Association Between Clinical Burden and Blood Eosinophil Counts in Asthma: Findings From a Korean Adult Asthma Cohort

Background@#Some reports have suggested that the clinical and economic burdens of asthma are associated with blood eosinophil levels. The association between clinical burden and blood eosinophil counts were evaluated in a Korean adult asthma cohort. @*Methods@#Clinical information including blood eosinophil counts that were not affected by systemic corticosteroids were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea database. Clinical burden was defined as 1) asthma control status, 2) medication demand and 3) acute exacerbation (AE) events during 1 consecutive year after enrollment. All patients were divided into atopic and non-atopic asthmatics. The associations between asthma outcomes and the blood eosinophil count were evaluated. @*Results@#In total, 302 patients (124 atopic and 178 non-atopic asthmatics) were enrolled. In all asthmatics, the risk of severe AE was higher in patients with blood eosinophil levels < 100 cells/µL than in patients with levels ≥ 100 cells/µL (odds ratio [OR], 5.406; 95% confidence interval [CI], 1.266–23.078; adjusted P = 0.023). Among atopic asthmatics, the risk of moderate AE was higher in patients with blood eosinophil levels ≥ 300 cells/µL than in patients with levels < 300 cells/µL (OR, 3.558; 95% CI, 1.083–11.686; adjusted P = 0.036). Among non-atopic asthmatics, the risk of medication of Global Initiative for Asthma (GINA) steps 4 or 5 was higher in patients with high blood eosinophil levels than in patients with low blood eosinophil levels at cutoffs of 100, 200, 300, 400, and 500 cells/µL. @*Conclusion@#The baseline blood eosinophil count may predict the future clinical burden of asthma.

Clinical Outcomes of a Refractive, Aspheric, Bifocal Intraocular Lens Imparting 1.5 Diopters Adding Power

Purpose@#We evaluated the 3-month, postoperative clinical outcomes of patients implanted with refractive, aspheric, bifocal, Lentis Comfort (LS313-MF15, Oculentis) intraocular lenses (IOLs). @*Methods@#Eighty-two eyes of 51 cataract patients underwent phacoemulsification and were implanted with LentisComfort IOLs. The uncorrected distant visual acuity (UCDVA), the 80-cm uncorrected intermediate visual acuity (UCIVA), the 40-cm uncorrected near visual acuity (UCNVA), and refractive values were evaluated 1 and 3 months postoperatively. At the latter time, defocus curves were drawn, contrast sensitivity tested, and satisfaction surveyed. @*Results@#At the 3-month postoperative follow-up, the mean spherical equivalent was -0.12 ± 0.21 D; and the mean LogMAR UCDVA, 80-cm UCIVA, and 40-cm UCNVA were 0.02 ± 0.03, 0.13 ± 0.07, and 0.42 ± 0.10 respectively. The defocus curves revealed visual acuities in excess of 0.2 LogMAR at points between the distant and intermediate targets. The mean contrast sensitivity fell in the range of 90% of a normal population under both photopic and mesopic conditions. In terms of satisfaction, 71.8% of patients were satisfied or very satisfied, but about 20% reported dysphotopsia. @*Conclusions@#Implantation of the refractive, aspheric, bifocal, intraocular, LentisComfort in patients with cataracts improved both the distant and intermediate visual acuities by 3 months after surgery and the visual quality was comparable to that afforded by other IOLs both objectively and subjectively.

Does the Difference in Microbial Patterns in the Airways Induce Distinct Endotypes of Asthma?

No abstract available.

Bee pollen-induced anaphylaxis: Report of a patient with oral allergy syndrome

Bee pollen is a mixture of pollen, nectar collected by honeybees, and digestive enzymes secreted from honeybees, which is consumed as a dietary supplement. We experienced a case of anaphylaxis after ingestion of bee pollen in a patient with seasonal allergic rhinitis and oral allergy syndrome caused by watermelons, Korean melons, peaches, and plums. The skin prick test was positive for bee pollen, dandelion, ragweed, and mugwort, and specific IgE to honeybee venom was negative. According to the literature, bee pollen causing systemic allergic reactions mainly consists of the plant family Compositae, including dandelion, ragweed, and mugwort. Thus, ingestion of bee pollen should be closely monitored in patients with allergic rhinitis worsening in autumn, especially those with oral allergy syndrome for foods that cross-react with weed pollen.

Analysis of clinical features of adult asthma according to blood basophils and their association with cytokines in exhaled breath condensate

Purpose@#Although basophils are major effector cells involved in asthma, their pathophysiological role in asthma remains uncertain. In this study, we investigated the relationship between blood basophils, clinical features in asthmatics, and cytokines in exhaled breath condensate (EBC) which could be noninvasively obtained. @*Methods@#A total of 13 adult asthmatics were prospectively enrolled. We obtained information on demographics, asthma control levels, history of acute exacerbation as well as the asthma control test and Quality of Life Questionnaire for Adult Korean Asthmatics (QLQAKA) scores. Peripheral blood and EBC samples were collected, and pulmonary function test was also performed. The association between blood basophil count and clinical feature and severity of asthma or inflammatory cytokines in EBC was analyzed. @*Results@#The percentage of blood basophils was positively correlated with that of blood eosinophils (Spearman r=0.665, P=0.013). The number of acute exacerbations was significantly larger (1.2±0.6 vs. 5.3±5.8, P=0.049) in the group with blood basophils ≥50 cells/μL, while the QLQAKA score was lower (68.8±7.9 vs. 49.0±12.0, P=0.028). There were no significant differences in age, atopy status, smoking history, and forced expiratory volume in 1 second according to blood basophil count. Blood basophil count was positively correlated with interleukin-33 (IL-33) (r=0.651, P=0.016) and IL-17 (r=0.732, P=0.004) in EBC. @*Conclusion@#Blood basophils may be associated with frequent asthma exacerbations and lower quality of life due to asthma. IL-33 and IL-17 may be the key mediators that stimulate basophils to participate in the pathogenesis of asthma.

Inhaled Corticosteroids in Asthma and the Risk of Pneumonia

PURPOSE: Asthma is a common disease that is expensive and burdensome for patients. Inhaled corticosteroids (ICS) are the most important drugs for asthma treatment and are often prescribed long-term. However, the use of ICS has been reported to increase pneumonia, though this remains controversial. We evaluated whether the use of ICS increases the risk of pneumonia in asthmatic patients using the Health Insurance Review and Assessment Service (HIRA) database in Korea. METHODS: The Asthma Management Adequacy Assessment was performed by the HIRA in Korea. Patients with claimed insurance benefits for asthma disease codes and who were prescribed asthma medications more than 2 times were enrolled. Patient demographics, asthma medications, healthcare use, and complications were analyzed. RESULTS: The total number of asthma patients was 831,613. Patients using ICS were older and had more comorbidities than those not using ICS; they also visited outpatient clinics and emergency departments, and were more often hospitalized. Pneumonia and other complications occurred more often in patients using ICS, and they used more respiratory medications, except for theophylline. Multiple logistic regression analysis showed that ICS prescription was associated with pneumonia (odds ratio, 1.38; 95% confidence interval, 1.36-1.41). Age, sex, medical care, use of secondary and tertiary hospitals, and hospitalization due to asthma in the previous year were also associated with pneumonia. CONCLUSIONS: ICS use was associated with increasing pneumonia in asthmatic patients in Korea. Therefore, it is critical to acknowledge that the use of ICS may increase the risk of pneumonia and should be meticulously monitored in asthmatics.

Characteristics of Adult Severe Refractory Asthma in Korea Analyzed From the Severe Asthma Registry

PURPOSE: Although mild to moderate asthma is much more common, the morbidity and mortality of severe asthma are much higher. This study was performed to identify and analyze the clinical characteristics of severe asthma in Korea. METHODS: We registered patients with severe refractory asthma into the Severe Asthma Registry supported by the Severe Asthma Work Group of the Korean Academy of Asthma, Allergy and Clinical Immunology. Patients were enrolled since 2010 from the 15 university hospitals nationwide in Korea. Severe asthma was defined according to modified European Respiratory Society/American Thoracic Society criteria. Information on demographics, medical history, pulmonary function tests and skin prick tests was collected; the clinical characteristics of severe asthmatics were analyzed from the collected data. RESULTS: A total of 489 patients were enrolled with a mean age of 62.3; 45% are male. Sixty percent of patients received Global Initiative for Asthma step 4 treatment, and 30% received step 5 treatment. The most common comorbidities were allergic rhinitis (58.7%). Aspirin hypersensitivity was observed in 14.0%. Approximately half (53.9%) are non-smokers. Atopy was proven in 38.5% of the patients. Regarding asthma medications, inhaled corticosteroids and long-acting β-agonist combination inhalers were most commonly prescribed (96.5%), followed by leukotriene antagonists (71.0%). A recombinant anti-immunoglobulin E monoclonal antibody (omalizumab) has been used in 1.8% of the patients. The mean forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC were 78.7%, 67.5% and 67.9% of predicted values, respectively. The mean Asthma Control Test and quality of life questionnaire scores were 16.5 out of 25 and 59.5 out of 85, respectively. CONCLUSIONS: The baseline characteristics of severe asthma patients in the Korea Severe Asthma Registry were analyzed and reported for the first time. With this cohort, further prospective studies should be performed to search for ways to improve management of severe refractory asthma.

Corneal Stromal Edema during Lidocaine Injection for Blepharoplasty

PURPOSE: To report a case of corneal edema caused by an iatrogenic lidocaine injection into the corneal stroma created while performing a local anesthetic (lidocaine) injection into the eyelid for a blepharoplasty procedure. CASE SUMMARY: A 15-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection in the upper blepharon for a blepharoplasty procedure. At the first clinical visit, visual acuity was hand motion and an accurate anterior chamber examination was difficult because of corneal edema. The Seidel test was negative. On corneal optical coherence tomography, the corneal thickness was 1,580 µm without any sign of Descemet's membrane detachment. We prescribed 5% NaCl four times a day and prednisolone acetate eight times a day. On the next day after injury, the corneal edema was significantly improved (central corneal thickness: 660 µm), and Descemet's membrane detachment was still not observed. One week after injury, the naïve visual acuity was 20/20, the central corneal thickness was 560 µm, and the endothelial cell count was 3,260 cells/cm². Three weeks after injury, the corneal edema was fully resolved and only slight temporal corneal haziness remained. After 2 months, the cornea was clear without any subjective discomfort. CONCLUSIONS: Corneal edema without Descemet's membrane detachment can be resolved spontaneously without aggressive treatment such as gas or air injection. However, endothelial cell count and corneal opacity need to be monitored on follow up exam. This clinical experience suggests that severe corneal edema in anterior stromal layer could be spontaneously resolved without severe complication.

Clinical Outcomes of Intraocular Lenses Produced in the Republic of Korea

PURPOSE@#To evaluate the clinical outcomes of aspheric hydrophilic acrylic EYELIKE® (Koryo Eyetech Co., Seoul, Korea) intraocular lenses (IOLs).@*METHODS@#We conducted a retrospective study of 176 consecutive eyes of 160 patients who underwent cataract surgery with implantation of aspheric EYELIKE® IOLs. The following preoperative measurements were collected: slit-lamp examination, uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), automatic and manual keratometry, fundus examination, corneal topography, and specular microscopy. The UCDVA, CDVA, IOP, refraction, and slit-lamp examination were evaluated postoperatively at 1 week and at 1, 3, and 6 months. Specular microscopy was also postoperatively conducted at 1 month.@*RESULTS@#At the 6-month postoperative visit, the mean UCDVA was 0.15 ± 0.23, and the mean CDVA was 0.03 ± 0.07 logarithm of minimal angle of resolution (logMAR). No statistically significant differences were observed among the four groups (postoperative 1 week, postoperative 1 month, postoperative 3 months, and postoperative 6 months) in the manifest spherical equivalent. In total, 74% of IOL Master700 and 54% of A-scan measurements were within ± 0.5 diopters (D) difference from the target refraction, and 95% and 77%, respectively, were within ± 1.0 D from the target refraction. With regard to complications, one case of CME and posterior capsule opacification with decreased visual acuity was detected at month 3 postoperatively; in this case, the CDVA recovered to 0 logMAR with conventional treatment and yttrium aluminium garnetlaser posterior capsulotomy after postoperative 6 months.@*CONCLUSIONS@#Domestically produced EYELIKE® IOLs had high refraction predictability and stability.

Lactobacillus plantarum-derived Extracellular Vesicles Protect Atopic Dermatitis Induced by Staphylococcus aureus-derived Extracellular Vesicles

PURPOSE: The microbial environment is an important factor that contributes to the pathogenesis of atopic dermatitis (AD). Recently, it was revealed that not only bacteria itself but also extracellular vesicles (EVs) secreted from bacteria affect the allergic inflammation process. However, almost all research carried out so far was related to local microorganisms, not the systemic microbial distribution. We aimed to compare the bacterial EV composition between AD patients and healthy subjects and to experimentally find out the beneficial effect of some bacterial EV composition METHODS: Twenty-seven AD patients and 6 healthy control subjects were enrolled. After urine and serum were obtained, EVs were prepared from samples. Metagenomic analysis of 16s ribosomal DNA extracted from the EVs was performed, and bacteria showing the greatest difference between controls and patients were identified. In vitro and in vivo therapeutic effects of significant bacterial EV were evaluated with keratinocytes and with Staphylococcus aureus-induced mouse AD models, respectively. RESULTS: The proportions of Lactococcus, Leuconostoc and Lactobacillus EVs were significantly higher and those of Alicyclobacillus and Propionibacterium were lower in the control group than in the AD patient group. Therefore, lactic acid bacteria were considered to be important ones that contribute to the difference between the patient and control groups. In vitro, interleukin (IL)-6 from keratinocytes and macrophages decreased and cell viability was restored with Lactobacillus plantarum-derived EV treatment prior to S. aureus EV treatment. In S. aureus-induced mouse AD models, L. plantarum-derived EV administration reduced epidermal thickening and the IL-4 level. CONCLUSIONS: We suggested the protective role of lactic acid bacteria in AD based on metagenomic analysis. Experimental findings further suggest that L. plantarum-derived EV could help prevent skin inflammation.

Comparison of Ocular Biometry Using New Swept-source Optical Coherence Tomography-based Optical Biometer with Other Devices

PURPOSE: To evaluate the agreement between optical biometry with swept-source optical coherence tomography-based optical biometry (IOLMaster 700) and other devices. METHODS: A total of 137 eyes (78 patients) with cataracts were included in this retrospective study. Axial length (AL), anterior chamber depth (ACD), keratometry, and white-to-white (WTW) distance measured using IOLMaster 700 were compared with results for the following five different biometers: IOLMaster 500, A-scan, automated refractor, manual keratometry, and Galilei G4. Differences and correlations among the devices were assessed using the Bland-Altman plot and intraclass correlation coefficient (ICC). RESULTS: For AL values, the IOLMaster 700, IOLMaster 500, and A-scan measurements showed excellent agreement (all ICC >0.99). For ACD values, ICC of IOLMaster 700 and Galilei G4 was 0.965 but A-scan was poorly correlated with either IOLMaster 700 or Galilei G4. The ICCs of IOLMaster 700 and other devices were all greater than 0.9 for average keratometry, but those of the mean cylinder keratometry were all between 0.7 and 0.8. The mean difference in the WTW distance between the IOLMaster 700 and Galilei G4 was 0.029 mm, but the ICC was 0.525. AL measurements were not possible for 10 eyes with the IOLMaster 500 but were obtained in all eyes with the IOLMaster 700. CONCLUSIONS: In clinical practice, AL, ACD, and average keratometry values of IOLMaster 700 can be used interchangeably with those of the other devices tested. However, the ACD value between IOLMaster 700 and A-scan or the WTW distance between IOLMaster 700 and Galilei G4 are not interchangeable because of clinical and statistical differences in measurements between the devices.

Clinical Outcomes of Diffractive Aspheric Trifocal Intraocular Lens Implantation

PURPOSE: To evaluate the clinical outcomes of patients with diffractive aspheric trifocal intraocular lens FineVision Pod F IOL (PhysIOL, Liège, Belgium) implantation. METHODS: Thirty eight eyes received phacoemulsification and implantation of FineVision Pod F IOL. Uncorrected distant visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), refractive values, and defocus curve were evaluated at postoperative 1 month and 3 months. Optical quality was evaluated with the contrast sensitivity test, OQAS® (Optical Quality Analysis System, Visiometrics, Cerdanyola del Vallès, Spain) and questionnaire. RESULTS: At the 3-month postoperative follow-up, the mean spherical equivalent was 0.01 ± 0.31 D and the mean UDVA, UIVA and UNVA were 0.04 ± 0.07, 0.19 ± 0.12, and 0.04 ± 0.07, respectively. Mean contrast sensitivities at 0.75, 1.5, 3, 6, 12, and 18 cycles per degrees were 2.00 ± 1.54, 2.16 ± 1.60, 2.25 ± 1.76, 2.16 ± 1.83, 1.52 ± 1.47 and 1.03 ± 0.95 respectively and mean objective scatter index by OQAS® (Optical Quality Analysis System, Visiometrics) was 1.54 ± 0.74. In satisfaction analysis, general satisfaction with surgery was 89% and spectacle independence were 89% at far, 78% at intermediate and 83% at near distance. Postoperative dissatisfaction factors were dryness (36%), glare at night (32%), halo (18%). CONCLUSIONS: The FineVision Pod F IOL showed excellent distant and near visual acuities with an effective intermediate visual acuity. The eyes with FineVision Pod F IOL expected to achieve the favorable visual outcome and patient satisfaction.

A Metagenomic Analysis Provides a Culture-Independent Pathogen Detection for Atopic Dermatitis

PURPOSE: Atopic dermatitis (AD) is an inflammatory skin disease, significantly affecting the quality of life. Using AD as a model system, we tested a successive identification of AD-associated microbes, followed by a culture-independent serum detection of the identified microbe. METHODS: A total of 43 genomic DNA preparations from washing fluid of the cubital fossa of 6 healthy controls, skin lesions of 27 AD patients, 10 of which later received treatment (post-treatment), were subjected to high-throughput pyrosequencing on a Roche 454 GS-FLX platform. RESULTS: Microbial diversity was decreased in AD, and was restored following treatment. AD was characterized by the domination of Staphylococcus, Pseudomonas, and Streptococcus, whereas Alcaligenaceae (f), Sediminibacterium, and Lactococcus were characteristic of healthy skin. An enzyme-linked immunosorbent assay (ELISA) showed that serum could be used as a source for the detection of Staphylococcus aureus extracellular vesicles (EVs). S. aureus EV-specific immunoglobulin G (IgG) and immunoglobulin E (IgE) were quantified in the serum. CONCLUSIONS: A metagenomic analysis together with a serum detection of pathogen-specific EVs provides a model for successive identification and diagnosis of pathogens of AD.

Toxic epidermal necrolysis induced by deflazacort

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions to drugs, which carry significant morbidities and mortalities. Although SJS and TEN can be treated by corticosteroids or intravenous immunoglobulin, they may be induced by steroids. We experienced a 36-year-old man who developed whole body erythromatous maculopapular rashes and multiple bullae after ingestion of deflazacort. After avoidance of deflazacort and use of dexamethasone, skin lesions resorbed. We reported a case of TEN diagnosed by characteristic clinical findings with a brief review of the literature.

Microbiome research in food allergy and atopic dermatitis

Food allergy (FA) and atopic dermatitis (AD) are representative allergic diseases that begin early in life and result in considerable socioeconomic burden. While the pathophysiology and the optimal treatment modalities of these diseases are largely unknown, the role of microbes in health and disease are being highlighted. Recent advances in analyzing microbiome have enabled us to expand our research on impacts of the microbiome on the onset and course of FA and AD. Risk factors that are presumed to affect intestinal microbiome also modulate the onset of allergic diseases, which is more evident in AD than in FA. Considering animal studies, intestinal microbiota interacts with FA and the influence is bi-directional. The activation of regulatory T cell and the innate immune system is supposed to mediate the interaction. Regarding human studies, there exists the difference in the composition of microbiome between subjects with FA or AD and matched normal controls, which can further play as a predictive marker for later development of FA or AD. Probiotics are now investigated as a primary therapeutic agent or as an adjuvant tool for conventional therapies in preventing or modulating FA or AD. Currently, several reports on favorable outcomes become available, which should be replicated and backed up by large-scale studies with more detailed protocols.

Comparison of Clinical Outcomes between Laser Blended Vision and Monovision Laser Refractive Surgery for Presbyopia

PURPOSE: To compare the efficacy and safety of Laser Blended Vision (LBV) and monovision laser refractive surgery (monovision) for presbyopia correction in patients with myopia. METHODS: This retrospective comparative study included 42 eyes of 21 patients with LBV and 50 eyes of 25 patients with monovision. Monocular and binocular distance, intermediate and near visual acuity, and refractive changes were evaluated preoperatively and 3 months after the surgery and compared. The patients in the LBV group underwent further evaluation of spherical aberration 3 months after the surgery and treatment satisfaction 3-6 months after the surgery. RESULTS: The mean age of the patients was 47.9 years in the LBV group and 41.7 years in the monovision group. Three months after surgery, the spherical equivalents were +0.11 ± 0.17 D in the dominant eye and -1.52 ± 0.36 D in the non-dominant eye in the LBV group. In contrast, the spherical equivalents were +0.23 ± 0.26 D in the dominant eye and -0.82 ± 0.28 D in the non-dominant eye in the monovision group. All patients achieved a binocular uncorrected distance visual acuity of 0.10 (log MAR) or better, and 86% of the LBV group and 100% of the monovision group achieved a binocular uncorrected intermediate visual acuity of better than 0.10. Moreover, 95% of the LBV group and 100% of the monovision group achieved a binocular uncorrected near visual acuity of better than 0.18. In the LBV group, mean spherical aberration increased after surgery than before, but it was not statistically significant. Complications such as corneal opacity that could decrease visual acuity were absent in both groups. Overall patient satisfaction after surgery was 80% in the LBV group. CONCLUSIONS: Despite the relatively higher mean age of the LBV group, both groups showed similar results regarding presbyopia correction in patients with myopia.

House Dust Mite-Derived Chitin Enhances Th2 Cell Response to Inhaled Allergens, Mainly via a TNF-α-Dependent Pathway

PURPOSE: Chitin is a potent adjuvant in the development of immune response to inhaled allergens in the airways. According to other studies, chitin is known as multi-faced adjuvants which can induce Th2 responses. Recently, we found that TNF-α is a key mediator in the development of Th2 cell response to inhaled allergens. Here, we evaluated the immunologic mechanisms in the development of airway hypersensitivity to inhaled allergens, enhanced by house dust mite (HDM)-derived chitin. METHODS: The role of TNF-α and TLRs was evaluated in an airway hypersensitivity mouse model induced by a sensitization with an allergen (ovalbumin, OVA) and HDM-derived chitin using mice with the null mutation of target genes. RESULTS: The present study showed that airway sensitization with HDM-derived chitin plus OVA enhanced OVA-induced airway inflammation v. OVA alone. This phenotype was associated with the increased expression of Th1, Th2, and Th17 cytokines and also with the enhanced production of OVA-specific IgE, IgG1, and IgG2a. As for T cell responses, OVA-specific Th2 cell response, enhanced by chitin, was abolished by the treatment of chitinase, whereas Th1 and Th17 cell responses enhanced by this treatment. Moreover, the null mutation of the TNF-α gene revealed similar effects as the chitinase treatment. In contrast, all the OVA-specific T cell responses, enhanced by chitin, were blocked by the absence of TLR2, but not of TLR1, TLR4, or TLR6. CONCLUSIONS: In conclusion, these data suggest that HDM-derived chitin may enhance airway hypersensitivity to inhaled allergens, via the TLR2-dependent pathway, and that chitin-induced TNF-α can be a key mediator in the development of Th2 cell response to inhaled allergens.

Osteochondroma Arising from Anterior Inferior Iliac Spine as a Cause of Snapping Hip

Snapping hip syndrome is a relatively common problem that can be easily managed with conservative treatment. This syndrome can be divided into external, internal and intra-articular types. Internal snapping hip syndrome is the rarest amongst these and its etiology is not well understood. We report a unique case of osteochondroma arising from the anterior inferior iliac spine (AIIS), which caused the internal snapping hip syndrome with hip pain and restriction of activity. This rare case of snapping hip syndrome from the AIIS was treated surgically and the symptoms completely disappeared after excision of the tumor.

Sensory Neuropathy of the Common Palmar Digital Nerve Caused by Ganglion Cyst

Ganglion cysts that arise from the palm and compress the median nerve are rarely reported. Previous studies have described ganglion cysts compressing the motor branch of the median nerve, but no reports have described sensory neuropathy of the common palmar digital nerve as a result of ganglion cysts. We present a case of sensory neuropathy similar to carpal tunnel syndrome caused by a ganglion cyst that originated from the second carpometacarpal joint.

Factors associated with mortality after asthma admission in the intensive care unit of a tertiary referral hospital

PURPOSE: Asthma is a global health concern involving 300 million people, and mortality due to asthma still accounts for a significant proportion of deaths. The purpose of this study was to define risk factors for the mortality of patients admitted to the intensive care unit because of asthma exacerbation. METHODS: A retrospective analysis of 163 severe asthma patients, who were admitted to Ewha Womans University Mokdong Hospital from January 1997 to December 2011 with the need for intensive medical care, was performed. The medical history and laboratory workup at initial visit to hospital were collected by reviewing medical records. To identify risk factors for mortality, data was compared between the survivors (survivor group) and the dead (death group). RESULTS: As a result, mortality rate was 30.7%. The number of patients 65 years or older was larger in the death group. The number of patients on mechanical ventilation was larger in the death group compared to the survivor group. In arterial blood gas analysis, the levels of pH and PaO2 were higher and the PCO2 levels were lower in the death group. In multivariate analysis, the risk of death was higher in patients on mechanical ventilation (odds ratio [OR], 5.327). PCO2 and O2 saturation were protective factors for mortality (OR, 0.90 and 0.915, respectively). CONCLUSION: Use of mechanical ventilator, low PCO2, and O2 saturation are the most important factors for mortality while admitted to the intensive care unit in severe asthma patients. We should pay attention to patients who are on mechanical ventilation and have low PCO2 and O2 saturation levels.