS Version 25 using descriptive statistics, t-tests, Chi-square tests, and odds ratios with 95% confidence intervals (CI), with significance set at P<0.05.
Results: 451 children were included in this study. Low birth weight (OR=2.60, 95% CI=1.12-6.33, P=0.026), age at first episode>2 months (OR=0.28, 95% CI=0.16-0.48, P=0.001), family history of febrile seizure (OR=5.21, 95% CI=2.92-9.28, P=0.001), no intermittent prophylaxis (OR=15.25, 95% CI=7.05- 32.90, P=0.001), treatment for fever (OR=0.26, 95% CI=0.13- 0.51) and low socioeconomic status (OR=5.87, 95% CI=3.32- 10.38) were significantly associated with recurrent febrile seizures. Conclusions: Low birth weight, age at first episode ≤12 months, family history of febrile seizure, no intermittent prophylaxis, inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.
2025(14):1-3, DOI: 10.4103/jad.jad_102_24
Abstract:
Rationale: Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae. It threatens global health and signifies a lack of proper access to clean water and sanitation. If not treated properly, cholera causes severe watery diarrhea that can lead to hypovolemic shock.
Patient’s Concern: A 23-year-old male patient was admitted with severe diarrhea with a frequency of fifteen to twenty loose, watery stools and was severely dehydrated. The patient developed severe bradycardia with a positive serum troponin level and no chest pain. Initial electrocardiogram on the day of admission was sinus tachycardia with a heart rate of 120 beats/min on the third day of admission, the patient developed bradycardia with a heart rate of 45 beats/min with a prolonged QT interval of 550 msec (corrected QT interval 476 msec).
Diagnosis: Cholera with sinus bradycardia with prolonged QT interval.
Interventions: Based on the clinical situation and the inferior vena cava status determined by ultrasound, a thorough fluid resuscitation using crystalloids was performed. The patient was then administered antibiotics: oral doxycycline 300 mg STAT and intravenous ciprofloxacin 15 mg/kg twice daily for three days.
Outcomes: After 5 days of adequate hydration and antimicrobial treatment, diarrhea was resolved and heart rate improved with no electrocardiogram abnormalities.
Lessons: This case report highlights the importance of timely diagnosis and managing severe diarrhea in cholera patients to prevent morbidity and mortality. Public awareness regarding cholera and its complications is necessary for the betterment of the community.
Rationale: Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae. It threatens global health and signifies a lack of proper access to clean water and sanitation. If not treated properly, cholera causes severe watery diarrhea that can lead to hypovolemic shock.
Patient’s Concern: A 23-year-old male patient was admitted with severe diarrhea with a frequency of fifteen to twenty loose, watery stools and was severely dehydrated. The patient developed severe bradycardia with a positive serum troponin level and no chest pain. Initial electrocardiogram on the day of admission was sinus tachycardia with a heart rate of 120 beats/min on the third day of admission, the patient developed bradycardia with a heart rate of 45 beats/min with a prolonged QT interval of 550 msec (corrected QT interval 476 msec).
Diagnosis: Cholera with sinus bradycardia with prolonged QT interval.
Interventions: Based on the clinical situation and the inferior vena cava status determined by ultrasound, a thorough fluid resuscitation using crystalloids was performed. The patient was then administered antibiotics: oral doxycycline 300 mg STAT and intravenous ciprofloxacin 15 mg/kg twice daily for three days.
Outcomes: After 5 days of adequate hydration and antimicrobial treatment, diarrhea was resolved and heart rate improved with no electrocardiogram abnormalities.
Lessons: This case report highlights the importance of timely diagnosis and managing severe diarrhea in cholera patients to prevent morbidity and mortality. Public awareness regarding cholera and its complications is necessary for the betterment of the community.
2025(14):1-3, DOI: 10.4103/jad.jad_4_25
Abstract:
Rationale: Advances in sleep research have introduced medications like lemborexant, a dual orexin receptor antagonist. While effective for regulating sleep, overdoses are a concern, especially in suicide attempts. However, limited data exist on lemborexant overdose, prompting this case report to elucidate its clinical course.
Patient’s Concern: A 91-year-old Japanese woman with multiple comorbidities, including insomnia and chronic kidney disease, was admitted after ingesting 315 mg of lemborexant in a suicide attempt.
Diagnosis: Lemborexant overdose.
Interventions: Supportive care with 500 mL of Ringer’s acetate solution at the emergency room.
Outcomes: She gradually regained full consciousness with no residual deficits. Due to persistent suicidal ideation, she was transferred to a psychiatric hospital after seven days of supportive care.
Lessons: A review of four lemborexant overdose cases managed at our hospital revealed that overdoses primarily induce altered consciousness and are unlikely to cause organ dysfunction. Supportive care is generally sufficient for management. However, given the limited data, further case accumulation is needed to enhance clinical understanding.
Rationale: Advances in sleep research have introduced medications like lemborexant, a dual orexin receptor antagonist. While effective for regulating sleep, overdoses are a concern, especially in suicide attempts. However, limited data exist on lemborexant overdose, prompting this case report to elucidate its clinical course.
Patient’s Concern: A 91-year-old Japanese woman with multiple comorbidities, including insomnia and chronic kidney disease, was admitted after ingesting 315 mg of lemborexant in a suicide attempt.
Diagnosis: Lemborexant overdose.
Interventions: Supportive care with 500 mL of Ringer’s acetate solution at the emergency room.
Outcomes: She gradually regained full consciousness with no residual deficits. Due to persistent suicidal ideation, she was transferred to a psychiatric hospital after seven days of supportive care.
Lessons: A review of four lemborexant overdose cases managed at our hospital revealed that overdoses primarily induce altered consciousness and are unlikely to cause organ dysfunction. Supportive care is generally sufficient for management. However, given the limited data, further case accumulation is needed to enhance clinical understanding.
Alireza Mirahmadizadeh, Maryam Janfada, Alireza Heiran, Amir Askarinejad, Mohammad
Javad Moradian, Afshan Javadi, Leila Kasraian, Andishe Hamedi
2025(14):1-6, DOI: 10.4103/jad.jad_111_24
Abstract:
Objective: To determine the causes of COVID-19 deaths at home.
Methods: This descriptive cross-sectional study was conducted on confirmed COVID-19 deaths, which were confirmed to occur at home using the “Electronic Death Registration System (EDRS)” database, from February 20, 2020, to September 23, 2021, in the Fars province, south of Iran. A semi-structured, face-to-face survey consisting of 29 items was filled by the family caregivers, and the information was confirmed based on medical records.
Results: One hundred and ninety-three deaths were included, with 60.1% male and 39.9% female. More than 75% of cases had at least one comorbid condition. Death was unexpected for 65.8% of the families and 45.1% of the deceased cases had been medically managed at home during the disease. According to the family caregivers’ opinion, the most frequent causes of death at home in their COVID-19 patients were early discharge/release from the hospital (28.5%), physician's reassurance to continue home quarantine/supportive care (14.5%), hopeless/oldest-old patient (11.9%), and family/relative recommendation to not to hospitalize their patient due to fears, myths, etc. (8.8%).
Conclusions: In family caregivers’ belief, deaths at home might be related to healthcare system preparedness, physicians’ knowledge, and public education and empowerment.
Objective: To determine the causes of COVID-19 deaths at home.
Methods: This descriptive cross-sectional study was conducted on confirmed COVID-19 deaths, which were confirmed to occur at home using the “Electronic Death Registration System (EDRS)” database, from February 20, 2020, to September 23, 2021, in the Fars province, south of Iran. A semi-structured, face-to-face survey consisting of 29 items was filled by the family caregivers, and the information was confirmed based on medical records.
Results: One hundred and ninety-three deaths were included, with 60.1% male and 39.9% female. More than 75% of cases had at least one comorbid condition. Death was unexpected for 65.8% of the families and 45.1% of the deceased cases had been medically managed at home during the disease. According to the family caregivers’ opinion, the most frequent causes of death at home in their COVID-19 patients were early discharge/release from the hospital (28.5%), physician's reassurance to continue home quarantine/supportive care (14.5%), hopeless/oldest-old patient (11.9%), and family/relative recommendation to not to hospitalize their patient due to fears, myths, etc. (8.8%).
Conclusions: In family caregivers’ belief, deaths at home might be related to healthcare system preparedness, physicians’ knowledge, and public education and empowerment.
Vahab Hassan Kaviar, Zahra Farshadzadeh, Azar Dokht Khosravi, Mohammad Hossein
Haddadi, Somayeh Karamolahi, Marzieh Hashemian, Nazanin Omidi, Moloudsadat Motahar, Nourkhoda Sadeghifard, Saeed Khoshnood, Fatemeh Shahi
2025(14):1-12, DOI: 10.4103/jad.jad_104_24
Abstract:
Objective: To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii (A. baumannii) isolates in this study.
Methods: A. baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study, and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2® systems. All isolates were analyzed for biofilm production, then presence of biofilm-associated genes, and classⅠand Ⅱ integron genes.
Results: 60 non-replicate A. baumannii isolates were included in this study. The resistance rates reached 100% for aztreonam, cefepime, ceftazidime, ciprofloxacin, piperacillin-tazobactam, piperacillin, ticarcillin, and trimethoprim-sulfamethoxazole. A. baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments. Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3% and 16.7%, respectively. Of the isolates, 91.6% formed biofilms, categorized as 10% strong, 31.6% moderate, and 50% weak. No correlation was found between antibiotic resistance and biofilm formation. The genes csuE, abaI, and ompA were prevalent, but their distribution was similar across biofilm categories. A relationship between Int1 and biofilm production was noted.
Conclusions: The high rates of antibiotic resistance and biofilmformation, alongside the presence of integrons including class ⅠandⅡ, underscore the necessity for ongoing monitoring of A.baumannii. Notably, class Ⅰintegron presence was significantly linked to biofilm formation. Further research is needed to explore the connection between antibiotic resistance and biofilm production in A. baumannii.
Objective: To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii (A. baumannii) isolates in this study.
Methods: A. baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study, and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2® systems. All isolates were analyzed for biofilm production, then presence of biofilm-associated genes, and classⅠand Ⅱ integron genes.
Results: 60 non-replicate A. baumannii isolates were included in this study. The resistance rates reached 100% for aztreonam, cefepime, ceftazidime, ciprofloxacin, piperacillin-tazobactam, piperacillin, ticarcillin, and trimethoprim-sulfamethoxazole. A. baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments. Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3% and 16.7%, respectively. Of the isolates, 91.6% formed biofilms, categorized as 10% strong, 31.6% moderate, and 50% weak. No correlation was found between antibiotic resistance and biofilm formation. The genes csuE, abaI, and ompA were prevalent, but their distribution was similar across biofilm categories. A relationship between Int1 and biofilm production was noted.
Conclusions: The high rates of antibiotic resistance and biofilmformation, alongside the presence of integrons including class ⅠandⅡ, underscore the necessity for ongoing monitoring of A.baumannii. Notably, class Ⅰintegron presence was significantly linked to biofilm formation. Further research is needed to explore the connection between antibiotic resistance and biofilm production in A. baumannii.
2025(14):1-4, DOI: 10.4103/jad.jad_16_25
Abstract:
2025(14):1-6, DOI: 10.4103/jad.jad_94_24
Abstract:
Objective: To investigate the diagnostic value of the neutrophil/ lymphocyte ratio, which has not been studied sufficiently to determine the cause of acute gastroenteritis worldwide. Methods: The prospective, observational study included patients diagnosed with acute gastroenteritis who were treated at Dışkapı Yıldırım Beyazıt Application and Research Center, Emergency Medicine Clinic between 1 September 2020 and 31 May 2021.
Demographic characteristics, as well as neutrophil count, lymphocyte count, white blood cell count, and the neutrophil-to lymphocyte ratio, were compared across the viral, bacterial, and parasitic acute gastroenteritis groups.
Results: A total of 168 acute gastroenteritis patients, 31 of whom had parasitic, 39 bacterial and 98 viral etiologies, were included in this study. Neutrophil/lymphocyte ratio was 2.73 (4.03) in the viral acute gastroenteritis group, 4.58 (8.61) in the bacterial acute gastroenteritis group, and 4.52 (5.49) in the parasite acute gastroenteritis group. A statistically significant difference was found among the groups regarding neutrophil/lymphocyte ratio (P=0.022). However, post-hoc analysis revealed no statistically significant differences in the neutrophil-to-lymphocyte ratio among the groups (P>0.05).
Conclusions: Neutrophil/lymphocyte ratio alone cannot distinguish etiological causes in patients admitted to the Emergency Medicine Clinic diagnosed with acute gastroenteritis.
Objective: To investigate the diagnostic value of the neutrophil/ lymphocyte ratio, which has not been studied sufficiently to determine the cause of acute gastroenteritis worldwide. Methods: The prospective, observational study included patients diagnosed with acute gastroenteritis who were treated at Dışkapı Yıldırım Beyazıt Application and Research Center, Emergency Medicine Clinic between 1 September 2020 and 31 May 2021.
Demographic characteristics, as well as neutrophil count, lymphocyte count, white blood cell count, and the neutrophil-to lymphocyte ratio, were compared across the viral, bacterial, and parasitic acute gastroenteritis groups.
Results: A total of 168 acute gastroenteritis patients, 31 of whom had parasitic, 39 bacterial and 98 viral etiologies, were included in this study. Neutrophil/lymphocyte ratio was 2.73 (4.03) in the viral acute gastroenteritis group, 4.58 (8.61) in the bacterial acute gastroenteritis group, and 4.52 (5.49) in the parasite acute gastroenteritis group. A statistically significant difference was found among the groups regarding neutrophil/lymphocyte ratio (P=0.022). However, post-hoc analysis revealed no statistically significant differences in the neutrophil-to-lymphocyte ratio among the groups (P>0.05).
Conclusions: Neutrophil/lymphocyte ratio alone cannot distinguish etiological causes in patients admitted to the Emergency Medicine Clinic diagnosed with acute gastroenteritis.
2025(14):1-3, DOI: 10.4103/jad.jad_12_25
Abstract:
Rationale: Abdominal pain is a common complaint with a broad differential diagnosis, including both intra-abdominal and abdominal wall pathologies. While visceral causes are frequently considered, abdominal wall conditions are often overlooked, leading to diagnostic delays. Among them, umbilical abscesses are rare but require distinction from urachal abscesses due to differences in management.
Patient’s concern: A 46-year-old woman presented with a one week history of periumbilical pain unresponsive to analgesics.
Diagnosis: Physical examination revealed localized tenderness and a positive Carnett’s sign. Computed tomographic images identified an umbilical abscess without evidence of urachal remnants, ruling out a urachal abscess.
Interventions: The patient underwent abscess drainage and received cefalexin (1500 mg/day) for 28 days.
Outcomes: The abscess resolved completely without recurrence.
Lessons: Umbilical abscesses are rare and may be mistaken for urachal abscesses. A thorough clinical evaluation, including Carnett’s sign and imaging studies, is crucial for accurate diagnosis. Prompt differentiation facilitates appropriate management and prevents unnecessary interventions.
Rationale: Abdominal pain is a common complaint with a broad differential diagnosis, including both intra-abdominal and abdominal wall pathologies. While visceral causes are frequently considered, abdominal wall conditions are often overlooked, leading to diagnostic delays. Among them, umbilical abscesses are rare but require distinction from urachal abscesses due to differences in management.
Patient’s concern: A 46-year-old woman presented with a one week history of periumbilical pain unresponsive to analgesics.
Diagnosis: Physical examination revealed localized tenderness and a positive Carnett’s sign. Computed tomographic images identified an umbilical abscess without evidence of urachal remnants, ruling out a urachal abscess.
Interventions: The patient underwent abscess drainage and received cefalexin (1500 mg/day) for 28 days.
Outcomes: The abscess resolved completely without recurrence.
Lessons: Umbilical abscesses are rare and may be mistaken for urachal abscesses. A thorough clinical evaluation, including Carnett’s sign and imaging studies, is crucial for accurate diagnosis. Prompt differentiation facilitates appropriate management and prevents unnecessary interventions.
2025,14(14):1-4, DOI: 10.4103/jad.jad_110_24
Abstract:
Rationale: IgA vasculitis or Henoch-Schonlein purpura is an immune complex mediated small vessel vasculitis characterized by clinical triad of arthritis, palpable purpura and gastrointestinal symptoms. It is commonly seen in children below 10-year-old, though adults may be affected.
Patient’s Concern: A 40-year-old man with type-2 diabetes mellitus presented with fever, melena, palpable purpuric rash and hematuria with acute kidney injury, associated with nephrotic range proteinuria. Skin biopsy revealed leukocytoclastic vasculitis and renal biopsy showed IgA deposits in the mesangium and capillary loops with fibro cellular crescents confirming the diagnosis of IgA vasculitis with crescentic rapidly progressive glomerulonephritis.
Diagnosis: IgA vasculitis with rapidly progressive glomerulonephritis.
Interventions: The patient was treated with pulse intravenous methylprednisolone 500 mg/day for 3 days with tapering doses of oral prednisolone and intravenous cyclophosphamide (0.5 gm/m 2body surface area) under the cover of intravenous antibiotics for diabetic foot ulcer.
Outcomes: Patient improved gradually with return to baseline creatinine after 3 months of follow up.
Lessons: Rapidly progressive glomerulonephritis is a rare manifestation of IgA vasculitis and warrants special care and early treatment. The incidence of rapidly progressive glomerulonephritis in IgA vasculitis is unknown. It carries a high risk of progression to chronic kidney disease and thus should be treated as soon as feasible after diagnosis.
Rationale: IgA vasculitis or Henoch-Schonlein purpura is an immune complex mediated small vessel vasculitis characterized by clinical triad of arthritis, palpable purpura and gastrointestinal symptoms. It is commonly seen in children below 10-year-old, though adults may be affected.
Patient’s Concern: A 40-year-old man with type-2 diabetes mellitus presented with fever, melena, palpable purpuric rash and hematuria with acute kidney injury, associated with nephrotic range proteinuria. Skin biopsy revealed leukocytoclastic vasculitis and renal biopsy showed IgA deposits in the mesangium and capillary loops with fibro cellular crescents confirming the diagnosis of IgA vasculitis with crescentic rapidly progressive glomerulonephritis.
Diagnosis: IgA vasculitis with rapidly progressive glomerulonephritis.
Interventions: The patient was treated with pulse intravenous methylprednisolone 500 mg/day for 3 days with tapering doses of oral prednisolone and intravenous cyclophosphamide (0.5 gm/m 2body surface area) under the cover of intravenous antibiotics for diabetic foot ulcer.
Outcomes: Patient improved gradually with return to baseline creatinine after 3 months of follow up.
Lessons: Rapidly progressive glomerulonephritis is a rare manifestation of IgA vasculitis and warrants special care and early treatment. The incidence of rapidly progressive glomerulonephritis in IgA vasculitis is unknown. It carries a high risk of progression to chronic kidney disease and thus should be treated as soon as feasible after diagnosis.
2025,14(14):1-10, DOI: 10.4103/jad.jad_115_24
Abstract:
Objective: To explore the current status of sepsis-associated acute kidney injury (SA-AKI) research and predict its future research directions.
Methods: The bibliometric overview of publications was conducted in the field of SA-AKI based on Web of Science Core Collection database from January 2013 to August 2023. This study employed software such as CiteSpace and VOSviewer to conduct bibliometric and visualization analysis of the included literature, including publication trends, geographic distribution characteristics, author contributions, citations, funding sources characteristics, and keyword clustering.
Results: A total of 6509 articles were analyzed, and the number of publications and citations increased from 2013 to 2022. The United States had the highest number of publications in SA AKI, while France was the country with the highest number of citations per publication. Keyword clustering analysis showed that the pathophysiology and definition of SA-AKI were the research focus, and the research hotspots were "machine learning", "vitamin C", "kinase", "hemodynamics", "renal microcirculation" and "mitochondria". Literature coupling analysis indicated that exploring the management and treatment of SA-AKI was the research frontier.
Conclusions: Over the past decade, SA-AKI research has shown a upward trend in terms of the number of publication. Research primarily focuses on exploring mechanisms and improving early warning systems. Mechanisms involve microcirculatory dysfunction, inflammation, and other pathophysiological factors. Future recommendations include continuing basic research, achieving clinical application of novel biomarkers, and prioritizing renal recovery mechanisms in treatment strategies.
Objective: To explore the current status of sepsis-associated acute kidney injury (SA-AKI) research and predict its future research directions.
Methods: The bibliometric overview of publications was conducted in the field of SA-AKI based on Web of Science Core Collection database from January 2013 to August 2023. This study employed software such as CiteSpace and VOSviewer to conduct bibliometric and visualization analysis of the included literature, including publication trends, geographic distribution characteristics, author contributions, citations, funding sources characteristics, and keyword clustering.
Results: A total of 6509 articles were analyzed, and the number of publications and citations increased from 2013 to 2022. The United States had the highest number of publications in SA AKI, while France was the country with the highest number of citations per publication. Keyword clustering analysis showed that the pathophysiology and definition of SA-AKI were the research focus, and the research hotspots were "machine learning", "vitamin C", "kinase", "hemodynamics", "renal microcirculation" and "mitochondria". Literature coupling analysis indicated that exploring the management and treatment of SA-AKI was the research frontier.
Conclusions: Over the past decade, SA-AKI research has shown a upward trend in terms of the number of publication. Research primarily focuses on exploring mechanisms and improving early warning systems. Mechanisms involve microcirculatory dysfunction, inflammation, and other pathophysiological factors. Future recommendations include continuing basic research, achieving clinical application of novel biomarkers, and prioritizing renal recovery mechanisms in treatment strategies.
Wei Gu, Shuo Wang, Ling Wang, Yang Liu, Chuanzhu Lv, Guoqiang Zhang, Yuefeng
Ma, Wei Guo, Society of Emergency Medicine of Chinese Medical Association, Emergency
Medicine Branch of Chinese Geriatrics Society
2025,14(14):1, DOI: 10.4103/jad.jad_65_25
Abstract:
Community-acquired pneumonia (CAP) in adults (≥18 years old) is the most common infectious disease encountered in emergency departments. Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management. The physician-pharmacist collaborative management (PPCM) model, which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists, has demonstrated strong clinical value in practice. However, the lack of standardized national guidelines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption. This guideline is developed based on evidence-based medicine and clinical practice experience, with a focus on the application of the PPCM model in the management of CAP in emergency settings. It outlines the significance of the PPCM model, its applicable scenarios, the respective roles of emergency physicians and clinical pharmacists, and its practical implementation in the antimicrobial treatment of CAP patients. In addition, the guideline proposes standardized implementation processes and clinical pathways. By promoting the PPCM model, the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP, reduce the risk of antimicrobial resistance, and improve patient outcomes.
Community-acquired pneumonia (CAP) in adults (≥18 years old) is the most common infectious disease encountered in emergency departments. Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management. The physician-pharmacist collaborative management (PPCM) model, which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists, has demonstrated strong clinical value in practice. However, the lack of standardized national guidelines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption. This guideline is developed based on evidence-based medicine and clinical practice experience, with a focus on the application of the PPCM model in the management of CAP in emergency settings. It outlines the significance of the PPCM model, its applicable scenarios, the respective roles of emergency physicians and clinical pharmacists, and its practical implementation in the antimicrobial treatment of CAP patients. In addition, the guideline proposes standardized implementation processes and clinical pathways. By promoting the PPCM model, the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP, reduce the risk of antimicrobial resistance, and improve patient outcomes.
2025,14(14):1-6, DOI: 10.4103/jad.jad_84_24
Abstract:
Objective: To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.
Methods: This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin, Turkey, between January 2019 and January 2022. Clinical findings and laboratory results, including leukocyte count, C-reactive protein (CRP), and procalcitonin levels in blood, were examined. Logistic regression, Chi square test, and receiver operating characteristics (ROC) curve analyses assessed the predictive value of these parameters.
Results: A total of 199 participants were included in the study; 99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls. Patients with meningitis exhibited significantly higher leukocyte counts (median: 11 890×103 / uL vs. 7 905×103 /uL, P<0.001) and CRP levels (median: 6.00 mg/dL vs. 0.95 mg/dL, P<0.001) compared to controls. Procalcitonin levels were significantly elevated in meningitis patients (median: 0.21 ng/mL vs. 0.10 ng/mL, P<0.001). Logistic regression identified albumin (OR=0.16, 95% CI=0.06-0.40), and CRP (OR=1.18, 95% CI=1.08-1.28) as independent predictors of meningitis. ROC analysis for CRP demonstrated a sensitivity of 80.6% and specificity of 70.0% at a cut-off value of 2.23 mg/dL (AUC=0.792).
Conclusions: Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service. Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
Objective: To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.
Methods: This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin, Turkey, between January 2019 and January 2022. Clinical findings and laboratory results, including leukocyte count, C-reactive protein (CRP), and procalcitonin levels in blood, were examined. Logistic regression, Chi square test, and receiver operating characteristics (ROC) curve analyses assessed the predictive value of these parameters.
Results: A total of 199 participants were included in the study; 99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls. Patients with meningitis exhibited significantly higher leukocyte counts (median: 11 890×103 / uL vs. 7 905×103 /uL, P<0.001) and CRP levels (median: 6.00 mg/dL vs. 0.95 mg/dL, P<0.001) compared to controls. Procalcitonin levels were significantly elevated in meningitis patients (median: 0.21 ng/mL vs. 0.10 ng/mL, P<0.001). Logistic regression identified albumin (OR=0.16, 95% CI=0.06-0.40), and CRP (OR=1.18, 95% CI=1.08-1.28) as independent predictors of meningitis. ROC analysis for CRP demonstrated a sensitivity of 80.6% and specificity of 70.0% at a cut-off value of 2.23 mg/dL (AUC=0.792).
Conclusions: Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service. Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
2025,14(14):1-5, DOI: 10.4103/jad.jad_140_24
Abstract:
Rationale: Cavernous internal carotid artery dissection (ICAD) is a rare cause of cavernous sinus syndrome, presenting diagnostic challenges, particularly in resource-limited settings.
Patient’s concern: A 43-year-old man presented with sudden, painless left eye blindness, partial ptosis and reduced facial sensation. Examination revealed a relative afferent pupillary defect, anisocoria, mild ophthalmoplegia and a pale optic disc. Initial computed tomography imaging was unremarkable, and lumbar puncture suggested meningoencephalitis. Despite treatment, his condition deteriorated to complete ptosis and total ophthalmoplegia. Urgent magnetic resonance imaging and computed tomography angiography confirmed cavernous internal carotid artery dissection and multiple areas of infarction.
Diagnosis: Cavernous sinus syndrome secondary to cavernous ICAD with non-arteritic ischemic optic neuropathy, total ophthalmoplegia and trigeminal nerve palsy.
Interventions: The patient initially received treatment for meningoencephalitis. Upon confirming the diagnosis of ICAD, he declined surgical intervention.
Outcomes: Irreversible left eye blindness.
Lessons: This case highlights the progressive nature of cavernous ICAD, the critical role of advanced imaging in diagnosis, and the need for clinical vigilance in resource-limited settings for timely diagnosis and intervention.
Rationale: Cavernous internal carotid artery dissection (ICAD) is a rare cause of cavernous sinus syndrome, presenting diagnostic challenges, particularly in resource-limited settings.
Patient’s concern: A 43-year-old man presented with sudden, painless left eye blindness, partial ptosis and reduced facial sensation. Examination revealed a relative afferent pupillary defect, anisocoria, mild ophthalmoplegia and a pale optic disc. Initial computed tomography imaging was unremarkable, and lumbar puncture suggested meningoencephalitis. Despite treatment, his condition deteriorated to complete ptosis and total ophthalmoplegia. Urgent magnetic resonance imaging and computed tomography angiography confirmed cavernous internal carotid artery dissection and multiple areas of infarction.
Diagnosis: Cavernous sinus syndrome secondary to cavernous ICAD with non-arteritic ischemic optic neuropathy, total ophthalmoplegia and trigeminal nerve palsy.
Interventions: The patient initially received treatment for meningoencephalitis. Upon confirming the diagnosis of ICAD, he declined surgical intervention.
Outcomes: Irreversible left eye blindness.
Lessons: This case highlights the progressive nature of cavernous ICAD, the critical role of advanced imaging in diagnosis, and the need for clinical vigilance in resource-limited settings for timely diagnosis and intervention.
2025,14(14):1-7, DOI: 10.4103/jad.jad_64_25
Abstract:
Objective: To evaluate the effects of early bronchoalveolar lavage (BAL) on inflammatory response, oxidative stress, and clinical outcomes in older adult patients with severe pneumonia using generalized estimating equations (GEE).
Methods: Eighty-three older adult patients (≥60 years) hospitalized with severe pneumonia between August 2024 and December 2024 were enrolled and assigned to either a control group (n=47), which received standard therapy (including antimicrobials, expectorants, and mechanical ventilation), or an intervention group (n=36), which received additional BAL at 12 and 48 hours post-admission. Clinical efficacy and time to symptom improvement were compared between groups. Serum concentrations of inflammatory markers—interleukin (IL)-6, procalcitonin, and C-reactive protein (CRP)—and oxidative stress markers—superoxide dismutase and malondialdehyde (MDA)—were measured at baseline (T0) and at 24 (T1), 72 (T2), and 144 hours (T3) following admission. Intergroup differences were analyzed using GEE.
Results: Compared with the control group, the intervention group demonstrated significantly lower Clinical Pulmonary Infection Score, Acute Physiology and Chronic Health Evaluation 栻 score, Murray Lung Injury Score, duration of lung inflammation, and length of hospital stay (all P<0.05). GEE analyses indicated that the intervention group exhibited significantly reduced levels of IL- 6, procalcitonin, CRP, and MDA (all P<0.05), and significantly increased superoxide dismutase levels (P<0.05).
Conclusions: Early administration of BAL significantly mitigates systemic inflammation and oxidative stress, while improving clinical outcomes in older adult patients with severe pneumonia. These findings support further investigation of broader clinical application of early BAL in this population.
Objective: To evaluate the effects of early bronchoalveolar lavage (BAL) on inflammatory response, oxidative stress, and clinical outcomes in older adult patients with severe pneumonia using generalized estimating equations (GEE).
Methods: Eighty-three older adult patients (≥60 years) hospitalized with severe pneumonia between August 2024 and December 2024 were enrolled and assigned to either a control group (n=47), which received standard therapy (including antimicrobials, expectorants, and mechanical ventilation), or an intervention group (n=36), which received additional BAL at 12 and 48 hours post-admission. Clinical efficacy and time to symptom improvement were compared between groups. Serum concentrations of inflammatory markers—interleukin (IL)-6, procalcitonin, and C-reactive protein (CRP)—and oxidative stress markers—superoxide dismutase and malondialdehyde (MDA)—were measured at baseline (T0) and at 24 (T1), 72 (T2), and 144 hours (T3) following admission. Intergroup differences were analyzed using GEE.
Results: Compared with the control group, the intervention group demonstrated significantly lower Clinical Pulmonary Infection Score, Acute Physiology and Chronic Health Evaluation 栻 score, Murray Lung Injury Score, duration of lung inflammation, and length of hospital stay (all P<0.05). GEE analyses indicated that the intervention group exhibited significantly reduced levels of IL- 6, procalcitonin, CRP, and MDA (all P<0.05), and significantly increased superoxide dismutase levels (P<0.05).
Conclusions: Early administration of BAL significantly mitigates systemic inflammation and oxidative stress, while improving clinical outcomes in older adult patients with severe pneumonia. These findings support further investigation of broader clinical application of early BAL in this population.
Yaxin Xiong, Jiuyue Sun, Yu Song, Jia Xu, Yingfei Zhi, Yuan Gao, Huaming Li, Mingyan Zhao, Xianglin Meng
2025(14):1, DOI: 10.4103/jad.jad_88_25
Abstract:
Objective: To investigate the infulence of the International Normalized Ratio (INR) on the prognosis of patients with acute coronary syndrome (ACS) admitted to intensive care units (ICUs).
Methods: A retrospective analysis was conducted on ACS patients from the MIMIC-桇 2.0 database, who were admitted to ICUs for the first time between 2008 and 2019 and met the study criteria. The association between the initial INR upon admission and the prognosis of ACS patients was assessed using a restricted cubic spline model at a continuous level. Based on the restricted cubic spline (RCS) curve, patients were stratified into three groups, and a multivariate Cox regression model was applied to analyze the effect of INR on the prognosis of ACS patients.
Results: When INR was 曑1.0, the mortality risk gradually decreased with increasing INR levels; when INR ranged between 1.0 and 1.5, the mortality risk rose significantly with further elevation of INR; when INR exceeded 1.5, the mortality risk stabilized at a persistently high level, with minimal fluctuations observed despite substantial changes in INR values. Multivariate Cox regression analysis also demonstrated that patients in the medium (1.0-1.5) and high (>1.5) INR groups exhibited significantly higher mortality risks compared to those in the low (曑1.0) INR group.
Conclusions: Fluctuations in the INR among patients with ACS admitted to the ICU are associated with an increased risk of mortality and adversely affect patient prognosis.
Objective: To investigate the infulence of the International Normalized Ratio (INR) on the prognosis of patients with acute coronary syndrome (ACS) admitted to intensive care units (ICUs).
Methods: A retrospective analysis was conducted on ACS patients from the MIMIC-桇 2.0 database, who were admitted to ICUs for the first time between 2008 and 2019 and met the study criteria. The association between the initial INR upon admission and the prognosis of ACS patients was assessed using a restricted cubic spline model at a continuous level. Based on the restricted cubic spline (RCS) curve, patients were stratified into three groups, and a multivariate Cox regression model was applied to analyze the effect of INR on the prognosis of ACS patients.
Results: When INR was 曑1.0, the mortality risk gradually decreased with increasing INR levels; when INR ranged between 1.0 and 1.5, the mortality risk rose significantly with further elevation of INR; when INR exceeded 1.5, the mortality risk stabilized at a persistently high level, with minimal fluctuations observed despite substantial changes in INR values. Multivariate Cox regression analysis also demonstrated that patients in the medium (1.0-1.5) and high (>1.5) INR groups exhibited significantly higher mortality risks compared to those in the low (曑1.0) INR group.
Conclusions: Fluctuations in the INR among patients with ACS admitted to the ICU are associated with an increased risk of mortality and adversely affect patient prognosis.
2025(14):1, DOI: 10.4103/jad.jad_96_25
Abstract:
Objective: To systematically evaluate the global research landscape of artificial intelligence (AI) applications in sepsis management to identify evolutionary patterns and inform evidence-based clinical decision-making.
Methods: We extracted 1 100 publications from the Web of Science Core Collection (1985-2024), employing Excel, CiteSpace, and VOSviewer for quantitative analysis of national contributions, institutional collaborations, author networks, and keyword evolution.
Results: Our findings reveal exponential growth in publication output since 2017 (annual growth rate: 56.3%), driven by advancements in machine learning and interdisciplinary integration. China and the United States emerged as dominant contributors, collectively accounting for over 60% of total publications. The top three institutions were Harvard University, University of California System and Emory University. Keywords co-occurrence and cluster analysis identified research hotspots such as AI-driven prediction models, immune infiltration, precision medicine and single-cell sequencing. Keywords were categorized into five clusters: clinical management of sepsis, pathological mechanism and biomarkers, complications and monitoring, AI-based research, and diagnostic criteria.
Conclusions: The publications interest in the application of AI in sepsis management is continuously increasing, especially in aspects such as the immune mechanism of sepsis, critical care management, and treatment plans. Moreover, there is great potential for research in precision medicine and single-cell sequencing. Future research should focus more on the application of AI in the prediction and precise intervention of sepsis.
Objective: To systematically evaluate the global research landscape of artificial intelligence (AI) applications in sepsis management to identify evolutionary patterns and inform evidence-based clinical decision-making.
Methods: We extracted 1 100 publications from the Web of Science Core Collection (1985-2024), employing Excel, CiteSpace, and VOSviewer for quantitative analysis of national contributions, institutional collaborations, author networks, and keyword evolution.
Results: Our findings reveal exponential growth in publication output since 2017 (annual growth rate: 56.3%), driven by advancements in machine learning and interdisciplinary integration. China and the United States emerged as dominant contributors, collectively accounting for over 60% of total publications. The top three institutions were Harvard University, University of California System and Emory University. Keywords co-occurrence and cluster analysis identified research hotspots such as AI-driven prediction models, immune infiltration, precision medicine and single-cell sequencing. Keywords were categorized into five clusters: clinical management of sepsis, pathological mechanism and biomarkers, complications and monitoring, AI-based research, and diagnostic criteria.
Conclusions: The publications interest in the application of AI in sepsis management is continuously increasing, especially in aspects such as the immune mechanism of sepsis, critical care management, and treatment plans. Moreover, there is great potential for research in precision medicine and single-cell sequencing. Future research should focus more on the application of AI in the prediction and precise intervention of sepsis.
2025(14):1, DOI: 10.4103/jad.jad_93_25
Abstract:
Objective: To evaluate the association between serum levels of macrophage inflammatory protein-1 (MIP-1β) and disease severity as well as 28-day mortality in sepsis patients.
Methods: The retrospective study included adult patients with sepsis who were admitted to the emergency department. Demographic characteristics and laboratory parameters measured within 3 hours of admission were compared, including MIP-1β, lactate, procalcitonin, C-reactive protein, Acute Physiology and Chronic Health Evaluation 栻 (APACHE 栻) score, and Sequential Organ Failure Assessment score.
Results: The study included a total of 202 sepsis patients, who were stratified by 28-day outcomes into 61 survivors and 141 non-survivors. MIP-1β levels were significantly higher in the non-survivor group [(196.08v.s.10.75) pg/mL] than in the survivor group [(125.48v.s.4.70) pg/mL, P<.05]. The areas under the receiver operating characteristic curves (AUC) for predicting 28-day mortality were 0.712 for MIP-1β, 0.599 for lactate, and 0.766 for APACHE 栻 score. MIP-1β levels showed a positive correlation with lactate (r=0.172). Binary logistic regression identified MIP-1 β (OR=1.02, 95% CI: 1.01-1.03, P=.001), APACHE 栻 score (OR=1.16, 95% CI: 1.08-1.24, P<.001), and lactate (OR=1.45, 95% CI: 1.08-1.95, P=.01) as independent risk factors for 28-day mortality in sepsis patients.
Conclusions: MIP-1β demonstrates high sensitivity and specificity in predicting poor outcomes in sepsis. MIP-1β, APACHE 栻 score, and lactate are independent risk factors for 28-day mortality in these patients.
Objective: To evaluate the association between serum levels of macrophage inflammatory protein-1 (MIP-1β) and disease severity as well as 28-day mortality in sepsis patients.
Methods: The retrospective study included adult patients with sepsis who were admitted to the emergency department. Demographic characteristics and laboratory parameters measured within 3 hours of admission were compared, including MIP-1β, lactate, procalcitonin, C-reactive protein, Acute Physiology and Chronic Health Evaluation 栻 (APACHE 栻) score, and Sequential Organ Failure Assessment score.
Results: The study included a total of 202 sepsis patients, who were stratified by 28-day outcomes into 61 survivors and 141 non-survivors. MIP-1β levels were significantly higher in the non-survivor group [(196.08v.s.10.75) pg/mL] than in the survivor group [(125.48v.s.4.70) pg/mL, P<.05]. The areas under the receiver operating characteristic curves (AUC) for predicting 28-day mortality were 0.712 for MIP-1β, 0.599 for lactate, and 0.766 for APACHE 栻 score. MIP-1β levels showed a positive correlation with lactate (r=0.172). Binary logistic regression identified MIP-1 β (OR=1.02, 95% CI: 1.01-1.03, P=.001), APACHE 栻 score (OR=1.16, 95% CI: 1.08-1.24, P<.001), and lactate (OR=1.45, 95% CI: 1.08-1.95, P=.01) as independent risk factors for 28-day mortality in sepsis patients.
Conclusions: MIP-1β demonstrates high sensitivity and specificity in predicting poor outcomes in sepsis. MIP-1β, APACHE 栻 score, and lactate are independent risk factors for 28-day mortality in these patients.
2025,14(14):1, DOI: 10.4103/jad.jad_142_24
Abstract:
Rationale: Although traditionally linked to myocardial dysfunction, left ventricular (LV) thrombus with preserved systolic function presents a distinct diagnostic challenge, necessitating its consideration in all cardioembolic strokes.
Patient’s Concern: A 50-year-old woman with diabetes experienced sudden unresponsiveness accompanied by significant right upper limb weakness. Remarkably, her clinical history was devoid of symptoms suggestive of ischemic or arrhythmic cardiac events.
Diagnosis: Advanced neuroimaging identified acute bilateral medial thalamic and paramedian midbrain infarctions. Transthoracic echocardiography revealed an unexpectedly large, mobile LV thrombus, coexisting with normal systolic function (ejection fraction: 60%).
Interventions: Immediate anticoagulation with low molecular weight heparin was initiated, followed by oral warfarin titrated to an international normalized ratio of 2.0-3.0. Physical therapy was implemented to address residual motor deficits.
Outcomes: Three months post-intervention, the patient demonstrated marked neurological improvement (right upper limb power: 3/5) and complete thrombus resolution, confirmed by follow-up echocardiography.
Lessons: This case highlights that LV thrombus is a rare but critical consideration in embolic stroke of uncertain origin, even with normal cardiac function. It underscores the necessity of prompt echocardiography and early anticoagulation to achieve optimal outcomes.
Rationale: Although traditionally linked to myocardial dysfunction, left ventricular (LV) thrombus with preserved systolic function presents a distinct diagnostic challenge, necessitating its consideration in all cardioembolic strokes.
Patient’s Concern: A 50-year-old woman with diabetes experienced sudden unresponsiveness accompanied by significant right upper limb weakness. Remarkably, her clinical history was devoid of symptoms suggestive of ischemic or arrhythmic cardiac events.
Diagnosis: Advanced neuroimaging identified acute bilateral medial thalamic and paramedian midbrain infarctions. Transthoracic echocardiography revealed an unexpectedly large, mobile LV thrombus, coexisting with normal systolic function (ejection fraction: 60%).
Interventions: Immediate anticoagulation with low molecular weight heparin was initiated, followed by oral warfarin titrated to an international normalized ratio of 2.0-3.0. Physical therapy was implemented to address residual motor deficits.
Outcomes: Three months post-intervention, the patient demonstrated marked neurological improvement (right upper limb power: 3/5) and complete thrombus resolution, confirmed by follow-up echocardiography.
Lessons: This case highlights that LV thrombus is a rare but critical consideration in embolic stroke of uncertain origin, even with normal cardiac function. It underscores the necessity of prompt echocardiography and early anticoagulation to achieve optimal outcomes.
Chuanzhu Lv, Wei Guo, Xufeng Chen, Yong Mei, Jing Sun, Ling Wang, Yuguo Chen, Huadong Zhu, Yu Cao, Yanfan Chai, Emergency
Medicine Branch of Chinese Geriatrics Society
2025,14(14):1, DOI: 10.4103/jad.jad_123_25
Abstract:
In recent years, venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a critical intervention in the management of adult respiratory failure, with its clinical application expanding at a rapid pace annually. For critically ill patients receiving VV-ECMO support, achieving and maintaining a balance between oxygen supply and oxygen consumption is of paramount importance. Oxygen supply primarily relies on cardiac output and arterial oxygen content; notably, in patients under VV-ECMO support, arterial oxygen content is closely linked to the parameter configurations of both VV-ECMO and mechanical ventilators. Therefore, based on national and industrial needs, this document has been formulated by integrating the latest advancements and practical experience in this field from both domestic and international sources. Its core objectives are to standardize the adjustment of oxygen supply during the combined use of mechanical ventilators and VVECMO, provide unambiguous guidance for healthcare professionals, and ultimately enhance the success rate in the treatment of severe respiratory conditions.
In recent years, venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a critical intervention in the management of adult respiratory failure, with its clinical application expanding at a rapid pace annually. For critically ill patients receiving VV-ECMO support, achieving and maintaining a balance between oxygen supply and oxygen consumption is of paramount importance. Oxygen supply primarily relies on cardiac output and arterial oxygen content; notably, in patients under VV-ECMO support, arterial oxygen content is closely linked to the parameter configurations of both VV-ECMO and mechanical ventilators. Therefore, based on national and industrial needs, this document has been formulated by integrating the latest advancements and practical experience in this field from both domestic and international sources. Its core objectives are to standardize the adjustment of oxygen supply during the combined use of mechanical ventilators and VVECMO, provide unambiguous guidance for healthcare professionals, and ultimately enhance the success rate in the treatment of severe respiratory conditions.
Abhishek Mishra, Shalendra Singh, Sirisha Anne, Chandra Prakash Sharma, Shibu Sasidharan, Priya Taank, Anushree Mishra
2025(14):1, DOI: 10.4103/jad.jad_2_25
Abstract:
Rationale: Acute appendicitis is a surgical emergency that can be difficult to diagnose, especially in females, due to a broad differential diagnosis. One of the conditions that may mimic or coexist with appendicitis is a ruptured ovarian cyst. However, distinguishing between the two is critical, as their management strategies differ significantly.
Patient concerns: A 23-year-old married woman with no known comorbidities presented with a one-day history of pain in her right iliac fossa.
Diagnosis: Abdominal ultrasonography confirmed an inflamed appendix; however, further pelvic scanning identified a ruptured right adnexal cyst. This indicated a case of acute appendicitis coexisting with a right adnexal cyst, resulting in hemoperitoneum.
Interventions: Laparoscopic appendectomy and deroofing of the cyst were performed, along with peritoneal lavage, and clot evacuation.
Outcomes: The patient was discharged one week after surgery.
Lessons: Clinicians should maintain a high index of suspicion for clinical variants of acute appendicitis, especially in female patients presenting with abdominal pain and a concurrent right hemorrhagic ovarian cyst.
Rationale: Acute appendicitis is a surgical emergency that can be difficult to diagnose, especially in females, due to a broad differential diagnosis. One of the conditions that may mimic or coexist with appendicitis is a ruptured ovarian cyst. However, distinguishing between the two is critical, as their management strategies differ significantly.
Patient concerns: A 23-year-old married woman with no known comorbidities presented with a one-day history of pain in her right iliac fossa.
Diagnosis: Abdominal ultrasonography confirmed an inflamed appendix; however, further pelvic scanning identified a ruptured right adnexal cyst. This indicated a case of acute appendicitis coexisting with a right adnexal cyst, resulting in hemoperitoneum.
Interventions: Laparoscopic appendectomy and deroofing of the cyst were performed, along with peritoneal lavage, and clot evacuation.
Outcomes: The patient was discharged one week after surgery.
Lessons: Clinicians should maintain a high index of suspicion for clinical variants of acute appendicitis, especially in female patients presenting with abdominal pain and a concurrent right hemorrhagic ovarian cyst.
2025(14):1, DOI: 10.4103/jad.jad_99_25
Abstract:
Objective: To compare the diagnostic performance of DeepSeek-R1 and ChatGPT-4o in emergency department inpatients and explore their clinical practical value.
Methods: A retrospective study was conducted using clinical data from emergency department inpatients discharged in December 2024. Discharge diagnoses served as the gold standard. Patient data (age, symptoms, exams, tests) were input into DeepSeek-R1 and GPT-4o with the prompt: “What is the most likely diagnosis? ” Two physicians scored outputs (0–3) to assess accuracy and consistency.
Results: A total of 328 cases were analyzed. The mean scores for DeepSeek-R1 and ChatGPT-4o were 2.33±1.07 and 2.32±1.05, respectively, with no statistically significant difference (P=0.82). The Z-score was -0.232, indicating highly similar performance between the two models. However, the rate of accurate diagnoses was 66.5%. Diagnostic performance declined with increasing patient age.
Conclusions: DeepSeek-R1 and ChatGPT-4o demonstrated comparable diagnostic performance in emergency department settings, but the misdiagnosis risk remained high. Both models can serve as auxiliary tools to expand physicians' diagnostic considerations but should be integrated with clinical expertise for comprehensive judgment.
Objective: To compare the diagnostic performance of DeepSeek-R1 and ChatGPT-4o in emergency department inpatients and explore their clinical practical value.
Methods: A retrospective study was conducted using clinical data from emergency department inpatients discharged in December 2024. Discharge diagnoses served as the gold standard. Patient data (age, symptoms, exams, tests) were input into DeepSeek-R1 and GPT-4o with the prompt: “What is the most likely diagnosis? ” Two physicians scored outputs (0–3) to assess accuracy and consistency.
Results: A total of 328 cases were analyzed. The mean scores for DeepSeek-R1 and ChatGPT-4o were 2.33±1.07 and 2.32±1.05, respectively, with no statistically significant difference (P=0.82). The Z-score was -0.232, indicating highly similar performance between the two models. However, the rate of accurate diagnoses was 66.5%. Diagnostic performance declined with increasing patient age.
Conclusions: DeepSeek-R1 and ChatGPT-4o demonstrated comparable diagnostic performance in emergency department settings, but the misdiagnosis risk remained high. Both models can serve as auxiliary tools to expand physicians' diagnostic considerations but should be integrated with clinical expertise for comprehensive judgment.
2025(14):1, DOI: 10.4103/jad.jad_41_2
Abstract:
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Available online:August 21, 2025, DOI: 10.4103/jad.jad_113_24
Abstract:
"Objective: To compare the impacts of ephedrine, ketamine, ondansetron, and atropine on postoperative nausea and vomiting among patients with lower limb fracture repair surgery under spinal anesthesia.
Methods: This randomized, double-blind trial was conducted at Valiasr Hospital, Arak, Iran. Participants were allocated via balanced block randomization into four groups: ephedrine, ketamine, ondansetron, and atropine. Nausea frequency (episode count) and severity (visual analogue scale [VAS]) were assessed at recovery and 2, 4, 6, 12, and 24 hours postoperatively. Severe nausea (VAS>3) was treated with intravenous metoclopramide (10 mg), with total 24-hour doses recorded. Sedation levels (Ramsay Sedation Scale) and medication side effects (e.g. , confusion, hallucinations) were evaluated at recovery and 1, 2, and 4 hours post-surgery. Data were analyzed using SPSS (v. 20.0), with P<0.05 considered significant.
Results: A total of 128 patients were included. No significant difference was observed among the groups concerning vomiting score and nausea frequency (P>0.05). Nausea severity in the ondansetron and ephedrine groups was significantly less than the other two groups (P=0.001) and nausea severity in the ondansetron group was significantly less than the ephedrine group (P=0.01). The Ramsay sedation score in the ketamine group was also significantly higher than the other groups at recovery and one hour after surgery (P=0.001).
Conclusions: Ondansetron and ephedrine are effective in significantly reducing postoperative nausea severity and ondansetron acts better. Therefore, these medications can be recommended for postoperative nausea and vomiting management."
"Objective: To compare the impacts of ephedrine, ketamine, ondansetron, and atropine on postoperative nausea and vomiting among patients with lower limb fracture repair surgery under spinal anesthesia.
Methods: This randomized, double-blind trial was conducted at Valiasr Hospital, Arak, Iran. Participants were allocated via balanced block randomization into four groups: ephedrine, ketamine, ondansetron, and atropine. Nausea frequency (episode count) and severity (visual analogue scale [VAS]) were assessed at recovery and 2, 4, 6, 12, and 24 hours postoperatively. Severe nausea (VAS>3) was treated with intravenous metoclopramide (10 mg), with total 24-hour doses recorded. Sedation levels (Ramsay Sedation Scale) and medication side effects (e.g. , confusion, hallucinations) were evaluated at recovery and 1, 2, and 4 hours post-surgery. Data were analyzed using SPSS (v. 20.0), with P<0.05 considered significant.
Results: A total of 128 patients were included. No significant difference was observed among the groups concerning vomiting score and nausea frequency (P>0.05). Nausea severity in the ondansetron and ephedrine groups was significantly less than the other two groups (P=0.001) and nausea severity in the ondansetron group was significantly less than the ephedrine group (P=0.01). The Ramsay sedation score in the ketamine group was also significantly higher than the other groups at recovery and one hour after surgery (P=0.001).
Conclusions: Ondansetron and ephedrine are effective in significantly reducing postoperative nausea severity and ondansetron acts better. Therefore, these medications can be recommended for postoperative nausea and vomiting management."
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2023(6):254-254, DOI: 10.4103/2221-6189.390391
Abstract:
2023(6):255-256, DOI: 10.4103/2221-6189.390392
Abstract:
2018(3):99-102, DOI: 10.4103/2221-6189.236822
Abstract:
Pulmonary embolism (PE), with the incidence of about 60 per 100 000 annually, can be a life-threatening disease if it is not treated promptly. It has been estimated that some 10% of PE patients die within the first hour of the event. Untreated PE has a mortality of about 30%. PE is a condition that is treatable if suspected and diagnosed early. The chest radiograph is still the first investigation that is ordered in patients presenting with cardiorespiratory symptoms or symptoms suggestive of PE. The CXR is also helpful in identifying or excluding other conditions or diagnoses. Thus, knowing and understanding some of the more specific CXR signs can be useful. We suggest that physicians to be aware of and utilize CXR findings such as Palla's sign, Westermark sign and Hamptons hump to help with the diagnosis of PE and to exclude other conditions that can mimic venous thrombo-embolism. Even if these signs are not common, their presence, even in an unsuspected patient without a high pretest probability of PE, should prompt further investigations such as a D-dimer test, lung scintigraphy or computed tomography pulmonary angiography as required.
Pulmonary embolism (PE), with the incidence of about 60 per 100 000 annually, can be a life-threatening disease if it is not treated promptly. It has been estimated that some 10% of PE patients die within the first hour of the event. Untreated PE has a mortality of about 30%. PE is a condition that is treatable if suspected and diagnosed early. The chest radiograph is still the first investigation that is ordered in patients presenting with cardiorespiratory symptoms or symptoms suggestive of PE. The CXR is also helpful in identifying or excluding other conditions or diagnoses. Thus, knowing and understanding some of the more specific CXR signs can be useful. We suggest that physicians to be aware of and utilize CXR findings such as Palla's sign, Westermark sign and Hamptons hump to help with the diagnosis of PE and to exclude other conditions that can mimic venous thrombo-embolism. Even if these signs are not common, their presence, even in an unsuspected patient without a high pretest probability of PE, should prompt further investigations such as a D-dimer test, lung scintigraphy or computed tomography pulmonary angiography as required.
2018(3):93-98, DOI: 10.4103/2221-6189.236821
Abstract:
Acupuncture is actually convoked for supporting Western Medicine. Its “Golden Points” can undoubtedly help patients during its neurological recovery. After almost thirty years of experience in saving patients at impending death situations and having made numerous contributions on the field, the author herein provides a reasoned survival bio-energetic circuit based on a detailed methodological and functional analysis of the Main Channels and the Wondrous Vessels (Qi jing ba mai) participating in it. K-1 Yongquan complementary resuscitation maneuver, systematized since 1987, has been consistently performed in sudden death and cardiac arrest conditions as a final resource in both basic and advanced CPR failure. Experimental analytical studies identify the prevention, control and assessment of treatments set up as well as the determination of their efficiency. Acupuncture K-1 Yongquan Resuscitation Maneuver is presented not only as a complementary CPR rescuer but as a protective aid for both traumatic and vascular acute brain injury. Current indications of KI-1 Yongquan are not limited to actuarial results in cardiac arrest resuscitations, but it functions as a brain protector in both traumatic and vascular brain injury situations should be included. Although many acupuncturists indicate only standard techniques for bio-energetic rehabilitation, it has not been noticed that they insist with greater emphasis in those specific points to stimulate the “Sea of Marrow” (encephalon). Divulgation of K-1 emergency therapeutic possibilities look for its inclusion into Critical Care Protocols, in order to upgrade survival rates in both cardiac arrest and stroke victims. Traditional Chinese Medical balancing effect principle can improve cognitive, intellectual and psycho-motor patterns after even severe brain injuries. Beyond the scientific methodology that supports it the efficiency of the maneuver derives mainly from the sustained increase in survival rates presented in the successive statistics published in renowned scientific journals since its application.
Acupuncture is actually convoked for supporting Western Medicine. Its “Golden Points” can undoubtedly help patients during its neurological recovery. After almost thirty years of experience in saving patients at impending death situations and having made numerous contributions on the field, the author herein provides a reasoned survival bio-energetic circuit based on a detailed methodological and functional analysis of the Main Channels and the Wondrous Vessels (Qi jing ba mai) participating in it. K-1 Yongquan complementary resuscitation maneuver, systematized since 1987, has been consistently performed in sudden death and cardiac arrest conditions as a final resource in both basic and advanced CPR failure. Experimental analytical studies identify the prevention, control and assessment of treatments set up as well as the determination of their efficiency. Acupuncture K-1 Yongquan Resuscitation Maneuver is presented not only as a complementary CPR rescuer but as a protective aid for both traumatic and vascular acute brain injury. Current indications of KI-1 Yongquan are not limited to actuarial results in cardiac arrest resuscitations, but it functions as a brain protector in both traumatic and vascular brain injury situations should be included. Although many acupuncturists indicate only standard techniques for bio-energetic rehabilitation, it has not been noticed that they insist with greater emphasis in those specific points to stimulate the “Sea of Marrow” (encephalon). Divulgation of K-1 emergency therapeutic possibilities look for its inclusion into Critical Care Protocols, in order to upgrade survival rates in both cardiac arrest and stroke victims. Traditional Chinese Medical balancing effect principle can improve cognitive, intellectual and psycho-motor patterns after even severe brain injuries. Beyond the scientific methodology that supports it the efficiency of the maneuver derives mainly from the sustained increase in survival rates presented in the successive statistics published in renowned scientific journals since its application.
2019(6):221-232, DOI: 10.4103/2221-6189.272853
Abstract:
Legionellosis is the generic term used to describe infections caused by different varieties of Legionella spp., including Legionnaires’ disease (LD), a severe and potentially fatal form of pneumonia, and Pontiac fever, a self-limited flu-like illness. Legionellosis is usually acquired through inhalation or aspiration of aerosols containing Legionella spp. These bacteria can cause acute consolidating pneumonia in susceptible patients who are at an advanced age, have underlying debilitating diseases, or are immunodeficient. The main natural reservoir for Legionella is water and this pathogen colonizes many different natural and man-made freshwater environments such as water networks, cooling towers, and water systems in buildings and hospitals. In recent years, various laboratory diagnostic tests for Legionella infections have changed significantly. Although the sequencing method is nowadays considered the fastest and most reliable method for differentiation and detection of different Legionella species, the isolation of these bacteria from clinical specimens is the golden standard for diagnosis of Legionnaires’ disease. Today the urinary antigen test as the most rapid and inexpensive method is routinely used for diagnosis of LD caused by Legionella pneumophila serogroup 1. The macrolides and fluoroquinolones are still the mainstays for the treatment of Legionella infections. For the prevention of spreading the contaminated water aerosols and controlling Legionella infections, an effective water treatment procedure is necessary. This review describs and summarizes the latest available information about all aspects of Legionella and Legionnaires’ disease.
Legionellosis is the generic term used to describe infections caused by different varieties of Legionella spp., including Legionnaires’ disease (LD), a severe and potentially fatal form of pneumonia, and Pontiac fever, a self-limited flu-like illness. Legionellosis is usually acquired through inhalation or aspiration of aerosols containing Legionella spp. These bacteria can cause acute consolidating pneumonia in susceptible patients who are at an advanced age, have underlying debilitating diseases, or are immunodeficient. The main natural reservoir for Legionella is water and this pathogen colonizes many different natural and man-made freshwater environments such as water networks, cooling towers, and water systems in buildings and hospitals. In recent years, various laboratory diagnostic tests for Legionella infections have changed significantly. Although the sequencing method is nowadays considered the fastest and most reliable method for differentiation and detection of different Legionella species, the isolation of these bacteria from clinical specimens is the golden standard for diagnosis of Legionnaires’ disease. Today the urinary antigen test as the most rapid and inexpensive method is routinely used for diagnosis of LD caused by Legionella pneumophila serogroup 1. The macrolides and fluoroquinolones are still the mainstays for the treatment of Legionella infections. For the prevention of spreading the contaminated water aerosols and controlling Legionella infections, an effective water treatment procedure is necessary. This review describs and summarizes the latest available information about all aspects of Legionella and Legionnaires’ disease.
Amankwa Richcane, Tay Samuel CK, Agbenorku Pius, Frimpong Enoch, Gyampomah Thomas K, Osei Sampene Paul Poku
2017(4):181, DOI: 10.12980/jad.6.20170406
Abstract:
Objective: To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates. Methods: Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU) from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using KirbyBauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity. Results: A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3%) and females 35 (40.7%). Age of participants ranged from 0–56+ years. Pseudomonas aeruginosa was the commonest pathogen isolated 26(30.2%), followed by Pseudomonas spp. 21(24.4%), Escherichia coli 17(19.8%), Klebsiella spp. 12(14.0%). Coagulase negative Staphylococcus accounted for 2(2.3%). Overall prevalence of infection in the study was 90.7%. Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.
Objective: To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates. Methods: Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU) from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using KirbyBauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity. Results: A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3%) and females 35 (40.7%). Age of participants ranged from 0–56+ years. Pseudomonas aeruginosa was the commonest pathogen isolated 26(30.2%), followed by Pseudomonas spp. 21(24.4%), Escherichia coli 17(19.8%), Klebsiella spp. 12(14.0%). Coagulase negative Staphylococcus accounted for 2(2.3%). Overall prevalence of infection in the study was 90.7%. Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.
2019(2):82-83, DOI: 10.4103/2221-6189.254433
Abstract:
Distinguishing stroke mimics constitutes a considerable challenge for clinicians in emergency department. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Through the presentation of this case, we point out tardive phenomenon as an alternative differential diagnosis of stroke. Furthermore, this case adds substantial data presenting an interesting manifestation of isolated dysarthria as a tardive phenomenon, occurring due to betahistine usage which is extremely rare in literature.
Distinguishing stroke mimics constitutes a considerable challenge for clinicians in emergency department. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Through the presentation of this case, we point out tardive phenomenon as an alternative differential diagnosis of stroke. Furthermore, this case adds substantial data presenting an interesting manifestation of isolated dysarthria as a tardive phenomenon, occurring due to betahistine usage which is extremely rare in literature.
2018(2):90-92, DOI: 10.4103/2221-6189.233019
Abstract:
Acute renal failure is an important acute renal disease. It is the totally acute impairment of the renal function and can be fatal if there is no proper and timely treatment. There are various causes of acute renal failure. The acute renal failure might be due to contact with nephrotoxic substance. The food borne acute renal failure is an important problem that is sporadically seen worldwide. Of several food borne acute renal failure disorders, the fish borne acute renal failure is an important problem. In this specific short review, the authors summarize and discuss the cases on important fish borne acute renal failure disorders.
Acute renal failure is an important acute renal disease. It is the totally acute impairment of the renal function and can be fatal if there is no proper and timely treatment. There are various causes of acute renal failure. The acute renal failure might be due to contact with nephrotoxic substance. The food borne acute renal failure is an important problem that is sporadically seen worldwide. Of several food borne acute renal failure disorders, the fish borne acute renal failure is an important problem. In this specific short review, the authors summarize and discuss the cases on important fish borne acute renal failure disorders.
Luis Rafael Moscote Salazar, Amit Agrawal, Guru Dutta Satyarthee, Huber S. Padilla-Zambrano, Boris Vladimir Cabrera-Nanclares, Romario Mendoza-Flórez, Samer Hoz, Alexis Narvaez-Rojas
2018(3):103-107, DOI: 10.4103/2221-6189.236823
Abstract:
Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia; it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.
Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia; it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.
2018(1):45-48, DOI: 10.4103/2221-6189.228878
Abstract:
Hemoptysis is a common emergency symptom for pulmonary embolism. It's important to differential diagnosis for this symptom. This article reports a case of pulmonary vein stenosis. The patient was transferred to a number of hospitals for medical treatment, but was misdiagnosed for 7 months. This article aims to improve clinician's ability to differentially diagnose hemoptysis, and to deepen the knowledge of pulmonary vein stenosis.
Hemoptysis is a common emergency symptom for pulmonary embolism. It's important to differential diagnosis for this symptom. This article reports a case of pulmonary vein stenosis. The patient was transferred to a number of hospitals for medical treatment, but was misdiagnosed for 7 months. This article aims to improve clinician's ability to differentially diagnose hemoptysis, and to deepen the knowledge of pulmonary vein stenosis.
Tayebe Aghamohammadi, Mostafa Khaleghipour, Farahnaz Mohammadi Shahboulaghi, Asghar Dalvandi, Sadat Seyed Bagher Maddah
Numair
2019(5):179-184, DOI: 10.4103/2221-6189.268405
Abstract:
Objective: To determine the effect of self-management program on the health status of elderly patients with heart failure. Methods: The present study was a single-blind, randomized clinical trial, and conducted on 90 patients with heart failure of stages II-III at one teaching hospital in eastern Iran in 2017. The participants were randomly assigned into two groups: the intervention group and the control groups, with 45 patients in each group. Self-management programs including awareness and recognition, problem-solving process, diet, exercise, and stress management were carried out. The participants were trained for six weeks and were followed for two months. Data of the health status were collected before, after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire. Data analysis by chi-square, independent t-test, Fisher, ANOVA with repeated measures was conducted. Results: Patients in both groups were matched in terms of demographic characteristics before the intervention. There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention. However, the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001). Conclusions: Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms). Therefore, this supportive method can be used to improve the health of patients and manage problems caused by heart failure.
Objective: To determine the effect of self-management program on the health status of elderly patients with heart failure. Methods: The present study was a single-blind, randomized clinical trial, and conducted on 90 patients with heart failure of stages II-III at one teaching hospital in eastern Iran in 2017. The participants were randomly assigned into two groups: the intervention group and the control groups, with 45 patients in each group. Self-management programs including awareness and recognition, problem-solving process, diet, exercise, and stress management were carried out. The participants were trained for six weeks and were followed for two months. Data of the health status were collected before, after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire. Data analysis by chi-square, independent t-test, Fisher, ANOVA with repeated measures was conducted. Results: Patients in both groups were matched in terms of demographic characteristics before the intervention. There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention. However, the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001). Conclusions: Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms). Therefore, this supportive method can be used to improve the health of patients and manage problems caused by heart failure.
Miaad K. Alkhudhairy, Morteza Saki, Sakineh Seyed-Mohammadi, Nabi Jomehzadeh, Saeed Khoshnood, Mina Moradzadeh, Sajjad Yazdansetad
2019(3):113-117, DOI: 10.4103/2221-6189.259110
Abstract:
Objective: To investigate the frequency of integrase genes intI1, intI2 and intI3 of Escherichia coli strains, and their association with resistance to routinely used antibiotics. Methods: A total of 120 Escherichia coli strains were collected from patients with urinary tract infection in Ahvaz, Southwest of Iran. Antibiotic susceptibility testing was performed. The presence of intI1, intI2, andintI3 genes was determined by polymerase chain reaction. Results: Antibiotic susceptibility testing disclosed the highest resistance rate to ampicillin (91.7%) followed by trimethoprim/sulfamethoxazole (65.8%), and ceftazidime (56.7%). The imipenem susceptibility rate was 91.7%. IntI1 and intI2 were identified in 74 (61.6%) and 8 (6.6%) of Escherichia coli strains, respectively, but intI3 was not found in any isolates. The presence of integrons was significantly associated with resistance to ampicillin, trimethoprim/ sulfamethoxazole, ceftazidime, and ciprofloxacin antibiotics (P<0.05). Conclusions: The high resistant Escherichia coli isolates harboring class 1 integrons (intI1) were detected in patients with urinary tract infection in our region. Therefore, preventive strategies are necessary to restrict further dissemination of resistant strains.
Objective: To investigate the frequency of integrase genes intI1, intI2 and intI3 of Escherichia coli strains, and their association with resistance to routinely used antibiotics. Methods: A total of 120 Escherichia coli strains were collected from patients with urinary tract infection in Ahvaz, Southwest of Iran. Antibiotic susceptibility testing was performed. The presence of intI1, intI2, andintI3 genes was determined by polymerase chain reaction. Results: Antibiotic susceptibility testing disclosed the highest resistance rate to ampicillin (91.7%) followed by trimethoprim/sulfamethoxazole (65.8%), and ceftazidime (56.7%). The imipenem susceptibility rate was 91.7%. IntI1 and intI2 were identified in 74 (61.6%) and 8 (6.6%) of Escherichia coli strains, respectively, but intI3 was not found in any isolates. The presence of integrons was significantly associated with resistance to ampicillin, trimethoprim/ sulfamethoxazole, ceftazidime, and ciprofloxacin antibiotics (P<0.05). Conclusions: The high resistant Escherichia coli isolates harboring class 1 integrons (intI1) were detected in patients with urinary tract infection in our region. Therefore, preventive strategies are necessary to restrict further dissemination of resistant strains.
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.
2018(2):49-68, DOI: 10.4103/2221-6189.233013
Abstract:
The I-Ching is one of the most significant texts in the literature of the world and embodies, as no other text does, the Chinese spirit and thought. Its perpetuation along millennia has exercised crucial influence on the development of Chinese philosophy and medicine. The hypotheses of its abstractions compose a “body of assumptions” that hierarchs concepts through a self-regulated process of reciprocal control, which allows the accurate prediction of specific sequences of events according to “fields of similarities”. This peculiarity enables this system of knowledge to make possible predictions based upon the Natural Laws with incredible accuracy, which is effective to process expectations and arguments or to affirm or reject its judgments. A detailed analysis of two consecutive hexagrams (N°23 & N°24) allows the understanding not only of the bases that consolidate the “Reconciliation vessel” but also of the specific determination of its function in the frame of Risk management that can be compared to present ISO standards.
The I-Ching is one of the most significant texts in the literature of the world and embodies, as no other text does, the Chinese spirit and thought. Its perpetuation along millennia has exercised crucial influence on the development of Chinese philosophy and medicine. The hypotheses of its abstractions compose a “body of assumptions” that hierarchs concepts through a self-regulated process of reciprocal control, which allows the accurate prediction of specific sequences of events according to “fields of similarities”. This peculiarity enables this system of knowledge to make possible predictions based upon the Natural Laws with incredible accuracy, which is effective to process expectations and arguments or to affirm or reject its judgments. A detailed analysis of two consecutive hexagrams (N°23 & N°24) allows the understanding not only of the bases that consolidate the “Reconciliation vessel” but also of the specific determination of its function in the frame of Risk management that can be compared to present ISO standards.
2019(6):233-238, DOI: 10.4103/2221-6189.272854
Abstract:
Objective: To determine the effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery. Methods: This randomized clinical trial study was performed on 96 patients undergoing knee replacement surgery, who were randomly divided into two groups: the control group and the intervention group, with 48 patients in each group. In the intervention group, the patients received educational intervention in four stages (one day before surgery, 24 h and 48 h later, upon discharge from the hospital. In the control group, only the routine of the hospital was performed. Questionnaires were completed before and 6 weeks after the intervention. Results: The mean scores of pain, knee stiffness and performance difficulty were significantly decreased in the intervention group (P=0.01). Compared to the control group, the intervention group had a better outcome of the illness, including pain, knee stiffness and performance difficulty (P=0.001). Conclusion: Rehabilitation education could be a suitable way to improve the surgical outcomes of patients undergoing total knee replacement.
Objective: To determine the effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery. Methods: This randomized clinical trial study was performed on 96 patients undergoing knee replacement surgery, who were randomly divided into two groups: the control group and the intervention group, with 48 patients in each group. In the intervention group, the patients received educational intervention in four stages (one day before surgery, 24 h and 48 h later, upon discharge from the hospital. In the control group, only the routine of the hospital was performed. Questionnaires were completed before and 6 weeks after the intervention. Results: The mean scores of pain, knee stiffness and performance difficulty were significantly decreased in the intervention group (P=0.01). Compared to the control group, the intervention group had a better outcome of the illness, including pain, knee stiffness and performance difficulty (P=0.001). Conclusion: Rehabilitation education could be a suitable way to improve the surgical outcomes of patients undergoing total knee replacement.
2018(2):88-89, DOI: 10.4103/2221-6189.233018
Abstract:
Pox is an important infection that can cause the acute illness with dermatological manifestation. Apart from the well-known pox infections, the emerging zoonotic pox infections become interesting new issue in infectious medicine. In this short review, the acute illness which results from new important zoonotic pox infections such as monkeypox, cowpox, raccoon pox and buffalopox is discussed and summarized.
Pox is an important infection that can cause the acute illness with dermatological manifestation. Apart from the well-known pox infections, the emerging zoonotic pox infections become interesting new issue in infectious medicine. In this short review, the acute illness which results from new important zoonotic pox infections such as monkeypox, cowpox, raccoon pox and buffalopox is discussed and summarized.
2019(2):45-52, DOI: 10.4103/2221-6189.254411
Abstract:
Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.
Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.
2018(2):69-73, DOI: 10.4103/2221-6189.233014
Abstract:
Objective: To study the effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury. Methods: Patients with acute craniocerebral trauma who were admitted to the Third People's Hospital of Zigong from April 2014 to December 2016 were selected as the subjects and were randomly divided into two groups. The control group received conventional treatment, and the intervention group received large doses of vitamin C and vitamin E combined with conventional treatment. On the 3th day and 7th day after treatment, peripheral blood was collected and serum was isolated, then the contents of nerve injury index NSE, S100B, NGB, UCH-L1, Tf, Ft and neurotrophic indexes NTF-a, BDNF, NGF and IGF-I were determined by Enzyme-linked immunosorbent assay kit, and the contents of SOD, GPx, CAT, OH-, O2-, MDA and AOPP were measured by radioactive immunoprecipitation kit. Results: 3th day and 7th day after treatment, the contents of NSE, S100B, NGB, UCH-L1, Tf, Ft, NTF-a, BDNF, NGF, IGF-I, OH-, O2-, MDA and AOPP in the intervention group were all significantly lower than those in the control group. The content of SOD, GPx and CAT in serum in the intervention group was significantly higher than that in the control group. Conclusions: High-dose vitamin C and vitamin E treatment can alleviate nerve injury, oxidative stress response, and improve neurotrophic state in patients with acute craniocerebral injury.
Objective: To study the effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury. Methods: Patients with acute craniocerebral trauma who were admitted to the Third People's Hospital of Zigong from April 2014 to December 2016 were selected as the subjects and were randomly divided into two groups. The control group received conventional treatment, and the intervention group received large doses of vitamin C and vitamin E combined with conventional treatment. On the 3th day and 7th day after treatment, peripheral blood was collected and serum was isolated, then the contents of nerve injury index NSE, S100B, NGB, UCH-L1, Tf, Ft and neurotrophic indexes NTF-a, BDNF, NGF and IGF-I were determined by Enzyme-linked immunosorbent assay kit, and the contents of SOD, GPx, CAT, OH-, O2-, MDA and AOPP were measured by radioactive immunoprecipitation kit. Results: 3th day and 7th day after treatment, the contents of NSE, S100B, NGB, UCH-L1, Tf, Ft, NTF-a, BDNF, NGF, IGF-I, OH-, O2-, MDA and AOPP in the intervention group were all significantly lower than those in the control group. The content of SOD, GPx and CAT in serum in the intervention group was significantly higher than that in the control group. Conclusions: High-dose vitamin C and vitamin E treatment can alleviate nerve injury, oxidative stress response, and improve neurotrophic state in patients with acute craniocerebral injury.
2018(6):225-233, DOI: 10.4103/2221-6189.248026
Abstract:
The large amount of classifications about the concept of death from a medical-legal perspective leads us to think that there are still many aspects to accurately define that precise moment in which the end of our earthly existence is considered as a final and unalterable fact. An answer to such a question may come from a retrospective analysis of those victims of impending-death situations that have been rescued after both basic and advanced cardiac pulmonary resuscitation failure and their consequent medical-legal death declaration. The aim of the following work is to introduce a new phase within forensic thanatology, supported by a complementary resuscitation maneuver based upon millennial traditional Chinese medicine principles together with a detailed analysis of current global agreements on organ transplantation and an avant-garde perspective on actual knowledge about cell death. Those terms will then allow us to achieve a holistic view of said concept, still loosely defined at present. Such an innovative diagnostic-therapeutic resource can in turn enable us to evaluate and face the irreversibility of such extreme situation, analyzing the statistical feasibility of its promising results.
The large amount of classifications about the concept of death from a medical-legal perspective leads us to think that there are still many aspects to accurately define that precise moment in which the end of our earthly existence is considered as a final and unalterable fact. An answer to such a question may come from a retrospective analysis of those victims of impending-death situations that have been rescued after both basic and advanced cardiac pulmonary resuscitation failure and their consequent medical-legal death declaration. The aim of the following work is to introduce a new phase within forensic thanatology, supported by a complementary resuscitation maneuver based upon millennial traditional Chinese medicine principles together with a detailed analysis of current global agreements on organ transplantation and an avant-garde perspective on actual knowledge about cell death. Those terms will then allow us to achieve a holistic view of said concept, still loosely defined at present. Such an innovative diagnostic-therapeutic resource can in turn enable us to evaluate and face the irreversibility of such extreme situation, analyzing the statistical feasibility of its promising results.
2019(5):215-220, DOI: 10.4103/2221-6189.268412
Abstract:
Rationale: Acute myocardial infarction in the presence of right bundle branch block. Patient concerns: A 70-year-old, male heavy smoker presented with angina and hypertension. Interventions: Electrocardiography, intravenous nitroglycerin infusion, intravenous streptokinase infusion. Diagnosis: Acute myocardial infarction in the presence of with changeable trifascicular heart block. Outcomes: Dramatic clinical improvement with electrocardiographic ST-segment (whether elevation or reciprocal ST-depression) resolution. Lessons: Acute myocardial infarction may be associated right bundle branch block. Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block with left axis deviation and post-streptokinase left posterior fascicular block with right axis deviation.
Rationale: Acute myocardial infarction in the presence of right bundle branch block. Patient concerns: A 70-year-old, male heavy smoker presented with angina and hypertension. Interventions: Electrocardiography, intravenous nitroglycerin infusion, intravenous streptokinase infusion. Diagnosis: Acute myocardial infarction in the presence of with changeable trifascicular heart block. Outcomes: Dramatic clinical improvement with electrocardiographic ST-segment (whether elevation or reciprocal ST-depression) resolution. Lessons: Acute myocardial infarction may be associated right bundle branch block. Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block with left axis deviation and post-streptokinase left posterior fascicular block with right axis deviation.
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