A study on the characteristics of patients visiting the pediatric emergency department with post-tonsillectomy hemorrhage

Purpose@#This study was performed to identify risk factors associated with post-tonsillectomy hemorrhage (PTH)-related hospitalization in pediatric patients visiting an emergency department (ED). @*Methods@#We retrospectively reviewed the medical records of patients who underwent tonsillectomy at a single children’s hospital ED from January 2009 through December 2020. Data were collected on patient demographics, chief complaints, surgical methods, postoperative days, initial vital signs, and laboratory findings. The study population was divided into hospitalized and discharged groups. @*Results@#Among a total of 2,716 patients reviewed, 67 met the inclusion criteria. The hospitalized group showed a lower median systolic blood pressure (108.0 [interquartile range, 82.0-134.0] vs. 118.5 [89.8-147.2] mmHg; P = 0.021) and a faster median respiratory rate (23.0 [18.0-28.0] vs. 20.0 [17.0-23.0] breaths/minute; P = 0.019), compared with the discharged group. Multivariable logistic regression identified systolic blood pressure under 100 mmHg (odds ratio, 5.21; 95% confidence interval, 1.17-37.60) and respiratory rate over 24 breaths/minute (7.31; 1.07-145.79) as the factors associated with PTH-related hospitalization. @*Conclusion@#When pediatric patients visit EDs for PTH, close monitoring or hospitalization may be needed in those with low systolic blood pressure or rapid respiratory rate.

A case of methamphetamine intoxication in an adolescent

With the age of exposure to illegal substances decreasing and abuse of drugs such as methamphetamine increasing, substance abuse is no longer limited to adults. We report a Korean case of a 17-year-old girl with acute methamphetamine poisoning. The girl visited the emergency department for vomiting and loss of consciousness, with needle marks found on both arms. QT prolongation was confirmed on the initial electrocardiogram, so that we suspected drug addiction and proceeded with toxicologic tests. A lethal dose of methamphetamine was confirmed. We discontinued QT prolonging drugs, and closely monitored the girl in the pediatric emergency intensive care unit until the QT prolongation was resolved. This case highlights the recognition of pediatric methamphetamine poisoning in emergency departments.

Epidemiologic features of pediatric genital injury in emergency departments in Korea

Purpose@#Genital injury is a common pediatric injury. Given the lack of nationwide data, the authors aimed to show age group-related epidemiologic features of genital injury in Korea. @*Methods@#We reviewed the data from 2011-2016 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. From the dataset, we included children (< 18 years) with the International Classification of Diseases, 10th Revision codes related to genital injury as the final diagnosis with excluding those with other codes or combined injuries. Age groups were defined as follows; infants (< 1 year), toddlers (1-3), preschoolers (4-6), schoolers (7-12), and adolescents (13-17). The clinical features and outcomes were analyzed. @*Results@#A total of 3,030 children were included with the median age of 6 years (interquartile range, 4-10) and the proportion of girls of 53.0%. Only 144 children (4.8%) were transported by the emergency medical service providers. The most common mechanism and place were blunt injury (1,826 [60.3%]) and home (1,535 [50.7%]), respectively. Of the codes, “Contusion of external genital organs (S30.2)” was most common (1,574 [51.9%]). As for outcomes, 2,770 children (91.4%) were discharged, 252 (8.3%) were hospitalized (intensive care units, 1 child [0.03%]), and 108 (3.6%) underwent surgery. Severe injury occurred in 111 children (3.7%) without a mortality. With increasing age in the age groups, non-accidental injury, school and sports-related injuries, hospitalization, and surgery (All Ps < 0.001). @*Conclusion@#Genital injury may occur at evening, in spring and summer, at home, and in the form of accidental or blunt injury. Most children are discharged. Contrary to these general features, older children tend to undergo more frequently non-accidental injury, school and sports-related injuries, hospitalization, and surgery. Thus, we need age-specific strategies for injury prevention.

Association High-Iodine-Containing Seaweed Soup Consumption after Birth and Subclinical Hypothyroidism in Korean Women: Korea National Health and Nutrition Examination Survey IV (2013–2015)

BACKGROUND AND OBJECTIVES: This study was to investigate the association between the previous history of seaweed intake after childbirth and subclinical hypothyroidism (SCH) occurrence in Korean women based on the latest nationally representative epidemiological survey data, the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI).MATERIALS AND METHODS: This study used data from KNHANES VI, a cross-sectional, nationally representative survey that comprises a health interview survey, health examination survey, and nutrition survey. Of the initial 22,948 Korean participants enrolled in KNHANES VI, 2,046 women were selected for this analysis. To examine SCH, the thyroid-stimulating hormone (TSH) reference range was defined using a population-based TSH range.RESULTS: Subclinical hypothyroidism was increased in those who consumed seaweed soup after childbirth, but this was not significant (OR 1.3, CI: 0.80–2.13, p=0.293). However, the odd ratio for SCH differed according to the duration of seaweed soup consumption. When seaweed soup was consumed within 1 week after birth, the OR was increased in the crude model (OR 2.61, CI: 1.39–4.89, p=0.002), but this was no longer significant in the adjusted model (OR 1.89, CI: 0.79–4.50).CONCLUSION: The notable finding from this study is that the previous history of excessive seaweed consumption during post-partum period may not be a risk factor for SCH in Korean women.

Multiple Cancers in a Patient with Systemic Sclerosis and Aggravated Interstitial Lung Disease by Chemotherapy / 결핵및호흡기질환

Although the relationship between malignancy risk with systemic sclerosis (SSc) has been inconclusive, there are some previous studies for a positive correlation. Most patients with SSc have some degree of lung parenchymal involvement in the form of interstitial thickening and fibrosis. Interstitial lung disease is the most common pulmonary manifestation of SSc. Interstitial lung disease following chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX]) is an uncommon life-threatening complication and it is induced by oxaliplatin. We report a case of multiple cancers in a patient with SSc and aggravated interstitial lung disease by chemotherapy.

A Case of Disseminated Candidiasis and Subsequent Breakthrough Pulmonary Mucormycosis after Consolidation Chemotherapy for Acute Myeloid Leukemia / 감염과화학요법

Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in patients with acute leukemia who are receiving chemotherapy. Primary prophylaxis with antifungal agents has become the standard of care in this setting; as a result, invasive candidiasis has shown a significant reduction. However, broad use of antifungal prophylaxis has led to an increase in breakthrough candidiasis with reduced susceptibility or resistance to fluconazole. In addition, an increase in breakthrough mucormycosis has been reported in studies of voriconazole prophylaxis. We report on a case of disseminated candidiasis and subsequent breakthrough pulmonary mucormycosis in a patient with acute myeloid leukemia undergoing consolidation chemotherapy. To the best of our knowledge, in Korea, this is the first report of these two independent IFIs occurring in a single patient.

A Case of Septic Arthritis of the Knee Joint due to Group D Non-typhoidal Salmonella / 감염과화학요법

Osteoarticular infections due to non-typhoidal Salmonella are rare, occurring with an incidence rate of 0.1-0.2%. An immunocompromised state and the existence of sickle cell anemia are known risk factors for development of septic arthritis due to Salmonella. In this report, we describe a patient with septic arthritis of the left knee caused by non-typhoidal Salmonella . An 82-year-old woman visited the emergency room presenting with left knee pain, fever and dyspnea. The patient had osteoarthritis and was treated with oral analgesics, but not with an intra-articular injection. Upon assessment of the patient's joint fluid and blood culture results, non-typhoidal Salmonella (Salmonella group D) was detected. Arthroscopy-guided irrigation and debridement, and administration of oral antibiotics (fluoroquinolone) over six weeks were required in order to achieve a full recovery from the infection.

A Case of Severe Bevacizumab-induced Ischemic Pancolitis, Treated with Conservative Management / 대한소화기학회지

Bevacizumab (Avastin(R)) is a monoclonal antibody against the vascular endothelial growth factor (VEGF) receptor that increases the overall survival rate when added to standard chemotherapy regimens in patients with metastatic colorectal cancer. The known toxicities of bevacizumab are hypertension, proteinuria, wound healing complications, arterial thrombosis, bleeding, and gastrointestinal complications. Especially ischemic colitis can rapidly develop into bowel perforation, so an emergency operation often is needed. Recently, a 65-year-old male patient developed ischemic pancolitis after FOLFOX (85 mg/m2 Oxaliplatin, d1;200 mg/m2 Leucovorin, d1;400 mg/m2 5-FU iv bolus, d1-2;and 600 mg/m2 5-FU, d1-2, every two wk) and Bevacizumab combination chemotherapy was administered. However, he recovered after early conservative care without surgery. We report this case with a review of literature.

A Case of Pseudomembranous Colitis in a Juvenile Rheumatoid Arthritis Patient Taking Methotrexate / 대한소화기학회지

Pseudomembranous colitis is mainly caused by antibiotics and Clostridium difficile infection. But conditions such as gastrointestinal surgery, antacid medication, anti-neoplastic agent or immunosuppressive agent which influences the normal flora of colon can induce colitis without the administration of any antibiotics. We experienced a 13 year-old male who was taking low-dose methotrexate for juvenile rheumatoid arthritis complained diarrhea and abdominal pain for 3 weeks. Sigmoidoscopic findings revealed diffuse patch yellowish pseudomembranes on the rectum. Histologic finding was compatible to pseudomembranous colitis. His symptom was improved after stop taking methotrexate and the administration of metronidazole. If a patient treated with immunosuppressive agents or antineoplastic agents complains diarrhea, fever or abdominal pain and has not improved with conservative care, pseudomembranous colitis should be taken into account as a differential diagnosis and prompt treatment is required for better prognosis.