The first reported hepatitis E outbreak in a food manufacturing factory: Korea, 2022

Objectives@#On February 16, 2022, 12 cases of hepatitis E virus (HEV) infection were reported in a food manufacturing factory in Korea. The aim of this study was to identify additional cases and to determine the source of this HEV outbreak. @*Methods@#This study was an in-depth investigation of 12 HEV immunoglobulin M (IgM)-positive cases and their demographic, clinical, and epidemiological characteristics. On-site specimens were collected from the environment and from humans, and a follow-up investigation was conducted 2 to 3 months after the outbreak. @*Results@#Among 80 production workers in the factory, 12 (15.0%) had acute HEV infection, all of whom were asymptomatic. The follow-up investigation showed that 3 cases were HEV IgM-positive, while 6 were HEV IgG-positive. HEV genes were not detected in the HEV IgM-positive specimens. HEV genes were not detected in the food products or environmental specimens collected on-site. HEV was presumed to be the causative pathogen. However, it could not be confirmed that the source of infection was common consumption inside the factory. @*Conclusion@#This was the first domestic case of an HEV infection outbreak in a food manufacturing factory in Korea. Our results provide information for the future control of outbreaks and for the preparation of measures to prevent domestic outbreaks of HEV infection.

Communication with a noncooperative patient and his/her family / 의료커뮤니케이션

Difficult patients who meet in the clinic may have a negative effect on the patient’s clinical outcomes by leading to difficulties in history taking, relationship building, diagnosis and treatment. Factors that contribute to non-cooperative patients include physician factors, patient factors, environmental factors, and communication factors. In order to communicate with non-cooperative patients, efforts to prepare for interviews and build relationships, self-reflective attitudes, empathic listening, the use of preceptors or reflective teams, and the maintenance of identity as medical professionals should be emphasized. Multi-party conversations, including family members, may be difficult in patient interviews, and physician should check the emotional responses and expectations that families feel about patient care. Within a family, there are many hidden strengths that could become valuable resources for healing the patient. But they will most likely to come out when families are faced with challenges for which their present repertoire of responses seems inadequate. Health care providers can become a significant part of this process that can result in better patient care and rewarding relationships with families.

Transfusion in RhD Mismatch Hematopoietic Stem Cell Transplantation / 대한수혈학회지

In some cases, hematopoietic stem cell transplants (HSCT) show differences in the D antigen. In previous studies, there have been few cases of de novo anti-D alloimmunization, and even rarer cases of serious side effects or the outcomes. De novo anti-D alloimmunization has been reported to occur more frequently in minor D mismatch than in major D mismatch. For the RhD type of blood components, RhD-negative type is recommended in transfusion in RhD mismatch HSCT without anti-D in donors and recipients. But in situations of insufficient RhD-negative blood supply, this study suggests that the RhD type of blood components depends on the patients’ RhD type before transplantation, and it depends on the donors’ RhD type after transplantation, and an RhD-positive platelet transfusion may be available.

The Association of Relative Handgrip Strength with Impaired Fasting Glucose among Koreans Aged more than 20 Years Old

Background@#The prevalence of impaired fasting glucose (IFG) in Korea is increasing. Few studies have investigated the relationship between handgrip strength (HGS) and type 2 diabetes among Koreans; however, no study has investigated the relationship between IFG and HGS among Koreans. Therefore, we examined the relationship between relative IFG and HGS to evaluate HGS as a marker of prediabetes. @*Methods@#This cross-sectional study analyzed data from participants aged 20 years or older (n=9,190) who did not have diabetes and had had their body mass index, fasting plasma glucose (FPG), and HGS measured in the 2016–2017 Korea National Health and Nutrition Examination Survey. The association between relative HGS and IFG was analyzed using complex sample logistic regression analyses after adjusting for age, education, strengthening exercise, aerobic exercise, smoking, excessive drinking, and chronic diseases. @*Results@#The prevalence of IFG was 31.5 (0.9)% and 19.6 (0.7)% for men and women, respectively. According to the increase in quartile of relative HGS, FPG and HbA1c significantly decreased in both men and women (Ptrend<0.001). In multivariate logistic regression, the odds of IFG significantly decreased with the increase in quartile of relative HGS in both men and women (Ptrend=0.001 for men, Ptrend=0.002 for women). @*Conclusion@#This population-based, nationally representative study suggests that higher relative HGS is associated with a decreased risk of IFG for both men and women.

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

BACKGROUND: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). METHODS: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. RESULTS: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. CONCLUSIONS: The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.

Physicians' Perspectives on the Smoking Cessation Service for Inpatient Smokers

BACKGROUND@#Smoking cessation services for inpatients can be provided effectively through interdisciplinary collaborations. Physicians could play a central role in smoking cessation counseling and treatment for recovery from illness and health promotion of the inpatient. This study aimed to investigate the perspectives of physicians on inpatient smoking cessation services.@*METHODS@#We conducted one personal and two focus group interviews with clinical faculties at a university hospital in Seoul and a university hospital in Chungnam using semi-structured questionnaires. Interviews were recorded, and the transcribed verbatim was analyzed qualitatively.@*RESULTS@#The physicians recognized the need for inpatient smoking cessation services and recognized that smoking cessation was effective when the patient had a smoking-related illness such as respiratory or cardiovascular disease Additionally, the physicians recognized the need for hospital management to support smoking cessation in hospitalized patients and recognized that it was effective to have a dedicated workforce with a smoking cessation coordinator. There was support from four types of physicians in the smoking cessation program: active participant, passive supporter, passive ignorer, and active refuser.@*CONCLUSIONS@#The physician is important for the effective implementation of inpatient smoking cessation services. A dedicated team for the smoking cessation of the inpatient, the establishment of evidence-based data on the effectiveness of the inpatient smoking cessation services, and development of customized smoking cessation services will be necessary to strengthen the role of physicians.

Comparison of Information between Domestic and International Web-Pages for E-Cigarettes: What Are the Differences between Naver and Google?

BACKGROUND@#Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world.@*METHODS@#We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes.@*RESULTS@#There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%.@*CONCLUSIONS@#We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.

Comparison of Information between Domestic and International Web-Pages for E-Cigarettes: What Are the Differences between Naver and Google?

BACKGROUND: Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world. METHODS: We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes. RESULTS: There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%. CONCLUSIONS: We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.

Physicians' Perspectives on the Smoking Cessation Service for Inpatient Smokers

BACKGROUND: Smoking cessation services for inpatients can be provided effectively through interdisciplinary collaborations. Physicians could play a central role in smoking cessation counseling and treatment for recovery from illness and health promotion of the inpatient. This study aimed to investigate the perspectives of physicians on inpatient smoking cessation services. METHODS: We conducted one personal and two focus group interviews with clinical faculties at a university hospital in Seoul and a university hospital in Chungnam using semi-structured questionnaires. Interviews were recorded, and the transcribed verbatim was analyzed qualitatively. RESULTS: The physicians recognized the need for inpatient smoking cessation services and recognized that smoking cessation was effective when the patient had a smoking-related illness such as respiratory or cardiovascular disease Additionally, the physicians recognized the need for hospital management to support smoking cessation in hospitalized patients and recognized that it was effective to have a dedicated workforce with a smoking cessation coordinator. There was support from four types of physicians in the smoking cessation program: active participant, passive supporter, passive ignorer, and active refuser. CONCLUSIONS: The physician is important for the effective implementation of inpatient smoking cessation services. A dedicated team for the smoking cessation of the inpatient, the establishment of evidence-based data on the effectiveness of the inpatient smoking cessation services, and development of customized smoking cessation services will be necessary to strengthen the role of physicians.

Performance Evaluation of the Preanalytic Module of the ACL TOP 750 Hemostasis Lab System

No abstract available.

Percutaneous placement of H-configured triple biliary and enteral stents through a single access: A solution for complex bilio-enteric obstruction

A 75-year-old male with recurrent pancreatic adenocarcinoma after a previous Whipple's procedure presented with jaundice. The local advancement of the tumor caused obstructions of the common bile duct, intrahepatic bile duct hilum, and small bowel. Endoscopic stent insertion was precluded by the Roux-en-Y reconstruction. A successful transhepatic percutaneous single-access stenting of the whole biliary tree and intestine was achieved by H-configured triple stenting by combining T-configured dual stent placement in the biliary system with a duodenal stent insertion across the bottom of the anastomosis after looping a wire in the afferent limb. The ‘H-configured’ stents remained patent for 10 months without major or minor complications. This technique adds a new minimal-invasive and effective palliative option for patients with obstruction of a bilio-enteric anastomosis inaccessible to endoscopy.

Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques

Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers.

Eosinophilic Meningitis after Bovine Graft Duraplasty for Arnold-Chiari Malformation Type 1 in a 33-year-old Man

Cases of pediatric eosinophilic meningitis following duraplasty with a bovine graft have been reported. These patients recovered following the surgical removal of the dural graft or steroid therapy. Decompression for Chiari malformation is a common procedure in both pediatric and adult neurosurgery. We describe the case of a 33-yr-old male patient with eosinophilic meningitis following Chiari decompression via bovine graft duraplasty. Cerebrospinal fluid (CSF) study showed 49 red blood cells/μL and 129 leukocytes/μL with 17% eosinophils. There was no evidence of infectious disease. To our knowledge, this is the first report of adult eosinophilic meningitis after bovine graft duraplasty in Korea.

Analysis of Blood Culture Data at a Tertiary University Hospital, 2006-2015 / 대한임상미생물학회지

BACKGROUND: Cumulative blood culture data provide clinicians with important information in the selection of empiric therapy for blood stream infections. METHODS: We retrospectively analyzed blood culture data from a university hospital during the period from 2006 to 2015. Only the initial isolates of a given species for each patient were included. RESULTS: The number of blood cultures per 1,000 inpatient-days increased from 64 in 2006 to 117 in 2015. The ratio of significant pathogens to total isolates was 0.56-0.63. The most common organisms were Escherichia coli in 2006-2010 but changed to coagulase-negative staphylococci (CoNS) in 2011. The proportion of Staphylococci aureus was decreased during the study period, but Klebsiella pneumoniae was increased. Enterococci were increased, especially E. faecium, which was more frequently isolated than E. faecalis in 2015. Pseudomonas aeruginosa was decreased during the study, but Acinetobacter baumannii was increased. The prevalence of methicillin-resistant S. aureus (MRSA) changed from 62.2% to 53.9%, while vancomycin-resistant E. faecium increased to 35.8%. Extended-spectrum beta-lactamase (ESBL)-producing E. coli and K. pneumoniae increased to 25% and 34%, respectively, in 2015. Starting in 2008, three E. coli and 11 K. pneumoniae isolates were carbapenem-resistant Enterobacteriaceae (CRE), and three were carbapenemase-producing Enterobacteriaceae (CPE). The prevalence of imipenem-resistant A. baumannii rapidly increased during the study period. CONCLUSION: About 60% of all blood isolates were significant pathogens. The most common isolates changed from E. coli to CoNS in 2011. ESBL-producing E. coli and K. pneumoniae, vancomycin-resistant E. faecium, and imipenem-resistant A. baumannii were increased during the study, while the proportion of MRSA tended to decrease slightly. Of the total isolates, 14 were CRE, and 3 were CPE.

Multiple Brain Abscesses Caused by Nocardia asiatica in a Patient With Systemic Lupus Erythematosus: The First Case Report and Literature Review

No abstract available.

Delphi Survey for Designing a Intervention Research Study on Childhood Obesity Prevention / 가정의학회지

BACKGROUND: The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility. METHODS: The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,”“methods of intervention,”“measurement of outcomes,”“future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes. RESULTS: For priority populations, the panel favored “elementary,”“preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention. CONCLUSION: According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.

De novo hepatico-gastric stent placement for biliary stricture via percutaneous transhepatic biliary approach

Biliary stricture formation is a known complication of hepatic surgery in cases of adult living donor liver transplant. In our case, successful percutaneous placement of a hepatico-gastric stent was performed for the drainage of an isolated bile duct after right liver transplant with Roux-en-Y biliary anastomosis in a 42-year-old male. The patient initially presented with cholangitis and a percutaneous transhepatic cholangiogram revealed an isolated stricture of the posterior bile duct. Multiple attempts at regaining continuity of the isolated bile duct with the jejunum were unsuccessful. Thus a tract was created via a percutaneous transhepatic and transluminal approach between the isolated duct and the stomach using a covered stent. The patient had no complications at 18-month follow-up.

Preclinical development of a humanized neutralizing antibody targeting HGF

Hepatocyte growth factor (HGF) and its receptor, cMET, play critical roles in cell proliferation, angiogenesis and invasion in a wide variety of cancers. We therefore examined the anti-tumor activity of the humanized monoclonal anti-HGF antibody, YYB-101, in nude mice bearing human glioblastoma xenografts as a single agent or in combination with temozolomide. HGF neutralization, The extracellular signal-related kinases 1 and 2 (ERK1/2) phosphorylation, and HGF-induced scattering were assessed in HGF-expressing cell lines treated with YYB-101. To support clinical development, we also evaluated the preclinical pharmacokinetics and toxicokinetics in cynomolgus monkeys, and human and cynomolgus monkey tissue was stained with YYB-101 to test tissue cross-reactivity. We found that YYB-101 inhibited cMET activation in vitro and suppressed tumor growth in the orthotopic mouse model of human glioblastoma. Combination treatment with YYB-101 and temozolomide decreased tumor growth and increased overall survival compared with the effects of either agent alone. Five cancer-related genes (TMEM119, FST, RSPO3, ROS1 and NBL1) were overexpressed in YYB-101-treated mice that showed tumor regrowth. In the tissue cross-reactivity assay, critical cross-reactivity was not observed. The terminal elimination half-life was 21.7 days. Taken together, the in vitro and in vivo data demonstrated the anti-tumor efficacy of YYB-101, which appeared to be mediated by blocking the HGF/cMET interaction. The preclinical pharmacokinetics, toxicokinetics and tissue cross-reactivity data support the clinical development of YYB-101 for advanced cancer.

Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics / 가정의학회지

BACKGROUND: The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. METHODS: Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. RESULTS: External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). CONCLUSION: Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.

Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics / 가정의학회지

BACKGROUND: The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. METHODS: Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. RESULTS: External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). CONCLUSION: Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.