Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

OBJECTIVE: Acute myocardial infarction is a major cause of out-of-hospital cardiac arrest (OHCA). Coronary angiography (CAG) enables diagnostic confirmation of coronary artery disease and subsequent revascularization, which might improve the prognosis of OHCA survivors. Non-randomized data has shown a favorable impact of CAG on prognosis for this population. However, the optimal timing of CAG has been debated. METHODS: The clinical outcomes of 607 OHCA patients registered in CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance), a nationwide multicenter registry performed in 27 hospitals, were analyzed. Early CAG was defined as CAG performed within 24 hours of emergency department admission. The primary outcome was survival to discharge, with neurologically favorable status defined by cerebral performance category scores ≤2. RESULTS: Compared to patients without CAG (n=469), patients who underwent early CAG (n=138) were younger, more likely to be male, and more likely to have received bystander cardiopulmonary resuscitation, pre-hospital defibrillation, and revascularization (P<0.01 for all). Analysis of 115 propensity score-matched pairs showed that early CAG is associated with a 2.3-fold increase in survival to discharge with neurologically favorable status (P<0.001, all). Survival to discharge increased consistently according to the time interval between emergency department visit and CAG (P<0.05). CONCLUSION: Early CAG of OHCA patients was associated with better survival and favorable neurologic outcomes at discharge. However, there was no clear time threshold for CAG that predicted survival to discharge.
Cardiopulmonary Resuscitation ; Coronary Angiography* ; Coronary Artery Disease ; Emergency Service, Hospital ; Humans ; Male ; Myocardial Infarction ; Out-of-Hospital Cardiac Arrest* ; Prognosis ; Survival Rate ; Survivors

PURPOSE: Triage tags help prioritize the treatment for disaster patients based on the severity of the illness and help distribute limited resources during a time of disaster. In this study, we developed a novel triage tag and evaluated its feasibility during a hospital-based disaster drill. METHODS: For the first stage, we developed a new triage tag. The most commonly used triage tags (Medical Emergency Triage-TAG and SMART tag) were analyzed. We reassembled their advantages and invented a novel triage tag (NT tag). The second stage involved an evaluation of the quality of NT tag. The NT tag was used in a hospital-based disaster drill held in a single center with 22 mock patients. After the drill, hospital staffs were asked to complete a questionnaire which included visibility, comprehensibility, and ease of use with respect to the new NT tag. A five-category Likert scale was used to quantify the answer. RESULTS: The NT tag was successfully developed considering 6 quality indexes: visibility, expandability, flexibility, solidity, space, and fixity. Forty-two out of ninety (46.7%) subjects answered the questionnaire. Approximately 21% of participants had previous disaster drill experience and 33% had previous education of the SMART triage system. The visibility scale of the severity category was on average 3.3 (standard deviation (SD): 1.0), the comprehensiveness of the severity category was 3.6 (SD:0.9), the ease to understand patient information was 2.2-4.2, the ease to follow up symptoms and vital signs was 2.3-4.1. Eighty and percent of participants preferred to use the NT tag in a future disaster situation or disaster drill. CONCLUSION: We successfully developed a novel triage tag. The NT tag showed moderate feasibility.
Disasters ; Education ; Emergencies ; Follow-Up Studies ; Humans ; Pliability ; Triage* ; Vital Signs

PURPOSE: The population of senior citizens is rapidly growing in Korea, and this would inevitably result in the increase of elder abuse. This study was designed to survey healthcare providers in the emergency department, who may have a high probability of coming into contact with abused senior citizens, on the awareness of elder abuse, and to evaluate the level of legal knowledge and standard of education amongst these care providers. METHODS: This study was a descriptive, cross-sectional survey research and was made for doctors and nurses with at least a one-year experience working in an emergency department at a university hospital in Seoul. A total of 142 participants were included for analysis. RESULTS: Approximately 69.7% (n=99) of participants were relatively well aware of the obligation to report an elder abuse case. However, only 17.6% (n=25) of participants were aware of the method to file a report. Moreover, only 8.0% (n=11) of participants knew the provisions on punishing for not reporting. Only 15% (n=22) of participants received proper education relating to elder abuse after getting hired. Participants who received the education after getting hired have a better knowledge about elder abuse than those who did not receive the education (p=0.001). Participants who watch press reports about elder abuse showed to have better legal knowledge than those who do not watch such reports (p=0.012). CONCLUSION: With regard to participants' level of awareness of the severity according to the type of abuse, physical abuse was seen as the most serious (4.22), followed by neglect (3.52), abandonment (3.18), emotional abuse (2.66), sexual abuse (2.61), and financial abuse (2.27).
Aged ; Cross-Sectional Studies ; Delivery of Health Care* ; Education ; Elder Abuse* ; Emergencies* ; Emergency Service, Hospital* ; Health Personnel* ; Humans ; Korea ; Methods ; Physical Abuse ; Seoul ; Sex Offenses

PURPOSE: Middle East respiratory syndrome (MERS) outbreaks occurred in Korea during the year 2015, with the involvement of 186 patients in a relatively short period of time. The epidemiological pattern in South Korea was hospital-associated. Infection control plans for all hospitals were implemented to stop the spread of and to protect the healthcare workers from MERS infection. Such enhanced guidelines for infection control measures might affect healthcare workers. The purpose of this study was to determine the changes of tertiary emergency department healthcare workers' perception and compliance to hand hygiene and personal protective equipment (PPE) before and after the MERS outbreak. METHODS: A written questionnaire was administered to members in the emergency department at Samsung Medical Center. Participants were asked to rate the combined overall effectiveness of hand hygiene and PPE and to report their compliance on a 5-point scale. This survey was conducted between 11th and 26th of September 2015. RESULTS: The total number of participants was 123. Perception of effectiveness before and after the MERS outbreak was improved on hand hygiene, N-95 masks, gowns, eye protection, and gloves, except surgical masks (3.65 vs. 3.68, p=0.714). Respondents showed a statistically higher compliance with hand washing and PPE. Compliance with hand hygiene and PPE showed a dependency on their patients' symptoms; symptoms of fever or fever with upper respiratory symptoms were reported with statistically increased compliance, with the exception of surgical masks. CONCLUSION: Infection control measures except surgical masks were perceived to be more effective post the MERS outbreaks. The emergency department's workers reported increased compliance on hand hygiene and PPE, except surgical masks.
Compliance* ; Coronavirus Infections* ; Delivery of Health Care ; Disease Outbreaks ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Hand Disinfection ; Hand Hygiene ; Humans ; Infection Control* ; Korea ; Masks ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Personal Protective Equipment ; Surveys and Questionnaires

A 59-year-old man presented to the emergency department with a chief complaint of sore throat after swallowing sodium picosulfate/magnesium citrate powder for bowel preparation, without first dissolving it in water. The initial evaluation showed significant mucosal injury involving the oral cavity, pharynx, and epiglottis. Endotracheal intubation was performed for airway protection in the emergency department, because the mucosal swelling resulted in upper airway compromise. After conservative treatment in the intensive care unit, he underwent tracheostomy because stenosis of the supraglottic and subglottic areas was not relieved. The tracheostomy tube was successfully removed after confirming recovery, and he was discharged 3 weeks after admission.
Airway Obstruction* ; Cathartics ; Caustics ; Citric Acid* ; Colonoscopy ; Constriction, Pathologic ; Deglutition ; Eating* ; Emergency Service, Hospital ; Epiglottis ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Middle Aged ; Mouth ; Pharyngitis ; Pharynx ; Sodium* ; Tracheostomy ; Water

DNA pyrosequencing, one of the advanced methods for DNA sequencing, has been employed for phylogenetic analysis of bacterial communities using the conserved 16S rRNA gene. We performed a pilot study on a mother-neonate pair utilizing the DNA pyrosequencing assays to investigate the diversity of microbial communities in maternal amniotic fluid (AF), vagina, and rectum and newborn gastric fluid (GF) and stool. Phylum level analysis revealed that bacterial community was dominated by Firmicutes (63.2%) in maternal feces, and Actinobacteria (84.9%) in maternal vaginal swab. The bacterial communities in both the AF and GF were dominated by Proteobacteria (67.8%). Interestingly, the bacterial community in the newborn's meconium was quite similar to that in the AF. However, the composition of the bacterial community in newborn's feces was different on day 14 and dominated by Firmicutes (91.1%). Genus-level analysis revealed that the bacterial community in maternal feces was dominated by Anaerococcus (19.5%) and Prevotella (18.7%), whereas that in the maternal vaginal swab was dominated by Atopobium (83.6%). The bacterial communities in both the AF and GF were dominated by Sphingomonas (38.5%). The bacterial community in the newborn's meconium was quite similar to that in the AF, which was dominated by Sphingomonas (45.2%). However, the composition of bacterial community in the newborn's feces on day 14 was relatively different. Future studies with a large number of infants are needed to determine the factors involved in the changing profile of newborn's fecal bacterial communities.
Actinobacteria ; Amniotic Fluid ; DNA ; Feces ; Female ; Genes, rRNA ; Humans ; Infant ; Infant, Newborn* ; Infant, Premature* ; Meconium ; Microbiota ; Pilot Projects* ; Prevotella ; Proteobacteria ; Rectum ; Sequence Analysis, DNA ; Sphingomonas ; Vagina

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhage. As the number of elderly people is increasing, the incidence of cSDH is growing. Therefore, we analyzed clinical manifestation of the cSDH. METHODS: The authors retrospectively reviewed the data of the 169 patients of cSDH who were 65 years or older and undergone burr-hole trephination and closed drainage in our hospital between January 2008 and December 2012. Patients were divided into two subgroups; group A: young than 75 years, group B: 75 years or older. We analyzed the differences of clinical aspects and surgical results in both groups. RESULTS: Proportion of male patients in group A (83.8%) was higher than in group B (58.4%) with statistical significance (p=0.003). Alteration of consciousness as an initial symptom was significantly more frequent in group A (17.5%) than in group B (4.4%)(p=0.006). Postoperatively, 164 of 169 patients (97%) were free from symptom within three days in both groups. Pneumonia followed the surgery in three patients (one in group A and two in group B). CONCLUSION: There were no difference in the rate of complications between group A and B. Therefore, burr-hole trephination and external drainage is safe and effective management in both groups.
Aged ; Consciousness ; Drainage ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Pneumonia ; Retrospective Studies

Oral anticoagulant therapy is generally being used in patient with a high thromboembolic risk such as cerebrovascular or cardiovascular accident, in spite of increased bleeding tendencies and most of them are old-age patients. A stroke frequently leads to a fall, which in turn causes a minor trauma, and it is often reported that anticoagulant therapy for treatment of stroke may aggravate traumatic brain injury. The authors report a case that required surgical treatments for subacute subdural hematoma which was found during antiplatelets and anticoagulant therapy for acute ischemic stroke. The hematoma had not been found at the time of head injury accompanied by a cerebral infarction.
Brain Injuries ; Cerebral Infarction* ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Stroke ; Warfarin

Oral anticoagulant therapy is generally being used in patient with a high thromboembolic risk such as cerebrovascular or cardiovascular accident, in spite of increased bleeding tendencies and most of them are old-age patients. A stroke frequently leads to a fall, which in turn causes a minor trauma, and it is often reported that anticoagulant therapy for treatment of stroke may aggravate traumatic brain injury. The authors report a case that required surgical treatments for subacute subdural hematoma which was found during antiplatelets and anticoagulant therapy for acute ischemic stroke. The hematoma had not been found at the time of head injury accompanied by a cerebral infarction.
Brain Injuries ; Cerebral Infarction* ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Stroke ; Warfarin