Practice of Clinical Pharmacists Participating in the Anti-infective Treatment for A Child with Pulmonary In-fection and Brain Abscess after a Near-drowning Incident / 中国药房

OBJECTIVE:To explore the role of clinical pharmacists participating in anti-infective treatment for a child with complex infection. METHODS:Clinical pharmacists participated in treatment process of one child with pulmonary infection and brain abscess after a near-drowning incident,assisted physicians to adjust antibiotics therapy plan,and put several suggestions as the adjustment of anti-gram-positive and anti-gram-negtive bacterium drugs,the dosage adjustment of vancomycin,vancomycin-induced ADR and disposal,the selection of anti-Pasteurella pneumotropica drugs,the enhancement of anti-fungal infection therapy,accord-ing to pathogen characteristics,treatment effect and ADR. RESULTS:Physicians partly adopted the advice of clinical pharmacists, the child’s pulmonary and brain infection were controlled effectively and ADR disappeared after 5 times of adjusting anti-infective the rapy plan. CONCLUSIONS:Clinical pharmacists participate in the treatment process of one child with complex infection,and assist physicians to formulate safe and effective anti-infective plan according to the results of etiological examination;dispose ADR timely and carry out efficacy evaluation of antibiotics and pharmaceutical care,that can give positive effects on patient treatment.

A Case of Severe Acute Kidney Injury by Near-Drowning

Acute kidney injury (AKI) secondary to near-drowning is rarely described and poorly understood. Only few cases of severe isolated AKI resulting from near-drowning exist in the literature. We report a case of near-drowning who developed to isolated AKI due to acute tubular necrosis (ATN) requiring dialysis. A 21-yr-old man who recovered from near-drowning in freshwater 3 days earlier was admitted to our hospital with anuria and elevated level of serum creatinine. He needed five sessions of hemodialysis and then renal function recovered spontaneously. Renal biopsy confirmed ATN. We review the existing literature on near-drowning-induced AKI and discuss the possible pathogenesis.

Successful Recovery after Drowning by Early Prone Ventilatory Positioning and Use of Nitric Oxide Gas: A Case Report / 대한구급학회지

Drowning is the third leading cause of unintentional accidental death globally. The most serious pathophysiologic consequence of drowning is hypoxemia from acute respiratory distress syndrome. Herein, we report a drowning victim who presented with hypothermia and cardiac arrest, followed by acute respiratory distress syndrome, rhabdomyolysis (with acute kidney injury), and disseminated intravascular coagulopathy. Aided by advanced cardiac life support and mechanical ventilation in a prone position, the patient fully recovered after two days of hospitalization. Recovery was largely attributed to early prone ventilatory positioning and use of nitric oxide gas.

Disseminated Scedosporium apiospermum Infection Induced from Aspiration Pneumonia after Near-Drowning / 결핵및호흡기질환

Scedosporium apiospermum, the anamorph of Pseudallescheria boydii, is a ubiquitous saprophytic fungus. S. apiospermum can cause life-threatening infections usually in immunocompromised patients or after near-drowning incidents. Here, we report the first case of disseminated infection caused by S. apiospermum after near-drowning in Korea. A 44-year-old healthy man developed aspiration pneumonia, followed by multiple brain abscesses, and endopthalmitis, after a near-drowning incident in a septic tank. S. apiospermum infection was diagnosed on the 33rd day after the incident had occurred. The patient died from the progressive renal failure 255 days after incident, although he had been treated with voriconazole.

Prognostic value of proton magnetic resonance spectroscopy findings in near drowning patients: reversibility of the early metabolite abnormalities relates with a good outcome / Valor prognóstico da espectroscopia de prótons em vítimas de quase-afogamento: reversibilidade das anormalidades metabólicas precoces relacionou-se com bom prognóstico

In two children with near drowning hypoxic encephalopathy and normal-appearing structural MRI, acute proton magnetic resonance spectroscopy (¹H MRS) showed biochemical alterations that correctly indicated prognosis and helped to guide management decisions. Elevation of the lipid-lactate and glutamine-glutamate peaks, on the early (72 hour) ¹H MRS, predicts a poor prognosis. Absence of lipid-lactate and glutamine-glutamate peaks on the early ¹H MRS and reversibility of early mild metabolite abnormalities on follow up examination relates with good outcome.

Em duas criancas vítimas de quase-afogamento com encefalopatia hipóxico-isquêmica, que apresentaram ressonância magnética por imagem normal, a espectroscopia de prótons por ressonância magnética (¹H MRS) na fase aguda mostrou alterações bioquímicas que corretamente indicaram o prognóstico e ajudaram a guiar o manejo terapêutico. Elevação dos picos de lipídeo-lactato e glutamina-glutamato na ¹H MRS precoce realizada com 72 horas previu um mau prognóstico. Relacionaram-se com bom prognóstico; a ausência dos picos de lipídeo-lactato e glutamina-glutamato na ¹H MRS precoce, e a reversibilidade no exame de controle (3 meses) das discretas anormalidades metabólicas encontradas no primeiro exame.

Profile of near drowning victims in a coastal region of Karnataka.

BACKGROUND: Drowning and near drowning are serious public health problems and an important cause of morbidity and mortality worldwide. Present study is done to understand the pattern of near drowning cases in this coastal region of Karnataka. METHODS: This hospital based retrospective research was conducted at Kasturba Hospital, Manipal in Southern India from January 1993 to December 2003. A detailed victimologic profile was made. RESULTS: Study included a total of 58 cases of near drowning. Males were predominantly affected (84.5%). Majority of the victims were aged below 10 years (39.7%). Manner was accidental in maximum (82.3%) reported cases. Incidence of fresh water drowning was more than sea water drowning. Fatal outcome was reported in 12.1% cases with maximum fatalities occurring within one to three days of hospitalization. Most of the victims witnessed respiratory complications (55.2%). CONCLUSION: Males in the first decade are at increased risk of accidental drowning. Swimming under adult supervision, immediate resuscitative measures and early medical aid is proposed.

A Case of Multiple Gastric Mucosa Lacerations in Near Drowning

The causes of complicated upper gastrointestinal bleeding in near-drowning have been known to be stress-induced gastritis, gastric ulcer, Mallory-Weiss syndrome, or Boerhaave syndrome. However, gastric mucosa laceration has often been observed in a drowned body's autopsy. Gastric fundus is the most common site of gastric mucosa lacerations, and the number of lacerations is almost always less than three. Reflex gasping in drowning leads to passive vigorous vomiting, the mechanical force of which causes gastric mucosa laceration. Gastric mucosa laceration is an important forensic clue in autopsy because it means that the victim was drowned alive or was abandoned after being murdered. However, gastric mucosa laceration has rarely been observed in a drowning survivor. We report a neardrowning case of a 9-year-old boy, who had multiple gastric mucosa lacerations treated by endoscopic hemostatic procedure. In our case, we suspect abdominal blunt trauma also to be another cause of gastric mucosa laceration because of uncommon site of the laceration and the large number of lesions. We also present a literature review.

Clinical Feature of Submersion Injury in Adults / 결핵

BACKGROUND: Drowning represents the third most common cause of all accidental deaths worldwide. Although few studies of submersion injury were done in Korea, the subjects were mainly pediatric patients. The purpose of this study is to describe the clinical feature of submersion injury in adults. METHODS: The medical records of 31 patients with submersion injury who were >15 years of age and admitted to Kyungpook National University Hospital from July 1990 to March 2003 were retrospectively examined. RESULTS: The most common age-group, cause, and site of submersion accidents in adults were 15-24 years of age, inability to swim, and river followed by more than 65 years of age, drinking, and public bath respectively. The initial chest radiographs showed bilaterally and centrally predominant distribution of pulmonary edema at lung base in about 90% of patients with pulmonary edema represented by submersion injury but at only upper lung zone in 10%. Eventually, 25 patients (80.6%) survived without any neurologic deficit and 2 patients (6.5%) with significant neurologic deficit, and 4 patients (12.9%) died. Age, arterial gas oxygenation, and mental status among baseline variables showed significant difference for prognosis. CONCLUSIONS: More than 65 years of age, drinking, and occurrence in public bath were relatively important in submersion injury of adults, and the successful survival of 80.6% of patients suggests that cardiopulmonary resuscitation should be intensively done in even adults.

Clinical Aspects and Prognostic Factors of Near Drowning Children / 대한소아신경학회지

PURPOSE: We intended to find out clinical aspects and prognostic factors of near drowning children in this study. METHODS: We conducted a retrospective study on twenty eight near-drowning children, who were admitted to Gangneung Asan Hospital from March, 1996 to March, 2002. We investigated their clinical aspects and the differences between two groups, namely a good prognosis group and a poor prognosis group. Those in the good prognosis group had no neurologic impairments and were fully recovered while those in the poor prognosis group died or fell into vegetative states. RESULTS: Out of 28 patients, there were 18 males(64.3%) and 10 females(35.7%). Age distribution was < or =4 years in 10 cases, 5 to 8 years in 7 cases, 9 to 12 years in 8 cases, and 13 to 16 years in 3 cases. Seasonal distribution was summer in 18 cases, spring in 6 cases, autumn in 3 cases, and winter in 1 case. Submersion time was < or =5 minutes in 15 cases, 5 to 10 minutes in 7 cases, and unknown in 7 cases. Initial blood glucose level was 175.2+/-88.0 mg/dL and initial arterial blood pH was 7.24+/-0.21. Good prognosis group had 23 out of 28 cases(82.1%) while poor prognosis group had 5 out of 28 cases(17.9%) which included 4 deaths and 1 vegetative case. Between the two groups there were no significant differences in the distributions of sex, age, season, submersion place, transfer time to hospital and resuscitation time. However, submersion time, mechanical ventilation need, initial blood glucose level and initial arterial pH were significantly different between the two groups. CONCLUSION: We found out that poor prognosis is expected for near-drowning children of submersion time over 10 minutes, applied mechanical ventilation, high initial blood glucose level, and low initial arterial blood pH.

Acute Respiratory Distress Syndrome after Severe Hypothermia and Hypotension Due to Near Drowning / 대한구급학회지

The increase in short-term survival of near-drowning victims after an acute submersion episode has resulted in an increase of major complications. Two major complications are the development of acute respiratory distress syndrome and persistent hypoxic-ischemic central nervous system injury. A 43-year-old male patient was presented with acute respiratory distress syndrome after near drowning. He was severely hypothermic and hypotensive when he arrived to emergency department. His body temperature was 24oC. There was no pulse and no spontaneous respiration. He was treated with advanced life support measure. He was intubated and vasoactive drugs such as epinephrine and norepinephrine were used. On ICU admission, his blood pressure and pulse rate were 80/40 mmHg, 170 beats/min respectively. His oxygen saturation was 40~60% with 100% oxygen. We applied 16~30 cmH2O of PEEP with low tidal volume for recruitment. Patient was flipped over to prone position. Solu-medrol 1.0 g was infused. The blood pressure restored to 140/50 mmHg, and the pulse rate was normalized to 100 beats/min. The dose of vasopressors and inotropes were reduced and stopped 5 hour after the arrival. When the oxygenation has improved, the position was changed to supine and PEEP was lowered. Eventually weaning was successful. Brain MRI and EEG showed global atrophy of cerebral cortex and moderate diffuse brain dysfunction respectively. He received tracheostomy since he was semi-comatose. He was transferred to general ward on 39th ICU day.

Present status of study of seawater drowning-induced acute lung injury / 解放军医学杂志

With the exploitation of marine resources and environmental deterioration, perilous events in the sea are gradually increasing. Seawater drowning is one of the most important causes of death. Researches on seawater drowning have attracted more and more interests in recent years, and certain progresses have been achieved in scientific research and clinical treatment. In the aspects of theory and establishment of a model, a renewed concept of seawater drowning-induced acute lung injury (SWD-ALI) has been acquired, the animal model of SWD-ALI has been successfully reprodaced for elucidation of the pathological and pathophysiological changes in lung tissue. Multiple results of molecular biological research on SWD-ALI have contributed to illuminating the pathogenesis involved. It is indicated that, compared with freshwater-induced lung injuries, SWD-ALI is severer in clinical picture, and it might develop to a peculiar seawater drowning-induced acute respiratory distress syndrome (SWD-ARDS) if no prompt and effective treatment is employed. For the clinical treatment for SWD-ALI, comprehensive therapies based on mechanical ventilation have been approved. The scientific outcomes mentioned above have laid a foundation for the full realization of SWD-ALI and more effective rescue of SWD-ALI patients.

Inhibitory effects of ventilation with various tidal volumes on inflammatory responses of rabbits with acute lung injury induced by seawater drowning / 解放军医学杂志

0.05). After ventilation with 6ml/kg tidal volumes, the TNF-? in alveolar lavage fluid (1.58?0.56pg/ml) was significantly lower in b1 group compared with that in control group (1.73?0.81pg/ml, P

Dynamic changes in apoptosis of polymorphonuclear neutrophil in rabbit with acute lung injury induced by seawater drowning / 解放军医学杂志

Objective To explore the dynamic changes in apoptosis of polymorphonuclear neutrophil (PMN) during the course of seawater drowning-induced acute lung injury (SWD-ALI), and the possible roles of cytokines in the process. Methods Thirty-six NZ rabbits were randomly divided into 6 groups by using a random number table: control group (0h, as baseline value) and 5 seawater drowning groups (S1h, S3h, S6h, S12h and S24h). Blood gas analysis and hemogram were observed at different time points. The ratio of wet to dry lung weight (W/D) and lung permeability index (LPI) were calculated. The changes in PMN apoptosis were analyzed by flow cytometer. The concentrations of tumor necrosis factor alpha (TNF-?), interleukin-1 (IL-1 ) and IL-10 in serum were detected by ELISA. Meanwhile, the pathological changes in lung tissue were examined with hematoxylin-eosin (HE) staining, and lung pathologic scores (LPS) were evaluated. Results The W/D ratio reached its peak value at 3h, while LPI at 6h. The histopathologic findings indicated that inflammatory cell infiltration was most massive at 6～12h. LPS increased at 1h, significantly higher than that of control group (P0.05). Conclusions The apoptosis of PMN, the main inflammatory effector cells, is significantly inhibited in the early stage of SWD-ALI. The serum cytokines, TNF-?, IL-1 and IL-10, play important roles in the pathogenesis of SWD-ALI, but have no evident effects on the inhibition of PMN apoptosis.

Childhood Near-Drowning in Chinju

PURPOSE: Drowning is the second most common cause of accidental death in children, exceeded only by motor vehicle accidents. The purpose of the present study was to investigate the prognostic factors of near-drowning in children, such as age, sex, season, site of submersion, and initial clinical or laboratory manifestrations, and to formulate preventive strategies for decreasing injuries by drowning. METHODS: Sixty-one near-drowning children who were admitted to Gyeongsang National Hospital from January, 1988 to August, 1996, were identified. A review of the medical charts provided information concerning the submersion accidents. RESULTS: Boys had a greater risk of submersion than girls (m=42, F=19). The peak age of 1 to 4 years is consistent with the known propensity of toddlers for accidents. Submersion occurred 21 in the sea, 14 in rivers, 7 in bathtubs, 6 in puddles, 3 in ponds, 3 in swimming pools, 2 in valleys, 2 in water tanks, 2 in Korean classic toilets, and 1 in well. There were differences in the concentrations of electolytes between fresh and salt water submersion. Near-drowning occurred most commonly in summer, but it could be observed all the year round, because of the geographical factor of Chinju. Among 61 cases, 49 cases recovered without significant neurologic sequalae and 12 cases died or survived with severe anoxic encephalopathy. Poor prognostic factors were Glasgow coma scale (GCS) less than 5, body temperature less than 36.0degrees C, initial arterial pH less than 7.10, serum glucose over 300mg/dL, AST and/or ALT over 50IU/L, presence of early convulsion, presence of chest X-ray abnormalities, and need for an artificial ventilation. CONCLUSIONS: Childhood near-drowning accidents are more frequently observed in Chinju than expected in any other province of Korea. We found that known poor prognostic factors for death or severe neurologic sequalae also were operating in our study population. Preventive measures against drowning and near-drowning through school and local education programs seems to be the most important strategy. If submersion victim is found, a quick appropriate extensive cardiopulmonary resuscitation is important to prevent the death or neurologic sequalae.

Clinical Observation on Accidents for Infant and Childhood Who Visited the Emergency Room in the Wonju Christian Hospital from Kangwon Area

Accidents have become one of the most important problem in the pediatric and child health field because of the recently observed high incidence of and mortality from accidents. Due to an improvement of the living standard in general and especially due to the wide application of vaccination and antibiotics, there has been a decline of incidence of infectious diseases in childhood. However, in contrast accidents have occurred increasingly involving childhood recently. Many accidents have been recognized as being preventible. Therefore, parental health education should be emphasized as one of the more important preventive measures against accidents. This clinical study was carried out for analysis on 1,297 cases which were diagnosed as accidents at the emergency room in Wonju Christian Hospital during the 5 years, from Jan. 1, 1975 to Dec. 31, 1979. The results were as follows: 1. The most common type of accidents was traffic accidents which accounted for 393 cases(30.4%) of the total accidents, followed by falls(233 cases, 18.0%), burns(209 cases, 16.1%), trauma(199 cases, 15.3%), poisoning(126 cases, 9.7%), foreign body aspiration(42 cases, 3.4%), dog bites(30 cases, 2.3%), drowning and near drowning(24 cases, 1.6%). 2. An absolute number of accident patients increased in each year compared with the previous year. However, the child accident case found in the emergency room showed only 30% annually. 3. Traffic accidents and falls showed the highest incidence in children between 4 and 7 years. On the other hand, however, burn and foreign body aspiration showed the highest incidence between 2and 5 years. 4. Accidents were found more in males than females. Falls, drowning, near drowning, and snake bites were prodominantly in males. 5. Accidents were shown higher in summer and autumn and relatively lower in winter. 6. Sedans among all the various vehicles were the most common cause of traffic accidents (25.4%), followed by trucks(20.4%) and autobicycles(15.8%). 7. Falls occurred mostly at the play ground(13.3%), stairs(10.3%), roofs(8.6%) and trees(3.9%). 8. Scalding burns(64.8%) were the most common cause, followed by flame burns(13.3%) and coal briquet(3.9%). 9. In trauma, violence(24.1%) was the most common cause. Accidental injuries caused by farmer's tools(12.0%), hitting with stone(11.2%) and injury with pieces of glass(9.5%) followed in that order. 10. In poisoning, carbon monoxide intoxication and insecticides were the most common 26.2% in each, followed by D.D.S.(16.7%) and pestides(9.5%). 11. The most common material aspirated was coins(78.6%), followed by pins(95%) and buttons(4.7%). 12. 1,024 cases(78.9%) among 1,297 cases showed improvement. 65 cases(5.0%) expired and 64 cases(4.9%) had some complications.