Association between measurement time of fractional excretion rate of sodium and mid-long term clinical prognosis in acute kidney injury patients

Objective@#Rapid identification of the cause for acute kidney injury (AKI) is very crucial. Among the diagnostic indicators of AKI, the fractional excretion rate of sodium (FENa) is clinically considered the most useful indicator. Numerous studies have reported that rapid identification and treatment of AKI improves the short-term clinical prognosis of AKI patients. However, insufficient studies have reported on the benefits of early assessment of FENa to help improve the mid-long term clinical prognosis of AKI patients. @*Methods@#We analyzed the timing of FENa in AKI patients who were admitted through our hospital emergency department, over a period of 3 years. The experimental groups are divided into the early group, measuring FENa within 3 hours after arrival in the emergency room, and the late group, measuring FENa later than 3 hours after arrival in the emergency room. The prognostic outcomes determined are major adverse kidney events (MAKE), including new dialysis, deterioration of kidney function to chronic kidney disease (CKD), and death, as well as MAKE and AKI recurrence (MAKER). @*Results@#Significant differences were obtained between the early group and late group in time taken to start fluid resuscitation (P=0.001), intermittent hemodialysis (P=0.005), and continuous renal replacement therapy (P=0.016), as well as in the mid-long term clinical prognosis of new dialysis (P=0.018) and deterioration of kidney function to CKD (P=0.004). Differences between early group and late group in MAKE (P<0.001) and MAKER (P<0.001) were also statistically significant. In the mid-long term clinical prognosis of death (P=0.706) and AKI recurrence (P=0.466), no significant differences were obtained between the two groups. @*Conclusion@#Early measurement of FENa (within 3 hours) for AKI patients visiting the emergency room showed better mid-long term clinical prognosis than patients with delayed FENa measurement.

Association between measurement time of fractional excretion rate of sodium and mid-long term clinical prognosis in acute kidney injury patients

Objective@#Rapid identification of the cause for acute kidney injury (AKI) is very crucial. Among the diagnostic indicators of AKI, the fractional excretion rate of sodium (FENa) is clinically considered the most useful indicator. Numerous studies have reported that rapid identification and treatment of AKI improves the short-term clinical prognosis of AKI patients. However, insufficient studies have reported on the benefits of early assessment of FENa to help improve the mid-long term clinical prognosis of AKI patients. @*Methods@#We analyzed the timing of FENa in AKI patients who were admitted through our hospital emergency department, over a period of 3 years. The experimental groups are divided into the early group, measuring FENa within 3 hours after arrival in the emergency room, and the late group, measuring FENa later than 3 hours after arrival in the emergency room. The prognostic outcomes determined are major adverse kidney events (MAKE), including new dialysis, deterioration of kidney function to chronic kidney disease (CKD), and death, as well as MAKE and AKI recurrence (MAKER). @*Results@#Significant differences were obtained between the early group and late group in time taken to start fluid resuscitation (P=0.001), intermittent hemodialysis (P=0.005), and continuous renal replacement therapy (P=0.016), as well as in the mid-long term clinical prognosis of new dialysis (P=0.018) and deterioration of kidney function to CKD (P=0.004). Differences between early group and late group in MAKE (P<0.001) and MAKER (P<0.001) were also statistically significant. In the mid-long term clinical prognosis of death (P=0.706) and AKI recurrence (P=0.466), no significant differences were obtained between the two groups. @*Conclusion@#Early measurement of FENa (within 3 hours) for AKI patients visiting the emergency room showed better mid-long term clinical prognosis than patients with delayed FENa measurement.

Comparison of outcomes according to urine chemistry testing time for the causes of acute kidney injury patients admitted to the emergency room

Objective@#The rapid identification and treatment of an acute kidney injury (AKI) can help to restore the kidney function. To differentiate between pre-renal AKI and intrinsic AKI, a urine chemistry test was performed to determine the function of the renal tubules. On the other hand, there is no report showing that it is helpful to arrive at the hospital as early as possible and to perform these urine chemistry tests as soon as possible. @*Methods@#This study analyzed the timing of urinary chemistry tests in AKI patients who were admitted to the author’s hospital through the emergency departments (ED) in the last three years and divided into two groups. The early group was defined as patients who performed the test within three hours of arrival in the ED. The late group was defined as patients who were late or not. The prognostic factors were the change in 30-day estimated glomerular filtration rate (eGFR) and duration of hospital stay. @*Results@#The changes of eGFR after 30 days in each group were 41.6±27.57 mL/min/1.73 m2 (early group, n=92) vs. 30.39±26.37 mL/min/1.73 m2 (late group, n=180) (P=0.001). Early group patients were discharged more quickly than patients in the late group (hospital day, 11.49±10.14 vs. 13.84±10.53; P=0.041). @*Conclusion@#A urine chemistry test is a test to help determine the cause of AKI. Based on the results of urine chemistry performed within three hours after arrival at the hospital, patients with AKI who visited the emergency room had betterimproved kidney function and less hospitalization time than the patients who were late or untested at the time of treatment.

Comparison of outcomes according to urine chemistry testing time for the causes of acute kidney injury patients admitted to the emergency room

Objective@#The rapid identification and treatment of an acute kidney injury (AKI) can help to restore the kidney function. To differentiate between pre-renal AKI and intrinsic AKI, a urine chemistry test was performed to determine the function of the renal tubules. On the other hand, there is no report showing that it is helpful to arrive at the hospital as early as possible and to perform these urine chemistry tests as soon as possible. @*Methods@#This study analyzed the timing of urinary chemistry tests in AKI patients who were admitted to the author’s hospital through the emergency departments (ED) in the last three years and divided into two groups. The early group was defined as patients who performed the test within three hours of arrival in the ED. The late group was defined as patients who were late or not. The prognostic factors were the change in 30-day estimated glomerular filtration rate (eGFR) and duration of hospital stay. @*Results@#The changes of eGFR after 30 days in each group were 41.6±27.57 mL/min/1.73 m2 (early group, n=92) vs. 30.39±26.37 mL/min/1.73 m2 (late group, n=180) (P=0.001). Early group patients were discharged more quickly than patients in the late group (hospital day, 11.49±10.14 vs. 13.84±10.53; P=0.041). @*Conclusion@#A urine chemistry test is a test to help determine the cause of AKI. Based on the results of urine chemistry performed within three hours after arrival at the hospital, patients with AKI who visited the emergency room had betterimproved kidney function and less hospitalization time than the patients who were late or untested at the time of treatment.

The exposure level of environmental harmful substances related to the secondhand smoke in Korean non-smoker adults: data from the second Korean National Environmental Health Survey (KoNEHS 2012–2014): a cross-sectional study

BACKGROUND: We aimed to find the exposure level of environmental harmful substances related to the secondhand smoke (SHS) using a nationally representative data of the general population in Korea. METHODS: Total 3,533 people were included in this study. We compared the proportion exceeding 95 percentile of the concentrations of harmful substances by sex according to SHS exposure. 16 kinds of substances related to tobacco smoke were analyzed including heavy metals, polycyclic aromatic hydrocarbons, volatile organic compounds, and environmental phenol. For 16 kinds of substances, the odds ratios (ORs) for exceeding 95 percentile of each harmful substance were calculated by multiple logistic regression according to SHS exposure. Age, education level, marital status, body mass index, drinking, and exercise were adjusted as covariates. Cotinine level was additionally adjusted to increase reliability of our results. RESULTS: SHS was associated with high exposure of mercury, methylhippuric acid, fluorene, and cotinine. In women, SHS was associated with mercury, methylhippuric acid, fluorene, and cotinine, while in men, it was associated with cotinine. After adjusting covariates, ORs of blood mercury, methylhippuric acid and hydroxyfluorene in the exposed gruop were greater than that in the non-exposed group. Especially in female, methylhippuric acid and hydroxyfluorene showed consistent result. CONCLUSIONS: Our finding demonstrates that SHS is related to several harmful substances. Therefore, to reduce the health effects of SHS, it is necessary to educate and publicize the risk of SHS. Future studies are necessary to more accurately analyze factors such as exposure frequency, time, and pathway of SHS.

Association between sleep duration and impaired fasting glucose according to work type in non-regular workers: data from the first and second year (2016, 2017) of the 7th Korean National Health and Nutrition Examination (KNHANE) (a cross-sectional study)

Background@#We aimed to find the relationship between sleep duration and impaired fasting glucose according to working type in non-regular workers using the 2016 and 2017 Korean National Health And Nutrition Examination (KNHANE, 7th revision).Method: In the 1st and 2nd year (2016, 2017) of the 7th KNHANE, 16,277 people participated. Minors were excluded because this study was intended for individuals aged 19 years and older.As this study was based on wage workers, unemployment, self-employed workers, employers, unpaid family workers, and those who have insufficient answers such as unknown or no response were excluded. Regular workers were excluded because this study was intended for non-regular workers. Finally, a total of 2,168 people were included in the survey, except those who had been diagnosed with diabetes, had a fasting blood glucose level of 126 mg/dL or higher, or taking hypoglycemic agents or receiving insulin injections. To find the relationship between sleep duration and impaired fasting glucose according to work type in non-regular workers, multiple logistic regression analysis was performed by adjusting the general and occupational characteristics after stratification according to work type. All statistical analyses were performed using the SPSS software (version 26.0; SPSS Inc., Chicago, IL, USA). @*Results@#In the case of insufficient sleep duration in irregular female workers, the odds ratio (OR) of impaired fasting glucose was statistically insignificant, but in the case of insufficient sleep duration in irregular male workers who have shift work, the odds ratio (OR) of impaired fasting glucose was significantly higher than that of sufficient sleep duration (Model 1, OR: 3.05, 95% confidence interval [CI]: 1.18–7.90; Model 2, OR: 2.81, 95% CI: 1.08–7.29). @*Conclusions@#Our findings demonstrate that insufficient sleep duration was associated with an increase in fasting blood glucose levels in non-regular male workers working shifts. This means that non-regular workers are in desperate need for adequate sleep and health care. We hope that our study will help improve the health of non-regular workers and more systematic and prospective follow-up studies will be conducted to further improve the health of nonregular workers.

Association between sleep duration and impaired fasting glucose according to work type in non-regular workers: data from the first and second year (2016, 2017) of the 7th Korean National Health and Nutrition Examination (KNHANE) (a cross-sectional study)

Background@#We aimed to find the relationship between sleep duration and impaired fasting glucose according to working type in non-regular workers using the 2016 and 2017 Korean National Health And Nutrition Examination (KNHANE, 7th revision).Method: In the 1st and 2nd year (2016, 2017) of the 7th KNHANE, 16,277 people participated. Minors were excluded because this study was intended for individuals aged 19 years and older.As this study was based on wage workers, unemployment, self-employed workers, employers, unpaid family workers, and those who have insufficient answers such as unknown or no response were excluded. Regular workers were excluded because this study was intended for non-regular workers. Finally, a total of 2,168 people were included in the survey, except those who had been diagnosed with diabetes, had a fasting blood glucose level of 126 mg/dL or higher, or taking hypoglycemic agents or receiving insulin injections. To find the relationship between sleep duration and impaired fasting glucose according to work type in non-regular workers, multiple logistic regression analysis was performed by adjusting the general and occupational characteristics after stratification according to work type. All statistical analyses were performed using the SPSS software (version 26.0; SPSS Inc., Chicago, IL, USA). @*Results@#In the case of insufficient sleep duration in irregular female workers, the odds ratio (OR) of impaired fasting glucose was statistically insignificant, but in the case of insufficient sleep duration in irregular male workers who have shift work, the odds ratio (OR) of impaired fasting glucose was significantly higher than that of sufficient sleep duration (Model 1, OR: 3.05, 95% confidence interval [CI]: 1.18–7.90; Model 2, OR: 2.81, 95% CI: 1.08–7.29). @*Conclusions@#Our findings demonstrate that insufficient sleep duration was associated with an increase in fasting blood glucose levels in non-regular male workers working shifts. This means that non-regular workers are in desperate need for adequate sleep and health care. We hope that our study will help improve the health of non-regular workers and more systematic and prospective follow-up studies will be conducted to further improve the health of nonregular workers.

Emotional labor, workplace violence, and depressive symptoms in female Bank employees: a questionnaire survey using the K-ELS and K-WVS

BACKGROUND: In modern society, the scale of the service industry is continuously expanding, and the number of service workers is increasing. Correspondingly, physical and mental problems related to emotional labor are becoming a major social problem. In this study, we investigated the relationship between emotional labor, workplace violence, and depressive symptoms in female bank employees, which is a typical service industry. METHODS: In this study, the Korean Emotional Labor Scale (K-ELS) and Korean Workplace Violence Scale (K-WVS) were distributed to 381 female workers in their 20s at a bank in Seoul, Korea. Data were obtained from 289 subjects (75.9%) and analyzed for 278 respondents, after excluding those with missing responses. We examined the relationship between emotional labor, workplace violence, and depressive symptoms, using multiple logistic regression analysis. RESULTS: Among 278 subjects, 27 workers (9.7%) had depressive symptoms. “Emotional disharmony and hurt” (OR 2.93, 95% CI = 1.17–7.36) and “Organizational surveillance and monitoring” (OR 3.18, 95% CI = 1.29–7.86) showed a significant association with depressive symptoms. For workplace violence, the “Experience of psychological and sexual violence from supervisors and coworkers” (OR 4.07, 95% CI = 1.58–10.50) showed a significant association. When the number of high-risk emotional labor-related factors was 1 or more, 13.1% showed depressive symptoms. When the number of high-risk workplace violence-related factors was 1 or more, 14.4% had statistically significant depressive symptoms. CONCLUSIONS: A significant result was found for depressive symptoms related to Emotional disharmony, which is a sub-topic of emotional labor, and those at high risk for “Organizational surveillance and monitoring.” For workplace violence, depressive symptoms were high for the group at high risk for the “experience of psychological and sexual violence from supervisors and coworkers.” In this way, management of emotional disharmony, a sub-factor of emotional labor, is necessary, and improvements to traditional corporate culture that monitors emotional labor is necessary. Violence from colleagues and supervisors in the workplace must also be reduced. IRB Approval No. SCHUH 2017–01-029. Registered 26 January 2017. Retrospectively registered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40557-018-0229-9) contains supplementary material, which is available to authorized users.

The association between long working hours and work-related musculoskeletal symptoms of Korean wage workers: data from the fourth Korean working conditions survey (a cross-sectional study)

BACKGROUND: It has been reported that long working hours are hazardous to the workers’ health. Especially, work-related musculoskeletal disorders (WMSDs) have been considered as one of the significant health issues in workplace. The objective of this study was to identify the association between long working hours and work-related musculoskeletal symptoms. METHODS: The analysis was conducted using data from the Fourth Korean Working Conditions Survey (KWCS). Subjects of this study were 24,783 wage workers and divided into three groups according to the weekly working hours, which were ≤ 40, 41–52 and > 52 h. The relationship between long working hours and work-related musculoskeletal symptoms was analyzed by multivariate logistic regression method after adjusting for general, occupational characteristics including specific working motions or postures and psychosocial factors. RESULTS: Approximately 18.4% of subjects worked more than 52 h per week and 26.4 and 16.4% of male subjects and 33.0 and 23.4% of female subjects experienced work-related upper and lower limb pains, respectively, over the last 12 months. Moreover, the prevalence of upper and lower limb pain was increased in both genders as the weekly working hours increased. The odds ratios (ORs) of upper limb pain for those working 41–52 h and more than 52 h per week when adjusted for general, occupational characteristics including specific motions or postures and psychosocial factors were 1.36 and 1.40 for male workers and 1.26 and 1.66 for female workers compared to the reference group, respectively. Furthermore, ORs of lower limb pain for the same weekly working hour groups were 1.26 and 1.47 for male workers and 1.20 and 1.47 for female workers, respectively. CONCLUSIONS: Long working hours were significantly related to work-related musculoskeletal symptoms in Korean wage workers and appropriate interventions should be implemented to reduce long working hours that can negatively affect workers’ health.

Relationship of activities outside work to sleep and depression/anxiety disorders in Korean workers: the 4th Korean working condition survey

BACKGROUND: Sleep disorders and depression/anxiety disorders are long-standing and significant problem for mental health. Also there are already known so many negative health effect of these disorders. But there were few studies to examine the association between activities outside work and forementioned disorders. So this study aimed the association of those things by using the Republic of Korean data. METHODS: Data from 32,232 wage workers were used in the 4th Korean Working Condition Survey. General and occupational characteristics, sleep disorders, depression/anxiety disorders and activities outside work are included in questionnaire. To find the relationship between activities outside work and sleep, depression/anxiety disorders, multivariate logistic regression analysis was used after adjusting for general and occupational characteristics. RESULTS: We observed that volunteer activities increased the odds ratio of both sleep disorders and depression/anxiety disorders(Odds ratio[OR] = 1.35, 95% confidence interval[CI]: 1.03–1.78 and OR = 1.54, 95% CI: 1.29–1.84, respectively). And self-development activities increase the odds ratio of sleep disorders(OR = 1.35, 95% CI: 1.17–1.57). Gardening activities lowered the odds ratio of depression/anxiety disorders(OR = 0.74, 95% CI: 0.59–0.94). CONCLUSION: Some of activities outside work were related to sleep disorders and depression/anxiety disorders among Korean wage workers. Our results showed negative health effect of some kinds of activities outside work such as volunteering and self-devlopment compared to other studies that emphasized positive effect of those activities for health.

A case of pneumococcal endocarditis complicated by meningitis / 대한내과학회지

pneumonia in the setting of chronic alcoholism and may be complicated by meningitis. Only one adult case of pneumococcal endocarditis (PE) has been reported in Korea. We report the case of a 73-year-old woman who suffered from PE complicated by embolic cerebral infarction and meningitis. This is the first Korean case of PE complicated with meningitis. The patient was treated medically and died from a cardiac complication. This case shows that PE is difficult to treat without surgery because its evolution is usually acute and very aggressive; it has a high rate of local and systemic complications despite the administration of appropriate antibiotics.

The Influence of Rotation Order on Medical Students' BLS Performance during the OSCE Examination

PURPOSE: An objective structured clinical examination (OSCE) is an examination made up of a series of stations through which the candidate rotates to test clinical skill performance. This study was conducted to evaluate whether the testing ability changed and the basic life support (BLS) performance was influenced during the OSCE as a function of the time elapsed during the rotations. METHODS: Candidates rotated around the 10 stations in 6 groups lasting 6 minutes each, for a total examination period of approximately 1 hour. For our analysis, 58 third-year medical students were divided into four groups by testing order; early, early-middle, late-middle, and latter. BLS performance scoring consisted of 50 points with 13 question items. We also analysed their objective BLS performance by Resusci(R) Anne Skill Report TM scoring results. RESULTS: The total OSCE scores of each group were 404.8 +/-28.5, 395.8+/-18.7, 386.0+/-20.9, and 386.3+/-39.5 (p=0.187), respectively. The station scores were as follows: 40.8+/-5.4, 36.6+/-7.2, 34.2+/-6.1, and 33.7+/-6.2 for total BLS examination score (p=0.008), respectively; 2.5+/-2.6, 5.0+/-0.0, 4.7+/-1.2, and 5.0+/-0.0 for performance of sequence (p=0.000), respectively; 43.0+/-23.7%, 47.2+/- 17.6%, 12.7+/-2 2.0%, and 16.8+/-21.4% for adequate ventilation (p=0.000), respectively; and 77.3+/-21.5%, 62.8+/- 46.1%, 52.4+/-22.4%, and 31.3+/-36.1% (p=0.003) for adequate compressions, respectively. The general performance- related variables were lesser points in the early group. As the test progressed, accuracy decreased conspicuously in the middle groups. However, accuracy rose again, but fatigue-related scores were deteriorated in the latter group. CONCLUSION: According to our study, the rotating order has exerted a strong influence on medical students' BLS performance and examination scores. Therefore, we should consider score distribution in the performance evaluation and accuracy of items to according to the rotation order during the OSCE examination.

Emergency Care and Disposition of Prisoners in the Emergency Department

PURPOSE: Most emergency departments (EDs) treat prisoners; however, in so doing, there is often a disruption in the normal routines of the ED and associated problems for the treating physician. The current study was conducted to describe the use of emergency medical care by the prison population in an effort to better understand the needs of prisoners and to plan specific services to care for prisoners. METHODS: We retrospectively analyzed 220 ED admissions involving 188 prisoners at Konyang University Hospital between August 2004 and January 2009. The medical records of all prisoners admitted to the ED were collected and analyzed from the ED computerized database. The following data were extracted for each prisoner: time and reason for admission, age, gender, Emergency Severity Index (ESI), final diagnosis, and disposition. RESULTS: The 220 admissions (188 prisoners; mean age, 42.3 years; range, 20-78 years) consisted of the following: medical illnesses (64.1%), self-injuries (16.8%), surgical conditions (7.7%), injuries sustained from violence (6.4%), accidental injuries (3.6%), sports injuries (0.9%), and miscellaneous (0.5%). Eighty ED admissions (36.4%) had significant medical histories, including hypertension, diabetes, myocardial infarctions, and seizure disorders. Ninety-six ED admissions (43.6%) were subsequently admitted to the hospital as inpatients. Twenty prisoners visited the ED more than 1 time (a total of 52 times), including 2 prisoners who were admitted to the ED 5 times each. There were 19 ED admissions for ingestion of foreign objects by 15 prisoners. The most common foreign body was a metal wire. The overall mortality rate was 6.9%. CONCLUSION: Prisoners referred to the ED have serious medical conditions with a high mortality rate that require specific emergency management. In rendering care for a confined prison population, the ED staff should be aware of the increased risk of sudden cardiac death.

A Case of Left Ventricular Outflow Tract Obstruction and Microangiopathic Hemolytic Anemia after Mitral Valve Repair

Many cases have been reported hemolytic anemia and left ventricular outflow obstruction with systolic anterior motion developing after bioprosthetic valve replacement. We report a case of hemolytic anemia and left ventricular outflow tract obstruction occured after mitral valve repair using Duran ring and were resolved by preservative therapy.