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   Table of Contents - Current issue
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September 2017
Volume 6 | Issue 5
Page Nos. 193-240

Online since Thursday, December 7, 2017

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ORIGINAL ARTICLES  

Protective effects of Aristolochia longa and Aquilaria malaccensis against lead induced acute liver injury in rats Highly accessed article p. 193
Derouiche Samir, Zeghib Khaoula, Gharbi Safa, Khelef Yahia, Feriani Anouar
DOI:10.4103/2221-6189.219611  
Objective: To investigate the protective effects of Aristolochia longa (A. longa) and Aquilaria malaccensis (A. malaccensis) on acute hepatotoxicity induced by lead in female albino rats. Methods: Twenty five (25) apparently healthy female Wistar rats were randomly divided into five groups of five rats in each: control, Pb, Pb + A. longa (Ar), Pb+ A. malaccensis (Aq), and Pb+ A. longa (Ar) + A. malaccensis (Aq) lead (100 mg/kg b.w.) as Pb (C2H3O2)2 added in their drinking water for 75 days. A. longa (rhizome powder at a dose of 10 g/kg of diet) and A. malaccensis (heartwood powder at a dose 10 g/kg of diet) were added to the feed during the last 15 days of lead exposed in the animals. Results: Obtained results revealed that lead treatment caused a significant increase in serum GOT, GPT and ALP activities and in liver of MDA level and CAT activity. In contrast, it led to an decrease in the liver GOT, GPT and GST activities and in GSH level in rats. Also, the results clearly showed that lead causes alterations of hepatic tissue in comparison with controls. Our results showed that treatment with A. malaccensis and A. longa a partial correction of the previous parameters. The histological observations confirmed the hepatoprotection results by the biochemical parameters. Conclusions: Results demonstrated beneficial effects of A. longa and A. malaccensis treatment in Pb-induced oxidative stress and tissue damage in liver.
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Acute abdomen presentation in dengue fever during recent outbreak p. 198
Bal Kishan Gupta, Hardeva Ram Nehara, Sahil Parmar, Shyam Lal Meena, Suresh Gajraj, Jigyasa Gupta
DOI:10.4103/2221-6189.219612  
Objective: To evaluate the etiology, clinical profile and outcome of acute abdomen presentation in Dengue Fever (DF). Methods: This clinical prospective study was done on confirmed cases of DF admitted in the department of medicine during recent epidemic (September 2015 to November 2016). All patients were evaluated clinically and by laboratory and imaging investigations and followed-up during hospital stay till discharge. The cause of pain abdomen was ascertained by blood tests (amylase, lipase and liver function test etc), radiology (Flat plate abdomen-erect, Ultrasonography of abdomen, CECT abdomen) and/or endoscopy. Results: Out of the 501 patients diagnosed as DF, 165 (32.93%) presented with acute abdomen. Some patients presented in other departments like surgery, gastroenterology and emergency, were later diagnosed as DF on laboratory evaluation. Various causes of acute abdomen in our study were nonspecific severe pain abdomen (67 cases), acute hepatitis (46) one had acute fulminant hepatitis, acute acalculous cholecystitis (31), ascitis (12), acute hyperemic gastritis with malena (5), acute pancreatitis (2), and 1 case each of acute appendicitis and acute jejuno-ileal intussuception. All patients were managed conservatively. One patient of acute pancreatitis died of multi-organ failure. Conclusion: Our study concludes that clinical vigilance about such type of presentations is important as timely recognition can influence outcome and may prevent unwanted surgery.
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Analysis of the disease spectra in patients seeking emergency medical treatment in Haikou, China p. 205
Dong-Mei Sun, Qing-Fei Zhong, Qian-E Du, Jia-Qi Xu, Fu-Jiang Liu, Xiao-Ran Liu
DOI:10.4103/2221-6189.219613  
Objective: To explore the characteristics of medical emergency disease spectra in Emergency Department of Haikou, China; and to provide clinical data for emergent disease treatment as well as emergency department personnel and equipment management. Methods: A total of 11 870 patients (over 16 years old) who visited Emergency Departments of the First Affiliated Hospital of Hainan Medical University, Haikou city from January 1, 2015, through December 31, 2015 were selected. Data on patients' age, sex, diagnosis, treatment duration, and treatment month were analyzed with Microsoft Excel. Results: Peak treatment times were from 18:00 to 24:00. The top four diseases were involved with respiratory, digestive, nervous, and cardiovascular systems, respectively. Respiratory problems peaked from November to February and digestive problems peaked from February to August. Temperatures ranging from >22.5 °C to 26 °C and high humidity exacerbated respiratory and digestive system diseases. Conclusion: The frequency of specific diseases that require emergency room care are affected by the local climate of Hainan Province.
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Emergency treatment of proximal femural fracture within 48h: The Umbria Region experience p. 210
Pellegrino Ferrara, Luca Khalil El Jaouni, Giuseppe Rocco Talesa, Serena Parmeggiani
DOI:10.4103/2221-6189.219614  
Objective: To study the main aspects of osteoporotic emergency fracture of the hip in the Umbria Region in the years 2006-2011. Methods: The study was conducted from January 1 of 2006 to December 31 of 2011, and included only patients over 49 years of age. Patients who did not habitually reside in the region were excluded. They were collected in each based on the following data: age, sex, place of residence (urban or rural), time of the year, fractured side, type of trauma, history of fracture contralateral and perioperative mortality. Results: From 2006 to 2011, a progressive increase in the number of femoral fracture admissions in regional hospitals was observed, equal to 4.73% per annum. The incidence went from 6.8 to 8.1 for 1.000 ultra-65th residents. The most affected age groups are those between 75-84 years and 85- 94 years. Conclusions: The epidemiology of osteoporotic hip fracture in the Umbria Region follows a pattern similar to that of other Italian regions. The in-hospital mortality of these patients is partly determined by age and number of complications they suffer during admission. The impact of economic resources on patients who break the osteoporotic hip justifies the implementation of programs for the prevention of osteoporosis and fractures.
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Acute complications of liver hydatidosis: Still associated with significant morbidity p. 214
Gianmarco Lotito, Ionut Negoi, Mircea Beuran
DOI:10.4103/2221-6189.219615  
Objective: To detail the pattern of postoperative morbidity in patients with acute complications of liver hydatidosis. Methods: We retrospectively studied all patients with liver hydatidosis, managed in a tertiary university centre between January 2011 and December 2016. Results: Fifty-three patients with cystic liver echinococcosis and a mean age of (43.64±17.54) years were selected. The mean diameter of the cyst was (8.11± 4.84) cm. Thirty-five (66%), 12 (22.6%), 4 (7.5%), and 2 (3.8%) patients had one, two, three, or four cysts, respectively. Nine (17%) patients were admitted in an emergency setting. The surgical approach was by laparotomy in 43 (81.1%) and by laparoscopy in 10 (18.9%) patients. Eleven (20.8%) patients developed postoperative complications: Class I – 3 (5.7%), Class II – 7 (13.3%), Class III – 1 (1.9%), Class IV – 1 (1.9%) patient according to Clavien-Dindo classification. Four (7.5%) patients developed long-term complications. 18 (34%) patients had more than one hospital admissions. Conclusions: Acute complications of the liver hydatid disease are associated with significant post-therapeutic morbidity, which correlates with the cyst's type according to Gharbi classification.
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Conversion disorder in a neurological emergency department: Restrospective series p. 218
Alejandro Cardozo, Maria-Alejandra Rubiano, Giovanny Garces, Jaime-Andres Giraldo, Jose Bareño
DOI:10.4103/2221-6189.219617  
Objective: To observe the conversion disorder in a neurological emergency department. Methods: It is common that the initial approach to this patients include the use of various diagnostic exams. In this series we reviewed 94 patients that arrived a neurological emergency room in a 3 year period. Results: 72 patients were females (76%), and the initial presumptive diagnosis were: neurovascular syndrome in 36 patients (38.3%), convulsive disorder in 20 patients (21.28%), and conversive disorder in 8 patients (8.51%). 82 patients had motor symptoms and 61 sensitive symptoms. 88 patients (93%) required neuroimaging studies, 77 (81%) patients underwent through basic biochemical panels. Other tests performed were: electroencephalogram in 12 patients (12.77%), electromyography in 11 patients (11.7%), lumbar punction in 8 patients (8.04%) and regarding the medical consult in the care of these patients 11 were evaluated by 1 specialists, 35 (37.2%) by 2 different specialties, 42 (44.63%) patients required evaluation by 3, and 6 patients (6.38%) required evaluation by 4 different specialties. Conclusions: Based on this data, we conclude that conversion disorders require a lot of resources in the emergency room and that the similarities with neurological diseases demands a complete workup including expensive diagnostic tools. However, this patients can be discharged safely without requiring hospitalization.
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The damage control in tibial pilon open fractures with a new external fixator delta frame p. 222
Giuseppe Rollo, Andrea Pasquino, Paolo Pichierri, Michele Bisaccia, Alessandro Stasi, Marco Giaracuni, Niki Cazzella, Luigi Meccariello
DOI:10.4103/2221-6189.219618  
Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy). Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator; the time taked to treat the ankle associated lesions; the time of skin healing; the ankle alignment; the subjective/objective Ovadia and Beals score; and complications. The Endpoint assessment was set at the days of the definitive surgery. Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score. Conclusion: Pilon fractures are complex and often present complications; the damage control treatment, in emergency, with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy.
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MINI REVIEW Top

Acute opisthorchiasis: What about the clinical manifestation? p. 227
Pathoom Sukkaromdee, Viroj Wiwanitkit
DOI:10.4103/2221-6189.219619  
Opisthorchiasis or liver fluke infestation is a common parasitic infestation in tropical countries. In chronic infection, the malignant transformation of hepatobiliary cell can be seen. Its high prevalence in Indochina is relating to the high incidence of cholangiocarcinoma in that area. Nevertheless, the acute clinical problem due to opisthorchiasis is also existed but little mentioned. In this short article, the authors review and discuss on the clinical manifestation of acute opisthorchiasis.
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CASE REPORTS Top

An uncommon cause of abdominal pain in a child: Meckel diverticulum p. 229
Anna Chiara Iolanda Contini, Tamara Caldaro, Giovanni Federici di Abriola, Erminia Romeo, Valerio Balassone, Francesca Rea, Filippo Torroni, Paola De Angelis, Simona Faraci, Giulia Angelino, Renato Tambucci, Luigi Dall'Oglio
DOI:10.4103/2221-6189.219620  
Meckel diverticulum, a common congenital anomaly of the small intestine, can be responsible of several complications due to the presence of ectopic gastric mucosa and represents a challenge for diagnosis. We present the case of a 11-year boy suffering from intestinal pain and bleeding in which radiological examinations unexpectedly raised the suspicion of Meckel diverticulum. The diagnosis was confirmed using 99mTc-pertechnetate scintigraphy. At surgery, a fistulous tract between Meckel diverticulum and an inflamed appendix was found. The authors discuss the role of medical nuclear imaging which, notwithstanding its limitations, is of fundamental importance to achieve a correct and timely diagnosis. This is of particular relevance in unusual cases, as the one presented, in which Meckel diverticulum is found concurrently with other intestinal abnormalities.
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Traumatic transection of main stem bronchus with unexpected clinical presentation- a case report p. 232
Chao-Kun Chen, Ying-Chieh Su, Chu-Li Tu, Chien-Ming Chao, Yao Fong
DOI:10.4103/2221-6189.219621  
Tracheobronchial injury is very challenging in diagnosis and treatment. Highly suspicious airway injury and early diagnosis is recommended. We present a case of 39 years-old woman suffering from acute respiratory failure with bilateral hemo-pneumothorax and diffuse subcutaneous emphysema initially. She weaned from ventilator a few days later, but dyspnea recurred due to delayed diagnosis of complete disruption of right main bronchus. However, the image study was incompatible with clinical findings. It showed collapse of left lower lung and hyperinflation of right lung, instead of right pneumothorax or fallen-lung sign. Under the assistance of veno-venous extracorporeal membrane oxygenation, primary repair of right main bronchial injury was performed successfully. Finally, she recovered well uneventfully. In tracheobronchial injury, early diagnosis is a positive prognostic factor. The other important point is primary repair, instead of lobectomy or pneumonectomy.
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Status epilepticus and acute promyelocytic leukemia p. 235
Sunil Kumar Garg, Pragya Garg
DOI:10.4103/2221-6189.219622  
Neurological manifestations are rare as initial presentation in acute promyelocytic leukemia (APL). This case illustrates status epilepticus as initial presentation in this disease. Atypical cells on peripheral smear led to the diagnosis of leukemia.
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Conservative management for acute renal rupture in blunt trauma p. 237
Rim Karray, Olfa Chakroun-Walha, Basma Souissi, Noureddine Rekik
DOI:10.4103/2221-6189.219623  
Renal injuries are commonly reported in blunt abdominal trauma and are usually associated to other abdominal injuries. Renal rupture may be misdiagnosed and its management, especially in severe lesions, is still controversial. We describe the case of renal rupture diagnosed in the Emergency Department and conservatively managed. The outcome was good thanks to the early diagnosis and the management of the renal trauma. Conservative management in renal rupture is possible in stable patients provided that the imaging is early done.
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Staphylococcus cohnii: Not so innocuous p. 239
Sunil Garg
DOI:10.4103/2221-6189.219624  
Staphylococcus cohnii is not known to causes meningitis. We present a case of mennigitis due to this organism. We are highlighting this case not only for its rarity but rapidity of worsening also. This report indicates that Staphylococcus cohnii are not as innocuous as once thought to be and these organisms should not be disregarded as possible skin contaminants. Before labelling them as contaminants their possible association with disease should be ruled out.
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