- Prognostic Predictors of Outcome in Patients with Snake Bite, Based on Initial Findings in the Emergency Department
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In Yeop Baek, Tae Kwon Kim, Sang Chan Jin, Woo Ik Cho
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J Korean Soc Clin Toxicol. 2017;15(1):1-10. Published online June 30, 2017
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DOI: https://doi.org/10.22537/jksct.2017.15.1.1
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- Purpose: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. Methods: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. Results: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). Conclusion: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.
- Limitation of Psychiatric Intervention for Suicidal Drug Intoxication Patients in Emergency Room
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Joo Hwan Lee, Seung Jun Yang, Seung Wan Eun, Sang Chan Jin, Woo Ik Choi, Sung Won Jung
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J Korean Soc Clin Toxicol. 2016;14(1):37-46. Published online June 30, 2016
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- Purpose: This study was designed to determine the factors hindering psychiatric intervention for suicide attempters in the emergency room (ER). Methods: Participants were 299 patients aged 18 years or older admitted to the ER for suicidal drug overdose between July 2012 and June 2014. Patients were divided into two groups according to whether they had received psychiatric treatment in the ER. Medical histories and follow-up treatments were determined by examining patients' medical records and through phone surveys, and were then compared using ${chi}^2$-test and Fisher's exact test. In addition, the rate of satisfaction of the treatment group and the reasons for their dissatisfaction were also determined. Results: The treatment and non-treatment groups comprised 135 (45%) and 164 patients (55%), respectively. Factors influencing participation in psychiatric intervention were previous history of suicide attempts (p=0.004), history of psychiatric disorder (p<0.001), time of day (p=0.039), and day of the week (p=0.040) of arrival in the ER. Whether or not the patient received follow-up psychiatric treatment was not significantly relevant (p=0.300). Of the 82 patients who participated in the treatment satisfaction survey, 50.2% reported being unsatisfied, mainly because of unfriendly medical personnel (36.6%), discomfort regarding other people's perceptions (24.4%), and cursory care (14.6%). Conclusion: To raise the participation rate of psychiatric consult, cooperation with psychiatry at night and on weekends is required, and incorporation of patients without previous history of suicidal attempt or other psychiatric disorder is important. Resolution of complaints toward psychiatric consult in suicide attempt survivors is also required.
- Comparison of Clinical Characteristics and Prognosis by Initial Endoscopic Severity in Caustic Injury
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Sang Min Lee, Woo Ik Choi, Sung Jin Kim, Sang Chan Jin
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J Korean Soc Clin Toxicol. 2015;13(2):87-94. Published online December 31, 2015
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- Purpose: We investigated comparison of clinical characteristics and prognosis by initial endoscopic severity in caustic injury and then discussed predisposing factors which can be helpful in predicting the prognosis and determining the treatment. Methods: This study was a retrospective review of medical records from patients over the age of 15, who underwent initial endoscopy for caustic injury from April 2007 through November 2014. Patients were classified according to two groups based on the initial endoscopic finding by Zargar's classification: patients with grade 0, I, IIa at esophagus (low risk group) and patients with grade IIb, IIIa, IIIb at esophagus (high risk group). The two groups were then compared. Results: A total of 55 patients were included (low risk group [n=44] vs. high risk group [n=11]). Old age (p<0.001), large amount of ingestion (p<0.05), oropharyngeal symptoms (p<0.01), high SOFA score (p<0.001), high WBC count (p<0.05), low base excess (p<0.01), and HCO3 (p<0.05) were statistically significant factors in the high risk group. A poor prognosis was observed for hospital stay (p<0.001), ICU admission (p<0.001), mortality (p<0.01), and stricture (p<0.001) in the high risk group. Conclusion: Clinical characteristics including age, amount of ingestion, oropharyngeal symptoms, SOFA score, WBC count, base excess, and $HCO_3$ can be helpful in the decision to undergo initial endoscopy and risk assessment by initial endoscopic severity can be helpful in predicting prognosis and determining the treatment plan.
- Genotoxicity of low-dose Glyphosate by Sister Chromatid Exchange
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Sang Hoon Lee, Sung Jin Kim, Woo Ik Choi, Sang Chan Jin, In Jang Choi, Jae Ho Lee
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J Korean Soc Clin Toxicol. 2014;12(1):8-13. Published online June 30, 2014
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- Purpose: Glyphosate (N-phosphonomethyl glycine) is widely used as an herbicide for weed control in rural areas. It is also readily available for suicide attempts. Glyphosate has high toxicity and negatively affects the human body. The aim of this investigation was to study the genotoxicity of a low-concentration of glyphosate through sister chromatid exchange (SCE) in human blood lymphocytes in vitro. Methods: Primary lymphocyte cultures were obtained from blood samples of 11 males and seven females who had been exposed to glyphosate (0, 100, 200, and 300 ng/mL). The frequency of SCEs was examined and statistical analysis was performed. Results: All doses of glyphosate induced a significant dose-dependent increase in SCE frequency compared with the control group (P<0.001). In particular, the SCE frequency for exposure to low-dose glyphosate was significantly higher in females than in males. Conclusion: According to the result of this study, even a low-dose of glyphosate may damage DNA and females are more vulnerable to glyphosate.
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KSCT
Korean Society of Clinical Toxicology