Nirmatrelvir/Ritonavir Prescription Rate and Outcomes in Coronavirus Disease 2019: A Single Center Study / 감염과화학요법

Background@#Nirmatrelvir/ritonavir was Korea's first oral antiviral agent to treat coronavirus disease 2019 (COVID-19). We analyzed the nirmatrelvir/ritonavir prescription rate and treatment outcomes in treatment-eligible patients with COVID-19 receiving home-based care. @*Materials and Methods@#We retrospectively collected data of patients with COVID-19-eligible for nirmatrelvir/ritonavir treatment from January 14, 2022, to February 15, 2022. We analyzed the prescription rate of nirmatrelvir/ritonavir, the reasons for non-prescription, and patient outcomes. @*Results@#A total of 414 patients were included, of whom 44.2% were male, and the mean age was 64.6 (standard deviation [SD] = 8.5). Approximately 73.2% (n = 303) of patients were not prescribed nirmatrelvir/ritonavir. More than fourth-fifths of the patients refused nirmatrelvir/ ritonavir treatment (n = 262, 86.5%). The mean symptom duration was significantly shorter in the prescription group (5.2 days [SD = 2.3] vs. 4.4 days [SD = 1.9], P = 0.001). A total of 6 (1.4%) patients were hospitalized, and none of the patients who received nirmatrelvir/ ritonavir required admission. Among the patients prescribed nirmatrelvir/ritonavir (n = 111), 17 (15.3%) patients experienced side effects, and 5 (4.5%) patients discontinued nirmatrelvir/ ritonavir due to side effects. @*Conclusion@#The nirmatrelvir/ritonavir prescription rate was low, with more than fourth-fifths of non-prescriptions being due to patient refusal. Symptom resolution was faster, and no life-threatening side effects were reported. Accurate information about drug safety must be provided to patients to make informed decisions regarding nirmatrelvir/ritonavir treatment.

Clinical Progression and Cytokine Profiles of Middle East Respiratory Syndrome Coronavirus Infection

Clinical progression over time and cytokine profiles have not been well defined in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. We included 17 patients with laboratory-confirmed MERS-CoV during the 2015 outbreak in Korea. Clinical and laboratory parameters were collected prospectively. Serum cytokine and chemokine levels in serial serum samples were measured using enzyme-linked immunosorbent assay. All patients presented with fever. The median time to defervescence was 18 days. Nine patients required oxygen supplementation and classified into severe group. In the severe group, chest infiltrates suddenly began to worsen around day 7 of illness, and dyspnea developed at the end of the first week and became apparent in the second week. Median time from symptom onset to oxygen supplementation was 8 days. The severe group had higher neutrophil counts during week 1 than the mild group (4,500 vs. 2,200/µL, P = 0.026). In the second week of illness, the severe group had higher serum levels of IL-6 (54 vs. 4 pg/mL, P = 0.006) and CXCL-10 (2,642 vs. 382 pg/mL, P < 0.001). IFN-α response was not observed in mild cases. Our data shows that clinical condition may suddenly deteriorate around 7 days of illness and the serum levels of IL-6 and CXCL-10 was significantly elevated in MERS-CoV patients who developed severe diseases.

A Case of Varicelliform Zoster in a Patient Treated with Etanercept for Ankylosing Spondylitis

Tumor necrosis factor-alpha (TNF-alpha) inhibitors are increasingly used in treatment of inflammatory disorders because of their immunomodulatory efficacy. Increased risk of infection is an adverse effect of anti-TNF-alpha therapy. The incidence rate and severity of herpes zoster is significantly higher in patients on anti-TNF-alpha therapy than in the general population. The clinical presentation of varicella zoster virus infection is also often atypical in these patients. We experienced a patient who presented with a disseminated varicelliform rash while on etanercept therapy for ankylosing spondylitis.

Infected Aortic Aneurysm caused by Mycobacterium bovis after Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer / 감염과화학요법

A 70-year-old man presented with lower back pain and cyanotic changes in his left lower extremity. He was diagnosed with infected aortic aneurysm and infectious spondylitis. He had received intravesical Bacillus Calmette-Guerin (BCG) therapy up to 1 month before the onset of symptoms. The aneurysm was excised and an aorto-biiliac interposition graft was performed. Mycobacterium tuberculosis complex was cultured in the surgical specimens. Real-time polymerase chain reaction (PCR) targeting the senX3-regX3 region, and multiplex PCR using dual-priming oligonucleotide primers targeting the RD1 gene, revealed that the organism isolated was Mycobacterium bovis BCG. The patient took anti-tuberculosis medication for 1 year, and there was no evidence of recurrence at 18 months follow-up.

Benign Lymphoepithelial Cyst of the Parotid Gland as an Initial Manifestation of Human Immunodeficiency Virus Infection / 대한내과학회지

Benign lymphoepithelial cysts are rare, and are associated with swelling of the salivary glands (usually the parotid gland). The cytopathological features include lymphoid hyperplasia with an epithelial component, exhibiting cystic and proliferative changes. Development of a benign lymphoepithelial cyst commonly precedes acquisition of acquired immunodeficiency syndrome, but may also be the initial clinical manifestation of human immunodeficiency virus (HIV) infection. A 43 year-old male presented with a slowly growing multilocular cystic mass in his right cheek. Computed tomography of the neck revealed a well-circumscribed cystic lesion in the bilateral parotid glands. A provisional diagnosis of a benign lymphoepithelial cyst associated with HIV infection was made, and Western blotting confirmed the HIV infection. Three months after initiation of antiretroviral therapy, the parotid swelling was completely resolved. We report this case to suggest that clinicians should consider the possibility of HIV infection when patients present with benign lymphoepithelial cysts of the parotid gland.

Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Hospital / 병원감염관리

BACKGROUND: This study aimed to evaluate the quality of surgical antibiotic prophylaxis (SAP) in a tertiary hospital. METHODS: Medical, anesthetic, and nursing records from the 27,320 procedures conducted in a tertiary hospital during 2012 were retrospectively reviewed. Three clinical performance indicators of SAP (selection of antibiotic, timing of the first administration, duration of prophylaxis) were included as part of the National Hospital Evaluation Program (NHEP) of the Health Insurance Review and Assessment Service. In addition, 2 other parameters were assessed according to recent guidelines (weight-based initial dosing for obesity, intraoperative re-dosing for excessive blood loss, and prolonged duration of procedures). RESULTS: Prophylactic antibiotics were administered in 19,637 (71.8%) of 27,320 total procedures. Quality of the 3 performance indicators was higher in the types of operations included in NHEP than in other procedures. However, additional doses were administered in 15 (1.2%) of 1,299 surgical procedures that lasted more than twice the half-life of the antibiotic used, and in 9 (3.3%) of 273 procedures with excessive blood loss greater than 1,500 mL. NHEP and non-NHEP results did not differ significantly. CONCLUSION: Three SAP quality indicators showed more improvement in NHEP surgical procedures than in non-NHEP, but the other parameters did not perform well regardless of NHEP assessment. Therefore, more measures to improve the appropriateness of SAP should be developed.