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.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a common cause of autoimmune encephalitis. The condition is difficult to diagnose or suspect in the emergency department because it usually presents with nonspecific neurological or psychiatric symptoms. It is often mistaken for viral encephalitis or psychiatric illness. This paper reports a case of anti-NMDAR encephalitis in which the patient experienced mood changes, including suicidal ideation, which led to a delayed diagnosis after three visits to the emergency department. This paper aims to raise awareness among emergency physicians about the possibility of anti-NMDAR encephalitis and to encourage them to consider it in their differential diagnosis in the emergency department.

Objective: Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis. Methods: Data from patients with sepsis, collected prospectively between January 2018 and December 2021, were analyzed. In Korea, the new academic year starts on March 1, so the “July effect” appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes in March were compared to other months. A multivariate Cox proportional hazard regression was performed to adjust for confounders. Results: We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405–2.638; P<0.001). Conclusion The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These results suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.

Tracheopathia osteoplastica(TO) is a rare, clinical and pathologic benign condition of unknown cause and characterized by submucosal cartilaginous or bony projections into tracheobroncheal lumen, usually not involved posterior membranous portion of tracheobroncheal tree. We report two cases of tracheopathia osteoplastica that involved trachea and both main bronchus, diagnosed by chest CT, fiberoptic bronchoscopic biopsy.
Biopsy ; Bronchi ; Tomography, X-Ray Computed ; Trachea

Despite being a very new field, forensic imaging is rapidly being used in forensic medical practices around the world. Computed tomography images are being produced and used for many reasons. Forensic imaging is being used for preliminary examination of serious findings before a routine autopsy, as it might help to give positive proof in some cases. Some major preliminary findings, such as brain hemorrhage, cardiac tamponade, or aortic dissection, can then be substantiated with the results of the physical autopsy. Forensic imaging techniques may also provide additive evidence about the cause of death such as pneumothorax, ileus, gas embolism, and aspiration that are difficult to detect with the traditional surgical autopsy techniques. Forensic imaging is also proving useful outside the autopsy room; forensic anthropologists and odontologists are using images to help them determine the age, sex, and even lifestyle of human specimens. Finally, forensic images have also begun to function as a form of record keeping in complex cases.
Autopsy* ; Cardiac Tamponade ; Cause of Death ; Embolism, Air ; Humans ; Ileus ; Intracranial Hemorrhages ; Life Style ; Pneumothorax

B-lineage non-Hodgkin lymphoma may aberrantly coexpress T-cell markers. In general population, however, cases of diffuse large B-cell lymphomas with CD3 co-expression are rare because the CD3 marker is the most lineage specific T-cell antigen. We report a case of CD3 coexpressed diffuse large B-cell lymphoma in a 47-year-old male patient presented with dyspepsia who had transplanted a kidney 17 years ago. An esophagogastroduodenoscopy displayed an ulcerated mass in the gastric antrum. The pathology of the mass was monomorphic post-transplant lymphoproliferative disorder - specifically, CD20- and CD3-positive diffuse large B-cell lymphoma. Resection of the mass and postop chemotherapy were performed. A follow-up computerized tomography showed disapperance of tumor. No recurrence was observed until 7 month after treatment. Nevertheless, the patient's renal function gradually aggrevated and progressed to end stage renal disease. As far as we know, this is the first case of diffuse large B-cell lymphoma with CD3 coexpression after kidney transplant.
B-Lymphocytes ; Dyspepsia ; Endoscopy, Digestive System ; Follow-Up Studies ; Humans ; Kidney ; Kidney Failure, Chronic ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Lymphoproliferative Disorders ; Male ; Middle Aged ; Neoplasm Transplantation ; Pyloric Antrum ; Recurrence ; T-Lymphocytes ; Transplants ; Ulcer

OBJECTIVES: This study was conducted to investigate the association between emotional labor and dysmenorrhea among women working in sales and call centers in Seoul, South Korea. METHODS: Working women in sales jobs and call centers in Seoul were interviewed face-to-face by well-trained interviewers. In total, 975 participants were analyzed in the final model. Emotional labor was measured using a constructed questionnaire with two components: an emotive effort component with three questions and an emotive dissonance component with five questions. To examine the association between emotional labor and dysmenorrhea, chi-squared tests and logistic regression were applied. RESULTS: The prevalence of dysmenorrhea among sales workers and call center workers were 43.0% and 61.1%, respectively. The adjusted odds ratios (OR) of emotive effort and emotive dissonance for dysmenorrhea in call center workers were 1.88 (95% confidence interval [CI], 1.07-3.28) and 1.72 (95% CI, 1.13-2.63), respectively. The adjusted OR of emotive effort and emotive dissonance for dysmenorrhea in sales workers were 1.71 (95% CI, 0.92-3.16) and 1.15 (95% CI, 0.67-1.98), respectively. CONCLUSIONS: Emotional labor was found to be associated with dysmenorrhea in call center workers. Further studies to investigate other factors, such as management strategies and the relationship between emotional labor and dysmenorrhea, are needed to support interventions to prevent dysmenorrhea that will further promote the quality of health and life of working women.
Commerce* ; Dysmenorrhea* ; Female ; Humans ; Korea ; Logistic Models ; Odds Ratio ; Prevalence ; Seoul ; Women, Working

PURPOSE: The purpose of this study was to investigate whether early CT scans are useful for improving the clinical management of acute biliary pancreatitis. MATERIALS AND METHODS: We retrospectively reviewed 56 consecutive patients who experienced first attack of acute pancreatitis and underwent CT scans within 48 hours of symptom onset in the emergency department, between March 2015 and March 2016. CT images were retrospectively evaluated for absence or presence, and etiology of acute pancreatitis, and probability of biliary pancreatitis. Urgent procedures for acute pancreatitis were analyzed. RESULTS: Of 56 patients, 54 (96.4%) showed acute pancreatitis and 23 (41.1%) had biliary pancreatitis on CT. The diagnostic accuracy, sensitivity, and specificity of CT-diagnosed biliary pancreatitis were 94.6% (53/56), 91.7% (22/24), and 96.9% (31/32), respectively. Of the 56 patients, 17 (30.4%) patients with biliary pancreatitis underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) within 72 hours (mean time interval between CT and ERCP: 25.5 ± 19.8 hours; range: 2–67 hours). There was a significant difference in the urgent procedures between non-biliary and biliary pancreatitis groups (0 of 32 vs. 17 of 24, p < 0.001). CONCLUSION Early CT may be used in patients visiting hospital with suspected acute biliary pancreatitis to facilitate urgent treatment.

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.