Objective: Community-acquired pneumonia (CAP) in older patients is a potentially life-threatening infection with a poorprognosis. Therefore, is important to predict the mortality rate of CAP for older patients. This study examined the effectsof predictive increases on CAP mortality by adding a biomarker to known CAP severity prediction tools. Methods: A retrospective analysis of information was conducted on patients older than 65 years, who were treated withCAP in five emergency departments from October 2016 to February 2017. The primary outcome was the 28-day mortality.The following were calculated for each patient: qSOFA (quick Sequential Organ Failure Assessment), A-DROP (Age,Dehydration, Respiratory failure, Orientation, blood Pressure), CURB-65 (Confusion, Urea level, Respiratory rate, Bloodpressure, age≥65 years), SMART-COP (Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate,Tachycardia, Confusion, Oxygen and pH), NLR (neutrophil:lymphocyte ratio), PLR (platelet:lymphocyte ratio), and CAR(high-sensitivity C-reactive protein:albumin ratio). The prognostic value for the 28-day mortality was determined by multivariatelogistic regression analysis. Results: The 28-day mortality was 12.0% of 693 CAP patients. Multivariate logistic regression analysis showed that lactate(odds ratio [OR], 1.589; P<0.001) and CAR (OR, 1.208; P=0.006) were correlated with the 28-day mortality. NLR(OR, 1.00; P=0.983) and PLR (OR, 1.00; P=0.784) were not correlated. The area under curve (AUC) was significant asCAR 0.649, lactate 0.737, and SMART-COP 0.735 (P<0.001), and the AUC of lactate+SMART-COP increased significantlyto 0.784 compared to SMART-COP (P=0.014). Conclusion A combination of lactate and SMART-COP can be used as a tool to assess the severity of older hospitalizedCAP patients who visited emergency departments.

Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

OBJECTIVE: A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea. METHODS: In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey results using descriptive statistics. RESULTS: Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for >75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers. CONCLUSION: A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies.
Adult* ; Cardiopulmonary Resuscitation* ; Catheterization ; Coma ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Hypothermia ; Korea ; Out-of-Hospital Cardiac Arrest* ; Practice Guidelines as Topic ; Prospective Studies ; Research Personnel ; Shock ; Standard of Care

PURPOSE: Rapid activation of the cardiac catheterization laboratory (CCL) is fundamental in the treatment of ST-segment elevation myocardial infarction (STEMI), and it is recommended that emergency department physicians activate CCL as soon as possible, however false positive activation is a major concern. The aim of this study is to assess the relationship between false positive activation and clinical factors available at the time of diagnosis. METHODS: All subjects with CCL activation by an emergency physician between August 2009 and May 2012 were included in this study. False-positive CCL activation was defined as absence of a clear culprit lesion on coronary angiography or by assessment of electrocardiographic and biomarker data in the absence of angiography. RESULTS: Of 222 STEMI activations by emergency physicians, 55 (25%) were false-positive STEMI. Coronary spasm, cardiomyopathy, known CAD, and heart failure were the most common diagnoses among false-positive STEMI. A history of cardiomyopathy (adjusted odds ratio, 13.393; 95% CI, 2.550-70.334; p=0.002), systolic blood pressure<100 mmHg at presentation (adjusted odds ratio, 2.817; 95% CI, 1.129-7.026; p=0.026), no chest pain on admission (adjusted odds ratio, 2.460; 95% CI, 1.162-5.209; p=0.019), and prior coronary disease (adjusted odds ratio, 3.966; 95% CI, 1.828-8.606; p<0.001) independently increased the odds of false-positive STEMI activations. CONCLUSION: False-positive CCL activations were relatively common according to the definition in this study. Various patient-level characteristics were significantly associated with false-positive CCL activation.
Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Coronary Disease ; Diagnosis ; Diagnosis, Differential ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital ; Heart Failure ; Myocardial Infarction* ; Odds Ratio ; Predictive Value of Tests ; Spasm

Transdermal drug delivery is applicable to only a few drugs because the stratum corneum is an excellent barrier to percutaneous absorption. Iontophoresis is a non-invasive technique which increases the drug deliveries into the skin through an electric current. In iontophoretic systems, the movement of ionized drugs is facilitated by electrical energy according to the basic electrical principles of "like charges repel each other and opposite charges attract". Iontophoresis has been explored for many dermatological applications with considerably successful reports. This article reviews the principles and advantages/limitations of iontophoresis, the factors affecting iontophoresis and its applications in various dermatological conditions.
Fees and Charges ; Iontophoresis ; Skin ; Skin Absorption

PURPOSE: We report on neurologic outcomes and experience with specialized post-cardiac arrest (PCA) care of transferred patients at a regional emergency center in Seoul over a one-year period, and we evaluate factors related to neurologic outcomes by analyzing the characteristics of the patients, transport processes, and therapeutic interventions. METHODS: We conducted a retrospective review of patients who were transferred to our facility after successful resuscitation at another hospital. The variables evaluated included clinical variables, whether there was the presence of any critical event on arrival, the transport time, the transport distance, the PCA care delay, and whether or not specialized PCA care was administered. RESULTS: A total of 31 cardiac arrest patients were included in this study. Of these, 27 patients (87.1%) were treated with therapeutic hypothermia. Thirteen patients (41.9%) were ultimately included in the good outcome group (discharge CPC 1, 2), and 18 were included in the poor outcome group (discharge CPC 3-5). During transport, occurrence of re-arrest was uncommon (n=1, 3.2%). Conversely, other critical events were common (11 patients, 35.5%). Transport time, distance, and PCA care delay were not statistically relevant to occurrence of critical events during inter-facility transport. A critical event was more likely to occur in patients who were on vasopressors (p=0.045), and it was an independent risk factor of poor outcome (odds ratio 12.28 [95% confidence interval, 1.44-104.83]). CONCLUSION: The transfer of resuscitated patients is reasonable for specialized PCA care. Because critical events were common during transport and showed correlation with poor neurologic outcomes, a critical care transport team must be used with these patients.
Critical Care ; Dinucleoside Phosphates ; Emergencies ; Heart Arrest ; Humans ; Hypothermia ; Passive Cutaneous Anaphylaxis ; Republic of Korea ; Resuscitation ; Retrospective Studies ; Risk Factors

Vacuum-assisted closure therapy is an alternative method for a massive subcutaneous emphysema treatment. It is easily applicable and shows rapid effectiveness in massive subcutaneous emphysema, intractable with chest tube drainage.
Chest Tubes ; Drainage ; Negative-Pressure Wound Therapy ; Subcutaneous Emphysema

PURPOSE: Due to an increased interest in health, there have been many types of marathon races for athletes and the general population. Marathon is an extremely difficult sport, therefore, many running injuries can occur. In this study, we aimed at characterization of injuries and clinical courses resulting from marathon induced heat stroke. Based on our findings, we provide suggestions for proper management of patients with marathon induced heat stroke. METHODS: We performed a retrospective study of 24 patients who visited the emergency department (ED) at Yeouido St. Mary's hospital between January 2000 and August 2011 with symptoms of heat stroke resulting from participation in a marathon race. We reviewed the medical records, which showed clinical presentation and laboratory findings. RESULTS: Of the 24 patients, 20(83.3%) were men. Their average age was 38.1+/-8.4 years old and their average initial rectal temperature was 39.9+/-1.3degrees C. Seventeen (70.8%) patients came to the ED complaining of syncope and seven(29.2%) came because of mental change. In follow-up laboratory tests, ten patients showed an increased level of serum Creatine phosphokinase (CPK) to over 1,000 IU/L, six showed serum Aspartate aminotransferase (AST)/Alanine aminotransferase (ALT) to over 300 IU/L, four showed serum creatinine to over 2.0 mg/dL, and two showed an increase in serum troponin-I and MB fraction of creatine kinase. Results of initial laboratory tests showed normal AST/ALT levels, however, they started to rise between 12 to 24 hours, and reached the highest record after 2~3 days of hospitalization. CONCLUSION: Marathon induced heat stroke can cause various complications, such as rhabdomyolysis, acute hepatic injury, acute renal failure, and metabolic acidosis. Therefore, we recommend follow-up and observation for patients with marathon induced heat stroke.
Acidosis ; Acute Kidney Injury ; Aspartate Aminotransferases ; Athletes ; Continental Population Groups ; Creatine Kinase ; Creatinine ; Emergencies ; Follow-Up Studies ; Heat Stroke ; Hot Temperature ; Humans ; Male ; Medical Records ; Porphyrins ; Retrospective Studies ; Rhabdomyolysis ; Running ; Sports ; Syncope ; Troponin I

PURPOSE: Numerous reports have suggested that apoptosis may play an important role in postresuscitation syndrome. The aim of this study is to assess the levels of molecules that are associated with apoptosis in the serum of patients who underwent successful resuscitation after cardiac arrest. METHODS: The serum levels of cytochrome c, tumor necrosis factor type 1 receptor (TNF-R1) and Fas ligand in 11 patients were measured at 0, 4, 12, 24, 48 and 72 hours after successful resuscitation. The primary endpoint consisted of survival to hospital discharge. Ten healthy volunteers were also evaluated as a control group. RESULTS: Patients with successful resuscitation had increased levels of cytochrome c and TNF-R1 at 0, 4, 12, 24 and 48 hours after return of spontaneous circulation (ROSC), as compared with those levels of the healthy volunteers (p<0.05). Higher levels of TNF-R1 at 12, 24 and 48 hours after ROSC were found in the non-survivors as compared to those levels of the survivors (p=0.01, 0.03, 0.02). The Fas ligand level at ROSC was also higher in the patients with successful resuscitation (p=0.00). However, the Fas ligand levels at 24, 48 and 72 hours after ROSC were lower in the patients with successful resuscitation than those levels in the healthy volunteers. CONCLUSION: These results suggest that apoptosis belonging to the TNF-R1 and cytochrome c pathways may be involved in the pathogenesis of postresuscitation syndrome. The serum levels of the death-receptor TNF-R1 could serve to quantitate the severity of injury and to prognosticate the survival outcomes.
Apoptosis ; Cardiopulmonary Resuscitation ; Cytochromes ; Cytochromes c ; Fas Ligand Protein ; Heart Arrest ; Humans ; Receptors, Tumor Necrosis Factor, Type I ; Resuscitation ; Survivors ; Tumor Necrosis Factor-alpha

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization