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.

Clinical Application of the Standard Q COVID-19 Ag Test for the Detection of SARS-CoV-2 Infection

We evaluated the Standard Q COVID-19 Ag test for the diagnosis of coronavirus disease 2019 (COVID-19) compared to the reverse transcription-polymerase chain reaction (RT-PCR) test.We applied both tests to patients who were about to be hospitalized, had visited an emergency room, or had been admitted due to COVID-19 confirmed by RT-PCR. Two nasopharyngeal swabs were obtained; one was tested by RT-PCR and the other by the Standard Q COVID-19 Ag test. A total of 118 pairs of tests from 98 patients were performed between January 5 and 11, 2021. The overall sensitivity and specificity for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for the Standard Q COVID-19 Ag test compared to RT-PCR were 17.5% (95% confidence interval [CI], 8.8–32.0%) and 100% (95% CI, 95.3–100.0%). Analysis of the results using RT-PCR cycle thresholds of ≤ 30 or ≤ 25 increased the sensitivity to 26.9% (95% CI, 13.7–46.1%), and 41.1% (95% CI, 21.6–64.0%), respectively.

Clinical Application of the Standard Q COVID-19 Ag Test for the Detection of SARS-CoV-2 Infection

We evaluated the Standard Q COVID-19 Ag test for the diagnosis of coronavirus disease 2019 (COVID-19) compared to the reverse transcription-polymerase chain reaction (RT-PCR) test.We applied both tests to patients who were about to be hospitalized, had visited an emergency room, or had been admitted due to COVID-19 confirmed by RT-PCR. Two nasopharyngeal swabs were obtained; one was tested by RT-PCR and the other by the Standard Q COVID-19 Ag test. A total of 118 pairs of tests from 98 patients were performed between January 5 and 11, 2021. The overall sensitivity and specificity for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for the Standard Q COVID-19 Ag test compared to RT-PCR were 17.5% (95% confidence interval [CI], 8.8–32.0%) and 100% (95% CI, 95.3–100.0%). Analysis of the results using RT-PCR cycle thresholds of ≤ 30 or ≤ 25 increased the sensitivity to 26.9% (95% CI, 13.7–46.1%), and 41.1% (95% CI, 21.6–64.0%), respectively.

Dynamics of viral load and anti-SARS-CoV-2 antibodies in patients with positive RT-PCR results after recovery from COVID-19

Recently, the number of patients with coronavirus disease 2019 (COVID-19) who have tested positive for severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), via the reverse transcription polymerase chain reaction (RT-PCR) test, after recovery has increased; this has caused a dilemma regarding the medical measures and policies. We evaluated the dynamics of viral load and anti-SARSCoV-2 antibodies in four patients with positive RT-PCR results after recovery. In all patients, the highest levels of immunoglobulin G (IgG) and IgM antibodies were reached after about a month of the onset of the initial symptoms. Then, the IgG titers plateaued, and the IgM titers decreased, regardless of RT-PCR results.The IgG and IgM levels did not increase after the post-negative positive RT-PCR results in any of the patients. Our results reinforced that the post-negative positive RT-PCR results may be due to the detection of RNA particles rather than reinfection in individuals who have recovered from COVID-19.

A Case of Jejunal Intussusception caused by Burkitt Lymphoma in an Acquired Immunodeficiency Syndrome Patient

Non-Hodgkin's lymphoma of B-cell type is the second most common neoplasm after Kaposi's sarcoma among patients with human immunodeficiency virus infection. Most non-Hodgkin's lymphoma cases that are associated with acquired immunodeficiency syndrome (AIDS) involve extranodal sites, especially the digestive tract and the central nervous system. We report a case of multiple jejunal intussusception caused by Burkitt lymphoma in a 42-year-old AIDS patient. Upper gastrointestinal endoscopy and surgical biopsy were performed and a complete diagnostic study including histological and immunohistochemical analyses showed Burkitt lymphoma.

A Case of Jejunal Intussusception caused by Burkitt Lymphoma in an Acquired Immunodeficiency Syndrome Patient

Non-Hodgkin's lymphoma of B-cell type is the second most common neoplasm after Kaposi's sarcoma among patients with human immunodeficiency virus infection. Most non-Hodgkin's lymphoma cases that are associated with acquired immunodeficiency syndrome (AIDS) involve extranodal sites, especially the digestive tract and the central nervous system. We report a case of multiple jejunal intussusception caused by Burkitt lymphoma in a 42-year-old AIDS patient. Upper gastrointestinal endoscopy and surgical biopsy were performed and a complete diagnostic study including histological and immunohistochemical analyses showed Burkitt lymphoma.

A case report on telescopic denture with a small number of residual teeth in mandible / 대한치과보철학회지

Restoration of a patient with thin and low residual ridges using a removable partial denture cannot provide proper anterioposterior stability and support, so it results in patient discomfort and severe occlusal force. Also, when a small number of residual teeth are far apart from one another, it is difficult to splint. When these teeth are not splinted, they become solitary abutments, which is not a wise treatment decision. In this case, telescopic system reduces severe lateral load on abutments resulting from a clasp denture and it provides stable and definite retention and solidity. In this case report, a patient exhibited full edentulism in maxilla, and a small number of residual teeth in mandible, which were restored with a complete denture and a telescopic denture respectively. In treatment planning, it was concluded that a patient was restored with a telescopic denture since it was highly probable that a clasp denture would create discomfort and difficulty due to a small number of residual teeth located far apart and residual ridges without proper support.

A Case of Neonatal Sepsis with Meningitis due to Gardnerella vaginalis / 대한주산의학회잡지

Gardnerella vaginalis is a normal component of the vaginal flora and is one of the organisms associated with bacterial vaginosis. It is rarely involved in neonatal infection. Although it is possible that G. vaginalis plays an etiologic role in bacteremia, facial cellulitis and abscess, conjunctivitis, infected cephalhematoma, scalp abscess, respiratory disease and meningitis in newborns, G. vaginalis is an uncommon pathogen of neonatal sepsis and meningitis. We report a 3,830 g term neonate with sepsis and meningitis due to G. vaginalis and review the characteristics of neonatal G. vaginalis infection reported in the literatures.

Effect of intravenous deferoxamine in multiply transfused patients / 소아과

PURPOSE: Multiple transfusions in patients with chronic anemia can result in excessive iron deposition in tissues and organs. Effective iron chelation therapy in chronically transfused patients can only be achieved when iron chelators remove sufficient amounts of iron equivalent to those accumulated in the body from transfusions, thus leading to maintain body iron load at a non-toxic level. This study was retrospectively carried out to investigate the effect of intravenous iron chelation therapy with deferoxamine in patients who have received multiple transfusions. METHODS: From March 2005 to January 2007, 15 patients who have received multiple transfusions were included in this study. Transfusion dependent patients were defined as those receiving >1 packed red blood cell (RBC) units/month for at least 6 months. They received intravenous deferoxamine for 7 days (10-30 mg/kg/day, 24 hour continuous infusions). Before and after deferoxamine infusions and 3 months later, we compared serum iron, TIBC, and ferritin in transfusion dependent patients and transfusion independent patients. RESULTS: There were 6 males and 9 females and their age range was 5.6-21.3 (median 8.3) years. Transfusion dependent patients were 7 and 8 were transfusion independent states after stem cell transplantation or chemotherapy. There was no significant change in ferritin level after deferoxamine treatment for the transfusion dependent patients but significant falling of ferritin level was observed for the transfusion independent patients 3 months later compared with baseline ferritin level (P=0.046). Some adverse events were observed but symptoms were mild and tolerable. CONCLUSION: Seven days of intravenous deferoxamine was safe and effective in transfusion independent patients. In transfusion dependent patients, chelation therapy should be maintained, in order to minimize or prevent iron accumulation and storage in the tissues.

Expression of Topoisomerase II alpha and Ki-67 in Invasive Mammary Carcinoma and Their Clinicopathologic Implication

PURPOSE: Various prognostic indicators have been identified for mammary carcinomas, but the issue of their significance remains unsettled. The prognostic impact of c-erb B2, Ki-67 and topoisomerase II alpha expression was investigated in relation to prognostic factors for carcinomas of the breast and to the tumor cell growth fraction. METHODS: One hundred eighteen cases of invasive mammary carcinoma were investigated by immunohistochemical staining for c-erb B2, topoisomerase II alpha, and Ki-67. Clinicopathologic parameters were compared with the expression pattern and incidence of c-erb B2, topoisomerase II alpha and Ki- 67 in invasive mammary carcinoma. RESULTS: C-erb B2 showed significant correlation with topoisomerase II alpha (P<0.05), but others were not significant. Topoisomerase II alpha and Ki-67 index closely paralleled each other, indicating that both reflect the proliferate activity of tumor cells and were associated with high nuclear and histological grade, ER and PR expression (P<0.05). CONCLUSION: These results indicate that ki-67 and topoisomerase II alpha proteins might play a role in tumor progression of breast carcinoma. The Ki-67 and topoisomerase II alpha index may be proliferate factors of breast cancer. In addition, the increase expression of Ki-67 and topoisomerase II alpha and hormone receptor were closely correlated each other, and could be used as factors suggesting poor prognosis in breast carcinoma.

Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion Using the Fluoroscopy and Minimal Skin Incision

PURPOSE: Continuous ambulatory peritoneal dialysis (CAPD) is an important method of performing renal replacement therapy in patients with chronic renal failure. A significant number of complications and catheter failures in CAPD are due to mechanical pro-blems and peritonitis. We describe our experience with CAPD with using fluoroscopy and a minimal incision technique to reduce complications. METHODS: We reviewed 57 CAPD patients at Dong-A University Medical Center from June 2004 to March 2005. All the procedures were standardized and performed by a single surgeon with using a flexible guide wire under aseptic fluoroscopic control through a minimal incision. Antibiotic treatment was done for three days after the surgery. RESULTS: The patients consisted of 30 males and 27 females. The common reasons for CAPD insertion were diabetic nephropathy (25 patients) and hypertension (9 patients). The mean operation time was 52.2+/-15.8 minutes. All the initial procedures were carried out under local anesthesia. Four of the patients needed their catheter repositioned during their postoperative course, which was done under local anesthesia in three cases and under spinal anesthesia in one case. Catheter malfunction occurred in 4 patients, and peritonitis developed in 8 patients (for wound related peritonitis in 1 patient and for catheter related peritonitis in 7 patients). CONCLUSION: Making a minimum incision and catheter insertion under fluoroscopic control for CAPD is a safe and highly effective method to reduce the incidence of catheter related complications. Furthermore, strict patient education is crucial for optimum catheter care, which is closely associated with development of peritonitis in CAPD patients.

Surgical Treatment of Primary Small Bowel Volvulus Using Laparoscopy

Small bowel volvulus is a condition that usually occurs secondary to malrotation, congenital bands, postoperative adhesions and internal hernias. However, primary small bowel volvulus in adults is very rare, and this is defined as torsion of all or a large segment of the small intestine and its mesentery in the absence of preexisting etiologic factors. This is relatively prevalent in the adult populations of Central Africa, India and the Middle East, but it rarely occurs in Western European and North American populations and in Far-East Asians, including Koreans. The preoperative diagnosis is difficult because clinical examinations and plain films are of limited diagnostic value. Abdominal CT plays a major role in the preoperative diagnosis of this entity. Proper management of patients with a strangulated obstruction depends on an early and accurate diagnosis, and treatment must be timely to prevent gangrene. Prompt preoperative management and early surgical treatment is essential for a better outcome. We report here on a case of a 49-year-old man who was admitted with severe abdominal pain, and he had no history of previous abdominal operations. He was diagnosed as primary small volvulus by diagnostic laparoscopy, and he was managed using this modality.