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Background@#With the growth of the Internet, social media platforms have emerged as major sources of medical information. We assessed the reliability, quality, and accuracy of the most-viewed YouTube videos containing information on the effect of vitamin C on the common cold. @*Methods@#The YouTube videos were searched on August 1, 2022, using the keywords: (“ascorbic acid” OR “vitamin C” OR “Sodium Ascorbate” OR “L-ascorbic”) AND “common cold”. The 30 most-viewed videos were included in our study. The reliability and quality of the videos were analyzed using modified DISCERN and Global Quality Scales, respectively. When the videos included at least one correct or inaccurate scientific statement about the effect of vitamin C on the common cold, they were classified as accurate or misleading videos, respectively; those without any pertinent information were considered neither accurate nor misleading. If a video contained both accurate and inaccurate statements, it was classified as misleading. @*Results@#Of the 30 most-viewed videos, 73% were unreliable, and 67% contained misleading information and were of a poor quality. Of these 30 videos, 14 videos were produced and posted by customers who were not specialized in medicine or nutrition. Moreover, these videos were of significantly lower reliability, quality, and accuracy than those produced by nutrition or fitness channels or by medical or nutrition professionals. @*Conclusion@#The reliability, quality, and accuracy of videos uploaded by non-professionals were low. Therefore, video creators should upload reliable, high-quality videos to ensure the dissemination of accurate medical information.
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Background@#Videofluoroscopic swallowing study (VFSS) is currently considered the gold standard to precisely diagnose and quantitatively investigate dysphagia. However, VFSS interpretation is complex and requires consideration of several factors. Therefore, considering the expected impact on dysphagia management, this study aimed to apply deep learning to detect the presence of penetration or aspiration in VFSS of patients with dysphagia automatically. @*Methods@#The VFSS data of 190 participants with dysphagia were collected. A total of 10 frame images from one swallowing process were selected (five high-peak images and five low-peak images) for the application of deep learning in a VFSS video of a patient with dysphagia. We applied a convolutional neural network (CNN) for deep learning using the Python programming language. For the classification of VFSS findings (normal swallowing, penetration, and aspiration), the classification was determined in both high-peak and lowpeak images. Thereafter, the two classifications determined through high-peak and low-peak images were integrated into a final classification. @*Results@#The area under the curve (AUC) for the validation dataset of the VFSS image for the CNN model was 0.942 for normal findings, 0.878 for penetration, and 1.000 for aspiration. The macro average AUC was 0.940 and micro average AUC was 0.961. @*Conclusion@#This study demonstrated that deep learning algorithms, particularly the CNN, could be applied for detecting the presence of penetration and aspiration in VFSS of patients with dysphagia.
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In actual clinical practice, injuries of the lower extremities are frequently encountered. Some diseases are diagnosed through a physical examination, but when non-specific symptoms are complained, it may be difficult to diagnose only with a physical examination. Therefore, the ultrasound examination can be used as an appropriate diagnostic tool by using the inherent advantages of the device. This review article aims to describe in detail the main features of ultrasound imaging for common injuries of the distal lower extremity, ankle, and foot.
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Objective@#The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. @*Conclusion@#This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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Objective@#The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. @*Conclusion@#This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.
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Background@#and Purpose: The Spinal and Bulbar Muscular Atrophy Functional Rating Scale (SBMAFRS) is a reliable and valid instrument for evaluating the functional status of patients with spinal and bulbar muscular atrophy (SBMA). This study aimed to validate a Korean version of the SBMAFRS in an SBMA population. @*Methods@#We applied the SBMAFRS to 64 SBMA patients at their regular follow-up clinical visits. The patients underwent clinical evaluations that included the 6-minute walking test (6MWT), forced vital capacity (FVC), manual muscle test, and the Penetration-Aspiration Scale (PAS). To estimate the stability of the SBMAFRS, the scale was reapplied to a subset of 31 randomly selected patients within 4 weeks of the initial test. The convergent validity was evaluated, and correlations were examined between SBMAFRS items and the muscular force, the total and subscores on the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), FVC, PAS score, age at onset, disease duration, and 6MWT results. @*Results@#The internal consistency of the scale was confirmed by a high Cronbach’s alpha (total raw alpha=0.867, total standardized alpha=0.863). The test-retest reliability as assessed by Spearman’s rho was also high. The total score and subscores of the SBMAFRS were strongly correlated with the respective items and subscores of the ALSFRS-R, respiratory function, and the 6MWT. @*Conclusions@#We have performed a validation study of the Korean version of a disease-specific functional rating scale for SBMA patients. The SBMAFRS is a useful tool for clinical practice and as a potential outcome measure for Korean SBMA patients.
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Background@#Coronavirus disease 2019 (COVID-19) has become a global pandemic, which prompts a consensus for the necessity to seek risk factors for this critical disease. Risk factors affecting mortality of the disease remain elusive. Diabetes and hyperglycemia are known to negatively affect a host’s antiviral immunity. We evaluated the relationship between a history of diabetes, fasting plasma glucose (FPG) levels and mortality among severely ill patients with COVID-19. @*Methods@#This was a retrospective cohort study that assessed 106 adult inpatients (aged ≥18 years) from two tertiary hospitals in Daegu, South Korea. The participants were transferred to tertiary hospitals because their medical condition required immediate intensive care. The demographic and laboratory data were compared between COVID-19 patients who survived and those who did not. @*Results@#Compared with the survivor group, age, and the proportions of diabetes, chronic lung disease and FPG were significantly higher in the deceased group. In the Cox proportional hazards regression model for survival analysis, FPG level and age were identified as significant predictors of mortality (P68 years and FPG of 168 mg/dL, respectively. Among those without diabetes, high FPG remained a significant predictor of mortality (P<0.04). @*Conclusion@#High FPG levels significantly predicted mortality in COVID-19, regardless of a known history of diabetes. These results suggest intensive monitoring should be provided to COVID-19 patients who have a high FPG level.
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Isolated respiratory onset amyotrophic lateral sclerosis (ALS) is a rare clinical manifestation and the diagnosis can be challenging. A 72-year-old man presented with dyspnea and hypercapnia that had started 11 months earlier. A phrenic nerve study was conducted and he was diagnosed promptly with ALS with no significant time delay. The phrenic nerve study is a noninvasive and useful tool in the diagnosis of respiratory onset ALS that can be applied easily in an emergency department.
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Anciano , Humanos , Esclerosis Amiotrófica Lateral , Diagnóstico , Disnea , Diagnóstico Precoz , Servicio de Urgencia en Hospital , Fasciculación , Hipercapnia , Nervio FrénicoRESUMEN
OBJECTIVE: To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions. METHODS: The medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed. RESULTS: Eleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625–0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689–0.953; p < 0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%). CONCLUSION: In patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.
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Humanos , Encéfalo , Cognición , Deglución , Trastornos de Deglución , Métodos de Alimentación , Incidencia , Modelos Logísticos , Registros Médicos , Métodos , Neumonía por Aspiración , Estudios Retrospectivos , Curva ROC , Sensibilidad y Especificidad , SialorreaRESUMEN
OBJECTIVE: To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions. METHODS: The medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed. RESULTS: Eleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625–0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689–0.953; p < 0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%). CONCLUSION: In patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.
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Humanos , Encéfalo , Cognición , Deglución , Trastornos de Deglución , Métodos de Alimentación , Incidencia , Modelos Logísticos , Registros Médicos , Métodos , Neumonía por Aspiración , Estudios Retrospectivos , Curva ROC , Sensibilidad y Especificidad , SialorreaRESUMEN
Neurogenic bladder is common in most spinal cord injury patients. Voiding cystourethrography (VCUG) is recommended in these patients to detect urinary tract complications. However, rare but serious complications may occur during VCUG, although VCUG is generally safe. There are several case reports of bladder rupture occurring in pediatric patients. Here, we report the first case of iatrogenic bladder rupture in an adult spinal cord injury patient in Korea. Particularly, extravasation of contrast without manual instillation has hardly ever been reported. To the best of our knowledge, this is the first reported case of bladder rupture without manual instillation during VCUG. We report a case of a 59-year-old female with paraplegia due to tuberculous spondylitis who underwent VCUG as a part of routine evaluation of neurogenic bladder. Extravasation of the contrast media during VCUG developed as a complication and the patient recovered spontaneously without any intervention. Therefore, VCUG should be performed properly in chronic spinal cord injury patients.
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Adulto , Femenino , Humanos , Persona de Mediana Edad , Medios de Contraste , Corea (Geográfico) , Paraplejía , Rotura , Traumatismos de la Médula Espinal , Médula Espinal , Espondilitis , Vejiga Urinaria , Vejiga Urinaria Neurogénica , Sistema UrinarioRESUMEN
OBJECTIVE: To evaluate the prevalence of vulnerable blood vessels around cervical nerve roots before cervical nerve root block in the clinical setting. METHODS: This retrospective study included 74 patients with cervical radiculopathy who received an ultrasonography-guided nerve block at an outpatient clinic from July 2012 to July 2014. Before actual injection of the steroid was performed, we evaluated the vulnerable blood vessels around each C5, C6, and C7 nerve root of each patient's painful side, with Doppler ultrasound. RESULTS: Out of 74 cases, the C5 level had 2 blood vessels (2.7%), the C6 level had 4 blood vessels (5.45%), and the C7 level had 6 blood vessels (8.11%) close to each targeted nerve root. Moreover, the C5 level had 2 blood vessels (2.7%), the C6 level 5 blood vessels (6.75%), and the C7 level had 4 blood vessels (5.45%) at the site of an imaginary needle's projected pathway to the targeted nerve root, as revealed by axial transverse ultrasound imaging with color Doppler imaging. In total, the C5 level had 4 blood vessels (5.45%), the C6 level 9 blood vessels (12.16%), and the C7 level 10 had blood vessels (13.51%) either at the targeted nerve root or at the site of the imaginary needle's projected pathway to the targeted nerve root. There was an unneglectable prevalence of vulnerable blood vessels either at the targeted nerve root or at the site of the needle' projected pathway to the nerve root. Also, it shows a higher prevalence of vulnerable blood vessels either at the targeted nerve root or at the site of an imaginary needle's projected pathway to the nerve root as the spinal nerve root level gets lower. CONCLUSION: To prevent unexpected critical complications involving vulnerable blood vessel injury during cervical nerve root block, it is recommended to routinely evaluate for the presence of vulnerable blood vessels around each cervical nerve root using Doppler ultrasound imaging before the cervical nerve root block, especially for the lower cervical nerve root level.
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Humanos , Instituciones de Atención Ambulatoria , Vasos Sanguíneos , Inyecciones Epidurales , Desplazamiento del Disco Intervertebral , Bloqueo Nervioso , Prevalencia , Radiculopatía , Estudios Retrospectivos , Raíces Nerviosas Espinales , Ultrasonografía , Ultrasonografía DopplerRESUMEN
OBJECTIVE: To investigate the predictive value of enhanced-magnetic resonance imaging (MRI) and fluoroscopic factors regarding the effects of transforaminal epidural steroid injections (TFESIs) in low back pain (LBP) patients with lumbosacral radiating pain. METHODS: A total of 51 patients who had LBP with radiating pain were recruited between January 2011 and December 2012. The patient data were classified into the two groups ‘favorable group’ and ‘non-favorable group’ after 2 weeks of follow-up results. The favorable group was defined as those with a 50%, or more, reduction of pain severity according to the visual analogue scale (VAS) for back or leg pain. The clinical and radiological data were collected for univariate and multivariate analyses to determine the predictors of the effectiveness of TFESIs between the two groups. RESULTS: According to the back or the leg favorable-VAS group, the univariate analysis revealed that the corticosteroid approach for the enhanced nerve root, the proportion of the proximal flow, and the contrast dispersion of epidurography are respectively statistically significant relative to the other factors. Lastly, the multiple logistic regression analysis showed a significant association between the corticosteroid approach and the enhanced nerve root in the favorable VAS group. CONCLUSION: Among the variables, MRI showed that the corticosteroid approach for the enhanced target root is the most important prognostic factor in the predicting of the clinical parameters of the favorable TFESIs group.
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Humanos , Estudios de Seguimiento , Inyecciones Epidurales , Desplazamiento del Disco Intervertebral , Pierna , Modelos Logísticos , Dolor de la Región Lumbar , Imagen por Resonancia Magnética , Análisis MultivarianteRESUMEN
BACKGROUND/AIMS: The purpose of this study was to develop new parameters of high-resolution manometry (HRM) and to applicate these to quantify the effect of bolus volume and texture on pharyngeal swallowing. METHODS: Ten healthy subjects prospectively swallowed dry, thin fluid 2 mL, thin fluid 5 mL, thin fluid 10 mL, and drinking twice to compare effects of bolus volume. To compare effect of texture, subjects swallowed thin fluid 5 mL, yogurt 5 mL, and bread twice. A 32-sensor HRM catheter and BioVIEW ANALYSIS software were used for data collection and analysis. HRM data were synchronized with kinematic analysis of videofluoroscopic swallowing study (VFSS) using epiglottis tilting. RESULTS: Linear correlation analysis for volume showed significant correlation for area of velopharynx, duration of velopharynx, pre-upper esophageal sphincter (UES) maximal pressure, minimal UES pressure, UES activity time, and nadir UES duration. In the correlation with texture, all parameters were not significantly different. The contraction of the velopharynx was faster than laryngeal elevation. The durations of UES relaxation was shorter in the kinematic analysis than HRM. CONCLUSIONS: The bolus volume was shown to have significant effect on pharyngeal pressure and timing, but the texture did not show any effect on pharyngeal swallowing. The parameters of HRM were more sensitive than those of kinematic analysis. As the parameters of HRM are based on precise anatomic structure and the kinematic analysis reflects the actions of multiple anatomic structures, HRM and VFSS should be used according to their purposes.
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Pan , Catéteres , Recolección de Datos , Trastornos de Deglución , Deglución , Ingestión de Líquidos , Epiglotis , Manometría , Estudios Prospectivos , Relajación , YogurRESUMEN
Neuromuscular electrical stimulation (NMES) has been increasingly used on dysphagic patients with the aim of improving their swallowing ability. However, there were insufficient clinical and basic knowledge of NMES in regard to the selection of stimulation parameters, which optimize improvement in swallowing-related muscular function. This review summarizes the results of clinical and basic researches in terms of acute and chronic physiologic effects of different stimulation protocols, explains the role of the various parameters of stimulation in determining the effect of NMES training protocols, and gives clinical recommendations for the selection of stimulation parameters. We speculate that this topic is important for medical doctors and therapists who want to investigate and practice NMES.
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Humanos , Trastornos de Deglución , Deglución , Estimulación EléctricaRESUMEN
The pharyngeal phase of swallowing is a complex event consisted with subsequent muscular contractions and pressure generation to move a bolus from the mouth to the esophagus. Recently, high-resolution impedance manometry (HRIM) was developed and used for the evaluation of pharyngeal dysphagia. Although HRIM provides precise pharyngeal pressure information, it has yet to be used as part of routine clinical practice for the assessment of dysphagia. The main reasons are thought to be that the test method and result interpretation are not easily applicable and standardized. The anatomical landmarks for HRIM parameters are velopharynx, tongue base, epiglottis, low pharynx, and upper esophageal sphincter. With HRIM, the pressure and timing data could be obtained at a precise anatomical structure. In the present review, we will review how to apply HRIM for the evaluation of pharyngeal dysphagia, including the interpretation of its parameters.