ABSTRACT
We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and Kmbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5–12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors. Recommendations 13–16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
ABSTRACT
Background@#Dapsone has been used for a long time to treat skin diseases. Although various drug-related side effects and adverse reactions to dapsone have been reported, most studies have addressed only one or two specific reactions to dapsone. @*Objective@#This study aimed to investigate the overall adverse reactions to dapsone in Koreans and their relationship with patient demographics. @*Methods@#A retrospective analysis was conducted by reviewing the electronic medical records from 2005 to 2020. The association between adverse drug reactions and dapsone use was assessed using the Naranjo scale. Correlations between variables and adverse reactions were analyzed using univariate and logistic regression analyses. @*Results@#The overall incidence of adverse drug reactions to dapsone was 7.7% (41 of 533 patients). The incidence was significantly higher in female than in male, and predictable adverse reactions were significantly higher (6.8%, 36 of 533 patients) than in unpredictable cases (0.9%, 5 of 533 patients). The most common adverse event was methemoglobinemia/anemia (3.0%, 16 of 533 patients), and the least common was hypersensitivity syndrome, which occurred in only one case (0.2%, 1 of 533 patients). With the exception of hypersensitivity syndrome, which is a severe drug-related side effects and adverse reactions, most patients recovered after drug discontinuation. @*Conclusion@#Dapsone can be used relatively safely for various chronic diseases if medical personnel are aware of its adverse reactions.
ABSTRACT
We aimed to develop evidence-based recommendations for treating axial spondylarthritis (axSpA) in Korea. The development committee was constructed, key clinical questions were determined, and the evidence was searched through online databases including MEDLINE, Embase, Cochrane, KoreaMed, and KMbase. Systematic literature reviews were conducted, quality of evidence was determined, and draft recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluations methodology. Recommendations that reached 80% consensus among a voting panel were finalized. Three principles and 21 recommendations were determined. Recommendations 1 and 2 pertain to treatment strategies, regular disease status assessment, and rheumatologist-steered multidisciplinary management. Recommendations 3 and 4 strongly recommend patient education, exercise, and smoking cessation. Recommendations 5~12 address pharmacological treatment of active disease using nonsteroidal anti-inflammatory drugs, glucocorticoids, sulfasalazine, biologics, and Janus kinase inhibitors.Recommendations 13~16 address treatment in stable disease. We suggest against spa and acupuncture as therapies (Recommendation 17). Recommendations 18 and 19 pertain to total hip arthroplasty and spinal surgery. Monitoring of comorbidities and drug toxicities are recommended (Recommendations 20 and 21). Recommendations for axSpA treatment in a Korean context were developed based on comprehensive clinical questions and evidence. These are intended to guide best practice in the treatment of axSpA.
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Background@#Differentiating between verruca plana (VP) and VP-like seborrheic keratosis (SK) is difficult and little research has been performed on the topic. @*Objective@#The aim of this study was to elucidate clinical differences between these two diseases. @*Methods@#We conducted a retrospective review of cases of VP and VP-like SK identified by biopsy. Demographics (age and gender) and clinical information (location, color, distribution, and shape) were collected. @*Results@#A total of 224 cases were identified. Thirty-nine cases were finally diagnosed with VP (17.4%) and 159 cases with VP-like SK (71.0%). The rest of the diagnoses accounted for 26 cases. On multivariate analysis, extremities (odds ratio [OR] 7.91, confidence interval [CI] 2.61∼23.93), flesh color (OR 3.69, CI 1.43∼9.49), erythematous color (OR 36.83, CI 7.50∼180.84), and clustered distribution (OR 4.73, CI 1.66∼13.46) were significantly associated with VP. Shape is not predictive in VP occurence. @*Conclusion@#We provide clinical information regarding the differentiation of VP and VP-like SK, which should prove useful in clinical dermatological practice.
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Background@#Causative antigens in allergic contact dermatitis (ACD) can be changed by several variables, including time and place. Change in antigens over a period of time in the same institution is one way to reduce the variables; however, these investigations have rarely been performed in Korea. @*Objective@#To investigate the change in patch test results by comparing with the results obtained 10 years ago at the same hospital. @*Methods@#Patch test results were analyzed retrospectively through the medical records of patients with suspected ACD who underwent the patch test using Korean standard series between September 2015 and September 2018. The institutional Review Board of the Dongguk University Ilsan Hospital approved this study. The results of the patch test were compared with those obtained 10 years ago. @*Results@#A total of 360 patients (males: 142, females: 218) were included. Compared with the results obtained 10 years ago, the positivity rates of metal-related allergens (nickel sulfate, cobalt chloride, and potassium dichromate), fragrance allergens, and 4-phenylenediamine base were increased, whereas the positivity rates of mercury ammonium chloride, thimerosal, and formaldehyde were decreased. @*Conclusion@#The patch test results obtained at the same hospital over a 10-year interval suggest that causative allergens in ACD could change with time lapse. In the future, collaborative studies including a number of participating hospitals are needed for obtaining more reliable results.
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Background@#Despite the numerous treatment options for cutaneous warts, choosing the appropriate method for optimum results can be challenging. Treatment strategies should be individualized according to the patient and lesion characteristics. However, there is a paucity of research on the clinical factors predicting treatment response. @*Objective@#To investigate the efficacy of diphenylcyclopropenone immunotherapy for warts, based on anatomical location @*Methods@#This retrospective study included 262 wart lesions from 99 patients treated with diphenylcyclopropenone immunotherapy for warts between 2007 and 2018. The lesions were divided into three groups−periungual wart, palmoplantar wart, or hair-bearing skin wart−according to anatomical location. Periungual warts were divided into hyponychium, proximal nail fold, and lateral nail fold-type subgroups. Treatment success rates were compared between the groups. @*Results@#The treatment success rate of periungual warts (75.3%) was significantly higher than those of palmoplantar (60.4%) and hair-bearing skin (60.3%) warts. No significant differences were observed between the treatment success rates of the periungual wart subgroups. @*Conclusion@#Diphenylcyclopropenone immunotherapy is an effective treatment modality for periungual warts.
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No abstract available.
Subject(s)
Diagnosis , Emergencies , Emergency Service, Hospital , KoreaABSTRACT
Rhus is a common cause of allergic contact dermatitis (ACD), particularly in East Asia. Rhus can cause localized contact dermatitis following direct contact with the skin, and systemic contact dermatitis following its ingestion, causing pruritus, erythema, and occasionally blistering. Bullous pemphigoid (BP) is an acquired subepidermal autoimmune bullous disease that typically occurs in the elderly. Although BP usually occurs sporadically, some precipitating factors of BP have been suggested, such as other autoimmune diseases, drugs, and malignancies. We report a rare case of BP induced by ingestion of Rhus in a 54-year-old man who presented with itchy erythematous rash and blisters on the whole body, initially misdiagnosed as ACD, and treated with systemic steroids.
ABSTRACT
Rhus is a common cause of allergic contact dermatitis (ACD), particularly in East Asia. Rhus can cause localized contact dermatitis following direct contact with the skin, and systemic contact dermatitis following its ingestion, causing pruritus, erythema, and occasionally blistering. Bullous pemphigoid (BP) is an acquired subepidermal autoimmune bullous disease that typically occurs in the elderly. Although BP usually occurs sporadically, some precipitating factors of BP have been suggested, such as other autoimmune diseases, drugs, and malignancies. We report a rare case of BP induced by ingestion of Rhus in a 54-year-old man who presented with itchy erythematous rash and blisters on the whole body, initially misdiagnosed as ACD, and treated with systemic steroids.
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Orofacial granulomatosis is a rare granulomatous inflammatory disease, characterized by recurrent orofacial swelling. Infectious, genetic, and immunologic etiologies are suggested, but not fully understood. Herein, we report a case of synchronous orofacial granulomatosis with brain cavernous hemangioma in a 44-year-old female patient, which may be considered paraneoplastic syndrome.
Subject(s)
Adult , Female , Humans , Brain , Granulomatosis, Orofacial , Hemangioma, Cavernous , Hemangioma, Cavernous, Central Nervous System , Paraneoplastic SyndromesABSTRACT
OBJECTIVE: Gynecologic oncologists are uncertain about the safety of tibolone application in cervical adenocarcinoma (AC) patients. This study examined the possible adverse effects of tibolone on the survival of cervical AC patients. METHODS: Medical records of 70 cervical AC patients with International Federation of Gynecology and Obstetrics stages IA to IB were reviewed. A bilateral salpingo-oophorectomy was performed in all patients, and survival outcomes between tibolone users (n=38) and non-users (n=32) were compared. RESULTS: A comparison of the tibolone users with non-users revealed similar clinicopathological variables. Progression-free survival (P=0.34) and overall survival (P=0.22) were similar in the users and non-users. The risks of progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 0.46–6.37; P=0.43) and death (HR, 1.59; 95% CI, 0.06–45.66; P=0.79) were also similar in both groups. CONCLUSION: Tibolone has no adverse effect on the survival of cervical AC patients and can be administered safely to this population. These findings may be helpful in improving the quality of life of cervical AC patients.
Subject(s)
Humans , Adenocarcinoma , Disease-Free Survival , Gynecology , Medical Records , Obstetrics , Prognosis , Quality of Life , Uterine Cervical NeoplasmsABSTRACT
No abstract available.
Subject(s)
Atherosclerosis , Bacterial Infections , Foot Ulcer , Foot , Tinea Pedis , TineaABSTRACT
OBJECTIVE: To evaluate the potential effects of previous abdominal surgery on post-operative outcome and incidence of complications after total laparoscopic hysterectomy (TLH). METHODS: Between June 2008 and December 2016, 331 patients who underwent TLH were retrospectively reviewed. Participating patients were divided into 2 groups according to previous abdominal surgery. We compared the 2 groups based on estimated blood loss, operation time, hospital stay, surgery-related complications, and conversion to laparotomy rates. RESULTS: Group 1 included patients without a history of abdominal surgery (n=186), group 2 included patients with a history of abdominal surgery (n=145). The complication rate was 3.2% in group 1 and 2.8% in group 2. Other post-operative outcome and complications such as estimated blood loss, hospital stay and conversion to laparotomy rates did not differ significantly between groups. Adhesiolysis was significantly more common in group 2 (P < 0.001) and operation time was significantly longer in the group 2 (P=0.004). The rate of conversion to laparotomy was higher in group 2, but this difference was not significant (P=0.115). Group 2 patients were divided into subgroups according to the number of surgery. In subgroups analysis of group 2, there were 70 patients who had one previous abdominal surgery and 75 patients who had 2 or more previous surgeries. Moreover, there were significant differences in adhesiolysis (P=0.004) and conversion to laparotomy (P=0.034). There were no significant differences in other complications observed upon subgroup analysis. CONCLUSION: TLH can be conducted successfully regardless of previous abdominal surgery. Patients with previous abdominal surgery are suitable and feasible candidates for TLH.
Subject(s)
Humans , Hysterectomy , Incidence , Laparoscopy , Laparotomy , Length of Stay , Postoperative Complications , Retrospective StudiesABSTRACT
OBJECTIVE: To detect the possible clinicopathologic factors associated with parametrial involvement in patients with stage IB1 cervical cancer and to identify a cohort of patients who may benefit from less radical surgery. METHODS: We retrospectively reviewed 120 patients who underwent radical hysterectomy and pelvic lymphadenectomy as treatment for stage IB1 cervical cancer. RESULTS: Overall, 18 (15.0%) patients had parametrial tumor involvement. Tumor size larger than 2 cm, invasion depth greater than 1 cm, presence of lymphovascular space involvement (LVSI), corpus involvement, and positive lymph nodes were statistically associated with parametrial involvement. Multivariate analysis for other factors showed invasion depth >1 cm (P=0.029), and corpus involvement (P=0.022) were significantly associated with parametrial involvement. A subgroup with tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. CONCLUSION: Tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. Invasion depth >1 cm and corpus involvement were significantly associated with parametrial involvement in multivariate analysis. These finding may suggest that tumor size may a strong predictor of parametrial involvement in International Federation of Gynecology and Obstetrics stage IB1 cervical cancer, which can be used to select a subgroup population for less radical surgery.
Subject(s)
Humans , Cohort Studies , Gynecology , Hysterectomy , Lymph Node Excision , Lymph Nodes , Multivariate Analysis , Obstetrics , Retrospective Studies , Uterine Cervical NeoplasmsABSTRACT
BACKGROUND: Palmar hyperhidrosis is a common disorder of excessive sweating. A number of studies have demonstrated the effectiveness of iontophoresis in the treatment of palmar hyperhidrosis. However, controlled clinical studies on iontophoresis for palmar hyperhidrosis have been limited. OBJECTIVE: To determine the efficacy and safety of iontophoresis in the treatment of palmar hyperhidrosis with a randomized, sham-controlled, single-blind, and parallel-designed study. METHODS: Twenty nine patients with significant palmar hyperhidrosis were enrolled in this study. They received active iontophoresis treatment (group A) or sham treatment (group B). Iontophoresis was performed 20 minutes each time, five times per week, for 2 weeks. Its efficacy was assessed with starch-iodine test, mean sweat secretion rate, and hyperhidrosis disease severity scale. RESULTS: Twenty-seven of the 29 patients completed the 2-week treatment. After completion of 10 times of treatment, results of the starch-iodine test showed clinical improvement in 92.9% of patients in group A and 38.5% of patients in group B (p=0.001). The mean sweat secretion rate was reduced by 91.8% of patients in group A and by 39.1% of patients in group B (p<0.001). Improvement in quality of life was reported by 78.6% of patients in group A and by 30.8% of patients in group B (p=0.028). In group A, one case of localized adverse event was noted, although no adverse event was encountered in group B. CONCLUSION: Tap water iontophoresis could be used as an effective and safe treatment modality for palmar hyperhidrosis.
Subject(s)
Humans , Hyperhidrosis , Iontophoresis , Placebos , Quality of Life , Sweat , Sweating , WaterABSTRACT
Wrong-route or -patient medication errors due to human mistakes have been considered difficult to resolve in clinical settings. In this study, we suggest a safety injection system that can help to prevent an injection when a mismatch exists between the drug and route or patient. For this, we prepared two distinct adapters with key and keyhole patterns specifically assigned to a pair of drug and route or patient. When connected to a syringe tip and its counterpart, a catheter injection-port, respectively, the adapters allowed for a seamless connection only with their matching patterns. In this study, each of the adapters possessed a specific key and keyhole pattern at one end and the other end was shaped to be a universal fit for syringe tips or catheter injection-ports in clinical use. With the scheme proposed herein, we could generate 27,000 patterns, depending on the location and shape of the key tooth in the adapters. With a rapid prototyping technique, multiple distinct pairs of adapters could be prepared in a relatively short period of time and thus, we envision that a specific adapter pair can be produced on-site after patient hospitalization, much like patient identification barcodes.
Subject(s)
Humans , Catheters , Hospitalization , Medication Errors , Syringes , ToothABSTRACT
Cylindrocarpon destructans causes root rot disease in ginseng and can survive for a long time, producing chlamydospores. We optimized conditions to induce chlamydospore production from the conidia of C. destructans, isolated from Korean ginseng. This will provide the basis for testing the efficacy of control agents targeting these chlamydospores.