Background: Numerous patients around the globe are dying from coronavirus disease 2019 (COVID-19). While age is a known risk factor, risk analysis in the young generation is lacking. The present study aimed to evaluate the clinical features and mortality risk factors in younger patients (≤ 50 years) with a critical case of COVID-19 in comparison with those among older patients (> 50 years) in Korea. Methods: We analyzed the data of adult patients only in critical condition (requiring high flow nasal cannula oxygen therapy or higher respiratory support) hospitalized with PCR-confirmed COVID-19 at 11 hospitals in Korea from July 1, 2021 to November 30, 2021 when the delta variant was a dominant strain. Patients’ electronic medical records were reviewed to identify clinical characteristics. Results: During the study period, 448 patients were enrolled. One hundred and forty-two were aged 50 years or younger (the younger group), while 306 were above 50 years of age (the older group). The most common pre-existing conditions in the younger group were diabetes mellitus and hypertension, and 69.7% of the patients had a body mass index (BMI) > 25 kg/m 2 .Of 142 younger patients, 31 of 142 patients (21.8%, 19 women) did not have these pre-existing conditions. The overall case fatality rate among severity cases was 21.0%, and it differed according to age: 5.6% (n = 8/142) in the younger group, 28.1% in the older group, and 38% in the ≥ 65 years group. Age (odds ratio [OR], 7.902; 95% confidence interval [CI], 2.754–18.181), mechanical ventilation therapy (OR, 17.233; 95% CI, 8.439–35.192), highest creatinine > 1.5 mg/dL (OR, 17.631; 95% CI, 8.321–37.357), and combined blood stream infection (OR, 7.092;95% CI, 1.061–18.181) were identified as independent predictors of mortality in total patients.Similar patterns were observed in age-specific analyses, but most results were statistically insignificant in multivariate analysis due to the low number of deaths in the younger group.The full vaccination rate was very low among study population (13.6%), and only three patients were fully vaccinated, with none of the patients who died having been fully vaccinated in the younger group. Seven of eight patients who died had a pre-existing condition or were obese (BMI > 25 kg/m 2 ), and the one remaining patient died from a secondary infection. Conclusion About 22% of the patients in the young critical group did not have an underlying disease or obesity, but the rate of obesity (BMI > 25 kg/m2 ) was high, with a fatality rate of 5.6%. The full vaccination rate was extremely low compared to the general population of the same age group, showing that non-vaccination has a grave impact on the progression of COVID-19 to a critical condition. The findings of this study highlight the need for measures to prevent critical progression of COVID-19, such as vaccinations and targeting young adults especially having risk factors.

Background: Patient-centered management is becoming increasingly important in gout, but there are limited studies exploring patients' perspectives and preferences. We aimed to investigate patients' perspectives and preferences regarding gout and gout management, and their impacts on adherence to urate lowering therapy (ULT). Methods: A paper-based survey was performed in patients with gout seen at the rheumatology outpatient clinics of 16 tertiary hospitals. The survey included questions regarding demographics, comorbidities, gout attacks, current treatment and adherence, and patients' perspectives and preferences regarding gout and gout management. Multivariate regression analysis was performed to determine the factors associated with ULT adherence. Results: Of 809 surveyed patients with gout, 755 (94.5%) were using ULT. Among those using ULT, 89.1% had ≥ 80% adherence to ULT. Majority of the patients knew management strategies to some extent (94.8%), perceived gout as a life-long disease (91.2%), and were making efforts toward practicing at least one lifestyle modification (89.2%). Most patients (71.9%) obtained information about gout management during their clinic visits.Approximately half of the patients (53.6%) preferred managing their disease with both ULT and lifestyle modification, 28.4% preferred ULT only, and 17.4% preferred lifestyle modification only. Adherence was better in patients with older age (odds ratio [OR], 1.03), those with better knowledge of gout management strategies (OR, 3.56), and those who had preference for ULT (OR, 2.07). Conclusion Patients' perspectives and management preferences had high impacts on adherence to ULT in gout. Consideration of patients' perspectives and preferences is important for achieving the desired clinical outcome in gout.

Background: Patient-centered management is becoming increasingly important in gout, but there are limited studies exploring patients' perspectives and preferences. We aimed to investigate patients' perspectives and preferences regarding gout and gout management, and their impacts on adherence to urate lowering therapy (ULT). Methods: A paper-based survey was performed in patients with gout seen at the rheumatology outpatient clinics of 16 tertiary hospitals. The survey included questions regarding demographics, comorbidities, gout attacks, current treatment and adherence, and patients' perspectives and preferences regarding gout and gout management. Multivariate regression analysis was performed to determine the factors associated with ULT adherence. Results: Of 809 surveyed patients with gout, 755 (94.5%) were using ULT. Among those using ULT, 89.1% had ≥ 80% adherence to ULT. Majority of the patients knew management strategies to some extent (94.8%), perceived gout as a life-long disease (91.2%), and were making efforts toward practicing at least one lifestyle modification (89.2%). Most patients (71.9%) obtained information about gout management during their clinic visits.Approximately half of the patients (53.6%) preferred managing their disease with both ULT and lifestyle modification, 28.4% preferred ULT only, and 17.4% preferred lifestyle modification only. Adherence was better in patients with older age (odds ratio [OR], 1.03), those with better knowledge of gout management strategies (OR, 3.56), and those who had preference for ULT (OR, 2.07). Conclusion Patients' perspectives and management preferences had high impacts on adherence to ULT in gout. Consideration of patients' perspectives and preferences is important for achieving the desired clinical outcome in gout.

BACKGROUND: The National Lung Screening Trial (NLST) and NELSON trial showed that low-dose chest computed tomography (LDCT) screening significantly reduced the mortality form lung cancer. Although cancer survivors are known to have high risk for second malignant neoplasm (SMN), the usefulness of LDCT screening for lung cancer in cancer survivors is not clear. METHODS: Between August 2016 and August 2017, 633 long-term colorectal cancer (CRC) survivors visited the survivorship clinic in Cancer Prevention Center, Yonsei Cancer Center, Seoul, Republic of Korea. We surveyed the smoking status and recommended LDCT screening to ever-smoking CRC survivors aged 55–80 years. The participants were classified into three risk groups: risk group 1 (RG1) who met the NLST criteria (Age 55–74 years, ≥ 30 pack-years of smoking, smoking cessation < 15 years); risk group 2 (RG2) who would not meet the NLST criteria but were at increased 6-year risk of lung cancer (PLCOM2012 ≥ 0.0151); risk group 3 (RG3) who did not meet any of the criteria above. RESULTS: Among 176 ever-smoking CRC survivors, 173 (98.3%) were male, 32 (18.2%) were current-smoker, and median age was 66 years (range, 55–79 years). We found 38 positive findings (non-calcified nodule ≥ 4 mm), 8 clinically significant findings, 66 minor abnormalities, and 64 negative findings on LDCT. Positive findings were identified in 15 of 79 (19.0%) of RG1, in 9 of 36 (25%) of RG2, and in 14 of 61 (23.0%) of RG3. Second primary lung cancers were found in 2 patients of RG2, and in 1 patient of RG3. SMN was most frequently found in RG2 (11 of 36 patients, 30.6%), compared with RG1 (12.7%) or RG3 (9.8%) (P = 0.016). CONCLUSIONS: LDCT screening for lung cancer in Korean CRC survivors is feasible. Well-designed clinical trial for defining high risk patients for lung cancer among CRC survivors is needed.
Colorectal Neoplasms ; Early Detection of Cancer ; Humans ; Lung Neoplasms ; Lung ; Male ; Mass Screening ; Mortality ; Neoplasms, Second Primary ; Republic of Korea ; Seoul ; Smoke ; Smoking ; Smoking Cessation ; Survival Rate ; Survivors ; Thorax

This nationwide, prospective cohort study evaluated pulmonary function and radiological sequelae according to infection severity in 73 survivors from the 2015 Middle East respiratory syndrome (MERS) outbreak in Korea. Patients with severe pneumonia in MERS-coronavirus infection had more impaired pulmonary function than those with no or mild pneumonia at the 1-year follow-up, which was compatible with the radiological sequelae. Severe pneumonia significantly impairs pulmonary function and makes long radiological sequelae in MERS.
Cohort Studies ; Coronavirus ; Coronavirus Infections* ; Follow-Up Studies ; Humans ; Korea ; Middle East* ; Pneumonia* ; Prospective Studies ; Survivors

The original version of this article contained wrong informations of some authors which should be changed.

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the clinical outcomes of two surgical techniques-modified Bondy technique and canal wall up mastoidectomy with tympanoplasty type I and scutumplasty (CWUM/T1)-to remove attic cholesteatoma while preserving ossicular chain intact. SUBJECTS AND METHOD: A retrospective study was performed on 23 surgical cases for the attic cholesteatoma with postoperative audiometry data of more than six months after surgery. The patients' postoperative clinical features and audiometric results were compared between the two surgical groups. RESULTS: Out of 23 patients, CWUM/T1 was performed in 13 cases and modified Bondy technique was used in 10 cases. There were no significant differences for the preoperative and postoperative audiograms between the two groups. But air-bone gap increased significantly after CWUM/T1 while it decreased after modified Bondy technique. Three cases with postoperative problems were seen after CWUM/T1 (recurrent cholesteatoma, pars tensa adhesion, recurrent otitis media with effusion). Two cases with postoperative problems were found after modified Bondy technique (mild attic retraction, pars tensa retraction). CONCLUSION: Both surgical techniques seem to be adequate to treat attic cholesteatoma while preserving intact ossicular chain. Given good postoperative hearing results and stability of open cavity against recidivism, the modified Bondy technique seems to be a good choice for the attic cholesteatoma with intact ossicular chain when mastoid is not highly pneumatized.
Audiometry ; Cholesteatoma* ; Hearing ; Humans ; Mastoid ; Methods ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Tympanoplasty*

BACKGROUND AND PURPOSE: Nonmotor symptoms (NMS) in Parkinson's disease (PD) have multisystem origins with heterogeneous manifestations that develop throughout the course of PD. NMS are increasingly recognized as having a significant impact on the health-related quality of life (HrQoL). We aimed to determine the NMS presentation according to PD status, and the associations of NMS with other clinical variables and the HrQoL of Korean PD patients. METHODS: We surveyed patients in 37 movement-disorders clinics throughout Korea. In total, 323 PD patients were recruited for assessment of disease severity and duration, NMS, HrQoL, and other clinical variables including demographics, cognition, sleep scale, fatigability, and symptoms. RESULTS: In total, 98.1% of enrolled PD subjects suffered from various kinds of NMS. The prevalence of NMS and scores in each NMS domain were significantly higher in the PD group, and the NMS worsened as the disease progressed. Among clinical variables, disease duration and depressive mood showed significant correlations with all NMS domains (p<0.001). NMS status impacted HrQoL in PD (rS=0.329, p<0.01), and the association patterns differed with the disease stage. CONCLUSIONS: The results of our survey suggest that NMS in PD are not simply isolated symptoms of degenerative disease, but rather exert significant influences throughout the disease course. A novel clinical approach focused on NMS to develop tailored management strategies is warranted to improve the HrQoL in PD patients.
Cognition ; Demography ; Humans ; Korea ; Movement Disorders* ; Parkinson Disease* ; Prevalence ; Quality of Life*

BACKGROUND/AIMS: Narrow band imaging (NBI) is a new technique that is expected to improve the detection rate of colorectal polyps, but results have been inconsistent. The aim of this study was to compare the polyp miss rate and the characteristics of missed colorectal polyps using white light (WL) and NBI. METHODS: 62 patients were randomized into two groups. In the first group (NBI first, NBIF), a colonoscopic examination of each segment (cecum-ascending, transverse, descending, and rectosigmoid colons) was performed first with NBI followed by a re-examination of the same segment using WL. An opposite sequence was applied for the other group (white light first, WLF). RESULTS: 67 polyps were found in the first examination, and 31 polyps were found on the re-examination, resulting in a polyp miss rate of 31.6%. The polyp miss rate was 39% for WLF and 23% for NBIF (p>0.05). Seventy-four small polyps (<5 mm) were found, and miss rates for NBIF and WLF were 20% and 46%, respectively (p=0.01). The polyp miss rate at the rectosigmoid was 11% for NBIF and 54% for WLF (p=0.01). CONCLUSIONS: The polyp miss rate was not significantly different between NBI or WL when a colonoscopy was performed. NBI resulted in a lower polyp miss rate for small (<5 mm) and rectosigmoid polyps than WL.
Colonoscopy ; Humans ; Light ; Narrow Band Imaging ; Polyps

Fluconazole is a fungistatic agent that is used for treating systemic and superficial fungal infections like onychomycosis and tinea pedis. Various adverse effects of fluconazole have been reported regardless of the total dosage and the duration of treatment. We consider the number of patients who visit the emergency room with nonspecific symptoms that are related to antifungal agents are not inconsiderable. In this case, 44-year-old male patient experienced mental change during taking fluconazole to treat tinea pedis. The understanding of the side effects and the drug interactions with antifungal agents like fluconazole can help to treat patients with nonspecific symptoms that are related to antifungal agents.
Adult ; Antifungal Agents ; Consciousness ; Drug Interactions ; Emergencies ; Fluconazole ; Humans ; Hyperammonemia ; Male ; Onychomycosis ; Tinea ; Tinea Pedis