Spontaneous Rupture of Urinary Bladder Diagnosed by Bedside Ultrasound; a Case Report

Introduction: Spontaneous rupture of the urinary bladder (SRUB) is rare condition. It is often difficult to diagnose particularly in busy emergency department (ED). SRUB is usually secondary to an underlying pathology, but in extremely rare condition, it can be idiopathic. Significant morbidity and mortality can result from a missed or delayed diagnosis. Case presentation: We report a case of idiopathic SRUB in a young male presented with inability to pass urine and abdominal pain in the absence of prior trauma or alcohol intoxication. A bedside ultrasound was performed by the emergency physician (EP) to confirm his suspicion, which demonstrated free intra-peritoneal fluid. This expedited further workup and management. Emergency consultation to urologist on call was initiated, the diagnosis was confirmed by CT scan and the patient was taken to the theatre. Conclusion: We report this case as it is unique in presentation, very rare in occurrence and bedside US had expedited further workup and management

Presence of BlaPER-1 and BlaVEB-1 Beta-Lactamase Genes among Isolates of Pseudomonas Aeruginosa from Burn and Trauma Hospital Peshawar, Pakistan

Pseudomonas aeruginosa spp are the most prevalent bacteria that cause nosocomial infections in hospitals. Most antibiotics, including novel new β-lactams, are already resistant to them, and they can become resistant during treatment, which can make the treatment fail. P. aeruginosa isolates from ICU patients who had Per-1 and VEB-1 were the main focus of this study. These two ESBLs are the two most common in ICU patients who had them. 50 isolates were gathered from Peshawar\u27s LRH ICU facilities in the year 2021. The antibiotic susceptibility test was conducted in accordance with the Clinical and Laboratory Standards Institute\u27s standards (CLSI). The combination disc test used to identify isolates that produce ESBLs. Ceftazidime MIC was determined using the agar dilution method using particular primers, the PER-1 and VEB-1 genes were detected using polymerase chain reaction (PCR). Fifty-six percent patients (n=40) male, whereas forty percent (n=25) were female. Augmentin (96.6%, n=61) and cefpodoxim (86.7%, n=55) resistance was found in the majority of ICU isolates. Fifty isolates (77%) tested positive for ESBL, with 94 percent (n=47) carrying the PER-1 gene and VEB-1 gene 52 percent (n=26). Ten isolates had blaPER1 and blaVEB1 present at the same time, and seven of them amplified all three genes. ESBL producers were found in a large number of ICU P. aeruginosa isolates. Although blaVEB1 and blaPER1 were found in a small number of isolates, their frequency was very high. Furthermore, carbapenem resistance was negligible. Because of drug-resistant P. aeruginosa isolates, it is vital to monitor ICU centers

The Effectiveness of the ‘Extended Sick Neonatal Score in Predicting Mortality in a ResourceConstrained Neonatal Care Uni

Objectives: To determine the diagnostic accuracy of the extended sick neonatal score (ESNS) in neonates admitted in a resource-limited neonatal intensive care unit (NICU) at Peshawar. Study Design: Cross-sectional analytical study Place and Duration of Study: Neonatal Intensive Care Unit, CMH Peshawar Pakistan, from Mar to May 2020. Methodology: Primary data was collected from 60 neonates admitted to NICU after taking consent from the parents. The receiver operating characteristic curve (ROC) was plotted to determine the clinical score (ESNS) cut-off value in predicting mortality. Result: The sensitivity and specificity of the Extended sick neonatal score to predict mortality among neonates was 93.3% and 97%, respectively, for a cut-off of 12.5. The area under the ROC curve was 0.990 (95% CI: 0.971–1.000). This was statistically significant with a p-value of <0.001 Conclusion: Extended Sick Neonatal score is an important tool that helps predict the risk of mortality of a neonate without the help of any invasive diagnostic procedure, thus enhancing the prioritization of health care to the most deserving neonates

N-(2-hydroxyphenyl)acetamide and its gold nanoparticle conjugation prevent glycerol-induced acute kidney injury by attenuating inflammation and oxidative injury in mice

The protective activity of N-(2-hydroxyphenyl)acetamide (NA-2) and NA-2-coated gold nanoparticles (NA-2-AuNPs) in glycerol-treated model of acute kidney injury (AKI) in mice was investigated. NA-2 (50 mg/kg) and NA-2-AuNPs (30 mg/kg) were given to the animals for four days followed by 24-h water deprivation and injection of 50% glycerol (10 ml/kg im). The animals were sacrificed on the next day. Blood and kidneys were collected for biochemical investigations (urea and creatinine), histological studies (hematoxylin and eosin; and periodic acid-Schiff staining), immunohistochemistry (actin and cyclooxygenase-2, Cox-2), and real-time RT-PCR (inducible nitric oxide synthase, iNOS; nuclear factor-κB p50, NFκB; hemeoxygenase-1, HO-1; and kidney injury molecule-1, Kim-1). NA-2 protected renal tubular necrosis and inflammation, though the result of NA-2-AuNPs was better than compound alone and it also exhibited the activity at far less dose. The test compound and its gold nano-formulation decreased the levels of serum urea and creatinine level in the treated animals. Both NA-2 and NA-2-AuNPs also conserved actin cytoskeleton, and lowered COX-2 protein expression. Moreover, the mRNA expressions of iNOS and NFkB p50 were down-regulated, and HO-1 and Kim-1 genes were up-regulated. We conclude that NA-2 and NA-2-AuNPs ameliorates kidney inflammation and injury in glycerol-induced AKI animal model via anti-oxidant and anti-inflammatory mechanisms which make it a suitable candidate for further studies. We believe that these findings will contribute in the understanding of the mechanism of action of paracetamol-like drugs and can be considered for clinical research for the prevention of AKI. © 2018, Springer Science+Business Media, LLC, part of Springer Nature

Avulsion fracture of anterior inferior iliac spine complicated by hypertrophic malunion causing femoroacetabular impingement: Case report

Introduction: Avulsion fractures of the anterior inferior iliac spine are uncommon and such injuries are caused by the sudden forceful contraction of the straight head of rectus femoris muscle while the hip is hyperextended and the knee is flexed. Case presentation: This case report describes the condition of 17 year old male footballer who complained of pain in the right groin for duration of 2 years after being involved in forceful sport activity. Detailed history, clinical examination, X-rays and CT scan revealed hypertrophic malunion of avulsion fracture of anterior inferior iliac spine causing an extra-articular type of femoroacetabular impingement. The patient was surgically treated when conservative management was unsuccessful. Discussion: This is the first case of hypertrophic malunion of avulsion fracture of anterior inferior iliac spine with femoroacetabular impingement that has been recognized in Qatar. The patient was surgically treated in order to relieve symptoms and avoid osteoarthritis. Conclusion: Malunited avulsion fracture of anterior inferior iliac spine can cause extra-articular femoroacetabular impingement

Knowledge of Primary School Teachers Regarding Dental Trauma Management in Hail Region, Saudi Arabia

Objective:To evaluate the knowledge of elementary school teachers about the management of dental trauma. Material and Methods:An observational study, with the cross-sectional design, was conducted among primary school teachers in Hail, Saudi Arabia during January 2017. The questionnaire distributed among 400 primary school teachers from 18 different schools using convenient sampling. Data were gathered and analyzed using SPSS version 20. Results:378 (94.5%) respondents to the questionnaire. It was found that only 37.8% of the primary school teachers were able to distinguish between the primary and permanent teeth. Only 59.5% reported starting the management of a child with trauma immediately. Merely 38.4% believed that it is important to search for the missing tooth or the broken pieces, whereas 31% would re-implant the permanent tooth into the socket by themselves. Regarding the storage media, only 16.6% respond correctly. According to school teachers, the best way of learning the management of dental trauma at school is through videos (36.2%) and phone application (33.9%). Conclusion:School teachers lack knowledge regarding the management of dental trauma. We strongly recommend planning for dental trauma educational based on the teacher's perception after pilot testing its effectiveness

A mutagenicity and cytotoxicity study on Limonium effusum aqueous extracts by Allium, Ames and MTT tests

Nowadays plants or plant extracts have become very important for alternative medicine. Plants and their extracts have many therapeutical advantages but some of them are potentially toxic, mutagenic, carcinogenic and teratogenic. Root, stem and leaf parts of Limonium effusum were used in this study and this species is an endemic species for Turkey. Mutagenic and cytotoxic effects of root, stem and leaf aqueous extracts were observed with Allium, Ames and MTT tests. Allium root growth inhibition test and mitotic index studies showed that aqueous extracts have dose-dependent toxic effects. Chromosome aberration studies indicated that especially sticky chromosome, anaphase-telophase disorder and laggard chromosome anomalies were highly observed. Ames test performed with Limonium effusum root aqueous extracts, showed weak mutagenic effects in Salmonella typhimurium TA98 strain with S9. MTT test based on mitochondrial activity indicated that most of the aqueous extracts have cytotoxic effects. This study aimed to determine the possible mutagenic and cytotoxic effects of L. effusum aqueous extracts by using bacterial, plant and mammalian cells. This research showed that some low concentrations of the L. effusum extracts have inhibited cytotoxic effects but high concentrations have induced cytotoxicity. On the other hand only a weak mutagenic activity was identified by Ames test with TA98 S9(+).В настоящее время растения или экстракты растений стали очень важными для альтернативной медицины. Растения и их экстракты имеют много терапевтических преимуществ, однако некоторые из них являются потенциально токсичными, мутагенными, канцерогенными и тератогенными. Корни, стебли и листья Limonium effusum, эндемичного вида Турции, были изучены в этой работе. Мутагенные и цитотоксические эффекты водных экс-трактов корней, стеблей и листьев Limonium effusum были изучены с помощью Allium-теста, теста Эймса и МТТ-теста. Тест на ингибирование роста корней лука и определение митотического индекса показали, что водные экстракты имеют дозозависимый токсичный эффект. При изучении хромосомных аберраций обнаружено большое количество таких аномалий, как слипшиеся хромосомы, нарушения анафазы-телофазы и отставшие хромосомы. Тест Эймса, проведенный на водных экстрактах корней Limonium effusum, показал слабо выраженный мутагенный эффект по отношению к Salmonella typhimurium, штамм TA98 с S9. МТТ-тест, основанный на митохондриальной активности, показал, что большинство экстрактов имели цитотоксические эффекты. Цель этого исследования изучить возможные мутагенные и цитотоксические эффекты водных экстрактов L. effusum с использованием бактериальных, растительных клеток и клеток млекопитающих. Определенные низкие концентрации экстрактов L. effusum ингибировали цитотоксические эффекты, а высокие концентрации индуцировали цитотоксичность. Слабая мутагенная активность была определена только при помощи теста Эймса с TA98 S9(+)