Melioidosis, which is an infectious disease caused by Burkholderia pseudomallei, is prevalent mostly in Southeast Asia and northern Australia; it can progress to abscess formation, pneumonia and sepsis, and ultimately cause death. A 66-yr-old male patient with diabetes mellitus was hospitalized for sepsis 3 months after coming back from Cambodia, and B. pseudomallei was identified from the blood culture. The B. pseudomallei strain was found to be susceptible to carbapenem, and non-susceptible to trimethoprim/sulfamethoxazole and ceftazidime. Although the patient was treated with carbapenem, to which the strain was susceptible, the bacteremia persisted, and progressed to septic shock and pneumonia, and eventually to acute respiratory distress syndrome (ARDS). The patient died on the 12th day of hospitalization. This study, which reports the first case of ceftazidime-nonsusceptible B. pseudomallei in Korea, indicates the importance of B. pseudomallei infection, which is highly likely to be imported to Korea, and discuss its clinical progress, which can lead to fatality.
Abscess ; Asia, Southeastern ; Australia ; Bacteremia ; Burkholderia pseudomallei* ; Burkholderia* ; Cambodia ; Ceftazidime ; Communicable Diseases ; Diabetes Mellitus ; Hospitalization ; Humans ; Korea ; Male ; Melioidosis ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Sepsis ; Shock, Septic

PURPOSE: This study was conducted to status and needs for continuing education for trauma hospital nurses in Korea. METHODS: Thirty nurses from the seven level I trauma center hospitals or trauma treatment systems were randomly selected and surveyed. The survey was conducted from March 1 to May 31, 2017. Categorical data were analyzed with Pearson chi-square tests and Continuous variables were analyzed with ANOVA. RESULTS: Only 86 out of 204 nurses had received continuing education (42.1%). The current status of continuing education programs, delivering institution (p<0.001), education method (p<0.001), education period (p=0.003), number of participants (p=0.007), and instructors (p=0.014) were also significantly different from trauma center to trauma center. There were 108 (52.9%) nurses who responded that continuing education programs were “needed” 92 (45.1%) and “very much needed” 16 (7.8%). According to each trauma center's characteristics were significantly differences in the need for continuing education (p=0.089), subject selection method (p<0.001) and the number of continuing education sessions (p=0.043) depending on the hospital. CONCLUSIONS It is necessary to consider differences between the hospitals to develop continuing education programs that reflect the needs of nurses, in order to improve the efficiency of and satisfaction with the educational programs.

BACKGROUND: The objective of this study was to investigate the frequency and characteristics of HLA-DR⁻/CD34⁻ acute myeloid leukemia (AML) also known as acute promyelocytic leukemia (APL)-like AML. METHODS: This study included 683 newly diagnosed patients with AML. After exclusion of 211 patients with recurrent genetic abnormalities, one with acute panmyelosis with myelofibrosis, two with myeloid leukemia associated with Down syndrome, and two devoid of metaphase cells, we classified the remaining 467 patients as follows: group 1, HLA-DR⁺/CD34⁺ (typical AML); group 2, HLA-DR⁺/CD34⁻ or HLA-DR⁻/CD34⁺; group 3, APL-like AML. RESULTS: Group 1 comprised 294 patients, group 2 comprised 133, and group 3 comprised 40. Therefore, the frequency of APL-like AML among 683 unselected patients with AML was 5.9%. Group 3 patients had significantly higher leukocyte counts and bone marrow (BM) blast percentages, higher frequencies of normal karyotypes and NPM1 mutation, higher fractions of CD33-positive cells, higher concentrations of fibrin degradation products and D-dimers, lower frequencies of complex karyotypes, monosomal karyotypes and poor cytogenetic risk, lower fractions of CD13-positive cells, and lower fibrinogen concentrations, compared with group 1 patients. The values of the BM blast percentage, number of CD33-positive cells, and DIC score of the patients with APL-like AML were intermediate between those of the patients with typical AML and APL. CONCLUSIONS: This study demonstrates that APL-like AML is not uncommon, and it has characteristics distinguishable from those of typical AML. APL-like AML may have some pathophysiological relationships with APL, which need further investigation.
Bone Marrow ; Cytogenetics ; Dacarbazine ; Down Syndrome ; Fibrin Fibrinogen Degradation Products ; Fibrinogen ; HLA-DR Antigens* ; Humans ; Karyotype ; Leukemia, Myeloid ; Leukemia, Myeloid, Acute* ; Leukemia, Promyelocytic, Acute* ; Leukocyte Count ; Metaphase ; Primary Myelofibrosis

No abstract available.
Classification* ; Leukemia*

Background: Plasma cell myeloma (PCM) is caused by immune dysregulation. We evaluated the expression of immune checkpoint programmed cell death protein-1 (PD-1) on T cell subsets in PCM patients according to disease course and cytogenetic abnormalities.This study aimed to find a target group suitable for therapeutic use of PD-1 blockade in PCM. Methods: A total of 188 bone marrow (BM) samples from 166 PCM patients and 32 controls were prospectively collected between May 2016 and May 2017. PD-1 expression on BM T cell subsets was measured using flow cytometry. Results: At diagnosis, the median PD-1 expression on CD4+ T cells was 24.6%, which did not significantly differ from that in controls. After stem cell transplantation, PD-1 expression on CD4+ T cells was higher than that at diagnosis (P < 0.001), regardless of residual disease. PD-1 expression on CD4+ T cells in patients with residual disease after chemotherapy was significantly higher than that at diagnosis (P = 0.001) and after complete remission following chemotherapy (P = 0.044). PD-1 expression on CD8+ T cells was higher in PCM patients with cytogenetic abnormalities, including monosomy 13, 1q gain, complex karyotype, and hypodiploidy. Conclusions PD-1 blockade might have therapeutic potential in refractory PCM patients after chemotherapy, especially in those with high- or intermediate-risk cytogenetic abnormalities.

BACKGROUND: Acute promyelocytic leukemia (APL) can be life threatening, necessitating emergency therapy with prompt diagnosis by morphologic findings, immunophenotyping, cytogenetic analysis, or molecular studies. This study aimed to assess the current routine practices in APL and the clinico-pathologic features of APL. METHODS: We reviewed the medical records of 48 Korean patients (25 men, 23 women; median age, 51 (20-80) years) diagnosed with APL in 5 university hospitals between March 2007 and February 2012. RESULTS: The WBC count at diagnosis and platelet count varied from 0.4 to 81.0 (median 2.0)x10(9)/L and 2.7 to 124.0 (median 54.5)x10(9)/L, respectively. The median values for prothrombin time and activated partial thromboplastin time were 14.7 (11.3-44.1) s and 29 (24-62) s, respectively. All but 2 patients (96%) showed a fibrin/fibrinogen degradation product value of >20 microg/mL. The D-dimer median value was 5,000 (686-55,630) ng/mL. The t(15;17)(q22;q12 and PML-RARA fusion was found in all patients by chromosome analysis and/or multiplex reverse transcriptase-polymerase chain reaction (RT-PCR), with turnaround times of 8 (2-19) d and 7 (2-13) d, respectively. All patients received induction chemotherapy: all-trans retinoic acid (ATRA) alone (N=11, 26%), ATRA+idarubicin (N=25, 58%), ATRA+cytarabine (N=3, 7%), ATRA+idarubicin+cytarabine (N=4, 9%). CONCLUSION: Since APL is a medical emergency and an accurate diagnosis is a prerequisite for prompt treatment, laboratory support to implement faster diagnostic tools to confirm the presence of PML-RARA is required.
Cytogenetic Analysis ; Emergencies ; Emergency Treatment ; Fibrin Fibrinogen Degradation Products ; Hospitals, University ; Humans ; Immunophenotyping ; Korea ; Leukemia, Promyelocytic, Acute ; Male ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Tretinoin

BACKGROUND: Acute promyelocytic leukemia (APL) can be life threatening, necessitating emergency therapy with prompt diagnosis by morphologic findings, immunophenotyping, cytogenetic analysis, or molecular studies. This study aimed to assess the current routine practices in APL and the clinico-pathologic features of APL. METHODS: We reviewed the medical records of 48 Korean patients (25 men, 23 women; median age, 51 (20-80) years) diagnosed with APL in 5 university hospitals between March 2007 and February 2012. RESULTS: The WBC count at diagnosis and platelet count varied from 0.4 to 81.0 (median 2.0)x10(9)/L and 2.7 to 124.0 (median 54.5)x10(9)/L, respectively. The median values for prothrombin time and activated partial thromboplastin time were 14.7 (11.3-44.1) s and 29 (24-62) s, respectively. All but 2 patients (96%) showed a fibrin/fibrinogen degradation product value of >20 microg/mL. The D-dimer median value was 5,000 (686-55,630) ng/mL. The t(15;17)(q22;q12 and PML-RARA fusion was found in all patients by chromosome analysis and/or multiplex reverse transcriptase-polymerase chain reaction (RT-PCR), with turnaround times of 8 (2-19) d and 7 (2-13) d, respectively. All patients received induction chemotherapy: all-trans retinoic acid (ATRA) alone (N=11, 26%), ATRA+idarubicin (N=25, 58%), ATRA+cytarabine (N=3, 7%), ATRA+idarubicin+cytarabine (N=4, 9%). CONCLUSION: Since APL is a medical emergency and an accurate diagnosis is a prerequisite for prompt treatment, laboratory support to implement faster diagnostic tools to confirm the presence of PML-RARA is required.
Cytogenetic Analysis ; Emergencies ; Emergency Treatment ; Fibrin Fibrinogen Degradation Products ; Hospitals, University ; Humans ; Immunophenotyping ; Korea ; Leukemia, Promyelocytic, Acute ; Male ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Tretinoin