The Effects of Agent Orange in Patient with Pneumonia

Purpose@#Agent Orange (AO) is a herbicide and defoliant used by the United States and its military allies during the Vietnam War. Pneumonia is a common cause of death among Vietnam veterans in our hospital. There have been no previous studies researching any association between AO exposure and the prognosis for pneumonia. The primary objective of this study was to investigate associations between AO exposure and 30-day mortality due to pneumonia. The secondary objective was to examine the clinical factors associated with therapeutic outcomes in veterans with pneumonia, and to assess the prevalence of combined diseases in AO-exposed veterans. @*Methods@#This study retrospectively included veteran patients diagnosed with pneumonia in the emergency department and hospitalized between February 2014 and March 2018. The enrolled patients were grouped according to their defoliant exposure history, and the clinical information of defoliant-exposed and non-defoliant-exposed groups were compared. Patients were divided according to 30-day mortality, and significant factors influencing mortality were evaluated by using univariate analysis and multivariate analysis. The final multivariate model revealed the effect of AO exposure on therapeutic outcomes of pneumonia. @*Results@#A total of 1006 patients were analyzed. Of these, 276 patients had a history of AO exposure, whereas 730 patients had not been exposed. Factors positively associated with 30-day mortality were malignancy, respiratory rate, blood urea nitrogen, and albumin which was negatively associated with mortality. @*Conclusion@#Exposure to defoliant is not associated with 30-day mortality in patients with pneumonia. However, veterans with defoliant exposure are associated with a high prevalence of diabetes mellitus, hypertension, cerebrovascular accident, malignancy, and chronic kidney disease.

Time Interval from Intubation to Return of Spontaneous Circulation in Out-of-hospital Cardiac Arrest Patient with Brain Hemorrhage

PURPOSE: This study was conducted to investigate the relationship of time interval from intubation to return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients according to the presence or absence of intracranial hemorrhage (ICH). METHODS: This retrospective study used data from a prospectively collected OHCA registry for patients treated from January 2008 to December 2016. Non-traumatic adult OHCA patients who underwent brain computed tomography were included, while patients who achieved a prehospital ROSC or required advanced airway management were excluded. Utstein variables, initial blood gas analysis, electrolyte levels, and the time interval from intubation to ROSC were used to compare the ICH and non-ICH groups. RESULTS: A total of 448 patients were analyzed. The ICH group was younger and had more females than the non-ICH group. The time interval from intubation to ROSC was significantly shorter in the ICH group than the non-ICH group. The median time and interquartile range were 3 (2 to 7) minutes in the ICH group and 6 (3 to 10) minutes in the non-ICH group. The patient age, gender, potassium level, and time interval from intubation to ROSC were significant variables in the multivariable analysis. In a multivariable logistic regression model that included these variables, the area under the receiver operating characteristic curve was 0.838. CONCLUSION: OHCA patients with ICH achieve ROSC after intubation in a shorter amount of time than those without ICH.

Clinical Insights for Early Screening of Pulmonary Tuberculosis in Homeless Patients Who Visited Emergency Department

PURPOSE: In 2014, Korea ranked as the first among the Organization for Economic Cooperation and Development countries on the prevalence, incidence, and mortality of pulmonary tuberculosis (TB). The prevalence of TB among the homeless was 6.4% in the United State and 7.1% in South Korea. The aim of this study is to develop predicting indicators of TB by analyzing homeless people who visit the public hospital emergency department (ED). METHODS: We analyzed 7,500 homeless individuals who visited a public hospital ED between January 1, 2001 and May 31, 2014. A total of 4,552 patients were included, and of these, 145 homeless patients were infected with TB. We conducted univariate and multivariate analysis of clinical variables obtained from the initial check list and later lab analysis, and made a scoring system by weighing each variable. Then applying this scoring system, the area under the receiver (AUC) operating characteristic curve (ROC) was calculated. RESULTS: The prevalence of TB was 3.2%. The initial meaningful predictor variables were as follows: Being homeless, abnormal heart rate, abnormal respiratory rate, no alcohol intake, hypoalbuminemia, and CRP elevation. The AUC of ROC curve from these predictor variables were 0.815. CONCLUSION: We developed a novel scoring system to screen TB patients in a vulnerable social group who visit the ED. We can detect potential TB patients early and effectively control TB, preventing the spread of TB. Prospective internal and external validation is necessary by using the scoring system of TB among the homeless.