PURPOSE: This study aims to verify the effects of the Group Motivational Interviewing Compliance Therapy on drug attitude, medicine application self-efficacy and medicine application in psychiatric patients. METHODS: This was a quasi-experimental study with a non-equivalent control group pre-posttest design. Participants were 43 patients (22 in experimental group and 21 in control group) who were registered at neuro-psychiatric day care center in one university hospital, S city. The experimental group received the Group Motivational Interviewing Compliance Therapy for 6 sessions over 6 weeks. Data were collected between November, 2014 and September, 2016. Comparison of the pre-post results was performed by paired t-test and between-group effect was analyzed by ANCOVA with the SPSS/WIN 23.0 program. RESULTS: The experimental group had a significant increase in drug attitude compared to the control group. However, there was no significant difference in medicine application self-efficacy and medicine application between the two groups. CONCLUSION: The Group Motivational Interviewing Compliance Therapy is suggested as a promising program that helps psychiatric patients improve drug attitude. Further studies are needed to confirm the effects of the Group Motivational Interviewing Compliance Therapy.
Compliance* ; Day Care, Medical ; Humans ; Medication Adherence ; Motivational Interviewing* ; Non-Randomized Controlled Trials as Topic

The spontaneous spinal epidural hematoma is rare, but the severe and permanent motor disability underlines its importance. The clinical picture begins with a local spinal and radicular pain but some hours or days later progressive neurologic symptoms develop. The standard treatment for spinal epidural hematoma has been a prompt surgical evacuation. We reported two cases of spontaneous spinal epidural hematoma which had no underlining conditions. The neurological deficit progressed to complete paraplegia despite of an early operation in one case of hematoma located in T2, 3 level, whereas another case in T10 to L2 level showed complete paraplegia at the initial evaluation but good functional recovery after the operation. The outcomes seemed to be dependent mainly on the location of hematoma in the spinal cord. So early diagnosis and prompt surgical treatment are critical to the patient with hematoma located in the upper thoracic level and progressive neurological deficit.
Early Diagnosis ; Hematoma ; Hematoma, Epidural, Spinal* ; Humans ; Neurologic Manifestations ; Paraplegia ; Spinal Cord

OBJECTIVE: To analyze the clinical and electrodiagnostic findings of patients with failed back surgery syndrome after lumbar disc operation. METHOD: We investigated 28 patients with back and/or lower limb pain and weakness who were underwent lumbar spine operation. Seven patients who had undergone surgery due to spinal infection or fracture were excluded. Twenty-one patients included 7 female and 14 male patients with ages 20~63 years, and the mean age was 44.4 years. The following data were evaluated: clinical symptoms, neurological examination, duration from operation to first visit, preoperative diagnosis, operation number and site, electrodiagnostic studies, radiologic studies (simple radiographs, epidurography, CT, MRI), and psychological evaluations (SCL-MPD). RESULTS: The time of the visit after the operation varied between one month and 15 years (mean 48.5 months). Electrodiagnostic study revealed lumbar radiculopathy in 18 patients and the most common level was at the fifth lumbar root. All eight patients who undergone epidurography showed filling defect or indentation. Psychologic evaluations were performed on five patients and they revealed high scores in depression and somatization. CONCLUSION: Clinical and electrodiagnostic findings of lumbar radiculopathy, abnormal epidurographic findings and psychological results after lumbar disc operation were related to the causes of failed back surgery syndrome.
Depression ; Diagnosis ; Failed Back Surgery Syndrome* ; Female ; Humans ; Lower Extremity ; Male ; Neurologic Examination ; Radiculopathy ; Spine

We aimed to review the current data composition of the Korean Tuberculosis and Post-Tuberculosis Cohort, which was constructed by linking the Korean Tuberculosis Surveillance System (KNTSS; established and operated by the Korean Disease Control and Prevention Agency since 2000) and the National Health Information Database (NHID; established by the National Health Insurance Service in 2012). The following data were linked: KNTSS data pertaining to patients diagnosed with tuberculosis between 2011 and 2018, NHID data of patients with a history of tuberculosis and related diseases between 2006 and 2018, and data (obtained from the Statistics Korea database) on causes of death. Data from 300 117 tuberculosis patients (177 206 men and 122 911 women) were linked. The rate of treatment success for new cases was highest in 2015 (86.7%), with a gradual decrease thereafter. The treatment success rate for previously treated cases showed an increasing trend until 2014 (79.0%) and decreased thereafter. In total, 53 906 deaths were confirmed among tuberculosis patients included in the cohort. The Korean Tuberculosis and Post-Tuberculosis Cohort can be used to analyze different measurement variables in an integrated manner depending on the data source. Therefore, these cohort data can be used in future epidemiological studies and research on policy-effect analysis, treatment outcome analysis, and health-related behaviors such as treatment discontinuation.

OBJECTIVES: Patients, who have had a history of benign paroxysmal positional vertigo (BPPV)-like symptoms, but no characteristic nystagmus, were often present. They are diagnosed as having a resolved state from BPPV or normal, and tend to be overlooked. We investigated the dizzy and psychological scales in BPPV-suspicious patients. METHODS: Thirty-nine patients, which they had vertigo of a short duration at the specific head position, and clinically suspicious BPPV, but no nystagmus in positional tests, were enrolled. We compared dizzy and psychological scales of suspicious BPPV patients with 138 BPPV patients, using dizziness handicap inventory (DHI), the beck depression inventory (BDI), and the Spielberger state-trait anxiety inventory. Additionally, among the BPPV-suspicious group, patients with a BPPV history were compared with those with no previous BPPV. RESULTS: No differences in the all scales were found between the two groups. However, DHI scores of patients with a previous BPPV attack were significantly higher than those of patients with no BPPV-like symptoms; in particular, there was a significant difference in emotional scores. CONCLUSION: Although the patients had no characteristic nystagmus, if they have a BPPV-like history and symptoms, emotional support and periodic follow up are needed. In particular, careful observation should be performed in patients with previous BPPV attack.
Anxiety ; Benign Paroxysmal Positional Vertigo ; Depression ; Dizziness ; Follow-Up Studies ; Head ; Humans ; Vertigo ; Weights and Measures

Objective: To prove the hypothesis that the parameters of intraoperative neurophysiological monitoring (IONM) during will be more deteriorated in neuromuscular scoliosis (NMS) than in adolescent idiopathic scoliosis (AIS). Methods: This retrospective study reviewed the data of 69 patients (NMS=32, AIS=37) who underwent scoliosis surgery under IONM. The amplitude of motor evoked potentials (MEPs), and the amplitude and the latency of somatosensory evoked potentials (SEPs) were examined. Demographic, preoperative, perioperative and postoperative data were analyzed to determine whether they affected the IONM parameters for each group. Results: Of the items analyzed, the bleeding amount was the only significant risk factor for SEP latency deterioration in the NMS group only. The amplitude of SEP and MEP did not correlate with the hemodynamic parameters. The NMS/AIS ratios of the bleeding-related parameters were higher in the order of bleeding amount/weight (2.62, p<0.01), bleeding amount/body mass index (2.13, p<0.01), and bleeding amount (1.56, p<0.01). This study suggests that SEP latency is more vulnerable than SEP or MEP amplitude in ischemic conditions during scoliosis surgery. Conclusion In NMS patients, it should be considered that the bleeding amount can have a critical effect on intraoperative electrophysiological deterioration.

Background: Effective treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis (FQr-MDR-TB) is difficult because of the limited number of available core anti-TB drugs and high rates of resistance to anti-TB drugs other than FQs. However, few studies have examined anti-TB drugs that are effective in treating patients with FQr-MDR-TB in a real-world setting. Methods: The impact of anti-TB drug use on treatment outcomes in patients with pulmonary FQr-MDR-TB was retrospectively evaluated using a nationwide integrated TB database (Korean Tuberculosis and Post-Tuberculosis). Data from 2011 to 2017 were included. Results: The study population consisted of 1,082 patients with FQr-MDR-TB. The overall treatment outcomes were as follows: treatment success (69.7%), death (13.7%), lost to follow-up or not evaluated (12.8%), and treatment failure (3.9%). On a propensity-score-matched multivariate logistic regression analysis, the use of bedaquiline (BDQ), linezolid (LZD), levofloxacin (LFX), cycloserine (CS), ethambutol (EMB), pyrazinamide, kanamycin (KM), prothionamide (PTO), and para-aminosalicylic acid against susceptible strains increased the treatment success rate (vs. unfavorable outcomes). The use of LFX, CS, EMB, and PTO against susceptible strains decreased the mortality (vs. treatment success). Conclusion A therapeutic regimen guided by drug-susceptibility testing can improve the treatment of patients with pulmonary FQr-MDR-TB. In addition to core anti-TB drugs, such as BDQ and LZD, treatment of susceptible strains with later-generation FQs and KM may be beneficial for FQr-MDR-TB patients with limited treatment options.

Background: The treatment outcomes of patients with multidrug/rifampin-resistant (MDR/RR) tuberculosis (TB) are important indicators that reflect the current status of TB management and identify the key challenges encountered by TB control programs in a country. Methods: We retrospectively evaluated the treatment outcomes as well as predictors of unfavorable outcomes in patients with MDR/RR-TB notified from 2011 to 2017, using an integrated TB database. Results: A total of 7,226 patients with MDR/RR-TB were included. The treatment success rate had significantly increased from 63.9% in 2011 to 75.1% in 2017 (P < 0.001). Among unfavorable outcomes, the proportion of patients who failed, were lost to follow up, and were not evaluated had gradually decreased (P< 0.001). In contrast, TB-related death rate was not significantly changed (P= 0.513), while the non-TB related death rate had increased from 3.2% in 2011 to 11.1% in 2017 (P < 0.001). Older age, male sex, immigrants, low household income, previous history of TB treatment, and comorbidities were independent predictors of unfavorable outcomes. Of the 5,308 patients who were successfully treated, recurrence occurred in 241 patients (4.5%) at a median 18.4 months (interquartile range, 9.2–32.4) after completion treatment. Conclusion The treatment outcomes of patients with MDR/RR-TB has gradually improved but increasing deaths during treatment is an emerging challenge for MDR-TB control in Korea. Targeted and comprehensive care is needed for vulnerable patients such as the elderly, patients with comorbidities, and those with low household incomes.

Background/Aims: To determine whether metformin, which is considered a host-directed therapy for tuberculosis (TB), is effective in improving the prognosis of patients with TB and diabetes mellitus (DM), who have higher mortality than those without DM. Methods: This cohort study included patients who were registered as having TB in the National Tuberculosis Surveillance System. The medical and death records of matched patients were obtained from the National Health Information Database and Statistics Korea, respectively, and data from 2011 to 2017 were collected retrospectively. We classified patients according to metformin use among participants who used diabetes drugs for more than 28 days. The primary outcome was all-cause mortality during TB treatment. Double propensity score adjustment was applied to reduce the effects of confounding and multivariable Cox proportional hazard models were used to estimate adjusted hazard ratio (aHR) with 95% confidence interval (CI). Results: The all-cause mortality rate during TB treatment was lower (9.5% vs. 12.4%, p < 0.01) in the metformin user group. The hazard of death due to all causes after double propensity score adjustment was also lower in the metformin user group (aHR 0.76, 95% CI 0.67–0.86, p < 0.01). There was no significant difference in mortality between metformin users and non-users for TB-related deaths (p = 0.22); however, there was a significant difference in the non-TB-related deaths (p < 0.01). Conclusions Metformin use in patients with TB–DM co-prevalence is associated with reduced all-cause mortality, suggesting the potential for metformin adjuvant therapy in these patients.

BACKGROUND: Keloids are abnormal wound responses that are caused by hyperproliferative growth of connective tissue during the healing process. Recent research findings introduced the roles of reactive oxygen species (ROS) in the process of keloid formation. ROS induces oxidative stress and promotes the activities of oxidative damage-inducible genes. Aldo-keto reductase 1C3 (AKR1C3) prevents destructive ROS toxicity by detoxification of reactive carbonyl species. Thus, this study aimed to compare the expression of AKR1C3 in both normal and keloid skin in vivo. METHODS: Six specimens of normal skin and six specimens of keloid tissues from human subjects were used to evaluate the expression of AKR1C3 by immunofluorescent staining of tissues and western blotting. RESULTS: By western blotting, it was confirmed that the amount of AKR1C3 protein is significantly reduced in keloid tissues compared to normal tissues. Weak expression of AKR1C3 was also found in keloid tissues by immunofluorescent staining. CONCLUSIONS: This study confirmed that the expression of AKR1C3 protein participates in ROS metabolism and plays a part in the downregulation of human keloid formation. To the best of our knowledge, this is the first work that reveals that AKR1C3 can affect the formation of keloids.
Blotting, Western ; Connective Tissue ; Down-Regulation ; Humans* ; Keloid* ; Metabolism ; Oxidative Stress ; Oxidoreductases ; Reactive Oxygen Species ; Skin* ; Wounds and Injuries