Ingestion of puffer fish can result in severe and potentially lethal intoxication, referred to as tetrodotoxin intoxication. Tetrodotoxin is a potent neurotoxin well known for its ability to ability neuromuscular function. Tetrodotoxin is a specific and potent blocker of axonal sodium channel; it may block sodium channels in the axon of the neurons of the neurohypophysis, thereby inhibiting the release of vasopressin and causing diabetes insipidus neurotoxin. To our knowledge, previous report on diabetes insipidus causing tetrodotoxin is the only one case in Singapore. A married couple (69-year-old man and 57-year-old woman) ingested two green rough-backed puffer fish (Lagocephalus lunaris). They complained of paresthesia on perioral area and extremity and developed not only grade IV intoxication but also an increased urine output (4455 ml/day and 5035 ml/day), elevated serum sodium (157.4 mEq/L and 166.7 mEq/L) and elevated serum osmolality (324 mosmol/kg and 339 mosmol/kg), which suggested the development of diabetes insipidus. The administration of desmopressin nasal spray was successful in normalizing urine volume. Both were discharged on 20th and 18th hospital day, respectively, without any complications.
Axons ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Eating ; Extremities ; Neurons ; Osmolar Concentration ; Paresthesia ; Pituitary Gland, Posterior ; Sodium ; Sodium Channels ; Tetraodontiformes ; Tetrodotoxin ; Vasopressins

Alocasia was originally distributed throughout subtropical and tropical areas. Recently, in Korea, it has been used in air cleaners and in control of humidity. Despite easy access in Korea, there are few reports on Alocasia toxicity. We report on two cases of Alocasia intoxication. One patient was a 16-month-old male, who was admitted with a complaint of irritability after biting leaves of Alocasia. Four hours later, he was discharged without any symptoms. Another patient, a 52-year-old female, complained of oral pain, numbness on the perioral area, dysphonia, swallowing difficulty, and chest and abdominal pain after eating root stuck of alocasia odora. She underwent gastrointestinal fibroscopy (GIF) due to lasting chest and abdominal pain. Finding on GIF showed erythema and swelling in the aryepiglottic fold and larynx. Her symptoms lasted 13 days; she was then discharged without any complications or sequelae.
Abdominal Pain ; Alocasia ; Bites and Stings ; Deglutition ; Dysphonia ; Eating ; Erythema ; Female ; Humans ; Humidity ; Hypesthesia ; Korea ; Larynx ; Male ; Thorax

PURPOSE: Patients who are hemodynamically unstable because of severe trauma may require very early transfusion during their care in the emergency center. I employed a four-level scoring system in order to shorten the interval from evaluation to treatment in early transfusion. METHODS: Trauma patients receiving transfusions, who visited our emergency center from May 2003 to December 2006 were retrospectively recruited. The scoring system consisted of four levels; "most urgent" or level I, "urgent" or level II, "emergent" or level III and "routine" or level IV. Type O/Rh(+) bloods were transfused for the most urgent level, type-specific bloods were transfused for the urgent level, type-specific and incompletely cross-matched bloods were transfused for the emergent level, and fully crossmatched bloods were transfused for the routine level. RESULTS: The mean interval from evaluation to treatment with transfusion was 4.4+/-1.8 min in the most urgent group, 15.5+/-8.4 min in the urgent group, 36.4+/-17.3 min in the emergent group, and 70.5+/-25.9 min in the routine group. The cut-off values ware < or =90 mmHg for systolic blood pressure, < or =6.9 for revised trauma score, and > or =4.5 for emergency room transfusion score. CONCLUSION: Establishment of a four-tiered scoring system for treatment of severe trauma patients by early transfusion was successful in shortening the interval between evaluation and initiation of transfusion. Patients who do not meet cut-off values require careful observation.
Blood Pressure ; Blood Transfusion ; Emergencies ; Emergency Service, Hospital ; Humans ; Multiple Trauma ; Retrospective Studies

We report on a case of right thalamic hemorrhage resulting from low-voltage electrical injury caused by contact between a wet hand and an electronic scale. The patient was treated with clopidogrel for control of a previous cerebral infarction. The patient complained of numbness of the left upper extremity. On neurological examination, decreased motor power of her left side, grade IV, was observed. Findings on computerized tomography of the brain revealed a right thalamic hemorrhage. To the best of our knowledge, cerebral hemorrhage resulting from low-voltage electrical injury has not been previously reported in the literature.
Brain ; Cerebral Hemorrhage ; Cerebral Infarction ; Electric Injuries ; Electronics ; Electrons ; Hand ; Hemorrhage ; Humans ; Hypesthesia ; Neurologic Examination ; Ticlopidine ; Upper Extremity

Glufosinate ammonium (GLA, BASTA(R)), a non-selective herbicide, is widely used in many countries including Korea. The neurological complications of GLA intoxication are manifested as a loss of consciousness, convulsion, or memory impairment. We encountered a 59-year-old male, who was presented to the emergency department 1 hour after orally ingesting GLA. The patient developed mental disturbances, impaired respiration and generalized tonicch ronic seizures. Although the patient was initially treated with lorazepam and phenytoin, the seizures continued to occur. Through continuous infusion of midazolam along with respiratory support, the occurrence of the seizures was controlled. The patient was discharged with no medical and neurological abnormalities except for a shortterm memory loss.
Ammonium Compounds* ; Emergency Service, Hospital ; Humans ; Korea ; Lorazepam ; Male ; Memory ; Memory, Short-Term ; Midazolam ; Middle Aged ; Phenytoin ; Respiration ; Seizures ; Status Epilepticus* ; Unconsciousness

Ingestion of the eyes and many of the internal organs of puffer fish can result in severe and potentially lethal intoxication, but there is little available information regarding the results of grade IV tetrodotoxin (TTX) intoxication. Thus, we retrospectively reviewed and analyzed the clinical characteristics of ventilator therapy patients and those suffering respiratory failure after ingestion of TTX from puffer fish, who were admitted to our hospital from January 2002 to May 2011. Of the total patients evaluated, we observed seven cases of Fukuda classification grade IV TTX poisoning. All patients were discharged without any complications within 5-26 days after admission.
Eating ; Eye ; Humans ; Respiratory Insufficiency ; Retrospective Studies ; Stress, Psychological ; Tetraodontiformes ; Tetrodotoxin ; Ventilators, Mechanical

Objective: Various out-of-hospital cardiac arrest (OHCA) prognostication scores have been developed. However, the application of these scores is often limited owing to missing predictor variables. This study aimed to compare and validate various OHCA prognostication scores using simple imputation methods that can easily be applied in clinical situations. Methods: Adult patients presenting with OHCA with a sustained return of spontaneous circulation (ROSC) between October 2015 and June 2020 were the subjects for the analysis. We evaluated six OHCA prognostication scores: the ROSC after cardiac arrest (RACA) score, CaRdiac Arrest Survival Score (CRASS), NULL-PLEASE, predictive score (PS), cardiac arrest hospital prognosis (CAHP) score, and the OHCA score. For missing predictors, median imputation for continuous variables and mode imputation for categorical variables were performed before the analysis. We evaluated the discrimination and calibration powers of each prognostic score for good neurological recovery at discharge. The area under the receiver operating characteristic curve (AUC) was used to assess the discrimination power, and a calibration plot and the Hosmer-Lemeshow test were used to assess the calibration power. Results: Of the 12,321 patients, 5,191 were subjected to analysis. Among them, 924 (17.8%) had good neurological recovery. Certain predictors often had missing values-no-flow time 1,107 (21.3%), low-flow time 862 (16.6%), pH 1,104 (21.3%), lactate 1,820 (35.0%), and creatinine 2,257 (43.5%). After imputing the missing variables, the CAHP score showed the highest AUC (0.957; 95% confidence interval, 0.950-0.963), and the CRASS and PS also presented excellent discrimination power (AUC 0.914 and 0.942, respectively). However, the CAHP and NULL-PLEASE scores were well calibrated (Hosmer-Lemeshow test, P>0.05). Conclusion Among the six prognostic scores, the CAHP score showed the highest discrimination and calibration powers.

PURPOSE: This study was to evaluate temporal changes in the expressions of the phosphorylated extracellular-regulated kinase1/2 (pERK1/2), the phosphorylated MAPK/ERK kinase1/2 (pMEK1/2) and the cFos proteins in the hippocampus of rats following transient global ischemia. METHODS: Transient global ischemia was induced in the forebrains of Sprague-Dawley rats by using a 4-vessel occlusion for 20 min under anesthetic condition. Hematoxyline-eosin staining showed typical microscopic findings that represented neuronal cell death in hippocampal CA1 regions 5 days after transient global ischemia. Four-vessel occlusion-reperfusion produced ischemic injury in major forebrain structures, such as the striatum, the cortex and the hippocampus, in the finding of triphenyltetrazolium chloride (TTC) staining. RESULTS: A high density of pERK1/2 immunoreactivity existed in the pyramidal-cell layers of the CA2-3 regions and in the granular-cell layers of the dentate gyrus 5 min after ischemia. Following ischemia, expression of the pMEK1/2 protein showed temporal changes similar to that of the pERK1/2 protein. A significant expression of the cFos protein was noted in the pyramidal-cell layers of the CA2-3 regions and in the granular-cell layers of the dentate gyrus 2 hours after global ischemia. CONCLUSION: Intracellular signaling cascades of the ERK or the cFos protein take part in early cellular events in the hippocampus of rats in response to ischemic insult.
Animals ; CA1 Region, Hippocampal ; Cell Death ; Dentate Gyrus ; Hippocampus* ; Ischemia ; Neurons ; Prosencephalon ; Rats* ; Rats, Sprague-Dawley ; Reperfusion Injury*

Development of a competence-based curriculum is important. This study aimed to develop competence assessment tools in emergency medicine and use it to assess competence of Cameroonian healthcare professionals. This was a cross-sectional, descriptive study. Through literature review, expert survey, and discrimination tests, we developed a self-survey questionnaire and a scenario-based competence assessment tool for assessing clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey consisted of 23 domains and 94 questionnaires on a 5-point Likert scale. Objective scenario-based competence assessment tool was used to validate the self-survey results for five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey was 82.6%. In this first half of competence assessment, knowledge of infectious disease had the highest score (4.6 ± 0.4) followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, respondents rated the lowest score in the domains of disaster, abuse and assault, and psychiatric and behavior disorder (all of mean 2.8). In the scenario-based test, knowledge of multiple trauma had the highest score (4.3 ± 1.2) followed by anaphylaxis (3.4 ± 1.4), diabetic ketoacidosis (3.3 ± 1.0), ST-elevation myocardial infarction (2.5 ± 1.4), and septic shock (2.2 ± 1.1). Mean difference between the self-survey and scenario-based test was statistically insignificant (mean, −0.02; 95% confidence interval, −0.41 to 0.36), and agreement rate was 58.3%. Both evaluation tools showed a moderate correlation, and the study population had relatively low competence for specific aspects of emergency medicine and clinical procedures and skills.
Anaphylaxis ; Cameroon* ; Communicable Diseases ; Curriculum ; Delivery of Health Care* ; Developing Countries ; Diabetic Ketoacidosis ; Disasters ; Discrimination (Psychology) ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Gynecology ; Hematology ; Mental Competency* ; Multiple Trauma ; Myocardial Infarction ; Obstetrics ; Professional Competence ; Shock, Septic ; Surveys and Questionnaires

PURPOSE: To assess the behaviour of fresh frozen cancellous allograft used for supporting the reconstructed articular surface in impacted tibial plateau fractures. MATERIALS AND METHODS: Between May 2004 and May 2008, 13 cases of impacted tibial plateau fracture were evaluated retrospectively. All fractures were treated with open reduction-internal fixation after restoration of the tibial plateau surface and insertion of fresh frozen cancellous allograft chips for subchondral support. Mean age was 46.6 (31~65) years. Average follow-up period was 36 (13~58) months. The radiological and clinical result for every patient was assessed according to the modified Rasmussen's system and Lysholm's knee score. RESULTS: According to last follow-up weight bearing A-P X-ray, the fresh frozen cancellous allograft incorporated soundly in all cases and no complications such as joint depression, fracture reduction loss, angular deformity, and malunion were found. The mean time to complete bone union was postoperative 10+/-0.7 weeks. The mean range of motion was 135 (115~145) degrees. The mean Rasmussen's radiological score at last follow up was 15.3 (10 cases: excellent, 3 cases: good). The mean Lysholm's knee score at last follow up was 88.2+/-4.3. CONCLUSION: We concluded that fresh frozen cancellous allograft in impacted tibial plateau fractures showed good results in terms of bone union and functional improvement and was considered to be a good structural supporter.
Congenital Abnormalities ; Depression ; Follow-Up Studies ; Humans ; Joints ; Knee ; Range of Motion, Articular ; Retrospective Studies ; Transplantation, Homologous ; Transplants ; Weight-Bearing