OBJECTIVE: Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF). METHODS: It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214). RESULTS: Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ≥ 3 (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement. CONCLUSION: Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.
Anticoagulants ; Atrial Fibrillation* ; Cardiology ; Dabigatran* ; Drug-Related Side Effects and Adverse Reactions ; Electric Countershock ; Electronic Health Records ; Hemorrhage ; Humans ; Inpatients ; National Health Programs ; Neurology ; Prescriptions ; Retrospective Studies ; Rivaroxaban* ; Stroke*

Many risk factors for atherosclerosis have been proposed to identify high risk individuals. We conducted a retrospective study to determine the risk factors for development of carotid stenosis (CS) in Koreans. Database of 2,805 subjects who underwent a check up of carotid artery for health examination were analyzed. Stenosis (%) of common carotid artery or proximal internal carotid artery was examined with ultrasonography. Subjects were divided into 2 groups (Group I; CS <10%, Group II; CS > or =30%). We compared demographic, laboratory and clinical data between 2 groups to determine the risk factors of CS. One hundred ninety seven subjects (7.0%) were categorized as Group II. At age- and sex-adjusted multivariate analysis, diabetes mellitus, hypertension, cerebrovascular disease, ischemic heart disease, hyperlipidemia, aspirin medication, current smoking, fasting glucose, total cholesterol, low density lipoprotein-cholesterol (LDL-C) and leukocyte count were significant risk factors of CS. At stepwise logistic regression analysis, age, hypertension, hyperlipidemia, LDL-C and leukocyte count were independent risk factors. At subgroup analysis by smoking, age and leukocyte count were independent risk factors in smoker and age and hypertension in nonsmoker.
Adult ; Age Factors ; Aged ; Carotid Stenosis/blood/*epidemiology/etiology ; Cholesterol/blood ; Comparative Study ; Female ; Humans ; Korea/epidemiology ; Lipoproteins, LDL Cholesterol/blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoking/adverse effects

PURPOSE: Platycodon grandiflorum (PG) is known to have effective antimicrobial and anticancer activity. The main bioactive components of PG are saponins, and these could contribute to anti-inflammatory activity. However, little is known about the anti-inflammatory effect of PG. In this study, we aim to assess the anti-inflammatory response to Red PG Extract (RPGE) in splenocytes under ex vivo conditions. METHODS: The cell viability of isolated splenocytes taken from mice was analyzed by performing a Cell Counting Kit-8 assay. The productions of nitric oxide (NO) and cytokines (specifically interleukin-6 (IL-6) and interleukin-10 (IL-10)) were measured utilizing Griess reagent and ELISA, respectively. RESULTS: We found that co-treatment with RPGE and Lipopolysaccharide (LPS) decreased isolated splenocyte proliferation as compared with that of the LPS-stimulated control. We also observed that RPGE markedly suppressed NO synthesis and IL-6 production that was induced by LPS. There were no significant differences of IL-10 production between co-treatment with RPGE plus LPS and treatment with LPS alone. CONCLUSION: When taken together, our data has shown that RPGE mitigates LPS-induced inflammation in splenocytes isolated from mice. Further research is surely needed to confirm the anti-inflammation effects of RPGE in an in vivo model.
Animals ; Cell Count ; Cell Survival ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Mice ; Nitric Oxide ; Platycodon ; Saponins

This study was designed to investigate the effect of preoperative collection of blaod and acute normovolemic hemodilution(ANH) on the requirement of homologous transfusion, perioperative blood loss and hematological parameters in patients undergoing open heart surgery. Ninety two adult patients for elective open heart surgery were randomly assigned to one of three groups. Group I, ANH group, had blood withdrawn to a hematocrit of 33%o after induction of anesthesia(n =54). In Group II preoperative collection of blood in accordance with hospital protocol and ANH were performed(n=16). Ciroup III was control group(n=22). Autologous blood was replaced post bypass. The patients whose hematocrit fell below 25% were transfused with homologous blood. The use of homologous transfusion was 2.2+/-0.4 units in group I, 0.1+/-0.1 units in group II and 4.1+/-0.8 units in group III. Requirement of homologous transfusion in group II was reduced compared with group II and III with statistical significance(P<0.05). There was statistical significance between group I and group III(P<0.05) in homologous transfusion. Postoperative blood loss was 760.7+/-74.6 ml in group I, 675.6+101.5 ml in group II and 819.3+/-91.3 rnl in group III. There was no statistical significance among 3 groups. There was no difference in hematocrit or platelet count, and total blood loss on immediately post surgery or on day 1. Our data show that preoperative collection of blood and ANH can reduce the amount of homologous transfusion.
Adult ; Heart* ; Hematocrit ; Hemodilution* ; Humans ; Platelet Count ; Postoperative Hemorrhage ; Thoracic Surgery*

Doxylamine succinate is common over-the-counter sleep medication that is frequently involved in accidental poisonings and suicide attempts. Doxylamine overdose is generally directed at the anticholinergic effect including autonomic,and central nervous system effect and direct cardiac toxicity. Rarely, rhabdomyolysis has been reported with doxylamine overdose. We experienced two cases of rhabdomyolysis with overdose of doxylamine in 17-year-old and 31-year-old male. They were diagnosed with high levels of creatine phosphokinase in serum, myoglobin in serum and urine, and increased radionuclide uptake of muscles in (99m)Tc-MDP bone scan. Patients recovered without any complications with hydration and diuresis. Clinicians should be aware of the possibility of rhabdomyolysis in patients with doxylamine overdose.
Acute Kidney Injury ; Adolescent ; Adult ; Central Nervous System ; Creatine Kinase ; Diuresis ; Doxylamine* ; Humans ; Male ; Muscles ; Myoglobin ; Poisoning ; Rhabdomyolysis* ; Succinic Acid ; Suicide

Although coagulase-negative staphylococci (CNS) have been considered part of the resident flora on the human skin, Staphylococcus lugdunensis is an unusually virulent CNS and can cause many types of infection. We report a rare case of acute lymphadenitis with cellulitis in the right infraauricular region caused by S. lugdunensis. A 62-yr-old woman visited the Department of Otolaryngology of Busan Paik university hospital. She had a palpable mass and swelling in the right infraauricular region and complained of aggressive pain and a febrile sensation in the region for 5 days. On the suspicion of abscess with infection, percutaneous aspiration was performed and smooth, flat, white, opaque colonies grew on a blood agar plate as a pure culture. The biochemical test results showed the organism to be catalase positive, tube coagulase negative, ornithine decarboxylase positive, slide coagulase positive, and latex agglutination tests for coagulase positive. The API Staph Kit was used to identify the isolate to the species level as S. lugdunensis with a 64.6% probability (profile 6716152). We confirmed the species identification of this strain by 16S rDNA sequence analysis. The patient's clinical condition improved with appropriate antimicrobial therapy and pus drainage.
Acute Disease ; Cellulitis/*diagnosis/*microbiology ; Drainage ; Ear, External ; Female ; Humans ; Lymphadenitis/*diagnosis/drug therapy/*microbiology ; Microbial Sensitivity Tests ; Middle Aged ; RNA, Ribosomal, 16S/genetics ; Sequence Analysis, DNA ; Staphylococcal Infections/*diagnosis/microbiology

Purpose: This study examined the recognition of rehabilitative robots for treatment in physical therapists. Methods: This study surveyed 100 physical therapists in Seoul and Gyeonggi-do using Google Form, an online survey tool. The questionnaire consisted of 21 questions, including eight questions on the general characteristics, 13 questions on the recognition of rehabilitative robots. Results: The general characteristics of the physical therapists showed differences and influences on recognition of rehabilitative robots, and there were statistically significant differences. There were significant differences in the recognition of rehabilitation robots according to general characteristics in gender, age, education degree, type of hospital, average weekly working time, and treatment field. Multiple regression analysis found that gender and the type of hospital influenced the recognition of rehabilitation robots. Conclusion Physical therapists showed differences in recognition of rehabilitative robots according to their general characteristics, and gender and the type of hospital influence the recognition of rehabilitation robots. Sufficient systematic education programs should be provided, and physical therapists require policy adjustments to increase their accessibility to rehabilitation robots through continuing education.

Purpose: This study examined the recognition of rehabilitative robots for treatment in physical therapists. Methods: This study surveyed 100 physical therapists in Seoul and Gyeonggi-do using Google Form, an online survey tool. The questionnaire consisted of 21 questions, including eight questions on the general characteristics, 13 questions on the recognition of rehabilitative robots. Results: The general characteristics of the physical therapists showed differences and influences on recognition of rehabilitative robots, and there were statistically significant differences. There were significant differences in the recognition of rehabilitation robots according to general characteristics in gender, age, education degree, type of hospital, average weekly working time, and treatment field. Multiple regression analysis found that gender and the type of hospital influenced the recognition of rehabilitation robots. Conclusion Physical therapists showed differences in recognition of rehabilitative robots according to their general characteristics, and gender and the type of hospital influence the recognition of rehabilitation robots. Sufficient systematic education programs should be provided, and physical therapists require policy adjustments to increase their accessibility to rehabilitation robots through continuing education.

Purpose: This study was conducted to investigate the nursing needs and workload of nurses according to nursing dependency for effective placement of nursing staff in the emergency department (ED). Methods: In June 2020, 256 adult patients who visited the ED were classified as two groups, suspected COVID-19 patients and general patients. The participants’electronic medical records were analyzed using descriptive statistics, t-test, x 2 -test, and Fisher's exact test using the SPSS. Results: The patient dependence score showed a significant difference between the two groups, with an average of 13.99±1.85 for the suspected COVID-19 patient group and 10.58±2.10 for the general patient group (t=12.42, p<.001). There were statistically significant differences in communication (t=3.28, p=.001), mobility (t=3.29, p=.001), nutrition, elimination, and personal care (t=7.34, p<.001) among the six domains of nursing dependency. In the domains of environment, safety, health, and social needs, the dependency score was 3 for all suspected COVID-19 patients and 1 for all general patients. Conclusion The results of this study confirmed that infection control activities of emergency patients who need isolation affect the patients’ nursing dependency on nursing care.

Purpose: This study was conducted to investigate the nursing needs and workload of nurses according to nursing dependency for effective placement of nursing staff in the emergency department (ED). Methods: In June 2020, 256 adult patients who visited the ED were classified as two groups, suspected COVID-19 patients and general patients. The participants’electronic medical records were analyzed using descriptive statistics, t-test, x 2 -test, and Fisher's exact test using the SPSS. Results: The patient dependence score showed a significant difference between the two groups, with an average of 13.99±1.85 for the suspected COVID-19 patient group and 10.58±2.10 for the general patient group (t=12.42, p<.001). There were statistically significant differences in communication (t=3.28, p=.001), mobility (t=3.29, p=.001), nutrition, elimination, and personal care (t=7.34, p<.001) among the six domains of nursing dependency. In the domains of environment, safety, health, and social needs, the dependency score was 3 for all suspected COVID-19 patients and 1 for all general patients. Conclusion The results of this study confirmed that infection control activities of emergency patients who need isolation affect the patients’ nursing dependency on nursing care.