Sildenafil acts as a selective inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase type 5 causes smooth muscle relaxation and vasodilatation, and enhances penile erection. Sildenafil can reduce blood pressure and possibly myocardial infarction by aggravating hypotension induced by nitric oxide. In addition, sildenafil use combined with physical exertion and the emotional stress of sexual intercourse might trigger coronary plaque rupture and acute myocardial infarction (AMI) in patients with asymptomatic coronary artery disease independently of nitrate intake. This case study concerns a patient with acute myocardial infarction who went into cardiac arrest (ventricular fibrillation) after visiting an emergency department with chest pain that started 10 minutes after taking sildenafil without sexual activity. There were no underlying diseases and no history of drug use or relevant family history. Emergency physicians should be aware that AMI may occur after taking sildenafil in previously healthy patients and be especially careful when patients are elderly. In addition, when treating patients with chest pain in the emergency department, it is important to check whether sildenafil has been used.

Sildenafil acts as a selective inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase type 5 causes smooth muscle relaxation and vasodilatation, and enhances penile erection. Sildenafil can reduce blood pressure and possibly myocardial infarction by aggravating hypotension induced by nitric oxide. In addition, sildenafil use combined with physical exertion and the emotional stress of sexual intercourse might trigger coronary plaque rupture and acute myocardial infarction (AMI) in patients with asymptomatic coronary artery disease independently of nitrate intake. This case study concerns a patient with acute myocardial infarction who went into cardiac arrest (ventricular fibrillation) after visiting an emergency department with chest pain that started 10 minutes after taking sildenafil without sexual activity. There were no underlying diseases and no history of drug use or relevant family history. Emergency physicians should be aware that AMI may occur after taking sildenafil in previously healthy patients and be especially careful when patients are elderly. In addition, when treating patients with chest pain in the emergency department, it is important to check whether sildenafil has been used.

Sildenafil acts as a selective inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase type 5 causes smooth muscle relaxation and vasodilatation, and enhances penile erection. Sildenafil can reduce blood pressure and possibly myocardial infarction by aggravating hypotension induced by nitric oxide. In addition, sildenafil use combined with physical exertion and the emotional stress of sexual intercourse might trigger coronary plaque rupture and acute myocardial infarction (AMI) in patients with asymptomatic coronary artery disease independently of nitrate intake. This case study concerns a patient with acute myocardial infarction who went into cardiac arrest (ventricular fibrillation) after visiting an emergency department with chest pain that started 10 minutes after taking sildenafil without sexual activity. There were no underlying diseases and no history of drug use or relevant family history. Emergency physicians should be aware that AMI may occur after taking sildenafil in previously healthy patients and be especially careful when patients are elderly. In addition, when treating patients with chest pain in the emergency department, it is important to check whether sildenafil has been used.

Sildenafil acts as a selective inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase type 5 causes smooth muscle relaxation and vasodilatation, and enhances penile erection. Sildenafil can reduce blood pressure and possibly myocardial infarction by aggravating hypotension induced by nitric oxide. In addition, sildenafil use combined with physical exertion and the emotional stress of sexual intercourse might trigger coronary plaque rupture and acute myocardial infarction (AMI) in patients with asymptomatic coronary artery disease independently of nitrate intake. This case study concerns a patient with acute myocardial infarction who went into cardiac arrest (ventricular fibrillation) after visiting an emergency department with chest pain that started 10 minutes after taking sildenafil without sexual activity. There were no underlying diseases and no history of drug use or relevant family history. Emergency physicians should be aware that AMI may occur after taking sildenafil in previously healthy patients and be especially careful when patients are elderly. In addition, when treating patients with chest pain in the emergency department, it is important to check whether sildenafil has been used.

Catastrophic antiphospholipid syndrome (APS) is defined as a rare, life-threatening autoimmune disorder leading to multiorgan failure. Probable APS, with clinical manifestations similar to APS without antiphospholipid antibodies, was suggested to be seronegative catastrophic APS. The triggering factors of catastrophic APS are various, including infection, trauma, malignancy, and surgery. In approximately 40% of patients, catastrophic APS develops from an unknown cause. We report a case of seronegative catastrophic APS due to an unknown origin. A 20-year-old man presented with cough, abdominal pain, skin lesions, tunnel vision, and watery diarrhea without fever. His symptoms and laboratory test suggested disseminated intravascular coagulation. Considering seronegative catastrophic APS, we treated with intravenous steroid and intravenous immunoglobulin, but the effects were limited. After weekly treatment with rituximab, an immune-modulating agent, his laboratory findings including thrombocytopenia and coagulation tests, returned to normal. We conclude that rituximab can be an effective treatment for seronegative catastrophic APS.
Abdominal Pain ; Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome ; Autoimmune Diseases ; Cough ; Diarrhea ; Disseminated Intravascular Coagulation* ; Fever ; Humans ; Immunoglobulins ; Skin ; Thrombocytopenia ; Young Adult ; Rituximab

Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal tract. Most NCMH has a benign nature and can be cured by complete resection. Only a few NCMH cases have been reported worldwide due to its rarity. Here, we report three cases of successfully treated NCMH, of which one case was diagnosed during preliminary ultrasound. All three cases were consistent with the benign symptoms of NCMH. Tumor in all of the cases were successfully treated through an endoscopic approach surgery and no evidence of aggressive recurrence was reported.

OBJECTIVE: Since 2018, the surviving sepsis campaign recommended one-hour bundle therapy in septic shock patients. On the other hand, evidence for the effectiveness of bundle therapy has not been established. The object of this study was to determine the prognostic value of one-hour bundle completion in septic shock patients. METHODS: This prospectively collected registry-based, retrospective observational study, between January 2016 and December 2018. A one-hour bundle in septic shock was defined by the serum lactate measurements, blood cultures, administration of antibiotics, and adequate fluid administration within one hour from emergency department admission. Eligible septic shock patients were included in the analysis, and the prognostic abilities of the completion of the one-hour bundle and each item were analyzed. The primary outcome was the 28-day mortality. RESULTS: The study included 381 patients, and the overall 28-day mortality was 24.7%. The overall one-hour bundle completion rate was 11.3%, and each completion rate of serum lactate measurement, blood cultures, administration of antibiotics, and adequate fluid administration were 85.8%, 74.3%, 19.4%, and 48.6%, respectively. On the other hand, overall bundle completion as well as each bundle were not associated with the 28-day mortality except for adequate fluid administration (odds ratio [OR], 0.67 [95% confidence interval (CI), 0.30–1.50]; OR, 1.33 [95% CI, 0.66–2.70]; OR, 1.50 [95% CI 0.85–2.64]; OR, 1.17 [95% CI 0.66–2.07]; and OR, 0.54 [95% CI, 0.34–0.87], respectively). Multivariate logistic regression analysis showed that adequate fluid administration was independently associated with the 28-day mortality (OR, 0.22 [95% CI, 0.09–0.55]; P=0.001). CONCLUSION In this study, most of the one-hour bundle completions were not associated with 28-day mortality. Although adequate fluid administration was associated with the 28-day mortality, multicenter interventional study will be needed to generalize this result.

Background: There is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak. Materials and Methods: We conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA. Results: Advanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA (P = 0.018).Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (95% confidence interval [CI]: 65.4 – 100) and a specificity of 22.5% (95% CI: 13.5 – 34.0). Conclusion The screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19 infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19 infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR

Objective: This study compared the prognostic performance of the following five injury severity scores: the Geriatric Trauma Outcome Score (GTOS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS) for in-hospital mortality in severe geriatric trauma patients. Methods: A retrospective, cross-sectional, observational study was conducted using a database of severe geriatric trauma patients (age ≥65 years and ISS ≥16) who presented to a single regional trauma center between November 2016 and October 2018. We compared the baseline characteristics between the survivor and mortality groups and the predictive ability of the five scoring systems. Results: A total of 402 patients were included in the analysis; the in-hospital mortality rate was 25.6% (n=103). The TRISS had the highest area under the curve of 0.953 (95% confidence interval [CI], 0.927-0.971); followed by RTS, 0.777 (95% CI, 0.733-0.817); NISS, 0.733 (95% CI, 0.687-0.776); ISS, 0.660 (95% CI, 0.612-0.707); and GTOS, 0.660 (95% CI, 0.611-0.706) in severe geriatric trauma. The TRISS also had the highest area under the curve of 0.961 (0.919-0.985) among the injury severity scoring systems in polytrauma. The predictive ability of TRISS was significantly higher than the other four scores with respect to overall trauma and polytrauma (P<0.001). Conclusion The TRISS showed the highest prognostic performance for predicting in-hospital mortality among all the injury severity scoring systems in severe geriatric trauma.

Background: There is currently a lack of evidence-based postresuscitation or postmortem guidelines for patients with out-of-hospital cardiac arrest (OHCA) in the setting of an emerging infectious disease. This study aimed to develop and validate a multimodal screening tool that aids in predicting the disease confirmation in emergency situations and patients with OHCA during a coronavirus disease 2019 (COVID-19) outbreak. Materials and Methods: We conducted a retrospective, multicenter observational study of adult patients with OHCA in Daegu, Korea. To identify the potential predictors that could be used in screening tools in the emergency department, we applied logistic regression to data collected from March 1 to March 14. The prediction performance of the screening variables was then assessed and validated on the data of patients with OHCA who were treated between February 19 and March 31, 2020. General patient characteristics and hematological findings of the COVID-19-negative and COVID-19-positive groups were compared. We also evaluated confirmation test criteria as predictors for COVID-19 positivity in patients with OHCA. Results: Advanced age, body temperature, and abnormal chest X-ray (CXR) revealed significant predictive ability in the derivation cohort. Of the 184 adult patients with OHCA identified in the validation cohort, 80 patients were included in the analysis. Notably, 9 patients were positive and 71 were negative on the COVID-19 reverse transcription polymerase chain reaction test. Five patients (55.6%) in the COVID-19-positive group had a fever before OHCA, and 12 (16.9%) of the COVID-19-negative group had a fever before OHCA (P = 0.018).Eight patients (88.9%) in the COVID-19-positive group had a CXR indicating pneumonic infiltration. Of the criteria for predicting COVID-19, fever or an abnormal CXR had a sensitivity of 100% (95% confidence interval [CI]: 65.4 – 100) and a specificity of 22.5% (95% CI: 13.5 – 34.0). Conclusion The screening tools that combined fever or abnormal CXR had a good discriminatory ability for COVID-19 infection in adult patients with OHCA. Therefore, during the COVID-19 outbreak period, it is recommended to suspect COVID-19 infection and perform COVID-19 test if patients present with a history of fever or show abnormal findings in postmortem CXR