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Eslicarbazepine acetate: A therapeutic agent of paramount importance in acute anticonvulsant therapy
Farah Iram, Shah Alam Khan, Aftab Ahmad, Anees A Siddiqui, Asif Husain
November 2017, 6(6):245-254
Eslicarbazepine acetate (ESL) is a new, once daily, orally administered, third generation antiepileptic drug which is indicated in the treatment of partial-onset seizures. ESL is known to exert it’s anticonvulsant effect by blocking the voltage-gated sodium channels. Several clinical trials and pharmacological studies have revealed that seizure control was better with ESL monotherapy (1 200 or 1 600 mg once daily) following a switch from other antiepileptic drugs in comparison with pseudo-placebo patients. The studies have indicated the ESL to be well tolerated and produced only mild to moderate emergent adverse events with the therapy. Being a dibenzazepine family member, structure and chemistry of ESL resembles more or less to carbamazepine and oxcarbazepine. ESL differs structurally from carbamazepine and oxcarbazepine at the 10, 11 position of dibenazepine nucleus. This molecular variation results in differences in metabolism and thus helps to prevent the formation of toxic epoxide metabolites. ESL following oral administration is rapidly metabolised to active metabolite namely S-licarbazepine which is responsible for its pharmacological activity. ESL exhibits acceptable pharmacokinetic profile and shows insignificant drug-drug interactions. In phase III clinical program, ESL was found to be efficacious and well tolerated in adult patients with partial onset seizures previously not controlled with treatment with one or two other antiepileptic drugs.
  36,226 468 1
The chest X ray in pulmonary embolism: Westermark sign, Hampton's Hump and Palla's sign. What's the difference?
Tan Si Hong Shawn, Lim Xin Yan, Fatimah Lateef
May 2018, 7(3):99-102
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.
  26,564 1,369 1
Acute abdomen presentation in dengue fever during recent outbreak
Bal Kishan Gupta, Hardeva Ram Nehara, Sahil Parmar, Shyam Lal Meena, Suresh Gajraj, Jigyasa Gupta
September 2017, 6(5):198-204
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.
  26,214 478 1
Knowledge, attitude, and practice towards coronavirus disease 2019 (COVID-19) among medical students: A cross-sectional study
Sonam Maheshwari, Puneet Kumar Gupta, Richa Sinha, Pravesh Rawat
May 2020, 9(3):100-104
Objective: To assess knowledge, attitude, and practice of medical students towards coronavirus disease 2019 (COVID-19). Methods: A self-designed questionnaire was developed and given to the students of a government medical college in Uttarakhand. The demographics, mean knowledge, attitude, and practice of the participants were investigated, and the scores were calculated. t-test and ANOVA were used for statistical analysis. Results: Out of the total participants (n=354), 50.3% were male and 54.5% were 21-23 years. Almost all the participants (96.6%) increase the frequency of washing hands under the influence of COVID-19. Although no significant relationship was found between different religions, age-categories in terms of knowledge, the participants who were aged 21-23 years had higher knowledge. In addition, gender had a significant impact on practice scores (P<0.05) while no demographic variable was found to have a significant relation with attitude score (P>0.05). Conclusions: The majority of the participants had good knowledge, positive attitude, and sufficient practice. Females and males have significantly different practices. Although the results are very positive, it is suggested that people should continue to strengthen knowledge, attitude, and practice towards COVID-19, so that India can win the battle against the disease.
  12,461 1,426 6
A severe case of levothyroxine intoxication successfully treated in intensive care unit
Yusuf Savran, Tugce Mengi, Merve Keskinkilic
August 2018, 7(4):175-177
Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, a patient who ingested high dose (15 mg) levothyroxine for suicide and admitted to intensive care unit was presented. There was a decrease in Glasgow coma score in the follow-up. The patient was intubated due to acute respiratory failure. Gastric lavage, activated charcoal, methylprednisolone, cholestyramine and therapeuthic plasma exchange were administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms resolved with appropriate treatment and the patient was discharged from the intensive care unit.
  10,265 445 2
The effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury
Cheng Zhang, Jian-Ming Li, Jun-Lin Hu, Xia Zhou
March 2018, 7(2):69-73
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-α , 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-α , 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.
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Latest research progress on acute nephrotic syndrome
Satinder Kakar, Vishal Kumar, Ramandeep Singh
November 2017, 6(6):255-259
Etiology of nephrotic syndrome is somewhat complex in nature. It may range from primary to secondary forms. Nephrotic syndrome patients often need immunosuppressive treatment although it has some side effects and may lead to renal disease which may be acute or severe. This review deals with herbal treatment and other recent approaches for treating symptoms of nephrotic syndrome.
  6,697 425 -
Epidemiological and demographic study of acute animal biting in Abdanan County, Ilam Province, Western Iran
Hamid Kassiri, Masoud Lotfi, Atefe Ebrahimi
November 2017, 6(6):272-277
Objective: To determine the incidence, epidemiology and demography of acute animal bites referred to Abdanan health centers in the years 2009 to 2013. Methods: This study was a descriptive analytical research. Questionnaires for each case of acute animal bite was completed. Data about age, gender, kind of animal, residency, site of bite, etc taken from Abdanan health centers were analyzed. Data were analyzed in SPSS by using descriptive statistics. Results: Total number of exposed persons to acute animal bites was reported 67 in 2009 and 69 in 2013. The average incidence rate was 1.2 per 1 000 population. Bites were frequent among the age group of 20-30 years. Most of the cases were self-employment. Around 83.8% of cases were bitten by dogs. Of total 309 studied patients, 73.8% were male. Feet (71.5%) and hands (22.7%) were the most common body part affected. About 53.1% of cases were in rural population. Conclusions: Dogs seems to play a very important role in the epidemiology of rabies in Abdanan, Iran. No cases of human rabies were observed in our study. This may be because of increasing public awareness and the upgrading of health and treatment centers, all of which in study region provide post-exposure anti-rabies treatment including vaccination, immunoglobulin and wound washing.
  5,690 230 1
Hypertriglyceridemia–induced acute pancreatitis: A systematic review of the literature
Ionut Negoi, Sorin Paun, Massimo Sartelli, Fausto Catena, Luca Ansaloni, Ruxandra Irina Negoi, Mircea Beuran
January 2017, 6(1):1-5
Objective: To summarize the current evidence about the hypertriglyceridemia–induced acute pancreatitis (HAP). Methods: Systematic review of the English language literature was conducted using PubMed/ Medline database from its inception until August 2016. As a searching methodology, we have used a combination of ‘acute pancreatitis’ and ‘hypertriglyceridemia’ as keywords into the title. Results: The diagnosis of HAP should be based on two out of the three criteria recommended by the international guidelines: characteristic clinical picture, serum pancreatic enzymes, and appropriate imagistics. The diagnosis of HAP should be distinguished between mild hypertriglyceridemia (> 150 mg/dL), which accompanies around one-third of all-causes acute pancreatitis, and severe hypertriglyceridemia (> 1 000 mg/dL) which generates acute pancreatitis. There is mixed evidence regarding a worse prognosis for patients with HAP, and a clear conclusion cannot be drawn. Similar to all the other etiologies, in HAP the initial treatment efforts should be nonspecific and addressed to acute pancreatitis, while pharmacologic and mechanical techniques should be added to lower the serum triglycerides as soon as possible. Conclusions: We may conclude that HAP should be managed to respect all the general principles, also adding all the available resources to lower the serum triglycerides value, as early as possible in the acute setting and on long-term to prevent recurrences.
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Hyponatremia in the acute phase of spinal cord trauma: Review
Luis Rafael Moscote Salazar, Amit Agrawal, Guru Dutta Satyarthee, Huber S Padilla-Zambrano, Boris Vladimir Cabrera-Nanclares, Romario Mendoza-Flórez, Samer Hoz, Alexis Narvaez-Rojas
May 2018, 7(3):103-107
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.
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Myasthenia gravis exacerbation and diarrhea associated with erythromycin treatment
Sora Yasri, Viroj Wiwanitkit
March 2017, 6(2):85-86
An important problem in management of the case with myasthenia gravis (MG) is the control of exacerbation. There are several possible causes of exacerbation of MG including the use of drug. Here, the authors report a case of MG exacerbation and diarrhea associated with erythromycin treatment.
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Corneal perforation and rare primary adenocarcinoma of the lacrimal gland: A case report
Sunny Chi Lik Au, Edwin Chan, Simon Tak Chuen Ko
September 2020, 9(5):227-230
Rationale: Primary adenocarcinoma of the lacrimal gland is rare, and its presentation as corneal perforation is even rarer. Corneal perforation is an ocular emergency that warrants urgent ophthalmic surgery, yet complete staging of lacrimal gland tumor pre-operatively is essential for optimal oncological management. Patient’s concerns: A 57-year-old man presented with left eye pain was found to have left eye proptosis and fleshy tissue mass around the eyeball. Uveal tissue was prolapsing over the perforated keratitis cornea, and the eye was full of discharge. Diagnosis: Bedside ultrasound B-scan confirmed vitreous haze, and emergency contrast computed tomography (CT) revealed soft tissue density mass (>40 mm) molding around the left globe and optic nerve without any rim enhancing abscess. Left exogenous endophthalmitis from exposure keratopathy secondary to proptosis caused by the bulky lacrimal tumor located in the confined orbital cone was diagnosed. Interventions: Emergency enucleation surgery of the left eyeball was done for this painful blind eye to control the infection from spreading. Orbital walls were biopsied intra-operatively, and tumor staging was completed by positron emission tomography- CT scan and magnetic resonance imaging. Without evidence of metastasis, left orbital exenteration was followed by adjuvant orbital chemoradiotherapy for the sake of close proximity of resection margin. Outcomes: Left exenterated orbit was fully epithelialized at around 2 months, and there was no recurrence of the disease up to present at the 1 year follow-up. Lessons: Thorough workup on the staging of the disease to minimize the number of operations for oncological patients is always a top priority, yet it may not always be possible as in our case presenting with corneal perforation.
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"Reconciliation vessel" within de I-Ching book: Theoretical methodological analysis of its relevant hexagrams
Adrián Ángel Inchauspe
March 2018, 7(2):49-68
The I-Ching is one of the most significant texts in the literature of the world and embodies, as no other text does, the Chinese spirit and thought. Its perpetuation along millennia has exercised crucial influence on the development of Chinese philosophy and medicine. The hypotheses of its abstractions compose a “body of assumptions” that hierarchs concepts through a self-regulated process of reciprocal control, which allows the accurate prediction of specific sequences of events according to “fields of similarities”. This peculiarity enables this system of knowledge to make possible predictions based upon the Natural Laws with incredible accuracy, which is effective to process expectations and arguments or to affirm or reject its judgments. A detailed analysis of two consecutive hexagrams (N 23 & N 24) allows the understanding not only of the bases that consolidate the “Reconciliation vessel” but also of the specific determination of its function in the frame of Risk management that can be compared to present ISO standards.
  3,624 325 -
Acute electrical injury: A systematic review
Noor-Ahmad Latifi, Hamid Karimi
May 2017, 6(3):93-96
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.
  3,402 450 -
A review on Acinetobacter baumannii
Xin Wang, Li-Jie Qin
January 2019, 8(1):16-20
Acinetobacter baumannii is a major cause of nosocomial infections worldwide. By summarizing the epidemiology, molecular and drug resistance mechanisms, diagnosis and treatment strategies of Acinetobacter baumannii, the clinical outcome is finally improved.
  3,041 690 1
The laparoscopic approach in emergency surgery: A review of the literature
Ionut Negoi, Mircea Beuran, Cezar Ciubotaru, Adelina Cruceru, Sorin Hostiuc, Massimo Sartelli, Matthew Hernandez, Mihaela Vartic
January 2018, 7(1):15-19
The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in bdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.
  3,252 441 2
Comparison between laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy
Miao Zhou
May 2017, 6(3):97-100
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.
  3,373 256 -
Staphylococcus cohnii: Not so innocuous
Sunil Garg
September 2017, 6(5):239-240
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.
  3,292 334 -
Thyroid storm precipitated by acute biliary pancreatitis
Mehrdad Karimi, Adnan Tizmaghz
January 2017, 6(1):43-44
Thyroid storm is an acute, life-threatening exacerbation and sudden releasing large amounts of thyroid hormone in a short period of time. Nevertheless, critical aggravation of hyperthyroidism typically resulted from concurrent disorder. Synchronous management of thyroid storm along with its precipitant, such as infection is recommended. We described the case of an acute biliary pancreatitis complicated with a thyroid storm. The patient was successfully managed with a quick surgical intervention and further critical care for thyroid storm. Although it is widely believed that pancreatitis is seldom concurrent with thyrotoxicosis, thyroid storm can be precipitated by a variety of factors, including intra-abdominal infections such as acute pancreatitis or perforated peptic ulcer. In conclusion, acute pancreatitis in patients with thyrotoxicosis seems to be extremely rare, but such patients should be managed intensively against underlying thyroid disorders as well as pancreatitis.
  3,350 177 -
Intranasal ketamine as an analgesic agent for acute pain management in emergency department: A literature review
Abdolghader Pakniyat, Morteza Qaribi, Dorin Rahnama Hezaveh, Ali Abdolrazaghnejad
November 2018, 7(6):241-246
Ketamine is a well-known dissociative anesthetic agent, and has been used over 50 years. Intranasal pathway is a mucosal way for absorbing agents to directly affect in brain via olfactory sheets, bypassing first pass metabolism and the blood brain barrier. The current uses of intranasal ketamine as an analgesic agent for acute pain management in emergency department are discussed in this review article. Using "ketamine", "pain or analgesia", and "intranasal" as keywords, a search of google scholar, Pubmed, web of science, and Medline database from 1970 until 2017 was performed. Finally, from 1 204 papers extracted via primary search, 1 088 papers were omitted and finally 10 studies were considered for further assessment. There were four observational studies, one case series and report and 5 clinical trials. Ketamine was used for acute pain control due to musculoskeletal trauma, burns, and painful procedures. A total of 390 cases were included in these studies. The studies used ketamine with doses ranging 0.45-1.25 mg/kg via intranasal pathway. Intranasal ketamine provides relatively rapid, well tolerated, and clinically significant analgesia for emergency department patients. Considering the lack of adequate studies and undetermined intranasal dose, it is better to conduct further high quality investigation in both adults and pediatrics.
  2,887 399 -
Severe eclampsia and HELLP syndrome at 18 weeks of pregnancy in a patient with chronic hypertension
Tomasz Wojewoda, Edyta Unkiewicz, Ewa Wojewoda-Chmiel, Piotr Bijak, Michal Bogusiewicz
November 2018, 7(6):265-267
Preeclampsia is a pregnancy specific disease characterized by hypertension and proteinuria, by definition, developing after 20 weeks of pregnancy. Here we present an atypical case of severe preeclampsia complicated by generalized convulsions (eclampsia) and hemolysis, elevated liver enzymes, and low platelet count syndrome in an 18 weeks pregnant patient with chronic hypertension. Occurrence of these complications was preceded by upper right quadrant abdominal pain and severe hypertension. In this case no evidence of autoimmunity disorders or molar pregnancy was found.
  2,986 226 -
Therapeutic effect of Sinapic acid in aluminium chloride induced dementia of Alzheimer's type in rats
Souravh Bais, Renu Kumari, Yash Prashar
July 2017, 6(4):154-162
Objective: To evaluate the effect of sinapic acid against Aluminium chloride-induced dementia of Alzheimer's disease (AD) type in rat. Methods: The study was designed to induce dementia by chronic exposure of aluminium chloride at a dose of 175 mg/kg, p.o. for a period of 25 days in rats and then divided into different groups, i.e. Treatment group, negative control and two groups of sinapic acid, (at a dose of 20 and 40mg/kg, p.o.), where these groups treated and observed till the 35th day of experimental trial. The behavioural, neuronal and biochemical parameters were determined during or end of experiment. Histological changes in the brain were also observed. Results: Aluminium chloride at a dose of 175 mg/kg, o.p. had significantly induced the dementia and sinapic acid, at a dose of 40 mg/kg, p.o., possessed therapeutic effect against Aluminium chloride induced-dementia of AD type in rats. Conclusions: Sinapic acid is a class of compound wide spread in plant kingdom and could be a better source of neutraceuticals in brain disorders. The compound showed an in vivo MAO-A and MAO-B inhibiting activity and their role in Alzheimer's disease type of dementia was unexplored. The article also provides information on acute toxicity of sinapic acid with no toxicological sign on brain with chronic dose of AlCl3.
  2,821 364 -
The damage control in tibial pilon open fractures with a new external fixator delta frame
Giuseppe Rollo, Andrea Pasquino, Paolo Pichierri, Michele Bisaccia, Alessandro Stasi, Marco Giaracuni, Niki Cazzella, Luigi Meccariello
September 2017, 6(5):222-226
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.
  2,817 318 -
Proptosis in orbital myeloid sarcoma: A precursor to acute leukaemia
LC Fhun, ELM Tai, WH Wan-Hazabbah, AT Liza-Sharmini, MF Chong
May 2017, 6(3):134-136
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.
  2,848 183 -
Cardiovascular complications associated with spinal cord injury
Roberto Fabio Calvo-Infante, Alexis Narvaez-Rojas, Huber Padilla-Zambrano, Samer S Hoz, Amit Agrawal, Luis Rafael Moscote-Salazar
August 2018, 7(4):139-144
Spinal cord injury can lead to important functional, psychological and social sequelae. Despite the progress in medicine and greater understanding of the pathophysiological events associated with a traumatic spinal cord injury, spinal cord injury is still associated with a high morbidity and mortality. The involvement of the autonomic nervous system has implications in acute and chronic stages of the injured spinal cord patients. The most frequent cardiovascular complications in the acute phase of the traumatic spinal lesions are bradyarrhythmia, hypotension, increased vasovagal reflexes, ventricular and supraventricular ectopic beats, venous stasis, and vasodilation. In the chronic phase, we find orthostatic hypotension, alteration of the arterial pressure and the regulation of the body temperature as well as alteration of the blood volume. The knowledge of the cardiovascular alterations is of vital importance for the management and rehabilitation of the patients with spinal cord injury. In this article, we present a critical review of medical literature.
  2,657 343 -