Journal of Acute Disease
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    2019(6), DOI:
    Abstract:
    Objectives: To investigate the epidemiology of animal bites and associated factors in Abadeh district (central Iran) from 2012 to 2018. Methods: In this cross-sectional study, 1 407 individuals with animal bites who were referred to the Abadeh Rabies Treatment Center were investigated by using the census method from 2012 to 2018. The variables included the victim’s demographic information (age, gender, occupation), the type of biting animals (dog, cat, and other animals), the domesticated and wild animals, the time of biting based on year and month, the residence location (urban or rural), the treatment status, and the anatomical location of the wounds. Results: The annual incidence rate of animal bites was 189.62 per 100 000 population. Totally 83.4% of the victims were male. The average age was (33.66±18.97) years and individuals in the age range of 36-50 years were greater at risk. Most of the animal bites were from dogs (77.8%). About two thirds (62.1%) of the bites were from household animals. A total of 57.1% of individuals lived in urban areas. Most victims were engaged in farming and animal husbandry. The highest prevalence of animal bites (37.4%) happened in the summer. None of the patients had any clinical signs of rabies. Conclusions: To reduce the incidence of animal bites, high-risk groups including farmers and ranchers should be educated about bite prevention, and it should be ensured that they are managed correctly.
    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.
    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.
    2019(6):239-244, DOI: 10.4103/2221-6189.272855
    Abstract:
    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.
    2019(6):245-249, DOI: 10.4103/2221-6189.272856
    Abstract:
    Objective: To determine the prevalence of the recurrent stroke and its risk factors in the city of Ahvaz, Iran. Methods: The present study investigated the medical records of 389 ischemic stroke patients admitted to the Department of Neurology, Ahvaz Hospitals from March 2015 to January 2016. Patients’ information was collected. Patients who suffered recurrent stroke but survived were followed up for at least 12 months after the first attack, and their medical records were collected. Results: The incidence rate of recurrent stroke was 14.91% (n=58). There was a significant relationship between the incidence rate of recurrent ischemic stroke with atrial fibrillation (OR=2.012, P<0.05) and ischemic heart disease (OR=1.695, P<0.05). However, there was no significant relationship between recurrent stroke and age, sex, dyslipidemia, diabetes, hypertension, and cigarette smoking (P>0.05). Conclusions: Patients with a history of atrial fibrillation and ischemic heart disease were at a higher risk of recurrent ischemic stroke. The incidence can be reduced by better treatment of atrial fibrillation and active follow-up.
    2019(6):250-254, DOI: 10.4103/2221-6189.272857
    Abstract:
    Objective: To study the prevalence of HHV-8 infection in patients undergoing hemodialysis. Methods: In this study, blood samples of 89 patients undergoing hemodialysis were collected. DNA was extracted from peripheral blood mononuclear cells and HHV-8 DNA was evaluated by nested-PCR. Results: Of total 89 patients, 51 (57.3%) were males and 38 (42.7%) were females. The patients’ age ranged from 24 to 90 years and the mean age was (57.5±1.4) years. HHV-8 DNA was found in 9 of 89 (10.1%) peripheral blood mononuclear cell samples, 8/51 (15.7%) in males and 1/38 (2.6%) in females (P=0.07). All patients who were positive for HHV8-DNA were more than 50 years old. Conclusions: This study shows high prevalence of HHV-8. Since hemodialysis patients are candidates for kidney transplantation and due to the possibility of HHV8-reactivation and its serious complications in immunocompromised patients, routine screening for detection of the virus should be implemented for all hemodialysis patients.
    2019(6):255-259, DOI: 10.4103/2221-6189.272858
    Abstract:
    Objective: To identify the biodiversity of Nocardia species isolated from the environments of Tehran hospitals via phenotypic and PCR molecular methods. Methods: A total of 236 samples were collected from the transplantation and cancer centers of five Tehran hospitals, and the presence of Nocardia was identified by using standard protocols. Conventional tests were used for preliminary identification, and PCR amplification of the 598 bp amplicon of the 16S rRNA and sequence analysis of 16S rRNA were performed for genus and species identification. Results: From the 236 soil samples, 16 samples were identified as positive based on the culture tests, while 8 samples showed positive results based on the molecular method. The phylogenetic tree showed that the most frequent genus of Nocardia was related to Nocardia cyriacigeorgica. Conclusion: The hospital environment is a potential reservoir of a diverse range of Nocardia species. Due to the strong capability of survival, these bacteria bring a threat to the health of patients. Its identification can help physicians to implement treatments and is important for healthcare centers.
    2019(6):260-264, DOI: 10.4103/2221-6189.272859
    Abstract:
    Objective: To investigate the prevalence of snakebites and associated epidemiologic factors in Khorram-shahr County, Iran, between 2013 and 2017. Methods: This was a cross-sectional descriptive-analytical study. Information was collected and recorded via questionnaires. Snakebite data included gender, age, occurrence regions, bite site, time of being bitten, month and season. Data were analyzed by Chi-square and t-tests with SPSS version 18. Results: A total of 102 cases of snakebites occurred in Khorram-shahr County of Khuzestan Province, southwestern Iran. There were 75 men (73.5%) and 27 women (26.4%), without significant difference in incidence. The highest frequency of snakebites was observed in the age group of 41-50 years with 28 cases (27.4%). In total, 58 cases (56.9%) occurred in urban areas and 44 cases (43.1%) in rural areas. No statistically significant difference was observed between the age groups or residential areas. Snakebites occurred in May with 19 cases (18.6%), spring with 45 (44.1%) and summer with 45 (44.1%). The results showed significant difference among different seasons and months of the year. Snakebites were in feet in 62 cases (60.8%) and hands in 36 cases (35.3%) which were bitten more than other organs, respectively, with significant difference among different bite sites in the body. The highest and lowest frequencies of snakebites were observed between 18:00 and 24:00 with 43 cases (42.2%) and between 6:00 and 12:00 with 14 cases (13.7%), with a significant difference among different hours of the day. Conclusions: Useful information about snakebites, venomous snakes, their hazards, prevention of bites and the importance of early hospital referral and treatment of victims should be provided to people using different educational tools.
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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):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):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 blaGES 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):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-1 C1772T and G1790A polymorphisms of Hif-1 gene, and differences in genotypes between the 2 groups were compared. Results: Hif-1 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 G1790A polymorphism was not significant between PARDS and non-PARDS groups. In addition, Hif-1 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 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):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 毬-lactamase adeR, OprD, adeS genes among A. baumannii strains. 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. baumannii isolates 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):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, IL, 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):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):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.
    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.
    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.
    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, and intI3 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(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(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.
    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(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(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(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.
    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.
    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(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.

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