World journal of emergency medicine最新文献

{"title":"Impact of next-generation sequencing on antimicrobial treatment in immunocompromised adults with suspected infections.","authors":"Jia Li, Jiazhen Luo, Tao Hu, Ling Cheng, Weiwei Shang, Li Yan","doi":"10.5847/wjem.j.1920-8642.2024.025","DOIUrl":"10.5847/wjem.j.1920-8642.2024.025","url":null,"abstract":"<p><strong>Background: </strong>Prompt pathogen identification can have a substantial impact on the optimization of antimicrobial treatment. The objective of the study was to assess the diagnostic value of next-generation sequencing (NGS) for identifying pathogen and its clinical impact on antimicrobial intervention in immunocompromised patients with suspected infections.</p><p><strong>Methods: </strong>This was a retrospective study. Between January and August 2020, 47 adult immunocompromised patients underwent NGS testing under the following clinical conditions: 1) prolonged fever and negative conventional cultures; 2) new-onset fever despite empiric antimicrobial treatment; and 3) afebrile with suspected infections on imaging. Clinical data, including conventional microbial test results and antimicrobial treatment before and after NGS, were collected. Data were analyzed according to documented changes in antimicrobial treatment (escalated, no change, or de-escalated) after the NGS results.</p><p><strong>Results: </strong>The median time from hospitalization to NGS sampling was 19 d. Clinically relevant pathogens were detected via NGS in 61.7% of patients (29/47), more than half of whom suffered from fungemia (<i>n</i>=17), resulting in an antimicrobial escalation in 53.2% of patients (25/47) and antimicrobial de-escalation in 0.2% of patients (1/47). Antimicrobial changes were mostly due to the identification of fastidious organisms such as Legionella, <i>Pneumocystis jirovecii</i>, and <i>Candida</i>. In the remaining three cases, NGS detected clinically relevant pathogens also detected by conventional cultures a few days later. The antimicrobial treatment was subsequently adjusted according to the susceptibility test results. Overall, NGS changed antimicrobial management in 55.3% (26/47) of patientst, and conventional culture detected clinically relevant pathogens in only 14.9% of patients (7/47).</p><p><strong>Conclusion: </strong>With its rapid identification and high sensitivity, NGS could be a promising tool for identifying relevant pathogens and enabling rapid appropriate treatment in immunocompromised patients with suspected infections.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 2","pages":"105-110"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10925535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of biomarkers for the prognostic prediction of cardiac arrest survivors using a multi-modal approach.","authors":"Changshin Kang, Yeonho You, Jung Soo Park, Byeong Kwon Park, Jae Kwang Lee, Byung Kook Lee","doi":"10.5847/wjem.j.1920-8642.2024.029","DOIUrl":"10.5847/wjem.j.1920-8642.2024.029","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 2","pages":"131-134"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10925537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a cervical collar on optic nerve sheath diameter in trauma patients.","authors":"Mümin Murat Yazici, Özcan Yavaşi","doi":"10.5847/wjem.j.1920-8642.2024.023","DOIUrl":"10.5847/wjem.j.1920-8642.2024.023","url":null,"abstract":"<p><strong>Background: </strong>As advocated in advanced trauma life support and prehospital trauma life support protocols, cervical immobilization is applied until cervical spine injury is excluded. This study aimed to show the difference in optic nerve sheath diameter (ONSD) between patients with and without a cervical collar using computed tomography (CT).</p><p><strong>Methods: </strong>This was a single-center, retrospective study examining trauma patients who presented to the emergency department between January 1, 2021, and December 31, 2021. The ONSD on brain CT of the trauma patients was measured and analyzed to determine whether there was a difference between the ONSD with and without the cervical collar.</p><p><strong>Results: </strong>The study population consisted of 169 patients. On CT imaging of patients with (<i>n</i>=66) and without (<i>n</i>=103) cervical collars, the mean ONSD in the axial plane were 5.43 ± 0.50 mm and 5.04 ± 0.46 mm respectively for the right eye and 5.50 ± 0.52 mm and 5.11 ± 0.46 mm respectively for the left eye. The results revealed an association between the presence of a cervical collar and the mean ONSD, which was statistically significant (<i>P</i><0.001) for both the right and left eyes.</p><p><strong>Conclusion: </strong>A cervical collar may be associated with increased ONSD. The effect of this increase in the ONSD on clinical outcomes needs to be investigated, and the actual need for cervical collar in the emergency department should be evaluated on a case-by-case basis.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 2","pages":"126-130"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10925536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department management of acute agitation in the reproductive age female and pregnancy.","authors":"Ariella Gartenberg, Kayla Levine, Alexander Petrie","doi":"10.5847/wjem.j.1920-8642.2024.011","DOIUrl":"10.5847/wjem.j.1920-8642.2024.011","url":null,"abstract":"<p><strong>Background: </strong>Agitation is a common presentation within emergent departments (EDs). Agitation during pregnancy should be treated as an obstetric emergency, as the distress may jeopardize both the patient and fetus. The safety of psychotropic medications in the reproductive age female has not been well established. This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.</p><p><strong>Methods: </strong>A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.</p><p><strong>Results: </strong>While nonpharmacological management is preferred, ED visits for agitation often require medical management. Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects. Adverse effects are common in pregnant females. For mild to moderate agitation in pregnancy, diphenhydramine is an effective sedating agent with minimal adverse effects. In moderate to severe agitation, high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics. Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy. Second generation psychotropics are often utilized as second-line therapy, including risperidone. Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.</p><p><strong>Conclusion: </strong>While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation, animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure <i>in utero</i>. As the fetal risk associated with multiple doses of psychotropic medications remains unknown, weighing the risks and benefits of each agent, while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 2","pages":"83-90"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10925524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bicycle-related traumatic injuries: a retrospective study during COVID-19 pandemic.","authors":"Jie Er Janice Soo, Yuan Helen Zhang, Gek Hsiang Lim, Fatimah Lateef","doi":"10.5847/wjem.j.1920-8642.2024.043","DOIUrl":"https://doi.org/10.5847/wjem.j.1920-8642.2024.043","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to review bicycle-related injuries during the COVID-19 pandemic to assist with reinforcement or implementation of new policies for injury prevention.</p><p><strong>Methods: </strong>This is a retrospective descriptive analysis of injuries sustained during cycling for patients 18 years old and above who presented to Singapore General Hospital from January to June 2021. Medical records were reviewed and consolidated. Descriptive analyses were used to summarize patient characteristics, and differences in characteristics subgrouped by triage acuity and discharge status were analyzed.</p><p><strong>Results: </strong>The study included 272 patients with a mean age of 43 years and a male predominance (71.7%). Most presented without referrals (88.2%) and were not conveyed by ambulances (70.6%). Based on acuity category, there were 24 (8.8%) Priority 1 (P1) patients with 7 trauma activations, 174 (64.0%) and 74 (27.2%) P2 and P3 patients respectively. The most common injuries were fractures (34.2%), followed by superficial abrasion/contusion (29.4%) and laceration/wound (19.1%). Thirteen (4.8%) patients experienced head injury and 85 patients (31.3%) were documented to be wearing a helmet. The majority occurred on the roads as traffic accidents (32.7%). Forty-two patients (15.4%) were admitted with a mean length of stay of 4.1 d and 17 (6.3%) undergone surgical procedures. Out of 214 (78.7%) discharged patients, no re-attendances or mortality were observed. In the subgroup analysis, higher acuity patients were generally older, with higher proportions of head injuries leading to admission.</p><p><strong>Conclusion: </strong>Our study highlights significant morbidities in bicycle-related injuries. There is also a high proportion of fractures in the young healthy male population. Injury prevention is paramount and we propose emphasizing helmet use and road user safety.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 4","pages":"256-262"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11265626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation-related iron metabolism disorders and anemia in patients with anti-glomerular basement membrane disease without overt bleeding: a case report.","authors":"Ping Gong, Fang Chen, Yonggang Gui, Yanfen Chai, Yi Jiang","doi":"10.5847/wjem.j.1920-8642.2024.086","DOIUrl":"10.5847/wjem.j.1920-8642.2024.086","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 6","pages":"505-507"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11586152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation.","authors":"Huixin Zhao, Yiming Dong, Sijia Wang, Jiayuan Shen, Zhenju Song, Mingming Xue, Mian Shao","doi":"10.5847/wjem.j.1920-8642.2024.041","DOIUrl":"10.5847/wjem.j.1920-8642.2024.041","url":null,"abstract":"<p><strong>Background: </strong>Disseminated intravascular coagulation (DIC) is associated with increased mortality in sepsis patients. In this study, we aimed to assess the clinical ability of sepsis-induced coagulopathy (SIC) and sepsis-associated coagulopathy (SAC) criteria in identifying overt-DIC and pre-DIC status in sepsis patients.</p><p><strong>Methods: </strong>Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022. The performances of the SIC and SAC were assessed to identify overt-DIC on days 1, 3, 7, or 14. The SIC status or SIC score on day 1, the SAC status or SAC score on day 1, and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC. The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.</p><p><strong>Results: </strong>On day 1, the incidences of coagulopathy according to overt-DIC, SIC and SAC criteria were 11.7%, 22.0% and 31.5%, respectively. The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14 (<i>P</i><0.05). On day 1, the SIC score with a cut-off value > 3 had a significantly higher sensitivity (72.00%) and area under the curve (AUC) (0.69) in identifying pre-DIC than did the SIC or SAC status (sensitivity: SIC status 44.00%, SAC status 52.00%; AUC: SIC status 0.62, SAC status 0.61). The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC (0.79 vs. 0.69, <i>P</i><0.001). Favorable effects of anticoagulant therapy were observed in SIC (adjusted hazard ratio [<i>HR</i>]=0.216, 95% confidence interval [95% <i>CI</i>]: 0.060-0.783, <i>P</i>=0.018) and SAC (adjusted <i>HR</i>=0.146, 95% <i>CI</i>: 0.041-0.513, <i>P</i>=0.003).</p><p><strong>Conclusion: </strong>The SIC and SAC seem to be valuable for predicting overt-DIC. The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 3","pages":"190-196"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy: a meta-analysis.","authors":"Zeyu Yang, Huiruo Liu, Dazhou Lu, Shengchuan Cao, Feng Xu, Chuanbao Li","doi":"10.5847/wjem.j.1920-8642.2024.048","DOIUrl":"10.5847/wjem.j.1920-8642.2024.048","url":null,"abstract":"<p><strong>Background: </strong>This meta-analysis aimed to assess the efficacy of high-dose glucose-insulin-potassium (GIK) therapy on clinical outcomes in acute coronary syndrome (ACS) patients receiving reperfusion therapy.</p><p><strong>Methods: </strong>We searched the PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library databases from inception to April 26, 2022, for randomized controlled trials (RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy. The primary endpoint was major adverse cardiovascular events (MACEs).</p><p><strong>Results: </strong>Eleven RCTs with 884 patients were ultimately included. Compared with placebos, high-dose GIK markedly reduced MACEs (risk ratio [<i>RR</i>] 0.57, 95% confidence interval [95% <i>CI</i>]: 0.35 to 0.94, <i>P</i>=0.03) and the risk of heart failure (<i>RR</i> 0.48, 95% <i>CI</i>: 0.25 to 0.95, <i>P</i>=0.04) and improved the left ventricular ejection fraction (LVEF) (mean difference [<i>MD</i>] 2.12, 95% <i>CI</i>: 0.40 to 3.92, <i>P</i>=0.02) at 6 months. However, no difference was observed in all-cause mortality at 30 d or 1 year. Additionally, high-dose GIK was significantly associated with increased incidences of phlebitis (<i>RR</i> 4.78, 95% <i>CI</i>: 1.36 to 16.76, <i>P</i>=0.01), hyperglycemia (<i>RR</i> 9.06, 95% <i>CI</i>: 1.74 to 47.29, <i>P</i>=0.009) and hypoglycemia (<i>RR</i> 6.50, 95% <i>CI</i>: 1.28 to 33.01, <i>P</i>=0.02) but not reinfarction, hyperkalemia or secondary reperfusion. In terms of oxidative stress-lowering function, high-dose GIK markedly reduced superoxide dismutase (SOD) activity but not glutathione peroxidase (GSH-Px) or catalase (CAT) activity.</p><p><strong>Conclusion: </strong>Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering efficacy in response to high-dose GIK. Moreover, with a higher incidence of complications such as phlebitis, hyperglycemia, and hypoglycemia. Furthermore, there were no observed survival benefits associated with high-dose GIK. More trials with long-term follow-up are still needed.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 3","pages":"181-189"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of ventilator-associated pneumonia with inhaled antibiotics.","authors":"Stephan Ehrmann, Jie Li","doi":"10.5847/wjem.j.1920-8642.2024.051","DOIUrl":"10.5847/wjem.j.1920-8642.2024.051","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 3","pages":"165-168"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xuebijing improves intestinal microcirculation dysfunction in septic rats by regulating the VEGF-A/PI3K/Akt signaling pathway.","authors":"A-Ling Tang, Yan Li, Li-Chao Sun, Xiao-Yu Liu, Nan Gao, Sheng-Tao Yan, Guo-Qiang Zhang","doi":"10.5847/wjem.j.1920-8642.2024.035","DOIUrl":"10.5847/wjem.j.1920-8642.2024.035","url":null,"abstract":"<p><strong>Background: </strong>This study aims to explore whether Xuebijing (XBJ) can improve intestinal microcirculation dysfunction in sepsis and its mechanism.</p><p><strong>Methods: </strong>A rat model of sepsis was established by cecal ligation and puncture (CLP). A total of 30 male SD rats were divided into four groups: sham group, CLP group, XBJ + axitinib group, and XBJ group. XBJ was intraperitoneally injected 2 h before CLP. Hemodynamic data (blood pressure and heart rate) were recorded. The intestinal microcirculation data of the rats were analyzed via microcirculation imaging. Enzyme-linked immunosorbent assay (ELISA) kits were used to detect the serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) in the rats. Histological analysis and transmission electron microscopy were used to analyze the injury of small intestinal microvascular endothelial cells and small intestinal mucosa in rats. The expression of vascular endothelial growth factor A (VEGF-A), phosphoinositide 3-kinase (PI3K), phosphorylated PI3K (p-PI3K), protein kinase B (Akt), and phosphorylated Akt (p-Akt) in the small intestine was analyzed via Western blotting.</p><p><strong>Results: </strong>XBJ improved intestinal microcirculation dysfunction in septic rats, alleviated the injury of small intestinal microvascular endothelial cells and small intestinal mucosa, and reduced the systemic inflammatory response. Moreover, XBJ upregulated the expression of VEGF-A, p-PI3K/total PI3K, and p-Akt/total Akt in the rat small intestine.</p><p><strong>Conclusion: </strong>XBJ may improve intestinal microcirculation dysfunction in septic rats possibly through the VEGF-A/PI3K/Akt signaling pathway.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 3","pages":"206-213"},"PeriodicalIF":2.1,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}