scholarly journals Progressive nicotine poisoning by multiple transdermal nicotine patches

2021 ◽  
Vol 18 (2) ◽  
pp. 31-34
Author(s):  
Jeong Ho Kang ◽  
Sung Kgun Lee
Keyword(s):  
Present Report ◽  
Altered Mental Status ◽  
University Hospital ◽  
Cotinine Level ◽  
Nicotine Administration ◽  
Nicotine Patches ◽  
Transdermal Nicotine ◽  
Level Of Consciousness ◽  
Pharmacokinetic Properties ◽  
National University

The pharmacokinetic properties of transdermal nicotine patches (TNPs) are different from those of other routes of nicotine administration; further, acute nicotine poisoning by TNPs may present with different clinical features. In the present report, we describe the case of a 23-year-old woman who was admitted to emergency department (ED) at Jeju National University Hospital with loss of consciousness. Five hours before the ED visit, she used multiple TNPs to attempt suicide. Initially, nausea and vomiting occurred, and the symptoms worsened over time. We immediately removed the TNPs, and the application sites were gently washed with sterile water. The patient’s level of consciousness gradually improved, and she fully recovered an altered mental status 5 hours later. Her initial urinary cotinine level was 324 ng/mL. Physicians should be aware that acute nicotine poisoning by TNPs can cause various toxic symptoms.

The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department

2010 ◽  
Vol 30 (8) ◽  
pp. 836-843 ◽  
Author(s):  
Jeong Mi Moon ◽  
Min Ho Shin ◽  
Byeong Jo Chun
Keyword(s):  
Carbon Monoxide ◽  
Mental Status ◽  
Altered Mental Status ◽  
Clinical Severity ◽  
University Hospital ◽  
Co Poisoning ◽  
Term Outcome ◽  
National University ◽  
Lactate Levels ◽  
Patient Prognosis

Patients with carbon monoxide (CO) poisoning have been found to have a correlation between initial clinical severity on admission and blood lactate levels. Recently, it is suggested that the lactate level may be a useful prognostic factor in cases study. The purpose of this study was to determine whether lactate levels were associated with the short-term outcome of patients with CO poisoning and identify the characteristics of patients with high initial lactate levels. Eighty patients that presented to the Chonnam National University Hospital after CO poisoning, over 5 years, were enrolled in this retrospective study. Fifty-six (70.0%) patients had high lactate (>2.1 mmo/L) on admission. Thirty-three (41.3%) patients had medical complications and one patient (1.3%) died. The patients with high initial lactate had an altered mental status more frequently, higher WBC, glucose and carboxyhemoglobin (COHb), and lower base deficit on admission. The multivariate analysis showed that lactate was an independent factor associated with serious complications and the need for intensive medical treatment, along with advanced age, WBC, and altered mental status on admission. The results of this study show that the initial lactate was useful for patient prognosis after CO poisoning.

Intestinal parasite survey of Kyungpook National University Hospital patients

1971 ◽  
Vol 9 (2) ◽  
pp. 47 ◽  
Author(s):  
Dong Wik Choi ◽  
Sung Deok Park ◽  
Jae Woun Kim ◽  
Doo Hong Ahn ◽  
Young Myung Kim
Keyword(s):  
Intestinal Parasite ◽  
University Hospital ◽  
Hospital Patients ◽  
National University

scholarly journals Circulating regulatory T cells predict efficacy and atypical responses in lung cancer patients treated with PD-1/PD-L1 inhibitors

2021 ◽  
Author(s):  
Da Hyun Kang ◽  
Chaeuk Chung ◽  
Pureum Sun ◽  
Da Hye Lee ◽  
Song-I Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Advanced Nsclc ◽  
Checkpoint Inhibitors ◽  
Standard Of Care ◽  
Treg Cells ◽  
University Hospital ◽  
X Rays ◽  
Lung Cancer Patients ◽  
National University

Abstract Background Immune checkpoint inhibitors (ICIs) have become the standard of care for a variety of cancers, including non-small cell lung cancer (NSCLC). In this study, we investigated the frequency of pseudoprogression and hyperprogression in lung cancer patients treated with ICIs in the real world and aimed to discover a novel candidate marker to distinguish pseudoprogression from hyperprogression soon after ICI treatment. Methods This study included 74 patients with advanced NSCLC who were treated with PD-1/PD-L1 inhibitors at Chungnam National University Hospital (CNUH) between January 2018 and August 2020. Chest X-rays were examined on day 7 after the first ICI dose to identify changes in the primary mass, and the response was assessed by computed tomography (CT). We evaluated circulating regulatory T (Treg) cells using flow cytometry and correlated the findings with clinical outcomes. Results The incidence of pseudoprogression was 13.5%, and that of hyperprogression was 8.1%. On day 7 after initiation of treatment, the frequency of CD4+CD25+CD127loFoxP3+ Treg cells was significantly decreased compared with baseline (P = 0.038) in patients who experienced pseudoprogression and significantly increased compared with baseline (P = 0.024) in patients who experienced hyperprogression. In the responder group, the frequencies of CD4+CD25+CD127loFoxP3+ Treg cells and PD-1+CD4+CD25+CD127loFoxP3+ Treg cells were significantly decreased 7 days after commencement of treatment compared with baseline (P = 0.034 and P < 0.001, respectively). Conclusion Circulating Treg cells represent a promising potential dynamic biomarker to predict efficacy and differentiate atypical responses, including pseudoprogression and hyperprogression, after immunotherapy in patients with NSCLC.

scholarly journals Association of Carotid Artery Endothelial Signal Intensity Gradient with Unilateral Large Artery Ischemic Stroke

2021 ◽  
Vol 50 (3) ◽  
pp. 270-278
Author(s):  
Chan-Hyuk Lee ◽  
Sang Hyuk Lee ◽  
Young I. Cho ◽  
Seul-Ki Jeong
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Signal Intensity ◽  
Internal Carotid ◽  
University Hospital ◽  
Large Artery ◽  
Intensity Gradient ◽  
National University ◽  
Endothelial Shear Stress ◽  
Stroke Center

<b><i>Background:</i></b> Common carotid artery (CCA) and internal carotid artery (ICA) are aligned linearly, but their hemodynamic role in ischemic stroke has not been studied in depth. <b><i>Objectives:</i></b> We aimed to investigate whether CCA and ICA endothelial shear stress (ESS) could be associated with the ischemic stroke of large artery atherosclerosis (LAA). <b><i>Methods:</i></b> We enrolled consecutive patients with unilateral ischemic stroke of LAA and healthy controls aged &#x3e;60 years in the stroke center of Jeonbuk National University Hospital. All patients and controls were examined with carotid artery time-of-flight magnetic resonance angiography, and their endothelial signal intensity gradients (SIGs) were determined, as a measure of ESS. The effect of right or left unilateral stroke on the association between carotid artery endothelial SIG and ischemic stroke of LAA was assessed. <b><i>Results:</i></b> In total, the results from 132 patients with ischemic stroke of LAA and 121 controls were analyzed. ICA endothelial SIG showed significant and independent associations with the same-sided unilateral ischemic stroke of LAA, even after adjusting for the potential confounders including carotid stenosis, whereas CCA endothelial SIG showed a significant association with the presence of the ischemic stroke of LAA. <b><i>Conclusion:</i></b> Although CCA and ICA are located with continuity, the hemodynamics and their roles in large artery ischemic stroke should be considered separately. Further studies are needed to delineate the pathophysiologic roles of ESS in CCA and ICA for large artery ischemic stroke.

scholarly journals Immunosuppressive and Anti-Inflammatory Effects of Nicotine Administered by Patch in an Animal Model

2004 ◽  
Vol 11 (3) ◽  
pp. 563-568 ◽  
Author(s):  
Roma Kalra ◽  
Shashi P. Singh ◽  
Juan C. Pena-Philippides ◽  
Raymond J. Langley ◽  
Seddigheh Razani-Boroujerdi ◽  
...  
Keyword(s):  
Animal Model ◽  
Immune System ◽  
Inflammatory Responses ◽  
Nicotine Patch ◽  
Subcutaneous Administration ◽  
Spleen Cells ◽  
Self Administration ◽  
Nicotine Administration ◽  
Nicotine Patches ◽  
Immunological Effects

ABSTRACT To study the immunological effects of nicotine, there are several rodent models for chronic nicotine administration. These models include subcutaneously implanted miniosmotic pumps, nicotine-spiked drinking water, and self-administration via jugular cannulae. Administration of nicotine via these routes affects the immune system. Smokers frequently use nicotine patches to quit smoking, and the immunological effects of nicotine patches are largely unknown. To determine whether the nicotine patch affects the immune system, nicotine patches were affixed daily onto the backs of Lewis rats for 3 to 4 weeks. The patches efficiently raised the levels of nicotine and cotinine in serum and strongly inhibited the antibody-forming cell response of spleen cells to sheep red blood cells. The nicotine patch also suppressed the concanavalin A-induced T-cell proliferation and mobilization of intracellular Ca2+ by spleen cells, as well as the fever response of animals to subcutaneous administration of turpentine. Moreover, immunosuppression was associated with chronic activation of protein tyrosine kinase and phospholipase C-γ1 activities. Thus, in this animal model of nicotine administration, the nicotine patch efficiently raises the levels of nicotine and cotinine in serum and impairs both the immune and inflammatory responses.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Surgical Outcomes of Phacoemulsification Surgery in a Restructured Asian Training Hospital

1970 ◽  
Vol 12 (4) ◽  
pp. 201-207
Author(s):  
David Zhiwei Law ◽  
Seng Chee Loon ◽  
Wan Ling Wong ◽  
Marilou Sevilla Ebreo ◽  
Xiang Li ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Outcomes ◽  
Perioperative Complications ◽  
University Hospital ◽  
Complication Rates ◽  
Corrected Visual Acuity ◽  
Duration Of Surgery ◽  
National University ◽  
Chi Squared ◽  
Best Corrected Visual Acuity

Aim: To evaluate the surgical outcomes of phacoemulsification performed at National University Hospital, Singapore, with emphasis on the results achieved by residents.Methods: This was a retrospective analysis of surgical outcomes of patients who underwent phacoemulsification in a restructured hospital in 2008. The study included 318 eyes of patients of predominantly Asian descent. Pre- and postoperative best-corrected visual acuity, perioperative complications and associations of patient, surgical and surgeon factors were studied. One-way analysis of variance for means, chi-squared test for proportions, and multivariate analyses were performed to determine factors associated with postoperative best-corrected visual acuity outcomes. Main outcome measures included postoperative best-corrected visual acuity, degree of improvement in best-corrected visual acuity, and achievement of specific best-corrected visual acuity targets of 6/9 and 6/12 at postoperative months 1 and 3.Results: Duration of surgery of less than 20 minutes was found to be significantly associated with better postoperative best-corrected visual acuity. Level of surgical experience was also associated with betterpostoperative best-corrected visual acuity at postoperative months 1 (p < 0.001) and 3 (p = 0.004). While senior consultants produced the best postoperative best-corrected visual acuity outcomes, the results achieved by residents were comparable to those reported in prior resident-only studies. For surgeries performed by residents, the overall rate of posterior capsule rupture was 3.1% with a 0.0% rate of vitreous loss.Conclusions: The continued close guidance and training of ophthalmology residents in a restructured Asian training hospital will ensure that complication rates remain low while maintaining postoperative outcomes at safe levels.

scholarly journals A Bittersweet Memoir

2021 ◽  
Vol 16 (1) ◽  
pp. 128-135
Author(s):  
Anita Y. N. Lim
Keyword(s):  
Video Clip ◽  
Early Period ◽  
General Medicine ◽  
University Hospital ◽  
World Health ◽  
Public Healthcare ◽  
The Novel ◽  
National University ◽  
Novel Coronavirus ◽  
Health Organization

Abstract I wrote this journal in March 2020 prior to the World Health Organization declaring the COVID-19 infection as a worldwide pandemic on March 11. The situation in Singapore was unfolding even as public healthcare institutions were tasked to lead the charge to contain the novel coronavirus as it was then called. This journal describes my experiences and impressions during my work in an isolation ward at the National University Hospital during this early period. I was to be catapulted into Pandemic Team 3 in the second and third weeks of February 2020. The urgency of hospital measures to respond to the novel coronavirus meant that the general medicine consultant roster which I was on was hijacked to support the pandemic wards. I thought wryly to myself that it was a stroke of genius to commandeer the ready-made roster of senior physicians; it would have been difficult for the roster monster to solicit senior physicians to volunteer when there were still so many unknowns about this virus. Graphic images of the dire situation in Wuhan, China, were circulating widely on social media. It was heart-wrenching to read of Dr. Li Wen Liang’s death. He had highlighted the mysterious pneumonia-causing virus. The video clip of him singing at a karaoke session that went viral underscored the tragedy of a young life cut short. Questions raced in my mind. “Are we helpless to prevent the spread of this virus?” “Is the situation in China to be replicated here in Singapore?” This seemed incredulous, yet, might it be possible? The immediate responses that jumped up within me was “yes, it’s possible, but let’s pray not. Whatever has to be done, must be done.”

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