ABSTRACT
Objective@#Predictive tools such as the Glasgow Blatchford Score (GBS) and Pre-Rockall Score (PRS) have been used to foresee risks for gastrointestinal patients. This study was undertaken to determine the usefulness of the various available predictive tools in a vulnerable population. @*Methods@#Data of patients with vulnerable upper gastrointestinal bleeding, who visited the emergency room from January 1, 2017 to December 31, 2018, were retrospectively examined. The GBS and PRS values were determined for all patients. Predictions of therapeutic endoscopy were evaluated with the area under curve (AUC) in the receiver operatory characteristic (ROC) curve. @*Results@#A total of 152 patients were included in the study, 46 of whom required therapeutic endoscopes. In the area below the ROC curve, higher GBS values were obtained as compared to PRS in predicting therapeutic endoscopy (AUC, 0.726; 95% confidence interval [CI], 0.648-0.795 vs. 0.705; 95% CI, 0.626-0.776; P=0.689, respectively), transfusion (AUC, 0.861; 95% CI, 0.796-0.912 vs. 0.715; 95% CI, 0.637-0.786; P=0.001, respectively), and 30-day mortality (AUC, 0.698; 95% CI, 0.618-0.770 vs. 0.622; 95% CI, 0.540-0.699; P=0.351, respectively). Considering GBS 0, we determined with 100% sensitivity and 4.72% specificity that endoscopic treatment is redundant. @*Conclusion@#Compared to PRS, GBS excelled in predicting interventional treatment (endoscopy, transfusion) of vulnerable upper gastrointestinal patients, as well as the 30-day mortality. GBS is more useful in predicting low-risk patients that do not require treatment endoscopy, and is therefore a suitable procedure for outpatient care.
ABSTRACT
Objective@#Predictive tools such as the Glasgow Blatchford Score (GBS) and Pre-Rockall Score (PRS) have been used to foresee risks for gastrointestinal patients. This study was undertaken to determine the usefulness of the various available predictive tools in a vulnerable population. @*Methods@#Data of patients with vulnerable upper gastrointestinal bleeding, who visited the emergency room from January 1, 2017 to December 31, 2018, were retrospectively examined. The GBS and PRS values were determined for all patients. Predictions of therapeutic endoscopy were evaluated with the area under curve (AUC) in the receiver operatory characteristic (ROC) curve. @*Results@#A total of 152 patients were included in the study, 46 of whom required therapeutic endoscopes. In the area below the ROC curve, higher GBS values were obtained as compared to PRS in predicting therapeutic endoscopy (AUC, 0.726; 95% confidence interval [CI], 0.648-0.795 vs. 0.705; 95% CI, 0.626-0.776; P=0.689, respectively), transfusion (AUC, 0.861; 95% CI, 0.796-0.912 vs. 0.715; 95% CI, 0.637-0.786; P=0.001, respectively), and 30-day mortality (AUC, 0.698; 95% CI, 0.618-0.770 vs. 0.622; 95% CI, 0.540-0.699; P=0.351, respectively). Considering GBS 0, we determined with 100% sensitivity and 4.72% specificity that endoscopic treatment is redundant. @*Conclusion@#Compared to PRS, GBS excelled in predicting interventional treatment (endoscopy, transfusion) of vulnerable upper gastrointestinal patients, as well as the 30-day mortality. GBS is more useful in predicting low-risk patients that do not require treatment endoscopy, and is therefore a suitable procedure for outpatient care.
ABSTRACT
Leber's hereditary optic neuropathy (LHON) is a mitochondrial genetic disease characterized by acute or subacute visual loss associated with other neurologic diseases. We report a man with LHON caused by a mitochondrial DNA point mutation at nucleotide position 11778, who presented various types of seizures, and hydrocephalus. EEG showed frequent brief generalized 2.5~3 Hz spike or polyspikes-and-wave activities. Brain MRI and cisternography showed communicating hydrocephalus. LHON plus associated with epilepsy and hydrocephalus in our patient widens the clinical presentation of LHON.