Clinical and Experimental Emergency Medicine最新文献

Hyperbaric oxygen therapy (HBOT) has garnered significant attention as a therapeutic modality with potential benefits across a variety of medical conditions, ranging from wound healing and ischemic conditions to neurologic disorders and radiation-induced tissue damage. HBOT involves the administration of 100% oxygen at higher-than-atmospheric pressures, which increases the amount of oxygen dissolved in body fluids and tissues. Those elevated oxygen levels are proposed to facilitate tissue repair, reduce inflammation, and promote angiogenesis. This case report presents a compelling instance of the usefulness of HBOT in promoting skin perfusion and healing following peripheral tissue injury caused by administration of inotropic and vasopressor agents to a septic shock patient.

Objective: Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not well understood, and its relationship with the functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes.

Methods: In this multicenter cohort study, we retrospectively analyzed data from 27 hospitals that contributed to the Saiseikai Stroke Database (2013-2021). We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of BAD compared with lacunar infarction (LI) for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included, and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI.

Results: Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (aOR, 2.77; 95% CI, 2.42-3.17; relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients.

Conclusion: BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.

Objective: This study investigated the status and evaluated factors associated with knowledge and attitudes regarding pediatric concussions among Korean parents of children aged 6 to 18 years.

Methods: A cross-sectional online survey was employed to collect data from a panel of parents in Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of total knowledge score (range, 0-30) and total attitude score (range, 7-49) were categorized into tertiles. We conducted multivariable ordinal logistic regression analyses with participants and their children based on demographic information and characteristics as covariates.

Results: A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, 21; interquartile range [IQR], 18-22.5). The respondents exhibited favorable attitudes toward concussions (median total score, 39; IQR, 34-43), except the attitude of the importance of reporting concussion. Multivariable ordinal regression analysis for outcomes revealed only career of healthcare provider (adjusted odds ratio, 3.15; 95% confidence interval, 1.13-8.75) to be associated with parental concussion-related knowledge. No factors exhibited a significant association with parental attitudes toward concussions.

Conclusion: Our results confirmed the knowledge-attitude gap regarding pediatric concussions among Korean parents. Effective strategies are warranted to improve parental knowledge and attitudes.

Objective: This study was conducted to determine whether the presence and degree of left ventricular diastolic dysfunction (LVDD) can be predicted by the simple computed tomography -measured left atrial diameter (CTLAD).

Methods: Among adult patients who underwent both chest CT imaging and echocardiography in the emergency department from January 2020 to December 2021, a retrospective cross-sectional study enrolled patients in whom the time interval between the two tests was <24 hours. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of CTLAD for echocardiographic LVDD.

Results: In a study involving 373 patients, 192 (51.5%) had LVDD. Among them, 122 (63.5%) had grade 1, 61 (31.8%) had grade 2, and nine (4.7%) had ≥grade 3. Median CTLAD values were 4.1 cm for grade 1, 4.5 cm for grade 2, and 4.9 cm for ≥grade 3. The area under the ROC curve value of CTLAD in distinguishing ≥grade 1, ≥grade 2 (optimal cutoff ≥4.4 cm), and ≥grade 3 (optimal cutoff ≥4.5 cm) were 0.588, 0.657 (sensitivity, 61.4%; specificity, 66.0%, positive predictive value, 29.5%; negative predictive value, 88.1%; odds ratio, 3.1), and 0.834 (sensitivity, 88.9%; specificity, 70.1%; positive predictive value, 6.8%; negative predictive value, 99.6%, odds ratio, 18.7), respectively.

Conclusion: CTLAD ≥4.4 cm can be used as a rough reference value to distinguish LVDD of ≥grade 2, while CTLAD ≥4.5 cm can reliably distinguish LVDD of ≥grade 3. CTLAD might be a useful parameter for predicting LVDD in situations where echocardiography is not available.

Following the 2011 ban on paraquat sales, Korea has witnessed a significant reduction in the mortality rate associated with acute pesticide poisoning. Traditionally, paraquat and diquat, alongside several highly toxic organophosphates, carbamates, and organochlorine insecticides, have been recognized as culprits in causing fatalities among patients with acute pesticide poisoning. However, despite global efforts to curtail the use of these highly toxic pesticides, certain pesticides still exhibit a level of lethality surpassing their established clinical toxicity profiles. Understanding the clinical progression of these pesticides is paramount for physicians and toxicologists, as it holds the potential to enhance patient prognoses in cases of acute poisoning. This review aims to address the persistence of such highly lethal pesticides, which continue to pose a grave threat to victims of acute poisoning.