Journal of Acute Disease

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  • 1  Diagnostic value of biomarkers for sepsis in adult patients in theemergency department: Don't forget the neutrophil-lymphocyte countratio
    G Visveswari Bernadette Tan Qiao Min Fatimah Lateef
    2019(2):45-52. DOI: 10.4103/2221-6189.254411
    [Abstract](199) [HTML](0) [PDF 708.99 K](1403)
    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.
    2  Energetic death: The unknown phase of thanatology
    Adrián ángel Inchauspe
    2018(6):225-233. DOI: 10.4103/2221-6189.248026
    [Abstract](170) [HTML](0) [PDF 901.49 K](358)
    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.
    3  Legionella and legionnaires' disease: An overview
    Nabi Jomehzadeh Mojtaba Moosavian Morteza Saki Mohammad Rashno
    2019(6):221-232. DOI: 10.4103/2221-6189.272853
    [Abstract](128) [HTML](0) [PDF 3.33 M](347)
    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.
    4  Preparedness for handling injuries by female primary school teachers: A cross-sectional survey in Southwestern Saudi Arabia
    Hafiz A Makeen Ahmed A Albarraq Otilia J F Banji Shamna Machanchery AbdulKarim Meraya Saad Alqahtani Amal Abdullah Mubaraki David Banji
    2019(6):239-244. DOI: 10.4103/2221-6189.272855
    [Abstract](128) [HTML](0) [PDF 2.28 M](277)
    Objective: To assess the preparedness for handling injuries by female primary school teachers based on their knowledge, attitude, practice and their willingness to learn first aid. Methods: A cross-sectional questionnaire on first aid was provided to female primary school teachers, and the knowledge, attitude, practice and their willingness to learn first aid were investigated. Data were analyzed using SPSS version 23. Quantitative data were analyzed by one-way ANOVA, categorical variables were analyzed by the Chi-square test. The level of significance was set at P<0.05. Results: In total, 464 teachers of different age groups and education responded. The mean knowledge score was low but the mean attitude score was high. Parental consent was sought by one-fourth of the teachers, and 25.6% of teachers documented the health status of children. Most of the teachers desired to have a first aider, and they were keen on training (62.3%) and educating children (88.1%) on first aid. Knowledge scores were significantly impacted by age (P<0.05) and experience (P<0.01), while specialization impacted mean practice scores (P<0.001). Teachers’ qualification (P<0.05), first action to be taken at the accident site (P<0.05), and frequency of training (P<0.05), were significantly associated with the need of a first aider. Conclusions: Based on the paucity of awareness and expertise, on priority basis, it is important to strengthen teachers’ skills. Child safety is an important public health issue and can be improved by educating and training teachers.
    5  Effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery: A randomized clinical trial
    Sheyda Atabaki Mansoureh Ashghali Farahani Shima Haghani
    2019(6):233-238. DOI: 10.4103/2221-6189.272854
    [Abstract](126) [HTML](0) [PDF 3.12 M](316)
    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.
    6  Acute cyanide poisoning due to apricot kernel ingestion
    Mehmet Tatli G?khan Eyüpo?lu Hilal Hocagil
    2017(2):87. DOI: 10.12980/jad.6.2017JADWEB-2016-0075
    [Abstract](118) [HTML](0) [PDF 236.58 K](182)
    Cyanide is a toxin and one of the most rapidly acting fatal poisons that human being is aware. If it is not treated promptly, encountering to cyanide poison will lead to die in minutes. Cyanide avoids cellular oxygen usage by inactivating mitochondrial cytochrome oxidase thus inhibits cellular respiration. In this case, we represent a case report describing uncommon cyanide intoxication owing to consumption of a few portion of apricot kernels and its rapid treatment with dicobalt edetate after suspection of cyanide poisoning.
    7  "Reconciliation vessel" within de I-Ching book: Theoretical methodological analysis of its relevant hexagrams
    Adrian Angel Inchauspe
    2018(2):49-68. DOI: 10.4103/2221-6189.233013
    [Abstract](114) [HTML](0) [PDF 835.61 K](344)
    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.
    8  Descriptive epidemiological study of burn admissions to the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital, Kumasi-Ghana, 2009–2016
    Pius Agbenorku Manolo Agbenorku Angelina Tima Effah Abdul-Rahman Adamu Bukar Nana Yaa Odamea Asare
    2017(3):112. DOI: 10.12980/jad.6.2017JOAD_2016_76
    [Abstract](112) [HTML](0) [PDF 387.72 K](223)
    Objective: To determine the trends in burn admissions, and aetiology, severity and mortality of patients admitted to the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital from May 2009 to April 2016 (7 years). Methods: Patients’ data used in this longitudinal and retrospective study were accessed from the records of the Reconstructive Plastic Surgery and Burns Unit. Processed data were depicted in tables and figures as appropriate. Univariate and multivariate analysis and Pearson’s rank correlation were used in comparing relevant groups. Data analysis was conducted using Excel version 2013 and SPSS version 17.0. Results: A total of 681 patients, with a male to female ratio of 1.1:1.0, were analysed. The average annual incidence was 97.28 with a progressive decline in incidence. Mortality rate was 24.2%. Majority of the patients were children less than 10 years (43.5%) with scalds as the main aetiology in this group. Open flame was the major aetiology of burns (49.9%). Majority of the patients spent less than 10 days on admission (67.1%). Mean total body surface area was 30.54%. There was correlation between TBSA and disposition, total body surface area and aetiology and number of days in the Burns Intensive Care Unit, total body surface area and aetiology, and aetiology and number of days in the Burns Intensive Care Unit. Conclusions: Children below 10 years were the main victims. There was a shift from scald to open flame burns in this current study. Mean total body surface area and mortality rate have increased. There is urgent need for prevention campaign of flame burn and first aid education on intensive burns.
    9  Noninvasive ventilation in cancer children with acute respiratory failure
    Sema Yilmaz Riza Dincer Yildizdas Oguz Dursun Bulent Karapinar Tanil Kendirli Demet Demirkol Agop Citak Alphan Kupesiz Hakan Tekguc Muhterem Duyu Pinar Yazic Ufuk Yukselmis Caglar Odek Ayhan Yaman Suleyman Bayraktar Guntulu ??k Fatma Betul Cakir
    2017(1):23. DOI: 10.12980/jad.6.2017JOAD_2016_46
    [Abstract](110) [HTML](0) [PDF 999.97 K](230)
    Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/FiO2 ratios were (164.22 ± 37.24) and (126.80 ± 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0001). Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation.
    10  The chest X ray in pulmonary embolism: Westermark sign, Hamptons Hump and Pallas sign. Whats the difference
    Tan Si Hong Shawn Lim Xin Yan Fatimah Lateef
    2018(3):99-102. DOI: 10.4103/2221-6189.236822
    [Abstract](110) [HTML](0) [PDF 667.37 K](661)
    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.
    11  Evaluation of the primary anastomosis side effects in patients with sigmoid volvulus in Imam Hossein and Firoozgar Hospitals in 2014-2015
    Mahdi Alemrajabi Mostafa Hosseini Behzad Nemati Honar Mahdi Kayyal Adnan Tizmaghz Amirmohsen Jalaeefar
    2017(3):103. DOI: 10.12980/jad.6.2017JADWEB-2016-0078
    [Abstract](107) [HTML](0) [PDF 216.22 K](221)
    Objective: The term volvulus is derived from a Latin word volvere means to turn, twist which is mainly referred to as twisting of sigmoid and can lead to ischemia and gangrene. Nowadays, it is the 3rd most common reason of bowel obstruction mostly in the Middle East countries, Africa, India, and Russia where average age is younger compared to the west (about 40 to 50). Methods: In this study, patients who referred to Imam Hossein and Firoozgar Hospitals within2014 and 2015were included by the first impression of obstruction and finally diagnosis of sigmoid volvulus that were not in septic shock. After primary survey, routine lab profile, electrolyte correction and resuscitation if needed, the process of choices of patients and terms and conditions were explained for patients. They were prepared for operation after obtaining a written consent. During operation, those who are not necrotic sigmoid and do not have peritonitis undergone primary resection and anastomosis of intestine as suggested by surgeon. Anastomosis has given by 3-0 silk thread separately. Results: Twenty-five patients, 7 females (28 %) and 18 males (72%), underwent primary resection and anastomosis whose age ranged from 18 to 84 (mean 61.5 years, variance 56, 25). Average leukocytes count for our patients once they entered the emergency ward was 8500(with max level of 14/9 and min of 4/1). Two patients had fever after operation. Five patients experienced tachycardia within 24hours after surgery and one patient experienced infectious wound and 2 cases passed away. Conclusions: With regard to the obtained results, examining all aspects of patients is recommended to conduct primary anastomosis. Primary anastomosis is not recommended for patients with multiple underlying diseases considering the longer operation time.
    12  Acute abdomen presentation in dengue fever during recent outbreak
    Bal Kishan Gupta Hardeva Ram Nehara Sahil Parmar Shyam Lal Meena Suresh Gajraj Jigyasa Gupta
    2017(5):198. DOI: 10.4103/2221-6189.219612
    [Abstract](103) [HTML](0) [PDF 393.78 K](172)
    Objective: To evaluate the etiology, clinical profile and outcome of acute abdomen presentation in Dengue Fever (DF). Methods: This clinical prospective study was done on confirmed cases of DF admitted in the department of medicine during recent epidemic (September 2015 to November 2016). All patients were evaluated clinically and by laboratory and imaging investigations and followed-up during hospital stay till discharge. The cause of pain abdomen was ascertained by blood tests (amylase, lipase and liver function test etc), radiology (Flat plate abdomen-erect, Ultrasonography of abdomen, CECT abdomen) and/or endoscopy. Results: Out of the 501 patients diagnosed as DF, 165 (32.93%) presented with acute abdomen. Some patients presented in other departments like surgery, gastroenterology and emergency, were later diagnosed as DF on laboratory evaluation. Various causes of acute abdomen in our study were nonspecific severe pain abdomen (67 cases), acute hepatitis (46) one had acute fulminant hepatitis, acute acalculous cholecystitis (31), ascitis (12), acute hyperemic gastritis with malena (5), acute pancreatitis (2), and 1 case each of acute appendicitis and acute jejuno-ileal intussuception. All patients were managed conservatively. One patient of acute pancreatitis died of multi-organ failure. Conclusion: Our study concludes that clinical vigilance about such type of presentations is important as timely recognition can influence outcome and may prevent unwanted surgery.
    13  Frequency and molecular diagnosis of trichomoniasis in symptomatic women referred to laboratories in urmia north west Iran
    Elham Shahnazi Habib Mohammadzadeh Chiman Daneshyar Alireza Chavshin Shahram Khademvatan
    2017(4):175. DOI: 10.12980/jad.6.20170405
    [Abstract](102) [HTML](0) [PDF 306.79 K](184)
    Objective: To obtain the frequency of trichomoniasis and molecular diagnosis among women referred to a laboratory in Urmia (north west Iran). Methods: In the cross sectional study during the year 2014-2015, women with complaints of abnormal discharge, itching, irritation and unpleasant odor were studied using convenience sampling. These people were referred to one of the laboratories in city by gynecologist. After preparing the checklist of underlying data, vaginal wet smear samples was prepared to direct microscopy and molecular assess. Results were analyzed with statistical tests. Results: Totally 39.2% of referred cases were 30-40 years old, and about 54.8% of referred were illiterate and primitive. The frequency of trichomoniasis was 11.1% and statistically there was no significant difference. There was no significant difference among the age, education level, method of contraception, marriage age, location, employment status and the number of delivery with T. vaginalis. Conclusion: T. vaginalis compared to other studies have a moderate frequency among women of Urmia. Because of the concordance of this infection with other sexual transmitted diseases, it is recommended further studies about the prevalence of trichomoniasis in Urmia.
    14  Protective effects of Aristolochia longa and Aquilaria malaccensis against lead induced acute liver injury in rats
    Derouiche Samir Zeghib Khaoula Gharbi Safa Khelef Yahia Feriani Anouar
    2017(5):193. DOI: 10.4103/2221-6189.219611
    [Abstract](99) [HTML](0) [PDF 327.37 K](205)
    Objective: To investigate the protective effects of Aristolochia longa (A. longa) and Aquilaria malaccensis (A. malaccensis) on acute hepatotoxicity induced by lead in female albino rats. Methods: Twenty five (25) apparently healthy female Wistar rats were randomly divided into five groups of five rats in each: control, Pb, Pb + A. longa (Ar), Pb+ A. malaccensis (Aq), and Pb+ A. longa (Ar) + A. malaccensis (Aq) lead (100 mg/kg b.w.) as Pb (C2H3O2)2 added in their drinking water for 75 days. A. longa (rhizome powder at a dose of 10 g/kg of diet ) and A. malaccensis (heartwood powder at a dose 10 g/kg of diet) were added to the feed during the last 15 days of lead exposed in the animals. Results: Obtained results revealed that lead treatment caused a significant increase in serum GOT, GPT and ALP activities and in liver of MDA level and CAT activity. In contrast, it led to an decrease in the liver GOT, GPT and GST activities and in GSH level in rats. Also, the results clearly showed that lead causes alterations of hepatic tissue in comparison with controls. Our results showed that treatment with A. malaccensis and A. longa a partial correction of the previous parameters. The histological observations confirmed the hepatoprotection results by the biochemical parameters. Conclusions: Results demonstrated beneficial effects of A. longa and A. malaccensis treatment in Pb-induced oxidative stress and tissue damage in liver.
    15  Acute otitis media with facial nerve palsy: our experiences at a tertiary care teaching hospital of eastern India
    Santosh Kumar Swain Alok Das Jatindra Nath Mohanty
    2019(5):204-207. DOI: 10.4103/2221-6189.268410
    [Abstract](97) [HTML](0) [PDF 593.50 K](282)
    Objective: To assess acute otitis media with facial nerve paralysis, its prognosis, and treatment. Methods: It is a retrospective study. Thriteen patients of acute otitis media associated with facial nerve paralysis attended the outpatient department of otorhinolaryngology between May 2017 and April 2019. All patients were clinically assessed with appropriate investigations, prognosis, and treatment. Results: Out of 13 patients, 2 were identified with complete facial paralysis and the remaining 11 patients presented with incomplete paralysis. Medical treatment including antibiotics and corticosteroids failed, while myringotomy and facial nerve decompression were done with a favorable outcome. Eleven patients recovered to grade-I (House-Brackmann) and 2 cases to grade-II (House-Brackmann). Conclusion: Peripheral facial nerve paralysis in acute otitis media is rare. Antibiotics and steroids yield good outcome as conservative management. In case of failure by conservative treatment, facial nerve decompression yields a favorable outcome.
    16  Comparison between laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy
    Miao Zhou
    2017(3):97. DOI: 10.12980/jad.6.2017JADWEB-2017-0002
    [Abstract](96) [HTML](0) [PDF 261.59 K](218)
    Objective: To study the stress reaction after laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy. Methods: 68 patients with acute ruptured ectopic pregnancy who received emergency surgical treatment in Pangang Group General Hospital between July 2013 and September 2016 were selected and analyzed retrospectively, including 29 patients with laparoscopic surgery and 39 patients with laparotomy who were included in the laparoscopy group and laparotomy group respectively. Before operation as well as 1d and 3d after operation, serum was collected to detect biochemical indexes and stress hormones. Results: 1d and 3d after operation, serum Alb, AST, ALT, BUN, Scr and UA levels were not significantly different between laparoscopy group and laparotomy group (P>0.05); serum NE (149.65±17.58 vs. 186.61±23.52, 162.32±20.15 vs. 295.86±28.97 pg/mL), E (135.28±19.85 vs. 179.55±22.52, 152.11±18.52 vs. 231.38±29.58 pg/mL), ACTH (3.88±0.49 vs. 5.12±0.82, 4.39±0.52 vs. 6.58±0.92 pmol/L), Cor (177.64±20.12 vs. 224.59±35.55, 185.21±22.12 vs. 289.45±41.28 ng/mL), Ins (12.21±1.86 vs. 17.58±2.52, 18.95±2.68 vs. 27.61±4.12 IU/ mL), PRA (1.65±0.25 vs. 2.18±0.35, 1.73±0.21 vs. 2.55±0.47ng/mL), AngII (44.12±7.64 vs. 59.63±7.92, 52.27±7.95 vs. 76.12±9.35 pg/mL) and ALD (155.22±19.76 vs. 205.62±24.52, 189.10±22.58 vs. 316.85±42.85 pg/mL) levels of laparoscopy group were significantly lower than those of laparotomy group (P<0.05) Conclusions: Laparoscopic surgery for acute ruptured ectopic pregnancy causes less adrenal stress reaction and RAAS system stress reaction, and the overall level of trauma is lower than that of laparotomy
    17  Effect of protective lung ventilation strategy combined with lung recruitment maneuver in patients with acute respiratory distress syndrome (ARDS)
    Sheng Yu Tian-Xiao Hu Jun Jin Sheng Zhang
    2017(4):163. DOI: 10.12980/jad.6.20170403
    [Abstract](94) [HTML](0) [PDF 419.94 K](221)
    Objective: To evaluate the efficacy and safety of protective lung ventilation strategy combined with lung recruitment maneuver (RM) in the treatment patients with acute respiratory distress syndrome (ARDS). Methods: Totally 74 patients with ARDS admitted to the Department of Intensive Care Unit, Changshu Second People's Hospital in Jiangsu Province between September 2010 and June 2013 were selected and randomly divided into lung recruitment group and non-lung recruitment group, and the initial ventilation solution for both groups was synchronized intermittent mandatory ventilation (SIMV). For RM, SIMV mode (pressure control and pressure support) was adopted. Positive end expiratory pressure (PEEP) was increased by 5 cm H2O every time and maintained for 40-50 s before entering the next increasing period, and the peak airway pressure was kept below 45 cm H2O. After PEEP reached the maximum value, it was gradually reduced by 5 cm H2O every time and finally maintained at 15 cm H2O for 10 min. Results: A total of 74 patients with mean age of (49.0±18.6) years old were enrolled, 36 patients were enrolled in lung recruitment maneuver (RM) group and 38 patients were enrolled into non-lung recruitment maneuver (non-RM) group. 44 were male and accounted for 59.5% of all the patients. For the indicators such as PEEP, pressure support (PS), plateau airway pressure (Pplat), peak airway pressure (Ppeak), vital capacity (VC) and fraction of inspired oxygen (FiO2), no statistical differences in the indicators were found between the RM group and non-RM group on D1, D3 and D7 (P>0.05), except that only FiO2 of RM group on D7 was significantly lower than that of non-RM group (47.2±10.0) vs. (52.2±10.5), P>0.05). 28-day mortality, ICU mortality and in-hospital mortality were 25% vs. 28.9%, 25% vs. 26.3% and 36.1% vs. 39.5% respectively between RM group and non-RM group (all P>0.05). Conclusion: Protective lung ventilation strategy combined with lung recruitment maneuver can improve the indicators such as PaO2, FiO2 and PaO2/FiO2 on D7, but failed to improve the final outcomes such as 28-day mortality, ICU mortality and in-hospital mortality
    18  Prospected epigenetic moderators from natural sources and drug of class NSAIDS as effective treatment options to prostate cancer
    Vaibhav Dubey Richard Owusu-Apenten Shipra Tripathi Udaya Pratap Singh Alok Semwal
    2017(4):145. DOI: 10.12980/jad.6.20170401
    [Abstract](93) [HTML](0) [PDF 372.20 K](163)
    Prostate cancer (PC) is one of the most common and leading cancer amongst the males all around the world. Depending upon it long latency and cost involved in its management and treatment, there is extensive need for more personalized and economical therapeutic approach for its effective therapy. The current review here discusses agents from natural dietary sources and drug class Non-Steroidal Antinflammatory (NSAIDS) that bears chemopreventive potential to regulate PC progression & tumour development and therefore could be devised into effective future treatment strategy against PC along with its metastatic castration-resistant form. Based on the literature search the therapeutic scope of selected agents are delineated, sighting their previous activity and prospects as epigenetic moderators in specific to particular PC causing biomarkers like over expression of AKR1C3, lost intracellular glutathione/glutathione-stranferases(GSH/GST) expression, DNA hypermethylation, aberrant cell proliferation and other related factors that are thought to potentiate and aggravate the onset of PC like smoking and use of other narcotics products.
    19  Acute complications of liver hydatidosis: Still associated with significant morbidity
    Gianmarco Lotito Ionut Negoi Mircea Beuran
    2017(5):214. DOI: 10.4103/2221-6189.219615
    [Abstract](92) [HTML](0) [PDF 299.68 K](170)
    Objective: To detail the pattern of postoperative morbidity in patients with acute complications of liver hydatidosis.Methods: We retrospectively studied all patients with liver hydatidosis, managed in a tertiary university centre between January 2011 and December 2016. Results: Fifty-three patients with cystic liver echinococcosis and a mean age of (43.64±17.54) years were selected. The mean diameter of the cyst was (8.11± 4.84) cm. Thirty-five (66%), 12 (22.6%), 4 (7.5%), and 2 (3.8%) patients had one, two, three, or four cysts, respectively. Nine (17%) patients were admitted in an emergency setting. The surgical approach was by laparotomy in 43 (81.1%) and by laparoscopy in 10 (18.9%) patients. Eleven (20.8%) patients developed postoperative complications: Class I – 3 (5.7%), Class II – 7 (13.3%), Class III – 1 (1.9%), Class IV – 1 (1.9%) patient according to Clavien-Dindo classification. Four (7.5%) patients developed long-term complications. 18 (34%) patients had more than one hospital admissions. Conclusions: Acute complications of the liver hydatid disease are associated with significant post-therapeutic morbidity, which correlates with the cyst's type according to Gharbi classification.
    20  Effect of adjuvant therapy with ginkgo-damole on apoptosis, nerve injury and platelet aggregation of patients with acute cerebral infarction
    Zhi-Yong Lu
    2017(2):66. DOI: 10.12980/jad.6.2017JADWEB-2016-0064
    [Abstract](89) [HTML](0) [PDF 230.86 K](154)
    Objective: To investigate the effect of adjuvant therapy with ginkgo-damole on apoptosis, nerve injury and platelet aggregation of patients with acute cerebral infarction. Methods: A total of 74 patients with acute cerebral infarction treated in our hospital from March 2014 to December 2015 were retrospectively analyzed, and they were divided into ginkgo-damole group and conventional treatment group according to a therapeutic schedule that whether ginkgo-diyidamolum were included. At Week 2 and Week 4 after treatment, contents of apoptosis molecule, nerve injury molecule and index of platelet aggregation in serum were detected. Results: At Week 2 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients’ sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. At Week 4 after treatment, contents of soluble Fas, soluble Fas ligand, soluble tumor necrosis factor related apoptosis inducing ligand, S100β, neuron specific enolase, glial fibrillary acidic protein, myelin basic protein, malonaldehyde, endothelin-1, fibrinogen and D-dimer in patients’ sera of ginkgo-damole group were significantly lower than those of conventional treatment group. Contents of nitric oxide in sera were obviously higher than that of conventional treatment group. Conclusions: Adjuvant therapy with ginkgo-damole can inhibit the apoptosis of neuron cells and neurogliocyte and reduce the neural function injury and the situation of platelet aggregation.

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