Seung Baik Han

Hospital‐based influenza surveillance in Korea: Hospital‐based influenza morbidity and mortality study group

Influenza epidemics occur annually with variations in size and severity. Hospital‐based Influenza Morbidity & Mortality was established to monitor influenza epidemics and their severity, which is composed of two surveillance systems: emergency room‐based and inpatient‐based surveillance. Regarding emergency room‐based surveillance, influenza‐like illness index (influenza‐like illness cases per 1,000 emergency room‐visiting subjects), number of laboratory‐confirmed cases and the distribution of influenza types were estimated weekly. Inpatient‐based surveillance included monitoring for hospitalization, complications, and mortality. The emergency room influenza‐like illness index correlated well with the number of laboratory‐confirmed influenza cases, and showed a bimodal peak at Week 4 (179.2/1,000 emergency room visits) and Weeks 13‐14 (169.6/1,000 emergency room visits) of 2012. Influenza A was the predominant strain during the first epidemic peak, while influenza B was isolated exclusively during the second peak. In 2011–2012 season, the mean admission rate of emergency room‐visiting patients with influenza‐like illness was 16.3% without any increase over the epidemic period. Among the hospitalized patients with influenza, 33.6% (41 out of 122 patients) were accompanied by complications, and pneumonia (28.7%, 35 out of 122 patients) was the most common. Most fatal cases were caused by influenza A (96.2%) after the first epidemic peak. In conclusion, Hospital‐based Influenza Morbidity & Mortality was effective for monitoring the trends in circulating influenza activity concurrently with its severity. In the 2011–2012 season, the influenza epidemic persisted for a ≥5‐month period, with a bimodal peak of influenza A and B in sequence. Overall, influenza A was more severe than influenza B. J. Med. Virol. 85:910–917, 2013.

Inhibition of 6-hydroxydopamine-induced endoplasmic reticulum stress by l-carnosine in SH-SY5Y cells

Conditions that cause endoplasmic reticulum malfunction (ER stress) play a key role in the development of various human diseases including neurodegenerative diseases. Carnosine is an endogenous peptide, present in excitable tissues such as brain and skeletal muscle. Although there are reports suggesting that carnosine has a biological role independent of its antioxidant activity, there have been no reports of the effects of carnosine on the ER stress response. We investigated the effects of carnosine on 6-hydroxydopamine (6-OHDA)-induced cell death and ER stress in SH-SY5Y cells. After assessing control cell viability in serum-free conditions for 24h (100% viability), we found that 50 microM 6-OHDA reduced cell viability to 76.4% of control values, whereas addition of 10mM carnosine significantly reduced cell death to 96.1% viability in a dose-dependent manner. Consistent with its cytoprotective action, carnosine markedly inhibited subsequent ER stress responses, including phosphorylation of eukaryotic initiation factor 2alpha (eIF2alpha) and c-jun, expression of glucose regulatory protein 78 and C/EBP homologous protein, and mRNA splicing of X-box protein 1. The measurement of reactive oxygen species (ROS) generation by 6-OHDA showed that addition of 10mM carnosine slightly but obviously inhibits the 6-OHDA-induced ROS production. In conclusion, our results show that carnosine almost completely inhibits 6-OHDA-induced ER stress responses and cytotoxicity, and that slight antioxidant activity of carnosine against 6-OHDA is observed. Further in vivo studies are needed to investigate clinical uses for carnosine.

Laboratory Surveillance of Influenza-Like Illness in Seven Teaching Hospitals, South Korea: 2011-2012 Season

Background A well-constructed and properly operating influenza surveillance scheme is essential for public health. This study was conducted to evaluate the distribution of respiratory viruses in patients with influenza-like illness (ILI) through the first teaching hospital-based surveillance scheme for ILI in South Korea. Methods Respiratory specimens were obtained from adult patients (≥18 years) who visited the emergency department (ED) with ILI from week 40, 2011 to week 22, 2012. Multiplex PCR was performed to detect respiratory viruses: influenza virus, adenovirus, coronavirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, parainfluenza virus, bocavirus, and enterovirus. Results Among 1,983 patients who visited the ED with ILI, 811 (40.9%) were male. The median age of patients was 43 years. Influenza vaccination rate was 21.7% (430/1,983) during the 2011–2012 season. At least one comorbidity was found in 18% of patients. The positive rate of respiratory viruses was 52.1% (1,033/1,983) and the total number of detected viruses was 1,100. Influenza A virus was the dominant agent (677, 61.5%) in all age groups. The prevalence of human metapneumovirus was higher in patients more than 50 years old, while adenovirus was detected only in younger adults. In 58 (5.6%) cases, two or more respiratory viruses were detected. The co-incidence case was identified more frequently in patients with hematologic malignancy or organ transplantation recipients, however it was not related to clinical outcomes. Conclusion This study is valuable as the first extensive laboratory surveillance of the epidemiology of respiratory viruses in ILI patients through a teaching hospital-based influenza surveillance system in South Korea.

Post-Nargis medical care: experience of a Korean Disaster Relief Team in Myanmar after the cyclone.

The objective of this study was to assess the epidemiology and clinical data of patients observed by the Korean Disaster Relief Team, during its deployment in Myanmar, from 6 to 12 June 2008. A cross-sectional, medical record-based study in the Korean Disaster Relief Team clinic, established a month after the cyclone Nargis devastated Myanmar. Data collected included demographic variables, and whether or not the problem was acute or chronic, and traumatic or medical. We included 2641 patients in the study. Of those, 57.6% presented with an acute condition, and the rest had chronic conditions. Approximately 5% of the patients presented with trauma/injury; and in 29% of the trauma cases, the problem was directly related to the cyclone. The most common diagnostic category was musculoskeletal problems (21.5%), followed by respiratory (15.3%), and digestive (14.6%) abnormalities. A little over 5% of patients had posttraumatic stress disorder, and the odds ratio was 2.62 (95% confidence interval 1.63–4.21) for women to have posttraumatic stress disorder. Most of the patients (97.5%) had minor problems and were sent home. In conclusion, a huge unmet medical need in at-risk populations and a relatively large proportion of chronic medical conditions should be considered in any future planning of a similar type of disaster.

Recurrent Massive Subcutaneous Hemorrhage in Neurofibromatosis Type 1: A Case Report

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that has three major features: multiple neural tumors, café-au-lait spots, and pigmented iris hamartomas (Lisch nodules). The purpose of this case report is to advise physicians of the danger associated with the progression of fast-onset massive hemorrhage to hemodynamic instability, which mandates rapid treatment to prevent the development of a life-threatening condition. A 64-yr-old woman with NF-1 was admitted to the Emergency Department (ED) because of a rapidly growing, 10×5×3 cm-sized mass on the left back area. She had previously undergone surgery for a large subcutaneous hematoma, which had developed on her right back area 30 yr before. She became hemodynamically unstable with hypotension during the next 3 hr after admission to ED. Resuscitation and blood transfusion were done, and the hematoma was surgically removed. The mass presented as a subcutaneous, massive hematoma with pathologic findings of neurofibroma. We report a case of NF-1 that presented as recurrent, massive, subcutaneous hemorrhage on the back region combined with hypovolemic shock.

Complete cervical tracheal transection caused by blunt neck trauma: case report.

This study aimed to report the survival of a rare case of complete tracheal transection followed by blunt neck trauma. A 66-year-old man was presented in the emergency room after a motorcycle accident in which a rope was wrapped around his neck. Although alert, he was in respiratory distress. A computed tomographic scan showed transection of the cervical trachea. Emergency neck exploration revealed that the tracheal laceration had been cut from the tracheal anterior third ring to the posterior first ring and the anterior esophageal wall had ruptured. Laryngectomy, tracheostomy, and esophagopharyngeal anastomosis were performed. Prompt airway management and immediate neck exploration is important for survival in these cases.

Current practices for paediatric procedural sedation and analgesia in emergency departments: results of a nationwide survey in Korea

Objective Procedural sedation and analgesia (PSA) in children has become a standard tool in emergency settings, but no national PSA guidelines have been developed for the emergency department (ED) in Korea. Therefore, we investigated the practice of PSA and the level of adherence to institutional PSA guidelines in EDs of teaching hospitals. Methods This study was a cross-sectional, web-based survey. The study subjects were the faculty of EDs from 96 teaching hospitals. The questionnaire was posted on an internet site, and the participants were requested that the questionnaire be answered by email and telephone in May 2009. Results The questionnaires were completed by 67.7% of the participants. Only 20% of EDs had institutional PSA guidelines, 21.5% of those had discharge criteria and 13.8% of EDs had a discharge instruction form. Residents were administered PSA at 76.9% of EDs. The airway rescue equipment was near the area where PSA was performed in 76.9% of EDs. The most commonly used medication for both diagnostic imaging and painful procedure was oral chloral hydrate (87.7%, 61.5%). In 64.6% of EDs, patients were monitored. In only 21 cases, EDs (50.0%) monitored the patients to recovery after PSA or discharge. Conclusions Current PSA for paediatric patients have not been appropriately applied in Korea. Unified PSA guidelines were rare in the hospitals surveyed, and many patients were not monitored over an appropriate duration, nor did they receive adequate medications for sedation by the best trained personnel. Therefore, the national PSA guidelines must be developed and implemented as early as possible.

Application of high-flow nasal cannula in the ED for patients with solid malignancy.

Age, y 71.6 ± 10.6 Male sex 4 (36.3%) Body mass index, kg/m 20.3 ± 5.4 Mode of arrival, ambulance 8 (72.7%) Triage, red 10 (90.9%) Location of primary cancer Lung 4 (36.3%) Gastrointestinal tract 4 (36.3%) Hepatobiliary tract 2 (18.1%) Disease status Active 8 (72.7%) No evidence of disease 3 (27.2%) Metastasis to lungs 5 (45.4%) Chemotherapy in the last 30 d 3 (27.2%) Comorbid conditions Diabetes mellitus 3 (27.2%) Heart diseases 2 (18.1%) Neurodegenerative diseases 2 (18.1%) Chronic lung diseases 1 (9.0%) APACHE II 23.3 ± 4.0 Reasons for acute respiratory failure Pneumonia 8 (72.7%) Cardiogenic 1 (9.0%) Nephrogenic 1 (9.0%) Other 1 (9.0%) Do-not-intubate order 4 (36.3%) Vital signs on presentation Systolic blood pressure, mm Hg 136.8 ± 39.9 Diastolic blood pressure, mm Hg 76.4 ± 20.1 Heart rate, beats/min 112.9 ± 27.7 Respiratory rate, breaths/min 32.1 ± 6.2 Body temperature, °C 36.7 ± 0.8 Saturation, % 79.1 ± 8.9 Bilateral pulmonary infiltrates on chest radiograph 9 (81.8%) Arterial blood gas on presentation pH 7.3 ± 0.1 PCO2, mm Hg 37.4 ± 13.0 PO2, mm Hg 48.1 ± 12.2 HCO3, mmol/L 19.4 ± 5.0 SpO2 76.3 ± 16.9 Neutropenia 1 (9.0%) CRP, mg/dL 12.3 ± 11.2 Use of vasopressor 2 (18.1%) Hopeless discharge 2 (18.1%) Death 4 (36.3%)

A CASE OF ANGIOEDEMA DUE TO ACQUIRED C1 ESTERASE INHIBITOR DEFICIENCY MASQUERADING AS SUSPECTED PERITONITIS: A CASE REPORT

Angioedema due to acquired C1 esterase deficiency is a rare condition and a non-inflammatory disease characterized by episodes of edema of the mucosa of the upper airway or gastrointestinal tract. The purpose of this case report is to heighten awareness among emergency physicians of a peritonitis-like condition that can develop into angioedema due to acquired C1 esterase inhibitor deficiency, and thereby help to prevent false diagnosis resulting in unnecessary surgical intervention. We report the case of a 21-year-old man who presented to the Emergency Department (ED) with abdominal pain. He was later diagnosed with angioedema of the gastrointestinal tract due to acquired C1 esterase deficiency that was initially suspected as peritonitis. Careful evaluation of the acute abdomen in acquired C1 esterase deficiency is very important in the ED to distinguish between medical and surgical causes of an acute abdomen.

Isolated cerebrospinal fluid leakage due to a spinal stab wound in a child.

Spinal stab wounds are relatively rare, especially in children. Moreover, as the pediatric spine anatomy differs from that of an adult, physicians managing stab wounds in this area should keep some special considerations in mind. This study reports an interesting case of spinal cerebrospinal fluid leakage without significant spinal injury in a 32-month-old child.