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Objective@#Severe acute cholecystitis is an infectious disease that requires immediate gallbladder drainage. Although percutaneous transhepatic gallbladder drainage (PTGBD) is the most common method of gallbladder drainage, the optimal timing remains unclear. @*Methods@#This study is a retrospective analysis of patients diagnosed with severe acute cholecystitis who underwent PTGBD between July 2018 to June 2021. This study investigated the effect of time from emergency department arrival to PTGBD (tPTGBD) on patient prognosis. @*Results@#Totally, 48 patients were included in this study. Based on the cutoff value calculated using the Youden index, the group with tPTGBD of <5.93 hours had a shorter hospital stay (10 vs. 13.5 days, P=0.021), lower portion of progression (27:5 [15.6%] vs. 7:9 [56.3%], P=0.004), even they had a higher initial SOFA score (6 vs. 4.6, P=0.049). However, no statistical difference was obtained for the length of ICU stay between both groups (1 vs. 2, P=0.617). @*Conclusion@#Executing PTGBD to severe acute cholecystitis patients within 5.93 hours after presenting at the emergency department is associated with reduced progression and hospital stay.
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Objective@#This study aimed to compare the accuracy of the visual estimation of blood loss between medical personnel (MP) and non-medical personnel (NP) and to evaluate how it varies with changes in the bleeding volume and environment. @*Methods@#A total of 78 MP and 132 NP were recruited for the study and asked to evaluate nine artificial blood stations and three different volumes of artificial blood (192 mL, 384 mL, 768 mL) in three different environments (floor, diaper, and commode). Statistical analysis and the two-way repeated measures analysis of variance test were used for data analysis. @*Results@#There were significant differences between MP and NP regardless of the actual bleeding loss in all the bleeding environments-floor (F=25.332, P<0.001), diaper (F=9.942, P=0.002), and commode (F=29.588, P<0.001). NP consistently had higher estimates of bleeding volume compared to MP. The interaction effect between group and volume was statistically significant for the floor and diaper-floor (F=9.708, P<0.001) and diaper (F=5.420, P=0.013), but there was no significant difference for the commode (P=0.087). Additionally, the standard deviation of bleeding volume estimates was higher for NP. @*Conclusion@#Visual estimation of blood loss differed significantly between MP and NP, with NP consistently overestimating and demonstrating lower accuracy and reliability compared to MP. These findings underscore the need for caution when relying on estimates by NP as a diagnostic tool for assessing blood loss.
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Purpose@#As coronavirus disease 2019 pandemic has been prolonged, it became crucial to analyze the long-term impact of the pandemic on emergency department (ED) utilization for efficient use of emergency medicine resources. @*Methods@#We reviewed the data of children (≤ 18 years) who visited the ED in Daejeon, Korea, from February 2019 through January 2021. This period was dichotomized by February 2020 into the reference and pandemic periods. The latter period was further divided into the early (February-August 2020) and late pandemic periods. Between the reference and pandemic periods, and between the early and late pandemic periods, we respectively compared proportions of children in all patients (including adults), age groups, high acuity (the Korean Triage and Acuity Scale 1-2), diagnostic codes, visits via ambulances, ED length of stay, and ED disposition. @*Results@#Compared to the reference and early pandemic periods, the pandemic and late pandemic periods respectively showed changes as follows: proportion of children in all patients (from 29.8% to 19.0% and from 19.8% to 18.1%; all Ps < 0.001), children younger than 5 years (from 56.7% to 49.9% and from 52.1% to 47.4%; all Ps < 0.001), high acuity (from 12.0% to 7.8% [P < 0.001] and from 8.8% to 6.7% [P = 0.004]), “Injury, poisoning and certain other consequences of external causes (S00-T98; from 30.0% to 49.0% and from 48.3% to 49.8%),” and “Diseases of the respiratory system (J00-J99; from 29.6% to 10.3% and from 12.8% to 7.5%).” Increases in the visits via ambulances, ED length of stay, children undergoing intensive care unit hospitalization or death were noted only in comparison between the reference and pandemic periods. @*Conclusion@#A long-term impact of the pandemic on ED use may be a decrease in the proportion of young or ill children.
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PURPOSE: To define early predictors of critical cases involving patients who visited the emergency department (ED) due to gas inhalation, with the goal of identifying patients who require intensive monitoring and treatment. METHODS: The retrospective study was carried out for patients who visited the ED at Ulsan University Hospital due to gas inhalation from March 2014 to February 2016. General demographics, mechanism of accident, critical symptoms, vital signs, blood lab test results, severity, and clinical manifestation were investigated. Patients were divided into a critical group and non-critical group, and predictors of critical cases were investigated by comparing both groups. RESULTS: Of the 180 patients, 26 patients were in the critical group. In this group, more patients displayed altered mentality and cardiac arrest (both p<0.001). The critical group also showed significantly higher fractions for low-blood pressure (systolic blood pressure<90 mmHg; p<0.001), number of critical symptoms (p<0.001), transport by emergency medical services (p=0.003), and consultation involving other departments (p<0.001). Patients in the critical group showed higher Korean Triage and Acuity Scale (KTAS) level (p<0.001), lactate value (p=0.001), and carboxy-hemoglobin value (p=0.017) as well as older age (p=0.001), lower pH (p=0.001), and HCO₃⁻ value (p<0.001). Multiple regression analysis revealed that predictors of critical cases were older age and higher KTAS level (both p<0.001). CONCLUSION: Patients admitted to the ED for treatment of gas inhalation, who were older and had a higher KTAS level, require intensive monitoring and treatment.
Asunto(s)
Humanos , Análisis de los Gases de la Sangre , Demografía , Urgencias Médicas , Servicios Médicos de Urgencia , Medicina de Emergencia , Servicio de Urgencia en Hospital , Paro Cardíaco , Concentración de Iones de Hidrógeno , Inhalación , Ácido Láctico , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Lesión por Inhalación de Humo , Triaje , Signos VitalesRESUMEN
PURPOSE: The aim of this study was to investigate the therapeutic effects of a herbal formula, PerioH-035, containing Angelica sinensis, steamed Rehmannia glutinosa, Angelica dahurica, Cimicifuga heracleifolia, and Zanthoxylum piperitum on the periodontal breakdown in a well-established ligature-induced periodontitis model in rats. METHODS: Sprague-Dawley rats were randomly assigned to 1 of 4 groups: NL (non-ligatured), L (ligatured), P1 (ligatured and treated with 1 mg/mL PerioH-035), P100 (ligatured and treated with 100 mg/mL PerioH-035). Periodontitis was induced by placing a ligature around the mandibular first molars. PerioH-035 was topically applied to both sides of the first molar for 2 weeks. The right side of the mandibles was retrieved for micro-computed tomography (CT) and methylene blue staining to analyze alveolar bone loss. The left side of the mandibles was histologically analyzed by TRAP and H&E staining. The MMP-9 mRNA level in gingival tissue was investigated by RT-PCR. RESULTS: Alveolar bone resorption was significantly reduced in the PerioH-035-treated groups. The number of dense multi-nucleated cells found to be TRAP-positive by staining in the ligatured rats was markedly decreased by PerioH-035 application. In addition, periodontal tissue destruction, especially cementum demineralization, was ameliorated in the P1 and P100 groups. Moreover, gingival tissue from the PerioH-035-treated group showed a decrease in the MMP-9 mRNA level, resulting in recovery of collagen degradation. CONCLUSIONS: These results suggest that PerioH-035 has therapeutic effects on periodontitis, and thus, PerioH-035 shows promise as a treatment for periodontitis. GRAPHICAL ABSTRACT: