Background: Umeclidinium/vilanterol (UMEC/VI; ANORO ELLIPTA, GSK) is a commonly used dual bronchodilator. This study evaluated the safety and effectiveness of UMEC/VI in Korean patients with chronic obstructive pulmonary disease (COPD) over a 6-year period. Methods: This was an open-label, multicentre, observational, post-marketing surveillance study. A total of 3,375 patients were enrolled consecutively in 52 hospitals, by 53 physicians, between July 2014 and July 2020. Patients who were administered UMEC/VI (fixed-dose 62.5 μg/25 μg) at least once and were monitored for safety and effectiveness were included in the analysis. Incidence and severity of adverse events (AEs) reported after administrating at least one dose of UMEC/VI were monitored, including unexpected adverse events (UAEs) and adverse drug reactions (ADRs). Effectiveness of UMEC/VI after 24 weeks of administration was also assessed using physician’s evaluation (effective, ineffectiveo change, worsening, indeterminable) and lung function improvement. Results: Of 3,375 patients, 3,086 were included in the safety assessment group (mean age±standard deviation: 69.76±8.80 years; 85.9% male [n=2,652]; 73.1% aged ≥65 years [n=2,255]). The overall incidence of AEs was 28.8% (n=890), of which 2.2% (n=67) were ADRs. Serious AEs and UAEs were reported in 181 (5.9%) and 665 (21.6%) patients, respectively, and two patients (<0.1%) reported unexpected severe ADR. Of the 903/3,086 patients analysed for effectiveness, most (82.8%, n=748) showed overall disease improvement after UMEC/VI treatment. Conclusion This study confirmed UMEC/VI administered to Korean patients according to the prescribing information was well-tolerated and can be considered an effective option for COPD treatment.

Background: The integrase strand transfer inhibitor dolutegravir has been indicated in Korea since 2014 for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in combination with other antiretroviral agents. This regulatory post-marketing surveillance (PMS) study evaluated the real-life safety and effectiveness of dolutegravir in patients with HIV-1 in clinical practice in Korea. Materials and Methods: This open-label PMS study examined data from consecutive patients (aged ≥12 years) with HIV-1 infection receiving dolutegravir according to locally approved prescribing information; treatment-naïve and treatment-experienced patients were permitted. Data regarding patient demographics, medical history, clinical characteristics, medications (HIV-related and concomitant), and comorbidities were extracted from patient records over a 1-year treatment period. Outcomes included the safety of dolutegravir (primary endpoint) and real-life effectiveness according to the Physician Global Assessment (PGA) and the proportion of patients with plasma HIV-1 RNA count <50 copies/mL at 48 weeks. Results: Of 147 patients treated with dolutegravir at 18 centers in Korea (August 2014 – August 2020), 139 were eligible for the safety analyses and 75 for effectiveness analyses.Patients (mean age 47 years) were mostly male (92.8%) and received dolutegravir in combination with nucleoside reverse transcriptase inhibitor (70.5%) or protease inhibitors (21.6%). Adverse events (AEs) (n = 179 in total) were mostly mild in severity, with the most common being nasopharyngitis (5.0%), dyspepsia (5.0%), pruritus (4.3%), and rash (4.3%).Of 16 adverse drug reactions (ADRs), the most frequent were rash, diarrhea, headache, insomnia, and somnolence (1.4% each). Of 2 serious ADRs, only 1 (gastroenteritis) was unexpected, and both resolved. The risk of experiencing an AE while receiving dolutegravir appeared to be especially increased in patients receiving concomitant medications for other conditions. Dolutegravir effectively suppressed HIV-1 (93.3% of patients had plasma HIV-1 RNA <50 copies/mL), and 100% of patients showed symptom improvement based on physician global assessment. Conclusion Results of this PMS study showed that dolutegravir administered as highly active antiretroviral therapy was well tolerated and effective in patients with HIV-1 infection.

No abstract available.
Cranial Nerve Diseases ; Granuloma, Plasma Cell* ; Polychondritis, Relapsing*

Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.
Abdomen ; Abdominal Pain ; Bezoars ; Bulimia* ; Child, Preschool ; Diagnosis ; Diaphragm* ; Duodenal Obstruction ; Duodenum ; Failure to Thrive ; Female ; Humans ; Membranes ; Parturition ; Vomiting ; Weight Gain ; X-Ray Film

According to law the employer who has over 50 workers in his enterprise should employ an occupational physician as industrial health manager. The main role of the occupational physician is emphasized to the prevention of occupational diseases rather than the treatment and he should be the team leader of industrial health personnel. But this ideal system in terms of stipulations has lots of problems in operation. Therefore this study was designed to prove the attitude of reception, real condition and work content of the occupational physician in enterprise. The survey was done in 500 stratified random sampled enterprises over the country from July through September in 1987 by mailing questionnaire. As a result of the response from 145 enterprises, more than 85% of enterprise displaced occupational physicians. Among the occupational physicians 43% of them has no allowance for their working as industrial health managers and are payed less than 100,000 won monthly. And 66% of them visited only once a month or none enterprise, where they were nominated as a occupational physician managers. The major work content of occupational physician was doing outpatient clinic or regular physical examination rather than prevention of occupational disease. And it shows a deep discrepancy with the object of law or the expect of enterprise in which industrial hygiene and health education are more stressed for prevention of occupational diseases. The most of industrial workers showed no interest in work of occupational physician. As a conclusion, the current system of industrial health manager has maintained on paper formally and is apt to fall into making outward show. It is urgent for government and enterprise to find a solution which can be practically used the system of occupational physician. The work content of occupational physician is required high advanced knowledge and experience, and it should be operated dual system by special field and nonspecial field.
Ambulatory Care Facilities ; Health Education ; Jurisprudence ; Korea* ; Occupational Diseases ; Occupational Health ; Physical Examination ; Postal Service ; Questionnaires

Activation of the sympathetic nervous system in mediating the stress response attends traumatic brain injury. Plasma dopamine(DA), epinephrine(E), norepinephrine(NE) levels were measured in 26 severe traumatically brain injured patients to determine whether catecholamine levels obtained within 24 hours after injury provide reliable prognostic endogenous markers of outcome. Patient outcome was determine at 1 week using the Glasgow Coma Scale(GCS) and at the time of discharge the Glasgow Outcome Scale(GOS), 7 patients with diseases except those with a severe traumatic brain injury were selected as a control group. Firstly, we analyzed the difference of the average DA, E, and NE between the control group and severe traumatic brain injury patients. Secondly, we analyzed the difference of the average catecholamine levels in the 3 groups according to admission GCS scores(respectively 3~4, 5~7, 8~9). Third, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS scores at 1 week(respectively dead, 3~4, 5~7, 8~11, >11). Finally, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS at the time of discharge. As a result, there was no statical difference between the level of DA in the control group and those of the severe brain injury patients. But the level of E an NE in the experimental group were higher than the control group(respectively p<0.03, p<0.04). The admission GCS score correlated highly with the catecholamine levels(NE : r=0.69, p<0.001 ; E ; r=0.42, p<0.03 ; DA ; r=0.42, p<0.03). In patients with admission GCS of 3 to 4, NE levels increaed fourfold above other group(p<0.005). In the 13 patients with GCS scores of 3 or 4 on admission. NE levels predicted outcome at 1 week. All two patients with NE levels less then 750 pg/ml were survived, while 10 of 11 with NE levels greater than 750 pg/ml were died(p<0.02). The levels of NE was significantly higher in patients who died than in those with better outcome(p<0.02). Therefore, these findings indicated that the level of circulating NE is an excellent endogenous marker that appear to reflect the extent of brain injury and that may predict the likelihood of recovery.
Brain ; Brain Injuries* ; Coma ; Dopamine ; Epinephrine ; Humans ; Negotiating ; Norepinephrine ; Plasma* ; Prognosis* ; Sympathetic Nervous System

During the eleven months from September, 1989 to July, 1990, a total of 118 subarachnoid hemorrhage(SAH) patients were admitted. Among these, in 2 cases, the etiology was unknown and another 8 cases of Hunt & Hess clinical grade V patients died in the emergency room or intensive care unit within 24 hours after admission. The remaning 108 cases were managed with protocol as follows. 1) Surgery was done within 9 days after the SAH(total 67 cases) : Extraventricular drainage(EVD) was performed and a cisternal drainage(CD) catheter was positioned during surgery. EVD, CD nimodipine irrigation(0.4mg) through the CD catheter, and intravenous injection(IV) of nimodipine(1~2mg/hr)continued for 13days after the SAH. 2) Surgery was done after the 9th SAH day due to late transfer neurology or other hospitals or posterior circulation aneurysms(32 cases), and 9 cases refused surgery : Nimodipine was used orally(240mg/day) in 35 cases and an IV route(1~2mg/hr) in 6 cases. Total management outcome and results were obtained as follows. 1) A total unsatisfactory management outcome was 18.52%(serve disabled : 4.63%, vegetative : 0.93%, death : 12.96%. In the surgical cases only, 40.8%, 1.02%, 9.19%, respectively). 2) An unsatisfactory surgical outcome in cases following surgery after the 9th SAH day was 6.24%(severe disabled : 3.12%, death : 3.12%). 3) An unsatisfactory management outcome in cases of admission grades I & II following surgery within the 9th SAH day or those non-surgical patients was 19.15%(severe disabled : 4.25%, death : 14.89%. In surgical cases only 2.33%, 9.30%, respectively). 4) An unsatisfactory management outcome in cases of admission grades III & IV with surgery within the 9th SAH day or non-surgical patients was 29.63%(severe disabled : 7.41%, vegetative : 3.70%. death : 18.52%. In surgical cases only 9.09%, 4.55%, 13.64%, respectively). One case of admission grade V died. 5) Causes of unsatisfactory outcome were vasospasm : 9 cases(8.33%), SAH itself : 4 cases, rebleeding : 3 cases, surgical complication : 1 case, medical complication : 1 case, anesthesia : 1 case, and head trauma : 1 case. 6) Complications in management protocol with EVD, CD, CD nimodipine irrigation, and IV of nimodipine were transient hypotension(1 case) and meningitis(5 cases). These complications were improved without sequelae with discontinuing the IV of nimodipine and using antibiotics. We concluded that this protocol may improved the total management outcome of aneurysmal SAH patients, especially poor grade patients(Hunt & Hess grade III & IV) without significant complications. However, in spite of this protocol, the leading cause of an unsatisfactory outcome is vasospasm.
Anesthesia ; Aneurysm ; Anti-Bacterial Agents ; Catheters ; Craniocerebral Trauma ; Drainage* ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intracranial Aneurysm* ; Neurology ; Nimodipine*

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are main pathogens of bloodstream infection. We compared the epidemiology of ESBL-producing E. coli and K. pneumoniae. METHODS: From January 2003 through March 2007, we retrospectively investigated the clinical characteristics and comorbidities of patients with bloodstream infection by ESBL-producing E. coli and K. pneumoniae. RESULTS: During the study period, 79 patients (54 with E. coli and 25 with K. pneumoniae) with blood cultures positive for ESBL-producing E. coli or K. pneumoniae were studied. When comparing the source of bloodstream infections, urinary tract infections (UTIs) were more commonly caused by E. coli (24% vs. 0; P=0.007), and respiratory tract and soft tissue infection (36% vs. 15%; P=0.04, 12% vs. 0; P=0.03, respectively) were more commonly associated with K. pneumoniae. Among hospital-acquired bloodstream infection, third-generation cephalosporin was more commonly used in patients with E. coli than patients with K. pneumoniae (81% vs. 24%, P<0.001). Medical devices (central venous catheter and urinary catheter) were more commonly used in patients with K. pneumoniae. CONCLUSION: ESBL-producing E. coli bloodstream infection is more common in urinary tract infections. ESBL-producing K. pneumoniae is more common in respiratory tract infections and in skin and soft tissue infections. In hospital-acquired infections, ESBL-producing E. coli bloodstream infection is more common in biliary tract infection. ESBL-producing E. coli was more commonly associated with prior frequent antibiotics use and K. pneumoniae was more commonly associated with use of medical devices.
Anti-Bacterial Agents ; beta-Lactamases ; Biliary Tract ; Catheters ; Comorbidity ; Epidemiology* ; Escherichia coli* ; Humans ; Klebsiella pneumoniae* ; Pneumonia ; Respiratory System ; Respiratory Tract Infections ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Urinary Tract Infections

No abstract available.
Intracranial Arteriovenous Malformations* ; Radiosurgery*

Purpose: The aim of this study is to investigate the effect of the surgical hospitalist system on postoperative outcomes and hospital costs for surgical patients. Methods: We reviewed the medical records of 522 patients who were admitted to the divisions of colorectal and gastrointestinal surgery for operation from September to December 2017 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. All patients were divided into 2 groups; one that was managed by surgical hospitalists group (HG) and another that was managed by non-hospitalist residents group (NHG) after elective surgery. Postoperative outcomes and hospital costs were analyzed for each group. Results: Two hundred ninety-eight patients were managed by HG and 189 patients were managed by NHG after surgery. The length of hospital stay in the first group was shorter (9.6 ± 5.8 days vs. 12.2 ± 7.9 days, P < 0.001), the incidence of complications was lower (44.6% vs. 55.6%, P = 0.019), and the readmission rate was lower (3.0% vs. 6.9%, P = 0.046) in the HG than in the NHG. The difference in total hospital costs was not significant between the HG and the NHG (₩8,381,304 vs. ₩9,242,493, P = 0.559), but surgery-independent hospital costs were lower in the HG than in the NHG (₩3,020,873 vs.₩3,923,308, P = 0.001). Conclusion The surgical hospitalist system reduced the length of hospital stay, the incidence of postoperative complications, and the readmission rates of surgical patients. This led to the effect of a reduction in total hospital costs.