Effect of vasopressin on prognosis in sepsis shock

Objective@#This study analyzed the relationship between the timing of vasopressin treatment and the prognosis ofpatients with septic shock. @*Methods@#Patients who were admitted to a university hospital for one year using vasopressin were studied retrospectively.All records were collected through the medical records; several factors were studied to determine the prognosis of thepatient. The 24-hour, 48-hour mortality, and hospital mortality were examined. The difference in the timing of vasopressinadministration between death and survival patients was analyzed to determine the effect of the vasopressor on the survivalrate using the receiver operating characteristic (ROC) curve. @*Results@#The general characteristics of the patients in the hospital and survivors were similar. Vasopressin infusion wasfaster in the surviving patients than in the death patients, but there was no significant difference (survival, 187.0 minutes;interquartile range [IQR], 95.0-548.0 minutes vs. death, 285.5 minutes; IQR, 92.7-739.2). To determine the effect of vasopressorinjection on the survival rate, the ROC curve was drawn, and the area under curve was not affected significantlyby norepinephrine (NE) 0.416 and vasopressin 0.529. In addition, the duration of the ventilator application was found toincrease with increasing NE injection period in survivors (period of application of ventilator: NE injection time, r=0.460,P=0.048; vasopressin, r=0.369, P=0.120). @*Conclusion@#The prognosis was similar regardless of the timing of vasopressin in patients with septic shock.

Emergency Department Laparotomy Can Be a Resuscitative Option for Patient with Cardiac Arrest and Impending Arrest due to Intra-Abdominal Hemorrhage

Purpose@#Managing patients with hemorrhagic shock is mainly dependent on stopping the bleeding as fast as possible. Emergency Department laparotomy (EDL) is considered one of the approaches to control intra-abdominal bleeding rapidly. This study aims to evaluate the outcomes of EDL in a regional trauma center of Pusan National University Hospital in a 4-year period. @*Methods@#The medical records and data of patients who underwent EDL from January 2016 to December 2019 were analyzed. Patients who underwent preperitoneal pelvic packing only or did not receive surgery immediately after EDL were excluded. @*Results@#Twenty-four patients who underwent EDL were included in the study. 18 patients had sustained blunt trauma, and 6 suffered from penetrating injuries. Small bowel mesentery and liver injuries were the most frequent. Increase of median systolic blood pressure (SBP) after EDL was 55.5 mmHg. Four (16.7%) out of the 24 survived; one of the four survivors received cardiopulmonary resuscitation (CPR). In the nonsurvivor group, Injury Severity Score was significantly higher (p = 0.013), initial pH was lower (p = 0.035) and the amount of packed red blood cells transfusion after EDL was significantly higher (p = 0.013) than those in the survivor group. @*Conclusion@#The mortality rate was very high in trauma patients who were required EDL. Although EDL was not proved to be an effective procedure for resuscitation in trauma patients, it could be considered as one of the treatment options for trauma patients in extremis. Further studies are required to examine the effects of EDL.

Emergency Department Laparotomy Can Be a Resuscitative Option for Patient with Cardiac Arrest and Impending Arrest due to Intra-Abdominal Hemorrhage

Purpose@#Managing patients with hemorrhagic shock is mainly dependent on stopping the bleeding as fast as possible. Emergency Department laparotomy (EDL) is considered one of the approaches to control intra-abdominal bleeding rapidly. This study aims to evaluate the outcomes of EDL in a regional trauma center of Pusan National University Hospital in a 4-year period. @*Methods@#The medical records and data of patients who underwent EDL from January 2016 to December 2019 were analyzed. Patients who underwent preperitoneal pelvic packing only or did not receive surgery immediately after EDL were excluded. @*Results@#Twenty-four patients who underwent EDL were included in the study. 18 patients had sustained blunt trauma, and 6 suffered from penetrating injuries. Small bowel mesentery and liver injuries were the most frequent. Increase of median systolic blood pressure (SBP) after EDL was 55.5 mmHg. Four (16.7%) out of the 24 survived; one of the four survivors received cardiopulmonary resuscitation (CPR). In the nonsurvivor group, Injury Severity Score was significantly higher (p = 0.013), initial pH was lower (p = 0.035) and the amount of packed red blood cells transfusion after EDL was significantly higher (p = 0.013) than those in the survivor group. @*Conclusion@#The mortality rate was very high in trauma patients who were required EDL. Although EDL was not proved to be an effective procedure for resuscitation in trauma patients, it could be considered as one of the treatment options for trauma patients in extremis. Further studies are required to examine the effects of EDL.

The influence of symptom to balloon time in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVE@#The current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommends early reperfusion with a door to balloon (DTB) time of 90 minutes or less in patients undergoing primary percutaneous coronary intervention (PPCI). Therefore, the focus of most studies has been the DTB time. On the other hand, the ischemic time is related to the symptom to balloon (STB) time rather than the DTB time. This study examined the clinical effects of the STB time as well as the social and clinical factors affecting the STB time in STEMI patients.@*METHODS@#This study analyzed 286 patients diagnosed with STEMI from December 2008 to December 2016. The STB time (≤4 hours and>4 hours, ≤12 hours, and >12 hours) in the groups was compared. The mortality and ejection fraction were investigated. In addition, the characteristics of patients and socioeconomic factors affecting STB were analyzed.@*RESULTS@#The SBT time is inversely associated with the ejection fraction (R=−0.126, P=0.033), and the ejection fraction of the ≤12 hours group was higher than that of the >12 hours group (54% vs. 50%, P=0.047). On the other hand, there was no significant difference in mortality between the two groups (3.26% vs. 4.84%, P=0.506). In multivariate analysis, the variable related to SBT was only typical chest pain (adjusted odd ratio, 1.931; 95% confidential interval, 1.014-3.792; P=0.045).@*CONCLUSION@#The results of the study support the prognostic value of SBT in STEMI undergoing PPCI. Therefore, efforts should be made to shorten the STB time.

Impact of interhospital transfer on outcomes for trauma patients: impact of direct versus non-direct transfer

OBJECTIVE: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). METHODS: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. RESULTS: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. CONCLUSION: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.

Relationship between emergency department disposition, level of emergency base on Korean Triage and Acuity Scale, visit mode

OBJECTIVE: The policy to judge the level of emergency (emergent vs non-emergent) based on Korean Triage and Acuity Scale (KTAS) has been introduced by government to control the flow of emergency patients. The purpose of this study is to identify the variables expected to affect the disposition and to compare the relative importance of the variables. And we also evaluate the validity of the policy to judge the level of emergency based on KTAS. METHODS: We enrolled a total of 29,865 patients who visited a Wide Regional Emergency Center in Busan from Jan 2016 to Dec 2016. Data of those patients were extracted from National Emergency Department Information System (NEDIS) and analysed retrospectively. We determined disposition as the outcome variable. We evaluated the relationship between disposition and visit time, visit mode (firehouse ambulance, inter-facility transfer and self-transport), level of emergency based on KTAS, cause of morbidity. And we also evaluated general and conditional dominances of those variables to compare their relative importance each other. RESULTS: The disposition of the patients was discharge to home (53.5%), general ward admission (30.3%), intensive care unit admission (11.6%), and inter-facility transfer (4.8%). In the univariate analysis, age, gender, visit time, visit mode, cause of morbidity, KTAS level had a significant effect on the disposition. All variables that had a significant effect on univariate analysis also had a significant effect on disposition in multivariate analysis. As a result of dominance analysis, visit mode was the most important variable in both general dominance and conditional dominance. However, if KTAS was devided into 5 levels, it was the most important variable. CONCLUSION: Level of emergency based on KTAS was significantly effective on patient disposition, however it was relatively less important compared to the visit mode. If the visit mode is reflected in the triage system, triage accuracy is expected to be improved. And it also can be a good option to construct triage system based on 5 level KTAS.

The Analysis about Tendency of Emergency Medicine in Pain Control

PURPOSE: Inadequate treatment of pain, which has been termed as “oligoanalgesia”, appears to be common phenomenon the emergency department (ED). In order to improve pain recognition and management, a study concerning physician characteristics on pain and pain management is needed. METHODS: This study was based on a survey that targeted emergency medicine doctors from September to November 2015 (the response rate was 7%). Firstly, the survey showed that physicians preferred medicating on five diseases abdominal pain, cancer, simple musculoskeletal disease, trauma, headache in the ED. Secondly, it demonstrated the criteria used to choose the analgesic treatment in accordance with each disease and the level of pain, which is determined using a numerical rating scale (NRS). RESULTS: In the cases of abdominal pain that requires surgery, cancer pain, and multiple trauma, physicians preferred using an opioid as the first medication, while non steroidal anti inflammatory drugs (NSAIDs) are prescribed in most of the other cases. Meperidine was the preferred choice as the opioid. For almost diseases, the NSAIDs are selected in the lower NRS cases over the opioid. Physicians deal with pain of patients who are already diagnosed with specific diseases, such as cancer, while they avoid managing pain from those patients who have not been definitively diagnosed with a specific disease. CONCLUSION: Physicians in the ED prefer the use of NSAIDs as the analgesic treatment, in particular, prescribing meperidine as the preferred opioid. However, it seems that they are hesitant to manage pain without a clear diagnosis.

Anxiety symptoms and occupational stress among young Korean female manufacturing workers

BACKGROUND: The prevalence of anxiety disorders has been increasing in South Korea, with recent studies reporting anxiety disorders as the most common mental disorder among all South Korean females. Anxiety disorders, which are independent risk factors of suicidal ideation and suicide attempts, are significantly correlated with productivity loss, high medical costs, impaired work performance, and frequent worker absence, and thus are potentially serious problems affecting the health of South Korean female workers. In previous studies, anxiety disorders were shown to have a significant correlation with occupational stress. This study seeks to examine the prevalence of anxiety symptoms as well as the relationship between occupational stress and anxiety symptoms among South Korean female manufacturing workers. METHODS: A structured self-reported questionnaire was administered to 1,141 female workers at an electrical appliance manufacturing plant. The questionnaire collected data on general characteristics, health behaviors, sleep quality, job characteristics (shift work, shift work schedule, and job tenure), occupational stress, and anxiety symptoms. Sleep quality was measured using the Pittsburgh Sleep Quality Index, occupational stress with the Korean Occupational Stress Scale-Short Form (KOSS-SF), and anxiety symptoms with the Korean version of the Beck Anxiety Inventory. A chi square test was conducted to determine the distribution differences in anxiety symptoms based on general characteristics, health behaviors, job characteristics, and sleep quality. A linear-by-linear association test was used to determine the distribution differences between anxietysymptoms and the levels of occupational stress. Last, logistic regression analysis was used in order to determine the association between occupational stress and anxiety symptoms. RESULTS: The prevalence of anxiety symptoms was 15.2 %. In the multivariate logistic regression analysis that adjusted for sleep quality and general characteristics, a significantassociation was found for those with anxiety disorders; the odds ratios (OR) were significantly higher the greater the total KOSS-SF score (moderate-risk group OR=2.85, 95 % CI=1.79-4.56; high-risk group OR=5.34, 95 % CI=3.59-7.96). In addition, excluding insufficient job control, all other KOSS-SF subscales were significantly associated with anxiety symptoms, and a relatively high OR was seen in the high-risk group for job demand (OR=3.19, 95 % CI=2.27-4.49), job insecurity (OR=4.52, 95 % CI=2.86-7.13), and occupational culture (OR=4.52, 95 % CI=2.90-7.04). CONCLUSION: There was a significant association between anxiety symptoms and occupational stress stemming from the psychosocial work environment among these South Korean female manufacturing workers. Future longitudinal studies are needed to examine the association between the occupational stress caused by the psychosocial work environment and the incidence of anxiety disorders and anxiety symptoms. Furthermore, intervention programs that aim to address the prevalence of anxiety symptoms and improve the psychosocial work environment, especially for younger female manufacturing workers, are needed.

The relationship between depressive symptoms among female workers and job stress and sleep quality

OBJECTIVE: Recently, workers' mental health has become important focus in the field of occupational health management. Depression is a psychiatric illness with a high prevalence. The association between job stress and depressive symptoms has been demonstrated in many studies. Recently, studies about the association between sleep quality and depressive symptoms have been reported, but there has been no large-scaled study in Korean female workers. Therefore, this study was designed to investigate the relationship between job stress and sleep quality, and depressive symptoms in female workers. METHODS: From Mar 2011 to Aug 2011, 4,833 female workers in the manufacturing, finance, and service fields at 16 workplaces in Yeungnam province participated in this study, conducted in combination with a worksite-based health checkup initiated by the National Health Insurance Service (NHIS). In this study, a questionnaire survey was carried out using the Korean Occupational Stress Scale-Short Form(KOSS-SF), Pittsburgh Sleep Quality Index(PSQI) and Center for Epidemiological Studies-Depression Scale(CES-D). The collected data was entered in the system and analyzed using the PASW (version 18.0) program. A correlation analysis, cross analysis, multivariate logistic regression analysis, and hierarchical multiple regression analysis were conducted. RESULTS: Among the 4,883 subjects, 978 subjects (20.0%) were in the depression group. Job stress(OR=3.58, 95% CI=3.06-4.21) and sleep quality(OR=3.81, 95% CI=3.18-4.56) were strongly associated with depressive symptoms. Hierarchical multiple regression analysis revealed that job stress displayed explanatory powers of 15.6% on depression while sleep quality displayed explanatory powers of 16.2%, showing that job stress and sleep quality had a closer relationship with depressive symptoms, compared to the other factors. The multivariate logistic regression analysis yielded odds ratios between the 7 subscales of job stress and depressive symptoms in the range of 1.30-2.72 and the odds ratio for the lack of reward was the highest(OR=2.72, 95% CI=2.32-3.19). In the partial correlation analysis between each of the 7 subscales of sleep quality (PSQI) and depressive symptoms, the correlation coefficient of subjective sleep quality and daytime dysfunction were 0.352 and 0.362, respectively. CONCLUSION: This study showed that the depressive symptoms of female workers are closely related to their job stress and sleep quality. In particular, the lack of reward and subjective sleep factors are the greatest contributors to depression. In the future, a large-scale study should be performed to augment the current study and to reflect all age groups in a balanced manner. The findings on job stress, sleep, and depression can be utilized as source data to establish standards for mental health management of the ever increasing numbers of female members of the workplace.

Clinical evaluation of a collagen matrix to enhance the width of keratinized gingiva around dental implants

PURPOSE: The purpose of this study was to evaluate the effect of collagen matrix with apically positioned flap (APF) on the width of keratinized gingiva, comparing to the results of APF only and APF combined with free gingival graft (FGG) at the second implant surgery. METHODS: Nine patients were selected from those who had received treatments at the Department of Periodontics, Chosun University Dental Hospital, Gwangju, Korea. We performed APF, APF combined with FGG, and APF combined with collagen matrix coverage respectively. Clinical evaluation of keratinized gingival was performed by measuring the distance from the gingival crest to the mucogingival junction at the mid-buccal point, using a periodontal probe before and after the surgery. RESULTS: The ratio of an increase was 0.3, 0.6, and 0.6 for the three subjects in the APF cases, 3, 5, and 7 for the three in the APF combined with FGG case, and 1.5, 0.5, and 3 for the three in the APF combined with collagen matrix coverage case. CONCLUSIONS: This study suggests that the collagen matrix when used as a soft tissue substitute with the aim of increasing the width of keratinized tissue or mucosa, was as effective and predictable as the FGG.

A Study of the Misinformed Methods of Childcare

PURPOSE: An inexperienced mother depends on the recommendation by an experienced person on how to bring up her child. Therefore, we performed a study to evaluate the wrong methods of childcare and to establish effective childcare counselling. METHODS: Two thousand eighty questionnaires filled out by mothers who visited local pediatric clinics and medical centers in Chonbuk, from March 2001 to April 2001, were analyzed according to the distribution of location, age of infant, maternal age and the question of each field. RESULTS: Many mothers have been known to squeeze the breast causing hypertrophy of the neonate. Most infants are placed on their side or supine for sleep. The most common reason for stopping breast feeding was insufficient amount of breast milk. The appropriate age to start whole cow's milk is after the first year of life. The main food used for weaning was commercial baby food. The main oral hydration solution for diarrhea has been boiled water. The main reasons for using a pacifier were to help the mother. The most common reason to use herbs was for the prevention of disease. The use of infant walkers has been widespread among infants and young children. The most common reason was to keep the infant quiet and happy. Most mothers did not use car safety seats for young children. CONCLUSION: The findings of this study revealed that many mothers were misinformed concerning childcare, so pediatricians should make more efforts and perform more studies to establish rational methods of childcare.

Analysis of Induced Sputum to Examine the Effects of Inhaled Corticosteroid on the IL-8 and Myeloperoxidase in Asthmatic Subjects / 소아알레르기및호흡기학회지

PURPOSE: The of this study was to describe the changes of airway inflammation in children with stable, steriod naive asthma after inhaling fluticasone by using serial induced sputum. We sought to investigate the role of neutrophils, interleukin-8(IL-8), and myeloperoxidase(MPO) in asthma. METHOD: To examine the change of neutrophil and their products in childhood asthma after inhaling fluticasone, we assessed the cell counts, IL-8, and MPO in the sputum at each visit. Also, the daily symptom scores, FEV1, peak expiratory flow variability, and methacholin airway responsiveness were checked and their relationships were analyzed. RESULT: There was a significant improvement in asthma severity, as measured by symptom score, and FEV1. There were significant reductions in IL-8 and MPO after 3 weeks treatment, and significant increase in the total sputum cell counts. Significant increase in total lymphocyte and alvelor macrophage cell counts with no increase in neutrophil and eosinophil counts were found. Airway responsiveness was significantely correlated with total eosinophil counts before inhaling fluticasone and it was correlated with IL-8 after the treatment. CONCLUSION: This study highlight, the probable importance of IL-8 and myeloper-oxidase within the asthmatic airways and the beneficial modulatory effect of inhaled fluticasone treatment upon them.

Duplication Cyst of the Pylorus in a Newborn

Enteric duplications are uncommon congenital anomalies. Duplications of the stomach account for only 3.8% of gastrointestinal duplication. More particularly, duplications involving the pylorus are extremely rare. These are characterized by firm attachment to at least one point of the alimentary tract with a well developed coat of smooth muscle and mucous membrane. The most frequent presentation is an abdominal mass with vomiting, mainly discovered during the first year of life. We experienced a 24-day-old boy with non-bilous, non-projectile vomiting and palpable abdominal mass, clinically similar to hypertrophic pyloric stenosis. He was diagnosed as having gastropyloric duplication cyst by abdominal ultrasonography, upper gastrointestinal series and abdominal computerized tomography. Thus we report a newborn infant with gastric outlet obstruction secondary to a duplication of the pylorus which is a rare cause of gastric obstruction.

Analysis of the Impacts of the Ratio of Kidney Weight to the Recipient's Body Weight and of the Kidney Volume to Body Surface Area on the Renal Function after Renal Transplantation

PURPOSE: It is known that in animal experiments, a very small transplanted kidney relative to the recipient's size caused renal failure by a hyperfiltration injury on the nephron. Currently, studies of post-transplant renal function related to the allograft size are in process at many centers, checking the weight and the volume of the transplanted kidney. The results, however, need to be analyzed because of the diverse outcomes from different analytic points. The proper discriminating point should provide sound predictable factors for obtaining better recipient and graft survival. METHODS: We analyzed the results of renal function according to the different comparative points of the ratios of the kidney weight to the recipient's body weight (KW/BW) and of the kidney volume to the recipient's body surface area (KV/BSA). Among 243 patients who underwent a renal transplant between December 1995 and July 1997, 71 cases were excluded because of early graft loss, acute rejection and incomplete data. The remaining 172 patients were grouped into two groups above and below the various comparative points of the KW/BW and KV/BSA. Thereafter, serum Cr and 24-hr urine protein at 1-yr and 2-yr post- transplantation were compared between the groups. Also we analyzed the correlation between the renal size index (KW/BW, KV/BSA) and the serum Cr, the 24-hr urine protein, and the creatinine clearance at one and two years. RESULTS: From 2.5 to 2.9 of KW/BW, there were relatively consistent results; the transplanted kidneys which had more larger sizes excreted less protein in the 24-hr urine at one year (p<0.05). However, there was no difference in serum Cr level at 1- and 2-yr post-transplantation or in the 24-hr urine protein at 2 yr. Also there were correlations between the KW/BW and the 24-hrurine protein at 1 yr and between the KV/BSA and serum Cr at 1 yr (p<0.05). CONCLUSION: We conclude that the KW/BW, rather than the KV/BSA, was more predictable for post-transplant renal function such as urinary protein excretion, especially at 1 yr. The comparative point, however, should be deliberately adopted by using different multiple point. Also a method of measuring the functional size of the kidney, other than the simple geometric size, needs to be found.