Risk of lung diseases in patients with previous carbon monoxide poisoning: a nationwide population-based cohort study in the Republic of Korea.

INTRODUCTION: Carbon monoxide poisoning is associated with severe damage to various organs. In this study, we aimed to determine if previous carbon monoxide poisoning was associated with an increased risk of lung diseases. METHODS: The study population was derived from the National Health Insurance Service database of Korea between 1 January 2002 and 31 December 2021. Adults with carbon monoxide poisoning, with at least one visit to medical facilities between 2002 and 2021, were included. For comparison, an equal number of matched controls with the same index date were selected from the database. RESULTS: A total of 28,618 patients with carbon monoxide poisoning and 28,618 matched controls were included in this study. Approximately 42.8 per cent of the patient and control groups were female, with a mean age of 51.3 years. In patients with carbon monoxide poisoning, there was a significant increase in the risk of lung cancer (adjusted hazard ratio, 1.84; 95 per cent confidence interval, 1.42-2.39; P < 0.001), chronic obstructive pulmonary disease (adjusted hazard ratio, 1.60; 95 per cent confidence interval, 1.36-1.89; P < 0.001), pulmonary tuberculosis (adjusted hazard ratio, 1.46; 95 per cent confidence interval, 1.13-1.88; P = 0.003), and non-tuberculous mycobacterial infection (adjusted hazard ratio, 1.54; 95 per cent confidence interval, 1.01-2.36; P = 0.047). DISCUSSION: In this retrospective cohort study, previous carbon monoxide poisoning was associated with an increased risk of lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection. Further studies are needed to confirm such an association in other populations and the risk of lung diseases due to the toxic effect of carbon monoxide from different sources. CONCLUSIONS: Previous carbon monoxide poisoning was associated with an increased risk of lung diseases, but the relative importance of the causes and sources of exposure was not known. The long-term management of survivors of acute carbon monoxide poisoning should include monitoring for lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection.

Gastric bezoar and intraoral foreign body after plaster ingestion successfully treated without surgical intervention: a case report.

Some cases of plaster ingestion include the occurrence of gastrointestinal obstruction that requires surgery. To date, there are no reports on the treatment of plaster lesions in the mouth. A 50-year-old woman was referred to the emergency department after intentionally drinking a solution of approximately 100 g of plaster powder in 250 mL of water, 3 hours earlier. On arrival, the patient was alert but unable to speak because the plaster had hardened in her mouth. Hardened plaster was also found in her stomach. There was no evidence of acute gastrointestinal obstruction on abdominal computed tomography; we therefore decided to perform surgical observation. The intraoral plaster lesions were successfully removed using forceps, and the plaster bezoar was successfully eliminated without surgical treatment. The present case shows that not all patients with plaster poisoning require surgery; the patient's conditions, such as gastrointestinal obstruction, should indicate the course of treatment.

Major component causing neurological toxicity in acute glufosinate ammonium poisoning: determination of glufosinate, 1-methoxy-2-propanol, and ammonia in serum and cerebrospinal fluid.

OBJECTIVE: To determine the primary contributor to neurotoxicity in patients with glufosinate ammonium (GLA) poisoning, by quantifying glufosinate, 1-methoxy-2-propanol, and ammonia in serum and the cerebrospinal fluid (CSF). MATERIALS AND METHODS: We collected and analysed data from confirmed cases of GLA poisoning between May 2018 and August 2020. Based on the occurrence of neurological complications (mental change, seizure, and central apnoea), patients were assigned to one of two groups: those with complications (NCx) and without (non-NCx) complications. Concentrations of glufosinate, 1-methoxy-2-propanol (1M2P), and ammonia were measured in the serum upon admission and during hospital stay. The concentrations of all these substances were again measured in the CSF following a decline in the mental status or seizure (NCx group) or on the day after hospitalisation (non-NCx group). RESULTS: Of the 20 patients included, ammonia levels in the serum and CSF at onset of altered sensorium in the NCx group (n = 16) were significantly higher than those at one day after hospitalisation in the non-NCx group (n = 4) (p = 0.011 in serum, p = 0.047 in CSF), with its concentration in the CSF being higher than that in the serum in 15/16 cases. The concentration of 1M2P was similar in the serum and CSF (8/16), but the concentrations of glufosinate (7/16) was lower in the CSF than in the serum. In the non-NCx group (n = 4), only ammonia was detectable. CONCLUSIONS: Among patients with GLA poisoning, increased CSF ammonia was significantly correlated with neurological complications.

Application of a new hyperbaric oxygen therapy protocol in patients with arterial and venous gas embolism due to hydrogen peroxide poisoning.

Hydrogen peroxide (H2O2) ingestion can cause vascular gas embolism (GE). Hyperbaric oxygen therapy (HBO2) is known to improve neurological abnormalities in patients with arterial gas embolism (AGE). Previously, HBO2 based on the U.S. Navy Table 6 diving protocol has been adopted for treating AGE and preventing the progression of portal venous GE, caused by H2O2 ingestion, to AGE. However, the indication and protocol for HBO2 have not been established for GE related to H2O2 ingestion. Herein, we describe a case in which GE caused by H2O2 ingestion was treated using HBO2 with a short protocol. A 69-year-old female patient presented with abdominal pain, vomiting, and transient loss of consciousness after ingesting 35% H2O2. Computed tomography revealed gastric wall and portal venous gas. She was administered an HBO2 protocol with 2.8-atmosphere absolute (ATA) compression for 45 minutes. This was followed by a 2.0-ATA treatment for 60 minutes with a five-minute air break, after which all gas bubbles disappeared. After HBO2 treatment, brain magnetic resonance imaging revealed focal cytotoxic edema lesions; however, the patient was discharged without additional symptoms.

Uses of Inflammatory Markers for Differentiation of Intrahepatic Mass-Forming Cholangiocarcinoma from Liver Abscess: Case-Control Study.

BACKGROUND: Pyogenic liver abscess (LA) is difficult to distinguish from intrahepatic mass-forming cholangiocarcinoma (IMCC) in the emergency department (ED). We evaluated the predictive ability of white blood cells (WBC) and C-reactive protein (CRP) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and delta neutrophil index (DNI) in LA and IMCC in the ED. METHODS: Forty patients with IMCC between January 2011 and December 2018 were included in this study. For each patient with IMCC, two control patients with LA were enrolled based on matching age and sex,-i.e., 80 patients with LA. RESULTS: Inflammatory markers, including WBC, PLR, NLR, DNI, and CRP were significantly higher in the LA group than in the IMCC group. For both groups, the area under the curve (AUC) of the initial CRP value was significantly higher (AUC: 0.909) than that of the initial serum WBC count, PLR, and DNI levels. On multivariable logistic regression analysis with inflammatory markers, serum CRP (odds ratio, 1.290; 95% confidence interval, 1.148-1.449, p < 0.001) was the only significant predictor for differentiation between the LA and IMCC groups. CONCLUSION: Serum CRP may be a potential inflammatory marker to differentiate IMCC from LA in the ED.

Identifying alcohol problems among suicide attempters visiting the emergency department.

BACKGROUND: Many suicide attempters brought to our emergency department (ED) have been found to have alcohol problems, and this should be taken serious consideration because alcohol use disorder is a risk factor for suicide reattempt. In this study, we aimed to estimate the effectiveness of alcohol-related biochemical markers and Alcohol Use Disorder Identification Test Consumption (AUDIT-C) in suicide attempters who visited our ED based on the gold standard for clinical diagnosis used by psychiatrists for alcohol use disorder. Moreover, we aimed to search for a significant standard when clinicians make correct predictions about alcohol use disorder using these markers. METHODS: Among the subjects who visited ED following a suicide attempt, a total of 203 subjects were selected. Following a psychiatric interview, the subjects who met the criteria for alcohol abuse or alcohol dependence according to DSM-IV-TR in the past year were defined as the "alcohol use disorder" group. Although some subjects did not meet these criteria, men with a weekly alcohol intake of ≥14 drinks and women with a weekly alcohol intake of ≥7 drinks were classified as the "risky drinking" group. AUDIT-C was used as a self-report; further, aspartate aminotransferase, gamma-glutamyltransferase (GGT), and carbohydrate-deficient transferrin (CDT) were assayed using standard methods, and GGT-CDT was calculated using this formula: 0.8 × ln(GGT) + 1.3 × ln(%CDT). RESULTS: In total, 88 subjects met the criteria for alcohol use disorder and 115 were included in the reference group. In the screening for alcohol use disorder, the AUC of AUDIT-C was 0.89 for men and 0.87 for women. In the screening for risky drinking, the AUC of AUDIT-C was 0.99 for men and 0.93 for women. Compared with other biochemical markers, AUDIT-C showed the highest AUC value for screening for both alcohol use disorder and risky drinking, with the trend being more prominent in men. CONCLUSIONS: Among the biochemical markers, AUDIT-C yielded the highest sensitivity, specificity, and accuracy in diagnosing alcohol use disorder among suicide attempters in ED. Comparison of results revealed that the use of AUDIT-C with biochemical markers or its use alone can help screen for alcohol use disorder or risky drinking in clinical settings.

Validation of the Korean criteria for trauma team activation.

OBJECTIVE: We conducted a study to validate the effectiveness of the Korean criteria for trauma team activation (TTA) and compared its results with a two-tiered system. METHODS: This observational study was based on data from the Korean Trauma Data Bank. Within the study period, 1,628 trauma patients visited our emergency department, and 739 satisfied the criteria for TTA. The rates of overtriage and undertriage in the Korean one-tiered system were compared with the two-tiered system recommended by the American College of Surgery-Committee on Trauma. RESULTS: Most of the patient's physiologic factors reflected trauma severity levels, but anatomical factors and mechanism of injury did not show consistent results. In addition, while the rate of overtriage (64.4%) was above the recommended range according to the Korean criteria, the rate of undertriage (4.0%) was within the recommended range. In the simulated two-tiered system, the rate of overtriage was reduced by 5.5%, while undertriage was increased by 1.8% compared to the Korean activation system. CONCLUSION: The Korean criteria for TTA showed higher rates of overtriage and similar undertriage rates compared to the simulated two-tier system. Modification of the current criteria to a two-tier system with special considerations would be more effective for providing optimum patient care and medical resource utilization.

Parenchymal lung injuries related to standard cardiopulmonary resuscitation.

OBJECTIVES: We analyzed chest computed tomographic scan to evaluate parenchymal lung injury and its clinical significance in patients who received standard cardiopulmonary resuscitation and were resuscitated from cardiac arrest. METHODS: We enrolled nontraumatic out-of-hospital cardiac arrest patients older than 19 years who had been admitted to the emergency department in cardiac arrest and successfully resuscitated after cardiopulmonary resuscitation. Chest computed tomography was obtained immediately after return of spontaneous circulation (ROSC). To allocate the area of lung contusion, we divided both hemithoraces into 3 regions longitudinally, and each part was subdivided into 4 segments except the lower part of the left lung. To stratify the severity of lung contusion, each segment was scored depending on the area of lung contusion. Oxygen index (OI) was measured at the time of ROSC, 24, 48, and 72 hours and 1 week after cardiac arrest. RESULTS: Lung contusion was developed in 37 (41%) patients and median lung contusion score (LCS) was 17 (12-26). Lung contusion was not associated with hospital mortality (P = .924) or length of intensive care unit stay (P = .446). The OI at the time of ROSC was lower in patients with LCS greater than 23 than that in patients with LCS less than or equal to 23 (126 [93-224] vs 278 [202-367]; P = .008); however, the OI at the other timelines was not different between patients with LCS greater than 23 and patients with LCS less than or equal to 23. CONCLUSION: Extensive lung contusion is associated with a lower oxygenation index at the time of ROSC, but did not affect the resuscitation outcome.

Evaluation of usefulness of myeloperoxidase index (MPXI) for differential diagnosis of systemic inflammatory response syndrome (SIRS) in the emergency department.

BACKGROUND: The myeloperoxidase index (MPXI) is elevated in infection. We ascertained whether MPXI might be useful in differentiation of sepsis versus non-infectious systemic inflammatory response syndrome (SIRS) in emergency department (ED). METHODS: After exclusion of patients with an age of <18 years, trauma, haematological disease and on anticancer chemotherapy, 444 consecutive cases with SIRS (sepsis: 224, 50.3%; and non-infectious SIRS: 220, 49.7%) diagnosed and treated at the ED of The Wonju Severance Christian Hospital from May 2012 to June 2012 were retrospectively reviewed. RESULTS: Median MPXI was higher in sepsis versus non-infectious SIRS (0.1 (IQR: -3.1 to 2.5) vs -1.2 (-4.1 to 1.6), respectively, p=0.020). Median white cell count, neutrophil percentage, C reactive protein level and δ neutrophil index were also higher. However, MPXI resulted as not statistically useful for differential diagnostic parameter in analysis. CONCLUSIONS: MPXI is higher in sepsis than in non-infectious SIRS. However, there is currently no evidence that the MPXI adds any additional benefit to differentiate sepsis from non-infectious SIRS in the ED. Therefore, further study will be needed.