OBJECTIVE: This study was to investigate and develop a training program that integrated and strengthened clinical competence and capacity of hospital pharmacists which would be implemented at the pharmacy department of Ewha Womans University Mokdong Hospital. METHODS: We assessed the training programs of hospital pharmacists in the United Kingdom, the United States and Japan and compared those of major hospitals in Seoul and Gyeonggi provinces in Korea. The survey assessed the satisfaction on the current educational programs for pharmacists at Ewha Womans University Mokdong Hospital and a newly designed education program was suggested. RESULTS: The major differences of the programs among the Korean hospitals and Mokdong Hospital were the training period and contents of the entry-level pharmacist education program. The overall satisfaction of the training program was >3 points on 5-Likert scale in the survey. There was no significant difference of the satisfaction level based on the employment period of pharmacists. The pharmacists were in more than 7 training programs of clinical support work. We proposed the clinical support training for the new pharmacists to be separated from orientation and concentrated on actual work duty. In order to improve the competency, it was encouraged to participate the in-house seminar or certify the related fields provided by Korean Society of Health-system Pharmacists. CONCLUSION: The education program was assessed among different countries and hospitals of Korea. We suggested to update education program in the hospital to enhance pharmacists' competency.
Clinical Competence ; Education* ; Employment ; Female ; Great Britain ; Gyeonggi-do ; Humans ; Japan ; Korea ; Mental Competency ; Pharmacists* ; Pharmacy ; Seoul ; United States

An adrenal crisis is a serious medical emergency. Most such crises develop in patients with Addison's disease when they are stressed. However, the clinical features of an impending adrenal crisis are nonspecific, delaying diagnosis and management. Adrenal tuberculosis is very rare among the extrapulmonary forms of tuberculosis. We herein report a case of an adrenal crisis triggered by bilateral adrenal tuberculosis. A 35-year-old man was admitted to our hospital because of drowsiness, fever, and hypotension. Abdominal computed tomography revealed bilateral adrenal enlargement, and computed tomography-guided adrenal gland biopsy allowed us to diagnose adrenal tuberculosis.
Addison Disease ; Adrenal Glands ; Adrenal Insufficiency ; Adult ; Biopsy ; Diagnosis ; Emergencies ; Fever ; Humans ; Hypotension ; Sleep Stages ; Tuberculosis* ; Tuberculosis, Endocrine

Invasive pulmonary aspergillosis (IPA) has been known to occur in immunocompromised patients, but has been rarely reported in immunocompetent patients. In immunocompetent patients, pulmonary fungal infections are not initially considered. This results in diagnosis and treatment delays, as well as poor prognosis. We report a case and serial CT findings of IPA in an immunocompetent 29-year-old male after congenital heart disease surgery.

Tigecycline is a broad spectrum antibiotic which has been used for complicated intra-abdominal infection and complicated skin and soft tissue infection by multi-drug resistant bacteria. However recent meta-analysis studies have raised a concern for adverse events of tigecycline. We analyzed retrospectively adverse events, associated factors of adverse events in multi-drug resistant bacteria caused infections treated with tigecycline in Korean patients. One hundred-sixty patients treated with tigecycline from July 2009 to September 2013 were enrolled in this study. Their clinical and microbiologic data were reviewed. History of invasive procedure within 7 days and recent operation within 3 months were associated with adverse events. The most common adverse events were nausea and vomiting. Associated factors of nausea were soft tissue injury and recent operation within 3 months. In this study, nausea was the most common adverse event in patients who received tigecycline. Although it is not serious complication, monitoring of adverse events is required to increase compliance.
Bacteria ; Compliance ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Incidence* ; Intraabdominal Infections ; Nausea ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Soft Tissue Injuries ; Vomiting

Kikuchi-Fujimoto disease (KFD) is a benign, self-limiting disease, with a specific histopathology. It can be diagnosed clinically, and specific symptoms include fever and cervical lymphadenopathy. The histological finding of KFD in cervical lymph nodes includes necrotizing lymphadenitis. KFD needs conservative treatments. If KFD persists for a long period, steroids or nonsteroidal antiinflammatory drugs can be used to control symptoms. Previous studies have reported the treatment of KFD with hydroxychloroquine (HC) in patients unresponsive to steroids. Herein, we report a case of a 25-year-old female patient diagnosed with KFD unresponsive to steroids, and was successfully treated with HC.
Adult ; Female ; Fever ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Hydroxychloroquine* ; Lymph Nodes ; Lymphadenitis ; Lymphatic Diseases ; Steroids

Purpose: This study was performed to investigate the gender differences in suicide attempts in adolescents. Methods: We reviewed the medical records of adolescents (≤ 18 years) who had visited a university hospital emergency department (ED) for suicide attempts from January 2018 through December 2019. General characteristics of the adolescents, details of the attempt, and outcomes were analyzed. The characteristics were age, gender, the Korean Triage and Acuity Scale, previous attempts, and psychiatric history. The details were initial Glasgow Coma Scale, attempt-arrival time, living alone, method, place, and motivation of the attempt, and concurrent use of alcohol. The outcomes included psychiatric consultation, ED length of stay, and ED outcomes. Results: A total of 86 adolescents were included. Their age ranged from 13 to 18 years, and girls accounted for 65.1%. The girls had more frequent psychiatric history than boys (66.1% vs. 30.0%; P = 0.001) without a significant difference in previous attempts (55.4% vs. 46.7%; P = 0.442). The most common methods of the attempt in the girls and boys were poisoning and sharp objects (53.3% [16 of the 30 boys] vs. 60.7% [34 of the 56 girls]; P = 0.002), respectively. No differences were found in the other details of the attempt and in the rate of psychiatric consultation. The girls had longer ED length of stay (247.0 minutes vs. 186.5; P = 0.033), a lower rate of discharge against medical advice, and higher rates of hospitalization (discharge against medical advice, 53.6% vs. 76.7%; non-psychiatric, 23.2% vs. 3.3%; psychiatric, 12.5% vs. 0%; P = 0.003). Conclusion Girls may make suicide attempts, usually by poisoning, and undergo relevant hospitalization, more often than boys. In contrast, boys usually use sharp objects, with a higher rate of discharge against medical advice and lower rates of the attempt and hospitalization.

Purpose: This study was performed to investigate the gender differences in suicide attempts in adolescents. Methods: We reviewed the medical records of adolescents (≤ 18 years) who had visited a university hospital emergency department (ED) for suicide attempts from January 2018 through December 2019. General characteristics of the adolescents, details of the attempt, and outcomes were analyzed. The characteristics were age, gender, the Korean Triage and Acuity Scale, previous attempts, and psychiatric history. The details were initial Glasgow Coma Scale, attempt-arrival time, living alone, method, place, and motivation of the attempt, and concurrent use of alcohol. The outcomes included psychiatric consultation, ED length of stay, and ED outcomes. Results: A total of 86 adolescents were included. Their age ranged from 13 to 18 years, and girls accounted for 65.1%. The girls had more frequent psychiatric history than boys (66.1% vs. 30.0%; P = 0.001) without a significant difference in previous attempts (55.4% vs. 46.7%; P = 0.442). The most common methods of the attempt in the girls and boys were poisoning and sharp objects (53.3% [16 of the 30 boys] vs. 60.7% [34 of the 56 girls]; P = 0.002), respectively. No differences were found in the other details of the attempt and in the rate of psychiatric consultation. The girls had longer ED length of stay (247.0 minutes vs. 186.5; P = 0.033), a lower rate of discharge against medical advice, and higher rates of hospitalization (discharge against medical advice, 53.6% vs. 76.7%; non-psychiatric, 23.2% vs. 3.3%; psychiatric, 12.5% vs. 0%; P = 0.003). Conclusion Girls may make suicide attempts, usually by poisoning, and undergo relevant hospitalization, more often than boys. In contrast, boys usually use sharp objects, with a higher rate of discharge against medical advice and lower rates of the attempt and hospitalization.

Neural stem cells (NSCs) have been suggested as a groundbreaking solution for stroke patients because they have the potential for self-renewal and differentiation into neurons. The differentiation of NSCs into neurons is integral for increasing the therapeutic efficiency of NSCs during inflammation. Apoptosis signal-regulating kinase 1 (ASK1) is preferentially activated by oxidative stress and inflammation, which is the fundamental pathology of brain damage in stroke. ASK1 may be involved in the early inflammation response after stroke and may be related to the differentiation of NSCs because of the relationship between ASK1 and the p38 mitogen-activated protein kinase pathway. Therefore, we investigated whether ASK1 is linked to the differentiation of NSCs under the context of inflammation. On the basis of the results of a microarray analysis, we performed the following experiments: western blot analysis to confirm ASK1, DCX, MAP2, phospho-p38 expression; fluorescence-activated cell sorting assay to estimate cell death; and immunocytochemistry to visualize and confirm the differentiation of cells in brain tissue. Neurosphere size and cell survival were highly maintained in ASK1-suppressed, lipopolysaccharide (LPS)-treated brains compared with only LPS-treated brains. The number of positive cells for MAP2, a neuronal marker, was lower in the ASK1-suppressed group than in the control group. According to our microarray data, phospho-p38 expression was inversely linked to ASK1 suppression, and our immunohistochemistry data showed that slight upregulation of ASK1 by LPS promoted the differentiation of endogenous, neuronal stem cells into neurons, but highly increased ASK1 levels after cerebral ischemic damage led to high levels of cell death. We conclude that ASK1 is regulated in response to the early inflammation phase and regulates the differentiation of NSCs after inflammatory-inducing events, such as ischemic stroke.
Animals ; Cell Death ; Infarction, Middle Cerebral Artery/*metabolism ; Lipopolysaccharides/pharmacology ; MAP Kinase Kinase Kinase 5/genetics/*metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Microtubule-Associated Proteins/genetics/metabolism ; Neural Stem Cells/cytology/drug effects/*metabolism ; *Neurogenesis ; Neuropeptides/genetics/metabolism ; p38 Mitogen-Activated Protein Kinases/genetics/metabolism

Acute pulmonary embolism is a cardiovascular emergency and is a major cause of morbidity and mortality. Endothelial damage secondary to invasion by Orientia tsutsugamushi can lead to focal occlusive endangiitis, causing microinfarcts in various tissues. This localized process can also cause venous thrombosis and peripheral gangrene. However, pulmonary embolism associated with scrub typhus has not been reported in Korea. Here, we report a patient diagnosed with pulmonary embolism associated with scrub typhus, the first report of its kind. The patient had an eschar with detection of anti-tsutsugamushi antibody, fever, dyspnea, and a maculopapular rash over the entire body. He was treated with doxycycline and anticoagulation therapy.
Doxycycline ; Dyspnea ; Emergencies ; Exanthema ; Fever ; Gangrene ; Humans ; Korea ; Mortality ; Orientia tsutsugamushi ; Pulmonary Embolism* ; Scrub Typhus* ; Venous Thrombosis

Arachnoid cyst of the cavernous sinus is very rare. When present, its anatomic location frequently gives rise to cranial nerve palsy. We report a case of arachnoid cyst of the cavernous sinus in a 38-year-old man with impaired eyeball movement and diplopia.
Adult ; Arachnoid Cysts ; Arachnoid* ; Cavernous Sinus* ; Cranial Nerve Diseases ; Diplopia ; Humans