Disseminated Nontuberculous Mycobacterial Infection in a Tertiary Referral Hospital in South Korea: A Retrospective Observational Study

Purpose@#Disseminated nontuberculous mycobacterial (D-NTM) disease occurs primarily in immunocompromised hosts. However, these cases have rarely been reported in South Korea. This study aimed to describe the clinical manifestations, disease course, and underlying immune deficiencies of patients with D-NTM disease. @*Materials and Methods@#We retrospectively reviewed the cases of D-NTM disease from January 2005 to December 2019 at a tertiary referral hospital in South Korea. D-NTM disease was defined as a bloodstream infection or infection of two or more non-contiguous body organs with species identification. @*Results@#Of the 53342 mycobacterial samples from 23338 patients, extrapulmonary NTM was detected in 104 patients, and 3 (2.9%) were diagnosed with D-NTM disease. Mycobacterium avium was isolated from two patients, while M. abscessus subspecies abscessus was identified in one. The patients were aged between 18 and 25 years, and two patients were male. All patients were immunocompromised – one received lung transplantation, one was diagnosed with anhidrotic ectodermal dysplasia with T-cell immune deficiency, and one had monocytopenia and mycobacterial infection syndrome associated with GATA2 mutations. All patients underwent a standard macrolide-based regimen for >5 months, and their sputum tested negative. However, one patient died of bacterial sepsis, while the other two survived. @*Conclusion@#D-NTM disease is rare in a tertiary referral center in South Korea. They occur primarily in immunocompromised patients at a relatively young age. Careful investigation of the underlying immune status is required when treating patients with DNTM disease.

The snacking pattern, diet, lifestyle and menu preferences of elementary school students in Gyeonggi area, considering the most frequently eaten snacks / 한국영양학회지

Purpose@#This study compares the snacking pattern, diet, lifestyle, and food preference of children by evaluating the most frequently eaten snacks. @*Methods@#The survey enrolled 435 students from three elementary schools in Gyeonggi. Based on the most frequently eaten snacks, the subjects were divided into 3 groups: fruits and milk/dairy products for natural snacks (NS, n = 114); noodles, snack foods and fast foods for meal-like snacks (MS, n = 74); cookies, beverages and bread as sweet snacks (SS, n = 247). @*Results@#Compared to the MS group, preferences of the NS group were significantly higher for jabgokbap (cooked rice with multi-grains, p < 0.05) and saengchae (seasoned raw vegetables, p < 0.01), and significantly lower for gogitwigim (deep-fried meat, p < 0.05). Taste preference of the NS group was considered to be more desirable; the taste preference of more subjects was ‘sweet taste’ in the SS group, ‘spicy taste’ in the MS group, ‘salty taste’ in the MS and SS groups, and ‘sour taste’ and ‘bland taste’ in the NS group than the other groups. Compared tothe MS and SS groups, the NS group was determined to exercise more frequently; exercising for more than 30 minutes/day was determined to be 76.3% in the NS group and 58.1% and 57.9% in the other groups (p < 0.01). Moreover, a higher proportion of subjects in the MS group tended to answer ‘not hungry’ as the reason for leaving school meals, as compared to other groups (p = 0.055), thereby suggesting that inappropriate snacking habits interfere with regular meals. @*Conclusion@#This study provides evidence that healthy snacking habits, which include natural snacks such as milk/dairy products and fruits, are important for children during the elementary school years, since these habits are associated with healthier diet, lifestyle, and food and taste preferences. These results provide basic information for developing nutritional education materials for elementary school children.

Global Trends of Regional Health Information Systems and Suggested Strategic Utilization of their Medical Information / 대한의료정보학회지

Objectives@#Along with the exponentially-growing data produced and accumulated every day through mobile platforms, social networking services, the Internet, and other media, information is becoming increasingly important as a strategic resource. This report presents specific and clear directions and suggests empirical project plans regarding innovations in regional health information systems to promote the utilization of medical information. @*Methods@#We reviewed and examined documents about global trends and examples of regional health information systems. The problems and solutions of health information utilization and regional health information systems in Korea were analyzed. @*Results@#This study presented examples of the establishment of health information systems, problems in the use of local healthcare information, and an empirical project for improvement. @*Conclusions@#The results of this study imply the need for long-term and systematic approaches for the use of medical information and the establishment of a local healthcare information system, along with implementation plans. As a first step, it is imperative to clarify the goal of building a medical information system, the information that must be provided to build the system, and the data that should be collected to provide such information, while moving away from the mentality of focusing on technology-oriented medical information services. In addition, it is necessary to consider information governance, data-based service development, and the medical innovation framework, which are ways to efficiently manage, utilize, and systemize the data to be collected.

Global Trends of Regional Health Information Systems and Suggested Strategic Utilization of their Medical Information / 대한의료정보학회지

Objectives@#Along with the exponentially-growing data produced and accumulated every day through mobile platforms, social networking services, the Internet, and other media, information is becoming increasingly important as a strategic resource. This report presents specific and clear directions and suggests empirical project plans regarding innovations in regional health information systems to promote the utilization of medical information. @*Methods@#We reviewed and examined documents about global trends and examples of regional health information systems. The problems and solutions of health information utilization and regional health information systems in Korea were analyzed. @*Results@#This study presented examples of the establishment of health information systems, problems in the use of local healthcare information, and an empirical project for improvement. @*Conclusions@#The results of this study imply the need for long-term and systematic approaches for the use of medical information and the establishment of a local healthcare information system, along with implementation plans. As a first step, it is imperative to clarify the goal of building a medical information system, the information that must be provided to build the system, and the data that should be collected to provide such information, while moving away from the mentality of focusing on technology-oriented medical information services. In addition, it is necessary to consider information governance, data-based service development, and the medical innovation framework, which are ways to efficiently manage, utilize, and systemize the data to be collected.

Unusual Suicide with Chainsaw: An Autopsy Case Report / 대한법의학회지

In autopsy practice, we encounter case of suicide or murder using various methods or tools. Damage caused by tools such as a knife or hammer is commonly encountered, but a case of damage using a chainsaw is not commonly encountered. We present an autopsy case of a suicide due to neck injury using a chainsaw. A 56-year-old man was found dead with a neck injury and a chainsaw below him. Soft tissue of the neck, thyroid cartilage, trachea, carotid vessels, cervical vertebrae, and cervical spinal cord were found to be cleaved, and a cogwheel-shaped pattern was observed in the injured area.

Unusual Suicide with Chainsaw: An Autopsy Case Report / 대한법의학회지

In autopsy practice, we encounter case of suicide or murder using various methods or tools. Damage caused by tools such as a knife or hammer is commonly encountered, but a case of damage using a chainsaw is not commonly encountered. We present an autopsy case of a suicide due to neck injury using a chainsaw. A 56-year-old man was found dead with a neck injury and a chainsaw below him. Soft tissue of the neck, thyroid cartilage, trachea, carotid vessels, cervical vertebrae, and cervical spinal cord were found to be cleaved, and a cogwheel-shaped pattern was observed in the injured area.

Fatal Complications of Dental Implant Surgery: An Autopsy Case Report / 대한법의학회지

Dental implants have become a popular and rapidly advancing technique to replace missing teeth. They have increasingly been used in the past few decades and have been associated with an increasing number of complications. There may be mechanical side effects, such as implant fracture while chewing, but side effects related to general procedures, such as bleeding and inflammation, may occur. Here, we report an autopsy case of death from pulmonary abscess and pneumonia due to septic emboli from gingival inflammation and sinusitis associated with dental implant surgery.

Unusual Suicide with Chainsaw: An Autopsy Case Report / 대한법의학회지

In autopsy practice, we encounter case of suicide or murder using various methods or tools. Damage caused by tools such as a knife or hammer is commonly encountered, but a case of damage using a chainsaw is not commonly encountered. We present an autopsy case of a suicide due to neck injury using a chainsaw. A 56-year-old man was found dead with a neck injury and a chainsaw below him. Soft tissue of the neck, thyroid cartilage, trachea, carotid vessels, cervical vertebrae, and cervical spinal cord were found to be cleaved, and a cogwheel-shaped pattern was observed in the injured area.

Anesthetic management during the first combined heart-liver transplant performed in Korea: a case report / 대한마취과학회지

Herein, we describe the anesthetic management during the first combined heart-liver transplant (CHLT) performed in Korea. Though CHLT is a rare procedure, accumulating evidence suggests that it is a feasible option for patients with coexisting heart and liver failure. A 45-year-old female patient presented with severe cardiac dysfunction requiring extracorporeal membrane oxygenation (ECMO) support and secondary congestive hepatopathy. The patient underwent consecutive heart and liver transplantation using extracorporeal circulatory devices—heart transplant with cardiopulmonary bypass, and liver transplant with peripheral ECMO. In this case report, we focus on the specific anesthetic considerations for CHLT pertaining to the challenges associated with dual pathophysiology.

Repeated Oral Administration of Human Serum Albumin Protects from the Cerebral Ischemia in Rat Brain Following MCAO

Albumin is known to have neuroprotective effects. The protein has a long half-life circulation, and its effects can therefore persist for a long time to aid in the recovery of brain ischemia. In the present study, we investigated the neuroprotective effects of human serum albumin (HSA) on brain hemodynamics. Albumin is administrated using repeated oral gavage to the rodents. Sprague-Dawley rats underwent middle cerebral artery occlusion procedures and served as a stroke model. Afterwards, 25% human serum albumin (1.25 g/kg) or saline (5 ml/kg) was orally administrated for 2 weeks in alternating days. After 2 weeks, the rodents were assessed for levels of brain ischemia. Our testing battery consists of behavioral tests and in vivo optical imaging sessions. Modified neurological severity scores (mNSS) were obtained to assess the levels of ischemia and the effects of HSA oral administration. We found that the experimental group demonstrated larger hemodynamic responses following sensory stimulation than controls that were administered with saline. HSA administration resulted in more significant changes in cerebral blood volume following direct cortical electric stimulation. In addition, the mNSS of the treatment group was lower than the control group. In particular, brain tissue staining revealed that the infarct size was also much smaller with HSA administration. This study provides support for the efficacy of HSA, and that long-term oral administration of HSA may induce neuroprotective effects against brain ischemia.

The Relation between the Frequency of Family Gathered Meals and the Body Mass Index-Standard Deviation Score in Elementary Students

BACKGROUND: Skipping family gathered meals, because of lack of time due to increased academic demands, leads to nutritional imbalance and further contributes to obesity among children and teens. This study was conducted to underscore the importance of family gathered meals and to serve as a basis for reducing the prevalence of childhood obesity. METHODS: The relation between frequency of family gathered meals and body mass index-standard deviation score (BMI-SDS) was assessed at 247 elementary students in Gyeonggi-do. Survey based on self reported questionnaire was conducted from April to May of 2013. Parental consents from participants were received and parents were asked to answer the questionnaire together with their children. The questionnaire included questions regarding anthropometric characteristics, socioeconomic informations, number and environmental characteristics of family gathered meals, and eating habits of their children. RESULTS: The average frequency of family gathered breakfast was 3.65+/-2.18 times/week, frequency of family gathered dinner was 6.10+/-1.54 times/week, and frequency of family eating-out was 1.64+/-1.43 times/week. Although the prevalence of family gathered breakfast among the participants was shown to be 51%, the prevalence of skipping breakfast was 14.2%, which was relatively high. The BMI-SDS increased in correlation with less frequent breakfast consumptions (P=0.015) and family gathered breakfasts (P<0.001), also with more frequent family gathered dinners (P=0.001) and family eating-outs (P<0.001). CONCLUSION: The eating frequency of breakfast, family gathered breakfast, family gathered dinner, and the family eating-out is associated with BMI-SDS.

Profile of Forensic Autopsy Practices in Small Towns and Cities in Rural Areas / 대한법의학회지

Forensic autopsy service in a metropolitan area of Korea is well established and optimized for high population density based on high social system and infrastructures. However, forensic autopsy in rural areas in our country might be affected due to their low population density, and inconveniences related to special and temporal limitations as well as cultural and traditional limitation. Therefore, for an advanced and optimized model of forensic autopsy service in rural areas, we performed a retrospective analysis on the profile of forensic autopsy based on the eastern part of our nation for 8 years between 2005 and 2013 and analyzed them by cause of death, manner of death, demographic data, toxicological results, and additional information. Through our study we presented the profile of forensic autopsy practice in rural areas and suggested that it can be affected by such regional characteristics.

Myocardial Contrast Defect Associated with Thrombotic Coronary Occlusion: Pre-Autopsy Diagnosis of a Cardiac Death with Post-Mortem CT Angiography

We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

Analysis of Ambiguities of HLA-B Typing using the Dynal RELI(TM) SSO HLA-B Test and Development of an`Interpretation Program for Koreans' / 대한진단검사의학회지

BACKGROUND: In recent years, DNA typing has been increasingly used in HLA-A and B typing, and commercial kits based on the PCR-SSO method are most commonly used in Korea. However, SSO typing kits show ambiguities to some extent in the generic level typing of HLA-B alleles. We analyzed the ambiguities in the Dynal RELI(TM) SSO HLA-B test (Dynal B test) with confirmatory typing results, and developed and evaluated the accuracy and efficacy of an `Interpretation Program for Koreans'. METHODS: A total of 2, 169 Korean marrow donor registry samples were typed for HLA-B alleles using the Dynal B test (56 probes) and all of the 222 cases showing ambiguities were subjected to confirmatory typing. We have developed an `Interpretation Program for Koreans' for the Dynal B test on the basis of the allele frequencies of Korean, Japanese and Asian populations. The samples showing ambiguities in the Dynal B test were interpreted using the `Interpretation Program for Koreans' and the results were compared with confirmatory typing results. RESULTS: The Dynal B test showed 10.2% (222/2, 169) of ambiguities and these ambiguities were classified into 47 different band patterns. These ambiguity patterns were interpreted using the `Interpretation Program for Koreans', which showed ambiguities in 14 band patterns and 3.4% (73/2, 169) of the total samples. Among these ambiguities, 4 band patterns (55 samples) arose from those alleles which are not found in Koreans and rarely found in Japanese or Asians (B*1522, *3521, *7802). Thus, excluding these rarities, only less than 1% (18/2, 169) of samples resulted in ambiguities, and most (16/18) of these were B55 vs. B56 ambiguities. The results from the `Interpretation Program for Koreans' were fully concordant with the confirmatory typing results. CONCLUSIONS: The Dynal B test showed around 10% ambiguities and the `Interpretation Program for Koreans' showed 3.4% of ambiguities. Excluding the ambiguities with extremely low probabilities arising from rare alleles in Japanese or Asians, actually >S99% of the samples could be typed accurately using the program without additional confirmatory tests.