Coronavirus disease 2019 pandemic-related change in children’s visits to the emergency department

Purpose@#This study was performed to investigate the coronavirus disease 2019 pandemic-related changes in visiting pattern of an emergency department (ED). @*Methods@#The author investigated all children younger than 19 years who visited the ED from 2018 through 2020 without exclusion criteria. Pandemic period was defined as 2020. Variables of interest were monthly and annual numbers of visits, age and age groups (< 1, 1-4, 5-9, 10-14, and 15-18 years), sex, visits for diseases, disposition, high acuity, and top 5 chief complaints per each age group. Timing of social distancing and influenza-related visits were additionally analyzed to speculate the impact of such variables on the visiting patterns. @*Results@#The annual visits were 11,435 (2018), 10,741 (2019), and 5,626 (2020), with a 47.6%-50.8% pandemic-related decrease. Trauma-related visits increased from 27.7%-28.4% to 36.5% (P < 0.001). In the children aged 9 years or younger, trauma as a chief complaint increased from 22.2%-29.6% to 36.2%-42.5% while fever decreased from 27.7%-47.3% to 16.7%-42.6%. In the pre-pandemic period, visits increased in February-March and October-December with a sharp increase in influenza-related visits in the latter 3 months. During the pandemic, a sharp decline in the visits was noted in January-February without the above-mentioned increasing patterns in neither total nor influenza-related visits. After the social distancing was implemented in the 13th week of 2020, the visits remained steady until a slight increase was noted after the school opening. @*Conclusion@#During the pandemic period, a decrease was noted in the numbers of visits to the ED, along with decreases in fever as a chief complaint in young children and influenza-related visits, and the mitigation of social distancing. These findings could be useful in preparing emergency medicine resources for ongoing and future pandemics.

A case of gastrointestinal stromal tumor of ileum preoperatively diagnosed as extrauterine myoma / 대한산부인과학회잡지

Gastrointestinal stromal tumor (GIST) of ileum is a rare tumor of gastrointestial tract that arise from primitive mesenchymal cells. GIST occur predominantly in persons over 40 years of age with an equal sex incidence. GIST expresses a heterogenous clinical course and the most important prognostic factors are tumor size, site, degree of mitotic activity, tumor necrosis. We report a case of GIST of ileum, which was misdiagnosed as extrauterine leiomyoma preoperatively.

Proper Time of Delivery to Decrease Minor Perinatal Morbiditles / 대한산부인과학회잡지

OBJECTIVE: Much emphasis has been placed on the morbidity and mortality of infants delivered before 32 weeks of gestation, including intraventricular hemorrhage and respiratory distress. The incidence of these complications and their association with long-term sequelae are well defined. This information is important, especially when decisions regarding delivery have to be made. Although delivery at >32 weeks of gestation may be considered free of serious sequelae of prematurity, morbidities are still associated with delivery between 32 and 36 weeks of gestation. The purpose of this study is to determine the incidence of minor morbidities associated with premature delivery between 32 and 36 weeks of gestation. We tried to find out the proper time to decrease the minor perinatal morbidities and the adverse effect of tocolytic treatment. METHOD: The study population is consisted of infants delivered between 20 and 36 weeks of gestation at Kang Nam St. Mary's hospital from 1995 to 1999. Maternal and neonatal charts were abstracted for maternal past history, pregnancy complications and neonatal demographics comparing complications present at each gestational week. Mann-Whitney test and x2 test were used to assess statistical significance. RESULTS: There was no significant difference of delivery time due to maternal age and parity. There was increased risk of low Apgar score and low birth weight before 34 weeks of gestation. Neonatal death was significantly high before 32 weeks of gestation. Neonatal death, sepsis, intraventricular hemorrhage, respiratory distress, ventilatory equipment use was significantly high before 32-33 weeks of gestation. Hypothermia, feeding difficulty, jaundice, NICU admission was significantly high before 30, 32, 35, 35 weeks of gestation. So it is approved that minor perinatal morbidity was decreased after 34-35 weeks of gestation. CONCLUSION: Major morbidity was significantly high before 32-33 weeks of gestation and Minor morbidity was significantly high before 34 weeks of gestation. Therefore considering of minor and major morbidity, it is reasonable to postpone the preterm delivery until 34 weeks of gestation.

The Expression of LH/CG receptor, alpha and Beta-hCG mRNA in the trophoblast of spontaneous abortion / 대한산부인과학회잡지

OBJECTIVE: To investigate the mechanisms involved in the mRNA expressions of hCG, LH/CG receptor and in hormone secretion in the trophoblast of normal and abnormal early pregnancy. METHODS: hCG, free Beta-hCG, and progesterone concentrations were measured in serum and the mRNA expressions of alpha,Beta-hCG and LH/CG receptor were measured in the placental trophoblast of 22 spontaneous abortion patients (spontaneous abortion group), 20 normal pregnancy women (normal pregnancy group) and 6 hydatidiform mole patients (hydatidiform mole group). RESULTS: 1. Mean values of serum hCG and free Beta-hCG concentrations were the lowest in spontaneous abortion group (46343.63+/-40404.18 mIU/ml, p<0.001; 31.34+/-61.57 mIU/ml, p<0.01 respectively) among the three groups. Mean progesterone concentration was the lowest in spontaneous abortion group (11.84+/-7.60 ng/ml, p<0.01), too.2. The expression levels of alpha,Beta-hCG were the highest in spontaneous abortion group (4.64+/-5.47, p=0.015; 4.57+/-4.42 p=0.002 respectively). The expression levels of LH/CG receptor were not different statistically among the three groups and they were high at the 5th week of gestation, reaching nadir at the 10th week of gestation when the concentrations of serum hCG showed peak values in normal pregnancy group.3. The correlations between serum hCG and progesterone concentrations were positive in both spontaneous abortion (r=0.827, p<0.001) and normal pregnancy (r=0.438, p=0.054) group. Though they were not significant statistically, the correlations between progesterone concentrations and the levels of alpha,Beta-hCG expressions were negative in both spontaneous abortion (r=-0.237, p=0.289; r=-0.211, p=0.347) and normal pregnancy (r=-0.270, p=0.250; r=-0.235, p=0.318) group. In hydatidiform mole group, the correlation between progesterone concentrations and the levels of Beta-hCG expression was positive (r=0.968, p=0.002). CONCLUSION: Our results suggest that the mechanisms involved in the secretion of hCG, progesterone and the expression of alpha,Beta-hCG, LH/CG receptor be normal in spontaneous abortion as in normal pregnancy and in the both groups, hCG stimulate the secretion of progesterone by autocrine function and control the secretion of itself, through the suppression of the expressions of alpha,Beta-hCG and LH/CG receptors. So the cause of spontaneous abortion in early pregnancy may be not placental dysfunction but the defect of embryo itself with poor placental growth.

A case of Benign Cystic Peritoneal Mesothelioma in a Male Fetus / 대한산부인과학회잡지

No abstract available.

A Case of Pulmonary Embolism After Cesarean Delivery / 대한산부인과학회잡지

Pulmonary Embolism, one of the causes of maternal death, is a life threatening disease that needs early and accurate diagnosis. We have exprerienced a case of a fatal pulmonary embolism which was diagnosed by lung perfusion scan on the postoperative 1 day after cesarean delivery and was managed with heparin therapy. We present this case with a brief review of literatures.