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1.
Yonsei Medical Journal ; : 352-358, 2021.
Article in English | WPRIM | ID: wpr-875577

ABSTRACT

Purpose@#Base deficit (BD) is superior to vital signs in predicting trauma outcomes in adults. The authors aimed to compare BD and vital signs as criteria for the four-tiered hemorrhagic shock classification in children with trauma. @*Materials and Methods@#We retrospectively reviewed the data of 1046 injured children who visited a Korean academic hospital from 2010 through 2018. These children were classified separately based on BD (class I, BD ≤2.0 mmol/L; II, 2.1–6.0 mmol/L; III, 6.1–10 mmol/L; and IV, ≥10.1 mmol/L) and vital signs (<13 years: age-adjusted hypotension and tachycardia, and Glasgow Coma Scale; 13–17 years: the 2012 Advanced Trauma Life Support classification). The two methods were compared on a class-by-class basis regarding the outcomes: mortality, early transfusion (overall and massive), and early surgical interventions for the torso or major vessels. @*Results@#In total, 603 children were enrolled, of whom 6.6% died. With the worsening of BD and vital signs, the outcome rates increased stepwise (most p<0.001; only between surgical interventions and vital signs, p=0.035). Mortality more commonly occurred in BD-based class IV than in vital signs-based class IV (58.8% vs. 32.7%, p=0.008). Early transfusion was more commonly performed in BD-based class III than in vital signs-based class III (overall, 73.8% vs. 53.7%, p=0.007; massive, 37.5% vs. 15.8%, p=0.001). No significant differences were found in the rates of early surgical interventions between the two methods. @*Conclusion@#BD can be a better predictor of outcomes than vital signs in children with severe hemorrhagic shock.

2.
Article in Korean | WPRIM | ID: wpr-903061

ABSTRACT

Purpose@#This study was performed to investigate the association of high age-adjusted shock index (AASI) with mortality in Korean children with trauma. @*Methods@#The data of children (aged < 15 years) with trauma who visited an university hospital in Korea from 2010 through 2018 were reviewed. High AASI was defined by age groups as follows: < 12 months, ≥ 2.7; 12-23 months, ≥ 2.1; 2-4 years, ≥ 1.9; 5-11 years, ≥ 1.5; and 12-14 years, ≥ 1.1. Age, sex, transfer status, injury mechanism, hypotension, tachycardia, base deficit, hemoglobin concentration, trauma scores, hemorrhage-related procedures (transfusion and surgical interventions), and severe traumatic brain injury were compared according to high AASI and in-hospital mortality. The association of high AASI with the mortality was analyzed using logistic regression. @*Results@#Of the 363 enrolled children, 29 (8.0%) had high AASI and 24 (6.6%) died. The children with high AASI showed worse trauma scores and underwent hemorrhage-related procedures more frequently, without a difference in the rate of the traumatic brain injury. High AASI was associated with in-hospital mortality (survivors, 6.5% vs. non-survivors, 29.2%; P = 0.001). This association remained significant after adjustment (adjusted odds ratio, 6.42; 95% confidence interval, 1.38-29.82). The other predictors were Glasgow Coma Scale (for increment of 1 point; 0.62; 0.53-0.72) and age (for increment of 1 year; 0.84; 0.73-0.97). High AASI showed a 29.2% sensitivity and 93.5% specificity for the mortality. @*Conclusion@#High AASI is associated with mortality, and have a high specificity but low sensitivity in Korean children with trauma. This predictor of mortality can be used prior to obtaining the results of laboratory markers of shock.

3.
Article in English | WPRIM | ID: wpr-897514

ABSTRACT

A previously healthy 12-month-old girl presented to the emergency department with vomiting of water beads (superabsorbent polymer). The girl did not have clinical or radiographic signs of residual foreign bodies or intestinal obstruction. Point-of-care ultrasound showed well-demarcated, round, and hypoechoic materials in the stomach and first part of the duodenum, indicating ingested beads. Subsequently, the beads were retrieved by the esophagogastroduodenoscopy. Because water beads can be readily found with point-of-care ultrasound, the use of this imaging modality can expedite endoscopic intervention and avoid surgical removal of foreign bodies.

4.
Article in Korean | WPRIM | ID: wpr-895357

ABSTRACT

Purpose@#This study was performed to investigate the association of high age-adjusted shock index (AASI) with mortality in Korean children with trauma. @*Methods@#The data of children (aged < 15 years) with trauma who visited an university hospital in Korea from 2010 through 2018 were reviewed. High AASI was defined by age groups as follows: < 12 months, ≥ 2.7; 12-23 months, ≥ 2.1; 2-4 years, ≥ 1.9; 5-11 years, ≥ 1.5; and 12-14 years, ≥ 1.1. Age, sex, transfer status, injury mechanism, hypotension, tachycardia, base deficit, hemoglobin concentration, trauma scores, hemorrhage-related procedures (transfusion and surgical interventions), and severe traumatic brain injury were compared according to high AASI and in-hospital mortality. The association of high AASI with the mortality was analyzed using logistic regression. @*Results@#Of the 363 enrolled children, 29 (8.0%) had high AASI and 24 (6.6%) died. The children with high AASI showed worse trauma scores and underwent hemorrhage-related procedures more frequently, without a difference in the rate of the traumatic brain injury. High AASI was associated with in-hospital mortality (survivors, 6.5% vs. non-survivors, 29.2%; P = 0.001). This association remained significant after adjustment (adjusted odds ratio, 6.42; 95% confidence interval, 1.38-29.82). The other predictors were Glasgow Coma Scale (for increment of 1 point; 0.62; 0.53-0.72) and age (for increment of 1 year; 0.84; 0.73-0.97). High AASI showed a 29.2% sensitivity and 93.5% specificity for the mortality. @*Conclusion@#High AASI is associated with mortality, and have a high specificity but low sensitivity in Korean children with trauma. This predictor of mortality can be used prior to obtaining the results of laboratory markers of shock.

5.
Article in English | WPRIM | ID: wpr-889810

ABSTRACT

A previously healthy 12-month-old girl presented to the emergency department with vomiting of water beads (superabsorbent polymer). The girl did not have clinical or radiographic signs of residual foreign bodies or intestinal obstruction. Point-of-care ultrasound showed well-demarcated, round, and hypoechoic materials in the stomach and first part of the duodenum, indicating ingested beads. Subsequently, the beads were retrieved by the esophagogastroduodenoscopy. Because water beads can be readily found with point-of-care ultrasound, the use of this imaging modality can expedite endoscopic intervention and avoid surgical removal of foreign bodies.

6.
Article in English | WPRIM | ID: wpr-764240

ABSTRACT

Zika virus (ZIKV) is one of the pathogens which is transmitted world widely, but there are no effective drugs and vaccines. Whole genome sequencing (WGS) of viruses could be applied to viral pathogen characterization, diagnosis, molecular surveillance, and even finding novel pathogens. We established an improved method using direct RNA sequencing with Nanopore technology to obtain WGS of ZIKV, after adding poly (A) tails to viral RNA. This established method does not require specific primers, complimentary DNA (cDNA) synthesis, and polymerase chain reaction (PCR)-based enrichment, resulting in the reduction of biases as well as of the ability to find novel RNA viruses. Nanopore technology also allows to read long sequences. It makes WGS easier and faster with long-read assembly. In this study, we obtained WGS of two strains of ZIKV following the established protocol. The sequenced reads resulted in 99% and 100% genome coverage with 63.5X and 21,136X, for the ZIKV PRVABC59 and MR 766 strains, respectively. The sequence identities of the ZIKV PRVABC59 and MR 766 strains for each reference genomes were 98.76% and 99.72%, respectively. We also found that the maximum length of reads was 10,311 bp which is almost the whole genome size of ZIKV. These long-reads could make overall structure of whole genome easily, and WGS faster and easier. The protocol in this study could provide rapid and efficient WGS that could be applied to study the biology of RNA viruses including identification, characterization, and global surveillance.


Subject(s)
Bias , Biology , Diagnosis , DNA , Genome , Genome Size , Methods , Nanopores , Polymerase Chain Reaction , RNA Viruses , RNA , RNA, Viral , Sequence Analysis, RNA , Tail , Vaccines , Zika Virus
7.
Article in English | WPRIM | ID: wpr-764237

ABSTRACT

The diverse infectious diseases can occur everywhere in the world, but high-risk infectious diseases should be monitored immediately after the occurrence, and be controlled not to spread to the public. Other highly contagious ones also should be screened with the surveillance system and made to be prevented from a serious effect on public health. The outbreak information, articles and news reports concerning global infectious disease outbreaks were collected from known web-based resources and deposited in Global Center for Infectious Diseases since 2016. The number of reports collected from various sources was analyzed on the respect of Blueprint priority diseases and vaccine-preventable diseases, and the characteristic outbreak trend was shown in the geographic distribution and the so-called socio-economic level of countries. The WHO R&D Blueprint priority diseases are being reported especially in the region of Africa and Asia. The vaccine-preventable and other infectious diseases also are reported continuously and world-widely. They threaten the safety of life continuously in public. Therefore, keeping close observation and strengthening infectious disease surveillance is needed, and more effort to expand the collecting resources to get more outbreak information is warranted.


Subject(s)
Africa , Asia , Communicable Diseases , Disease Outbreaks , Public Health
8.
Article in English | WPRIM | ID: wpr-760853

ABSTRACT

Damage control resuscitation is a relatively new resuscitative strategy for patients with severe traumatic hemorrhage. This strategy consists of permissive hypotension and early balanced transfusion, and transfers the patients to subsequent surgery. There is growing evidence on harms of excessive fluids. Since 2013, survival benefit of massive transfusion protocol has been proven in adults. Despite insufficient evidence, pediatric massive transfusion protocols are widely used in North American trauma centers. This review focuses on the concept of damage control resuscitation, and summarizes the relevant pediatric evidence.


Subject(s)
Adult , Blood Coagulation Disorders , Blood Transfusion , Child , Emergency Medicine , Hemorrhage , Hemostasis , Humans , Hypotension , Hypotension, Controlled , Resuscitation , Trauma Centers , Wounds and Injuries
9.
Article in English | WPRIM | ID: wpr-741800

ABSTRACT

A previously healthy, 3-year-old boy presented to the emergency department with an afebrile focal motor seizure. He was found crying and having a seizure 30 minutes earlier. During this seizure, he was jerking his head and right extremities. Subsequent magnetic resonance imaging showed acute infarction in the bilateral frontal lobes, chiefly in the left. After hospitalization, conventional angiography demonstrated bilateral stenosis of the distal internal carotid arteries with development of lenticulostriate collaterals, which confirmed the diagnosis of moyamoya disease. It is vital to recognize focal motor seizures and situations related to hyperventilation in children with a seizure, which imply a structural lesion and a provoked cerebral ischemia in preexisting moyamoya disease, respectively.


Subject(s)
Angiography , Brain Ischemia , Carotid Artery, Internal , Child , Child, Preschool , Constriction, Pathologic , Crying , Diagnosis , Emergencies , Emergency Service, Hospital , Extremities , Frontal Lobe , Head , Hospitalization , Humans , Hyperventilation , Infarction , Ischemia , Magnetic Resonance Imaging , Male , Moyamoya Disease , Seizures , Stroke , Vasoconstriction
11.
Article in English | WPRIM | ID: wpr-764915

ABSTRACT

Japanese encephalitis (JE) cases have been increasingly reported recently especially in Seoul and its vicinity. Pigs are known as amplifying host of JE virus (JEV), but do not play an important role in these recent events because pig-breeding is not common in Seoul. The distribution and the density of migratory birds are correlated with JE cases in cities and they might be highly potential hosts contributing to transmit JEV in metropolitan areas. JE genotype and sero-prevalence in birds should be determined for the verification of the transmission route of JEV in the recent sporadic occurrence of JE cases in Seoul.


Subject(s)
Asian Continental Ancestry Group , Birds , Encephalitis, Japanese , Genotype , Humans , Korea , Seoul , Swine
12.
Article in Korean | WPRIM | ID: wpr-225126

ABSTRACT

PURPOSE: To retrospectively validate the Step-by-Step approach, a sequential algorithm for prediction of serious bacterial infections (SBI) using the appearance, age, and inflammatory markers, in febrile infants younger than 90 days. METHODS: The presence of SBI was reviewed in febrile infants younger than 90 days undergoing blood and urine cultures (using perineal adhesive bags), assays for procalcitonin, C-reactive protein and absolute neutrophil count, and urinalysis at the emergency department from September 2015 through August 2017. The low-risk infants were classified according to the Step-by-Step approach. SBI was defined as urinary tract infection (UTI), bacteremia or meningitis. We measured the sensitivity and negative predictive value (NPV) of the approach in predicting SBI, and compared the values to those of the Rochester criteria and the Lab-score. RESULTS: Of 488 febrile infants (44.7% underwent lumbar puncture), 71 (14.5%) had SBI, including 67 UTI, 5 bacteremia, and 3 meningitis (mutually inclusive). Of 208 low-risk infants (42.6%), no SBI was found. The Step-by-Step approach showed a 100% sensitivity (95% confidence interval [CI]: 94.9–100.0) and NPV (95% CI: not applicable). The Rochester criteria showed a 98.6% sensitivity (95% CI: 92.4–100.0) and 99.6% NPV (95% CI: 97.1–99.9), and missed 1 meningitis. The Lab-score showed a 59.2% sensitivity (95% CI: 46.8–70.7) and 93.2% NPV (95% CI: 91.2–94.8), and missed 2 meningitis and 27 UTI. CONCLUSION: The Step-by-Step approach showed a 100% sensitivity and NPV in predicting SBI. This approach may help predict SBI without lumbar puncture in febrile infants younger than 90 days.


Subject(s)
Adhesives , Bacteremia , Bacterial Infections , Biomarkers , C-Reactive Protein , Emergencies , Emergency Service, Hospital , Humans , Infant , Meningitis , Neutrophils , Retrospective Studies , Risk Assessment , Spinal Puncture , Urinalysis , Urinary Tract Infections
13.
Article in Korean | WPRIM | ID: wpr-148716

ABSTRACT

PURPOSE: To investigate whether performance of point-of-care ultrasound (POCUS) can reduce emergency department length of stay (EDLOS) for children with nonspecific manifestations of intussusception (NMI), defined as 2 or less manifestations of the classic triad of intussusception, and/or vomiting. METHODS: We reviewed medical records of 141 consecutive children with intussusception aged 6 years or younger who visited the emergency department of Asan Medical Center in Seoul, Korea from May 2014 through April 2016 and underwent diagnostic radiology ultrasound and pneumatic reduction. The children were grouped according to whether they underwent POCUS or not (POCUS and no POCUS groups, respectively). POCUS was performed to children with NMI by an attending emergency physician who had completed a POCUS training course endorsed by the Korean Society of Pediatric Emergency Medicine. We measured EDLOS, which consisted of door-to-reduction and observation times. These time intervals were compared between the 2 groups. RESULTS: Of 112 eligible children, 65 (58%) underwent POCUS. The median EDLOS was shorter in the POCUS group than in the no POCUS group (566 minutes, interquartile range [IQR] 497 to 765 vs. 745 minutes, IQR 551 to 981; P = 0.003). The median door-to-reduction and observation times were also shorter in the POCUS group (105 vs. 138 minutes, P < 0.001 and 440 vs. 628 minutes, P = 0.008, respectively). These differences were possibly due to the performance of POCUS and the trend toward early discharge after pneumatic reduction. We found 1 child with false negative result on POCUS, but there may have been more. CONCLUSION: Performance of POCUS may reduce EDLOS in children with NMI.


Subject(s)
Child , Emergencies , Emergency Medicine , Emergency Service, Hospital , Humans , Intussusception , Korea , Length of Stay , Medical Records , Point-of-Care Systems , Seoul , Ultrasonography , Vomiting
14.
Article in Korean | WPRIM | ID: wpr-190315

ABSTRACT

A 3-year-old boy presented to our emergency department with a 3-week history of pain in the bilateral hip and abdomen that had persisted through antibiotic therapy based on diagnosis of acute osteomyelitis. At presentation, he had fever, anemia, and increased concentration of lactate dehydrogenase. After the identification of a left adrenal mass indicating neuroblastoma on computed tomography scan, he was admitted to the hospital by a pediatric oncologist. Subsequently, positron emission tomography and bone scintigraphy showed disseminated metastasis to the bone and bone marrow, and neuroblastoma was pathologically confirmed. This case highlights the importance of differential diagnosis of non-traumatic hip pain in toddlers considering the protean manifestations of neuroblastoma.


Subject(s)
Abdomen , Anemia , Bone Marrow , Child , Child, Preschool , Diagnosis , Diagnosis, Differential , Emergencies , Emergency Service, Hospital , Fever , Hip , Humans , L-Lactate Dehydrogenase , Male , Neoplasm Metastasis , Neuroblastoma , Osteomyelitis , Positron-Emission Tomography , Radionuclide Imaging
15.
Article in English | WPRIM | ID: wpr-97572

ABSTRACT

p53 is a well-known multi-functional transcription regulator and is critical in the induction of apoptosis in response to various stresses. Human cytomegalovirus (HCMV) infection induced the accumulation of p53, which was partly relocalized in cytoplasm, but no apparent cell death in human fibroblasts. p53 in HCMV-infected cells was mainly mono-ubiquitinated, which might be resulted from the decreased expression of MDM2 in the course of HCMV infection. Ubiquitinated p53 was also phosphorylated at serine 20. CRM1 increased in the cytoplasm of HCMV-infected cells. It was found that p53 and its mutant in nuclear export sequences were localized in the cytoplasm of cells when co-expressed with CRM1. Collectively, our data suggest that HCMV infection modifies p53 into a stable and exportable form and accumulates it in the cytoplasm, but does not result in apoptotic death of cells.


Subject(s)
Active Transport, Cell Nucleus , Apoptosis , Cell Death , Cytomegalovirus Infections , Cytomegalovirus , Cytoplasm , Fibroblasts , Humans , Serine , Ubiquitin
16.
Article in English | WPRIM | ID: wpr-200670

ABSTRACT

Adeno-associated virus (AAV) and human papillomavirus (HPV) DNAs were found in abnormal quality semen, early abortus and female genital tissues. It was suggested that they might cause male infertility and miscarriages. This study was performed to determine the detection rate of these viruses in the semen and to assess the relationship between the presence of virus and male factor infertility and recurrent miscarriages. Sixty-three of 99 recruited male were included in this study according to the completeness of follow-up and the sample availability. Fourteen male with normal reproductive capacity were allocated to control group, 15 male with abnormal results in semen analysis were grouped as male factor infertility (MF) group, and 34 male whose spouses have had history of repeated spontaneous abortions were designated as repeated miscarriage (RM) group. AAV and HPV were detected in semen by polymerase chain reaction. The detection rate of AAV in the MF infertility group and RM group was 60.0% and 50.0%, respectively, while 14.3% in the control group (p < 0.05). However, the differences in the detection rate of HPV were not statistically significant among groups. These results suggest that AAV could be related to repeated miscarriages and male infertility.


Subject(s)
Abortion, Habitual , Abortion, Spontaneous , Dependovirus , DNA , Female , Fertilization , Follow-Up Studies , Humans , Infertility , Infertility, Male , Male , Polymerase Chain Reaction , Pregnancy , Semen , Semen Analysis , Spouses , Stress, Psychological , Viruses
17.
Article in English | WPRIM | ID: wpr-151526

ABSTRACT

BACKGROUND: Acute pulmonary thromboembolism is fatal because of abruptly occurring hypoxemia and right ventricular failure. There are several treatment modalities, including anticoagulation, thrombolytics, ECMO (extracorporeal membrane oxygenator), and thromboembolectomy, for managing acute pulmonary thromboembolism. MATERIALS AND METHODS: Medical records from January 1999 to December 2004 at our institution were retrospectively reviewed for pulmonary thromboembolectomy. There were 7 patients (4 men and 3 women), who underwent a total of 8 operations because one patient had post-operative recurrent emboli and underwent reoperation. Surgery was indicatedfor mild hypoxemia and performed with CPB (cardiopulmonary bypass) in a beating heart state. RESULTS: The patients had several symptoms, such as dyspnea, chest discomfort, and palpitation. Four patients had deep vein thromboembolisms and 3 had psychotic problems, specifically schizophrenia. Post-operative complications included hemothorax, pleural effusion, and pericardial effusion. There were two hospital deaths, one each by brain death and right heart failure. CONCLUSION: Emergency operation should be performed when medical treatments are no longer effective.


Subject(s)
Hypoxia , Brain Death , Dyspnea , Emergencies , Extracorporeal Membrane Oxygenation , Heart , Hemothorax , Humans , Male , Medical Records , Membranes , Pericardial Effusion , Pleural Effusion , Pulmonary Embolism , Reoperation , Retrospective Studies , Schizophrenia , Thorax , Thromboembolism , Veins
18.
Yonsei Medical Journal ; : 207-209, 2011.
Article in English | WPRIM | ID: wpr-136357

ABSTRACT

Acupuncture-related hemopericardium is a rare but potentially fatal complication. We describe a hemopericardium that occurred shortly after acupuncture in a 55-year-old woman. A chest CT scan and echocardiography revealed a hemopericardium, and pericardiocentesis was then immediately and successfully performed. Subsequently, her clinical course improved. This case increases the attention of emergency physicians for acupuncture-related complications, especially hemopericardium, and the necessity of rapid diagnosis and management.


Subject(s)
Acupuncture Therapy/adverse effects , Echocardiography , Female , Humans , Middle Aged , Pericardial Effusion/diagnosis , Pericardiocentesis
19.
Yonsei Medical Journal ; : 207-209, 2011.
Article in English | WPRIM | ID: wpr-136356

ABSTRACT

Acupuncture-related hemopericardium is a rare but potentially fatal complication. We describe a hemopericardium that occurred shortly after acupuncture in a 55-year-old woman. A chest CT scan and echocardiography revealed a hemopericardium, and pericardiocentesis was then immediately and successfully performed. Subsequently, her clinical course improved. This case increases the attention of emergency physicians for acupuncture-related complications, especially hemopericardium, and the necessity of rapid diagnosis and management.


Subject(s)
Acupuncture Therapy/adverse effects , Echocardiography , Female , Humans , Middle Aged , Pericardial Effusion/diagnosis , Pericardiocentesis
20.
Article in English | WPRIM | ID: wpr-225196

ABSTRACT

BACKGROUND: Xenotransplantation is thought to be one of the alternative methods to overcome the shortage of human organs for transplantation. Recipients should be immunosuppressed for graft survival, and thus, there is a need for developing diagnostic modality that can detect diverse infections originating from animals and recipients rapidly, in the early stage, and with high sensitivity using small volume of samples. This study was carried out to develop a fast, simple, and robust technique for the preparation of HCMV DNA and PERV RNA using small volume of samples. MATERIALS AND METHODS: Nucleic acids were extracted from serially diluted samples with one step extraction method as well as with Qiagen kit. The presence of genomic DNA of human cytomegalovirus (HCMV) and porcine endogenous retrovirus (PERV) was detected by PCR and specific primer set, respectively. RNA of HCMV and PERV was extracted and then detected by RT-PCR and specific primer set, respectively. For absolute quantification of HCMV, standard curve was established by real time PCR. RESULTS: HCMV DNA and PERV RNA were prepared from culture supernatant and cells for PCR or RT-PCR with one step extraction method. It was possible to extract both the DNA and RNA from the samples in about 20 minutes with one step extraction method in a single tube. HCMV and PERV could also be detected by PCR and one step extraction method, respectively. It was also good with small quantity samples. CONCLUSIONS: One step extraction method is simpler and faster method than other extraction methods when there are two types of DNA and RNA viruses in one sample. From these results, we could see that the one step extraction method could be very useful in detecting HCMV and PERV rapidly from the pig cells or organ transplanted recipients with a small amount of sample.


Subject(s)
Animals , Cytomegalovirus , DNA , Endogenous Retroviruses , Graft Survival , Humans , Nucleic Acids , Polymerase Chain Reaction , RNA , RNA Viruses , Transplantation, Heterologous , Transplants
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