Journal of acute medicine最新文献

{"title":"A Young Woman With New-Onset Focal Seizures.","authors":"James O Robbins, Julia H Rothschild, Ana C Albuja, M. Villamar","doi":"10.6705/j.jacme.202203_12(1).0007","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0007","url":null,"abstract":"","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"43-44"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44544721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microorganism Distributions and Antimicrobial Susceptibility in Community-Onset Bacteremia: A 6-Year Longitudinal Multicenter Cohort in Southern Taiwan.","authors":"Yi-Tzu Huang, Chao-Yung Yang, Chih-Chia Hsieh, Ming-Yuan Hong, Ching-Chi Lee","doi":"10.6705/j.jacme.202203_12(1).0001","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0001","url":null,"abstract":"Background\u0000Prompt administration of appropriate antimicrobials has been correlated with improved prognoses in patients with bacteremia. Because the Clinical and Laboratory Standards Institute (CLSI) has numerously revised the interpretive criteria of susceptibility to numerous antimicrobials, the updated susceptibility is useful for empirical administration.\u0000\u0000\u0000Methods\u0000In the multicenter retrospective cohort study consisting of adults with community-onset bacteremia in the emergency department (ED) during the period between January 2010 and December 2015, causative microorganisms were identified by the Vitek 2 system and prospectively collected. Antimicrobial susceptibility were respectively tested by the disk diffusion method for aerobes and the agar dilution method for anaerobes, in accordance with the contemporary CLSI criteria. Clinical information was retrospectively retrieved by reviewing the medical records.\u0000\u0000\u0000Results\u0000Of the total 3,194 patients and 3,583 causative microorganisms, the leading source of bacteremia was the urinary tract infection (1,034 patients, 32.4%), and Escherichia coli accounted for the majority (1,332 isolates, 37.2%) of the total microorganisms. Overall, the lowest (58.2%) and highest (93.5%) susceptibility to cefazolin and piperacillin/tazobactam were, respectively, observed. In the leading five sources of bacteremia, in terms of the urinary tract infections, pneumonia, intraabdominal infections, skin and soft-tissue infections, and biliary tract infections, cefazolin or cefuroxime was only active against 49.3%-62.3% or 63.2%-74.1% of causative microorganisms, respectively. Notably, E. coli , Klebsiella species, and Proteus mirabilis (EKP) with the production of extended-spectrum beta-lactamases (ESBLs) accounted for 7.4% (142 isolates) of 1,908 EKP and 4.0% of all 3,583 microorganisms; and methicillin-resistant Staphylococcus aureus (MRSA) accounted for 37.7% (158 isolates) of S . aureus and 4.4% of all causative isolates.\u0000\u0000\u0000Conclusions\u0000For adults with community-onset bacteremia, a low incidence (approximate 4%) of ESBL-producing EKP and MRSA among all causative microorganisms, but low susceptibility to cefazolin and cefuroxime were recognized. To achieve favorable prognoses by prompt administration of appropriate antimicrobials in EDs, our findings might offer useful information for the antimicrobial stewardship program.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":" ","pages":"13-22"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43757577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Patients Returning to Emergency Department With Initial False-Negative Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-Based COVID-19 Test.","authors":"Eric H. Chou, J. Healy, C. Tzeng, Alec Jessen, M. Hall, C. Patel, Chih-Hung Wang, Tsung-Chien Lu, T. Bhakta, J. Garrett","doi":"10.6705/j.jacme.202203_12(1).0004","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0004","url":null,"abstract":"Background\u0000The coronavirus disease 2019 (COVID-19) outbreak is an international public health emergency. Early identification of COVID-19 patients with false-negative RT-PCR tests is paramount in the ED to prevent both nosocomial and community transmission. This study aimed to compare clinical characteristics of repeat emergency department (ED) visits among coronavirus disease 2019 (COVID-19) patients with initial false-negative reverse transcriptase-polymerase chain reaction (RT-PCR)-based COVID-19 test.\u0000\u0000\u0000Methods\u0000This is a retrospective, multi-center, cohort study conducted at 12 hospitals affiliated with Baylor Scott & White Health system. Patients visiting the EDs of these hospitals between June and August 2020 were screened. Patients tested negative for viral RNA by quantitative RT-PCR in the first ED visit and positive in the second ED visit were included. The primary outcome was the comparison of clinical characteristics between two consecutive ED visits including the clinical symptoms, triage vital signs, laboratory, and chest X-ray (CXR) results.\u0000\u0000\u0000Results\u0000A total of 88 confirmed COVID-19 patients with initial false-negative RT-PCR COVID-19 test in the ED were included in the final analyses. The mean duration of symptoms in the second ED visit was significantly higher (3.6 ± 0.4 vs. 2.6 ± 0.3 days, p = 0.020). In the first ED visit, lymphocytopenia (35.2%), fever (32.6%), nausea (29.5%), and dyspnea (27.9%) are the most common signs of COVID-19 infection during the window period. There were significant increases in the rate of hypoxia (13.6% vs. 4.6%, p = 0.005), abnormal infiltrate on CXR (59.7% vs. 25.9%, p < 0.001), and aspartate aminotransferase (AST) elevation (26.1% vs. 9.1%, p < 0.001) in the second ED visit.\u0000\u0000\u0000Conclusions\u0000Early COVID-19 testing (less than 3 days of symptom duration) could be associated with a false-negative result. In this window period, lymphocytopenia, fever, nausea, and dyspnea are the most common early signs that can potentially be clinical hints for COVID-19 diagnosis.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"29-33"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48604919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methanol Intoxication After Suicidal Ingestion of Liquid Rodenticides: A Report of Two Cases.","authors":"Chan-Wa Cheong, Shao-Feng Liao, Chun-Kuei Chen, C. Seak, Hsien-Yi Chen","doi":"10.6705/j.jacme.202203_12(1).0006","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0006","url":null,"abstract":"Methanol is highly toxic to humans. Although methanol poisoning is not uncommon in developing countries, poisoning caused by ingestion of commercial products containing undeclared methanol has rarely been reported. Herein, we describe two patients who experienced methanol poisoning after ingestion of liquid rodenticides. A 39-year-old woman attempted suicide by ingesting liquid rodenticide which contained bromadiolone. She developed high anion gap metabolic acidosis and coagulopathy. Methanol poisoning was confirmed 20 hours later. She received oral ethanol therapy and hemodialysis. Vitamin K1 was also administered. She did not develop any hemorrhage or visual impairment and was discharged after 11 days. The rodenticide sample was tested and found to have a methanol concentration of 324 g/L. In another case, a 62-year-old man ingested the same brand of rodenticide. Laboratory data showed mild metabolic acidosis with an increased osmol gap, suggestive of methanol poisoning. He received hemodialysis and eventually recovered without sequelae. Liquid rodenticide may contain methanol as a solvent. Ingestion of a methanol-containing commercial product without a clear label can result in a considerable delay in diagnosis and management. Methanol poisoning should be considered for patients who present with unexplained metabolic acidosis following exposure to liquid rodenticides or other liquid commercial products.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"39-42"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49029187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 44-Year-Old Man With Acute Mutism: Acute Stroke, Psychiatric Disorder, or Substance Abuse?","authors":"Po-Hsiang Liao, H. Chiu, Tse-Yao Wang, Yen-Chia Chen","doi":"10.6705/j.jacme.202203_12(1).0005","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0005","url":null,"abstract":"Mutism is a common presentation of psychiatric diseases. However, patients presenting to the emergency department with mutism should be assumed to have an organic pathology irrespective of their psychiatric history. Little is known about the causality between mutism and illicit drug use. We report a case of a 44-year-old man with acute mutism who was initially diagnosed with ischemic cerebral infarction involving the dorsolateral frontal cortex causing Broca's aphasia. He was later found to have a history of amphetamine, ketamine, and new psychoactive substance use. Substance abuse could be a precipitating factor for acute stroke, especially among patients aged below 55 years. Patients should be routinely screened and counseled regarding illicit drug use. The present case report highlights the possibility that transient ischemia could be associated with acute mutism in drug abusers. Prompt acquisition of drug abuse history or basic drug screening is especially mandatory.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"34-38"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44442508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Prognosis of Snake Envenomation Among Pediatric Patients: A National Database Study.","authors":"Lin-Chi Chiang, C. Chaou, Yi-yun Li, C. Seak, Shiuan-Ruey Yu, Chih-Chuan Lin","doi":"10.6705/j.jacme.202203_12(1).0002","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0002","url":null,"abstract":"Background\u0000Snakebites constitute a common medical emergency in tropical and subtropical regions. Pediatric snake envenomation is a special category that has not been well studied. This study investigated the management and prognostic factors of snake envenomation in children using a Taiwanese national database.\u0000\u0000\u0000Methods\u0000This observational study used the National Health Insurance database of all pediatric snake envenomation patients treated from 2005 to 2009. Patients' demographic data, antivenom types and doses, medical and surgical interventions, and prognostic variables were collected. Comparisons were made according to the envenomation types, age groups, and whether the patients were hospitalized using univariate and multivariate methods.\u0000\u0000\u0000Results\u0000A total of 106 patients' data were collected. Of the patients, 73 (68.9%) were male, 62 (58.5%) were under the age of 12, 69 (65.1%) received intravenous (IV) antibiotic treatment, 38 (35.9%) were hospitalized, 5 (4.72%) required surgical intervention, and none died. Compared with non-hospitalized patients, the patients who required hospitalization were more likely to have suffered hemorrhagic envenomation ( p = 0.035), receive IV antibiotic treatment ( p = 0.0078), and require surgical intervention ( p = 0.005). In the multivariate analysis, hemorrhagic envenomation was an independent predictor for hospitalization (odds ratio: 3.47, 95% confidence interval: 1.18-10.21) after adjusting for other covariates. No significant differences were observed between age groups in total antivenom usage ( p = 0.2880), IV antibiotic usage ( p = 0.3190), hospitalization ( p = 0.3988), and surgical intervention ( p = 0.1874).\u0000\u0000\u0000Conclusions\u0000In this Taiwanese population-based national database study, antivenom treatment of pediatric snakebite patients resulted in zero mortality and a low surgical intervention rate. Patients with hemorrhagic envenomation were associated with a higher probability of hospitalization.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"13-22"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43239434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shock Management Without Formal Fluid Responsiveness Assessment: A Retrospective Analysis of Fluid Responsiveness and Its Outcomes.","authors":"Andrew Hong,&nbsp;Nicholas Villano,&nbsp;William Toppen,&nbsp;Montoya Elizabeth Aquije,&nbsp;David Berlin,&nbsp;Maxime Cannesson,&nbsp;Igor Barjaktarevic","doi":"10.6705/j.jacme.202112_11(4).0002","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0002","url":null,"abstract":"<p><strong>Background: </strong>In order to quantify fluid administration and evaluate the clinical consequences of conservative fluid management without hemodynamic monitoring in undifferentiated shock, we analyzed previously collected data from a study of carotid Doppler monitoring as a predictor of fluid responsiveness (FR).</p><p><strong>Methods: </strong>This study was a retrospective analysis of data collected from a single tertiary academic center from a previous study. Seventy-four patients were included for post-hoc analysis, and 52 of them were identified as fluid responsive (cardiac output increase > 10% with passive leg raise) according to NICOMTM bioreactance monitoring (Cheetah Medical, Newton Center, MA, USA). Treating teams provided standard of care conservative fluid resuscitation but were blinded to independently performed FR testing results. Outcomes were compared between fluid responsive and fluid non-responsive patients. Primary outcome measures were volume fluids administered and net fluid balance 24- and 72-hour post-FR assessment. Secondary outcome measures included change in vasopressor requirements, mean peak lactate levels, length of hospital/intensive care unit stay, acute respiratory failure, hemodialysis requirement, and durations of vasopressors and mechanical ventilation.</p><p><strong>Results: </strong>Mean fluids administered within 72 hours were similar between fluid non-responsive and fluid responsive patients (139 mL/kg [95% confidence interval [CI]: 102.00-175.00] vs. 136 mL/kg [95% CI: 113.00-158.00], p = 0.92, respectively). We observed an insignificant trend toward higher 28-day mortality among fluid non-responsive patients (36% vs. 19%, p = 0.14). Volume of fluids administered significantly correlated with adverse outcomes such as increased hemodialysis requirements (32 patients, 43%), (odds ratio [OR] = 1.7200, p = 0.0018). Subgroup analysis suggested administering ≥ 30 mL/kg fluids to fluid responsive patients had a trend toward increased mortality (25% vs. 0%, p = 0.09) and a significant increase in hemodialysis (55% vs. 17%, p = 0.024).</p><p><strong>Conclusions: </strong>Without formal FR assessment, similar amounts of total fluids were administered in both fluid responsive and non-responsive patients. As greater volumes of intravenous fluids administered were associated with adverse outcomes, we suggest that dedicated FR assessment may be a beneficial utility in early shock resuscitation.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"129-140"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743191/pdf/jacme-11-4-02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Presentation of Posterior Reversible Encephalopathy Syndrome.","authors":"Yu-Chun Liu,&nbsp;Jiann Ruey Ong","doi":"10.6705/j.jacme.202112_11(4).0005","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0005","url":null,"abstract":"Epilepsy is one of the most common reasons for patients presenting to the emergency department (ED). However, epilepsy events have a variety of causes, which we tend to ignore. The leading cause is renal artery dissection with renal infarction. The case reported herein is of a patient without a medical history of epilepsy who presented to the ED with sudden epileptic seizures caused by malignant hypertension.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"150-152"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743192/pdf/jacme-11-4-05.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Female Patient With a Urinary Tract Infection and Multiple Vaginal Ulcers.","authors":"Min-Yi Hsieh,&nbsp;Tzen-Tak Lee,&nbsp;Jung-Mou Yang,&nbsp;Hung-Chun Chung","doi":"10.6705/j.jacme.202112_11(4).0006","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0006","url":null,"abstract":"<p><p>This report is to describe a rare case of urinary tract infection (UTI) with multiple vaginal ulcers. In the report, the 45-year-old female patient was diagnosed with a UTI, but white blood cells and neutrophil are higher than reference value. A vaginal ultrasound was performed with a positive fi nding of uterine myoma and multiple painless vaginal ulcers in the vaginal wall. Also, elevated antinuclear antibodies were found. After treated with antibiotic, self-healed vaginal ulcers were observed even without topical ointment use for vaginal ulcers. In conclusion, UTIs are a common disease in females. This is a rare case of a UTI with multiple vaginal ulcers. Observation of the genital condition is necessary if a woman has a UTI. Treating the source of the UTI is necessary, and the vaginal ulcerations also require appropriate treatment and follow up.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"153-157"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743194/pdf/jacme-11-4-06.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Man With Right-Sided Weakness.","authors":"Jen-Chih Tsai,&nbsp;Kai-Yuan Cheng,&nbsp;Ming-Jen Tsai","doi":"10.6705/j.jacme.202112_11(4).0007","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0007","url":null,"abstract":"A-57-year-old deaf-mute male with type 2 diabetes and a history of HIV infection receiving Odefsey treatment presented to the ED with right-sided weakness, headache, poor appetite, and loss of spirit for 2 weeks. On arrival, his temperature was 38°C, the pulse was irregular at 148 beats per minute, and the blood pressure was 123/88 mmHg. Physical examination showed right-sided weakness. The muscle strength of both right upper and lower limbs was grade 3. Electrocardiogram showed atrial fibrillation with rapid ventricular response. The laboratory tests showed elevation of C-reactive protein (6.35 mg/dL), but white blood cell count (8,600/uL), procalcitonin (0.19 ng/mL), renal and liver functions tests, and urinalysis were all within normal range. The chest X-ray revealed cardiomegaly and mild pulmonary congestion. Brain computed tomography (CT) for a suspected stroke was arranged (Fig. 1).","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"158-161"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743193/pdf/jacme-11-4-07.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}