Journal of acute medicine最新文献

We report a case highlighting the global prevalence of atrial fibrillation (Afib) and the increased use of ablation therapy, underscoring the importance of understanding its complications, especially atrio-esophageal fistula (AEF), a rare but potentially fatal outcome. This case involves a 38-year-old male who underwent radiofrequency ablation for Afib and was subsequently hospitalized with abrupt left-sided weakness. Initially presumed to be a transient ischemic attack (TIA), his condition progressed to seizures and reduced consciousness. The computed tomography scans revealed pneumocranium, leading to a diagnosis of AEF. Despite the rapid identification of this complication, the patient's condition deteriorated quickly, resulting in his death on the 10th day. This case exemplifies that while AEF is an infrequent complication (0.1%-0.2%) following Afib ablation, it is of critical concern. The initial symptoms of AEF can be misleading, which accentuates the necessity for prompt recognition and timely intervention. Employing appropriate diagnostic techniques and ablation strategies are crucial to enhance patient outcomes and reduce the risks associated with AEF.

Background: Acute kidney injury (AKI) is a significant concern in critically ill patients, with mortality and morbidity implications. The serum uric acid-to-albumin ratio has been proposed as a potential prognostic marker for patients with and without AKI. This study aimed to investigate the relationship between this ratio and 28-day mortality in these patient groups.

Methods: A retrospective study was conducted on critically ill patients aged over 18, hospitalized in the internal medicine ICU at Osmangazi University, Eskisehir, Turkey, from May 2020 to November 2021. Patients were categorized based on the presence or absence of AKI. The primary outcome was 28-day mortality. The serum uric acid-to-albumin ratio was calculated, and its prognostic value was assessed using Receiver Operating Curve (ROC) analysis.

Results: Of the 1,016 patients, 449 had AKI. The mean age was 67.1 ± 15.27 years, with 53.9% being male. The serum uric acid-to-albumin ratio was found to have significant prognostic value in predicting 28-day mortality in both groups. In the overall study group, a ratio of 2.32 mg/g predicted 28-day mortality with 71.1% specificity and 58.3% sensitivity. For patients with AKI, a ratio of 3.59 mg/g predicted mortality with 85.3% specificity and 44% sensitivity. For those without AKI, a ratio of 2.28 mg/g predicted mortality with 84.1% specificity and 39.3% sensitivity.

Conclusion: The serum uric acid-to-albumin ratio is a valuable prognostic tool for predicting 28-day mortality in critically ill patients, irrespective of AKI status. Incorporating this low-cost biomarker into scoring systems could enhance patient management and outcome predictions.

Background: This study aimed to assess the diagnostic value and safety of using Pulmonary Embolism Rule-Out Criteria (PERC) in an emergency care setting.

Methods: We conducted a retrospective application of the PERC to the patients suspected of having pulmonary embolism (PE) and who underwent computed tomography pulmonary angiogram (CTPA) Karolinska University Hospital's emergency department (ED) from 2016 to 2017. The patient data, including D-dimer (DD) and ED waiting times were extracted from the Karolinska Venous Thromboembolism cohort (VTE cohort).

Results: Among the 295 patients included in the cohort, 34 (11.5%) were diagnosed with PE. Of these 202 (68.5%) patients were PERC-positive, while 93 (31.5%) were PERC-negative. Among the 93 PERC-negative patients, three had PE; resulting in a sensitivity of 91% (95% CI: 0.77-0.97), a specificity of 34% (95% CI: 0.29-0.40), and a false negative rate (FNR) of 8.8%. Combining positive DD and PERC resulted in a sensitivity of 100% (95% CI: 0.86-1.00), a specificity of 23% (95% CI: 0.15-0.34), and no FNR. When patients classified as high risk for PE (determined by clinical gestalt) were excluded, no PEs were missed. The median total ED stay was 450 minutes in patients who underwent CTPA compared to 203 minutes in the reference group ( p < 0.0001).

Conclusions: Using the PERC rule along with DD testing in low-risk patients effectively rules out PE in ED without the need for further testing. Properly using PERC may significantly reduce patients' waiting time in the ED.

Retroperitoneal biloma and accompanying bilioscrotum are very rare entities. A 49-year-old male patient underwent endoscopic retrograde cholangiopancreatography procedure with the preliminary diagnosis of stone-mud in the common bile duct. On the seventh day after the procedure, diffuse air densities observed around the duodenum and biliary stent protruding beyond the lumen in the non-contrast abdominal computed tomography examination were evaluated as duodenal perforation. In addition, a collection area compatible with biloma was observed in the retroperitoneal area. Extension of the retroperitoneal biloma from the inguinal canal to the scrotal sac was observed in the follow-up imaging (bilioscrotum). The patient was operated after biliary drainage with percutaneous treatment was provided. Delay in the diagnosis and intervention following duodenal perforation leads to significantly higher mortality, and bilioscrotum should be kept in mind in a patient presenting with scrotal pain and swelling after any surgical or invasive procedure, and duodenal perforation should be considered as a possible cause.

Aortic dissection (AD) is the most prevalent aortic pathology, with an incidence of 2.6-3.5 cases per 100,000 inhabitants per year with mortality rates as high as 90% at 3 months without proper management. Despite the presence of typical symptoms, it has been reported that up to 38% of cases go unnoticed in the initial evaluation, either due to additional symptomatology or the absence of classic symptoms. In 28% of cases the diagnosis is made post-mortem, highlighting the severity and importance of timely diagnosis. The main goals of this study were to identify the primary neurological manifestations of acute AD and the frequency of these manifestations in type A and B AD according to the Stanford classification. A total of 2,734 records were retrieved from two databases, of which 2,611 were excluded. Therefore, 123 articles were obtained and 88 were evaluated for eligibility. Consequently, 79 articles were included in the review. The abstracts identified in the search were screened by seven blinded independent authors and excluded those who lacked relevance. The authors read the full texts independently to determine inclusion. A third reviewer adjudicated discrepancies when opinions were at odds. There were 169 patients diagnosed with Stanford type A, of which 43.8% displayed quantitative impairment of consciousness. Within this group, transient loss of consciousness was observed in 34.3% of cases. Motor syndrome was present in 54.5%, with 23.7% of patients presenting with hemiparesis or hemiplegia. 3.6% had facial paresis or paralysis and less frequently monoparesis, paraparesis, hyperreflexia, spasticity, and muscle spasms. 7.6% presented with language impairments including Broca's aphasia and dysarthria. Seizures were present in 3.6%. Neuro-ophthalmological symptoms were 2.9%, cortical or cognitive symptoms and headache were 2.3%, cerebellar syndrome was 1.8%, and sensory syndrome was 1.2%. Of 86 patients diagnosed with Stanford type B, 57.0% displayed motor syndrome, with 50.0% being paraparesis or paraplegia, 4.7% monoplegia, and 2.3% hemiplegia or hemiparesis. Additionally, impairment of consciousness was present in 26.7%, sensory syndrome in 12.8%, and language impairments in 3.5%. In the emergency department, understanding the neurological manifestations in both Stanford type A and B dissections emerges as a pivotal cornerstone for conducting precise assessments and efficient patient management. Given the wide spectrum of manifestations, we emphasize the importance of suspecting AD when neurological disorders are associated with the classic symptoms. In these cases, we encourage a complete neurological examination to be performed and a multidisciplinary group assembled to tackle this entity.

Acute deteriorated consciousness is commonly reported in elderly COVID-19 patients. Secondary bacterial infection is common in critically ill COVID-19 patients. Listeria monocytogenes is a gram-positive, facultatively intracellular rod-shaped bacterium ubiquitously distributed in the environment and is an opportunistic and foodborne pathogen. Pregnant women and their newborns, adults aged 65 years or older, and immunocompromised people are more vulnerable to Listeria -related invasive disease. A 74-year-old man with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with initial presentations of headache and acute disorientation, which was finally diagnosed with L . monocytogenes bacteremia and meningitis. Multiplex polymerase chain reaction (Multiplex PCR) assay was used to rapidly diagnose it in the emergency department.

Background: Emergency medicine (EM) is a growing specialty both clinically and academically. Academic EM development can be measured by number of scientific publications. This study aimed to evaluate the academic international cooperation trend of Taiwan emergency departments (EDs) in the past two decades using social network analysis (SNA).

Methods: The study population were publications with first author affiliated with Taiwan EDs and the study duration was publication year before 2021. The enrolled publications were categorized into two groups: Group one, all authors were affiliated with Taiwan (domestic publications) and Group two, authors were affiliated with Taiwan and other countries (international publications). The primary outcome measurement was the degree centrality of Taiwan before 2021. The secondary outcome measurements included the trend in annual publication number of Group one and Group two, the trend in country number of each year in Group two, the top five countries that collaborate with Taiwan, the difference between the median of citation numbers in Group one and Group two, and the difference between the median of author numbers in Group one and Group two.

Results: A total 4,363 publications were enrolled, of which 4,046 publications were classified in Group one and 317 publications were in Group two. The annual publication number of both groups increased significantly. The annual country number of collaboration with Taiwan ED publications had also significantly increased. The median of citation number and author number in Group two were both significantly higher than Group one. The top five countries collaborating with Taiwan were the United States, China, Malaysia, Japan, and Australia.

Conclusions: Taiwan EDs' growing international collaboration in the past two decades indicated a capacity to conduct multi-country research. International collaboration publications obtained higher citations compared to domestic publications. Researchers should enhance international collaborations for academic advancement.

In modern medical practice, procedures that involve the use of catheters are common. These procedures can range from percutaneous coronary and peripheral vascular interventions to using catheters to drain fluid. However, complications associated with catheter usage can arise, and the most severe one is the puncture of a vital organ due to catheter misplacement. In this case, we present a rare complication related to the use of a pigtail catheter, which caused perforation of the left ventricular free wall. The patient presented with an electrocardiogram showing ST segment elevation in the anterior wall, indicative of a heart attack. The patient underwent coronary angiography, which showed that the coronary arteries were unblocked. However, during the procedure, the medical team suspected that the pigtail catheter was stuck in the left ventricle chamber, based on the use of fluoroscopy. This suspicion was later confirmed using computer tomography. To address the issue, the patient underwent an emergent cardiorrhaphy, which was performed immediately. Fortunately, the patient survived the complication.

Emamectin Benzoate, a potent pesticide extensively used in agriculture, has raised concerns due to its potential for severe poisoning. While its safety in mammals is attributed to limited blood-brain barrier penetration and reduced affinity for specific channels, Emamectin Benzoate Poisoning can unexpectedly manifest with severe symptoms. Predominantly resulting from intentional ingestion, clinical presentations involve central nervous system depression, respiratory distress, gastrointestinal symptoms, and sore throat. Formulation solvents enhance toxicity, leading to corrosive injuries and metabolic imbalances. Skin contact induces irritation. Diagnosis relies on clinical evaluation, lacking specific laboratory data. Treatment lacks a designated antidote; hence, decontamination and cautious symptomatic management play pivotal roles. Severe cases require vigilant monitoring, with intensive care unit admission calling for altered consciousness and respiratory distress.