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   Table of Contents - Current issue
January-March 2021
Volume 11 | Issue 1
Page Nos. 1-48

Online since Saturday, March 27, 2021

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What's new in critical illness and injury science? Convalescent plasma for coronavirus disease-2019 patients with severe or critical illness p. 1
Andrew Carl Miller, Shadi Ghadermarzi, Shobi Venkatachalam
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Statin therapy improves serum Annexin A1 levels in patients with acute coronary syndrome: A case-controlled study Highly accessed article p. 4
Hayder M Al-Kuraishy, Ali I Al-Gareeb, Oula Mohamed Samy
Background: The objective of the study is to estimate the protective role of statins in patients with acute coronary syndrome (ACS) through modulation of annexin A1 (AnxA1) serum levels. Methods: A total number of 63 patients with ACS were recruited compared with 25 healthy control subjects. The enrolments were divided into – Group (A): Patients with ACS on atorvastatin (n = 20), Group (B): Patients with ACS on rosuvastatin (n = 20), Group (C): Patients with ACS but not on statin therapy (n = 23), and Group (D): Healthy controls (n = 25). Body mass index and both systolic blood pressure and diastolic blood pressures were measured. Lipid profile, atherogenic index, cardiac risk ratio, cardiovascular risk index, and human AnxA1 level were estimated. Results: AnxA1 serum level was higher in patients with ACS (3.35 ± 0.84) compared with healthy controls (1.71 ± 0.91) and nonstatin using patients (1.47 ± 0.76) (P = 0.005). Conclusion: AnxA1 serum level is reduced in patients with ACS compared with healthy controls. Patients with ACS on statins therapy showed a higher level of AnxA1 compared with patients with ACS but not on statin therapy.
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Use of intensive care unit priority model in directing intensive care unit admission in Sudan: A prospective cross-sectional study p. 9
Ihab B Abdalrahman, Shaima N Elgenaid, Mohammed Alhadi Babiker Ahmed
Background: The shortage of specialized intensive care beds is one of the principal factors that limit intensive care unit (ICU) admissions. This study explores the utilization of priority criteria in directing ICU admission and predicting outcomes. Methods: This was a prospective cross-sectional study conducted in two ICUs in Sudan from April to December 2018. Patients were assessed for ICU admission and were ranked by priority into Groups 1, 2, 3, and 4 (1 highest priority and 4 lowest priority), and these groups were compared using independent t-test, Chi-square, and ANOVA. Results: A total of 180 ICU admitted patients were enrolled, 53% were male. The prioritization categories showed that 86 (47.8%), 50 (27.8%), 13 (7.2%), and 31 (17.2%) were categorized as priority 1, 2, 3, and 4, respectively. Patients in priority groups 3 and 4had significantly higher ICU mortality rates compared to those in groups 1 and 2 (P < 0.001), were likely to be older (P < 0.001), had significantly more comorbidities (P = 0.001), were more likely to be dependent (P < 0.001), and had longer ICU length of stay (P = 0.028). Conclusion: Patients classified as priority 3 and 4 were predominantly older and had many comorbidities. They were likely to be dependent, stay longer in ICU, and exhibit mortality.
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Are we selecting appropriate admissions for intensive care following major abdominal surgery: A retrospective cohort study on outcomes of 1059 patients p. 14
Jeremy P Batt, Rosie C Vincent
Background: Like any other medical treatment, The intensive care unit (ICU) is a limited resource that needs to be utilized appropriately. This study aimed to identify the outcomes of patients admitted to the ICU based on patient demographic and severity score parameters. Methods: An observational retrospective cohort study of 1059 patients undergoing laparotomy who were admitted to the ICU was performed. Cases were sub-classified by the mode of admission and risk prediction scores and analyzed outcomes of mortality, ICU length of stay (LOS), and hospital LOS. Results: The mean age of patients who did not survive was older than those who survived, and higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Intensive Care National Audit and Research Centre Physiology Score (ICNARC) observed in patients who died. Emergency admission was also an indicator of increased mortality. Survivors APACHE II scores were the same if they were elective or emergency admissions, although Survivors ICNARC scores were higher in emergency than in elective admissions. Patients who did not survive had a longer ICU LOS stay than those who survived, whereas elective survivors had shorter ICU LOS than the emergency survivors. Regardless of this hospital LOS was the same for both elective and emergency survivors. Conclusion: The most unwell patients had the highest risk prediction scores, were more often admitted in the emergency setting, required longer stays in ICU, and had less favorable outcomes. However, ICU did appear to expedite the hospital discharges of emergency patients to match their elective counterparts. Decisions around when and to which patients ICU is an appropriate intervention remains a difficult decision and one that cannot be made without full consideration of all aspects of patient factors.
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Impact of blood alcohol concentration on hematologic and serum chemistry parameters in trauma patients: Analysis of data from a high-volume level 1 trauma center p. 18
Kathryn Clare Kelley, Philip Salen, Thomas R Wojda, Aliaskar Z Hasani, Joshua Luster, Jacqueline Seoane, Marissa Zwiebel Cohen, Roberto Castillo, Stanislaw P Stawicki
Background: Alcohol (EtOH) intoxication is common among trauma patients. While providers are familiar with the clinical aspects of acute EtOH intoxication, few studies have investigated the effects that EtOH levels may have on common laboratory markers. The aim of this study was to identify hematologic and serum chemistry parameters that may be affected by the blood alcohol concentration (BAC), hypothesizing that BAC influences both comprehensive blood count (CBC) and comprehensive serum chemistry (CSC) components. Methods: We performed an IRB-exempt institutional registry review of all trauma patients who had serum EtOH levels measured between January 2009 and June 2015. Data for each patient included: patient demographics, BAC determinations (g/dL), injury mechanism/severity information (ISS), hematologic parameters included in a CBC (hemoglobin, hematocrit, white blood cell [WBC] count, and platelet count), and CSC panel components (sodium, potassium, chloride, bicarbonate, blood urea nitrogen [BUN], creatinine, glucose, and hepatic function tests). Laboratory markers were contrasted across predefined categories of BAC: <0.10%, 10%–15%, 15%–20%, and >20%. Statistical comparisons were performed using SPSS 18 Software, employing analysis-of-covariance with adjustments performed for the patient demographics and injury characteristics. Statistical significance was set at α = 0.005. Results: A total of 2167 patient records were analyzed. After adjusting for patient age, gender, and ISS, increasing BAC correlated with 4.8% increase in hemoglobin and 32.5% higher hematocrit (both P < 0.001), as well as a 27.8% decrease in WBC count. There were also statistically significant differences between low (<0.10%) and high (>0.20%) BAC groups across multiple CSC parameters, with largest impact on BUN (32.2% decrease); creatinine (31.5% decrease); and glucose (13.6% decrease) values. Elevated BAC (>0.20 g/dL) was also associated with 81.8% increase in total bilirubin, and hepatic transaminases were elevated among patients with BAC >0.10. Conclusion: Due to the paucity of literature relating to the effects of BAC on serum hematologic and biochemical markers in acute trauma, this study provides a foundation for further exploration of these relationships and their clinical impact. More specifically, we found that BAC levels significantly influenced key laboratory markers, suggesting that acute EtOH intoxication may lead to hematologic and CSC changes that are potentially important in acute trauma management by frontline clinical staff.
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Impact of COVID-19 lockdown on the spectrum of trauma patients at a major trauma center in central India: A retrospective observational study p. 25
Abdul Haque M. Quraishi, Shiv Sahu, Pankaj Tongse, Ankit Agrawal
Context: A total lockdown was announced in India from March 25 to May 31 in four phases in response to the COVID-19 pandemic. This study aimed to study the impact of this national lockdown on the volume and the nature of injuries in patients admitted during this period at a major trauma center in central India. Methods: This is a retrospective descriptive study of prospectively collected data which were collected from the hospital records. Patients admitted to the trauma center during lockdown were compared to patients admitted in the prelockdown period for the change in volume and spectrum and severity of injuries across all age groups and both genders. Results: There was a significant fall in the overall number of trauma patients across all age groups and both genders during the lockdown period (66.8%). There was a significant decrease in numbers among males (68.1%). Road traffic accidents decreased by 75.2%. There was a relative increase in trauma due to falls and assault during the lockdown period. The mortality due to trauma decreased significantly by 79.8%. Conclusions: There has been an overall decrease in the number of patients admitted to the trauma center during the lockdown period. However, there is a relative increase in preventable injuries such as falls, assault, and animal-related injuries. Focused strategies to decrease preventable injuries need to be devised to reduce the load on overburdened resources during the COVID-19 crisis.
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A cross-sectional study on fear-avoidance beliefs and chronic low back pain in fighter pilots p. 29
Sami S AlAbdulwahab, Shaji John Kachanathu, Ali S N. AlSunaidi
Background: Chronic low back pain (CLBP) is considered a serious complaint among fighter pilots because the vertebrae of these pilots are exposed to high compression forces from prolonged sitting on a hard ejection seat and frequent sudden fighter aircraft maneuvers. It is yet unknown whether a correlation exists between CLBP and psychosocial/behavioral performance of fighter pilots. Methods: This was a cross-sectional study of 66 fighter pilots with nonspecific CLBP voluntarily participated in this study. Self-efficacy was measured based on the degree of physical activity and work performance using the fear-avoidance beliefs questionnaire (FABQ). Results: A significant inverse correlation was found between the work subscale of the FABQ (FABQw) (mean score: 27.4 ± 8.4) and both age (mean: 35 ± 4.9 years) and flying experience (mean: 13.2 ± 4.4 years) among fighter pilots with nonspecific CLBP. In contrast, there was no significant correlation between physical activity subscale of the FABQ (mean score: 12.3 ± 6.4) and both age and flying experience. Conclusions: An inverse correlation was observed between FABQw and both age and flying experience among fighter pilots with nonspecific CLBP. It is important for rehabilitation specialists to understand the role of cognitive/affective components of a pain from tissue injury and nociception to prevent occupational disability and enhance occupational performance.
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Emergency medical care in dentistry: A cross sectional analysis of competencies for undergraduate students p. 33
Raghad Hashim, Lity Susan Mathew, Suhad Rustom, Fatima Amer, Ruba Odeh
Background : The possibility of a medical crisis, albeit a relatively uncommon occurrence in a dental practice, is often overlooked and it is imperative that dental practitioners equip themselves with the knowledge and skills essential to manage potentially life-threatening situations. The aim of this study was to evaluate the knowledge and competency levels of dental undergraduate students training across universities in the UAE in basic life support (BLS) and medical emergencies in a dental setting. Methods: A cross-sectional survey-based study was conducted and 411 students undergoing clinical training (4th and 5th year of dental school) voluntarily participated in this study. The questionnaire comprised questions related to commonly occurring medical emergencies that they may have encountered in a dental setting. Data collected were then tabulated and subjected to descriptive statistical analysis. Results: More than half of the respondents (55.2%) reported that they had lower confidence in handling medical emergencies, with 54.7% claiming that they had not received training on the subject during their undergraduate course. Majority of the respondents (216) reported that they would only choose to record vital signs if the medical history of the patient was indicative of an underlying condition. Discussion: Findings from the present study strongly mandate the inclusion of training for BLS and medical emergencies in the existing dental curriculum to equip graduate dental practitioners to handle a medical crisis in their dental practice.
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Expanded dengue syndrome with small–medium-vessel vasculitis: A case report p. 39
Augustine Jose, Minakshi Dhar, Prasan Kumar Panda, Sanjeev Kishore
Expanded dengue syndrome (EDS) is a well-described entity in the literature (after 2009), with various new atypical presentations being identified each year. We report a case of 38-year-old man who presented to the emergency department with high-grade, intermittent fever for 7 days along with myalgia and headache. He had multiple painless palpable purpura over both lower limbs and breathlessness from the 4th day of fever. On admission, purpura progressed in the severity and dry impending gangrene of the toes of both feet developed. Blood cultures turned out to be sterile, and other infectious markers (malaria, scrub typhus, and chikungunya) were negative except for dengue serology (enzyme-linked immunosorbent assay-immunoglobulin M [ELISA-IgM]). Skin biopsy confirmed to be cutaneous small-vessel vasculitis. The respiratory distress was due to myocarditis (supported by raised NT-pro-BNP levels) and pulmonary edema. He also had possibly hemolytic anemia due to microangiopathy. Although there are many EDS cases of dengue myocarditis reported till date, dengue resulting in widespread endothelial activation and extensive vasculitis (small vessel due to purpura and medium vessel due to gangrene) is a rare phenomenon.
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Diffuse bone metastasis from cholangiocarcinoma involving the sternum: A case report and review of literature p. 43
Balraj Singh, Amr Ramahi, Kok Hoe Chan, Parminder Kaur, Gunwant Guron, Hamid Shaaban
Cholangiocarcinoma (CCA) is a rare cancer of the bile duct epithelial cells and it commonly spreads to the regional lymph nodes, liver, and lungs. Bone metastasis has been reported in patients with CCA, involving both the axial and appendicular skeleton. Herein, we report a case of extrahepatic CCA with extensive bone metastases involving the calvarium, sternum, bilateral ribs and scapulae, entire spine, pelvis, and bilateral femur. To our knowledge, this is the first case report on sternum metastasis in CCA. The case presentation and review of literature highlighted the rarity of this metastasis, and health-care providers should be aware of the rare presentation of CCA.
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Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals – A multicentric study in India: A comment p. 47
Mohd Saif Khan, Jay Prakash, Rash Kujur, Ramesh Kumar Kharwar
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