Journal of Acute Disease
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    2023(3):89-95, DOI: 10.4103/2221-6189.379271
    Objective: To evaluate morphine's risk-benefit profile in the treatment of acute heart failure.
    Methods: Different electronic databases, including PubMed, MEDLINE, Cochrane Library, and Google Scholar, as well as, were searched for articles published between 2012 and 2022. The risk of bias in the present study was evaluated by employing randomized controlled trials (RCTs) checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups. The two-part tool was used to address the five specific domains such as selection bias, performance bias, detection bias, attrition bias, and selective reporting bias. Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software (version 5.4), a quality assessment tool.
    Results: A total of 13 studies were included in the present review, in which there were 5 retrospective studies, 3 randomized-control studies, 2 prospective studies, 1 multicenter pharmacodynamics study, 1 multicenter cardiac magnetic resonance imaging study, and 1 open-label, cross-over study. The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine.
    Conclusions: Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine. Considering the adverse effects, including mortality associated with morphine, there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure.
    2023(3):96-101, DOI: 10.4103/2221-6189.379276
    Objective: To assess the effectiveness of simulation-based learning regarding the management of post-COVID complications in terms of knowledge, clinical decision-making ability, and self-efficacy among nursing students.
    Methods: This was a quasi-experimental study conducted among 115 2nd-year nursing students. The participants were selected by a simple random sampling technique. The participants were divided into an experimental (n=56) and a comparison group (n=59) by a random table method. Data were analyzed using descriptive and inferential statistics with SPSS version 20.
    Results: There were significant differences in mean post-test knowledge scores (P=0.03) and mean post-test self-efficacy scores (P=0.001) between the experimental and the comparison groups while the difference in mean post-test clinical decision-making ability scores between the two groups was non-significant (P=0.07). A positive correlation was found between knowledge and clinical decision-making ability in pre-test (P=0.03) and in post-test (P<0.001) and a non-significant correlation was found between pre-test knowledge and self-efficacy score (P=0.52) among the experimental group.
    Conclusions: Simulation-based learning regarding the management of post-COVID complications is effective among nursing students. Simulation labs should be established in health care settings where simulation training can be provided for updating the knowledge, clinical decision-making ability, and self-efficacy of nursing personnel during program installment and continuous nursing education.
    2023(3):102-106, DOI: 10.4103/2221-6189.379272
    Objective: To investigate the impact of COVID-19 on the mortality trends and patterns in a tertiary teaching hospital in Raipur, Chhattisgarh, India.
    Methods: A hospital-based retrospective study was conducted to analyze the case reports of all deaths from January 2016 to December 2021 in a tertiary teaching hospital in Raipur, Chhattisgarh, India. The socio-demographic profile and the pattern of causes of death were recorded. The deaths were classified according to the 10th revision of the International Classification of Diseases.
    Results: A total of 6 128 deaths were registered from 2016 to 2021 and the maximum death number was observed in 2021 (38.2%) followed by 2020 (32.5%) when the country was hit by the COVID-19 pandemic. The highest number of deaths was observed in the age group of 51 to 65 years i.e., 31.1% of the total deaths. In all five years, male deaths were more than female deaths, and more than 50% occurred within three days of hospitalization during the study period.
    Conclusions: Even though there is a rise in the death rate due to the sudden hit of COVID-19, the burden of both communicable and non-communicable diseases remains gradually increasing over the five years. There is a need for health awareness in the community about changing lifestyles and their harmful effects on health.
    2023(3):107-113, DOI: 10.4103/2221-6189.379274
    Objective: To investigate the effect of the first prone position on arterial blood gas analysis and respiratory parameters of acute respiratory distress syndrome (ARDS) patients with and without COVID.
    Methods: This study was conducted retrospectively with 22 COVID-ARDS and 22 non-COVID ARDS patients, who were placed in a prone position for at least 16 hours on the first day at the intensive care unit admission, and arterial blood gas analysis was taken in the pre-prone, prone and post-prone periods.
    Results: PaO2 were significantly increased in the pre-pronevs. prone comparison in both groups, but the increase in the PaO2/FiO2 ratio was not significant. In comparing the pre-prone vs. post-prone PaO2/FiO2 ratios, there was a significant difference only in the non-COVID ARDS group.
    Conclusions: The improved oxygenation provided by prone positioning is more permanent with the “post-prone effect” in non-COVID ARDS patients. This can be attributed to the differences in the pathogenesis of the two ARDS types.
    2023(3):114-120, DOI: 10.4103/2221-6189.379275
    Objective: To determine the association of the three umbilical cord blood parameters: umbilical cord pH, base deficit, and lactate levels, with neonatal outcomes.
    Methods: This prospective observational study was conducted from April 2021 to September 2022 with 100 term and late preterm (>35 weeks) neonates whose umbilical cord blood pH was <7.10, Apgar score was <7 at 1 min, and required positive pressure ventilation. Umbilical cord blood was assessed for pH, base deficit, and blood lactate levels. The neonatal outcomes of neonatal intensive care unit admission, Apgar score at 1 min, and Apgar score at 5 min were assessed.
    Results: The mean of umbilical cord blood pH was 7.04±0.07, mean base deficit was (−9.3±3.9) mmol/L, and mean lactate levels were (6.51±2.29) mmol/L. Neonatal intensive care unit (NICU) admission was needed in 78 (78%) neonates. The mean NICU stay length was (2.4±2.2) days ranging from 0 to 12 days with a median of 2 days. Univariate analysis showed no significant difference in cord blood pH (P=0.736) and base deficit (P=0.393) between neonates without NICU admission and neonates who required NICU admission, but lactate level was significantly higher in neonates who required NICU admission (P<0.001). There was no significant difference in cord blood pH (P=0.400) and base deficit (P>0.999) between neonates with Apgar scores 4-7 at 1 min and neonates with Apgar scores <4, but lactate level was significantly higher in neonates with Apgar scores <4 at 1 min (P<0.001).
    Conclusions: Umbilical cord blood pH, base deficit, and lactate levels are useful novel markers showing a significant correlation with neonatal intensive care unit admission and adverse neonatal morbidities among hypoxic newborns. Overall, lactate was a better predictor of adverse neonatal outcomes as compared to umbilical cord blood pH and base deficit.
    2023(3):121-128, DOI: 10.4103/2221-6189.379277
    Objective: To explore the modeling of time series of animal bite occurrence in northwest Iran.
    Methods: In this study, we analyzed surveillance time series data for animal bite cases in the northwest Iran province of Iran from 2011 to 2017. We used decomposition methods to explore seasonality and long-term trends and applied the Autoregressive Integrated Moving Average (ARIMA) model to fit a univariate time series of animal bite incidence. The ARIMA modeling process involved selecting the time series, transforming the series, selecting the appropriate model, estimating parameters, and forecasting.
    Results: Our results using the Box Jenkins model showed a significant seasonal trend and an overall increase in animal bite incidents during the study period. The best-fitting model for the available data was a seasonal ARIMA model with drift in the form of ARIMA (2,0,0) (1,1,1). This model can be used to forecast the frequency of animal attacks in northwest Iran over the next two years, suggesting that the incidence of animal attacks in the region would continue to increase during this time frame (2018-2019).
    Conclusions: Our findings suggest that time series analysis is a useful method for investigating animal bite cases and predicting future occurrences. The existence of a seasonal trend in animal bites can also aid in planning healthcare services during different seasons of the year. Therefore, our study highlights the importance of implementing proactive measures to address the growing issue of animal bites in Iran.
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    2019(2):45-52, DOI: 10.4103/2221-6189.254411
    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):99-102, DOI: 10.4103/2221-6189.236822
    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.
    2019(2):78-81, DOI: 10.4103/2221-6189.254431
    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):53-57, DOI: 10.4103/2221-6189.254426
    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):67-71, DOI: 10.4103/2221-6189.254429
    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):58-62, DOI: 10.4103/2221-6189.254427
    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):72-77, DOI: 10.4103/2221-6189.254430
    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
    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):82-83, DOI: 10.4103/2221-6189.254433
    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
    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(2):90-92, DOI: 10.4103/2221-6189.233019
    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
    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.
    2017(4):181, DOI: 10.12980/jad.6.20170406
    Objective: To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates. Methods: Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU) from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using KirbyBauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity. Results: A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3%) and females 35 (40.7%). Age of participants ranged from 0–56+ years. Pseudomonas aeruginosa was the commonest pathogen isolated 26(30.2%), followed by Pseudomonas spp. 21(24.4%), Escherichia coli 17(19.8%), Klebsiella spp. 12(14.0%). Coagulase negative Staphylococcus accounted for 2(2.3%). Overall prevalence of infection in the study was 90.7%. Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.
    2018(3):103-107, DOI: 10.4103/2221-6189.236823
    Hyponatremia is a common electrolyte disturbance usually observed in neurosurgical patients undergoing surgical management of traumatic, as well as, nontraumatic intracranial pathology. The spinal cord trauma is also associated with occasional development of such hyponatremia; it usually occurs within the first two-weeks of the injury. Hyponatremia can lead to alterations of consciousness, convulsions, coma, cardiac arrhythmias and on rare occasions, death. Authors present a practical oriented review of the literature.
    2018(1):45-48, DOI: 10.4103/2221-6189.228878
    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(5):179-184, DOI: 10.4103/2221-6189.268405
    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.
    2019(2):86-88, DOI: 10.4103/2221-6189.254435
    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
    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):69-73, DOI: 10.4103/2221-6189.233014
    Objective: To study the effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury. Methods: Patients with acute craniocerebral trauma who were admitted to the Third People's Hospital of Zigong from April 2014 to December 2016 were selected as the subjects and were randomly divided into two groups. The control group received conventional treatment, and the intervention group received large doses of vitamin C and vitamin E combined with conventional treatment. On the 3th day and 7th day after treatment, peripheral blood was collected and serum was isolated, then the contents of nerve injury index NSE, S100B, NGB, UCH-L1, Tf, Ft and neurotrophic indexes NTF-a, BDNF, NGF and IGF-I were determined by Enzyme-linked immunosorbent assay kit, and the contents of SOD, GPx, CAT, OH-, O2-, MDA and AOPP were measured by radioactive immunoprecipitation kit. Results: 3th day and 7th day after treatment, the contents of NSE, S100B, NGB, UCH-L1, Tf, Ft, NTF-a, BDNF, NGF, IGF-I, OH-, O2-, MDA and AOPP in the intervention group were all significantly lower than those in the control group. The content of SOD, GPx and CAT in serum in the intervention group was significantly higher than that in the control group. Conclusions: High-dose vitamin C and vitamin E treatment can alleviate nerve injury, oxidative stress response, and improve neurotrophic state in patients with acute craniocerebral injury.
    2018(2):88-89, DOI: 10.4103/2221-6189.233018
    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.


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