Appropriateness of rabies post-exposure prophylaxis in pediatric patients visiting the emergency department due to animal bite

Purpose@#To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). @*Methods@#The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’ electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. @*Results@#Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. @*Conclusion@#In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources.

Is Atropine Necessary for Cardiopulmonary Resuscitation?

PURPOSE: According to the 2010 guidelines for cardiopulmonary resuscitation (CPR) of the American Heart association, administration of atropine for non-shockable rhythm is no longer recommended, however, there are insufficient data in humans. This study was conducted to evaluate the results of CPR, whether the combined administration of atropine and epinephrine (Atropine combined group, AG) compared with epinephrine only injection (epinephrine only group, EG) for patients with non-shockable rhythm. METHODS: A total of 449 patients who underwent CPR in the emergency department from 2009 to 2012 were included. Retrospective analysis was performed according to atropine administration during CPR. We investigated Return of Spontaneous Circulation (ROSC), sustained ROSC, 30-day survival, and 30-day neurological outcome using Utstein templates. RESULTS: There were 178 (48.9%) patients in the AG. There were no significant differences in the baseline characteristics. The two groups had similar rates of ROSC, sustained ROSC, and 30-day survival. However, AG had a significantly poor neurological outcome compared to EG, with an adjusted odds ratio of 0.074 (95% CI 0.012-0.452, p=0.005). CONCLUSION: The combination therapy of atropine and epinephrine during CPR showed poor neurological outcome compared with epinephrine alone. Atropine is not useful for adults with non-shockable rhythm in terms of 30-day neurological outcome.

Characteristics of Geriatric Trauma Patients Transferred from Long-term Care Hospitals: A Propensity Score Matched Analysis

PURPOSE: Transfer from long-term care (LTC) hospitals to the emergency department (ED) of larger hospitals has increased due to limited capability for management of patients needing special diagnostic tools or emergency treatment in the LTC hospital. We investigated the characteristics of geriatric trauma patients transferred from LTC hospitals to the ED. METHODS: A retrospective analysis included data on geriatric trauma patients (age> or =65) who visited two EDs in Korea. All data of patients transferred from the LTC hospital were compared with those of patients who visited the ED from home. Patients visiting from home were selected according to age, sex, and main diagnosis, using the statistical matching method. RESULTS: A total of 44 patients were transferred, and 132 patients were selected after matching. No differences in mechanism of injury, injury severity score (ISS), outcomes, transfusion, length of hospital stay, or mortality were observed between the two groups. The odds ratios (OR) of transferred patients for stroke and dementia were 5.027 (95% confidence interval (CI) 1.292-16.915) and 13.941 (95% CI: 5.112-38.015), respectively. In addition, the OR of transferred patients for dependent activities of daily living was 8.165 (95% CI: 2.886-23.104). Thirty five transferred patients (79.5%) had been injured in the LTC hospital (p<0.001). CONCLUSION: The transferred patients had more stroke, dementia, and dependent activities, but showed no significant difference in severity or prognosis. Most transferred patients had been injured in the hospital. Greater attention to hospitalized patients and system development are required in order to prevent injuries in the LTC hospital.

Clinical Significance of National Patients Sample Analysis: Factors Affecting Mortality and Length of Stay of Organophosphate and Carbamate Poisoned Patients / 대한의료정보학회지

OBJECTIVES: This study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Services (HIRA). The utility and representativeness of the HIRA data as the source of prognosis analysis in poisoned patients were also evaluated. METHODS: Organophosphate and carbamate poisoned patients' mortality and length of stay were analyzed in relation to the initial and final treating hospitals and departments, as well as the presence of inter-hospital transfers. RESULTS: Among a total of 146 cases, there were 17 mortality cases, and the mean age was 56.8 +/- 19.2 years. The median length of stay was 6 days. There was no inter-hospital or inter-departmental difference in length of stay. However, it significantly increased when inter-hospital transfer occurred (transferred 11 days vs. non-transferred 6 days; p = 0.037). Overall mortality rate was 11.6%. The mortality rate significantly increased when inter-hospital transfer occurred (transferred 23.5% vs. non-transferred 7.0%; p = 0.047), but there was no statistical difference in mortality on inter-hospital and inter-department comparison at the initial treating facility. However, at the final treating facility, there was a significant difference between tertiary and general hospitals (5.1% for tertiary hospitals and 17.3% for general hospitals; p = 0.024), although there was no significant inter-departmental difference. CONCLUSIONS: We demonstrated that hospital, clinical department, length of stay, and mortality could be analyzed using insurance claim data of a specific disease group. Our results also indicated that length of stay and mortality according to inter-hospital transfer could be analyzed, which was previously unknown.

Criminal Responsibility in Emergency Care

PURPOSE: When a criminal act occurs during emergency care, it becomes fatal to both the patient and doctor. Criminal acts during emergency care and judged by the Supreme Court of Korea were analyzed and investigated to decrease and prevent medical malpractice. METHODS: After assessing the Medical Act in Korea and Act on Emergency Care in Korea, a pattern of emergency care was categorized and applicable provisions were analyzed. Emergency medical malpractice cases were collected from previous reports and an internet site managed by the Supreme Court of Korea (http://glaw.scourt.go.kr). RESULTS: The patterns of emergency care can be categorized into "general emergency care", "interhospital patient transfer", and the "request for medical treatment sent to another department or hospital". Furthermore, inerthospiatl patient transfer can be categorized into "after request for emergency care" and "after medical treatment." There were ten medical malpractice cases in emergency care in which criminal responsibility occurred. There were six cases related to general emergency care and four related to interhospital patient transfer. CONCLUSION: Though the emergency care cases in which criminal responsibility occurred were few, the results critically impacted the patient and doctor. Therefore, emergency physicians must do their best to decrease and prevent medical negligence. In addition, a nation has a primary responsibility to save lives and must support emergency care.

Criminal Responsibility in Emergency Care

PURPOSE: When a criminal act occurs during emergency care, it becomes fatal to both the patient and doctor. Criminal acts during emergency care and judged by the Supreme Court of Korea were analyzed and investigated to decrease and prevent medical malpractice. METHODS: After assessing the Medical Act in Korea and Act on Emergency Care in Korea, a pattern of emergency care was categorized and applicable provisions were analyzed. Emergency medical malpractice cases were collected from previous reports and an internet site managed by the Supreme Court of Korea (http://glaw.scourt.go.kr). RESULTS: The patterns of emergency care can be categorized into "general emergency care", "interhospital patient transfer", and the "request for medical treatment sent to another department or hospital". Furthermore, inerthospiatl patient transfer can be categorized into "after request for emergency care" and "after medical treatment." There were ten medical malpractice cases in emergency care in which criminal responsibility occurred. There were six cases related to general emergency care and four related to interhospital patient transfer. CONCLUSION: Though the emergency care cases in which criminal responsibility occurred were few, the results critically impacted the patient and doctor. Therefore, emergency physicians must do their best to decrease and prevent medical negligence. In addition, a nation has a primary responsibility to save lives and must support emergency care.

Usefulness of the Pediatric Risk of Mortality Score III as a Predictor of Severity or Mortality for Injured Children

PURPOSE: The primary prevention and proper initial treatment of childhood injuries is important, as it encompasses a bigger social and economic burden than cancer and ischemic heart disease. The Pediatric Risk of Mortality III (PRISM III) scoring system, used to evaluate the severity or mortality of pediatric patients in critical condition, was investigated for children with injuries in an emergency department (ED). METHODS: A retrospective analysis included data on 293 injured children (age<16) who visited the ED in two hospitals from March 2010 to February 2012. Physiologic and laboratory data were collected to calculate the PRISM III score and the Injury Severity Score (ISS). The correlation was analyzed between PRISM III scores, the Revised Trauma Scale (RTS), and ISS. The PRISM III score and ISS were assessed for their ability to predict mortality by comparing their receiver operating characteristic (ROC) curves. RESULTS: The median PRISM III score was 5.0 (Interquartile Range, 5.0-9.0) and correlated with RTS and ISS (the Spearman's rho were -0.19 (p=0.001) and 0.20 (p=0.001), respectively. Five children did not survive after ED admission. The area under the ROC (AUC) was 1.00 for PRISM III (95% confidence interval [CI], 0.99-1.00), and the cutoff value was placed over 20 to predict mortality. The AUC of ISS and RTS was 0.99 (95% CI, 0.98-1.00) and 0.99 (95% CI, 0.98-1.00), respectively. CONCLUSION: The PRISM III score excellently predicts the mortality of injured children in the ED, and can be used to sort minor pediatric trauma patients in the ED. However, the PRISM III score had no great difference or advantage compared with RTS. The development of other tools for effective prognosis is needed to efficiently predict mortality and severity in the ED.

Bacillus sp. BS061 Suppresses Powdery Mildew and Gray Mold

The use of a microorganism, or its secretions, to prevent plant disease offers an attractive alternative or supplement to synthetic fungicides for the management of plant disease without the negative effects of chemical control mechanisms. During a screening for microorganisms with the potential to be used as microbial fungicides, Bacillus sp. BS061 was isolated from a plant leaf. The strain BS061 potently inhibited the mycelial growth of Botrytis cinerea, and significantly reduced disease incidence of powdery mildew in cucumber and strawberry. We also found that the culture filtrate of BS061 inhibited the mycelial growth of various plant pathogens.

Bacillus sp. BS061 Suppresses Gray Mold and Powdery Mildew through the Secretion of Different Bioactive Substances

A Bacillus sp. BS061 significantly reduced disease incidence of gray mold and powdery mildew. To identify the active principle, the culture filtrate was partitioned between butanol and water. The antifungal activity against B. cinerea was evident in the butanol-soluble portion, and active substances were identified as cyclic lipopeptides, iturin A series, by nuclear magnetic resonance spectrometry (NMR) and mass analysis. Interestingly, antifungal activity against powdery mildew was observed in the water-soluble portion, suggesting that cyclic lipopeptides have no responsibility to suppress powdery mildew. This finding reveals that biocontrol agents of Bacillus origin suppress gray mold and powdery mildew through the secretion of different bioactive substances.

Fomitoside K, a New Lanostane Triterpene Glycoside from the Fruiting Body of Fomitopsis nigra

In an effort to identify the chemical constituents of fruiting bodies of Fomitopsis pinicola, a new lanostane triterpene glycoside, designated as fomitoside K, has been isolated from its methanolic extract. Its chemical structure was assigned on the basis of various spectroscopic studies.

Liver Transplantation for Acute Toxic Hepatitis due to Herbal Medicines and Preparations

PURPOSE: Acute toxic hepatitis is a common cause of acute liver failure (ALF). We investigated the causes, clinical manifestation, and outcomes of ALF patients who underwent liver transplantation due to acute toxic hepatitis caused by herbal medicines and preparations. METHODS: Between January 1992 and May 2008, we retrospectively reviewed the medical records of 24 patients who were transplanted due to acute toxic hepatitis caused by herbal medicines and preparations. We applied the RUCAM score to patients with acute toxic hepatitis and assessed the relationship between herbal preparations and liver injury. We studied the patients' medication history, liver function tests, and clinical outcomes. RESULTS: The type of liver injury was divided into three groups: hepatocellular type, 14 patients (58.3%); cholestatic type, 4 patients (16.7%); and mixed type, 6 patients (25%). Polygonum multiflorum Thunberg (3 cases) was the most common cause of acute toxic hepatitis, followed by Acanthopanax senticosus (2 cases), pumpkin juice (2 cases), Dictamnus dasycarpus Turcz (2 cases), Hovenia dulcis (1 case), Phellinus linteus (1 case), and Artemisia capillaries (1 case). One year survival after liver transplantation was 76%. CONCLUSION: We identified the herbal preparations leading to acute liver failure. Many patients consider herbal remedies to be completely free of unwanted side effects. However, we found that many herbal products have biological activities that can lead to severe hepatotoxicity.

Diagnosis of Acute Ischemic Stroke using Blood Biologic Markers in the Emergency Department

PURPOSE: In patients with acute neurological symptoms, brain computed tomography (CT) is usually used to exclude hemorrhagic stroke. After CT imaging, there is no rapid, effective biologic marker for differentiating between acute cerebral ischemia and other etiologies, precluding rapid triage for further evaluation. We evaluated the diagnostic value of a panel of biochemical markers. METHODS: We performed the Triage Stroke Panel (Biosite Inc., UK) test using blood samples of patients who were admitted to the emergency department with suspected acute stroke between December, 2007, and March, 2008. The TSP is represented as MMX (multimarker index) compiles from individual biomarker values, based on quantitative measurement of B-type natriuretic peptide (BNP), fibrin degradation products containing D-dimer, matrix metalloproteinase-9 (MMP-9), and S100. All patients were prospectively evaluated with imaging and laboratory tests for final diagnosis. RESULTS: Of 105 patients, 51.4% had ischemic stroke and 48.6% had non-ischemic, non-organic abnormalities, primarily peripheral vertigo. High levels of BNP and MMX were observed in patients with ischemic stroke (both p 54.7 pg/mL, OR=99.4 [8.5-1,171.0]). A model combining BNP and MMX had 92% specificity and a 91% positive predictive ratio for prediction of acute ischemic stroke. CONCLUSION: Using biomarkers may improve the differential diagnosis of ischemic stroke after initial brain CT imaging for hemorrhagic stroke, rapidly guiding further evaluation and treatment initiation in the emergency department.

The development and application of active RFID entrance management system for emergency patient safety / 대한의료정보학회지

OBJECTIVE: Unauthorized exit of emergency patients could cause serious safety problems in the emergency room. If the entry and exit of emergency patients can be monitored by RFID (Radio Frequency Identification) technology, such safety issues may be resolved. METHOD: We determined the fundamental requirements of the system for emergency patient safety, and chose an active RFID tag to conduct the recognition test. Subsequently, we performed the entrance recognition rate test and safety test using pacemakers. After developing the entrance management programs, we implemented the system in the emergency room and collected data for 6 months. RESULT: The overall success rate of the entrance recognition test was 99.5%, and during the safety test, pacemaker oversensing due to noise did not occur. We intended to fulfill the fundamental requirements in developing entrance management programs. A total of 508 patients were given RFID tags for the study period, and the recognition failure rate was 4.7%. "Alert" pop-ups occurred 62 times. CONCLUSION: An active RFID entrance management system would be very useful for safety management in emergency room because the system enables detection of the unauthorized exit of emergency patients in real. time.