Objective: This study evaluated the accuracy of the pre-hospital shock index multiplied by the AVPU scale (PSIAVPU) as a predictor of massive transfusion (MT) and traumatic coagulopathy. Methods: This research was a retrospective single-center study that included patients consecutively presenting to a trauma center between 2017 and 2020. The predictive value of the PSIAVPU for MT, in-hospital mortality, and traumatic coagulopathy was measured using the area under the curve (AUC) of the receiver operating characteristic curve. The AUC of the PSIAVPU was compared with the Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) measured at the trauma center presentation. Results: One thousand seven hundred and ninety-two patients were included, of which 163 patients (9.09%) received MT and 195 patients (10.88%) died during their hospital stay. Traumatic coagulopathy was observed in 245 patients. The AUC values for the PSIAVPU in terms of predicting MT, hospital mortality, and traumatic coagulopathy were 0.755, 0.752, and 0.736, respectively. Conclusion In patients with trauma, the predictive power of the PSIAVPU was higher than that of the prehospital shock index and was comparable to that of the rSIG. The PSIAVPU is a useful indicator that can be used easily and quickly for trauma patients at the prehospital stage.

Objective: Urgent upper endoscopy is performed to achieve acute hemostasis in patients with high-risk bleeding sources. Emergency physicians must identify patients who require urgent endoscopic treatments. This study assessed the performance of blood urea nitrogen (BUN) for predicting severe bleeding that necessitates urgent endoscopic hemostasis compared to the risk assessment scores in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB). Methods: The presumed ANVUGIB patients were classified into endoscopic and non-endoscopic hemostasis groups. Data including historical features, symptoms, signs, and routine laboratory tests were collected and compared. Results: Three hundred and ninety-one patients were analyzed, including 116 patients in the endoscopic hemostasis and 275 patients in the non-endoscopic hemostasis group. In the area under curve (AUC) of the receiver operator characteristic curve, BUN (AUC 0.733; 95% confidence interval [CI], 0.681-0.785) and BUN/creatinine (AUC, 0.727; 95% CI, 0.672-0.783) were superior to total protein, Glasgow-Blatchford score (GBS), modified GBS (AUC, 0.649, 0.623 and 0.646, respectively) for predicting endoscopic hemostasis. Pre-endoscopy Rockall score and AIMS65 were statistically insignificant. The same results were obtained when the patients with liver and chronic kidney diseases were excluded. Conclusion The current results suggest that BUN was an independent predictor of endoscopic hemostasis in patients with ANVUGIB. Further studies will be needed to determine if BUN can be used in clinical practice.

Neutralizing antibodies targeted at the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein have been developed and now under evaluation in clinical trials. The US Food and Drug Administration currently issued emergency use authorizations for neutralizing monoclonal antibodies in non-hospitalized patients with mild to moderate coronavirus disease 2019 (COVID-19) who are at high risk for progressing to severe disease and/or hospitalization. In terms of this situation, there is an urgent need to investigate the clinical aspects and to develop strategies to deploy them effectively in clinical practice. Here we provide guidance for the use of anti-SARS-CoV-2 monoclonal antibodies for the treatment of COVID-19 based on the latest evidence.

Despite the global effort to mitigate the spread, coronavirus disease 2019 (COVID-19) has become a pandemic that took more than 2 million lives. There are numerous ongoing clinical studies aiming to find treatment options and many are being published daily. Some effective treatment options, albeit of variable efficacy, have been discovered. Therefore, it is necessary to develop an evidence-based methodology, to continuously check for new evidence, and to update recommendations accordingly. Here we provide guidelines on pharmaceutical treatment for COVID-19 based on the latest evidence.

Neutralizing antibodies targeted at the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein have been developed and now under evaluation in clinical trials. The US Food and Drug Administration currently issued emergency use authorizations for neutralizing monoclonal antibodies in non-hospitalized patients with mild to moderate coronavirus disease 2019 (COVID-19) who are at high risk for progressing to severe disease and/or hospitalization. In terms of this situation, there is an urgent need to investigate the clinical aspects and to develop strategies to deploy them effectively in clinical practice. Here we provide guidance for the use of anti-SARS-CoV-2 monoclonal antibodies for the treatment of COVID-19 based on the latest evidence.

Despite the global effort to mitigate the spread, coronavirus disease 2019 (COVID-19) has become a pandemic that took more than 2 million lives. There are numerous ongoing clinical studies aiming to find treatment options and many are being published daily. Some effective treatment options, albeit of variable efficacy, have been discovered. Therefore, it is necessary to develop an evidence-based methodology, to continuously check for new evidence, and to update recommendations accordingly. Here we provide guidelines on pharmaceutical treatment for COVID-19 based on the latest evidence.

Copper sulfate is widely used as a fungicide and pesticide. Acute copper sulfate poisoning is rare but potentially lethal in severe cases. Copper sulfate can lead to cellular damage of red blood cells, hepatocytes, and myocytes. Toxic effects include intravascular hemolysis, acute tubular necrosis and, rhabdomyolysis. A 76-year-old man presented with vomiting and epigastric pain. He had ingested a copper-containing fungicide (about 13.5 g of copper sulfate) while attempting suicide 2 hours prior to presentation. From day 3 at the hospital, laboratory findings suggesting intravascular hemolysis were noted with increased serum creatinine level. He was treated with a chelating agent, dimercaptosuccinic acid (succimer). His anemia and acute kidney injury gradually resolved with a 19-day regimen of succimer. Our case suggests that succimer can be used for copper sulfate poisoning when other chelating agents are not available.

Purpose: The purpose of this study was to investigate factors affecting the quality of life of middle-aged women with urinary incontinence by using Wilson and Cleary (1995)'s health-related quality of life model and previous studies. This article was done to construct a model for the collection of data on women with urinary incontinence and verifying the suitability of the model and the hypotheses presented in the model. Methods: A total of 209 valid questionnaires which met the criteria of middle-aged women who experienced urinary incontinence was used for final analysis. The exogenous and endogenous variables of the hypothesis model consisted of age, number of delivery, menstrual status, self-esteem, social support, physical symptoms, depression, anxiety, self-care agency and quality of life. The data were analyzed using IBM SPSS/WINdow 25.0 and AMOS 18.0 program. Results: The fitness of the modified model, x2/df=1.675, RMR=0.047, RMAEA=0.057, GFI=0.900, AGFI=0.855, NFI=0.923, TLI=0.957, CFI=0.9674. In the modified model, self-esteem showed the strongest total impact including the direct and indirect impacts on the quality of life of women with incontinence. In the result of verification of the modified model, quality of life explained by 58.8% through self-esteem, social support, self-care agency. Conclusion Efforts are needed to improve self-esteem for middle-aged women with urinary incontinence, alleviate psychological symptoms, and develop self-care agency that they can manage themselves. Various aspects of physical, mental and psychological aspects can be comprehensively assessed and utilized to develop an interactive strategy system through individual programs and social support.

Since the first case was reported in Wuhan, Hubei Province, China on December 12, 2019, Coronavirus disease 2019 (COVID-19) has spread widely to other countries since January 2020. As of April 16, 2020, 10635 confirmed cases have been reported, with 230 deaths in Korea. COVID-19 patients may be asymptomatic or show various clinical manifestations, including acute symptoms such as fever, fatigue, sore throat; pneumonia presenting as acute respiratory distress syndrome; and multiple organ failure. As COVID-19 has such varied clinical manifestations and case fatality rates, no standard antiviral therapy regimen has been established other than supportive therapy. In the present guideline, we aim to introduce potentially helpful antiviral and other drug therapies based on in vivo and in vitro research and clinical experiences from many countries.