Comparison between Proton Pump Inhibitor and H2 Receptor Antagonist in Relieving Cyclosporine-Associated Adverse Gastrointestinal Events: A Single Center, Randomized Controlled Trial / 대한피부과학회지

Background@#Cyclosporine (CS) has been effectively used in various skin diseases, but gastrointestinal (GI) adverse events are so common. However, there is no standardized treatment for managing CS-induced GI adverse events. @*Objective@#To analyze the effectiveness of two empirical GI medications, an H2 receptor antagonist (H2RA) and proton pump inhibitor (PPI), in relieving CS-induced GI adverse events. @*Methods@#This is a prospective, randomized clinical trial conducted at Ajou University Hospital. The patients completed a gastrointestinal symptom rating scale (GSRS) questionnaire to assess GI symptoms before and after taking the drugs. @*Results@#A total of 60 patients, divided into a PPI group (n=30) and an H2RA group (n=30), were analyzed. The onset of GI events occurred in 6.04 days on average. GSRS scores improved significantly in both groups (p＜0.01). While abdominal pain, reflux syndrome, and indigestion syndrome consistently improved, changes in diarrhea syndrome and constipation syndrome were not statistically significant. The overall change in GSRS scores was higher in the PPI group, but the difference was not significant (p=0.76). @*Conclusion@#Both PPI and H2RA significantly improved CS-induced GI side effects, with PPI showing a slight advantage over H2RA, but the cost of PPIs should be considered when deciding on first-line therapy. GI side effects typically appeared within 6.04 days of starting CS therapy, highlighting the importance of close monitoring and personalized intervention for improving patient compliance.

Facial Telangiectasia as an Initial Notable Symptom of Systemic Sclerosis / 대한피부과학회지

Systemic sclerosis (SSc), also called scleroderma, is a rare debilitating autoimmune disease of the connective tissue characterized by microvascular damage, specific immunologic abnormalities, and progressive fibrosis of the skin and internal organs. The disease may be associated with serious visceral complications involving the pulmonary, gastrointestinal, cardiac and renal systems, why early identification is important. Cutaneous telangiectasia was originally one of the diagnostic criteria of the CREST syndrome (calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias), and is now included in the 2013 American College of Rheumatology/European League Against Rheumatism criteria for the diagnosis of SSc. We report herein three cases of SSc who presented our department for telangiectasia, because eruptive telangiectasia on exposed area associated with high titer of antinuclear antibody could be the first sign of SSc.

Comparison of Short- and Long-Term Efficacy between Interleukin-17A and Interleukin-23 Inhibitors among Patients with Moderate-to-Severe Plaque Psoriasis:A Single Center Experience / 대한피부과학회지

Background@#Interleukin (IL)-17 and IL-23 inhibitors have helped achieve clear skin in many patients with psoriasis. However, real-world data to compare short- and long-term efficacy of these biologics in Korean patients are lacking. @*Objective@#To compare short- and long-term efficacy of IL-17A and IL-23 inhibitors in patients with moderateto-severe psoriasis. @*Methods@#We retrospectively evaluated efficacy of IL-17A and IL-23 inhibitors among patients treated at Ajou University Hospital from 2017 to 2022. The specific agents studied were as follows: secukinumab, 32 patients; ixekizumab, four patients; guselkumab, 13 patients; and risankizumab, 31 patients. Patients who were followed up for less than a year or changed biologics were excluded. @*Results@#The rates of psoriasis area and severity index (PASI) 90 achievement of secukinumab were 62.5%, 86.7%, 89.3%, 80.8%, and 70.8% at weeks 16, 40, 88, 112, and 136, respectively. For ixekizumab, the PASI90 achievement rates were 75%, 100%, 75%, and 100% at weeks 16, 40, 64, and 88, respectively. The PASI90 achievement rates of guselkumab were 53.8%, 76.9%, 72.7%, and 77.8% at weeks 20, 44, 68, and 92, respectively. For risankizumab, PASI90 achievement rates were 69.7%, 90.0%, 93.7%, and 100% at weeks 28, 52, 76, and 100, respectively. Before 52 weeks, PASI90 achievement was significantly lower with guselkumab than with secukinumab (hazardratio=0.22). After 52 weeks, PASI90 achievement was significantly higher with risankizumab than with secukinumab (hazard ratio=2.00). @*Conclusion@#PASI90 was achieved faster with IL-17A inhibitors than with IL-23 inhibitors. However, IL-23 inhibitors afforded the maintenance of a higher PASI score after 52 weeks.

Two Cases of Patients with a Rash along the Intertriginous Area without Certain Drug History / 대한피부과학회지

We report a skin rash with a sharply demarcated erythema on the flexural area. The differential diagnoses included Baboon syndrome and symmetrical drug-related intertriginous and flexural exanthema. The diagnosis can be made based on the presence of previous cutaneous sensitization and causative agents. Our cases were consistent with a diagnosis of Baboon syndrome with no drug history.

Telephone follow-up care for disabled patients discharged after receiving dental treatment under outpatient general anesthesia

BACKGROUND: Patients were subjected to post-discharge follow-up (by telephone) in order to investigate the potential complications of outpatient general anesthesia or deep sedation that could develop in disabled dental patients discharged from the hospital. The ultimate aim of this study was to establish an appropriate response measure for such complications. METHODS: The caregivers of 79 disabled patients who underwent dental procedures under general anesthesia at our outpatient clinic were interviewed over telephone. Necessary care instructions were provided during the phone calls when required. The patient satisfaction level regarding the telephonic follow-up care was surveyed by additional telephone calls. RESULTS: Most of the patients did not suffer any serious complications; however, some reported fever and bleeding. The data obtained in this study can be utilized towards the development of caregiver education pertaining to the ambulatory general anesthesia of dental patients with disabilities. CONCLUSIONS: Additionally, we hope that the findings of this study will help minimize the effects of complications experienced by disabled dental patients undergoing ambulatory general anesthesia, as well as increase the overall patient satisfaction level.

Emergency response team activation in the outpatient clinic of a single dental teaching hospital in Korea: a retrospective study of 10 years' records

BACKGROUND: To prepare for possible emergency situations during dental treatment, it is helpful to know how often and what kinds of emergencies may arise. This study set out to evaluate the incidences, causes, treatments, and outcomes of emergency situations in the outpatient clinic of a dental teaching hospital in Korea. METHODS: We retrospectively reviewed the records of patients who had experienced an emergency situation and emergency response team activated in a selected outpatient clinic between November 2004 and November 2013. Specific information about the emergency cases was collected, including the patient characteristics and the frequency, types, treatments, and outcomes of the emergency situations. RESULTS: We identified 35 instances of emergency situations in 2,890,424 patients (incidence = 0.012 per 10,000 outpatients). The number of cases was as follows: 10 (28.6%) in the Department of Periodontics, 10 (28.6%) in the Department of Oral and Maxillofacial Surgery, 6 (17.1%) in the Department of Oral and Maxillofacial Radiology, 4 (11.4%) in the Department of Prosthodontics, 2 (5.7%) in the Department of Conservative Dentistry, 2 (5.7%) in the Department of Pediatric Dentistry, and 1 (2.9%) in the Department of Orthodontics. Three (8.6%) of the emergency situations arose before treatment, 22 (62.9%) during treatment, 7 (20.0%) after treatment, and 2 (5.7%) in a patient's guardian. CONCLUSIONS: In accordance with the growing elderly population and more aggressive dental procedures, the number of emergency situations may increase in the future. We recommend that clinicians keep in mind airway management and the active control of emergency situations.

Clinical considerations in the use of forced-air warming blankets during orthognathic surgery to avoid postanesthetic shivering

BACKGROUND: During head and neck surgery including orthognathic surgery, mild intraoperative hypothermia occurs frequently. Hypothermia is associated with postanesthetic shivering, which may increase the risk of other postoperative complications. To improve intraoperative thermoregulation, devices such as forced-air warming blankets can be applied. This study aimed to evaluate the effect of supplemental forced-air warming blankets in preventing postanesthetic shivering. METHODS: This retrospective study included 113 patients who underwent orthognathic surgery between March and September 2015. According to the active warming method utilized during surgery, patients were divided into two groups: Group W (n = 55), circulating-water mattress; and Group F (n = 58), circulating-water mattress and forced-air warming blanket. Surgical notes and anesthesia and recovery room records were evaluated. RESULTS: Initial axillary temperatures did not significantly differ between groups (Group W = 35.9 ± 0.7℃, Group F = 35.8 ± 0.6℃). However, at the end of surgery, the temperatures in Group W were significantly lower than those in Group F (35.2 ± 0.5℃ and 36.2 ± 0.5℃, respectively, P = 0.04). The average body temperatures in Groups W and F were, respectively, 35.9 ± 0.5℃ and 36.2 ± 0.5℃ (P = 0.0001). In Group W, 24 patients (43.6%) experienced postanesthetic shivering, while in Group F, only 12 (20.7%) patients required treatment for postanesthetic shivering (P = 0.009, odds ratio = 0.333, 95% confidence interval: 0.147-0.772). CONCLUSIONS: Additional use of forced-air warming blankets in orthognathic surgery was superior in maintaining normothermia and reduced the incidence of postanesthetic shivering.

Differential Roles of Transcriptional Coactivators: CBP and CIITA on GAS (Interferon-r Activated Site) - Mediated Transcription in Thyroid Cells / 대한내분비학회지

BACKGROUND: In the previous studies, we identified that the interferon-gamma activated sequence (GAS) in the 5-flanking region of rat ICAM-1 gene is major element for interferon-y-inducible expression of the gene in rat thyroid cells, FRTL-5. We here, investigated the role of transcriptional coactivators, CBP (CREB binding protein) and CIITA (class II transactivator) in the modulation of the activity of GAS which could interacts with signal transducers and activators of transcription-1 and 3 (STAT1 and STAT3). METHODS: The expression of CBP RNA and protein were quantitated in FRTL-5 after stimulation with interferon-y (IFN-gamma), thyroid stimulating hormone (TSH), forskolin and methimazole. Direct association of CBP with STAT were analyzed by irnmunoprecipitation. The transcriptional roles of CBP and CIITA in the regulation of GAS were assessed by the cotransfection with their expression vectors with reporters; 5-deletion constructs of rat ICAM-1 promoter or 8xGAS-luc constructs, into FRTL-5 thyroid cells. RESULTS: The level of CBP RNA and protein were not changed by the treatment with TSH, IFN-y, forskolin and methimazole in FRTL-5, FRT and BRL liver cells. The CBP could be directly associated with STAT1. Furthernmore, the overexpression of CBP significantly increases the both promoter activities; rat ICAM-1 gene promoter which has GAS element and 8xGAS-luc cassette constructs. However the cotransfection of CI1TA decreased the constitutive and CBP-mediated transactivation of rat ICAM-1 promoter and SxGAS-luc cassette constructs. CONCLUSION: We identified that the two transcriptional coactivators; CBP and CIITA has differential roles in the regulation of transcriptional activity of GAS drived promoter. CBP increases the GAS activity through the direct binding with STATl, but CIITA inhibited the CBP-mediated transactivation of GAS activity.