The Clinical Utility of Blood Cultures by Pneumonia Severity Index for Patients with Community-Acquired Pneumonia in the Emergency Department

PURPOSE: Community-Acquired Pneumonia (CAP) is a common cause of mortality and serious morbidity. Regardless of the condition of the patients, almost all are hospitalized. And it seems to be a standard procedure to obtain blood cultures before the administration of antibiotics in suspected pneumonic patients. Recent studies show that the blood cultures don't affect the treatment of the patients with CAP. Accordingly, this study was designed to examine the usefulness of the blood cultures routinely performed and to evaluate the stratification of the patients with CAP by Pneumonia Severity Index (PSI) in the Emergency Department (ED). METHODS: Research subjects were patients over 16 years old who had been diagnosed with CAP in a general hospital between January and December 2008 and were admitted by way of the ED. We evaluated their records retrospectively. RESULTS: A total of 261 patients were diagnosed with CAP. According to the PSI, 155 (59%) of the 261 were classified as being in the low risk group and 106 (41%) in the high risk group. Blood cultures were positive in 13 of 261 (5%). Three of 13 patients belonged to the low risk group, and 10 to the high risk group. Antibiotics were changed in 43 of 261 patients. Nineteen of those belonged to the low risk group and 24 to the high risk group. Of the 13 bacteremic patients, blood cultures results altered therapy for 4 patients. CONCLUSION: Most often, blood cultures performed in the ED do not alter the therapy of patients with CAP. But we do recommend blood cultures for the high risk group.

Coloration of the skin on the face due to clofazimine is cleared by Q-switched ND-YAG laser / 나학회지

The Clofazimine is a rimino-phenazine dye. The color is a purplish-back. The drug is reported to be weakly bactericidal and also effective in the management of leprosy reactions apparently. The drug produces relatively few side effects in the majority of patients. The most prominent is coloration of the skin. The coloration can range anywhere from a reddish-tan to purplish-black. so, many patients avoid taking clofazimine. The Q-switched ND-YAG laser is a good medical instrument for clearing coloration of the skin. It releases two wavelength of 532nm and 1064nm. The wavelength of 532nm reachs shallow depth of the skin. So, it is effective in the clearance of a red, yellow tatto, freckle and lentigo. The wavelength of 1064nm reachs about 4-6mm depth of the skin. So, it is effective in the clearance of blue-black tatto and ota nevus. The leprosy patients who has purplish-black coloration of the skin in the face due to clofazimine is cleared by Q-switched ND-YAG laser. We operated twice with 3months interval. The wavelength is 532nm, spot size 3mm, energy 1.5J/cm2. The coloration of the skin in the face is almost cleared.