Acute Disease

REVIEW ARTICLES
	Biomarkers in acute brain trauma: A narrative review	p. 1
	GA Quinones-Ossa, H Padilla-Zambrano, R Pal, A Ghosh, LR Moscote-Salazar, VA Kiran Kumar, A Agrawal DOI:10.4103/2221-6189.250370   Biomarkers have been used to diagnose, prognose, evaluate, and identify the severity and outcomes in traumatic brain injury (TBI) patients. This study explored if it is possible to predict the outcome of TBI patients by estimating the biomarkers in cerebrospinal fluid and serum. We searched data bases and literature about biomarkers, and found forty epidemiologic studies from 92 potentially relevant articles. However, limited data are available about postanoxic encephalopathy. It showed that presently, neurofilament, S100B, glial fibrillary acidic protein, and ubiquitin carboxyl terminal hydrolase-L1 seemed to have the best potential as diagnostic biomarkers for distinguishing focal and diffuse injury, whereas C-Tau, neuron-specific enolase, S100B, glial fibrillary acidic protein, and spectrin breakdown products appear to be candidates for reflective biomarkers of TBI. Point-of-care biomarkers are needed in TBI which is one of the most important additional risk factors in road traffic injuries. In a holistic approach, more researches about biomarkers of TBI are required. These biomarkers are very useful for treatment of patients with TBI.
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	Association of MBL2 gene polymorphisms with sepsis in children and adult	p. 7
	Jun-Yi Yao, Zhi-Qian Luo, Wei Zhang, Ying-Qing Li, Yong-Yan Li, Xiu-Ru Li, Wei-Cheng Wang, Zhi-Tao Liu, Shao-Wen Cheng, Chuan-Zhu Lyu DOI:10.4103/2221-6189.250371   Sepsis is a syndrome characterized by systemic inflammatory response caused by infection or toxin, with high morbidity and mortality. Different infection microflora and environment have great influence on the occurrence, development and prognosis of sepsis, but individual genetic factors also play an extremely important role. It was reported that the polymorphisms of mannose-binding lectin 2 gene were closely relevant to the occurrence and development of sepsis, but the conclusions in different studies were inconsistent. Therefore, we performed this reviews on the relevance of mannose-binding lectin 2 gene polymorphisms and sepsis.
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	Acute ethanol-related nervous system injuries	p. 12
	Gentian Vyshka, Tefta Shaqiri, Bujar Cakani, Artan Distafa DOI:10.4103/2221-6189.250372   Acute ethanol intoxication has a diversity of clinical pictures that extend from mere euphoria to severe neurological impairment culminating in coma. Although the majority of cases have a reversible and benign course, the situation needs a careful medical monitoring. Authors describe pharmacological aspects of the acute ethanol intoxication, with organs and systems affected during the consumption of exaggerated quantities. Correlations between blood alcohol concentration and neurological symptomatology are given, and a brief discussion of the criteria for the acute intoxication is made. The fact that this occurrence has been of little attention is due not only to the reversibility of the majority of symptoms, but also because that medical research has been ever since focused more on chronic diseases related to alcohol abuse, withdrawal syndrome and recently with hangover as an independent situation. With no specific antidote actually at hand, treatment is symptom-oriented and the pharmacological armamentarium is richer when it comes to dealing with withdrawal, abstinence and other chronic complications of ethanol abuse.
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	A review on Acinetobacter baumannii	p. 16
	Xin Wang, Li-Jie Qin DOI:10.4103/2221-6189.250373   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.
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ORIGINAL ARTICLES
	Safety assessment of Chlorophytum alismifolium tuber extract (Liliaceae): Acute and sub-acute toxicity studies in Wistar rats	p. 21
	Abdulhakim Abubakar, Abdullahi Balarabe Nazifi, Fatima Ismail Hassan, Kehinde Andem Duke, Theophillus Danjuma Edoh DOI:10.4103/2221-6189.250374   Objective: To explore the toxicological profile of methanol extract of Chlorophytum alismifolium (MECA) tubers in Wistar rats. Methods: MECA was subjected to acute and sub-acute studies which were conducted according to Organization for Economic Co-operation and Development (OECD 425 and 407 guidelines respectively). In the acute toxicity experiment, a limit test (5 000 mg/kg) was administered to five rats and monitored for 2 weeks. The sub-acute studies were conducted on 4 groups of rats. The first group served as control, while the 2nd, 3rd and 4th groups received MECA (150, 300 and 600 mg/kg respectively). The treatments were given orally and daily for 4 weeks. At the end of the experiment (29th day), the animals were euthanized to obtain blood samples and organs for haematological, biochemical and histological evaluations. Results: Acute toxicity study showed that the oral median lethal dose was >5 000 mg/kg. In the sub-acute studies, the results showed no significant (P>0.05) changes in the haematological, hepatic and renal indices compared to control animals. In the fourth week, a significant (P<0.01) increase in body weight of the rats was observed at 150 mg/kg and 600 mg/kg compared to week one. However, there were no major changes in the organ/ body weights of the rats. Histological examination of the kidney showed slight glomerular adhesion and tubular distortion. Moderate hepatic necrosis was observed at 150 mg/kg and 300 mg/kg. Conclusions: The results of this research revealed that the MECA tubers is virtually non-toxic after acute administration and it has low sub-acute toxicity potential in rats.
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	Immunoglobulin G1 binding with various molecular receptors: A new paradigm of IgG1 as a potential adjuvant	p. 28
	Shweta Saxena, Vignesh Sounderrajan, Saravanan Konda Mani, Shakila Harshavardhan DOI:10.4103/2221-6189.250375   Objective: To explore the possible IgG1 binding receptors by protein-protein docking experiments. Methods:The protein-protein cognate interactions such as IgG with Fc Receptors (FcRs) potentiate signaling cascades to ameliorate antigen uptake, processing and presentation are studied by protein-protein docking experiments. Results: However, the propensity of IgG interactions with other cognate receptors largely remains obscure. In this direction, possibilities of IgG1 binding with various five receptors were explored. In this study, we report previously unidentified associations between IgG1 and other receptors. Herein, we show that IgG1 binds to the granulocyte-macrophage receptor, β common receptor and complementary receptor(complementary receptor I and complementary receptor II) to form a complex structure. We show the binding ability and important protein-protein interactions of IgG1 with four receptors in comparison to Fc Receptor, and also find out the conserved amino acids and hydrophobic-hydrophobic interactions amongst them. Conclusions: Comparative interaction studies of IgG1 binding to various receptors revealed close similarities of IgG1 binding to its native receptor Fc. In conclusion, our study has shown the comparable binding efficiency of four receptors to IgG1 apart from the conventional Fc receptor.
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	Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou	p. 34
	Xiao-Peng Shi, Li-Jie Qin, Yu-Xia Chang, Fa-Liang Li, Peng Wang DOI:10.4103/2221-6189.250376   Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods:Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9 305 687 from 2007 to 2016 in Zhengzhou, of which 418 882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups: emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.
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CASE REPORTS
	Unusual isolated extrapulmonary sarcoidosis: Case report	p. 38
	Soheil Ebrahimpour, Zeinab Mohseni Afshar, Mahmoud Sadeghi-Haddad-Zavareh, Sahar Oladzad, Arefeh Babazadeh DOI:10.4103/2221-6189.250377   Sarcoidosis is a granulomatous condition with unidentified etiology. This disease should be considered in differential diagnosis if non-caseating granulomas is noted in biopsies, because numerous cases presented with no clinical symptoms. Although the lung is the most common organ involved in the disease, there also is an extra-pulmonary form (<10%). It should be noted that the presentation of sarcoidosis may be atypical. In this article, we report a systemic sarcoidosis case, with specific clinical findings: extrathoracic onset with lymph nodes.
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	An unusual case of pediatric acute nicotine poisoning due to a dermal exposure	p. 41
	Manel Weli, Mouna Jerbi, Olfa Chakroun-Walha, Bayen Maalej, Lamia Gargouri, Noureddine Rekik, Abdelmajid Mahfoudh DOI:10.4103/2221-6189.250378   Acute intoxication with nicotine is possible to cause nonspecific clinical signs and may be serious and lead to the death. We report a rare and severe form of acute nicotine poisoning secondary to dermal absorption of tobacco.
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	Acute pancreatitis with cytomegalovirus infection in a kidney transplant recipient: A case report	p. 43
	Zeinab Mohseni Afshar, Arefeh Babazadeh, Soheil Ebrahimpour, Sima Golmohammadi DOI:10.4103/2221-6189.250379   Cytomegalovirus (CMV) can cause significant inflammation. Besides, it is an important cause of pancreatitis in organ transplantations. We report a case of CMV pancreatitis in a 48-year-old male kidney transplant recipient who was admitted with elevated amylase (3 337 U/L) and lipase (1 160 U/L) enzymes, and abdominal pain. CMV infection was tested by reverse transcription polymerase chain reaction and the result was positive. CMV viremia was successfully cleared with ganciclovir. Then the absence of some of more noticeable clinical symptoms of pancreatitis may not be a decisive reason not to rule out the disease in transplanted cases.
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