Objective: To review low-voltage, high-voltage and lightening electrical burns in adults and children, identify novel areas that are not recognized and improve treatments results and outcome. Methods: An extensive literature search on electrical burn injuries was performed using Ovid Medline, PubMed and Embase databases from 1976 to 2016. Studies related to electrical injury in the adult and children (< 15 years of age) population were included in our study. Fifty-one research papers and review articles were identified and included in this study. Results: Total occurrence of electrical injury among burn injuries ranged from 3.5% to 15.0%. Most of them were low voltage (73%) and one fourth were high voltage and percentage of lightening injuries were very low around 2%–4% of total cases of electrical injury. Mortality is somehow higher among high voltage electrical injuries and lightening. Most of complications of them were morbid in kidney, heart, extremities (including amputations) and nervous systems. Long-term psychological problems were reported with greater incidence rates in highvoltage injuries. Psychological and posttraumatic stress disorders were also reported. Mortality rates from electrical injuries were 2.6% in low voltage and 5.2% in high voltage. Conclusions: High-voltage injury leads to greater morbidity and mortality than low-voltage one. Lightening has mortality of about 32%, higher rates of complications and specialty long-term complications. Strict multi-specialty treatment and rehabilitations are required for proper treatment of electrical injuries.

Objective: To study the stress reaction after laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy. Methods: 68 patients with acute ruptured ectopic pregnancy who received emergency surgical treatment in Pangang Group General Hospital between July 2013 and September 2016 were selected and analyzed retrospectively, including 29 patients with laparoscopic surgery and 39 patients with laparotomy who were included in the laparoscopy group and laparotomy group respectively. Before operation as well as 1d and 3d after operation, serum was collected to detect biochemical indexes and stress hormones. Results: 1d and 3d after operation, serum Alb, AST, ALT, BUN, Scr and UA levels were not significantly different between laparoscopy group and laparotomy group (P>0.05); serum NE (149.65±17.58 vs. 186.61±23.52, 162.32±20.15 vs. 295.86±28.97 pg/mL), E (135.28±19.85 vs. 179.55±22.52, 152.11±18.52 vs. 231.38±29.58 pg/mL), ACTH (3.88±0.49 vs. 5.12±0.82, 4.39±0.52 vs. 6.58±0.92 pmol/L), Cor (177.64±20.12 vs. 224.59±35.55, 185.21±22.12 vs. 289.45±41.28 ng/mL), Ins (12.21±1.86 vs. 17.58±2.52, 18.95±2.68 vs. 27.61±4.12 IU/ mL), PRA (1.65±0.25 vs. 2.18±0.35, 1.73±0.21 vs. 2.55±0.47ng/mL), AngII (44.12±7.64 vs. 59.63±7.92, 52.27±7.95 vs. 76.12±9.35 pg/mL) and ALD (155.22±19.76 vs. 205.62±24.52, 189.10±22.58 vs. 316.85±42.85 pg/mL) levels of laparoscopy group were significantly lower than those of laparotomy group (P<0.05). Conclusions: Laparoscopic surgery for acute ruptured ectopic pregnancy causes less adrenal stress reaction and RAAS system stress reaction, and the overall level of trauma is lower than that of laparotomy.

Living in the dormitory is usually the requirement for university students who live far from the university. The medical disorder occurring at night among the university students is rarely reported. The acute problem due to accident is a topic of interest. Here, the authors summarize on pattern of accident at night of university students in a dormitory.

Objective: The term volvulus is derived from a Latin word volvere means to turn, twist which is mainly referred to as twisting of sigmoid and can lead to ischemia and gangrene. Nowadays, it is the 3rd most common reason of bowel obstruction mostly in the Middle East countries, Africa, India, and Russia where average age is younger compared to the west (about 40 to 50). Methods: In this study, patients who referred to Imam Hossein and Firoozgar Hospitals within2014 and 2015were included by the first impression of obstruction and finally diagnosis of sigmoid volvulus that were not in septic shock. After primary survey, routine lab profile, electrolyte correction and resuscitation if needed, the process of choices of patients and terms and conditions were explained for patients. They were prepared for operation after obtaining a written consent. During operation, those who are not necrotic sigmoid and do not have peritonitis undergone primary resection and anastomosis of intestine as suggested by surgeon. Anastomosis has given by 3-0 silk thread separately. Results: Twenty-five patients, 7 females (28 %) and 18 males (72%), underwent primary resection and anastomosis whose age ranged from 18 to 84 (mean 61.5 years, variance 56, 25). Average leukocytes count for our patients once they entered the emergency ward was 8500(with max level of 14/9 and min of 4/1). Two patients had fever after operation. Five patients experienced tachycardia within 24hours after surgery and one patient experienced infectious wound and 2 cases passed away. Conclusions: With regard to the obtained results, examining all aspects of patients is recommended to conduct primary anastomosis. Primary anastomosis is not recommended for patients with multiple underlying diseases considering the longer operation time.

Objective: To study the effect of surgery combined with nerve growth factor preparation treatment of acute cerebral hemorrhage on nerve cytokines and nerve injury. Methods: 68 patients with acute cerebral hemorrhage who received emergency minimally invasive evacuation of hematoma in Zigong No. 4 People's Hospital between August 2014 and September 2016 were selected and randomly divided into mNGF group and control group, mNGF group received postoperative mouse nerve growth factor preparation combined with conventional therapy, and control group accepted routine postoperative treatment. 10d, 20d and 30d after treatment, the serum was collected to determine the levels of nerve cytokines and nerve injury molecules. Results: 10d, 20d and 30d after treatment, serum BDNF (5.29±0.88 vs. 3.58±0.61, 6.94±0.93 vs. 3.78±0.55, 9.28±1.13 vs. 4.57±0.62 ng/mL), NTF-α (2.94±0.52 vs. 1.35±0.18, 3.88±0.58 vs. 1.51±0.20, 5.21±0.72 vs. 2.95±0.46 ng/mL), NGF (0.89±0.11 vs. 0.62±0.08, 1.02±0.15 vs. 0.78±0.09, 1.45±0.18 vs. 0.92±0.12 ng/mL) and VEGF (147.53±19.52 vs. 110.38±14.28, 184.95±22.51 vs. 121.29±17.85, 237.49±31.28 vs. 145.38±18.31 pg/mL) levels of mNGF group were significantly higher than those of control group while S100β (1.27±0.20 vs. 2.19±0.33, 0.94±0.14 vs. 1.76±0.25, 0.71±0.09 vs. 1.32±0.17 ng/mL), GFAP (2.08±0.36 vs. 4.42±0.55, 1.65±0.25 vs. 3.57±0.51, 1.31±0.17 vs. 2.93±0.42 pg/mL), NSE (34.21±5.82 vs. 73.19±9.35, 27.58±4.12 vs. 58.76±8.28, 22.12±3.25 vs. 39.52±5.28 ng/mL), MBP (5.28±0.93 vs. 11.28±1.86, 3.89±0.51 vs. 9.12±1.14, 3.12±0.41 vs. 6.79±0.94 ng/mL), MDA (6.97±0.93 vs. 14.21±1.87, 5.02±0.78 vs. 11.75±1.76, 3.57±0.62 vs. 8.12±0.99 μmol/L), AOPP(65.19±9.68 vs. 155.62±19.63, 48.59±7.21 vs. 118.75±16.85, 37.83±5.28 vs. 82.11±10.18 (μmol/L) and 8-OHdG (4.77±0.67 vs. 10.28±1.52, 3.52±0.51 vs. 9.38±1.15, 2.33±0.41 vs. 6.52±0.92 ng/mL) levels were significantly lower than those of control group. Conclusion: Surgery combined with nerve growth factor preparation treatment of acute cerebral hemorrhage can improve neural nutritional status and reduce nerve injury degree, and it is beneficial to the recovery of neural function.

Objective: To determine the trends in burn admissions, and aetiology, severity and mortality of patients admitted to the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital from May 2009 to April 2016 (7 years). Methods: Patients' data used in this longitudinal and retrospective study were accessed from the records of the Reconstructive Plastic Surgery and Burns Unit. Processed data were depicted in tables and figures as appropriate. Univariate and multivariate analysis and Pearson's rank correlation were used in comparing relevant groups. Data analysis was conducted using Excel version 2013 and SPSS version 17.0. Results: A total of 681 patients, with a male to female ratio of 1.1:1.0, were analysed. The average annual incidence was 97.28 with a progressive decline in incidence. Mortality rate was 24.2%. Majority of the patients were children less than 10 years (43.5%) with scalds as the main aetiology in this group. Open flame was the major aetiology of burns (49.9%). Majority of the patients spent less than 10 days on admission (67.1%). Mean total body surface area was 30.54%. There was correlation between TBSA and disposition, total body surface area and aetiology and number of days in the Burns Intensive Care Unit, total body surface area and aetiology, and aetiology and number of days in the Burns Intensive Care Unit. Conclusions: Children below 10 years were the main victims. There was a shift from scald to open flame burns in this current study. Mean total body surface area and mortality rate have increased. There is urgent need for prevention campaign of flame burn and first aid education on intensive burns.

Objective: Since pre-transfusion screening for Toxoplasma gondii is not performed on blood packs, thalassemia patients are susceptible to acquiring toxoplasmosis; thus, the aim of this study was to evaluate the seroprevalence status of T. gondii in individuals who suffer from thalassemia in comparison to healthy persons in the southwest of Iran. Methods: In this case-control study, 117 thalassemia patients and 205 healthy persons participated. All samples were tested for the presence of specific IgG and IgM antibodies against T. gondii using ELISA technique. Data were analyzed using Chi-square test. Results: Seroprevalence of anti-T. gondii IgG was detected in 30.76% (36/117) of patients and 20% (41/205) of healthy individuals (P=0.04), also anti-T. gondii IgM in these groups was detected 1.70% (2/117) and 0.48% (1/205), respectively (P=0.3). In present study, nine related risk factors with toxoplasmosis were evaluated and data analysis showed that only contact with cat was significantly correlated with IgG seroprevalence (P=0.02). Conclusions: Current research suggests thalassemia patients are more prone than normal persons to acquiring T. gondii infection (P=0.04, OR:1.77). Due to limited studies in this high risk group, further studies are recommended.

Objective: To study the effect of EPO therapy on liver injury, inflammation, oxidative stress and cell apoptosis in model rats with infection-induced acute liver injury. Methods: SD rats were selected and randomly divided into Sham group, sepsis group (CLP group) and EPO intervention group (EPO group), the cecal ligation and puncture was adopted to establish sepsis models and 5000IU/kg human recombinant EPO was provided for intervention. 24 hours after intervention, serum levels of liver injury molecules, inflammatory factors and oxidative stress molecules as well as liver tissue levels of oxidative stress molecules and cell apoptosis molecules were detected. Results: Serum ALT, AST, TNF-α, IFN-γ, IL-1β, IL-6, IL-8, MDA and AOPP levels, liver tissue Nrf2, ARE, MDA and AOPP levels as well as Bax, Caspase-9 and Caspase-3 mRNA expression of CLP group were significantly higher than those of Sham group while liver tissue HO-1 and SOD levels as well as Bcl-2 mRNA expression were significantly lower than those of Sham group; serum ALT, AST, TNF-α, IFN-γ, IL-1β, IL-6, IL-8, MDA and AOPP levels, liver tissue MDA and AOPP levels as well as Bax, Caspase-9 and Caspase-3 mRNA expression of EPO group were significantly lower than those of CLP group while liver tissue Nrf2, ARE, HO-1 and SOD levels as well as Bcl-2 mRNA expression were significantly higher than those of CLP group. Conclusions: EPO therapy could reduce liver injury and inhibit inflammation, oxidative stress and cell apoptosis in model rats with infection-induced acute liver injury.

Inverted papilloma is an uncommon histopathological finding of maxillary sinus tumor. We reported here a rare case of inverted papilloma of maxillary sinus presented initially with ipsilateral proptosis. A middle-aged lady with history of having allergic rhinitis presented with progressive left eye proptosis. Assessment revealed presence of orbital mass arising from paranasal sinus, in which the histopathological examination was initially inconclusive, and later it turned up to be inverted papilloma, partly with malignant transformation. High index of suspicion is necessary especially in those patients with recurrent non-specific sinonasal symptoms, which may need repeated biopsy and histopathological examination. Ocular manifestation signifies a more advance disease.

Myeloid sarcoma is a rare, aggressive presentation of acute myeloid leukemia which tends to affect bones and soft tissue. It is usually seen in children, and has a poor prognosis. We report a case of orbital myeloid sarcoma presenting with unilateral proptosis in a young adult who subsequently developed acute myeloid leukaemia. An 18-year-old male presented with sudden, progressively increasing right eye swelling over two weeks. Examination revealed right eye proptosis, with a positive relative afferent papillary defect and a right eye visual acuity of 6/60, pinhole 6/18. The right fundus showed optic disc hyperemia, tortuous veins and choroidal folds. The left eye was normal. On initial examination, computed tomography (CT) of the brain and orbit showed an enhancing mass at the lateral aspect of the right orbit measuring 3.8 × 2.1 cm, with optic nerve displacement. Right lateral orbitotomy and excisional biopsy yielded a tissue diagnosis of myeloid sarcoma. The peripheral blood smear was normal at this time. The patient defaulted treatment but presented again three months later with right eye massive proptosis and loss of vision. A repeated CT scan showed a large lobulated mass measuring 104.5mm × 87.21mmm × 77.25mm occupying the right orbit, with destruction of the bony orbital walls and intracranial extension. A repeat full blood picture and bone marrow aspiration showed 30% blast cells, consistent with the diagnosis of acute myeloid leukemia. Patient was started on chemotherapy and radiotherapy. The tumour reduced in size after five cycles, but unfortunately, patient passed away due to brain metastases.

Primary non Hodgkin's lymphoma of the lacrimal sac is uncommon but potentially delay in diagnosis as it may mimic the presentation of primary post saccal nasolacrimal duct obstruction. In this article, we reported a case of primary non Hodgkin's lymphoma of the lacrimal sac presented with recurrent acute dacryocystitis in a young lady. A 28 years old Malay lady had history of persistent epiphora on left eye for 4 years. Prior to presentation to our clinic, it was preceded by progressive recurrent painful medial canthal swelling for 6 months duration. Clinical diagnosis of post saccal naso lacrimal duct obstruction was made and otorhinolaryngology assessment revealed intranasal mass. Endoscopic excision was done showed diffuse large B cell lymphoma on histology. The patient was started on 6 cycles of chemotherapy which subsequently result in no recurrence of the tumour post chemotherapy. Any case of post saccal nasolacrimal duct obstruction should be investigated thoroughly as it may become as a presentation of other sinister pathology.