Clinical Sensitivity of the (1–3)-β-D-glucan Test for Predicting Candidemia

The sensitivity of the (1–3)-β-D-glucan (BDG) diagnostic test for candidemia varies in different clinical settings, and its usefulness in early diagnosis of candidemia is suboptimal. We evaluated the sensitivity of the test for early candidemia prediction. All adult patients with culture-proven candidemia who underwent a serum Goldstream Fungus (1–3)-β-D-Glucan Test within seven days prior to candidemia onset at a tertiary referral hospital between January 2017 and May 2021 were included. Any-positive BDG results within seven days prior to candidemia onset were obtained in 38 out of 93 (40.9%) patients. The positive rate increased when the test was performed near the day of candidemia onset (P=0.04) but reached only 52% on the day of candidemia onset. We observed no significant differences between BDG-positive and -negative groups in terms of underlying disease, risk factors for candidemia, clinical presentation, origin of candidemia, and 30-day mortality. Candida albicans was significantly associated with positive BDG results than with all-negative BDG results (P=0.04). The Goldstream BDG test is unreliable for candidemia prediction because of its low sensitivity. Negative BDG results in patients with a high risk of invasive candidiasis should be interpreted with caution.

Adverse Reactions Following the First Dose of ChAdOx1 nCoV-19 Vaccine and BNT162b2 Vaccine for Healthcare Workers in South Korea

Background@#We performed a prospective survey on the adverse reactions following the first dose of two types of vaccines against coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs) in South Korea. @*Methods@#HCWs at a tertiary referral hospital in Seoul, South Korea, received a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) or an mRNA-based vaccine (BNT162b2) between March 5 and March 26, 2021. The HCWs were asked to report adverse reactions through a mobile self-report questionnaire for three days after vaccination. @*Results@#A total of 7,625 HCWs received the first dose of ChAdOx1 or BNT162b2 vaccine during the study period. Of them, 5,866 (76.9%) HCWs (ChAdOx1, n = 5,589 [95.3%];BNT162b2, n = 277 [4.7%]) participated at least once in the survey, of whom 77% were female and 86% were younger than 50 years. The overall adverse reaction rate was 93% in the ChAdOx1 group and 80% in the BNT162b2 group (P < 0.001). Both local and systemic reactions were more commonly reported in the ChAdOx1 group, and the difference was larger in systemic reactions such as fever and fatigue. In the ChAdOx1 group, the incidence of adverse reactions was significantly higher in females and those in the younger age groups, while the BNT162b2 group showed such difference according to age. @*Conclusion@#In our prospective survey, vaccine-associated adverse reactions were more commonly reported in the ChAdOx1 group than in the BNT162b2 group. Females and younger age groups experienced vaccine-associated adverse reactions more frequently.

Adverse Reactions of the Second Dose of the BNT162b2 mRNA COVID-19Vaccine in Healthcare Workers in Korea

We conducted a prospective, mobile-based survey on the self-reported adverse reactions in healthcare workers (HCWs) who received both doses of the BNT162b2 mRNA vaccine. Of the 342 HCWs who completed the two-dose vaccination, 265 (77.5%) responded to the survey at least once. Overall, the rates of adverse reactions were higher after the second dose compared with the first dose (89.1% vs. 80.1%, P = 0.006). The most common systemic reactions were muscle ache (69.1%), fatigue (65.7%), headache (48.7%), chills (44.2%), and fever (32.1%), and were notably more common after the second dose vaccine as well. We also noted a sex difference in which the frequency of adverse reactions after the second dose of the vaccine was significantly higher in females, which was not observed after the first dose. The rates of adverse reactions were lower in older age groups, and the rates and severities of the adverse reactions decreased during the 3-day period following vaccination.

Adverse Reactions Following the First Dose of ChAdOx1 nCoV-19 Vaccine and BNT162b2 Vaccine for Healthcare Workers in South Korea

Background@#We performed a prospective survey on the adverse reactions following the first dose of two types of vaccines against coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs) in South Korea. @*Methods@#HCWs at a tertiary referral hospital in Seoul, South Korea, received a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) or an mRNA-based vaccine (BNT162b2) between March 5 and March 26, 2021. The HCWs were asked to report adverse reactions through a mobile self-report questionnaire for three days after vaccination. @*Results@#A total of 7,625 HCWs received the first dose of ChAdOx1 or BNT162b2 vaccine during the study period. Of them, 5,866 (76.9%) HCWs (ChAdOx1, n = 5,589 [95.3%];BNT162b2, n = 277 [4.7%]) participated at least once in the survey, of whom 77% were female and 86% were younger than 50 years. The overall adverse reaction rate was 93% in the ChAdOx1 group and 80% in the BNT162b2 group (P < 0.001). Both local and systemic reactions were more commonly reported in the ChAdOx1 group, and the difference was larger in systemic reactions such as fever and fatigue. In the ChAdOx1 group, the incidence of adverse reactions was significantly higher in females and those in the younger age groups, while the BNT162b2 group showed such difference according to age. @*Conclusion@#In our prospective survey, vaccine-associated adverse reactions were more commonly reported in the ChAdOx1 group than in the BNT162b2 group. Females and younger age groups experienced vaccine-associated adverse reactions more frequently.

Adverse Reactions of the Second Dose of the BNT162b2 mRNA COVID-19Vaccine in Healthcare Workers in Korea

We conducted a prospective, mobile-based survey on the self-reported adverse reactions in healthcare workers (HCWs) who received both doses of the BNT162b2 mRNA vaccine. Of the 342 HCWs who completed the two-dose vaccination, 265 (77.5%) responded to the survey at least once. Overall, the rates of adverse reactions were higher after the second dose compared with the first dose (89.1% vs. 80.1%, P = 0.006). The most common systemic reactions were muscle ache (69.1%), fatigue (65.7%), headache (48.7%), chills (44.2%), and fever (32.1%), and were notably more common after the second dose vaccine as well. We also noted a sex difference in which the frequency of adverse reactions after the second dose of the vaccine was significantly higher in females, which was not observed after the first dose. The rates of adverse reactions were lower in older age groups, and the rates and severities of the adverse reactions decreased during the 3-day period following vaccination.

Poor agreement between QuantiFERON-TB Gold test and tuberculin skin test results for the diagnosis of latent tuberculosis infection in rheumatoid arthritis patients and healthy controls

BACKGROUND/AIMS: We investigated the agreement between the QuantiFERON-TB Gold (QFT-Gold) test and the tuberculin skin test (TST) in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis (RA), compared with healthy controls, in Korea. METHODS: We recruited 64 patients with RA and 79 healthy controls at two university hospitals in South Korea. The participants underwent both the QFT-Gold test and the TST simultaneously between August 2006 and February 2009. All patients were diagnosed using the classification criteria for RA revised in 1987 by the American College of Rheumatology. Bacillus Calmette-Guerin vaccination status and current medications were evaluated, and disease activities were assessed using the Disease Activity Score in 28 joints. Eleven patients with RA produced indeterminate QFT-Gold test results and were thus excluded from the kappa analysis. RESULTS: Based on an induration of 10 mm in diameter as the TST cutoff value, the QFT-Gold test and TST demonstrated 75.0% agreement (kappa = 0.23) in patients with RA and 75.9% agreement (kappa = 0.19) in healthy controls. Among the 56 patients with RA who had negative TST results, 11 patients (17.2%) also yielded indeterminate QFT-Gold results. CONCLUSIONS: Our study showed poor agreement between the results of the QFT-Gold test and the TST in both RA patients and healthy controls. Based on these findings, we emphasize the importance of making clinical decisions in the diagnosis of latent tuberculosis in Koreans with or without RA.

Hepatotoxicity of Combination Treatment with Leflunomide and Methotrexate in RA Patients / 대한류마티스학회지

OBJECTIVE: Leflunomide is the newest disease-modifying anti-rheumatic drug (DMARD) that is known to have an equivalent clinical efficacy and tolerability to methotrexate (MTX). Previous studies reported that a co-treatment with MTX and leflunomide can induce additive clinical improvements in RA patients. However, a previous study also demonstrated a reversible elevation of the transaminase levels in up to 63% of patients administered a combination treatment of leflunomide and MTX. This study examined the hepatotoxicity of a combination treatment of MTX and leflunomide. METHODS: From March, 2004, to February, 2006, 203 patients who had been treated in 3 rheumatology clinics, Goyang city, South Korea, were reviewed retrospectively. The data showed that 38.92% of patients scored higher than grade 1 hepatotoxicity and 6.90% of patients scored higher than grade 2 according to the NCI/NIH (National Cancer Institute/National Institutes of Health) Common Toxicity Criteria. RESULTS: The median onset time of hepatotoxicity was 5.91 months after treatment. Leflunomide administration was stopped in 39 patients due to several adverse reactions. Among the 39 patients, hepatotoxicity was observed in only 20.51%, suggesting that the hepatotoxicity was not more frequent than expected. Hepatotoxicity did not increase in proportion to the dose of leflunomide and MTX, age, gender, and disease activity. CONCLUSION: These results indicate that a combined treatment of leflunomide and MTX can be used safely by monitoring the liver enzyme, particularly in the first six months.

Treatment of Behcet's Disease: Graded Approach / 대한내과학회지

No abstract available.

Treatment of Behcet's Disease: Graded Approach / 대한내과학회지

No abstract available.

A Case of Remission of Systemic Juvenile Rheumatoid Arthritis(Still's Disease) Treated with High-dose Intravenous Gammaglobulin

High dose intravenous gammaglobuline (IVLG) therapy is effective in some of the autoimmune diseases. Although the exact mechanism of action of IVIG is uncertain, the action as a neutralizing antibody against unknown etiologic agents, the action of blocking of Fc receptors of effector cells, or the action as a antiidiotypic antibody are suggested. We report a case of 12 year old girl with systemic juvenile rheumatoid arthritis who was treated with high dose IVIG and got a remission. In August 1990 she was admitted to our hospital. because of intermittent fever, transient rash and multiple arthralgia. Under the diagnosis of systemic juvenile rheumatoid arthritis, aspirin (4.0g/day) had been given with symptom improvement. She was readmitted in October 1990 because of aspirin intoxication and acute fulminant hepatitis. She was discharged after recovery and any medicine was not prescribed. In November 1990 she was admitted because of epigastric pain, vomiting, intermittent fever, multiple arthritis, and mild hepatomegaly. Total parenteral alimentation had been given under the diagnosis of superior mesenteric artery syndrome and gold sodium thiomalate (Myochrysine, 5 and 10 mg, two weekly IM injection) was given in conjunction with prednisolone (30 mg/day) and naproxen (375 mg/day). She was admitted again in February 1991 due to the fever, coughing, rash, and hepatosplenomegaly. Pneumonia and leukopenia (2100/mm(3)) were found and gold sodium thiomalate injection was discontinued. Gammaglobulin 1 g/kg/day was given intravenously for 2 consecutive days with dramatic symptom improvement. Five more monthly IV gammaglobulin had been given and the side reaction of injection were nausia, fever, and headache which were controlled by the decrease of infusion rate. Four months after the last IVIG injection she had no symtom of arthritis and the hepatosplenomegaly was decreased. Hemoglobin level was increase to 12.2 mg/dL form 6.2mg/dL and ESR was decrease to 15mm/h. The oral prednisolne and ibuprofen were stopped one year after th last IVIG injection. All the laboratory parameters of arthritis and physical examinations had been normal for more than two year after the stop of all the medications until March of 1994. We suggest that high dose intravenous gammaglobulin can be one of treatments for severe systemic juvenile rheumatoid arthritis.

Neurotologic Analysis of Cerebellopontine Angle Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The authors performed seven removal operations cerebellopontine angle tumor, six of which were acoustic neuroma. The purpose of this research is to analyze different cases of cerebellopontine angle tumor, determine their clinical characteristics, and evaluate the efficacy of various surgical approaches. MATERIALS AND METHODS: We performed neurotological analysis of both clinical characteristics and the results of each surgical approach for seven patients who have been treated for cerebellopontine angle tumor. RESULTS: The most frequent symptom was the complaint of hearing disturbance, where the mean PTAs measured were 66 dB, and the mean speech discrimination score was 35%. The average size of tumors measured by MRI was 3.9 cm. The following surgical approaches were used: translabyrinthine in 4 cases, modified translabyrinthine in 2 cases, transcochlear in one case. Complete removal of the tumor was possible in six patients. Facial nerve was preserved anatomically in six patients, and hearing preservation was possible in one patient for whom we performed the modified translabyrinthine approach. CONCLUSION: Early diagnosis and treatment is important in order to improve the facial nerve function after the operation. The modified translabyrinthine approach is worth performing for hearing preservation.

Most comgortable level and uncomfortable level of hearing in healthy Koreans / 대한이비인후과학회지

No abstract available.

The Study of Urinary Hydroxypyridinium Crosslinks Concentrations in Patients with RA or OA , and Its Clinical Significance / 대한내과학회지

OBJECTIVES: To evaluate the urinary concentrations of hydroxyridinium crosslinks of collagen in patients with osteoarthritis(OA) or rheumatoid arthritis(RA), and to compare its clinical correlation with the classic indices of the disease activity of RA. METHODS: Concentrations of urinary pyridinoline (Pyd) and deoxypyridinoline(Dpd) were measured in urinary samples collected from 18 control patients, 35 patients with OA, 45 patients with RA by competitive enzyme immunoassay using microplate coated with monoclonal antibody. RESULTS: 1) Mean urinary concentrations of Pyd in OA patients were 33.5nmol/mmol creatinine, in RA patients were 50.0nmol/mmol creatinine which were higher than the values in controls (25.1 nmol/mmol creatinine). Also, mean concentrations of Dpd in OA patients were 9.2nmol/mmol creatinine, in RA patients were 10.1nmol/mmol creatinine which were higher than the values in controls(5.6nmol/mmol creatinine)(p<0.01). 2) Mean urinary concentration of Pyd was 50.0 nmol/mmol creatinine in RA patients, which was significantly higher than the values in OA(33.5 nnmol/mmol creatinine)(p<0.05), but the mean Dpd concentratians were not significantly different between the two groups. 3) The concentrations of urinary Pyd in RA patients was significantly correlated with the biologic markers indicating inflammatory activity such as ESR(r=0.68, p<0.001), CRP(r=0.72, p<0.001) and the number of tender joint(r=0.66, p<0.01) CONCLUSION: Urinary concentrations of Pyd and Dpd were significantly higher in OA and RA patients than in controls, Especially urinary Pyd concentrations were significantly increased in RA patients than in OA patients, and strongly correlated with disease activity index of rheumatoid arthritis. The mean Dpd concentration, bone specific analogue, in RA patients was not significantly different from that of OA patients and it was not correlated with disease activity index Thus measurement of urinary Pyd might provide a sensitive, noninvasive biochemical marker for studying activity of RA.

Clinical Characteristics and Joint Involvement of Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the clinical, laboratory, radiologic characteristics, and joint involvement of rheumatoid arthritis (RA) in Korean. METHODS: We retrospectively reviewed initial medical records of 210 patients diagnosed as rheumatoid arthritis in Seoul, Sanggye, and Ilsan Paik Hospital, Inje University. Evaluation included age, sex, disease duration, duration of morning stiffness, joint involvement, the number of tender and swollen joints, rheumatoid factor, erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), and bony erosion in simple X-ray. RESULTS: In total 210 patients, mean age was 50.1+/-13.5 years, and male to female ratio was 1 to 5.6. Mean duration of arthritis was 51.8+/-72.6 months and positive rate of rheumatoid factor was 66.7%. Mean time interval between symptom onset and first visit was 14.1+/-19.1 months. Bony erosion rate was 15.3% in early RA patients, who had been diagnosed as RA within 1 year. The order of frequency of joint involvement was as the follows; metacarpophalangeal (MCP) joints, wrist joints, proximal interphalangeal (PIP) joints, metatarsophalangeal (MTP) joints, ankle joints, and knee joints. It was noted that the joints on the right and left sides behaved in like fashion. This pattern was not different with early RA. The titer of rheumatoid factor showed poor correlations with variables of clinical activity (ESR, CRP, duration of morning stiffness, and number of tender and swollen joints). CONCLUSION: In Korea, clinical manifestations and joint involvement of RA patients were not different from other published studies. The most commonly involved joints are MCP joints, wrist joints, PIP joints, and MTP joints.

A Case of SLE-systemic Sclerosis Overlap Syndrome Complicated with Nephrotic Syndrome / 대한류마티스학회지

Renal manifestations of systemic sclerosis are proteinuria, hypertension, azotemia and renal crisis. Mild proteinuria is common, but the nephrotic syndrome occurring in association with systemic sclerosis has been rarely reported. The majority of nephrotic syndrome cases are caused by glomerulonephritis in patients with an overlap syndrome of SLE and systemic sclerosis. This report suggests that the nephrotic syndrome can be an infrequent sequel of systemic sclerosis alone without glomerulopathy. A 38-year old woman was suffering from visual loss and headaches. She had Raynaud's phenomenon and thickened skin on nearly whole body. Urine protein was 4,950 mg/day and serum albumin level was 2.7 g/dL. The result of renal biopsy was renovasculopathy-compatible with systemic sclerosis.

Study on Effect of Benzbromarone in the Patients with Gout / 대한류마티스학회지

OBJECTIVE: Benzbromarone is a most potent uricosuric agent which has been marketed in Europe. The purpose of this study was to evaluate the safety and efficacy of benzbromarone as a uric acid lowering agent in gouty patients in Korea. METHOD: Twenty-one patients with gout, who were lower excreter of uric acid and had no other complication of gout, were treated with benzbromarone for 6 months. In these patients we checked complete blood count, liver function test, BUN, creatinine, serum uric acid, 24 hour urine uric acid excretion and uric acid clearance before and after treatment with benzbromarone. RESULTS: Significant improvements(p<0.01) were found in the serum uric acid level, 24h uric acid excretion and uric acid clearance. The mean serum uric acid decreased from 8.2mg/dl to 5.1mg/dl at the end of 6 months; mean urinary uric acid excretion increased from 425.9mg/day to 760.3mg/day; and the uric acid clearance increased from 3.5mL/min to 10.9mL/min. There are no clinical or laboratory side effects, except skin rash in the one patient. CONCLUSION: Benzbromarone was effective to control plasma uric acid concentration at doses ranging from 25 to 50mg/day.

Effect of scopolamine and glycopyrrolate on the secretory function of salivary glands / 대한이비인후과학회지

No abstract available.

Analysis of Treatment in the Patients with Non-Hodgkin's Lymphoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND: The patients with non-Hodgkin's lymphoma(NHL) of the head and neck was treated with radiotherapy traditionally, but the results were not satisfactory. Although chemotherapy or combined chemotherapy and radiotherapy was tried recently, prognostic factors and treatment of choice has not been described yet. OBJECTIVES: We performed this study to investigate the prognostic factors of NHL and the differences of treatment outcomes among chemotherapy, radiotherapy and combined therapy for NHL of the head and neck. MATERIALS AND METHOD: The subjects are 50 patients with NHL localized in the head and neck, who were treated at Kosin University Gospel Hospital from January 1988 to January 1996. We analyzed clinical datas retrospectively. RESULTS: Five year overall survival rate was 41% in the patients whose primary lesion was Waldeyer's ring and 78.3% in patients who present with primary lesion in cervical node(p<0.05). Five year overall survival rate of chemotherapy, radiotherapy, and combined therapy was 50.8%, 20%, 77% respectively(statistically not significant). These results suggest that location of primary site, pathologic type and response rate to treatment may be significant prognostic factors on univariate analysis(p<0.05). CONCLUSION: Combined chemotherapy and radiation therapy are more effective for the patients with NHL presenting in the head and neck.

Imaging and Acoustic Study of Laryngectomees after the Amatsu Tracheoesophageal Shunt Operation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The two most important methods for voice rehabilitation after total laryngectomy are tracheoesophageal speech and esophageal speech. The former can be obtained in several ways, for example, by the primary Amatsu tracheoesophageal (T-E) shunt operation or by the use of a low-resistance valve such as the Provox prosthesis. The purpose of this investigation was to study the anatomy and physiology of the neoglottis and to evaluate the vocal quality of tracheoesophageal speech. MATERIALS AND METHODS: A total of 12 patients, who had undergone the Amatsu T-E shunt operation after total laryngectomy, were analyzed using the stroboscopy, laryngofiberscopy, videofluoroscopy, and computerized speech lab. RESULTS: With stroboscopy, the neoglottis was split from left to right in 3 patients and in 9 patients, the direction of opening and closure of rheeoglottis was anterior-posterior. The regular vibratory features were observed in patients with a shortened visible vibratorvsegment. The results of videofluoroscopy indicate that the location of the vibration was mostly situated between C3 and C5. The cervical esophagus closure during tracheoesophageal phonation was located at a level between C7-T2. CONCLUSION: The anatomical and morphological characteristics of the neoglottis was related to the healing process after operation. The neoglottis was considered to be formed by the thyropharyngeal muscle, and concentric contraction under subneoglottic extension was formed by the contraction of the cervical esophagus.

A Case of Polyarteritis Nodosa Preceded by Otitis Media / 대한류마티스학회지

Polyarteritis nodosa (PAN) is a disease of small and medium sized muscular arteries, typically involving the skin, kidney, peripheral nerves, muscle and gut. Although its etiology has not been known clearly yet, an immune complex is believed to initiate a vasculitis. Infections, such as hepatitis B virus, hepatitis C virus, and streptococcal infection, may be related with the development of PAN. We experienced a case of PAN preceded by Methicillin resistant staphylococcus aureus-associated otitis media in a 50-year-old woman. This is the first case reported in Korea.