Background: The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies among countries owing to demographics, patient comorbidities, surge capacity of healthcare systems, and the quality of medical care. We assessed the clinical outcomes of patients with COVID-19 during the first wave of the epidemic in Korea. Methods: Using a modified World Health Organization clinical record form, we obtained clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation. Results: The median age of the patients was 43 years of age; 43.6% were male. The median time from illness onset to admission was 5 days. Of the patients with a disease severity score of 3–4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness by day 28. Of the patients with disease severity scores of 5–7, 7 (19.5%) of the 36 patients recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50–59, 60–69, 70–79, and ≥ 80 years of age, respectively. Conclusion In Korea, almost all patients of < 50 years of age with COVID-19 recovered without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with age, reaching 14% in patients of ≥ 80 years of age.

BACKGROUND: We evaluated the outcomes of serum galactomannan (GM) assay for the screening of invasive pulmonary aspergillosis (IPA) in allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients while on primary antifungal prophylaxis (PAP). METHODS: This study included patients with hematologic disorders who underwent alloHSCT from January 2013 to November 2015. Patients received routine PAP with fluconazole before 2014 and micafungin after 2014; serum GM tests were performed and retrospectively analyzed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of serum GM tests for detection of probable/proven IPA were evaluated. The serial change of serum GM levels was illustrated on a time series plot. RESULTS: A total of 136 alloHSCT recipients at Seoul National University Hospital were included in the study. Fluconazole was administered in 72 patients for PAP, while micafungin was administered in the remaining 64 patients. The overall sensitivity, specificity, and NPV of serum GM assays were 95.8% (95% confidence interval [CI] 78.9–99.9%), 93.8% (95% CI 91.7–95.5%), and 99.8% (95% CI 99.1–100.0%), respectively. However, the PPV of GM tests was relatively low at 35.4% (95% CI 23.9–48.2%). The serial change in serum GM levels differed according to the antifungal agents used. With effective PAP using micafungin, serial serum GM levels showed zero order kinetics during the neutropenic period. CONCLUSION: Although the serum GM assay is a sensitive and specific test for detecting IPA in alloHSCT recipients, its role for routine surveillance in an era of effective PAP with micafungin is limited.
Antifungal Agents ; Fluconazole ; Hematology ; Hematopoietic Stem Cell Transplantation ; Humans ; Invasive Pulmonary Aspergillosis* ; Kinetics ; Mass Screening* ; Retrospective Studies* ; Sensitivity and Specificity ; Seoul ; Stem Cell Transplantation* ; Stem Cells*

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

Many people in Korea suffer from a fear of dental treatments; however, only a few studies have focused on this population. This study assessed the effectiveness of cognitive behavioral therapy (CBT) and its interventions in reducing dental anxiety, especially when administered by trained dental staff. Using case studies, the authors analyzed the content of each session and examined the process of reducing dental anxiety. First, the authors observed that the results of both dental fear scale and subjective unit of disturbance decreased significantly with changes in cognitive distortions related to dental anxiety and that rapid improvements were noted after two therapy sessions. Second, the study reported that practicing relaxation (deep-breathing) and muscle relaxation techniques; using hand signals to indicate anxiety or discomfort; establishing an empathic relationship with the therapist; making an anxiety list; and graded insensitive and exposure along with rehearsal, were effective in coping with dental anxiety and in changing negative thoughts towards the dentist. Third, a simple cognitive behavioral intervention can be effective in reducing dental anxiety. In summary, a short-term, five-session psychological intervention with CBT produced a sustained decrease in the symptoms of dental anxiety, allowing the patients to receive the required procedures. The authors discussed the study limitations and the implication of their results on future research.
Anxiety ; Cognitive Therapy* ; Dental Anxiety* ; Dental Staff ; Dentists ; Hand ; Humans ; Korea ; Muscle Relaxation ; Qualitative Research ; Relaxation

The posaconazole tablet formulation was developed to have improved bioavailability compared to the oral suspension. Here, we compared posaconazole plasma concentration (PPC) with the posaconazole oral suspension versus the tablet in Korean patients undergoing remission induction chemotherapy for hematologic malignancies. PPC was measured at 3, 8, and 15 days of treatment with the oral suspension (174 patients) or the tablet (40 patients). At all time-points, mean PPC was significantly higher with the tablet compared to the oral suspension. Our findings suggest that posaconazole tablets generate an optimal PPC earlier and in more patients than the oral suspension among Korean patients.
Antifungal Agents ; Biological Availability ; Dosage Forms ; Drug Therapy ; Hematologic Neoplasms* ; Humans ; Plasma* ; Remission Induction ; Tablets

"Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" is a 2nd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 1st edition published in 2009. After 1st stroke rehabilitation CPG, many studies concerning stroke rehabilitation have been published and the necessity for update has been raised. The Korea Centers for Disease Control and Prevention supported the project "Development of Clinical Practice Guideline for Stroke Rehabilitation" in 2012. Thirty-two specialists in stroke rehabilitation from 18 universities and 3 rehabilitation hospitals and 10 consultants participated in this project. The scope of this CPG included both ischemic and hemorrhagic stroke from the acute to chronic stages. The purpose of this CPG is to provide guidelines for doctors and therapists to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. "Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" consists of 'Chapter 1; Introduction of Stroke Rehabilitation', 'Chapter 2; Rehabilitation for Stroke Syndrome, 'Chapter 3; Rehabilitation for Return to the Society', and 'Chapter 4; Advanced Technique for Stroke Rehabilitation'. Both the adaptation and de novo development methods were used to develop this 2nd edition of CPG. The appraisal of foreign CPGs was performed using 'Korean appraisal of guidelines for research and evaluation II' (K-AGREE II); moreover, four CPGs from Scotland (2010), Austrailia (2010), USA (2010), Canada (2010) were chosen for adaptation. For de novo development, articles that were published following the latest foreign CPGs were searched from the database system, PubMed, Embase, and Cochrane library. Literatures were assessed in the aspect of subjects, study design, study results' consistency, language and application possibility in the Korean society. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. GPP (Good Practice Point) was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised.
Canada ; Centers for Disease Control and Prevention (U.S.) ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.
Anti-Bacterial Agents ; Biopsy ; Breast ; Breast Neoplasms ; Cough ; Diagnostic Imaging ; Disease Progression ; Female ; Fever ; Glass ; Humans ; Lung ; Lung Diseases, Interstitial ; Neoplasm Metastasis ; Pneumonia ; Sputum ; Steroids

OBJECTIVES: A growing body of research has documented that job stress has a pivotal role in developing adverse health outcomes. However, little is known about the relationship between farmers' job stress and health outcomes. This study was undertaken to identify the relationship between job stress and self-perceived fatigue in Korean farmers. METHODS: A total of 526 Korean farmers were asked to participate in this study. A self-administered questionnaire was used to assess the participants' general characteristics, job stress and self-perceived fatigue. Job stress was measured using a forty-eight item Farm Stressor Inventory (FSI), and the self-perceived fatigue was estimated by Multidimensional Fatigue Scale (MFS). Binary logistic regression analysis was conducted to examine the relationship between job stress and self-perceived fatigue. RESULTS: The result showed that job stress was associated with self-perceived fatigue. For the farmers with high job stress, the risk of self-perceived fatigue was more likely to increase compared to those with low job stress. For males, labor intensity (OR, 3.88; 95% CI, 1.91~7.89), job environment (OR, 2.45; 95% CI, 1.22~4.93), social support (OR, 2.10; 95% CI, 1.07~4.13), social isolation (OR, 2.45; 95% CI, 1.15~5.60), financial problems (OR, 3.25; 95% CI, 1.53~6.91), uncertainty (OR, 2.48; 95% CI, 1.30~4.75) and health problems (OR, 5.77; 95% CI, 2.46~13.53) were associated with self-perceived fatigue. For females, job environment (OR, 2.23; 95% CI, 1.22~4.08), social isolation (OR, 2.08; 95% CI, 1.05-4.15), physical environment & weather condition (OR, 2.61; 95% CI, 1.33~5.12), financial problems (OR, 2.87; 95% CI, 1.55~5.32), uncertainty (OR, 3.65; 95% CI, 1.95~6.83) and health problems (OR, 3.38; 95% CI, 1.57~7.27) were associated with self-perceived fatigue. CONCLUSIONS: This result suggests that farmers' job stress plays a role in the development of fatigue, and job stressors related to fatigue are slightly different according to gender.
Agriculture ; Fatigue ; Female ; Humans ; Logistic Models ; Male ; Questionnaires ; Social Isolation ; Uncertainty ; Weather

Inflammatory fibroid polyp (IFP) is a rare benign fibroproliferative disease that arises from the submucosal layer of the gastrointestinal tract. Surgical resection has been performed in most cases and the application of endoscopic resection is rare. Endoscopic submucosal dissection (ESD), which was recently introduced, enables en-bloc resection of a tumor regardless of the tumor size and location. Since IFP is benign, ESD can be very useful for both the diagnosis and treatment of a large-sized IFP. A 45-year-old woman was referred for the management of a gastric mass. Esophagogastroduodenoscopy showed a round submucosal mass with a central bulging at the gastric body. Endoscopic ultrasonography showed a 3.5x3.0 cm-sized hypoechoic mass in the third layer of the stomach. The tumor was removed by ESD with using a hook knife for complete en-bloc resection. The pathologic finding was compatible with the diagnosis of IFP. We report here on a case of IFP that presented as a gastric submucosal tumor and it was treated by the ESD method.
Endoscopy, Digestive System ; Endosonography ; Female ; Gastrointestinal Tract ; Humans ; Leiomyoma ; Middle Aged ; Polyps ; Stomach

BACKGROUND/AIMS: CT colonography is a rapid and safe imaging method for detecting polyps in the colon and rectum. We assessed the efficacy of CT colonography in colorectal polyp detection. METHODS: We prospectively studied 84 subjects (mean age 55.7+/-11.1 years; 52 men, 32 women) undergoing CT colonography followed by colonoscopy. Based on the results of CT colonography, all polyps were classified by size (any size, and those larger than 5, 7, and 10 mm) and were checked for location, morphology, and histological characteristics. We determined the sensitivity and specificity of CT colonography using colonoscopy as a reference standard with a segmental unblinding method. RESULTS: A total of 56 lesions were identified in 26 of 79 subjects undergoing both CT colonography and conventional colonoscopy. The sensitivities of CT colonography for polyps of any size, and larger than 5, 7, and 10 mm were 60.7%, 70.5%, 75.9%, and 81.8%, respectively. The per-subject sensitivities of CT colonography for the polyps of any size, and larger than 5, 7, and 10 mm, were 80.7%, 95.0%, 93.3%, and 90.9%, respectively. The per-subject specificities of CT colonography for polyps were 86.8%, 89.8%, 95.3%, and 100.0%, respectively. The sensitivities of CT colonography for flat, sessile, and pedunculated polyps were 30.8%, 85.0%, and 90.0%, respectively. CONCLUSIONS: CT colonography is a useful diagnostic method for screening colorectal neoplasias larger than 7 mm diameter, showing 75.9% sensitivity and 71.0% positive predictive value.
Colon ; Colonic Neoplasms ; Colonography, Computed Tomographic ; Colonoscopy ; Humans ; Male ; Mass Screening ; Polyps ; Prospective Studies ; Rectum ; Sensitivity and Specificity