Effectiveness of Simulation-Based Education for Caring Patients with COVID-19

Purpose@#The role of medical staff gained immense significance in the context of the prolonged coronavirus disease (COVID-19) pandemic.However, few studies had explored the impact of simulation-based education on the ability of nursing students to care for the patients of COVID-19. This study provided nursing students with simulation-based education in caring for the patients of COVID-19 and confirmed its effectiveness. @*Methods@#This study used a non-equivalent control group pretest-posttest design. The participants were recruited from the nursing departments of two universities in Korea through convenience sampling. A total of 79 participants were included: 37 in the intervention group and 42 in the control group. The intervention group received four sessions of simulation training based on the National League for Nursing Jeffries simulation theory. @*Results@#The intervention group showed an improvement compared to the control group in terms of knowledge related to coronavirus, confidence in performing infection control skills, and perception of preparedness for caring for the patients of COVID-19, with a high-level of satisfaction and self-confidence in learning. There was no significant difference between the two groups in terms of anxiety. @*Conclusion@#This simulation is expected to be a significant strategy for alleviating the global burden in terms of staff safety and patient outcomes by improving the competencies of prospective medical staff in responding to pandemics.

Compliance with Respiratory Infection Preventive Behaviors and Its related Factors in Older Adults using a Senior Center

PURPOSE: The purpose of this study is to identify factors related to compliance with respiratory infection preventive behaviors including hand washing, cough etiquette, and oral hygiene of older adults. METHODS: A cross-sectional study was conducted with a convenience sample of 100 older adults (mean age: 76.11±6.35 years, female: 86.0%). Data were collected from a community senior center through face to face interviews by using instruments including measuring knowledge, perceived threat, self-efficacy, compliance with respiratory infection preventive behaviors. RESULTS: The mean score of knowledge was 7.52 out of 13 in total. The compliance with hand washing with soap was 6.0% for 8 or more times per day. Among the participants, 12.0% adhered to the cough etiquette. Sixty-two older adults (62.0%) didn't use interdental brushes or floss at all. The stepwise linear regression indicated that age and self-efficacy for respiratory infection preventive behaviors were significant factors and explained 24.0% of the compliance with hand washing and the cough etiquette. Education level, cancer diagnosis, and self-efficacy for respiratory infection preventive behaviors were significant predictors of oral hygiene. The factor with the greatest effect was self-efficacy in the two models. CONCLUSION: The findings suggest that it is necessary to improve compliance with respiratory infection preventive behaviors among older adults using senior centers. In order to enhance the compliance, it is necessary to develop nursing programs based on the self-efficacy for respiratory infection preventive behaviors in the senior centers.

Prevalence and Factors Related to Sarcopenic Obesity among Community-dwelling Elderly Women

PURPOSE: The aims of this study were to identify prevalence and identify factors related to sarcopenic obesity among community-dwelling elderly women. METHODS: This is a secondary analysis of the prospective cohort study. Our analysis included 338 elderly women (≥65 years old) in South Korea as a part of the Community-dwelling Older Adult Health Cohort (COHC) Study (2014-2015). Sarcopenic obesity was defined as the Asian Working Group of Sarcopenia recommendations and upper two quintiles for percentage body fat. Logistic regression analysis was used to determine the factors related to sarcopenic obesity including chronic diseases, medications, stress, fatigue, depression, exercise, level of proteins on body compositions, smoking, and alcohol use. RESULTS: The prevalence of sarcopenic obesity was 6.2%. A lower protein on body compositions (OR 0.017, 95% CI 0.003-0.081, p<.001), a larger number of medications (OR 2.104, 95% CI 1.404-3.152, p<.001), and a higher level of fatigue (OR 1.255, 95% CI 1.023-1.541, p=.030) were related factors of sarcopenic obesity. CONCLUSION: The findings suggest that nutritional interventions focusing on protein intakes should be needed to prevent sarcopenic obesity among the elderly women. Polypharmacy issue for preventing adverse outcomes and level of fatigue as indicator for early identification are also considered to develop community prevention programs.

Efficacy of Lactose-free Milk in Korean Adults with Lactose Intolerance / 대한소화기학회지

BACKGROUND/AIMS: Lactose-free milk (LFM) is available for nutrient supply for those with lactose intolerance (LI). However, there are no consistent results of the efficacy of LFM in LI subjects. We aimed to examine the changes of gastrointestinal (GI) symptoms and hydrogen breath test (HBT) values after ingestion of lactose contained milk (LCM) vs. LFM. METHODS: From May 2015 to September 2015, thirty-five healthy adults with history of LCM-induced GI symptoms were recruited at a tertiary hospital. For the diagnosis of LI, HBT with LCM 550 mL (lactose 25 g) was performed every 20 minutes for 3 hours. The test was defined as "positive" when H2 peak exceeded 20 ppm above baseline values (DeltaH2>20 ppm). When the subjects are diagnosed as LI, the second HBT using LFM 550 mL (lactose 0 g) was performed 7 days later. Subjects were asked to complete a questionnaire about the occurrence and severity of GI symptoms. RESULTS: Among a total of 35 subjects, 31 were diagnosed with LI at first visit, and their LCM-related symptoms were abdominal pain (98.6%), borborygmus (96.8%), diarrhea (90.3%), and flatus (87.1%). The DeltaH2 value in subjects taking LCM (103.7+/-66.3 ppm) significantly decreased to 6.3+/-4.9 ppm after ingesting LFM (p<0.0001). There were also significant reduction in total symptom scores and the severity of each symptom when LCM was changed to LFM (p<0.0001). CONCLUSIONS: This is the first report that LFM reduce LCM-related GI symptoms and H2 production in Korean adults. LFM can be an effective alternative for LCM in adults with LI.

Disseminated Gonococcal Infection Presenting as Bacteremia and Liver Abscesses in a Healthy Adult

Herein, we describe a bacteremia caused by Neisseria gonorrhoeae that presented as liver abscesses. The patient had no risk factors for disseminated gonococcal infection. Periodic fever, skin rashes, and papules were present and the results of an abdominal computed tomography scan indicated the presence of small liver abscesses. The results of blood culture and 16S rRNA sequencing of the bacterial isolates confirmed the presence of N. gonorrhoeae. The patient improved with antibiotic therapy.

Genome-wide Association Study Identification of a New Genetic Locus with Susceptibility to Osteoporotic Fracture in the Korean Population

Osteoporotic fracture (OF), along with bone mineral density (BMD), is an important diagnostic parameter and a clinical predictive risk factor in the assessment of osteoporosis in the elderly population. However, a genomewide association study (GWAS) on OF has not yet been clarified sufficiently. To identify OF-associated genetic variants and candidate genes, we conducted a GWAS in a population-based cohort (Korean Association Resource [KARE], n=1,427 [case: 288 and control: 1139]) and performed a de novo replication study in hospital-based individuals (Asan and Catholic Medical Center [ACMC], n=1,082 [case: 272 and control: 810]). In a combined meta-analysis, a newly identified genetic locus in an intergenic region at 10p11.2 (near genes FZD8 and ANKRD30A ) showed the most significant association (odd ratio [OR] = 2.00, 95% confidence interval [CI] = 1.47~2.74, p=1.27x10(-5)) in the same direction. We provide the first evidence for a common genetic variant influencing OF and genetic information for further investigation in bone metabolism.

Accuracy of Live Fluoroscopy to Detect Intravascular Injection During Lumbar Transforaminal Epidural Injections

BACKGROUND: Complications following lumbar transforaminal epidural injection are frequently related to inadvertent vascular injection of corticosteroids. Several methods have been proposed to reduce the risk of vascular injection. The generally accepted technique during epidural steroid injection is intermittent fluoroscopy. In fact, this technique may miss vascular uptake due to rapid washout. Because of the fleeting appearance of vascular contrast patterns, live fluoroscopy is recommended during contrast injection. However, when vascular contrast patterns are overlapped by expected epidural patterns, it is hard to distinguish them even on live fluoroscopy. METHODS: During 87 lumbar transforaminal epidural injections, dynamic contrast flows were observed under live fluoroscopy with using digital subtraction enhancement. Two dynamic fluoroscopy fluoroscopic images were saved from each injection. These injections were performed by five physicians with experience independently. Accuracy of live fluoroscopy was determined by comparing the interpretation of the digital subtraction fluoroscopic images. RESULTS: Using digital subtraction guidance with contrast confirmation, the twenty cases of intravascular injection were found (the rate of incidence was 23%). There was no significant difference in incidence of intravascular injections based either on gender or diagnosis. Only five cases of intravascular injections were predicted with either flash or aspiration of blood (sensitivity = 25%). Under live fluoroscopic guidance with contrast confirmation to predict intravascular injection, twelve cases were predicted (sensitivity = 60%). CONCLUSION: This finding demonstrate that digital subtraction fluoroscopic imaging is superior to blood aspiration or live fluoroscopy in detecting intravascular injections with lumbar transforaminal epidural injection.

Sacral Nerve Stimulation for Treatment of Chronic Intractable Anorectal Pain: A Case Report

Despite recent methodological advancement of the practical pain medicine, many cases of the chronic anorectal pain have been intractable. A 54-year-old female patient who had a month history of a constant severe anorectal pain was referred to our clinic for further management. No organic or functional pathology was found. In spite of several modalities of management, such as medications and nerve blocks had been applied, the efficacy of such treatments was not long-lasting. Eventually, she underwent temporary then subsequent permanent sacral nerve stimulation. Her sequential numerical rating scale for pain and pain disability index were markedly improved. We report a successful management of the chronic intractable anorectal pain via permanent sacral nerve stimulation. But further controlled studies may be needed.

Retropharyngeal Abscess after an Unexpected Difficult Tracheal Intubation: A case report / 대한마취과학회지

A retropharyngeal abscess is a rare complication of tracheal intubation.A case of retropharyngeal abscess after unexpected difficult tracheal intubation is presented with a review of the medical literature.A 45-year-old female patient underwent excision and biopsy of the left false vocal cord mass under general anesthesia with tracheal intubation.There was unexpected difficulty of the tracheal intubation and several trials of intubations were performed.The patient complained of pain on the left side of the neck, a sore throat, dysphagia, and chest discomfort one day postoperatively.The patient had fever of 38.7degrees C.Flexible laryngoscopy, neck X-ray, neck computed tomography, and pharyngoesophagographic studies were performed, which revealed a retropharyngeal abscess.The patient was treated with antibiotics, nil per os, nasogastric tube feeding and underwent surgery for incision and drainage of the retropharyngeal abscess under local anesthesia.The patient recovered without complications, and the patient was discharged 12 days postoperatively.

Opposite Sciatic Nerve Injury after Fixation of Femur Shaft Fracture: Two case reports / 대한마취과학회지

A sciatic nerve injury as a complication of the position appears to be rare. There are several reports on sciatic nerve injuries that occurred as complications of the lithotomy position. We present two cases of an opposite sciatic nerve injury after the fixation of a femur shaft fracture. Two patients complained of hyperesthesia of the right foot and a foot drop after surgery. Nerve conduction and electromyographic studies were performed, which revealed a sciatic nerve injury. The patients were treated with physiotherapy and an ankle-foot orthotic. In the case 1, patient had completely recovered ten months after surgery. However, in case 2, the patient still had residual hyperesthesia and weakness two months after surgery when he was lost to follow-up. The mechanism of nerve injury in these patients was a stretching of the nerve. Tension was placed on the nerve as a result of the external rotation of the thigh with the hip and knee joints flexed.

Protective Effects of N-acetylcysteine and Selenium against Doxorubicin Toxicity in Rats

To investigate the neutralizing effect of N-acetylcysteine (NAC) and selenium (Se) aganist doxorubicin (DOX) toxicity in rats, NAC (140 mg/kg, p.o.) and Se (0.5 mg/kg, p.o.) were administered for 2 days before DOX injection and then 3 times a week. Cell viability and the level of lipid peroxidation were examined in cultured-rat astrocytes. Severe morphologic changes in the kidney of DOX group; thickening of Bowmans capsule, presence of multifocal tubular casts were observed, but not in the other treated groups. Vacuoles in some hepatic cells and focal aggregation of stellate macrophages were also detected in DOX group, but not in the other treated groups. However, the severe inhibition of spermatogenesis was found in all treated groups. The cell viability of DOX (10 mg/ml) treated group and NAC (5 mM) or Se (0.001 mg/ml) combinedtreated group was 52.5+/-2.0 % , 85.3+/-4.5 % and 75.5+/-1.6 %, respectively. In MDA (malondialdehyde) assay, the level of lipid peroxidation on DOX (10 mg/ml), NAC (5 mM) and Se (0.001 mg/ml) was 0.77+/-0.06, 0.35+/-0.06 and 0.54+/-0.11 nmol/mg protein, respectively. Thus, it is known that NAC and Se have protective effects in kidney and liver but not in the testes. Morphological change was not detected in brain and heart in all groups for experiment period. From this in vitro study, it is known that NAC and Se protect well the astrocytes against DOX induced-cell damage.

A Review of Endoscopic Removal Methods in 127 Cases of the Esophageal Foreign Bodies

PURPOSE: The aim of this study was to evaluate the latest tendency of esophageal foreign body's extraction and to obtain a consensus from recent trends of indications and techniques of flexible endoscopy of esophageal FB in children. METHODS: We retrospectively reviewed medical records of 127 cases with foreign bodies in esophagus at Dept. of Pediatrics and Otorhinolaryngology, Gyeongsang National University Hospital (GNUH) from Jun, 1987 to July, 2001. They were divided into two groups by the kinds of endoscopy: flexible endoscope(66 cases) or rigid endoscope(61 cases). Rigid endoscopy was performed under general anesthesia at Dept. of Otorhinolaryngology but flexible endoscopy was performed without general anesthesia or sedative drugs(midazolam or diazepam). RESULTS: An annual number of cases of two groups were similar from 1991 to 1998. But from 1999, flexible endoscopy was performed actively. Asymptomatic cases were frequently observed in flexible endoscopy(28 cases/66 cases) but swallowing difficulties were frequently observed in the rigid endoscopy group(25 cases/61 cases). Other symptoms were vomiting, irritability, chest discomfort and abdominal pain. The total number of cases with underlying disease(esophageal stenosis, cerebral palsy) was 8. The total number of cases with complications (erosion, ulcer, bleeding, perforation) was 11. The above cases were not correlated between the two groups. In 55 cases(83.3%) of the flexible endoscopic group and 53 cases(86.8%) of the rigid endoscopic group, foreign bodies in the esophagus were removed within 24 hours. CONCLUSION: We could not find any benefit in rigid endoscopic technique. Flexible endoscopic FB removal can be performed safely and effectively in children by an experienced endoscopist.

Gastrointestinal Foreign Bodies: Review of 96 Cases / 대한소아소화기영양학회지

PURPOSE: Foreign body swallowing is common in children. Most of foreign bodies passed upper esophagus are removed spontaneously. But recently, therapeutic endoscopy in children is widely used. In this study, we reviewed gastric foreign bodies regarding types, location, interval from swallowing, complications, and treatment or method of removal. METHODS: We reviewed medical records of 96 cases with foreign bodies in gastrointestinal tract at Department of Pediatrics in Gyeongsang National University Hospital (GNUH) from Feb 1987 to Feb 2002. RESULTS: The peak age of patients (male=60, female=36) with foreign bodies in gastrointestinal tract was 2 to 5 years of age. Sixty two patients (64.5%) were asymptomatic. The location of foreign bodies in gastrointestinal tract were detected by simple X-ray in eighty one patients (86.0%), barium study (1 case), and gastroduodenoscopy in 37 cases. The most common location was stomach (63.5%). The most common foreign body was coin (41.7%). In thirty seven cases (38.5%), foreign bodies were removed with flexible gastroduodenoscopy. Fifty four patients (56.3%) visited GNUH in 24 hours after swallowing foreign bodies. The long interval (over 24 hours) of swallowing of foreign bodies is related with high frequency of endoscopic removal. CONCLUSION: The flexible gastroduodenoscopy was effective in diagnosis and removal of foreign bodies. Further studies for indication and validity of endoscopic removal of foreign bodies in upper gastrointestinal tract are needed.