Clinical characteristics and risk factors for mortality of patients hospitalized with COVID-19 in Korea

Objective@#The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2, is a global concern. This study aimed to examine the clinical characteristics, demographics and outcomes of COVID-19 patients in the emergency department (ED) and explore clinical predictors of in-hospital mortality. @*Methods@#This single-center, retrospective, observational study used 1,003 adult patients with laboratory-confirmed COVID-19 who went to the ED and were admitted to the hospital between February 28 and September 30, 2020. @*Results@#The median age of the included patients was 55 (37-68) years, and 533 were women (53.1%). Severe COVID-19 was noted in 173 patients (17.2%); seven patients (0.7%) received mechanical ventilation. The mortality rate was 2.1%. Multivariable Cox regression analysis found the risk factors associated with in-hospital death of patients (age >70 years [hazard ratio (HR), 27.411; P70 years, hypoalbuminemia, CURB-65≥3 and thrombocytopenia on admission were independent risk factors for mortality in patients hospitalized with COVID-19. Early detection of these predictors and application of CURB-65 score in the ED may provide guidance for appropriate risk stratification at triage and disposition of patients at increased risk of poor prognosis.

Unmet Primary Physicians' Needs for Allergic Rhinitis Care in Korea

Allergic rhinitis (AR) is one of the most common chronic allergic respiratory diseases worldwide. Various practical guidelines for AR have been developed and updated to improve the care of AR patients; however, up to 40% patients remain symptomatic. The unmet need for AR care is one of the greatest public health problems in the world. The gaps between guideline and real-world practice, and differences according to the region, culture, and medical environments may be the causes of unmet needs for AR care. Because there is no evidence-based AR practical guideline reflecting the Korean particularity, various needs are increasing. The purpose of the study was to evaluate whether existing guidelines are sufficient for AR patient management in real practice and whether development of regional guidelines to reflect regional differences is needed in Korea. A total of 99 primary physicians comprising internists, pediatricians, and otolaryngologists (n=33 for each) were surveyed by a questionnaire relating to unmet needs for AR care between June 2 and June 16 of 2014. Among 39 question items, participants strongly agreed on 15 items that existing guidelines were highly insufficient and needed new guidelines. However, there was some disagreement according to specialties for another 24 items. In conclusion, the survey results demonstrated that many physicians did not agree with the current AR guideline, and a new guideline reflecting Korean particularity was needed.

Crinical diagnostic guidelines for allergic rhinitis: medical treatment

The social and economic burden of allergic rhinitis (AR) is increasing, with significant effects on the quality of life of patients suffering from AR. Therefore, physicians require evidence-based guidelines regarding the diagnosis, differential diagnosis and proper management management of patients with AR. The Korean Academy of Asthma, Allergy and Clinical Immunology developed new clinical guidelines for the appropriate management of AR, especially in Korean patients. For the core questions (i.e. questions that most practitioners were curious about), several experts in the field of allergology, pediatrics, and otorhinolaryngology developed a set of practical guidelines based on a systematic review of the literature. Furthermore, we determined the level of evidence associated with the recommendations for each answer. In this article, we suggest 15 answers for core questions about the medical treatment of AR.

Clinical diagnostic guidelines for allergic rhinitis: diagnosis

As the prevalence and socioeconomic burden of allergic rhinitis is steadily increasing every year, it is essential that clinical practitioners diagnose and manage allergic rhinitis in an evidence-based manner. Therefore, the Korean Academy of Asthma, Allergy and Clinical Immunology developed new clinical guidelines for Korean patients and practitioners. We first performed a questionnaire survey to address the core questions, about which clinical practitioners are the most curious. A large group of physicians (allergists), pediatricians, and otorhinolaryngologists developed answers for those questions by performing a systematic literature review and determining the appropriate levels of recommendation. In this article, we propose 11 answers for core questions regarding the diagnosis and differential diagnosis of allergic rhinitis.

Clinical diagnostic guidelines for allergic rhinitis: diagnosis

As the prevalence and socioeconomic burden of allergic rhinitis is steadily increasing every year, it is essential that clinical practitioners diagnose and manage allergic rhinitis in an evidence-based manner. Therefore, the Korean Academy of Asthma, Allergy and Clinical Immunology developed new clinical guidelines for Korean patients and practitioners. We first performed a questionnaire survey to address the core questions, about which clinical practitioners are the most curious. A large group of physicians (allergists), pediatricians, and otorhinolaryngologists developed answers for those questions by performing a systematic literature review and determining the appropriate levels of recommendation. In this article, we propose 11 answers for core questions regarding the diagnosis and differential diagnosis of allergic rhinitis.

Clinical diagnostic guidelines of allergic rhinitis: comprehensive treatment and consideration of special circumstances

In order to prevent sensitization to a new allergen and the development of asthma, practitioners may consider allergen-specific immunotherapy in patients with allergic rhinitis. Additionally, in patients with severe allergic rhinitis refractory to medication, practitioners can also consider surgical management for improving the patients' nasal symptoms. However, there are still no practical guidelines regarding the indications for immunotherapy, the appropriate selection of the allergen, and the optimal duration of therapy. Moreover, no clear indications exist for surgical treatment. Pregnant or lactating women frequently complain of symptoms of rhinitis. However, due to the fear of potential complications to their babies, they avoid medical treatment despite significant discomfort. Therefore, we present 14 answers to core questions about immunotherapy, surgical treatment, and considerations for special circumstances, such as pregnancy and lactation.

PMI (PostMortem Interval) Estimation Through Forensic Entomology Method: A Case study of Whasung Woman University Student Dead Affair / 대한법의학회지

It is difficult to estimate PMI of whom died long times ago, because corpse goes by many decomposition stages. So it makes investigation more difficult. Nowadays many studies about PMI estimation have been performed. In other countries, forensic entomology studies which is possible to estimate not characteristic of death site but also exact death time are actively advanced. So forensic entomology has been more important related not PMI estimation but also many lawsuits in other countries. In Korea, the necessity of Forensic entomology has increased after occuring of the case 'Gaeguri Sonyeon(missing boys who went to catch a flog)'. In this case, regional characteristic is known by insects found on the corpse or clothes. We suggest possibility of applying forensic entomology, consideration, some limitations and the direction of the future study through the analysis, comparison with true facts, and PMI estimation using collected fly larvae in "Hwaseong Case".

The Statistical Analysis on Legal Autopsy in 2002: The Headquarters of National Institute of Scientific Investigation / 대한법의학회지

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Institute Scientific Investigation(NISI), requested by every kind of law enforcement agencies during the year of 2002. NISI is located in Seoul, Korea and has three branches throughout the country. The Seoul NISI covers all legal autopsies in Seoul City, Incheon City and Kyunggi Province and some cases referred from other regions. This report aims to analyse various aspects of 3,045 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 2,199 cases (72.2%) and that of female 846 (27.8%). Male was over twice more than female. The forties were 766 cases (25.2%), the thirties 692 (22.7%), and these two decades occupied 47.9%. 2. Unnatural deaths were 1,810 cases (59.5%), natural 1082 (35.5%), and the unknown 153 (5.0%). Among 1,810 unnatural deaths, suicide was 416 (23.0%), homicide 394 (21.8%), accident 592 (32.7%), and the unclear 408 (22.5%). Homicide occupied 33.3% of trauma, 49.3% of blunt force injury excluding traffic and fall-down injury, and 88.2% of sharp force injury. The homicide rate in asphyxia was 31.7%,but it went up to 59.2% excluding hanging. It showed only 0.4% percent of homicide in poisoning. 3. Traumatic deaths were 867 cases, occupying 47,9% of 1,810 unnatural deaths, followed by poisoning deaths (269 cases). Blunt trauma was 284 cases (32.8%) and the leading cause of death in traumatic death. Poisoning was 269 cases, among which the agrochemicals were dominant (64cases). Thermal injuries were 193 cases, electrocution 16 cases, and starvation/neglect 9 cases. and 17 cases were directly due to medical procedures.4. Among 1,082 natural deaths, heart diseases were 450 cases (41.6%), and vascular diseases 186 (17.2%), and these two categories were added up to 636 (58.8%). 5. Child deaths under the age of 10 were 179 cases. Homicide was 35 cases (37.2%) out of 94 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 48 cases (26.8%)

The Statistical Analysis on Legal Autopsy in 2001: The Headquarters of National Institute of Scientific Investigation / 대한법의학회지

This is a statistical analysis based on the data of legal autopsies performed at the Headquarters of the National Institute Scientific Investigation(NISI), requested by every kind of law enforcement agencies during the year of 2001. NISI is located in Seoul, Korea and has three branches throughout the country. The Seoul NISI covers all legal autopsies in Seoul City, Incheon City, and Kyunggi Province and some cases referred from other regions. This report aims to analyse various aspects of 2,807 unusual deaths in Korea, chiefly Seoul and its surrounding area. Followings are the summary of the results. 1. The number of male was 2,043 cases (72.8%) and that of female 764 (27.2%). Male was over twice more than female. The forties were 723 cases (25.8%), the thirties 641 (22.8%), and these two decades occupied 48.6%. 2. Unnatural deaths were 1,690 cases (60.2%), natural 1020 (36.3%), and the unknown 97 (3.5%). Among 1,690 unnatural deaths, suicide was 415 (24.6%), homicide 418 (24.7%), accident 505 (29.9%), and the unclear 352 (20.8%). Homicide occupied 37.1% of trauma, 44.1% of blunt force injury excluding traffic and fall-down injury, and 83.5% of sharp force injury. The homicide rate in asphyxia was 32.5%, but it went up to 62.7% excluding hanging. It showed only 1.0% of homicide in poisoning. 3. Traumatic deaths were 825 cases, occupying 48,8% of 1,690 unnatural deaths, followed by asphyxial death (249 cases). Blunt trauma was 295 cases (35.8%) and the leading cause of death in traumatic death. Poisoning was 213 cases, among which the agrochemicals were dominant (68 cases). Thermal injuries were 193 cases, electrocution 31 cases, and starvation/neglect 10 cases. 36 cases were direct- 4. Among 1,020 natural deaths, heart diseases were 398 cases (39.0%), and vascular diseases 145 (14.2%), and these two categories were added up to 543 (53.2%). 5. Child deaths under the age of 10 were 194 cases. Homicide was 43 cases (48.9%) out of 88 unnatural deaths. Neonates including still births were the leading period of age in unnatural death, counting 64 cases(33.0%).

Three Dimensional Fourier Transformation Constructive Interferencein Steady State Magnetic Resonance Imaging (3DFT-CISS MRI) ofthe Inner Ear in Patients with Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Three dimensional fourier transformation constructive interference in steady state magnetic resonance imaging (3DFT-CISS MRI) allows fast and precise imaging of the inner ear structures and provides excellent cerebrospinal fluid-nerve contrast within the internal auditory canal and cerebellopontine angle. This study was performed to delineate the inner ear structure in patients with sensorineural hearing loss (SNHL) using 3DFT-CISS MRI and to evaluate the correlation between structural abnormality and clinical symptoms of the affected ear. MATERIALS AND METHODS: Fourteen patients with sensorineural hearing loss were studied using 3DFT CISS axial and coronal MRI scans of both ears. We observed the visualization of the inner ear structures and measured them individually. The radiological measurements were analyzed to compare the findings in non-affected ears with those in affected ears of SNHL patients. In addition, the onset of symptoms was also evaluated for any relationship to their MR findings. RESULTS: The inner ear structures including cochlea, semicircular canal, vestibule, and cranial nerve VII, VIII were precisely visualized. There was statistically no difference in the measurements of the inner ear structures between affected and non-affected ears in patients with sudden SNHL. However, statistically significant differences in the width and height of the vestibule were observed in the affected ears between sudden SNHL and idiopathic chronic SNHL. CONCLUSION: 3DFT-CISS MRI allows detailed study of the normal and pathologic inner ears. Therefore, this MR technique can be a useful method as a routine protocol in the study of the inner ear diseases.

Lateral Pharyngotomy as an Approach to the Oropharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The wide surgical resection combined with postoperative radiotherapy is commonly accepted as the most effective approach to the advanced stage of oropharyngeal cancers. As the lateral pharyngotomy provides a sufficient space to obtain enough surgical margin for surgical treatment of oropharyngeal cancers without disturbing the mandible, it can not only reduce the post-operative morbidity, but also obtain good functional results. To evaluate the efficiency and indication of lateral pharyngotomy as an approach to oropharyngeal cancers. MATERIALS AND METHODS: The medical records of 10 patients who had been treated by lateral pharyngotomy approach between 1994 and 1998 were reviewed retrospectively. RESULTS: The sites of primary tumor were the tonsil in 6 patients, the tongue involving the base and the tonsil fossa in 2 patients and the base of the tongue in 2 patients. Seven cases were T2 stage cancers and 3 cases were T3. No recurrences have risen on primary sites to date. Postoperative radiotherapy was performed within 29 to 43 days. Oral diet was possible within 16 to 29 days. Conclusions: As lateral pharyngotomy can avoid disturbing the mandible, thereby facilitating early postoperative radiotherapy, it is an excellent approach to the T2 or T3 oropharyngeal cancers with low postoperative morbidity and good functional results, especially when the open size of the mouth is proper.

Detection and Subtyping of Humam Papillomavirus in Laryngeal Cancers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mounting evidence suggests that human papillomavirus (HPV) might play an etiologic role in head and neck cancers. Both epidemiologic and molecular data support that certain types of HPV, such as HPV-16,-18 are associated with specific clinical and pathological characteristics and these are classified into high risk group. The aims of this study were to analyze the relationship between the presence of HPV in tissues from patients with laryngeal cancer and clinicopathologic characteristics. MATERIALS AND METHODS: HPV was detected in 39 laryngeal cancer specimens and 12 cervical lymph node tissue by polymerase chain reaction (PCR). To identify the types of HPV, positive results specimens were examined by PCR with HPV-16,-18 E6 type specific primer. RESULTS: HPV was detected in 9 cases (23.1%) among the 39 laryngeal cancers. Detection rate was higher in the tumors that infiltrate less than 1cm to the parenchyme (p=0.032). HPV-16 was detected in 5 cases (12.8%), HPV-18 in 1 case (2.6%). In cervical lymph node, HPV was found not only in histologically positive nodes (22.2%), but also in histologically negative nodes (33.3%). CONCLUSION: The results of this study suggest that types of HPV have no relationship with clinicopathologic parameters and that HPV play a role not only in the early stage tumorigenesis but also in the cervical lymph node metastasis.