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Comparative Analysis of Overdose with Common Sleep-aid Medications - Doxylamine vs Diphenhydramine - (주요 수면유도제인 독실라민과 디펜히드라민의 급성 중독 비교)

  • Ryu, Hyun-Sik;Lee, Mi-Jin;Park, Seong-Soo;Jeong, Won-Joon;Kim, Hyun-Jin
    • Journal of The Korean Society of Clinical Toxicology
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    • v.8 no.2
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    • pp.79-87
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    • 2010
  • Purpose: The previous studies on $H_1$ antihistamine overdose have generally been limited to cases of acute doxylamine succinate (DS) poisoning, yet there have been some studies on diphenhydramine (DPH) overdosing. But many clinicians consider the two drugs to be very similar and to have similar ingredients. The purpose of this study was to clarify the toxicologic characteristics and clinical outcomes between DS and DPH poisoning/overdose. Methods: We reviewed the medical and intensive care records of the patients with acute DS or DPH poisoning and who admitted to our emergency department from January 2008 and April 2010. We collected patient information regarding the features of the poisoning and the clinical and demographic characteristics. The patients were assessed for the clinical outcomes, the GCS, the PSS (Poisoning Severity Score) and the SOFA (Sequential Organ Failure Assessment). Results: Fifty seven patients (45 cases of DS poisoning and 12 cases of DPH poisoning) were enrolled. Compared with the DS group, the DPH group had higher incidences of intubation, serious mental change, QTc prolongation and ECG conduction abnormality (p=0.041, <0.001, 0.014 and 0.044, respectively). The DPH group had a higher PSS and a longer ICU stay. The peak CPK time and the CPK normalization time were longer for the patients with rhabdomyolysis due to DS poisoning. Conclusion: Two common $H_1$ antihistamines, doxylamine and diphenhydramine, are in the same ethanolamine-structural class, but the toxico-clinical outcomes are different according to many aspects. Therefore, clinicians could take a careful approach for the differential diagnosis and management between DS and DPH poisoning.

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Clinical Effects of Intra-Abdominal Pressure in Critically Ill Trauma Patients

  • Ryu, Dong Yeon;Kim, Hohyun;Seok, June Pill;Lee, Chan Kyu;Yeo, Kwang-Hee;Choi, Seon-Uoo;Kim, Jae-Hun;Cho, Hyun Min
    • Journal of Trauma and Injury
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    • v.32 no.2
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    • pp.86-92
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    • 2019
  • Purpose: There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population. Methods: Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8-12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as $IAP{\geq}12mmHg$. Abdominal compartment syndrome was defined as $IAP{\geq}20mmHg$ plus ${\geq}1$ new organ failure. The main outcome measure was in-hospital mortality. Results: According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with $IAP{\geq}20mmHg$ than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum $IAP{\geq}20mmHg$ exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values. Conclusions: Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

A Study of Predicting the Severity Following Glufosinate Ammonium Containing Herbicide Poisoning Experienced in Single Emergency Medical Institution (단일 응급의료기관에서 경험한 글루포시네이트 암모니움 포함 제초제 중독 후 중증도 예측에 관한 연구)

  • Lee, Doo Sung;Choi, Kyoung Ho
    • Journal of The Korean Society of Clinical Toxicology
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    • v.17 no.1
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    • pp.7-13
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    • 2019
  • Purpose: Owing to the increased agricultural use of the herbicide glufosinate ammonium (GLA), the incidence of GLA poisoning has recently increased. Therefore, we investigated the possible predictive factors associated with severe complications following GLA poisoning. Methods: A retrospective analysis of medical records was conducted based on 76 patients who had visited our regional emergency medical center with GLA poisoning from 2006 to 2017. Severe complications were defined as respiratory failure requiring intubation, systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (GCS) less than 8, and presence of seizure. Results: Age, ingested amount and ingested amount per weight were significantly greater in the severe group (p<0.001). PSS grade 2 or higher was more common in the severe group (p<0.001), and In addition, the APACHE II score was significantly higher in the severe group (p<0.001), as were the SOFA scores (p=0.002). Serum ammonia levels were significantly higher in the severe group (p=0.007), while MDRD-GFR was smaller in the severe group (p=0.002). The spot urine protein levels were significantly higher in the severe group (p=0.005), as was the urine protein to creatinine ratio (p=0.001). Upon multivariate analysis, the amount ingested per weight and PSS grade 2 or higher were identified as significant predictors. Conclusion: Our study showed that MDRD-GFR was significantly lower in the severe group after GLA poisoning. PSS grade 2 or higher and ingested amount per weight may be useful to evaluate the severity of complications after GLA poisoning.

A Study on the Design and Behavioral Analysis of Commercial Rest Area -Focused on the Rest Area and Furniture of Shinsegae Department Store, Busan- (상업 휴게 공간의 디자인과 이용 행태 연구 -부산 신세계 백화점 휴게 공간과 가구를 중심으로-)

  • Yu, DeSheng;Yoon, Ji-Young
    • The Journal of the Korea Contents Association
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    • v.19 no.9
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    • pp.280-292
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    • 2019
  • This study was carried out for the Centum Shinsegae Department Store, to grasp the indoor rest space and furniture design status, this study analyzes the characteristics of visitors' use behavior centered on furniture. The purpose of this study is to provide basic data for commercial rest space design by understanding the characteristics of resting space in commercial space and whether the furniture can support the behavior of visitors. The research method is to carry out on-site inspection, including the location of the rest space on each floor, the type and design characteristics of the furniture design, and the characteristics and patterns of the users on each were analyzed. The results of the study are as follows. As a result of analyzing the rest space and furniture, the furniture is brown, it has been provided with various designs such as fan-shaped, arched bench, sofa, chair type, and comfortable colors of lightness ranging from light gray to black, and appropriately supported the most common usage patterns.However, in the case of Shinsegae Department Store, it is necessary to consider the safety and convenience of the vulnerable groups.

A study on the site-specific theatre-performance - focused on the Korean performances - (장소특정적 연극-퍼포먼스 연구 - 한국의 공연작품들을 중심으로 -)

  • Shin, Hyun-Sook
    • Journal of Korean Theatre Studies Association
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    • no.49
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    • pp.171-208
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    • 2013
  • Site-specific performance is always the real on-site work taking place at the site. Hence, it deals with the reality, in other words, the time of creation and formation. And it creates value and meaning through the interaction and continuous direct communication process between the performers, audience and the local residents. In this performance, the audience's status as the passive observer changes. They become the co-agent who actively lead and complete the performance through their own experience. We have examined the The Working Methods of Site-specific Performance and Aesthetics of Effect through four Korean performances ; Marie, An aesthetic experiment of site as the storyteller; Heterotopia and Urban Movement Research or Play: We Will Move Your Sofa, as performances which have Revealed history, politics, institution engraved in the site ; A Song of Mandala and Miracle, as a ritualistic site-specific performance at the historic site. Some remarks on Site-specific performance ; First, In Site-specific performance, the habitus peculiar to the stage art and the mode of reception are changed. Second, a new mode of theatrical communication requires creator and audience to have a sharp aesthetic sensibility and to change one's perceptual habit. Third, Site-specific performance can act as a demonstration for the viewpoints of political activism through what could be called a dramatic close-up effect. Fourth, Site-specific performance also has the risk of merely becoming an unfocused and scattered performance or degenerating into a pseudo-sightseeing. To avoid this, an in-depth study of the site and its socio-cultural context, and the clear motivation with which one is trying to reveal and tell from the site must be indispensable. As the co-agent, the audience should also be aware and think about what the given performance signifies today.

Study on the indoor exposure factors of phthalates using bio-monitoring data (생체시료를 이용한 프탈레이트의 실내 노출인자 연구)

  • Yang, Ji Yeon;Shin, Dong Chun;Lee, Si Eun;Lee, Geon Woo;Kim, Joon Hyeog;Lee, Yong Jin;Lim, Young Wook
    • Journal of odor and indoor environment
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    • v.17 no.4
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    • pp.315-321
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    • 2018
  • Phthalate is an endocrine disruptor that interferes with homeostasis and developmental regulation. It is highly toxic to the environment and is associated with various diseases of the human body. Using biological samples from 140 adult subjects, to evaluate the influencing factors which are related to contaminant concentration levels, we used correlation analysis and multiple regression analysis. Lastly, in order to analyze the health effects related to exposure to phthalates, we conducted a risk assessment by estimating acceptable daily intake exposure according to the influential factors. When we compared the concentration level according to influential factors, in general, the subjects who had engaged in home remodeling work had higher urinary phthalate metabolite concentrations levels than the subjects who had not engaged in home remodeling work. We can confirm statistically significant differences in DBP metabolites. In addition, we can confirm the concentration appeared higher in the categories such as using air freshener, sofa and foods. Through conducting a risk assessment of DEHP, BBzP, DiBP, and DnBP by using data on phthalate metabolite concentration in urine, it was found that the average concentration of all metabolites did not exceed TDI.

Initial Serum Ammonia as a Predictor of Mortality in Patients with Acute Glufosinate Ammonium Herbicide Poisoning (글루포시네이트 암모늄 제초제 중독환자에서 혈중 암모니아 농도와 사망률과의 연관성에 대한 연구)

  • Ko, Eun Na Lae;Kim, Dong Hoon;Lee, Soo Hoon;Jeong, Jin Hee;Lee, Sang Bong;Sung, Aejin;Suh, Ja Hyoen;Kang, Changwoo
    • Journal of The Korean Society of Clinical Toxicology
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    • v.18 no.2
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    • pp.136-140
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    • 2020
  • Purpose: The association of the initial serum ammonia level with in-hospital mortality in patients with acute glufosinate-ammonium herbicide poisoning was studied. Methods: This retrospective cohort study was conducted between March 2012 and August 2019 in the emergency department after glufosinate-ammonium herbicide poisoning. Survivors and non-survivors were analyzed using a Mann-Whitney U test and Fisher's exact test. Multivariate logistic regression analysis was performed to determine the independent risk factors for mortality. Results: One hundred and six patients were enrolled; 11 died, yielding a mortality of 10.4%. The serum bicarbonate level was significantly lower in the non-survival group than the survival group. Age, serum ammonia, blood urea nitrogen, creatinine levels, SOFA score, and APACHE II score were significantly higher in the non-survival group than the survival group. Age, serum ammonia, and creatinine level were independent risk factors for mortality in multivariate logistic regression analysis. Conclusion: The initial serum ammonia level is associated with mortality in patients with acute glufosinate herbicide poisoning.

A Study on the Korea-U.S. Negotiation Process for AFKN-TV Color Broadcasting in 1977

  • Yoon, Sangkil
    • Journal of the Korea Society of Computer and Information
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    • v.27 no.8
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    • pp.111-121
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    • 2022
  • The purpose of this study is to examine the historical facts about the negotiation process between Korea and the U.S. over the launch of AFKN-TV's color broadcasting in 1977, which can be evaluated as the first time that the government raised the issue of broadcasting sovereignty against the U.S. government. More specifically, through literature research on archive documents stored in the Korean National Archives and Diplomatic Archive of Korea National Diplomatic Academy, this study examined the arguments, perceptions, and actions of the two governments by dividing three phases of the negotiation process. As a result of the study, the negotiations with the U.S. government over the unilateral color broadcasting of AFKN-TV in early 1977 and the conflict between the two countries led to a new perspective of broadcasting sovereignty. The Korean government's commitment to broadcasting sovereignty targeted the U.S. government in the 1980s once again.

Randomized, Double-blind, and Placebo-controlled a Clinical Study for Chronic Fatigue via the Analysis of Efficacy and Safety of Gongjin-dan and Ssanghwa-tang : Study Protocol (만성피로에 대한 공진단과 쌍화탕의 안전성 및 유효성 평가를 위한 무작위배정, 이중눈가림, 위약대조 임상시험 : 임상연구 프로토콜)

  • Jun-Yong, Choi;Byungmook, Lim;Hyeun-kyoo, Shin;Kibong, Kim
    • Journal of Society of Preventive Korean Medicine
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    • v.26 no.3
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    • pp.97-108
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    • 2022
  • Objectives : The purpose of this study is to confirm the efficacy and safety of Gongjin-dan and Ssanghwatang for chronic fatigue. Methods : A total of 90 people, between 19 and 65 years old, will be recruited to participate in a randomized, double-blind, and placebo-controlled a clinical trial. Participants in the Gongjin-dan group will take one pill of Gongjin-dan along with three packs of placebo oral liquid Ssanghwa-tang per day for 4 weeks. Participants in the Ssanghwa-tang group will take three packages of liquid Ssanghwa-tang and one placebo Gongjindan pill per day for 4 weeks. In the placebo group, participants will take one pill of placebo Gongjin-dan and three packs of placebo liquid Ssanghwa-tang per day, for 4 weeks. Outcomes will be measured at the baseline, 4th week, and 6th week. The primary outcome is the change in the Fatigue Severity Scale (FSS). Secondary outcomes are the change of Multidimensional Fatigue Inventory-20 (MFI-20), Chalder Fatigue Scale (CFQ), Short-Form 36 Health Survey (SF-36), Korean Version of Schedule of Fatigue and Anergy/General Physician (SOFA/GP), Glucose, Lactate, Ammonia, Free Fatty Acid (FAA), d-ROMs&BAP, Selenium, and Cortisol. Results : This trial was approved by the institutional review board of Pusan National University Korean Medicine Hospital (registry number: PNUKHIRB 2021-10-005). Recruitment opened in November 2021 and is supposed to be completed by December 2022. Conclusions : This trial will provide clinical information to determine the efficacy and safety of Gongjindan and Ssanghwa-tang for chronic fatigue.

Prediction of Intubation after Bronchoscopy with Non-invasive Positive Pressure Ventilation Support in Patients with Acute Hypoxemic Respiratory Failure (급성 저산소혈증 환자에서 비침습적 양압환기 적용 하 기관지경 검사 후 기관 삽관의 예측 인자)

  • Song, Jae-Uk;Kim, Su-A;Choi, E Ryoung;Kim, Soo Min;Choi, Hee Jung;Lim, So Yeon;Park, So Young;Suh, Gee Young;Jeon, Kyeongman
    • Tuberculosis and Respiratory Diseases
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    • v.67 no.1
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    • pp.21-26
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    • 2009
  • Background: Non-invasive positive pressure ventilation (NPPV) ensures adequate gas exchange during bronchoscopy in spontaneously breathing, hypoxemic patients, thus avoiding endotracheal intubation. However, in some patients, endotracheal intubation is eventually required after bronchoscopy. This study investigated the incidence of intubation and predictors of a need for emergency intubation prior to NPPV bronchoscopy initiation. Methods: On a retrospective basis, we reviewed the medical records of 36 patients (median age, 55 years; interquartile range [IQR], 43~65 years) with acute hypoxemic respiratory failure who required NPPV during bronchoscopy between January 2005 and October 2007. Results: All patients were hypoxemic (median $PaO_2/FiO_2$ ratio 155; IQR 90~190), but tolerated bronchoscopy with NPPV support. SOFA score and SAPS II score immediately before NPPV initiation were 4 (3~7) and 36 (30~42), respectively. Seventeen (47%) patients needed endotracheal intubation at a median time of 22 (2~50) hours after bronchoscopy. Patients who needed intubation after bronchoscopy had a higher in-hospital mortality (11 [65%] vs. 4 [21%], p=0.017). Upon multiple logistic regression analysis, the need for intubation after bronchoscopy was independently associated with a $P_aO_2/FiO_2$ ratio (OR, 0.961; 95% CI, 0.924~0.999; p=0.047) immediately before NPPV initiation for bronchoscopy. Conclusion: The severity of the hypoxemia immediately prior to NPPV initiation for bronchoscopy was associated with the need for intubation after bronchoscopy in patients with hypoxemic respiratory failure.