Evolution of the Stethoscope: Advances with the Adoption of Machine Learning and Development of Wearable Devices / 결핵및호흡기질환

The stethoscope has long been used for the examination of patients, but the importance of auscultation has declined due to its several limitations and the development of other diagnostic tools. However, auscultation is still recognized as a primary diagnostic device because it is non-invasive and provides valuable information in real-time. To supplement the limitations of existing stethoscopes, digital stethoscopes with machine learning (ML) algorithms have been developed. Thus, now we can record and share respiratory sounds and artificial intelligence (AI)-assisted auscultation using ML algorithms distinguishes the type of sounds. Recently, the demands for remote care and non-face-to-face treatment diseases requiring isolation such as coronavirus disease 2019 (COVID-19) infection increased. To address these problems, wireless and wearable stethoscopes are being developed with the advances in battery technology and integrated sensors. This review provides the history of the stethoscope and classification of respiratory sounds, describes ML algorithms, and introduces new auscultation methods based on AI-assisted analysis and wireless or wearable stethoscopes.

Clinical outcomes of and risk factors for secondary infection in patients with severe COVID-19: a multicenter cohort study in South Korea

Background/Aims@#Secondary infection with influenza virus occurs in critically ill patients and is associated with substantial morbidity and mortality; however, there is limited information about it in patients with severe coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical outcomes of and risk factors for secondary infections in patients with severe COVID-19. @*Methods@#This study included patients with severe COVID-19 who were admitted to seven hospitals in South Korea between February 2020 to February 2021. Multivariate logistic regression analyses were performed to assess factors associated with the risk of secondary infections. @*Results@#Of the 348 included patients, 104 (29.9%) had at least one infection. There was no statistically significant difference in the 28-day mortality (17.3% vs. 12.3%, p = 0.214), but in-hospital mortality was higher (29.8% vs. 15.2%, p = 0.002) in the infected group than in the non-infected group. The risk factors for secondary infection were a high frailty scale (odds ratio [OR], 1.314; 95% confidence interval [CI], 1.123 to 1.538; p = 0.001), steroid use (OR, 3.110; 95% CI, 1.164 to 8.309; p = 0.024), and the application of mechanical ventilation (OR, 4.653; 95% CI, 2.533 to 8.547; p < 0.001). @*Conclusions@#In-hospital mortality was more than doubled in patients with severe COVID-19 and secondary infections. A high frailty scale, the use of steroids and application of mechanical ventilation were risk factors for secondary infection.

Corticosteroid outcome may be dependent of duration of use in severe COVID-19

Background/Aims@#For patients hospitalized with coronavirus disease 2019 (COVID-19) who require supplemental oxygen, the evidence of the optimal duration of corticosteroid is limited. This study aims to identify whether long-term use of corticosteroids is associated with decreased mortality. @*Methods@#Between February 10, 2020 and October 31, 2021, we analyzed consecutive hospitalized patients with COVID-19 with severe hypoxemia. The patients were divided into short-term (≤ 14 days) and long-term (> 14 days) corticosteroid users. The primary outcome was 60-day mortality. We performed propensity score (PS) analysis to mitigate the effect of confounders and conducted Kaplan-Meier curve analysis. @*Results@#There were 141 (52%) short-term users and 130 (48%) long-term corticosteroid users. The median age was 68 years and the median PaO2/FiO2 at admission was 158. Of the patients, 40.6% required high-flow nasal cannula, 48.3% required mechanical ventilation, and 11.1% required extracorporeal membrane oxygenation. The overall 60-day mortality rate was 23.2%, and that of patients with hospital-acquired pneumonia (HAP) was 22.9%. The Kaplan-Meier curve for 60- day survival in the PS-matched cohort showed that corticosteroid for > 14 days was associated with decreased mortality (p = 0.0033). There were no significant differences in bacteremia and HAP between the groups. An adjusted odds ratio for the risk of 60-day mortality in short-term users was 5.53 (95% confidence interval, 1.90–18.26; p = 0.003). @*Conclusions@#For patients with severe COVID-19, long-term use of corticosteroids was associated with decreased mortality, with no increase in nosocomial complications. Corticosteroid use for > 14 days can benefit patients with severe COVID-19.

Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation / 고신대학교의과대학학술지

Cardiopulmonary resuscitation (CPR) is an important life-saving procedure in emergency care. However, CPR is associated with various complications. A 41-year-old man was admitted to the intensive care unit after CPR. A sudden decrease in the blood pressure and hematocrit level was recorded. An abdominal computed tomography (CT) showed a large subcapsular hematoma in the left lobe of the liver. With conservative treatment, the hematoma reduced in size, but it was later managed with percutaneous drainage. The patient recovered and was discharged. We obtained a favorable outcome with conservative, nonsurgical treatment. Subcapsular hepatic hematoma is a potential life-threatening complication that should be considered in CPR survivors.

Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation / 고신대학교의과대학학술지

Cardiopulmonary resuscitation (CPR) is an important life-saving procedure in emergency care. However, CPR is associated with various complications. A 41-year-old man was admitted to the intensive care unit after CPR. A sudden decrease in the blood pressure and hematocrit level was recorded. An abdominal computed tomography (CT) showed a large subcapsular hematoma in the left lobe of the liver. With conservative treatment, the hematoma reduced in size, but it was later managed with percutaneous drainage. The patient recovered and was discharged. We obtained a favorable outcome with conservative, nonsurgical treatment. Subcapsular hepatic hematoma is a potential life-threatening complication that should be considered in CPR survivors.

Klebsiella pneumoniae-induced Liver Abscess Complicated with Septic Pulmonary Embolism in a Non-diabetic Adult / 고신대학교의과대학학술지

A 72-year-old non-diabetic man was admitted to the intensive care unit because of liver abscess, cholecystitis, and septic shock. He underwent percutaneous catheter drainage and received intravenous antibiotics. Shock was improved, and the patient’s fever subsided. Klebsiella pneumoniae was isolated in blood and bile cultures. However, he suddenly developed dyspnea and oxygen desaturation. Chest computed tomography scan revealed multifocal ground-glass opacities with consolidation with peripheral preponderance. Appropriate antibiotic therapy was provided for 2 weeks. The patient recovered fully, and cholecystectomy was then performed. Herein, we report a case of K. pneumoniae-induced liver abscess complicated with septic pulmonary embolism in a non-diabetic patient.

A Survey of Medical Students' Social Participation and Direction in Medical Education / 의학교육논단

In the ever-changing medical environment, the social participation of medical doctors is becoming more necessary. Currently, there is not enough participation or action by doctors within our society due to reasons such as a lack of educational curriculum in this area. This study aimed to investigate medical students' opinions and attitudes about social participation and action. A total of 438 medical students were surveyed about their attitudes toward doctors' relations with the public, social participation, social action, and medical education for social participation or action. Regarding doctors' relations with the public, participants responded that the government (73.5%) and the media (82.0%) were causing social distrust of doctors, and more than 70% of the respondents answered that doctors were passive when it comes to social participation. When asked about social participation and social action, 76.7% of the students surveyed had experienced social participation, and 28.3% had experienced taking social action. A total of 73.4% of the students answered that medical education needs to be changed, and it is necessary to introduce subjects such as sociology and law to improve social participation and action. The results are significant in that they show medical students' thoughts on social participation and social action as doctors in the Fourth Industrial Revolution. We believe that a change of medical curriculum to promote active and collaborative social participation by doctors is necessary.

Successful Removal of a Large Common Bile Duct Stone by Using Direct Peroral Cholangioscopy and Laser Lithotripsy in a Patient with Severe Kyphosis

A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.

Spontaneous renal artery dissection in Ehlers-Danlos syndrome / 영남의대학술지

Primary dissection of the renal artery is rare. Spontaneous renal artery dissection can be associated with diseases such as medial degeneration, neurofibromatosis, syphilitic arteritis, tuberculosis, polyarteritis nodosa, Marfan syndrome, fibromuscular dysplasia, or Ehlers-Danlos syndrome (EDS). Among these causes, EDS related renal artery dissection is very rare worldwide and has not been previously reported in Korea. EDS are a group of heritable connective tissue disorders characterized by fragility of the skin and hypermobility of the joints. We describe the case history of a young man who presented with left side flank pain, hypermobility of the hand joints and showed left renal artery dissection on computed tomography and angiography that turned out to be the first complication of vascular type EDS.

Heart Failure Secondary to Pazopanib for Treatment of Metastatic Renal Cell Carcinoma / 대한내과학회지

A 78-year-old man was diagnosed with renal cell carcinoma, and left nephrectomy was performed. He started pazopanib. One month later, he visited our hospital because of general weakness and dyspnea. His oxygen saturation was low. A chest X-ray showed pulmonary edema and bilateral pleural effusion. An echocardiogram showed a larger left ventricle and lower ejection fraction than observed at the previous examination. The patient discontinued pazopanib and started diuretics and digoxin. His symptoms improved and a follow-up X-ray showed improvement in the pulmonary edema with bilateral pleural effusion.

Valacyclovir-Induced Neurotoxicity in a Maintenance Hemodialysis Patient

Valacyclovir is an oral antiviral agent used in the treatment of herpesvirus infection. Although neuropsychiatric symptoms may accompany the use of this drug, valacyclovir is increasingly used to treat herpes zoster, as it is more effective when orally administered. This paper reports one case of neurotoxicity of valacyclovir in patients with end stage renal disease who were undergoing maintenance hemodialysis. Valacyclovir can induce life-threatening neurotoxicity, especially in end stage renal disease patients despite the appropriate dose reduction. Furthermore, Valacyclovir-induced neurotoxicity can be effectively managed by intensive hemodialysis.