In order to successfully determine the etiology of fungal disease, proper management in terms of the collection, transport, and processing of clinical specimens should be considered. Inappropriate collection and handling of specimens may induce confusing results and mislead to wrong diagnosis and subsequent failure in the management of the infection. All health care workers involved in obtaining the specimens, collection of them from appropriate sites, and proper labeling of specimen containers should follow appropriate instructions, usually in the form of a specimen collection procedure manual provided by the responsible laboratory. The best specimen for determining the etiologic agent is usually obtained from the active infection site, as with all disease processes. All specimens should be properly labeled with information of the collection, as well as the patient's clinical data. Appropriate transport and storage of specimens are necessary for fungal elements to remain viable for a successful culture. In the laboratory, all acceptable specimens could be processed appropriately before culturing for identification of the etiologic agents. They include direct microscopy, antigen detection procedures and/or direct molecular methods. This review article is devoted to standard recommendations in obtaining, transporting, and processing clinical specimens. In addition, some of the basic procedures of direct microscopy for the clinician is dealt for the clinician.
Delivery of Health C ; Microscopy ; Specimen Handling

BACKGROUND: It has been reported that cardiovascular factors such as hypertension, smoking, diabetes and obesity are related to decrease in heart rate variability (HRV). This study purposed to examinate the association of HRV with Framingham risk score in non-obese males and the affecting factors of HRV. METHODS: The study was carried out in 323 males who visited a health care center from June to August, 2004, None had previous cardiovascular and cerebral diseases, diabetes, or obesity (BMI> or =25 kg/m(2)). The subjects were divided into three groups by Framingham risk score and we compared the means of HRV parameters including the Mean Heart Rate (MHR), Standard Deviation of NN interval (SDNN), the Square Root of the Mean Squared Differences of successive NN intervals (RMSSD), Total Power (TP), Very Low Frequency (VLF), Low Frequency (LF), High Frequency (HF), and LF/HF ratio in these three groups. RESULTS: There were significant differences among the groups by age. Among HRV parameters, SDNN (P<0.001), RMSSD (P=0.001), TP (P=0.008), LF (P=0.024), and HF (P=0.003) are inversely associated with the risk score group. Multiple regression analysis revealed age, systolic blood pressure and C-reactive protein as independent explanatory variables of HRV. CONCLUSION: SDNN, RMSSD, TP, LF and HF were decreased in the higher risk group, we can suggest that autonomic function is impaired as the cardiovascular risk increases.
Blood Pressure ; C-Reactive Protein ; Delivery of Health Care ; Heart ; Heart Rate ; Humans ; Hypertension ; Male ; Obesity ; Smoke ; Smoking

BACKGROUND/AIMS: The introduction of direct-acting antivirals (DAA) in 2013 revolutionized hepatitis C virus (HCV) treatment, offering a cure rate >90%. However, this therapy is expensive, and estimations of the number of chronic HCV-infected (CHC) patients and their treatment costs pre-2013 are therefore essential for creating policies and expanding drug access. Herein, we aimed to investigate the number of HCV-related liver disease patients, their healthcare utilization, their annual direct medical costs, and the interferon-based antiviral treatment rates and costs from 2009 to 2013 in South Korea. METHODS: The National Health Insurance database was reviewed, and patients diagnosed with CHC from 2009 to 2013 were extracted. Data regarding detailed healthcare utilization, prescribed drugs, and direct medical costs were obtained. For annual direct healthcare cost calculations, a prevalence-based approach was used. RESULTS: Overall, 181,768 CHC patients were identified. In 2013, the annual per-patient costs for chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and the first year post-liver transplant were 895, 1,873, 6,945, and 67,359 United States dollars, respectively. Interferon-based antiviral therapeutics were prescribed to 25,223 patients (13.9%). CONCLUSIONS: Healthcare costs have increased remarkably with increasing liver disease severity. Thus, efforts to stop disease progression are needed. Moreover, the low rate of interferon-based therapy indicates an unmet need for DAA.
Antiviral Agents ; Carcinoma, Hepatocellular ; Costs and Cost Analysis ; Delivery of Health Care* ; Disease Progression ; Health Care Costs* ; Hepacivirus ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Korea* ; Liver Cirrhosis ; Liver Diseases ; National Health Programs* ; Ribavirin ; United States

The 20th National Assembly of Korea was called to order on April 13, 2016. The National Assembly is invested with the authority to play a significant role in influencing healthcare policy. There are many pending issues in healthcare policy that the Assembly needs to address in this term. The low fertility rate and population aging that Korea faces can exert a major impact on the healthcare system, as aging will lead to an expansion of non-communicable diseases, which can place a high burden on society. This requires strengthening the social security system, including National Health Insurance. A paradigm shift is necessary, in which healthcare providers are organized in the National Health Insurance using approaches such as the Accountable Care Organization (ACO) and Patient_Centered Medical Home (PCMH), and people are offered choices similar to the US Medicare Advantage Program. Additionally, it is essential that healthcare accessibility is enhanced by covering catastrophic medical costs and guaranteeing patient safety through quality improvement so that healthcare costs are kept within an affordable range. Therefore, the 20th National Assembly must overcome differences in ideology to improve the healthcare system with the aim of promoting national health.
Accountable Care Organizations ; Aging ; Birth Rate ; Delivery of Health Care ; Health Care Costs ; Health Personnel ; Health Policy* ; Humans ; Korea ; Medicare Part C ; National Health Programs ; Patient Safety ; Patient-Centered Care ; Quality Improvement ; Social Security

Hepatitis C virus (HCV) is one of the major causes of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. In South Korea, the prevalence of HCV infection in adults is 0.78%. Recent outbreaks of HCV infection in Korea were associated with unsafe injection practices such as syringe reuse, contaminated multi-dose vials, and unsanitary medical procedures. The findings emphasize the role of unsafe injection practices in the community outbreak of hepatitis C, as well as the need to establish a routine surveillance system and increase awareness among health care workers regarding safe injection practices. In response to the HCV outbreaks, the Korean government and Korean Medical Association announced a strategy for prevention and control of HCV infection. It should encompass health care institutions as well as non-medical facilities providing invasive procedures carrying the risk of HCV transmission. Furthermore, the government needs to consider including an anti-HCV test in national health screening and broaden financial support for expensive novel oral anti-HCV drugs for early detection and eradication of HCV infection.
Adult ; Carcinoma, Hepatocellular ; Delivery of Health Care ; Disease Outbreaks* ; Financial Support ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Korea* ; Liver Cirrhosis ; Mass Screening ; Prevalence ; Syringes

BACKGROUND/AIMS: The aim of this study was to investigate outcomes and current status of the National Liver Cancer Screening Program in a single healthcare center. METHODS: Subjects received abdominal ultrasonography (US) and/or serum alpha-fetoprotein (AFP) testing from January 2011 to December 2012. The clinical characteristics of the subjects, detection rate of liver cancer, and direct medical costs were investigated. RESULTS: Among 621 subjects, five (0.8%) were newly detected with hepatocellular carcinoma. Four underwent curative treatment, and all were detected by US (two surgical resections and two radiofrequency ablations). The remaining patient, whose disease was detected by an elevated AFP level, was infiltrative type with a poor prognosis. Of 492 subjects whose medical history was revealed, 45% had hepatitis B, 5% had hepatitis C, 1% had both, and 3% had other liver cirrhosis including alcoholic cirrhosis. The remaining 46% of subjects had no risk factors for liver cancer. Direct medical costs were estimated at 8,420,000 Won for detecting a single case of liver cancer, which was much lower than that of stomach cancer at 45,060,000 Won. If the non-high risk subjects were excluded, the cost for a single case of liver cancer decreased to 5,560,000 Won. CONCLUSIONS: The high-risk group should be more accurately defined by appropriate screening tests to optimize liver cancer surveillance. The detection rate by the liver cancer surveillance program was about 1%, and most tumors could be detected at the early stage by US. The role of AFP seemed to be small for early defection of liver cancer.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Delivery of Health Care ; Hepatitis B ; Hepatitis C ; Humans ; Liver ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic ; Liver Neoplasms ; Mass Screening ; Prognosis ; Risk Factors ; Stomach Neoplasms

The healthcare industry employs over one million workers in Korea and encompasses a usually broad spectrum of occupations and related exposures. There are so many biological exposures in healthcare settings, including blood-borne pathogens, HIV, hepatitis B and hepatitis C, air-borne pathogens such as tuberculosis, and a wide variety of respiratory viruses. The World Health Organization (WHO) estimates the global burden of disease (GBD) from occupational exposure to be 40% of Hepatitis B and C infections and 2.5% of the human Immunodeficiency virus (HIV) infections among Healthcare workers (HCWs). Some countries have used surveillance systems to monitor national trends and incidence rates of occupational infections among HCWs; identify newly emerging hazards for HCWs; assess the risk of occupational exposures and infections; and evaluate preventive measures including engineering controls, work practices, protective equipment, and post-exposure prophylaxis to prevent occupational infections. Infection control programs such as engineering control in medical facilities, immunization, post exposure prophylaxis, and use of personal protective equipment (PPE) have been widely introduced to reduce occupational infectious disease among HCWs. Thus some developed countries which have actively introduced infection control program have decreased incidences of occupational infectious diseases among HCWs. This study describes the epidemiologic characteristics of occupational infectious diseases among HCWs, the kinds of surveillance system to monitor infectious diseases among HCWs, and infection control measures that apply to healthcare settings.
Blood-Borne Pathogens ; Communicable Diseases ; Delivery of Health Care ; Developed Countries ; Health Care Sector ; Hepatitis ; Hepatitis B ; Hepatitis C ; HIV ; Humans ; Immunization ; Incidence ; Infection Control ; Korea ; Occupational Exposure ; Occupations ; Organothiophosphorus Compounds ; Post-Exposure Prophylaxis ; Tuberculosis ; World Health Organization

A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist(R), Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma.
Berlin ; Carcinoma, Hepatocellular ; Delivery of Health Care ; Diagnosis ; Female ; Hemangioma* ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Liver ; Magnetic Resonance Imaging* ; Middle Aged ; Risk Factors ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: The diagnosis of hepatitis C virus (HCV) infection is screened by anti-HCV enzymelinked immunosorbant assay (ELISA) and confirmed by recombinant immunoblotting assay (RIBA) or HCV RT-PCR. We attempted to evaluate the results between anti-HCV ELISA and a qualitative HCV RT-PCR. METHODS: Four hundred and twenty patients who were tested with anti-HCV ELISA and HCV RTPCR, simultaneously, from January 2002 to June 2005 were enrolled in this study. Anti-HCV ELISA was performed by AxSYM HCV version 3.0 (Abbott Laboratories, USA). HCV RT-PCR was performed using in-house RT-nested PCR methods from January 2002 to October 2004 and HCV Genotype Amplification Kit (LiPA) (Bayer Healthcare, USA) from November 2004 to June 2005. RESULTS: Of the 420 patients tested, 321 were positive for anti-HCV ELISA, and 204 were positive for RT-PCR. The positive predictability of anti-HCV ELISA was 63.6%. Among anti-HCV positive patients, RT-PCR was positive in 7.3% of the patients with sample/cut-off (S/CO)<6, compared with 82.8% of the patients with S/CO> or =6. Among the 117 patients with positive anti-HCV, but with negative HCV RT-PCR, 64 had liver diseases such as chronic hepatitis C, chronic hepatitis B, or hepatocellular carcinoma. Twelve patients showed positive HCV RT-PCR, but negative anti-HCV results; of these 9 had hepatic dysfunction. CONCLUSIONS: In the patients who were positive for anti-HCV ELISA with a low S/CO, HCV RT-PCR positivity was shown in a low proportion. Therefore, in such cases, the results should be confirmed by RIBA or HCV RT-PCR. The liver function test showed increased levels of hepatic enzymes in patients with positive HCV RT-PCR, but negative anti-HCV. Such findings correlate to an early phase of chronic hepatitis C, suggesting the necessity of continuous follow up.
Carcinoma, Hepatocellular ; Delivery of Health Care ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Humans ; Immunoblotting ; Liver Diseases ; Liver Function Tests ; Polymerase Chain Reaction

Health care is a labour intensive industry and, in most countries, health care workers (HCWs) are fast growing sector of the workforce. Variety of occupational hazard, such as biological, ergonomical, chemical, physical and psychological factors, have been reported in HCWs. Major occupational infectious diseases in HCWs are blood-borne pathogens such as HIV, hepatitis B and hepatitis C, and airborne pathogens such as tuberculosis, and a wide variety of respiratory viruses. Most common occupational musculoskeletal disorder (MSD) in HCWs are low back pain and related diseases. One of the most prevalent ergonomical risk factor of low back pain is moving the patients or changing the patients' position. Important carcinogenic chemicals in HCWs are formaldehyde, ethylene oxide and anticancer drugs, which have been reported reported to be cause of occupational lymphohematopoietic cancer. Glutaraldehyde and latex glove can cause allergic asthma and contact dermatitis. Physical hazard such as ionizing radiation and noise also should be considered for HCWs's occupational health. Because, HCWs comprise a wide range of professional, technical and support personnel, the organizational factor might affect to job stress. In addition to organizational factors, the shift work and night work is serious health problem of HCWs. Theses risk factors can affect to chronic underlying disorder.
Asthma ; Blood-Borne Pathogens ; Communicable Diseases ; Delivery of Health Care ; Dermatitis, Contact ; Ethylene Oxide ; Ethylenes ; Formaldehyde ; Glutaral ; Hepatitis B ; Hepatitis C ; HIV ; Humans ; Latex ; Low Back Pain ; Noise ; Occupational Diseases ; Occupational Health ; Radiation, Ionizing ; Risk Factors ; Tuberculosis