Negative Conversion of Polymerase Chain Reaction and Clinical Outcomes according to the SARS-CoV-2 Variant in Critically Ill Patients with COVID-19 / 결핵및호흡기질환

Background@#Coronavirus disease 2019 (COVID-19) is an ongoing global public health threat and different variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been identified. This study aimed to analyse the factors associated with negative conversion of polymerase chain reaction (PCR) and prognosis in critically ill patients according to the SARS-CoV-2 variant. @*Methods@#This study retrospectively analysed 259 critically ill patients with COVID-19 who were admitted to the intensive care unit of a tertiary medical center between January 2020 and May 2022. The Charlson comorbidity index (CCI) was used to evaluate comorbidity, and a negative PCR test result within 2 weeks was used to define negative PCR conversion. The cases were divided into the following three variant groups, according to the documented variant of SARS-CoV-2 at the time of diagnosis: non-Delta (January 20, 2020–July 6, 2021), Delta (July 7, 2021– January 1, 2022), and Omicron (January 30, 2022–April 24, 2022). @*Results@#The mean age of the 259 patients was 67.1 years and 93 (35.9%) patients were female. Fifty (19.3%) patients were smokers, and 50 (19.3%) patients were vaccinated. The CCI (hazard ratio [HR], 1.555; p<0.001), vaccination (HR, 0.492; p=0.033), and Delta variant (HR, 2.469; p=0.002) were significant factors for in-hospital mortality. The Delta variant (odds ratio, 0.288; p=0.003) was associated with fewer negative PCR conversion; however, vaccination (p=0.163) and remdesivir (p=0.124) treatments did not. @*Conclusion@#The Delta variant of SARS-CoV-2 is associated with lower survival and negative PCR conversion. Contrary to expectations, vaccination and remdesivir may not affect negative PCR conversion in critically ill patients with COVID-19.

Strategies for successful implementation and permanent maintenance of a rapid response system

Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

Strategies for successful implementation and permanent maintenance of a rapid response system

Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

A Case of Refractory Oral Aphthous Ulcer Successfully Treated with Adalimumab

Oral aphthous ulcer is a common lesion characterized by loss of dermal tissue of various shapes in many diseases. It is not serious, but may affect quality of life through pain and discomfort. In many cases, it heals spontaneously without treatment or with topical agents such as antiseptics, analgesics and corticosteroid in a few days. However, rarely, there are a few cases of aphthous ulcer that remain refractory despite appropriate treatment. Tumor necrosis factor-α inhibitors have recently been used in treatment of severe mucosal ulcer in Behçet's disease. Herein, we report a patient suffering from refractory oral aphthous ulcers that were resistant to topical and systemic agents, but were successfully treated with adalimumab.

Tacrolimus-induced, Transplant-associated Thrombotic Microangiopathies after Lung Transplantation / 대한이식학회지

We report a case of tacrolimus-induced transplant-associated thrombotic microangiopathies (TA-TMA) after lung transplantation. A 71-year-old man underwent lung transplantation secondary to idiopathic pulmonary fibrosis. After 4 months, he presented with abdominal discomfort and dyspnea, and was diagnosed with hemolytic anemia and thrombocytopenia. Tacrolimus was considered the cause of the TMA. Tacrolimus was stopped and several sessions of plasma exchange were performed immediately after diagnosis of TA-TMA. However, his platelet count did not normalize, gastrointestinal bleeding was recurrent, and severe pneumonia developed, following which he died. TA-TMA are rare but severe, life-threatening complications in lung transplant recipients. Therefore, the possibility of TA-TMA should be considered in posttransplant recipients.

Two Cases of Seasonal Influenza Virus (H3N2) and Acute Respiratory Distress Syndrome

Compared with the 2009 pandemic influenza A (H1N1), the seasonal influenza A (H3N2) in 2011–2012 was self-limited and mild. However, some cases proceeded to acute respiratory distress syndrome (ARDS) due to underlying medical history. Here we report two cases with influenza A (H3N2) progressing to fatal ARDS. One case with several underlying medical conditions eventually died from multi-organ failure despite the application of extracorporeal membrane oxygenation. When patients are suspected to have influenza, it is imperative to investigate their medical histories and risk factors. If they have many co-morbidities or risk factors, clinicians should initiate aggressive management immediately regardless of the type of influenza infection.