Objective: Gastrointestinal (GI) bleeding is one of the most common reasons for people to visit the emergency department. Despite advances in treatments, the intensive care unit (ICU) admission rates due to GI bleeding are still high. Therefore, many scoring systems had been developed to screen patients who need active care. Among these scoring systems, the AIMS65 score, Glasgow-Blatchford score (GBS), and Pre-Rockall score (PRS) are known to be accurate risk assessment scoring models. A recent study has shown that hypoalbuminemia is related to poor prognosis in patients with GI bleeding. In this study, we compared the prognostic performance of the blood urea nitrogen to serum albumin ratio (B/A ratio) with the AIMS65, GBS, and PRS scores in patients with GI bleeding. Methods: This is a retrospective cohort study of patients presenting with GI bleeding in the Seoul Regional Emergency room from February to December 2018. The baseline characteristics of these patients were obtained. The data were compared with the prevalence of ICU admission from the emergency department and in-hospital mortality. The B/A ratio, AIMS65, GBS, and PRS scores as predictors of ICU admission and in-hospital mortality were evaluated using the area under the receiver operating characteristic (AUROC) curve. Results: A total of 433 patients were included in this study. Of these, 354 (81.8%) were admitted to the hospital, 121 (27.9%) were admitted to the ICU, and 26 (6.0%) died during hospitalization. Multivariate logistic regression analysis revealed that the B/A ratio was a significant predictor of ICU admission and in-hospital mortality. The predicting ICU admission AUROC value of the B/A ratio was 0.735, and those of the AIMS65, GBS, and PRS scores were 0.763, 0.741, and 0.704, respectively. For predicting in-hospital mortality, the AUROC value of the B/A ratio was 0.758, and those of the AIMS65, GBS, and PRS scores were 0.826, 0.717, and 0.744, respectively. Conclusion The B/A ratio is a useful tool for predicting the prognosis for patients with GI bleeding as are the AIMS65, GBS, and PRS score models.

A male, 3.5 month old Pomeranian dog was diagnosed with a natural infection of Crenosoma (C.) vulpis in Daejeon, Korea. First stage larvae of C. vulpis were detected by fecal examination using the Baermann technique. Thoracic radiographs revealed mild, pervasive bronchial infiltration of the lung. Enumeration of larvae via the McMaster technique revealed 1,600 larvae per gram of feces. The dog was treated with mebendazole, and clinical symptoms were resolved 2 weeks post-treatment, as indicated by the subject presenting fecal tests negative for C. vulpis.
Animals ; Dogs* ; Feces ; Humans ; Korea ; Larva ; Lung ; Male ; Mebendazole

We report a case of ruptured mycotic aneurysm involving innominate artery requiring an urgent surgical treatment. A 62-yr-old woman presented with fever and dyspnea. Previously, she was diagnosed with colon cancer and received right hemicolectomy and one cycle of adjuvant chemotherapy. On echocardiogram, pericardial effusion was noted and emergency pericardiocentesis was performed. CT scan revealed aortic aneurysm involving ascending aorta and innominate artery, and thrombi surrounding those structures. Patch repair of the defect in the ascending aorta and ringed Goretex graft to bypass the innominate and ascending aorta were performed. We believe that this is the first case of ruptured mycotic aneurysm involving innominate artery.
Aneurysm, Infected/*surgery ; Aorta/pathology ; Aortic Aneurysm/surgery ; Brachiocephalic Trunk/pathology ; Colonic Neoplasms/drug therapy/surgery ; Female ; Human ; Middle Aged ; Tomography, X-Ray Computed ; Transplants

Deer serve as reservoirs of tick-borne pathogens that impact on medical and veterinary health worldwide. In the Republic of Korea, the population of Korean water deer (KWD, Hydropotes inermis argyropus) has greatly increased from 1982 to 2011, in part, as a result of reforestation programs established following the Korean War when much of the land was barren of trees. Eighty seven Haemaphysalis flava, 228 Haemaphysalis longicornis, 8 Ixodes nipponensis, and 40 Ixodes persulcatus (21 larvae, 114 nymphs, and 228 adults) were collected from 27 out of 70 KWD. A total of 89/363 ticks (266 pools, 24.5% minimum infection rate) and 5 (1.4%) fed ticks were positive for Anaplasma phagocytophilum using nested PCR targeting the 16S rRNA and groEL genes, respectively. The 16S rRNA gene fragment sequences of 88/89 (98.9%) of positive samples for A. phagocytophilum corresponded to previously described gene sequences from KWD spleen tissues. The 16S rRNA gene fragment sequences of 20/363 (5.5%) of the ticks were positive for A. bovis and were identical to previously reported sequences. Using the ITS specific nested PCR, 11/363 (3.0%) of the ticks were positive for Bartonella spp. This is the first report of Anaplasma and Bartonella spp. detected in ticks collected from KWD, suggesting that ticks are vectors of Anaplasma and Bartonella spp. between reservoir hosts in natural surroundings.
Anaplasma/genetics/*physiology ; Animals ; Arachnid Vectors/microbiology ; Bartonella/genetics/*physiology ; Chaperonin 60/genetics ; Deer/parasitology ; Disease Reservoirs/veterinary ; RNA, Ribosomal, 16S/genetics ; Republic of Korea/epidemiology ; Ticks/*microbiology

Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.