Rationale: Dengue is an important tropical disease that can cause acute hemorrhagic fever. Other atypical clinical presentations of dengue also can occur, and acute ascites is one of them. Patients’ concern: A 47-year-old male patient was referred to the physician with acute abdominal extension for 2 days. He revealed a history of fatigue and right upper abdominal pain in the past 4 days. Diagnosis: Dengue-induced acute ascites. Intervention: Standard fluid replacement therapy. Outcome: The clinical finding of the patient returned to normal within 5 days. Lesson: Since dengue has been expanding its endemic area at present, an atypical clinical presentation is possible and should not be ignored in the process of diagnosis. In addition, the clinical presentation of acute distention of abdomen with abnormal petechiae is a good diagnostic implication for dengue-induced ascites.

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Diabetes, as the major cause of hyperglycemia, is a chronic metabolic disease. Immune system disorders caused by diabetes can increase the risk of respiratory diseases. Thus, diabetes is considered to be a major risk factor for viral respiratory infections such as coronavirus infections. Coronaviruses are members of the Coronaviridae, which has caused three outbreaks from 2003 to 2020. Patients with coronavirus infection in the lower and upper respiratory tract could show mild to severe symptoms. In this review, we focus on the relationship between diabetes and three coronaviruses: SARS-CoV, MERS-CoV, and SARS-CoV-2.

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The pathogenesis of vestibular paroxysmia (VP) is the neurovascular cross-compression of cranial nerve VIII with short episodes of vertigo as the common symptom. The exact etiological and clinical profiles of the patients with VP are uncertainly reported in literature. It is general thought that loop of the anterior inferior cerebellar artery and posterior inferior cerebellar artery (less commonly), vertebral artery, or a vein is involved in compressing cranial nerve VIII. Ephaptic neural discharges at the proximal end of cranial nerve VIII, which is covered by oligodendrocytes, are thought to be the mechanism for VP. Patients with VP often suffer from brief vertiginous attacks of several episodes in a single day, and nystagmus is seen during the vertiginous episodes. Cranial magnetic resonance imaging could reveal the arterial compression of cranial nerve VIII. The important differential diagnosis of VP includes vestibular migraine, Meniere’s disease, benign paroxysmal positional vertigo, superior canal dehiscence syndrome, epileptic vertebral aura, paroxysmal brainstem attacks (in multiple sclerosis or after brainstem stroke), transient ischemic attacks and panic attacks. The vertiginous attacks can be ceased by administration of a low dose of carbamazepine. Carbamazepine or oxcarbazepine, even in low doses, can be efficient to relieve VP, and they have the same efficiency both in adults and in children.

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Acute upper gastrointestinal bleeding is one of the most common life-threatening diseases. Standardized diagnosis and treatment of acute upper gastrointestinal bleeding are of great importance for improving the prognosis. In 2015, the Emergency Physician Branch of the Chinese Medical Doctor Association updated an expert consensus statement on the emergency diagnosis and treatment procedures for acute upper gastrointestinal bleeding. Based on the 2015 consensus statement, members of the expert panel decided to reconvene and draw up a 2020 update on the advancements in the clinical care for acute upper gastrointestinal bleeding. The 2020 expert consensus statement is summarized in 10 sections: emergency assessment, diagnosis, stratified treatment, emergency treatment, comprehensive assessment, medication management, endoscopy, interventional radiology, multidisciplinary treatment, and evaluation of prognosis. The consensus statement is based on experts’ opinions combined with the latest relevant medical evidence.

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Objective: To investigate the risk factors and protective measures of COVID-19 among policemen in an eastern state of India. Methods: This case-control study was conducted in Bihar, located in the eastern part of India. In total, 6 confirmed COVID-19 cases (the case group) and 11 negative contacts of these cases (the control group) of Bihar Military Police participated in the study. Results: All subjects were male with a median age of 51 (range: 23-60) years. Among these 6 confirmed cases, 5 cases were asymptomatic. One third (33.3%) of the case group and the majority (90.9%) of the control group reported maintenance of physical distance of at least 1 meter with others all the time, which was significantly different (P=0.028). There was no other statistically significant difference between the case group and the control group. Conclusions: Physical distancing is the most effective public health measure to control contagious diseases like COVID-19, especially in the absence of an effective vaccine in police settings.

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Objectives: To evaluate clinical features, treatment strategies, and outcomes of pleural empyema for children who were treated at referral pediatric hospitals in 8 provinces of Iran. Methods: In this retrospective, multicenter cross sectional study, we retrospectively retrieved patients’ data from 8 teaching hospitals during 2010 and 2017. A questionnaire was applied and filled, and all data were statistically and descriptively analyzed. Results: In total, 191 children (109 males and 82 females) were included. Their mean age was 4.95 years and ranged from 11 months to 16 years. The majority of cases (45.1%) were 1-4 years old. Fever (70.3%), cough (65.6%), tachypnea (53.1%), chest pain (14.6%), and abdominal pain (12%) were the most common manifestations at admission. The mean length of admission in hospital was 16.4 d. Consequently, 27 patients (14.1%) were admitted into the pediatric intensive unit because of severe illness, and 15 patients (7.9%) died. Logistic regression analysis showed that younger age (less than 12 months) and presence of underlying diseases (such as cardiovascular disease, immune deficiencies, malignancies, and neuro-developmental delay) significantly increased the mortality rate of patients with pleural empyema (P=0.004 and P=0.001, respectively). Conclusions: Pleural empyema children of younger age and with underlying diseases are at higher risks of death. In addition, guidelines for treating pleural empyema should be developed.

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Objective: To identify the risk factors of Clostridium difficile infection (CDI) in diarrheal patients admitted to the intensive care unit (ICU) in Tehran Baharloo Hospital. Methods: A case-control study was conducted on ICU patients with hospital-acquired diarrhea. A total of 101 patients were divided into two groups: the case group (CDI positive, n=47) and the control group (CDI negative, n=54). The baseline information such as use of antibiotics, other drugs administration, treatments before diarrhea, laboratory results, and vital signs of the two groups were compared. Besides, logistic regression model was used to assess the correlation between CDI positivity and mortality. Results: Hospital stay length, ICU stay length, duration from admission to diarrhea onset, and nasogastric feeding duration, mechanical ventilation rate and its duration were significantly different from these of the control group (P<0.05). The frequency of proton pump inhibitor and carbapenem in the case group was significantly higher than that of the control group (P<0.05). In addition, age had a significant effect on the mortality of CDI patients. Conclusions: Patients with older age, longer duration of hospital or ICU stay, longer duration of endotracheal feeding and/or intubation were more susceptible to CDI. In addition, proton pump inhibitor and carbapenem use influenced the gut microbiome diversity and increased the CDI risk in patients.

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Rationale: Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries. Such enormous pressure into the rectum can lead to devastating injuries. Patient’s concern: A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus. There was diffuse subcutaneous emphysema over the neck, chest, abdomen, and extremities, and he presented with hemodynamic instability and respiratory failure. Diagnosis: Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum, pneumomediastinum, pneumothorax, and extensive subcutaneous emphysema. Intervention: In view of tension pneumoperitoneum, urgent percutaneous needle decompression was performed using 16 G needle, 5 cm superomedial to the anterior superior iliac spine. The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics. Outcome: The patient succumbed two days later due to septic shock. Lessons: This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India.

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