ABSTRACT
Background@#Many aspects are considered when selecting psoriasis treatments, such as psoriasis severity. In particular, patients’ subjective aspects, such as quality of life and treatment satisfaction, are important when planning treatment, and several studies on these aspects exist. However, studies on the direct thoughts of Korean patients with psoriasis, such as what patients value the most, are limited. @*Objective@#This study aimed to evaluate treatment satisfaction and perceptions regarding the importance or subjective achievement of goals in Korean patients with psoriasis treated with biologics or oral agents. @*Methods@#A total of 59 patients with psoriasis treated with biologics or oral agents for ＞16 weeks completed the questionnaire. The questionnaire consisted of four main parts: patient information, past history and treatment experience associated with psoriasis, treatment satisfaction, and subjective importance and degree of achievement of treatment goals in daily life. @*Results@#Treatment satisfaction in the biologics group was higher in terms of effectiveness, improvement in symptoms, speed of improvement, method of administration, frequency of administration, and comprehensive aspects than that in the oral agents group (p＜0.05). However, in both groups, the degree of improvement did not reach the patients’ subjective importance, and “concerned with other people’s eyes due to lesions in exposed area” had the biggest difference. @*Conclusion@#Although biologics had higher treatment satisfaction than oral agents, in some parts of daily life, the degree of improvement did not reach the patients’ subjective importance; therefore, some points still needs to be improved.
ABSTRACT
Generalized pustular psoriasis of pregnancy (GPPP), characterized by widespread sterile pustules and erythematous patches with systemic symptoms such as fever, is a rare form of pustular psoriasis. GPPP typically occurs in the third trimester of pregnancy and can be triggered by various factors such as infections, hypocalcemia, and drugs including N-butyl-scopolammonium bromide. We report a rare case of new-onset GPPP in a 33-yearold multigravida female at 17 weeks’ gestation, which occurred earlier than usual, after taking hydroxychloroquine for 3 weeks to treat systemic lupus erythematosus. She stopped her medications and was treated with systemic corticosteroid, but without improvement.Her medication was changed to systemic cyclosporine; her skin lesions improved, which completely resolved after delivery. This is the first case of GPPP developed following hydroxychloroquine use for systemic lupus erythematosus, which occurred earlier than usual and completely resolved after delivery. This case demonstrates that hydroxychloroquine can induce GPPP before the third trimester of pregnancy.
ABSTRACT
Vitamin B12 deficiency causes a variety of symptoms in the hematologic, gastrointestinal tract, and neurologic deficit. We report a rare case of progressive gait disturbance, bradykinesia and dysarthria which was that vitamin B12 deficiency was diagnosed as the cause, and symptoms improved after intramuscular cobalamin treatment. Vitamin B12, homocysteine, and methylmalonic acid tests are recommended for patients with progressive gait disturbance, even in the absence of obvious anemia symptoms.
ABSTRACT
Healthcare workers (HCWs) may be at high risk for exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of their frequent contact with patients or the direct handling of respiratory samples. We investigated the seroprevalence of SARS-CoV-2 IgG in HCWs in Seoul compared to those in coronavirus disease (COVID-19) patients and community-based individuals to evaluate the antibody response. A total of 358 samples from 348 individuals (155 HCWs, 7 COVID-19 patients, and 186 community-based individuals) were collected from April to November 2020. SARS-CoV-2 IgG was detected in 1 of 155 HCWs (1 of 46 HCWs with direct contact), 7 of 7 COVID-19 patients, and none of the 186 communitybased individuals (95% CI: 0.6%, 0.1 - 3.6%; 100%, 64.5 - 100%; 0.0%, 0.0 - 2.0%, respectively).The single HCW with a positive result showed 2.32 signal-to-cutoff (S/C) and 2.31 S/C at a 3-week interval. Therefore, it was assumed to be a false positive due to autoantibody or medication. The positive samples from 7 patients had a median of 3.79 S/C (range 1.72 - 6.54). The seroprevalence of SARS-CoV-2 IgG in HCWs was very low. The current infection control standard seems to be effective in protecting HCWs from COVID-19.
ABSTRACT
Healthcare workers (HCWs) may be at high risk for exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of their frequent contact with patients or the direct handling of respiratory samples. We investigated the seroprevalence of SARS-CoV-2 IgG in HCWs in Seoul compared to those in coronavirus disease (COVID-19) patients and community-based individuals to evaluate the antibody response. A total of 358 samples from 348 individuals (155 HCWs, 7 COVID-19 patients, and 186 community-based individuals) were collected from April to November 2020. SARS-CoV-2 IgG was detected in 1 of 155 HCWs (1 of 46 HCWs with direct contact), 7 of 7 COVID-19 patients, and none of the 186 communitybased individuals (95% CI: 0.6%, 0.1 - 3.6%; 100%, 64.5 - 100%; 0.0%, 0.0 - 2.0%, respectively).The single HCW with a positive result showed 2.32 signal-to-cutoff (S/C) and 2.31 S/C at a 3-week interval. Therefore, it was assumed to be a false positive due to autoantibody or medication. The positive samples from 7 patients had a median of 3.79 S/C (range 1.72 - 6.54). The seroprevalence of SARS-CoV-2 IgG in HCWs was very low. The current infection control standard seems to be effective in protecting HCWs from COVID-19.
ABSTRACT
Background@#Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) is increasingly used for immunosuppressive drug tests. However, most LC-MS/MS tests are laboratory-developed and their agreement is unknown in different Korean laboratories.This interlaboratory comparison study evaluated test reproducibility and identified potential error sources. @*Methods@#Test samples containing three concentrations of tacrolimus, sirolimus, everolimus, cyclosporine, and mycophenolic acid were prepared by pooling surplus samples from patients undergoing routine therapeutic drug monitoring and tested in duplicate in the participating 10 clinical laboratories. Reconstitution and storage experiments were conducted for the commonly used commercial calibrator set. The robust estimators of reproducibility parameters were calculated. Spearman’s rank correlation coefficient (rho, ρ) was used to evaluate the correlation between drugs. Multiple linear regression was used to determine whether the experimental conditions alter the calibration curves. @*Results@#The reproducibility coefficient of variation exceeded 10% only for sirolimus concentrations 1 and 2 (10.8% and 12.5%, respectively) and everolimus concentrations 1 and 2 (12.3% and 11.4%, respectively). The percent difference values showed weak correlations between sirolimus and everolimus (ρ = 0.334, P = 0.175). The everolimus calibration curve slope was significantly altered after reconstitution following prolonged 5°C storage (P = 0.015 for 14 days; P = 0.025 for 28 days); the expected differences at 6 ng/mL were 0.598% for 14 days and 0.384% for 28 days. @*Conclusions@#LC-MS/MS test reproducibility for immunosuppressive drugs seems to be good in the Korean clinical laboratories. Continuous efforts are required to achieve test standardization and harmonization, especially for sirolimus and everolimus.
ABSTRACT
Background@#Accurate serum creatinine (Cr) concentration measurement is essential for evaluating kidney function. In 2011, the Korean Association of External Quality Assessment Service (KEQAS) launched an accuracy-based Cr proficiency testing (ABCr PT) survey. We analyzed long-term data of the KEQAS ABCr PT survey collected between 2011 and 2019 to assess recent trends in Cr assays in Korea. @*Methods@#The ABCr PT survey including three commutable fresh-frozen serum samples was performed twice a year. The target Cr concentration was assigned using isotope-dilution mass spectrometry. We analyzed data obtained from the participating laboratories, calculated the yearly bias, and evaluated bias trends for the major reagents and instruments. Outliers were excluded from all analysis. @*Results@#The mean percentage bias based on the total data of all participating laboratories was 10.8% in the 2011-A survey and 0.2% in 2019-B survey. Bias for the major reagents and instruments differed depending on the manufacturer. Enzymatic assays generally showed desirable bias ranging from –3.9% to 3.2% at all Cr concentrations and lower interlaboratory variability than non-enzymatic assays (enzymatic vs. non-enzymatic, 3.3%– 7.2% vs. 6.3%–9.1%). @*Conclusions@#Although the mean percentage bias of Cr assays tends to decrease over time, it is necessary to continuously strive to improve Cr assay accuracy, especially at low concentrations.
ABSTRACT
Background@#Neutrophil gelatinase-associated lipocalin (NGAL) is a useful biomarker for acute kidney injury (AKI) prediction. However, studies on whether using both plasma NGAL (PNGAL) and urine NGAL (UNGAL) can improve AKI prediction are limited. We investigated the best approach to predict AKI in high-risk patients when using PNGAL and UNGAL together. @*Methods@#We enrolled 151 AKI suspected patients with one or more AKI risk factors. We assessed the diagnostic performance of PNGAL and UNGAL for predicting AKI according to chronic kidney disease (CKD) status by determining the areas under the receiver operating curve (AuROC). Independent predictors of AKI were assessed using univariate and multivariate logistic regression analyses. @*Results@#In the multivariate logistic regression analysis for all patients (N = 151), Model 2 and 3, including PNGAL (P = 0.012) with initial serum creatinine (S-Cr), showed a better AKI prediction power (R2 = 0.435, both) than Model 0, including S-Cr only (R2 = 0.390). In the non-CKD group (N = 135), the AuROC of PNGAL for AKI prediction was larger than that of UNGAL (0.79 vs 0.66, P = 0.010), whereas in the CKD group (N = 16), the opposite was true (0.94 vs 0.76, P = 0.049). @*Conclusions@#PNGAL may serve as a useful biomarker for AKI prediction in high-risk patients. However, UNGAL predicted AKI better than PNGAL in CKD patients. Our findings provide guidance for selecting appropriate specimens for NGAL testing according to the presence of CKD in AKI high-risk patients.
ABSTRACT
Background and Objectives@#Although studies of test-retest reliability of the standard polysomnography has been reported numerous times, studies of portable sleep devices have been reported in very few cases to date. The purpose of this study is to investigate the test-retest reliability of level III devices, to examine the characteristics of patients with tendency of underestimation and to determine whether there are factors that can predict when retest is needed. Subjects and Method We enrolled 74 patients for this study from April 2014 to March 2019. Two indicators were used to assess night to night variability. If the difference of apneahypopnea index (AHI) score was less than 10 or there is no difference of severity of obstructive sleep apnea (OSA) between two nights, we decided that the results have a reliability. @*Results@#Seventeen out of 57 patients with an AHI difference of less than 10 showed unreliable results based on severity, and 3 out of 17 patients with the AHI difference more than 10 showed reliable results based on severity. Eight out of 74 patients were diagnosed at Night 2 but not at Night 1. In other words, about 11% of the subjects needed retest. Based on the change in severity of OSA, subjective sleep scores showed a statistically significant difference, indicating that the subjective sleep score should be considered when deciding a retest. AHI differed by more than 10 in about 23% of the subjects in this study, falling within “15%- 32%,” which has been reported in the literature on the level I test. @*Conclusion@#This suggests that there is no significant difference in reliability between level I and III.
ABSTRACT
Collagenous fibroma (CF) is a rare benign tumor that occurs at various anatomical sites including the head and neck. CFs are often omitted from differential diagnosis before surgery. We describe a case of CF in a 54-year-old male who presented with a growing neck mass of 1-year duration at the site of previous right hemithyroidectomy for papillary thyroid carcinoma (PTC). Although radiologic findings demonstrated a benign tumor, surgical excision was carried out per patient’s preference and to rule out recurrent thyroid cancer. The mass was severely adherent to the surrounding muscles, but was resected completely without any injury to the adjacent structures. Histological studies revealed CF. The postoperative course was uneventful without vocal fold paralysis. CFs can be a diagnostic challenge in preoperative evaluation. Conservative excision was sufficient in most cases without recurrence. Clinicians should be aware of CFs in diagnosis, especially in postoperative site.
ABSTRACT
Objectives@#The purpose of this study was to investigate the condylar morphology and position of Koreans using cone-beam computed tomography (CBCT) images. Analyzing the mean values of this study with reference to left and right sides, gender, and age will help to understand the size of the condyle and glenoid fossa, condylar morphology, and temporomandibular joint (TMJ) symmetry for establishing the standard temporomandibular joint structures of Koreans and then design the standard temporomandibular joint prosthesis for Koreans. @*Results@#There was no significant result in the condyle size, condyle axis angle, joint space, fossa depth, and mandibular body size between the left and right sides (p > 0.05). On the other hand, the mediolateral width of the condyle and mandibular body size show significantly different with the gender (P < 0.05). Also, significant differences were found in condyle size, joint space, fossa depth, and mandibular body size according to age groups (P < 0.05). @*Conclusions@#Condylar position and morphology vary according to side, age, and gender. The results of this study are expected to help in customizing a treatment for the patients who need TMJ reconstruction by predicting the TMJ morphology according to age and gender and design the standard temporomandibular joint prosthesis for the Koreans.
ABSTRACT
Background@#Full-thickness skin grafts (FTSGs) have been widely used after facial skin cancer resection, for correcting defects that are too wide to be reconstructed using a local flap or if structural deformation is expected. The preauricular, posterior auricular, supraclavicular, conchal bowl, nasolabial fold, and upper eyelid skin areas are known as the main donor sites for facial FTSG. Herein, we aimed to describe the effectiveness of using infraclavicular skin as the donor site for specific cases. @*Methods@#We performed FTSG using the infraclavicular skin as the donor site in older Asian adults following skin cancer resection. Outcomes were observed for > 6 months postoperatively. The Manchester Scar Scale was used for an objective evaluation of satisfaction following surgery and scarring. @*Results@#We analyzed the data of 17 patients. During follow-up, the donor and recipient sites of all patients healed without complications. Upon evaluation, the average Manchester Scar Scale scores for the recipient and donor sites were 7.4 points and 5.7 points, respectively. @*Conclusion@#In general, conventional donor sites, such as the preauricular, posterior auricular, and supraclavicular sites, are widely used for facial FTSG because they achieve good cosmetic results. However, the infraclavicular skin may be a useful donor for facial FTSG in cases where the duration of time spent under anesthesia must be minimized due to a patient’s advanced age or underlying health conditions, or when the recipient site is relatively thick area, such as the nose, forehead, or cheek.
ABSTRACT
A new diagnosis-related group (DRG) based payment system has been implemented in most public hospitals in Korea. We investigated the effects of the new DRG system and its incentive policy on the utilization rate of diagnostic laboratory tests. Three groups were categorized; 36 hospitals under the new DRG system (participant group), 72 hospitals (control-1) matching with 36 participants according to the number of beds, and 42 tertiary hospitals (control-2). The patients of acute myocardial infarction, cerebral infarction, type 2 diabetes mellitus, and gonarthrosis receiving total arthroplasty were included. We analyzed the mean length of stay and the number of diagnostic laboratory tests conducted during hospitalization of the three groups according to the new DRG system and the incentive policy rates under the new DRG system. Before participating in the new DRG system, the number of diagnostic laboratory tests in the participant group was less than that in the two control groups for all four diseases. However, although the participant group’s length of stay decreased under the new DRG system, the number of diagnostic laboratory tests increased as the maximum incentive policy rate increased. The increment of the number of diagnostic laboratory tests was prominent in the period of a maximum of 35% incentive policy rates. Finally, the number of diagnostic laboratory tests of the participant group was similar to or exceeded that of the control-2 group. The new DRG system’s incentive policy rates played a driving force on the increased utilization rate of the diagnostic laboratory test. For preparing in advance for the change in incentive policy rates, monitoring and guidelines for the utilization of diagnostic laboratory tests are necessary.
ABSTRACT
Rhinophyma is a painless benign tumor of the skin of the nose. It is the most severe form of rosacea. Rhinophyma is particularly rare among Asians. It can be treated with surgical resection using various methods, including scalpel excision, dermabrasion, cryosurgery, argon laser, carbon dioxide laser, and electrocautery. However, the gold standard treatment of rhinophyma remains unknown. In the present case, we debulked a giant rhinophyma with a scalpel and contoured it using a bur. Along with a relevant literature review, we present a case of rhinophyma in an Asian patient who was treated at no additional cost using a bur widely used in general plastic surgery.
ABSTRACT
Background@#A rise and/or fall in cardiac troponin value with at least one value above the 99th percentile upper reference limit is essential for acute myocardial infarction (AMI) diagnosis. We evaluated the clinical usefulness of serial high-sensitivity cardiac troponin I (hs-cTnI) measurements in AMI diagnosis, in terms of the predictability of absolute and relative changes. @*Methods@#For this retrospective, forward observational study, we enrolled 281 patients older than 18 years who presented with chest pain at the emergency department (ED) between August 2015 and December 2016. The patients were grouped as AMI and nonAMI, and 73 (26%) were diagnosed as having AMI. Hs-cTnI (Abbott Diagnostics, Abbott Park, IL, USA) was measured at presentation and 3 hours later. We assessed the diagnostic performance of the absolute and relative changes in hs-cTnI. @*Results@#The cut-off values to predict AMI were 16.2 ng/L and 42.1% for the absolute and relative hs-cTnI changes, respectively. The area under the curve of hs-cTnI for AMI diagnosis was larger for absolute changes than for relative changes [0.96 (95% confidence interval [CI], 0.92–0.98) vs 0.89 (95% CI, 0.85–0.93)] (P = 0.014). @*Conclusions@#The absolute hs-cTnI change at 3 hours after presentation was superior to the relative change, and a rise and/or fall in hs-cTnI of > 16.2 ng/L at 3 hours after presentation was useful to identify AMI in patients presenting at the ED.
ABSTRACT
Accurate detection of BCR-ABL fusion transcripts at and below molecular response (MR) 4 (0.01% International Scale [IS]) is required for disease monitoring in patients with chronic myeloid leukemia (CML). We evaluated the analytical performance of the QXDx BCR-ABL %IS (Bio-Rad, Hercules, CA, USA) droplet digital PCR (ddPCR) assay, which is the first commercially available ddPCR-based in vitro diagnostics product. In precision analysis, the %CV was 9.3% and 3.0%, with mean values of 0.031% IS and 9.4% IS, respectively. The assay was linear in the first order, ranging from 0.032% IS to 20% IS. The manufacturer-claimed limit of blank, limit of detection, and limit of quantification were verified successfully. There was a very strong correlation between the results of the QXDx BCR-ABL %IS ddPCR assay and the ipsogen BCR-ABL1 Mbcr IS-MMR (Qiagen, Hilden, Germany) real-time quantitative PCR assay (r=0.996). In conclusion, the QXDx BCR-ABL %IS ddPCR assay can provide reliable results for CML patients.
Subject(s)
Humans , In Vitro Techniques , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Limit of Detection , Polymerase Chain ReactionABSTRACT
Background@#Full-thickness skin grafts (FTSGs) have been widely used after facial skin cancer resection, for correcting defects that are too wide to be reconstructed using a local flap or if structural deformation is expected. The preauricular, posterior auricular, supraclavicular, conchal bowl, nasolabial fold, and upper eyelid skin areas are known as the main donor sites for facial FTSG. Herein, we aimed to describe the effectiveness of using infraclavicular skin as the donor site for specific cases. @*Methods@#We performed FTSG using the infraclavicular skin as the donor site in older Asian adults following skin cancer resection. Outcomes were observed for > 6 months postoperatively. The Manchester Scar Scale was used for an objective evaluation of satisfaction following surgery and scarring. @*Results@#We analyzed the data of 17 patients. During follow-up, the donor and recipient sites of all patients healed without complications. Upon evaluation, the average Manchester Scar Scale scores for the recipient and donor sites were 7.4 points and 5.7 points, respectively. @*Conclusion@#In general, conventional donor sites, such as the preauricular, posterior auricular, and supraclavicular sites, are widely used for facial FTSG because they achieve good cosmetic results. However, the infraclavicular skin may be a useful donor for facial FTSG in cases where the duration of time spent under anesthesia must be minimized due to a patient’s advanced age or underlying health conditions, or when the recipient site is relatively thick area, such as the nose, forehead, or cheek.
ABSTRACT
Mucormycosis is a fungal infection, which is difficult to treat due to its rapid dissemination and low susceptibility to anti-fungal agents. Peritonitis preceded by gastrointestinal mucormycosis is very rare, and only a few cases have been reported. We present a case of peritonitis and disseminated mucormycosis caused by Mucor circinelloides in an immunocompromised patient. A 59-year-old man, diagnosed with nodal marginal zone B-cell lymphoma, was diagnosed with liver failure due to severe septic shock. A white, woolly cotton-like growth, which was consistent with that of Mucor species, was isolated from ascites and sputum specimens. Targeted DNA sequencing confirmed the isolate as M. circinelloides with 100% identity. Despite anti-fungal treatment, the patient died after four days. This is a rare case of peritonitis and disseminated mucormycosis that was probably preceded by gastrointestinal mucormycosis caused by M. circinelloides, as determined by molecular methods. Accurate and rapid identification of mold using molecular methods might be necessary for early treatment in critical cases, and more cases should be clinically evaluated further.
ABSTRACT
The accuracy-based lipid (ABL) proficiency testing (PT) program was started in 2016 by the Korean External Quality Assessment Service to minimize the matrix effect. We analyzed 3 years of the program. We made or purchased six kinds of commutable frozen sera based on the Clinical and Laboratory Standards Institute 37A guideline and distributed it in two rounds per year from 2016 to 2018. We obtained reference values for levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), total glycerides, and triglycerides in each fresh frozen pool at the reference-measurement laboratories. We evaluated the average percent bias of the participating laboratories based on the National Cholesterol Education Program (NCEP) bias limit. The number of participating laboratories evaluating TC, HDLC, LDLC, total glycerides, and triglycerides increased from 164 to 223, 163 to 223, 158 to 214, 98 to 139, and 61 to 82, respectively. The average percent bias of all participating laboratories for TC, HDLC, LDLC, total glycerides, and triglycerides was +0.14%, −0.54%, +2.9%, −1.08%, and −1.32%, respectively. The average percent bias exceeded the NCEP bias limit only once or twice for TC, HDLC, and total glycerides but frequently for LDLC (eight out of 18 pools). The manufacturer-specific bias estimation report seemed useful for traceability. Although the average percent bias of participating laboratories for TC, HDLC, LDLC, total glycerides, and triglycerides was mostly within the bias limit provided by NCEP, cases of bias limit exceeding the NCEP bias limit occurred occasionally, especially for LDLC during the 3 years of the ABL PT program in Korea, suggesting that ABL PT can be used to keep maintaining traceability.
Subject(s)
Bias , Cholesterol , Education , Glycerides , Korea , Laboratory Proficiency Testing , Lipoproteins , Reference Values , TriglyceridesABSTRACT
The Clinical Mass Spectrometry Research Committee (CMSRC), in affiliation with the Korean Society of Clinical Chemistry (KSCC), conducted a questionnaire survey on opinions about the general status of clinical mass spectrometric analysis in Korea. As a result, we understand that this field has passed through the introductory stage and is settled as a field of clinical laboratory testing in Korea, with the number of new laboratories performing mass spectrometric analysis being low. In spite of the many difficulties in introducing and operating clinical mass spectrometric analysis, there is a strong interest in this field, and even though further expansion is expected, there are still many issues to be resolved. In the future, it will be necessary to make concrete and thorough efforts to further develop the laboratory tests using clinical mass spectrometric analysis in Korea, centering on the CMSRC affiliated with the KSCC.