Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department

Objective@#The National Early Warning Score (NEWS), based on the patients’ vital signs, detects clinical deterioration in critically ill patients and is used to reduce the incidence of in-hospital cardiac arrest. However, although mortality prediction based on vital signs may be difficult in older patients, the effectiveness of the NEWS has not yet been evaluated in this population. This study aimed to test the hypothesis that an elevated NEWS at admission increases the mortality risk in older patients admitted to the emergency department (ED). @*Methods@#We conducted a single-center retrospective study, including patients admitted to the ED between November 2016 and February 2017. We included patients aged >65 years who were admitted to the ED for any medical problem. The NEWS was calculated at the time of ED admission. The primary outcome was in-hospital mortality. @*Results@#In total, 3,169 patients were included in this study. Median age was 75 years (interquartile range [IQR], 70 to 80 years), and 1,557 (49.1%) patients were male. The in-hospital mortality rate was 5.1% (161 patients). Median NEWS was higher in non-survivors than in survivors (5 [IQR, 3–8] vs. 1 [IQR, 0–3], P65 years.

Acquired Reactive Perforating Collagenosis after Coronary Artery Bypass Graft Surgery / 대한피부과학회지

Perforating disorders are a group of skin disorders that present the characteristic clinical finding of transepidermal elimination. Acquired reactive perforating collagenosis is an uncommon condition characterized by umbilicated hyperkeratotic papules, and in almost all cases, it coexists with other disease conditions, such as diabetes mellitus, renal failure, and malignancies. The pathologic mechanism of this disease remains largely unknown. Here, we describe the case of a 42-year-old man who developed acquired reactive perforating collagenosis after coronary artery bypass graft surgery.

Mycological and Molecular Analysis of Soil Keratinophilic Fungi Isolated in Summer Beaches of the Korean South Coast / 대한피부과학회지

BACKGROUND: Some species of soil keratinophilic fungi (KPF) are known to be pathogens that may lead to cutaneous infection. People exposed to these species through direct contact with soil on beaches can contract KPF infection. However, there is little literature regarding pathogenic KPF isolated from beaches during summer time. OBJECTIVE: This study aims to evaluate the distribution of soil KPF isolated from beaches in Korea during summer. METHODS: One hundred eighty soil samples from six beaches in the southern coastline of Korea under three different climatic conditions were collected. The KPF species were isolated using the hair-baiting technique. Then, molecular identification was performed by sequencing the ribosomal RNA (rRNA) internal transcribed spacer (ITS) region to investigate the exact species of the isolated fungi. RESULTS: Among the one hundred eighty soil samples, twenty-nine strains (16.1%) of KPF were recovered. The isolation rate of KPF among the beaches varied from 0 to 34.5%. KPF was most frequently isolated in shaded dry areas (30%), followed by sunny dry areas (18.3%), and sunny wet areas (0%). Molecular identification of the fungi using rRNA ITS analysis helped in their classification. Microsporum gypseum/Arthroderma incurvatum (69.0%), Microsporum gypseum/Arthroderma gypseum (3.4%), Trichophyton ajelloi/Arthroderma uncinatum (13.8%), Microsporum cookei/Arthroderma cajetani (10.3%), and Chrysosporium indicum/Aphanoascus terreus (3.4%) were identified. Single nucleotide polymorphism (SNP) was observed at position 180 of the rRNA ITS2 in the 20 strains of Microsporum gypseum/Arthroderma incurvatum, and the species was divided into Types 1 (14 strains) and 2 (6 strains) depending on the base present at the SNP position. The geographic distribution of these two types differed. CONCLUSION: Our results show that the beach is a possible source of keratinophilic fungal infection in humans. People should be aware of pathogenic fungi on the soil of beaches during summer and take measures to prevent possible superficial fungal infections.

The Clinical and Mycological Study of Tinea Faciei in Daegu / 대한의진균학회지

BACKGROUND: Tinea faciei is a superficial dermatophyte infection on non-bearded skin of face. It is often confused with other dermatoses. Tinea faciei accounts for 3~4% of cases of tinea corporis. There have been only a few reports on the clinical and mycological features of tinea faciei. OBJECTIVE: This study aims to evaluate the demographic, clinical, and mycological features of tinea faciei in Daegu, Korea. METHODS: The medical records of 56 cases with tinea faciei from the Daegu catholic university medical center and Catholic skin clinic from January 2013 to December 2014 were evaluated retrospectively. RESULTS: The incidence was highest at 6th decade age group. The most frequent occupation of patients was agro-livestock area. Among 56 cases, the lesions were round patches in 40 cases (71.5%), followed by ring-shaped patches in 8 cases (25.0%) and plaques in 2 cases (3.5%). The most commonly isolated organism was Trichophyton rubrum (79.2%). CONCLUSION: Tinea faciei could easily be misdiagnosed clinically due to its abnormal presentation. When facing erythematous patches on face, physician should be aware of tinea faciei and undergo careful history taking with mycological study.

A Case of Phaeohyphomycosis from Exophiala Species Mimicking Facial Cutaneous Tumor / 대한의진균학회지

Phaeohyphomycosis is an infection of humans and other animals caused by a number of phaeoid fungi. It is characterized by the development of dark-colored hyphae and other types of fungal elements in invaded tissues. Phaeohyphomycosis caused by Exophiala species is an unusual infection, but it has been reported with increasing frequency as laboratory methods for diagnosis have improved. A 68-year-old woman presented with yellowish round crusted plaque which is similar to actinic keratosis or keratoacanthoma on her right cheek. Histopathologic examination showed mononuclear cell infiltrate and dark-brown hyphae. The nucleotide sequence of internal transcribed spacer-2 was identical to that of Exophiala species. We report a case of phaeohyphomycosis mimicking skin cancer.

A Case of Malignant Melanoma with Zosteriform Skin Metastasis Arising in a Medium-sized Congenital Melanocytic Nevus / 대한피부과학회지

Zosteriform metastasis from malignant melanoma is a rare type of skin metastasis that shows cutaneous lesions including patches, plaques, and nodules along with dermatomes, and thus needs to be distinguished from herpes zoster skin infection. Although some authors have explained the mechanism of zosteriform metastasis, its pathogenesis remains unknown. Herein, we describe an 85-year-old woman with zosteriform metastasis of malignant melanoma arising in a medium-sized congenital melanocytic nevus.

The Clinical and Mycological Study of Tinea Manus and Concomitant Dermatophytosis / 대한의진균학회지

BACKGROUND: Tinea manus is a common superficial dermatophyte infection that is usually coexistent with tinea pedis. Trichophytom rubrum is the most commonly isolated agent in tinea manus. Despite this condition, there have been only a few reports on the clinical and mycological features of tinea manus. OBJECTIVE: This study aims to evaluate the variables related with tinea manus and to determine the correlation with other superficial dermatophyte infection. METHODS: Clinical and mycological features of 54 cases with tinea manus from the department of dermatology in Daegu Catholic University Hospital and the Catholic Skin Clinic from January 2011 to December 2012 were evaluated retrospectively. RESULTS: The male to female ratio was 2:1. The age distribution ranged from 14 to 81 years old. The affected site was the palm in 31 cases (57.4%), the dorsum in 13 cases (24.1%), and both palm and sole in 10 cases (18.5%). Tinea manus was accompanied with other superficial dermatophyte infections, such as tinea pedis, tinea unguium, and tinea corporis in 42 cases (77.8%) and not in 12 cases (22.2%). Fungal culture result was positive in 8 cases of tinea manus only group and in 26 cases of tinea manus with other dermatophyte infection group. The most commonly isolated agent was Trichophyton rubrum in both groups. CONCLUSION: The patients with only tinea manus tend to predilect the dorsum of hand and were relatively more caused by other fungus than Trichophyton ruburum when compared with the patients with other dermatophytosis.