Jeong Mi Moon

Inhibition of microRNA-181 Reduces Forebrain Ischemia-Induced Neuronal Loss

MicroRNA (miRNA), miR-181a, is enriched in the brain, and inhibition of miR-181a reduced astrocyte death in vitro and infarct volume after stroke in vivo. This study investigated the role of miR-181a in neuronal injury in vitro and hippocampal neuronal loss in vivo after forebrain ischemia. miR-181a levels were altered by transfection with mimic or antagomir. N2a cells subjected to serum deprivation and oxidative stress showed less cell death when miR-181a was reduced and increased death when miR-181a increased; protection was associated with increased Bcl-2 protein. In contrast, transfected primary neurons did not show altered levels of cell death when miR-181a levels changed. Naive male rats and rats stereotactically infused with miR-181a antagomir or control were subjected to forebrain ischemia and cornus ammonis (CA)1 neuronal survival and protein levels were assessed. Forebrain ischemia increased miR-181a expression and decreased Bcl-2 protein in the hippocampal CA1 region. miR-181a antagomir reduced miR-181a levels, reduced CA1 neuronal loss, increased Bcl-2 protein, and significantly prevented the decrease of glutamate transporter 1. Thus, miR-181a antagomir reduced evidence of astrocyte dysfunction and increased CA1 neuronal survival. miR-181a inhibition is thus a potential target in the setting of forebrain or global cerebral ischemia as well as focal ischemia.

Acute endosulfan poisoning: a retrospective study.

Endosulfan is a widely used insecticide that is associated with a high fatality rate in humans when ingested accidentally or with the aim of suicide. However, the literature concerning human endosulfan exposure is limited to case reports. Thus, we sought to 1) describe the clinical features of patients with acute endosulfan poisoning and 2) identify independent factors to predict patients’ outcome. Fifty-two patients who presented with acute endosulfan poisoning between January 2001 and January 2007 were enrolled in this retrospective study. Sixteen (30.7%) of the 52 patients died, and 48 patients experienced seizures. Endosulfan poisoning caused the hypotension and the abnormalities on electrocardiogram at presentation. Over half of the patients developed complications, such as rhabdomyolysis, hepatic toxicity, and hypotension. These complications resolved without sequelae in the survival group. Refractory status epilepticus was the most common cause of death in this series (75.0%). Amount ingested being greater than 35 g of endosulfan was the most found to be an independent variable that predicted patient mortality. Patients with this risk factor must be treated aggressively during the early stage of endosulfan poisoning.

The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department.

Patients with carbon monoxide (CO) poisoning have been found to have a correlation between initial clinical severity on admission and blood lactate levels. Recently, it is suggested that the lactate level may be a useful prognostic factor in cases study. The purpose of this study was to determine whether lactate levels were associated with the short-term outcome of patients with CO poisoning and identify the characteristics of patients with high initial lactate levels. Eighty patients that presented to the Chonnam National University Hospital after CO poisoning, over 5 years, were enrolled in this retrospective study. Fifty-six (70.0%) patients had high lactate (>2.1 mmo/L) on admission. Thirty-three (41.3%) patients had medical complications and one patient (1.3%) died. The patients with high initial lactate had an altered mental status more frequently, higher WBC, glucose and carboxyhemoglobin (COHb), and lower base deficit on admission. The multivariate analysis showed that lactate was an independent factor associated with serious complications and the need for intensive medical treatment, along with advanced age, WBC, and altered mental status on admission. The results of this study show that the initial lactate was useful for patient prognosis after CO poisoning.Patients with carbon monoxide (CO) poisoning have been found to have a correlation between initial clinical severity on admission and blood lactate levels. Recently, it is suggested that the lactate level may be a useful prognostic factor in cases study. The purpose of this study was to determine whether lactate levels were associated with the short-term outcome of patients with CO poisoning and identify the characteristics of patients with high initial lactate levels. Eighty patients that presented to the Chonnam National University Hospital after CO poisoning, over 5 years, were enrolled in this retrospective study. Fifty-six (70.0%) patients had high lactate (>2.1 mmo/L) on admission. Thirty-three (41.3%) patients had medical complications and one patient (1.3%) died. The patients with high initial lactate had an altered mental status more frequently, higher WBC, glucose and carboxyhemoglobin (COHb), and lower base deficit on admission. The multivariate analysis showed that lactate was an independent factor associated with serious complications and the need for intensive medical treatment, along with advanced age, WBC, and altered mental status on admission. The results of this study show that the initial lactate was useful for patient prognosis after CO poisoning.

The efficacy of high doses of vitamin C in patients with paraquat poisoning.

Paraquat (PQ) poisoning is an extremely difficult condition to manage clinically because of the lack of effective treatments. The purpose of this study was to assess the effect of high doses of vitamin C in combination with anti-inflammatory and immunosuppressant therapy in patients with PQ poisoning. The medical records of 134 patients who presented to the emergency department within 24 hours after PQ poisoning were reviewed retrospectively. The 57 patients presented between January 2004 and September 2005 were group 1; they received pulse therapy, which included cyclophosphamide and methylprednisolone, followed by the administration of dexamethasone over 2 weeks. The 77 patients that presented between October 2005 and January 2008 were group 2; they received the above-mentioned therapy and high-dose vitamin C for 2 weeks. There was no difference in the distribution of baseline variables between the 2 groups. However, group 2 showed a significant reduction in acute kidney injury related to PQ. Furthermore, a multivariate logistic regression analysis showed that the addition of vitamin C to the treatment was significantly associated with an increased survival of the patients. Larger trials will be needed to verify the effect of high-dose vitamin C on survival in patients with PQ poisoning.Paraquat (PQ) poisoning is an extremely difficult condition to manage clinically because of the lack of effective treatments. The purpose of this study was to assess the effect of high doses of vitamin C in combination with anti-inflammatory and immunosuppressant therapy in patients with PQ poisoning. The medical records of 134 patients who presented to the emergency department within 24 hours after PQ poisoning were reviewed retrospectively. The 57 patients presented between January 2004 and September 2005 were group 1; they received pulse therapy, which included cyclophosphamide and methylprednisolone, followed by the administration of dexamethasone over 2 weeks. The 77 patients that presented between October 2005 and January 2008 were group 2; they received the above-mentioned therapy and high-dose vitamin C for 2 weeks. There was no difference in the distribution of baseline variables between the 2 groups. However, group 2 showed a significant reduction in acute kidney injury related to PQ. Furthermore, a multivariate logistic regression analysis showed that the addition of vitamin C to the treatment was significantly associated with an increased survival of the patients. Larger trials will be needed to verify the effect of high-dose vitamin C on survival in patients with PQ poisoning.

FENTANYL INTOXICATION CAUSED BY ABUSE OF TRANSDERMAL FENTANYL

Fentanyl has an analgesic effect 100 times greater than that of morphine; therefore, transdermal administration of fentanyl has been widely used to control pain. Due to misconceptions regarding the proper use of fentanyl, its simple method of administration, and the absence of regulatory rules regarding its use, both medical providers and non-medical providers have abused fentanyl. We report on three cases of fentanyl intoxication and suggest solutions to prevent its abuse in the future. Three patients were intoxicated by transdermal fentanyl, which resulted in respiratory depression. Two of these cases were attributed to non-medical use of the drug and the other occurred while using fentanyl as directed by medical personnel. Physicians should use transdermal fentanyl only to control chronic pain, and rules should be established to prevent abuse of fentanyl that occurs due to its ease of use and the absence of any established policy regarding the prescription and disposal of this drug.

Can Early Hemodialysis Affect the Outcome of the Ingestion of Glyphosate Herbicide

The ingestion of small amounts of glyphosate herbicide usually causes only mild symptoms. However, when large volumes of concentrates are ingested intentionally, it can generate potentially fatal symptoms that are refractory to treatment. It also is well known that the treatment for glyphosate poisoning is primarily of a supportive nature. We report two patients who intentionally ingested glyphosate herbicide, and both exhibited cardiovascular collapse and complicated renal failure despite the use of aggressive supportive therapy. Hemodialysis was conducted and the results were satisfactory; both patients were discharged without any sequelae. After analyzing these cases, we suggest that hemodialysis might have contributed to the favorable outcomes of our patients, and that there are several mechanisms that might justify the use of hemodialysis in these patients. In conclusion, physicians may wish to consider the early use of hemodialysis to improve the prognosis of patients exhibiting refractory hypotension and oliguria, despite vigorous supportive treatment in glyphosate herbicide intoxication.The ingestion of small amounts of glyphosate herbicide usually causes only mild symptoms. However, when large volumes of concentrates are ingested intentionally, it can generate potentially fatal symptoms that are refractory to treatment. It also is well known that the treatment for glyphosate poisoning is primarily of a supportive nature. We report two patients who intentionally ingested glyphosate herbicide, and both exhibited cardiovascular collapse and complicated renal failure despite the use of aggressive supportive therapy. Hemodialysis was conducted and the results were satisfactory; both patients were discharged without any sequelae. After analyzing these cases, we suggest that hemodialysis might have contributed to the favorable outcomes of our patients, and that there are several mechanisms that might justify the use of hemodialysis in these patients. In conclusion, physicians may wish to consider the early use of hemodialysis to improve the prognosis of patients exhibiting refractory hypotension and oliguria, despite vigorous supportive treatment in glyphosate herbicide intoxication.

Predicting the complicated neutropenic fever in the emergency department

Objectives: The purpose of this study was to identify independent factors that can be used to predict whether febrile neutropenic patients who appear healthy at presentation will develop subsequent complications, using variables that are readily available in the emergency department (ED). Method: The medical records of 192 episodes in which the patients presented to the ED with neutropenic fever resulting from chemotherapy, with an alert mental state and haemodynamic stability were retrospectively reviewed. Endpoints examined were fever response to administered antibiotics, death or severe medical complications during hospitalisation. Results: Thirty-eight episodes of neutropenic fever with complicated outcomes were identified from among a total of 192 episodes. Three parameters emerged as independent factors for the prediction of neutropenic fever with complications in the multivariate regression analysis: platelet count (130−450 × 103 cells/mm3) <50 000 cells/mm3, serum C-reactive protein (CRP, 0.1–1 mg/dl) >10 mg/dl and pulmonary infiltration on chest x ray. Conclusions: Platelet count, CRP and pulmonary infiltration on chest x ray at presentation could be used to identify febrile neutropenic patients who will develop complications, and these factors may be useful in making treatment-related decisions in the ED.

Symptomatic epidural pneumorrhachis associated with an occult pneumomediastinum due to minor trauma.

Study Design. A case report and review of the literature. Objective. To discuss the significance of identifying symptomatic epidural pneumorrhachis associated with an occult pneumomediastinum in the absence of pneumothorax and subcutaneous emphysema after minor trauma. Summary of Background Data. Pneumorrhachis is defined as the presence of air in the epidural space or subarachnoid space. Previous reports have suggested that traumatic epidural pneumorrhachis was usually asymptomatic and a combination of pneumothorax, pneumomediastinum, and subcutaneous emphysema following major trauma and managed by conservative treatment. Methods. A 53-year-old man was admitted to the emergency department after the traffic collision. He presented with diffuse pain ranging from the neck to back, and complained of radiating shoulder pain. Results. The lateral cervical spine radiograph revealed an air shadow in the anterior cervical space. Axial image of cervical spine computed tomography (CT) revealed epidural pneumorrhachis. The sagittal reconstruction image of neck CT showed a small amount of air in the posterior mediastinum, and scattered air in the anterior cervical spinal canal. Our patient was treated conservatively and had a complete and uneventful recovery. Conclusion. To our knowledge, this is the first case in which symptomatic traumatic epidural pneumorrhachis was associated with an occult pneumomediastinum in the absence of pneumothorax and subcutaneous emphysema. These findings may be useful in alerting trauma specialists to carefully evaluate the associated pathologies leading to pneumorrhachis enabling adequate therapy.

Bowel perforations induced by multiple magnet ingestion.

We report two cases of bowel perforation that presented to the ED after ingesting multiple magnets as diagnosed with exploratory laparotomy. Foreign body ingestion is a common occurrence in the paediatric population. Diagnosis is often delayed because it is difficult to obtain a precise history of foreign body ingestion. Fortunately, in many cases, ingested foreign bodies pass spontaneously without complications. However, surgical intervention is required for about one percent of foreign body ingestions. Multiple magnet ingestion produces bowel injuries, including bowel obstruction, ischaemia, necrosis, perforation and fistula formation, finally requiring surgical intervention. The incidence, which is rare, of magnet ingestion with complications has increased as a result of the popularity of magnetic toys. This case report highlights the complications that might occur with multiple magnet ingestion. We aim to alert physicians that multiple magnet ingestion can be a serious matter.

Glasgow coma scale score in the prognosis of acute carbamate insecticide intoxication

Objectives. Carbamate is a widely used insecticide, and fatality due to carbamate insecticide intoxication has been reported. However, no studies have addressed the factors associated with outcome of patients poisoned by carbamate insecticide. The present study sought to identify the independent factors that could help predict the development of medical complications as a result of carbamate intoxication. Methods. Fifty two patients presenting with acute carbamate insecticide ingestion at Chonnam National University Hospital were enrolled in this retrospective observational case series. The morbidities that needed intensive treatment such as hypotension, respiratory failure, and death were regarded as complications. To identify the associated factors to these complications, objective variables that are easily assessed at presentation, such as age, initial Glasgow coma scale (GSC) and corrected QT (QTc) prolongation, were analyzed by univariate and multivariate stepwise logistic regression analyses. Results. Of the 52 patients, 35 (67.3%) had medical complications within 24 hours after carbamate insecticide intoxication and seven (13.5%) died. Respiratory failure was the most common medical complication. The significant factors determined by univariate analysis were initial GCS, elevated lactate, and QTc prolongation. However, initial GCS (≤13) was the only independent factor determined by multivariate analysis that was associated with serious complications requiring intensive medical treatment. Conclusions. Carbamate insecticide intoxication is not a mild disease, as previously thought, having a mortality rate of 13.8% and a morbidity rate of 67.3%. Initial GCS ≤ 13 can be used as a significant factor to identify carbamate insecticide-intoxicated patients who will experience complications.