Correlation of rib fracture patterns with abdominal solid organ injury: A retrospective observational cohort study / 中华创伤杂志(英文版)

PURPOSE@#Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.@*METHODS@#This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.@*RESULTS@#Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.@*CONCLUSION@#There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.

frequency of non-organ-specific autoantibodies in patients with chronic hepatitis C and its relation with disease severity and response to therapy

Increased levels of non-organ-specific autoantibodies are frequently seen in patients suffering from chronic hepatitis C [CHC]; however, the etiology and its effects on the course of the disease and response to therapy are largely undetermined. Particularly, it seems of utmost importance to define whether this increase is solely an insignificant coincidence or a major finding which have an impact on the course of the disease. Materials and methods: Fifty-two patients with CHC [case group] and 52 aged- and sex-matched IBS patients [controls] were enrolled. The sera of all subjects were checked for non-organ-specific autoantibodies, including antinuclear antibody [ANA], anti-smooth muscle antibody [ASMA], anti-mitochondrial antibody [AMA], and anti-liver/kidney microsomal antibody [ALKM]. All cases underwent a liver biopsy and treated with a 12-month course of combination therapy with interferon and ribavirin. The mean age of cases and controls was 32.8 +/- 12.7 and 31.6 +/- 14.1 years, respectively. The overall frequency of non-organ-specific antibodies was significantly higher in anti-HCV positive patients in comparison with controls [36.5% vs 7.7%, p < 0.001]. Seropositivity of ANA and ASMA was significantly higher in patients with CRC than in controls [11.5% vs. 1.9%, p < 0.05 and 13.5% vs. 1.9%, p < 0.027, respectively]. There was no significant relationship between seropositivity of different autoantibodies and patients' age and sex, duration of disease and serum aminotransferases levels. Nor this seropositivity had significant relationship with grade and stage of the liver disease and response to treatment, while serum globulin level was significantly higher in ANA positive patients. Seroprevalence of ANA and ASMA seems to be higher in patients with CHC but its impact on the severity of disease and response to therapy is the subject for further investigations. Keywords: Hepatitis C, Autoantibody, Response to treatment, Aminotransferases

Gastrointestinal complications in two patients with common variable immunodeficiency

Common variable immunodeficiency [CVID] is a primary immunodeficiency disease characterized by hypogammaglobulinemia and recurrent bacterial infections especially in respiratory and gastrointestinal systems. We present here 2 cases of CVID with gastrointestinal complications. Case 1 is a 25-year-old man with a history of chronic diarrhoea from childhood. Ultrasonography revealed ascites, with liver size smaller than normal. Liver biopsy showed non-specific hepatitis. Lymphoid proliferation and Histiocytosis were reported in his ascites cytology. Moreover friability in colonoscopy due to moderate active chronic colitis was detected. Case 2 is a 26-year-old man with chronic diarrhoea since 8 years. Abdominal sonography revealed increased liver echogenicity, increased liver size, and some enlarged lymph nodes beside pancreas. Colonoscopy revealed friability and decreased vascularity while biopsy showed moderate active chronic colitis. Lymph node biopsy showed unusual immunologic reaction. Moreover, small bowel transition test showed nodularity. CVID should be considered in any patient with gastrointestinal manifestations especially chronic diarrhoea in association with recurrent bacterial infections in other organs. Diagnostic delay results in more morbidity and complications in untreated patients

efficacy and safety of peginterferon alpha-2a [pegasys] monotherapy in the treatment of chronic hepatitis C infected subjects with transfusion dependent thalassemia

Background and aims: interferon monotherapy is currently the only approved treatment for chronic hepatitis C [CHC] infection in transfusion dependent thalassemic patients, in whom ribavirin has limited use because of its hematologic complications. Our aim was to evaluate the efficacy and safety of pegylated Interferon monotherapy for the treatment of HCV infection in transfusion dependent thalassemic patients

Methods: the trial was a multicenteric, open label, single treatment prospective study of Peginterferon alfa-2 a [PEGASYS, 180 micg per week] for a period of 48 weeks. 32 subjects, 18 to 42 years old [mean +/- SD: 24.1 9.44 years], whose serum HCV RNA was positive and mean ALT remained greater than 1.5 times upper limit of normal were enrolled. A percutaneous liver biopsy was performed before treatment and all patients underwent monthly assessment of any adverse events and were monitored for serum ALT. Efficacy was assessed by measuring serum HCV RNA following 24 week treatment-free period . One patient missed follow up and another died due to a drug unrelated cause and 30 patients were evaluated

Results: liver biopsy showed mild fibrosis in 3 1.2%, moderate fibrosis in 53.1 % and cirrhosis in 15.6% of patients. Siderosis was severe in 16 patients [50%]. In 26 out of 30 patients [86.6%] HCV RNA was negative at the end of treatment [ETR response]. Data about 24 weeks post treatment was available in 23 patients, which showed a sustained virological response [SVR] of about 14/23 [60.8%]. Two patients had an elevated end of treatment serum ALT instead of negative HCV RNA but their ALT returned to normal assoon as the treatment stopped. These 2 patients were considered to have INF toxicity

Conclusion: our experience indicates that the cure of HCV-related liver disease in thalassemic patients is not an unrealistic aim and may be reached with Peginterferon alfa-2a monotherapy in a sizable portion of cases

efficacy and side effects of therapy peginterferon alpha-2a [pegasys] combined with ribavirin in chronic hepatitis C patients: an open label clinical trial

Background and aims: peginterferon alpha-2a is a known standard therapy for patients with chronic HCV infection. However, efficacy and safety of this treatment is still unclear in regional settings. This study was designed to clarify efficacy and safety of peg-interferon based therapy in Iranian patients

Methods: 23 patients were treated with Peginterferon alpha-2a in combination with ribavirin for 48 weeks. The patients were observed for adverse effects and response to therapy during treatment and 24 weeks after the end of therapy

Results: early virologic response, end of treatment response, and sustained virologic response rates were 86.9 % [20/23], 82.6 % [19123], and 78.3 % [18123] respectively- The most common adverse effects in descending order were flue-like symptoms [74%], mood changes [48%], and weight loss [43%]

Conclusion: combination therapy with Peginterferon alpha-2a and ribavirin for 48 weeks is an effective treatment with minimal adverse effects

Comparison of sucralfate and hydrocortisone enemas in treatment of active ulcerative proctitis; a double-blind randomized clinical trial

Sucralfate enema has been proposed and investigated in treatment of ulcerative proctitis, but its efficacy is still a matter of debate. Hydrocortisone enema is still an established drug in treatment of ulcerative proctitis. This study was designed to compare the effect of sucralfate enema with hydrocortisone enema. Patients with active sigmoidoscopic and histologic features of ulcerative proctitis were included. All patients had clinical manifestations of proctitis for at least four weeks prior to the study and had negative parasitic stool culture. The total of 25 patients entered the study. They were randomly divided in two groups; group I [n =14] and group II [n = 11] who received sucralfate and hydrocortisone enemas respectively for 4 weeks. Both groups had a significant improvement in clinical features, histologic activity and sigmoidoscopic evaluation in comparison with the baseline. Furthermore there was no significant differences between the two groups concerning mean changes of clinical, sigmoidoscopic, and histologic grading, after treatment. Considering the low cost and minimal adverse effects of sucralfate, and almost equal efficacy in comparison with hydrocortisone enema, its usage can be recommended