Publications by authors named "Hyun Ah Kim"

342 Publications

Head-Shaking Nystagmus in Posterior Canal Benign Paroxysmal Positional Vertigo with Canalolithiasis.

J Clin Med 2021 Feb 26;10(5). Epub 2021 Feb 26.

Department of Neurology, School of Medicine, Keimyung University, Daegu 42601, Korea.

Background: There have been several studies about head-shaking nystagmus (HSN) in posterior canal benign paroxysmal positional vertigo (PC-BPPV). The purpose of the study was to determine the characteristics of HSN and its relationship with head-bending nystagmus (HBN) and lying-down nystagmus (LDN) in PC-BPPV and to suggest a possible pathomechanism of HSN based on these findings.

Methods: During the study period, 992 patients with BPPV were initially enrolled. After excluding horizontal or anterior canal BPPV, multiple canals involvement, secondary causes of BPPV, identifiable central nervous system (CNS) disorders, unidentifiable lesion side, or poor cooperation, 240 patients with unilateral PC-BPPV were enrolled. We assessed the frequency, pattern of HSN, and correlation with other induced nystagmus after positional maneuvers such as head bending, lying down, head-turning, and Dix-Hallpike test.

Results: Approximately 32% of patients with PC-BPPV showed HSN. Among patients with HSN, approximately 61% of patients showed predominantly downbeat nystagmus, and two-third of them had a torsional component. The torsional component was mostly directed to the contralesional side. Horizontal nystagmus (36%) and upbeat nystagmus (3%) were also observed after head-shaking in PC-BPPV. The presence of HSN was significantly correlated with that of HBN in PC-BPPV ( = 0.00). The presence of a torsional component of HSN was also significantly correlated with that of HBN in PC- BPPV ( = 0.00).

Discussion: Perverted HSN, a typical sign of central vestibulopathy, is common in posterior canal BPPV and related to HBN. For generating HSN in PC-BPPV, the otolithic movements related to the endolymph dynamics seem to be more important than the velocity storage mechanism.
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http://dx.doi.org/10.3390/jcm10050916DOI Listing
February 2021

Comparison of the clinical characteristics of community-acquired acute pyelonephritis between male and female patients.

J Infect Chemother 2021 Feb 25. Epub 2021 Feb 25.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea. Electronic address:

Background: Community-acquired acute pyelonephritis (CA-APN) is relatively rare in men. This study aimed to compare the clinical characteristics of CA-APN between male and female patients.

Methods: We prospectively collected the clinical and microbiological data of hospitalized CA-APN patients aged ≥19 years in South Korea from March 2010 to February 2011 in 11 hospitals and from September 2017 to August 2018 in 8 hospitals. Only the first episodes of APN of each patient during the study period were included.

Results: From 2010 to 2011, 573 patients from 11 hospitals were recruited, and from 2017 to 2018, 340 patients were recruited from 8 hospitals. Among them, 5.9% (54/913) were male. Male patients were older (66.0 ± 15.2 vs. 55.3 ± 19.0 years, P < 0.001), had a higher Charlson comorbidity index (1.3 ± 1.5 vs. 0.7 ± 1.2, P = 0.027), and had a higher proportion of structural problems in the urinary tract (40.7% vs. 6.1%, P < 0.001) than female patients. Moreover, the total duration of antibiotic treatment was longer (21.8 ± 17.8 d vs. 17.3 ± 9.4 d, P = 0.001) and the proportion of carbapenem usage was higher (24.1% vs. 9.5%, P = 0.001) in men than in women. Male patients were hospitalized for longer durations than female patients (median, 10 d vs. 7 d, P < 0.001).

Conclusions: Male CA-APN patients were older and had more comorbidities than female CA-APN patients. In addition, male patients received antibiotic treatment for a longer duration than female patients.
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http://dx.doi.org/10.1016/j.jiac.2021.02.014DOI Listing
February 2021

Comparison of joint degeneration and pain in male and female mice in DMM model of osteoarthritis.

Osteoarthritis Cartilage 2021 Feb 17. Epub 2021 Feb 17.

Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kyunggi, 14068; Institute for Skeletal Aging, Hallym University, Chunchon 24251, Korea. Electronic address:

Objective: While the prevalence of radiographic and symptomatic osteoarthritis (OA) is higher in women, male mice are more frequently used in animal experiments to explore its pathogenesis or drug efficacy. In this study, we examined whether sexual dimorphism affects pain and joint degeneration in destabilization of the medial meniscus (DMM) mouse model.

Methods: DMM or sham surgery was performed on the knee of male and female C57BL/6 mice. Joint damage was assessed by safranin O staining and scored using the Osteoarthritis Research Society International (OARSI) scoring system. Von Frey hair, incapacitance, and rotarod tests were conducted to measure joint pain. The analgesic effect of capsazepine (CPZ), a TRPV1 antagonist, was compared between male and female mice.

Results: Histology and OARSI scoring analysis showed that cartilage degeneration developed, and progressed in both male and female DMM groups, however, damage was less severe in females at the late stage of OA. Pain behavior, as measured by mechanical allodynia, was displayed for longer in male DMM mice compared to females. Incapacitance data showed that CPZ significantly reduced DMM-induced pain in male mice but not in female mice. Immunofluorescence microscopy analysis demonstrated that DMM surgery increased the expression of TRPV1 in both female and male dorsal root ganglion (DRG). Injection of CPZ significantly suppressed TRPV1 expression in the DRG of male mice only.

Conclusion: Joint damage develops comparably in both female and male mice after DMM although it progresses less in females. There was a subtle sex difference in pain behaviors and analgesic efficacy of a TRPV1 antagonist, which was accompanied by a differential regulation of TPRV1.
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http://dx.doi.org/10.1016/j.joca.2021.02.007DOI Listing
February 2021

Effects of steroid therapy in patients with severe fever with Thrombocytopenia syndrome: A multicenter clinical cohort study.

PLoS Negl Trop Dis 2021 Feb 19;15(2):e0009128. Epub 2021 Feb 19.

Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. Here, we evaluated the effects of steroid therapy in Korean patients with SFTS.

Methods: A retrospective study was performed in a multicenter SFTS clinical cohort from 13 Korean university hospitals between 2013 and 2017. We performed survival analysis using propensity score matching of 142 patients with SFTS diagnosed by genetic or antibody tests.

Results: Overall fatality rate was 23.2%, with 39.7% among 58 patients who underwent steroid therapy. Complications were observed in 37/58 (63.8%) and 25/83 (30.1%) patients in the steroid and non-steroid groups, respectively (P < .001). Survival analysis after propensity score matching showed a significant difference in mean 30-day survival time between the non-steroid and steroid groups in patients with a mild condition [Acute Physiology and Chronic Health Evaluation II (APACHE II) score <14; 29.2 (95% CI 27.70-30.73] vs. 24.9 (95% CI 21.21-28.53], P = .022]. Survival times for the early steroid (≤5 days from the start of therapy after symptom onset), late steroid (>5 days), and non-steroid groups, were 18.4, 22.4, and 27.3 days, respectively (P = .005).

Conclusions: After steroid therapy, an increase in complications was observed among patients with SFTS. Steroid therapy should be used with caution, considering the possible negative effects of steroid therapy within 5 days of symptom onset or in patients with mild disease (APACHE II score <14).
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http://dx.doi.org/10.1371/journal.pntd.0009128DOI Listing
February 2021

Is mastectomy with immediate reconstruction safe for patients undergoing neoadjuvant chemotherapy? A nationwide study from Korean Breast Cancer Society.

Breast Cancer 2021 Feb 14. Epub 2021 Feb 14.

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.

Purpose: In this study, we compared the prognoses of patients who underwent mastectomy with immediate breast reconstruction (IBR) after neoadjuvant chemotherapy with those who underwent mastectomy.

Methods: This retrospective study included 87,995 patients who were surgically treated for primary breast cancer between 2008 and 2014. We compared the three groups of patients who were divided based on the following surgeries: breast-conserving surgery (BCS), mastectomy, and mastectomy with IBR.

Results: Of the 3295 patients who were treated with neoadjuvant chemotherapy, 482 patients achieved a pathological complete response (pCR) and 2813 patients did not (non-pCR). In survival analysis of the pCR patients, the 5-year Overall Survival (5 yr OS) between those who underwent mastectomy with IBR and mastectomy (P = 0.639) In the non-pCR group, 5 yr OS of the mastectomy with IBR group was 90.0%, while those of the mastectomy group was 84.4% in patients with clinical stage II (P = 0.032). In a multivariate analysis by Cox regression method revealed that the prognoses of the patients who underwent mastectomy with IBR were not different from those of patients who underwent mastectomy group in both groups (the pCR group and the non-pCR group).

Conclusion: In the pCR group, the prognoses of patients who underwent mastectomy with IBR were not different from those of patients who underwent mastectomy. In the non-pCR group, women in the mastectomy with IBR group had shown worse prognoses than the mastectomy group in advanced clinical stage. Appropriate operation should be determined depending on the status of individualized patients.
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http://dx.doi.org/10.1007/s12282-021-01223-2DOI Listing
February 2021

Serum uric acid and knee osteoarthritis in community residents without gout: a longitudinal study.

Rheumatology (Oxford) 2021 Jan 25. Epub 2021 Jan 25.

Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.

Objectives: Emerging evidence suggests a potential link between osteoarthritis (OA) and gout; however, the association between serum uric acid (UA) itself and knee OA remains uncertain due to a lack of longitudinal studies. Here, we investigated the association between serum UA and knee OA according to cartilage status in elderly community residents without gout.

Methods: In this longitudinal study, participants without a history of gout were recruited from among the Korean cohort of the Hallym Aging Study (n = 296 for radiography study and n = 223 for MRI study). Weight-bearing knee radiographs and 1.5-T MRI scans, along with blood collection for analysis of serum UA, were performed at baseline and after 3 years. The severity and structural progression of knee OA were evaluated using the Kellgren-Lawrence grading system and the Whole-Organ MRI Score (WORMS) cartilage scoring method. Multivariable logistic regression analysis was conducted using generalized estimating equation (GEE) models.

Results: Serum UA levels were not associated with radiographic progression after adjusting for age, sex, and body mass index (BMI). There was no significant association between serum UA and tibiofemoral cartilage loss on MRI. However, baseline serum UA levels were negatively associated with patellofemoral cartilage loss over 3 years (adjusted odd ratio 0.70, 95% confidence interval 0.49-0.98).

Conclusion: In this population-based cohort, serum UA was not a risk factor for knee OA progression. Further large-scale longitudinal studies in other populations are needed to validate the effects of UA on cartilage damage.
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http://dx.doi.org/10.1093/rheumatology/keab048DOI Listing
January 2021

A preliminary clinical trial to evaluate Cu-NOTA-Trastuzumab as a positron emission tomography imaging agent in patients with breast cancer.

EJNMMI Res 2021 Jan 21;11(1). Epub 2021 Jan 21.

Department of Nuclear Medicine, Korea Cancer Centre Hospital, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul, Korea.

Background: The purpose of this study was to evaluate both the biodistribution and safety of Cu-1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA)-Trastuzumab, a novel Cu-labeled positron emission tomography (PET) tracer for human epidermal growth factor receptor 2 (HER2) in patients with breast cancer.

Methods: PET images at 1, 24, and 48 h after 296 MBq of Cu-NOTA-Trastuzumab injection were obtained from seven patients with breast cancer. Both the primary tumors' and metastatic lesions' maximum standardized uptake value (SUV) was evaluated. The mean SUV (SUV) was evaluated in the other organs, including the blood pool, liver, kidney, muscle, spleen, bladder, and the lungs, as well as the bones. Moreover, the internal radiation dosimetry was calculated using the OLINDA/EXM software. Safety was assessed based on feedback regarding adverse reactions and safety-related issues within 1 month after Cu-NOTA-Trastuzumab administration.

Results: Cu-NOTA-Trastuzumab PET images showed that the overall SUV values in each organ negatively correlated with time. The liver's average SUV values were measured at 5.3 ± 0.7, 4.8 ± 0.6, and 4.4 ± 0.5 on 1 h, 24 h, and 48 h after injection, respectively. The average SUV blood values were measured at 13.1 ± 0.9, 9.1 ± 1.2, and 7.1 ± 1.9 on 1 h, 24 h, and 48 h after injection, respectively. The SUV of HER2-positive tumors was relatively higher than HER2-negative tumors (8.6 ± 5.1 and 5.2 ± 2.8 on 48 h after injection, respectively). Tumor-to-background ratios were higher in the HER2-positive tumors than in the HER2-negative tumors. No adverse events related to Cu-NOTA-Trastuzumab were reported. The calculated effective dose with a 296 MBq injection of Cu-NOTA-Trastuzumab was 2.96 mSv. The highest absorbed dose was observed in the liver (0.076 mGy/MBq), followed by the spleen (0.063 mGy/MBq), kidney (0.044 mGy/MBq), and heart wall (0.044 mGy/MBq).

Conclusions: Cu-NOTA-Trastuzumab showed a specific uptake at the HER2-expressing tumors, thus making it a feasible and safe monitoring tool of HER2 tumor status in patients with breast cancer.

Trial Registration: CRIS, KCT0002790. Registered 02 February 2018, https://cris.nih.go.kr.
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http://dx.doi.org/10.1186/s13550-021-00746-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818354PMC
January 2021

Spontaneous upbeat contratorsional nystagmus with downbeat ipsitorsional nystagmus during horizontal gaze in chronic lateral medullary infarction.

Neurol Sci 2021 Jan 16. Epub 2021 Jan 16.

Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.

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http://dx.doi.org/10.1007/s10072-020-04966-6DOI Listing
January 2021

Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology.

Clin Neurophysiol 2021 Feb 22;132(2):666-682. Epub 2020 Dec 22.

Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA. Electronic address:

Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
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http://dx.doi.org/10.1016/j.clinph.2020.11.024DOI Listing
February 2021

Serologic Evaluation of Healthcare Workers Caring for COVID-19 Patients in the Republic of Korea.

Front Microbiol 2020 20;11:587613. Epub 2020 Nov 20.

Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

The safety of healthcare workers (HCWs) against severe acute respiratory syndrome virus 2 (SARS-CoV-2) transmission is an important aspect of managing the coronavirus disease 2019 (COVID-19) pandemic. In the South Korea, highly stringent infection prevention and control (IPC) guidelines are implemented, and reports of healthcare-associated SARS-CoV-2 transmission among HCWs are limited. However, subclinical infections may have been missed by the current symptom-based screening strategy. To evaluate the risk of undetected SARS-CoV-2 transmissions from COVID-19 patients to HCWs, we conducted a multicenter seroprevalence study after the first surge of the COVID-19 outbreak. A total of 432 HCWs were evaluated, comprising 309 HCWs designated to laboratory-confirmed COVID-19 patient care and 123 non-designated HCWs. Designated HCWs wore personal protective equipment including an N95 respirator, eye protection, hooded overalls, shoe covers, and inner and outer gloves. Use of a powered air-purifying respirator was recommended for aerosol-generating procedures or long-duration care activities. A high-sensitivity (99.1%) fluorescence immunoassay immunoglobulin G (IgG) kit was used as the initial screening test, and two enzyme-linked immunosorbent assay kits for total and IgG antibodies were used to confirm the test results. A microneutralization test was additionally performed to evaluate the neutralizing activity of positive specimens. Among the evaluated HCWs, none of the non-designated HCWs had a positive result, while one of the HCWs designated for COVID-19 patient care (1/309, 0.3%) was seropositive for SARS-CoV-2 with confirmed neutralizing activity (1:40). This finding suggests that subclinical seroconversion may occur among HCWs caring for COVID-19 patients, although the risk is low under strict IPC guidance.
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http://dx.doi.org/10.3389/fmicb.2020.587613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714715PMC
November 2020

Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality.

PLoS One 2020 9;15(12):e0243528. Epub 2020 Dec 9.

Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

Although the lungs are major targets for COVID-19 invasion, other organs-such as the kidneys-are also affected. However, the renal complications of COVID-19 are not yet well explored. This study aimed to identify the incidence of acute kidney injury (AKI) in patients with COVID-19 and to evaluate its impact on patient outcomes. This retrospective study included 704 patients with COVID-19 who were hospitalized at two hospitals in Daegu, Korea from February 19 to March 31, 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The final date of follow-up was May 1, 2020. Of the 704 patients, 28 (4.0%) developed AKI. Of the 28 patients with AKI, 15 (53.6%) were found to have AKI stage 1, 3 (10.7%) had AKI stage 2, and 10 (35.7%) had AKI stage 3. Among these patients, 12 (42.9%) recovered from AKI. In the patients with AKI, the rates of admission to intensive care unit (ICU), administration of mechanical ventilator (MV), and in-hospital mortality were significantly higher than in patients without AKI. Multivariable analysis revealed that old age (Hazard ratio [HR] = 4.668, 95% confidence interval [CI] = 1.250-17.430, p = 0.022), high neutrophil-to-lymphocyte ratio (HR = 1.167, 95% CI = 1.078-1.264, p < 0.001), elevated creatinine kinase (HR = 1.002, 95% CI = 1.001-1.004, p = 0.007), and severe AKI (HR = 12.199, 95% CI = 4.235-35.141, p < 0.001) were independent risk factors for in-hospital mortality. The Kaplan-Meier curves showed that the cumulative survival rate was lowest in the AKI stage 3 group (p < 0.001). In conclusion, the incidence of AKI in patients with COVID-19 was 4.0%. Severe AKI was associated with in-hospital death.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243528PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725289PMC
December 2020

Lessons from a COVID-19 hospital, Republic of Korea.

Bull World Health Organ 2020 Dec 6;98(12):842-848. Epub 2020 Oct 6.

Department of Obstetrics and Gynaecology, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.

Objective: To document the experiences of converting a general hospital to a coronavirus disease 2019 (COVID-19) designated hospital during an outbreak in Daegu, Republic of Korea.

Methods: The hospital management formed an emergency task force team, whose role was to organize the COVID-19 hospital. The task force used different collaborative channels to redistribute resources and expertise to the hospital. Leading doctors from the departments of infectious diseases, critical care and pulmonology developed standardized guidelines for treatment coherence. Nurses from the infection control team provided regular training on donning and doffing of personal protective equipment and basic safety measures.

Findings: Keimyung University Daegu Dongsan hospital became a red zone hospital for COVID-19 patients on 21 February 2020. As of 29 June 2020, 1048 COVID-19 patients had been admitted to the hospital, of which 22 patients died and five patients were still being treated in the recovery ward. A total of 906 health-care personnel worked in the designated hospital, of whom 402 were regular hospital staff and 504 were dispatched health-care workers. Of these health-care workers, only one dispatched nurse acquired COVID-19. On June 15, the hospital management and Daegu city government decided to reconvert the main building to a general hospital for non-COVID-19 patients, while keeping the additional negative pressure rooms available, in case of resurgence of the disease.

Conclusion: Centralized coordination in frontline hospital operation, staff management, and patient treatment and placement allowed for successful pooling and utilization of medical resources and manpower during the COVID-19 outbreak.
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http://dx.doi.org/10.2471/BLT.20.261016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716105PMC
December 2020

Prognostic Factors of COVID-19 Infection in Elderly Patients: A Multicenter Study.

J Clin Med 2020 Dec 4;9(12). Epub 2020 Dec 4.

Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea.

The outbreak of the COVID-19 pandemic is a substantial threat to the health of all populations worldwide, and old age is a robust risk factor for poor prognosis of COVID-19 infection. To reduce the fatality rate of COVID-19 infection, further understanding of elderly patients with COVID-19 is necessary. We aimed to investigate the prognostic factors in elderly patients with COVID-19. This was a multicenter and retrospective study. Overall, 340 elderly patients with COVID-19 were enrolled in 3 hospitals in Daegu, South Korea. Death and severe pneumonia requiring oxygen treatment were defined as poor clinical outcomes. Of the patients studied, 15% died and 35.2% were classified as having severe pneumonia. In binary logistic regression analysis, activities of daily living (ADL) impairment, fever during hospitalization, initial infiltration on chest radiograph, and initial increased C-reactive protein (CRP) were significantly associated with severe pneumonia (OR = 5.33, < 0.001; OR = 3.2, = 0.002; OR = 2.32, = 0.044; and OR = 1.33, < 0.001, respectively). ADL impairment, comorbidity, fever during hospitalization, and initial increased CRP were significantly associated with death (OR = 7.13, < 0.001; OR = 3.28, = 0.005; OR = 3.15, = 0.032, and OR = 1.18, < 0.001, respectively). ADL impairment, fever, and initial CRP were poor prognostic factors in elderly patients with COVID-19. Understanding these poor prognostic factors is necessary to control the disease in elderly patients.
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http://dx.doi.org/10.3390/jcm9123932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761972PMC
December 2020

Early prediction of neoadjuvant chemotherapy response for advanced breast cancer using PET/MRI image deep learning.

Sci Rep 2020 12 3;10(1):21149. Epub 2020 Dec 3.

Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea.

This study aimed to investigate the predictive efficacy of positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) for the pathological response of advanced breast cancer to neoadjuvant chemotherapy (NAC). The breast PET/MRI image deep learning model was introduced and compared with the conventional methods. PET/CT and MRI parameters were evaluated before and after the first NAC cycle in patients with advanced breast cancer [n = 56; all women; median age, 49 (range 26-66) years]. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained with the corresponding baseline values (SUV0, MTV0, and TLG0, respectively) and interim PET images (SUV1, MTV1, and TLG1, respectively). Mean apparent diffusion coefficients were obtained from baseline and interim diffusion MR images (ADC0 and ADC1, respectively). The differences between the baseline and interim parameters were measured (ΔSUV, ΔMTV, ΔTLG, and ΔADC). Subgroup analysis was performed for the HER2-negative and triple-negative groups. Datasets for convolutional neural network (CNN), assigned as training (80%) and test datasets (20%), were cropped from the baseline (PET0, MRI0) and interim (PET1, MRI1) images. Histopathologic responses were assessed using the Miller and Payne system, after three cycles of chemotherapy. Receiver operating characteristic curve analysis was used to assess the performance of the differentiating responders and non-responders. There were six responders (11%) and 50 non-responders (89%). The area under the curve (AUC) was the highest for ΔSUV at 0.805 (95% CI 0.677-0.899). The AUC was the highest for ΔSUV at 0.879 (95% CI 0.722-0.965) for the HER2-negative subtype. AUC improved following CNN application (SUV0:PET0 = 0.652:0.886, SUV1:PET1 = 0.687:0.980, and ADC1:MRI1 = 0.537:0.701), except for ADC0 (ADC0:MRI0 = 0.703:0.602). PET/MRI image deep learning model can predict pathological responses to NAC in patients with advanced breast cancer.
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http://dx.doi.org/10.1038/s41598-020-77875-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712787PMC
December 2020

Association of Postural Instability with Autonomic Dysfunction in Early Parkinson's Disease.

J Clin Med 2020 Nov 23;9(11). Epub 2020 Nov 23.

Department of Neurology, Keimyung University School of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea.

Background: There have been several pathologic data that support an association between postural instability (PI) and autonomic dysfunction in Parkinson's disease (PD). The purpose of this study was to investigate the correlation of PI and autonomic deficits in early PD.

Methods: We collected 17 patients with a diagnosis of early PD. PI was assessed by computerized dynamic posturography (CDP). Standardized autonomic function test (AFT) and time and frequency domain spectral analysis of heart rate variability (HRV) were performed. CDP data obtained from the 21 patients were compared to that from age- and sex-matched healthy controls. We collected HRV data from 18 other age- and sex-matched controls. All patients were evaluated in the "OFF" state. We used Mann-Whitney U-test to compare parameters of CDP between the early PD and control groups. Spearman correlation was used for correlation analysis between parameters of CDP and autonomic function test in PD patients.

Results: Most patients (76.5%) showed mild or moderate autonomic dysfunction in the standardized AFT. In CDP, sensory ratios of equilibrium score (e.g., visual and vestibular) and composite scores were significantly lower in PD patients than in controls. In HRV, the low-frequency/high-frequency ratio during the tilt and the gap of low- frequency/high-frequency ratio from supine to tilt were significantly different in both groups. The parameters of time and frequency domains of HRV reflecting parasympathetic function were correlated with equilibrium scores for somatosensory organization test in CDP.

Discussion: PI was associated with parasympathetic autonomic dysfunction in early PD. This result was in accordance with a previous assumption that PI in PD is related to parasympathetic cholinergic neuron loss in the brainstem.
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http://dx.doi.org/10.3390/jcm9113786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700469PMC
November 2020

Detection of SARS-CoV-2 in Nasal Swabs: comparison with Nasopharyngeal Swabs.

J Infect Dev Ctries 2020 10 31;14(10):1081-1083. Epub 2020 Oct 31.

Division of Infectious disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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http://dx.doi.org/10.3855/jidc.12942DOI Listing
October 2020

Infectious Spondylitis and Septicemia due to : a Literature Review of Non-Endocarditis Cases.

Infect Chemother 2020 09 1. Epub 2020 Sep 1.

Department of Infectious Diseases, Keimyung University Dongsan Hospital, Daegu, Korea.

Lactococci are Gram-positive cocci that occur in short chains or pairs and are traditionally considered to be of low virulence in human. Most species are not associated with human disease. There are few reports regarding isolation in humans and the clinical significance of this rarely-encountered genus is unknown. Here, we report a case of infectious spondylitis due to confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS). A 77-year-old man was admitted to our hospital with back pain that had lasted 5 days. He had diabetes mellitus, hypertension, and histories of pulmonary tuberculosis and endovascular aneurysm repair due to an abdominal aortic aneurysm. Magnetic resonance imaging of his spine revealed paravertebral enhancement on T8-9 and a compression fracture on the lower endplate of T8. On blood cultures, was identified by MALDI-TOF MS. To our knowledge, this is the first report of spondylitis caused by in Korea. In this context, we reviewed non-endocarditis cases due to reported in the English-language literature to summarize its clinical features and outcomes.
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http://dx.doi.org/10.3947/ic.2019.0015DOI Listing
September 2020

Molecular Mechanisms of Sex-Related Differences in Arthritis and Associated Pain.

Int J Mol Sci 2020 Oct 26;21(21). Epub 2020 Oct 26.

Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Gyeonggi 14068, Korea.

Clinical conditions leading to chronic pain show important sex-related differences in the prevalence, severity, and degree of functional disability. Decades of epidemiological and clinical studies have demonstrated that women are more sensitive to pain than men. Arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA), is much more prevalent in females and accounts for the majority of pain arising from musculoskeletal conditions. It is therefore important to understand the mechanisms governing sex-dependent differences in chronic pain, including arthritis pain. However, research into the mechanisms underlying the sex-related differences in arthritis-induced pain is still in its infancy due to the bias in biomedical research performed largely in male subjects and animals. In this review, we discuss current advances in both clinical and preclinical research regarding sex-related differences in the development or severity of arthritis and associated pain. In addition, sex-related differences in biological and molecular mechanisms underlying the pathogenesis of arthritis pain, elucidated based on clinical and preclinical findings, are reviewed.
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http://dx.doi.org/10.3390/ijms21217938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663489PMC
October 2020

Isoflavone intake on the risk of overall breast cancer and molecular subtypes in women at high risk for hereditary breast cancer.

Breast Cancer Res Treat 2020 Nov 17;184(2):615-626. Epub 2020 Oct 17.

Interdisciplinary Program in Cancer Biology, Seoul National University College of Medicine, Seoul, South Korea.

Purpose: We investigated the association between isoflavone (ISF) intake and hereditary breast cancer (BC) risk, particularly by molecular subtype, in East-Asian BRCA1/2 mutation carriers and non-carriers at a high risk of hereditary breast cancer (i.e., family history of BC (FHBC) and early-onset BC [EOBC, age < 40 years]).

Methods: The association between ISF intake and BC risk by molecular subtypes was assessed in 1709 participants (407 BRCA1/2 carriers, 585 FHBC non-carriers, 586 EOBC non-carriers, and 131 unaffected non-carriers) from the Korean Hereditary Breast Cancer Study using hazard ratios (HRs) and 95% confidence intervals (CIs) in weighted Cox regression models. Daily ISF intake was assessed using a validated food frequency questionnaire. We evaluated gene-environment interactions between BRCA1/2 mutation and ISF intake in 1604 BC cases by calculating the case-only odds ratios (CORs) and 95% CIs in logistic regression models.

Results: ISF intake was inversely associated with luminal A BC risk in BRCA2 mutation carriers and FHBC non-carriers (HR = 0.14, 95% CI = 0.04-0.50 for high intake [ISF intake ≥ 15.50 mg/day]; HR = 0.27, 95% CI = 0.11-0.69 for high intake, respectively). We observed a reduced risk of triple negative BC (TNBC) in BRCA1 carriers and FHBC non-carriers (HR = 0.09, 95% CI = 0.02-0.40 for high intake; HR = 0.19, 95% CI = 0.05-0.69 for high intake, respectively). In the case-only design, an interaction between BRCA1 mutation carrier status and ISF intake emerged in TNBC patients (COR = 0.39, 95% CI = 0.16-0.95).

Conclusions: This study suggests that ISF intake is inversely associated with BC risk in women at high risk of hereditary BC and that the effect could differ by molecular subtypes.
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http://dx.doi.org/10.1007/s10549-020-05875-0DOI Listing
November 2020

The Implication of Cardiac Injury Score on In-hospital Mortality of Coronavirus Disease 2019.

J Korean Med Sci 2020 Oct 12;35(39):e349. Epub 2020 Oct 12.

Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.

Backgrounds: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes.

Methods: This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed.

Results: A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, = 0.026), and were more male (59.1% vs. 18.8%, = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis ( = 0.008).

Conclusion: The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.
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http://dx.doi.org/10.3346/jkms.2020.35.e349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550234PMC
October 2020

How to Improve Patient Safety Literacy?

Int J Environ Res Public Health 2020 10 7;17(19). Epub 2020 Oct 7.

Department of Quality Improvement, Konkuk University Medical Center, Seoul 05030, Korea.

The aim of this comparative study involving pre- and post-tests was to analyze the effectiveness of patient safety educational materials developed for the Comprehensive Plans for Patient Safety in Korea (2018-2022), and to suggest how to improve patient safety literacy. A face-to-face survey interview comprising items related to general information and patient safety literacy was completed by 217 patients and their families who visited three general hospitals in Seoul and one general hospital in Gyeonggi-do for treatment between 25 October and 15 November 2019. In the interview, the patients were asked questions about whether the patient safety educational materials were "easy to understand," provided "help in safe hospitalization," and enabled patients to practice patient safety independently ("do it yourself"). The literacy of the patient safety educational materials was analyzed using a paired -test with a value of 0.05. The comparison between patient safety literacy on pre- and post-tests revealed that among all participants, there were significant differences in "easy to understand," "help in safe hospitalization," and "do it yourself" scores. To improve patient safety literacy, patient education materials need to optimize communication by improving patients' knowledge, skills, and attitudes for maintaining and promoting healthy living.
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http://dx.doi.org/10.3390/ijerph17197308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579463PMC
October 2020

Cardiogenic vertigo: characteristics and proposed diagnostic criteria.

J Neurol 2021 Mar 6;268(3):1070-1075. Epub 2020 Oct 6.

Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea.

Early identification of cardiogenic vertigo (CV) is necessary to prevent serious complications of cardiovascular diseases. However, the literature is limited to case reports without detailed clinical features or diagnostic criteria. The aim of this study was to define characteristics of CV and propose diagnostic criteria. This study included patients with CV diagnosed at Pusan National University and Keimyung University Hospitals. Demographic, clinical, laboratory, and treatment data were analyzed. Of 72 patients with clinically suspicious CV, 27 were finally included. The age ranged from 63 to 88 years (75.1 ± 7.2 years). Recurrent vertigo occurred without syncopal attacks in 52% [95% CI, 32-71], while it preceded (37% [19-58]) or followed (11% [2-29]) syncope. The patients with recurrent isolated vertigo had suffered from symptoms from 15 days to 5 years until final diagnosis (median 122 days). The vertigo lasted only for a few seconds (93% [76-99]) or a few minutes (7% [1-24]). Fourteen patients presented with spinning vertigo, and one of them showed spontaneous downbeat nystagmus during the attack. Accompanying symptoms including chest discomfort, palpitation, headache, arm twitching, and lightheadedness were found in 70% [50-86]. Between patients with and without syncope, there was no difference in clinical parameters and results of cardiac function tests. The most common cardiac abnormality during the attacks of vertigo was bradyarrhythmia (89% [71-98]). Cardiovascular diseases can develop recurrent isolated vertigo without or preceding syncope. Onset age, duration of vertigo, accompanying symptoms, and underlying cardiac diseases can aid in differentiation from other vestibular disorders. Early identification of CV would reduce morbidity and mortality associated with cardiac syncope.
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http://dx.doi.org/10.1007/s00415-020-10252-4DOI Listing
March 2021

Absence of pain in subjects with advanced radiographic knee osteoarthritis.

BMC Musculoskelet Disord 2020 Sep 29;21(1):640. Epub 2020 Sep 29.

Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Kyunggi, South Korea.

Background: To investigate the frequency of pain among subjects with advanced radiographic knee osteoarthritis (OA) defined as Kellgren-Lawrence (KL) grade 4 and clinical features associated with pain.

Methods: Subjects from the Hallym Aging Study (HAS), the Korean National Health and Nutrition Examination Survey (KNHANES), and the Osteoarthritis Initiative (OAI) were included. Participants were asked knee-specific questions regarding the presence of knee pain. Clinical characteristics associated with the presence of pain were evaluated with multivariable logistic regression analysis.

Results: The study population consisted of 504, 10,152 and 4796 subjects from HAS, KNHANES, and OAI, respectively. KL grade 4 OA was identified in 9.3, 7.6, and 11.5% of subjects, while pain was absent in 23.5, 31.2, and 5.9% of subjects in KL grade 4 knee OA, respectively. After multivariable analysis, female gender showed a significant association with pain in the KNHANES group, while in the OAI group, younger age did. Advanced knee OA patients without pain did not differ from non-OA subjects in most items of SF-12 in both Korean and OAI subjects. Total WOMAC score was not significantly different between non-OA and advanced knee OA subjects without pain in the OAI.

Conclusions: Our study showed that a considerable number of subjects with KL grade 4 OA did not report pain. In patients whose pain arises from causes other than structural damage of the joint, therapeutic decision based on knee X-ray would lead to suboptimal result. In addition, treatment options focusing solely on cartilage engineering, should be viewed with caution.
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http://dx.doi.org/10.1186/s12891-020-03647-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526196PMC
September 2020

A nationwide, multicenter retrospective study on the effectiveness and safety of eribulin in Korean breast cancer patients (REMARK).

Breast 2020 Dec 16;54:121-126. Epub 2020 Sep 16.

Department of Surgery, Gangnam Severance Hospital Yonsei University, Seoul, South Korea. Electronic address:

Purpose: Approval of eribulin for metastatic breast cancer was based on data primarily from Western patients, and there is a paucity of data on the effectiveness and safety of eribulin for Asian patients. To determine the effectiveness and safety of eribulin in Korean women with breast cancer in a real-world setting, we conducted a nationwide, multicenter, retrospective study.

Methods: Patients with locally advanced or metastatic breast cancer who were treated with eribulin in 14 centers throughout Korea were included in this study. Eribulin was generally administered at a dose of 1.23 mg/m (equivalent to 1.4 mg/m eribulin mesylate) by intravenous infusion for 2-5 min, or as a diluted solution, on Days 1 and 8 of every 21-day cycle. The primary endpoint was progression-free survival (PFS) rate at 6 months. Secondary endpoints included median PFS, overall survival (OS), time-to-treatment failure (TTF), tumor response rate, and incidence of hematologic treatment-emergent adverse events (TEAEs).

Results: The safety and full analysis populations included 398 and 360 (38 had no efficacy data) patients, respectively. The PFS rate at 6 months was 37.8%. Median PFS, OS, and TTF were 134, 631, and 120 days, respectively. Objective response rate, clinical benefit rate, and disease control rate were 18.1%, 50.6%, and 49.4%, respectively. Hematologic TEAEs were reported in 65.1% of patients; neutropenia (56.8%) and anemia (11.3%) were most common.

Conclusion: Real-world effectiveness and safety of eribulin in Korean breast cancer patients were consistent with previous reports; no new safety concerns were identified.
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http://dx.doi.org/10.1016/j.breast.2020.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519365PMC
December 2020

COVID-19: Comparing the applicability of shared room and single room occupancy.

Transbound Emerg Dis 2020 Sep 26. Epub 2020 Sep 26.

Division of Infectious Diseases, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.

To curb the COVID-19 pandemic, isolation measures are required. Shared room occupancy is recommended when isolation rooms are insufficient. However, there is little evidence of the applicability of shared and single room occupancy for patients with COVID-19 to determine whether shared room occupancy is feasible. COVID-19-infected patients admitted to the Daegu Dongsan Hospital of Keimyung University from 21 February 2020 to 20 April 2020 were enrolled in the study and randomly assigned to hospital rooms. Clinical symptoms, underlying diseases and epidemiological data of patients were analysed after dividing participants into a shared room occupancy group (group A) and a single room occupancy group (group B). Outcomes analysed included microbiological cure rates, time to clinical symptom improvement, time to defervescence and negative-to-positive conversion rates of polymerase chain reaction (PCR) results during hospitalization. A total of 666 patients were included in this study, 535 and 131 patients in groups A and B, respectively. Group B included more underlying conditions, such as pregnancy and solid organ transplantation, and was more closely associated with severe pneumonia during hospitalization. Besides, no statistically significant differences between the two groups in terms of negative PCR rates at HD 7 and 14, conversion rates of PCR results from negative-to-positive, as well as time to the improvement of clinical symptoms, and time to defervescence were observed. Our results suggest that the shared room occupancy of patients with mild symptoms could be an alternative to single room occupancy during the COVID-19 pandemic.
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http://dx.doi.org/10.1111/tbed.13853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646660PMC
September 2020

Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic in South Korea in the Past Decade.

Antibiotics (Basel) 2020 Sep 18;9(9). Epub 2020 Sep 18.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea.

This study examined changes in the clinical characteristics of community-acquired acute pyelonephritis (CA-APN) in South Korea between the period 2010-2011 and 2017-2018. We recruited all CA-APN patients aged ≥19 years who visited eight hospitals in South Korea from September 2017 to August 2018, prospectively. Data collected were compared with those from the previous study in 2010-2012, with the same design and participation from 11 hospitals. A total of 617 patients were enrolled and compared to 818 patients' data collected in 2010-2011. was the most common causative pathogen of CA-APN in both periods (87.3% vs. 86.5%, = 0.680). isolates showed significantly higher antimicrobial resistance against fluoroquinolone (32.0% vs. 21.6%, < 0.001), cefotaxime (33.6% vs. 8.3%, < 0.001), and trimethoprim/sulfamethoxazole (37.5% vs. 29.2%, = 0.013) in 2017-2018 than in 2010-2011. Total duration of antibiotic treatment increased from 16.55 ± 9.68 days in 2010-2011 to 19.12 ± 9.90 days in 2017-2018 ( < 0.001); the duration of carbapenem usage increased from 0.59 ± 2.87 days in 2010-2011 to 1.79 ± 4.89 days in 2010-2011 ( < 0.001). The median hospitalization was higher for patients in 2017-2018 than in 2010-2011 (9 vs. 7 days, < 0.001). In conclusion, antimicrobial resistance of to almost all antibiotic classes, especially third generation cephalosporin, increased significantly in CA-APN in South Korea. Consequently, total duration of antibiotic treatment, including carbapenem usage, increased.
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http://dx.doi.org/10.3390/antibiotics9090617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559700PMC
September 2020

Protection of Surgical Team from COVID-19 during Bipolar Hemiarthroplasty in an Infected Elderly Patient.

Clin Orthop Surg 2020 Sep 19;12(3):286-290. Epub 2020 Aug 19.

Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.

The novel coronavirus disease 2019 (COVID-19), which began in Wuhan, China, has rapidly flared up all over the world, evolving into a pandemic. During these critical times, we should give emphasis on infection prevention for the health care staff as well as appropriate patient management in order to maintain the health care system. We report our experience in protecting a surgical team from COVID-19 infection during a bipolar hemiarthroplasty in an infected patient. This case highlights the importance of appropriate protection of the health care staff and education in minimizing the risk of transmission of the infection and maintaining the health care system.
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http://dx.doi.org/10.4055/cios20177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449860PMC
September 2020

The Clinical Characteristics and Outcomes of Patients with Moderate-to-Severe Coronavirus Disease 2019 Infection and Diabetes in Daegu, South Korea.

Diabetes Metab J 2020 08 12;44(4):602-613. Epub 2020 Aug 12.

Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea.

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes.

Methods: We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group.

Results: Compared with the non-DM group (=847), patients with DM (=235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease.

Conclusion: DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.
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http://dx.doi.org/10.4093/dmj.2020.0146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453989PMC
August 2020

Survival after in-hospital cardiopulmonary resuscitation from 2003 to 2013: An observational study before legislation on the life-sustaining treatment decision-making act of Korean patients.

Medicine (Baltimore) 2020 Jul;99(30):e21274

Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kyunggi.

We analyzed cardiopulmonary resuscitation (CPR) rates, deaths preceded by CPR, and survival trends after in-hospital CPR, using a sample of nationwide Korean claims data for the period 2003 to 2013.The Korean National Health Insurance Service-National Sample Cohort is a stratified random sample of 1,025,340 subjects selected from among approximately 46 million Koreans. We evaluated the annual incidence of CPR per 1000 admissions in various age groups, hospital deaths preceded by CPR, and survival rate following in-hospital CPR. Analyses of the relationships between survival and patient and hospital characteristics were performed using logistic regression analysis.A total of 5918 in-hospital CPR cases from 2003 to 2013 were identified among eligible patients. The cumulative incidence of in-hospital CPR was 3.71 events per 1000 admissions (95% confidence interval 3.62-3.80). The CPR rate per 1000 admissions was highest among the oldest age group, and the rate decreased throughout the study period in all groups except the youngest age group. Hospital deaths were preceded by in-hospital CPR in 18.1% of cases, and the rate decreased in the oldest age group. The survival-to-discharge rate in all study subjects was 11.7% during study period, while the 6-month and 1-year survival rates were 8.0% and 7.2%, respectively. Survival tended to increase throughout the study period; however, this was not the case in the oldest age group. Age and malignancy were associated with lower survival rates, whereas myocardial infarction and diabetes mellitus were associated with higher survival rates.Our result shows that hospital deaths were preceded by in-hospital CPR in 18.1% of case, and the survival-to-discharge rate in all study subjects was 11.7% during the study period. Survival tended to increase throughout the study period except for the oldest age group. Our results provide reliable data that can be used to inform judicious decisions on the implementation of CPR, with the ultimate goal of optimizing survival rates and resource utilization.
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http://dx.doi.org/10.1097/MD.0000000000021274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387056PMC
July 2020

Characteristics of COVID-19 Patients Who Progress to Pneumonia on Follow-Up Chest Radiograph: 236 Patients from a Single Isolated Cohort in Daegu, South Korea.

Korean J Radiol 2020 11 27;21(11):1265-1272. Epub 2020 Jul 27.

Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objective: We investigated the prevalence of pneumonia in novel coronavirus disease 2019 (COVID-19) patients using chest radiographs to identify the characteristics of those with initially negative chest radiographs, who were positive for pneumonia on follow-up.

Materials And Methods: Retrospective cohort data of 236 COVID-19 patients were reviewed. Chest radiography was performed on admission, with serial radiographs obtained until discharge. The 'positive conversion group' was defined as patients whose initial chest radiographs were negative but were positive for pneumonia during follow-up. Patients with initially positive chest radiographs were defined as the 'initial pneumonia group.' Patients with negative initial and follow-up chest radiographs were defined as the 'non-pneumonia group.' Clinical and laboratory findings were compared between groups, and predictors of positive conversion were investigated.

Results: Among 236 patients, 108 (45.8%) were in the non-pneumonia group, 69 (29.2%) were in the initial pneumonia group, and 59 (25%) were in the positive conversion group. The patients in the 'initial pneumonia group' and 'positive conversion group' were older, had higher C-reactive protein (CRP) and lactate dehydrogenase levels, and lower absolute lymphocyte counts than those in the 'non-pneumonia group' (all < 0.001). Among patients with negative initial chest radiographs, age ≥ 45 years (odds ratio [OR]: 3.93, 95% confidence interval [CI]: 1.76-8.75, = 0.001), absolute lymphocyte count < 1500 cells/μL (OR: 2.25, 95% CI: 1.03-4.89, = 0.041), and CRP > 0.5 mg/dL (OR: 3.91, 95% CI: 1.54-9.91, = 0.004) were independent predictors for future development of pneumonia.

Conclusion: More than a half of COVID-19 patients initially had normal chest radiographs; however, elderly patients (≥ 45 years of age) with abnormal laboratory findings (elevated CRP and low absolute lymphocyte counts) developed pneumonia on follow-up radiographs.
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http://dx.doi.org/10.3348/kjr.2020.0564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462767PMC
November 2020