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Background@#Enlarged perivascular space (ePVS) is recently reported to be associated with cerebral small vessel disease (SVD) and Alzheimer’s disease (AD). The topographical location of ePVS may relate to the underlying pathology; basal ganglia (BG)-ePVS has been associated with cerebral vascular diseases and centrum semi-ovale (CSO)-ePVS associated with cerebral amyloid angiopathy (CAA). However, the effects of ePVS on various neurological conditions remain still controversial. To investigate the clinical relevance of ePVS in neurodegenerative diseases, we tested relationships between ePVS and cognition, markers of SVD, vascular risk factors, or amyloid pathology. @*Methods@#We retrospectively reviewed 292 patients (133 AD dementia, 106 mild cognitive impairment, 39 other neurodegenerative diseases, 14 subjective cognitive decline) who underwent both amyloid positron emission tomography and brain magnetic resonance imaging. Vascular risk factors and cognitive tests results were collected. The ePVS in the BG and CSO, SVD markers and the volume of white matter hyperintensities were measured. @*Results@#There were no significant differences in the severity and distribution of ePVS among clinical syndromes. Both BG- and CSO-ePVS were not related to cognitive function. Patients with lacunes were more likely to have high-degree BG-ePVS. High degree CSO-ePVS had an odds ratio (OR) for amyloid positive of 2.351, while BG-ePVS was a negative predictor for amyloid pathology (OR, 0.336). @*Conclusions@#Our findings support that ePVS has different underlying pathologies according to the cerebral topography. BG-ePVS would be attributed to hypertensive angiopathy considering the relation with SVD markers, whereas and CSO-ePVS would be attributed to CAA considering the association with amyloid pathology.
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Objective@#This study examined the clinical consequences of a discharge against medical advice (DAMA) among pneumonia patients recommended to be hospitalized in a general ward and identified the risk factors related to a revisit after DAMA. @*Methods@#This retrospective observational study included pneumonia patients who presented at a university hospital emergency department (ED) and were recommended to be hospitalized in a general ward between January 2017 and December 2019. A multivariate logistic regression analysis was performed to identify the risk factors related to a revisit after DAMA and mortality. @*Results@#In the ‘revisit after DAMA’ group, the mortality rate was higher than the ‘no DAMA admission’ group (6.9% vs. 2.1%, P=0.009). Among all admitted patients, DAMA was a risk factor for mortality (odds ratio [OR], 6.185; P=0.023). In the ‘revisit after DAMA’ group, sex (OR, 6.590; P=0.005), C-reactive protein (CRP) score (OR, 1.149; P=0.022), febrile symptoms (OR, 6.569; P=0.004), and dyspnea (OR, 5.480; P=0.002) were risk factors of revisit. Furthermore, in the ‘revisit after DAMA’ group, the CRP score of the 2nd ED visit was higher than that of the 1st ED visit (6.55±6.27 vs. 8.20±7.31, P=0.014). @*Conclusion@#This study shows that DAMA is one of the risk factors for mortality. When DAMA patients revisit, the severity of their pneumonia was observed to have increased.
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Background@#and Purpose Alzheimer’s disease (AD) does not always mean amyloid positivity. [ 18 F]THK-5351 has been shown to be able to detect reactive astrogliosis as well as tau accompanied by neurodegenerative changes. We evaluated the [ 18 F]THK-5351 retention patterns in positron-emission tomography (PET) and the clinical characteristics of patients clinically diagnosed with AD dementia who had negative amyloid PET findings. @*Methods@#We performed 3.0-T magnetic resonance imaging, [ 18 F]THK-5351 PET, and amyloid PET in 164 patients with AD dementia. Amyloid PET was visually scored as positive or negative. [ 18 F]THK-5351 PET were visually classified as having an intratemporal or extratemporal spread pattern. @*Results@#The 164 patients included 23 (14.0%) who were amyloid-negative (age 74.9±8.3 years, mean±standard deviation; 9 males, 14 females). Amyloid-negative patients were older, had a higher prevalence of diabetes mellitus, and had better visuospatial and memory functions. The frequency of the apolipoprotein E ε4 allele was higher and the hippocampal volume was smaller in amyloid-positive patients. [ 18 F]THK-5351 uptake patterns of the amyloid-negative patients were classified into intratemporal spread (n=10) and extratemporal spread (n=13).Neuropsychological test results did not differ significantly between these two groups. The standardized uptake value ratio of [ 18 F]THK-5351 was higher in the extratemporal spread group (2.01±0.26 vs. 1.61±0.15, p=0.001). After 1 year, Mini Mental State Examination (MMSE) scores decreased significantly in the extratemporal spread group (-3.5±3.2, p=0.006) but not in the intratemporal spread group (-0.5±2.8, p=0.916). The diagnosis remained as AD (n=5, 50%) or changed to other diagnoses (n=5, 50%) in the intratemporal group, whereas it remained as AD (n=8, 61.5%) or changed to frontotemporal dementia (n=4, 30.8%) and other diagnoses (n=1, 7.7%) in the extratemporal spread group. @*Conclusions@#Approximately 70% of the patients with amyloid-negative AD showed abnormal [ 18 F]THK-5351 retention. MMSE scores deteriorated rapidly in the patients with an extratemporal spread pattern.
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Purpose@#Neuroinflammation is considered an important pathway associated with several diseases that result in cognitive decline. 18F-THK5351 positron emission tomography (PET) signals might indicate the presence of neuroinflammation, as well as Alzheimer’s disease-type tau aggregates. β-amyloid (Aβ)-negative (Aβ–) amnestic mild cognitive impairment (aMCI) may be associated with non-Alzheimer’s disease pathophysiology. Accordingly, we investigated associations between 18F-THK5351 PET positivity and cognitive decline among Aβ– aMCI patients. @*Materials and Methods@#The present study included 25 amyloid PET negative aMCI patients who underwent a minimum of two follow-up neuropsychological evaluations, including clinical dementia rating-sum of boxes (CDR-SOB). The patients were classified into two groups: 18F-THK5351-positive and -negative groups. The present study used a linear mixed effects model to estimate the effects of 18F-THK5351 PET positivity on cognitive prognosis among Aβ– aMCI patients. @*Results@#Among the 25 Aβ– aMCI patients, 10 (40.0%) were 18F-THK5351 positive. The patients in the 18F-THK5351-positive group were older than those in the 18F-THK5351-negative group (77.4±2.2 years vs. 70.0±5.5 years; p<0.001). There was no difference between the two groups with regard to the proportion of apolipoprotein E ε4 carriers. Interestingly, however, the CDR-SOB scores of the 18F-THK5351-positive group deteriorated at a faster rate than those of the 18F-THK5351-negative group (B=0.003, p=0.033). @*Conclusion@#The results of the present study suggest that increased 18F-THK5351 uptake might be a useful predictor of poor prognosis among Aβ– aMCI patients, which might be associated with increased neuroinflammation (ClinicalTrials.gov NCT02656498).
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Objective@#We aimed to present the study design and baseline cross-sectional participant characteristics of biobank innovations for chronic cerebrovascular disease with Alzheimer’s disease study (BICWALZS) participants. @*Methods@#A total of 1,013 participants were enrolled in BICWALZS from October 2016 to December 2020. All participants underwent clinical assessments, basic blood tests, and standardized neuropsychological tests (n=1,013). We performed brain magnetic resonance imaging (MRI, n=817), brain amyloid positron emission tomography (PET, n=713), single nucleotide polymorphism microarray chip (K-Chip, n=949), locomotor activity assessment (actigraphy, n=200), and patient-derived dermal fibroblast sampling (n=175) on a subset of participants. @*Results@#The mean age was 72.8 years, and 658 (65.0%) were females. Based on clinical assessments, total of 168, 534, 211, 80, and 20 had subjective cognitive decline, mild cognitive impairment (MCI), Alzheimer’s dementia, vascular dementia, and other types of dementia or not otherwise specified, respectively. Based on neuroimaging biomarkers and cognition, 199, 159, 78, and 204 were cognitively normal (CN), Alzheimer’s disease (AD)-related cognitive impairment, vascular cognitive impairment, and not otherwise specified due to mixed pathology (NOS). Each group exhibited many differences in various clinical, neuropsychological, and neuroimaging results at baseline. Baseline characteristics of BICWALZS participants in the MCI, AD, and vascular dementia groups were generally acceptable and consistent with 26 worldwide dementia cohorts and another independent AD cohort in Korea. @*Conclusion@#The BICWALZS is a prospective and longitudinal study assessing various clinical and biomarker characteristics in older adults with cognitive complaints. Details of the recruitment process, methodology, and baseline assessment results are described in this paper.
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Objective@#This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the emergency department length of stay (ED-LOS) and outcomes of patients admitted with pneumonia. @*Methods@#This was a retrospective observational study that included adult pneumonia patients admitted to the emergency department during the period from February to July 2019 and the corresponding period in 2020. After the COVID-19 outbreak, many changes occurred in medical systems, causing prolonged ED-LOS. We divided ED-LOS into pre-, mid-, and post-ED-LOS and compared ED-LOS, hospital LOS and in-hospital mortality rates of pneumonia patients during the above-mentioned periods. In addition, a multivariable logistic regression analysis was performed to identify the risk factors leading to in-hospital mortality in 2020. @*Results@#A total of 365 patients were included in the study. Pre-ED-LOS, mid-ED-LOS, post-ED-LOS, and in-hospital mortality in the 2020 group were significantly higher than those of the 2019 group (P<0.05). Mid-ED-LOS (odds ratio [OR], 1.474; P=0.001) and post-ED-LOS (OR, 1.098; P=0.024) were identified as being independently associated with an increased risk of in-hospital mortality in 2020. @*Conclusion@#Our study shows that ED-LOS and in-hospital mortality increased after the COVID-19 pandemic. Mid-ED-LOS and post-ED-LOS were independently associated with an increased risk of in-hospital mortality in patients with pneumonia in 2020.
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This study was conducted as a pilot project to evaluate the feasibility of building an integrate dementia platform converging preexisting dementia cohorts from several variable levels. The following four cohorts were used to develop this pilot platform: 1) Clinical Research Center for Dementia of South Korea (CREDOS), 2) Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer’s disease (K-BASE), 3) Environmental Pollution-induced Neurological Effects (EPINEF) study, and 4) a prospective registry in Dementia Platform Korea project (DPKR). A total of 29916 patients were included in the platform with 348 integrated variables. Among participants, 13.9%, 31.5%, and 44.2% of patients had normal cognition, mild cognitive impairment, and dementia, respectively. The mean age was 72.4 years. Females accounted for 65.7% of all patients. Those with college or higher education and those without problems in reading or writing accounted for 12.3% and 46.8%, respectively. Marital status, cohabitation, family history of Parkinson’s disease, smoking and drinking status, physical activity, sleep status, and nutrition status had rates of missing information of 50% or more. Although individual cohorts were of the same domain and of high quality, we found there were several barriers to integrating individual cohorts, including variability in study variables and measurements. Although many researchers are trying to combine pre-existing cohorts, the process of integrating past data has not been easy. Therefore, it is necessary to establish a protocol with considerations for data integration at the cohort establishment stage.
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Purpose@#Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). @*Materials and Methods@#Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. @*Results@#We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. @*Conclusion@#While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).
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Objective@#This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. @*Methods@#This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. @*Results@#A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). @*Conclusion@#In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.
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This study was conducted as a pilot project to evaluate the feasibility of building an integrate dementia platform converging preexisting dementia cohorts from several variable levels. The following four cohorts were used to develop this pilot platform: 1) Clinical Research Center for Dementia of South Korea (CREDOS), 2) Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer’s disease (K-BASE), 3) Environmental Pollution-induced Neurological Effects (EPINEF) study, and 4) a prospective registry in Dementia Platform Korea project (DPKR). A total of 29916 patients were included in the platform with 348 integrated variables. Among participants, 13.9%, 31.5%, and 44.2% of patients had normal cognition, mild cognitive impairment, and dementia, respectively. The mean age was 72.4 years. Females accounted for 65.7% of all patients. Those with college or higher education and those without problems in reading or writing accounted for 12.3% and 46.8%, respectively. Marital status, cohabitation, family history of Parkinson’s disease, smoking and drinking status, physical activity, sleep status, and nutrition status had rates of missing information of 50% or more. Although individual cohorts were of the same domain and of high quality, we found there were several barriers to integrating individual cohorts, including variability in study variables and measurements. Although many researchers are trying to combine pre-existing cohorts, the process of integrating past data has not been easy. Therefore, it is necessary to establish a protocol with considerations for data integration at the cohort establishment stage.
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Purpose@#Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). @*Materials and Methods@#Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. @*Results@#We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. @*Conclusion@#While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).
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Objective@#This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. @*Methods@#This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. @*Results@#A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). @*Conclusion@#In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.
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Because of repeated failures of clinical trials, the concept of Alzheimer's disease (AD) has been changing rapidly in recent years. As suggested by the National Institute on Aging and the Alzheimer's Association Research Framework, the diagnosis and classification of AD is now based on biomarkers rather than on symptoms, allowing more accurate identification of proper candidates for clinical trials by pathogenesis and disease stage. Recent development in neuroimaging has provided a way to reveal the complex dynamics of amyloid and tau in the brain in vivo, and studies of blood biomarkers are taking another leap forward in diagnosis and treatment of AD. In the field of basic and translational research, the development of animal models and a deeper understanding of the role of neuroinflammation are taking a step closer to clarifying the pathogenesis of AD. Development of big data and the Internet of Things is also incorporating dementia care and research into other aspects. Largescale genetic research has identified genetic abnormalities that can provide a foundation for precision medicine along with the aforementioned digital technologies. Through the first international conference of the Korean Dementia Association, experts from all over the world gathered to exchange opinions with association members on these topics. The Academic Committee of the Korean Dementia Association briefly summarizes the contents of the lectures to convey the depth of the conference and discussions. This will be an important milestone in understanding the latest trends in AD's pathogenesis, diagnostic and therapeutic research and in establishing a future direction.
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Background@#Cerebrospinal fluid (CSF) biomarkers are increasingly used in clinical practice for the diagnosis of Alzheimer's disease (AD). We aimed to 1) determine cutoff values of CSF biomarkers for AD, 2) investigate their clinical utility by estimating a concordance with amyloid positron emission tomography (PET), and 3) apply ATN (amyloid/taueurodegeneration) classification based on CSF results. @*Methods@#We performed CSF analysis in 51 normal controls (NC), 23 mild cognitive impairment (MCI) and 65 AD dementia (ADD) patients at the Samsung Medical Center in Korea. We attempted to develop cutoff of CSF biomarkers for differentiating ADD from NC using receiver operating characteristic analysis. We also investigated a concordance between CSF and amyloid PET results and applied ATN classification scheme based on CSF biomarker abnormalities to characterize our participants. @*Results@#CSF Aβ42, total tau (t-tau) and phosphorylated tau (p-tau) significantly differed across the three groups. The area under curve for the differentiation between NC and ADD was highest in t-tau/Aβ42 (0.994) followed by p-tau/Aβ42 (0.963), Aβ42 (0.960), t-tau (0.918), and p-tau (0.684). The concordance rate between CSF Aβ42 and amyloid PET results was 92%. Finally, ATN classification based on CSF biomarker abnormalities led to a majority of NC categorized into A-T-N-(73%), MCI as A+T-N-(30%)/A+T+N+(26%), and ADD as A+T+N+(57%). @*Conclusion@#CSF biomarkers had high sensitivity and specificity in differentiating ADD from NC and were as accurate as amyloid PET. The ATN subtypes based on CSF biomarkers may further serve to predict the prognosis.
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OBJECTIVE@#This study examined the change tendency in the arterial blood gas analysis (ABGA) results according to the body mass index (BMI) of patients admitted through the emergency department (ED) with dyspnea, as well as the risk factors for intensive care unit (ICU) admission and in-hospital mortality in obese patients.@*METHODS@#A retrospective study was conducted on 768 patients, who were admitted to the ED for dyspnea during 2017 and underwent ABGA. The patients were divided into four groups according to their BMI. Multivariate logistic regression analysis was used to determine the risk factors of ICU admission and in-hospital mortality in obese patients using the ABGA results.@*RESULTS@#A higher BMI was associated with a lower pH (P<0.001) and higher arterial carbon dioxide pressure (PaCO2, P=0.001), hematocrit (P=0.009), and lactate concentration (P=0.012). In the obese group, low pH (odds ratio [OR], 5.780; P<0.001 and OR, 16.393; P=0.013), high PaCO2 (OR, 1.123; P=0.005), high lactate concentration (OR, 1.886; P=0.015), and base excess reduction (OR, 1.267; P=0.001) were the risk factors for ICU admission, whereas pH<7.33 (OR, 14.493; P=0.014) and high lactate concentration (OR, 1.462; P=0.008) were the risk factors for in-hospital mortality. The pH (area under the curve [AUC], 0.817; AUC, 0.890) and lactate concentration (AUC, 0.762; AUC, 0.728) were useful for predicting the ICU admission and in-hospital mortality.@*CONCLUSION@#A higher BMI in the subjects was associated with a lower pH and higher lactate concentration. In addition, pH and lactate concentration were significant risk factors for ICU admission and in-hospital mortality.
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OBJECTIVE@#University hospitals nationwide are experiencing a shortage of neurology residents and excessive workloads; new measures are required because a lack of neurologists in the emergency department (ED) leads to ED overcrowding. This study examined the effects of emergency medicine doctors taking over the role of neurologists in the treatment of primary headache patients visiting the ED.@*METHODS@#A study group of primary headache patients, who visited a single university hospital ED between 1 June and 31 October 2017 and were treated by an emergency medical doctor, was selected. The control group consisted of patients who met the same conditions as the study group and visited the ED during the same period in 2016 but were treated by a neurologist. The following variables between the two groups were compared: length of stay in the ED, medical expenses in the ED, and the time taken to decide on neuroimaging tests.@*RESULTS@#This study was conducted on 300 patients in the control group and 94 patients in the study group. The study group showed a shorter time to decide on neuroimaging tests (64.4%, 95% confidence interval [CI], P<0.001), shorter length of stay in the ED (15.2%, 95% CI, P<0.001), and lower medical expenses (12.8%, 95% CI, P=0.011).@*CONCLUSION@#When emergency medicine doctors take over the neurologic medical care of primary headache patients in ED, it can be expected to reduce ED overcrowding and medical expenses.
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BACKGROUND AND PURPOSE: In Alzheimer's continuum (a comprehensive of preclinical Alzheimer's disease [AD], mild cognitive impairment [MCI] due to AD, and AD dementia), cognitive dysfunctions are often related to cortical atrophy in specific brain regions. The purpose of this study was to investigate the association between anatomical pattern of cortical atrophy and specific neuropsychological deficits. METHODS: A total of 249 participants with Alzheimer's continuum (125 AD dementia, 103 MCI due to AD, and 21 preclinical AD) who were confirmed to be positive for amyloid deposits were collected from the memory disorder clinic in the department of neurology at Samsung Medical Center in Korea between September 2013 and March 2018. To analyze neuropsychological test-specific neural correlates representing the relationship between cortical atrophy measured by cortical thickness and performance in specific neuropsychological tests, a linear regression analysis was performed. Two neural correlates acquired by 2 different standardized scores in neuropsychological tests were also compared. RESULTS: Cortical atrophy in several specific brain regions was associated with most neuropsychological deficits, including digit span backward, naming, drawing-copying, verbal and visual recall, semantic fluency, phonemic fluency, and response inhibition. There were a few differences between 2 neural correlates obtained by different z-scores. CONCLUSIONS: The poor performance of most neuropsychological tests is closely related to cortical thinning in specific brain areas in Alzheimer's continuum. Therefore, the brain atrophy pattern in patients with Alzheimer's continuum can be predict by an accurate analysis of neuropsychological tests in clinical practice.
Subject(s)
Humans , Alzheimer Disease , Atrophy , Brain , Cognition , Dementia , Korea , Linear Models , Memory Disorders , Cognitive Dysfunction , Neuroanatomy , Neurology , Neuropsychological Tests , Plaque, Amyloid , SemanticsABSTRACT
OBJECTIVE: This study examined the utility of combined chest and abdominal computed tomography (CT) for the identification of infection sources in acute febrile patients without clinical clues. The groups for whom combined CT was helpful and not were compared. In addition, the factors that affected the positive infection sources and predictors of the presence of infection sources when performing combined CT was investigated. METHODS: Acute febrile patients without clinical clues from a basic examination and the confirmation procedure were investigated prospectively for 6 months. A range of factors, such as demographic factors, duration of fever, vital signs, presence of prior medical treatment, inflammatory markers, and several sepsis prediction tools, were analyzed. RESULTS: Of the 87 patients, 32 (36.8%) tested positive for infection sources on combined CT, whereas 55 (63.2%) tested negative. The mean age, heart rate, procalcitonin (PCT) level, and proportion of the patients aged ≥65 years showed significant differences between the infection source-positive group and infection source-negative group (P=0.027, P=0.008, P=0.035, and P=0.026, respectively). The factors that affected the positive results for infection sources on combined CT included age (odds ratio [OR], 1.047; P=0.011), absence of chronic disease (OR, 0.157; P=0.045), and heart rate (OR, 1.056; P=0.030). Analysis of the receiver-operating characteristic curve showed that age (area under the curve [AUC], 0.630; P=0.041) and heart rate (AUC, 0.659; P=0.008) were significant predictive factors of positive results for infection sources. On the other hand, their predictive powers were poor, and PCT did not show a significant result (AUC, 0.565; P=0.351). CONCLUSION: In patients with underlying chronic disease, older age, increased heart rate due to fever, or a high PCT level, combined CT can be used to identify infection sources when its possible clinical benefits are considered to be high.
Subject(s)
Humans , Chronic Disease , Demography , Emergency Service, Hospital , Fever , Hand , Heart Rate , Prospective Studies , Sepsis , Thorax , Vital SignsABSTRACT
Kounis syndrome is defined as the occurrence of acute coronary syndrome associated with vasoactive mediators, such as histamines in the setting of hypersensitivity and allergic reactions or anaphylactic insults. The condition can be caused by various drugs, foods, or environmental factors that cause allergic reactions. A 35-year-old male visited the emergency room with anaphylaxis accompanied by chest pain approximately 20 minutes after taking zaltoprofen, a nonsteroidal anti-inflammatory drug. After acute treatment for the anaphylaxis, the patient was stabilized and all symptoms disappeared, but the ischemic changes in the electrocardiogram and elevation of the cardiac enzymes were observed. The emergency cardiac angiography and echocardiography were all normal. The allergic reaction of this patient to zaltoprofen was believed to cause a temporary coronary arterial vasospasm, inducing Type 1 Kounis syndrome. Thus far, there have been case reports of Kounis syndrome caused by a range of nonsteroidal anti-inflammatory drugs, but there are no reports of the condition being caused by zaltoprofen. According to the pathophysiology, both cardiac and allergic symptoms must be solved simultaneously, so rapid treatment and diagnosis are needed. Doctors treating acute allergic reactions and anaphylaxis patients must check the cardiovascular symptoms thoroughly and consider the possibility of Kounis syndrome.
Subject(s)
Adult , Humans , Male , Acute Coronary Syndrome , Anaphylaxis , Angiography , Chest Pain , Diagnosis , Echocardiography , Electrocardiography , Emergencies , Emergency Service, Hospital , HypersensitivityABSTRACT
OBJECTIVE: Motor, perceptual, and cognitive functions are known to affect driving competence. Subcortical ischemic changes on brain magnetic resonance imaging (MRI) can reflect reduction in cognitive and motor performance. However, few studies have reported the relationship between subcortical ischemic changes and driving competence of the elderly. Thus, the objective of this study was to investigate the association between subcortical ischemic changes on MRI and driving abilities of the elderly. METHODS: Participants (n=540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort. Each participant underwent MRI scan and interview for driving capacity categorized into ‘now driving’ and ‘driving cessation (driven before, not driving now)’. Participants were divided into three groups (mild, n=389; moderate, n=116; and severe, n=35) depending on the degree of white matter hyperintensity (WMH) on MRI at baseline. Driving status was evaluated at follow-up. Statistical analyses were conducted using χ2 test, analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE). RESULTS: In SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive or motor dysfunction (β=-0.110, p < 0.001). In GEE models after controlling for age, sex, education, cognitive, and motor dysfunction, more severe change in the degree of WMH was associated with faster change from ‘now driving’ state to ‘driving cessation’ state over time in the elderly (β=-0.508, p < 0.001). CONCLUSION: In both cross-sectional and longitudinal results, the degree of subcortical ischemic change on MRI might predict driving cessation in the elderly.