The Effect of the Rapid Antigen Test for Influenza on Clinical Practice in the Emergency Department: A Comparison of Periods before and After the 2009 H1N1 Influenza Pandemic

Introduction. The rapid antigen test (RAT) plays an important role in the Emergency Room (ER). In this study, we investigated the effect of the RAT for influenza on clinical practice in an emergency department. Methods. A retrospective chart review was conducted considering two periods, namely before and after the 2009 influenza pandemic. The rate of antibiotic administration, the use of blood sample tests, the use of simple chest X-rays, the rate of antibiotic administration according to the result of the RAT, and the duration of ER stay in the case of influenza-like illnesses were investigated for the two study periods considered. Results. The use of the RAT increased from 23.9% to 39.8% in influenza-like pediatric patients (p<0.05) and from 4.9% to 67.6% in adult patients (p<0.001). After the 2009 influenza pandemic, the number of cases of antibiotic administration, blood sample test and simple chest X-ray decreased by 19.0%, 46.2%, and 27.4%, respectively, in pediatric patients with the use of RAT. Among RAT-positive patients, after the 2009 influenza pandemic, none of the pediatric patients and only 3 of the adult patients (17.6%) were administered antibiotics. The duration of ER stay was longer in patients who underwent RAT than in those who did not. Conclusion. The increased use of RAT for influenza has led to a decrease in antibiotic administration and a reduction in additional diagnostic tests in influenza-like illnesses. However, the use of RAT has not contributed to a decrease in the duration of ER stay

Medical Image Segmentation for Mobile Electronic Patient Charts Using Numerical Modeling of IoT

Internet of Things (IoT) brings telemedicine a new chance. This enables the specialist to consult the patient’s condition despite the fact that they are in different places. Medical image segmentation is needed for analysis, storage, and protection of medical image in telemedicine. Therefore, a variety of methods have been researched for fast and accurate medical image segmentation. Performing segmentation in various organs, the accurate judgment of the region is needed in medical image. However, the removal of region occurs by the lack of information to determine the region in a small region. In this paper, we researched how to reconstruct segmentation region in a small region in order to improve the segmentation results. We generated predicted segmentation of slices using volume data with linear equation and proposed improvement method for small regions using the predicted segmentation. In order to verify the performance of the proposed method, lung region by chest CT images was segmented. As a result of experiments, volume data segmentation accuracy rose from 0.978 to 0.981 and from 0.281 to 0.187 with a standard deviation improvement confirmed

Congenital Epidermoid Cyst of the Oral Cavity: Prenatal Diagnosis by Sonography

Epidermoid cysts are benign developmental anomalies that are rarely observed in the oral cavity of neonate. If large in size, especially in the developing fetus or newborn infant, they can cause swallowing difficulty and occasionally respiratory difficulty. We report a case of epidermoid cyst in the oral cavity detected prenatal sonography. The sonographic finding was large cystic mass, measuring 30×25 mm. In this case, supplies and equipment for an emergency tracheostomy were made available prior to the delivery. However, the infant did not require intervention to secure the airway. The lesion was surgically excised, and histologic diagnosis was epidermoid cyst. After 6 months of follow up, the cyst had not recurred. This case illustrates the value of accurate prenatal diagnosis and planned perinatal management using a team approach

Clinical Implications of Residual Urine in Korean Benign Prostatic Hyperplasia (BPH) Patients: A Prognostic Factor for BPH-Related Clinical Events

Purpose Although post-void residual urine (PVR) is frequently utilized clinically in patients with benign prostatic hyperplasia (BPH), mainly because of its procedural simplicity, its role as a clinical prognostic factor, predictive of treatment goals, is still under much dispute. We investigated the predictive value of PVR for BPH-related clinical events including surgery, acute urinary retention (AUR), and admission following urinary tract infection (UTI). Methods From January to June of 2006, patients over 50 years of age who were diagnosed with BPH for the first time at the outpatient clinic and were then treated for at least 3 years with medications were enrolled in this study. The variables of patients who underwent surgical intervention for BPH, had occurrences of AUR, or required admission due to UTI (Group 1, n=43) were compared with those of patients who were maintained with medications only (Group 2, n=266). Results Group 1 had a significantly higher PVR, more severe symptoms, and a larger prostate at the time of the initial diagnosis in both the univariate and the multivariate analysis. In the 39 patients who underwent BPH-related surgery, although there was a significant change in Qmax at the time of surgery (mean, 13.1 months), PVR and the symptom score remained unchanged compared with the initial evaluation. In the receiver-operating characteristic curve analysis, the area under the curve of Group 1 was in the order of prostate volume (0.834), PVR (0.712), and symptom score (0.621). When redivided by arbitrarily selected PVR cutoffs of 50 mL, 100 mL, and 150 mL, the relative risk of clinical BPH progression was measured as 3.93, 2.61, and 2.11. Conclusions These data indicate that, in the symptomatic Korean population, increased PVR at baseline is a significant indicator of BPH-related clinical events along with increased symptom score or prostate volume

Prospective Validation of FibroTest in Comparison with Liver Stiffness for Predicting Liver Fibrosis in Asian Subjects with Chronic Hepatitis B

Liver stiffness measurement (LSM) and FibroTest (FT) are frequently used as non-invasive alternatives for fibrosis staging to liver biopsy. However, to date, diagnostic performances of Enhanced Liver Fibrosis (ELF) test, which consists of hyaluronic acid, aminoterminal propeptide of procollagen type-III, and tissue inhibitor of matrix metalloproteinases-1, have not been compared to those of LSM and FT in Asian chronic hepatitis B (CHB) patients.Between June 2010 and November 2011, we prospectively enrolled 170 CHB patients who underwent liver biopsies along with LSM, FT, and ELF. The Batts system was used to assess fibrosis stages.Areas under receiver operating characteristic curves (AUROCs) to predict significant fibrosis (F≥2), advanced fibrosis (F≥3), and cirrhosis (F = 4) were 0.901, 0.860, and 0.862 for ELF, respectively; 0.937, 0.956, and 0.963 for LSM; and 0.896, 0.921, and 0.881 for FT. AUROCs to predict F≥2 were similar between each other, whereas LSM and FT had better AUROCs than ELF for predicting F≥3 (both p<0.05), and LSM predicted F4 more accurately than ELF (p<0.05). Optimized cutoffs of ELF to maximize sum of sensitivity and specificity were 8.5, 9.4, and 10.1 for F≥2, F≥3, and F = 4, respectively. Using suggested ELF, LSM and FT cutoffs to diagnose F1, F2, F3, and F4, 91 (53.5%), 117 (68.8%), and 110 (64.7%) patients, respectively, were correctly classified according to histological results.ELF demonstrated considerable diagnostic value in fibrosis staging in Asian CHB patients, especially in predicting F≥2. However, LSM consistently provided better performance for predicting F≥3 and F4

Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study

ObjectivesTo evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA.MethodsWe enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a ≥50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of ≥4 hours per night and ≥5 days per week.ResultsA total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects.ConclusionThe extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery