Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

Objective: To examine the association of inferior vena cava (IVC) diameter ratio measured using computed tomography with outcomes in patients with gastrointestinal bleeding (GIB). Methods: A single-center retrospective observational study was conducted on consecutive patients with GIB who presented to the emergency department. The IVC diameter ratio was calculated by dividing the maximum transverse and anteroposterior diameters perpendicular to it. The association of the IVC diameter ratio with outcomes was examined using multivariable logistic regression analysis. The primary outcome was in-hospital mortality. The area under the receiver operator characteristic curve (AUC) of the IVC diameter ratio was calculated, and the sensitivity and specificity, including the cutoff values, were computed. Results: In total, 585 patients were included in the final analysis. The in-hospital mortality rate was 4.6% (n=27). The IVC diameter ratio was significantly associated with higher in-hospital mortality in multivariable logistic regression analysis (odds ratio, 1.793; 95% confidence interval [CI], 1.239–2.597; P=0.002). The AUC of the IVC diameter ratio for in-hospital mortality was 0.616 (95% CI, 0.498–0.735). With a cutoff of the IVC diameter ratio (≥2.1), the sensitivity and specificity for predicting in-hospital mortality were 44% (95% CI, 26%–65%) and 71% (95% CI, 67%–75%), respectively. Conclusion The IVC diameter ratio was independently associated with in-hospital mortality in patients with GIB. However, the AUC of the IVC diameter ratio for in-hospital mortality was low.

Purpose: This study investigates the characteristics and prognosis of acute poisoning patients visiting nationwide emergency departments before and after the Coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from the National Emergency Department Information System (NEDIS). Methods: This nationwide retrospective observational study included acute poisoning patients who visited the emergency departments between February 1 to December 31, 2020, which has been determined as the pandemic period. The same periods in 2018 and 2019 were designated as the control periods. The primary outcome assessed was the length of stay in emergency departments (EDLOS). The secondary outcomes examined were intensive care unit admission rate and in-hospital mortality rate before and after the pandemic. A subgroup analysis was performed for inpatients and intentional poisoning patients. Results: A total of 163,560 patients were included in the study. During the pandemic, the proportion of women increased from 50.0% in 2018 and 50.3% in 2019 to 52.5% in 2020. Patients aged 20-29 years increased from 13.4% in 2018 and 13.9% in 2019 to 16.6% in 2020. A rise in cases of intentional poisoning was also noted - from 33.9% in 2018 and 34.0% in 2019 to 38.4% in 2020. Evaluating the hospitalized poisoned patients revealed that the EDLOS increased from 3.8 hours in 2018 and 3.7 hours in 2019 to 4.2 hours in 2020. ICU admissions were also markedly increased (2018, 48.2%; 2019, 51.8%; 2020, 53.2%) among hospitalized patients. Conclusion The COVID-19 pandemic has changed the epidemiology, clinical characteristics, and prognosis of acute poisoning patients visiting nationwide emergency departments in Korea. The proportion of young adults, women, and intentional poisoning patients has increased after the COVID-19 pandemic. Prolonged length of stay at the emergency department and an increased rate of intensive care unit admissions were determined in hospitalized acute poisoning patients.

Objective: Lactate clearance is reportedly associated with the outcomes of various critical illnesses. However, few studies have examined the association between lactate clearance and outcomes in patients with gastrointestinal bleeding (GIB). Methods: A single-center retrospective observational study between 2016 and 2020 was conducted. Consecutive adult patients with GIB symptoms (melena, hematemesis, and hematochezia) presenting to the emergency department were included. Lactate clearance was calculated as ([initial lactate-subsequent lactate]/initial lactate)×100. The association between lactate clearance and outcomes was examined by multivariable logistic regression analysis. The primary outcome was the in-hospital mortality. The area under the curve (AUC) of lactate clearance for in-hospital mortality was calculated. The sensitivity and specificity with optimal cutoff values were computed. The AUC of lactate clearance was compared with the Glasgow-Blatchford score and AIMS65 for predicting in-hospital mortality. Results: Three hundred and fifty-one patients were included in the final analysis, and the in-hospital mortality rate was 12%. Lactate clearance was significantly associated with lower in-hospital mortality (odds ratio, 0.991; P=0.016). The AUC of lactate clearance for in-hospital mortality was 0.64. The AUC of Glasgow-Blatchford score and AIMS65 for inhospital mortality was not significantly different from lactate clearance (P=0.759 and P=0.442, respectively). A cutoff lactate clearance of less than 10% had 45.2% sensitivity, 30.7% specificity, 8.2% positive predictive value, and 80.5% negative predictive value for predicting in-hospital mortality. Conclusion Lactate clearance was independently associated with in-hospital mortality in GIB patients. Further prospective studies will be needed to address the prognostic value of lactate clearance in GIB.

Background: Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city. Methods: This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity. Results: In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity. Conclusion If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.

Background: Rapid triage reduces the patients' stay time at an emergency department (ED). The Korean Triage Acuity Scale (KTAS) is mandatorily applied at EDs in South Korea.For rapid triage, we studied machine learning-based triage systems composed of a speech recognition model and natural language processing-based classification. Methods: We simulated 762 triage cases that consisted of 18 classes with six types of the main symptom (chest pain, dyspnea, fever, stroke, abdominal pain, and headache) and three levels of KTAS. In addition, we recorded conversations between emergency patients and clinicians during the simulation. We used speech recognition models to transcribe the conversation. Bidirectional Encoder Representation from Transformers (BERT), support vector machine (SVM), random forest (RF), and k-nearest neighbors (KNN) were used for KTAS and symptom classification. Additionally, we evaluated the Shapley Additive exPlanations (SHAP) values of features to interpret the classifiers. Results: The character error rate of the speech recognition model was reduced to 25.21% through transfer learning. With auto-transcribed scripts, support vector machine (area under the receiver operating characteristic curve [AUROC], 0.86; 95% confidence interval [CI], 0.81–0.9), KNN (AUROC, 0.89; 95% CI, 0.85–0.93), RF (AUROC, 0.86; 95% CI, 0.82–0.9) and BERT (AUROC, 0.82; 95% CI, 0.75–0.87) achieved excellent classification performance.Based on SHAP, we found “stress”, “pain score point”, “fever”, “breath”, “head” and “chest” were the important vocabularies for determining KTAS and symptoms. Conclusion We demonstrated the potential of an automatic KTAS classification system using speech recognition models, machine learning and BERT-based classifiers.