Staphylococcus pettenkoferi is a coagulase-negative staphylococci (CoNS) of growing concern. As CoNS could be an important cause of infections in hospitalized patients, especially in immunocompromised patients, accurate identification is critical to timely and effective treatment. In the past, S. pettenkoferi was not identifed by conventional methods or was misidentified as another Staphylococcus species or another genus. To the best of our knowledge, this is the first case of S. pettenkoferi identified using Vitek MS (bioMérieux, France). Two patients admitted to our hospital were confirmed to have bacteremia caused by S. pettenkoferi, which was identified in blood cultures using Vitek MS (bioMérieux). Therefore, we recommend using the Vitek MS (bioMérieux) for rapid and accurate identification of the pathogen causing bloodstream infection when CoNS is suspected.
Bacteremia ; Humans ; Immunocompromised Host ; Staphylococcus

Background: Remdesivir is a US Food and Drug Administration-approved drug for coronavirus disease 2019 (COVID-19). Clinical trials were conducted under strictly controlled situations for a selected population, and their reported adverse events may not fully represent conditions in real-world patients. We aimed to estimate the incidence of adverse drug events (ADEs) associated with remdesivir in hospitalized patients with COVID-19, including vulnerable subpopulations, such as those with impaired renal or hepatic function and pregnant women. Methods: This retrospective observational study included hospitalized patients with confirmed COVID-19 treated with remdesivir between January and December 2021 at ten hospitals. ADEs and severe ADEs (Common Toxicity Criteria for Adverse Events grade ≥ 3) were operationally defined and analyzed through laboratory investigations. The incidence of ADEs was compared with that of each matched control in subpopulations with renal or hepatic impairment and pregnant women. Results: Among 2,140 patients, 1,416 (66.2%) and 295 (13.8%) experienced at least one ADE and severe ADE, respectively. The most frequent ADE was 'hepatic injury' (42.9%), followed by anemia (27.6%). The most common severe ADEs were 'hypokalemia' (5.3%), 'hepatic injury' (2.9%), and 'anemia' (3.6%). There was no significant difference in the incidence of ADEs in patients relative to their respective matched-control groups, including those with renal impairment (80.0% vs. control 71.8%, P = 0.063), hepatic impairment (70.4% vs. control 75.0%, P = 0.623) and pregnant women (78.6% vs. control 63.7%, P = 0.067). However, severe ADE incidence was significantly higher in patients with renal impairment (40.8% vs. 16.0%, P < 0.001). The most common severe ADEs in those were 'anemia' (15.3%), 'hypokalemia' (10.5%), and 'thrombocytopenia' (8.9%). There was no statistically significant difference in the incidence of severe ADEs in patients with hepatic impairment or in pregnancy (P = 0.230; P = 0.085). Conclusion A significant proportion of patients with COVID-19 treated with remdesivir experienced ADEs and severe ADEs. Given the high incidence of severe ADEs, caution is required in patients with renal impairment. Further studies are needed to investigate ADEs in pregnant women and patients with hepatic impairment.

No abstract available.
Cannibalism ; Urinary Bladder

Background: Detection of anti-human leukocyte antigen (HLA) antibodies is important during the selection of an appropriate donor prior to organ transplantation and also for monitoring the patients after transplantation. In this study, we compared antibodies detected via C3d assays, which monitors C3d complement-binding activities of HLA antibodies with those detected via single antigen bead (SAB) assays. Methods: A total of 66 serum samples were tested in parallel by SAB assays (Immucor Transplant Diagnostics, USA) and C3d assays (Immucor) for the detection of HLA class II antibodies. The relationship between these two methods was analyzed based on the types, numbers, median fluorescent intensity (MFI) values, and positivity of the antibodies using MATCH IT! Antibody (Immucor) program. Results: The number of antibodies obtained based on SAB and C3d assays was the highest with 24 samples (36.4%) in the 11–20 range and 23 (34.8%) in the 2–5 range detected via each assay. Among the SAB-positive antibodies, only 28 (6.4%) of the 440 antibodies with MFI ≤3,000 were C3d-positive, and 341 (61.3%) of the 556 antibodies with MFI ≥3,001 were C3d-positive. Whereas, among the 442 C3d-positive antibodies, SAB assays were positive except for 32 (7.2%) and 41 (9.3%) antibodies in the sections of MFI ≤500 and 1,001 ≤MFI ≤10,000, respectively. C3d-positive samples had higher maximum MFI values based on SAB assays, compared with C3d-negative samples. Conclusions MFI values of HLA class II antibodies detected through SAB assays in C3d-positive samples were higher than those in C3d-negative samples.

Objectives: This study examined the stigma against social withdrawal syndrome (hikikomori) among mental health practitioners, and compared levels of stigma against social withdrawal syndrome versus mental illness. Methods: The participants were 133 mental health practitioners (28 males, 105 females) with experience of social withdrawal syndrome that self-reported levels of stigma against social withdrawal syndrome and mental illness. Results: Stigma against social withdrawal syndrome was generally significantly lower than stigma against mental illness. However, mental health practitioners tended to agree they would be reluctant to become personally involved with a person that had experienced social withdrawal syndrome (e.g., dating, hiring). Levels of stigma also differed across mental health occupations. Conclusion This study suggests although mental health practitioners may generally have less negative attitudes toward social withdrawal syndrome in the context of mental illness, that they may also have some reservations about personal interactions with individuals with social withdrawal syndrome.

Purpose: The aim of this study was to evaluate the diagnostic image quality of low dose abdominal digital radiography processed with a new post-processing technique. Materials and Methods: Abdominal radiographs from phantom pilot studies were post-processed by the novel and conventional post-processing methods of our institution; the proper dose for the subsequent patient study of 49 subjects was determined by comparing image quality of the two preceding studies. Two radiographs of each patient were taken using the conventional and derived dose protocols with the proposed post-processing method. The image details and quality were evaluated by two radiologists. Results: The radiation dose for the patient study was derived to be half of the conventional method. Overall half-dose image quality with the proposed method was significantly higher than that of the conventional method (p < 0.05) with moderate inter-rater agreement (κ = 0.60, 0.47). Conclusion By applying the new post-processing technique, half-dose abdominal digital radiography can demonstrate feasible image quality compared to the full-dose images.

Plasma exchange performed with the aid of acid-citrate-dextrose formula A (ACD-A) is generally regarded as safe. However, unfractionated heparin (UFH) can serve as an anticoagulant for patients experiencing serious side effects such as anaphylaxis. No guidelines have currently been defined for the stand-alone UFH dosing during plasma exchange. We describe here two patients who developed anaphylaxis to ACD-A during plasma exchange, and we successfully used UFH as a standalone anticoagulant. The first patient was a 55-year-old man who required plasma exchange before ABO-incompatible kidney transplantation. During plasma exchange, he developed an allergic reaction. Thereafter, UFH was used as a standalone anticoagulant during four sessions of plasma exchange; the UFH (5,000 units) was added to a 500 mL normal saline bag and the UFH:whole blood ratio was maintained at 1:28. The second patient was an 80-year-old woman with steroid pulse-resistant neuromyelitis optica. She developed an allergic reaction during the first session of plasma exchange. The patient subsequently underwent five successful sessions of plasma exchange using UFH as a standalone anticoagulant. These findings may be useful when establishing a protocol for UFH as a standalone anticoagulant during plasma exchange in patients who develop an allergic reaction to citrate.

Occult breast cancer (OBC) is an asymptomatic condition. We report a case of OBC in a 72-year-old male patient who presented with severe dyspnea and upper extremity swelling. Computed tomography scan showed multiple lymph node enlargements in the supraclavicular and infraclavicular areas, and ultrasound scan showed multiple axillary lymph node enlargements. Based on the radiological findings, clinicians suspected lymphoma or disseminated metastasis from unknown primary malignancies. However, the axillary biopsy specimen revealed invasive breast cancer with hormonal receptor positivity.

Background: Detection of anti-human leukocyte antigen (HLA) antibodies is important during the selection of an appropriate donor prior to organ transplantation and also for monitoring the patients after transplantation. In this study, we compared antibodies detected via C3d assays, which monitors C3d complement-binding activities of HLA antibodies with those detected via single antigen bead (SAB) assays. Methods: A total of 66 serum samples were tested in parallel by SAB assays (Immucor Transplant Diagnostics, USA) and C3d assays (Immucor) for the detection of HLA class II antibodies. The relationship between these two methods was analyzed based on the types, numbers, median fluorescent intensity (MFI) values, and positivity of the antibodies using MATCH IT! Antibody (Immucor) program. Results: The number of antibodies obtained based on SAB and C3d assays was the highest with 24 samples (36.4%) in the 11–20 range and 23 (34.8%) in the 2–5 range detected via each assay. Among the SAB-positive antibodies, only 28 (6.4%) of the 440 antibodies with MFI ≤3,000 were C3d-positive, and 341 (61.3%) of the 556 antibodies with MFI ≥3,001 were C3d-positive. Whereas, among the 442 C3d-positive antibodies, SAB assays were positive except for 32 (7.2%) and 41 (9.3%) antibodies in the sections of MFI ≤500 and 1,001 ≤MFI ≤10,000, respectively. C3d-positive samples had higher maximum MFI values based on SAB assays, compared with C3d-negative samples. Conclusions MFI values of HLA class II antibodies detected through SAB assays in C3d-positive samples were higher than those in C3d-negative samples.

The establishment and prompt reporting of critical values to patient care providers is one of the crucial requirements of clinical laboratories. Each laboratory is expected to individually establish the thresholds of critical values and periodically update the lists. In this study, we attempted to investigate the status of critical value reporting (CVR) systems in Korean clinical laboratories and develop adequate guidelines based on comparative reviews examining expert consensus. In responses from 11 clinical laboratories, the number of test items with a critical value threshold was 9.4 on average (standard deviation=5.0). Some of the test items, especially ammonia, lactate, and carboxyhemoglobin, lacked critical value thresholds despite having been recommended by expert opinions and guidelines. The upper limit of critical value thresholds showed variability, with glucose showing the largest difference among laboratories (range, 450–700 mg/ dL; coefficient of variation=14.7%). When evaluating the appropriateness of establishing critical value for a particular test, it is generally recommended to consider the “actionability” factors, which consist of effectiveness in decreasing mortality, availability of immediate response systems, and inclusion of the decision-making process in the institution’s critical pathway of standard patient care. As for the optimal value of individual thresholds, laboratory managers should review three quantitative markers: the ratio of CVR cases in total reported results, the ratio of confirmed CVR and responses by clinicians in total CVR cases, and the turnaround time of the tests assigned with critical value thresholds.