Modest Effects of NeurofeedbackAssisted Meditation Using a Wearable Device on Stress Reduction: A Randomized, Double-Blind, and Controlled Study

Background@#To evaluate the therapeutic effectiveness and safety of a neurofeedback wearable device for stress reduction. @*Methods@#A randomized, double-blind, controlled study was designed. Participants had psychological stress with depression or sleep disturbances. They practiced either neurofeedback-assisted meditation (n = 20; female, 15 [75.0%]; age, 49.40 ± 11.76 years) or neurofeedback non-assisted meditation (n = 18; female, 11 [61.1%]; age, 48.67 ± 12.90 years) for 12 minutes twice a day for two weeks. Outcome variables were self-reported questionnaires, including the Korean version of the Perceived Stress Scale, Beck Depression Inventory-II, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and State Trait Anxiety Index, quantitative electroencephalography (qEEG), and blood tests. Satisfaction with device use was measured at the final visit. @*Results@#The experimental group had a significant change in PSS score after two weeks of intervention compared with the control group (6.45 ± 0.95 vs. 3.00 ± 5.54, P = 0.037). State anxiety tended to have a greater effect in the experimental group than in the control group (P = 0.078). Depressive mood and sleep also improved in each group, with no significant difference between the two groups. There were no significant differences in stress-related physiological parameters, such as stress hormones or qEEG, between the two groups.Subjective device satisfaction was significantly higher in the experimental group than in the control group (P = 0.008). @*Conclusion@#Neurofeedback-assisted meditation using a wearable device can help improve subjective stress reduction compared with non-assisted meditation. These results support neurofeedback as an effective adjunct to meditation for relieving stress.

Secondary Malignancies in Multiple Myeloma in Korean Patients: A Nationwide Population-Based Study / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study investigated the incidence of secondary malignancy in multiple myeloma (MM) patients compared with that in the general population using a population-based database covering all residents in Korea. @*Materials and Methods@#Based on the national health insurance system in Korea, all people primarily diagnosed with MM between January 1, 2010 to December 31, 2018 were identified. A total of 9,985 MM patients aged ≥ 20 years in Korea were included. @*Results@#Among them, 237 (2.4%) developed secondary malignancies by 2018. The standardized incidence rates (SIRs) of all secondary malignancies in MM patients were 0.87 (95% confidence interval [CI], 0.76 to 0.98), with a higher incidence of hematologic malignancies than in the general population with an SIR of 3.80 (95% CI, 2.61 to 5.00). The incidence rates of both lymphoid malignancy (SIR, 3.56; 95% CI, 2.31 to 4.82) and myeloid malignancy (SIR, 3.78; 95% CI, 1.16 to 6.39) were higher in MM patients than in the general population. In contrast, a lower incidence of solid cancer was observed in MM patients than in the general population (SIR, 0.76, 95% CI, 0.65 to 0.86). There was no significant difference in survival in MM patients without secondary malignancies, with hematologic malignancy, and with solid cancer (p=0.413). @*Conclusion@#MM patients had a greater risk of secondary malignancies, especially hematologic malignancies, than the general population. Future studies with a focus on analyzing patients’ history, treatment details, and genetic information in various stages of MM patients are needed to better understand the mechanism behind this increased risk.

Prevalence and Burden of Human Adenovirus-Associated Acute Respiratory Illness in the Republic of Korea Military, 2013 to 2022

Background@#Human adenovirus (HAdV) is a common cause of acute respiratory disease (ARD) and has raised significant concerns within the Korean military. Here, we conducted a comprehensive epidemiological analysis of HAdV-associated ARD by evaluating its prevalence, clinical outcomes, and prognosis. @*Methods@#We reviewed data from multiple sources, including the New Defense Medical Information System, Defense Medical Statistical Information System, Ministry of National Defense, Army Headquarters, Navy Headquarters, Air Force Headquarters, and Armed Forces Medical Command. We analyzed data of patients who underwent polymerase chain reaction (PCR) testing for respiratory viruses between January 2013 and July 2022 in all 14 Korean military hospitals. The analysis included the PCR test results, demographic characteristics, health care utilization, and prognosis including types of treatments received, incidence of pneumonia, and mortality. @*Results@#Among the 23,830 individuals who underwent PCR testing at Korean military hospitals, 44.78% (10,670 cases) tested positive for respiratory viruses. Across all military types and ranks, HAdV was the most prevalent virus, with a total of 8,580 patients diagnosed, among HAdV, influenza virus, human metapneumovirus, human parainfluenza virus, and human respiratory syncytial virus. HAdV-infected patients exhibited higher rates of healthcare use compared to non-HAdV-infected patients, including a greater number of emergency visits (1.04 vs. 1.02) and outpatient visits (1.31 vs. 1.27), longer hospitalizations (8.14 days vs. 6.84 days), and extended stays in the intensive care unit (5.21 days vs. 3.38 days).Furthermore, HAdV-infected patients had a higher proportion of pneumonia cases (65.79%vs. 48.33%) and greater likelihood of receiving advanced treatments such as high flow nasal cannula or continuous renal replacement therapy. @*Conclusion@#Our findings indicate that HAdV posed a significant public health concern within the Korean military prior to the coronavirus disease 2019 (COVID-19) pandemic. Given the potential for a resurgence of outbreaks in the post-COVID-19 era, proactive measures, such as education, environmental improvements, and the development of HAdV vaccines, are crucial for effectively preventing future outbreaks.

Differences in White Matter Hyperintensity in Elderly Veterans With and Without Post-Traumatic Stress Disorder

Objective@#Exposure to stressful events is associated with the progression of white matter hyperintensity (WMH). The purpose of this study was to determine the difference in WMH depending on the presence of Post-traumatic stress disorder (PTSD). @*Methods@#The patients who underwent brain magnetic resonance imaging and clinician-administered PTSD scale (CAPS) at the Veteran Health Service Medical Center were reviewed retrospectively. WMH were evaluated using the Fazekas scale. The patients with PTSD (n=51; age 66.25±10.43 years) were compared with patients exposed to trauma without PTSD (n=67; age 69.45±10.44 years). @*Results@#The scores of Beck Depression Scale, Beck Anxiety scale, and CAPS were significantly higher in the PTSD group. The PTSD group showed a significant difference on the Fazekas scale compared to the trauma-exposed group without PTSD (periventricular white matter, p=0.001; deep white matter, p=0.008). After adjusting for age, smoking and comorbidity, WMH was higher in the PTSD group than in the trauma exposed group (periventricular white matter, p<0.001; deep white matter, p=0.006). @*Conclusion@#The results suggests that there may be an association between PTSD and WMH as well as stressful events.

Risk Factors for the Prescription of Ineffective Antiviral Candidates for COVID-19 During the Early Pandemic Period in Korea

Background@#Although the evidence of treatment for coronavirus disease 2019 (COVID-19) changed rapidly, little is known about the patterns of potential pharmacological treatment during the early period of the COVID-19 pandemic in Korea and the risk factors for ineffective prescription. @*Methods@#Using claims data from the Korean National Health Insurance System, this retrospective cohort study included admission episodes for COVID-19 from February to December 2020. Ineffective antiviral prescriptions for COVID-19 were defined as lopinavir/ ritonavir (LPN/r) and hydroxychloroquine (HCQ) prescribed after July 2020, according to the revised National Institute of Health COVID-19 treatment guidelines. Factors associated with ineffective prescriptions, including patient and hospital factors, were identified by multivariate logistic regression analysis. @*Results@#Of the 15,723 COVID-19 admission episodes from February to June 2020, 4,183 (26.6%) included prescriptions of LPN/r, and 3,312 (21.1%) included prescriptions of HCQ.Of the 48,843 admission episodes from July to December 2020, after the guidelines were revised, 2,258 (4.6%) and 182 (0.4%) included prescriptions of ineffective LPN/r and HCQ, respectively. Patient factors independently associated with ineffective antiviral prescription were older age (adjusted odds ratio [aOR] per 10-year increase, 1.17; 95% confidence interval [CI], 1.14–1.20) and severe condition with an oxygen requirement (aOR, 2.49; 95% CI, 2.24–2.77). The prescription of ineffective antiviral drugs was highly prevalent in primary and nursing hospitals (aOR, 40.58; 95% CI, 31.97–51.50), public sector hospitals (aOR, 15.61; 95% CI, 12.76–19.09), and regions in which these drugs were highly prescribed before July 2020 (aOR, 10.65; 95% CI, 8.26–13.74). @*Conclusion@#Ineffective antiviral agents were prescribed to a substantial number of patients during the first year of the COVID-19 pandemic in Korea. Treatment with these ineffective drugs tended to be prolonged in severely ill patients and in primary and public hospitals.

Real-World Effectiveness of Nirmatrelvir-Ritonavir and Its Acceptability in High-Risk COVID-19Patients

Background@#Nirmatrelvir-ritonavir is highly effective in preventing severe coronavirus disease 2019 (COVID-19) in high-risk patients with mild-to-moderate severity. However, real-world performance data are limited, and the drug is not so acceptable to the COVID-19 patients at high risk who need it in Korea. @*Methods@#To evaluate the effectiveness of nirmatrelvir-ritonavir, we conducted a propensity score-matched retrospective cohort study on patients with mild-to-moderate COVID-19 at high risk for a severe disease who were hospitalized at four hospitals in South Korea from February 2022 to April 2022. A total of 236 patients in the treatment group (administered nirmatrelvir-ritonavir) and 236 in the matched control group (supportive care only) were analyzed for the primary outcome, i.e., the time to oxygen support-free survival. The secondary outcome was a composite result of disease progression. The reason for not prescribing nirmatrelvir-ritonavir to the indicated patients was also investigated. @*Results@#The treatment group showed significantly longer oxygen support-free survival than the matched control group (adjusted hazard ratio [aHR], 0.07; 95% confidence interval [CI], 0.01–0.31; P < 0.001). Multivariate Cox regression analysis showed that age (aHR, 1.03; 95% CI, 1.00–1.07), National Early Warning Score-2 at admission (aHR, 1.36; 95% CI, 1.08–1.71), nirmatrelvir-ritonavir treatment, female sex (aHR, 0.37; 95% CI, 0.15–0.88), and time from symptom onset to admission (aHR, 0.67; 95% CI, 0.48–0.95) were significantly associated with oxygen therapy. However, none of the factors were related to the composite outcome. In the unmatched control group, 19.9% of 376 patients had documented explanations for nirmatrelvir-ritonavir non-prescription, and 44.0% of these were due to contraindication criteria. In the treatment group, 10.9% of patients discontinued the medication primarily because of adverse events (71.4%), with gastrointestinal symptoms being the most common (50.0%). @*Conclusion@#Nirmatrelvir-ritonavir treatment significantly reduced oxygen therapy requirements in high-risk patients with COVID-19 during the omicron variant surge in South Korea. Physicians are encouraged to consider the active use of nirmatrelvir-ritonavir and to be watchful for gastrointestinal symptoms during medication.

Short-Term Effectiveness of Oral Nirmatrelvir/Ritonavir Against the SARS-CoV-2 Omicron Variant and Culture-Positive Viral Shedding

Background@#Information on the effectiveness of nirmatrelvir/ritonavir against the omicron is limited. The clinical response and viral kinetics to therapy in the real world need to be evaluated. @*Methods@#Mild to moderate coronavirus disease 2019 (COVID-19) patients with risk factors for severe illness were prospectively enrolled as a treatment group with nirmatrelvir/ritonavir therapy versus a control group with supportive care. Serial viral load and culture from the upper respiratory tract were evaluated for seven days, and clinical responses and adverse reactions were evaluated for 28 days. @*Results@#A total of 51 patients were analyzed including 40 in the treatment group and 11 in the control group. Faster symptom resolution during hospitalization (P= 0.048) was observed in the treatment group. Only minor adverse reactions were reported in 27.5% of patients. The viral load on Day 7 was lower in the treatment group (P = 0.002). The viral culture showed a positivity of 67.6% (25/37) vs. 100% (6/6) on Day 1, 0% (0/37) vs. 16.7 (1/6) on Day 5, and 0% (0/16) vs. 50.0% (2/4) on Day 7 in the treatment and control groups, respectively. @*Conclusions@#Nirmatrelvir/ritonavir against the omicron was safe and resulted in negative viral culture conversion after Day 5 of treatment with better symptomatic resolution.

Types of Recovered Alcoholics Based on the Factors Influencing Recovery from Alcoholism: A Q methodology / 정신간호학회지

Purpose@#The objectives of this study were to identify the types of recovered alcoholics based on the factors that influence recovery, using the Q methodology. @*Methods@#Forty-six statements were selected from in-depth interviews with eight psychiatric healthcare professionals and four abstinent alcoholics and literature review. Then, 50 participants sorted these statements in a forced grid with normal distribution from -4 to 4. Finally, factor analysis was performed with the PC-QUANL program. @*Results@#Three types of recovered alcoholics were identified. Firstly, the ‘positive-centered recovery type’ emphasized on self-affirmation and self-confidence and acted on the belief of the possibility of recovery from alcoholism. The second type was the ‘temperance-centered recovery type’, which focused on complete control over daily life to stay sober. Finally, the ‘acceptance-centered type’ was likely to admit the weakness of human beings and pursue spirituality. @*Conclusion@#This study found three types of recovered alcoholics, focusing on the factors that had an impact on recovery and analyzed their characteristics. These findings provided useful information to understand recovered alcoholics, and they can be used to develop a tailored intervention to prevent a relapse of alcoholism.

Effectiveness of Regdanvimab at Preventing the Need for Oxygen Therapy in Patients with Mild-to-Moderate COVID-19: A Retrospective Cohort Study / 감염과화학요법

Background@#Monoclonal antibodies are a treatment option for patients with mild-tomoderate coronavirus disease (COVID-19). We investigated the effectiveness of regdanvimab, an anti-severe acute respiratory syndrome coronavirus-2 monoclonal antibody approved in Korea, in the treatment of patients with mild-to-moderate COVID-19. @*Materials and Methods@#Medical records of patients who were admitted to a COVID-19 designated hospital during the study period of February 1 to June 31 and met the indications for administration of regdanvimab were reviewed to assess baseline characteristics and clinical outcomes such as supplemental oxygen requirements, mortality, and length of hospitalization. Multivariable logistic regression analysis was conducted to identify factors associated with requiring supplemental oxygen. Subgroup analysis was performed according to the presence of pneumonia confirmed on a chest X-ray. @*Results@#Three hundred ninety-eight COVID-19 patients were included in the study, and 65 (16.3%) of them were administered regdanvimab. The proportion of patients requiring supplemental oxygen was significantly lower in the regdanvimab group than in the control group (6.2% vs. 20.1%, P = 0.007). There was no significant difference in mortality (0% vs.1.5%, P >0.999) and the length of hospitalization (median: 10 days vs. 10 days, P = 0.267) between two groups. The multivariable analysis demonstrated that administration of regdanvimab was independently associated with lower oxygen supplement [odds ratio (OR): 0.20, 95% confidence interval (CI): 0.06 - 0.55, P = 0.004] after adjustment of potential risk factors related to supplemental oxygen including age, sex, chest X-ray abnormality, and underlying chronic kidney disease. Among the patients with pneumonia radiologically, administration of regdanvimab was also associated with lower risk of oxygen supplement (OR: 0.13, 95% CI: 0.02 - 0.46, P = 0.007). @*Conclusion@#Regdanvimab use was related to lower need for supplemental oxygen in patients with mild-to-moderate COVID-19 for the indications for administration of regdanvimab.

Early Oxygen Requirement in Patients with Mild-to-Moderate COVID-19 Who Received Regdanvimab after DeltaVariant Outbreak / 감염과화학요법

Background@#Regdanvimab is a monoclonal antibody targeted against the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and a treatment option for patients with mild-to moderate coronavirus disease 2019 (COVID-19). However, there has been limited information on the clinical effectiveness of regdanvimab in the Delta variant of SARS-CoV-2. Therefore, we aimed to investigate the effectiveness of regdanvimab after the Delta variant was dominant using chronological analysis of regdanvimab use in a real-world setting. @*Materials and Methods@#The electrical medical records of patients infected with mildto-moderate COVID-19 who received regdanvimab within 7 days of symptom onset were reviewed before (February – June 2021) and after (August – November 2021) the Delta variant became predominant in Korea. Clinical outcomes were assessed by the need for oxygen supplementation, time from symptom onset to oxygen requirement, in-hospital mortality, and length of hospitalization. To match the difference between the basic characteristics of the two groups, the clinical outcomes were compared again after 1 : 1 propensity score matching. @*Results@#Patients treated with regdanvimab in the Delta-predominant group were more likely to require oxygen supplementation (17.5% vs. 6.0%, P = 0.019) and had shorter times from symptom onset to supplemental oxygen use (mean ± standard deviation [SD]: 5.8 ± 2.8 vs. 10.0 ± 3.7, P = 0.007) than those in the control group. After propensity score matching, the percentage of patient requiring oxygen supplementation was higher (15.2% vs. 6.1%, P = 0.156), while the time from symptom onset to oxygen supplementation was significantly shorter in the Delta-predominant group (mean ± SD: 4.9 ± 2.1 vs. 10.0 ± 3.7, P = 0.007) than that in the control group. @*Conclusion@#Considering that high proportion of vaccinated patients in the Deltapredominant group, this finding suggests the uncertainty whether the effect of regdanvimab is maintained even during the Delta-predominant period. It is hence necessary to continuously monitor the effectiveness of regdanvimab as new SARS-CoV-2 variants emerge.

A Review on Sleep Disorders Similar to REM Sleep Behavior Disorder / 수면정신생리

REM sleep behavior disorder is parasomnia characterized by unpleasant dreams and dream-enactment behaviors associated with excessive electromyography activity in REM sleep. This may appear idiopathic or secondary to other neurological or medical conditions. REM sleep behavior disorder, which appears to be idiopathic, most often implies the possibility of later neurodegenerative diseases due to synucleinopathy, so accurate diagnosis is important in predicting prognosis. For the diagnosis of REM sleep behavioral disorder, REM sleep without atonia, which appears in the polysomnography, is essential. Obstructive sleep apnea, trauma-related sleep disorders, and vigorous periodic leg movements during sleep are known as diseases that show dream enactment behavior in elderly patients. Considering that it may be accompanied by other sleep disorders that can mimic REM sleep behavioral disorders, it is important to differentiate sleep

Mental illness in patients with end-stage kidney disease in South Korea: a nationwide cohort study

The limited literature on mental illness in end-stage kidney disease (ESKD) patients suggests that this disease is common and burdensome but underrecognized in clinical practice. This study aimed to analyze the prevalence of mental illness in ESKD patients. Methods: We assessed the prevalence and patterns of mental illnesses in a nationwide cohort of patients diagnosed with ESKD between January 1, 2008, and December 31, 2017. The risk of mental illness was evaluated using a multivariable Cox proportional hazards model. Results: A total of 70,079 patients met all study inclusion criteria. A total of 28.3% of patients had mental illness, and the specific distribution was as follows: depression, 16.8%; anxiety, 20.0%; somatoform/conversion disorder, 0.9%; stress reaction/adjustment disorder, 2.5%; and substance abuse disorder, 0.6%. The frequency of mental illness was highest in patients on hemodialysis (HD), followed by patients on peritoneal dialysis (PD) and kidney transplant (KT) patients. The peak rate of mental illness in HD and PD patients was reached 1 to 2 years after renal replacement therapy initiation, but the peak rate of most mental illnesses in KT patients occurred before surgery. The prevalence of depression was 2.19 times higher in HD patients and 1.97 times higher in PD patients than in KT patients. Conclusion: ESKD patients are at high risk of mental illness, and the prevalence of mental illness is highest in HD patients. Since the onset of mental illness occurs around the initiation of renal replacement therapy, clinicians need to pay attention to mental illness when treating ESKD patients.

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

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.

Cognitive Processing Therapy as a First-line Treatment for Post-Traumatic Stress Disorder / 정신신체의학

Posttraumatic stress disorder (PTSD) is well known to have a limited response to drug treatment. Many recently published clinical care guidelines recommend trauma-focused psychotherapies such as cognitive processing therapy (CPT) and prolonged exposure therapy (PE) as first-line treatment and medication such as sero-tonin reuptake inhibitors and venlafaxine as second-line treatment. Current review introduces the session composition and contents of CPT and presents various CPT studies that show therapeutic effect for civilian and veterans/military with PTSD. In order for clinicians to help effectively patients with PTSD, it is necessary to learn and actively use evidence-based trauma-focused psychotherapies including CPT and PE.

Clinical Characteristics of Patients With Psoriatic Spondylitis Versus Those With Ankylosing Spondylitis: Features at Baseline Before Biologic Therapy

Background@#Clinical characteristics and manifestations of psoriatic arthritis (PsA) have been extensively studied in western countries, yet data of Korean patients with PsA are very limited. We aimed to investigate the clinical traits of patients with PsA and dissect the characteristics of those with axial involvement. @*Methods@#In this observational study, we analyzed clinical data of 109 patients with PsA who were enrolled in the Korean College of Rheumatology Biologics and Targeted Therapy registry between December 2012 and March 2022 at the time point of initiating or switching to a biologic agent. Data from 2,221 patients with ankylosing spondylitis (AS) registered during the same period were also analyzed. We divided patients with PsA into patients with or without axial involvement and then added AS patients with psoriasis (total three subgroups) for comparative analyses. @*Results@#Asymmetric oligoarthritis was the most common clinical manifestation in patients with PsA, followed by symmetric polyarthritis and spondylitis. Our analysis indicated that methotrexate and sulfasalazine were the two most prescribed disease-modifying antirheumatic drugs for patients with PsA before starting biologic therapy. The patients with psoriatic spondylitis had more peripheral joint involvement (P = 0.016), less prior uveitis (P < 0.001), and lower human leukocyte antigen B27 (HLA-B27) positivity (P < 0.001) than the AS patients with psoriasis. Furthermore, syndesmophytes and radiographic sacroiliitis were prevalent among patients with PsA and AS patients with psoriasis who had the HLA-B27 gene. @*Conclusion@#Our study shows that the degree of peripheral arthritis is less severe in Korean patients with PsA who require biologics and reestablishes that psoriatic spondylitis is a common and important clinical pattern in Korean patients with PsA.

Clinical Characteristics of COVID-19: Use of Steroids in Mostly Unvaccinated COVID-19 Patients Before the Omicron Variant

Background@#Glucocorticoids are one of the current standard agents for moderate to severe coronavirus disease 2019 (COVID-19) treatment based on the RECOVERY trial. Data on the real clinical application of steroids for COVID-19 are scarce and will help guide the optimal use of steroids. We described the current prescription pattern of steroids for COVID-19 and investigated the factors related to specific practices. @*Methods@#All adults aged ≥ 19 years who were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction and admitted to one of 3 study hospitals from 8 December 2020 to 30 June 2021 were enrolled. Demographic and clinical data, including medications and oxygen therapy, were retrospectively collected from electronic medical records. The severity of comorbidities and COVID-19 were measured. The subjects were divided into steroid and nonsteroid groups, and the steroid group was then subdivided into standard and higher/longer groups. @*Results@#Among a total of 805 patients, 217 (27.0%) were treated with steroids. The steroid group showed a higher rate of oxygen therapy (81.1% vs. 2.7%), more concomitant use of remdesivir (77.4% vs. 1.4%) or antibiotics (79.3% vs. 4.3%), and a higher proportion of high risk according to National Early Warning Score-2 score (30.0% vs. 0.9%) or severe risk according to National Institute of Allergy and Infectious Disease Ordinal Scale score (81.1% vs. 2.7%) than the nonsteroid group. The mortality of the steroid group was 4.6%. In the steroid group, 82.5% received a standard or lower dose of steroids within ten days, and 17.5% (38/217) received a higher or longer dose of steroids. Multivariate analysis showed that initial lymphopenia (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.89–0.99) and high level of lactate dehydrogenase (LDH) (aOR, 1.00; 95% CI, 1.00–1.01) were independent risk factors for higher doses or longer steroid use. @*Conclusion@#The dose and duration of steroids were in line with current guidelines in 82.5% of COVID-19 patients, but the outliers may need tailored therapy according to surrogate markers, such as initial lymphopenia or high level of LDH.

Cancer risk in Korean patients with gout

Background/Aims@#Using a nationwide cohort, we investigated the cancer risk in Korean patients with gout. @*Methods@#Data were obtained from the Korean National Health Insurance Service Database. Patients with gout were defined as those aged ≥ 20 years who were diagnosed with gout and received anti-gout medication (allopurinol, colchicine, and benzbromarone) between 2008 and 2010. Patients with nail disorders were randomly assigned to a control group (1:1 ratio) after frequency matching for age and sex. Cancer incidence was then investigated between 2012 and 2018. Cox proportional hazard regression analysis was used to investigate the association between gout and cancer after adjusting for concomitant diseases. @*Results@#This study included 179,930 patients with gout and an equal number of matched controls. The incidence of overall cancer was higher in patients with gout than in controls (incidence rate ratio, 1.08). Cox proportional hazards regression analysis showed that gout was associated with a hazard ratio of 1.053 (95% confidence interval ,1.031 to 1.077) after adjusting for concomitant diseases. @*Conclusions@#Gout was associated with a significantly high risk of cancer, especially esophageal, stomach, colon, liver, pancreatic, lung, ovarian, renal, and bladder cancers.

Treatment for Immune Thrombocytopenia in Coronavirus Disease 2019 (COVID-19) Infection after COVID-19 Vaccination: A Case Report / 감염과화학요법

Thrombocytopenia is one of the rare signs of both the coronavirus disease 2019 (COVID-19) and COVID-19 vaccination. An 85-year-old man was diagnosed with immune thrombocytopenia and COVID-19, 7 days after COVID-19 vaccination. The patient was successfully treated with a short course of intravenous immunoglobulin and oral corticosteroids.

A Review on the Cause of Fever During Clozapine Treatment / 정신신체의학

Clozapine is accepted as the “gold standard” antipsychotics for treatment-resistant schizophrenia. Clozapine rarely causes extrapyramidal syndrome and tardive dyskinesia, which are common with other antipsychotics, and only a transient elevation of hyperprolactinemia has been reported. Despite such clinical usefulness, there are limitations to the use of clozapine due to adverse drug reactions (ADR). Fever is a common in adverse drug reactions associated with clozapine. At initiation of clozapine most fatal ADR such as agranulocytosis and neuroleptic malignant syndrome associated with fever, in which case clozapine should be discontinued immediately. However, as benign causes of fever are much more frequent than life-threatening ADR, clozapine should not be discontinued unconditionally in the event of fever during clozapine initiation. In addition, fever may occur at any time during the maintenance of clozapine treatment. In particular, since the risk of pneumonia does not decrease over time, and clozapine has a higher risk of pneumonia than other antipsychotic drugs, it is recommended to adjust clozapine dosage through therapeutic drug monitoring.

Breakthrough COVID-19 Infection During the Delta Variant Dominant Period: Individualized Care Based on Vaccination Status Is Needed

Background@#The clinical features of coronavirus disease 2019 (COVID-19) patients in the COVID-19 vaccination era need to be clarified because breakthrough infection after vaccination is not uncommon. @*Methods@#We retrospectively analyzed hospitalized COVID-19 patients during a delta variantdominant period 6 months after the national COVID-19 vaccination rollout. The clinical characteristics and risk factors for severe progression were assessed and subclassified according to vaccination status. @*Results@#A total of 438 COVID-19 patients were included; the numbers of patients in the unvaccinated, partially vaccinated and fully vaccinated groups were 188 (42.9%), 117 (26.7%) and 133 (30.4%), respectively. The vaccinated group was older, less symptomatic and had a higher Charlson comorbidity index at presentation. The proportions of patients who experienced severe progression in the unvaccinated and fully vaccinated groups were 20.3% (31/153) and 10.8% (13/120), respectively. Older age, diabetes mellitus, solid cancer, elevated levels of lactate dehydrogenase and chest X-ray abnormalities were associated with severe progression, and the vaccination at least once was the only protective factor for severe progression. Chest X-ray abnormalities at presentation were the only predictor for severe progression among fully vaccinated patients. @*Conclusion@#In the hospitalized setting, vaccinated and unvaccinated COVID-19 patients showed different clinical features and risk of oxygen demand despite a relatively high proportion of patients in the two groups. Vaccination needs to be assessed as an initial checkpoint, and chest X-ray may be helpful for predicting severe progression in vaccinated patients.