ABSTRACT
Background@#In 2017, Korea implemented nationwide latent tuberculosis infection (LTBI) project targeting healthcare workers (HCWs). We aimed to assess its performance using the cascade of care model. @*Methods@#We included 45,503 employees of medical institutions with positive interferongamma release assay result who participated between March 2017 and December 2018. We described percentages of LTBI participants completing each step in the cascade of care.Poisson regression model was conducted to assess individual characteristics and factors associated with not-visiting clinics for further care, not-initiating LTBI treatment, and notcompleting treatment. @*Results@#Proportions of visiting clinics and initiating and completing treatment in HCWs were 54.9%, 38.5%, and 32.0%, respectively. Despite of less likelihood of visiting clinics and initiating LTBI treatment, older age ≥ 65 years were more likely to complete treatment (adjusted relative risk [aRR], 0.80; 95% confidence interval [CI], 0.64–0.99), compared to young age < 35 years. Compared to nurses, doctors were less likely to visit clinic; however, were more likely to initiate treatment (aRR, 0.88; 95% CI, 0.81–0.96). Those who visited public health centers were associated with not-initiating treatment (aRR, 1.34; 95% CI, 1.29–1.40). When treated at private hospitals, 9-month isoniazid monotherapy was less likely to complete treatment, compared to 3-month isoniazid and rifampicin combination therapy (aRR, 1.33; 95% CI, 1.16–1.53). @*Conclusion@#Among employees of medical institutions with LTBI, only one third completed treatment. Age, occupation, treatment center, and initial regimen were significantly related to LTBI treatment performance indicators. Rifampicin-based short treatment regimens were effective under standard of care.
ABSTRACT
In 2017, the Korean government launched an unprecedentedly large-scaled latent tuberculosis infection (LTBI) screening project which covered more than a million individuals in congregate settings. A total of 1,047,689 participants of source population (n = 2,336,157) underwent LTBI testing from 2017 to 2018. The overall LTBI test uptake rate during this project was 44.8%. Workers in daycare centers (83.5%) and kindergartens (78.9%) showed high participation rate. A total of 1,012,206 individuals with valid results of interferongamma release assay (IGRA) were selected to constitute the IGRA cohort. Most of the enrolled participants in the IGRA cohort were in their working age. Approximately, threequarters of total enrolled population were female. Investigating the LTBI prevalence, stages of LTBI care cascade, natural history of LTBI, efficacy of LTBI treatment and cost-effectiveness of LTBI screening are feasible within this IGRA cohort.
ABSTRACT
In 2017, the Korean government launched an unprecedentedly large-scaled latent tuberculosis infection (LTBI) screening project which covered more than a million individuals in congregate settings. A total of 1,047,689 participants of source population (n = 2,336,157) underwent LTBI testing from 2017 to 2018. The overall LTBI test uptake rate during this project was 44.8%. Workers in daycare centers (83.5%) and kindergartens (78.9%) showed high participation rate. A total of 1,012,206 individuals with valid results of interferongamma release assay (IGRA) were selected to constitute the IGRA cohort. Most of the enrolled participants in the IGRA cohort were in their working age. Approximately, threequarters of total enrolled population were female. Investigating the LTBI prevalence, stages of LTBI care cascade, natural history of LTBI, efficacy of LTBI treatment and cost-effectiveness of LTBI screening are feasible within this IGRA cohort.
ABSTRACT
Small cell lung cancer (SCLC), which originated from neuroendocrine tissue, can develop into paraneoplastic endocrine syndromes, such as Cushing syndrome, because of an inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH). This paraneoplastic syndrome is known to be a poor prognostic factor in SCLC. The reason for poor survival may be because of a higher risk of infection associated with hypercortisolemia. Therefore, early detection and appropriate treatment for this syndrome is necessary. But the diagnosis is challenging and the source of ACTH production can be difficult to identify. We report a 69-year-old male patient who had severe hypokalemia, metabolic alkalosis, and hypertension as manifestations of an ACTH-secreting small cell carcinoma of the lung. He was treated with ketoconazole and spironolactone to control the ACTH dependent Cushing syndrome. He survived for 15 months after chemotherapy, which is unusual considering the poor outcome of the ectopic ATH syndrome associated with SCLC.
Subject(s)
Aged , Humans , Male , ACTH Syndrome, Ectopic , Adrenocorticotropic Hormone , Alkalosis , Carcinoma, Small Cell , Cushing Syndrome , Diagnosis , Drug Therapy , Hypertension , Hypokalemia , Ketoconazole , Lung , Paraneoplastic Endocrine Syndromes , Paraneoplastic Syndromes , Small Cell Lung Carcinoma , SpironolactoneABSTRACT
Broncholiths are defined as calcified materials that occur in a tracheobronchial tree or in a cavity communicating with that. Broncholith has variable clinical features. The therapeutic options to remove broncholiths are so variable that clinicians need to select the most safe and effective methods by mass size, mobility, and location. As yet, there is no consistent guideline removing a broncholith. We report 2 successful cases of removing a fixed broncholith by flexible bronchoscopy guided cryoadhesion. With repeated technique of thawing and freezing with ryoprobe, we could extract the fixed broncholith safely. This method is promising as a way to remove broncholith in the future.
Subject(s)
Bronchial Diseases , Bronchoscopy , Calculi , Cryotherapy , FreezingABSTRACT
Coronary artery bypass graft (CABG) intervention, particularly anastomosis site intervention, is challenging for interventional cardiologists. A paclitaxel-eluting balloon catheter (SeQuent Please) is a recently-introduced device capable of delivering paclitaxel homogeneously into the targeted vessel wall. We herein report our experience with two cases. In the first case, coronary angiography showed significant stenosis at the site of anastomosis between the saphenous vein graft and the left anterior descending artery (LAD). In the second case, coronary angiography showed significant stenosis at the site of anastomosis between the left internal mammary artery and the LAD. We performed percutaneous intervention of these CABG anastomoses using paclitaxel-eluting balloon catheters, and obtained favorable angiographic and clinical outcomes.
Subject(s)
Angioplasty, Balloon, Coronary , Arteries , Catheters , Constriction, Pathologic , Coronary Angiography , Coronary Artery Bypass , Coronary Vessels , Glycosaminoglycans , Mammary Arteries , Paclitaxel , Saphenous Vein , TransplantsABSTRACT
No abstract available.
Subject(s)
Female , Humans , Middle Aged , Biopsy, Fine-Needle , Choristoma/diagnosis , Thyroglossal Cyst/diagnosis , Thyroid Dysgenesis/diagnosis , Thyroid Nodule/diagnosisABSTRACT
Patients with the nephrotic syndrome are at risk of developing thromboembolic complications. Much evidence suggests that a hypercoagulable state exists in the setting of the nephrotic syndrome, but the exact mechanisms are poorly understood. The nephrotic syndrome associated with portal vein thrombosis is relatively uncommon. We experienced a case of minimal change nephrotic syndrome presented as portal vein thrombosis and acute renal failure. On renal biopsy, electron microscopic examination reveals diffuse foot process effacement. Treatment with corticosteroid and anticoagulation resulted in complete remission of proteinuria.
Subject(s)
Humans , Acute Kidney Injury , Biopsy , Electrons , Foot , Nephrosis, Lipoid , Nephrotic Syndrome , Portal Vein , Proteinuria , ThrombosisABSTRACT
Citrobacter species is a gram-negative bacilli that can cause opportunistic infections in immunocompromised hosts. Citrobacter braakii refers to the genomospecies 6 of the Citrobacter freundii complex. There are no detailed studies on infections caused by this newly identified specific genetic species in Korea. We herein report a case of a patient with hepatocellular carcinoma who, after undergoing transcatheter arterial chemoembolization, developed biloma which later progressed to C.braakii sepsis and did not respond to treatment. To our knowledge, this is the first reported case in Korea on C. braakii infection resulting in septic shock in a patient with malignancy in Korea.
Subject(s)
Humans , Carcinoma, Hepatocellular , Citrobacter , Citrobacter freundii , Immunocompromised Host , Korea , Opportunistic Infections , Sepsis , Shock, SepticABSTRACT
Sirolimus is a promising immunosuppressive agent with low nephrotoxicity and anti-tumor effects; it replaces calcineurin inhibitors, but serious adverse effects have been reported. We report on sirolimus-induced pneumonitis, which is a rare but fatal complication. The patient was a 51-year-old renal transplant recipient who had received sirolimus for 3 months before admission. The patient had a productive cough and mild fever, which began 3 weeks before admission. The chest PA and CT findings were consistent with pneumonia, but a microbiological study and bronchoscopic findings revealed no evidence of infection. Sirolimus-induced pneumonitis was suspected, so the sirolimus was stopped and high-dose steroids were initiated. The respiratory symptoms and radiologic findings improved dramatically after sirolimus withdrawal and the initiation of steroid treatment. These findings strongly suggest a casual relationship between sirolimus and pneumonitis. This is the first case of sirolimus-induced pneumonitis in Korea.
Subject(s)
Humans , Middle Aged , Calcineurin , Cough , Fever , Korea , Pneumonia , Sirolimus , Steroids , Thorax , TransplantsABSTRACT
We report a case of necrotizing fasciitis and severe sepsis complicated by emphysematous gastritis. The patient initially presented with sepsis due to extensive necrotizing fasciitis. Although he recovered from severe sepsis after intensive treatment including amputation of involved lesion, fatal emphysematous gastritis developed later during long-term hospitalization. To the best of our knowledge, this is the first report on emphysematous gastritis associated with necrotizing fasciitis and sepsis.
Subject(s)
Humans , Amputation, Surgical , Fasciitis, Necrotizing , Gastritis , Hospitalization , SepsisABSTRACT
Leflunomide, a disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis has been available in Korea since 2003. Leflunomide-associated interstitial pneumonitis has been appearing recently. A 25-year-old woman with a 12-month history of seronegative rheumatoid arthritis (RA) presented with acute respiratory insufficiency. She developed fever, dyspnea, and non-productive cough. Her medication history included methotrexate (15 mg/week. commencing 1 year prior) and leflunomide (20 mg/day, no loading dose, commencing 4 months prior). She was diagnosed with leflunomide-associated interstitial pneumonitis based on history, physical examination, laboratory and radiologic findings. She recovered quickly after leflunomide was withdrawn and steroids and cholestyramine were initiated quickly. We report a case of leflunomide-associated interstitial pneumonitis treated successfully with intravenous high-dose steroid and cholestyramine.
Subject(s)
Adult , Female , Humans , Arthritis, Rheumatoid , Cholestyramine Resin , Cough , Dyspnea , Fever , Isoxazoles , Korea , Lung Diseases, Interstitial , Methotrexate , Physical Examination , Respiratory Insufficiency , SteroidsABSTRACT
Methotrexate (MTX) is indicated for patients with moderate to severe rheumatoid arthritis (RA), but it sometimes causes severe hematologic complications in patients with impaired renal function. We experienced three cases of pancytopenia due to low-dose MTX treatment in RA patients with impaired renal function. Two patients were dialysis patients, and the other had stage 4 chronic kidney disease. The mean cumulative MTX dose and treatment duration for the three patients was 25 mg and 10 days, respectively. All cases experienced severe stomatitis and pancytopenia and recovered with conservative care. In conclusion, MTX should be used cautiously in patients with impaired renal function.