No abstract available.
Larva ; Tick Bites*

No abstract available.
Humans ; Sarcoptes scabiei ; Scabies*

No abstract available.
Insect Bites and Stings*

Background: Alopecia areata (AA) is a T cell-mediated autoimmune disease. In patients with chronic AA, hair loss occurs because of the insidious destruction of the stem cells in the hair bulge and hair-bulb matrix along with the attack of the cytotoxic T cells and infiltration of the T-helper 17 cells. Cyclosporine (CsA) inhibits the action of calcineurin in hair stem cells and subsequently induces the inhibition of the nuclear factor of activated T cells c1 and expression of cyclin-dependent kinase 4, thereby stimulating hair regrowth.
Objective
The purpose of this study was to evaluate the long-term therapeutic outcomes of low-dose systemic CsA treatment in patients with chronic AA, relative to their initial severity of AA. Methods: A total of 98 outpatients with chronic AA, who were treated with low-dose systemic CsA, were included in the study. Results: Among the 98 patients, 72 (73.5%) had more than 50% hair regrowth, while 30 patients (30.6%) had more than 90% hair regrowth after 18 months of CsA treatment. Patients with a lower initial severity of alopecia tool (SALT) score demonstrated better treatment outcomes than those with a higher initial SALT score. Conclusion Patients with chronic AA who were treated with low-dose, systemic CsA experienced significant hair regrowth with fewer side effects. Therefore, the use of low-dose, systemic CsA is recommended in the treatment of patients with chronic AA.

Purpose: : This study aims to explore nursing activities after the decision to discontinue life-sustaining treatment, awareness of a good death, and perception of life-sustaining treatment decisions among nurses in intensive care units (ICUs) at tertiary general hospitals. Methods: : Participants were 173 nurses working in two tertiary general hospitals. The data were collected using structured questionnaires and analyzed using an independent t-test, paired t-test, one-way ANOVA, Scheffé’s test, and Pearson’s correlation coefficient. Results: : Participants were 173 nurses working in two tertiary hospitals. The nursing activity increase was the greatest in the spiritual domain, and the physical domain was where the activities decreased the most. There were significant associations between Awareness of good death (Clinical) and Perception of life-sustaining treatment decision(r=.26, p＜.001), Awareness of good death (Closure) and Perception of life-sustaining treatment decision(r=.36, p＜.001), and Awareness of good death (Personal control) and Perception of life-sustaining treatment decision(r=.49, p＜.001). Conclusion : Based on the results, systematic education programs and job training are required to improve the awareness regarding good death and perception of life-sustaining treatment decision for nurses in ICUs where discontinuing lifesustaining treatment decisions are made.

Purpose: To analyze eye drop instillation by glaucoma patients using video-recording. Methods: Glaucoma patients who had applied eye drops to both eyes for more than 1 month were enrolled. Patients who did not self-instill eye drops, those with best-corrected visual acuities of 0.01 or less, and patients requiring glaucoma surgery, were excluded. The patients were requested to instill their eye drops as usual, and this was video-recorded. Patients completed questionnaires exploring their usual instillation methods and the videos were viewed. The correctness of instillation (10 steps) was evaluated. We used the survey and imaging data to explore whether each step was performed correctly, and whether the patients were conscious of their instillation behaviors. We explored whether the survey responses and the video data were consistent. Results: Fifty-four patients were enrolled. Of the 10 steps, washing hands before instillation (9.3%), blocking the tear duct (9.3%), gently shaking the bottle (11.1%), and wiping away excessive eye drops with tissue (11.1%) were the steps that were most commonly poorly performed (as revealed by the videos). The mismatches between the survey and actual performances were greatest in the following order: Wiping away excessive eye drops with tissue (66.7%), delivering a single drop accurately into the eye (59.3%), and closing the eye to allow of absorption (57.4%). Conclusions Great proportion of glaucoma patients instill eye drops incorrectly revealed by video recording. Careful education on how to instill eye drops is required. It may be difficult to detect problems regarding eye drop instillation only by asking questions.

The effects of C-phycocyanin (C-pc), a phycobiliprotein, on the expression of pro-fibrotic mediators in hyper-tropic scarring such as connective tissue growth factor (CTGF) and α-smooth muscle actins (α-SMA) were investigated in relation to trans-differentiation of fibroblast to myo-fibroblast, an icon of scar formation. C-pc was isolated from Spirulina Platensis extract using sonication method and C-pc concentration was determined by Bennet and Bogorad equation. α-SMA and CTGF levels in wounded primary human dermal fibroblasts were determined by western blot analysis and immuno-fluorescence confocal microscope was employed. Fibroblast contractility was examined by three-dimensional collagen lattice contraction assay. There was an elevation of α-SMA (121%) and CTGF (143%) levels in wound cells as compared with non-wound cells. The does-response profiles of down regulation demonstrated that the maximum inhibitions of α-SMA by 63% (p<0.05) and CTGF by 50% (p<0.1) were achieved by C-pc (6 nM) treated cells. In confocal assay, non-wound fibroblasts exhibited basal level of α-SMA staining, while wounded cells without C-pc treatment showed strong up-regulation of α-SMA by 147% (p<0.05). C-pc (6 nM) inhibited α-SMA expression by 70% (p<0.05) and reduced collagen contraction by 29% (p<0.05). C-pc seemed to lessen the over expression of CTGF, α-SMA, subsequently alleviating the fibrotic contracture. This study suggests the potential application of C-pc to regulation of the expression of pro-fibrotic mediators in scarring process and its potential usage as an efficient means for anti-fibrosis therapy.
Actins* ; Blotting, Western ; Cicatrix ; Collagen ; Connective Tissue Growth Factor* ; Connective Tissue* ; Contracture ; Down-Regulation ; Fibroblasts ; Humans ; Methods ; Myofibroblasts ; Phycocyanin* ; Sonication ; Spirulina ; Up-Regulation ; Wound Healing ; Wounds and Injuries

Lower urinary tract dysfunction (LUTD) is a common health challenge in dementia patients with significant morbidity and socioeconomic burden. It often causes lower urinary tract (LUT) symptoms, restricts activities of daily life, and impairs quality of life. Among several LUT symptoms, urinary incontinence (UI) is the most prominent storage symptom in the later stages of dementia. UI in patients with dementia results not only from cognitive impairment, but also from urological defects such as detrusor overactivity. Management of LUTD in patients with dementia is based on multiple factors, including cognitive state, functional impairment, concurrent comorbidities, polypharmacy and urologic condition.Behavioral therapy under caregiver support represents appropriate treatment strategy for UI in these patients. Pharmacological treatment can be considered in patients refractory to behavioral therapy, but it is more effective when combined with behavioral therapy.Antimuscarinics and mirabegron, a beta-3 receptor agonist, are effective for managing storage symptoms involving the LUT. However, anticholinergic side effects in elderly subjects are a concern, particularly when there is a risk of exacerbating cognitive impairment with prolonged use of antimuscarinics. Proper recognition and treatment of LUTD in dementia can improve quality of life in these patients.

Purpose: : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units. Methods: : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels. Results: : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend＜.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend＜.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p ＜.05). Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

BACKGROUND: Singapore has the stable healthcare system with utilizing pharmacist manpower in proper positions by demand of populations' health among Asian countries. OBJECTIVE: This study aims to systematically review (1) the pharmacists' role and (2) the pharmacy education system of Singapore in comparison with Korea. METHOD: We searched for information about academic, medical and governmental institutions related to professional pharmacists' practice in Singapore by primarily using database such as DBpia, KISS, Google Scholar and ProQuest and the official website of the Singapore Ministry of Health. We contacted and arranged the visit schedules with National University of Singapore, National Health Group's polyclinics, Agency for Integrated Care, National University Hospital, and community chain pharmacies. During onsite visits, we interviewed pharmacists working in each institution and obtained additional documents and materials relevant to this manuscript work. RESULTS: To become a registered pharmacist in Singapore, the pharmacy curriculum requires four full-time academic years and six additional months allotted for pre-registration training. Pharm.D. course is offered for pharmacy graduate students with additional two full-time years of study. Team teaching and inter professional education program seem the most significant method in pharmacy education. Pharmacists working at hospitals, polyclinics, and community pharmacies in Singapore take broader roles and offer more cognitive services such as smoking cessation program and medication reconciliation. Especially, pharmacists in Agency for Integrated Care fill the role of primary care providers for the continuing care of the community through the governmental support toward the patients-centered integrated care. CONCLUSION: Singaporean pharmacists take significant and active roles in collaboration with other healthcare providers. Efforts such as interprofessional pharmacy education and governmental endorsement of the systematic and interactive care between pharmacists and other medical providers in Singapore are needed to be urgently applied to Korea healthcare system for the promotion of population health.
Appointments and Schedules ; Asian Continental Ancestry Group ; Cooperative Behavior ; Curriculum ; Delivery of Health Care* ; Education, Pharmacy* ; Education, Professional ; Health Personnel ; Humans ; Korea ; Medication Reconciliation ; Pharmacies ; Pharmacists ; Pharmacy* ; Primary Health Care ; Singapore ; Smoking Cessation