Rhabdomyolysis induced by venomous snake bite

Purpose@#Despite previous studies reporting the development of rhabdomyolysis (RM), this affliction tends to be neglected as an envenomation sign in South Korea. The current retrospective study investigates the prevalence and prognosis of RM after a snakebite. We further searched for predictors of snakebite-induced RM, which can be observed at presentation. @*Methods@#This study included 231 patients who presented to the ED within 24 hours after a snakebite. The patients were classified according to the severity of RM, and the data, comprising baseline characteristics and clinical course including the level of creatine kinase (CK), were collected and compared according to the severity of RM. @*Results@#The prevalence of RM and severe RM were determined to be 39% and 18.5%, respectively. Compared to the group without RM or with mild RM, the group with severe RM had a higher grade of local swelling, a higher frequency of acute kidney injury and neurotoxicity, and a greater need for renal replacement therapy and vasopressor administration. However, the incidence of acute renal injury in the RM group was 7.7%, with two patients needing renal replacement therapy. No mortalities were reported at discharge. Results of the multinomial logistic regression model revealed that the WBC levels are significantly associated with the risk of severe RM. @*Conclusion@#RM should be considered the primary clinical sign of snake envenomation in South Korea, although it does not seem to worsen the clinical course. In particular, physicians should pay attention to patients who present with leukocytosis after a snakebite, which indicates the risk of developing RM, regardless of the CK level at presentation.

Qualitative Evaluation of YouTube Videos on Conservative Treatment after Ankle Sprain and Analysis of Correlation with Preference / 대한정형외과학회잡지

Purpose@#Ankle sprains are among the most common musculoskeletal injuries, and many videos have been shared with patients through YouTube. YouTube allows the easy sharing of information, but there are accuracy and reliability issues due to the lack of verification processes for video producers. This study evaluated ankle sprain videos on YouTube and the correlation between the video scores and viewer preferences using “the number of likes and views”. @*Materials and Methods@#For analysis, the words “ankle sprains”, “ankle exercise”, and “ankle rehabilitation” were searched on YouTube. Only videos taken in Korean were analyzed, and videos with less than 10,000 views and for commercial purposes were excluded. For 31 videos, two orthopedic surgeons and one orthopedic resident used one evaluation tool to evaluate the video quality with up to 30 points for subcategories. The scores between each evaluator were then averaged to evaluate the video quality. To reflect the viewer preferences, “the number of likes and views” were analyzed, and the relationship between the video score and “the number of likes and views” of the video was analyzed statistically. @*Results@#The average score for the video was 9.33. The average scores for subcategories were anatomy and symptoms, 0.90; biomechanics and trauma-mechanism, 0.61; imaging quality, 0.95; clinical evaluation and physical examination, 0.61; treatment, 1.41; rehabilitation, 2.39; prevention and after effects, 0.89; and overall video quality, 1.61. The average of “the number of views” was 50,218.35 times, and “the number of likes” was 893.77 times. No correlation was observed between the video scores and “the number of likes and views”. @*Conclusion@#Most videos posted on YouTube did not provide high-quality medical information on ankle sprain, and there was no correlation between the video scores and viewer preferences. This suggests that incorrect medical information is being transmitted to patients, which can be harmful. Therefore, it is necessary to present the latest trend treatment and rehabilitation protocols for ankle sprains in an expert council and promote it through various channels.

Comparison of Epidemiological Characteristics and Outcomes for the in-hospital Cardiac Arrest between Nursing Care Hospitals Versus Non-nursing Care Hospitals of Korea: A Population Study Based on Korean Health Insurance Review and Assessment Service

PURPOSE: The aim of this study was to investigate the epidemiological characteristics and outcomes for in-hospital cardiac arrest (IHCA) patients who were 65 years and older between nursing care hospitals versus non-nursing care hospitals in Korea. METHODS: This is a population study enumerating 24,203 IHCA patients registered in Korean Health Insurance Review and Assessment Service in 2013. The Cardiopulmonary resuscitation (CPR) outcomes including survival discharge and 30 day survival rate were analyzed. The main diagnoses of IHCA patients were categorized according to the Korean Standard classification of Disease version 6 (KCD-6). All data of patients who were CPR recipients in nursing care hospitals were compared with those of CPR recipients in non-nursing care hospitals. RESULTS: The overall survival discharge and 30 day survival rate were 29.5% and 28.1%, respectively. However, the survival discharge rate of IHCA patients was significantly low in nursing care hospitals compared to non-nursing care hospitals (20.0% vs. 30.0%, p<0.001). The 30 day survival rate was similarly low in nursing care hospitals (20.1% vs. 28.4%, p<0.001). The most common diagnosis of IHCA patients was respiratory disease in nursing care hospitals and cardiovascular disease in non-nursing care hospitals. The most common respiratory disease leading to IHCA in nursing care hospitals was acute respiratory infections. CONCLUSION: The survival rate after IHCA was lower in nursing care hospitals, and the major diagnosis leading to CPR was acute respiratory infections rather than chronic underlying diseases. Therefore, it is crucial to set higher standards in performing CPR and controlling infections in nursing care hospitals nationwide.

A Study of Thyroid Function in Partial Thyroxine-Binding Globulin Deficiency

OBJECTIVE: It is generally thought that thyroxine-binding globulin (TBG)-deficient individuals are euthyroid and do not require treatment. However, there have been case reports of TBG deficiency combined with hypothyroidism. The purpose of this study was to investigate the relationship between TBG deficiency and thyroid function. METHODS: We reviewed the medical records of 32 patients diagnosed with TBG deficiency between 1997 and 2008 in Soonchunhyang University Seoul Hospital. All were partial TBG deficiency. Eighteen patients had combined hypothyroidism, and 14 patients had normal thyroid function. We compared the TBG, thyroid-stimulating hormone, free thyroxine, and total triiodothyronine levels between these 2 groups. Eighteen patients with TBG deficiency with hypothyroidism started thyroxine medication and continued for 2-3 years. After, they were followed up with thyroid function tests after discontinuing medication for 4 weeks at 2-3 years of age. RESULTS: The TBG level in TBG deficiency with hypothyroidism patients was significantly lower than that in TBG deficiency with normal thyroid function (4.43+/-2.22 mg/L vs. 6.23+/-1.81 mg/L; P=0.02). The percent TBG compared with normal mean TBG level according to age in the hypothyroidism patients was also significantly lower than that of patients with normal thyroid function (13.42%+/-6.92% vs. 19.08%+/-4.87%; P=0.014). Sixteen of 18 patients diagnosed with TBG deficiency with hypothyroidism showed persistent hypothyroidism at 2-3 years of age. CONCLUSION: We conclude that TBG-deficient patients should be observed closely and undergo thyroid function testing in order not to miss hypothyroidism. More investigations of TBG deficiency and thyroid function are needed in the future.