Acute Medicine & Surgery
ISSN / EISSN : 2052-8817 / 2052-8817
Current Publisher: Wiley (10.1002)Former Publisher:
Total articles ≅ 571
Latest articles in this journal
Acute Medicine & Surgery; doi:10.1002/ams2.664
The Coronavirus disease 2019 (COVID‐19) has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J‐SSCG) 2020 Special Committee created the Japanese Rapid/Living recommendations on drug management for COVID‐19 using the experience of creating the J‐SSCGs. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of the recommendations. The first edition of this guideline was released on September 9, 2020, and this document is the revised edition (ver. 3.1) (released on March 30, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ‐2), hydroxychloroquine (CQ‐3), corticosteroids (CQ‐4), tocilizumab (CQ‐5), ciclesonide (CQ‐6), and anticoagulants (CQ‐7). Favipiravir is recommended for patients with mild COVID‐19 not requiring supplemental oxygen (GRADE 2C); remdesivir for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization (GRADE 2B); hydroxychloroquine is not recommended for all COVID‐19 patients (GRADE 1B); corticosteroids are recommended for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization (GRADE 1B) and severe COVID‐19 patients requiring ventilator management/intensive care (GRADE 1A); however, their administration is not recommended for mild COVID‐19 patients not requiring supplemental oxygen (GRADE 1B); tocilizumab is recommended for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization (GRADE 2B); and anticoagulant therapy for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization and severe COVID‐19 patients requiring ventilator management/intensive care (GRADE 2C). We hope that these clinical practice guidelines will aid medical professionals involved in the care of COVID‐19 patients.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.629
Background The current report describes a case of stomach perforation, a rare but serious complication, that occurred during cardiopulmonary resuscitation following severe cibenzoline intoxication. Case Presentation A woman aged in her 30s was brought into our hospital while receiving cardiopulmonary resuscitation for pulseless electrical activity. After starting extracorporeal membrane oxygenation (ECMO), her abdominal X‐ray examination revealed free air in her abdomen. She was diagnosed with internal gastric perforation. An emergency operation was carried out while the circulation was maintained using ECMO. As the patient’s blood cibenzoline concentration on admission was 3,868 ng/mL, she was diagnosed with cibenzoline intoxication caused by the self‐intake of twice the prescribed dose. She was successfully weaned off ECMO and discharged alive with full recovery. Conclusion We successfully treated a case of gastric perforation after pulseless electrical activity requiring ECMO support due to cibenzoline intoxication. Abdominal surgery can be carried out even if ECMO support is needed.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.627
Background Caffeine overdose can cause life‐threatening circulatory failure, neurological abnormalities, and ventricular fibrillation. We report the case of a patient with caffeine poisoning who was successfully treated with early hemodialysis and venoarterial extracorporeal membrane oxygenation. Case Presentation A 43‐year‐old man who had ingested pills containing 20 g caffeine was transported to the hospital 100 min after ingestion. Hemodynamic collapse and refractory arrhythmia were most likely the potential complications. The patient developed ventricular fibrillation when placed in the left lateral decubitus position. Return of spontaneous circulation with defibrillation and introduction of venoarterial extracorporeal membrane oxygenation were followed by emergency dialysis, which led to rapid improvement in the clinical findings. Conclusion Acute caffeine poisoning in a patient who developed an arrhythmia was successfully treated using an indwelling arterial and venous sheath followed by venoarterial extracorporeal membrane oxygenation.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.630
Aim We aimed to investigate the association between aortic calcification and 90‐day mortality in sepsis patients admitted to the intensive care unit. Methods We evaluated adult patients (≥18 years) diagnosed with sepsis based on the Sepsis‐3 criteria and admitted to our intensive care unit between April 2011 and March 2015. They were classified according to the degree of abdominal aortic calcification (severe and non‐severe), grouped per age (75 years), and matched. Survival curves were generated, and between‐group differences were evaluated. Results Overall, 164 patients were included. The Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were not significantly different between the severity groups, whereas there were significant differences in age (P < 0.001), sex (P = 0.017), and presence of diabetes mellitus (P < 0.001), hypertension (P < 0.001), dyslipidemia (P = 0.048), and maintenance dialysis (P = 0.001). The severe abdominal aortic calcification group showed significantly poorer prognosis than the non‐severe group (log–rank P = 0.009). The adjusted odds ratio of severe calcification was the highest in patients aged <65 years (7.167; 95% confidence interval, 1.042–49.28, P = 0.045). Twenty‐eight patients from each group were matched. The 90‐day survival rate of the severe calcification group remained significantly lower than that of the non‐severe calcification group (53.6% [15/28] versus 82.1% [23/28], P = 0.022). Conclusions Severe abdominal aortic calcification is associated with the 90‐day mortality of sepsis patients, particularly among those aged <65 years. Thus, caution is necessary in patients younger than 65 years; they may need to be treated with as much care as the elderly.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.625
Aim The complement system is important for defending against pathogens, however, excessive complement activation is associated with a poor prognosis and organ dysfunction in sepsis. Complement factor H (CFH) acts to prevent excessive complement activation and damage to the self through the regulation of the complement alternative pathway. We investigated the association between plasma CFH levels on admission to the intensive care unit (ICU) and 90‐day mortality, severity scores, and organ dysfunction in patients with sepsis. Methods We assessed the relationship between the plasma CFH on admission to the ICU and 90‐day mortality, severity scores such as the Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, and Simplified Acute Physiology Score 2, and organ dysfunction. Results This analysis included 62 patients. The plasma CFH levels were significantly lower in 90‐day non‐survivors than in survivors (70.0 μg/mL [interquartile range, 51.2–97.6] versus 104.8 μg/mL [interquartile range, 66.8–124.2]; P = 0.006) . The plasma CFH levels were associated with 90‐day mortality (odds ratio 0.977; 95% confidence interval, 0.957–0.994; P = 0.01). The plasma CFH levels were negatively correlated with severity scores. The Sequential Organ Failure Assessment scores for the coagulation and neurological components were negatively correlated with the CFH concentration. Conclusion Lower plasma levels of CFH were associated with increased severity and mortality in patients with sepsis on admission to the ICU and were correlated with central nervous system dysfunction and coagulopathy.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.622
Traumatic brain injury (TBI) is a major cause of mortality and morbidity affecting all ages. It remains to be a diagnostic and therapeutic challenge, in which, to date, there is no Food and Drug Administration‐approved drug for treating patients suffering from TBI. The heterogeneity of the disease and the associated complex pathophysiology make it difficult to assess the level of the trauma and to predict the clinical outcome. Current injury severity assessment relies primarily on the Glasgow Coma Scale score or through neuroimaging, including magnetic resonance imaging and computed tomography scans. Nevertheless, such approaches have certain limitations when it comes to accuracy and cost efficiency, as well as exposing patients to unnecessary radiation. Consequently, extensive research work has been carried out to improve the diagnostic accuracy of TBI, especially in mild injuries, because they are often difficult to diagnose. The need for accurate and objective diagnostic measures led to the discovery of biomarkers significantly associated with TBI. Among the most well‐characterized biomarkers are ubiquitin C‐terminal hydrolase‐L1 and glial fibrillary acidic protein. The current review presents an overview regarding the structure and function of these distinctive protein biomarkers, along with their clinical significance that led to their approval by the US Food and Drug Administration to evaluate mild TBI in patients.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.623
Aim This study assessed whether emergency abdominal surgeries were changed in the coronavirus disease (COVID‐19)‐affected environment at a community hospital in Japan, with the goal of planning and preparing hospital resources against the further spread of COVID‐19. Methods A total of 179 patients who underwent emergency abdominal surgery over 4 months during the pandemic (1 March, 2020 to 30 June, 2020) and a control period (1 March, 2019 to 30 June, 2019) were enrolled in this retrospective study. Patient demographics, hospital visiting patterns (visit time, ambulance transport, and duration of symptom onset to hospital visit), severity of patients’ condition, and surgical characteristics were compared between the two periods. Results The number of patients undergoing emergency abdominal surgery during the pandemic did not decrease in comparison to the control period (89 patients versus 90 patients). The duration of symptom onset to hospital visit during the pandemic was not prolonged compared to the control period. Other hospital visiting patterns, severity of patients’ condition, and surgical characteristics were also similar in both periods. Conclusion Although the situation of the pandemic was different between countries and regions, the number of emergency surgeries in our hospital remained unchanged, and those patients visited the emergency room no later than usual.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.628
Background J waves are abnormal electrocardiogram findings that indicate an elevation at the junction between the QRS complex and the ST segment. Hypothermia is associated with fetal arrhythmia, along with the increase of J‐wave manifestation. Case Presentation A 68‐year‐old woman with a medical history of old cerebral infarction and dementia was admitted to the emergency department with accidental hypothermia. An admission, electrocardiogram (ECG) showed prominent J waves with the highest amplitude recorded in limb and precordial leads. Continuous ECG monitoring was recorded during the rewarming therapy. As the body temperature increased, the amplitude of J waves became lower and disappeared. This case clearly showed that the degree of core body temperature is related to the height of the J‐wave amplitude. There was no fatal arrhythmia during rewarming therapy. Conclusion This case describes serial changes in the J‐wave amplitude and morphology during rewarming therapy. Continuous ECG monitoring is important in a patient with severe hypothermia.
Acute Medicine & Surgery, Volume 8; doi:10.1002/ams2.624