Adverse events and preventive measures related to COVID-19 vaccines

The coronavirus disease 2019 (COVID-19) vaccines are categorized according to the manufacturing technique, including mRNA vaccines and adenovirus vector vaccines. According to previous studies, the reported efficacy of the COVID-19 vaccine is excellent regardless of the type of vaccine, and the majority of studies have shown similar results for safety. Most of the adverse reactions after vaccination were mild or moderate grade, and severe reactions were reported in a very small proportion. However, the adverse reactions that might occur after nationwide vaccinations can contribute to crowding of emergency departments, and this can further lead to significant obstacles to providing necessary treatment for life-threatening conditions. Therefore, as emergency physicians, we would like to present some concerns and suggestions to prevent these predictable problems.

Adverse events and preventive measures related to COVID-19 vaccines

The coronavirus disease 2019 (COVID-19) vaccines are categorized according to the manufacturing technique, including mRNA vaccines and adenovirus vector vaccines. According to previous studies, the reported efficacy of the COVID-19 vaccine is excellent regardless of the type of vaccine, and the majority of studies have shown similar results for safety. Most of the adverse reactions after vaccination were mild or moderate grade, and severe reactions were reported in a very small proportion. However, the adverse reactions that might occur after nationwide vaccinations can contribute to crowding of emergency departments, and this can further lead to significant obstacles to providing necessary treatment for life-threatening conditions. Therefore, as emergency physicians, we would like to present some concerns and suggestions to prevent these predictable problems.

Comparison of Poisoning Severity Score (PSS) according to alcohol co-ingestion in intentional poisoning patients

Purpose@#Alcohol ingestion enhances impulsivity and aggression, and has been proven to have a close relationship with suicide.This study investigates whether alcohol co-ingestion affects the Poisoning Severity Score (PSS) grade in patients with intentional poisoning. @*Methods@#We conducted a retrospective analysis of intentional poisoning patients who visited the emergency department (ED) from January 1 to December 31, 2020. Patients were divided into non-drunken and drunken groups. We collected the data based on the medical records of the patients and serum ethanol level results recorded during initial blood tests at the ED. To grade the PSS, the highest score was assessed through clinical signs and test results during the hospital stay. A comparative analysis was conducted between the two groups. @*Results@#A total of 277 patients were included in the study. 163 (58.8%) were in the non-drunken group, and 114 (41.2%) were in the drunken group. The PSS grade showed a significant difference between the two groups (p=0.002). While grade 1 (mild) was observed more in the non-drunken group, grade 2 (moderate) and grade 3 (severe) were seen more in the drunken group. In an ordinal logistic regression analysis, alcohol co-ingestion (adjusted odds ratio [aOR] 2.557, 95% confidence interval [CI] 1.554-4.208, p<0.001) was considered to be a risk factor for a higher PSS grade. There was no significant correlation between the serum ethanol level and the PSS grade. (p=0.568) @*Conclusion@#Intentional poisoning patients with alcohol co-ingestion had a higher PSS. Hence close observation and aggressive treatment in the ED is warranted in such cases.

Usefulness of initial red blood cell distribution width as a prognostic factor for predicting 30-day mortality in acute decompensated heart failure patients

OBJECTIVE: This study evaluated the efficacy of the initial red blood cell distribution width (RDW) level in the emergency department (ED) to predict the 30-day mortality in patients with acute decompensated heart failure (ADHF). METHODS: A retrospective analysis study of patients who visited the ED and were diagnosed with ADHF from January 2015 to December 2016 was conducted. The patients were divided into the 30-day survival group and non-survival group. The data were obtained from the medical records of the patients, and the blood test results were taken from the initial blood test at the ED. The data and blood test results were compared between the 30-day survival and non-survival groups. Multivariate logistic regression analysis was performed to determine the risk factors for mortality. RESULTS: A total of 626 patients were included. The mean age was 78.5 years and the overall mortality was 15.5%. The non-survival group had higher RDW levels than the survival group (18.0% vs. 14.6%). In a multivariate logistic regression analysis, RDW (odds ratio, 2.242; 95% confidence interval [CI], 1.673−3.005; P<0.001) were considered to be a useful factor for predicting the prognosis. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.848 (95% CI, 0.811–0.886; P<0.001), and the sensitivity and specificity of predicting mortality was 76.3% and 78.1%, respectively, after setting the RDW cutoff value to 15.95%. CONCLUSION: The initial RDW level is a useful prognostic marker for predicting the 30-day mortality in ADHF patients.

TRAIL-induced cell death and caspase-8 activation are inhibited by cisplatin but not carboplatin / 부인종양

OBJECTIVE: Platinum (Pt) based drugs including cisplatin and carboplatin are widely used as anticancer drugs in various human cancers. Many studies have shown that chemotherapeutic agents synergistically enhance cell death induced by death ligands. However it has been recently reported that cisplatin may inhibit tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-induced cell death through inactivation of caspases. Thus, we investigated whether carboplatin also inhibits TRAIL-induced cell death. METHODS: HeLa cells were treated with TRAIL in the presence of cisplatin or carboplatin, and cell death was analyzed using the crystal violet staining method. Caspase activation was checked through detection of Bid cleavage by Western blotting using anti-Bid antibody. RESULTS: Cisplatin inhibits TRAIL-induced cell death in HeLa cells; however, carboplatin enhanced TRAIL-induced cell death. Whereas cisplatin inhibited caspase-8-mediated Bid cleavage, carboplatin had no effect on caspase-8 activity. CONCLUSION: Although cisplatin and carboplatin are platinum-containing cancer therapeutic agents, they have the opposite effects on TRAIL-induced cell death.