Journal of Acute Disease
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    2020(4):137-144, DOI: 10.4103/2221-6189.288590
    Abstract:
    The author has performed several rescues in both basic and advanced CPR failure. Such practice consists in stimulating an acupuncture point called KI-1 Yongquan, where terrestrial Yin energy enters into our bodies to nourish heart and lungs to maintain vital functions. Said stimulus follows the same ascending path of a lightning bolt. This integration between heart and kidneys makes up the deepest energetic level in acupuncture: the Shao Yin. Such level not only proceeds over cardiovascular physiology but also influences the central nervous system. This helps us to better understand the outstanding response when applied in cardiac arrest and stroke (84.51% survival rate in last 30 years). Such benefit in patients with bilateral amputation lead the discovery of a new energetic path called “reconciliation vessel”, presented before the Chinese National Academy of Medical Science in 2014 and 2016. The “resuscitator” can be used when physical barriers hamper the precordial massage: crashed or overturned vehicles, building collapses, landslides, and other catastrophes with a large number of victims. This prototype was developed under safety measures to avoid any collateral damage in patients or rescuers. By 2020, the global number of victims of cardiovascular diseases will involve 30 million people. Adding the 7% of brain-vascular victims will reach over 30% of all causes of death. Advanced technology may provide the “resuscitator” with global positioning systems to notify the emergency network to send the closest rescue unit to the victim. The present invention has been developed to assist resuscitation maneuvers in humans as well for veterinary use.
    2020(4):145-151, DOI: 10.4103/2221-6189.288591
    Abstract:
    The five main arbovirus families that cause diseases in humans and other animals are Bunya viridae, Togaviridae, Flaviviridae, Reoviridae, and Rhab doviridae. Chikungunya arbovirus (Togaviridae: Alphavirus), an arbovirus transmitted by Aedes spp., is a well-known global health threat. It has been recognized in more than 60 countries in Asia, Africa, Europe, and the Americas. Pakistan, the eastern neighborhood of Iran, is one of the endemic foci of this disease. As the largest province of Iran, SistanBaluchestan has always been threatened by infectious diseases from abroad due to its geographical location and neighborhood with Afghanistan and Pakistan. Contagious diseases are more likely to occur in the eastern borders of Iran arising from (1) lack or limited jobs due to deprivation of the area, the harsh weather conditions, unbearable conditions, traditional society, and lack of industry development; (2) Lack or limited facilities due to the distance from the center of the country and high percentage of illiteracy or low literacy, and traffic to neighboring countries to trade goods and get a job. Therefore, health authorities should pay more attention to trafficking of illegal aliens, traveling of people to high-risk countries, smuggling of livestock, and strengthening of quarantine posts across borders, especially in the eastern borders of Iran. The first case of chikungunya disease was confirmed in Sistan-Baluchestan province in 2019, where most of the cases have been reported. The findings of the present study provide evidence of chikungunya virus in Iran and emphasize the urgency to increase the preventive standards and surveillance system.
    2020(4):152-156, DOI: 10.4103/2221-6189.288592
    Abstract:
    Objective: To evaluate the incidence of Enterobius vermicularis (E. vermicularis) in appendectomies in Iran from 1993 to 2018 . Methods: Data were systematically collected on the electronic databases including PubMed, GoogleScholar, ScienceDirect, Scopus, Web of Science, Magiran, Irandoc (Bareket), IranMedex, and Scientific Information Database in English or Persian. Six articles including 29 694 cases of appendicitis with 258 positive cases of infection with E. vermicularis were eligible to enter into this systematic review and meta-analysis. Results: The overall prevalence of E. vermicularis in appendicitis in Iran was 1% (95%CI=0.00-0.02) with the highest rate of 3% (95%CI=0.02-0.03) and lowest rate of 0% (95%CI=0.00-0.01). Conclusions: Prevalence of E. vermicularis infectionin appendicitis in Iran is low and has no statistically significant correlation with age and gender.
    2020(4):157-160, DOI: 10.4103/2221-6189.288593
    Abstract:
    Objective: To investigate the prevalence of isolated organisms in patients with lower respiratory tract infections and the antibiotic susceptibilities at a tertiary care center. Methods: In this observational and cross-sectional analysis, 114 patients admitted in the intensive care unit were enrolled. The endotracheal aspirates and bronchoalveolar lavage were collected. The bacteria were isolated and identified, and finally, antimicrobial sensitive pattern of the isolated bacteria was examined. Results: The prevalence of infection was 72.72% in male patients and 27.28% in females. The predominant bacteria were Klebsiella pneumoniae (37.50%) followed by Acinetobacter spp. (36.36%), Pseudomonas aeruginosa (7.95%), Escherichia coli (6.81%), Proteus mirabilis (2.27%), atypical Escherichia coli (1.13%), Enterococcus spp. (1.13%), Elizabethkingia meningoseptica (1.13%), Staphylococcus aureus (1.13%), Proteus vulgaris (1.13%), Citrobacter freundii (1.13%), and Citrobacter koseri (1.13%). High resistance to cephalosporins (82.18%) was demonstrated in all Gram-negative bacteria. Bacteria showed susceptibility to colistin (88.75%) followed by tigecycline (83.11%), gentamycin (36.18%), and amikacin (49.23%). Conclusions: As the most frequent respiratory organisms, Klebsiella pneumoniae and Acinetobacter spp. have increased resistance to cephalosporins and susceptibility to colistin followed by tigecycline.
    2020(4):161-165, DOI: 10.4103/2221-6189.288594
    Abstract:
    Objective: To compare the effect of 8-week and 12-week of triple therapy (doxycycline, rifampicin, and gentamicin) on brucellosis. Methods: This parallel clinical trial was conducted on 339 brucellosis patients who were divided into 2 groups. The first group (175 patients) received doxycycline (100 mg/12 h) for 8 weeks, rifampicin (600 mg/d) for 8 weeks, and gentamicin (5 mg/kg/ d) for 7 d, while in the second group (164 patients), doxycycline and rifampicin treatment were prolonged to 12 weeks, along with gentamicin therapy for 7 d. The patients were followed-up for six months after the treatment. Baseline information, clinical manifestations of the patients were collected, and serological tests for brucellosis were performed after the treatment. Results: The mean age of the patients was (45.95 ± 18.65) years, and 56.9% of the patients were male. In total, 73.5% of the patients were residents in rural areas and the majority of them were farmers and ranchers (34.6%). The 3-month relapse rates of the two groups were 11.42% and 6.70%, respectively (P=0.132). Moreover, the 6-month relapse rate of the two groups was 6.3% and 2.4%, respectively (P=0.085). In the two groups, both treatments could reduce serological titers based on Wright and 2ME tests (P<0.05). Conclusions: The efficacy of 8-weeks and 12-weeks triple therapy (doxycycline, rifampicin, and gentamicin) is similar in terms of brucellosis relapse. The 8-week triple therapy including doxycycline, rifampicin, and gentamicin can be considered as an effective approach for the treatment of brucellosis.
    2020(4):166-169, DOI: 10.4103/2221-6189.288595
    Abstract:
    Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type II fracture and 20 had Mason type III fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions: The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.
    2020(4):170-175, DOI: 10.4103/2221-6189.288596
    Abstract:
    Objectives: To assess the outcomes of the intensive care of Syrian refugees under temporary protection (SRUTP). Methods: The sample of the study was composed of 110 SRUTP patients who were treated at a tertiary intensive care unit (ICU) between 2013 and 2019 in Istanbul, Turkey. Baseline information and clinical data of the patients were collected by scanning the hospital’s electronic database and clinical decision support system. Results: The mean length of ICU stay was 97.6 (36.3-187.8) h. Among the patients, 71 (64.5%) had comorbid diseases, and ICU mortality was 40%. The median cost of health care for each patient was 2 144 (1060-4 471) USD, and the total health care cost of all patients was 534012USD. Conclusions: Use of vasoactive drug, hemodialysis application, and low Glasgow Coma Scale scores are independent risk factors of the mortality. More researches are needed to clearly reveal the health and cost consequences of war.
    2020(4):176-178, DOI: 10.4103/2221-6189.288597
    Abstract:
    Rationale: Cope’s sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient’s concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope’s sign and complete heart block. Intervention: Emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.
    2020(4):179-182, DOI: 10.4103/2221-6189.288598
    Abstract:

    Rationale:
    Fever of unknown origin (FUO) is a frequently observed phenomenon in clinical practice. Definite diagnosis of FUO is a great challenge in clinical practice since potential causes for FUO involve more than 200 diseases. Adult-onset Still’s disease is a defined clinical entity and a known rare cause of FUO.
    Patient’s concern:
    A 19-year girl was referred to the clinic with the concern of intermittent fevers and shivering for almost a year despite multiple investigations and consultations. She had undergone intensive serologic, radiologic, laboratory investigations to exclude infectious diseases, connective tissue diseases, and malignancy, and all the investigation showed no conclusive diagnosis.
    Diagnosis:
    Adult-onset Stills disease.
    Intervention:
    Steroids and supportive treatment.
    Outcomes:
    The symptoms were relieved within three days, and the patient became asymptomatic.
    Lessons:
    Physicians need to be familiar with the diagnostic criteria of adult-onset Still’s disease, or it shall remain a diagnostic dilemma. Besides, all shivers are not infections.
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    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.
    2019(2):53-57, DOI: 10.4103/2221-6189.254426
    Abstract:
    Objective: To evaluate the drug susceptibility profiles and the frequency of beta-lactamase encoding genes in Pseudomonas aeruginosa (P. aeruginosa) obtained from burn patients. Methods: Totally 93 non-duplicate clinical isolates of P. aeruginosa were recovered from burn patients of Taleghani Burn Hospital of Ahvaz. Antibiotic susceptibility testing was conducted by disk diffusion method according to the CLSI 2017 recommendations. PCR assay was performed by to find beta-lactamase encoding genes. Results: In this study, most clinical specimen was obtained via wound swabs [65 (69.9%)], followed by blood [14 (15.1%)] and biopsy [7 (7.5%)]. Forty-two (45.16%) patients were male and 51(54.84%) were female. High resistance was observed for most of antibiotics especially for gentamicin and ciprofloxacin (Up to 85%), whereas the highest susceptibility was reported for colistin (100.0%), followed by ceftazidime (66.7%). According to PCR results, 16.1% (15), 9.7% (9) and 14.0% (13) of isolates carried blaDHA, blaVEB and blaVEB genes, respectively. It also revealed that the blaVEB gene was found to coexist within 2 isolates (2.2%). Conclusions: Antibacterial resistance is high among P. aeruginosa isolates. Colistin is highly active against multi-drug resistant P. aeruginosa isolates. Antimicrobial susceptibility testing can confine indiscriminate uses of antibiotics and resistance increase, and can improve management of treatment.
    2019(2):58-62, DOI: 10.4103/2221-6189.254427
    Abstract:
    Objective: To specify the clinical and sociodemographic characteristics, risk factors, factors affecting mortality including hematologic parameters, and red blood cell distribution width to platelet ratio (RPR) in patients with pulmonary thromboembolism, and to reduce the mortality. Methods: The archive records of patients diagnosed with pulmonary embolism were retrospectively examined. The histories, risk factors, physical examination findings, arterial blood gas analysis, X-rays, laboratory, and computed tomography reports of all cases were obtained via the hospital information system. Logistic regression analysis was performed to determine the independent variables affecting early mortality. Results: A total of 146 patients with a definitive diagnosis of pulmonary thromboembolism were included. Thirteen point seven percent (n=20) of the deceased patients died at early term. Ninety percent of patients with early mortality was 65 years or older. There were significantly differences in age, RPR, D-dimer, creatinine, lymphocyte, pH, and body temperature between patients with and without early mortality (P=0.017, P<0.001, P=0.019, P=0.025, P=0.042, P=0.013, P=0.017, respectively).Logistic regression analysis showed that RPR was a statistically significant and independentrisk factors of mortality [P=0.026, OR: 0.254., 95% CI (0.326-5.056)]. In addition, there was a significant difference in pulmonary embolism severity index classification between patients with and without early mortality(P<0.034). Conclusions: RPR is an independent risk factor of mortality of pulmonary embolism patients and may help emergency physician to stratify mortality risks of pulmonary embolism patients.
    2019(2):67-71, DOI: 10.4103/2221-6189.254429
    Abstract:
    Objective: To examine if hypoxia-inducible factor-1α (Hif-1α) polymorphisms are associated with pediatric acute respiratory distress syndrome (PARDS). Methods: Twenty two patients with PARDS and 11 non-PARDS controls were examined in pediatric intensive care unit in Cukurova University Balcali Hospital. Blood polymorphism was used to assess the Hif-1α C1772T and G1790A polymorphisms of Hif-1 αgene, and differences in genotypes between the 2 groups were compared. Results: Hif-1 α C1772T polymorphism was observed only in one case of PARDS group but non-PARDS group didn't show any C1772T polymorphism. Particularly, the difference in number of cases with Hif-1 α G1790A polymorphism was not significant between PARDS and non-PARDS groups. In addition, Hif-1 α G1790A polymorphism was significantly related to the distribution of lung opacities in children with PARDS (P<0.05). Conclusions: Our results indicate that Hif-1 α G1790A polymorphism is related to an increased susceptibility to pulmonary for PARDS children. The detection of G1790A polymorphism could help pediatricians to predict the extensity of PARDS early in lung tissue.
    2019(2):72-77, DOI: 10.4103/2221-6189.254430
    Abstract:
    Objective: To explore the patterns and prevalence of complications of type 2 diabetes mellitus(T2DM) in Jazan region. Methods: A cross-sectional study was conducted with a sample (n=281) of the Jazan population attending Jazan Diabetes Centre. A structured questionnaire was used for data collection, and the statistical analysis was performed using SPSS ver. 17.0(SPSS Inc., Chicago,Ⅱ , USA) software. Results: The prevalence of one or more complications due to T2DM was 42.7%, which was significantly increased with age, BMI and T2DM duration. The prevalence also differed significantly according to gender and participation in exercise (P<0.05 for all factors). The prevalence of cardiovascular complications was found to be 7.1%, higher among males (9.4%) than females (4.1%), although the difference was not significant (P>0.05). The prevalence of retinopathy was estimated as 32.4% and significantly differed according to gender, age groups, participation in exercise and BMI categories (P value< 0.05 for all). The multivariate logistic regression analysis suggested that the most important independent predictors of T2DM complications were T2DM duration (11-15 years) (P=0.028,OR=3.54) and having T2DM for more than 15 years (P=0.013, OR=5.38). Conclusions: This study reveals a high prevalence of long-term complications among T2DM patients attending Jazan Diabetes center. T2DM prevention and proper T2DM management strategies are strongly needed to minimize the burden of the disease due to T2DM complications.
    2019(2):63-66, DOI: 10.4103/2221-6189.254428
    Abstract:
    Objective: To explore the characterization and frequency of antibiotic resistance related to membrane porin and efflux pump genes among Acinetobacter baumannii (A. baumannii) strains obtained from burn patients in Tehran, Iran. Methods: In this cross-sectional descriptive study, 100 strains of A. baumannii isolated from burn patients visiting teaching hospitals of Tehran were collected from January 2016 to November 2017. After A. baumannii strains were confirmed, antimicrobial susceptibility testing was done via Kirby-Bauer disc diffusion method according to the Clinical and Laboratory Standards Institute guidelines. PCR amplification was performed for detection of β-lactamase adeR, OprD, adeS genes among A. baumanniistrains. Results: All isolates (100%) were resistant to ceftazidime, cefotaxime, cefepime,ciprofloxacin, and piperacillin, and most isolates indicated high resistance (95%-97%) to meropenem, imipenem, gentamicin, ceftriaxone, trimethoprim-sulfamethoxazole, piperacillintazobactam,amikacin, and tetracycline. The most effective antibiotic against A. baumanniiisolates was colistin (97% sensitivity), followed by tigecycline. The frequency of OprD, adeS,and adeR genes were 98%, 91%, and 77%, respectively. Conclusions: This study shows that the majority of A. baumannii isolates are highly resistant to the antibiotics most commonly used in burn patients. Also, high distribution of OprD and adeRS genes may be responsible for the observed resistances among A. baumannii isolates that demonstrate the possible role of both efflux pumps in simultaneous of carbapenemase production during antibiotic resistance.
    2019(2):78-81, DOI: 10.4103/2221-6189.254431
    Abstract:
    Shoshin syndrome is a rare fulminating heart failure caused by thiamine deficiency. In Japanese “sho” means acute damage and “shin” means heart. It consists of a rare and hyperacute manifestation of beriberi that was first described in polished white rice-eating communities in various locations across Asia including China, Japan and Indonesia. In a totally different context, ‘Shoshin’ is a word from Zen Buddhism meaning "beginner's mind”, which is considered the necessary attitude to approach the Zen practice. This case report is a prime example of clinical manifestations of thiamine deficiency for the presence of both cardiological and neurological disorders, for hyperacute onset of cardiac failure (shoshin syndrome), for the simultaneous involvement of peripheral and central nervous system, and for the dramatic global recovery after thiamine replacement therapy. We therefore explain why the physician should adopt a beginner’s mind in clinical practice.
    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.
    2019(2):84-85, DOI: 10.4103/2221-6189.254434
    Abstract:
    Uncontrolled diabetes gives rise to severe systemic complications that affect different systems of our body. Among those complications, hemiballismus is a rare manifestation that occurs due to hyperglycemia and can be reversible in most cases by decreasing elevated sugar levels to normal range. Here, we present a case of a patient with diabetic history since 10 years ago, who presented with uncontrolled jerky movements on one side of his body since 15 d, and he recovered after appropriate therapy. Medication adherence in diabetic patients and regular monitoring of blood sugar levels are important.
    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.
    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.
    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.
    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.
    2019(2):86-88, DOI: 10.4103/2221-6189.254435
    Abstract:
    Rationale: Acute abdomen is a medical emergency that requires prompt diagnosis and management. Lymphoma is a rare cause of acute abdomen. Patient concerns: A 54 year old patient complained of repeated episodes of acute abdominal pain over the past 3 months. Diagnosis: Mantle cell lymphoma. Interventions: Chemotherapy and stem cell transplantation.Outcomes: Abdomen pain disappeared and the patient was discharged uneventfully. Lessons: Although it is a rare cause of acute abdomen, lymphoma should be included in the differential diagnosis workup of patients with unexplained and unusual acute abdomen.
    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.
    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.
    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.
    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.
    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.
    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.

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