The diagnostic accuracy of the data reported in the Korean tuberculosis surveillance system (KTBS) has not been adequately investigated. We reviewed the clinical data of pulmonary tuberculosis (PTB) cases notified from private medical facilities through KTBS between January and June, 2004. PTB cases were classified into definite (culture-proven), probable (based on smear, polymerase chain reaction, histology, bronchoscopic finding, computed tomography, or both chest radiograph and symptoms) or possible (based only on chest radiograph) tuberculosis. Of the 1126 PTB cases, sputum AFB smear and culture were requested in 79% and 51% of the cases, respectively. Positive results of sputum smear and culture were obtained in 43% and 29% of all the patients, respectively. A total of 73.2% of the notified PTB cases could be classified as definite or probable and 81.7% as definite, probable, or possible. However, where infection was not confirmed bacteriologically or histologically, only 60.1% of the patients were definite, probable, or possible cases. More than 70% of PTB notified from private sectors in Korea can be regarded as real TB. The results may also suggest the possibility of over-estimation of TB burden in the use of the notification-based TB data.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Private Sector ; Republic of Korea/epidemiology ; Severity of Illness Index ; Sputum/microbiology ; Tuberculosis, Pulmonary/*diagnosis/epidemiology/pathology ; Young Adult

It often happens that a removable partial denture needs to be repaired due to tissue changes in the remaining alveolar ridge, fracture of the denture, or fracture of the abutment tooth. There are several advantages to retrofitting a customized surveyed crown under the existing RPD. Retrofitting a crown to the RPD decreases the economic burden to the patient and avoids the need for several appointments to fabricate a new RPD. It is difficult for artificial teeth used to repair dentures due to fractured natural teeth to have a shape similar to that of natural teeth, and to repair aesthetic artificial teeth, it is necessary to manufacture customized artificial teeth similar to the shape of each patient’s teeth. Recently, CAD/CAM technology has been used to fabricate customized prosthetics on existing RPD to achieve high retention and fitness accuracy, and by manufacturing customized artificial teeth, more aesthetic and harmonious artificial tooth repair is possible. This is a case in which a denture was repaired using a digital method to fabricate a customized prosthesis on an existing partial denture and customized artificial teeth that mirrored the adjacent dentition, saving time and cost, simplifying the process, and achieving aesthetically and functionally satisfactory results.

It often happens that a removable partial denture needs to be repaired due to tissue changes in the remaining alveolar ridge, fracture of the denture, or fracture of the abutment tooth. There are several advantages to retrofitting a customized surveyed crown under the existing RPD. Retrofitting a crown to the RPD decreases the economic burden to the patient and avoids the need for several appointments to fabricate a new RPD. It is difficult for artificial teeth used to repair dentures due to fractured natural teeth to have a shape similar to that of natural teeth, and to repair aesthetic artificial teeth, it is necessary to manufacture customized artificial teeth similar to the shape of each patient’s teeth. Recently, CAD/CAM technology has been used to fabricate customized prosthetics on existing RPD to achieve high retention and fitness accuracy, and by manufacturing customized artificial teeth, more aesthetic and harmonious artificial tooth repair is possible. This is a case in which a denture was repaired using a digital method to fabricate a customized prosthesis on an existing partial denture and customized artificial teeth that mirrored the adjacent dentition, saving time and cost, simplifying the process, and achieving aesthetically and functionally satisfactory results.

It often happens that a removable partial denture needs to be repaired due to tissue changes in the remaining alveolar ridge, fracture of the denture, or fracture of the abutment tooth. There are several advantages to retrofitting a customized surveyed crown under the existing RPD. Retrofitting a crown to the RPD decreases the economic burden to the patient and avoids the need for several appointments to fabricate a new RPD. It is difficult for artificial teeth used to repair dentures due to fractured natural teeth to have a shape similar to that of natural teeth, and to repair aesthetic artificial teeth, it is necessary to manufacture customized artificial teeth similar to the shape of each patient’s teeth. Recently, CAD/CAM technology has been used to fabricate customized prosthetics on existing RPD to achieve high retention and fitness accuracy, and by manufacturing customized artificial teeth, more aesthetic and harmonious artificial tooth repair is possible. This is a case in which a denture was repaired using a digital method to fabricate a customized prosthesis on an existing partial denture and customized artificial teeth that mirrored the adjacent dentition, saving time and cost, simplifying the process, and achieving aesthetically and functionally satisfactory results.

BACKGROUND: The “Tuberculosis Relief Belt Supporting Project (Tuberculosis Patient Management Project for Poverty Groups)” is a national program for socioeconomically vulnerable tuberculosis (TB) patients. We sought to evaluate the clinical and socioeconomic characteristics of poverty-stricken TB patients, and determined the need for relief. METHODS: We examined in-patients with TB, who were supported by this project at the National Medical Center from 2014 to 2015. We retrospectively investigated the patients' socioeconomic status, clinical characteristics, and project expenditures. RESULTS: Fifty-eight patients were enrolled. Among 55 patients with known income status, 24 (43.6%) had no income. Most patients (80%) lived alone. A total of 48 patients (82.8%) had more than one underlying disease. More than half of the enrolled patients (30 patients, 51.7%) had smear-positive TB. Cavitary disease was found in 38 patients (65.5%). Among the 38 patients with known resistance status, 19 (50%) had drug-resistant TB. In terms of disease severity, 96.6% of the cases had moderate-to-severe disease. A total of 14 patients (26.4%) died during treatment. Nursing expenses were supported for 12 patients (20.7%), with patient transportation costs reimbursed for 35 patients (60%). In terms of treatment expenses for 31 people (53.4%), 93.5% of them were supported by uninsured benefits. CONCLUSION: Underlying disease, infectivity, drug resistance, severity, and death occurred frequently in socioeconomically vulnerable patients with TB. Many uninsured treatment costs were not supported by the current government TB programs, and the “Tuberculosis Relief Belt Supporting Project” compensated for these limitations.
Drug Resistance ; Health Care Costs ; Health Expenditures ; Humans ; Medically Uninsured ; Nursing ; Poverty* ; Retrospective Studies ; Social Class ; Transportation ; Tuberculosis*

Background/Aims: Although the incidence and mortality of tuberculosis are decreasing in South Korea, the number of applications for financial assistance with the cost of tuberculosis treatment made by individuals from vulnerable groups was 3.8 times higher in 2019 compared to 2017 (Tuberculosis Relief Belt Project, 2019). Methods: We analyzed the data of patients who received financial aid for tuberculosis treatment (in the period 2014-2018) from the Tuberculosis Relief Belt Project, which was designed to assist vulnerable groups. This study analyzed 137 subjects, and the independent variables included patient factors (age, gender, nationality, tuberculosis type, number of comorbidities, and place of residence) and treatment type (outpatient or inpatient). The dependent variable was the treatment outcome. Results: The likelihood of treatment success was significantly lower for patients with one (odds ratio [OR] 0.202), two (OR 0.147), or three or more (OR 0.070) comorbidities compared to those with no comorbidities. This was also the case for patients living alone (OR 0.097), and for those classified as homeless (OR 0.053). Korean patients (OR 8.512) had a significantly higher probability of a successful treatment outcome than foreigners. Conclusions Appropriate community-based management of individuals with tuberculosis from vulnerable groups, including foreigners, people with comorbidities, people living alone, and people with an unstable residential situation or homeless status, is important.

Streptococcus salivarius is a Gram-positive organism that belongs to the viridians group of streptococci. It is a relatively non-virulent bacterium that is part of the normal flora. It is rarely isolated from blood and is usually considered a contaminant. Nevertheless, S. salivarius may cause life-threatening infections, especially in immunocompromised hosts. There have been relatively few reports of S. salivarius pneumonia. Nocardiosis is also a rare opportunistic infection. Pulmonary nocardiosis is difficult to diagnose and, consequently, the diagnosis is often delayed. We report an unusual presentation with multiple pulmonary mass-like consolidations caused by a mixed infection of S. salivarius and Nocardia sp. in a 58-year-old man with rheumatoid arthritis who was taking oral corticosteroid, methotrexate, and leflunomide. The patient's symptoms and radiographic findings improved after six weeks of antibiotic therapy
Arthritis, Rheumatoid ; Coinfection ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; Isoxazoles ; Methotrexate ; Middle Aged ; Nocardia ; Nocardia Infections ; Opportunistic Infections ; Pneumonia ; Streptococcus

Some cases of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) infection presented renal function impairment after the first MERS-CoV patient died of progressive respiratory and renal failure. Thus, MERS-CoV may include kidney tropism. However, reports about the natural courses of MERS-CoV infection in terms of renal complications are scarce. We examined 30 MERS-CoV patients admitted to National Medical Center, Korea. We conducted a retrospective analysis of the serum creatinine (SCr), estimated glomerular filtration rate (eGFR), urine dipstick tests, urinary protein quantitation (ACR or PCR), and other clinical parameters in all patients. Two consecutive results of more than trace (or 1+) of albumin and blood on dipstick test occurred in 18 (60%) (12 [40%]) and 22 (73.3%) (19 [63.3%]) patients, respectively. Fifteen (50.0%) patients showed a random urine ACR or PCR more than 100 mg/g Cr. Eight (26.7%) patients showed acute kidney injury (AKI), and the mean and median durations to the occurrence of AKI from symptom onset were 18 and 16 days, respectively. Old age was associated with a higher occurrence of AKI in the univariate analysis (HR [95% CI]: 1.069 [1.013-1.128], P = 0.016) and remained a significant predictor of the occurrence of AKI after adjustment for comorbidities and the application of a mechanical ventilator. Diabetes, AKI, and the application of a continuous renal replacement therapy (CRRT) were risk factors for mortality in the univariate analysis (HR [95% CI]: diabetes; 10.133 [1.692-60.697], AKI; 12.744 [1.418-114.565], CRRT; 10.254 [1.626-64.666], respectively). Here, we report renal complications and their prognosis in 30 Korean patients with MERS-CoV.
Acute Kidney Injury/*etiology/mortality/therapy ; Adult ; Aged ; Coronavirus Infections/*complications/physiopathology ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Hematuria/etiology ; Hospitals ; Humans ; Male ; Middle Aged ; Prognosis ; Proteinuria/etiology ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors

The rapid response system (RRS) is an innovative system designed for in-hospital, at-risk patients but underutilization of the RRS generally results in unexpected cardiopulmonary arrests. We implemented an extended RRS (E-RRS) that was triggered by actively screening at-risk patients prior to calls from primary medical attendants. These patients were identified from laboratory data, emergency consults, and step-down units. A four-member rapid response team was assembled that included an ICU staff, and the team visited the patients more than twice per day for evaluation, triage, and treatment of the patients with evidence of acute physiological decline. The goal was to provide this treatment before the team received a call from the patient's primary physician. We sought to describe the effectiveness of the E-RRS at preventing sudden and unexpected arrests and in-hospital mortality. Over the 1-yr intervention period, 2,722 patients were screened by the E-RRS program from 28,661 admissions. There were a total of 1,996 E-RRS activations of simple consultations for invasive procedures. After E-RRS implementation, the mean hospital code rate decreased by 31.1% and the mean in-hospital mortality rate was reduced by 15.3%. In conclusion, the implementation of E-RRS is associated with a reduction in the in-hospital code and mortality rates.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Education, Professional ; Female ; Heart Arrest/mortality ; *Hospital Mortality ; *Hospital Rapid Response Team ; Hospitals, University ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Young Adult

Gynecomastia is a benign enlargement of the male breast attributable to proliferation of the ductal elements. Gynecomastia has been rarely reported as an adverse effect of isoniazid therapy. We report the case of a 35-year-old man who was prescribed with isoniazid, rifampicin, ethambutol and pyrazinamide to treat pulmonary and lymphatic tuberculosis. After five months of treatment, the patient complained of painful engorgement in the bilateral breasts and the presence of male gynecomastia was confirmed with a physical examination and radiographical methods. The serum level of estradiol was also increased. Common causes of male gynecomastia were excluded through history taking and the laboratory findings. The anti-TB drugs were changed to a second line regimen due to radiographical progression and the intolerance of the patient to gynecomastia. Gynecomastia was relieved very slowly and a tender subareolar palpable mass decreased in size and consistency over five-month period after stopping the probable causative drug, isoniazid. From a review of the literature, gynecomastia has been shown to be a side effect of treatment with first line anti-tuberculosis drugs, and especially with isoniazid. We report the rare case.
Adult ; Breast ; Estradiol ; Ethambutol ; Gynecomastia ; Humans ; Isoniazid ; Male ; Physical Examination ; Pyrazinamide ; Rifampin ; Tuberculosis