Tumor necrosis factor-alpha (TNF-alpha) inhibitors are increasingly used in treatment of inflammatory disorders because of their immunomodulatory efficacy. Increased risk of infection is an adverse effect of anti-TNF-alpha therapy. The incidence rate and severity of herpes zoster is significantly higher in patients on anti-TNF-alpha therapy than in the general population. The clinical presentation of varicella zoster virus infection is also often atypical in these patients. We experienced a patient who presented with a disseminated varicelliform rash while on etanercept therapy for ankylosing spondylitis.
Exanthema ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Incidence ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha ; Etanercept

Understanding the long-term kinetics of antibodies in coronavirus disease 2019 (COVID-19) is essential in interpreting serosurvey data. We investigated the antibody response one year after infection in 52 mildly symptomatic patients with severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2) infection, using three commercial immunoassays and a surrogate virus neutralization test (sVNT) kit. Anti-N pan-immunoglobulin (Ig), anti-S IgG, and anti-S1 IgG were detected in 43 (82.7%), 44 (84.6%), and 30 (57.7%), respectively. In 49 (94.2%), the antibody could be detected by either anti-N pan-Ig or anti-S IgG assay. In the sVNT, 30 (57.7%) had positive neutralizing activity. Despite waning immunity, SARS-CoV-2 antibodies can be detected up to one year after infection, even in mild COVID-19 patients.

Understanding the long-term kinetics of antibodies in coronavirus disease 2019 (COVID-19) is essential in interpreting serosurvey data. We investigated the antibody response one year after infection in 52 mildly symptomatic patients with severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2) infection, using three commercial immunoassays and a surrogate virus neutralization test (sVNT) kit. Anti-N pan-immunoglobulin (Ig), anti-S IgG, and anti-S1 IgG were detected in 43 (82.7%), 44 (84.6%), and 30 (57.7%), respectively. In 49 (94.2%), the antibody could be detected by either anti-N pan-Ig or anti-S IgG assay. In the sVNT, 30 (57.7%) had positive neutralizing activity. Despite waning immunity, SARS-CoV-2 antibodies can be detected up to one year after infection, even in mild COVID-19 patients.

BACKGROUND: The Fitzpatrick skin type has been a simple and useful method to categorize cutaneous sensitivities to ultraviolet radiation. OBJECTIVE: In this study, we intended to know the distribution of Fitzpatrick skin type in Korean by interview method using questionnaire. METHODS: A total of 1296 Koreans from various districts were included in this study. Each subject was interviewed about their skin reactions to ultraviolet radiation and determined their skin type by interview method. To evaluate the statistical significance, we used generalized logit model. RESULTS: 1. The order of frequency of skin type was type III(48.8%), IV(22.2%), V(17.8%) by the interview method, with the sun sensitive categories(type I and type II) reported for 11.2%. 2. The skin type III was the predominant skin type in both men and women. However, skin type IV was found more frequently in men and it was statistically significant. 3. There is a tendency that frequency of skin type IV and V were increasing with advancement of age. 4. The Fitzpatrick skin type has some relationship with each individual`s occupation, the degree of sun exposure and their own skin color in Korean. CONCLUSION: This study included relative large numbers of subjects from various districts in Korea. It can be used as basic data for various studies related to cutaneous reactions to ultraviolet radiation.
Female ; Humans ; Korea ; Logistic Models ; Male ; Occupations ; Skin* ; Solar System ; Surveys and Questionnaires

BACKGROUND: The Fitzpatrick skin type has been a simple and useful method to categorize cutaneous sensitivities to ultraviolet radiation. OBJECTIVE: In this study, we intended to know the distribution of Fitzpatrick skin type in Korean by interview method using questionnaire. METHODS: A total of 1296 Koreans from various districts were included in this study. Each subject was interviewed about their skin reactions to ultraviolet radiation and determined their skin type by interview method. To evaluate the statistical significance, we used generalized logit model. RESULTS: 1. The order of frequency of skin type was type III(48.8%), IV(22.2%), V(17.8%) by the interview method, with the sun sensitive categories(type I and type II) reported for 11.2%. 2. The skin type III was the predominant skin type in both men and women. However, skin type IV was found more frequently in men and it was statistically significant. 3. There is a tendency that frequency of skin type IV and V were increasing with advancement of age. 4. The Fitzpatrick skin type has some relationship with each individual`s occupation, the degree of sun exposure and their own skin color in Korean. CONCLUSION: This study included relative large numbers of subjects from various districts in Korea. It can be used as basic data for various studies related to cutaneous reactions to ultraviolet radiation.
Female ; Humans ; Korea ; Logistic Models ; Male ; Occupations ; Skin* ; Solar System ; Surveys and Questionnaires

Background/Aims: As the novel coronavirus (coronavirus disease 2019 [COVID-19]) outbreak progresses rapidly, staying home is recommended for suspected patients; however, the safety of this recommendation is uncertain. In Korea, non-hospital facilities called “living and treatment centers (LTCs)” have been established since 5 March 2020. The LTCs provided a unique opportunity to evaluate the safety of selection criteria for low-risk groups. Methods: Between 5 March and 9 April 2020, patients with COVID-19 who met the following criteria were admitted to the LTC; alert, age below 65 years old, no underlying disease or well-controlled underlying disease, body temperature below 38.0°C, whether taking antipyretics or not, and no dyspnea. Patients were closely observed by doctors or nurses’ interviews twice a day and transferred to hospitals when symptoms worsened. Results: A total of 113 patients were admitted to the LTC; 52.2% were female, with a median age of 25 years (interquartile range, 21.5 to 39.5). Of 113 patients, 54 (47.8%) were asymptomatic at diagnosis, and 15 (13.3%) had no symptoms until they were released from isolation. During the follow-up period, two (1.8%) patients were transferred to a hospital but did not progress to severe status during hospitalization. Conclusions The risk of progression was negligible in COVID-19 patients who met the admission criteria for LTC at the time of diagnosis. LTCs could be a safe alternative considering shortage of hospital beds.

Clinical progression over time and cytokine profiles have not been well defined in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. We included 17 patients with laboratory-confirmed MERS-CoV during the 2015 outbreak in Korea. Clinical and laboratory parameters were collected prospectively. Serum cytokine and chemokine levels in serial serum samples were measured using enzyme-linked immunosorbent assay. All patients presented with fever. The median time to defervescence was 18 days. Nine patients required oxygen supplementation and classified into severe group. In the severe group, chest infiltrates suddenly began to worsen around day 7 of illness, and dyspnea developed at the end of the first week and became apparent in the second week. Median time from symptom onset to oxygen supplementation was 8 days. The severe group had higher neutrophil counts during week 1 than the mild group (4,500 vs. 2,200/µL, P = 0.026). In the second week of illness, the severe group had higher serum levels of IL-6 (54 vs. 4 pg/mL, P = 0.006) and CXCL-10 (2,642 vs. 382 pg/mL, P < 0.001). IFN-α response was not observed in mild cases. Our data shows that clinical condition may suddenly deteriorate around 7 days of illness and the serum levels of IL-6 and CXCL-10 was significantly elevated in MERS-CoV patients who developed severe diseases.
Coronavirus ; Coronavirus Infections* ; Dyspnea ; Enzyme-Linked Immunosorbent Assay ; Fever ; Humans ; Interleukin-6 ; Korea ; Middle East Respiratory Syndrome Coronavirus* ; Middle East* ; Neutrophils ; Oxygen ; Prospective Studies ; Thorax

PURPOSE: To understand the involvement of BRCA1 gene in Korean breast and/or ovarian cancer families. MATERIALS AND METHODS: Germline mutations of BRCA1 gene were analyzed in 13 families which included 3 hereditary site-specific breast cancer families, 6 suspected breast cancer families, and 3 suspected breast-ovarian cancer family, and one Li-Fraumeni family by screening BRCA1 gene using single strand conformation polymorphism (SSCP) analysis on polymerase chain reaction (PCR) amplified genomic DNA and confirmed the results by sequencing. RESULTS: Including one family with previously reported nonsense mutation of BRCA1 gene, we detected two mutations in unrelated families. One newly identified mutation was frame shift mutation resulting from TG deletion in codon 1701, which results in a truncated BRCA1 protein, at codon 1714. CONCLUSION: The proportion of families who inherit the mutated BRCA1 gene seems to be small among Korean breast and/or ovarian cancer families.
BRCA1 Protein ; Breast Neoplasms ; Breast* ; Codon ; Codon, Nonsense ; DNA ; Frameshift Mutation ; Genes, BRCA1* ; Germ-Line Mutation* ; Humans ; Mass Screening ; Ovarian Neoplasms* ; Polymerase Chain Reaction

PURPOSE: Recent discovery of BRCA1 and BRCA2 genes has made it possible to perform presymptomatic diagnosis in hereditary breast/ovarian cancer families. We have previously reported germline mutations of the BRCA1 gene in Korean hereditary breast/ovarian cancer families. In that study two out of 13 families were found to have germline mutations in BRCA1 gene. One was a nonsense mutation in codon 1815, and the other was a frameshift mutation due to 2 base-pair deletion in codon 1701 of BRCA1 gene. This study was intended to identify germline mutations of the BRCA2 gene in Korean breast/ovarian cancer families. MATERIALS AND METHODS: Peripheral blood DNA was obtained from 10 breast cancer patients registered at the Korean Hereditary Tumor Registry with positive family history of breast and/or ovarian cancer. Exons 11 and 27 of the BRCA2 gene(together accounting for 50% of the coding region of the BRCA2 gene) were amplified by polymerase chain reaction(PCR) and screened for mutations by in vitro transcription/translation method. For confirmation of the mutations, automatic sequencing of the PCR products displaying abnormal truncated protein bands was perfomed. RESULT: We identified an abnormal truncated protein in the exon 11 of the BRCA2 gene from a member of hereditary breast cancer family, SNU-B4. Sequencing analysis revealed a 4 bp deletion in codons 1248-49 of the exon 11, resulting in frameshift that led to premature stop codon and truncation of the protein product. CONCLUSION: We have identified a germline mutation from a Korean hereditary breast cancer family. So far only one case of the same mutation has been registered in Database of BRCA2 mutation (BIC) by a commercial genetic diagnosis company, Myriad Genetics, Inc. Identification of the germline mutation in BRCA2 gene should aid in the accurate presymptomatic diagnosis of the at-risk members in this family.
Breast Neoplasms ; Breast* ; Clinical Coding ; Codon ; Codon, Nonsense ; Diagnosis ; DNA ; Exons ; Frameshift Mutation ; Genes, BRCA1 ; Genes, BRCA2* ; Genetics ; Germ-Line Mutation* ; Humans ; Ovarian Neoplasms* ; Polymerase Chain Reaction

Four hypertensive patients with chronic renal insufficiency who were treated with sustained release verapamil hydrochloride subsequently developed acute toxic effects. All four patients developed marked bradycardia, hypotension, hyperkalemia and metabolic aciodosis and were treated with atropine, fluid therapy, potasium lowing measure, dialysis, and temporary pacemaker, and were restored to the renal function and sinus rhythm after 12-24 hr. Patients with renal impairement who are treated with sustained release verapamil may accumulate verapamil or its metabolites and develop toxic side effects. We conclude that sustained release verapamil should be used with caution in chronic renal failure and that patients should be closely monitored for adverse cardiovascular, metaboic, and hepatic side effects.
Atropine ; Bradycardia ; Dialysis ; Fluid Therapy ; Humans ; Hyperkalemia ; Hypotension ; Kidney Failure, Chronic* ; Renal Insufficiency, Chronic ; Verapamil*