Acanthamoeba keratitis, a vision-threatening disease, is caused by a free-living amoeba of genus Acanthamoeba. Amoeba is widely distributed all around the world. Several cases of Acanthamoeba keratitis have been reported from the Middle East and Iran as well. The infection is mainly caused by inappropriate use of contact lens; therefore, it is more common among lens wearers. The number of reported cases worldwide is increasing annually due to the increasing number of contact lens wearers for medical or cosmetic reasons. It is known that early diagnosis and treatment can reduce consequent damages, while the delay in these processes will deteriorate the vision. Nowadays contact lens wearing, surgery and use of corticosteroids are known to predispose to Acanthamoeba keratitis, and it was also believed that trauma was the main cause. Increasing public knowledge about Acanthamoeba infection, inquiring the history of patients, clinical signs and laboratory findings can be helpful to early diagnosis and better treatment. Regardless of the increasing knowledge of diagnosis and treatment, this disease is still a challenge. Considering the long curative time, and insufficient efficacy of available treatments, it seems that the prevention is more important than the treatment. This review aimed to explain Acanthamoeba keratitis in the Middle East and Iran from the aspects of epidemiology, diagnosis, and therapeutic treatment.

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Rationale: Stevens-Johnson syndrome is a disorder mostly attributed to drug use, which can cause different skin problems. Patient concerns: A 31-year-old woman presented with severe pain and pounding in the left ear. Diagnosis: Fluconazole-induced Stevens-Johnson syndrome with fungal infection in ear. Intervention: Surgical and systemic antibiotic therapy. Outcomes: The patient recovered and resumed her normal life. Lessons: The prescription of fluconazole for patients with underlying conditions should be done with caution.

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Rationale: Necrotizing fasciitis is a rare infection of fascia tissues. It progresses quickly and has high morbidity and mortality. In this study, we aimed to explore a case of necrotizing fasciitis in a diabetic patient. Patient concerns: A 46-year-old woman presented with severe pain and inflammation in the left leg, and with fever and chills. Diagnosis: Necrotizing fasciitis in the left leg. Intervention: Broad debridement of infectious tissues and broad-spectrum venous antibiotics. Outcomes: The patient was discharged without pain, inflation, or fever. Lesson: This disease is a surgical emergency, therefore, early diagnosis and quick and invasive treatment could significantly decrease morbidity and mortality.

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Objective: To analyze the epidemiological and clinical data of patients who were admitted to Inönü University Turgut Özal Medical Center Emergency Department with bites and stings between 2013 and 2015. Methods: Patients with bites and stingings who were admitted to Inönü University Turgut Özal Medical Center during 2013-2015 were selected for this retrospective evaluation. We retrived the following information including age, gender, anatomic localization of the sting or bite, admission time, complaints, vital signs, length of stay, laboratory findings and hospitalization department. Pearson’s chi-square test, Fisher’s exact test, One-way ANOVA test and the Bonferroni correction as post hoc were used for statistical analysis. Results: The mean age of the patients was (43.51±16.90) years, and 55% were male. The most common admission reason was pain (34.7%), followed by rash (19.1%) and panic (11.6%). A total of 16.8% of the admissions occurred in July, 16.8% in August and 16.5% in June while the occurrence was the lowest in November with 1.5%. The most prevalent bites or stinging animals were scorpions (34.6%), followed by ticks (19.7%) and bees (12.9%). Antihistaminic-steroid-tetanus and analgesic-antihistaminic-steroid combinations were administered, respectively to 59.6% and 25% of the patients. The longest length of stay was (48.56±26.92) h due to snake bites. Conclusions: The community should be educated about the living areas of these animals, the seasons and hours in which they are active. Since individuals living and working in rural areas are at risk, more education should be given to them.

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Objective: To investigate the diagnostic value of platelet parameters in acute appendicitis. Methods: This retrospective case-controlled study was performed among 200 healthy people and 200 patients with a primary diagnosis of acute appendicitis between October 2017 and June 2018. The patients were classified into three groups: the acute complicated appendicitis (suppurative and gangrenous) group, acute non-complicated appendicitis group and the control group. Red blood cell, white blood cell, lymphocyte, monocyte and platelets count, red blood cell distribution width, hemoglobin, hematocrit, mean platelet volume, platelet distribution width, and C-reactive protein were compared between the groups. Results: Thirty-nine (19.5%) patients with acute appendicitis had no complication and 161 (80.5%) developed a complication. The white blood cell count, neutrophil count and C-reactive protein serum levels were significantly higher, whereas the mean age, lymphocyte count, monocyte count, red blood cell distribution width and platelet count were significantly lower in acute appendicitis patients with and without complications compared with the control group. Moreover, combined analysis of best diagnostic parameters (white blood cell, neutrophil and lymphocyte counts) showed that combined parallel sensitivity and specificity were 98.7% and 42.7%, respectively. Conclusions: White blood cell, lymphocyte counts and neutrophil count could be used for diagnosis of acute appendicitis. More over the utility of mean platelet volume for differential diagnosis might be overestimated.

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Rationale: Gastropericardial fistula is a rare condition in which the patient presented with chest pain, dyspnea, tachycardia, pneumo/hydropericardium, or pericarditis. Alcohol intake or previous history of gastroesophageal surgery made the patient susceptible to fistula formation. Patient concerns: An 80-year-old male complained of sudden onset of dyspnea and respiratory distress. Nausea, hematemesis, and constipation were noted on clinical examination. Diagnosis: Herniation of the gastric fundus and massive pneumopericardium due to formation of fistula in the lesser curvature. Interventions: Urgent surgery was performed. Outcomes: The patient was discharged without any complication. Lessons: Although the lethal form of this condition is rare, gastroepicardial fistula should be included in the differential diagnosis workup of cases with stomach cardia and fundus ulceration.

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Objectives: To assess the basic knowledge of cardiopulmonary resuscitation (CPR) among health workers in a tertiary health facility in a semi-rural county. Methods: A questionnaire based, cross sectional study involving health care professionals was performed in Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria from April to July 2017. A purposive sampling method was adopted for subject selection. A pretested self-administered questionnaire was distributed; this included knowledge on basic life support; participation in basic life supportand outcomes. It was adopted from the American Heart Association guidelines for CPR and emergency cardiac care. Results: One hundred and two respondents were recruited (40 doctors and 62 nurses). There were 50 males (49%) and 52 females (51%). Their age ranged from 23 to 54 years with mean of (34.9± 7.4) years. Only 20% of the respondents were aware of circulation, airway and circulation in adult resuscitation; however, 61.0% of all respondents were aware of airway, breathing and circulation of resuscitation in children. Furthermore, only 10% of the respondents were aware of the correct steps of single rescuer resuscitation. Their knowledge was poor about chest compression and ventilation for both adult and children resuscitation. The overall knowledge score ranged from 0.0% to 100% with mean knowledge score of (21.2±18.6)%. The date of last training about CPR had no relationship with the knowledge scores (χ²=2.951, P=0.300). The cadre of the respondents (doctors and nurses) had no relationship with their knowledge score (χ²=0.100, P=0.633 for doctors and nurses; ,χ²=7.074, P=0.225 for doctors cadre; XX²=3.868, P=0.677 for nurses cadre) respectively. Conclusions: The knowledge about CPR among health workers is poor; furthermore, the last date of training about CPR and the cadre of staffs have no relationship with knowledge of CPR.

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Objective: To evaluate the epidemiology, clinical profile and treatment for patients with snake bite in the intensive care unit of our hospital. Methods: A retrospective analysis of patients with snake bite admitted to the intensive care unit of a tertiary care hospital, North Delhi, was conducted between January 2013 and October 2018. Their demographic profile, time and site of bite, clinical manifestations and time interval between the bite and anti-snake venom administration were recorded. Results: A total number of 102 patients with snake bite were studied, of which 54.9% were males and 45.1% were females. Most patients were presented in the monsoon season and snake bites occurred mainly in the night and early morning. A total of 56.3% of the patients with clinical manifestations received anti-snake venom within 3 h after the snake bite. Most patients presented with painless bites and neuroparalytic features with ptosis that was the most common clinical manifestation (50.9%). Anti-snake venom was administered to 55 patients (53.9%) with an average dose of 42 vials per patient and the mortality was 11.7%. Conclusions: Neuroparalytic krait envenomation accounted for the highest incidence of venomous bites in our study. Early medical treatment with judicious anti snake venom administration and related education is crucial.

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Objective: To compare the inhibitory effect between DL-tryptophan and bovine lactoferrin on biofilm formed by isolated Pseudomonas aeruginosa strains. Methods: The study was carried out on 40 patients suffering from surgical site infection. Wound pus was collected using sterile swabs after isolation, and identified by common bacteriological methods. Isolated Pseudomonas aeruginosa strains were grown on biofilm enhancing materials, and then the inhibitory effects of different concentrations of DL-tryptophan and lactoferrin were tested using scanning electron microscopy and microtitre plate methods. Results: There was no significant difference in the inhibitory effect between DL-tryptophan and lactoferrin at 0.5 mg/mL. While in concentration of 1 mg/mL and 2 mg/mL, tryptophan showed more significant inhibitory effect than lactoferrin. Conclusions: Both DL-tryptophan and bovine lactoferrin have inhibitory effect on Pseudomonas aeruginosa biofilm formation in a dose dependent manner, and the inhibitory effect of DL- tryptophan is stronger.

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