The usefulness of quantitative 99mTc-HMPAO WBC SPECT/CT for predicting lower extremity amputation in diabetic foot infection.

We investigated the usefulness of quantitative 99mTc-white blood cell (WBC) single photon emission computed tomography (SPECT)/computed tomography (CT) for predicting lower extremity amputation in diabetic foot infection (DFI). A total of 93 feet of 83 consecutive patients with DFI who underwent WBC SPECT/CT for treatment planning were retrospectively analysed. The clinical and SPECT/CT parameters were collected along with the measurements of the maximum standardized uptake value (SUVmax) at DFI. Statistical logistic regression analysis was performed to explore the predictors of LEA and receiver operating characteristic (ROC) curve was analysed to assess the predictive value of SPECT/CT. The independent predictors of amputation were previous amputation (OR 11.9), numbers of SPECT/CT lesions (OR 2.1), and SUVmax of DFI; either continuous SUVmax (1-increase) (OR 1.3) or categorical SUVmax > 1.1 (OR 21.6). However, the conventional SPECT/CT interpretation failed to predict amputation. In ROC analysis, the SUVmax yielded a fair predictor (area under the curve (AUC) 0.782) of amputation. The model developed from these independent predictors yielded an excellent performance for predicting amputation (AUC 0.873). Quantitative WBC SPECT/CT can provide new information useful for predicting the outcomes and guiding treatment for patients with DFI.

Deep Learning Model to Evaluate Sensorimotor System Ability in Patients With Dizziness for Postural Control.

Balanced posture without dizziness is achieved via harmonious coordination of visual, vestibular, and somatosensory systems. Specific frequency bands of center of pressure (COP) signals during quiet standing are closely related to the sensory inputs of the sensorimotor system. In this study, we proposed a deep learning-based novel protocol using the COP signal frequencies to estimate the equilibrium score (ES), a sensory system contribution. Sensory organization test was performed with normal controls (n=125), patients with Meniere's disease (n=72) and vestibular neuritis (n=105). The COP signals preprocessed via filtering, detrending and augmenting during quiet standing were converted to frequency domains utilizing Short-time Fourier Transform. Four different types of CNN backbone including GoogleNet, ResNet-18, SqueezeNet, and VGG16 were trained and tested using the frequency transformed data of COP and the ES under conditions #2 to #6. Additionally, the 100 original output classes (1 to 100 ESs) were encoded into 50, 20, 10 and 5 sub-classes to improve the performance of the prediction model. Absolute difference between the measured and predicted ES was about 1.7 (ResNet-18 with encoding of 20 sub-classes). The average error of each sensory analysis calculated using the measured ES and predicted ES was approximately 1.0%. The results suggest that the sensory system contribution of patients with dizziness can be quantitatively assessed using only the COP signal from a single test of standing posture. This study has potential to reduce balance testing time (spent on six conditions with three trials each in sensory organization test) and the size of computerized dynamic posturography (movable visual surround and force plate), and helps achieve the widespread application of the balance assessment.

Gender differences in psychosocial determinants of hand hygiene among physicians.

OBJECTIVE: We investigated gender differences in psychosocial determinants that affect hand hygiene (HH) performance among physicians. DESIGN: The survey included a structured questionnaire with 7 parts: self-assessment of HH execution rate; knowledge, attitude, and behavior regarding HH; internal and emotional motivation for better HH; barriers to HH; need for external reminders; preference for alcohol gel; and embarrassment due to supervision. SETTING: The study was conducted across 4 academic referral hospitals in Korea. PARTICIPANTS: Physicians who worked at these hospitals were surveyed. METHODS: The survey questionnaire was sent to 994 physicians of the hospitals in July 2018 via email or paper. Differences in psychosocial determinants of HH among physicians were analyzed by gender using an independent t test or the Fisher exact test. RESULTS: Of the 994 physicians, 201 (20.2%) responded to the survey. Among them, 129 (63.5%) were men. Male physicians identified 4 barriers as significant: time wasted on HH (P = .034); HH is not a habit (P = .004); often forgetting about HH situations (P = .002); and no disadvantage when I do not perform HH (P = .005). Female physicians identified pain and dryness of the hands as a significant obstacle (P = .010), and they had a higher tendency to feel uncomfortable when a fellow employee performed inadequate HH (P = .098). Among the respondents, 26.6% identified diversifying the types of hand sanitizers as their first choice for overcoming barriers to improving HH, followed by providing reminders (15.6%) and soap and paper towels in each hospital room (13.0%). CONCLUSION: A significant difference in the barriers to HH existed between male and female physicians. Promoting HH activities could help increase HH compliance.

Hierarchical Machine Learning-Based Growth Prediction Model of Panax ginseng Sprouts in a Hydroponic Environment.

Due to an increase in interest towards functional and health-related foods, Panax ginseng sprout has been in the spotlight since it contains a significant amount of saponins which have anti-cancer, -stress, and -diabetic effects. To increase the amount of production as well as decrease the cultivation period, sprouted ginseng is being studied to ascertain its optimal cultivation environment in hydroponics. Although there are studies on functional components, there is a lack of research on early disease prediction along with productivity improvement. In this study, the ginseng sprouts were cultivated in four different hydroponic conditions: control treatment, hydrogen-mineral treatment, Bioblock treatment, and highly concentrated nitrogen treatment. Physical properties were measured, and environmental data were acquired using sensors. Using three algorithms (artificial neural networks, support vector machines, random forest) for germination and rottenness classification, and leaf number and length of stem prediction models, we propose a hierarchical machine learning model that predicts the growth outcome of ginseng sprouts after a week. Based on the results, a regression model predicts the number of leaves and stem length during the growth process. The results of the classifier models showed an F1-score of germination classification of about 99% every week. The rottenness classification model showed an increase from an average of 83.5% to 98.9%. Predicted leaf numbers for week 1 showed an average nRMSE value of 0.27, which decreased by about 33% by week 3. The results for predicting stem length showed a higher performance compared to the regression model for predicting leaf number. These results showed that the proposed hierarchical machine learning algorithm can predict germination and rottenness in ginseng sprout using physical properties.

Late-Onset Granulomatous Pneumocystis jirovecii Pneumonia in A Renal Transplant Recipient: A Clinical Grand Round Conference Case in 2022.

Late-onset Pneumocystis jirovecii pneumonia (PCP) can be developed in solid organ transplant (SOT) patients. Granulomatous P. jirovecii pneumonia (GPCP) can occur in immunocompromised patients, but has rarely been reported in SOT recipients. The diagnosis of GPCP is difficult since the sensitivity of sputum and bronchoalveolar lavage is low and atypical patterns are shown. A 60-year-old man, who had undergone renal transplantation 24 years ago presented with nodular and patchy lung lesions. He was asymptomatic and stable. After empirical treatment with a fluoroquinolone, the condition partially resolved but relapsed 4 months later. The pulmonary nodule was resected, and GPCP was confirmed. The pathogenesis of GPCP remains unclear, but in SOT recipients presenting with an atypical lung pattern, GPCP should be considered. This case was discussed at the Grand Clinical Ground of the Korean Society of Infectious Disease conference on November 3, 2022.

Hand hygiene knowledge, attitude, barriers and improvement measures among healthcare workers in the Republic of Korea: a cross-sectional survey exploring interprofessional differences.

BACKGROUND: Hand hygiene (HH) is a fundamental component of infection prevention and control in healthcare settings. This study aimed to identify knowledge, attitude, and barriers to HH according to occupational groups and strategies to increase the rate of HH compliance among healthcare workers (HCWs). METHODS: This cross-sectional survey was conducted in July 2018 at four university-affiliated hospitals. The survey comprised seven parts with 49 items, including self-reported HH compliance, knowledge, attitudes, behaviours, barriers to HH, and improvement strategies. RESULTS: A total of 1046 HCWs participated in the survey. The nursing group's self-reported HH compliance rate was the highest, followed by other HCWs and physicians. The scores regarding knowledge, attitudes, and behaviours regarding HH were the highest in the nursing group. The nursing group also had higher internal and emotional motivation scores. Physicians and nurses found HH the most challenging in emergencies, while other HCWs considered skin problems caused by HH products the most significant barrier. Among 12 improvement measures, approximately 20% of the respondents ranked "diversify types of hand sanitisers," "install soap and paper towels in each hospital room," and "change perception through various HH campaigns" as the top three priorities. The physician group deemed the timely reminder of HH compliance as the second most critical improvement measure. CONCLUSION: Differences in knowledge, attitude and barriers hindering HH compliance and improvement plans were identified for each group. The findings suggest that targeted interventions tailored to the specific needs of different occupational groups may effectively improve HH compliance in healthcare settings.

Ventilation strategies based on an aerodynamic analysis during a large-scale SARS-CoV-2 outbreak in an acute-care hospital.

BACKGROUND: This study aimed to investigate ventilation strategies to prevent nosocomial transmission of coronavirus disease 2019 (COVID-19). METHODS: We conducted a retrospective epidemiological investigation of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a teaching hospital (February-March 2021). The largest outbreak ward was studied, and measurements were taken to determine the pressure difference and air change per hour (ACH) of the rooms. Airflow dynamics were assessed using an oil droplet generator, indoor air quality sensor, and particle image velocimetry in the index patient's room, corridor, and opposite rooms, by varying the opening and closing of windows and doors. RESULTS: During the outbreak, 283 COVID-19 cases were identified. The SARS-CoV-2 spread occurred sequentially from the index room to the nearest room, especially the opposite. The aerodynamic study demonstrated that droplet-like particles in the index room diffused through the corridor and the opposite room through the opening door. The mean ACH of the rooms was 1.44; the air supply volume was 15.9% larger than the exhaust volume, forming a positive pressure. Closing the door prevented diffusion between adjacent rooms facing each other, and natural ventilation reduced the concentration of particles within the ward and minimised their spread to adjacent rooms. CONCLUSIONS: Spread of droplet-like particles between rooms could be attributed to the pressure difference between the rooms and corridor. To prevent spread of SARS-CoV-2 between rooms, increasing the ACH in the room by maximising ventilation and minimising the positive pressure through supply/exhaust control and closing the room door are essential.

Steady amelioration of institutional hand hygiene behavior among health care personnel after 12-year consistent intervention.

BACKGROUND: Institutional hand hygiene (HH) behavior is difficult to monitor and improve consistently, especially over long periods. This study aimed to investigate the long-term effects of HH promotion activities. METHOD: We launched the HH promotion team in 2010 and conducted interventions including goal setting, observation and feedback, education, reward incentives, and accountability. Optimal HH compliance rates were calculated based on adherence to all 6-step HH technique and appropriate time recommended by the World Health Organization. HH and optimal HH compliance were calculated over 12 years. Poisson regression analysis was used to determine the trend in HH compliance according to year. RESULTS: In 2010, HH and optimal HH compliance were 59.7% and 15.6%, respectively. HH compliance increased by 83.9% in 2013 and remained over 75%. HH compliance increased significantly, with a relative risk (RR) of 1.014 (95% CI 1.002-1.025, P = .018). Optimal HH compliance increased by 67.8% in 2013 and remained over 60%, except in 2016 (58.8%) and 2019 (59.8%). Optimal HH compliance increased with RR 1.033 (95% CI 0.991-1.076, P = .123). DISCUSSION: HH and optimal HH compliance increased significantly over the 12 years when subgroup analysis was performed by job category. CONCLUSIONS: HH promotion team activities improved and maintained optimal HH compliance among HCWs.

Professional Status of Infectious Disease Specialists in Korea: A Nationwide Survey.

BACKGROUND: Infectious disease (ID) specialists are skilled facilitators of medical consultation who promote better outcomes in patient survival, antibiotic stewardship as well as healthcare safety in pandemic response. This study aimed to assess the working status of ID specialists and identify problems faced by ID professionals in Korea. METHODS: This was a nationwide cross-sectional study in Korea. An online-based survey was conducted over 11 days (from December 17-27, 2020), targeting all active adult (n = 281) and pediatric (n = 71) ID specialists in Korea (N = 352). Questions regarding the practice areas of the specialists were divided into five categories: 1) clinical practices of outpatient care, inpatient care, and consultations; 2) infection control; 3) antibiotic stewardship; 4) research; and 5) education and training. We investigated the weekly time-use patterns for these areas of practice. RESULTS: Of the 352 ID specialists, 195 (55.4%; 51.2% [144/281] adult and 71.8% [51/71] pediatric ID specialists) responded in the survey. Moreover, 144 (73.8%) of the total respondents were involved in all practice categories investigated. The most common practice area was outpatient service (93.8%), followed by consultation (91.3%) and inpatient service (87.7%). Specialists worked a median of 61 (interquartile range: 54-71) hours weekly: patient care, 29 (14-37) hours; research 11 (5-19) hours; infection control 4 (2-10) hours; antibiotic stewardship, 3 (1-5) hours; and education/training, 2 (2-6) hours. CONCLUSION: ID specialists in Korea simultaneously undertake multiple tasks and work long hours, highlighting the need for training and employing more ID specialists.

Egg Freshness Prediction Model Using Real-Time Cold Chain Storage Condition Based on Transfer Learning.

Maintaining and monitoring the quality of eggs is a major concern during cold chain storage and transportation due to the variation of external environments, such as temperature or humidity. In this study, we proposed a deep learning-based Haugh unit (HU) prediction model which is a universal parameter to determine egg freshness using a non-destructively measured weight loss by transfer learning technique. The temperature and weight loss of eggs from a laboratory and real-time cold chain environment conditions are collected from ten different types of room temperature conditions. The data augmentation technique is applied to increase the number of the collected dataset. The convolutional neural network (CNN) and long short-term memory (LSTM) algorithm are stacked to make one deep learning model with hyperparameter optimization to increase HU value prediction performance. In addition, the general machine learning algorithms are applied to compare HU prediction results with the CNN-LSTM model. The source and target model for stacked CNN-LSTM used temperature and weight loss data, respectively. Predicting HU using only weight loss data, the target transfer learning CNN-LSTM showed RMSE value decreased from 6.62 to 2.02 compared to a random forest regressor, respectively. In addition, the MAE of HU prediction results for the target model decreased when the data augmentation technique was applied from 3.16 to 1.39. It is believed that monitoring egg freshness by predicting HU in a real-time cold chain environment can be implemented in real-life by using non-destructive weight loss parameters along with deep learning.

Same-day and rapid initiation of antiretroviral therapy in people living with HIV in Asia. How far have we come?

Human immunodeficiency virus (HIV) continues to be a major public health issue, and the effectiveness of HIV prevention, diagnosis, treatment, and care varies, particularly in the Asia-Pacific region. The rapid initiation of antiretroviral therapy (ART) is important to control the HIV epidemic and to optimize the health of people living with HIV; many guidelines now recommend ART initiation within 7 days of HIV diagnosis, with same-day initiation for people diagnosed with HIV who feel ready. Many countries in the Asia-Pacific region have already implemented or are moving towards implementation of rapid or same-day ART initiation. However, there are many obstacles and challenges to its implementation, which vary substantially across the region. This article summarizes the latest evidence on rapid and same-day ART initiation and discusses lessons learned and barriers to implementation in Asian countries, particularly focusing on Taiwan, Thailand, Singapore, and the Republic of Korea.

Deep Learning-Based Near-Fall Detection Algorithm for Fall Risk Monitoring System Using a Single Inertial Measurement Unit.

Proactively detecting falls and preventing injuries are among the primary keys to a healthy life for the elderly. Near-fall remote monitoring in daily life could provide key information to prevent future falls and obtain quantitative rehabilitation status for patients with weak balance ability. In this study, we developed a deep learning-based novel classification algorithm to precisely categorize three classes (falls, near-falls, and activities of daily living (ADLs)) using a single inertial measurement unit (IMU) device attached to the waist. A total of 34 young participants were included in this study. An IMU containing accelerometer and gyroscope sensors was fabricated to acquire acceleration and angular velocity signals. A comprehensive experiment including thirty-six types of activities (10 types of falls, 10 types of near-falls, and 16 types of ADLs) was designed based on previous studies. A modified directed acyclic graph-convolution neural network (DAG-CNN) architecture with hyperparameter optimization was proposed to predict fall, near-fall, and ADLs. Prediction results of the modified DAG-CNN structure were found to be approximately 7% more accurate than the traditional CNN structure. For the case of near-falls, the modified DAG-CNN demonstrated excellent prediction performance with accuracy of over 98% by combining gyroscope and accelerometer features. Additionally, by combining acceleration and angular velocity the trained model showed better performance than each model of acceleration and angular velocity. It is believed that information to preemptively handle the risk of falls and quantitatively evaluate the rehabilitation status of the elderly with weak balance will be provided by monitoring near-falls.

The Role of Age in Subclinical Atherosclerosis in Asian People Living with Human Immunodeficiency Virus.

BACKGROUND: People living with human immunodeficiency virus (PLHIV) have an increased risk of atherosclerosis and cardiovascular disease, but specific guidance on when to suspect the onset of these diseases is limited. MATERIALS AND METHODS: We aimed to identify cardiovascular risk factors in PLHIV using carotid intima-media thickness (IMT) through a cross-sectional, retrospective cohort study that enrolled 217 PLHIV who underwent carotid IMT measurement at a teaching hospital in Korea. We compared clinical characteristics between PLHIV with subclinical atherosclerosis and PLHIV with IMT within the normal range, and used a receiver operating characteristic curve to determine the cut-off age for predicting subclinical atherosclerosis. RESULTS: Among the study population, 115 participants (53.0%) had subclinical atherosclerosis. In logistic regression, age and dyslipidemia were significantly associated with increased carotid IMT even after adjusting for other variables (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.06 - 1.15, P <0.001; OR: 3.92, 95% CI: 1.87 - 8.22, P <0.001, respectively). The cut-off age for predicting subclinical atherosclerosis was 39.5 years (area under the curve 0.78, 95% CI: 0.72 - 0.84, P <0.001). CONCLUSION: Conventional risk factors including age and dyslipidemia were associated with subclinical atherosclerosis in Asian PLHIV. In particular, Asian PLHIV older than 40 years had an increased risk of subclinical atherosclerosis and may benefit from carotid IMT screening.

A Novel Optimization-Based Convolution Neural Network to Estimate the Contribution of Sensory Inputs to Postural Stability During Quiet Standing.

Adequate postural control is maintained by integrating signals from the visual, somatosensory, and vestibular systems. The purpose of this study is to propose a novel convolutional neural network (CNN)-based protocol that can evaluate the contributions of each sensory input for postural stability (calculated a sensory analysis index) using center of pressure (COP) signals in a quiet standing posture. Raw COP signals in the anterior/posterior and medial/lateral directions were extracted from 330 patients in a quiet standing with their eyes open for 20 seconds. The COP signals augmented using jittering and pooling techniques were transformed into the frequency domain. The sensory analysis indices were used as the output information from the deep learning models. A ResNet-50 CNN was combined with the k-nearest neighbor, random forest, and support vector machine classifiers for the training model. Additionally, a novel optimization process was proposed to include an encoding design variable that can group outputs into sub-classes along with hyperparameters. The results of optimization considering only hyperparameters showed low performance, with an accuracy of 55% or less and F-1 scores of 54% or less in all models. However, when optimization was performed using the encoding design variable, the performance was markedly increased in the CNN-classifier combined models (r = 0.975). These results suggest it is possible to evaluate the contribution of sensory inputs for postural stability using COP signals during a quiet standing. This study will facilitate the expanded dissemination of a system that can quantitatively evaluate the balance ability and rehabilitation progress of patients with dizziness.

A SARS-CoV-2 outbreak associated with vaccine breakthrough in an acute care hospital.

BACKGROUND: We aimed to analyze an outbreak caused by a vaccine breakthrough infection in a hospital with an active infection control program where 91.9% of health care workers were vaccinated. METHODS: We investigated a SARS-CoV-2 outbreak between September 9 and October 2, 2021, in a referral teaching hospital in Korea. We retrospectively collected data on demographics, vaccination history, transmission, and clinical features of confirmed coronavirus disease 2019 (COVID-19) in patients, health care workers, and caregivers. RESULTS: During the outbreak, 94 individuals tested positive for SARS-CoV-2 using reverse transcription-polymerase chain reaction testing. There were infections in 61 health care workers, 18 patients, and 15 caregivers; 74.5% (70/94) were vaccine breakthrough infections. Most transmissions appeared to be caused by three index cases, which accounted for 86.2% (81/94) of transmissions. Forty-seven (58.0%, 47/81) cases were associated with the hospital staff cafeteria and offices located in the basement. Among health care workers and caregivers, only one required oxygen supplementation. In contrast, among patients, there were four fatal cases (22.2%, 4/18), 3 of which were unvaccinated. CONCLUSIONS: Superspreading infection among fully vaccinated individuals occurred in an acute care hospital while the delta variant was dominant. Given the potential for severe complications, as this outbreak demonstrated, preventive measures including adequate ventilation should be emphasized to minimize transmission in hospitals.

Appropriateness of antibiotic prescriptions during hospitalization and ambulatory care: a multicentre prevalence survey in Korea.

OBJECTIVES: Antimicrobial resistance is one of the most urgent global health threats. The need for the qualitative evaluation of antibiotic use at the national level is increasing. To identify areas for improvement, we aimed to assess the prevalence and appropriateness of antibiotic prescriptions during hospitalization and ambulatory care in Korea. METHODS: The prevalence and appropriateness of antibiotic prescriptions on 29 August 2018 were assessed for 20 hospitals in Korea. Infectious disease specialists determined appropriateness. Except for antiviral and anti-tuberculosis agents, all antibacterial or antifungal agent prescriptions during hospitalization or ambulatory care were evaluated. RESULTS: The prevalence of antibiotic prescription was 14.1% (8,400/59 216 patients) on the study date. Antibiotics were prescribed for 50.8% of inpatients (6557/12 902), with two or more antibiotics prescribed for 27.4% (1798/6557) of patients. A total of 10 948 prescriptions (7999 therapeutic, 2105 surgical prophylaxes, and 844 medical prophylaxes) were included in the final analysis, and 27.7% of these were inappropriate. Surgical prophylaxis was inadequately prescribed most frequently (54.4%), followed by medical prophylaxis (29.5%) and therapeutic antibiotics (20.5%). The most common indications for therapeutic antibiotics were respiratory (29.1%, n=2332), gastrointestinal (22.4%, n=1791), and urinary tract infections (13.1%, n=1050). The most frequently prescribed antibiotics were cephalosporins (52.0%, n=5490), followed by beta lactam/beta lactamase inhibitors (13.7%, n=1373), fluoroquinolones (9.1%, n=957), and metronidazole (6.6%, n=699). CONCLUSION: This was the first nationwide qualitative antibiotic prescription adequacy evaluation in Korea. A significant proportion of antibiotic prescriptions were inappropriate. Therefore, interventions for high-frequency infections and prescription antibiotics are needed.

Previous Long-term Care Facility Admission as a Risk Factor for Scabies in a Medical Facility.

The study aimed to elucidate simple and effective risk factors for scabies infection in the medical environment for early detection and prevention of exposure to other patients and medical staff. We conducted a case-control study of patients who were diagnosed with scabies among hospitalized patients between 2008 and 2019 in an acute-care teaching hospital. Each case was matched according to sex and age with two randomly selected controls without scabies during hospitalization. Clinical characteristics of cases at the time of hospital admission were compared to those of the control group. The scabies group included 34 patients and 68 patients who were included in the control group. After adjusting for confounding factors, previous long-term care facility admission was only associated with scabies (adjusted odds ratio, 5.44; 95% confidence interval, 1.46-20.27; P = 0.012). Careful examination, particularly for patients with previous long-term care facility admission, might be useful for the early detection of scabies.

Appropriate number of observations for determining hand hygiene compliance among healthcare workers.

We sought to determine the minimum number of observations needed to determine hand hygiene (HH) compliance among healthcare workers. The study was conducted at a referral hospital in South Korea. We retrospectively analyzed the result of HH monitoring from January to December 2018. HH compliance was calculated by dividing the number of observed HH actions by the total number of opportunities. Optimal HH compliance rates were calculated based on adherence to the six-step technique recommended by the World Health Organization. The minimum number of required observations (n) was calculated by the following equation using overall mean value (ρ), absolute precision (d), and confidence interval (CI) (1 - α) [the equation: [Formula: see text]]. We considered ds of 5%, 10%, 20%, and 30%, with CIs of 99%, 95%, and 90%. During the study period, 8791 HH opportunities among 1168 healthcare workers were monitored. Mean HH compliance and optimal HH compliance rates were 80.3% and 59.7%, respectively. The minimum number of observations required to determine HH compliance rates ranged from 2 ([Formula: see text]: 30%, CI: 90%) to 624 ([Formula: see text]: 5%, CI: 99%), and that for optimal HH compliance ranged from 5 ([Formula: see text]: 30%, CI: 90%) to 642 ([Formula: see text]: 5%, CI: 99%). Therefore, we found that our hospital required at least five observations to determine optimal HH compliance.

Actinomycosis presenting as an isolated pleural effusion in a patient with an HIV infection: a case report and literature review.

BACKGROUND: Thoracic actinomycosis is an uncommon, chronic, and progressive infection, especially in patients with HIV. We report a case of thoracic actinomycosis presenting as an isolated pleural effusion in a patient with an HIV infection. CASE PRESENTATION: A 68-year-old patient with progressive dyspnea and fever was admitted. On the right side, an ipsilateral massive pleural effusion was confirmed on the chest radiograph, and an HIV infection was newly diagnosed. A pleural biopsy was performed for the further differential diagnosis of potential opportunistic infections and malignancies. The pathology findings were consistent with actinomycosis. CONCLUSIONS: Active diagnostic approaches such as a pleural biopsy should be considered for indeterminate pleural effusions in immunocompromised patients.