Objective: The emergency department (ED) serves as the initial point of contact for many sepsis patients, but crowding can affect the timely delivery of essential interventions, such as antibiotics. This paper explores the relationship between antibiotics administration and ED crowding in the context of sepsis management. Methods: This single-center study at a tertiary care hospital included adult patients aged 18 and above who visited the emergency department from January 2018 to December 2022. Patients showing signs of septic shock upon arrival were selected as the study population. This study examined factors such as emergency department occupancy, antibiotic administration time, and their correlation with timely antibiotic treatment. Results: This study of 839 adult patients with septic shock found a weak correlation (P=0.107) between the time to antibiotic administration and department occupancy. Delayed antibiotic administration was observed when the occupancy exceeded 100%. On the other hand, there was no significant correlation between antibiotic administration within one hour and department occupancy. Conclusion Various factors, such as ED bed occupancy, medical staffing, resource allocation, and patient acuity, must be considered when comprehensively evaluating the impact of ED overcrowding on treating septic shock and other conditions.

PURPOSE: To evaluate the refractive outcomes of small incision lenticule extraction (SMILE) in high myopia patients compared with mild to moderate myopia patients. METHODS: This study included 332 eyes of 166 myopic patients treated with SMILE using Visumax 500 kHz femtosecond laser. Treated eyes were divided into 2 groups according to preoperative spherical equivalent (SE): mild to moderate myopia (A group, <-6.0 D) and high myopia (B group, > or =-6.0 D). Follow-up visits were at 1 day, 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index and predictability. RESULTS: Preoperative SE was -4.85 +/- 0.86 D in the A group and -7.70 +/- 1.0 D in the B group. No differences were observed between -0.04 +/- 0.29 D in the A group and -0.30 +/- 0.37 D in the B group at 6 months postoperatively (p = 0.062). At 6 months postoperatively, 98.3% and 97.3% had UDVA of 20/25 or better in the A group and B group, respectively. In the A group, 97.3% and 100% were within +/-0.5 D and +/-1.0 D of intended correction and in the B group, 91.7% and 96.9% were within +/-0.5 D and +/-1.0 D, respectively. Efficacy indices were 1.02 +/- 0.19 in the A group and 0.99 +/- 0.18 in the B group. Safety indices were 1.16 +/- 0.16 in the A group and 1.14 +/- 0.16 in the B group. The efficacy and safety indices were not significantly different between the A and B groups at 6 months postoperatively (p = 0.09, p = 0.695, respectively). CONCLUSIONS: This study showed that SMILE is effective and safe for correcting high myopia as well as mild to moderate myopia.
Follow-Up Studies ; Humans ; Myopia* ; Outcome Assessment (Health Care) ; Visual Acuity

While epidural abscesses are rare in hemodialysis patients, they can cause severe neurological complications that can be fatal because only nonspecific symptoms appear in the early stages of the infection. Their incidence increased recently due to intravenous drug abuse, invasive spinal surgery, percutaneous vertebral procedures, and the development of diagnostic modalities. The increased number of cases is related to the use of dialysis catheters in hemodialysis patients. If a patient has fever and back pain, doctors should eliminate the possibility of other common diseases and consider spinal epidural infection. Early diagnosis and proper treatment are important to prevent neurological complications. In this paper, the symptoms, blood work, magnetic resonanceimaging (MRI) findings, and clinical course of two hemodialysis patients who developed spinal epidural abscesses are described.
Back Pain ; Catheters ; Dialysis ; Early Diagnosis ; Epidural Abscess ; Fever ; Humans ; Incidence ; Low Back Pain ; Magnetics ; Magnets ; Renal Dialysis ; Substance Abuse, Intravenous

PURPOSE: The aim of this study is to report on preliminary data regarding the prevalence of major eye diseases in Korea. METHODS: We obtained data from the Korea National Health and Nutrition Examination Survey, a nation-wide cross-sectional survey and examinations of the non-institutionalized civilian population in South Korea (n = 14,606), conducted from July 2008 to December 2009. Field survey teams included an ophthalmologist, nurses, and interviewers, traveled with a mobile examination unit and performed interviews and ophthalmologic examinations. RESULTS: The prevalence of visual impairment, myopia, hyperopia and astigmatism in participants over 5 years of age was 0.4 +/- 0.1%, 53.7 +/- 0.6%, 10.7 +/- 0.4%, and 58.0 +/- 0.6%, respectively. The prevalence of strabismus and blepharoptosis in participants over 3 years of age was 1.5 +/- 0.1% and 11.0 +/- 0.8%, respectively. In participants over 40 years of age, the prevalence of cataract, pterygium, early and late age-related macular degeneration, diabetic retinopathy and glaucoma was 40.2 +/- 1.3%, 8.9 +/- 0.5%, 5.1 +/- 0.3%, 0.5 +/- 0.1%, 13.4 +/- 1.5%, and 2.1 +/- 0.2%, respectively. CONCLUSIONS: This is the first nation-wide epidemiologic study conducted in South Korea for assessment of the prevalence of eye diseases by both the Korean Ophthalmologic Society and the Korea Center for Disease Control and Prevention. This study will provide preliminary information for use in further investigation, prevention, and management of eye diseases in Korea.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Cross-Sectional Studies ; Eye Diseases/*epidemiology ; Female ; Humans ; Male ; Middle Aged ; Nutrition Surveys/*statistics & numerical data ; Prevalence ; Republic of Korea/epidemiology ; Young Adult

OBJECTIVES: To compare the urodynamic characteristics between pre- and post-menopausal women with stress urinary incontinence. METHODS: Forty premenopausal women and 44 postmenopausal women with stress urinary incontinenece were enrolled. All of the patients underwent a detailed history, gynaecologic examination, urinalysis and urodynamics including cystometry and pressure-flow analysis. RESULTS: There was no difference in the body mass index between the two groups. The mean age of pre- and post-menopausal women was 40.9 +/- 6.4 years and 62.1 +/- 9.4 years, respectively. The parity in postmenopausal women was greater than premenopausal women (2.8 +/- 1.2 vs 2.2 +/- 0.8, P = 0.026). The valsalva leak point pressure (VLPP) in postmenopausal women was lower than that in premenopausal women (106.4 +/- 30.3 vs 88.2 +/- 25.1 cmH2O, P = 0.04). The maximal urethral closure pressure (MUCP) in postmenopausal women was lower than premenopausal women (44.9 +/- 21.4 vs 77.4 +/- 32.2 cmH2O, P < 0.001). The functional urethral length (FUL) in postmenopausal women was shorter than it in premenopausal women (29.0 +/- 9.7 vs 37.0 +/- 10.9 mm, P = 0.003). There were no significant statistical differences in maximal flow rate, residual urine, maximal bladder capacity and Q tip test. CONCLUSION: The VLPP and MUCP were lower, and the FUL was shorter in postmenopausal women with stress urinary incontinence than premenopausal women. The parity and number of vaginal deliveries were different between the two groups. Further investigation will be needed concerning these variables.
Body Mass Index ; Female ; Humans ; Parity ; Postmenopause ; Premenopause ; Retrospective Studies ; Urinalysis ; Urinary Bladder ; Urinary Incontinence ; Urodynamics

The unique clinical syndrome of the uterus didelphys, a unilateral partially or completely obstructed vagina, and ipsilateral renal agenesis is quite rare, and observed on the right side in greater frequency than on the left. The case of fifteen year old girl with uterus didelphys, unilateral partially obstructed vagina and acute renal failure associated with ureteral stone in unilateral kidney is described. Extracorporealshock wave lithotripsy (ESWL) and evacuation of the hematocolpos and excision of the vaginal septum were done. Aware of this relatively rare condition is mainstay of prompt diagnosis which will prevent permanent renal failure and unnecessary and destructive surgery.
Acute Kidney Injury ; Congenital Abnormalities ; Female ; Hematocolpos ; Kidney ; Kidney Diseases ; Lithotripsy ; Renal Insufficiency ; Ureter ; Uterus ; Vagina

A cornual pregnancy occurs when the conceptus implants at the cornus of the uterus which is the junction between the fallopian tube and uterine cavity. Cornual pregnancy is a rare form of ectopic pregnancy and its diagnosis is difficult. It accounts for 2 to 4% of tubal pregnancy and rupture usually occurs between 8 weeks and 16 weeks of gestation. The rich vascularity in this location makes the rupture particularly dangerous, resulting in higher maternal mortality. We have experienced a case of unruptured cornual pregnancy at 9 weeks of atypical ultrasonographic findings, which was hourglass appearance. We present this case with a brief review of the literature.
Cornus ; Fallopian Tubes ; Female ; Maternal Mortality ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Rupture ; Uterus

Uterine prolapse is extremely rare during pregnancy. However in some cases significant complications such as urinary tract infection, voiding difficulty, abortion, and preterm labor may develop. Conservative management consisted of bed rest and use of a pessary. An elective cesarean section near term is the safest mode of delivery in cases where the cervix is edematous and elongated. We present a case of a patient developing uterine prolapse at 12 weeks of gestation, treated with bed rest and use of a pessary. A repeat cesarean section was performed at 38 weeks of gestation and report with a brief review of literatures.
Bed Rest ; Cervix Uteri ; Cesarean Section ; Cesarean Section, Repeat ; Female ; Humans ; Obstetric Labor, Premature ; Pessaries ; Pregnancy ; Prolapse ; Urinary Tract Infections ; Uterine Prolapse

Ectopic pregnancy and appendicitis in pregnancy are two most common causes of acute abdomen in young women and differenciation of these diseases is very difficult. Heterotopic pregnancy is a rare event, occuring less than 1:30,000 pregnancies in natural conception cycles. However, with assisted reproduction techniques, this incidence has increased. We experienced a case of spontaneous heterotopic pregnancy after missed abortion and acute appendicitis treated by laparoscopy. So we report this case with brief review of literature.
Abdomen, Acute ; Abortion, Missed ; Appendicitis ; Female ; Fertilization ; Humans ; Incidence ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic ; Reproductive Techniques

The incidence of ectopic pregnancy has increased considerably a decade. And treatment has changed from salpingectomy by laparotomy to conservative laparoscopic surgery or medical treatment. This procedure has many advantages, but there are also disadvantages with the conservative approach and several studies have reported a higher incidence of residual trophoblastic tissue remaining in the tube after treatment. Postoperative follow up of human chorionic gonadotropin (hCG) levels and ultrasonography are needed. This report describes a rare case of persistent trophoblastic implants to the ovary and peritoneum 40 days after laparoscopic salpingectomy. Treatment consisted of laparoscopic excision with biopsy forceps and bipolar, followed by medical treatments. So we report with a brief review of literatures.
Biopsy ; Chorionic Gonadotropin ; Female ; Follow-Up Studies ; Incidence ; Laparoscopy ; Laparotomy ; Ovary ; Peritoneum ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Salpingectomy ; Surgical Instruments ; Trophoblasts