Objective: This study aimed to assess whether the conventional treatments administered in the emergency department (ED) for hypertensive urgencies (observed or peroral [PO]-controlled) in severe high blood pressure (BP) patients with epistaxis increase the incidence of epistaxis recurrence and the mortality rate as compared to immediate BP control using intravenous (IV) antihypertensive medication Methods: A retrospective study over 7 years was conducted at the ED of a tertiary university hospital. Among adult patients with spontaneous epistaxis, subjects with severe high BP (systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg) were included in the study. Participants were divided into three groups determined by the methods used to control BP: non-controlled, PO-controlled, and IV-controlled groups. The incidence of epistaxis recurrence and mortality rate within 6 months were compared. Results: Among the 380 patients enrolled, 238 were discharged from the ED without any pharmacological antihypertensive treatment (non-controlled group), 83 received PO antihypertensive medication (PO-controlled group), and 59 received IV antihypertensive medication (IV-controlled group). Of these, 29 (12.2%), nine (10.8%), and seven (11.9%) patients from the non-controlled, PO-controlled, and IV-controlled groups, respectively, experienced epistaxis recurrence within 24 hours, which was statistically not different among the three groups (P=0.948). The 6-month mortality rates were determined to be 0.8%, 2.4%, and 3.4% in the non-controlled, PO-controlled, and IV-controlled groups, respectively. The difference was also not significant among the groups (P=0.294). Conclusion The conventional treatments of hypertensive urgencies (observed or PO-controlled) in patients with severe high BP with epistaxis in the ED did not increase the incidence of epistaxis recurrence and short-term mortality rate when compared to immediate BP control using IV antihypertensive medication.

No abstract available.
Candida albicans* ; Candida* ; Hydrophobic and Hydrophilic Interactions*

No abstract available.
Diagnosis ; Gas Chromatography-Mass Spectrometry

Candida albicans is one of the most frequently isolated fungal pathogens in human. Recently, the prevalence of candida infection has markedly increased, partially due to the increase of immunocompromised hosts. Proposed virulence factors of the pathogenic Candida are the ability to form hyphae to adhere to epithelial cell surfaces, and to secrete acid proteinases and phospholipases. We measured the relative cell surface hydrophobicity (CSH) and the ability of proteinase production (PROT), phospholipase production (PLase), adherence to host epithelium (ADH), and hyphal transition (Germ). The relative risk of virulence factors was analyzed by lethality test in murine model of hematogeneously disseminated candidal infection. According to Cox's proportional hazard analysis, the statistically significant virulence factors were PROT, ADH, and CSH. PROT was the highest risk factor of them. To evaluate the applicability for the diagnosis and treatment of Candidiasis, we examined the protective effect of the active and passive immunizations with the materials purified from virulence factors and antibodies to them in Candia-infected mice model. The mean survival times of active and passive immunized groups were slightly longer than those of non-immunized groups.
Animals ; Antibodies ; Candida ; Candida albicans ; Candidiasis ; Diagnosis ; Epithelial Cells ; Epithelium ; Humans ; Hydrophobic and Hydrophilic Interactions ; Hyphae ; Immunization, Passive ; Immunocompromised Host ; Mice* ; Peptide Hydrolases ; Phospholipases ; Prevalence ; Risk Factors ; Survival Rate ; Virulence Factors* ; Virulence*

Objective: Patients presenting with fingertip skin defect injuries without exposed bone can avail of two treatment options at the emergency department (ED). This study compared outcomes between dressing and composite graft (CG) using skin stump for patients visiting the ED with fingertip skin defect injuries without exposed bone. Methods: This was a single-center, retrospective, observational study. We reviewed 244 patients with fingertip skin defect injuries without exposed bone who visited the ED from September 2018 to February 2021. We compared the outcomes of the patients who were treated by CG using skin stump and those who received a dressing in the ED. Results: In all, 142 patients were treated by CG using skin stump, and 102 patients were given a dressing only. In the CG group, good outcomes were obtained in 140 patients, whereas additional skin graft treatment was required for two patients with bad outcomes. In the dressing group, 81 patients had good outcomes and 21 patients had bad outcomes which required additional skin graft treatment. Conclusion Results of our study revealed that compared to traditional dressing, ED treatment for fingertip skin defects without exposed bone showed good outcomes when administered CG using skin stump. Hence, we recommend that instead of simple dressing, CG using skin stump is the preferred mode of treatment for patients presenting in the ED with fingertip skin defect injuries without exposed bone.

No abstract available.
Bone Marrow/metabolism/pathology ; DNA Mutational Analysis ; Gene Rearrangement, T-Lymphocyte ; Humans ; Immunophenotyping ; Infant ; Lymphohistiocytosis, Hemophagocytic/*diagnosis ; Male ; Membrane Proteins/chemistry/genetics ; Polymorphism, Single-Stranded Conformational ; Republic of Korea ; T-Lymphocytes/immunology/*metabolism

Patients undergoing hemodialysis are susceptible to sarcopenia. As intracellular reservoirs of water, skeletal muscles are important contributors to intradialytic hypotension. This study was designed to determine the role of skeletal muscle mass in intradialytic hypotension. Methods: In a cross-sectional study, the body composition of 177 patients was measured immediately after hemodialysis using bioelectrical impedance analysis. The parameters measured were skeletal muscle mass, intracellular and extracellular water contents, total body water, and cell-membrane functionality (in phase angle at 50 kHz). Data from laboratory tests, chest radiography, measurements of handgrip strength and mid-arm circumference, and questionnaires were collected. The main outcome was intradialytic hypotension, defined as more than two episodes of hypotension (systolic blood pressure of <90 mmHg) with intervention over the 3 months following enrollment. Logistic regression models including each parameter related to sarcopenia were compared with a clinical model. Results: Patients with a low ratio of skeletal muscle mass to dry body weight (SMM/WT) had a higher rate of intradialytic hypotension (40.7%). Most low-SMM/WT patients were female, obese, diabetic, and had a lower handgrip strength compared with the other patients. In the high-SMM/WT group, the risk of intradialytic hypotension was lower, with an odds ratio of 0.08 (95% confidence interval [CI], 0.02–0.28) and adjusted odds ratio of 0.06 (95% CI, 0.01–0.29). Conclusion: Measurement and maintenance of skeletal muscle can help prevent intradialytic hypotension in frail patients undergoing hemodialysis.

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.